Exploring the presentation of REDs in ultra endurance sport: a review.

Ultra-endurance sports involve high training volumes and extreme energy demands. These factors may increase risks for Relative Energy Deficiency in Sport (REDs), which is a condition where athletes do not sufficiently fuel to support their activity level, potentially leading to serious health issues. This review explored existing quantitative and qualitative research on REDs and related problems like low energy availability, disordered eating, and eating disorders in ultra-endurance athletes. Findings showed that up to 65% of ultra-endurance athletes may be at risk for REDs. Psychological factors were linked to restrictive eating and overtraining. Despite this, REDs is often treated as a physical problem, with less attention paid to mental health. This review suggests that treatment should address both physical and psychological needs, especially for athletes who restrict food intentionally. It also highlights the need for further research on recreational, male, and gender-diverse athletes, who remain overlooked despite being at-risk.