6 Things That Are Keeping You Fat.

K. Aleisha Fetters, U.S. News & World Report
MARCH 30, 2015  11:23 AM

You're filling up on healthy foods, exercising daily and still, the scale isn't budging. It's mind-numbingly frustrating. Luckily, it's also fixable. Here are six common things that could be standing between you and your weight-loss goals – plus easy ways to bust through each.


1. You Aren't Tracking What You Eat

"Most of the time, when someone comes into my office saying they aren't losing weight, the problem is that they are eating a lot more than they think they are," says Holly Herrington, a registered dietitian and clinical nutritionist with the Center for Lifestyle Medicine at Northwestern Medical Faculty Foundation. "Almost every single person underestimates how much they are eating." You can blame oversized restaurant portions, mindless munching and "health halos" for that, she says.

After all, French fries and ice cream aren't the only things that are calorie-packed. So are healthy foods, including olive oil, avocado and nuts. For instance, 1 cup of almonds contains about 750 calories. If you're snacking on them (a great idea), but without measuring and tracking those calories (a bad idea), you could easily end up gaining weight, Herrington says.

She recommends tracking everything you eat, at least for a couple months, with apps like My FitnessPal, which will help you learn proper portion sizes and how your favorite health foods measure up calorie-wise. In one American Journal of Preventive Medicine study, people who kept daily food records lost double the weight of those who didn't track their food intake.

2. You're Not Sleeping Enough

A bad night's sleep can wreck your weight-loss efforts through a two-pronged approach. For one, it makes you hungry and likely to overeat. "When you don't get enough sleep, your levels of cortisol and also ghrelin, a hormone that increases the sensation of hunger, rise," explains board-certified internist Dr. Patricia Salber.

For example, in one University of Chicago study, healthy young men who got just four hours of sleep two nights in a row (compared to their usual seven to nine hours) reported a 24 percent increase in appetite, along with cravings for candy, cookies, chips, bread and pasta. They also experienced an 18 percent decrease in leptin, which promotes fullness, and a 28 percent increase in the hunger-hormone ghrelin.

Second of all, not getting enough sleep could make your body store what you do eat as fat. For instance, a 2011 study in the American Journal of Clinical Nutrition found that just one night's bad sleep caused healthy men's resting energy expenditure – the number of calories they burned by simply being alive – to drop by 5 percent. The number of calories they burned after each meal also dropped by 20 percent.

"Sleep deprivation and sleep apnea may affect blood sugar levels and increase insulin resistance," says endocrinologist Dr. Michael Bergman, clinical professor of medicine at the NYU Langone Medical Center. "Sleep disorders, namely obstructive sleep apnea, [have] been associated with the development of Type 2 diabetes."

If clean-sleep habits – such as keeping your bedtimes consistent and not playing on electric devices in the hour before bed – don't help you get eight solid hours a night, talk to your doctor about how you can sleep better and longer, he says.

3. You're Eating the Same Number of Calories You Did on Day One of Your Diet

Oh, the weight-loss plateau: At the beginning of your diet, you were losing weight and feeling great. But now, you're doing the exact same thing, but with zero results. That might be the problem. "As you lose weight, your caloric needs will change," Herrington says. "The smaller you get, the fewer calories your body needs, so the fewer calories you'll need to eat to continue losing weight."

If your weight-loss results have plateaued for one to two months, she recommends gradually cutting back on calories. Start by eating 100 fewer calories a day and see how the scale shifts in a couple weeks' time. Don't cut back too much, though. Most women shouldn't eat any fewer than 1,200 calories a day and men shouldn't eat any fewer that 1,700 a day. Meanwhile, you should never feel famished or low on energy, she says.

4. You're Constantly Stressed

Acute stress – say from a looming work deadline or relationship drama – can cause your appetite to go MIA. But if the stress keeps up and becomes chronic, too-high levels of the stress hormone cortisol can increase your appetite, particularly for high-carbohydrate foods, according to Salber.

"When stressed, people seek to comfort themselves and relieve the tension," she says. "All too often, that means turning to sugar or starchy foods." High-carb foods can cause a quick spike in blood sugar and feel-good serotonin levels. But both crash quickly, and put you in a vicious cycle of stress and overeating.

Meanwhile, by stimulating the production of insulin, cortisol also increases your body's tendency to store calories as visceral fat. A type of fat that hangs out in the abdominal cavity and likes to hug your vital organs, visceral fat is associated with the development of insulin resistance and, in some cases, diabetes, Salber says.

If you can't remember the last time you weren't stressed, consider visiting your doctor or a therapist to help you manage your stress levels and get healthy. Mental health issues, including stress, are no different than physical health issues, she says. They deserve professional help.

5. You're Using Artificial Sweeteners

Artificial sweeteners, whether you stir them into your coffee, get them from diet sodas or spoon them from your yogurt container, are an easy way to cut calories and sugar in the short term, but they could harm your long-term weight-loss efforts. Case in point: Research from the University of Texas found that over the course of 9.5 years, the average two-a-day diet-soda drinker puts on five times more belly fat than do people who abstain.

That could be because your brain responds to artificial sweeteners by telling you to eat more sweet stuff, according to the Harvard School of Public Health. Meanwhile, they may also throw off the balance of healthy bacteria in the gut, Salber says.

A 2014 study from the Israel-based Weizmann Institute of Science's immunology department found a significant correlation between the consumption of artificial sweeteners, gut bacterial configuration and a tendency to develop glucose intolerance, which contributes to the development of obesity and Type 2 diabetes.

Eliminate any artificial sweeteners in your diet and replace them with sweeteners that also contain vitamins and minerals, such as honey and maple syrup. Just make sure to count their calories.

6. You Have a Medical Condition

While rare, underlying health conditions can make weight-loss difficult to achieve on your own. For instance, Cushing's disease, marked by excess cortisol levels, and polycystic ovary syndrome, a common endocrine disorder in women, can both contribute to glucose disorders, Bergman says.

Meanwhile, hypothyroidism, a condition in which the thyroid gland doesn't produce enough hormones, can also contribute to weight-management issues. About half of thyroid disorder cases in America are undiagnosed, according to the American Association of Clinical Endocrinologists.

If you aren't losing weight, but feel like you are following your body's caloric needs and are exercising between two and five hours a week, Herrington recommends talking to your doctor about your weight-loss concerns. He or she may be able to run some simple tests to make sure a health condition isn't behind your frustrations. If something is amiss, treating it will do more than help you lose weight.

Snooze and lose: Getting more sleep may be the key to weight loss

Registered dietitian Caryn Alter talks to her "Lighten Up Weight Loss" class in Freehold. Alter is one of a growing number of health professionals who agree that sleep deprivation can hinder weight loss. (Noah K. Murray | For NJ Advance Media)

By Susan Bloom | For The Star-Ledger 
on March 05, 2015 at 3:57 PM

Frustrated about that extra weight you've put on or those few pounds you just can't seem to lose? Put down that iPad and plump up your pillow instead -- a growing body of research has shown a strong connection between sleep duration and weight in adults and children, and suggests that a little more sleep might be just what you need to kick your body into natural weight loss or weight management mode.

With the hustle and bustle of 21st century life leading the average American to get up to two hours less sleep per night while tipping the scales at over 20 pounds more than they did 50 years ago, a variety of studies have explored the powerful correlation between sleep and weight. Among their findings, a Mayo Clinic study recently found that women who slept less than six hours or more than nine hours per night were more likely to gain 11 pounds than women who slept seven hours per night, while researchers at the Harvard-affiliated General Hospital for Children determined that, of the 1,000 children they tracked from the age of six months to seven years old, those who were the most sleep-deprived were about 2 1/2 times as likely to be obese as the children who consistently got enough sleep.

The average American requires 7-9 hours of sleep each night to function optimally, according to the National Sleep Foundation in Arlington, Va.

"But an estimated one-third of Americans are sleep-deprived in some way, which is an issue because a lot of important things happen as we sleep, " said Dr. Priyanka Yadav pediatrics and sleep medicine specialist at Robert Wood Johnson University Hospital's Comprehensive Sleep Disorders Center in Hillsborough.

State of Check

In addition to providing the body with critical restorative time and supporting focus, retention, and memory consolidation of what we learned during the day, she said, the process of sleep keeps the body in an important state of check and balance and sleep deprivation can absolutely affect metabolism and appetite.

That's because sleep-deprived individuals have been found to possess both higher levels of ghrelin, a hormone which drives feelings of hunger, as well as lower levels of leptin, a hormone which triggers feelings of fullness and satisfaction after we eat - a dangerous double whammy for weight gain.

"Many patients I treat for sleep issues also have weight management issues - these seem to go hand in hand because sleep deprivation can cause glucose intolerance, hormonal imbalances, and other metabolic conditions, " Yadav said. "In addition, when you're sleep-deprived, the frontal cortex of the brain - which controls our ability to plan, problem-solve, and make decisions and naturally blunts the impulse to eat more fatty, carbohydrate-heavy, and caloric foods - is less active, " she said.

Caryn Alter, a registered dietitian at CentraState Medical Center's Health Awareness Center in Freehold, agrees that sleep-deprived individuals can gain weight because of poor dietary choices they make - consciously or unconsciously.

"Carbohydrates tend to raise the body's levels of the neurotransmitter serotonin, which makes people feel sleepier and calmer, " Alter explained. "So when they're tired or stressed out, people often eat with less self-control and reach for carb-laden foods like ice cream, cookies and potato chips. The hitch is that these 'comfort foods, ' in large portions, can cause weight gain."

Her message for the tens of millions of Americans struggling with weight issues? "It's not necessarily that you don't have willpower or mindfulness, but rather that there may be a chemical event in the brain causing you to feel hungrier because you're simply tired, " she said.

"If you seem to have more of an appetite or find yourself nibbling more, it could be stemming from a physiological cause - too little sleep - rather than a psychological one."

At the "Lighten Up"weight-loss classes that she conducts weekly at CentraState, Alter instructs attendees on nutrition, exercise, and body chemistry but is also quick to advise on the importance of sleep to an overall healthy lifestyle and recommends a few extra hours of sleep each week for those getting less than six hours per night.

When it comes to weight loss, "getting more sleep and/or regulating your sleep pattern, in addition to mindful eating and exercising, may just be the missing link, " said Alter, who noted that it can be difficult to motivate yourself to exercise if you're tired, another factor increasing the likelihood for sleep-deprived individuals to pack on pounds.

Don't go too far

Yadav agreed that for many people, getting more sleep can be an easy way to feel better and start losing weight - to a point.

"Too much sleep causes people to burn fewer calories and is associated with an increased risk of mortality, " she said.

Colts Neck resident and former nurse Kathie Nolte, 64, said she experienced some of the diminishing returns of too much sleep following her retirement two years ago.

"When I was working a 7 a.m.-3 p.m. shift, I was waking up at 5:30 a.m. and going to bed at 9:30 p.m. and I was able to maintain my weight, " she said.

"But after retiring, I found myself going to bed later, reaching for a lot of carbs late at night, and waking up late after sleeping for 10 hours. I didn't have the same energy level as I did when I was working and it made me get down on myself, " she said of the way her new sleep pattern threw off her eating schedule, made her less productive throughout the day, negatively impacted her mood, and ultimately contributed to a 30-pound weight gain.

Sleep and slimming down

Nolte said she is already several pounds down since changing her sleep schedule and joining Alter's "Lighten Up" class in January.

"I feel much better about myself now - more put together and organized," Nolte said. "And I learned that getting good-quality sleep and the right amount is as important to your health as eating a proper diet or exercising."

"Most people know that diet and exercise are important to health, but many forget that sleep is the missing, third component of a healthy life cycle, " agreed Natalie Dautovich, National Sleep Foundation Environmental Scholar.

"Not only is adequate sleep necessary for healthy cognitive functioning, but because sleep is rejuvenating, a good night's sleep can help you slim down and maintain an ideal body weight. This rejuvenation can lead to more enthusiastic and longer workouts, which in turn can also lead to increased weight loss and better quality sleep. Sufficient, high-quality sleep also leads to a greater ability to self-regulate and select healthy food choices, which in turn helps with maintaining a healthy weight, " she said.

"It's great to see more awareness of the importance of sleep to our overall health and to our weight in particular, " said Yadav, who advises people to tap into the body's natural rhythm and enjoy the benefits of even an hour more sleep a night if they've been getting short-changed.

"The body is intuitive and is designed to survive. So we should just let it do what it needs to do and stop getting in the way of ourselves."

Neck-to-waist ratio can help predict pediatric obstructive sleep apnea

Sharon M. O'Brien, MPAS, PA-C
January 19, 2015

Research from Canada demonstrated that a neck-to-waist ratio of >0.41 has sufficient sensitivity and specificity to be considered a predictor of obstructive sleep apnea.

Neck-to-waist ratio can help predict pediatric OSA

Adults are not the only ones who develop sleep apnea. The condition occurs frequently in children as well. The statistics are quite staggering -- up to 66% of obese children are diagnosed with apnea compared with 5.7% of non-obese children. This is another reason to keep children active and help them make better food choices.

Just as with adults, the consequences of sleep apnea can lead to other health issues. In children, learning and behavioral problems can be the first symptoms that suggest there is something happening in their sleep.

In adults, obstructive sleep apnea is the collapse of the pharyngeal tissue which causes obstruction of breathing during sleep. Children often develop sleep apnea because of large tonsils and adenoids. When a child is not sleeping well, ask his or her parents about snoring or if they can hear their child breathing from across the room. These are indications that tonsils and adenoids are hypertrophic.

As a provider, keep a measuring tape in your drawer can be helpful in determining whether your pediatric patient has obstructive sleep apnea. Research from Canada suggests that a neck-to-waist ratio of >0.41 has sufficient sensitivity and specificity to be considered a predictor of obstructive sleep apnea. The neck circumference is measured at the most prominent part of the thyroid cartilage and the waist circumference equidistant between the iliac crest and the lowest rib.

Of course, if you believe a child has obstructive sleep apnea it is important to order a polysomnogram to confirm the diagnosis. As it is often a concern, assure your patient that sleep labs have rooms set up for parents to stay with their child. Treatment may be as simple as removal of tonsils and adenoids, however, some children may need continuous positive airway pressure (CPAP) therapy. 

Children are not able to always put into words what they are feeling physically. As adults, we can say we are tired or fatigued, while children might not be able to do so. Ask parents how the child is interacting with other children or siblings. Are they falling asleep if not active? How are they doing in school? How is their behavior at home?

On your pediatric patient's next visit, remember to measure their neck and waist to see if they might need to a sleep study to assess for obstructive sleep apnea.

How Long You Sleep May Be in Your Genes

By Agata Blaszczak-Boxe, Contributing Writer   |   December 02, 2014 02:09pm ET

The amount of time people spend sleeping is linked with two regions of their DNA, a new studysuggests.

In the study, researchers examined data from more than 47,000 people of European ancestry who were participating in ongoing studies in Europe, the United States and Australia, and nearly 5,000 African-Americans. The researchers compared people's genetic information with how long they reported sleeping on an average night.

The results revealed two regions of DNA that might be related to how long a person usually sleeps.

The first of the two regions was associated with longer-than-average sleeping times, the new study showed. In previous research, this region has also been linked with better glucose metabolism and a lower likelihood of attention deficit hyperactivity disorder. The other region was associated with shorter-than-average sleeping times, and previous studies had linked it with an increased risk of depression and schizophrenia.

"Sleep patterns are influenced by genetic differences," said study author Dr. Daniel Gottlieb, the director of the Sleep Disorders Center at VA Boston Healthcare System. "This study is one of the first to begin identifying these genetic differences, and will hopefully help us better understand the causes of sleep disorders and their relation to other important conditions, such as diabetes and psychiatric disorders." [5 Things You Must Know About Sleep]

Previous research has linked both sleeping too much and sleeping too little with health problems such as obesity, diabetes, hypertension, heart disease, psychiatric illness and even premature mortality, according to the study. For example, in a 2013 study published in the journal PLOS ONE, researchers found that the risk of type 2 diabetes was 30 percent higher in people who slept less than six hours per night, compared with the risk in people who slept seven hours.

In an October 2013 study, researchers at the Centers for DiseaseControl and Prevention found that sleeping either less than six hours or more than 10 hours per night was linked with a great risk of coronary heart disease, stroke, and diabetes and obesity, compared with getting seven to nine hours of sleep a night. And, in a study published in February 2013 in the journal Sleep, researchers found that people who got less than six hours of sleep per night had an increased risk of dying prematurely.

The researchers do not know what underlying mechanisms may explain the observed association between sleep duration and the two genetic regions identified in the new study, Gottlieb said. "This will require more detailed study of these regions of DNA," he said.

However, the researchers speculated that the first gene region identified in the study (the one associated with longer sleep duration) may influence sleep patterns by regulating thyroid hormone levels. The DNA region is located close to a gene called PAX8, which is involved in thyroid development and function. Moreover, people with hypothyroidism — a condition in which the thyroid gland does not produce enough thyroid hormones — are prone to excessive sleepiness, whereas those with hyperthyroidism (in which the thyroid makes too much of the hormone) may have insomnia, the researchers wrote in the study.

However, because the timing and duration of sleep are strongly influenced by environmental factors such as work schedule and other social demands, "large numbers of individuals must be studied in order to separate out genetic influences," Gottlieb said.

The new study was published today (Dec. 2) in the journal Molecular Psychiatry.

The vicious cycle: Sleep loss can lead to diabetes and vice versa

Snoring may just be a sign of worse things to come from sleep deprivation and diabetes. (Tetra Images, Getty Images)

October 23, 2014, 4:28 p.m.
By Leslie Mann, Chicago Tribune

David Lombrozo was never a good sleeper. "Then I started my own company, and it got worse," said the Marietta, Ga., owner of an information-technology management company. "I got to bed later, got up earlier, wasn't eating well. I gained 15 pounds, which made me snore and woke me up even more."

As a result, Type 2 diabetes, which had been lurking in his family genes, caught up with him. Now Lombrozo must give himself a daily insulin injection and test his blood-sugar levels several times a day to keep the disease in check.

Like the 27 million other Americans afflicted with Type 2 diabetes, Lombrozo learned the sleep deprivation and diabetes feed on each other: Diabetes symptoms disturb sleep, while sleep loss contributes to diabetes. Add obesity and stress, and you have a vicious circle.

Formerly known as adult-onset diabetes, Type 2 means having too little insulin (a hormone that helps the body use sugar) and too much glucose (sugar). As Americans' average number of sleep hours has decreased, Type 2 diabetes has become more common.

Seven to nine hours of sleep per night is ideal, according to the American Diabetes Association, but 35 percent of us get less.

Thanks to diabetes complications such as restless-leg syndrome and neuropathy (nerve pain or numbness), many diabetics cannot sleep well, causing their condition to worsen. But the road to diabetes can start from the other direction too, meaning sleep deprivation.

The No. 1 sleep enemy is apnea, a breathing interruption caused by obstructed airways.

"Sleep apnea and diabetes go hand in hand," said Dr. Florence Comite, a New York City endocrinologist. About 36 percent of Type 2 diabetics have sleep apnea, according to the diabetes association.

Adequate sleep allows HGH (human-growth hormone) and IGF-1 (insulin-like growth factor 1) to grow cells and repair tissues."Sleep helps our bodies restore themselves," Comite explained. "Without enough sleep, we can actually bring on diabetes." It's all about hormones, she explained, starting with insulin, the hormone that's in short supply for diabetics.

With enough sleep, the body produces leptin, the hormone that depresses the appetite. Without enough sleep, it produces more ghrelin, which stimulates the appetite.

Sleep deprivation increases cortisol, the "stress hormone" that prevents insulin from getting into the cells ("insulin resistance").

In addition to preventing sleep, apneas reduce the amount of oxygen going to the brain and heart. "The pressure from trying to breathe stretches the heart, which puts out a diuretic," explained Robert Rosenberg, DO, a Prescott Valley, Ariz., sleep specialist . "Men blame their prostates, and women blame menopause, but really it's their sleep apnea that's causing them to have to go to the bathroom at night."

Sleep apnea is more common among people who are male, older, have thick necks or sunken chins, and among those who carry their excess weight at their waists.

Though being overweight elevates sleep apnea risk, even diabetics who are not obese are at risk.

The doctor diagnoses apnea with a home monitor or by sending you to a sleep center for the night.

OSA (obstructive sleep apnea) is the most common form of apnea and causes breathing to stop briefly. With the less common but more dangerous type, CSA (central sleep apnea), breathing stops completely for longer periods. This can be fatal.

The first line of sleep apnea treatment is weight loss. If that doesn't help, the doctor prescribes a mask or nose plugs that feed pressurized air into the airways. If this fails, surgery to unblock obstructions might be an option.

If obesity is not part of the diabetes-sleep equation to start, it often becomes one. A hormone imbalance causes the diabetic to eat the wrong foods and be too tired to exercise. The threat of heart disease causes worry, which makes comfort foods like cookies more enticing.

"No wonder people just give up," said Dr. Charlie Seltzer, a Philadelphia obesity medicine physician who lost 75 pounds by following his own advice: "Figure out how many calories you take in, and eat less."

For Seltzer, having diabetes in his family scared him into a healthier lifestyle, he said. Others can prevent Type 2 diabetes with his multipart prescription of more sleep, more hours at the gym, and healthy foods instead of sugary and salty foods.

Because restaurant meals encourage overeating, Seltzer offers this tip: "Before you go to the restaurant in the evening, look at the menu and calorie count online. Choose your entree before you go so you won't order on impulse. Then you work backward to wear off the calories by evening."

Lombrozo can shrug off stress, which affects sleep and diabetes prevention, even if he gets a late-night call from a client. "I'm one of those people who can turn it off," he said. But others must consciously de-stress to keep their cortisol levels down.

Following are ways to fight the battle:

• Exercise in the morning so your body can wind down before bedtime, advised the doctors. Avoid drinking alcohol, caffeine and big meals in the evening. Go to bed at the same time, even on weekends, but sleep late on weekends if you need to catch up.

• Make your bedroom relaxing, dark and free of electronic devices including computers, TVs, tablets and cellphones. "They emit blue light, which destroys melatonin production," Rosenberg explained.

• If your partner must have a bedroom TV, use an eye mask and earplugs to block light and noise. "Or get a separate room," Rosenberg said.

• Parents know what helps their kids sleep but seldom indulge themselves in the routine, Comite said. "Take a warm bath and talk quietly," she said. "Then wear out a melodic book like 'Goodnight Moon.' "

Sleep Apnea Increases Risk of Atrial Fibrillation After Bypass Surgery

MedicalResearch.com Interview with:
Adrian Baranchuk MD FACC FRCPC
Associate Professor of Medicine
Director, EP Training Program Queen’s University
Kingston, Ontario, Canada



Medical Research: What are the main findings of the study?

Dr. Baranchuk: In this study, we investigated whether obstructive sleep apnea increases the risk of atrial fibrillation after coronary artery bypass surgery. We found the risk to increase by approximately two-fold for patients with obstructive sleep apnea, suggesting that this disease is a strong predictor of atrial fibrillation after coronary artery bypass surgery.

We also found that the risk increases in patients with more severe obstructive sleep apnea.

This is an important association to explore since atrial fibrillation after coronary artery bypass surgery increases patient mortality, the risk of stroke, hospital stay, healthcare costs, and has substantial burden on patients and their families. It is also a common complication of the surgery, occurring in up to half of the patients. Knowing which factors increase its risk gives us a better understanding of how to manage it and mitigate its negative consequences.

Medical Research: What was most surprising about the results?

Dr. Baranchuk: Factors like age, obesity, and many others can influence the risk of atrial fibrillation after coronary artery bypass surgery. Some studies we investigated in our systematic review controlled for these factors, and obstructive sleep apnea became a stronger risk factor when these study results were pooled.

This suggests that obstructive sleep apnea independently predicts which patients are more likely to have atrial fibrillation after coronary artery bypass surgery.

Medical Research: What should clinicians and patients take away from your report?

Dr. Baranchuk: Healthcare specialists of multiple disciplines, including cardiologists, anesthesiologists, and cardiac surgeons should equip themselves with the necessary knowledge and tools to both recognize and optimally manage obstructive sleep apnea. This can include screening patients for obstructive sleep apnea using questionnaires, as well as following up to date guidelines and using the best available evidence to manage it.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Baranchuk: We were not able to identify any studies that investigated the effectiveness of obstructive sleep apnea management strategies on reducing the risk and negative consequences of atrial fibrillation following coronary artery bypass surgery. This is an appealing research topic to explore, since it can inform whether managing obstructive sleep apnea, such as using continuous positive airway pressure, has a positive impact for outcomes in this patient population.

Citation:

Obstructive Sleep Apnea as a Predictor of Post Coronary Artery Bypass Graft Atrial Fibrillation: A Systematic Review and Meta-analysis
Qaddoura, Amro et al.

Canadian Journal of Cardiology

Received: September 23, 2014; Received in revised form: October 10, 2014; Accepted: October 13, 2014; Published Online: October 14, 2014

DOI: http://dx.doi.org/10.1016/j.cjca.2014.10.014

12 Foods That Sabotage Sleep

Notes from Dr. Norman Blumenstock
Remember not to go to sleep on a "full stomach".

It's recommended that you have at least 3 hours after eating before you go to sleep in order to avoid any negative issues.

Sleep Better

The foods you eat for dinner or shortly before bed can prevent you from getting some much-needed zzz's. Here's what to shun for up to several hours before turning in if you want to sleep better and wake rested — from tomatoes and chocolate to cheddar cheese.

Celery

Steer clear of celery just before bed. Celery and other foods with a high water content (cucumbers, watermelon, radishes and such) are natural diuretics that may cause you to wake in the middle of the night with a full bladder.

Tomatoes

Tomatoes are rich in tyramine, an amino acid that triggers the brain to release norepinephrine, a stimulant that boosts brain activity and delays sleep. Other tyramine-rich foods include eggplant, soy sauce, red wine and aged cheeses, such as brie and Stilton.

Cheese Pizza

Foods high in fat and fried foods take longer to digest and can cause discomfort that interferes with sleep. They can also reduce the effectiveness of some medications taken at night, says Alon Avidan, a neurologist and director of UCLA's David Geffen School of Medicine Sleep Disorders Center.

Alcohol

Although a nightcap or a glass of wine before bed may help you doze off quicker, it disrupts sleep later in the night and robs you of rapid eye movement (REM) sleep. Lack of REM sleep harms concentration, memory and motor skills.

Black-bean chili

This dish could be a disaster if you eat it close to bedtime. The body has a hard time digesting beans, so stomach-rumbling gas pains will keep you from a good night's sleep, says Helen Rasmussen, a research nutritionist at Tufts University.

Dark chocolate

A small piece of dark chocolate each day helps keep your heart healthy — but don't nibble it right before you go to bed. Dark chocolate (though not white chocolate), hot cocoa and tea all contain caffeine, and if you're caffeine-sensitive, you may find yourself staring at the ceiling instead of sleeping.

Gumdrops

A handful of gumdrops (or any candy) may cause your blood sugar levels to spike and then fall rapidly as the body releases insulin to bring them under control. You may fall asleep easily, but these fluctuations make it difficult to stay asleep.

Tacos

A taco liberally sprinkled with hot sauce may set your taste buds tingling, but eating it within a few hours of lights-out can set you up for a bad case of heartburn and a restless night. Ditto for other spicy foods.

Steak

Save the leftover slice of steak for lunch tomorrow. Foods high in protein and marbled fats, such as steak and roast beef, are slow to digest. If your body is busy digesting food, there's more of a chance that you'll have a restless night.

Carbonated soft drinks

Caffeine, that sneak thief of sleep, can turn up in unexpected places, including root beer and lemon-lime soda. Added to a food or beverage, caffeine must be listed as an ingredient; if it occurs naturally (coffee, tea, chocolate), it doesn't. Check the label.

Dagwood sandwich

A heavy meal just before bed can rob you of the shut-eye you need. Allow at least three hours post-meal before you turn in so your body has a chance to digest the food and you don't feel too uncomfortable to sleep.

Broccoli

Broccoli is a nutrition powerhouse, but its slow-to-digest fiber will keep your body working hard into the night. Broccoli and its relatives cauliflower and brussels sprouts also contain an indigestible sugar that will produce large amounts of gas.

Notes from Dr. Norman Blumenstock
Dr Oz  understands the importance of of optimal sleep.

Please check out the video.

http://www.doctoroz.com/episode/dr-oz-nationwide-sleep-clinic-sleep-breakthroughs-uncovered

Dealing with snoring helps both partners

Notes from Dr. Norman Blumenstock
"Laugh and the world laughs with you. Snore and you sleep alone"

Unlike high blood pressure or blood sugars, snoring is unique in that it causes problems not just to the person with the issue, but to both partners. As a result, 25 percent of married couples state that they sleep separately because their partners snore. Besides sleeping alone, it can also adversely affect our health. For-tunately, there is a lot that can be done to turn down the noise, improve our relationships and maintain our best health.

Dr. Nina's what you need to know about snoring to improve our sleep, relationships and health:

Why all that noise? A partial obstruction of our breathing passages can cause our respiratory structures to vibrate when we breathe. The vibration results in the harsh sound that we call snoring. To get a better understanding of this, try to create a snoring sound so we can feel the vibration.

What can cause a partial obstruction?

•When we are overweight, extra fatty tissue accumulates not just on our waist and hips, but also along our breathing passages.

•Drinking, smoking and certain medications can cause our airway muscles to relax, making them more likely to vibrate when breathing.

•With age cometh wisdom, narrowing of our throats, and decreased airway muscle tone.

•Nasal deviation and sinus problems can narrow our breathing passages.

•Sleeping flat on our backs can cause our tongue or other fleshy structures to relax and block our airways.

•And some of us are just built with long uvulas (the funny looking dangly thing), large tongues or narrow throats.

Is snoring the same as obstructive sleep apnea (OSA)? No. When we snore, we are breathing but the noise we hear is due to a partial (not total) obstruction; there is movement of air. OSA means that our breathing has stopped temporarily due to complete breathing obstruction and there is no movement of air. This causes us to wake up and is often accompanied by a loud snort or gasping sound. Over time, the repeated sleep interference and drops in oxygen levels can result in a number of ill effects on our health.

What are some ill-effects that can occur from OSA? OSA may be dubbed the "not-so-quiet" culprit of a number of chronic and dangerous health conditions. Studies have shown that it can increase our risk for stroke, heart disease, acid reflux, car accidents and other injuries, mental health issues and weight gain. In other words, we cannot ignore the warning sounds.

What can I do if I snore? Losing weight, quitting smoking and avoiding heavy meals and alcohol at night are some lifestyle changes that can literally put a stop to the noise. For some, sleeping on our sides, performing throat strengthening exercises or "clearing" our nasal passages by humidifying the room or using nasal sprays may do the trick.

When should I see a doctor? When lifestyle changes do not work; we experience daytime drowsiness; or we gasp or choke while sleeping. Our doctors will take a complete history and perform a physical exam. Based on the findings, he or she may order a radiology imaging or sleep study to determine the cause and best treatment. One option is a CPAP (pronounced cee-pap) machine. This device blows pressurized air into a mask that covers our mouth and nose in order to keep our airway open while sleeping. In some cases, a dental appliance may be used to prevent our lower jaw or tongue from blocking airflow. It may be necessary to undergo surgery to remove tissue or correct abnormalities in order to increase the size of our airway.

Although snoring may cause us to sleep alone, we can solve the problem by coming together. I was once told, "Teamwork divides the task but multiplies the success." Dealing with the problem head on will reap rewards to both our relationships and health. So, let's breathe easier and not wait to exhale.

Dr Nina Radcliff, of Galloway Township, is a physician anesthesiologist, television medical contributor and textbook author. Email questions on general medical topics to her at drninaradcliff@aol.com

The Scientific 7-Minute Workout

Exercise science is a fine and intellectually fascinating thing. But sometimes you just want someone to lay out guidelines for how to put the newest fitness research into practice.

An article in the May-June issue of the American College of Sports Medicine’s Health & Fitness Journal does just that. In 12 exercises deploying only body weight, a chair and a wall, it fulfills the latest mandates for high-intensity effort, which essentially combines a long run and a visit to the weight room into about seven minutes of steady discomfort — all of it based on science.

“There’s very good evidence” that high-intensity interval training provides “many of the fitness benefits of prolonged endurance training but in much less time,” says Chris Jordan, the director of exercise physiology at the Human Performance Institute in Orlando, Fla., and co-author of the new article.

Work by scientists at McMaster University in Hamilton, Ontario, and other institutions shows, for instance, that even a few minutes of training at an intensity approaching your maximum capacity produces molecular changes within muscles comparable to those of several hours of running or bike riding.

Interval training, though, requires intervals; the extremely intense activity must be intermingled with brief periods of recovery. In the program outlined by Mr. Jordan and his colleagues, this recovery is provided in part by a 10-second rest between exercises. But even more, he says, it’s accomplished by alternating an exercise that emphasizes the large muscles in the upper body with those in the lower body. During the intermezzo, the unexercised muscles have a moment to, metaphorically, catch their breath, which makes the order of the exercises important.

The exercises should be performed in rapid succession, allowing 30 seconds for each, while, throughout, the intensity hovers at about an 8 on a discomfort scale of 1 to 10, Mr. Jordan says. Those seven minutes should be, in a word, unpleasant. The upside is, after seven minutes, you’re done.

‘Fed Up’ Asks, Are All Calories Equal?

Notes from Dr. Norman Blumenstock

Since obstructive sleep apnea gets worse with weight gain, I thought that this would be an interesting article about dealing with obesity.

By ANAHAD O'CONNOR

 MAY 9, 2014, 8:17 AM

Americans have long been told that the cure for obesity is simple: Eat fewer calories and exercise more.

But a new documentary challenges that notion, making the case that Americans have been misled by the idea that we get fat simply because we consume more calories than we expend. The film explores what it sees as some of the more insidious corporate and political forces behind the rise of childhood obesity, and it examines whether increasing levels of sugar consumption have played an outsized role in the epidemic.

The film, called “Fed Up,” has as executive producers Katie Couric, the former anchor of “The CBS Evening News,” and Laurie David, who was also a producer of the global warming documentary “An Inconvenient Truth.” Ms. Couric, who narrates the film, said she came up with the idea after years of covering the obesity epidemic left her with more questions than answers.

“What struck me was that the more I reported on childhood obesity and the longer I was in this business, the worse the problem seemed to be getting,” Ms. Couric said in an interview. “I felt like we were never really giving people a handle on what was causing this and why the rates were skyrocketing the way they were.”

The film draws on commentary from obesity experts and nutrition scientists, and it tells the stories of several obese children around the country who struggle to lose weight despite strict dieting and in some cases hours of daily exercise. But at the heart of the film is a question that is widely debated among scientists: Are all calories equal?

Dr. David Ludwig, the director of the obesity program at Boston Children’s Hospital, argues in the film that they are not. In recent studies, Dr. Ludwig has shown that high-carbohydrate diets appear to slow metabolic rates compared to diets higher in fat and protein, so that people expend less energy even when consuming the same number of calories. Dr. Ludwig has found that unlike calories from so-called low glycemic foods (like beans, nuts and non-starchy vegetables), those from high glycemic foods (such as sugar, bread and potatoes) spike blood sugar and stimulate hunger and cravings, which can drive people to overeat.

While people can certainly lose weight in the short term by focusing on calories, Dr. Ludwig said, studies show that the majority of people on calorie-restricted diets eventually fail. “The common explanation is that people have difficulty resisting temptation,” he said. “But another possibility is that highly processed foods undermine our metabolism and overwhelm our behavior.”

At Harvard Medical School, Dr. Dariush Mozaffarian, an associate professor of medicine and epidemiology whose research was cited by experts in the film, said that the long-held idea that we get fat solely because we consume more calories than we expend is based on outdated science.

He has studied the effects that different foods have on weight gain and said that it is true that 100 calories of fat, protein and carbohydrates are the same in a thermodynamic sense, in that they release the same amount of energy when exposed to a Bunsen burner in a lab. But in a complex organism like a human being, he said, these foods influence satiety, metabolic rate, brain activity, blood sugar and the hormones that store fat in very different ways.

Studies also show that calories from different foods are not absorbed the same. When people eat high-fiber foods like nuts and some vegetables, for example, only about three-quarters of the calories they contain are absorbed. The rest are excreted from the body unused. So the calories listed on their labels are not what the body is actually getting.

“The implicit suggestion is that there are no bad calories, just bad people eating too much,” Dr. Mozaffarian said. “But the evidence is very clear that not all calories are created equal as far as weight gain and obesity. If you’re focusing on calories, you can easily be misguided.”

Some of the harshest criticism in the film is aimed at a recent food industry initiative – led by companies like Coca-Cola and PepsiCo – to remove calories from their products in an effort to address obesity.

“If somebody is drowning in a swimming pool, you could remove a few gallons of water from the pool, and that person will still likely drown,” Dr. Ludwig said. “Whether there is on average 1,000 calories in the food supply too many per person or 800 is really unlikely to make a meaningful difference. What would make a difference is improvement in the quality of the foods available.”

But Marianne Smith Edge of the International Food Information Council, an industry-financed group that published a review of “Fed Up,” said the film overstates data on how much sugar Americans are consuming and wrongly portrays sugar as a lone dietary villain, much as dietary fat was vilified in decades past. Just as research in the last few years has vindicated some fats and shown them to be beneficial, she said, the science on sugar is evolving as well.

“I think the focus on particular nutrients doesn’t tell you the true story,” she said. “It really is about overall calorie consumption and reduced physical activity.”

Ms. Smith Edge, who is a registered dietitian, cited a 2012 study by Y. Claire Wang of the Mailman School of Public Health at Columbia University, which showed that the average child must eliminate 64 calories a day in order for the childhood obesity rate to fall to 14.6 percent by 2020, a goal set by the federal government.

In an interview, Dr. Wang said that for the most part, “if we’re just talking about body weight and obesity, the evidence seems to point in the direction that calories are calories.”

Dr. Wang said that studies consistently show that sugary beverages, potato chips and other high-glycemic foods are indeed associated with weight gain. But this is because they are rapidly digested and easy to consume in large amounts, “not because they bypass our energy balance.”

Dr. Wang said, however, that reducing calories should not be the sole focus of obesity prevention programs. Studies show, for example, that sugary beverages are linked to an increased risk of diabetes and other chronic diseases, but their impact on body weight explains only half of the increased risk, Dr. Wang said.

“These foods mess up our insulin regulation system and affect other inflammatory pathways,” she said. “And that has nothing to do with how they affect body weight.”

Ms. Couric, who has two children, said that she became involved in making the film “as a mom and a concerned citizen,” and that her goal was to start a national dialogue about the quality of our food supply.

“This film doesn’t purport to have all the answers,” Ms. Couric said. “But this is a wake-up call that I hope will spur some solutions. This is not just about carrying a few extra pounds or looking better in your bathing suit. This is a national epidemic with huge societal ramifications.”