Nutrition Information

RED-S: Relative Energy Deficiency in Sport

RED-S is a condition that affects many young athletes. There are many ways to help boost kids' energy but the usual suspect is iron deficiency (usually as anemia). Below are some guidelines to help kids be successful by fueling recommendations, sleep recommendations, and blood testing. As with everything, trust your family doctor and ask them questions. These are recommendations and NOT medical advice. Click the two buttons below to learn more about diet and sleep recommendations after reading about what Anemia is and what you can do to directly fight it.

Diet Recommendations

Sleep As Training

Defining Anemia

Ferritin, iron, anemia, hemoglobin – what is all this stuff?

Ferritin is a storage protein for iron, and iron is a critical mineral for oxygen transport in the body. Without enough iron, your body cannot produce sufficient hemoglobin, which is the protein chain in your red blood cells that delivers oxygen in the body. If your body’s iron stores are low, the body’s hemoglobin levels drop, which means red blood cells deliver less oxygen to the body – and that’s a big problem for athletes!

Physiologists estimate that a one-point drop in hemoglobin (for example, a drop from 13.5g/100g of blood to 12.5g/100g of blood) equates to roughly 7% drop in performance

What 7% looks like in track and field:

400m: about 4 seconds slower

800m: about 8-10 seconds slower

1600m: about 20 seconds slower

3200m: about 30 seconds slower

Bottom line: If your hemoglobin levels are low, your performance suffers. New research shows that ferritin also is a great indicator on performance as well. A ferritin reading of 30ng/mL of blood is about as low as endurance athletes should have before performance begins to suffer.

Why are athletes – particularly female athletes – so susceptible to iron deficiencies and anemia?

1. Modern diets are typically low in iron

2. Iron is a difficult mineral for the body to absorb

3. Female athletes lose blood regularly through menstruation

4. Endurance training produces more hepcidin, a hormone that has a negative effect on iron

Why is testing – especially regular testing – useful?

· Tests can identify athletes that are already anemic as well as athletes that are susceptible to becoming anemic

· Testing data is much more useful as a referential than an absolute. Multiple tests over time give a baseline to individuals (especially useful when the athlete feels good so you know what “normal” is for them)

o Example: Ferritin varies wildy for “normal” levels in people 40ng/mL to 100 ng/mL. Less useful to know the number and more useful to know where the number is trending (up or down over time)

Doctors and Testing: Important Points

· Some doctors will resist testing without symptoms – ask for the test anyway

· The readings considered “normal” for a regular sedentary person are not the same as appropriate ranges for an endurance athlete

o Hemoglobin is “normal” at 12g/100g but if a runner is below 13.5g/100g their performance will be impacted

o Ferritin is “normal” above 10ng/mL but athletes will begin to have trouble below 30ng/mL

Ordering Tests Online is an option

1. Go to TrueHealthLabs.com

2. Search for “anemia panel” in the testing options

3. Double check that the test you’ve chosen is the correct test. The anemia panel should cover a CBC (complete blood count), in addition to iron levels, ferritin levels, and a metric called “total binding capacity” (FSA and HSA are usually allowed to be used to pay for these tests, always check with insurance provider)

4. Click the “draw locations for this test” to select a testing area that is convenient. You can search by zip code. Quest Diagnostic – Lincoln is local and they do the draws near LSB

5. Check out – but during the checkout step, be sure to note that the test is not for you but for your child

What do the tests get me?

1. Complete blood count (CBC) – this test should assess critical hemoglobin and hematocrit markers, as well as other useful markers like RBC and Vitamin D (Vit D has relationship with bone health)

2. Serum ferritin – This test can be used a predictor of the athlete’s susceptibility to becoming anemic in the future, most useful as a referential test (as described above, where does this number head over time? Is it stable, lowering, or going up?)

3. Vitamin D – usually optional but useful if you are already getting blood work done. Vitamin D affects bone health, immune system function, and more

When do I get tested?

Ideally, each athlete would get tested 2-4 times a year. Winter and summer breaks between seasons are great. The best time to get tested is when the athlete is feeling great and running well. If you wait until they are struggling it is too late to intervene to keep that from happening. Testing during lighter training periods is better than heavy work load.

To be completely bulletproof, the recommendation is:

· June – Post track season before summer workouts begin during rest period

· August/September – beginning of fall sports when things start to pick up

· November – Post fall season and before winter sports really pick up

· March – Beginning/Middle of track season once work as started a bit

What do I do when my levels are low?

First, always consult a doctor. However, as described above they need to be told that your child is an athlete who needs slightly higher levels than a sedentary person.

· Usually, the solution is supplements either a pill or liquid iron. Consult with a doctor before taking iron supplements

· Usually taken 1-3 times per day – something to ask your doctor about: new research indicates that taking a supplement 2x a day then taking a day off facilitates better absorption of iron than consistently. NOTE: THIS IS NOT MEDICAL ADVICE, ASK YOUR DOCTOR IF THIS IS CORRECT FOR YOU

Diet is another way to combat low iron levels

Eat iron rich foods – which you should anyway, as outlined in fueling below – and eating foods that facilitate absorption of iron

· List of foods: https://www.webmd.com/diet/iron-rich-foods#2

· Iron sources from foods are usually more easily absorbed and in less concentration. That’s why supplements + diet is usually the answer

· Supplement dosage and frequency depends on what your body responds to and what your doctor recommends