# A Proposal for a Standardized Approach to Inducing Low Energy Availability in Athletes
## 4 Discussion  
### Measuring EA  
The 3-5-day diary records are considered to be more appropriate than logs of longer duration due to less burden on the participant, especially in the non-athletic population. However, for EA assessment longer periods might have a greater value since there are daily  
\begin{table}
\begin{tabular}{c c c} \hline \hline  & **Strenghts** & **Opportunities** \\ \hline \(\bullet\) & training volume remains the same, which is easier to achieve from duration standpoint & to compare differences when EI is reduced with equal meal distribution across the day or if EI is reduced by eliminating some meals (but retaining the daily macronutrient content) \\ \(\bullet\) & lowering EI with unchanged EEE might be easier for some subjects & **Theats** \\ \hline \hline  & **Weaknesses** & **theats** \\ \hline \(\bullet\) & new EI must be calculated by an experienced dietitian & electrolyte disturbances must be prevented by enabling free salt consumption micronutrients should be supplemented to avoid any deficiencies in severe cases of LEA, ketosis might occur that can be tolerated differently by subjects depending on their previous eating habits by changing EI, the diet induced thermogenesis is reduced, so EB is not the same as in case of induced LEA with increased EEE \\ \end{tabular}
\end{table}
Table 2: SWOT analysis of low-EI protocol (EEE = exercise energy expenditure, EI = energy intake, LEA = low energy availability, EB = energy balance).  
Figure 2: A schematic representation of low-EI protocol. EEE remains identical, while EI is reduced in a way to reach a target EA.  
fluctuations in EB and EA. Short duration excursions into EA might provide a distorted image of an athlete's status. A review in dietary assessment techniques concluded monitoring EI should be performed the whole time while measuring energy expenditure [13]. This is why it seems that the whole micro cycle in training periodization, i.e., the whole week (7 days), should be included in measurements when assessing EA [13]. This has been done in some papers that included measuring EA with dietary logs [10; 17; 21; 22; 23], but also shorter durations of 5 days [24; 25], 4 days [26] and 3 days [7; 27; 28] have been used. This could be one of the reasons for inconsistent results. In our research group, we have demonstrated that a 7-day EI measuring period together with detailed EEE measurement shows lower EA values in male athletes as expected since average EA was below 30 kcal/kg FFM/day. We included rest days and training days, which we think is necessary when observing EA. The disadvantage of a 7-day diary log is more burden on the dietitian [29], but even small errors in EA can greatly influence EA calculation. This is why we propose a 7-day period should be used for EI assessment as part of EA measurement.  
As in the case of EI measurement, a whole micro-cycle consisting of 7 consecutive days should be included in the analysis. This would include possible rest days and days of higher training volume or different intensities. At this time, we do not know how long LEA has to last to cause undesirable effects. We know that within-day energy deficiency is associated with these effects [21; 30]. Nevertheless, health related consequences such as poor bone health, reproductive status, or compromised immunity do not happen over few days but more probably over longer periods of time. This is why observing EA over more than just a few days could be more appropriate. We suggest variability in EEE over 7 days in training week should be included in EA assessment. This would provide a better representation of EA status in an athlete than just 3 or 5 days.