The red flags of relative energy deficiency (REDs) in sport 🪫🚩
Identify, intervene and monitor.
Relative Energy Deficiency in Sport (REDs) and Body Composition
Study Details
This new review summarised the available evidence on REDs including the importance of nutrition, common red flags, intervention strategies (📝) and monitoring tools (🔍)
Here are the 8 key red flags ⬇️
Key Findings
Menstrual dysfunction, low libido, fatigue 🚩
📝 Increase EA by 300–600 kcal/day (330 kcal in REFUEL); add energy-dense snacks pre/post-training
🔍 LEAF-Q, CAT2, sex hormones
Frequent injuries/stress fractures 🚩
📝 Boost calcium/vitamin D (diet/supplements); prioritise bone health
🔍 DXA scan, vitamin D/ferritin
Performance plateau, GI issues 🚩
📝 Periodise carbs (1–4 g/kg pre-exercise, 30–60 g/h during, 1.0–1.2 g/kg post)
🔍 Training logs, glycogen markers
Elevated RMR suppression 🚩
📝 Reduce training loads; restore EA gradually
🔍 RMR testing, EA calculations
Immune suppression, frequent illness 🚩
📝 Avoid chronic “train-low”; ensure carb fuelling for endocrine/immune protection
🔍 Immune markers, infection logs
Muscle loss, poor recovery 🚩
📝 Protein 1.6–2.2 g/kg/day, distributed 0.3–0.4 g/kg/meal; collagen + vitamin C for tendons
🔍 FFM via DXA, injury history
Iron deficiency (esp. endurance/females) 🚩
📝 Screen ferritin/haemoglobin; nutrient-rich diet + targeted iron supplements
🔍 Ferritin, haemoglobin levels
Chronic low EA symptoms (e.g. skewed intake) 🚩
📝 Tailored plans: portion increases, sustainable snacks, education
🔍 EA questionnaire, weight trends
Reference
https://www.mdpi.com/2075-4663/14/8/314
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