Editor’s Note: This story is part three of a three-part series on cultivating a positive relationship with food. Part one focused on why a good relationship with food is important and part two focused on practical tips.

Nutrition is a crucial part of an athlete’s performance, but for many athletes, it can also be an area of struggle.

Relative Energy Deficiency in Sport (RED-S) is a condition in which athletes and highly active people don’t consume enough food to meet their high energy needs, resulting in a state of low energy availability.

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“There’s a mismatch between the energy they’re putting into their bodies and the energy they’re expending not only in exercise, but also in daily needs,” said Skylar Weir, a clinical dietitian at UCHealth Yampa Valley Medical Center.

The condition, which can wreak havoc on overall health, is surprisingly common.

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“It’s very common, especially in mountain athletes,” Weir said. “Everyone is so active, and we’re busy, and often we experience these symptoms of low-energy availability.”

This under-fueling may be unintentional, for instance when an athlete isn’t aware of how much energy their activities require, but it can also be intentional.

“There can be a perception that athletes need to look a certain way or have a certain body type to excel in their sport of choice, even if it isn’t suitable for your body,” Weir said. “Someone may strive for that ideal by skipping a post-workout snack or not fueling during long endurance efforts.”

Symptoms of RED-S can be vague and far-reaching, including sleep disturbances, increased irritability, mood changes, gastrointestinal issues and not experiencing gains with training. Eventually, those symptoms can lead to long term consequences such as poor bone health, a compromised immune system, disruptions to reproductive health, poor cardiovascular health and more.

Strategies for combating RED-S vary depending on the individual.

If the under-fueling is intentional, it’s important to foster a more positive relationship with food, performance and your body.

For cases of both intentional and unintentional under-fueling, it may be helpful for athletes to better understand the demands their training schedule can place on their bodies. Mapping out energy intake and expenditures might reveal a need to increase consumption of carbohydrates and protein, or to change up the timing of nutrition.

Some athletes may need to stop training until their health and energy levels stabilize, and may need to work with a dietitian to develop an eating plan to help rebuild their strength and well-being.

At first, those shifts may be a challenge.

“Athletes are often high achievers and can be very competitive and can sometimes get wrapped up or fixated on something they heard from a coach or other athletes,” Weir said. “We can work through that together.”

For example, breaking down what happens to a runner’s body during a three-hour run may be motivation enough for someone to start including a snack of carbohydrates during their workout.

As soon as athletes experience the benefits of properly fueling their bodies, they’re often sold on the approach.

“They may set personal records or find they’re getting consistently faster and adapting to training better,” Weir said. “They may feel more energy and mental clarity, recover better and even experience fewer injuries.”

For instance, an athlete who would find themselves laying on the couch all day after a long training session may discover that fueling during the training boosts their energy for the rest of the day.

“These little breakthroughs start happening,” Weir said. “Sometimes they happen quickly and sometimes they take a little more time.”

RED-S is a condition that Weir is personally passionate about, in part because of her own experience in athletics.

“Growing up, I was really active, and no one really talked about this,” Weir said. “It can be really valuable to learn from a young age that these are all the things I’m asking my body to do, and so food shouldn’t be a scary thing – it should be a supportive thing for my body.

“You’re asking your body to do a lot as an athlete, and you need to thank your body in terms of food, to give it the tools it needs to progress.”

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.