What is RED-S?
Formerly known as the female athlete triad, Relative Energy Deficiency in Sport (RED-S) is a serious condition that is defined as impaired physiological functioning caused by relative energy deficiency.
More simply, RED-S occurs when your body is not taking in enough energy to meet the demands placed on it by the amount of exercise being performed for a prolonged period of time.
RED-S can have various negative implications on your body’s essential biological systems. These impairments include but are not limited to, impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health. This can have devastating effects on athletes’ performance within their sport.
Although RED-S can affect athletes of any gender in any sport, it is most common in sports and activities where low body weight and leanness are important for performance (e.g., long-distance running etc.), aesthetics (e.g., dancing etc.) or to meet a weight category (e.g., boxing etc.). Elite athletes and athletes who have recently increased the intensity of their athletic training are also at a higher risk of developing RED-S.
What causes RED-S?
RED-S is caused by a prolonged state of Low Energy Availability (LEA). While it is generally associated with disordered eating, LEA can also be invertedly caused by the following situations:
- Insufficient understanding of your individual energy needs.
- Changes to training or competition load are not matched with increased energy intake.
When your body is in a prolonged state of LEA, your body will attempt to conserve energy by depressing essential biological systems and inhibiting the production of hormones in the reproductive system. This can have a series of negative implications on both your health and athletic performance.
How is RED-S diagnosed?
Diagnosis can be difficult as everyone’s body responds differently to LEA and the signs and symptoms of the condition can be subtle and have crossovers.
As early detection is crucial to improve performance and prevent long-term consequences, you should consider RED-S if you have noticed any of the above changes in your health and performance.
The diagnosis of RED-S involves a multi-disciplinary approach and requires medical assessment. This can involve blood tests to assess hormone levels, bone scans to assess bone health and/or metabolic rate testing. There are also various screening tools for RED-S that can assist with this process (i.e., the REDS clinical assessment tool).
How can RED-S affect your health?
RED-S can manifest in a variety of physical and psychological ways. Unfortunately, the symptoms of the condition are often overlooked as many women also put their signs and symptoms down to simply ‘being tired’ and do not seek medical advice. A key symptom of RED-S seen in female athletes is amenorrhea, or the absence of a period, as it signals a change in your body’s intricate hormone system. This occurs when your body perceives too large a gap between energy intake and energy expenditure causing estrogen levels in the body to drop and your menstrual period to stop. This can have adverse effects as consistent low estrogen levels can cause your bones to become progressively more porous, increasing your risk of developing osteopenia, osteoporosis and stress fractures.
How does it influence athletic performance?
RED-S can have numerous adverse health and athletic performance consequences, impairing both your health and sporting performance. Due to its effect on your body’s essential biological systems, if left untreated RED-S can have serious consequences on your athletic performance and health long term.
Potential performance effects can include:
How is RED-S treated and managed?
Treatment for RED-S should be conducted by working with an interdisciplinary team (i.e., doctor, dietitian, and psychologist) and be individualised based on your symptoms, sport, goals and personal circumstances.
The key component treatment should address is the disconnect between energy intake and energy expenditure. This can be achieved by generally increasing dietary intake of energy and/or reducing energy expenditure by limiting exercise intensity and quantity, where possible. Additional treatment may also be required to address your menstrual and bone health, as well as any psychological conditions you may be experiencing.
If you are interested in getting more information, we recommend consulting a qualified sports medicine practitioner to get started.
Should I see a doctor?
If you think you may have RED-S, we recommend you get in contact with a specialised women’s General Practitioner or gynaecologist an Ignite Athlete as soon as practical.
They will be able to discuss your medical history, individual circumstances and symptoms to determine whether further investigation or management is required. If you track your menstrual cycle, this log will be beneficial to bring to your appointment.
- RED-S is a serious condition that is defined as impaired physiological functioning caused by relative energy deficiency, having various negative implications on your body’s essential biological systems and athletic performance.
- It is important to seek medical advice from a specialised women’s health GP as the early detection of RED-S is crucial to improve performance and prevent long-term consequences.