Relative Energy Deficiency in Sport

Relative Energy Deficiency in Sport

Relative Energy Deficiency in Sport


Relative Energy Deficiency in Sport or RED-S, is something that affects many athletes from the professional level to your everyday athlete, both men and women. Sport has been a part of my life, from a young age from gymnastics and figure skating to Division I Cross Country in college to mountain ultras in my pre-mom life. Energy deficiency and missed periods is something I have seen in many athletes around me but I am thankful this is not something that I dealt with personally. Oftentimes, it was thought of and talked about as a good thing or just generally brushed off. “I never get my period during peak training” or “I’m not getting my period so that means I’m light enough for competition season.” I’m glad we are learning so much more about this and it is being talked about more in the endurance and athletic worlds. What we know now is that the menstrual cycle is like a vital sign, especially for athletes! And those missed periods are more an early sign of a more serious problem. I couldn’t leave this hormone blog series without talking about RED-S because it can affect athletes and active individuals of all types and can wreck havoc on our hormones. 

What is RED-S

Relative Energy Deficiency in Sport is defined as just that: taking in fewer calories than an athlete is burning. It has also been commonly called the female athlete triad – (irregular menstrual cycle, low energy availability, and decreased bone mineral density), but we know that it can also affect males (minus the menstrual irregularities piece). RED-S is characterized by not having enough energy available which can affect the body in different ways including:

  • Energy levels (for training and day to day life)
  • Menstrual irregularities / missing cycles
  • Hormone issues beyond the menstrual cycle including infertility 
  • Bone health
  • Healthy growth and development in children and adolescents
  • Heart health
  • Immune health
  • Ability to recover from workouts 
  • Mental health

Symptoms of RED-S

RED-S can present with a wide variety of signs and symptoms like:

  • Fatigue
  • Weight loss
  • Dehydration
  • GI problems 
  • Irregular or absent menstrual cycles
  • Bone loss
  • Stress fractures
  • Vitamin and mineral insufficiencies (iron, calcium, magnesium and vitamin D)
  • Muscle or tendon injuries
  • Cold intolerance
  • Fasting or limiting foods
  • Binge eating
  • Extreme exercise
  • Low heart rate and blood pressure
  • Anxiety and depression
  • Trouble concentrating
  • Sleep issues 

Trigger and Diagnosis for RED-S

RED-S may be intentional (an athlete is intentionally restricting intake) or unintentional (high training volume and not focusing on getting in the right nutrition). However in either scenario athletes are setting themselves up for relative energy deficiency. This can happen over a short period (months) or can be an athlete can be slightly energy deficient for years. Active individuals can be more at risk for RED-S if they: 

  • Compete at a high level or feel pressure to perform at a high level 
  • Participate in sports that have weight requirements or emphasize size/leanness
  • Are focused on body image
  • Exercise excessively
  • Have a history of depression

Relative Energy Deficiency in Sport is diagnosed by talking with a medical provider or nutrition professional who will discuss eating habits, menstrual cycles, medications, injuries, mental health and exercise routine/volume. Working with a provider who is able to recognize and who can help a patient work through energy deficiency is key. Finding a nutritionist to get diet back on track can be helpful and working with a mental health professional who is trained in working with individuals who have disordered eating or body image issues can be a key piece in overcoming RED-S. 

Prevention and Recovery from RED-S

I love Dr. Stacy Sims work in this area and she recommends that on a moderate intensity training day (defined as doing a HIIT or strength training session or 1-2 hours of cardio) women need:

3-4 grams of carbohydrates per kg of bodyweight

2-2.3 grams of protein per kg of bodyweight

1.2 grams of fat per kg of bodyweight

When you total this up, for a 140 pound woman, on a training day, she would need 2300-2500 calories which is far less than many women consume or even think about consuming. It is also helpful to look at labs to check for nutrient deficiencies and insufficiencies (iron. b vitamins, vitamin D, zinc) which is something I routinely do with athletes in my practice. 

If you are looking for a provider to work with to make sure you are on track to keep up with training and life, book a free 15 minute call below! And for more information about my services and Wild Rice Wellness click HERE!