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Updated: Jun 12, 2025

Determining the Contribution of the Energy Systems During Exercise
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Does Relative Energy Deficiency in Sport (REDs) Syndrome Exist?

Asker E Jeukendrup1,2, Jose L Areta3, Lara Van Genechten2

  • 1Loughborough University, Loughborough, UK.

Sports Medicine (Auckland, N.Z.)
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Relative energy deficiency in sport (REDs) diagnosis faces challenges due to difficulty measuring energy availability and generic symptoms. An unbiased approach focusing on athlete health is recommended, considering all potential causes.

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Area of Science:

  • Sports Medicine
  • Exercise Physiology
  • Athlete Health

Background:

  • The Relative Energy Deficiency in Sport (REDs) model, updated in 2023, explains adverse health and performance outcomes from low energy availability (LEA) in athletes.
  • Practitioners increasingly diagnose REDs based on symptoms, but the model's scientific rigor and diagnostic process are questioned.

Purpose of the Study:

  • To critically evaluate the REDs concept and the empirical evidence supporting the model.
  • To challenge dogmas surrounding REDs and promote rigorous scientific processes in athlete health assessment.

Main Methods:

  • Critical review of existing literature on REDs, focusing on the challenges of measuring energy availability and isolating LEA's effects.
  • Discussion of the limitations of current diagnostic approaches, including symptom-based diagnosis and the multifactorial nature of symptoms.
  • Introduction of the Athlete Health and Readiness Checklist (AHaRC) as a tool for unbiased, comprehensive athlete health assessment.

Main Results:

  • Accurate field measurement of energy availability is deemed impossible, leading to symptom-based REDs diagnoses that are potentially biased.
  • Isolating LEA's effects from other causes of similar symptoms is experimentally challenging, making the REDs model difficult to falsify.
  • Existing evidence primarily shows associations rather than causality between LEA and symptoms, with limited long-term observational data.

Conclusions:

  • The REDs model's diagnostic approach may be flawed due to measurement difficulties and the multifactorial etiology of symptoms.
  • An unbiased approach prioritizing overall athlete health and considering all potential contributing factors is more beneficial than a REDs-specific diagnosis.
  • The Athlete Health and Readiness Checklist (AHaRC) offers a practical framework for a holistic assessment of athlete health and performance issues.