What is RED-S?

Relative Energy Deficiency Syndrome, or RED-S for short, is the difference between daily energy intake (food) - exercise energy expenditure, resulting in a state of low energy availability. In turn, this causes a range of varying physiological and/or psychological dysfunctions which can negatively affect sports performance and daily function.

Previously known as the ‘Female Athlete Triad’, this name was too narrow and categorised the syndrome as a gender-based condition. RED-S has no bias, and affects the general population and athletes of all kinds. Thus, screening for RED-S in men and women is necessary. The only differences surround asking about the regularity of a menstrual cycle. 

Multifactorial

Screening for RED-S considers

1. Impaired reproductive function

2. Impaired bone health

3. Impaired GI function

4. Impaired energy/metabolism regulation

5. Impaired hematological function

6. Urinary continence

7. Impaired glucose & lipid metabolism

8. Mental health issues

9. Impaired neurocognitive function

10. Sleep disturbances

11. Impaired cardiovascular function

12. Reduced skeletal muscle function

13. Impaired growth and development

14. Reduced immunity

Why It Matters

Without adequate energy intake, the body begins prioritising essential survival functions over performance and recovery.

This can lead to:

• Increased injury risk

• Reduced training adaptations

• Impaired immune function

• Long-term health consequences

How Intervention Can Help

Early intervention

• Aims to minimise and reduce exposure to negative and/or harmful behaviours associated with low energy availability

• Educational initiatives and de-promoting leanness in athletes of all kinds and the general population. 

The next step

• Early identification and management with the support of a multidisciplinary team to facilitate a healthy recovery environment. Preventing development of more serious RED-S outcomes before long-term complications occur

• Intervention at this stage considers self-reporting screening instruments, individual consultations with health professionals, and objective assessments related to RED-S markers. 

Tertiary intervention

• At the third level, determining the source to treat the low energy availability is key.

• We look towards involving the athletes health and performance team where available (this can include something as simple as parents, or a personal trainer), any relevant sports organisations, and any other stakeholders that influence a supportive and safe sporting environment 

A multidisciplinary team can include but isn’t limited to:

• Dietitians

• Coaches

• GPs

• Sports physicians

• Psychologists 

Treatment focuses on

• Balancing training and recovery

• Tailoring exercise programming

• Monitoring training load

• Returning safely after injury

• Building sustainable performance habits

Key Takeaways

✅ RED-S affects more than just elite athletes 

✅ Under-fuelling can impair both health and performance 

✅ Early intervention is important 

✅ Proper recovery and nutrition support training adaptations

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Post by Lizzie Cowden, 05/06/26