Although the diagnosis of Relative Energy Deficiency in Sport (REDs) is relatively new (it was first coined by the International Olympic Committee in 2014), we are not new to understanding how to treat the symptoms that make up REDs. In fact, the medical field has decades of extensive research on managing malnutrition in athletes and treating symptoms of REDs that long predate the coining of the diagnosis.
While I understand that in the medical model, having a specific diagnostic label helps streamline research and treatment protocols, we can’t overlook the bigger picture: REDs is not a mystery. It is malnutrition, and we know how to treat malnutrition.
In this blog post, we’re diving into how REDs is malnutrition in athletes and how to spot it before it compromises health and performance.
Your Body Doesn’t Care Why It’s Not Getting Enough
Our bodies are smart, but they can’t distinguish between unintentional and intentional under-fueling. Whether an athlete skips meals because of poor time management or due to disordered eating beliefs, the body experiences the same physiological stress and thus, responds the same.
That stress results in symptoms that reflect malnutrition, not performance enhancement.
Signs of Malnutrition in Athletes
Malnutrition in athletes doesn’t always look extreme or dramatic. It often starts subtly and builds gradually on a spectrum.
Watch for these signs and symptoms of REDs:
- Cutting out food groups
- Skipping meals
- Feeling more fatigued
- GI Issues/food intolerances
- Low mood/irritability
- Increased injuries
- Loss of period/low libido
- Low heart rate/low HRV
- Decreased immunity
These aren’t just “training setbacks.” They are clinical signs of undernourishment that should be taken seriously.
Misconceptions That Hide Malnutrition in Athletes
Athletes often hear (and internalize) harmful myths that mask real symptoms of REDs.
But the truth is…
- Underfueling is not “the result of discipline or dedication”… it is malnutrition.
- An irregular menstrual cycle is not “common in active individuals”… it is malnutrition.
- Low carbohydrate availability is not “a means to promote adaptation”… it is malnutrition.
- Low iron is not “an inevitable part of training hard”… it is malnutrition.
- Increased injuries or illness is not “unlucky timing”… it is malnutrition.
These are dangerous misinterpretations of symptoms that deserve medical-level attention.
REDs Is a Spectrum, Not a Diagnosis Checklist
Just as signs and symptoms of malnutrition in athletes don’t look the same in everyone, REDs doesn’t require a full checklist of symptoms to be valid. Some athletes may still have a regular cycle or appear to be in energy balance, but that doesn’t mean the body isn’t compensating elsewhere.
Energy deficiency affects multiple systems – hormonal, cardiovascular, digestive, and psychological. Just one or two symptoms can indicate your body is undernourished and under stress. Malnutrition is a spectrum, not a checklist.
Let’s Get Back to Sports Nutrition Basics
If you’re an athlete, stop waiting for a crisis to start fueling properly. The basics of good sports nutrition are often what prevents malnutrition in athletes from escalating.
Join the waitlist for my upcoming Athlete Nutrition Challenge to get practical tools to fuel with confidence, meet your nutritional needs, and train at your best.
If you’re an athlete provider looking for more information and training on diagnosing, treating, and preventing RED-S, check out my RED-S Informed Provider Masterclass!