Since the passage of Title IX in 1972 female participation in high school athletics has skyrocketed. In the year preceding passage of the legislation, which mandated that any school accepting federal funds must provide equal athletic opportunities for boys and girls, a mere 300,000 high school girls competed in school sports. Today over 3.2 million girls reap the benefits of team sports including decreased obesity, better grades, lower dropout rates, fewer unwanted pregnancies and decreased engagement in risky behaviors like smoking and illicit drug use.
The exponential increase in female athletes has also highlighted a unique health challenge many face known as Female Athlete Triad Syndrome (Triad). First identified by the American College of Sports Medicine in 1992, the Triad refers to three health problems that are linked to each other: energy deficiency, menstrual problems and weak bones.
Energy deficiency
The primary cause of the Triad, energy deficiency, is caused by an imbalance between calories consumed and calories expended during exercise. Simply put the athlete is not eating enough to meet the rigors of her sport. For example, according to the Female Athlete Triad Coalition if a 150 pound athlete adds a two hour vigorous volleyball practice to her daily activities she will burn approximately 1100 calories in addition to her normal requirements.
Some athletes consciously restrict food intake due to pressure to be thin or eating disorders but most simply slip into an energy deficient state because they don't realize how important proper nutrition is for athletic performance and general well being. Girls who routinely expend more calories than they consume will end up with an energy deficit. This results in the body having too little energy to maintain normal functions like having a menstrual period every month or developing healthy bones.
Menstrual problems
Energy deficiency caused by underfueling the body results in irregular or less frequent menstrual cycles. When three or more cycles in a row are missed the condition is known as amenorrhea. Eating too few calories can also delay the onset of menstruation so that a girl does not begin having periods by age 15.
When periods are missed the body makes less estrogen, a hormone essential to the building of healthy bones.
Poor bone health
Because of hormonal deficits triggered by energy deficiency the body is not able to replace old bone cells with healthy new cells. This sets the stage for stress fractures and the early onset of osteoporosis (weak bones that break easily). Bone loss is made worse if the athlete isn't consuming enough calcium or Vitamin D.
During the teen years girls should be building up their bone mass, which is now thought to peak between the ages of 18-25. Poor bone health during the teenage years may have a lasting effect on how strong the athlete's bones are later in life.
Signs and symptoms
The Female Athlete Triad Coalition lists the following signs and symptoms of the Triad:
• Irregular or absent menstrual cycles
• Always feeling tired or fatigued
• Problems sleeping
• Stress fractures and frequent or recurring injuries
• Often restricting food intake
• Constantly striving to be thin
• Eating less than needed in an effort to improve performance or physical appearance
• Cold hands and feet
According to Dr. Anastasia Fischer, a sports medicine expert at Nationwide Children's Hospital, girls should track their periods, which can now be done on free and private smartphone apps. They should talk to their parent, coach, or doctor if they are going more than 35 days between periods, if their periods have stopped, or if they are 15 years old and have not yet experienced a menstrual cycle. Any menstrual irregularities must be evaluated by a physician or nurse practitioner for proper care to be provided.
Prevention and treatment
The Female Athlete Triad Coalition recommends that athletes track how many calories they eat each day. They should also track how much they exercise each day and adjust their food intake to account for the increased expenditure of energy. Their website includes an energy availability calculator to help athletes make healthy nutritional choices. Online resources like marathonguide.com can also be useful tools in these calculations.
The Coalition also recommends that athletes eat every three to four hours - three meals a day and a couple snacks. Chosen by the athlete on the basis of taste, nutrition and convenience snacks can be thought of as mini-meals. Examples include instant oatmeal with raisins, peanut butter sandwiches, crackers with peanut butter, and low fat milkshakes or fruit smoothies.
Girls with eating disorders need to be treated by a specialist in those conditions but for most athletes the key to building strong bones and avoiding menstrual problems is to eat enough calories to fuel the body during exercise and at rest.
The Coalition urges athletes to seek medical attention when even one aspect of the Triad is present. For example, if the athlete has a stress fracture that won't heal or is enjoying her sport less because of anxiety over food and weight a medical evaluation is in order.
Boys can be energy
deficient, too
Testosterone endows men with wider bones less susceptible to fracture and they don't have to fuel menstrual cycles. But if they don't consume enough calories to meet the demands of their sport they can suffer some of the same consequences as females like impaired concentration, fatigue and poorer athletic performance. For this reason the International Olympic Committee proposes changing the name of the disorder to Relative Energy Deficiency in Sport (RED-S).
Many of the recommendations for female athletes like adjusting food intake to account for increased expenditure of energy also apply to males.
For more information visit femaleathletetriad.org[[In-content Ad]]
