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7 Signs You Should Be Assessed for RED-S

By: Reese Dait, Temple University Dietetic Intern

RED-S is a term you may have heard before if you participate in sports or physical activity. RED-S stands for relative energy deficiency in sport and can have detrimental effects on your physical health and mental well-being. RED-S stems from another condition called low energy availability (LEA). LEA occurs when there is inadequate energy (calories) to support the functions required by the body to maintain optimal health and normal function. Here are 6 signs you may be suffering from RED-S or LEA:

  1. You’re feeling fatigued more quickly during exercise or feeling low energy levels throughout the day: During exercise and physical activity, the body uses its stored energy sources and the main goal after exercise is to replenish those stores. When physical activity increases, it’s important to be intentional with food choices to keep up with the body’s energy needs. If you can’t seem to get through the day without several cups of coffee or you can’t make it through a normal practice, this could be a sign of under-fueling.

  2. You have disrupted menstrual functions: RED-S and LEA can lead to the disruption of gonadotropin releasing hormone which eventually results in disturbances in menstrual functions. This condition also contributes to impaired bone health, especially in female athletes.

  3. You notice a decrease in your athletic performance: LEA is associated with factors which negatively influence athletic performance including illness, injury, iron deficiency, and impaired cognition. You may notice you’re sick or injured more frequently. You may also have trouble making sport decisions or performing sport-specific skills. LEA can also make it challenging to make muscular gains because it impairs glycogen storage and protein synthesis. Without proper nutrition intake, your body can’t perform optimally during sport.

  4. Your muscles are constantly sore or take longer to recover after exercise. You may also notice a decrease in muscle mass: Inadequate caloric intake, LEA, and RED-S can negatively impact muscle contraction, growth, and repair as well as cardiac function. These factors influence how your muscles perform during exercise and how they recover afterwards.

  5. You’re consistently dehydrated or notice electrolyte imbalances: RED-S can lead to severe dehydration and electrolyte imbalances. This may present as irregular heart rate, confusion, dizziness, or blood pressure changes.

  6. You notice negative changes in your mental health and mood: Consistently under-eating can have a negative impact on your mental health. It can increase symptoms of anxiety and depression and reduce your overall well-being.

  7. You experience GI distress in and around training.RED-S can impact your metabolic hormones including insulin, cortisol, and ghrelin which can leave your

GI tract feeling upset or uncomfortable. This may present as bloating, indigestion, gas, and constipation.

If you are experiencing some of these symptoms, it’s a good idea to be evaluated for RED–S. The team of dietitians at Balanced Nutrition can help rule out other related conditions or recommend a plan to help you fuel properly for exercise and day-to-day life.


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