Login | July 21, 2018

The female athletic triad

Pete’s World

Published: September 11, 2017

An athlete’s drive to excel is often so powerful that she might unwittingly forego common sense health practices in leu of attaining sport-specific improvements.

One such unhealthy practice is the dangerous act of chronic weight loss, an issue that’s more specific to female athletes - this likely because female athletes have been darned near brainwashed over the years into believing that losing weight will increase their athletic performance.

And as is typical with competitive athletics, there’s always a faction who end up taking certain training tenants to extremes.

So in this week’s column I’d like to talk about female athletes who take the tenant of “weight loss equals better performance,” to such an extreme that their resultant unhealthy eating practices lead to calamitous outcomes.

You see, as the female athlete becomes malnourished, her body begins to experience hormonal disruptions which cause an imbalance of bone building versus bone break down.

The outcome is bone loss that can spiral into osteoporosis, where fractures, injuries and debilitation becomes the norm rather than the exception.

Kim Gladden, not only my amazingly brilliant sister, but also a sports med doc at the Cleveland Clinic, explains the issue this way: “EVERYTHING starts with energy intake. There is a complex interplay between energy availability, menstrual function and bone health. If energy is deficient, menstrual cycles will change and the hormonal balance will affect bony deposition leading to deterioration of good bone health.”

Now when we’re talking about energy availability, Dr. Gladden defines it as, “The amount of energy available for normal body functions, with the equation: dietary intake - energy expenditure = energy availability. Energy availability affects menstrual regularity, and because of the hormonal regulation that is tied to menstrual function, the downstream effect of insufficient energy availability is the reduction of bone remodeling and strength - leading to osteopenia and or osteoporosis.”

Thus, the practice of restrictive eating can eventually steer the female athlete to a very dangerous place, to a malady termed the Female Athletic Triad.

The American College of Sports Medicine defines Female Athletic Triad as a “health concern for active women and girls who are driven to excel in sports. It involves three distinct and interrelated conditions: disordered eating (a range of poor nutritional behaviors), amenorrhea (irregular or absent menstrual periods) and osteoporosis (low bone mass and microarchitectural deterioration, which leads to weak bones and risk of fracture).

As you can see, restrictive dietary intake can spiral out of control to such an extent that secondary and tertiary issues occur.

But what’s so insidious about this issue is the fact that we’re not just talking about extreme cases of disordered eating.

“Many tend to think of these women as having anorexia or bulimia,” says Dr. Gladden. “When the reality is that you may have a very healthy female with no elements of eating disorder - they simply aren't taking in enough energy to sustain their activity level.”

Dr. Gladden goes on to say, “the problem I frequently see in female athletes is that their coach or trainer has told them ‘it's okay if you don't have periods, that is normal for an athlete.’

“The reality is that skipping menstrual cycles is a warning sign that your body is likely not taking in enough energy to sustain menstrual function and thus putting the bones at risk.

“We need to educate women that skipping periods is not normal (unless of course they are pregnant or perimenopausal).”

Now the truly scary part of the Female Athletic Triad Syndrome is the fact that doctors sometimes cannot ascertain if any damage had been done until the damage is done.

“Unfortunately there may be no sign of bone loss until we begin to see pathology such as stress fractures,” said Dr. Gladden. “One stress fracture in a runner who has never had any others gives me less concern, although I will check a vitamin D level and ask them about their food and menstrual history. A pattern of stress fracture is much more concerning.”

The long term affects of bone loss in active women can be devastating - and permanent.

So what's the best way for an athletic woman to prevent herself from falling into the Female Athletic Triad?

Fuel the body with nutritious food. Period.

If you’re unsure then speak to a licensed athletic trainer or a registered nutritionist.

I always explain to my athletes that nutritious food is high-test fuel that provides energy.

And to perform at your best, you need energy.