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Unlocking The Secrets Of RED-S: A Guide For Athletes

RED-S (Relative Energy Deficiency in Sport) is a condition characterized by insufficient energy intake to support the normal functioning of the body in athletes. It can occur when athletes do not consume enough energy through food to meet the demands of their intense training regimen. Studies have shown that up to 60% of elite athletes have symptoms of RED-s.

But this condition can occur even if you are not involved in professional sports. It is all about the balance between training load, the body’s needs, and nutrient intake. If you have images of girls with anorexia in mind when you hear about RED-S, you are mistaken. Athletes do not need to exhaust themselves to the point of having problems. They can look perfectly healthy. However, their nutritional and recovery needs are significantly higher compared to the general population, making RED-S highly prevalent among athletes. This is especially true among adolescent females, but not limited to them. Now, let’s discuss this topic in more detail.

Why is RED-S called a triad of female athletes?

The Female Athlete Triad is a term that describes a combination of three conditions commonly seen in some female athletes:

  • Energy deficiency;
  • Menstrual cycle disturbances;
  • Osteoporosis.

The Female Athlete Triad is associated with inadequate nutrition and intense physical training. When it was recognized that this condition could also affect male athletes, it was given another name – Relative Energy Deficiency in Sport (RED-S).

RED-S and age

RED-S can occur in athletes of all ages, starting from adolescence and beyond. It can impact the development, health, and athletic performance of athletes.

The signs and symptoms of RED-S can vary depending on the age group and individual circumstances. In adult athletes, RED-S can affect their work capacity, overall health, and well-being. Adolescents, especially girls, are at an increased risk of developing RED-S due to their age-related characteristics and physiological changes associated with growth and sexual development.

Athletes engaged in high-intensity sports with demanding training loads, such as gymnastics, track and field, figure skating, swimming, and others, are particularly at risk of developing the condition.

Symptoms of RED-S

The symptoms that may indicate the presence of RED-S can be physical, psychological, and physiological. Here are the main signs that may suggest the presence of RED-S:

  1. Decreased athletic performance despite continued training efforts.
  2. Persistent fatigue, lack of energy, decreased concentration, and endurance.
  3. Menstrual cycle disturbances, irregular or absent periods (amenorrhea).
  4. Increased frequency of stress fractures and other bone-related injuries.
  5. Muscle weakness, coordination impairments.
  6. The weakened immune system, making athletes more susceptible to infections, illnesses, and prolonged recovery periods.
  7. Hormonal imbalances, including disruptions in estrogen, testosterone, thyroid hormones, and growth hormones.
  8. Impaired cardiovascular function, including reduced heart rate and cardiac output. This can also impact endurance and athletic performance.
  9. Changes in body composition, including muscle loss and/or increased fat deposition.
  10. Mood disturbances, increased irritability, anxiety, depression, poor concentration, and decreased motivation.
  11. RED-S is often associated with disordered eating behaviours, including food restriction, excessive exercise, and preoccupation with weight and body shape.

It’s important to note that the presence of these symptoms does not automatically indicate the presence of RED-S, as they can be associated with other conditions as well. To determine the underlying cause of these disturbances, it is necessary to consult a specialist and undergo a comprehensive evaluation.

Treatment for RED-S

Treatment for RED-S involves addressing the underlying energy deficit through a comprehensive approach, such as:

  • Adequate nutrition;
  • Increasing energy intake;
  • Monitoring menstrual function (for women);
  • Modifications to training and workload;
  • Psychological support when necessary.

Diet and Nutrients for RED-S

Individual dietary needs may vary, but here are some general nutrition recommendations for athletes with RED-S syndrome:

  1. Sufficient energy intake: It is crucial for athletes to consume enough calories to meet their energy needs. Restoring energy balance may require increasing overall calorie intake and/or temporarily reducing training intensity.
  2. Carbohydrates: Carbohydrates are the primary fuel source for athletes and are necessary for energy production.
  3. Protein: Protein is essential for muscle recovery and repair.
  4. Healthy fats: Include omega-3 fats and phospholipids. Omega-3 fatty acids found in fish oil or algae oil supplements can have anti-inflammatory effects and support overall health. Phospholipids can help maintain healthy cell function, restore energy balance, and improve athletes’ overall condition. Both types of fats can aid in cell repair, support the immune system, and reduce inflammation.
  5. Micronutrients: Ensure a balanced diet that includes a variety of fruits and vegetables to provide the body with necessary vitamins and minerals. Calcium, vitamin D, and iron are particularly important for bone health and overall functionality.
  6. Gut health: Training can improve gut function and mask important symptoms that may indicate hidden dysbiosis. Pay attention to gut microbiota and digestive health. Restoring a normal balance of microorganisms through probiotics and prebiotics, as well as proper nutrition and digestive support, can help improve the overall condition and energy balance of athletes with RED-S.
  7. Meal timing and distribution: Spread meals and snacks throughout the day to maintain a constant energy supply.
  8. Hydration: Proper hydration is necessary for optimal performance and overall health. Drink an adequate amount of fluids throughout the day, taking into account individual fluid needs based on activity level, sweating rate, and environmental conditions. Don’t forget about electrolytes! High water consumption without replenishing electrolytes can lead to mineral imbalances, including sodium, potassium, calcium, magnesium, chloride, and phosphorus.
  9. Regular monitoring and support: Regularly assess progress and make adjustments as needed.

Remember that each athlete’s situation is unique, and the best diet for RED-S will depend on individual needs, body characteristics, goals, and preferences. To determine the appropriate and balanced diet, it is best to consult with specialists.

Lifestyle Changes and RED-S

Maintaining a balance between activity and rest is crucial for managing relative energy deficiency in sport (RED-S) and allowing the body to recover, restore energy balance, and improve overall health. Here are some recommendations for finding the right balance:

  1. Listen to your body: Pay attention to signs of fatigue, decreased performance, prolonged recovery, or repetitive injuries. These may indicate that your body needs more rest. Injured in Palm Bay, FL? The personal injury lawyers from Kogan & DiSalvo law firm can help. If you experience excessive fatigue or prolonged muscle soreness, it may be a sign that you need to reduce training or take additional rest days.
  2. Adjust training volume and intensity: Modify your training program to align with your energy availability and overall well-being. Work with a coach or sports medicine specialist to adjust the volume, intensity, and frequency of your workouts as needed. This may involve reducing overall training load, incorporating active recovery days, or modifying workouts to focus on low-impact activities.
  3. Prioritize adequate sleep: Prioritize quality sleep to support recovery and overall health. Aim for 7-9 hours of uninterrupted sleep per night.
  4. Manage stress: Engage in activities that promote recovery and reduce stress on the body. Low-impact exercises such as yoga, stretching, and meditation can help reduce stress, improve circulation, decrease muscle tension, and aid in recovery.
  5. Rest days: Plan regular rest days in your training program to ensure complete recovery. Use these days to rest, engage in light activities, or pursue non-sporting hobbies that help reduce physical and mental stress.
  6. Gradual return to activity: If you have experienced RED-S and have taken a break from training or adjusted your activity level, gradually reintroduce training to avoid sudden increases in workload. Slowly increase the volume and intensity of your workouts over time, allowing your body to adapt and adjust.

Remember that finding the right balance between activity and rest is essential for recovery, maintaining energy balance, and overall health. Everyone’s needs will be different, so it’s important to listen to your body, seek professional guidance, and make adjustments as necessary to support your well-being and long-term athletic performance.


RED-S can have a significant impact on the health and athletic performance of athletes. This syndrome can lead to various problems, including menstrual cycle disruptions, loss of bone density, disordered eating behaviours, impaired immune function, and reduced physical and psychological performance.

Early detection and treatment of RED-S help athletes avoid serious consequences for their health and athletic careers. This includes a balanced nutritional regimen, sufficient energy and nutrient intake, as well as adequate rest and recovery. To timely identify and address RED-S, it is important to consult with a doctor who is knowledgeable about this issue.


Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52(11):687-97.

Loucks AB, Kiens B, Wright HH. Energy availability in athletes. J Sports Sci. 2011;29 Suppl 1:S7-15.

Stellingwerff T, Heikura IA, Meeusen R, et al. Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED‑S): Shared Pathways, Symptoms and Complexities. Sports Med. 2021.

Heikura IA, Uusitalo ALT, Stellingwerff T, et al. Low Energy Availability Is Difficult to Assess but Outcomes Have Large Impact on Bone Injury Rates in Elite Distance Athletes. Int J Sport Nutr Exerc Metab. 2018;28(4):403-11.

Research Spotlight- Big Push in RED-S Research in Canadian High Performance Sport