As athletes and students, we put our bodies through a lot of physical and mental stress. Whilst a little bit of stress is good for us, chronic stress and over exposure to high pressure environments, such as training, uni and work, can have a negative impact on our physical and mental health.  This along with the ‘type A’ personality trait of athletes -ambitious, perfectionists, highly self critical, and obsessive- and a culture that often praises pushing the limits, can put us at risk of burning out. 

What is RED-s? 

Relative Energy Deficiency in Sport, formally known as the female athlete triad, is a condition of low energy availability due to a negative balance between energy intake and energy output, resulting in a deficit. 

Low energy availability means you don’t have enough energy available to keep up with the demands of exercise, as well as normal bodily functions (eg growth, respiration and digestion). If this continues over a period of time, the body goes into ‘survival mode’ and ‘switches off’ some of these normal bodily functions in an effort to preserve energy. This can result in poor repair of muscle tissue (literally DOMs for days), poor bone formation, lack in the production of hormones as well as an increase in injury risk. 

A serious effect of RED-S in female athletes is the suppression of the menstrual cycle resulting in Hypothalamic Amenorrhea (HA). However, this is not a prerequisite for RED-S, some females experience RED-s without losing their periods. This also brings about the important message that males can also be affected by RED-S and can lead to a drop in testosterone levels. 

Who’s at Risk?


RED-S can affect any athlete, of any age, gender, weight and level. Endurance sports, very weight focused sports, and sports that involve a mixture of the two, tend to be at greater risks of developing RED-S due to the high energy output and pressure to look a certain way or meet a certain weight. In some cases athletes might just not realise how much food is needed to fuel their body. However many athletes may start to restrict their food intake to lose weight and change body composition, believing it will make them better at their sport.  

The RED(s) flags 

Physical signs

  • Unexplained lack of energy 
  • Sniffles and colds that won’t budge 
  • recurrent or persistent injuries (including bone and soft tissue)
  • Performance stagnation or decline 
  • Absence of menstruation (female)
  • Decline in morning erectile function (male)
  • Low libido 
  • Constipation or feeling bloated 
  • Growth of hair all over the body 


  • Increased irritability
  • Poor concentration 
  • Poor sleep pattern 
  • Constantly thinking about food 
  • Restricting or strict control of food
  • Fear of weight gain
  • Difficulties taking rest days 
  • Becoming withdrawn and reclusive 

The RED-S Clinical Assessment tool is also a useful guide for athletes or coaches concerned they, or someone they coach might have RED-S. 

Talking to a knowledgeable doctor or healthcare professional is very important if you think you may be experiencing RED-S. I’ve listed a couple of specialists in this field below and some good websites that give more information on this topic! 

Resources and support 

  • Dr Nicky Keay  Endocrinologist and RED-S researcher. Nicky is founder of Health4Performance and also works alongside Renee McGregor as a part of the EN:SPIRE Clinic 
  • Dr John Rodger  Sport and Exercise Medicine consultant specialising in overtraining,  mental health problems and nutritional deficiencies.
  • TRAINBRAVE A campaign with the aim of raising awareness of RED-S 
  • Athletes in balance A mentorship programme founded by Pippa Woolven. Her website provides good information on RED-S as well as her own experiences of it. 

Running in silence An American based community which helps to support athletes in the prevention and recovery of eating disorders in sport.