Scientists Search for the Best Sleepers

Working to unravel the secrets of sleep, gene by gene.

Less than 1% of Americans need less than six hours of sleep. Researchers are trying to unlock the secrets of the early-to-bed, early-to-rise sleeper. WSJ health reporter Sumathi Reddy discusses on Lunch Break with Tanya Rivero. Photo: Getty

In a lab at the University of California, San Francisco, a husband-and-wife team is working to unravel the secrets of sleep, gene by gene.

Louis Ptáček is studying why some people are genetically wired to be morning larks—an estimated 3% of the population who go to bed unusually early and rise early—while others are night owls.

His wife, Ying-Hui Fu, is researching another phenomenon: why some people require unusually short amounts of sleep, a group that is estimated to be less than 1% of the population. These hardy few, called short-sleepers, can biologically get by with less than six hours of sleep a night and feel fully refreshed.

Dr. Ptáček hopes soon to begin testing for drugs that could alter the body's circadian rhythms—the internal clocks that influence virtually all our biological workings, from sleeping and eating to cardiovascular function. Such a drug might be useful to treat jet lag, for instance, or to enhance the curative powers of cancer treatments.

And Dr. Fu's goal is to someday develop a drug therapy that can reduce how much sleep we need. "The natural, short-sleeper—these people are very optimistic, very energetic, they are go-getters," said Dr. Fu, "If we can identify the pathways that can regulate our sleep duration then maybe someday we can come up with something better than caffeine."Drs. Fu and Ptáček, both in their 50s, are neurology professors at UCSF and share a lab there. Dr. Fu was trained in molecular biology and human genetics and worked in the biochemical industry before turning to academia. Dr. Ptáček is a neurologist who became interested in human genetics and molecular neuroscience. The couple met at an American Society of Human Genetics conference.

Their interest in circadian rhythm came about by chance in 1996 when the two were professors at the University of Utah. A 69-year-old woman came to the sleep clinic complaining that she had to go to sleep very early at night and woke up very early. The woman and her family are still subjects of the research, as are about 100 other families who fall into the lark group of sleepers.

In the process of studying early risers, Drs. Fu and Ptáček stumbled into the phenomenon of the short-sleeper, which spurred a separate research project.

The researchers enlist subjects for the studies nationwide. The participants submit a questionnaire and send in a blood sample or sometimes a saliva swab.

Lab technicians extract DNA from the samples and sequence the participants' entire genome to look for genetic mutations. It is time-consuming, needle-in-a-haystack kind of work. The researchers also conduct animal studies to test their work.

"These families are an important way to learn about the genetics of sleep and of clock function in humans. Understanding that is going to help understand the implications of sleep deprivation on our health," said Dr. Ptáček.

Our internal circadian clocks are located in every cell in our body. They are controlled by a part of the brain called the suprachiasmatic nucleus, which ensures that every cell is in sync with the others.

All our biological functions oscillate daily with our circadian rhythm.Studies have shown that disrupting the body's clocks, by working night shifts, for instance, can increase risk for developing chronic diseases such as cancer, obesity and metabolic syndrome.

Light helps our roughly 24-hour internal clocks reset themselves every day, as do our genes. Researchers are trying to identify the specific genes, as well as learn more about how the clock ticking in our brain coordinates the daily oscillation of all our physiological processes.

Dr. Fu is studying the genetics of a database that currently includes more than 50 families of short-sleepers. Many in the group seem to share characteristics in addition to sleep patterns, the research team has observed. They are generally optimistic and appear to have a high pain threshold, Dr. Fu says. One participant doesn't need Novocaine for dental work. Another said she had little pain during childbirth even without a painkiller.There are many genes involved in regulating sleep. So far Dr. Fu has discovered one mutation common to short sleepers in the gene Dec2, and is zeroing in on two more mutations in other genes.

She says the next step is to determine what pathways each of the three genes they've identified are involved in and if they intersect. She says any effort to begin developing a drug that mimics short-sleepers' behavior is at least 10 years in the future.So-called morning larks, the focus of Dr. Ptáček's research, generally sleep on average seven to eight hours, like a normal adult. But larks' chronotype, or preferred sleep pattern, is earlier than others. (Those who prefer a later-than-normal sleep time are often called owls. Most people fall somewhere between the two types.)

Dr. Ptáček focuses on the most extreme larks—those that tend to fall asleep at 8:30 p.m. and wake up before 5:30 a.m. His research team has found multiple gene mutations in their group of larks, including in the gene Per2, which plays a central role in regulating circadian rhythms.

The group has already identified a possible therapeutic target—a protein that regulates the Per2 gene—and is currently preparing a lab screening to test the effect of various drugs.Dr. Ptáček says a drug that manipulates people's circadian rhythms could be used to help jet-lagged travelers and night-shift workers stay more alert. He says a more important use would be to enhance the effects of existing treatments for diseases, such as chemotherapy for cancer.

Because of people's circadian rhythms, there is usually an optimal time of day when chemotherapy will be more effective. But scheduling cancer treatment usually doesn't take this into consideration. With a circadian-rhythm drug, cancer patients would be able to adjust their body clock when they get chemotherapy so their body gets the optimal benefit from it, Dr. Ptáček says.

"Being able to shift the clock, I think, will have profound implications for many different things, from night-shift work to driving at night to conducting chemotherapy," he said.

Unmasking Sleep Apnea Treatments: What to Try If CPAP Doesn't Work for You

Notes from Dr. Norman Blumenstock
Looking for a CPAP alternative?

Posted: 05/15/2014 5:36 pm EDT Updated: 05/15/2014 5:59 pm EDT

Your piercing, chainsaw snore may be a favorite family joke -- but it should also be a figurative wake-up call.

Habitual, loud snoring is a key symptom of sleep apnea, a disease that affects 12-18 million Americans and increases the risk of health problems including heart disease, stroke, high blood pressure, erectile dysfunction and depression.

You've likely heard of the "gold standard" for sleep apnea treatment, a machine with a running motor, tubing and a face mask called a continuous positive airway pressure (CPAP) machine. However, for many sleep apnea sufferers, relief lies far from the mask in an effective alternative treatment called oral appliance therapy.

Oral appliance therapy uses a "mouth-guard" like device worn only during sleep to hold your jaw forward and open your airway. Pioneered by dentists, oral appliance therapy began its surge into sleep apnea treatment plans in the early 1990s. Now, more than 20 years later, a growing mass of research is proving that oral appliances are an effective alternative to CPAP in treating many people with sleep apnea, and that patients are more likely to use oral appliances, even seven days a week, to get a good night's rest.

What does oral appliance therapy offer the sleepless snorer?

• Comfort -- Sleeping with a CPAP machine can prove difficult. According to the AADSM, up to 50 percent of sleep apnea patients do not comply with or tolerate CPAP. Oral appliance therapy can help unmask sleep apnea. Patients like oral appliances because they are comfortable and easy to wear. They are also a more discreet treatment for those who want to change positions during sleep or snuggle their bed partner.

• Quiet -- On average, the bed partner of a snorer loses at least an hour of sleep per night, according to a study published by Mayo Clinic Proceedings. A CPAP machine may silence the snoring, but its constantly running motor might not help the bed partner sleep more soundly. Oral appliance therapy is a quieter option that can minimize the symptoms of sleep apnea, such as loud snoring, without making a peep of its own.

• Low-maintenance -- An oral appliance is easy to care for and easy to travel with. Most appliances only need to be cleaned with a toothbrush and mild soap, and all can fit discretely into a purse or briefcase.

• Effective Treatment -- Oral appliance therapy works and leaves patients healthier, rejuvenated and well rested. More than 80 oral appliances have received FDA clearance and, for those with a sleep apnea diagnosis, appliances are often covered by medical insurance plans.

If you've been diagnosed with obstructive sleep apnea by a board-certified sleep physician and CPAP is not working for you, a custom-fitted oral appliance can be your key to better sleep and better health. Visit www.localsleepdentist.com to find a dentist in your area who offers oral appliance therapy.

Why Being Sleep Deprived Is NOT a Sign of Productivity

Notes from Dr. Norman Blumenstock
Obstructive sleep apnea (OSA) is a form of sleep deprivation. Please read about the neurological affects of OSA.

May 29, 2014   By Dr. Mercola

Sleep deprivation is a serious health concern that many simply choose to ignore. The price for doing so can be steep. Research tells us that lack of sleep can contribute to everything from diabetes, obesity, and heart disease to physical aches and pains and irreversible brain damage.

In one recent animal study,1 sleep deprived mice lost 25 percent of the neurons located in their locus coeruleus, a nucleus in the brainstem associated with wakefulness and cognitive processes. The research also showed that "catching up" on sleep on the weekend will not prevent this damage.

Other research published in the journal Neurobiology of Aging2 suggests that people with chronic sleep problems may develop Alzheimer's disease sooner than those who sleep well.

If you're cutting down on sleep in order to get ahead in your career while juggling a household and your kids' jam-packed schedules, such findings should give you pause. As noted in a recent article in The Atlantic:3

"For some, sleep loss is a badge of honor, a sign that they don't require the eight-hour biological reset that the rest of us softies do. Others feel that keeping up with peers requires sacrifice at the personal level—and at least in the short-term, sleep is an invisible sacrifice."
The Cult of Manly Wakefulness

According to the 2013 International Bedroom Poll by the National Sleep Foundation,4 25 percent of Americans report having to cut down on sleep due to long workdays.

On average, Americans get only 6.5 hours of sleep on weeknights, but report needing 7.25 hours in order to function optimally. Canadians fare slightly better in this regard. On average, Canadians get just over seven hours of sleep per night, which brings them closer to the amount needed to function at their best.

Another recent survey5 of the sleeping habits of Britons revealed that nearly six out of 10 people get less than seven hours of sleep per night. This is a surprisingly dramatic rise from 2013 data, which showed that a little less than four out of 10 people slept less than seven hours nightly.

Modern man's penchant for equating sleep with unproductiveness (if not outright laziness) can be traced back to the heyday of Thomas Edison, who was known for working at all hours and shunning sleep. As noted in the featured article:6

"As Derickson writes in his book Dangerously Sleepy: Overworked Americans and the Cult of Manly Wakefulness, 'Edison spent considerable amounts of his own and his staff's energy on in publicizing the idea that success depended in no small part in staying awake to stay ahead of the technological and economic competition.'

No one, Derickson argues, 'did more to frame the issue as a simple choice between productive work and unproductive rest…' Over time, children's books and magazines began to promote this type of Edisonian asceticism... Edison encouraged all Americans to follow his lead, claiming that sleeping eight hours a night was a waste and even harmful. 'There is really no reason why men should go to bed at all,' he said in 1914."

Today, science has established just how dangerously incorrect Edison's belief was. Sleep is actually imperative for physical and mental health,7 and as detailed in T.S. Wiley's book, Lights Out: Sleep, Sugar, and Survival, Americans are quite literally sick from being tired.

This culture of sleep deprivation started with the invention of the light bulb, and has only gotten worse with the proliferation of light-emitting electronics.

While some do sacrifice sleep on purpose, others have simply fallen victim to the modern lifestyle, which sets you up for daytime light deficiency, followed by too much light exposure at night. This disrupts your natural waking-sleeping cycle, and can easily lead to disrupted sleep at night and impaired wakefulness during the following day.
Acting Against Your Body Clock Can Lead to Serious Health Problems

According to sleep researchers,8 people now get one to two hours less sleep each night, on average, compared to 60 years ago. A primary reason for this is the proliferation of electronics, which also allows us to work (and play) later than ever before.

The blue light emitted from electronics such as TVs and computers suppresses your melatonin production, thereby preventing you from feeling sleepy. What you may not realize is that even if you don't feel sleepy, you need sleep. You've simply artificially disrupted your body clock; you have not in any way altered your body's biological needs. As noted by Oxford University Professor Russell Foster:9

"We are the supremely arrogant species; we feel we can abandon four billion years of evolution and ignore the fact that we have evolved under a light-dark cycle. And long-term, acting against the clock can lead to serious health problems."

For example, research shows that sleeping less than six hours per night more than triples your risk of high blood pressure, and women who get less than four hours of shut-eye per night double their chances of dying from heart disease.10The following infographic, created by BigBrandBeds.co.uk, illustrates how your electronic gadgets wreak havoc on your sleep when used before bedtime.11

Source : www.bigbrandbeds.co.uk/blog/268/how-technology-affects-sleep

Your Body Is Programmed to Rise with the Sun, and Sleep When It's Dark

Maintaining a natural rhythm of exposure to sunlight during the day and darkness at night is one crucial foundational component of sleeping well. This was addressed in an interview with Dan Pardi, a researcher who works with the Behavioral Sciences Department at Stanford University and the Departments of Neurology and Endocrinology at Leiden University in the Netherlands.

The reason why light exposure during the daytime is so important is because it serves as the major synchronizer of your master body clock. This master clock is a group of cells in your brain called the suprachiasmatic nuclei (SCN). As a group, these nuclei synchronize to the light-dark cycle of your environment when light enters your eye. You also have other biological clocks throughout your body, and those clocks subsequently synchronize to your master clock.

To maintain healthy master clock timing, aim to adjust your light exposure to a more natural light rhythm, where you get bright light exposure during the day and limited blue light and bright light exposure once the sun sets. Pardi recommends getting at least 30-60 minutes of outdoor light exposure during daylight hours, in order to "anchor" your master clock rhythm. The ideal time to go outdoors is right around solar noon but any time during daylight hours is useful.

Once sun has set, the converse applies. Now, you want to avoid light as much as possible, in order for your body to secrete melatonin, which helps you feel sleepy. As mentioned earlier, modern technologies such as TVs and computer screens (including smartphones) emit blue light that your brain mistakes for sunlight. This is why electronic gadgets must be avoided at least an hour or so before bedtime, to allow your body to ready itself for sleep.

Other Helpful Tips to Improve Your Sleep

Besides maintaining a natural circadian rhythm, there are a number of additional ways to help improve your sleep if you're still having trouble. Below are half a dozen of my top guidelines for promoting good sleep. For a comprehensive sleep guide, please see my article "33 Secrets to a Good Night's Sleep."

1. Avoid watching TV or using your computer or smartphone at night—or at least about an hour or so before bedtime—as these technologies can have a significantly detrimental impact on your sleep. TV and computer screens emit blue light, similar to daylight. This tricks your brain into thinking it's still daytime, thereby shutting down melatonin secretion. Under normal circumstances, your brain starts secreting melatonin during something called dim light melatonin onset. If the light in your environment doesn't dim, because of multiple artificial light sources, melatonin won't be released and this affects sleep timing, quantity, and quality.
2. Sleep in darkness. Refrain from using night-lights, cover up your clock radio, cover your windows — I recommend using blackout shades or drapes, or use an eye mask—and don't turn on a light if you have to go to the bathroom at night. You don't need to sleep in complete darkness. The intensity of light needs to be at a certain level (different levels depending on the spectrum) to suppress melatonin production. Complete darkness is probably best, however.
3. Keep the temperature in your bedroom less than 70 degrees F. Many people keep their bedrooms too warm. A reduction in core body temperature is a part of the sleep-initiation and sleep maintenance process. A room temperature that is too warm or too cool can prevent your core temperature from lowering to its ideal place for good sleep. Aim to keep your bedroom temperature between 60 to 68 degrees, and identify the best room temperature for you through trial and error.
4. Take a hot bath or shower 30 minutes before bedtime. The hot bath increases your core body temperature, opening up the blood vessels in your limbs. When you get out of the bath, heat can leave your body easily (if the room temperature is cool), abruptly dropping your core body temperature, making you drowsy and ready for great sleep.
5. Check your bedroom for electromagnetic fields (EMFs). These can disrupt your production of melatonin and serotonin, and may have other negative effects as well. To do this, you need a gauss meter. You can find various models online, starting around $50 to $200. Some experts even recommend pulling your circuit breaker before bed to shut down all power in your house.
6. Move alarm clocks and other electrical devices away from your bed. If these devices must be used, keep them as far away from your bed as possible, preferably at least three feet. This serves at least two functions. First, it can be stressful to see the time when you can't fall asleep, or wake up in the middle of the night. Secondly, the glow from a clock radio could be enough to suppress melatonin production and interfere with your sleep. Cell phones, cordless phones, and their charging stations should ideally be kept three rooms away from your bedroom to prevent harmful EMFs.

Sleeping Well Is Part of a Healthy Lifestyle Plan

Remember, there's no glory in being sleep deprived. On the contrary, not sleeping is a risk factor for a wide array of health problems, including diabetes, heart disease, and Alzheimer's disease. Lack of sleep will also dampen both your creative and logical problem solving abilities, along with your brain's ability to form memories.

In fact, highly successful entrepreneurs such as Arianna Huffington who have chosen to ditch the status quo that equates sleep deprivation with productivity affirm that getting sufficient sleep makes them more creative and efficient. Hence they get more done in less time. They also make fewer mistakes. From that perspective, sleeping can be viewed as a valuable performance enhancement tool.

In order to sleep well on a regular basis, you have to have properly aligned circadian rhythms. If you don't, aspects of your waking/sleeping system will be working at the wrong time. So first and foremost, make sure to get daylight exposure, ideally around solar noon, for at least half an hour or more each day. A gadget that can be helpful in instances when you, for some reason, cannot get outside during the day is a blue-light emitter. Philips makes one called goLITE BLU. (You can find it on Amazon12 for less than $150.) It's a small light therapy device you can keep on your desk. Use it twice a day for about 15 minutes to help you anchor your circadian rhythm if you cannot get outdoors.

Then, in the evening, dim environmental lights and avoid the blue light wavelength. Use blue-blocking light bulbs, dim your lights with dimmer switches and turn off unneeded lights, and if using a computer, install blue light-blocking software like f.lux.13 Also keep in mind that digital alarm clocks with blue light displays could have a detrimental effect.

4 Days, 11 Pounds

Notes from Dr. Norman Blumenstock

If you are looking to lose weight you might find this of interest.  Loss of weight is usually a help in managing obstructive sleep apnea.

By GRETCHEN REYNOLDS 

 MAY 22, 2014 12:01 AM

This article appeared in the May 25, 2014 issue of The New York Times Magazine.

Losing weight is simple: Ingest fewer calories than your body burns. But how best to do that is unclear. Most experts advise small reductions in calories or increases in exercise to remove weight slowly and sensibly, but many people quit that type of program in the face of glacial progress. A new study, published in March in The Scandinavian Journal of Medicine & Science in Sports, suggests that minimal calories and maximal exercise can significantly reduce body fat in just four days — and the loss lasts for months. The catch, of course, is that those four days are pretty grueling.

Researchers in Spain and Sweden had 15 healthy but overweight Swedish men restrict their calories to about 360 a day, a reduction of approximately 1,800 calories. What calories they did ingest came in liquid form: Some men drank mostly sugary carbohydrates, others a high-protein drink. The men also exercised — a lot. Their days began with 45 minutes of cranking an arm-pedaling machine for an upper-body workout. Then, as a group, the men strolled for eight hours across the Swedish countryside, with only a 10-minute break every hour. They were allowed as much of a low-calorie, sports-type beverage as they wanted during their walks.

Most of the men “were surprised that it was easier than they thought it would be,” says José Calbet, a professor at the University of Las Palmas de Gran Canaria in Spain; he and his colleague Hans-Christer Holmberg, a professor at Mid Sweden University in Ostersund, led the study. Some of the subjects experienced “minor problems with pain in the joints” and blisters on their feet, according to Calbet, but none dropped out or complained of hunger.

After four days, the men had each lost almost 11 pounds, with nearly half of that coming from body fat; the rest of the loss came primarily from muscle mass. The researchers had anticipated that the high-protein drink would protect people against muscle-mass loss. In fact, the losses were the same, whether the men had been given sugar or protein.

More surprising, the men did not immediately put the weight back on after the study ended. “We thought they would overeat and regain the weight lost,” Dr. Calbet says. Instead, when the volunteers returned a month later, most had lost another two pounds of fat. And a year after the experiment, they were still down five pounds, mostly in lost body fat.

Dr. Calbet and his colleagues hope to study whether women respond similarly to men and whether repeated bouts of such a program might affect muscular health and appetite hormones.

But given the doleful statistics on weight loss — most people regain everything they lose dieting and more — these results are startling. They also, at the moment, are inexplicable. “The only explanation we can offer” for the sustained loss, Dr. Calbet says, is that the men were inspired by their hypercompressed success to change their lifestyles. The men moved more and ate less than before.

Train Derailment Fuels Sleep Apnea Screening Talks

Notes from Dr. Norman Blumenstock
Screening of truck drivers is another area of concern.

WHITE PLAINS, N.Y. (AP) — A deadly Metro-North train derailment last year in which the "dazed" engineer was found to have sleep apnea has pushed the commuter railroad to look into establishing screening for the condition, which could include measuring operators' necks and asking them and their spouses about snoring habits.

Metro-North spokesman Aaron Donovan confirmed that the railroad that serves New York City's northern suburbs is working with unions on sleep apnea screening, but he cautioned nothing has been decided. Any program, he said, "would be for all employees in any safety-sensitive positions."

While no cause has been established for the Dec. 1 derailment in the Bronx that left four dead and dozens hurt, apnea has gotten much of the attention. Even before the accident, federal railroad officials had been discussing requirements related to sleep disorders. But there is still no national screening requirement for apnea, and railroads around the country have varying practices.

Any screening program that emerges is likely to start with questioning about the subject's sleep habits and some physical measurements. Overnight sleep-observation studies, which can be time-consuming and expensive, could follow.

Apnea robs its victims of rest because their tongue and throat muscles relax too much during sleep, and they are repeatedly awakened as their airway closes and their breathing stops.

"The person basically gasps himself awake," said Dr. Gregory Belenky, director of the sleep and performance research center at Washington State University. "It's very much the functional equivalent of waterboarding."

Loud snoring is a symptom and apnea is more common in those who are overweight. Having a large neck size, over 17 inches for men, is a risk factor.

In the case of engineer William Rockefeller, who was at the controls during the Metro-North derailment, the National Transportation Safety Board said he was classified as obese at 5-foot-11 and over 260 pounds.

Rockefeller told NTSB investigators that he felt strangely "dazed" before his train hit the curve, which has a 30 mph speed limit, at 82 mph. Asked if he was clearheaded enough to realize he was entering a curve, he replied, "Apparently not."

Rockefeller's medical exam after the accident uncovered "severe obstructive sleep apnea," and when experts studied his sleep, he woke up about 65 times an hour without being conscious of it. As few as five interruptions an hour can make someone chronically sleepy.

The Federal Railroad Administration, with the help of Harvard's medical school, has set up a website with resources including an apnea questionnaire and a video of a man snoring thunderously and repeatedly waking up to breathe during a sleep test.

James Stem, a lobbyist with the International Association of Sheet Metal, Air, Rail and Transportation Workers, said the website is useful but nationwide rules are needed.

"Fatigue is the No. 1 safety issue in the industry today," he said.

At Boston's Massachusetts Bay Transportation Authority, anyone hired to drive a bus or a train is screened for sleep disorders using the Epworth Scale, a questionnaire that asks people to rate their chances of dozing off in various daytime situations, including watching TV and driving but stopped in traffic.

"People with sleep apnea, they fall asleep at stoplights, they fall asleep at meetings during the day," Belenky said. "They'll deny any sleepiness and nod off right in front of you."

If the questionnaire leads to a diagnosis, Boston's drivers are required to get treatment and comply with it.

A common treatment of obstructive sleep apnea is CPAP, or continuous positive airway pressure, which uses a mask and hose to push a steady flow of air pressure into a person's airway during sleep. The mask can be programmed to reveal whether a person is following doctor's orders.

At the Chicago-area Metra network, spokeswoman Meg Riley said there's no specific test of engineers for sleep apnea, but if their regular exams lead to a diagnosis, the railroad requires treatment and a doctor's statement that the employee is cleared for work.

The Schneider trucking company, based in Green Bay, Wisconsin, imposed a screening program after finding that fatigue was the top cause of crashes, said spokesman Don Osterberg. Drivers were asked questions about sleepiness and had their neck circumference and body mass index measured.

If a trucker shows potential risk, a sleep study is ordered, Osterberg said. And if apnea is diagnosed, treatment and compliance are mandatory.

Although Schneider pays for the testing and the CPAP masks, health care costs have dropped because accidents were fewer and less severe, Osterberg said — and drivers felt better.

Rockefeller responded well to CPAP and felt more energetic, the NTSB said. His Epworth scale score dropped from 12 ("See the advice of a sleep specialist without delay.") to 1 ("Congratulations, you are getting enough sleep.").

‘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.”

Is it ADHD, or does your child have sleep apnea?

Notes from Dr. Norman Blumenstock
Older research from Children's Hospital of Philadelphia (CHOP) confirm that there seems to a ADHD connection with obstructive sleep apnea.

Not much is understood by parents about snoring or sleep apnea, especially in their children. (istockphoto.com)iStockphoto

Lana B. Patitucci, D.O., Doctor of Osteopathy, Pennsylvania Snoring & Sleep Institute
POSTED: Wednesday, May 7, 2014, 2:23 PM

Not much is understood by parents about snoring or sleep apnea, especially in their children. The Stanford School of Medicine states that about 10% of children 10 years of age and younger snore and, of those children who snore, about 20% will have obstructive sleep apnea.

Snoring can be a sign that your child has sleep apnea as it indicates, at the very least, that their airway is partially obstructed during sleep. Sleep apnea is a serious medical condition that can interrupt or stop your child’s breathing, prevent a normal night’s sleep, impair growth, and lead to a lower quality of life. It also can cause serious fatigue during the day which is why it is so often confused with ADHD.

Sleep-disordered breathing such as snoring and obstructive sleep apnea (OSA) have long been associated with ADHD (Attention Deficit Hyperactivity Disorder). You should know that not every child diagnosed with sleep apnea has ADHD, just as not every child diagnosed with ADHD has sleep apnea. However, many studies have been performed indicating a significant correlation between OSA and behavioral issues. Children with obstructive sleep apnea do not get restful sleep, and as a result may complain of morning headaches, be irritable and have difficulty concentrating.

Children with sleep apnea may complain of being tired during the day and, at the same time, exhibit hyperactive behavior or act impulsively. Herein lays the confusion of separating sleep apnea from ADHD because many of the classic symptoms of ADHD are often exhibited in children with OSA. So, as a parent of a child diagnosed with ADHD, what do you do?

It will be in your child's best interest if you dig a little deeper into the root of what may be causing these behaviors. Watch your child sleep at night - and even record it if you can. Check for restlessness, mouth breathing, snoring, or breathing pauses. If they occur, have your child evaluated for possible sleep apnea to ensure the proper diagnosis and treatment.

Figuring out if your child has sleep apnea or ADHD may seem quite complex but it doesn’t have to be. Consult with a sleep apnea doctor if you can answer ‘yes’ to any or some of the following questions:

- Does your child snore?
- Does your child stop breathing for a few seconds at night?
- Does your child frequently mouth breathe?
- Does your child sleep through the night or is it a restless sleep?
- Is there frequent bedwetting?
- Does your child seem irritable during the day? Is there difficulty focusing? Are there periods of hyperactivity?

The good news is that sleep apnea is treatable. Enlarged tonsils and adenoids are the most common causes of sleep apnea in children. An Ear, Nose and Throat specialist can determine if your child’s tonsils and adenoids are enlarged and possibly blocking the airway at night. A tonsillectomy and adenoidectomy can successfully treat sleep apnea by removing the obstruction in the airway resulting in a complete elimination of symptoms in 80-90% of children.

Dr. Lana B. Patitucci, D.O. is a Board Certified Otolaryngologist at The Pennsylvania Snoring and Sleep Institute. She is trained in all aspects of general and pediatric otolaryngology including endoscopic sinus, otologic, head and neck, and facial plastic surgery. Her hospital affiliations include Abington Surgical Center, Blue Bell, Chestnut Hill, Einstein Medical, Mercy Suburban, and Roxborough Memorial Hospital