RED-S: how to know if you’re overtraining and under-fuelling

Exercise can be addictive. The endorphin rush, the moment you start to see the results you crave, whether that’s lifting heavier weights, running further or suddenly being able to out-burpee your training buddy – it often leaves you hungry for more. 

But if you are training frequently it’s crucial to ensure that you’re nourishing yourself sufficiently within your diet, as overtraining and under-fuelling can have serious health consequences, and it’s more common than you think. 

RED-S or Relative Energy Deficiency in Sport, refers to “a mismatch of the energy going in to the work that’s being done,” explains Renee Mcgregor, a registered dietician who recently opened EN:Spire, the UK’s first Sport and Dance RED-s, Overtraining and Eating Disorder Specific recovery clinic, and who says she has seen referrals for the condition increase five-fold in the last year alone. 

The energy deficit results in there not being enough to maintain bodily processes such as metabolic rate, menstrual function, bone health and immunity. As a consequence, your body goes into preservation mode, McGregor explains, and “starts to shut things down”.

While it is a phenomena most discussed in the context of the sporting world, in reality it can affect anyone who takes their fitness seriously. In addition to professional and semi-professional athletes, McGregor sees gym-goers, fitness fanatics, recreational runners, club cyclists and age-group triathletes in her practice. 

“We do know that there is a higher prevalence of disordered eating/eating disorders in those who are more physically active in comparison to their non active peers,” she adds, “however I think what has changed is that diversity in the prevalence. Previously it was associated only with endurance or aesthetic sports but now we’re seeing it across all sports including football, hockey, cross fit, weight training.”

Symptoms of RED-S can include anything from a drop in libido, a drop in serotonin levels, changes in bowel habit (often misdiagnosed as symptoms of IBS), finding yourself more prone to injury, lowered immune function and not being able to train and perform at the level you once could. 

One of the most common symptoms is missed periods. Previously known as Female Athlete Triad​, RED-S was once thought to only affect women, but recent research has shown it also affects men. “We see lots of males whose testosterone have dropped, they’ve noticed it in the sense of they haven’t felt great and their GP has tested them and found that their levels are really low,” McGregor adds. 

“You don’t always lose weight, that’s another thing people don’t appreciate,” she continues. “Initially you might drop a kilo or something and you might find your performance actually improves but it’s not sustainable so then you end up presenting with injuries or recurrent coughs and colds and your performance starts to stagnate. By the time you come to see us it can be a real mix of stress fractures, or noticed low energy, heart rate changes or not being able to train at the level you used to.” If left untreated these symptoms can manifest themselves into long-term health issues, including infertility and and poor performance. 

The condition can be caused both when people knowingly don’t eat enough to sustain their activity and also unwittingly. McGregor explains: “Voluntary RED-S is a conscious decision to restrict your intake and/or overtrain – it’s an eating disorder within sport.” ​She adds that she often sees athletes with voluntary RED-S when they’re injured. “They tend to feel like they need to earn their food, so when they’re training they can eat, but as soon as they’re injured [and can’t train] they find it really difficult to eat and that’s when the wheels come off.”

However, around 10 per cent of the people she sees have no idea they’re not fuelling themselves properly. A person’s training routine may not look excessive at first glance, but once you factor things as simple as the daily commute or the fact that they spend most of their working day on their feet, it’s easier than you think to underestimate the energy you require to function properly. 

McGregor, who is also the author of Othorexia: When Healthy Eating Goes Bad, says healthy eating accounts on Instagram which often encourage people to cut out entire food groups don’t help. 

“​For the first time ever, food is so related to our sense of identity and how we are perceived. The #cleaneating movement may have died a death, but now it’s just promoted as something different. The turmeric lattes and buddha bowls you see on Instagram – now people hide behind calling it ‘wellness’ rather than ‘healthy eating.’

“We are still seeing too many photos of pretty bowls of bulgar wheat,” she adds.”To the untrained eye food can look really healthy, but to the trained eye, if you’re training regularly, you can see when something is not energy dense enough to give you the energy you require.”

You’ve heard it before and you’ll hear it again, but if you’re training frequently, it’s crucial to ensure you’re eating a balanced diet of protein, carbs and fats – check out the best foods to eat before and after a workout here. If you suspect you might have any symptoms of RED-S, the first port of call should be to see your GP. 


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