Understanding Relative Energy Deficiency in Sport: Key Facts

University of Michigan cross-country and track runner Erin Finn suffered from multiple injuries and believed her body was no longer responding well to training. Little did she know, her issues were caused by a syndrome called Relative Energy Deficiency in Sport (REDs), which occurs when athletes don’t eat enough to fuel their bodies. Finn, now a medical resident, has started an educational resource and virtual community called Out of the RED-S to help other athletes avoid the same fate.

REDs is characterized by low energy availability, meaning that if athletes don’t consume enough food, their bodies will use up their calories on exercise, leaving them without enough energy to support day-to-day bodily functions. It only takes a small deficit of about 250 calories over a five-day period to set in motion REDs-related dysfunction. The syndrome was once referred to as the “female athlete triad,” but it is now recognized as a broader syndrome that can affect people of any gender.

REDs can have a wide range of effects on an athlete’s health, including impaired gastrointestinal, cardiovascular, and neurocognitive function, reduced immunity, increased injury risk, and mental health issues. It can also negatively impact athletic performance by decreasing muscle strength, endurance, power, training response, recovery, and motivation. Paradoxically, athletes may respond to this downturn by training even harder, which further depletes their energy.

Diagnosing REDs can be challenging, as healthcare providers consider multiple criteria. However, the prevalence of REDs is likely higher than reported, as many cases go unnoticed. There are misconceptions surrounding the syndrome, such as the belief that it only affects elite athletes, underweight athletes, or those with disordered eating. In reality, REDs is likely to be common among recreational athletes, as they often lack the same support and resources available to professional athletes.

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One significant contributing factor to the prevalence of REDs is diet culture. The focus on weight loss rather than fueling for performance has hindered understanding of the syndrome. Coaches and members of the athlete health and performance team may also exert pressures on athletes to regulate body weight and composition without proper knowledge of how to do it safely. Even in healthcare, REDs may not be fully appreciated, as healthcare providers often prioritize other health concerns over assessing energy availability and other factors related to REDs.

Treatment for REDs involves eating more food, but it can be more complicated than it sounds. It requires a mindset shift and a supportive coach and team that promotes accountability and proper fueling. Institutional culture changes, including body-positive communication, are necessary to address the issue effectively. Athletes should not accept REDs symptoms as normal and instead strive for a well-fed body that is resilient and free from these issues.

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