LEA: Not Just Women’s Issue

Low Energy Availability (LEA) Isn’t Just a Female issue

It Also Hurts Men’s Performance too!

Many fad diets are being promoted across social media. This has created an uptick in the low energy availability (LEA) across the spectrum of endurance athletes. I have seen this 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. In that club, I have seen the number of men being impacted by low energy availability be just as high. The difference is that the men don’t talk about it like women do. 

We all hear LEA in reference to women in sport, and especially in younger women.  LEA used to be called the female athlete triad. Regardless of age, it has debilitating effects for all. The damage it can cause in women is extremely harmful. Some side effects include dangerously low bone mineral density, reproduction dysfunction and hypotension. There is also hypoglycemia, and suppressed immune system (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. Yes, men have estrogen too). Additional side effects include, decreased bone mineral density (it’s not just a women’s issue), muscle loss, psychological issues (irritability, depression, decreased concentration), and performance decline (2). 

In order for men and women to avoid the impact of low energy availability, they need to follow the advice I provide which is: eat enough.

What Is LEA? How Is It Defined?

Low energy availability (LEA) represents a state in which the body does not have enough energy to support all the physiological functions needed to maintain optimal health. LEA may result from altered dietary behaviours 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). 

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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&postmenopausal athletes….

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. 

Fuel Right, Train Strong, Race Better

Nutrition is a nuanced field, we all need to figure out what exactly works for us. Everybody should be 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. For men and women, be sure to stay fueled, avoid the low energy availability impact, and crush your next event. 

References:

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

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