What is relative energy deficiency in sports (RED-S)?

By JillMerkel on 30th Mar 2021

Have you heard of RED-S: Relative Energy Deficiency in Sport? It is a common syndrome that looks at the signs and consequences of under-fueling. Previously known as the Female Athlete Triad, RED-S is a broader, more comprehensive term for a deficiency in dietary intake via disordered eating behaviors or unintentional under fueling. The change from the Female Athlete Triad to RED-S was made primarily to include a more extensive description of symptoms caused by energy deficiency. RED-S also includes males, as they are not immune from the effects of energy deficiency and its symptoms.
RED-S refers to when an individual is not consuming enough nutrition or calories for their body to function adequately in all realms. This includes and affects metabolism, menstrual cycle, bone health, psychological symptoms, and more.

The deficiency in energy may be intentional (such as when someone is trying to lose weight by restricting intake) or it may be unintentional (such as when someone fails to increase their food intake to match an increase in exercise or training).
What may have started out as a seemingly innocent attempt at “getting healthy” or to lose weight or body fat, if taken too far, can result in severe consequences for one’s health and athletic performance. It is important to not ignore the warning signs and to seek treatment as soon as possible. This can help avoid the long-term effects RED-S can have on the body.

Irregular or missing menstrual cycles (or not getting a menstrual cycle in the first place for younger athletes) is one major warning sign of inadequate fueling. When the body isn’t getting enough nutrition, it must decide what to take energy away from. One of those areas is the menstrual cycle, because while it’s very important, it is not necessary for survival in the here-and-now. However, if someone is having irregular or missing menstrual cycles, that can lead to long-term health concerns, so is not something that should be viewed as “normal” or as “something that happens in active females”. An irregular or missing menstrual cycle is only ONE symptom of RED-S. You can still have symptoms of RED-S if you are getting a regular, natural cycle. Everyone is different and unique.

Although birth control pills are often prescribed when a female athlete is not obtaining her menstrual cycle naturally, it is not a recommended course of treatment. Instead of addressing the root cause of the problem, birth control pills are simply masking the symptoms. This can lead an individual to think they are better, which is not the case.

I absolutely love Lauren Fleshman’s Dear Younger Me letter. I think it’s a great resource for young athletes to hear from a former professional athlete about her real-life experience struggling with fueling their body properly for their sport.
Follow me on Instagram for most posts on this very important topic, RED-S! Also, watch the replay of the RED-S webinar I did with Dr. Alexis Morgan, a physical therapist.

Jill Merkel is a Nashville-based Registered Dietitian (RD) and Certified Specialist in Sports Dietetics (CSSD). She works individually with clients on body image, Intuitive Eating, disordered eating, and sports nutrition. Visit www.JillMerkelRD.com for more information or follow her on IG @JillMerkelRD.

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