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Relative Energy Deficiency in Sport (RED-S) (Read 6314 times)

shark

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Relative Energy Deficiency in Sport (RED-S)
October 21, 2019, 10:01:53 am
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

Quote
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

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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

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‘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

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

nick63

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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

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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

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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

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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".

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

 :guilty:  :-[

Nibile

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Excellent piece of writing on a crucial subject.

Mr E S Capegoat

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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

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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

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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

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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

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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

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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

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Careful Dan you are starting to make sense. :o

abarro81

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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

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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

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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

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Careful Dan you are starting to make sense. :o

Sorry I’ll stop it now

abarro81

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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

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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

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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

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

Stu Littlefair

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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.

abarro81

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Good post, except we all know that doing things that are fun is for losers. Start down that road and you'll end up like mr scapegoat, pontificating about the Freudian implications of spending too much time aerocapping on jugs shaped like dongs

Mr E S Capegoat

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You clearly need to read Kuntworthy’s latest schematic Alex. Overcoming Kleinian envy which developed through witnessing parental coitus. The energy systems pathway is clear and yes it does involve the budding ‘energy system acolyte’ hanging off a big yellow cock for 15 minutes before continuing to traverse in circles for 10. While an onlooking crowd of angry Self serious ukbers call for justice.

That one’s on you btw


SA Chris

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Can we get Jim'll Paint it to do that on the new T Shirt?

T_B

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This is both shocking and sad. I really hope that climbing can avoid going this way

https://www.nytimes.com/2019/11/07/opinion/nike-running-mary-cain.html


Mr E S Capegoat

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It seems shocking because it’s quite explicit and brought into public consciousness. A direct example of a brand ‘owning’ a person. I’m in two minds about the Red-s name. On one hand it raises awareness to sports people and navigates the potential shame of an anorexia or restrictive eating disorder diagnosis, possibly enabling ‘athletes’ to feel safer in accessing help on the other hand it’s absolutely not different on any level to an eating disorder diagnosis. Maybe it could be renamed red-L or relative energy deficiency in Life

T_B

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It's the level of abuse from Salazar that I find shocking and the fact that this culture remains so prevalent/accepted. There are other female Nike athletes now going public basically saying "yeah we knew this abuse was going on, sorry we didn't say anything".

But yes, as you say, Nike owns them.

Mr E S Capegoat

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It’s definitely interesting that a company at the end point of the capitalist system like Nike would employ a narcissist to do their dirty work. It’s similar to the point I was making in the other thread. The desire for perfection based on a sense of self that’s ‘held’ by others is a common theme in restrictive eating disorders. In this way the behaviour might not even have been recognised as abuse and coercive control, just ‘normal’. I’d argue you could expand this out quickly to the controlling culture as a whole and is fully present within climbing.

Stu Littlefair

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The desire for perfection based on a sense of self that’s ‘held’ by others is a common theme in restrictive eating disorders.

It's the human condition. As you say higher up the page it's only dysfunctional if it causes dysfunction. When held in check it also drives most human endeavour, including exploration, adventure and arguably charity.

It's easy to pile onto Salazar and Nike, and their behaviour is clearly horrible. BUT, in another context, society might view this kind of pressure and perfectionism as an ideal to strive for (e.g the Apollo programme). I think this makes the issue a bit harder to react to than just an "oh, isn't this awful" response.

To drag back onto RED-S I think it's power in helping athletes deal with disorder eating without stigma makes it a worthwhile concept. But it's also the weakness of a diagnosis, since it doesn't encourage the athlete to think about other areas of live that are putting their bodies under stress.

Mr E S Capegoat

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In this sense Salazar, Nike and society are one in the same. Under the illusion of free will the ‘athlete’ embraces their approach supported by the crowds desire to see performance and therefore experience themselves in this individual. Honnold and free solo is a good example of this in climbing, a bewildered man acting on motivations beyond his control for difficult to fully articulate reasons, held aloft by a community and idolised in this way. We all experienced a bit of what it was like to be him in the cinema. Some level of insight into this can offer a sense of freedom and opportunity to be more ‘yourself’. It’s clear many ‘great’ performances and endeavours have been undertaken in this way, smashey and nicey for example. I’d hazard that in the end the more driven and owned by the ‘other’ real person or abstraction (money, grades and it’s symbolism) the results are inevitably problematic for some if not all the people involved. Perfectionism exists because others make it so. This is a paradox in restrictive eating disorders and many other things, the society / government which is working so hard to ‘cure’ them is the very thing creating them e.g the education system

T_B

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Dan. Get yersel to a ParkRun ;D

Mr E S Capegoat

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You’re taking the piss right Tom? 🤣

webbo

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In this sense Salazar, Nike and society are one in the same. Under the illusion of free will the ‘athlete’ embraces their approach supported by the crowds desire to see performance and therefore experience themselves in this individual. Honnold and free solo is a good example of this in climbing, a bewildered man acting on motivations beyond his control for difficult to fully articulate reasons, held aloft by a community and idolised in this way. We all experienced a bit of what it was like to be him in the cinema. Some level of insight into this can offer a sense of freedom and opportunity to be more ‘yourself’. It’s clear many ‘great’ performances and endeavours have been undertaken in this way, smashey and nicey for example. I’d hazard that in the end the more driven and owned by the ‘other’ real person or abstraction (money, grades and it’s symbolism) the results are inevitably problematic for some if not all the people involved. Perfectionism exists because others make it so. This is a paradox in restrictive eating disorders and many other things, the society / government which is working so hard to ‘cure’ them is the very thing creating them e.g the education system
I was of the belief that systems tended to be a causative factor in eating disorders, often the family system.

Mr E S Capegoat

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I think so. Family, educational, broader informing or governing, societal / cultural. Anything that ‘has’ or influences part of a person in that way. I guess trans-diagnostically it could work for lots of problems. Neurotic being ‘alienated’ from the inside world or self and ‘psychotic’ being alienated from the outside world or ‘other’ fully immersed inside your own head. Ps I don’t fully follow that broad idea and of course it’s a heuristic / oversimplification of the bio-psycho-social systems and their relative complex interactions.

webbo

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I don’t think I ever came across an individual with eating issues who wasn’t or had been part of a dysfunctional family.

Mr E S Capegoat

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We’re agreeing then? ✌️💗 please say yes.....

webbo

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Did you say the same, I would have never have guessed.
Do you speak like that in real life. :-\

Mr E S Capegoat

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The old ukb lose-lose. To say any one system is to blame is overly simplistic without taking into consideration ideas like the nature of consciousness and the illusion of free will, predetermination, individual and broader cultural forces. Values, belief systems etc. So are the ‘family’ to blame? Only in that they represent the broader fucking mess in their dysfunctional behaviour. Is it the government / society / culture to blame? well we live in a performance orientated world where winning or getting your ‘medal’  whatever that might mean, is held paramount. Is genetics to blame, well in some part of course people can be more obsessional or ‘driven’ whatever. So are there a significant amount of climbers out there operating in this ‘system’ of course. And to be honest, so what? Every time somebody posts their weekly report including weight etc in power club, the whole thing is so predictable because it is a predetermined set of behaviours which have been instigated by all these driving factors and assimilated in the unconscious before they’ve even happened.
Jeez webbo I thought we could become solid pals there for a minute

webbo

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Well I suppose I could be become pals with someone as well balanced as your good self.
Well balanced as in a chip on either shoulder. ;)
Fuck me Dan you need to lighten up. I have climbed for about 47 years if you can call it climbing. These days I spend most of my time pissing about on a piece of overhanging plywood in the garage believing I’m training to get better or futility not any worse.
I would love to be doing what Jimmy Webb or Daniel Wood are doing not because they are the driven to be the best in the world by a society which thrives on elitism.
Because those moves they do just look fantastic and being able to do them must be out of this world.
« Last Edit: November 08, 2019, 07:00:38 pm by webbo »

Mr E S Capegoat

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Cheers for the advice. Although I’m not sure ‘Webb n Woods’ are real people? A bit like that ‘Shultez’ bloke. Figments of their own imagination.

Mr E S Capegoat

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Actually one thing about this -
When I responded to Tom’s post about ‘shocking and sad news’ with a well thought out and in depth reply to the best of my ability I get told to lighten up etc when it isn’t in-line with peoples thinking. Here’s the alternate response

‘Ooooo yes balsalsa fellah, shocking yes very terrible. Nike should give him the sack. How did some one like him ever get that job. Our young athletes need proper training to win medals. Ooooo terribly sad etc... I blame the parents and possibly teachers cos they’re all rubbish these days....’ ‘now that Jimmy Webb and Danny woods are the real thing, they’re not even aware of climbing as a ‘thing’ just turned up to a rock one day and celebrated getting to the top... amazing I’d like to be like them etc... true role models and they drink beer and eat macdonalds.... proper climbers’


Ged

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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.

You seem to get quite angry quite quickly.

moose

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This latest Ross Tucker "The Science of Sport Podcast" might be of interest.  I've not listened myself but the preceding ones in the series - on talent development, cheating / doping, and the evolution and effectiveness of the Nike Vaporfly were excellent.

https://play.acast.com/s/realscienceofsport/4676edf0-7f8a-4208-8464-0b929be25d66

https://player.fm/series/the-real-science-of-sport-podcast/mary-cain-challenging-the-culture-of-fat-shaming-and-elite-performance

https://podcasts.apple.com/us/podcast/mary-cain-challenging-culture-fat-shaming-elite-performance/id1461719225?i=1000457810935

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Plus ca change, plus c'est la meme chose  :-\

Johnny Brown

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Who's playing Gill's role nowadays?

 

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