By Riley Nickols, PhD, CEDS
What is Relative Energy Deficiency in Sport (RED-S)?
In 2014, the International Olympic Committee (IOC) published the consensus statement Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport whereby RED-S expanded upon the Female Athlete Triad’s three conditions: low bone mineral density, functional hypothalamic amenorrhea, and low energy availability (LEA).1,2 A primary tenet of RED-S is that any athlete, regardless of gender, sport, or competitive level can experience this syndrome.
It is important for athletes and sport personnel to understand how RED-S can have damaging effects on all systems in the body including psychological functioning. The RED-S framework includes more considerations due to low energy availability (LEA). LEA is a state in which the body does not have enough energy to support all of its functions. This leads to issues with reproductive health (menstrual dysfunction and low estrogen for females, low testosterone for males, decreased sex drive for those with LEA), cardiovascular function (unstable vital signs, bradycardia or tachycardia due to LEA), immune function, growth and development, hematological, gastrointestinal, and metabolic functioning. Psychological consequences can either precede RED-S or may worsen by RED-S.3,4
Despite the maintenance, or even improved, sport performance for a period of time, a continued state of RED-S will eventually negatively impact an athlete’s sport performance due to:1
- Concentration and focus difficulties
- Decreased training response
- Increased injury risk
- Decreased coordination and impaired judgment
- Depression and irritability
- Decreased glycogen stores
- Decreased muscle strength and endurance performance
Although there is overlap between symptoms of RED-S and an eating disorder, there are differences between these two conditions. For this reason, qualified providers need to determine whether an eating disorder is also present in the context of a RED-S diagnosis.
What Causes of RED-S?
Low energy availability is the primary component of RED-S whereby there is a mismatch between an athlete’s nutritional/energy intake and the energy expended during exercise, so there is not enough energy to support the body’s functions to stay healthy and perform well.5
How to Detect RED-S
A specialist should evaluate if an athlete’s symptoms support a RED-S diagnosis. A comprehensive evaluation by a sports medicine physician should occur that entails obtaining an athlete’s medical history in addition to heart rate and blood pressure data to determine if an athlete meets criteria for RED-S and/or medical instability.6
Additionally, the multidisciplinary treatment team (i.e., sports medicine physician, sports dietitian, and mental health provider) should assess an athlete’s sport history, an athlete’s current training volume and intensity, eating behaviors, and be aware if any changes have recently occurred specific to an athlete’s mood, energy levels, fatigue, injury, hormonal functioning, and/or sport performance.6
Click here to access the IOC’s Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool Version 2 (IOC REDs CAT2) (NOTE: This assessment tool is intended for use by medical professionals only)