Luke:
Working and training in Kenya presented many challenges. Some I was prepared for, I knew I might struggle training at altitude and with adapting to a higher training load. What I did not expect was that one of my biggest struggles would be maintaining a healthy body weight. I am not a big human so a loss of 5kg is more than I ever thought I could lose, and with it I noticed a significant difference in my demeanor and general attitude to those around me. I also noticed a significant increase in energy following a meal, but I would crash very quickly afterwards and not have the appetite to eat more.

While I watched my weight go down, I initially thought it was a natural result of my increased training load. However, over time it began to creep down further and further and I became increasingly worried, to the point I was talking to my coach about it and I even had a few concerned people reach out to me. That was surely a wake-up call for me to get my weight and nutrition sorted!

I think that it is important to highlight weight among athletes: what is considered to be healthy in a sport, healthy for the individual, and how this can correlate to performance and wellbeing. Within my clinical role, weight management and nutrition are something that I have seen my clients struggle with, and I have been firm with them about the importance of getting this under control, primarily for long term health.

While Sports Lab does not have a dietician on staff, we do deal with the conditions that can result from a poor balance of energy-in and energy-out. For example, energy deficiency from lack of adequate nutrition can have a negative impact on bone density, leaving the individual more prone to stress fractures, a condition we deal with regularly at Sports Lab. The effect of poor nutrition, both in quality and quantity of food can be dramatic on the body and therefore we keep our eyes peeled for these symptoms and refer on to the appropriate professionals if we have any concerns.

We think that it is important to bring attention to weight and dietary requirements among athletes, who can be tempted to go to great lengths to reduce bodyweight in hopes of jumping higher, running faster, or reaching new weight-classes. We asked expert Claire Badenhorst (PhD Exercise Physiology) (Massey University School Sport, Exercise and Nutrition) to shed a little light on the issue, the following are her words.

Relative Energy Deficiency in Sport (RED-S)

Claire:
If you are an athlete competing in sport, you would have had a chat with your coach or done some research yourself on the best nutrition for your personal sporting performance. With the ever-expanding influence of social media, we have the ability to get information from various sources and get numerous opinions, something that I consider to be a bit of a double-edged sword. While social media has many beneficial influences it can also induce some serious negative effects, one that is particularly brought to light is body image issues. This is a topic that is heavily discussed when dealing with female athletes, and I am sure that most people would have heard of the ‘Female Athlete Triad’. The triad discusses the notion of female athletes purposely or accidentally reducing their food intake and as a result not supplying enough energy to meet the energy demands for exercise and normal physiological functioning. This discrepancy between energy intake and energy expenditure is typically referred to Low Energy Availability (LEA), and the factors that contribute to its induction and duration of exposure will largely depend on the individual and the sport in which they are competing. Female athletes that present with LEA for a prolonged period of time compromise their reproductive cycles and bone health, a result that can be very damaging to the physiological and psychological health. In 2014 the International Olympic Committee (IOC) first coined the term ‘Relative Energy Deficiency in Sport’ (RED-S) to expand the concept of the female athlete triad, i.e. low food intake that does not meet the demands for training or normal body functioning, to male athletes. Yes, that’s right, male athletes can also suffer from RED-S. Due to all the research in this area previously been focused on females, we are only now learning about the negative impacts that this may have on male athletes and their ability to adapt to training or perform optimally. (If you want to read more about IOCs consensus statement on the matter click here.)

The potentially hazardous effects that we know are present in male athletes with RED-S includes but are not limited to:

1.    Reduce testosterone levels in subsets of male athletes, this is particularly evident in endurance and lean sport athletes.

2.    Impaired skeletal health, particularly in running sports

3.    Reduced body weight: which may be associated with reduced bone mineral density especially in adolescent males. This may also increase the incidence of bone stress related injuries (not something you would wish on anyone as it means ~12 weeks away from your sport to recover)

4.    Some sports like cycling may have eating behaviours that are prone to inducing low energy availability as athletes may focus on achieving higher power outputs for lower body weight

5.    The disordered eating that comes with RED-S is frequently associated with impairments in mood, performance and recovery

6.    Chronic low energy availability is noted in many East African runners, where low energy intake combined with prolonged endurance training. This may be a result of cultural eating practices, limited food availability, higher carbohydrate foods with lower fat and protein options and food insecurity, lack of finances or limited resources. This has been associated with lower bone mineral density in a number of runners from this region.

Chronic LEA in athletes is associated with many health issues including nutrient deficiencies from inadequate food intake, chronic fatigue and increased risk of illness and infection, all of which can be damaging to an athlete’s training plan or racing season. Psychological effects can range from increased stress to depression, neither of which is conducive to good training mindset. While I could go on listing the effects of RED-s on the health of athletes for a considerable period of time, sometimes (as the saying goes), ‘a picture says a thousand words’, hence for a short summary of the impact of RED-S on an athletes health I suggest you refer to the following diagram adapted from the British Journal of Sports Medicine (Mountjoy et al 2014). But please be aware that the intensity of these symptoms and the number an athlete will present with will depend on their current training and eating behaviours and how long they have been exposed to LEA. The IOC statement on RED-S provides a number of action points that coaches and athletes themselves may use to return to full training if they are in fact presenting with LEA. Again, treatment type and time will depend on the severity of the symptoms which the athlete is presenting with.

So in a short summary the key point which I hope most athletes who read this and will take away with them is: the ‘female athlete triad’ is not an exclusive female athlete problem. Low energy availability (LEA) is a problem that plagues male and female athletes and has serious health consequences (personal and training wise). If you think an athlete is presenting with LEA, maybe kindly suggest they talk to their coach or dietitian and allow the experts to help them achieve an optimal energy state that will allow them to train and perform and achieve their goals.

Dr Claire Badenhorst (PhD Exercise Physiology, Academic at Massey University in Auckland) has research focus areas currently in female health, iron deficiency and endurance athletes. She also happens to be a Lab Local, and pretty much part of the furniture here.
Thanks to Luke for sharing his experience and for dragging Claire in to help. Luke is a talented Sports Lab massage therapist and distance runner.