Picture this: You’re driving a high-performance car, and there’s a sudden glitch in the engine. It looks fine from the outside, but something just doesn’t feel right when you’re behind the wheel. That’s what Relative Energy Deficiency in Sport (REDs) can feel like for many athletes. Everything seems okay on the surface, but underneath, your body might not be getting the energy it needs to function at its best.
The International Olympic Committee (IOC) recognized this problem and issued an updated consensus statement which has significantly expanded our understanding of the potential impacts of REDs on athlete health and performance (1). Along with the updated consensus statement, the IOC issued an updated assessment tool to help healthcare professionals identify and manage REDs—the IOC REDs Clinical Assessment Tool v2 which has since been implemented with more than 200 elite athletes (70 men & 143 women) identified 45% were at moderate, high or severe risk of REDs, with almost 1 in 10 (9%) falling in the high or severe risk category (2). And while you may not consider yourself an elite athlete, you could be at risk for REDs and not be aware of it.
So What Exactly is REDs?
REDs is a syndrome that occurs when there’s an imbalance between the energy an athlete consumes through food and the energy they expend through training and daily activities. It’s not just about being tired or not eating enough; REDs impacts almost every system in the body. Think of it like your car running low on gas—it can’t perform well, and over time, it starts to break down.
For athletes, REDs can lead to decreased performance, impaired bone health, menstrual dysfunction in women, reduced immunity, and a whole host of additional health issues which can also result in impacts to athletic performance. In short, it’s like driving that high-performance car with an empty tank—eventually, it’s going to stop. The health & performance impacts from REDs are summarized in the graphics below:
Health Impacts of REDs (1)
Graphics reproduced from Montjoy et al, 2023 with permission from BMJ Publishing Group Ltd.
Performance Impacts of REDs (1)
Graphics reproduced from Montjoy et al, 2023 with permission from BMJ Publishing Group Ltd.
REDs and Female Athletes
While REDs can affect all athletes, female athletes are particularly at risk with an estimated 1 in 2 or even higher at risk for low energy availability, the precursor for development of REDs (3,4). Sports that emphasize leanness or have weight categories, such as gymnastics, figure skating, and endurance running, often see even higher rates (4). This makes it crucial for female athletes and their support teams to be vigilant about recognizing the signs of REDs and addressing it promptly.
Why You Should Care (And What to Do About It)
Athletes often push their bodies to the limit, and while that drive is part of what makes you great, it can also put you at risk for REDs. By educating yourself on proper fueling, the signs & symptoms of REDs and partnering with knowledgeable healthcare professionals, you can ensure that you’re performing at your best. If you’re an athlete or part of an athlete’s support team, here are a few steps you can take:
- Get Educated: Learn more about the signs and symptoms of REDs as the more you know, the better you can prevent it!
- Get Assessed: Invest in a comprehensive sports nutrition assessment can help you learn how to fuel what you are doing and to avoid the health & performance consequences of REDs.
- Listen to Your Body: If something feels off, don’t ignore it. Partner with a healthcare team that understands REDs and uses the updated IOC REDs Clinical Assessment Tool. We highly recommend the multi-disciplinary team in the Wu Tsai Female Athlete Program at Boston Children’s Hospital!
Ready to learn how to fuel for health & performance? Schedule a complimentary information call to learn more & to schedule your comprehensive sports nutrition assessment. And don’t forget to sign up for the monthly Nutrify News to gain more insights on athlete health and performance.
References
- Mountjoy M, Ackerman KE, Bailey DM, et al 2023 International Olympic Committees (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs) British Journal of Sports Medicine 2023;57:1073-1098.
- Heikura IA, McCluskey WTP, Tsai MC, Johnson L, Murray H, Mountjoy M, Ackerman KE, Fliss M, Stellingwerff T. Application of the IOC Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool version 2 (CAT2) across 200+ elite athletes. Br J Sports Med. 2024 Aug 20:bjsports-2024-108121. doi: 10.1136/bjsports-2024-108121. Epub ahead of print. PMID: 39164063.
- Holtzman, B., Ackerman, K.E. Recommendations and Nutritional Considerations for Female Athletes: Health and Performance. Sports Med 51 (Suppl 1), 43–57 (2021). https://doi.org/10.1007/s40279-021-01508-8
- Jagim, A. R., Fields, J., Magee, M. K., Kerksick, C. M., & Jones, M. T. (2022). Contributing factors to low energy availability in female athletes: A narrative review of energy availability, training demands, nutrition barriers, body image, and disordered eating. Nutrients, 14(5), 986. https://doi.org/10.3390/nu14050986
