Nutrition & bone health
Nutrition for bone health — how to gain weight if you’re too thin
by Dr. Susan E. Brown, PhD
In a couple of my blog posts, I’ve talked about how inadequate or imbalanced nutrition
affects bone health, putting thin persons — particularly thin women — at greater
risk for bone fractures. The most recent
post, Beauty is Bone Deep, focused
on women who try to force a thin physique on their (usually unwilling) bodies for
the sake of an unrealistic beauty ideal. But there are those women, and men too,
who try and try to gain weight rather than lose it, often to no avail.
These aren’t people who have an eating disorder or anorexia — they’re otherwise
healthy-seeming people who simply can’t gain a single pound.
The problem everyone wants — unless they have it
Now, many folks out there will read this and think, “Gee, that’s a problem I wish
I had.” But as people who do have this problem will tell them, the struggle to gain
weight is actually harder than the struggle to lose it. Think about it: there are
dozens, if not hundreds, of weight loss solutions out there (some better than others),
but there aren’t many workable solutions to gain weight in a healthy manner. If
you search the internet, you’ll find most information on weight gain is for bodybuilders
and focuses on building bulky muscle, but that’s not something most women (and many
men, too) really want. And contrary to the suggestions some of my underweight clients
hear, eating cheeseburgers, ice cream and cookies 24/7 does not help, and
it’s a highly acidifying, bone-damaging
way of life as well.
So what should an underweight woman or man do to gain weight in a healthy
Root causes of being unable to gain weight
Just as with any health issue, solving underweight requires examining root causes.
I’ve noticed that people who are underweight fall into several camps:
- There are those who tell me, “I eat just fine, but I just never seem to put on any
- Others say they simply don’t get hungry or don’t feel like eating, so they skip
meals. Sometimes, these people say that 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.
For people who stay thin despite eating well, I look at three factors. First, are
they really eating enough food on a regular basis, or is that simply their
perception? Is a meal something they sit down to at a table, with 2 or 3 different
dishes, and spend time enjoying — or do they consider an apple and a small tub of
yogurt consumed between meetings at work to be “lunch”? 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. Moreover, if you’re underweight because of a nutritional deficit,
you may need to supplement with the
20 key nutrients required for bone health because if your muscles, skin,
organs and tissues aren’t getting what they need, they’ll take it from your bones!
Second, I 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 — and sometimes, these disorders
are “silent,” meaning they have no clear-cut symptoms. I often recommend a
medical workup for osteoporosis for this very reason. Simple blood tests
can generally uncover the presence of autoantibodies or hormone imbalances, however.
Such disorders represent significant health issues that need to be addressed by
Finally, I’d look at the possibility that they might not be absorbing the food they
eat. A great many malabsorption syndromes and digestive issues can prevent a person
who eats reasonably well from reaping the benefits of the food they take in. Some
of these, 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. Poor nutrient absorption frequently occurs in
older people simply as a byproduct of aging. So if I saw indications of poor nutrient
absorption (dry, brittle hair and nails, for instance), I might suggest that a client
ask her physician for testing for celiac or other GI issues, 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. And I’d offer them suggestions for
how to strengthen their digestion.
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 don’t prioritize meals sufficiently. The second problem is likely
more common than the first — many folks 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:
- Review their diets to make sure they are getting a full balance of
fats, carbohydrates, and proteins
- Help them schedule their mealtimes, including time for pre-meal “appetizer” foods
such as broth (warm liquids stimulate the appetite).
- 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?
The Personal Program for Better Bones: the approach I recommend for naturally strong bones.
At the Center for Better Bones we promote an all-natural approach to bone regeneration
and repair that includes nutrition, diet, exercise, lifestyle guidance, and support.
The Personal Program for Better Bones is a convenient,
at-home version of this approach that was developed with Women to Women, one of America's premiere on-line women's
health websites. Working together, we've developed the most comprehensive approach
to bones health available today, and based on the 25 years of Dr. Brown's leading-edge
research in the field.
Questions about the Personal Program for Better Bones? Call toll-free at
Original Publication Date: 04/11/2011
Principal Author: Dr. Susan E. Brown, PhD