What is relative energy deficiency in sport?
Relative energy deficiency in sport (RED-S) affects active people. It happens when they burn more calories than they take in. It used to be called the female athlete triad. RED-S affects males and females differently. Not having enough available energy affects the way our bodies work in the following ways:
Healthy growth and development
Normal heart function
Immune function (ability to fight infections)
Normal musculoskeletal function (ability to recover from workouts and heal muscle injuries)
Signs and symptoms of RED-S:
Gastrointestinal (stomach) problems
Abnormal or absent periods
Repeated muscle and tendon injuries
Slow heart rate
Low blood pressure
Periods of fasting
Fasting, limiting food, or binge eating
Anxiety or depression
What causes RED-S?
RED-S is caused by an energy imbalance. This imbalance may be on purpose or by accident from intense exercise or by not eating enough. Some people with RED-S may have an eating disorder such as anorexia or bulimia. People with prolonged low energy levels will notice fatigue, abnormal periods, mental health issues, increased bone and muscle injuries, and, eventually, bone loss.
Very active patients can be at risk for RED-S if they:
Are a competitive athlete
Participate in sports emphasizing leanness or with weight requirements
Are focused on a certain body image
Feel pressured to perform at a high level
How is RED-S diagnosed?
Talk to your doctor if you think that you or someone you know may have RED-S. Your doctor will ask you about your periods, eating habits, exercise routine, mental health, and muscle and bone injuries. They may ask about certain medicines such as birth control. They may also ask if you use medicines such as diet pills or laxatives or if you skip meals or purge your food to lose weight.
How can RED-S be treated?
Your doctor may ask you to keep track of your exercise levels and food intake. Then they may make changes to your diet or activity level. A nutritionist can help create an eating plan, and a counselor or psychologist may also help with depression, low mood, or an eating disorder. There are many things you can do to stay healthy and prevent RED-S:
Eat a healthy diet with enough fats, carbohydrates, and proteins
Exercise in moderation and be sure to match your exercise level to the amount of food you eat
Give yourself time to rest
Avoid coaches who focus on competition instead of your health
Avoid coaches who focus on your weight
Talk to a doctor or counselor for help and resources
If you or someone you know has an eating disorder, please contact the National Eating Disorders Association at https://www.nationaleatingdisorders.org/help-support/contact-helpline or call their hotline at (800) 931-2237.
Female athlete triad
Relative energy deficiency in sport