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Athletes and Relative Energy Deficiency in Sport

Tired female runner

February 19, 2020

Relative energy deficiency in sport (RED-S) occurs when athletes consume too few calories for their activity level. Without any available energy, an athlete is unable to support the full range of body functions involved in health and performance. It was once known as the Female Athlete Triad because female athletes developed a cluster of related conditions, including the loss of their menstrual cycle, poor bone health and stress fractures. RED-S expands this definition to reflect all the body processes effected by low energy availability. Additionally, RED-S can occur in both men and women. Lisa Vopat, MD, shares why this condition can affect athletes of all ages.

  • A: RED-S can occur when an athlete is not taking in enough calories for the amount they expend in exercise. When you're performing a lot of high-level training and can't eat large meals before and after because of GI distress or other reasons, you may not realize you aren't taking in the right amount of food.

  • A: Athletes of all ages can develop it, but it usually occurs in high school and collegiate athletes because they are involved in highly competitive sports and are training daily. However, I treat athletes for energy deficiency who are in their 50s, so athletes of every age group can suffer from this condition.

  • A: Yes, it is more common in endurance sports, where the idea of "leaner is faster" is often promoted. If you are within an ideal weight range for height, thinner is not faster. Any further energy deficiency can actually decrease your overall performance. Also, aesthetic sports that involve wearing tight-fitting clothing, such as figure skating, gymnastics and dance, have higher risk of RED-S. Wrestlers who need to make a certain weight class are also more likely to develop energy deficiency.

  • A: It is very difficult to diagnose and presents in a lot of ways. For females, losing your menstrual cycle is a big red flag that you might be energy deficient. If you have a regular cycle and then lose it, you should really see a medical professional.

    Other symptoms, such as repetitive stress injuries, not performing well or not being able to train at a high level, brain fog and fatigue can all be signs of energy deficiency.

  • A: The bone health effects can be permanent. Peak bone mass in females is achieved by the ages of 26-30, so if you suffer from energy deficiency that's not recognized during your adolescent and collegiate years, then your ability to reach your peak bone mass is going to be compromised. It can be difficult to correct this, and it can potentially cause osteoporosis later in life. RED-S can also cause short-term reversible effects, such as a slow heart rate, bloating, irritability, depression, difficulty concentrating and a compromised immune system.

  • A: Eating disorders and RED-S can be overlapping conditions. Both involve energy deficiency and physiologic problems. While those with RED-S can have energy mismatch from an eating disorder, there are many athletes with RED-S that have an unintentional mismatch of energy. They don't even realize they are not taking in enough fuel for their training level. Those with eating disorders are harder to treat because they require a strong focus on recovery and therapy.

  • A: Athletes should work with a multidisciplinary team, including a sports medicine physician and a sports dietitian who can help them with their energy needs. Some athletes might also benefit from seeing a therapist, especially if there's a component of disordered eating involved.

To request an appointment with a sports medicine specialist, call 913-574-4878 or toll free 855-898-9275.

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