Mary Cain Put an Incredible Spotlight on Female Athlete Health

November 21, 2019

Some of you may have heard the story of 17-year-old running phenomenon Mary Cain this past week. She broke records, made the world championships, and was an inspiration to women everywhere... until she trained with the Nike Oregon Project, which was considered one of the premier training groups in the world. You can read her story in The New York Times here.

After learning about her story, I was inspired to do a female athlete health series. I think Mary Cain put a spotlight on WHY the culture needs to change, so I want to talk about HOW to change the culture. I believe we can do this by giving women the knowledge of how to stay healthy as an athlete. This knowledge can empower and inspire women, and hopefully keep them from falling into a system that feels wrong.

“I got caught in a system designed by and for men which destroys the bodies of young girls.”

I see this all the time in my practice. The same advice that’s given to men is applied to women. There’s not enough women-specific knowledge out there. When you think about it, women participating in sports is relatively new. It was only 52 years ago that Kathrine Switzer changed the conversation and raced the Boston Marathon despite the fact that women were not allowed. The reason they were not allowed? At the time they believed women were physically incapable of running a marathon. Boy, have women proved that notion wrong! No pun intended.

Kathrine Switzer

Along with that, understanding how women’s bodies respond to physical stress is new too. For a long period of time, men were making the calls on female health. It’s time for a change. 


KNOWLEDGE IS POWER. One way to change the culture is to understand your body and take your health into your own hands. That way women are calling the shots, leading by example, and lighting the way for other women who feel lost.

Mary Cain went into a program that failed her. Some people pointed out that there were many successful women in that same program. What was the difference between those who failed and those who succeeded? The answers lie in their hormones. 

Women can have incredibly different hormone patterns. It’s a complete misconception that females experience the same pattern of sex and stress hormones throughout their monthly cycle. When you assume that all women athletes’ hormones are fluctuating as they should, you miss many underlying health issues. Diet, genetics, stress, environment, nutrition, detoxification, digestion, and infection all have an affect on our hormones. When things go awry, the perfect storm can cause female athletes to crash.

What was Mary Cain’s perfect storm? From what I gathered from the article, there were a few red flags that jumped out to me. 

Red Flag #1:

“When I first arrived, an all-male Nike staff became convinced that in order for me to get better, I had to become thinner, and thinner, and thinner”


Mary Cain struggled with RED-S, which is an acronym for Relative Energy Deficiency in Sports. This decreased energy can be perpetuated by many things, but in the world of female athletics, trying to be thin is one of the main culprits, and is what I will talk about today.

To put it simply, we eat food so our body can use it for energy. When we exercise, we use the stored energy from food to fuel our bodies. The problem arises when we use more energy than we replenish. Essentially we get into an energy debt. Just like with financial debt, when you spend more money than you make, there are consequences. 

This debt is dangerous. It accumulates interest in the form of blood sugar dysregulation, hormone dysregulation, and anovulation. Anovulation is when you stop ovulating. Ovulating is one of the most important things you can do as a female athlete because it allows you to make the hormones you need to perform and recover properly. Without healthy levels of testosterone, progesterone, and estrogen your body will break down and lead to poor health and performance.

To break this down:

  • Low testosterone leads to muscle wasting, impaired performance, impaired recovery, fatigue, and a higher risk of anemia
  • Low progesterone leads to increased muscle pain, water retention, anxiety, and depression
  • Low estrogen leads to weak bones, heart palpitations, and arrhythmias
  • Blood sugar dysregulation impairs proper fuel utilization during competitions and can be an underlying cause of mood disorders and depression

No fuel, weak muscles, pain with every muscle movement, competition anxiety, depression, and bone can see why these women crash and burn, and fall out of their sport.

So what do you do?

Healthy Not Candy

For one thing, getting the right amount of calories, and the right type of calories important. Working with a sports nutritionist can help you figure out the amount of carbohydrates, fat, and protein you need to be eating. The quality of food you are eating is also incredibly important. You need to be fueling your body with healthy unrefined grains, vegetables, grass- fed or pastured-raised animals, fruits, and fiber-rich foods instead of Pixie Stix’s and Coco Puffs. I personally like to use this calculator to figure out the macronutrients for athletes, but it’s best to work with a professional to help dial you in your macros according to your sport. Different sports have different needs.

Red Flag #2:

“He would usually weigh me in front of my teammates and publicly shame me if I wasn’t hitting weight”

As women, body image will weave its way into our lives in a way many men will not be able to understand. A negative body image can lower our self esteem and self value, lead to depression, and affect our lives in many negative ways. There is an emotional component for sure. It’s important to seek support to try to understand why it’s important to be thin because as we just laid out, it’s not going to help your performance if it stops ovulation and your period. There are many different types of therapists out there, so search around and find one that resonates with you. If you sense you are over concerned with your weight, make sure to let someone who cares know about it. 

Red Flag #3:
“He wanted to give me birth control pills and diuretics to lose weight”
female athletes and weight

This is outright incorrect and outdated information. Unfortunately, birth control is used as a panacea for all women's health issues, when it in fact disrupts one of the most important things for female health—ovulation. While men have their testes to produce testosterone, we have our ovaries. This is a major fundamental difference between men and women. When we shut down ovulation with birth control, we shut down our testosterone and progesterone production. Can you imagine a coach using a medication to shut down testosterone production in men so they could lean out? It doesn't make biological sense as you need testosterone for healthy lean muscle mass, and yet that is what many women are recommended to do. 

Playing with diuretics is also a dangerous game as it doesn't help you lose actual weight, but it helps you shed water weight and electrolytes. Chronic use of diuretics can lead to chronic dehydration, and hydration is fundamental for proper nerve conduction. Dehydrated cells and low levels of electrolytes negatively affect every muscle contraction, movement coordination, heartbeat, and thought you experience. Water and electrolytes allow fluids and nutrients to move in and out of the cell. Most importantly, water and electrolytes generate energy and electricity, and without them, we would power off.

Red Flag #4:

“Suddenly, you realized you’ve lost your period for a couple months. And then a couple months becomes a couple years. And in my case it was a total of three.”

Three years without ovulation means three years of severely diminished testosterone and progesterone production along with estrogen, which can weaken your bones. It’s no wonder Mary Cain broke five different bones.

Red Flag #5:

“I felt so scared. I felt so alone. And I felt so trapped. And I started to have suicidal thoughts. I started to cut myself.”

This is a big topic. Low progesterone due to either lack of ovulation and/or depletion from too many stress hormones can lead to depression, suicidal thoughts, and self-harming behaviors. We are missing this in womens’ health, it’s not checked on routine blood tests. If you stopped getting your period, are on birth control, or are overridden with stress, read this article and get your progesterone levels checked. Making sure our progesterone levels are in range can be a simple and powerful tool to prevent depression and anxiety caused by low hormone levels.

“We need more women in power. Part of me wonders if I had worked with more female psychologists, nutritionists, and even coaches where I’d be today”

I’ll leave it on that note. Just as we broke into sports 50 years ago, now is the time to break into women’s health in sports. We need to work together to build a better system where everyone can thrive.


Watch Mary Cain's video here:

To learn more:

Clean Sport Collective:

Good Morning America:


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