Is RED-S Preventing You From Making Progress in Your Workouts?

By: Jackie Confalone, read her bio below

Many people begin, or ramp up, their fitness routine with a specific goal in mind. But as the days and weeks pass, they’re feeling cranky, tired, and out of sorts. It seems like the harder they work at the gym or on the running or cycling path, the less progress they make.

So, what’s going on? You may be expending more calories or energy than you take in. “Since your body needs resources, it begins to “turn the volume down” on your hormone systems,” says Marci Goolsby, MD, a sports medicine physician at the Hospital for Special Surgery and medical director of the Womens Sports Medicine Center.

If you don’t do something, you can develop a syndrome called Relative Energy Deficiency in Sport (RED-S or REDs), says Rebecca McConville, MS, RD, a registered dietitian and author of the book ‌Finding Your Sweet Spot: How to Avoid RED-S by Optimizing Your Energy Balance.[i]

RED-S is a complex syndrome where your body adapts to conserve energy for its essential survival, and it’s the result of something called low-energy availability. Low-energy availability occurs when we’re not eating enough to support the exercise we’re doing.[ii]

Since your body uses up your calories on exercise, there’s not enough left in the tank to support your day-to-day bodily functions—and it leads to a cascade of health problems. Over time, RED-S can lead to weak bones and fractures, fertility issues, and cardiovascular complications.

But the overall population remains unfamiliar with REDs, and some misperceptions persist–that RED-S affects only elite athletes, underweight athletes, or those with disordered eating. RED-S may be even more prevalent among recreational athletes than in professional sports since everyday people don’t have the same coaching or medical support available. It’s not always intentional. We may not even realize how much energy we’re burning up in our workouts, creating a deficit without being aware of it.[iii]

What Are the Warning Signs of RED-S?

Symptoms that suggest an energy imbalance include:

  • Trouble sleeping or waking up hungry. This is especially common when you’re short on carbs, which your body needs to formulate the sleep hormone melatonin.
  • Mood shifts, including feeling sad, irritable, or wanting isolation.
  • Trouble focusing
  • Missing or irregular periods in people who menstruate
  • Low libido, especially in men
  • Frequent respiratory illnesses due to impaired immune function
  • Disconnection from your body’s hunger and fullness cues
  • Gut problems
  • Hair loss
  • Declines in athletic performance
  • Small injuries, or larger ones, including stress fractures[iv]


Who Gets RED-S?

Anyone can develop it. Elite athletes who train for hours each week can easily fall behind in fueling their bodies. But RED-S can occur in casual runners or gym members, especially if they’ve recently made a change in their routine.

“For some people, it’s a nutrition issue, and for some people it’s an exercise issue.” In other words, you can create a deficiency by either exercising more or cutting back on what you’re eating. “In most people, it’s a combination of the two,” states Rebecca McConville.[v]

Also, people who frequent high-intensity group fitness classes, such as a boot camp class, four or five days a week are putting a high demand on their body. Although they may not think of themselves as elite athletes, they’re asking as much of their body as a high-level competitor.

What if You Think You Have RED-S?

The good news is that almost everything is reversible when you’re adequately fed.

  • Talk to a health care provider trained in sports medicine, and work with a registered dietitian who’s certified in sports dietetics and has experience in treating RED-S. Look for the letters “CSSD” (Certified Specialist in Sports Dietetics) in their credentials and ask about their background. A CSSD can identify gaps in your nutrition, whether skipping meals or not getting enough carbs, protein or fats, and work to fill them.
  • Discuss changes to your fitness regimen: dialing down the intensity or increasing the amount of rest you take between workouts, for instance.
  • Complications such as missing periods and stress fractures may require more time and additional treatments. Be wary of physicians who suggest oral contraceptives to restore menstrual cycles; they don’t truly rebalance hormones or improve bone health. Instead, it’s important to treat the underlying cause by eating more, exercising less or both.

Healing can also require a mindset shift, including body-positive communication that focuses more on what a person’s body can do than what it looks like.

How Can You Prevent RED-S?

  • Choose an activity that complements your natural body strengths and suits you as an individual.
  • Do an energy audit from time to time. You don’t have to count calories, but be “calorie conscious,” occasionally checking that what you’re eating matches up with what you’re expending.
  • Appreciate your own healthy, active body. Don’t compare yourself to others, especially those portrayed in the media.
  • Think of fuel as the ultimate performance enhancer. Before choosing a weight-loss program, consult with a nutritionist for personalized recommendations to promote a healthy weight.
  • Don’t starve your bones. Part of your fuel mix should include several servings/day of good calcium sources: milk, yogurt, cheese, calcium-fortified juices, and soy products.
  • Use the exercise principle called “FITT.” This stands for frequency, intensity, time, and type. If you make a change in one of these areas — working out more often, for longer or more intensely — you need to bump up your intake to compensate.[vi]

Athletes and those who exercise recreationally shouldn’t accept RED-S symptoms as normal; they are a sign of dysfunction. A well-fed body is a resilient body. Give yourself enough fuel and the right kind of fuel to keep your body working at an optimal level.

[i] What Is RED-S? If You’re Underfueling, You Might Be At Risk | livestrong

[ii] Should you be eating more? (

[iii] Well+Good: Well-Being for Your Body, Mind, and Spirit | Well+Good (

[iv] What Is RED-S? If You’re Underfueling, You Might Be At Risk | livestrong

[v] What Is RED-S? If You’re Underfueling, You Might Be At Risk | livestrong

[vi] Relative Energy Deficiency in Sport (RED-S) | Health Promotion | Brown University

About Jackie Confalone:
Although retired from full-time work, Jackie is a freelance writer and has been a group fitness instructor for more than 35 years, the last 13 at Body Zone. She particularly loves working with seniors and people with chronic illnesses. She is nationally certified as a personal trainer and instructor for group fitness, Les Mills BODYFLOW, Pilates and SilverSneakers.

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