Avoid RED-S with proper fueling for athletes

This paid piece is sponsored by Avera Health.

If you are physically active and your periods become irregular or stop all together, it is time to see a doctor.

“Female athletes are not always told this, but it is absolutely not normal to stop your period because of how much you exercise,” said Dr. Leah Prestbo, a bone density specialist with Avera. “This means that your body is under stress, and it is not regulating itself properly.”

In fact, missing a period may be a sign that an athlete has Relative Energy Deficiency in Sports or RED-S. This is a condition parents should be aware of as well if their teens participate in athletics.

“Basically, RED-S occurs in athletes when they’re not getting enough nutrition to fuel the things they do physically,” Prestbo explained.

Symptoms of energy deficiency 

In addition to missing or irregular periods, moodiness, fatigue and constipation are also signs of RED-S.

And if the condition is not treated soon enough with proper nutrition, stress fractures can occur because of loss in bone density, explained Dr. Dustin Volkmer, an orthopedic surgeon and sports medicine specialist with Avera Orthopedic Institute.

“Estrogen helps maintain bone mineral density. If the body goes into energy-conservation mode because it is not getting enough calories and estrogen levels decrease, bone mass decreases,” Volkmer said. “This creates an increased risk for stress fractures.”

Stress fractures are tiny cracks in bone that occur when a bone is not strong enough to handle the repetitive stress put upon it.

RED-S affects men and women

Because missed or irregular periods are a symptom of Relative Energy Deficiency in Sports, or RED-S, the diagnosis initially was made in female athletes and referred to as Female Athlete Triad Disorder. However, if their nutritional needs are not met, male athletes are just as susceptible to stress fractures resulting from bone density issues.

“It takes more than estrogen to build strong bones,” Prestbo said. “In order to build up bone mass, which we typically do in childhood and adolescence, individuals need proper nutrition – protein, calcium, vitamin D, magnesium, phosphorus – so if you are not fueling your body, it will lead to less dense, less strong bones. It is really important for young men and women to set themselves up to fuel their physical activity properly so they get to that peak bone mass and reduce risks of stress fractures and breaks.”

A team approach to RED-S recovery

When athletes are diagnosed with RED-S, Prestbo and Volkmer are not alone in helping them recover. A team of Avera specialists are called upon.

Volkmer explained that if an athlete comes in with a stress fracture and is diagnosed with RED-S, while the sports medicine team treats the athlete’s stress fracture, the athlete also will work with a dietitian to formulate a well-balanced diet that provides them with adequate nutrition and calories.

“Athletes can take comfort in knowing that if they are diagnosed with RED-S, they will actually be better off in the long run,” Volkmer said. “Because our team will work with them, they have the opportunity to improve their health and long-term athletic goals.”

Meanwhile, the sports medicine team works on treating the stress fracture. Athletes must quit all impact activity for six weeks to three months depending on the severity and location of a stress fracture.

Get more wellness information at Avera.org/Balance.