REDs: Understanding Relative Energy Deficiency in Sport
BBC Sport explores the impact of Relative Energy Deficiency in Sport (REDs) on athletes, highlighting the challenges faced by both men and women.
By Sarah Dawkins, BBC Sport Senior Journalist
Warning: this article contains discussion of eating disorders.
"If you keep this up, you'll be in a wheelchair at 30." This was the stark warning given to British long-distance runner Jake Smith by doctors four years ago.
From the outside, Smith's career was thriving. By 23, he had signed with Nike and represented Great Britain globally. However, his body was suffering. He returned from a running camp in Uganda at 5ft 5in (1.7m) and 8 stone (51kg), with such brittle bones that his career was in jeopardy.
After two stress fractures in four months, Smith sought help and was diagnosed with REDs - a syndrome affecting anyone, regardless of gender.
What is REDs?
REDs is characterized by a relentless cycle of race, illness, injury, repeat. It can lead to serious health issues, including:
- Bone stress injuries
- Disrupted sleep
- Fatigue
- Low mood
- Long-term health problems like osteoporosis, cardiovascular disease, and fertility issues
Dr Nicky Keay, an expert in hormone health, explains:
"Hormones go to every single bit in your body. So, if your hormones are not working well for you, you're going to feel it in all sorts of different areas... In order to have healthy hormones, they need to be fed regularly. If you're not doing that and there's an energy deficit, often some of those hormone systems will slow down or shut down completely."
Gender and REDs
Women have a monthly barometer of their hormone health with their menstrual cycle, making REDs symptoms easier to identify. They may experience periods stopping, among other issues.
Men, however, experience a more subtle impact. Testosterone levels drop, leading to reduced libido and fatigue.
The term "female athlete triad" initially described REDs, but it was renamed in 2014 by the International Olympic Committee to acknowledge the broader symptoms and its impact on male athletes.
Underdiagnosed and Overlooked
Despite its prevalence and severity, REDs remains an under-reported and overlooked area in sports science. Stigma and lack of obvious warning signs contribute to this. Many athletes, like Smith, suffer in silence.