💡Key Takeaway

RED-S is NOT just the "Female Athlete Triad" renamed. It's a broader syndrome affecting both sexes, impacting nearly every organ system — and it starts with one thing: not eating enough to support training.

What Is RED-S?

Relative Energy Deficiency in Sport (RED-S) occurs when an athlete's energy intake is insufficient relative to the energy expended in exercise, resulting in Low Energy Availability (LEA).

Low Energy Availability = Energy consumed minus exercise expenditure falls below ~30 kcal/kg of fat-free mass per day

The Old Model vs The New Model

Female Athlete Triad (1992)	RED-S (2014, updated 2023)
3 conditions: disordered eating, menstrual dysfunction, bone loss	10+ systems affected
Females only	Both males and females
Linear progression	Complex, interconnected web
Focus on clinical eating disorders	Includes unintentional underfueling

Systems Affected by RED-S

Metabolic — decreased metabolic rate, thyroid suppression
Reproductive — menstrual irregularity (F), low testosterone (M)
Bone — decreased bone density, stress fractures
Cardiovascular — endothelial dysfunction, bradycardia
Immunological — increased illness frequency
Psychological — depression, irritability, impaired concentration
Gastrointestinal — delayed gastric emptying, bloating
Hematological — iron deficiency, anemia
Growth & Development — stunted growth in adolescents
Performance — decreased endurance, strength, coordination

Why This Matters for Your Team

50% of female and 20% of male adolescent endurance athletes experience LEA
Most is unintentional — they simply don't eat enough for their training volume
High school athletes face unique risks: growth demands, school schedules, social pressure
Coaches see athletes more frequently than any other adult — you are the early warning system

The Spectrum: Intentional vs Unintentional

Unintentional LEA (Most Common)	Intentional LEA
Busy schedules, no time to eat	Disordered eating behaviors
Doesn't know how much to eat	Restrictive dieting
School lunch is inadequate	Excessive exercise beyond training
Stomach issues reduce intake	Coach/parent pressure to lose weight
Coach can fix this directly	Requires clinical referral

✅Action Item

Create a simple team intake survey asking:

"Do you eat breakfast before morning practice?"
"Do you eat a snack within 30 minutes of practice ending?"
"Do you eat after 7pm?"
"How many meals do you eat on a typical school day?"

Any athlete answering "no" to the first two questions or eating fewer than 3 meals is at elevated LEA risk.

📚References

Mountjoy M, et al. (2023). 2023 International Olympic Committee's (IOC) Consensus Statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine.
De Souza MJ, et al. (2014). 2014 Female Athlete Triad Coalition Consensus Statement. British Journal of Sports Medicine.

What Is RED-S?

Relative Energy Deficiency in Sport (RED-S) occurs when an athlete's energy intake is insufficient relative to the energy expended in exercise, resulting in Low Energy Availability (LEA).

Low Energy Availability = Energy consumed minus exercise expenditure falls below ~30 kcal/kg of fat-free mass per day

The Old Model vs The New Model

Female Athlete Triad (1992)

RED-S (2014, updated 2023)

3 conditions: disordered eating, menstrual dysfunction, bone loss

10+ systems affected

Females only

Both males and females

Linear progression

Complex, interconnected web

Focus on clinical eating disorders

Includes unintentional underfueling

Systems Affected by RED-S

Metabolic — decreased metabolic rate, thyroid suppression

Reproductive — menstrual irregularity (F), low testosterone (M)

Bone — decreased bone density, stress fractures

Cardiovascular — endothelial dysfunction, bradycardia

Immunological — increased illness frequency

Psychological — depression, irritability, impaired concentration

Gastrointestinal — delayed gastric emptying, bloating

Hematological — iron deficiency, anemia

Growth & Development — stunted growth in adolescents

Performance — decreased endurance, strength, coordination

Why This Matters for Your Team

50% of female and 20% of male adolescent endurance athletes experience LEA

Most is unintentional — they simply don't eat enough for their training volume

High school athletes face unique risks: growth demands, school schedules, social pressure

Coaches see athletes more frequently than any other adult — you are the early warning system

The Spectrum: Intentional vs Unintentional

Unintentional LEA (Most Common)

Intentional LEA

Busy schedules, no time to eat

Disordered eating behaviors

Doesn't know how much to eat

Restrictive dieting

School lunch is inadequate

Excessive exercise beyond training

Stomach issues reduce intake

Coach/parent pressure to lose weight

Coach can fix this directly

Requires clinical referral

✅Action Item

Create a simple team intake survey asking:

"Do you eat breakfast before morning practice?"
"Do you eat a snack within 30 minutes of practice ending?"
"Do you eat after 7pm?"
"How many meals do you eat on a typical school day?"

Any athlete answering "no" to the first two questions or eating fewer than 3 meals is at elevated LEA risk.

📚References

Mountjoy M, et al. (2023). 2023 International Olympic Committee's (IOC) Consensus Statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine.
De Souza MJ, et al. (2014). 2014 Female Athlete Triad Coalition Consensus Statement. British Journal of Sports Medicine.

RED-S Recognition & Response for Coaches

Module 1: Understanding RED-S — Beyond the Female Athlete Triad

What Is RED-S?

The Old Model vs The New Model

Systems Affected by RED-S

Why This Matters for Your Team

The Spectrum: Intentional vs Unintentional

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RED-S Recognition & Response for Coaches

Module 1: Understanding RED-S — Beyond the Female Athlete Triad

What Is RED-S?

The Old Model vs The New Model

Systems Affected by RED-S

Why This Matters for Your Team

The Spectrum: Intentional vs Unintentional

Enjoying this preview?