As a Clinical Nutritionist, one of the most important aspects of supporting athletes - especially women, is addressing the impact of Low Energy Availability (LEA). LEA is a condition that occurs when an athlete’s energy intake (the calories they consume) is insufficient to meet the demands of both their exercise routine and their body's basic functions. This imbalance can result in a variety of health consequences, and it’s particularly common in female athletes. Understanding LEA, its prevalence, and how it affects performance is essential for ensuring long-term health and success in sports.
What is Low Energy Availability?
Energy availability (EA) refers to the amount of energy available for the body after accounting for the energy expended during exercise.
The formula for calculating energy availability is:
Energy Availability = Energy Intake - Exercise Energy Expenditure / Fat-Free Mass
When energy availability is too low, the body doesn’t have enough calories to support normal physiological functions, including maintaining hormonal balance, bone health, and immune function. This chronic energy imbalance can lead to health issues, from hormonal disruptions to impaired performance, fatigue, and even increased risk of injuries.
LEA is often associated with disordered eating patterns, whether intentional (to control body composition) or unintentional (due to lack of knowledge or disorganised meal planning).
While it's commonly recognised in endurance sports, it can also affect athletes across various disciplines including recreational athletes.
Prevalence of Low Energy Availability in Female Athletes
Women are more likely to experience LEA due to the unique hormonal and metabolic factors that influence their energy needs. Female athletes may feel pressure to maintain a certain body weight, especially in sports where aesthetics and weight categories matter. Furthermore, they may be misguided by male coaches or male training partners who have very different nutrient needs. This can lead to restrictive eating habits, low calorie intake, and an overall mismatch between energy consumption and energy expenditure.
Studies have shown that up to 60% of female athletes may experience LEA at some point in their careers, putting them at risk for a range of conditions, such as:
Menstrual dysfunction (e.g., amenorrhea or irregular cycles)
Osteoporosis and stress fractures due to impaired bone health
Decreased immune function, leading to frequent illness
Increased injury risk due to muscle weakness and poor recovery
Fatigue and decreased performance, impacting training intensity and competition outcomes
The combination of physical and psychological factors often makes it difficult to identify LEA early, as many athletes may be unaware of the long-term effects of an energy deficit.
How a Clinical Nutritionist Can Help
A Clinical Nutritionist can assess, identify, and support athletes experiencing Low Energy Availability. Their expertise in nutrition can help restore balance and promote healthier habits, not just for optimal performance but for overall health and well-being.
Comprehensive Nutritional Assessment: The first step in managing LEA is identifying the signs and symptoms. An evaluation of the athlete’s current dietary intake, training demands, and body composition will determine whether they’re in a state of negative energy balance. Often, this involves a detailed food diary, a breakdown of energy expenditure, and an understanding of menstrual health and bone density (if applicable).
Personalised Nutrition Plans: Understanding the athlete's unique needs, enables the nutritionist to create tailored plans to ensure adequate calories are being consumed to support their training and recovery. This includes focusing on nutrient-dense foods that provide not just energy, but also the micronutrients needed for hormone regulation, bone health, and immune function.
Addressing Disordered Eating Patterns: Low Energy Availability often coincides with disordered eating behaviours. A Clinical Nutritionist works with athletes to create healthier relationships with food and nutrition. This might involve setting realistic, body-positive goals and educating athletes on the importance of fuelling their bodies properly. The nutritionist will also refer to a psychologist or therapist for additional support when necessary.
Monitoring Progress: Nutrition is dynamic, and an athlete's energy needs can change over time as their training or goals shift. Regular check-ins help track progress, adjust caloric intake, and ensure that energy availability remains optimal. A Clinical Nutritionist also helps with periodisation—modifying nutrition based on training loads and competition schedules.
Collaboration with Other Healthcare Providers: Working in a multi-disciplinary setting, a Clinical Nutritionist often collaborates with physiotherapists, chiropractors, osteopaths, massage therapists, and other healthcare providers to offer holistic care. This may include interventions for injury prevention, stress management, and recovery strategies, all of which are influenced by adequate energy intake.
The Importance of Education and Prevention
Many athletes may not recognise the consequences of overtraining and under-eating until they experience symptoms like menstrual irregularities or stress fractures. One of the biggest misconceptions is that eating more will automatically result in weight gain - In reality, ensuring adequate calorie intake actually supports metabolic health, body composition, and performance.
A key component in a Clinical Nutritionists role, is to educate athletes on how to fuel their bodies adequately for both their sport and overall health. This education can help prevent the development of LEA before it leads to more serious issues.
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