Relative energy deficiency in sport

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

Relative energy deficiency in sport also known by the acronyms REDs or RED-S is defined by the International Olympic Committee (IOC) as "deleterious health and performance outcomes experienced by female and male athletes expose to low energy availability". The IOC appointed group published the first consensus statement in 2014, a second consensus in 2018, and a follow-up consensus statement in 2023.

Prior to the IOC 2014 statement, another term was used, "Female Athlete Triad". There has been some controversies regarding this change in terminology, but recent papers have adopted this term since both female and male athletes are affected.

There are also still ongoing discussions within the medical society if this condition exists, and a recent paper by Mountjoy et al, 2025, provides arguments that this condition is real and affects several athletes.

The literature indicate that the REDs condition affects multiple systems and organs in the human body. Currently, there are no consensus on specific treatment, except for sufficient rest and adequate nutrition.


Signs and symptoms

  • Not recovering after exercise
  • Fatigue
  • Reduced bone mass
  • Reduced sleep quality

Possible causes

  • High physical activity combined with high cognitive activity, infections and inadequate nutrition

ME/CFS

There are some co-morbidities between RED-S and ME/CFS, and the relation between these two diagnoses might be elucidated in the future.

Prevention and treatment

Currently no consensus regarding treatment, however adequate nutrition and reduced activity are recommended for prevention.


Notable studies

Notable articles

Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, Meyer N, Sherman R, Steffen K, Budgett R, Ljungqvist A. The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014 Apr;48(7):491-7. doi: 10.1136/bjsports-2014-093502. PMID: 24620037.

De Souza MJ, Williams NI, Nattiv A, Joy E, Misra M, Loucks AB, Matheson G, Olmsted MP, Barrack M, Mallinson RJ, Gibbs JC, Goolsby M, Nichols JF, Drinkwater B, Sanborn C, Agostini R, Otis CL, Johnson MD, Hoch AZ, Alleyne JM, Wadsworth LT, Koehler K, VanHeest J, Harvey P, Kelly AK, Fredericson M, Brooks GA, O'Donnell E, Callahan LR, Putukian M, Costello L, Hecht S, Rauh MJ, McComb J. Misunderstanding the female athlete triad: refuting the IOC consensus statement on Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014 Oct;48(20):1461-5. doi: 10.1136/bjsports-2014-093958. PMID: 25037200.

Mountjoy M, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, Heikura IA, Melin A, Pensgaard AM, Stellingwerff T, Sundgot-Borgen JK, Torstveit MK, Jacobsen AU, Verhagen E, Budgett R, Engebretsen L, Erdener U. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023 Sep;57(17):1073-1097. doi: 10.1136/bjsports-2023-106994. Erratum in: Br J Sports Med. 2024 Feb 7;58(3):e4. doi: 10.1136/bjsports-2023-106994corr1. PMID: 37752011.

Angelidi AM, Stefanakis K, Chou SH, Valenzuela-Vallejo L, Dipla K, Boutari C, Ntoskas K, Tokmakidis P, Kokkinos A, Goulis DG, Papadaki HA, Mantzoros CS. Relative Energy Deficiency in Sport (REDs): Endocrine Manifestations, Pathophysiology and Treatments. Endocr Rev. 2024 Sep 12;45(5):676-708. doi: 10.1210/endrev/bnae011. PMID: 38488566.

Mountjoy ML, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, Heikura IA, Melin AK, Pensgaard AM, Stellingwerff T, Sundgot-Borgen J, Torstveit MK, Uhrenholdt-Jacobsen A, Verhagen E, Budgett R, Engebretsen L, Erdener U. Yes: Relative Energy Deficiency in Sport (REDs) Does Exist! Sports Med. 2025 Aug;55(8):2045-2049. doi: 10.1007/s40279-025-02219-0. Epub 2025 May 1. PMID: 40307664.

Kiss J, Critchley M, Gabel L, Galarneau J, Doyle-Baker P, Ballinger K, Lun V, Emery C. Relative Energy Deficiency in Sport (REDs) and site-specific bone mineral density in female adolescent artistic athletes. Appl Physiol Nutr Metab. 2026 Jan 1;51:1-11. doi: 10.1139/apnm-2025-0330. PMID: 41628421.


Talks and interviews

See also

Learn more

  • [1] - International Olympic Committee

References

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