Relative Energy Deficiency in Sport: Is It Just Present in Athletes with Eating Disorders?
Relative Energy Deficiency in Sport or RED-S is extremely relevant in the athletic community for longevity and performance. RED-S is when there is not enough energy coming into the body as being used. This leaves athletes in a state of low energy availability (LEA) and can leave you with short and long term negative health impacts. RED-S is not limited to elite athletes or those in eating disorders treatment.
What is Relative Energy Deficiency in Sport (RED-S)?
When energy intake doesn’t meet the body’s energy expenditure, it affects both performance and health. RED-S expanded from the Female Athlete Triad. This was a concept that only accounted for female athletes that have lost their period, where not fueling enough and bone issues. RED-S has expanded to include all genders and broader physiological systems.
As an eating disorder therapist in NJ, I see how RED-S can occur with or without an eating disorder or intentional restriction. Intentional restriction includes dieting or pressure to maintain a certain body type. Unintentional under-fueling can be from busy schedules or misinformed nutrition beliefs. High training load without adequate recovery or fueling can easily put you in a place of low energy availability without the proper knowledge or information about fueling.
The Body’s Response to Low Energy Availability
RED-S can lead to both short term and long term consequences. So let's break it down by the effects on physical health, psychological and performance.
Physical
RED-S can impact all different systems in your body. This includes the immune system, gastrointestinal, cardiovascular, endocrine, reproductive, and metabolic. Symptoms are often seen are a loss of period in female athletes, bone stress injuries, GI issues, difficulty with recovery or getting sick often.
Psychological
This is sometimes one of the first ways to notice under-fueling. You may notice irritability, poor concentration, anxiety, isolation from friends or teammates or preoccupation with food.
Performance
Having difficulty recovering from workouts or frequent injuries is sometimes seen both short term and long term. Bone injuries have been shown to appear more frequently due to reduced bone density. Plateauing or declining in performance can happen as well.
It is important to remember that RED-S is the body’s way of protecting itself. It is not a failure of willpower. Every body responds differently to RED-S and signs can show up in different ways.
Why Athletes Are at Higher Risk
There is a certain culture that is emphasized in athletics of “no pain, no gain”. This can lead athletes to feel they need to push through fatigue or pain, despite it being a way their body is trying to warn them. Discipline and perfectionism are two characteristics that athletes often hold. These may feel as though they get them far in sports. However, it often holds them back. Misconceptions around what “healthy eating” or “clean fueling” looks like, leads you to have difficulty fueling enough or eating disorders in athletes. These dynamics can stem from external pressures from body image expectations or sports culture.
RED-S can look different in male athletes versus female athletes. It is often unrecognized and under-diagnosed in male athletes. This can cause issues such as decreased sperm count, delayed puberty, low libido, low testosterone, poor bone health or stress fractures, or stunted growth and development.
Recovery and Treatment
Having a treatment team to support your through RED-S recovery is extremely important. This includes a sports therapist, sports dietitian, physician and coach who collaborate on your care. There are three goals that are important in RED-S recovery. These include the following:
Restoring energy balance through adequate nutrition
Addressing underlying beliefs about food, body and performance
Reframing rest as part of training
These goals lead to finding a healthy balance to being a high performance athlete. Recovery is possible and leads to better performance in the long run.
An Eating Disorder Therapist’s Perspective
From my own experience as an eating disorder therapist working with athletes, RED-S seems to occur more often than one may think. Whether RED-S is connected to an eating disorder or an athlete not realizing just how much fuel they need for their level of activity, it is common. The emotional components of RED-S may not stem from wanting to be a certain physic or a fear of their body changing. However, there may be a fear of losing fitness or not being able to reach their athletic goals.
Healing your relationship with food, movement and performance is the key to healing and will only help your overall athletic potential. If you resonate with any of this, know that you do not need to figure this out alone. It is okay to not know how to properly fuel your body. Professionals, including eating disorder therapists and sports dietitians are here to help you through the process.
How to Support an Athlete Experiencing RED-S
This part is for coaches, parents and teammates. There is a high likelihood that RED-S is going on, on your team. It is important to focus on performance and wellbeing, not weight. I encourage open conversations about nutrition and recovery and the importance of eating and resting enough. Model a balanced attitude towards rest and fuel because athletes are watching.
For Athletes Looking for Support
I encourage you to reflect on your own performance goals. Are you fueling enough for your goals in order to reach your potential in sport and overall health? If you are looking for 1:1 support as an athlete, here are the steps to follow:
Contact Serendipity Counseling Services to schedule a free consultation.
Chat with Kate to find out if you are a good fit and schedule your first therapy appointment.
Get started on your RED-S recovery journey!
Not ready for 1:1 therapy? Check out the number of sports related podcasts that Kate is featured on about going through an eating disorder or RED-S recovery as an athlete. Join the “Retired” athletes support group if you are looking for extra support around your relationship with your sport or check out the many blogs on eating disorder recovery as an athlete.
About the Author: A RED-S Informed Eating Disorder Therapist in NJ
Kate Ringwood is a licensed professional therapist that focuses on supporting athletes through their fueling and performance journey. Kate’s experience as an athlete going through eating disorder recovery, led her deep passion for supporting others. Her background in nutrition and mental health offers the perfect combination of insight into helping you health from RED-S.
