Nutritional Needs of the Female Athlete: Risk and Prevention of Low Energy Availability
Abstract
To date, most of the research surrounding low energy availability (LEA) and female athletes has focused on the high prevalence rates (2–77%). Despite the severe negative health and performance consequences, awareness of this issue is low. There are potentially a multitude of factors that contribute to the development of LEA across the menstrual cycle and training phases. This review highlights these influences and provides practical tips for those working with female athletes.
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Sex similarities in glycogen re-synthesis contradict suggestions that women require unique recovery feeding recommendations when compared to men.
“Sex similarities in glycogen re-synthesis contradict suggestions that women require unique recovery feeding recommendations when compared to men (Black et al. 2019; Rehrer et al. 2017), indicating that consumers and athletes should be wary of sex-specific marketing related to carbohydrate-rich recovery products.”
From Males and females exhibit similar muscle glycogen recovery with varied recovery food sources (2020) · cites this paper as Black et al. 2019
Many athletes, especially females, have a lower overall energy intake and consume less than the recommended amounts of carbohydrate.
“Evidence shows that many athletes, especially females, have a lower overall energy intake and consume less than the recommended amounts of carbohydrate (Baranauskas et al. 2015; Black et al. 2019; Burke et al. 2001; Masson and Lamarche 2016; Shriver et al. 2013).”
From Males and females exhibit similar muscle glycogen recovery with varied recovery food sources (2020) · cites this paper as Black et al. 2019
Cites
International society of sports nutrition position stand: nutrient timing
Kerksick, C. M., Arent, S., Schoenfeld, B. J., Stout, J. R., Campbell, B., Wilborn, C. D., Taylor, L., Kalman, D., Smith-Ryan, A. E., Kreider, R. B., et al. (2017) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-017-0189-4 · Cited by 622 · cited 2× · see citing works
“NUTRITION AROUND TRAINING There is emerging evidence to suggest that nutrient timing to be of importance for attenuating the health effects of LEA as well as for maximizing training adaptations and optimizing performance (11).”
BackgroundEnergy availability in athletes
Loucks, A. B., Kiens, B., & Wright, H. H. (2011) · Journal of Sports Sciences · doi:10.1080/02640414.2011.588958 · Cited by 513 · see citing works
Melin, A., Tornberg, Å. B., Skouby, S., Faber, J., Ritz, C., Sjödin, A., & Sundgot-Borgen, J. (2014) · British Journal of Sports Medicine · doi:10.1136/bjsports-2013-093240 · Cited by 435 · see citing works
Oosthuyse, T., & Bosch, A. N. (2010) · Sports Medicine · doi:10.2165/11317090-000000000-00000 · Cited by 380 · see citing works
Effects of repeated days of intensified training on muscle glycogen and swimming performance
COSTILL, D. L., Flynn, M. G., Kirwan, J. P., Houmard, J. A., Mitchell, J. B., Thomas, R. G., & Park, S. H. (1988) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-198806000-00006 · Cited by 362 · see citing works
Neuroendocrinology of nutritional infertility
Wade, G. N., & Jones, J. E. (2004) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00475.2004 · Cited by 296 · see citing works
Energy availability and the female athlete triad in elite endurance athletes
Melin, A., Tornberg, Å., Skouby, S., Møller, S., Sundgot-Borgen, J., Faber, J., Sidelmann, J., Aziz, M., & Sjödin, A. (2015) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.12261 · Cited by 289 · see citing works
Kong, P., & Harris, L. M. (2014) · The Journal of Psychology · doi:10.1080/00223980.2013.846291 · Cited by 264 · see citing works
Pitfalls of conducting and interpreting estimates of energy availability in free-living athletes
Burke, L. M., Lundy, B., Fahrenholtz, I. L., & Melin, A. K. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0142 · Cited by 244 · see citing works
Brennan, I. M., Feltrin, K. L., Nair, N. S., Hausken, T., Little, T. J., Gentilcore, D., Wishart, J. M., Jones, K. L., Horowitz, M., & Feinle‐Bisset, C. (2009) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00051.2009 · Cited by 226 · see citing works
PREVALENCE OF THE FEMALE ATHLETE TRIAD IN HIGH SCHOOL ATHLETES AND SEDENTARY STUDENTS
Hoch, A., Pajewski, N., Moraski, L., Carrera, G., Wilson, C. R., Hoffmann, R., Schimke, J., & Gutterman, D. (2009) · Clinical Journal of Sports Medicine · doi:10.1097/jsm.0b013e3181b8c136 · Cited by 221 · see citing works
Ovarian Suppression Impairs Sport Performance in Junior Elite Female Swimmers
VanHeest, J. L., Rodgers, C. D., Mahoney, C. E., & De Souza, M. J. (2014) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3182a32b72 · Cited by 203 · see citing works
Stubbs, R. J., Hughes, D. A., Johnstone, A. M., Whybrow, S., Horgan, G. W., King, N. A., & Blundell, J. E. (2004) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00196.2003 · Cited by 169 · see citing works
Campbell, S. E., Angus, D. J., & Febbraio, M. A. (2001) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.2001.281.4.e817 · Cited by 165 · see citing works
Krentz, E. M., & Warschburger, P. (2011) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/j.1600-0838.2011.01380.x · Cited by 141 · see citing works
The Development of the Brief Eating Disorder in Athletes Questionnaire
Martinsen, M., Holme, I., Pensgaard, A. M., Torstveit, M. K., & Sundgot-Borgen, J. K. (2014) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000276 · Cited by 136 · see citing works
Dietary Recommendations and Athletic Menstrual Dysfunction
Manore, M. M. (2002) · Sports Medicine · doi:10.2165/00007256-200232140-00002 · Cited by 135 · see citing works
Menstrual disruption with exercise is not linked to an energy availability threshold
LIEBERMAN, J. L., DE SOUZA, M. J., WAGSTAFF, D. A., & WILLIAMS, N. I. (2018) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001451 · Cited by 127 · see citing works
Within‐day energy deficiency and reproductive function in female endurance athletes
Fahrenholtz, I. L., Sjödin, A., Benardot, D., Tornberg, Å. B., Skouby, S., Faber, J., Sundgot‐Borgen, J. K., & Melin, A. K. (2018) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.13030 · Cited by 106 · see citing works
Association Between the Female Athlete Triad and Endothelial Dysfunction in Dancers
Hoch, A., Papanek, P., Szabo, A., Widlansky, M. E., Schimke, J., & Gutterman, D. (2011) · Clinical Journal of Sports Medicine · doi:10.1097/jsm.0b013e3182042a9a · Cited by 105 · see citing works
Woods, A. L., Garvican‐Lewis, L. A., Lundy, B., Rice, A. J., & Thompson, K. (2017) · PLoS ONE · doi:10.1371/journal.pone.0173807 · Cited by 98 · see citing works
Within-Day Energy Deficiency and Metabolic Perturbation in Male Endurance Athletes.
Torstveit, M. K., Fahrenholtz, I., Stenqvist, T. B., Sylta, O., & Melin, A. (2018) · International Journal of Sport Nutrition & Exercise Metabolism · doi:10.1123/ijsnem.2017-0337 · Cited by 97 · see citing works
Influence of Running and Walking on Hormonal Regulators of Appetite in Women
Larson‐Meyer, D. E., Palm, S. M., Bansal, A., Austin, K. J., Hart, A. M., & Alexander, B. M. (2012) · Journal of Obesity · doi:10.1155/2012/730409 · Cited by 96 · see citing works
Low‐energy density and high fiber intake are dietary concerns in female endurance athletes
Melin, A., Tornberg, Å. B., Skouby, S., Møller, S. S., Faber, J., Sundgot‐Borgen, J., & Sjödin, A. (2016) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.12516 · Cited by 89 · see citing works
Carbohydrate Loading and Female Endurance Athletes: Effect of Menstrual-Cycle Phase
McLay, R. T., Thomson, C. D., Williams, S. M., & Rehrer, N. J. (2007) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.17.2.189 · Cited by 76 · cited 1× · see citing works
“Although some have reported small differences in substrate metabolism with greater carbohydrate and lower lipid utilization in the follicular phase compared with the luteal phase (3), others have reported no significant differences in carbohydrate oxidation during exercise during the menstrual cycle (20).”
BackgroundGuebels, C. P., Kam, L., Maddalozzo, G., & Manore, M. (2014) · International Journal of Sport Nutrition & Exercise Metabolism · doi:10.1123/ijsnem.2012-0165 · Cited by 73 · see citing works
Female Recreational Exercisers at Risk for Low Energy Availability
Slater, J., McLay-Cooke, R., Brown, R., & Black, K. (2016) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2015-0245 · Cited by 62 · cited 1× · see citing works
“(27) reported that significantly fewer participants in team sports were at risk of LEA (34.”
BackgroundSelf-citationLow Energy Availability in Exercising Women: Historical Perspectives and Future Directions
Slater, J., Brown, R., McLay-Cooke, R., & Black, K. (2017) · Sports Medicine · doi:10.1007/s40279-016-0583-0 · Cited by 59 · see citing works
Self-citationChange in women's eating habits during the menstrual cycle
Kammoun, I., Saâda, W. B., Sifaou, A., Haouat, E., Kandara, H., Salem, L. B., & Slama, C. B. (2016) · Annales d Endocrinologie · doi:10.1016/j.ando.2016.07.001 · Cited by 53 · see citing works
Vegetarian, Gluten-Free, and Energy Restricted Diets in Female Athletes
Cialdella-Kam, L. A., Kulpins, D., & Manore, M. M. (2016) · Sports · doi:10.3390/sports4040050 · Cited by 53 · see citing works
Koehler, K., Williams, N. I., Mallinson, R. J., Ricker, E. A., Allaway, H. C. M., & Souza, M. J. D. (2016) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00110.2016 · Cited by 52 · see citing works
Elite synchronized swimmers display decreased energy availability during intensified training
Schaal, K., Tiollier, E., Meur, Y. L., Casazza, G. A., & Hausswirth, C. (2016) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.12716 · Cited by 42 · see citing works
Drinkwater, B. L. (1986) · Medical Entomology and Zoology · Cited by 8 · see citing works
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Protein Requirements of Pre-Menopausal Female Athletes: Systematic Literature Review
Mercer, D., Convit, L., Condo, D., Carr, A. J., Hamilton, D. L., Slater, G., & Snipe, R. M. J. (2020) · Nutrients · doi:10.3390/nu12113527 · Cited by 20 · see citing works
Males and females exhibit similar muscle glycogen recovery with varied recovery food sources
Flynn, S., Rosales, A., Hailes, W., & Ruby, B. (2020) · European Journal of Applied Physiology · doi:10.1007/s00421-020-04352-2 · Cited by 17 · see citing works
- Authors
- Black, K. E., Baker, D. F., & Sims, S. T.
- Affiliations
- University of Otago (NZ)
- High Performance Sport New Zealand, National Training Centre, Mairangi Bay, Auckland, New Zealand; and
- University of Waikato (NZ)
- Corresponding author
- Sims, Stacy T.
- Venue
- Strength & Conditioning Journal
- Published
- 2020-08
- Volume
- 42
- Issue
- 4
- Pages
- 77-81
- ISSN
- 1073-6840 (ISSN-L)
- 1524-1602
- OpenAlex
- W2914472743
- Cited by
- 15
- References
- 33
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2022: 4 · 2021: 2 · 2020: 2 · 2019: 1
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Strength and conditioning journal (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- low energy availability, female athletes, nutrient requirements, energy balance, menstrual cycle, training stages, eating disorders, health effects, performance consequences, prevention
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