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.

More Reasons Why Dance is Good for Our Bodies

           "Stifling an urge to dance is bad for your health - it rusts your spirit and your hips." - Terri Guillemets

         We begin dancing, our heart rate increases, the number of blood vessels increases, increased blood flow delivers more oxygen and nutrients to our muscles, and our circulatory system becomes more efficient as was discussed in last week's post.

           Additionally, our nervous, skeletal, and muscular systems are called upon to work at their peak levels, and our bodies reap the benefits.

            As we dance, our nervous system responds in a variety of ways.  The nervous system is continually growing and adapting to accommodate the body’s needs. Each time we engage in a new movement, a new neural pathway is formed. This pathway is the route that a message travels on to go from the brain to the muscle and back to the brain again and is made up of specialized cells called neurons. Messages are passed along the neurons with the help of substances called neurotransmitters. As we begin to move, the brain, which is the control center of the nervous system, signals the body to release extra proteins and neurotransmitters. The proteins promote new neuron growth, and the neurotransmitters help to improve the speed at which messages travel the pathways. These new, efficient neural pathways increase muscle responses and coordination.

            Additionally, when we dance, the brain releases endorphins, which are hormones that promote feelings of happiness and euphoria. These feelings help improve moods, and studies have shown that physically active people recover more quickly from mild depression and have a healthier mental state.

            Dance can also create a healthier skeletal system.  Since dance is a weight bearing activity, it can positively affect bone density.  The cells in our skeletal system respond to increased weight loads, or stressors, by increasing bone tissue to protect the body.  The constant impact with the floor that occurs when dancers execute dance steps, jump, and practice choreographed falls increases the load, or amount of weight, the body must support. The bones respond by adding more layers of protein cells called collagen to support the load.  These layers increase bone density and help protect against broken bones and stress fractures. Dancing can also decrease the risk of developing osteoporosis, which is a bone disease that manifests itself in brittle bones that break because they are not dense enough to support the body and the loads placed upon it.

            Lastly, the muscular system’s response to dance is also a healthy one. As we dance and call upon our muscles to move our bodies in various ways, several things happen. As physical activity increases, the number of mitochondria found in muscle cells increases. The mitochondria are the organelles found in individual cells, which produce the ATP, or energy, that the body needs to move. The more mitochondria in our muscles cells, the greater the energy production capabilities. As muscles are exercised continually, individual muscle fiber size increases by 40-50%. As fiber size increases, muscles grow stronger, the nervous system must create more neural pathways, and muscles generate more power.  Additionally, connective tissue like tendons and ligaments also grow stronger, and the body develops greater protection against injuries.

            Clearly, dance provides the body with a multitude of benefits and can create happy, healthy people when they take the time to learn to dance in ways that are anatomically correct for their individual bodies.

Eating Disorders: What's Happening on the Inside?

“Do I want to die from the inside out or the outside in?”

― Laurie Halse Anderson, Wintergirls

The human body is amazing and will go to great lengths to protect itself, and that is exactly why eating disorders are so devastating….

         Whenever a person “diets", drastically reduces caloric intake or skips meals, the body goes into survival mode.  The body instinctively believes there is a scarcity of food and, therefore, thinks it must conserve energy.  The metabolism (the rate at which the body converts food into energy) slows down so that consumed food will last longer.

         When diets become extreme, as in anorexia, the entire body slows down in an attempt at self-preservation.  The heart rate slows, and since the heart is a muscle, if activity slows down, the muscle begins to atrophy, or grow weaker.  The weakening and slowing of the heart causes a slower blood flow, which results in lower blood pressure.  These factors combine to cause fatigue, weakness and fainting.  Since the body believes there is not enough food to sustain its own activity, it will not allow the possibility of supporting a second life, and, therefore, the reproductive system shuts down.  Female anorexics develop amenorrhea (ceasing of menstrual periods), which can cause difficulty in getting pregnant in the future, and a decrease in estrogen levels.  The body uses estrogen to aid calcium absorption, and reduced calcium absorption leads to reduced bone mass, resulting in osteoporosis.  Restricting food means that the body is not getting all the necessary vitamins and minerals it needs to function.  Reduced calcium intake increases the osteoporosis risk, and decreased iron intake can lead to anemia, which causes fatigue and bruising.  As the anorexic’s weight decreases, his/her layers of fat are also reduced.  Without a sufficient layer of fat to preserve body heat, the body grows lanugo (a down-like covering of hair) over its entirety in an effort to stay warm.

Those suffering from bulimia are constantly bingeing on food and then purging the body of it.  This behavior keeps the body from absorbing necessary nutrients and causes electrolyte and chemical imbalances.  Sodium and chloride regulate fluid levels in the body, and when there is an imbalance in these minerals, dehydration can occur.  Sodium is also responsible for generating electrical impulses.  A sodium imbalance can be responsible for nervous system malfunctions. Potassium is used by the body to regulate heart rate and muscle function.  Too much or too little potassium can lead to arrhythmias (irregular heartbeats), which can cause heart failure.  Unbalanced potassium levels also affect the nervous and muscular systems, resulting in diminished reflexes.  The purging behavior irritates and inflames the esophagus which results in a chronic sore throat and can lead to an esophageal rupture.  The constant abuse weakens the stomach muscles making the stomach susceptible to ulcers.  A weakened stomach operates slowly, and food that is in the stomach remains there for a long time, allowing bacteria to grow and an ulcer to develop.  Since the stomach walls are weakened, there is also the potential for stomach ruptures.  Dental health is also affected, and the teeth become stained and decay from the stomach acids they are exposed to each time a bulimic vomits.  As in anorexia, there is a disturbance in menstrual function, and the reproductive system begins to shut down, putting the female bulimic at risk for future pregnancy complications as well as osteoporosis due to reduced estrogen levels.

         Eating disorders may begin as a small pre-occupation with food, but they soon take on a life of their own.  The psychological part of the disease drives the illness, but the physical destruction is widespread, not always reversible and can be fatal.

         My next post will focus on the role dance educators can play in helping to reduce the risk of eating disorders among their students and the resources that are available for those battling these diseases.

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Why Dancers May Be At Risk for Stress Fractures and Osteoporosis

"Movement is life. Life is a process. Improve the quality of the process and you improve the quality of life itself." – Moshe Feldenkrais

            Dancers exercise daily. They are constantly on their feet.  They jump, they turn and they constantly apply additional stress to their bones.  The skeleton knows how to respond to this stress, it grows, or models, more bone to support it.  However, studies of ballet dancers have found that they are at risk for stress fractures and that their bone mass measurements, or bone mineral density scores, are equal to or below that of their inactive peers.  How can this be true?  Why isn’t the body doing its job?

            The answer is that the body can only do its job or respond properly if it’s given the right tools and cues.

            Dancers tend to be thin and even underweight.  Less weight means there is less stress put on the bones on a daily basis.  Therefore, even though classes and rehearsals include weight-bearing exercises, the stress on the skeleton is still less than it would be for someone who falls into the ideal or average weight bracket.

            Dancers are known to restrict the amount of food they eat.  There is a constant pressure in the dance community to eat less and look thinner.  Additionally, dancers spend an enormous amount of time doing physical activity.  Large amounts of physical activity burn large amounts of calories.  When that factor is combined with a low or restricted caloric intake, the body is burning more fuel than it is receiving and an energy deficit is created.  Research has linked energy deficits to lower bone mineral density values.

            Restricting food can also lead to diets that are low in nutritional value and high in caffeine.  Diets lacking in nutritional value tend to be low in calcium, which is necessary for bone growth and development.  When you add that caffeine interferes with the body’s ability to absorb calcium, a recipe for a calcium deficit is created.

            Moreover, studies have shown that poor diets can lead to disruptions in the reproductive system.  Research has shown that female dancers go through adolescence and get their first period, or menarche, later than their peers.  This delay in adolescence means there are lower levels of estrogen in the body, and estrogen plays a big role in making sure that the body can absorb the calcium that is eaten.

            Since it is important for the body to create and “stock up” on as much bone as possible during the teen years to avoid fragile bones, it is easy to see why dancers might be at risk for developing osteoporosis.  The good news is that dancers, when armed with some knowledge, can change that.

            Additional weight-bearing exercises can be added to a dancer’s life - weight training and walking can easily be added into a training schedule.  Knowing how to properly fuel the body is important for everyone, but it is especially important for dancers and athletes.  Our next post will help you figure out how to do just that!

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Dancers & Bone Health

“The harder the demand placed upon the structure, the stronger the foundation must be.” Our bones – they protect our organs, they manufacture red blood cells, they store calcium, they provide a place for muscles to connect, they permit movement and they provide the framework for our bodies.  Without our skeletal system, we could not exist, yet we rarely think about how our bones develop or bone health. Although our bones appear sedentary, bone tissue is very active and each week 5-7% of our bone mass is recycled, or remodeled.  The outer surface of our bones is compact bone, which is composed of a web of proteins that hardens into a tough structure.  The inside of our skeletons is made of spongy bones with spaces in between the bone cells. Our bones grow from the outside in.  Specialized cells called osteoblasts build bone by travelling to the surface of the bones and depositing collagen molecules between the structural cells to form a matrix and that hardens into layers of compact bone. Meanwhile, other cells called osteoclasts resorb, or breakdown, the mineralized matrix from the inside.  The bottom most layer is dissolved and calcium is released into the bloodstream. This process serves to renew our bones and occurs in a balanced manner most of the time.  During growth spurts, and especially during adolescence, the creation, or modeling, of new bone occurs in addition to the remodeling process, resulting in a surplus of new bone. It is also important to know that osteoblasts (the builders) respond to increased loads that are placed upon the bones such as weight training or weight bearing activities like walking, running and jumping.  When the body recognizes an increased load, or stress, on the skeleton, the osteoblasts are called in for overtime and begin to model more new bone to protect the body against the increased strain. Bone cells grow old like any other cells, and, unfortunately, osteoblasts (the builders) age quicker than the osteoclasts (the dissolvers).  Between the ages of 30 and 40, the osteoblasts begin to slow down while the osteoclasts continue to resorb bone tissue.  A deficit of bone mass is naturally created which can lead to osteoporosis.  People with osteoporosis have brittle, fragile bones which can fracture easily. The best defense against osteoporosis is encouraging the body to create as much bone mass as possible during the formative years and to stimulate the osteoblasts with weight bearing physical activity. Since dance is a weight bearing activity, it would seem that dancers have nothing to worry about, right?  Next week’s post will explain why dancers have to be concerned.