Cutting calories and upping exercise works for weight loss, but it may lead to an unhealthy triad of exhaustion, irregular periods, and weak bones

By Markham Heid
July 15, 2015
Corbis Images

Its name is ominous-like some kind of global terrorist organization made up of super-fit women. But the Female Athlete Triad is actually a syndrome brought on by lots of exercise and too little to eat.

"The Triad is associated with a failure to consume enough calories to support exercise recovery and bodily functions," says Mary Jane De Souza, Ph.D., director of the Women's Health and Exercise Lab at Pennsylvania State University and former president of the Female Athlete Triad Coalition, a non-profit started to raise awareness of the syndrome. What does it look like? Feeling wiped out, foggy-brained, or having problems concentrating are all related symptoms. (Plus, there are these 5 Weird Signs You Could Have a Nutritional Deficiency.)

De Souza says the name includes the word "triad" because it has three key interrelated characteristics: energy deficiency, menstrual cycle disturbances, and bone loss. Experience any one of them, and you're considered a Triad sufferer, she adds.

How It Works

Exercise is unquestionably great for you. But you need fuel to power your body through frequent workouts.

Poor or inadequate nutrition-sometimes called "dietary stress"-can lower or disrupt your body's levels of hormones like estrogen and luteinizing hormone. "It's complicated," says Michelle Barrack, Ph.D., R.D., an assistant professor of nutrition and dietetics at California State University, Long Beach. "But when someone has lower energy intake compared to energy expenditure, over time, this low energy availability will disrupt various hormones linked to the menstrual cycle, which also affects bone density." (Why Women Need a New Approach to Sports Nutrition.)

Like putting an extra large glass at the top of a champagne pyramid, exercise hoards a lot of the calories you dump into your body. Take in too few calories, and some of those glasses at the bottom of the pyramid won't be filled.

Are You At Risk?

While the deficiency can happen unintentionally, like if you aren't tracking your calorie burn and therefore aren't aware of how much is necessary to refuel, De Souza says she most often sees Triad among physically active women who are exercising daily and also consciously trying to restrict their calorie intake.

Of course, exercising and cutting calories is the old-school golden combo for weight loss. But, as we all know, thinness doesn't always equate healthiness. (See: 5 Nutrients Even Healthy People Forget About.)

"Your body needs energy for muscle recovery, bone health, and proper hormone function," De Souza says. If you're burning a lot of calories through exercise and not eating enough to replenish what you've lost, you're headed for trouble.

Early signs of trouble include daily fatigue-especially if you feel like you're sleeping a lot-problems thinking or focusing, and a plateau in your athletic performance. "I speak to women who say they're training like crazy but their performance is flatlining or getting worse," De Souza says. "That tells me they're not eating enough and are at risk for Triad."

As the syndrome progresses, symptoms might include getting sick all the time, experiencing irregular or absent menstrual cycles, or suffering frequent stress fractures or other injuries, De Souza says. In fact, a new study in the Journal of American Academy of Orthopaedic Surgeons found some Triad sufferers are up to 50 percent more likely to incur bone stress injuries than non-sufferers.

Protect Yourself

A rough rule of thumb for physically active women is to consume 2,000 to 2,500 calories a day, De Souza says. Avocados, nuts, seeds, dried fruit, and low-fat dairy are all healthy, calorie-dense foods, which are helpful for women trying to add much-needed energy to their diets, Barrack says. (If terms like "calorie-dense" freak you out, keep in mind that multiple studies have linked healthy calorie sources like nuts and avocado to lower rates of obesity.)

Barrack advises sticking to smaller meals and snacks spread throughout the day, as opposed to three big meals. For women who may be worried about Triad and so have started to increase their energy intake, Barrack says spreading your calories among smaller meals will help you maintain stable blood glucose and avoid gastrointestinal discomfort. (Fuel up mid-run with these 6 All-Natural, Energizing Foods for Endurance Training.)

While not specifically tied to combating Triad, post-exercise is a great time to help your body refuel with some quick calories, Barrack adds. "Within 30 minutes of finishing a workout, you want to eat some healthy carbohydrates with some protein," she says. She recommends almond butter on whole wheat toast with banana, or low-fat yogurt with dried fruit. (And try to Eat Protein Foods Rich in This Amino Acid After a Workout for the Best Hot-Body Results.)

Of course, different women will have different energy needs. If you're working out all the time, consider speaking with a doctor or sports dietitian about developing a healthy diet plan to match your workout goals.

De Sousa adds, "For women, our culture places so much emphasis on leanness and low body weight, and that precipitates these problems." Exercise is awesome, but you need enough food to support a physically demanding workout routine.

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