The female athlete triad – also an interesting read for guys

I have one more race and then I call it quits for the season. My motivation is low and my body has been complaining, nagging me with small pains, poor sleep and stiff muscles. 

So I will be writing a few blogs about the end of season and recovery. To kick off properly, I’d like to give an example of what can happen if you don’t give your body enough rest and nutrition. It’s a cluster of symptoms called the Female Athlete Triad and is, indeed, seen most often in women. Nevertheless, men can suffer from a similar condition, so I strongly encourage you guys to read on.

Female Athlete Triad – what is it?

The Triad is a cluster of 3 symptoms that are seen particularly in young female athletes: disordered eating, amenorrhoea (loss of periods) and osteoporosis (loss of bone mass). Its prevalence seems to be higher in sports emphasizing leanness and physique, and where body weight is important for performance (running, cycling, swimming, XC skiing etc). Together these symptoms can obviously pose a serious threat to health.

 

This condition is considered to start with disordered eating. Poor nutrition then triggers the other two symptoms. ‘Disordered’ doesn’t necessarily imply an eating disorder like anorexia nervosa or bulimia, but merely that energy intake and expenditure don’t match. This might be unwilling, when the athlete is eating too little without knowing, or, more seriously, the low energy intake is the result of a diet to lose weight. Since both voluntary and involuntary energy restriction can lead to the other two components of the triad (amenorrhoea and osteoporosis) it is important to realise that someone doesn’t necessarily have an eating disorder to have the other two symptoms. One can think of women on vegetarian or vegan diets, or people who have a bowel disease, food intolerance (lactose, gluten) or food allergy, all conditions that might complicate adequate intake of essential nutrients.

Leanness is considered important for performance in weight bearing sports such as running.

The disordered eating can lead to a fertility problem, reflected in the absence of menstruation for 3 consecutive periods, also called amenorrhoea. Low body mass and/or low energy intake is a signal to the body to go into an energy conserving mode, which, not surprisingly, does not include being able to conceive and grow another little human. Thus, fertility is reduced. Problem is, birth control measures like the pill can mask this symptom very easily. Osteoporosis is the loss of bone mass from the body. Up to the age of about 30, bone mass should be build and bones get stronger and stronger. But, when intake of nutrients essential to bone mass, like protein, calcium and vitamin D, is too low, bone mass will actually decline. Also, the change in hormone levels that accompany menstrual problems compromises bone mass increases. Stress fractures as well as ‘real’ fractures are often a warning sign of low bone mass. Sure, you break a collar bone in a failed attempt to avoid your neighbour’s dog on your bike, but frequent stress fractures and other recurring injuries should get you worried over your bone density.

A stress fracture in the hip bone, surgery was needed. Source: femaleathletetriad.org

While (voluntary) disordered eating can and should be treated with psychotherapy, the loss of fertility and bone mass might not be as reversible, thus potentially leaving huge consequences for the rest of one’s life.

A myth?

Science wouldn’t be science without a controversy. The definition of the Triad as stated by the American College of Sports Medicine is rather broad, meaning that many female athletes (>60%) might fall into this category. And what if an athlete, for example, has disordered eating and no periods, but her bone mass is not (yet) in the danger zone? Studies investigating the prevalence of the syndrome are also ambiguous. The symptoms of the Triad are, after all, also seen in non-active women –and perhaps even as often as in athletes. All in all, some scientists fear that focussing on the negative effects of sports casts a shadow over the positive effects, and might scare women away from activity. In a society where overweight and obesity rates are sky high, this might not be the right direction to take.

The female triad in men

Okay, guys don’t have periods. But they do have sex hormones. And these levels can be disturbed, just as in women, and with similar consequences for fertility and bone health. And, not to mention, adaptations to exercise such as muscle growth, protein synthesis and production of red blood cells. Indeed, male endurance athletes often have lower testosterone values. Problem is that not much research has been done on the prevalence and consequences of disordered eating (or downright eating disorders) in men so it’s hard to say whether disordered eating is a part of this.

Take home message? It’s worth remembering that too much of a good thing might not be...good. Don't restrict your energy just because it makes you a little faster. Ask for a bone scan if you think you are at risk (have had stress fractures, have bowel disease etc). And, dare to talk to a fellow athlete (or his/her coach) if you think someone is at risk. But don’t use this syndrome as an excuse to open another bag of chips.

Interested in reading more? Click on the text for a link.
- www.femaleathletetriad.org

- Andrological aspects of physical exercise and sport medicine.

- American College of Sports Medicine position stand. The female athlete triad.

 

Source: femaleathletetriad.org