Bringing Up Broadway: Training the Body and Mind

With the ever-increasing interest in musical theatre performance comes increased competition. Our triple (and quadruple!) threats are under significant pressure to stand out and aim to do so by doubling down on training.

Broadway hopefuls are spending many hours and dollars taking classes with the top instructors to build their singing, acting, and dancing chops. But there's another, often overlooked path to maximizing performance.

I recently interviewed a physician who works in the emerging field of health and performance optimization. He is a best-selling author, the head of cognitive enhancement for Nourish Balance Thrive, which works with elite athletes from around the world. He is also the chief medical officer for humanOS, the president-elect for the Physicians for Ancestral Health, and the medical editor for the Journal of Evolution and Health.

This physician happens to be my husband, Dr. Josh Turknett, and he details a holistic health approach for performers to help them develop healthy habits as they push the limits of their bodies and minds.

Here is an excerpt from that interview:

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Can you tell us a little about your background in this emerging field of health and performance optimization?

One of my roles is as the head of cognitive enhancement for Nourish Balance Thrive, a company that helps elite athletes around the world optimize their performance and their health.

These are people who are pushing their bodies to the limits, so they need their bodies to be in top form. In recent years people have really begun to recognize that this goes far beyond just training for sports and that they can get greater results than what training alone would yield by attending to factors like nutrition and lifestyle. That translates to improved performance, reduced injuries, improved recovery, and ultimately allows them to perform at a much higher level for a longer period of time.

I also do cognitive performance consulting for people who are using their brains for a living. These are people who are knowledge workers, pushing their brains to the limit and looking for ways to improve focus, and concentration, memory, creativity, productivity, and learning.

The same is true here, too - people are realizing you can get a lot more from your brain by attending to relevant nutrition and lifestyle factors. Theatre performers fall into both of these categories! They are trying to get the most out of their bodies and brains. So a lot of the strategies that we recommend for folks who are elite athletes or knowledge workers, we would also recommend for theatre performers.

Right, because our performers have to combine both. Can you give some more specific examples of the ways in which people benefit from taking the holistic approach you suggest?

For those who are doing things that are physically demanding, they will see improvements in their performance and in the prevention of injuries. And then with regard to long-term health, they will see prevention of chronic disease, both that result from just normal everyday life but also anything that would come specifically from the activities that they're doing.

In particular, wear and tear on the musculoskeletal system and the joints is probably much more likely related to the accumulated effects of diet and lifestyle rather than the activities themselves.

We know that joint injuries are really common in sports. Yet, in cultures where people don't follow the standard Western diet and lifestyle but are just as hard on their bodies, we don't see the same level of joint problems. The relative increase in joint and tissue injuries we see in the West is likely due to the high demands on the musculoskeletal system PLUS a weakening of the connective tissue structures by systemic inflammation and nutrient deficiencies. So in most cases, you would need both of those things for the joints to break down, not just the wear and tear.

That also makes me think of migraines, which I know you work a lot with, and that can be treated with the diet and lifestyle piece. I've always thought about performers who can't go on stage and perform with a migraine. So if you can prevent those as well through diet and lifestyle change, that would be another bonus.

Can you give us an overview of the different aspects of diet and lifestyle that need to be addressed in order to maximize performance?

Sure, so what are the things that we can do? How can we help our bodies to thrive and flourish right now today and what can we do to protect them over the long run?

If we look at the biggest levers that we have, the biggest broad categories that are going to help improve physical and mental performance and impact our long-term health, those will be:

• Sleep (a big one)
• Nutrition
• Physical activity
• Social connection
• And I'd probably throw in Mindset in there, as well

Maybe we can talk a little bit about each of these areas and perhaps tailor them a little bit towards parents, or teenagers, trying to work within their constraints. I know that because we homeschool, we have a lot more flexibility to address some of these issues, but maybe we can think about some strategies that people can implement to work within the current framework.

Yes, and obviously each of these categories we could spend many, many hours on. I'm going to try to hit the highlights and also try to hit the kind of the low-hanging fruit -- the things that you can do that will give you the most return on your initial efforts.

Sleep

Beginning with sleep, I think the best place to start is always to think about what our body expects, and that's why understanding our evolutionary history is so important. We were hunter-gatherers for about two-and-a-half million years and then we became modern humans living in this very foreign world only very, very, very recently. So our body, and our genes, still mostly expect that we're going to be living in the wild, in nature.

If you think about that, and about what the life of a typical hunter-gatherer was like, it means you go to sleep at sunset or not long thereafter, partly depending on your age, and then wake when the sun comes up.

So a typical good night of sleep for an adult will usually be about seven to eight hours, and for a child about nine to 12, and for teenagers more like 10 to 12 hours.

Sleep is the time for our bodies and brains to repair and recover. That's when you build muscles, that's when you repair connective tissue. So it's crucial for anybody putting any type of physical demands on their body -- like our dancers. If you don't get the repair and recovery during sleep, then you end up with this cycle of inflammation that's hard to stop.

There's also a lot of evidence that it's how we regulate our mood, and it's been recognized to be a factor in just about every chronic health problem. So insufficient sleep, quality or quantity, raises the risk of inflammation and autoimmune disorders, learning and memory problems, mood and anxiety disorders, as well as attentional disorders.

Also, the reason sleep is so important for kids is because that's when the brain is developing, and the time they're asleep is the time when their brains are changing, developing, and growing. So the more sleep they get, the bigger their brains are going to become. It's as simple as that.

It's hard to argue that there is anything more important than getting good sleep, especially given that for most people right now it's compromised, both quality and quantity. It's not just how many hours you get but also whether or not you're cycling through all stages of sleep each time.

Obviously, the demands of our lifestyle have made things challenging. We're waking people up before they should be woken. We also have indoor lighting that allows us to detach ourselves from the rhythms of nature, but there are certain things that we could do to help mitigate that.

For example, just keeping a consistent schedule is helpful in improving our sleep quality and quantity. People who sleep on a consistent schedule fall asleep faster, have better sleep architecture (stages of sleep) and also maintain their circadian alignment better.

For teens, the biggest issue is the amount of time they get to sleep. Most teens are going to be relatively good sleepers, but their biggest issue likely will be giving them enough time in bed to get all the sleep that they need.

Teenagers need more sleep than they ever will at any other point in their lives, and they also shift their sleep to where they will naturally go to bed later. They want to go to bed later and they want to wake up later, which is tricky for school, of course. So oftentimes in order for a teen to get the sleep that they need and still wake on school hours, they're going to have to go to sleep before they're really ready to.

For a teen, 10 hours of sleep really is the bare minimum and anything less that can cause problems. If waking up early, the sleep lost will be mostly REM sleep, and there's good evidence that REM sleep has a lot to do with regulating our mood. So we see anxiety disorders much worse in folks who are not getting REM sleep, and we're also seeing anxiety disorders are worsening amongst teens.

There's a great book that came out recently called "Why We Sleep" by Matthew Walker. I would encourage everyone to read that book, especially everyone with children. One of the greatest public health challenges we face right now is helping our kids sleep more, given how we've set up school. We're going to look back at this era with horror, I think, in terms of sleep, but hopefully, we can change things.

So thinking in terms of our teenagers, kind of naturally shifting to wanting to stay up later, but really within the confines of the school schedule really needing to go to bed earlier. Any quick tips or strategies for helping them to be able to go to bed a little bit earlier?

One of the best things that has been shown to help is maintaining a consistent schedule and having a set routine. You can take advantage of conditioning. We have our own natural rhythms, but we also have learned rhythms. You can teach yourself to adopt a different schedule with a consistent bedtime every night and having a consistent routine that you follow beforehand that tells your body and brain, "Hey, it's time to get sleepy."

Take a shower, have tea, read, have a ritual with your family, whatever works for your family as a bedtime routine. All these little things cue our body to say, "Hey, it's about time to sleep." Sleep is really a complex process that starts unfolding before you actually get to sleep.

Another important thing that's very relevant these days is blue light. So for any child that's having any difficulty sleeping whatsoever, that's going to be probably prime issue number one to address.

The sun contains the whole spectrum of light, with all the colors of the rainbow, but it turns out that only light in a blue spectrum can suppress our melatonin secretion. Melatonin is a hormone that the brain makes when it's time to get sleepy, and blue light tells the brain the sun is still up so it's not time to sleep. Where do you find blue light? In our devices, and iPhones, and screens, and all sorts of things.

That's why the iPhone developed night mode. There are also TVs now that can change the lighting so that it shifts to the red spectrum, or you can wear glasses that filter out the blue light. There's an app called F.lux that you can install on your computer to shift the light also.

Filtering out blue light after sunset can significantly impact when you feel sleepy. So people who do that will start to feel sleepy about an hour earlier than the people who don't.

I think it's also important to note that the science shows that there's no such thing as catching up on sleep. This idea that you can sort of cheat it during the week and then catch up on the weekend is not true. You don't get the benefits back from the brain's standpoint.

Let's move on to nutrition.

Nutrition

The easiest way to think about nutrition is first to consider what your body needs to operate and maintain our structure, and then second to avoid things that are harmful. The typical modern Western diet is insufficient on both of those counts, but probably worse when it comes to eating things that cause harm. We probably do a little bit better in providing the essential nutrients but and worse on eating things that cause harm.

Again, so if we think about what the diet of a human is supposed to be, it's pretty simple, and from one standpoint we are omnivores, so we eat animals and the edible plants that are in nature. So it should come as no surprise that most of the things that we eat that cause harm and that are linked to disease are not available in nature but require either farms or factories to produce. So that's what your low-hanging fruit is going to be.

The simplest approach of all is really just to eat whole foods -- to just eat meats of all kinds and then vegetables and fruits when they're in season. Shop at the perimeter of the grocery store, avoid the middle, avoid things in boxes and bags and you're pretty much good to go. But if you want to talk about the specific ingredients and things to avoid, I think you have to probably put refined sugar at the top of the list.

The average American's sugar consumption has risen about 3,000-4,000% over what it would've been for our ancestors. I think we'll probably view sugar much like tobacco in the next few decades. It's linked to virtually every chronic disease that we see. Almost every single processed food is going to list sugar as the first ingredient.

Avoiding foods with added sugar or at least minimizing them, and relegating them to being a treat would go a long way. The problem is that sugar has become the primary source of calories in many people's diets.

The next foods to avoid would be those that are cooked in vegetable and seed oils -- including soybean oil, canola oil, corn oil, all of those require factory processing. Again, they would not be something our ancestors ever would've eaten, not something that was part of the human diet. These oils likely are a driver of chronic low-level inflammation that we find with almost virtually every chronic disease.

So what oils should people be cooking with?

Starting with the animal fats, you have beef fat, tallow, pork fat, lard, and duck fat. There's also butter and ghee (clarified butter). And then there are fruit oils like olive oil, coconut oil, and avocado oil. Those are the best sources of fats to cook in.

If I go to the grocery store and every package I look at is using one of the oils you listed not to use.

I'm glad you made that point because the easiest way to avoid that is just to avoid packaged food. Like I said in the beginning, the simplest thing is if you stick to whole foods, you don't have these issues.

What other foods cause harm and should be avoided?

Third would be the gluten grains (wheat, barley, and rye). Gluten is a topic of great confusion. It was long known that about one to 3% of the population was gluten intolerant (celiac disease). Any amount of gluten in the diet for them causes inflammation in their gut, inflammation in the body, and it has to be avoided.

But more recently it's emerged that a much greater proportion of the population is gluten sensitive. People were discovering that a range of health issues would go away after gluten was removed from their diet. In addition to that, evidence came out that gluten disrupts the gut barrier in every human. So in all of us, if you expose the gut to gluten, there are tight junctions in our gut that keep the bad stuff out and the good stuff in, and with gluten exposure, they open up and let the bad stuff in.

So that's true even if I have no reaction to gluten?

That's true even if you have no reaction. That's true with every human's gut according to the research. So most likely this is a spectrum or a continuum, not an either-or thing. There's a range of how sensitive someone is to gluten, how much gut disruption it causes, and what the consequences of that are.

What is the most common mistake people make when they are eliminating gluten from their diet?

Right, so what often happens when people eliminate gluten from their diets is that they look for foods to substitute for the ones that have gluten in them. They will try gluten-free bread, and pasta, and things like that.

And with those you're still introducing all the issues with processed foods and so forth that come with that. So you may be eliminating the gluten component, but you're still getting a lot of bad stuff with it. So again, sticking to the perimeter of the grocery store.

I do sympathize because it does take changing habits since we've created our food culture around bread.

When we were trying to begin removing gluten from our diet, we started with the gluten-free flours like almond flour and coconut flour would make substitute treats and baked goods. That may not be a bad idea for a teenager when you're trying to stepstone them on the way to being gluten-free.

Then we began to realize that we were still doing a disservice to our bodies with these foods, and so then we continued to refine and eliminate those things, and I think that slow progression has been helpful.

Yes, you can start by choosing lesser evils and that's perfectly fine. I personally noticed that I still felt kind of lousy after I ate those things.

We would associate improvements in nutrition to improvements in physical performance, but you can also improve your cognitive performance by improving your diet, as well?

Absolutely. A lot of the work I do is for that particular purpose. Improving cognitive performance translates to improvements in your ability to focus for long periods of time, thinking clearly, sustaining energy levels, and improving creativity, problem-solving, and mood.

So let's move on to physical activity.

Physical Activity

Again we'll start with what our bodies expect from what we know of the lifestyles of our ancestors. That was lots of low-level walking with much of the day spent walking, lifting heavy things periodically, so engaging all of your muscles fairly often. And that was punctuated by brief all-out activities like sprinting. Of course, most of it was done outdoors with sunlight on the skin.

The nice thing is, aside from the sunlight piece, athletes and performers are generally doing quite well in this particular area. In fact, if there are any issues it's often related to overtraining, so doing too much, too much activity, particularly high intensity, rather than too little. So stressing the body too much, especially if you're not attending to recovery.

This is an area where a lot of progress has been made recently, so you're seeing a lot of athletes now who are in the professional ranks performing at very high levels at much older ages than we're used to, and a lot of that has come from paying close attention to recovery and repair, in addition to all of these nutritional pieces that we've talked about. You can really extend a career and stay healthy and at top performance levels for a lot longer period of time by doing so.

And what about the social connection piece?

Social Connection

The effects of connection or lack thereof on health might be surprising, but the research is pretty profound. It affects us all the way down to DNA and how our genes are transcribed.

So again, what does our body expect? Our ancestors were usually part of a tribe of up to about 150 people. That was an extended family of people that you could depend on and who depended on you. So you were producing, you were part of the tribe, you were a valuable contributor, and you had people you knew you could depend on when you needed it.

That sounds a little bit like a theatre community.

I was about to say that!

So many people don't have the social connections anywhere near what's really needed for a human to thrive, and social media doesn't count. It's seen as a substitute, but the research shows that it's not. It can help facilitate connection when it's used wisely, but by itself, it's not a substitute. But like you say, performers are actually doing very well.

A theatre troupe is a tribe of sorts, and to me, that's one of the greatest values of it. But the culture of any particular theatre community matters a lot. If it's a culture of acceptance, and support, and community, then yes it's a great form of social connection.

I'll just take this as another opportunity to give yet another plug for the value of theatre. I've already said that in two areas where a lot of people have trouble meeting their basic human needs (physical activity and social connection) theatre addresses.

I've spent my career in neurology, and neuroscience, and in the optimization of health and performance, and I would say there's no better activity than musical theatre training for the development of the brain and the body. It's both physically and cognitively demanding, and performers have to push the limits of their capacity, of both their body and their brain. In the book "Range" by David Epstein, he cites the statistic that Nobel Prize winners are 22 times more likely than their peers to have been performers of some kind.

And I believe you also mentioned mindset as a key component to consider.

Mindset

Yes, so the mind can powerfully influence our health in either direction, either for us or against us. This really gets to the impact that stress can have. If we consider the mismatch areas in modern human life compared to our ancestors, the amount of time we spend suffering in our own minds probably greatly exceeds theirs, and that has a lot to do with mindset.

In my work with clients, that's a huge piece. Not only mindset in terms of the way we look at the world, but also then understanding how to shape the impact of your mind in a favorable direction. It's all about understanding the ways in which the mind connects to our health, how it can undermine it or help us to be healthier and achieve the things that we want to achieve. Mindset and meditation are big topics that we'll cover in a separate episode.

We would love to see everyone addressing these five areas and building these habits early on because we know that the habits you build as a kid oftentimes last many years.

They do impact performance and they can be a way for young performers to maximize their potential and stand out in the rising tide of Broadway hopefuls.

To hear the full episode with additional information on each of these topics, check out the full interview with Dr. Turknett on the "From Atlanta to Broadway" podcast.