Is our definition of the female athlete in science really reflective of a female athlete?
Is energy deficiency a health problem only encountered by female athletes, or, is it an issue we see in our current society?
Well after a nice easy blog post, I thought why not straight dive into a juicy topic of discussion. I introduced myself as a researcher in Exercise Physiology, but what I didn’t mention is that outside of my work hours I attempt to train and compete in triathlons. Yes, for any one with some knowledge of psychology – I am your typical type ‘A’ personality that strives on routine and finds a 5:00 or 4:30 am wake up followed by a 60-120 minute training session to be the most relaxing and invigorating part of my day. In all honesty, an early morning session is a great time to think about research, especially if you have 60+ minutes in a pool staring at a black line. I have had some incredible brain waves during a swim session and I am sure my colleagues think I am absolutely mad when they get an email at 7:00am that reads ‘Morning- while I was swimming this today I had this great idea…..’.
Aside from being researcher in exercise physiology, I would also lump myself into the basket of training female athlete (athlete because I spend way too much time doing training to be classified as ‘recreational’). I think this gives me a unique perspective on understanding and interpreting science for a female, as I am able to see it from the health and sporting perspective. Now, I am not the first to admit the field of sport physiology or even exercise, medical and health physiology has done a great dis-service to females as the majority of research in physiology is done in males (not trying to be a feminist here guys- just stating the facts). What we know about performance, training periodization, majority of the nutrition research and supplement research is done in males. Why? Well males have a consistent hormonal profile after puberty with no fluctuations, so to many researchers this means quick and easy research trials. You can essentially get a guy into a lab and test him once a week and you don’t need to worry about any changes to the internal hormonal profile of the dude. Females post-puberty differ from males, instead of a constant reproductive hormonal profile we have a cyclical hormonal profile with two leading hormones, progesterone and oestrogen that change concentrations throughout a roughly 28 day cycle. Research-wise people have used the excuse that this makes research trials difficult as a female’s internal physiology will change week to week depending on the concentrations of progesterone or oestrogen in her body. Instead of testing every week like you would in males, you may need to test once a month. I mean, really, why are we creating a big song and dance about testing once a month? I am pretty sure there are worse things in life. But sadly, because of this excuse and others such as low funds and more blood tests to identify where a female is in her menstrual cycle, we have ended up with very limited literature on female physiology. So limited that we have a void in information on how healthy and normally menstruating females respond in various situations (health and sporting). One area that we do know a lot about in female athletes is known as the ‘Female Athlete Triad’ or ‘Relative Energy Deficiency in Sport’ (RED-S). This research focuses on reduced food intake and excessive exercise in females resulting in minimal energy remaining for normal body functioning. Females that present with this have no menstrual cycle, diminished bone health, poor psychological/cardiovascular health, and poor training adaptations/performance. But here is my problem, all the research in this area of RED-s is in FEMALES…female athletes to be more precise. It is like sport science is selling the image of males athletes being strong, well balanced and capable of excellence in sport, yet a female athlete is defined in research by disordered eating or even an eating disorder. Excuse my language but I would truly like to call bulls*** on this whole idea. I know plenty of healthy, strong and vibrant female athletes that are excelling in their sport, and on the flip side I know plenty of male athletes who present with every single symptom of relative energy deficiency (RED-S) in sport, but because they don’t have a menstrual cycle it goes un-diagnosed. If we were to flip this point of view, I would actually say I feel sorry for the guys because they could go years in a state that is detrimental to their body’s health and may experience poor sporting performances because they have no menstrual cycle to detect or diagnose RED-S. Poor guys and girls- all hail a healthy and regular cycle!
Ok, let me quickly cycle back and explain RED-S. The premise for this diagnosis works on the basis that we need energy from the food we eat to survive and exercise. When we exercise we ‘burn up’ and use energy from food- like a car uses fuel. Our food is the petrol and exercise and movement uses this fuel. But the human body is slightly different to a car (bit of a captain obvious statement there). When we turn a car off it uses no fuel, and here is where the difference occurs. The human body at rest STILL USES FUEL TO FUNCTION. Yes believe it or not the food you eat provides energy to sit, stand, breath, digest food, repair and build muscles, you even use energy to blink and well you may blink up to 28,000 times a day! Here is the problem that many people may be faced with, they work out how much energy they burn during exercise and then eat enough to provide energy for that, without taking into account all the other processes in the body that need and use fuel. As a result, they create a state known as ‘low energy available for normal functioning at-rest ’. Now, I hate to be the barer of bad news, but although humans think of themselves as superior beings and highly intelligent, our physiology and how we adapt to our environment is still programmed like it was in the days of caves and loin cloths. We may be capable or rocket science but physiologically our bodies will adapt to whatever environmental stress we expose ourselves too in order to achieve one goal- survival. So if we don’t provide enough food for exercise and normal functioning our bodies will adapt to this in order to increase our chance of survival.
People with RED-S will:
- have reduced metabolic rates
- store more fat (basically the opposite of what you are trying to achieve)
- have poor concentration
- be irritable (very short fuse)
- suffer from gastro-intestinal upset and dysfunction (a real issue as they then try elimination diets that further reduce their food intake)
- reduce reproductive functioning (in females your menstrual cycle goes AWOL).
Now the reductions in reproductive functioning are not exclusive to females. Guys, if you are presenting with RED-S you will likely have reduced testosterone levels (lower end of the normal range) and while you may not see visual changes like a female will, what you may notice is poor adaptation to training, or a plateau in your sporting performance. Quite frankly you and your partner may even notice you have lost your libido! Now the concept and presentation of RED-S in males is an area I would like to delve into but I may leave the details of that for another blog post- otherwise we would be reading a book and not a blog post today.
I personally think that RED-S is not an area that is exclusive to athletes or training individuals. I think it is a societal problem. Whether we like to admit it or not we are a society with a lot of pressures to look a certain way (applicable to both genders here) and we have access to so much dieting (mis)information! It seems like every week people are trying a new diet or exercise regime because suddenly this is the new thing to do. And based on the fact that majority rules and ‘everyone on Instagram is doing it- so I better do it too’. As far as I can remember I have grown up in an environment where people talk about obesity and losing weight and ‘to do this you need to count calories‘ or ‘eat highly processed low fat food/low sugar foods/low carbohydrate foods‘. People that follow this method will often increase their exercise and drastically reduce their intake, resulting in rapid initial weight loss. But after a few weeks their weight may rebound or they will ‘struggle to lose those last couple of kilograms of fat around their waist’. Here is a thought, maybe the reason your body is retaining fat is because you are not providing enough fuel from the food you are eating to sustain your increased exercise regime AND normal healthy functioning at rest. Maybe you are presenting with relative energy deficiency. Just a thought – but maybe the reason diets like the paleo diet and keto diet appear to suddenly work in people is because these diets focus on eating foods in their original format that are not ‘low fat, low carb, low sugar-basically air with a texture’. While I am not a massive supporter of the keto diet (I still think we are lacking in many areas of research particularly long term health and female responses to this diet), it does encourage people to eat foods that are high in energy. It could be very likely that your everyday person who has been trying to lose weight may switch to this diet and suddenly see a change in their body composition and how they feel and function, and this may not be because keto is magic. Instead, it may be due to the fact that they are now eating foods with enough energy to support exercise AND healthy physiological functioning, allowing their body to respond and adapt in a normal manner, as such – they are no longer presenting with RED’s. Maybe energy deficiency, and the health consequences it presents, is not a female athlete problem, maybe it is a societal problem….