Sleep Your Way to Successful Weight Loss

More than a third of American adults are not getting enough sleep. Similarly, more than a third of American adults are overweight or obese. These statistics are not surprising; however, the link between them is less obvious.

After just one week of sleep deprivation, people had worse metabolism for carbs, higher blood sugars and higher cortisol levels in one study. All of these changes cause insulin resistance and high insulin levels, which lead to obesity and type two diabetes.

Targeting insulin resistance and high insulin levels makes for effective weight control, and sleep  is an important part.

Recommendations

  • Get at least 7 hours of sleep/night
  • If you are sick or recovering from sleep debt, sleeping more than 9 hours/night may help
  • Limit daytime naps to 30 minutes
  • Avoid caffeine and nicotine close to bedtime
  • Exercise during the day
  • Avoid foods that cause indigestion near bedtime (ex: spicy food, citrus, fatty/fried foods, carbonated drinks)
  • Expose yourself to natural light during the day
  • Establish a relaxing bedtime routine
  • Sleep in the dark, the following can help:
      • Sleep mask : I highly recommend this one!
    • Black out curtains
    • Turn off the TV, cell phones, lamps, night lights
  • Optimize your sleep environment with:
    • Comfortable bed and pillows
    • Cool bedroom (60-67 degrees Fahrenheit)
    • Earplugs

Shaping metabolism starts young (probably even in utero), so make sure your kids have good sleep habits, too. They need even more sleep than adults.

  • Infants 4-12 months: 12- 16 hours per 24 hours
  • Children 1-2 years: 11-14 hours per 24 hours (including naps)
  • Children 3-5 years: 10-13 hours per 24 hours (including naps)
  • Children 6-12 years: 9-12 hours per 24 hours
  • Teens 13-18 years: 8-10 hours per 24 hours

“CDC Newsroom.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/media/releases/2016/p0215-enough-sleep.html.

Paruthi, Shalini, et al. “Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine.” Journal of Clinical Sleep Medicine, vol. 12, no. 06, 2016, pp. 785–786., doi:10.5664/jcsm.5866.

“Sleep Hygiene.” National Sleep Foundation, sleepfoundation.org/sleep-topics/sleep-hygiene.

Spiegel, Karine, et al. “Impact of sleep debt on metabolic and endocrine function.” The Lancet, vol. 354, no. 9188, 1999, pp. 1435–1439., doi:10.1016/s0140-6736(99)01376-8.

Watson, Nathaniel F., et al. “Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion.” Journal of Clinical Sleep Medicine, 2015, doi:10.5664/jcsm.4950.Consensus Conference Panel: Nathaniel F.

 

 

Phoning a Friend

It’s the height of flu season and today I was super sick. My husband is working nights. I have a clingy almost 2-year-old and I’m 30 weeks pregnant.

So what did I wake up thinking? Absolutely nothing different. Hubby will sleep, I get Ava up for bath, breakfast. Maybe we can watch movies together since I’m not feeling well. I hope she poops today.

During my last month of pregnancy with Ava I had a slew of medical problems. I had quadriceps tendonitis and couldn’t walk after literally running between hospitals to take care of patients. If anyone knows how hilly Pittsburgh is, they know that nobody should run the mile incline from Magee Women’s hospital up to the VA – pregnant or not.

At the begging of my orthopedic surgeon, “Arti, I really don’t want to have to do surgery on a 9 month pregnant lady,” I sort of took two days off – I did rehab at home over a weekend and covered the inpatient consult service overnight by phone.

I returned to work on the inpatient service on the busiest month of the year, January. I developed pneumonia, could not sleep at night due to a productive cough for the last month of my pregnancy and broke a rib from the hacking cough.

Thanks to my iPhone’s activity tracker, I knew I would walk 4 miles between hospitals and up and down stairs before noon. I had such severe edema in my legs, I gained 20 pounds just from the swelling in that last month. I thought I was getting fat, but when I was below pre-pregnancy weight within two weeks of delivery, I knew the swelling was legit.

I have no health problems normally and I’d had a very healthy pregnancy until the end. Ultimately Ava came into the world after an arduous 40-hour labor that ended in an urgent c-section. My OB could only chalk up the complications to the stress I’d put my body through in the few weeks leading up. All this because partially, I feared the consequences of advocating for myself and because I really thought I was doing the right thing by not requesting help.

Flash forward to this weekend. Hubby came home from a long night shift – his fifth night out seven. Luckily he’s an intensivist who sees the sickest. After checking my vitals, he got the toddler up and ready and insisted we need to ask for help. I hemmed and hawed. He finally convinced me by saying our daughter needed limited exposure to me so she doesn’t get sick, too.

We phoned a friend, and I felt awful. I would happily help anyone in the same situation, but asking for help seemed like asking for so much. For the sake of my kid and so my husband could get some sleep, I acquiesced.

He dropped us off, I loaded up on Tamiflu and cough syrup, and crashed in my friend’s guestroom while my daughter played with her’s, ate lunch and napped. I felt so much better than I would have if I’d stayed home by myself and tried to do it myself. And as far as I know, my friend still likes me.

I’m not the only one who has this awful and wonderful combo of being a type A physician mom who thinks she should be able to do everything alone. But sometimes, we just need a little help from our friends, and having the courage to ask can save everyone a lot of trouble in the end.

*written 1/27/18

Eating for Two

As soon as I got pregnant with my daughter, the advice started rolling in.

“Stop running.” “Don’t exercise.” “Eat more.” “You’re too skinny.”

The age-old line, “You’re eating for two,” bombarded me all day, everyday.

Pregnancy number two was no different.

We grow up with this notion that pregnancy is a blissful time when a woman should indulge her cravings. I grew up in a culture that has no expectation that a woman will return to a normal weight postpartum.

As a physician who focuses my entire life on metabolism, I know this well-intentioned advice is not only wrong; it is dangerous.

Ladies, let me be the one to break it to you – pregnancy is not the time to load up on pies, fries and ice cream. It is not the time to pack on a ton of extra weight with a plan to lose it later.

First of all, you are eating for 1.1 at max, not even close to two. My 28-week- old fetus weighed just a tad more than 2 pounds when I had my most recent oral glucose tolerance test. Sure he’s growing fast, but he does not need the 1200 calories I typically need for an average day. Eating for two will make you rapidly gain weight.

Second, all of us have increased insulin resistance during pregnancy. For some women, this manifests as gestational diabetes that needs close monitoring. Even if you are not diabetic, you become more glucose intolerant during pregnancy and this programs us to lay down fat.Worse, women who are overweight or obese are likely to gain more weight than recommended during pregnancy and to gain weight postpartum.

Third, eating right in pregnancy is hard between nausea and reflux. If we don’t try, we will fail.

Why is this important?
1. Gestational diabetes: If not well-controlled, GDM can cause birth defects, big babies with delivery complications, dangerously low blood sugar in the newborn, and increased risk of obesity and diabetes for your child.
2. Losing the baby weight is hard: Studies showed that around 20% of women have more than 10 pounds hanging around long-term after having a baby. Excessive pregnancy weight gain and postpartum overweight directly correlate with overweight decades after pregnancy leading to detrimental health consequences.

3. Your child’s long-term health: Kids whose moms were overweight or obese while pregnant are pre-programmed to be at higher risk for obesity and type two diabetes during their lifetime due to persistent high insulin levels transferred during gestation.

Recs:
– Eat nutritiously during pregnancy – avoid processed foods
– Talk to your OB about recommended weight gain
– Stay active during pregnancy
– Get enough sleep
– Work on stress management
– Invest in your partner for support

Gunderson, Erica P. “Childbearing and Obesity in Women: Weight Before, During, and After Pregnancy.” Obstetrics and Gynecology Clinics of North America, vol. 36, no. 2, 2009, pp. 317–332., doi:10.1016/j.ogc.2009.04.001.

Doctor. Mom. Wife. Journalist.

Hi and welcome to my blog! I’m a practicing physician in San Antonio, Texas, and I specialize in endocrinology, diabetes and metabolism. My field focuses on hormones, which are chemical signals in the body that enable important body functions – hunger, satiety, weight, temperature, sleep, blood sugar, blood pressure, the list goes on.

I treat patients who suffer from diabetes, overweight and obesity, thyroid diseases, metabolic bone disease including osteoporosis, diseases of the pituitary and adrenal glands and male and female reproductive hormone problems. The interplay of organ systems and their impact on people fascinates me. As you may guess, my job involves taking detailed histories, enabling me to learn so much about my patients’ lives and bodies. This process requires trust and faith and it is an honor to provide my patients individualized care.

I am continually exploring avenues to strengthen the patient-physician interaction, and this blog will chronicle my journey to develop these. Technology can bridge the gap between physicians and patients, especially in the management of chronic diseases, like diabetes and obesity, which require active daily engagement. Gaps in engagement have led to growing epidemics despite pharmaceutical innovation.

I believe in no wasted effort, and I am a formally trained journalist courtesy of Northwestern’s Medill School of Journalism. I’ve worked at newspapers, magazines, free-lanced and kept a blog for Medscape as a medical student. I took a hiatus during training, and now with more experience, knowledge and passion, I am ready to write again.

I hope this blog is a place where I can teach, help, share and bridge the gap. I’m a doctor, a mom, a wife, a daughter, a sister, a niece, an aunt, a struggler, a juggler, and both a superhero and the worst person in the world to a toddler. My life is a beautiful journey of learning and change, and I’d love for you to join me for the ride.