Can you be Healthy at Every Size

This is a blog I have struggled with.

I started writing it the first week of July 2020. I struggle with it because I know people who struggle with Body Acceptance. I Know people who Body shame others. I know people with significant Body Dysmorphia and Eating disorders. 

One of my goals as a Functional Medicine Wellness Coach is to Empower People to Health. So I feel obligated to write this particular article. But also, obligated to be vulnerable with you and caring in what I write. There is a Movement called Health at Every Size, or HAES for short. It wants people to recognize that a person who is Morbidly Obese can be as healthy as a person of “Normal” size. (20-25% body fat in the pictures below).

 

Body Fat Percentages
20-25% is considered healthy for Females, 12-20% for Males

HAES challenges some of the key assumptions of traditional approaches to weight management. These include

  1. that adiposity poses significant morbidity and mortality risk,
  2. that weight loss will prolong life,
  3. that anyone who is determined can lose weight and keep it off through appropriate diet and exercise,
  4. that the pursuit of weight loss is a practical and positive goal,
  5. that the only way for people living with obesity to improve health is to lose weight, and
  6. that obesity-related costs place a large burden on the economic and health system, and this can be corrected by focused attention to obesity treatment and prevention

Principles of HAES:

  1. Intuitive eating
  2. Body acceptance
  3. Movement for health not weight loss or performance

So What does the research say?

HAES says that not every approach works the same on each individual and a 2015 Study in the American Journal of Public Health denounced HAES research stating that While the exact proportion of obese people who are metabolically healthy varies depending on what criteria are used to define both obesity and health, it is smaller than the proportion of obese people who are not metabolically healthy. As it is currently not possible to predict which people will remain metabolically healthy despite excessive weight gain, it may be dangerous to make blanket community statements that people can have health at every size. 

Interpreted: We are unsure who is really healthy and stays that way according to cardiac and lung function, Diabetes as well as Cholesterol levels. This also includes things like Sleep Apnea. 

Study published in the Journal of American Diet Association in 2005  Showed that persons of obese nature improved metabolic fitness in cardio, lipid profiles, social behavior, depression and self esteem. But Intuitive eating not without risks: Food is calorie dense and nutrition deficient, which allows for people who lack satiety gene to over eat, as they don’t feel full, Causes those with sweet tooth gene to eat more sugars which lead to further obesity and then other health concerns. Cost of Nutrient poor versus nutrient rich foods is significantly different and has a significant impact on Socio-economic habits and allowances. Then the environment which someone grows up in with genetic predisposition for obesity or thinness.

Body Acceptance:

On top of all of this, body acceptance is lacking world wide in the female population. The Number of women who berate themselves daily about weight, acne, size of hips or thighs is remarkable. It shows how we look at the world as a society and what society believes is attractive versus what’s healthy is out of balance. There is also research that has been published on the difference, particularly in women, on how providers see and treat women. It showed that if a woman was obese, no matter the reason for her visit, she was more likely to be lectured about weight ad diet. A woman who was put together with good clothing, hair, makeup was less likely to be taken seriously regarding pain. Also, a woman who was dressed in sweats, hair in a bun and no make-up was looked on as drug seeking if there was a complaint of pain. As providers of Healthcare it means that we need to be aware of the bias we come to the table with and try to think of the person in front of us. Try and connect more intimately with the complaint they have in front of us and try and treat equally, regardless of size. 

 

Here is some startling information: If you use the calculator found here:Calculate BMI and HERE: Calculate Body Fat You can get a sense of where you fall according to Normals. I have a BMI of 25.1, putting me at obese. My Body Fat with this crude calculation is 36.5%, placing me also in the obese category. 

Moving for health, Not Fitness

Movement for health is a great tipping point many have difficulty overcoming, Particularly in the Endurance category and Body Building Category. The ability to just go for a walk to walk and enjoy the outdoors is lost on many. The use of E-bikes has improved the number of persons in a specific socioeconomic class enjoying trains throughout the cities in the US recently. The other portion of this coin is Movement sometimes takes an inner motivation that people don’t possess and therefore need a significant amount of goals or push to get the exercise in. 

The Skeletal system:

Whether or not a person with excess weight develops metabolic diseases such as diabetes or cardiovascular disease, sooner or later the mechanical effects of excess weight and the resultant gait abnormalities, combined with systemic inflammation, are likely to take a toll. As one example, adults who are overweight have a 2.2-fold greater chance of developing knee osteoarthritis than those with a BMI under 25 kg/m2, and this increases to a 2.6-fold greater risk for adults with a BMI of 30 kg/m2 or more. Moreover, every increment in BMI contributes to escalating difficulties in performing activities of everyday life, such as walking, getting out of a chair and climbing stairs.

How do we know that inflammation happens overtime with obesity? Studies of adipose tissue show that they have their own homeostasis in relation to Hormone secretion and cytokine production. The Adipose or Fat tissue actually makes its own estrogen and Cytokines. In the current environment with COVID-19 showing a Cytokine storm as the leading cause of Intubation in ventilator use, we know that an Obese person is more likely to suffer this fate. Intubation comes with a host of problems later down the road such as poor lung function. Poor lung function leads to decreased ability for the Cardio-respiratory system to keep up with the body’s needs. 

In addition to this, Cytokines can actually cause destruction of small Blood vessels in the capillary beds.  

After this time, carrying excess weight may become ‘hard wired’ into the parts of the brain that regulate body weight, and it may be almost impossible to make any changes at all. In normal animals, exposure to an energy dense diet that is high in fat, or high in fat and sugar – similar to the default diet of modern societies – initially leads to physiological changes that would tend to counteract weight gain, as recently reviewed

The study by Sainsbury showed that animals originally will stop eating or eat lighter meals when exposed to high sugar and high fat diets in order to regulate body fat. This is done by the hypothalamus supporting release of Leptin. What happened over time though was that the animals became leptin resistant in a period of 9-12 months and then developed higher body fat and lost the ability to feel satiety. They never felt full, so kept over eating. 

Studies in 2006 and 2007 showed that Obese Rats that were continually fed the same diet developed a leptin resistance. In the 2007 study, Rats were able to “reset” Their Leptin resistance and become a healthier weight again with dietary changes. However, the 2006 study showed that the rats actually reached a “Set Point” that was higher than the original point at which the body thought it was healthy. This is why some people say things like “I have to starve myself to get below X and maintain it.” This is where the Genetics come into play. If you are predisposed to weight gain and have a difficult time taking it off, using Lipids circulating in your blood as energy or converting stored fat to energy, you may develop a higher “set point” This is the Definition of epigenetic. The effect the environment, including nutrition, has on the genes you were born with. The really dangerous part of that: IT leads to future generations of obesity due to the fact that the DNA is changed. 

The HAES movement says wait until it is convenient to do something about the weight. Epigenetics says you can not waste that time. By Age 50, it may be too late. If you have a family history of obesity and you want to see positive changes for your future generations, it should start prior to pregnancy and certainly through your lifetime and the child’s lifetime. That does not mean Body Shaming. It means education about healthy choices and responsibility. It will take 3 generations to DAMAGE the DNA and 5 generations to REVERSE the Damage.

 

 

Studies:

Vincent HK, Heywood K, Connelly J, Hurley RW: Obesity and weight loss in the treatment and prevention of osteoarthritis. PM & R. 2012, 4 (5 Suppl): S59-S67.

Blagojevic M, Jinks C, Jeffery A, Jordan KP: Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis and cartilage / OARS. 2010, 18: 24-33. 10.1016/j.joca.2009.08.010.

Enriori PJ, Evans AE, Sinnayah P, Jobst EE, Tonelli-Lemos L, Billes SK, Glavas MM, Grayson BE, Perello M, Nillni EA, Grove KL, Cowley MA: Diet-induced obesity causes severe but reversible leptin resistance in arcuate melanocortin neurons. Cell Metab. 2007, 5: 181-194. 10.1016/j.cmet.2007.02.004.

MacLean PS, Higgins JA, Jackman MR, Johnson GC, Fleming-Elder BK, Wyatt HR, Melanson EL, Hill JO: Peripheral metabolic responses to prolonged weight reduction that promote rapid, efficient regain in obesity-prone rats. Am J Physiol Regul Integr Comp Physiol. 2006, 290: 1577-1588. 10.1152/ajpregu.00810.2005.

Milagro FI, Campion J, Garcia-Diaz DF, Goyenechea E, Paternain L, Martinez JA: High fat diet-induced obesity modifies the methylation pattern of leptin promoter in rats. J Physiol Biochem. 2009, 65: 1-9. 10.1007/BF03165964.

Zhang FF, Morabia A, Carroll J, Gonzalez K, Fulda K, Kaur M, Vishwanatha JK, Santella RM, Cardarelli R: Dietary patterns are associated with levels of global genomic DNA methylation in a cancer-free population. J Nutrition. 2011, 141: 1165-1171. 10.3945/jn.110.134536.

Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J: Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011, 365: 1597-1604. 10.1056/NEJMoa1105816.

Size acceptance and intuitive eating improve health for obese, female chronic dieters.

Bacon L, Stern JS, Van Loan MD, Keim NL, J Am Diet Assoc. 2005 Jun; 105(6):929-3

Am J Public Health. 2015 May; 105(5): e38–e42.

Published online 2015 May. doi: 10.2105/AJPH.2015.302552The Health at Every Size Paradigm and Obesity: Missing Empirical Evidence May Help Push the Reframing Obesity Debate Forward, Tarra L. Penney, BSc, MA and Sara F. L. Kirk, PhD

Velho S, Paccaud F, Waeber G, Vollenweider P, Marques-Vidal P: Metabolically healthy obesity: different prevalences using different criteria. Eur J Clin Nutrition. 2010, 64: 1043-1051. 10.1038/ejcn.2010.114.

Sainsbury A: The Biology of Weight Control. A modern epidemic – expert perspectives on obesity and diabetes. Edited by: Baur L, Twigg S, Magnusson R. 2012, Sydney, Australia: Sydney University Press

 

 

 

 

 

Toxic Load: What is it and How Do I Fix it?

Toxic Load refers to the Accumulation of toxins in the body from ingesting them in the air we breath, food we eat, water or other things we drink and exposure to chemicals from lotions to cleaners. Toxic load is further affected by Genetics. If we have failed or broken Toxic removal pathways, Our ability to tolerate toxins is lower.1

What does that mean for you? Well, A lot of people don’t realize that they are exposing themselves daily and what to do to reverse exposure. If you use pesticides, household cleaners from a brand store and eat non-organic GMO food, you are exposing yourself. You also expose yourself to toxins if you live in an area with high radiation, overhead power lines, poor air quality and Highly dense cities. People who live in the mountains and countryside have fewer daily toxin exposures from city persons, but they may use chemicals in farming or farming equipment that cause a toxin load to increase. =

Toxin Build Up in the body has been linked to cancer, autism, neurocognitive decline and Mental health issues.3 It also leads to chronic autoimmune conditions. Many people can reverse simple disorders with doing a full metabolic detox. The most

common thing to start with is increased water intake. If you have high exposure to toxins in your environment, You should aim to drink 100 oz of water a day. If you are exercising, particularly outside with poor air quality, aim for 120oz per day.

Let's talk about Bathroom habits:

Many people think it is not a problem that they only poop 1-2 times a week, but that lack of excretion causes a lot of toxins to build up in the gut.(4) The gut bacteria then start to grow out of control for the bacteria that make you crave more unhealthy foods and sugary drinks. They can actually tell your brain that you don’t like vegetables. Unbelievable right? Read the book the Gut Brain. It goes in detail about healthy gut bacteria and healthy brain function. There is even some research to suggest that people with poor gut bacteria

are more likely to be overweight than people with good gut bacteria.7

Urine is a great way to get rid of toxins as well. Your kidneys filter out some things that are not processed by the liver and things that are processed by the liver and concentrate the urine to get rid of the un-needed items. They also have the ability to filter out toxins and concentrate them into the urine and push it out. Going Pee, every two hours is a normal amount, which means that you need to drink enough water to get to the bathroom every two hours.

So what if we could help you with Bathroom habits and Detox and get your body supported in a Natural way?

Digestive enzymes are a great way to improve bathroom habits. A lot of people have concerns about probiotics, because they have heard mixed reviews about them. The problem with probiotics is this: Not all are created equal, just like supplements. You want to go with a refrigerated Probiotic in most cases. One that is not stored in Sugar (think yogurt). If you don’t want to go Probiotic route, go with digestive enzymes and Prebiotics. These things help break down food so you can better absorb it. This then makes it so that you can ease bathroom habits.

Another Way to detox is drinking Lemon in the water, particularly in the morning and keeping it warm. Not hot, But warm. Lemon has high levels of limonene in it, which helps the liver detox well. Another way to help with detox is to do a cleanse. That cleanse can be for the Gut, the Liver or the Kidneys, but typically they all go hand in hand. A typical cleanse can go from no less than 10 days up to 90 days. It depends on the toxic load. 10 days can help you clean out, 23 helps you actually detox and form habits, 90 days will restore your health. This is the primary way that you start to reverse damage to the body.

The hardest part about a cleanse is Budget. Whether it is time or money, budget is the most common complaint. Often, I will also hear “I can not eat like that because my family doesn’t like it”. Well, If your family is eating the same as you are right now, what is their toxic load? Are you wanting to start the family out with poor health or great health? 90 days to change the eating habits and health of your ENTIRE FAMILY. Can you imagine the benefits? Less physician visits. Less medications. What does that cost you?

Essential Oils can also help with Detoxification as well. Lemon,

grapefruit, Cinnamon, Peppermint, Anise, fennel, Ginger, Caraway, coriander and Tarragon all help with Digestion motility. Increasing Digestive motility increases the body getting rid of toxins.

So what detox is right for you?

That is subjective, but in general, the goal should be to eat 100 grams of protein, 5 servings of fruit (½ cup each) and 7 servings of vegetables (½ cup each) with most being organic. Also, 100-120oz of water daily. Snacks to a minimum and healthy fat like a ¼ cup of nuts or ½ avocado with salsa.

Message me for more information about regaining your health.

References:
  1. Nutr Today. Author manuscript; available in PMC 2017 Jul 1.
  2. 1) Jones OA, Maguire ML, Griffin JL. Environmental pollution and diabetes: a neglected association. Lancet. 2008 Jan 26;371(9609):287-8./li>
  3. (2) Lang IA, et al. Association of urinary bisphenol A concentration with medical disorders and loratory abnormalities in adults. JAMA. 2008 Sep 17;300(11):1303-10.
  4. (3) Environmental Working Group “Study Finds Industrial Pollution Begins in the Womb” (www.ewg.org/reports/bodyburden2/newsrelease.php)
  5. (4) McCallum, J.D., Ong, S., M Mercer-Jones. (2009) Chronic Constipation in Adults: Clinical Review, British Medical Journal. 338:b831
  6. (5) National Institutes of Health (https://digestive.niddk.nih.gov/ddiseases/pubs/constipation/)
  7. (6) Crinnion, WJ (2011) Sauna as a Valuable Clinical Tool for Cardiovascular, Autoimmune, Toxicant-induced and other Chronic Health Problems, Alternative Medicine Review 16(3): 215-225
  8. (7) Published in final edited form as:Nutr Today. 2016 Jul-Aug; 51(4): 167–174. doi: 10.1097/NT.0000000000000167 The Gut Microbiome and Its Role in Obesity. Cindy D. Davis, Ph.D.

What Role do Genetics Play in Pharmacology?

Ever Had a bad experience with a Prescription?

Ever thought it was an allergic reaction to a medication?

In 2017 I had a significant abdominal surgery that required me to take pain medication, anti-inflammatories, and Antibiotics. The Surgery was supposed to help with a significant abdominal umbilical hernia. It occurred on a Wednesday, and by Monday, I was having a significant reaction to the Pain medication, where my FACE went NUMB. Talk about scary.

Leading up to the surgery, I had taken part in 2 appointments where I discussed previous bad reactions to the pain medication and talked about my concerns. They told me it was a necessary evil in this case so that I could sleep. The Morning of Surgery, After long discussion with the Anesthesiologist, He asked If I had testing done to look at my response to different drugs. At that time, I didn’t even know that was a thing that could be done.

The News media and Medical Media lately has talked a lot about epigenetics, Epigenomics and now, we are starting to hear about pharmacogenetics. Pharmacogenetics can be done through DNA testing to specifically look at your genetics and how they might react to specific types of drugs. They can allow for better dosing, Better drug choice, so there is less guess work, And over all better outcomes. Pharmacogenetics can also help in looking at how some people may become addicted and others not to things like Marijuana, which the Prop 64 group in Colorado would have us believe is not possible.

Pharmacogenetics can also let us know when it might be time to change a drug, because the Epigenetics/Epigenomics, or the Environmental Factors that cause the genes to change, may have been affected over long term use of specific drugs. These drugs can be related to addiction treatment, Pain Management, Mental Health Disorders (Bipolar, Schizophrenia, Depression), Autoimmune Logical Drugs including Chemotherapy.

Along the line of Epigenetics/Epigenomics, there is a specific testing that can be done that supports your DNA sections. IT looks at what will optimally support your health and with that information, we can create a supplement that is SPECIFIC to you. Repeating the test about 6 months after initial testing and consuming of those supplements is recommended due to the changes you could potentially make. Then every year.

 

Why would you need a DNA specific supplement? Colorado has one of the highest levels of radiation exposure in the continental US. Specifically, We have a lot of naturally occurring Uranium and Radon. Both of those are known carcinogens. Also, think about how much and what type of sunscreen you apply every year in Colorado while enjoying the outdoor lifestyle you love. Chemical Barriers are more likely to interact with the radiation from the sun to create mutation of cells. It starts at the Skin level, But Quickly spreads to the body as the skin is an organ that ABSORBS things you put on it.

 

If you have questions about how DNA Testing can improve your health, life and longevity, Don’t Hesitate to reach out!

 

References:

*https://dnalife.academy/dna-health/

*Recent developments in genetic/genomic medicine, Rachel H. Horton and Anneke M. Lucassen, Clin Sci (Lond). 2019 Mar 15; 133(5): 697–708.Published online 2019 Mar 5. Prepublished online 2019 Feb 27. doi: 10.1042/CS20180436

*Pharmacogenomics in the treatment of mood disorders: Strategies and Opportunities for personalized psychiatry; Azmeraw T. Amare,1 Klaus Oliver Schubert,1,2 and Bernhard T. Baune1; EPMA J. 2017 Sep; 8(3): 211–227.Published online 2017 Sep 5. doi: 10.1007/s13167-017-0112-8
*Future Trends in the Pharmacogenomics of Brain Disorders and Dementia: Influence of APOE and CYP2D6 Variants; Ramón Cacabelos,1,2,* Lucía Fernández-Novoa,1,2 Rocío Martínez-Bouza,1,2 Adam McKay,1,2 Juan C. Carril,1,2 Valter Lombardi,1,2 Lola Corzo,1,2 Iván Carrera,1,2 Iván Tellado,1,2 Laura Nebril,1,2 Margarita Alcaraz,1,2 Susana Rodríguez,1,2 Ángela Casas,1,2 Verónica Couceiro,1,2 and Antón Álvarez1,2Pharmaceuticals (Basel). 2010 Oct; 3(10): 3040–3100.Published online 2010 Sep 29. doi: 10.3390/ph3103040
*Some observations on the role of environment and genetics in behaviour of wild and domestic forms of Sus scrofa (European wild boars and domestic pigs)S Robert, J Dancosse, A Dallaire – Applied Animal Behaviour Science, 1987 – Elsevier

Exercise is a Miracle Drug.

“Exercise is a miracle drug. I’m such a believer that it’s the key to health, wellness and longevity that I prescribe it to every patient I see. It’s the most powerful, readily available drug in the world, and it’s free.” Sports Medicine Physician Jordan Metzl expresses his support for physical activity as an intervention to mitigate the effects of almost any adverse health condition.

Many conditions that we as Physical Therapists treat could, if done correctly, be prevented by regular physical activity, as well. If a drug were invented that could do for human health everything that exercise can, people would fight to get their hands on it. It would be the most valuable pharmaceutical ever developed.

There are an unlimited number of benefits behind increased daily movement and PA that have been established in people of all ages, including:

  • Decreases risk of premature death due to coronary heart disease
  • Decreases risk of developing Type II Diabetes
  • Decreases risk of developing hypertension or high blood pressure
  • Reduces blood pressure of those who already have hypertension
  • Decreases risk of developing breast and colon cancer
  • Helps maintain healthy weight
  • Builds and maintains health bones, muscles and joints
  • Decreases number of falls in older adults
  • Reduces mortality rates compared to sedentary populations
  • Reduces arthritis symptoms and delay progression of Osteoarthritis
  • Increases self-esteem, promotes mental health, prevents depressive illness, and possible protective effect from cognitive decline
  • Possible increase in brain cell growth which enhances learning and memory (animal studies)
  • Possible link to increased capacity for learning and academic achievement in students
  • Reduces frequency of tobacco, drug and alcohol use among physically active
  • Reduces direct medical costs among Americans by $76.6 billion (regular moderate exercise)
  • Reduces workplace short-term sick leave by 6-32% and increase productivity by 2-52%

While many are aware of the physical and aesthetic benefits of exercise, not everyone realizes the significant positive impact on mental health. Physical activity has a role in management of severe mental illnesses in its ability to lessen symptoms and also potentially extend the life in these populations.

The European Psychiatric Association (EPA) has issued recommendations for supervised physical activity as a potentially effective intervention for individuals with severe mental illnesses, such as schizophrenia, bipolar disorder and major depression. According to researchers, those with severe mental illnesses face an increased risk of early mortality by as much as 10 to 20 years, with physical disorders accounting for as much as 70% of those early deaths.

In its latest edition of nationwide guidelines for physical activity (PA), the Department of Health and Human Services state “adults should move more and sit less throughout the day.” 80% of all Americans are not meeting current PA recommendations, a failure that is contributing to the prevalence of a host of chronic health conditions. Regular PA reduces your risk for many chronic diseases, including prostate and breast cancers, dementia and brain strokes, and is considered to be as effective as taking medication for many conditions.

The new guidelines emphasize the concept that some amount of PA is better than none in preventing disease and extending life, no matter an individual’s age. The revisions to the PA guidelines are the first in 10 years, and they do not significantly alter the goals for adults. Instead, the new guidelines further reinforce the benefit of PA at any level by removing the statement that activity must occur for at least 10 minutes to be effective. The Department of Health and Human Services recommendations for physical activity vary by age and are as follows:

Children and adolescents (6 to 17 years): 60 minutes or more per day of moderate-to-vigorous PA; with at least 3 days of muscle- and bone-strengthening PA per week

Adults: 150 minutes per week of moderate-intensity PA, or 75 or more minutes per week of high-intensity PA is recommended for adults; at least 2 or more days per week should include muscle-strengthening activities.

Older adults: If possible, 150 minutes per week of moderate-intensity PA, tempered by an individual’s “level of [PA] relative to their fitness,” and a clear understanding of how various chronic conditions can affect the ability to reach PA goals. No matter what PA level is achieved, activities should include balance training, aerobic, and muscle-strengthening activities.

A brisk walk, gardening, housework and cycling count toward the recommended 150 minutes of moderate aerobic exercise a week. If you are struggling to fit a gym routine into your schedule, yet you would like to begin incorporating more movement into your day, you can start with some of the following simple changes:

  1. Organize a walking group with coworkers during lunch or meet friends in the park. Bonus: fresh air and being social without food and drink.
  2. Get off one stop earlier on the bus or subway
  3. Choose one meal a day and walk for 10 minutes after it. Walking after eating regulates blood sugar and helps weight loss.
  4. Walk your dog rather than letting them out in the backyard
  5. Choose a parking spot in the back of the lot, further from the front entrance of your work or store
  6. Walk around the track or field while your kids play sports
  7. Walk to breakfast, lunch or dinner.
  8. Take the stairs instead of the elevator
  9. Drink more water. This will ensure you take breaks often to use the restroom (great tactic for mental clarity) and also keep you hydrated!
  10. Return your missed calls while walking

I am sure you have heard the phrase, “physical activity as medicine” at least once before. After reading through some of the general benefits of increased physical activity and simple ways to fit more movement into your day, one must be convinced.

 

This information is for informational purposes and is not intended to be used in place of seeking individualized care from a healthcare professional.

 

 

References:

Sallis JF, McKenzie TL. Effects of health-related physical education on academic achievement: Project SPARK. Research Quarterly for Exercise and Sport 70(2):391-5.

Physical Activity May Decrease Mortality Risk in Frail Older Adults, Says Researchers. PT in Motion News. October 30, 2018.

European Psychiatrists Recommend Physical Activity in the Treatment of Severe Mental Illness. PT in Motions News. November 9, 2018.

8 Tips to Get a Better Night of Sleep

If you are not sure how to get a good night of rest, look no further. To optimize sleep and wake up feeling refreshed, start by tackling some of the following tips.

1. Exercise!
Experimental evidence has suggested that exercise may be associated with better sleep quality. One study that evaluated exercise in patients with insomnia showed that an acute bout of moderate-intensity aerobic exercise about 3 hours before bed reduce sleep onset latency, total wake time and pre-sleep anxiety, while increasing total sleep time and sleep efficiency.
2. Limit use of artificial light during evening hours.
Blue light influences secretion of melatonin, which is a neurotransmitter that makes us sleepy and regulates our circadian rhythm. Circadian rhythms regulate nearly all of the body’s processes, from metabolism and immunity to energy, sleep, mood and cognitive function. Unfortunately, computer screens, tablets, televisions and cell phones all emit blue light. Many electronic devices have a “night shift” setting that automatically switches your device to a warmer color at a designated time. Set a curfew on the amount of artificial light exposure to get a better night of quality sleep. Also try to avoid checking your phone in the middle of the night if you wake up. As soon as the blue light from a screen hits the retina in the eye, the effect of melatonin is immediately reversed and actually promotes a state of wakefulness over sleep.
3. Avoid caffeine and alcohol 5 hours before bed.
Caffeine is the most popular drug in the world. While it is very beneficial to improve performance in workouts and keep us alert during the day, caffeine does not replace sleep. After consuming caffeine, its effects can occur within 15 minutes and take up to 5 hours to die down. Considering this timeline, caffeine should not be consumed 5+ hours before bed in order to avoid a restless night.

Consuming alcohol close to bedtime can also increase your heart rate and keep you awake. While alcohol is commonly used to aid a person’s ability to fall asleep, it can interfere with quality of sleep. Alcohol blocks REM sleep, which is the most restorative type of sleep. Alcohol consumption also affects the normal production of neurotransmitters and increases tendencies to wake up in the middle of the night.
4. Calm your mind.
Your body and mind need time to wind down and shift into sleep mode before bed. Incorporate a routine, bedtime ritual away from activities that cause excitement, stress or stimulation, will make it easier to fall or remain asleep. Relaxing activities include meditation, a warm bath, reading, foam rolling, stretching or belly breathing. It is best to take work materials, computers and televisions out of the bedroom to strengthen the association between bed and sleep. Checking email or doing work right before bed can also trigger anxious thoughts and make it difficult to fall asleep.

Practicing breathing and meditation exercises before bed can increase parasympathetic response to relax the entire body and decrease your heart rate. Lie down comfortably with one hand on your stomach and your second hand on your chest. Inhale deeply through your nose for a count of 5 while pushing your belly through your hand on your stomach. Then exhale through your mouth for a count of 10 as if you are blowing out candles very slowly while gentle pressing on your stomach to facilitate air exiting. Repeat this 3 to 10 times.

Essential oils have been proven to promote and induce a calmer state of mind and encourage a more balanced central nervous system, which allows us to more effectively prepare for sleep. Essential oils are broken down organic plant molecules that can be very powerful and aromatic. Natural fragrances such as lavender, chamomile, sandalwood, ylang, valerian, bergamot, and cedarwood are often used in the bedroom to infuse the air with calming molecules, relax our systems and encourage deeper breathing.
5. Tailor your sleeping environment.
Evaluate your bedroom to ensure ideal temperature, sound and light. The bedroom should be in the colder temperatures for optimal sleep. Your bedroom should also be free from any noise or extra light that may disturb your sleep. Using blackout curtains, eye shades, ear plugs, white noise machines, fans or other devices may help reduce distractions in the bedroom.
6. Have sex!

Experiencing an orgasm during sex has a sedative effect due to the rush of endorphins and other hormones towards the same part of your brain that regulates arousal and sleep-wake cycle. Endorphins are hormones that can activate the pleasure center in your brain and drop cortisol levels, which relate to stress. Additionally, dopamine and oxytocin are both released during orgasm, which relaxes the mind and eases anxiety.
7. Create a consistent sleep schedule
Going to bed early may seem obvious but also difficult to enact. Many of us are guilty of bedtime procrastination, or delaying going to because we didn’t accomplish everything on our to-do list. Sticking to the same sleep and wake time, during the week and on the weekends, will subconsciously regulate your body’s internal sleep-wake clock and help you fall asleep better at night. Life will inevitably interfere, but try not to sleep in for more than an hour or two, tops, to stay on track.

If you are currently going to bed at 11 pm, don’t decide that tonight you will go to bed by 9 pm, because it likely won’t happen. Your internal clock resets at a rate of about one hour per day. Generally, when making behavioral changes, aim to take small steps towards the bigger end-goal. Set a reminder and aim to go to bed 15-30 minutes earlier tonight.
8. Find a comfortable sleeping position.
There is no single sleeping position that works for every person. With that being said, your sleeping position impacts your sleep quality and general feeling the following day in various ways and is therefore very relevant in this discussion.

Some people are most comfortable sleeping on their stomachs and have no issues, but it does put the neck, spine and shoulders in poor positions for blood flow, muscle imbalances and nerve tension. Regardless of your ideal sleeping position, try to strive towards keeping the body in neutral alignment to avoid kinks and imbalances. This is especially important when it comes to the neck position. Pillows that are too soft or bulky, as in the photos, will lack support for the neck or overstretch the soft tissue and likely lead to shoulder and neck aches. Aim to use a pillow that will keep your neck in line with the rest of your spine.

Sleeping on the back is typically the most recommended position, as it allows the body to rest in a neutral position. If this position is uncomfortable on your back, try putting a small pillow under both your knees. Sleeping on your back has also been shown to minimize the formation of face wrinkles. This position may be uncomfortable for people (or their partners) because it usually causes a person to snore more than other positions.

Side sleeping may prevent snoring completely. If you are most comfortable sleeping on your back, use a rounded pillow to support the natural curve of the neck and a flatter pillow beneath the head. Also, having a pillow under the knees will support the low back. In all sleeping positions, avoid using a pillow that is too high and takes the neck out of neutral alignment, as this leads to pain and stiffness the following day. If sleeping on your side, use a pillow between the knees and arms to keep the front body open and supported, promoting optimal body alignment. Side sleeping is recommended for those with sleep apnea. Sleeping on the left side is advised for those with heartburn and acid reflux.

Sleeping on the stomach is very hard on the cervical spine and the remainder of the system as the neck must be turned to breathe in this position and the rib cage doesn’t expand in the anterior direction as it should.

Finally, If you have an injury on one side of the body, it is not advised to sleep on that side.

It may seem difficult and overwhelming to follow all these recommendations right off the bat. Start by identifying the factors that are most disruptive to your own sleep and then focus on altering particular behaviors to overcome those factors. Happy sleeping!

If you haven’t already read our last post on the importance of sleep, you can find it here

Article written by Dr. Jessica Khani, PT, DPT, CSCS

The information provided is not medical advice and is not intended to be used in place of seeking advice from a professional.

Sources:
“Sleep Duration as Risk Factor for Diabetes Incidence in a Large US Sample.” Sleep Research Society. Sleep. Dec 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276127/.

“Association Between Sleep Disorders, Obesity, and Exercise: A Review.” Nature and Science of Sleep. Dovepress. March 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630986/

“How Much Sleep Do We Really Need?” National Sleep Foundation. 2018.

You should be getting at least 7 hours of sleep. Here’s why.

We all know sleep is important, but it is often under-appreciated. Sleep is a low hanging fruit to make progress in almost any goal, no matter what it may be. By tending to our sleep-related needs, we can maximize our productivity throughout the day, enhance immune system function, balance hormones, improve recovery, and overall cultivate a deeper connection with the world around us with the extra boost of energy.

The National Sleep Foundation recommends that adults ages 18-64 years old should sleep 7-9 hours a night. However, every person has a different load of stress and activity in their life. Therefore, an individual’s workload, amount of exercise, underlying sickness, or other stressors influence the amount of sleep required for adequate rest each night.

Regardless of the individual amount of sleep needed per night, if your body learns to function on low levels of energy over the course of a period of insufficient sleep, there will be less energy to facilitate recovery from daily stressors. While caffeine and other stimulants cannot substitute for sleep, but they do help to counteract some of the effects of sleep deprivation. Additionally, the body excels in managing acute damage or stress by utilizing our fight or flight system to allow us to meet challenges while performing at a high level. While it is beneficial that our bodies can adapt and function at low energy levels, chronic stress without recovery is temporary and will lead to burnout and decreased function of all bodily systems.

Not getting enough sleep, while still allowing us to function in a seemingly normal manner, impairs motor and cognitive functions. A person who is sleep deprived will typically experience reduced ability to concentrate, memory lapses, loss of energy, fatigue, lethargy, difficulty with complex thought, delayed response to stimuli, and emotional instability.

Furthermore, chronic lack of sleep has been associated with many adverse health conditions, including chronic fatigue, diabetes, high blood pressure, heart disease and even musculoskeletal injury. Studies in which subjects underwent short-term sleep deprivation to examine the immediate effects of a lack of sleep were found to have heightened blood pressure, lowered blood glucose levels and increased inflammation. It follows that long-term persistence of these symptoms could lead to more deep-rooted dysfunction. Sleep disturbances are also highly prevalent in chronic pain patients and have been shown to deteriorate the pain condition. It has been hypothesized that descending pain control may be compromised by disturbed sleep.

Sleep is the number one recovery mechanism from stress and it affects the way we look, feel and perform on a regular basis. We tend to think of sleep as a time when the mind and body shut down, but this isn’t the case. During sleep, the body is in an elevated anabolic state, meaning that repair mechanisms are used throughout the body when we are resting. Sleep is an active process during which important processing, restoration and strengthening occur.

One of the essential roles of sleep is to consolidate memories. Our brain takes in unlimited amounts of information throughout the day. While we sleep, experiences, memories and skills are processed and stored from short-term memory to long-term memory in more efficient and permanent brain regions. This results in higher proficiency and better recollection the next day.

In addition to improved memory of past information, sleep also helps us synthesize new ideas. While you are sleeping, pieces of knowledge can be pulled together from different experiences and parts of the brain to create novel concepts.

A recent study found that when subjects slept abundantly throughout the night, cellular waste byproducts that were accumulated in the interstitial space were removed. This clearance of toxins also allows the brain to function optimally the next day.

An internal biological clock, known as the circadian clock, regulates the timing for sleep in humans. The activity of this clock is coordinated by light input during the day, which promotes wakefulness, and melatonin secretion during the night, which makes us sleepy. Most hormone secretion is controlled by the circadian clock or in response to physical events.

Sleep is one the events that modify the timing of secretion of certain hormones. Hormone imbalances that occur as a result of sleep deficiency increase the prevalence of mood swings and anxiety and predispose the body to weight gain.

While we are resting, our body stimulates the parasympathetic nervous system. Lack of sleep stimulates our fight or flight system instead of the parasympathetic system, which has been associated with greater secretion of cortisol, a stress hormone. Elevations of evening cortisol levels in chronic sleep loss are likely to promote the development of insulin resistance, a risk factor for obesity and diabetes. Additionally, the regulation of leptin, a hormone released by the fat cells that signals satiety to the brain and thus suppresses appetite, is markedly dependent on sleep duration. Decreased leptin levels in individuals who lose sleep may lead to feelings of hunger, despite adequate food intake. One study that examined shorter sleep duration found decreased leptin levels to be significantly correlated with increased BMI.

Another hormone that is influenced by sleep is growth hormone. Growth hormone plays a key role in growth, body composition, cell repair and metabolism, with the highest secretion levels occuring at night. It has been hypothesized that nocturnal growth hormone increases are involved in various tissue repair mechanisms throughout the body.

Studies have shown that sleep deprivation also decreases levels of glycogen, which is the body’s principal store of energy used for mental and physical activity. Because the brain does not typically utilize fat for energy, glycogen is the only source of spare energy for brain cells. During the metabolically active wakeful period, glycogen is exhausted. Glycogen supply takes time and reduced activity to restore. Both muscle and liver glycogen levels have been shown to replenish with recovered sleep, providing our brain with the energy to function optimally.

If you are not sure how to get a good night of rest, look no further. To optimize sleep and wake up feeling refreshed, start by tackling some of the following tips in the blog post next week!

Article written by Dr. Jessica Khani, PT, DPT, CSCS

The information provided is not medical advice and is not intended to be used in place of seeking advice from a professional.

Sources:
“Sleep Duration as Risk Factor for Diabetes Incidence in a Large US Sample.” Sleep Research Society. Sleep. Dec 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276127/.

“Association Between Sleep Disorders, Obesity, and Exercise: A Review.” Nature and Science of Sleep. Dovepress. March 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630986/

“How Much Sleep Do We Really Need?” National Sleep Foundation. 2018