Physicians Should Be On The Lookout For “Female Athlete Triad,” Research Suggests.
We first learned of the “female athlete triad” in the family practice literature. This triad consists of eating problems (anorexia, bulemia), menstrual abnormalities and weakened bones. This triad is the “worst case scenario” for female athletes. Even with the magnitude of these problems, this disorder gets little press. This is only the second report I’ve seen in several years.
The frightening thing is that ALL teenagers and older females who are engaged in significant aerobic activity are suffering from dramatic changes in physiology. We are seeing an epidemic of what we call hypothalamic dysfunction, where the brain senses the exercise as life threatening stress and takes counter measures to save the individual. These include: DECREASED Metabolic Rate through a thyroid mechanism, DECREASED Estrogen, ovulation dysfunction with infertility and increased miscarriage rate, INCREASED Cortisol and associated fat accumulation, INCREASED Adrenaline and stress, and INCREASED Endorphin, a narcotic compound designed to help people through a life threatening situation. All these are Bad! Metabolic decrease conserves calories in the stressed individual, decreased ovarian stimulation from the hypothalamus prevents pregnancy, an unwanted condition in times of stress, increased cortisol can safe a life in severe trauma and maintain blood sugar and pressure in severe injury, and adrenaline elevation heightens stress that is suppressed completely by the endorphins. As one might expect or realize, none of these events is positive. The most frightening and least known aspect of this process is its permanency. We see that if a woman engages in mod to high level aerobics for about a year or so at any time in their life, that the hypothalamus is permanently altered and continues to result in the above changes. With decreased exercise, the problems improve, but never normalize.
Other subtle symptoms that relate to the physiologic changes mostly the low estrogen are but not limited to: Anxiety, depression, ADD, memory problems, bone pain, night sweats, migraine headaches, PMS mood changes, PMS bloating, vulvar pain, vaginal dryness, urinary frequency, urgency, getting up at night to urinate, skin and hair changes, being cold all the time (low metabolic rate), and sleep disturbance. Most women that we see with these symptoms don’t have major menstrual abnormalities as described in the triad. Cycles are generally pushed out only to 30 days but are regular and pronounced normal by anyone who reads a gynecologic textbook.
The reason exercise is addicting is due to the narcotic, endorphin and true physical addiction to narcotic does develop. Ever see an over exerciser after 3 days or so without exercise? They are agitated and unable to focus on anything but getting back to the gym and often don’t rest until that happens. The first five minutes of that run or aerobic exercise, before endorphin release is when the body signals are true and not altered. Most people are hating life in the first minutes of aerobic exercise. That’s the body’s signal to stop a toxic situation.
I know that this is a dramatic departure from mainstream belief. None of what I’m telling you exists in writing anywhere but in the description of the worst case scenario patient described in the female athletic triad. 99.9% of women are not going to relate the triad, yet more than 50% can relate to what I have described. So what can be done? Stop aerobics and walk with low key resistance training. Stop pushing young girls into high level sports and pressuring them into the belief that aerobic exercise controls weight or helps to lose weight – it does the opposite. Weight loss relates to diet and aerobics simply increases fat. I have interviewed patients who exercise 2-3 hours per day and are gaining weight! How can that be possible? One has to look at the above physiologic changes for the answers. Until the 1970’s it was common knowledge that adults should not engage in strenuous exercise, it has only been the exercise revolution and the “industry” of exercise that has taught us otherwise?
Michael D. Fox, MD