How often have you heard the remark, “A girl can never be too thin”? All of us know someone or the other who is size zero and still wants to lose more weight. (You might wonder from where, especially if everything seems just perfect.)
As a sports medicine physician, my professional goal is to make sedentary people more active. However, the whole objective of this article is to forewarn of the side effects of overdoing things. Too much of even a good thing can be dangerous—including exercise.
Too much exercise? Is it possible?
Yes, it is. And it can even take the form of a disorder similar to eating disorders such as anorexia. This exercise disorder can result in a dangerous condition called the Female Athlete Triad (FAT), so named because of the symptoms it entails.
After all, it’s not like athletes are immune to peer pressure. They have it worse: Not only is there the lure of the elusive perfect physique, there is also the desire to perfect performance by losing body fat and weight.
What is Female Athlete Triad?
According to the ACSM (American College of Sports Medicine) Position Stand on FAT: “Because the benefits of exercise far outweigh the risks, the ACSM encourages all girls and women to participate in physical activities and sports. In 1992, however, an association of disordered eating, amenorrhea and osteoporosis seen in activities that emphasize a lean physique was recognized as the Female Athlete Triad.”
Also Read Warning Signs (PDF)
In fact, in describing disordered eating in athletes, the authors of the ACSM Position Stand were careful to specify that, in athletes, restrictive eating behaviours include “inadvertently failing to balance energy expenditures with adequate energy intake”.
The triad is represented by three interrelated problems in active girls and women:
• Low energy availability, understood as an eating disorder;
• Menstrual disorders such as amenorrhea, which implies the absence of regular menstrual cycles;
• Osteoporosis, which means poor bone mass, which can leave an athletic person especially prone to stress fractures.
Who is susceptible?
First of all, note that the triad affects only women. That’s not to say men can’t suffer from excessive exercising. However, eating disorders in pursuit of a smaller size are more common in women. Also, the female body is less tolerant of losing body fat since it affects menstruation, which wouldn’t be an issue with men. And it is the hormonal disturbance which is largely responsible for the osteoporosis problem as well.
Also, though FAT talks only about athletes, non-competitive or amateur athletes have been observed to be at greater risk of these symptoms than elite athletes. Some studies have also shown that individual components of the triad are found in similar proportions in athletes and non-athletes (though, in case of non-athletes, it couldn’t be labelled FAT), and that’s the whole point: anyone can succumb.
How do you know you are at risk?
Check for the symptoms carefully and regularly. It is easy to be dismissive and say, “Of course I don’t have an eating disorder”; but do you know exactly what it entails?
Explaining ‘eating disorder’
You would think that it should be common sense that intensive exercising should go hand in hand with increased dietary intake. Instead, what usually happens in the triad is that the person also reduces her food intake at the same time, leading to extremely low energy availability—to the level where the body’s natural processes of immunity, growth, movement and reproductive functions are compromised.
Often, it starts with an effort to improve performance or achieve a perceived ideal of lower body fat. As the sufferer loses body weight, the energy imbalance gets worse. This creates a downward spiral, leading to the other symptoms.
When too little energy is available—first because excessive exercise is depleting body stores and further complicated by poor eating—the female body reduces energy expenditure in less critical processes. Without a certain minimal level of body fat, women simply can’t have normal menstrual periods. One result is the suppression of menstrual function, since reproduction is only secondary to survival. In very young athletes, low energy availability may also delay the onset of menstruation.
It is important to understand, however, that exercise itself has no suppressive effect on menstrual function beyond the impact of its energy demand. That means the disruptive influence can be prevented simply by increasing dietary energy intake to compensate for the energy lost in exercise.
Low energy availability also reduces energy expenditure in other less critical functions, such as by slowing the turnover of bone tissue. The normal turnover rate is how bone continuously grows and heals—which includes the routine repair of millions of micro-cracks that occur in everyone’s bones every day! Impairing bone growth is especially harmful for young athletes, because 50% of bone mass accumulates during the teenage years and low bone mass is a major risk factor for fractures. And even in adults, if daily wear and tear is not repaired, the damage worsens and stress fractures will result.
At the same time, if there is loss of regular menstrual cycles, there is lowered production of oestrogen in the body, which normally restrains the rate of bone resorption (the taking up of minerals from bone tissue for other uses in the body). The resulting imbalance—in which resorption exceeds formation—can cause a progressive irreversible reduction in bone density.
It is important to recognize that an adolescent athlete can fall farther and farther behind her peers in bone density through slow bone formation alone—without ever actually losing bone. Poor eating habits may also decrease the intake of calcium, besides other vitamins and minerals needed to build and repair bone.
Meanwhile, the physical demands of her sport increase an active girl’s risk of stress fractures and other bone problems.
Unfortunately, if her condition worsens to the point that she cannot train or compete, she may become depressed and/or eat even less to compensate for the lack of exercise.
What does one do then?
Stop exercising and start eating in one uncontrolled binge? No, the answer is simply to do things in moderation.
Exercise is one of the better “vices” out there. It gives you a high. However, make sure you are doing it because you like it and it makes you feel good about yourself, not because of peer pressure or just as a path to an “ideal figure”.
Also, realize that you need to replace all that energy that you have burnt up doing the exercises. You need to increase your energy intake to compensate for your active lifestyle as soon as you hit your ideal weight range. Also, the most important component of any training schedule is rest, so please don’t ignore that.
And remember, moderation is the key—which may sound simple, but is often not that easy to achieve.
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