Schedule A Consultation

Under-fueled and Underperforming: Relative Energy Deficiency in Sport

atlanta dr. krystal nutrition overtraining performance physical therapy recovery Jan 18, 2023

You may have heard of the female athlete triad, especially if you competed as a young lady, which is characterized in its simplest form by losing your period, not consuming adequate calories, and resulting in bone density loss fractures and soft tissue injuries. The loss of a menstrual cycle used to be one of the first signs that a shift is occurring and for some athletes, this used to be a welcome relief as to not have physical limitations with pain and hormones get in the way of their training. Relative energy deficiency in sport (RED-S) is the new terminology for female athlete triad as it does not just affect women and it takes a comprehensive look at how this affects all of the systems of our body. 

Here is a diagram outlining the effects on performance and health with RED-S and its interplay with the former nomenclature of the female athlete triad. 

Anyone that exercises is susceptible to RED-S, however from my experience, I have seen this occur in weight based sports like dancing and martial arts, anyone with perfectionistic tendencies, new moms eager to drop baby weight, runners both elite and novice, and myself! 

For me, it was unintentional both times. In my early 20s, I was a full-time personal trainer and began tracking my food on MyFitnessPal (it is still a fabulous resource!) because I had never done so and wanted to experience it with my clients. Turns out, it can become an obsession and, for me, unnecessary to track my food and aim for lower calories just to “try it out.” It was an experiment and I ended up with chronic fatigue, little to no energy for both school and work, and gastrointestinal issues. The second time this happened was recently when I began working with a strength coach twice a week because I needed routine weightlifting in my life. What I did not anticipate was needing to have a meal plan, make ahead said meals, pack snacks for the day, and not rely on only coffee as I did these intense workouts. I should have known better, but I thought my body was invincible and would perform like it did when I was a teenager. Once I recognized some signs like my period never stopping (irregularity), and other hormonal changes, I sought advice and intervention from several practitioners, and now I can say I’m on a better and balanced path. 

The point is, this can happen intentionally or unintentionally. In my case, I didn’t prepare well. In some other cases it could be a lack of information or a negative relationship with food. When I am working with a client and I start to see signs in the chart above or a plateau in tissue healing, we need to consider additional practitioner referrals, and make a plan to have balance between calories in and calories out for their sport. Our bodies love balance and homeostasis. Even if we have well-meaning intentions, we can overdo it and put ourselves at risk of mental, emotional and/or physical harm. 


Ready To Come See Us?


​At Athletes’ Potential, we address your pain/injuries holistically by additionally considering how nutrition, stress management and sleep affect your recovery. Click the link above to schedule an appointment or discovery call with us! 

In health,

Dr. Krystal PT, DPT, CMTPT, RYT-200


Let us help you figure out to live your best active life today! 

 Remember, Movement is Medicine! 

Book an Appointment