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Cited by 33Sports Performance and TrainingMuscle metabolism and nutritionEating Disorders and Behaviors

Considerations of Low Carbohydrate Availability (LCA) to Relative Energy Deficiency in Sport (RED-S) in Female Endurance Athletes: A Narrative Review

Open access
Lodge, Melissa T., Ward-Ritacco, Christie L., Melanson, Kathleen J.·2023·Nutrients
DOI 10.3390/nu15204457PMC PMC10609849
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Abstract

The purpose of this narrative review is to identify health and performance consequences associated with LCA in female endurance athletes. The intake of carbohydrates (CHO) before, during, and after exercise has been demonstrated to support sport performance, especially endurance activities which rely extensively on CHO as a fuel source. However, low energy availability (LEA) and low carbohydrate availability (LCA) are common in female athletes. LEA occurs when energy intake is insufficient compared to exercise energy expenditure, and LEA-related conditions (e.g., Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S)) are associated with a myriad of health and performance consequences. The RED-S model highlights 10 health consequences and 10 performance consequences related to LEA. The independent effect of LCA on health and performance has been under-researched, despite current CHO intake being commonly insufficient in athletes. It is proposed that LCA may not only contribute to LEA but also have independent health and performance consequences in athletes. Furthermore, this review highlights current recommendations for CHO intake, as well as recent data on LCA prevalence and menstrual cycle considerations. A literature review was conducted on PubMed, Science Direct, and ResearchGate using relevant search terms (i.e., “low carbohydrate/energy availability”, “female distance runners”). Twenty-one articles were identified and twelve met the inclusion criteria. The total number of articles included in this review is 12, with 7 studies illustrating that LCA was associated with direct negative health and/or performance implications for endurance-based athletes. Several studies included assessed male athletes only, and no studies included a female-only study design. Overall, the cumulative data show that female athletes remain underrepresented in sports science research and that current CHO intake recommendations and strategies may fail to consider female-specific adaptations and hormone responses, such as monthly fluctuations in estrogen and progesterone throughout the menstrual cycle. Current CHO guidelines for female athletes and exercising women need to be audited and explored further in the literature to support female athlete health and performance.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review examines whether low carbohydrate availability (LCA) contributes independently to health and performance consequences in female endurance athletes, beyond low energy availability (LEA) and RED-S. It concludes that female athletes remain underrepresented in carbohydrate research, current CHO recommendations may not account for female-specific menstrual/hormonal factors, and LCA is linked to negative outcomes though evidence is limited.

Key findings

  • Of 21 articles identified, 12 met inclusion criteria; 7 of the 12 studies illustrated that LCA was associated with direct negative health and/or performance implications for endurance-based athletes.
  • Across the 12 included primary studies, there were 197 total participants: 21% women, 75% men, and 4% who did not disclose sex/gender; 7 studies included male-athlete-only designs, and no studies included a female-only design.
  • Female athletes commonly fail CHO recommendations: the review reports that 45–98% of female athletes across sport types are not meeting current daily CHO recommendations, including 85% of female collegiate distance runners consuming less than recommended CHO, with an average intake of 4.7 ± 1.9 g CHO/kg BW/day.
  • LCA was independently associated with poor bone outcomes even with adequate EA; periodic CHO restriction was associated with a 9% greater risk of illness and injury in 46 endurance athletes (n = 27 females), and RED-S estimates showed 80% of elite/pre-elite female athletes had at least one symptom versus 47.7% of male Olympic-level athletes.

Methods

  • Narrative review using PubMed, Science Direct, and ResearchGate with MeSH-compliant keywords; search period was 15 June 2003 to 15 June 2023, including primary research articles in English, available in full text, with athletes as participants.
  • Twenty-one articles were identified and 12 met inclusion criteria: 1 cross-sectional study, 7 longitudinal studies, and 4 randomized controlled trials; authors independently extracted information and synthesized findings through collaborative discussion.

Limitations

  • Stated: a more formal systematic review would add precision and replicability; many studies used to illustrate deleterious LCA consequences were performed on male athletes; more intervention-based, longitudinal studies are needed, particularly in female athletes.
  • Evident from the text: no included study used a female-only design, women were only 21% of participants across the included studies, and there is no standardized equation, methodology, or established ranges for determining CHO availability status, so many studies assessed CHO intake rather than LCA.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/nu15204457

Cites

65 of 66 references verified1 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

61 of 144 cited sources checked · 27 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    37% of elite and pre-elite female athletes demonstrated two or more symptoms of RED-S, compared to 15.9% of male athletes.

    “37% of elite and pre-elite female athletes demonstrated two or more symptoms of RED-S, compared to 15.9% of male athletes [19,20].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [19] Stenqvist, 2021, Prevalence of Surrogate Markers of Relative Energy Deficiency in Male Norwegian Olympic-Level Athletes, Int. J. Sport Nutr. Exerc. Metab. source

      The RED-S criteria section (p. 6) reports that 7 of 44 male athletes (16%) had exactly two criteria, while another five had three or four. Thus 12 of 44 (27%) had two or more, not 15.9%. The study examined male athletes and provides no 37% figure for female athletes. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [20] Peklaj, 2022, Is RED-S in athletes just another face of malnutrition?, Clin. Nutr. ESPEN source
  • Premisecitation

    LEA-related conditions such as the Female Athlete Triad and Relative Energy Deficiency in Sport are associated with many health and performance consequences.

    “LEA is associated with unfavorable health and sport performance consequences, as illustrated by LEA-related conditions such as Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S) [8,9].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [8] Mountjoy, 2018, IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update, Br. J. Sports Med. source
    • cites [9] Nattiv, 2014, 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013, Br. J. Sports Med. source
  • Premisecitation

    Prospective studies to date illustrate a causal relationship between low energy availability and menstrual disturbances.

    “Prospective studies to date illustrate a causal relationship between LEA and menstrual disturbances [9,10,11,12,13,14].”
    Quote in the paperSubstantial claim1 of 6 sources checked
    • cites [9] Nattiv, 2014, 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013, Br. J. Sports Med. source
    • cites [10] Otis, 1997, ACSM Position Stand: The Female Athlete Triad, Med. Sci. Sport Exerc. source
    • cites [11] Nattiv, 2007, The Female Athlete Triad, Med. Sci. Sports Exerc. source
    • cites [12] Beals, 2002, Disorders of the Female Athlete Triad Among Collegiate Athletes, Int. J. Sport Nutr. Exerc. Metab. source
    • cites [13] Carson, 2022, Identifying latent classes of Relative Energy Deficiency in Sport (RED-S) consequences in a sample of collegiate female cross country runners, Br. J. Sports Med. source
    • cites [14] Brook, 2019, Low energy availability, menstrual dysfunction, and impaired bone health: A survey of elite para athletes, Scand. J. Med. Sci. Sport. source
  • Premisecitation

    Current findings show a strong correlation between the Female Athlete Triad and negative bone health outcomes, such as increased bone stress injuries and decreased bone mineral density.

    “current findings show a strong correlation between Triad and negative bone health outcomes, such as increased bone stress injuries and decreased BMD [6,7,9,11,14,15,16,17,18].”
    Quote in the paperNot a substantial claim3 of 9 sources checked
    • cites [6] Mountjoy, 2014, The IOC consensus statement: Beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S), Br. J. Sports Med. source
    • cites [7] Logue, 2018, Low Energy Availability in Athletes: A Review of Prevalence, Dietary Patterns, Physiological Health, and Sports Performance, Sports Med. source
    • cites [9] Nattiv, 2014, 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013, Br. J. Sports Med. source
    • cites [11] Nattiv, 2007, The Female Athlete Triad, Med. Sci. Sports Exerc. source
    • cites [14] Brook, 2019, Low energy availability, menstrual dysfunction, and impaired bone health: A survey of elite para athletes, Scand. J. Med. Sci. Sport. source
    • cites [15] Barrack, 2014, Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: A prospective multisite study of exercising girls and women, Am. J. Sports Med. source
    • cites [16] Papageorgiou, 2017, Effects of reduced energy availability on bone metabolism in women and men, Bone source

      The Introduction links the Female Athlete Triad with impaired bone health and identifies energy-deficiency factors as risks for low BMD and stress-fracture injury. It does not characterize the correlation as strong; the paper also studies bone metabolism rather than measuring BMD or injury incidence directly. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [17] Holtzman, 2019, Characterization of Risk Quantification Differences Using Female Athlete Triad Cumulative Risk Assessment and Relative Energy Deficiency in Sport Clinical Assessment Tool, Int. J. Sport Nutr. Exerc. Metab. source
    • cites [18] Hutson, 2021, Effects of Low Energy Availability on Bone Health in Endurance Athletes and High-Impact Exercise as A Potential Countermeasure: A Narrative Review, Sport Med. source
  • Premisecitation

    Low energy availability is more common in female athletes compared to male athletes.

    “LEA is more common in female athletes compared to male athletes [8].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Mountjoy, 2018, IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update, Br. J. Sports Med. source

      The section ‘Low energy availability in male athletes’ says that LEA prevalence ‘has been suggested to be higher in females than in males,’ but adds that ‘precise differences are unknown.’ The citing sentence presents that suggested difference as an established fact. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 13
  • May combine two claims. 44

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The current acute recommendation for carbohydrate intake for 4-6 h following a glycogen-depleting exercise session is at least 1.2 g carbohydrate/kg body weight/h.

    “the current acute recommendation for CHO intake for 4–6 h following a glycogen-depleting exercise session is ≥1.2 g CHO/kg BW/h [5].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [5] Holtzman, 2021, Recommendations and Nutritional Considerations for Female Athletes: Health and Performance, Sport Med. source

  • May combine two claims.

    Premisecitation

    80% of elite and pre-elite female athletes have at least one symptom of RED-S, compared with 47.7% of male Olympic-level athletes.

    “80% of elite and pre-elite female athletes have at least one symptom of RED-S, compared with 47.7% of male Olympic-level athletes [19,20].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [19] Stenqvist, 2021, Prevalence of Surrogate Markers of Relative Energy Deficiency in Male Norwegian Olympic-Level Athletes, Int. J. Sport Nutr. Exerc. Metab. source

      The RED-S criteria section (p. 6) reports surrogate markers in 44 male Olympic-level athletes, supporting the population and the presence of RED-S-related signs. It groups 32 athletes as having either zero or one criterion, however, so our copy does not establish that 47.7% had at least one. The female-athlete figure is not judged against this male-athlete study because the sentence carries another citation. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [20] Peklaj, 2022, Is RED-S in athletes just another face of malnutrition?, Clin. Nutr. ESPEN source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The current recommended amount of carbohydrate for athletes is 55-75% of total calories.

    “The current recommended amount of CHO for athletes is 55–75% of total calories [5,43].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [5] Holtzman, 2021, Recommendations and Nutritional Considerations for Female Athletes: Health and Performance, Sport Med. source

      The Carbohydrate subsection of Nutritional Strategies for Endurance Athletes gives intake recommendations in grams per kilogram and grams per hour, not as a percentage of total calories. Searches for 55–75% and carbohydrate recommendations expressed as a percentage of calories found no passage establishing the claimed range. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [43] Fensham, 2022, Short-Term Carbohydrate Restriction Impairs Bone Formation at Rest and During Prolonged Exercise to a Greater Degree than Low Energy Availability, J. Bone Miner. Res. source

      The Study protocol (page unavailable) describes a control diet with about 65% of energy from carbohydrate, but does not identify it as a recommendation for athletes. Searches for the 55–75% range and carbohydrate-intake recommendations found no passage stating the claimed recommendation. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In a 2022 audit of 937 research studies evaluating acute carbohydrate intake recommendations, only 11% (n = 197) of participants were women, and only 31% of these studies utilized sufficient methodologies to define menstrual status.

    “Only 11% (n = 197 of 937 studies) of the participants in these studies were women, and of these studies, only 31% utilized sufficient methodologies to define menstrual status [4].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] Kuikman, 2022, Fuelling the Female Athlete: Auditing her Representation in Studies of Acute Carbohydrate Intake for Exercise, Med. Sci. Sport Exerc. source

      The Results report 937 studies and 11,202 participants, approximately 11% of whom were women. They identify 197 as the number of studies that included at least one woman, not the number of female participants. The Menstrual status and grade section reports that 61 of those 197 studies (about 31%) provided sufficient information to define menstrual status. (LLM, conf=0.94)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In the same study, leptin levels decreased by 50% in response to dietary restriction, and this difference is proportional to reductions in carbohydrate intake.

    “In this same study, leptin levels decreased by 50% in response to dietary restriction, and this difference is proportional to the reductions in CHO intake [45].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [45] Hilton, 2000, Low energy availability, not exercise stress, suppresses the diurnal rhythm of leptin in healthy young women, Am. J. Physiol. Endocrinol. Metab. source

      The Carbohydrate availability section says leptin falls by 50% during dietary restriction and declines in proportion to reduced dietary carbohydrate, but cites Jenkins et al. (reference 15) for both statements. The Energy availability section reports a 72% reduction in 24-hour mean leptin in this paper’s own dietary-restriction experiment. Thus the findings are reported in the source, but the claim incorrectly presents the 50% figure as a result of this same study. (LLM, conf=0.91)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In a 2020 study of competitive female Australian rules football players, 30% were at risk for low energy availability via the Low Energy Availability Female Questionnaire, and only 3.7% met the current carbohydrate requirements for moderate-intensity exercise.

    “A 2020 study examining competitive female Australian rules football players demonstrated that 30% of players were at risk for LEA via the Low Energy Availability Female Questionnaire (LEAF-Q), and only 3.7% of athletes met the current CHO requirements for moderate-intensity exercise [50].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [50] Condo, D., Lohman, R., Kelly, M., and Carr, A. (2019). Nutritional Intake, Sports Nutrition Knowledge and Energy Availability in Female Australian Rules Football Players. Nutrients, 11. source

      Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable, 1 not checked. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Bone remodeling pathways were impaired after short-term low carbohydrate, high fat accommodation, and only the bone resorption marker recovered after acute carbohydrate restoration.

    “Bone remodeling pathways were impaired after short-term LCHF accommodation, and only the bone resorption marker recovered after acute CHO restoration [40].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [40] Heikura, 2020, A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise, Front. Endocrinol. source

  • May combine two claims.

    Premisecitation

    By maintaining naturally cycling hormones, carbohydrate helps regulate normal menstrual cycles and bone health maintenance through benefits to hormones such as estrogen, IGF-1, cortisol, and growth hormone influencing bone mineral density.

    “By maintaining these naturally cycling hormones, CHO helps regulate normal menstrual cycles and bone health maintenance through benefits to hormones (e.g., estrogen, IGF-1, cortisol, growth hormone) influencing BMD [43].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [43] Fensham, 2022, Short-Term Carbohydrate Restriction Impairs Bone Formation at Rest and During Prolonged Exercise to a Greater Degree than Low Energy Availability, J. Bone Miner. Res. source

      The Conclusion reports that adequate carbohydrate may help prevent an unfavorable imbalance in bone turnover markers, supporting the bone-health portion of the claim. The Methods’ blood-analysis section lists bone turnover markers, not estrogen, IGF-1, cortisol, or growth hormone; the paper does not show that carbohydrate maintains menstrual cycles through those hormones or demonstrate a change in BMD. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Post-exercise carbohydrate with protein is protective for bone health as it decreases bone resorption markers and increases bone formation markers, creating a positive bone turnover balance.

    “the effects of post-exercise CHO (with protein) are protective for bone health as it decreases bone resorption markers and increases bone formation markers, which creates a positive bone turnover balance [39].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [39] Townsend, 2017, The effect of postexercise carbohydrate and protein ingestion on bone metabolism, Med. Sci. Sports Exerc. source

      The Discussion reports that CHO+PRO immediately after intense exercise reduced bone-resorption markers and increased bone-formation markers during short-term recovery. It does not establish a positive bone-turnover balance or a protective effect on bone health; the Discussion says the effects did not persist to the following morning and cautions that suppressing resorption may not always be desirable. Page numbers were not available in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Low carbohydrate availability ranges have not been established based on these criteria for carbohydrate availability, and many studies continue to report carbohydrate intake, using low carbohydrate intake to define intake below current recommendations.

    “Nonetheless, LCA ranges have not been established based on these criteria for CHO availability, and many studies continue to report CHO intake, using low CHO intake to define intake below current recommendations [34,35,36,37,38,39,40,41,42,43].”
    Quote in the paperNot a substantial claim4 of 10 sources checked
    • cites [34] Viner, 2015, Energy availability and dietary patterns of adult male and female competitive cyclists with lower than expected bone mineral density, Int. J. Sport Nutr. Exerc. Metab. source
    • cites [35] Mckay, 2019, Chronic Adherence to a Ketogenic Diet Modifies Iron Metabolism in Elite Athletes, Med. Sci. Sports Exerc. source
    • cites [36] Mckay, 2022, Six Days of Low Carbohydrate, Not Energy Availability, Alters the Iron and Immune Response to Exercise in Elite Athletes, Med. Sci. Sports Exerc. source
    • cites [37] Macdermid, 2006, A Whey-Supplemented, High-Protein Diet Versus a High-Carbohydrate Diet: Effects on Endurance Cycling Performance, Int. J. Sport Nutr. Exerc. Metab. source
    • cites [38] Hammond, 2019, Post-exercise carbohydrate and energy availability induce independent effects on skeletal muscle cell signalling and bone turnover: Implications for training adaptation, J. Physiol. source

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

      Experimental — accuracy not yet measured
    • cites [39] Townsend, 2017, The effect of postexercise carbohydrate and protein ingestion on bone metabolism, Med. Sci. Sports Exerc. source

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

      Experimental — accuracy not yet measured
    • cites [40] Heikura, 2020, A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise, Front. Endocrinol. source

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

      Experimental — accuracy not yet measured
    • cites [41] Badenhorst, 2015, Acute dietary carbohydrate manipulation and the subsequent inflammatory and hepcidin responses to exercise, Eur. J. Appl. Physiol. source
    • cites [42] Badenhorst, 2016, Seven days of high carbohydrate ingestion does not attenuate post-exercise IL-6 and hepcidin levels, Eur. J. Appl. Physiol. source
    • cites [43] Fensham, 2022, Short-Term Carbohydrate Restriction Impairs Bone Formation at Rest and During Prolonged Exercise to a Greater Degree than Low Energy Availability, J. Bone Miner. Res. source

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

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    As estrogen is associated with decreased gluconeogenesis, reduced exogenous carbohydrate intake can compound unfavorable rates of gluconeogenesis.

    “As estrogen is associated with decreased gluconeogenesis, reduced exogenous CHO intake can compound these unfavorable rates of gluconeogenesis [5].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [5] Holtzman, 2021, Recommendations and Nutritional Considerations for Female Athletes: Health and Performance, Sport Med. source

  • May combine two claims.

    Premisecitation

    Iron intake is lower in athletes consuming a low CHO diet compared to those consuming CHO-rich diets, increasing the risk of iron deficiency.

    “However, iron intake is lower in athletes consuming a low CHO diet, compared to those consuming CHO-rich diets, thus increasing the risk of iron deficiency [55].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [55] McKay, A.K.A., Pyne, D.B., Burke, L.M., and Peeling, P. (2020). Iron metabolism: Interactions with energy and carbohydrate availability. Nutrients, 12. source

      Section 4.4 reports lower iron intake on low-carbohydrate, high-fat diets than on carbohydrate-rich diets in two athlete cohorts. But it does not establish that this increased iron-deficiency risk: ferritin fell less in the low-carbohydrate group in one study and did not change in either group in the other. The Conclusions likewise say chronic carbohydrate restriction has not shown clear evidence of negative effects on iron status. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Consuming a high CHO snack 3-4 h before exercise can help mitigate the effects of reduced gluconeogenesis rates during the luteal phase and help protect against associated performance decrements.

    “Despite no current recommendations for CHO intake before activity specific to female athletes, it is suggested that consuming a high CHO snack (e.g., granola bar, dried fruit, pretzels, and/or fruit juice) 3–4 h before exercise can help mitigate the effects of reduced gluconeogenesis rates during the luteal phase and help protect against associated performance decrements [5].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [5] Holtzman, 2021, Recommendations and Nutritional Considerations for Female Athletes: Health and Performance, Sport Med. source
    • Rests on an assumption: Estrogen peaks during ovulation and has another secondary increase during the luteal phase.

  • May combine two claims.

    Premisecitation

    Low CHO diets have demonstrated promising effects on body composition and cardiovascular health.

    “Low CHO diets have demonstrated promising effects on body composition and cardiovascular health [64], but more work is needed to address both health and performance outcomes [63,65].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [64] Seid, H., and Rosenbaum, M. (2019). Low Carbohydrate and Low-Fat Diets: What We Don’t Know and Why we Should Know It. Nutrients, 11. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Iron is a necessary nutrient that plays an important role in athlete-related processes (O2 transport, cellular energy production, immune function, cognitive processing), optimizing endurance performance.

    “Iron is a necessary nutrient that plays an important role in several athlete-related processes (e.g., O2 transport, cellular energy production, immune function, and cognitive processing), which optimizes endurance performance [55].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [55] McKay, A.K.A., Pyne, D.B., Burke, L.M., and Peeling, P. (2020). Iron metabolism: Interactions with energy and carbohydrate availability. Nutrients, 12. source

  • May combine two claims.

    Premisecitation

    CHO loading (8.4-9 g CHO/kg BW/day) in the mid-luteal phase results in no change to a small increase (13%) in muscle glycogen, which could potentially enhance performance.

    “To that end, CHO loading (8.4–9 g CHO/kg BW/day) in the mid-luteal phase has resulted in no change to a small increase (13%) in muscle glycogen, which could potentially enhance performance [57,58].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [57] Heigenhauser, 2000, Dietary carbohydrate, muscle glycogen content, and endurance performance in well-trained women, J. Appl. Physiol. source
    • cites [58] Mclay, 2007, Carbohydrate Loading and Female Endurance Athletes: Effect of Menstrual-Cycle Phase, Int. J. Sport Nutr. Exerc. Metab. source

      The Muscle-Glycogen Measurements section reports essentially no increase in mid-luteal glycogen after loading (756 versus 771 mmol/kg dry weight), and the Menstrual-Cycle Phase and Resting Muscle Glycogen section reports another study’s 13% increase. This paper tested 8.4, not 9, g/kg/day. Its Exercise Performance discussion describes a possible link to improved endurance in that other study, while its own trial found no performance improvement. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • Rests on an assumption: Estrogen peaks during ovulation and has another secondary increase during the luteal phase.

  • May combine two claims.

    Premisecitation

    Reduced muscle glycogen causes muscular fatigue and a drop in intensity below 60% VO2max.

    “Reduced CHO availability is disadvantageous to exercise performance due to the following pathways: (1) reduced muscle glycogen causes muscular fatigue and a drop in intensity (<60% VO2max), and (2) reduced circulating CHO (e.g., blood glucose) for central neural nourishment impairs cognition [5].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [5] Holtzman, 2021, Recommendations and Nutritional Considerations for Female Athletes: Health and Performance, Sport Med. source

      The Carbohydrate subsection of Nutritional Strategies for Endurance Athletes says reduced muscle glycogen leads to fatigue and a drop in intensity. It does not specify that intensity drops below 60% VO2max; its nearby VO2max figure concerns a different point about gluconeogenesis. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    CHO loading during the mid-follicular phase results in a 17-31% improvement in muscle glycogen but not performance.

    “However, CHO loading during the mid-follicular phase has resulted in a 17–31% improvement in muscle glycogen but not performance [58,59,60].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [58] Mclay, 2007, Carbohydrate Loading and Female Endurance Athletes: Effect of Menstrual-Cycle Phase, Int. J. Sport Nutr. Exerc. Metab. source
    • cites [59] James, 2001, Muscle glycogen supercompensation: Absence of a gender-related difference, Eur. J. Appl. Physiol. source
    • cites [60] Paul, 2001, Carbohydrate-Loading During the Follicular Phase of the Menstrual Cycle: Effects on Muscle Glycogen and Exercise Performance, Int. J. Sport Nutr. Exerc. Metab. source
    • Rests on an assumption: Estrogen peaks during ovulation and has another secondary increase during the luteal phase.

  • May combine two claims.

    Premisecitation

    Correcting iron deficiency via supplementation increases VO2max, time trial performance, and exercise efficiency in athletes.

    “Once iron deficiency was corrected via supplementation, increases in VO2max, time trial performances, and exercise efficiency were observed in athletes [55].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [55] McKay, A.K.A., Pyne, D.B., Burke, L.M., and Peeling, P. (2020). Iron metabolism: Interactions with energy and carbohydrate availability. Nutrients, 12. source

      Section 2 reports increases in VO2max, time-trial performance, and exercise efficiency after iron stores were restored through supplementation. It frames that statement as applying to iron-compromised individuals with anemia; the citing sentence omits that condition and presents the outcomes as applying to iron-deficient athletes generally. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Some studies have illustrated no decrement in low CHO diets in moderate-to-vigorous intensity exercise, but these studies have also confirmed decreases in exercise economy in highly trained endurance athletes at greater than 70% of their VO2max compared to those with high CHO diets.

    “While some studies have illustrated no decrement in low CHO diets in moderate-to-vigorous intensity exercise experiences, these studies have also confirmed decreases in the exercise economy observed in highly trained endurance athletes at greater than 70% of their VO2max compared to those with high CHO diets [65].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [65] McSwiney, 2019, Impact Of Ketogenic Diet On Athletes: Current Insights, Open Access J. Sport Med. source

  • May combine two claims.

    Findingown data

    Several included studies assessed male athletes only, and no included study used a female-only design.

    “Several studies included assessed male athletes only, and no studies included a female-only study design.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Twenty-one articles were identified and twelve met the inclusion criteria for this review.

    “Twenty-one articles were identified and twelve met the inclusion criteria.”
    • Also stated in: § 4.1. Literature Search · plain
      “Twenty-one articles were identified, and twelve met the inclusion criteria and were included in this review.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The identified studies included one cross-sectional study, seven longitudinal studies, and four randomized control trials.

    “The identified studies included one cross-sectional study [52], seven longitudinal studies [34,35,36,38,40,43,53], and four randomized control trials [37,39,41,42].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In total, 21% of participants identified as women, 75% as men, and 4% did not disclose their sex/gender.

    “In total, 21% of participants identified as women while 75% identified as men and 4% did not disclose their sex/gender.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Across the 12 primary research studies included in this narrative review assessing the effects of LCA, there were a total of 197 participants.

    “Across the 12 primary research studies included in this narrative review assessing the effects of LCA, there were a total of 197 participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    More specific carbohydrate recommendations vary from 5-12 g carbohydrate/kg body weight/day for athletes, depending on training activities.

    “more specific recommendations vary from 5–12 g CHO/kg BW/day for athletes, depending on training activities [33].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Charlton, 2022, Low Energy Availability and Relative Energy Deficiency in Sport: What Coaches Should Know, Int. J. Sport. Sci. Coach. source

  • May combine two claims.

    Premisecitation

    Low carbohydrate availability can lead to decreased glucose utilization, hypometabolism, muscular fatigue, impaired fat storage mobilization, decreased performance, and decreased growth hormone production.

    “it has been illustrated that LCA can lead to decreased glucose utilization, hypometabolism, muscular fatigue, impaired fat storage mobilization, decreased performance, and decreased growth hormone production [20,22].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [20] Peklaj, 2022, Is RED-S in athletes just another face of malnutrition?, Clin. Nutr. ESPEN source
    • cites [22] Hawley, 2010, Carbohydrate Availability and Training Adaptation: Effects on Cell Metabolism, Exerc. Sport Sci. Rev. source

  • May combine two claims.

    Premisecitation

    In a review of 1382 exercise and sports science articles published from 2011-2013, 39% of study participants identified as female, and only 4-13% of the articles incorporated a female-only design.

    “in a review of 1382 exercise and sports science articles published from 2011–2013, 39% of study participants identified as female, and only 4–13% of the articles incorporated a female-only design in their studies [2].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] Costello, 2014, Where are all the female participants in Sports and Exercise Medicine research?, Psychol. Soc. Sci. Humanit. source

  • May combine two claims.

    Premisenone given

    There is currently no standardized equation or methodology to determine an individual's carbohydrate availability status, as a majority of studies have simply assessed carbohydrate intake.

    “Currently, there is no standardized equation or methodology to determine an individual’s CHO availability status as a majority of studies have simply assessed CHO intake.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Low carbohydrate availability may not only contribute to low energy availability but also have independent health and performance consequences in athletes.

    “It is proposed that LCA may not only contribute to LEA but also have independent health and performance consequences in athletes.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Findings from studies that included male-only or mixed-sex samples can be generalized to female endurance athletes for the health and performance consequences of low carbohydrate availability.

  • May combine two claims.

    Premisecitation

    Low carbohydrate availability is a separate concern, independent of low energy availability, though they often occur simultaneously.

    “LCA is a separate concern, independent of LEA, though they often occur simultaneously [7].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Logue, 2018, Low Energy Availability in Athletes: A Review of Prevalence, Dietary Patterns, Physiological Health, and Sports Performance, Sports Med. source

  • May combine two claims.

    Premisecitation

    The importance of acute carbohydrate intake has primarily been studied in male athletes, and recommendations have been extrapolated to female athletes.

    “the importance of acute carbohydrate (CHO) intake has primarily been studied in male athletes and recommendations have been extrapolated to female athletes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The independent effect of low carbohydrate availability on health and performance has been under-researched.

    “The independent effect of LCA on health and performance has been under-researched, despite current CHO intake being commonly insufficient in athletes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In an updated review of six major journals including 5261 sports science articles published from 2014-2021, 34% of participants identified as women and 6% of articles included women-only study designs.

    “An updated review of six major journals, including a total of 5261 sports science articles published from 2014–2021 illustrated that 34% of all participants reviewed identified as women and 6% of articles included women-only study designs [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Cowley, 2021, “Invisible Sportswomen”: The Sex Data Gap in Sport and Exercise Science Research, Women Sport Phys. Act. J. source

  • May combine two claims.

    Premisecitation

    RED-S can affect both female and male athletes but is more prevalent in female athletes.

    “RED-S can affect both female and male athletes but is more prevalent in female athletes”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Fifty percent of female soccer players consumed less than 5 g carbohydrate/kg body mass/day, while 5 g carbohydrate/kg body mass/day is the adult sport nutrition recommendation.

    “Fifty percent of female soccer players consumed < 5 g CHO/kg body mass (BM)/day, while 5 g CHO/kg BM/day is the adult sport nutrition recommendation [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Gibson, 2011, Nutrition Status of Junior Elite Canadian Female Soccer Athletes, Int. J. Sport Nutr. Exerc. Metab. source

  • May combine two claims.

    Premisecitation

    In a retrospective study of young and elite female athletes, the prevalence of carbohydrate intake below 4 g/kg body mass/day was 49.2% in young female athletes and 33.3% in elite female athletes, and the prevalence below 8 g/kg body mass/day was 98.3% in young female athletes and 83.3% in elite female athletes.

    “the prevalence of CHO intake < 4 g/kg BM/day was 49.2% in young female athletes and 33.3% in elite female athletes, and the prevalence of CHO intake < 8 g/kg BM/day was 98.3% in young female athletes and 83.3% in elite female athletes [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Peklaj, 2022, Is RED-S in athletes just another face of malnutrition?, Clin. Nutr. ESPEN source

  • May combine two claims.

    Interpretationcitation

    There is a dose-dependent effect of low energy availability on carbohydrate availability, and dietary restriction is detrimental to the use of carbohydrate during activity.

    “These data demonstrate that there is a dose-dependent effect of LEA on CHO availability and that dietary restriction is detrimental to the use of CHO during activity [23].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Loucks, 2003, Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women, J. Clin. Endocrinol. Metab. source

  • May combine two claims.

    Interpretationcitation

    Low carbohydrate availability may be a primary contributor to chronic low energy availability because low carbohydrate intake drives down total energy intake.

    “which illustrates that LCA may be a primary contributor to chronic LEA as low CHO intake drives down total energy intake [34].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Viner, 2015, Energy availability and dietary patterns of adult male and female competitive cyclists with lower than expected bone mineral density, Int. J. Sport Nutr. Exerc. Metab. source

  • May combine two claims.

    Premisecitation

    Few studies have attempted to define carbohydrate availability; one study calculated carbohydrate availability as the difference between dietary carbohydrate intake and the amount of carbohydrate oxidized during exercise beyond the requirements of normal activity.

    “Few studies have attempted to define CHO availability; however, one study calculated CHO availability as the difference between dietary CHO intake and the amount of CHO oxidized during exercise beyond the requirements of normal activity [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Loucks, 2003, Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women, J. Clin. Endocrinol. Metab. source

  • May combine two claims.

    Premisecitation

    Fear of carbohydrate leads to underconsumption of carbohydrate, despite carbohydrate-fueling strategies being well-documented as beneficial for health and sports performance.

    “This fear of CHO leads to underconsumption of CHO, despite CHO-fueling strategies being well-documented as beneficial for health and sports performance [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] McHaffie, 2022, Carbohydrate fear, skinfold targets and body image issues: A qualitative analysis of player and stakeholder perceptions of the nutrition culture within elite female soccer, Sci. Med. Footb. source

  • May combine two claims.

    Premisecitation

    Carbohydrate-rich diets in international-level racewalkers exhibited more favorable changes to post-exercise IL-6 and hepcidin compared to low carbohydrate, high fat diets, which improved iron availability during a 3-week training program.

    “CHO-rich diets in international-level racewalkers (n = 31 males, 6 females) exhibited more favorable changes to post-exercise IL-6 and hepcidin, compared to LCHF, which improved iron availability during a 3-week training program [35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Mckay, 2019, Chronic Adherence to a Ketogenic Diet Modifies Iron Metabolism in Elite Athletes, Med. Sci. Sports Exerc. source

  • Classified as probably not a substantial claim.

    Premisenone given

    A narrative review process was chosen due to the insufficient number of studies examining the impact of low carbohydrate availability on the health and performance consequences outlined in the RED-S model.

    “A narrative review process was chosen due to the insufficient number of studies examining the impact of low carbohydrate availability on the associated health and performance consequences outlined in the RED-S model.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In female collegiate distance runners, 85% consumed less than the recommended amount of carbohydrate, with an average carbohydrate intake of 4.7 ± 1.9 g carbohydrate/kg body weight/day.

    “In a study of female collegiate distance runners, 85% of runners consumed less than the recommended amount of CHO, with an average CHO intake of 4.7 ± 1.9 g CHO/kg BW/day [49].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Beermann, 2020, Nutritional Intake and Energy Availability of Collegiate Distance Runners, J. Am. Coll. Nutr. source

  • May combine two claims.

    Premisecitation

    Low carbohydrate intake has been associated with micronutrient deficiencies, especially iron and calcium, which have implications on low energy availability and bone health, respectively.

    “Low CHO intake has been associated with micronutrient deficiencies (especially iron and calcium) which have implications on LEA and bone health, respectively [27].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Jordan, 2020, Micronutrient deficiency in athletes and inefficiency of supplementation: Is low energy availability a culprit?, PharmaNutrition source

  • May combine two claims.

    Premisecitation

    In a longitudinal study of 10 adult competitive endurance cyclists (n = 4 females), energy intake and carbohydrate intake were both significantly below minimum sport nutrition recommendations and low bone mineral density persisted through 10 months.

    “Energy intake and CHO intake were both significantly below the minimum sport nutrition recommendations and low BMD persisted through the 10 months”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Viner, 2015, Energy availability and dietary patterns of adult male and female competitive cyclists with lower than expected bone mineral density, Int. J. Sport Nutr. Exerc. Metab. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Low carbohydrate or ketogenic diets have become more popular over the past decade.

    “However, over the past decade, low carbohydrate or ketogenic diets have become more popular [62].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] Bartlett, 2015, Carbohydrate availability and exercise training adaptation: Too much of a good thing?, Eur. J. Sport Sci. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Traditional sports nutrition has approached fueling for endurance training with the promotion of adequate or high CHO intake to promote sufficient CHO availability.

    “Traditional sports nutrition has approached fueling for endurance training with the promotion of adequate or high CHO intake to promote sufficient CHO availability [62].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] Bartlett, 2015, Carbohydrate availability and exercise training adaptation: Too much of a good thing?, Eur. J. Sport Sci. source

  • May combine two claims.

    Premisecitation

    In male endurance-trained cyclists, consuming a higher protein/lower CHO diet (3.3 g protein/kg BW/d and 5.9 g CHO/kg BW/d) resulted in significantly worse time trial performance compared to consuming a typical endurance athlete diet (1.3 g protein/kg BW/d and 7.9 g CHO/kg BW/d), which saw no significant change from baseline.

    “In a study of male, endurance-trained cyclists, those consuming a higher protein/lower CHO diet (3.3 g protein/kg BW/d and 5.9 g CHO/kg BW/d) performed significantly worse on a time trial compared to those consuming a diet more representative of the typical endurance athlete diet (1.3 g protein/kg BW/d and 7.9 g CHO/kg BW/d) who saw no significant change in performance from the baseline [37].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Macdermid, 2006, A Whey-Supplemented, High-Protein Diet Versus a High-Carbohydrate Diet: Effects on Endurance Cycling Performance, Int. J. Sport Nutr. Exerc. Metab. source

  • May combine two claims.

    Premisecitation

    Low-CHO diets can spare glycogen and enhance fat oxidation.

    “Some studies have demonstrated that low-CHO diets can spare glycogen and enhance fat oxidation, but these adaptations fail to improve performance [33].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Charlton, 2022, Low Energy Availability and Relative Energy Deficiency in Sport: What Coaches Should Know, Int. J. Sport. Sci. Coach. source

  • May combine two claims.

    Interpretationreasoning

    Increased injury risk decreases athlete availability for training and competition and limits advantageous performance adaptations to training.

    “Increased injury risk decreases athlete availability for training and competition, as well as limiting advantageous performance adaptations to training.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In a review of 937 studies (11,202 total participants), 34% of all participants identified as women, and only 6% of studies included women-only designs.

    “Of the 937 studies included (n = 11,202 total participants), 34% of all participants identified as women, and only 6% of studies included women-only designs [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Cowley, 2021, “Invisible Sportswomen”: The Sex Data Gap in Sport and Exercise Science Research, Women Sport Phys. Act. J. source

  • May combine two claims.

    Premisecitation

    In male endurance-trained cyclists, a high CHO diet was associated with better endurance performance, higher average power output, and lower heart rate compared to a lower CHO diet.

    “Athletes consuming the high CHO diet also illustrated better endurance performance, average power output, and a lower heart rate, compared to those consuming a lower amount of CHO [37].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Macdermid, 2006, A Whey-Supplemented, High-Protein Diet Versus a High-Carbohydrate Diet: Effects on Endurance Cycling Performance, Int. J. Sport Nutr. Exerc. Metab. source

  • May combine two claims.

    Interpretationreasoning

    Diets with adequate energy and CHO availability support the physiological demands of elite athletes while minimizing unfavorable health and performance consequences.

    “In conclusion, diets with adequate energy and CHO availability support the physiological demands of elite athletes while minimizing unfavorable health and performance consequences.”
    Quote in the paperSubstantial claim
54 of 54

  • The paper relies on this without support.

    Low carbohydrate intake below current recommendations is a valid proxy for low carbohydrate availability.

    “Currently, there is no standardized equation or methodology to determine an individual’s CHO availability status as a majority of studies have simply assessed CHO intake.”
    “many studies continue to report CHO intake, using low CHO intake to define intake below current recommendations”

  • The paper relies on this without support.

    Findings from studies that included male-only or mixed-sex samples can be generalized to female endurance athletes for the health and performance consequences of low carbohydrate availability.

    “Several studies included assessed male athletes only, and no studies included a female-only study design.”
    “Overall, the cumulative data show that female athletes remain underrepresented in sports science research”

  • The paper relies on this without support.

    Estrogen peaks during ovulation and has another secondary increase during the luteal phase.

    “Estrogen peaks during ovulation and has another secondary increase during the luteal phase.”

  • The paper relies on this without support.

    Much of the current literature classifies CHO intake based on recommendations rather than CHO availability.

    “To date, much of the current literature classifies CHO intake based on recommendations, rather than CHO availability.”

  • The paper relies on this without support.

    Few studies calculate LCA or use it as a primary outcome.

    “Few studies calculate LCA or use it as a primary outcome, despite it being an important indicator of CHO availability for the body to use, which is of importance to fuel exercise and physical activity.”
5 of 5

Self-check

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

Each contradiction between two passages listed here was confirmed by an independent check.

  • 197 of 937 is not 11%

    Major

    The stated count is about 21% of 937, not 11%. The sentence also calls 197 a count of participants while its denominator is studies.

    Reported 11 · recomputed 21.024546

  • Conflicting female-participant percentages for 937 studies

    Minor

    The paper reports both 11% and 34% women for a set of 937 studies. It elsewhere associates the 34% figure with a different review of 5261 articles.

2 of 2

Cites

Flagged first, then by citations

1 of the 67 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Hawley, 2014, Manipulating Carbohydrate Availability to Promote Training Adaptation, Sport Sci. Exch., 27, 1
  2. Harris, A. (2021). Longitudinal Assessment of Dietary Intake in Collegiate Cross Country Runners Throughout a Competitive Season. [Bachelor’s Honors Thesis, Florida State University].
  3. Randell, 2020, Nutritional Factors That Affect Fat Oxidation Rates During Exercise, Sport Sci. Exch., 33, 1

Cited by

Sorted by citations

Related

Authors
Lodge, M. T., Ward-Ritacco, C. L., & Melanson, K. J.
Affiliations
  • University of Rhode Island (US)
  • Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
Corresponding author
Lodge, Melissa T.
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2023-10-20
Volume
15
Issue
20
Pages
4457
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu15204457
PMC
PMC10609849
OpenAlex
W4387806679
Semantic Scholar
e75963c7b5f9a56215e6957269a3ad6584b85681
Cited by
33
References
67
Citations by year
2026: 12 · 2025: 11 · 2024: 9 · 2023: 1
FWCI
2.10
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • Journal of Media Literacy Education (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Keywords
relative energy deficiency in sport, low energy availability, female endurance athletes, female distance runners, carbohydrate intake, menstrual cycle, estrogen and progesterone, female athlete triad, athletic performance
MeSH terms
Relative Energy Deficiency in Sport, Energy Intake, Carbohydrates, Energy Metabolism, Female, Humans, Male, Nutritional Status, Sports, 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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-14.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-14.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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