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As the syndrome and its symptoms are still not commonly known, it is often difficult to know where to find help.
After former GB runner Pippa Woolven's struggles with the condition, she set up a website called Project REDs which offers information and practical resources for athletes, coaches, parents and healthcare professionals.
Keay also helps people competing at all levels to recover from REDs. Most of her patients are women, but she is starting to see more men reach out for help who, she says, are often in "bad shape".
"I think the men are maybe more reluctant than the women, or maybe they don't realise they've got it. Sometimes they might use a different word for it, they say burnout," Keay says.
"I don't mind that though because there is definitely a psychological aspect to REDs. Why are you doing this? Why are you not eating the carbohydrates?"
Sometimes, it's hard to answer those questions because the under-fuelling is unintentional, either from not understanding or underestimating energy requirements or failing to match an increase in the intensity or duration of exercise with higher calorie or carbohydrate intake.
For others, former British cycling champion Brian Smith among them, the answer comes from intention.
Competing in the road race for Great Britain at the 1996 Olympics should have been the highlight of his career but, behind the scenes of the success, Smith was suffering with an eating disorder and serious mental health condition called bulimia – something he believes he developed from his sport's obsession with weight.
"I always felt like I was overweight. Everybody was under pressure regarding weight, but nobody really spoke about it," he says.
"I'm just under six foot and I've got large glutes and thigh muscles. As a road cyclist, I used to race at 68kg and for my height and build, that's quite skinny. I even got down to about 66kg and when I got down to that, I felt underpowered, I felt bad."
Smith, now 59, only discovered he had been suffering from REDs during his career when he started running eight years ago and developed three severe stress fractures, including one in his femur.
Such has been the toll on his body that Smith says he would now never encourage anyone to pursue a career as a professional cyclist.
"It really is not healthy," he says. "If you want to go to the highest levels of the sport, you will suffer later on in life. You're destroying your body.
"Sporting teams don't care - all they're worried about is performance. So they will nurture a rider, they will feed a rider, they'll get a rider to be a certain weight. They don't care about what happens to them later in life.
"I'm suffering now and I've so many regrets. I just wish I'd known more about this."
While Smith believes his sport has a long way to go in changing attitudes, British Cycling says a lot of progress has been made through education that starts at academy level and annual physical and psychological screenings.
"One of the big things we've done in the past 10 years is try and turn this into a performance-related conversation," Dr Nigel Jones, British Cycling chief medical officer, tells BBC Sport.
"Now, we couch the conversation with an athlete around 'if you under-fuel, you will not be able to perform at your best', whereas previously, conversations in power-to-weight ratio sports might have been 'you need to be lighter'.
"I think it would be naive to say REDs is never going to be an issue. But I would like to believe that its prevalence will reduce with the work that we're doing," he adds.
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