RED-S: The Hidden Injury

RED-S is an acronym many dietitians, some orthopedists, personal trainers, and physical therapists have heard of. It’s a “newish” term that’s important for every athlete and coach to understand and assess. This acronym which stands for Relative Energy Deficiency in Sport has developed over time.

In the 1980’s sports physiologist Barbara Drinkwater recognized a relationship between under fueling and performance. This was labeled the Female Athlete Triad with symptoms of low energy availability, menstrual dysfunction, and low bone mineral density.

From the 1900’s through the 2000’s, clinicians and researchers recognized that low energy affects much more than menstruation and bone health. In fact, athletes of all genders were showing negative metabolic, cardiovascular, immunity, and emotional side effects. This led to the International Olympic Committee introducing RED-S in 2014.

America is surrounded by diet culture. Avoid this, eat clean, carbs make you fat. This is all misinformation which will destroy an athletes performance and potential. The load that athletes add to their everyday life demands an increase in carbohydrates to fuel the activity, protein to recover, and fat to provide long lasting energy, maintain hormone health, and reduce inflammation. The majority of athletes I work with are under fueled in carbohydrates and fat. It’s not intentional it’s that they are getting their information from uneducated coaches, parents who don’t understand their child’s needs, or Social Media University.

Here’s the core symptoms of RED-S in both genders:

• Chronic Fatigue
• Declining Performance – slower times, reduced power, impaired recovery
• Frequent Illness
• Mood Changes or Low Motivation
• Sleep disturbances – trouble staying asleep
• GI Symptoms – constipation, early fullness, and nausea
• Increased Injury – stress fractures
• Impaired Concentration
• Cold Intolerance
• Deficiencies: iron, vitamin D, calcium, and B vitamins
• Irregular menstrual cycles
• Low Testosterone = reduced muscle mass
• Low Heart Rate variability
• Decreased Bone Density
• Increased Anxiety, compulsiveness, and rigidity

Symptoms such as declining performance, decision making, mood instability, trouble sleeping, and low heart rate will present before bone density or repetitive stress fractures. Stress fractures often take athletes out of their sport leading to even increased depression and anxiety.

RED-S is grossly under diagnosed. If you suffer from any of the symptoms above it’s time to see a sports dietitian. All of the symptoms can be resolved with appropriate intake and hydration and early intervention yields the best results.