I spent about 6 years in the state of unintentional low energy availability. These were long and tiring years. What really annoys me is that throughout all this time I thought I was eating really well. Smoothies, sprouts and all that jazz. And still.
I came to realise that every time I talk about Low Energy Availability, most people presume that I’m just talking about having ‘low energy’. Well, I guess that kind of makes sense: sleepiness and fatigue are among the most common complaints heard by primary care physicians. Everywhere you turn you see adverts for energy drinks and energy supplements (even the humble iron is always paired with ‘get more energy images’ when advertised).
And thus, caffeine drinks are getting stronger, sugar consumption continues to skyrocket, the use of stimulating antidepressants is increasing dramatically, and adrenaline-mediated drama is at play everywhere. But still… we are wilting… Why is that? Let’s dig deeper.
Low Energy Availability is a much broader concept than just low energy, however, fatigue is for sure one of its symptoms.
Low energy availability (LEA) represents a state in which the body does not have enough energy left to support all physiological functions needed to maintain optimal health.
If you do not have enough energy to support all your physiological functions (respiration, digestion, movement, reproduction etc.) then, it is basically a path to illness. Of course, fatigue, often extreme, comes along. In fact, constantly feeling tired is a smart way for your body to tell you to slow down… and conserve every bit of energy.
It is done via the thyroid system which regulates the body’s metabolic rate. In case of famine, it turns the metabolic rate down into conservation mode. And thus, not surprisingly, people who are in the conservation mode frequently say: “I don’t have any interest in anything anymore.” or “I just don’t feel like doing anything.” [1]
That state of constantly feeling tired is something that plagues the modern society. Now, once you start entering your perimenopausal years, this state of fatigue usually multiplies tenfold. There could be a million reasons why that is but today we’ll focus on Low Energy Availability, as once you understand the concept, it’s relatively easy to deal with. I also strongly believe, it should be one of the first things to check for when dealing with a constant state of fatigue, especially in perimenopause.
But you might ask, why not blame the hormones (especially the flatlining estrogen)? Well, yes, the sex steroid hormones are fluctuating in perimenopause, but they will not cause your Low Energy Availability. However, your Low Energy Availability will exacerbate your hormonal imbalance and intensify your fatigue.
When we talk about Low Energy Availability (LEA) we’re not necessarily looking at just calories in, calories out as not all calories are equal, meaning, they affect the body differently (thermogenic effect of food for example).
What we want to focus on is the daily energy expenditure (DEE) which includes everything on top of your resting metabolic rate. And resting metabolic rate is the energy that you need to just exist; for your heart to beat, for your eyelids to flutter, for your hormones to respond, for your brain to function.
Then when we start adding any other activities on top, this increases our energy needs.
This is the number that we need to maintain in a positive light, to keep our endocrine system going, our heart beating, our brains functioning.
Low Energy Availability is divided into two different categories:
Intentional LEA refers to the conscious and deliberate restriction of energy intake and/or increase in energy expenditure.
Unintentional LEA refers to the unwitting failure to consume sufficient energy.
This is important to know as with unintentional LEA (without an eating disorder) we might not always be aware that we are in the state of under-fuelling. However, our body will know and might demonstrate it in irregular or absent menstrual cycles, suppression of bone formation (osteopenia type aspects) and/or repeated stress injuries.
Figure 1. The signs of the female athlete triad exist on a continuum from healthy to pathological, as demonstrated by the green to red transition, and they are causally associated in the manner indicated by the arrows. [2]
What about peri or post-menopausal women who don’t have their period to count on to let them know if they’re having an endocrine dysfunction?
For those who exercise, there are specific tell-tale signs to be aware of:
Decreased endurance performance.
You're not recovering well.
You're not adapting to your training.
You start getting injured.
Other symptoms:
Immune system is depressed - you start picking up every cold, every flu, you’re prone to infections.
Gut microbiome dysbiosis - IBS symptoms, bloating, gaseous, feeling nauseous, not being able to eat well, when you do eat you feel this is just not right.
Chronic inflammation - happening from the inability to pull in enough nutrition to counter inflammatory responses that happen with exercise.
Mood changes – irritability, anger, anxiety, depression.
Also, our hunger cues are completely misaligned to our energy needs.
We might be in a sort of denial about the fact that we’re not eating enough. We don't feel hungry, or we feel really hungry at inopportune times: like we haven’t eaten throughout the day and it's time to go to sleep and then you're like, "Whoa, I'm really hungry. What's going on?".
Also, you might be feeling that flat fatigue aspect no matter how much you sleep. If on top of this your iron and your thyroid is coming back on the low end of normal, then you should start really asking yourself these questions:
What training am I doing?
Have I upped things too much?
What are my appetite cues?
Chronic low caloric intake may result from harmless reasons, such as
lack of knowledge about appropriate nutrition and the need for optimal energy balance,
lack of time to prepare meals,
inadequate cooking skills,
financial reasons,
physiological reasons, i.e., loss of appetite after a training session.[3]
The last point is especially poignant as I’m sure a lot of us are guilty of it. Personally, I’m never hungry after a hard workout and, if I didn’t know better, I probably wouldn’t eat.
So, what can we do to reduce the risk of Low Energy Availability?
Eating in & around exercise, reduces the risk of LEA. This concept is called ‘Nutrition Timing’.
A concept that has been designed to time the food intake with the time of when the body needs it the most – in and around training. Apart from the obvious goal of maximizing the exercise-induced muscular adaptations we also want to enhance our recovery process by:
Decreasing the catabolic state (pulling the body out of a breakdown state) and instead:
Stimulating the body to get into that muscle protein synthesis.
Stimulating the body to pull carbohydrate into the liver and into the muscles (improved glucose control).
Bringing down cortisol levels.
And how we’re going to do it?
For peri & post-menopausal women we are looking at regular doses of 30-40 grams of protein at each meal and 15-20 grams with your snacks. Post-training dose is 40 grams of protein.
[2] Low Energy Availability and Relative Energy Deficiency in Sport: What Coaches Should Know
[3] Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention
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