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Dr. Stephanie Howe Violett
Nutrition for High School Female Athletes
I. Female Athlete Triad: A syndrome of three interrelated conditions: low energy
availability, amenorrhea, and decreased bone mineral density. Common in female
athletes when exercise occurs without adequate energy intake. The triad can lead to
adverse effects on reproductive, bone, and cardiovascular health. Athletes may
present with 1, 2, or all 3 of the components.
Components of the Triad:
1. Energy Availability. EA = Daily dietary energy intake – exercise energy
expenditure. Decreased EA may or may not be caused by disordered eating or eating
disorders (meaning you can have low EA without either) Low EA adversely affects
bone remodeling and can disrupt menstrual function and bone mineralization.
Up to 54% of adolescent athletes have disordered eating habits. Eating behaviors
form a continuum that can range from normal to clinically diagnosed abnormal
behaviors. Pattern of disordered eating may begin as infrequent, but progress when
not acknowledged.
Signs & Symptoms: fasting use of diet pills, diuretics, or laxatives, fat free diet,
excessive exercise, restrictive eating, avoiding a certain food group or nutrient,
avoiding social eating, etc.
2. Menstrual Function. Whole spectrum of menstrual disturbances, but changes are
an energy-conserving strategy to protect biological and reproductive processes.
CAUSES: High EE, low EI, and high physical stress lead to inadequate EA, which can
cause functional hypothalamic amenorrhea. Adolescent athletes with amenorrhea
also have significantly lower BMD, and 3 times more likely to sustain bone stress
injury. Also associated with higher CV risk factors, including increased blood
cholesterol and abnormal endothelial function.
3. Bone Mineral Density. Bone mass gains during adolescence are critical for
attainment of peak bone mass. By the end of adolescence, 90% of adult bone mass
has been attained. Adequate dietary intake can positively influence bone mass. Low
EA and menstrual dysfunction suppression of bone formation. Reduced BMD
increases risk of musculoskeletal injuries, especially stress fractures.
Common signs of the Triad:
1. Fluctuations or excessive weight loss
2. Irregular or absent menstrual periods
3. Stress fractures
4. Self-esteem and mood driven by body weight and shape
5. Compulsive overexercise
Dr. Stephanie Howe Violett
*An individual can fall anywhere on this spectrum. You don’t have to have all 3
components to be at risk. If you suspect something, talk about it. If you have
questions ASK! Don’t ignore the problem or assume it will go away on it’s own.
Coaches/Parents: Focus on strong healthy women as role models. Eat meals together
and select real, nutrient dense foods (don’t fall prey to diet “fads”). Talk about body
image and health, but from a positive perspective.
National Eating Disorders Association (
II. Self Esteem
A. Media portrayal of female bodies. Unattainable, unhealthy, and often not
even real. Focus on strong, healthy women- confidence is attractive.
B. Don’t compare yourself to others
C. Build yourself and each other up. Instead of focusing on things you dislike,
focus on things you LOVE about yourself.
III. Proper Fueling
A. Why does good nutrition matter?
a. Nutrient dense vs. energy dense
b. Healthy eating is not restrictive
B. What should I eat?
a. Carbohydrates. Primary source of energy and required for optimal
function of the body & brain. 55-65% total energy should be from
i. Choose: whole grains, fruits, and vegetables. As many
whole/real foods as possible.
ii. Limit: highly processed foods, refined grains, added sugars,
packaged foods with long ingredient lists.
b. Fat. Important source of energy and also helps the body absorb many
vitamins and minerals. Essential for biological functioning of the body.
20-35% total energy from fat
i. Choose: unsaturated fats, including omega-3 and omega-6 fats.
ii. Limit: saturated fats (<10%) and avoid trans fat.
c. Protein. Used for many functions, including regulation, building and
repair, and sending messages throughout the body. Protein is
normally not used for energy during exercise, but becomes important
for recovery post- exercise. 10-35% of total energy from protein.
i. Choose: High quality proteins from whole foods, such as meat,
dairy, or legumes.
ii. Limit: protein powders and supplements or heavily processed
C. Timing
a. Spread Energy Intake throughout the day
i. No more than 2-3 hours without eating
ii. Snacks = quality foods. Not grazing.
b. Pre and Post-Exercise
Dr. Stephanie Howe Violett
i. Improve fitness adaptations, enhance performance, and
improve recovery (see examples below)
D. Differences between males and females
a. Body composition, Hormones, Metabolic
IV. Example Foods
A. Carbohydrates:
Whole grains: oatmeal, 100% whole wheat bread, brown rice, quinoa
Vegetables: eat a colorful array of what’s in season. Vegetables such as dark
leafy greens, sweet potatoes, beets, carrots, and peppers can be found year
Fruit: eat seasonal. Some fruits such as bananas, frozen or fresh berries, and
apples/applesauce can be found year round. B. Fat: 
Nuts: walnuts, almonds, cashews, pecans
Oils: olive oil, grapeseed oil, canola oil
Fish: salmon, tuna
Avocados Omega 3: flax seeds, walnuts, salmon,
Omega 6: vegetable oils
C. Protein:
Lean meats, such as chicken, fish, turkey
Legumes such as beans, peas, nuts, and seeds
Eggs and dairy products
V. Energy Requirements
Energy (calorie) needs depend on a variety of factors, including resting metabolic
rate (RMR), genetics, and energy expenditure (exercise). The body is complex- it’s
not as simple and energy in and energy out. Each person is different. The important
thing is to consume enough energy for your body and your activity level.
Inadequate energy intake suppresses metabolism, delays recovery, and
negatively impacts endurance performance.
VI. Nutrient Timing Examples
Pre-event Meal: Goal is to replenish glycogen stores and increase blood glucose to
supply energy for the event.
Type: emphasize familiar foods high in carbohydrate.
Amount: 150-300g carbohydrate, approx. 300-500 kcal, up to 800 kcal.
Timing: 1-3 hours before event.
Dr. Stephanie Howe Violett
Examples: cereals/granola with yogurt, oatmeal, banana, toast with jam,
bagel and cream cheese, pancakes/waffles, rice
Post-exercise: Goal is to provide fuel to start the recovery process
Type: simple carbohydrates + protein (4:1 ratio)
Amount: 50-100g immediately post-exercise or 1-1.5g/kg carbohydrate
Timing: IMPORTANT. Within first 30 minutes upon cessation of exercise.
Examples: sports drink, chocolate milk, peanut butter & jelly sandwich,
banana with peanut butter, sports bar, yogurt, turkey sandwich, baked
potato with cheese.
Example Meal Plan & Timing:
6am Breakfast: oatmeal, milk, banana, peanut butter, honey
9am AM Snack: whole milk yogurt + fruit
12pm Lunch: turkey sandwich, carrots & hummus, apple, chocolate chip oatmeal
2pm Snack: banana
3pm Workout
5pm Post-workout snack: chocolate milk
6pm Dinner: chicken rice bowl with vegetables and avocado
8pm PM Snack: cereal + milk