- Reuters/Eric Draper
- Elite runner Mary Cain said in a recent New York Times video that a Nike-affiliated coaching program was emotionally and physically abusive, leading to devastating injuries that derailed her career.
- Her symptoms, including broken bones, missing menstrual periods, and extreme low energy, are part of a syndrome known as the “female athlete triad” that may affect as many as 60% of female athletes.
- While all athletes, regardless of gender, can experience physical and mental consequences if they don’t eat enough, women are particularly susceptible to both internal and external pressures to lose weight.
- While some of the condition’s symptoms are quickly reversible with enough calories, some of the damage it can do to bones can be permanent.
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Elite runner Mary Cain, a member of Nike’s now-shuttered Oregon Project track program who was once called “the fastest girl in America,” said in a damning New York Times video that the program’s physically and emotionally abusive coaching system caused devastating injuries and derailed her career.
In the video, Cain, a record-breaking runner at age 17, said her head coach Alberto Salazar, who was banned for doping allegations in late September, and his colleagues pressed her to lose more and more weight. Eventually, she suffered five broken bones and missed her period for three years, and even began cutting herself and experiencing suicidal thoughts.
Nike has since released a statement noting that the company had not been aware of the allegations but takes them “extremely seriously” and will launch an immediate investigation.
Outside of the controversy of Nike’s alleged role in Cain’s physical and mental decline, her experience eating too few calories, having dangerously low bone density, and missing her periods is illustrative of a disturbingly common condition among female athletes.
Called the female athlete triad or relevant energy deficiency syndrome, the condition can be a career-ending or even life-threatening danger to athletes at all levels, from high schoolers to Olympians.
Female athlete triad involves not eating enough to support activity
Studies suggest female athlete triad may affect as many as 60% of female athletes, and may be more common than when the term was first coined in 1992 since there are so many more women in sport, Mary Jane De Souza, a professor of kinesiology and physiology at Penn State who specializes in the syndrome, told Insider.
Some research has also shown women at higher levels of sport may be at greater risk because of the high competitive pressure and specific demands of certain sports, such as running.
The condition occurs when athletes don’t eat enough to fuel their exercise, causing a calorie deficit that can lead to serious consequences over time, De Souza said. As a result, athletes will feel fatigued, and notice their performance isn’t improving, even after hard training.
They’ll also start to miss menstrual periods, a condition known as amenorrhea. This means their low body weight and intense exercise have started effecting their hormone levels, and they’ve stopped ovulating, or releasing an egg from the ovaries. That can affect fertility long-term and even increase the risk of certain cancers.
The disruption of estrogen levels can actually damage an athlete’s bones, making them less dense and more susceptible to injury, De Souza said. Research shows that women are at greater risk of stress fractures, in part because of the female athlete triad.
While the symptoms can affect anyone, female athletes are more at risk
All athletes, regardless of gender, can struggle with disordered eating and resulting injuries and health complications, but women may be uniquely vulnerable. While culturally, men are encouraged to become more muscular, women often feel pressure to lose weight, including muscle mass.
That’s why the female athlete triad is often, but not always, related to disordered eating or an obsession with becoming thinner. It can also be due to pressure from coaches or peers to lose weight, De Souza said.
“Women also get a lot of cues from our environment that thin is better. A lot of female athletes have a high drive for thinness, so they see themselves as being more overweight than they are,” De Souza said.
- Brian Snyder/Reuters
The symptoms can be dangerous and even life-threatening, but treatment is available
Over time, the cumulative effects of the female athlete triad can derail careers and threaten lives, causing multiple serious injuries like bone breaks as well as severe depression.
However, some side effects of the syndrome can be reversed, De Souza said. With enough calories, athletes can begin to recover from energy deficit within days or weeks, according to the most recent guidelines from the Female and Male Athlete Triad Coalition.
In studies, athletes suffering from amenorrhea were able to start having periods again within three months, and began ovulating within a year.
But the longer-term issues are harder to address, De Souza explained. Research has suggested bone density problems are much harder to remedy, and athletes’ bones may never return to their previous strength. The 12-month study showed little improvement to bone health, even as the athletes’ other health metrics improved.
“It’s not just that bone density is lower, it’s that the bones have changed, and that’s really hard to fix,” De Souza said.
The best solution, De Souza said, more education and awareness can go a long way toward making sure the triad never happens in the first place. “All of this can be prevented if athletes are educated to eat enough, and that’s what’s not happening when there’s this focus on thinness,” she said.