Female Athlete Triad Could Cause Irreversible Health Damage to Endurance Athletes

If you’ve been in the running world for some time, you’ve surely noticed what the typical road race winner looks like, right? Tall, toned, and thin. It’s fair to assume that this is what it takes to be fast. Unfortunately, many of us, and especially females, go about improving our performance based on looking like these elites. Many female athletes are under nourished in relation to the amount of energy they expend. Truth is, this common behavior is actually very dangerous and can cause serious damage to a female athlete’s body.

I have been running since 2006. In 2024, after my sixth marathon, my doctor raised his concerns about my weight, my bone health, and something called the female athlete triad. I had never heard this term before, but I was quickly learning that I was in serious danger of falling into this condition.

Loyola University defines the female athlete triad as being characterized by disordered eating, irregular periods, and osteoporosis. I sat listening to my doctor explain the condition and knew that my periods were not regular, however, surely the other issues didn’t apply to me, or so I thought. He proceeded to perform a dual-energy X-ray absorptiometry, or DEXA scan, to check my bone density. He didn’t like what he saw for a female in her late twenties. But then he got to the eating. I was in complete denial. I was thin, but I was a runner and I needed to keep my calories low so I could stay light for performance. So I thought.

Long story short, I was was deep into the female athlete triad. A recent report from Loyola titled, “Endurance Sports Can Leave Women Running on Empty,” suggests that many female endurance athletes are in the same boat and at risk for serious health issues, including stress fractures, infertility issues, and osteoporosis.

Haemi Choi, MD, assistant professor of family medicine at Loyola University Chicago Stritch School of Medicine, shared how runners can easily fall into the risk category. “Individuals who are the greatest risk for low energy availability are those who exercise for prolonged periods of time, restrict their diets, limit the type of food they eat, and participate in sports that emphasize leanness.”

That category is exactly where a runner falls. The most striking element about this condition is the one that lead me to seek help.

Neeru Jayanthi, MD stated in the Loyola report that, “Many who participate in these events are inexperienced athletes who do not properly care for their bodies while training. This can lead to irreversible damage to their health.”

Irreversible. Those words should strike deep within any female athlete. Yes, we want to be at the top of our game today, but we should want to be able to walk in our sixties as well.

The subject used in the Loyola report wasn’t unlike me or many of my counterparts. She was young, thin, and training hard. She was also under eating for how much she was expending in order to stay trim. She, like me, was assigned to treatment that included medical, psychological and nutritional counseling. This seems to be the standard treatment for those who fall into the female athlete triad.

In a nutshell, females who land in this category are simply not eating enough. As training increases, the body demands more, and many of us are not giving the body what it needs. The irony is that we think we’re helping ourselves stay trim and race ready, however a Loyola study of distance runners found that the total calories consumed is the best “predictor of performance.” Yet, women specifically tend to not adjust their diet to compensate for the intense training endurance sports require.

It took some time for me to get comfortable with eating more and eating better, I had to seek counseling and still remain in the care of a nutritionist on a regular basis. But, I can also attest to the fact that the process works. I just ran my fastest marathon this month and I ate more during training than I’ve ever allowed myself to eat. Thin bodies don’t win races, healthy bodies do.

These are the dietary tips from the Sports Medicine Doctors at Loyola University:

  • Consume carbohydrates. Eat carbohydrates two hours prior to exercising and immediately following a training session or event.
  • Load up on calcium. A regular multivitamin does not have an adequate amount of calcium. Premenopausal women should consume 1,000 – 1,200 mg of calcium daily and postmenopausal women should take 1,500 mg in 500 mg doses with magnesium and vitamin D for optimal absorption.
  • Eat small well-balanced meals regularly. Consume small, balanced meals every three to four hours to ensure energy levels support training needs.
  • Ensure caloric intake is sufficient. Physicians recommend eating 30 calories per kilogram of weight daily and adjusting this based on exertion levels.

Also Read:

Top Marathon Runner Questions Answered

Chris Deacon Lost 200 Pounds and Finished the Chicago Marathon

The Big Difference in Pre-Workout and Post-Workout Snacks

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