After years of struggling with REDs<\/a>, the 31-year-old was forced to indefinitely sideline herself in order to prioritize her recovery from the condition.<\/p>\n \u201cI\u2019ve put myself into a hole by abusing my body for too long. Although I improved my fueling and eating habits, it wasn\u2019t enough. My body needs a full reset before it can be at its best,\u201d Ewers\u00a0wrote this week on Instagram.<\/a><\/p>\n \u201cNow is the time to focus on my health because if I don\u2019t, then I will continue to be stuck in a healing body that can\u2019t perform nor fully heal,\u201d she wrote. \u201cIf I ever want to perform at the top level again, I need to take the time to fully recover.\u201d<\/p>\n And Ewers isn\u2019t alone.<\/p>\n REDs (also known as Relative Energy Deficiency in Sport, or RED-S) is a scourge across the sporting spectrum.<\/p>\n Yet despite its prevalence, it\u2019s one of the most mysterious and misunderstood conditions of endurance.<\/p>\n REDs is sometimes \u201cintentional,\u201d but often not. It\u2019s not an \u201ceating disorder,\u201d but it can be provoked by disordered eating. And no, it\u2019s not just for girls \u2013 it\u2019s been ruining this writer\u2019s life for the last decade.<\/p>\n And just to complicate things further, there\u2019s no one clear symptom.<\/p>\n At a low level, REDs might manifest as a few months of flatlining performance and temporary hormonal disturbance.<\/p>\n If it digs its claws deeper, it can trigger a downward spiral that damages long-term daily life.<\/p>\n And while Ewers has left the door open to returning to pro cycling, REDs can end an athlete\u2019s career.<\/p>\n Here\u2019s what every endurance athlete needs to know about REDs.<\/p>\n What is REDs, and why is it so common in endurance athletes? REDs is underpinned by low energy availability (LEA).<\/p>\n Energy deficiencies occur when the diet fails to meet the demands of daily life and training.<\/p>\n This energy equation is what makes REDs so prevalent in endurance sport, where the huge caloric demands of training make it easy to \u201caccidentally\u201d dip into LEA. Remember, even an hour-long recovery ride might burn as much as a small meal.<\/p>\n It\u2019s worth noting REDs also shadows sports governed by weight or aesthetics. Climbers, ballet dancers, and gymnasts are common victims.<\/p>\n REDs can be accidental, but it\u2019s just as often the result of an \u201cintentional\u201d decision to restrict intake or overtrain.<\/p>\n Athletes chasing \u201crace weight<\/a>\u201d are at high risk.<\/p>\n For a short period, caloric restriction can result in an intoxicating uptick in performance. However, REDs hovers over any athlete who toes the line of leanness too long.<\/p>\n In endurance populations, the chance of REDs is escalated by toxic myths and misconceptions of what makes a committed athlete.<\/p>\n Zo\u00eb Rom co-hosts \u201cYour Diet Sucks,\u201d a podcast that cuts through the BS of diet culture<\/a>.<\/p>\n She explained how athletes influenced by societal ideals or pressures can find themselves on a slippery slope toward energy deficiency.<\/p>\n \u201cEndurance sports have deeply entrenched cultural beliefs that lighter equals faster, that hunger is discipline, that elite athletes operate in a state of perpetual leanness,\u201d Rom told Velo. \u201cThese ideas get reinforced by coaches, social media, and the visibility of very thin athletes at the pointy end of races.<\/p>\n \u201cAdd in the fact that endurance sports attract people who are already prone to perfectionism, rule-following, and self-control, and you\u2019ve got a population uniquely vulnerable to disordered eating patterns that get reframed as \u2018discipline\u2019 or \u2018optimization,\u2019\u201d Rom said.<\/p>\n The chase for \u201coptimal\u201d can backfire, bad.<\/p>\n Symptoms of REDs A body deprived of energy clicks into \u201cpreservation mode.\u201d<\/p>\n It suppresses non-essential functions, wreaking havoc on the endocrine and reproductive systems, downregulating the immune system, and derailing bone health.<\/p>\n The systematic impact of REDs means the range of symptoms is huge. They encompass daily wellbeing, athletic performance, mental health, and more.<\/p>\n Here are some of the easiest symptoms to detect:<\/p>\n Disruptions to sexual function: For women, that\u2019s repeated missed periods. For men, that\u2019s loss of morning wood. It\u2019s also important to note that REDs is not always correlated to weight loss. Repeated, temporary dips into energy deficit can be enough.<\/p>\n Common mistakes that can cause REDs In many cases, REDs can be the consequence of a diagnosed eating disorder. Ewers this week recounted her history of anorexia and bulimia in a heartbreaking post on her Substack.<\/a><\/p>\n However, it\u2019s very easy to fall into a caloric deficit without realizing. That\u2019s the \u201caccidental\u201d REDs outlined above.<\/p>\n Among amateurs, the very common, very damaging notion of \u201cearning food\u201d often leads to energy deficits, as do more \u201cinnocent\u201d misunderstandings of caloric demand.<\/p>\n Chronic underfueling (whether pre, during, or post-exercise), over-reliance on low-carb approaches, and inconsistent eating on rest days are common mistakes that can lead to REDs.<\/p>\n Train before breakfast and then rush out to work with only a banana?<\/p>\n Skip your final gels on a long ride to \u201cmake space\u201d for evening dessert?<\/p>\n Crush carbs when you train, but consciously cut back on a day off?<\/p>\n We bet you\u2019ve done one, if not all.<\/p>\n Don\u2019t do them any more.<\/p>\n The role of carbs in REDs Another big mistake in the endurance population? Not eating your carbs.<\/p>\n And we\u2019re not just talking about the on-bike \u201ccarbohydrate revolution\u201d here.<\/p>\n Registered dietician Kylee Van Hoorn co-hosts the \u201cYour Diet Sucks\u201d podcast with Rom. Van Hoorn highlighted how carbs are king, morning, noon, and night \u2013 and particularly around a workout.<\/p>\n \u201cCarb timing matters enormously,\u201d Van Hoorn told Velo. \u201cEating carbs before and during hard sessions protects against the hormonal disruption that underlies REDs.<\/p>\n \u201cIf you\u2019re regularly doing hard efforts on empty, you\u2019re sending repeated stress signals that accumulate over time.\u201d<\/p>\n In the 2010s, low-carb diets and intermittent fasting were \u201cthe thing.\u201d Team Sky and Fortress Froome regularly rode on empty stomachs to improve fat efficiency.<\/a><\/p>\n But times have changed, and a new understanding of carbohydrates is rethinking athletes\u2019 attitudes to fasted training.<\/p>\n In the pro peloton, training priorities have shifted<\/a> to suit a high-power, all-aggression new era. Low-carb workouts are programmed sparingly, and only at very particular times of year.<\/p>\n The science around carbohydrates and their specific role in provoking and perpetuating REDs is mixed.<\/p>\n Some papers suggest that carbohydrates play an independent role and that only total calories matter. Others suggest low carbohydrate availability can amplify the problems associated with low energy availability.<\/p>\n Whatever the theory, any hard-training athlete should eat their damn carbs to protect themselves against an energy imbalance.<\/p>\n \u201cThe advice is simple \u2013 don\u2019t avoid carbs and eat more than you think you need. That\u2019s important for overall health, too,\u201d Paul Booth told Velo.<\/p>\n Booth is a leading ultra-endurance nutritionist who specialises in professional trail running.<\/p>\n \u201cI rarely find elite athletes meeting their carbohydrate needs,\u201d he said. \u201cMake sure to eat carbs at every meal. The idea that carbs are bad needs to be changed.<\/p>\n \u201cIf you want to perform, eat carbs.\u201d<\/p>\n Carbohydrate recommendations depend on the volume and intensity of training.<\/p>\n Booth suggests 5-7g\/kg of carbs for someone training at a moderate intensity for 1 hour per day. Female athletes should be particularly conscious of these targets \u2013 oestrogen and progesterone production is dependent on carbohydrates.<\/p>\n We\u2019ll let you do your carbohydrate math while you go buy all the\u00a0bread, pasta, and rice.<\/p>\n How to avoid REDs: 5 key points We asked Rom and Van Hoorn from \u201cYour Diet Sucks\u201d for their key pointers for athletes looking to stay in the green and avoid REDs.<\/p>\n \u201cThe unsexy answer: eat enough, eat consistently, and eat carbs,\u201d Van Hoorn said.<\/p>\n \u201cDon\u2019t let \u2018perfect\u2019 be the enemy of \u2018good enough\u2019 fueling,\u201d she said. \u201cAthletes don\u2019t need to optimize every gram of carbohydrate. They need to consistently meet energy demands, stay flexible, and treat food as fuel rather than reward or punishment.\u201d<\/p>\n Here are Van Hoorn and Rom\u2019s 5 key pointers. Print this out and stick it on your fridge:<\/p>\n Fuel around training. Carbs before hard sessions, fuel during anything over 75\u201390 minutes, and prioritize recovery nutrition within a couple hours of finishing. REDs in pro cycling Concerns about rider health, weight, and the pressures of watts per kilo have always been a part of pro cycling. However, they truly barged into the conversation this summer at the Tour de France Femmes.<\/p>\n Pauline Ferrand-Pr\u00e9vot\u2019s pre-race \u201ccut\u201d sparked a furore that extended beyond the sport.<\/p>\n \u201cThe weight debate\u201d put added pressure on cycling\u2019s stakeholders to safeguard their athletes.<\/p>\n While the majority of leading men\u2019s and women\u2019s teams are supported by nutritionists and medical teams, some feel there should also be wider oversight.<\/p>\n In 2024, the Federation of Sport Climbing introduced mandatory screenings for REDs. Many in the world of cycling, including the women\u2019s riders\u2019 group the TCA, called on the UCI to follow suit.<\/a><\/p>\n Shortly after the Tour Femmes this August, the UCI confirmed in a press release<\/a> that \u201cit is in the process of finalizing documentation and tools that can be used by team doctors to enable the diagnosis of REDs.\u201d<\/p>\n The protocol will follow that published by the International Olympic Committee, tweaked to fit the cycling context.<\/p>\n Several team nutritionists told Velo that a bunch of box-checking might miss the bigger picture. There\u2019s more to managing REDs and fostering positive relationships with food than some blood markers and questionnaires.<\/p>\n But if they can help raise warning flags, it\u2019s better than ignoring the matter altogether.<\/p>\n My experience of REDs When I was at my very mediocre bike-racing \u201cpeak,\u201d I became fixated on being thin. It was a simple and cheap way to get faster.<\/p>\n And the more I dialed down my diet, the more fascinated I became by the hollow cheeks and veinous limbs of the Tour de France.<\/p>\n I became obsessed with food, or how to deny myself of it.<\/p>\n I spiraled to the point where I considered every mouthful, counted every calorie, and exerted painful control over what went in my storecupboards.<\/p>\n My body became a bag of bones. And for a time, I got significantly faster.<\/p>\n I also got very cold, very often. I was moodier than I already was. Thoughts about food, eating, and training buzzed around my brain from my fasted morning ride until I turned the light off on my grumbling belly at night.<\/p>\n The wave eventually crashed down very hard and very fast.<\/p>\n In the space of a few distressing months, I stopped making progress in training, became permanently exhausted, and hated everything.<\/p>\n I hid away from the world until a cluster of stress fractures forced me into a series of blood tests.<\/p>\n They revealed a hormonal wasteland.<\/p>\n I stepped away from cycling for some time, went to eating disorder therapy, and tried to gain weight.<\/p>\n In the decade since, I\u2019ve transitioned to a mix of running, riding, and lifting, and have tried to reframe my attitude to food.<\/p>\n I\u2019m not yet in the clear, but after two rounds of intensive therapy, years of introspection, and countless injuries and illnesses associated with being underweight, things are starting to turn around.<\/p>\n However, many of the hormonal impacts of anorexia and REDs remain.<\/p>\n My bones are like chalk. If I raise my running volume too far, my feet crumble. My blood profile is a joke. I\u2019m prone to bouts of intense depression and self-inflicted isolation.<\/p>\n REDs changed my life. I\u2019m hopeful that one day, I will change it back.<\/p>\n Diagnosis and recovery Athletes who are concerned that they may be suffering with REDs should seek medical advice and consult a qualified dietician. They should also express their worries to their coach, if they have one.<\/p>\n The next steps will be multidisciplinary, beginning with a review of training and nutrition habits and a series of blood tests. Athletes who exhibit any disordered eating behaviors may also be referred to a therapist.<\/p>\n Recovery will be similarly multifaceted, with the ultimate goal of restoring energy availability and addressing any psychological issues.<\/p>\n At a basic level, this will require a reassessment of training frequency and intensity, and a modification to daily diet.<\/p>\n That\u2019s why Ewers had no choice but to step away from pro sport.<\/p>\n After years of trying to train, race, and recover simultaneously, she accepted that something had to give.<\/p>\n \u201cAt this point, my body is in a recovery state, and there is no way it will prioritize performance and training adaptation at this point,\u201d she wrote on her Substack.<\/p>\n \u201cUntil I am healthy, I won\u2019t be able to perform well, so what is the point?\u201d she concluded.<\/p>\n Recovery from REDs can be short and straightforward.<\/p>\n Or, if you\u2019re like Ewers, me, and many thousands more, it can be long, non-linear, and nasty.<\/p>\n However, whatever the journey, a complete turnaround is achievable.<\/p>\n Resources<\/p>\n Project RED-S Website: Resources and education\u00a0<\/a>
\n![\"\"](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/12\/Z8D_3932-1200x947.jpg\"\/)
Endurance sport creates a perfect storm for energy deficiency and REDs. (Photo: Gruber Images)<\/p>\n
\n![\"\"](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/12\/bjsports-2023-September-57-17-1073-F1.large_-1200x1201.jpg\"\/)
This graphic from the British Journal of Sports Medicine highlights how wide-ranging REDs can be. (Photo: BSMJ<\/a>)<\/p>\n
\nBottoming out blood markers: Particularly testosterone, oestrogen, and certain thyroid hormones. Elevated cortisol is also a red flag, as is a decrease in bone density (measured via a DEXA scan).
\nFlatlining performance: Difficulty adapting to training load, problems with daily recovery, susceptibility to injury.
\nChanges in mood and character: An obsession with food and\/or exercise, withdrawn and antisocial, impatience and irrationality.<\/p>\n
\n![\"Ewers](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/12\/GettyImages-2211087124.jpg\"\/)
Ewers has put her career on an indefinite hiatus to allow herself the time and energy to recover from REDs. (Photo: Luc Claessen\/Getty Images)<\/p>\n
\n![\"\"](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/12\/GettyImages-2233570560-1200x800.jpg\"\/)
Eat your damn carbs. (Photo: Getty Images.)<\/p>\n
\n![\"\"](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/12\/Vuelta-Espana-Stage-08-Harry-Talbot-5023-1200x782.jpg\"\/)
At worst, REDs can be devastating. It\u2019s also relatively straightforward to avoid it. (Photo: Gruber Images)<\/p>\n
\nDon\u2019t undereat on rest days. Your body is still working. Feed it.
\nWatch for warning signs. Persistent fatigue, recurrent injuries, mood changes, disrupted sleep, changes to menstrual cycle (for those who menstruate), declining performance despite training\u2014these are red flags.
\nReject the \u201cearn your food\u201d mentality. You need energy to train, not the other way around.
\nWork with a sports dietitian if something feels off. REDs is insidious because it often feels like discipline. An outside perspective can catch patterns you\u2019ve normalized.<\/p>\n
\n![\"\"](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/12\/Z8A_8565-1200x800.jpg\"\/)
Rider health moved to the center of the conversation at the Tour de France Femmes. (Photo: Gruber Images)<\/p>\n
\n![\"\"](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/12\/Z8D_9078-1200x744.jpg\"\/)
I became obsessed with training, getting lean, and am still living with the impacts of an eating disorder and REDs. (Photo: Gruber Images)<\/p>\n
\n![\"Recovery](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2025\/12\/Z8D_1702-1200x750.jpg\"\/)
Recovery from REDs can be long and complex, but a complete turnaround is achievable. (Photo: Gruber Images)<\/p>\n
REDs in Sport Website: Resources and education<\/a>
Your Diet Sucks: Podcast<\/a>
Performance nutritionist Renee McGregor: Substack and contact details<\/a>
Registered dietician Kylee Van Hoorn: Contact details<\/a>
Sports and Performance Nutritionist Paul Booth: Contact details<\/a><\/p>\n