What to Know About Female Athlete Triad
One of the first things Dr. Carol Otis points out about the condition known as "female athlete triad" is that it's probably misnamed. She believes the name implies that it's a condition that only competition-level athletes can suffer, and that's not the case at all.
"People think because their daughter isn't on an athletic team they can't have this disorder," Dr. Otis says. "That's where we may have misnamed the triad, because this can happen to anyone. The condition was just described about eight to 10 years ago, so it's relatively new, which makes it even more important to raise awareness."
The Truth About Triad
To put it very simply, female athlete triad is a condition that is made up of a combination of three disorders: amenorrhea (absence of menstruation), disordered eating (not taking in enough calories) and loss of bone mass. This last part of the triad can only be diagnosed by a doctor, and by the time it's gone this far, the damage to a female's growing body may be irreversible.
The problem with calling it female athlete triad is that, while it does affect athletes, it also includes girls who are obsessed with being thin. They may develop the triad when they take the desire to be thin to the point where they develop bulimia or anorexia, while at the same time, they exercise far too much for their limited caloric intake. This causes the body to try to conserve energy, and the first thing it will do to conserve that energy is stop the menstrual cycle.
Ultimately, this loss of bone mass is something that can't be undone. According to Dr. Amanda Weiss, director of pediatric sports medicine at Rainbow Babies & Children's Hospital, by the time a female is 18 or 19 years old, they have already formed 90 percent of their bone mass. If they don't build up their maximum bone mass in that time, they can't make it up.
"There's not really anything we can do to replace bone mass in a young woman, especially one of child-bearing age," says Dr. Weiss. "If you don't put down your optimal bone mass when your young, you may get to age 27 and discover you have osteoporosis."
What to Watch For
Dr. Otis, the author of The Athletic Woman's Survival Guide: How to Win the Battle Against Eating Disorders, Amenorrhea, and Osteoporosis (Human Kinetics, September 2000), calls it "old bones in young women." She says that parents need to be aware of the warning signs of the triad in order to prevent problems for their daughters down the road.
"It isn't always easy to spot these problems in young people, especially if they tend to be secretive or want to hide it," says Dr. Otis. "While there's no way you can know if they're losing bone mass, and you may not realize that they are no longer menstruating, food obsessions are usually easier to spot."
Dr. Otis recommends watching for food-fad type behavior, such as eliminating entire food groups. While she notes that sometimes these fads are a normal part of the adolescent years, a parent should be concerned if it seems to become an obsession. Additional warning signs include any evidence of diet pills, laxatives, vomiting and constant comments about weight.
The Triad in Athletes
While female athlete triad is used to describe these conditions that are often a result of a body image problem, Dr. Weiss points out that sometimes an athlete can develop this even though their intention isn't necessarily to be thin.
"Sometimes high school and college kids don't realize how many calories they're truly expending during their exercise and don't understand how many they need to replace," says Dr. Weiss. "Some kids are not purposely trying to lose weight; they just don't realize how much they need to eat."
According to Dr. Weiss, the key is an understanding of the term "disordered eating." While it can refer to an eating disorder, such as anorexia or bulimia, it can also refer to poor eating habits. In other words, a diet that doesn't supply enough energy to make up for what the athlete is expending.
This is when good parental communication is effective, says Dr. Weiss. She notes that athletic kids who develop the triad as a result of poor eating habits are more likely to come to their parents when their periods cease.
"The athletes who aren't doing this on purpose are more likely to share information about their bodies with their parents or coaches, because they're not trying to lose weight and they're not trying to hide it," says Dr.Weiss. "It's a red flag for any adult if a young athlete comes to them and tells them they are no longer having periods and means they need to be evaluated, and their diet definitely needs to be adjusted."
The danger for athletes in not catching this as soon as possible – or in not preventing it altogether – is that the weakened bones can make them more susceptible to stress fractures. It also can take them longer to recover from other injuries.
For athletes, the best cure is to prevent the problem in the first place. Dr. Otis says it's important that the young athlete understand the concept of "food as fuel," and if they don't get enough fuel, their motor won't run properly. An athlete needs to be willing to snack and eat small meals throughout the day to keep the body running.
"Number one, have breakfast – even if it's just a smoothie or a Power Bar," says Dr. Otis. "It's also important for recovery after a workout to get a small amount of carbohydrate and protein. Then, an hour or so after practice, eat about 250 calories, which can be a Power Bar, sports drink, Fig Newtons or something like a piece of bread with peanut butter. You have to keep putting gas in the tank."
Dr. Weiss also recommends trying to steer an athlete toward the lesser of two evils, such as a Power Bar over a Snickers Bar.
"If your daughter is practicing two hours with her high school team, then two hours with her national-level team, it can be difficult to find time for a healthful meal, and our convenience food, junk food culture doesn't help," says Dr. Weiss. "We have to help them develop creative strategies for healthy snacks and [educate] them about good choices."