Fit. Careful. Consistent. Training most days and thoughtful about food.
Also exhausted, sweating through the night, and with no libido left.
That combination has walked into my consult room repeatedly this month, and every one of those people is doing what they've been told to do.
What comes up when we go through nutrition
The same thing surfaces again and again. Carbohydrates have been cut out completely, or they're being eaten at a level nowhere near enough to support the training being done or the hormonal health underneath it.
This isn't limited to one sport or one type of training. It shows up across the board in women who are physically active and who have absorbed the idea that eating less is the more disciplined choice.
I want to be clear that I'm not describing carelessness. These are people paying very close attention. That's precisely what makes the pattern so hard to interrupt.
Why the belief is so durable
The logic underneath it feels intuitive. If you want to change your body composition, train more and eat less. More output, less input. It sounds like arithmetic.
It's also the single belief I meet most often, and it works against the exact result the person is chasing.
Under fuelling while training hard hurts your hormones. It allows muscle loss. And it opens the door to nutrient deficiencies.
None of those three things move anyone toward the composition they wanted, and all three arrive quietly enough that the connection is rarely made.
By the time someone is sitting in front of me describing night sweats and exhaustion, they've usually concluded they need to try harder. Every available explanation in their environment is about discipline. Almost none of them are about fuel.
There's a name for this in sports medicine
The 2023 IOC consensus statement on Relative Energy Deficiency in Sport describes a syndrome affecting health and performance that follows a mismatch between energy taken in and energy burned through training. Two things in it matter for this conversation.
The first is that the statement specifically highlights emerging evidence on the role of inadequate carbohydrate intake, which is exactly what keeps showing up in my consults.
The second is that it flags the overlap between this syndrome and overtraining. The two present so similarly that a coach looking at a flat athlete can reasonably reach for a training answer to a nutrition problem.
It's also worth saying that low energy availability isn't confined to elite sport. Anyone training consistently can sit in it, whether or not they'd call themselves an athlete.
Why I take this one personally
I've been part of this crowd myself.
I train and I compete, and I understand the mindset from the inside. Eating more when you want to look leaner feels wrong. It feels like undoing your own work.
Knowing the physiology doesn't make the shift easy, which is why I have a lot of patience with people who find it hard. Food as fuel, and what it does for hormonal health, isn't an abstract clinical position for me.
What to watch for if you work with active people
If you're a coach, a biokineticist, a physiotherapist or a dietitian, you're almost certainly working with someone in this pattern right now.
The signals aren't subtle once you know to look. Recovery taking longer than it used to. Sleep quality dropping. Performance plateauing or sliding while training volume holds or climbs. Cycle changes. A flatness that gets written off as a demanding season.
The instinct in a performance environment is to adjust the programme. More recovery work, a deload, a change in periodisation. Those are reasonable responses and sometimes they're the right ones.
But if intake has been quietly shrinking for months, no programme adjustment fixes it. The body isn't failing to adapt to the training. It's being asked to run a system it doesn't have the resources for.
The conversation worth having
The most useful thing anyone working with active women can do is ask about food directly and without judgement.
Not as a calorie audit. As a question about whether the fuel matches the work. Most people have never been asked it in those terms, and a surprising number have never considered that their carbohydrate intake and their hormonal symptoms might be connected at all.
Where symptoms are already present, bloods are worth running, and this is the kind of picture integrative and hormone health work is built to unpick. Where symptoms aren't there yet, the conversation is still worth having early, because this is far easier to interrupt before it becomes the reason someone stops training altogether.
The point
Under fuelling is not discipline.
It's a slow withdrawal from the systems that keep someone feeling like themselves, and it's one of the more fixable things I see, provided the person training is willing to hear that the answer is more food rather than more effort.
If you want to change your composition, fuel the work properly and protect the muscle you already have.
For the coaches and clinicians reading this, I'm curious. How do you raise fuelling with someone who's convinced that eating less is the disciplined choice?