relative energy deficiency in sport showing the areas of the body affected by underfueling

Do you know how many calories you need to consume for your activity level?  Most people don't and this can lead to a condition called Relative Energy Deficiency in Sport (RED-S).


There's a lot of misconceptions around nutrition and this can lead to people not only being confused about what to eat, how much to eat and when to eat. 

What is RED-S?

Relative Energy Deficiency in Sport is a syndrome resulting from relative energy deficiency that affects many aspects of physiological function including metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular and psychological health. (1) In simple terms, if you aren't consuming enough calories for your activity level, you are increasing your risk for serious health concerns. 

RED-S is the updated version of Female Athlete Triad.  The name Female Athlete Triad would lead one to believe that only females can be affected.  This has proven to be untrue as anyone can develop RED-S. 

How does it develop?

The underlying factor is under fueling.  Under fueling, whether intentional (eating disorder) or unintentional, can lead to hormonal imbalances.  In people who have the ability to menstruate this can lead to changes or loss of their monthly cycle.  It can also lead to nutritional deficiencies, causing anemia, chronic fatigue, and increased risk of infections & illness.  Bone health is affected leading to stress fractures and osteoporosis.

Who is at risk?

Energy deficiency has been seen across all sports but is more common in sports where aesthetics is important such as dancers & gymasts, weight class sports like wrestling & body building, and endurance sports like running & cycling.  Females are more likely to develop than males but it has been seen in all sexes, races & ability levels. 

Why does it matter?

Beyond the health issues described above, for athletes, this can lead to a decrease in performance.  As athletes, we want to be on top of our game so if you are struggling to complete your workouts, being injured more frequently or not healing as expected, re-evaluating your eating habits may be needed.  

Ways to decrease RED-S from developing:

  1. Education on healthy eating & proper fueling looks like for activity level.
  2. Focus on health instead of weightloss as a means for performance.
  3. Avoid critical comments of people's bodies.
  4. Seek treatment promptly if any signs of RED-S develop


Since there are a lot of factors that can go into the reasons why someone may be underfueling, working with a multidisciplinary team will make sure that both the physical and mental causes are being addressed.  I highly recommend working with providers who understand athletes, how to screen & treat RED-S.  

An ideal team would include:

A Sports Medicine Physician - someone who can address the systemic issues that come with underfueling. 

A Registered Dietician - someone who specializes in working with athletes & can give evidence based fueling recommendations.  In the Boise area, I recommend Erin Green.

A Coach - many recreational athletes use Google as their coach which can lead to following training programs that their body isn't prepared for.  Finding someone who coaches your sport of choice can ensure you are training appropriately. 

A Rehab Professional -  Sports Chiropractor or Physical Therapist who can address any musculoskeletal injuries.

A Mental Health Professional - if underfueling is intentional, addressing the mental health aspects is key to long term health.  Working with someone who has experience working with eating disorders/disordered eating would be best. 

All of these people on your team will increase your chances of recovery and improve your performance.  Your long term health and ability to continue being active is worth seeking treatment. 

1. Mountjoy M, Sundgot-Borgen J, Burke L, et al The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S) 

Emily Rausch

Emily Rausch


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