Amy Stephens
MS, RDN, CSSD, CDCES
Licensed dietitian
specializing in sports nutrition
and eating disorders
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Don't Wait: Understanding Relative Energy Deficiency in Sport (RED-S) and Low Energy Availability (LEA)
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By Amy Stephens RDN CSSD
By Kate Cochran, Nutrition Intern, NYU Track and Field
When I first learned about low energy availability (LEA) and relative energy deficiency in sport (RED-S) at twenty-one, I was four years deep into my distance running journey. It was while reading “How She Did It” by renowned female distance athletes Molly Huddle and Sara Slattery, both esteemed Olympians themselves, where I first learned about the syndrome. It was something I wish I knew when I began running at sixteen. I firmly believe it’s essential for every female athlete to familiarize themselves with RED-S early on, considering its potential impact on their athletic path.
LEA, or Low Energy Availability, is a condition where the body lacks sufficient energy to sustain vital physiological functions, jeopardizing overall health. It occurs when caloric intake fails to match the increased demands of intensified training, such as higher mileage or more strenuous workouts. Counting calories, restricting necessary food groups, waiting too long to eat after exercising, running on an empty stomach, and skipping meals can often result in LEA. When your energy availability is low, your performance in sport will likely suffer. In short, being in a constant state of low energy availability will prevent you from reaching your potential in sport.
Some symptoms of RED-S and LEA are:
- Frequent illnesses (common cold, stomach bugs)
- Recurring injuries
- Regularly feeling tired and sluggish in and after training
- Absent or irregular periods
- Poor concentration
- Low mood
- Underperforming in training and competition
- Loss of enjoyment from sports
- Poor sleep
Being in a prolonged state of low energy availability will eventually lead to RED-S. RED-S is a broader syndrome encompassing LEA as one of its components. RED-S involves a spectrum of health and performance issues resulting from prolonged low energy availability, affecting not only physical health but also metabolic, hormonal, and psychological aspects, ultimately impairing athletic performance. In addition to LEA, RED-S may involve disruptions in menstrual function, bone health, immunity, cardiovascular health, and psychological well-being.
Those at risk for RED-S are typically female endurance athletes, and anyone who is cutting calories while playing a high demand sport.
How to treat RED-S:
- Ensure you’re consuming enough calories to meet the energy demands of your training and daily life. This might involve working with a registered dietitian to develop a balanced meal plan tailored to your needs. Generally, you should aim to consume as many calories as you are losing through sport and everyday activities.
- Make sure you are getting a good balance of macronutrients. Carbohydrates, fats, and proteins support energy production, muscle repair, and overall health. In your diet, aim for about half of your food to come from carbohydrates, around one-third from protein, and another one-third from fats.
- Incorporate adequate rest, sleep, and recovery strategies into your routine to support overall health and performance.
- Consider working with a mental health professional or sports psychologist to manage stress, anxiety, or disordered eating patterns.
- With sufficient rest and energy intake, the majority of athletes can replenish their energy stores and maintain their training at their usual capacity.
