Tuesday, April 10, 2012

Beware the Female Athlete Triad

Female sports participation at the high school level has significantly increased since the 1970s.  Nationwide, boys still outnumber girls in high school sports, at a ratio of roughly 3:2, according to the 2011 High School Athletics Participation Survey from the National Federation of State High School Associations, but female participation has increased every year since 1988-89.  *

Physical activity in females has numerous positive benefits, including improved body image and overall health. Unfortunately, a select population of exercising females may experience symptoms related to the "female athlete triad (FMAT)," which refers to the interrelationships among energy availability, menstrual function, and bone mineral density.

According to the University of Wisconsin School of Medicine and Public Health:

Clinically, these conditions can manifest as disordered eating behaviors, menstrual irregularity, and stress fractures. Athletes with conditions related to the triad are distributed along a spectrum between optimal health and disease and may not experience all conditions simultaneously. Previous research related to the triad has primarily focused on collegiate and elite athletes. However, mounting evidence demonstrates that the triad is present in the high school population. High school athletes should be assessed for triad components at pre-participation physicals. In addition, parents, coaches, and health care professionals should be educated and informed about the female athlete triad syndrome. In the presence of triad symptoms, further evaluation and treatment by a multidisciplinary team is strongly recommended for the athlete. **

The evidence may show an increasing rate of FMAT among high school girls but why now?  My best guess is that girls are participating in competitive sports more than they ever have.  Additionally the demands of the “travel team” schedule and nearly year round sports consistently beat their bodies up with little if any time for restoration.  The popular media may play a role by creating a false image of health and beauty for young girls, though this issue has likely been around for decades.  Girls are bombarded with images on magazine covers, TV and the movies and then look at themselves in the mirror and think they are “fat.”  The natural result is girls think they eat too much and cut back on their food intake.

This sets off a chain reaction that is at the core of the FMAT.  Developing and active young women have high energy demands and throw into that mix the menstrual cycle and it’s recipe for trouble if they decide to restrict food intake.

Last week I touched on the fact that menstruating women have a higher risk of iron deficiency.  Valuable nutrients like iron are lost in the menstruation process and they need to be replaced by eating food.  Similarly the stress fractures related to this syndrome are at he least partially due to the lack of nutrients available for the regeneration and lying down of new bone.  Females that cut back on food because they think it’s making them “fat” are putting their immediate and long-term health at great risk.

The participation of women in sport has evolved to the point it’s no longer considered odd, it wasn’t that long ago that it was frowned upon.  However the idea those women don’t need to eat very much food has not evolved.  Active and developing young women should be encouraged to eat enough food to meet their energy requirements.  According to the Center for National Health the estimated energy (caloric) needs for highly active girls age 8-15 range from 2100 (8 years) up to 3000 (15+years) calories a day.

Strategies to help girls meet their nutritional needs must extend beyond calorie counting.  We don’t eat calories we eat food so asking a young girl to count calories would ultimately be a fruitless exercise, not to mention irresponsible in my view.   While we need to make sure children are getting enough food, the type of food they eat is significant.  It’s quite possible and a reality given the high levels of youth obesity in this country, that many children are overfed and undernourished.  Kids eat a lot of packaged and processed food that lack the essential vitamins, minerals, protein, fiber and healthy fats that are essential for optimal growth and development.  So even if a young girl is meeting her daily energy requirements she could still be malnourished if she’s not eating the right type of foods.  So the FMAT is not just a problem for girls that are thin it can affect girls of all heights and weights.

 Here is what I recommend for highly active young ladies:

1.     Eat breakfast every morning
2.     At each meal have fruit, vegetable, protein source (animal or vegetarian)
3.     Eat a snack after school or before practice
4.     Drink plenty of water throughout the day especially after practice/game
5.     After an intense practice or game especially in the heat an electrolyte replacement drink like Gatorade is a good choice.
6.     Eat your biggest meal after exercise.  This meal should include protein, fruit and vegetable, and/or a serving of starch like brown rice or sweet potatoes.
7.     No need for protein shakes, go for a glass of grass fed milk.  Chocolate milk is a good choice after intense exercise.
8.     Include healthy fats each day from sources like almonds, walnuts, avocado, olive oil, and whole pastured eggs.
9.     No supplements required if you are eating a variety of whole foods.  Fish oil may be the lone exception because eating a lot of fish is not recommended because of mercury concerns.  For healthy individuals pure fish oil is highly beneficial but check with your doctor or pediatrician for proper dosages.

Another strategy that is the best option in my mind is one relating to leadership.  I know plenty of mothers that set terrific examples for their children because they are extremely active and walk the talk by eating nutritious foods.  Role modeling has a powerful impact on our youth. 

I have also been heartened in recent years by many of the high school girls I have coached.  They seem to have a better understanding than their male counterparts of the importance of eating nutritious foods.   These young ladies should be encouraged to mentor the younger girls and show them what being fit and healthy really looks like.

Starving your self to look like a cover model is not cool, more importantly it’s not healthy.  Boys click on ESPN and have plenty of athletic role models to choose from, for better or worse.  Positive athletic females aren’t quite as visible or as easy to find in today’s culture.  Maybe that is the next step in the women’s athletic revolution, a new definition and image of a healthy young lady…  Ladies are you ready to lead?

I would also like to point out that many teenagers are at the point where image is very meaningful and they may decide to make statements through their lifestyle choices.  One of these choices may be to become a vegan or vegetarian.  I am not one to discourage any type of lifestyle choice particularly if it is on the grounds of ethical or health concerns.  That said, it is extremely important that if a young child makes the decision to try the vegan or vegetarian lifestyle that they get professional guidance to ensure they don’t develop any nutrient deficiencies.  Nutrients sourced from animals are plentiful and highly beneficial for the body.  If these nutrients are missing, a plan must be in place to make up for any potential deficiencies.

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