Exploring the Presentation of RED-S in Ultra-Endurance Sports: An In-Depth Review
Recent years have seen a burgeoning interest in the physiological and psychological phenomena surrounding athletes engaged in ultra-endurance sports—disciplines requiring exceptional physical and mental resilience. As these competitions increase in popularity, so does the complexity of issues confronting their participants. Among the most pressing is the emergence of Relative Energy Deficiency in Sport (RED-S)—a condition that has become a focal point of concern for sports scientists, coaches, and athletes alike. This article delves into the intricacies of presenting RED-S in the context of ultra-endurance sports, based on a comprehensive review conducted by Colangelo et al. (2025).
The phenomenon of RED-S is characterized by an insufficient energy availability, which is rooted in the imbalance between dietary energy intake and the energy expended during physical activity. For ultra-endurance athletes who frequently train at high intensities for prolonged periods, the risk of entering a state of energy deficiency is heightened. This complex issue can lead to serious physiological disruptions, including hormonal imbalances and impaired metabolic function, which ultimately compromise athletic performance and overall well-being.
One of the striking findings reported in the review is the relationship between RED-S and mental health issues, particularly among athletes in the ultra-endurance community. It has been demonstrated that energy deficiency can contribute to anxiety, depression, and increased stress levels, creating a vicious cycle that can severely hamper an athlete’s performance. This relationship underscores the importance of a holistic approach when addressing the health of ultra-endurance athletes, where both physical and psychological aspects are considered in tandem.
The review also highlights the significant variations in the presentation of RED-S symptoms among male and female athletes. While both genders experience similar physiological consequences, the manifestation of symptoms may differ due to hormonal factors and societal pressures. Female athletes, in particular, may face greater scrutiny regarding their body image, which can exacerbate the risk of energy deficiency. Addressing these gender-specific issues is crucial for creating effective prevention and treatment strategies tailored to the unique needs of ultra-endurance athletes.
Nutritional strategies play a critical role in preventing and managing RED-S among ultra-endurance athletes. Maintaining a sufficiently high caloric intake, alongside a well-balanced diet rich in essential nutrients, is paramount for sustaining performance and health. The review emphasizes the need for athletes to work with registered dietitians or nutritionists who specialize in sports nutrition, ensuring they receive personalized advice that accounts for their unique training regimens and energy expenditure demands.
Moreover, the role of education and awareness cannot be overstated. Athletes, coaches, and support personnel must be well-versed in the warning signs of RED-S and understand the implications of energy deficiency on both performance and health. Training programs should incorporate educational components that inform athletes about the importance of energy balance, proper nutrition, and self-care strategies, fostering a culture that prioritizes physical and mental well-being.
In recent years, there has been a significant shift towards a more supportive and empathetic approach in the athletic community concerning mental health. This shift is paramount for addressing issues related to RED-S, as athletes may feel pressured to conform to certain body standards or performance expectations. Creating an open dialogue around mental health within the realm of ultra-endurance sports is essential for breaking the stigma associated with seeking help and fostering an environment where athletes feel comfortable discussing their challenges.
In addition to mental health considerations, the review points to the role of technology in monitoring athletes’ health and performance. Wearable devices and apps can aid in tracking energy expenditure, nutrient intake, and physiological responses, providing valuable insights that can inform nutrition and training regimens. Coaches and athletes alike can harness this technology to create more data-driven, personalized approaches to training that prioritize energy balance and overall health.
The review by Colangelo et al. also presents a call to action for organizations governing ultra-endurance sports, urging them to develop comprehensive guidelines and policies that address issues related to RED-S. These measures could include mandatory nutrition education for athletes and coaches, as well as protocols for identifying and managing energy deficiency in competitive settings. A proactive stance from governing bodies would contribute significantly to raising awareness and reducing the incidence of RED-S among athletes.
Cross-disciplinary collaborations are essential for tackling the multifaceted nature of RED-S in ultra-endurance sports. An alliance between sports scientists, nutritionists, psychologists, and trainers can generate a wealth of knowledge and strategies that address the variables contributing to energy deficiency. By integrating expertise from diverse fields, the sports community can develop more robust frameworks for preventing and managing RED-S, ultimately enhancing athlete health and performance.
Furthermore, examining cultural and societal influences on the perception of body image within the context of ultra-endurance sports is critical. Athletes, especially emerging talents, are often subjected to unrealistic ideals propagated by media and social platforms, leading to unhealthy behaviors in their pursuit of success. Addressing these influences through advocacy and positive representation can help empower athletes to embrace diverse body shapes and sizes as they strive for excellence in their respective sports.
As the conversation surrounding RED-S continues to evolve, the importance of community support cannot be overstated. Peer support networks can play a vital role in helping athletes navigate the challenges they face, providing a platform for sharing experiences and coping strategies. Fostering an inclusive environment that encourages athletes to connect and support one another can be a powerful determinant in promoting health and performance standards.
The rich tapestry of ultra-endurance sports presents unique challenges that demand attention and action, particularly concerning RED-S. The insights derived from the review by Colangelo et al. shed light on the various dimensions of this condition, offering a comprehensive understanding of its implications. By prioritizing education, open dialogue, personalized nutrition, and mental health advocacy, the sports community can pave the way for healthier, more resilient athletes.
In summary, the exploration of RED-S within ultra-endurance sports reveals a landscape fraught with complexities that require a concerted effort from all stakeholders involved. Through collective awareness and a commitment to athlete well-being, the potential for a healthier future in ultra-endurance sports is within reach.
Subject of Research: The presentation of Relative Energy Deficiency in Sport (RED-S) in ultra-endurance sports.
Article Title: Exploring the presentation of REDs in ultra endurance sport: a review.
Article References:
Colangelo, J., Smith, A., Henninger, K. et al. Exploring the presentation of REDs in ultra endurance sport: a review.
J Eat Disord 13, 210 (2025). https://doi.org/10.1186/s40337-025-01381-0
Image Credits: AI Generated
DOI: 10.1186/s40337-025-01381-0
Keywords: Relative Energy Deficiency in Sport (RED-S), ultra-endurance sports, nutrition, mental health, energy balance.
