RED-S, or Relative Energy Deficiency in Sport, coined in 2014 by the International Olympic Committee (IOC), describes the health and performance consequences that occur when an athlete isn’t eating enough to meet the demands of training.

REDs serves as a replacement for the more limited ‘female athlete triad’, which is now considered a subset of REDs. This was an important shift, because we know that all athletes - and not just females- suffer consequences from underfueling. REDs and eating disorders share many symptoms, but not everyone with REDs has an eating disorder, and not everyone with an eating disorder has REDs

Certain types of athletes are at greater risk, such as:  

• Endurance athletes (i.e. cycling, running, swimming)

• Competitive athletes 

• Weight-sensitive sport athletes (i.e. wrestlers, rowers, martial artists, gymnasts, divers, dancers) 
  

Anyone engaging in regular exercise can develop REDs.  This includes people who…

• Are not considered ‘thin’ or ‘underweight’

• Are in larger bodies

• Are male

• Don’t have an eating disorder

• Aren’t trying to lose weight or eat less

• Play power/contact sports (e.g. football, baseball, basketball, weight lifting) 

Why is underfueling such a big deal?

Prolonged underfueling, even when unintentional, can impact athletic performance, injury risk, and mental and physical health. An energy deficit can quite literally affect every organ system in the body.

Yet, approximately 1/3 of athletes have at least 5 REDs symptoms! Common signs and symptoms include:

• Fatigue

• Anemia

• Low heart rate

• Low blood pressure

• Decline (or plateau) in athletic performance

• Failure to make expected performance/strength gains

• Weight loss (in bodies of all sizes) or weight/growth suppression

• Poor recovery after training

• Getting sick easily and often

• GI problems like constipation, early fullness, or bloating after meals

• Cold hands and feet

• Mood changes, including symptoms of depression or anxiety

• Insomnia

• Decreased mental sharpness

• New or increased preoccupation with food

• Irregular, unusually light or absent periods (in those who menstruate)

• Suppressed hormone levels (e.g. estrogen and testosterone)

• Overuse injuries and bone stress fractures/injuries

TLDR:

To summarize, subpar eating habits can negatively impact mood, performance and health. ALL athletes are vulnerable, including those who are often overlooked, such as men, recreational athletes, and persons who don’t appear to be underweight.

Stay tuned…. There’s a lot to unpack with REDs, which we’ll tackle in future blog posts. 

Interested in a deeper dive? Check out Project RED-S or IOC’s Consensus Statement on REDs.