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Relative Energy Deficiency in Sport (RED-S)

Apr 29, 2021

Today on Coffee & Questions ☕️ I answered Maggie's question on RED-S

"I Currently have RED-S for the second time while marathon training - is this something I'm prone to?"

What is it?

Relative Energy Deficiency in Sport (RED-S)

The syndrome refers to impaired physiological function including, but not limited to:

  • metabolic rate,
  • menstrual function,
  • bone health,
  • immunity,
  • protein synthesis,
  • cardiovascular health

caused by relative energy deficiency - either by inadequate energy intake and/or increased energy expenditure

We need energy to support:

Daily function, growth and exercise. The body fuels exercise first - so if you're not eating enough to support training, you don't have enough energy to support daily function and this can have long term impact on our health.

RED-S is a continuous spectrum ranging from the healthy athlete with optimal energy availability, regular menses and healthy bones to the opposite end of the spectrum characterised by amenorrhoea, low EA and osteoporosis.

Signs and symptoms of RED-S

  • Not training well
  • Poor recovery
  • recurrent injury/illness
  • GI issues
  • menstrual function - light / irregular / absent - females
  • reduced sex drive - males
  • eat the same thing every day despite varied training
  • restriction / binging behaviour

What can you do to resolve it?

1. Get a thorough assessment with a Sports Dietitian and Sports Physician (your multi-disciplinary team)

  • Thorough nutrition assessment with a qualified Sports Dietitian
  • Biochem - sex hormones, thyroid hormones, iron and others - e.g. IGF-1, insulin etc - talk to a professional about this
  • BMD (bone mineral density) with a DXA scan - particularly if no menstrual cycle for 6 months 
  • Ideally, AVOID taking an OCP to get your menstrual cycle back if you can
    It only masks the problem, doesn't fix it


People you want in your multi-disciplinary team:

  1. Sports Dietitian - to guide you specifically with nutrition to support life + training
    I help clients eat differently every day to better support training and resolve issues with menstrual function. It's an easy fix, but not necessarily easy - it does require work on your side

  2. Sports Physician

  3. Coach/physio/EP - whoever manages your training load


If you need help resolving RED-S or more specific nutrition to support training, work with us and BOOK A CONSULTATION now


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