Athletes And Coaches Should Know About RED-S And Be On The Lookout For Signs And Risks 

By Elizabeth Carey for DyeStat

When Mary Cain spoke out about her experience with the Nike Oregon Project she mentioned Relative Energy Deficiency in Sport — shedding much-needed light on a serious condition that all athletes should know about.  

Relative Energy Deficiency in Sport negatively affects health, performance, and growth, with wide-ranging consequences for both males and females. It is caused by low energy availability, aka not enough fuel. It’s called RED-S for short (pronounced “reds” or “red ess” depending on who you talk to). 

“RED-S” is a relatively new term that researchers coined and continue to study. The International Olympic Committee first addressed it in 2014, explaining how eating issues affect more than women and their periods. (You might’ve heard of the Female Athlete Triad, an issue with eating, weak bones, and/or lost periods; it’s just one part of RED-S.) Awareness is still lacking — even among coaches and doctors.

With that said, let's cover what is known about RED-S, its signs and symptoms, prevention and resources. 

What is RED-S and why does it happen?

RED-S is triggered by low energy availability That’s when athletes don’t eat and drink enough fuel to support their bodies’ daily functions and activities, on top of the demands of growth and development (see: adolescence). Restricting food and eating disorders contribute to energy deficits over days, weeks and longer. But so do increased loads of training and exercise, unawareness or miseducation around nutrition needs, and other obstacles to getting enough fuel, like socioeconomics and busy-ness. 

Low fuel disrupts the body’s functions, in particular the endocrine system. (As your body is just trying to survive!) Studies have shown that this compromises the health of bones, metabolism, immunity, and hormones, plus the reproductive, cardiovascular and gastrointestinal systems. (Yikes!)

Plus, it affects performance factors — including muscle strength, endurance performance, glycogen stores, injury risk, mood, coordination, and even how someone adapts to training. Zoom out on these consequences and you’ll see RED-S, a complicated web of short- and long-term consequences. 

What are the signs of RED-S? 

RED-S, as with eating disorders, isn’t spotted by the naked eye. Generally, doctors diagnosis it by ruling out other medical issues and by using risk assessments. It’s important to see health care professionals and credentialed, licensed experts — including doctors, registered dieticians, psychologists, athletic trainers and others who specialize in sports and/or eating issues, and who are up to date on the emerging research about RED-S — with any concerns or questions. 

Energy requirements and baselines vary from person to person, but it’s easy to underestimate adolescent athlete’s needs. Registered dietitians who specialize in sports and eating disorders (ideally with an Intuitive Eating and Health At Every Size approach) help individuals — and teams — with their unique fueling needs. 

But there are signs to pay attention to. In women, a red flag is missing periods (aka amenorrhea), as Cain and other athletes (including Lauren Fleshman), experienced. It disrupts men’s hormone fluctuations, too. Drew Hunter recently detailed his own diagnosis of RED-S.

For all athletes, bone injuries like stress fractures are another red flag. Other signs include fatigue, other injuries, digestive issues, body changes, trouble regulating body temperature, pre-occupation or rigid behaviors around food and exercise, mood disturbances and performance declines. 

Sometimes, however, inadequate fueling may cause a boost in short-term performance, says Kara Bazzi, founder of Opal Food and Body Wisdom in Seattle, Washington, and mask dangerous underlying issues. That’s why it’s especially important for athletes and coaches to embrace adequate fueling, and nix toxic culture, especially when it comes to body and food talk. Remember, taking care of yourself and treating your body with the respect you offer friends, as Melody Fairchild writes, “will add years to your running career and joy to your life.”

What questions do you have about RED-S and running? Comment below or holler at us on social:

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Elizabeth Carey (https://elizabethwcarey.com/) is a freelance writer and running coach based in Seattle, Washington.