RED-S 101

What it is, the symptoms and how to spot it in yourself and others.

The official definition:

RED-S is the impaired physiological functioning caused by relative energy deficiency. It includes but is not limited to impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health.

RED-S in simple:

1. Calories coming in don’t cover calories burned.
2. It leads to impaired physiological functioning (AKA it can stop your body working properly).

The symptoms

This is list certainly isn’t exhaustive but RED-S symptoms can include changes to the menstrual cycle, drops in performance, weight loss, mood changes (including irritability, anxiety and depression), heart problems, loss of cognitive functions (for example difficulty focusing), increased injury and increased illness.

It may be one of these. It may be all of them. Symptoms may be totally different. But the condition is still RED-S so long as chronic underfuelling is the underlying cause.

The primary sign of RED-S in female athletes is changes to the menstrual cycle. A period is a vital sign of health for female athletes, so changes to their cycle — or losing their period entirely — is always a cause for concern. If an athlete’s period changes, vanishes completely, or is late to start it is important to investigate the possibility that they may be suffering from RED-S.

Other symptoms of RED-S can include:

• Feeling colder
• Weight loss
• Anxiety around food and training
• Tiredness
• Injury
• Changes in sleep patterns
• Lowered performance
• Low mood, anxiety/depression

It’s also important to remember that RED-S can impact athletes of all shapes and sizes in any sport. It’s not just about athletes who look thin. That’s why it’s so important that athletes, coaches and practitioners are aware of RED-S. That they know how to spot it, and know how to avoid it.