Sports Nutritionist: Malnutrition Is Ruining Female Athletes

Tina Goršek Šparovec in her work at the Human Performance Centre, where she also works with our Dr. Tim Podlogar, regularly deals with an increasing problem in the world of sports, malnutrition. Even though malnutrition is common among male athletes as well, Tina focuses on young women who have serious health issues caused by malnutrition.

Tina had always wanted to become a researcher. Following a series of coincidences, which so often direct the lives of individuals, after finishing her studies of biotechnology at the Biotechnical Faculty in Ljubljana she continued to study biomedicine in Munich, where she also met Dr. Tim Podlogar. Now she works as a young researcher at the Medical University of Graz, working on her PhD on stem cells and the womb at the Department of Obstetrics and Gynecology.

Tina, how did you end up in this study program?

I was never interested in food. I was interested in research. My whole study program was focused on research, how the body functions, physiological aspects, and carrying out experiments. Writing a PhD thesis on hormones and stem cells seemed too interesting an opportunity to pass. I also wanted to spend some time in Austria in touch with the German culture.

But you also work in nutrition?

My PhD thesis is not about nutrition. Nutrition is my part time job at the Human Performance Centre. There I work on endocrinology, that is the functioning of hormones, in relation to training and nutrition.

If we understand correctly, there is a problem in this area?

Yes. Simply put, young women (and men) don't eat in sufficient quantities, while also pushing themselves too hard athletically. This disrupts the hormonal balance and leads to relative energy deficiency in sports, also known as RED-S.

You told us that you acquainted yourself with malnutrition in sport through personal experience, is that correct?

It is correct. I used to cycle and go to the gym. I tried many diets to be as thin and light as possible. Everyone was telling me that was a good thing and I would be able to be faster uphill. This blinds you and makes you want to get even thinner.

You start to eat less and less. You can spend several hours on the bike and eat nothing. After a training session, you don't consume a recovery drink. You also don't know what to eat around your training sessions.

This can quickly affect your immune system. You lose your menstruation, have trouble sleeping, motivation for training declines, and during training you often "bonk", which means you end up with no energy.

Can it also lead to injury?

Personally, I was only injured because of my clumsiness (laughs).

But it definitely can. Especially runners with RED-S often experience stress fractures. You can go for a light run, and all of a sudden a little bone in your foot breaks or, even worse, in your hip. Malnutrition and absence of sexual hormones represent an increased risk of stress fractures.

So what you're saying is that stress fractures are not a consequence of lack of calcium or magnesium or lack of diversity in the diet but are caused by energy deficiency?

Good absorption of calcium requires estrogen.

Estrogen is also involved in how the bones rebuild and break down. After each training session, the bones start to remodel. After being pressured, the normal process is for the bone to become stronger. Young women (and men) who are in an energy deficiency don't have enough energy or the right hormones to rebuild their bones.

Within six months after these young athletes enter RED-S, the bones break down faster than they rebuild. This quickly leads to osteopenia and osteoporosis.

I can give the example of a 17-year old girl who came to me for help. She already had osteopenia and had lost her menstruation.

What is most worrying is the fact that after thirty years of age, it is very difficult for us to acquire bone mass, which means that if an athlete enters adulthood with a low bone mass, they will have a lot of bone-related health issues in their old age.

And coaches don't know this?

They are in denial. They claim it's normal that a young woman is without menstruation. They prefer that their girls are light, which also means they have light bones. They see it that as an advantage. Especially in athletic circles, there is this belief that it is perfectly normal for female athletes to be without menstruation.

And I agree, it is perfectly normal that before a race, when your training sessions are really intense, you skip a menstrual cycle or two. But afterwards, you need to take time for proper recovery and restore the energy balance and create an energy surplus. 

But it definitely is not normal if it lasts for several years. Such an athlete cannot be successful for long. She may be great at 16 or 17 years of age, but she won't be able to maintain that long term without serious consequences.

Coaches should be careful not to let their athletes conclude their careers half-disabled with serious fractures or osteoporosis.

When talking about balance, which macronutrient do you think is the most important?

I believe it's carbohydrates.

As far as I understand the signalization in our body, our brain is constantly detecting how much food we ingest, what is the concentration of sugar in the blood, how much energy is acutely available. If these signals are missing, the body concludes there is no energy and shuts down its less important functions.

The biggest mistake coaches make is instruct their athletes not to eat so many carbohydrates because sugar is the most important signal for a female athlete.

Why persist with such a diet if it is harmful to our health and leads to worse results? Is being thin reason enough?

I honestly don't know. No matter how thin you are, if you don't consume enough carbohydrates around your training session, your training will be unsuccessful, especially at higher intensities.

Studies demonstrate that athletes who didn't eat enough achieved significantly inferior results in training sessions and tests. There was no progress, and sometimes their performance even declined.

We have young male and female athletes who work hard, but they are malnourished and because of that don't achieve good results. We could say they train for nothing.

Consuming a bag of candy, an energy gel, or a sports drink, such as Nrgy Unit Drink, could make all the difference in the world.

Then why do people still do this?

They are afraid of carbohydrates. In this industry people believe that carbohydrates will make them fat. This is why they are afraid to ingest the appropriate amount. And at the same time, there is pressure from their peers: "Will you really eat that much?" or "You eat for two or you eat more than a boy."

Where does this fear come from?

It is the consequence of false belief that potato will make us fat. We think candy will give us diabetes and such. There is too much ignorance. We can hear statements like: "I quit eating pasta cause it makes you fat."

It is physiologically almost impossible for carbohydrates to make us gain body mass in such a way. 

You seem quite certain. Where does this certainty that carbohydrates are so important come from?

I listen to Dr. Tim Podlogar (laughs).

It is important to read the correct literature, think critically, go to various conferences on the subject of sports and nutrition, female physiology, endocrinology, etc.

It is such a complex topic. Not every article is good.

People love to say they did their research. They read the literature, watched some YouTube videos, and now they are convinced a certain supplement has potential. And then it turns out that the experts have a completely differing opinion. Why is it so difficult to separate good research or articles from bad ones?

During my studies I wrote many articles and papers. This teaches you to find a good article, examine it critically, and how to evaluate its methods and conclusions.

When evaluating research, you definitely need some prior knowledge. A PhD helps you to be able to evaluate things more critically. Someone who is a coach or completed a sports nutrition course will have a hard time examining this type of literature critically enough.

Do you feel that what they taught you in school is congruent with what you realized later on as a researcher?

I must say that our study program was of very high quality. The only thing I would point out is that studies make you somewhat biased. The thing you research becomes the most important for you. For example, someone doing research on the microbiome starts to believe that the microbiome is the most important thing and influences everything.

It's important to be able to listen to a different opinion.

Apart from that, there is very little being taught about female physiology. I am really glad that sometimes the university invites me to have a lecture on this topic.

Tina, thank you for your time. Next time we will address more specifically the nutrition mistakes young female athletes make, how to recognize problems, and how to deal with this rising issue.

Thank you, too. I am glad I can warn young athletes about this persistent problem.