It’s commonly thought that sleep apnea is simply a problem of obesity or structural issues that interfere with breathing. However, a commonly overlooked cause of sleep apnea in men and women is the brain. When the brain is not functioning properly, this can interfere with the body’s ability to maintain proper breathing function while asleep.

Sleep apnea and the brain in women

The brain’s influence on sleep apnea can be seen in women during perimenopause and menopause if their estrogen drops too low.

Insufficient estrogen causes the brain to fail in signaling the palate and tongue to maintain tone during sleep. The resulting lack of tone blocks the airway.

The brain-related cause of sleep apnea is different in men. In a rat study, young male rats responded to normal episodes of oxygen deprivation during sleep by automatically increasing brain activity to take deeper and more frequent breaths. However, the older male rats did not respond in the same way due, it’s theorized, to more aged brains.

Researchers observed a much different response to these normal episodes of sleep-induced oxygen deprivation in female rats. For one thing, older female rats responded much more positively to these hypoxic events than the older males.

Younger female rats had an even better response, especially during specific times in the menstrual cycle. This led scientists to believe female hormones play a role in how they respond to normal episodes of oxygen deprivation during sleep.

This theory is what leads researchers to believe estrogen deficiency contributes to sleep apnea in women during perimenopause and menopause. Estrogen influences serotonin, a brain neurotransmitter chemical that plays a role in giving the tongue and palate tone, including during sleep.

Estrogen tells the brain to breathe in women

To test the theory that the interplay between estrogen and serotonin plays a role in sleep apnea, researchers induced menopause in female rats by removing their ovaries. Sure enough, post-mortem brain biopsies showed less serotonin in the area of the brain that controls the tongue. This had made it harder for the female rats to respond to episodes of oxygen deprivation during sleep. This helps explain why sleep apnea affects more women in midlife.

Sleep apnea and the brain in men

Middle-aged men also experience higher rates of sleep apnea due to the effect of declining testosterone on the brain.

In midlife, men snore more and have more episodes where they stop breathing.

Middle-aged women, however, more commonly complain of insomnia, as well as headaches, fatigue, and irritability caused by sleep deprivation and poor sleep quality. That estrogen deficiency promotes weight gain, and restless leg syndrome only worsens the problem of sleep apnea.

Hormone status that plummets too low in midlife can be the result of chronic stress, poor diets, lack of exercise, and other standard bad habits of modern living. These are areas we can address through functional medicine.

Functional neurology and sleep apnea

Sleep apnea can also arise in relation to traumatic brain injuries, childhood brain development disorders such as autism, or other brain-related issues. In functional neurology we can identify areas of dysfunction related to sleep apnea, such as with nerves traveling from the tongue to the brain through the brainstem. Based on findings, customized rehabilitation exercises may help address problems with sleep apnea.

Functional medicine and neurology strategies can profoundly improve both brain and hormone function so you not only sleep better, but also feel and function better. Ask my office for more advice.

Recent studies have shown rice can be dangerously high in inorganic arsenic, particularly rice grown in the southern United States. This is bad news for gluten-free people who eat rice-based products — one study showed people on a gluten-free diet have twice as much arsenic in their urine compared to controls (and 70 percent more mercury).

Although guidelines exist to minimize arsenic exposure (buy rice from California, eat white rice, wash rice thoroughly before cooking, and cook rice like pasta in a ratio of about 6 to 1 water to rice), what about rice-based gluten-free foods? It’s nearly impossible to know where their rice comes from, how it’s processed, and what the arsenic levels are.

Arsenic levels in popular gluten-free foods

Until now. The Gluten-Free Watchdog has begun testing arsenic levels in popular brands of gluten-free foods, which you can view with a subscription.

Keep in mind that what is considered an acceptable amount of arsenic varies. Codex, an international collection of safety standards, proposes a maximum of 200 parts per billion in white rice. The European Union proposes 100 parts per billion.

However, arsenic expert Dr. Andrew Meharg proposes a  maximum of 50 parts per billion for children, who carry a heavier toxic body burden, and a maximum of 100 parts per billion for adults.

Arsenic levels in rice-based gluten-free foods

For results of inorganic arsenic testing on various brands of gluten-free foods that you can browse by category, visit Gluten-Free Watchdog. A paid subscription is required to access the reports. However, below are examples of arsenic level ranges in some categories of popular gluten-free foods.*

Inorganic arsenic in gluten-free breads

Inorganic arsenic in popular gluten-free breads ranged from 10 parts per billion to 40 parts per billion.

Pastas

Inorganic arsenic in popular gluten-free pastas ranged from 20 parts per billion to 150 parts.

Cereals

Inorganic arsenic in popular gluten-free cereals ranged from 70 parts per billion to 280 parts.

Miscellaneous rice products (rice bran, rice milk, rice syrup, rice cakes)

Inorganic arsenic in miscellaneous rice products ranged from 20 parts per billion to 540 parts.

Rice

Inorganic arsenic in several rice brands ranged from 80 parts per billion to 140 parts per billion. (Brown rice has more than white rice. Gluten-Free Watchdog reports a brand called Mighty Rice grown on the island of Mauritius shows very low levels of inorganic arsenic in their tests.)

Factor in frequency and amount of consumption

It’s important to understand these numbers tell us the concentration of inorganic arsenic in each product. The frequency and amount of any item eaten and whether the eater is an adult or a developing child are also very important factors in the equation. For example, at 540 parts per billion of inorganic arsenic, one rice bran product looks pretty bad. But consumed in very small quantities as brans typically are, it may not pose as much a problem, relative to the other foods listed, as it first may seem.

It would be better if rice were not high in inorganic arsenic. Thankfully groups such as Gluten Free Watchdog are around to help us reduce exposures. Also, there is a group based at Cornell University working to shift the world to a rice farming method that uses up to 50 percent less water while increasing yields, thus saving precious water while reducing the amount of arsenic in the rice produced.

*Ranges included with permission from Gluten-Free Watchdog LLC.

Humans have been fasting for millennia, either for religious or spiritual reasons or simply due to lack of food. Today, a new form of fasting called intermittent fasting is increasingly popular among those seeking it’s anti-aging and health benefits.

Intermittent fasting, or IF, makes fasting an everyday part of life versus something you do once or twice a year. Many people use it successfully for weight loss and inflammation control, as well as to improve brain function and insulin sensitivity. The promise of increased longevity is another reason people choose to fast regularly.

Different forms of intermittent fasting

Intermittent fasting can be done in a number of ways:

• 5:2 diet — In this plan you eat normally five days per week, and either fast completely, or severely restrict calories (500-600 calories) the other two days.
• Alternate day fasting — This plan includes normal eating for 24 hours and zero, or very low calories (500-600) for the next 24-hour period, alternating every other day. These 24-hour periods typically begin at dinnertime so that in any one day you may miss one or two meals, but not all three.
• 16:8 or 14:10 — Also known as the “eating window plan,” this plan has you eat during an 8- or 10-hour window and fast the remaining 16 or 14 hours of each 24-hour period. For example, you stop eating at 7 p.m and do not eat again until 14 hours later at 9 a.m. the next morning.

Intermittent fasting for weight loss

Restricting caloric intake can lead to weight loss, but intermittent fasting seems to help with weight loss in more ways than that. For one thing, studies show intermittent fasters have better insulin sensitivity and glucose regulation. Among other things, this makes a person crave less sugar and use glucose more efficiently for energy production instead of being stored as fat. Intermittent fasting also causes your body to burn more fat. Because it depletes glycogen, the storage form of glucose, your body switches over to burning stored fat for energy.

Intermittent fasting for brain function

Studies show intermittent fasting can benefit brain function and potentially even stave off Alzheimer’s disease and depression. This is likely due to better glucose and insulin control (Alzheimer’s disease is often called type 3 diabetes), as well as production of ketone bodies for fuel. Ketones provide a ready source of clean-burning fuel for the brain that leave behind fewer free radicals than glucose does. High-fat ketogenic diets have long been used to help prevent seizures.

Other benefits

Intermittent fasting has been shown in trials to reduce blood pressure, triglycerides, LDL cholesterol, and insulin-like growth factor, a hormone that is linked to cancer and diabetes. There is still much to learn about the benefits and pitfalls of intermittent fasting. Fortunately, it is an area of great scientific interest and research is happening at a rapid pace.

Intermittent fasting is not for everyone

Children and teens, pregnant women, people with eating disorders, as well as those with hypoglycemia should not fast. Also, diabetics taking insulin should only attempt this diet under supervision of a doctor.

Women often find less stringent forms of intermittent fasting are more suitable for them. For example, a woman might start by trying a 12:12 eating window plan and potentially lengthen her fasting time gradually, or not, as it suits her.

As always, it is important to understand that there is no one-size-fits-all remedy to any health concern. Contact my office to discuss if intermittent fasting might be right for you.