Sarah McMullin, M.D. - RED-S

Dr. McMullin is currently practicing pediatrics and sports medicine at the University of South Alabama. This week she was able to come and speak to us about RED-S, formerly known as the Female Athlete Triad. RED-S stands for relative energy deficiency in sport, clinical endpoints include, eating disorder (low energy availability +/- disordered eating), amenorrhea (menstrual dysfunction), and osteoporosis (low bone mineral density). RED-S commonly affects dancers and athletes or performers in disciplines emphasizing leanness. Low energy availability is a mismatch between energy intake and energy expended in exercise. This means there is inadequate energy to support the body functions and level of exercise. Amenorrhea means no menstrual period ever by the age of 16 (primary), no menstrual period for 3 months in a row (secondary). This also includes oligomenorrhea, cycles greater than 35 days in duration. Fewer than 6 cycles per year put females at high risk, 93% more likely to sustain stress fractures. Low bone mineral density is another symptom of RED-S. This is primarily made up of estrogen and testosterone inhibiting osteoclasts (bone breaking) and stimulating osteoblasts (bone building). When this becomes severe, it can lead to osteoporosis, meaning brittle bones. Amenorrhoeic women lose approximately 2-3% of bone mass per year if the condition remains untreated. Teenage and young adult years are the most important years for building bones and this condition undermines these critical years.

Formerly known as FAT, female athlete triad, RED-S now stands to include male athletes as well. Male athletes are also affected because this condition is not a triad of entities, but a syndrome that affects: metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health, and psychological health. In order to prevent obtaining this syndrome, the following must be done: make sure you're eating enough healthy calories to make up for what's being expended, calories should increase during intense training times, and if trying to lose weight, do it slowly and think about talking to a nutritionist/dietitian and do it out of season.