Tag Archives: Sleep

Keys to Paleo Success Part 4: Being Conscious

In the final part of this series on my keys to Paleo success we will talk about consciousness; not being awake, but being alert!  Together with cooking, understanding, and patience this will conclude the series on keys to success.  How conscious you are on a day to day basis may ultimately determine just how successful the Paleo lifestyle will be for you.

Eating: It’s fairly obvious that you must be supremely aware of what you are eating to be successful.  There are certain areas though that I think are more important as they are the most likely to make you slip up. 

Although I don’t encourage calorie counting to my patients, I do ask my patients to be conscious overall of how much food they are eating.  Eat slowly and enjoy your food that way you give it time to settle and for your natural sense of satiety to kick in.  It is not uncommon to overeat even while eating clean.  There is a sense at times that since the food is clean, you can eat as much as you want.  Although technically true, try to be aware of what your body really needs and not just what you think it wants. 

When you are shopping at the grocery always be aware of this; even when you have multiple food choices, there is almost always one that is better than the other.  For example choosing a leaner cut of meat will be better than a fattier cut.  By all means, eat a ribeye at times, but fit in some leaner meats as well.  I want you to also read every label you can in the grocery.  Even when you think that you know what is in there, check again.  Are there nitrate free choices for some of your meat choices?  If so, try to get them as often as you can. 

Also take the time to ask your grocer, or preferably a butcher or meat farmer where the meat you are buying is from, what it is fed,  and how it is raised.  Do not feel obligated to eat only grass fed meat; although optimal, it is not possible or practical for many people out there, even myself at times.  Lastly, look at anything that is processed in any way with skepticism.  As my goal is 90% compliance with my Paleo diet, I very rarely blatantly eat what I know is not good for me.  I look at what I consume that is processed, or not prepared by me as being unclean, and it accounts for my 10% fudge factor. 

Eating is an absolute joy for me, and it should be for you as well.  When you do it consciously, ALL the time, it can be fun and enjoyable instead of the dread it has become for many.

Feelings:  I want you to be completely aware of how you are feeling at all times.  Before you eat make yourself aware of just how hungry you are.  While eating, enjoy how the food makes you feel, and eat slowly enough to feel how full your meal is making you before you overeat.  Tie your feelings together with eating in every way that you can and it will really help you be more successful.

One key are of feelings I want you to be aware of is how certain foods make you feel, especially pay attention when you cheat.  Everybody reacts differently to foods, and even to non-Paleo foods.  I have learned over time what kinds of foods I can and can’t cheat with if I expect to feel well.  Keeping a food diary early in your journey will really help with this are of your lifestyle.  You want to be able to look back and say “I feel really sluggish, what could I have eating in the last few days to cause this?”  Is your stomach more unsettled than usual?  It’s probably something you ate!

Another thing to really pay attention to when you cheat is WHY did you cheat?  If you are like me, emotional eating can be a problem.  Don’t just look back at cheats and see how they made you feel, but look at what emotions led to you cheating.  Over time you can analyze what circumstances or emotions trigger cheating so you can control them.  You want cheating to make you feel GOOD when you do it because there is no guilt involved, but that will take time and patience to achieve.

Are you hurting somewhere that you normally don’t day to day, or after a workout?  I’m not talking about typical soreness post workout; you know when something is not right. People come in to the office all the time and complain to me about something.  I talk to them about it, and come up with a plan to figure out what could be causing it.  Commonly the patient then says something along the lines of “It’s not that big a deal, let’s just not worry about it.”  Symptoms are your body’s way of talking to you.  People who ignore their symptoms are the one’s that end up with medical conditions or injuries that could likely have been prevented with earlier intervention.  If you feel something is wrong, there probably I something wrong.  Instead of just living with it, how about calling your doctor, making an apt, and getting it sorted out!

Food and feelings always go hand in hand.  Get a good hold on both concerning all aspects of your life and your diet and you will be happy you did.

Sleep:  This is such an important part of your life, I don’t want you to overlook it in any way.  The number of people out there who chronically get too little sleep is staggering.  Do something for me, for the next month keep a sleep log.  You can get great little apps for your smart phone if you would like, but it’s easy enough to do on your own.  Here is a link to the sleep diary Sleep Diary my sleep center gives out to patients and it is very useful.  I want everyone to be very aware of how much sleep they are getting and how much they are not getting.  Everyone is also different with how much sleep it “enough” for them.  The sleep literature says normal sleep is anywhere from 6-10 hours a night, but you have to see what is best for you. 

The most common cause of chronic fatigue is a very technical sleep diagnosis known as ISS, or Insufficient Sleep Syndrome J.  Do you suffer from this?  Well, do the sleep log and see how many hours of sleep you are getting.  Then ask yourself this question: “Am I more tired in the day than I feel I should be?”  If the answer is yes, make a concerted effort to increase your nightly sleep by at least one hour and keep logging your sleep.  Do you see an improvement in how you feel?  If you do, then keep getting more sleep.  If you don’t, or you have trouble falling asleep, don’t settle for how you feel please.  Look up a board certified sleep physician and make an appointment.  You will NEVER feel or be your best if you are not sleeping enough.  Insufficient sleep does more than make you tired, it is dangerous and increases your risk of chronic disease.  Most people simply go through life dealing with how they feel and not trying to fix it.  Become conscious of your sleep patterns and sleep volume, and make adjustments to improve them if needed. 

Ultimately you can read every book and follow every blog, but nobody out there is talking directly to you.  Only your body is talking directly to you, but you have to learn to be conscious of it and adjust to its needs.  Always remember that success with a Paleo lifestyle is up to you, and nobody can change that.  Don’t fall victim of thinking you can’t do it “right” so why bother, or that you are doing all you can.  Are you really?  Is there some place you can improve your health?  Do you have strongholds you are still not willing to give up? 

You want to succeed with your Paleo goals?  Learn to cook at home, be patient with yourself, acquire the understanding of why Paleo is right for you, and become conscious of every aspect of your life. 

Do you have specific keys that have helped you?  Post a response and share your experiences with everyone else.  If you have specific questions, always feel free to email me at  And as always, share this blog with anyone out there who you feel could benefit from learning more about the Paleo lifestyle. 



Posted by on June 3, 2012 in General Paleo Discussion


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Could Your Fatigue Put You at Risk for Cancer?

My world of modern medicine and my world of the Paleo lifestyle can, and must blend together to achieve ultimate health.  Your world should to.  Most assume you have to be overweight and snore like a freight train to have sleep apnea and that is just not true.  As many as 1/3 of OSA patients are normal weight, and as many as 1/3 do not snore significantly.  The main cause of this disease is a small airway that is susceptible to collapse during the normal relaxation process of sleep.  If you assume you because you are slim, trim, and fit there is no way you could have it…think again.

Two studies came out earlier this week linking untreated sleep apnea with an increased risk of cancer.  This is pretty amazing and as a Board Certified Sleep Specialist I find it very exciting.  Sleep apnea is already clearly recognized to have an association with obesity, high blood pressure, heart attacks, strokes, diabetes, and even asthma.  As if those were not impressive enough, now we can add cancer to the list.

You want real numbers?  One study showed that people with significant breathing problems at night (otherwise known as sleep disordered breathing) were 4.8 TIMES more likely to deveolop cancer thoughout their lifetime than those without SDB.  Did you just read that?

As a Paleo community we tend to think that we can control our own destiny healthwise by eating clean and exercising regularly.  Well, two weeks ago I saw a 26 year old female, 5 foot 6, 120 pounds who was as symptomatic from the sleep apnea standpoint as possible.  She did NOT snore.  She eats Paleo, and trains at crossfit regularly.  Her sleep study showed significant sleep apnea and we placed her on CPAP therapy at night.  She is lucky that her primary care provider is a thoughtful internist who refused to blame her fatigue on being a mother of two and waking early to exercise (as her prior doctor head).  She is young, lean,fit…and has a serious disease linked with the long list of scary conditions above.  Now she is being treated, and we are making her current symptoms and long term health better.  That’s why I love sleep medicine!

What’s my point with all this?  I know there is a general distrust of modern medicine among the Paleo community, and some of that is warrented.  But, I urge all of you to pay attention to your bodies.  If you are having symptoms that won’t go away, seek help.

More specifically, if you have trouble sleeping, see a well trained sleep physician to work out your problems.  You HAVE to sleep to be at your best.  Do you get sleepy in the afternoons?  Ever wake up with a headache you did not go to sleep with?  Do you wake up as tired as you went to bed?  Have you been told you have “funny” breathing at night while you sleep?  Sleepy at the wheel? Those are classic symptoms of sleep apnea.  It all comes down to this though regardless of symptoms: Are you more tired or sleepy than you THINK you should be?  If the answer is yes, take a long look at the list of conditions associated with sleep apnea and realize that these associations are real…no matter how good your diet is or how fit you are.  Don’t settle for how you feel, you could pay the price later in life.

Learn to listen to your body.  Are you just occasionally fatigued?  Could you be overtraining?  Take a well needed rest day or TWO!  Something hurt worse or in a new way?  Don’t injure further through ignorance of what is wrong!  Are you always tired or sleepy?  Are you ok as long as you are doing something, but have trouble staying awake or focused if you have some down time?  Don’t take the risk…see a sleep doctor and get the right answers.



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Posted by on May 24, 2012 in General Paleo Discussion


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Can Going Paleo Help Your Sleep?

Being that I am a sleep doctor, one of the things that I found most curious about my transition to a Paleo diet is how much it seems to have improved my sleep. I was never necessarily a bad sleeper, but I find my sleep to be exceptional since my diet change. I fall asleep quickly, which I always have, but it’s the continuity of my sleep that has improved. In the past I would often toss and turn, waking up several times during the night for no particular reason. These days I fall asleep, and the next thing I know my alarm is going off and it’s morning. I feel more refreshed in the mornings and don’t feel the afternoon fatigue I used to have on occasion.

My wife has also noticed a difference. For almost two years she used Lunesta to help her fall asleep and she was tired of having to use it. It left her groggy in the mornings and she seemed to just drag all day. Without it she could not fall asleep easily so she used it out of necessity. Once she also committed 100% to a Paleo diet she began to sleep better. She got off the Lunesta and after a week or so of flushing it out of her system, she has been sleeping better than she has in over 10 years. She sleeps well, feels refreshed in the mornings, and has very infrequent awakenings throughout the night.

In almost all of my patients that have adapted their diet to the Paleolithic plan I have seen an improvement in sleep similar to our experience. So the question is why? Why does sleep, in particular sleep continuity seem to improve with a change in diet? I’ve searched the medical literature and have found no definitive studies to answer that question. So, I’m going to offer my OPINION on why this may be the case. Let’s look at a couple of things.

I discussed in a prior post that a fairly well timed hormonal dance occurs around the time we go to sleep. Cortisol nears its nadir at the time we normally fall asleep, and growth hormone is on the rise during this time. This exchange of hormone levels, along with an increase in our natural melatonin leads to us going to sleep. If these hormones are off for whatever reason, the result can be disjointed sleep. We know that cortisol and insulin are closely tied, so it makes perfect sense that by adapting a diet that lowers your overall insulin levels that will likely have a positive affect on your cortisol levels. Although maybe not completely understood, an interplay between insulin, cortisol, and growth hormone are involved in the improvements in sleep seen with Paleo.

Another area that affects sleep is your gastrointestinal system. When you eat a diet full of GI irritants, large meals are bound to affect how you feel. Your sleep is an ever changing state where you move between sleep stages freely throughout the night. Normally the changes in your sleep stages, or stage “shifts” are fairly well timed leading to a fairly small number of overall shifts though out the night. Anything that disrupts sleep such as Obstructive Sleep Apnea or Periodic Limb Movement Disorder does so by essentially increasing the number of stage shifts. This increase in shifts leads to a higher rate of arousal from sleep (aka waking up) and therefore less restful sleep. Any number of things can lead to stage shifts, including any pain or discomfort you may have. Chronic GI irritation from a traditional carb based diet leads to excessive gas, bloating, and cramping that I believe disrupts sleep quite a bit. You do not have to be completely conscious of your arousals, in fact you are not aware of most, but your brain recognizes them and you feel them in the morning as fatigue. I’m sure we all would agree that a Paleo lifestyle has led to much a much calmer GI system…to say it nicely. If we feel better in the day, we feel better at night, and we sleep better because of it as well.

Sleep is also very closely tied to one’s emotional well being. One of the most common signs of chronic depression is chronic insomnia. There are two basic forms of insomnia: sleep onset and sleep maintenance. As you may expect sleep onset insomnia is trouble falling asleep, and sleep maintenance is trouble staying asleep. A typical depressed sleep pattern is taking too long to fall asleep due to excessive thinking, and early morning awakening. This early morning awakening can be anywhere from 2-5 AM, and again is prolonged by what I call the “I can’s shut my brain off” syndrome. Once people wake up, they just can’t stop thinking enough about what they have to do or what has happened to them to fall back asleep. A gluten laden diet has been linked to depression in many studies, and many people report significant improvements in their underlying depression or hopelessness by changing to a gluten free diet. Paleo of course is gluten free and then some. It’s not hard to link a paleo diet with improved depression, and improved depression with improved sleep. When we treat depression with traditional antidepressants one of the first thing patients report is a dramatic improvement in sleep, particularly sleep maintenance. If you consider Paleo eating more of a natural antidepressant, then the improvements in sleep are easy to understand.

Lastly I think sleep is improved with the Paleo diet basically by association with other aspects of the so called Paleo “lifestyle”. When you decide to go Paleo, you normally do it with the basic intention of getting healthier and feeling better. To that end most do not stop only with their diet. Adapting a new lifestyle also includes increasing your physical activity and focusing on a more overall positive attitude. When you exercise you get tired, and getting more tired in the day leads to better sleep at night. Think of your kids; when they play hard or swim for hours they sleep like logs…we are the same!

Over the next few months, try to focus a little more on your sleep. See how certain things affect your sleep. In particular, notice how any “cheats” may affect your sleep. Some can be a little less compliant and get away with it, but many can’t. Gluten and dairy in particular can significantly affect your sleep, even in small doses.

One last thing, what if you are totally Paleo, and still can’t sleep? Paleo can make you sleep better, but it cannot treat or cure many sleep problems. Insomnia is not to be taken lightly, and can be a significant medical issue requiring sleeping pills to treat. From Restless Leg Syndrome to Delayed Sleep Phase Disorder, sleep disorders are real and are not always treatable “naturally.” Likewise, depression is a pervasive and life changing illness that often requires medication to manage. If you feel depressed despite a Paleo diet, or you can’t sleep, or both!, please do not feel “ashamed” or “weak” in any way by seeking appropriate care and treatment from a health professional. Don’t lose another night of sleep worrying about it.


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Posted by on May 9, 2012 in General Paleo Discussion


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What Can Sleep Apnea Teach Us About Sleep Deprivation?

Around 25% of my medical practice is devoted to sleep related disorders.  Without question, the most common sleep disorder I diagnose is Obstructive Sleep Apnea (OSA) [Click HERE for a link to my guest blog article written for Dr. Samuel Bledsoe’s blog, Bariatric Freedom] Most believe insomnia would be the most common disorder, but that type of patient rarely visits my office.  Why you may ask?  Typically, because their family physician treats them with sleeping aids to band aid the problem, or they never complain because they do not recognize poor sleeping habits as a problem with a solution.

Americans do not value sleep.  I see it daily, and unfortunately I see the price my patient’s pay in their overall health.  The symptoms most commonly associated with poor sleep hygiene are daytime fatigue and poor work performance.   However, would it surprise you learn that inadequate amounts of sleep have also been linked to heart disease, high blood pressure, elevated insulin and thus blood sugar levels, worsening of asthma symptoms, and even death?  To learn why, look at one of the most common sleep problems, Obstructive Sleep Apnea.

OSA is a condition where you have intermittent pauses in breathing (apneas) while you sleep.  As you cycle through sleep, typically, you move from the lighter phases of sleep (Stages I and II) into the deeper stages (Stage III and REM).  The graph below illustrates a fairly normal sleep cycle in a healthy young adult.  I might point out that recently state III and IV sleep were combined into once stage known as Delta sleep in the sleep medical literature, and the hypnogram below still has the old nomenclature.

When you have intermittent apneas at night, usually from your airway closing on itself, it leads to at least a 10 second pause in breathing.  As your oxygen goes down, your carbon dioxide goes up.  It is this carbon dioxide that eventually reaches a level which tells your brain that it is time to breathe!  The key is when you start to breath again, you almost always experience what we call an arousal.  This means your brain waves, or EEG, shows a shift to a lighter stage of sleep, usually all the way back to wake.  Just as quickly as you woke, you fall right back asleep, but at a lighter level.  Therefore, if you have moderate sleep apnea, you may stop breathing 30 times an hour, and thus wake up 30 times an hour!  Of these, you may actually be aware of only once that you wake, but your brain is aware of each and every time.

What is the result of this very intermittent and choppy sleep?  Symptoms!  Classic symptoms of sleep apnea include feeling sleep deprived upon waking, morning headaches, drowsiness while driving, mental fogginess in the morning, fatigue, sexual dysfunction, and getting busted snoring in public places.  An analogy I tell patients is to imagine you slept 8 hours overnight; however, during this sleep period you were awakened every 30 seconds, then you immediately fell back asleep.  Obviously, you will not feel refreshed!  This is a life with sleep apnea.

It is important to note that you do NOT have to be overweight, or even snore to have sleep apnea!  Sleep apnea is caused by a narrow upper airway that has an abnormal tendency to close when relaxed.  If your airway has this propensity, you are at risk of developing OSA.  If you are at risk and gain too much weight, your chances increase dramatically.  Therefore, obesity makes OSA worse, but does not necessarily cause it.  Yes, I do diagnose 115 pound, 35 year old females with severe sleep apnea.  If you have these symptoms and they are unexplained, see a certified sleep physician.  Do not solely rely on how you feel.  Let me say that again, having sleep apnea is not necessarily related to poor life choices.  Like many disorders, you can inherit the tendency to have problems that can lead to poor health.

So, what does this have to do with anything you ask?  Let me just lay out a few of the hormonal changes that occur with sleep apnea.

-Cortisol is bad for you.  It’s bad for sleep, it’s bad for your insulin levels, and it’s bad for your blood sugars.  Cortisol normally reaches its low right before bed time, which allows for an easy transition from wake to sleep.  Sleep should be a relaxed time when your “stress-hormones”, of which cortisol is one, are at a low level.  Chronic sleep disruption from OSA leads to both, a slower level of cortisol decrease as sleep approaches, and a general increase in cortisol levels all night.  Given that cortisol increases insulin levels, which increases glucose levels and your risk for obesity and diabetes, this is clearly a problem.  This elevation in cortisol also makes controlling a diabetic’s blood sugars difficult if they have untreated OSA.

-The yin to cortisol’s yang is growth hormone (GH).  GH levels typically rise during the night as you sleep.  This is important, because GH has the ability to counteract insulin and grant you some relative protection against insulin resistance syndrome.

-Leptin is your friend.   This hormone essentially triggers to your brain that you are full.  Leptin also appears to be affected by sleep amounts!  Studies in patients subjected to sleep deprivation, in large and moderate amounts, show a significant fall in leptin levels.  This is because your bodys fat cells, which secrete leptin, are signaling to your body to eat, even when it is full! So yes, poor sleep makes you hungry.

-Grehlin, works basically the opposite of Leptin by stimulating the appetite.  If you had to guess what sleep does to Grehlin levels, what would you say?  Yep, sleep deprivation leads to abnormally high levels of Grehlin and thus hunger.

-This is just the tip of the iceberg.  The sleep medical literature is constantly finding new links to hormones and metabolism.  As things evolve, I will try to keep you informed.

So, now that I have potentially bored you all to death, what does this all mean?  OSA patients have chronic sleep disruption from the disease.  However, a result of the everyday choices we make, many of us also suffer these hormonal consequences. Think of the amount of sleep you need as a checking account.  You need to deposit a certain amount every night, in order to make withdrawals the next day.  If you fail to make nightly deposits, debt will accumulate.  Unfortunately, if you miss thirty minutes here, an hour there, and never make it up, the debt starts to accumulate fast.  After continuing this habit, your sleep debt has accumulated to such a large amount that you are bankrupt.  You are tired, cranky, sluggish at the gym, hungry, stalled on your weight loss, stressed…get the picture.  The cause of this common picture is the hormonal consequences detailed above.


The Paleo world tends to focus way too much on food, and forget about other aspects of health.  As a sleep doctor, I would sayAmerica’s overall sleep health grade is an F minus.  We don’t value sleep.  How can you want to be your best, do your best, have the best time possible without giving your body the proper rest?  It won’t work.

Like I said above, the hormonal landscape of sleep and how it affects your everyday life is a work in progress.  We just do not know everything there is about the neuroendocrine nature of sleep to connect all the dots.  However, we have connected a few important dots.

-We have mortality data demonstrating the risk of dying is 30% greater for untreated OSA at any point in your life.

-European data recently showed a significant increase in the mortality of individuals who reported sleeping less than 6 hours a night…regardless of BMI or lifestyle!

So people, no matter how “in shape” you think you are, how many pull-ups you can do, or how little carbs you eat…lack of sleep will catch up by making your long-term health worse.  Don’t get caught thinking you are above the fray because your WOD times are always best!  Get your sleep, invest in your health, you’ll be glad you did.



Posted by on May 1, 2012 in General Paleo Discussion


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