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Time and time again, adequate sleep has been shown to be critical to daily functioning and long-term health. Sleep serves numerous roles: recovering energy for the brain, clearing waste products, and forming memories. Prior studies have clearly linked shortened sleep times to heart disease, obesity, reduced cognitive performance, worsened mood, and even a shorter life. There is now new research that suggests that lack of a certain type of sleep (the dream stage of sleep) may be related to an earlier death in middle-aged and older people.
Normal sleep is broken down into two sleep types: rapid eye movement (REM) and non-rapid eye movement (NREM). NREM is further classified by depth of sleep; N1 and N2 are lighter sleep stages, and N3 is deep sleep, which is most restorative. (REM is the stage where vivid dreaming occurs.) Brainwave activity during this time appears similar to the brain’s activity while awake. REM periods generally occur every 90 minutes, and are longest during the second half of the night. REM sleep normally makes up 20% to 25% of sleep time.
Sleep time and sleep stages naturally change as we age. Total sleep time decreases by 10 minutes every decade until age 60, when it stops decreasing. Time in N3 sleep, the deepest sleep stage, also shortens with age; time in N1 and N2 tends to increase. As a result, people wake more easily from sleep as they age. The percentage of REM sleep also naturally decreases; thus, reduced time spent in REM may be a marker of aging.
The circadian rhythm is a 24-hour internal clock that governs numerous body functions including body temperature, release of hormones, and sleep time. The internal clock “advances” with age, so older adults tend to fall asleep earlier and wake earlier. Adapting to jet lag and shift work becomes more difficult. Daytime napping also increases as the strength of the circadian rhythm and the drive to sleep at night decrease.
Studies have also shown that older adults who are healthy may not perceive problems with sleep when it is actually impaired, or may assume that certain disruptions are part of aging when they have treatable conditions.
In the short term, sleep deprivation increases cortisol levels, causes increased blood pressure, decreases glucose tolerance, and increases the activity of the body’s fight-or-flight system, all of which are linked to increased risk of diabetes, heart attacks, and strokes. Daytime cognitive performance is also reduced, resulting in more accidents. Twenty-four hours of sustained wakefulness impairs driving ability to the same degree as a blood alcohol concentration of 0.10%, which is above the legal limit.
In the long term, both short and long sleep (less than five hours or more than nine hours) have been associated with earlier death. People who sleep less than four hours dramatically increase their risk of dying early, possibly through heart disease, diabetes, high blood pressure, chronic stress, lower immunity, and overall more rapid aging.
We know that short sleep is associated with increased mortality, but until now it has been unclear if shorter sleep in a particular sleep stage makes a difference in the health risks associated with sleep deprivation. A new study published in JAMA Neurology looked at the relationship between REM sleep and earlier death in two large study groups, one consisting of 2,675 older men and the other of 1,386 middle-aged men and women. They followed both groups over time and looked at the relationship between sleep stages and causes of death.
Both groups showed increased mortality rates related to a decrease in REM sleep, with a 13% higher mortality rate for every 5% reduction in REM sleep. REM sleep was the most important sleep stage for predicting survival.
This study showed an association between reduced REM and increased mortality, but it did not demonstrate the cause of the association. REM deprivation could independently contribute to the development of numerous other diseases. The results apply more clearly to older adults, given that the age groups studied averaged in the 50s and 70s. Short REM may also be a marker of a sick or aging brain; less REM sleep has already been tied to a greater risk of dementia. Overall, ensuring adequate REM sleep is important to protecting your long-term health.
Maintaining good sleep should remain a priority throughout your life. Everyone can make healthy choices to maximize restorative sleep. Dr. Suzanne Bertisch has written previously about recommendations for improving sleep hygiene, and even more suggestions are available in the Harvard Health Publishing Special Health Report Improving Sleep: Getting a Good Night’s Rest.
Some fundamental steps to improve your sleep and health include:
The post Shorter dream-stage sleep may be related to earlier death appeared first on Harvard Health Blog.
If you have breathing troubles, nitrates — a compound found in beets — may be able to help. Previous studies have shown that nitrates can help improve muscle function by optimizing the way the muscles use calcium. Since the diaphragm is a muscle, researchers from the University of Florida wanted to see if those benefits could be translated to the diaphragm.
For the study,1 researchers split old mice into two groups. One group was given drinking water that contained sodium nitrate daily for 14 days. The other group was given plain water.
After the study period, they measured the isometric force and peak power of the diaphragm muscles in the mice and found that both significantly increased in the group of mice given nitrates in their drinking water.
This increase in force and power translated to improved contraction of the diaphragm muscle, which can then improve lung function and breathing. The increased power in the diaphragm could also help older people clear the lungs more effectively, which may help reduce the risk of developing infections. For reference, the mice used in the study were 24 months old, which is equivalent to about 70 years of age in humans.
This is especially important during the COVID-19 pandemic for two reasons. The first is that severe symptoms disproportionally affect the older population. We already know that respiratory muscle function declines with age, contributing to breathing troubles, impaired airway clearance and a decreased quality of life. Since nitrates can improve muscle function of the diaphragm, it may help improve the outlook for older populations with respiratory infections like COVID-19.
The study's author, Leonardo Ferreira, also points out that one of the problems with weaning COVID-19 patients off ventilators is respiratory muscle dysfunction. If dietary nitrates can help improve that muscle function, it may make the transition from ventilators to independent breathing more successful.2
The nitrates in beets have also been shown to help improve oxygen uptake by dilating the blood vessels and allowing more oxygen to be delivered to muscles, like the diaphragm, and other cells.3
But beets aren't only good for your lungs. Other studies have shown that red beets may also:
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Lower your blood pressure — Drinking beet juice may help to lower blood pressure in a matter of hours. One study found that drinking one glass of beet juice lowered systolic blood pressure by an average of four to five points.4 The benefit likely comes from the naturally occurring nitrates in beets, which are converted into nitric oxide in your body. Nitric oxide, in turn, helps to relax and dilate your blood vessels, improving blood flow and lowering blood pressure. Another study5 found drinking 8 ounces of beet juice per day lowered blood pressure by an average of nearly eight points after the first week, which is more than most blood pressure medications. |
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Boost your stamina — If you need a boost to make it through your next workout, beet juice may again prove valuable. Those who drank beet juice prior to exercise were able to exercise for up to 16% longer.6 The benefit is thought to also be related to nitrates turning into nitric oxide, which may reduce the oxygen cost of low-intensity exercise as well as enhance tolerance to high-intensity exercise. |
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Fight inflammation — Beets are a unique source of betaine, a nutrient that helps protects cells, proteins and enzymes from environmental stress. It's also known to help fight inflammation, protect internal organs, improve vascular risk factors, enhance performance and likely help prevent numerous chronic diseases.7 As reported by The World's Healthiest Foods:8
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Stave off cancer — The powerful phytonutrients that give beets their deep crimson color may help to ward off cancer. Research has shown that beetroot extract reduced multi-organ tumor formations in various animal models when administered in drinking water, for instance, while beetroot extract is also being studied for use in treating human pancreatic, breast and prostate cancers.9 |
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Provide valuable nutrients and fiber — Beets are high in immune-boosting vitamin C, fiber and essential minerals like potassium (essential for healthy nerve and muscle function) and manganese10 (which is good for your bones, liver, kidneys, and pancreas). Beets also contain the B vitamin folate, which helps reduce the risk of birth defects. |
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Support detoxification — The betalin pigments in beets support your body's Phase 2 detoxification process,11 which is when broken down toxins are bound to other molecules so they can be excreted from your body. Traditionally, beets are valued for their support in detoxification and helping to purify your blood and your liver. |
Almost 80% of dietary nitrates come from vegetables.12 Beets are one of the richest sources, containing more than 250 milligrams of nitrates per 100 grams. Other foods with high nitrate content include arugula, celery, cress, chervil, celeriac, Chinese cabbage, fennel, endive, kohlrabi, mustard greens, leeks and parsley.
Keep in mind that naturally occurring nitrates are different from the nitrates found in processed foods, such as bacon or sausages. The nitrates that you get from vegetables are converted to nitric oxide (NO) in your body.
NO has potent health benefits, as described in "Why You Need to Try the Nitric Oxide Dump Workout." However, when nitrates and nitrites from processed meats react with the gastric acid in your stomach, it forms nitrosamines, harmful compounds that have been linked to several different types of cancer.13,14
The reason meat-based nitrites don't boost NO production but rather turn into harmful N-nitroso compounds has to do with the presence of proteins and heme15 (an iron-containing compound that makes up part of the hemoglobin molecule in blood) and the absence of antioxidant compounds.
On the other hand, plants contain antioxidants such as vitamin C and polyphenols that impede the formation of harmful nitrosamines. The presence of these compounds helps ensure that the nitrites are converted into NO once they reach your stomach rather than harmful N-nitroso compounds.16
Unlike processed meats like bacon, most plant foods are also not cooked or fried at high temperatures, which further minimizes the chances that harmful substances will be produced.
If you're new to beets, there are plenty of ways you can enjoy them:
Please note that if you're interested in buying beets to make your own juice, the industry has gone the way of so many crops in the U.S. — toward genetic engineering, according to the Organic and Non-GMO Report.17 This is particularly true with sugar beets.
While the table beets most people eat are not currently genetically engineered, they're often grown in close proximity to sugar beets, which are often GE, and cross-pollination is known to occur. So, when choosing beets to eat, opt for organic varieties whenever possible.
Genetically modified organisms (GMOs) are dangerous for humans on a number of levels. GMOs may alter DNA, potentially cause cancer, and may trigger other "less severe" problems like organ failure, liver and kidney damage.
Although beets have the highest sugar content of all vegetables, most people can safely eat beet roots a few times a week. Beetroot juice, however, should be consumed in moderation.
Make sure you also eat the beet greens, which are loaded with valuable nutrients, including phosphorus, zinc, fiber, vitamin C, vitamin A, vitamin B6, magnesium, potassium, copper, manganese, calcium and iron.18
Will smoking raise your risk of severe COVID-19 and risk of dying from the disease?1,2 Interestingly, much of the research looking at conventional smoking has found mortality rates tend to be lower among smokers than nonsmokers. Results are not entirely homogenous, though, as some studies have come to the converse conclusion.
Vaping e-cigarettes, on the other hand, appears to increase risks to young adults, who are otherwise at very low risk of COVID-19. It's still unclear what might account for the differences between conventional cigarettes and vaping, although several hypothetical mechanisms for why conventional smoking doesn't increase COVID-19 severity and lethality have been proposed.
June 14, 2020, a study3,4 posted on the preprint server medRxiv reported that national smoking rates inversely correlated with COVID-19 mortality. To avoid confounding by temperature (heat tends to lower risk of SARS-CoV-2 infection), the researchers looked at 20 of the hottest and 20 of the coldest nations, and compared mortality rates for COVID-19 among smokers and nonsmokers in those countries. According to the authors:5
"A highly significant inverse correlation between current daily smoking prevalence and COVID-19 mortality rate was noted for the group of hot countries, cold countries, and the combined group …
In hot countries, for each percentage point increase in smoking rate mortality decreased by .147 per 100,000 population. This resulted in mortality rates several-fold elevated in the countries with the lowest smoking rates relative to the highest smoking rates. In the combined group, mortality decreased by .257 per 100,000 population.
These findings add support to the finding of an inverse relationship between current smoking and seriously symptomatic COVID-19. However, we conclude that the difference in mortality between the highest and lowest smoking countries appears too large to be due primarily to the effects of smoking per se.
A potentially beneficial effect of smoking is surprising, but compatible with a number of hypothetical mechanisms which deserve exploration:
• Studies show smoking alters ACE2 expression which may affect COVID-19 infection or its progression to serious lung pathology.
• Nicotine has anti-inflammatory activity and also appears to alter ACE2 expression.
• Nitric oxide in cigarette smoke is known to be effective in treating pulmonary hypertension and has shown in vitro antiviral effects including against SARS-CoV-2.
• Smoking has complicated effects on the immune system involving both up and down regulation, any of which might alone or in concert antagonize progression of COVID-19.
• Smokers are exposed to hot vapors which may stimulate immunity in the respiratory tract by various heat-related mechanisms (e.g. heat shock proteins)."
An earlier meta-analysis6,7 published in May 2020, which reviewed five different studies, also failed to find a link between conventional smoking and COVID-19 severity.
A second systematic review and meta-analysis8 of 22 studies, however, found smoking modestly increased the risk of more severe symptoms among hospitalized COVID-19 patients, especially among younger nondiabetic patients. As reported by Healio9
"They found that overall, smoking modestly increased the risk for severe COVID-19 (OR = 1.34 …). However, the researchers found a difference in the relationship between smoking and disease severity between Chinese studies (… OR = 1.48 …) and American studies (… OR = 0.65 …).
'This difference may be explained by the higher age and diabetes ratio of the non-Chinese population, which we showed to be important risk moderators, or could be due to further differences in comorbidities and care,' the researchers said.
Specifically, among studies in which less than 15% of the patients had diabetes, smoking increased the risk for severe disease (OR = 1.66 … ). However, among studies in which 15% or more had diabetes, 'there was a trend for a negative association' (OR = 0.7 …) according to the researchers.
Karanasos and colleagues also reported that smoking was not significantly associated with increased mortality from COVID-19. After restricting their analysis to studies 'explicitly reporting current smoking,' the researchers said the association between smoking and disease severity was no longer statistically significant."
I wouldn't jump to the conclusion that smoking provides any particular benefits, though. A third meta-analysis10 of 19 studies, published in the September 2020 issue of Nicotine & Tobacco Research, throws these inverse findings into question, showing that smoking may have some negative effects after all.
Here, they found patients with a history of smoking (either current or former) had, on average, a 91% higher odds ratio (OR) of suffering more severe COVID-19 illness than patients who had never smoked. According to the authors:11
"A total of 11,590 COVID-19 patients included in our meta-analysis, 2,133 of whom (18.4%) experienced disease progression and 731 (6.3%) with a history of smoking. A total of 218 patients with a history of smoking (29.8%) experienced disease progression, compared with 17.6% of nonsmoking patients.
The meta-analysis showed an association between smoking and COVID-19 progression (OR 1.91 …). There was moderate heterogeneity among the studies … and no significant evidence of publication bias."
Teens and young adults who either vape exclusively or smoke both conventional cigarettes and e-cigarettes are also at far greater risk of testing positive for SARS-CoV-2 and exhibiting symptoms of the illness, although it's unclear whether it actually increases the risk of COVID-19 severity in this age group as the data was obtained via online surveys, not hospital or medical data.
Research12,13,14,15 by Stanford University researchers published online August 11, 2020, in the Journal of Adolescent Health, found teens and young adults who smoked conventional and/or e-cigarettes were 2.6 to nine times more likely to test positive for SARS-CoV-2. Those who vaped were also five times more likely to exhibit COVID-19-related symptoms and receive a COVID-19 diagnosis than nonusers.
(For clarity, testing positive does not mean that you are actually ill. A vast majority of people testing positive remain asymptomatic.) In a press release, lead author and postdoctoral scholar Shivani Mathur Gaiha, PhD., stated:16
"Young people may believe their age protects them from contracting the virus or that they will not experience symptoms of COVID-19, but the data show this isn't true among those who vape. This study tells us pretty clearly that youth who are using vapes or are dual-using [e-cigarettes and cigarettes] are at elevated risk, and it's not just a small increase in risk; it's a big one."
In all, a total of 4,351 participants between the ages of 13 and 24 completed the online surveys, which included questions about vaping and conventional smoking habits, and whether they'd experienced COVID-19 symptoms, been tested or diagnosed with SARS-CoV-2 infection. As reported by Stanford:17
"Young people who had used both cigarettes and e-cigarettes in the previous 30 days were almost five times as likely to experience COVID-19 symptoms, such as coughing, fever, tiredness and difficulty breathing as those who never smoked or vaped.
This may explain why they were also more likely to receive COVID-19 testing … Depending on which nicotine products they used and how recently they had used them, young people who vaped or smoked, or both, were 2.6 to nine times more likely to receive COVID-19 tests than nonusers.
Among the participants who were tested for COVID-19, those who had ever used e-cigarettes were five times more likely to be diagnosed with COVID-19 than nonusers. Those who had used both e-cigarettes and conventional cigarettes in the previous 30 days were 6.8 times more likely to be diagnosed with the disease."
Curiously, as indicated by several of the studies cited earlier, the Stanford study18 again found no connection between COVID-19 diagnosis and the smoking of conventional cigarettes alone.
As for why vaping but not conventional cigarette smoking puts you at greater risk of testing positive or exhibiting symptoms of SARS-CoV-2 infection, Wired cited some theories proposed by coauthor Bonnie Halpern-Felsher, a pediatrics professor at Stanford University:19
"Halpern-Felsher has a few theories … Smokers may have more lung damage, making them more susceptible to the virus. Or they might be touching their hand to their mouth more often than other people, or sharing vapes, increasing their likelihood of being exposed in the first place.
Or it could be that the virus is being spread through the aerosols vapers exhale. 'Those are all hypotheses,' she says. 'Someone needs to follow it up.'"
Overall, research20 suggests vaping may in fact be more inflammatory and damaging to your lungs than conventional cigarette smoking. I've discussed such evidence in previous articles, including "Vaping Lung Injury Cases Rise to Nearly 300" and "E-Cig Flavoring Harms Blood Vessels."
The fact that vaping damages your vascular system may offer a hint at why it appears riskier in terms of COVID-19. Vascular changes associated with cardiovascular disease have been shown to appear almost immediately when using certain flavored vape liquids.
That's not to say that smoking cigarettes does not harm your vascular system. It certainly does. But vaping may perhaps bring on those side effects more rapidly. COVID-19, while affecting the lungs, really appears to be more of a blood and vascular disorder than a strict respiratory illness, which is why vaping's vascular effects might be a good place to start when trying to tease out the link.
Some of the latest research suggests COVID-19's disease progression can be explained by the SARS-CoV-2 virus' effect on your renin-angiotensin system, a central regulator of cardiovascular functions. The virus was also found to increase production of hyaluronic acid in the lungs.
Hyaluronic acid can absorb more than 1,000 times its own weight in fluid, and when it combines with fluid buildup in the lungs — which can occur from vaping,21 alone — it forms a thick hydrogel that inhibits your ability to breathe.
You can learn more about this in "Bradykinin Hypothesis Explains COVID-19 Complexities." That said, none of this fully explains why combustible cigarettes don't have the same degree of influence on your COVID-19 risk as vaping does.
The difference between vaping and smoking cigarettes becomes even more curious when you factor in recent research22,23,24 showing that nicotine increases ACE2 expression in bronchial epithelial cells. Since ACE2 receptors are the cellular entry point of SARS-CoV-2, all forms of nicotine should theoretically increase your risk of SARS-CoV-2 infection in the lungs.
Potentially, it could be that vaping is worse in this regard because it increases your risk of pneumonia,25 but then again, combustible cigarettes also significantly raise your pneumonia risk.26
One theory presented in a European Respiratory Journal correspondence article27 has to do with the different effects of combustible cigarette smoke and e-cigarette vapors have on the epithelial and smooth muscle cells in the airways. According to the authors:
"We compared cigarette smoke versus e-cigarette and IOQS on airway epithelial and smooth muscle cells. All tested pathological biomarkers were elevated in cells exposed to e-cigarette aerosols and IQOS, which included chemokine CXCL8, extracellular matrix proteins and markers of mitochondrial dysfunction.
We found these products toxic to the cells, evident from decreased cellular viability and integrity. More devastatingly, vaping also interfered with cellular energetics.
Our results further substantiate current research that e- cigarettes and IOQS are indeed detrimental with increases in oxidative stress, inflammation, infections and airway remodelling in the lungs of these device users."
It remains to be seen whether a conclusive answer will be found to these questions. Overall, I believe it's reasonable to assume that all forms of smoking will ultimately harm your lungs and cardiovascular system to some degree, and increase your risk of infections of all kinds, including SARS-CoV-2.
I certainly do not think it would be prudent to assume cigarette smoking confers any kind of protection against the virus. If you're concerned about your health, quitting smoking/vaping is always a good strategy.
On a positive note, CDC statistics reveal vaping among teenagers has declined significantly over the past year, dropping from 27.5% in 2019 to 19.6% in 2020.28 That’s equivalent to a decline of 1 million regular users, from 4.1 million down to 3 million. Use of e-cigarettes has also dropped sharply among middle school students, from 1.24 million in 2019 down to 550,000 in 2020.
