Relative Energy Deficiency in Sport: Many athletes at risk due to prolonged, severe calorie mismatch
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Many athletes could be at risk of developing a serious health and performance syndrome brought on by a mismatch in calories consumed versus calories burned in exercise, says a new consensus statement led by a McMaster University professor and a team of international researchers.
The International Olympic Committee (IOC) consensus statement, published in the British Journal of Sports Medicine, found that the condition known as Relative Energy Deficiency in Sport (REDs) was a specific risk when the mismatch in calories was prolonged and/or severe.
“REDs is common in both male and female athletes in many sports, and although we understand a lot more about its causes, awareness of the syndrome, and its consequences for health and performance, is still low among athletes, their medical and performance support teams, and the general public,” says lead author Margo Mountjoy, a clinical professor with McMaster’s Department of Family Medicine and IOC Games Group member.
REDs was first recognized by the IOC in 2014. Its prevalence varies by sport and gender, but estimates range from 15 per cent to 80 per cent. The consensus noted that athletes and their teams may not even realize this is happening possibly due to the short-term gains in performance from a limited calorie intake.
“We very much hope that this consensus statement will enhance awareness and understanding of REDs and stimulate action by sports organizations and scientists, and athlete health and performance teams to protect the health and wellbeing of the many athletes at risk of this syndrome,, says Mountjoy, the regional assistant dean at the Michael G. DeGroote School of Medicine, Waterloo Regional Campus.
Mountjoy also assisted in compiling 10 supporting papers on REDs which serve to inform the content of the consensus statement. Individual papers include guidelines for prevention and treatment of REDs, as well as research guidelines for studying REDs. Mental health precursors and outcomes of REDs are reviewed in a supportive paper, as well as the validation of the IOC REDs Clinical Assessment Tool.
The researchers developed clinical guidelines for safe body composition measurement and assessing low energy availability (LEA) – a deficit in the energy needed to maintain optimal health and performance. As part of the REDs clinical assessment guidelines, the team created a four-colour traffic light system to help in diagnosing and assessing the risk or severity of LEA.
The consensus notes that the human body can adapt, in the short term, to LEA. However, it is prolonged and frequent deficits, known as “problematic LEA,” that can lead to REDs.
REDs effects on the body can manifest in different ways. This can include hormonal disturbances, bone weakness, impaired metabolism and mental health impacts.
“IOC consensus statements have a central role to play in the translation of research and theory into clinical practice. And this statement will do much to protect athletes’ health through improvements in both the prevention and management of REDs,” says IOC medical director Dr. Richard Budgett.
Recovery from REDs is possible, with existing research pointing to dietary interventions as the most effective means of reversing the syndrome.
The latest consensus recommends the inclusion of sports medicine specialists, nutritionists, psychologists and sports scientists as part of the recovery plan.
The statement says more research is still needed to further understand the relationship between LEA and REDs.
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