A Thin Line: Nutrition

Considerations for the Female Athlete

 

Julie Stackhouse

Stackhouse Fitness, Owner

Performance Running Coach, Jacksonville Running Company

www.getstackednow.com

stackhouse.julie@gmail.com

Potential Breeding Ground for Eating Disorders:

Long distance running is often connected with the stigma that lower body weight will have a positive effect on performance. The pressure of sports performance (self-induced or outside influences) involved in cross country and distance events in track can be a breeding ground for ED’s. If other factors are involved such as social pressures or low body image/self-esteem, the risk for developing an ED can be greatly increased. Losing weight can be justified as a part of the effort to improve performance but then can develop into a serious eating disorder.

Chrissie Wellington, Ironman World Champion:

“The victims of such illnesses are often very successful, outwardly successful young women who pursue these ideas of control and achievement. We’re driven, compulsive, obsessive, competitive, persistent and seek perfection. That can be channeled incredibly negatively.”

THE THICK & THIN OF ITThe Thick and Thin of It:

• 91% of women surveyed on a college campus had attempted to control their weight through dieting. 22% dieted “often” or “always.” • 86% report onset of eating disorder by age 20; 43% report onset between ages of 16 and 20.6. • Anorexia is the third most common chronic illness among adolescents. • 95% of those who have eating disorders are between the ages of 12 and 25.8. • 25% of college-aged women engage in bingeing and purging as a weight-management technique. • The mortality rate associated with anorexia nervosa is 12 times higher than the death rate associated with all causes of death for females 15-24 years old. • Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives. • In a survey of 185 female students on a college campus, 58% felt pressure to be a certain weight, and of the 83% that dieted for weight loss, 44% were of normal weight.

EATING DISORDERS FOUND IN FEMALE RUNNERS

Eating Disorders: 1. Anorexia Nervosa 2. Bulimia 3. EDNOS

Anorexia Nervosa Defined

An eating disorder characterized by a low body weight, fear of gaining weight, a strong desire to be thin and food restriction. Many people with anorexia see themselves as overweight even though they are actually underweight. If asked, they usually deny they have a problem with their low weight.

Anorexia (cont’d.)

• Often weigh themselves frequently

• Eat only very small amounts

• Only eat certain foods – very restrictive

• May exercise excessively

• May use laxatives to produce weight loss

• Source of control in their lives

• Perfectionist mentality

Bulimia Nervosa Defined

Also known simply as bulimia, an eating disorder classified by binge eating followed by purging. Binge eating refers to eating a large amount of food in a short time. Purging refers to an attempt to rid oneself of the food consumed. It is important to note that most people with bulimia have normal body weight.

Bulimia (cont’d.)

• Frequently associated with other disorders (depression, anxiety or problems with drugs/alcohol)

• Higher risk of suicide and self-harm

• Estimated to affect 6.5 million people in 2015

• 9 times more likely to occur in women than men

• More difficult to identify

EDNOS Defined

Eating disorders not otherwise specified (EDNOS) is an eating disorder that does not meet the criteria for anorexia or bulimia. Individuals with EDNOS usually fall into one of three groups: sub-threshold symptoms of anorexia or bulimia, mixed features of both disorders, or extremely atypical eating behaviors that are not characterized by either of the other established disorders.

EDNOS (cont’d.)

• Most prevalent eating disorder (60%)

• Just as serious as other ED’s

• Can experience the same negative psychological, social and physical consequences as a person diagnosed with anorexia or bulimia

• May demonstrate a spectrum of disordered eating behaviors which may change over time

• Binge eating disorder

FEMALE ATHLETE TRIAD

Why Bone Density is Critical for Female Athletes

Bone mass is now thought to peak between the ages of 18-25. Thus, behaviors which result in low bone density in youth could be detrimental to an athlete’s bone health throughout her lifetime.

- Hobart & Smucker, 2000

- Osteoporosis: low bone density.

- Amenorrhea: loss of menstrual cycle.

Calcium Needs for Teenage Female Athletes

• 1300mg/day (equivalent of 4 glasses of milk)

• Food sources

• Supplements – Citracal Plus

• Factors affecting calcium absorption: soda, coffee, iron, lactose intolerance

Calcium Sources in Food

• Milk or chocolate milk (low fat varieties)

• Almond milk or fortified soy milk

• String cheese, cottage cheese

• Greek yogurt (watch sugar content)

• Dark, leafy greens

• Calcium fortified cereal or juices

• Broccoli

Calcium Supplements: Key Ingredients

• Calcium Citrate

• Magnesium

• Vitamin D3 (aids absorption)

• Vitamin K

• Knowledge is empowering!

HOW YOU CAN HELPHow a Coach Can Identify Risk Factors:

Brittle fingernails or blue fingertips Menstrual irregularities (3 consecutive cycles) Lanugo Hair (furry on arms, face, body) Excuses to skip meals or eat on one’s own Light-headedness/Dizziness Abdominal Pain Decrease in performance over time Itchy/Dry Skin with Pale Undertones Preoccupation with one’s food or others’ food Exercise as a coping mechanism Exercise compulsion – prolonged training beyond what is required for one’s sport Personality shifts: withdrawal, negativity, moodiness, irritability, inability to

concentrate, impatience, cranky. Decreased immunity: frequent colds/infections Overuse injuries that take longer than usual amounts of healing time More frequent injuries such as sprains or muscle strains Loss of Bone Density: Stress Fractures Teammates, teacher or trainer reporting a concern

How You Can Help (cont’d.)

• Recognize red flags – early intervention.

• Refer an athlete to get the appropriate counseling: school counselor, school nurse, athletic director, nutritionist, physician, support groups.

• Establish trust with the athlete so they don’t feel attacked.

• Pay close attention to pre-participation physical exam – questions may identify ED tendancies.

• Determine your school’s policy on treatment options; if one doesn’t exist work with admin to help create one.

• Don’t allow the athlete to compete until healthy.

Food for Thought“It makes me sad and disappointed when I see coaches not helping a young woman with ED (eating disorder) because at the end of the day I believe coaches have the ability and power to set the stage for that young person’s life. It’s a big responsibility, but it’s all about teaching life lessons and becoming the best versions of ourselves.” - Shalane Flanagan

Lauren Fleshman Speaks Out:

“When you allow an athlete with an ED the opportunity to compete in a uniform you are sending a strong message to the team that poor choices are supported and you are sending a strong message to every single athlete that their health is not as important as their immediate performance.”

Dangers of Ignoring Eating Disorders

• Stress fractures

• Lifelong battles with ED’s

• Encouraging other athletes who may be at risk for developing ED’s

• Heart damage

• Infertility

• Destruction of tooth enamel or stomach lining

• Illness or death

Healthy Snacks Increase Performance

• Snacks can help meet the increased calorie and nutrient needs of growth and sport.

• Snacks can boost stamina and endurance and improve athletic performance.

• Calories from snacks should be from quality nutrients, not from a lot of sugar, processed foods or unhealthy fats.

• Help an athlete to plan ahead in order to maintain energy levels throughout the day.

Healthy Snacking for Teenage Athletes

• PB & banana: Healthy eyes and strong muscles; increased feeling of fullness; heart-healthy.

• Greek yogurt & blueberries: Healthy eyes, hair, nails, skin, strong bones; heart-healthy; rich in disease-fighting antioxidants.

• Hummus & baby carrots: Supports healthy digestion; increased feeling of fullness; important for healthy vision.

Healthy Snacking (cont’d.)

• Pistachios & apple: Increased feeling of fullness; cancer-fighting properties; heart-healthy.

• Low-fat cottage cheese & red peppers: Strong muscles and bone health; healthy vision.

• Snack mix (nuts, oats & dried cranberries): Increased feeling of fullness; strong muscles; supports healthy digestion.

• Quest bars or Mini Luna Bars

Timing is Everything

Pre-training (1-2 hours before):

High in carbohydrates (not sugar)

Low in fat and fiber

High in fluid content

Moderate in protein, as tolerated

Salty (if hot/humid weather)

Timing is Everything

Post-training (<1 hour after):

• High in carbohydrate (not sugar)

• Moderate to high in protein

• Moderate in fat

• High in fluid

• Salty (if very sweaty)

• Aim for 3-4:1 ratio of carbs to protein (3-4 grams of carbs for each gram of protein)

Questions?

References

• Thompson, Ron A. and Roberta Trattner Sherman. “Eating Disorders in Sport.” NYC: Routledge, 2010.

• Brittin, Lize. “Training on Empty.” Create Space Independent Publishing Platform, 2013.

• Harvey, Karen. “Female Health, Equipping Coaches to Be A Solution.” USTFCCCA, 2013.

• Pantano, Kathleen J. “Coaching Concerns in Physically Active Girls and Young Women.” Strength and Conditioning Journal 32.2, 2009.

• Hobart, J.A. and Dr. Smucker. “The Female Athlete Triad.” American Family Physician 61.11, 2000.

• B. Van Dorsten. “Stress Fractures in Elite Cross Country Athletes.” Orthopedics 30.4, 2007.