RED-S syndrome: the dark side of staying super lean

I used to struggle to stay lean. I’d crash diet then rebound every time. So when I found a way to stay not just lean, but super-lean, I thought I’d found the holy grail. But it turned out to be a health-ruining nightmare.

The experiment

I’d spent most of life either flabby or straying into the obese BMI category. As such it seemed like I was genetically programmed to be that way.

I wanted to reprogram my body to be leaner, and thought it might be possible by staying very lean for an extended period of time. The hope being that my metabolism would return to normal, and I’d be able to live life as normal, but extremely lean.

In hindsight it was naive, though at the time there was less awareness of the negative of impact staying too lean. Now we have a term for it: RED-S (Relative Energy Deficiency in Sport).

My experience with RED-S

I knew basically what to expect in the short term from previous diet experience. However, this time everything was more intense because it was the leanest I’d ever been. Contrary to my hope, time went on and things only got worse.

In total I spent about a year with the following symptoms:

Insatiable hunger

It was impossible to feel satisfied no matter how much I ate. It’s surreal to eat a massive, high energy meal and remain ravenous.

This also lead to preoccupation with food. The moment one meal ended, I was anticipating the next.

Muscle and strength

I kept losing muscle. As time progressed the circumference measurements of my limbs and torso kept decreasing, even as I slowly added food back in.

Strength dropped a lot and training became a dreaded chore. Things that had previously been easy took immense effort and concentration.

Skin quality degradation

My skin was very dry and structurally weak. For example, the pressure of dental floss being wrapped around my fingers was enough to penetrate the skin, and I had little cuts from it.

Immune dysfunction

I got dermatitis on my face, which I’d never had before. It took about five weeks to heal, and left noticeable scars on my cheek. I also got sick easily.


Energy was always low, which made doing anything very difficult. At the worst times even standing up seemed to take monumental effort.

Hormonal abnormality

Reduced sex hormones meant libido was almost non-existent.

Heart rate was often around 40 beats per minute, which I assume was due to low thyroid. It was strange to have pulse barely rise during high exertion.

Poor sleep

Sleep was short and of low quality. I averaged about five hours per night, which is unusually low for me.

I was extremely tired by the end of the day and nodding off when I sat on the couch in the late evening, again unusual for me. I dropped off easily, but would wake early and couldn’t sleep further.

Other observations

My blood pressure was low, resulting in frequent dizziness (not the best during a heavy set of squats). Mood was effected, too. I was irritable and life was generally less enjoyable. Favorite pastimes were just uninteresting.

Difficult but informative

I subsequently got my health in order by getting to a higher level of body fat. In a way the experiment was successful because I’m far leaner now than I used to be. Except for the occasional bulking phase, I’ve maintained visible abs for years.

My time with RED-S was rough, but provided insight. Permanent reduction of body fat is possible and a worthwhile goal, but you can push it too far, and no amount of time will make your body adjust. However, too far is different for everyone, and the trick is in finding and stopping short of that point.

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