My Experience With Relative Energy Deficiency in Sport

When I was in college, I dealt with a scarcely known condition called Relative Energy Deficiency in Sport (REDs). REDs occurs when calorie intake is below calorie expenditure for an extended period of time. This lack of energy makes the body unable to sufficiently perform basic physiological functions, leading to a host of ailments including fatigue, poor immunity, decreased bone mineral density, hormonal dysfunction, slowed metabolism, and cardiovascular issues. Often, these are the downstream effects of abnormal blood markers resulting from this state of chronic calorie deficiency.

For context, I ran NCAA D1 Cross Country and Track at California Polytechnic State University. I likely began experiencing the effects of REDs during my second year of college, and the condition peaked during my fourth and final year. I stopped competing after my sophomore year, partly due to a knee injury—a bone contusion sustained from hyperextending my knee while falling to the ground after an attempted box jump that was too high for me. However, the more subtle reason for leaving the team was persistent fatigue and weakness. At the time, the cause was unknown; I figured it could be low iron or ferritin, but supplements provided little relief even as my levels improved with them. Looking back, it’s clear that this lack of physical strength contributed to my knee injury. My fatigue was often debilitating. During a summer spent trying to regain fitness to rejoin the team, I could only manage an average-paced four-to-five-mile run each day—about half my intended volume and lower intensity—and I would be bedridden for the rest of the day afterward.

Throughout my college years, I remained physically active; biking or walking to class, working out in the gym, running if my knee permitted it, and even cooking my own meals and getting groceries via bike.

Now, it is important to note my eating habits. I was keenly health conscious and almost obsessively desired to eat healthy foods. Out of interest, I self-educated about nutrition science and what it says about a healthy diet. I became almost subconsciously calorie-mindful in that I restricted calorie-dense foods in place of low calorie foods. I took on an increasingly plant-based diet in alignment with what the evidence shows is the most healthful diet, also taking into consideration the benefits to the environment and animal welfare.

Now let me be clear on this: my experiences did not turn me away from this way of eating. A well-balanced, plant-forward way of eating still works well for me.

My breakfast was a routine overnight oats mixture which amounted to no more than 250 calories. Come lunchtime, I would be quite hungry, and my meals would vary, usually consisting of a homemade breakfast bread (e.g., banana bread) with fruit and soy milk along with leftovers from prior dinners. At dinnertime, I loaded up on vegetables, eating a grande bowl of salad filled with an impressive variety of plants as the first thing in every dinner. My dressing would be intentionally low-calorie. This filled my stomach with fibrous bulk and often left little room for much else post-salad. With what appetite I did have left, I’d usually have a dish with legumes, whole grains, and a dense protein source such as soy foods, plant-based meats, or occasionally fish or eggs (I wasn’t exclusively plant-based).

My intention was never to lose weight; however, in hindsight, I discovered a powerful formula for doing so, which I detail in my article, How to Lose Weight Naturally.

In my fourth year of college, REDs was at its worst. And it didn’t help that I got ClearCorrect teeth aligners, which I was supposed to wear as much of the day as possible, only taking them off for meals and discouraging snacking. Looking back at pictures of myself during this time, it is strikingly clear that I was underweight.

Even at a weight of around 120 lbs, I was convinced I was eating sufficiently and that my body weight was normal. The turn toward addressing the issue didn't happen until late spring of my senior year. When sports medicine specialists at AthleatMD first raised the possibility of REDs—a condition I had never even heard of—and my mom agreed, my initial reaction was denial. Yet, driven by desperation, I ultimately chose to open my mind to their perspective.

Over those years, I underwent numerous blood tests and medical appointments to pinpoint the underlying cause of my health issues. The lab results were significantly disrupted, showing abnormally low red blood cell count, hematocrit, hemoglobin, white blood cell count, and platelets, alongside elevated mean corpuscular hemoglobin, alanine aminotransferase, and total iron-binding capacity. Additionally, I presented with low testosterone levels, bradycardia, and low blood glucose.

Fortunately, within three to six months of initiating targeted interventions to address REDs, every single one of these abnormal markers returned to normal parameters. Resolving the condition required no drastic dietary shifts; the key was achieving body weight homeostasis simply by increasing total caloric intake. To accommodate the additional energy, I incorporated more calorie-dense foods while slightly scaling back on high-fiber bulk to ease stomach volume.

Upon increasing my calorie intake, I experienced hyper-metabolism: a substantially increased appetite driven by an elevated metabolic rate. This is a physiological response the body uses to restore depleted systems and repair the damage caused by prolonged energy deficiency. I was honestly flabbergasted by how much I was eating; my appetite felt almost insatiable. This surge lasted about two weeks before settling back down. From there, my weight gradually increased and I began to feel a newfound sense of energy, though it took another four to five months before that energy became consistent, with occasional days of unexplained fatigue still cropping up along the way.

Reflecting on this experience now, I don't think the lesson is that healthy eating or discipline is something to be wary of. I still believe a healthy diet is well worth pursuing, and it can become just as enjoyable as any other way of eating once your tastebuds and preferences adapt, which they will if given enough time. What I've come to recognize instead is the risk of dietary hyper-fixation: when something that starts as a value becomes the primary lens through which you see everything else. I've always believed it's easier to be 100% committed to something than 90%, but full commitment only serves you when what you're committed to stays in proportion to everything else in your life. Give it too much attention, and it stops being a value and starts being a distraction from what actually matters. Whatever you focus on gains power over you. So the question worth sitting with is this: what are you giving your focus to right now, and is it serving you, or quietly starting to run the show?