What is RED-S and Why Does it Matter?

Athlete RED-SRED-S, or Relative Energy Deficiency in Sport, is a condition of low energy which can affect high performing athletes who do not fuel enough to support their energy output.


Simply put:
Input < Output 



When there is not enough energy available, the body cannot perform its normal functions.  So energy which is normally used for daily body function is now used to fuel performance, resulting in health and performance consequences.


Why is it Important?

RED-S can cause serious health consequences, including reductions in:

  • Performance
  • Bone density
  • Menstrual function
  • Energy metabolism
  • Infection resistance
  • Protein synthesis
  • Cardiovascular health
  • Psychological health


Signs of RED-S

  • Poor performance
  • Performance which does not improve despite training load
  • Low energy/fatigue
  • Recurrent injuries/niggles
    • Particularly tendon injuries
  • Menstrual dysfunction
    • Not starting periods by age 16 or not having periods for >6 months requires medical investigation
  • History of stress fractures
  • Reluctance to rest
  • Perfectionist tendencies
  • Mood and behaviour changes
    • Loss of enjoyment in sport
    • Poor concentration
    • Low mood


Who is at Risk for RED-S?

Athlete RED-S

  • Females
    • This is due to energy loss through menstruation
    • NZ research has shown that over 50% of active exercising females are at risk
  • Athletes
    • Research showed that the prevalence of disordered eating was found to be 20% higher amongst athletes vs non-athletes (Joy et al, Br J Sports Med 2016)
  • Endurance sports athletes with high energy expenditure eg. Long distance runners
  • People who take part in sports with an emphasis on being lean eg. Gymnastics


How Can I Be Supportive?

For an athlete, having an injury can mean a loss of identity.  When fit and healthy, you may identify as ‘I am an athlete’.  Therefore an injury can be devastating, and cause reluctance to rest to allow for adequate healing.  As a support person, it is very important to help the athlete to recognise other valuable attributes that make them who they are.  They may have pushed these aside whilst working solely towards their sporting goals.

Encourage them no matter the outcome!  If someone believes they are only ‘good enough’ if they are winning or achieving their goals, then they may be driven to train harder, and under-fuel, in order to feel valued.  This will put them more at risk of RED-S.  Don’t just praise them when they achieve ‘greatness’, support them every step of the way!


How Can We Help?

As a physio, we can help to identify and support athletes with RED-S.  If we consider someone at risk for RED-s we will refer on for medical investigation, including blood tests or imaging.  We work with the client to help identify and address causes for RED-s.  In some cases it can be helpful to have input from a wider team, including a dietician, nutritionist or psychologist.

If you are an athlete affected by fatigue, frequent injuries, under-performance, weight loss or irregular menstruation, get in touch today.


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