Who hasn’t tried to disconnect mind and body, and try to explain their symptoms by one, but not the other? This is very common, and probably due to a lack of understanding how these two are connected, or quite literally intertwined. By educating yourself about this connection, you can turn this knowledge into your superpower, and it can make all the difference between being a good dancer and an excellent dancer.
So let’s get started!
UNDER-EATING: Whilst it’s still a widespread belief that dancers need to restrict their food intake to ‘look the part’, in reality this couldn’t be further from the truth. Recent research (Keay N, AusDancersOverseas, Francis G, 2020) has - once again - shown that the prevalence of under-eating/disordered eating and eating disorders in the dance population is still alarmingly high, and sometimes even reinforced. Out of 247 dancers, 71% of female dancers and 43% of male dancers stated that a leading role would favor someone of lower weight rather than height. Furthermore, 44% of female dancers and 32% of male dancers reported that they had been told to lose weight at some point in their training or professional career, most often by teaching staff or directors. 83% of dancers were influenced by social media in trying to lose weight, with 30% of females dancers and 14% of male dancers saying that this was a constant influence. So, there’s no way to sugarcoat it - the dance industry still has a huge problem with weight, which in turn leads to the high prevalence of dancers not eating enough to be healthy and dance at their best.
We need to ask, why is it possible that dancers can still achieve what is considered to be ‘excellent’, when so many of them rarely eat enough? No, I won’t talk about the ‘starving artist’ and the beliefs and myths people have made up around this phenomenon. I’ll talk about the physiological reasons behind the ability to cope, even with the most adverse of circumstances - and the high cost that comes with it; and also why audiences are okay with sub-optimal performances, because no one can be ‘at their best’ when the body trying to achieve this ‘best’ performance doesn’t have the energy to do so.
So, here are the facts:
Our genetic heritage will forever prioritize movement, even if you severely under-eat/restrict food intake - and that’s why it can be so hard to spot what’s going on, or if anything is going on at all. Because … somehow, as long as you can dance, you must be healthy, right?! This age-old mechanism in our body is a really smart one, but not necessarily helpful when it comes to dance. If the body shut down movement instead of multiple processes in the body, dancers (and their teachers) would spot the signs that there’s something not quite right so much earlier (and easier). But what actually is shut down if we don’t eat enough?
Not eating enough to cover everything your body needs without dancing, PLUS everything your body needs when dancing has a multitude of negative effects on health and performance. Let’s look at effects on health first:
- Bone health: Many dancers present with (stress) fractures, which is possibly one of the most obvious signs. Other dancers find out by chance that their bone health isn’t great (often when other symptoms of under-eating are investigated, e.g. loss of menstrual cycle in female dancers)
- Immune system: Frequent infections or infections are rather severe? Wounds aren’t healing well? These can be signs that your immune system doesn’t have enough energy to build a thorough defense.
- Gastrointestinal problems: This is so well-known among dancers - and yet, rarely associated with under-eating, but instead a belief that you must be intolerant to the foods you ate. Cutting out is often the dancers’ go-to option. In reality though, the gut is upset as it’s not getting enough energy to function well.
- Hormonal issues: Feels like you’ve plateaued in your training? Humans need growth hormone (GH) - amongst others - to adapt to their training. Under-eating lowers growth hormone levels - and adaption is no longer taking place. Many dancers think this is when they need to put in the extra hours in the studio, maybe even on a rest day - and the results are fatal.
- Metabolic issues: With hormones and our metabolism being closely linked, it isn’t a surprise that what affects one, affects the other. Typical, albeit unspecific, signs are often that you’re feeling cold, tired, sluggish, unmotivated with little ability to concentrate (woohoo, this is where the connection between body and mind comes into play, more on that in a minute).
- Growth and development: There’s a certain belief in dance that a late maturation, especially in girls in ballet will result in a ‘better ballet body’. It doesn’t. Not only can a delayed maturation result in all of the above symptoms (plus more to come below), the biggest problem is that a huge chunk of maturation then takes place when the dancer is ready to graduate and dance professionally. This shows in physical symptoms (often feeling weak, uncoordinated and less flexible than before), but also, and please do not underestimate these - in mental symptoms: Research has shown that female dancers with delayed maturation perceive themselves as not ready for the profession, and can feel socially isolated, or even anxious on top of that (Mitchell S et al., 2016 and 2020).
- Cardiovascular complications: This one may not appear to be obvious, but let’s just take a moment and appreciate that our heartbeat requires energy. So when it comes to under-eating, your body has to decide where to lower its energy requirements (or shut them down completely), and your heartbeat obviously isn’t part of this - which is good news. The bad news is that this doesn’t mean your heart and circulation are okay. A severely underfueled heart tends to reduce the number of beats per minute to preserve energy, which in turn means that your heart has a hard time supplying blood (and with it oxygen) to all the places where it is needed for while dancing. Dizzy while doing a forward port de bras? Uhum ….. On top of that, with a slowed-down heart rate (that isn’t due to being really fit - under-eating and being fit are mutually exclusive), many processes in the body are slowed down, affecting not only your gastrointestinal health but also your brain health.
- Hematological issues: Rather deranged blood parameters in underfed dancers are common. These can include anything from blood cell or platelet counts (think immune system or blood clotting) to nutrients (think iron or vitamin D or vitamin B12 - and many more) and hormones (cortisol, our stress hormone skyrockets whereas hormones for adaptation to training, bone health, brain health, or the menstrual cycle in female dancers are low/shut down).
- And here we go, the menstrual cycle: This monthly, free health-check ceases in a high number of female dancers (or they don’t get it in the first place). And while many think that having babies really is the last thing on their agenda right now, the hormones involved in this cycle, and in particular estrogen, play a big role in bone health (going back to point no 1!), cardiovascular health (Oops, we’ve just been there, right?), skin health (the skin is our biggest organ), as well as brain health! Having low levels of estrogen can result in low mood, depressive symptoms, feeling anxious, irritable, inability to focus (What did the teacher just say?) as well as deficiencies in your ability to memorize (Uhm, what was yesterday’s choreo like?).
- Female versus male dancers: Male dancers have consistently shown to be more resilient to low energy availability (under-eating), however, they can be affected as well (Areta J et al. 2021). Any sign except for the menstrual cycle can show in male dancers as well. And instead of losing a cycle (which they don’t have in the first place), a sign that their reproductive health is affected can be that they feel a loss of libido and/or morning erections. We should not assume that male dancers are not feeling a similar pressure to ‘look the part’: Results published in 2020 (Keay N, AusDancersOverseas, Francis G, 2020) indicated that a significant number of male dancers are being told to lose weight (usually by teaching staff/directors) or to cut out foods. Furthermore, social media plays a huge role in making them believe that they need to ‘tone up’ or ‘slim down’.
So, next up are effects on performance - because we don’t really believe that if our health is affected we can still dance at our best, do we?! Exactly.
- Increased risk of injury: This now makes total sense after having read the effects on health.
- Decreased training response: No/insufficient levels of hormones - no adaptation to training.
- Decreased coordination: Our coordination is an intricate interplay between brain and body. If both are lacking in energy how would we expect to have the coordination required for dance? Off-balance all the time? It may be time to stop blaming your technique (or teacher) and start looking into your diet …!
- Decreased muscle strength and glycogen: Glycogen (a carbohydrate) is the very energy that ‘powers’ your muscles, whereas strength has a lot to do with protein. Both nutrients are needed for optimal muscle health. Not getting enough? You’re likely to feel fatigued early on in class.
- Decreased concentration: Learning choreography gets harder? Or you find it difficult to follow conversations? Your brain is quite an energy-demanding organ. If it doesn’t get enough, it will let you know. But you need to be able to read the signs - and hooray, that’s why you’re here!
- Irritability: Think back to estrogen being part of the body for ‘good mood’; no estrogen = no good mood.
- Impaired judgement: That is the effect when your brain doesn’t get all the nutrients and transmitters it needs to function properly. The sad part here is that you think you’re being smart in what you’re doing, but in hindsight, dancers always admit that their choices really weren’t great.
- Depression: This is a multi-layered illness, and while personal factors, and/or character traits play a big role in developing depression, so can all of the above mentioned factors and behaviours. Serotonin, our happy hormone, has a precursor that is called tryptophan. We consume tryptophan with our diet - and some of our gut bacteria can actually build tryptophan (but they need food for it!), but to facilitate tryptophan uptake into the brain, we need insulin, a hormones that is released after eating carbohydrate-rich meals. No/not enough insulin (aka ’cutting out carbs’) = no happiness (this is slightly simplified, but a good start to understand how connected the mind and brain are, and how important good nutrition is). It always makes me so sad to see dancers being treated for depression, and a lot is invested on behavioral therapy, but nutrition isn’t addressed at all. Despite so much research over the past decade showing how connected these two are.
STRESSING ABOUT YOUR BODY: We’ve briefly touched on cortisol, our stress hormone. It is worth mentioning it again, as its release is connected with physical activity as well as emotional stressors. While the stress that exercise puts on the body can be beneficial, the emotional stress that many dancers experience (body shaming, being criticized for their body, connecting their appearance to their artistry, etc) is not detected as beneficial by the body, but rather the opposite. The body believes there is an actual threat (‘fight-or-flight response’) and will try to preserve as much energy as possible, as it doesn’t know how long this threat will last. Its go-to mechanism is to break down muscle tissue and instead pile on body fat tissue.
The explanation for that is actually quite rational: Body fat stores more than 2x the energy of muscle tissue, which means the more body fat that is stored, the longer your body can fight against this threat. There’s no way that we’re making our body understand that we’re ‘just’ stressing about our body - it will take it personally. In turn, this means that not only areas with a high number of cortisol receptors in your brain will be alarmed, no longer supporting you to make good decisions or memorize well, the same reaction will also make you look bigger, as 1kg of body fat tissue takes up almost 2x the volume of muscle tissue. Working your way out of this situation requires you to not only eat enough (remember, under-fueling raises cortisol levels, too), but also learn coping strategies to help avoid emotional stress getting the best of you.
Last but not least: THE GUT-BRAIN-AXIS: The gut is often called our 2nd brain. While that may sound a bit odd, it is very helpful to understand that gut and brain do have a 2-way connection, or communication. Let’s just get back to stress: Stress down-regulates our digestion, just as much as not eating enough does. But then again, not eating enough also causes stress. So there’s no way to separate one from the other. The human body is hugely complex and I’d love dancers to understand that this isn’t something to fear, but rather to embrace. It helps us to become the artist we want to be.
Our gut is home to numerous microorganisms, most of them being bacteria. These little helpers use the food we eat to synthesize transmitters, which in turn are sent to the brain. A good diet allows us to support these microorganisms to produce transmitters that are beneficial for our health, and that make us feel good. Most people believe that is due to the ‘good’ bacteria, however that is oversimplified and would mean as long as we have good bacteria, we’re fine. Sorry to disappoint you, but if a dancer doesn’t eat enough, even the good guys can act out and make you feel terrible, because they no longer produce what would make you feel good; and your brain responds to it. Tapping into your gut health can therefore possibly play a pivotal role in your mental health. And it’s not only food or stress these microorganisms react to, it’s also a lack of sleep. Alright, so let’s work on sleeping better, right? Hm… you guessed it by now; good sleep is associated with eating enough. Let’s take a second and get back to tryptophan, the precursor of serotonin (’the happy hormone’). Our happy hormone in turn is the precursor of our sleep hormone, melatonin. Alllllright!
Human beings are complex and that’s part of what makes them so fascinating!! To sum it up: If we want to perform at our best, we need to eat, sleep, and deal with life at our best. We need to be at peace with who we are, and who we want to become. We’ve got some daily household chores to do, but they’re not really complicated, we just need to be taught ‘how to’. And as soon as we’ve nailed that, we’re good to go, and ready to start being the healthiest and best dancer we can be!
What makes the best dancer? Often the opposite of what you think it does.
And why do audiences put up with dancers not being at their best? Because not too many audiences experience what healthy (and happy) dancers can actually express. As they don’t know any better, they’re fine with what they see. The bulk of the work is within the dance world itself, and possibly the most crucial part in this work is educating dancers to make informed choices, being able to take care of the one and only instrument they have, their body.
Keay N, AusDancersOverseas, Francis G (2020). Indicators and correlates of low energy availability in male and female dancers. BMJ Open Sport Exerc Med, Nov 26;6(1):e000906. doi: 10.1136/bmjsem-2020-000906
Mitchell SB, Haase AM, Malina RM, Cumming SP (2016). The role of puberty in the making and breaking of young ballet dancers: Perspectives of Dance Teachers. J Adolesc, 47:81-9. doi: 10.1016/j.adolescence.2015.12.007
Mitchell SB, Haase AM, Cumming SP (2020). Experiences of delayed maturation in female vocational ballet students: An interpretative phenomenological analysis. J Adolesc, 80: 233-241. https://doi.org/10.1016/j.adolescence.2020.03.005
Areta JL, Taylor HL, Koehler K (2021). Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males. Eur J App Physiol, 2021 Jan;121(1):1-21. doi: 10.1007/s00421-020-04516-0. Epub 2020 Oct 23.
Overall concept of low energy availability as defined by the International Olympic Committee (IOC): Mountjoy M et al. (2018). IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med, 52(11):687-697. doi: 10.1136/bjsports-2018-099193.
Dr. Stephanie Potreck
Stephanie received early training in classical ballet, and later specialized in musical theatre. After a serious back injury, Stephanie studied medicine and worked in human genetics and global health before returning to dance as a healthcare professional. Specializing in the treatment of low energy availability and relative energy deficiency in sport (RED-S), she qualified in sports nutrition as well in order to be able to better understand and treat current problems in the dance world.
Stephanie is still an active researcher and has teamed up with Dr Nicky Keay in recent years. Her platform AusDancersOverseas is an educational hub with focus on providing high-quality evidence and support to improve physical and mental health in dancers, to use sports nutrition as a tool to help dancers not only be the healthiest but also the best they can be, and she’s never shy to call out mistreatment and abuse. She regularly teaches webinars for dancers, teachers, and parents worldwide, often together with Nicky Keay. Follow her on Instagram at @AusDancersOverseas