Nutrition for athletes

Disordered eating is characterized by attitudes about weight, food, and body size and shape that cause a person to follow strict eating and exercise habits. These behaviors are used to achieve or maintain a low body weight and can impair mental and physical health.

If you are concerned about signs of disordered eating in your or someone you know, speak to a medical professional.

Eating disorders are clinically diagnosed psychological conditions involving disordered eating behaviors that can be classified into the following categories:

Anorexia

Low body weight, intense fear of weight gain, body dysmorphia, and loss of menstrual cycle

Bulimia

Recurrent episodes of binge eating, followed by purging (vomiting, fasting, laxative abuse)

Binge eating disorder

Recurrent episodes of compulsive overeating without purging

Orthorexia

Pre-occupation with healthy food and refusal to consume foods deemed as unhealthy

All eating disorders may be accompanied by depression, anxiety, shame, guilt, and other psychological symptoms.

Athletes may set out to improve performance by losing weight or changing their body composition. Athletes are also more likely to have perfectionistic tendencies that support development of disordered eating behaviors. Athletes have higher energy needs to support training and growth, so they require more food than their non-athlete peers.

• Preoccupation with weight, food, and dieting
• Denying feelings of hunger
• Refusing to eat certain foods or food groups
• Making consistent excuses to avoid mealtimes or situations involving food
• Cooking meals for others without eating
• A strong need for control
• Maintaining a rigid exercise routine regardless of weather, fatigue, or illness
• Showing inflexible thinking
• Withdrawing from friends and activities and becoming more isolated, withdrawn, and secretive
• Expressing concerns about eating in public
• Dressing in layers to hide weight loss or to stay warm

• Bloating and constipation
• Difficulty falling or staying asleep
• Muscle weakness
• Impaired immune function
• Weight loss
• Thinning, dry, or brittle hair
• Dry or brittle nails
• Dry or yellow skin
• Dental problems, such as enamel erosion, cavities, and tooth sensitivity
• Dizziness and lightheadedness
• Lack of focus or difficulty concentrating

RED-S occurs when athletes expend more energy than they consume. Energy is obtained from food and expended to power the brain, heart, lungs, muscles, and other organs. Energy availability is the amount of energy left over after exercise. This energy is required for essential functions like growth and development.

Some athletes with RED-S may experience female athlete triad symptoms, which include disordered eating, amenorrhea (loss of menstrual cycle), and low bone mineral density. Not all athletes experience all symptoms.

RED-S is caused by underfueling, or eating fewer calories than the body requires. This may be intentional or unintentional. Intentional underfueling may include skipping meals, limiting portions, and restricting foods or food groups. It may be related to body image concerns or weight pressures in sport.

It occurs with the goal of controlling body weight or composition. Unintentional underfueling may include increasing training volume without increasing food intake, skipping meals due to scheduling, or undereating due to limited food access. It occurs without the goal of controlling body weight or composition.

• Impaired growth and development
• Impaired immune health
• Impaired bone health (reduced bone density and increased risk of stress fractures)
• Impaired digestive health (bloating, constipation)
• Impaired heart health (low heart rate and blood pressure)
• Impaired hormonal health
• Depression, mood changes, and body dysmorphia

• Decreased muscular strength
• Decreased endurance performance
• Decreased training response
• Reduced focus, concentration, and coordination
• Fatigue and lethargy
• Increased risk of injury and illness

The most common risk factors for RED-S include:

• Athletes in sports placing an emphasis on weight
• Athletes experiencing weight-related pressure from coaches or support staff
• Athletes following vegan or vegetarian diets
• Athletes with medical conditions that restrict foods or food groups
• Teenage athletes going through puberty or periods of growth
• Athletes with disordered eating behaviors
• Athletes with limited access to food

Treatment strategies for RED-S are dependent on the cause.

Athletes who are unintentionally underfueling can benefit from nutrition education (increased portion sizes, increased meal frequency, changes in food choices) and changes in training (reduced training load and increased recovery time).

Athletes who are intentionally underfueling should work with a multidisciplinary team of medical, nutritional, and mental health support. These athletes may need to suspend training until RED-S symptoms have improved.

Fueling:

• Work with your sports RD to determine how much energy your body needs to support training.
• Create a fueling plan with at least three meals and three snacks per day.
• Consume adequate portion sizes; athletes will need to eat more than their non-athlete peers.
• Incorporate nutrient-dense, high-calorie foods, especially during periods of intense training.
• Incorporate a balance of carbohydrates, protein, fat, fruits, and vegetables.
• Avoid restricting foods or food groups without guidance from your sports RDN.

Training:

• Incorporate rest days into your training plan.
• Avoid training through illness or injury.
• Discontinue training and consult your health care professional if you experience weight loss, missing or irregular periods, frequent illness or injury, or excessive fatigue.

Parents and coaches who notice the following signs and symptoms should refer their athletes to a sports medicine team for evaluation. RED-S can occur in any athlete. Signs and symptoms should be taken seriously, regardless of age, gender, sport, or body size.

• Preoccupation with food or body image
• Skipping meals or limiting portion sizes
• Weight loss
• Engaging in additional training outside of practice
• Changes in mood or personality
• Cold hands and feet
• Dry skin, nails, and hair
• Repetitive injuries or illness