Exercise has powerful physical and psychological health benefits. You can improve body composition, optimize metabolism, boost mood and self-confidence, radically reduce disease risk, and promote other healthy behaviors.
Women can benefit just as much as men from exercise and sports participation. However, research shows that female athletes are at greater risk of developing dangerous health problems from training if nutrition, training programs, and recovery aren’t tailored to their unique physiology.
Due to an inadequate energy intake, excessive exercise, or nutrient deficiencies, female athletes are at high risk of the following health problems:
- Insufficient Nutrition For Peak Performance
- Menstrual Irregularities
- Low Bone Mineral Density/Osteoporosis
- Hormone Imbalances: Low Androgens, Elevated Cortisol & Low Thyroid Hormone
This article will discuss the health issues affecting active woman and provide strategies for avoiding them so that every female athlete can optimize both health and performance.
#1: Insufficient Nutrition For Peak Performance
It’s common sense that female athletes need adequate energy to fuel training and promote recovery. What a lot of people don’t realize is that when female athletes have a low calorie intake, their risk of health problems skyrockets. All of the issues discussed in this article are at least partly caused by a low energy availability or lack of nutrients.
First, we need to identify why female athletes aren’t eating enough. Surveys suggest that a staggering 2/3 of collegiate female athletes are actively dieting in an effort to lose weight. Although in certain situations, fat loss may be beneficial and warranted for overweight athletes, energy restriction will lead to the loss of lean mass.
Either due to a coach telling them they need to lose weight, social pressure to be thin, or shame about body image, female athletes tend to have a significantly lower energy intake relative to body mass as men. Additionally, they are commonly reported to be eating at or below their metabolic rate, which is defined as the amount of calories burned at rest during the day without accounting for calories used during training.
Then there are eating disorders: Although the rate of female athletes who have been diagnosed with a clinical eating disorder is around 8 percent, a much larger number are “at risk” for disordered eating and calorie restriction—possibly as high as 62 percent of female athletes in long-distance running and physique sports like gymnastics. This puts them at risk of depression, lower athletic performance, social isolation, and poor quality of life.
Recognition of inadequate emery intake, disordered eating, or other at risk behaviors is low among coaches. Further, research indicates that athletes who are encouraged to diet by their coaches may resort to fasting and other dangerous methods of weight loss.
Solution: The first step is for coaches and athletes to calculate calorie needs and identify an optimal macronutrient distribution.
Scientists recommend that female athletes never go below 30 cal/kg of bodyweight a day, with ideal intakes being between 39 to 44 cal/kg bodyweight/day. Endurance athletes or those who burn large volumes of energy during training may need to add exercise energy expenditure on top of that. For example, a 55 kg middle distance runner would have baseline energy needs ranging from 2145 to 2420 a day. Running 5 to 6 miles a day could bump that up to 2745 to 3020.
#2: Menstrual Irregularities
One of the primary side effect of a low calorie intake is menstrual irregularities, specifically amenorrhea or lack of a period. It is considered one part of the three components Female Athlete Triad, which also includes low energy availability and low bone mineral density.
Scientists believe that hypothalamic amenorrhea in female athletes is a protective reaction by a women’s body, reducing her fertility when there is inadequate energy available to support the individual’s energy needs, much less the needs of fetal development. Naturally, it reduces a woman’s fertility and decreases bone mineral density due to low levels of the hormone estrogen.
Solution: Studies have had success resolving menstrual dysfunction in female athletes by increasing calorie intake. Body weight increases may or my not result. However, the athlete should be aware that weight gain may occur and needs to have the appropriate psychological support from a clinician and coaches and teammates to accept the change.
The energy intake guidelines recommended above may suffice, however, reducing the exercise volume may be necessary. The increased energy intake should be used until menstruation returns and continue while training and competing.
Another option is to take an oral contraceptive in an effort to replace estrogen to protect against bone loss and stress fractures. However, many experts suggest this is treating the symptoms rather than the cause and may mask the benchmarks associated with a healthy body that can produce a period without pharmaceutical intervention.
#3: Low Bone Mineral Density/Osteoporosis
Female athletes with adequate calorie intake and nutrition tend to have stronger skeletons and less risk of osteoporosis than the general population. However, the benefits of heavy loading from weight lifting and regular weight bearing activity are negated when athletes consume too few calories and develop amenorrhea. If amenorrhea persists over time, it will decrease skeletal mineralization and increase risk of osteoporosis.
One survey found that rates for osteopenia, which is defined as low bone mineral density range from 22 to 50 percent of collegiate female athletes. Rates for osteoporosis may be as high as 13 percent.
Solution: Besides restoring menstruation and ensuring adequate calorie intake, certain nutrients will promote bone health.
Adequate protein to supply the amino acid building blocks to synthesize bone is necessary in the range of 1.3 to 1.8 g/kg of body weight a day for omnivores, with vegetarians requiring the higher end of this range.
Healthy fats provide the bone building vitamins A, D, E, and K in a bioavailable form. It’s recommended to eat a variety of meat, fish, eggs, and whole-fat dairy.
Vitamin D may need to be supplemented if the athlete doesn’t get regular midday sun exposure. Deficiency rates are high for female athletes, ranging from 33 to 42. Experts recommend testing vitamin D levels quarterly and supplement with up to 5,000 IUs to maintain a blood value of above 30 ng/ml.
Calcium may need to be supplemented due to losses through sweat or amenorrhea and low estrogen levels. Well absorbable calcium can be found in green leafy vegetables (e.g., lettuce, celery), meat, fish, soy, rice milk, and certain legumes (peanuts). If supplementation is necessary for amenhorrheic athletes, it’s recommended to take 1000 mg/day in two 500 mg doses from calcium carbonate or citrate.
#4: Hormonal Imbalances
Besides low estrogen, low energy intake and the stress of body image preoccupation lead to a variety of other hormonal imbalances that reduce performance, health, and quality of life.
Similar to patients with anorexia, very lean exercising women have elevated levels of the appetite suppressing compound peptide YY. Interestingly, they also have high levels of ghrelin, a hormone that typically raises appetite. However, it’s thought that in lean, female athletes with amenorrhea, the high peptide YY blunts the appetite raising effects of ghrelin.
IGF-1, a hormone that is involved in bone repair and muscle growth, is reduced in response to a sustained energy deficit. Testosterone, which has a performance enhancing effect in women, is also compromised.
Cortisol, which is a stress hormone that degrades lean tissue and causes depression when elevated, is increased in response to lack of calories. Cortisol elevations are worsened in women suffering from a drive for thinness because body image preoccupation, dieting, and disordered eating raise what is known as “perceived stress,” significantly raising cortisol release.
Finally, thyroid hormone is suppressed in athletes in a negative energy balance. Thyroid hormone is involved in maintaining metabolic rate (low levels mean metabolism is downregulated and the body burns fewer calories), but it also plays a role in the body’s ability to produce energy at a fast rate. Low thyroid hormone may alter a female athlete’s ability to perform repeated bouts of high-intensity exercise.
Solution: In addition to the solutions already mentioned above, female athletes should plan diets around the most nutrient-rich whole foods in order to boost blood antioxidant levels and lower inflammation that can negatively impact hormone balance.
Though not easily done, every female athlete should develop a system to cope with the stresses of training and the pressures regarding body composition and physical aesthetics. Working with a counselor who is experienced in guiding female athletes to navigate the unique challenges that they face may also help.
Proven stress-reduction strategies include doing fun activities, laughing, listening to music, and meditation. With awareness and support from family members and teammates, female athletes will not only overcome the health challenges presented here but thrive in their chosen sports.