The Female Athlete Triad is a condition that includes three components:
– Low bone density (risk for stress fractures and osteoporosis)
– Disordered eating
– Amenorrhea (no menstrual cycle for three months or more)
(Matzkin et al., 2015).
The consequences of the Female Athlete Triad can be long-term and irreversible, and include stunting of growth, reproductive dysfunction, and osteoporosis. Any female athlete is at risk for this syndrome, but women who participate in dance are more susceptible because of the desired lean aesthetic and rigorous training schedule (Barrack et al., 2014). Peak bone density is achieved between ages 18 to 25 years. Poor nutrition (i.e., insufficient calories, calcium and vitamin D), stress, and intense training lead to hormonal disruption during the peak-forming period. Reduced estrogen production leads to bone resorption, and this can occur despite the fact that load-bearing physical activity such as dance usually improves bone-mineral density. Some female athletes have bone density similar to older postmenopausal women, which is dangerously low. One study reported that 80% of female dancers diagnosed with stress fractures of the second metatarsal started their menstrual period late (O’Malley, 1996). This type of bony injury requires at least 6-8 weeks to heal and even longer to rehab.
The remedy for Female Athlete Triad requires that energy needs be met consistently, either by modifying diet or reducing exercise. If body fat is inadequate, restoring body weight to a healthy level is the best strategy for normalizing menstrual periods and improving bone health.
Looking and performing your best for auditions should not involve suffering or engaging in crash diets. Obtaining ideal body composition may require you to be more aware of the quality and quantity of your food choices as well as the intensity of your training regimen.
Some simple suggestions for staying lean include:
Remember, don’t be intimidated by other dancers or their bodies - focus on doing your best and shining in areas you excel at! Allow nutrition to help fuel you during the audition season - you need adequate food fuel to provide energy, build strength, and maintain a healthy immune system.
Homemade chicken noodle soup made in the crock pot for a set-it-and-forget-it easy dinner. You can evan prep all the ingredients ahead of time and store them in the freezer to pull out on a day where you forgot to plan dinner. Just make sure you thaw the ingredients before adding it to the slow cooker to prevent it from staying at an unsafe temperature for too long.
8 ounces whole-wheat egg noodles or other whole-wheat noodles
3 pounds bone-in chicken breast, skin removed
2 cups chopped onion
1 cup chopped carrot
1 cup chopped celery
2 sprigs thyme
8 cups low-sodium chicken broth
2 teaspoons kosher salt
2 cups frozen peas
¼ cup chopped fresh dill, plus more for garnish
2 tablespoons lemon juice
The immune system provides protection from seasonal illness such as the common cold as well as other health problems including arthritis, allergies, abnormal cell development and cancers. Dancers are exposed to physical stress from training, which increases susceptibility to illness. Additionally, working in close proximity with other dancers increases exposure to infection. Nutrition plays an important role in maintaining immune function to protect against infection. Learn how to boost your immunity by including these nutrients in your eating plan.
Proteins form many immune cells and transporters. Try to consume a variety of protein foods including seafood, lean meat, poultry, eggs, beans and peas, soy products and unsalted nuts and seeds.
Vitamin A helps regulate immune function and protects from infections by maintaining healthy tissues in skin, mouth, stomach, intestines and respiratory system. Vitamin A is found in foods such as sweet potatoes, carrots, kale, spinach, red bell peppers, apricots, eggs or foods labeled "vitamin A fortified," such as cereal or dairy foods.
Vitamin E works as an antioxidant to neutralize free radicals. Include vitamin E in your diet with fortified cereals, sunflower seeds, almonds, vegetable oils (such as sunflower or safflower oil), hazelnuts and peanut butter.
Vitamin C protects stimulates the formation of antibodies, which are necessary to fight infection. Citrus fruits such as oranges, grapefruit and tangerines, red bell pepper, papaya, strawberries, and tomato juice are good sources of vitamin C.
Zinc is critical for wound healing and aids the immune system. This mineral can be found in lean meat, poultry, seafood, milk, whole grain products, beans, seeds and nuts.
Other nutrients, including vitamin B6, folate, selenium, iron, as well as prebiotics and probiotics, may also influence immune response.
Academy of Nutrition and Dietetics (2017). Protect Your Health with Immune-Boosting Nutrition. Retrieved at eatright.org.
Probiotics are beneficial bacteria that exist in our gastrointestinal tract. Prebiotics feed the beneficial bacterial colonies and work synergistically with probiotics. In other words, prebiotics nourish and maintain probiotics, which restores and improves gut health. Probiotic sources include yogurt, kimchi, sauerkraut, miso, tempeh and cultured non-dairy yogurts. Some good sources of prebiotics are bananas, onions, garlic, leeks, asparagus, artichokes, soybeans and whole-wheat foods. Products that combine both are called synbiotics. For best results, try combining pre- and probiotics in your usual diet by enjoying bananas with yogurt or stir-frying asparagus with tempeh.
Are probiotic supplements necessary for everyone? Probably not. In fact, there are risks associated with use of probiotic supplements. These include: systemic infections, metabolic disruption, excessive immune stimulation in compromised individuals, gene transfer, and gastrointestinal side effects (Doron & Syndman, 2015). By consuming regular food sources of probiotics, you can safely maintain the integrity of your gut and avoid disrupting your body's natural microbiome. At a minimum, prebiotics and probiotics are keys for optimal gut health. Research indicates that the gut bacterial environment has implications beyond digestive health. The microbiome may impact weight management and risk of central nervous system diseases (Shreiner et al., 2015). Incorporating health-promoting functional foods, such as foods containing prebiotics and probiotics contributes to a healthier you!
Our registered dietitian, Nasira, can provide more advice on obtaining pre- and probiotics for your specific health needs, especially if you have gut issues or a weakened immune system, Contact her today:
(425) 445-3914 or email@example.com.
Doron, S., & Snydman, D. R. (2015). Risk and safety of probiotics. Clinical Infectious Diseases, 60(suppl_2), S129-S134.
Shreiner, A. B., Kao, J. Y., & Young, V. B. (2015). The gut microbiome in health and in disease. Current opinion in gastroenterology, 31(1), 69.
According to the Center for Disease Control and Prevention, nutrient dense foods are those that provide an average of 10% or more daily value per 100 calories of 17 nutrients, including potassium, protein, fiber, iron and calcium (DiNoia, 2014). While there are several fruits and vegetables that are nutrient dense, there are some in particular that are best in the summertime, because they also happen to be refreshing and help with hydration. Citrus fruits and berries are excellent choices for summer snacking. According to CDC’s nutrient density approach, the healthiest of them all is the strawberry, with a nutrient density score of 17.6 (DiNoia, 2014). According to the FDA, strawberries have more vitamin C than any citrus fruit, and are also rich in potassium and fiber. As an added bonus, strawberries are a good source of flavonoids (Odriozola-Serrano et al., 2008) group of phytonutrients linked to reduced risk of diabetes, heart disease, and some cancers (Arnoldi, 2004). Strawberries are about 92% water (NNDS, 2016) a proportion similar to that of watermelon; and, because of their electrolyte content, strawberries are an ideal source of hydration on warm days. If you aren’t a fan of eating a portion of plain fresh strawberries, the flavor of strawberries is delicious when sliced pieces are added to your ice water. There are also many healthy summer recipes, both sweet and savory, that contain strawberries, such as the Caprese Salad with Strawberries recipe below.
Refreshing Caprese Salad with Strawberries
2 pounds fresh strawberries, stemmed and halved
2 cups bite-sized fresh mozzarella balls (Bocconcini), drained and halved
2 tablespoons extra virgin olive oil
1/3 cup balsamic vinegar
3-4 fresh basil leaves, finely diced
Salt, pepper to taste
In medium sized bowl, toss strawberries and mozzarella balls with olive oil. Season mixture with salt and pepper. Add basil and toss again. Drizzle balsamic syrup over and around salad. Grind more pepper on top and serve.
Di Noia J. Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach. Preventing Chronic Disease. 2014;11:E95.
Odriozola-Serrano, I., Soliva-Fortuny, R., & Martín-Belloso, O. (2008). Phenolic acids, flavonoids, vitamin C and antioxidant capacity of strawberry juices processed by high-intensity pulsed electric fields or heat treatments. European Food Research and Technology, 228(2), 239-248.
Arnoldi, A. (Ed.). (2004). Functional foods, cardiovascular disease and diabetes. Elsevier.
National Nutrient Database for Standard Reference, Release 28 slightly revised May, 2016, Software v.2.6.1.
Rest is essential for recovery and healing. It is a recommended to take a couple weeks off after a summer intensive. Adjustments in food intake should be made during these rest periods. Typically, one week is not enough time for your metabolic rate to decrease or for lean mass to dissipate significantly. However, durations longer than one week can result in loss of muscle mass and fat gain if you're not supplementing with resistance training and/or adjusting calorie intake. Plan to make small, simple changes to account for the reduced calorie expenditure when you're not dancing. Be careful not to overcompensate with extreme calorie restriction.This is counterproductive and can cause muscle loss, illness, and injury when you begin training again.
What adjustments should be made to diet during the off-season?
Rather than restricting calories during vacation or off-season, consider cross-training with cardio and resistance training. Low-impact, moderate-intensity cardio such as swimming or fast walking are excellent options to allow for extra calorie burning and promote muscle retention. Walking at ~3.8 to 4 miles per hour (3 to 4 miles/day) or swimming for 30 minutes at a moderate intensity are good options. Add light resistance training with weights, Pilates, or yoga while on a break from dance in order to maintain flexibility and promote muscle gain.
Enjoy your summer and remember that you deserve a break!
Dancers consume fewer calories than they expend (Dahlstrom et al., 1990; Beck et al., 2015; Hassapiduo et al., 2001; Doyle-Lucas et al., 2010; Brown et al., 2017) due to busy schedules, deliberate calorie restriction, pressure to maintain low body weight, and a lack of knowledge. Taking class on an empty stomach increases muscle breakdown, which is undesirable for dancers who need strength to dance. It is critical that dancers consume carbohydrates prior to training to reduce muscle fatigue and help preserve muscle fibers that generate power for jumping. The purpose of a pre-exercise meal - consumed within an hour or less before training - is to hydrate, top off glycogen stores, and decrease hunger. If you take a class early in the morning, you have most likely fasted overnight and will need carbohydrates to help fuel your first class. Consuming carbohydrate spares the use of protein for energy, thereby freeing up protein to synthesize muscle and repair tissue. Poor nutrition may result in the following consequences:
Dancers should consume about 15 calories per pound body weight, plus the training energy expenditure, which is approximately 200 calories per hour of class or rehearsal. For example, a 130-pound (60-kg) dancer might need 1,860 calories per day plus an additional 500 to 800 calories to meet the demands of class, rehearsal or performance that day, for a total of 2,360 to 2,660 calories. Nutrition needs are very individualized, so it is important that dancers seek dietary advice from qualified specialists (i.e., a Registered Dietitian for dancers).
Brown, M. A., Howatson, G., Quin, E., Redding, E., & Stevenson, E. J. (2017). Energy intake and energy expenditure of pre-professional female contemporary dancers. PLoS ONE, 12(2), e0171998.
Dahlstrom M, Jansson E, Nordevang E, Kaijser L. (1990). Discrepancy between estimated energy intake and requirement in female dancers. Clinical physiology; 10(1):11-25. Epub 1990/01/01.
Hassapidou MN, Manstrantoni A. (2001). Dietary intakes of elite female athletes in Greece. Journal of human nutrition and dietetics: the official journal of the British Dietetic Association;14(5):391-6. Epub 2002/03/22.
Kostrzewa-Tarnowska A, Jeszka J. (2003). Energy balance and body composition factors in adolescent ballet school students. Polish Journal of Food and Nutrition Sciences;12(3):71-5.
Beck KL, Mitchell S, Foskett A, Conlon CA, von Hurst PR. (2015). Dietary Intake, Anthropometric Characteristics, and Iron and Vitamin D Status of Female Adolescent Ballet Dancers Living in New Zealand. Int J Sport Nutr Exerc Metab; ;25(4):335-43. Epub 2014/11/12. doi: 10.1123/ijsnem.2014-0089 25386731
Doyle-Lucas AF, Akers JD, Davy BM. (2010). Energetic efficiency, menstrual irregularity, and bone mineral density in elite professional female ballet dancers. J Dance Med Sci;;14(4):146-54. Epub 2010/01/01. 21703085
Hirsch NM, Eisenmann JC, Moore SJ, Winnail SD, Stalder MA. (2003). Energy Balance and Physical Activity Patterns in University Ballet Dancers. Journal of Dance Medicine & Science;7(3):73-9.
Sousa, M., Carvalho, P., Moreira, P., Teixeira, V. (2013). Nutrition and Nutritional Issues for Dancers. Medical Problems of Performing Artists, 28, 119.
Montanari, A., & Zietkiewicz, E. A. (2000). Adolescent South African ballet dancers. South African journal of psychology, 30(2), 31-35.
Do you need some unique ideas for a breakfast smoothie or a portable meal? Check out these recipes from Nasira. The instructions are simple for each: add all ingredients to a blender, puree until smooth, and enjoy! Consider using an insulated thermos to keep your smoothie cold until lunch or snack time.
Oat Avocado Smoothie
½ cup plain non-fat Greek yogurt
1/2 cup unsweetened almond milk
¼ cup raw rolled oats
1 frozen ripe banana
¼ cup mashed avocado
½ ripe pear
1 Tbsp ground flaxseed
1 scoop soy or whey protein powder
Cocoa Almond Smoothie
1 very ripe frozen banana
3 Tbsp almond butter
¾ cup white Northern beans (drained)
1 Tbsp chia seeds or flaxseeds
2 Tbsp unsweetened cocoa powder
1 cup unsweetened almond milk
Green Vanilla Mint Smoothie
¼ cup unsweetened almond milk
¼ cup fresh baby spinach
Fresh mint leaves or ½ tsp mint extract
¼ cup vanilla or plain whey protein or egg white protein powder
2 Tbsp unsalted pistachio nuts
1 Tbsp Stevia
1 tsp vanilla extract
Strawberry Banana Smoothie
1 cup unsweetened almond milk
1 cup strawberries, quartered
1 banana, frozen
1/2 cup plain greek yogurt
1 Tbsp ground flaxseed meal
2 scoops soy or whey vanilla protein powder
Tropical Chia Fruit Smoothie
1 cup unsweetened almond milk
¼ cup unsweetened shredded coconut
½ cup mango chunks, fresh or frozen
½ cup pineapple chunks, fresh or frozen
2 scoops soy or whey protein powder
Good nutrition is essential to help dancers achieve ideal body composition and ensure adequate energy to support growth and fuel training. Training may last for the majority of the day and run over several meal times, so it's important to take a variety of snacks and small meals along to the studio or rehearsal venue. If there are small breaks between classes, light snacks like cereal bars, smoothies, fruit, and low-fat yogurt are ideal. If there are larger breaks during the day, sandwiches, wraps, frittatas, rice, couscous, potato, or pasta salad might be more suitable. Protein should be included in each snack to repair and maintain muscle. Protein synthesis (i.e., muscle building) occurs by consuming as little as 15 to 25 grams of complete protein (e.g., egg, dairy or soy) after exercise. There are numerous foods that offer quality, complete protein - you can learn more about them in our upcoming post about protein quality! Including healthy fats, such as the kind found in nuts and seeds, in your snacks will promote concentration and enable quick thinking during rehearsals.
Here is an example of a one-day meal plan for a day consisting of two dance classes (1.5 hours each) and an evening rehearsal (1.5 hours):
This is a basic example. Food options are customizable according to your schedule, food preferences, and tolerances. An individual meal plan requires preparation, so don’t hesitate to bulk prep on the weekends to allow for easy meal packing during your busy week of class and rehearsal.
Check back soon for more recipe ideas from Nasira!