100% of the top conditions seen by a General Practitioner can be related to poor sleep. Some of these include:
- Alzheimer’s Disease
- Anxiety and Depression
We have different phases of sleep including:
REM sleep (Rapid Eye Movement):
The body is paralysed but brainwaves are most similar to when awake.
This is important for memory consolidation and emotional control
Important for physical repair and learning
Brainwaves are slow, growth hormone is secreted. Children have a lot of this phase of sleep, it gradually decreases across adulthood.
During sleep, the brain has a special detoxification and clearance system called the Glymphatic System. Breakdown products and proteins are cleared by immune cells specific to the brain.
Sleep complaints are very common and include:
- Snoring while sleeping – 48%
- Snort, gasp or stop breathing – 11%
- Trouble falling asleep – 16%
- Unrested during day regardless of hours of sleep – 27%
- not enough sleep – 26%
Poor sleep and chronic pain have a vicious cycle with new research showing sleep disruptions increase pain, more than pain disrupts sleep.
Quote: The best bridge between despair and hope is a good night’s sleep. E. Joseph Cossman
The most common sleep disorder in the USA is “insufficient sleep”. The number of recorded sleep hours is steadily declining, with reports in 2001 of 7h sleep on worknights, compared with 6.7h in 2008. Almost 50% of adults get less than the recommended amount of sleep and up to 57% of children get less than needed.
Global effects of insufficient sleep include:
Mental health: anxiety, depression, panic
Physical health: inflammation, high blood pressure, obesity
Cognitive Performance: reduced short term memory, verbal fluency and creativity
Physical performance: decreased reaction time and coordination
Emotional Intelligence: ethical decision making and identifying emotional states.
Tips for better sleep:
- Start with a good wind-down before sleep. Avoid strong overhead lights as these make your body think it is daytime. Have a minimum of 1h wind down time to bring your body into parasympathetic mode ready for sleep.
- Control light exposure: use blue light blocking glasses 2h before bedtime when using devices or watching a screen. Use night time control for screen brightness/blue light blocking on your mobile phone.
- Turn mobile phone into Airplane mode or ideally keep in another room where you won’t be disturbed.
- Choose your bedtime so you get sufficient sleep – adults need 7-8h per night. Wake up time may be decided for you as per your schedule, YOU have the choice of when to go to bed.
Set up your bedroom for a good night’s sleep:
- No pets
- No wakeful stimuli eg devices
First thing in the morning ensure you have exposure to full spectrum light (ideally sunlight) for 30 minutes of the first 2 hours of waking. This will help set your day-night clock for better sleep. Aim for 10 minute bursts of light every couple of hours.
A few weeks ago, I went to Leura to attend a 3 hour seminar on obesity, held by Metagenics. It was a great turn out from practitioners from Sydney, Canberra as well as the Blue Mountains and Central West.
In Australia, it is estimated that by the year 2025, there will be more obese
(BMI >30) people than people in the healthy weight range (BMI 20-25). Currently 63% of Australians are overweight or obese.
Why is this so important? Obesity is a medical issue in terms of the potential health implications. The more fat mass a person carries the greater risk of chronic disease:
- Cardiovascular disease
- Sleep apnoea
- Mood disorders
- Neurological diseases
Even modest amounts of weight loss (5-10% reduction) leads to dramatic improvements in health. The Diabetes Prevention Program showed that losing 5.5% of body weight over 2.8 years, decreases the risk of getting diabetes (from a pre-diabetic situation) by 48%. (1)
Obesity relates to our brains – they drive what we eat. We are hardwired to seek out more calories and remain less active, so we have ample supplies for the lean times. But in 2018 with food available 24/7 the lean times don’t come.
Body weight regulation is under UNCONSCIOUS homeostatic control – similar to blood pressure, blood sugar and pH regulation. The body weight our body likes to maintain is called the “body weight set point”. There is a 2-6kg fluctuation around this point. (2)
Our body weight set point is developed around the age of 20y, around 24y in some males. This body weight set point goes up in our 50s and as we then get older, this starts to drop. If there is obesity in childhood, the body weight set point will be set higher at an earlier stage.
Our brains control the energy we use. For example, in a group of obese people who had 20% weight loss, they were inclined NOT to move MORE than obese people who had lost 10%.
So, the gut-brain connection rears up again – in animal studies, inflammation in the brain (in particular the hypothalamus) precedes obesity. What drives inflammation? A high fat and high sugar diet. Eating food triggers dopamine release, a neurotransmitter, which activates reward, motivation and learning centres in the brain. The more calorie dense a food is, the more dopamine is released. (3)
Studies show that obese people demonstrate higher reward centre activation in the brain compared with lean controls. (4)
What are some of the real causes of obesity in 2018?
- We are eating more than we have historically – calorie intake is 425 kcal/day higher
- The body weight set point is reset so there is a 20% increase in energy intake (2)
So, what can we do to lower the set-point?
- Have a diet with low to moderate palatability (tastiness)
- Eat adequate protein
- Restrict fat OR carbohydrate
- Have diet breaks (time off restricted eating, to prevent metabolic adaption and give a psychological boost)
- Ensure adequate good quality sleep
- Maintain good levels of physical activity
Having a buddy when focusing on weight loss has been shown to be very beneficial for accountability, psychological support and better outcomes.
Watch out with the upcoming holiday season….much of weight gained through the year happens during the smallest window. Research shows that annually 52% of weight gain occurs over the holiday season, which is only 12% of the year. Lots of hyper-palatable (very tasty) food is consumed/over-consumed, which has been found to drive up the set-point. (5)
- Diabetes Prevention Program Outcomes Study. Lancet. 2009 14;374:1677-86
- Obesity Pathogenesis: An Endocrine Society Scientific Statement. Endocrine Rev. 2017 1;38:267-296
- The gut-brain dopamine axis: a regulatory system for caloric intake. Physiol Behav 2012 6;106:394-9
- Widespread reward-system activation in obese women in response to pictures of high-calorie foods. Neuroimage 2008 41:636-47
- Defence of body weight depends on dietary composition and palatability in rats with diet-induced obesity. Am J Physiol Regul Integr Comp Physiol. 2002 282:R46-54
It is estimated that 25% of the world’s adult population has Metabolic Syndrome (Met Sy) (1). This is a very common syndrome and I want to empower you to take a preventative approach to minimise your risks of developing Met Sy.
Essentially it represents 5 variables which increase “cardiometabolic risk”.
- Obesity (BMI >30)
- Raised fasting glucose (blood sugar)
- High triglycerides
- Low high density lipoprotein (HDL)
- High blood pressure
Fundamentally central obesity (apple shape) is associated with insulin resistance. This means cells are not responding to insulin as they usually do, moving glucose from the blood stream into cells. When there is excess insulin secreted from the pancreas:
- Excess glucose (sugar) is stored as fat and energy levels drop
- Testosterone and cholesterol levels increase
- Fat burning is reduced and diabetes risk increases
In obesity, the extra fat causes inflammation, can result in high blood pressure, clotting and adverse blood fat profiles. It acts like a metabolic organ of it’s own, producing inflammatory factors that affect whole body health.
So what action steps can you take to decrease your risks of metabolic syndrome?
- Exercise more
- Lose weight – between 5-10% weight loss can increase HDL and reduce blood pressure and blood sugar levels
- Avoid trans fats – these are not recognised by the body – commonly found in baked goods eg pastries and deep fried foods.
- Cut back on refined carbohydrates or processed foods
- Stop smoking
- Alcohol in moderation – no more than 1 drink per day for women and 2 drinks per day for men is recommended.
Metabolic Syndrome and Mental illness
The incidence of obesity and Met Sy in people with mental illness compared with the general population is:
- More than two times higher in women
- Almost twice as high in men
This reflects the brain effects of vascular and hormonal changes with metabolic syndrome (2)
At Braid Health, we take a preventative and proactive approach to health. Metabolic Syndrome is a condition we look out for in our clients and routinely do comprehensive blood panels and detailed functional pathology testing. We aim to empower our clients through education, discussion and implications of results of testing, and use science-based approaches to optimise their health.
Who to test and when?
- Asymptomatic men >45y
- Asymptomatic women >55y
- In Maori, Pacific and Indo-Asian people start 10 years ie
- asymptomatic men >35y
- asymptomatic women >45y
- If there are multiple risk factors begin 10 years earlier.
- Long term steroid or antipsychotic treatment
- BMI>30 or BMI >27 for Indo-Asian people
- Family history of early onset type 2 diabetes
- Personal history of gestational diabetes mellitus
- Ischaemic heart disease (heart attack or angina) (3)
1. Anagnostis P et al 2009
2. Allison et al 2009