Female endurance sports athletes are at risk for serious health issues, say physicians

Female endurance sports athletes may be at risk for serious health issues, according to physicians at Loyola University Health System. Excessive exercise and inadequate nutrition can lead to problems such as low energy, menstrual irregularity, fertility issues, stress fractures and osteoporosis.

"Marathons and triathlons have become increasingly popular in recent years," said Neeru Jayanthi, MD, medical director of primary care sports medicine, Loyola University Health System. "Many who participate in these events are inexperienced athletes who do not properly care for their bodies while training. This can lead to irreversible damage to their health."

Distance runner Ashley Raymond, 23, was one competitive athlete who exercised six days a week on a 1,000 calorie-a-day diet. The intense exercise and poor diet caused her to lose 20 pounds in a short amount of time. Raymond experienced extreme fatigue, and she stopped getting her period for two years. She also consistently felt cold and developed dry hair and brittle nails. Shortly after Raymond's weight reached 92 pounds, she turned to Loyola physicians for help.

Doctors diagnosed her with female athlete triad. This is a condition characterized by disordered eating, irregular periods and osteoporosis. Treatment for her condition included medical, psychological and nutritional counseling. Doctors also prohibited her from running for nine months while she regained weight and began eating larger portions of healthier foods. Raymond has since recovered and returned to running. She plans to train for a marathon later this year.

"I thought restricting my diet would make me lighter and improve my performance," Raymond said. "However, my lifestyle choices negatively impacted my health and kept me from running for nearly a year. I would encourage other athletes to not worry about body image or weight loss while training. Eating well and taking care of yourself ensures that you have the energy necessary to train."

Athletes put themselves at risk for health issues, if the number of calories they burn from exercise is greater than their caloric intake from food. Caloric intake also can impact performance issues. In fact, a Loyola study of distance runners found that total calories consumed is the greatest predictor of performance. However, women in particular tend to not alter their diet to compensate for the rigorous training endurance sports require.

"Female athletes are at greater risk for these health problems," said Haemi Choi, MD, women's sports medicine specialist, Loyola University Health System. "If we can educate women on how to listen to their bodies and support themselves with proper nutrition, we can better protect their health."

Loyola sports medicine specialists offer these dietary tips to help women prevent health issues from popping up during marathon and triathlon training season.

Consume carbohydrates. Eat carbohydrates two hours prior to exercising and immediately following a training session or event.

Load up on calcium. A regular multivitamin does not have an adequate amount of calcium. Premenopausal women should consume 1,000 - 1,200 mg of calcium daily and postmenopausal women should take 1,500 mg in 500 mg doses with magnesium and vitamin D for optimal absorption.
Eat small well-balanced meals regularly. Consume small, balanced meals every three to four hours to ensure energy levels support training needs.
Ensure caloric intake is sufficient. Physicians recommend eating 30 calories per kilogram of weight daily and adjusting this based on exertion levels.

"Harm caused by the female athlete triad is reversible if caught early and caloric intake or exercise levels are corrected," Dr. Jayanthi said. "Bone loss may be permanent and can occur if this condition is left untreated, so early diagnosis and treatment is critical."

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