Thursday, 28 February 2013

Supplements use in dancers

Dietary supplements are taken by athletes to supplement their existing nutritional intakes and address any insufficiencies or deficiencies that may affect their health or performance. While some are taken for performance and others for health, others are completely pointless, occasionally dangerous, and all cost a considerable amount of money. Individuals with low caloric intakes may need to consider supplementation in order to ensure their nutrient intake is adequate. As many dancers use calorie restriction in an attempt to control weight and body composition, they are an at-risk group for nutrient insufficiencies/deficiencies and so it is worth considering where insufficiencies may arise.


First off, let's address common mistakes dancers make in supplement use. There are two in particular that permeate the dance community, one of significantly more concern than the other.

Multivitamins
Many dancers I know take multivitamins by the shedload. A fear of getting ill seems to underlie the belief that running down to Boots and shelling out for a jar with every letter of the alphabet on the front is going to stop flu hitting you. They're pointless. If you have a balanced diet you don't need multivitamins. If you don't have a balanced diet, sort if out, and you still won't need multivitamins.  Your body can only use so much of the vitamins you put in, anything over and above is a waste. Further to this excessive intake can cause gastrointestinal problems and the last thing you need is making yourself ill by trying to keep yourself healthy. Be sensible and eat a balanced diet and you should be getting the dietary vitamins you need.

Diet Pills
Okay, diet pills, fat burners, appetite suppressants. Stop, just stop. You exercise all day, you feel hungry; you shouldn't be attempting to suppress it, accept your body is needing fuel and feed it. Your body doesn't tend to be stupid, whereas your head will have it's moments; make sure when it comes to what you need you listen to your body.

Even the most 'natural' of diet pills, fat burners and appetite suppressants tend to contain excessively high levels of caffeine, if it's equal to 4 cups of coffee it's not good for your heart. Less innocently - if the ingredients include ephedrine or yohimbine you may end up experiencing some unpleasant, not to mention dangerous side-effects. Ephedrine increases blood pressure and is linked to the development of cardiac conditions, it causes gastrointestinal and genitourinary problems; restlessness;  insomnia; paranoia; hostility; panic and agitation. Yohimbine, a drug used to treat erectile dysfunction, similarly causes a rapid increase in heart rate and has been linked to kidney failure and seizures. It has never been proven to help weight loss. These two drugs show up regularly in diet pills and fat burners. These types of pills are often only available for a short space of time before concerns over their legality and safety are raised and they are taken off the market.

I'll assume you aren't willing to take methamphetamine to assist in your weight loss, so why take ephedrine or yohimbine?! If you take a pill that combines caffeine, ephedrine and yohimbine, you are at best going to feel agitated, hyperactive and have your heart thudding in your chest, at worst you are going to end up becoming seriously ill. The health risks completely outweigh any weight loss benefits. Control your body composition through nutritional intake and exercise, don't attempt to use pills to quell your hunger or allow you to drastically cut your calorie intake.

So now that the bad choices have been discussed, what, if any, supplements are useful for the dancer?

Vitamin D. 
Back to that again. Your main source of vitamin D is the sun, you train inside all day, rehearse inside all day, you don't see the sun, you become vitamin D deficient. Dancers aside, anyone who lives above 40 degrees north of the equator (most of Europe and half of the USA) are likely to have vitamin D insufficiency. Even in countries with high levels of sunlight such as Australia, vitamin D deficiency is being realised as a widespread and serious healthcare issue.

RDA guideline amounts are repeatedly being raised, as it turns out we need more than previously thought. What do you need it for? Only to improve your muscular strength; your calcium and phosphorus absorption and therefore your bone strength; strengthen your immune system; regulate blood pressure; prevent autoimmune conditions, various types of cancer, diabetes, cardiovascular disease, Parkinson's, multiple sclerosis, arthritis...convinced it's worth looking into? 50ug (2000 iu) daily has been shown improve muscular strength and power in dancers, and exceeds the currently low set level of RDA.

Calcium
Dietary sources of calcium
Again, with a balanced diet, supplementation should not be necessary. However due to the relatively widespread issue of low bone mineral density in dancers, calcium intake should be a consideration. If you skimp on calcium rich foods (dairy, sesame seeds, tofu, nuts, leafy greens) then yes, calcium supplements should be considered. But honestly, it's not that difficult to get consume adequate levels through your normal diet. Bare in mind that if your calcium levels show up low in a blood test but your diet seems fine, it may be calcium absorption that is the issue, where again, vitamin D plays a role.

Protein and Iron
Why would I put these together? Simply because deficiency is common in individuals with who are vegetarian and have low body weight, and so it's a consideration for the vegetarian diet. Protein supplementation isn't necessary if you balance your diet carefully, bare in mind if you are training hard you do need enough protein to build and repair your muscles. Dairy, pulses, nuts and eggs are all easy sources of increasing protein intake. Anaemia is not uncommon in dance, and is again a condition that often appears in vegetarians. If anaemia is present, supplementation is liable to be necessary, however do not take iron supplements without seeing your doctor first.  Increased consumption of seeds, eggs, leafy greens, dark chocolate and iron-enriched cereals will increase your dietary intake of iron without the need for supplementation.

Fish Oil/Omega 3

Your Grandma wasn't wrong when she would try to get you to drink a tablespoon of cod liver oil every morning, disgusting maybe, but not wrong. Omega 3 fatty acids are essential for health, however cannot be synthesised within the body. Omega 3 oils can improve cardiovascular health and lower triglycerides, they play a role in control of conditions such as rheumatoid arthritis and depression and have been linked to improvements in numerous conditions including ADHD, Alzheimers and dementia. It has anti-inflammatory properties that can help control joint pain and promote ease of movement. Most people in western cultures do not eat enough oily fish,  hence why supplementation is so commonplace. If your diet is low in oily fish such as tuna, mackerel or salmon, supplementation may be worth considering.
Getting nutrients from your dietary intake is always preferable to taking it from supplements - a balanced diet should provide you with almost all of the nutrients your body needs. If you are falling short of some though, supplementation is an easy way to address a deficiency. 



Sources:
Aulin, K.P. (2008) Minerals: Calcium in Maughan, R. J. (ed.) Nutrition in Sport: Olympic Encyclopaedia of Sports Medicine vol. VII. Chichester: Wiley, pp.318-325.
Cimolai, N and Cimolai, T (2011) Yohimbine use for physical enhancement and its potential toxicity. Journal of Dietary Supplements, 8(4), pp, 346-354.
Dwyer JT, Allison DB, Coates PM. (2005) Dietary supplements in weight reduction. Journal of the American Dietitians Association, 105(5), pp. S80-86.
Giampreti A, Lonati D, Locatelli C, Rocchi L, Campailla MT. (2009) Acute neurotoxicity after yohimbine ingestion by a body builder. Clinical Toxicology (Philadelphia), 47(8), pp. 827-829.
Forte RY, Precoma-Neto D, Chiminacio Neto N, Maia F, Faria-Neto JR. (2006) Myocardial infarction associated with the use of a dietary supplement rich in ephedrine in a young athlete. Arquivos brasileiros de cardiologia, 87(5), pp. 179-181.
Koutedakis, Y. and Sharp, N. (1999) The Fit and Healthy Dancer. 
Rovner, A.J. and O’Brien, K.O. (2008) Hypovitaminosis D among healthy children in the United States: a review of the current evidence. Archive of Paediatric and Adolescent Medicine162(6), pp.513-519.
Stockton, K.A., Mengersen, K., Paratz, J.D., Kandiah, D. and Bennell, K.L. (2011) Effects of vitamin D supplementation on muscle strength: a systematic review and meta-analysis. Osteoporosis International, 22(3), pp. 859-871.
Van der Mei, I.A., Dore, D., Winzenberg, T., Blizzard, L. and Jones, G. (2012) Vitamin D deficiency in Tasmania: A whole of life perspective. International Medicine Journal. Electronically published before print, 5 April 2012. Abstract only, available through www.pubmed.org [Accessed 9 April 2012].

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