Relative Energy Deficiency in Sport Explained

Relative energy deficiency in sports (RED-S) is a complex problem that can negatively impact many areas of the human body. It was previously referred to as the Female Athlete Triad, but it is a problem that can affect men, too. Here is an explanation of the causes, the diagnosis, and possible treatment options.

RED-S syndrome

Relative energy deficiency in sport (RED-S) is a common issue that affects athletes of all sports. This type of energy deficit impairs almost every system in the body. It can be caused by intentional or unintentional under-eating habits. Treatment can include a change in diet or a birth control pill to regulate the menstrual cycle.

RED-S affects both males and females. If it isn’t addressed it can seriously compromise long-term health. It has been identified as an acute ailment by the International Olympic Committee in 2014. Although the issue has been identified as a medical problem, it still isn’t widely recognized by health professionals and coaches.

This condition is often overlooked, but it is important to know how to recognize the symptoms and the right treatment. Relative energy deficiency can be a dangerous side effect of excessive exercise, or too little energy intake. If undiagnosed, the athlete could suffer from a range of health conditions, including low bone density, menstrual disturbance, and anaemia.


Relative energy deficiency has been implicated in many serious conditions, including amenorrhea, low bone mineral density, and disordered eating. It can also affect athletes’ physical performance, which may result in overtraining or chronic fatigue.

Relative energy deficiency in sport is a condition in which an athlete is not getting sufficient calories to fuel their activity. Insufficient energy supplies affect multiple physiological systems, including bone health, immunity, protein synthesis, cardiovascular health, and psychological health.

Although women have a greater risk of developing relative energy deficiency, male athletes are not immune to the problem.

RED-S Symptoms

RED-S is a condition that can be debilitating for athletes. This condition affects a person’s ability to adapt to training, which can negatively impact their cardiovascular and muscle performance. Furthermore, it can result in emotional and psychological distress. Therefore, it is critical to know how to spot the symptoms and consequently treat REDS.

Early intervention is important for athletes to avoid further complications. In order to detect and treat athletes with RED, sports physicians should be able to recognize the symptoms early on.

Relative Energy Deficiency in sport affects the metabolism, immune system, bone health, and menstrual cycle. It can also adversely impact cardiovascular health and overall health. If left untreated, RED-S can lead to severe health consequences, including depression, lowered performance, and other maladies.

RED-S is often difficult to diagnose, and it is often ignored. The symptoms of REDS may include decreased energy, hair loss, and fatigue. In addition, athletes may experience depression, lack of self-esteem, and an increased risk of injury. Athletes with irregular menstrual cycles, recurring stress fractures, or poor performance should be examined by a sports physician.

As a result, athletes with REDS must limit their training and focus on restoring their energy stores.


RED-S is an underdiagnosed, common health problem that negatively affects athletes. It can be caused by several factors, including improper diet and exercise habits, excessive exercise, and low energy availability. Relative energy deficiency in sports can cause significant health and performance problems and can be prevented by getting regular screenings.

The first step in diagnosing the condition is to gather a detailed medical history. The clinician will ask questions about the athlete’s symptoms, training history, diet habits, and attitudes toward food. He or she will also perform physical exams, such as blood pressure and heart rate.

The lack of energy can adversely affect the performance and health of almost all systems of the body, including the reproductive and mental systems. If RED-S is overlooked it may result in mental and physical collapse.

Cumulative Endocrine Dysfunction in Relative Energy Deficiency in Sport

RED-S is a chronic endocrine disorder that affects athletes and their bodies. This condition can result from excessive exercise and low energy diets. It affects the endocrine system, and can cause a variety of adverse effects, including compromised bone health and menstrual dysfunction. Additionally, this condition can lead to cardiovascular deficits and altered immune function.

This syndrome is especially dangerous for young athletes, who already have high energy demands. RED-S also has long-term consequences, including attenuated peak bone mass and increased risk of stress fractures as training loads increase. Hence, it is imperative for athletes to have regular screenings and appropriate nutritional support to prevent RED-S.

In addition to biochemical markers, clinical markers of low energy availability (LEA) are useful for early detection. Questionnaires have been developed to be issued to athletes, but these can come with their own limitations. It is important to note that not all questionnaires have been validated in specific athlete populations. Only eight out of 13 questionnaires have been validated in an active population. Furthermore, there is a risk of under-reporting and response bias.

This 2021 study examined seven female NCAA Division I distance runners from August to February. The researchers collected data about the athletes’ physical activity, diet, and nutritional intake. They also assessed their risk of developing Triad and the availability of energy.

Five of the seven athletes met the criteria which placed them at moderate risk, with one athlete seeing a decline in their performance and a reduced resting metabolic rate (RMR). However, these issues were addressed with nutritional intervention and a limit on exercise which saw a return in performance. The study was keen to note that changes in body mass or composition were not a sign of other concerns of RED-S.

How Do You Prevent Relative Energy Deficiency in Sport?

RED-S is a potentially serious condition that occurs in athletes. It occurs when athletes exercise for prolonged periods and limit their intake of certain types of food. Early detection of this condition is critical for treatment and future treatment. As we know, if left untreated, RED-S can lead to bone stress injury, amenorrhea, and other performance impairments. Treatment focuses on increasing caloric intake and decreasing energy expenditure during exercise, as we have seen in the earlier study, these interventions saw the athlete regain their performance.

Athletes are constantly trying to improve their performance and can run away with their training. As a sports nutritionist, you can attempt to help them further by adjusting their diet or training schedule. While these changes may be necessary to improve performance, they can also impact their health. Recent research has shed new light on the causes and consequences of RED-S. It affects athletes of all levels and genders and can negatively affect both their performance and health.

If the body lacks energy for normal functioning, it will resort to a survival mode and stop gaining or retaining lean muscle mass. Low energy levels can impair immune system function and cause illness. Common symptoms associated with LEA include respiratory and gastrointestinal tract illnesses, body aches, and headaches.

In young female athletes, this condition can occur because they train more than usual, are competitive, and are body dysmorphic. This increased output naturally requires more calories. In addition, this energy requirement must also take into account growth and development. Therefore, the condition can lead to injury, dehydration, and even depression.

Treatment options

RED-S is a syndrome marked by low energy availability, low bone mineral density, and disordered eating. It is often caused by too much physical activity or improper diets. If an athlete develops RED-S, nutritional therapy is recommended.

The International Olympic Committee introduced the term “relative energy deficiency in sport” in 2014 and updated it in 2018. The term aims to educate athletes and support systems about the effects of relative energy deficiency on health and performance. Relative energy deficiency in sports affects athletes of all ages and genders. Regular screening is necessary to prevent the affliction from progressing to its severe form.

A sports nutritionist along with other professional disciplines will collectively assess a number of parameters regarding the athlete’s health, performance, food intake, attitudes to food and training, as well as taking hormone and blood tests.

If an athlete is showing signs of RED-S this will be addressed with amendments to their training schedules, routines, competition (where viable), and nutritional intake. Other areas of treatment may include intervention from a sports psychologist.


RED-S is a condition that can affect all athletes at any level and gender. RED-S is caused by high levels of training which cannot be sustained by the amount of food consumed. The treat RED-S the athlete must either reduce training frequency or intensity and increase energy intake to support their activity.

Without any sustainable and suitable intervention, RED-S can lead to a number of physiological problems and can have a negative effect on the mental well-being of an athlete which will reduce their performance.

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