Female Athlete Triad – Part 1
Last week I spoke at an area high school to the female athletes about fueling their futures and the Female Athlete Triad. I wanted to share with you all about my presentation because I truly think its important for every one of all ages.
As a physical therapist serving many of the area school kids I was excited (and nervous) to present to this group of kids. As a high school athlete I got very little education on how to properly fuel my body and know many people who poorly or improperly fueled themselves for their athletic performance.
I tell my kids in PT often “if I only knew now what I knew then I would’ve been a top athlete, rather than just a good one.” I honestly believe this, when I was a high school athlete we would “fuel” with huge meals between matches, sweets after practice, and often a pre or post practice run to a fast food restaurant. While the majority of my teammates and myself were not acutely aware of what we were putting in our bodies we also were not deviating extremely from the “norm.”
As a high schooler & in general I think it is important to just eat!! Your body needs energy and energy comes from food, and once you focus on only eating certain foods or counting calories you risk a bigger problem than just eating the food you enjoy. Being mindful of moderation and portion control, the two things which I did not have in high school and hardly thought about.
As athletes we are exposed to a greater risk of social pressures and societal norms for the sport which we play and the athletic performance we wish to achieve. These pressures can monumentally impact growth and maturation of the female athlete.
Females are susceptible to what is called “The Female Athlete Triad” and what I think had a bad rap for being a huge scary thing. When really it should be discussed with each female sports team (and honestly male sports team even though the impact is different) because it is not as scary at it sounds.
Female Athlete Triad is the combination of three factors which exist on a continuum of severity 1. Energy deficiency with or without eating disorder 2. Menstrual disturbances/amenorrhea & 3. Bone loss/osteoporosis.
I spoke mostly on energy deficiency as I believe this is the biggest component of the triad and honestly the conduit to the other two components. While they can all exist exclusively they all can co-exist and this coexistence is a result from a cascade of responses.
Energy deficiency is defined as “Not having enough energy available” and is due to under-fueling and caloric deficits. It can lead to disordered eating but does not have to, and the result is not always a diagnosed eating disorder. Energy deficiencies can be unintentional and often occur within the exercise community.
Have you ever gone to a workout or sporting game and forgot to eat something before you went? How did you feel after the first 10minutes or 1 hour of full exertion exercise? not great right?
This is unintentional energy deficiency, some people think they perform better with fasted workouts and some do not, a fasted workout or state of unintentional energy deficiency puts your body in a “temporary state of female athlete triad” but if you replenish your fuel sources and continue to eat & fuel normally and healthily you are okay!
The Problem comes with sustained disordered eating, not just one day of poor eating or unintentional deficiencies. When you are in a sustained disordered state your body goes into starvation mode and stores each morsel of food. Since our body is a lot smarter than we are it knows that we are in a constant calorie deficit and so it stores all our food to use for energy to survive.
With sustained energy deficiencies our body searches for other areas to leach energy from so it can take that energy for vital processes such as thinking, digesting, sleeping, walking… This leached energy often comes in the form of discontinuing the normal menstrual cycle, or amenorrhea (absence of menstruation). While we all would love to not have our monthly visit from Aunt Flow it is an important regulatory function for females and vital part of our life.
Secondary Amenorrhea is defined as the “absence of menstrual cycles for 3 or more consecutive months or < 3 cycles/year” this is the amenorrhea that we are concerned about. This means your body has stopped menstruation for an important reason, typically the result of chronic energy deficiency. Prolonged or long-term secondary amenorrhea can lead to difficulty getting pregnant, infertility, pelvic pain and
… osteoporosis due to low estrogen levels. (perfect segue ay?)
Bone loss is no joke my friends and bone health is predominantly impacted by genetics (60-80%), exercise, hormones, nutrition and toxins. While we have little impact on our genetics we definitely have the ability to positively impact the other 20-40% of our bone health.
Starting to see how it all works together? Nutrition and poorly fueling our body leads to hormone imbalances which can negatively impact your bone health leading to weak or brittle bones and increasing your risk for osteoporosis and bone disease. Severe undernutrition impairs reproductive health and skeletal health resulting in low bone mineral density.
The POSITIVE is that exercise and physical activity positively impacts the bone builders and should improve bone mineral density.
Ok so now you know the gist of Female Athlete Triad. Tomorrow I will share more about how to properly fuel and recognize energy deficiency plus some personal stories on unintentional deficiency.
Questions and comments welcomed.
Fuel safe, perform strong, stay healthy.