February 2012

Insomnia: The Nutrition Connection


Editorial by Patrick Holford, CEO, Food for the Brain Foundation
There’s a simple contributor to depression, anxiety, stress and other mental health issues and that is a lack of sleep. According to the National Sleep Foundation we sleep 20% less now than they did 100 years ago, one in three suffer from some kind of insomnia and, in the US, 10 million people take prescription drugs to help them sleep. Being too tired or needing sleep is also the most common reason given for not wanting sex, says a Consumer Reports survey [1].The chemistry of sleep hinges on two key components. The first is melatonin and the second is adrenalin.Melatonin is the brain’s sleep neurotransmitter that is released as it gets darker to give you a good night’s sleep. Melatonin is an almost identical molecule to serotonin, from which it is made, and both are made from 5-HTP, itself derived from the amino acid tryptophan which is present in most protein foods.One way to improve matters is to provide more of the building blocks that are used to make serotonin and that means 5-HTP (5-hydroxyytryptophan), which in turn is made from tryptophan, a conversion process that requires folic acid, B6, vitamin C and zinc. So you’ve got a biochemical chain stretching straight from foods that are particularly high in tryptophan, like chicken, cheese, tuna, tofu, eggs, nuts, seeds and milk, up to melatonin. Other foods associated with inducing sleep are cherries, lettuce and oats. To support your brain’s ability to turn tryptophan into serotonin and melatonin, it’s best to supplement a high-potency multivitamin that contains at least 200mcg of folic acid, 20mg of vitamin B6, 10mg of zinc, as well as 100mg of vitamin C and 100mg of magnesium, which promotes both mind and muscle relaxation.Or you could supplement with these natural chemicals directly. Melatonin, which is a neurotransmitter, not a nutrient, is proven to help you get to sleep but needs to be used much more cautiously than a nutrient. In controlled trials it’s about a third as effective as pharmaceutical sleeping pills, but has a fraction of the side effects [2]. If you have both difficulty getting to sleep, perhaps only going to sleep very late, and are prone to feeling low it’s particularly effective both for helping you sleep and for improving mood [3].Even so, supplementing too much can have undesirable effects such as diarrhoea, constipation, nausea, dizziness, reduced libido, headaches, depression and nightmares. However, if you do sleep badly, can’t get to sleep until late and are prone to low moods, you may want to try between 3mg and 6mg before bedtime. Although melatonin is available over the counter and on the internet in countries such as the US and South Africa, in the UK, melatonin is classified as a medicine and is only available on prescription therefore, if you live in the UK, you will need to discuss this option with your doctor. I don’t recommend melatonin on a long-term basis but it can be very useful to bring you back into balance.Another option is to take the amino acid 5-HTP. Supplementing 100 to 200mg of 5-HTP half an hour before you go to bed helps you get a good night’s sleep [4]. It’s also been shown to reduce sleep terrors in children when given at an amount equivalent to 1mg per pound of bodyweight before bed [5]. 5-HTP is best taken on an empty stomach, or with a small amount of carbohydrate such as an oatcake or a piece of fruit, one hour before sleep.The second factor is the process of relaxing and switching off adrenalin, the fight flight hormone. Many people find it hard to switch out of a state of general anxiety sufficiently to fall asleep without help. Many resort to alcohol, which temporarily promotes GABA, a neurotransitter that switches off adrenalin. But the effect doesn’t last and too much alcohol leads to GABA depletion. Again, you can supplement directly with GABA. In the US and other countries you can buy GABA in 500mg capsules. Taking one to three an hour before bed helps promote a good night’s sleep. The combination of GABA and 5-HTP is even better. In a placebo-controlled trial the combination of GABA and 5-HTP cut time taken to fall asleep from 32 minutes to 19 minutes and extended sleep from 5 to almost 7 hours [6]. Taking 1,000mg of GABA, plus 100mg of 5-HTP is a recipe for a good night’s sleep. The herb Valerian also promotes GABA. A review of studies to date cites six studies that show a significant benefit [7]. My experience is that it works exceptionally well for many people. To use to help sleep, take 150 to 300mg about 45 minutes before bedtime.It’s also critical to avoid caffeine after noon because caffeine suppresses melatonin for up to ten hours [8]. Have a glass of cherry juice instead. Those who drank two glasses of Cherry Active versus placebo had increased melatonin levels, sleep duration and sleep quality, finds a recent study [9].Learning how to switch off adrenalin in the evening is a key skill for insomniacs. Practising yoga, T’ai Chi or meditation are all good options. So too is listening to a CD called Silence of Peace by John Levine, which is music specifically designed to switched brain activity into alpha waves, which is the pre-requisite for a good night’s sleep. Also, avoid stimulating exercise, movies or the ten o’clock news in the evening. It’s also important to get to the root of deep-seated worries and fears and get some resolution. Psychotherapy can also be very helpful.We treat many people at the Brain Bio Centre with insomnia and explore these and other potential reasons for having sleeping problems.


Case study


Richard (35) came to the Brain Bio Centre for help with sleep as he was having difficulty falling asleep at night and regularly woke at intervals throughout the night. Some mornings he felt like he hadn't slept at all leaving him feeling exhausted most of the time. He also felt anxious, had "a fuzzy head all day long" and was generally feeling low. Richard's GP recommended antidepressants, but he preferred not to take medication if it was possible to use more natural means.Richard ate a healthy diet and exercised regularly. He drank coffee every day (about 4 or 5 cappuccinos most days) which he felt he needed in order to function. Test results revealed a low level of the mineral magnesium, and low serotonin, both required for good sleep patterns.Richard was advised to gradually reduce his coffee, starting with the cups later in the day. At the same time, Richard was recommended to increase his intake of tryptophan-rich foods such as oats, turkey and bananas to provide the raw materials (precursor) for his body to manufacture more serotonin (and melatonin), B vitamins to support the manufacturing process and a supplement of 5-HTP as a direct precursor of serotonin. Also recommended were magnesium rich foods, such as green leafy vegetables and seeds, and to take a magnesium supplement to bring his level back into the normal range.At Richard's follow-up appointment he reported that his sleep had improved significantly. He now slept well about five nights out of seven. His coffee consumption was down to one cappuccino after breakfast. His mood was better, he had no anxiety and his head was clear. He felt "back to his old self."


Keep it simple


Healthy diet best for ADHD
A recent review of the current evidence for using diet to help manage ADHD in children concluded that a simple, healthy diet which was low in unhealthy fats and high in fruits, vegetables and fibres may work best. They found that ‘junk food’, fizzy drinks and ice-cream are probably the worst for affected children. They also found some evidence for the benefits of omega-3 and omega-6 essential fat supplementation.Their review considered a range of other dietary interventions but weren’t able to come to any solid conclusions. This is most likely because of a lack of quality studies to review and the complications of studying dietary changes in children – it’s very difficult to study dietary changes in a double-blind, randomised, controlled fashion where the researchers, subjects and their parents don’t know who is eating the modified and diet and who isn’t, thereby making it impossible to rule out the placebo effect.Millichap JG, Yee MM (2012) The Diet Factor in Attention-Deficit/Hyperactivity Disorder. Pediatrics. Jan 9. [Epub ahead of print]. Click here for the abstract.


Feeding the autistic brain


Multi-nutrients reduce symptoms and improve biological function
Dietary studies for autism are also few and far between for the same reasons as outlined above in relation to ADHD. The next best thing is a study involving supplementation – it’s not quite representative of real dietary changes as a change in food would be of course, but at least it can be carried out in a double-blind randomised controlled fashion which eliminates any bias and carries much more weight within the scientific community.The following is just such a study. It involved giving 141 children and adults with autism, a multi-nutrient formula containing a broad range of vitamins and minerals or a placebo. Their symptoms were assessed before and after the study which ran for three months. Fifty-three of the children in the study also had blood measures taken of nutritional and metabolic status(biomarkers) before and after.In terms of symptoms, the supplemented group had significantly greater improvements than the placebo group on the following scores: Parental Global Impressions (PGI-R), Hyperactivity, Tantrumming, Overall and Receptive Language. The change in the PGI-R was strongly associated with a number of the biomarkers suggesting that there is a relationship between changes in biomarkers and changes in symptoms.Levels of many vitamins, minerals, and biomarkers improved including markers of oxidative stress thought to be elevated in autism, as well as markers of key biological processes such as methylation and sulphation.Our comment: Many children on the autistic spectrum who are brought to the Brain Bio Centre eat very restricted diets – this is often a feature of autism. While we work with parents to make gradual changes to broaden their diet to include more food sources of essential nutrients, we also use supplementation to provide these nutrients in the meantime. Anecdotal experience and this study illustrates that this approach may improve both symptoms and biological function. Early improvements can also ease the process of broadening the child’s diet making it a virtuous cycle of improvement.Adams JB, Audhya T, McDonough-Means S, Rubin RA, Quig D, Geis E, Gehn E, Loresto M, Mitchell J, Atwood S, Barnhouse S, Lee W. (2011) Effect of a vitamin/mineral supplement on children and adults with autism. BMC Pediatr. 11:111. Click here for the abstract.


Use it or lose it


Cognitive activity throughout life supports a healthy brain
The ‘use it or lose it’ hypothesis is fairly well established in relation to brain ageing, and it makes good sense. In this study, researchers wanted to compare cognitive and physical activity taken over a person’s lifetime with the amount of a protein called ?-amyloid which had been deposited in their brain. ?-amyloid is the protein which is the key marker of Alzheimer’s disease. In total they studied 86 people (65 healthy older individuals with an average age of 76 years, 10 Alzheimer’s patients with an average age of 75 years, and 11 young healthy people with an average age of 25 years).The researchers found a significant association between lower levels of ?-amyloid and greater participation in cognitively stimulating activities across the lifespan, particularly when undertaken in early and middle life. The researchers’ findings suggest that keeping your brain active throughout life may prevent or slow deposition of ?-amyloid, perhaps influencing the onset and progression of Alzheimer’s disease.Landau SM, Marks SM, Mormino EC, Rabinovici GD, Oh H, O'Neil JP, Wilson RS, Jagust WJ. (2012) Association of Lifetime Cognitive Engagement and Low ?-Amyloid Deposition.Arch Neurol. Jan 23. [Epub ahead of print]Click here for the abstract.


Volunteers needed to test the new Cognitive Function Test


Over 100,000 people have now completed the original online Cognitive Function Test. Are you aged between 50 and 65 and can you spare 30mins to test-run the new annual test prior to its launch in March?We are seeking 50 volunteers aged between 50 and 65 to test the new version prior to the launch. Can you spare 30 minutes of your time online? Our researcher will then compare your results against your previous results to validate the new test as well as take on board any comments to improve the tool. Please email info@foodforthebrain.org to volunteer.


Are you a statistician?


Can you spare some time to support the research on the Alzheimer’s Prevention Project?
With over 100,000 people having completed the Cognitive Function Test, we are collating and analysing the results to publish a validation paper that can contribute to the body of evidence around prevalence of Alzheimer’s. We are seeking a statistician with experience of doing T-tests, correlation analysis, etc to review and validate the statistical analysis. This is voluntary but is not expected to be a long project. If you are interested please email info@foodforthebrain.org.


Are you a psychiatrist with PANSS experience?


Can you spare some time to participate in our Schizophrenia research project?
We are seeking volunteers with experience of PANSS tests to participate in our Schizophrenia project to start later in the year. The project is seeking to enrol 55 participants via the Brain Bio Centre over a 2 year period and each would require a PANSS test and re-test 6 months later. For more information on the project, click here. If you are interested in volunteering, please email info@foodforthebrain.org.




[1] Consumer Reports (2009) CR poll: Economy isn't hurting Americans' sex lives But insomnia and poor health could be taking a toll. Available from: www.consumerreports.org/health/conditions-and-treatments/sex-poll/overview/sex-poll-ov.htm[2] A. Brzezinski et al., ‘Effects of exogenous melatonin on sleep: a meta-analysis’, Sleep Medicine Reviews, 2005;9(1):41-50S[3] A. Rahman et al., ‘Antidepressant action of melatonin in the treatment of Delayed Sleep Phase Syndrome’, Sleep Medicine, 2010 Feb;11(2):131-136[4] T. C. Birdsall, ‘5-Hydroxytryptophan: a clinically-effective serotonin precursor’, Alternative Medicine Review, 1998;3(4):271-80[5] O. Bruni et al., ‘L-5-Hydroxytryptophan treatment of sleep terrors in children’, European Journal of Pediatric Neurology, 2004;163(7):402-7[6] W. Shell et al., ‘A Randomized, Placebo-Controlled Trial of an Amino Acid Preparation on Timing and Quality of Sleep’, American Journal of Therapeutcis, 2009 May 15[7] S. Bent et al., ‘Valerian for sleep: a systematic review and meta-analysis.’ American Journal Medicine. 2006 Dec;119(12):1005-12. Review.[8] L. Shilo et al., ‘The effects of coffee consumption on sleep and melatonin secretion’ Sleep Medicine 2002;3(3):271-3[9] Pigeon WR, Carr M, Gorman C and Perlis ML. Effects of a Tart Cherry Juice Beverage on the Sleep of Older Adults with Insomnia: A Pilot Study. Journal of Medicinal Food, 2010; 13: 579-583 Become a FRIEND of Food for the Brain and support our Alzheimer's and schizophrenia research.