Annual Meeting Abstracts: D-21 – Clinical Case Slide: Endurance Medical Issues
HISTORY: Patient is a 51 year old female who presented complaining of a 15 pound weight gain over the past year despite beginning a strenuous triathlon and marathon training program. Patient was training up to 2 hours per day 5–6 days per week. Careful 3-day diet analysis estimated daily caloric intake at 1000–1200 calories per day. Patient denies any new medications although she had been taking prescription medication for depression for several years. Patient complained of irregular menses but denied amenorrhea. She denied any change in her eating habits during the period of the weight gain. Patient also denied fatigue, constipation, dry skin, hair loss, cold intolerance or change in her voice. Patient reports no family history of thyroid disease or diabetes. She also denied any polyuria, polydypsia or hyperphagia.
PHYSICAL EXAMINATION: Examination revealed a well-developed, wellnourished slightly overweight female. Body fat was measured at 37 % via bioelectrical impedance. There was no evidence of thyromegaly, delayed reflexes, or dry skin. Excess adiposity was present in a general rather than visceral distribution.
- Type 2 Diabetes
TEST AND RESULTS:
- indirect calorimetry—resting metabolic rate of 950 calories (28% below predicted for age, height, weight and gender)
- fasting glucose of 93 mg/dl (normal 65–109 mg/dl)
- TSH – 3.14 MIU/L (normal 0.4–5.5 MIU/L)
- body composition 37 % body fat via professional model bioelectrical impedance scale
FINAL/WORKING DIAGNOSIS: Over-training/Under-eating
TREATMENT AND OUTCOMES:
- Increase daily caloric intake by approximately 100 calories per week to a goal of 1500 calories per day with a protein/carbohydrate/fat composition of 32%/35%/33% respectively.
- Consume 5–6 small meals per day with small amounts of protein with each meal or snack. Choose high fiber starches and select predominantly mono- and poly- unsaturated fats. Restrict consumption of starch with evening meals unless focused around training.
- Add whole body isometric resistance training to exercise regimen at a minimum frequency of 2 days per week.
- Take daily multi-vitamin and mineral supplement
- Upon repeat testing at 6 weeks, patient's resting metabolism increased 35% to 1282 calories per day (which was now only 2% below predicted RMR for age, height weight and gender) and patient lost 5 pounds of body fat thereby decreasing total body fat by 3% to 34 %.