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Since the early 1970s the number of female athletes has grown by a whopping 560 percent among high school students and nearly one thousand percent among college students. This is fantastic news, of course: Athletics can lead to lifelong benefits in terms of girls’ (and women’s) health and self-esteem.

But in-step with this rise in participation, a syndrome called the female athlete triad has also become a growing problem. Characterized by an irregular menstrual cycle, low energy, and low bone density, the female athlete triad syndrome is most often caused by under-eating in relation to exercise.

As Health‘s contributing nutrition editor, I’ve written plenty on cravings, portion sizes, and ways to curb overeating. But in my work as a sports nutritionist, it’s not at all uncommon for me to tell one of my clients, “You aren’t eating enough.”  I work with active women of all ages, from high school athletes to marathon-running women over 40 and everything in between, and I see undereating across the age spectrum.

While the triad (which can cause brittle bones, not to mention affect your performance) is most serious in female athletes who restrict their food because they have a true eating disorder, there are also plenty of active women who are unknowingly shorting themselves on their body’s energy needs.

Often there are telltale signs, but you may ignore them because you think you’re eating right. I’ve also seen women afraid to make eating changes due to fear of weight gain. 

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