Module 3 RED-S

Question 1

When was the female athlete triad originally described?

Answer 1

1992

Question 2

What was the original discovery of the female athlete triad compared to now?

Answer 2

First recognized as three separate but related conditions BUT now recognized by the American College of Sports Medicine (ACSM) as a spectrum of related symptoms and conditions that can impact female athletes.

Question 3

ACSM

Answer 3

American College of Sports Medicine

Question 4

What are the three interrelated conditions of the female athlete triad?

Answer 4

1. Relative Energy Deficit( with or without Disordered Eating)
2. Menstrual Disturbances/Amenorrhea
3. Bone Loss/Osteoporosis

Question 5

What is the trigger for the female athlete triad?

Answer 5

A relative deficit in energy intake

Question 6

a syndrome of poor health and declining athletic performance that happens when athletes do not get enough fuel through food to support the energy demands of their daily lives and training.

Answer 6

relative energy deficit

Question 7

describes an approach where energy needs factor consider variations in FFM.

Answer 7

relative energy

Question 8

What is relative energy “relative” to?

Answer 8

The estimate is relative to the athlete’s body composition and FFM levels.

Question 9

What are the constituents of FFM

Answer 9

• skeletal muscle mass
• body cell mass
• total body water
• bone mineral mass.

Question 10

How does FFM differ with athletes?

Answer 10

Athletes, by virtue of their training pattern, can have levels of FFM that are proportionally higher than their less active counterparts, even at the same body weight.
* More FFM = more metabolically active tissue = higher BMR= higher basal energy requirements.

Question 11

Spectrum of the female athlete triad

Answer 11

Question 12

Absence of menstruation by age 16 in a girl with secondary sex
characteristics

Answer 12

Primary amenorrhea

Question 13

Absence of 3 or more consecutive menstrual cycles in a female who has begun menstruating

Answer 13

secondary amenorrhea

Question 14

What is amenorrhea associated with the Female Athlete Triad is driven by?

Answer 14

low energy availability and negative changes to hypothalamic function.

Question 15

Hypothalamic dysfunction with the female athlete triad

Answer 15

Low energy availability disrupts the hypothalamic-pituitary- ovarian axis
1. Decrease in Gonadotropin-releasing hormone (GnRH), disrupts pituitary secretion of Lutenizing Hormone (LH) and Follicle Stimulating Hormone (FSH)
2. Disruption of LH and FSH shuts down stimulation to the ovary, ceasing production of estradiol
3. Low estradiol level create a hormonal environment that mimics that seen in menopause

Question 16

How does the female athlete triad mimic menopause?

Answer 16

• Amenorrhea
• Loss of bone mass/osteoporosis

Question 17

Bone health and menstruation

Answer 17

Female athletes have higher BMD than nonathletic counterparts UNLESS they have menstrual dysfunction
* Risk of stress fractures is two to four fold higher in amennorrheic athletes
* Bone density declines in proportion to the number of menstrual cycles missed
* Low bone mineral density may be irreversible resulting in a lifetime lower bone density

Question 18

Chronic condition characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced skeletal fragility and increased risk of fracture

Answer 18

osteoporosis

Question 19

Principal cause of premenopausal osteoporosis in active women

Answer 19

• decreased ovarian hormone production
• hypoestrogenemia

Question 20

Consequence of premenopausal osteoporosis

Answer 20

Athletes may be at risk for fractures during their competitive years and premature osteoporotic fractures in the future

Question 21

What occurs with osteoporosis?

Answer 21

• causes weak bones
• bones lose minerals (calcium).
• bones become fragile and break easily

Question 22

RED-S

Answer 22

Relative Energy Deficiency in Sport

Question 23

What does RED-S refer to?

Answer 23

impaired physiological functioning caused by relative energy
(calorie) deficiency.

Question 24

What is RED-S relative to?

Answer 24

relative to the athlete’s fat-free mass (metabolically active mass)

Question 25

physiological effects of RED-S

Answer 25

include impairments to: * Metabolic rate * Menstrual function * Bone health * Immunity * Protein synthesis * Heart health

Question 26

Health consequences of RED-S

Answer 26

Question 27

Potential performance effects of RED-S

Answer 27

Question 28

What causes RED-S?

Answer 28

occurs when an athlete suffers from “low energy availability” * Insufficient energy intake to support the energy expenditure required for health, basic physiological function, and daily living, **once the cost of exercise and sporting activities is taken into account**. * Can occur with or without a diagnosed eating disorder being present.

Question 29

low energy availability in RED-S

Answer 29

Inadequate caloric intake: * Pathologic caloric restriction * Expending more calories than are taken in

Question 30

Calculation for energy availability

Answer 30

Question 31

normal and deficit values for energy availability

Answer 31

* normal > 45 kcal/kg * negative effects at ≤ 30 kcal/kg

Question 32

BMI suggesting low energy availability

Answer 32

<17.5 BMI * adolescents <85% estimated body weight

Question 33

RED-S in Male Athletes

Answer 33

Males can also suffer from lower energy availability but are at lower risk for disordered eating * male cyclists had severely reduced EA of 8 kcal/kg/FFM/day * high prevalence of underweight international level ski jumpers. * jockeys

Question 34

Consequence of low EA in male athletes

Answer 34

associated with low bone mineral density and stress factures in male athletes.

Question 35

Screening for RED-S

Answer 35

the RED-S Risk Assessment Model can be used as part of an athlete’s regular health checks or when an athlete presents with symptoms of: * Disordered eating/eating disorders * Significant weight loss * Lack of normal growth and development (youth) * Endocrine dysfunction * Recurrent injuries and illnesses * Decreased performance / performance variability * Mood changes.

Question 36

Treatment of low EA

Answer 36

The treatment of low EA should involve an increase in EI, reduction in exercise or a combination of both. * A reasonable starting treatment approach to address low EA is to implement an eating plan that increases current EI by ∼300–600 kcal/day and address issues such as meal timing and food choices * Should be paired with reductions in training volume and intensity.

Question 37

Treatment for menstrual irregularities

Answer 37

Weight gain is the strongest predictor of recovery of normal menstrual cycles. * An eating plan that promotes adequate protein and carbohydrate intake is recommended to restore liver glycogen and, in turn, facilitate normalization of hypothalamic function.

Question 38

female treatment for bone demineralization

Answer 38

* Weight gain with or without the subsequent resumption of menses restores the coupling of bone formation and resorption and improves BMD. * However, full recovery may not be feasible, as bone microarchitecture can be permanently damaged.

Question 39

treatment for bone demineralization (men and women)

Answer 39

The athlete’s diet should include 1500 mg/day of calcium from dietary sources with supplementation if required PLUS 1500– 2000 IU/day of vitamin D.