What You Haven’t Been Told About the Stress-Osteoporosis Connection and How to Reduce Your Risk

You probably know that stress can make you tired, depressed, cause insomnia, and lead to weight gain. But did you know that it pulls calcium out of your bones? Not many people do. In fact, the stress-osteoporosis connection is hardly ever mentioned in books on stress, osteoporosis, hormones, or menopause!

If you’ve been exercising, eating a healthy bone-conserving diet, and taking your supplements faithfully, you may think you’re doing enough to protect your bones. Not necessarily. Chronic stress can lead to brittle bones even after you’ve done everything else right.

Look at cortisol
Cortisol is one of many hormones secreted by your adrenal glands in response to any type of stress. Its levels are normally highest in the morning and lowest at night. High early morning cortisol wakes you up, and lower late evening cortisol lets you sleep well. If your cortisol is low in the morning, you’ll find it’s difficult to wake up and you are likely to feel tired throughout the day. If it remains high at night, you may be depressed and have difficulty sleeping.

All of us experience occasional bursts of cortisol in response to daily stresses — like when another car nearly misses hitting your car or you hear that a good friend is very sick. These reactions are normal and won’t cause thinning bones. Not if your cortisol levels re-adjust after each event.

But when your adrenal glands keep secreting this hormone inappropriately, they can leave you with high cortisol. Some medications, such as prednisone, cortisone, and other steroids, trigger your adrenal glands to keep secreting cortisol, as well. Over time, high cortisol can lead to exhausted adrenal glands and chronically low cortisol levels.

When you have high cortisol throughout the day, you feel exhausted all the time. In addition to what you feel, this excess cortisol pulls calcium out of your bones and interferes with its absorption, putting you at risk for losing bone density.

Measuring cortisol levels
Fortunately, you can now measure your cortisol and find out whether or not yours is chronically high with a simple saliva test your doctor can order. The test consists of saliva samples taken at four different times during the day and night. This is because cortisol fluctuates at specific times. The combined results show whether or not your hormone levels rise and fall when they should and indicate whether or not you are secreting too much. It also measures DHEA, a hormone that balances cortisol. One reason for high cortisol could be low DHEA, so it’s important to get both hormones tested.

This Adrenal Function Test is available through a number of laboratories. I particularly like Aeron LifeCycles (800-631-7900) because they accept Medicare for full payment and will work with you if you can’t find a qualified doctor to order this test. A number of insurance companies also pay for this test that costs $141.

In the past I wrote about a test, Pyrilinks-D, which measures the rate at which your bone breaks down and rebuilds itself. If you happen to have had this test, also available through Aeron, evaluating your cortisol levels may be your next step. If not, you may want the Pyrilinks-D test as well.

There are a number of natural solutions, should you find that your cortisol is too high. They include improving your diet, getting regular exercise, and taking one or more of a number of nutritional supplements.

Natural ways to regulate cortisol
Begin with daily exercise, meditation or prayer, and a sensible diet. Then support your adrenal glands with supplements. I like using a classification of supplements called adaptogens because they regulate your body’s response to stress. They turn on areas that have been turned off, and vice versa. I’ve talked about adaptogens in the past, and you can read these articles on my website, http://www.womenshealthletter.com. But let me tell you briefly about some of the best adaptogens that help regulate cortisol.

Rhodiola rosea is an adaptogen used in Chinese traditional medicine that prevents stress-induced heart damage. Low doses of a standardized extract have worked to lower stress in a number of studies. Try taking one capsule twice a day, or 20 drops of an extract (HerbPharm, 800-348-4372).

Withania somnifera, or ashwaganda, is an
Ayurvedic herb. It’s found in many formulas that have
significant anti-stress activity. Both Rhodiola and
ashwaganda, along with Cordyceps mushrooms, are used in
Adrenamin, an anti-stress formula available through ProThera
(888-488-2488). This is one formula I recommend to help
regulate high cortisol levels (one capsule, twice a day).

Eleutherococcus senticosus (formerly called Siberian ginseng) isn’t a true ginseng. It’s an excellent adaptogen that slows down excess cortisol excretion caused by stress. I’ve used Eleuthero, as it’s called, for decades. It’s a safe product, most potent in an alcohol base. HerbPharm makes an excellent product available in many health food stores.

DHEA, or dihydroepiandrosterone, is the hormone that is often low when cortisol is high. You can buy it in any health food store – but don’t. Some supplements don’t contain the amount of DHEA listed on the labels. Besides, I strongly believe that hormones should be dispensed through your doctor. If you get the Adrenal Function Test, your doctor will know how much DHEA you should take. Too much can cause facial hair, rashes, and other side effects. Never self-administer DHEA or other hormones (except one to three mg of melatonin for insomnia). Hint: You may need only 5-10 mg.

Magnesium: It’s cheap and has a profound effect on stress. If you are magnesium-deficient, and some doctors believe that most people are, stress increases your risk for heart disease, arrhythmias, and sudden death. Any stress — physical or emotional — increases your need for magnesium. Magnesium also helps carry calcium into the bones, so it’s an important nutrient for your bones on several counts. How much should you take? Whatever your bowels can tolerate up to 1,000 mg per day. Use a magnesium glycinate or amino acid chelate, which is well absorbed, and avoid poorly absorbed magnesium oxide. From 100-400 mg of magnesium, along with a good multi, should be enough for most people.

Avoid stimulants
Keep your caffeine intake low. Don’t take herbs like ephedra (Ma Huang) that stimulate the adrenal glands. Avoid guarana, the seeds of a Brazilian plant, with about twice the amount of a chemical that is almost identical to caffeine.

Bottom line: If you’ve been under stress for a long time, have difficulty sleeping, are depressed, and can’t wake up in the morning without help (like coffee or tea), you may have chronically high cortisol. Get your levels tested first, then begin a serious stress-reduction plan. It should be an integral part of any osteoporosis-prevention plan.

Brown, Susan E., PhD Better Bones, Better Body, Keats Publishing, 1996.

Maslova, L.V., et al. “The cardioprotective and antiadrenergic activity of an extract of Rhodiola rosea in stress,” IuB Eksp Klin Farmakol, November-December 1994.

Talbott, Shawn, PhD The Cortisol Connection, Hunter House, 2002.