Poor or sub-optimum nutrition is more common in female athletes than in male athletes. Proper diet is of the utmost importance in order for active individuals to maintain adequate energy during intense bouts of exercise/activity and for recovery afterwards. In our sports injury practice, we often see female athletes with exercise related injuries in which inadequate nutrition may play a factor in the development or perpetuation of their injuries. Indeed, several scientific papers in recent years have raised concerns about inadequate nutrition and its effects upon female athletes.

Female athletes who are at the greatest risk for nutrition related problems are those who participate in sports that encourage “leanness” because of a need to wear contour-revealing clothing or those that are involved in competitions that involve scoring on the basis of body appearance. It is these women who often have inadequate nutritional intake.

Sports that emphasize “leanness” or a particular body aesthetic include:

• Gymnastics • Distance running • Diving • Figure skating • Classical ballet • Bikini/Figure competitions

Indeed, some studies have found that female dancers, for example, consume less than 70% of recommended daily energy needs. Too often such restrictions are employed to achieve a certain “look” rather than to achieve maximum physical performance. And, very often, this is where problems begin.

Therefore, in order to formulate a winning nutritional plan the athlete’s sex and body size, the demands of the activity performed, and the duration for which that person performs the activity, or trains for that activity, must all be carefully considered.

What Are Macronutrients And Micronutrients?

The essential nutritional components are categorized as “macronutrients” (calories, carbohydrates, protein, and fat) and “micronutrients” (fluids, electrolytes, vitamins, and minerals).



Carbohydrates are necessary to meet energy needs. Carbohydrates are, generally, more important to endurance athletes than strength athletes.

When creating a sports nutrition plan, carbohydrate needs are generally formulated on the basis of an athlete’s body size and activity level. There is no optimum carbohydrate intake that universally suits all people in all circumstances. However, for discussion purposes, some researchers suggest that persons engaged in moderate-duration sports/exercise require at least 2.5-3.5 g of carbohydrates per pound of body weight. Those participating in long-duration endurance sports/exercise might require 3.5-5.5 g of carbohydrates per pound of body weight. Again, proposed nutrient ratios such as these constitute very general guidelines that are not prescriptive since they do not take into consideration individual factors relevant to each individual athlete.

Fruit, vegetables, brown rice, enriched whole-grain breads, whole grain cereals, rolled oats, beans, legumes, and sweet potatoes are examples of valuable carbohydrate foods for athletes and active people.


Active individuals have a higher protein requirement than less active people. This is due to the fact that active people and athletes: 1) generally have a higher percentage of lean muscle mass to support, 2) they need protein to repair muscle tissue that is damaged during exercise, and 3) they require additional protein for energy during exercise.

The amount of protein each athlete requires, again, depends on the type of activity being performed. For the purpose of discussion, some researchers conservatively recommend a minimum protein intake of around .5 grams per pound bodyweight/day for individuals participating in endurance sports and around .75 grams per pound bodyweight/day for those involved in strength/anaerobic activities. Again, these protein intakes are not prescriptive for all individuals under all circumstances. Certainly, those athletes who have achieved an “elite” level in strength sports, contact sports, and bodybuilding would probably find these dietary protein ratios inadequate for their needs.

The benefits of emphasizing protein over carbohydrates can include the following:

• Enhanced weight loss • Reduction of fat in the belly and waist areas • Optimal maintenance of blood sugar levels • Improved blood lipid profiles/improved cardiovascular risk factors

Protein-rich foods include lean beef, chicken, turkey, fish, eggs, whey protein, and other low-fat dairy products. Women at risk for having a low protein intake are those who restrict their energy intake to achieve weight loss or those who eat a vegetarian diet. It is often difficult to persuade vegetarian women who visit our office with chronic injuries or overtraining syndrome that they may need to increase their intake of quality proteins. However, we often note that when protein intake is improved in these individuals their strength, power, muscle tone, and recovery from injury rapidly improves.

We occasionally encounter questions as to whether a high-protein diet can cause kidney damage. In this regard, there has been no conclusive evidence suggesting that a high-protein diet negatively affects healthy adults with normal kidney function.


Fat provides essential elements for the cell membranes and is essential for the absorption of fat-soluble vitamins. Many researchers suggest that fat provide 25-30% of a person’s energy intake. Diets should be limited in saturated and trans-fats, while providing adequate amounts of essential fatty acids (EFA’s). For female athletes, the following essential fatty acids are very important:

• Linoleic acid • Alpha-linoleic acid intake (ALA) • EPA (eicosapentaenoic acid) • DHA (docosahexaenoic acid)

Essential fatty acids are important in the regulation of blood clotting, blood pressure, heart rate, and immune function. Omega-3 fatty acids (EPA, DHA) may play a role in reducing inflammation, regulating blood sugar levels, and optimizing brain lipids.

Dietary fatty acids should come from naturally lean protein foods, grass fed meats, certain nuts & seeds, fatty fish (eg, salmon, mackerel, anchovies), fish-oil supplements, flaxseed oil, safflower oil, canola oil, sunflower oil, olive oil, avocados, and egg yolks. Women should avoid consuming fats found in processed foods because of their highly saturated nature.

Low-fat diets are not recommended for high activity individuals. Low-fat diets decrease energy and nutrient intake, reduce exercise performance, and decrease oxidation of body fat stores. Fat provides the most energy per gram of all the macronutrients and can help in achieving a positive energy balance. Dietary fat also maintains concentrations of sex hormones and may prevent menstrual problems.


Fluids and electrolytes

Dehydration impairs performance. It is important that athletes are well hydrated. Adequate fluid intake starts with approximately 1/2 gallon per day for women aged 19-30 years. Increased drinking is required for active individuals or those doing activities in hot environments.

Athletes should consume 14-20 fluid ounces of water 2 hours before exercising. During exercise, 6-12 fluid ounces should be ingested every 15-20 minutes. For exercise lasting longer than 1 hour or occurring in hot environments, the fluid may be a drink containing carbohydrates and electrolytes. Post-exercise meals should include fluids and foods containing some sodium, because increased urinary output may occur with the ingestion of plain water alone.

Vitamins and minerals

Female athletes are at increased risk for iron, calcium, vitamin B, and zinc deficiencies.These nutrients are vital for building bone and muscle and for energy production. Vegetarians are particularly at risk for developing deficiencies in these vitamins and minerals.

Iron insufficiency is one of the most prevalent nutritional deficiencies among the female athlete because of menstrual losses. Iron deficiency may lead to fatigue. On the other hand, excessive iron ingestion by iron over-supplementation may also cause problems, including gastrointestinal distress, constipation, and iron toxicity.

For female athletes that spend most of their time indoors, supplementation with vitamin D-3 may be appropriate. The impact of vitamin D on women’s health is very important. Low levels of vitamin D have been linked to breast cancer, colon cancer, ovarian cancer, high blood pressure, and strokes. Vitamin D is also involved in maintaining bone density.

Signs of Nutritional Deficiencies in Females

Girls and women with low energy and nutrient intake may develop the following signs and symptoms:

• Fatigue • Dehydration • Delayed growth • Decreased immune response that make the body more susceptible to foreign invaders and increase the frequency of conditions such as upper respiratory tract infections. • Irritability • Poor performance

Among athletes, a lack of proper nutrition can have many negative effects, including the following:

• Loss of motivation • Decreased maximal performance • Increased short- and long-term fatigue • Poor concentration • Preoccupation with food • Hormonal imbalances • Muscle soreness • Increased frequency or lingering of musculoskeletal injuries


Inadequate nutrition can lead to the absence of a menstrual period in a woman of reproductive age. This is called “amenorrhea.” Inadequate nutrition can also delay or arrest puberty in some girls. Amenorrhea can also occur because of emotional or physical stress, such as intense training. Amenorrhea is more prominent in the female athlete population (3-66%) than in the general female population (2-4%).

The Female Athlete Triad – An important warning to athletes and parents

The so-called “female athlete triad” can lead to severe and long-standing effects. Characteristics of this triad are the following:

• Amenorrhea • Disordered eating • Osteoporosis (loss of bone density)

At least one study has demonstrated that athletes competing in “leanness sports” (70.1%) are more likely to be at risk for the female triad than those participating in “non-leanness sports” (55.3%).

Disordered Eating

Examples of disordered eating or deficient nutrient intake include the following behaviors:

• Skipping meals (eg, because of busy schedules, training, work, school, and/or desired weight loss) • Engaging in unsafe weight-loss methods, such as consumption of ultra-low calorie diets, fasting, laxative abuse, self-induced vomiting, or use of diet pills, energy drinks, “fat burners,” or “pre-workout” drinks. • Using supplements to compensate for inadequate diets

Healthy Weight Control

Weight loss can be accomplished in a healthy manner. It should be achieved during a period without competitive events scheduled.

The goal of maximizing fat loss while minimizing loss of lean tissue is best accomplished with a gradual weight loss of no more than 1-2 pounds per week.

Energy intake should not be restricted to less than 1800 calories per day in highly active athletic women. Severe caloric restriction can lead to many of the complications described above.

Nutrition in Endurance Athletes

Triathletes and runners have been known to consume 5 or 6 meals per day, whereas cyclists may consume 8-10 meals per day. Bodybuilders are also famous for multiple feedings, but of different composition. This frequent eating ensures that the athlete’s high-energy needs are met, while decreasing the gastrointestinal discomfort associated with consuming large meals. It is very important that endurance athletes maintain good hydration, as mentioned previously.

Nutrition in Strength Athletes

Studies indicate that women who are focused on gaining muscular mass and strength appear to rely less on glycogen during exercise than on other body energy sources. They are less responsive than men to carbohydrate-mediated glycogen synthesis (“carb-loading”) during recovery. Therefore, to enhance their training and general health, the diet of these women should focus on good-quality proteins and fats rather than on a large amount of carbohydrates.

Female strength athletes should also include high-quality proteins in their diet because they provide essential amino acids, vitamin B-12 and vitamin D, thiamine (vitamin B-1), riboflavin (vitamin B-2), calcium, phosphorus, iron, and zinc. These women should consume protein-rich foods every day before and after exercise, as well as between meals to maintain and promote the growth of lean muscle.

Many of our patients ask us about creatine supplementation. Creatine has been shown to improve anaerobic performance. Creatine augments strength and gains in lean body mass when it is used in conjunction with weight/resistance training. However, in our clinic, we find creatine supplementation unnecessary in those athletes consuming frequent red meat meals.

About Us

Our facility, Performance Sport-Care in Walnut Creek, CA, offers a variety of state of the art exercise and nutritional programs that target the needs of people that seek recovery from injury, better physical performance, increased strength, weight loss, weight gain, and improved overall wellness. Our programs involve the same protocols and equipment used in professional sports, but are custom tailored to be compatible and safe for people of different ages and fitness levels. If you are interested in improving your strength, improving your physical appearance, and reducing injury risk factors please contact us with your questions or concerns. 

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or request an appointment.

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