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45. Optimizing Hormone Health for Dancers with Dr. Nicky Keay
182 Plays2 months ago
Join us in today’s episode as we talk with Dr. Nicky Keay, a medical doctor specializing in dance and exercise endocrinology. With a deep passion for both hormone health and the world of dance, Dr. Keay offers expert advice for optimizing athletic performance through personalized approaches to endocrine health.
As a lifelong ballerina, Dr. Keay brings her unique understanding of both medical and dance worlds to her practice, integrating her clinical experience with tangible, actionable steps for active dancers. She is dedicated to providing dancers at all stages of their careers with tailored hormone health strategies to support both performance and overall well-being as well as injury prevention.
Whether you're a professional dancer or someone simply passionate about dance, don't miss out on these valuable insights from Dr. Nicky Keay to optimize your hormone health and improve your dance performance!
Key Topics Covered:
✨ Hormone health for dancers at all stages of life
✨ Red flags indicating hormone imbalances in dancers
✨ Remedies to optimize hormone health for improved performance
✨ Dr. Nicky Keay’s approach to personalized healthcare for dancers
✨ Integrating dance and medical expertise to enhance athletic performance
Connect with Dr. Nicky
Dr Nicky’s Website: www.nickykeayfitness.com
Check out Dr. Nicky on Instagram @drnickykeay & Facebook
Links & Resources
Get 20% off your first order of ALOHA protein bars: https://aloha.com/BRAINYBALLERINA
Visit the Ballet Help Desk website today!: https://ballethelpdesk.com/
Let’s connect!
My WEBSITE: thebrainyballerina.com
INSTAGRAM: instagram.com/thebrainyballerina
Questions/comments? Email me at caitlin@thebrainyballerina.com
This episode was brought to you by the Pivot Ball Change Network.
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Transcript
Introduction to Hormonal Health in Dancers
00:00:00
Speaker
I think if the overall training load from whatever source, dance, other things you're doing, you know, general activity, do you cycle, do you walk to places? If all of this is too much above the optimal level, then in that case, the hormones are going to say, oh gosh, now this is too much for the body to cope with. This is too much stress on the body.
00:00:22
Speaker
And so then rather than having beneficial effects or this exercise having beneficial effects, then it can start to turn into... unhelpful effects.
00:00:34
Speaker
I'm Caitlin, a former professional ballerina turned dance educator and career mentor. And this is the Brain New Ballerina podcast. I am here for the aspiring professional ballerina who wants to learn what it really takes to build a smart and sustainable career in the dance industry.
00:00:50
Speaker
I'm peeling back the curtain of professional dance world with open and honest conversations about the realities of becoming a professional dancer. Come along to gain the knowledge and inspiration you need to succeed in a dance career on your terms.
Impact of Hormones on Dancers
00:01:09
Speaker
Hello and welcome to the Brainy Ballerina Podcast. I'm your host, Caitlin Sloan, and I am joined today by Dr. Nikki Kaye. Dr. Nikki Kaye is a medical doctor with specialist expertise in the field of dance and exercise endocrinology.
00:01:23
Speaker
Nikki's passion and objective is to provide a more personalized approach for hormone health to optimize the overall health and performance of the individual. We're going to get into all things hormones, menstrual health, and menopause, especially as it relates to dancers today.
00:01:38
Speaker
But before we get into that, Nikki, could you tell us a little bit about your dance background and how you got into the work you're doing today? Sure. Well, first of all, thanks for inviting me to come and and discuss a really important topic, hormone health for dancers.
00:01:52
Speaker
So my personal interest in dancing, particularly ballet, I have to say, i was taken to my first ballet class by my grandmother. My grandmother was invited by Nanette de Valois to join her company.
00:02:06
Speaker
with Margot Fontaine et al. But in those days, her mother thought it was not a respectable profession or or we didn't think of it as a profession, shall I say, for a young lady.
00:02:18
Speaker
So really sadly, she didn't do that. But nevertheless, she was, as you can imagine, a dancer of a good standard. And I've got lovely pictures of her on point and everything. So... pretty cool. So it's kind of in the family. And then my mother obviously did dancing as well, never professionally. And then it was kind of like, I fell in love with it, ballet. So I've always been doing it, even when I was studying medicine and as a junior doctor, somehow I managed to squeeze in, still go into class and some performance, well, amateur performances. Even now at my advanced age, I still continue to take roughly four ballet classes a week. That's what I really look forward to.
00:02:55
Speaker
ah Not least because of all my friends are there and we've been doing the class together. We're a reasonable standard, despite some of us being a little bit older than others, shall we say. And I'm also a medical advisor to Scottish Ballet as well. One of those sort of dream jobs. What would your dream job be for me? It is precisely this working with dancers and helping them reach their full potential, like you said ah in the intro.
00:03:16
Speaker
Amazing. Can you give ah kind of a brief overview of what our hormones do and how they impact ah the dancer's health and their performance?
Role of Hormones in Bodily Functions
00:03:25
Speaker
Well, in terms of medicine, why did I choose to specialize in medicine? Because as a youngster, I was always saying, oh, yeah, I want to study medicine,
00:03:33
Speaker
to support dancers and everyone said, oh, you want to do injuries. It's like, no, i don't want to do injuries. I mean, injuries, sadly, sometimes these things happen. But my thought process was we need to know what can we do to minimise injuries and reduce injury risk, at least. And also, shouldn't we be going for the dancer being in their top form in terms of health and performance? So I was trying to figure out how could I do this? How am I going to achieve this? And then as I sort of got into studying medicine, I realised the answer came in the form of hormones.
00:04:02
Speaker
So hormones are, well, invisible. I think this is why it's sort of challenging to get the concept. You can't see them. Hormones, by the way, they do amazing choreography inside our bodies. And they are chemical messengers transported in the bloodstream. They whiz around in the bloodstream and get to every single cell in the body, including the brain, by the way. We're not just talking about physical health, mental health as well.
00:04:22
Speaker
And then the key thing is, what do they actually do? And the clue comes from the derivation of the word hormone from ancient Greek means setting in motion. And that exactly describes what a hormone does. When it arrives at a cell, it goes into the cell nucleus where the DNA resides, the blueprint for life, as we know.
00:04:39
Speaker
And it directs the expression of the DNA, tells the DNA what proteins to make. so very crudely, if you think you've done a class, and then the hormones will respond to what you've been doing. And it will send messengers to the DNA to say, right, we need more muscle protein, please. Thank you very much, you know, to get stronger and whatever. So that is why I'm so passionate about hormones. I want to tell everyone about them.
00:05:03
Speaker
And also that is one of the key things. for dancers to realize they can harness their hormones to provide optimal health and performance because the hormones drive these adaptations. Like I said, you go to the class, why do class? Well, yes, of course you enjoy it, but you're hoping that you will improve and et cetera.
00:05:20
Speaker
Those improvements are driven by the hormones. And the good news is that to a certain extent, you can harness your hormones. So now I've told you the power of hormones. It's like, great, what do How do I harness them? And actually i refer again to ancient Greek times, Hippocrates said, if we could give every individual just the right amount of nourishment, just the right amount of exercise, not too little and not too much, would have found the surest way to help.
Balancing Training and Hormone Health
00:05:44
Speaker
So it sounds pretty sort of simple and straightforward, but it is, you know, if you really think about that logically. How are you going to get a good balance between your training, your nutrition, your recovery, your sleep?
00:05:56
Speaker
That will harness your hormones to drive those positive adaptations that we're all looking for in terms of our health and performance. So you can unlock the key. So what effect does the intense training that we do as dancers have on our hormones?
00:06:11
Speaker
So I've said those three things, the exercise, the nutrition, and the sleep, the recovery. The challenging bit, it's like the Goldilocks scenario, you know, just the right amount, not too much, not too little, like Hippocrates said.
00:06:24
Speaker
In terms of training load, of course, you need to go and do class and practice, of course. You don't want to do too little, otherwise you're not going to provide sufficient stimulus for the hormones to work their magic. But equally, too much of a good thing.
00:06:36
Speaker
If you're doing back-to-back classes, plus I found a lot of dancers also doing other activities, cross-training. So that's, I think, where the problem is. So if you add all this up, I mean, already dancers will be doing several classes, probably, maybe even within the day, of course, depending on what the level they are. Like me, I do four per week. But by the way, i also do other things. So i think if the overall training low from whatever source, dance, dance,
00:07:02
Speaker
other things you're doing, general activity, do you cycle, do you walk to places? If all of this is too much above the optimal level, then in that case, the hormones are going to say, oh gosh, now this is too much for the body to cope with. This is too much stress on the body.
00:07:20
Speaker
And so then rather than having beneficial effects or this exercise having beneficial effects, then it can start to turn into unhelpful effects. And don't blame the hormones. The hormones just adapt to what you put in, you know, so that's why it's crucial.
00:07:33
Speaker
But this is also good. This also means we have control over it. And we have to get that right balance between the training load and the other factors. In finding that balance, can you share some early signs that our hormones are out of balance, or they're speaking to us trying to give us a message?
Signs of Hormonal Imbalance
00:07:49
Speaker
Some of the first things are that you will just feel tired. Yeah. I mean, there are many reasons I know why wine can feel tired. Maybe you've had a bad night's sleep. Maybe you've had a particularly stressful thing from another source, like an argument or something like that.
00:08:03
Speaker
So I do accept that there are lots of factors that can make you feel tired. But if, you know, you're really struggling every morning getting up and you're like really feeling tired and then you reflect,
00:08:15
Speaker
Is it because how much exercise have I been doing? Have I had a rest day? So just how are you feeling is not a bad starting point. For the female dancer who's having or hopefully is is having menstrual cycles, so regular periods, an early warning sign for them is that the periods might become irregular or even stop amenorrhea, lack of periods.
00:08:36
Speaker
And so that is the period. for a female dancer or for any woman, I suppose you could say, is the barometer of internal healthy hormones. So you don't almost even have to do a blood test. It's like, well, are you having a regular period? That's really the key question to ask yourself.
00:08:52
Speaker
And if actually you realize, well, actually, my periods have become really irregularly spaced out or actually... they've stopped, then that could be an indicator. And by the way, this happens in men as well.
00:09:03
Speaker
So it will be the similar thing. The equivalent to the menstrual cycle, I suppose, is the level of testosterone. So that will become lower in men. And this will make them feel tired. They can't jump so high. I've had male dancers say, just feeling really tired. I just haven't got the energy for Allegro, these things. So the problem is that these are sort of apart from the period stopping yes or no, ah lots of the symptoms you might be experiencing, there could be for other reasons. So I think you have to really be honest with yourself and sit down and say, okay, fine, I'm not feeling great, not feeling 100% feeling tired, not sleeping well, what am I doing? And then if it's like, oh, gosh, no wonder, I haven't had a rest day this week, and I'm really trying to pack in extra classes or something.
00:09:46
Speaker
And then that would be an early warning sign. We hope that you would notice these things before you get him an injury. Because ultimately what we're talking about could lead to injury, soft tissue and bone stress injuries. But it's better to try and obviously nip it in the bud and recognize those symptoms for what they are before you get the injury, like I said at the beginning.
00:10:06
Speaker
Can you talk a little bit more about having an irregular or an absent period? Because I think a lot of dancers are told that that's normal for a high level athlete's But can you touch on the danger of this and how it affects a dancer's health even more? I'm definitely going to blow that myth totally out of the water because it's the opposite way around.
00:10:28
Speaker
It's normal physiology. And as I said, a barometer of internal hormone health, if you're a woman, not on hormonal contraception, because to be clear, you're on the combined pill, you get a bleed, that's withdrawal bleed, that's not your own period. So we're talking about menstrual periods, you're not on any hormonal contraception.
00:10:46
Speaker
If you're having these in a regular manner, then that's thumbs up, everything's going but well, the hormones inside are doing their beautiful hormone choreography or the menstrual cycle, all good. But if periods stop, the body's really trying to tell you something, saying, look, honestly, we're not happy.
00:11:01
Speaker
After all, it could be a medical condition. Occasionally, there are medical conditions which can cause periods to stop. So definitely you want to pick up on that. Or it could be the imbalance in the training load and the nutrition we've we've mentioned.
00:11:12
Speaker
And you know, why is this a big deal? The big deal is these hormones of the menstrual cycle are really important for all aspects of health, mental and physical health. And so the dancer who has amenorrhea, lack of periods, due to the imbalance in her training and nutrition,
00:11:29
Speaker
She runs a really high risk of definitely injuries. Soft tissue and bone stress injuries are really important to ah stress that. Just not feeling great. And the thing is, lots of dancers I come across whose periods have stopped.
00:11:43
Speaker
By the way, this including myself in the past, we kid ourselves. Oh, we're fine. I can dance. I can do a class. It's fine. And it's true. Your body is amazing. It will prioritise doing dancing. Hooray.
00:11:54
Speaker
So you will get through a class. But you could be even better dancing in terms of accuracy of your steps, your technique, your strength, your endurance, all those things if you have periods. So rather than it's a good sign, positive sign that training hard, actually, the other that we need to flip it around and say this is actually, it's not a badge of honour, it's a big warning sign.
00:12:17
Speaker
And so anybody that says training or you're told, oh, this is normal, natural, refer them to me. No, seriously, I mean, just because something is common doesn't mean it's healthy.
00:12:30
Speaker
At the other end of the spectrum, got a big increase in obesity, big increase in type 2 diabetes, so it is becoming more common. But do we now say, oh, that's normal? Then no, of course, it's still... ah problem. It still means that we haven't got the right balance. In that case, too much nutrition and too little exercise, you see, like Hippocrates said.
00:12:47
Speaker
But in the case of the dancer, please do embrace your hormones and use your menstrual cycle as a training metric for reassurance that actually your hormones are happy.
00:12:58
Speaker
So if a dancer has lost their period or they're having a regular cycle, what are the first action steps that you would have them take?
Addressing Hormonal Imbalances in Dancers
00:13:06
Speaker
Well, I would advise that they do go and see their doctor. In UK, we call that the GP or your primary care physician or whoever, and get some blood tests to be sure. Because like I said, rarely, but there are some medical conditions which can stop your period. So obviously, well, actually, probably we should do first things first. First thing, make sure you're not pregnant. So do a pregnancy test.
00:13:27
Speaker
You never know. Right. And then get some blood tests to check, exclude a medical condition like prolactinoma. So make sure the prolactin isn't too high. Make sure the thyroid's OK.
00:13:39
Speaker
Make sure there's nothing else going on. And then at that point, then you say, OK, this is what we call ah functional hypothalamic amenorrhea, FHA. So amenorrhea means no periods.
00:13:50
Speaker
Hypothalamus is the control center in the brain that controls what the hormones are doing. And the word functional means it's because of the imbalance in your behaviors. So it's a sort of a step process.
00:14:02
Speaker
Exclude pregnancy, exclude medical condition. And then, OK, now we know it's because you've got an imbalance in what you're doing. So then you have to look at the training load, the nutrition and the recovery. Is there an imbalance there?
00:14:14
Speaker
Are you overtraining, underfueling, relatively speaking? So we're talking about relative energy deficiency. And it's i have to be honest, it's not an easy process to overcome this, if this is the case, especially in the dance world. And also if you have yourself got into a mindset of restricting what you eat and doing loads of exercise, it's difficult to make those changes in your behavior, but it's definitely possible and will be...
00:14:38
Speaker
worthwhile in the long term and lots of my job is doing precisely this exactly the process we've described a dancer will come to me if we're talking about a female dancer my periods stopped we'll go through the blood test make sure there's nothing else going on and then we go through what is she doing at the moment and then these are the steps and in a stepwise way making adjustments as we go along comfortable with this move on to the next and then eventually periods will come back if there's not a medical reason you see Let's quickly pause this episode so I can share with you one of my favorite snacks that I have been loving lately.
00:15:13
Speaker
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Speaker
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00:15:40
Speaker
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00:15:53
Speaker
And the best news is you can get 20% off your first order with code BRAINYBALLERINA. Head to the show notes and click the link to try Aloha Protein Bars for yourself today. Say a dancer hasn't gotten to this point yet, but they do feel like, okay, something feels off. Like you said earlier, I'm really fatigued.
00:16:11
Speaker
And they want to go see their doctor and talk about it. How can they approach this? Because i feel like it can be hard sometimes to explain this to your doctor. Like, I'm just feeling kind of tired. And it's like a lot of people feel tired. So like, what would you tell a dancer? What kind of doctor specifically should they look for if they're thinking, I want to make sure that I'm taking care of myself before it gets to this point. No, absolutely. You're all you're absolutely right. It's all about prevention. You don't want end up, it breaks my heart every time when the dancer is hobbling in with a stress fracture. It's like, you know, like I said at the beginning, I want to prevent this happening the first place. So I think you know your body well.
00:16:50
Speaker
And so if you're you, you're tracking it, I think always it's helpful to write it down. Because when you do go and see your doctor, they're going to say, how long have you been feeling tired for? What other symptoms have you got? what's going on.
00:17:01
Speaker
I would advise writing it down. I've been noticing really more fatigue than usual for the past X. If your periods have stopped, mention that or become lighter or regular, write note it down what's going on and any other things.
00:17:14
Speaker
that could help. And then ultimately, it will come down to then a blood test to make sure there's not a medical reason. So typically, this would check on the thyroid function. Typically, I always check, of course, all the hormones of the reproductive axis.
00:17:29
Speaker
I also check other things. Micronutrients, vitamin D, very common thing to be low. Iron, ferritin, B12. If you're going to see your doctor, by the way, as I said, you can always contact me because I do give online advice as well. it's I call it advisory. So I can take you through the steps of that. And if you've got the blood test, then we can go through and see. So it's a case of it is literally a process of exclusion to make sure there isn't something medical going on.
00:17:56
Speaker
And most times it's not, frankly. And then we've done all of that. And then it's like, OK, now the steps to get a better balance between the nutrition and the exercise. So who to go and see?
00:18:07
Speaker
It really depends. We're getting better at things here in the UK. And I wrote something for the the GPs here, the general practitioners in their journal. So the first protocol would be in in the UK, your GP did, just to see how you can go armed with that information and the facts.
00:18:25
Speaker
And almost like the suggestion of, oh, could we do some blood chest to check? Sometimes you have to sort of lead lead your doctor a little bit that way. But the same way, wherever you are living in the world, writing it down is really helpful.
00:18:36
Speaker
And then going to be the informed patient when you see your doctor so that they can see easily and listen to you. You can sort of nudge them, please, can we do some blood chest to check?
Menopause and Dancers
00:18:46
Speaker
Okay, let's talk about menopause.
00:18:49
Speaker
yeah I feel like we hear a lot about menopause in general health, but we don't hear about how it affects dancers specifically quite as much. Is there anything that makes this transition unique for a dancer?
00:19:01
Speaker
Well, speaking from experience... to ah For sure, first things to say are menopause is a natural physiological event. It's not an illness, and not disease. Just as when your periods first start, there's a big upheaval. There's a big flux changing in the hormones.
00:19:15
Speaker
And then, of course, when the ovaries retire, which is what menopause is and stop producing hormones, of course, you can appreciate the hormone levels have changed a lot. And so you can feel like a little bit off kilter.
00:19:27
Speaker
Simple as that. And so it can be a challenging time for sure. And specifically, if you're a dancer, I think what you might notice, because you are hopefully very in tune with your body and asking a lot of for your body to dance, then you might be more sensitive, I can put it that way, of the fact that you are...
00:19:49
Speaker
feeling like sluggish, that literally your brain is a little bit sluggy sluggish, picking up the exercises and and whatever, and hot flushes. There you are standing at the bar and suddenly it's like you haven't even got to Allegro and you're like, it's like, oh gosh, that's awful. Don't feel good. So I think that it is an extra.
00:20:08
Speaker
challenge if you're trying to keep going with your classes or you're dancing or whatever it is, and or if you're a dance teacher. You'll get the same symptoms as other women, for sure. Vasomotor symptoms, heart flushes, et etc. You'll get all those things, but maybe you'll be more acutely aware of it because...
00:20:25
Speaker
you're in that situation. The same, I suppose you could argue for athletes as well. The body composition can change, body weight. So you don't quite look, well, suppose it's not surprising. You're not going to look like you did when you were 21. It's going to be slightly different. But I think it's all a case of being aware that this change will happen.
00:20:43
Speaker
and trying not to be too negative about it. It's just a fact of life sort of thing. And being alert and aware that this will happen at some point in your life. If you're a woman, that's it. Facts are facts.
00:20:53
Speaker
And be ready for it. And what are you going to do? If you're in any situation, the key thing is how do you respond, right? You can get really upset. Oh, I'm really old. if This is awful. thatdadada Or you can say, oh, okay, this is what's happening.
00:21:09
Speaker
I can't change it, but I'm going to really revise and review all the things under my control to make me feel as good as I can. And by the way, because of the increased life expectancy, women probably get to live about third of their life in menopause.
00:21:24
Speaker
You want to get on the front foot and see, OK, what can I do to deal with these symptoms, overcome these in terms of rejigging the nutrition, the exercise and the sleep, etc. And then possibly also considering HRT.
00:21:37
Speaker
So there are definitely... things you can do and be proactive about it. You touched on a few of these, but can we go through some of the first signs of perimenopause that you might notice or the dancers might notice?
00:21:51
Speaker
Difficult to say which one exactly comes first, but in terms of your periods, what you might notice very early on is that the cycle length is actually getting shorter. Because the problem is that you're not ovulating every cycle. So therefore, you're not producing progesterone.
00:22:07
Speaker
So there's no incentive for the endometrium to stick around. So it sheds. So the cycle length might become shorter. And then actually the period itself might become heavier because estrogen is ruling the roost ah because the progesterone maybe isn't quite so high.
00:22:21
Speaker
So the change in your cycle length, short at first and heavy, and then gradually as you move closer to menopause and the gaps between them actually go the other way, become longer and longer. until they stop. So the period itself is really the barometer of what your internal hormones are doing. So that's something to look out for.
00:22:38
Speaker
And then the main symptom, 75% of women will experience what we call vasomotor symptoms. So there's hot flushes. So there are will be times when basically the temperature control system goes a little bit haywire.
00:22:50
Speaker
And then you're just sitting still, not doing anything. You're not in a sauna, but you feel like you are in a sauna. And you come out and sweating and look really and feel really red and all this sort of things.
00:23:01
Speaker
Brain fog, just feeling a little bit forgetful. Maybe your mood a bit more anxious. These are things that... I felt things like this, also random aches and pains, not necessarily an injury, digestive issues, change in body weight shape. There's quite a long list and I describe it as Pandora's box.
00:23:19
Speaker
And I think this is why it makes it really confusing. because you're logically, as a woman, trying to put this all together. It's like, well, hold on. On the one hand, I've got really dry skin and itchy skin, and then I've got this hot flush. It's like, how they all connected? But they are.
00:23:33
Speaker
Some women won't have these symptoms, or these will be very minor symptoms. But for some women, it will be really, really tough. Sleep disturbance, for example. It can be aggravated by the hot flushes and also your sleep pattern isn't so good as hormones change.
00:23:47
Speaker
So now you've got a double whammy. Anyone knows a bad night's sleep just isn't good, right? but So these are the the top symptoms to look out for, be aware of. And when does perimenopause happen?
00:23:58
Speaker
It's difficult to say. I mean, the average age of menopause is 51, the range being 45 to 55. So that's when the periods stop entirely and that's it. But this part time over is said the perimenopause.
00:24:10
Speaker
Therefore, it's said to happen from about six years before. But because there's a variation of the age of menopause, for some, when we'll be late 30s, 40s, I think is probably more average or even maybe late 40s depends when your menopause is. And we haven't got a crystal ball. We don't know.
00:24:26
Speaker
I think it's being aware if you're late 30s, 40s and you're experiencing these symptoms, then there's a high index of suspicion this might be perimenopause. Is that genetic? Can you look to your mother, your grandmother, whoever, to see when they went through it to see if that could give you some signs?
00:24:42
Speaker
Yeah, that's a really good point. I mean, basically, what determines the age of menopause? The honest answer is quite a lot of things we don't exactly know, but certainly there is a genetic element. So there are lots of genetic tests. They say could do this, that the other, la la la but actually one easy free genetic test is just ask your mother and your grandmother if she's still around and get a feel because there can, you're right, be a family history of very early or indeed very late or later menopause. So it will give you some idea where you might expect to fall in that range.
00:25:13
Speaker
For dancers experiencing perimenopause, menopause, are there some specific lifestyle adjustments they should be making in terms of just the regular lifestyle then in terms of their training and their dancing as well?
Adapting to Menopause
00:25:27
Speaker
Again, speaking from experience, as dancers, we like dancing. We don't really, well, I don't anyway, like doing I don't particularly like doing strength training. That fills me with dread that word, but I'm afraid that's what it is.
00:25:40
Speaker
So in terms of exercise for perimenopause menopause dancer, of course, absolutely. You keep doing your dancing. That's great. And actually dancing is pretty good. terms of strength, balance, all those things, great.
00:25:53
Speaker
But you probably do need to do some specific strength training as well, cause there's a tendency to lose muscle. So strength training, but it can take any form you wish, as I've sort of alluded to, I don't like lifting weights going into the a gym, but if you like doing that, or you want a new challenge, you want to do that,
00:26:11
Speaker
go for it. But if you're like me, the reluctant gym goer, then there are other ways of doing your strength. Pilates, for example, with resistance bands or the Pilates apparatus, that's really good.
00:26:23
Speaker
Even body weight can be helpful. And we all know it depends how much effort you put into it, as it were. You can do a plank just like dangling there, or you can do a plank and really engage. So it depends how much beans you put into those exercises. So there are alternatives to free weights. You could argue even better than free weights if you've got a resistance band, gives you resistance and Pilates machine spring on the way out and on the way in. So the full range of movement.
00:26:48
Speaker
So strength training, yes, you need to... do some extra stuff alongside your dancing for sure. I think that balance, hopefully that's okay because you're doing dancing and that includes balance. So I think we'll sort of give that one a tick.
00:27:01
Speaker
So that's the exercise point of view. What about the nutrition point of view? No crazy diets, please don't, but don't do it. It's not going to help, but it is advisable to increase your protein intake.
00:27:13
Speaker
So eat your regular meals for sure. But just look every time you're having a meal, look at the portion size of protein and try and make it bigger. That's the key thing. You still need some complex carbohydrates.
00:27:24
Speaker
OK, I think some there's a sort of a urban myth that bread, pasta, rice, all these things are like evil and make you put on weight. ah Sure, if you eat a lot of them and you're totally sedentary, probably they would.
00:27:38
Speaker
But if you're a dancer, you need energy to to do a quality class. and to reap the benefits like we've discussed. So just be strategic with your complex carbohydrate. If you're going to a class, my class is typically in the evening during the week at 6.30.
00:27:56
Speaker
So my lunch will have been like a long time ago. So having a banana before you do the class, that's a good idea. So you have to be strategic with complex with your complex carbohydrate. And then, yeah, you probably do need more rest and recovery.
00:28:09
Speaker
Okay. So you're not being lazy. If you have a day off doing exercise, actually, it's really important to give the hormones a chance to continue working. at The hormone levels are lower, so you need to give them more encouragement with the strength training. You need to feed them nicely, and then you need to give them time to keep you fit and healthy.
00:28:30
Speaker
Let's pause this episode so I can tell you about one of my favorite resources for dancers, Ballet Help Desk. If you've been loving the Brainy Ballerina podcast, you'll want to add the Ballet Help Desk pod to your list.
00:28:44
Speaker
This is the premier podcast for dance parents and hosts Brett and Jenny share weekly extra expert insights on supporting your students' ballet education. They cover key topics like summer intensives, ballet competitions, full-time and post-grad training, health and wellness, boys in ballet, and more to help your dancer make the most informed decisions about their unique training path.
00:29:09
Speaker
Another one of my favorite resources from Ballet Help Desk is their reviews. Head to their website for over 1,400 reviews on summer intensives and year-round training programs.
00:29:21
Speaker
And while you're at it, submit your review to help other dancers and their families make important decisions about their future. The more transparency in the dance world, the better. Head to the show notes to visit the Ballet Help Desk website today.
Benefits of Hormone Replacement Therapy (HRT)
00:29:36
Speaker
Can we talk about hormone replacement therapy? And for anyone who doesn't know what this is, and then ah there are there any special considerations for dancers when trying to figure out if this can fit into their program?
00:29:49
Speaker
So HRT, hormone replacement therapy, in the States is also called menopause hormone therapy. I prefer the term HRT because sometimes we will give HRT to young dancers who haven't reached the menopause yet.
00:30:02
Speaker
If a dancer's periods have stopped, like we mentioned earlier, with relative energy energy deficiency, we're going to try and get her periods back, absolutely. But if we're concerned about her bone health in the meantime, to protect her bones, we would give temporising HRT.
00:30:16
Speaker
But I have to accept that's sort of less common use. The main use would be for the menopause or woman or the woman in perimenopause around that time and the main indication for HRT is quality of life in this age group.
00:30:31
Speaker
If all the symptoms we described, the Pandora's box, if the individual woman has done everything she can, she's eating her protein, she's doing her strength exercise, she's doing good sleep, she's really done everything she can,
00:30:44
Speaker
but still struggling in terms of quality of life, then this is where HRT is indicated so to help deal with these symptoms. So what is HRT?
00:30:57
Speaker
Every woman who's still got a uterus, so unless you've had a hysterectomy, you will need a combination of both estrogen and progesterone. If you take estrogen by itself, then that could be dangerous, potentially make the lining of the uterus, the endometrium get too thick.
00:31:09
Speaker
So you take both of these hormones together. And again, there is various variations on the theme Typically, you'll take some estrogen every day. And then you can take the progesterone. and You either take that also every day or you could take it in blocks to sort of mimic the menstrual cycle. It sort of depends on whether you're still having your own periods or not.
00:31:30
Speaker
And then the sort of other detail about that is the best way of taking estrogen is through the skin, transdermal. So that's gel or a patch. Personally, gel I find much better, especially if you're dancing. Otherwise, having a patch is just like annoying. And the gel gives more flexibility, subtlety, if I could put it like that.
00:31:46
Speaker
And then the type of progesterone or progestogen, should I say more correctly? Ideally, not the synthetic one. Ideally, the micronized progesterone, which is the same as molecular structure as your own body produces.
00:31:58
Speaker
That's really the best one. And also a study from Canada shows that... type of the progesterone, the mycorrhizal progesterone in that in its own right helps with sleep and hot flushes.
00:32:08
Speaker
As I say, there are lots of variations on the theme, but those are the general principles. HRT for menopausal women, perimenopausal women is to for quality of life. And it's usually you have take the combination of both those hormones, but the exact sort of a recipe, if I could call it that, or dosage or whatever will depend on the individual woman. I just want to say one other thing, if I can, about HRT. Although the main indication is quality of life, we know that HRT reduces all-cause mortality.
00:32:39
Speaker
So the main cause of death in menopausal women is cardiovascular disease, not breast cancer. So you kind of like got that up your sleeve to know that. And also, like I mentioned, for the bones, it's really important. Osteoporosis is the silent killer, especially in menopausal women.
00:32:52
Speaker
So although you wouldn't advise HRT for the long-term health benefits, we do know that there are some. Can you go into more detail about exactly what estrogen and progesterone do in the body?
00:33:06
Speaker
Wow. Okay, that could be quite a long list. But ah to so to summarize, amazing hormones. These are sex steroid hormones produced by the ovaries, all, as we said, taken externally. OK, so the top one, what's so good about these hormones is the musculoskeletal system.
00:33:23
Speaker
So estradiol rules supreme for bone health. There's no two ways about it. So that's it's really important for your bone health as you're developing your bone mineral density when you're a youngster to reach your bone mass.
00:33:34
Speaker
And similarly, this is why osteoporosis is the silent killer after menopause. So if you don't take HRT, then the estrogen, it will really drop. And one in two women after menopause get osteoporosis. So it's like, wow.
00:33:45
Speaker
So this is a really powerful hormone for bone health. Also soft tissues. We know dancers and athletes whose periods stop low low levels of estrogen, more prone to soft tissue injuries. So musculoskeletal system.
00:33:57
Speaker
Cardiovascular system. These two hormones, super important for cardiovascular system. I mentioned in the main cause of death, the menopausal women who don't take HRT is cardiovascular disease. So these hormones keep a good, healthy lipid profile and the reactivity of the arteries, the endothelial lining, as we call it. Neurological function, important for for mood, well-being in general, I suppose you could say, and also very interesting studies showing that athletes whose periods have stopped, they have a slower reaction to time and lower peak power production.
00:34:28
Speaker
As a dancer, you definitely want quick reaction time, right? Doing really fast breezes, you want to be quick. So these hormones are so important for this and also digestive system. One of the symptoms of your periods stopping before menopause is that actually you can get digestive issues, feeling of bloating, etc. I could keep going with this list, but I think these are the the key ones. These are really powerful, beneficial hormones for our health.
00:34:53
Speaker
What about testosterone? I've heard women talking about also having to add testosterone into their HRT. Is that something you see? Yes. So testosterone is another anabolic hormone, as we say, that builds muscle and bone and blood vessels.
00:35:08
Speaker
And although you might think, oh, testosterone, isn't that just something men have as women? We do produce a small amount as well from the ovaries. So correct. When we reach menopause, the testosterone tends to go down a little bit as well. And so would you give testosterone as well as HRT? The answer is sometimes.
00:35:26
Speaker
It depends. So the main indication, clinical indication for testosterone is low libido. That's it. It's not you shouldn't be taking it or it shouldn't be prescribed oh to make you feel stronger or something like this.
00:35:38
Speaker
And certainly if you're an athlete, you can't because it's on the wider band list. So that's a no-no anyway. So if you're a menopausal woman, you're taking HRT, you're feeling a lot better, but still experiencing problematic low libido, then actually vaginal estrogen would also be the next step to make sure, because obviously if it's painful...
00:35:59
Speaker
That's a bit of a turnoff, right? So you've done all of this, you've done everything you can, this is still a problem for you, then in that case, then testosterone, it's it's reasonable to add that as well. Okay, this has been so helpful and so informational. I want to end with some really actionable advice for dancers in every stage of their life.
Sustaining Hormonal Health Through Life Stages
00:36:18
Speaker
If a dancer wants to set themselves up for long-term hormonal health, can you give us just like one or two action steps they should be taking throughout their life to be able to get to the stage of menopause and be set up for success? Yeah, sure. Absolutely. So it's the same principles at every age, Hippocrates.
00:36:38
Speaker
exercise and nutrition. There are some saltities according to the age group. So for the younger teenage dancer in training, they've got a big, big energy demand and it's very easy to fall short because not only will they be doing a lot of dancing, and that demands a lot of energy, but they also need a lot of energy for growing and developing to become an adult and to get the reproductive axis going.
00:37:00
Speaker
So I see a lot of dancers of this age group who are falling short of their energy demands. Maybe not even intentionally. They just didn't realize they're whizzing around doing all this stuff. The body's trying to grow and develop and there's just not enough energy to go around. So that's the key thing for the youngster. Really keep on top of your energy demands and also make sure you are having a day off. Again, I find so many dancers, they've got a full timetable at their dance school.
00:37:25
Speaker
And then on a Sunday, when there isn't anything scheduled, they go off and do their another dance class off their own back. You actually, having rest is just as valuable as doing a class in a rested state. So for the youngsters, it's really keep on top of all those ah demands. To a certain extent, the same thing applies during the menstruating years of the female dancer.
00:37:44
Speaker
Again, keeping on top of all your energy demands in terms of the nutrition, not over-training, maybe doing some strength training already, starting to do some. By then you'll know if you've got a particular weakness. but If one calf muscle isn't strong as the other or something, then You do have to work on your weaknesses. I know it sounds a bit tedious, but you do have to sort of do that. Don't always do what you're good at because it's not just about one step in ballet, is it? So it's it's everything really.
00:38:10
Speaker
And so, yeah, be still alert to that relative energy deficiency thing. And if there's any disruption of your menstrual cycles, please do go and get it checked out sooner than later.
00:38:21
Speaker
Because I have some dancers who come and, oh, I haven't had any periods for 10 years. It's like, oh, crikey. And they're hobbling in with numerous stress fractures. So better to get that looked at sooner than later in those reproductive menstruating years, should I say.
00:38:36
Speaker
And then menopause, again, going back to the same formula. Now it's all the same things, the nutrition exercise, the recovery, but now the proportions change. So with the nutrition, it's more protein.
00:38:47
Speaker
And with the exercise, it's still recovery and also really emphasising, making sure you're backing up your classes with the strength training. So I like keeping things simple.
00:38:58
Speaker
Remember those three things. And then according to your age, you're going to have to change the proportions of what that balance looks like for you. And also to stress, it's for you.
00:39:10
Speaker
Unless you're a clone, you're going to have different, even identical twins. It will be slightly different. Their demands, how their body's responding to the inputs, how your body's... Try not, I know it's difficult, try not to make comparisons. Oh, so-and-so is doing whatever, whatever.
00:39:28
Speaker
Or so-and-so isn't eating breakfast and and something like this. You know, you just have to do what you know. it works for you. This has been so helpful. Can you tell us how to find you if anyone wants to see more of your research or reach out to you for support? Sure.
00:39:43
Speaker
I've got a website called nickikfitness.com. And on that website, by the way, you'll find all the things I do. Like I do some blog, publications, the information about appointments, information about talks. So if you do want personal advice and appointment, that's the place to go and send me an email.
00:40:01
Speaker
Let me know about you and and we can fix something up. And also on social media. And that's at Dr. Nikki Kaye across all the various social media platforms. Look forward to hearing from you. Oh, and if I could mention one other thing.
00:40:13
Speaker
Yes. I published two books and they're directed at, it's not a medical textbook, is absolutely not. So don't worry about that. But it will have good information with references to explore some of the topics we've discussed.
00:40:25
Speaker
My first book was called Hormones, Health and Human Potential. And that takes you through all the hormones and the life stages like we've discussed. And by the way, of course, it is divided into acts and scenes.
00:40:36
Speaker
Of course it would be. ah Right, anyway. And then the more recent book I've edited, it's called Myths and Menopause. And as the title suggests, it's all about busting all those myths swirling around. Some of them we just touched on now. If you want to get your teeth into some reading and reasonably priced available on Amazon,
00:40:58
Speaker
across the world, whatever wherever you're living. Okay, perfect. Thank you so much for all of this information. This was so helpful and I'll definitely be checking out those books. So thank you so much. My pleasure. Thanks so much.
00:41:12
Speaker
Thank you for tuning into the Brainy Ballerina podcast. If you found this episode insightful, entertaining, or maybe a bit of both, I would so appreciate you taking a moment to leave a rating and hit subscribe.
00:41:25
Speaker
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00:41:38
Speaker
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