Health and Wellness News – Nurtured Nature Wellness

We read the articles and interpret the scientific data to offer you relevant highlights, professional perspective, and sensible conclusions. We welcome suggestions for topics.

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Insufficient Sleep and Metabolic Dysfunction

The rates of sleep deprivation and obesity are both rising dramatically. While concerning, this is not surprising since sleep and metabolism are bidirectionally related. Inadequate sleep increases the risk of obesity and metabolic dysfunction, and metabolic disorders can negatively affect sleep quantity and/or quality. Over 35% of US adults report insufficient sleep, which is defined as <7 hours of sleep per 24-hour period, and the age group with the highest percentage of sleep insufficiency is adults aged 45 to 54 years. A major contributor to sleep loss is societal modernization, including electronics, artificial lighting, and long work days. Managing involuntary sleep disturbance (i.e., insomnia) falls under the purview of a healthcare provider; but, as a Wellness Coach, I focus on volitional sleep deprivation (i.e., due to lifestyle). I help my clients recognize the importance of adequate sleep, and strive for it, to reduce their chances of developing metabolic disease.

A recent review out of Johns Hopkins summarized the existing literature on sleep and metabolism. Simplistically, the levels of the hunger-promoting hormone, ghrelin, decline throughout the night and then rise in the morning in anticipation of breakfast. In an opposite manner, leptin, a satiety (fullness) hormone, peaks during sleep and then declines until mid-morning. Additionally, metabolic rate (i.e. calorie burn) falls during sleep since you are not moving around. Not getting enough sleep increases the likelihood of developing obesity, type 2 diabetes, and incident metabolic syndrome… but why?

At the most basic level, the link is largely due to energy intake versus energy expenditure, or the old adage of “calories in, calories out”. Studies looking at both total and partial sleep deprivation have consistently shown that nocturnal wakefulness does result in a small increase of calories burned; however, the amount of excess calories consumed ranges from double to as much as ten times the additional amount burned. Midnight snackers also show a greater affinity for high-fat foods, which are more calorie-dense. Further compounding this is that calorie consumption during the day following sleep deprivation does not decrease despite the additional overnight feeding. Interestingly, subjects who were prevented from excess eating during sleep deprivation ate more calories the following day. This indicates that it is the overeating, not the actual sleep loss, that causes the weight gain.

One might posit that they can just choose NOT to eat more even when sleeping less. In an unfair twist, however, humans are actually biologically driven to eat more when sleep deprived. Instead of quieting down, ghrelin, the hunger-promoting devil on one shoulder continues yapping in your ear that you are hungry well past the hour that you should be sleeping. On the other shoulder, the fullness angel leptin is (ironically) asleep instead of gently reminding you that you already ate enough during the day. As if that weren’t enough, sleep deprivation also results in increased activity in the regions of the brain associated with hedonic (pleasure-seeking as opposed to hunger-driven) urge for food, as well as deficient cognitive control over food stimuli. In a nutshell, with insufficient sleep, your body mistakenly thinks you are hungry and your brain tells you that it feels good to eat.

In addition to lack of sleep leading to obesity, and obesity increasing the risk for type 2 diabetes, sleep deprivation, itself, also impacts glucose and insulin metabolism. Specifically, sleep loss promotes glucose production but decreases insulin sensitivity. Conversely, data across multiple studies have shown that increasing sleep extension by at least one hour per night in sleep-deprived adults improved their insulin sensitivity, decreased their appetite, and resulted in weight loss.

The takeaway from existing research is that not getting enough sleep doesn’t just make you cranky and slow to get the joke. Sleep deprivation has very real effects on your metabolism and health. Everyone is busy, but what is the point of working so very hard if your health deteriorates prematurely and you cannot enjoy the results of your efforts? Sleep may seem like “wasted time”, but it is an investment in YOU and YOUR health. As a Wellness Coach, I help clients prioritize sleep, emphasizing sleep quality in addition to sleep quantity. As for me, I am definitely susceptible to late-night snacking, especially when binge-watching a series that ends each episode on a cliffhanger (“just one more…”). Rather than struggle against the very real biological drive to eat, I think I will just go to sleep a little earlier tonight. My metabolism will thank me for it.

Duan, D., Kim, L. J., Jun, J. C., & Polotsky, V. Y. (2023). Connecting insufficient sleep and insomnia with metabolic dysfunction. Ann NY Acad Sci., 1519, 94– 117.

Blog posted: May 22, 2023

This content is for educational and informational purposes only, and does not constitute medical advice. Do not rely solely on this information. Consult your healthcare professional for advice specific to your situation.

Intermittent Fasting versus Daily Caloric Restriction

In the United States, two-thirds of adults are overweight or obese, increasing the risk for non-communicable chronic conditions like cardiovascular disease, type 2 diabetes, and some cancers. Clinically meaningful weight loss (defined as 5% or more) can improve the markers of disease, thereby lowering the chances of developing these conditions. Of course, losing weight can be hard, and individuals have varying levels of success with different dietary approaches.

One weight loss strategy is “daily caloric restriction”, where a person generally consumes the same reduced number of calories each day with no limits on what times they eat. “Intermittent fasting” is another category of dietary intervention where individuals periodically lower or restrict caloric intake. One approach to intermittent fasting is time-restricted eating, where calorie consumption is limited to a specific window of time every day (e.g. 10 hours between 8:00 am and 6:00 pm). Another is intermittent calorie restriction, where a person cycles between reduced-calorie days and typical dietary days (e.g. the 5:2 diet where substantial reduction is practiced on 2 non-consecutive days each week.) Many studies have shown that intermittent fasting can facilitate weight loss and improve chronic disease markers. However, it has been difficult to discern if the results are due to the overall reduction in caloric intake, or if they are enhanced by the fasting process itself.

A recent systematic review published in the Journal of the Academy of Nutrition and Dietetics aimed to address this question. The researchers evaluated existing randomized controlled studies that compared intermittent fasting with daily caloric restriction. For a study’s results to be included, the fasting group and the restriction group must have been “isocaloric”, meaning the total number of calories consumed was identical in the two groups. Dietary protocols varied among the studies, and some included individuals with known metabolic disease.

Thirteen published studies were included, and all showed that clinically meaningful weight loss was similar between the two dietary approaches. However, two studies showed greater reduction in body fat with intermittent fasting. Regarding markers for cardiovascular disease and diabetes, the results of individual markers varied greatly between studies. When comparisons could be drawn, though, effects were equivalent between the two dietary approaches. However, in two studies, insulin sensitivity was improved with specific intermittent fasting protocols. The authors concluded that intermittent fasting approaches produced similarly beneficial effects compared to daily caloric restriction when total daily calorie intake is the same. Although there is some suggestion that intermittent fasting could be superior for fat loss and insulin sensitivity, more research is needed. Furthermore, the optimal intermittent fasting protocol has not been elucidated.

The takeaway is that weight loss in overweight and obese individuals is a health benefit, whether assisted by a consistent calorie deficit or a cyclical fasting approach. Your schedule, lifestyle, and other competing responsibilities may be more conducive to one strategy over another. It is very reasonable to begin with one approach knowing you can always modify it later. As for me, I get hangry, so fasting days make my kid (and dog) run for cover. However, a “no calories after 8:00 pm” rule is one my whole family can endorse!

Ezzati A, Rosenkranz SK, Phelan J, Logan C. The Effects of Isocaloric Intermittent Fasting vs Daily Caloric Restriction on Weight Loss and Metabolic Risk Factors for Noncommunicable Chronic Diseases: A Systematic Review of Randomized Controlled or Comparative Trials. J Acad Nutr Diet. 2023 Feb;123(2):318-329.

Blog posted: May 4, 2023

Exercise Time of Day and Cardiovascular Disease Risk Factors

A long-standing question many people have is about the optimal time of day to exercise. Morning exercise sets the tone for the day and gets your proverbial metabolic juices flowing, whereas evening exercise lets you sweat out the day’s stressors and end on a strong note. That said, are there proven health benefits to exercising in the morning versus the evening? So far, the data are inconsistent. However, a recent analysis published in the Journal of Science and Medicine in Sport aimed to make sense of the conflicting results. A big strength of this article is that it is a systematic review and meta-analysis, meaning that the authors combined the results from 22 different studies to better identify associations. The review also only included crossover studies, where all participants were evaluated after both morning and evening exercise. This differs from epidemiological studies where cohorts are often defined based on their preferred exercise times.

The authors focused on the effects of exercise on blood pressure (both systolic and diastolic), as well as blood glucose (sugar), and whether time of day of exercise had an impact. This is important because elevated blood pressure is a risk factor for cardiovascular disease, and blood glucose is associated with diabetes which can cause heart disease. Most of the included studies focused on sedentary or recreationally active people, about half had participants considered to be normal weight, and a small percentage of participants had underlying health conditions. Almost all of the included studies examined aerobic exercise, although intensity and duration varied among protocols. Interestingly, only 6 of the included studies had female participants.

Overall, time of day of exercise had no influence on blood pressure or blood glucose in healthy individuals. Additionally, the authors saw no effect of age, sex, body mass index (BMI), exercise intensity, or exercise duration when comparing time of day. However, they did note that participants with diabetes showed elevated blood glucose with morning exercise more so than with evening exercise.

The takeaway is that healthy adults benefit from exercise regardless of the time of day. Morning exercise ensures that you will not get “too busy” to exercise later, while afternoon or evening exercise may be preferred by those who are barely functional before 2 cups of coffee. As for me, I am going to continue to hit the snooze button without guilt… especially because afternoon television motivates me to stay on the treadmill longer!

Sevilla-Lorente R, Carneiro-Barrera A, Molina-Garcia P, et al. Time of the day of exercise impact on cardiovascular disease risk factors in adults: a systematic review and meta-analysis. J Sci Med Sport. 2023 Mar;26(3):169-179

Blog posted: May 3, 2023

Coffee and Health Effects in Adults

Are you a coffee-drinker but wonder about the health effects? For some, coffee is merely an occasional social event, while others (like me!) depend on it to be a functional and coherent human being. There are numerous articles about this commonly consumed beverage, often with conflicting conclusions. Many studies rely on participants to self-report how much coffee they drink and the effects they experience. However, a recent study published in the New England Journal of Medicine took a clinical trial approach to this issue. One hundred adults were randomly assigned to drink coffee or to abstain for 2-day intervals over a 14-day period. They wore monitors for heart rhythm, daily activity (steps), sleep duration, and blood glucose (sugar). Geolocation was also used to track visits to coffee shops, and date-stamped receipts confirmed purchases.

One strength of this study is that the participants served as their own controls. This means that a participant’s experiences on coffee-drinking days were compared to their own experiences on coffee-abstaining days. This allowed the researchers to observe individual differences that might be diluted or missed when only considering effects within a group of people.

The primary outcome of the study was the number of premature atrial contractions (PAC’s; extra heartbeats starting in the heart’s upper chambers) in a 24-hour period. There was no statistical difference in the number of PAC’s observed on coffee consumption days versus coffee abstinence days. Secondary outcomes included premature ventricular contractions (PVC’s; extra heartbeats starting in the heart’s lower chambers), activity levels, sleep duration, and blood glucose. On days that participants consumed coffee, they experienced more PVC’s. They also averaged almost 1,000 more steps, but slept 30 fewer minutes. Daily average blood glucose levels did not differ based on coffee consumption.

What does this mean for the average adult? As with many things, there are pros and cons to coffee consumption. Drinking coffee may increase one’s daily activity levels, which is definitely a good thing! If a daily cup of coffee gives you the energy you need to move more, I am all for it. However, coffee drinkers might not get enough sleep, which can negatively impact health and wellness. This sleep effect was more pronounced in participants who are slower caffeine metabolizers, which is not surprising. Restricting coffee consumption to the morning may be ideal by motivating you to move more throughout the day but not interfering with sleep at night. Although some coffee drinkers experience more PVC’s (which are described to feel like skipped heartbeats), they are unlikely to be worrisome in healthy adults without underlying heart disease. Additionally, the lack of effect on blood glucose would also suggest that coffee is unlikely to negatively impact sugar regulation in healthy adults.

Overall, coffee consumption is personal preference. This study did not identify extreme benefits or extreme risks associated with drinking coffee, meaning that healthy adults should decide for themselves if coffee is right for them. As for me, I am going to top off my mug o’ joe and then take a walk around the block!