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When you’re stressed out and cortisol, the main stress hormone, is wildly fluctuating, many things happen in a cascade of badness…
- Your serotonin, the happy brain chemical, falls off a cliff. Result? You feel like crap: weepy, despairing, and not like your happy self.
- You deposit belly fat, as in suddenly you stare down at a beach floatie at your midsection.
- Your hippocampus – the part of your brain in charge of memory consolidation and emotional regulation – shrinks. Then your attention span is shorter, you can’t remember why you walked into a room, and inappropriate mood swings take over your life. (Note that the mood swings may feel very appropriate at the time!)
How’s that?Bad stress and wayward cortisol do a number on your body. We know that about 95 percent of disease is caused by or worsened by bad stress. Unremitting, unmanaged, and/or “bad” stress worsens your sleep and keeps you from assimilating key nutrients – and set you up to be deficient in vitamin Bs, vitamin C, magnesium, and zinc. High glucocorticoids, of which cortisol is a member of the family, reduces bone building and increases bone resorption, which are the ways that your bone remodels itself intelligently. Additionally, high glucocorticoids, from high stress and adrenal dysregulation – perhaps even taking corticosteroids like Prednisone – muck with your ability to assimilate nutrients from food such as calcium and may indirectly lower other hormones like estrogen and thyroid. Short version: You’re stressed out, you get cranky, fat, and ADD, and then your bones dissolve. Not being an alarmist, just want to help you de-stress in novel ways so that you can look hot in your bathing suit from inside out. Newsflash: Boniva Isn’t the Answer (Sorry, Sally!) Remember Sally Fields of Norma Rae? Love her, but I don’t love the marketing campaign she did for Boniva as an answer for protecting your bone. Bis-phosphonates, such as Boniva and Fosmax aren’t the magic pill that Big Pharma would like you to believe. In fact, bis-phosphonates can actually weaken your bone.[v]
What’s a Smart Woman to Do?I don’t want to dissolve into a pile of bone dust, and you don’t either, so let’s fix this situation now.
Step 1: Remove 10 foods that raise cortisol (a.k.a. “The Dr. Sara Blacklist”)Stay away from the foods that are on the blacklist for triggering the immune system. Top research shows that bugging the immune cells in the gut may raise your stress hormones. Some of the most common allergy-inducing foods include:
- Sugar and sugar substitutes
Step 2: Fill your nutrient gaps
- Get the magnesium you need.
- Obtain calcium from food.[vi]
- Take a multivitamin with minerals.
- Take Vitamin D3 – I recommend 2000 IU per day, and studies show that > 700 IU is needed to improve bone density and many mainstream investigators remain skeptical.[vii]
Step 3: May the force be with youAh, yes… exercise! Tell me you’re regularly getting physical activity, because I get depressed when I read that fewer than 30% of 65- to 74-year-olds and less than 15% of adults >75 report moderate physical activity lasting >10min in the previous 4weeks.[viii] No, no, no. Our bones need movement. Vertical weight bearing – that is, vigorous, high impact exercise – helps the bones most, such as jumping, plyometrics, stair climbing, squatting, and running.[ix] So get your vertical loading on, but mix it up.[x] But… running raises cortisol, which is why I recommend chi running and/or burst running. Additionally, the vertical weight bearing (defined in studies as >4g) seems to be very good for adolescents and young adults, but it’s not clear it’s enough of an impact in older adults. Here’s what we know:
- If you’re premenopausal, go for progressive, high-intensity resistance training. It helps the bone density in your spine, but may not impact your hips.[xi] Wonder what I do? Find me at the gym, doing plyometrics and burst training with weights, or at a Barre class.
- Is walking enough? Probably not.[xii]
- Young women with low body fat don’t benefit as much from vigorous exercise.[xiii]
- More active kids have stronger hips than less active kids.[xiv]
- The Cochrane Database reviews says exercise is not a definitive treatment if you already have a spine (vertebral) fracture.[xv] Even so, my opinion is that it’s helpful for many reasons – bone remodeling, to help you develop agility (so you can fall well), and to improve one’s mental performance. My genius bar at UCSF concurs – more physical activity stimulates bone formation and is associated with fewer hip fractures.[xvi]
- Have you had a problem with bone density? At what age, and what did you do to change the situation?
- Have you measured any nutrient gaps in your body? If so, what was low, and how did you replete?
- Do you exercise for your bones? If so, what do you do?
[i] Lasco A, Catalano A, Pilato A, et al. Subclinical hypercortisol-assessment of bone fragility: experience of single osteoporosis center in Sicily. Eur Rev Med Pharmacol Sci. 2014 Feb;18(3):352-8. http://www.ncbi.nlm.nih.gov/pubmed/24563434 http://www.europeanreview.org/article/6635; Chiodini I1, Scillitani A. [Role of cortisol hypersecretion in the pathogenesis of osteoporosis]. [Article in Italian] Recenti Prog Med. 2008 Jun;99(6):309-13.
[ii] Osella G, Ventura M, Ardito A, et al. Cortisol secretion, bone health, and bone loss: a cross-sectional and prospective study in normal non-osteoporotic women in the early postmenopausal period. Eur J Endocrinol. 2012 May;166(5):855-60. doi: 10.1530/EJE-11-0957. Epub 2012 Feb 6. http://www.ncbi.nlm.nih.gov/pubmed/22312036.
[iii] Labouesse MA, Gertz ER, Piccolo BD, et al. Associations among endocrine, inflammatory, and bone markers, body composition and weight loss inducedbone loss. Bone. 2014 Apr 4;64C:138-146. doi: 10.1016/j.bone.2014.03.047. [Epub ahead of print].
[iv] Peeters GM, van Schoor NM, van Rossum EF, et al. The relationship between cortisol, muscle mass and muscle strength in older persons and the role of genetic variations in the glucocorticoid receptor. Clin Endocrinol (Oxf). 2008 Oct;69(4):673-82. doi: 10.1111/j.1365-2265.2008.03212.x. Epub 2008 Jan 31.
[v] Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014 Jan;29(1):1-23. doi: 10.1002/jbmr.1998. Epub 2013 Oct 1; Edwards BJ, Bunta AD, Lane J, et al. Bisphosphonates and nonhealing femoral fractures: analysis of the FDA Adverse Event Reporting System (FAERS) and international safety efforts: a systematic review from the Research on Adverse Drug Events And Reports (RADAR) project. J Bone Joint Surg Am. 2013 Feb 20;95(4):297-307. doi: 10.2106/JBJS.K.01181; Gedmintas L, Solomon DH, Kim SC. Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systematic review and meta-analysis. J Bone Miner Res. 2013 Aug;28(8):1729-37. doi: 10.1002/jbmr.1893; Black DM, Kelly MP, Genant HK, et al. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med. 2010 May 13;362(19):1761-71. doi: 10.1056/NEJMoa1001086. Epub 2010 Mar 24.
[vi] Hunt CD, Johnson LK. Calcium requirements: new estimations for men and women by cross-sectional statistical analyses of calcium balance data from metabolic studies. Am J Clin Nutr. 2007 Oct;86(4):1054-63 http://ajcn.nutrition.org/content/86/4/1054.long
[vii] Cranney A, Horsley T, O'Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep). 2007 Aug;(158):1-235; Theodoratou E, Tzoulaki I, Zgaga L, et al. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ. 2014 Apr 1;348:g2035. doi: 10.1136/bmj.g2035;
[viii] Tobias JH, Gould V, Brunton L, et al. Physical Activity and Bone: May the Force be with You. Front Endocrinol (Lausanne). 2014 Mar 3;5:20. eCollection 2014.
[ix] Mosti MP, Carlsen T, Aas E, et al. Maximal strength training improves bone mineral density and neuromuscular performance in young adult women. J Strength Cond Res. 2014 Apr 14. [Epub ahead of print]; Martyn-St James M, Carroll S Br J Sports Med. 2009 Dec; 43(12):898-908; Deere K, Sayers A, Rittweger J, et al. Habitual levels of high, but not moderate or low, impact activity are positively related to hip BMD and geometry: results from a population-based study of adolescents. J Bone Miner Res. 2012 Sep;27(9):1887-95. doi: 10.1002/jbmr.1631; Sayers A1, Mattocks C, Deere K, et al. Habitual levels of vigorous, but not moderate or light, physical activity is positively related to cortical bone mass in adolescents. J Clin Endocrinol Metab. 2011 May;96(5):E793-802. doi: 10.1210/jc.2010-2550. Epub 2011 Feb 16.
[x] Martyn-St James M1, Carroll S. A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes. Br J Sports Med. 2009 Dec;43(12):898-908. doi: 10.1136/bjsm.2008.052704. Epub 2008 Nov 3.
[xi] Martyn-St James M1, Carroll S. Progressive high-intensity resistance training and bone mineral density changes among premenopausal women: evidence of discordant site-specific skeletal effects. Sports Med. 2006;36(8):683-704.
[xii] Martyn-St James M1, Carroll S. Meta-analysis of walking for preservation of bone mineral density in postmenopausal women. Bone. 2008 Sep;43(3):521-31. doi: 10.1016/j.bone.2008.05.012. Epub 2008 May 26.
[xiii] Deere K, Sayers A, Rittweger J, et al. A cross-sectional study of the relationship between cortical bone and high-impact activity in young adult males and females. J Clin Endocrinol Metab. 2012 Oct;97(10):3734-43. doi: 10.1210/jc.2012-1752. Epub 2012 Jul 16. http://www.ncbi.nlm.nih.gov/pubmed/22802090
[xiv] Cardadeiro G1, Baptista F, Rosati N, et al. Influence of physical activity and skeleton geometry on bone mass at the proximal femur in 10- to 12-year-old children-a longitudinal study. Osteoporos Int. 2014 May 9. [Epub ahead of print]; Cardadeiro G1, Baptista F, Ornelas R, et al. Sex specific association of physical activity on proximal femur BMD in 9 to 10 year-old children. PLoS One. 2012;7(11):e50657. doi: 10.1371/journal.pone.0050657. Epub 2012 Nov 29.
[xv] Giangregorio LM1, Macintyre NJ, Thabane L, et al. Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database Syst Rev. 2013 Jan 31;1:CD008618. doi: 10.1002/14651858.CD008618.pub2.
[xvi] Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet. 1993 Jan 9; 341(8837):72-5.