Diet, Menopause and Insomnia - Are they connected? - January 2022

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Research is growing on the relationship between diet and sleep and has produced inconsistent findings, with little attention on menopausal and postmenopausal women. Insomnia affects an estimated 30 percent of adults, impacting women disproportionately. Current insomnia treatments, such as cognitive behavioural therapy or medications, can be costly or have side effects.

A study by US researchers looked at the relationship between diet and sleep for postmenopausal women. Senior study author James Gangwisch, Ph.D., assistant professor at Columbia University, explained that the research team sought to determine other factors leading to insomnia, and use this information to develop alternative interventions.

Background on carbohydrates 
Wendy Sweet, Ph.D., developer of an online 12-Step Menopause Transformation Program, shares a common misconception that people should avoid carbohydrates when carbohydrates are essential for the body, especially the brain. Carbohydrates provide the body with glucose, and the body converts glucose to energy used to support bodily functions and physical activity. For women in menopause, the quality of carbohydrates is essential. Carbohydrates are not created equally and differ in how they affect blood sugar levels. The Harvard TH Chan School of Public health explains that the "not so good" or unhealthier carbohydrate choices are processed and high in sugar, e.g., white bread, pastries, sodas, and other highly processed or refined foods. Called simple carbohydrates, they are easily digested and may contribute to weight gain, interfere with weight loss, and promote diabetes and heart disease. Processed foods and foods high in sugar are carbohydrates we want to minimize. 

Healthy carbohydrates are unprocessed or minimally processed whole grains, vegetables, fruits and beans. These are healthy choices because they provide vitamins, minerals, fibre, and essential phytonutrients (literally, plant nutrients). Unlockfood explains that phytonutrients have antioxidant properties. Several reduce the risk of chronic conditions such as heart disease, stroke, and cancer. Eating a diet rich in these foods promotes healthy aging.

The glycemic index (GI) is a ranking of carbohydrate-containing food or drink on a scale from 0 to 100 according to how much they raise blood sugar levels after eating or drinking them. GI measures how quickly foods increase blood glucose levels; foods with a high glycemic index rapidly increase blood glucose levels. On this scale, pure glucose is 100. Diabetes Canada explains that, in general, the more highly processed, the higher the GI. Some plant foods are considered high GI (bananas and watermelon), but Diabetes Canada points out that they are not likely "bad" when eaten in moderation.

Low GI foods do not spike blood sugar and insulin levels. Examples include plant foods such as most fruits and vegetables, legumes and beans, nuts, seeds, and whole grains. Examples of low GI fruits include apples, strawberries, oranges and peaches.  

High GI foods increase blood sugar higher and faster than foods with a low GI because the body quickly digests, absorbs and metabolizes these foods. Examples include foods made from processed grains such as white bread, pasta, baked goods, white rice, and added sugars, e.g., sweets and sugar-sweetened beverages. 

Diabetes Canada defines glycemic load (GL) as "a calculation that estimates the glycemic response of a serving of carbohydrate-containing food or drink." GL measures how much foods raise blood glucose levels. Harvard Medical School comments that the GI doesn't tell you how high your blood sugar could go when you eat the food, whereas the GL tells you how quickly a food makes glucose enter the bloodstream and how much glucose per serving it can deliver. They provide the example of watermelon, which has a high GI of 80 but a GL of only five because it has so little carbohydrate. 

The study used dietary data from more than 50,000 menopausal women with the Women's Health Initiative Study. The average participant's age was 65. The authors hypothesized that a higher GI and GL would be associated with greater insomnia prevalence and incidence odds. Prevalence is the measure of a condition in a population at a given point in time, while the incidence is the number of newly diagnosed disease cases. The research team looked at carbohydrate intake through food diaries, collecting data on GI, GL, added sugars, starch, total carbohydrate, dietary fibre, and intake of specific carbohydrates, e.g., whole grains, processed or refined grains, whole fruits, vegetables, and dairy products. Researchers measured insomnia at baseline and three years later. The findings, published in the American Journal of Clinical Nutrition, included: 

Women with a higher GI diet, especially with added sugars (e.g., white and brown sugar, syrups, honey and molasses) and processed grains, had a greater the risk of developing insomnia.

Added sugars, but not total sugars or total carbohydrates, were associated with insomnia incidence. Women eating higher amounts of vegetables, fibre and whole fruit (not juice) were less likely to develop problems with insomnia. While whole fruits contain sugar, the fibre content slows the rate of absorption of sugar to prevent spikes in blood sugar levels   Researchers controlled for potential confounding variables (other variables that may cause research results) such as education, income, marital status, smoking, alcohol and caffeine intake, physical activity, stress, social connection, body mass index, various medical diagnoses, hormone therapy and snoring. 

Why might high GI foods be associated with insomnia? The belief is that high GI foods' spike and crash blood sugar levels. This blood sugar drop can lead to the release of hormones such as adrenaline and cortisol, which can interfere with sleep. 

Dr. Gangwisch comments that the findings suggest high GI foods could be a risk factor for insomnia in postmenopausal women, and the findings may apply to the broader population. The results indicate that low GI foods, such as dietary fibre, whole fruit, and vegetables, could prevent and treat insomnia in postmenopausal women. Future research requires randomized controlled trials to clarify these results. What can you do? 

Choose low GI foods more often, e.g., salmon and vegetables versus pasta and meatballs Time large meals to be eaten three to four hours before going to bed If you choose to eat something before bed, consider plant-based snacks, e.g., blueberries and nut milk, instead of sugars and processed grains

For a list of low and medium GI foods, visit the Diabetes Canada website. Some dietitians believe that keeping track of the GI and GL of foods is too complex. Find what works best for you or speak to a dietitian. The HealthLink BC website has "Dietitian Services" available by phone or email.  

Sources: Columbia University press release, Harvard Medical School website, Harvard Medical School website, University of Manitoba website, IFT website, Deccan Chronicle website, Harvard TH Chan School of Public Health website, Unlockfood website, Diabetes Canada The Glycemic Index Educator's Handbook

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