Relative Energy Deficiency in Sport
Condition that occurs when athletes or active individuals do not consume enough energy to meet the demands of training and competition.
Relative Energy Deficiency (REDs)
Relative energy deficiency in sport (REDs) is a complex condition that occurs when athletes or active individuals do not consume enough energy to meet the demands of training and competition (known as low energy availability). This can lead to an array of health and performance consequences (including reproductive and hormonal dysfunction, poor bone health, delayed recovery, digestion issues, lowered immunity, mood changes, reduced training response and endurance, and increased injury).
This is my favourite area to work in, and I have had the privilege of navigating and guiding many athletes and dancers through their experience with REDS (in conjunction with a multi-disciplinary team).
This is a complex multi-system condition that can affect an athlete at a physiological and psychological level, and requires specialised healthcare providers to identify and treat. It is often missed due to prevalent under-awareness among medical professionals, and because symptoms often mimic other conditions or are misunderstood. Treatment is so much more complex than “eat more and exercise less”.
The Potential Signs Of Low Energy Availability Or Underfuelling:
- Recurring soft tissue injuries or niggles
- Delayed recovery
- Bone stress injuries
- Plateau in performance
- Getting ill more often
- Disrupted sleep
- Mood changes (such as irritability and feeling down)
- Gut issues
- Menstrual changes
- Low libido
- Brain fog
A Few Things To Consider:
Although low energy availability can occur as a result of disordered eating, it can also result unintentionally. For example, if an athlete increases their training volume or intensity without a matching increase in energy or carbohydrate intake, or due to suppressed appetite around training sessions.
Low energy availability and REDs can affect any athlete (male athletes too!) in any sport, and of any body size. There is a common misconception that if a person is not underweight, it is not possible for them to be underfuelling. However, it is possible (and common) to experience REDs without any weight loss, and in ANY body size. In some instances we even observe weight or body fat gain. Since human bodies are naturally programmed to protect themselves from the perceived threat of starvation, prolonged energy restriction (or low energy availability) may result in metabolic adaptations and an increased stress response, which can counteract any weight loss.
An absent menstrual period (amenorrhea) or irregular period (oligomenorrhea) are common consequences of low energy availability and REDs in female athletes. where the body conserves energy and redirects resources away from non-essential bodily functions, like reproductive function, for survival. Although missing periods are often normalised in sports settings, this should not be the case and should be investigated. Unfortunately, many athletes, coaches, parents and even doctors are likely to miss the crucial link between amenorrhea and an energy deficit, and its negative and serious impact on health (especially bone, heart, and brain health).
It’s important to note that it is impossible to tell whether a natural menstrual cycle is present while using hormonal contraceptives, as these work by suppressing the body’s natural menstrual cycle, often producing a synthetic withdrawal bleed instead.
Disordered Eating And Eating Disorders
Athletes are 2-3 times more likely to experience a disordered relationship with food.
As an athlete and eating disorder trained dietitian, I understand the challenges and complexities that you may face when it comes to food-related issues such as restrictive or disordered eating, or pressures to conform to certain body ‘ideals’.
If you are concerned that your relationship with food, exercise, or your body may not be optimal, please know that you are not alone and that recovery is so possible and worth it!