Overtraining, Under-fuelling & Women’s Health – An Issue Worth Talking About

1409overtraining

Warning – honest article ahead. I’ve been asked to write about over-training on the blog quite a bit this year. I have written about it in the past (check that out here), and I think as we have recently rolled into a new year that it’s time to chat about it again. What is over-training? Quite simply put, it’s training to excess (either in volume, frequency, or both) without adequate rest or recovery in between.

Have I over-trained in the past? Yep. Multiple times. I’m very open about the fact that I spent a large part of my teenage years and early twenties being a ‘cardio bunny.’ I played a LOT of team sports in my early teens, which I loved – camogie, gaelic football, basketball, volleyball, athletics – but when I got to the last 2 years of my medical degree I found the team training commitments very difficult to balance with college placement and study hours. So, I started using the gym more, and doing more running and home workouts via Youtube. Which, being honest, was a LOT of very frequent cardiovascular type training. This was around the time that the HIIT (High Intensity Interval Training) craze landed, and that formed a large part of my training too. I think I just thought this was all the ‘normal’ way to train – even if I did know deep down that the frequency at which I was engaging with it was to excess.

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There’s this funny thing about ‘getting sweaty’ during your workout – it can become something you think you ‘need’ to be able to feel as though you’ve worked hard. I find it hilarious now that I used to believe that so fiercely. What’s more hilarious to me now (I say hilarious with a touch of sarcasm, because over-training isn’t funny) is that I used to think I ‘should’ ‘train’ (i.e. sweat) 7 days a week. NOT. NORMAL. But hindsight is 20:20 vision, as they say.

Fast forward to me in a better place when I qualified as a doctor, and started my intern year. My friend Aisling got me into weight training (we became fast friends, laughing over many things including her love of weights and dislike of cardio, with me the opposite when we met!), and I was instantly hooked. It made me feel strong, it challenged my body in a very different way to the tired training I was stuck in a cycle of, and I realised very quickly that my cardio-bunny ways hadn’t really given me much muscle mass to speak of. Don’t get me wrong, I wasn’t unwell, nor did I look unwell – but I was definitely, as my dad wisely said more than once, ‘writing cheques my body couldn’t handle.‘ So, over time, as I started lifting weights more, I began to reduce the cardio/HIIT style stuff, and found more of a balance.

exercise photo

I would honestly say it’s really only in the last 18 months that I have really found a true balance to my training, and I’m still learning. You’ll see I’ve chatted more about how I began prioritising regular weekly rest days after an injury from a 10km event in 2017 in a blog post from that time (read here). So I won’t rehash that now. I’ve also written about the concept of exercise addiction on my blog in the past (read here). In that article I discussed some of the very subtle signs of over-training, which I was largely ignorant of for a very long time – here’s a recap below, which I hope is helpful to some of you:

  • Difficulty with sleeping
  • Poor concentration (at work, school, college, or home)
  • Changes in mood – irritability, restlessness, low mood
  • Fatigue or feeling lethargic
  • Reduced performance physically – are you getting through your workouts the way you used to? Or have you stalled in your progress?
  • Reduced body-weight (whether intentional or not)
  • Frequent minor injuries
  • Frequent minor illnesses e.g. colds/flu-like symptoms
  • Headaches/General aches
  • Delayed recovery from workouts (prolonged DOMs for example!)
  • Lack of motivation

So, particularly since January this year when I found and developed a love for yoga (and became hooked on long walks with Podcasts and audiobooks), I think I’ve finally found a real balance I love to my training. I lift weights 3-4 days per week, depending on the program I am doing . My main ‘cardio’ is my walks, and sometimes short little finishers on the end of my weights sessions (as part of the program). I do yoga either in a class, or at home, multiple times a week, not in a structured way. I come to the mat when my body and/or mind needs it, which might be for 30 minutes, an hour in a class, or just 10 minutes. I set myself some 2019 goals to try new things and shake up my fitness identity, so to speak – I recently tried a Reformer Pilates class, and loved it!

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Let’s get to the real crux of the issue – why is over-training such a big deal? Please note that I’m going to stick to the implications for female health here (purely from an article length perspective!), but of course over-training is not limited to females. And as I always say, though I am a doctor, I am of course not an expert in this area. But, similarly to the post I wrote on gut health recently, I think it’s important to share the basics and raise awareness on those, as well as my own reflections too.

First of all, as you can see above, the signs/symptoms of over-training can potentially have quite a significant impact on your day to day well-being, as well as your physical, mental and social functioning.

Secondly, if you’re prioritising your training above ALL else in your life, that can negatively affect both you and those who love to spend time with you – family, friends, boyfriends – and even affect your college or work commitments.

Thirdly, let’s get to the nitty gritty. Exercise is a stress to your body, one which, in the appropriate dosage, can be and is beneficial for your health. For example, when I lift weights, I apply a stress to my body by lifting heavier over time, which forces my muscle to adapt and ideally allow me to get stronger over time (given appropriate rest and recovery). Any form of stress in excess is however NOT good for our health. That’s not rocket science.

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There is a medical condition observed in physically active females that you may have heard of, called ‘the Female Athlete Triad.’ The American College of Obstetrics and Gynaecology (ACOG) describes the three components of it – ‘1) low energy availability with or without disordered eating, 2) menstrual dysfunction, and 3) low bone density’ – and it really is a spectrum of disorders (i.e. it will look a little bit different for each female suffering from it). I’ve given you the full link to the ACOG website page on this condition here. Essentially, it is a condition that results from an energy imbalance – you expend more energy via training than you take in, meaning there isn’t enough energy available for your body to carry out the basic functions it needs to. For females, this low energy availability can lead to disruption of your menstrual cycle (your period) via it’s effect on a part of your brain called the hypothalamus. The hypothalamus is a fascinating part of our brain that plays a key role in lots of different bodily functions – hormone production, temperature, thirst, appetite, emotions, sleep cycles and many more.

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Stick with me here. Because of this effect on the hypothalamus, your menstrual cycle (your period) becomes affected. That’s because there is a hormonal pathway between your hypothalamus, your pituitary gland (in the brain also) and your ovaries. The hormone produced by the hypothalamus (GnRH – gonadotropin-releasing hormone) stimulates your pituitary to release FSH and LH (follicle-stimulating hormone and luteinising hormone), both of which are essential for a normal menstrual cycle as they stimulate the production of oestrogen and progesterone. So, if the hypothalamus doesn’t produce that first signal, GnRH, this can result in a range of possibilities including menstrual cycle irregularities, primary amenorrhoea (i.e. where you have never had a period) or secondary amenorrhoea (i.e. where you started your period with puberty, but then lost it for a period of greater than 90 days). The two main hormones in our menstrual cycle are oestrogen and progesterone. Not having a regular or any menstrual cycle results in a low oestrogen level in the body. We NEED oestrogen to maintain bone health, which is why female athlete triad can cause a negative effect on bone density (conditions known as osteopenia and osteoporosis). Poor bone density puts us at a higher risk of fractures, which I think we can all agree is NOT a good outcome.

There is a whole other realm to this discussion around nutrition, fuelling your training sufficiently, and on that train of thought, having adequate calcium and vitamin D for bone health. As I’ve said before, I’m a doctor, not a nutritionist or dietitian, but the rise in dairy-bashing on social media scares me, because it has led to massive rises in numbers of young women renouncing dairy in favour of plant-based alternatives. I’m not saying it’s wrong to make a dietary choice based on your personal ethical values around animal welfare or climate change, but it is dangerous to give up a food group without really planning out where you’re going source a replacement for the nutrients that food group provided. I eat dairy yoghurt pretty much everyday, and although I do use soy and sometimes oat milk, I recently started consuming dairy milk again (a glass a day, or in my Overnight Oats!) because when I looked at my calcium intake, it was far below what I should be getting, even with attempts to supplement with calcium-fortified milk alternatives. I’m not a huge cheese fan which probably contributed! That scared me, and made me realise that I can help the environment with my dietary choices – but not to the extent that it puts my own health (i.e. bone health) at risk. So my bottom line on the nutrition side of things (until I get a follow-up blog post on this together) is please, get yourself fully educated and informed (ideally from a professional such as a dietitian, qualified nutritionist and/or your doctor) before you starting chopping out food groups, especially if your sole reason for doing so is because your favourite blogger did it.

In 2014, the International Olympic Committee described ‘Relative Energy Deficiency in Sports (RED-S)’ as a broader, more comprehensive term for the Female Athlete Triad syndrome, and to recognise the fact that these issues can also occur in males (with of course the exception of the menstrual aspect!), with the overall emphasis on the impairment of many of our bodily functions due to excess energy expended by activity and not enough replaced. Now, I don’t pretend to be an expert in this area, but I did think that was worth mentioning, and I think it’s also worth being aware of the female menstrual and bone health implications via the relatively straightforward to understand model of Female Athlete Triad.

Note (April 2019): After writing and publishing this article, I was contacted by Danielle Logue, current Irish Research Council PhD scholar and performance nutritionist investigating RED-S in Ireland. She pointed me in the direction of two recently published journal articles on which she was the lead author and which looked at the issue of Low Energy Availability (LEA) (LEA is characteristic of RED-S). I wanted to update this article with the insights from Danielle’s Irish data, because it’s as I’ve said an issue we don’t talk about enough, and I’m very passionate about bringing more awareness to the topic (though it’s definitely an area I’m not an expert in but am currently reading research on to further my knowledge!). So the next 2 paragraphs below are a little more detail from Danielle Logue’s 2018 publication on LEA in the Irish female athlete population (Logue et al., 2019). Her group also published a fascinating literature review on LEA (Logue et al., 2018), and I’ve linked both articles at the end of this one. Check out Danielle’s brilliant content on Instagram by following @daniellelogue_nutrition

What is LEA? So, the EA part of LEA stands for ‘energy availability’, which refers to the energy we have available for normal physiological functions such as movement, growth and immunity. LEA refers to a state whereby we DON’T have enough energy for these essential and normal physiological functions to optimally continue, which can lead to our bodies adapting to this low energy availability unfavourably – for example, leading to poor bone health (through lowered bone density), menstrual cycle dysfunction and possibly increased risks of injury and illnesses. There is a lot of ongoing research into LEA in both professional and recreational athletes because of these potential negative impacts to our short and long-term health as a result of insufficient energy for the exercise we do. Now, LEA may or not may not be accompanied by disordered eating or eating disorders as Logue et al. point out, but going into that further is beyond the scope of this article, and perhaps something I may discuss in the future, ideally through a specialised dietetic or registered nutritionist professional.

What was fascinating about the most recent article by Logue et al. (2019) is that they conducted a study with two key aims I’ve bullet pointed below. I’m not going to go nitty gritty into the study research design and strengths/limitations but I wanted to share the key insights with you guys to relate this aspect of the article to a representative Irish context. Their study sample size was impressive at 883 healthy active females in total – ranging from athletes competing inter- and intra-nationally to those exercising recreationally. The study aims were to:

  • ‘To identify the risk of LEA in active females competing in different age groups and at different levels of competition in Ireland’ – using a specific questionnaire used to identify LEA (the LEAF-Questionnaire).
  • ‘To determine if associations between risk of LEA, illness and restrictive dietary habits exist in active females competing at different levels of competition.

I’ve summarised their main findings for you guys below, and the article is referenced at the end if you want to read the study in full (do!):

  • Approximately 40% (!) of study participants were considered at risk of LEA.
  • LEA risk occurred frequently not only in athletes participating in weight-sensitive sports, but also among recreationally active individuals and athletes competing in team sports, irrespective of the level of competition.
  • 62% of participants reported absence from training due to an injury in the previous year, and of the 60 participants who reported having sustained a stress fracture in the previous year, 46 (76.6%!) were considered at risk of LEA.
  • This highlights the importance screening for risk of LEA to potentially help identify athletes who may be at a greater risk of injury and illness. 
  • A high proportion of participants reported following a restrictive type of diet, with dietary restriction of carbohydrate occurring most frequently (47%!), which may be due to the amount of media myths that have surrounded this macro-nutrient over the last few years. This is absolutely of concern given the importance of carbohydrates in the diet for energy, especially for athletes – we can’t run on an empty tank!
  • LEA risk was associated with missing more than 22 days of training during the previous year due to illness and with stress fractures.

I couldn’t have agreed more with the conclusion of this article, which was:

Given the negative short- and long-term health and performance consequences associated with LEA, an approach to athletes that includes regular screening for LEA and that incorporates evidence-based educational interventions should improve the identification and management of this condition.’

Phew. Let’s recap. Over-training and under-fuelling = negative effects on all aspects of our health. In females, it can result in ‘female athlete triad’, negatively affecting our menstrual cycles, oestrogen levels and bone density. All in all, something we would ideally safeguard against.

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How? Rest. Recovery. Refuel. REGULARLY. For me, that now looks like a rest day (i.e. no gym, no heavy cardio or HIIT) 2 days per week minimum, maybe 3 depending on how busy my week has been or how my weight training has been progressing (i.e. sometimes it might be more, I’m still trying to figure it out fully!). I like to structure one day in mid-week, and one day at the weekend, or I’ll use Saturday and Sundays for rest days. People talk about ‘active’ rest days, where you might go for a walk, or do some yoga – some agree with this, others do not. Personally, I use a Fitbit watch, and like to hit my 10,000 steps a day every day (including rest days), and I do believe our bodies are designed to move every day. On my rest days away from the gym, I’ll always go for a Podcast walk, and I might do a short yoga sequence at home, or I’ll book into a class with a friend. I won’t book the classes I know are a bit more intense on those days. I find yoga incredible helpful to complement my gym training and really work on my mobility and flexibility, so I keep it up. It’s important to find a balance that works for you and your body, and to first of all learn to listen to those subtle signals your body is giving you. This takes time, and really until I started yoga I didn’t fully hear them. I do now.

I hope this post was helpful guys. I recommend checking out Dr. Anita Mitra (@gynaegeek on Instagram) if you want to hear more on female hormone health and over-training, as well as female gynaecological health, her content is fantastic, and she has done some awesome Podcast interviews too. I also think the content shared by Renee McGregor, a performance and eating disorder dietitian, is fantastic. She has been interviewed on multiple Podcasts (including the Food Medic, it’s a great listen!) and has her own website which I’ve linked, I definitely recommend checking her out!

Let me know your thoughts as always – I’m @theirishbalance on Instagram/Twitter/Facebook!

Ciara 🙂 x

References

  • Logue et al. (2019) ‘Screening for risk of low energy availability in athletic and recreationally active females in Ireland’, European Journal of Sports Science, 19(1), pp. 112-122.
  • Logue et al. (2018) ‘Low energy availability in athletes: A review of prevalence, dietary patterns, physiological health and sports performance’, Sports Medicine, 48(1), pp. 73-96.

 

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