If you have RED-S / REDs (Relative Energy Deficiency in Sport), or suspect that you may, there are several biomarkers that you should pay close attention to. Sports nutrition and performance expert Rebecca McConville advises focusing on iron/ferritin, vitamin D, and thyroid levels.

She explains how they affect the body’s functions, why we need them to be at adequate levels, and why athletes are sometimes incorrectly prescribed thyroid medication.


Read the transcript

[Tina]  I’ve had blood work done. What biomarkers should I be paying attention to?

[Becca]  So some of the biggest ones are iron, specifically ferritin. Ferritin is our storage form of iron. When we’re going through a training cycle or a menstrual cycle, they require iron. Iron brings oxygen into our muscles, and so sometimes we’ll feel that fatigue. The other piece of it is, when iron is low, it actually decreases our appetite, which can make the RED-S even more complicated, when we don’t have a drive to eat. The other piece is when iron is low, we become more anaerobic, which actually requires more energy to metabolize and to function. So you can see how I kind of call it the domino cascade. While they may not be directly responsible for RED-S, they can kind of lean into it and make the situation worse.

 Another one is vitamin D. Vitamin D has such a marker, or cofactor, in our metabolism and health and immune system, and especially bone function, that we want to make sure that that’s within adequate range.

 And thirdly is thyroid. A lot of athletes get overlooked for hypothyroidism, or low thyroid function. When it’s a down regulation of the thyroid hormone, ,going back to the body temperature going down, that’s a means of first starting to dim the lights in the house. Now when those start to get shut down, it really wants to keep the production as low as possible, because having a nice, warm body is actually a luxury of being well-nourished. And so sometimes they can get misdiagnosed and they’re started on thyroid medication, which makes it even more difficult, because now we’ve sped up the metabolism in an undernourished body. So they call that Sick Thyroid Syndrome. 

 [Tina]  So what would you say to someone whose doctor is suggesting thyroid medication?

[Becca]  It goes back to again that advocating, being able to say, “Okay, I acknowledge that my thyroid level is low and there are some concerns there; however, while I’m working on restoring my nutrition and energy availability, can we please hold off on medication and see if my thyroid levels improve?” If it’s truly related to a lack of energy availability, it will improve. If it is a genetic component or stress, or even we see that in postpartum where thyroid levels will go lower or TSH will actually elevate, then that won’t correct by itself with improving your nutrition. 

 [Tina] Okay, thank you.

check it out

Recovering from RED-S is hard. It’s even harder if you’re working through it alone. Even if you have professional support, they’re not available 24-7, and that can lead to going down search engine rabbit holes that have the potential to derail everything.

Our online resource, RED-S: Realize. Reflect. Recover, will answer all those questions swimming around in your head about recovery. It will give you the opportunity to connect with the experts you’ve come to know here, and to surround  yourself with a community of others who are going through it too. THANK YOU! to Athletic Greens and Tracksmith for supporting this YouTube series and RED-S: Realize. Reflect. Recover.

Go to athleticgreens.com/reds to get five free travel packs of AG1 and a free one year’s supply of vitamin D3+K2 with your subscription!

When you go to https://tracksmith.com/tina and use the code TINA15 at checkout, you’ll get free shipping and Tracksmith will donate 5% of your order to Rising Hearts, the Indigenous-led nonprofit founded by Jordan Marie Daniels.

more about becca:

Rebecca McConville, RD, LD, CSSD, CEDS, is a sports nutrition and performance expert who helps her clients explore and strengthen their relationship with food, weight, body image and sports performance. Her book, “Finding Your Sweet Spot,” helps athletes maximize their potential while avoiding the dangers of RED-S. You can find Becca at https://beccamcconville.com.

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