Archive for category: blog

From Metagenics Institute

If you’re trying to maintain a healthy weight, counting sheep may be as important as counting the carbs on your plate or weight repetitions at the gym. Because, while physical activity and a balanced diet are key factors, sleep may be the most overlooked aspect of your weight management plan.

Can you sleep your way to your dream body? Perhaps not. But if you are sleep deprived, more sleep may help you reach your weight goals. Here’s what you need to know about the sleep-weight connection.

Are you sleep deprived?

The National Sleep Foundation recommends seven to nine hours of sleep per night for adults 24-64, slightly more for younger adults and a bit less for those older.¹ But due to electronic gadget lights, chronic stress, habitual caffeine, shift-work, and many other reasons, few folks get their target rack time. In fact, according to the Centers for Disease Control and Prevention (CDC), insufficient sleep is a public health problem² with serious concerns for our productivity, safety, and health—including your waistline.

It’s not just you

If you’re sleep deprived and find yourself battling the bulge, you’re in good company. Studies have found consistency in the sleep-weight connection; sleep deficiency is linked to weight gain. The largest study of its kind involved over 200 participants and simulated a sleep-restricted workweek. It compared the effects of restricting sleep to only four hours per night compared to unrestricted sleep, up to ten hours per night.³ After only five days, the sleep-restricted subjects had gained about 2 pounds. In contrast, the control group, allowed to sleep for up to 10 hours a night, gained virtually no weight.

If sleep restriction can cause you to gain two pounds in just five days, what can happen on the scale long-term?

A lot, according to women tracked for 16 years in The Nurses’ Health Study. Women reporting six hours of sleep per night were 12% more likely to gain at least 30 pounds during the study compared to the women who slept seven hours per night. But those women who were even more sleep deprived, reporting no more than five hours per night, were 28% more likely to gain at least 30 pounds during that same period!⁴ Apparently, with the sleep-weight connection, every hour counts.

How does less sleep = less svelte?

There are several underlying factors behind the sleep-weight connection. But a common thread is our own chemistry, which almost seems to revolt when restorative sleep is intentionally or unintentionally withheld. It’s you against them—and it’s not a fair fight.

Getting to know your hunger chemistry

There’s more than your sensation of fullness and stomach-brain communication involved. Rather, when it comes to hunger regulation and sleep, we have several chemical messengers at play. And when it gets complicated between you and the sandman, those messengers are not on your side. So get to know them:

• Ghrelin: When ghrelin, known as the “hunger hormone,” is released from the stomach, it sends your brain a “feed me” signal. It signals not only when to eat, but also when to switch from burning calories to storing them as fat. Ghrelin naturally decreases after a meal and remains lower while you sleep, when caloric needs are less. But less sleep means more ghrelin.
• Leptin: The opposite of ghrelin, leptin, is known as the “satiety hormone,” as it plays a crucial role in appetite and weight control. Released from fat cells, leptin crosses the blood-brain barrier and signals, ‘‘We’re good here. Put the fork down.” It also stimulates fat burning to create energy. Leptin levels naturally increase after a meal and remain elevated while you sleep, until you awaken and your metabolism increases. But less sleep means less leptin. Making things even trickier, sometimes leptin is secreted, but the brain’s not getting its signals. Think boy who cried wolf. This situation, known as “leptin resistance” can mean there is an underlying insulin resistance, a sign of disordered blood sugar metabolism, which puts you at risk for obesity and metabolic syndrome. While research on how to reverse leptin resistance is limited, animal studies show that an unbalanced diet can cause leptin resistance.⁵ So a dietary approach to reducing the underlying insulin resistance is a logical start.

As you can see, proper balance of ghrelin and leptin is very sleep-dependent. And for the caveman, perhaps these hormones were key to survival during the shorter, sleep-heavy but food-poor days of winter. They also played a part in the ability to capitalize on the longer, lighter sleep and more food-abundant days the rest of the year.

Today, our sleep-deprived bodies are prone to having too much ghrelin and not enough leptin. The result is that the body doesn’t feel satiated, thinks it’s hungry, and needs more calories—and squirrels away those calories for the long winter. In short, ghrelin and leptin kept the caveman alive, but they may be making you heavy.

• Endocannabinoids: “It’s 1 AM, and I’m craving a salad,” said no one ever. If you’ve ever experienced sleepiness munchies, blame it on endocannabinoids. Sound vaguely familiar? Endocannanbinoids are the endogenous version of the cannabinoids in marijuana—our bodies can generate a very close facsimile of the previously illegal (in some states) substance. Endocannabinoids bind to the same receptors in the brain, fat cells, muscles, and elsewhere, causing a similar appetite-inducing effect as cannabis.⁶ Further, the endocannabinoid system interacts with your dopamine and opioid pathways, driving not just hunger, but according to some studies cravings for high-carb and high-fat.⁷ You want cookies. Now. Resistance is pretty much futile.

What to do?

That depends. There are two main reasons behind sleep deprivation. Either you have a sleep hygiene issue (trouble falling asleep or staying asleep), or you have a scheduling issue, in that your lifestyle is interfering with adequate sleep.

For sleep hygiene issues, the typical recommendations always merit consideration: limiting caffeine, avoiding blue light before bed, creating a cool and dark environment, etc. But, when you have a scheduling challenge, getting adequate sleep requires some lifestyle restructuring. It’s worth the time to re-engineer your schedule to slowly go to bed earlier or rise later to increase your sleep time. But in the meantime, can you catch up on sleep on the weekends?

Weekend catch-up sleep: is it a real thing?

Of course, you can get extra sleep on the weekend. But can it potentially reverse your Monday-Friday sleep deprivation? Perhaps. In a study of over 2,000 people participants, those who slept longer on the weekends, nearly two hours longer on average, had a significantly lower body mass index (BMI) than those who didn’t. Further, it appears that the sleep: BMI relationship was dose-dependent in that every extra hour of weekend catch-up sleep was associated with a significantly lower body mass.⁸ So catch-up sleep can indeed be a good strategy. That is, if your overall average sleep for the week puts you out of the red and into the black, as in you’ve paid back your sleep debt.

Sleep more. Weigh less. Not convinced? Sleep on it…

Citations

1. National Sleep Foundation. National Sleep Foundation Recommends New Sleep Time. https://sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times. Accessed July 19, 2017.
2. CDC. Insufficient sleep is a public health problem. https://www.cdc.gov/features/dssleep/index.html#References. Accessed July 19, 2017.
3. Spaeth AM et al. Effects of experimental sleep restriction on weight gain, caloric intake, and meal timing in healthy adults. Sleep. 2013;36(7):981-990.
4. Patel SR et al. Association between reduced sleep and weight gain in women. Am J Epidemiol. 2006;164(10):947-954.
5. Vasselli JR et al. Dietary components in the development of leptin resistance. Adv Nutr. 2013;4(2): 164-175.
6. Hanlon EC et al. Sleep restriction enhances the daily rhythm of circulating levels of endocannabinoid 2-arachidonoylglycerol. Sleep. 2016;39(3):653–664.
7. De Luca MA et al. Cannabinoid facilitation of behavioral and biochemical hedonic taste responses. Neuropharmacology. 2011;63(1):161–8.
8. Im HJ et al. Association between weekend catch-up sleep and lower body mass: population-based study. Sleep. 2017;40(7):zsx089.

by Michael Stanclift, ND

Sourced from Metagenics Institute

Introduction
Expectant mothers may find some reassurance in recent evidence suggesting COVID-19 infection during pregnancy doesn’t appear to pose the same dangers as related viral infections (e.g. SARS, MERS).¹ Pregnant women contracting COVID-19 must still be cautious about their and their developing babies’ health, especially since treatment options are more limited during pregnancy; however, documented cases give us some insight into the short-term effects. As with all things related to COVID-19, the data is still emerging, and we must keep in mind that new information could further support or undermine what we know now. Data on pregnancy is limited by the number of cases and the time frame of the pandemic—meaning we will not know longer range effects or the validity of these findings for some time.

COVID-19-positive pregnant women mostly without symptoms
Doctors in a London hospital during its COVID-19 peak detected coronavirus (SARS-CoV-2) in 7% of pregnant women admitted for delivery; nearly all of them (89%) had no symptoms.² During the pandemic peak in New York, the positive rate for SARS-CoV-2 in pregnant women was over twice as high as London (15%), with a similar number of them asymptomatic as well.^2,3 The authors expressed concern that their findings support a trend of asymptomatic infection in healthcare facilities, suggesting poor infection control.²

What happens when a pregnant woman gets COVID-19
Unlike with infections such as influenza, pregnant women do not appear to be at increased susceptibility for COVID-19 infection, nor do they have more severe disease when they contract it.⁴ COVID-19 infection in pregnant women presents in much the same way as in nonpregnant patients—usually with a cough, fever, labored breathing, and low lymphocytes.¹ Compared to infections caused by similar coronaviruses (SARS/MERS), the death rate in pregnant women with COVID-19 has yet to be determined; initial reports are very low, while SARS/MERS respectively have an 18% and 25% mortality rate in this population.^1,5,6

• 1^st trimester: In other infections, developing a fever in the first trimester doesn’t contribute to birth defects, though it does increase the likelihood of inattention disorders in childhood.¹ Because of the timeline of the pandemic, we don’t have data on COVID-19-related effects from young children born to mothers who had the infection, but experts hypothesize the same may hold true.¹ Based on small numbers of COVID-19 cases, it doesn’t appear to increase the risk for miscarriage (spontaneous abortion) above the risk of the general population.^1,7
• 2^nd/3^rd trimester: Data from small numbers of cases show COVID-19 infection poses fetal risks, such as intrauterine growth restriction (9-10%) and preterm birth (39-43%), though the preterm birth information is somewhat conflicting.^1,7,8
• Early childhood: COVID-19 presents mostly as a mild respiratory illness in most children.¹
• Predicting severity of COVID-19 in pregnancy: Assessing and predicting mortality of COVID-19 in pregnant patients is more difficult than in nonpregnant patients, as the normal course of pregnancy skews measures used to predict the course of disease, such as D-dimer and sequential organ failure assessment (SOFA).¹ This can make it a bit more difficult to predict when the severity of a case may increase and require higher levels of interventions.
• Treatment of COVID-19 in pregnancy: Pregnant women who develop severe disease and require a ventilator need higher levels of oxygen to adequately provide for their growing fetus.¹ Remdesivir, the most promising drug for the treatment of COVID-19, appears to be safe for use during pregnancy, as does chloroquine, though it may require higher doses in pregnant patients.¹ An HIV antiviral being used, lopinavir-ritonavir, is safe in pregnancy, as demonstrated through public health data.¹ Unfortunately, ribivarin, an antiviral drug, and baricitinib, a Janus kinase inhibitor being used for COVID-19, aren’t safe to use during pregnancy.¹ Pregnant and breastfeeding women are excluded from current vaccine phase 1 and 2 clinical trials, though some OB/GYNs argue this is “both misguided and not justifiable and may have excluded them from potentially beneficial interventions.”^9-11
• Special considerations for pregnant healthcare workers: N95 masks can reduce oxygen uptake and are recommended against (as is frontline work) for pregnant women working in healthcare with growth-restricted fetuses.¹
• Vertical transmission (mother spreading the virus to baby): In theory, passing the infection from mother to baby while in utero is possible due to ACE2 (the receptor the virus uses to enter cells) expression on the placenta; however, no confirmed cases proving this have been recorded to date.¹ A study published in JAMA found IgG and IgM antibodies against SARS-CoV-2 in newborn infants born to COVID-19-positive mothers.¹² Since IgM does not cross the placenta, it suggests the infants were possibly exposed to the virus in utero; however, throat swabs and blood samples from the babies were negative for the virus.¹² Measuring IgM antibodies has limitations with the possibility of false positives, so more evidence is needed to confirm the infection could be passed this way.¹³ In cases where a baby tested positive after being delivered by a COVID-19-infected mother, other causes of transmission could not be completely ruled out.¹ Additionally, in COVID-19-positive mothers the virus does not seem to appear in amniotic fluid, umbilical cord blood, breast milk, or throat swabs from the infants.¹
• Delivery, breastfeeding, and skin-to-skin contact: Numerous reputable professional obstetrics societies declare vaginal delivery is safe for women with COVID-19, without risk of spreading the infection to the infant.^1,8 Women with the infection may need to wear a facemask and avoid skin-to-skin contact with their new babies after delivery; however, all evidence suggests it is safe for the baby to drink breastmilk—which should bring some comfort to both.¹

Conclusion
Pregnant women are not more likely to get COVID-19, nor are they more likely to have a severe case based on the findings so far. While COVID-19 infection during pregnancy certainly presents possible risks to them and their babies, the emerging evidence is reassuring. In the absence of other modifying factors that increase risk and course of disease, pregnant women can reasonably expect that contracting COVID-19 while pregnant has the same risks as nonpregnant patients of similar makeup. Treatment options for pregnant women are mostly similar, with some limitations. There is no compelling evidence that pregnant women can spread the infection to their babies, other than normal transmission routes, namely respiratory droplets. Should their babies develop the infection, the course is generally mild in children.

The American College of Obstetricians and Gynecologists (ACOG) along with the Centers for Disease Control (CDC) has created guidelines based on the available research to date; however, there are still several unanswered questions, and additional information is needed to make better informed decisions.  Therefore, those clinicians with pregnant women under their care should routinely monitor any changes and updates to these recommendations.

Citations

1. Dashraath P et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol. 2020. pii: S0002-9378(20)30343-4.
2. Khalil A et al. SARS-CoV-2 in pregnancy: symptomatic pregnant women are only the tip of the iceberg. Am J Obstet Gynecol. pii: S0002-9378(20)30529-9.
3. Coronavirus Resource Center. Johns Hopkins University and Medicine. https://coronavirus.jhu.edu/map.html. Accessed May 14, 2020.
4. Blitz MJ et al. Intensive care unit admissions for pregnant and non-pregnant women with COVID-19. Am J Obstet Gynecol. 2020. pii: S0002-9378(20)30528-7.5.
5. Karami P et al. Mortality of a pregnant patient diagnosed with COVID-19: A case report with clinical, radiological, and histopathological findings. Travel Med Infect Dis. 2020;101665.
6. Hantoushzadeh S et al. Maternal death due to COVID-19 disease. Am J Obstet Gynecol. 2020;S0002-9378(20)30516-0.
7. Yan J et al. Coronavirus disease 2019 (COVID-19) in pregnant women: A report based on 116 cases. Am J Obstet Gynecol. 2020;S0002-9378(20)30462-2.
8. Della Gatta AN et al. COVID19 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol. 2020;S0002-9378(20)30438-5.
9. Safety and immunogenicity study of 2019-nCoV vaccine (Mrna-1273) for prophylaxis of SARS-CoV-2 iInfection (COVID-19). ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT04283461?term=mrna-1273&draw=2&rank=1. Accessed May 13, 2020.
10. Safety, tolerability and immunogenicity of INO-4800 for COVID-19 in healthy volunteers. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT04336410?term=ino-4800&draw=2&rank=1. Accessed May 13, 2020.
11. Costantine MM et al. Protection by exclusion: Another missed opportunity to include pregnant women in research during the coronavirus disease 2019 (COVID-19) pandemic. Obstet Gynecol. 2020. [Epub ahead of print].
12. Zeng H et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA. 2020;323(18):1848‐1849.
13. Kimberlin DW et al. Can SARS-CoV-2 infection be acquired in utero?: Moredefinitive evidence is needed. JAMA. 2020. [Epub ahead of print].