New Haven Register (Sunday) (New Haven, CT)
The unique health risks to female athletes
As March Madness has given way to April, with the UConn women's basketball team falling just short of its goal, I revere the athleticism of our most talented players from across the nation. Women compete at higher levels in athletics than ever before. But even as we celebrate these great achievements, we should confront how women face unique health risks that have not been adequately addressed by coaches, scientists and medical providers.
In some ways, this might be a product of progress. But great progress often requires great vigilance to avoid unintended consequences.
In 2019, the National Collegiate Athletic Association reported that 47 percent of athletes in all NCAA championship sports were women. There are now 10,660 women's sports teams associated with the NCAA and 9,226 male teams. Title IX, signed into law in 1972, bans sex discrimination in federally funded educational programs. Consequently, female collegiate athletes have increased in number by 545 percent, and as of 2016, 2 out of 5 women in college play sports compared to 1 out of 27 before Title IX.
Female athletes, like their male counterparts, often use dietary supplements to enhance their athletic performance and overall health and wellness. One study of NCAA Division I athletes at two California universities in 2020 found that 45 percent of all athletes took supplements each week, including about 40 percent of female athletes. Women were more likely to use supplements for health-based reasons than for performance enhancement (as men were more inclined to do). Examples of dietary supplements with demonstrated benefits include betaalanine,
caffeine, creatine and glycerol. Beta-alanine has been shown to increase muscle carnosine concentrations, thereby reducing muscle fatigue. Caffeine acts as an ergogenic substance that reduces fatigue in aerobic exercise. Glycerol may increase endurance.
However, a recent meta-analysis of more than 1,800 studies published about supplement use by athletes reveals that such supplements and their impacts have been investigated primarily regarding men. Only 23 percent of participants in these studies were women. Fewer than 1 percent of the studies made classifications or analyzed the impacts of supplements on female bodies relating to menstruation. In addition, studies that did include data analysis for women were more focused on performance than on health impacts.
So while research indicates these supplements can be safe and efficacious for men, there has been a lack of extensive research on their impacts on women, leaving female athletes without solid data to guide their training diets.
Female athletes are also at unique risk for what is known as the female athlete triad, a medical condition in which three health concerns — disordered eating, amenorrhea (the absence of menstruation) and low bone mass — triangulate to pose a great, long-term threat to overall health and well-being. Data on the incidence of the complete triad among female athletes remain unclear. But disordered eating or amenorrhea might be present in more than 60 percent of female college athletes. When one part of this triad is present, female athletes have a greater risk of developing at least
one of the other two. And each can have severe health consequences.
Disordered eating affects many more women than men, and the long-term outcomes can include infertility, cardiac arrest, and seizures. Exercise-induced amenorrhea can have lasting impacts on bone and heart health. Low bone mass is a loss of bone density causing a condition called osteoporosis in which frail bones can easily break. Women must set themselves up well in their youth to avoid osteoporosis, which in older women can be completely debilitating and even life-threatening. Elderly women who break bones (like their hips) may have greatly increased risks of dying within a year of the fracture.
Athletes frequently face pressures concerning their weight as well as performance pressure and social isolation caused by their athletic intensity. Gendered societal expectations can increase pressure on women to achieve an ideal body image even beyond athletic expectations.
Coaches, parents, athletic mentors and female athletes should be aware of the risks posed by untested supplements and the female athlete triad. We need further research. But we should also encourage more conversations to promote healthy eating habits and controlled training schedules so that women's health and well-being can be prioritized. If one main purpose of athletics is to promote overall health, then we should provide women the support they need to achieve their athletic goals in a safe, informed and effective manner.