RED-S in Youth Athletics: Low Energy in Athletes
In the world of youth athletics, maximizing performance and success often takes center stage. Coaches, parents, and athletes themselves focus heavily on training, competition, and skill development, while sometimes overlooking a key component of athletic performance: adequate energy availability. One growing concern among youth athletes today is Relative Energy Deficiency in Sport (RED-S), a condition characterized by insufficient energy intake to support both the energy demands of training and normal bodily functions. This imbalance can lead to a range of serious health consequences, both physical and psychological, that can affect an athlete’s performance and overall well-being.
What is RED-S?
RED-S is a condition that occurs when an athlete does not consume enough energy (calories) to meet the demands of both their sport and their body’s basic physiological functions, such as growth, recovery, and repair. While it is a condition most commonly associated with female athletes due to the historical emphasis on conditions like the “female athlete triad,” recent research has shown that RED-S affects both male and female athletes across a variety of sports.
In youth athletics, where growth and development are critical, the consequences of RED-S can be particularly severe. Youth athletes are still in a stage of rapid physical and cognitive development, meaning their bodies require adequate energy not only for sport but also for normal growth processes.
The Signs and Symptoms of RED-S
RED-S can be difficult to identify, as its symptoms often overlap with other conditions or can be misattributed to the natural rigors of athletic training. However, there are several key signs and symptoms to watch for in youth athletes:
Fatigue or chronic low energy levels: Despite regular training, athletes may feel persistently tired or lacking in energy, making it difficult to perform at their best.
Frequent injuries or stress fractures: A lack of energy can impair the body’s ability to recover, leading to an increased risk of overuse injuries and stress fractures.
Impaired recovery: Athletes with RED-S may notice that their recovery times after training or competition are significantly prolonged.
Decreased athletic performance: Despite continued training, athletes may experience a decline in performance, such as slower times, reduced strength, or decreased endurance.
Delayed or interrupted puberty: In youth athletes, RED-S can disrupt the normal progression of puberty, which can have long-term implications for growth and development.
Psychological symptoms: These may include irritability, increased anxiety, and difficulty concentrating—especially under the added pressure of competition.
Why is RED-S So Prevalent in Youth Sports?
Several factors contribute to the prevalence of RED-S in youth athletics, many of which are rooted in the culture of sport and performance:
Pressure to Perform at a High Level: Youth athletes are often encouraged to specialize in a single sport at an early age and train year-round, which increases their energy demands. The emphasis on peak performance can sometimes lead to overtraining without considering the body’s nutritional needs.
Lack of Nutrition Education: Many youth athletes, coaches, and even parents may not fully understand the energy demands of competitive sports or the importance of proper fueling. In some cases, athletes may unintentionally under-eat because they are unaware of how much energy their bodies truly need.
Body Image and Societal Pressures: Young athletes, particularly in sports where leanness is perceived as beneficial (such as gymnastics, running, or dance), may feel pressured to maintain a certain physique, leading them to restrict food intake or engage in disordered eating behaviors. These pressures can come from both external sources (coaches, social media) and internal sources (self-comparison to peers).
Overtraining and Lack of Rest: Many youth athletes train intensively with minimal rest or recovery periods. Without sufficient rest and proper nutrition, their bodies cannot fully recover, leading to the energy deficit that characterizes RED-S.
The Health Consequences of RED-S
The consequences of RED-S are far-reaching and can affect every system in the body. For youth athletes, the condition is particularly concerning because of the critical stage of development they are in. Some of the most serious consequences include:
Bone Health: One of the most significant risks of RED-S is poor bone health. Without adequate energy and nutrient intake, particularly calcium and vitamin D, youth athletes are at a higher risk for stress fractures and long-term bone density issues, such as osteoporosis. This is especially concerning for athletes in their teenage years, as this is the time when peak bone mass is being developed.
Menstrual Irregularities: For female athletes, RED-S can cause disruptions in the menstrual cycle, including irregular periods or complete cessation (amenorrhea). This is a sign that the body is not receiving enough energy to support both physical activity and reproductive function.
Delayed Growth and Development: In growing athletes, an energy deficiency can lead to delayed growth, delayed puberty, and, in extreme cases, stunted height.
Metabolic Issues: Prolonged RED-S can lead to a slowed metabolism, as the body tries to conserve energy by reducing non-essential functions. This can result in weight loss, fatigue, and poor overall health.
How to Address RED-S in Youth Athletics
Preventing and managing RED-S requires a proactive approach that focuses on education, awareness, and collaboration between athletes, coaches, and healthcare providers.
Education on Nutrition and Energy Needs: Educating youth athletes about the importance of proper nutrition is the first step in addressing RED-S. Athletes need to understand that food is fuel and that their bodies require more energy than their non-athletic peers, especially during periods of growth and intense training. Parents and coaches should also be aware of the signs of RED-S and emphasize proper fueling over restrictive dieting or appearance-based goals.
Monitor Energy Intake and Output: Regularly assessing an athlete’s energy intake compared to their training demands is crucial. Athletes should be encouraged to eat balanced meals that include carbohydrates, protein, and fats, and to avoid skipping meals or snacks, especially around training sessions.
Encourage Rest and Recovery: Overtraining is a key factor in the development of RED-S. Coaches and parents should encourage proper rest and recovery periods, including off-days, active recovery, and periods of lower-intensity training. This allows the body to repair and replenish energy stores.
Work with Healthcare Providers: In cases where RED-S is suspected, working with healthcare providers, such as sports dietitians, physical therapists, and physicians, can help create a comprehensive care plan. A sports dietitian can assess an athlete’s dietary needs and help them develop a plan to increase energy intake, while a physical therapist can address any biomechanical issues that may be contributing to injury risk.
Promote a Healthy Training Environment: Finally, it’s important to create a training culture that prioritizes health and well-being over performance at any cost. Coaches, parents, and teammates should foster an environment where proper fueling, rest, and injury prevention are valued as much as athletic achievement.
RED-S is a growing concern in youth athletics, but with the right approach, it can be prevented and managed. By educating athletes, promoting proper nutrition, and encouraging rest and recovery, we can help young athletes avoid the dangers of low energy availability and set them up for long-term health and success in their sport. At Evolve Physical Therapy, we are committed to supporting youth athletes through individualized care and education, helping them stay healthy, strong, and ready to perform at their best.
