What You Need to Know About Relative Energy Deficiency in Sports (RED-S)
Pushing yourself in ballet is normal. But have you ever noticed an extended period of time when you feel exhausted with no relief? While it’s typical to feel tired after a day of classes, maybe you aren’t performing at your usual level, or your body is feeling run down. You may have even stopped menstruating, or have a nagging injury that won’t resolve. If so, you might be suffering from relative energy deficiency in sports, or RED-S, a serious condition that can cause long-lasting damage to dancers’ bodies.
“At its most basic level, RED-S develops due to an energy mismatch between how much activity the body is [expending] and how many calories are supporting that level of activity,” says Dr. Kathleen Davenport, company physician at Miami City Ballet. Put simply, RED-S occurs when you take in less food than the energy you expend, which can result in negative health and performance outcomes.
Without guidance of how nutrition fuels performance, dancers may not be eating enough to keep up. Understanding the importance of a balanced diet of protein, carbohydrates, and healthy fats to sustain their energy is crucial. Many serious ballet students, particularly those in daytime conservatory or trainee programs, can train for 30 hours or more a week, so their caloric needs are often higher than those of their less active peers. A packed, “no excuses” training regimen can make matters worse. Jaimie Tapper, an organizational psychologist and head of performance coaching and development for The Royal Ballet, says: “Organizational and cultural factors can put dancers at increased risk of RED-S, such as limited schedule opportunities to fuel during the day, and training cultures that instill a value of thinness over health, or that reward behaviors such as restrictive eating.”
Read on to learn more about RED-S, how it affects the body, and why it is so crucial to understand how to fuel during busy dance days.
Common Warning Signs
Because ballet requires a great deal of stamina, dancers commonly experience end-of-day fatigue. But when the body isn’t receiving enough fuel, low energy can become chronic and damaging. “This can cause harm to the musculoskeletal, heart, endocrine, immune, reproductive, and hematological (blood) systems, to name a few,” says Davenport. Under-fueling can also increase your risk of illness and injuries, as well as impair performance. “The longer this goes on, and the more severe the imbalance, the higher the risk for permanent damage to the body,” she adds.
Tapper says that bone-stress injuries, impaired growth or development, and, for females, not having your period for more than three months, are warning signs that indicate RED-S. She adds that dancers may also experience reduced sleep quality, reoccurring injuries or sickness, delayed recovery and healing times, and decreased mood and motivation.
“If you find that you regularly don’t have the energy to do fun things in your downtime away from school and dance, this could be a sign you are expending more energy than you are taking in,” says Tapper. Cold hands and feet, noticeable weight loss, and depression or negative thought patterns are other potential warning signs.
RED-S, which is a broadened form of a condition known as the “female athlete triad,” is often easier to identify in women because of missed periods, and the condition has been studied more in females. But athletes of any sex or gender can experience similar issues, including, says Davenport, “impaired metabolism, increased fatigue, decreased performance, impaired immune function, decreased lean body mass accrual, decreased bone health, and decreased libido.”
Why Are Dancers Especially at Risk?
Sherry Lin, a registered dietitian nutritionist who works with dancers and athletes at her practice, Rhythm and Nutrition, notes that dancers face unique pressures that increase their risk for developing RED-S. In addition to long training hours, she points to the industry’s aesthetic ideals towards lean body types. “This type of pressure can lead to under-fueling, intentionally or unintentionally,” she says.
Davenport agrees that dancers can fall into RED-S without being fully aware of what’s happening. “Most of the dancers I work with who are on the RED-S spectrum are there without knowing it,” she says. “They’re not intentionally restricting calories, and they’re trying to eat healthily. However, they’ve increased their dancing and have no idea their body has fallen behind what it needs to support that level of exercise.” Unfortunately, Lin says that some dancers intentionally restrict their calorie intake in an attempt to achieve or maintain a thin physique. But disordered eating behaviors can also lead to RED-S and other serious health issues.
Educating yourself about nutrition and healthy food intake is key. “Dancers can know if they’re taking in enough fuel in two ways,” says Lin. The first is by observing how your body feels. Constant fatigue, heavy legs, muscle cramps, decreased or lack of stamina, and mood swings are tell-tale signs of under-fueling, she says. Proper fueling should keep you feeling consistently energized, focused, and excited about your body’s performance ability.
The second is through data collection tools, like activity trackers, food logs, or lab tests. Lin advises working with a health-care professional, like a registered dietitian, who understands your needs (based on your training) and is familiar with your medical history and lifestyle, if you want to collect data on your health. But, she warns, “dancers need to understand that tracking options are tools and not rules.” For example, counting calories without a solid understanding of how the body works can lead to anxiety, guilt, or even obsessive behaviors. When this is the case, “these tools are no longer useful and are not appropriate,” she says.
Consider not just what you eat but how often you eat. Pack meals and snacks in your dance bag so that you have food at the ready during breaks. Skipping meals and snacks or not eating for more than a few hours is not advisable. “Young dancers really do need to pay attention, especially in the years of puberty and peak years of growth,” Lin says.
When to Seek Help
If you think that you may be experiencing RED-S, ask for help as soon as possible. The longer it goes on, the longer your recovery may take. “Your parents or teachers might not be aware of RED-S, but they can help you seek medical advice from your doctor,” Tapper says. That said, dancers often have high pain tolerance, and in dance settings where they are encouraged to work through injuries or considerable fatigue, they may miss or ignore early warning signs.
Davenport has even seen dancers express happiness about losing their periods, “but this would be an indication to seek medical attention,” she says. Losing your period for more than three months, a condition known as amenorrhea, can eventually lead to infertility, bone loss, increased risk for cardiovascular disease, and mental health problems.
Students may be worried about discussing eating, missed periods, or even pain out of fear that their doctor will tell them to stop dancing, but a medical professional familiar with ballet will have a better understanding of your needs, says Davenport. If possible, look for specialized dance physicians, dietitians, and clinicians in your area. (If you have a local dance company or professional academy, look into who they work with.)
Remember, keeping your body in optimal condition is imperative for peak performance. “Your body is the vehicle for your technical excellence and artistic expression, but also for a fulfilling life outside and beyond dance,” Tapper says. By ensuring that it’s well-fueled during these important developmental years, “you will not only reap the benefits in your dancing now, but also lay the foundations for a healthy, capable, and expressive body for a lifetime.”
In March, the International Youth Dancer Health Alliance launched the inaugural International Youth Dancer Health Awareness Week 2025, an initiative designed to educate the global dance community. RED-S was the focus for this year’s event. IYDHA offers expert-led webinars— designed for dancers, parents, and artistic staff/teachers—featuring practical strategies, nutrition insights, and evidence-informed practices for maintaining dancer health. To access these resources, please visit: youtube.com/@IYDHAlliance
