The Risk of Eating Disorders in Female Runners: A Warning Sign of Low Energy Availability

Introduction

She runs 10 km every day, strictly controls her diet, and her weight keeps dropping—yet her performance stagnates or even declines. She also begins experiencing menstrual irregularities and recurrent injuries. Such stories are not uncommon in the female running community. At the core of the issue lies a seemingly contradictory truth: eating too little actually makes you run worse.

The sports medicine community calls this problem “Low Energy Availability” (LEA)—when the energy consumed, after subtracting exercise expenditure, leaves insufficient energy for the body to maintain normal physiological functions. When LEA persists over time, it can develop into “Relative Energy Deficiency in Sport” (RED-S), affecting systems throughout the entire body.

The Chain Reaction of Low Energy Availability

Why Female Runners Are Particularly Prone to LEA

• Appearance pressure: The “lighter means faster” culture in the running community leads some women to pursue excessively low body weight
• Underestimating training load: Women sometimes underestimate their running energy expenditure, especially when energy demands are higher in the late menstrual phase (luteal phase)
• Dieting culture: The aesthetic pressure on women to be “slender” in Taiwanese society makes restrictive eating behaviors easier to rationalize
• Insufficient protein intake: Many female runners do not consume enough protein to support muscle repair

How to Tell If You Are Energy Deficient?

If you answer “yes” to 3 or more of the following questions, it is recommended to consult a sports medicine physician or sports dietitian:

• Menstruation has stopped or cycles exceed 35 days
• Frequently feeling fatigued, even when training volume has not increased
• Strong feelings of guilt or a need for control over food
• Recurrent stress fractures or overtraining injuries
• Training volume increases but performance does not improve
• Feeling especially sensitive to cold even on cold days
• Large mood swings, easily anxious or depressed
• Thoughts about food occupy a significant amount of time each day

Healthy Energy Management: Dietary Principles for Runners

Basic Calculation Reference

A healthy energy availability is recommended to be ≥ 45 kcal per kilogram of fat-free mass (FFM) per day. For a female runner with a fat-free mass of approximately 50 kg who burns 500 kcal per day from running, her dietary intake should be at least:

50 × 45 + 500 = 2,750 kcal

This figure is often far higher than what many women actually consume.

Practical Dietary Strategies

• Carbohydrates are not the enemy: Long-distance running requires glycogen; carbohydrates should be consumed both before and after runs (sweet potatoes, brown rice, and bananas are all good choices)
• Refuel within 30 minutes after running: A carbohydrate + protein combination (such as soy milk with a steamed bun, or egg toast) promotes muscle repair
• Don’t skip breakfast: Consuming carbohydrates before a morning long run helps maintain stable blood sugar during the run
• Avoid compensatory reductions in food intake around runs: Some people feel they “can eat one less meal” after running—this is exactly the breeding ground for LEA

When Is Professional Help Needed?

If the following situations occur, it is recommended to seek psychological counseling or a specialist in eating disorders:

• Strong feelings of control or fear regarding food that interfere with daily life
• Compensatory behaviors (running to “earn back” food consumed)
• Severely distorted body image (still believing you are too fat even when already underweight)

Eating disorders are medical issues, not willpower issues. An increasing number of psychologists and physicians in Taiwan provide relevant support.

Practical Advice

1. Stop calculating “what I can eat for the calories I burned running”: Treat food as fuel for your body, not as a reward or punishment tool
2. Share meals with fellow runners: Observe how healthier female runners eat; sometimes community has more influence than numbers
3. If menstruation has stopped for more than 3 months, make restoring your period the top priority, and let running performance take a back seat
4. Track the connection between food and energy: When you eat enough carbohydrates, your training will feel noticeably better—let your body convince you
5. Find a coach or community that supports healthy eating, and stay away from cultures that glorify “running on empty”

Conclusion

The truly high-performing female runner is the one who eats enough, recovers well, and runs sustainably for the long term. Turning food from an object of fear back into the wings that support your flight—this transformation is more powerful than any training plan.

Related Reading

• RED-S in Female Runners: Relative Energy Deficiency Is Not Simply About Eating Less
• Relative Energy Deficiency in Sport (RED-S) in Female Runners: Identifying the Risks and Prevention
• Daily Management of Energy Availability for Female Endurance Athletes: Turning “Eating Enough” into an Executable Training Discipline
• RED-S Relative Energy Deficiency: The Most Overlooked Health Breakdown in Endurance Athletes