### The Female(?) Athlete Triad - Part III/III: Road to Recovery! Step #1 = "Increase Your Energy Intake"! Plus: Learn How to Calculate Your Resting Energy Expenditure (BMR)

*SuppVersity*Female(?) Athlete Triad Series. When I wrote the first part of this series, I originally did not even plan to have a second, let alone third part. Now, I've reached Part III and have to realize that the simple question "how much do I have to eat" can become pretty hairy. Not the least, because I personally have never been an advocate of meticulous calorie counting and yet cannot ignore the fact that I have to give you something you can start from... to cut a long story short, also to avoid falling victim to the aforementioned

*"bloggers triad"*, I will tackle the rest of this series, the

*"Road to Recovery"*as I called it in as many steps as it will take: No renumbering just Step #1, Step #3, Step #3, ...

In view of the fact that each of those steps should contain at least one thing you can actually

*do*, we will start out right with

__the single most important__change you will have to make in order to escape the self-perpetuation vicious circle I've been outlining in the last installment of this series.

**Step 1: Increase your energy intake! But how much do you need?**

__above__this critical threshold.

**For a 25-year old woman with a body fat percentage of 20% and a total body weight of 65kg this would imply that your daily energy intake must**

__never__be lower than 0.8 x 65kg x 30kcal/kg = 1560kcal -*even when you are dieting*.Despite being based on empirical evidence, going solely by LH abnormalities is probably not the best way to estimate your energy requirements. Therefore, I have picked two practical alternatives for you to chose from:

- The
**standard equation**to calculate the basal metabolic rate independent of your daily activity levels, i.e. thereads (the values are in kg, cm and years, for weight, height and age, respectively)*Harris-Benedict equation* **REE (women) = 65.51 + 9.5663 x weight in kg + 1.85 x height - 4.676 x age****REE (men) 66.5 + 13.75 x weight + 5.003 x height - 6.775 x age**Active (wo-)men need more than their REE (img sheknows.ca) *Acitivity Level Factors*these REE values will also yield an estimation of your overall daily energy expenditure which is 1.53x, 1.76x and 2.25x higher than your REE depending on whether you are sedentary or lightly active (1.53x), active or moderately active (1.76x) or vigorously active (2.25x), with the latter being the category approx. 90% of those who are trapped in the athlete triad still belong to.- Probably
**more accurate**since developed and tested with an athletic population, but reliant on way more information would be a recently proposed equation by., which reads*Oshima et al* **REE (men & women) = 2.3 x bone mineral weight + 4.5 x adipose tissue weight + 13 x skeletal muscle weight + 54 x rest weight****(brain, liver, kidney, glands, skin, etc.)- It is easy to see that this equation has been developed to be used in professional studies. After all, the majority of people won't even know that there is a profound difference between both your fat mass and your total adipose tissue mass, as well as your "lean mass" and the amount of skeletal muscle tissue you are effectively carrying around.

* * *

While the calculation of your resting energy expenditure with the *Harris-Benedict equation*should actually be pretty straight forward and yields

**Daily REE (Harris-Bendict) = 655.1kcal + 9.5663kcal/kg x 65 kg**

+ 1.85kcal/cm x 170cm - 4.676kcal/year x 25 years

+ 1.85kcal/cm x 170cm - 4.676kcal/year x 25 years

**= 1474.51kcal**

**How to use the Oshima equation without DXA data - An example**

Since this is at least in my experience the parameter most of you will be missing, I base the following example calculation on the assumption that we don't have the quantitative data on Mrs Jane Average's bone mineral density and are thus not able to estimate the corresponding bone mass (in kg) by multiplying the bone mineral density (in g) by x 1.85 / 1000.

*figure 2*(don't tell me that's not accurate, you will be surprised ;-):

**Do not count each salad leaf!**As mentioned in the introduction, already, I have never been a fan of calorie counting. Part of the problem of the athlete triad is however that once you are in it, you have no baseline you could tweak by following my usual advise of logging your food intake for 1-2 weeks, taking stock and going from there. Likewise you can (for the reasons I explained in the last installment) not go by your appetite / hunger, simply because you have long "starved it away". If you really want to return to normalcy, however, you must not start to count the energetic value of each and every salad leaf, tomato, piece of broccoli or single rice corn you put into your. Therefore, the things you will count are ...

- meats, eggs, fish, dairy, etc.
- rice, (sweet) potatoes, oats, pasta, bread, etc.
- coconut oil, olive oil, butter, ghee, sauces, etc.
- any form of treat / fast and convenient food or caloric beverage
- food supplements, e.g. protein shakes or bars

__pieces__of fruits and veggies with a caloric value similar to carrots, but whenever you catch yourself cutting off half of the asparagus spear you were just about to eat, eat at least another two + buttery

*Sauce Hollandaise*on top ;-)

- assuming that the body height of our woman is 1,70cm, she would have a BMI of 22.5 kg/m² and therefore fall into the
**middle category**in*figure 2* - accordingly her bone mineral weight would be ~7% of her body weight, which allows us to estimate her
**total bone mineral weight to be 4.55kg** - her total fat mass, which is ~85% of the total adipose tissue weight would be 20% of her body weight, i.e. 13kg; we need to multiply that by 1.18 in order to accommodate for the non-fat part of the adipose tissue and get a
**total adipose tissue mass of 15.3kg**

*figure 2*(remember with a BMI of 22.5 our exemplary woman falls into the middle category) instead of simply relying on the common yet incorrect assumption that the skeletal muscle mass was was more or less identical to the difference of total body and fat mass:

- to determine the weight of the metabolically highly active organs (compare the coefficients to those of the "purported fat burner" skeletal muscle - at rest, brain, liver, kidney, but also ovaries & co consume
__4x more energy than muscle__!) in the*Oshima equation*we multiply the total body weight with0.3 (=30%) and get a a**"rest weight" of 19.5kg** - eventually we determine the skeletal muscle weight by simply subtracting all the values we have from the total body weight - viola, our exemplary woman has a
**skeletal muscle weight of 25.65kg**

*Oshima equation*, which will then look like this:

**Daily REE (**

+ 13kcal/kg x 25.65 kg + 54kcal/kg x 19.5kg = 1465.77kcal

*Oshima*) = 2.3kcal/kg x 4.55kg + 4.5kcal/kg x 15.3kg+ 13kcal/kg x 25.65 kg + 54kcal/kg x 19.5kg = 1465.77kcal

*Harris-Benedict*equation yielded. This in turn, goes to show you that within the "normal zone", into which Mrs. Jane Average certainly would fall, simple standard equations such as the often criticized, yet still widely used

*Harris-Benedict*equation appear to be pretty accurate. At least, when we are talking about the minimal requirements of someone who's not doing much more than walk from the bed, to the fridge, to the car, to the table in his office, back to the car and ... you know what the average white-color worker does these days.

Extraordinary individuals have extraordinary energy requirements - and you are extraordinary! |

**Fortunately, you are none of those office "**

*triseathletes*" whose athletic triad consists of exhaustive*in your office chair idling*, extreme*stressed in the car sitting*and lazy on the couch lying... right? I thought so! And this is why there is__no way__that the ~1,500kcal will suffice to break out of the vicious circle of a real athlete's triad.On the contrary, it is however "as sure as eggs is eggs" that falling short of those minimal energy requirements is the single best recipe to fall victim to the very same triad.

**Resting metabolic rate and real-life energy requirements**

If you take another look at

*figure 1*, the corresponding LH-based energy intake rule of thumb, I derived from the data by Loucks et al., as well as the coefficients (the factors in front of the parameters) in the

*Oshima equation*, it should actually be obvious that those basal energy requirements are more or less "hard-wired" into our hypothalamic energy control system. With 54 out of 74kcal/kg body weight (73%) being used simply for the maintenance of organ functions, alone (!), there is not much room to conserve energy other than eating up the organs, the bones and the skeletal muscle and of course shutting down such superfluous organs as the ovaries or testes, and... hold on, aren't that all the symptoms of the athlete's triad?

Figure 3: Mean, median and minimal energy intake (in kcal/kg) in eumenorrheoic vs. amenorrheoic female athletes (data calculated based on an overview in Manore. 2002) |

__absolute__minimum for the real light-weights among female athletes. Only in one of the 15 studies with datasets from 138 women on which the values in

*figure 3*are based, were the ~30kcal/kg body weight sufficient to prevent onset of amenorrhea. And when I am telling you that this group of female athletes also happened to be the group who consumed the highest amount of carbohydrates relative to their overall calorie intake per kg of body weight, I am actually already touching on the topic of the next installment, in which we are going to take a look on how you should distribute your overall energy intake across the macronutrient spectrum.

A pros pos, while you are waiting for the next installment of this series you should stop counting asparagus spears, calculate your resting metabolic rate and see where you are standing, in terms of your current caloric intake! And though I personally doubt both the quantitative validity of the

*activity level factors*Harris and Benedict provide, you should not forget that chances are slim if not non-existent, that you will recover, if you don't aim for a 1.76x higher energy intake than your RMR calculations would prescribe on workout days.

**References:**

- Harris JA, Benedict FG. A biometric study of basal metabolism in man. Publ no 279. Washington, DC: Carnegie Institution, 1919.
- Loucks AB, Thuma JR. LH pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. J. Clin. Endocrinol. Metab. 2003; 88: 297–311.
- Manore MM. Dietary recommendations and athletic menstrual dysfunction. Sports Med. 2002;32(14):887-901.
- Oshima S, Miyauchi S, Kawano H, Ishijima T, Asaka M, Taguchi M, Torii S, Higuchi M. Fat-free mass can be utilized to assess resting energy expenditure for male athletes of different body size. J Nutr Sci Vitaminol (Tokyo). 2011;57(6):394-400.
- Taguchi M, Ishikawa-Takata K, Tatsuta W, Katsuragi C, Usui C, Sakamoto S, Higuchi M. Resting energy expenditure can be assessed by fat-free mass in female athletes regardless of body size. J Nutr Sci Vitaminol (Tokyo). 2011;57(1):22-9.