Signs and Identification of REDs

As discussed, REDs can impact multiple systems in the body therefore, no athlete will experience the exact symptoms as another (Jeukendrup et al., 2024). There is a large range of REDs signals or signs to which include:

Performance specific:

• Delayed or difficulty recovering between training sessions
• Insufficient adaptation to training
• Decline in overall performance
• Lack of concentration
• Early fatigue onset in competition or training. 

Physiological:

• Loss of libido in males (reduced testosterone levels)
• Irregular or absent periods in females (amenorrhea or oligomenorrhea)
• Difficulty maintaining body weight (not in all cases)
• Low mood or feeling irritable
• Recurrent injuries/niggles that are not been managed (typically soft tissue injury)
• Stress fracture occurrence/low bone mineral density
• Frequent and reoccurring illnesses
• Disrupted sleep
• Gastrointestinal challenges such as bloating, constipation and loss of appetite (to name a few).

Identification of REDs involves a multidisciplinary approach with each member of the athlete support team playing a pivotal role in prevention, identification and treatment of REDs. As REDs is a condition which impacts multiple body systems, no single symptom confirms it, and therefore identification requires a multi-dimensional approach. It is worth noting that many of the above symptoms overlap with numerous other syndromes or conditions, and therefore, flagging suspected ‘signs’ with your medical team is crucial to rule out other conditions beyond REDs and further determine the correct diagnosis (Jeukendrup et al., 2024). 

In addition to awareness of symptoms, if a practitioner has concerns about energy availability with an athlete, there are available population screening tools that can be used to provide further data and insight, including LEAF-Q (low energy availability in females questionnaire), LEAM-Q (low energy availability in males questionnaire) and REDS-CAT (relative energy deficiency in sport clinical assessment tool). Other tools, including DEXA assessment (to assess bone mineral density) and blood profiling (to assess nutrient profile, blood markers and hormonal profile) can also be used to assist in the diagnosis of REDs in the athletic population. Such tools should be used in a multidisciplinary conversation/performance review to ensure development of an appropriate treatment plan if REDs is diagnosed. 

Coaching tips: 

• Those working in Women’s teams should be aware of the above signs and symptoms of REDs to assist in identification in their playing group.
• Simple exercises such as encouraging their athletes to keep track of their menstrual cycle, recording illness bouts throughout the season, and the medical team recording injury occurrence can all be effective measures to identify onset early.