WAY TO BETTER SLEEP
by Pauline N. Harding, MD, who is
residency trained in Internal Medicine, Board Certified in Family Practice,
and licensed as a Dietician/Nutritionist. She is an instructor in the Department
of Family Practice at the University of Illinois College of Medicine in Chicago.
She has been on the speakers' forum for the Rush Presbyterian St. Luke's Medical
Center Conference for Body-Mind Healing and the Wilson Foundation Conference
on Ethics for High School Science Teachers, and she has acted as panel discussant
for the American Psychological Association. Dr. Harding is Medical Director
at Prairie Trail Family Medicine, S.C., in Winfield, Illinois. Her medical practice
focuses on natural healing techniques, especially as they apply to problems
associated with environmental sensitivity, allergies, fibromyalgia, fatigue,
colitis, and sleep disturbances. She addresses the cortisol rhythm disturbances
of school-age children, teens, and adults. She incorporates the use of natural
hormone replacement therapy for men and women with consideration of the adrenal
and thyroid status of the individual.
Ultimately, to maintain a normal
sleep rhythm, one must maintain a normal eating rhythm. Part of the reason for
this linking of eating and sleeping is the body's cortisol rhythm.
Normal Cortisol Rhythm - A Key
to Better Sleep
Cortisol is a hormone produced by the adrenal glands that are located above
the kidneys. Cortisol helps regulate many body functions including activation
of thyroid hormone, bone resorption, muscle strength, energy production, resistance
to infection and cancer, resistance to auto-immune diseases, and intensity of
allergic reactions. Cortisol is a strong determinant in how rejuvenating sleep
Cortisol is produced in a cyclic
fashion with the highest levels being released in the morning and the lowest
at night. This 24-hour cycle is called the circadian rhythm, and an abnormal
circadian rhythm of adrenal hormones can adversely affect multiple critical
functions in the body, including energy production and immune surveillance.
Any disruption in this rhythm can result in a tendency toward fatigue, easy
bruising, infection, osteoporosis, low sex drive, infertility, migraine headaches,
adult acne, abdominal bloating, and either low or high blood pressure.
A disruption in the cortisol level
during the night will affect the quality of sleep. If the cortisol level is
high during the night, an individual will have disrupted rapid eye movement
(REM) sleep and will wake up non-refreshed, no matter how many hours of sleep
the individual appeared to have.
Ultimately, to maintain a normal
sleep rhythm, one must maintain a normal eating rhythm. Part of the reason for
this linking of eating and sleeping is the body's cortisol rhythm.
REM sleep is the stage of sleep during
which an individual dreams. It is accompanied by muscle relaxation and an increase
in the breathing rate. The intense dreaming that occurs during REM sleep is
a result of heightened cerebral activity. The paralysis that occurs simultaneously
in the major voluntary muscle groups, including the muscles of the chin and
neck, is thought to be a way to keep the body from acting out the dreams that
occur during this intensely cerebral stage.
REM-disrupted sleep may be one of
the reasons that some individuals can have a full eight hours or more of rest
and none-the-less wake up exhausted.
Key to rejuvenating sleep is having
a normal level cortisol at night. Key to a normal cortisol level at night is
a normal cortisol rhythm during the day and leading up to sleep.
Food Glycemic Index and Cortisol
Cortisol levels are rapidly responsive to our food intake during each day. The
glycemic index of a meal affects the cortisol level for approximately the upcoming
The glycemic index of a food reflects
how our blood sugar level is affected by the particular food. Foods containing
high sugar and low fiber have a high glycemic index and result in wider fluctuations
in insulin levels than foods with a low glycemic index.
High insulin levels have been found
to be an underlying culprit in many diseases such as coronary artery disease.
(N.B. If you have diabetes and use insulin injections, please do not interpret
this statement to mean that you would be well served to cut back inappropriately
on your dose. Please discuss interpretation of this information with your physician.)
High glycemic index foods, such as
sugar and refined starches, cause cortisol levels to rise. For individuals who
start the day with a normal cortisol level, starchy or sugary breakfast food
choices can cause the cortisol to overshoot the normal range. The cortisol will
likely remain elevated all day - and all night. Intervention with herbs or supplements
that lower cortisol can help.
Worse than having a high glycemic
meal is having no meal at all. Any time during the day that one does not eat
within five hours of the previous meal or snack, the cortisol level tends to
rise. A rise above the normal range during the day almost guarantees that the
nighttime cortisol will be high and thus disrupt REM sleep.
If the cortisol level is high
during the night, an individual will have disrupted rapid eye movement (REM)
sleep and will wake up non-refreshed, no matter how many hours of sleep the
individual appeared to have. . . . REM-disrupted sleep may be one of the reasons
that some individuals can have a full eight hours or more of rest and none-the-less
wake up exhausted.
A single late meal or skipped meal
or high glycemic index meal during the day can result in a high cortisol during
the early part of the night. A cortisol level higher than it should be during
the night results in a disruption of REM sleep and with it non-refreshing sleep.
Low glycemic index foods such as
eggs, meats, poultry, fish, and most vegetables tend to lower the cortisol level.
If one starts with a normal morning cortisol, eating foods from the low glycemic
index category every five hours during the day is needed to keep the cortisol
on its normal downward track.
Note that the high glycemic index
of sugar or starch, including whole grains, requires consumption of nearly an
equal weight of animal protein to maintain glycemic balance. Vegetables usually
balance themselves in terms of glycemic index, but vegetables are not of sufficiently
low glycemic index to balance grains - at least not the grains as they are routinely
prepared by most Americans. Note that many cultures about the world have developed
a 3-step process of pan-frying, soaking, and steaming rice that lowers the glycemic
index of this non-gluten grain.
To prevent the deleterious upward
swing of cortisol, one usually does better to balance all sugars and grains,
including whole grains, with animal protein. Even given what we know about the
various pitfalls of animal protein, it probably remains better to eat animal
protein with each meal at which we have sugar, including fruit, and/or grains.
If animal protein is not tolerated for medical or religious or social-consciousness
reasons, it probably better to remain vegan than to be carbo-vegan.
Has it always been this way? Perhaps
not. Many factors have changed in the past century.
High Cortisol Caused by Non-Sprouted
For example, our grains have been hybridized to contain about half the protein
that they contained in 1900. In addition, our failure to sprout our grains in
the preparation of the flour used for our commercial breadstuffs has added to
the disruption in our cortisol rhythm.
Non-sprouted grains result in an
inflammatory-response in the gut that causes the secretion of excess cortisol
into the intestinal tract. This hormonal drain of cortisol in the gut deprives
other parts of the body of their fair share of cortisol. While allergy and inflammation
manifest themselves elsewhere in the body, the gut is a set-up for intestinal
dysbiosis (abnormal gut flora), lowered immune protection (due to lowered secretory
IgA levels), and metabolic reactivity to foods.
. . . an elevated nighttime cortisol
suppresses the immune system and with it our resistance to infection and cancer.
Sprouting removes much of the toxic
peptides that are found on the hull of grains. Feed children sprouted grains
to avoid or delay gluten- and gliadin-intolerance. Individuals with gluten-intolerance
are advised to avoid gluten grains. Note that the incidence of gluten intolerance
is especially high for those with Celtic, Nordic, or German background. However,
travel and inter-marriage has led to the dispersion of this gene to virtually
every land. In addition, with the introduction of genetically-modified grains
into our food supply, the incidence of grain intolerance has risen in populations
from all backgrounds.
The Fallacy of Carbohydrate Loading
Individuals who have been violating these eating guidelines may have depleted
their liver glycogen stores. These individuals may find themselves hypoglycemic
in fewer than five hours. It usually requires about three months of consistently
eating glycemically-balanced meals at regular intervals in order to replenish
the glycogen stores.
Glycogen from the liver is necessary
to provide energy to allow the brain to continue to function during the night
and during periods of skipped meals during the day. Brain cells are injured
when glycogen is not available.
A fallacy that led to serious health problems for many athletes in recent decades
was the belief that foods high in sugar and starch helped to promote glycogen
storage. Carbohydrate-loading leads many athletes to develop profound fatigue
and other conditions related to glycogen depletion. It now appears that a balanced
intake of protein with non-gluten grains and non-fructose carbohydrates would
have been a wiser choice.
Cancer and an Elevated Midnight
In addition to disrupted REM sleep, an elevated nighttime cortisol suppresses
the immune system and with it our resistance to infection and cancer. Researchers
have reported that an elevated secretory midnight cortisol is correlated with
an increased risk of breast cancer. Individuals who take measures to correct
their cortisol rhythm find a better response to the regimens they use not only
for recovering from infection but from malignancies as well.
Sex Hormone Balance and Cortisol
Also keep in mind that the body corrects abnormal cortisol levels by "stealing"
from the sex hormones. The biochemists call this "pregnenelone steal,"
because pregnenelone is the precursor of BOTH cortisol and the sex hormones.
Thus, abnormal cortisol by its nature causes derangements in the sex hormone
Imbalances of sex hormones lead to
lowered sex drive, balding, prostate enlargement, urinary hesitancy and dribbling,
nighttime urination, PMS, uterine fibroids, heavy menstrual flow, and breast
tenderness. It is much easier to correct the sex hormone imbalances if the cortisol
rhythm is normal. If one fails to correct the cortisol rhythm, long-lasting
correction of sex hormone imbalances is unlikely.
Pain, even a simple headache,
can elevate cortisol. Pain and the elevated cortisol both contribute to sleep
It is also important to note that
hormone imbalances can rarely be corrected safely simply by taking more of the
hormone that is determined to be low. It is imperative that an effort be made
to determine why the level is low and to address the primary imbalance whenever
It is almost always necessary to
correct dietary indiscretions in order to safely replace and balance hormones.
Much of what one reads about the hazards of taking hormones such as progesterone
or estrogen is associated with problems from the diet.
Diet modification can not only reduce
the risks associated with the use of sex hormones, but also the proper diet
can often reduce or eliminate the need for sex hormone replacement at all.
Actions to Take If I Do Not Start With a Normal Cortisol Rhythm
So far, this discussion has assumed a normal circadian rhythm of cortisol and
the recommendations were for maintaining the normal rhythm.
If the rhythm starts out with disruption,
then the first measure would be to correct the basic rhythm. A physician familiar
with management of cortisol circadian rhythm can assist you.
The circadian rhythm of cortisol
can be disrupted from birth. Contributing factors can include viral infections,
birth canal trauma, an abnormal maternal rhythm, and irregular eating patterns.
Any cause of disruption of the signals from the hypothalamus and pituitary to
the adrenal can contribute to an abnormal cortisol rhythm.
Measures to reverse patterns caused
by such diverse factors can include homeopathy, acupuncture, manual therapy
such as cranio-sacral or Bowen (a neurostructural technique), herbs, and diet.
Pain as a Major Cause of Cortisol
Pain, even a simple headache, can elevate cortisol. Pain and the elevated cortisol
both contribute to sleep disruption. Dietary measures alone are seldom adequate
to overcome the disruption of cortisol caused by pain. Pain management and correction
of the underlying causes are primary in these instances.
A single skipped or late meal or a high starch or sugar load is enough to throw
off the cortisol rhythm for the upcoming night and makes it less likely that
the next day will start with a normal cortisol rhythm.
Emotions as a Contributor to Aging
Emotions that arise out of feeling threatened or feeling any sense of lack are
associated with the release of specific stress hormones, most notably cortisol.
Fear, frustration, anger, and sadness increase cortisol and reduce sex hormones.
. . . the body corrects abnormal
cortisol levels by "stealing" from the sex hormones. . . . Imbalances
of sex hormones lead to lowered sex drive, balding, prostate enlargement, urinary
hesitancy and dribbling, nighttime urination, PMS, uterine fibroids, heavy menstrual
flow, and breast tenderness.
In addition, release of digestive
enzymes does not occur during a sense of flight or fight. Food will sit in the
stomach and decay rather than digest when one eats while feeling stressed.
To determine whether it is safe to
divert energy from the fight-or-fight system to the digestive system, the body
effectively is asked, "Do I have enough of everything?" Those of us
who have adequate food, clothing, and shelter sometimes fail to respond in the
affirmative to the questions, "Do I have enough time? Do I have enough
respect?" Satisfaction with our blessings is key to proper digestion.
Herbal Measures to Lower an Abnormally High Cortisol
Measures to help correct an overshoot in cortisol can include herbs such as
de-glycerinized licorice (DGL) or phosphorylated serine or phosphatidyl serine.
Phosphorylated serine taken at 6 p.m. can help bring a high cortisol down to
normal by bedtime. In some individuals, the action occurs in as little as one
hour and these individuals may need to take the phosphorylated serine later
in the evening.
Herbal Measures to Raise the Cortisol
Note that whole licorice root extract (Glycyrrhiza glabra) does the opposite
of DGL. Whole licorice root extract tends to raise the cortisol level. It is
helpful for individuals with morning fatigue due to low cortisol. A cup of licorice
tea in the morning can help overcome the lack of appetite experienced by those
with low cortisol levels.
Adaptogenic Herbs to Balance the Hormones
Among other herbs that affect cortisol are included various adaptogens such
as ashwaganda, Rhodiola rosea (Arctic root or golden root), Reishi,
wild Chinese and American ginseng, cordyceps, Siberian ginseng (eleutherococcus
senticosus), Dong quai, and black cohosh.
The mechanism by which adaptogenic
herbs achieve their stress protection activity has been well-researched around
the world. Adaptogens act by restoring hypothalamic and peripheral receptor
sensitivity to the effects of cortisol and other adrenal hormones.
Siberian ginseng stimulates the adrenal
gland. Sarsaparilla (Smilax officinalis) contains precursors to progesterone
and testosterone. Rhodiola can help improve erectile dysfunction and premature
ejaculation in men. Rhodiola activates fat breakdown and mobilizes fat from
Rose hips and Hawthorne berries contain
high levels of Vitamin C and bioflavonoids. The adrenal gland is one of the
highest utilizers of Vitamin C in the body.
Adaptogens allow the body to respond
to stress with lower amounts of cortisol than may otherwise be needed. Adaptogens
help the adrenals recover more quickly.
Steps to Take for a Normal Balanced Cortisol Rhythm:
- Go to bed by 10 p.m.
- Eat breakfast by 7 a.m.
- Eat low glycemic index meals every
five hours while awake.
- If you eat gluten grains, use
sprouted whole grains.
- Avoid sugar and excess starch.
- Maintain erect posture and avoid
prolonged periods of sitting or flexion posture such as fetal position during
the night. (See "How to Age Rapidly - or Not," in my "Doctor's
Corner," for NOHA NEWS, Winter 2002.)
- Control pain.
- Manage emotional stress. Following
the first seven guidelines allows us to respond with more stamina and less
stress to the challenges of daily life.
- Confer with a health practitioner
familiar with hormone function and therapies that help correct cortisol rhythm.
- Meditate daily. Know that each
of us prays without ceasing. Discover anew that every thought and every word
is a prayer. Keep in touch with the True Source of health and healing.
Establishing and maintaining a normal circadian rhythm of cortisol is a worthwhile
Normal cortisol rhythms would go
a long way toward tipping the balance away from chronic infections, cancer,
fatigue, and obesity. It will even help with easy bruising and stretch marks.
Quite importantly, achieving a normal cortisol rhythm may change dragging out
of bed in the morning to bouncing out of bed.
A relentlessly positive attitude
will do more for your health than any fretting and fuming — even about diet.
Smiles to you!
Books of Interest on Related Topics:
Adrenal Fatigue: The 21st-Century Stress Syndrome by James L. Wilson,
Petaluma, CA: Smart Publications, c2001.
Dangerous Grains: Why Gluten Cereal
Grains May be Hazardous to Your Health by James Braly, MD, Ron Hoggan, MA,
Avery Publishing Group C2002. See the review in the Spring 2003 NOHA NEWS,
pages 9-10, "DANGEROUS GRAINS."
Living Well with Chronic Fatigue
Syndrome and Fibromyalgia: What Your Doctor Doesn't Tell You … That You
Need to Know by Mary J. Shomon, NY: Quill, c2004.
The No-Grain Diet: Conquer Carbohydrate Addiction and Stay Slim for
the Rest of the Your Life by Joseph Mercola, DO, Alison Rose Levy, Dutton
Books, c2003. See the review in the Summer 2003 NOHA NEWS, pages 9-10,
"LOSE WEIGHT-GAIN HEALTH."
Seeds of Deception: Exposing Industry
and Government Lies About the Safety of the Genetically Engineered Foods You're
Eating by Jeffrey M. Smith, Fairfield, IA: Yes! Books, c2003.
Share with me the names of your favorite
books and authors who truly inspire you and refresh your soul. PHardingMD@comcast.net
Article from NOHA NEWS,
Vol. XXX, No. 2,Spring 2005, pages 2-6.