Summary

• What is low-energy availability (LEA)?
• How to identify LEA
• What are the consequences of LEA?
• How to avoid and prevent LEA

Introduction

The concept of low-energy availability (LEA) has been around since the 1980’s when researchers identified several alarming symptoms in female athletes (Drinkwater et al, 1924). 

LEA is a growing concern with increased prevalence being observed in both elite and non-elite sports, especially among female athletes. It has pervaded the elite and olympic realms, which have received a lot of the attention from researchers. 

However, many non-elite track and field athletes, gymnasts and those in other weight-related sports have shown symptoms of LEA. If you are reading this article, as an athlete, coach or parent, it is important to understand that LEA can be present in your sport too! 

What is low-energy availability?

You might have read the paragraph above, and are now quite fearful. You might be asking yourself “What is LEA?”

First of all, don’t worry too much, because with some simple strategies, you can avoid this phenomenon occurring at various points in your career. 

To explain LEA, let’s first break down the concept of energy availability (EA) as a whole. Put simply, this is the difference in energy (kCals) between energy output (organ function, physical activity) and energy intake (food & drink), relative to an individual’s lean mass (muscle). To put it even more simply, it is the amount of energy available for bodily functions and recovery, after subtracting energy burned from energy consumed. 

From this, you can probably guess that LEA occurs when an individual is not consuming enough energy through their diet to support their activity output. This can be a result of some of the following; 

• Disordered eating
• Extreme dieting tactics (in weight-related sports)
• Extreme energy outputs (several hours of intense training daily)

How is LEA diagnosed?

The phenomenon of LEA is relatively new, and quite difficult to measure, without expert help or expensive materials. There is a mathematical equation that can be used for estimating your current EA, but you will need three things:

• Your energy intake (in Calories) 
• Your energy expenditure (in Calories) 
• Your lean body mass (in kilograms).

From here, you simply subtract your energy output from your intake and divide by your lean body mass. If you are calculating this, and have access to accurate tools to measure those variables, you will want to take a 3-7 day average. While one day is not enough to develop LEA, research has shown that it can occur in just 4-5 days of restricted energy intake (Heikura, Stellingwerff and Areta, 2021). 

You can now see that EA is not something that is measured in the majority of sports. Coaches would need dietary recalls and accurate activity measurements, along with body composition testing, and they ain’t paying for that! 

What are the short-term consequences of LEA?

If this imbalance occurs sporadically, only for a couple of days, it is usually nothing to worry about. A solid recovery with plenty of energy (kCals) and carbohydrates will be sufficient for a return to optimal EA. However, when LEA is chronic, athletes are consistently underfueling for their high levels of exercise and/or in pursuit of a low body weight, this can lead to manifestations of symptoms. 

Before we highlight some of the manifestations and consequences of LEA, it is important to understand that it has different severities, and with these different symptoms: 

• Clinical LEA: Exhaustion, difficulty recovering from illness, amenhorhea, stress fractures, poor performance
• Sub-clinical LEA: Extreme fatigue, longer recovery from illness, ammenorhea, stress fractures, pain, reduced performance 
• LEA: Fatigue, longer recovery from training and competition, stress-injury, slightly-reduced performance

What are the long-term consequences of LEA?

These are the impacts that have sparked the increased research and funding of this research in elite sporting circles. If sustained for long periods of time, athletes can increase their risk of long-term health conditions due to LEA. 

First up is relative energy deficiency syndrome (REDS-S). This is the term given to long-term and clinical LEA, when it is present along with two other major factors: amenorrhea (menstrual dysfunction) and bone mineral losses. This syndrome was officially classified as such, in place of the former ‘Female Athlete Triad’ in 2005 by the Olympic Committee (Source: Mountjoy et al, 2014). 

The below quote is sourced directly from the committee’s statement: 

“The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency.”

(Source: Mountjoy et al, 2014)

As you can see here, there are several long-term consequences of LEA and RED-S. Before listing these, I want to highlight a major one. When an athlete is in a state of LEA, hormone production will be downregulated. One of these hormones is eostrogen, which is an important regulator of bone density (eostrogen prevents the breakdown process; Stand et al, 2007). 

For this reason, LEA and RED-S have been shown to contribute to significant losses in bone mineral density among females. This can increase the risk of developing osteoporosis at a much earlier age than it is commonly seen. 

Here are some of the other long-term consequences: 

• Reduced metabolic rate 
• Loss of menstruation
• Fertility issues 
• Compromised bone health 
• Weakened immune system 
• Muscle losses 
• Reduced fitness levels 
• Joint pain and soreness 
• Fatigue 

How do I avoid suffering from LEA?

These are the impacts that have sparked the increased research and funding of this research in elite sporting circles. If sustained for long periods of time, athletes can increase their risk of long-term health conditions due to LEA. 

If you feel you are suffering from LEA currently, it is important that you seek guidance from a professional nutritionist or dietician. This information is not intended to help an individual reverse LEA or RED-S, but should provide some basic principles for avoiding it. 

• Don’t estimate – Every now and then it is important to log your activity, estimate your output in Calories and match this up with your recorded energy intake.
• Plan your cut – If you are in a weight-dependant sport (gymnastics, combat, track and field) it is often the priority to be a target weight for competition. Just remember, if you use unsustainable practices to get to this weight, in too short a time, your performance will severely suffer. To do this, you should seek the services and guidance of a qualified nutritional professional. Give yourself enough time to comfortably reach your goal weight, without increasing your risk of LEA, and reduced performance.

• Fuel for the work required – Just a reminder to prioritise fuel and recovery above all else. Although performance might be higher on your list, it will ultimately be influenced by your fueling and recovery strategies.
• Get all your essential nutrients – Balancing your meals with lean protein, wholegrains, fruits and vegetables will ensure you are getting enough essential vitamins and minerals. 

            Of special importance here is iron, vitamin D, calcium and omega-3 fatty acids. 

• Take a day off – If you feel tired, weak or lethargic, it is most likely your body telling you something. Listen to it! Give yourself at least a day to recover. Relax, do a small bit of stretching, but most importantly, eat large, nutrient-dense meals throughout the day, to replenish your stores

We hope you enjoyed and learned from this article about LEA in athletes. At daveynutrition, we aim to help you avoid and prevent LEA by sharing content in the form of meal plans, recipes and articles like this one. The combination of these enables our members to meet their required Calories. 

References

1. Drinkwater, B.L., Nilson, K., Chesnut III, C.H., Bremner, W.J., Shainholtz, S. and Southworth, M.B., 1984. Bone mineral content of amenorrheic and eumenorrheic athletes. New England journal of medicine, 311(5), pp.277-281.
2. Heikura, I.A., Stellingwerff, T. and Areta, J.L., 2021. Low Energy Availability in Female Athletes: From the Lab to the Field. European Journal of Sport Science, (just-accepted), pp.1-18.
3. Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Meyer, N., Sherman, R., Steffen, K., Budgett, R. and Ljungqvist, A., 2014. The IOC consensus statement: beyond the female athlete triad—relative energy deficiency in sport (RED-S). British journal of sports medicine, 48(7), pp.491-497.
4. STAND, P., 2007. The female athlete triad. Med. Sci. Sports Exerc, 39(10), pp.1867-82.

Want more like this?

Have you seen our most recent daveynutrition meal plans? We have a meal plan to suit every goal whether it be muscle building, fat loss, performance or health. Make sure to use the Performance Nutrition Calculator to determine your specific calorie and macronutrient requirements and then choose a meal plan based on your calorie goal. 

For help and support, please check out the How To and FAQ pages or email expertsupport@daveynutrition.com