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:
“Sometimes.”
“That depends.”
“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.”
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The most basic of the basics:
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When it comes to dietary supplements, here are most basic concepts:
repeat after me
1. You can’t out-supplement a bad diet.
2. Supplements are intended to cover gaps (to supplement), not to be a primary provider of nutrition.
3. If it sounds too good to be true, it probably is.
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.
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Now it’s my turn to ask some questions:
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(There are more, but this will get us started.)
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- Do you have a diagnosis or specific health concern we are working with, or are you looking for a nutritional “insurance policy”?
- What other supplements or medications are you taking? (Some medications and supplements don’t play nicely together)
- What does your diet look like?
- What’s your schedule and where are you in your dance season or career?
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Demands, demands, demands!
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Dance was recently ranked as the most physically demanding job. 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, 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.
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Here are some examples of when targeted supplementation would be recommended:
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- You spend most of your time indoors between school, work, classes, and rehearsals. Since the best source of Vitamin D is reasonable sun exposure, you may fall short on this crucial nutrient that is required for bone health, immunity, and mood. It’s even been shown to support strength and jump height. After a nutrition history review, it would likely be reasonable to recommend a Vitamin D supplement with Vitamin K2. Why K2? It plays a central role in the metabolism of calcium, a primary mineral found in your bones and teeth. Vitamin K2 activates the calcium-binding actions of two proteins, which help to build and maintain bones.
- You have a genetic variant that prevents you from adequately metabolizing certain nutrients to their active form. Taking the active form in a supplement form, as well as avoiding synthetic forms in processed foods, could improve overall health, mood, performance and longevity.
- If you’ve been on a course of antibiotics or don’t eat fermented foods regularly, a probiotic might be appropriate.
- If you’ve been diagnosed with any sort of anemia, you should take the necessary vitamins or minerals to reverse it.
- If you have a hard time physically eating enough due to time constraints, IBS or other GI issues, or from the sheer demand of your work, supplements may be needed to keep you at peak performance.
- If you are looking to improve strength or training, certain target supplements such as creatine or whey could be beneficial.
- You’re vegan, meaning you don’t eat any animal products. Since Vitamin B12 is only found in animal sources, many vegans benefit from a high-quality B12 supplement.
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There’s that term “high-quality” again. What does it mean, exactly?
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High-quality supplements can be expensive. Really expensive. Why do they cost so much?
1. It takes a lot to get a little
Take fish oil supplements. 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. It takes a lot of fish to extract the EPA and DHA that support brain health and have been shown to reduce inflammation. 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 are a good source of calcium.
2. Third-party testing
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 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, and 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 a 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 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 allergins not listed on the label. The ingredients may not be included in the amounts listed or in a form that is biologically active.
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 records, 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 can take. Additionally, a registered dietitian can recommend specific trusted brands to ensure you get what you’re paying for.
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