Jan 29, 2015
Understanding the Female Athlete Triad

As the number of high school girls participating in sports increases so does the number of girls afflicted with female athlete triad, a combination of an eating disorder, decreased bone density, and markedly low levels of estrogen. While the affliction can seriously threaten a young woman’s health for years after she finishes playing sports, Dawn Weatherwax-Fall’s “The Female Athlete Triad: Body Fat vs. Energy Balance–Effective Prevention and Treatment Techniques” workshop discussed how tackling issues with food and physiological behaviors can help reverse the negative impact.

Proactive athletic trainers have clutch roles in helping young players overcome female athlete triad, said Weatherwax-Fall. Because this disorder is primarily habit based, any little changes a young woman makes in her diet will result in improvements relatively quickly. The tricky part, however, is overcoming certain social trends and misperceptions:

  • Female athlete triad can be overlooked if a high school student is of normal weight, falls between 17 and 25 percent body fat, and is otherwise healthy.
  • Approximately 60 percent of high school students (males and females) get the recommended daily allowance (RDA) of calcium a day.
  • Wanting to stay “lean and mean,” female athletes tend to avoid high-calorie, yet energy-sufficient foods, which can impair how the body metabolizes fat and glycogen.
  • Food aversion is commonly mistaken by the public as an eating disorder, such as anorexia nervosa. Food aversion is a physiological behavior; eating disorders are psychological behaviors.
  • The majority of high school female athletes believe missing menstrual cycles is normal. In fact, the opposite is true. Consistently missed cycles are often the first indicators that estrogen levels have dropped below the hormone’s normal threshold, which increases the odds of depleted bone mass later on in life.
  • Overall, women are less likely to take mineral supplements than males. Instead, women’s diets are more likely to include juices or foods marked as having “added” health benefits.
  • The body has difficulties absorbing some these “added benefits” foods because of how they are processed.

The good news amid these findings is that research has found by upping the intake of calcium, vitamin D, and magnesium–often the forgotten mineral when it comes to talk on bone health– a few units above the RDA value, bone mass increased by five percent in young adults (male and female). In addition, high school females accumulate 70 to 80 percent of their bone density by their senior year. Bone density in women peak between 25- and 30-years old, so time is on the young female’s side to reach her maximum levels with just a little extra effort.

As far as what an ATC and strength and conditioning coach can do to help guide a high school athlete toward overcoming treating female athlete triad, Weatherwax-Fall suggests:

  • During pre-season physicals or on a health form, ask the athlete when she last had her menstrual cycle and what her daily mineral intake is.
  • Flag abnormalities and ask the student about her diet to see if she is maximizing her meals to fit her energy needs. (This may require a week-long food journal and a follow-up visit.)
  • If there is an imbalance between the player’s energy expenditure and diet, refer her to a registered dietitian or sports nutritionist.
  • If the abnormalities appear serious or if the athlete has consistent episodes of missed menstrual cycles, talk to her parents about getting a blood test to measure the player’s vitamin D levels as well as undergo a metabolism test to measure exactly how her body is exerting energy. The results will help rule out any serious medical conditions and help the female athlete and her dietitian develop meal plans that optimize her health needs.
  • Encourage incremental weight lifting programs as part of the athlete’s training to increase bone strength. (This is easier said than done, Weatherwax-Fall says, as many high school girls view “bulking up” negatively and unfeminine.)

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