Sports science is changing the way female Olympians train. It could also help youClick to enlarge the image.Annie Kunz, a Colorado track and field star, used to feel tired even during warmups. Then there was her constant hunger. Sometimes, her stomach would growl during practice. She felt constantly thinking about food and would restrict her intake of certain foods, such as carbs, to avoid them. She also experienced terrible, debilitating cramps every time she had her period. Kunz, who is representing America in the women's Olympic heptathlon in Tokyo this week, didn't feel as if she was performing at her very best.Any of these symptoms could indicate a health issue and may affect her performance. Kunz claims that she has rarely, if ever, discussed such issues with her coaches. Kunz says they've almost always been male, Kunz said, and many weren't comfortable discussing topics like weight, hormones, and menstrual cycles among their female athletes.After graduating college in 2016, Kunz moved to California to prepare for the Olympic heptathlon, which requires seven events and strength. Kunz sought advice on improving her performance and health, and discovered that there was recent research that looked at female athletes in sport.She worked with someone who was well-versed in this research. They helped her to focus on eating enough calories and not restricting her diet. They also encouraged her to track her periods and their impact on her mood, energy, performance, and mood.Kunz learned more about the best practices for female athletes and made it a point to share her cycle with her coach. Her coach and Kunz have also changed Kunz's focus on physical fitness from becoming leaner to becoming stronger.Kunz, 28 years old, said that it had literally made a huge difference before she set off for Tokyo and the first Olympic Games. "I don't have those days anymore when I just drag to warm up. I'm full of energy.Kunz won the heptathlon at the Olympic trials in Eugene in June. This was a far cry of her eighth-place finish in the 2016 trials. She says that her performance has improved by focusing her training on recent findings from sports medicine research.This is a relatively new area of studyDr. Kate Ackerman first heard the term "female-athlete triad" while she was in medical school twenty years ago. The American College of Sports Medicine coined the term "female athlete triad" in 1997. It describes the three conditions amenorrhea, bone-thinning osteoporosis, and disordered food that are sometimes seen in women athletes. Extreme exercise and low body fat are the triggers. Ackerman states that aside from this descriptive term, very little sports science research has been published on female athletes. These findings were the norm, as almost all previous research had been conducted on male athletes.Ackerman, who was an elite rower during her medical school years, says that there wasn't really any sex- and gender-specific training for athletes. She recalls that she and her teammates were often curious about their periods and birth control options. They also wanted to know if any of these factors affected training. However, science-based answers weren't available at the time.Ackerman's work over the past decade, as well as other researchers in the field, has made the female athlete triad more commonly known as relative energy deficit in sport (or RED-S). It is essentially a problem with athletes underfueling. Ackerman says that a lack of energy can cause a host of health problems, including irregular periods, missing periods, and reduced bone density. RED-S may also include depression, impaired immune function, and impaired cardiovascular function. As strength decreases and injury rates increase, the physical strain can adversely affect athletic performance.The myth of "Thinner is better"Ackerman believes that some of the motivations for athletes to develop this disorder are messages they receive from coaches and trainers. She summarizes it as "thinner, faster, or lighter, is better."For years, it has been a common message that athletes need to lose weight in order to be more successful in certain sports.Kunz states, "I have had coaches in track and soccer that would tell me, " "If you lose 10 pounds, you'd look so great." These coaches believed in her, and tied her weight to her performance. She says, "I wouldn’t say that I ever had an eating disorder. But I do think it was something which weighed heavy on me a lot."Small research studies in the past suggested that endurance athletes who have a lower body mass index perform better than others. Recent research that includes female athletes has shown this correlation is not true for most people involved in sports, particularly for younger female athletes.Maya DiRado is a Rio Olympics medalist in 2016. She says that she received the message from Stanford University that athletes should be focused on their thinness while on the Stanford University swim team.She says that in the early years of her college career, it was believed there was a "swimmer body type" and everyone should work to become leaner and toned. She says that even then, this advice didn't seem right to her. "I believe that swimming is especially dangerous, and it's obvious when you look at competitive swimmers on the pool deck."According to researchers, she is correct. Research around RED-S has shown that a one-size fits all approach to body weight and caloric intake is not healthy for athletes, regardless of gender or for performance.Alicia Glass is a senior sport dietitian at the U.S. Olympic Committee and has worked with USA Track & Field for the past ten years. It is so frustrating when I receive emails from coaches asking me questions like "What is the average bodyfat percentage of X national teams?" She says. This misses the point. Your numbers will fall if you focus on the right foods and look at how many carbohydrates and protein your body needs in order to exercise. They look after themselves. It does not do justice to the target by focusing only on body fat percentage.Even doctors don't know this.It is still a new field, even though sex-specific sports science research has become more common. Ackerman states, "Even today, I see [female] athletes every day who don't understand it and don't necessarily have to see physicians who can treat RED-S. We still have much work ahead of us.She says that diet is a good place to start a conversation about female athletes with RED-S symptoms. I think of nutrition as a sort of pyramid. You need to ensure you are getting enough calories. Next, we can adjust the amount of calories and when you eat them. Then we can go on to the specifics, such as 'OK, you have to take this supplement on Day 17'. Let's start with the basics.For female athletes who have been receiving calorie-cutting messages for so many years, even these basics can be difficult to understand. Glass states, "You cannot just say, "Eat more" or "Eat less." They can be persuaded."Athletes need to care about their health and avoid injury. She says that if you are able to manage your workload, complete all phases of training and feel good about it, then wellness should be the main focus. "The performance and health of the individual, not the numbers."It is important to take care of your menstrual healthAlthough more people are now aware that menstrual health is an important indicator of female athlete health, it can be difficult to have this conversation. DiRado, who was competing in swimming when she retired from the 2016 Olympics, said that she didn't have a regular period and she doesn't recall ever being asked about it by coaches or support staff unless she was experiencing something very serious.DiRado recalls one time she got her period, during college. She was so nauseated that she had to get out the pool and lie on concrete at 5:30 a.m. as it was the only thing that made the nausea go away. DiRado said that even then she and her coach felt confused. It's strange to think back and see that maintaining a regular period wasn't considered a priority. "I didn't have any idea of my body's needs, even though I was very aware of how it felt and what was happening."Glass, who was a former USA Swimming swimmer, said she is now more proactive about her menstrual health and routinely asks the athletes she coaches, "Are your periods every month?" Are you aware of the length of your cycle? Are you aware of how heavy your cycle is? Are you aware of how heavy it is? How does it relate to your feelings?She notes that healthy menstrual cycles can differ in length and severity, and that hormone levels vary from one person to the next. She advises athletes to keep track on their symptoms each month. She says nutrition can help with issues such as cramps or cravings that can impact performance. She suggests athletes eat more anti-inflammatory foods like strawberries, raspberries, and other fruits and veggies before cramps start. When they do, it is important to consume small amounts of dark chocolate.Kunz, the heptathlete says that keeping track of her own physiological changes has made a huge difference and has also shown a willingness to share her thoughts with her coaches. She might tell her coach something like "It's mine week and my self confidence always drops during that week." Let's not take this week too seriously. She can also tell her coach if she feels more tired or needs to take more naps during the week.What's next for research?Ackerman and her coworkers are keen to find out more about the effects of the menstrual cycle on performance. She says that the next step is to research "What estrogen's effect is on strength?" What does it do for endurance if you have a higher estrogen and lower progesterone components? What does this mean for strength? Are there different benefits to these training phases?Researchers believe that Kunz's and other female athletes' recent improvements are only the beginning.Ackerman states, "We are applying so many information to women that was based on men." Ackerman also says that once women start doing studies specifically for women, and have results that can be applied to women's training programs, I expect that we will see significant improvements in performance. We have yet to fully tap the potential of female athletes.