This article was written by Sophie Gastman, associate nutritionist (ANutr), and reviewed by dietitian Maeve Hanan.
The impact on bone health is an often overlooked consequence of eating disorders. Unlike some other physical side effects such as hair loss, fatigue, and loss of periods, deteriorating bone health may be less obvious to spot.
This article will explain why bone health is so important, what impact a disordered diet can have on it, and practical tips for managing bone health during recovery.
Understanding bone health
Our bones have two main functions: they give structure to our body, allowing us to move and stand, and they also serve as a reservoir for essential minerals, such as calcium and phosphorus.
We all have a maximum strength and density that our bones can achieve. This is called peak bone mass and is largely determined by our genetics. However, lifestyle factors, such as diet and exercise, will influence whether or not we achieve our full bone mass potential.
A key point to emphasize is that the majority of bone mass is acquired during childhood and adolescence.
Most people will reach their peak bone mass between the ages of 25 and 30.
After that, your bone mass gradually begins to decrease over the years. This is why it is so important to take care of your bone health, because the closer you get to your peak bone mass during this period of adolescence, the more bone “banked” you will have to help you aging and prevention. the appearance of osteoporosis.
Impact of Eating Disorders on Bone Health
The main cause of poor bone health in people with eating disorders is inadequate diet, but it is not the only cause. Rather, it is the result of the complex interaction between several factors linked to eating disorders.
Inadequate nutrition, coupled with being underweight, high stress hormones, and other hormonal imbalances, has a cascading effect on various aspects of health, including the menstrual cycle, which in turn directly influences bone health.
For example, if your body weight is low, less weight is placed on your bones, which will eventually lead to bone loss as well as loss of muscle that strengthens and supports your bones.
Hormonally, things can get more complicated.
Disordered eating behaviors can disrupt hormones that play an important role in bone health. For example, low levels of estrogen are common in people with eating disorders, and estrogen is a key regulator of bone metabolism in both men and women, with lower levels associated with decreased bone mineral density (1). These low estrogen levels are a common cause of amenorrhea (absence of periods), which can also reduce peak bone mass and increase the risk of osteoporosis (2).
Research has also shown that higher levels of the stress hormone cortisol are associated with disordered eating habits (independent of body mass index) (3), and cortisol is known to have a negative impact on bone mineral density (4). The impact is twofold, as prolonged excessive levels of cortisol in the blood can not only decrease calcium absorption in the gut, but also decrease bone formation (5).
IGF-1 (6) is another important hormone for bone health that is affected by eating disorders. This growth hormone is fundamental to both bone development during puberty and bone health throughout life (7).
It is particularly important to note that when disordered eating behaviors occur during youth and adolescence, there is a risk that bones will not develop to be as strong and dense as they should be. Indeed, this corresponds to the critical period during which maximum bone mass can be achieved, as indicated earlier in this article. The earlier eating disorders occur and the longer they persist, the greater the risk of bone loss and, ultimately, the development of osteoporosis (8).
Managing Bone Health During DE Recovery
The best way to support your bone health when recovering from an eating disorder is to prioritize your diet.
Here are some bone-healthy nutrients to focus on:
Calcium
Calcium is an essential component of our bones that keeps them strong, and adults need it 700mg A day. Good sources include milk and other dairy products, green leafy vegetables, tofu, nuts, fortified plant milks, bread and any other fortified foods.
Vitamin D
Vitamin D is necessary to help our bodies absorb calcium and adults need it 10 micrograms A day. Foods rich in vitamin D include fatty fish, such as salmon and mackerel, egg yolks, and fortified foods like cereals and bread, although it is difficult to meet our daily needs through diet alone. . Fortunately, our bodies can produce vitamin D by being exposed to direct sunlight, but in the UK this only happens between March and September. During the winter months, it is recommended to take a daily vitamin D supplement.
protein
In addition to getting enough calcium and vitamin D, it’s also helpful to ensure you’re getting enough protein for optimal bone health, especially if you’re still growing. Animal and plant protein sources will have a positive impact on your bone health.
Other important minerals
Magnesium and phosphorus also contribute to the formation and maintenance of healthy bones. Good sources of these minerals include dark chocolate, nuts, seeds, dark leafy greens, avocados, dairy products, red meat and poultry.
Vitamin K helps make various proteins essential for the production of healthy bone tissue. Green leafy vegetables, such as kale, Swiss chard, spinach and broccoli, are good sources of vitamin K.
Weight restoration
If you are underweight, it is important to prioritize weight restoration, as research has shown that it is one of the most effective strategies for stopping or reversing any bone loss (9 ).
Restoring weight will also help resume the menstrual cycle, which will also have a positive impact on bone health by maintaining or increasing bone mineral density (10).
Exercise
Being physically active is also a key factor in maintaining strong bones, because the more you use them, the stronger they become. Weight-bearing and muscle-strengthening exercises are normally recommended to maintain bone strength.
However, during recovery from an eating disorder, a balanced and mindful approach to exercise is necessary.
If you are underweight, have missed your menstrual cycle, or exercise too much, you may need to limit your physical activity. In these cases, in addition to adequate nutrition, rest and hormonal balance, it may be recommended to incorporate low-intensity weight-bearing activities such as walking, stair climbing or dancing. Always follow individual advice from your treatment team.
Conclusion
Overall, bone health should not be overlooked or underestimated in the context of eating disorders, as it can have a lasting impact. However, focusing on good nutrition, weight restoration and conscious exercise can help alleviate adverse effects.
If you are suffering from an eating disorder, you will find information here on how we can help you.
References
- Cauley, JA (2015) “Estrogen and bone health in men and women”, Steroids, 99, pp. 11–15. doi:10.1016/j.steroids.2014.12.010.
- Gordon, CM and Nelson, LM (2003) “Amenorrhea and bone health in adolescents and young women”, Current opinion in obstetrics and gynecology15(5), p. 377-384. doi:10.1097/00001703-200310000-00005.
- Lawson, EA et al. (2011) “The appetite-regulating hormones cortisol and peptide YY are associated with eating disorder psychopathology independent of body mass index”, European Journal of Endocrinology, 164(2) , pp. doi:10.1530/eje-10-0523.
- Lawson, EA et al. (2009) “Hypercortisolemia is associated with severity of bone loss and depression in hypothalamic amenorrhea and anorexia nervosa”, Endocrinology, 150(11), pp. 5191-5192. doi:10.1210/endo.150.11.9998.
- Fazeli, PK and Klibanski, A. (2014) “Anorexia nervosa and bone metabolism”, Bone, 66, pp. doi:10.1016/j.bone.2014.05.014.
- Brambilla, F. et al. (2018) “Growth hormone and insulin growth factor 1 secretions in eating disorders: correlations with psychopathological aspects of the disorders”, Psychiatry research263, p. 233-237. doi:10.1016/j.psychres.2017.07.049.
- Locatelli, V. and Bianchi, VE (2014) “Effect of GH/IGF-1 on bone metabolism and osteoporosis”, International Journal of Endocrinology, 2014, pp. doi:10.1155/2014/235060.
- Biller, B.M. et al. (1989) “Mechanisms of osteoporosis in adult and adolescent women suffering from anorexia nervosa*”, The Journal of Clinical Endocrinology & Metabolism68(3), p. 548-554. doi:10.1210/jcem-68-3-548.
- Steinman, J. and Shibli-Rahhal, A. (2019) “Anorexia nervosa and osteoporosis: pathophysiology and treatment”, Journal of Bone Metabolism26(3), p. 133. doi:10.11005/jbm.2019.26.3.133.
- Indirli, R. et al. (2022) “Bone health in functional hypothalamic amenorrhea: what the endocrinologist needs to know”, Frontiers of Endocrinology13. doi:10.3389/fendo.2022.946695.