REDs: How Eating Disorders and Sports Connect

Proper nutrition plays a key role in athletes’ performance, physical health and well-being. The amount of food, timing of intake, and macronutrient composition are all key when competing at the highest level. If an athlete’s caloric intake and overall nutrition are inadequate, they will experience low energy availability (LEA) and a condition known as Relative Energy Deficiency in Sport (REDS).

What is Low Energy Availability (LEA)?

LEA refers to a condition where an athlete does not consume enough calories to support the physical demands of their training and competition. This can be intentional or unintentional. Intentional LEA could look like decreasing caloric intake purposefully, increasing movement intentionally, or both done simultaneously. LEA can occur unintentionally for various reasons, especially if the athlete struggles with food access or other factors that may limit caloric intake, such as a busy schedule, dietary restrictions, or food allergies.

LEA can lead to a slowed metabolism in athletes, where the body struggles to regulate efficiently due to a lack of proper nutrients and energy. This can lead to bodily adaptations that are not favorable for athletes, including slowed heart rate, slowed digestion, and lack of hunger cues. These metabolic adaptations generally cause fatigue, bloating, constipation, or difficulty eating. 

Additionally, LEA can hinder athletic performance overall. This may look like decreased muscle mass or bone density, which can increase the overall risk of injury in athletes. Without proper energy and macronutrient intake, key drivers of athletic performance (such as muscle mass and bone health) can suffer, leading to possible long-term consequences such as osteoporosis or premature muscle degradation.

What is REDs?

REDs may result in impaired physical, mental, or emotional regulation due to this prolonged LEA in athletes, causing them to struggle to succeed in their sport.

REDs can occur in any athlete, including all gender identities, races, and body types. Development of LEA and REDs could be impacted by a lack of knowledge, team culture, the training environment, coaching behaviors, or pressure to perform well. Because of this, knowing the signs and symptoms of REDs is important to best support athletes.

Signs & Symptoms of REDs

After an intense workout or bout of exercise, energy can usually be replenished with adequate food intake and time for recovery. Without this, athletes may find themselves in a prolonged state of energy deficiency, leading to many adverse side effects experienced with REDs, including:

• Changes in reproductive health, including inconsistent menstruation in women and low libido in men.
• Increased risk of injury, such as stress fractures due to low bone density.
• Decreased immunity, which could lead to more illness.
• Slowed metabolism, meaning athletes’ bodies are working less efficiently during movement and while sedentary.
• Poor heart health that could result in dizziness or long-term heart rate changes.
• Increased mental health struggles, such as anxiety or depression.
• A preoccupation with food (an increase in “food noise”).
• An increase in fatigue and possible sleep disturbances.
• Possible GI disturbances, including slowed digestion, abdominal pain, and bloating.
• Impaired concentration on school or work tasks.

Preventing REDs

To avoid long-term health complications associated with REDs, athletes should focus on adequate intake and recovery methods. Meals and snacks should be built with proper nutrition, incorporating protein, carbohydrate, and fats in the proper proportions. A registered dietitian can help athletes ensure they eat enough to fuel their sport properly. RDs work with athletes to create consistent meal patterns with balanced meals that incorporate all food groups. Additionally, RDs can help athletes optimize nutrition by discussing meal timing and nutrient composition before and after exercise to ensure athletes are prepared for and recovering well from movement. Lastly, an RD will consider the different aspects that may influence an athlete’s eating patterns, including access to food, GI health, relationship with food, and more.

How to Treat REDs

REDs is a complex condition that can negatively impact an athlete’s sports performance goals and overall well-being. Registered dietitians and other care team members (physical therapists, sports psychiatrists, and physicians) can work together to ensure an athlete’s safety and well-being. REDs are best corrected using a care team as described above. Our team of registered dietitians at Healthier Tomorrows is trained to work with different members of the care team to improve our athlete clients’ sports performance and help these clients reach their goals in a healthy and safe way!

Citations: 

Cabre, H., Moore, S., Smith-Ryan, A., & Hackney, A. (2022). Relative energy deficiency in sport (red-S): Scientific, clinical, and practical implications for the female athlete. Deutsche Zeitschrift Für Sportmedizin/German Journal of Sports Medicine, 73(7), 225–234. https://doi.org/10.5960/dzsm.2022.546

2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs).

Br J Sports Med. 2023 Sep;57(17):1073-1097. doi: 10.1136/bjsports-2023-106994. PMID: 37752011.

Article by Mia Bailey MS, RD, LDN, CSN

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