Female Athlete Triad, Calcium and Iron

The Female Athlete Triad

The female athlete triad happens when energy availability, amenorrhea and decreased bone mineral density are present. The female athlete triad can be very dangerous to the female athlete. The consequences include: premature fractures, and lost bone mineral density. (2)

The triad is caused by an imbalance between energy expenditure and energy intake and can be associated with significant medical morbidity. It occurs most frequently in sports where a lean figure is emphasized.

In an adolescent athlete, amenorrhea should be considered an indicator of a potential problem and should not simply be attributed to a consequence of training. The athlete should be evaluated for an underlying eating disorder and tested for osteoporosis. Prevention, through education will help ensure the health and safety of young female athletes. (3) If your child has the triad I recommend starting with a physician. I do not recommend treating the disorder yourself and hoping for the best. It can be very serious.

Alarmingly a study suggested that a majority of high school athletic programs are not adequately screening girls for the components of the triad. (6)

For a better understanding of each facet of the triad read these three key points.

Energy Availability (Disordered Eating)

Low energy intake (e.g., <1800-2000 kcal•d-1) for female athletes is a major nutritional concern because a persistent state of negative energy balance can lead to weight loss and disruption of endocrine function. (5)

Desiring to look lean is a reality for young teenage women. These intense feelings of over striving for a thin look may come from a variety of reasons. This and possible other reasons may cause disordered eating or excessive exercise.

Amenorrhea

Amenorrhea is the absence of a menstrual period.

Osteoporosis

The NIH defines osteoporosis or porous bone, as a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. One of the risk factors of osteoporosis is the abnormal absence of menstrual periods (amenorrhea), anorexia nervosa and more. (4)

Iron

A review of nutrition and hydration concerns of the female soccer player mentioned that women are probably more at risk of iron deficiency than men. When one group reviewed vegetarians they saw 27% of females vs. 5% of males had iron deficiency. There is also a prevalence of iron deficiency in women from minority populations and lower socioeconomic groups. Another very interesting number showed that of 28 players in the Swedish national squad, 59% were found to have iron deficiency and 29% iron deficiency anemia six months prior to the FIFA women’s world cup. (8)

I understand these numbers may not reflect young female soccer players but to me it shows a trend. So why is iron so important?

Hemoglobin, which contains iron, is the part of red blood cells that carries oxygen from the lungs to all parts of the body, including muscles. Since your muscles need oxygen to produce energy, if you have low iron levels in your blood, you may tire quickly. Symptoms of iron deficiency include fatigue, irritability, dizziness, headaches and lack of appetite. Many times, however; there are no symptoms at all. A blood test is the best way to find out if your iron level is low. It is recommended that athletes have their hemoglobin levels checked once a year.

The RDA for iron is 15 milligrams a day for women and 10 milligrams a day for men. Red meat is the richest source of iron, but fish and poultry also are good sources. Fortified breakfast cereals, beans and green leafy vegetables also contain iron. Our bodies absorb the iron found in animal products best. (7)

Should you take an iron supplement?

Taking iron supplements will not improve performance unless an athlete is truly iron deficient. Too much iron can cause constipation, diarrhea, nausea and may interfere with the absorption of other nutrients such as copper and zinc. Therefore, iron supplements should not be taken without proper medical supervision. (7)

Calcium

Getting enough calcium and weight bearing physical activity helps build strong bones. According to the CDC, by the age of 20 the average woman has acquired most of her skeletal bone mass. After the age of 40, bone mass is lost typically at a rate of .5 to 1% a year. (8) It is very important for young women to reach their peak bone mass to maintain bone health throughout life. (9)

Why is calcium so important?

Calcium is needed for strong bones and proper muscle function. Dairy foods are the best source of calcium. However, studies show that many female athletes who are trying to lose weight cut back on dairy products. Female athletes who don't get enough calcium may be at risk for stress fractures and, when they're older, osteoporosis. Low-fat dairy products are a rich source of calcium and also are low in fat and calories. (1)

What should I take to help calcium absorb?

Vitamin D helps with the absorption of calcium. Vitamin D can be absorbed from the sun or taken as a supplement.

For recommendations look at the website bestbonesforever.gov.