RED-S
The Lightbulb Moment: What Our New Research Tells Us About Recovering from REDs
Performance Dietitian
Published
June 2, 2026
Performance Dietitian
Published
June 2, 2026
Relative Energy Deficiency in Sport (REDs) is a serious clinical condition that occurs when an individual fails to consume enough energy to meet the combined demands of their training and normal physiological function. Prolonged low energy availability can disrupt menstrual function, compromised bone health, impair immunity, and have a lasting impact on performance. While REDs is most commonly associated with female athletes, if affects males too, and its consequences extend well beyond sport.
Despite how significant REDs is, the evidence based on how to support recovery has remained surprisingly limited. Most practitioners have been navigating a recovery process that is, too often, part trial and error. That is exactly why this research matters.
This study grew directly from the work we do at the Axis REDs Clinic. Patients were drawn from our own clinical records, women aged 18 - 42, all with a confirmed REDs diagnosis, who were then referred to me for nutritional support. This study was a collaboration between Axis Sports Medicine, ERH Associates, and the University of Otago, led by Penny Matkin-Hussey as part of her PhD, and myself, Dr Megan Ogilvie, Dr Sarah Beable and Professor Katherine Black as co-authors. This study has recently been published in the Journal of Sports Medicine and Physical Fitness.
To our knowledge, this is one of the first studies to examine outcomes in a clinically diagnosed, free-living REDs population, as opposed to athletes who self-identified symptoms or were observed in a laboratory setting.
When I sit down with a new REDs patient, there are patterns I recognise consistently. Many have already attempted to address their fuelling, often with generic advice that lacked the structure to make it meaningful. Some carry significant anxiety around body composition, or concern that eating more will compromise their performance. Others have been inadvertently under-fuelling, not through any intention, but because demands outpaced intake without anyone realising.
What I have found works, and what this research supports, is taking time to do two things well: educating individuals about their own energy equation, what they are expending versus what they are actually consuming, and building a fuelling plan structured around their training.
Fifty-five women with a clinical REDs diagnosis completed a detailed questionnaire about their experience of a sport dietician consultation and a personalised energy intake plan. The finding showed improvements in menstrual function, gastrointestinal symptoms, and appetite following the consultation and plan, outcomes that are clinically meaningful in this population.
Perhaps the most notable finding was that 93% of participants had underestimated how much they need to eat to fuel their exercise, and for most, this was new information. This helps explain something we observe clinically all the time: the gap between knowing you need to eat more and actually being able to do it. Understanding their specific energy requirements, in the context of what their body was actually working to do, appeared to provide the permission needed to increase intake and work through the associated anxiety.
The study also confirmed that structuring in intake around exercise is the most practical entry point into recovery. Eating before and after training was the element patients found easiest to implement and least likely to provide stress, which makes sense when fuelling is framed as purposeful and performance based.
Understanding the barriers matters as much as identifying the facilitators. Concerns about weight or body shape change was cited by 62% of participants as a barrier to plan implementation, alongside challenges with appetite and food volume. Education along is not sufficient, the plan needs to be more personalised, visual, and structured around an individual's training load. The role of a support network was also significant, with two-thirds of participants rating it as important or very important to their recovery.
This is why the interdisciplinary approach at our REDs Clinic is central to what we do. Patients are assessed by a specialist physician or reproductive endocrinologist before being referred for nutritional support, a co-ordinated team approach aligned with the IOC framework for REDs management.
This paper is one of a series of investigations into REDs being conducted through the clinic, with Penny leading the research programme. We are looking forward to sharing findings from our next study shortly, work examining the application of continuous glucose monitoring in REDs management, which we believe will add a further important dimension to how we assess and support this patient group.
If you are a clinician working with active patients presenting with menstrual irregularities, fatigue, recurrent illness or injury, or unexplained performance decline, REDs should on on your differential. Early referral to a specialist interdisciplinary team makes a difference. To refer a patient or make an appointment at the Axis REDs Clinic, refer to our website or call 09 521 9845.
