A Practical RED-S Early Risk Self-Screen Checklist

Suspect you may be at risk of RED-S (Relative Energy Deficiency in Sport)?

Below is a practical checklist to identify early signs of low energy availability before injury, hormone disruption or performance decline occurs, based on important principles to support our bodies as ambitious active females and recreational runners.

Instructions: Answer YES / NO honestly. Patterns matter more than perfection. 

PRINCIPLE 1: TRAINING MUST BE FUELED

☐ I often train fasted or under-fueled

☐ I delay eating after workouts

☐ I avoid carbohydrates most days

☐ I rely on caffeine instead of food

☐ I lose weight without trying

Answered yes to 2 or more = you are likely mismatching your fueling needs with your training and exercise demand.

PRINCIPLE 2: PERFORMANCE SHOULD INCREASE & TREND UP WITH TRAINING

☐ Workouts feel harder at the same output

☐ Strength, speed, or endurance has plateaued

☐ I feel “flat” more than energized

☐ Recovery takes longer than it used to

Answered yes to 2 or more =  a counterproductive energy deficit is likely.

PRINCIPLE 3: HORMONES ARE SUPPORTED & SIGNALING SAFETY

☐ Cycles are lighter, shorter, irregular, or absent (women)

☐ Libido reduced

☐ I feel cold when others don’t

☐ Hair, skin, or nail quality has declined

Answered yes to 2 or more =  significant early flags.

PRINCIPLE 4: BONES & TISSUE NEED FUEL TO BE BUILD & RECOVER

☐ Recurrent aches or tendon pain

☐ Stress reactions or fractures

☐ Injuries linger or repeat

☐ Frequent illness or slow healing

Answered yes to 2 or more = elevated concern.

PRINCIPLE 5: SLEEP SHOULD RESTORE & SUPERPOWER YOUR BODY

☐ Early waking (3–5 a.m.)

☐ Restless or unrefreshing sleep

☐ Wired but tired feeling

☐ Sleep worsened as training increased

Answered yes to 2 or more =  your nervous system is likely strained.

PRINCIPLE 6: APPETITE & YOUR GUT SHOULD FUNCTION OPTIMALLY

☐ Little or no hunger despite training

☐ Feel full quickly

☐ GI issues (bloating, constipation)

☐ New food sensitivities

Answered yes to ANY =  metabolic down-regulation is likely and you should seek professional support.

PRINCIPLE 7: TRAINING SHOULD BE FLEXIBLE

☐ Anxiety if a workout is missed

☐ Guilt around rest or eating more

☐ Rigid food or training rules

☐ Training feels compulsory

Note: Behavioral signs often appear FIRST before RED-S occurs.

HOW TO INTERPRET:

Few YES answers with good recovery and stable hormones = LOW RISK. Continue your current approach and monitor trends for warning signs or symptoms.

Multiple YES across sections = MODERATE RISK.  Increase energy intake (most likely to be carbs for most female athletes), fuel each training session before and after, reassess load and seek professional support to ensure you are confidently supporting your body to thrive, maximizing your health, performance and longevity in active living.

Multiple 2 or more YES across sections = HIGH RISK with likely hormonal disruption, injuries, sleep or mood changes. Professional support is strongly recommended. 

Remember This:  If the body doesn’t sense energy safety, it down-regulates health, hormones and performance, regardless of body size or discipline.

Additional Resources

Suspect you're under fueling and/or lacking confidence in knowing how to best support your female body, hormones and thrive through perimenopause? Consider the award-winning Badass Breakthrough Academy and learn more about working 1:1 with Louise here.

Other resources to support your female body include our top podcast Maximizing Hormones, Physique & Running Through Perimenopause here.  Episode 120 will discuss this topic in depth.

If you or someone you love is suffering from an eating disorder, consider reaching out to Louise's go-to virtual eating disorder clinic recommendation: Dr. Megan Hellner of AthleatMD.com.

Cheers to vibrantly healthy, fit & well fueled women!