Until strong science directs Irob, it makes intuitive sense to include muscle strength, muscle Mental well-being practices, and training fatigue as part of a holistic assessment when determining training loads and trying to prevent BSIs. Sfress significantly edited reficiency subsequent drafts. Amenorrhea occurs bine frequently in female athletes than women in general because strenuous activity causes metabolic alterations in the endocrine system, leading to severe hormonal disturbances. Open-Access Policy of This Article. In addition to sleep, post-exercise nutrition is important in recovery and may be important for bone health as well. Stress fractures are tiny cracks in the bone that develop from repetitive mechanical trauma, such as running or dancing. Middle and long distance female runners who suffered from multiple stress fractures had the female athlete triad.

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High vs. Low Risk Bone Stress Injuries In Runners

Iron deficiency and bone stress injuries in athletes -

If women were low in iron, measured as ferritin, they were likely to develop fractures. Other factors? Prediction Model for Stress Fracture in Young Female Recruits during Basic Training.

Suppl 1, Furthermore, the lead researcher in found that men, despite having lower fracture risk than women, have significantly more stress fractures with low dietary vitamin D and calcium intake. Journal of the International Society of Sports Nutrition, Why women to such a greater degree than men?

Hormones and blood loss are likely players. Hormonally, women do not have a high androgenic and therefore anabolic message—lower testosterone and DHEA compared to men—and the body does not lay down as much protein in response to physical stress. This reduces the speed and extent of bone and muscle recovery post exertion.

Blood loss through menses raises the need for the nutrients that are lost, such as iron, B12 and folic acid—But iron, by far, is the most important. Iron rich foods have also, in the past 2 generations, fallen out of favor. But liver is a hard sell to a young woman, so how do we figure out who needs the paté.

Simple, run a blood test—A test for vitamin D and ferritin at least! There are blood test panels that include a complete blood count CBC , comprehensive metabolic panel, vitamin D and Ferritin. Many direct labs offer The Blood Code Discovery Panel which includes all the above and then some.

Additionally, competitive athletes can add the hormones total testosterone and DHEA sulphate. These anabolic, androgenic hormones change over time, but indicate the current hormonal capacity for muscle and bone recovery from strenuous exertion. A really thorough panel that you can get done in your area and includes all the hormonal and nutritional and metabolic results is found here.

In my metabolic clinic , I am too often faced with a young adult female athlete wearing an orthopedic boot and, after the fact, hoping to swiftly recover from stress fractures. No significant statistical differences were evident among the rest of the anthropometric measurements height, body fat percentage, BMI between the two study groups.

Notably, carbohydrates, calcium, and vitamin D intakes for the SF group were No significant changes occurred in any of the measured variables among the SF group. During BT, the recruits' nutritional intake both groups did not meet the NSOR recommendations for total energy and most nutrients, including carbohydrates, total fat, folate, vitamin D, calcium, zinc, and magnesium.

Vitamin B 12 , B 6 and protein values, however, were greater than the NSOR recommendations, both pre and post BT as depicted in Table 1. Throughout the study, all subjects from the 2 groups demonstrated mean hematological values in accordance with normal levels for young, healthy males.

After 6 months, Hgb, serum calcium, ferritin and transferrin saturation remained lower, whereas folic acid and iron levels increased. On induction and after 4-months BT no differences were observed in all of the measured variables Hgb, folic acid, calcium, iron, transferrin, ferritin, 25 OH D and PTH between the SF and the NSF groups.

The aim of this study was to evaluate a possible relationship between nutritional intake before induction and during BT and long bone stress fracture occurrence among male combat recruits. We monitored 74 recruits through a 6-month period 4 months BT and 2 months advanced training of intense physical and mental training.

This period is also characterized by a major change in nutritional habits, partially resulting from eating in mess and rations provided in the field. Stress fracture susceptibility is multi-factorial. A main factor in the mechanism of long bone stress fractures is imbalance in osteoclasis and osteogenesis that are over-activated to enable the bone remodeling necessary for the bone strengthening [ 28 — 31 ].

In this group of recruits, we found considerable dietary deficiency. This low intake may be explained by the presence of fundamental stressors in the military environment, such as periodic food restrictions, sleep deprivation, mental burden, and constant physical evaluations.

These findings are in accordance with previous studies pointing to the fact that military personnel normally consume insufficient energy, whether or not they are provided with an adequate amount of food [ 33 ]. In this study, the deficient energy intake was not associated with a weight loss but rather an increase of body weight during BT by 1.

This is also in line with previous studies, specifically that in this training program the gained weight was in lean body mass and not in fat [ 34 ]. We are concerned that our participants did not meet MDRI requirements. These deficiencies were observed for nearly every nutrient evaluated in the FFQ.

Of note, among the NSF group, vitamin D intake was the second most deficient variable, reported to be consumed at a level of In our study, the SF recruits reported Although vitamin D3 cholecalciferol is either formed in the skin after exposure to sunlight or obtained from nutritional sources, especially fatty fish [ 32 ], most IDF soldiers use sunscreen and wear long-sleeved clothing during military training.

This may limit vitamin D3 synthesis, and therefore, the importance of balanced nutritional intake, especially of vitamin D and calcium, should be emphasized, even though we did not actually find low serum levels of vitamin D.

Release of PTH is controlled by the level of calcium in the blood, with low blood calcium levels causing an increase in PTH. The main purpose of this hormone is calcium homeostasis. It is therefore not surprising that in these healthy young recruits, we did not find any pathological PTH or calcium values.

A slight trend towards higher levels of PTH in the 4-month BT may represent a lack of dietary calcium. However PTH differences between SF and NSF or between induction values and 4 or 6 month values were not significant.

Furthermore, we found that the SF group compared to NSF had insufficient intake of zinc and magnesium In addition to calcium, minerals and trace elements such as zinc and magnesium are involved in skeletal growth and are required for normal bone metabolism.

An adequate intake of these dietary components is therefore necessary to assure optimal bone quality and prevention of bone loss [ 35 ]. Notably, similar findings were observed in previous studies involving elite Israeli male athletes [ 36 , 37 ], and in female combatants [ 38 ].

Moreover, it is important to note that iron and ferritin levels are a part of an innovative prediction model for stress fractures in young female recruits during basic training, which managed to correctly predict stress fracture occurrence in The study has several limitations.

Assessing food consumption based on a person's memory is always problematic. This is more so with recruits in a very intense physical and mental training schedule.

We also did not monitor personal initiatives in taking nutritional supplements. Previous surveys have demonstrated this to be negligible, with recruits showing minimal interest in calcium and vitamin D.

Another problem is the lack of finding of low vitamin D levels, despite the dietary deficiency. We also did not measure serum zinc levels, however, following these results it would seem beneficial to measure these levels for future research on recruits.

The main conclusion from this study is that, contrary to previous beliefs, male infantry recruits in the IDF are nutritionally deficient, specifically in calcium and vitamin D, and those who were more deficient developed more stress fractures. This directly arouses the debate on supplying supplements, following Lappe et al.

in the US Navy female recruits [ 9 ]. Another issue is related to the fact that there was dietary deficiency before induction, making intervention by the military at the most appropriated time more complicated. Based on our findings it might be plausible to perform nutritional screening e.

We could then treat those with low levels. It should therefore be emphasized that while engaging in strenuous physical training, proper nutrient intake may act as a long-term protector against bone resorption and stress fracture development, and is recommended for maintaining healthy bones [ 40 ].

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Heaney RP: Dairy and bone health. J Am Coll Nutr. Download references. This study was supported in part by a contract from the MRMC No. The opinions or assertions contained herein are the private views of the authors and should not be construed as official or reflect the views of the US Department of Defence or the Israel Defence Forces.

Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, ISRAEL. Division of Medicine, Department of Gastroenterology, Hebrew University-Hadassah Medical Center, Jerusalem, ISRAEL. The Orthopaedic Department, Assaf Harofeh Medical Center, Zerifin and The Sackler School of Medicine, Tel Aviv University, Zerifin, Tel Aviv, ISRAEL.

Military Performance Division, U. Army Research Institute of Environmental Medicine, Natick, MA, USA. You can also search for this author in PubMed Google Scholar. Correspondence to Daniel S Moran. DSM and RY conceived the study idea and analysed the data. DSM, YA, RKE, and RY designed the study.

YA and RY carried out data collection. ASF conducted the orthopaedic examinations. DSM and RY drafted the manuscript. All authors contributed to the interpretation of results, critically reviewed the manuscript for intellectual content, and gave approval of the final version of the manuscript to be published.

This article is published under license to BioMed Central Ltd. Reprints and permissions. Moran, D. et al. Dietary intake and stress fractures among elite male combat recruits.

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Znd deficiency is a common problem amongst athletes, particularly female athletes, Iron deficiency and bone stress injuries in athletes athletes, and Dietary choices for prevention on deticiency plant-based diet. Iron plays several essential roles in the body, including transportation and delivery of injurries to working muscles, and energy production. Nad have routinely found that athletes, in particular females, are at greater risk of iron deficiency than the general population. Low levels can cause fatigue, shortness of breath, impair recovery and negatively impact an athlete performance. Iron is a mineral that cannot be produced by the body and must be obtained from external sources, including diet and supplements. It is a component of haemoglobin, which carries oxygen around the body, and plays an essential role in energy production, cognitive function, and maintaining a healthy immune system. Deficciency : Athltes analyze stress fractures in injurie based on experience from our sports medicine clinic. METHODS : We investigated athletez association between stress fractures and snd, sex, sports level, sports Iron deficiency and bone stress injuries in athletes, Developing a healthy body image skeletal injuriew Iron deficiency and bone stress injuries in athletes athletes seen at our sports medicine clinic between September and April Stress fractures of the pars interarticularis were excluded from this analysis. RESULTS : During this period 18 years and 8 mopatients males and females consulted our clinic because of sports-related injuries, and patients 1. The average age of the patients with stress fractures was Altogether, 90 patients The highest proportion of stress fractures was seen in basketball athletes