{"id":7626,"date":"2018-02-18T01:56:33","date_gmt":"2018-02-18T00:56:33","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=7626"},"modified":"2018-02-18T01:56:33","modified_gmt":"2018-02-18T00:56:33","slug":"cumulative-endocrine-dysfunction-relative-energy-deficiency-sport-red-s","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2018\/02\/18\/cumulative-endocrine-dysfunction-relative-energy-deficiency-sport-red-s\/","title":{"rendered":"Cumulative Endocrine Dysfunction in Relative Energy Deficiency in Sport\u00a0(RED-S)"},"content":{"rendered":"

By Dr Nicky Keay\u00a0@nickyKfitness<\/b><\/span><\/a><\/strong><\/em><\/p>\n

\"\"<\/p>\n

Unfortunately I continue to see athletes, both male and female, whose health and athletic performance is hampered due to\u00a0Relative Energy Deficiency in Sports (RED-S)<\/a>. There have been some high profile athletes who are very open about how RED-S has affected them, alerting\u00a0younger athletes<\/a>\u00a0to potential pitfalls.<\/p>\n

Does this issue warrant highlighting? Yes! The athletes I see and those that speak out are only just the tip of the iceberg. In a study of\u00a0exercising females<\/a>, half were found to have subtle menstrual hormone disruption such as luteal phase deficit or anovulation. A third were amenorrhoeic, with no periods at all.\u00a0All women of reproductive age, whether an athlete or not, should have regular periods, otherwise there are potential serious health and performance sequaelae<\/strong>. However studies in both the\u00a0USA<\/a>\u00a0and\u00a0Australia<\/a>\u00a0have revealed that the majority of young exercising women are not aware of the link between menstrual disruption and deleterious, potentially irreversible effects on bone health.<\/p>\n

The impact of non-integrated periodisation of training, nutrition and recovery has evolved since the early description of the\u00a0female athlete triad<\/a>. The constellation of amenorrhoea, disordered eating and osteoporosis is now considered to be a clinical spectrum. In turn the female athlete triad is part of a much broader picture of\u00a0RED-S<\/a>, which includes adverse multi-system effects beyond bone health and is also seen in\u00a0male athletes<\/a>.<\/p>\n

Although an athlete may appear healthy, what are the underlying\u00a0Endocrine\u00a0<\/a>disruptions occurring in RED-S that ultimately will impede both optimal health and performance to full potential? In general, female exercisers are more susceptible to internal and external perturbations as the female Endocrine system is more finely balanced than in males. Nevertheless, in a study of male athletes, in the short time period after completing a training session,\u00a0bone turnover<\/a>\u00a0was adversely affected, with an increase in markers of resorption relative to formation, if an athlete did not refuel rapidly with protein and carbohydrate. In the now classic research by\u00a0Loucks<\/a>, 5 days of manipulated energy restricted availability, via dietary intake and exercise output, caused disruption in LH pulsatility in previously eumenorrhoeic women. From this research and subsequent studies, not only is the reproductive axis disrupted with reduced energy availability, in addition hypothalamus-pituitary-thyroid (decreased T3) and adrenal axes (increased cortisol) and decreased IGF1 due to relative GH resistance are all disrupted. These interactive hormonal dysfunctions occur even before reduction in sex steroids. A recent study demonstrated that beyond the average energy availability over a 24 hour time window,\u00a0within day energy deficits<\/a>\u00a0in terms of duration and magnitude are associated with a greater degree of disruption of Endocrine and metabolic markers, in particular decreased oestradiol and increased cortisol. So consistency of nutrition, not only during a training season but from day to day is vital.<\/p>\n

Although energy availability is the crucial factor in the pathophysiology of RED-S, measuring this is not practical for all athletes in terms of accuracy and cost.\u00a0Clinical menstrual status in female athletes and basic Endocrine markers<\/a>\u00a0are proposed as being more reliable and accessible. The Endocrine system is very sensitive to internal and external perturbations, as described above, and presages performance consequences of RED-S, such as injury. An important starting point is for all female athletes is to ask themselves: are my periods regular? This is also a vital question that coaches and parents need to consider for athletes in their care. If the answer is no, then this needs to be assessed, ideally by those with experience in Sports Endocrinology.<\/p>\n

Why are these clinical and biochemical markers of Endocrine dysfunction important for athletes? Essentially there are significant health and performance implications for athletes. As outlined in the stories of female athletes, by the time career limiting stress fractures become obvious, typically in early twenties, the Endocrine system has been in disarray for a significant time. Long term, irreversible poor bone health and adverse\u00a0body composition<\/a>\u00a0have been established.<\/p>\n

In my opinion, emphasis should be placed on the\u00a0positive<\/strong>\u00a0outcome of integrating periodised training, nutrition and recovery to support a\u00a0functional Endocrine system<\/strong>\u00a0and therefore\u00a0optimal health and ability to reach full athletic potential<\/strong>. For example for female athletes, competing in sports where low body mass confers a performance advantage, such as ballet, gymnastics and road cycling, finely tuned neuromuscular skills are essential to reach maximal potential and minimise injury risk. Yet these are the athletes most at risk of developing RED-S, with consequential adverse effects on menstrual cycles, endogenous oestrogen secretion and\u00a0neuromuscular function<\/a>.<\/p>\n

Rather than reading headlines about the concerning health issues amongst athletes, more guidance for athletes and those working with them, on the warning signs and how to combat RED-S are needed so that athletes can reach their full potential and the headlines become about athlete achievements.<\/p>\n

For more discussion on the Endocrine and Metabolic aspects of Sport and Exercise Medicine, all members of multi-disciplinary team working with athletes, including athletes and coaches are welcome to the BASEM Spring Conference<\/a><\/p>\n

\"\"<\/p>\n

References<\/strong><\/p>\n

Relative Energy Deficiency in Sports (RED-S) Practical considerations for endurance athletes<\/a><\/p>\n

British middle-distance runner Bobby Clay is struggling with osteoporosis but wants her experience to act as a lesson for fellow young athletes\u00a0<\/a>Athletics Weekly 2017<\/p>\n

In a special AW report, former English Schools champion Jen Walsh reveals the devastation that the female athlete triad can wreak<\/a>\u00a0Athletics Weekly 2017<\/p>\n

Optimal Health: Especially Young Athletes! Part 3 \u2013 Consequences of Relative Energy Deficiency in Sports<\/a>\u00a0BASEM 2017<\/p>\n

Prevalence\u00a0High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures.<\/a>\u00a0Human Repro 2010<\/p>\n

Energy deficiency, menstrual disturbances, and low bone mass: what do exercising Australian women know about the female athlete triad?<\/a>\u00a0Int J Sport Nutr Exerc Metab. 2012<\/p>\n

Female adolescent athletes\u2019 awareness of the connection between menstrual status and bone health<\/a>\u00a0J Pediatr Adolesc Gynecol. 2011<\/p>\n

Optimal health: including female athletes! Part 1 Bones<\/a>\u00a0BJSM 2017<\/p>\n

Optimal Health: For All Athletes! Part 4 \u2013 Mechanisms<\/a>\u00a0BASEM 2017<\/p>\n

Optimal health: including male athletes! Part 2 Relative Energy Deficiency in sports<\/a>\u00a0BJSM 2017<\/p>\n

Sports Endocrinology \u2013 what does it have to do with performance?<\/a>\u00a0BJSM 2017<\/p>\n

The Effect of Postexercise Carbohydrate and Protein Ingestion on Bone Metabolism\u00a0<\/a>Translational Journal of the American College of Sports Medicine 2017<\/p>\n

Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women<\/a>\u00a0JCEM 2003<\/p>\n

Within-day energy deficiency and reproductive function in female endurance athletes\u00a0<\/a>Scandinavian Journal of Science and medicine in Sports 2017<\/p>\n

Low Energy Availability is Difficult to Assess But Outcomes Have Large Impact on Bone Injury Rates in Elite Distance Athletes\u00a0<\/a>Sports Nutrition and Exercise Metabolism 2017<\/p>\n

Body Composition for Health and Sports Performance<\/a><\/p>\n

Reduced Neuromuscular Performance in Amenorrheic Elite Endurance Athletes\u00a0<\/a>Medicine & Science in Sports & Exercise 2017<\/p>\n","protected":false},"excerpt":{"rendered":"

By Dr Nicky Keay\u00a0@nickyKfitness Unfortunately I continue to see athletes, both male and female, whose health and athletic performance is hampered due to\u00a0Relative Energy Deficiency in Sports (RED-S). There have been some high profile athletes who are very open about how RED-S has affected them, alerting\u00a0younger athletes\u00a0to potential pitfalls. Does this issue warrant highlighting? Yes! […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":7627,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[235,8258,16059,1596,16068,3040],"class_list":["post-7626","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-conference","tag-conferences","tag-endocrine-system","tag-energy","tag-featured","tag-red-s"],"yoast_head":"\nCumulative Endocrine Dysfunction in Relative Energy Deficiency in Sport\u00a0(RED-S) - BJSM blog - social media's leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2018\/02\/18\/cumulative-endocrine-dysfunction-relative-energy-deficiency-sport-red-s\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cumulative Endocrine Dysfunction in Relative Energy Deficiency in Sport\u00a0(RED-S) - BJSM blog - social media's leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"By Dr Nicky Keay\u00a0@nickyKfitness Unfortunately I continue to see athletes, both male and female, whose health and athletic performance is hampered due to\u00a0Relative Energy Deficiency in Sports (RED-S). 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