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The impact of nutrition on women's health, training and performance

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Article written by  Rob Hobson

Date published  06 September 2022

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Are there any nutritional considerations specific to women?

The basic principles of healthy eating apply to all athletes. Regarding performance, once the energy needs of an athlete have been established, their diet can be tailored to suit their needs. This includes establishing where these calories come from in terms of carbohydrates, protein and fats, and micronutrients (vitamins and minerals).

Historically gender-specific nutrition guidelines have been lacking. However, a recent review published in the Journal of the International Society of Sports Nutrition offered some guidance to female athletes regarding food and supplements.1

Don’t skimp on healthy fats

Fat is an important part of the diet and essential for maintaining sex hormone concentrations and absorbing fat-soluble vitamins. It has also been shown that amongst females adequate amounts of fat in diet can help to sustain a normal menstrual cycle.2 Considering this, women should get at least 15% of their total calorie intake from healthy fats such as nuts, seeds, olive oil, eggs and avocado.

During the luteal phase of the menstrual cycle, elevated oestrogen levels lead to an increased reliance on fat oxidation (burning fat for energy). Female endurance athletes have also been shown to rely more on fat oxidation than males during endurance exercise.3 This suggests that to meet the increased demand for fat these athletes should increase their intake to around 20% of their total daily energy. Emphasis should also be placed on fat intake during the luteal phase of an athletes menstrual cycle to support the increased reliance on fat metabolism.

Omega 3 is important for health as it has been shown to reduce inflammation in the body and individuals who consume more omega 3 seem to be less likely to be depressed.4 These essential fats are also important when trying to counteract the issue of RED-S which can incur detrimental side effects such as amenorrhea and lower done mineral density. Supplementation of 1-3g daily may be beneficial to help tackle the increase inflammatory response seen in women after exercise as well as reducing symptoms of depression and anxiety.

Maintain good iron intakes

Iron is a crucial consideration for female athletes. Women, in general, have been shown to have low intakes of iron, putting them at greater risk of anaemia. Some female athletes are also at greater risk of iron deficiency.

These include:

  • Athletes following restrictive diets such as veganism
  • Athletes involved in sports with high amounts of repetitive ground strikes, such as long-distance runners
  • Endurance athletes – training can cause antioxidant depletion and red blood cell damage
  • Athletes with heavy menstrual bleeding
Woman using battle ropes at the gym

Women need to take different nutrients into consideration when training, as their needs are different to men, which otherwise may impact performance

The UK RDA for iron in women is 14.8mg. However, given iron deficiencies are widespread amongst female athletes; it has been suggested they consume 18mg per day.5 Vegan athletes should partner their iron-rich foods (beans, lentils, pulses, dark green leafy vegetables, nuts, and seeds) with foods rich in vitamin C to help with absorption.

Maintain good intakes of calcium and vitamin D

Calcium and vitamin D are also important, especially for women during menopause or those known to have low bone density. Athletes should include 3-4 servings of calcium-rich foods in their diet daily to achieve an intake of 1000mg daily. Supplementing with vitamin D is also essential, especially during the winter months.

Vegans should be aware of B12

Veganism is more popular amongst women and maintaining a good intake of B12 is essential particularly as this vitamin is found in very few foods. Low levels of vitamin B12 can increase the risk of anaemia which can hamper performance. Vegan female athletes should consider a supplement to maintain good levels of this nutrient. Fortified foods can also help maintain a good B12 status.

Consider the effect of the menstrual cycle on protein intake

Protein is vital for all athletes, and it should be consumed after training and regularly across the day. Current advice on protein intake for athletes recommends 1.2-2g per kg body weight.5 Research suggests that during the follicular phase of the menstrual cycle, female athletes increase their intake of protein to at least 1.6g per kg body weight6 It has also been suggested that protein intakes may be higher during the luteal phase as increased progesterone leads to higher rates of protein breakdown.7

Women are not only physiologically different from men but have specific health needs unique to their gender.

More research is needed to fully understand the impact female health has on performance. Still, given what is known, coaches should make considerations to provide a truly individualised approach.

1Wohlgemuth, K. J., Arieta, L. R., Brewer, G. J., Hoselton, A. L., Gould, L. M., & Smith-Ryan, A. E. (2021). Sex differences and considerations for female specific nutritional strategies: a narrative review, Journal of the International Society of Sports Nutrition 18(1), 27.
2Volek JS, Forsythe CE, Kraemer WJ (2006). Nutritional aspects of women strength athletes, Br J Sports Med, 40(9):742–8
3Tarnopolsky MA, Atkinson SA, Phillips SM, MacDougall JD (1995). Carbohydrate loading and metabolism during exercise in men and women, J Appl Physiol, 78(4):1360–8.
4Hibbeln JR, Gow RV (2014). The potential for military diets to reduce depression, suicide, and impulsive aggression: a review of current evidence for Omega- 3 and Omega-6 fatty Acids, Mil Med 179(11S):117–28.
5Kerksick, C. M., Wilborn, C. D., Roberts, M. D., Smith-Ryan, A., Kleiner, S. M., Jäger, R., Collins, R., Cooke, M., Davis, J. N., Galvan, E., Greenwood, M., Lowery, L. M., Wildman, R., Antonio, J., & Kreider, R. B. (2018). ISSN exercise & sports nutrition review update: research & recommendations, Journal of the International Society of Sports Nutrition 15(1), 38
6Holtzman, B., & Ackerman, K. E. (2021). Recommendations and Nutritional Considerations for Female Athletes: Health and Performance, Sports medicine (Auckland, N.Z.) 51(Suppl 1), 43–57
7Kriengsinyos, W., Wykes, L. J., Goonewardene, L. A., Ball, R. O., & Pencharz, P. B. (2004). Phase of menstrual cycle affects lysine requirement in healthy women, American journal of physiology, endocrinology and metabolism 287(3), E489–E496

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About Rob Hobson

Rob Hobson MSc RNutr is a Registered Nutritionist who has worked with some of the UK’s largest food and health companies and performs training in the public health sector (including government agencies and the NHS). Rob contributes regularly to press publications and has a monthly column in Women’s Health magazine.

robhobson.co.uk