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Female Athlete Triad SyndromeSammie SeamanNTR 300

+What is the Female Athlete Triad?

The triad is a combination of 3 health complications; energy deficit/disordered eating, menstrual disturbances/Amenorrhea, and bone loss/Osteoporosis. It is likely that an athlete suffering from just one of the elements is suffering from all three as well. Most athletes are not diagnosed with extreme cases but may display intermediate symptoms. For example, an athlete may show signs of restrictive eating but not meet the criteria for an eating disorder. It is most common among athletics that require leanness, train an excessive amount of hours, and demand of the body.

+The New Model

The Triad was first identified 25 years ago. Recently the model has advance with more research upon the topic. Originally the three components were disordered eating, low bone mass, and amenorrhea. The components have been proven to be related to each other as energy deficiency is linked to development of menstrual disturbances, as well as, low estrogen initiating bone loss. The new model reaffirms this but, it is being represented as a continuum of severity of healthy disease. This model also highlights athletes that may not present the extreme ends of the continuum, but the intermediate cases and the progressions along the three main points. While the conditions represented by each continuum can occur independent of the other two conditions, it is likely that an athlete suffering from one condition is suffering from the other three too.

+Signs of the Female Athlete Triad

There are many signs and symptoms that an athlete may have the syndrome. The most common is restriction of food intake which will leave an athlete feeling tired and fatigue. Many athletes have the a constant feeling to be thin. They eat less then needed in an effort to improve their performance and physical appearance. Since athletes aren’t getting enough caloric intake, the body shuts down. Stress fractures and recurrent injuries are also a side effect of the triad. Other side effects may include trouble sleeping, cold hands and feet, and irregular menstrual cycles.

+Which Sport Does this Effect the Most?

The Triad is seen in sports that emphasize leanness. It is most commonly seen in cross country, gymnastics, ballet and figure skating. Female athletes are expected to be fit, lean and competitive in their sport. They also have the pressures of today’s society, which places a high emphasis on body image and thinness. Because of this, some athletes will use extreme measures to reshape their bodies. Female athletes will diet or restrict various food groups in the hope that a thinner body will make them better in their sport.

+Energetic Efficiency, Menstrual Irregularity, and Bone Mineral Density in Elite Professional Female Ballet DancersBy: Ashley F. Doyle-Lucas, Ph. D., Jeremy D. Akers, Ph.D., and Brenda M. Davy, R.D., F.A.C.S.M.

The graph above shows the relationship between female dancers and lean control women and the resting metabolic rate. The less calories consumed the lower the metabolic rate. This only proves that eating less does not always benefit the body

This second graph explains how energy efficiency is related to resting metabolic rate. The lower the metabolic rate the less energy an athlete will have.

+Nutrition

As you can imagine, constant dieting and/or restriction of energy intake can have a negative impact on nutritional status, repair of muscle tissue and recovery from injury. Many athletes do not know how to lose weight in a healthy way. They frequently fast, skip meals and/or eliminate food groups, such as meat and dairy. Energy restriction and the elimination of food groups can dramatically reduce the intake of protein, carbohydrate and health fats, which are necessary to fuel exercise and recover from hard training. Protein intake may be inadequate for the building and repair of muscle tissues, while inadequate carbohydrate intake will reduce muscle glycogen replacement. In addition, many of the micronutrients needed for bone (calcium, magnesium, vitamin D), energy production (B vitamins), red blood cell and hemoglobin synthesis (iron, folate, B12) and immune function (zinc, antioxidants, iron) may be missing from the diet. In young athletes, reduced energy intake can also compromise growth. Female athletes need to learn that food will help fuel them in their sport and give them the energy and nutrients for growth and good health.

+Nutrition: Calcium

Calcium is important when building and maintaining strong bones. This is essential when talking to athletes about nutrition linked to the Female Athlete Triad Syndrome. Overtime if your diet is too low in calcium your bones become weak and will be more susceptible to breaking. Here is a chart of important calcium sources:

+Nutrition: Vitamin D

Vitamin D is a nutrient found in some foods that is needed for health and to maintain strong bones. It does so by helping the body absorb calcium form food. Athletes with little vitamin D intake develop soft bones. The amount of vitamin D you need each day depends on your age. Average daily recommended amounts from the Food and Nutrition Board (a national group of experts) for different ages are listed below in International Units (IU):

The best source of vitamin D in foods is fatty fish such as salmon, tuna, and mackerel. The body makes vitamin D when it is directly exposed to the sun, and most people meet their vitamin intake this way.

+Risk Factors

The Female Athlete Triad is a serious syndrome and is being seen more in women’s athletics. Health consequences are linked to each point of the triad. Eating disorders can also lead to medical complications involving the cardiovascular system, endocrine, reproductive, skeletal, gastrointestinal, renal, and central nervous system. Amenorrheic women are infertile due to the absence ovulation. This can also effect the skeletal muscle oxidative metabolism, low-density lipoprotein cholesterol levels, and muscle fatigue. Low bone mineral density can be a result of not enough nutrient intake which can lead to reoccurring stress fractures. Women with low bone mineral density increase their chances by four times as much.

+Prevention

The best way to prevent the Female Athlete Triad from happening is by educating athletes, coaches, and parents on the subject. This will allow them to recognize it and take steps to prevent it. As a coach:

Remind athletes that eating is an important part of successful training and performance.

Focus on a healthy body image, and NOT on weight. Support athletes through training and everyday life Have available resources such as nutritionists, trainers, or counselors.

As an athlete: Monitor menstrual cycle by using a calendar. Consult a physician if you have an irregular menstrual cycle and recurrent

injuries like stress fractures. Talk to a counselor if you are overly concerned about your body image. See a sport nutritionist to help you design a healthy diet that is specific to

your sport. Seek emotional support from coaches, guardians, or teammates.

+Sources

Thompson, S. (2007). Characteristics of the female athletic triad in collegiate cross-country runners. Journal Of American College Health, 56(2), 129-136. chart collegiate female athlete article

Doyle-Lucas, A. F., Akers, J. D., & Davy, B. M. (2010). Energetic Efficiency, Menstrual Irregularity, and Bone Mineral Density in Elite Professional Female Ballet Dancers. Journal Of Dance Medicine & Science, 14(4), 146-154.

Female Athlete Triad Coalition. Female Athlete Triad Organization, 2012. Web. 30 Sep 2012. <http://www.femaleathletetriad.org>.

Office of Dietary Supplement. National Institute of Health, June 24, 2011. Web. 30 Sep 2012. <http://ods.od.nih.gov/factsheets/VitaminD-QuickFacts/>.

Manore, Melinda. "The Female Athlete Triad: Nutrition and Eating." Sports Coach. National Institute of Health, June 24, 2011. Web. 30 Sep 2012.