The Lifestyle MD

Episode 028 Sleep Deprivation: The Silent Saboteur of Weight Loss

• Dr. Angela Andrews • Episode 28

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Are you struggling with weight management despite your best efforts? You may want to consider the role of sleep in your wellness journey. In this episode, Dr. Angela dives deep into how adequate sleep supports healthy metabolism and regulates essential hormones responsible for hunger and satiety. She discusses the significant impact of sleep deprivation on your food choices, revealing why you're more likely to reach for unhealthy snacks when tired.

Dr. Angela shares condensed information and backed by research to reveal how chronic lack of sleep can lead to hormonal imbalances, decreased energy expenditure, and increased fat storage. More troubling, she connects sleep loss to long-term health risks, including obesity and diabetes. The episode provides actionable strategies to enhance your sleep quality, from establishing a consistent sleep schedule to creating a restful environment, urging listeners to prioritize rest for effective weight management. Don't overlook the importance of sleep—it's time to make it a key component of your health plan! Be sure to listen in and discover practical tips to make a meaningful difference in your wellness. Don’t forget to subscribe, share, and leave us a review!

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Speaker 1:

A person who is getting adequate sleep seven to nine hours per night consistently is going to have stable blood sugar, going to have regular hunger hormones that are going to be well controlled and going to have high energy and energy expenditure. Another person who is chronically sleep deprived or even just intermittently sleep deprived, is going to have increased hunger, poor glucose control, lower metabolism and higher fat storage. Poor glucose control, lower metabolism and higher fat storage. Welcome to the Lifestyle MD podcast, the podcast dedicated to high achieving women who are conquering their careers while striving for total wellness. I am Dr Angela Andrews and I am thrilled to be your guide on this journey. On this journey, hello. Welcome to another episode of the Lifestyle MD. So grateful to have you with me today. In this podcast episode, we're going to be talking about sleep and, yep, I delayed this one a little bit because I have been struggling with sleep myself, but we'll get more into that later. Oh man, sleep is so important. All right, if this is your first time listening to our podcast and you like it, please leave a review and share with someone else If you're already a subscriber and you are a regular listener. Thank you again, and we love to hear your suggestions about topics that you'd like to hear about.

Speaker 1:

On to our topic Today. We are not just talking about sleep, but really the impact of sleep, or lack thereof, on weight management. I cannot tell you how often patients will come to me with concerns about weight and weight gain, and one of the things that they are neglecting amongst all of the other issues whether it's lack of exercise or diet is their inadequate sleep. It's not uncommon for a woman to tell me that she's getting, on average, four hours of sleep per night. Well, I can tell you that is inadequate for a whole lot of reasons, but not the least of which. If you're trying to lose weight, it is definitely insufficient, and in this episode, I'm going to get into why. The topics I'll be breaking down today about sleep, how sleep affects your metabolism, how sleep affects the hormones, how sleep affects your food choices, and then I'll break down some ways that you can improve your sleep and hopefully also have a positive impact on your weight management.

Speaker 1:

All right, let's get into it. Just in case you are questioning the connection between sleep and weight, I'll share with you a little bit of research. A meta-analysis in the obesity reviews found that people who slept less than six hours per night had a 55% higher risk of obesity than those who slept seven to nine hours. Another study showed that sleep deprived individuals burn fewer calories, but stored more fat, especially around the midsection. In this first section, I'm going to explain to you why this makes sense. It's because of the metabolism changes that go along with sleep deprivation. So let's define what metabolism really is.

Speaker 1:

So metabolism is the body's process of converting food into energy. Sleep is a crucial component to regulating that, and if you are getting inefficient sleep, it's going to affect how efficiently your body burns calories. It's also going to influence the rate of fat storage and it's also going to influence your insulin sensitivity. Chronic sleep deprivation will chronically disrupt these processes. So, starting off with circadian rhythm, a natural internal process that regulates your sleep-wake cycle, and this repeats roughly every 24 hours. Suffice to say, it is controlled by a spot deep in your brain. A well-regulated circadian rhythm helps promote both deep and restorative sleep, and if you have disruptions in that, so whether it's jet lag, shift work, a regular sleep schedule, this can lead to poor sleep quality, insomnia and then daytime fatigue. Okay, big picture here your internal clock. Circadian rhythm regulates metabolic functions, everything from digestion, energy expenditure and energy storage. Sleep disruption misaligns this rhythm and that can lead to slowing of your metabolism and increased fat storage.

Speaker 1:

I should probably do a separate episode entirely on metabolism and all the things that affect it, just generally speaking. But I'm going to give you a quick overview of what goes into your determination of your metabolic rate. So metabolic rate, or metabolism amount of calories you burn overall, or your total energy expenditure for the day, is made up of three things. One, your basal metabolic rate, so that is the calories that your body is burning at rest to perform basic life functions breathing, circulating blood, cellular repair. The next component, number two, is a thermic effect of food, or the calories your body burns from digestion. Interestingly, protein has the highest thermic effect 20 to 30% followed by carbohydrates, 5 to 10% and fats, 0 to 3%. The next part is energy expenditure, or calories burned from movement. So your total metabolism, or your total energy expenditure, is a sum of basal metabolic rate, thermic effect of food and activity, energy expenditure, or the calories you burn through movement.

Speaker 1:

Inadequate sleep lowers your basal metabolic rate and can decrease the amount of energy your body is burning through digestion. So get this without altering the amount of calories you consume no more, no less, without altering how much exercise you're doing no more, no less, without altering how much exercise you're doing no more, no less. Simply getting inadequate rest is going to lower your basal metabolic rate, lower the amount of calories your body burns from digestion and lower the calories burned from exercise. You do nothing different and you're going to lower your total daily energy expenditure. It's going to take more effort to burn more calories because your body is less efficient at doing it. That's what that means, okay.

Speaker 1:

Final component on sleep and metabolism has to do with insulin sensitivity and glucose regulation. This is going to lead us into the next part of our conversation about hormones. But specifically here, when you're getting poor sleep, you're going to decrease your body's sensitivity to your natural insulin. That means that you're going to have higher circulating levels of blood sugar and you're going to consequently have more fat storage, because when you've got a lot of extra sugar floating around, your body sees energy sugar equals energy and says we have got to put some of this in storage and that's how you build more fat. So chronic sleep deprivation is linked to increased risk of type two diabetes. See the connection there Less insulin sensitivity, poor glucose regulation, higher risk type two diabetes. So if I could paint a picture here showing you what this looks like, a person who is getting adequate sleep seven to nine hours per night consistently is going to have stable blood sugar, going to have regular hunger hormones that are going to be well controlled and going to have high energy and energy expenditure. Another person who is chronically sleep deprived, or even just intermittently sleep deprived, is going to have increased hunger, poor glucose control, lower metabolism and higher fat storage. That's it in a nutshell. All right.

Speaker 1:

Section two hormones that influence your weight Leptin, ghrelin, cortisol and growth hormone. Those are the ones we're going to talk about. Leptin is a satiety hormone. When that is down, that leads to increased hunger. Ghrelin is a hunger hormone. When that is up, that leads to increased food cravings. Cortisol, your stress hormone. When that is up, that's going to lead to more fat storage, especially in the abdominal area. And when insulin sensitivity is decreased, you're going to have more risk of weight gain and diabetes, as I talked about just a moment ago.

Speaker 1:

There's not a whole lot to say here. An article produced in 1999, spiegel et al, in the Lancet found that sleep deprivation reduced leptin levels and increased ghrelin, leading to increased appetite. Another article published in Endocrine Reviews in 2008 demonstrated that chronic sleep restriction leads to insulin resistance, which is a precursor to type 2 diabetes. We test for this in our clinic by measuring fasting insulin levels as an early sign that you might be heading that direction. And then, finally, another article published in the American Journal of Clinical Nutrition in 2010 showed that sleep restriction reduces fat loss during caloric restriction. So if you're dieting and sleep deprived, you are going to decrease your rate of fat loss. Bad combination. I'm not sure what else I can say to make the point more clear, but just as a quick reminder here.

Speaker 1:

Leptin and ghrelin this affects your satiety and hunger. We want to make sure that those are in check. Cortisol this is influenced by stress and also lack of sleep. Increased cortisol equals increased belly fat. And growth hormone this hormone is necessary for muscle repair and fat metabolism and overall weight regulation. A growth hormone is secreted at its highest during night and if we're not, or during our slow wave sleep, and so if we're not getting adequate sleep, we're missing out on that the healing and repair that is needed in order to build new muscle. All right, quick reminder before we go on to the next topic. If you're not already following us, check me out on Instagram Angela Lifestyle MD. If you are in the Grand Rapids area and looking for a primary care doctor and looking for a direct primary care, check out our practice, seeds of Health. You can look on our website at wwwseedsofhealthdpccom. And yeah, that's it. Take a look, check us out, follow, if you're not already following us on Instagram.

Speaker 1:

All right, sleep deprivation and unhealthy eating habits. When you are not getting enough sleep, you are more likely to make poor food choices. When the body does not get enough rest, it compensates by increasing your cravings for high calorie, high sugar, high fat foods. By impairing impulse control and your decision making. You ever wonder why, when you're tired, you're more likely to crave these fatty, high calorie foods. Well, this is a natural, protective evolutionary process that does not serve us well at all in modern society. So why is this happening? What is it about sleep deprivation that makes us crave these foods?

Speaker 1:

Research has shown us that sleep restriction increases endocannabinoid circulating levels. Endocannabinoid system activation leads to heightened pleasure response from junk food, and this is because when these levels are higher, you have a higher preference for energy dense foods. Your body starts seeking out energy dense foods, such as those high in fat, high in sugar. Furthermore, the brain's reward system becomes more active, the dopamine response, making junk food more compelling and appealing. So you're seeking that out. When you eat junk food and you have these things that are high in fat, sugar and salt, it actually activates that dopamine response system. You don't have to take my word for it. A study published by Greer et al in 2013, published in Nature Communications, used fMRI scans to show that sleep deprived individuals had an increased activation in the brain's reward centers when they were exposed to unhealthy foods. So they were more likely to choose those foods because that reward system was more hyper reactive. Okay, great.

Speaker 1:

So why does our prefrontal cortex, why is it not doing this job? If you're in the medical field or you're a scientist, or you're already familiar with some of this stuff, you may be aware that our impulse control, our ability to forego reward, to forego pleasure, in favor of what's perceived as a better choice or delayed gratification, comes from our prefrontal cortex. Well, no surprise here. Sleep deprivation reduces your prefrontal cortex function. It reduces your willpower and self-control. Sleep deprivation also makes your amygdala more overreactive. We've all seen an overtired toddler, an overtired teenager and even an overtired adult. And what happens when you are overly tired? Your stress response is amplified, you are more impulsive and you are craving more high cal. Stress response is amplified, you are more impulsive and you are craving more high caloric foods, processed foods. It's all tied to all these things and, of course, stress. Your stress response is more heightened, full circle. Higher levels of cortisol, higher levels of insulin, you know, decrease insulin sensitivity full circle, you get it.

Speaker 1:

Got another study here to prove this point, and this study was published in 2007 by Kilgore et al, titled the effects of sleep deprivation on cognition and decision making, and in this study they found that sleep deprived individuals had reduced reactivity in the prefrontal cortex, leading to poor dietary decisions. So same conclusions and again earlier reference to study by Greer showing that sleep deprivation reduced self-control, making people more likely to choose high fat, high carb foods. And if that's not enough, our energy expenditure is lower. We're making poor food choices. And now we're also more fatigued, which means we have less motivation for exercise and a higher tendency to be sedentary. So sleep deprivation reduces your desired exercise. Also reduces your endurance and muscle recovery. This combination as a whole leads to increased caloric intake and reduce energy expenditure, which is a perfect recipe for weight gain.

Speaker 1:

Okay, now, great, I've told you all of the reasons why sleep is important and how sleep could be impacting your ability to lose weight. What can you do about it? I mean, the obvious answer is get more sleep. But for most people especially busy, overworked, stretched in so many directions, not prioritizing yourself, type A type individuals this is a challenge. And then compound that by hormonal changes later in life, compound that by you haven't done this in a very long time. So there's so many factors to take into consideration.

Speaker 1:

Well, first of all, let's try to break this cycle of poor sleep and fatigue. Quality sleep is crucial I cannot say this enough to weight management. This point was driven home to me when I did bodybuilding. It wasn't until I graduated residency and I met my bodybuilding coach, tina, and in her program, one of the first things that she emphasized, besides water intake, was sleep and how important sleep was if you were going to be a competitor. So if it's that much, if it's that important on that level, I mean and that's fine, tuning, trying to get you know your peak performance, how much, how much more critical is it in your day to day life? You know, arguably, when I was competing, I was doing less overall because, basically, it consumed my life and I was either working. I was either working or training, and that was it. Now I'm juggling business, podcasts, family all these things at one time, right?

Speaker 1:

Sleep helps you regulate your hunger, hormones, metabolism and energy levels. You must adopt practical, good sleep hygiene habits If you are going to adjust your diet and lifestyle. These things are not separate, they are codependent. Lack of sleep equals more fatigue, equals less exercise, equals lower metabolism, equals weight gain. First step maintain consistent sleep schedule. Go to bed and wake up same time every day, even on the weekends. I struggle with this. I get it. When I'm doing well at this, I can tell the difference. My body just wakes up much more easily. A study published in 2018 in the journal Sleep found that irregular sleep schedules led to higher BMI and body fat percentage, regardless of the calorie intake. So again, just your sleep routine alone, even if you're not eating more calories, can impact your ability to lose weight.

Speaker 1:

Number two reduce screen time before bed. Just flat out avoid them. Avoid screens, tv, phones, tablets, all that stuff 60 to 90 minutes before bedtime. I don't care if you have a filter and a nighttime mode, I don't care. Stop looking at screens before bedtime. Blue light from the screens is one factor, but blue light aside, whatever you're doing on your screen is certainly not doing anything to contribute to your ability to fall asleep, unless you're doing a meditation program. So if whatever you're doing on your phone that 60 to 90 minutes before bedtime, or on your tablet on your screen, is not pertinent to you falling asleep and you are not exposing yourself to blue light, then don't do it. Another research study produced by Harvard found that exposure to blue light before bed reduced melatonin levels by 50%, delaying the onset of sleep by an average of 90 minutes. So if you're having a hard time falling asleep, I'll tell my patients get out of bed and go into the room and then restart. But don't get out of bed. Go into the room and look at the TV or look at your phone tablet, read a book, sit quietly, meditate something else, but don't look at a screen. All right.

Speaker 1:

Number three create an optimal environment for sleep. I'm surprised actually to find that many of my patients actually do this already, but I'll reiterate the points here. Cool room temperature between 60 and 67 degrees Fahrenheit. So your cool room temperature between 60 and 67 degrees Fahrenheit. I admit it's cold, but I often wake up warm, warmer than I did when I went to sleep, right. So cool temperature before bed is important. If you take a hot shower before bed it actually can help your body cool down because then your body is going to try to dissipate all that heat and actually it will lead to a cooler body temperature in preparation for sleep.

Speaker 1:

So you could try that in addition to lowering the temperature in your home blackout curtains, white noise machines. So if you have external lights or lights that are creating problems or, let's say, you're doing shift work you know that's a whole other conversation but something to keep the lights low and also noise If noise is a factor in your living environment, if you don't have any problems with that, then you don't need to use a noise machine. But sometimes people need white noise machines. Sometimes people, a lot of people, sleep with a fan, not because they want the air, because they like the noise. Nothing wrong with that. If you need that, do it. Also, make sure your mattress and your pillows are appropriate for sleep. That's a barrier for a lot of folks, you know, if you can't afford and you're sleeping on a really difficult mattress. That sucks, because that really impacts your sleep. So if you need to start saving up for a better mattress, you don't have to spend multiple thousands of dollars.

Speaker 1:

Spend the time to understand what your body needs for sleep, because it can make a big difference. Now, an often neglected part of improving your sleep is the impact of nutrition and lifestyle habits on your overall sleep routine. So first thing we need to focus on is making sure you're eating energy dense foods throughout the day that are going to support sleep. So magnesium rich foods, leafy greens, nuts, seeds that helps relax your muscles. Tryptophan containing foods, turkey eggs, dairy although I'm not a big fan of dairy supports melatonin production. Complex carbohydrates, oats, quinoa, brown rice these help release serotonin for relaxation and if you are concerned about inadequate magnesium, you can also take a magnesium supplement before bed. Magnesium glycinate, magnesium oxide great options to take before bed.

Speaker 1:

Limit caffeine and alcohol consumption before bed. Avoid caffeine after 2 pm because the effects of that linger and even if you are falling asleep, your sleep is poor quality. That includes coffee, tea, energy drinks, also alcohol. This disrupts sleep and really not even just before bedtime, like ideally. You should stop consuming alcohol four hours before bedtime to give your body enough time to fully metabolize it before going to sleep. If you're in the habit of consuming alcohol or drinking wine or drinking having a drink at night to go to bed and relax, you may think you're helping your sleep, but you're actually disrupting your sleep because alcohol consumption, especially close to bedtime, within four hours of bedtime, can lead to more wakings and, depending on your body's metabolism, it could be a longer time. So at minimum, don't consume alcohol on a daily basis. Daily consumption of alcohol is gonna lead to daily disruptions in your sleep-wake cycle. Even if you are sleeping through the night, you will find that you are generally less rested because you're getting less deep sleep.

Speaker 1:

Now I've actually got a recent example of this from a patient. We were going through his history and I review lifestyle just all components of lifestyle choices and habits to get an understanding of how that's influencing where someone is health-wise. And one of my patients had reported frequent alcohol consumption, not daily but more than half of the days of the week, like four days out of the week at least, and usually heavy on those days. And as we were talking about it and I was making the connection between his sleep and alcohol consumption. He noticed, as he thought back, that on the days that he drank he was much more tired and had poorer sleep compared to the days where he didn't drink, and it actually took a day or two for that to improve. So roughly two days after he hadn't been drinking he observed that he slept better, he was more rested and had better energy. And that was just, you know, in a person, comparing days that he drinks compared to days that he doesn't drink. So at minimum, just don't drink every day. It's not good for you anyway.

Speaker 1:

Another thing avoid late night eating. We talked about foods that you should eat, but eating close to bed, especially heavy meals close to bed, is going to put your body in the focus of digestion instead of sleeping. You really need to aim to finish most of your eating two or three hours before bedtime. If you're going to have something to eat, it should be super light and easily to digest, because otherwise your body's energy and attention is going to be going toward digestion. All right.

Speaker 1:

Final point in this part is stress management and relaxation. It's a little bit harder to do. Cortisol affects your sleep, right. If you're chronically stressed, you're going to have a hard time getting sleep, and so this is harder to unpack. But you know relaxation techniques, journaling, mindfulness, working with a therapist, working with a sleep specialist if you're struggling with this because of chronic stress, it's really important. You know, using sleep aids is a bandaid. It's actually not improving your recovery and your sleep is in some ways, worsening the problem can have a whole nother episode just talking about sleep aids and how really ineffective they are at improving your sleep quality. So if you're not getting good sleep because of chronic stress and you're chronically dealing with high cortisol levels, definitely recommend working with your practitioner and getting a therapist, kind of like, taking a more holistic approach to trying to resolve this issue. All right, that's it. We finally have made it to the end.

Speaker 1:

That was a long-winded, complicated, detailed episode. I hope you found it helpful. I'm gonna just give you some key takeaways here. First of all, inadequate sleep. Sleep deprivation leads to hormone imbalances which increase your appetite. It also leads to increased cravings for high-calorie foods, leads to poor decision-making and more impulsive eating habits. Leads to lower physical activity and lower energy burning. And although this episode was focused on the impact of sleep on weight, the long-term effects of poor sleep go way beyond that. Yes, you have higher risk of obesity, but you also have higher risk of insulin resistance and diabetes, more likely to have belly fat storage, which is going to increase your risk of all sorts of metabolic-related syndromes and diseases, going to increase chronic inflammation and gut-related issues.

Speaker 1:

So five things I want you to take away from this episode. Number one prioritize getting seven to nine hours of sleep per night to help regulate your hunger hormones. Limit your screen time before bed to improve your sleep quality. Avoid late night snacking, especially high sugar, high fat foods. Prepare healthy meals in advance to prevent impulsive eating, so it kind of takes the energy out of having to use your prefrontal cortex. And then finally, incorporate regular exercise to balance your energy expenditure. What's missing from this is going back to number one. Don't compromise sleep in order to exercise more because it's not going to help you. Okay, that's it. I hope you found this episode helpful. I encourage you to prioritize your sleep as a part of a holistic approach to your overall health and weight management.

Speaker 1:

If you have any questions or you want to comment about this episode, email me at info at Angela lifestyle mdcom. If you're interested in hearing some other topics, you can also shoot us an email there and if you haven't already read this episode, please go on and rate us so we can get more listeners. And so grateful for you joining us today. Have a great one. Bye. This has been another episode of the Lifestyle MD Special. Thank you to Lou Moussa for the show theme music created with free photography and makeup by Janae for the cover photo. And if you enjoyed this podcast and you haven't already, please subscribe today and share with another woman doctor who may benefit. You may also follow me on Instagram at Angela Lifestyle MD. I am Dr Angela. Thank you for joining me today.

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