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Chapter 5: Nutrition and Supplements © 2011 McGraw-Hill Higher Education. All rights reserved • Proper nutrition can positively contribute to: – Strength – Flexibility – Cardiorespiratory Endurance • Performance vs. Food consumption – Myths and habits vs. physiological benefits – Psychological vs. physiological considerations • In a clinical, corporate or industrial setting the ATC may be responsible for providing nutritional counseling © 2011 McGraw-Hill Higher Education. All rights reserved Nutrition Basics • Science of substances found in food that are essential to life – Carbohydrates (CHO) – Protein – Fat – Vitamins – Minerals – Water Macronutrients Micronutrients © 2011 McGraw-Hill Higher Education. All rights reserved Nutritional Considerations Science of substances found in food that are essential to life Nutrients • Carbohydrates • Protein • Fat • Vitamins • Minerals • Water Roles • Growth, repair & tissue maintenance • Regulation of body processes • Production of energy © 2011 McGraw-Hill Higher Education. All rights reserved Carbohydrate • Body’s most efficient energy source • Accounts for 55-60% of total caloric intake • Sugars – Simple (sugars) and complex (starch and fiber) – Monosaccharides • single sugars (fruits, syrup and honey) • Glucose – Disaccharides • 2 sugars combined (milk sugar, table sugar) – Should account for <15% of caloric intake © 2011 McGraw-Hill Higher Education. All rights reserved • Starches – Complex CHO – Long chain glucose units – Rice, potatoes, breads – Body cannot use starch directly • Broken down in simple sugars • Unused starches and sugars are stored as glycogen to be used by the body later • Inadequate CHO intake results in protein utilization for energy • Protein sparing action of glucose occurs if adequate CHO in the system © 2011 McGraw-Hill Higher Education. All rights reserved • Fiber – Structural part of plants and is not digestible in humans – Soluble • Gums, pectin • Oatmeal, legumes, and some fruits – Insoluble • Cellulose • Grain breads and bran cereal – Aids normal elimination of waste (bulk) – Reduces risk of colon cancer and coronary artery disease – Reduces incidents of obesity, constipation, colitis, appendicitis, and diabetes © 2011 McGraw-Hill Higher Education. All rights reserved – Intake should be approximately 25 grams per day – Most only consume 10-15 grams per day – Excessive consumption may lead to intestinal discomfort and increased loss of calcium and iron © 2011 McGraw-Hill Higher Education. All rights reserved Fats • Most concentrated source of energy – Should account for 25-30% of caloric intake • Serves to make food flavorful and contains fat soluble vitamins • Essential for normal growth and development • Saturated vs. unsaturated – Saturated (fatty acids derived from animal products – Unsaturated (plant derivatives - liquid at room temperature) © 2011 McGraw-Hill Higher Education. All rights reserved • Other Fats – Phospholipids • Lecithin – Sterols • Cholesterol (consume <300mg/day) – Omega-3 fatty acids (unsaturated fat) aids in reduction of heart disease, stroke, hypertension) • Found in cold-water fish • Fat Substitutes – Simplese and Olean – Contain 80% fewer calories than fat and no cholesterol – May cause abdominal cramping and diarrhea © 2011 McGraw-Hill Higher Education. All rights reserved • Trans Fatty Acids – Physical properties resembling fatty acids – Found in cookies, crackers, dairy and meat products, fast foods – Increase levels of bad cholesterol – No safe level – People should eat as little of them as possible © 2011 McGraw-Hill Higher Education. All rights reserved Proteins • Required for growth, maintenance, and repair of the body • Aid with enzyme, hormone, and enzyme production • Should encompass ~15% of daily caloric intake © 2011 McGraw-Hill Higher Education. All rights reserved • Amino Acids – Basic units that compose protein – 20 amino acids compose the majority of body protein – Most can be produced by the body while others (essential) must be consumed – Animal products contain all essential amino acids – Incomplete sources (i.e. plants sources) do not contain all essential amino acids © 2011 McGraw-Hill Higher Education. All rights reserved • Protein sources and needs – Most diets are rich in protein and often athletes consume twice the amount that is recommended – Excess protein is converted to fat and may result in dehydration and potential kidney damage – Increased physical activity results in increased need for protein in the diet © 2011 McGraw-Hill Higher Education. All rights reserved Regulator Nutrients • Vitamins (13) serve as regulators in many body processes • Fat soluble – Vitamins A, D, E , K – Found in fatty portion of foods and oils • Water soluble – Vitamin C, B-complex vitamins – Help to regulate metabolism but cannot be stored – Each serves a series of roles © 2011 McGraw-Hill Higher Education. All rights reserved • Antioxidants – May prevent premature aging, cancers, heart disease and other health problems – Help protect cells from free radicals – Include vitamins A, C, E – Found in a number of dark green, deep yellow and orange fruits and vegetables – Supplements • Vitamin Deficiencies – Illness that results from a deficit in a particular vitamin/mineral – Are avoidable if an adequate diet is consumed © 2011 McGraw-Hill Higher Education. All rights reserved Minerals • More than 20 minerals have essential roles in the body • Many are stored in liver and bones • Examples – Iron (energy metabolism and oxygen transport) – Magnesium (energy supplying reactions) – Calcium (bone formation, clotting, muscle contractions) – Sodium and Potassium (nerve conduction) © 2011 McGraw-Hill Higher Education. All rights reserved Water • Most essential nutrient and most abundant in body (60% of body weight) • Essential for all chemical processes • Lack of water (dehydration) can lead to illness and death • Body has mechanisms to maintain homeostatic levels of hydration (kidneys and solute accumulation) © 2011 McGraw-Hill Higher Education. All rights reserved • Electrolyte Requirements – Involve minerals of the body - must maintain adequate levels for optimal functioning – Excess sweating can lead to depletion of these electrolytes – Help to maintain levels of hydration – Can generally maintain through proper diet, however, additional salts may need to be added periodically © 2011 McGraw-Hill Higher Education. All rights reserved Nutrient Requirements and Recommendations • Amount of nutrient required to prevent deficiency diseases • Vary among individuals and across populations • Requirements vs. Recommendations – RDA (Recommended Daily Allowance) vs. DRI (Dietary Reference Intake) © 2011 McGraw-Hill Higher Education. All rights reserved • DRI includes: – RDA – UL’s (upper intake levels) – EAR (estimated average requirements) – AI (adequate intake) • Food Labels – Aids consumers in determining levels of nutrients in foods © 2011 McGraw-Hill Higher Education. All rights reserved Figure 5-2 © 2011 McGraw-Hill Higher Education. All rights reserved MyPyramid • Replaced Food Guide Pyramid in 2005 • Emphasizes more individualized approach for diet and lifestyle – Stresses benefits of improvements in nutrition, lifestyle behavior and physical activity • Identifies amounts of food to consume depending on energy expenditure © 2011 McGraw-Hill Higher Education. All rights reserved • Represents recommended proportions of every food group while focusing on the importance of making smart food choices daily • MyPyramid Symbol illustrates – Gradual improvement – Physical activity – Variety – Moderation – Proportionality – Personalization © 2011 McGraw-Hill Higher Education. All rights reserved Figure 5-3 © 2011 McGraw-Hill Higher Education. All rights reserved Dietary Supplements • Activity increases need for energy not necessarily all vitamins, minerals and nutrients • Vitamin Supplementation – Athletes believe large doses can lead to superior health and performance – Common megadose practices • Vitamin C – For prevention of common cold and to slow aging – May cause kidney stones and diarrhea © 2011 McGraw-Hill Higher Education. All rights reserved • Vitamin E – Protects cell membranes from damage – Little evidence to support enhancing performance or life expectancy • B-complex vitamins – Aid in release of energy from CHO, fat, and protein – If additional energy is required, increased caloric intake is necessary • Mineral Supplementation – Calcium and iron tend to be low and diets may need to be modified • Particularly in those that do not consume dairy products, red meat or enriched breads/cereals © 2011 McGraw-Hill Higher Education. All rights reserved • Calcium Supplements – Most abundant mineral in body – Over time additional levels of calcium are required for bone maintenance • Without, bones become weak and brittle resulting in osteoporosis – Young adult requires 1000mg/day – Females tend not to get enough calcium in diet – While exercise helps bones to retain calcium, extreme levels of exercise, causing hormonal imbalances, can disrupt calcium retention – Supplementing with calcium carbonate or citrate is advisable © 2011 McGraw-Hill Higher Education. All rights reserved – Milk products are the most reliable source of calcium – Some athletes complain it causes upset stomach due to a build up of intestinal gas • May be lactose intolerant and lack the enzyme lactase (lactase deficient) • Can supplement with lactase (scientifically produced) • Iron Supplements – Common in females – Results iron-deficiency anemia, limiting oxygen carrying capacity of blood • Athlete feels tired and weak due to muscles’ inability to generate energy – Excess supplementation could be toxic and may result in constipation © 2011 McGraw-Hill Higher Education. All rights reserved • Protein Supplementation – Approximately 1-1.5g/kg body weight of protein should be consumed for increasing muscle mass – Often times exceeded with normal diet and supplementation is not necessary • Creatine Supplementation – Naturally occurring substance in body produced by kidneys, pancreas and liver – Found in meat and fish – Role in metabolism – Two types (free creatine and phosphocreatine) © 2011 McGraw-Hill Higher Education. All rights reserved – Phosphocreatine is stored in skeletal muscle and works to re-synthesize ATP during activity – Positive effects • • • • increase intensity of workouts lactic acid buffer stimulates protein synthesis decreases total cholesterol and total triglycerides and improves HDL-LDL ratio • increases fat free mass – Negative effects • weight gain • muscle cramping • gastrointestinal disturbances and renal dysfunction © 2011 McGraw-Hill Higher Education. All rights reserved • Loading Phase • Consists of ingesting .3 grams of creatine/kg of body weight per day • Should be split over 4-5 times per day with 16 ounces of water per dose • Loading phase last for 5 days • Research has shown that loading is not always required – Maintenance • Consuming .03 grams/kg body weight for one month – Wash-out phase • No supplementation for 1 month • Creatine is not a banned substance, however, distribution by NCAA institutions is banned © 2011 McGraw-Hill Higher Education. All rights reserved • Herbal Supplements – Trend - natural alternatives to drugs and medications – Safe to ingest as natural medicines with few side effects (occasional allergic reaction) – Offer nutrients that nourish brain, glands and hormones – Don’t need to consume with food - contain own digestive enzymes – Work with the body’s functions (whole body balancers) – Caution must be exercised as there is no governmental control or regulation © 2011 McGraw-Hill Higher Education. All rights reserved • Ephedrine – Stimulant used in diet pills, illegal recreation drugs and legitimate OTC medications – Similar to amphetamine – FDA has posted warning concerning use; 2003 its use in supplements was banned – NCAA, NFL, NBA, minor league baseball and the USOC have banned use by athletes – Potential dangers associated with use and has been known to cause numerous problems • • • • Heart attack, stroke, tachycardia Paranoid psychosis, depression, convulsions, coma Fever, vomiting, palpitations, hypertension Hypertension and respiratory depression © 2011 McGraw-Hill Higher Education. All rights reserved • Glucose Supplements – Ingesting large quantities of sugar prior to activity causes an increase glucose in the blood – Release of insulin stimulated, allowing cells to utilize free circulating glucose, sparing blood glucose – Positive effect on performance – However, some athletes are sensitive to high CHO feedings and have problems with increased levels of insulin • May lead to upset stomach or diarrhea • Athletes should test themselves with various food combinations prior to competitive events © 2011 McGraw-Hill Higher Education. All rights reserved Popular Eating and Drinking Practices • Caffeine – Central nervous system stimulant found in carbonated beverages, coffee, tea (chocolate contains compounds related to caffeine) – Increase alertness and decrease fatigue – Not detrimental to performance • Enhances fat utilization and endurance performance • Makes calcium more available allowing muscles to work more effectively • May cause slight headaches © 2011 McGraw-Hill Higher Education. All rights reserved • Caffeine (cont.) – Too much causes nervousness, irritability, increased heart rate and headaches – Headaches may result when ceasing caffeine use (withdrawal) – Olympic officials consider it to be a drug • Should not be present in a drug test at levels greater than 5-6 cups of coffee – Energy Drinks • Contain high levels of caffeine • Also contains some legal herbal supplements • Use may result in increased HR, BP, dehydrate the body and interfere with sleep • Should not be combined with exercise as fluid loss from exercise and diuretic quality of caffeine can result in severe dehydration © 2011 McGraw-Hill Higher Education. All rights reserved • Alcohol – Provides energy for the body – Little nutritional value – Central nervous system depressant • decreases coordination, slows reaction time, decreases mental alertness • increases urine production (diuretic effect) – Alcohol consumption is not recommended before, during or after activity © 2011 McGraw-Hill Higher Education. All rights reserved • Organic, Natural, of Health Foods – Claim to be safer and nutritionally superior due to absence of pesticides and fertilizers – All foods are organic due to presence of carbon – More expensive no increased benefit physiologically – Processing (preservatives) helps to maintain nutritional value © 2011 McGraw-Hill Higher Education. All rights reserved Vegetarianism • Utilize plants to form foundation of diet animal foods are either excluded or included in a variety of eating patterns • Economic, philosophical, religious, cultural, or health reasons • While practiced intelligently (not a fad) a vegetarian diet can result in deficiencies • Diet must be carefully planned © 2011 McGraw-Hill Higher Education. All rights reserved – Total vegetarian (vegan) • all plant diet, no animal products • must be certain to consume enough calories and vitamin B12, calcium, zinc, and iron – Lactovegetarian • Consume plant foods and milk products • Must watch iron and zinc levels – Ovolactovegetarian • Consume plant foods, milk products and eggs • Iron is still a concern – Semivegetarian • Still primarily plants but all other products are consumed except red meat. © 2011 McGraw-Hill Higher Education. All rights reserved Pre-event Nutrition • Importance and content pre-event meal vs. traditional rewarding that may hamper performance – Traditional steak and eggs • Long term food consumption is more important than immediate consumption • Purpose should be to provide competitor with nutrients/energy and fluids for competitions (taking digestibility into consideration © 2011 McGraw-Hill Higher Education. All rights reserved • Encourage athletes to be conscious of diet • Diets are also individual to each athlete • Individual is the best judge of what should or should not be consumed • What is the individual comfortable with • Liquid Supplementation – Extremely effective and successful – 225-400 calories per serving – Successful in reducing pregame symptoms of dry mouth, abdominal & leg cramps, nervous defecation and nausea © 2011 McGraw-Hill Higher Education. All rights reserved – Food generally takes 4 hours to clear stomach and upper GI tract – Liquid supplements clear stomach and upper bowel before game time, settling the stomach and making available nutrients © 2011 McGraw-Hill Higher Education. All rights reserved Eating Fast Foods • Way of life in America --world of fast food junkies • Often meal of choice during travel • Big concern is the amount of fat (4050% of calories from fat) • Size vs. supersize • Increased menu size is a plus (variety) • Nutritional information posting © 2011 McGraw-Hill Higher Education. All rights reserved Low Carbohydrate Diets • While fat reduction had been the trend in dieting, new recommendations for CHO reduction have come forth • Numerous versions – Most replace CHO intake with protein and fat • Unused CHO is readily turned into fat – CHO consumption increases insulin production – Insulin while allowing cells to use blood glucose also encourages fat to be deposited and a hunger response to be triggered © 2011 McGraw-Hill Higher Education. All rights reserved – Tendency becomes to consume more CHO’s as a result • Hyperinsulinemia – Elevated insulin in the blood which contributes to individuals becoming overweight – CHO restriction halts insulin cycle and improves glucagon production, enhancing fat burning and cholesterol removal from blood vessels – Dietary changes result in ketosis, which stabilizes blood glucose, a reduction in insulin levels and rapid weight loss © 2011 McGraw-Hill Higher Education. All rights reserved Glycogen Supercompensation • Increase muscle and liver glycogen stores prior to major event by altering eating and training habits • Decrease training at least 48 hours prior to event – Allows for clearance of metabolic waste products • Increase CHO loading to increase glycogen stores and positively impact muscle glycogen and muscle endurance © 2011 McGraw-Hill Higher Education. All rights reserved • Six-day period – Phase I (Days 1-2): hard training with reduced CHO intake – Phase II (Days 3-5): decrease training and increase CHO (potentially increasing glycogen stores 50-100%) – Phase III (Days 6-7): resume normal diet • Not clearly demonstrated as being beneficial in endurance activities • Do not perform more than 2-3 times per year • Ideally for prolonged duration events © 2011 McGraw-Hill Higher Education. All rights reserved Recommendations for Restoring Muscle Glycogen After Exercise • When the time period between events is <8 hours – Consume CHO ASAP to maximize recovery • Complete restoration requires 20-24 hours • Consume 0.45-0.55 grams of CHO per pound of body weight for each of the first 4 hours – Utilize nutrient rich carbohydrate foods • For a 24 hour period, 2.3 – 5.5 grams of CHO should be consumed per pound of BW © 2011 McGraw-Hill Higher Education. All rights reserved • Pasta, potatoes, oatmeal and sports drinks are recommended • The addition of protein to carbohydrate supplements has been shown to enhance aerobic endurance – The reason behind this is unknown – Evidence supports a 4:1 ratio of CHO:PRO • Other ratios (1:1; 3:1) have also been suggested • Peanut butter and tuna are good sources of protein © 2011 McGraw-Hill Higher Education. All rights reserved Fat Loading • Fat loading vs. carbohydrate loading • Intent = better energy source • Negative side effects – cardiac protein and potassium depletion – development of arrhythmias, increased serum and cholesterol © 2011 McGraw-Hill Higher Education. All rights reserved Body Composition and Weight Control • Gains and loss of weight in athletes can be problematic • Intelligent and conscientious approach involves some knowledge of what is involved on the part of the athlete and athletic trainer • Results in individual displaying discipline relative to types and quantities of food © 2011 McGraw-Hill Higher Education. All rights reserved Body Composition • Ideal body weight = age-related height/weight chart – Inaccurate due to broad ranges and failure to take individual body types into consideration • Health and performance may be best indicators • Fat vs. nonfat components of body = body composition © 2011 McGraw-Hill Higher Education. All rights reserved • Non-fat or lean tissue (lean body weight) – bone, muscle, tendon, connective tissue • Body comp is the relationship between fat tissue and lean body tissue • Averages – Female 20-25% body weight = fat – Male 12-15% body weight = fat – Should not fall below 3% and 12 % for males and female respectively • Results in loss of essential fat padding for organs © 2011 McGraw-Hill Higher Education. All rights reserved • Overweight = excess body weight relative to size and stature • Overfat = excessively high percentage of total body weight is fat • Obesity = extreme amount of excessive fat – Female >30% and male >20% percent body fat • Factors that determine amount of fat – Number of cells • Proliferation or hyperplagia of fat cells occurs from birth to puberty – Size of cells • Increase/decrease over time until adulthood relative to caloric balance © 2011 McGraw-Hill Higher Education. All rights reserved – Change of weight = change in size of adipose cell not the number of cells • Adipose cell stores triglycerides (liquid fat) – Moves in and out of cells according to energy demands • Moderate, long term activity uses greatest amount of fat • One pound of fat = 3500 calories, stored as triglycerides © 2011 McGraw-Hill Higher Education. All rights reserved Assessing Body Composition • Several methods – Hydrostatic weighing, bioelectrical impedance, skinfold thickness measures – Skinfolds based on the fact that 50% of body fat is subcutaneous • Utilize skin fold calipers • Relatively low accuracy but is easy to learn and utilize • Error is + 3-5% © 2011 McGraw-Hill Higher Education. All rights reserved Figure 5-5 © 2011 McGraw-Hill Higher Education. All rights reserved • Hydrostatic Weighing – Utilizes underwater tank to determine body density – Establishes relationship between lean mass (more dense) and fat mass (resulting in more buoyancy) – Very accurate method – Not always available, expensive equipment – Time consuming – Requires exhaling all air © 2011 McGraw-Hill Higher Education. All rights reserved • Bioelectrical Impedance – Measures resistance of electrical current flow between points – Based on principle that electricity will flow through path of least resistance – Fat = good insulator – Water = good conductor – Impacted by levels of hydration – Expensive equipment © 2011 McGraw-Hill Higher Education. All rights reserved Determining Body Mass Index • Determine extent of overweight or obesity using height and body weight • BMI (body mass index) is a ratio of height and weight • Utilized to measure health risks associated with obesity • BMI >25 indicate excess body fat • BMI 25-30 indicates overweight • BMI >30 indicates state of obesity © 2011 McGraw-Hill Higher Education. All rights reserved Assessing Caloric Balance • Caloric balance = Calories consumed - calories expended • Positive caloric balance results in weight gain and vice versa for negative caloric balance • Can be calculated through accurate record keeping of calories consumed and expended relative to metabolic and activity needs – Calories are expended through: • basal metabolism (calories expended at rest) = BMR • work (activity that requires more energy than sleeping) • excretion © 2011 McGraw-Hill Higher Education. All rights reserved – Must calculate total time engaged in all 3 areas over a 24 hour period – BMR is determined in laboratory setting through indirect calorimetry which measures oxygen uptake – Work (type, intensity, duration) must be determined – Body size also factors in – Energy expenditures can be consulted to determine average energy expenditures per activity (kcal/min/lb) © 2011 McGraw-Hill Higher Education. All rights reserved • Caloric Intake – Carbohydrate = 4 calories/gram – Protein = 4 calories /gram – Fat = 9 calories/gram – Alcohol = 7 calories/gram – College athletes consume 2000-5000 calories/day – Endurance athletes may consume as many as 7000 calories © 2011 McGraw-Hill Higher Education. All rights reserved Methods of Weight Loss • Exercise or dieting alone is ineffective over the long run • Dieting alone results in lean body tissue loss – Should not drop below 1000-1200 calories for women and 1200-1400 for men • Exercising, while resulting in loss of fat mass, will also enhance strength, cardiorespiratory endurance and flexibility © 2011 McGraw-Hill Higher Education. All rights reserved • The key is moderation – A combination of dieting and exercise – A negative energy balance must be achieved – Loss of 1.5-2.0 pounds per week is adequate – Weight loss of more than 4-5 pounds per week can be attributed to dehydration – It takes time to put weight on and also takes time to take it off © 2011 McGraw-Hill Higher Education. All rights reserved Methods of Weight Gain • Aim should be to increase lean body mass • Increased physical activity (muscle work) and dietary modifications • Approximately 2500 calories is required per pound of lean body mass, an increase 500-1000 calories per day • A 1-2 pound per week gain is adequate © 2011 McGraw-Hill Higher Education. All rights reserved Disordered Eating • Spectrum of abnormal eating habits – Mild food restriction, binging, purging, bulimia, anorexia nervosa • Multi-factorial – Social, familial, physiological, psychological components © 2011 McGraw-Hill Higher Education. All rights reserved • More prevalent in athletic populations – Control over body weight/composition for performance – In addition to the emotional and social pressures characteristic of eating disorders, physiological effects can impact health and performance of the athlete – Education of athletic trainers in this area is critical • Prevention and management strategies © 2011 McGraw-Hill Higher Education. All rights reserved • Bulimia – Generally identified in females (can also be found in males) ranging in age from adolescence to middle age – Periods of starvation, bingeing (thousands of calories) and purging through vomiting, fasting and laxatives/diuretics © 2011 McGraw-Hill Higher Education. All rights reserved – Characteristics • Typically bulimic athletes are white, middle to upper-middle class • Perfectionist, obedient, over-compliant, highly motivated, successful academically, well-liked, and a good athlete • Gymnastics, track, dance • Occasionally seen in male gymnasts and wrestlers – Bingeing and purging can result in stomach rupture, heart rhythm, liver damage, tooth decay from acids, chronically inflamed mucous lining of mouth and throat © 2011 McGraw-Hill Higher Education. All rights reserved – Binging does not include celebratory overeating that may occur during the holidays or other events – Binging is a loss of control over one’s eating; the resultant guilt drives he/she to vomit • Bulimics experience this scenario repeatedly © 2011 McGraw-Hill Higher Education. All rights reserved • Anorexia Nervosa – 30-50% of anorexics also suffer from bulimia – Characterized by distorted body image and constant concern about weight gain – Impacts mostly females – Starts often with adolescents and can be life threatening – While the individual tends to be too thin they continue to feel fat – Deny hunger and are hyperactive – Highly secretive © 2011 McGraw-Hill Higher Education. All rights reserved • Early intervention is critical with eating disorders – Empathy is a must • Psychological counseling is key • Must have individual recognize the problem, accept the benefits of assistance and must voluntarily accept help for treatment to work © 2011 McGraw-Hill Higher Education. All rights reserved • Anorexia Athletica – Condition specific to athletes – Characterized by features common in anorexia nervosa • No self-starvation practices – Signs • • • • • • • • Disturbance of body image Weight loss >5% of body weight Gastrointestinal complaints Primary amenorrhea Menstrual dysfunction Absence of illness explaining weight reduction Fear of becoming obese Binging, purging, compulsive eating, or caloric restriction © 2011 McGraw-Hill Higher Education. All rights reserved Female Athlete Triad • Potentially fatal problem • Combination of eating disorder, amenorrhea and osteoporosis • Some suggest eating disorders may exist in 62% of females in certain sports and amenorrhea found in 60% • Major risk is the fact that bone lost may not be regained © 2011 McGraw-Hill Higher Education. All rights reserved