NYC Marathon Training - Custom Performance NYC

Red-S Update


Breaking news: there are some new developments in RED-S (my favorite topic). The International Olympic Committee is working hard to research and educate athletes about RED-S and the danger of low energy availability. Here are some new areas of development that should not be ignored.


Iron has many different functions; it transports oxygen, regulates bone health, and aids in immune function. Iron is found in leafy greens, meat, beans, and fortified foods. When an athlete is under-fueling or is using more energy than is available, the body doesn’t store enough iron to maintain all of its functions. This is a major contributor or bone injury.

Low iron levels also mean that less oxygen is being transported through the blood, which has an impact on aerobic function and decreases efficiency during exercise. Iron is in every cell in your body, including your immune cells. If your immune cells do not contain the proper amount of iron, they become weaker and unable to fight bacteria. At the 2016 Rio Olympics, the IOC found a higher rate of upper respiratory infections and GI infections in athletes that were iron deficient.

Iron is also closely linked with reproductive function, making it even more important for women to watch their iron intake. Interestingly, research is also looking at a link between iron deficiency and psychological well-being in athletes. There is a theory that links depression and anxiety to iron deficiency.


As you already know, estrogen (in men and women) is a major player in RED-S. Recent research shows estrogen is a key player in the function of the endothelium of blood vessels. The endothelium is the layer of cells that lines the heart and blood vessels. This layer needs estrogen to function properly. Athletes with lower levels of estrogen (most commonly in women that are amenorrhoeic) are found to have more atherosclerosis (the “plaque” on your artery walls) on the wall of their blood vessels and also have higher levels of LDL (the bad cholesterol).

When these complications go undetected or untreated, athletes can experience significant changes such as valve abnormalities, arrhythmias, and hypotension. Once the function of the heart is disrupted in this way, the heart loses its ability to respond appropriately during a stressful situation. The RAA system which regulates your blood pressure, can not ct appropriately causing athletes to pass out regularly. It is common for these athletes to have severely low heart rates and blood pressure.

Maybe you thought your stress fracture was just a fluke. Maybe your increase in fatigue is totally random. Or maybe your body is showing you signs it needs help. It’s the only one you get so listen to what it is telling you.

*Source: Mountjoy, IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British Journal of Sports Medicine. 2018;52:687-697

Skip to content