So, if you've recently seen a doctor or else maybe just done your own inventory of your health and come to realize that you are suffering from part or all of the female athlete triad, then you may be wondering where you go from here.
There are many different strategies that you may take to help improve your health status and prevent any further complications of this condition.
1st Coming To Terms
The first step is obviously coming to the realization that you are suffering from this condition. Classic warning signs would be complaining about feeling any of the following:
- An inability to make it through a workout without feeling extremely fatigued.
- Higher than expected heart rate while training, along with a shaking feeling.
- Feeling hungry and irritable before or during your workouts.
- Inability to hold concentration for long periods of time.
- Missed menstrual cycles.
- Depressed immune system (frequent colds, injuries, or constant fatigue).
If you decide to go to the doctor, they may also run tests to check your blood profile, while paying extra attention to the level of reproductive hormones present in your body.
With self-diagnosis however, it is possible to misdiagnose yourself with this condition when you may just be suffering from normal fatigue or excess stress, however if you are continually feeling these symptoms it is best to get a professional opinion as it is better to ere on the safe side when we are considering your health.
2nd Diet Changes
The next, and perhaps the most important step that you should take to overcome this condition is by making progressive changes in your diet. Most female athletes require at least 1800 calories a day to ensure adequate energy and macro and micro-nutrients to maintain good health.
So, if you have been consuming significantly less than this, the first step would be to bring your total calories up to a more appropriate level. Often just performing this step is enough to get the athlete menstruating again and relieve them from many of the above mentioned symptoms.
Macronutrient Requirements ///
With regards to macronutrient requirements, the female athlete will want to ensure she is getting at least 1.2-1.4 grams of protein/kg of bodyweight per day. This will ensure she is supplying her body with the materials to repair and rebuild her muscles and other tissues that may have been damaged due to long periods of time without adequate energy.
She will also want to try and take in 5 grams or more of carbohydrates per day in order to maintain glycogen stores in her muscles. If she is training with high intensity on a daily basis, the range of 6-8 grams of CHO may be much more appropriate. This recommendation is particularly important for those athletes participating in endurance type sports where the body is primarily relying on stored carbohydrates to supply fuel.
Finally, often athletes suffering from this condition are restricting their dietary fat to levels below 15%. This will likely cause an insufficient intake of essential fatty acids as well as vitamin E. Increasing fat intake will also help to increase total caloric intake significantly.
Determine Your Daily Macronutrient Needs!
Micronutrient Requirements ///
Looking next to micronutrient requirements of females suffering from the female athlete triad, the B vitamins, and calcium are of prime importance. The B vitamins aide the body in energy synthesis, haemoglobin production, immune function and the repair and rebuilding of muscle tissues.
Exercising women have an increased need for Riboflavin (vitamin B2) compared to sedentary controls.
Their intakes should be approximately 1.4 mg per 1000 calories consumed. If the athlete was currently dieting, or in this case may have already been dieting for an extended period of time, an intake of 1.6 mg per 1000 calories per day may be more appropriate.
The next B vitamin, Pridoxine (Vitamin B6), is also needed in increased amounts in active women, with intakes of 2-3 mg/day recommended (approx 1.5-2.5 time the current RDA).
Folate is regularly low in the diets of female athletes so this is also an important nutrient to bring up. It can typically be found in foods such as leafy green vegetables, grains, nuts, fortified cereals, legumes and liver. If the athlete is currently not consuming these foods on a regular basis she may wish to look into taking a supplemental form of folate instead.
The recommended intake for women is 400 micrograms per day, however many athletes are only showing intakes between 250-316 micrograms per day.
Women who are suffering from amenorrhea are also in particular need to ensure they are meeting their calcium requirements. The reasoning for this is because these athletes usually will have irregular levels of reproductive hormones circulating in their bodies which will put them at risk for bone thinning and stress fractures.
These women want to ensure that they are meeting the requirements of at least 1000 mg/day. Often their diets are lacking in this particular nutrient because in an effort to loose weight, dairy products are often cut out or reduced. Along with ensuring adequate calcium, it is also important to make sure intakes of vitamin D are sufficient as this nutrients works along with calcium.
The next nutrient the athlete should look at in her diet is magnesium. The recommended intake for magnesium is 310-320 mg/day and athletes are who are currently taking in lower calorie diets are very likely to be reporting intakes less than this.
To ensure adequate magnesium levels it is important to include foods such as whole grains, meat, fish, milk and yogurt, beans and legumes, broccoli, carrots and bananas.
The final nutrient to be aware of when you are assessing your diet with regards to the female athlete triad is iron. Iron deficiency will commonly lead to anemia, which will cause fatigue and decreased vigor among athletes.
Since iron is commonly found in foods such as red meat, and red meat is often reduced in the diets of dieting women (due to it's relatively higher fat content), females are usually low in iron.
Another factor contributing to low iron levels is that iron is lost in sweat, so when the athlete is undergoing intense training she may be losing even more iron. The recommendation for iron is 15 mg per day, so the athlete would need to track her intake and either consider adding more foods to increase iron levels or add a supplement to her diet.
Final - Psychological Factors
The final factor to think about while in recover from the female athlete triad is the psychological one. This athlete may be suffering from a partial or full-blown eating disorder. If it is a serious case, professional counseling may be in order.
Often, athletes who are participating in image related sports (gymnastics, figure skating, ballet, fitness competitions) will be placing their self worth on how they look and will therefore be more susceptible to developing eating disorders. The athlete may not have all the diagnostic criteria for an eating disorder but may suffer from a distorted body perception which would need to be looked at as well.
This women may just consider some self-reflection as a strategy to overcome this and reassess why she is trying to lose weight in the first place and if in all reality it will help her achieve whatever it is she is trying to achieve (whether it be sport related or otherwise). Often this final factor is the one that is most likely to be under expressed as it is something many women are not comfortable talking about and don't want to admit that there may be a problem.
It is important for her family and teammates/coaches to be supportive of her during this time and for them to realize the consequences of the triad so they can aid in her recovery.
So in conclusion, some of the recommendations for athletes suffering from the female athlete triad are to:
- Put more emphasis on total health and exercise performance rather than on a weight scale.
- Consume more whole grains and fruits and vegetables to ensure you are reaching adequate carbohydrate levels and B vitamins.
- Consume adequate protein amounts from foods such as lean meats (including red meats) to promote muscle recovery and resynthesis and keep iron levels up.
- Increase daily fat levels to at least 15% of total calories by including foods high in mono and polyunsatured fat.
- Do not skip meals, and include snacks, to ensure adequate calorie levels.
- Reduce training intensity and frequency, consider taking a couple of weeks of initially to give the body time to fully heal and restock it's muscle glycogen.
- Include weight training exercises in your program to strengthen your bones.
- Eat foods from all food groups (including dairy) to ensure adequate calcium levels.
- Consider using supplementation for any other nutrients you may be deficient in.
If an athlete is serious in her recovery from the female athlete triad, the prognosis is very good.
Once she ensures a proper diet and a sound exercise program, she will likely regain her menstrual cycle, prevent osteoporosis (assuming not to much irreversible damage has not already been done - a reason to look at this symptom in it's early development!), and overcome any issues she may have related to body weight and image.