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Dr. Susan E. Brown

New research on sleep and bones

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Bet you feel healthier after a good night’s sleep — well, so do your bones. Here’s what the scientists have found in their latest research about the connection between sleep and your bones:

  • Reduced sleep duration was associated with lower bone density in middle aged and older women in one Chinese study.
  • Obstructive sleep apnea, with its loss of sleep and oxygen deprivation, weakens bone.  A recent Taiwanese study found the incidence of osteoporosis to be 2.7 times higher among those with sleep apnea.
  • Insomnia was associated with a 52% increased risk of osteoporosis in a recent Norwegian study.
  • In animal models lack of sleep was found to halt new bone formation, cause cell damage,  and produce abnormal bone marrow, all likely to be associated with poor bone repair.

These studies highlight that sleep is essential to give us a time and environment for crucial bone repair and regeneration. Inadequate sleep is a pro-inflammatory stressor that results in “repair deficit” — a deficit that goes bone deep.

How much sleep is enough?

While the amount of sleep needed varies by individual, the scientific evidence suggests 7 hours of sleep per night is needed to help reduce physiological and neurobehavioral deficits. Personally I feel best with 8 hours of sleep in the dark winter months, but do just fine with a bit less in the sunny summer.

Better Bones tips for restorative sleep

  1. Take care with caffeine. Try a few days without this stimulant and note any sleep improvement.
  2. Try a non-electronic quieting down period in the evening. Instead of plugging in, try a hot bath, short meditation or the Yoga Nidra sleep audio.
  3. Melatonin regulates nocturnal circadian rhythms. Using 3 mg before bed helps many women sleep better and also builds bone. There is good data that melatonin enhances bone formation, reduces bone breakdown, and has cancer-protective properties to boot.
  4. Reach out for help if needed. Sleep is a critical factor in your health. If you are not sleeping well it could be interfering with all sorts of biological processes. Work with your Doctor, or reach out to my office for my top protocols based on type of sleep issues.
  5. Finally, sharing my own story of sleep success. I am no stranger to sleep disruptions, and I suspect it’s due to mental over-activity and a “worry-wart” tendency (as my mother would say). Recently I have found the cortisol-controlling adrenal support formula known as Serinisol from Women’s Health Network to be a godsend. Using the natural product I feel more calm and at ease during the day and sleep happily, solidly through the night. If you give it a try, let me know how it works for you.

 

References:

Chen, Y. L., S. F. Weng, Y. C. Shen, C. W. Chou, C. Y. Yang, J. J. Wang, and K. J. Tien. 2014. Obstructive sleep apnea and risk of osteoporosis: A population-based cohort study in Taiwan. Journal of Clinical Endocrinology and Metabolism 99(7):2441–2447.

Everson, C. A., A. E. Folley, and J. M. Toth. 2012. Chronically inadequate sleep results in abnormal bone formation and abnormal bone marrow in rats. Experimental Biology and Medicine 237(9):1101–1109.

Everson, C. A., C. J. Henchen, A. Szabo, and N. Hogg. 2014. Cell injury and repair resulting from sleep loss and sleep recovery in laboratory rats. Sleep 37(12):1929–1940.

Fu, X., X. Zhao, H. Lu, F. Jiang, X. Ma, and S. Zhu. 2011. Association between sleep duration and bone mineral density in Chinese women. Bone 49(5):1062–1066.

Sivertsen, B., T. Lallukka, P. Salo, S. Pallesen, M. Hysing, S. Krokstad, and S. Øverland. 2014. Insomnia as a risk factor for ill health: Results from the large population-based prospective HUNT study in Norway. Journal of Sleep Research 23(2):124–132.

Swanson, C. M., S. A. Shea, K. L. Stone, J. A. Cauley, C. J. Rosen, S. Redline, G. Karsenty, and E. S. Orwoll. 2015. Obstructive sleep apnea and metabolic bone disease: Insights into the relationship between bone and sleep. Journal of Bone and Mineral Research 30(2):199–211.

Better Bones Blog
Dr. Susan E. Brown

Mary’s broken leg – Part 2

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A year ago, I told you the story of Mary, a 27-year-old client of mine who had broken her leg in a low-impact fall and came seeking answers for why her bones were weak. In the 18 months that have passed since her accident, Mary has learned a lot about the underlying health issues that led to her fracture. I think her story has some remarkable lessons to offer.

First, let’s recall that Mary’s vitamin D was low — 24 ng/mL. After our consult, Mary went ahead with a vitamin D supplementation protocol of 50,000 IU per week for 8 weeks to raise her vitamin D levels to the 32 ng/mL minimum needed for bone health. However, she couldn’t get retested as planned because shortly after she started, she was involved in a car accident that injured her back. Her physician told her that he wanted to wait until she was off the anti-inflammatory medications before retesting her, so she simply had to assume that the restorative dose she’d taken had done its job. She did take a maintenance dose of 4000 IU per day in the interim, knowing that Maine winters tend to deplete vitamin D stores. When she was finally able to get re-tested, surprisingly, Mary’s vitamin D level had only increased by 4 ng/mL, from 24 to 28.

Why had her vitamin D level stayed low?

It’s somewhat unusual that “front-loading” vitamin D won’t appreciably raise a person’s blood levels, so I realized that Mary’s problem might be more convoluted than we first thought. My first thought was that she might have an absorption problem — and since she said she had reported no obvious GI symptoms, I thought perhaps she had a “silent” disorder such as celiac disease, or perhaps hidden food allergies (and later testing showed that she indeed has multiple food allergies). But the story got even stranger when she recounted to me what she’d learned because of the car accident.

The car accident had taken place not long after our second consult. Mary was rear-ended, hard, by another car while her car was stopped. While checking her for spinal injuries, her primary care physician had ordered an MRI. This MRI uncovered a surprising fact: Mary has an abnormal thyroid. A normal thyroid gland is shaped like a butterfly, but Mary’s thyroid has only one “wing.” From this, you’d expect that Mary might have hypothyroidism, but as I mentioned in the earlier blog, her doctor had told her that her thyroid tested “normal.” Upon retesting almost a year after the car accident, though, Mary’s free T3 and T4 levels were high, not low — and excess thyroid hormones can be bone-damaging.

But there was still more. Mary asked to have a free cortisol blood test performed — one of the tests I generally recommend for a medical osteoporosis work-up, and particularly appropriate given her high stress levels. (Cortisol, for those who don’t know, is a stress hormone produced in the adrenal glands, and consistently high cortisol can be bone-depleting.) After almost a year of telling Mary it was a waste of time and money, in the end her doctor reluctantly ordered the test — and bet her $5 that it would show nothing of consequence. To his great surprise, it showed that Mary’s cortisol levels were at the high end of normal in the morning, and were significantly elevated above normal levels in the evening. The high cortisol levels help explain Mary’s recent bouts of insomnia, and are consistent with the high-stress life she leads. And it’s possible that they contribute to the weakness in her bones that led her to fracture.

These test results are building a picture of Mary’s bone health in which significant endocrine dysfunction, and possibly autoimmune disease, play a role. Let’s look at the pieces of the puzzle:

• Irregular menstrual cycles / possible sex hormone imbalance

• Vitamin D malabsorption / possible GI tract issue or autoimmune disorder

• Hyperthyroidism / possible thyroid hormone dysfunction

• Hypercortisolism / possible adrenal gland dysfunction

Now, it’s worth noting that even though Mary has all of these issues going on, she feels like a normal, healthy young woman. She has energy, she feels pretty good, and if it weren’t for her broken leg and her car accident, she wouldn’t have discovered these problems until much, much later in life. If there’s a silver lining to both incidents, it’s that she has uncovered these issues sooner rather than later — while she’s still young enough to address them and build strong, healthy bone before her menopause transition.

Mary is continuing to explore the source of her endocrine problems, but for me, her experience underscores some of the points I like to make about bone health:

• A low-trauma fracture is osteoporosis “proof of the pudding” and should inspire a search for causes of bone weakening,

• it’s never too early OR too late to pay attention to your bones,

• bones do not stand alone — they are intimately connected with all our bodies’ other systems, and

• if you strive to have better bones, you will have a better body — whether you’re young or old.

Better Bones Blog
Dr. Susan E. Brown

How Mary healed her broken leg fast

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In an earlier blog post, I told the story of Mary, a young woman who had shattered two bones in her leg in what should have been a fairly minor fall. I’d like to briefly revisit that story now, because Mary’s recovery illustrates points I made in my article on how to speed fracture healing.

Mary had an extremely serious injury to her bone. The only way it could possibly have been more serious would be if the bone had broken through the skin! Her body had a tremendous amount of work to do to knit that bone back together, even with the aid of the plates and pins holding it in place. And Mary was told at the outset that it would take at least a year, if not longer, for her bones to knit completely.

But what Mary’s doctors didn’t know was that she was determined to get back on her feet as quickly as possible, and for her, that meant finding a way to maximize her bones’ capacity to heal. That’s when Mary started the Better Bones protocol of 20 key nutrients, coupled with an alkaline diet and stress reduction (without exercise, at first, because exercising the damaged leg wasn’t really possible).

Mary’s x-rays (below) show the course of her healing from the time of the accident in February of 2009 to December 2009 (the middle x-ray was taken in June, just about 3 months after the accident). We’ve highlighted the striations of the original fracture in red on the February x-ray so you can see where the bones actually broke. It was about 6 weeks after the break that Mary started to make the dietary changes I suggested and take the Better Bones supplements I recommended to her. Later on, after her doctors approved, she started doing some gentle weight-bearing exercises to further promote bone-building activity.

MWinn_Feb2009_colored MWinn_Dec2009_cropped MWinn_Jun2009_croppedarrows

 

In the x-ray taken in June, you can still see the lines of the fracture (red arrows), but they’re fainter and much less clearly defined. Some of the narrower sections of the break are no longer visible. At that time, Mary told me, her doctor expressed surprise at how fast she was healing, and when she explained about the Better Bones program she was on, told her that “whatever she was doing, it worked, so she should keep doing it.”

Six months later, in December of 2009, the x-ray shows bones that are completely healed — at least two and a half months ahead of schedule, maybe more, since there were no x-rays taken between June and December.

Now it’s true, Mary is a young woman, and the young tend to heal quickly. But let’s not forget, Mary was vitamin D deficient, had some hormonal imbalance, and was under a great deal of stress even before her accident. Her body’s healing mechanisms might have been more dynamic than an older person’s, but they were also coping with more than just the task of building bone — so the speed of her recovery can’t just be attributed to youthful vigor. I would argue that the supplements and the dietary protocol Mary used to support her bones’ healing capabilities was the major reason she was able to recover so quickly — far more quickly than her doctors expected.

 

Better Bones Blog
Dr. Susan E. Brown

Mary’s broken leg – Part 1

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I often say it’s never too late to build strong, healthy bones, but I could just as easily say it’s never too early! Here’s a case that illustrates that point.

MWinn_Feb2009Recently I did a consultation with a young woman from Maine who’d had a severe, and rather strange, leg fracture. Mary is 27, active, and mostly healthy, if a little overweight. In February of 2009, she was standing in line at a skating rink (wearing rollerskates) when someone behind her fell and knocked her down. She doesn’t recall falling particularly hard, yet a sudden, excruciating pain in her leg turned out to be a bone fracture. But this was not just a garden-variety fracture — her right tibia and fibula were shattered. Repairing them would require 16 screws and two metal plates inserted surgically to hold the bone together, followed by months of rehabilitation. I spoke to her by phone after the accident and encouraged her to use the 20 key bone-building nutrients to speed her healing along.

After she was healed, Mary came back to me for a consultation because the extensive damage to her leg had her worried. Why had such a simple fall caused her such serious damage? Friends of hers had had much less injury with similar falls, or even worse falls, than the one that shattered her leg bone. What was going on? Was she at risk of another serious fracture if she fell again?

When we first sat down to review her medical history, about 9 months after the initial accident when she was pretty well healed up, I asked if she’d had a bone scan or a vitamin D test when she was first evaluated by the bone specialist who’d repaired her leg. She hadn’t, so I suggested she go back to her own doctor and ask for both tests. When we looked at the results, there was one point that stood out: her DEXA showed that her bone density was normal for a woman her age, but her vitamin D was surprisingly low — only 24 ng/mL, and this was after she’d been taking close to 3000 IU daily for many months.

If you’ve been reading my blog posts, you already know that Vitamin D deficiency has a huge impact on bone strength. I felt certain that this was one piece of the puzzle. Unfortunately, Mary’s vitamin D status before the accident was unknown, because her doctor, like many others, doesn’t routinely test his patients’ vitamin D levels. But if Mary was this low after supplementing for many months, it’s realistic to think she was even lower last spring after going through a Maine winter with no extra vitamin D.

But there was more to her story. Mary also told me that she’d gone to her doctor not long before the break because of dysfunctional uterine bleeding and highly irregular periods. Estrogen-based birth control pills did nothing to change it — and at around the same time she broke her leg, her menstrual cycles stopped altogether. When they resumed, six months after the accident, she was prescribed progesterone-based birth control pills that seemed to address the issue — her menstrual cycles became regular again. These hormonal irregularities offered another clue: it was likely that added progesterone was what brought Mary’s menses into balance, and low progesterone might be linked to her leg fracture. Years ago, endocrinologist Dr. Jerilynn Prior reported that 25% of all young women in North America suffered from hidden ovulatory disturbances resulting in low progesterone levels and subsequent sub-optimal bone mass development.  So now I started wondering why she might experience progesterone deficiency and if there were other hidden endocrine disorders contributing to her menstrual irregularities. Could a thyroid, adrenal, or other sex hormone imbalance be affecting her bones? I asked if she’d had any hormone tests, and she said her thyroid was tested.  Her doctor had reported that she’d had a “normal” TSH at her last visit… but the records didn’t specify the exact TSH level. So that’s another place for us to look, since different physicians have different (and sometimes erroneous) ideas of what’s “normal.”  No other hormones were tested.

Mary is also working full time and attending graduate classes to obtain a Master’s degree in public policy. She told me that her irregular periods started about the time she moved out of her parents’ house (she has a big, close-knit family) and started living on her own. This raised a red flag for me that stress, and the stress hormone cortisol, could also be an issue here.

Right now, Mary is increasing her dose of vitamin D to around 7000 IU per day (the usual protocol when vitamin D is severely depleted is to take 50,000 IU a week for 8 weeks, then retest to see if it’s gone up). When she goes back for her vitamin D retest, she’s planning to request several of the other tests I recommend to look for signs of bone loss: ionized calcium, intact parathyroid, NTx bone resorption test, and if available, free cortisol and DHEA tests to see whether excess stress hormones are a piece of the puzzle. Mary is still in her bone-building years, so being proactive right now to find out why her bones are weak may save her a lot of trouble later.

This particular case is of interest to me because it’s not often that we see this kind of bone weakness in a young person — but I strongly suspect it’s becoming a lot more common than most of us might wish. We have a lot of bone-weakening factors in our modern lifestyles and diets, not to mention high levels of stress! I’ll be coming back to this case from time to time to talk about what we can learn from it, but for now, I think the take-away is this: bone health isn’t just a concern for older people. There are so many risk factors that can contribute to weak bones that it’s worth stopping to take a look at them and think about which ones you can change right now. Because every little bit helps!