Female Athlete Triad and Nutrition

Female Athlete Triad is a syndrome in which female athletes have three interrelated symptoms; disordered eating, amenorrhea, and premature osteoporosis. Female Athlete Triad can managed and treated by, a balanced diet and higher caloric intake. In 1993, the American College of Sports Medicine began using the term female athlete triad to describe the relationship between disordered eating, amenorrhea and premature osteoporosis. With the passing of Title IX, the number of elite female athletes greatly increased. The rise in female athletes participating in organized sports has led to an increase in the number of athletes with the triad. It is most prevalent in sports promoting a lean appearance, such as distance runners and gymnasts. The triad is caused by an insufficient caloric intake to meet the energy demands of the athlete.

Disordered eating is often the cause and beginning of the triad. The causes of disordered eating in women are complex and involve social, psychological, and physiologic factors. Risk factors contributing to disordered eating in both athletic and non-athletic women include social pressures to be beautiful and thin, poor self-esteem, family dysfunction, sexual abuse, dieting, and biological factors. In athletes, additional factors may encourage disordered eating, including self-imposed expectations of athletic perfection and a belief in the inverse relationship between body size and performance. Pressure from coaches and parents to win at any cost may also be a contributing factor to unrealistic body image expectations. Athletes often believe that being thinner will improve their performance. This however is not often the case, because the lack of calories often results in a loss of muscle mass, and lower energy levels.

Disordered eating can range from the extreme end of the spectrum as bulimia nervosa or anorexia nervosa, to the less extreme end as a tendency towards restrictive eating, or possibly just inadequate caloric intake as forgetting to eat and not eating enough. Disordered eating among athletes begins with restrictive eating and calorie counting. The body needs a minimum amount of calories to function, too little caloric intake results in a decreased metabolic rate that hinders musculoskeletal and cardiovascular performance. Over time endocrine function is altered, and amenorrhea may ensue with sequelae.

When athletes try to lose weight to meet weight expectations or goals they have set for themselves, they often unknowingly put themselves at risk. Increasing the athlete's caloric intake and ensuring they have a balanced diet, greatly reduces the risk for the triad. The American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine are of the position that athletic performance, physical activity and recovery from exercise are enhanced by optimal nutrition. Theses organizations, suggest that the athletes choice in the food and fluids they injust, when they ingest them and the supplements they chose to take, can have a great positive effect on optimal health and peak exercise performance.

Amenorrhea the abnormal absence of menstruation specifically the absence of the last three menstrual periods, it is the most recognizable symptom of the triad. An unbalanced diet, inadequate caloric intake relative to exercise level and excessive amounts of training may contribute to menstrual abnormalities such as amenorrhea. Amenorrhea is present in 2%-5% of the general population. However it is found in 3.4% - 44% of Athletes. Amenorrhea is found in two forms, primary and secondary. Primary amenorrhea is the absence of menstruation by the age of 16 in a female with secondary sex characteristics. Secondary amenorrhea is the absence of menstruation for three to twelve consecutive periods after the first menstruation cycle. The most common cause of secondary amenorrhea in athletes is exercise-associated amenorrhea. It is believed that exercise-associated amenorrhea is the result of a disorder in the hypothalamus and results in a hypoestrogenic state. More specifically there is a lowering in the pulse frequency of gonadotrophic-releasing hormone. Resulting in a decrease in the frequency of luteinizing hormone from the pituitary. Over time, low estrogen levels can result in diminished