Healthy Bones For Dancers

Human skeleton with left arm extended; front and back views. Wellcome V0008012

See page for author [CC BY 4.0 (], via Wikimedia Commons

by Selina Shah, MD, FACP

Our bones are important because they serve as the foundation on which we are built. Bone is living tissue that contains blood vessels; proteins, including collagen; and cells that are actively maintaining healthy bone. Bone also contains many minerals, the most important of which is calcium.

Building Strong Bones

We have the best chance of building our strongest bones when we are young — because the rate at which we form bone is higher than that of losing bone up until about the age of 30, when peak bone mass is reached. After peak bone mass is reached, we starting losing bone at a higher rate than we form it. The majority of the mass of our bones forms between the ages of 11 – 14 in girls and 13 – 17 in boys. The more bone mass you have by the time you reach peak bone mass, the less of a chance of you have of breaking your bones, especially later in life as bone loss occurs.

Bone Health And Your Diet

fuel-2741_640As dancers, we place a lot of stress on our bones. This stress can lead to damage of bone tissue. However, luckily our body is designed to repair itself, so bones maintain their healthy structure by containing cells that remove damaged bone and replace it with healthy bone, also known as bone turnover.

In order to achieve the highest bone mass possible and to ensure healthy bone turnover, it is important for our bones to have the right ingredients. Dancers need have enough nutritional intake based on activity level, adequate calcium, and adequate Vitamin D. Without these, a decrease in bone density can occur, making a dancer susceptible to fractures and stress fractures.

Dance is a form of exercise which uses energy. This energy needs to be replaced by consuming enough healthy carbohydrates and fats so that your body can continue to function normally. Having adequate fuel is especially important for girls to ensure normal, regular menstruation. The hormones that regulate menstruation directly affect bone mass. If a dancer does not consume enough calories and fats to adequately re-fuel the body, then the hormone balance gets thrown off – which can result in a decrease in bone density.

It is not unusual to experience irregular periods (meaning periods that do not come monthly) during the first year of menstruation. However, missing your periods for months at a time or getting your period too late, may also be a sign that you are not consuming enough calories. Genetics and other medical issues could also be playing a role in abnormal menstrual cycles or later onset of menstruation. It is best to consult a physician if you do miss your period for more than 2 months, especially if this occurs on a regular basis, or if you are 15 years old and have not gotten your period. Males are also susceptible to bone loss due to inadequate energy consumption. All dancers need to consume enough calories to re-fuel the body.

Bone Density

broccoli-952532_640The human body is designed to always have normal calcium levels – so if you do not consume enough calcium, it will take it from bone which again will lead to decreased bone density. The Institute of Medicine currently recommends consuming the amount of calcium based on age shown in Table 1 below. It is best not to exceed the amount of calcium shown at the upper limit column because this can increase the risk of forming kidney stones. It is best to get calcium from dietary sources such as dairy, almonds, broccoli, Brussels sprouts, and dark leafy greens, to name a few. Check your food labels and calculate how much calcium you get in a day. If you do not reach the level recommended in Table 1, then buy a supplement. Do not take more than 500mg at a time to maximize effective absorption.

Table 1: Institute of Medicine Daily Adequate Intake of Calcium

Age Calcium (mg/day) Calcium (mg/day) Upper Level Intake
4 – 8 1000 2500
9 – 18 1300 3000
19 – 50 1000 2500
51 – 70 1200 2000
> 70 1200 2000
Osteoporosis 1500 2500

Bone Health And Vitamin D

pill-316601_640In order for your body to absorb dietary calcium, you need to have an adequate amount of Vitamin D. The best source for Vitamin D is from the sun. Vitamin D is formed by cells in the skin layer. Sun exposure to form Vitamin D in the skin is inhibited by sunblock and decreased by clouds and pollution. Additionally, the darker the skin color, the longer daily exposure time to sun is needed for the cells in your skin layers to form adequate vitamin D. Generally speaking safe sun exposure (no sunblock for the time allotted as long as there is no risk of skin cancer by family or personal history of skin cancer) is best obtained between the hours of 10am – 3pm on the arms and legs for a minimum of 20 minutes per day depending on skin color and the latitude in which you live.

The further you are from the equator, the less Vitamin D is formed during winter months. It is difficult to adequately consume Vitamin D from foods fortified with Vitamin D. A few foods such as Cod Liver Oil, egg yolks, salmon, sardines, mackerel, and canned Tuna are natural sources of Vitamin D. One study found that more than 95% of dancers are deficient in Vitamin D. If you cannot get enough sun exposure, the Institute of Medicine recommends the supplementing Vitamin D at the levels based on age shown in Table 2 below. Your doctor may check a blood level and recommend a higher dosage of Vitamin D to boost your levels quickly. It is difficult to become toxic with Vitamin D supplementation. Follow your doctor’s advice.

Table 2: 2010 Institute of Medicine Daily Adequate Intake of Vitamin D

Age Vitamin D (IU)
0 – 1 600
1 – 70 600
> 70 800
Pregnancy 600

In summary, it is best to ensure adequate Vitamin D levels, calcium intake, and food intake to develop and maintain strong bones. The younger you begin, the better off you will be in the future.

Selina Shah, MD, FACP

Selina Shah, MD, FACP

Selina Shah, MD, FACP is a board certified sports medicine and internal medicine physician and the Director of Dance Medicine at the Center for Sports Medicine in San Francisco, CA and Walnut Creek, CA. She has lectured nationally and internationally on various dance medicine topics and has published papers in medical journals and books including her original research on dance injuries in contemporary professional dancers. She is the dance company physician for the San Francisco Ballet School, Liss Fain Dance Company and Diablo Ballet. She is a physician for Berkeley Repertory Theater, Mill’s College, St. Mary’s College, and Northgate High School. She takes care of the performers for Cirque du Soleil and various Broadway productions when they come to the San Francisco Bay Area. She has taken care of several Broadway performers (i.e. American Idiot, South Pacific, Lion King, Book of Mormon, MoTown, and Billy Elliot). She is a team physician for USA Synchronized Swimming, USA Weightlifting, USA Figure Skating and travels with the athletes internationally and nationally. She is also a member of the USA Gymnastics Referral Network. As a former professional Bollywood and salsa dancer,

Dr. Shah is passionate about caring for dancers. She continues taking ballet classes weekly and also enjoys running, yoga, Pilates, weightlifting, and plyometric exercise.


For Dancers: An Easy Guide To Portion Sizes


by Catherine L. Tully

What you eat matters, but so does how much you eat. Unfortunately, portion sizes can be hard to estimate. Let’s face it, nobody wants to carry around a stack of measuring cups!

Luckily, there’s a fairly simple way you can ballpark portions without too much trouble, and it involves something you always have with you—your hand! Use the following to keep an eye on how much you are eating—it works quite well. (Sizes are approximate.)

  • 1 serving of meat = the palm of your hand
  • 1 tablespoon = your thumb, from the second knuckle to the tip
  • 1 teaspoon = the tip of your index finger, second knuckle to the tip
  • 1 cup = the size of your fist
  • 1 ounce = your thumb, from the first knuckle to the tip
  • 1⁄2 cup = loosely cupped hand

These simple measurements can help you estimate how much you are eating and keep you from overdoing it. Keep them in mind when you head out to a restaurant, or when you are preparing meals or snacks.

Dance Advantage and 4dancers have written a guide for healthy eating, studying smart, navigating dance coursework, roommate relations and more–designed specifically for college freshmen going off to a dance program. This post is an excerpt from that e-book.

Learn more about this resource and get it for yourself or someone you know here:

College Dance Programs




Dancing In The Dark – Dancers Need Vitamin D

Happy Holidays to all!

Today’s article is from Dr. Matt Wyon, Professor of Dance Science at the University of Wolverhampton, in Birmingham, England, who recently wrote an article on on the importance of supplemental physical fitness training in dance.  We are happy that Matt, who is also the Vice-President / President-Elect of IADMS (International Association for Dance Medicine and Science) has contributed a second article–this one on how important Vitamin D is for dancers.  It’s something of interest to everyone, in terms of general good health, but recent research has shown that it may be especially important for dancers.  Read on!

Hoping everyone has had a wonderful holiday season, with Nutcrackers abounding!

– Jan


sun-background-1Dancers spend so much time indoors, with classes / rehearsals / performances, that they get little exposure to sunlight. Even when they live in sunny climates they don’t get enough sun exposure on their skin, because we automatically cover-up with sunblock.

Direct sunlight is the main way we can increase vitamin D levels in our body. We can get the vitamin from our diet, through foods such as fortified cereals, oily fish and diary – but for the majority of us this is not enough to meet our needs. This has left vast numbers of people, including dancers, deficient in vitamin D.

Why is vitamin D important? It used to be known as the “bone hormone”, important for bone growth and development, but new research has shown that it  is involved in lots of other important systems in the body, including the immune system.  It also plays a part in diseases such as multiple sclerosis, rheumatoid arthritis and tuberculosis.

All of this is important for everyone, dancers included —but in addition, recent research points to an important link for athletes such as dancers.  There is a connection between muscle strength and vitamin D:  deficient levels of Vitamin D has been linked to decreased muscle strength.  In our recent study at the University of Wolverhampton (Birmingham, UK), we gave vitamin D supplements to ballet dancers and saw that jump height and leg strength increased for those on the supplementation, compared with those who didn’t take any.  The group who took the vitamin D tables (2000IU a day) also got fewer injuries over the 4 month period, probably because their legs were stronger.

In summary, as a dancer you should ask your doctor to check your vitamin D levels at least once a year.  This is just a blood test and doesn’t take long but could have a major effect on your stayer healthy and dancing longer / dancing stronger.

Matthew Wyon, PhD

Professor in Dance Science,

Research Centre for Sport Exercise and Performance, University of Wolverhampton, UK

National Institute of Dance Medicine and Science, UK

Photo courtesy of, under Creative Commons License 3.0


Nourishing Your Dancer Body: Understanding The Fundamentals of Making Good Food Choices

by Diana Clanin, M.F.A., AT

Dancers have such a love-hate relationship with food!  Of course we need it: it gives us sustenance, repairs our over-worked bodies, and provides us with energy.  And of course we enjoy it: it not only tastes good, but is part of every cultural and social life-occasion from birth to death.  Yet, we are often afraid that it will make us – and I shudder to even write the word – fat.   So we teeter between trying to be super vigilant about nutrition, and the fear of gaining weight.  And the less food we eat, or the more we try to avoid eating, the more we focus on it.  It’s an ongoing internal conflict.

As The Stomach Growls

So why is this so hard?  Seems like balancing food intake, good nutrition, and weight would be as straight forward as a tendu devant.  But dancers have a unique challenge: how to get the optimal nutrition we need in the fewest possible calories.

To complicate matters further, between the print and broadcast medias, and our hyper-immersion in “smart” electronic communication gadgetry, we are on information overload.  Sadly, very little of what passes for nutrition “news” is fact or evidence based.  If you are increasingly confused about what to believe, you are not dancing solo.  Much published nutritional advice or claims are dubious attempts to sell you some product, which may or may not perform as described. Influencing you to purchase a supplement or special “food” often means convincing you that you have some critical deficiency, or are needlessly suffering from a chronic lack of energy.  It is fear-based marketing psychology and you are the target.

Keeping It Simple

So let’s start by laying down a few basic guidelines for making sane and healthy – and economical – choices:

1. Eat food as close to how Mother Nature packaged it as possible.

  • Avoid pre-packaged food mixes (Bisquick, Hamburger Helper, etc.).
  • Stick with whole grains:  100% whole grain cereals, breads, and pastas.  If it is white, Don’t Bite!  (In the grain department, that is.)
  • And…if it came through the car window, is it really food?

2. Eat several small meals a day and include components from each of the macro-nutrient food groupings each time.

  • This means be sure you have protein, fats, and carbohydrates in your selections each time you eat.  Examples: yogurt and fruit with granola, or cheese and whole grain crackers with vegetable sticks.
  • Try eating five or six small meals instead of three larger ones.  This will give you more even, sustained energy and allow you to metabolize the food more efficiently.
  • And yes, this DOES mean that you may have to do a little food research!! – to learn which foods fall into which the various macro-nutrient categories (i.e., is it a protein? A fat?  A carbohydrate?).  In general, for dancers trying to eat healthy / maintain weight,  and get good nutrition for energy, these guidelines are recommended for daily intake:

+ Protein                      12-15%
+ Fat                             20-30%
+ Carbohydrates        55-60%

Speaking of carbs, it’s good to learn what are healthy carbs (called “complex carbs”, like fruits / veggies / bagels, breads and pastas made with whole grains) and what are not-so-healthy-carbs (called “simple carbs”, like sugars and white grain products).

IADMS – the International Association for Dance Medicine and Science – has an excellent fact sheet on Nutrition for Dancers under the “Resources” tab on the left side of the home page – if you aren’t that familiar yet with different foods and nutritional information, this can be a great start.

3.  Eat a wide variety of foods.

Read more


Dancers And Hydration

Dancers sweat. They sweat and they work their bodies for long periods of time–much like other athletes.

Enter hydration. Keeping your body properly hydrated is important as a dancer. Today we have Emily Harrison, MS, RD, LD with us to take a closer look at this key subject….

Emily Harrison, MS, RD, LD, Photo by Kim Kenney


Even mild dehydration can affect performance.  Staying hydrated is extremely important to a dancer’s performance because the first signs of dehydration are fatigue and poor balance.  Thirst actually only kicks in after the body has lost 1-2 liters of water. If you are thirsty then you are already dehydrated.

The science:

Water makes up approximately 60% of body weight and is the largest component of the human body.  The muscles we work so hard to develop as dancers (skeletal muscles) are about 73% water, your blood is about 93% water and even bones and teeth have some water. Water is critical for maintaining homeostasis within the body and is important in the thousands of biochemical and physiological functions our body goes through every day. Water aids in digestion and is important in the transport and elimination systems of the body.

Overheating and performance:

It’s important for dancers to know that being properly hydrated helps keep the body from overheating. Helping the body promote heat loss when dancing full out will improve athletic performance and aid in recovery. This is especially important for dancers wearing hot costumes and performing under stage lights. Sweat losses during performance can be significantly more than during rehearsal of the same piece. This is why drinking regularly (even small, regular sips) is an important habit during a show.

How much is really needed? Can a dancer get fluids from other things besides water?

Read more


Nutrition For The Dancer: Emily’s Apple And Pumpkin Oatcakes

Today I’d like to introduce Emily Harrison, who is sharing a great healthy recipe with us here at 4dancers, as well as talking a bit about nutrition. Part of our health/wellness focus for the month of February. I haven’t had a chance to make the recipe yet, but it sounds delicious and I can’t wait to try it!

Emily Harrison, MS, RD, LD, Photo by Kim Kenney

I am thrilled to be guest blogging with As a former professional dancer I learned early on in my career how important nutrition was to my performance. Now as the dancers dietitian, I work with dancers to help them be at their best with fewer injuries.

Nutrition is a complicated science, but if I had to only give one piece of advice it would have to be: “eat breakfast”. I know you all have heard this before, but you can’t minimize the importance of literally breaking the fasting state with a good source of complex carbohydrates.

Carbs have gotten a bad rap in recent years. But in fact carbs are the body’s preferred source of fuel for athletic activity. Complex carbs in whole grains, vegetables, and fruits give the muscles a prolonged source of energy that is critical in the type of start-stop activity we do as dancers. Whole grains are important sources of fiber, B-vitamins, iron, and folate. The American College of Sports Medicine recommends that athletes get 55-60% of their total calories from carbohydrates. Carbs can be found in whole grain pasta, bread, rice, quinoa, barley, all vegetables and all fruits. How can something like that be unhealthy? Sure we want to avoid simple sugars in sweets, juices, soda, refined grains, and baked goods. Those kind of carbs won’t give you enough energy to get through tendus in class. But have three of my oatcakes for breakfast and dance strong all the way through grande allegro.

This recipe has become a favorite of the dancers that I do food demos for. In fact the dancers from Atlanta Ballet’s summer program loved them so much that they set off the fire alarms in the dorms making them the next day:

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