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Nutrition advice for runners dealing with RED-S

Best practices for runners with low bone density and low energy

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The British Medical Journal has released a consensus statement regarding treatment strategies for RED-S and low energy availability. RED-S, or relative energy deficiency in sport, is a product of under fuelling and sustained (unhealthy) weight loss. The paper outlines the specific nutrition interventions that can help athletes dealing with RED-S get back on track. Below are the recommendations from some of the best doctors in the field on how athletes can get themselves healthy and performing at their best.

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If you have low energy availability

Low energy availability (LEA) means that your energy input (food) and energy output (exercise) don’t match up–your exercise is outweighing your food intake. This can result in weight loss, which then leads to the other symptoms of RED-S like menstrual dysfunction and loss of bone mineral density. If you’re noticing weight loss, here are a few ways you can reverse the trend.

The BMJ recommends LEA runners increase their caloric intake by between 300 and 600 calories a day, depending on how much of an energy discrepancy they’re dealing with. They recommend doing this through a liquid meal product, also known as a smoothie, or through supplements like a NSF certified protein powder (the NSF certification ensures it doesn’t contain any banned substances). This can simply be done by adding more peanut butter to your post-workout snack or going for seconds at dinner.

Another recommendation is to implement a weekly off day if you’re not already taking one. By taking one day to rest, your body will be ready to go the following day and you allow yourself to catch up on a caloric deficit from a week of hard work.

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If you have menstrual dysfunction

Menstrual dysfunction can be a result of so many things, but one of them is from low energy and weight loss. When your body isn’t getting the energy it needs, it shuts down processes it deems to be unnecessary. One of those processes is menstrual function.

Authors recommend a focus on carbohydrate and protein intake as a way to return to normal menstrual function. However, they do acknowledge that returning to normal can take time depending on the severity of the case, so be patient while waiting for your period to return.

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If you’re looking to optimize bone health

One of the common misconceptions about bone density is that it’s weakened by high-impact sports such as running. In fact, the opposite is true. When runners are getting adequate nutrition and coupling that with resistance training, their bone density should be optimal. Optimized bone health also significantly reduces a runner’s likelihood of developing a stress fracture.

However, where runners get into trouble is when their activity isn’t fuelled properly. If runners need to improve their bone density, on top of getting enough calories in through the day, they should also be supplementing. The key minerals for bone density include: 1,500 mg of calcium along with 1,500 to 2,000 IU of vitamin D a day. If runners are living in a cold, northern location (talking to you, Canadians) then vitamin D supplementation is strongly encouraged. If you’re lucky enough to live in a warm climate, then you’re likely getting enough vitamin D from your food coupled with sun exposure.

In terms of calcium intake, there are 305 mg of calcium in one cup of one per cent milk. This doesn’t mean that you need to drink five cups of milk a day, but adding just one (providing you tolerate lactose) to your daily diet can get you a fifth of the way to your recommended daily dose. Other foods that are high in calcium, that aren’t dairy products are: oat milk, almonds and salmon.

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