CoChat
Sign Up
Cited by 75Eating Disorders and BehaviorsSports Performance and TrainingMartial Arts: Techniques, Psychology, and Education

The psychological and physiological consequences of low energy availability in a male combat sport athlete

LANGAN-EVANS, CARL, GERMAINE, MARK, ARTUKOVIC, MARIO, OXBOROUGH, DAVID L., ARETA, JOSÉ L., CLOSE, GRAEME L., MORTON, JAMES P.·2021·Medicine & Science in Sports & Exercise
DOI 10.1249/mss.0000000000002519
Open this paper in CoChat — free account

Abstract

Purpose: This study aimed to evaluate the effects of low energy availability (EA) on health and performance indices associated with the Male Athlete Triad and Relative Energy Deficiency in Sport (RED-S) models. Methods: Over an 8-wk period, a male combat sport athlete adhered to a phased body mass (BM) loss plan consisting of 7-wk energy intake (EI) equating to resting metabolic rate (RMR) (1700 kcal·d −1 ) (phase 1), 5 d of reduced EI (1200–300 kcal·d −1 ) before weigh-in (phase 2), and 1 wk of ad libitum EI postcompetition (phase 3). EA fluctuated day by day because of variations in exercise energy expenditure. Regular assessments of body composition, RMR, cardiac function, cardiorespiratory capacity, strength and power, psychological state and blood clinical chemistry for endocrine, bone turnover, hydration, electrolyte, renal, liver, and lipid profiles were performed. Results: BM was reduced over the 8-wk period by 13.5% (72.5 to 62.7 kg). No consequences of Male Athlete Triad or RED-S were evident during phase 1, where mean daily EA equated to 20 kcal·kg·fat free mass (FFM) −1 ·d −1 (range, 7 to 31 kcal·kg FFM −1 ·d −1 ) and BM and fat mass (FM) losses were 6.5 and 4.4 kg, respectively. However, consequences did present in phase 2 when mean daily EA was consistently <10 kcal·kg FFM −1 ·d −1 , as evidenced by alterations to endocrine hormones (e.g., testosterone <5 nmol.L −1 ) and reduced RMR (−257 kcal·d −1 ). Conclusion: Data demonstrate that 7 wk of daily fluctuations in EA equating to a mean value of 20 kcal·kg FFM −1 ·d −1 permits reductions of BM and FM without perturbations to physiological systems associated with the Male Athlete Triad and RED-S. By contrast, a subsequent period of five consecutive days of EA <10 kcal·kg FFM −1 ·d −1 induced consequences of Male Athlete Triad and RED-S.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1249/mss.0000000000002519

Cites

7 of 7 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • While a universal cut-off of 30 kcal/kg FFM/day as a threshold of LEA leading to some REDs outcomes in females is debated, such a cut-off or range at which males experience REDs-related symptoms is even less understood, but appears to be lower (eg, ~9 to 25 kcal/kg FFM/day).

    “While a universal cut-off of 30 kcal/kg FFM/day as a threshold of LEA leading to some REDs outcomes in females is debated, 88 such a cut-off or range at which males experience REDs-related symptoms is even less understood, 89 but appears to be lower (eg, ~9 to 25 kcal/kg FFM/day).17 46 72 90 91”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [72]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • There is evidence that most males can sustain a lower EA before physiological and psychological disturbances manifest.

    “Indeed, there is evidence that most males can sustain a lower EA before physiological and psychological disturbances manifest.”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [72]

    The discussion (Changes in Anthropometric Measurements; page not provided) reports that one male athlete maintained physiological function and mood during seven weeks of fluctuating energy availability averaging 20 kcal·kg FFM⁻¹·day⁻¹. It explicitly says this single-participant case report cannot be extrapolated to wider populations, so it does not establish that most males can sustain a lower energy availability before disturbances appear. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • Problematic LEA can occur in male athletes and is associated with negative effects on the hypothalamic-pituitary-gonadal (HPG) axis and associated hormones; changes in metabolic hormones; impairments to immune function; detriments to bone health; negative performance outcomes and decreased lean body mass accrual.

    “Nevertheless, problematic LEA can occur in male athletes and is associated with negative effects on the hypothalamic-pituitary-gonadal (HPG) axis and associated hormones 72 92-100 ; changes in metabolic hormones 46 101-103 ; impairments to immune function 104 ; detriments to bone health 105 ; as well as negative performance outcomes 18 90 104 106 and decreased lean body mass accrual.107”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [72]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Psychological indicators associated with problematic LEA and REDs are mood disturbances/fluctuations, cognitive dietary restraint, drive for thinness, reduced sleep quality and perfectionistic tendencies.

    “Psychological indicators associated with problematic LEA and REDs are mood disturbances/fluctuations, 8 71 72 cognitive dietary restraint, 73 drive for thinness, 74 75 reduced sleep quality 50 76 and perfectionistic tendencies.77”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [72]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 32

  1. [1]1. Langan-Evans C, Close GL, Morton JP. Making Weight in Combat Sports. Strength &amp; Conditioning Journal. 2011;33(6):25-39.
  2. [2]2. Franchini E, Brito CJ, Artioli GG. Weight loss in combat sports: physiological, psychological and performance effects. J Int Soc Sports Nutr. 2012;9(1):52.
  3. [4]4. Centers for Disease Control and Prevention. Hyperthermia and dehydration-related deaths associated with intentional rapid weight loss in three collegiate wrestlers--North Carolina, Wisconsin, and Michigan, November-December 1997. JAMA. 1998;279(11):824-5.
  4. [6]6. Morton JP, Robertson C, Sutton L, MacLaren DP. Making the weight: a case study from professional boxing. Int J Sport Nutr Exerc Metab. 2010;20(1):80-5.
  5. [7]7. De Souza MJ, Koltun KJ, Williams NI. What is the evidence for a Triad-like syndrome in exercising men? Current Opinion in Physiology. 2019;10:27-34. ACCEPTED
  6. [10]10. Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52(11):687-97.
  7. [11]11. Burke LM, Close GL, Lundy B, Mooses M, Morton JP, Tenforde AS. Relative Energy Deficiency in Sport in Male Athletes: A Commentary on Its Presentation Among Selected Groups of Male Athletes. Int J Sport Nutr Exerc Metab. 2018;28(4):364-74.
  8. [13]13. Wilson G, Pritchard PP, Papageorgiou C, Phillips S, Kumar P, Langan-Evans C, et al. Fasted Exercise and Increased Dietary Protein Reduces Body Fat and Improves Strength in Jockeys. Int J Sports Med. 2015;36(12):1008-14.
  9. [15]15. Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. REDS CAT. Relative Energy Deficiency in Sport (RED-S) Clinical Assessment Tool (CAT). Br J Sports Med. 2015;49(7):421-3.
  10. [16]16. Nana A, Slater GJ, Stewart AD, Burke LM. Methodology review: using dual-energy Xray absorptiometry (DXA) for the assessment of body composition in athletes and active people. Int J Sport Nutr Exerc Metab. 2015;25(2):198-215.
  11. [17]17. Wilson G, Martin D, Morton JP, Close GL. Male Flat Jockeys Do Not Display Deteriorations in Bone Density or Resting Metabolic Rate in Accordance With Race Riding Experience: Implications for RED-S. Int J Sport Nutr Exerc Metab. 2018;28(4):434-9.
  12. [18]18. Bone JL, Ross ML, Tomcik KA, Jeacocke NA, Hopkins WG, Burke LM. Manipulation of Muscle Creatine and Glycogen Changes Dual X-ray Absorptiometry Estimates of Body Composition. Med Sci Sports Exerc. 2017;49(5):1029-35.
  13. [19]19. Cunningham JJ. A reanalysis of the factors influencing basal metabolic rate in normal adults. Am J Clin Nutr. 1980;33(11):2372-4.
  14. [20]20. Torstveit MK, Fahrenholtz I, Stenqvist TB, Sylta O, Melin A. Within-Day Energy Deficiency and Metabolic Perturbation in Male Endurance Athletes. Int J Sport Nutr Exerc Metab. 2018;28(4):419-27. ACCEPTED
  15. [21]21. Muller MJ, Enderle J, Pourhassan M, Braun W, Eggeling B, Lagerpusch M, et al. Metabolic adaptation to caloric restriction and subsequent refeeding: the Minnesota Starvation Experiment revisited. Am J Clin Nutr. 2015;102(4):807-19.
  16. [22]22. Wilson G, Fraser WD, Sharma A, Eubank M, Drust B, Morton JP, et al. Markers of bone health, renal function, liver function, anthropometry and perception of mood: a comparison between Flat and National Hunt Jockeys. Int J Sports Med. 2013;34(5):4539.
  17. [23]23. Sparks SA, Close GL. Validity of a portable urine refractometer: the effects of sample freezing. J Sports Sci. 2013;31(7):745-9.
  18. [24]24. Oxborough D, George K, Utomi V, Lord R, Morton J, Jones N, et al. Acute response and chronic stimulus for cardiac structural and functional adaptation in a professional boxer. Oxf Med Case Reports. 2014;2014(3):65-8.
  19. [28]28. Pettersson S, Pipping Ekstrom M, Berg CM. The food and weight combat. A problematic fight for the elite combat sports athlete. Appetite. 2012;59(2):234-42. ACCEPTED
  20. [29]29. Martin CK, Han H, Coulon SM, Allen HR, Champagne CM, Anton SD. A novel method to remotely measure food intake of free-living individuals in real time: the remote food photography method. Br J Nutr. 2009;101(3):446-56.
  21. [30]30. Hannon MP, Parker LJF, Carney DJ, McKeown J, Speakman JR, Hambly C, et al. Energy Requirements of Male Academy Soccer Players from the English Premier League. Med Sci Sports Exerc. 2020. DOI: 10.1249/mss.0000000000002443 · DOI
  22. [31]31. McLean BD, Coutts AJ, Kelly V, McGuigan MR, Cormack SJ. Neuromuscular, endocrine, and perceptual fatigue responses during different length between-match microcycles in professional rugby league players. Int J Sports Physiol Perform. 2010;5(3):367-83.
  23. [32]32. Foster C, Hector LL, Welsh R, Schrager M, Green MA, Snyder AC. Effects of specific versus cross-training on running performance. Eur J Appl Physiol Occup Physiol. 1995;70(4):367-72.
  24. [33]33. Wilson G, Sparks SA, Drust B, Morton JP, Close GL. Assessment of energy expenditure in elite jockeys during simulated race riding and a working day: implications for making weight. Appl Physiol Nutr Metab. 2013;38(4):415-20.
  25. [34]34. Loucks AB. The female athlete triad: A metabolic phenomenon. Pensar en Movimiento: Revista de Ciencias del Ejercicio y la Salud. 2014;12(1):1-23.
  26. [37]37. Hammond KM, Sale C, Fraser W, Tang J, Shepherd SO, Strauss JA, et al. Post-exercise carbohydrate and energy availability induce independent effects on skeletal muscle cell signalling and bone turnover: implications for training adaptation. J Physiol. 2019;597(18):4779-96. 42. Degoutte F, Jouanel P, Begue RJ, Colombier M, Lac G, Pequignot JM, et al. Food restriction, performance, biochemical, psychological, and endocrine changes in judo athletes. Int J Sports Med. 2006;27(1):9-18.
  27. [38]38. Papageorgiou M, Elliott-Sale KJ, Parsons A, Tang JCY, Greeves JP, Fraser WD, et al. Effects of reduced energy availability on bone metabolism in women and men. Bone. 2017;105:191-9.
  28. [39]39. Dolan E, Crabtree N, McGoldrick A, Ashley DT, McCaffrey N, Warrington GD. Weight regulation and bone mass: a comparison between professional jockeys, elite amateur boxers, and age, gender and BMI matched controls. J Bone Miner Metab. 2012;30(2):164-70.
  29. [41]41. Loucks AB, Thuma JR. Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. J Clin Endocrinol Metab. 2003;88(1):297-311. ACCEPTED
  30. [43]43. Hall CJ, Lane AM. Effects of rapid weight loss on mood and performance among amateur boxers. Br J Sports Med. 2001;35(6):390-5.
  31. [44]44. Dulloo AG, Jacquet J, Girardier L. Poststarvation hyperphagia and body fat overshooting in humans: a role for feedback signals from lean and fat tissues. Am J Clin Nutr. 1997;65(3):717-23.
  32. [48]48. Saarni SE, Rissanen A, Sarna S, Koskenvuo M, Kaprio J. Weight cycling of athletes and subsequent weight gain in middleage. Int J Obes (Lond). 2006;30(11):1639-44. ACCEPTED

Cited by

Sorted by citations

Authors
LANGAN-EVANS, C., GERMAINE, M., ARTUKOVIC, M., OXBOROUGH, D. L., ARETA, J. L., CLOSE, G. L., & MORTON, J. P.
Affiliations
Liverpool John Moores University (GB)
ORCID
Venue
Medicine & Science in Sports & Exercise
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-10-23
Volume
53
Issue
4
Pages
673-683
ISSN
  • 0195-9131 (ISSN-L)
  • 1530-0315
DOI
10.1249/mss.0000000000002519
OpenAlex
W3093499774
Cited by
75
References
7
Citations by year
2026: 8 · 2025: 17 · 2024: 18 · 2023: 17 · 2022: 5 · 2021: 10
FWCI
3.20
Type
journal article
Language
en
Open access
closed
Locations
  • Medicine & Science in Sports & Exercise (publishedVersion)
  • PubMed (publishedVersion)
  • Liverpool John Moores University (acceptedVersion)
Funders
Liverpool John Moores University
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
  • Social Sciences › Safety Research › Martial Arts: Techniques, Psychology, and Education
Keywords
low energy availability, relative energy deficiency in sport, combat sports athletes, weight loss, caloric restriction, testosterone, resting metabolic rate, fat-free mass, body composition, electrolytes, bone turnover, cardiac function, cardiorespiratory capacity, strength and power, psychological state
MeSH terms
Cardiorespiratory Fitness, Relative Energy Deficiency in Sport, Basal Metabolism, Body Composition, Energy Intake, Energy Metabolism, Heart Rate, Humans, Male, Myocardial Contraction, Stroke Volume, Testosterone, Time Factors, Weight Loss, Body Mass Index, Martial Arts, Muscle Strength, Athletic Performance, Young Adult, Athletes

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review