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Female Athletic Triad

by Dr. Trevor Pfaendtner, Powerlifting & Sport Nutrition Coach | May 13, 2015

For those of you not familiar with who I am, my name is Dr. Trevor Pfaendtner D.O. PGY-1 and I am a family medicine resident in Illinois. With the popularity of Renaissance Periodization diets amongst the hard working Crossfit female demographic, I wanted to first say how happy it makes me as a health care professional to see so many women taking initiative to pursue healthy athletics. Secondly, I want to discuss a serious situation that I hope none of our clients find themselves in called the Female Athletic Triad.

 The triad consists of a constellation of three symptoms:

1.) Disordered eating, 2.) Amenorrhea, 3.) Calcium loss / osteoporosis.

 The first aspect of the Female Athletic Triad (FeAT) should be of less concern to those closely following the RP templates as written by their consultants or in the automatic templates since the macronutrients are all laid out in an optimal way to be conducive of healthy fat loss/muscle gain. However, it is worth mentioning that disordered eating can come in numerous forms. Most well known include Anorexia (intentionally withholding food, excessive exercise, laxative/diuretic use resulting in BMI lower than 17.5) and Bulimia Nervosa (binge and purge behaviors via vomiting/laxatives most commonly resulting in typically normal BMI). Symptoms of disordered eating can include, but are not limited to fatigue, hair breakdown, dehydration, constipation, lowblood pressure, amenorrhea, and osteoporosis. Causes of disordered are often multifactorial with a large psychological component. As I stated previously, disordered eating should not be as much of an issue for RP clients, but the following two aspects of the FeAT should be kept in mind during the weight loss journey. (please note that if you have ever been medically diagnosed you cannot work with RP as that requires the work of a Registered Dietician of other Medical professional).

 Amenorrhea presents in two forms. Primary amenorrhea is the complete absence of menstruation by age 16 in a female with secondary sex characteristics.[5]Secondary amenorrhea is the absence of 3 to 12 consecutive menstrual periods after menarche.[15] Secondary amenorrhea should never be considered a normal response to intense training. Once amenorrhea is detected, the etiology must be determined. Amenorrhea occurs in 2% to 5% of the general female population.[13] In athletes, the prevalence is higher, ranging from 3.4% to 44%.” The disruption in normal function is thought to be related to hypothalamus function disruption resulting in a hypo-estrogen state, specifically a decrease in pulsatile release of gonadotrophic releasing hormones, which in turn decrease luteinizing hormone from the pituitary. While the RP approach is scientifically supported, it is important to keep in mind that each individual responds differently to training/diet stimuli. Bottom line: If you find yourself missing your period without some other factor involved such as certain types of birth control, then please seek medical attention from your physician, as this can be a sign of serious endocrinological disturbance.

 Another unfortunate side effect of the hypo-estrogen state that can accompany disordered eating is inadequate absorption of dietary calcium and poor incorporation into bone, leading to low bone mineral density and, eventually, premature osteoporosis. Lifting weights and other forms of loaded resistance exercise can help mitigate these effects, but after a long enough span of time in the extreme low energy states that come with disordered eating, weight lifting will not be enough to compensate for the diminished calcium uptake.

 What this all boils down to is a simple suggestion. If you have committed to performing better and eating better, then make the commitment to keeping things in perspective. At no point is the external presentation of yourself worth sacrificing your internal workings that will allow you to pursue your passion over time. I hope that our female athletes will pay close attention to their bodies while pursuing their personal fitness goals. Please make sure to keep your diet consultant well in the loop regarding changes in health so that the safest decisions can be made. It is also important to state that if you have an eating disorder of any kind, you must seek attention from your physician to be properly treated, Renaissance Periodization is not a suitable approach to treating these disorders and we cannot work with you.

Suggested Readings:

http://www.mayoclinic.org/diseases-conditions/anorexia/basics/definition/con-20033002 

http://journals.lww.com/sportsmedarthro/Abstract/2002/10010/Female_Athlete_Triad.5.aspx 

http://www.medscape.com/viewarticle/717390_5