RED-S Prevention

By Wendy Sterling, MS, RD, CSSD, CERDRD-S

Relative Energy Deficiency in Sport (RED-S) is common and occurs when there is a mismatch between energy intake and energy expenditure. This has a big impact on every system of the body including metabolism, menstrual function (and hormones in general), bone health, immune function, cardiovascular health, gastrointestinal health, and growth and development.  There is negative effect on mood (more irritable, depressed and anxious).

And not surprisingly, sports performance suffers! There will be reduced muscle strength, decreased endurance, increased injury risk, decreased training response, impaired concentration/coordination (a big deal in precision sports, or dance, gymnastics where concentration matters). Of course this can carryover to academic performance too. 

Prevention is Key!

Some tips here:

  1. Take rest days: I usually recommend 1-2x/ week. Really resting the muscles is recommended to allow for the parasympathetic nervous system activation. Examples of rest day activities include: stretching, yoga, short walks. But mostly, trying to relax!  You might “catch up” w/ food on these days, if you didn’t eat enough on training days. 
  2. Eat every few hours: This helps to stimulate the metabolism, and keeps body fueled. By eating regularly, this will also line up well with your pre and post workout snacks
  3. Include all food groups (carb, proteins, fats, veg/fruit, fats, and dairy or dairy alternative). Take a full plate of food, and eat it! This keeps meals balanced and “enough.”
  4. Add fats: This can help boost testosterone levels and estradiol levels. Fats are also necessary to absorb Vitamin D which is necessary to absorb calcium.  Bone health is at risk if hormone levels are low. 
  5. Add extra fuel for added workouts!  
  6. Track menstrual cycle: Download an app to track your menstrual cycle. This will help you notice when there is a chance in your cycle (both in length of cycle,  flow, and time between cycles). Check out free apps like Period Tracker, Period Diary, or Clue. 
  7. Talk to a sports dietitian to help you assess your energy balance needs. Look for a “Certified Specialist in Sports Dietitian” (CSSD) or a “Certified Eating Disorder Registered Dietitian”(CEDRD) to who can also help with energy balance.  
  8. Talk to an MD (who can assess vitals, lab work etc  and see if there are concerning changes) and a sports psychologist (who can make sure you mindset is in okay).  Make sure mindset and stress are okay throughout the grind of the season. 


Read about Relative Energy Deficiency here.

RED-S is a Real Problem for Runners

The Athletes Starving Themselves for Success (BBC) RED-S

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