Tag Archives: sleep

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The importance of a good night’s sleep can’t be overstated. Without the proper quantity and quality of sleep, our mood can deteriorate, our ability to focus often erodes, and we frequently feel run down, lethargic, and on edge. Research and anecdotal evidence all support the notion that sleep is integral to our overall health. In stressful times such as these, when a strong immune system is critical, quality sleep is paramount.

The latest sleep research suggests the quality and quantity of your sleep influences every component of human physiology. That influence extends to physical health, mortality, mental health, safety, learning, productivity, as well as our personal and professional relationships. Research even indicates that insufficient sleep shortens your life span. It’s no different when it comes to your immune system.

The current COVID-19 pandemic affects each of us differently; still, improving one’s immune system is universally beneficial. Sources on social media and the Internet abound with recommendations to improve one’s immune system; in most cases nutritional solutions are suggested. While eating well and staying fit are important components to maintaining a healthy immune system, sleep is often neglected.

Despite consuming one-third of our lives, sleep is one of the last basic physiological needs to be understood; there is still a great deal to be learned. While we have analyzed much about the drive to eat, drink, and reproduce, for a long time physiologists knew little about the drive to sleep and why we “repeatedly and routinely lapse into a state of apparent coma.” Scientists were also puzzled why our “mind will often be filled with stunning, bizarre hallucinations”!(1)

From an evolutionary perspective, sleep would seem to be a foolish practice, since none of the other drives can be accomplished while we sleep. Importantly, it also leaves one vulnerable to predators. Consequently, we can reason that there must be significant benefits to sleep that outweigh the negatives. Indeed, it now appears that there is not one major organ or process within the brain that does not benefit from sleep.

For the past 30 years, a significant body of research has examined the effect sleep has on human immunity. The internal clock we all possess, also known as our circadian rhythm, exists in every one of our cells, including those of our immune system. A great deal of research explaining the impact of sleep on our immune systems can be found for free at Pubmed.gov. (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)

With an understanding that the strength of your immune system is highly dependent on the quality and quantity of our sleep, the question becomes: How does one improve both of these important factors? There is more to it than simply telling someone to get more sleep.

 

Sleep 101

First, let’s review some basic sleep physiology. Contrary to what many people believe, we do not all possess the same circadian rhythm, and we possess this internal clock independent of the sun’s cycle.

This was demonstrated in an experiment conducted by Professor Nathaniel Kleitman and his research assistant Bruce Richardson from the University of Chicago in 1938. (1) Loaded with enough food and water to last for 32 days, along with a host of measuring devices to assess their body temperatures and their waking and sleeping rhythms, the research team went deep into Mammoth Cave in Kentucky where there is no detectable sunlight. Removed from the daily cycle of light and dark, they discovered that their biological rhythms of sleep and wakefulness, together with body temperature, were not erratic but showed a predictable and repeating pattern of approximately fifteen hours of wakefulness along with bouts of about nine hours of sleep. Further, these repeating cycles were not exactly 24 hours in duration. Richardson, in his twenties, developed a sleep-wake cycle of between twenty-six and twenty-eight hours long, whereas Kleitman, in his forties, was closer to, but still longer than, 24 hours.

The discovery that our innate biological clock is not exactly 24 hours is what led to the nomenclature of circadian rhythm (circa – “around” dian – derivative of diam – “day”). That is, one that is approximately one day in length, but not precisely one day.

We now know that, on average, adult humans display an endogenous circadian clock of about 24 hours and 15 minutes in length, 900 seconds longer than the 24-hour rotation of the Earth. And while a number of repeating cues, such as food consumption, exercise and temperature fluctuations, can help to reset our internal clock to 24 hours exactly, daylight is the preferential signal to do this. Sitting in the middle of our brains is the suprachiasmatic nucleus, located where the optic nerves from our eyeballs cross. This very small mass of approximately 20,000 brain cells uses light from the sun to act as the central conductor of our biological processes.

When sleep is measured in a laboratory, electrodes are used to record signals coming from three different areas: brainwave activity, eye movement activity, and muscle activity. These signals are grouped together under the term polysomnography (PSG). Measuring these activities allows the creation of a sleep cycle, also known as a hypnogram. Figure 1 shows the structure of such a sleep cycle, and being familiar with this pattern is crucial to understanding the recommendations for improving the quantity and quality of sleep.

A Sleep Cycle Hypnogram

Figure 1. A Sleep Cycle Hypnogram recreated from Why We Sleep. (1)

In 1952, Eugene Aserinsky, a graduate student working in Professor Kleitman’s laboratory, made the important observation that the eyes would rapidly move from side-to-side during sleep, coinciding with very active brainwaves. (These characteristics were remarkably similar to those of a wide-awake brain.) There would also be periods when the eyes would be still. They named these different stages of sleep non-rapid eye movement (NREM) and rapid eye movement (REM). It was further discovered that these two phases of sleep would repeat in a somewhat consistent pattern.

Along with the help of William Dement, another graduate student, Aserinsky made the observation that REM sleep was associated with dreaming.

Since these early discoveries, NREM sleep has been further divided into four stages, with stages three and four representing the deepest stages of sleep. We cycle through all of these stages multiple times per night, and the time spent in each stage changes with each cycle. For example, the longest time spent in the REM stage occurs in the later cycles of sleep; the full cycle of all stages repeats consistently every 90 minutes.

 

Improving the Quality and Quantity of Sleep to Benefit Your Immune System

We learned earlier that the suprachiasmatic nucleus is the key to re-setting our internal clock. Consequently, it is important that we allow our sleep-wake cycle to get its daily correction by going outside in the morning (without sunglasses!)—preferably between the hours of 7 a.m. and 11 a.m. Try to make this a regular habit: Find an activity you can do outside for at least 45 minutes, if possible.

If you live at a latitude where the winter months are extremely short, and darkness pervades many months of the year, there are products that provide the light with the desired wavelength, such as alarm clocks that mimic the rising sun.

When improving sleep quality, it’s also helpful to understand the sleep cycle. Knowing that each cycle lasts 90 minutes, it stands to reason that sleeping for five cycles (7.5 hours) per night offers the ideal amount of sleep. This equates to 35 cycles per week. Now, to reduce your stress around sleep, consider this: Your goal should be to get 35 cycles per week instead of always getting five cycles per night. It helps that we are quite capable of catching up a few cycles here and there. (Let’s face it, life can easily get in the way of your planned bedtime.) It’s also helpful to realize that some individuals do fine even if they get fewer than 35 cycles, while others will find they do better if they get a few more.

It’s also important to know what the best bedtime is for your needs. To do this, first establish when your body wants to wake up in the morning. This is a personal choice, not a societal demand that forces you into its timetable. So, if you were living on a desert island with no commitments, when would your body want to wake up? This time is usually pretty consistent, even if you do not get to bed at a normal hour.

Our current situation of having to work from home might just be the perfect time for you to try and figure this out. Once you have established your wake-up time, you can establish your bedtime as 7.5 hours prior. So, as an example, if you determine that your body likes to wake up at 6 a.m., then you should try to fall asleep at 10:30 p.m. the previous night. In order to fall asleep, you should get into a bedtime routine that helps you do so—whether it’s taking a hot bath or reading a book, find something that helps. If you must use your computer late at night, purchase a pair of glasses that block blue light waves, which have been shown to disrupt sleep quality.

 

Morning Larks and Night Owls

Some of you may feel that 6 a.m. is ridiculously early and might even struggle to get out of bed before 9 a.m. Herein lies the issue of your genetic chronotype. If 9 a.m. sounds more appealing, you are not a morning lark (as sleep researchers like to call it). Rather, you are a night owl (i.e., one that functions very well long into the night). For too long, night owls have been labeled lazy for struggling to rise early, and society has created a timetable that favors the morning lark. About 40 percent of us are morning larks, 30 percent are night owls, and a further 30 percent are a mix of the two (Figure 2).

Figure 2. Genetic Chronotype Percentages

From an evolutionary perspective, this makes perfect sense, as in primitive times staggering our sleep within a tribe would provide greater security from predators.

But, because society has created a timetable that favors the morning lark, night owls typically get less sleep. As a result, they have higher rates of depression, anxiety, diabetes, cancer, and cardiovascular disease.

Consequently, if you are a night owl and care about your health, you need to find a job with an employer that understands this issue and provides flexible hours. The employer would benefit from increased productivity and you would help your health and longevity. Thankfully, this is now happening. So, for the individual that likes to wake at 9 a.m., your bedtime is 1:30 a.m. Own and embrace it!

 

Catch the Next Cycle

Regardless of your chronotype, and despite the best plans, there are going to be many occasions when you miss your bedtime. If your bedtime is 10:30 p.m. and you miss it, do not rush to get to bed by 11 p.m. (i.e., 30 minutes into your intended first cycle). Instead, you will be better off going to bed at the start time of your intended second cycle (i.e., 90 minutes past your bedtime) at midnight. You will then get four good cycles. Later , if you are able and feel you need it, you can get another full 90-minute cycle as a nap the following day. If 90 minutes is not possible, a 20-30 minute nap can help; avoid a 45-60 minute nap since you will be waking out of the deeper stages of sleep.

And if you have a hard time getting to sleep at the start of one of your cycles (and not just the first cycle, since many people wake following a REM stage when they are close to wakefulness), do not lie there struggling. If you have not fallen asleep after about 15 minutes of trying, get up and keep yourself busy until the start of another cycle. just as in the above example when missing your bedtime.

These approaches will often relieve the pressure and anxiety many feel when sleep becomes a challenge.

 

For more help with your sleep

Obviously, there is a lot more to developing good sleep protocols. However, the above tips are where we’d recommend you start if you are trying to improve the quality and quantity of your sleep.

If you want to go deeper or need greater help, consider the writing of Nick Littlehales, a world-renowned and self-proclaimed “sleep coach” who has worked with the likes of Manchester United FC, Manchester City FC, Liverpool FC, Real Madrid C.F., UK Athletics & British Cycling, and many top corporations to improve the sleep of their athletes and employees. His book “Sleep” (13) is a great resource. He also has a lot of tips you can follow on his Instagram feed @_sportsleepcoach.

You may also consider “Why We Sleep” by Mathew Walker, PhD. (1)

 

References

1. Walker M, Why We Sleep, Unlocking the Power of Sleep and Dreams. Scribner, 2017.
2. Mazzoccoli G, Vinciguerra M, Carbone A, Relógio A. The Circadian Clock, the Immune System, and Viral Infections: The Intricate Relationship Between Biological Time and Host-Virus Interaction. Pathogens. 2020 Jan 27;9(2). pii: E83. doi: 10.3390/pathogens9020083. Review. https://www.mdpi.com/2076-0817/9/2/83/htm
3. Haspel JA, Anafi R, Brown MK, Cermakian N, Depner C, Desplats P, Gelman AE, Haack M, Jelic S, Kim BS, Laposky AD, Lee YC, Mongodin E, Prather AA, Prendergast BJ, Reardon C, Shaw AC, Sengupta S, Szentirmai É, Thakkar M, Walker WE, Solt LA. Perfect timing: circadian rhythms, sleep, and immunity – an NIH workshop summary. JCI Insight. 2020 Jan 16;5(1). pii: 131487. doi: 10.1172/jci.insight.131487. Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7030790/
4. Oikonomou G, Prober DA. Linking immunity and sickness-induced sleep. Science. 2019 Feb 1;363(6426):455-456. doi: 10.1126/science.aaw2113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628894/
5. Barik S. Molecular Interactions between Pathogens and the Circadian Clock. Int J Mol Sci. 2019 Nov 20;20(23). pii: E5824. doi: 10.3390/ijms20235824. Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928883/
6. Ibarra-Coronado EG, Pérez-Torres A, Pantaleón-Martínez AM, Velazquéz-Moctezuma J, Rodriguez-Mata V, Morales-Montor J. Innate immunity modulation in the duodenal mucosa induced by REM sleep deprivation during infection with Trichinella spirallis. Sci Rep. 2017 Apr 4;7:45528. doi: 10.1038/srep45528. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5379483/
7. Irwin MR, Opp MR. Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity. Neuropsychopharmacology. 2017 Jan;42(1):129-155. doi: 10.1038/npp.2016.148. Epub 2016 Aug 11. Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5143488/
8. Almeida CM, Malheiro A. Sleep, immunity and shift workers: A review. Sleep Sci. 2016 Jul-Sep;9(3):164-168. doi: 10.1016/j.slsci.2016.10.007. Epub 2016 Nov 6. Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241621/
9. Opp MR, Krueger JM. Sleep and immunity: A growing field with clinical impact. Brain Behav Immun. 2015 Jul;47:1-3. doi: 10.1016/j.bbi.2015.03.011. Epub 2015 Apr 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685944/
10. Ibarra-Coronado EG, Pantaleón-Martínez AM, Velazquéz-Moctezuma J, Prospéro-García O, Méndez-Díaz M, Pérez-Tapia M, Pavón L, Morales-Montor J. The Bidirectional Relationship between Sleep and Immunity against Infections. J Immunol Res. 2015;2015:678164. doi: 10.1155/2015/678164. Epub 2015 Aug 31. Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568388/
11. Ali T, Choe J, Awab A, Wagener TL, Orr WC. Sleep, immunity and inflammation in gastrointestinal disorders. World J Gastroenterol. 2013 Dec 28;19(48):9231-9. doi: 10.3748/wjg.v19.i48.9231. Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882397/
12. Zielinski MR, Krueger JM. Sleep and innate immunity. Front Biosci (Schol Ed). 2011 Jan 1;3:632-42. Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645929/
13. Littlehales N, Sleep, The Myth of 8 Hours, the Power of Naps . . . and the New Plan to Recharge Your Body and Mind. Da Capo Press, 2016.

 

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Do you look forward to Daylight Savings Time (DST) in the spring as much as I do? I love having that extra hour in the evening to go for a bike ride or just enjoy the daylight.

On the flip side, though, “springing ahead” means we lose an extra hour of sleep in order to gain those nice sunny evening hours.

It might not seem like much, but that hour of lost sleep can really mess with your circadian rhythm. Sometimes it takes people several days to adjust, and with good reason: There’s less light in the morning, making it harder to get up; and that extra sunlight at night, no matter how glorious it is, can prevent us from winding down.

Here’s how to get your body to adjust to DST quickly this year, so you can really enjoy that sunlight tradeoff.

 

How Our Paleo Ancestors Slept

You probably assumed that before there was Netflix and social media feeds keeping us up late at night, our hunter-gatherer Paleo ancestors did a better job of racking up the needed hours of sleep per night.

Interestingly, this might not actually be the case (though of course, they still slept a lot better than we do today). Since we can’t go back in time to see for ourselves, researchers studied the sleep habits of present-day hunter-gatherer societies in Africa and South America to get an idea as to how our Paleo ancestors might have slept. [1]

The study found that many of these tribes only sleep an hour or two more than the average American. However, they get up consistently with the rising sun—something many of us struggle to do naturally. Plus, they clock in an extra hour of sleep in the wintertime, possibly suggesting that we’re hard-wired to turn in early during those darker months.

 

How Modern Americans Sleep

Even though our Paleo ancestors might not have gotten as much shut-eye as we’d hoped, their sleep habits are still a lot healthier than ours.

Our busy lifestyle and constant online connection can be disruptive. Our internal calendar is less driven by the sun, and dictated instead by our need to stay up late to finish work, or to binge-watch our favorite show. Then we close the blinds tightly and sleep as late as we can on weekends.

That schedule may help with productivity (or, let’s be honest, our desire for entertainment) past sunset, but a highly variable sleep schedule can hurt us in the long run.

Add to that the bi-annual time change we have to wrestle with, and our sleep schedule is bound to lead us down a path of poor health.

In fact, one recent study [2] published in Scientific Reports found that irregular sleep can lead to both physical and mental health problems down the road, like cardiovascular disease and depression.

 

How Nutrition Affects Sleep

Believe it or not, the foods you eat can either prime your brain and body for sleep—or deprive you of it.

A recent study [3] on diet and sleep found that eating a diet low in fiber and high in saturated fat and sugar lead to lighter, less restorative sleep.

Our Paleo ancestors ate a much more nutrient-dense diet than humans do today. They gathered fresh, in-season foods that were filled with the fiber, vitamins, and healthy fats needed to support a healthy circadian rhythm.

In other words, those boxes of cereal and other grains, processed foods, and sugar most Americans eat on a daily basis might not support that deep, restful sleep we all crave—not to mention overall health.

 

Five Tricks to Sleep Better After “Springing Ahead”

In addition to cleaning up your diet and maintaining as close to a Paleo Diet as possible (we recommend a very doable 85-percent Paleo lifestyle), here are a few tips and tricks to help you get the most from those extra hours of daylight and enjoy as much restful sleep as you need.

  1. Get outside first thing in the morning. It’s well established that light has a big impact on the brain. Use it to your advantage and get outside first thing in the morning to reset your circadian rhythm.
  2. Limit that coffee. Caffeine can stay in your bloodstream for up to six hours. That’s why it’s important to avoid it in the afternoon. If you really need your morning cup of Joe to get you going, we won’t deny you that.
  3. Turn off electronics early. Ever notice that when you go camping (or even stay somewhere with no television), you get tired a lot sooner? Blue light disrupts melatonin production, keeping you awake longer than your body wants to be. Turn it off early.
  4. Engage in calming activities instead. So, what to do with your dark, pre-bed hours? Instead of watching TV or playing with your phone, try calming activities like journaling, meditating, a hot bath, reading a good novel, or listening to music—anything that will help you wind down, instead of keeping your brain activated.
  5. Prep your bedroom. You want your bedroom to be a calming place in which you look forward to resting your head at night. Ideally, your bedroom should be cool, dark, and not too quiet—consider using fans, dark curtains, or noise machines to achieve maximum sleep quality.

Yes, your modern lifestyle often can feel like an impediment to good sleep, but it doesn’t have to be that way. Sometimes just shifting your habits a bit can make a big difference in your sleep quality.

Rest easy.

 

References

  1. Ellen R. Stothard, Andrew W. McHill, Christopher M. Depner, Monique K. LeBourgeois, John Axelsson, Kenneth P. Wright, Jr. Circadian Entrainment to the Natural Light-Dark Cycle across Seasons and the Weekend. Current Biology 27, 508–513 (2017).
  2. Lunsford-Avery, J.R., Engelhard, M.M., Navar, A.M. et al. Validation of the Sleep Regularity Index in Older Adults and Associations with Cardiometabolic Risk. Sci Rep 8, 14158 (2018). https://doi.org/10.1038/s41598-018-32402-5
  3. St-Onge, M. P., Roberts, A., Shechter, A., & Choudhury, A. R. (2016). Fiber and Saturated Fat Are Associated with Sleep Arousals and Slow Wave Sleep. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 12(1), 19–24. https://doi.org/10.5664/jcsm.5384

 

Restorative Yoga as a Part of a Paleo Lifestyle

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Why is restorative yoga such a perfect complement to a Paleo lifestyle? The reasons are wide-ranging and inspiring:

  • It’s fantastic for joint health
  • It supports good digestion
  • It encourages mindfulness of body and breath
  • It improves the quality of sleep
  • It enhances overall health and wellness – yeah!

In this post we’ll highlight some restorative yoga poses that are especially effective for creating deep and nourishing sleep. They’re great to do after an invigorating day of hiking, biking, when you’ve spent a bit too much time in front of a computer, or any time you want to improve the quality of your sleep.

These positions are drawn largely from the Kaiut Yoga tradition, which specializes in deeply restorative and therapeutic yoga sequences. Doing them in the order they’re presented here is beneficial—though it’s also fine to choose just one or two if you prefer.

Supported Table Pose

For this pose you’ll need a small pillow or folded blanket, and a sturdy desk or table.

Clear off a section of the desk or table and place the pillow or blanket on the edge nearest to your body. Now place your hands, palms facing downward, near the center of the desk/table.

Next, step your feet back and rest your forehead on the pillow/blanket, with your arms extending forward along the desk/table, your spine parallel to the floor, and your hips directly above your feet. Your back should now be an extension of the tabletop (or desktop), with your forehead resting comfortably on the pillow (or folded blanket).

Reach forward through your fingers and at the same time draw your hips in the opposite direction (away from the table). Feel how these two movements together naturally lengthen your spine.

Remain in this position for a couple of minutes, relaxing your head and neck completely while becoming aware of the movement of your breath – how the inhalations and exhalations feel in your body.

Reclined Hands-Behind-Head Pose

For this pose you’ll need to lie down on the floor, facing upward. Hinge your knees so that the soles of your feet are flat on the floor, about hip-width apart.

Now interlace your fingers behind your head (or put them at your side) and allow your elbows to relax toward the floor. Your elbows may release naturally all the way to the floor or they may float a bit above the floor. Either way is fine.

Remaining in this position, gently close your eyes and once again bring your attention to the movement of your breath. Become aware of the sensations in your body, particularly in your upper chest, back, and shoulders.

Remain in the pose for a couple of minutes, then release your hands and gently role to the side.

Legs-Up-the-Wall Pose

The Legs-Up-the-Wall Pose (aka Viparita Karani) offers many benefits on its own or as part of a series. It’s a great one to do any time your legs could use a bit of rest and rejuvenation: You can even do it in the middle of a forest hike, using a tree-trunk instead of a wall. But here we’ll assume you’re indoors and using a wall.

Sit on the floor, close to a wall. Now release your torso downward and swing your legs up onto the wall. Try to have the base of your pelvis 4-6 inches away from the wall, so your legs are at an angle, with just the heels of your feet in contact with the wall.

Place your hands wherever they’re most comfortable – resting near your hips, with your hands on your belly, or with your hands interlace behind your head (as in the previous pose).

Reach up gently through your heals to fully extend your legs. Allow your eyes to gently close and welcome whatever physical sensations you become aware of.

Remain in this pose for three to five minutes or longer if you’d like. To come out of the pose, hinge your knees to slide your feet down the wall and then roll onto your side.

Calming-The-Senses Pose

This pose provides an opportunity to calm and soothe your sensory organs. Though it can be done at any time during the day, it’s especially wonderful right before bed. Here’s how:

Sit cross-legged or lie down on your bed, facing upward. If you wear glasses, take them off.

Rub the palms of your hands together for a few seconds, to generate warmth. Then place your cupped hands over your eyes so that the palms are forming domes over your closed eyes, with the edges of your hands firmly against the skin around the eyes. Remain in this position for one to two minutes, enjoying the relaxation of your eyes and forehead.

Now do the same thing with your ears. Rub the palms of your hands together to generate warmth and then cup your hands over your ears. With your eyes closed and your hands cupping your ears, enjoy the sound of your breath. Remain like this for one to two minutes.

Savasana: Corpse Pose

This final pose in our sequence, called Savasana (aka Corpse Pose), can be done lying down on the floor or – if you’re preparing to go to sleep immediately afterwards – right in your bed. In either case, lie down on your back, facing upward.

Extend your legs fully, and allow your arms to rest near your sides, wherever they’re most comfortable. Take a few deep, slow breaths, saying “ahh” as you relax the muscle of your face, neck and jaw completely. Smile gently as though you just got a joke that someone told you earlier in the day.

Allow your entire body to relax. Feel the weight of your body being supported completely by the bed or floor. Enjoy this support fully. Imagine your body slowly melting like an ice cube melting in a bowl of warm water.

Feel the inhalations and exhalations of your breathing cycle as they move gently into and out of your body.

After five minutes or so, move to your bed (if you’re not already there) and continue to relax and enjoy your breath, until you naturally drift off to sleep. Sweet dreams!

Media’s Botched Coverage of Long Term Weight Loss | The Paleo DietIt sounds like a gimmick, doesn’t it?

Well, it would be if the top five tips focused on pills, powders, and packaged shake mixes that often have some side effects and frequently don’t even offer lasting results.

But what if we take a more natural, soundproof approach to turning our bodies into better fat burners instead?

How do we do this?

By changing what we eat.

Some may be surprised to learn that one of the most effective strategies for getting more efficient at using fat rather than carbohydrate as our fuel is to eat more of the very thing we have been told for years to avoid:  fat.

To clarify, this is not to suggest that we should simply add fat to the diet; rather, to shift the focus away from a high carb method of eating to one garnering more of its calories from an array of natural fat sources.

A study published by the Harvard T.H. Chan’s School of Public Heath showed that “a low-carbohydrate diet may help people lose weight more quickly than a low-fat diet and may help them maintain that weight loss.”  In addition, a low-carb diet was most beneficial for lowering triglycerides – the main fat-carrying particle in the bloodstream – and also delivered the biggest boost in protective HDL cholesterol.” (1)

Trust me, not only will you begin to see the pounds come off slowly and surely, you’ll quite likely begin to enjoy your meals much more, due to how satiating fat is.

Below are my top five tips to help make the shift to eating more fat and begin the transition into being a better fat burner.


1. Up the Water

No, I’m not suggesting you take a mind-over-matter approach to your hunger by drinking water instead.  Rather, simply check in to see it the next time you’re feeling hungry, you’re actually just thirsty.  Thirst can sometimes masquerade as hunger since the same part of your brain is responsible for interpreting hunger and thirst signals (resulting in mixed signals) (2), Before reaching for a snack, it’s worth a quick check by simply having a glass or two of alkaline water to make sure that doesn’t do the trick. How much water should you be taking in? There’s no one-size fits all approach, as there are many factors that would skew one’s need for water, such as age, activity level, gender, supplements, and medications. A safer bet is to simply make sure that your urine is light straw-color.   If you actually are thirsty, that’s a clear sign you’re dehydrated. Thirst indicates you’re already about 2-3% under where you should be.   Bottoms up!


2. Reduce the Carbs- That Includes Fruit

Eating white sugar has no part in a sound approach to weight loss, or a sound approach to health, for that matter, but it’s not just white sugar we need to be concerned about.   Many people eat far more fruit than veggies, no thanks to the categorization of the two together when we get the recommendation to ‘eat fruits and veggies.’ The results is more more sugar and less fiber compared to eating abundant veggies.   Begin to reduce the number of fruits you’re consuming each day.   You may be surprised to see the need to eat as often decreases, due to how much more satisfied you are after eating!


3. Audit your Veggie intake

Let’s be honest; are you really eating enough leafy greens?    Did you know only 1 in 10 Americans eat enough? (3)   With spring in the air, this is the perfect time to head to your local farmer’s market and start to develop a relationship with the vendors of some of the most amazing bounty you’ve likley ever seen.   Tip:  Ask them for ‘how to’s’ in terms of ways to prepare veggies that you’re learning about, perhaps for the first time!


4. Up the Fat

While it does require some thinking outside, the box, adding a variety of healthy fats to the diet is really not all that radical.   Simply use a bit more coconut oil to sauté your veggies and prepare your over-easy whole eggs, or top off the meal with some sliced avocado. Little things like this can do the trick to take what might have been a low calorie and low fat meal from ‘lite’ to ‘luscious’.    Plus, it will be all the more enjoyable and you’re not going to need a snack in two hours.


5. Check your sleep

Not getting enough sleep can spoil even the most prefect eating and exercise regimes.  The Mayo Clinic reported in a study that women who slept less than six hours a night or more than nine hours were more likely to gain 11 pounds (5 kilograms) compared with women who slept seven hours per night. (4)

 

If you’re feeling skeptical about upping the fat and going against what we’ve been told for years, ask yourself one question:  how has the low fat approach been working for you so far?

If you find yourself trying to achieve a different result while following the same approach, why not try something new, rather than banging your head against the wall, trying to figure out why it’s just not working (again)?

References

1. “Low-Carbohydrate Diets.” The Nutrition Source. Harvard’s HT Chan School of Public Health, 12 Apr. 2016. Web. 07 May 2017.
2. Bruso, Jessica. “Difference Between Being Hungry and Thirsty.” LIVESTRONG.COM. Leaf Group, 13 May 2011. Web. 07 May 2017.
3. Thompson, Dennis. “Only 1 in 10 Americans Eats Enough Fruits and Veggies: CDC.” Consumer HealthDay. N.p., 09 July 2015. Web. 07 May 2017.
4. Hensrud, M.D. Donald. “Sleep and Weight Gain: What’s the Connection?” Mayo Clinic. Mayo Foundation for Medical Education and Research, 16 Apr. 2015. Web. 07 May 2017.

 

 

Sleep | The Paleo Diet
As we move into the colder, darker and shorter days of fall and winter it becomes more difficult to maintain your energy levels, productivity and fight off nasty colds and flu. These common complaints become the norm as the seasons change and people are constantly looking for that “magic bullet” supplement or medication to keep them running on all cylinders. Interestingly, a new study on the daily patterns of modern hunter-gatherer tribes across the globe might hold a few clues in how we can keep ourselves healthy, fit and productive through the winter season.

How Much Sleep Did Our Paleo Ancestors Really Get?

There is a romantic notion that our “hunter-gatherer” ancestors rested their heads with the setting sun in the evening, slept blissfully through the night for 8-10 hours and woke up with the rising sun. They certainly didn’t have cellphones, laptops or external light sources to keep them up. Was it partly down to this that they were so fit, strong, and free of chronic degenerative diseases? Not quite.

An interesting new study on modern day hunter-gatherer tribes – the San of southern Africa, the Tsimane in Bolivia, and the Hadza in Tanzania – found they only sleep an average of 5.7-7.1 hours per night.1 This is very surprising because sleep research today suggests most westerners are sleep deprived, averaging about 6.5 hours of sleep per night, which is approximately 1.0-1.5 hours less sleep than our grandparents got two generations ago. Experts believe we should be aiming for 7.5-8.0 hours per night for better health.

This new research suggests there is much more at play than simply the amount of hours of sleep you get (although, I believe this is also important). Let’s take a closer look at some key factors that could help you improve your sleep and upgrade your energy levels this winter and help fight off colds and flu.

The Tribes Go To Bed Earlier in the Winter

As the year comes to an end, most people are busier than ever at work and home as the holidays approach, rather than winding down to recharge their batteries. If we look to our ancestral roots to find answers to the “best” sleep practices, we find the tribes in the aforementioned study went to bed earlier during the darker days of winter/rainy season and later in the summer/dry season. Their average bedtime was just after 9:00 pm in the winter months, compared to 10:45 pm in the summer (still, not exactly “night owls” by today’s modern standard).
A lot people struggle to get bed before midnight (laptops, cellphones and TVs don’t help) and usually don’t get to bed earlier in the colder, darker, winter months. As we approach the darkest days of the year, we should be getting more sleep (not less), but holiday parties, travel, and work commitments usually ramp up at this time of year. This lack of sleep is shown in the research to suppress your immune system function, putting you at significantly increased risk of catching a cold or flu.2

The Tribes Wake Up Consistently With Morning Light

Hitting snooze is a morning ritual for a lot of people, as they struggle to find the energy to get out of bed and start their day. While I am sure we can all agree that sleeping in feels pretty good, is it what your body really needs? The tribal groups in this study woke up at virtually the same time throughout the entire year with the morning sun (not surprising if you’re an avid camper!).

Many of your key hormones are produced on a natural daily pattern or circadian rhythm that new research shows gets disrupted if you constantly change your sleeping and waking time. Disrupted circadian patterns have been shown to leave you more prone to fatigue (sound familiar?), inflammation, and even change the balance of “good” to “bad” bacteria in your gut.3

If you struggle with fatigue, insomnia or frequent colds and flus, aim to have a consistent bedtime and waking time this winter. Go to bed earlier (don’t sleep in longer in the mornings) to help kick your snooze button habit in the morning. If you really struggle to wake up, try some gentle stretching/mobility/yoga on the floor to ease your way into the day. (Not only that, research shows the later you get to bed the greater your likelihood for weight gain.4 If weight loss is also a goal, get ahead of your new year’s resolution by tucking in earlier at night).

The Tribes Are Exposed To Lots of Morning Light

It’s difficult to wake in the morning and get outside during the cold days of winter. Fatigue, lack of time and general desire to stay warm keep you huddled up in your house, car, and office. However, not exposing yourself to natural light may be having a significant negative impact on your health.

Modern hunter-gatherer communities get up daily with the morning sun and engage in the vast majority of their physical labor in the morning hours exposed to natural light. In contrast, most people are indoors all morning throughout the winter – commuting in cars and working in buildings – not getting nearly enough exposure to natural light. Even on a cloudy day, the natural light outside provides a whopping 100,000-lux (a measure of light intensity), compared to only 5,000-lux in your office or home.

New research shows that this light exposure is crucial for circadian hormone production and thus your energy levels, health and resiliency.5 It’s easy to find yourself stuck in your car, office or house all winter. Instead, get outside to grab your morning coffee, walk a few blocks to your next meeting, or go outdoors in the morning for a light run/jog to start your day. You’ll feel much better for it!

Often we’re drawn to the “shiny new toy” or exotic and complex solutions to our problems, however the real lasting solutions are typically always found in how you eat, move and lifestyle factors. While a Paleo diet will go a long way to keeping you energized and fighting off colds and flu this winter (check out my article on how to Paleo boost your immunity this fall), looking at your daily patterns of sleeping and waking from an ancestral perspective will likely help you dramatically upgrade your energy and vitality this winter.

 

References

  1. Yetish G et al. Natural Sleep and Its Seasonal Variations in Three Pre-industrial Societies. Current Biology. Vol 25, Iss. 21, 2 November 2015, Pages 2862–2868.
  2. Prather A et al. Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep Journal. Vol. 38, Issue 09.
  3. Voigt R et al. Circadian disorganization alters intestinal microbiota. Plos One. 2014 May 21;9(5):e97500.
  4. Asarnow L et al. Possible link between bedtime and change in body mass index. Sleep Journal. Vol. 38, Issue 10.
  5. Czeisler C, Klerman E. Circadian and sleep-dependent regulation of hormone release in humans. Recent Prog Horm Res. 1999;54:97-130; discussion 130-2.

Is the 40 Hour Work Week a Thing of the Past? | The Paleo Diet

America is somewhat (in)famous for its “work hard, play hard’ motto,1 whereas Europeans typically work less and relax more.2 As America’s health rapidly declines, many Americans are starting to wake up and realize all those extra hours aren’t really worth it.3, 4, 5 One recent example of this is a Portland-based company Treehouse, who have started a 32 hour work week trend for their employees without slashing their benefits.6 Interestingly, they have found that employees are more productive on this schedule.7 We have to ask: is this feasible for everyone?

Then there is the story of Ultra Romance – a 35 year old man who only works six months out of the year, spending the other six months riding his bicycle around the world, and living off of a mere $10.00 per day.8 While certainly not a mainstream idea, part of me thinks that he just might be on to something. He claims modern life is just too stressful, and often I’m inclined to agree with him. Scientific literature supports his claims, as well.9, 10, 11 Though there are other parts of his story that are even more fringe-like (he’s never owned a car, and he only got a bank account to buy and sell bicycle parts on eBay), at heart he may be more in tune with our Paleo ancestors, than we are.

But believe it or not, capitalism used to be even more demanding on the human psyche, with a 48 hour work week being a thing of the not-too-distant past.12 That clearly seems like too much to expect of human beings. It cannot be good for us to work that much…right? Correct.13 To put it simply, all that constant work is not great for our brain or body.14, 15, 16 And as life outside of the workplace becomes increasingly demanding it is a healthy question to ask: “how much is enough?” One alarming trend that has occurred only over the last 40-50 years is a completely diminished sleep quantity, across the board, for all genders and age groups.17 Not getting enough sleep can have long term negative consequences, on a variety of biomarkers of wellbeing.18, 19

Interestingly, before capitalism, most people did not work very long hours at all.20 Capitalism may have raised income levels, but precious time (the one thing you can never get back) was lost. Was this a good trade? As we reach the apex of technology and with the potential for nearly everything to be automated, we must reexamine our lifestyles.21

If you don’t believe me, believe the data. Never before have we seen such a widespread obesity pandemic.22 Never before has healthcare and diabetes been costing us so much.23 Happiness indexes are highest in the Nordic countries – countries which have vastly different work and leisure habits than we do.24

Hopefully I’ve given you some food for thought. We are undoubtedly in tough times. There is vast economic disparity, great economic instability, rapid advancements in technology, and hyper-stimulation of our senses. But our basic biology has not changed. We are still humans who require relaxation, 8-9 hours of sleep, high quality food, and smart amounts of physical activity. Our Paleo ancestors may have been right all along – and they certainly did not work a 40 hour week.

 

REFERENCES

[1] Available at: //www.stanforddaily.com/2012/04/30/editorial-work-hard-play-hard-not-healthy/. Accessed July 29, 2015.

[2] Okulicz-Kozaryn A (2011) Europeans work to live and Americans live to work (Who is happy to work more: Americans or Europeans?). J Happiness Stud 12:225–243

[3] Roth J, Qiang X, Marbán SL, Redelt H, Lowell BC. The obesity pandemic: where have we been and where are we going?. Obes Res. 2004;12 Suppl 2:88S-101S.

[4] James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obes Res. 2001;9 Suppl 4:228S-233S.

[5] Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804-14.

[6] Available at: //www.usatoday.com/story/tech/2015/07/10/portland-company-32-hour-work-week/29950755/. Accessed July 29, 2015.

[7] Available at: //www.washingtonpost.com/local/at-some-start-ups-fridays-are-so-casual-everyone-can-stay-home/2015/02/06/31e8407e-9d1c-11e4-96cc-e858eba91ced_story.html. Accessed July 29, 2015.

[8] Available at: //www.businessinsider.com/ultraromance-bike-camping-free-spirit-does-not-like-work-2015-7. Accessed July 29, 2015.

[9] Benson H, Allen RL. How much stress is too much?. Harv Bus Rev. 1980;58(5):86-92.

[10] Arnsten AF. Stress signalling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci. 2009;10(6):410-22.

[11] Babazono A, Mino Y, Nagano J, Tsuda T, Araki T. A prospective study on the influences of workplace stress on mental health. J Occup Health. 2005;47(6):490-5.

[12] Available at: //www.nbcnews.com/news/us-news/where-did-40-hour-workweek-come-n192276. Accessed July 29, 2015.

[13] Available at: //www.inc.com/jessica-stillman/why-working-more-than-40-hours-a-week-is-useless.html. Accessed July 29, 2015.

[14] Babazono A, Mino Y, Nagano J, Tsuda T, Araki T. A prospective study on the influences of workplace stress on mental health. J Occup Health. 2005;47(6):490-5.

[15] Sapolsky RM. Why stress is bad for your brain. Science. 1996;273(5276):749-50.

[16] Mcewen BS. Stressed or stressed out: what is the difference?. J Psychiatry Neurosci. 2005;30(5):315-8.

[17] Available at: https://www.advisory.com/daily-briefing/2015/07/10/were-sleeping-less-than-ever. Accessed July 29, 2015.

[18] Greer SM, Goldstein AN, Walker MP. The impact of sleep deprivation on food desire in the human brain. Nat Commun. 2013;4:2259.

[19] Irwin M. Effects of sleep and sleep loss on immunity and cytokines. Brain Behav Immun. 2002;16(5):503-12.

[20] Schor, Juliet. The overworked American : the unexpected decline of leisure. New York, N.Y: Basic Books, 1991.

[21] Available at: //www.wired.com/2015/02/ai-wont-end-world-might-take-job/. Accessed July 29, 2015.

[22] Malecka-tendera E, Mazur A. Childhood obesity: a pandemic of the twenty-first century. Int J Obes (Lond). 2006;30 Suppl 2:S1-3.

[23] Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033-46.

[24] Available at: //www.newyorker.com/magazine/2015/02/16/northern-lights-4. Accessed July 29, 2015.

Easy With That Salt Shaker: The Effect of Dietary Salt On Sleep | The Paleo Diet

INTRODUCTION

Got sleep? Fact is many of us have a problem sleeping. You probably fall into one category, either being unable to sleep, or not getting enough sleep. In actuality, “counting sheep” and staring at the clock may be the favorite pastimes of many adults. Poor sleep quality, and associated sleep disorders like insomnia remain at the foremost of global health issues. For many, a common solution to tiredness entails having a daily fix of caffeine. Yet, the negative effects of caffeine on the heart, as well as the importance of sleep in regulating chemical imbalances within the brain, cannot be overstated.1

Sleep disorders have long-term consequences. They increase the risk of chronic diseases such as cardiovascular conditions and diabetes, resulting in a dismal quality of life. In addition, this leads to a big hole in your wallet and great financial burden to the economy.2 Given the increasing prevalence of reduced sleep quality and its costs, finding hidden factors that affect sleep is required to improve public health. Many are aware of risk factors like alcohol and sugar consumption, but a possible risk factor that normally goes unmentioned may lie in the individual’s dietary salt intake.3

While devoted Paleo followers are conscious of reducing dietary salt, after reading Dr. Loren Cordain’s books, it is important to understand the scientific basis behind this premise. Let’s put together results from past research to connect the dots.

DIETARY SALT AND THE BIG WHAMMY CORTISOL

Research studies have shown possible evidence between high dietary salt consumption and increased levels of the stress hormone cortisol.4 Furthermore, there appeared to be indication of metabolic syndrome. This group of conditions are characterized by risk factors including truncal obesity (where fat deposits around the waist line), low HDL cholesterol levels (which helps eliminate bad cholesterol from the body), hypertension and insulin resistance (which leads to hyperglycemia-high blood sugar)5.

This sounds like a lot, but let us put this in perspective. An individual diagnosed with metabolic syndrome doubles the risk of cardiovascular (heart) disease, while also quintupling the risk of diabetes. This should have set some alarms going off.

What exactly is cortisol, and how does it affect the body physiologically and psychologically? That answer will help you really understand where this is headed. Cortisol is a glucocorticoid hormone made in the adrenal cortex, near your kidneys.6 Aldosterone, which regulates sodium, is also made in the same area. Known as the key stress hormone in the body, the highest levels of cortisol are seen in the early part of the morning. A term coined as the “awakening response.” That feeling when you wake up excited and ready to start the day, yes thanks should go to cortisol. Cortisol helps your body in maintaining homeostasis. It keeps everything “A-okay” during and after exposure to stress.7 Regulation of cortisol takes place via the hypothalamic–pituitary–adrenal (HPA axis).

Cortisol acts on many parts of the body. In your immune system, cortisol exhibits weakening effects, while inhibiting the inflammatory process. It leaves you prone to developing infections.8 Cortisol encourages gluconeogenesis, basically it increases glucose/sugar production within the body.9 Makes sense right? In a stressful situation, your body needs energy.

In the brain, the memory zone, known as the hippocampus, has numerous cortisol receptors. Excess cortisol during stress has been shown to affect the hippocampus, through atrophy or wasting, resulting in severe memory loss.10 Evidence shows that cortisol affects the limbic system in the brain, which is responsible for mood and emotion.11

Cortisol prepares the body for a fight or flight response to stress, which explains the link between cortisol and insomnia. High levels of cortisol have been linked with a dysfunctional HPA axis, which helps regulate the sleep-wake circadian cycle. This affects sleep quality, and decreases slow-wave sleep aka deep sleep, and sleep time.12 Well the problem is that we need deep sleep. This is where human growth hormone is released, and where the body undergoes healing and repairs.13

Some evidence has shown the likelihood that cortisol also inhibits the production and release of melatonin, the sleep hormone, from the pineal gland.14 Adequate melatonin hormone is needed to induce good sleep. Melatonin and cortisol work inversely, think of it like a see-saw. Melatonin levels are naturally higher at night, but high cortisol levels at night leave melatonin unable to regulate this process.15

TIME TO CONNECT THE DOTS

Enough said. You may be thinking cortisol is pretty bad, but what does that have to do with dietary salt and sleep again. Well, it is a simple linear relationship. Dietary salt leads to increased cortisol levels, and these excess levels affect sleep. This means you can deduce dietary salt may affect sleep. Sounds simple right? Well in science, a hypothesis can be proposed, but a study must be carried out to provide answers.

A research study using a sample size of 20 individuals validated this hypothesis.16 In the study, significantly affected sleep quality, decreased deep sleep, resulting in frequent awakenings, alongside increased thirst. Given the small sample size of this study, further work is needed. Another study also confirmed the hypothesis that salt affects sleep.17

Yet another study shows that dietary salt increased the severity of the sleep disorder known as obstructive sleep apnea.18 With this condition, your airway narrows, decreasing oxygen availability, and leaving you with the inability to breathe for periods at a time.19

So now you have some science to back up your knowledge, when asked the real reason behind your decreased salt intake. Also remember that increased salt intake will make you wake up frequently to use the bathroom. As the body tries to get rid of the sodium, water goes out with it, leaving you thirsty and feeling dehydrated. As you place the almost empty salt shaker next to the empty wine glass, remember there is indeed a science behind this supposed madness.

Best wishes,

Obianuju Helen Okoye, M.D, M.B.A, M.S.-Epi

 

REFERENCES

[1] Harvard Medical School Division of Sleep Medicine. (2007, December 18). Under The Brain’s Control. Retrieved May 19, 2015, from //healthysleep.med.harvard.edu/healthy/science/how/neurophysiology

[2]<Grandner, M., Jackson, N., Gerstner, J., & Knutson, K. (2014). Sleep Symptoms Associated with Intake of Specific Dietary Nutrients. J Sleep Res, 23(1), 22–34. Retrieved June 22, 2015, from //www.ncbi.nlm.nih.gov/pmc/articles/PMC3866235/

[3] Ibid.

[4] Baudrand, R., Campino, C., Carvajal, C. A., Olivieri, O., Guidi, G., Faccini, G., . . . Cerda, J. (2014). High sodium intake is associated with increased glucocorticoid production, insulin resistance and metabolic syndrome. Clin Endocrinol, 677–684. doi:10.1111/cen.12225

[5] National Health, Lung and Blood Institute. (2011, November 3). What Is Metabolic Syndrome? Retrieved June 23, 2015, from Metabolic Syndrome: //www.nhlbi.nih.gov/health/health-topics/topics/ms

[6]  Johns Hopkins Medicine. (2015). The Adrenal Glands. Retrieved June 23, 2015, from Health Library: //www.hopkinsmedicine.org/healthlibrary/conditions/endocrinology/adrenal_glands_85,P00399/

[7] Randall, M. (2011, February 3). The Physiology of Stress: Cortisol and the Hypothalamic-Pituitary-Adrenal Axis. Dartmouth Undergraduate Journal of Science. Retrieved June 24, 2015

[8] Ibid.

[9] Ibid.

[10] Ibid.

[11] Kandhalu, P. (2013, November 4). Berkley Scientific Journal, 18(1), 13-16. Retrieved June 22, 2015, from //bsj.berkeley.edu/wp-content/uploads/2013/11/04-FeaturesEffects-of-Cortisol_Preethi-KandhaluKim.pdf

[12] Kandhalu, P. (2013, November 4). Berkley Scientific Journal, 18(1), 13-16. Retrieved June 22, 2015, from //bsj.berkeley.edu/wp-content/uploads/2013/11/04-FeaturesEffects-of-Cortisol_Preethi-KandhaluKim.pdf

[13] National Sleep Foundation. (2006). Sleep-Wake Cycle: Its Physiology and Impact on Health. Washington DC. Retrieved May 15, 2015, from //sleepfoundation.org/sites/default/files/SleepWakeCycle.pdf

[14] Nikaidoa, Y., Aluru, N., McGuire, A., Park, Y., Vijayan, M., & Takemura, A. (2010, Jan). Effect of cortisol on melatonin production by the pineal organ of tilapia, Oreochromis mossambicus. Comp Biochem Physiol A Mol Integr Physiol, 155(1), 84-90. doi:10.1016/j.cbpa.2009.10.006

[15] Roden, M., Koller, M., Pirich, K., Vierhapper, H., & Waldhauser, F. (1993). The circadian melatonin and cortisol secretion pattern in permanent night shift workers. Am J Physiol, 265(1), R261-7. Retrieved June 24, 2015, from //ajpregu.physiology.org/content/265/1/R261

[16] Baudrand, R., Campino, C., Carvajal, C. A., Olivieri, O., Guidi, G., Faccini, G., . . . Cerda, J. (2014). High sodium intake is associated with increased glucocorticoid production, insulin resistance and metabolic syndrome. Clin Endocrinol, 677–684. doi:10.1111/cen.12225

[17] Grandner, M., Jackson, N., Gerstner, J., & Knutson, K. (2014). Sleep Symptoms Associated with Intake of Specific Dietary Nutrients. J Sleep Res, 23(1), 22–34. Retrieved June 22, 2015, from //www.ncbi.nlm.nih.gov/pmc/articles/PMC3866235/

[18] Pimenta, E., Stowasser, M., Gordon, R., Harding, S., Batlouni, M., Zhang, B., . . . Calhoun, D. (2013). Increased dietary sodium is related to severity of obstructive sleep apnea in patients with resistant hypertension and hyperaldosteronism. Chest, 143(4), 978-83. Retrieved June 21, 2015, from 10.1378/chest.12-0802

[19] Pimenta, E., Stowasser, M., Gordon, R., Harding, S., Batlouni, M., Zhang, B., . . . Calhoun, D. (2013). Increased dietary sodium is related to severity of obstructive sleep apnea in patients with resistant hypertension and hyperaldosteronism. Chest, 143(4), 978-83. Retrieved June 21, 2015, from 10.1378/chest.12-0802

 

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