18 May 2009

Girl athletes risk eating disorders

You may still remember gymnast Christy Henrich, who died from anorexia-associated complications at 22. Many South African athletes risk a similar fate - unless action is taken.

Many female athletes risk disordered eating, ranging from anorexia to bulimia, menstrual dysfunction and deteriorating bone health.

One of the most extreme examples is that of US gymnast Christy Henrich, who developed anorexia supposedly after being told by a judge that she was too fat to excel in her sport. In 1994, multiple organ failure killed her at the age of 22.

At a recent symposium in East London, sports nutrition expert Dr Hattie Wright from the North-West University delivered a thought-provoking paper on “The Female Athlete Triad", highlighting the diet-related problems our female athletes face.

While moderate exercise has many advantages, including increased strength, improved brain function and coordination, control of body weight and mental wellbeing, excessive exercise coupled with disordered eating can have a devastating effect on health.

Female athletes who train for many hours a day, and also restrict their energy and nutrient intake to maintain a low body weight, can disrupt the function of their reproductive systems and undermine their bone metabolism.

The numbers
Up to 62% of female athletes suffer from a variety of eating disorders, such as:

  • Eating highly restrictive diets that are low in energy and the nutrients we require for good health and bone growth, such as calcium.
  • Purging, which includes overuse of harsh laxatives and diuretics, to maintain their very low body weight.
  • Binge eating disorder, where the athlete alternates between eating large quantities of food and then ridding herself of the food by induced vomiting or diarrhoea.

Favourite methods
Dr Wright pointed out that female athletes use the following methods to keep their weight down, which will in turn cause a range of metabolic problems:

  • Fasting or starvation: this reduces lean muscle mass, causes nutrient deficiencies and depletes the body’s essential glycogen stores.
  • Diet pills, which reduce the appetite for healthy foods, cause anxiety, poor concentration, insomnia and dehydration.
  • Diuretics may result in dehydration (which can be fatal) and electrolyte imbalances that often cause heart arrhythmias (irregular heartbeat).
  • Laxatives or enemas, which also cause dehydration and electrolyte imbalances, constipation due to loss of normal bowel function, and addiction.
  • Self-induced vomiting, which also causes dehydration and electrolyte imbalances, disturbed digestion and tooth decay due to repeated exposure of the teeth to stomach acid during vomiting.
  • Saunas: when attempting to reduce weight by promoting weight loss through sweating, athletes expose themselves to dehydration and electrolyte imbalances that can cause the heart to malfunction.

It's ironic that athletes who need to be in the peak of health, and require top-class nutrition to be able to function at the highest level, are plagued by so many dietary imbalances, most of which are self-induced.

Loss of menstruation
Amenorrhoea is a condition where a woman stops menstruating for intervals lasting months to years, and sometimes permanently. This can, of course, have a devastating impact on a woman’s future ability to have children.

Dr Wright reported that in females, up to 43% of so-called “elite” athletes and 13.4% of “recreational” athletes suffer from amenorrhoea. Young female athletes who have a very low Body Mass Index (BMI) and train intensively are exposed to the greatest risk of menstrual dysfunction. Women who participate in “aesthetic” sporting activities such as ballet, diving and gymnastics are most vulnerable.

Research has found that the single most important cause of amenorrhoea in female athletes is the fact that they don't take in enough energy from their diet to sustain their punishing physical activity levels. The low energy intake has a disrupting effect on the various hormones that ensure normal ovulation and menstruation.

Stress fractures and osteoporosis
In association with disrupted menstrual cycles, female athletes are particularly prone to stress fractures and osteoporosis. There can be nothing more devastating to an athlete than to develop a bone injury, which could put an end to her athletic career. And yet statistics show that female athletes are up to four times more prone to stress fractures than other women, and 13% have osteoporosis at a young age.

According to Dr Wright, the solution to both amenorrhoea and bone disease is first and foremost to ensure that female athletes ingest sufficient energy to meet the demands of their training and/or to reduce the intensity of their exercise schedule.

It's understandable that most elite athletes who are prepared to die for their sport will not want to give up their disordered eating and will resist changes to their diet and exercise programme.

Dr Wright emphasised that a number of factors require attention in helping these athletes:

  • Behaviour change, which may require the intervention of a clinical psychologist.
  • Exercise intervention via trainers and coaches who must be made to see that a punishing exercise schedule may just kill the goose that lays the golden egg.
  • Use of energy and nutrient supplements (for example calcium, vitamin D, magnesium and vitamin K2) or medications such as hormone treatment.
  • Dietary changes under the guidance of a dietician trained in sports nutrition.

Dietary changes
The most important aspect of dietary treatment is to increase the energy intake of the affected athlete so that her energy intake equals her energy output.

Dr Wright maintains that diets that provide less than 7 500kJ per day are not sufficient, and that in general, female athletes need about 10 500kJ per day. Those that take part in marathons or triathlons need up to 17 000kJ per day.

Protein intake should be about 1.4g of protein per kilogram body weight per day, so a 50kg female athlete would need 70g of protein daily.

The minimum carbohydrate intake is 5g of carbohydrates per kilogram body weight per day, so our 50kg athlete would be expected to have 250g of carbohydrates a day.

Supplements to boost vitamin B intake, iron and calcium are also essential to restore a depleted young female athlete’s health and prevent bone damage.

If you are female and train hard every day and constantly use all kinds of damaging methods to maintain your weight, you are at risk of disordered eating, amenorrhoea and bone deterioration.

For the sake of your health, get help from a dietician as soon as possible, otherwise you may never achieve peak performance and the effects of imprudent dieting will ruin not only your bones, but also your future potential to have children.

- (Dr I V van Heerden, DietDoc, 18 May 2009)

(Wright, H (2009). The female athlete triad. Sugar & Health Symposium, 12-23 May 2009,East London.)


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