GUESTS: Dr. Kate Ackerman, Boston Children's Hospital, US, and Soren Meeuwisse, CAN
On Thursday, September 16, 2021, we hosted two powerful women who are committed RED-S advocates. RED-S stands for ‘Relative Energy Deficiency in Sport‘ and is a common condition in female (and male) athletes that can substantially affect your wellbeing, health, and performance. In their discussion between athlete and expert, Dr. Kate Ackerman and Soren Meeuwisse laid out the practical facts of RED-S and busted some myths.
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Watch Our Discussion: Don't Starve Your Potential
RED-S is increasingly recognised as a threat to athletes’ wellbeing, health, and performance. It has emerged as a far more complex condition from what was originally called the “female athlete triad,” and consisted of low energy availability with or without an eating disorder, amenorrhea (= absence of menstruation or missing of your period), and osteoporosis. While our knowledge of this condition continues to grow, many athletes and entourage are not aware of it.
This webinar was a rich dialogue between two experts in their own right: Dr. Kate Ackerman, Director of the Female Athlete Health Programme at Boston Children’s Hospital, US, is a world-renowned RED-S expert who treats female athletes at all levels of performance, and Soren Meeuwisse, whose career as a national-level cross-country mountain biker was ended by RED-S. Since then, Soren is on a mission to prevent others from having to go through what she had to. She asked all the right questions from an athlete’s perspective.
Be sure you meet our energy needs as an athlete
Your energy needs are determined by what your body requires to function normally and what you spend on your training and competition. This might be very individual and vary with your training schedule. Remember, it is not normal for an elite athlete to stop menstruating. This is a warning sign that you should take very seriously.
RED-S is common
- Female athletes are at higher risk than male athletes.
- Leanness sports are at high risk. In different cycling disciplines, a high power-to-weight ratio conveys a performance benefit, resulting in a culture of restricted eating.
- The frequency of RED-S in studies varies widely because they are based on self-reports, and athletes’ responses depend on what is asked, how it is asked, and who asks.
All body systems are affected by RED-S
- endocrine system
- growth and development
The more the merrier
Treatment of RED-S is always a team approach involving the athlete, coaches, trainers, physios, doctors, dieticians, psychologists, family, … Every clinician needs to build their own network of specialists. As an athlete, you need your team, your friends, and your family to root for you throughout the entire journey.
Questions and Answers
Do you have low bone density or stress fractures to have RED-S?
If my performance improves, how can I have RED-S?
In some sports, your performance might actually improve initially, particularly in some sports where low weight is an advantage. This supports a denial of the condition by the athlete. However, it is critical to understand that at some point, your performance will deteriorate. Dr. Ackerman calls that “falling off the cliff.”
In endurance sports, a low heart rate may indicate that you are well trained. How can athletes or physicians distinguish this from a low rate caused by RED-S?
Heart rate averages and thresholds are age-dependant. An adolescent’s heart rate should never be < 50/min. In adult endurance athletes, one should check for changes in heart rate rather than the actual value at rest.
Can I use the pill to treat my RED-S?
Birth control pills are not a treatment for RED-S. While your menstrual status is probably one of the best markers of your long-term energy availability, the use of oral contraceptives may mask the condition. They have also not been shown to improve bone density.
What is the role of psychotherapy in RED-S treatment?
It is critical that we continue to dismantle the stigma around therapy and psychological support in sport (and society). There can be various mental health issues underlying or aggravating RED-S and addressing them will help you become a better version of yourself and heal truly. Typical character traits and conditions related to RED-S are perfectionism, trauma, and depression. There is no specific type or kind of therapy that fits all, but you should try different approaches and find out what suits you and the problem you are trying to solve best.
About Doctor Kate Ackerman
Dr. Kathryn Ackerman is an internist, sports medicine doctor, and endocrinologist. She represented the US as a lightweight rower and is the current team physician for US Rowing. She is an assistant professor at Harvard Medical School and the founder and director of the Female Athlete Program at Boston Children’s Hospital, where she treats female athletes of all ages. The Program recently became part of the Wu Tsai Human Performance Alliance. She is also the director of the biennial Female Athlete Conference, which brings together researchers, coaches, medical professionals, and athletes to improve the knowledge about optimizing female athlete health and performance. Dr. Ackerman loves helping female athletes reach their full potential.
About Soren Meeuwisse
Soren Meeuwisse competed on the Cross-Country Mountain Bike Canadian National Team from ages 17-21 when she studied at McMaster University. While completing her Bachelor of Science in Kinesiology degree, she also competed in varsity sports for cross country running and Nordic skiing. She transitioned from sport to academics and became a coach, mentor, tutor, clinical research trial assistant, physiotherapist assistant volunteer, and RED-S advocate.