RED-S & Fertility
As a Dietitian specialising in the area of sports and fertility, I thought it be advantageous to showcase the relationship between RED-S (relative energy deficiency in sport) and its affect on reproduction and bone health in women. Several research papers indicate the risk of infertility is highest among those at the lowest and highest end of the BMI distribution, representing a “J”-shaped relationship between a low and high BMI & fertility. Women with a BMI <20kg/m2 and >30kg/m2 were at a higher risk of ovulatory disorder infertility than women between 20-25kg/m2 BMI range.
Research indicates energy availability below 30Kcal/kg FFM/day can increase a woman’s chance of experiencing abnormal menstrual cycles by 50%
What is RED-S and how does it affect an individual’s reproductive hormones?
RED-S refers to a condition that can result in low energy availability, low bone mineral density, and a negative shift in reproductive hormones resulting in reduced bone turnover, amenorrhea and or anovulation in women and for men, complications can be seen with reduced testosterone, iron regulation, bone turnover too.
When an individual enters a ‘low energy available state’, this means we are not meeting adequate caloric intake to match sufficient energy used up each day for physiological processes PLUS training/exercise demands, thus resulting in crucial hormonal shifts.
Women Hormonal Shifts - luteinising hormone, follicle stimulating hormone and estradiol (a form of estrogen) become low due to a BMI <20kg/m2 and thus result in menstrual dysfunctions, particularly anovulation (lack of ovulation) which accounts for 30% of infertility cases.
Research indicates energy availability below 30Kcal/kg FFM/day can increase a woman’s chance of experiencing abnormal menstrual cycles by 50%. However, several other factors also contribute to a woman’s shift in fertility hormones and thus should be considered as a whole picture rather than just diet alone
RED-S can affect a variety of exercising women (and men) of any age, including competitive and non-competitive individuals, plus recreationally active women (& men) who just aren’t eating enough to fuel their everyday requirements, even if they think they might be.
Sadly, it’s common for individuals to go undiagnosed with RED-S until they start their fertility journey. It’s important for women to address any health concerns prior to conceiving including dietary and physical activity modifications as best they can and with the support of a medical and allied health team working in the area.
How can I support you as an Accredited Sports Dietitian, specialising in the world of fertility?
Women or men who are struggling to lose weight
Women who are very active (recreation or competitive athletes) and sitting at a low BMI or fat percentage range and want to optimise their diet without jeopardising performance
Women who have come off the pill and not sure where to start regarding menstruation regularity
After looking at an individual’s diet, I can help to personalise supplemental choices in conjunction with your GP
Interesting Fact: Resumption of ovulation in women may take up to one year or longer, even after restoration of appropriate energy availability. Thus, it is crucial to intervene as early as possible, even if you think you might be eating a well-balanced diet that matches your energy requirements.
Regardless of whether you’re trying to conceive or not, remember foundations start early. The figure on the right depicts the affects RED-S can have on metabolic rate, menstrual function, bone health, immunity, protein and iron synthesis and cardiovascular health. If you’re concerned about any of these areas, please contact an Accredited Dietitian.
P.s. You don’t have to be trying to conceive to reach out to me, like I mentioned, early intervention is best!
PPs. Stay tuned, in the middle of our (Australian) Winter I am going to be releasing fertility and maternal packages that include one on one and or couple dietary support.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901401/#!po=0.602410
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374026/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079277
https://www.researchgate.net/publication/342253117_Relative_energy_deficiency_in_sports_RED-S_elucidation_of_endocrine_changes_affecting_the_health_of_males_and_females
