Does Fat Really Cause Sleep Apnea?

Sleep apnea was first described in obese men, so the general trend since then,  has been to blame the patient. We are taught that obesity is a disorder of “self-control”. Being fat is an “undesirable personality trait” and if you’d just  “try harder” you’d lose weight. All of you who have struggled with being overweight know deep down inside that this is not really true, but how can a normal weight individual know what it’s like to be you? Although it is true that self-control helps us to lose a few pounds this is not the whole story for people who are truly obese. Hunger, like sleep, is involuntary. If the bacteria that live inside us can affect our appetite and the amount of fat we put on, then the person eating the doughnut is not really completely in control. Since we doctors know so little about how hunger is controlled it’s much easier just to blame the patient.  Many of my patients have struggled for years to lose weight. They tell me that they eat less than other family members and still don’t lose. We don’t want to believe them because then we would have to open our minds to other possibilities. Could sleeping badly tell the body that it needs to store fat? Could a low vitamin D level or some other hormone that we don’t really understand yet be running this poor obese person’s life? Could their poop be wrong? I mean really, who would ever even think of that?

The “fat neck” explanation of sleep apnea has reigned for 20 years. The bad results:  we have attached “shame”, to something that is actually a brain cell malfunction AND we missed apnea in normal weight individuals. My headache patients didn’t look anything like what I had been trained to look for, so the idea that they might have sleep apnea would never have occurred to me. It is now quite clear that apnea is not because the neck is fat. So shouldn’t we at least wonder: “Could there be another cause?” “Could there be a different treatment that would help my sleep and help me lose weight?” Once we become brainwashed by the idea of CPAP masks we stop wondering if insomnia shares anything with apnea. They are both about sleep, could they be related?

 

Why the American Diet does not Deserve all the Blame

The concept of a “healthy diet” was described by the early nutritionists starting in the 1930’s and 1940’s. There were two B  vitamin deficiency diseases that did come from a poor diet. Pellagra and beriberi both resulted from very limited diets, pellagra from cornmeal only, beriberi from rice only. Clearly a “diet” made up entirely of a daily serving of a single starch is not a “healthy diet” but when they added back meat and vegetables they were able to cure the disease, so from then on we’ve been taught that “the B vitamins come from food”. ( See the blog “Healthy Bacteria Healthy Sleep” to learn why the B vitamins come from the intestinal bacteria, not from the food.)

At the time that the first “healthy diets”, (the five food groups etc.) were proposed, in the 1940’s and ‘50’s, most people still lived outside and the term “irritable bowel syndrome” had not come into common use. Most of the population still had the healthy bacteria living inside them. All of the primitive diets that are described as a solution for our modern ills were also eaten by humans who lived outside and had a healthy gut! Therefore, all of us who have unsuccessfully tried to find the “right diet” really need the “right bugs” and probiotics alone are not successful. In order to live inside us the “healthy” bacteria need our vitamin D and the “B vitamin soup” that they create to support each other. When we lose them our digestion suffers, our immune system suffers and even our sleep suffers.

Though I would agree that a diet of hamburgers and donuts is not a healthy diet, I do not agree that our eating habits alone have caused the epidemic of obesity and sleep apnea. Many of my patients tried so hard to lose weight by following a healthy diet, and were unsuccessful. There is really much more to this picture! Remember what I said about hunger being involuntary, it’s run by your brain, it’s also affected by the bacteria inside you. The bacteria in our intestine are now known to have very important effects on our appetite. Certain bacteria make chemicals called short chain fatty acids that are absorbed into our blood, go up into our nose and make donuts smell very good! In the past a change in the intestinal bacteria that promoted hunger in the winter, when the D was low, would enhance our survival, it made us try harder to find high fat, high calorie foods to sustain us until the winter ended. But this change in bacteria and increased appetite was not supposed to continue through one’s whole life while abundant food was all around. After converting the intestinal bacteria back to the healthy foursome most of my patients found it easier to be successful with a healthy diet. The diet was easier to follow, their hunger was less and their weight loss was more successful. Because the bacteria that live inside us affect our diet, our sleep and our pain level most patients also found that they had enough energy to start exercising and suffered less pain afterward. Thus, even those who do not have gut complaints still need to have the right bacteria in order to live the healthy life we were meant to have.

The cells in the brain that help us sleep correctly need B vitamins too, to do their job. At least one of them, pantothenic acid (B5), is not in any of the foods we eat. I will explain in a later blog why the statement “pantothenic acid deficiency doesn’t exist because it is in every food” is not true, despite being widely accepted. And, why this one mistake produced a global change in our sleep and our health.