Health & Fitness

During an acute stress response, your body undergoes chemical changes that enable you to run from predators or take down prey. It's known as the flight-or-fight response.

Unfortunately, some of those same life-saving chemical reactions used to protect you from danger may also be triggered as a coping response to perceived societal dangers, like dealing with a problem with a coworker or addressing the fear of public speaking. In other words, there are times your body finds it difficult to turn off the stress response.

This chronic stress is one of the biggest challenges faced by U.S. adults. Many report stress has a negative impact on their physical and mental health. In a 2015 survey by the American Psychological Association, results revealed a sizable number felt they were not doing enough to manage their stress levels.

Just half said they engage in stress management activities a few times a month or less and 18% said they never did. Some reported overeating or choosing unhealthy foods in response to stress, while 46% said they lie awake at night because their stress levels were so high.

Robert Sapolsky is a professor at Stanford University. Every year he spends a few weeks in the Kenyan wilderness studying baboons. He discovered those who had higher levels of stress experienced higher heart rates and blood pressure measurements. The arteries of the baboons under stress were filled with plaque, restricting blood flow to the heart.

This was the first time stress was scientifically linked to deteriorating health in wild primates. As it turns out, stress has the same effect on other primates — for example, us! Fortunately, the damaging effects of stress may be alleviated in part by relaxation, meditation and Emotional Freedom Techniques (EFT).

Another potential trigger for a chronic stress response is suboptimal levels of vitamin D, magnesium and omega-3 fatty acids — and there is something we can do about that, too.

Vitamin D Improves Symptoms of Depression and Anxiety

Vitamin D, otherwise known as the sunshine vitamin, is really a hormone produced by your body after exposure to UVB rays from the sun. The vitamin plays a significant role in several health conditions in your body. Deficiency in childhood may increase your risk of high blood pressure, and deficiency in adulthood may increase your risk of cancer and all-cause mortality.

Insufficiency and deficiency may lead to a number of other negative health effects, which I cover in my past article, “Top 5 signs of Vitamin D Deficiency.” Vitamin D also has an effect on other daily struggles, including mood and emotional health.

Research published in the Journal of Diabetes Research¹ evaluated the effect of vitamin D supplementation on women with Type 2 diabetes who were currently experiencing symptoms of depression. The data revealed a significant decrease in the symptoms of depression and anxiety and an improvement in mental health status with the administration of vitamin D supplementation.

They found the women who had the best response to the supplementation were not taking other medications for mood disorders, such as antidepressants or anxiolytics. Another published study² compared blood results of men and women who suffered from depression to those of a control group.

The researchers found significantly lower levels of calcidiol, a vitamin D analog found in the liver, in those suffering from depression and anxiety than in the control group without mental health conditions.

In an evaluation of the relationship between vitamin D and animal neuronal cells, one research team³ found vitamin D maintains the extracellular mood-regulating neurotransmitter serotonin in the brain, which may explain the role it plays in neuropsychiatric disorders.

How Much Vitamin D Do You Need?

A simple math error⁴ is one reason for the inaccuracies in levels of vitamin D believed to be necessary to maintain good health. The error resulted in underestimation by a factor of 10. If corrected, the official recommendation would become 6000 IUs a day for adults, not 600.

Data published in the Archives of Internal Medicine show 75% of American adults and teens are deficient when a sufficiency level of 30 nanograms per milliliter (ng/mL) is used. The only way to accurately measure how much vitamin D you need is to have your levels tested, preferably twice a year.

According to Vitamin D Council standards, you are aiming for a level between 60 and 80 ng/mL, with 40 ng/mL being the lowest cutoff for sufficiency.⁵ In fact, new research in 2018 showed that the optimal levels for cancer prevention are between 60 and 80.⁶

Magnesium Helps Regulate Neurological Function and Mood

Magnesium is the fourth most abundant mineral in your body, playing an important role in the health of nearly every one of your cells. A magnesium deficiency can have a wide range of consequences including constipation, muscle spasms, migraines and high blood pressure.

Sufficient amounts of magnesium can reduce your risk for heart disease, high blood pressure and migraines as well as help you sleep better and enjoy greater mental and physical relaxation.

Researchers have found a deficiency in magnesium is associated with the experience of subjective anxiety, and that supplementation may help mediate those symptoms. In a systematic review of research,⁷ including some unpublished studies, scientists found existing evidence magnesium is beneficial on subjective anxiety in those who are vulnerable to the condition.

As with vitamin D, many Americans are deficient in magnesium, and often unaware of it. Some statistics report the deficiency numbers may be as high as 75% of adult and teenage Americans. Unfortunately, your body uses more magnesium while you're under stress, so a deficiency can create a vicious cycle.

You can counteract this by eating magnesium-rich foods such as Brazil nuts, cashews, dark leafy greens like spinach and swiss chard, avocados and seeds. During particularly stressful times of the year you may want to consider using a supplement, as many of the world's growing soils have become severely depleted.

There is no simple routine blood test to determine your magnesium level so it may be best to get a magnesium red blood cell test to give you a reasonable estimate while tracking and evaluating your symptoms.

Your body requires magnesium for hundreds of biochemical reactions each day. Magnesium also plays a role as a catalyst for serotonin. You’ll discover more about this important mineral and how to optimize your levels in my past article, “Top Reasons to Make Magnesium a Priority.”

Neuroprotective Activity of Omega-3 May Help Anxiety

Your body requires dietary fat to keep your skin, hair and neurological system healthy. Fat helps you absorb certain vitamins and insulates your body to keep you warm. Although it’s harmful to eat too much of one or not enough of other types, without healthy fat your body doesn’t work properly.

Polyunsaturated fats (PUFAs) are essential, meaning you must eat them since your body doesn't make them. The two main types are omega-3 and omega-6 fatty acids. Although both are essential, it's also crucial to good health that you eat them in the right ratio.

After fat tissue, the brain has the highest concentration of fat. Also called lipids, omega-6 and omega-3 PUFAs are well represented in the brain. In one literature review⁸ scientists focused on addressing the question of the impact PUFAs have on anxiety and depression, an area of nutritional neuroscience.

The researchers found evidence to support that a low intake of omega-3 fatty acid is associated with depression and anxiety, including studies of subjects diagnosed with depression or anxiety who presented with low levels of omega-3 and high levels of omega-6.

Using an omega-3 index, a measurement of omega-3 on your red blood cells, researchers have been able to identify a range that may reduce your risk of heart disease. The reduction in inflammatory response associated with higher levels of omega-3 may also reduce symptoms of asthma and reduce your risk of Parkinson's disease, multiple sclerosis and depression.

Vitamin D, Vitamin K-2, Magnesium and Omega-3 Work Together

Your body is a complex organism that relies on what you eat to function at its best. Without a well-balanced intake of vitamins, minerals, fats and other nutrients, your body doesn’t have the tools it needs to function, and disease may result. But, none of these essential nutrients works in a vacuum. In other words, many of them need others to perform their jobs.

For optimal functioning you'll want to ensure you get vitamin D3, vitamin K2 MK-7, magnesium and omega-3 fatty acids to protect your brain health and prevent depression and anxiety. GrassrootsHealth is offering a dual test kit to measure your omega-3 and vitamin D3 levels. Participation in this project is giving researchers the opportunity to learn how these two nutrients function together.

I offer this test kit as a convenience since I don't benefit or participate in the research. Proceeds go directly to GrassrootsHealth. However, I believe deficiencies in these nutrients have a significant effect on health, and I’ve encouraged our staff to use the project to determine their best supplementation levels.

The authors of two studies identified interactions between vitamin D and magnesium. The results reveal that low magnesium levels negatively impact your ability to use vitamin D, even when you have adequate levels in your body. By simply consuming optimal amounts of magnesium, you could lower your risk of vitamin D deficiency, thus reducing your dependency on vitamin D supplements.

Vitamin K is a fat-soluble vitamin with significant influence over your health. Vitamin K2 works in tandem with vitamin D and magnesium to impact bone and heart health. While it is not integral to boosting your mood, if you are taking a vitamin D3 supplement, it's necessary to include vitamin K2 to reduce the potential for atherosclerosis.

Vitamin D helps improve bone development by increasing your absorption of calcium while vitamin K2 directs the calcium into your skeleton, preventing it from being deposited in the arteries.

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In his popular and oft-cited book, "Why We Sleep: The New Science of Sleep and Dreams,” professor Matthew Walker, Ph.D., founder and director of the University of California Berkeley’s Center for Human Sleep Science, details many supposed benefits of longer sleep.

I’ve frequently referenced Walkers book in a number of my previous articles about sleep, which is why I became more than a little curious when I came across the work of Alexey Guzey.¹

He claims to have spent more than 130 hours over the course of two months investigating the claims presented in only one chapter of Walker’s book, “Why We Sleep,” coming to the conclusion that the chapter, and likely the book, is “riddled with scientific and factual errors.”

“Continuing at the same pace, it would take me more than 3,000 hours to check the entire book. 3,000 hours is the equivalent of 75 weeks or 1.4 years of full-time work,” Guzey writes.² “I hope that going through one full chapter, rather than cherry-picking stuff from across the book, demonstrated the density of errors in the book.”

While I do not have the kind of time required to duplicate Guzey’s double-checking of Walker’s work, I decided to present some of Guzey’s findings here so that you can review them for yourself.

Certainly, I believe optimizing your sleep is crucial for mental and physiological health. The evidence for this is overwhelming. The question is how much sleep one actually needs, and whether more sleep equates to better health and increased longevity. Guzey’s findings contradict some of these assumptions.

Will Longer Sleep Increase Your Life Span? 

On page 4 in “Why We Sleep,” Walker states — without corroborating references — that “the shorter your sleep, the shorter your life span.” According to Guzey, this claim does not conform to findings in the medical literature, most of which show a U-shaped relationship between the length of sleep and longevity.

In other words, life span decreases at both ends of the spectrum, and Guzey cites three studies^3,4,5 demonstrating this nonlinear association. He points out that “The studies typically find that people who sleep 7 hours have the highest longevity.”

Figure 1 below is from a 2016 meta-analysis⁶ of 35 studies, published in Scientific Reports, which illustrates the nonlinear impact of sleep duration on all-cause mortality risk.

The solid black line in the middle is the estimated relative risk, while the two dashed black lines on either side represent the 95% confidence interval. Guzey added the red dashed lines to highlight the lowest risk zone.

Based on this meta-analysis, the lowest all-cause mortality was just short of seven hours of sleep per night, with rates rising sharply after seven hours. The estimated relative risk (solid black line) actually appears to be near-identical at four hours and eight hours of sleep.

Can Lack of Sleep Kill You?

Interestingly, while it’s generally accepted that all animals sleep — which would support the idea that there’s a definitive biological need for it — this turns out to be false as well.

Guzey points out that Walker contradicts himself on this issue in “Why We Sleep” — in one instance stating that “Every species studied to date sleeps,” while citing the “Encyclopedia of Sleep,” a 2,736-page book that states “many species reduce sleep for long periods of time … and that others do not sleep at all, in the way sleep is conventionally defined.”⁷

Guzey also has a problem with Walker’s claim that fatal familial insomnia (FFI) is evidence that lack of sleep can kill you. FFI is basically a genetically inherited prion disease, causing severe brain damage and organ failure.

While chronic insomnia is a symptom, “It is reckless to claim that people with FFI die because of lack of sleep, given the amount of damage across the brain that accumulates in the course of the disease,” Guzey says.⁸

What’s more, the “Encyclopedia of Sleep” Walker cites actually states “There is little evidence that sleep induced by sedation can greatly extend life in FFI patients,” which would suggest the lack of sleep has little to nothing to do with the demise of these patients.

Other research⁹ also notes that, ultimately, neurodegeneration appears to be the cause of death among FFI patients. So, on the whole, it’s probably not a good idea to draw any particular conclusions about the importance of sleep based on this disease.

Will Short Sleep Double Your Risk of Cancer?

In his book, Walker also claims that “Routinely sleeping less than six or seven hours a night demolishes your immune system, more than doubling your risk of cancer.”

Guzey points out that this claim is, again, unsupported. Walker actually doesn’t cite any research for this statement, and “There do not appear to exist any experimental studies or studies that would reasonably be able to establish causality, that would support this claim,” Guzey says.¹⁰

Meanwhile, epidemiological evidence — which cannot show or establish causality — seem to refute the idea that sleeping less than six hours a night might significantly increase your cancer risk.

Guzey cites a 2018 systematic review¹¹ of 65 studies published in BMC Cancer — which included a total of 1,550,524 participants and 86,201 instances of cancer — that suggest the cancer risk remains near-identical for those sleeping between 5.5 hours and eight hours per night.

Beyond eight hours a night, the cancer risk slowly increases, but not by much. Ditto for less than 5.5 hours of sleep. On his website,¹² Guzey presents the following graph from that BMC Cancer review¹³ (again with the red dotted lines added for clarity).

However, Guzey’s analysis also leaves some things out, as the BMC Cancer study¹⁴ he quotes does, in fact, state that subgroup analysis revealed that “short sleep duration increased cancer risk in Asians” by 36%, while “long sleep duration increased the risk of colorectal cancer.”

People Consistently Overestimate Their Sleep Time

The problem with epidemiological studies is the lack of verifiable accuracy, since most use self-reported data, and people can easily misjudge how much sleep they actually get on a regular basis. Guzey cites a study¹⁵ published in the journal Epidemiology, which found that people consistently over-reported their subjective sleep time. According to the authors:¹⁶

“Average measured sleep was 6 hours, whereas the average from subjective reports was 6.8 hours. Subjective reports increased on average by 34 minutes for each additional hour of measured sleep.

Overall, the correlation between reported and measured sleep duration was 0.47 … the average difference at the mean of 6 hours measured sleep was 0.80 hours (48 minutes).”

For this reason, it’s unclear just how meaningful epidemiological findings really are. As noted by the authors of this Epidemiology study, “The true associations between sleep duration and health may differ from previously reported associations between self-reported sleep and health.”¹⁷

So, while these kinds of studies can offer some general clues about correlation, one should remember that results are easily skewed, and when it comes to sleep, that people across the board tend to over-report the amount of sleep they believe they’re getting.

Guzey applies this finding to Figure 1 (above) from the 2016 meta-analysis¹⁸ that found those with the lowest mortality slept right around seven hours, pointing out that if you take this over-reporting tendency into account, the lowest mortality would actually end up being around six hours.¹⁹ 

Is Sleep Deprivation at Epidemic Proportions?

Next, Guzey tackles Walker’s claim that “The World Health Organization (WHO) has now declared a sleep loss epidemic throughout industrialized nations,” on page 4 of “Why We Sleep.”

As far as Guzey could determine, WHO has never made such a declaration, and the source for Walker’s claim is the National Geographic documentary “Sleepless in America,” which also does not mention WHO. What’s more, most of the sources making this claim actually use Walker as their source, Guzey points out. My own online search, while not comprehensive, revealed the following:

So, that’s two papers suggesting WHO’s data point to a global epidemic of sleep problems. What’s still missing is a reference for the “throughout industrialized nations” part of Walker’s statement, as Africa and Asia are unlikely to represent industrialized nations.

As for WHO recommendations on sleep duration, I’ve not found any, either. A WHO technical meeting on sleep and health document²⁴ from January 2004 discusses the health ramifications of insufficient sleep, but does not include any specific recommendations on adult sleep duration.

WHO does, however, have guidelines for sleep duration for children under the age of 5. In its 2019 report,²⁵ “Guidelines on Physical Activity, Sedentary Behavior and Sleep for Children Under 5 Years of Age,” WHO recommends infants aged 4 to 11 months get 12 to 16 hours of good quality sleep including naps; infants aged 1 to 2 should get 11 to 14 hours; and children aged 3 to 4 need 10 to 13 hours.

Insufficient Sleep Is Likely Rampant

All of that said, other researchers have stressed there’s a global sleep loss epidemic afoot, and that public health could indeed be improved were people to sleep a bit more. For example, a March 2019 review published in the journal Healthcare, states:²⁶

“Insufficient sleep is a pervasive and prominent problem in the modern 24-h society. A considerable body of evidence suggests that insufficient sleep causes hosts of adverse medical and mental dysfunctions. An extensive literature search was done in all the major databases for ‘insufficient sleep’ and ‘public health implications’ in this review.

Globally, insufficient sleep is prevalent across various age groups, considered to be a public health epidemic that is often unrecognized, under-reported, and that has rather high economic costs. This paper addresses a brief overview on insufficient sleep, causes, and consequences, and how it adds to the existing burden of diseases.

Insufficient sleep leads to the derailment of body systems, leading to increased incidences of cardiovascular morbidity, increased chances of diabetes mellitus, obesity, derailment of cognitive functions, vehicular accidents, and increased accidents at workplaces. The increased usage of smart phones and electronic devices is worsening the epidemic.”

Do a Majority of Adults Not Get Recommended Amount of Sleep?

Walker’s claim that two-thirds of adults in developed nations fail to get the recommended amount of sleep appears to have a similar sourcing problem. Guzey writes:²⁷

“Suppose that you recommend that adults sleep 7-9 hours per night. Then, someone learns²⁸ (a) that roughly 40% of people sleep less than 7 hours, roughly 25% sleep 7 hours, and roughly 35% sleep 8 hours or more, meaning that a bit over one-third of people sleep less than you recommend

Then they look at your recommendation and say that you recommended an average of 8 hours of sleep per night … Then they say that you recommended 8 hours of sleep per night, Then they say that two-thirds of people sleep less than the 8 hours you recommended

Would this be a fair representation of your position and of the data or would this be misleading? This is literally what Walker does in his book. On page 3, in the very first paragraph of Chapter 1, Walker writes: ‘Two-thirds of adults throughout all developed nations fail to obtain the recommended eight hours of nightly sleep.’

In the footnote to this sentence he writes: ‘The World Health Organization and the National Sleep Foundation both stipulate an average of eight hours of sleep per night for adults.’

Here are the National Sleep Foundation’s sleep recommendations²⁹ announced in 2015: ‘Adults (26-64): Sleep range did not change and remains 7-9 hours.’ Here are the World Health Organization’s sleep recommendations:

‎The quote is empty because the WHO does not stipulate how much an adult should sleep anywhere. I don’t know where Walker got this information.”

What Harm Can Walker’s Book Do?

Considering the importance of sleep for biological and psychological functioning, which I cover in “Sleep — Why You Need It and 50 Ways to Improve It,” one might argue that Walker’s book can do no harm by, perhaps, overstating the risks and encouraging eight hours of sleep. Guzey disagrees, saying, in part:³⁰

“… imagine that a 20-year-old who naturally needs to sleep for 7 hours a night, reads ‘Why We Sleep,’ gets scared, and decides to spend the full 8 hours in bed every day.

Then, assuming that they live until 75, they will waste more than 20,000 hours or more than 2 years of their life, with uncertain long-term side-effects. Finally, to be less speculative, here’s an email from a sleep coach Martin Reed I got after the publication of this essay:

‘Hello Alexey

I wanted to drop you a line to thank you for all the time and effort involved in debunking Matthew Walker’s book. As someone who works with individuals with insomnia on a daily basis, I know from firsthand experience the harm that Walker’s book is causing.

I have many stories of people who slept well on less than eight hours of sleep, read Walker’s book, tried to get more sleep and this led to more time awake, frustration, worry, sleep-related anxiety, and insomnia’ …

A sleep physician Daniel Erichsen writes: ‘Dear Alexey … I can’t thank you enough. I’m a sleep doctor in Oregon and have seen many many patients who have developed severe sleep anxiety and insomnia. Two friends in the sleep field and myself weekly have talked about people that slept well until reading this book.’”

Unsourced, Unsupported Data Entering Scientific Literature

Guzey also points out the problem with Walker’s book becoming a source in itself, given it doesn’t appear to stand on solid scientific ground.

“This is how academic urban legends are created,” he says, citing academic papers that use “Why We Sleep” as sources for statements such as “All known forms of animal life must sleep,” and “the World Health Organization has pointed to a ‘global epidemic of sleeplessness’ with roughly two-thirds of adults sleeping less than 8 h a night” — statements of “facts” that Guzey show are either false or unsupported.

Perhaps even more problematic, Walker sources his own book in his own academic papers; one published in The Lancet in 2018 and one in Neuron in 2019.

As noted by Guzey, “the quoted statistics from ‘Why We Sleep’ are unsourced and we have no way to see how or where Walker got these numbers. Via The Lancet and Neuron, they have now entered the scientific literature, while lacking a primary source.”

To Sleep More or Not Sleep More, That Is the Question

At the end of the day, how much sleep you need is quite personal, and you are probably the best person to assess whether your sleep habits are harmful or helpful. How do you feel when you wake up? How are your energy levels while driving to and from work? When do you get sleepy?

Sleepiness during the day is a telltale sign of insufficient sleep. Ditto if you’re really dragging your heels in the morning and need multiple cups of coffee to get yourself into a productive space. In the evening, do you heed your body’s call for sleep, or do you push through and stay awake another hour or more?

The key, I think, is being truly honest with yourself. Do you look, feel and behave your best after five, six, seven or eight hours of sleep? How much sleep do you need to be truly productive the next day? Take into account your mood too. Short-temperedness and getting easily frustrated are other telltale signs you’ve not slept enough.

That said, guidelines are typically helpful, provided they’re based on decent science. In 2015, the National Sleep Foundation updated their sleep guidelines based on a review of more than 300 studies published between 2004 and 2014 that looked at the sleep duration required to maintain health.

As noted earlier, the adult recommendations (ages 26 through 64) remained unchanged at between seven and nine hours, with an average of eight. The recommendation for seniors over 65 is seven to eight hours.

Now, it would take an enormous amount of time to double-check those 300 studies to determine how many were based on self-reported sleep, and thus likely over-estimated the needed amount of sleep to maintain health and prevent disease.

So, your best bet is to simply remember that sleep recommendations are not hard and fast. They’re guidelines, and if you’re sleeping like a prince or princess on seven hours and feel great, then forcing yourself to sleep more could be a mistake.

If you’re not feeling good emotionally or physically, however, or if you’re struggling with an acute or chronic health problem, increasing your sleep time may be part of your answer. Experiment and see what makes you feel your best. Chances are, you’re not going to put yourself in jeopardy if you’re following your body’s cues.

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