The Female Athlete Triad

What is the Female Athlete Triad?
The female athlete triad is a trio of the following symptoms that are found in some female athletes and exercisers; relative low energy availability, menstrual dysfunction and compromised bone mineral density (BMD). To summarize the triad briefly, it is the eventual (and somewhat permanent - although can be moderately treated) loss of bone density caused by severe calorie deficits
Are certain groups more likely to be effected than others?
This condition is typically seen in weight controlled sports and performance related fields and or those activities/lifestyles that induce frequent low energy availability. Research shows that the groups most commonly associated with showing symptoms of the triad are those within the performing arts (dancing etc.), track and field and or sports requiring an athlete to meet a certain weight (combat sports among some others). However this has now crept into the group of everyday “gym goers” and or women looking to achieve a certain physique.
Should I be concerned?
It may not seem like that important of an issue to some, with loss of menstruation possibly even seen as a “blessing” for some. However, menstrual dysfunction is certainly not normal and, the most severe issue with the female athlete triad is that compromised BMD, is asymptomatic, meaning that there are no real external, visual effects that can be easily noticed. Discovery of low BMD may only occur after the early onset of osteoporosis, arthritis and or when an athlete incurs a bone fracture or suffers increased frequency of fractures (from a relatively low impact event) as fracture risk increases as BMD decreases.
How serious is compromised BMD?
Well, common sense aside, increased risk of fracture means you’re more likely to incur a fracture. Not only are they incredibly painful (trust me), but they’re also debilitating, meaning simply, you can’t do what you normally like to do and or are very limited in what you can do. A fracture that could very well cost you your sporting and or performance career (and if not costing your career, severely impeding your progress and or having a permanent detriment to overall ability). The older you get the more serious the issue of “increased fracture rate” becomes as falls are the number one cause of fatal and non-fatal injuries in those aged 65 and older.
What part does nutrition and exercise play in all this?
Quick fix diets, “online gurus” and your local "experts" who may not be educated in the matter of gender specific dieting issues, all advocate the same thing for weight loss; non-specific, very-low calorie diets (VLCD) and excessive and scaling levels of exercise. This isn't just an issue of education however and can also be the fault of the individual choosing to self-employ these methods as people are so desperate for instant gratification to look, perform or even weigh a certain way or amount that their actual health is often forgotten about. Ironic that, isn't it?.
Regarding the nutrition component of these causes, we here at Team OutWrk are advocates of research, and there is a growing field of research on the use of VLCD diets to induce rapid weight loss. These diets are facilitated through the use of carefully designed shakes that provide all a person’s daily requirements (based on DRVs/RDAs) and the individuals in the studies are carefully monitored by a team of research and health professionals. These diets are used for morbidly obese individuals (typically who are facing life-threatening weight related issues and or need to make a certain weight for an upcoming surgery), not the everyday individual looking to lose a bit of body fat or improve body composition. Employing a poorly planned VLCD without the proper supervision is detrimental for the following reasons;
  • It wasn’t designed to meet your daily dietary requirements
  • It isn’t being monitored by a health professional (to conduct blood tests and monitor physical markers of health)
  • These are short term, extreme methods for weight loss - not long term tactics (they aren't sustainable nor are they healthy both physically and psychologically)
  • The refractory weight gain from a dietary approach like this will virtually negate any benefit you may have incurred from it as well as leaving you with a possible eating disorder.
It should also be noted that the severe food restriction not only impacts energy availability but also reduces the likelihood that you’re achieving your body’s requirements for certain nutrients and minerals which, relevant to bone health, would be calcium, vitamin D (which you do predominantly get from UV rays from the sun, but you can also get it from some dietary sources too), protein, vitamin K and even some non-digestible oligosaccharides.
Relative excessive exercise is also a key contributor. This is amplified when it goes hand in hand with relative low energy availability. For women, these two factors can affect them physiologically (and arguably more severely than men) as well as psychologically (but we’re not going to discuss that today as it deserves its own article). In short, women’s bodies tend to fight back harder, and sooner, the more extreme the approach to weight/fat loss is.
The science behind the Female Athlete Triad - The importance of Oestrogen
For women, within several days of inadequate energy availability, hormone levels crash. Oestrogen is one such hormone, and it is of particular relevance regarding any discussion surrounding the female athlete triad.
Oestrogen regulates bone density by; increasing bone resorption, protecting osteoblasts (the bone cells that aid in the growth and development of new bone and teeth) and reducing and or regulating the activity of osteoclasts (which regulate bone resorption, and if they become over active can result in osteoporosis).
So, if oestrogen levels drop, BMD can also begin to decrease (the longer and more severe the energy availability issue is, the greater the effect there will be on hormone levels and therefore BMD). BMD can continue developing up to the age of thirty where it reaches its peak. However, once compromised, getting BMD to a normal range may not be possible depending on the timing, severity, and duration of energy restriction and the individual will certainly never reach their peak BMD.
In Summary
Anyways, in summary, extreme solutions for problems that require patience, consistency and a conservative approach are the wrong approach. Obviously, there will be some scenarios in which rapid weight/fat loss is required but for most, particularly athletes, you need to remember to fuel your body to perform. Not just in the gym, on the field or whatever but also in your day to day activities.
I understand the desire for immediate fixes, I do, but look at it this way; are you willing to sacrifice your long-term health (both physiological and psychological) for some short lived, short term gain? Is it really worth stunting your metabolic rate, leaving you prone to weight and fat regain as well as damaging your relationships with food?
You want our advice? Here it is; Don't always seek the shortcuts and the promise of fast/immediate results. Don’t be afraid to ask “why”. If someone can’t explain the purpose behind an action or change in a way that you deem acceptable, don’t be afraid to refute it and refute their service. Seek education, it’ll help you, protect your health and improve your performance - both now and in the future.
Weight loss, fat loss and body re-composition isn’t complicated nor is it as extremely difficult but it is a game of patience; be in a relative and sustainable calorie deficit, consume adequate amounts of protein as well as your other daily requirements and exercise in the right amounts (bearing in mind your targets and how much you are consuming and what your rate of recovery would be in a calorie deficit - the more of a deficit the longer it typically takes to recover. It is better to be patient and consistent than desperate and aggressive with weight/fat loss and body re-composition in most cases, trust me, your body will thank you for it.

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