The Female Athlete Triad refers to the combination of energy deficiency, menstrual dysfunction, and low bone mineral density that can occur in female athletes. Originally consisting of three components, the triad model has advanced to view these conditions on a continuum of severity. Sports emphasizing leanness, like gymnastics and ballet, most commonly see cases of the triad. Preventive measures include education, monitoring menstrual cycles, consulting doctors, and seeing nutrition professionals to design healthy, sport-specific diets.

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Female Athlete Triad
Syndrome
Sammie Seaman
NTR 300

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What is the Female Athlete Triad?
 The triad is a combination of 3 health complications; energy
deficit/disordered eating, menstrual disturbances/Amenorrhea,
and bone loss/Osteoporosis. It is likely that an athlete suffering
from just one of the elements is suffering from all three as well.
Most athletes are not diagnosed with extreme cases but may
display intermediate symptoms. For example, an athlete may
show signs of restrictive eating but not meet the criteria for an
eating disorder. It is most common among athletics that require
leanness, train an excessive amount of hours, and demand of the
body.

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The New Model
The Triad was first identified 25 years ago. Recently the model has advance with more
research upon the topic. Originally the three components were disordered eating, low bone
mass, and amenorrhea. The components have been proven to be related to each other as
energy deficiency is linked to development of menstrual disturbances, as well as, low
estrogen initiating bone loss. The new model reaffirms this but, it is being represented as a
continuum of severity of healthy disease. This model also highlights athletes that may not
present the extreme ends of the continuum, but the intermediate cases and the
progressions along the three main points. While the conditions represented by each
continuum can occur independent of the other two conditions, it is likely that an athlete
suffering from one condition is suffering from the other three too.

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Signs of the Female Athlete Triad
 There are many signs and symptoms that an athlete may have
the syndrome. The most common is restriction of food intake
which will leave an athlete feeling tired and fatigue. Many
athletes have the a constant feeling to be thin. They eat less
then needed in an effort to improve their performance and
physical appearance. Since athletes aren’t getting enough
caloric intake, the body shuts down. Stress fractures and
recurrent injuries are also a side effect of the triad. Other side
effects may include trouble sleeping, cold hands and feet, and
irregular menstrual cycles.

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Which Sport Does this Effect the
Most?
 The Triad is seen in sports that emphasize leanness. It is
most commonly seen in cross country, gymnastics, ballet
and figure skating. 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.

6. + Energetic Efficiency, Menstrual Irregularity, and Bone Mineral Density in
Elite Professional Female Ballet Dancers
By: Ashley F. Doyle-Lucas, Ph. D., Jeremy D. Akers, Ph.D., and Brenda
M. Davy, R.D., F.A.C.S.M.
The graph above shows the relationship This second graph explains how
between female dancers and lean control energy efficiency is related to resting
women and the resting metabolic rate. The metabolic rate. The lower the
less calories consumed the lower the metabolic rate the less energy an
metabolic rate. This only proves that eating athlete will have.
less does not always benefit the body

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Nutrition
 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 hemoglobin 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.

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Nutrition: Calcium
 Calcium is important when building and maintaining strong bones.
This is essential when talking to athletes about nutrition linked to the
Female Athlete Triad Syndrome. Overtime if your diet is too low in
calcium your bones become weak and will be more susceptible to
breaking. Here is a chart of important calcium sources:

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Nutrition: Vitamin D
 Vitamin D is a nutrient found in some foods that is needed for health and to maintain strong
bones. It does so by helping the body absorb calcium form food. Athletes with little vitamin
D intake develop soft bones. The amount of vitamin D you need each day depends on your
age. Average daily recommended amounts from the Food and Nutrition Board (a national
group of experts) for different ages are listed below in International Units (IU):
The best source of vitamin D in foods is fatty fish such as salmon, tuna, and mackerel. The
body makes vitamin D when it is directly exposed to the sun, and most people meet their
vitamin intake this way.

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Risk Factors
 The Female Athlete Triad is a serious syndrome and is being
seen more in women’s athletics. Health consequences are
linked to each point of the triad. Eating disorders can also lead
to medical complications involving the cardiovascular system,
endocrine, reproductive, skeletal, gastrointestinal, renal, and
central nervous system. Amenorrheic women are infertile due
to the absence ovulation. This can also effect the skeletal
muscle oxidative metabolism, low-density lipoprotein
cholesterol levels, and muscle fatigue. Low bone mineral
density can be a result of not enough nutrient intake which can
lead to reoccurring stress fractures. Women with low bone
mineral density increase their chances by four times as much.

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Prevention
 The best way to prevent the Female Athlete Triad from happening is by educating athletes,
coaches, and parents on the subject. This will allow them to recognize it and take steps to
prevent it.
 As a coach:
 Remind athletes that eating is an important part of successful training and
performance.
 Focus on a healthy body image, and NOT on weight.
 Support athletes through training and everyday life
 Have available resources such as nutritionists, trainers, or counselors.
 As an athlete:
 Monitor menstrual cycle by using a calendar.
 Consult a physician if you have an irregular menstrual cycle and recurrent injuries
like stress fractures.
 Talk to a counselor if you are overly concerned about your body image.
 See a sport nutritionist to help you design a healthy diet that is specific to your sport.
 Seek emotional support from coaches, guardians, or teammates.

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Sources
 Thompson, S. (2007). Characteristics of the female athletic triad in collegiate cross-country
runners. Journal Of American College Health, 56(2), 129-136. chart collegiate female
athlete article
 Doyle-Lucas, A. F., Akers, J. D., & Davy, B. M. (2010). Energetic Efficiency, Menstrual
Irregularity, and Bone Mineral Density in Elite Professional Female Ballet Dancers. Journal
Of Dance Medicine & Science, 14(4), 146-154.
 Female Athlete Triad Coalition. Female Athlete Triad Organization, 2012. Web. 30 Sep
2012. <http://www.femaleathletetriad.org>.
 Office of Dietary Supplement. National Institute of Health, June 24, 2011. Web. 30 Sep
2012. <http://ods.od.nih.gov/factsheets/VitaminD-QuickFacts/>.
 Manore, Melinda. "The Female Athlete Triad: Nutrition and Eating." Sports Coach. National
Institute of Health, June 24, 2011. Web. 30 Sep 2012.