Bone Health and Disordered Eating with Dr. Marci Goolsby
What does bone health have to do with disordered eating?
Dr. Marci Goolsby is board certified in Family Medicine with a subspecialty of Sports Medicine. She is the medical director of the Women’s Sports Medicine Center at HSS and the incoming President of the American Medical Society for Sports Medicine. She has served as team physician for US Biathlon and the WNBA New York Liberty. She played college basketball where she met her b-baller hubby, Clark, and they have 2 wonderful kiddos, Penny and Nolan, and a rescue from Texas, Willie Nelson. She sees patients for sports medicine issues in Manhattan and White Plains.
Dr. Goolsby and I are all talking about bone health. When it comes to our overall health, we often overlook the importance of bone health. I mean, who even talks about bones when we talk about health? Surprisingly, bone health and disordered eating are closely interconnected. Today we will explore what bone health entails, the factors contributing to low bone density, and the relevance of bone health to our relationship with food.
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Let’s Start with the Basics:
What is bone health?
Dr. Goolsby explains: bone health encompasses the entire skeletal system from infancy to adulthood. It’s a lifelong process, where the choices we make during our childhood and adolescence impact our bone health in later years.
For instance, women experience a decline in bone health during menopause, while men undergo hormonal changes that affect their bone density as well. It’s important to consider these factors early on to protect our bones in the long run.
*Talk about long-term planning! What seven-year-old is planning for their bone health?!
Interestingly, bone health is often not brought up directly in public health discussions. While we frequently hear about the importance of staying active, engaging in sports, and exercising during adolescence, the direct correlation between these activities and bone health is rarely emphasized.
Factors that Contribute to Bone Health
Intrinsic Factors- meaning you do not have direct control over
Genetics (thanks, mom & dad)
Ethnicity- According to Dr. Goolsby certain populations, such as those having light skin and light eyes or Asian populations, are at a higher risk of low bone density.
Extrinsic Factors- meaning you have direct control over and you can manage
Exercise - Doing various types of exercise and including strength training and multidirectional exercise
Exercises directly benefit the bones, as they promote muscle development, which, in turn, enhances bone strength
Additionally, exercise helps prevent falls, reducing the risk of fractures, especially as we age. *If you don’t fall, it’s a lot harder to break a hip*
Also- Incorporate movement in your early years!
Vitamin D and Calcium- these need to be at adequate levels
More does not mean better. Take what you need. (some standard ranges, but overall the actual number is individualized)
Negative Effects on Bone Health
Smoking
Heavy alcohol consumption
Some medications, such as steroids and certain breast cancer medications
Too much exercise
Exercise is very beneficial for bone health BUT when you do it too much it can have a negative impact because of the lack of nutrition related to you exercise. Low energy availability, bone health, and menstrual dysfunction or hormonal dysfunction are known as the Triad.
Eating disorders and disordered eating
When energy intake is consistently lower than expenditure, it affects bone density and, consequently, long-term bone health. For individuals who are restricting, inadequate fuel supply increases the risk of short-term injuries like stress fractures and long-term bone health issues. So yes, some movement may be too much. But more on that later.
Menstrual Cycles and Bone Health
Our menstrual cycles and hormones play a crucial role in bone health. Despite what some believe, losing one’s period is not a badge of hard work but rather an indicator that something is wrong. This is common among athletes.
*Common does not equal normal– if you are not getting a regular period, please talk to a clinician*
Irregular periods resulting from imbalances in nutrition and exercise disrupt the hormonal system responsible for maintaining bone health. The absence of hormones like estrogen, progestogen, and testosterone, negatively impacts bone density. This is why menopause has such a profound effect on bones.
*In males, the situation is different since there is no menstrual cycle. Typically, significant imbalances would need to occur for males to exhibit symptoms such as fatigue, low sex drive, or erectile dysfunction.
Note: If someone is on birth control, it makes it more challenging to determine what exactly is going on with the hormones. Birth control is not bad per se; it just makes it harder to see everything as a clinician.
Thyroid and Bone Health
Thyroid conditions also impact bone health by affecting menstrual cycles. When the thyroid is too high or too low, menstrual irregularities arise, potentially leading to bone health issues. Proper management of thyroid conditions is crucial to mitigating their impact on bone health.
Recovery for Bone Health
Prolonged deficiencies in nutrition and deficiencies in exercise delay recovery and exacerbate bone health issues. Monitoring menstrual history, broken bones, stress fractures, and eating disorders provides valuable insights into an individual’s bone health.
A bone density scan (DEXA scan) helps evaluate bone density levels and categorizes them accordingly.
However, NOTHING is ever black and white (especially in the ED world). Definitions and interpretations of these scans can become complex. There are different measurements for different ages. Athletes, though, have unique requirements, with the female athlete triad group setting higher standards for athletes’ bone density levels.
And because we never say something is black and white, to further assess bone health, the trabecular bone score examines the internal structure of bones. Considering the comprehensive history, hormone tests, and other medical factors, healthcare professionals can differentiate between low density caused by female athlete triad or early onset menopause. But isn’t that scary? Someone with a restrictive eating disorder can be confused with a menopausal woman.
Takeaways
Understanding the interplay between bone health and disordered eating is vital. If you have lost your period or are experiencing disordered eating or an eating disorder, it’s crucial to undergo bone density scans, prioritize proper nutrition and consider adjustments to exercise routines.
There is such a thing as too much exercise.
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Tweetable Quotes
“There is such a thing as too much exercise.” - Rachelle Heinemann
“It’s a lifelong process, where the choices we make during our childhood and adolescence impact our bone health in later years. “ - Dr. Marci Goolsby
“Despite what some believe, losing one’s period is not a badge of hard work but rather an indicator that something is wrong.” -Dr. Marci Goolsby
“Common does not equal normal”- Dr. Marci Goolsby
Resources
Find Dr. Marci Goolsby
Instagram: marcigoolsbymd
Related Episodes:
26. Developing a Healthy Relationship with Exercise and Movement with Dawn Lundin MS, RD, CNSC
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Hey there! I’m Rachelle, the host of the Understanding Disordered Eating Podcast. As a Licensed Mental Health Counselor, I work with clients to make sense of life’s messy emotional experiences.
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