There is a single lifestyle related deficiency that is very common today that increases your risk for a heart attack or sudden cardiac death, decreases your cognitive function and brain speed, and promotes weight gain. What is this critical need?……………………..

The answer is SLEEP! Far too many people are not meeting their sleep requirements. They either don’t get enough, or it is poor quality sleep. Inadequate sleep worsens multiple aspects of hormonal health, lowers metabolic rates, increases appetites, and diminishes brain performance.

Having just returned  from a family trip to SE Asia with major jet lag, I was extra sensitive to this topic this week when several of my patients were suffering from obvious sleep deprivation.

Most people need 7-8 hours of sleep nightly, although 5-10% of people may do well with only six hours per night, and likely 5-10% of folks need 8-9 hours nightly. If you are getting enough quality sleep, you should be able to wake up and feel rested without an alarm in the morning, you don’t need extra caffeine to get and keep going, you don’t have afternoon or evening fatigue, and you feel mentally sharp all day long.

Here are seven tips to improve your quality of sleep.

1. Same sleep time: Aim to go to bed and go to sleep at a similar time each night and rise at a similar time each morning, ideally within one hour. Staying up late on the weekends and sleeping in and then getting up early all week decreases the quality of your sleep all week long. If you are exhausted, then take an extra hour in the morning on the weekends, but more important is to make sure you get to bed at a reasonable time.
2. Caffeine and alcohol: Don’t overdo caffeine during the day, or alcohol in the evening. It takes 6-7 hours to remove each cup of coffee from your system. Having more than two servings daily guarantees you go to bed with caffeine in your blood stream. You might fall asleep exhausted, but after 3-4 am the caffeine kicks in and you can’t stay asleep. Drinking alcohol before going to bed ensures your alcohol levels will drop during the night, potentially awakening you with a startle. If you have 1-2 glasses of wine with dinner at least two hours before going to bed, that is ok, but your body can only remove about one serving of alcohol per hour and if you go to sleep with excess alcohol in your system, likely you will feel a startle when the alcohol leaves your system, waking you up during the night. Typically this occurs around 2-3 am in the morning.
3. Exercise: Add daily exercise. Exercise improves sleep waves, burns off tension from the day, and helps your body to feel physically tired, improving sleep. One caveat is to avoid exercising 2-3 hours before bedtime as exercise initially revs up your mental alertness, a good thing during the day.
4. Keep your room cool, dark, and quiet. Most people sleep best in a room between 68-72 degrees F (about 20-22 degrees C). Here in Florida, many people try sleeping at 78 degrees F with high humidity and they wake up sweating during the night. Your room should be cool enough so you can enjoy covering with a comforter and if your feet are cold, wear socks. Ideally your bedroom should be dark, but if not you can easily wear eye blinders to keep out the light. City life can be very noisy at night, disrupting your sleep multiple times. Ear plugs can help, but better yet consider a bedroom window upgrade with sound proof (better insulation and safety too) to keep out the traffic and city sounds. Be sure to keep pets out of your bedroom as they can wake you up multiple times each night; the same applies to children, although obviously exceptions are made for children who are ill or nursing.
5. Limit your bedroom to sleep, relaxation, and romance. Don’t watch TV or work/play on the computer within 1-2 hours of going to sleep. TV and computer screens change brain waves and activate deep brain centers, making high quality sleep elusive. Ideally unwind before going to bed. Read, relax, use prayer or meditation, and spend time with loved ones. Additionally, keep  your office activities out of the bedroom. You don’t need a workstation to distract you from good sleep.
6. Certain foods help you sleep. The brain needs serotonin to relax and your body makes serotonin from tryptophan. It shouldn’t be a surprise that your grandmother suggested you have a snack before bedtime, in particular warm non-fat milk, turkey, bananas, and peanut butter are all high in tryptophan. But if you suffer from heartburn, eat these foods at least two hours before bedtime. Warm herbal brews, such as valarian can be helpful.
7. If you have problems falling asleep, then try meditation or listen to a relaxation recording to help calm your soul before falling asleep. If you can’t fall asleep, avoid watching the clock. Even better would be to get out of bed and read for a while, select something soothing, even boring, then return to bed.

If none of these optimize your quality of sleep, then talk to your medical provider about herbal agents for occasional use, such as valarian or ashwagandha and to clarify that medical issues are not disrupting your ability to sleep. For a short term crises, a minimal-habit forming sleeping medication can be used; however please keep in mind that if used long-term, all sleep medications disrupt normal sleep architecture and make it harder to sleep without the medication.

Wishing You Sweet Dreams!

Steven Masley, MD, FAAFP, CNS, FACN

Japan has fantastic food. Each dish is a display of visual art. The flavors are diverse and sumptuous.  Japan enjoys the longest lifespan and the longest  “health span” on the planet. I just spent part of our family holiday visiting Tokyo and the highlight for my wife Nicole and two sons was visiting the world’s largest seafood market with an incredible array of  fresh (still wiggling) seafood from around the world.

Let me share seven quick secrets to ensure you benefit from your next Japanese restaurant experience. A Japanese meal has multiple courses designed to stimulate most of our senses and add vitality to your life. Six to seven courses seem essential  for a complete meal, although we were served a sixteen course meal with fortunately many small portions.

Here are my  suggestions to a healthy, delicious meal. Keep in mind Japanese portions are typically modest and sometimes tiny.

1. Start with a soup.  Traditionally, a noodle or seafood soup would be the first course and Miso would actually be served towards the end of the meal. In an American Japanese restaurant, Miso is typically served first, so look at other options.  Miso is a soy based broth with a few slivers of tofu, seaweed, and green onion; it is very light and satisfying with delicate flavors after the main meal.
2. Next order edamame, fresh soy beans. Edamame with a tiny dash of rice vinegar and soy sauce is packed with protein, calcium, and many anti-aging compounds and has been a staple food in Japan for centuries.
3. A small salad comes next. My favorite is a mixed seaweed salad with wonderful flavor and texture, but if seaweed isn’t your thing, go for the green salad with the light Japanese dressing, often with ginger and rice vinegar.
4. Either sushi (rice rolled with seaweed and fish, cooked shrimp, and/or vegetables) or sashimi (raw fish) comes next. The quality must be fresh and excellent, or select the cooked shellfish option. Typically, sashimi is served as two small pieces, or one roll is split between two people. Although ahi tuna is one of my favorite foods, be cautious eating this type of big mouth fish often as it is very high in mercury.
5. A grilled or broiled entree is next, the most substantial part of the meal. Typically this is fish, shellfish, meat, or poultry served with white rice. From a health perspective, brown rice would be a much better choice, but white rice represents purity–fortunately it comes in a tiny bowel. My favorite entrees are unagi, (river eel) and unaga (sea eel) which are typically served over rice with a lovely sauce.
6. A mixture of pickled vegetables is next, adding  sour and bitter to complete a nearly full palate and aid in digestion. Various types of vinegar are used to pickle food. Cabbage is commonly included, and be sure to look beyond the pickled ginger that comes with  your sushi. Adding vinegar (acid) at the end of a meal is medically smart as acid improves digestion, nutrient absorption, and helps to prevent heart burn after a meal.
7. Last is fresh fruit and a cup of tea. During the dinner regular green tea is served, but the final cup will usually be something special, like Matcha (made from a special green leaf powder). If you enjoy alcohol with your dinner, then typically a lager beer or cold sake goes best with Japanese food. Although most Americans order warm sake, cold sake is usually much better quality and has a more delicate flavor suited for a Japanese meal. Fruit could be sliced mango, papaya, or strawberries.

This seems like a great deal of food, but the portions are small, and the flavors are complex and satisfying. The Japanese are not only one of the healthiest cultures on the planet, but they enjoy their food immensely, and despite their national wealth, they remain trim. We would all benefit from eating Japanese food more often.

Bon Appétit!

This weekend I had the pleasure of speaking to physicians at the Florida Academy of Family Physicians meeting on “Cutting Edge Nutrition”. I had a fantastic dinner while there, and the best part was that I had the chance to talk about food over dinner with long time friend and colleague, Michelle May, MD. Dr. May is a physician from Arizona and the author of several books including “Am I Hungry” plus her newest book, “Eat What You Love and Love What You Eat”. As I was enjoying each bite of my dinner, our conversation focused on “when” we eat, “why” we eat, and how the when and why often lead to what type of food and how much we consume.

Let me ask a few questions to clarify if our conversation would be  important to you:

• Do you sometimes over eat, to the point you feel uncomfortable?
• Do you eat out of control, when you know you shouldn’t?
• Do you eat when you are mad, stressed, or tired but not  hungry?
• Do you make a healthy eating plan, and then can’t resist junk foods that you carefully intended to avoid?
• Do you find yourself sneaking food so others won’t notice?

If you answer yes to these questions, then you are not eating mindfully.  If you don’t eat mindfully, then you risk overeating, eating foods you don’t want to eat, and feeling worse after you eat than you did before you took the first bite.

Over the holidays, we are surrounded by excessive amounts of food, often the nutrient quality of food is poor, and our  schedules are jammed-packed, making meal planning more chaotic.

Here are my four suggestions to eating mindfully over the holidays: 

Step 1: Ask yourself prior to eating, “Are you hungry?” Are you about to eat because you need fuel, because is it socially required, or because you are upset or stressed out? It doesn’t mean you can’t/shouldn’t eat, but be very clear “why” you are eating, or you risk uncontrolled eating, and subsequently regret. If you are not hungry, select a small portion.

Step 2: Declare your space for eating. Plan a place to sit (not in front of the television, not in the car, not in front of the computer, and not at your desk), and if you are lucky, sit with a loved one you want to spend time with. Before you take a bite, look at your food and your surroundings.

Step 3: To eat mindfully, be sure you visualize, smell, taste, and feel the food in your mouth, including each and every bite. Look at the presentation of your food. Is your plate colorful, and is it the right amount to match your appetite? As you slip your first bite across your lips, how does the food taste? Hopefully it tastes delicious, if not, before taking a second bite, ask yourself, do you really want more, or would you like something else? Can you smell the food as you eat it? What is the texture like in your mouth? Switch from one item on your plate to another, and appreciate the difference between each bite.

Step 4: If you are eating with another person, then talk about the food you are enjoying.

This style of eating reflects mindful eating. If you practice mindful eating, very likely you will eat less, enjoy your food more, and make better choices. In contrast with mindless eating, (such as eating in front of the television) you may not taste or smell your food clearly, you may over eat—perhaps to the point you will be uncomfortable, and you may eat foods you would not have normally chosen.

Practicing mindful eating over the holidays will allow you to enjoy your food at a new level, and help you to make excellent food choices.

I wish you a wonderful and meaningful holiday season, filled with love and happy memories, and of course, wonderful food.

Bon Appétit!

Steven Masley, MD, FAAFP, CNS, FACN