Relative Energy Deficiency in Sport

Relative energy deficiency in sport (REDs) is a syndrome of impaired health and performance caused by problematic low energy availability (LEA): exposure that is prolonged, severe, or both.

The shortfall may arise from disordered eating, or inadvertently, when intake does not keep pace with a rising training load.

REDs affects male and female athletes at all levels, but is under-recognised in men, who lack the early signal of menstrual disturbance. It grew out of the female athlete triad (low energy availability, menstrual dysfunction and low bone mineral density) and extends it to more body systems and to men.

For the sport and exercise medicine (SEM) clinician the importance is largely musculoskeletal: recurrent bone stress injuries, slow healing, poor recovery and unexplained underperformance.