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Bone Health Tips for Underweight Women

By Dr. Susan E. Brown, PhD

Special note: Just the other day, one of my thin worried blog subscribers wrote asking if I had suggestions for helping her gain to protect her bones.  It reminded me that while my blogs change from week to week, there is certain information that is worth repeating!  This summer I’ll be reintroducing you to some of the most popular reader blogs, and we’ll start with one of the top reader favorites.

I've talked about how women who can’t gain weight are at heightened risk of osteoporosis and fracture. Just to quickly recap, I identified 3 basic issues that I see fairly often:

•    There are those who tell me, “I eat just fine, but I just never seem to put on any weight.”

•    Others say they simply don’t get hungry or don’t feel like eating, so they skip meals. Sometimes, eating makes them feel sick, so they eat less (or less often) as a result.

•    Some say they eat well some of the time, but that they eat less when they’re under stress — and they’re under stress often.

The question now becomes, what can a woman do to address these issues?

For people who stay thin despite eating well, I’d look at three factors. First, are they really eating enough food on a regular basis, or is that simply their perception? While the average adult needs 2000-2500 calories, that’s an average; some people require more, but may not realize it — and gaining weight might simply be a matter of eating more nutrient-dense foods. I also recommend that underweight women supplement with the 20 key nutrients required for bone health, particularly if they’ve been thin most of their lives, so they can be sure those nutrients are available for bone strength.

Second, I’d consider whether a metabolic or endocrine issue could be at work. Hyperthyroidism, latent autoimmune diabetes in adults, and various other chronic disorders can prevent people from gaining weight, even when they eat well. Simple blood tests can generally uncover the presence of such health issues, which need to be addressed by a specialist.

Finally, I’d look at the possibility that they might not be absorbing the food they eat. Malabsorption syndromes and digestive issues like IBS or Crohn’s disease, have obvious symptoms attached — diarrhea, gas, bloating, pain — but others, such as celiac disease, can damage the GI tract and impair nutrient absorption capabilities, sometimes without causing any distinct symptoms related to the digestion. If I saw indications of poor nutrient absorption (dry, brittle hair and nails, for instance), I might suggest that a client ask for celiac or other GI testing, and we’d look very closely at how to boost the nutritional and caloric content of her food so she gets more of what she needs.

Suggestions for those who aren’t hungry
Those who don’t feel hungry or who don’t feel like eating usually have one of two problems. Either they have an imbalance in the “hunger hormones” that stimulate appetite (often associated with zinc inadequacy), or they simply are so rushed or busy that they habitually ignore their body’s signals that it needs food, to the point that they genuinely believe they’re not hungry even when they are! These folks benefit by taking time to acknowledge and understand their physiologic needs. I would do the following:
1.    Review their diets to make sure they are getting a full balance of fats, carbohydrates, and proteins
2.    Help them schedule their mealtimes, including time for pre-meal “appetizer” foods such as broth (warm liquids stimulate the appetite).
3.    Suggest an elimination diet or allergy testing for those who say they feel ill or uncomfortable after eating.

If anxiety or worry is prohibiting weight gain
For those who stop eating or eat less due to anxiety or stress, part of the problem is their response to anxiety and worry. For clients whose thinness is related to an anxious mind, I’d help them to learn stress-reduction techniques, and also have them focus on their intentions around eating — that is, to find ways to celebrate their meals as an affirmation of their worth. It doesn’t need to be complicated — simply saying grace before each meal, for example, can send a strong signal from the mind and spirit to the body that the food in front of you is a blessing meant to nourish you. The power of the mind should not be underestimated, and focusing it on nourishment (instead of on anxieties and worries) may be an important component of promoting healthy weight gain.

If you’re underweight, taking steps to build strong muscles, eat a nutritious diet, and reduce stress and anxiety can help you gain weight, meanwhile reducing your fracture risk.  Even if the tips outlined above don’t help you to add a single pound of weight, the bone-strengthening benefits of my Better Bones approach may make the difference in staying healthy and avoiding fractures — and isn’t that what matters in the long run?


You can try Dr. Brown’s comprehensive supplements in her at-home bone health program, developed with Women's Health Network. Get her exclusive formulations along with her detailed lifestyle and diet guidance, plus telephone support whenever you need it. Learn more about the Better Bones Health Program.

We created the Better Bones blog as our forum to express opinions and educate the public about natural means of supporting and improving bone health and overall wellness. As part of this forum, we sometimes discuss medical issues and medications, and their effects on bone health in general. However, we cannot advise readers about specific medical issues in this forum. If you wish to obtain advice from Susan E. Brown, PhD, about your specific bone health and nutritional concerns, please visit our Consultations page. Other specific medical questions should be referred to your healthcare provider.



June 30. 2014 22:24

"The type of food one eats also affects one’s ability to gain weight.
Have you ever seen an obese vegetarian?

Compare the physique of Asians whose diet consists primarily of vegetables, fruits, rice, fish and lean meat with the physique of people who eat a conventional American diet.

I know from experience that it can be difficult to gain weight when you exercise regularly, when you have a high intake of fruits and vegetables, when you limit sugary drinks and foods and when you replace trans and saturated fats with poly- and monosaturated fats like those in nuts, olives, avocados & salmon.

When my weight falls below my desired weight level, the easiest way to gain it back is to add foods high in saturated fat and sugar and to eat items such as hamburgers, pizza, lasagna, and burritos with lots of sour cream and cheese."

Renee Newman

Renee Newman

July 1. 2014 00:51

When will you publish something new? i've read this thing five times now.  And I'm tired of being told to buck up, since my weight loss is related to cancer treatment but my doctors won't address it.  I should look on the bright side of that?  reduce the stress of a life threatening illness coupled with the attendant loss of work and increased expenses--how, exactly?  just eat more?  undergo more invasive tests?  or continue to let them give me bisphos drugs so THEY feel better when the DEXA test looks better?  Why would I also want to buy a program from you?  Where's the info on reversing muscle wasting?  where's the walker that comes and puts me on a leash and takes me out to play -- but lets me quit when I feel too crummy keep WORKING OUT?  Tell me something new and helpful, but don't repeat and don't suggest I can bootstrap myself out of life ebbing away in every way.


July 1. 2014 13:40

Thank you for your blog.  I really appreciate your thoughtful posts.


July 1. 2014 14:35

Allyson I am so sorry that you experience such TREMENDOUS life-draining battles and extend my sincere sympathy. I cannot accurately empathize or imagine how horrific the emotional turmoil you undergo just on a on a day-to-day basis. Based on the vivid description you wrote it seems their blogs don't address your set of serious circumstances. I wish for you healing that starts from deep within that permeates your entirety. I wish for you peace. I wish for you miracles...


July 1. 2014 16:38

You mentioned hyperthyroidism and that simple blood tests can identify it.  Not true.  I have all the symptoms and the docs will not do any other testing but the basic blood work.  Often this blood work will be normal and the docs won't continue with more definitive tests.  I have been to 3 endocrinologists in S. Florida and have given up.  Plus, the treatment may be worse than the disease.

Most of the info out there pertains to hypothyroidism, which is more common.


July 1. 2014 16:52

I had Grave's (autoimmune hyperthyroid)several years ago.  Went to endo for drug suppression of symptoms; not lasting.  Then went to a doctor for acupuncture & traditional Chinese medicine treatment & was told thyroid problems are usually related to wheat/gluten sensitivity. TCM & acupuncture & wheat/gluten elimination worked with no side effects.  And I had Hashimoto's for over 30 years.  Thyroid is euthroid now.


July 1. 2014 22:27

Dear Linda,
One of the most definitive authorities on hyperparathyroidism is in Tampa, Florida and this is Dr. Norman of the Norman Parathyroid Center. If you haven't sought out his services, you might look into seeing if he can help you.

Best wishes, Susan Brown

susan e. brown

July 3. 2014 14:22

Thank you so much for this post. We don’t talk often about the underweight problem. I am in the beginning of my 40's, I measure 5'1 and started involuntarily to loose weight about 15 years ago. Now stable at 88 pounds, I am trying to gain weight without success since many years. I have digestive issues and food intolerences, but the medical tests I had did not reveal anything wrong. I should probably try the FODMAP diet for my disgestive issues, but how can we try a diet of that kind when you are already underweight and when you have osteoporosis with a high risk of fracture. The osteoporosis diet needs a lot of fruits and vegetables as I understand. Seems like this diet and the FODMAP diet are not compatible, so I have to make a choice: either I continue to endure my digestive symptoms that are very difficult to live with daily and concentrate my efforts to improve my osteoporosis with the diet suggested, or I don’t bother with my osteoporosis and go with a diet that might help me with the daily discomfort I live with. Doing exercices also seems to be a problem in my case. I already walk 20 to 30 minutes a day and I would like to do more exercices to help my osteoporosis, but I am afraid to lose weight. Any suggestions for the exercices that can be done? The solutions for our health problems are not always easy.


July 7. 2014 11:53

Allyson, I've worked with women going through cancer treatments and have complete empathy with what you are going through. I write my blog for my general audience and recognize how frustrated you feel that you didn't find your specific concerns addressed. To obtain personalized health information, I encourage you to reach out to a reputable practitioner in your local natural health community. I wish you peace and healing. - Susan Brown

Susan Brown

July 10. 2014 18:45

Why is coffee medium and espresso high in the acid creating category?


July 11. 2014 19:58

@Michaelia: Dr. Brown passes along that it's categorized this way because espresso is a concentrated/stronger form of coffee. - Jacqueline, Blog Admin

Blog Admin

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