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 Low Energy Availability (LEA) In Competitive Athletes

-US Olympic Committee Nutrition Team Summary


What is Energy Availability?

Energy availability is the amount of dietary energy remaining after exercise, available for other physiological functions such as growth, muscle recovery and homeostasis.

Low energy availability (LEA) occurs when the calorie intake of an athlete is insufficient to meet the energy required for daily living plus the demands of training. Energy intake should never drop below resting metabolic rate.

Soccer, Overuse Injury

Low Energy Availability in Sport

LEA is associated with the majority of consequences of relative energy deficiency in sport (RED-S) and the Female Athlete Triad. Consequences include, but are not limited to: suppressed metabolic rate; menstrual dysfunction (females) or reduced testosterone levels (males); and impairments of bone health, immunity, protein synthesis and cardiovascular health. The consequences can occur in as little as five days and be acute, intermittent or chronic.

Calories expended to meet demands of healthy physiology 

& physical activity

Calories consumed by diet

Low Energy Availability

Performance Consequences 

  • Decreased endurance performance 

  • Increased injury risk 

  • Decreased training response 

  • Impaired judgement 

  • Decreased coordination 

  • Irritability 

  • Decreased concentration 

  • Depression 

  • Decreased glycogen stores 

  • Decrease muscle strength 

Health Consequences 

  • Immunological

  • Menstrual function 

  • Bone health 

  • Endocrine 

  • Metabolic 

  • Hematological 

  • Psychological 

  • Growth & Development 

  • Cardiovascular 

  • Gastrointestinal 

Risk Factors for Developing Low Energy Availability

  • Participation in aesthetic, weight-making or endurance sports

  • Failure to increase calorie intake with increased or hard training loads

  • Attempts to lose weight when training loads are high 

  • Restricted calorie intake due to physical impairments, gut tolerance, or medical conditions 

  • Excessive focus by coaches and other support staff on weight and body fat as opposed to performance  in sport 

  • Presence of disordered eating behaviors, either in the athlete or in their training partners

  • Inadequate food availability (e.g. limited financial resources, hectic travel schedule, cramped living/cooking spaces or very busy lifestyles where food is of low priority)

  • Diets very high in fiber and low in energy density (e.g. large salads lacking in carbohydrate, tendency to only eat very specific “healthy” foods, extensive use of diet products)

Signs and Symptoms of LEA 

  • Reduced training capacity

  • Repeated injury or illness

  • Delayed or prolonged recovery times

  • Change in mood state

  • Failure to lose weight

  • Reduced or low bone density

  • Reduced libido

  • Cessation or disruption in menstrual cycle

  • Excessive fatigue

Soccer, Overuse Injury

Long Term Health Consequences of LEA

  • Suppressed metabolic rate, which can cause long-term difficulties with body composition 

  • Menstrual dysfunction (females)

  • Reduced testosterone levels (males)

  • Slowed protein synthesis compromising the athletes ability to build/repair soft tissue and recover from strenuous training

  • Reduced bone density, increasing the risk of stress fracture and other bone stress injuries 

  • Compromised immunity and frequent illness 

  • Compromised cardiovascular function 

  • Increased risk of psychological harm including, depression, social insecurity, and decreased ability to manage stress 

  • Acute and chronic health problems including gastro-intestinal issues and infertility 


Step 1:

Take the Quiz 

The Low Energy Availability in Females (LEAF-Q) questionnaire is the most widely accepted screening tool for the identification of female athletes at risk for the female athlete triad. The female athlete triad is a condition that includes the following 3 characteristics:

  • Disordered Eating:  unintentionally or intentionally under consuming dietary energy leaving the body in a low energy state (LEA).

  • Amenorrhea:  the loss of menstrual periods or delay of the first menstrual period caused by low energy availability.

  • Low Bone Density or Osteoporosis:  a decrease in bone density that causes weak, brittle bones that break easily.

What do your results mean?


0 -7



Risk Level:

Minimal Risk for Triad

At Risk for the Triad

High Risk for Triad


Step 2:

Achieve Energy Balance!

Optimize Your Health and Performance
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