RED-S red flags

Common RED-S red flags. Can you spot these in your teammates?

Perfectionist tendencies

Perfectionism is often seen as desirable in sports people but it is linked to eating disorders, which are closely linked to underfuelling and RED-S. Athletes are often rewarded for, and singled out as having great potential because of “excessive conscientiousness”, “rigidity” and a “preoccupation with details”, – but these traits can be dangerous under different circumstances

Disordered/ restricted eating

Whether intentional or unintentional, restrictive or disordered eating is a huge red flag for potential RED-S. Although athletes suffering from eating disorders are at heightened risk of RED-S, prevalence is still high among athletes who don’t suffer from disordered eating but are unintentionally underfuelling (and underrecovering) through a heavy training load.

Frequent injuries

Increased frequency of injuries, especially fractures, is a red flag for RED-S as RED-S can cause osteoporosis (brittle bones) due to the body’s low levels of oestrogen.

Illness

Low energy availability suppresses the immune system. If an athlete is getting ill more regularly than they used to — and can’t really explain why — then they could be suffering from RED-S.

Menstrual dysfunction

Possibly one of the most important signs of RED-S; changes to or the total loss of the menstrual cycle are massive red flags. If an athlete isn’t getting — or as with some young women never started — her period then this should be discussed with a doctor immediately.

Loss of sex drive

Low sex drive should be considered a RED-S red flag. Although these discussion aren’t a coach/athlete staple it is worth knowing that a lowered libido can be indicative of hormonal imbalance and underfuelling.

Mental health symptoms

Look out for:

• Low mood or anxiety
• Poor sleep
• Loss of enjoyment or enthusiasm for training or sport in general
• Underperformance – especially in an athlete who’s training hard but seems to be getting weaker or slower