What is the Relationship Between Sleep, Stress and Nutrition?

What is the Relationship Between Sleep, Stress and Nutrition?

  July 24, 2020    AVisenMD

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Q1. What are some of the ways you take care of yourself?

·        -        yoga/meditation

·       -          dietary supplements

·       -         exercise

·       -        healthy eating

·       -      outdoor activities

·       -       spa treatment

·       -      time spent with loved ones

·       -      other: _________

Q2. How many hours of sleep do you get each night?

·      -       <4

·      -       5-6 hrs

·       -      7-8 hrs

·      -       9+

Requirements of sleep defined by the National Sleep Foundation:

Newborns (3 months): 14-17hrs                             

Infants (4-11 months): 12-15hrs                                                                                                                 

Toddlers (1-2yrs): 11-14hrs                         

Preschool (3-5yrs): 10-13hrs                                                                                                     

School age (6-13yrs): 9-11hrs                     

Teens (14-17yrs): 8-10hrs                                                                                                          

Adults (18-64yrs): 7-9hrs                              

Seniors (>65yrs): 7-8hrs

     

Impact of Sleep Disorder on Lifespan: Top 4 Leading Causes of Preventable Deaths in 2014:

·         Heart disease: increased rates of heart attacks the Monday after the clock has shifted an hour ahead; increased risk of heart failure, A-fib and increased BP associated with sleep apnea

·         Unintentional injury: drowsy drivers; 1 in 4 MVA are unintentional

·         Cancer: interrupted circadian rhythms associated with a higher cancer risk; WHO has identified lack of proper sleep as a probable carcinogen; reduced sleep is associated with increased breast and prostate cancer, especially in shift workers

·         Stroke: untreated obstructive sleep apnea leads to a 2x increase in rate of stroke

So, who is mostly affected by sleep and related health conditions?  It is mostly present in older adults, women, low education background, decrease exercise routine, lower mental health, stressful occupation, lower socioeconomic status.

Sleep and Obesity:

·         <5hrs of sleep increases risk of obesity by more than 50%

·         Associated with more food cravings (sweet, salty & starchy foods) due to an increase in the hunger hormone and suppressed appetite-control hormone

·         tend to ingest 300+ extra calories

·         CDC guidelines on total spent on obesity annually: $190.2bn in medical costs, $4.3bn in absenteeism, $506/person in lost work productivity, increase of 36% in medical costs/person

Sleep Apnea and Heart Health:

                           

Terms to know:

·         Obstructive Sleep Apnea (OSA): A sleep disorder in which breathing repeatedly stops and starts during sleep. It occurs when the throat muscles intermittently relax and block the airway while sleeping.  One of the noticeable signs of OSA is snoring.

·         Sympathetic activity: Conducted by the sympathetic nervous system which is the body's rapid involuntary response to dangerous or stressful situations.

·         Metabolic dysregulation: A group of conditions including high blood pressure, high blood sugar, excess body fat and abnormal cholesterol or triglyceride levels that together increase the risk of heart disease, stroke and type 2 diabetes.

·         Inflammation: An immune response to injury, infection and stress. Helps heal and repair damaged tissue.

·         Oxidative stress: An imbalance between free radicals and antioxidants in the body, where free radical generation is higher, which disables the body to detoxify harmful substances.

·         Vascular endothelium dysfunction: Damage to the innermost thin layer that lines the blood vessels.

·         Intermittent hypoxia: Brief time intervals when an individual has lower than normal levels of oxygen.

·         Atrial fibrillation: An irregular and a rapid heart rate that increases risk of strokes, heart failure and other related complications.

Sleep Disorders and Chronic Inflammation:

·         Optimal window of sleep for adults is 7-9 hours (less or more than that is not beneficial)

·         Shorter sleep can increase the likelihood of catching a cold by 4x

·         According to CDC, common colds alone cost $40bn annually in medical costs & lost productivity

Sleep and Cognitive Performance:

·         Better academic performance in college students linked with: longer sleep duration, better sleep quality, greater sleep consistency (maintaining daily sleep habits)

·         Less sleep was found to be associated with fatigue which increased stress levels

IMPORTANT TO RECOGNIZE PHYSICAL SYMPTOMS OF STRESS:

  

Physical  Symptoms of Stress:

·         Adrenal glands secrete two hormones:

- Cortisol: primary stress hormone that coordinates the body's response to daily stressors; inversely related with melatonin (high cortisol associated with low melatonin and vice versa)

- DHEA: an abundant hormone that is a precursor of estrogen & testosterone

Vitamin D:

                               

Q3. Who may have trouble meeting vitamin D requirements? (select all that apply)

·         Those who wear sunscreen daily

·         Those who live in closer climates

·         Older individuals

·         Darker skinned individuals

·         Those who work inside

·         All of the above

 ·         Functions: essential for lung health, helps regulate insulin secretion, promotes bone health, essential in brain health, important for heart health, controls inflammation, supports muscle health, helps regulate immunity

·         Daily optimal intake: 1500-2000 IU (37.5 - 50 mcg) / day

·         Sources: 15min FULL sun exposure, 3 oz trout (16.2 mcg or 645 IUs), 3 oz salmon (14.2 mcg or 570 IUs), 1/2 cup wild mushrooms exposed to UV light (9.2 mcg or 366 IUs), 1 cup fortified milk (2.9 mcg or 120 IUs).

·         Regular dose: Up to 2000 IU - supports daily requirements for adults with normal vitamin D needs

·         Extra dose: 2000 - 6000 IU - supports daily requirements for adults with higher vitamin D needs

·         Maximum dose: 6000 - 10,000 IU - for short term use in adults with vitamin D deficiency to help restore healthy levels

                    

Magnesium:

                           

Q4.  What is the best food source of magnesium on this list?

·        -         Milk

·       -          Bananas

·        -         Spinach

·        -         Beans

·         -        Almonds

·         Functions: helps in building bone and teeth, regulates heartbeat, helps in muscle relaxation, regulates nervous system, drives metabolism, produces cellular energy

·         Brain health: addiction, depression, ADHD & other mood disorders are associated with magnesium deficiency

·         Daily optimal intake: 310 - 420mg

·         Sources:  23 almonds (1oz = 80mg), 1/2 cup boiled spinach (78mg), 2 shredded wheat biscuits (61mg), 1/2 cup black beans (60mg), 2 tablespoon peanut butter (49mg)

Omega-3:

                           

Q5. What is the 2015-2020 Dietary Guidelines for Americans' recommendation for frequency of eating seafood?

·       -     1 serving/day

·       -     1 serving/week

·       -      2 servings/week

·       -      4 servings/week

 ·         Functions: promotes eye health, supports brain health, maintains healthy triglycerides, maintains healthy blood pressure, supports heart health.

·         High concentration of Omega-6 (arachidonic acid - AA) compared to Omega-3 (Eicosapentaenoic Acid and Docohexaenoic Acid - EPA and DHA) leads to low grade inflammation: increased production of pro-inflammatory eicosanoids and cytokines (chemicals that cause inflammation), increased cortisol production, decreased serotonin.

·         Clinical trials on Omega-3 and Mood Disorders: When Omega-3 was given as an adjuvant therapy along with antidepressants, the positive results  were increased for depression and substance abuse disorders.

Ø                  -     Minimum of 1-2 grams total EPA and DHA combined must be administered with at least  1 gram of EPA in the total

·         Memory: An Omega-3 index of more than 8% is associated with a 31% lower risk for death over 14 years

Ø                            -    Associated with improved cognition and working memory

Ø                           -    Linked with prevention of cognitive decline

·         The Institute of Medicine recommends Omega-6 to Omega-3 ratio of 5-10 to 3 but an average American consumes the ratio of 16 to 1

·         Daily optimal intake: 1000mg/day

·         Sources: 3 oz salmon (1.24g EPA and 0.59g DHA), 3 oz herring (0.94g EPA and 0.77g DHA), 1 tablespoon flaxseed oil (7.26g ALA), 1 teaspoon chia seeds (5.06g ALA), 14 halves or 1 oz walnuts (2.57g ALA)

     

Ashwagandha:

                           

 Q6.  What is another common name for Ashwagandha?

-      Indian winter cherr

-    Black cohosh

-    Goatweed

-    Bearberry

-     Garden Heliotrope

 ·         Functions: reduces stress, maintains healthy blood pressure, reduces oxidative stress, reduces serum cortisol

·         Daily optimal intake: 125mg/day

Ø                      -    Safe to be taken either in day or night

Ø              -    Potency depends on different extracts

Ø                      -    Can be taken with hot water, warm milk or with smoothies

L-theanine:

                                

 Q7. According to research, what does L-theanine promote?

-    Deep sleep

-    Relaxation without drowsiness

-    Quick reflexes

-    Digestive health

·         Functions: improves concentration, helps in relaxation, reduces stress, promotes better sleep quality, may support the immune system

·         Daily optimal intake: 200mg/day

·         Sources: 1 cup green or black tea (25-60mg), Boletus mushrooms

Melatonin:

                               

 Q8. Melatonin can be found naturally in foods.

-    True

-    False

·         Increased screen time or exposure to light reduces melatonin levels = reduced sleep

·         Melatonin levels start increasing from 9pm, peaking at 3am and decrease to minimal levels by 9am

·         Inversely, cortisol begins to rise at 3am, peaking at 9am and gradually falls throughout the day till 12am

·         Body temperature drops from  9pm to around 12pm, which helps promote night time sleep

·         Sources: tart cherries (13.5ng in 1g), roasted Arabica coffee beans (9600ng in 1g), merlot (8.1ng/ml), cabernet (14ng/ml), pistachios (228,400ng in 1g), mushrooms (4300-6400ng in 1g)

Q9. Which dietary supplements do you take on a regular basis? (select all that apply)

-    Omega-3s

-    Vitamin D

-    Magnesium

-    Botanicals

-    Multivitamins

-    Calcium

-    Probiotics

-    Other: _____

 

National Sleep Foundation: Sleep Hygiene

Sleep hygiene is a set of habits and practices that regulate our sleep patterns, improve night time sleep quality and daytime alertness

·         Daytime naps should be limited to 30 minutes. Naps should not be used as an alternative to less night time sleep. However, a short nap can help enhance mood and performance.

·         Avoid consuming caffeine and nicotine around bed time. Alcohol must be taken moderately as a high amount close to bedtime can disrupt sleep.

·         Exercise can help promote quality sleep. As little as 10 minutes of aerobic exercising like walking or cycling can enhance night time sleep quality.

·         Do not eat foods that can disrupt a good night time sleep. These include rich fatty foods, fried meals, spicy food, carbonated drinks and citrus fruits. Such foods can trigger indigestion and cause heartburn that can affect sleep.

·         Expose yourself to adequate natural light. Exposing yourself to sunlight during the day and to darkness during night time helps regulate the sleep-wake cycle.

·         Maintain a relaxing routine around bedtime. These can include taking warn showers, reading a book or light stretches. Try not to engage in emotionally upsetting conversations at bedtime.

·         Maintain an ideal pleasant sleep environment. Mattress and pillows should be comfortable. The room temperature should be around 60 and 67 degrees for optimal sleep. Turn off any bright lights from cell phones, lamps or TV screens. Consider using eye shades, blackout curtain, ear plus, "white noise' machines, fans and other devices.

 

 Answer Key:

1. Exercise is the most common answer          2.  7-8hrs is the most common answer        

3. All of the above           4. Almonds         5. 2 servings/week          6. Indian winter cherry 

7. Relaxation without drowsiness            8. True                  9. Multivitamins is the most common answer

References:

1. National Sleep Foundation Recommends New Sleep Times. National Sleep Foundation. https://www.sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times. Published February 15, 2015. Accessed June6, 2020.

2. Data Sources: CDC. Behavioural Risk Factor Surveillance System 2014. Census 2010. ACS 2010-2014. Method from Zhang X et al. Al J Epidemiol 2014; 179(8): 1025-1033.

3. Sleep Disorder Categories. Sleep Education. http://sleepeducation.org/sleep-disorders-by-category. Accessed June 6, 2020.

4. Lack of Sleep Increases Your Risk of Some Cancers. https://www.sleepfoundation.org/articles/lack-sleep-increases-your-risk-some-cancers. National Sleep Foundation. Accessed June 6, 2020.

5.  The Effects of Sleep Deprivation. The Effects of Sleep Deprivation | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-effects-of-sleep-deprivation. Accessed June 6, 2020.

6. Javaheri S et al. Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. Journal of the American College of Cardiology 2017; 69(7):841-858.

7. Huang et al. Melatonin possesses an anti-influenza potential through its immune modulatory effect. Journal of Functional Foods 2019; 58:189-198.

8. Prather at al. Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep 2015; 38(9): 1353–1359.

9. Okano et al. Sleep quality, duration, and consistency are associated with better academic performance in college students. npj Sci. Learn 2019; 4(16).

10. Office of Dietary Supplements - Vitamin D. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Accessed June 6, 2020.

11. Holick et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism 2011; 96(7):1911-1930.

12. Office of Dietary Supplements - Vitamin D. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/. Accessed June 6, 2020.