ABSTRACT
For the female athlete with exercise-associated menstrual dysfunction (ExMD), energy intake (EI) is not adequate to meet the energy demands of exercise, activities of daily living, and menstrual function. This chapter examines diet and exercise approaches to improve energy status and then discusses the health consequences of chronic energy deficit in athletes. Chronic low energy availability (EA) can be a result of inadvertent low EI, subclinical disorder eating practices such as intermittent fasting or purging, or clinical eating disorders. Low EA is associated with health concerns beyond menstrual disturbances and bone loss such as nutritional deficiencies, chronic fatigue, frequent injuries and infections, and hormonal disruptions. Protein is an important nutrient for bone health during both childhood and adulthood. In low EA, dietary intakes of micronutrients such as the bone building nutrients, calcium, and vitamin D may also be inadequate. Leptin plays a critical role in energy balance and bone metabolism.
