Relative Energy Deficiency in Sport (REDs)

An overview of Relative Energy Deficiency in Sport (REDs) from a sport nutritionist perspective

Sport nutritionist and exercise physiologist Simone do Carmo leads this week with a lecture on REDs and the concept of EA, focusing on specific factors beyond EA. She concludes with a case study to showcase her integrative thinking and delivers a live workshop.

Lecture 1 content

Week 1 begins with an overview of REDs history, the concept of EA, and strategies for working with athletes at risk of LEA or REDs from a sport nutritionist’s perspective.

Topics include:

The current REDs model: We review how the current REDs model is defined and challenged, the concept of LEA as an underlying cause, and the many pitfalls associated in estimating an athlete’s EA while recognising the importance of improving it.

Beyond energy availability: We discuss exacerbating factors that could impact certain health outcomes of REDs along with the relevant research. These factors include high fibre intake, a lack of nutrients to support bone health and a lack of mechanical bone loading. We bring in other considerations such as the importance of looking at carbohydrate quality when trying to increase carbohydrate availability, and why not to overlook other macronutrients, micronutrients and the gut-muscle axis.

Case study of an aspiring female Powerlifter: To showcase integrative thinking as a sport nutritionist, Simone presents a case study of an aspiring female Powerlifter who is undernourished, pulling together the theory covered in the lecture and applying it to the athlete.

WEEK 2 – Intentional Relative Energy Deficiency in Sport (REDs)

Sports dietitian and clinical specialist Renee McGregor leads this week, focusing on intentional REDs where disordered eating or an eating disorder may combine with excessive exercise behaviours. Renee provides case studies and delivers a live workshop to showcase her clinical thinking.

Lecture 2 content

Week 2 covers the definition of intentional REDs, origins of dysfunctional behaviours, practical issues commonly seen in intentional REDs, and case studies highlighting the need for multidisciplinary collaboration.

Topics include:

Eating disorders and disordered eating (ED/DE): We discuss the difference between ED and DE, how social media influences these, and why athletes may be more at risk of DE or developing an ED.

Potential practical issues and diagnosing REDs: After highlighting the concept of energy availability, we look at some practical issues such as food trends and balance between school/work/social life and training. Renee then outlines how REDs is diagnosed with case study examples.

The road to REDs recovery: We discuss key considerations for recovery from REDs, emphasising the need for a multidisciplinary approach and how to manage certain challenges such as limiting beliefs around food and social media.

WEEK 3 – Relative Energy Deficiency in Sport (REDs): a focus on endocrine health

Exercise endocrinologist Dr Nicola Keay leads this week with her lecture on REDs and endocrine health, integrating different body systems. She provides an action plan for managing REDs and delivers a live workshop.

Lecture 3 content

Week 3 covers the hormonal network effects on performance, unbalanced athlete behaviours, the long-term consequences of LEA, and the diagnosis and management of REDs.

Topics include:

Harnessing hormones: We review key considerations to support healthy hormones for optimal health-based performance.

Clinical consequences of long-term LEA: We discuss the effects of LEA on endocrine networks and the clinical consequences of REDs, focusing on the impact on bone mineral density.

How to identify athletes at risk of REDs: After highlighting the primary and other potential indicators of REDs risk, we review how REDs is diagnosed by exclusion and look at the International Olympic Committee’s Clinical Assessment tool. Nicola concludes her lecture with the management of REDs and how to support restoration to full health and performance.

WEEK 4 – Action Learning Workshop

Your learning is now flipped from a state of expert-led presentation to participant-led discussion, where you will tap into your prior life learning and experiences, along with that of your peers, to move towards ‘action’ steps of professional development before departing from this module.

• You will firstly be asked to reflect on what you already knew about REDs before the beginning of this module i.e. what did you already bring into the classroom?
• As a team, you’ll then be asked to question what aspects of your thinking were potentially challenged and modified by your recent study of REDs.
• Finally, you’ll be asked to consider how you might now think and act differently as you carry your collective knowledge forwards with you towards the action steps of working with a suspected REDs client.
• Done well, this kind of workshop amasses the knowledge and experience of the whole group in addition to what has already been learned from the lecturers.

Module assignment

In a concise 1000 words, you will be asked to write a flowing essay on a case study of an athlete, or active individual, who has the goal of improving signs and symptoms associated with REDs, while undertaking a challenging exercise training programme. Honouring the professional practice style of your base career, you’ll look to incorporate learnings from this module in your case description and intervention strategies.