REDs Syndrome: Athletes Suffer in Silence as Energy Deficiency Impacts Health

Relative Energy Deficiency in Sport (REDs) is a syndrome affecting athletes that can lead to serious, long-lasting health problems, including bone stress injuries, disrupted sleep, fatigue, and low mood. While symptoms are more visibly documented in women, men are equally susceptible and often suffer in silence due to stigma and less obvious warning signs.

Dr. Nicky Keay, an expert in hormone health, explains that many REDs symptoms arise from hormonal disruption caused by insufficient energy intake. Hormones, essential for bodily functions, can slow down or shut down completely when the body is in an energy deficit. In women, this often manifests as the cessation of menstrual periods, a condition historically known as the 'female athlete triad'. For men, the signs are more subtle, including a drop in testosterone levels, leading to reduced libido and fatigue.

The International Olympic Committee renamed the condition to REDs in 2014 to acknowledge its broader impact on both male and female athletes, moving beyond the initial focus on the 'female athlete triad'. Recent research highlights the condition's prevalence in men; a meta-analysis published in the journal Sports Medicine indicated that 44.2% of female athletes and 49.4% of male athletes experienced low energy availability.

One contributing factor to REDs is the long-held belief in sports like endurance running and cycling that 'lighter is faster'. This can lead athletes to prioritize weight loss over adequate fueling, a strategy that may initially yield performance benefits but ultimately leads to decreased performance and a higher risk of injury. Olympic triathlete Jonny Brownlee acknowledged that his own career was impacted by under-fueling, contributing to injuries and suboptimal recovery.

Attitudes surrounding fueling in sports have contributed to the underreporting of REDs, particularly among male athletes. A 2019 experiment by Dr. Keay involving 50 male cyclists found that nearly half had poor bone health, and 25% were suffering from REDs. Those who received nutrition and training advice showed improved bone health and race results, while the control group experienced further bone density loss and underperformance.

Finding help for REDs can be challenging due to a lack of widespread awareness. Organizations like Project REDs offer resources for athletes, coaches, and healthcare professionals. While many seeking help are women, Dr. Keay notes an increasing number of men are reaching out, sometimes describing their symptoms as 'burnout'. Unintentional under-fueling can stem from a misunderstanding of energy requirements or failing to adjust intake with increased training intensity. For some, like former British cyclist Brian Smith, the under-fueling was intentional, driven by an obsession with weight that led to bulimia and serious mental health issues.

Smith, who developed REDs after transitioning to running, experienced severe stress fractures. He advocates for greater awareness, stating that professional sports teams often prioritize performance over an athlete's long-term health. While organizations like British Cycling have made progress through education and screening programs, emphasizing that under-fueling hinders performance, the issue persists.

World Climbing has taken a proactive approach with mandatory health checks for athletes, including questionnaires and screenings similar to doping tests, to identify and address low energy availability. Professor Naama Constantini, who developed the policy, stresses the importance of prevention and educating athletes and coaches that health and proper fueling are key to strength and performance, not unhealthy weight loss.

Jake Smith, who has successfully reversed his REDs diagnosis and achieved personal bests in his running career, now uses social media to share his recovery and support others. He emphasizes that prioritizing health has led to improved performance and happiness, highlighting the possibility of recovery and a healthier future for athletes affected by REDs.