From the Desk of Joleen Wilson, Pathway Dietician: The Dangerous Female Athlete Triad
Written by: Joleen Wilson, Registered Dietician, Certified Nutrition Support Clinician, for Pathway for Eating Disorders Treatment at Brookhaven Hospital
The Female Athlete triad is made up of three conditions that may vary in severity: 1) energy deficiency with or without disordered eating, 2) menstrual disturbances/amenorrhea, and 3) osteopenia/osteoporosis. The female athlete triad can start out as an innocent approach to better one’s physique for various reasons, including competitive sports, enjoyment through exercise, or over-exercising stemming from eating disordered behavior, to name a few. Many teenage girls face concerns with body image and a high drive for obtaining the thin ideal. Sometimes, these conditions can lead to disordered eating, or more serious eating problems like anorexia or bulimia. One such form of purge-type bulimia is over-exercise, where individuals exercise to the point of exhaustion to compensate for calories consumed. Coaches, parents, and peers often do not pick up on the fact that a young athlete may have developed an eating disorder and the female athlete triad may deteriorate into amenorrhea and/or bone loss.
Amenorrhea, defined as no menstrual period for 3 months or more, is common among athletes due to low body fat percentage secondary to frequent exercise and/or food restriction. Going long periods without a menstrual cycle puts a female at increased risk for bone loss due to dysregulation of the hormones progesterone and estrogen. While weight bearing exercise like running and weight lifting are thought to be protective against bone loss, these types of exercises (especially long distance running) are associated with the highest incidence of the female athlete triad.
Osteopenia and osteoporosis put individuals at increased risk for fractures, both from a simple stumble or from participation in organized sports. While we associate fragility fractures with the elderly population, their incidence is increasing in teens participating in sports due to the female athlete triad.
A quandary of mine regarding the female athlete triad is the TYPES of foods that teenagers are eating, further contributing to poor bone health. We know that foods high in calcium and vitamin D, like milk, salmon, and others are supposed to support bone health. The problem is that the diet of most young people consists of food with little nutritive value, such as soda, chips, and chocolate bars. While these foods are calorie dense and may protect against weight loss, they do not provide teens with necessary vitamins and minerals to support bone health. Therefore, many athletes may benefit from consultation with a Registered Dietitian to discuss ways to incorporate calcium- and vitamin D-rich foods into their diets. Furthermore, a multivitamin and mineral supplement can be a nutritional safeguard if the diet is thought to be poor.