The pressure to reach a specific weight, look a certain way, or hit a PR can sometimes lead to an athlete overtraining or underfueling — both of which are harmful to an individual’s mental and physical health.

Athlete Triad is a common disorder that is the long-term result of underfueling —training hard while dramatically restricting calories. Fitness enthusiasts and athletes competing in sports that emphasize endurance, appearance, or weight class are at higher risk for Athlete Triad. Three components suggest an athlete is suffering from Athlete Triad: disordered eating, hormonal imbalance, and low bone density.

Disordered eating can include a range of symptoms such as frequent dieting, feelings of guilt and shame associated with eating, and using exercise, food restriction, fasting or purging to “make up for bad foods” consumed. Disordered eating can result in a lack of calories and nutrients in relation to how many calories are being expended through physical activity.

Hormonal imbalances can occur, such as disruption of menstrual periods in females or low testosterone in males. As an ovulating female, it is not normal for an athlete to lose their period during the sports season or during times of intense training. This is known as amenorrhea, and can indicate a serious problem with a female athlete’s diet.

The third part of Athlete Triad is low bone density, which can be destructive and irreversible. Lost bone density causes fractures — or broken bones — to occur more easily, and can result in season-ending injuries. Once lost, bone density may never be regained.

The earliest and most common symptom is feeling tired or run down all the time with frequent irritability — easily noticed by others. Additional signs may develop, including sudden weight loss, lack of expected or normal weight gain, and feeling full quickly during meals. Depression, anxiety, and other compulsive behavior, chest pain with or without palpitations may follow. It can take weeks or months before menstrual disturbance and loss of bone density is observed, but may show through delayed or missing periods, stress fractures, and slow healing of injuries.

While underfueling can have devastating consequences and result in an athletic career cut short, Athlete Triad can be prevented. Getting enough calories to restore a positive energy balance is key. Eating food rich in carbohydrates, protein, iron, consuming more calcium, and monitoring levels of vitamin D are some recommendations.

Female athletes are encouraged to track menstrual cycles to understand if changes are occurring in parallel with a training regime. Instituting an appropriate diet and moderating the frequency of exercise may result in the natural return of menses. Hormone replacement therapy may also be considered to prevent the loss of bone density.

Early recognition of the Athlete Triad is accomplished through risk factor assessment and screening questions with a provider. It takes the collaboration of an athlete and their coach, parents, and athletic trainers to prevent or reverse Athlete Triad. Speak with your physician or a qualified coach if you feel you are experiencing any of these symptoms and get back to your powerful, strong self.

Janelle Dahlgren is a Performance Coach at the Barton Center for Orthopedics & Wellness. She specializes in athletic performance and offers personalized training and exercise programs to the Lake Tahoe community. To meet with Janelle and get started on an exercise program that is right for you, visit BartonOrthopedicsandWellness.com or call 530-600-1976.