RED-S
Optimise energy availability, restore bone health and hormonal balance, and protect athletic performance through expert multidisciplinary care
Understanding RED-S (Relative Energy Deficiency in Sport)
Relative Energy Deficiency in Sport (RED-S) is a complex physiological condition that requires specialised, evidence-based management to safely restore athletic health and performance. RED-S occurs when an athlete's energy intake from food consistently fails to match the energy expended during exercise and daily living, leaving the body with Low Energy Availability (LEA).
Understanding Low Energy Availability (LEA): LEA can develop intentionally through dietary restriction or unintentionally through high training loads, busy schedules, or inadequate fuelling knowledge. Chronic energy deficits force the body to downregulate "non-essential" systems, leading to hormonal disruption, irregular or lost periods (amenorrhea), impaired bone density, weakened immunity, and gut distress.
Recognizing the subtle warning signs of RED-S early is critical to preventing long-term bone loss, severe hormonal dysfunction, and performance decline. Without adequate fuel, athletes suffer from decreased muscle strength, impaired endurance, delayed training adaptations, frequent soft tissue injuries, and persistent fatigue.
Key indicators include recurring stress fractures, persistent fatigue, missed menstrual cycles, frequent colds, gut discomfort, unexplained changes in mood, and stagnation or deterioration of performance.
While RED-S can affect any athlete regardless of gender, up to 80% of elite young female athletes experience symptoms—particularly in endurance, aesthetic, dance, and weight-category sports.
Early diagnosis stops the progression toward early-onset osteoporosis, reproductive complications, and chronic injury, paving a clear, reassuring path back to full health.
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We utilise advanced clinical assessments and determine your goals and concerns to evaluate the impact of RED-S.
Working alongside Sports Physicians, our Sports Dietitian at Ultimo reviews DEXA bone density scans, blood panels, and precise energy availability calculations to evaluate systemic health.
Our clinical pathways strictly adhere to the latest Australian Institute of Sport (AIS), Sports Dietitians Australia (SDA), and IOC consensus statements on Low Energy Availability (LEA).
We create a compassionate environment focused on sustainable fuelling, training load modifications, and physical confidence rather than short-term weight goals.
Optimal management of athletes experiencing RED-S requires a multidisciplinary clinical approach, integrating expertise from sports physicians, dietitians, endocrinologists, and physiotherapists, alongside psychological support where necessary. This collaborative team ensures every contributing factor and physiological consequence of low energy availability is identified and addressed through evidence-based care.
Our Sports Dietitian at the Active Female Hub is ideally placed to review your fuelling needs, and can collaborate with a physiotherapist for injury rehabilitation or Exercise Physiologist for advice on exercise.
- Mountjoy, M., et al. (2023). 2023 International Olympic Committee (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine, 57(17), 1073–1097.
- Australian Institute of Sport (AIS) & Australian Sports Commission. (2023). Relative Energy Deficiency in Sport (RED-S) Position Statement and Clinical Resources.
- Sports Dietitians Australia (SDA). Relative Energy Deficiency in Sport (RED-S) Clinical Guidelines and Fuelling Protocols.
Who treats this?
Our experienced team members are ready to help. See their bios below and book online when ready.
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All major health funds accepted
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FAQ
The Female Athlete Triad focused specifically on three components in women: disordered eating, amenorrhea, and low bone density. RED-S expanded on this model to acknowledge that low energy availability impacts athletes of all genders and affects multiple body systems—including metabolic, immune, cardiovascular, and psychological health.
Our Accredited Sports Dietitian is based at the Active Female Hub in Ultimo, offering specialised, individual consultation for RED-S, under-fuelling, energy availability, and female athletic health.
When the body is chronically under-fuelled, reproductive hormones (like estrogen and testosterone) drop significantly. These hormones are essential for bone turnover; without them, bone resorption outpaces bone creation, leading to lower bone mineral density and recurring bone stress injuries.
Not necessarily. Complete rest is rarely required unless severe medical complications or high-risk stress fractures exist. We typically adjust training intensity and volume while increasing energy intake to achieve positive energy availability safely.
Please bring any recent blood test results, DEXA bone density scan reports, or medical summaries you have.