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By Elizabeth Carly Gessin
The warning signs were hard to miss. The student came to class looking pale and drawn. She was losing weight. She seemed listless. Before class began, she often boasted to friends about how long she’d exercised the night before. Elizabeth Shea, coordinator of the Indiana University Contemporary Dance Program, suspected that the student might suffer from the Female Athlete Triad. Shea knew she needed to have a talk with the student. “Sometimes dancers seem unaware they’re falling into an unhealthy state,” Shea says. “We can help them recognize there may be a problem.”
Many dancers and dance teachers have heard about the triad. Most summer intensives and college dance departments include a discussion of its symptoms in their wellness programs. A combination of disordered eating, menstrual irregularity, and bone loss that’s triggered by overexercise, the triad leads to an overall weakening of the skeletal structure. This can lead to fractures and breaks with longer healing periods. By her 40s, a dancer can have osteoporosis.
Though dancers can see their careers cut short by injury and arthritis, many ignore the signs of a developing problem. Here are some clues.
If I Eat, Then I Exercise
Most dancers watch calories, but for some, keeping an eye on what they eat becomes an obsession. They start to make up exercise equations. “A dancer may tell herself, ‘If I eat this piece of bread, I will run two extra miles,’ ” says John Schrader, a clinical professor of kinesiology at Indiana University. The pattern can ratchet up gradually, at first seeming merely like an ambitious cross-training program. Frequently the dancer ends up no longer eating enough calories to keep up with her energy output, which lowers estrogen levels. Over time, a dancer’s body fat can drop to a point where she no longer gets her period.
So What If I Skip My Period?
Losing your period may seem great at the time. No cramps, no bloating, no bleeding. But amenorrhea (its medical name) can have long-term consequences for bone density. Estrogen is essential to the body’s calcium uptake. Too little in the bloodstream jeopardizes bone health. Since maximum bone density must be reached by the time you turn 30, dancers can permanently undermine their skeletal strength. The combination of physical fatigue from inadequate nutrition, poor calcium uptake, and overuse of bone from too much exercise can make dancers prone to stress fractures, notes Schrader.
My Hands and Feet Are Cold!
Intense exercise also can lead to lower blood pressure. That sounds healthy, but if your metabolism sinks too far—everyone has a different set point—it can have an impact on your body’s circulation. This can cause cold hands and feet and paleness.
All of these symptoms can signal that you’re sliding into the triad. So can mood changes and personality swings, notes Monika Saigal, a registered dietitian at Midtown Nutrition Care in New York City who works frequently with dancers. She has found that the first and hardest step is getting a dancer to admit she might have a problem. “There’s a huge amount of denial,” agrees Schrader. One way is to focus on the consequences for their dancing. “If you are caught up in this particular syndrome, you will absolutely have a shortened career,” says Saigal.
Admitting that there’s a problem opens the door to recovery. And gaining even a small amount of weight can reverse the loss of menstruation, so adding a snack or two a day of high quality food can help. “Protein is needed for muscle repair,” notes Saigal, “and calcium is needed for bone health. Fish, turkey, beans, nut, eggs, and dairy products are all good sources of protein. Low-fat milk, cheese, and yogurt are good sources of calcium.”
Saigal recommends a snack like an apple with a tablespoon of peanut butter and a cup of skim milk. And it can help to talk to a doctor or therapist.
As one dancer, Samantha Jones*, discovered, reaching out makes a difference. “Life doesn’t have to be like this,” Jones says. “Talk to someone—don’t isolate yourself. That’s a prescription for bigger problems.” When a teacher expressed concern, Jones realized that she needed help. She started to see a nutritionist. “You learn to love life again,” she says. “You take it one day at a time.”
To find doctors and registered dietitians with experience in working with the triad, visit www.scandpg.org; www.eatright.org; www.healthprofs.com.
Elizabeth Carly Gessin, a former DM intern, recently graduated from Indiana U.
*The dancer’s name has been changed to protect her privacy.
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