Los Angeles Times Health Section - Oct. 9, 2000

Book Review of The Athletic Woman's Survival Guide

Dr. Carol Otis of UCLA is one of the world's leading authorities on the health of female athletes, and here she explores the pressures on them to conform to particular body types while excelling in their sports.

Otis questions the practice of pushing athletes to meet unrealistic standards for shape, weight, training and performance, which can eventually backfire and lead to illness. The illness typically occurs in the form of the "female athlete triad," a syndrome consisting of disordered eating, menstrual cycle disruptions and osteoporosis. According to Otis, all or parts of the triad occur in many active women and are a particular threat to female athletes.

The book explains the triad and how to avoid it but, perhaps more important, also urges women to adopt a definition of fitness that encourages whole-body health - and a positive body image based on an individual's physical characteristics.

As American women continue to gain fame in sports - as was seen during the Summer Games in Sydney - It's more important than ever to make sure those achievements are based on the tenets of good, comprehensive, long-term health.

The Athletic Woman's Survival Guide was written by a husband and wife team closely involved in college health and sports. Carol Otis is a physician at UCLA Student health Services who is known word-wide as a leading authority on the topic. She has worked with athletes in numerous sports, marathons, and Olympic trials and serves as the chief medical advisor for women's professional tennis. Goldingay, a former professional soccer player, write regularly for sports and fitness magazines.

At particular risk for the triad, say the authors of this book, are athletes in activities that emphasize a lean appearance, who have weight categories and mandatory weigh-ins, or who wear skimpy outfits.

The authors relate many examples of well-nourished female athletes who are "too fit to quit" and, in contrast, others who others who restrict their eating, diet, and are "too thin to win."

Disordered, restrictive eating and nutrient deficiencies are at the heart of the problem. Women athletes often follow food fads or avoid whole classes of food in an effort to eat fat free: "Dairy products and meat are often completely eliminated because they are regarded as 'fattening.' And yet these are the food groups that contain iron and calcium, the most important minerals and vitamins essential to the health of growing women."

One result is "old bones in young women." Loss of bone mass leads to porous bones that are subject to stress and crush fractures during strenuous training and athletic events. The Survival Guide stresses the need to fight any condition that attacks the integrity of our bones. The "silent disease" of osteoporosis is preventable.

Amenorrhea may be the first symptom an athlete is training too much and not giving herself the fuel needed to balance her energy output. This too is linked to weak bones and osteoporosis. Overtraining is defined as a state in which the body has done too much work and has not balanced that activity or workload with adequate sleep, rest or nutrition to recover. Other signs of overtraining are a decrease in performance, fatigue, mood disturbances and frequent infections.

This book engages the female athlete in a practical and compassionate way. It provides effective strategies and guidelines for overcoming the triad. Throughout, success stories are given of women who have conquered the triad, inspiring the reader to believe she can do it and be a successful athlete, too.

The authors discuss how to help a friend. Consistent, caring communication, assuring the friend of privacy and confidentiality, using "I" statements, speaking honestly of your concerns, and listening in a nonjudgemental manner are recommended. Yet one can expect denial, shame, embarrassment, and fear.

This valuable and timely book cries out to be read by all female athletes and their coaches, trainers, and parents. It is highly recommended.