Understanding REDs as a Recreational Athlete: Lessons from My Journey

by Jodie Pearlman

For six years, I struggled with symptoms I didn’t recognise as part of a bigger problem. When I eventually stumbled upon the term REDs (Relative Energy Deficiency in Sport) in 2021, I managed to regain my periods and thought I’d escaped unscathed. But three years, two stress fractures, and countless injuries later, it became clear that I hadn’t.

The growing awareness of REDs in professional sport is extremely encouraging, but many active people who wouldn’t call themselves “athletes” are still unaware of its risks. In this blog, I’ll share some of my experiences, the lessons I’ve learnt, and what makes REDs in recreational athletes unique.

And to any males reading this—don’t close the page at the mention of periods! While that was my main red flag, REDs symptoms vary widely and can affect both men and women in different ways.

You Don’t Have to Be a Pro Athlete to Experience REDs

My periods stopped shortly after I started university. I wasn’t training like an Olympian—just running a few times a week, going to gym classes, and occasionally swimming. But it was enough to trigger REDs because, quite simply, my energy intake didn’t match my expenditure.

This misconception, that you need to be an elite athlete to face these issues, means many recreational athletes may not recognise the risk they face.

We Need to Increase Awareness Among Health Professionals

Unlike professional athletes, recreational athletes aren’t typically surrounded by coaches, nutritionists, or physiotherapists. My first point of contact was my GP, and unfortunately, but not uncommonly, neither the GP nor I connected my exercise levels with my loss of periods.

Because I wasn’t underweight and didn’t have an eating disorder, the idea of low energy availability never came up. Instead, I was advised to go on the pill to “protect my bones and uterine lining”—advice we now know to be scientifically incorrect. Over the next six years, three more GPs and two gynaecologists gave me the same advice.

Symptoms Can Be Subtle and Varied

At the time, I thought I felt fine. Looking back, though, there were warning signs I missed, like nighttime hunger and digestive issues. I didn’t often get ill like others with REDs may do. I also hadn’t had a stress fracture, but as I hadn’t made the connection with REDs, bone issues hadn’t even occurred to me.

Loss of periods is one of the better-known indicators of REDs, and it was an obvious indicator for me. But not everyone can track periods, including males who can also be affected by REDs and those on hormonal contraception. While hormonal contraception doesn’t help, we need to recognise that it is the reality for many people. We need to ensure those who aren’t able to track periods are aware of other symptoms and signs of REDs, especially the ones unique to them.

Knowing How Much to Eat Isn’t Always Simple

While I wouldn’t say I had an eating disorder, and I wasn’t technically underweight, I definitely showed signs of disordered eating. Moving to university meant lots of lifestyle changes—buying my own food, cooking for myself, drinking more. I didn’t consciously aim to lose weight, but I also didn’t want to gain any either.

So, I became more careful with what and how much I ate, and instead of listening to my appetite, I modelled my eating habits after what I saw others doing. Over time, I lost touch with how much I needed to eat. And, once those habits have become well established, it can be hard to break them.

The picture becomes ever more complex once you’re in a state of low energy availability. Our bodies are incredible at adapting and compensating for low energy, for example, holding onto weight to protect us or even suppressing our appetite.

Small Changes Can Make a Big Difference

After university, I joined a running club and slightly increased my training, but I was keen to understand why I still wasn’t getting my periods. I resorted to my own reading around the subject and finally discovered the term REDs. This felt like a big step in itself, and I was lucky to be able to see a specialist in the area. While a scan revealed that my bone density was low, it didn’t hit home as I had never experienced a stress fracture. With some simple changes, like avoiding fasted training, eating more carbs, and refuelling quickly after exercise, I regained my periods. I thought I’d solved the problem.

Recovery Isn’t Always Linear

A year later, I suffered a sacral stress fracture while training for the London Marathon. I knew this type of fracture was closely linked to low energy availability. This was the first time I really felt the effects of REDs and it represented a massive low point.

At the time, being on hormonal contraception meant that I couldn’t tell if my periods had stopped again. But either way, this was the turning point. I overhauled my nutrition, prioritised strength training, and returned to running feeling stronger than ever.

However, the following year, I had another stress fracture, despite regular periods and being in “recovery,”. It’s been harder to accept. Recovery isn’t a straight line, and I’m learning to navigate the long-term effects of REDs, like osteopenia and injury susceptibility.

I still believe everything happens for a reason, and on a positive note, I’ve finally braved road cycling on the real roads as part of my cross-training routine. I also organised a panel on REDs for my running club (more details below), both of which probably wouldn’t have happened otherwise.

The Importance of Awareness

REDs is preventable. Yet, it’s a problem many of us face without realising it. Raising awareness among recreational athletes, GPs, physiotherapists, and coaches could make a huge difference.

Identifying and recovering from REDs is the first step, and it’s a big one. But what happens next? How much training can your body handle? What considerations do you need to make? These are some of the questions I’m now thinking about. I know I have osteopenia, and while I focus on nutrition and strength training, I’ve had several injuries in addition to stress fractures and wonder whether these were more likely post-REDs and if I can now cope with the same amount of training as others. We need more research and guidance on what to do post-REDs.

If this resonates with you, don’t wait to address potential signs of REDs, regardless of how ‘athletic’ you consider yourself to be. Explore the resources on this website and seek help. You might feel fine now, but your future self will thank you for acting sooner.

Watch the REDs Panel

Mornington Chasers and SOAR Running held a panel to raise awareness about the dangers of REDs to the amateur athlete. Panellists included hormone health expert Dr. Nicky Keay, clinical dietitian and sports nutritionist Alice Murray-Gourlay, and professional runner and NN Running Team member Jake Smith. The panel discusses what REDs is, how runners can recognise the signs and symptoms and how to avoid it, with a lively audience Q&A at the end.

You can watch the full talk and panel discussion, here.