5. Optimizing Nutrition to Support a Dancer’s Health with Kristin Koskinen, RDN

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00:00:00 

Jennifer Milner 

Welcome to bendy bodies. This is your guest cohost Jennifer Milner here with Dr. Linda Bluestein. For another  episode of this dance specific series today, we are so fortunate to be chatting with registered dietician,  nutritionist and dancer. Kristin Koskinen. Kristin pursued a career in dietetics to find the answers to her  questions about nutrition and its impact on health and performance. She owns a private practice where she offers  virtual nutrition counseling with a focus on performance nutrition. She incorporates the functional aspects of  food in her approach to help artistic athletes of all levels, including those who've retired from dance. Her  integrative approach recognizes that nutrition. Isn't just about the food you eat. It's important to take many  factors into consideration, including individual biochemistry environment, cultural influences, social norms and  body image, especially when working with dancers. Kristin is a founding member of dance med and is regularly  invited to speak on topics related to dancer health, and as a frequent contributor to media, including dance  magazine, shape Oprah Healthline, NBC, and today.com.  

00:01:23 

Linda Bluestein 

Hi, Kristin. Welcome to bendy bodies. Hello.  

00:01:27 

Kristin Koskinen 

Thank you so much for having me.  

00:01:28 

Jennifer Milner 

Absolutely. I can't wait to dive into our topic today. Before we start, with the questions that we have lined up for  you, can you give us some background on your life and just how you ended up as a nutritionist?  

00:01:42 

Kristin Koskinen 

Sure. Well as you mentioned, I'm a dancer. I grew up dancing in a pre-professional ballet company, and there was a lot of talk about diets and weight loss, but not much about how to eat, to support performance. Nutrition  was essentially acquainted with weight loss and in the culture then is there, unfortunately is now that are met  being better, it was better in ballet. By the time I was 12 or 13, I found that I was restricting what I ate to watch  the number on the scale go down. I was a normal weight and no one had ever suggested that I should lose  weight, but it was clear that thinner dancers were serious dancers and I wanted to be taken seriously. In spite of  that, interestingly, my artistic director was the first person to introduce me to the concept of nutrient timing.  That's the idea of, what to eat and when to support your performance.  

00:02:39 

Kristin Koskinen 

That combined with watching Rocky Balboa swallow raw eggs were really my introduction to nutrition. I'm  retired from ballet and I went on to college where, I, I switched from ballet to cheerleading and I studied,  biology and psychology and tending to go to medical school. However my biochem prof knew that my end goal  was nutrition and recommended that I switched gears to pursue a master's in nutrition, which I actually did after  I finished school, I worked as a clinical dietician. That means I worked in a hospital setting and then I took some  time off to be at home with our five kids. I even homeschooled them for several years. I love teaching. I found it  really rewarding, and that was an interesting part of my life that I wouldn't have forecasted. As the kids grew  and went to school, I decided to go into private practice because I wanted to practice functional nutrition.  

00:03:44 

Kristin Koskinen 

I really wanted to be who I needed when I was dancing. To a lot of people need when they're looking to take  care of their own health and wellbeing, health care is what we do at home. Sick care is what happens in  hospitals. When I was working in a hospital, I was taking care of sick people. I really wanted to, which is  wonderful and we absolutely need that. I just wanted to be on the other end of things, giving people more  control over their own health and destiny. I take a holistic approach in my practice where I emphasize long-term  health and wellness using food and nutrition to support the body's natural processes, including, recovery,  athletics immunity. I really tried to emphasize how foods make my clients feel. Sometimes the emphasis is more  physiologic and sometimes it's more emotional, but we're always mindful of where we're sourcing and how that  goes.  

00:04:44 

Jennifer Milner 

Things about that I love, including the concept that healthcare is what we do at home. Hopefully if we do that,  we don't end up at the hospital needing the sick care.  

00:04:55 

Kristin Koskinen 

So yeah, exactly. That is.  

00:04:56 

Jennifer Milner 

A great way to look at it. It's not really a luxury to be trying to eat healthy foods. It's a, it's a necessity. It's like  prehab instead of rehab.  

00:05:05 

Kristin Koskinen 

Oh, exactly. I love it. What I talked to when I talked to our, we shared friends, our dance, BT friends, it's the  same thing. They they, what they can do, what we can do ahead of time is so much more powerful than if we  wait to fix things that prevention really is the best cure.  

00:05:26 

Jennifer Milner 

Absolutely. I agree with you. One of the things we look at, in the circles that the three of us traveling is that  balance between dancers being the artist, but also being the athlete. Many times, we work on finding that perfect  aesthetic, right? Trying to make ourselves look a perfect way. In my line of work, it might be that they're  cheating the way their hip is used to get a beautiful line when that's just not physiologically how they're built  and in your, it might be, cheating, they're fueling in order to have a specific kind of aesthetic and a kind of look,  and going beyond that, what are some of the typical mistakes that dancers make in the way that they feel  themselves? 

00:06:12 

Kristin Koskinen 

Oh yeah, absolutely. You know, they are, they're artistic athletes. When we look at the cycle, this is why we  need to look at the psychology of the dancer. There's this spectrum that we find a dancer falls on in that term.  They really view themselves as artists and others really embrace the artist, the athletic component of dance.  Most people fall someplace in the middle, but no matter what, they are artists. This idea of line ballet is really  kind of my main area and line tends to be, we look at the beauty of a thin line. We drive a lot of thin ideologies,  which drives dancers to under eat, which drives them toward fad diets. Some of the diets they even pick up may  actually have an appropriate role for other people. Keto is a big one, like keto has like, can be used  therapeutically for great results.  

00:07:21 

Kristin Koskinen 

It's not a place that dancers should be. I think they get caught up in fad diets. They under fuel, they use artificial  means to elevate their energy levels, which is really just robbing yourself from another day, whether it's caffeine  or energy, drinks or sugar. It just drives things in the wrong direction and what we really want to do the dance  medicine field as a whole. It's really looking at longevity and dance. We're not looking at the dancer retiring at  18 or 22 or even 30. We're looking at dancers if they well into their fifties or maybe even 80. At what you do  now impacts how long and how strong you can dance. So did I dance around the question?  

00:08:13 

Jennifer Milner 

Nope. I don't think so. I, what I heard was that some of the things that you commonly see are, under eating,  looking at fad diets, just under fueling in general and then artificially raising energy levels as well. There in this  grouping of things that we see a lot, because I see those same things, and I like that you specifically talked about  artificially raising energy levels because a lot of dancers do that overdosing on coffee or shooting a pixie stick  before they have to go on to do snow or whatever. Yeah. But, but another common thing that I see is just not  knowing what and when to eat. Do you, do you see that as a common thing too, that they're not necessarily  trying to avoid eating healthy, but they don't know when can I eat a bigger meal and when should I eat less and  when should I eat this type of like, when should I eat more fat, heavier protein heavy, and when should I eat  healthy carbs, do you see that kind of thing commonly as well,  

00:09:22 

Kristin Koskinen 

All the time, all the time. That is okay, that's actually a decent place to because that's sports, nutrition, that's  specific knowledge that we want to layer in to a, a sound diet. W so this is part, so if I'm working with a dancer  or any athlete, but specifically dancers, we want to, we're going to have a foundational diet. The trick is we need  to be able to shift what they're eating depending on a lot of factors. Those factors could be where they are in  their season, whether it is before it, whether it's not Cracker, whether it's before audition for looking at the  audition season, after we're coming off of Nutcracker and maybe of a break, and then driving into the audition  season during the winter, some associated issues there, are they getting ready for summer intensives? How are  they going to eat during intensive? So all these things make those, make the particulars different, and they're  going to be different for each person.  

00:10:25 

Kristin Koskinen 

I really try to work with dancers to, find, to build flexibility into their diets and meal plans. One of the ways I do  that is with what I call the ballet. About two years ago, I was really thinking about how can we educate dancers  and provide real food solutions for them, whatever their needs are. That also turn them away from disordered  eating. I got thinking about it, and the bento is a beautiful tool for this. I use the bento as a tool. I if I can start a  dancer at eight years old, it's perfect. Kids at any age can do this dancers, dance professionals, PDs use the, Oh,  you got me started doing it. Right. Right. Exactly. And I did it because of this. They're portable. You can take  your healthy foods on the road. My dancers have been working with shelf stable foods for a while, because you  can't depend that you're going to have refrigerator space or, if you're at theater that taking a cooler may or may  not be an option for you, if you're traveling that may or may not be an option for you.  

00:11:35 

Kristin Koskinen 

We work on these things at the beginning and, with the ballet bento, the one I use has six compartments. That lets us build things up and prepare for the unexpected because there's always unexpected. What if you're more  hungry? What if rehearsal runs long? What if you only this much time to eat? What if you can only get your  nutrition in three bites, a big salad is a beautiful food, but it's, that's not a good idea if you've got, five minutes to  get in what you need before you're being called back, because guess what we did, we w w we're going to run it  three more times because we flopped it before. So, creating flexible strategies that a dancer can go to and create  on their own is really foundational to my work with this community. As it turns out, it works really well with  other people too.  

00:12:35 

Kristin Koskinen 

Now now, remind me what the question is. Cause I'm now I'm all in the ballet world. No.  

00:12:40 

Jennifer Milner 

You answered it because were talking about, starting out with a baseline of coming in, not knowing what to eat  and when to eat and dancers might feel like that's a terrible place to start, but you were saying that's actually a  great place to start because that's something that you can work with. Trying to find ways to learn how to do that  in a flexible way, learning how to, like you said, create flexible strategies. As we all know, dancers are masters  at dealing with the unexpected and love being flexible and living in uncertain times, I'm saying sarcastically, so  dancers very much want rules that they can follow. I, it sounds like part of what you do is teach them here are  the basic concepts, and now you have the tools to figure out how to work within this structure.  

00:13:35 

Kristin Koskinen 

Sure, absolutely. And you're right. And the bento creates that structure. We are all about. And that is dance. You  have re we have structure. Someone's always telling us what to do. There's a mirror. Someone says, you're right.  You're wrong. There are all these, the fundamentals and technique after that, we can flux it out. Even with the  parameters of a bento where, Hey, you're going to put some protein in here and we can look, if I'm working with  some, I can give general recommendations and put lists together to help people get started. If I'm working with  someone specifically, because they have specific needs, they really want to dial in their performance. They they  have a health condition that we need to do. We can still have lists of these are your options, and now do it, and  it's reliable. It can take a lot of pressure off, and remove a lot of anxiety when you just know you're going to be  okay.  

00:14:33 

Kristin Koskinen 

And you, it's a very, figureoutable,  

00:14:38 

Jennifer Milner 

That sounds completely doable. It sounds like it gives dancers that the flexibility they need. So I love that  concept. Like I said, you've got me, you already have me doing it.  

00:14:47 

Jennifer Milner 

Yay. I love it. Every every time I make.  

00:14:52 

Jennifer Milner 

One up, I look at them like, Oh, this makes me so happy.  

00:14:54 

Kristin Koskinen 

Oh, happy. I love hearing that. That really makes my day. So so.  

00:15:02 

Jennifer Milner 

It's great to have that flexibility. It's great to have that knowledge, of knowing that you can have that structure  and then have stuff to put in it. One of the things dancers deal with regularly is that we push ourselves too much  and that we're running on fumes. Sometimes we need to think beyond what do I need to eat in the next four hours? Sometimes we need to think my body is running completely on empty. What are some changes that I  need to make to help keep my immune system strong? And especially in today's world, it's even more important  than ever to keep that immune system strong. Are there, are there specific nutrients that dancers can focus on to  help keep their immune system elevated?  

00:15:46 

Kristin Koskinen 

Absolutely. There, generally speaking, I'm always going to go back to, we found, we want a foundationally,  strong diet. We want, we want the fuel. You're putting in your body on a regular basis. It's if that's the, we don't  want to run our tanks down to zero, and we want to have these nutrients and accessible on the regular. We don't  want to just fill the tank, top it off, and then spray the entire car with things, thinking that's going to solve the  problem. So let's start foundationally. And if we're not there, that's okay. We're going to start where we are. We  do know there are certain nutrients that are imperative for immunity. Part of the way we know about the role of  specific nutrients and immunity is by looking at undernutrition. We understand that well, when we look at, areas  impacted by food shortages or famines or explore, nutrition status in developing countries, however, we can  impose the same nutrient deficiencies on ourselves by dieting, under fueling, not by not paying attention, not  practicing the self care of eating the foods our bodies actually need.  

00:17:05 

Kristin Koskinen 

I think immunity really gets pushed to the side with dancers because they took the operate it's in the here and  now it's a miss performance. It's a miss versus for the long term, you're going to need this immunity strong and  going. Some of the nutrients of focused we would look at straight away would include, vitamins, a vitamin C  vitamin D vitamin E selenium zinc. There are a host of, plant, chemicals that can support immunity as well.  Nutrients that focus we're really going to dial in on are those nutrients. They conveniently tend to come  packaged in, fruits and vegetables. Some of them we may need to supplement or layer in. They also come. Some  of them may be more, reliably available to the body in animal product. We would talk about that with dancers  too. I know a lot of dancers come to me and they want to have a vegan diet.  

00:18:09 

Kristin Koskinen 

When we talk about plant-based, there's, I'd like to clarify this because it's really important, especially with, a lot  of documentaries we're saying come out these days, plant-based doesn't necessarily mean vegan. It means the  basis, the foundation of your diet is plants, and you can build other things into it. It may include some animal  products and for most people, I do recommend that because, it can be challenging to have a diet that meets all  your needs. That's simply plant-based. For example, zinc, we can find zinc in plant foods like legumes and  whole grains, but those kinds of foods also come with a lot of fiber, which is awesome, but it can make it harder  for the fiber tends to hold on to the zinc a bit more in the plant, and it can make it less easy for the body to  actually access it. Other foods we want to think of when we're looking at the immune system include fermented  foods, about 80% of your immune system is stationed in your gut and how we feed the gut, how we treat the  gut, influences what we call the microbiota.  

00:19:20 

Kristin Koskinen 

That's all the microbiome, microorganisms from parasites and viruses and bacteria. There's a whole host of them  that live in your gut. We want to feed those well, and we also want to take care of the gut tissue. Fermented  foods can be very supportive, for the general population for specific populations, we might not want to use  fermented foods. Fiber is generally a good one to support the gut vitamin a is found in, a lot of plant foods,  including we think of it in yellow and orange foods like carrots and squash and cantaloupe. It can also be in dark  leafy greens where the chlorophyll covers the, vitamin a, this is a precursor to vitamin a, it's not active vitamin a,  but dark leafy greens are another good source mango. You can get pre vitamin a in its pre done form, which is  going to be again, it's easier for the body to absorb in liver or egg yolks.  

00:20:27 

Kristin Koskinen 

Vitamin C we know is found in citrus fruits, Brussels sprouts, berries of all kinds. It's, it's really pretty easy to get a hold of in whole food form, vitamin E pretty much the same. We we find it and seeds and nuts and more  fat-based, plant foods and vitamin D is a little or vitamin D is of an outlier that our best source tends to be the  

sun. However most answers aren't getting enough sun it's not readily available in food sources. You can get it in  fortified, dairy, fortified, orange juice. It is present in egg yolk, grass fed and finished, meats. We'll have some as well as mushrooms that have been exposed to UV light, but a lot of people just aren't eating enough of those  foods to meet their immune and function needs. When we look at it's important to when we talk about how  much is enough, because that becomes a question, is that the RDA and I look at the RDA as a starting point,  that's, what's going to prevent a blatant deficiency like blatant deficiency.  

00:21:40 

Kristin Koskinen 

Vitamin D is a recut, a blatant divided deficiency of vitamin C is scurvy. When we are, when our bodies are  under a lot of stress, whether it's emotional stress, like when a lot of people are experiencing now, whether it's  physical stress, what we experience when we're dancing, have intense dance schedules and training schedules,  or both the body draws on a lot of these nutrients. So you may need more. Some people may even need some  additional support from supplements. Stress is a big one. What people may not understand, is your body doesn't  disseminate between physical stress and emotional stress. It reads stress as stress, and gonna fight or flight  comes into play. Your adrenal glands control a lot of the hormonal processes that drive these responses and your  adrenal glands. Also how's most of your vitamin C, which is a good indicator, how important it is for the stress  response, because it, the location makes it very rapidly accessible to producing what you, the hormones you  need first stress response.  

00:22:54 

Kristin Koskinen 

If you're under a lot of stress, your vitamin C demand may actually escalate. If you've been under a lot of stress,  what people find is like, Oh, it was under out, wow, I so busy, it was Nutcracker. I just like crashed and got sick,  or they find they're under a lot of pressure. They crash and get sick and maybe impart because they're burning  through their stores and they're not refueling the vitamin C stores to the degree they need to keep them healthy.  That may be part of the crash. There are other things too, but it can be a contributor. vitamin D not getting  enough vitamin D because dancers don't go outside. They don't expose their skin, even when they can go outside  in the summer, but summer break they're at intensive. We that's, we've got to address that and make sure that  they're covered. Absolutely.  

00:23:47 

Jennifer Milner 

I, and it, I love, it sounds to me like, you're not saying eat almonds and you'll be fine. I think we, as a society,  love to find that next big thing I know for awhile it was goji berries, right. Or whatever it is, and people think,  well, I'm just going to eat a bunch of these and I don't have to do anything else. I think we're realizing there's no  magic bullet that it's a wide variety. There are lots of great super foods, but there's not one super food. We have  to get a wide variety is what you're saying, which we all hear, but we don't like to believe cause we love  shortcuts.  

00:24:24 

Kristin Koskinen 

Right. Well and you know, okay. I'm going to tell on myself here when I was dancing, I saw total cereal. Okay.  It was like total, it's got a hundred percent of all these things I'd watch. It was if I just eat total cereal three times  a day, boom, I've done it. I don't have to think about it anymore. ? Right Yeah. That's not the way that works.  When we're getting our nutrition from food, we're getting what I call the speck of best theory. Are the emerging  science is always emerging. We're always learning more. When you get your nutrition from, the whole food  source, like potatoes or carrots or grapes or whatever, you're also getting phytochemicals, which we don't  classify in the federal government. Doesn't doesn't regulate that they don't monitor it. It's just not something  that's there, but they're super important. Resveratrol, quercetin, these are all foods or these are all plant  compounds that come in your food, that support immunity that are anti-inflammatory, that are best taken in food  form.  

00:25:37 

Kristin Koskinen 

Yeah, when we eat the food, we're hitting those bases and there is no one food. It's, it's really a broad swath of  foods is our best bet. If we need to limit foods for certain reasons, like right now you can get what you can get,  because that's where we're. You go to the store, you may not be able to find things, we can work with that, but  on the whole, and in normal circumstances, definitely go for a broad variety of plant-based foods and layer in,  well-sourced animal products. 

00:26:11 

Jennifer Milner 

Okay. I love that. I do want to get into supplements and I know Linda had several questions for you on that. To  start that off though, I wanted to circle back to, you mentioned fermented foods and how important they were  for the gut. Do you include, or do you see a place for probiotics as well? Which I know is a supplement, but do  you see probiotics being, as effective or helpful as fermented foods?  

00:26:38 

Kristin Koskinen 

Yeah. I think that, you know,  

00:26:41 

Jennifer Milner 

I'm talking about capsules as well as taking yogurt, but also the capsules that you can take to try to increase.  

00:26:48 

Kristin Koskinen 

That. Yeah. I think probiotics definitely have a place. The interesting thing is when we talk about probiotics,  there's not just one and we can actually look at what strains, different strains of bacteria offered different  benefits and depending, and I'll tell you this, it's always, the answer is always going to be, it depends. In the  general community, yes, probiotics are typically can typically beneficial. If we want to get really specific and  we have specific health concerns, we might want to look at what formulation of our probiotic we're using. For  example, someone with allergies may benefit from using a particular strain of probiotic. If someone has what we  call small intestinal bacterial overgrowth or SIBO, we may not want to do that because there's already a problem  where bacteria are, where they're not supposed to be, and we might, we need to resolve the underlying problem.  We don't want to necessarily fuel the fire with throwing more on that's going to be a specific case by case  measure, even with the fermented foods, if we're looking at the, dancers specifically with hypermobility who  may, have mast cell activation concerns, histamines can be a problem.  

00:28:20 

Kristin Koskinen 

We're going to say, no, we don't want to do fermented foods there because that can drive other issues, for those  dancers. It's, it starts to become of a dance with the specifics in generally speaking. Yes but when we're looking  at the human body n always equals one, what works for me will not necessarily work for someone else. What  works for me today may not work for me in 10 years may need to be shifted depending even on the day of the  week where a person isn't or a female is in her cycle, where we are in the calendar year, where we are in our  work year, where we are in the seasons. We're always mindful of these things and how we may need to shift and  adjust.  

00:29:07 

Linda Bluestein 

Excellent. Thank you.  

00:29:09 

Jennifer Milner 

Yeah. I'm really glad that you brought up SIBO, Small intestinal bacterial overgrowth,  

00:29:12 

Kristin Koskinen 

, because that is something that people with hypermobility disorders are definitely at increased risk of having,  and they can have a lot of those symptoms of, bloating and discomfort after meals and things like that are vague  enough that it can be take quite a bit of time before they can actually get that diagnosis. I'm really glad that you  brought that up. That well, probiotics might be really great for one group of people. They're not going to be  great for another group of people, so, right. That's so important. What are your thoughts about supplements in  general and are there certain circumstances under which you do encourage supplements? My idea on  supplements in general is we want to start with the diet. We use supplements to do just that to supplement, to  build in where we may have gaps. A lot of people have gaps because of what food is available, increased  demand, their physiologic needs and demands. 

00:30:14 

Kristin Koskinen 

Our food supply is not the nutrient density of our food supply is not what it was many years ago. Our our bodies  have to fight a host of toxins. Constantly. Our bodies are under attack on the regular from pesticides. What Pete,  your neighbor sprays in their yard, the fumes, the Marleys putting off. I mean, the crap we're dealing with wifi  and it's, there's a lot for our bodies to deal with. Generally speaking, yeah, I, I definitely use supplements in my  practice. They're not, I don't have a specific, formulary and not every, I don't necessarily think it's appropriate.  Even I'll tell you about even with the lead times. I'm not gonna lead with someone, particularly a dancer with a  lot of supplements at any one time, because it can give the false sense of security, like, Oh, but I'm taking this. I  don't need to pay attention to the diet, but your supplements aren't going to provide the curcumin noise that you  get from eating whole tumeric that you put into, the Indian dish that you enjoy.  

00:31:18 

Kristin Koskinen 

I'm really particular about how, when we bring these into the program, how psychologically the client takes it.  So that's part of it. Vitamin D honestly, I, I almost across the board, people just start getting enough. They spend  too much time inside. If people have any issues with liver or kidney or absorbing certain nutrients that support  those organs, they can fall short. I, I always pair vitamin D with vitamin K2 to make sure that the vitamin D  goes where we want it. Doesn't settle in soft tissues, like, arteries and blood vessels. Yeah. I think, high quality  we'll pause there. Let's talk about high quality. When were looking at settlements, it's really important to take a  high quality supplement. What that means is you're getting what you think you're getting, it's not been doctored  up with things you don't want or things that can hurt you. It's free of contaminants.  

00:32:29 

Kristin Koskinen 

It's been stored properly so that the active ingredients are still active when you get them. And yeah, and it's  efficacious. Like it's going to do what it's supposed to do because it's been processed, properly. We want to look  at high quality supplements. Those typically aren't going to come off the shelf from target. You are probably  going to your best bet is to consult with your healthcare provider who will have access to, a dispensary or to get  them from a pharmacy. Those are my initial. I just, I recently wrote a, I have a blog on supplements. It's like  supplements one Oh one. If if listeners want to check that out, and we want to know what's coming in our  supplements, like I've seen, I saw a supplement come out with colloidal silver now, colloidal silver,  antibacterial, antimicrobial, topically. It can also lead you to having permanently discolored skin.  

00:33:30 

Kristin Koskinen 

Some of these really cute, they're really cute supplements that we're seeing advertised on social media, have  some things in there with some, you might not anticipate that as a side effect, having your eyes discolored for  life, because someone threw some dis and it sounds fancy, right? I mean, but I, but unless you are under the  specific care of a healthcare provider who practices functional and integrative and holistic medicine, who  understands how to apply that specifically to your case for a limited duration. When the pull it out, don't go  there. That's one of the reasons we want to, when we're looking at supplements, it's, they're very thoughtful. It's  it's really, this is we're looking at, this is, it's almost pharmaceutical. When you look at it because the interplay  matters, if people say, Oh yeah, I heard Zinke's great for your immunity. I'm going to start, sloshing down to the  same.  

00:34:29 

Kristin Koskinen 

Well that's fine. If you overdo it, you can end up with a copper deficiency because copper and zinc compete for  absorption. If you end up with a copper deficiency, you're going to have a host of problems, including being  immunocompromised. You've circled around and caused a new problem.  

00:34:47 

Jennifer Milner 

So, so you mentioned you want to be under the guidance of a healthcare professional. Let me ask you really  quick on this licensed nutritionist, registered dietician, healthcare coach. There's so much out there on the  internet and through social media and people with these titles, how do we differentiate and how do we know  what we're looking for as far as who is really qualified to hand out this kind of information, 

00:35:13 

Kristin Koskinen 

Right? So what you say matters. For example, the term doctor, you can go to a doctor, who's a doctor of  philosophy who you probably don't want, teaching philosophy and your university. You don't want that person  necessarily managing your healthcare. They can be brilliant, but not in the way that you need them to be  brilliant. A registered dietician is a specific designation, a diet registered dietician or registered dietician. Nutritionist is the same thing. It's just how we choose to it's a moniker choice, but that's the same as someone  who puts letters after their name, it's a legal designation, just like MD for a medical doctor, IDEO for a doctor of  osteopathy and NB for, a naturopathic doctor, a chiropractor, Dr. Pete physical therapy and DMD DDS. All  these healthcare providers are, have regulations based on that. They have gone through a process to get where  they are that is outlined and consistent.  

00:36:15 

Kristin Koskinen 

For dietician, that means they have a minimum of a four year degree, with coursework that includes, but it is not  limited to biochemistry, microbiology, physiology, nutrition, sciences, that's a baseline. They also have passed  rigorous, ward exams. This is w he's here the same for physicians, dentists, all of us have done these things.  They have continuing education to stay that they're required to do, to stay abreast in the field or in the particular  area of practice where. My continuing education, I am every day, I'm reading medical journals, nutrition out  posts, all the things about what I do. Even though I understand school nutrition and how that works, and you'll  find dieticians there, I don't practice school diets, headaches, and I would refer. If you needed someone like that,  I would refer you out. Even within the field, what Linda does as a functional and integrative practitioner, she's  going to have a knowledge base about a lot of these things that others won't her knowledge about hypermobility  and pain management is going to give her a unique perspective that even if you went to another doctor and they  can know a lot of things, they may not be able to dial that in.  

00:37:39 

Kristin Koskinen 

One, you want to make sure you have a licensed credentialed practitioner, then you want to make sure that  practitioner, meets the needs. You're looking for, we don't want to send our sons to gynecologists necessarily.  They might, they might be missing some bases. So that's really important. There is no such thing as like, after  you have a registered dietetics degree and those, qualifications, there's certain programs, you can pick up  additional certifications. You can have a certification as a diabetes educator, as, a sports nutritionist. There are  things that you can do, but there is no broadly accepted, nationally accepted, internationally accepted certified  nutritionist. I'm saying that in air quotes or, even health coach, they can offer a health coach can offer. You  some great support, but they cannot offer you, the kind of background and knowledge and understanding that a  dietician is going to have because of what they bring in and the understanding they have about the body and  how people work and why the questions we're going to ask to get to Y to where you are and what approach  we're going to take, because we're, it's very layered.  

00:39:00 

Kristin Koskinen 

What makes sound is like a simple question. If you ask me a question or I'm looking at someone, I I've run that,  I'm running that through, a layer of filters to decide where we want to go next it's because there is no formulary.  There is no, we do this, that we do this, we prescribed this. That's not the way it can't, you can do that, but that's  not the way it actually works.  

00:39:24 

Linda Bluestein 

I think that this.  

00:39:25 

Kristin Koskinen 

Is such an important point. I'm so glad Jen, that you asked this question, because I think as you're explaining  this, Kristin, it's making me realize too, that when people are getting a, a simple answer or a something that  sounds too good to be true, that's, I think that's how a lot of people do end up, being successful at, convincing  people to try things that maybe are not in their best interest because they make, it just sounds so great. Like  you're saying, you're thinking of all of these different scientific things and the body is so incredibly complicated.  That's why you don't have like one single answer for everyone that is, going to work in every single person every single time, because there's just so many variables that you have to factor into consideration. Absolutely.  Another thing that a dietician, not all dieticians, but something that a dietician or a dietician who works in  concert with other health professionals will have access to is different levels of testing.  

00:40:25 

Kristin Koskinen 

If we have questions about things, so for it, we can test and not guess a lot of times we can use a clinical  approach and based on physical signs and symptoms and what you're eating in, and a number of inputs, we can  choose a right direction, but we also have access to these high-level supplements that other people don't have.  I'm not, that a multi-level marketing coach isn't going to have available to them. We're going to be able to test to  see how's this all working and what parameters do we have. The dietician is going to work in concert with your  other healthcare providers. If it's, when it's appropriate to make sure we're getting great results. We're looking at  communities or, populations with high-level needs or specific needs, we might need to get to that level of  complication and things. I would start with a dancer who, has hypermobility is someplace on the hypermobility  spectrum.  

00:41:30 

Kristin Koskinen 

I'm going to start at a much different place, but I'm going to start with a dancer who doesn't including maybe, we  might pull out some testing right away to start addressing some of these gut or SIBO or other issues or  inflammatory issues to mitigate the process. What test results would you want to see in a perfect world. You're  and let's say it as somebody with hypermobility, when you're first starting to see them, what test results would  you like to see in an ideal world? I'll take all the tests through it. I love it. I want everything, but that's not really  reasonable. You know, okay. For example, even if we're not really talking about thyroid, that's a little off, but I  see clients come to me, adult clients, Oh, everything's fine. You know, I don't have a Clara. My my primary care  provider, you did a thyroid test and they took one parameter out of, at least four that we want to look at to  actually gauge where you're.  

00:42:32 

Kristin Koskinen 

It's like, Oh man, that one TSH that's not the end of the story. I want to see the depth of testing to my, if I had to  choose my topics would be, I would go for a micronutrient panel and I would go for an MRT test because I, in  my practice, I found a lot of success using the results and MRT test essentially looks at what foods a person  specifically has adverse reactions to. So, and they can be even healthy foods. I have a client who is very, she's  really reactive to quinoa Bazell chicken. I mean, things that people think is healthy food bananas. When we  took those out of her diet and were able to give her other healthy options, she, her eczema went away, brain fog  cleared. This was, these are some, we can get some really good results. Everyone's going to respond differently,  but when we're looking at it at connective tissue concerns, and can I, we, our connective tissue, our gut, were  looking the fragility of that.  

00:43:51 

Kristin Koskinen 

I want to see what can we do to just, celiac disease is a big concern with Ehlers-Danlos. Sometimes the ensuing  mood issues that we might see from things leaking through the gut and hitting the rest of the body that can  impact our mental status. Those would be the ones that I would go with first and that income that gives, but  those two, I get a lot of them. Absolutely. Absolutely. And, and when it comes to the hypermobile population,  whether they have Ehlers-Danlos or hypermobility spectrum disorder, or, a different hypermobility condition,  but, so that population, which of we know does affect dancers more than the general population, how do you  approach their diet differently than a non hypermobile persons? Well, someone with hypermobility is going to  come in with a lot. They're going to have some other there we're looking at them differently because they're  going to, a lot of times come with different health concerns.  

00:44:51 

Kristin Koskinen 

Like we talked about SIBO or GI distress, or, all these things that we want to approach first. My first approach  is going to be, I'm going to look at the gut. We're going to talk about nutrient timing and a lot of those things,  and maybe more the sports, nutrition, performance items a little later, because if we put that ahead of tending to  the guts, we're going to miss a lot. I want to make sure that GI system is in the best form. We can get it, and it  may not be perfect or ideal, but we want it at its best, whatever that is just like extension, which your feet aren't.  We want them to be the best. We can't cheat this. A gut-friendly diet maybe impart removing offending foods. Foods that are pro-inflammatory, we there's some known pro-inflammatory food choices, gluten soy, corn,  dairy, sugar, a dancer.  

00:45:50 

Kristin Koskinen 

He comes to me with on the hypermobility spectrum. We're going to start off by getting rid of gluten. ? Why  Because gluten is known to drive zonulin, which drives, gaps in the intestine, which can lead to the subsequent  hyper inflammatory, these subsequent inflammatory issues with other food sources. We're going to pull gluten  right away. I don't necessarily do that with every dancer. I am going to do that with my hypermobile dancers, because it's just to me a no-brainer, we're going to look at the kinds of fiber that work to support that gut. If  they're coming with some other, n issues, do we need to rule out SIBO? Do we need to do some specific testing  for that? a lot of that I'll have, do have them do with their primary care provider, because it tends to be cheaper,  easier to do. Do they need to maybe go on a low histamine diet temporarily or for the long-term based on their  concerns.  

00:46:52 

Kristin Koskinen 

We're going to look at that. Do they, do they respond differently to different kinds of foods? So we talk about  apples and onions and grapes has been wonderful foods high in fiber, they offer, quercitin and some of these  resveratrol and some of these other phytonutrients we've talked about, but if a dancer's GI is such that it gives  

them gas, distention, and bloating, we might want to try, what's called a FODMAP diet, which is a temporary,  it's a temporary thing, but it's a therapeutic approach to pulling some foods out. We'll see how the body  responds, and then we'll bring back in slowly. We can maximize the diversity in their diet. I'm probably going to  be really quick to bring in hydrolyzed colleges with some of the bend to your body. ? Why Because we know  that when we, with elemental nutrients, that means when we break them down to their most, their smallest form,  like protein, they are more readily available to the body hydrolyzed college and has been broken down to  smaller peptides, which are readily absorbed.  

00:48:05 

Kristin Koskinen 

There's some research that even suggests that those peptides after they're absorbed, indicate that the body needs  to actually produce more colleges. We need college into heal the gut and to, for all the connected tissue, we need  it for bone, which is also connected tissue. I'm going to bring that in whether it has a direct response or not, we  don't have all the answers, we don't know, but it's not going to hurt. That's something I will, I would bring in  right away. It's a, it's a low to no risk outing. That all sounds great. When it comes to, I, we talked briefly about  mass cell activation syndrome earlier, and also we've talked of course, about chronic inflammation. Can you just  talk more about, both of those things and how you've mentioned some foods that can definitely potentially  increase inflammation? Are there certain foods that in terms of mass cell activation syndrome and, or  inflammation, certain things that can actually improve those things? yeah.  

00:49:15 

Kristin Koskinen 

What was that cell activation? A lot of it is, with inflammation are a lot of our first approaches we're moving  offenders. Things that drive histamine or that come as that actually deliver his demand where we want to pull  out. Specific foods would be fermented foods, aged foods like salamis and cheeses, leftovers, even. We want to  pull, we want to be really cautious with those in the diet foods that are known to be, and that have a wealth of  historic and scientific evidence as being anti-inflammatory include ginger cinnamon. Garlic we'd want to be a  little careful with that one with certain clients that can, that can drive them in the wrong direction. Green tea,  let's see, what else am I again, any there Robert Hall, that comes from grapes and those kinds of things. Ideally  read them in the whole food form, but if we can't because they, other components of the food may drive  inflammation, we can get them in supplement form too, and really actually get out of high load and say  cinnamon or ginger or tumeric as opposed to eating the food for them.  

00:50:43 

Kristin Koskinen 

And that can be really helpful. There are studies, there are some studies that are fairly new, that show that  dosing with, around 2,400 milligrams of cinnamon divided over the course of the day can help with menstrual  pain. Now, is that all kinds of pain? No. It a specific, was it a specific study? Yes. Can we extrapolate that?  Yeah. Would I add some cinnamon to the food I'm eating particularly Salen cinnamon, as opposed to Saigon  cinnamon, which is what you buy in the grocery store? Mostly it's the Saigon is less expensive. Look for Cylon you probably have to order it is it could, it, could it offer some benefits? You bet. If yeah, so I would totally pull  those kinds of things in, I don't have a lot of experience with mass cell activation and I would probably be  looking at colleagues to help me out with that, but these are some starting points where we would lead with.  

00:51:37 

Kristin Koskinen 

I love the tip about the cinnamon. I honestly, I've never heard that one before. My, amongst my patients, the  amount of, menstrual pain is really significant. I mean, this is a problem that's super common. I'm very curious  to do more research on that myself, because that sounds really intriguing and low risk. Sure. And ginger, the  same thing. Here's the thing too, when we look at a lot of these foods, what's important to know, and this is  again, why working with a health care practitioner can be super helpful is it's like, well, I tried the cinnamon, we  also know it can help with blood sugar control. It's like, in a particular patient, I may not want to give them that  if they tend to or hypoglycemia, right. We talk about this now, but if someone else says, Oh yeah, I'm going to  do all the sentiment.  

00:52:31 

Kristin Koskinen 

It could drive them in a wrong direction. We might want to time the cinnamon when they're taking it to make  sure that they don't crash in the middle of class or performance. These are the things we layer in. Yeah, but it's,  these are sometimes where we need to hit a threshold dose and what we do, it's not a one and done. These are  things that might take just like most, a lot of pharmacologic products take up to six weeks to hit a threshold and  to actually be effective. It can be the same with your food nutrition or even supplements. Sometimes you'll see  results, almost immediately, sometimes it may take time to actually, reveal its beautiful self and you really are.  It's explained to us so well. So, thoroughly the nuances to this and why it's so important to work with a  nutritionist, if you possibly can, rather than doing your own research, which is always going to be geared  towards the general public.  

00:53:37 

Kristin Koskinen 

So so this is such great information. How would you recommend that people find a nutritionist that can  specifically address their needs as a dancer or their needs as somebody with hypermobility or, any other specific  populations like that? I would recommend dancers head over to the International Association for Dance  Medicine and Science, which we affectionately call. IADMS. I think if you search IADMS.com, you'll go to the  website where there is a directory of dance medicine specialists, who that's, what they do. They work with  dancers and if, and you can contact. A lot of them work virtually because, one of the brilliant things about  COVID is we are, a lot of us are now I work virtually, but a lot of us are working more virtually. You can  contact any number of people. If someone doesn't have the answer or can't help you, perhaps because they're  state licensure, doesn't go over your state line, they can refer you to someone else.  

00:54:42 

Kristin Koskinen 

The network, this network is incredibly valuable because I can refer people. I refer people all the time to  physical therapists or, I, to Linda, Hey, check out Linda site. There's there's a wealth of information and wealth  of skill and knowledge, that these people are delighted and passionate. This is, this is how we keep, this is how  we stay involved with the dance world, even if, whether we're dancing anymore or not. Yes. It, and it's such a  collaborative group. I really just love that about it. All three of us being members, of course, I'm being actively  involved in it. Yeah yeah, absolutely. For sure. Okay great. What about, do we just want to maybe hit on just a  couple more things here and we'll be wrapping up, are there areas of nutrition that you hope to see more  research on in the future? Many, and things are moving ahead so quickly.  

00:55:47 

Kristin Koskinen 

Some of the things we're seeing now, like even how college in a dancer in college and then soft tissue and all  these things, and sometimes it just takes time for things to reveal. But it's exciting. I think what I'd really like to  see on the nutrition front is getting the information. We already have two dancers now and sometimes our best  gateway to the dancers are the people who love them and teach them and look after them, dance, parents,  choreographers, artistic directors, teachers, the people who coordinate RDA, the Valley Alliance and people  who take care of dancers and bring them together and provide education for them. If we can make this make  nutrition and give them the tools and the knowledge so they can make good decisions, if we can get that to  dancers at any stage of the game, not just premier companies like, New York city ballet or Miami or any of these, but if we could get this to dancers early on, we would give them such a leg up in their careers and in their  lives like this, these are skills that will last with them.  

00:56:58 

Kristin Koskinen 

Just like the skills we learn in dance that shape us. These things can shape people to have better lives.  Absolutely. Yeah. Me too. Me too. There anything else that we didn't ask you about that you'd like to add and if  you can make sure to let people know where to find you? Gosh, I think we covered pretty much everything. If  there's anything that comes up, maybe we can do a part D and keep those encapsulated. Yes. I'm, I'm glad to  have people reach out to me. They can find me, on my website, which is www.eat well pros.com. You can find  me on Instagram, my name, which is Kristen. K R I S T I N underscore Koskinen K O S K I N E N, underscore  R D N. You can find me on Facebook. I'm not there quite so much. Or you can email me directly.  

00:58:07 

Kristin Koskinen 

My email is Kristin K R I S T I n@eatwellprosewellpros.com. Wonderful. Well it's been such a pleasure  speaking with you today and it's been so great to have Jennifer Milner. My guest co-host on the sell again today  as well. This has been so informative and it's going to benefit so many people. It's so empowering for people to  realize that there are things that they really can do to improve their health while they're dancing, in their life post  dance. They can really just, improve their quality of life so much from all this information. So so thank you so  much, Kristen. Thank you so much for of before I leave, I will leave with this for some quick resources  available, the dancers I, and, and at the time of our recording, when we're in the midst of, COVID-19 some  things that I have, and this could change depending on when you're listening, but as of March 28th, I have an  article in dance magazine that talks about the way P dancers can use, shelf stable foods to create meals and  address, nutrients, some of which we spoke about today.  

00:59:29 

Kristin Koskinen 

Zinc vitamin a vitamin C, that kind of thing. I would direct them to dance magazine to read that, on my  Instagram account, I have links to a couple, dance specific handouts that I make available to dancers. One  includes shelf-stable recipes that help support, the dancer through this and almost all of them. I actually made it.  I think all of them are gluten free. For the populations we're looking for that they can have that as well as some  grab and go snacks for once we're through all of this. We're back in the studio, things that dancers can put  together and start flatten their bentos. So I encourage those resources. That's awesome. Yes. Yes. That's that's all  fabulous. So wonderful. I'm so glad that you mentioned those because people are definitely going to want to  look at those resources as well, so, well, great. Well will you've been such a, a great guest today, Kristen, and,  thank you again, Jennifer, and you all have been listening to bandy bodies with the hypermobility MD and,  today our guest has been Kristin Koskinen registered dietician and nutritionist, and my guest co-host has been  Jennifer Milner.  

01:00:43 

Kristin Koskinen 

It's been so fabulous having both of you here. Thank you so much for having me. It's been a, it's been a great  time. Thank you. Absolutely.  

01:00:52 

Linda Bluestein 

Please go to bendy bodies.org for links to all the episodes and to access the show notes. If you enjoyed this  podcast, please share, leave a review and consider rating us five stars. Don't forget to subscribe. You will be  notified of all new episodes. Feedback is greatly appreciated and can be emailed to bendy bodies  podcast@gmail.com. Go to hypermobility md.com to sign up for my newsletter. My guest coast, Jennifer  Milner can be reached at jennifer@jennifer-milner.com. That's M I L N E R. Thank you to Rhett Gill for  production and sound editing to Andrew Sevino for composing original music and to Jennifer for designing the  bendy bodies website and cover artwork. This podcast is for informational purposes only, and is not a substitute  for medical advice. Please see your own medical team prior to making any changes to your health care. Thanks  for tuning in, and we'll see you next time on bendy bodies with the hypermobility MD.