I recently completed another informative microlearning collection (MLC) course on Low Energy Availability (LEA) with Dr. Katie Scofield & Dr. Stacy Sims and wanted to share my learnings & highlight important information for female athletes & their coaches.

What is low energy availability?

Low energy availability (LEA) occurs when dietary energy intake (i.e. calories in) less energy expended in exercise does not leave enough energy to support normal body function. Simply put, the body is not getting enough energy to do what it’s being asking it to do. And when this occurs, the body compensates by prioritizing more critical functions and reduces functions like reproduction which is why the menstrual cycle stops without adequate energy intake. Dr. Katie Scofield used a great analogy of a battery in her course presentation e.g. when your laptop battery gets low, the screen dims to try to save power for other functions, like saving this blog post, for example.

How prevalent is LEA?

Research from Ackerman et al suggests almost half of female athletes (n=1,000 across 40 different sports) may be at risk for LEA but the incidence could be higher or lower depending on the sport.

What are symptoms & consequences of LEA?

LEA may present differently depending on the individual but some of the more common signs include:

• Loss of or irregular menstrual cycles (i.e. amenorrhea or oligomenorrhea)
• Compromised bone health and increased injuries e.g. bone stress fractures
• Increased GI distress
• Mood changes e.g. brain fog, emotional, depression irritability, etc
• Reduced performance and training adaptation. Some commonly reported performance impairments from Charlton et al include:
  • Decreased training response
  • Decreased glycogen stores
  • Decreased endurance performance
  • Decreased muscle strength
  • Decreased coordination
  • Decreased concentration
  • Impaired judgement
  • Lost training days due to illness or injury

While some of these symptoms sound much like what many experience in perimenopause, the feature that distinguishes them is that the symptoms occur more frequently or regularly with LEA.

Additionally, athletes with LEA may have suboptimal blood biomarkers when tested. Specifically, T3 and T4, thyroid hormones responsible for regulating metabolic rate, may be suppressed/low as the body slows metabolism to regulate energy use due to low energy intake. Additionally, low Iron and elevated HsCRP (inflammation biomarker) may be indicative of an athlete with inadequate energy intake/LEA.

Some of the consequences of LEA appear challenging to address once they occur. Recent research from the REFUEL study by DeSouza et al suggests that once estrogen and bone mineral density (BMD) are impacted by LEA, it may take more than 12 months of consuming 20-40% over baseline energy intake requirements to restore so it’s absolutely critical for athlete health and performance to fuel properly to avoid the consequences of LEA.

What causes LEA?

LEA may be intentional or unintentional and can result from a combination of factors. For example, it may occur due to:

• A misstep when increased training occurs (volume and duration) without a subsequent increase in energy intake
• Time pressures & lack of meal planning to allow for adequate energy intake, especially in and around training
• Dieting and/or food restriction
• Disordered eating or eating disorders
• Societal pressure & influences from social media, family, teammates, and coaches

Key Takeaways for Female Athletes & Coaches

Female Athletes: Do you know if you are eating enough to fuel your performance? If not:

• Educate yourself on what drives your unique energy intake requirements and be aware that increased training volume and duration means you need to eat more to properly adapt, perform and recover. Read more in our blog post.
• Ask your coach or a sports nutritionist/sports dietician to help develop a fueling plan that aligns with your training. Nutrify can help. Schedule a complimentary 15’ call to learn more.

Coaches: Aligning training loads with adequate nutrition is critical for athletic performance. And you are uniquely positioned to help your athletes stay healthy and avoid consequences of low energy availability. Our athletes have shared with us that they feel stronger and deliver better performances when they start to better align their energy intake with their training.

But don’t just take our word for it. A recent research by Schofield et al highlighted the benefits of this integrated approach in an interview with an experienced coach of elite/high performance athletes: “I have an athlete who was underperforming for a year or so. Once she started to plan her nutrition better…eating more on her higher volume days, and all of a sudden, she just got better. She started going good because she was actually feeling like she wasn’t [ruined] and she would train harder cos she was eating more.” Do you need help with nutrition assessments & plans for your athletes? We also offer exclusive discounts on InsideTracker blood biomarker testing. Schedule a complimentary 15’ call to learn more.

Sources

Scofield, K., Sims, S.T., Low Energy Availability (LEA) Microlearning Collection (2022).  Retrieved from: https://www.drstacysims.com/products/microlearning-plus/categories/2150336487

Wasserfurth, P., Palmowski, J., Hahn, A. et al. Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention. Sports Med – Open 6, 44 (2020). https://doi.org/10.1186/s40798-020-00275-6

Holtzman, B., Ackerman, K.E. Recommendations and Nutritional Considerations for Female Athletes: Health and Performance. Sports Med (2021). https://doi.org/10.1007/s40279-021-01508-8

Ackerman, K.E., Holtzman, B., Cooper, K.M. et al Low energy availability surrogates correlate with health and performance consequences of Relative Energy Deficiency in Sport British Journal of Sports Medicine 2019;53:628-633.

Charlton, B. T., Forsyth, S., & Clarke, D. C. (2022). Low energy availability and relative energy deficiency in sport: What coaches should know. International Journal of Sports Science & Coaching, 17(2), 445–460. https://doi.org/10.1177/17479541211054458

De Souza, M. J., Mallinson, R. J., Strock, N. C., Koltun, K. J., Olmsted, M. P., Ricker, E. A., Scheid, J. L., Allaway, H. C., Mallinson, D. J., Kuruppumullage Don, P., & Williams, N. I. (2021). Randomised controlled trial of the effects of increased energy intake on menstrual recovery in exercising women with menstrual disturbances: The ‘refuel’ study. Human Reproduction, 36(8), 2285–2297. https://doi.org/10.1093/humrep/deab149

De Souza, M. J., Ricker, E. A., Mallinson, R. J., Allaway, H. C., Koltun, K. J., Strock, N. C., Gibbs, J. C., Kuruppumullage Don, P., & Williams, N. I. (2022). Bone mineral density in response to increased energy intake in exercising women with oligomenorrhea/amenorrhea: The refuel randomized controlled trial. The American Journal of Clinical Nutrition, 115(6), 1457–1472. https://doi.org/10.1093/ajcn/nqac044

Schofield, K.L., Thorpe, H., Sims, S.T. (2022): “This is the next frontier of performance”: power and knowledge in coaches “proactive” approaches to sportswomen’s health, Sports Coaching Review, DOI: 10.1080/21640629.2022.2060635