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11/2/2020 0 Comments

Nourish & Flourish - Managing Stress with Nutrition

Stress is the tension felt when faced with a new, unpleasant, or threatening situation. The hormone surge we experience during stress produces an automatic physical reaction as well an emotional response that can be controlled and managed. The physical signs of stress include increased heart rate, perspiration, headaches, appetite changes, dry mouth, frequent urination, and diarrhea or vomiting. The emotions that accompany stress are typically anxiety, irritability, and fearfulness which often lead to impulsiveness, increased use of drugs or alcohol, and overeating. 

It is very important to find alternative coping strategies for stress that aren’t harmful to your health and performance. Taking care of your body and mind with adequate sleep and proper nourishment are critical. If overeating during stress is an issue for you, it is also helpful to establish an emotional outlet other than food. Fueling your body at regular intervals with balanced meals and snacks can often prevent the urge to overeat, even during stress. There are a number of nutrients related to brain function, including vitamin B12, B6, and folate. Some good sources of B12 are beef, fish, shellfish, dairy, and fortified grains. Vitamin B6 can be found in meats, whole-grains, vegetables, nuts, and bananas. Dark leafy vegetables, okra, asparagus, fruits, beans, yeast, mushrooms, orange juice, and tomato juice, and fortified grains are good sources of folate. With the wide array of food sources, a balanced diet generally provides adequate quantities of these nutrients, so it is only necessary to supplement if a deficiency exists. The essential omega-3 fatty acids are also necessary for mental and physical health due to their role in regulating inflammation and interacting with mood-related molecules in the brain. Food sources of omega-3 fats include fatty fish, flax and hemp seeds, walnuts, and canola oil.
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Additionally, there are amino acids and other dietary components that serve as precursors for neurotransmitters that function in mood stabilization, feelings of pleasure, learning and memory. The table below outlines the functions and food sources of some relevant examples. With adequate intake of high-quality proteins and/or a variety of seeds and legumes, adequate intakes of these dietary components can be achieved. It is important to recognize that a lack of the precursors needed to synthesize neurotransmitters can result in altered mood and poor coping skills. Consider integrating food sources of these neurotransmitter precursors, B vitamins, and omega-3 fatty acids to promote mental stability and wellness, even during the most stressful of times!
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References:
The VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention (VITAL-DEP): Rationale and design of a large-scale ancillary study evaluating vitamin D and marine omega-3 fatty acid supplements for prevention of late-life depression. Contemporary Clinical Trials, May 2018.

Haggerty, J. (2020). Vitamins for Bipolar Disorder. Psych Central. Retrieved on October 8, 2020, from https://psychcentral.com/lib/vitamins-for-bipolar-disorder/
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9/5/2020 1 Comment

Nutritional Anemias - Causes and Prevention

Anemia is a common blood disorder in which the body lacks adequate red blood cells to carry oxygen to tissues. The reduced oxygen delivery results in fatigue and weakness, and can severely interfere with exercise capacity and performance. Causes of anemia include inadequate dietary intake, poor absorption of nutrients,  blood disorders, or lack of red blood cell production from the bone marrow. Nutritional anemias are usually detected with blood tests that assess the size and number of red blood cells.
Symptoms of anemia include:
  • Weakness
  • Shortness of breath 
  • Chest pain
  • Dizziness
  • Irregular heartbeat
  • Pounding in the ears
  • Headache
  • Pale or yellow skin​
        Certain nutrients play an important role in the function and integrity of red blood cells. Iron-deficiency anemia is the most common nutritional anemia and not only decreases athletic performance, but also impairs immune function and results in physiologic dysfunction. Hemoglobin is an iron-rich protein in red blood cells that attaches to oxygen and carries it to body tissues. When iron stores are inadequate, hemoglobin levels become too low to transport sufficient oxygen, resulting in iron-deficiency anemia. Most often, dietary choices explain most of a negative iron balance, but it is also possible that a higher iron turnover rate occurs due to intense exercise. Diagnosis of anemia is confirmed by a blood test indicating a hemoglobin value less than 13.5 gm/dl in men or less than 12.0 g/dl in women. 
        Iron is important at any age, but particularly during stages of rapid growth. The high demands of dance training make dancers susceptible to iron deficiency because iron is lost in sweat. Menstruating females are at additionally elevated risk of developing anemia. The average adolescent should consume 6-8 mg of iron each day and dancers and athletes should aim for 9-12 mg per day to help distribute additional oxygen to working muscles and account for any iron that is lost through sweat. 
        The second and third most common nutritional anemias are related to folate and vitamin B12. Vitamin B12 deficiency anemia is unique in that it causes neurological problems and can take years of inadequate supply before symptoms develop. Inadequate levels of B12 are sometimes caused by poor absorption due to a lack of intrinsic factor (the protein that transports B12 to its absorption site in the gut) or a stomach disease. Folate deficiency manifests quickly and is typically a result of a poor diet or alcohol abuse. Folate needs are approximately 200-400 mcg/day and needs increase to 500-800 mcg/day during pregnancy and breastfeeding. Deficiencies of copper, zinc, and vitamins C, A, and B6 can also contribute to anemias.
        Eating a balanced diet can help you avoid both iron and vitamin-deficiency anemias. There are two kinds of iron found in foods. Iron that is found in animal products (e.g., beef, chicken, eggs)  is called heme iron, and the body can absorb 15-18% of heme iron. In contrast, the body only absorbs approximately 5% of non-heme iron, which is found in plant foods such as grains, dark leafy greens, dried fruits, and nuts. Vitamin B-12  is found in meat and dairy. Citrus, green leafy vegetables and legumes are rich in folic acid. A daily multivitamin can also help fill in any gaps in nutrient intakes from food and help prevent nutritional anemias. Be aware that iron supplements can result in toxic levels of the mineral and should only be used if instructed by a physician.
References:
John Beard, Brian Tobin, Iron status and exercise, The American Journal of Clinical Nutrition, Volume 72, Issue 2, August 2000, Pages 594S–597S, https://doi.org/10.1093/ajcn/72.2.594S

Faramarz Naeim, Chapter 23 - Disorder of Red Blood Cells: Anemias, Editor(s): Faramarz Naeim, P. Nagesh Rao, Wayne W. Grody, Hematopathology, Academic Press, 2008, Pages 529-565, ISBN 9780123706072, https://doi.org/10.1016/B978-0-12-370607-2.00023-5.



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6/2/2020 1 Comment

Superstar Seeds - Big Nutrition in a Tiny Package

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Research continues to shed light on the health benefits of nuts and seeds. Flaxseeds, chia seeds, and sunflower seeds are well-known options, but there are several lesser-known varieties of readily available seeds with potential health effects.
General Characteristics of Seeds
Seeds contain the embryo of future plants. To support their development from embryo to plant, seeds are endowed with ample energy and nutrients. This efficient packaging makes seeds calorie dense, so it is important to be aware of appropriate portion sizes when eating seeds as a snack or ingredient. Unique nutrition profiles exist for different seed varieties, therefore, including a diverse array of seeds in your diet can promote health. Seeds are typically a source of protein, unsaturated fats, minerals, and phytonutrients. For individuals with nut allergies, seeds and seed butters offer excellent substitutes! 

Consider trying one or all of these tasty and nutritious superstar seeds:
Sesame seeds are a good source of fiber, which not only supports digestive health but may play a role in reducing risk of obesity, type 2 diabetes, certain cancers, and heart disease. Some studies indicate that regular consumption of sesame seeds may help reduce cholesterol and triglycerides. Sesame seeds also provide phytonutrients (lignans and phytosterols) that may have cholesterol-lowering effects. These tiny seeds supply 5 grams of protein per 3-Tbsp serving and the micronutrients  B-vitamins, iron, zinc and copper. Unhulled sesame seeds are especially rich in calcium, a nutrient vital to bone health. Try adding sesame seeds to cereal, stir-fries or steamed veggies, smoothies, or salad dressings. Check out the Sesame Spring Salad recipe for another delicious idea!

Pumpkin seeds contain a range of beneficial nutrients, including sterols, magnesium, and polyunsaturated fatty acids. Research indicates that the nutrients in pumpkin seeds may protect against type 2 diabetes and heart disease as well as promote bone health. Pumpkin seeds are a rich source of the amino acid tryptophan, which the body converts into serotonin, a neurotransmitter that promotes relaxation. Pumpkin seeds are a great snack and add crunch and taste to recipes. Top a salad with pumpkin seeds or make homemade pumpkin seed butter by blending whole, raw pumpkin seeds in a food processor.

Tomato seeds may be more difficult to digest than most seeds, but they are worth the trouble since they provide a healthy dose of vitamins A and C, potassium and fiber. The seeds also contain lycopene, a phytonutrient known to reduce cancer risk; cooking helps activate lycopene in tomato seeds. The seeds are often consumed dried, but can be enjoyed in tomato sauces or as part of whole tomatoes.

References:
Carolina Alves Cardoso, Gláucia Maria Moraes de Oliveira, Luciana de Almeida Vittori Gouveia, Annie Seixas Bello Moreira & Glorimar Rosa (2018) The effect of dietary intake of sesame (Sesamumindicum L.) derivatives related to the lipid profile and blood pressure: A systematic review, Critical Reviews in Food Science and Nutrition, 58:1, 116-125, DOI: 10.1080/10408398.2015.1137858

González, Mónica, M. Carmen Cid, and M. Gloria Lobo. "Usage of tomato (Lycopersicum esculentum Mill.) seeds in health." Nuts and seeds in health and disease prevention. Academic Press, 2011. 1123-1132.


Sesame Spring Salad
1 pound fresh asparagus, trimmed and cut into 2-inch pieces
7 radishes, thinly sliced
2 tablespoons sesame seeds
Dressing:
2 tablespoons olive oil
2 tablespoons thinly sliced green onion
1 tablespoon white wine vinegar
1 tablespoon lemon juice
2 teaspoons honey
1 teaspoon Dijon mustard
1/4 teaspoon garlic powder
1/4 teaspoon grated lemon zest
1/4 teaspoon pepper
In a large saucepan, bring 6 cups of water to a boil. Add asparagus; cover and boil for 3 minutes. Drain and immediately place asparagus in ice water. Drain and pat dry.
Transfer to a large bowl; add radishes and sesame seeds. Place dressing ingredients in a jar with a tight-fitting lid; shake well. Pour over salad; toss to coat.


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3/2/2020 1 Comment

Anti-Inflammatory Foods - Can Diet Help Reduce Pain and Injury?

Inflammation is the body’s normal response to promote healing when the body is fighting infection related to injury, wounds, allergens, toxins, or infection. Typical signs of inflammation include swelling, pain, and redness. In contrast, signs of inflammation may not be apparent with chronic inflammation. Chronic inflammation is typically caused by excess body fat or immune dysfunction. While acute inflammation promotes healing, chronic inflammation can result in DNA damage and increase cancer risk.

Despite the numerous “anti-inflammatory diets” promoted online, research is barely emerging in regards to diet and inflammation. So far, scientific studies indicate that consuming a variety of nutritious foods may help reduce inflammation and keep chronic inflammation at bay. Foods that enhance immune function are also important in fighting inflammation. Here is what we know thus far about foods and inflammation:

  • Fruits and vegetables provide phytonutrients with potential anti-inflammatory properties.
  • Healthy omega-3 fatty acids and monounsaturated fats promote anti-inflammatory pathways.
  • A diet high in saturated fat may increase inflammation; trans fats may also be inflammatory.
  • Animal studies indicate that dark chocolate, green tea, red wine, turmeric and ginger may reduce inflammation.
However, these findings have not been observed in humans and it is unknown how much and how often these foods must be eaten to provide benefits. 

​Tips for reducing inflammation:


  • Include fruits and vegetables with every meal.
  • Consider eating a variety of protein sources, including fish, tofu, legumes, and low-fat dairy.
  • Choose monounsaturated fats including olive, canola, safflower, sunflower, peanut and avocado oils. Eat omega-3 rich foods like salmon, walnuts, flaxseed and chia seeds. Avoid partially hydrogenated oils and high amounts of saturated fat.
  • Choose whole grains such as quinoa, brown rice, millet, and bulgur.

In addition to a healthy diet, inflammation can be reduced by getting adequate sleep, remaining physically active most days of the week, and maintaining a healthy weight.
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2/5/2020 1 Comment

Popular Dietary Supplements - Helpful or Harmful?

Dancers train vigorously and encounter intense competition when trying to achieve peak potential. In an attempt to excel, it is tempting to experiment with dietary supplements. Although these supplements claim to improve strength, weight management, and agility, most do not live up to their claims.

Although the U.S. Food and Drug Administration regulates dietary supplements, the process is different than the regulation of drugs and conventional foods. Manufacturers are responsible for ensuring their products are reasonably safe and not misleading, but are not required to show evidence of supplement effectiveness prior to marketing or sale. Organizations such as the US Pharmacopeia or NSF International test supplements for purity Looking for their label on a supplement indicates at least some standards have been met. Nontheless, evidence is usually lacking or conflicting, supplements are expensive, and side effects are common. As an alternative, a balanced diet can provide the nutrients you need for overall health and peak performance. Foods can provide many of the substances found in popular supplements, for example:

Creatine - produced naturally in our muscles for energy production and also found in fish and meat. Creatine supplements are taken to increase exercise intensity and improve strength and muscle gains. Results tend to vary greatly depending on the study and particular athletic event. 

Branched-Chain Amino Acids (BCAAs) - leucine, isoleucine, and valine are amino acids found in protein-rich foods. BCAAs are often taken to delay fatigue and boost muscle growth, but studies are inconclusive regarding the effectiveness of taking BCAA supplements for performance. Fish, chicken, eggs, tofu and dairy are great sources of BCAAs. 

Chromium Picolinate - a supplement used for weight loss or muscle building and a naturally occurring mineral found in fruits and vegetables, and whole grains. Supplement doses may cause oxidative damage and can potentially interfere with iron functions in the body. Include sources of the mineral in the diet, but supplementation is not recommended. 

Collagen and Bone Broth - collagen is a protein needed for rebuilding bone, skin, and connective tissue. It is present in many high-protein foods that are also rich in minerals and contribute flavor and satisfaction to meals. Collagen and bone broth may be useful when solid foods are being avoided due to surgery or illness, but are not necessarily more nutritious than high protein whole foods. It is also important to note that bone broth and collagen water can be high in sodium, so if using for a soup or stew, opt for a low-sodium broth or stock. You will still obtain the protein and nutrients without consuming excessive sodium, which can contribute to dehydration and high blood pressure.

While supplement companies may provide interesting information about their products, it's best to take a balanced approach and review unbiased sources as well. You can find reliable information about dietary supplements from trusted online resources, such as the National Institute of Health’s Office of Dietary Supplements. For more information, consult a registered dietitian to assess your individual needs.
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11/5/2019 1 Comment

Healthy Fall Recipe - Chickpea Curry Wraps

The autumn season is upon us, bringing cooler temperatures, holiday traditions, and countless hours of Nutcracker rehearsal. For dancers, this time of year can be busier than ever, contributing to fatigue and susceptibility to illness. Good nutrition is especially important in the months ahead to keep you healthy through the season. We hope an easy and nourishing recipe idea will help - this complete meal can be prepared ahead, is portable, and delicious.

Ingredients:
  • 1 medium head of cauliflower
  • 1 medium yellow onion, diced
  • 3 Tbsp extra virgin olive oil
  • 2 tsp minced garlic
  • 1 Tbsp finely  grated ginger
  • 1 tsp salt
  • 1 Tbsp curry powder
  • 3 cups cooked or canned chickpeas, drained and rinsed well
  • 1/2 cup finely chopped cilantro leaves and stems
  • 6 large whole wheat tortillas
      Garlic Yogurt Sauce
  • 1 cup low-fat plain Greek yogurt
  • 1 tsp garlic powder
  • 1 Tbsp lemon juice
  1. Chop or break cauliflower into large chunks.
  2. Place cauliflower chunks onto a microwave safe plate with 2 Tbsp water and microwave on high for 5 to 7 minutes until tender. 
  3. Mash cauliflower with a potato masher. Set aside to cool
  4. Add olive oil to a large pot, then add the onions and sauté for 5-7 minutes, until brown. Add the ginger and garlic and sauté for a minute more.
  5. Reduce the heat to medium, and then add the salt and curry powder and sauté for one minute.
  6. Add the mashed cauliflower, chickpeas, and cilantro and stir well, cooking for 3-5 minutes. Remove from heat, and let cool slightly.
  7. To make the garlic yogurt, whisk together Greek yogurt, garlic, lemon juice, and add salt and pepper to taste.
  8. Spoon about 1/6th of the filling into the center of each tortilla. Fold one side over towards the center, fold the edges in, and roll up like a burrito. Serve with garlic yogurt sauce if desired.
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10/6/2019 2 Comments

Dance Training, Exercise and Nutrition During Pregnancy

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Photo credit: Pacific Northwest Ballet
During pregnancy, a woman’s body will change more in nine months than it’s likely to change during any other life stage. Because of these changes, pregnant women are generally encouraged to rest and enjoy “eating for two”. For dancers, taking it easy is not always ideal or even possible. Pre-professional and professional dancers often continue to train until their due date and will return back to the studio soon after delivery. What does training while pregnant involve?  Will dancing while pregnant harm an unborn child?

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8/8/2019 1 Comment

The Vegan Diet - Benefits & Concerns

Research indicates that a vegetarian diet does not negatively impact athletic performance. On the contrary, an energy restrictive and nutrient poor diet leads to a variety of deficiencies that diminish health and impede dance training. Is a vegan diet guaranteed to make you healthier and give you more energy? Not necessarily. A plate of fries may be free of animal products, but offers zero nutrients and contains hydrogenated oils. The effect of a vegan diet is also influenced by your training, lifestyle habits, and body weight. 

Benefits of a vegan diet include: 
  • Plant sources of protein contain antioxidants and are lower in fat
  • Carbohydrates from plant sources optimize muscle glycogen
  • Plant carb intake also provides polyphenols, tannins, phytate and fiber
  • Reduced risk of obesity, diabetes, and heart disease (Melina et al., 2016)

Concerns about a vegan diet include:
  • Lack of key nutrients - calories, protein, fat, vitamin B12 and calcium: For most vegan foods, you need to eat larger volumes in order to get the same amount of calories. For example, you would have to eat 35 cups of green beans to get the same number of calories in a pound of hamburger meat. Dancers burn more calories than the average person so they need to fuel adequately - eat more, not less. By eating calorie-dense foods, like avocados and dried fruit, your energy needs can be met. It is also crucial to eat something starchy at every meal such as whole-wheat varieties of cereal, pasta, bread, rice or potatoes. Nuts and seeds are also excellent options for snacking.
    • ​Vitamin B12 only exists in animal products (IOM, 1999). Animals obtain vitamin B12 by eating foods that are covered in bacteria or from the bacteria that already line their own guts. One study showed that over 85% of vegans were B12 deficient. This is alarming, considering the role of B12 in nerve function and neurological function. Over time, deficiency can cause severe anemia and paralysis (Pawlak et al., 2014).  Solution: The daily requirement for adults is 2.4 micrograms of B12 per day. Eat fortified foods two or three times a day to get at least three micrograms (mcg or µg) of B12 a day. As an alternative, take one B12 supplement daily providing at least 10 micrograms or a 2000-mg B12 supplement weekly.
    • ​Dancers are prone to stress fractures, so bone-building calcium is especially important. It is true that there are plant sources of calcium,but in limited amounts that are a fraction as absorbable as the equivalent of calcium. Solution: females ages 9 to 18 should aim for 1,300 mg of calcium a day from sources like tofu fortified with calcium, kale, broccoli and calcium-fortified soy foods or cereals. A calcium supplement with magnesium may also be helpful if you are concerned about your intake.
  • Protein from plant sources is not as complete as animal sources, This means that individual plants do not provide all the essential amino acids needed by your body. Examples of appropriate protein combinations include a peanut butter sandwich on whole-grain bread, brown rice and black beans, or lentils and barley.
    • Because animal and soy products are complete proteins, they can be consumed with any grain, legume, or nut/seed. Quinoa also happens to be a complete protein, although it has fewer grams of protein per serving compared to animal products.
  • Not having enough fat in your diet can lead to inadequate body fat, which can influence your hormones and  menstrual cycle. Vegans have to get the fat elsewhere which can include avocados, nuts, canola oil, or grapeseed oil. 
  • Excess fiber and phytate may interfere with mineral absorption. Green leafy vegetables are a great source of vitamin C and K as well as minerals such as iron and magnesium. Vegetables also contain high amounts of fiber and a substance called phytates. Both bind minerals and hinder their absorption. Include these foods, but be conscious of consuming them too frequently and avoid juices with high concentrations of green vegetables.

To prevent long-term deficiencies, vegan dancers should be especially diligent when preparing and managing food intake and should consider working alongside registered dietitian to ensure their needs are being met.

References:
Melina, V., Craig, W., & Levin, S. (2016). Position of the Academy of Nutrition and Dietetics: vegetarian diets. Journal of the Academy of Nutrition and Dietetics, 116(12), 1970-1980
Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press, 1998.
Brown, D. D. (2018). Nutritional Considerations for the Vegetarian and Vegan Dancer. Journal of Dance Medicine & Science, 22(1).


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6/20/2019 1 Comment

Navigating Food Choices When Traveling

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Traveling to a summer intensive or performing on tour can be exciting and educational, however being away from home presents several challenges related to good nutrition. Many factors may be out of your control, so it is important to be prepared and resourceful as you try to maintain some semblance of your usual routine. Below is some practical advice for nutrition during travel.
  • Check with hotel or schools ahead of time and research menus of restaurants that will be convenient to access during your trip. Options may be limited where you are traveling, but don’t overlook grocery stores or coffee shops that may offer healthy options. Even if your friends choose to stop at Taco Bell after rehearsal, make a trip to the grocery store to purchase prepared fruit cups, peanut butter, whole-grain bread, and rotisserie chicken. Even if it is not a traditional evening meal, oatmeal with almond butter or yogurt with granola are still good options for a satiating and nutritious bedtime snack.
  • If storage and refrigeration are a problem - pack nut butter and crackers, tuna in a pouch, and nuts or seeds. Use an insulated lunch bag to carry cheese sticks, yogurt, and hard-boiled eggs.
  • Make sure to practice food safety to avoid food poisoning, especially if traveling overseas. Don’t eat raw or undercooked meat and eggs or unpasteurized dairy. If the tap water is not safe to drink, use bottled or disinfected water to drink and wash produce.
  • Food establishments may not be open by the time you finish rehearsal or performance for the day. Plan ahead so that you have a hearty snack to eat right after the show as well as something ready to eat when you return. Having a more filling lunch is also appropriate to ensure you have enough energy to get you through the long evening.
Cafeteria-style dining can be convenient and healthy if you make the right choices.
  1. Be aware of all options prior to making selections for a meal.
  2. Choose fruit bowls and use the salad bar.
  3. Inform cafeteria staff if you have allergies.
  4. Allow enough time to pack a lunch if you are to take the cafeteria food to the studio for the day.
  5. ​Just because there is an ice cream machine doesn’t mean you should have ice cream with every meal - but remember it is ok to indulge in an occasional treat!
  6. Make a new friend to sit with at meals.

Have a safe, successful and healthy trip!

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4/3/2019 1 Comment

The Female Athlete Triad - Are You At Risk?

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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.

References:
  1. Barrack, M. T., Gibbs, J. C., De Souza, M. J., Williams, N. I., Nichols, J. F., Rauh, M. J., & Nattiv, A. (2014). Higher Incidence of Bone Stress Injuries With Increasing Female Athlete Triad–Related Risk Factors: A Prospective Multisite Study of Exercising Girls and Women. The American journal of sports medicine, 42(4), 949-958.
  2. Little, M., Brown, K., Brown, A. F., & Meenan, M. (2017). Dancers' Risk for the Female Athlete Triad, Disordered Eating, and Changes in Triad Knowledge Following Educational Intervention. Journal of the Academy of Nutrition and Dietetics, 117(9), A85.
  3. Matzkin, E., Curry, E. J., & Whitlock, K. (2015). Female athlete triad: past, present, and future. Journal of the American Academy of Orthopaedic Surgeons, 23(7), 424-432.
  4. O’Malley, M., Hamilton, W, Munyak, J., DeFranco, B. (1996). Second Metatarsal Stress Fractures in Dancers. Foot and Ankle International, 17(2): 89-92 ​​
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