Understanding RED-S in Athletes: How Training and Care Can Prevent It
As a chiropractor, sports therapist, and personal trainer specializing in helping athletes thrive, I often see the toll of pushing too hard without balance. Relative Energy Deficiency in Sport (REDS) is a serious condition that affects high-performing athletes, leading to energy shortages, hormonal disruptions, and health risks. But with smart training, proper nutrition, and my integrated approach, you can avoid RED-S and stay at your peak. Let’s break it down.
What is RED-S and Why It Matters
Relative Energy Deficiency in Sport (RED-S) is a syndrome that occurs when an individual's energy intake from food is insufficient to meet the demands of daily life, exercise, and overall bodily functions. This leads to low energy availability (LEA), which disrupts multiple physiological systems. Originally known as the "Female Athlete Triad," RED-S now encompasses a broader spectrum of health issues affecting both men and women, but it is particularly prevalent in active females due to factors like intense training, body image pressures, and menstrual cycle influences. In women, it often manifests as a triad of disordered eating or low calorie intake, menstrual irregularities (e.g., amenorrhea or oligomenorrhea), and reduced bone mineral density (osteopenia or osteoporosis). A 2023 review in Sports Medicine highlighted that up to 60% of elite athletes may be at risk, underscoring the need for awareness.
Causes and Risk Factors
RED-S is primarily triggered by an energy imbalance: calories burned (through exercise and basal metabolic needs) exceed calories consumed. This can happen intentionally (e.g., restrictive dieting for weight control) or unintentionally (e.g., high training volume without adequate fueling). Key risk factors in women include:
High-intensity sports: Endurance activities (running, cycling), aesthetic sports (gymnastics, dance), or weight-class sports (wrestling, rowing).
Eating disorders: Such as anorexia nervosa or bulimia, affecting up to 20-30% of female athletes.
Menstrual and hormonal factors: Low energy suppresses reproductive hormones like estrogen, leading to irregular or absent periods.
Psychosocial pressures: Perfectionism, low self-esteem, or coaching emphasis on leanness. Prevalence is higher in females than males, with studies showing up to 38% of elite female athletes affected.The Role of Training in Preventing RED-S
Training is essential for athletic performance, but overdoing it without adequate fueling exacerbates RED-S. Strength and cardiovascular exercises build resilience, but under-loading—failing to progressively challenge your body—can lead to imbalances and inefficiencies. In my practice, I combine chiropractic adjustments to maintain alignment, sports therapy to address soft tissue issues, and personalized training to ensure progressive overload. This holistic method not only boosts performance but also supports energy balance, reducing RED-S risk.
Symptoms and Health Impacts
Prolonged LEA can impair nearly every body system. In women, common signs include:
Reproductive: Absent or infrequent periods (functional hypothalamic amenorrhea), infertility, low libido, vaginal dryness.
Musculoskeletal: Increased stress fractures, slower healing, muscle weakness, and long-term bone loss (raising osteoporosis risk).
Cardiovascular: Low resting heart rate (bradycardia), dizziness, or reduced blood flow to muscles.
Metabolic: Fatigue, slowed metabolism, weight fluctuations, cold intolerance.
Gastrointestinal and Immune: Constipation, frequent illnesses, poor wound healing.
Psychological: Anxiety, depression, irritability, poor concentration. Athletic performance declines due to reduced endurance, strength, and recovery. Untreated, it can lead to irreversible issues like infertility or chronic bone fragility.Signs of RED-S and How to Spot Them Early
Watch for red flags like persistent fatigue, mood swings, stalled progress in training, or recurring stress fractures. Women might notice menstrual irregularities, while men could experience decreased testosterone. Early detection is key—regular check-ins with a professional can identify imbalances before they worsen.
Tips to Combat RED-S Through Smart Training
Fuel Your Body Right: Match calorie intake to training demands.
Balance Training Load: Incorporate rest days and vary intensity. Use progressive overload to build strength without burnout.
Strengthen Holistically: Focus on full-body workouts, including core and mobility training to prevent injuries.
Monitor Hormones and Bones: Get baseline assessments and monitor.
Integrate Recovery: My integrated manual therapy and training approach can help with NMSK pain and dysfunction.
Empower Your Athletic Journey
REDS doesn’t have to sideline you. By prioritizing energy balance through nutrition, smart training, and professional guidance, athletes can perform optimally and stay healthy. If you suspect RED-S or want to optimize your routine, reach out for a consultation.