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A High Price for Gold? : Now that female athletes are pushing their bodies more they find peak performance can also bring long-term health risks.


By now, thousands of young girls have tacked pictures of Olympic medalists such as Shannon Miller or Jackie Joyner-Kersee on their bedroom walls and dream of one day excelling in gymnastics or track and field.

And sports medicine experts hope that next generation of elite women athletes will be the first to benefit from some important new findings: For females training at high-intensity levels, the price of a toned body and peak performance may be some potentially serious health problems.

Many female athletes are at risk for three interconnected problems:

* Eating disorders, which include fasting, exclusion of certain foods or food groups, use of diet aids or laxatives, bulimia and anorexia.

* Irregular menstruation, including the absence of a period, called amenorrhea, or the delayed onset of menstruation.

* Premature bone loss, a phenomenon that may lead to stress fractures and the onset of early osteoporosis.

In their mildest forms--dieting, occasionally missing periods or suffering a stress fracture--these conditions are often accepted as a normal part of training. Increasingly, however, sports medicine experts call them signs of overtraining.

"Most women get all the benefits of exercise men get," says Dr. Carol Otis, a team physician and student health specialist at UCLA. "But in a subset of women, particularly those training at intense levels, we do see this 'triad' in which these women seem to have three things go together. That's what we are defining the female athlete triad. "

In June, the American College of Sports Medicine sponsored a national conference to discuss the female athlete triad. The Washington meeting is believed to be the first discussion of this newly recognized phenomenon by a prominent sports-medicine forum.

"In the past, women were pretty much treated as men. There is not a lot of information out about their special health concerns," Otis says. "And there are a lot of myths out there to be dispelled, such as: the thinner you are the faster you are going to go. And the lack of (menstrual) periods is the sign of good training."

While not wanting to discourage female athletes from excellence, experts caution that athletes, their trainers and coaches need to consider long-term effects of intense training--especially in sports that stress an optimum weight for competition.

Females at greatest risk include many high school and most college or world-class athletes, particularly those in gymnastics, track and field, and swimming, experts say. But some other athletes, such as hard-core aerobics enthusiasts, are also a concern.

"Women should compete at the highest level but in the safest possible way," says Randall W. Dick, assistant director of sports sciences for the National Collegiate Athletic Assn.

Says Otis: "The majority of women don't exercise enough. And now, just when we've said it's OK for women to go out there and train, we are putting out a scary message.

"We don't want to scare women. But any woman who trains intensively and has one of these three problems should seek medical consultation."

The problems for female athletes often begin with inadequate nutrition, experts say.

In recent years, the list of female athletes admitting to eating disorders include former Olympic gymnasts Cathy Rigby and Kathy Johnson, both of whom have talked about their battles with bulimia during training.

Studies have found high rates of eating disorders--anorexia nervosa (self-induced starvation) and bulimia (gorging and purging)--in male and female athletes, especially in gymnastics and swimming. Most athletes are neither anorexic nor bulimic, but many engage in what is called disordered eating, Otis says--using laxatives, dieting stringently or fasting to maintain an optimum competitive weight.

One study showed that 32% of female college athletes practiced at least one form of disordered eating. Another study found 62% of female gymnasts did so.

The practice is common as athletes press to conform to what they envision is the most suitable body weight and shape for their sports, says Dr. Aurelia Nattiv, a team physician at Pepperdine and assistant professor of family medicine at UCLA.

"There are women who, genetically, have a certain body type that makes them ideal for certain sports," she says. "But you can't take someone with an entirely different body and shape and sculpt them for a sport. A lot of times, that is what an athlete tries to do."

Among women, unnatural dietary habits that rob the body of nutrients can impair performance and lead to the next two steps in the "triad" of health problems: amenorrhea and poor bone health, Otis says.

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