What You Should Know About Fatty Liver Disease

An increasing number of obesity cases is driving an epidemic of a condition of excessive fat build-up in the liver. It is commonly called fatty liver disease (FLD) or hepatic steatosis.

A healthy liver contains a small amount of fat but when extra fat builds up in the liver and reaches 5% to 10% of your liver’s weight, it becomes a problem. Thus, understanding, diagnosing, and treating this progressive condition are becoming health priorities.

The Liver

The liver is a reddish-brown, wedge-shaped, unequal two-lobed organ located just below the diaphragm, to the right of the stomach, and overlies the gallbladder. It is around 6 inches wide, and weighs approximately 3.3 pounds, making it one of the largest and heaviest organs in our body.

The liver is responsible for up to 500 separate functions, usually in combination with other body organs and systems. Various liver functions are carried out by the hepatocytes (liver cells). Given its size, the liver has multiple life-supporting functions such as:

• Producing bile that helps with the digestion

• Producing proteins necessary for growth

• Storing iron needed by our red blood cells

• Regulating glycogen storage and converting nutrients into energy

• Producing substances that help blood clot for wound healing

• Producing immune factors for immunity

• Removing bacteria and toxins in our body for detoxification

Types of Fatty Liver Disease

Fatty liver disease has two types:

• Non-alcoholic fatty liver disease (NAFLD)

• Alcoholic liver disease

NAFLD is further subdivided into:

• Simple fatty liver

• Non-alcoholic steatohepatitis (NASH)

Don't let these terms get you confused. It is important to distinguish between simple fatty liver and NASH. Why? Because having a simple fatty liver does not cause liver-related sickness whereas having NASH means you have an inflammation or injury in your liver cells. NASH increases the risk of progression to more serious conditions like fibrosis (scarring) of the liver, liver cirrhosis, and liver cancer.

Statistics

It is not yet clear why some people with NAFLD develop simple fatty liver and others develop NASH. Most people with NAFLD have simple fatty liver and not NASH. In the U.S., about 3% to 7% only of the US population has NASH.

Fatty liver occurs more often in adult males. It also affects about 10% of children in the U.S. NAFLD affects about 30% of people in Western countries and 10% of people in Asia. Fatty liver is more prevalent in Hispanic people than Caucasians, while Black people have the lowest susceptibility. Therefore, you have a greater chance of developing the fatty liver disease if you are Hispanic or Asian.

For people with NAFLD, there is about an 80% 10-year survival or recovery rate. However, the rate of progression of fibrosis is estimated to be 1 per 7 years in NASH and 1 per 14 years in NAFLD, with an increasing speed.

More than 90% of heavy drinkers develop fatty liver while about 25% develop the more severe alcoholic hepatitis.

Recently, the term Metabolic dysfunction-Associated Fatty Liver Disease (MAFLD) has been proposed to replace NAFLD. MAFLD is a more inclusive diagnostic name as it is based on the detection of fatty liver by biopsy, medical imaging, or blood tests but should be accompanied by either overweight/obesity, type 2 diabetes mellitus, or metabolic dysregulation. The new definition no longer excludes alcohol consumption or the coexistence of other liver diseases. Using this more inclusive definition, the global prevalence of MAFLD rises to 50.7%.

If we use the "old" NAFLD definition, 80% of obese people, 35% of whom progress to NASH, and up to 20% of normal-weight people have NAFLD despite no evidence of excessive alcohol consumption.

Signs, Symptoms, Diagnosis

Most individuals with fatty liver are asymptomatic. If there are symptoms, it may be occasional tiredness or pain in the upper right side of the abdomen. Thus, fatty liver disease is usually detected by accident when an abdominal ultrasound, CT scan, or MRI is requested for another reason or unrelated medical conditions and your doctor may be the first one to spot it. Because fatty liver disease often has no symptoms, people would only know it until the disease progresses to liver cirrhosis.

Elevated liver enzymes on a blood test for other conditions may raise a red flag. It is a sign of possible liver injury. To make a diagnosis, your doctor may order:

• Ultrasound or CT scan to get a picture of the liver.

• Liver biopsy to determine how far advanced the liver disease has progressed.

Elevated liver enzymes are found in 50% of patients with simple steatosis. A simple blood test may help to determine the magnitude of the disease by assessing the degree of liver fibrosis. Histological diagnosis by liver biopsy is the most accurate measure of fibrosis and liver fat progression as of 2018. It takes a liver biopsy to know if a person has simple fatty liver or NASH. But the infrequent complications and cost of a liver biopsy make this impractical for people with NAFLD.

Causes

Fatty liver is commonly associated with diabetes, hypertension, obesity, and dyslipidemia, but can also be due to any one of these:

• Alcohol use - it is one of the causes of fatty liver due to the production of toxic metabolites like aldehydes during the metabolism of alcohol in the liver.

• Abnormal metabolism - aside from the mentioned metabolic syndromes, abetalipoproteinemia, glycogen storage diseases, Weber–Christian disease, acute fatty liver of pregnancy, and lipodystrophy are considered to cause fatty liver.

• Nutritional causes - obesity, insulin resistance, and malnutrition are the most common nutritional causes of fatty liver. Total parenteral nutrition, severe weight loss, refeeding syndrome, jejunoileal bypass, gastric bypass, jejunal diverticulosis with bacterial overgrowth may also cause fatty liver.

• Drugs and toxins such as amiodarone, methotrexate, diltiazem, expired tetracycline, highly active antiretroviral therapy, glucocorticoids, tamoxifen, environmental hepatotoxins (e.g., phosphorus, mushroom poisoning)

• Other causes such as celiac disease, inflammatory bowel disease, HIV, hepatitis C (especially genotype 3), and alpha 1-antitrypsin deficiency

Some people get the fatty liver disease without having any pre-existing conditions. But these risk factors make you more likely to develop it:

• Being obese or overweight.

• Having Type 2 diabetes or insulin resistance.

• Having metabolic syndrome (insulin resistance, high blood pressure, high cholesterol, and high triglyceride levels).

• Taking certain prescription medications, such as amiodarone, diltiazem, tamoxifen, or steroids.

Risks & Complications

Fatty liver disease doesn’t cause major problems for most people. However, it can turn into a more serious problem if it progresses into liver cirrhosis. Untreated liver cirrhosis eventually leads to liver failure or liver cancer.

NAFLD is intimately related to conditions like diabetes and obesity. It’s also linked to an increased risk of cardiovascular disease. The primary risks include alcohol, type 2 diabetes, and obesity. Other risk factors include certain medications such as glucocorticoids and hepatitis C.

Less than 10% of people with cirrhotic alcoholic FLD will develop hepatocellular carcinoma, the most common type of primary liver cancer in adults. But up to 45% of people with NASH without cirrhosis can develop hepatocellular carcinoma.

Treatment

If you have been diagnosed with fatty liver disease, it is important to keep your liver as healthy as possible and avoid anything that can further damage your liver. Treatment of NAFLD is generally by dietary changes and exercise to bring about weight loss. Decreasing caloric intake by at least 30% or by approximately 750–1,000 kcal/day results in an improvement in hepatic steatosis. In more serious cases, medications that decrease insulin resistance, hyperlipidemia, and those that induce weight loss such as bariatric surgery as well as Vitamin E have been shown to improve or resolve liver function. For those who are severely affected, a liver transplant may be an option.

Here are some important things you should do:

• Don’t drink too much alcohol. How much is too much remains debatable, but it’s probably best to avoid alcohol completely.

• Make sure that none of your medications are toxic to the liver. Even acetaminophen may be harmful if you take too much for too long.

• Get vaccinated to protect against hepatitis A and B.

• Control other health conditions that might also affect your liver, and check with your doctor if you might have other underlying, treatable diseases contributing to your fatty liver.

• Get regular screening tests for liver cancer if you already have cirrhosis.

Unfortunately, there are no FDA-approved medications for fatty liver disease. So far, the two best drug options affirmed by the American Association for the Study of Liver Diseases for biopsy-proven NASH are vitamin E (an antioxidant) and pioglitazone (used to treat diabetes). However, not everyone will benefit from these treatments, and there has been some concern about safety and side effects. If you have NASH, it’s best to ask your doctor whether these treatments are appropriate for you, as they are not for everyone.

Conclusion

Our body has an amazing ability to repair itself. So is our liver. Thus, fatty liver can be reversed. If you avoid alcohol, lose weight, and change your diet it is possible to reduce liver fat, inflammation, and reverse liver damage.

If you have questions regarding fatty liver disease, feel free to schedule a consultation. I will help and work with you and suggest changes that would help you. Who knows? One of the plans we offer might suit your needs. Or if you want to hear from me talk about Lifestyle Medicine, feel free to listen to our podcast or contact us.

Sources:

Armand, Wynne. 2019. “Fatty Liver Disease: What It Is and What to Do About It” Harvard Health Blog. January 10, 2019.

Castera, Laurent, Mireen Friedrich-Rust, and Rohit Loomba. 2019. “Noninvasive Assessment of Liver Disease in Patients with Nonalcoholic Fatty Liver Disease.” Gastroenterology 156 (5): 1264-1281.e4.

Francque, Sven M., Giulio Marchesini, Achim Kautz, Martine Walmsley, Rebecca Dorner, Jeffrey V. Lazarus, Shira Zelber-Sagi, et al. 2021. “Non-Alcoholic Fatty Liver Disease: A Patient Guideline.” JHEP Reports: Innovation in Hepatology 3 (5): 100322.

Wikipedia Contributors. 2019a. “Liver.” Wikipedia. Wikimedia Foundation. July 6, 2019.

———. 2019b. “Fatty Liver Disease.” Wikipedia. Wikimedia Foundation. November 2, 2019. https://en.wikipedia.org/wiki/Fatty_liver_disease.

Is Prolonged Sitting The New Smoking?

Ever since Dr. James Levine of the Mayo Clinic coined the phrase “Sitting is the new smoking”, there have been debates if this is truly so. Some health gurus made this phrase their mantra and inspired other people worldwide to work on their desk standing. On the other hand, some people think that the phrase sounds like a curse.

Studies showed that prolonged sitting is linked to diseases such as cancer, diabetes, and cardiovascular diseases --- the same health problems linked to smoking. This comparison became the reason why the phrase came to be.

And if we are going to look at the chart below, it seems that Americans are sedentary more than half of the day.

Is it really true?

Let the Numbers Speak For Themselves

People tend to become less active as they age. Obviously, elderly people aged 75 and above have the lowest level of activity achieving around 20 minutes of physical activity daily. Only one in four elderlies are considered sufficiently active.

According to the Centers for Disease Control and Prevention (CDC), 8.3% of deaths of non-disabled adults ages 25 and older were attributed to physical inactivity. Any extended sitting --- such as at a desk, or behind a wheel, or in a car, on long plane flights, or in front of a computer --- can be harmful. An analysis of 13 studies of sitting time and activity levels found that those who sat for more than eight hours a day with no physical activity had a risk of dying similar to the risks of dying posed by obesity and smoking.

One study said the men who think they sat almost 100% of the time were more likely to be obese than men who think they sat almost none of the time. Watching TV for 3 hours or more per day was associated with increased mortality regardless of physical activity.

What Happens When You’re Sitting For Too Long?

Humans are built to stand upright. Your heart and cardiovascular system work more effectively that way. Your bowel also functions more efficiently when you are upright. Even mobile phones were designed to be used standing but it turns out that people use them more while sitting. So what happens when you’re sitting for too long?

Stiff Neck and Shoulders

Working on your desk and in front of your computer for a long time can lead to pain and stiffness in your neck and shoulders.

Hips and Back

Prolonged sitting shortens your hip flexor muscles which can lead to problems with your hip joints. Poor posture causes compression in the discs in your spine, leading to premature degeneration, which can be very painful.

Legs and Gluteal Muscles

Prolonged sitting weakens your large leg and gluteal muscles. These large muscles are important for walking and for stabilizing you. If these muscles are weak you are more likely to injure yourself from falls, and from strains when you do exercise.

Weight

Physical activity helps your body digest the fats and sugars you eat. If you spend a lot of time sitting, digestion is not as efficient, so you retain those fats and sugars as fat in your body which leads to weight gain. Even if you exercise but spend a large amount of time sitting, you are still at risk of having metabolic syndrome. Research suggests you need 60 to 75 minutes of moderate-intensity activity per day to combat the dangers of excessive sitting.

Anxiety and depression

We know that the risk of both anxiety and depression is higher in people who sit more because they miss out on the positive effects of physical activity and fitness.

Cancer

Studies suggest the dangers of sitting include increasing your chances of developing lung, uterine, and colon cancers although the reason behind this is not yet known.

Heart disease

Sitting for a long time cannot remove the fat from your blood after eating a meal, and that puts you at 147% higher risk of cardiovascular disease, heart disease, and stroke. A study found out that men who watch more than 23 hours of television a week have a 64% higher risk of dying from cardiovascular disease than men who only watch 11 hours of television a week.

Diabetes

If you spend long periods sitting, then you cannot dispose of the glucose in the food that you’re eating. Glucose accumulates in your blood and increases the risk of diabetes. Studies have shown that five days lying in bed can lead to increased insulin resistance in your body which causes your blood sugar to rise. Another research suggests that people who spend more time sitting have a 112% higher risk of diabetes.

Varicose Veins

Prolonged sitting causes blood to pool in your legs which can lead to varicose veins or spider veins (a smaller version of varicose veins). Varicose veins are not usually dangerous.

Deep Vein Thrombosis

In rare cases, prolonged sitting can lead to blood clots which can cause serious problems. Deep vein thrombosis is a blood clot that forms in the veins of your leg. DVT is a serious problem because if part of a blood clot in the leg vein breaks off and travels, it can cut off the blood flow to other parts of the body, including your lungs, which can cause a pulmonary embolism. This is a medical emergency that can lead to major complications or even death.

What To Do?

It is important to reduce sitting time AND do regular exercise to combat the negative effects of physical inactivity. Being active is not as difficult as you think. One study found out that even a two-minute light activity every 30 minutes will keep your blood glucose at a normal level. Another study said five minutes of walking the dog, folding laundry, or taking out the trash for every hour of sitting is sufficient to reduce the negative effects of prolonged sitting. Thus, it is better to build more activity into your day.

Conclusion

The phrase “sitting is the new smoking” should not be taken at its face value. It would be better to say sitting is associated with the same health risks as smoking but both could not be compared.

The damage caused by smoking cannot be offset, but moderate physical activity can offset high levels of inactivity. However, this does not mean that having your regular daily 1-hour exercise allows you to slouch on the couch the rest of the day and still reap the health benefits. No. Meeting the recommended hours of physical activity is helpful but what you will be doing for the next 23 hours is another thing.

To combat the effects of obesity and other chronic diseases, reducing the time you spend sitting is the key. And since you decide what you do in a day, you have that key!

Sources:

Barlow, Carolyn E. 2016. “Association between Sitting Time and Cardiometabolic Risk Factors after Adjustment for Cardiorespiratory Fitness, Cooper Center Longitudinal Study, 2010–2013.” Preventing Chronic Disease 13.

Becker, Lara. 2020. “Sitting Isn’t the New Smoking, Apparently.” Medical Daily. October 21, 2020.

Better Health Channel. n.d. “The Dangers of Sitting: Why Sitting Is the New Smoking” www.betterhealth.vic.gov.au. Accessed December 18, 2021.

Chandler, Meredith. 2018. “Sitting Disease: The Terrifying Facts of Prolonged Sitting.” Ergonomics Health Association. April 19, 2018.

Ekelund, Ulf, Jostein Steene-Johannessen, Wendy J Brown, Morten Wang Fagerland, Neville Owen, Kenneth E Powell, Adrian Bauman, and I-Min Lee. 2016. “Does Physical Activity Attenuate, or Even Eliminate, the Detrimental Association of Sitting Time with Mortality? A Harmonised Meta-Analysis of Data from More than 1 Million Men and Women.” The Lancet 388 (10051): 1302–10.

Graff-Radford, Michelle. 2020. “Sitting Is the New Smoking.” https://Connect.mayoclinic.org/. February 11, 2020.

Khan, Coco. 2021. “Is Sitting the New Smoking? We Ask the Expert.” The Guardian. November 5, 2021.

Laskowski, Edward. 2018. “Sitting Risks: How Harmful Is Too Much Sitting?” Mayo Clinic. 2018.

Loh, Roland, Emmanuel Stamatakis, Dirk Folkerts, Judith E. Allgrove, and Hannah J. Moir. 2019. “Effects of Interrupting Prolonged Sitting with Physical Activity Breaks on Blood Glucose, Insulin, and Triacylglycerol Measures: A Systematic Review and Meta-Analysis.” Sports Medicine 50 (2): 295–330.

The Heart Foundation. 2019. “Is Sitting the New Smoking?” The Heart Foundation. August 10, 2019.

Understanding Sleep in Lifestyle Medicine

Overview

Ever since I re-launched this website, I started discussing Lifestyle Medicine as a medical discipline and started the six areas of focus with nutrition. Each area of focus is important in itself and these should go along with the others. So enumerating them does not mean that is the order or a pattern to be followed. The next area of focus of Lifestyle Medicine I am going to share today is about sleep.

Isn’t it funny that although everyone sleeps, it is difficult for us to define precisely what sleep is? Try asking people randomly what sleep means to them and you will get different answers. Yet, and this is a reality, sleep is a human activity that almost everyone takes for granted.

Sleep Health and World Sleep Day

Last month, World Sleep Day® was celebrated. Yes, there is such a thing. It is held every Friday before Spring Vernal Equinox each year. For this year, it was held last March 19th. This annual event is intended to be a celebration of sleep and at the same time, create a call to action on important issues related to sleep which includes medicine, education, productivity, driving, and other social aspects of human life.

It goes to show that Sleep Health is being recognized as a component of Lifestyle Medicine. Sleep Health or sleep medicine is relatively new in the field of Lifestyle Medicine that scientific studies and related literature on sleep health are limited. Be that as it may, this article is going to provide you an overview of the key issues associated with sleeping habits and how to incorporate this knowledge into your own lifestyle for better health.

Definition of Sleep

Sleep is a body and mind activity which is natural, recurring, and reversible. It is characterized by altered consciousness, decreased responsiveness to external stimuli, inhibited senses, reduced muscular activity, reduced interactions with surroundings, rapid eye movement, and dreams. It is associated with a typical posture of lying down with eyes closed. Scientists say that during sleep there are brain wave activity changes, as well as changes in the rate of breathing, heart rate, body temperature and other physiological functions. Also, sleep is relatively easy to reverse which distinguishes it apart from coma and other disorders of consciousness.

The Anatomy and Physiology of Sleep

For many centuries, physicians used to believe that sleep was a period of physical and mental inactivity only to realize over the last 60 years that the brain remains active during sleep. In fact, several brain structures are involved in sleep.

The brain’s hypothalamus contains nerve cells that control sleep and waking up. Within the hypothalamus is the suprachiasmatic nucleus (SCN) that receives information about light exposure directly from the eyes and controls your behavioral rhythm. The brain stem (includes the pons, medulla, and midbrain) communicates with the hypothalamus to control the transitions between wake and sleep. A brain chemical called GABA is produced in the hypothalamus and the brain stem. It reduces the activity of arousal centers. The pons and medulla send signals to the limbs and other body muscles to relax so that you don’t involuntarily act out your dreams while sleeping. The thalamus which relays information from the senses to the cerebral cortex becomes quiet, letting you tune out the external world. During REM sleep, the thalamus sends the cerebral cortex images, sounds, and other sensations which make your dreams come alive. The amygdala becomes active during REM sleep because it processes the emotions. The pineal gland receives signals from the suprachiasmatic nucleus (SCN) which increases the production of melatonin, a hormone that puts you to sleep once it gets dark. The basal forebrain promotes sleep and wakefulness, while a part of the midbrain acts as an arousal system. Release of adenosine, a chemical by-product of cellular energy consumption supports your sleep drive.

There are two basic types of sleep: the non-REM sleep and the rapid eye movement (REM) sleep.

The first stage of sleep is a non-REM sleep that changes over from your wakefulness then it slows down to your sleep. This lasts for only several minutes, thus it is short. It is characterized by a relatively light sleep. Your heartbeat, breathing, and eye movements are slow. Your skeletal muscles start to relax with occasional twitches. Your brain waves begin to slow down, too.

The second stage of sleep is also a non-REM sleep which is a period of light sleep before entering the deeper sleep. Your heartbeat and breathing are slow, your body cools down, your skeletal muscles relax even further, and your eye movements stop. Your brain wave activity slows down but with brief bursts of electrical activity. Most of your sleep cycles happen at this stage more than in any other stages.

The third stage of sleep is a non-REM sleep characterized by a period of deep sleep that you need to feel refreshed in the morning. It occurs during the first half of the night and has a longer period. Your heartbeat and breathing are slow at their lowest levels during sleep. Your skeletal muscles are relaxed. This is the stage where it would be difficult to wake you up. Your brain waves become even slower.

REM sleep occurs within the first 90 minutes after you fall asleep. Your eyes move rapidly from side to side behind closed eyelids. Your brain wave activities seem closer to that of your wakefulness. Your breathing becomes faster and irregular, and your heartbeat and blood pressure increase to near waking levels because most of your dreaming occurs at this stage. The arm and leg muscles become temporarily paralyzed preventing you from acting out your dreams.

Process C and Process S

There are two body mechanisms that work together to regulate your sleep: the Circadian regulation (Process C) and homeostatic control (Process S). Although there are other factors affecting your sleep, understanding these two processes will help you strive towards a consistent sleep schedule.

Process C refers to your internal clock, regulated by the suprachiasmatic nucleus (SCN) of the hypothalamus. This clock regulates and controls your 24-hour sleep-wake cycle via the influence of light and melatonin. In the absence of light, as during the evening, melatonin is produced by your body promoting sleep but in the presence of light, your production of melatonin ceases, signaling your brain that it is daytime and you need to wake up. However, your behavior can override these natural signals. For example, bright lights at night shut down your production of melatonin, delaying your sleep until late hours of the night.

Process S promotes your sleep based on the previous amount of time that you spent awake. During wakefulness your brain accumulates substances that promote sleep, when you sleep these substances are cleared up and you feel alert again. This process is particularly important when you take naps in the afternoon, because you deplete the sleep promoting substances and you are not able to fall asleep at a reasonable time in the evening. The best sleep is when you synchronize your sleep/wake times to your internal clock and find a perfect equilibrium between your Process C and Process S.

Why Do We Sleep?

There are numerous theories on why you sleep and no theory will ever be proven correct. However, sleep may be explained by two or more of these theories. By understanding why you sleep, you will learn to respect sleep as a body function and enjoy its benefits rather than taking it for granted.

Inactivity Theory

Also known as the Adaptive or Evolutionary Theory, this suggests that inactivity at night is an adaptation and means to survive especially when you would be vulnerable.

Energy Conservation Theory

According to this theory, sleep reduces your demand for energy and your energy expenditure during the day especially at times when you are not in search of food. This is because your body temperature and caloric demand decreases while sleeping. Studies show that energy metabolism goes down by 10 percent during sleep. This supports the opinion that sleep helps organisms conserve their energies.

Restorative Theory

This theory is based on the belief that sleep restores what your body has lost while you are awake. It provides a time for your body to repair and rejuvenate. There are findings that show muscle growth, tissue repair, protein synthesis, and growth hormone release happen during sleep.

Brain Plasticity Theory

This theory is based on findings that sleep is correlated to changes in the structure and organization of the brain known as brain plasticity. Its connection to sleep has critical roles especially in the brain development among infants and young children and with adults as well. This is seen in the effect sleep deprivation on learning and performance of various activities.

While these theories do not directly answer the question why you sleep, it does set the stage for putting sleep in a new context and generating new knowledge about this essential body activity.

How much sleep do we need?

Some people prefer going to bed early while others have a preference for staying up late. But as mentioned earlier, children need to get more sleep which is essential for proper growth and development. As you age, sleep influences your immune system, memory, attention, hunger, mood, response time, and many other body functions.

The CDC has recommended the number of hours of sleep for every age group. Refer to the image below:

Although individual sleep needs and patterns may vary, most adults usually need seven to nine hours of sleep. If you feel refreshed and energized upon waking up, you are getting enough sleep. But if you’re not, you probably feel sleepy, tired, sluggish, clumsy, forgetful, and even cranky.

The Sleep-Work-Life Balance Challenge

You have twenty-four hours in a day and one-third of that is allotted for sleep and the other two-thirds are for your activities during wakefulness. That two-thirds of a day is still divided into your working hours (mainly, your job) and your time for other activities of daily living (family, personal time, exercise, meals, commute, etc.).

But have you reflected on how you spend your twenty-four hours? Some of you may say no probably because you are too focused on your priorities like your job, or your family’s needs. A few of you would say yes because it has been your habit to track down what you’re doing.

Here is a challenge for you: For one week, try to take note of how many hours of sleep, work, and other activities of daily living you spend in a day. At the end of the week, count the number of hours you spent on sleep. If you get less than fifty hours of sleep in a week, reflect if you felt tired or sluggish most of your waking hours. Most likely you will answer yes and unaware that you already show signs of sleep deprivation.

Here is an example from a journal that shows the sleep-work-life balance:

Impact of Lifestyle and Technology Developments on Sleep

You are living in modern times, and that means you are too busy to sleep. It is increasingly difficult for you to sleep with so many things vying for your attention.

Screens

You might be spending many hours in front of your television set everyday. Americans spend more than four hours on average watching TV. That is more than three hundred hours a year spent staring at a bright television screen.

Social Media

Your social media keeps you from getting sleep because you are glued to your smartphones texting, chatting, or engaging on your different social media accounts even on bed.

Work

You value their work that there are times you bring home some of it. Now, you are probably working from home. Both setups affect your sleeping routines. Not only that, the concept of 24/7 company work shifts, or even working on a different time zone affects your sleep and can cause a sleep disorder called shift work sleep disorder.

Travel

Jet lag is characterized by difficulty of falling asleep during or after a flight, disrupted sleep, and loss of appetite. Although your friends may tag you as a jet-setter, the negative effects on your health is not “cool”.

Smoking

You already know that smoking is bad for your health. But smoking also affects sleep. A study shows that smokers sleep less and the quality of their sleep is lower as compared to non-smokers.

Substance Abuse

Some of you might take alcohol or medications just to get some sleep. Others take drugs so as not to fall asleep. These substances affect your sleeping routines severely and also lower the quality of the sleep over time.

Chronic Diseases and Sleep Deprivation

Sleep deprivation is a cumulative effect of not obtaining adequate sleep. It adversely affects the body, brain, mood and cognitive functions and impacts all aspects of health. Excessive daytime sleepiness, fatigue, clumsiness, and weight gain or loss are just several signs of sleep deprivation

Sleep deprivation can also increase your risk of vehicular accidents because lack of sleep can slow down your reaction time and decreased alertness. Also, when you don’t get enough sleep, your ability to fight infection may decrease.

We’ve been saying that chronic diseases are becoming top causes of death and illnesses. And I’ve been advocating that Lifestyle Medicine can reverse these chronic diseases. One of the areas of focus in Lifestyle Medicine is sleep. Therefore, there should be an interest in the role of sleep health in the management of chronic diseases. As per the National Heart, Lung and Blood Institute, insufficient sleep has been linked to the development and management of type 2 diabetes, cardiovascular disease, obesity, and depression.

Diabetes

Studies show that people who habitually slept for only a few hours are not able to process glucose. It seems that sleep duration and sleep quality could be predictors of Hemoglobin A1c levels, an important marker of blood sugar control. This could mean that they are most likely to develop type 2 diabetes. Therefore, it is suggested to optimize your sleep duration and quality in order to improve your blood sugar.

Cardiovascular Disease

Persons with sleep apnea, a sleep disorder, have an increased risk for a number of cardiovascular diseases like hypertension, stroke, coronary heart disease and irregular heartbeats. Also, sleep apnea and atherosclerosis share some characteristics suggesting that sleep apnea may be an indicator of cardiovascular disease.

Obesity

Research shows that obesity is linked to metabolic changes during a short sleep. Studies conducted also revealed an association between short sleep duration and excess body weight particularly in children. Sleep in childhood and adolescence is important for brain development and insufficient sleep among children may adversely affect the function of the hypothalamus which regulates appetite and food energy expenditure.

Depression

There is a complex relationship between sleep and depression. While sleep deprivation has been held as a sign of depression, recent research indicates that symptoms may decrease once sufficient sleep is restored. The study further suggests that it is important to assess the sleep sufficiency of persons with depression and to monitor symptoms of depression among persons with a sleep disorder.

Lifestyle Medicine’s Focus on Sleep

Lifestyle Medicine encourages a systematic approach to lifestyle issues including nutrition, exercise, and stress management. It also emphasizes heightened sensitivity to environmental factors in general and sleep health.

However, conventional medicine’s approach to sleep disorders falls short because they encourage reliance on sedative-hypnotics. This has taught us much about the biomedical view of sleep but it has forgotten the sleeper.

Lifestyle Medicine reduces this reliance on sedatives by (1) restoring our regard for you, the sleeper; (2) significantly expanding the range of effective interventions; and (3) reframing sleep health as a lifestyle issue.

Personalization begins by complementing standard evaluation procedures with an invitation to tell your personal “sleep stories.” Lifestyle Medicine emphasizes the importance of the doctor-patient partnership in healing. It also acknowledges your natural inclination to heal. Lifestyle Medicine has the wide range of evidence-based interventions available for sleep health in terms of sleep aids, relaxation practices, and alternative medical systems. Utilizing these interventions can help address overreliance on prescription and over-the-counter sleep medications. In recent years, practices that have long been staples of Lifestyle Medicine, such as yoga, mindfulness meditation, and breathing exercises, are finding acceptance in more mainstream medicine.

Tips to a Better Sleep

If you are having problems sleeping, here are a few tips:

1. Establish a regular bedtime and waking time. If you need to set an alarm, that’s fine, just don’t snooze.

2. Do not exceed 45 minutes of nap or daytime sleep. If you do, you may not be able to follow your established bedtime.

3. Do not smoke and do not drink excessive alcohol four hours before bedtime.

4. No coffee, tea, soda, or chocolate six hours before bedtime.

5. You are allowed to take a light healthy snack before bedtime but avoid eating heavy, creamy, spicy, or sugary foods four hours before bedtime.

6. If you think exercise will put you to sleep, you’re wrong. You are encouraged to exercise regularly but not before bedtime.

7. It also helps to have a short tepid or warm shower before bedtime.

8. Use a comfortable bed and keep your room well-ventilated. Your bed is for sleeping and should not be used for work. If you’re working at home in the bedroom, make sure that your workstation is away from the bed.

9. Turn off the lights and block out the noise.

Conclusion

Sleep Health is relatively new just as Lifestyle Medicine. Sleep, which is a natural body activity, should never be taken for granted because insufficient sleep could lead to sleep disorders and impact chronic diseases.

If you are having problems with your sleep, feel free to schedule a consultation. I will help and work with you to make changes at whatever pace you are comfortable with. There is a health program that might suit your needs. If you want to hear from me discuss more about Lifestyle Medicine, feel free to listen to my podcast. If you want to be updated with news and features from this website, subscribe to my newsletter or reach out using the contact forms below.

Sources:

American Sleep Association. 2017. “Sleep Deprivation: Symptoms, Causes, Treatments.” American Sleep Association. May 12, 2017.

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