Is Your Sleep Obstructed?

Sleep apnea is when there is a pause in breathing while asleep.  There are 3 different kinds of sleep anpea – obstructive, central and mixed.  Obstructive is when the airway has become narrow, blocked or floppy.  Central is when the brain temporarily stops sending signals to the muscles that are responsible for controlling breathing.  Mixed is a combination of the two.  This article will focus on obstructive sleep apnea (OSA), although many of the causes and treatments are similar for all kinds.

It is estimated that between 3% and 7% of the population have OSA but this number could be higher as many people do not seek treatment. Older men who are obese are more likely to have sleep apnea, but it can effect women and any age group including children.[i] Obesity is the biggest risk factor for OSA so it is projected that OSA will become more common as the population becomes bigger and bigger.

OSA can cause increased blood pressure and is associated with an increased risk of cardiovascular disease.[ii]  It is also associated with an increased risk of stroke, daytime drowsiness, motor vehicle accidents and lowered quality of life.[iii]  Rates of depression are also higher in people with OSA so it is very important to seek treatment.[iv]

Treatments

Starting to exercise is the first place to begin if you have OSA.  Studies have found that OSA improved even when participants didn’t lost weight.[v]  This can have a big effect on improving overall quality of life as decreased OSA will result in a better sleep leading to more energy during the day.  Then you will be able to exercise more!  You want to do at least 150 minutes of moderate intensity exercise a week.  See my blog article on exercise for weight loss for more details.

Studies have shown that acupuncture and herbal medicine are both safe and effective treatment options for OSA.[vi] [vii]

It is also important to avoid sleeping on your back.  Purchase a pillow that encourages you to sleep on your side or you can sew a tennis ball into the back of your pyjamas to keep yourself on your side.  Avoid alcohol.  Drinking alcohol within 6 hours of sleep will worsen sleep apnea. Quit smoking.  Easier said than done, but smoking is another major risk factor for OSA.

If you think you may have OSA it is important to see your healthcare provider as even mild cases are associated with increased morbidity.[viii]  For natural treatments, contact your local naturopath and start on your path to better sleep and better health.

References:

[i] Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007 Jul;132(1):325-37.

[ii] Phillips CL, Cistulli PA. Obstructive sleep apnea and hypertension: epidemiology, mechanisms and treatment effects. Minerva Med. 2006 Aug;97(4):299-312.

[iii] Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002 May 1;165(9):1217-39.

[iv] Ejaz SM, Khawaja IS, Bhatia S, Hurwitz TD. Obstructive sleep apnea and depression: a review. Innov Clin Neurosci. 2011 Aug;8(8):17-25.

[v] Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL, Davis JM, Youngstedt SD. The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep. 2011 Dec 1;34(12):1631-40.

[vi] Freire AO, Sugai GC, Chrispin FS, Togeiro SM, Yamamura Y, Mello LE, Tufik S. Treatment of moderate obstructive sleep apnea syndrome with acupuncture: a randomised, placebo-controlled pilot trial. Sleep Med. 2007 Jan;8(1):43-50.

[vii] Wu YH, Wei YC, Tai YS, Chen KJ, Li HY. Clinical outcomes of traditional Chinese medicine compound formula in treating sleep-disordered breathing patients. Am J Chin Med. 2012;40(1):11-24.

[viii] Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002 May 1;165(9):1217-39.

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) effects from 12-21% of Australian women of reproductive age.[i] It is diagnosed by having 2 out of 3 of the following symptoms: irregular or absent ovulation, signs of excessive testosterone such as facial hair or acne, and polycystic ovaries.  The consequences of PCOS are reduced fertility, weight gain, irregular menstruation, insulin resistance (a pre-type II diabetic state in which cells do not respond to insulin leading to excess glucose in the blood) and increased risk of cardiovascular disease (CVD) and endometrial cancer.[ii]  There are other health problems that can seem similar so it is important to have appropriate testing done.  It is estimated that 70% of women with PCOS in Australia are undiagnosed. [iii] PCOS can have major health implications so if you have similar symptoms it is important to see your healthcare provider. Women with PCOS should have measurements taken for abdominal obesity, triglycerides, HDL, blood pressure, and glucose tolerance.

If you have been diagnosed with PCOS the biggest improvement can be seen with a 5-10% reduction in weight. This reduces insulin resistance as well as improving fertility and excess testosterone symptoms.  According to Australian guidelines, pharmaceutical fertility treatments should not be given to anyone with a BMI over 35 until weight is reduced because it is too big a health risk to mother and baby.[iv]  The best way to achieve weight loss is through diet modifications and exercise.  For advice on exercise please see my previous article.  A minimum of 150 minutes a week is needed to see results.  Even for women with PCOS who are not overweight exercise improves symptoms.

There are some supplements that can be helpful in improving symptoms.  Cinnamon can be taken as a supplement to help reduce fasting glucose and insulin resistance.  Berberine is a compound found in several plants and can be found in supplement form.  It has been shown to reduce insulin resistance, aid in weight loss, and improve lipid levels. Chromium and Magnesium can be helpful in reducing insulin resistance but will not help with the other symptoms of PCOS.  Inositol can also improve lipid levels, reduce CVD risk and improve fertility.

If you have PCOS and are planning on falling pregnant, it is important to improve the condition before conceiving.  Daughters of women with PCOS often have metabolic problems from infancy.[v]

If you have any questions about PCOS please see your local naturopath.

References

Some information for this article was taken from the following online presentation:

Villella S. Oligo and Amenorrhoea (unpublished lecture notes]. Health Masters Live, online; lecture given – 2013 Nov 14.

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[i] Jean Hailes Foundation for Women’s Health. Evidence based guideline for the assessment and management of polycystic ovarian syndrome. Clayton South: Jean Hailes Foundation for Women’s Health; 2011. 130 p.

[ii] Barclay L. New Guidelines for Polycystic Ovary Syndrome (internet). Medscape Medical News; 2004 Jan 28. Available from: www.medscape.org/viewarticle/467811

[iii] Jean Hailes Foundation for Women’s Health. Evidence based guideline for the assessment and management of polycystic ovarian syndrome. Clayton South: Jean Hailes Foundation for Women’s Health; 2011. 130 p.

[iv] Jean Hailes Foundation for Women’s Health. Evidence based guideline for the assessment and management of polycystic ovarian syndrome. Clayton South: Jean Hailes Foundation for Women’s Health; 2011. 130 p.

[v] Barclay L. New Guidelines for Polycystic Ovary Syndrome (internet). Medscape Medical News; 2004 Jan 28. Available from: www.medscape.org/viewarticle/467811

FAQs about Exercise

I talk about exercise in most of my articles as I believe it is one of the key factors to good health and long life.  The list of potential effects of exercise could take up most of my space but include improving cholesterol, blood pressure, diabetes, polycystic ovarian syndrome, depression, sleep apnoea, sleep, arthritis, immune health, and how you look and feel.  Most people know they should exercise but may be unsure about a few facts.  Here I will attempt to answer some of the more common questions about exercise in relation to weight loss.

How much do I need to do?   It has been found that doing at least 150 minutes of exercise in a week will have the best results for weight loss.  The duration is more important than the intensity.[i] This is because the longer you exercise the more fat you will burn.  The body stores carbohydrates in muscle as glycogen.  This muscle glycogen is used for energy in the first 20-30 minutes of exercise.  Between 30-50 minutes the body starts to use fat for energy.  At the transition point is when many people start to feel tired.  If you push through this feeling and do 50 minutes of moderate intensity exercise 3-4 times a week you will get the best results.

When should I exercise? Many people believe that exercising in the morning is the best time to get the best results.  Although this may bring slightly better results, time of day is less important than just getting out there. The best time is the time that fits into your schedule.

Should I eat before I exercise? The best results can be achieved with exercise on an empty stomach.  This will burn more fat, deposit more protein on the muscle and improve insulin sensitivity. [ii] Not everyone can exercise without eating first though.  If you feel lightheaded during exercise make sure you eat something first but just keep it small such as a piece of fruit.

Should I eat after exercise? Yes! This is the most important meal of the day. If you don’t eat then cortisol levels continue to rise leading to muscle breakdown, immune suppression and insulin resistance.  Your body also needs to replenish the glycogen it used so that you can exercise next time.  The best time to eat is within 30 minutes of exercising. [iii]

What should I eat after exercise? This is your chance to eat carbohydrates! Eat at a ratio of 3:1 carbohydrates to protein [iv] (this ratio is ONLY for post exercise).  Have some fruit or low GI grains with a good protein source.  Most protein powders will have a good ratio of protein to carbohydrates.

I’ve hit a plateau.  What do I do? As a person loses weight they need less energy to move around so they burn fewer calories.  If you have hit this point it means you need to step up your exercise.  You need to either exercise longer or increase the intensity.  Trying a different form of exercise can often be helpful too.

Many people are worried they may have gained weight over the holidays.  If you indulged a bit more than usual kick up the exercise level to compensate.  But remember that you don’t have to stop at every sausage sizzle you see.  If you have any questions about exercise talk to your local naturopath.  Make 2014 the year you get moving!

For those of you in the area, I will be practising in both Thirroul and Engadine starting in February. Check out my website for details: www.natactive.com.au

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[i] Chambliss HO. Exercise duration and intensity in a weight loss program. Clin J Sports Med. 2005 Mar; 15 (2): 113-115.

[ii] [iii] [iv] Sutherland K. Nutrition & Fuelling for Exercise and Leanness (unpublished lecture notes]. Health Masters Live, online; lecture given – 2013 July 24.

Are You Being Preserved?

In my previous article on the advantages of organic food, I focused on the health risks involved with pesticides.  In order to be organic, foods must also be free of chemical preservatives.

Many foods are prepackaged and need to be able to sit on the grocery store shelf for long periods of time.  This has led to manufacturers using preservatives to keep the food from going off before the consumer buys the product.  Some natural preservatives include sugar, salt, vinegar, ascorbic acid (vitamin C), freezing and pasteurizing (heat treating).  Others are not so natural and may be detrimental to your health.

The recent health trend to help reduce cardiovascular disease (CVD) has been to cut down on eating saturated fats and cholesterol by decreasing the intake of red meat.  This has led people to increase their intake of ‘low fat’ processed meats.  A study published this year in BMC Medicine found that there was no link between unprocessed red meat and CVD.  The link is only with processed meats due to the high sodium and preservative content. [i]  Another study found an increased risk of ovarian cancer from eating vegetables and meat containing preservatives. [ii]

A study from the US published this year found that kids who drank more soft drinks were more likely to have asthma regardless of their weight.  They only looked at kids who drank regular soft drink so they were not consuming artificial sweeteners.  The authors speculate this is most likely due to the preservatives. [iii] So just because you exercise and burn off the calories, soft drinks still have detrimental effects on your health.

Certain preservatives have been found to have a wide range of side effects.  Sodium sulfite (221) and sorbic acid (200) were found to suppress immune cells. [iv]  Sodium nitrate (251) and sodium benzoate (211) have been found to alter DNA, which is how many cancers begin. [v] Sodium sulfite and sodium benzoate were found to decrease the hormone leptin. [vi] Leptin levels falling are a trigger for us to eat.  Consumption of these preservatives can lead to overeating which leads to weight gain. Sodium benzoate and artificial food colouring have been linked to hyperactivity in children. [vii]  Sodium benzoate and potassium benzoate (212) when combined with ascorbic acid (found in juice) creates benzene, which is a known carcinogen.  Benzoates are slowly being phased out but they are still in circulation so you need to watch out for them.

Sodium metabisulphite (223) has become more popular as a preservative but it actually kills food contaminants as opposed to the others, which just inhibit the growth.  It is used to sterilize equipment for wine and beer brewing.  It is used during processing and is present at levels lethal to bacteria when we consume the products that contain it.  As I have mentioned in previous articles, having healthy gut bacteria is important to our overall health status.  Consuming foods that contain lethal levels of preservatives is going to put your gut bacteria out of balance potentially causing illness.

In Australia, as in many other countries, if an ingredient is at a concentration of less than 10ppm it does not have to be declared on the label.  This has led some companies to advertise their products as ‘preservative free’ despite containing preservatives.  This is despite the fact that 10ppm is an effective level for killing bacteria.

Although it is important to keep microbes off our food, the best thing is to eat your food fresh so you don’t need to consume any chemicals.  If you do eat preserved food, make sure you check the labels carefully. 

References

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[i] Micha R, Michas G, Lajous M, Mozaffarian D. Processing of meats and cardiovascular risk: time to focus on preservatives. BMC Med. 2013 May 23; 11:136.

[ii] Lee AH, Su D, Pasalich M, Binns CW. Preserved foods associated with increased risk of ovarian cancer. Gynecol Oncol. 2013 Jun; 129(3): 570-3.

[iii] Park S, Blanck HM, Sherry B, Jones SE, Pan L. Regular-soda intake independent of weight status is associated with asthma among US high school students. J Acad Nutr Diet. 2013 Jan; 113(1): 106-11.

[iv] Winkler C, Frick B, Schroecksnadel K, Schennach H, Fuchs D. Food preservatives sodium sulfite and sorbic acid suppress mitogen-stimulated peripheral blood mononuclear cells. Food Chem Toxicol. 2006 Dec; 44(12): 2003-7.

[v] Loutsidou AC, Hatzi VI, Chasapis CT, Terzoudi GI, Spiliopoulou CA, Stefanidou ME. DNA content alterations in Tetrahymena pyriformis macronucleus after exposure to food preservatives sodium nitrate and sodium benzoate. Acta Biol Hung. 2012 Dec; 63(4): 483-9.

[vi] Ciardi C, Jenny M, Tschoner A, Ueberall F, Patsch J, Pedrini M, Ebenbichler C, Fuchs D. Food additives such as sodium sulphite, sodium benzoate and curcumin inhibit leptin release in lipopolysaccharide-treated murine adipocytes in vitro. Br J Nutr. 2012 Mar; 107(6): 826-33.

[vii] McCann D, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchin E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner JO, Stevenson J. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet. 2007 Nov 3; 370(9598):1560-7.

Is Eating Organic Worth It?

There is an ongoing debate about whether organic foods are really better for you than conventionally grown foods.  As it is more expensive, it is important to know whether it is worth the money or not.

For a product to become certified organic it must pass several criteria including being free from synthetic pesticides, herbicides, fertilizers, antibiotics and food additives.   These products are then labeled with the logo of the certifying body.  These organizations include the USDA, Australian Certified Organic, Canada Organic, or EU Organic Farming.  Some products aim to deceive by putting the word organic in their name, but this does not necessarily mean it is organic.  In Australia, several ‘organic water’ bottlers have been forced to remove the word organic from their name.  Water cannot be organic or otherwise.  Also, organic does not necessarily mean it is free from genetic modification, but these often go together.

Pesticides are made to kill bugs on plants.  Although they are allowed in low amounts on food, it only makes sense that if they can kill big bugs, that they could kill the small bugs in your gut.  Dr. Mark Donohoe is a GP in Sydney who previously thought there was no reason to eat organic, but has recently discovered that pesticides can have a big effect on your normal gut bacteria.  Good gut bacteria are needed to keep the bad bacteria at bay.  An overgrowth of bad gut bacteria has been connected to everything from IBS and headaches, to arthritis and weight gain.  With almost every health complaint I start by making sure a patient’s gut is functioning properly. 

It is still unknown the extent to the health problems that could be caused by pesticides but it is hard to believe they can kill bugs without affecting us.  The use of neonicotinoid insecticides has been banned in the EU due to its effects on bee health.  Beekeepers in Australia are calling for a ban on them too.

A study published in January 2013 found that fruit flies fed organic produce had greater fertility and lived longer. These flies were also more active and showed more resistance to stress.  Another study published in February found that tomatoes that were grown organically were subjected to more stress.  This stress caused them to be smaller, but higher in vitamin C and phenols.  Phenols can act as antioxidants that may help lower cholesterol.

A 2012 study found a higher risk of being exposed to antibiotic resistant bacteria after eating conventional chicken or pork as well as higher concentrations of pesticides in the urine of children eating conventionally grown foods.

To keep the cost of buying organic down, you can pick and choose some foods to buy organic and other conventional.  In Australia the foods with the highest pesticide residues are, in order, apples, wheat, strawberries, pears, grapes, lettuce, nectarines and peaches.  If you eat apples every day, but only have pears once in awhile, then you want to buy organic apples but could let the pears slide.  Buying seasonal, local foods is also cheaper.  When you do buy conventional produce, make sure that you wash it well.  Remember though, just because it is organic, doesn’t mean it is good for you.  Organic sugar is still sugar!

If you have any questions about organic produce, talk to your local naturopath.

References

Amis A. The Dose Makes The Poison (Internet). Friends of the Earth; 2012 Feb. Available from: http://www.foe.org.au/sites/default/files/TheDoseMakesThePoisonFeb2012_0.pdf

Australian Competition & Consumer Commission. ACCC negotiates removal of misleading ‘organic’ water claims (Internet). 2013 Jul 16. Available from: http://www.accc.gov.au/media-release/accc-negotiates-removal-of-misleading-‘organic’-water-claims

Australian Pesticides and Veterinary Medicine Authority. Neonicotinoids and honey bee health in Australia (Internet). 2013 Mar (updated 2013 May). Available from: http://www.apvma.gov.au/news_media/chemicals/neonics.php

Better Health Channel. Food - pesticides and other chemicals. 2011 July.  Available from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Food_pesticides_and_other_chemicals

Chhabra R, Kolli S, Bauer JH. Organically Grown Food Provides Health Benefits to Drosophila melanogaster. PLoS ONE. 2013 Jan 9; 8(1). Available from: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0052988

Kamal-Eldin A, Frank J, Razdan A, Tengblad S, Basu S, Vessby B. Effects of dietary phenolic compounds on tocopherol, cholesterol, and fatty acids in rats. Lipids. 2000 Apr; 35(4):427-35.

Oliveira AB, Moura CFH, Gomes-Filho E, Marco CA, Urban L, Miranda MRA. The Impact of Organic Farming on Quality of Tomatoes Is Associated to Increased Oxidative Stress during Fruit Development. PLoS ONE, 2013; 8 (2). Available from: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0056354

Organic food better for bowel health, Dr Mark Donohoe says (Internet). The Australian. 2013 Aug 23. Available from:

http://www.theaustralian.com.au/news/health-science/organic-food-better-for-bowel-health-dr-mark-donohoe-says/story-e6frg8y6-1226702834484

Smith-Spangler C, Brandeau ML, Hunter GE, Bavinger JC, et al. Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review. Ann Intern Med. 2012;157(5):348-366. 

Healthy Eating??

Eating a healthy diet these days can often be confusing.  Many foods are advertised as being health foods, but if you look at the nutrition labels they are actually just as bad as known ‘junk foods’. 

The dairy aisle can be particularly deceiving.  Yogurts are advertised as being healthy and even able to cure most of your ailments.  While yoghurts do contain some very beneficial probiotics that can help improve digestion, unless you are eating plain unsweetened yoghurt you may be consuming a large amount of sugar.  Jalna Low Fat Vanilla Yoghurt contains almost 11% added sugar.  Activia yoghurts, which are specifically advertised as being able to help you live a healthier lifestyle, contain from 6% to 13% sugar depending on flavour.  Compare this with products we all know to be unhealthy such as Paul’s Regular Vanilla Custard containing 14% sugar and cola soft drink containing 9% sugar.

Many people try to avoid sugar by eating ‘light’ products but these often contain artificial sweeteners.  Please refer to my previous articles on sweeteners for more information on these.

Many people choose low fat dairy products to try to cut down on their saturated fat intake.  There is still some controversy on whether or not saturated fats in dairy need to be avoided, but the main problem is that low fat products do not make you feel full and so you are more likely to eat more as a result.  The same is true for low fat ice cream. 

Yoghurt can still be part of a healthy diet by buying unsweetened full fat yoghurt and adding your own fruit.

Another product in the dairy aisle that can cause confusion is milk.  Some people consume flavoured milks to try to get their calcium intake.  Oak’s chocolate milk contains over 10% sugar.  When you compare this to the sugar content of the above foods it should be considered a junk food.

If you look in the ‘Health Food’ aisle of the grocery store, you can find some other unhealthy foods. Just because a product is labeled ‘all natural’, gluten free, or organic does not mean that it is actually good for you.  Mini Macro Wholegrain Apple Fruit Filled Bars contain the same amount of sugar as their Gluten Free Choc Biscuits – over 21%.

I’m not saying that you should never eat these foods, but just that you should check nutrition labels so you are aware that these are treats that should be consumed only on occasion along with your regular healthy diet.

References

Activia

http://www.activia.com.au/what-is-activia

Accessed 12 August 2013

Jalna

http://www.jalna.com.au/wellbeing/nutritional-data.html

Accessed 12 August 2013

Parmalat

http://parmalat.com.au/

Accessed 12 August 2013

Woolworths Online

www.woolworthsonline.com.au

Accessed 12 August 2013

Are Cold Sores Getting you Down?

Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are in the same family of viruses as the Varicella zoster virus that causes chicken pox and shingles and Epstein-Barr virus that causes mononucleosis (glandular fever).  HSV-1 generally causes oral infections (cold sores) and HSV-2 causes genital infections although they can be found in both locations.  It is estimated that over 75% of Australians are infected with HSV-1 and 12% with HSV-2.   This does not mean that all these people will show signs of the virus though.  Many people carry the virus, and can pass it on, without knowing.

Herpes is an opportunistic infection, which means that it comes out when your immune system is down.  Your immune system can be affected by many things including stress, lack of sleep, sugar, alcohol, some medications and food sensitivities. If you get Herpes infections there are several things you can do to help avoid outbreaks, or treat them when they do occur.

• Ice - put ice right on the sore.  It is best to do it for about 30 seconds and as often as possible.  This helps stop the virus from spreading.

• Tea tree - you can put the oil straight on, but only use a little the first time as some people find it too harsh.  You can get cold sore lip cream containing tea tree oil from most health food stores. 

• Lysine - Take 500-1000mg 3-4 times per day.

• Vitamin B12 – take 2000mcg/day orally or 1000mcg/day by injection.

• Probiotics - these improve your immune system.  While you have a sore you can take 2 capsules 2-3x/day.

• Olive leaf extract - take 2-3 capsules per day.  Always take with probiotics but not at the same time.

• Oregano  - you can buy this in oil and put directly on the sore as often as you can.

• Avoid all nuts, nut butters and chocolate as they contain arginine that aggravates the Herpes virus.

• Avoid alcohol.

• Avoid any foods that may lower your immune system – sugar, simple carbohydrates or any food you have a sensitivity to.

• Deep breathing – getting a herpes outbreak is a way of your body telling you to slow down and relax.

If you are getting cold sores often you should mention this to your naturopath so you can work on improving your immune system. 

References

Cunningham AL, Taylor R, Taylor J, Marks C, Shaw J, Mindel A. Prevalence of infection with herpes simplex virus types 1 and 2 in Australia: a nationwide population based survey. Sex Transm Infect 2006; 82:164-168. Available from: http://sti.bmj.com/content/82/2/164.abstract

Accessed 6 July 2013