stress fracture

Female athletes without monthly periods: Be concerned!

Female athletes without monthly periods: Be concerned!

Hey ladies, has your monthly “visitor” stopped coming? Some active women feel relieved when they no longer get a monthly menstrual period. (Yes! More freedom, less discomfort, no more cramps.) They may believe having no period is a sign they are training hard, like a real athlete. Others believe they have stopped menstruating because they are exercising too much or have too little body fat. No. Many very thin athletes who exercise hard have regular menses.

Absence of periods (called amenorrhea) can be linked to serious health problems, including loss of calcium from the bones, almost a three times higher incidence of stress fractures today and long-term problems with osteoporosis in the not-too-distant future. If you should want to start a family, amenorrhea interferes with the ability to conceive easily, and can also contribute to future problems with infertility (even though normal menses may have returned).

Amenorrhea is not sport-specific. Sports that emphasize lightness (ballet, running) have the highest prevalence. Up to 44% of these athletes may experience amenorrhea (as compared to 2% to 5% of women in the general population).The question arises: among a team of female athletes, why do some of the women experience menstrual problems and others don’t? The answer may relate to nutrition. Woman with amenorrhea commonly under-eat. Their bodies have inadequate fuel to support the menstrual process, to say nothing of nurture a baby. Under famine-like conditions, menstruation can stop to conserve energy.

If you among the estimated 20% of active women who have missed three or more consecutive menstrual periods and are experiencing amenorrhea, please stop rejoicing and go see your gynecologist. Amenorrhea is abnormal. It can be a red flag for body image problems (i.e., claiming to feel fat even when emaciated), an intense fear of gaining weight or becoming fat, and restrictive eating. Amenorrhea is part of The Female Athlete Triad, along with low bone mineral density (which leads to stress fractures) and restrictive eating patterns (including eating disorders). Amenorrhea can create undesired health issues.

Resolving the problem

If you no longer get regular menstrual periods and feel as though you are struggling to balance food and exercise, please get a nutrition check-up with a sports dietitian as well as a medical check-up with your doctor or gynecologist. To find a sports dietitian in your area, use the Academy of Nutrition and Dietetics referral networks at www.SCANdpg.org or www.eatright.org.

The most important change required to resume menses includes matching your energy intake with your energy output, so you eat enough to support both exercise and normal body functions. Historically, doctors gave the birth control pill to women with amenorrhea; this forced menstrual bleeding. But taking the birth control pill is a “Band-Aid approach” and does not resolve the underlying problem.

You are likely eating too few calories if you are hungry all the time and think about food too much. You can achieve energy balance by exercising a little less (add a rest day) and by eating a little more (add a healthy snack or two). Your goal is to consume about 15 calories per pound of body weight that you do not burn off with exercise. That means, if you weigh 100 pounds, you my need to eat ~1,500 calories to maintain your weight PLUS another 500 to 800 calories to replace the fuel you burned while training. That totals 2,000-2,300 calories for the entire day, a scary amount of food for some women.

Tips for resolving the issue

If eating this much sounds overwhelming to you, the following tips may help you get “back on the healthy track.”

  1. Take a vacation from dieting.

If you cannot let go of your compulsion to lose weight, at least be less restrictive. Cut back on your eating by only 100 to 200 calories at the end of the day, not by 500 to 1,000 calories during the active part of your day. Small deficits can result in losing excess body fat and are far more sustainable than the food chaos that accompanies starving-stuffing patterns.

  1. Throw away the bathroom scale.

Rather than striving for a certain number on the scale, let your body achieve a natural weight that is in keeping with your genetics.

  1. Eat adequate protein.

When you under-eat, your body burns protein for energy. Some of the protein comes from your diet; for example, the protein in your omelet gets used for fuel instead of building and repairing muscle. Some of the protein comes from your muscles, hence, you experience muscle wasting and that can lead to weaker bones and stress fractures. A 120-pound athlete should target 60 to 90 g protein per day. If you think your diet might be low in protein, track your food intake at www.supertracker.usda.gov.

  1. Eat a calcium-rich food at each meal to help maintain bone density.

Exercise alone is not enough to keep bones strong. Enjoy milk on cereal, low fat cheese on a lunchtime sandwich, a decaf latte in the afternoon, and a yogurt after dinner.

  1. Get adequate vitamin D to help with calcium absorption and bone health.

Sunlight on the skin helps make vitamin D. If you are an “indoor runner” (a “treadmill rat”) who gets little sunshine, be sure to choose foods fortified with D (milk, some breakfast cereals), fatty fish like salmon, eggs, and mushrooms. In the winter months, you may need to take a vitamin supplement.

  1. Eat at least 20% of your calories from (healthful) fat.

While excess calories from fat are easily fattening, a little fat at each meal (15 to 20 g fat per meal, or 45 to 60 g fat per day) is an important part of a sports diet. You won’t “get fat” by eating fat. Your body uses fat to absorb vitamins A, D, E, and K; these vitamins are important for good health. To boost your intake of healthy fats, sprinkle slivered almonds on cereal, snack on a banana spread with peanut butter, enjoy salmon for dinner, drizzle olive oil on steamed veggies, and add avocado to your turkey sandwich.

Is there long-term damage?

Loss of bone density can be irreversible and lead to early osteoporosis. The younger you are, the better your chances of recovery. My advice: nip this problem in the bud now!

Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sports Dietetics) counsels active people at her private practice in Newton, MA (617-795-1875). For more information, read her Sports Nutrition Guidebook and food guides for marathoners and new runners. The books are available at www.nancyclarkrd.com. Also see www.NutritionSportsExerciseCEUs.com for online education and CEUs.

Food & Health: Updates from the Academy of Nutrition & Dietetics

Food & Health: Updates from the Academy of Nutrition & Dietetics

 

Nutrition misinformation and food confusion surrounds today’s health-conscious athletes. To arm myself with knowledge to better educate my clients, I (along with 10,000 other registered dietitians) attended the Academy of Nutrition & Dietetics annual convention (FNCE) to learn the latest food and nutrition updates. Here is some information that might help you on your health journey.

  • Stress fractures are a common sports injury. Among 42 Division-1 cross-country runners, 35% of the male and 41% of the female runners reported having had a stress fracture. Inadequate nutrition could have contributed to the problem. Their diets tended to be low in calories, calcium and/or vitamin D. If you are going to push your body to the limits, at least fuel it optimally!
  • If intestinal distress sidetracks you during exercise, try reducing your intake of apples, onion, garlic and broccoli —particularly for 2 to 3 days before a competitive event. These are just a few commonly eaten foods that are high in fermentable (gas-producing) carbohydrates; they might contribute to undesired pit stops. You could also meet with a sports dietitian to help you systematically discover triggering foods. The referral network at www.SCANdpg.org can help you find your local sports food expert.
  • Exercise increases harmful free radicals within muscles that can lead to oxidative damage and inflammation. Should athletes supplement with anti-oxidants to counter this? No. The better bet is to let the body adapt to these higher levels (and eat abundant anti-oxidant rich fruits and vegetables). Adaptation creates a change for the better in an athlete’s physiology.
  • Alcohol contributes to hypoglycemia (low blood glucose) by suppressing the release of glucose from the liver into the blood stream. If an athlete hasn’t eaten much food (as can easily happen after an event), alcohol in an empty stomach can easily lead to hypoglycemia (a lack of glucose for the brain) and a drunken stupor. The same happens when a person with diabetes has low blood glucose; he or she can get mistaken for being drunk (when the brain just needs food).
  • In contrast to recreational marijuana, which is used with the intent to impair normal functioning, medical marijuana (MM) is used to relieve pain, reduce nausea and vomiting, and to overcome loss of appetite (as with cancer). If you have parents or friends who are new to using MM, caution them about using edibles. When MM is eaten, its pain relieving benefits are delayed for 30 to 120 minutes, as opposed to smoked MM, which offers immediate benefits. The problem with the delayed response with edibles is that a patient can easily overdose while waiting to feel an effect…
  • Meal timing affects circadian rhythms —as well as weight management. A study (Garaulet, 2013) with 420 subjects who ate an early lunch or a later lunch reports the early lunch eaters lost more weight, despite consuming the same number of calories and getting the same amount of sleep. Your best bet is to eat more food earlier in the day. As you have undoubtedly heard before: Eat breakfast like a king, lunch like a prince, dinner like a pauper.
  • We compromise our well-being every time we have a mis-match between the environment and our internal biological clock. (Think jet lag, shift work, sleep apnea, and watching late-night TV.) Every cell has a biological clock; all these cellular clocks need to be synchronized. If not, bodies become unhealthy. For example, shift workers experience more high blood pressure, heart disease and diabetes than people who work 9:00 to 5:00. For athletes, jet lag means poorer performance. Sleep is restorative and helps synchronize cell’s biorhythms. If you have trouble sleeping well: Avoid caffeine at least 4 hours before bedtime and limit it to 2 mugs (400 mg. caffeine) a day. Turn off your computer screen/TV an hour before bed.
  • Consumers are self-defining “healthy food.” It needs to be organic, natural, non-GMO, free of dyes/additives/ colors, and have a “clean” label with no strange words. Will this trendy definition lead to unintended health consequences as food producers try to meet consumers’ demands? Likely yes. If you make your food decisions based on trends rather than science, you might want to take a step back and look at the whole picture. For example, enriched foods offer added nutrients that can make a label look “dirty” but the extra ingredients are good for your health. Added iron reduces your risk of becoming anemic; folic acid reduces the risk of birth defects; iodine reduces the risk of goiter. Preservatives that have been generally regarded as safe help bread stay fresh for longer, reduce the growth of mold on cheese, and reduce the amount of food you waste. These ingredients can be beneficial for you and for the environment.
  • Sugar-sweetened beverages are the biggest source of dietary sugar in the US diet. Hence, research on sugar and health has focused on soft drinks. The question remains unanswered: Is sugar added to nourishing foods a health hazard? That is, is sugar added to spaghetti sauce (to make it less acidic) bad for you? What about the sugar added to bread (to help make the dough rise) — Is that a cause for concern? Doubtful. Yet, too many consumers freak out when a product lists sugar on the food label. Please note: sugar is just one of many nutrients listed on the label. Please look at the whole nutrient package. For example, chocolate milk has sugar (that refuels muscles) but it also offers protein (to repair muscles), sodium (to replace sweat loss), calcium & vitamin D to enhance bone health.

Dietary guidelines say 10% of total calories can come from added sugar. That’s 200 to 300 calories a day for athletes. Do you really need to freak out about a little sugar that makes that spaghetti sauce taste better? I think you can find bigger things to worry about.

Sports nutritionist Nancy Clark MS RD CSSD has a private practice in the Boston-area (Newton; 617-795-1875), where she counsels both fitness exercisers and competitive athletes, teaching them how to eat to win. Her popular Sports Nutrition Guidebook, and food guides for marathoners, cyclists and soccer are available at www.nancyclarkrd.com. For online workshops, see www.NutritionSportsExerciseCEUs.com.

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