REDS - pt. 1+2 Flashcards
Imbalance between intake and energy expenditure is most prevalent in what sports?
in bodyweight sensitive or aesthetic sports
Is REDs more prevalent in males or females?
females
What is energy availability?
defined as the amount of energy remaining after energy requirements for exercise training is removed
How do you calculate energy availability?
EA = energy intake - exercise energy expenditure
Chronic low EA can lead to what?
hormone disruption/menstrual disturbances (hypoestrogenemia)
suppressed bone formation
suppressed metabolic function
increased bone resorption
Recall how to determine energy intake?
24hr recall
FFQ
3-5 day food journal/records
Diet history
self-reported eating routine
Can weight maintenance be achieved with chronic low EA?
yes, that’s why it can be difficult to assess
What are overt signs of low EA?
What if bodyweight is not low?
BMI <17.5kg/m2 or <85% of expected BW for adolescents
If bodyweight is not low, look at current patterns of food intake compared to current level of physical training
How is EEE measured?
HR monitors
activity monitors
indirect equations
How is fat-free mass determined?
skinfolds, DEXA, underwater weighing
What are errors with diet recalls and assessing energy intakes?
labor intensive
time consuming
food knowledge
different people performing the tests
How does a balanced EA support health and performance?
hormones
bone
GI
cellular maintenance
circulation
thermoregulation
immunity
mental health
muscle strength
lean mass
concentration
coordination
glycogen storage
recovery
adaptation
aerobic performance
injury protection
What is LEA?
Low Energy Availability:
mismatch between dietary energy intake and energy expended in exercise that leaves the body’s total energy needs unmet, that is, there is inadequate energy to support the functions required by the body to maintain optimal health and performance.
What is the difference between adaptable LEA and problematic LEA?
adaptable LEA: typically a short-term experience with minimal or no impact on long-term health, well-being or performance.
problematic LEA: exposure to LEA that is associated with greater and potentially persistent disruption of various body systems, often presenting with signs and/or symptoms, and represents a maladaptive response. Characteristics may vary according to the body system and individual.
What are moderating factors for LEA?
may offer protection or additional risks in the progression from LEA exposure to the expression of disturbances to health, well-being or performance
ex. characteristics of ind. athletes
environment or behaviour activities
gender
age
genetics
duration/intensity
What are the 2 types of determinants of food consumption?
person-related factors (ex. nutrition knowledge, taste and food preferences, appetite, influences, psychological, biological, medical)
environmental-related factors (ex. time/schedule, economic stability, cultural background, culture of sport, cooking skills, access to food, cooking equipment)
What is REDs?
syndrome of impaired physiological and/or psychological functioning experienced by female and male athletes that is caused by exposure to problematic (prolonged) LEA
What are the detrimental outcomes of REDs?
include - not limited to - decreases in energy metabolism, reproductive function, musculoskeletal health, immunity, glycogen synthesis, cardiovascular and hematological health
all can individually and synergistically lead to impaired well-being, increased injury risk and decreased sports performance
What is the difference between disordered eating and eating disorders?
disordered eating: abnormal eating behaviours
(restrictive eating, irregular or inflexible eating patterns, excessive exercise beyond assigned training to compensate for dietary intake, and use of purgatives) - doesn’t meet clinical criteria for an eating disorder
eating disorders:
mental illnesses clinically diagnosed by meeting defined criteria characterized by abnormal eating behaviours
If female athlete triad still a thing?
yes, part of REDs
What are the 3 components of the female athlete triad?
low energy availability (with or without ED)
amenorrhea / menstrual dysfunction
low bone mineral density (osteoporosis)
Explain the how the female athlete triad is a spectrum.
What is the difference between primary and secondary amenorrhea?
primary: delay in onset of puberty & menarche @ 15 yrs
secondary: disruption in normal menstrual cycle, missing period for >3 months (consecutive or not, within a year)
What is the hormonal cause of amenorrhea?
low estrogen, progesterone, and testosterone levels
Is amenorrhea related to infertility?
can be, along with may other long term health problems
Discuss the impact and causes of low BMD and female athlete triad.
decreased estrogen from ovaries –> estrogen increases uptake of calcium into blood and deposit into bone/skeleton
reduced intake of important nutrients for bone health (protein, calcium, Vit D.)
increased risk of stress fractures
peak bone mass occurs around 19 yrs for females and 20.5 yrs for males
Is bone loss always reversible?
no, not always
When is peak bone mass for males and females?
19yrs for females
20.5yrs for males
What is the process for the treatment of the triad?
1) recovery of energy status (days-weeks)
2) recovery of menstrual status (months)
3) recovery of BMD (years)
What are some of the warning signs of LEA or REDs?
inconsistent training
poor training response
<9menstrual cycles per 12 months (females)
low libido
> 2 bone injuries
high levels of fatigue
poor sleep quality - increased hrs sleeping
poor sleep quality
decreased performance at training and competitions
low ferritin not responding to proper supplementation
restrictive eating habits
GI problems
weight loss or consistent BW
drops in muscle mass and strength
change in mood/irritable
What is the issue with the warning signs of LEA or REDs?
they are pretty generic symptoms, makes the diagnosis difficult; have to work with and understand the athlete
What are other factors that may impact fatigue?
dehydration, poor sleep quality, underfueling, doing workouts fasted, stress, low CHO intake, illness, poor planning with school/work and training, low iron stores, caffeine withdrawal
What is a major impact with LEA in the development of REDs?
low carbohydrate availability
How does overtraining syndrome relate to REDs?
there is a lot of overlap
What is included in the REDs health conceptual model? (13)
- impaired reproductive function
- impaired bone health
- impaired GI function
- impaired energy metabolism/regulation
- urinary incontinence
- impaired glucose & lipid metabolism
- mental health issues
- impaired neurocognitive function
- sleep disturbances
- impaired CV function
- reduced skeletal muscle function
- impaired growth & development
- reduced immunity
What is included in the REDs performance conceptual model? (8)
-decreased athlete availability
- decreased training response
- decreased recovery
- decreased cognitive performance/skill
- decreased motivation
- decreased muscle strength
- decreased endurance performance
- decreased power performance
What are the many aspects that need to be considered when assessing EA?
health
performance
moderating factors
exposure
the individual
What is the #1 cause of REDs in sport?
LEA
Who is at risk for REDs?
any athlete or active individual can suffer from REDs
particular risks for:
female athletes
weight class sports
aesthetically judged sports
where low BW is an advantage
sports with high energy expenditure
In the REDs health conceptual model, what factor is a 2-way street with LEA and REDs?
mental health issues
Neurodivergent thinker or mental health issue - can lead them into LEA as well. They affect each other.
In the IOC consensus statement, what is the CAT2 3-step protocol?
1) (screening) population-specific questionnaires or clinical interview
2) REDs severity/risk assessment
3) REDs clinical diagnosis and treatment
Does everyone with an LEA have an eating disorder?
no
Are eating disorders and disordered eating a common cause of LEA in athletes?
yes
The DSM-5 recognizes what EDs?
- anorexia nervosa
- bulimia nervosa
- binge eating disorder
- OSFED: other specified feeding and eating disorders
- avoidant/restrictive food intake disorder
- other
Is amenorrhea a requirement for diagnosis of anorexia nervosa?
no, not anymore
What is the diagnostic criteria for anorexia nervosa?
restriction of energy intake relative to requirements, causing low BW
intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain
disturbed by body’s weight or shape, self-worth influenced by bodyweight or shape, or persistent lack of recognition of seriousness of low bodyweight
Is taste fatigue a diagnosable thing?
no, but could lead to anorexia where athlete is refusing that product even though it would benefit their performance
What is the diagnostic criteria for bulimia nervosa?
recurrent episodes of binge eating, as characterized by both:
1) eating, within a 2-hr period, an amount of food that is definitively larger than what most individuals would eat in a similar period of time under similar circumstances
2) a feeling that one cannot stop eating or control what or how much one is eating
recurrent inappropriate compensatory behaviours in order to prevent weight gain such as self-induced vomiting, misuse of laxative, diuretics, or other medications; fasting or excessive exercise
binge eating and inappropriate compensatory behav. occurring at least once per week for 3 months
self-eval is unjustifiably influenced by body shape and weight
disturbance not exclusively during episodes of anorexia nervosa
Bulimia nervosa is seen in what % of general population?
~2-3%
What are some additional negative physiological effects of bulimia nervosa?
tooth decay, tears in esophagus, aspiration pneumonia, electrolyte imbalances, heart failure
What are the NCAA warning signs for AN?
dramatic weight loss;
preoccupation with food, calories, weight;
wearing baggy or layered clothing;
relentless, excessive exercise;
mood swings;
avoiding food-related social activities
What are the NCAA warning signs for BN?
noticeable weight loss or gain;
excessive concern about weight;
bathroom visits after meals;
depressive moods;
strict dieting followed by eating binges;
increasing criticism of one’s body
What is binge eating disorder?
eat an unusually large amount of food and feel out of control during binge
eat more quickly than usual, until uncomfortably full, when not hungry, alone due to embarrassment, disgusted, depressed, or guilty after eating
How is binge eating different from bulimia nervosa?
not followed by compensatory period
What is OSFED?
give example
does not meting criteria for AN and BN
exhibit some but not all of the characteristics associated with clinical eating disorders
ex. all of criteria for AN are met except despite significant weight loss, current weight is in the normal range
Night eating syndrome is an example of what type of eating disorder?
OSFED
What is anorexia athletica?
type of disordered eating that impacts athletes
take in a limited number of calories despite a high level of physical activity
become overly concerned with weight, exhibit some of diagnostic criteria associated with AN & BN
What are the 5 criteria for anorexia athletica?
excessive fear of becoming obese
restriction of kcal intake
weight loss
no medical disorder to explain leanness/weight loss
GI complaints
What is avoidant/restrictive food intake disorder?
symptoms of this usually appear in childhood
- avoids foods with certain textures and colours, traumatic experience involving food - can result in fear of eating
Does not include experiences of body dissatisfaction in the way body weight or shape are perceived
but can develop into AN or BN later in adulthood
What is orthorexia nervosa?
unhealthful fixation about eating ‘healthful foods’
may lead to elimination of entire food groups, later eliminating another group of food, and another - in quest for a “perfect” and “clean eating” diet
can lead to malnourishment
quality instead of quantity of food is severely restricted
Is orthorexia nervosa recognized in the APA diagnostics manual?
no, not yet anyways
What is the 4-level tiering system of performance indicators?
traffic light system: green, yellow, orange, red
want athletes to ideally be in green zone
ideally thresholds are provided when possible
What is the treatment plan for someone with REDs?
depends on severity and risk
requires an interdisciplinary team: medical, mental health, sport dietician support
increase energy availability via increased intake or decreased output
- increase current EI by 300-600 kcal/day and focus on energy intake timing around training sessions
What is the critical foundation of the training diet?
energy intake!
What about supplementation in treatment?
may be indicated with medical support
maybe for calcium, B12, iron is indicated, vitamin D
assessment piece needed
What are outcomes measures for treatment from REDs?
reversal of recent weight loss
return to normal bodyweight with normal menses
weight gain to achieve a BMI>18.5 or >90% predicted bodyweight
energy intake at 2000kcal per day+ for training demands
At what point is return to play after REDs?
back at green ideally
Explain how prevention is key, who should look out for indicators, and for what?
coaches and other support staff
What are prevention strategies from NCAA coach handbook?
de-emphasize weight
recognize individual differences in athletes
coach supported education - awareness is first step in any behaviour
involvement by sport governing bodies
