If you’re a female athlete you’ve probably heard of the female athlete triad – even if you didn’t know that’s what it was called. The female athlete triad is a combination of the following:
1. eating disorders or disordered eating
2. low bone mineral density
3. menstrual irregularity
There are varying degrees of each of the above and an athlete with the triad may display one condition more than another, but all three are closely related (1). Although female athletes from any sport can exhibit the triad, it is most common in sports that emphasize leanness or a low body weight for performance – gymnastics, ballet, distance running, and weight class sports.
In competitve sport environments, the pressure to perform can lead athletes to develop disordered eating behaviors. In fact, traits that make good athletes are also often the same as those the put one at risk for an eating disorder – perfectionism, high achievement orientation, and obsessive-compulsive tendencies (2,3). Disordered eating is different from a diagnosed eating disorder and can include things like avoiding certain foods/food groups, severely limiting calories to achieve a desired weight or body composition, and skipping meals. While many athletes may not meet all of the specific criteria for an eating disorder, a large number display disordered eating behaviors.
Some athletes may not even intend to alter their eating behaviors but, due to large training volumes, fail to meet their energy requirements and end up in an energy deficit, meaning they aren’t consuming enough calories to meet thier energy needs for daily life and training (4,5,6). Most websites and fitness apps do not provide reliable health and nutrition information, especially for an athlete training at a high level. Working with a sports dietitian is the best way to ensure that you’re meeting your specific energy requirements.
Whether intentional or unintentional, consuming fewer calories than your body requires forces your body to make several changes in order to survive. Processes that your body doesn’t feel are necessary for survival are essentially cut out in order to save energy for processes that are required for survival (7). This is why many female athletes struggle with menstrual irregularity or complete absence of the menstrual cycle (called amenorrhea). Reproductive function isn’t absolutely necessary for survival, so the body decides to take the energy that would usually be spent on normal menstrual function and use it elsewhere.
Although this may sound rather convenient, the hormones associated with normal menstrual function serve several other functions in the body, like normal bone and cardiovascular health (1,8). An abnormal menstrual cycle in the teens and early 20s when bones are still developing can lead to weak bones, stress fractucres, or even osteoporosis.
Hormone replacement therapy is often prescribed to athletes struggling with menstrual irregularity, but research suggests that this is not enough to overcome the hormal imbalance caused by inadequate energy intake and protect against bone loss or other detrimental effects (1, 9, 10, 11, 12, 13). The preferred method of treatment is increasing energy intake (1, 14, 15). However, for an athlete with an eating disorder, this is much easier said than done. If you or someone you know struggles with an eating disorder, seek help from medical professionals. A doctor, psychologist, and registered dietitian are all important parts of the team in helping an athlete overcome an eating disorder.
Although the main focus here is on females, male athletes can also suffer from disordered eating/eating disorders and, as a result, poor effects on their health. Recently, relative energy deficiency syndrome (RED-S) was proposed as a new way to describe the effects of not consuming enough calories to support physical activity as a way to recognize that males can suffer from the consequence of under fueling as well (16).
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