Key Takeaways

  • Relative energy deficiency in sport (RED-S) occurs when athletes don’t meet their body’s energy needs.
  • Both female and male athletes are at risk of RED-S, though symptoms may differ.
  • Low energy availability affects hormones, bone health, and performance.
  • Early identification and proper treatment can prevent long-term consequences.
  • Recovery from RED-S requires balancing energy intake, rest, and professional medical guidance.

Watch: Understanding RED-S and Safe Recovery

Introduction

Yes — athletes can safely return to their sport after experiencing relative energy deficiency in sport (RED-S), but recovery demands time, care, and balance. RED-S happens when the body doesn’t get enough fuel to meet its daily and exercise-related energy demands. This energy deficiency in sports can lead to disrupted hormones, decreased bone density, fatigue, and poor performance.

Once thought to affect only women under the “female athlete triad,” experts now recognize that male athletes can also experience RED-S. The International Olympic Committee (IOC) has released a consensus statement on relative energy deficiency to highlight its broad impact and guide treatment strategies.

Understanding Relative Energy Deficiency in Sport (RED-S)

RED-S is defined as a state where the body’s energy intake is insufficient to cover both basic physiological functions and the energy expended during training. In other words, athletes burn more calories than they consume, leaving the body with low energy availability.

This imbalance impacts multiple systems — including metabolism, immunity, cardiovascular function, and mental health. Many athletes are unaware of the condition until they begin noticing symptoms of RED-S, such as exhaustion, irregular menstrual cycles, or frequent injuries.

Low Energy Availability and Its Effects

Low energy availability doesn’t just cause fatigue. It can also reduce bone mineral density, delay recovery from injuries, and increase the risk of stress fractures. In women, it often leads to menstrual dysfunction and low estrogen, while in men, testosterone levels may drop, reducing muscle mass and energy.

When energy availability in athletes drops below a critical level, the body conserves energy by shutting down non-essential systems. This leads to performance consequences of relative energy deficiency, such as decreased endurance, slower reaction times, and impaired decision-making.

How RED-S Affects Female and Male Athletes

Female Athletes and the Female Athlete Triad

The female athlete triad — consisting of low energy availability, menstrual dysfunction, and low bone density — represents one of the earliest recognized patterns of RED-S. Female endurance athletes, dancers, and gymnasts are especially at risk.

Low energy availability in female athletes can cause missed periods, fatigue, and increased injuries in female athletes. Over time, it can lead to low bone density and even osteoporosis. These issues often stem from disordered eating or restricted caloric intake meant to maintain a lean physique.

For more insights into eating behaviors among women in sports, explore Why Women with Diabulimia Need Dialectical Behavior Therapy for Eating Disorder Recovery.

Male Athletes and RED-S

Although once overlooked, male athletes can also suffer from energy deficiency in sports. Low testosterone, poor recovery, and a decline in motivation or strength are common warning signs.

Research published in Sports Med Open and the American College of Sports Medicine indicates that male and female athletes experience similar metabolic and psychological effects when energy intake is inadequate.

Symptoms and Diagnosis of RED-S

Common symptoms of RED-S include:

  • Persistent fatigue or irritability
  • Frequent injuries or stress fractures
  • Decreased training performance
  • Irregular or missed menstrual cycles
  • Mood swings or loss of motivation
  • Poor immunity and frequent illnesses

Healthcare professionals may use tools like the Energy Availability in Females Questionnaire (LEAF-Q) or detailed energy balance assessments to identify athletes at risk. Proper diagnosis requires evaluating energy intake, exercise energy expenditure, and physiological markers.

If untreated, RED-S may lead to long-term consequences such as low bone mineral density and chronic hormonal imbalances.

Causes and Risk Factors

Several factors contribute to relative energy deficiency in sport, including:

  • Eating disorders or disordered eating patterns
  • Excessive training without adequate fueling
  • Misunderstanding energy requirements for specific sports
  • Pressure to maintain low body weight
  • Lack of education among coaches and healthcare providers

Athletes involved in endurance sports — such as distance running, cycling, and swimming — often face the highest risk of RED-S due to sustained energy demands and calorie expenditure.

To learn more about the connection between fitness culture and eating behaviors, read Coping Strategies for Anorexia After Fitness Culture Burnout.

Treatment and Recovery from Relative Energy Deficiency in Sport

Restoring Energy Balance

Treatment begins with increasing energy intake and decreasing energy expenditure to create an appropriate energy balance. Nutritionists specializing in sports medicine work with athletes to plan adequate meals that meet training and recovery needs.

A structured treatment plan may include:

  • Gradual increase in dietary energy intake
  • Reduction in training volume or intensity
  • Monitoring bone health through scans
  • Addressing eating habits and potential eating disorders

Multidisciplinary Approach

Recovery from relative energy deficiency involves collaboration between dietitians, psychologists, and sports physicians. Understanding and treating disordered eating is crucial, as many athletes with eating disorders may unknowingly restrict calories.

Programs like those at Virtue Eating Disorder Treatment Center provide individualized, compassionate care tailored to athletes’ unique needs.

Returning to Sport Safely

Athletes should not rush back into training. According to Med Sci Sports Exerc and the American College of Sports Medicine, gradual reintroduction of activity ensures the body regains full function. The process may take several months, depending on the severity of RED-S and the athlete’s response to treatment.

Elite athletes recovering from RED-S benefit from close supervision, periodic health evaluations, and performance monitoring to ensure that energy to support training remains sufficient.

For related insights on safe rehabilitation, visit Eating Disorder Treatment: Inpatient vs. Outpatient Levels of Care.

Prevention: Educating Athletes and Coaches

Preventing RED-S starts with awareness. Coaches, trainers, and healthcare providers must feel comfortable treating the female athlete triad and recognizing early warning signs of low energy availability. Promoting balanced nutrition, adequate rest, and body positivity helps reduce stigma and encourages athletes to seek help.

Many athletes are shamed for eating more during training, but meeting energy needs is essential for long-term performance and health. Encouraging open discussions about dietary energy intake and recovery can make all the difference.

Conclusion

Relative energy deficiency in sport (RED-S) is a serious but treatable condition that can affect both female and male athletes. Recognizing the symptoms of RED-S, understanding its impact on energy balance, and adopting a comprehensive treatment plan are crucial for full recovery and safe return to sport.

If you or someone you know is struggling with low energy availability, disordered eating, or performance decline, professional support can help.

Call Virtue Recovery today at (725) 777-2619 to speak with a caring team member and begin your recovery journey.
Address: 9230 Corbett St, Las Vegas, NV 89149

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FAQs

What causes RED-S in athletes?

RED-S develops when an athlete’s energy intake is too low to meet training and daily needs. Factors like disordered eating, restrictive diets, and excessive exercise play major roles.

Can male athletes experience RED-S?

Yes. Both female and male athletes can develop RED-S, though symptoms like hormonal changes or fatigue may differ.

How is RED-S diagnosed?

Professionals assess energy intake, training load, and hormonal balance using tools like the LEAF-Q or medical imaging for bone density.

What is the difference between RED-S and the female athlete triad?

The female athlete triad focuses on women’s health outcomes (menstrual function, bone density, nutrition), while RED-S expands the concept to include all genders and multiple body systems.

Can athletes fully recover from RED-S?

Yes, with proper treatment for RED-S that restores nutrition, hormone function, and energy balance, athletes can safely return to peak performance.

Resources

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