Column: Explaining Relative Energy Deficiency In Sport

"It's time to prioritize health and act on the signs of RED-S when we see them. Seeking help pays off BIG TIME in the long run and I say that sincerely from personal experience."

In honor of eating disorder awareness week, I wanted to bring awareness to two extremely important and under-discussed topics in the world of running: Disordered eating, and the Female Athlete Triad, which is more commonly known as Relative Energy Deficiency In Sport (RED-S) syndrome.

I have personally recovered from RED-S, so I speak on this topic from personal experience.

Having experienced RED-S and having struggled with amenorrhea (irregular/no menstruation), I have learned so much on this topic and become extremely passionate about helping other athletes who also may struggle with similar issues. 

The reason this disorder is SO important to discuss in the running world is because it is extremely overlooked. Symptoms of RED-S have become a "norm" at all levels of the sport, that even recognizing an athlete with this syndrome can be an extremely difficult task. 

What Is Relative Energy Deficiency In Sport? 

Relative energy deficiency in sport (RED-S) occurs when athletes consume too few calories for their activity level. Without any available energy, an athlete is unable to support the full range of body functions involved in health and performance

- Ref. University of Kansas Health System

In 2014, the International Olympic Committee (IOC) coined the name RED-S to diagnose what used to be called the Female Athlete Triad. The 'Female Athlete Triad' is characterized by three major signs: Amenorrhea (lack of/irregular periods), low energy availability (disordered eating), and low bone density (osteoporosis). It is when the athlete has or has had at least one or a combination of these symptoms that they are susceptible to the long-term -- and possibly short-term depending to what degree you experience these symptoms -- effects that this disorder can have.

RED-S can impact both men and women, and there are both physical and mental components involved. If left untreated or disregarded, it can have serious implications on your running career and life outside of sports. 

In RED-S, the body is in a major deficit of energy. As the body slowly breaks down from a lack of resources and a missing menstrual cycle, signs often go unnoticed or can be easily attributed to something else, like being stressed or sleep deprived. But the difference in RED-S is that general fatigue persists all of the time, no matter what circumstances change in your daily life.

Here's the problem, though: I resisted changing my eating habits because I was performing well, which is something I will forever regret because my performances were short lived and unsustainable.

One of the most common signs is when an athlete feels abnormally sluggish and low on energy during AND not during physical activity. Other signs may be losing a period, frequently getting sick, losing weight, restrictive eating and unhealthy eating habits, increased irritability and getting injured. 

In my personal experience with RED-S, it wasn't until I was injured that I even realized how I was being affected. A lot of times you may not even realize you are low on energy, because you don't know the amount of energy that you COULD have. I started dying in races, but it wasn't until much later that I realized it was because I was under-fueled and my body was depleted of energy. 

Looking back, this should have been the biggest red flag for RED-S. I did not get my period, I drastically lost weight and I knew I had an unhealthy relationship with food. Here's the problem, though: I resisted changing my eating habits because I was performing well, which is something I will forever regret because my performances were short lived and unsustainable.

Pretty soon, the slow and steady breakdown of my body caught up with me, my performance began to decline and I eventually got my first bone injury. 

Bone injuries occur as a result of the "low bone density" component of the Female Athlete Triad. As runners, we need so much fuel to meet the energy demands of both getting a regular period and the intensity of distance running training.  Missing a period should NEVER be considered normal just because you are training hard. As a result of not getting a period, our estrogen levels decrease. This is the hormone that keeps our bones healthy and strong. Therefore, when we aren't getting a period, our bones become weak and are at an increased risk for fractures.

This is a major sign of RED-S, or being in an energy (caloric) deficit, and it's why we need to be more aware of the signs before it gets to this point. 

I share this information along with pieces of my personal experience because I want to encourage runners to achieve their goals as strong and healthy women.

It's time to prioritize health and act on the signs of RED-S when we see them. Seeking help pays off BIG TIME in the long run and I say that sincerely from personal experience.

I wish I had somebody tell me these things throughout my struggles with RED-S, because I learned that nothing can be accomplished if you aren't healthy enough to get to the starting line!

Jessica is a 2019 graduate of Old Saybrook (CT) High School and a junior at the University of Delaware. She was a multiple-time CIAC State Open and CIAC Class Class S Championship qualifier and placer, and held PRs of 2:22.78 in the 800m and 5:07.42 in the 1,600m. This is the beginning of a monthly series where Jessica writes about important and wide-ranging subjects involving young and developing runners.