Dr. Stephanie Potreck is a medical doctor, registered nutritionist for sport, and a keen researcher. She began her dance training with ballet, both in Vaganova and Royal Academy of Dance methods, then added in other styles and ultimately trained for a diploma in musical theatre. Unfortunately, a fracture of a lumbar vertebra cut her career short. After graduating from medical school, she first spent a couple of years in global health and human genetics before getting back to dance during a sabbatical. Back in Sydney, she set up AusDancersOverseas, and now offers virtual appointments for dancers struggling with their relationship with food. Her clinical work focuses on low energy availability and disordered eating/eating disorders in dance.
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Could you talk about your journey from dancer to doctor and sports nutritionist? What sparked your interest in this career?
Dr. Stephanie Potreck: My journey hasn’t been as straightforward as many like to think. During my diploma course in musical theatre in the UK, I was injured. I fractured one of my lumbar vertebrae, and the surgeons in the NHS wanted to immobilise my spine. That didn’t sound appealing to me, so my parents and I started searching for dance specialists, which were hardly available at that time, and I ended up seeing a specialist in Zurich, Switzerland. He must have been at least 80 years old or so when I first met him, and he was married to a former principal dancer of Ballett Zürich. Seeing him really was a game-changer. He cared for me so well, and ultimately could prevent the surgery - which allows me to still dance today.
I don’t think I necessarily went into medicine because of my experience with this amazing doctor. I suppose it was more about doing something entirely different to dance. I was a bit stubborn and intent on leaving dance behind, probably because I just could not cope with what had happened at that time. Then I got “lost” in medicine (little did I know how many fascinating specialities there are within the field).
So, for quite a couple of years after graduation, I worked in global health and then later human genetics. I was somehow trying to understand the world from its smallest unit to its biggest. Only after I had decided to go on a sabbatical - the medical work environment can be just as relentless and toxic as the dance environment - I somehow found myself back in the Sydney Dance Company studios at least 5 times a week. That’s where the idea to combine both my passions started to grow.
Getting back into the dance environment made me realise how little knowledge about nutrition there is (other than beliefs and myths, of which we have plenty!) and how many health concerns and issues that dancers experience are related to nutrition. So I ended up applying for sports nutrition after going through a course designed specifically for doctors to qualify for any kind of further studies in the nutrition field. And here we are - I’m finally able to wear many professional hats and look at dancers quite holistically. For anything that is not part of my professional background, I am also connected with a brilliant team of healthcare colleagues all over the world.
Dancers are generally not treated as athletes when it comes to sufficient fuelling, cross training, and rest periods. Why do you think this is?
Stephanie: We tend to say it’s because dance wasn’t considered to be as physically demanding as other sports, as it was looked at as an art form. There was hardly any consideration of how this art is created, which is via physical activity. I’m afraid this is a sort of ignorance that has been made a stereotype, and we’ve got a very hard time getting rid of it now. It's so ingrained in too many former dancers turned teachers and directors - probably current dancers as well, though I like to believe attitudes really are changing. There is definitely more awareness of how demanding the profession is today, especially considering the versatility requirements of today’s dancers.
However, there have also been historical examples of people absolutely knowing how physically demanding dance has been: I remember reading Dame Beryl Grey’s biography (Royal Ballet dancer of the 1940s and 1950s) and she mentioned how her husband used to bring the dancers dextrose in order to be able to keep up with the strenuous rehearsals. One might argue that that was mostly during wartime when food was often scarce or rationed, but it shows how he knew how to keep the dancers going. Until today, dextrose is one of the most commonly consumed simple carbohydrates in sports in order to sustain exercise at medium-to high-intensity for prolonged times. “Prolonged” here refers to longer than 60-75 minutes, which is routine everyday life for dancers.
Can you explain the concept of body composition?
Stephanie: When we talk about body composition, we move away from focusing on a dancer’s weight. This is fantastic as weight can be such a trigger, but also, weight really doesn’t tell us much. Most of the time it’s a rather irrelevant detail of someone’s medical context.
Focusing on weight would mean that we don’t know how much muscle or how much body fat a dancer has. For dance, it is relevant to be strong, which means having sufficient and well-trained muscle tissue. It is also important and relevant to not be below certain body fat percentages, as a low body fat percentage most often means that a dancer is not able to produce enough hormones needed to adapt to training and be healthy overall.
In a nutshell, body composition tells us a lot more about “suitability” for dance (if we want to use that word) than weight ever could. A dancer can be the same weight but their body fat and body muscle percentages can be entirely different. That’s why weight alone isn’t helpful at all and should not be focused on.
Getting back into the dance environment made me realise how little knowledge about nutrition there is, and how many health concerns and issues that dancers experience are related to nutrition.
What is cortisol and how does it affect dancers’ bodies?
Stephanie: Cortisol is one of the body’s main stress hormones. It’s secreted in the adrenal glands, which are on top of our kidneys, and is especially important when we talk about prolonged periods of stress. During such times, cortisol gets upregulated (but no longer sufficiently downregulated) and interferes with a couple of processes, among them body composition, decision making, and memory.
Our brain has a lot of cortisol receptors and when these are all in use, we not only feel stressed, but our decision making and the ability to memorise are impaired as well. While we can probably all imagine that happening with psychological stress, it also happens when we stress our body through too much exercise (which is an easy trap to fall into as dancers) or not eating enough, or both. With higher than normal cortisol levels, the human body feels threatened and starts breaking down muscle tissue and storing more body fat. The body is also unable to build back that muscle tissue - as would be desired in order to adapt to training to improve our dancing. This particular mechanism is why often dancers wonder how their restrictive diet isn’t getting them where they want to be. Goals often include wanting to look leaner or more toned, but how would that be possible if the body feels threatened?
These are mechanisms that are thousands of years old and we absolutely cannot outsmart them. What is required in such moments is to look into training load and volume, plus sleep and nutrition and see where the actual problem lies. Spoiler alert - usually it’s about eating more to build muscle and reduce body fat.
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Restrictive and disordered eating are unfortunately prevalent in the industry. How do you go about assisting dancers who are struggling with these things?
Stephanie: I’m not sure I can answer that briefly here. It totally depends; I need to see where they’re at when they start working with me. I need to consider their age, their current medical status, their nutrition history, any beliefs that have already formed and how ingrained they are. I look at their family environment just as much as their dance environment, their social media consumption, whether they are hypermobile, whether they are neurodivergent, and so many other factors.
You can see, it really is about the individual. And everyone is unique: I may see someone newly diagnosed with an auto-immune disease but with an otherwise healthy relationship with food and their body, and all they need is some advice and guidance on food intake. But then I may see someone who has, even at a young age, formed so many beliefs about food and what they think is their best dance body, and this work is going to be entirely different. We’ll have to spend a considerable amount of time unpicking moral labels from foods, to name just one example. So it really depends. Recovery from an unhealthy relationship with food is often very hard as it feels like we’re thrown into the unknown and the uncontrollable, and that is scary. But it is so worth it; dancers really do gain a life with recovery, and usually a career as well.
How does restrictive eating increase the risk of injury?
Stephanie: As mentioned previously, restrictive eating has many consequences, one of them being the effects on the brain. When we can’t think clearly, we make decisions that can increase our risk of injury, such as squeezing in another workout that really is too much for the body to handle. Then - probably most obvious - we don’t have the energy to withstand the demands of the profession, and not having the energy means being physically active at a level we’re no longer safe at.
Restrictive eating also affects our metabolism on all levels, and that in itself is an increased risk of injury. The one example probably most are aware of is that restrictive eating can (and often does) decrease bone mineral density, so bones break easier and earlier. It is similar for tendons, ligaments and muscle, if there isn’t enough energy overall, and on a daily basis, to keep these tissues healthy, we increase our risk of injury. And if that injury happens, it’s high time to look into nutrition for it to be able to heal. Otherwise it’s a catch-22: injuries that don’t get enough fuel to heal won’t heal properly, will take much longer to heal, and are very often recurrent.
If companies and directors paid more attention to their dancers being well-fueled, rehearsal times would actually decrease; the dancers would be physically as well as mentally able to follow and execute what is asked of them more efficiently.
Why do you think teachers, choreographers, and directors are still giving unqualified nutritional advice and doing things like weigh-ins?
Stephanie: Because it’s been made a tradition that teachers, choreographers and directors know it all. Many of them still giving out such unqualified advice today have “inherited” a sense of entitlement from the environment they grew up in and have adopted this sense for themselves. It’s not helpful at all, and unfortunately most often a sign that they have chosen not to rise to the occasion that comes with their new position. I recently heard someone say, “they stay wilfully clueless” and I felt that.
As mentioned earlier, there are so many specialities within medicine alone. I would never prescribe a heart medication because I am not a cardiologist, while still too many dance teachers with absolutely no qualification in nutrition, let alone sports nutrition, don’t even question whether or not they should be talking about nutrition or health.
The obsession with weight is also harmful. Weight is a tiny detail of someone’s medical context, and most often not relevant. Maybe we should say that the dance world’s obsession with weight is the clearest sign we have that they have no idea what they’re talking about, or what they’re doing. It’s the biggest red flag out there for everyone.
Does medical bias exist for dancers? What should one look out for when seeing a medical professional?
Stephanie: Unfortunately, it does exist - and I have even experienced it myself, as a young doctor. First of all, most doctors today get to see what we call the general population, that is, individuals that have a sedentary lifestyle, a diet that doesn’t match said lifestyle, and many lifestyle-associated health conditions. So when a doctor sees a dancer, many of them assume, “Wow, they’re so pretty, the epitome of society’s beauty ideal, what could they even have?” That’s where many doctors get it wrong, because any dancer can have a multitude of health concerns or actual conditions.
Another aspect behind medical bias is that dancers are tough. They will put up with levels of pain most people just wouldn’t be able to deal with. A doctor may not take them seriously for exactly that reason. And last but not least, there is the general problem of time allocated per patient. It’s hardly possible to really listen to someone’s full story, despite the medical profession knowing that listening can change lives. This is the exact reason why I no longer work within the public and private healthcare system, where I would not have the time it takes to help someone recover from an unhealthy relationship with food.
Could you touch on the connection between dance training, perfectionism, and body dysmorphia?
Stephanie: When we grow up in dance, we are bombarded with all sorts of “drills” and perfectionism at a time when our brains are at their most impressionable and most vulnerable. This can include how we execute a step or movement just as much as how we look. We’re also told to always listen when corrections are given - meaning we also listen when a comment is made about someone else’s body. This all happens at an age when we’re not able to differentiate between “that’s relevant to me, too” or not. With a more positive and nurturing environment, we could prevent quite a couple of these rather extreme behaviours or ways of thinking.
On the other hand, society has normalised it to be discontent with our bodies. It’s rarely the dance environment alone that triggers perfectionism and/or body dysmorphia, but it is a well-known, and well-documented trigger, hence the dance world has the responsibility to minimise these as much as is humanly possible.
We are aware of the importance of rest for best possible performance – why do you think dance workloads and schedules fail to prioritise rest time?
Stephanie: Because that would mean truly acknowledging that it’s a physical activity that matches the principles of sport! This is one huge factor in the dance world’s failure to prioritise rest when it makes sense. I like to say that if companies and directors paid more attention to their dancers being well-fueled, rehearsal times would actually decrease; the dancers would be physically as well as mentally able to follow and execute what is asked of them more efficiently. That would honestly be the simplest way to add more rest into dancers’ schedules.
What are some basic steps dancers can take to encourage and maintain a healthy relationship to food?
Stephanie: The most important one would be, “do not follow any advice given by someone with no professional background in nutrition, preferably sports nutrition.” That includes all “advice” given by dance teachers, directors, choreographers, and peers. Also social media: a lot of dancers, particularly famous ones, still like to present themselves online as knowledgeable about nutrition when they really don’t know what they’re talking about, other than their personal experience, which is unlikely to be a good match for almost anyone reading it.
Other steps include finding dance healthcare professionals either in your area or internationally. Don’t be afraid to work on your relationship with food; no one needs to suffer, and especially not in silence. In sports, working with a dietitian or sports nutritionist is considered a badge of honour, as in “you’ve come so far that you’re allowed to work with a nutritionist.” In dance, it is still considered a punishment. It’s not - it’s going to be a game-changer.
Are things improving in terms of body image and proper nutrition, or are we at least on the right track?
Stephanie: We’re definitely on the right track!! The discussions that are possible today aren’t the same that they were ten, or even just five years ago. What I always find incredible is that once a dancer has started working with me, they recommend me to their friends or peers. So it’s almost like a parallel world, where not so much is happening on social media or in the public eye in general, but rather behind the scenes. That definitely helps me get up and be passionate about what I do every single day.
Top image: Courtesy of Nathan Dumlao
