Dr. Stephanie Howe Violett

Nutrition for High School Female Athletes

I. Female Athlete Triad: A syndrome of three interrelated conditions: low energy availability, amenorrhea, and decreased bone mineral density. Common in female athletes when exercise occurs without adequate energy intake. The triad can lead to adverse effects on reproductive, bone, and cardiovascular health. Athletes may present with 1, 2, or all 3 of the components.

Components of the Triad:

1. Energy Availability. EA = Daily dietary energy intake – exercise energy expenditure. Decreased EA may or may not be caused by disordered eating or eating disorders (meaning you can have low EA without either) Low EA adversely affects bone remodeling and can disrupt menstrual function and bone mineralization.

Up to 54% of adolescent athletes have disordered eating habits. Eating behaviors form a continuum that can range from normal to clinically diagnosed abnormal behaviors. Pattern of disordered eating may begin as infrequent, but progress when not acknowledged.

Signs & Symptoms: fasting use of diet pills, diuretics, or laxatives, fat free diet, excessive exercise, restrictive eating, avoiding a certain food group or nutrient, avoiding social eating, etc.

2. Menstrual Function. Whole spectrum of menstrual disturbances, but changes are an energy-conserving strategy to protect biological and reproductive processes. CAUSES: High EE, low EI, and high physical stress lead to inadequate EA, which can cause functional hypothalamic amenorrhea. Adolescent athletes with amenorrhea also have significantly lower BMD, and 3 times more likely to sustain bone stress injury. Also associated with higher CV risk factors, including increased blood cholesterol and abnormal endothelial function.

3. Bone Mineral Density. Bone mass gains during adolescence are critical for attainment of peak bone mass. By the end of adolescence, 90% of adult bone mass has been attained. Adequate dietary intake can positively influence bone mass. Low EA and menstrual dysfunction suppression of bone formation. Reduced BMD increases risk of musculoskeletal injuries, especially stress fractures.

Common signs of the Triad:

1. Fluctuations or excessive weight loss

2. Irregular or absent menstrual periods

3. Stress fractures

4. Self-esteem and mood driven by body weight and shape

5. Compulsive overexercise

*An individual can fall anywhere on this spectrum. You don’t have to have all 3 components to be at risk. If you suspect something, talk about it. If you have questions ASK! Don’t ignore the problem or assume it will go away on it’s own.

Coaches/Parents: Focus on strong healthy women as role models. Eat meals together and select real, nutrient dense foods (don’t fall prey to diet “fads”). Talk about body image and health, but from a positive perspective.

National Eating Disorders Association (nationaleatingdisorders.org)

II. Self Esteem

A.  Media portrayal of female bodies. Unattainable, unhealthy, and often not even real. Focus on strong, healthy women- confidence is attractive.

B.  Don’t compare yourself to others

C.  Build yourself and each other up. Instead of focusing on things you dislike, focus on things you LOVE about yourself.

III. Proper Fueling

A.  Why does good nutrition matter?

  1. Nutrient dense vs. energy dense
  2. Healthy eating is not restrictive

B.  What should I eat?

  1. Carbohydrates. Primary source of energy and required for optimal function of the body & brain. 55-65% total energy should be from carbohydrates.
  2. Choose: whole grains, fruits, and vegetables. As many whole/real foods as possible.
  3. Limit: highly processed foods, refined grains, added sugars, packaged foods with long ingredient lists.

b.  Fat. Important source of energy and also helps the body absorb many vitamins and minerals. Essential for biological functioning of the body. 20-35% total energy from fat

i.  Choose: unsaturated fats, including omega-3 and omega-6 fats.

ii.  Limit: saturated fats (<10%) and avoid trans fat.

  1. Protein. Used for many functions, including regulation, building and repair, and sending messages throughout the body. Protein is normally not used for energy during exercise, but becomes important for recovery post- exercise. 10-35% of total energy from protein.
  2. Choose: High quality proteins from whole foods, such as meat, dairy, or legumes.
  3. Limit: protein powders and supplements or heavily processed proteins

C.  Timing

  1. Spread Energy Intake throughout the day
  2. No more than 2-3 hours without eating
  3. Snacks = quality foods. Not grazing.
  4. Pre and Post-Exercise
  5. Improve fitness adaptations, enhance performance, and improve recovery (see examples below)

D.  Differences between males and females

  1. Body composition, Hormones, Metabolic

IV. Example Foods

A. Carbohydrates:

·  Whole grains: oatmeal, 100% whole wheat bread, brown rice, quinoa

·  Vegetables: eat a colorful array of what’s in season. Vegetables such as dark leafy greens, sweet potatoes, beets, carrots, and peppers can be found year round.

·  Fruit: eat seasonal. Some fruits such as bananas, frozen or fresh berries, and apples/applesauce can be found year round.

B. Fat:

·  Nuts: walnuts, almonds, cashews, pecans

·  Oils: olive oil, grapeseed oil, canola oil

·  Fish: salmon, tuna

·  Avocados

·  Omega 3: flax seeds, walnuts, salmon,

·  Omega 6: vegetable oils

C. Protein:

·  Lean meats, such as chicken, fish, turkey

·  Legumes such as beans, peas, nuts, and seeds

·  Eggs and dairy products

V. Energy Requirements

Energy (calorie) needs depend on a variety of factors, including resting metabolic rate (RMR), genetics, and energy expenditure (exercise). The body is complex- it’s not as simple and energy in and energy out. Each person is different. The important thing is to consume enough energy for your body and your activity level. Inadequate energy intake suppresses metabolism, delays recovery, and negatively impacts endurance performance.

VI. Nutrient Timing Examples

Pre-event Meal: Goal is to replenish glycogen stores and increase blood glucose to supply energy for the event.

·  Type: emphasize familiar foods high in carbohydrate.

·  Amount: 150-300g carbohydrate, approx. 300-500 kcal, up to 800 kcal.

·  Timing: 1-3 hours before event.

·  Examples: cereals/granola with yogurt, oatmeal, banana, toast with jam, bagel and cream cheese, pancakes/waffles, rice

Post-exercise: Goal is to provide fuel to start the recovery process

·  Type: simple carbohydrates + protein (4:1 ratio)

·  Amount: 50-100g immediately post-exercise or 1-1.5g/kg carbohydrate

·  Timing: IMPORTANT. Within first 30 minutes upon cessation of exercise.

·  Examples: sports drink, chocolate milk, peanut butter & jelly sandwich, banana with peanut butter, sports bar, yogurt, turkey sandwich, baked potato with cheese.

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Example Meal Plan & Timing:

6am Breakfast: oatmeal, milk, banana, peanut butter, honey

9am AM Snack: whole milk yogurt + fruit

12pm Lunch: turkey sandwich, carrots & hummus, apple, chocolate chip oatmeal cookie

2pm Snack: banana

3pm Workout

5pm Post-workout snack: chocolate milk

6pm Dinner: chicken rice bowl with vegetables and avocado

8pm PM Snack: cereal + milk