What is the biggest lie we have been taught by the diet industry?
“Move more, eat less!”
You may be surprised to hear this but physiological studies have shown us that this exact approach not only doesn’t support long term weight loss, for those of us who are physically active, it can actually turn into something a lot more complicated.
REDs — Relative Energy Deficiency in Sport.
REDs, relative energy deficiency in sport, is still a relatively new term in the world of health and fitness; however, it is a condition that is on the increase, with many athletes coming forward having been diagnosed. While this is great for awareness, it can also be confusing and as a result, there are still huge misconceptions around how it presents and who can be impacted by it.
REDs is a multi-system condition that can occur in those that are physically active. It can affect anyone from recreational to elite/professional, from young, all the way through to masters, and any gender.
It results in a physiological decline in the body, leading to poor physical health, mental health, and performance outcomes.
LEA — Low Energy Availability.
It is underpinned by Low Energy Availability (LEA), which occurs when there is not sufficient energy being consumed by the body relative for the work that the individual wants to do. This is where work is defined as training but also includes daily movement and the energy cost of biological processes within the body. That is all those processes that keep us alive from our brain, cardiovascular system, neurological network and hormonal system, to name a few.
The human body has evolved to survive. This means not only does it prioritise energy for movement, it also has the ability to turn on compensatory behaviours to preserve energy when there is just not enough energy available. This can happen in the short term – have you ever noticed how you can suddenly feel really cold if you delay or skip a meal? But equally becomes more longstanding and problematic, resulting in metabolic injury in the long term.
This means that all energy consumed will first be used for movement and energy availability is the amount of energy left over once energy for all movement has been removed.
REDs is further complicated by under recovery.
Endurance athletes can easily get caught up in LEA without realising it.
Recovery window: 30 minutes after a long or hard session.
Doing early morning fasted training sessions which are often convenient when juggling training and fulltime work, can often leave individuals in a deficit. Fixating on a weight over performance can encourage individuals to fuel inappropriately. Similarly, it is well documented that when we train hard, there is often a lag phase before our appetite catches up. Time is needed for the body to redirect blood flow from muscles back into the stomach. The key window for recovery after a long or hard session is 30 minutes but many individuals report they just don’t feel able to stomach nutrition at this time, which can lead to a disparity between nutritional requirements and intake. Taking sufficient nutrition during longer training sessions is critical in endurance events but many individuals find they fall into the trap of wanting to save their energy for a big feed post training which not only impacts performance pace but also provides another opportunity for them to fall into LEA.
This is one of the key aspects we are trying to tackle with the Nana Nutrition app. The aim is not only to provide appropriate nutrient intake for training, but to also prioritise distribution to ensure your body can make the most of training.
Joy et al., 2016. Trott et al., 2020.
Additionally, a study in 2016 (Joy et al) reported that the prevalence of disordered eating was 20% higher in athletes compared with their non-athletic peers. More recently, Trott et al (2020) demonstrated that individuals who have an exercise dependency are four times more likely to develop disordered eating.
Perry et al., 2022.
While these dysfunctional relationships with food are often linked to certain sports, particularly endurance, aesthetic and those linking power to weight ratio, recent evidence has shown us that the problem is much more widespread. A study in 2022, Perry et al. demonstrated that in women’s football, in the professional game, 36% of players had disordered eating.
So why do we turn to food for the answer?
While love and happiness are positive emotions to experience, many of us run a mile (quite literally) when it comes to experiencing difficult emotions such as loss, uncertainty, pain, failure, rejection, and abandonment. Often these emotions pose a “threat” which some of us will experience as generalised anxiety – we might not fully understand what is going on for us, just that “something is wrong”. This can be debilitating; the severe physical sensations, or somatic response of these feelings generates a deep unease within the body. Many individuals feel a huge need to escape their bodies, or a sense that they cannot inhabit their bodies at that moment. When individuals are in this state, the heightened sense of anxiety creates a bias towards intrusive and often catastrophic thinking.
It is human nature to want to avoid “threat”. While it is not conscious, many of us find means and ways of avoidance – restrictive eating, over exercising, excessive scrolling of social media, alcohol, drugs, striving etc these are all coping mechanisms used in order to ‘control, contain, avoid, and numb’ these difficult emotions. While these behaviours provide a temporary fix, they can in themselves become an addiction and problem in their own right.
We live in a society that cultivates a need to attain and prove our worth through our achievements, and for athletes this means sporting success. While healthy competition doesn’t hurt, it can also create anxiety and lead to dysfunctional behaviours.
We must remember that athletes of all levels tend to have certain personality traits. They are often driven, obsessive, focused, self-critical, perfectionist and highly sensitive in many cases. While these exact traits are what make them good at their sport, if they are not managed appropriately, they can tip into dysfunctional behaviours specifically around food, body image and training. All human behaviour has a purpose, and, as we have already stated, in most cases, this is protection from difficult and uncomfortable emotions. Being a perfectionist stems from feelings of not feeling good enough. If we strive for perfection, then no one can say we are not good enough. That is the illusion that is created and it helps to alleviate this feeling of not good enough. By continually pushing and cracking the whip, it provides you a false sense of security that you are working towards a goal but sadly a goal that will never be attained, because as soon as you hit that target, you raise the bar again.
As we mentioned in the opening paragraphs, while REDs is underpinned by low energy availability, it can also be further impacted by insufficient recovery, both in day-to-day training but also competitively.
With the rise of ultra-distance events, many individuals are enticed by new races. While it is great to have a goal, it has become increasingly popular to compete in as many of these events within a short space of time with little recovery. While the human body may be able to sustain this for a while, eventually, the cracks will start to show.
Similarly, in the recreational world, we have busy lives. Many of us have fulltime jobs and families, but we also want to train like professionals. This means many of us are skimping on sleep or valuable downtime to fit training in, once again leaving us under recovered.
All of these behaviours add a pressure on the nervous system, and it is this stress, more specifically, the layer upon layer of stress in the system that can also lead to REDs.
There are two types of REDs, intentional and unintentional.
Unintentional
Unintentional or accidental REDs is when the individual doesn’t appreciate just how much energy and rest is required to maintain biological function and training load. While they may present with similar symptoms to someone with intentional REDs, they are easy to work with as there is no psychological change which means they are happy to implement nutritional and training interventions to get their body back to optimal.
Similarly, an individual who is managed by a coach who has no awareness or even interest in understanding REDS, or who doesn’t necessarily communicate regularly with their athlete can easily tip an individual into this accidental REDS.
Intentional
Intentional RED-s is a conscious decision to restrict intake and/or over train. Technically it will involve some aspect of disordered eating and/or exercise dependency. When discussing with individuals, they will usually associate the start of these behaviours with the desire to change body composition, in most cases, lose weight, because they have either been encouraged to do so by the culture within their sport or through comparison to fellow athletes, and their belief system that this will improve their performance.
Additionally, some individuals who may start with unintentional REDS, if left overlooked, the sheer length of time associated with depletion can cause their thinking to change and this can morph into intentional REDS.
One key point I want to stress is that REDs is not always associated with weight loss.
You can have an individual who is in low energy availability at a normal or above normal weight. The human body does not like being in huge energy deficits and thus results in compensatory behaviours which can stop the body from losing weight and changing body composition.
Signs to be Aware Of
Physiological
- Lack of three consecutive periods in females or a change to a previously regular menstrual cycle
- Changes to thermoregulation, difficulties staying warm in the winter and cool in the summer months.
- IBS like symptoms due to gastroparesis (slow movement of food through the digestive system) and dysbiosis, a change in optimal microbiome
- Increased gut permeability leading to increased frequency of gastric distress
- Increased risk of urinary incontinence in females
- Depressed immune system and increase risk of developing autoimmune conditions
Performance
- Poor recovery between training sessions
- Recurrent injuries, including soft tissue, tendon and stress fractures
- Poor development of muscle mass and adaptation to training
- Increase risk and prevalence of infections and illness, making it difficult to train consistently.
Mainly seen in intentional REDs.
While the physiological and performance consequences are applicable to both types of REDs, the following symptoms are mainly associated in those who have intentional REDs.
Behavioural
- Pre-occupation and constantly talking about food
- Poor sleep patterns
- Restricting or strict control of food intake
- Overtraining or difficulties taking rest days
Psychological
- Irrational behaviour
- Fear of food and weight restoration
- Severe anxiety
- Becoming withdrawn and reclusive
- An inability to decipher the difference between fact and intrusive thoughts and limiting beliefs.
Contrary to what a lot of people assume, REDs is not just about energy intake or even being underweight, it is much more complicated, and can take many months to recover from.
At Nana nutrition, we have you covered. The aim is not only to support your nutritional intake around your training, but also to help you train responsibility and become aware of some of the signs that your body may be trying to tell you it is not as happy as you think it might be.