Bone Health + Cholesterol When You Have Hypothalamic Amenorrhea
If you have HIGH cholesterol (>200), HA (hypothalamic amenorrhea), and osteoporosis/osteopenia this is for you. If you have low cholesterol (< 160) and osteoporosis/osteopenia, this is for you too. And if you generally just fear cholesterol, keep reading this is for you too!
Role of Estrogen
When it comes to bone health and HA, there is a lot of talk about the role of estrogen. It is well known that low estrogen (hypoestrogenemia) increases bone fragility and decreases bone mineral density. It is also important to note that low estrogen levels as seen in HA, also increase MAT (bone marrow adipose tissue- type of fat deposited in bone marrow). This is of concern because an increase in MAT also leads to lower areal and volumetric BMD (bone mineral density) and bone strength.(1)
Role of Progesterone
While most of the research is focused on the relationship between estrogen and bone health, it is important to note that estrogen and progesterone work synergetically within women’s bodies. For example, both estrogen and progesterone contribute to peak bone mineral density. In vitro studies have shown that progesterone increases osteoblast (bone-forming cells) numbers and encourages osteoblast (bone-forming cells) maturation. A Danish study shows higher osteoblastic activity during the well-documented luteal phase (higher progesterone levels = more bone formation). Therefore progesterone deficiency contributes to decreased bone formation.(2) Multiple studies confirm that there is a higher follicular phase bone resorption and higher luteal phase bone formation. (2) Reminding us that estrogen and progesterone work together in bone health.
Role of Cholesterol
So where does cholesterol fit in? As mentioned above, osteoblasts are necessary for bone formation, remodeling, and function. So we can agree that supporting osteoblasts is important. Right?
Cholesterol has been found to be essential for SURVIVAL of osteoblast (bone-forming cells) function, along with bone mineralization.(3)
Cholesterol is also required for the maturation of bone marrow-derived mesenchymal cells (MSC). (3)
It is important to note that cholesterol, like every other hormone (estrogen, progesterone, testosterone,etc) there is a Goldilocks range that the body responds best to. Too high cholesterol can have a negative effect such as increased bone resorption and decreased bone formation as seen in human and rat studies.(3) This shouldn’t be shocking to us.
Already have high cholesterol?
If you have HA, osteoporosis/osteopenia, and have high cholesterol and you are ALREADY avoiding high-cholesterol foods then you may feel stuck and confused with this information on the role of cholesterol and bone health.
I encourage you to pause and ask yourself, did avoiding high-cholesterol foods such as animal fat/protein and excessive exercise PREVENT you from developing high cholesterol?
What if chronic dieting and restriction caused (AKA chronic energy deficit) you to develop HA? And now your low estrogen due to HA is causing your osteoporosis/osteopenia along with your high cholesterol?(4) And now your lack of animal fat/protein that has cholesterol is negatively impacting your bone heath too?
As you can see, the answer is NOT to avoid animal fat/protein to lower cholesterol. You already did that! Instead, we want to address the root cause of high cholesterol and bone health, which is your low estrogen and progesterone… restoring ovulation.
*It is important to note that it has NOT been established whether or not hyperlipidemia is a “consistent cause of low BMD and high fracture risk in humans.”(3)
If you want to work with a HA Fertility coach who is experienced in connecting the dots and addressing the root cause of your HA, then fill out a coaching application HERE.
If you want to become a Holistic Hypothalamic Amenorrhea Practitioner, then sign up for our next cohort HERE!
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