What You Should Know About the Syndrome Affecting Many Young Athletes
For mother Hanne Hjelbak, it was a real eye-opener when her son was diagnosed with osteoporosis at the age of 17.
Should Have Consumed More Carbohydrates
At home, there had always been a focus on healthy and nutritious eating. Hanne, his mother, prioritized whole foods and a balanced diet rich in nutrients.
But at age 16, the injuries started. He suffered from stress reactions and fatigue fractures in both his leg and back, and the injuries returned each time he resumed training.
A DXA scan at the Sports Medical Center gave the family a surprising answer: Iver had low bone density and showed many signs of the REDs syndrome (Relative Energy Deficiency in Sport).
— “For me, it was a wake-up call. He ate a lot, so I felt confident he was getting enough. But when I got this message, I immediately felt a kind of guilt. What had I overlooked?” Hanne recalls.
The family first shared their story on nrk.no earlier this winter. Looking back, Hanne now realizes there was one specific thing missing from their approach at home.
— “He clearly had a very high need for calories, especially in the form of fast carbohydrates. I have to admit that’s something I overlooked in his diet.”
A Syndrome with Various Effects on the Body
Christian Johnston is a clinical nutritionist at the Sports Medical Center and met Iver when he came in for an assessment.
He has recently encountered many young people like Iver, and they often share several common traits.
— “It doesn’t have to be eating disorders, nutrition-related illnesses, or allergies. Very often, these are young, ambitious athletes who train hard and focus on eating healthy and being healthy, but who don’t fully understand how much energy they actually need,” he says, adding:
— “Maybe they have little time in their daily lives and don’t manage to eat as much as they actually need.”
Johnston describes REDs as a syndrome with many different effects on the body.
The symptoms can be vague and vary widely from person to person.
— “If an athlete has a high training load and energy demand that isn’t met through food intake, it can cause problems—especially for a body that is still growing.”
Present in Both Individual and Team Sports
He mentions decreased training effect and performance, more frequent injuries and illness, reduced production of sex hormones, and lower bone density.
At WANG Toppidrett (a sports high school), these stories are well recognized.
Stine Østvold Aamodt, project leader for Holistic Health at WANG, sees youth with REDs across many different sports.
Not just in aesthetic or weight-class sports, where awareness has traditionally been higher.
— “We also see it in several endurance sports and increasingly in team sports. Many young people get lost in the details and forget the bigger picture,” Aamodt says.
Active Youth Need More Food Than You Might Think
But how much should a growing teenager who trains twice a day actually eat?
The nutritionist says the simplest answer is: more than most people think.
— “It’s hard to be specific because it varies greatly depending on body size and the type of training. But for a growing athlete – which requires a lot of energy – it’s hard to eat too much.”
Criticism of the Focus on Sugar
Following the NRK article, there was some public criticism regarding the emphasis on sugar and sweets. Both Iver and Niels (also featured in the article) had started including dessert, ice cream, and candy in their diets as part of their recovery.
— “It’s not about sugar and candy, and it never has been. That’s not what we talk to athletes about. It’s about having a relaxed relationship with food and the knowledge to understand that it’s okay to enjoy candy on Saturdays – and even on weekdays too – in addition to regular, healthy food,” Johnston explains.
Carbohydrates Are More Important Than Many Think
He notices that athletes, coaches, and parents are influenced by the broader societal discussion—where carbohydrates are often viewed with suspicion.
— “For most young athletes, carbohydrates are far more important than many believe. There’s a huge focus on protein right now, but for most athletes, it’s actually carbohydrates they’re lacking,” Johnston says.
When treating athletes at the Sports Medical Center, he specifically works on increasing carbohydrate intake during training sessions.
— “We recommend consuming carbs in the form of sports drinks or even regular juice during training. What we’ve seen is that it not only boosts performance but can also benefit bone health. It helps the body break down less during training and may lower injury risk while ensuring they get what they need.”
— “As long as you eat a reasonable, balanced diet with normal, healthy food, it’s almost like: the more, the better.”
Is your teenager showing these symptoms?
What should you, as a parent or coach, look out for if you're concerned that your young athlete isn’t getting enough energy?
Experts point to the following common symptoms in athletes who may be developing REDs:
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Mood swings
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More fatigue than usual
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More frequent illness or injury
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Menstrual irregularities
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Absence of morning erections
– “Some also report that they often feel sore, and that it just never really goes away,” says Aamodt, and adds:
– “One of these symptoms on its own isn’t necessarily a reason to be concerned about REDs, but if there’s a combination of several, it might be worth getting checked.”
The article is produced and funded by the Norwegian School of Sport Sciences
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