PERFORMANCE Q&A
03 WHAT IS RED-S AND HOW DO I COUNTER IT?
Dame Laura Kenny recently talked about fertility issues affecting female athletes, citing a condition called RED-S (Relative Energy Deficiency in Sport), which occurs when athletes chronically under-fuel, using more energy than they consume. It can impact long-term health and performance, while a key symptom in women is the absence of periods.
But RED-S can also affect men, while cyclists are predisposed to developing it due to various factors, including entrenched beliefs about nutrition. Cyclists neglecting weight-bearing exercise can also reduce bone density, a possible sign of chronic RED-S. As Jonny Sumner, Specialist MSK Physiotherapist and Clinical Director at LDN Physio, says, “When RED-S sets in and performance dwindles, there’s a tendency to push harder, spending more hours in the saddle. This can lead to a downward spiral, exhausting the body’s resources without replenishing them.”
51%
A 2023 study showed over half of female athletes had experienced two or more symptoms of RED-S
One of the primary challenges with RED-S is the variety of symptoms. Sumner cites fatigue, decreased performance, and menstrual irregularities, which may indicate hormonal disruptions.
Recurrent injuries are another sign. “A surge in injuries, particularly stress fractures, owing to compromised bone health, is a classic indicator of RED-S,” says Sumner. He advises cyclists not to neglect muscles and tendons, though. “These structures are the kingpins of performance and without awareness, nutrition, available energy, progressive training and rest, the body won’t repair and become restorative.”
Mood swings, irritability or depression can also be experienced and are often linked to hormonal imbalances and psychological stress.
Weight-bearing exercise Do this to build bone density
Having a nutritious diet that ensures calorie intake matches output is essential. Sumner also says not to exercise in a fasted state, and to avoid dieting or restrictive diet behaviours. It’s key for cyclists to ensure they enjoy varied exercise, too, including weight-bearing activities. An awareness of your exercise and nutrition behaviour and being aware of addictive behaviours or unhealthy relationships with food or exercise (seeking help if necessary) is also crucial.
Male awareness
As to why more women than men suffer from RED-S, the 2023 Female Athlete Health Report of 800 female athletes showed that 51% had experienced at least two symptoms of REDS. Sumner says body image expectations and physiological pressures such as dieting contrary to increased training demands, appear more pronounced for women.
Signs of RED-S can be more obvious in women too, whereas changes in male hormone levels may not always present clear symptoms. “Male athletes may also go undetected, highlighting the importance of considering RED-S across genders.”
FAST FACT
RED-S sufferers can experience a weakened immune function, making them susceptible to illness, and unintentional weight fluctuations. For men, RED-S causes a drop in testosterone which increases belly fat.