RED-S – What to expect

RED-S, short for Relative Energy Deficiency in Sport, refers to a condition where the body doesn’t get enough energy to meet the demands of exercise, on top of essential daily functions. This imbalance can lead to severe and long-lasting health problems. These can include reduced bone density, impaired reproductive function, suppressed immune system, impaired cognitive function, depression, and anxiety.

Why might I need to see a specialist?

Here are some reasons athletes might need to see a specialist:

• Trying to change body shape by cutting calories or certain foods without professional help.
• Not realising how much energy exercise requires, especially in endurance sports.
• Training more without eating more.
• Eating too few carbs, which can feel like not eating enough overall.
• Poor timing of meals, causing energy gaps throughout the day.
• Disordered eating habits or clinical eating disorders.
• Reduced appetite or stomach problems during training, leading to less eating. This can both cause and result from RED-S.
• Life changes like moving, starting university, walking or biking more, or aiming for a “healthier” lifestyle.

Important to note

It’s easy to dismiss or downplay disordered eating patterns and excessive training loads. Often it can be difficult for the athletes themselves to be aware of their patterns and is difficult for anyone to acknowledge that there might be a problem. However, the sooner it’s talked about and treated the improved the likelihood of preventing or lessening any physical or psychological problems.

Who can offer to give me support?

• Your GP
• Gynaecologist / Endocrinologist / Sports Medicine Consultant
• Dietician / Sports Nutritionist
• Psychologist / Psychiatrist/ Counsellor
• Personal Trainers / Sports and Fitness Coaches

RED-S – The facts

• It’s a red flag for a female athlete to lose their menstrual cycle.
• RED-S can occur in both male and female athletes.
• RED-S can impact any athlete of any body type or size, in other words you can’t tell by looking at an athlete if they have RED-S or not.
• No athlete chooses to have RED-S, having a system of personal, nutritional and coaching support can be the protective factor.

The Diagnosis

The RED-S Clinical Assessment tool suggests these initial investigations for RED-S.

• For both male and female athletes: full blood count, thyroid function, ferritin, vitamin B12, vitamin D, 9am cortisol and prolactin.
• For female athletes: FSH (follicle-stimulating hormone), LH (luteinizing hormone), oestradiol, testosterone and pregnancy test.
• For male athletes: testosterone and LH (luteinizing hormone).
• Possibly investigating coeliac disease and inflammatory bowel disease if relevant symptoms present.
• Possibly DEXA scan if an athlete has had two or more stress fractures.

Useful Resources

Project Reds https://red-s.com/about

International Olympics Committee – REDs IOC CAT V2

Your rights

• You have the right, always, to be safe from harm in any environment.
• Never feel bullied, harassed or intimated
• You should be asked to consent to body weight / body comp measurement and
  informed of how your data will be used and shared. You do not have to consent if
  you don’t want to.
• You can refuse any assessment or treatment that you are not comfortable with.
• You can change your mind and withdraw your consent at any point.
• Have a say in the decisions, assessment and treatments that will impact you
• No-one’s behaviours should negatively affect your relationship with your body or
  Food.