Have you had recurrent stress fractures? Maybe you lost your period or it's been abnormal? Perhaps you were recently diagnosed with iron deficiency and are experiencing chronic fatigue?
Each of these symptoms are very common, yet fly under the radar, of Relative Energy Deficiency in Sport (REDS). This is largely because it is a relatively new term, first coined in 2014. While new, it impacts thousands of people each and every day.
REDS can impact a multitude of body systems, including the menstrual cycle, bone, hematologic, cardiovascular, metabolic, psychologic, immune, endocrine, and gastrointestinal health (Marzuki et al, 2023). It is associated with a poor training response, an increased injury risk, decreased glycogen stores, decreased muscle strength, and decreased endurance performance (Marzuki et al, 2023). As could be assumed, the consequences of Relative Energy Deficiency in Sport (REDS) are significant and detrimental to health, training and performance (Marzuki et al, 2023).
Photo from: IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British Journal of Sports Medicine, 52(11). https://doi.org/10.1136/bjsports-2018-099193.
Relative Energy Deficiency in Sport (REDS): Explained
What is REDS?
Who does REDS impact?
Why does REDS happen?
How many people are affected by REDS?
"I don't purposely limit my food intake. Can this still happen to me?"
What might you recognize if you have REDS?
What are the health complications of REDS?
If you suspect you may be experiencing REDS, what should you do?
REDS Resources
What is Relative Energy Deficiency in Sport (REDS)?
A condition in which energy imbalance leads to impaired physiological functioning of multiple organ systems (Mountjoy et al, 2018).
Who does REDS impact?
More people than you realize! REDS can impact those of any gender, recreational and competitive athletes alike.
Studies from 2017 to 2019 show prevalence estimates of approximately 22% to 58% across a variety of sports... This is A LOT OF PEOPLE (Dave, 2022).
Why does REDS happen?
Low energy availability (LEA)! Energy intake < energy expenditure. Our body needs energy to keep us alive and even more energy to support exercise.
"I don't purposely limit my intake. Can this still happen to me?"
Absolutely. Unfortunately, due to diet culture, we are made to believe we need a minuscule amount of food each day. A lot of people who identify as an athlete may feel they are eating "enough" when that is unfortunately not the case.
What symptoms might you recognize if you have REDS?
Fatigue
Rapid weight loss
Training plateau
Poor recovery
Acute/chronic injury
Weakened immune system - ie. getting sick often
Inability to concentrate
Low mood/depression
Feeling cold all of the time
Gastrointestinal upset - early satiety, nausea, excess bloating, constipation, diarrhea, etc
Irritability
Low iron
Changes in reproductive function/hormones (low testosterone, low estrogen)
Irregular or absent period
Decreased sex drive
Reference: RED-S | Boston Children’s Hospital. https://www.childrenshospital.org/conditions/red-s. With a spice of my own professional knowledge and experience :)
What are the health complications of REDS?
Decreased strength/performance
Hormone imbalance/alteration
Decreased bone mineral density, increased prevalence of stress fractures - one of the biggest health complications of LEA is the negative impact it has on bone!
Stunted growth/development
Nutritional deficiencies - an example may be iron deficiency anemia
Increased cardiovascular risk - being in a state of LEA puts a lot of strain on the heart
Mood changes - heightened anxiety, depression and/or irritability
Weakened immune system/increased risk of illness/injury
Decreased metabolism (yes, energy restriction often results in a decreased metabolism)
Increased body fat storage (your body will do whatever it can to protect its vital organs!)
Reference: RED-S | Boston Children’s Hospital. https://www.childrenshospital.org/conditions/red-s. With a spice of my own professional knowledge and experience :)
What should you do if you think you may be experiencing Relative Energy Deficiency in Sport?
Schedule an appointment with a trusted member of a sports medicine team (athletic trainer, sports medicine physician, registered dietitian, sports psychologist)
Book with Kaitlyn here
Awesome REDS resources:
Watch the following:
Tina Muir’s - Running For Real - REDS Youtube Channel
Read the following:
Finding Your Sweet Spot: How to Avoid RED-S, Rebecca McConville, RDN, LD, CSSD, CEDS
Good For A Girl, Lauren Fleshman
Explore the following Instagram pages for more information:
@fed_collaborative
@stanfordfastr
@project_red_s
@rebeccaeddietitian
@energysportsdietitian
@thegymnastrd
Learn more:
Female Athlete Science and Translational Research, Stanford University
Relative Energy Deficiency in Sport - Boston Children's Hospital
References:
1. Marzuki, M. I. H., Mohamad, M. I., Chai, W. J., Farah, N. M. F., Safii, N. S., Jasme, J. K., & Jamil, N. A. (2023). Prevalence of Relative Energy Deficiency in Sport (RED-S) among National Athletes in Malaysia. Nutrients, 15(7), 1697. https://doi.org/10.3390/nu15071697
2. Mountjoy, M. ; S.-B., Jorunn Kaiander ;. Burke, Louise M. ;. Ackerman, Kathryn E. ;. Blauwet, Cheri ;. Constantini, Naama ;. Lebrun, Constance ;. Lundy, Bronwen ;. Melin, Anna Katarina ;. Meyer, Nanna L. ;. Sherman, Roberta T. ;. Tenforde, Adam S. ;. Klungland Torstveit, Monica ;. Budgett, Richard. (2018). IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British Journal of Sports Medicine, 52(11). https://doi.org/10.1136/bjsports-2018-099193
3. Dave, S. C., & Fisher, M. (2022). Relative energy deficiency in sport (RED – S). Menstrual Issues in Adolescents: Part II – Special Considerations, 52(8), 101242. https://doi.org/10.1016/j.cppeds.2022.101242