Working with lead academic, Dr Adrian Slee (Associate Professor [Teaching] in Nutrition at UCL) and specialist sports endocrinologist Dr Nicky Keay (Honorary Clinical Lecturer at UCL), students across multiple nutrition and medical science programmes have been contributing to this work through their research projects, with findings already making an impact in the international research community.

"We are aiming to publish results from our current and most recent graduate students and highlight the importance of REDs to the international community for both clinicians, athletes, and the layperson, eg, family member of an athlete concerned about health effects of REDs," says Dr Adrian Slee.

Keep reading to find out more about REDs and hear reflections from the research team.

Who better to answer these questions than Dr Nicky Keay?

“REDs arises when there is a mismatch between energy demand and energy intake. Energy intake is prioritised to cover the demand from movement. The residual energy is known as energy availability. If energy availability falls below the requirement to maintain resting metabolic rate, then the body makes adaptations to ‘save energy’.

"REDs is now becoming more widely recognised as a syndrome that can occur in men and women of any age and level of exercise in competitive and non-competitive sport and dance.

"In view of the adverse effects on health and performance, it is important as an area of research to gain a greater understanding, which can be translated into early identification of those at risk and effective support strategies."

"What is the impact of REDs?" continues Dr Keay. "It's a clinical syndrome that includes the adverse effects on health and performance. For example, hormones get down-regulated to an ‘economy drive’, which increases the risk of bone stress injuries. Exercise performance is also limited without fully functioning hormone networks to drive positive adaptations to exercise.

"Who gets REDs? Potentially, any exerciser of any age and any level can be at risk of developing REDs, whether unintentionally or intentionally, by restricting food intake.

"What can be done to identify those at risk of REDs? As REDs has a significant negative impact on health and performance in the short and long term, it is vital to understand more about the aetiology of REDs and identify those at risk as soon as possible. This underpins the research being done at UCL. Studies include men and women from a variety of sporting and dance backgrounds to increase understanding and come up with practical strategies. For example, based on REDs research, a web-based app has been developed called Personal Energy Availability Questionnaire (PEAQ) to identify physical, physiological and physiological indicators of low energy availability."

"Our findings confirmed a lot of what I have observed over the years among fellow athletes - many faced health consequences characteristic of REDs," says former BSc Nutrition and Medical Sciences student, Samantha Sharp, ANutr. “Yet, this was left undiscussed.”

"Our research highlighted how underrepresented female-specific health issues still are, even in elite athletic contexts," adds former MSc in Clinical and Public Health Nutrition, Roni Mashiach-Fransis, ANutr.

"I was struck by the prevalence of high-risk REDs (~1 in 5 in our study) and how psychological factors such as mindset appeared to influence risk," says Alexa Eichelmann, MSc in Clinical and Public Health Nutrition 2023–24.

"This experience has allowed me to explore how psychological risk factors such as low mood, weight-related anxiety and behavioural control may be just as crucial as traditional physiological markers in identifying those at risk," says Carina Helander, MSc in Clinical and Public Health Nutrition, 2024–25. "My findings reinforced the importance of adopting a multidimensional lens when assessing energy availability, particularly in recreationally active populations where symptoms can be subtle or atypical."

"This project deepened my appreciation for multidisciplinary collaboration and athlete-centred research," says Eichelmann, who now works with Stanford Female Athlete Science and Translational Research Program (FASTR).

For Dr Francesca Testa, MSc Clinical and Public Health Nutrition 2023–24, the project "highlighted the prevalence of misinformation among healthcare professionals in recognising and managing REDs".

"As a medical doctor and general practice trainee, this project has been instrumental in enhancing my knowledge and skills in this area and has strengthened my commitment to promoting greater awareness among clinicians to ensure timely identification and holistic management of REDs," she adds.

Current MSc students, including Hannah Frais, Rohan Patel, and Carina Helander, are building on previous studies.

"I have enjoyed working with a variety of athletes over the last month to collect anthropometric data and questionnaires to help my peers assess the prevalence of REDs in athletes," says Hannah Frais, MSc in Dietetics, 2024–25. "I look forward to analysing the data we have collected and hope to continue to raise awareness of REDs in the future."

"It has been fascinating to see how athletes view nutrition and how their relationship with food can impact their training and performance," says Rohan Patel, MSc in Clinical and Public Health Nutrition, 2024–25. "Our research this summer, focusing on methods of assessing REDs and the risk of malnutrition in athletes, will build upon the work conducted and will provide more data to help us reach clearer conclusions," he adds. "We will also be running an educational programme to discuss and raise awareness of the risk of REDs."

Former students, Sam Sharp (BSc in Nutrition and Medical Sciences) and Roni Mashiach-Fransis (MSc in Clinical and Public Health Nutrition) combined their data on female endurance runners and had their findings published earlier this year in Clinical Nutrition Open Science. To find out more, you can read their write-up on our student research area.