How to improve RED-S: A Complete Athlete's Guide to Recovery

December 11, 2025 •

4 min read

Chronic low energy availability from an energy intake and expenditure mismatch, the core cause of RED-S, can impact multiple body systems, including reproductive health and bone density. Addressing this deficit is the foundation of a successful recovery, allowing the body to restore optimal health and athletic performance.

Quick Summary

Effective recovery from Relative Energy Deficiency in Sport (RED-S) requires restoring energy balance through increased nutritional intake and moderated training. This approach is supported by a multidisciplinary team addressing physical, dietary, and psychological aspects to ensure a safe and complete return to health and performance.

Key Points

Restore Energy Balance: The central goal is to increase energy intake and, if necessary, decrease exercise to close the energy deficit.
Team Up with Professionals: A multidisciplinary team including a physician, dietitian, and mental health expert offers the best path to a full recovery.
Re-establish Healthy Eating: Focus on eating consistently, consuming energy-dense foods, and prioritizing carbohydrates to restore depleted energy stores.
Modify Your Training Load: Rest and reduced training volume are essential to allow the body to recover, heal, and rebuild.
Address Mental Health: Work with a psychologist to address underlying psychological factors, such as body image issues, that can contribute to RED-S.
Monitor Your Body's Progress: Pay attention to physical and hormonal cues, such as the return of a regular menstrual cycle, as signs of recovery.

Understanding the Core Principle of RED-S Recovery

At its heart, improving Relative Energy Deficiency in Sport (RED-S) is about reversing the state of low energy availability (LEA). This is a physiological state where an athlete's dietary energy intake is insufficient to support the energy demands of exercise and the body's essential functions. Addressing this energy gap is the primary and most crucial step towards recovery. Rather than just a single action, it requires a comprehensive, multi-pronged approach that restores the body's balance, focusing on nutrition, training, and mental well-being.

Nutritional Restoration: Fueling Your Recovery

Restoring energy balance must start with nutrition. This is not just about eating more, but about eating smart and consistently throughout the day to meet your body’s true energy needs. Working with a sports dietitian is highly recommended to create a personalized fueling plan.

Key Nutritional Strategies

Prioritize Regular and Consistent Eating: Aim for three balanced meals and regular snacks daily. Avoid long periods without eating to prevent energy dips.
Focus on Carbohydrates: Adequate carbohydrate intake is essential for replenishing glycogen stores, especially around training sessions.
Increase Overall Energy Intake: Include energy-dense foods to close the energy gap. Athletes in recovery may need to eat beyond their typical hunger cues to re-establish a healthy metabolic rate.
Optimize Micronutrient Intake: Pay attention to key nutrients vital for recovery, particularly bone health. These include:
- Calcium
- Vitamin D
- Protein
- Magnesium

Training Modifications: Prioritizing Health Over Performance

For a body in an energy-deficient state, intense training can be counterproductive and even dangerous. A period of rest or significantly reduced training is often necessary to allow the body to heal and rebuild.

Practical Training Adjustments

Reduce Training Load and Intensity: Temporarily decrease the volume and intensity of your workouts. High-volume training depletes energy and exacerbates the negative effects of RED-S.
Focus on Rest and Recovery: Build adequate rest days into your schedule. The body repairs and rebuilds during rest, a process that is stalled during RED-S.
Monitor Your Progress: A gradual return to training should be guided by your recovery, not your past performance. Listen to your body and avoid ramping up too quickly.

Building a Multidisciplinary Support Team

RED-S often has complex underlying factors, and recovery is rarely a solo journey. A team-based approach is considered the gold standard for treatment and offers the most robust support.

Essential Team Members

Physician: The medical professional monitors physical health markers, such as heart rate, blood pressure, and bone density.
Registered Dietitian: Provides expert guidance on nutritional restoration and addresses any disordered eating patterns.
Mental Health Professional: A psychologist or therapist helps address the psychological issues linked to RED-S, such as anxiety, depression, and body image concerns.
Coach/Trainer: A supportive coach can help adjust training programs to prioritize health and prevent relapse.

Psychological Recovery: Addressing Underlying Issues

Many athletes with RED-S have psychological factors, such as a strong drive for perfection or fear of weight gain, that perpetuate the condition. Effective recovery must address these mental aspects.

Strategies for Mental Well-being

Challenge Limiting Beliefs: Work with a mental health professional to reframe thoughts about food, body image, and performance. Understand that under-fueling leads to a performance decline, not improvement.
Focus on Health, Not Just Aesthetics: Shift your mindset away from achieving an unhealthy, low body weight. Prioritizing health is the true path to long-term athletic success.
Find Balance Outside of Sport: Engage in hobbies and social activities that are unrelated to your training to reduce identity fixation with being an athlete.

Comparison of RED-S vs. Healthy Athlete Behaviors


Trait / Behavior	Athlete with RED-S (Energy Deficient)	Healthy Athlete (Energy Balanced)
Energy Intake	Inconsistent, often restrictive; inadequate calories to support activity.	Consistent, regular fueling; adjusted energy intake to match training load.
Training Mindset	Obsessive, high volume, low rest; feeling guilt over missed sessions.	Balanced; values rest as part of training; focuses on adaptation and recovery.
Performance Trends	Declining performance, poor training response, increased injury risk.	Stable or improving performance, efficient training adaptations, reduced injury frequency.
Body Composition	Unhealthy low body fat (though not always present) and potential muscle mass loss.	Healthy and stable body weight; optimal muscle mass and body fat for sport.
Psychological State	Irritability, anxiety, depression, disordered eating patterns.	Positive mood, high concentration, strong self-esteem.

Conclusion

Improving RED-S is a journey that requires patience, commitment, and a shift in focus from short-term performance to long-term health and well-being. The process centers on restoring energy balance through strategic nutrition, modifying training loads, and building a strong support network of medical, dietary, and psychological professionals. By prioritizing overall health, athletes can not only recover from RED-S but also lay the foundation for a longer, more sustainable, and ultimately more successful athletic career.

To learn more about the diagnosis and treatment process, consult an authoritative resource like Boston Children's Hospital's comprehensive guide on Relative Energy Deficiency in Sport: https://www.childrenshospital.org/conditions/reds.

Frequently Asked Questions

The most critical first step is to increase your energy availability by consuming more food to match or exceed your training and daily energy expenditure. Addressing this energy imbalance is the foundation of recovery.

Recovery time varies by individual, but it is a gradual process that can take several months. It is important to be patient and work closely with a healthcare team to monitor your progress and ensure a safe and complete recovery.

Yes, it is possible to have RED-S without significant weight loss. The body can adapt to chronic under-fueling by reducing its metabolic rate to conserve energy, which can keep body weight stable even in an energy-deficient state.

A multidisciplinary team is crucial because RED-S affects multiple body systems and often involves complex nutritional and psychological factors. A physician, dietitian, and mental health professional can provide comprehensive care to address all aspects of the condition.

Depending on the severity of your condition, you may need a period of complete rest or reduced training volume. A healthcare provider can assess your risk level and help you develop a safe return-to-training plan.

By restoring energy balance and ensuring adequate intake of bone-building nutrients like calcium and Vitamin D, you can help reverse the decreased bone mineral density caused by RED-S. For female athletes, the return of a regular menstrual cycle is also vital for restoring bone health.

Mental health support helps address the underlying thoughts and anxieties that can drive under-fueling and overtraining, including body image concerns, and helps build a healthier relationship with food and exercise.