nutrients Archives - Britt Fit


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This week, I would like to spread a bit of awareness about something called F.A.T.  I’m not talking about the “fat” we all know and love to hate– saturated fat, intramuscular triglycerides, cholesterol, etc.  Today’s topic is a bit less widely-discussed, even among endurance athlete populations.

F.A.T. stands for Female Athlete Triad.

According to the American College of Sports Medicine:

The female athlete triad (Triad) refers to the interrelationships among energy availability, menstrual function, and bone mineral density, which may have clinical manifestations including eating disorders, functional hypothalamic amenorrhea, and osteoporosis. With proper nutrition, these same relationships promote robust health (ACSM, 2007).

Low energy availability, whether inadvertent or intentional, occurs when energy (food/drink) consumption is insufficient to meet energy (training/activity) expenditure, and has been identified as the main culprit in F.A.T. reproductive system dysfunction and skeletal health impairment.

Until about 2 years ago, when I began writing a thesis on a related subject, I knew little to nothing about the triad, except that it sounded like some obscure condition that only occurs in athletes with extreme eating disorders.  However, I learned that low energy availability (and its side effects) can be present even in athletes without disordered eating and regardless of body shape or size– that it is possible for someone to maintain low energy balance while appearing “normal” and well-nourished on the outside.  Yet, a low-energy state, coupled with resultant hormonal abnormalities, can trigger a multitude of potential performance hindrances such as bone weakening, decreased immune function and loss of mental focus.

Takeaways regarding low energy availability and the Triad:

Fuel Your Body

Without obtaining sufficient nutrients and energy from foods, your body cannot perform optimally.  A chronic and/or extreme low-energy state may lead to fatigue, slow recovery from workouts, decreased bone strength, immune function, power, strength, and endurance

Low Energy Availability (low EA)

    • More energy (calories) expended than consumed
    • Less available energy to maintain bone formation and other body functions
    • Common Causes: under-eating, eating disorders, illness, etc
    • Often triggered by desired weight loss for appearance or performance benefits
    • Over-exercising (without calorie compensation) is another strategy that athletes may use to lose weight and “improve” performance/looks
    • May be unintentional— the athlete is not careful to take in enough calories, and/or is unaware of the increased calorie demands of exercise

Low bone mineral density (low BMD)

    • Commonly associated with low EA
    • Can be caused by low estrogen levels and/or low dietary calcium & vitamin D intake
    • Associated with stress fractures, osteoporosis, and increased injury frequency
    • Especially dangerous for younger athletes in developmental stages

Risk factors/warning signs of chronic Energy Deficiency (low EA)

    • Overly-controlling or excessively-critical parents and coaches
    • Having a “perfectionist” and/or self-critical attitude
    • Low self-esteem, extreme fatigue and/or depression
    • Low BMD and frequent stress fractures without increased training
    • Frequent illness (weak immune system)
    • Anemia, dry skin, constipation, dizziness, or inability to concentrate
    • Poor and irregular eating habits
    • Playing a sport in which revealing attire is worn (insecurities)

What can athletes do to maintain optimal energy levels?

  • Consume sufficient energy to sustain normal body functions and to fuel exercise
    • Have a fueling strategy: eat for optimal energy and recovery
    • Choose nutritious foods and balanced meals/snacks (fruit-yogurt smoothie, baked potato with veggies & cheese, etc.)
    • Understand that there is no ideal “athlete body”
    • Focus on maintaining optimal energy and health


American College of Sports Medicine. The Female Athlete Triad Position Stand. 2007. Available at: http://journals.lww.com/acsm-msse/Fulltext/2007/10000/The_Female_Athlete_Triad.26.aspx