Thursday, June 27, 2013

Female Triad

The "female triad" refers to the a condition that results in (as the author states):

* Low energy availability/intake - this is with or without an eating disorder
* Menstrual disturbances - amenorrhea or irregular cycles
* Bone loss - osteoporosis/osteopeniaTriad

The Triad results from pro-longed under eating, and probably specifically from under eating fat/protein - that is to say, there's some anecdotal evidence that in the presence of a high fat and adequate protein, ladies can sustain lower body fat with normal monthly cycles.

The author points to this article for further discussion:
*Please check out Figure 1 from the position paper by ACSM for a fantastic model showing the progression of the triad here

Any female is susceptible to the triad, but it is commonly seen in female athletes whose sports emphasize low body weight or leanness - think gymnasts, ballerinas, or endurance runners. The female doesn't have to be an athlete nor do they need to be in a sport that emphasizes leanness. It could simply just be a woman who is restricting her calorie intake.

She continues:
In fact, sometimes women have no idea that they are experiencing the female athlete triad until they present to the doctor with a broken bone. It sounds crazy, but even signs and symptoms, such as a lack of a monthly period, become second thoughts to these women. Sometimes they are even happy about not having to DEAL with a monthly cycle. This is not okay. Women are supposed to have monthly cycles during their reproductive years.

This is an important metric in the context of gauging your health by how you look, feel and perform:
"Fertility is a sign of health - whether or not you want to get pregnant."

I am not qualified to treat anyone with an eating disorder and don't want to imply otherwise, but my bet is that many eating disorders and the triad that may result stems from unnecessary restriction of fat intake. A healthy young (or not quite as young as she used to be) athlete should be eating "healthy" portions of fat (in other words, quite a lot of fat). A fact about humans is we are not different biologically than any other animals - our relevance in the creation of the future is our ability to reproduce, at least insofar as the genetics that got us to this point are concerned. If you want to look, feel and perform well (thank you Robb Wolf for that perspective), you will get the most gain for the least pain if you work with your genetic purpose (Fertility!), even if you don't plan to express that genetic purpose in the short term.

The implication of this genetic purpose for women is they must store enough raw material to concoct a six to eight pound human over a nine month period of gestation. The only way to do this is to start that process with plenty of fat stores and well fortified bones/teeth, since a lady will not likely be able to ingest enough of the raw materials to support herself and the rapidly growing fetus.
Now take a young person, or not quite so young, who is trying to look like what she thinks is feminine and fertile, and in that process hears that eating fat is counterproductive. If she fat deprives herself, she will also likely deprive herself of the nutrient dense foods that give her the raw materials for baby making. This will not be normal. The body will respond as it always does to nutritional deficiency - hunger will result. I don't know that this scenario leads to the complex cycles of eating disorders, but I can see how those disorders might be a natural result of doing something as drastic and unnatural as substituting carb consumption for healthy fat consumption for the purpose of looking "skinny" at a time when the body is programmed to put a goodly amount of fat into storage.
Which is to say, if you can convince the young ladies in your circle of influence that eating fat is not the bugaboo it is made to be in terms of body composition management, and that they need a good quantity of healthy fat to look and feel good, you may be doing them a great benefit, with long and short term implications for their health and wellbeing.
As an aside, I think that CrossFit may give young ladies another huge benefit by giving them a way to understand what their bodies are for aside from having a certain idealized appearance - their bodies can generate a lot of force, and complete a great deal of work. The young lady can chase performance, and in so doing begin to see a purpose separate that the one created by exercising for a benefit in appearance.
I don't think we can make folks believe that how they look, and really how they think they look, is not significant - it is, and it always will be. The win would be bending their perception that deprivation of fat is the key to a better appearance, and helping them to see that, on the contrary, low fat intake is a ticket to high appetite and low nutrition.

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