Low energy availability in the marathon and other endurance sports

Energy availability is the amount of dietary energy remaining after exercise training for all other metabolic processes. Excessively low energy availability impairs reproductive and skeletal health, although genetics and age may alter an individual's initial conditions and sensitivity when low energy availability is imposed. Many marathon runners and other endurance athletes reduce energy availability either (i) intentionally to modify body size and composition for improving performance; (ii) compulsively in a psychopathological pattern of disordered eating; or (iii) inadvertently because there is no strong biological drive to match energy intake to activity-induced energy expenditure. Inadvertent low energy availability is more extreme when consuming a low fat, high carbohydrate diet. Low energy availability, reproductive disorders, low bone mineral density and stress fractures are more common in female than male athletes. Functional menstrual disorders caused by low energy availability should be diagnosed by excluding diseases that also disrupt menstrual cycles. To determine energy availability (in units of kilocalories or kilojoules per kilogram of fat-free mass), athletes can record their diets and use diet analysis software to calculate energy intake, measure energy expenditure during exercise using a heart monitor and measure fat-free mass using a bioelectrical impedance body composition scale. All are commercially available at consumer prices.