REDs in Gymnasts: Signs, Symptoms and What to Do

REDs in gymnasts is far more common than most parents realize. If your gymnast is always tired, keeps getting hurt, hasn’t gotten her period, isn’t growing or just isn’t herself, REDs should be on your radar.

Let’s talk about what REDs is, why gymnasts are at such high risk, the signs to watch for in every part of her body (and in the gym), what changed in the 2023 update, and what to do if you’re worried.

By Christina Anderson MS, RDN, CSP, CSSD · Updated October 2026

What is REDs?

REDs stands for Relative Energy Deficiency in Sport. In plain English, your gymnast isn’t getting enough energy (enough food) to cover everything her body is trying to do: train 20+ hours a week, grow, go through puberty, get through a full school day and recover from yesterday’s practice.

When there isn’t enough energy to go around, her body doesn’t just stop. It goes into what I call low power mode and starts cutting corners. The first things to go are the ones it considers optional in the short term: building bone, hormones and periods, growth and development, immune function, mood and, eventually, performance.

The International Olympic Committee (IOC) introduced REDs in 2014 to expand on the “female athlete triad,” which only described women with missing periods, disordered eating and stress fractures. That left out a huge group of athletes, including boys and gymnasts who weren’t trying to restrict at all. The most recent 2023 IOC consensus statement updated the science again, and changed the name from RED-S to REDs.

REDs is not the same as an eating disorder

They can overlap, but most of the underfueled gymnasts my team works with are NOT trying to restrict. This is what I call unintentional underfueling. A lot of gymnasts simply aren’t hungry enough for what they need, when they need it. Some focus more on “healthy eating” than on eating enough. Others are so busy between school and the gym that fitting in enough food is really hard. And many were never taught how much energy it takes to fuel 20+ hours of training a week.

Why are gymnasts at such high risk for REDs?

Gymnastics stacks almost every REDs risk factor on top of each other:

• Huge training loads, often 20-30 hours a week, with almost no off season
• Training through the years when kids grow and develop the most
• An aesthetic sport where body image pressure is real
• Long practices that run through meals and snacks
• A culture that treats late periods, being small and frequent injuries as “normal for a gymnast”

None of those things are normal. Being a gymnast does not exempt her from biology.

Low energy availability is a spectrum

One of the most helpful changes in the 2023 update is that low energy availability is described as a spectrum, from “adaptable” to “problematic.”

Adaptable is short term and mild. She had a longer workout than normal and ran a little low that day, or she was sick and didn’t eat much for a few days. Her body can handle that, and it’s NOT REDs.

Problematic is when she doesn’t eat enough for weeks, months or years. That’s where REDs develops. One rough practice isn’t REDs. Months of 5-hour workouts on a granola bar, a skipped breakfast and not enough after practice is where we get into trouble. (More in Is Your Gymnast Underfueled? Signs of Acute vs. Chronic Underfueling.)

And “too long” doesn’t take much. Missing only about 300 calories a day, basically a snack, is enough to cause bone loss. In a sport with a very high rate of bone stress injuries, a small gap day after day turns into a big problem.

This is the recovery gap: the difference between what her body NEEDS and what she’s actually getting. Closing it each and every day is how we prevent REDs.

Low carbs matter on their own

The 2023 update calls out low carbohydrate availability as a threat to bone health, even when total calories don’t look terrible. So when a parent tells me “she eats so healthy, lots of protein, lots of veggies,” I’m not celebrating. Protein and veggies are great, but carbs are what fuel a long bars and beam practice.

• Before practice, we aim for about 1 g of carbs per kg of body weight
• For practices of 3.5 hours or longer, she should start getting carbs about 1.5-2 hours in
• For the whole day, we usually start around 5-7 g/kg and adjust for growth and training

For a 40 kg (about 88 lb) gymnast, that’s roughly 200-280 grams of carbs a day. That’s probably more than you eat, and that’s OK. You’re probably not training 20 hours a week while growing.

Signs of REDs in gymnasts

REDs isn’t one symptom. It can touch almost every system in the body. So when a parent tells me her gymnast is always sick, moody, can’t sleep and now has a stress reaction, I’m not hearing four separate problems. I’m hearing one.

Periods

Periods are one of the best signs we have that her body is getting enough to grow and stay healthy. When the brain senses there isn’t enough energy, it turns down the hormones that run the menstrual cycle. Periods get irregular, then stop.

• No period by 15 (primary amenorrhea) is a red flag
• Losing her period for 3+ months after it started (secondary amenorrhea) is a red flag
• No signs of puberty (breast development) by 13 is worth a conversation with her doctor

Many gymnasts are told it’s normal not to get a period until 16, 17, 18 or after they retire. It’s common in gymnastics, but it’s NOT normal. Family history matters, but keep in mind that many gymnast moms were athletes too, and may have been underfueled themselves. (More in Do Gymnasts Get Periods?)

Birth control doesn’t fix this. The monthly bleed on many forms of birth control is a withdrawal bleed, not a real period, so it can hide underfueling. And it doesn’t protect her bones the way her own hormones do.

Bones

Without enough energy and normal hormones, especially estrogen, her body can’t build or maintain bone. That’s a big deal, because the teen years are when she builds the most bone she’ll ever have. This is where stress reactions and stress fractures come from.

Many stress fractures in gymnasts get chalked up to overuse or bad luck. Very often, underfueling is a big part of the story. Bone loss isn’t always fully reversible, and the only way to stop it is to fix the energy gap, along with enough calcium and vitamin D.

Growth and development

Her growth chart is one of the best tools we have. What matters isn’t where she sits, it’s whether she’s following HER curve. Some gymnasts normally track at the 80th percentile for weight, others at the 25th. The red flag is falling off her own curve, like a gymnast who tracked at the 50th-70th percentile from ages 7-10 and then dropped to the 25th as training hours climbed.

BMI isn’t helpful here. It wasn’t designed for growing athletes and can swing a lot with small changes. I want gymnasts plotted on their growth chart 3-4 times a year, because it’s much easier to catch a problem early than after years of it. (See Does Gymnastics Stunt Your Growth?)

Metabolism

When she’s underfueled, her body gets really good at running on less. That sounds efficient, but it means she’s in survival mode, not performance mode. Signs include:

• Feeling cold all the time
• Hair loss or easy bruising
• Fatigue that doesn’t go away, even with lots of sleep

Some gymnasts with REDs lose weight. Others lose muscle and gain fat. Neither is sustainable for health or performance.

“Won’t eating more make her gain weight?”

This is the biggest fear I hear. Here’s the thing: when an underfueled body finally gets enough, it often speeds back up to use that energy. Many athletes I’ve worked with increase their food significantly and don’t gain much weight at all. If she does gain, it’s usually the normal, necessary weight she needed for growth and development. We can’t predict exactly what her body will do, but an underfueled gymnast eating enough will only help her training and performance.

Iron and blood

Low iron and iron deficiency anemia often show up with underfueling. They wreck energy and endurance, and everything feels harder than it should. Watch for fatigue, shortness of breath, dizziness and practice feeling “heavier.” Athletes should have iron checked at least once a year, and more often with heavy periods or little red meat. Iron problems usually take 3-6 months to fully fix.

Heart

In severe cases, underfueling can lead to an abnormally low resting heart rate or low blood pressure, which can show up as dizziness or lightheadedness. Athletes often get complimented on a low heart rate, but a malnourished heart is different from an athletic one. A significantly underfueled athlete needs her heart checked by her doctor.

Gut

Bloating, constipation, stomach pain and feeling full fast are very common. The gut is muscle too, and it slows down when she’s underfueled. Then it becomes a vicious cycle: she feels bloated, doesn’t want to eat and starts cutting out foods thinking it’s a food problem, when it’s really a not-enough-food problem. An elimination diet on top of underfueling usually makes things worse. (More on gymnasts and GI issues.)

Immune system

Sick all the time, sick longer than she used to be, catching every bug at the gym. Enough food is the number one way to protect her immune system, more than any amount of fruit, veggies or “superfoods.”

Sleep and mental health

Trouble falling asleep, staying asleep or waking in the middle of the night. More irritability, anxiety, low mood and trouble focusing. This often gets written off as teenage moodiness, but underfueling plays a big role. Her brain runs on carbs, and when it’s short on fuel, emotional regulation gets much harder.

As a gymnast myself, for me this looked like crying on bars every single day when I had REDs. At the time, I had no idea it was a sign I was underfueled.

It goes both ways, too: stress and anxiety make it harder to eat, which makes the underfueling (and the mood) worse. If mood changes are showing up, it’s important to have her energy intake assessed, and to see a therapist if needed.

How REDs shows up in the gym

This is the part gymnasts care about most.

• Strength and power: training hard but not getting stronger, or going backward. Floor and vault feel heavy and slow.
• Endurance: great for the first hour or two, then fading. The last rotations are the sloppy ones.
• Training response: she can do all the conditioning in the world, but her body can’t adapt without fuel.
• Recovery: sore for days, wrecked by the end of the week, barely hanging on by the end of comp season.
• Coordination and focus: missed connections, falls on beam that shouldn’t happen, getting lost in a routine.
• Injuries: more injuries, and ones that take longer to heal.
• Motivation: losing the love of the sport. Parents read it as attitude, when her tank is just empty.

As a nationally rated NCAA/USAG judge for 18+ years, I can tell you that so many deductions I see aren’t skill problems. They’re energy problems: short landings, bent arms and legs, wobbles and form breaks at the end of a routine.

What one growth chart showed us

A Level 9/HOPES gymnast came to us after a wrist fracture that everyone had chalked up to overuse or a freak accident. By every outside measure, she seemed fine. Then we pulled up her growth chart. For years she’d grown steadily along the 85th-90th percentile. When we saw her, she’d dropped to the 35th.

A few months into working on her fueling, she was diagnosed with elbow OCD (osteochondritis dissecans), because her body was still trying to catch up. Underfueling doesn’t reverse overnight. She looked fine. Her growth chart told a very different story.

What changed in the 2023 REDs update?

The 2023 IOC consensus replaced the 2014 and 2018 versions. The biggest changes for gymnastics families:

1. The name: RED-S is now REDs. If an article still says RED-S or only talks about the female athlete triad, it may be working off older information.
2. A spectrum: low energy availability ranges from adaptable (short term, OK) to problematic (long term, where REDs develops).
3. Carbs matter on their own: low carbohydrate availability is a separate threat to bone health.
4. Overlap with overtraining and mental health: REDs can look like burnout, mood problems or overtraining. (See Does Your Gymnast Have REDs or Overtraining Syndrome?)
5. A better screening tool: the REDs CAT2 helps doctors look at injuries, periods, labs and growth together.
6. Boys get REDs too: see below.

For the full breakdown, listen to Episode 219: What Changed in the 2023 REDs Update.

Boys get REDs too

As a boy mom, I take this one personally. Male gymnasts show many of the same signs: injuries that keep coming back, stress fractures, not growing, not developing and not getting stronger despite training a ton. Low testosterone is one difference. Energy, recovery and performance are affected the same way. (Have a son in the sport? See our men’s gymnastics nutrition program.)

What to ask your gymnast’s doctor about REDs

• If she has a stress reaction or fracture: where is she on her growth curve, and is she eating enough?
• Can we look at her growth chart together?
• Should we check labs? Iron and vitamin D are a good place to start.
• She has no period by 15 (or no breast development by 13). Can we look into underfueling?

You might hear “she’s fine, she’s just small” or “that’s normal for gymnasts.” Missing periods and not growing are never normal for a gymnast. The good news? Underfueling is something we can fix.

What to do if you think your gymnast has REDs

1. See a pediatric sports dietitian who knows gymnastics. A dietitian can look at her food, training and growth charts together. Not a general nutritionist, and not a meal plan off the internet.
2. Build a team. I work directly with my clients’ pediatricians, therapists, PTs and orthopedists, because REDs touches so many systems.
3. Increase fuel gradually. Your dietitian will help you add meals, snacks and practice fueling step by step.
4. Set up support. Recovering from REDs is physically AND emotionally hard. She needs people in her corner.

Remember, an athlete can be underfueled at ANY weight. Trusting the process of eating more is scary, but it’s the only way to resolve REDs and get her back to full strength doing what she loves.

Frequently asked questions

Get help for your gymnast

A gymnast won’t reach her full potential in the gym if she’s dealing with REDs. The earlier you catch it, the easier it is to turn around.

Not sure if your gymnast is underfueled? Start with the free Underfueled Gymnast Check. And if you want more than a generic meal plan, The Balanced Gymnast® Program is our 1:1 program, built by a former gymnast, nationally rated NCAA/USAG judge and pediatric sports dietitian who lives and breathes this sport. We build her plan around HER: her training, her growth, her labs and the foods she actually likes, so she can close the recovery gap each and every day.