May 24, 2017

Ten Ways to Sleep Better and Feel Better in Recovery — Dr. Ralph Carson

When do you eat your first meal of the day? Your last meal? We all have a preference for the types of foods we eat and when we eat them each day. This varies greatly from person to person. Some people are very structured with their meals — others aren’t structured at all.
 
The timing of meals matters

If you have a tendency towards binge eating, I would guess that you probably don’t eat at specific times of the day, each day.
 
In our clinic, those who seek help for binge eating disorder (BED), night eating syndrome (NES), and loss of control eating (LOC) tend to skip meals, eat light during some meals and heavy during others, graze one day and eat a lot of food the next.
 
This random timing of meals can make binge eating and associated problems worse. Here’s how:
  • Many people who have a tendency to binge skip breakfast; skipping breakfast increases body weight (Wu, 2011; Yoshida, 2012).
  • Those with a tendency of binge eating consume a high percent of their daily calories in the evening hours; night eaters often have a higher body mass index (BMI); those that consume a modest amount of food late in the day generally maintain a lower body weight (Colles, 2007).
  • Many people who binge eat tend to snack frequently; excess snacking increases weight (Howarth, 2007; Cultler, 2003; Piernas 2010 Bellisle, 2014).
  • Many binge eaters fluctuate between binge eating and restricting themselves; skipping meals can increase the tendency to binge later on.
The studies cited above seem to be in agreement with a famous saying from the mid to late 1100s:

“Eat like a king in the morning, a prince at noon and a peasant at dinner” - Rabbi Maimonides 1135- 1204).

Perhaps there is some truth to this phrase.
 
Understanding your body clock
 
Your body is run by “clocks” and you may have heard of the term “circadian rhythm.” The circadian rhythm refers to a unique, 24-hour internal clock that characterizes every aspect of human physiology, including the reproductive system, blood pressure and heart rate, metabolism and immune system.
 
You may notice this clock working when you feel as though you are “wired” to get up early or sleep in most days of the week. You may notice this clock working when you get tired at a certain time each day, or prefer to eat, exercise or socialize during certain times of the day.
 
The good news (for those who have slipped into bad habits) is that we can adjust our body clocks. What we eat and when we eat can make a difference. Light, darkness, physical activity, temperature, behaviors, social interactions, aging — these factors can alter our clocks and affect the ways our bodies function.  
 
How to regulate your body clock
 
There are a number of ways to adjust your body’s clock. If you’d like to sleep better, have more energy and reduce loss of control or binge eating, you have the power to change. Here are ten ways to reset and shift your body clock:
 
  1. For those with a tendency towards binge eating, the tendency is to stay up late and have trouble falling asleep. This makes it hard to get up in the morning. To fall asleep quicker and more easily, regulate the times you go to sleep and wake each day. Essentially, you should go to bed at the same time and wake up at the same time every day — on weekdays and on weekends. This will help to improve your circadian rhythm (Schroeder, 2013).
  2. Take melatonin but preferably only under the care of a health care professional. Discuss your sleep patterns with your doctor; he or she can prescribe a specific amount to take at a specific time each day to help you sleep better. Taking it earlier in the day may help you get to sleep earlier.
  3. Keep lighting dim at night. In the evenings, two hours before you plan to get into bed, remain in dim lighting. And, do not use blue light devices two hours before bed (put down your cellphones and tablets).
  4. Try light therapy in the morning. Expose yourself to bright light — eat breakfast by a sunny window or take a brief walk in the sunlight. If this isn’t possible, consider light box therapy. If you have questions about light therapy, please talk to your healthcare professional.
  5. Many people with BED have trouble getting up. By staying with a consistent sleep schedule, waking up becomes easier. Wake up early in the day, at the same time each day, even if you feel tired.
  6. Don’t stay up late. Get in bed at the same time each day and be consistent.
  7. Pay attention to what you eat and when you eat it. Eat a larger amount of food earlier in the day. Eat an adequate breakfast or at least eat something that resembles a balanced breakfast. On the same note, have a smaller evening meal and don’t snack — or just have a minimal/light snack between dinner and bedtime. Eat a bigger lunch and perhaps consider having your largest meal at lunchtime. Most people are conditioned to having their largest meal at night but this isn’t really chronobiologically ideal.
  8. Exercise at a regular time each day and finish your workouts at least two hours before bedtime. Late afternoon/early evening exercisers may notice that activity somewhat curbs appetite late in the day. And, exercise in the late afternoon or early evening has been shown to improve sleep quality in older adults with insomnia (Reid, 2010). If it works better for you, you may prefer to exercise early. Exercising early in the day may be more convenient or allow you to enjoy your evenings more.
  9. Eat foods high in polyphenols, particularly whole natural foods associated with the Mediterranean diet. Examples of these foods that can help to keep your body clock in sync include: dark chocolate, cocoa powder, blueberries, plums, blackberries, strawberries, seasonings (oregano, rosemary, sage, thyme, curry, basil, cloves), seeds (flaxseeds, celery seeds), tree nuts: (hazelnut, pecans, chestnuts), peppermint and spearmint, black and green olives, and soybeans (Perez-Jimenez, 2010).
  10. Avoid social jet lag. Do not prioritize professional and personal obligations at the expense of sleep. Sleep should be of high importance every day.
Get even more sleep tips here.

Why change the body clock?
 
Why do we discuss the circadian rhythm on a health blog? Well, a number of serious health problems can result when the circadian rhythm is misaligned (Laber-Warren, 2015). Here are some examples:
 
  • Decline in coordination and increased dizziness
  • Obesity
  • Cancer (breast)
  • Metabolic issues and diabetes
  • Heart disease and hypertension
  • Headaches and optical migraines
  • Insomnia
  • Fatigue
  • Infertility
  • Mood disorders and depression
  • Digestive problems, IBD, diarrhea and nausea, and more
 
For many people with chronic disorders, making lifestyle changes to alter the body clock should not be the sole focus of treatment. BUT, regulating the body clock and becoming more regular in the areas of sleeping, eating and other behaviors can help patients find structure, improve health and reduce episodes of binge eating.
 
A healthy body clock helps to keep your hormones in sync
 
As an interesting aside, here is a quick rundown of some important hormones and how they relate to the body clock, eating and sleeping:
 
  • Leptin — Turns on at night to reduce hunger
  • Ghrelin — Turns on when you wake and increases hunger; affected by meal times
  • Glucose — Peaks after meals; should stay regulated to avoid having low blood sugar during the day
  • Melatonin — Helps to regulate sleep
  • Cortisol — A stress hormone that drops at night and increases during the day; highest within 30 minutes of waking; patients with BED often have increased cortisol levels
  • Insulin — Elevated by night eating; reduces ghrelin after a meal
 
Ralph Carson, RD, PhD, is a nutritionist and exercise physiologist with over 40 years of experience. He is currently Vice President of Science and Innovation for Eating Recovery Centers (ERC). Dr. Carson is an active member on the board of the International Association of Eating Disorder Professionals (iaedp) and author of The Brain Fix: What’s the Matter with Your Gray Matter.
 
References:
 
  • Bellisle F Mals and snacking, diet quality and energy balance Physiol Behav (2014) 134: 38 – 43
  • Colles SL et al Night eating syndrome and nocturnal snacking: association with obesity, binge eating and psychological distress Int J Obes (2007) 31: 1722 – 30
  • Cutler D et al Why have Americans become more obese?  Journal of Economic Perspectives (2003) 17: 93 - 118
  • Howarth NC et al Eating patterns and dietary composition in relation to BMI in younger and older adults Int J Obes (2007) 31: 675 – 84
  • Laber-Warren E Out of Sync Scientific American Mind (September/October 2015) 26: 30-39
  • Perez-Jimenez J et al Identification of the 100 richest dietary sources of polyphenols: an application of the Phenol-Explorer database Eur J Clin Nutr (2010) 64 (Suppl3): S112 – 20
  • Piernas C and Popkin BM Snacking Increased among U.S. Adults between 1977 and 2006  J Nutr (2010) 140: 325 – 332
  • Reid KJ et al Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia Sleep Med (2010) 11: 934 – 40
  • Schroeder AM and Colwell CS How to Fix a Broken Clock Trends in Pharmacological Sciences (2013) 34:  605–619
  • Wu T et al Differential roles of breakfast and supper in rats on a daily three meal schedule upon circadian regulation and physiology Chronbiol Int (2011) 29: 890 – 903
  • Yoshida C et al Early nocturnal meal skipping alters the peripheral clock and increases lipogenesis in mice Nutr Metab (2012) 9: 78 
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