运动中的相对能量缺乏（RED-S）

In a recent意见片断为了The New York Times, “I Was the Fastest Girl in America, Until I Joined Nike,” Mary Cain details how her Nike track coach Alberto Salazar encouraged her to lose weight to become faster. Instead of increasing her speed, she developed relative energy deficiency in sport (RED-S) which resulted in low estrogen and weakened bone strength. She did not menstruate for three years and broke five different bones.

What is relative energy deficiency in sport? And how does it relate to eating disorders? How common is it?

Background

RED-S首先由国际奥林匹克委员会（IOC）于2014年被介绍。这是一种综合征，从运动员中的能源赤字产生。IOC将Red-s描述为“一种影响生理功能，健康和运动表现的许多方面的综合症”。

Athletes typically have higher energy needs than non-athletes. In RED-S an athlete is eating too little relative to the energy they expend and various bodily functions are negatively impacted, including the gastrointestinal, immunological, endocrine, metabolic, hematological, and cardiovascular systems.

RED-S is a term replacing an earlier one used to describe the same conditions. Energy deficiency in sport was previously thought to be only a female problem and was called thefemale athlete triad。女运动员三合会是1997年由美国体育医学院妇女问题的工作队于1997年描述的。女运动员三合会是指三个联系问题：能量缺乏，月经功能障碍和骨质损失。认识到男运动员也受到影响，Red-S取代了女运动员三合会。

Red-s有多常见？

RED-S的流行率不是很好的。Red-s是2014年仅限于唯一定义的综合征 - 所以研究有限。此外，许多运动员可能不愿意报告问题，或者在鼓励节食和限制的许多运动中的性能和薄度关注表现和薄度，可能会没有意识到问题。

The rates of eating disorders in athletes have been somewhat better investigated. Most studies to date have studied female athletes. Compared to non-athlete peers, female athletes report eating disorders at a higher rate: 18% to 20% compared to 5% to 9%. Prevalence rates of the entire spectrum of eating disorders and subclinical disordered eating vary from 0 to 19% in male athletes and from 6 to 45% in female athletes. The prevalence varies significantly among different sports.

Risk Factors

Red-s可以影响任何年龄和性别的运动员。虽然任何运动员都可以遭受Red-s，但是那些风险最大的人是判断运动中的那些，并强调外观或美学（如体操或花样滑冰），重量类别运动（如船员）和耐力运动（如越野）。

Although there appears to be an increased risk of disordered eating—and therefore RED-S—among athletes, there is not enough research to draw strong conclusions on who is most at risk among athletes. However, there are some factors that may increase risk.

Revealing Outfits

For example, the requirement to wear revealing clothing in sports such as volleyball and swimming is believed to play a role by heightening body surveillance, comparisons with others, and promoting body dissatisfaction. Other factors can be the pressure of weight requirements in certain sports that increase preoccupation with weight and reinforce dieting.

Coach Expectations

此外，教练的压力和影响 - 例如玛丽凯樟来自Alberto Salazar的压力 - 可以是一个缴费的因素。重要的是要承认教练和其他体育专业人员可以产生积极影响，如果他们促进了足够的加油和早期识别和管理在运动员之间的饮食问题。

症状and Diagnosis

诊断为红色“s”可能是一个挑战,因为症状can be subtle. Symptoms can vary among athletes and may include:

• Fatigue
• Weight loss
• Dehydration
• Lack of normal growth and development
• 肌肉损失
• Poor concentration and coordination
• Recurrent injuries and illnesses
• Decreased performance
• 情绪变化

In the case of athletes who should be menstruating the月经周期is an obvious clinical indicator of sufficient energy availability. There exists no such obvious clinical sign in athletes who physically cannot menstruate which may be why RED-S has been less frequently recognized among cis men and trans women and perceived as a "female" problem.

RED-S猫是评估涉嫌能量缺乏的运动员和活跃个体的临床评估工具，并用于指导回归追溯决定。如果您或您知道的人被怀疑拥有Red-S，他们应该有彻底的体检。

Consequences

Ironically, while weight loss may often be undertaken as an effort to increase athletic performance, as in the case of Mary Cain, the ultimate consequence may be decreased athletic performance as well as serious deleterious consequences for many bodily systems. In other words—the exact opposite effect of what an energy restricting athlete is aiming to achieve. They may experience reduced responsiveness to training and subsequent decreased performance.

未能充分燃料可以导致hypothalamic amenorrheain athletes who physiologically can menstruate. Low availability of sex hormones in athletes of all genders with RED-S can lead to low bone mineral density which places athletes at increased risk for stress fractures. This bone loss can be irreversible and can lead to osteoporosis.

RED-S and Eating Disorders

Red-s可能与饮食失调重叠，是饮食障碍的结果，或者可以是饮食障碍的危险因素。根据定义，综合症导致曝光。

在一端进入饮食和锻炼之间的适当平衡范围内存在无序的饮食，另一端临床进食障碍，坐在中间的饮食或曝光无序。

无序的饮食可以是对控制体重和组成的有意的营养限制，或者不符合从增加的训练载荷增加的能量消耗的增加的无意后果，其具有相应的能量摄入量增加。即使在不存在饮食障碍时，Red-S都可以产生心理影响。

How is it Treated?

Treatment for RED-S should involve anincrease in dietary intake, a reduction in exercise, or both. Energy-rich supplemental drinks and exercise rest days are often initial steps. In collegiate athletes, weight gain is the strongest predictor of resumption of normal menstrual function. Oral contraceptives are not recommended for the treatment of RED-S because they do not reduce bone loss and can mask low energy availability and menstrual dysfunction.

当运动员无法跟随时treatmentrecommendations to increase intake, decrease activity level, and gain weight, then psychological factors such as an eating disorder may be considered to be a factor. According to the IOC consensus statement, “Athlete resistance to treatment usually increases with the severity of the eating problem.”

当涉嫌或涉及饮食障碍时，治疗应涉及多学科团队，包括医生，registered dietitian, and mental health therapist well versed in eating disorders and sports. This team should coordinate closely with the athlete’s coach or trainer. Treatment is usually required for several months.

Many athletes may need to take a complete break from their sports training depending on the severity of the eating issues and medical consequences. The IOC has developed a return-to-play model that determines an athlete’s readiness to return to their sport.

A Word From Verywell

If you are an athlete, recognize that getting adequate intake relative to energy expended is critical for optimal health and athletic performance. If a coach is pressuring you to lose weight to increase performance, consult with other experts. Recognize that loss of menstruation due to training is not normal and a warning sign. If you are unsure about your energy needs, consult a registered dietitian.