The new lowdown on REDs - and why every athlete needs to know the warning signs.
REDs is the term that describes impaired physiological functioning caused by relative energy deficiency. It can result in widespread effects including impaired bone health, absent or irregular periods, low immunity, mental health issues - and ultimately on your athletic performance.
It can affect both female and male athletes and is the term that replaced and expanded upon the outdated ‘female athlete triad’ which connected low energy availability (LEA) with menstrual cycle disturbance and poor bone health in female athletes.
What causes REDs?
Put simply, REDs occurs when athletes don’t eat enough to fuel themselves. Ultimately, there is a deficit between energy intake (from diet) and energy expenditure (from maintaining health, daily living, growth, and physical activity) leading to LEA (Mountjoy et al, 2014). A state of LEA can occur from an increase in exercise load with insufficient fueling, or a combination of both under-fueling and over training. This mismatch can result from intentionally undereating or also inadvertent undereating.
What are the signs and symptoms of REDs?
Lack of available energy causes important body systems to reduce energy expenditure, causing the potential disruption in hormonal and metabolic functions. Symptoms can be widespread as demonstrated below in the IOC (2023) Consensus Statement on RED-s graphics. They can include a decreased training response and performance, irregular or absent periods, joint pain (possible stress fractures), low immunity, gut distress, hunger, low mood, low libido.
Image credit: Mountjoy et al (2023) IOC consensus statement on Relative Energy Deficiency in Sport (REDs)
What to do if you think you or an athlete you coach may be exhibiting symptoms of REDs
It is very important that if symptoms are being identified that a clinical assessment by a doctor specialising or with expertise in REDs is arranged to get correct diagnosis and move forward with the best individualised treatment plan (Mountjoy et al, 2023).
Recovery from REDs
Recovery is possible! Usually, it means you need to eat more in a more planned way. For health and performance, we want athletes to be in optimal energy availability through a well-considered and adequate diet. By using a multi-disciplinary team (doctors, coaches, nutritionists, parents) you can restore your energy status. The aim is healthy athletes, with optional energy availability, regular periods, and healthy bones. This then promotes improved training, improved performance improved recovery and ultimately more enjoyment in sport.
If you would like support to create a nutrition plan that provides optimal energy for your athletic goals, or to discuss ongoing strategies to avoid or recover from REDs, please book a free discovery call.
References
Mountjoy M, Sundgot-Borgen J, Burke L, et al. Br J Sports Med 2014;48:491–497.