How to Overcome RED-S: A Comprehensive Guide for Athletes

December 11, 2025 •

4 min read

According to a New Zealand study, over half of all actively exercising females could be at risk of developing Relative Energy Deficiency in Sport (RED-S). Understanding how to overcome RED-S is critical for any athlete facing this condition, which impacts both health and performance due to insufficient energy intake.

Quick Summary

Recovering from Relative Energy Deficiency in Sport (RED-S) involves a tailored, multidisciplinary strategy addressing the core issue of low energy availability. It prioritizes nutritional restoration, controlled adjustments to training volume, and comprehensive psychological support.

Key Points

Address the Energy Deficit: The core of RED-S recovery is restoring a positive energy balance by strategically increasing caloric intake and, if necessary, decreasing exercise load.
Assemble a Multidisciplinary Team: Successful recovery is best managed with a team of experts, including a sports physician, registered dietitian, and mental health professional.
Focus on Nutritional Timing: Optimizing the timing of carbohydrate intake, especially before and after training, is crucial for fueling performance and recovery.
Modify Training Safely: Adjusting training volume and intensity, and prioritizing rest and resistance training, allows the body to heal without completely halting activity.
Seek Psychological Support: Underlying issues like anxiety, body image concerns, and disordered eating must be addressed through counseling and therapy to achieve lasting recovery.
Avoid Hormonal Interventions as a Fix: Hormonal contraceptives can mask RED-S symptoms, delaying true recovery by hiding the underlying energy deficiency.

Understanding the Foundational Issue: Low Energy Availability

Relative Energy Deficiency in Sport (RED-S) occurs when an athlete's energy intake fails to match the energy expenditure of daily life and training, creating a state of 'low energy availability' (LEA). This energy imbalance forces the body to conserve resources by downregulating non-essential physiological functions, leading to impaired metabolic rate, reproductive function, and bone health, among other serious complications. Recovery from RED-S, therefore, must focus on reversing this energy deficit and restoring the body's natural processes. A team-based approach involving a sports physician, registered dietitian, and mental health professional is considered the gold standard for successful and sustainable recovery.

Pillar 1: Prioritizing Nutritional Restoration

At its core, overcoming RED-S requires increasing energy intake, a process best guided by a sports dietitian. This is not simply about 'eating more' but about strategic fueling to meet the body's increased needs and repair damaged systems.

Key Nutritional Strategies for RED-S Recovery:

Increase Caloric Intake: A primary goal is to increase daily calories by 300–600 kcal to restore energy balance. This can be achieved through larger portion sizes and incorporating more energy-dense foods, like nuts, seeds, and healthy fats.
Consistent Fuelling: Establish a regular eating pattern with three balanced meals and 2-3 snacks per day. Some athletes may benefit from eating every 3 hours to ensure a continuous energy supply.
Timed Carbohydrate Intake: Carbohydrates are the body's preferred fuel source. Athletes should prioritize carbohydrate consumption before, during, and immediately after training sessions to optimize energy stores and aid recovery.
Adequate Bone-Building Nutrients: Address potential nutrient deficiencies by ensuring adequate intake of calcium (around 1500mg/day) and Vitamin D. This is crucial for reversing bone mineral density loss associated with RED-S.
Balanced Macronutrients: While focusing on carbohydrates is key, a balanced intake of protein for muscle repair and fats for overall health is also necessary.

Pillar 2: Modifying Training Load

While athletes are often concerned about reducing training, a temporary modification of exercise is often essential to allow the body to heal. Working with a coach, physiotherapist, and physician ensures that any adjustments are safe and effective.

Strategies for Adjusting Training:

Reduce Volume and Intensity: Temporarily decrease training volume and intensity to reduce energy expenditure. This gives the body a crucial break to focus on recovery and repair.
Incorporate Rest Days: Structured and planned rest days are non-negotiable. They are not a sign of weakness but a vital part of the recovery and rebuilding process.
Add Resistance Training: For athletes in non-weight-bearing sports (e.g., swimmers, cyclists) who may have reduced bone density, incorporating resistance training can help stimulate bone strength, provided calorie intake is increased concurrently.
Monitor Progress: The return-to-play process should be based on clinical health markers, not just a set timeline. Medical professionals will monitor hormone levels, bone density, and menstrual function to guide this process.

Pillar 3: Addressing Psychological Health

RED-S is not just a physical problem; it has significant psychological components, including anxiety, depression, and disordered eating behaviors. A mental health professional is an essential part of the recovery team to address the root causes and develop healthy coping mechanisms.

Psychological Support Interventions:

Counselling and Therapy: Cognitive Behavioral Therapy (CBT) can help athletes address the psychological stress and anxiety surrounding food, weight, and body image that often contribute to RED-S.
Supportive Environment: Moving away from toxic training environments that emphasize extreme leanness is critical. A supportive team and coach can foster a healthier mindset.
Reframe Goals: Focus on long-term health and sustainable performance, rather than short-term aesthetic goals. This shifts the focus from body composition to overall well-being and strength.

Recovery Plan Comparison: Moderate vs. High-Risk RED-S


Feature	Moderate-Risk RED-S	High-Risk RED-S
Energy Deficit	Symptoms like irregular periods, minor fatigue, and history of stress fractures.	More severe symptoms like significant weight loss, very low heart rate, and severe bone density loss.
Energy Intake	Gradually increase intake by 300-600 kcal/day while monitoring symptoms.	More aggressive caloric increase required, potentially with a temporary stop or reduction in training.
Training Modification	Minor adjustments, such as incorporating more rest days or slightly lowering intensity.	Temporary cessation of training or significant reduction until energy balance is restored and health markers improve.
Monitoring	Regular follow-up with a team dietitian and physician, monitoring symptoms and energy levels.	More frequent medical monitoring, including blood tests and possibly DXA scans, is necessary.
Psychological Support	Education on healthy fueling and body image is important for long-term prevention.	Intensive therapy to address potential eating disorders and mental health issues is critical.

Conclusion

Overcoming Relative Energy Deficiency in Sport is a journey that demands a holistic and patient approach. While the underlying cause is an energy imbalance, the recovery process involves far more than simply eating more. It requires dedicated nutritional restoration, careful training modification, and crucial psychological support to address the complex factors contributing to the condition. With the right multidisciplinary team and a commitment to long-term health, athletes can reverse the negative effects of RED-S and return to optimal performance, ultimately building a more resilient and sustainable athletic future. For more information on preventative measures and treatment protocols, consult trusted resources like the REDinSport website.

Frequently Asked Questions

The first step is to address the low energy availability by increasing your daily calorie intake. For many, this involves working with a sports dietitian to create a plan that consistently provides sufficient energy for both bodily functions and exercise.

Not always. While some high-risk cases require a temporary break, many athletes can continue training with modifications. This may involve reducing volume and intensity, incorporating more rest days, and focusing on safe, low-impact activities under medical supervision.

Weight gain is often a necessary and positive indicator of recovery, particularly the restoration of hormonal function. The body will use the increased energy to repair itself, normalize metabolic rate, and build lean muscle mass, not just store fat.

No, hormonal contraception is not a treatment for RED-S. It can create a withdrawal bleed that mimics a period, masking a crucial symptom of the underlying energy deficiency and delaying a proper diagnosis and recovery.

Recovery time is highly individual and depends on the severity and duration of the condition. While some metabolic functions can improve within weeks, hormonal and bone density recovery can take many months or even years.

Signs of recovery include improved energy levels, better concentration, a more stable mood, and a return to a regular menstrual cycle for females. A medical team will also monitor physical markers, such as hormone levels and bone density.

Psychological support from a mental health professional is crucial for addressing the underlying anxieties, disordered eating behaviors, and body image issues that contribute to and are exacerbated by RED-S.