Low Energy Availability (LEA) Isn’t Just a Female issue, it also hurts Men's Performance too!

With all these fad diets like keto, and intermittent fasting just to name a few, being promoted all across the social media stratosphere, there has been an uptick in the low energy availability (LEA) across the entire group of endurance athletes. This is especially seen in my practice with many of my clients/athletes being female. However, I also coach a local tri club with somewhere in the range of 400 plus members, and the number of men being affected by LEA is just as high, they just don’t talk about it like women do. 

We all hear LEA in reference to women in sport, and especially in younger women when it used to be called the female athlete triad. Regardless of age, it has debilitating negative effects for all. The damage it causes in women is, dangerously low bone mineral density, reproduction dysfunction, hypotension, hypoglycemia, and suppressed immune system just to name a few (1). However did you know that for men the negative effects are just as bad. Decreased hormone levels (both decreased testosterone production but also estrogen, and yes men have estrogen too), decreased bone mineral density (it’s not just a women’s issue), muscle loss, psychological issues (irritability, depression, decreased concentration), and performance decline (2). 

The one thing I tell every one of them, women AND men, when it comes to avoiding LEA, is that it starts with eating enough.

What is LEA? How is it defined?

Low energy availability (LEA) represents a state in which the body does not have enough energy left to support all the physiological functions needed to maintain optimal health. LEA may result from altered dietary behaviors that are caused by body dissatisfaction, the belief that a lower body weight will result in greater performance, or social pressure to look a certain way. Pressure can also be experienced from the coach, teammates, and in this day and age through social media platforms.

Knowing what your body composition is, is the first step to understanding how to avoid LEA. 

If you know your body composition, you can start with using the following equation (3) for determining your energy availability, EA for short. Dietary energy intake (kcal) minus your exercise energy expenditure (kcal) divided by your fat free mass (FFM) in kilograms (kg). 

EA = (Daily intake(kcal) - Exercise Energy Expenditure (kcal)) / Fat Free mass (kg)

You want the final number (EA) to be over 45 calories per kilogram of FFM; 50 calories per kilogram FFM is a good number to aim for if you train regularly. Anything less than 30 calories per kg is defined as LEA, and at that point you start experiencing health risks after only 5 days of low EA (4). These numbers are the same for both women and men regardless of age or hormonal season in life (5). 

Recommendations for avoiding LEA

First and foremost, fuel for the work required! This means providing enough carbohydrate relative to your upcoming session, but finishing that session not fully depleted and eating as soon after exercise as possible. Thanks to the amazing work by Dr Stacy Sims and Selene Yeager for their work on Road and Next Level, not only has there been research on this, there are guidelines specifically for women in all phases of life.

The recommendations on carbohydrates and protein intake based on intensity for peri and postmenopausal athletes….these are slightly higher than the requirements that most people see from research, that is because most research is done on young college age men, and does NOT apply to women.

Carbohydrates: 

Moderate to high intensity training days, lasting 60-120 minutes: You need 3 to 3.5 grams of carbohydrates per kilogram. 

Light or active recovery days: aim for 2.5 grams per kilogram. 

For short intense days (think HIIT, CrossFit): aim for 2.5 to 3 grams of carbs per kilogram. 

Endurance Training 2-5 hours of intense training per day (distance swim/bike/run): Aim for 5 to6 grams of carbohydrates per kilogram.

Extreme intense training of 5 or more hours a day (Ironwoman/man type events): Aim for 6 to 8 grams of carbohydrates per kilogram

Protein:

Strength & Power phases of training: You need 2.0 to 2.2 grams per kilogram.

Endurance phases of training: You need 1.8 to 2.0 grams per kilogram.

For recovery days: You need 1.8 grams per kilogram.

For optimal recovery try to get 30 to 40 grams of protein within 30 minutes post event/training.

To stimulate maximal muscle protein synthesis aim for a per-meal amount of 0.5 to 0.6 grams per kilogram of protein.

A note on protein, especially for women. If you don’t eat any protein, your body will not use carbohydrates for refueling muscle and liver glycogen, as it is supposed to; instead the carbs you eat will assist in repairing your muscles.Meaning when you go to exercise next time your energy stores will be low due to the carbs being used for muscle repair instead of glycogen storage for fueling exercise.  Protein is also necessary to facilitate fat loss, as it keeps the muscles repairing and rebuilding, a process that allows carbohydrates to refuel the muscles and liver - thus allowing fat stores to stay empty (6).

These numbers are a little lower for men when it comes to protein as their hormones naturally are building their muscles at all times. Women on the other hand have a hormone that builds and a hormone that breaks down, thus why it is so much more important for women to eat the proper amount and not go into LEA. 

Nutrition is a nuanced field, we all need to figure out what exactly works for us. Both for Women and Men by aiming to fuel appropriately from breakfast to dinner, then stopping eating about 2 hours before bed, you are on the right track for optimal training adaptations, recovery, and health. So stay fueled, avoid LEA, and crush your next event. 

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC9724109/#:~:text=The%20health%20concerns%20associated%20with,the%20risk%20of%20injury%20or

2. https://journals.humankinetics.com/view/journals/ijsnem/28/4/article-p385.xml#:~:text=The%20reviewed%20literature%20indicates%20that%20a%20prolonged,when%20approaching%20the%20lower%20limits%20of%20BF.

3. https://sportsmedicine-open.springeropen.com/articles/10.1186/s40798-020-00275-6

4. https://asbmr.onlinelibrary.wiley.com/doi/full/10.1359/JBMR.040410

5. https://thesportjournal.org/article/low-energy-availability-lea-in-male-athletes-a-review-of-the-literature/

6. Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals Through Menopause and Beyond

Guide to Macro Nutrients & Timing for the Endurance Athlete

Events vary, as do athletes and your everyday health-conscious exerciser. So, it should be no surprise that one’s nutritional needs are not a one-size-fits-all solution. Factors to consider include weekly exercise expenditure requirements, body weight, environmental conditions, and nutrient timing. 

Each person will have different needs for different events. Finding the best solution may involve starting with basic nutrition recommendations. If they don’t supply the desired results, modify them as needed. Finding the best diet is often a trial-and-error process. 

Nutrition Basics:

1. Get most of your protein from animal sources (skinless chicken, turkey, and fish) unless you are vegan/vegetarian. If vegan/vegetarian you will need to increase your protein intake to make up for the incomplete protein molecules in vegetables from your diet. 

2. Timing: EAT Breakfast! Have ⅔ of your calories in the first ⅔ of your day. Dinner should be small but complete. Try to space out your food so you are having about 300-400 calories every 3 hours. For peri & menopausal women those needs are increased to 500+ calories per balanced meal 3x a day, plus nutrition before/after workouts.

3. Make sure to have Prot/Carb/Fat in each meal, and a big dose (30-40g for Women 40+, 20-25g for all others) of protein immediately post-workout. For women, adding EAA’s (especially Leucine 3-4g) and creatine (3-5g) to your daily intake is highly advised. 

4. Eat whole grains & Starchy vegetables: Quinoa, Whole Grain bread or crackers, cauliflower, broccoli, colorful potatoes, and lots of dark green leafy veggies. Eat your fruits, don’t drink them unless it’s during exercise/competition.

Macronutrients are the basic components of the food we eat. These are carbohydrates, protein, and fat. 

Eating macros in proper ratios fuels your endurance and strength training protocols. Healthy “adult” (aka college age men) eating includes ratios of, 45-65% of calories from carbs, 20-35% of calories from fat, and 10-35% of calories from protein.

Adjust these ratios based on the goal of the physical activity. For example, when training for endurance an athlete would increase their carb percentage to improve muscle glycogen stores. When training for strength, an athlete would consume a higher protein intake to help rebuild muscle fibers to better support more muscle mass. The numbers for most people would then look like 40% Carb, 30% Protein and 30% fat. 

Carbohydrates: 

Carbs come in different forms. Two to know are simple and complex carbs.

• Simple carbs, also known as simple sugars, have one to two sugar molecules. These include glucose*, dextrose, or fructose. Simple carbs break down quickly in the body. Foods with simple sugars include fruits (grapes, watermelon, stone fruits), milk, vegetables, table sugar, candy, and soft drinks. They supply energy but lack fiber, vitamins, and other key nutrients.

• Complex carbs have three or more sugar molecules. You'll find these in foods like beans, whole grains, whole-wheat pasta, colorful potatoes, corn, and legumes.

So, what kind of carbohydrate should you consume? Most carbs should come from complex sources and naturally occurring sugars. Processed carbs and refined sugars should be limited to racing and hard training sessions, or avoided if your body has trouble using it.

How many carbs should endurance athletes eat?

There will be some differences based on the type and duration of training. The general rule is to increase carbohydrate intake up to 70% of total daily calories. This helps support the high volume of glucose needed for that level of physical activity.

Endurance athletes should eat 8 to 10 grams of carbohydrate per kilogram (kg) of body weight per day. This will depend on the duration of their endurance event. For endurance training lasting 4 to 5 hours, endurance athletes should consume 10 grams per kilogram of body weight, this is based on healthy young men and does not include recommendations for women, and especially peri& postmenopausal women. Instead, according to Dr. Stacy Sims, women should follow: 

For light days, rest days  or strength training days aim for 1.1 to 1.4 grams of carb per pound of body weight per day.

For Moderate to high-intensity training (60-120 minutes), you need 1.6 to 1.8 grams of cab per pound of body weight per day.

For endurance training of 2 to 5 hours of intense training per day, you need 2 to 2.7 grams of cab per pound of body weight per day.

For extreme training of 5 hours or more of intense training per day, you need 2.7 to 3.1 grams of carbs per pound of body weight per day.

How Much Protein Should Endurance Athletes Eat?

Many people focus only on carbs for endurance exercise. However, protein intake for endurance athletes is equally important. The purpose of protein is to build and replenish lean muscle tissue. Protein also acts as a source of energy in times of caloric deficits.

There are two different types of protein:

• Animal-based protein

• Plant-based protein

Animal-based protein, as the name implies, is a protein that comes from animals. It can come from the animal’s body, such as a cut of beef or fish filet. Or it may be a protein food they produce, like cow’s milk or an egg. This type of protein is considered a complete protein. It is complete because it contains all nine essential amino acids. 

Plant-based protein is a protein that comes from plants. This type of protein can come from the plant’s leaves and roots, or a fruit or nut produced by the plant. Plant-based protein is considered an incomplete protein. This isn't to say it is bad, it just doesn't have all essential amino acids. Plant-based protein sources include edamame, chickpeas, spinach, broccoli, chia seeds, quinoa, hemp seeds, and peanut butter. Endurance athletes on a plant-based diet will have an increased protein requirement. This is due to a plant-based diet consisting of incomplete proteins.

Protein has 4 calories per gram. How much protein do you need to eat?  Protein intake for a normal healthy adult (again these guidelines are based on research done solely on young males) is around 0.8 grams/kg/day. Endurance athletes should eat protein at 1.4 g/kg/day. Athletes taking part in longer endurance events need more protein than those running shorter distances. This is based on research done on healthy young men and does not include recommendations for women, and especially peri& postmenopausal women. Instead, according to Dr. Stacy Sims, women should follow: 

For strength/power phases of training, you need 1.0 to 1.2 grams of protein per pound per day.

For endurance phases of training, you need 0.8 to 1.0 grams of protein per pound per day.

For optimal recovery, try taking 35-40 grams of protein immediately post-workout, or within no more than 30 minutes after to take advantage of the non-insulin-dependent first phase of glycogen synthesis. In addition to the 35-40 grams of protein immediately after a workout, peri & postmenopause women need to make sure there are EAA’s (essential amino acids: Leucine, isoleucine, and valine) with a 3 to 4 gram content of Leucine, and creatine in a 3-5g amount.

 

How Much Fat Should Endurance Athletes Eat?

Endurance athletes need healthy fats in their diet. Roughly 30% of one’s daily calories should come from fat when involved with endurance exercise. 

Dietary fat has six major roles in the body: Supply energy; Help manufacture and balance hormones; Form cell membranes; Form the brain and nervous system, Transport fat-soluble vitamins (A, D, E, and K); Supply two fatty acids the body can't manufacture (linoleic acid and linolenic acid); There are many types of fat, some good and some not. The most significant types are triglycerides, fatty acids, phospholipids, and cholesterol. Of these, triglycerides are most commonly found in food. Fatty acids break down further into saturated, monounsaturated, and polyunsaturated fats. 

Endurance athletes need to minimize the amount of saturated fat consumed. Most fat calories should be in the form of monounsaturated fatty acids.

When adding fat to your diet to keep up with the demands of endurance training, focus your fat intake on healthy fats. This includes: Fatty fish - salmon, mackerel, or tuna; Avocado; Seeds - sunflower, sesame, and pumpkin seeds all have healthy fats; Nuts - peanuts, walnuts, almonds, or cashews; Olive oil; Eggs; Ground flaxseed; Beans - kidney, navy, or soybeans.

Nutrition for Endurance: Bringing it All Together

Balancing one's nutrition is not an easy task, involves a lot of thought and trial and error. But when endurance athletes pay attention to the recommendations and figure out what methods work best for them, the outcome is improved athletic performance. This can translate to higher awards come race day.

Whether you are an elite athlete, a weekend warrior, or a personal trainer designing programs for athletes, it is important to fuel your body properly. Proper nutrients at the right time allow the body to perform at its highest level.