FOR a runner, Alex DeVinny wasn't all that skinny on the day that she won a state track title in 2003. At 17, she was 5-foot-8 and weighed 125 pounds.
LOOKING FOR CLUES Alex DeVinny, above, was a state track champion in Racine, Wis.
Few people watching her run the 3,200 meters in 10 minutes 53 seconds would have guessed that she had had symptoms of an eating disorder since age 9 and that she had yet to start menstruating. Her coach didn't know. The college recruiters certainly did not know.
She was never going to run for those colleges. The summer after she won the title, Ms. DeVinny, from Racine, Wis., began to run even harder and eat even less. When she came out for cross-country in the fall, she looked frail and underweight. Her coach was concerned enough to prevent her from competing in several meets, but he allowed her to do two-thirds of her training. He never asked about her menstrual periods and did not know about her anorexia.
Ms. DeVinny sneaked in extra workouts, but her dazzling window of athleticism had already begun to close. "Her body kind of broke down during her senior year," said her sister Gabby Fekete, 27. "She had lived on adrenaline."
Last March, Ms. DeVinny died from cardiac arrest related to her starvation. She was 20 and weighed roughly 70 pounds.
Looking back, her coach, Dan Jarrett, questions himself. "I did not understand how someone with anorexia would be capable of making decisions that weren't in their best interest," he said. "I totally failed to grasp what it meant." He is so troubled by her death that he has since quit
"Nothing makes me madder than when I go to an N.C.A.A. meet and I see girls who look like a skeleton and are in a school uniform," said Karen Harvey, a cross-country coach at the University of Illinois.
The problem may be a reluctance by many coaches — even women — to ask about menstrual cycles.
Coaches also need to know that losing the menstrual cycle is not normal. "What we know from research is that women can exercise as much as they want, they can run 100 miles a week and if they fuel themselves properly, they will have normal periods," Dr. Hoch said.
The loss of menstruation is often a symptom of under-eating, which sometimes is a result of an eating disorder.
"Running is a magnet for eating-disorder patients and people who run to lose weight," said John Mead, a director of the eating disorder program at Rush University Medical Center in Chicago.
For runners without eating disorders, under-eating may simply be a failure to increase calories with higher training loads. In this case, the triad is an informational problem that requires "convincing these kids they're not going to be able to increase their weight with fruit and low fat yogurt," said Dr. Margot Putukian, the director of athletic medicine at Princeton University. They need to eat more substantial food.
In high school, Emily Brown, 22, lost her period for six months. But lately Ms. Brown, who has increased her mileage as a member of the cross-country team at the University of Minnesota , menstruates normally. How? She eats more.
Having a vigilant coach like Gary Wilson has also helped. A team doctor asks athletes about their periods. Later Mr. Wilson also asked. "To make kids feel comfortable I'm not the first to talk about it," he said. Amenorrhoeic athletes are referred for tests, which can include measuring bone density.
Other programs also are proactive. "I tell my athletes you need to tell me when you lose your cycle," said Ms. Harvey, the coach at Illinois. If a runner reports they haven't had their period in months, than they are referred for nutrition counseling and screenings, which may include blood work and bone scans. Ms. Harvey also looks for signs of an eating disorder, including brittle hair, emaciation, "always talking about food."
But even with screenings, some competitive runners still end up suffering the consequences of under-eating. When Julia Stamps-Mallon, from Santa Rosa, Calif., was winning three state high school cross-country titles, her parents made sure she had bone scans and met with a nutritionist because they worried she would get stress fractures. She was not menstruating at the time, but she knew few runners who were. "If someone had a normal cycle, it would be odd," said Ms. Stamps-Mallon, 27.
In college, a scan showed that her bones were thinning, and team-appointed nutritionists had her drinking Ensure to gain weight. Within a year, the base of her spinal column broke mid-run and a fall from a skateboard shattered her leg. Finally, Ms. Stamps-Mallon said, she "saw what a problem osteoporosis is."
Wake-up calls aren't always so glaring. Sometimes coaches have to act on a hunch if they suspect that an athlete is restricting calories. "We say, 'We're not going to run you if you're not a healthy person,' " Mr. Wilson said. "That doesn't mean we won't help you. I'll get you help and sit on the bench alongside you, but we're not going to run you if you're anorexic or bulimic.' "
Doug and Lana DeVinny wish that the coach had told their daughter not to train. When asked whether they wish they had stopped her, Mr. DeVinny is moved to tears. "We never said 'you can't run,' " he said. "We begged her, but especially after she turned 18, it just became really hard."
I can't believe this. A refusal to ask about menstrual cycles is so prevelant, people die? Jesus. We need to grow up.