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Table 8-14 Iron Content of Foods


Milligrams of Iron

Liver (3oz)


Turkey, pork, beef (3oz)


Shrimp (3oz)


Chicken breast (3oz)


Fish (3oz)


Egg (1)


Dried fruit (4oz)


Kidney beans (1/ cup)


Cream of Wheat (1/> cup)


Fortified cereal (1/> to 3/4 cup)



"Growing Out" of One's Sport

Research studies have shown that girls play sports primarily to have fun, to exercise to get in shape, and to socialize with their peers. Boys reported that they play sports to have fun but also to gain improvement in sport skills and for the excitement of competition. When high school students were asked how they wished to be remembered, boys most frequently reported "for being an athlete"; girls answered "for being a leader in activities."66 During puberty, boys generally get taller and stronger; however, girls may increase in size and weight, but frequently do not gain proportionally in strength. Moreover, for some sports such as ballet, dance, and ice skating, the change from adolescence to the more curvaceous figure of womanhood, especially if the change is not accompanied by a proportional increase in muscle mass and strength, may result in a loss of sports fitness and abilities. The female athlete may become frustrated as she tries to cope with her new body and she may not wish to continue in the sport in which she excelled as a youth.

Frequently, these young women have a difficult time with confronting the reality that their bodies no longer fit their sport. As noted previously in the female athlete triad discussion, eating disorders are common in this age group. Some girls, feeling no longer comfortable in their sport, will present to their physician complaining of various aches and pains that limit sport participation. Often one must see the deeper problem beneath these superficial complaints and help the young athlete and her family face the reality of this young girl not wishing or not being able to continue in her sport.

Sport Burnout

Since female athletes have less of their identity tied to sport, young female athletes, even those very good at their sport, may decide to stop sport participation to have more time to spend with friends, on academics, or in other extracurricular activities. This sport burnout or change of activity focus can be difficult for coaches and parents to accept. The young athlete may find it more "socially acceptable" to have an "injury" that sidelines her. Once again, recognizing that the injury is merely a superficial expression of the deeper issue and helping the young athlete to recognize this as well are an important responsibility of the sports physician.

Overtraining Syndrome

Overtraining syndrome has been documented in elite athletes, especially endurance athletes such as runners or swimmers, or power athletes. This condition can have an impact on both the athlete's health and mental state. The athlete with this syndrome is training at such a high level of intensity that she is unable to adequately recover between sessions. The syndrome is a continuum from training fatigue to overload to full overtraining syndrome. The female athlete experiences worsening fatigue and inability to recover from the physical strain of workouts. Mental symptoms include fatigue, depression, anxiety, irritability, and difficulty concentrating.67 Physical symptoms include increased resting blood pressure, increased heart rate, weight loss, muscle soreness, and frequent illnesses and injuries. Numerous theories have been proposed as to the cause of overtraining syndrome including hypothalamic dysfunction, amino acid imbalance, changes in the hypothalamic-pituitary axis, auto-nomic nervous system dysfunction, immune dysfunction, and others.68-69

The syndrome is difficult to diagnose because it has no diagnostic test. A careful patient history is needed. The diagnosis is one of exclusion and is made following exclusion of biochemical abnormalities with simple laboratory tests such as electrolytes, blood count, thyroid, iron studies, cortisol, and testosterone. Treatment in principle is simple, but sometimes difficult to accomplish. Although rest is the most important treatment, many female athletes do not want to follow this treatment suggestion. In some cases, it is only after the athlete's performance has significantly declined that she will rest. Therapeutic rest, which may be more acceptable to the athlete, is not total rest, but training at a much reduced level with more complete recovery periods. Treatment also includes ensuring that there is adequate nutrition, addressing depression, and improving sleep quality. Overtraining syndrome remains a well-recognized but difficult to understand problem (Table 8-15).

Table 8-15 Stages of Overtraining Syndrome


Overload Training volume/intensity Beyond normal levels


Develops after intense training and overload

Overtraining syndrome

"Staleness," not able to recover


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