As a registered dietitian, I'm often asked:
"Do you recommend supplements?"
"Can you recommend a supplement for me?"
"When people recommend taking a 'high-quality supplement,' what does that even mean?”
Here are my usual responses:
“How much time do you have?”
I promise, I’m not dodging the questions, it’s just that it’s, well, complicated and giving one-off answers can sometimes lead to more harm than good. Without getting too deep or diving into all the science, I'm going to break it down for you and give you some fundamentals. One of the things I love about dancers is that they have a deep understanding of how important the fundamentals are: We call it technique. It’s foundational to everything you do and determines not only how well you can dance, but also protects against injury. Nutrition is the same. Rather than start with pliés and tendus, we start with what your day-to-day intake is, which we generally call your “diet."
The most basic of the basics:
When it comes to dietary supplements, here are the most basic concepts:
*Repeat after me.*
So what constitutes a “bad diet”? Generally, it's one that's inadequate in macronutrients, micronutrients, fiber, or phytonutrients. It may provide insufficient or excessive energy for demand. It typically includes an abundance of processed foods and a paucity of produce. It may include foods that elicit chronic inflammation. In summary, it’s a pattern of food and eating choices that don’t support health, wellness, longevity, or performance. Food doesn’t just provide the fuel needed for life, training, and performing, it provides the building blocks necessary for functions of metabolism, immunity, growth, recovery, and repair, just to name a few.
Now it's my turn to ask some questions:
When a dancer, or their parent, ask me about supplements, these are a few of the questions I ask. It’s not all of them, but it gets us started.
(Do you have targeted needs or are you looking for a nutritional "insurance policy”?)
(Some medications and supplements don't play nicely together.)
(Filling in the gaps with diet changes is always my first choice.)
(Are you on the road? Competing? Performances? Summer intensive? Off-season?)
Demands, demands, demands!
Dance was recently ranked as the most physically demanding job. Physically demanding activities come with a risk of injury. Dancer injuries aren't a question of if but when. We define "when" in terms of hours, not years. For every thousand hours of dancing, you can expect to have around 6 injuries. The severity of injuries varies, but the science is pretty consistent about the frequency. It seems reasonable to think that the most physically demanding job would require some serious attention to the details of nutrition.
An injury we see far too often is stress fractures in the lower leg, and dancers' feet are especially susceptible. It's a big reason why bone health is a topic of concern in the dance world. When people think about healthy bones, calcium comes to mind. It's true that calcium is important to bone health, but it's not the only thing. Bone is actually considered connective tissue and it is constantly remodeling. To keep up with the process requires a host of vitamins and minerals including protein, Vitamins A, C, D, K1, and K2, in addition to the minerals calcium, magnesium, zinc, manganese, boron, copper, silicon, iron, and selenium. You can certainly find all these nutrients in supplement form, but if you don't eat enough food, your body won't produce the hormones needed to support bone health. No matter how many vitamin and mineral supplements you throw at it, persistent caloric inadequacy in dancers can lead to stress fractures. Ouch.
We are physiologically designed to get our nutrients from food. However, even if you eat well and do your best to meet all your nutritional needs, it may be appropriate to add supplements to your routine. Supplements come into play when there is an internal or external influence that keeps us from buying, preparing, eating, digesting, or absorbing foods.
Here are just a few examples of when targeted supplementation would be recommended:
There's that term "high-quality" again. What does it mean, exactly?
High quality means your supplement is what the label says it is. There’s nothing in it you don’t expect; it’s not contaminated; it’s in a form that is biologically advantageous, and it’s been produced and stored in a way that means you should achieve the intended results if taken properly. High-quality supplements can be expensive. Really expensive. Why do they cost so much?
Take fish oil supplements. It takes a lot of fish to extract the EPA and DHA that support brain health and have been shown to reduce inflammation. Reputable manufacturers of fish oil supplements are also mindful of how they source their fish to minimize the impact on the environment and to ensure safe options for their customers. If you have access to wild-caught, cold-water fish like tuna, mackerel, cod, or sardines, you may be better off eating the whole-food source instead. Not only will you get the benefit of the high-quality fish protein that has been shown to support muscle growth and development, but it may also be more cost-effective. Economical options include canned tuna, sardines, or salmon. As a bonus, fish that are canned with the bones intact is a good source of calcium.
Supplements fall under the jurisdiction of the Food and Drug Administration (FDA). The Dietary Supplement Health and Education Act of 1994 (DSHEA), is a 1994 statute of United States Federal legislation that defines and regulates dietary supplements. Essentially, legislation was driven by consumers that effectively treats supplements more like food than drugs. The FDA is busy, and with over 85,000 supplements on the market, it doesn't act as the supplement safety police. Rather, individual companies are given the task to self-regulate. This is where that whole "high-quality" part comes into play.
Supplements, like food, are assumed safe unless proven otherwise, unlike drugs, which must be proven to be safe before they hit the market. This isn't a bad thing, it simply means the buyer must beware. Reputable manufacturers hire outside companies such as NSF International to ensure the safety, quality, and efficacy of products. This is a multi-faceted process that includes testing ingredients for safety and efficacy, inspecting facilities, and randomized testing of supplements produced. Look for the NSF or NSF Certified for Sport label or consult with a registered dietitian or other health care provider well-versed in supplements for brand recommendations.
3. The form
Minerals are often chelated for better absorption. Some processes of chelation are better than others, which may be reflected in the price. Many vitamins come in more than one form, including the B vitamins folate and B12. A less expensive form of folate, called folic acid, can be found in multi-vitamins and in enriched grain products like bread and cereal. However, if you have a common genetic variant called an SNP (pronounced, "snip") you may not be able to metabolize the synthetic version, leaving you with a build-up of folic acid and a deficit of the methylated version your body needs. Methylated folate is available in higher quality multi-vitamins, which tend to be more expensive. Folate is also widely available in a variety of dark leafy greens, legumes, citrus fruits, asparagus, broccoli, and eggs, to name just a few food sources.
The cheaper alternative may come with their own costs. They may sit on store shelves for years or left in heated trucks to degrade. They may contain contaminants, illegal ingredients, or allergens not listed on the label. The ingredients may not be included in the amounts listed or in a form that is biologically active. One of the reasons they’re cheaper is that the company isn’t paying for third party testing, which can also be an indicator of their commitment to quality. A registered dietitian can recommend specific trusted brands to ensure you get what you expect and what you need.
So, what's the verdict?
When used properly, high-quality supplements can be a useful tool in the dancer's nutrition plan. Keep in mind, supplement recommendations are best when they come from a qualified health care provider, namely a registered dietitian nutritionist (RDN), after a thorough review of your health and medical history, diet and nutrition history, and review of lab work you may have recently done. If you're on a tight budget, food, even expensive food, is almost always your cheapest source of quality nutrients. A registered dietitian can help you plan meals to meet your needs as well as help you prioritize what, if any, supplements you should take.
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About Kristin Koskinen, RDN
Kristin Koskinen, RDN, LD,CD is a registered dietitian who grew up dancing. Her interest in nutrition began when she was in her teens and danced in a pre-professional ballet company. There was a lot of talk among the dancers about diets and weight loss, but not much understanding about nutrition to maximize performance or the disordered eating that too often results from dieting. Now, she is a resource for dancers and those who support them.
Kristin owns a private practice where she offers nutrition counseling with a focus on performance nutrition. She incorporates the functional aspects of food in her approach to help artistic athletes of all levels. Her integrative approach recognizes that nutrition isn’t just about the food you eat. It’s important to take many factors into consideration, including the environment, cultural influences, social norms, and body image, especially when working with dancers.
She is an active member of the International Association for Dance Medicine & Science, Academy of Nutrition and Dietetics, Doctors for Dancers, and a founding member of DanseMed. She is regularly invited to speak on topics related to dancer health and is a frequent contributor to media including Dance Magazine, Shape, Oprah, Healthline, NBC, and Today.com. You can find her on social media or at her website, www.eatwellpros.com.
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