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RED-S Relative Energy Deficiency in Sport

Previously called the Female Athlete Triad, it was defined as “a perfect storm of disordered eating and a drop in estrogen and other hormones that in turn led to irregular periods and low bone density.”  Experts believed that active women sat on a spectrum that ranged from a healthy athlete with optimal energy availability and healthy bones, to the other end of the spectrum where active women had poor nutrition, missed periods and thinning bones.  

Further investigation into underlying causes that can contribute to menstrual dysfunction made it clear that it isn’t just a perfect storm of 3 factors.  It is a cascade of hormone disruption that results from one main factor: inadequate nutrition. 

When active women don’t feed themselves enough to meet their physical demands, their physiology is in turmoil. 

In 2014 the International Olympic Committee (IOC) issued a statement that the Female Athlete Triad is really a syndrome that is the result of “relative energy deficiency that affects many aspects of physiological function including metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular and psychological health.”  As such the IOC issued the name change to reflect this new level of understanding: relative energy deficiency in sport.  RED-S.

This specifically occurs when women’s diets are too low in carbohydrates, which causes a drop in Estradiol (the main estrogen in menstruating women) A rise in Estrone (which is one of the 3 estrogen hormones that fat tissue secretes) signals your body to store more fat and the stress hormone cortisol, which also signals fat storage under long periods of high stress. 

From a survival standpoint, your body is thinking famine and the last thing that is needed is new babies, so it shuts down our ability to reproduce.  Even if your body fat percentage is well above what experts typically consider within the amenorrhea range, you can still experience menstrual dysfunction. 

In turn, a hypocaloric, high-stress state, signals the hormonal changes to stop reproduction. 

Note: this is also why many women struggle with intermittent fasting and low-carb, keto diets, while men tend to thrive on them. 

If you are experiencing menstrual disruption or need help figuring out what and how much you should be eating, reach out to for nutrition coaching.