I had the pleasure of attending the COAST/UCOP Sleep Symposium last week entitled Sleep, Stress, & Obesity: A Weighty Issue. It was a combined presentation by UCB, UC Davis, and UCSF. There were several interesting points raised about the connection of sleep, stress, and weight, some of which I thought I might share here. 

First off, some general information about sleep deficiency. Sleep deficiency and sleep disorders are associated with weight changes, mood changes including depression, diabetes and pre-diabetic changes, cardiac problems such as hypertension, and cognitive problems that can often look like early dementia. Sleep disorders such as sleep apnea (multiple periods while asleep where breathing stops or the airway becomes very narrow and oxygen levels drop) can cause psychiatric symptoms such as poor sleep, daytime sleepiness, mood changes, depression, fatigue, poor concentration, and memory problems. Up to 10% of men have sleep apnea and most are not diagnosed.  

There were multiple great presentations. Below are two that were of interest to me:

One study looked at how chemical changes normally associated with feeling of hunger, satiety, and sugar cravings were altered with sleep deprivation. They were able to see actual changes in these chemicals with only a few nights of reduced sleep. Studies showed that the sleep deprived individuals would then overeat and prefer sweets and snacks accordingly. 

Another presented on 900 children that had their sleep measured at 6 months, 2 years, and also had their weight and BMI (a measure of body mass index) measured during this time and at age 3. They found that children who slept less than 12 hours over the course of the day were 2 times more likely to be overweight. They also found that children whose “parents were single or divorced or who lived in homes with lower household incomes and lower maternal educational attainment were more likely to sleep less than 12 hours per day.”  They also found that the “combination of low levels of sleep and high levels of television viewing appeared to be synergistic and was associated with markedly higher BMI scores…” Taveras et al “Short sleep duration in infancy and risk of childhood overweight.” Arch Pediatr Adolesc Med 2008. 

So, how do you ensure good sleep? There are a lot of possibilities but consider some of the following:

1. if you snore excessively, your partner notes you hold your breath or stop breathing while asleep, you have a lot of daytime sleepiness despite sleeping, ask your doctor to check you for sleep apnea. Always rule out medical causes of sleep problems. 

2.  Avoid alcohol and caffeine in the evening. Both interfere with normal sleep structure and can disrupt your quality of sleep without you even realizing it. 

3. Reduce your bright light exposure as the night progresses. Your body has an internal thermometer that produces chemicals that help you get sleepy when there is lack of bright light. Staring at a bright computer screen, a bright TV, or having all the lights on in the house before bed impedes this gauge. Start to dim the lights as the evening progresses and avoid bright screens right before bed. 

4. Exercise! Daytime and early evening (but not too late) exercise can help with sleep tremendously. Look for a relaxing yoga evening class in your neighborhood. You’ll go to bed feeling relaxed and refreshed. 

5. Keep a routine. We’re creatures of habit. The more we keep a routine the more our body will know to go to the bed and to wake up at the times we want it to. Eating, exercise, etc are all part of this routine. 

6. Relax. Do some relaxation exercises before bed. Listen to a guided podcast. Do a progressive muscle relaxation. You can find many examples on itunes and the web for free these days. 

7. Sleep disturbances can sometimes be a symptom of depression, anxiety, or other mood conditions. See your doctor if your sleep is not improving or you are worried that there may be something else going on.

Best dreams to you.

This month had the publication in the Annals of Internal Medicine a review or meta-analysis of 237 studies regarding organic vs conventional foods with the purpose to:

"…comprehensively synthesize the published literature on the health, nutritional, and safety characteristics of organic and conventional foods."

The Stanford group looked at two general distinctions:

1) What were the health outcomes of eating organic vs conventional foods to humans. Specifically, they looked at literature that found medical complications associated with organic vs conventional foods, pesticides found in fluid components (urine etc), and markers of improved health such as immune or antioxidant markers. 

2) The second group, and which constituted 223 of the 237 studies, looked at the vitamin and nutrient values of the foods, residual pesticide contamination, bacterial contamination, and antibiotic resistance in meats. 

The findings were fairly underwhelming for me but seem to have caused controversies in the news media questioning why we should eat organics based on this study.

Here are a few thoughts about “news.” Check your sources and check their sources and best yet, go to the source. With just a bit of thoughtfulness, you can read journal articles and start to understand why each article must always be held in some suspicion. 

What were the results?

1. There were no clear improvements in some health outcomes (eczema, allergies etc)

2. Urine pesticides in children were lower in organic group

3. There was no vitamin difference between the groups.

4. The only nutrient differences were in phosphorous and phenols.

5. Possible higher levels of omegas in some organic foods though this often depended on the brand. 

6. Organic foods had a 30% lower risk of being contaminated with pesticide residues.

7. No meat bacterial contamination differences were noted (though a few studies pointed towards organics having higher rates on bacteria). None were dangerous.

8. Antibiotic resistance was 33% higher in conventional meat. 

A few things about this study:

The study admits most of the original data they looked at had “fair” quality only. Meaning the original research lacked important information. The one I noticed most was a lack of description of the organic methods used to grow the food. For both health and nutritional values, about 50% of studies did not clarify what organic methods were used. We know that “organic” varies a lot from farm to farm and country to country. Secondly, about 50% of the studies were from experimental farms - not real world comparisons, meaning they might or might not be true in the real world. Third, USDA has often identified dozens of pesticides on foods, the study here only reported on a handful and measurement and sampling methods (ie how the pesticides were measured and recorded) were not reported. 

To me, however, the question I’m left with is not whether the apple grown on a regular farm is more nutritional than the apple that is organically grown - it never really was. My question is what does it mean to be exposed to pesticides? The study did not address this question and therefore the study didn’t help me understand my risks or benefits of eating organic vs conventional foods. How do I weigh the costs, the lack of information, my ethics, my concerns about health, lobby interests etc? I use common sense and do my best. If I can peel it, then get it conventional, if it’s not horribly more expensive and has a thin peel or none at all, invest in organic. 

In the end, I come back to the EWG listing of the Dirty Dozen and Clean 15 - a yearly listing based on USDA research of what level of pesticides are left on food when cleaned thoroughly. Find the full list here:http://www.ewg.org/foodnews/

Welcome to my website. I will use this journal in the future to post my thoughts on integrative psychiatry, links to articles I find useful, and other resources that may be helpful to my patients.

I wish you well-being of body, mind, and spirit.

Norana