Kathy and I mentioned in our last podcast that some people can’t lose weight no matter how much they exercise or how little they eat. This week, I saw one such woman. She weighed 250 pounds and she is 5’6” tall. Her BMI is over 40. She is very active, working all day, and comes home around 10PM. She eats a healthy dinner around 11PM, and goes to bed about an hour afterwards.
On a typical night, sleep sleeps about 4 to 5 hours. She wakes up 2 to 3 times to urinate. During the day, she tends to fall asleep if she’s sitting still. She had high blood pressure and also has borderline pre-diabetes. She also has a stuffy nose.
Her father snored like a train and underwent heart bypass surgery in his 60s, but died a few years later. Her mother is alive but is also very overweight, and snores heavily.
On examination, her airway was very narrow. A sleep study was ordered to measure the severity of her likely sleep apnea. Losing weight is also a major priority. However, as mentioned before, she’s exercising intensely and eating very little (but healthy) food.
What did I recommend?
I didn’t recommend nutritional counseling, diet pills, CPAP, or even bariatric surgery. I recommended my NOSE diet:
Nasal congestion management. I can’t emphasize how important it is to breathe normally through your nose. The nose acts to moisten, warm, filter and process the air you breathe in before it goes into your lungs. It also contains a gas called nitric oxide, which increases oxygen uptake in your lungs by 10 to 20%. Having a stuffy nose can also create a vacuum effect in your throat, sucking up more stomach juices, especially if you have apneas. I have a resource on How to Unstuff Your Stuffy Nose.
Outdoor exercise. Many people prefer to exercise indoors, but in general, exercising outdoors in sunlight has advantages. First of all, you’re exposed to more sunlight, which is the most important source for Vitamin D, which is actually a hormone that affects every part of your body and brain. If you can get some sunlight into your eyes early in the morning, it also helps to reset your sleep clock so that you’ll want to go to bed earlier.
Sleep more than 7 hours. Studies have shown that people who sleep less than 5 or more than 9 hours have much higher risks of diabetes, cancer, depression, suicide, and even death. Just like in the story of Goldilocks and the Three Bears, your sleep quantity has to be “just right.”
Empty your stomach. Going to bed with your stomach juices lingering can potentially worsen your sleep quality. Having even occasional apneas can suction up your juices (which includes acid, bile, enzymes, and bacteria) into your ear, nose, throat, and lungs.
Studies have shown that poor sleep in general (lack of quality or quantity of sleep) can alter your stress and appetite hormones. For example, both sleep deprivation and obstructive sleep apnea will raise your stress hormones. It’s also been found to lower leptin, which is the hormone made by your fat cells telling you that you’ve had enough food (the satiety hormone). Ghrelin, which is made in the stomach, goes up. This hormone signals that you’re hungry. All this happens so your body can get more energy. This is one of hundreds of pathways how lack of sleep can cause you to gain weight, or have difficulty losing weight. Not too surprisingly, gaining weight is a major risk factor for developing obstructive sleep apnea.
Poor sleep in general (as well as stress) also will make you prefer to eat unhealthier foods, particularly items that contain sugar, starch, salt, or fat. Notice the vicious trend: Poor sleep causes more hunger later in the night, with cravings for less healthy foods. This causes more acid reflux in the throat, causing more swelling and more apneas, suctioning up more stomach juices into your throat.
Additionally, having multiple obstructions at night will stretch your heart, making it think that you have too much fluid. Atrial natriuretic peptide is created by your heart, which acts on your kidneys to make you urinate slightly more than usual. Notice that you’ll typically wake up around the same time, or at multiple intervals of 90 to 120 minutes, which is one sleep cycle.
What if you can’t fall asleep, keep waking up in the middle of the night, or can’t stay asleep for more than 5 to 6 hours?
Ultimately, all three situations are connected, but need to be addressed separately. If you’re having trouble falling asleep (taking longer than 30 minutes to fall asleep), there are 3 simple steps that may help:
1. Follow the 4 steps of the NOSE diet
2. Avoid electronic screens close to bedtime. Extra bright blue light from newer LED screens on your computer, phones, and tablets will lower melatonin, which is your sleep hormone. If you have to work at night, use various software filters or software features that dim blue light.
3. If you can’t fall asleep within 30 minutes, get out of bed and do something quite and relaxing (such as reading a book) until you feel drowsy.
If you snore or are told you stop breathing, get checked for obstructive sleep apnea. This is a major under-diagnosed condition that will wake you up in the middle of the night, cause you to urinate at night, and potentially aggravate weight gain, lack of energy, and in more severe cases, place you at risk for high blood pressure, diabetes, heart disease, and more car accidents.
Notice that I didn’t mention anything about changing what you eat. Obviously, you have to make the right choices to eat healthy and observe portion control. But by improving your sleep quality and quantity, you’re more likely to choose healthier foods, and will be better able to know when you’re full during meals.
Make a commitment now to follow the NOSE diet for the next few months. Please come back to this post and update me with your progress.