Sleep II: Glucose Intolerance and Hormone Dysfunction

My introduction to insulin will be important to understand before getting into today’s conversation. We will be discussing sleep, its affect on blood sugar levels, and its affect on serum insulin levels. If you don’t want to spend the five minutes reading the post on insulin, the most important takeaway is that insulin in a ginormous growth signal to the body. When insulin is present in the bloodstream, our ability to break down and burn stored body fat is blocked, while our ability to form and store new fat molecules is amplified. With that brief introduction, let’s dive in.

I don’t think anyone would argue that humans are incredibly diverse and adaptable. We live and learn to thrive in every environment the world has to offer (mostly). Adaptability is no more than responding positively to your environment. It is making subtle changes in your functioning to better facilitate your existence in that environment in the future. A prerequisite to being adaptable is the ability to sense your environment. Before you can begin to optimize outputs, you have to understand the inputs to the system. Sleep is a primary, pivotal, essential, etc., etc., input to our body functioning. The duration and quality of our sleep each night sends a truckload of data to our body. And being the adaptable creatures we are, our system processes that data and makes compensatory psychologic and physiologic changes. One of the huge levers our body can manipulate in response to this input of data is hormonal and metabolic functioning. If you remember from Sleep I, short sleep induces higher levels of ghrelin (a hormone associated with hunger) and lower levels of leptin (a hormone associated with satiety). These changes in chemical concentration lead to an overall subjective feeling of increased hunger. Today’s topic fits right along side this increased sensation of hunger. When we do not get adequate sleep we become less glucose tolerant. Meaning our blood sugar stays elevated for a longer time after eating, as do our levels of insulin. Short sleep leads to more insulin spending more time in our bloodstream.

In this small study participants were put through two different sleep regiments. Initially they were restricted to four hours in bed per night for six nights, and then allowed 12 hours in the bed for the next seven nights. In each condition they they were subject to a glucose tolerance test while also having their insulin levels measured. During the sleep restricted condition, there was a clear impairment of carbohydrate tolerance. Injected glucose was cleared from the body 40% slower after sleep restriction. They also measured the acute insulin response to be 30% lower in the sleep-debt condition. Glucose effectiveness, a measure of ability to dispose of glucose independent of insulin, was also 30% lower in the sleep debt condition. The combination of these outcomes would certainly lead to prolonged blood sugar elevation, and these differences in glucose tolerance are very similar to those seen in a non-insulin-dependent diabetic male compared to a normoglycemic male. Lastly, the researchers also measured glucose levels and insulin response to a 60% carbohydrate meal; opposed to the IV glucose injection which the above results were in reference to. They measured the increase in peak glucose after eating breakfast was higher in the sleep restricted state. However, peak glucose measurements following lunch and dinner did not differ much between the sleep states [1]. This is certainly no evidence of causation, I simply want to point out that there seems to be some level of hormonal and metabolic dysfunction in response to sleep restriction.

In this study researchers were investigating if sleep restriction impairs insulin signaling. In order for insulin to exert its effect at a cellular level, it first binds to a receptor on the outer membrane of a cell. This binding initiates a cascade of events (molecules tagging other molecules, turning them on) eventually resulting in the body’s ability to move glucose from the bloodstream into the cell. The researchers were able to measure a specific molecule in the insulin pathway (phosphorylated Protein Kinase B, aka pAkt) in order to assess insulin sensitivity of individuals in a sleep deprived state and in a well-slept state. They measured the concentration of insulin that was required to stimulate pAkt to adequate levels. In an insulin insensitive state, the amount of insulin required to reach this level of pAkt stimulation would be higher. In this experiment the participants were subjected to four and a half hours in bed to achieve the sleep deprived state versus eight and a half hours in bed to create the well-slept state (four consecutive days in each state). In the sleep deprived condition the amount of insulin required to elicit the desired pAkt response was 3-fold higher [2]. Another significant manifestation of hormonal disruption after short sleep.

There are many more studies out there, but I like to keep these posts relatively short. It is fairly obvious that there is some level of hormonal dysfunction that occurs after less than a week’s worth of inadequate sleep. Admittedly these studies are small, but we have seen some level of evidence for disruptions to ghrelin, leptin, insulin, and glucose tolerance. So for a quick summary of what we have covered so far: short sleep causes you to feel more hungry and less satisfied after a meal. You then have a decreased ability to deliver glucose from your bloodstream into your cells, elevating your blood sugar for a longer period of time. You also have a decreased response to insulin, further inhibiting your ability to remove glucose from the bloodstream and increasing the overall amount of insulin in your body throughout the day. There is certainly some level of a runaway feedback loop here, as prolonged blood sugar elevation further increases the demand for more insulin secretion. And remember, when you have high levels of insulin circulating, you cannot break down fat, but you can certainly build it.

My concern is not with the 40% slower glucose clearance the day after cramming for an exam or finishing a big project. I am concerned with what happens after 25 years of consistently getting 4-6 hours of sleep. What happens when endocrine dysfunction becomes our normal? What happens when our body is forced to adapt to metabolic conditions it would have only seen in the most stressful times in pre-historic life? Of course we will never know a definitive answer to these questions, but when you are dealing with something as ubiquitous as chronic disease, I naturally look at things equally ubiquitous, i.e. sleep, as possible culprits. The idealized, “I can sleep when I die,” needs to go, or those who believe it will surely meet that end sooner than they should have.

Best explorations

-Ryan; 6/5/2020

See Sleep I: An Evolutionary Imperative

References:

[1] Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1435‐1439. doi:10.1016/S0140-6736(99)01376-8

[2] Broussard JL, Ehrmann DA, Van Cauter E, Tasali E, Brady MJ. Impaired insulin signaling in human adipocytes after experimental sleep restriction: a randomized, crossover study. Ann Intern Med. 2012;157(8):549‐557. doi:10.7326/0003-4819-157-8-201210160-00005

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Food Rules 2: Eat REAL Food

Why we need Food Rules

Preface
Food is the greatest vehicle through which we expose exogenous (outside the body) substances to our body. What we ingest is no more than chemical information packets that direct our cellular machinery to behave and operate in specific ways. Food is the primary language we have to communicate with our body, and communication (information exchange) is key to a thriving ecosystem.

Everyone has dieted and everyone has failed. Food choice is a psychological game that we are not well equipped to deal with. Unless we educate ourselves on what is really going on, we are severely disadvantaged in an unfair fight. A big part of this is changing the language we use to describe the food we eat. This is not a diet. Diets are temporary and don’t work. We must focus on small changes that can be implemented for the rest of our lives. We wont’t be listing foods you “can’t have.” When you mentally tag a food as something “I can’t have,” you have just lost a battle in this realm of psychological warfare – there is always that small part of us that wants only what we cannot have. This is not about counting calories or joining a Facebook group for the newest fad diet. Food can get complicated and even tribal, so we will attempt to remove the extraneous information and focus on the things that actually make a difference. These are a a few simple rules to help you change your relationship with food.

Rule 2: Eat REAL food. If you have to question if it’s “real food,” it’s probably not.

Our bodies were not designed for environments where food is plentiful. The behavior and functionality we developed was shaped by the absolute necessity to acquire energy in a world where that energy was scarce and fleeting. We carry the same biology and psychology with us today, however we are inundated with calorically dense, easily accessed, unending supplies of food. The intricate reward systems that were crafted to help us find and acquire the energy of life are still very much alive and functioning. The problem is that in our modern food environment, these systems that underly our decision making processes no longer lead us to a productive and healthy life.

Our immediate job in this modern food environment is to realize those moments of bliss experienced while eating some sugar soaked dessert are not serving your organism as a whole. It is activating a particular reward pathway in the brain. Setting off a brilliant electrical display – the perfect pattern in the perfect rhythm of time that we interpret as perfected happiness. That is the very moment were everything else, the pain, the anger, the hunger, the to-do list, all fade away. It is so obvious why so many of us comfort ourselves though food. But it only last a moment. Just as mysteriously, the fleeting feeling of bliss fades as the food passes from our mouth to the later stages of our digestive system. Simply clearing mouth real estate to make room for the next bite that will assuredly set off the same beautiful sequence of events.

The mouth pleasure is not the problem. The problem is what now masquerades as food. Food is, and always has been, that which we consume from our surroundings to nourish our energetic requirements. Think of food as an idea, a symbol. This symbol that has taken many forms throughout time. It has imbued roots, flowers, berries, organs, muscles, eggs, hamburgers, laboratory constructed hamburgers, grain, and even shelf-sustainable-indestructible-conglomerations of sugar and fat with the life sustaining force that we identify as food.

Throughout our existence food has been sacred. It is that which allows us to move through time and space. It becomes the body. Somewhere along the way we have lost the life-sustaining dimension of food. In our blistering pursuit of reward pathways in the brain, we have disregarded those aspects of food that nourish the body as a whole. We must reconnect to those life-giving qualities of food.

The easiest way to do this is to eat REAL food. That stuff on the outer rim of the the grocery store. If it doesn’t look like it came from the earth or from a creature that once inhabited the earth, it was most likely engineered for shelf life and reward pathways in the brain. When you eat plants and animals from the earth you are trusting that most masterful engineer, Mother Nature. That engineer that crafted the intricate harmony of life itself. She understands food goes beyond mouth pleasure. She understands that what is eaten becomes the body, for that cyclic interdependency is her law.

Thanks for reading.

Best explorations

-Ryan; 5/3/2020

Health Unrefined

*This is a combination of previous posts. I wanted to have the entire idea collected in a single page.

Medical Problems of the 21st Century

Pause and think about what diseases concern you you today. What diseases do you see or hear about frequently? Which conditions affect someone close to you? Those that populate my mind are cancer, heart disease, obesity, diabetes, depression, and dementia, among others. There is something that connects these seemingly disparate diseases, they are all chronic diseases. A chronic condition can be defined as a physical or mental health condition that lasts more than one year, causes functional restrictions, and requires ongoing monitoring or treatment [1]. Let’s break down this definition.

Chronic disease can be physical or mental. We interpret the world through differentiation. We like to have clear cut distinctions, labels, and discrete entities which have specific meaning. The disease process, of course, exists in the natural world, outside of our psyche and outside of our distinctions. In the natural world these clear boundaries we perceive are not so well defined, as things exist on a continuum or gradient. I make this point to emphasize that although we separate physical and mental diseases, they are not exclusive to one another. From the perspective of the disease, there is no distinction between the mind and the body. This means that even though we may consider depression to be a “mental” condition, there are very real physical effects of depression. Just as there are very real psychological effects of cancer. Disease is not limited to the artificial boundaries we use to perceive the world.

A chronic condition lasts more than one year and requires ongoing monitoring or treatment. There is a lot to unpack here. Many of us may believe that modern medicine has a drug or procedure to fix the majority our ailments. The so called silver bullet. However, if a disease is still lingering after a year, then clearly there has been no drug, no treatment, and no procedure that has done anything to remove or reverse the disease. We certainly have many tools to suppress symptoms that arise from the disease, but the root, the disease state itself, remains relatively untouched. And when the disease remains untouched, you get exactly what the definition tells us, ongoing monitoring and treatment. Ongoing monitoring and treatment is a euphemism for lifelong prescription medications (often with side effects that instigate the need for additional medication), frequent visits to the doctor, numerous referrals to specialists, occasional trips to the emergency room – all while the actual disease remains largely unchanged beneath its cloak of symptoms. And lastly, we get to the real kicker with chronic disease, chronic disease causes functional restriction. So not only do you get to deal with the disease for an extended length of time, but the life that you are able to live is no longer the life you have lived. There is the obvious loss of time and money associated with the ongoing monitoring and treatment, but the real problem is the decrease in quality of life. Dependencies are limitations. Chronic disease erodes the body’s ability to thrive, reduces its capacity to function, and forces dependencies on medical interventions that seem to only be bailing water from a boat riddled with holes.

Modern medicine has saved countless lives, and it will save and improve the lives of many more. However, I think it is largely missing the mark when it comes to the prevention and treatment of chronic disease. The numbers almost seem fake. 45% (and growing) of Americans have at least one chronic disease. 25% have multiple chronic diseases. Chronic disease is responsible for 7 out of 10 deaths in the United States. 96% of all Medicare spending goes towards the treatment of chronic disease and 83% of Medicaid spending [1]. And these are just a few of the statistics. Chronic disease is clearly demanding a different approach. *Side note, you may not use Medicare or Medicaid, but if you think you are not paying for these expenses, you would be dead wrong.*

How Chronic Disease Manifests

Chronic conditions affect the entire human organism. They are not limited to a single organ or tissue, but manifest complications throughout the body and mind. It seems that something so ubiquitous can only arise from that which is just as commonplace. These are lifestyle diseases.

Our lifestyle is an ecosystem in which the components of our body are forced to function. It is no different than the way other aspects of life organize all around us. The plants and animals that flourish in the tropical rainforests are vastly different than those that inhabit the northern hardwood forest, which look nothing like the creatures of the desert. Life suits itself to its surroundings.

Ecosystems are a collection of energy transforming machines. The outputs of one machine are the inputs of the next, and this cycle allows for different pieces to function and grow together. Each ecosystem contains unique sets of raw materials, or primary inputs. These would include things like amount of sunlight, rainfall, soil conditions, temperature, and diversity of organisms. These parameters are essentially the gatekeepers of what type of life will develop in that particular environment. Life is dynamic, diverse, and infinitely creative. These primary inputs drive the creative output of life. Only the organisms (energy converting machines) that are best suited to their particular environment will survive the endless competition for resources.

Chronic disease is a form of life that emerges from the primary inputs of our body. It is the group of machines best suited to the inputs of the way we live our life. It is type of life selected for through the environment we live in! Therefore, if the inputs are not changed, the disease state will continue to thrive, and we will be forced to live a life confined by chronic disease.

Disease is a confluence of genetic predisposition and environment, more heavily influenced by the latter. Our genes are no more than a starting point. A beginning state from which we can move largely in any direction. There are certainly those diseases in which the individual’s fate is sealed from the beginning, but these are few and far between, and much less interesting for no other reason than they are entirely out of our control. The vast majority of disease can be viewed as an opportunistic drive, capitalizing on particular set of environmental factors at a particular time.

We need a definition of our environment. It will function as an all encompassing term, denoting any phenomena, internal or external, that exerts any level of influence on the human organism. This includes, but is not limited to, the food (or food like products) we consume, physical movement (or lack thereof), our thoughts, social and family interaction, light exposure, sleep, emotional state, etc. These environmental factors represent the tools we have at our disposal to create a state which minimizes probability of disease gaining a foothold. These are our primary inputs.

These are the levers with which we can influence our health outcomes. You will notice I did not list medications, surgical procedures, or any other “medical interventions.” The goal is to construct a suitable environment so that we do not develop the conditions requiring complex medical intervention. Disease is constantly probing for a chink in our armor. This has been clearly displayed in the recent COVID-19 pandemic. It affects individuals in vastly different ways, posing a more significant risk to those already dealing with underlying health conditions (diabetes, obesity, etc.). We cannot control when our bodily ecosystems are going to be challenged by some external threat, but we can certainly try to maintain our defenses. We can push back against those lifestyle diseases that increase our risk. We can stack the deck in our favor.

Gambling On Health

We largely proceed through our days with little to no surprise. That is to say, what we expect to happen, largely does happen. In a way, this is what our nervous system has developed to do. It reduces the infinitely complex world around us to groupings of patterns, allowing us to process our surroundings and act. However, even with this predictive modeling capability that is hardwired into us, we also know that the unexpected will eventually happen. At some point, at some place, our models and predictions are completely shattered, and chaos dominates our perspective.

Imagine we each have a 365 sided dice, and every morning we have to roll the dice one time. If the dice lands on 2-365 (any number besides 1), our day is to proceed completely as expected. However, if the dice lands on 1, life is going to demand much more from us on that day. Maybe that is the beginning of a common cold, a bout of depression, an especially stressful event, the onset of neurodegeneration (that won’t be be detectable for another 20 years), back pain, a blood clot, a broken hip, stroke, heart attack, etc. Each outcome would certainly be unique to every individual, but the idea holds true for all. We all have to roll the dice every day, and chaos is lurking right around the corner.

I am proposing that we have the ability to change the size the dice we throw. We have the tools to create a robust organism that is capable of withstanding the chaos that life throws our way. I believe we have the capability to throw a 10,000,000 sided dice. That we can dramatically decrease the odds of a disease being able to capitalize on our health. The actual numbers are completely irrelevant. The idea is that we can continuously add to our dice, become more resilient, more vigorous, and more adaptable. But the 1 will always be present – even that illusory person of optimum health can be outmatched by the forces of mother nature. We should all look to increase our odds because the pursuit of health is a game we are forced to play everyday, and it only gets harder.

It should be emphasized that we can certainly decrease the numbers on our dice. In fact, the world we live in today is conducive to many behaviors that would reduce our chances of avoiding disease. Society often promotes (sometimes below the level of our conscious awareness) actions that diminish our resiliency and increase the probability that some disease will take hold. If we do not act with intention and awareness, the gravitational pull of our environment will slowly deteriorate the dice we have to throw. The ecosystem we find ourselves in today cultivates those machines of chronic disease. And it almost certainly becomes a matter of when instead of if.

The things I will talk about are nothing new. It is not cutting edge science coming to save the day. It is about finding a way to do the hardest thing in life, change the way we live. Will power sucks, it comes and goes with the wind. Diets don’t work. And the answer is not sleeping less so we can do more. We all have access to incredible levers that completely influence our state of health or lack thereof.

This concludes the table setting of our health situation in the 21st century. Going forward we will be more focussed on the strategies available to push back against chronic disease. There are issues on all levels from the healthcare institutions and laws to the individual choices we all make. We will discuss many of them, but the focus will be on the individual and the choices we can each make on a daily basis to improve our lives and the lives of those around us. I will be starting medical school in less than four months. I am going in with the acknowledgement that there are big problems with our healthcare system. Chronic disease is the downstream effect of the way we live our lives. Every individual has to take the responsibility on themselves. If we fail to give proper importance to sleep, food, movement, and our mental or emotional state, we are selecting for chronic disease. It starts today, and health is a conscious decision we all have to make day in and day out. Through food, movement, sleep, and management of stress you can create the ecosystem that pushes against chronic disease.

Best explorations

-Ryan; 4/30/2020

Sources:

Raghupathi W, Raghupathi V. An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach. Int J Environ Res Public Health. 2018;15(3):431. Published 2018 Mar 1. doi:10.3390/ijerph15030431

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Health Unrefined Part Three: Gambling on Health

Preface: This is a continuation of previous two posts regarding the ubiquity of chronic disease, and the necessity of a new approach to health. This post will hopefully stand alone, but reading the first two pieces will provide more context.

Best explorations

-Ryan; 4/27/2020

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Health Unrefined Part Two: The Manifestation of Chronic Disease

Preface: This is a continuation of yesterday’s post regarding the ubiquity of chronic disease, and the necessity of a new approach to health. This post will hopefully stand alone, but reading yesterday’s piece will provide more context.

We should start with a definition of our environment. It will function as an all encompassing term, denoting any phenomena, internal or external, that exerts any level of influence on the human organism. This includes, but is not limited to, the food (or food like products) we consume, physical movement (or lack thereof), our thoughts, social and family interaction, light exposure, sleep, emotional state, etc. These environmental factors represent the tools we have at our disposal to create a state which minimizes probability of disease gaining a foothold. These are our primary inputs.

To be continued…

Best explorations

-Ryan; 4/26/2020