Relative Energy Deficiency in Sport (RED-S): What it is and How to Identify it
There may be something more behind your workout fatigue.
What is RED-S?
Relative Energy Deficiency in Sport (RED-S) is essentially a state of underfueling your body to meet the demands of your sport. This condition creates physiological changes within your body that alter its ability to function and perform. The three main components of RED-S are decreased energy availability (decreased energy stores to utilize for sport and daily life), hormonal disruption (including loss of menstrual cycle), and decreased bone mineral density (structure and strength of your bones).
These three components lead to many “downstream” effects that are often the first signs that you or your athlete may be experiencing RED-S. These signs include:
Decreased muscle strength
Decreased endurance
Increased injury risk
Decreased training response
Impaired judgment
Decreased coordination
Decreased concentration
Irritability
Depression
Decreased glycogen stores
These signs may present in a variety of ways. Maybe you are struggling to focus at work or in school. You may have noticed mood changes in recent weeks. Workouts may feel extra hard and especially frustrating because you are not performing to the level you want to be.
Who can be affected by RED-S?
RED-S can be very common for very lean women or in weight class or aesthetic sports. Though that is not always the case. RED-S can occur in males and females of any age and participating in any sport.
It is especially important to recognize this condition in youth and adult female athletes, particularly those taking oral contraceptives. The mechanism of birth control utilizes hormones that can mask the symptoms of RED-S, making it harder to recognize the warning signs and diagnose early on.
This condition is crucial to identify early, as it can have significant effects on almost all body systems. It can especially cause a decline in bone mineral density, even after a short period of time. Changes in bone mineral density can place athletes at a greater risk of developing bone stress injuries (BSI) or other injuries. In adolescents, their bones are still developing, so a decrease in bone building now due to underfueling may be detrimental to potential bone health later in life.
What next?
If you feel that you or an athlete you know may be experiencing these symptoms, it is important to connect with a healthcare professional to determine a plan of action. This could include your primary care physician, pediatrician, dietician, or counselor.
RED-S can be associated with disordered eating, which may be the cause of underfueling. If you or your athlete show signs of disordered eating, it is important to meet with a sports dietician and counselor to help the underlying root of those behaviors.
In the meantime, it may be beneficial to reduce exercise intensity while increasing caloric intake with hearty, nutritious foods. Focus on improving your body’s recovery with sleep, nutrition, and hydration. This includes those sleep hygiene tips we talked about last month and prioritizing whole and nutritious foods.