Monday, November 26, 2012

Female Athlete Triad Syndrome

In medicine doctors like to use acronyms to shorten "big words".  It's ironic that the Female Athlete Triad that is intimately involved in eating/nutrition, is shortened to FAT. (IMHO, I would call it ROAR - Runner's Osteoporosis and AmenorRhea, fitting since eastern symbolism equates the warrior archetype with athleticism.)  The three major components to the medical problem are
1. an eating disorder
2. loss of normal mense
3. early onset osteoporosis
Any woman who has been in competitive athletics will usually attest to having her period/mense trickle off to a few days of spotting or turn off altogether.  Most of my runners love this as to avoid running with a napkin or changing a soaked tampon during an event.  Problem is when the brain turns off the monthly hormone cycle, it also maintains daily bodily function with minimal feedback loops (like a skeleton crew during holidays).  One of the important functions effected is calcium deposition in bone.  When the brain is more concerned about surviving a life threatening situation (predators, infection, starvation...) it diverts all energy to muscle and adrenals.  Digestion, love, strong bones, sex, creative introspection are not important and suffer for the short bursts of fight or flight.  Here is the rub....with sport events and most athletic practice, there is a call on the fight or flight response.  What if we call on the response only for the last 5-10 minutes of an uphill run?  The last repetition of a superset?  The last burst to steal base in the 9th inning?  Yes, even if society doesn't perceive exercise as a stressor, most people invoke the stress response during the endeavor.  (except tai chi and most traditional yoga where the relaxation response is intentionally practiced during the pinnacle of exercise) 
Getting back to bone basics, during fight or flight, you want abundant calcium in the blood stream for muscle to take advantage of in running fast or defense.  If too much calcium is leached from bone over the course of a few months to a few years, osteopenia is noted on xrays and bone scans.  Thin bones are expected in menopause/manopause as hormones cycles peeter off with normal aging.  If a woman enters her 40's with already thin bone, osteoporosis is diagnosed much earlier.  So whats the big deal with osteopenia or porosis in your 30's to 40's?  Talk to anyone that's suffered a stress fracture.  Pain, disability, loss of mobility, sleepless no further exercise! (usually temporary but occasionally permanent).   Telling an athlete not to exercise is like telling a smoker to stop smoking.  Anxiety, stress, a wonder of how will life go on is entertained/added onto the bone issue and the need for prescription medicines.  And here we mention the behavioral part of FAT (ROAR).  Most people who exercise are very in tune with watching/counting calories, portions, macro nutrients.  Some athletes can be obsessed with eating and according to the DSM "bible" of psychiatric pathology, there is a fine line between observing nutrition and having an eating disorder.  To keep it simple, women athletes can fall into bulemia, male athletes can fall into body dysmorphism.  (typical examples are gymnasts and body builders.....easy parents!..... this doesn't mean all gymnasts and body builders have disorders!)  If there is truly an altered sense of self and the disorder is causing disease to interrupt daily living-time for behavioral help.  (pastoral care, social worker, counselor, psychologist or psychiatrist)  If there is no harmful behavior found by a professional, we can pragmatically concentrate on nutrition and exercise.  Only in western medicine do we separate mind from body.  I remember a colleague saying with sarcasm, just increase protein and the menses will come back!  Duh!....the athlete would have done that already but then the weight comes on and performance dwindles. 
This is where the great nutritionists and registered dietitians become rock stars.  Even if a patient knows what s/he has to do, having to answer to someone with a personal created nutrition plan increases chances for sustainability.  Just telling an athlete to increase protein is not sustainable.  Just telling someone overweight to cut calories is not sustainable, just telling a smoker to stop smoking is not sustainable.  This is why it is so important to have a team involved in reversing disease.  It increases the chances of successful life change.   With Runners Osteoporosis and AmenorRhea, having an exercise coach help mix up activities that incorporate stress response and relaxation response to balance the hormonal waves of exercise; enlisting the knowledge base of a registered dietitian to weave in a calorie dense, low GI, personal preference food shift; a behavior therapist to be the pillar of support during the athletic metamorphosis, and an integrative physician to coordinate/recalibrate life planning when "snags" occur (they always occur so be prepared)
There is always the easy way out:
1. stop exercising
2. take prozac
3. take fosamax
4. prepare for prediabetes and prehypertension as the BMI increases with age

It's Your Choice.