Do you experience ANY of these symptoms?
• Fatigue and low energy levels
• Weakened immune system
• Hair loss
• Skin problems
• Hormonal imbalances
• Irregular or absent menstrual cycles
• Fertility issues
• Mood changes, including irritability and depression
• Cognitive impairment and difficulty concentrating
• Decreased bone density
• Muscle loss
• Slowed metabolism
• Increased hunger and food cravings
• Difficulty regulating body temperature
• Poor sleep quality
• Digestive issues
• Increased risk of nutrient deficiencies
• Reduced athletic performance
• Anxiety and obsessive thoughts about food
If you've nodded your head to any of these, you might be surprised to learn that these symptoms can all stem from a single issue: not eating enough.
This condition is known as Low Energy Availability (LEA), and it can have profound effects on women's health. LEA, along with its broader implications known as Relative Energy Deficiency in Sport (RED-S), highlights how insufficient caloric intake can disrupt numerous physiological functions - within just five days...
For decades, the concept of "eating less to lose weight" has been the go-to advice for women. The infamous 1200-calorie diet gained popularity in the early 20th century, long before we truly understood the complexities of female physiology. This recommendation emerged at a time when "eat less" was the primary weight loss advice, without any real understanding of "how much less" was appropriate or safe, especially for women.
Importantly, this 1200-calorie guideline predates our current knowledge of women's metabolic processes, hormonal fluctuations, and the potential dangers of under-eating. We now know that this approach, along with rigid calorie counting, is outdated and can be particularly harmful to women's health.
This is where understanding Low Energy Availability (LEA) and its broader implications, known as Relative Energy Deficiency in Sport (RED-S), becomes crucial. These conditions highlight the risks of chronic under-eating and emphasise the importance of adequate nutrition for women's health and performance.
The truth is, many women need significantly more than 1200 calories to support their basic physiological functions, let alone to thrive and perform at their best.
In this blog, we'll delve deeper into how LEA and RED-S impact women specifically, why the old "eat less" mantra is flawed, and how understanding your body's true nutritional needs can lead to better health, performance, and overall well-being.
We have evolved from calorie counting and simply "eat less", to fueling our body's and building strong healthy physiques, it's time the advice given reflects that.
The Persistent Myth of the 1200-Calorie Diet
Despite advancements in nutritional science, many women are still trapped in the outdated and potentially harmful mindset of extreme calorie restriction. The 1200-calorie diet, a relic from a time when we knew far less about women's nutritional needs, continues to be recommended by some doctors, coaches, and diet programs. This one-size-fits-all approach ignores the complex and individual nature of women's bodies and can lead to serious health issues.
The truth is, there's no universal calorie count that works for every woman.
The 1200-calorie recommendation fails to account for crucial factors such as:
Individual metabolic rates
Activity levels
Body composition
Hormonal fluctuations
Age and life stage (e.g., pregnancy, menopause)
Overall health status
For most women, 1200 calories are simply not enough to support basic bodily functions, let alone fuel an active lifestyle or support fitness goals.
Your body needs energy for basic functions (like breathing and keeping your heart beating), digesting food, daily activities (like walking, standing, and fidgeting), and exercise. For an average woman, these needs can easily add up to over 2000 calories per day.
Eating only 1200 calories creates a massive deficit that your body simply cannot sustain - any longer that 5 days to be exact (1).
This extreme restriction can lead to nutrient deficiencies, muscle loss, hormonal imbalances, and a slowed metabolism. Instead of thriving, your body goes into survival mode, holding onto every calorie it can. That's why you might initially lose weight on a 1200-calorie diet, but soon find yourself tired, irritable, and unable to lose more, despite eating so little.
Low Energy Availability (LEA)
LEA occurs when an individual's energy intake is insufficient to support the body's basic physiological functions after accounting for energy expended during exercise or daily activities. This condition is particularly concerning for active women and female athletes. LEA can result from intentional or unintentional undereating, excessive exercise, or a combination of both. When energy availability drops below a critical threshold (typically around 30 kcal/kg of fat-free mass per day), the body begins to prioritise essential functions and suppress others, leading to a cascade of physiological and psychological consequences.
LEA can disrupt hormonal balance, particularly affecting reproductive hormones, thyroid function, and cortisol levels. This hormonal dysregulation can lead to menstrual disturbances, decreased bone mineral density, and impaired metabolic rate. Additionally, LEA can compromise immune function, increase the risk of injuries, and negatively impact cardiovascular health. Cognitively, women experiencing LEA may suffer from decreased concentration, mood disturbances, and increased anxiety around food and body image.
'Clinical studies have exhibited negative health implications from LEA in as little as five days of <30 kcal/kg FFM/day', published in Energy Availability in Athletics: Health, Performance, and Physique.
Relative Energy Deficiency in Sport (RED-S)
Relative Energy Deficiency in Sport (RED-S) is a more comprehensive syndrome that evolved from the concept of the Female Athlete Triad in 1992. RED-S describes the impaired physiological functioning caused by relative energy deficiency and includes, but is not limited to, impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health.
While initially identified in female athletes, RED-S can affect also effect active individuals. The central component of RED-S is low energy availability, where the body doesn't have enough energy to support exercise and normal physiological functions. This energy deficit can lead to a wide range of health and performance consequences. Women with RED-S may experience decreased endurance, increased injury risk, decreased training response, impaired judgment, decreased coordination, and irritability. Long-term consequences can include osteoporosis, infertility, and cardiovascular problems. Recognising and addressing RED-S early is crucial for preventing long-term health issues and maintaining athletic performance.
The Truth About "Eat Less" and Its Limitations
While the principle of "eat less" to lose weight is fundamentally true - creating a calorie deficit is necessary for weight loss - there's a crucial caveat that's often overlooked: there's a limit to how little you can eat before it becomes counterproductive and potentially harmful.
As we've seen with LEA and RED-S, eating too little for too long can lead to serious health consequences. The body doesn't simply continue to lose fat when you keep reducing calories. Instead, it adapts to conserve energy, slowing metabolism and potentially leading to muscle loss, hormonal imbalances, and other health issues.
Understanding Your Body's Energy Needs
To understand the right amount of food for your body, it's crucial to understand how your body uses energy. This knowledge forms the foundation for recognising whether you're eating enough and if you might be at risk for Low Energy Availability (LEA).
Total Daily Energy Expenditure (TDEE) & Calories
Calories are units of energy derived from food and beverages that the body uses for various physiological functions, including metabolism, movement, and bodily functions like breathing and circulation. They are essential for providing the energy needed to sustain life and perform daily activities, and every body's calorie needs vary based on factors such as age, sex, weight, height, activity level, and overall health - if you have ever heard someone say eat 1200 calories this is the first huge argument - your needs are different to the next person.
Total Daily Energy Expenditure (TDEE) represents the total number of calories your body needs to maintain its current weight based on various activities and bodily functions throughout a 24-hour period. It accounts for all the energy expended (calories burned) in a day to support basic bodily functions (BMR), daily tasks and movement (NEAT), exercise (EAT), and the energy required to absorb and digest food (TEF).
Basal Metabolic Rate (BMR) represents calories the body burns at REST to perform essential functions (breathing, thinking, organ function etc.) Influenced by age and sex, but mainly body composition. Outside of building or maintaining muscle (the more we have the higher BMR is) and total body weight (the more you weigh, including from fat, the higher BMR is), we have very little control over BMR.
This is often ignored, and no (or none that I have ever found) calorie equations account for this, leaving women to underestimate their needs. In turn women are undereating, experiencing hunger, fatigue, cravings, headache and cramps due to the lack of additional calories requires to support their bodies at this time.
For the average women, this is a difference of around 2-300 calories every day for 10-14 days per month.
Non-Exercise Energy Expenditure (NEAT) represents the calories your body expends through general movement (excluding intentional exercise), like fidgeting, moving around the house or the office. Influenced by ‘lifestyle factors’ such as, if you have a sedentary or physical job, fidget often, do chores or walk around the house all day.
We intuitively move less when we eat less, and vice versa. We have a moderate level of control over this, so maintaining a minimum number of daily steps or movement is essential and can drastically increase our daily energy expenditure.
The Thermic Effect of Food (TEF) represents the calories burned to extract and process nutrients from the foods we eat - digestion, absorption & excretion. Influenced by the macronutrients we consume. Some foods require more energy to digest and break down, like protein 20-35%, while carbohydrates require 5-15%, and fats 5%.
Exercise Energy Expenditure (EAT) represents the calories your body expends through exercise you have chosen, or programmed, to do. Although we have a lot of control over EAT and can increase this percentage slightly, for most women, calorie expenditure from EAT accounts for the smallest portion of calorie burn.
Knowing your approximate TDEE is essential because it provides a baseline for understanding your body's energy needs.
This baseline is crucial for several reasons:
Recognising Low Energy Availability (LEA):
If you're consistently eating well below your TDEE and experiencing symptoms like fatigue, irregular periods, or poor recovery from workouts, you may be in a state of LEA.
Supporting Your Goals:
Whether you're looking to maintain weight, lose fat, or gain muscle, understanding your TDEE helps you make informed decisions about your nutrition.
Fueling Performance:
For active women, knowing your TDEE ensures you're eating enough to support your training and recovery.
Hormonal Health:
Eating enough to meet your TDEE is crucial for maintaining hormonal balance, which affects everything from your menstrual cycle to your mood and energy levels.
Estimating Your TDEE
While precise calculation requires professional assessment, you can get a rough estimate of your TDEE using the equation below.
BMR = (10 × weight in kg) + (6.25 × height in cm) - (5 × age in years) - 161
To calculate Total Daily Energy Expenditure (TDEE), multiply the BMR by the appropriate activity factor:
Sedentary (little or no exercise): TDEE = BMR × 1.2
Lightly active (light exercise 1-3 days/week): TDEE = BMR × 1.375
Moderately active (moderate exercise 3-5 days/week): TDEE = BMR × 1.55
Very active (hard exercise 6-7 days/week): TDEE = BMR × 1.725
Extremely active (very hard exercise, physical job, or training twice a day): TDEE = BMR × 1.9
So, the complete equation for women, including activity level, would be:
TDEE = [(10 × weight in kg) + (6.25 × height in cm) - (5 × age in years) - 161] × Activity Factor
Actual Energy Needs for Females
The understanding of female physiology has evolved significantly since the initial development of calorie equations. Just as these equations were established before we fully grasped the concepts of Low Energy Availability (LEA) and Relative Energy Deficiency in Sport (RED-S), they also failed to account for the complex hormonal fluctuations unique to women.
A critical discovery in recent years is the impact of the menstrual cycle on a woman's basal metabolic rate (BMR). Research has shown that during the luteal phase - the period between ovulation and menstruation - a woman's BMR can increase by approximately 10-20%.
This significant metabolic shift is not accounted for in standard calorie calculations.
This oversight has far-reaching implications. The body's increased energy demands during the luteal phase, if not met, can lead to a cascade of issues. One common manifestation of this energy deficit is intense food cravings, particularly in the days leading up to menstruation. These cravings are often misinterpreted as a lack of willpower or dismissed as "PMS symptoms." In reality, they are the body's way of signaling its increased energy needs. Moreover, consistently failing to meet these cyclical energy demands can contribute to hormonal imbalances, exacerbate PMS symptoms, and potentially impact fertility and overall health. It may also play a role in the development of LEA and RED-S, especially in active women or those engaged in calorie-restricted diets.
Understanding and accounting for these hormonal fluctuations is crucial for women's health and performance. It underscores the need for a more dynamic and personalised approach to nutrition that considers the menstrual cycle alongside other individual factors.
The conversation around women's nutrition has evolved significantly, especially as we recognise the dangers of Low Energy Availability (LEA) and Relative Energy Deficiency in Sport (RED-S).
The outdated 1200-calorie diet was established long before we understood the profound impact that insufficient food intake can have on women's health. Now that we have a clearer understanding of the unique nutritional needs of women, it’s time to abandon the "eat less" mentality and embrace the concept of "eating to support our bodies." By prioritising adequate nutrition, we can enhance fat loss, boost performance, improve fertility, and reduce health risks such as osteoporosis.
This shift in mindset is crucial for achieving sustainable health and wellness.
Things you can do immediately, that will ensure you are properly fueling your body:
Calculate your TDEE or daily intake needs.
Prioritise protein: 1.6-2.2g per kg bodyweight.
Build muscle: muscle is essential for increasing metabolism, maintaining hormone balance and preventing health risks, lift weights, preferably heavy, 6-12 reps (group classes and yoga do not cut it).
Eat small meals more often: stabilise blood sugar levels, provide a steady stream of energy, and, make it easier to meet your protein and overall calorie needs.
Adjust for the Menstrual Cycle: tailor your nutrition to suit your needs throughout the menstrual cycle, if you experience symptoms like cravings and fatigue during the luteal phase, increase your food intake by adding more protein and another small meal or snack.
Once you are consuming enough to support your daily intake needs then, and only then, should you ever consume eating less to lose weight.
I get it, the advice you have received, the available information, and pressures from society are hard to ignore, but if you've tried everything else and it's failed, perhaps a different approach is required.
A female specific approach.
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