What is this condition, what are its risks and why should runners know about it?
GUWAHATI: Running, especially marathon running is one of the fastest growing sports in the world. For the first time in history, in the Summer Olympics 2024, Mass Participation Marathon, amateur athletes will be able to run the Olympic marathon route at night, enabling as many people as possible to follow in the footsteps of elite athletes. With widespread acceptance, the cultural and market implications of the marathon’s surge in popularity are apparent in the growing number of runners and running clubs in countries like India. From Tata Mumbai Marathon, Pinkathon, Airtel Delhi Half Marathon, Goa River Marathon to Ladakh Marathon are some of the top marathon events organized in India every year.
Of all these events, Pinkathon is a special marathon that is held in nine different cities in India including Guwahati, specifically for women with the main objective to promote women’s fitness and general health and also to raise awareness about breast cancer. These sporting extravaganzas have been designed not only for the general population but also to attract top-tier athletes, both from within the country and around the world. In the recent times, since marathon running has become the most popular sporting event of Assam too, with the aid of the government and the civic authorities, besides Pinkathon, Guwahati also hosts other events like Guwahati Marathon and Guwahati Half Marathon year after year and it is quite heartwarming to see the growing support from people here with increasing numbers of runners each year.
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People run a marathon for a number of different reasons – a personal goal, to raise money for charity, lose weight or get in shape and it offers a number of benefits for the body, mind and soul too, improving overall health. By far the most notable benefits are improvements in cardiovascular fitness and muscular endurance. Completing a marathon itself brings a great sense of personal accomplishment. Distance running is an endurance sport and when an amateur athlete attempts the marathon, they push the body out of their comfort zone and going beyond their limits is often celebrated as a sign of grit and strength. However, while such drive may result in short term performance gains and new heights, when taken too far it may have far more negative long term consequences. As such, those present gains may lead to future losses. It may seem a paradox to talk about unhealthy endurance athletes when we can only see the amazing results, but it’s a lot more common than one might think.
RED-S, which stands for Relative Energy Deficiency in Sport, was coined by the International Olympic Committee back in 2014, is a syndrome that affects countless sports fanatics – many of whom don’t even know that it exists. It is described as a syndrome of poor health and declining athletic performance that happens when athletes do not get enough fuel through food to support the energy demands of their daily lives and training.
RED-S can and does affect athletes of any gender and ability level. Low energy availability is something many athletes experience after a particularly demanding practice or competition. With rest and hearty, nutritious meals, most athletes can replenish their energy stores and continue training in a healthy way. However, if an athlete continues to push themselves without refueling, the energy deficit grows more serious and, over time, takes a toll on their endurance, strength, health and well-being.
Sports that tie athletic success to a thin body like endurance athletes, such as marathoners and cyclists experience RED-S at high rates. While runners have personality characteristics such as self-motivation, rigid behavior and dedication to train regularly to achieve success, if nutrition is not taken into consideration, this can become problematic.
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RED-S manifests in a variety of physical and psychological symptoms, many of which often get overlooked, go under the radar until a dramatic collapse or injury occurs. It might start with a series of benign colds and general fatigue, which are common enough that they are unlikely to sound any alarm bells. In time, biological processes become depressed, especially reproductive hormones networks, metabolism drop off when there is not enough energy in the system, digestion slows, resulting in bloating, discomfort and IBS symptoms. The immune system also becomes impacted, which puts the individual at a higher risk of infections. A significant relationship has also been found between psychological factors such as depression, moodiness, anxiety and low energy availability.
The female athlete triad is a subset of RED-S. It describes three interrelated conditions: disordered eating, irregular menstruation/ amenorrhea and bone loss. While regular periods are a sign of good health, they can also be an inconvenience or worse for many female runners. The problem can be that their disappearance - however unhealthy - is often a welcome relief from monthly cramps, headaches and mood swings, all of which can impact training and racing. This acceptance of amenorrhea speaks to an uncomfortable truth about RED-S - that its early symptoms can perversely actually enhance performance – if only in the short-term. Excessive training and restrictive eating inevitably leads to lower body weight, which can result in faster times, more medals and more acclaim on social media and so, the profound unhealthiness of these behaviors is masked by their immediate benefits.
Regardless of the specific sport, a team’s culture can also contribute to RED-S. A culture of body shaming- insulting an athlete’s weight or the shape of their body- or winning at all costs can push athletes to over train and under-fuel, ignoring hunger and other signals from their bodies to the detriment of their health. With runners often being unable to identify the issue objectively, it’s therefore crucial that their support team develops an understanding of RED-S. Nevertheless, RED-S is preventable, but it requires a shift in sports culture and addressing the mismatch between energy intake and energy expenditure plays the pivotal role. A sports dietician, a doctor who understands the condition and the demands of the athlete’s sport, the coach and the athlete need to work together to return the athlete to optimal health, and subsequently optimal performance.
(The author is an MBBS, MD. All thoughts and views expressed are the author’s own.)