Everyone deserves to formulate their opinions on what works for them—on an individual level. After struggling with a confusing thyroid diagnosis in 2021, I truly understand how profound it can feel to desire treatment methods when conventional medicine doesn’t necessarily provide all the answers we seek.
Dancers who look for integrative, holistic, alternative, and functional approaches should never feel shameful or invalidated by their experiences. But it is important to understand what is involved.
Integrative- Holistic- Alternative- Functional- what even is it?
Most functional medicine practitioners (also referred to as integrative or alternative practitioners) hold licenses and degrees (like MD for a medical doctor and even RD for a Registered Dietitian), which reflect the use of evidence-based practices. But additionally, functional medicine practitioners utilize non-science-based practices in their care. The Cleveland Clinic, a well-known center for functional medicine explains that “the foundation of functional medicine is the use of food as a first-line therapy” and [functional medicine] “uses a holistic approach to treat chronic disease, with a focus on nutrition.”
In regard to medicine, much of a functional approach is centered around challenging the roots of conventional medicine—instead of treating bodily systems independently from one another, functional medicine “seeks to identify and address the root causes of disease and views the body as one integrated system.” Fellow Registered Dietitian Christy Harrison further covers this topic and makes many great points. While the idea of functional medicine sounds great in theory, “it plays on people’s fears of disease” says Harrison.
Terms like “functional,” “integrative,” “holistic,” and “alternative” seem to be interchangeable–and can be nothing more than descriptive terms for otherwise harmless advice. I previously discussed what a holistic approach looks like in the realm of nutrition for dancers. And I know of some great individuals who offer very helpful advice to dancers about building balance into their lives.
But these approaches can also trigger disordered eating if centered on the use of food as a one-dimensional tool to support physical health. This is especially true for those most vulnerable to perfectionism—dancers included. As The Cleveland Clinic says, “The right nutrition, combined with lifestyle and behavioral interventions, will help you take charge of your health.” As with most of what we see from diet and wellness culture, an extreme focus on nutrition can result in behaviors that become encompassing and restrictive.
What does the research say?
The American Academy of Family Physicians (AAFP) utilizes a team for Continuing Professional Development (COCPD) to oversee provider organizations applying for continuing education credits and certifications. In 2018, the COCPD conducted a literature review on functional medicine, and based on this review, determined that “there wasn’t sufficient evidence to award credit to activities and sessions on the topic.” And not only was there insufficient evidence to support the use of functional medicine in family medicine but “in some cases, [COCPD] determined the claims being made to be potentially dangerous.”
Just a note: according to Harrison, the reason why the AAFP awards continuing education credit for classes that provide a broad overview of functional medicine is that “…it recognizes that even though [functional medicine] isn’t evidence-based, patients still may be asking their doctors about it and the doctors need to know enough to answer them.”
The Human Experience
In regard to food and nutrition, interventions based on functional medicine often involve the cutting out of certain foods or food groups–most notably dairy, sugar, wheat (or gluten). We cannot invalidate anyone’s personal experience—especially when they truly feel better after implementing such protocols (like cutting out foods and food groups). Yes, many dancers might initially experience a true sense of feeling better when seeking these protocols in support of challenges (examples include inflammation and auto-immune diseases).
But as Harrison explains, either a placebo or nocebo effect often occurs. To review, the placebo effect is defined as the experience of perceived benefits from an inert substance or research variable (an example would be a dairy-free diet), The nocebo effect is the experience of perceived harm from an inert substance or research variable (an example would be a diet that includes dairy). According to Harrison, “These effects demonstrate the power of… the mind-body connection to create real, physical symptoms.”
And here’s another keyword: initially. We know that restrictive diets eventually lead to a cycle where one initially feels very in control around food, only to eventually feel very out-of-control around food (mainly the foods that are restricted).
FYI- this is separate from the need for some dietary restrictions in the navigation of medically diagnosed food allergies and intolerance—particularly gluten for the management of Celiac Disease and lactose for the management of lactose intolerance. If these are challenges you can relate to, then check out this article where I discuss them in depth.
Functional and integrative approaches often flood the nutrition space as a tool to promote wellness. And while for some, this might be harmless, for many, the fixation on “food as medicine” can trigger disordered eating. Bottom line: there is no sufficient evidence to support the use of restrictive diets (and supplements for that matter) often sold by functional medicine practitioners.
For those most vulnerable to the development of disordered eating—including dancers who face undeniable pressures around food and body for the success of their careers—it’s important to remember the role that food plays in our lives beyond just being a tool for physical health. Food is functional, but it’s also fun. Food plays a role in our social relationships and our cultures. Food is a celebration and when we turn it into a divisive tool for “wellness,” it quickly becomes anything but.
Recommendation: Christy Harrison, a fellow Registered Dietitian Nutritionist, speaks on this topic and more both on her blog and on her Podcast, Food Psych. I highly encourage you to check out her resources, give her a follow, and consider her books, Anti-Diet and The Wellness Trap.