[shark]

Article by Mina on UKC

https://www.ukclimbing.com/articles/features/relative_energy_deficiency_in_sport_-_a_cautionary_tale-12345


Not heard of RED-S before.

From the article

So, low energy availability is the villain here and lack of periods is just one of many problems associated with RED-S. Essentially, when the body doesn't receive enough energy (specifically carbohydrate) relative to demand, it will prioritise fuelling movement and down-regulate other physiological processes in order to conserve energy. Over-exercising, relative under-fuelling (intentional or unintentional), psychological stress or any combination of the three can lead to low energy availability.

RED-S can result in a multitude of dysfunctions with signs and symptoms including frequent illness and injury, lack of or irregular menstruation, fatigue, decreased performance and training response, impaired concentration, stress fractures, cold intolerance, mood swings, weight loss, delayed puberty and decreased morning erections in men.

[Doylo]

I can’t imagine training as hard as that no matter what I’m eating. Don’t know how people do it double sessions 5/6 days a week. Not surprised doing it for years along with underfueling causes problems. Hope she makes a quick recovery. I’m sure she will now she knows what’s going on.
 

and decreased morning erections in men.

I put this down to self loathing.

[Mr E S Capegoat]

‘Red-S’ sounds like a combination of overtraining and restrictive eating patterns which seem quite common in climbing. Other factors associated include obsessional behaviour, perfectionism, singular goal driven behaviour  lots of repetition, despite downwards spiral, failing to see the wood for the trees etc. Wander round Malham catwalk any given weekend and it’s all going on. Sardines and salad etc. Other non sports related but physiologically related ideas include neuro fatigue, central fatigue, ME, chronic fatigue, depression, post viral syndrome etc. I think this might be often reported in sport, did Steve Ovett suffer this in the late 80’s?

[mrjonathanr]

Seb Coe  struggled to recover from virus,  not uncommon with overtraining

[nick63]

There's lots of info on RED-S on the British Journal of Sports Medicine site. It's a big problem and used to be thought only a female issue, however the latest evidence suggests it's both female and male.

There's good podcast, again on the BJSM site, about RED-S. We all know climbing is a power to weight ratio sport but not eating enough will probably cause more problems in the long run; increased risk of injury, poor recovery from injury or illness, sudden drop in performance. Stress fractures are a common and again fail to heal or re-fracture with little stress.

Is it better to get strong at a healthy weight (whatever that is) or calorie restrict and risk the consequences of RED-S?

[cheque]

I'm pretty sure RED-S used to sponsor Crawley Town a few years ago.

Takes a lot of guts to altruistically write an article like this, particularly all the periods stuff. If nothing else it's an absolute goldmine for those of us who might want a resource of excuses for only training once a week and eating Jaffa Cakes at the crag. 

[shark]

Is it better to get strong at a healthy weight (whatever that is) or calorie restrict and risk the consequences of RED-S?

Or tactically and temporarily drop the weight for when you need to perform

[Paul B]

That's a really well written piece. I'm glad to see people writing (and publishing) such things rather than the Insta/FB "only the good bits".

but I realise now there was also an element of compulsive behaviour and using exercise as an emotional management tool.

  

[Nibile]

Excellent piece of writing on a crucial subject.

[Mr E S Capegoat]

Branding as ‘Red-s’ gives an opportunity for an industry to pop up around what appears to be already well recognised psychologically mediated sets of symptoms e.g disordered eating and compulsive / obsessional training. They’ll be some Red-s experts out there I’m sure. Life coaches in the wholistic sense.

[abarro81]

Branding as ‘Red-s’ gives an opportunity for an industry to pop up around what appears to be already well recognised psychologically mediated sets of symptoms e.g disordered eating and compulsive / obsessional training. They’ll be some Red-s experts out there I’m sure. Life coaches in the wholistic sense.

Surely the "symptoms" you describe are causes, not symptoms, of the physiological symptoms of RED-S (hormonal dysfunction, bone density getting messed up etc)?

[Stu Littlefair]

I think Dan's point is that there can be a psychological component to much of this. In general eating too little/training too much could be the immediate cause of similar issues but in many cases (not necessarily Mina's) the root cause of eating too little/training too much may be psychological.

And then there's the possibility that the psychological issues and stress are the more immediate cause of similar issues...

[Mr E S Capegoat]

Sure it would be too dualistic to suggest one without the other. The name RED-S is dualistic in that it reads as a physical illness, a collection of signs and symptoms. Obsessionality, compulsive behaviour, rigid thinking, perfectionism, emotional numbing, distorted body image all come along with a chronic calorie deficit and in turn become part of what keeps a person there. Reduced bone density, risk of cardiac event, halted periods, fatigue are signs of a body struggling to cope with the demands of the training and diet regime.
These regimes are often continued as they provide rewards. Feelings of euphoria, control, emotional numbing, sometimes they act as punishment or self harm which has its own returns. This stuff is closely linked to self esteem and body image / sporting performance culture. Calling it RED-S is a little confusing in a sense because what it’s describing is-
1. Calorie deficit
2. Compulsive over exercise
However you contextualise it. 

[mrjonathanr]

The name RED-S is dualistic in that it reads as a physical illness, a collection of signs and symptoms.

That’s basically a textbook definition of a syndrome, which seems fair enough. As it’s behaviourally induced, ipso facto, there’s some psychological component.

Still seems valid to represent the range of physical signs and symptoms as such though (at least to me, a layman).

[Mr E S Capegoat]

The textbook is wrong RED-S is a nonsense diagnosis. Most likely made up by some sport scientist / coach collaboration who don’t want to call it what it is so they can still keep hammering the same old shit.

[webbo]

Careful Dan you are starting to make sense.

[abarro81]

Is that 1 and 2 or 1 or 2 Dan? (Would quote but on phone and it's a faff..)

It would be interesting to know how many people have it undiagnosed. I have an instinctive aversion to your post, which I think is this (on the presumption that your answer to the above is 1 AND 2):
I can imagine that years of hard training and cyclical dieting could lead my body to a place where it gets screwed up, confused and, for example, decides to mess up my testosterone or something. But I can't identify with your number 2..

[webbo]

You could speculate that continued training or exercising whilst suffering from some sort of injury would be compulsive over exercising.
Which would include about 99% of climbers.

[Mr E S Capegoat]

It’s only dysfunctional if it causes dysfunction.

Low body weight is associated with a number a physical and psychological symptoms of which obsessional rigid thinking and compulsive behaviour is one of them.
Low body weight also generates interpersonal difficulties for some / most people.
When you’re ‘stuck’ in a cycle of intense diet and exercise it is possible to tread water at a low BMI say 16.5 and still function pretty well. This situation tends to bring a fair few pro’s which keep it going. 
A significant majority of people existing at this won’t recognise it as a problem.
Intensive exercise in whatever form often driven by conscious and unconscious needs and desire to control. E.g physical, emotional, psychological systems is part of this.
Rigid structures and protocols in diet and exercise feed into this.  Which is all fantastic if it’s working for you.
Our psychological and physical ‘systems’ aren’t separable in this way. The concept of ‘mental’ and ‘physical’ health is a false dichotomy stemming from a dualist culture in medicine. The RED-S  diagnosis is a  socially acceptable branding of a more complex  set of difficulties which are individually variable.
One person does it to numb and forget, another to ‘perform’, another to  self punish, another to control, another to conform and be accepted. The destination is usually the same or similar.

[Mr E S Capegoat]

Careful Dan you are starting to make sense.

Sorry I’ll stop it now

[abarro81]

Apparently cordial discussions of this on UKC are now a banning offense. Looks like the Mick Ryan censorship program lives on...

[Mr E S Capegoat]

What happened Alex?

*seemed like a reasonable thread to me all sides getting along, apart from that ged bloke seeing his arse about mental health / eating disorders.

[TobyD]

The textbook is wrong RED-S is a nonsense diagnosis. Most likely made up by some sport scientist / coach collaboration who don’t want to call it what it is so they can still keep hammering the same old shit.

In much the same way as many blanket diagnoses that attempt to cover a range of actual symptoms. The problem is that  people seem to want diagnoses. There's a rather broader point about these encouragingly healthcare behaviour, dependence and over medicalisation. Essentially I'm saying I think you've got a good point Dan.

[abarro81]

I take it back.. jumped to conclusions too fast.. apparently it was their anti-spam not erroneously flagging me! Sorry ukc

[Stu Littlefair]

Quite a good thread that. It would have been wierd if you’d been banned for it!

My impression from reading the document alicia linked and some surrounding medical research on hypothalamus function and functional hypothalamic amenorrhea (FHA) is that the idea of RED S is useful, but suffers from too narrow a focus on energy deficit.

FHA is also strongly linked to emotional stress, for example, and occurs in sedentary women with normal diets too.

It’s not too much of a stretch to imagine nutrition beyond calories plays a role, and there’s some evidence that, e.g. vitamin D is important (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265788/)

If Mina’s excellent article strikes a chord with someone reading it, then some self care (eat well, reduce stress, engage in activities that are simply fun) might yield more benefit than just eating more.