Dear Dr. Jeff: My boyfriend is a very dedicated athlete on one of Bowdoin's most competitive teams. He and some of his teammates seem to think they need to lose weight and skip meals or eat tiny portions. They're still working out many hours a day. Can this be healthy?-B.B.
Dear B.B.: I think you may be raising two questions-first, about healthy diets, weight loss and exercise, and second, about athletes, distorted body image, and disordered eating.
Skipping meals, especially for someone who works out even an hour a day, is very simply a bad idea. If you don't eat but then exercise, your blood sugar will be low and you'll likely feel light-headed or sluggish. Your performance will be compromised. And, perhaps most importantly, you'll start burning up muscle protein for fuel.
Carbohydrates are your muscles' main source of fuel. They are stored in relatively small amounts in the muscle cells themselves, in the form of glycogen. Glycogen from other organs (e.g. your liver) cannot be "borrowed" by your muscles, and if you are physically active, muscle glycogen stores need to be replenished, topped off if you will, throughout the day. Sixty to 90 minutes of aerobic exercise will use up all of your muscles' glycogen stores, and if you continue to exercise longer, your muscles will start to break down and literally consume themselves, using their own protein for energy. That's called "hitting the wall," and it can only be avoided by taking in adequate carbohydrates before exercise. Then, if your workout is prolonged, you'll need to take in more carbohydrates as you exercise.
Experts now also stress the importance of post-exercise eating; comsuming carbohydrates to replenish glycogen stores, and smaller amounts of protein to help repair microscopic muscle damage. The carbohydrates should ideally be complex (from whole grains, vegetables or fruits), and not simple sugars or sweets.
Now to your second question, B.B. Some sports seem to demand low percentages of body fat. Some have specific weight requirements. Most, however, require neither dramatic nor recurrent weight loss. I wonder about the source of your friend's "need" to lose weight.
Certainly men in our culture, much like women (though much less so), are under considerable pressure to try to attain the reigning idealized and distorted body type. Athletes may be under added pressure. And athletes who also tend to be overachieving and perfectionist may be particularly at risk for the compulsive exercising and fanaticism about weight and body image that leads to "anorexia athletica."
No one really knows how common this disorder is. Most experts estimate that at least 10 percent of young male athletes develop anorexia athletica. The disorder is most commonly found in wrestlers, gymnasts, swimmers, or cross-country runners. Whatever the actual prevalence of the disorder, it can certainly be deadly. In 1997, for instance, three college wrestlers died of their excessive weight-loss efforts.
Researchers have compared the psychological characteristics and clinical outcomes of anorexic athletes and non-athletes, and concluded there are no significant differences on either count. They found that there is little clinical justification for the separate labels anorexia athletica versus anorexia nervosa, and that the anorexic athletes were no less ill than the non-athletes. Their symptoms were not simply due to overtraining, or to the intensive training sometimes required of highly competitive athletes, but to their illness-their anorexia.
A good deal of attention has been focused in recent months, on the problems of negative body image and eating disorders in our culture and here at Bowdoin. So many who struggle with these problems are women, but a very significant number are men.
We live in a culture that idealizes distorted body images and equally distorted lifestyle expectations. Clearly all of us, women and men, athletes and non-athletes, need to examine our roles in perpetuating this culture. We must be willing to reach out to each other, to try to understand each other, and to join together to change it.
Be well!
Jeff Benson, M.D.
Dudley Coe Health Center