Dietary treatment for the triad of the athlete woman.

The triad of the athlete woman is a clinical entity that refers to the relationship of 3 factors that present in a negative state generating:

1.- Low energy availability.

2.- Osteoporosis.

3.- Functional hypothalamic amenorrhea.

Currently, it is not only a ”triad”, since the consequences of low energy availability or relative energy deficiency in sport (RED-S) can affect beyond these three items.

What are the causes of low energy availability?

 

Low energy availability is not necessarily due to eating disorders (as was initially stipulated within this concept), since it can occur due to an increase in training loads, which in turn generates an increase of energy expenditure, which does not necessarily increase feelings of hunger, that is, it is due to low energy consumption/poor nutrition on the part of the female athlete, with a poor training load/recovery ratio

What are the consequences of an S-NETWORK?

 

The consequences of a RED-S affect the state of health beyond the triad, affecting growth and development, presenting gastrointestinal, immunological, cardiovascular, hormonal, as well as psychological symptoms and this can affect sports performance at several levels: decreasing musculoskeletal glycogen reserves, concentration, coordination, response to training, decreasing muscle strength and increasing the risk of injury.

It should be noted that the risk of presenting the consequences of a RED-S increases in elite athletes, although it is not exclusive to women or this small group of people.

Nutritional intervention

 

If the energy deficiency is due to an unintentional decrease in intake (as may occur with increasing training loads) then nutritional education may be sufficient for treatment.

However, if the causes are other, the treatment will be based on increasing energy intake through the implementation of a feeding plan that increases actual intake by 300 – 600 Kcal per day to increase availability by at least 30 kcal. . /kg of weight making changes in food choice, energy distribution and other characteristics of the diet, based on individualized and periodized changes according to the athlete’s energy expenditure and exercise objectives.

Likewise, the treatment is accompanied by a reduction in exercise, which includes: a decrease in the intensity and duration of training by 10%

Strategies for the treatment of low energy availability associated with menstrual dysfunction:

An adequate intake of proteins and carbohydrates is recommended to restore liver glycogen and facilitate the pulsatility of Luteinizing hormone.

Treatment Strategies for Optimizing Bone Health:

Part of the treatment is an adequate intake of nutrients for bone formation, since serum levels of 25-hydroxy Vitamin D < 30 ng/mL are associated with an increase in the incidence of bone stress injuries. Vitamin D intake of 600 to 800 IU daily is recommended by the USDA dietary guidelines. However, a higher intake may be necessary temporarily to achieve serum 25-hydroxy Vitamin D levels > 30 ng/mL.

Improving levels of 25-hydroxy Vitamin D may also reduce healing time and facilitate an earlier return to sport in the event of a bone stress injury.

Finally, adequate calcium consumption can help reduce the incidence of bone stress injuries. The current recommendation for daily calcium intake is 1000 mg/day for men and women aged 19 to 50 years and 1300 mg/day for children and adolescents aged 9 to 18 years.

References:

1.- Mountjoy M, Sundgot-Borgen J, Burke L, Ackerman KE, Blauwet C, Constantini N, et al. International Olympic committee (IOC) consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Int J Sport Nutr Exerc Metab. 2018; 28(4):316–31.

2.- Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. The IOC consensus statement: beyond the Female Athlete Triad–Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014;48(7):491–7.

3.- Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. Authors’ 2015 additions to the IOC consensus statement: Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2015; 49(7):417–20.

4.- Birch K. Female athlete triad. BMJ. 2005;330(7485):244–6

5.- Nazem TG, Ackerman KE. The female athlete triad. Sports Health. 2012;4(4):302–11.