RED-S: Accidental Under Fueling and the Male Cyclist

Dr. Keay said their findings reinforce the importance of a detailed history. “Questionnaire alone can lead to athletes giving ‘correct’ answers on nutrition and training load. Clinical interview gave details on the temporal aspects of EA in the context of cycle training schedule: whether riders were experiencing acute intermittent LEA, as with multiple weekly fasted rides, or chronic sustained LEA with prolonged periods of suppressed body weight. Additionally the SEAQ-I provided insights on attitudes to training and nutrition practices,” she wrote in a blog for the British Journal of Sports Medicine.

She warned against the used of periodized carbohydrate intake for low intensity sessions in athletes with chronic LEA, saying “increasing training load improves performance, but this training is only effective if fueling is tailored accordingly.”

Another study, “Alternate-Day Low Energy Availability During Spring Classics in Professional Cyclists”, published in the Human Kinetics Journal also found that weight loss isn’t always the best indicator of RED-S. In an analysis of cyclists on the Mitchelton-Scott men’s team, the researchers found that while the men stayed consistent in weight, those with reduced caloric intake experienced hormonal change.

Tips for Sports Medicine Doctors

So how should sports medicine doctors handle diagnostic challenges of RED-S when trying to protect the health of their athletes? Bentall suggests three learning points for clinicians dealing with RED-S:

• Coaches, physiotherapists and medical professionals all need to be aware of this risk in amateur cyclists, both women and men.
• When training seriously, cyclists may be under fueling without realizing it.
• There needs to be more education for cyclists about RED-S and the importance of matching nutrition to training levels.

He wrote, “I appreciate that many people may benefit greatly from losing weight, but there is not enough information available warning the lightweight middle-aged men in lycra to take care.”

Sports medicine experts agree that when an athlete presents with a bone stress injury, under fueling should be considered as a possible underlying cause of poor bone health.

Dr. Keay, when asked how she would advise sports medicine doctors, said, “Ask questions relating to morning erections, nutritional practices etc. As RED-S is a diagnosis of exclusion run some baseline tests and consider DXA as indicated. Addressing behavioural change is key.”