Female Vegetarians and Amenorrhea

Female athletes commonly choose to eat a meatless diet. They may refer to themselves as vegetarians, but many fit into the non-meat-eater category. That is, they eat too much fruit, too many salads, and sometimes abundant jellybeans—but too little beans, tofu, yogurt, or plant sources of protein. This protein deficiency, in conjunction with an overall calorie-deficient diet, is associated with medical problems, specifically loss of regular menstrual cycles.

Some athletic women, in their obsession to lose weight, consume a very low-calorie and low-protein "vegetarian" diet. This drastic restriction of food intake can lead to amenorrhea; that is, they stop having regular menstrual periods. Research suggests that amenorrheic athletes have a two to four times higher risk for suffering a stress fracture than do regularly menstruating athletes (Clark, Nelson, and Evans 1988; Nattiv 2000; ACSM 2007). Eating a balanced diet with adequate calories can enhance resumption of menses, provide adequate protein for building and protecting muscles, and enhance overall health. (See chapter 16 for more information on amenorrhea.)

Jessica, now a healthy gymnast, used to live on melon for breakfast, a salad for lunch, and steamed vegetables with brown rice for dinner. Once or twice a week, she'd sprinkle a few garbanzo beans on a salad or add some soy cheese to the vegetables. She thought her vegetarian diet was great, when in fact it was deficient in several nutrients. At one point she suffered a stress fracture that healed very slowly. She had spindly arms and legs with tiny muscles (despite her exercise program), and her menstrual period was absent, a sign of a malfunctioning body.

Jessica needed to understand that a well-balanced sports diet includes adequate protein—either small portions of lean beef, pork, and lamb or generous portions of tofu, beans, and nuts. (Because plant protein is less concentrated than animal protein, you must eat larger portions to get the same amount of protein.) Dark meats are also important sources of two minerals—iron and zinc.

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