Aidan:

Hello and welcome to the Ideal Nutrition podcast. My name is Aidan Muir and I’m here with my co-host, Leah Higl. We’re going to be talking about REDS and low energy availability. REDS stands for relative energy deficiency in sport and low energy availability is kind of self-explanatory because we’ll talk about it in detail, but like those are the two things we’re covering today.

Leah:

Yeah, so briefly touching on the downsides of low energy availability. literally just not having enough calories for the basic function. So in these circumstances, we see things like loss of menstrual cycle, decreases in bone mineral density, things like reduced aspects of recovery and muscle protein synthesis.

So for athletes, that can be quite problematic, higher frequency of illness, so getting sick more often, and also seeing potentially more injury through things like training. We also see things like reduced metabolic rate. So that makes sense considering there’s not a ton of energy coming in and potentially a ton of energy going out that the metabolic rate would somewhat adapt to that. So those are kind of the main ones we see, but there are a lot of other things that may come alongside reds or low-energy availability.

Some of the downsides from this stuff can be fairly easily quantified and are easy to back with research. Like a lot of the things like, you know, loss of menstrual cycle, reduction in bone mineral density and whatnot can be measured. But there are other things that are a little less easy to measure. So there is quite a common link between LEA, like low energy availability and gastrointestinal symptoms. The mechanisms here do make sense.

For example, even just the body spending fewer calories on digestion could potentially impact how well things are digested and then the presence of gastrointestinal symptoms. But it is harder than you would expect to actually have like a clear, like clear research backing this claim up without delving into other areas like eating disorder research.

Aidan:

Yeah, I remember I made a post about that once on Instagram and just one dietician just asked me being like, what’s the research backing this? And I hadn’t even thought to check that before because there are so many like consensus papers on LEA and stuff like that. And I’d seen so many other people talk about it. And then I just assumed it was part of that. And when I went and looked at all of these consensus pages, like papers, none of them really spoke about that. And some of the research I looked at, they mentioned it, but didn’t cite any sources or anything like that.

But we do have that clear like ED research in terms of like a lot of people with eating disorders in general and or just anorexia nervosa have quite high rates of gastrointestinal issues. Anecdotally, we see it, but that’s kind of the point. It’s kind of hard for us to like back that claim with research as well. So make of that what you will.

In terms of how we measure energy availability and also some flaws in it, which I believe we’ve also discussed on this podcast previously, but I’ll just talk about how we measure it. So energy availability equals energy intake minus energy expenditure through exercise specifically divided by fat-free mass. So going deeper, LEA, so low energy availability is typically defined as having less than 30 calories per kilo of fat-free mass per day. Feel like it’s a bit too mathematical for the podcast, but..

Leah:

Hard to visualise.

Aidan:

Yeah. It doesn’t really matter. Cause I’m going to be honest, I never use an equation like that. Even the researchers in this space, I’ve heard them speak on this topic typically talk about being like, you shouldn’t be whipping out the calculator and measuring this. It’s more of a tool that is useful for research and analysing this type of stuff, but not really for practitioners and people working in this space. I’m going to talk about two floors. The first one’s not really a major floor. And I believe the researchers and stuff like that in this space would align pretty closely with my thoughts on this topic.

But one floor I see with that equation is if you took it super literally and oversimplified, you would think that it ignores that we can access our fat stores. Like I don’t know how to go into that too deeply without thinking about being like, say you go into a 500 calorie deficit per day. And theoretically that puts you in a state of low energy availability because you don’t have that many calories leftover after exercise.

You could think that that means, my basal metabolic rate obviously has to decrease because there’s only so many calories available. But you can just tap into your fat stores. You can just use that for energy. It’s just that that might become harder under certain circumstances. Your body might not want to do that for the long term for a certain point. The leaner you get, the less access you might have to that. So there’s a variety of things there. But I just wanted to touch on that as a potential flaw if you took this way too literally.

The second flaw, is a real flaw. It’s that underreporting is a massive issue. This is why you shouldn’t whip out the calculator and stuff like that. There are many practitioners who had been using this equation or probably have still been using this equation with athletes that they’re working with. And they’ll get the athlete to tell them what they eat. And then they’ll chuck them to my fitness pal, something like that to come out of their calories. They’ll figure out how many calories that athlete is likely burning through exercise.

And somebody who might be completely well functioning as an athlete has no symptoms of LEA could be consuming less than 30 calories per kilo and they would be now diagnosed, so to speak, with low energy availability, even though they’re thriving, have no symptoms, anything like that. That leads to two things. That could be due to underreporting that that issue is present. Or maybe that person is just thriving even if they are in what would typically be a state of low energy availability for other people as well. So it makes a lot more sense to look at the symptoms than it does to try and use a formula to figure out this stuff.

Leah:

Yeah, I almost see like personally that formula is more of like part of a screening tool I might consider for using with athletes where maybe I am checking this alongside checking other symptoms and how that athlete is feeling and whatnot and then utilising all of that to potentially make some decisions. I one of the other big things to be aware of is that if you get too caught up in that particular equation, it could make you scared to go into a calorie deficit at all, particularly if you are someone that has fairly high training loads. Like it’s very clear that many athletes actually do go into a state of low energy availability at various points and there are no noticeable issues that arise. So I think the length of this occurring and the degree at which it occurs as well as individualisation in terms of that particular person, like all that comes into play whether or not there is actually a state of low energy availability that is problematic, I suppose.

So like short durations are typically less of an issue than someone who is consistently has a very low energy availability overall and then just factoring in that some people are more adaptable than others. I suppose using a little bit of a client case study is that I have one client who whenever we put even in a mild to moderate deficit, they do seem to start to get the symptoms of low energy availability, even though maybe in other athletes, this wouldn’t happen. So loss of menstrual cycle, extreme fatigue, illness, injury more frequently, all those types of things.

For that particular athlete, I theorise that like they have a very stressful life plus a high, high training load and anxiety. And that probably adds to the overall stress on the body in combination with low energy availability. And all that combined together has led to their body adapting in this way and then showing these particular symptoms. But I might do the exact same thing with another athlete who is just a different person with different circumstances and then not see those symptoms arise. So again, just not getting too caught up in that equation and really just looking at you as an individual.

Aidan:

Sure. Now let’s talk about what to do if you are experiencing symptoms of LEA. The simple answer is eat more or do less training. Those are your two options. And the reason why that’s a little bit funny to me is you people always criticise, eat less, move more. It’s the opposite of that. So like, that’s a starting point. Maybe that helps you. Maybe it doesn’t. A lot of athletes will be in positions where doing less training doesn’t really seem like a feasible option or anything like that.

Eating more is something that is often realistic and possible. Somebody might be hearing this advice being like, I’m trying, I’m trying to eat more. What to do then? Well, if the logistics of eating more are an issue, I would be focusing on more calorie dense foods, changing your food intake around that. That would be an entire podcast in itself. We have done a podcast on that previously as well about how to get in higher-calorie foods and stuff like that. And if you did want more information on that, literally Google what to do if you struggle to enough calories, ideal nutrition, Aidan Muir and multiple things will come up. That would be my recommendation of what to do with that. We might even put that in the show notes.

Leah:

Yeah, and the show notes will have a few things in there, including a blog post we have done on relative energy deficiency in sports and how to manage it. So again, if you want more information, you can go and have a little look at that. But this has been episode 168 of the Ideal Nutrition podcast. If you haven’t yet left a rating or review, it would be so greatly appreciated for you to do so. But otherwise, thanks for tuning in.