This writing serves as an add-on to the "The Triathlon Triad" I wrote about in the July issue of Lava Magazine. The "Female Athlete Triad" as it pertains to athletics on the other hand is something many athletes have heard of: a combination of three conditions - disordered eating, amenorrhea, and osteoporosis.

Disordered Eating

The primary cause of the Female Athlete Triad is disordered eating and its impact on caloric, and vitamin/mineral intake. For athletes, this disordered eating is fueled by the perception that thinner is always better - I can tell you that it certainly isn't. Many times, this route cause of disordered eating can lead to more serious eating disorders such as anorexia or bulimia.

Amenorrhea

Irregular menstrual cycles are also a factor in the Female Triad. Amenorrhea, defined as no menstrual period for 3 months is quite common among female triathletes. However, those with the root cause from disordered eating run particular risk of being impacted by the triad.

Osteoporosis

Women with the Triad are at higher risk for fractures, including stress fractures related to low bone mass. Severely weakened bones can get the classification of osteoporosis. This is really due to the lack of nutrient intake related to the disordered eating, and the lack of estrogen causing the Amenorrhea.

What to Watch Out For

In the print version of this article, I outlined a quick assessment age groupers can use to identify this triad as a potential issue. Once it is identified, steps can be taken to protect against its pitfalls, and focus on training and racing at optimal fitness. Here is a version for female athletes, should they be worried about encountering the vicious Female Triad:

1) Do you find yourself being very restrictive with your dietary intake even when others such as coaches and dietitians say that you shouldn't be?

2) Have you had more than one stress fracture within the past two years?

3) Have you not had a menstrual cycle within the past 90 days?

4) Do you try to stay lean year-round, even when not in the competitive season?

5) Do you experience extreme fatigue, and/or low self-esteem or depression?

If you answered "yes" to at least three of the above questions, there is a good chance you may be going down the path of the Female Athlete Triad. If this is the case, you should work with a coach and/or psychologist to discuss your mental health. You should also work closely with a dietitian to establish support of nutrition habits.

I've introduced in Lava print a new type of acute triad that can plague triathletes, male or female, beginner or professional. "The Triathlete Triad", although more dangerous at long course, can undermine potentially great performances at all race distances. The Triathlon Triad is defined by three factors: a weak state of mental fitness, over-doing workout intensity, and over-dieting. Athletes who suffer from this condition will often show up on race day with a mental atmosphere lacking any sense of confidence, and a body that is malnourished and overtired. It typically results in a disappointing finish which further feeds into already an present lack of confidence, pushing the athlete into a downward spiral of negativity. Among Type-A triathletes, the usual response is to work harder and place even more dietary restrictions on oneself. A certain recipe for relative disaster! Chronic occurrence of the more acute Triathlon Triad I have outlined here can certainly lead to the female athlete triad, in females, as the root causes follow similar psychological patterns, leading to nutrition modifications.

As you can see, although the root of this issue is mental fitness, its ramifications can certainly cross over into the physical factors impacting a successful race day.

An Example For the Triathlon Triad

There was an age group athlete I was working with some time ago who fell into the scenario I have outlined above. I'll call her Jane for the purpose of this writing. She was training for Ironman with the ultimate goal of Kona qualification. Early on in the program she heard everything I had to say regarding being focused on those items you have complete control over first, then those items like wattage and pace targets, and lastly outcomes - letting those fall out of the first two. She kept the long term goal of Kona in the back of her mind knowing it would be a long term process. The first year was a huge success and she made tremendous progress in her racing/results. Sometime between year one and year two her thought process began to change. I could feel that her mental state had begun to switch to a more outcome based thought process. As we were planning for year two, she began asking questions related to Kona qualification. She wanted to know which races gave her the best shot, and was willing to go to those events even if it meant undermining her long term progress. I knew that she still needed 30-40 minutes to have a legitimate shot at Kona qualification. I spoke to her about this but she decided that she still wanted to give it a go. As the season began, other stresses in her life become significant as she was finishing her PhD. She continued on the path of increasing training stress, with a likely reduced available stress budget due to school commitments. As we got closer to the first race of the year she began asking questions like "how much weight do you think I can lose in the next 6 weeks?", "how much faster would I go if I were xx pounds lighter". When checking her menus I'd find that she was always undercutting planned protein, carbohydrate, and fat needs.* She also began looking at the start lists in great detail and frequently sent me lists of the athletes in her age group including their previous results and asked if she could beat them. Finally, as she began to taper for race day, she consistently over shot her training ranges and asked "Can I do more race effort pickups? I feel I need those to race well next week." If her assigned heart rate range for a workout was 150-160 bpm she'd always average 159bpm, meaning that she had spent a good portion at a higher intensity than planned. Summarizing the stage that's been set you can see that she was applying a tremendous amount of self-imposed pressure, in a situation where she really didn't have a good shot at her outcome related goal. Because of the self-imposed pressures, she was making intensity and nutrition mistakes leading into race day. She had created a proverbial pressure cooker. As race week approached, I knew she was in trouble after tightening the nutrition too much, adding too much stress during a period of planned rest, and created a difficult mental state with expectations that couldn't be met. Race day came and went with a disappointing finish time; slower than the previous season, despite a great improvement in her training metrics. As a coach or athlete, this is the most frustrating situation to be in, and many times leads to the athlete placing blame on the training program, with the claim that they simply didn't work hard enough. You can see that once this how this downward spiral begins, it can ultimately force the athlete from the sport. In Jane's case, that is exactly what happened. She finished out the season, and then decided Ironman racing just wasn't for her.

Conclusion

I encourage age group athletes to live a balanced lifestyle where health is achieved first, then consistency in training and race results, and finally speed. Patience truly is a virtue. I see too many athletes taking the opposite approach of rushed outcome focused goals which can add the external pressures that lead to the triathlon triad, and many times the more serious female triad. This sets the stage for disappointment as they are very likely not going to meet their expected outcome related goals. It is the athlete who focuses on the process and those items they have 100% control over who ultimately reduce their externally applied pressures and end up meeting their long term goals.

* These scenarios seem to result in protein being the largest deficiency many times resulting in Iron Anemia.

Jesse Kropelnicki is an elite/pro level triathlon coach who founded QT2 Systems, LLC; a leading provider of personal triathlon and run coaching, as well as TheCoreDiet.com a leading provider of sports nutrition. He is the triathlon coach of professional athletes Caitlin Snow, Ethan Brown, and Jacqui Gordon among others. His interests lie in coaching professional triathletes using quantitative training and nutrition protocols. You can track his other coaching comments/ideas via his blog at www.kropelnicki.com.