Relative Energy Deficiency in Sport (RED-S) in Adolescent Athletes

A big part of our mission at Kimberly Cover Associates is working with adolescent athletes to improve and optimize energy intake to meet energy needs for normal growth and development as well as peak sports performance. Many of our adolescent clients come to us in an energy deficit which is reflected in either weight loss, stunted growth, poor bone density, fatigue, decreased sports performance, or loss of menstrual cycle/low testosterone. Having one or more of these symptoms may put an adolescent athlete at risk for relative energy deficiency in sport (RED-S).

RED-S is a term first coined by the International Olympic Committee (IOC) in 2014.1 It was introduced due to a need to classify a growing list of negative health and performance markers identified in both male and female athletes due to low energy availability (LEA).1  LEA  is a state where an athlete's daily energy intake is too low, so the remaining energy available to the body after energy for exercise is used, is insufficient to fuel various important biological functions.2 

The signs & symptoms of RED-S include but are not limited to impaired growth and development, decreased immunity, impaired bone health, poor reproductive function, impaired gastrointestinal function, impaired heart function, and mental health issues.2 Along with these signs & symptoms there are some other markers that may help identify RED-S according to the IOC REDs CAT2 tool. These markers include amenorrhea (absence of a period), sub-clinical or clinically low testosterone and or free T3, decreased BMI, and deviation from previously established growth trends.3 

Now that we have defined and discussed RED-S as well as it’s signs and symptoms let's move to discussing the negative performance outcomes experienced by athletes with RED-S. These performance outcomes include decreased endurance, decreased muscle strength, decreased cognitive performance, and decreased recovery.2 One of the first noticeable changes to performance adolescent athletes with RED-S notice during our work together is a decrease in fatigue and an increase endurance capacity!

At Kimberly Cover Associates our goal in working with adolescent athletes with RED-S is to return them to, or promote continuation of, their normal historic weight and height growth trends. We accomplish this through ensuring adequate energy intake is met to support both growth and development as well as sport. We work with athletes to build a personalized supportive meal plan to meet their energy, macronutrient, and micronutrient needs for growth and development as well as sports performance. Our athletes report to us that once they begin to fuel properly they see an increase in strength, power, a decrease in fatigue levels, and an increase overall sports performance and exercise recovery.

If your adolescent athlete is struggling with RED-S or inadequate energy intake consider working with us here at Kimberly Cover Associates or another registered dietitian who specializes in sports nutrition!

References:

1.     Gould RJ, Ridout AJ, Newton JL. Relative Energy Deficiency in Sport (RED-S) in Adolescents - A Practical Review. Int J Sports Med. 2023 Apr;44(4):236-246

2.     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.

3.     Dvořáková K, Paludo AC, Wagner A, Puda D, Gimunová M, Kumstát M. A literature review of biomarkers used for diagnosis of relative energy deficiency in sport. Front Sports Act Living. 2024 Jul 12;6:1375740