ioc conference 2012 los angeles, usa
TRANSCRIPT
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Medical Issues Women in Sport
• Larry Gaul M.D. • USSA Nordic Team Physician
• FIS Medical Committee
• 3rd FIS Ladies Seminar “Women and Health’
• 28 May 2012
• Kangwonland, Korea
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IOC Conference 2012 Los Angeles, USA
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Today What WE Should be Aware of For
Our Women Athletes Who Are “We”
ATHLETES Physios Coaches Staff Doctors Everyone in room Trainers
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Help Athlete Finish Here Carrie 2nd Place Kikkan 1st Place
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NOT Here!
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Today’s Focus It’s The Female Athlete and You
Not The Doctor
• Women- Are They Different How? – What is Known (Some)
– What is Not Known (Lots)
– What is Needed (Research)
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What is Known ? • Hormones
• Body Size and Muscle Mass
• Heart and Blood Related issues
• Orthopedic Problems- ACL
• Concussion
• Urinary Problems
– Stress Incontinence
– Infections
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Hormones
• Growth Hormone
• IGF-1
• Estrogen, Testosterone
• DHEAS
• Thyroid T3
• PTH, Cortisol etc.
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Hormonal Issues
• Osteoporosis - Weak Bones
• Amenorrhea - No Period
• Female Athlete Triad- The BIG Problem
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Osteoporosis
• Fractures Now and in the future
• 23 year old athlete -17 fractures
– Normal Menstrual cycles
– Ate lots but very constant foods
– Impact sport but trained off season low impact
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Bone Mass
• Peak bone mass predicts Fractures
• 90% of bone by age 25
• 60 % Genetic
• Hormones
• Nutrition
• Exercise
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Exercise
• Site Specific
• Weight Bearing better
• Fast Intense decreases Bone
• Long endurance Increases Bone
• Overtraining Decreases
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So How About Carrie? 2nd Place remember
Periods-Rare Eats- LOTS!
Osteoporosis-?????
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Female Athlete Triad
• Term Originated 1992 Revised 2007
• 3 Components (Maybe 4)
– Decreased Energy Availability
• Not enough calories - after exercise
– Low Bone Density
– Menstrual Dysfunction
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Triad – Decreased Energy Availability
• After Exercise- How many Kcal are left?
• Concept has Evolved
– Not just “Anorexics or Bulimics”
– Mild = Missing certain beneficial nutrients
– Severe = Classic Anorexia or Bulimia
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Good Nutrients
• Lots of Calcium Of Course – > 1000 mg elemental Calcium / day
• Phosphorus
• Vitamin D
• ? Folic Acid for Blood Vessel Function
• Protein
• Already eat lots of Carbohydrates
• LOTS OF CALORIES
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Vitamin D
• Check Levels in Young Athletes F and M
• Unknown ideal levels
• < 50 nmol / L = LOW
– Stress Fx, Infections, Poor muscle function
• Levels lower in Winter - less Sun
• Women eat less than Men
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So - Does Carrie Have the Triad? NO She is Hypothyroid Not everything is as it looks
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Anemia and Low Iron • More common in Female Athletes
• 3 Main Types
– Dilutional “Pseudo-Anemia”
• Blood Volume, Kidney hormones
– Exercise Induced Hemolysis
• Mechanical, Acidosis, High body Temperature
– Iron (Fe) Deficiency
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Iron Deficiency Stage 3 - Anemic
• Stage 1 and 2 last months before Anemia
• Iron Stores-Ferritin low before Hgb
• Levels below 20 µg / L Too Low
• Below 40 µg / L MAY cause poor
performance
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How Do Women Loose Iron?
• Menstrual up to 1.5 mg/day
• Poor Dietary Intake Need >15 mg/d vs. 10 for
Men
• GI Losses
– Poor Gut Blood Flow
– NSAIDS (Aspirin, Ibuprofen)
– Poor Absorption vs. Non Athletes
• Runners
– Men: 16 % Women 20 % Fe Deficient training
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How About the “Other Stuff”
• Concussion: – Women ? 1.5 x higher risk
– Neck Strength, Reporting, Estrogen effects
– Symptoms More Severe • Last Longer Uncertain Why? Metabolic demands
• ACL – more common
– ? Hormonal ? Biomechanical
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“Minor” “Other Stuff”
• Pregnancy • Lots of issues, rare in major competitions
• Stress Incontinence • 25 % age 14-21 90 % Don’t report
• Heart Related
– Irregular Heart Beats From Antibiotics
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So What Do we Need To Know?
LOTS AND LOTS
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THANK YOU!