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What Gymnasts Need to Know about RED-S

As a gymnast, have you ever said any of the following:

I'm tired all the time...

Skills and routines that used to be easy now seem harder...

I feel like I'm constantly dealing with injuries...

I'm not getting my period anymore, but that's okay right?

I don't have practice today so I should eat less (or do my own workout) so I can eat as much as usual...

Unfortunately, these are all common but potentially dangerous misconceptions for many athletes, and they are all so prevalent within the gymnastics community as well.

Gymnasts, It's NOT normal to feel tired all the time. It's NOT normal for skills and routines that used to seem easy to now seem difficult. It's NOT normal to constantly be injured. It's NOT normal to stop getting your period when you previously had one (or to have not started by the time you're 16 years old). And it's NOT true that you don't need as much (if not more because recovery!) food and energy on off days (please remember - you never have to earn your food by working out).

The belief that you don't need energy on off days or while you're injured is especially harmful. The reality is, gymnasts need A LOT of energy, no matter whether you had practice or not. You could lay in bed all day, and you would still need energy to carry out basic functions like breathing, nervous signaling, and pumping blood (pretty important functions right?!).

When I was a gymnast (and before I began learning more about nutrition), I too fell into the mindset trap - "I can't eat as much today because I don't have practice". Now, my goal is to help other gymnasts avoid this harmful thinking because it can greatly hinder your health and performance.

So what can happen when gymnasts don't eat enough to provide energy for exercise AND basic functions? Gymnasts can develop what's called RED-S.

RED-S stands for Relative Energy Deficiency in Sport, and is a very serious syndrome with a growing body of research about the condition itself and its symptoms. RED-S is a low energy availability state that leads to harmful effects across every system in the body. (If you've heard of the female athlete triad before, RED-S is similar but has been expanded to incorporate all of the negative effects that are also associated with low energy availability that can apply to all athletes).

So what is low energy availability?

Energy availability is the difference between the energy (calories) you take in (through eating) and the energy you use through every day activities and exercise each day.

The energy that's left (available) is what your body the can use for all of its essential functions: like breathing, digestion, and transportation of oxygen and nutrients in the blood.

When your energy availability is low, your body does not have enough to support exercise and everyday activities, and has to make compromises.

Let's set up an analogy:

You have $500 in your bank account. You really want a new leo that's $50. You don't need the leo, but you decide you'll buy anyway it because you have enough, and will still have plenty of money left for other things you may need or want (like to put gas in your car).

On the other hand, if you only have $50 in your bank account, you probably wouldn't buy that new leo because then you wouldn't have anything left in your bank account, and that's not enough to buy other things you absolutely need (like food).

RED-S is like having only $50 in your bank account. Your body is frequently in a stressed-out state, sacrificing things it wants for things it truly needs to survive.

What happens when my body doesn't have enough energy?

RED-S affects every single system in the body, which is why it's so serious and important to avoid through proper fueling and adequate energy intake.

When the energy available for the body to use is not enough, the body will start to adapt. The body will actually slow or even shut down many functions to save energy to make sure it has enough for absolutely essential functions (like breathing and digestion).

For example: one of the biggest, most well know red-flags of the female athlete triad/RED-S is if a female (who previously had a regular period) stops getting her period altogether - a condition called amenorrhea. This is a sign of improper hormone and reproductive system function. As your body "shuts off" reproductive function because it has barely enough energy to support you, let alone trying to support a whole new person. Not only does this have potential long-term hormonal and reproductive consequences, this reduction in hormones also leads to decreased bone health and bone density, increasing risk for overuse injuries such as stress fractures.

This is just one example of how the low energy availability of RED-S leads to a cascade of numerous detrimental health effects.

As a gymnast, RED-S can impact your

  • Energy in the gym

  • Strength and Endurance

  • Day to day recovery

  • Recovery from Injury

  • Focus and Coordination

  • Mood and Mental Wellbeing

As you can see, RED-S is a condition any gymnasts would want to avoid. Decreased coordination, decreased strength and endurance, and increased injury risk will certainly not help a gymnast reach her goals in the gym.

Luckily, RED-S can be prevented! The best way to do so is through proper fueling and ensuring that you eat enough food to give you the energy you need in AND out of the gym!


If you're interested in learning more about RED-S, register for the FREE Webinar "Relative Energy Deficiency in Sport (RED-S) in a Gymnast" on Sunday, June 13th at 7:00pm-8:30pm EST provided by Gymnastics Medicine: Education and Research Group.

And if you're concerned about RED-S, talk to your doctor and/or a Registered Dietitian to make sure you are eating enough and avoiding the consequences of RED-S.


Kerry Bair, RD, LDN, MPH

The Gymnast RD

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