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© 2011 McGraw-Hill Higher Education. All rights reserved Chapter 5: Nutrition and Supplements.

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1 © 2011 McGraw-Hill Higher Education. All rights reserved Chapter 5: Nutrition and Supplements

2 © 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

3 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

4 Nutritional Considerations Nutrients Carbohydrates Protein Fat Vitamins Minerals Water Roles Growth, repair & tissue maintenance Regulation of body processes Production of energy Science of substances found in food that are essential to life © 2011 McGraw-Hill Higher Education. All rights reserved

5 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

6 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

7 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

8 –Intake should be approximately 25 grams per day –Most only consume 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

9 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

10 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

11 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

12 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

13 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

14 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

15 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

16 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

17 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

18 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

19 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

20 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

21 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

22 Figure 5-2 © 2011 McGraw-Hill Higher Education. All rights reserved

23 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

24 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

25 Figure 5-3 © 2011 McGraw-Hill Higher Education. All rights reserved

26 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

27 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

28 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

29 –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

30 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

31 –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

32 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

33 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

34 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

35 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

36 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 Popular Eating and Drinking Practices © 2011 McGraw-Hill Higher Education. All rights reserved

37 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

38 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

39 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

40 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

41 –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

42 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

43 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 – 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

44 –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

45 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 (40- 50% 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

46 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

47 –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

48 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

49 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 %) –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

50 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 hours Consume 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

51 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

52 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

53 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

54 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

55 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

56 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

57 –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

58 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

59 Figure 5-5 © 2011 McGraw-Hill Higher Education. All rights reserved

60 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

61 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

62 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 indicates overweight BMI >30 indicates state of obesity © 2011 McGraw-Hill Higher Education. All rights reserved

63 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

64 –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

65 Caloric Intake –Carbohydrate = 4 calories/gram –Protein = 4 calories /gram –Fat = 9 calories/gram –Alcohol = 7 calories/gram –College athletes consume calories/day –Endurance athletes may consume as many as 7000 calories © 2011 McGraw-Hill Higher Education. All rights reserved

66 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 calories for women and 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

67 The key is moderation –A combination of dieting and exercise –A negative energy balance must be achieved –Loss of 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

68 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 calories per day A 1-2 pound per week gain is adequate © 2011 McGraw-Hill Higher Education. All rights reserved

69 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

70 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

71 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

72 –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

73 –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

74 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

75 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

76 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

77 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


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