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Review
. 2021 Sep;51(Suppl 1):43-57.
doi: 10.1007/s40279-021-01508-8. Epub 2021 Sep 13.

Recommendations and Nutritional Considerations for Female Athletes: Health and Performance

Bryan Holtzman  1   2 , Kathryn E Ackerman  3   4   5
Affiliations
Review

Recommendations and Nutritional Considerations for Female Athletes: Health and Performance

Bryan Holtzman et al. Sports Med. 2021 Sep.

Abstract

Optimal nutrition is an important aspect of an athlete's preparation to achieve optimal health and performance. While general concepts about micro- and macronutrients and timing of food and fluids are addressed in sports science, rarely are the specific effects of women's physiology on energy and fluid needs highly considered in research or clinical practice. Women differ from men not only in size, but in body composition and hormonal milieu, and also differ from one another. Their monthly hormonal cycles, with fluctuations in estrogen and progesterone, have varying effects on metabolism and fluid retention. Such cycles can change from month to month, can be suppressed with exogenous hormones, and may even be manipulated to capitalize on ideal timing for performance. But before such physiology can be manipulated, its relationship with nutrition and performance must be understood. This review will address general concepts regarding substrate metabolism in women versus men, common menstrual patterns of female athletes, nutrient and hydration needs during different phases of the menstrual cycle, and health and performance issues related to menstrual cycle disruption. We will discuss up-to-date recommendations for fueling female athletes, describe areas that require further exploration, and address methodological considerations to inform future work in this important area.

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Conflict of interest statement

Bryan Holtzman and Kathryn E. Ackerman have no conflicts of interest relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Hypothetical examples of the hormonal profiles of three eumenorrheic women with different cycle lengths. a 28-day cycle; b 22-day cycle; c 35-day cycle. Solid arrow indicates estradiol peak; dashed arrow indicates luteinizing hormone peak; shaded area indicates ovulation. Reproduced from Vescovi with permission [3]
Fig. 2
Fig. 2
a Health consequences of relative energy deficiency in sport (RED-S); b performance effects of RED-S. Adapted from Constantini (with permission) [25]
Fig. 3
Fig. 3
Potential hierarchy of nutritional considerations and needs for female athletes. When designing nutrition plans, athletes should ensure that all lower components are achieved when stepping up the pyramid
See this image and copyright information in PMC

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