Research

Energy balance

Low energy availability (EA), defined as dietary energy intake minus exercise energy expenditure normalized to fat-free mass, is strongly associated with increased risk of menstrual dysfunction, poor bone health, metabolic issues, haematological detriments, psychological disorders, cardiovascular impairment, and gastrointestinal dysfunction in female athletes.

If you are a female athlete, getting enough energy is critical for your overall health and performance. Low energy availability is linked to serious health issues like menstrual dysfunction, poor bone health, metabolic problems, and psychological disorders. It also hurts your performance by decreasing your endurance, coordination, and concentration. Don't rely on BMI to judge your fueling; use screening tools like the LEAF-Q or consult a sports medicine professional if you suspect you are not eating enough to support your activity level.

ModerateSupportsMEDIUM confidence
Athletes with low EA were more likely to be classified as having increased risk of menstrual dysfunction, poor bone health, metabolic issues, haematological detriments, psychological disorders, cardiovascular impairment and gastrointestinal dysfunction than those with adequate EA.
Kathryn E. Ackerman et al. · British Journal of Sports Medicine · 2018

Why this rating

Large sample size (n=1000) but cross-sectional design using self-reported surrogates for EA rather than direct measurement.

Source

Low energy availability surrogates correlate with health and performance consequences of Relative Energy Deficiency in Sport

Kathryn E. Ackerman et al. · British Journal of Sports Medicine · 2018

DOI 10.1136/bjsports-2017-098958

cross_sectional · n=1000Cited 232×
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DOI resolved against Crossref · corpus check 2026-06-10

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