The female athlete triad: nutrition and eating
Issue: Volume 30 Number 1
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.
Unfortunately, the dieting techniques or eating practices they use are unhealthy and can lead to disordered eating behaviours and, in extreme cases, a clinical eating disorder. Low energy intake in highly active females can bring about a cascade of events termed the Female Athlete Triad (Triad) by the American College of Sports Medicine. The Triad refers to the causal relationships between low energy intake, menstrual function and bone health, which may manifest as eating disorders, amenorrhea (no menstrual cycles) and low bone density or osteoporosis.
How does restricting energy intake impact on the menstrual cycle and bone health? First, when energy intake is low the body does not have enough energy to cover the cost of physical activity and the energy costs of daily living, menstrual function and growth. The body senses this low energy intake and signals the reproductive organs to reduce the production of oestrogen and other reproductive hormones. Second, this low energy intake also increases cortisol, a catabolic hormone that has a negative impact on muscle and bone. Third, oestrogen plays an important role in calcium absorption, so low oestrogen levels can decrease the amount of calcium in the body, which prompts the removal of calcium from the bone. In this way, energy intake that is too low to cover the cost of both physical activity and the other energy demands of the body can bring about menstrual dysfunction and the loss of bone. This cascade of events can impact on the health of the athlete by increasing their risk of injury, especially stress fractures, while decreasing their nutritional status and ability to perform at their best.
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 haemoglobin 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.
How can you be sure that your female athletes are getting the nutrition they need to fuel their sport, perform at their best and stay healthy? How do you know if they are eating enough to avoid the health problems associated with the Triad?
You will know if your athlete is not eating enough food if you notice that they display the following characteristics:
- hunger, irritability or difficulty concentrating before or during exercise
- shaky or light headed before, during or after exercise
- not growing (young female athletes)
- no menstrual period by age 15, irregular periods or cessation of periods
- weight loss in a normal weight or thin athlete.
What can you do to help fuel your athletes for optimal performance and good health? If you have access to a sports dietitian, use them to talk to your athletes about good nutrition and help those athletes who struggle with their weight. If you do not have a sports dietitian, use the following guidelines to help get your athlete fuelled for exercise while also keeping them healthy.
Fuel before exercising
If training sessions are from 3.00pm to 6.00pm, make sure your athlete eats lunch at noon. They may also need a snack at 2.00pm. This snack should contain ~800–1600 kilojoules (200–400 calories), for example:
- half a sandwich
- one or two pieces of fruit
- carton of yoghurt
- energy, breakfast or granola bar
- 250–355ml of fruit juice
- bagel spread thinly with light cream cheese, peanut butter or jam
- bowl of cereal and milk
- fruit smoothie
- crackers and cheese/peanut butter.
Eating a snack before exercise provides energy to fuel the brain and muscles. Fuelling the brain enhances concentration on athletic performance. If the exercise training session is long, it may be important to eat during exercise breaks. A piece of fruit, a glass of juice or a sports drink can keep your athlete energised.
All the energy consumed before and during a training session will be used during the workout, so you should not worry about your athletes gaining unwanted body fat. Of course, the more your athletes exercise, the more energy they need to fuel their body. Teach your athletes to listen to their body and eat when they are hungry.
Eating on the road
Pack snacks! Energy bars, granola bars, dried fruit, fruit and yoghurt are convenient and pack well. This way you have healthy snacks on hand.
Drink water
Water is vital for optimal muscle performance, so encourage your athletes to drink water freely and frequently during the day. They may also need to use a sports drink during exercise, especially on hot days or when they are exercising hard for longer than one hour.
Refuel after exercise
It is important for athletes to refuel their body for the next day. A hearty meal after exercise will provide energy for building and repairing muscle tissue, refuelling the energy stores of muscles, and preparing the body for the following day’s workout.
Your female athletes can achieve maximum performance by eating enough food to fuel their body, while still maintaining a healthy body weight. Help your athletes see that making good food selections will improve their performance and can be the key to a winning season.
