Until a few years ago, Colorado’s elite track and field athlete Ani Kunz felt tired – even during the warm-ups. And then there was the constant hunger: Sometimes her stomach would growl in the middle of a workout. He felt that he always thought about food, always limited what he ate, avoiding whole categories – such as carbohydrates – completely, because he thought they were unhealthy. Add to these horrible, exhausting cramps when you get your period. Kunz, who represents the U.S. Olympic team in this week’s women’s heptathlon in Tokyo, simply didn’t feel like she was performing best most of the time.
Each of the above can be a signal of a major health problem and can also affect its performance. But Kunz says she has rarely, if ever, discussed these issues with her coaches. They have almost always been men, says Kunz, many of whom are simply not used to discussing topics such as weight, hormones and the menstrual cycle with their athletes.
Kunz moved to California after graduating from college in 2016 to focus on preparing for the 7-event Olympic heptathlon, which requires strength, speed and a tremendous amount of athleticism. She sought advice on improving her health and performance and learned that recent research on women in sports has provided insights that could help.
In 2018, she worked with a person well acquainted with this study, which helped her focus on getting enough calories instead of limiting what she ate, and encouraged her to track her menstrual cycle, along with its impact on her performance, mood and energy level.
As Kunz gained more knowledge of what works best for athletes, she also made sure to be more open about her cycle with her current coach. She and her coach have also shifted Kunz’s physical focus from weaker to stronger.
“It was literally just a world of difference,” Kunz, 28, said before leaving for Tokyo and her first Olympics. “I never have those days again when I just drag myself to warm up. I come with energy.”
At the Olympic trials in Eugene, Oregon, in June, Kunz not only won the heptathlon, but published the fifth best heptathlon performance of all time, far from her 8th place during the trials in 2016. Building her training regime around the latest findings from sports medicine research related to gender has changed her performance, she says.
A relatively new field of study
When Dr. Kate Ackerman was in medical school 20 years ago, she had heard of the term “athlete triad.” Founded in 1997 by the American College of Sports Medicine, it describes the constellation of three disorders – amenorrhea (lack of menstruation), osteoporosis, which thins the bones and malnutrition – which is sometimes seen among female athletes. It is triggered by extreme exercise and low body weight. But apart from this descriptive term, says Ackermann, not many sports research has been published on athletes. Almost all such studies so far have focused on men, which means that these findings are becoming standard.
“In fact, there was no training related to gender or gender [for athletes],” said Ackermann, who competed as an elite athlete on the national rowing team during her years in medical school. She and her teammates often had questions about their menstrual cycles and birth control options and whether any of these things affected training, she said, but finding scientifically sound answers at the time simply proved to be a “void.”
Thanks to Ackermann’s research over the past 10 years, along with the work of others in this field, the triad of female athletes is now often more widely known as Relative Energy Deficit in Sport (RED-S) – essentially a problem for undercharged athletes. with fuel. That is, a lack of energy from not consuming enough calories for what you expend can, Ackermann says, can lead to a range of health problems that go beyond irregular or missing periods and reduced bone density. RED-S may also include depression, impaired cardiovascular and immune function. Exercise can negatively affect athletic performance as strength decreases and the likelihood of injury increases.
Breaking the myth of “thinner is faster”
Some of what drives athletes in this disorder, Ackermann says, has to do with messages they receive a lot from their coaches and coaches, a philosophy she sums up as “thinner is faster” or “lighter is faster.” “Good.”
The message that athletes in some sports need to lose weight to perform better has been common for years.
“I definitely had football and track coaches who would just be like, ‘If you lose 10 pounds, you’ll be so great,’” Kunz said. She trusted these coaches, linking her weight to her performance. “I wouldn’t say I’ve ever had an eating disorder, but I definitely think it’s something that weighs a lot on my mind,” she said.
Earlier, small studies showed that endurance athletes in men with lower BMI outperformed others. But more recent research – studies involving athletes – has shown that this link does not apply to many people in sports, especially younger athletes.
Maya DiRado, a four-time Olympic medalist at the 2016 Rio Olympics, says that while she was on the Stanford University swimming team, the message that athletes need to focus on weakness seems clear.
“In the early years of my college career, it was thought to be a ‘swimmer type’ and we should all try to become slimmer and more toned,” she said. But that advice doesn’t sound right to her, she says, even then. “I think with swimming, especially, it’s so obvious that it’s not true when you look at the pool deck [of racing swimmers].”
She is right, say researchers in this field. The science around RED-S shows that a universal approach to body weight or calorie consumption is not healthy for athletes, regardless of gender, or is good for performance.
Alicia Glass, a senior sports nutritionist with the U.S. Olympic Committee, has worked with the United States on athletics and swimming in the United States for the past decade. “I get so nervous when I get emails from coaches who just say – and I get a lot of them – ‘What’s the average body fat percentage on the X national team?’ “She says. “It completely misses the point. If we focus on choosing the right foods, looking at how many carbs and how much protein your body actually needs to complete exercise, your numbers fall into place. They take care of themselves. But we just focus on body fat percentage – this does a disservice and totally misses the mark. “
Even many doctors do not know
Even with gender-specific research in sports science, more common now, this is a nascent field. “Even today,” says Ackerman, “I see [athletes] all the time who don’t know about it and don’t necessarily visit doctors who feel comfortable treating RED-S. So we still have a lot of work to do. “
A good way for doctors to start a conversation with athletes who may experience RED-S symptoms or warning signs is to start a diet, she says. “I think of nutrition as a kind of pyramid. First make sure you get enough calories – make sure you eat enough just to do that, and then we can change what calories and calorie times. … before we get there to the specific: “Okay, you need this supplement on the 17th day of your menstrual cycle. We need to cover the basics.”
Even these basics can be difficult for some athletes to hear, especially for women who have been receiving messages about reducing calories for so long. “You can’t just go to someone and say ‘eat more’ or ‘eat less,’” Glass said. But they can be convinced.
“Athletes need to stay healthy and not hurt. So focusing on wellness – being able to manage the load, completing the whole phase of training and feeling really good – that really needs to be the focus.” she added. “Health and productivity, not numbers.”
Menstrual health is key
Although more and more people in the world of athletics nowadays understand that menstrual health is a key indicator of athletes’ health, it can still be a difficult conversation to begin with. For example, when DiRado swam competitively (she retired after the 2016 Olympics), she never had a regular menstrual cycle, she says, and she doesn’t remember ever being asked about her cycle by coaches or support staff unless something it did not drastically push him.
DiRado remembers one of the rare occasions when she had a period during her college career: Her nausea was so bad that she had to get out of the pool and lie on the concrete at 5:30 in the morning because that was the only thing made her feel better. Even then, she and her coach just felt confused, DiRado said. Now she finds it strange to look back and realize that maintaining a regular menstrual cycle is not considered a priority. “I had no idea what my body was going through, even though in so many other areas I was so in tune with how it felt and what was going on inside it.”
Voice, who worked with DiRado during her stay at USA Swimming, says she is now active in menstrual health, routinely asking the athletes she works with: “Do you menstruate every month? Do you know how long the cycle is? Do you know how heavy it is? Did you admit how heavy it is and how it relates to how you feel? “
A healthy menstrual cycle can vary greatly in length or severity of bleeding, and everyone’s hormone levels are different, she notes. She encourages athletes to monitor their symptoms every month. Problems such as cramps and hunger, which can affect work, can be solved by eating, she says. She advises athletes to eat more anti-inflammatory foods, such as strawberries, raspberries and other fruits and vegetables, before expecting cramps to start, and to consume small amounts of dark chocolate in time, when sugar cravings usually occur.
Kunz, the heptathlete, says tracking changes in her own physiology has made a big difference for her, as well as a growing desire to be honest with her coaches. She says she can say something to her coach like, “This is my week and my confidence is always falling this week … let’s not take our hearts too seriously this week.” And if she’s tired and needs more naps this week, she tells her coach.
What’s next, scientifically
Ackermann and her colleagues are eager to learn more details about how the menstrual cycle affects performance. “The next step in terms of research,” she says, is, “What is the effect of estrogen on strength? So when you have a higher estrogen component and a lower progesterone component, what does that do for endurance? For strength? You get it?” Are there different benefits to learning these different phases? “
Researchers say the improvements Kunz and other athletes have noticed in recent years are just the beginning.
“We apply so much information about women that is based on men,” says Ackerman, “that once we start doing these studies on women who are specifically for women and we have results that we can then apply to women’s education. , I expect to see huge improvements in performance