THE BLOG
10/17/2012 11:45 am ET | Updated Dec 17, 2012

Abstinence May Make the Bones Grow Stronger (or Can't a Girl Get a Drink Anymore?) Part 1

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Dr. SaraWhen it comes to your health, your hormones, and your mission, you know I'm looking out for you, right? I want to help you be as juicy, gorgeous, healthy and happy as you can be, from your cells to your soul, and especially your lovely bones. It helps you rock your mission on this planet, and this is true for both for men and women.

You probably also know that for us California girls (okay, I moved to San Francisco from Boston 18 years ago, but that makes me almost a native, right?), Napa Valley is home away from home and wine flows through our veins like blood.

In other words, I'm no axe-wielding killjoy prohibitionist -- I don't want to shut down your good times, especially when it comes to girlfriends celebrating together, because girlfriend time is divine. It raises oxytocin, the neuro-hormone of love and bonding. Women as a whole love their "tend and befriend" time -- the way that women respond to stress with the desire to seek the company of other women, as opposed to the fight-or-flight of men under stress, as described by Professor Shelley Taylor and colleagues at UCLA.[1] For women, affiliation raises oxytocin, which suppresses the stress hormone cortisol, although this depends on your oxytocin gene, a topic for another time![2],[3]

But I've got to tell you about a new study that rattled my bones. Bottom line? Abstinence may help reverse bone loss.[4] No joke. You've probably heard me harp before on the news that came out last year that even as little as three to six glasses of wine per week raise your bad estrogens and increase your risk of breast cancer, according to the Nurses Health Study.[5] As if it wasn't enough to have the shadow of breast cancer hanging over our heads every time we sip a cosmo (See my post "Your Boobs on Booze: How Alcohol Affects Your Breast Health" -- I swear to you I'm a Carrie Bradshaw, not a Carrie Nation!), now we have to think about our bones, too.

Yes, we could totally downplay this one. We could go into denial or the avoidant pattern of your choice that you trot out when the latest science doesn't jibe with how you want to run your life. But my sacred duty is to bring the evidence to your attention, and then let you decide how to calibrate your lifestyle design based on it.

When it comes to this latest study, not only are the results reported preliminary, but they are also limited. Here's why. The study had only 53 subjects, and they were all men. And they were all hardcore alkies in rehab. But the fact remains that after just two months of subtracting alcohol and adding exercise, their bone mineral density indicators showed improvement:

Over the course of eight weeks, during which the men abstained from alcohol, there was a significant increase in osteocalcin plasma levels, from a mean of 21.47 µg/L to 25.54 µg/L, indicating a higher rate of bone formation, the authors report in Alcoholism Clinical and Experimental Research.[4] The author explained:

This means that an increased fracture risk could be reduced during abstinence if no manifest osteoporosis is actually present. In addition, regular physical exercise seems to be "bone-protective" in alcoholic patients, likely due to the fact that a dynamic strain on bone through physical activity increases the rate of bone formation and resorption, which is good for bone density.

Okay, we knew that part about exercise. Whether it's yoga, tennis, ballet or just taking a walk around the block, any activity gives gravity the opportunity to gently exert its force and pull your muscles away from the bones they're attached to. This pull wakes up your bone cells. They realize, "Hey, we're alive! Yippee! We get new cells! Like, now!" Stimulated by activity, your bones make new cells and give a needed makeover (also known as "remodeling," as long as you give them the building materials they need, like calcium, magnesium and vitamins D and K). For people without gravity pulling at their bones -- astronauts in zero gravity, people who don't have enough muscle mass or couch potatoes who don't get enough exercise, loss of bone density can become a problem.

Here's the problem with ignoring this cutting-edge data: It confirms what we know already in women. We've known for many years that alcohol leads to bone loss in a dose-dependent manner because it inhibits osteoblasts (cells responsible for building bone).[6] We know that alcohol raises cortisol, which accelerates bone loss. Additionally, alcohol alters other important stakeholders of your bone, including parathyroid hormone (PTH), vitamin D, osteocalcin, and testosterone. Most importantly, older studies have confirmed that abstinence, in women too, reverses bone loss.[7]

I'll dish more about the science and the solution next time in part two -- just wanted to keep your finger on the pulse. What's also interesting to me is this: Alcohol raises your cortisol for 24 hours or longer. As a good friend once wisely said to me, "The very thing you think you're getting from alcohol -- soothing, ease, transition, celebration, peace -- it's actually stealing from you." Plus alcohol is a depressant, and robs you of deep sleep.

Does bone loss (or the potential threat of breast cancer) motivate you to reconsider your drinking habits? Why or why not?

If yes, is it possible to cut back this week? What motivates you most?

Have you tried before to cut back on alcohol? What's made it successful or not?

What's the hardest part of reducing alcohol to three to six servings per week? That is, what do you get from a glass of fine wine that you don't get from a glass of, say, fizzy water with a splash of apple cider vinegar?

References:

[1] Taylor SE, Klein LC, Gruenewald TL, et al. "Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight." Psychol Rev. 2000 Jul;107(3):411-29. http://www.ncbi.nlm.nih.gov/pubmed/10941275. See also: Tamres LK, Janicki D, Helgeson VS. "Sex Differences in Coping Behavior: A Meta-Analytic Review and an Examination of Relative Coping." Personality and Social Psychology Review 6 (2002) 2-30, doi:10.1207/S15327957PSPR0601_1.

[2] Heinrichs M, Baumgartner T, Kirschbaum C, Ehlert U. "Social Support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress." Biol Psychiatry. 2003 Dec 15;54(12):1389-98.

[3] Normal GJ, Hawekley L, Luhmann M, et al. "Variation in the oxytocin receptor gene influences neurocardiac reactivity to social stress and HPA function: a population based study."
Horm Behav. 2012 Jan;61(1):134-9. Epub 2011 Nov 25.

[4] Malik P, Gasser RW, Moncayo R, et al. "Markers of Bone Resorption and Formation During Abstinence in Male Alcoholic Patients," Alcohol Clin Exp Res. 2012 Sep 14. doi: 10.1111/j.1530-0277.2012.01834.x. [Epub ahead of print]

[5] Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC. "Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk." Journal of the American Medical Association 306 (17) (2011): 1884-90. See also Li CI, Chlebowski RT, Freiberg M, Johnson KC, Kuller L, Lane D, Lessin L, O'Sullivan MJ, Wactawski-Wende J, Yasmeen S, Prentice R. "Alcohol consumption and risk of postmenopausal breast cancer by subtype: the women's health initiative observational study." Journal of the National Cancer Institute 102 (18) (2010):1422-31.

[6] Diamond T, Stiel D, Lunzer M, et al. "Ethanol reduces bone formation and may cause osteoporosis." Am J Med 1989;86:282-8. See also: Turner RT. "Skeletal response to alcohol." Alcohol Clin Exp Res 2000;24:1693-701.

[7] Alvisa-Negrin J, Gonzalez-Reimers E, Sontolaria-Fernandex F. "Osteopenia in alcoholics: effect of alcohol abstinence." Alcohol Alcohol. 2009 Sep-Oct;44(5):468-75. Epub 2009 Jun 17.

Sara Gottfried, M.D., is a practicing integrative physician and author of the forthcoming book, The Hormone Cure (Scribner/Simon &Schuster, 2013). You can follow Dr. Sara on Twitter, connect with her on Facebook, watch her videos on Youtube, and subscribe to her newsletter.

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