Many athletes, coaches, and even healthcare professionals may struggle with understanding RED-S (Relative Energy Deficiency in Sport). There are hidden dangers of energy imbalances in sports and athletics. While the focus is often on the physical aspects of training, nutrition, and performance, there are hidden dangers of energy imbalance. There is a fine line between maintaining health and maximizing performance for athletes of all ages. This condition can have serious consequences for athletes of all levels, affecting not only their performance but also their long-term health.

Let’s work towards understanding RED-S by exploring the causes, the symptoms, and how to prevent and treat it.

What is RED-S?

RED-S was first introduced to the International Olympic Committee (IOC) in 2014 as an expansion of the Female Athlete Triad. It is a condition that affects both male and female athletes. It is characterized by an energy imbalance, where the energy expenditure through exercise exceeds the energy intake from food. This leads to a deficiency in energy availability. This imbalance can disrupt various physiological systems and have wide-ranging effects on an athlete’s health.

Causes of RED-S

  1. Inadequate Caloric Intake: Athletes may consciously or unconsciously restrict their caloric intake to maintain a certain body weight or composition.
  2. Excessive Exercise: Overtraining or excessive exercise without adequate rest and recovery can contribute to a negative energy balance.
  3. Disordered Eating: Athletes may develop unhealthy eating habits, such as extreme dieting or binge eating.
  4. Low Body Fat: Athletes, especially those in sports with weight classes, may aim for excessively low body fat percentages.
  5. Psychological Factors: The pressure to perform and achieve certain body standards can lead to anxiety, stress, and depression, which may affect an athlete’s eating habits and overall well-being.

Symptoms of RED-S

RED-S can manifest in various ways, and its symptoms can vary from athlete to athlete. Some common symptoms include:

  1. Decreased Athletic Performance: Athletes may experience a decline in their performance, including reduced strength, endurance, and coordination.
  2. Poor Recovery: Athletes may begin to notice it takes longer to recover between hard workouts.
  3. Menstrual Irregularities: In female athletes, RED-S can lead to menstrual irregularities or the absence of menstruation altogether, which is known as amenorrhea.
  4. Decreased Bone Density: RED-S can weaken bones, increasing the risk of stress fractures and osteoporosis.
  5. Hormonal Imbalances: Hormonal disruptions can affect both male and female athletes, leading to a range of issues such as low testosterone levels in men and infertility in women.
  6. Psychological Distress: Athletes may experience mood swings, irritability, anxiety, depression, and decreased motivation.

Preventing and Treating RED-S

Preventing RED-S is crucial for the long-term health and success of athletes. There are multiple strategies for prevention and treatment.


Athletes, coaches, and healthcare providers should be educated about RED-S and its consequences to recognize and address it early.

Balanced Nutrition

Athletes should maintain a well-balanced diet that provides enough energy to support their training and recovery needs.


Regular monitoring of an athlete’s energy intake, expenditure, and overall health can help detect RED-S in its early stages.

Psychological Support

Addressing the psychological aspects of RED-S is crucial. Athletes should have access to mental health support to manage stress and body image concerns.

Rest and Recovery

Adequate rest and recovery are essential to prevent overtraining and energy deficits.

Multidisciplinary Approach

A team of healthcare professionals, including dietitians, psychologists, and coaches, should work together to create a holistic treatment plan.

Relative Energy Deficiency in Sport (RED-S) is a complex and often underestimated condition. Understanding RED-S is essential because it can have severe consequences for athletes’ health and performance. Recognizing the signs and symptoms, addressing the root causes, and providing appropriate treatment and support are essential steps in preventing and managing RED-S. Athletes and their support networks must prioritize not only success in sports but also long-term well-being and health.