Iron Intake, Anemia & Dancers

Proper nutrition is always a concern for dancers. Dance is an activity that requires high levels of energy fueled by food, but it is also an activity that requires an aesthetically pleasing body. Since dancers are often concerned about their appearances, they tend to limit the amount of food they eat. Eating a limited amount of food means dancers are not likely to get enough required vitamins and minerals in their daily diets.

Not consuming adequate amounts of iron can be detrimental to dancers and other athletes. It becomes an even bigger concern when you understand that iron is a mineral that can be lost through sweat. On extremely warm days, during an intense class or rehearsal, dancers can lose between 1 and 2 mg of iron.

A study of 47 female teen dancers in New Zealand found that 28% of them had iron levels that were less than ideal, and 5 dancers were found to have an iron deficiency. Another study conducted in the United States found that only 12% of 28 teen female ballet dancers ingested the recommended daily intake of iron.

Iron deficiency is a problem because results in anemia. Our bodies use iron to make hemoglobin. Hemoglobin is the main part of our red blood cells and the part of our blood that binds with oxygen. Hemoglobin’s main job is to attach itself to oxygen in the lungs and deliver that oxygen to all of the other parts of the body. Our muscles and organs need oxygen to function, and our brains need oxygen to think clearly and operate well.

When there is not enough iron in the body, hemoglobin cannot be created, and oxygen delivery cannot occur. When a dancer is anemic, he or she may feel tired or weak, may have cold hands or feet, look pale, be moody, get injured easily and may have difficulty with concentration and memory.

It is very important that dancers consume enough iron so their bodies can function at their highest levels, and they can focus in class and remember combinations and choreography. 

Although everyone needs iron, it is especially important for teens. The body needs higher amounts of iron when going through a growth spurt. The average adolescent should try to ingest 6-8 mg of iron each day. Dancers and athletes need to have 9-12 mg per day to help distribute extra oxygen to their active bodies and make up for any iron that is lost through sweat.

Although iron can be gained from a supplement, the majority of iron we ingest should come from the food we eat. There are two kinds of iron that can be found in food. Iron that is found in meat is called heme iron. The body can absorb 15-18% of this kind of iron. Some sources of heme iron are beef, lamb, liver, seafood, pork, and chicken.  The other kind of iron can be found in plants and is called non heme iron. The body can only absorb about 5% of the iron found in these foods. Some sources for non heme iron are grains, dried fruits, and nuts.

It is very important for dancers to think about how much iron they are getting when they plan their meals and snacks. Being sure to ingest enough iron will keep them dancing at peak levels and help lower chances of injury.

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Beck K.L., Mitchell S., Foskett A., Conlon C.A. & Von Hurst, P.R. (2015). Dietary intake, anthropometric characteristics, and iron and vitamin D status of female adolescent ballet dancers living in New Zealand. International Journal of  Sports Nutrition and  Exercise  Metabolism, 25 (4), 335-43.

Bonbright, J. (1989). The nutritional status of female ballet dancers 15-18 years of age. Dance Research Journal, 21(2), 9-14.

Lee, H., Kim, D. & Kim, S. (2015). An analysis of nutrients intake, related factors of anemia and bone density in ballet dancers. Indian Journal of Science and Technology, 8(25), 1-6.

Pacy, P.J., Khalouha, M., & Koutedakis, Y. (1996) Body composition, weight control and nutrition in dancers. Dance Research,  14(2), 93-105.

The Female Athlete Triad and What It Means for Dancers

"To keep the body in good health is a duty..." - Buddha

The female athlete triad is a medical term that refers to three separate health conditions occurring at the same time in female athletes. The three conditions are:

Caloric Energy Deficit – Typically dancers are conscious of the food they eat.  They worry about ingesting too many calories and gaining weight. The problem with this logic is that calories also supply dancers with the energy they need to perform in class, rehearsals and on stage.  By reducing their caloric intake, dancers often end up burning more calories than they eat and create an energy deficit.

Irregular Menstrual Cycles – Many dancers experience irregular cycles or may find that their periods stop completely. The purpose of periods is to support the life of a developing baby. If the body does not have enough fat or is not at a healthy weight that could sustain both the body and a developing fetus, periods will stop. Dancers who are below a healthy body weight and/or lack body fat may experience irregular cycles or an absence of a cycle.

Osteoporosis – Irregular or absent menstrual cycles cause low levels of estrogen in the body. Our bodies need estrogen to be able to properly absorb and use calcium, which is necessary for bone growth. If our estrogen levels are low, calcium is not absorbed and bone growth in hindered. The lack of bone growth leads to osteoporosis. Osteoporosis is a decrease in bone density which results in weakened bones that can break easily and may result in stress fractures in dancers.

When all three of these factors combine, they create a weakened state and a very unhealthy dancer.  

http://www.femaleathletetriad.org/for-professionals/what-is-the-triad/

Knowing how to eat healthy is a key element in avoiding the female athlete triad. Dancers need to remember that they expend a lot of energy on a daily basis and that the food we eat is the fuel that powers our bodies. According to USDA Dietary Guidelines for Americans, active teen females should consume between 2200-2400 calories per day. It is extremely important that these calories be healthy calories that will provide dancers with enough energy to get through their long days of classes and rehearsals and enough protein to keep their muscles healthy. 

Learning about nutrition and what to eat before and after class and rehearsals is extremely important. It is also important that dancers who experience irregular or an absence of menstrual cycles speak with their health professionals to avoid sliding down the slippery slope of injury.

Dancers, Fatigue & Injuries

           "Fatigue makes fools of us all. It robs you of your skills and your judgment, and it blinds you to creative solutions. It's the best-conditioned athlete, not the most talented, who generally wins when the going gets tough." - Harvey Mackay


Participation in any type of physical activity bears the risk of injury.  Injuries occur in all types of sports programs and across all forms of dance.  With the increased availability of educational information about cross-training and caring for the body, Sports Medicine and Dance Medicine professionals are hoping to decrease the incidence rates, but it is interesting to look at when injuries are more apt to occur and why.

            Studies within the dance community have indicated injury rates as high as 95% in professional ballet dancers and 82% in professional contemporary dancers.  Injury rates in dance are comparable to those in other professional sports.

            Research has shown that 67% of dance injuries occur late in the day and that 75% of all injuries occur during preparation for performances when bodies are tired and/or overworked.   The lack of time and resources for tissue repair, additional hours of rehearsal, and constant repetitive movements when rehearsing specific phrases from dance pieces have all been cited as causes. 

            Dancers are known for diets that are low in nutritional value.  They are constantly going to extremes to avoid foods that may cause them to gain weight or diminish the aimed for aesthetic in the dance community.  Performance and rehearsal schedules allow little time for careful meal planning and food consumption, and it is difficult for dancers to consume enough calories to equal the amount of calories burned during an intensive performance season.

             Additionally, a large percentage of female professional dancers are amenorrheic, or do not have regular menstrual cycles.  The absence of a monthly period results in abnormal estrogen levels which reduce the amount of calcium that the body can absorb and use for repair. 

            Although most athletes’ bodies are able to use protein to recover quickly from minor muscle tears, this is not the case for dancers.  Without a proper diet filled with additional calories for tissue repair, the body is placed under stress during normal situations.  Once the intense performance season begins, the body is unable to care for itself efficiently.

            When this nutrition deficit is combined with a rehearsal/performance schedule that allows little time for rest and recovery, dancers are placed at a high risk for injuries.  While a minor breakdown in body tissue can be sufficiently repaired during an interval of rest, in dancers, who do not have sufficient rest time, the breakdown of tissue becomes greater than the body’s ability to repair, or remodel. 

            When the same muscle groups are used repeatedly during long hours of rehearsal and performance, they grow tired and use up their energy reserves.  When the central nervous system (CNS) receives the message that a muscle is fatiguing and having difficulty holding a contraction, it either tries to get the muscle to work harder, or activates surrounding muscles (synergists) to help.

            Muscular fatigue is only one piece of the puzzle.  Long work hours also stress the central nervous system.  The CNS uses sensory input to determine where the body is in space.  Messages communicated through visual clues and proprioceptive clues help the CNS determine which muscles need to contract and to determine the force that must be used to keep the body moving safely.  Although the body is engineered so that the CNS will protect the tired muscles by directing adjustments in the body, when the CNS is stressed, its ability to direct these adaptations slows down.  The delayed response affects motor control and coordination.  Landings from jumps and the body’s ability to slow down after leaps or turns are affected.  As a result, the way the body normally distributes the stress over the bones and joints is also compromised.

            The change in stress distribution and the lag time in reorganizing the muscular response set the body up for injuries.  All of these factors explain why most dance injuries occur late in the day or during an intense performance season.  Since dancers have a very high pain tolerance, when they get injured, they often do not realize it immediately.  Moreover, injured dancers tend to “dance through” the pain so they do not lose roles or jobs.

            In an ideal world, major rehearsals could be scheduled early in the day before the body is fatigued, and schedules could be designed to accommodate rest periods for dancers to allow for ample recovery time.  Unfortunately, rehearsal space is not always available at ideal times, and dancers need to be able to accommodate the schedules of theater personnel, musicians, and stage, sound, and lighting crews.  Additionally, audiences are only available after the traditional workday ends – in the evening.

            Educating dancers to listen to their bodies, eat properly, cross-train, and using periodization training can be helpful.  Rather than “dancing through” pain, dancers should be encouraged to care for injuries before they become chronic or more serious.  While eating properly has always been a challenge for dancers, a bit of knowledge about healthy foods and the convenience of food today make it easier.  Cross-training will strengthen all of the muscles in the body so that when some muscles fatigue, the synergistic, or helper muscles, will be prepared to start working, and periodization training can help prepare the dancer for performance season and alleviate some of the stress on the body.

            We are given one body to last our entire life.  It is up to us to learn as much as we can about how to dance in a way that preserves its health to the best of our ability.

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       Liederbach, M. Schanfein, L. & Kremenic, I. What is known about the effect of fatigue on injury occurrence among dancers? Journal of Dance Medicine and Science. 2013;17(3):101-8.

       Murgia, C. Overuse, tissue fatigue, and injuries. Journal of Dance Medicine and Science. 2013;17(3):92-100.

      Shah, S., Weiss, D. & Burchette, R.  Injuries in professional modern dancers: incidence, risk factors and management.  Journal of Dance Medicine and Science. 2012;16(1):17-25.

      Tajet-Foxell, B. & Rose, F. D. Pain and pain tolerance in professional ballet dancers.  British Journal of Sports Medicine. 1995:29:31-4.

What To Eat Before and After Class or Rehearsal

“To eat is a necessity, but to eat intelligently is an art.”
 – François de La Rochefoucald

Dance students attend classes and rehearsals after already completing a long day at school.  It is at the time when most people begin to experience the “afternoon slump” that dancers are expected to begin the next part of their day.  Classes are starting and are often followed by rehearsals and require enormous amounts of energy.  Eating intelligently will help dancers perform at their best and feel good while doing it.

            It is imperative that dancers, who are expected to perform at their peak during the late afternoon and evening hours, make healthy eating choices throughout the day.  Eating food every few hours helps maintain a constant metabolism (the rate at which the body converts food into energy) and keeps energy levels even.  Eating a breakfast consisting of proteins and complex carbohydrates sets a healthy metabolic rate for the rest of the day.  Dancers need to be mindful about what they eat for lunch since this meal will need to help sustain them through classes and/or rehearsals until they get a dinner break.

            Healthy lunches containing complex carbohydrates could include:

sandwiches made with whole grain bread

whole grain pastas

fruit and yogurt smoothies with granola

            While having a healthy breakfast and a healthy lunch will stock the body’s energy stores, it is also important for dancers to have a snack between lunch and class to keep energy levels constant.

            Snacks should be easy to digest but able to provide energy that will last throughout classes.  Unfortunately, sometimes the easiest snacks to grab may not be the healthiest choices.  Candy bars or fruit juices are high in sugar.  Sugar is metabolized quickly by the body and used rapidly.  High sugar snacks cause a spike in energy followed by a sudden drop in energy.  Simple carbohydrates like white bread or crackers made from enriched flours are treated the same way as sugar.  Fruit, although naturally high in sugar, is a healthier choice than fruit juice because the fiber in fruit is digested slowly and helps slow down the metabolic process.

It is also important for dancers to know that snacks that are high in fat content are not the healthiest choices.  Snacks like doughnuts, potato chips, pepperoni and french fries are difficult to digest and could cause cramping.  Because they are so difficult to digest, it will take a while before the body is able to turn them into energy.

Some healthy snack choices are:

whole grain crackers

popcorn

pretzels

trail mix containing whole grain cereals, nuts & dried fruits

apple with almond butter

            After class and rehearsals are done, overworked muscles need protein to help repair muscle fibers and to help reduce soreness.  Some healthy choices after intense workouts include:

peanut butter, graham crackers & bananas

almonds

yogurt

meat or fish

            Knowing how to fuel their bodies before, during and after class will help dancers keep their energy levels constant and even which allows the body to operate efficiently and optimally.  Fueling the body efficiently is not difficult and will produce positive results.  Making healthy choices is every dancer’s responsibility –ensuring that their instrument performs well and lasts a lifetime.

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Dancer Health: Fueling the Body Efficiently

“We are indeed much more than what we eat, but what we eat can nevertheless help us to be much more than what we are.” – Adelle Davis

            When people prepare for a long road trip, they fill their cars with gasoline and make certain that they choose the type of fuel that will keep their cars running efficiently.  Food is the body’s fuel, and if the body is going to run efficiently, we need to be mindful of the food we use for energy.

            There is constant talk about “good” foods like fruits and vegetables and “bad” foods like ice cream sundaes and desserts.  Foods are not truly good or bad, but there are definitely foods that are healthier than others.  There are times in our lives for all different kinds of foods, and we should never feel guilty about eating certain foods.  It is important, however, to know enough about nutrition to understand when to eat which foods.  Dancers need to know that a doughnut or an ice cream sundae are not healthy food choices before a class or rehearsal because these foods will not supply the necessary energy for those activities.  With some knowledge, dancers can make healthy choices that will keep their bodies functioning at optimal levels.

            In order to keep the body running efficiently, carbohydrates should compose about 60% of the human diet since they are the body’s main source of energy.  Carbohydrates also help maintain even blood sugar levels and supply the body with fiber and vitamin B.  It is important to understand the difference between simple carbohydrates and complex carbohydrates.  The body treats simple carbohydrates the same way it treats sugar.  Simple carbohydrates are broken down into energy by the body immediately and burned through very quickly.  Eating a lot of simple carbohydrates causes short bursts of energy followed by drops in energy and creates a high sugar environment within the body.  Research has shown that sugar suppresses the immune system, increasing susceptibility to disease.  Complex carbohydrates are excellent sources of energy because they break down easily and slower than simple carbohydrates so the energy is released at a more even rate, avoiding the spike in sugar levels.  Whole grain breads, rice, and pastas as well as beans and snacks like pretzels and popcorn are great sources of complex carbohydrates.

            Fats should comprise about 25% of the human diet because they also supply necessary energy.  The body uses carbohydrates first, but after about twenty minutes of exercise, the body begins to rely upon stored fats for fuel.  Mono-saturated fats are healthier choices than trans fats.  Trans fats are very difficult for the body to break down, accumulate in arteries and can cause blockages that lead to heart attacks and strokes.  Mono-saturated fats, however, aid the immune system and supply building blocks for hormones.  Some healthy food choices that contain mono-saturated fats are olive oil, canola oil, nut butters, nuts, olives and avocados.

            Protein should make up about 15% of the human diet.  The body uses protein to build and repair muscle tissue, making high protein foods a perfect exercise recovery choice.  Proteins help supply necessary enzymes and minerals like iron and zinc.  While protein is essential, too much protein can put extra stress on the liver, kidneys and digestive system.  Protein can be found in meats, soy, dairy products and eggs.

            Knowing the roles that carbohydrates, fats and proteins play in the body is the key to understanding the best way to fuel the body.  Armed with this knowledge, dancers can begin to make healthy choices to keep their bodies running at optimal levels.  Next week’s post will offer some suggestions for healthy eating before, after and during classes and rehearsals.

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