2023 IOC Consensus Statement on REDs: What’s new?

Written by: Nancy Clark, MS RD CSSD

In 2014, the International Olympic Committee published “Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport “. In 2018, the IOC published an update, and then again, in 2023. The updated 2023 Consensus statement provides the latest perspectives on REDs and low energy availability (LEA). (Note, the original acronym RED-S has changed to REDs; the hyphen has been removed so the acronym can be hash-tagged in social media!)

One focus of the 2023 statement is to heighten awareness of the syndrome among professionals and coaches, so they can take steps to reduce the risk of REDs and optimize athlete health, psychological well-being, and performance. Athletes themselves—who are often caught up in a sports culture that promotes leanness and limiting calorie intake— also need to be taught the symptoms associated with REDs. Despite popular belief, REDs is not a problem for women only. Males just don’t have the warning that women get (amenorrhea), so they don’t get the clue that something is wrong. Hence, they are not going to the doctor with a concern and getting diagnosed. REDs can also be seen among para-athletes.

Here are some of the key points from the 2023 consensus statement:

  • LEA exists on a spectrum from being an adaptation that occurs naturally at high levels of exercise to being problematic for health. Individuals vary in their responses to LEA. Long-term LEA is more of a concern than a short-term bout of dieting.
  • How the body conserves energy varies from person to person. For some, LEA is not a problem. Their body adjusts and adapts. Evolution shows us that humans have faced energy scarcity and have adapted to being able to handle it.
  • More research is needed to determine if there a difference between LEA caused by reducing energy intake or by increasing exercise expenditure. We also don’t know if when you eat your carbs and calories makes a metabolic difference—such as consuming a big dinner at the end of the day vs. evenly spreading out food during the day.
  • Low carbohydrate availability commonly comes along with low energy availability. Is lack of carbs the problem? Or lack of total energy intake? More research is needed. We do know that with low carbohydrate availability, inflammatory markers increase.
  • REDs is commonly intertwined with symptoms associated with overtraining. Overlap exists among athletes who train heavily and those with REDs. Are they two sides of the same coin?
  • Health-care professionals want to monitor over time the biomarkers associated with LEA, including body composition, bone mineral density, resting metabolic rate, disordered eating behavior, exercise addiction, VO2peak, and muscle strength.
  • Health care professionals also want to pay attention to an athlete’s mental health, which gets impacted by LEA.

The 2023 consensus statement also includes:
• A validated assessment tool (IOC REDs CAT2), that is available for free.
• Practical clinical guidelines to promote athlete health and well-being.
• Research guidelines to encourage consistent methodology.
• A new visual: two “wheels.” One wheel highlights the performance impacts of REDs, the other wheel highlights the health impacts. LEA is now positioned in the middle of the wheel (as opposed to the previous “flower” visual where RED-S was in the middle) and REDs is positioned on the rim of the wheel.
–The collection of symptoms expand into REDs as they become more severe.
–Sleep disturbance, growth impairment, and urinary incontinence are newly added symptoms.

Unfortunately, the current 2023 update is closed access. If you have no access to the article, you can glean the highlights from this podcast with Louise Burke. She discusses the IOC REDs updates in this Fueling Endurance podcast: Episode #70

Reference:
Mountjoy M, Ackerman K, Bailey D, Burke L, et al. 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med 57(17): 1073–1097.
The full paper can be accessed here (for a fee): https://bjsm.bmj.com/content/57/17/1073

Author

Nancy Clark MS RD CSSD counsels both fitness exercisers and competitive athletes in the Boston-area. Her best-selling Sports Nutrition Guidebook is a popular resource, as is her online workshop. Visit NancyClarkRD.com for info.