Are you exercising more, controlling what you eat and still not losing weight? REDs may be to blame, as performance dietitian Renee McGregor explains
As you’re reading this, the chances are you understand the importance of keeping physically fit. You might even take it one step further and measure your performance at regular intervals. But whether you thrive on competition with yourself or others, competitiveness – continually striving for progress – isn’t always a positive influence.
From my experience of working with athletes of all levels – recreational through to Olympic and Paralympic standard; young to old, male and female – it’s like walking on a tightrope. Stay balanced and you will make it to the other side, but it doesn’t take much to push this balance off kilter.
We live in a society that’s always demanding that we prove our worth through our achievements. For athletes, this will be through sporting success. And while healthy competition doesn’t hurt anyone, when it becomes something that creates anxiety and defines your worth, it can be something that becomes destructive and dysfunctional; this pursuit for constant happiness/success/completeness often results in extreme behaviours, which can result in short- and long-term health problems.
It’s all relative
This phenomenon has recently been described as REDs, or ‘relative energy deficiency in sport’, and is an extension of the ‘female athlete triad’, which is well known in the sports world. It was noted that female athletes who didn’t meet sufficient energy requirements for the work they did often suffered from hypothalamic amenorrhea (loss of periods), which then had a negative impact on bone density. However, in recent years, it has been determined that not only does low energy availability affect bone health, but it also actually has a much wider reach affecting all biological systems, and it’s been shown that male athletes are also at risk.
Physical presentations may be any one or a combination of the following: low energy levels; increased prevalence of bone and soft-tissue damage; low mood; poor or stagnating performance; low libido and a reduction in morning erectile function due to declining testosterone levels. There are two types of REDs, voluntary and involuntary, but both will present with the same symptoms.
Involuntary REDs is simply a case that the individual involved doesn’t appreciate just how much fuel they require for the work they are doing: that is the energy required for biological function and then the energy for their physical activity. While most athletes will consider training as physical activity, they often forget about the day-to-day activity that will also contribute to the demand. For example, commuting by bike or foot, having an active job, as well as the cost of just living: respiration, metabolic function, etc. These people are easy to work with, as you provide them with the information they require, and they are happy to put the intervention into practice. Their body usually responds very quickly.
Voluntary REDs, on the other hand, is a conscious decision to restrict intake and/or over-train. This is a far more complex issue because it often involves a psychological aspect and can take the individual a lot longer to recover from. Both forms of REDs may or may not involve weight loss. The body always prioritises movement, so when there is low energy availability within the system, it often tends to down-regulate biological processes, lowering metabolic rate in order to preserve energy. So while many assume that restricting intake and increasing movement will result in weight loss, this is not always the case.
Knock-on effects
It’s important to remember that the mind and body are not separate entities: making a change at one level can have severe implications and consequences at another point within the body.
If we look at the example of restrictive eating in athletes, the culture within their given sport often creates this belief that being lighter will improve their performance. What they don’t stop to consider is that maybe their body is already as low as it needs to be. The need to be the best, the inability to manage expectations, drives them to a place where they overly restrict their intake and/or significantly increase their training. While they may find that initially they do see positive results, it soon plateaus and usually declines rapidly. Instead of being able to see that their stagnating and deteriorating performance is a direct result of these extreme behaviours, they further crack the whip, believing they’re still not working hard enough.
Over time, their high training volume and low energy intake becomes so restrictive it leads to biochemical and hormonal irregularities. These could include reduction of testosterone in men that results in depression, anxiety and many long-term physical consequences, such as gastro-intestinal symptoms, a depressed immune system and poor adaptation to training, including holding on to fat rather than putting on lean muscle mass.
While many may believe that REDs is specific to the world of elite sport, my experience is that it is more common in those who are recreational or semi-professional: people who often don’t have a wider support network monitoring training load, performance outcomes, and overall health.
Many athletes are of a particular personality: determined, obsessive, self-critical perfectionists. While these traits can result in positive outcomes, when combined within a competitive environment they can become dysfunctional – creating the perfect storm for extreme behaviours.
The difficulty is that their compulsive behaviours create both physical pathways to a decline and an irrational way of thinking, making it very challenging to work with. Physically, when the body is under stress, levels of cortisol rise; when this is chronic, it prevents the pituitary gland from working effectively, leading to hormonal disturbances that have serious negative consequences. The more obsessive and restrictive an individual becomes, it affects not only the levels and transmission of neurotransmitters, but has also been shown to structurally affect the brain, making it more and more difficult to make decisions.
Pursuit of perfect
Where does this all come from? Why the constant need and search for ‘perfect’?
In athletes, the highly competitive environment creates the need to constantly push and prove their place, often to the detriment of their long-term health. For the rest of us, when we struggle with our sense of self, anxiety increases and we crack the whip harder, but no matter what we do, we are never good enough. While love and happiness are positive emotions to experience, many of us run a mile (quite literally) when it comes to experiencing difficult emotions such as loss, uncertainty, pain, and trauma.
It’s understandable. Many of us who suffer from anxiety know that it can be debilitating: the severe physical feelings that you can sense deep within you make you want to unzip and escape from your own body. However, the problem is that no matter what coping mechanisms you put in place to control, contain, and numb these difficult emotions – such as restrictive eating, over-exercising, alcohol, sex, or drugs – they are always temporary. Those difficult emotions always come back, and eventually, you have to choose to accept them and work your way through them in order to finally come out the other side and get on with your life. This obviously feels terrifying, but working with a qualified psychological practitioner, as part of a wider support network (including a coach, dietitian, and medic) is critical. In order to change a behaviour, we have to challenge it.
