What is Relative Energy Deficiency in Sport (RED-S)?

Properly fueling yourself as an athlete, especially if you are an athletic woman over 40, can have a huge impact on your training, strength, and overall health and well-being. Understanding RED-S, or Relative Energy Deficiency in Sports, is a key piece of educational information I think every athlete needs to know about.

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If You are Concerned About RED-S, You Should:

1. Make sure you are eating enough protein and non-protein energy for your training
2. Work with a nutrition professional if you are struggling to gain clarity about what to do next
3. Seek a team approach treatment if you are intentionally under-fuelling

Understanding RED-S

You don’t have to be an Olympic athlete to deal with RED-S or the implications of low energy availability. RED-S transcends different populations and athletic individuals. This is why it is so important to gain a clearer picture of how RED-S is defined, the signs and symptoms of low energy availability, how it impacts your performance and health, and what you can do to fuel yourself for the best success and performance possible.

Fueling Properly Is Not Optional

I want to challenge you to think about the amount you are fueling yourself in comparison to your training schedule. By the time you account for the energy you have spent through exercise and how much you are eating, there are a lot of cases where we don’t provide our bodies enough energy to facilitate even basic bodily functions.

Fueling your body with enough energy to recover from training is incredibly important to basically every system you have in your body, from hormones to metabolism to menstruation. Low energy availability, or RED-S, doesn’t just affect what is going on in the gym; it also has serious implications for your overall health and well-being.

What did you think about this topic? Have you ever struggled with low energy availability? Let me know your thoughts in the comments below.

In This Episode

• What is RED-S and why you should know about it (5:06)
• Why is there a different name associated with the female athlete triad (7:22)
• Understanding low energy availability and the causes of RED-S (10:22)
• Physiological signs that you may be dealing with low energy availability (19:19)
• The possible impacts on your training and performance when it comes to RED-S (24:40)
• What to do if you suspect you are in a state of low energy availability (28:29)

Quotes

“We are trying to fuel, we are trying to eat better and fuel our performance. And at the at the same time, it is revolutionary, talking about actually eating enough as female athletes.” (2:53)

“RED-S is more inclusive in terms of what the physiological implications of low energy availability happen to be. It is more expansive in terms of how this could potentially be affecting someone’s performance and also their health and wellbeing.” (9:18)

“The physiological impacts when it comes to under eating, especially if we have a high amount of physical activity and exercise, can accumulate quite quickly.” (17:00)

“We just need enough energy in order for us to get the output in our training so that we will see the beneficial adaptations.” (23:57)

“You need to eat enough to cover your training and also your basic bodily needs. And that includes both protein and non-protein energy.” (28:41)

Featured on the Show

Schedule A Call About Strength Nutrition Unlocked Here

IOC consensus statement on relative energy deficiency in sport (RED-S)

National Eating Disorders Association Website

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FYS 367: 5 Strength Nutrition Lessons I Wish I Learned a Decade Ago

FYS 350: Are You Eating Enough? Low Energy Availability in Sport

What is Relative Energy Deficiency in Sport (RED-S)? Transcript

If you’ve listened to this podcast for any length of time, it’s no secret that I talk a ton about properly fueling yourself as a female athlete, especially if you’re an athletic woman over the age of 40, there is still so much awareness to bring to all of you. I talk a lot about low-energy availability. And today on the podcast, I’m going to be talking about its outcome or potential outcome, better known as RED-S. If you’ve never heard of RED-S, then this is absolutely a podcast that you need to hear. And by the end of this episode, you’ll have a clearer picture of what it is, how it affects your performance and your health, and more importantly, how to fuel yourself for success and performance.

If you’re an athletic 40, something woman who loves lifting weights, challenging yourself, and doing hard shit, the fuel your strength podcast is for you. You’ll learn how to eat, train, and recover smarter, so you build strength and muscle, have more energy, and perform better in and out of the gym. I’m strength nutrition strategist and weightlifting coach, Steph Gaudreau. The Fuel Your Strength podcast dives into evidence-based strategies for nutrition training and recovery, and why once you’re approaching your 40s and beyond, you need to do things a little differently than you did in your 20s. We’re here to challenge the limiting industry narratives about what women can and should do in training and beyond. If that sounds good, hit subscribe on your favorite podcast app. And let’s go.

Welcome back to the podcast. Thank you so much for being here today. And make sure you hit subscribe on your podcast app. Thank you so much for doing that. today’s podcast is all about RED-S. And this episode was inspired by a couple of things. First of all, if you are at all connected in with the CrossFit community, maybe you saw the rogue invitational happened fairly recently. And everybody’s favorite strong woman, Danny Spiegel wearing a crop top that said, Girls Who Eat and everybody lost their minds, including me and I said I want that shirt. Sidenote, she’s going to be selling them at Wadapalooza. So whenever that happens, I think it’s February she’s going to be selling those shirts Girls Who Eat.

But it was so interesting because it’s almost like this rally cry, we’re trying to fuel we’re trying to eat better and fuel our performance. And at the same time, it’s like, revolutionary, right? Talking about actually eating enough as female athletes. The second thing that really inspired this is that every time I talk about low energy availability, and I’ll kind of mentioned read s, in conjunction with that, I always get a ton of people who are like, I have never heard of this. Why have I haven’t I heard about this thing? I didn’t even know this was a thing. So I really want to make sure that I bring this to you today as an educational piece. And really would ask you if you have somebody in your life who needs to hear this besides just you that you share this episode with them. Because this really transcends so many different groups of people and groups of athletes or athletic individuals. So please make sure that you share this if you found it to be useful.

Now, of course, if you’re listening to this, and you think, okay, I need, I need some guidance with this, I need a framework where everything plays together, the nutrition and the training and the recovery, and the stress management. And I just need someone to lay it all out in a system that works, then I want you to go ahead and schedule a call with the team to chat with us all about Strength Nutrition Unlocked. This is my signature group program. It’s freaking amazing. And it is full of so many women over 40, probably just like you who are like, I know something’s not right with the training that I’m doing with my workouts. I really want to get stronger to build muscle and perform better in and out of the gym. I want that energy back, then you can go ahead and book a call with us at StephGaudreau.com/apply.

All right, so let’s go ahead and jump into RED-S. So I’ve done lots of episodes in the past on low energy availability, or it’s come up as part of those conversations and we’ll link those episodes in the show notes for this podcast. But low energy availability is very common. We’re going to actually define that a little bit more specifically in this episode and then give some caveats but I really want to start off by talking about what is RED-S.

So RED-S is an acronym that stands for relative energy deficiency in sport, relative energy deficiency in sport. So this was really popularized and kind of came to a lot of consciousness in 2014. And then again in 2018, as part of an IOC, International Olympic Committee, sort of statement on RED-S and acknowledging that this is something that is happening in athletic populations. Now, you don’t have to be an Olympic athlete to deal with RED-S or the implications of low energy availability. So just set that aside for now, because you’re probably thinking, Yeah, but I didn’t go to the Olympics, and I never will.

That’s okay, this stuff still applies to you. So, RED-S is a relatively new term. But you may have heard of a related and sort of nested idea called the female athlete triad. female athlete triad was first identified in 1992. So I am 43. I graduated high school in 97. And a lot of you who listen to this podcast are just a little bit younger or older than me. And so you may have been a teen or young adult may be in college or college-aged when you first heard the term female athlete triad. Now, the female athlete triad, as the name implies, triad, three things was originally characterized by three main points, the first A Maria, the loss of menstruation, the second osteoporosis, so which is reduced bone density, and then the third, disordered eating or disordered eating patterns, or in some cases, eating disorders. So that was the female athlete triad that was introduced or identified in 1992. So why is there a different name?

Two reasons. First of all, it was elucidated through studies and research. And of course, people in the field working with all athletes, that this is not that the implications of low energy availability are not just something that affects females. So yes, male athletes can also be affected by and experience the ramifications of low energy availability. So in a way, RED-S is much more inclusive and says that all athletes, all athletic individuals, can really be affected by low energy availability. Now, of course, there can be differences in the reproductive implications. And there’s actually some differences in terms of what are the cut-offs of low energy availability, and we’ll mention those in a little bit. However, it was really a hat tip to say, hey, this stuff affects all athletes.

Secondly, it expanded the effects or symptoms, if we want to call it that have this low energy availability state beyond just the triad beyond just the A Maria, osteoporosis or in some cases, osteopenia, and the disordered eating slash eating disorders. So RED-S is more inclusive in terms of what the physiological implications of low energy availability happen to be. It’s more expansive, in terms of how this could potentially be affecting someone’s performance, and also their health and well-being. So if you want to picture a circle or a trip, I always think about the trivial pursuit for some reason, I guess I played it a lot as a kid growing up, but if you want to pay for a trivial pursuit pie, then female athlete triad is like one slice of the pie that’s nested amongst all of these other signs or signals or symptoms of low energy availability leading to this syndrome, relative energy deficiency in sport.

Okay, so I hope that kind of explains where this came from, and what it stands for at least. So let’s now dig into the part where we talk about what causes RED-S. And then we will then talk about what are some of the impacts on training, performance, health, and well-being. And then what do we do about this? All right, so let’s kind of dive into that low energy availability or energy availability, state. So the simplest way to describe what energy availability is, is how much energy is left over after you subtract out the amount that you spend through exercise. That’s basically your energy availability. Now, more specifically, in this context, what it’s really saying is, by the time we account for the energy we have spent through exercise, we compare it to how much we’re actually eating, we can see in many cases, that there is not enough energy left over to run our basic bodily functions.

These are our core physiological functions that relate to health and well-being. We’re not even talking about performance. You know, at that level, we’re really talking about the energy that’s there to really run your body’s basic functioning. And of course, a lot of athletic folks are also concerned about performance. So performance is affected also, by your energy availability. Now put it as an equation, there is an equation that is conceptually at least there to help people understand. But I want to caution you that the tendency for a lot of people is to want to turn this into your body as a spreadsheet, plug, and chug. And that’s not how human bodies necessarily work in every circumstance. So there are going to be those of you out there, I know who you are already.

You’re like, Oh, I’m gonna plug in the numbers and run the numbers. And you know, it’s fine for illustrative purposes. But we have to know that there are limitations to any kind of equation like this, because a lot of it is it’s either conceptual, or it’s measured across broad groups of people, it may not necessarily represent individuals. And when it comes to optimal energy availability, science is still trying to figure some of this stuff out. We’re getting further and understanding where the thresholds might be for low energy availability. However, it’s not always perfect. And science is always changing. So let’s just caveat it that way. So the estimate for where are the cut-offs for low energy availability? Because this is a question everybody always has.

Well, how do I know if I’m there, I think it’s important to take stock of how you’re feeling and how you’re performing. And again, not just in the gym, but for the rest of your life. But also, when we’re taking a look at the actual cut-off for low energy availability that’s been proposed as the threshold, we see that in females, that number is about 30 calories, per kilogram of fat-free mass. If you’re below that, that’s kind of the low basement cut-off for low energy availability, which, interestingly enough for most individuals, roughly averages, what the resting metabolic rate needs would be for that individual. So that’s very, very interesting.

Males have a lower threshold meaning low energy availability in males is a lower number, meaning oftentimes, they can get away with slightly less energy intake before it becomes an issue. So this comes into play sometimes when I see women come to work with me, and maybe they’ve followed advice from their, their trainer, or they were just copying their male partners, food log or something, I don’t know, like, they figured out their macros or whatnot. And they’re like, I can’t figure out why I feel like absolute dogshit, my partner is doing fine. Again, everybody is different. However, the female body because of the influence of hormones and physiological differences, is less tolerant of that lower energy availability.

We see all sorts of perturbance in reproduction, and all of the things that we’ll talk about here in a moment, but interesting to know, and I’m going to quote part of the IOC paper, and I’ll also link that in the show notes. The IOC paper says although some caveats are noted in relation to differential responses of various body systems. Many of these systems are substantially perturbed at an energy availability below 30 kilocalories per kilogram of fat-free mass per day, making it historically a targeted threshold for low energy availability. However, recent evidence suggests that this cut-off does not predict Amen. Maria, in all women.

Okay, so again, sometimes, you know, we used to think, Oh, well, as long as you’re not some Ultra lean body fat percentage, that you would be fine, you wouldn’t have any interruptions to your menstrual cycle, that’s not necessarily true. We can’t just predict and say, Oh, well, you’re a slightly higher body fat percentage, so you’ll be fine. So, of course, there are, like I said, individual differences here. The optimal energy availability that’s been sort of elucidated through research, is somewhere around 40 to 45 kilocalories per kilogram of fat-free mass per day. So we had 30, as being kind of the low energy availability kind of clinical cut-off. And then we have 40 to 45. Different sources and different papers give a different number, I’ve seen both.

And somewhere in between would be kind of that like reduced energy availability, or what might be termed subclinical. So between 30 and 40 kilogram kilocalories per kilogram of fat-free mass, all of this is to say that, and again, I think when it comes down to practical implementation, one day of random, not eating very much is probably not going to have a huge effect. However, the physiological impacts of eating, especially if we have a high amount of physical activity and exercise can accumulate quite quickly. This isn’t we’re not just talking about years here. In some cases, we’re seeing changes happen within days. Okay, so when this becomes a chronic state of low energy availability, that’s when we start to see issues, especially when we’re hitting that below that clinical cutoff. Right? So now, y’all know why I harp on this shit so much, is because I was this person.

I was this person in a state of low energy availability. Right. So this isn’t just a nice, like, oh, women need to eat more, or athletes should be fueling. And, you know, some pie-in-the-sky idea. These are scientific principles. This is sports, nutrition, 101 here. So it’s really, really important that if we’re out there, where we’re training hard, we want to perform at whatever our sport is, or our physical pursuit, we have goals for ourselves, we want to build that muscle, because we’re insurance shit, not going to build muscle in a low energy availability state when our body is catabolic as fuck, then we need to eat.

And so this is why I, I am honest, and this is like probably the hill I will die on is that we need to eat enough, we need to eat enough, then there are some, of course, nuances past that, right? Like we need enough protein energy compared to carbohydrate and fat energy. Like, there’s a lot of stuff here. However, it’s really, really important that we are at least getting enough caloric intake, not just to support, you know, our squats and snatches in the gym, but that our body is going to run optimally or run well. And we’re we stay healthy. This isn’t just a, you know, we want to eke out the last one or 2% performance this is a health and wellbeing issue.

So what are let’s kind of transition what are some of the possible impacts on your training and your performance? So let’s check off that first. And then we’ll go and look at the other broader impacts on health. So, when it comes to training and performance, what are some of the things that we can see from low energy availability? And what are some of the signs I guess you can call them of being at risk for RED-S? So first of all, we see things like reduced strength, I mean, we just cannot lift as much or we cannot, we have reduced power output we cannot go as quickly we can’t move as fast, and our muscles fatigue much more quickly.

We’re hitting a wall or bonking or just not able to complete the workout as expected. We often see that the actual size of our muscles starts to decrease. And this has to do with a lot of different things, including the effects of cortisol and you know, the reduced muscle protein synthesis that we’re experiencing, especially if our protein intake is too low. So the ironic part in this is that, as an endurance athletes, we’re always had it drilled into our heads power to weight ratio, power to weight ratio, meaning be really light, and lean, and small, but very powerful, very, very much able to go up hills quickly on a bike or run much faster, or put the hammer down when we needed to. And the terribly ironic part about that is that when you’re losing your muscle, oftentimes, you will see your strength reduces and your power output declines.

So chasing this excessive amount of leanness or making that the prize at all costs, will often have a reduction or have had a decline, have you seen a decline in your performance? I experienced this absolutely firsthand. And I see this just in so many people. And I’ve talked on this podcast in the past, and I’ve brought it up a couple of times, about female athletes in the Olympics, and their teams, sports dieticians or coaches recognizing, hey, we’re not, they’re not eating enough. And they ate more. Particularly, I’m thinking of one of the Team USA I think she’s the heptathlete. And then also team New Zealand, they’re some of their rowing team. These women began to eat more and they got better at their sports. I mean, who knew? Right?

But seriously, right, we’re seeing things like a decline in muscle strength or muscle size we’re having that is called atrophy folks, right muscle loss of muscle size, it’s called atrophy. atrophy is not what we want. So oftentimes, we’re seeing kind of this reduced energy availability, or relative energy deficiency, working against the exact goals that we’re trying to accomplish. By eating less, we do not recover as well. Again, we need energy for recovery, we have to replenish muscle glycogen, and we have to get the process of muscle protein synthesis going so that we have an overall greater muscle protein synthesis rate compared to muscle protein breakdown, or else we’re going to stay in a breakdown state. And when we cannot recover, we run the risk of overtraining. Injury, including muscle and soft tissue like ligaments and tendons.

Oftentimes you’ll see more strains or overuse injuries, you might see stress fractures, this happens a lot. And actually, there was a 2016 study out of New Zealand that looked at recreational female exercisers, not professional athletes. And there was a significant number, look a statistically significant number of women in the study who had stress fractures, and who were at risk for low energy availability category coincidence. Probably not. So that’s important to note, you know, we have to have the energy to actually get the adaptations of our training, whether that’s strength training for our muscles, or cardiovascular training, such that we’re trying to improve our efficiency, we just need enough energy in order for us to get to have the output in our training such that we’re going to actually see the beneficial adaptations.

So poor training, adaptation, decreased endurance, we see reductions in things like coordination, which can actually further increase injury risk, we see increased rates of illness, and again, this is kind of venturing into the health and well-being. However, things like being more at risk for upper respiratory infections can absolutely cut into your training time and your training schedule, decreases in concentration, mood swings, and irritability, it just runs the gamut, right? So these are all again, things that we see our impacts on training and performance. Now, what are the possible impacts on health and well-being if we zoom out and we look at some of these physiological symptoms, and slash physiological processes, right, we said earlier that when we’re in low energy availability, we are not eating enough such that we’re spending a good portion of our energy intake on exercise and there’s not enough leftover to run our basic bodily functions?

So we see possible impacts on health and well-being including endocrine function. So hormonal function, including issues with ovulation and menstruation in females. And that’s a big one. It’s a big one. But like we said, There’s no magical number that applies to everyone that says, Oh, well, we can exactly predict because, you know, this would result in this amount of energy would result in a Maria, for example, it’s not across the board, we see issues again with bone health. And again, I want to throw out my favorite macronutrient protein. But seriously, protein is really important in bone health as well.

So that’s just kind of a side note, we see issues with metabolic adaptation, and not in a favorable direction, but rather pushing metabolic adaptation in a direction that we just overall are subsisting on fewer and fewer calories, and it’s affecting things like our NEET levels. So that’s nonexercise Activity Thermogenesis, of course, it’s impacting our exercise Activity Thermogenesis and how much energy we are able to put out during our training, right, where we’re just not moving as much, we’re not moving as heavy loads, we have fewer muscles, or using less energy to actually contract our muscles, we’re seeing impacts to things like, you know, eating less, so the thermic effect of food goes down.

And our basal metabolic rate also can decline. So we’re seeing overall impacts to metabolism, iron deficiency, so common, I’ve mentioned this on another podcast, but I was looking back at my Facebook memories like one does. And I saw a post from 2010, maybe 2009, somewhere in there, when I was definitely doing endurance training, up up the wazoo, and also not eating enough. And I made a post on Facebook that said, I’m iron deficient. And I just thought that was really weird, because I always thought I ate quote, unquote, healthy, but turns out, when you don’t eat enough food, you’re also put yourself at risk for nutrient deficiencies, including iron, which is very, very common, especially amongst endurance athletes, we have impacts to digestive function I hear so often from clients, that they’re just really, you know, constipated or backed up, or they just can’t seem to have even normal bowel movements, or they get lots of bloating and intestinal discomfort.

And oftentimes, it’s because there’s not enough moving through the system. And certainly being too low and Viber, of course, but digestive function can, of course, be affected immunity and immune function kind of mentioned that earlier, cardiovascular health, we see again, disordered eating or eating disorders being looped into this as well, and overall psychological well being. So there is a lot here, that can potentially be the result of low energy availability, especially on a more chronic level. And of course, it’s not just affecting what goes on in the gym, or what goes on in our training sessions. This has potentially serious implications for our overall health and well-being, as I just mentioned. So what do we do about this?

Well, you know, the basic take-home message here is that you need to eat enough to cover your training, and also your basic bodily needs. And that includes both protein and nonprotein energy. When I say nonprotein or energy, all I mean, are carbohydrates, and fats. And yes, having enough overall calories coming in is kind of, again, sports nutrition, 101 needs to make sure there’s enough energy coming in, compared to what’s going out. However, I see this quite frequently that the protein energy is way too low, way too low for athletic people, especially for protecting muscle mass as we’re aging. And we’re training on top of that too in most cases. So on some level, there does have to be a discussion of what those kinds of ratios are in terms of protein intake and nonprotein energy. So we need enough energy from protein and we need energy from nonprotein energy.

That being said, protein is really a macromolecule or macronutrient. of building. So it’s it plays a much more minor role in energy production. It can be used for gluconeogenesis. However, when I say protein energy, I just mean the energy that you eat, that comes from the macronutrient protein. Okay, so that stuff is all very, very important. And, you may or may not be able to address that on your own. Quite frequently I see that people just need a little bit of support, a little bit of guidance, to work through some of their own mind trash about some of this, like, Oh, if I eat more, I’m automatically going to get heavier like just all of the stuff that comes with having to implement change in your routines and your habits.

And frankly, that’s the stuff that we do in Strength Nutrition Unlocked. So come and hang out with us, at StephGaudreau.com/apply. However, there’s kind of two other tracks that I want to talk about here. You know, if you’re unintentionally under fueling because you just didn’t know you just don’t know what you need, then I would really recommend that if you feel like this is something you’re not capable of tackling on your own, you’re just busy, you have a lot going on.

You’re not a nutrition professional. And even sometimes, coaches need coaches too. But it’s, you know, you’re gonna get clarity, and you’re going to get a sense of what to do next and focus. If you consult a professional for guidance and coaching. Again, a lot of times, you’re just unintentionally doing this, and you don’t realize it, and you kind of need someone to bring you back down to earth and help you figure out well, you know, realistically, what kind of energy intake do I need? Realistically speaking, what does that look like in terms of macronutrients?

Realistically, what does that look like in terms of putting food on a plate, even if I don’t want to count macros, let’s not say like, we need to just get clear that that’s not required. And I even teach my students how to do all of this without counting their macronutrients or, or keeping track of macros, if you will. So guidance can go a really long way in getting you to your goals, or resolving some of this stuff a lot faster. And I will say the biggest thing that I see with my students is that almost immediately, I’m talking about within one to two weeks, sometimes days, their energy throughout the day gets so much better because they’re not under fueling.

Okay, so I always recommend that if you feel like this isn’t something you can tackle on your own, you’re just like, oh my gosh, I didn’t know this was it was a thing, and like, go talk to somebody who can help you. Now, if you are intentionally under fueling, especially if you’re really worried about potentially something like a weight class sport, or you felt pressure in order to stay small, or whatever that happens to be and you’re intentionally under eating, especially if we’re talking about disordered eating, and eating disorders, it’s really important that you work with a professional for treatment, someone who is skilled and trained to help athletes.

And more than likely that’s going to require a team, a team effort, or a team approach. To help you start to replenish the nutrients that you need to really prioritize or treat any health problems that have popped up as a result of this, and to get you moving back toward a plan to get back to your sport. So I just wanted to throw that out there too. There is no shame in realizing that you need help. And I will go ahead and toss out. The website for any da or NIDA, which is the National Eating Disorders Association, is National Eating disorders.org. They have a screening tool and a helpline on their website if it’s time for you to take next steps.

Thanks so much for being with me today. We covered a lot of ground on this podcast, we talked about what is RED-S. And where did it get its origins, where the hell did it come from? We also talked about how we really define what is low energy availability or energy availability in general, and how the amount of energy that you take in can potentially lead to a state of RED-S. We also talked about possible impacts on training and performance, as well as physiological impacts on health and well-being. And then we talked about what to do if you suspect that you are in a state of low energy availability, or you just need guidance with how to properly fuel yourself for your performance, but overall, for your well-being. I really appreciate that you’re here.

Thanks so much for being with me on the show today. Please hit Subscribe on your podcast app. And if this podcast episode helps you out, please share it. You can tell a friend or a loved one or a training partner or your coach or you could share it on Instagram stories and tag me at Steph Gaudreau I would really love to hear what you have to say about this podcast and how it has impacted you. You can get the episode show notes over on StephGaudreau.com And of course, if you’re ready to work with me on this yourself, then you can go ahead and find out more at StephGaudreau.com/apply Thank you so much for being with me today on this really important episode. And until next time, stay strong.