Protecting an Athlete’s Health: IOC Focuses on Energy Deficiency
A goal of the International Olympic Committee (IOC) is to protect the health of the athlete. To this end, they have followed up an earlier consensus statement on the Female Athlete Triad with a new statement “Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport (RED-S).”
Unlike the Female Athlete Triad, which addresses inadequate energy availability often accompanied by loss of menstrual cycle and suppression of bone mineralization in women, RED-S acknowledges that male under-eating has consequences as well. And yet while major athletic groups including the National Collegiate Athletic Association (NCAA), American College of Sports Medicine (ACSM) and the IOC have stepped up efforts to increase awareness of the Female Athlete Triad among athletes, coaches, and trainers, male athletes who don’t eat enough have historically received far less attention.
Scientists and clinicians have become increasingly aware that eating too little affects the bone health of males as well as females. This is disturbing as weak bones can result in stress fractures and bones which will remain under-mineralized throughout the lifespan, but that is not all. Protein synthesis, metabolic rate, immune function, and cardiovascular function will all be compromised as well. The result? Decreased muscle strength and performance, decreased endurance performance, and an increased risk of injury and illness.
The new designation RED-S broadens our focus to both males and females who fail to make up for the energy cost of their sport with an adequate increase in calories. This may be deliberate as an athlete tries to lose weight, or unconscious as athletes struggle to ingest enough food to compensate for calories used each day training for their sport, which may amount to several thousand, especially for endurance athletes such as swimmers, skiers, and triathletes.
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The expert work group who developed the consensus statement recommends that a multi-disciplinary support system including sports physician, sports nutritionist, psychologist, physiotherapist and physiologist be identified, and that athletes and all who work with them be educated as to how to prevent, recognize and treat this syndrome.
Mountjoy M et al The IOC consensus statement: beyond the Female Athlete Triad-Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine 2014;48:491-497.