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Join Nisha Kuruvadi, an internal medicine physician, as we explore the intriguing connection between sleep and weight loss. Did you know those precious hours of sleep could be more than just rest? Sleep is a complex interplay of hormones, brain waves, and bodily functions that regulate appetite, metabolism, and energy balance—vital factors in weight management. We’ll uncover how sleep deprivation affects hunger hormones, stress levels, and metabolism, leading to weight gain and health issues.

Nisha Kuruvadi is an internal medicine physician.

She discusses the KevinMD article, “How quality sleep can be your secret weapon for effective weight loss.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Nisha Kuruvadi. She’s an internal medicine physician and obesity medicine specialist. Today’s KevinMD article is “How quality sleep can be your secret weapon for effective weight loss.” Nisha, welcome to the show.

Nisha Kuruvadi: Thank you so much for having me.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Nisha Kuruvadi: Yeah, so I’m Dr. Nisha Kuruvadi. I am a double board certified internal medicine and obesity medicine physician, and I practice currently in San Diego, California. And I’m a primary care physician and weight management specialist.

Kevin Pho: Perfect. So tell us a typical case that you would see on a daily basis.

Nisha Kuruvadi: Yeah, so you know, I see patients for weight management all the time. And the reason I wrote this article is a lot of patients just tend to focus on diet and exercise and they don’t think about sleep at all. And it’s an important pillar of health that really does impact our ability to maintain a healthy weight. And then addressing these sleep issues can be a great way to manage weight. And it’s important for people to be aware of this connection, because obesity is such a complex issue, and there’s a lot of components that play a part in it, and it’s not just diet and exercise.

Kevin Pho: All right. So your KevinMD article, where you focus on that intersection, “How quality sleep can be your secret weapon for effective weight loss,” so tell us more about that connection between sleep and weight loss.

Nisha Kuruvadi: Great question. So there is a huge connection between sleep and weight. So sleep plays a really big role in regulating our body’s metabolism, our appetite, our energy balance. When we don’t get enough sleep there’s a lot of hormonal changes that happen that can increase our risk for obesity.

So for example, sleep deprivation can lead to higher levels of ghrelin, which is the hormone that stimulates appetite, and there’s lower levels of leptin, which is the hormone that signals fullness. So that imbalance makes us feel hungrier and less satisfied after eating, and it can even lead to overeating.

And then cortisol, which is the hormone released in response to stress, is also one of the key hormonal factors. So stress and obesity and sleep are all closely linked, and higher cortisol levels increase appetite and promote the storage of fat, especially visceral abdominal fat. So that means that chronic stress and poor sleep can create a feedback loop that causes weight gain.

It also affects the brain. So lack of sleep can affect the brain’s decision-making areas, and it makes it harder to make healthy choices and control impulses. And it slows down your metabolism, so you can’t really burn calories effectively. It can also affect your insulin sensitivity, so it can increase your risk of type 2 diabetes as well. So it really affects so many things.

Kevin Pho: And just for some context, what is the recommended number of hours of sleep for adult males and females?

Nisha Kuruvadi: Yeah, so usually you want to have about seven to nine hours of sleep, and you want it to be good quality of sleep as well, not just good quantity. So you want to look out for sleep disorders and things like sleep apnea, and it’s important for providers to screen for that as well, because you want to make sure the quality of the sleep is good, not just the number of hours that you get.

Kevin Pho: So what are some of the studies that really make that empirical connection between poor quality or a lack of sleep and weight gain? So is there a strict correlation, if you sleep less than say seven hours do you gain a certain amount of weight? So what is the empirical correlation?

Nisha Kuruvadi: Yeah, so there’s a lot of studies that link obesity and even being overweight with sleep deprivation. And there’s not a specific number, but definitely with less sleep there’s more risk and more numbers of being overweight and obese, plus also having comorbidities like diabetes, hypertension, more stress. So it’s all related.

Kevin Pho: So you’re an internal medicine physician like myself doing primary care, you also have a specialty in obesity medicine. So how do you introduce the topic of sleep in the exam room as it relates to someone being overweight?

Nisha Kuruvadi: Yeah, great question. So having some screening questionnaires can help, so that you have an idea of how they sleep. So in terms of sleep apnea there’s the STOP-BANG questionnaire, for insomnia there’s the Epworth Sleepiness Scale. So that’s a good thing that patients can fill out in the waiting room before they even come in to see me, so I have an idea of their level of sleep. And there’s a lot of other screening questionnaires as well.

And then I like to ask them, you know, how is your sleep? And it’s something that not everyone asks, and usually people come in and you just talk about your diet and your exercise. But I tell them there’s a lot more to sleep, there’s a lot more to obesity, and sleep is a big part of that.

So understanding, even going through sleep hygiene, you know, what time do they sleep, what time do they wake up, do they feel like they’re sleeping well? And really getting a good sleep history is really important.

And then there are different things you can do to help them sleep. So sleep hygiene is huge. So recommending establishing a consistent sleep schedule, so going to bed at the same time every day, and waking at the same time, including weekends, can help build that sleep schedule and help promote sleep.

Make a relaxing bedtime routine, so engaging in calming activities before bed like reading, taking a warm bath, and limiting screen time. That exposure to blue light from phones, TVs, even computers, it can interfere with the production of melatonin, so you do want to limit that and not be on your phone for an hour before you go to sleep. Which can be difficult for some patients, but it does make an impact.

You want to optimize your sleep environment, so make sure that the room is dark, get blackout shades if you need to, wear earplugs, wear a mask, get a white noise machine that can help with ambient noises.

And then changing your diet a little bit in terms of decreasing caffeine, decreasing alcohol, especially close to bedtime, and then avoiding heavy late night meals, trying to get your dinner time a few hours at least before you fall asleep. All those things can help, and it’s not things that people usually think about. So if you actually describe that to patients, a lot of times just making those changes can help. And then there are sleep medicine physicians that you can refer your patients to. There is cognitive behavioral therapy for insomnia. So all those things can help.

Kevin Pho: So let’s say someone comes to your office and they have some positive responses to the screening questions, or when you do their screening questionnaires it comes back positive for potential poor sleep or not enough sleep. So tell us some of your next steps in terms of your approach in terms of addressing anything that’s positive.

Nisha Kuruvadi: Yeah, definitely. So first getting a good sleep history, so I can understand what the actual sleep disorder is, if it’s just insomnia, or also screening for sleep apnea, because I see that all the time with my obese patients. And sleep apnea can really affect your quality of sleep and make you feel tired and unrefreshed during the day. So definitely making sure there’s no sleep apnea, sending patients to sleep study if I think there is. And then if it’s just purely insomnia, that sleep hygiene can work really well. There are medications that can help promote sleep. So just really understanding what actually is going on and addressing that.

Kevin Pho: So as you know there are a lot of over the counter options that promote better sleep. Could be medications, could be supplements, melatonin, CBD oil. So if a patient comes to you and asks you whether those over the counter options are effective, what do you normally say, or how do you counsel them?

Nisha Kuruvadi: Yeah, so melatonin is something that I do recommend. You know, it is your natural sleep hormone that’s already in your body, so it can help augment that. And it really depends on the person, sometimes it works well, sometimes it doesn’t, so it just depends. But it’s a good thing to try, because it can be effective for some people.

It definitely helps when you have like a shift in your sleep. So people that sleep during the day, or during the night, because they work shift work, it can definitely help more with those kind of people, because it helps that sleep hormone when it’s usually not supposed to be there. But it really just depends on the person. But I do recommend melatonin.

Kevin Pho: What about the antihistamine based sleep aids that are commonly out there?

Nisha Kuruvadi: Yeah, I don’t feel like those, like Benadryl and things like that, they’re not really that helpful and they can have side effects. So I don’t recommend it, it’s not the best for sleep.

Kevin Pho: And at what point would you consider a prescription sleep aid? A lot of physicians prescribe benzodiazepines, they prescribe Ambien. Are those part of the equation when it comes to helping people sleep?

Nisha Kuruvadi: It’s definitely part of it and it’s a great tool. First would be kind of addressing all the sleep hygiene and making sure they’re doing everything they can to optimize their sleep. And you know, cognitive behavioral therapy for insomnia is also very helpful if patients don’t want to start medication. But either way, starting a medication, even like trazodone, there is Ambien as well which is a little stronger, but there are definitely medications that can help. And that’s something that can help with sleep, and that can in turn help with obesity as well.

Kevin Pho: So tell us a case study or a success story that you’ve had where you’ve treated someone’s sleep and it actually helped with their weight loss goals.

Nisha Kuruvadi: Yeah, so I’ve definitely seen this in my practice. I remember one patient that came in with me, he was of course morbidly obese and was trying everything that he possibly could to lose weight. And so we discussed his diet, sent him to a nutritionist, made sure he was exercising well, even had him on some weight loss medications, had him on Wegovy for weight loss. And he was doing OK but still wasn’t getting that weight loss that he wanted.

And I remember asking him about sleep, and he of course was not sleeping well at all. He had a lot of stress from just life in general, and he was only getting probably a few hours of quality sleep every night. And that was just his normal, he was dealing with stress for so long and that’s how his sleep was, so he didn’t think to bring it up, and he didn’t think it was related at all.

And so when we kind of helped with the sleep hygiene and got to the core of what was causing it and dealt with his anxiety, it was like night and day difference. He started losing so much weight. So it really makes a big impact, and it’s something people don’t know about. And a lot of times you don’t really ask patients because you’re so focused on the diet and the exercise, but it really makes such a big impact.

Kevin Pho: One of the things that you said earlier was that people who have poor sleep, they make less wise choices when it comes to their cravings and choices of higher calorie food. So talk more about that connection.

Nisha Kuruvadi: Yeah, so it does affect the decision-making areas of your brain when you’re sleep deprived, and so it makes it harder to resist unhealthy foods and you can’t really control your impulses, and it can lead to emotional eating as well. And even chronic stress can lead to emotional eating.

So it’s kind of like a vicious cycle where that sleep deprivation makes you more stressed, and that stress makes you more sleep deprived, and then you start emotionally eating. And you can’t really make the decisions to eat that healthy food when you’re sleep deprived.

You know, anyone can know, if you’re kind of that one night where you don’t sleep well, you don’t really feel good during the day and you feel kind of annoyed and you don’t feel like yourself. And imagine being in that situation every single day. You’re not going to make good choices, because it’s natural, you don’t feel well, you’re not getting that rest for your brain and for your body.

Kevin Pho: So as you know, a lot of physicians are so busy, they get 15 minutes with the patient. And I know a lot of doctors, whenever someone says they have poor sleep, it’s much easier just to write a prescription than to go through that entire sleep history and answer those questions about sleep hygiene. So how do you fit a sleep history in when someone comes to you saying that they have poor sleep, or if there’s something that you could elucidate, they come in for something else and then you elucidate that they have poor sleep? So how do you fit all that comprehensive history in?

Nisha Kuruvadi: Yeah, that’s a great question. So I know as primary care physicians we’re so limited by the time that we have. Sometimes it does elucidate, so sometimes people come in and they’re talking about stress and sometimes they naturally talk about their sleep, so that’s a good way to discuss it.

You know, I definitely do start the conversation about diet and exercise first, and if you feel like they’ve really made a lot of changes and it’s not helping, it’s a good time to think about obesity, and sleep and stress can cause that. So if you feel like they’ve been trying everything and they’re doing everything that they should and they’ve kind of reached a barrier, then sleep is a good next question.

Having those screening questionnaires initially can help, because it’s something they can fill out in the waiting room, it’s not taking up your time, and you can quickly look at it and see if they have an issue with their sleep or not. And so that is a good way to know if you should discuss sleep during your appointment.

And if you feel like you’re running out of time, you can refer patients to an obesity medicine specialist or a sleep specialist, and they can really get down into it and see what is causing it. They have a little more time to address those issues. So if you feel like you’re really limited on time, you could refer out, and that way patients have more time to discuss these issues as well.

Kevin Pho: We’re talking to Nisha Kuruvadi. She’s an internal medicine physician and an obesity medicine specialist. Today’s KevinMD article is “How quality sleep can be your secret weapon for effective weight loss.” Nisha, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Nisha Kuruvadi: So I would just say that if you’re a patient and you’re struggling with your weight, and you see that you’re not really sleeping well, discuss it with your health care provider, because there are definitely a lot of things that can help, and that can be a really big factor in contributing to your weight gain.

And you know, addressing sleep issues can be such a powerful tool in managing weight. It’s not just about diet, exercise. Sleep is such a crucial pillar of health. And so it’s something for health care providers to also be aware of. If you get that patient that’s really not losing weight no matter how much they try, ask them about their sleep, and it can make an impact.

Kevin Pho: Nisha, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Nisha Kuruvadi: Thank you so much for having me, I appreciate it.