Why Is It So Hard To Control Our Appetites? A Doctor’s Struggles With Giving Up Sugar

We’ve become convinced that if we can eat more healthily, we will be morally better people. But where does this idea come from? Near the end of the hellish first year of the coronavirus pandemic, I was possessed by the desire to eliminate sugar – all refined sugar – from my diet. In retrospect, it probably wasn’t the best time to add a new challenge to my life. My wife and I had been struggling to remote-school three young kids with no childcare. My elderly parents lived out of state and seemed to need a surprising number of reminders that pandemic restrictions were not lifted for Diwali parties or new Bollywood movie releases.

Like many people in those early days, we were looking around for masks and trying to make sense of shifting government guidelines about when to wear them. In addition, as a doctor, I was seeing patients in clinic at a time dominated by medical uncertainty, when personal protective equipment was scarce, and my hospital, facing staff shortages, was providing training videos and “how-to” tip sheets to specialists like me who hadn’t practised in an emergency room for years, in case we were needed as backup.

It would have been enough to focus on avoiding the virus and managing all this without putting more on my plate. But cutting processed sugar seemed like an opportunity to reassert some measure of order to the daily scrum, or at least to the body that entered the fray each day.

My former physique was behind me and the stress of clinical practice during the pandemic was taking its toll. Maybe it was all the pandemic death in the air, but I started feeling like I was what the narrator in Arundhati Roy’s novel The God of Small Things calls “Not old. Not young. But a viable die-able age.” Maybe doing away with sugar could slow things down? More tantalisingly, maybe it could even take me back to a fresher time, the days in college when I had actually gone sugar-free for a while.

My friends offered condolences on what they called my soon-to-be joyless lifestyle. But I was set, compelled by literature about the deleterious, even toxin-like effects of added sugar. I had my doubts about being able to pull something like this off again, though, so I decided – as doctors often do – to tackle the problem by studying it.

That year, in what was arguably an act of masochism, I began the coursework required to sit for a medical-board exam on dietetics, metabolism and appetite. By earning another qualification, I thought, I would credential my way to realising my goal. After shifts at work, during breaks or once the kids were asleep, I would attend virtual lectures and pore over board-review books in a quest to understand the body’s metabolism.

I immersed myself in the physiology of exercise, the thermodynamics of nutrition, and the neuroendocrine regulation of appetite. But this knowledge didn’t break my pandemic eating habits. Cupcakes and ice cream and cookies didn’t call to me any less. And big food corporations were winning the bet that Lay’s potato chips first made back in the 1960s with its “Betcha can’t just eat one” ad campaign. So, I found myself reaching for Double Stuf Oreos while flipping through my medical textbooks and scarfing chocolate bars even as I correctly answered my practice-exam questions.

My body refused to be disciplined by my intellectual mastery of its operations. I passed the board examination, but my appetite for sugar didn’t change. I was left with more questions than I had when I started. Was sugar really a problem? Or had I internalised hangups about desire from the culture at large? Why did my soul feel so inexplicably sick – so unsatisfied – with the outcome of my first effort to quit that I tried it all again? And what does my “success” – I’ve been sugar-free for a year now – even mean?

I turned to Plato – a man occupied by appetite – for some answers. In his body map of the soul, the stomach was the dwelling place of desire. Reason, of course, resided in the head, while courage rested in the chest. In this tripartite architecture, it was up to reason – with the help of courage – to subjugate appetite and elevate the individual. The thinking went that if we could just rule our stomachs, we might be able to hold our heads up high and our chests out wide. For the Greeks, the right moral posture was key to the good life, or eudaimonia.

Early medical science in the west borrowed heavily from Plato, beginning with Aristotle, who practiced and taught medicine throughout his life. Aristotle agreed that eudaimonia could be realized by moderating the visceral and sensual appetites. He saw the heart as the vessel of intelligence, and arguably the most virtuous of organs. In his hypothesis, the heart occupied – physically and figuratively – a central place in the body, controlling other organs. The brain and lungs played supporting roles, merely cooling and cushioning the heart. The heart was, for Aristotle, where reason flowed.

Five hundred years later, the Greek anatomist and surgeon Galen challenged the centrality of the heart but still adhered closely to Plato’s triadic notion of the soul. Galen’s treatises, foundational to the development of modern medicine, are suffused with Platonic assumptions, and he painstakingly tried to stitch the divided parts of the soul – the rational, the spirited and the appetitive – on to specific organs in the human body.

In a striking display of topographical certitude, Galen writes in On the Doctrines of Hippocrates and Plato: “I do claim to have proofs that the forms of the soul are more than one, that they are located in three different places … and further, that one of these parts [rational] is situated in the brain, one [spirited] in the heart, and one [appetitive] in the liver. These facts can be demonstrated scientifically.”

The Harvard classicist Mark Schiefsky writes that, in Galenic physiology, equilibrium is understood “as a balance of strength between the three parts; the best state is when reason is in charge, the spirited part is strong and obedient, and the appetitive part is weak”.

Should we be sceptical of this aspiration to tame appetite? Sigmund Freud doubted whether desire could ever be so readily controlled. In tossing Plato’s map aside, Freud erased the “soul” and instead sketched a three-part atlas of the “self” and its ratio of desires and repressions – endlessly fractured, negotiating between order (superego), consciousness (ego) and appetite (id). For Freud, appetites could not be overcome but only better managed. Perfect harmony and permanent equilibrium were nowhere in sight. Rather, in Freud’s idea of the self, anxiety for order loomed above the ego, with desire buried beneath it. Appetite was the subterranean tether that consciousness could never escape, but only sublimate.

There was something talismanic about my focus on sugar. So often, liberty is conceived of as the ability to say yes to things. To make affirmative choices: to open this door or that window. But there is also a flipside to that freedom: the power to say no. To refuse. Increasingly during the pandemic, I felt like I was powerless in the face of my cravings. If there was a knock at the door of appetite, a tap on the window of impulse, I had to answer it. And this felt shameful. Why couldn’t I say no? And why was realizing this so painful?

I don’t pretend to anything approaching total understanding of my motivations. But there were a few loosely detected currents worth illuminating here. For one thing, not being able to say no to sugar sometimes felt like a form of bondage to the demands of the body, the very body that I was eager to assert power over, particularly during a global health crisis that was damaging bodies everywhere.

If I couldn’t control this plague, could I not at the very least control myself? I wonder now if this insistence on regulating appetite was my sublimated response to the coronavirus’s immense death toll – a way of denying mortality in the midst of its excess. In this respect, perhaps there was not as much separating me from other kinds of pandemic deniers as I would like to believe. Were we all just coping with the inexorability of our decay – laid painfully bare by Covid-19 – in different ways?

Maybe. But there was something beyond the exigencies of the pandemic on my mind as well. The inability to resist sugar cravings – to break the habit – seemed like a victory of the past over the present. It felt like the triumph of the mere memory of pleasure over real satisfaction in the moment. Saying no to that memory – the neurological underpinning of craving – became important, because it felt like the only way to say yes to imagination. “I am free only to the extent that I can disengage myself,” the philosopher Simone Weil wrote.

Detachment from an indulgence, however small, felt like a way to stop being beholden to an old storehouse of desires (and aversions and beliefs). Developing the ability to refuse to reach for the cookie was also a way to break free from the impulse to reach for patterns of the past, from the compulsion of replicating yesterday at the expense of tomorrow. It’s the trick of habit to convince us that we are reaching forward, even as we are stepping back. Or, as the British scholar of asceticism Gavin Flood elegantly summarizes: “The less we are able to refuse, the more automated we become.”

If Freud dismantled the soul, modern medicine mechanized what he left of the self. But where Freud’s psychoanalytic theory allowed for a pinch of poetry, materialist models hold comparatively dry sway today. A look at the biomedical literature on appetite reveals a tortuous mix of neural circuits and endocrine pathways. What’s clear is that if there was a moral aspect of appetite for ancient philosophers and physicians, it’s not readily discernible in the language of contemporary scientific literature.

There are upsides to this development. In the modern era, medicine’s tradition-bound framing of appetite as a moral problem has been demoralizing for patients, who often felt – and still feel – objectified, policed and discriminated against by institutions that sermonize about it. The stigmatisation of appetite remains pervasive in the culture, in and out of medicine. The loss of at least an explicit moral charge in the scientific literature is a welcome shift.

In the century or so since Freud’s conjectures, appetite has been atomised by medicine into a problem of eating, or more specifically, of fighting the body’s tendency toward “disordered” eating. In the pursuit of better and longer lives, maladies of appetite – of eating too much, too little, or not the right kinds of food – have been studied and treated with varying degrees of success. The empirical study of digestion and appetite in the laboratory moved hunger from the moral arena into a biochemical one. Still, in both experimental physiology and clinical medicine, the ancient impulse to locate the appetite persisted: was it in the body or in the mind? Lines were drawn – and defended – between diseases of the stomach and diseases of the psyche.

What was at stake in the difference? Pinning down the appetite – claiming it belonged to the gut or the brain – was arguably the first in a series of steps leading to its regulation. Understood this way, medicine’s mission to uncover the mechanisms of appetite, despite the erasure of the soul from scientific databases, cannot escape Plato’s legacy. Whether we’re trying to improve or curtail appetite, we seem unable to resist the desire to control it.

It would have been different – I wouldn’t have felt the need to go all-or-nothing with sugar – if I could have simply walked away after a few bites. But increasingly during the pandemic, I wouldn’t stop even after I was full. What started off as pleasure would morph into painful excess. Sure, there’s pleasure in abundance, in overdoing a thing. But I found myself barrelling past that threshold.

While studying for the board exam in my first, failed attempt at going sugar-free, I was also using various apps and devices to keep track of my body. I had long used a smart watch to log my steps and workouts. I was also using a calorie-tracking app, studiously punching in numbers for every meal and scheming how much I could eat and still remain under the calorie limit. But all that logging and calculating felt joyless and anxiety-ridden. Sometimes, at a meal, in the middle of tallying up numbers like an accountant, I’d explain to impatient friends and family that “I’m just entering my data”. It was a lot of data.

I grew weary of all the inputting, and so I switched to an app with more of a behavioural focus. This app still had me tracking calories, but also came with recipes, a personal coach and “psychology-based” courses, as part of what the company calls your “journey”. The courses were a welcome shift from the myopic focus of calorie counting, and chatting with a coach added an opportunity to get some clarity about my goals.

The coach would share chipper motivational advice and provide tips to overcome obstacles. I diligently went through the app’s courses, answered its behavioural questions and followed its nudges. There were a few weeks where I was able to go sugar-free, but after a couple of months, the coaching advice seemed more and more generic, and the courses too simplistic when I was already spending so much time studying for my upcoming exam. I lost interest and reverted to simply recording calories.

I eventually passed that exam without much to show for it in terms of changes to my nutritional habits. I needed something different, a way to hold myself accountable and mean it. I stumbled upon another app that described itself as being “on a mission to disrupt diet culture and make our relationship with food, nutrition – and ourselves – healthier for good”. It promised live coaching calls with a certified nutritionist, shared recipes, and even offered to tailor my coaching with a vegetarian dietician. It did not ask you to track calories or enter food items from a database. All it wanted was for you to send pictures … of your food. It felt radically different than tapping numbers into a screen: someone else would see this.

The app’s slogan was “100% accountability and “0% judgment”. But, to be clear, it was the judgment that I came for. The simple fact that my nutritionist wouldn’t just know but also actually see what I was eating was the killer feature. I answered a questionnaire about my dietary habits and goals. I made it clear that I wanted to go sugar-free, and repeated as much to my nutritionist during a preliminary call.

She didn’t exactly endorse this goal, but rather acknowledged it as something that was important to me and gently marked it as a topic we would come back to, adding that she hoped I would get to the point where a more balanced approach would suffice. I told her we’d see. I made a promise to take a photo of every meal, good or bad. She kindly reminded me there are not “good” and “bad” foods, and we were on our way.

It’s been a year since I downloaded the app. Every day since then, I have taken a photo of every morsel of food I’ve eaten, whether it’s a handful of pistachios, a salad or a veggie burger. In every one of those pics, every day, I have been sugar-free. I’ve eaten more vegetables and greens and fruits than I’ve probably ever eaten in my life. My plates look balanced (I make sure of it). I take care to snap pictures that look nice for my nutritionist. Though she never judges me negatively, I look forward to the raising-hands emoji and approving words she sends if she sees a salad with asparagus and garlic balsamic drizzle and avocado up front.

Like an influencer on Instagram, I’ll take another shot if the lighting isn’t quite right, or if the framing is off. It’s been satisfying to upload a cache of sugar-free images, all beautifully arranged on the app’s user interface. Even more satisfying has been avoiding feeling like the guy who said he’d go sugar-free only to end up sending in pictures of donuts and cookies. Compared to calorie logs and food diaries, the prospect of someone else seeing photos of what I’m eating has made the potential pain of falling short feel more proximate than the pleasure of eating sweets. So I just stopped eating sugar. And it’s still working. Was this all it took?

Perhaps the persistent effort to control appetite, replicated across many cultures and times, reveals just how vigorously it resists that very control. The seemingly endless proliferation of constraints on appetite – from the disciplinary to the pharmacological – underscores its untamable quality. And yet the training of appetite – both as physiological fact and, more abstractly, as desire – can function as an ascetic practice. In this paradigm, as religion scholars such as Flood argue, the negation of desire amplifies the subjectivity of the individual.

Depriving the body paradoxically accentuates the conscious subject, because hunger unsatiated allows the pangs of the self to be felt more acutely, and renders being more vivid. In other words, appetite unfulfilled creates the conditions for expanding self-awareness. This is seen in the Bhagavad Gita in the figure of the ascetic, one who has renounced the pull of appetite and “attains extinction in the absolute” – in seeming contradiction, gaining infinity through loss.

If philosophy is after theoretical victories, science aims more concretely to hack, or at least short-circuit, a physiological truth. Take, for example, gastric bypass surgery, an operation that cuts the stomach into two parts (leaving one functional thumb-size pouch alongside a larger remnant) and radically reconstructs separate intestinal systems for each segment to restrict the amount of food that can be eaten. By shrinking the stomach to fool the mind into feeling satisfied with less, this surgery builds on growing recognition that the long-embraced brain-gut divide is far more porous than previously thought.

Recipients of the surgery generally do well in the short term, with reduced appetite, marked weight loss, better control of diabetes and improved health markers. But the percentage of patients who “fail” in the long-term after bariatric surgery (ie achieve less than half of excess weight loss) is reportedly as high as 35%. During that first post-op year, studies suggest, an influx of appetite-reducing intestinal hormones decreases patients’ urge to eat. Crucially, however, there are questions about the duration of those salutary hormonal changes and their effectiveness in controlling appetite as post-surgical days add up.

For a significant proportion of patients, even surgically shrinking the stomach – the historical seat of hunger – doesn’t offer complete freedom from unchecked appetite. This fact is not entirely surprising, given what is now known about the multiple neuroendocrine nodes that govern appetite, but it poses a conundrum for medical science: can appetite, as Freud asked in his own way, ever be fully controlled? And if not, is it a wonder that patients turn back to more personal strategies to pursue the work that prescriptions and sutures leave undone?

I can’t say I fully understand why teaming up with a nutritionist on an app worked so well, so fast. Would sharing pics of my food with friends and family in a group chat or a Facebook page have been as effective? Probably not. The issue seemed to be one of epistemology. My friends and family wouldn’t have been as suitable an audience, since they don’t just know me as I am, but also as I was. That knowledge of what’s bygone necessarily shapes the stories we can tell and believe about one another.

But with my nutritionist reviewing pictures of my meals from god knows what timezone, the app created an epistemological gap into which both of us could step. It was within this gap that my future self – the self I aspired to be, still unrealised and therefore unknown – could intercede in the present with slightly less inertia from the past. The app provided an illusion that daily life could not, offering a space for the dormant commitments of the future to come to fruition in the present. A space for imagination to overcome memory.

As my sugar-free streak extended, I began to wonder about the future of this illusion. Was it a rare example of tech living up to its glitteringly naive promise of liberation? Or was this an instance of the digital panopticon yet again determining our ability to imagine ourselves, revealing just how far-reaching its gaze is? And, more practically, I began thinking about how long I needed to keep eating this way. The cravings that had knocked so loudly at my door at the start of the pandemic now softly shuffled from leg to leg right outside it. I could still hear their shoes creaking at the threshold, but they couldn’t force their way in anymore. Things seemed quiet, maybe a little too quiet.

Whereas the Greeks soughtto regulate appetite in pursuit of the good life, perhaps what is sought after today is a facsimile of it: a corporatised eudaimonia-lite, where the goal isn’t virtue but efficiency; not equanimity, but productivity. In this view, it’s not a better way to live we’re seeking, just a less painful way to work and die – all while “looking good”. A more charitable and poetic possibility is that the constraint of appetite continues to appeal because it provides the same sense of structure to selfhood that metre does to a poem: a limit against which to construct narrative unity of the psyche.

As fascinating as it is to think about this question, even more essential ones – about the links between appetite, scarcity and loss – loom in the writings of Toni Morrison, a writer who provides a necessary counterbalance to the obsession with appetite restriction in societies glutted with luxury. In particular, I’m thinking of Beloved, which tells the story of human beings struggling for survival and wholeness in the face of slavery’s horrors. In portraying this struggle, Morrison uses the language of food and appetite to unfurl narratives saturated with the metaphysics of hunger: the difficulty of sating the self; the confusion between hunger, history and hurt.

I was struck by this unexpected resonance while rereading the book in the middle of my bid to quit sugar. Morrison’s characters think about what it would mean to satisfy what the narrator calls their “original hunger” – and whether doing so is even possible. They imagine getting to a place “beyond appetite”, but are also compelled by history to contemplate the price of doing so.

In my reading of the book, the denial of hunger risks becoming a costly exercise in self-abnegation – a severing of self from history, of self from self – whose consequences Plato doesn’t seem to fully consider, but which Morrison is deeply wary of. I think Morrison is, like Freud, skeptical of the metaphysicians who would have us render hunger subordinate. But where Freud is an anti-idealist, Morrison appears willing to reach for hunger, perilous though it may be. Straddling both the risk of self-destruction posed by contact with the original hunger, and the anguish of self-denial created by leaving it unrecognised, Morrison casts her faith in the human ability to embrace the beautiful, blood-hued predicament of incarnation.

About 10 months into my sugar-free life, a scent from the pantry hit me like it hadn’t for a while. My wife had just baked chocolate-chip cookies for our kids as a treat. By then, I was unfazed by sweets around the house. They might as well have been made of stone. But, at the end of a long day, I found myself unexpectedly at the pantry door. Minutes passed. After a while, I opened the plastic container and inhaled. My mouth began to water. I could almost taste the cookies.

I remembered the delightful way the chocolate melted at the back of the tongue. I remembered the satisfaction of soaking a warm cookie in milk. A part of my brain was humming, eager to replicate the memory of sugar, butter and dough on the cortex. Another part was already dreading the pain of not being able to stop. I picked up the cookie and, having built nearly a year’s worth of muscle memory, simultaneously opened the app on my phone. I centred the cookie in the glowing frame and was about to press send when, looking at the screen, it hit me: what would my nutritionist think?

As of this writing, my streak remains unbroken, despite a few close calls. In many ways the story seems to be going the way I intended: I am eating well balanced, sugar-free meals and haven’t counted a calorie in more than a year. The cravings that were troubling me aren’t gone, but the future version of me – the unsweetened aspirant – grows closer with each picture I snap. I feel the spiritual and physical acuity that comes with ascetic practice.

But I also feel some qualms about neglecting Morrison’s original hunger, with all its attendant risks and possibilities. I think about how I have sacrificed memory at the altar of imagination, recognising the chance that imagination ends up being overrated and memory proves to be the last storehouse of joy. But then I remind myself that visions like Morrison’s may be too large, too untimely for us to inhabit. They come from a place we haven’t arrived at. At least not yet.

By

Source: Why is it so hard to control our appetites? A doctor’s struggles with giving up sugar | Health & wellbeing | The Guardian

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What Happens to Your Body When You Don’t Get Enough Sleep?

We’ve all been there before: You promise yourself just a few more minutes—and suddenly, it’s 2 a.m. and you’re still wide awake. Perhaps you’re binging a new favorite Netflix series or fretting over a morning meeting— whatever the root cause, you’re tossing and turning in bed all night, instead of getting the shut-eye you so desperately need.

What most of us don’t understand, however, is what really happens to our bodies when we don’t achieve that optimal level of sleep, which for most adults clocks in between seven and eight hours. Ahead, we asked a few doctors to explain how are bodies react to too-little sleep—and their answers might surprise you.

It becomes more difficult to focus on mental and physical tasks.

According to Dr. Jan K. Carney, MD, MPH, the Associate Dean for Public Health & Health Policy, and Professor of Medicine at Larner College of Medicine at the University of Vermont and the National Institutes of Health, sleep is essential for health at every age. “When we don’t get enough sleep, it is harder to stay alert, focus on school or work, and react quickly when driving,” Dr. Carney says.

Your memory and mood suffers—and your appetite increases.

Sleep physician Dr. Abhinav Singh, MD, FAASM, the Medical Director of the Indiana Sleep Center, and Sleep Foundation Medical Review Panel member, says that, believe it or not, losing precious hours of sleep and drinking excessive amounts of alcohol have similar physical consequences. “Sleep loss is linked to memory impairment, poor mood, increased appetite (think obesity and diabetes), and reduced reflexes,” he says. “Increased reaction time and some studies have compared it to being worse than being intoxicated with alcohol.”

Long-term sleep shortage could lead to chronic physical and mental health concerns.

While Dr. Carney says the short-term risks of sleep loss are things we’re all familiar with—feeling drowsy and having trouble concentrating—the real risk is what a compounded lack of sleep can do over time. “Longer-term sleep shortage is associated with increased risks for chronic health conditions such as high blood pressure, heart disease, obesity, stroke, and depression.”

You can’t make up for lost sleep.

Unfortunately, you can’t “catch up” on sleep—once those hours are gone, they’re gone for good. “It is best to develop and keep regular sleep habits over the long term,” shares Dr. Carney, adding that you also can’t “learn to live” with less sleep. “The best way to ensure both adequate sleep and high-quality sleep is to develop good sleep habits.”

This means implementing a routine with a consistent bedtime and wake time each day—even on weekends. “Regular exercise helps, as does avoiding caffeine or alcohol near bedtime,” Carney says. “Our environment is essential—we need a calm, quiet, dark, and cool location where we sleep regularly.”

By:

Source: What Happens to Your Body When You Don’t Get Enough Sleep?

How Much Sleep Do You Need?

These guidelines serve as a rule-of-thumb for how much sleep children and adults need while acknowledging that the ideal amount of sleep can vary from person to person.

For that reason, the guidelines list a range of hours for each age group. The recommendations also acknowledge that, for some people with unique circumstances, there’s some wiggle room on either side of the range for “acceptable,” though still not optimal, amount of sleep.

Deciding how much sleep you need means considering your overall health, daily activities, and typical sleep patterns. Some questions that you help assess your individual sleep needs include:

  • Are you productive, healthy, and happy on seven hours of sleep? Or have you noticed that you require more hours of sleep to get into high gear?
  • Do you have coexisting health issues? Are you at higher risk for any disease?
  • Do you have a high level of daily energy expenditure? Do you frequently play sports or work in a labor-intensive job?
  • Do your daily activities require alertness to do them safely? Do you drive every day and/or operate heavy machinery? Do you ever feel sleepy when doing these activities?
  • Are you experiencing or do you have a history of sleeping problems?
  • Do you depend on caffeine to get you through the day?
  • When you have an open schedule, do you sleep more than you do on a typical workday?

Start with the above-mentioned recommendations and then use your answers to these questions to home in on your optimal amount of sleep.

How Were the Recommendations Created?

To create these recommended sleep times, an expert panel of 18 people was convened from different fields of science and medicine. The members of the panel reviewed hundreds of validated research studies about sleep duration and key health outcomes like cardiovascular disease, depression, pain, and diabetes.

After studying the evidence, the panel used several rounds of voting and discussion to narrow down the ranges for the amount of sleep needed at different ages. In total, this process took over nine months to complete.

Other organizations, such as the American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) have also published recommendations for the amount of sleep needed for adults2 and children3. In general, these organizations closely coincide in their findings as do similar organizations in Canada.4

Improve Your Sleep Today: Make Sleep a Priority

Once you have a nightly goal based on the hours of sleep that you need, it’s time to start planning for how to make that a reality.

Start by making sleep a priority in your schedule. This means budgeting for the hours you need so that work or social activities don’t trade off with sleep. While cutting sleep short may be tempting in the moment, it doesn’t pay off because sleep is essential to being at your best both mentally and physically.

Improving your sleep hygiene, which includes your bedroom setting and sleep-related habits, is an established way to get better rest. Examples of sleep hygiene improvements include:

If you’re a parent, many of the same tips apply to help children and teens get the recommended amount of sleep that they need for kids their age. Pointers for parents can help with teens, specifically, who face a number of unique sleep challenges.

Getting more sleep is a key part of the equation, but remember that it’s not just about sleep quantity. Quality sleep matters5, too, and it’s possible to get the hours that you need but not

feel refreshed because your sleep is fragmented or non-restorative. Fortunately, improving sleep hygiene often boosts both the quantity and quality of your sleep.

If you or a family member are experiencing symptoms such as significant sleepiness during the day, chronic snoring, leg cramps or tingling, difficulty breathing during sleep, chronic insomnia, or another symptom that is preventing you from sleeping well, you should consult your primary care doctor or find a sleep professional to determine the underlying cause.

You can try using our Sleep Diary or Sleep Log to track your sleep habits. This can provide insight about your sleep patterns and needs. It can also be helpful to bring with you to the doctor if you have ongoing sleep problems.

By: Eric Suni  – SleepFoundation

Effects of Inadequate Sleep and Poor Sleep Quality In Athletes

1

Athletes are always looking for ways to improve performance and take goals to the next level. Efforts for doing just that are often limited to waking hours: nutrition, hydration, recovery protocols, supplement routine and, of course, training itself. And despite all this, research shows that, on average, athletes neglect a critical performance tool: sleep. So how does inadequate sleep affect athletic performance? Interestingly, the oversight of sleep can impact performance, both directly and indirectly, and the effects largely differ by sport. 

 
The impact of sleep quality on overall health
 

Before moving into the impact of sleep on performance, it is important to understand how sleep affects overall health and wellness. Both the amount and quality of sleep impacts our mood and energy levels, our metabolism, and immune system health. Inadequate quality sleep can be linked to a variety of serious health problems, including an increased risk of depression, obesity, type II diabetes, and cardiovascular disease. It can even increase an individual’s risk for illness and infection.

Athletes as a population do not get adequate sleep, contributing to overtraining syndrome

Adequate rest and recovery are considered key components of improving athletic performance and preventing sleep disturbances commonly reported in overtraining syndrome. Sleep provides the body with an opportunity to rest from both the physiological and cognitive stressors many athletes face throughout the day. However, despite the body of evidence on the benefits of sleep in athletes (and the potential for sleep to alleviate fatigue), sleep duration and quality are often neglected by athletes.

It is well-reported that, on average, athletes do in fact get less than seven hours of sleep per night, often of poor quality. This falls below the recommended eight hours to combat the negative effects of sleep deprivation. Despite some research limitations, the British Journal of Sports Medicine consensus statement on the topic states that sleep deprivation does affect recovery, training, and performance in elite athletes and that these athletes as a population do not get enough sleep.

Athletes are, in general, a highly motivated group—the type of people who may willingly restrict sleep to fit more activities into waking hours. But even if you’re someone who ‘gets by just fine’ on a restricted sleep schedule, such a lifestyle can have immediate detrimental effects; evidence shows that restricting sleep to six hours per night for just four consecutive nights can impair cognitive performance and mood, glucose metabolism, appetite regulation, and immune function.

Effects of sleep deprivation on different types of athletes

Before we jump into the research of the effects of sleep deprivation in athletes, a disclaimer: Despite the recognized importance of sleep in athletes’ routines, the research on sleep in athletic populations is sparse at this time. The available research on this topic has specific limitations, including the underrepresentation of female subjects, inconsistent research methods across studies, and small sample size.

Now, the science. Current research does show a number of potential performance implications of poor sleep that should be considered in both endurance and power sport athletes. Among the subjects that have been studied, individual sport athletes appear to be more susceptible sleep deficiency and had poorer sleep efficiency than their team sport counterparts.

Two main detrimental effects of sleep deprivation on performance in all sport types are cognitive impairments and mood disturbances. Blumert et al. looked at the effects of just 24 hours of sleep deprivation in collegiate weightlifters (so, for a single night’s sleep). While they saw no difference in performance tasks, training load or intensity, there was a significant difference in mood state including fatigue and confusion in the sleep deprived athletes.

There are also observed direct effects of sleep deprivation on physical performance. Oliver et al. studied endurance running performance in a 24 hour sleep deprived state and found that that subjects who were sleep deprived ran fewer miles in the same amount of time as well-rested athletes but with the same perception of effort.[8] Athletes should also be mindful of the non-direct consequences of sleep deprivation on their performance including but not limited to metabolism, hormone regulation, immune health, and limiting recovery.

Much like everything related to health, wellness, and performance, each individual will have different sleep requirements. These requirements may also vary depending on phase or training season, sex, training volume, intensity, and type of sport.

Biomarkers related to sleep and performance in athletes

Adequate sleep helps to regulate cortisol levels, and inadequate sleep can cause cortisol levels to rise above optimized levels. Cortisol is a catabolic steroid hormone that breaks down muscle, so chronically-elevated cortisol can directly combat progress to become stronger or faster in our athletic performance. 

Sleep also helps to regulate testosterone levels. This hormone is anabolic, meaning it helps build muscle (the opposite of cortisol). But, as you might have guessed, insufficient sleep can reduce testosterone levels.

Research shows that sleep deprivation can also cause chronic inflammation, as indicated by high hsCRP levels. As athletes, inflammation and muscle damage are to be expected with any sort of training—after all, we need to cause slight damage to our muscles to make them stronger. But chronic inflammation, the kind that’s caused by overtraining or insufficient rest, can leave an athlete prone to poor performance, illness, and injury. 

Actions for athletes to take to improve sleep

While the benefits of adequate sleep are well-documented in healthy individuals, the research specific to athletes and different athlete types continues to emerge. That being said, there are well-established actions you can take right now to improve your sleep. Here are some actions to optimize your sleep habits:

. If you have trouble getting the recommended amount of sleep at night, consider taking regular naps.

. Begin tracking your sleep with a wearable activity tracker. While research has displayed varying accuracy of these devices for sleep management, they can help you establish a healthy and regular bedtime routine.

. Work on implementing good sleep habits or a bedtime routine that reduces stress and promotes a good sleeping environment.

. Consider adjusting your exercise routine and incorporate more rest and active recovery in times of sleep deprivation or high life stress to help support your overall health and prevent injury or illness.

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Source: Effects of inadequate Sleep and Poor sleep Quality in Athletes.

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Cancer Without Chemotherapy A Totally Different World

Dr. Seema Doshi was shocked and terrified when she found a lump in her breast that was eventually confirmed to be cancerous. “That rocked my world,” said Dr. Doshi, a dermatologist in private practice in the Boston suburb of Franklin who was 46 at the time of her diagnosis. “I thought, ‘That’s it. I will have to do chemotherapy.’”

She was wrong.

Dr. Doshi was the beneficiary of a quiet revolution in breast cancer treatment, a slow chipping away at the number of people for whom chemotherapy is recommended. Chemotherapy for decades was considered “the rule, the dogma,” for treating breast cancer and other cancers, said Dr. Gabriel Hortobagyi, a breast cancer specialist at MD Anderson Cancer Center in Houston. But data from a variety of sources offers some confirmation of what many oncologists say anecdotally — the method is on the wane for many cancer patients.

Genetic tests can now reveal whether chemotherapy would be beneficial. For many there are better options with an ever-expanding array of drugs, including estrogen blockers and drugs that destroy cancers by attacking specific proteins on the surface of tumors. And there is a growing willingness among oncologists to scale back unhelpful treatments.

The result spares thousands each year from the dreaded chemotherapy treatment, with its accompanying hair loss, nausea, fatigue, and potential to cause permanent damage to the heart and to nerves in the hands and feet.

The diminution of chemotherapy treatment is happening for some other cancers, too, including lung cancer, the most common cause of cancer deaths among men and women in the United States, killing about 132,000 Americans each year. Breast cancer is the second leading cause of cancer deaths among women, killing 43,000.

Still, the opportunity to avoid chemotherapy is not evenly distributed, and is often dependent on where the person is treated and by whom.

But for some patients who are lucky enough to visit certain cancer treatment centers, the course of therapy has changed. Now, even when chemotherapy is indicated, doctors often give fewer drugs for less time.

“It’s a totally different world,” said Dr. Lisa Carey, a breast cancer specialist at the University of North Carolina.

Dr. Robert Vonderheide, a lung cancer specialist who heads the University of Pennsylvania’s Abramson Cancer Center, remembers his early days on the job, about 20 years ago.

“The big discussion was, Do you give patients two different types of chemotherapy or three?” he said. There was even a clinical trial to see whether four types of chemotherapy would be better.

“Now we are walking in to see even patients with advanced lung cancer and telling them, ‘No chemo,’” Dr. Vonderheide said.

The breast cancer treatment guidelines issued by the National Cancer Institute 30 years ago were harsh: chemotherapy for about 95 percent of patients with breast cancer.

The change began 15 years ago, when the first targeted drug for breast cancer, Herceptin, was approved as an initial treatment for about 30 percent of patients who have a particular protein on their tumor surface. It was given with chemotherapy and reduced the chance of a recurrence by half and the risk of dying from breast cancer by a third, “almost regardless of how much and what type of chemotherapy was used,” Dr. Hortobagyi said.

In a few studies, Herceptin and another targeted drug were even given without chemotherapy, and provided substantial benefit, he added.

That, Dr. Hortobagyi said, “started to break the dogma” that chemotherapy was essential. But changing cancer therapies was not easy. “It is very scary,” to give fewer drugs, Dr. Hortobagyi said.

“It is so much easier to pile on treatment on top of treatment,” he continued, “with the promise that ‘if we add this it might improve your outcome.’”

But as years went by, more and more oncologists came around, encouraged by new research and new drugs.

The change in chemotherapy use is reflected in a variety of data collected over the years. A study of nearly 3,000 women treated from 2013 to 2015 found that in those years, chemotherapy use in early-stage breast cancer declined to 14 percent, from 26 percent. For those with evidence of cancer in their lymph nodes, chemotherapy was used in 64 percent of patients, down from 81 percent.

More recent data, compiled by Dr. Jeanne Mandelblatt, a professor of medicine and oncology at Georgetown, and her colleagues, but not yet published, included 572 women who were 60 or older and enrolled in a federal study at 13 medical centers. Overall, 35 percent of older women received chemotherapy in 2012. That number fell to 19 percent by the end of 2019.

Cheaper and faster genetic sequencing has played an important role in this change. The technology made it easier for doctors to test tumors to see if they would respond to targeted drugs. Genetic tests that looked at arrays of proteins on cancer cells accurately predicted who would benefit from chemotherapy and who would not.

There are now at least 14 new targeted breast cancer drugs on the market — three were approved just last year — with dozens more in clinical trials and hundreds in initial development.

Some patients have reaped benefits beyond avoiding chemotherapy. The median survival for women with metastatic breast cancer who are eligible for Herceptin went from 20 months in the early 1990s, to about 57 months now, with further improvements expected as new drugs become available. For women with tumors that are fed by estrogen, the median survival increased from about 24 months in the 1970s to almost 64 months today.

Now some are in remission 10 or even 15 years after their initial treatment, Dr. Hortobagyi said.

“At breast cancer meetings, a light bulb went off. ‘Hey, maybe we are curing these patients,’” Dr. Hortobagyi said.

Dr. Doshi’s oncologist, Dr. Eric Winer of the Dana-Farber Cancer Institute, gave her good news: A genetic test of her tumor indicated she would not get any significant benefit from chemotherapy. Hormonal therapy to deprive her cancer of the estrogen that fed it would suffice.

But as much as Dr. Doshi dreaded chemotherapy, she worried about forgoing it. What if her cancer recurred? Would chemotherapy, awful as it is, improve her outcome?

She got a second opinion.

The doctor she consulted advised a “very aggressive” treatment, Dr. Doshi said — a full lymph node dissection followed by chemotherapy.

She had multiple conversations with Dr. Winer, who ended up discussing her case with four other specialists, all of whom recommended against chemotherapy.

Finally, Dr. Doshi said, “my husband said I should just pick a horse and run with it.” She trusted Dr. Winer.

Her struggles mirror what oncologists themselves go through. It can take courage to back off from chemotherapy.

One of the most difficult situations, Dr. Winer said, is when a patient has far more advanced disease than Dr. Doshi did — hers had spread to three lymph nodes but no further — and is not a candidate for one of the targeted treatments. If such a patient has already had several types of chemotherapy, more is unlikely to help. That means there is no treatment.

It falls to Dr. Winer to tell the patient the devastating news.

Dr. Susan Domchek, a breast cancer specialist at the University of Pennsylvania, can relate to those struggles.

“It is the nature of being an oncologist to be perpetually worried that you are either overtreating or undertreating a patient,” she said.

“Some cases keep me up at night,” she said, “specifically the cases where the risks and benefits of chemotherapy are close, yet the stakes still feel so high.”

When Dr. Roy Herbst of Yale started in oncology about 25 years ago, nearly every lung cancer patient with advanced disease got chemotherapy.

With chemotherapy, he said, “patients would be sure to have one thing: side effects.” Yet despite treatment, most tumors continued to grow and spread. Less than half his patients would be alive a year later. The five-year survival rate was just 5 to 10 percent.

Those dismal statistics barely budged until 2010, when targeted therapies began to emerge. There are now nine such drugs for lung cancer patients, three of which were approved since May of this year. About a quarter of lung cancer patients can be treated with these drugs alone, and more than half who began treatment with a targeted drug five years ago are still alive. The five-year survival rate for patients with advanced lung cancer is now approaching 30 percent.

But the drugs eventually stop working for most, said Dr. Bruce Johnson, a lung cancer specialist at Dana-Farber. At that point many start on chemotherapy, the only option left.

Another type of lung cancer treatment was developed about five years ago — immunotherapy, which uses drugs to help the immune system attack cancer. Two-thirds of patients from an unpublished study at Dana-Farber were not eligible for targeted therapies but half of them were eligible for immunotherapy alone, and others get it along with chemotherapy.

Immunotherapy is given for two years. With it, life expectancy has almost doubled, said Dr. Charu Aggarwal, a lung cancer specialist at the University of Pennsylvania.

Now, said Dr. David Jackman of Dana-Farber, chemotherapy as the sole initial treatment for lung cancer, is shrinking, at least at that cancer treatment center, which is at the forefront of research. When he examined data from his medical center he found that, since 2019, only about 12 percent of patients at Dana-Farber got chemotherapy alone, Dr. Jackman said. Another 21 percent had a targeted therapy as their initial treatment, and among the remaining patients, 85 percent received immunotherapy alone or with chemotherapy.

In contrast, in 2015, only 39 out of 239 patients received a targeted therapy as their initial treatment. The rest got chemotherapy.

Dr. Aggarwal said she was starting to witness something surprising — some who had received immunotherapy are still alive, doing well, and have no sign of cancer five years or more after their initial treatment.

She said: “I started out saying to patients, ‘I will treat you with palliative intent. This is not curative.’”

Now some of those same patients are sitting in her clinic wondering if their disease is gone for good.

Chong H. Hammond’s symptoms were ambiguous — a loss of appetite and her weight had dropped to 92 pounds.

“I did not want to look at myself in the mirror,” she said.

It took from October 2020 until this March before doctors figured it out. She had metastatic lung cancer.

Then Dr. Timothy Burns, a lung cancer specialist at the University of Pittsburgh, discovered that Mrs. Hammond, who is 71 and lives in Gibsonia, Pa., had a tumor with two unusual mutations.

Although a drug for patients with Mrs. Hammond’s mutations has not been tested, Dr. Burns is an investigator in a clinical trial involving patients like her.

He offered her the drug osimertinib, which is given as a pill. This allowed her to avoid chemotherapy.

Ten days later she began feeling better and started eating again. She had energy to take walks. She was no longer out of breath.

Dr. Burns said her lung tumors are mostly gone and tumors elsewhere have shrunk.

If Mrs. Hammond had gotten chemotherapy, her life expectancy would be a year or a little more, Dr. Burns said. Now, with the drug, it is 38.6 months.

Dr. Burns is amazed by how lung cancer treatment has changed.

“It’s been remarkable,” he said. “We still quote the one-year survival but now we are talking about survival for two, three, four or even five years. I even have patients on the first targeted drugs that are on them for six or even seven years.”

Mark Catlin, who is being treated at Dana-Farber, is one of those patients.

On March 8, 2014, Mr. Catlin, who has never smoked, noticed a baseball-size lump under his arm. “The doctors told me to hope for anything but lung,” he said.

But lung it was. It had already spread under his arm and elsewhere.

Oncologists in Appleton, Wis., where he lives, wanted to start chemotherapy.

“I was not a fan,” Mr. Catlin said. His son, who lives in the Boston area, suggested he go to Dana-Farber.

There, he was told he could take a targeted therapy but that it would most likely stop working after a couple of years. He is 70 now, and still taking the therapy seven years later — two pills a day, with no side effects.

He rides a bike 15 to 25 miles every day or runs four to five miles. His drug, crizotinib, made by Pfizer, has a list price of $20,000 a month. Mr. Catlin’s co-payment is $1,000 a month. But, he says, “it’s keeping me alive.” “It’s almost surreal,” Mr. Catlin said.

Gina Kolata

By:

Source: Cancer Without Chemotherapy: ‘A Totally Different World’ – The New York Times

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Related Contents:

Bitcoin Cryptocurrency Price Chart May Show $30,000 as Floor

Bitcoin has been grinding lower in a trading range just above $30,000, prompting cryptocurrency insiders to flag the round number as a potential floor for the virtual coin.

Crypto prognostication is fraught with risk, not least because Bitcoin’s price has roughly halved from a record high three months ago. Even so, some in the industry are coalescing around $30,000 as a support point, citing clues from options activity and recent trading habits.

In options, $30,000 is the most-sold downside strike price for July and August, signaling confidence among such traders that the level will hold, according to Delta Exchange, a crypto derivatives exchange. It “should provide a strong support to the market,” Chief Executive Officer Pankaj Balani said.

Traders are also trying to take advantage of price ranges, including buying between $30,000 and $32,000 and selling in the $34,000 to $36,000 zone, Todd Morakis, co-founder of digital-finance product and service provider JST Capital, said in emailed comments, adding that “the market at the moment seems to paying attention more to bad news than good.”

Bitcoin has been hit by many setbacks of late, including China’s regulatory crackdown — partly over concerns about high energy consumption by crypto miners — and progress in central bank digital-currency projects that could squeeze private coins. The creator of meme-token Dogecoin recently lambasted crypto as basically a sham, and the appetite for speculation is generally in retreat.

Bitcoin traded around $31,600 as of 9:26 a.m. in London and is down about 6% so far this week. It’s still up more than 200% over the past 12 months, despite a rout in calendar 2021.

Konstantin Richter, chief executive officer and founder of Blockdaemon, a blockchain infrastructure provider, holds out hope for institutional demand, arguing Bitcoin would have to drop below $20,000 before institutions start questioning “the validity of the space.”

“If it goes down fast, it can go up fast,” he said in an interview. “That’s just what crypto is.”

— With assistance by Akshay Chinchalkar

Source: Bitcoin (BTC USD) Cryptocurrency Price Chart May Show $30,000 as Floor – Bloomberg

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Critics:

The dramatic pullback in bitcoin and other cryptocurrencies comes as a flurry of negative headlines and catalysts, from Tesla CEO Elon Musk to a new round of regulations by the Chinese government, have hit an asset sector that has been characterized by extreme volatility since it was created.

The flagship cryptocurrency fell to more than three-month lows on Wednesday, dropping to about $30,000 at one point for a pullback of more than 30% and continuing a week of selling in the crypto space. Ether, the main coin for the Ethereum blockchain network, was also down sharply and broke below $2,000 at one point, a more than 40% drop in less than 24 hours.

Part of the reason for bitcoin’s weakness seems to be at least a temporary reversal in the theory of broader acceptance for cryptocurrency.

Earlier this year, Musk announced he was buying more than $1 billion of it for his automaker’s balance sheet. Several payments firms announced they were upgrading their capabilities for more crypto actions, and major Wall Street banks began working on crypto trading teams for their clients. Coinbase, a cryptocurrency exchange company, went public through a direct listing in mid-April.

The weakness is not isolated in crypto, suggesting that the moves could be part of a larger rotation by investors away from more speculative trades.

Tech and growth stocks, many of which outperformed the broader market dramatically during the coronavirus pandemic, have also struggled in recent weeks.

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