Promoting Dancer Wellness: An Ayurvedic Approach

When one envisions a ballet dancer, the picture most frequently described is one of long lines, petite frames, and graceful limbs. Dancers at the pre-professional and professional levels put in long hours at the studio, perfecting their technique, and have often done so for many years. Training and performing at this level is considered a medium-high intensity activity and, therefore, requires extra fuel (food) to fulfill the demands requested of the body. Dancers, particularly those at the highest levels, face significant challenges with their nutritional habits, often influenced by societal pressures and industry norms. However, by integrating personalized nutrition based on Ayurvedic principles alongside conventional nutritional guidelines, dancers can address their unique dietary needs and promote overall health and well-being in a more effective way.

Seasoned dancers, with their muscular limbs and trim waistlines, are commonly associated with poor nutritional habits. The ballet culture, especially, is notorious for idolizing "thinness," striving for long lines, petite frames, and not overly muscular bodies. Young dancers wishing to seriously pursue dance as a profession often experience pressure and criticism at an early age to be leaner and "careful" with the foods they put into their bodies. Many ballet companies and conservatories have weight "guidelines" in their contracts, which require dancers to maintain a specific weight in relation to their height. While serious dance schools often have policies in place discouraging eating disorders, they simultaneously restrict dancers over a certain weight from participating in pas de deux (partnering) classes. The Bolshoi Ballet, also known as the Moscow State Academy of Choreography, specifically states in their contract that dancers over 110 lbs. will not be allowed to participate yet are required to observe the pas de deux classes (Contract. Traineeship Program, 2024). As a professional dancer, I have personally experienced teachers pulling me aside after class and suggesting I be mindful of what I eat, even going as far as recommending the latest "fad diet," which eliminated carbohydrates and sugars from my diet. This first began at the age of 11 and continued throughout high school. As a young dancer, I associated lower weight as an advantage in the dance industry.

Athletes in the performing culture are often (poorly) encouraged by company directors or teachers to lose weight and/or restrict specific food groups in their diets. While instructors are well-meaning in their advice, it often comes from antiquated practices passed down through their teachers and not from formal nutritional education. In a 2020 study regarding low energy availability (LEA) among dancers, Keay and colleagues (2020) found that 73% of female dancers claimed that being of low body weight would give them an advantage in casting decisions, while 44% percent of female dancers and 33% of males reported, "being advised, at some point, to lose weight" (p.6). Unfortunately, aesthetics in dance has long been prioritized over career longevity by many company directors and teachers. This ill advice often results in digestion issues, which are likely caused by limiting or completely removing food groups from their diets. Carbohydrates are usually one of the first food groups to be eliminated or restricted in many popular diets; however, low-carbohydrate diets are often the culprit for gut issues like constipation, gas, and bloating due to lack of appropriate dietary fiber (Harvey et al., 2019). It is essential that athletes get tested when a food intolerance is suspected to ensure they are eliminating the correct foods from their diets and not causing the body further distress.

While lower body weight and caloric intake may seem like an advantage to the dancer, they often have detrimental effects. Due to the high demands of dance training combined with low-calorie consumption, energy availability among pre-professional and professional dancers is overwhelmingly below the recommended amount, largely resulting from low caloric intake. Consequently, this often results in relative energy deficiency in sports (RED-S) (Keay et al., 2020, p. 5). The female athlete triad (which is a subset of RED-S) is frequently seen in active female athletes who suffer from LEA (with or without an eating disorder), menstrual dysfunction, and low bone mineral density. In their 2020 study, Keay and colleagues (2020) concluded that "A history of amenorrhea was reported 28% in dancers. Oligomenorrhoea associated with increase in training loads was reported in 17% of dancers. Overall, half of the female dancers reported disrupted menstrual function" (p. 5). In addition, LEA has also been connected to soft-tissue injuries (strains, sprains, contusions, etc.) resulting from increased muscle fatigue (Prus et al., 2022, p. 8). These adverse consequences are not only harmful to the long-term health of the dancer but can also result in training and performance setbacks due to injury. Far more education is needed within professional dance schools and companies to inform dancers of the short and long-term consequences of LEA and RED-S.

Due to the diet's restrictive nature and low-caloric intake, dancers often do not ingest enough macro- and micronutrients. Macronutrients are essential to a balanced diet, providing energy (fuel) for our body to support everyday life. In a recent study (Moore et al., 2023), dancers were found to have consumed the recommended amount of fats yet neglected the recommended amount of carbohydrates and proteins, two vital macronutrients for energy availability (p. 11). They also reported considerably low levels of essential micronutrients, including Vitamin D, Calcium, both Vitamin B 6 and B 12, Vitamin E, and Zinc. Carbohydrates are especially important for dancers as they are the only macronutrient that can quickly be broken down for energy during high-intensity exercise (i.e., dancing) (Kanter, 2018, p. 36). Moreover, many of the key micronutrients lacking in the dancer's diet are commonly found in both carbohydrates and proteins. It is crucial that this is addressed as prolonged low nutrient consumption can lead to vitamin and mineral deficiency, which, if left untreated, can promote disease.

While many nutritional guidelines are available for athletes, we need to consider that every dancer is unique in their phenotypic makeup, and these guidelines should be tailored specifically to each dancer. With the high energy demands of dancers, The International Association of Dance Medicine and Science and the American College of Sports Medicine (ASCM) have released similar nutritional guidelines for dancers, recommending that dancer diets be composed of 55%- 60% carbohydrates, 12%-15% proteins, and 20%-30% fats (Moore et al., 2023, p. 11). I do agree with these nutritional outlines for the most part, yet I believe there is a way we can further tailor the macronutrients needed for each unique dancer on a more personalized level, which assures the food they take in will promote health and balance instead of misery.

With this in mind, I would like to introduce the concept of Ayurvedic nutrition, which offers an individualized approach to diet for the athlete's distinct constitution. Unlike Western medicine, Ayurveda takes a personal approach to healthcare, offering detailed dietary recommendations tailored to each individual, primarily based on their inherent constitution (Prakriti) and current state of imbalance (Vikriti) as they relate to the doshas. It is understood in Ayurveda that each person is created from a combination of three human phenotypes: Vata, Pitta, and Kapha (the Tridoshas), which combine to create seven distinct human constitutions known as the Prakriti (Banerjee et al., 2015). Ayurveda takes a preventative approach to disease and endorses nourishing mind-body health through diet, exercise, lifestyle, and daily routines. The Ayurvedic concept essentially recognizes that one's unique constitution requires a personalized diet to maintain balance and prevent disease—there is no "one size fits all" diet approach. Each distinct dosha (the categoric phenotype) requires a unique set of foods to maintain balance. Consuming foods unsuited to our constitution can bring discomfort and even manifest into disease (Sharma, 2016). It is understood in the practice of Ayurveda that every food, whether plant-based or meat-based, is influenced by the taste (rasa), qualities (gunas), and actions (karma) of that food. These elements help determine the medicinal/beneficial or detrimental effects in conjunction with other basic Ayurvedic principles.

From a Western medicine perspective, Ayurveda nutrition can be compared to the study of nutrigenomics. This emerging science focuses on the connection between diet and the expression of our genomes. In essence, nutrigenomics uses your genetic variation (or Prakriti in Ayurveda) to determine how your body responds to food and creates a personalized diet to impact how our genes are expressed. Recent Ayurvedic studies suggest an association between an individual's Prakriti and the genotypes of modern medicine. An analysis by Bhardwaj and Sabharwal (2023) determined that "…individuals from the three most contrasting constitutional types show striking differences for biochemical and hematological parameters and at genome-wide expression levels" (p. 55). The blood samples taken from this study examined the biochemical profiles (liver, kidney, and lipid profile functions) and the hematological profiles (size and characteristics of blood). They determined that significant differences were demonstrated between the three major Prakrit: Vata, Pitta, and Kapha. This is a wonderful advancement in correlating ancient Ayurvedic phenotyping with modern medicine, which I believe helps make Ayurveda more “user friendly”.

While these exciting new connections between Prakriti—which is believed to be an "indirect representation" of our genetic makeup (Soni & Laxmita, 2022, p. 102)— and nutrigenomics help support the basis of individualized Ayurvedic nutrition, more research is needed in the study of Ayurveda. In fact, you will be hard-pressed to find any peer-reviewed studies on dosha-based dietary benefits of Ayurvedic nutrition. As I have mentioned, Ayurveda is highly personalized, with nutritional recommendations structured not only to an individual's unique constitution but also to their Vikruti, or current imbalance. This makes controlled studies incredibly challenging and hard to replicate. The additional lack of funding for Ayurveda research makes conducting large-scale studies even more difficult. It is my hope that with the continual growth in popularity of Ayurveda more funding will become available for high-quality analyses.

Where studies are lacking in dosha-based diets, they are abundant in herbal Ayurvedic remedies. One of the most beneficial herbal supplements for athletes is Ashwagandha, also known as Withania somnifera. Commonly referred to as the "king of herbs" (Sudeep et al., 2018), Ashwagandha root and berries are frequently used to treat a wide variety of health issues in Ayurvedic medicine and have many promising benefits for performance athletes. Studies on Ashwagandha have demonstrated reduced anxiety and stress scores, improved memory, sleep quality, muscle strength, as well as improvements in the muscle renewal process. In addition, research has shown a dramatic increase in VO2 max (maximum oxygen consumption rate), muscle recovery, bone density parameters, and energy levels (Obhrai et al., 2023; Mikulska et al., 2023). While all of these benefits are advantageous to dancers, the increase in energy levels would help combat (in conjunction with an individualized diet plan) the low energy availability commonly seen in dancers. This, in turn, could result in a lower number of soft-tissue injuries related to LEA. Additionally, the improvements Ashwagandha provides for bone density could help eliminate the risk for osteopenia and osteoporosis in dancers—effectively treating two out of the three conditions of the female athlete triad. As with any supplement, consultation with your doctor or practitioner is recommended before adding Ashwagandha to your routine.

Many dancers report experiencing food intolerances (without being formally tested) (Keay et al., 2020), which may stem from consuming foods that are not well-suited for their distinct constitutions. Researchers did not remark on the specific diets of the dancers in the 2020 and 2023 studies, and as this was not an Ayurvedic study, it is impossible to know what the dancers' distinct Prakriti is. However, I believe Ayurveda's emphasis on personalized dietary recommendations based on one's constitution offers a promising solution. Imbalances and disease can occur in our body (or Doshas) even if we eat the healthiest and most organic foods in excess. Depending on one's constitution, it may be advised to avoid specific foods (including certain vegetables and fruits) as it may cause too much of an increase within a particular dosha, throwing your body into an imbalanced state. For example, a dancer with a prominent Vata constitution (which is characterized by a petite frame and lower body weight—much like a ballet dancer) should avoid food with astringent, bitter, and pungent tastes, as well as foods with dry, rough, cold, and light qualities. Foods in this category include broccoli, bell peppers, celery, kale, lettuce, spinach, apples, popcorn, rice cakes, and kidney beans, just to name a few. As a dancer myself, I can say with certainty that most, if not all, dancers are actively consuming foods in this category. Without realizing it, these foods may very well be the reason for any digestive discomfort (bloating, gas, constipation) that dancers may experience.

By identifying and understanding our dominant dosha(s), we can begin to fuel ourselves with foods that encourage balance and eliminate the specific foods that create discomfort and imbalance. In doing so, dancers can choose from various healthy carbohydrate, fat, and protein options for their particular constitution in adequate amounts for their energy expenditure needs, giving them the essential macronutrients their bodies need to reduce fatigue, increase their endurance, build and repair muscles, and promote healthy digestion. While there are quite a few online resources, such as MAPI (Dosha Quiz: What Are You? N.D.) and Banyan Botanicals (More Than a Dosha Quiz, N.D.) that are designed to help individuals determine their dosha type, consultation with a qualified Ayurvedic practitioner is essential to ensure educated and practical implementation within the performing arts community.

While Ayurveda is becoming more popular throughout the states, it still remains a foreign practice among most Americans. One of the challenges I foresee is how to introduce such an unfamiliar concept to a group of dancers with their own challenging paradigms about nutrition. I think at the present moment, a good option to acquaint dancers with this new take on personalized diets would be to reach out to local studios and companies and offer to teach a workshop on basic Ayurveda principles. A group-based setting will allow students a chance to take in the basis of Ayurvedic nutrition in a comfortable setting, providing them tips on how to determine their constitution and foods that might be suitable for their needs. Following the workshop, a standard consultation could be scheduled for any dancers wishing to receive individualized dietary recommendations, which would include Nadi Vigyan, or pulse reading, to help address underlying imbalances. As most prominent dance institutions have in-house nutritionist, I think it would be highly beneficial to work in conjunction with each other, as they most likely have a good relationship with the dancers in addition to their own extensive knowledge in western nutrition. By merging modern medicine with the ancient practices of Ayurveda, the principles become more relatable and easier to maintain.

In conclusion, the outdated approach to nutrition in the dance industry often prioritizes aesthetics over health, frequently resulting in detrimental effects like low energy availability, the female athlete triad, and low bone density. Dancers can promote balance, vitality, and overall well-being by integrating Ayurvedic principles, which emphasize personalized dietary recommendations based on individual constitutions. Consulting with qualified Ayurvedic practitioners allows dancers the ability to correctly tailor their diets to support their heightened energy needs and ultimately foster a healthier and more sustainable approach to nutrition within the performing arts community.

References:

Banerjee, S., Debnath, P., & Debnath, P. K. (2015). Ayurnutrigenomics: Ayurveda-inspired personalized nutrition from inception to evidence. Journal of traditional and complementary medicine, 5(4), 228–233. https://doi-org.miu.idm.oclc.org/10.1016/j.jtcme.2014.12.009

Bhardwaj, P. & Sabharwal, P. (2023). Changing the Phenotypes − Epigenetics in Ayurveda. Journal of Ayurveda, 17(1), 54-57. DOI: 10.4103/joa.joa_13_21

Challis, J. & Stevens, A. (2019). Nutritional resource paper. [resource paper]. International Association for Dance Medicine & Science. https://iadms.org/media/3589/iadms-resource-paper-nutrition-resource-paper.pdf

Contract. Traineeship Program. (2024). Moscow State Academy of Choreography. Retrieved April 22, 2024. https://en.balletacademy.ru/admission/documents/

Dosha quiz: What are you? (2024). Mapi. Retrieved April 12, 2024, from https://mapi.com/pages/dosha-quiz-landing

Harvey, C., Schofield, G., Zinn, C., & Thornley, S. (2019). Effects of differing levels of carbohydrate restriction on mood achievement of nutritional ketosis, and symptoms of carbohydrate withdrawal in healthy adults: A randomized clinical trial. Nutrition, 67–68, 100005. https://doi.org/10.1016/j.nutx.2019.100005

Kanter M. (2018). High-Quality Carbohydrates and Physical Performance: Expert Panel Report. Nutrition Today, 53(1), 35–39. https://doi.org/10.1097/NT.0000000000000238

Keay, N., Overseas, A., & Francis, G. (2020). Indicators and correlates of low energy availability in male and female dancers. BMJ Open Sport & Exercise Medicine, 6(1). https://doi.org/10.1136/bmjsem-2020-000906

Mikulska, P., Malinowska, M., Ignacyk, M., Szustowski, P., Nowak, J., Pesta, K., Szeląg, M., Szklanny, D., Judasz, E., Kaczmarek, G., Ejiohuo, O. P., Paczkowska-Walendowska, M., Gosciniak, A., Ciellecka-Piontek, J. (2023). Ashwagandha (Withania somnifera)—Current Research on the Health-Promoting Activities: A Narrative Review. Pharmaceutics. 15(4):1057. https://doi.org/10.3390/pharmaceutics15041057

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Moore, K., Uriegas, N. A., Pia, J., Emerson, D. M., Pritchett, K., & Torres-McGehee, T. (2023). Examination of the Cumulative Risk Assessment and Nutritional Profiles among College Ballet Dancers. International Journal of Environmental Research and Public Health, 20(5), 4269. https://doi.org/10.3390/ijerph20054269

Obhrai, S., Devraj, S., & Arora, M. (2023). Effect of Ashwagandha on bone mineral density in animal models: A narrative review. Indian Journal of Applied Research. 10-12. 10.36106/ijar/4203614.

Prus, D., Mijatovic, D., Hadzic, V., Ostojic, D., Versic, S., Zenic, N., Jezdimirovic, T., Drid, P., & Zaletel, P. (2022). (Low) Energy Availability and Its Association with Injury Occurrence in Competitive Dance: Cross-Sectional Analysis in Female Dancers. Medicina, 58(7), 853. https://doi.org/10.3390/medicina58070853

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Sudeep, H. V., Gouthamchandra, K., Venkatesh, B. J., & Prasad, K. S. (2018). Viwithan, a Standardized Withania somnifera Root Extract Induces Apoptosis in Murine Melanoma Cells. Pharmacognosy magazine, 13(4), S801–S806. https://doi.org/10.4103/pm.pm_121_17