Insomnia

What Is Insomnia?

[dropcap]I[/dropcap]nsomnia is a distressing sleep disorder that includes inability to fall asleep, inability to stay asleep, and inability to get deep sleep depending on the type of insomnia.

Q: What are the types of insomnia?

A: There are two types of insomnia: primary or secondary which have different causes.

1. Primary insomnia is characterized by sleeplessness due to reduction of synthesis of neurotransmitters (brain chemicals) in the central nervous system (brain) required for sleep, especially melatonin. Melatonin is produced during the night hours by the pineal gland from tryptophan, an essential amino acid derived from food.

Neurotransmitters are released when the axon terminal of a presynaptic neuron (nerve cell) is stimulated and acts by stimulating or inhibiting a target nerve cell.

2. Secondary insomnia has many causes. It can be a feature of malnutrition, lack of exercise, heartburn, mental disorders such as dementia and psychosis, emotional disorders such as depression and anxiety, guilt, worry, many conditions that involve itchiness, pain, disability, and a side effect of certain medications.

What Is Insomnia In Celiac Disease and/or Gluten Sensitivity?

• Relationship between insomnia and celiac disease. Insomnia in celiac disease is an associated disorder that develops from malnutrition.

• Relationship between insomnia and nutrients. A large study using data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) investigated the role of nutrients associated with sleep and found the following results of low intake (in order):

  Nutrient deficits that were associated independently with difficulty falling asleep included: alpha-carotene, selenium, dodecanoic acid (lauric fatty acid found in palm and coconut), calcium, and hexadecanoic acid (palmitic fatty acid as found in meat, milk and palm oil). Nutrient deficits that were associated independently with sleep maintenance difficulties included: salt, butanoic acid (butyric fatty acid as found in milk), carbohydrate, dodecanoic fatty acid, vitamin D, lycopene, hexanoic acid (caproic fatty acid found in goat, sheep milk) and moisture.

  Nutrient deficits that were associated independently with non-restorative sleep included butanoic acid, calcium, vitamin C, water, moisture and cholesterol. Nutrient deficits that were associated independently with sleepiness included: moisture, theobromine (found in cocoa, tea), potassium, and water.¹

• Relationship between insomnia and health disorders in celiac disease. Sleep disorders are related to depression, anxiety and fatigue, and inversely related to quality of life scale scores.² In celiac disease, each of these related disorders stems from malabsorption.

How Prevalent Is Insomnia In Celiac Disease and/or Gluten Sensitivity?

Insomnia is common in celiac disease.³

What Are The Symptoms Of Insomna?

Insomnia in celiac disease is marked by any/or all of these symptoms:

• Inability to fall asleep.
• Inability to stay asleep.
• Inability to get deep sleep.
• Lack of sleepiness.

How Does Insomnia Develop In Celiac Disease and/or Gluten Sensitivity?

• Insomnia in celiac disease results from multiple micronutrient malabsorption including vitamin B6  (pyridoxine), vitamin B12, B-complex, magnesium, vitamin B1 (thiamin), calcium, the omega-3 fatty acid EPA, and especially the amino acid tryptophan which is required for synthesis of melatonin.⁴

• Nutrients associated independently with difficulty falling asleep included: alpha-carotene, selenium, dodecanoic fattty acid, calcium, and hexadecanoic acid.
• Nutrients associated independently with sleep maintenance difficulties included: salt, butanoic acid (butyric fatty acid found in animal fat, milk), carbohydrate, dodecanoic acid, vitamin D, lycopene, hexanoic acid and moisture.
• Nutrients that were associated independently with non-restorative sleep included butanoic acid, calcium, vitamin C, water, moisture and cholesterol.
• Nutrients associated independently with sleepiness included: moisture, theobromine, potassium, and water.⁵

• These deficiencies can also cause anxiety, depression, and fatigue which interfere with sleep.³

Does Insomnia Respond To Gluten-Free Diet?

Yes. Celiac disease-related insomnia responds to gluten free diet that supplies the nutrients that are needed for normal sleep.

6 Steps To Improve Insomnia In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both insomnia and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁶
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk, disrupts intestinal permeability causing leaky gut.⁷
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁷ Many cause cancer such as polysorbate 60, potassium bromate, and sodium nitrate.
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁷.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁷
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Artificial sweeteners. Includes Aspartame, Sucralose, and Saccharin which are also linked to cancer and autoimmune disease.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁷
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁷[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

 

• [dropcap]4[/dropcap] Manage Your Medications Safely:

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Certain prescription drugs deplete nutrients, causing insomnia. Deficiencies include vitamin B1 (thiamin), vitamin B6 (pyridoxine), vitamin B12, B-complex, vitamin C, vitamin D, magnesium, calcium, selenium, potassium, the omega-3 fatty acid EPA, and especially the amino acid tryptophan which is required for synthesis of melatonin.

Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

DIABETIC DRUGS 

• Metformin® depletes Vitamin B12.

ANTI-DEPRESSANTS

• Adapin®, Aventyl®, Elavil®, Pamelor®, and others deplete Vitamin B12.

DIURETICS

• Loop Diuretics (Lasix®, Bume®x, Edecrin®) depletes Vitamin B1, Vitamin B6, Magnesium, Calcium.

CARDIOVASCULAR DRUGS

• Antihypertensives (Catapres®, Aldomet) deplete Vitamin B1, Vitamin B6.
• Beta blockers (Inderol®, Lopressor®, Corgard®, Atenolol®) deplete melatonin.

ANTI-INFLAMMATORIES – Disrupt Intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Magnesium, Vitamin B6, Calcium, Magnesium, Vitamin B12, Vitamin D, Selenium.
• Aspirin and Salicylates deplete Calcium, Vitamin B12.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Vitamin B1, Calcium, Vitamin B12, Vitamin D, Selenium.

ANTIBIOTICS  disrupt intestinal permeability.

• Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete B Vitamins.
• Tetracyclines deplete Magnesium, Calcium, Vitamin B6.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Magnesium, Calcium, Vitamin B12, Vitamin D.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Magnesium, Calcium, Vitamin B12, Vitamin D.
• Alka Seltzer®, Baking Soda deplete Magnesium.

ANTIVIRAL AGENTS

• Zidovudine (Retrovir®, AZT and other related drugs) deplete Vitamin B12.
• Foscanet depletes Calcium, Magnesium, Potassium. 

BRONCHODILATORS

• Inhaled corticosteroid inhalers (Flovent, Pulmicort and others) that are breathed in on a daily basis as a long term therapy to reduce inflammation in airways deplete Potassium, Calcium, Vitamin D, and B vitamins.
• Albuterol inhalers that are breathed in on a daily basis as a long term therapy and also for quick relief as rescue inhalers to open airways depletes Potassium, Magnesium, Calcium.
• Theophylline by mouth as a long term therapy to open airways depletes Potassium.

CHOLESTEROL DRUGS

• Colestid® and Questran® deplete Vitamin B12, Vitamin D, Beta-carotene.

DIURETICS

• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete Magnesium, Potassium.
• Loop Diuretics (Lasix®, Bumex®, Edecrin®) deplete Calcium, Magnesium, Vitamin B1, Vitamin B6, Vitamin C, Potassium, Sodium.

FEMALE HORMONES – Disrupt Intestinal permeability

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Vitamin B6, Magnesium, Vitamin B12, Selenium.
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Vitamin B6, Magnesium, Vitamin B12.

LAXATIVES

• Metamucil, FiberCon, Citrucel, Colace, Glycolax, Milk of magnesia, Dulcolax deplete: Vitamin D, Calcium, Sodium, Potassium.

MAJOR TRANQUILIZERS  

• Thorazine®, Mellaril®, Prolixin®, Serentil® and others deplete Vitamin B2.

WEIGHT LOSS DRUGS THAT BIND FAT also interfere with absorption of some nutrients.

• Zenicol (Orlistat®) depletes Vitamin D, Beta-carotene, the fatty acids lauric, palmitic, and capric.

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• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

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The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient. Nutrients made from food sources are superior to synthetic ones that are derived from chemicals.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• 100% of the B vitamins, or as prescribed by a doctor. About B Vitamin supplements:  some labeling can be confusing, for example, “B 100” does not mean 100%. If the ingredient list shows  an excessive amount like 3000% or more, look for another brand because this excessive amount will cause the loss of mineral in the urine.
• Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.
• Vitamin D3 as prescribed following blood test for status.
• Chelated magnesium  as prescribed but do not take at same time as calcium because they compete for absorption.
• Fish oil to supply omega-3 fatty acids EPA and DHA.
• Other nutrients that are deficient.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table. Refrigerate fish oil.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients that are needed for sleep.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort which are often part of chronic anxiety.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile (allergy note: related to ragweed), lemon balm, and fennel (as a tea) also help relieve nervous tension and help induce sleep.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise during the day conditions the body and helps get rid of stress hormones and toxins. On the other hand, exercise close to bedtime keeps the body awake.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Insomnia In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Sleep symptoms associated with intake of specific dietary nutrients.” This study investigating the role of nutrients that are associated with sleep found the following results suggesting new associations between sleep symptoms and diet/metabolism:

Nutrients that were associated independently with difficulty falling asleep included (in order): alpha-carotene, selenium, dodecanoic acid, calcium, and hexadecanoic acid. Nutrients that were associated independently with sleep maintenance difficulties included: salt, butanoic acid, carbohydrate, dodecanoic acid, vitamin D, lycopene, hexanoic acid and moisture.

Nutrients that were associated independently with non-restorative sleep included butanoic acid, calcium, vitamin C, water, moisture and cholesterol. Nutrients that were associated independently with sleepiness included: moisture, theobromine, potassium, and water.

Data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) were used (n = 4552) to determine which nutrients were symptoms in a nationally representative sample. Survey items assessed difficulty falling asleep, sleep maintenance difficulties, non-restorative sleep and daytime sleepiness. Analyses were adjusted for energy intake, other dietary factors, exercise, body mass index (BMI) and sociodemographics. Population-weighted, logistic regression, with backwards-stepwise selection, examined which nutrients were associated with sleep symptoms.¹

“The quality of sleep in patients with celiac disease.” This study investigating the quality of sleep in celiac disease found that sleep disorders are common in celiac disease not only at diagnosis but also during treatment with a gluten-free diet. Sleep disorders are related to depression, anxiety and fatigue, and inversely related to quality of life scale scores.

The participants were celiacs at diagnosis; celiacs on a gluten-free diet at follow-up and healthy volunteers. Participants completed the Pittsburgh Sleep Quality Index (PSQI), SF36, Zung and Fatigue scales and State-Trait Anxiety Inventory (STAI).

RESULTS: The PSQI score was higher in celiacs at diagnosis and in a gluten-free diet than in healthy volunteers (P < 0.001). A gluten-free diet did not improve the PSQI score (P = 0.245) in celiac disease. The other test scores were similar between celiacs at diagnosis and those on a gluten-free diet, whereas significant differences were found between celiacs and volunteers. PSQI score was inversely associated with the quality of the physical and mental component scores. The sleep quality scores were related to depression, fatigue, state anxiety and trait anxiety.⁸

Sources:

1. Grandner MA, Jackson N, Gerstner JR, Knutson KL. Sleep symptoms associated with intake of specific dietary nutrients. J Sleep Res. 2014 Feb;23(1):22-34. doi: 10.1111/jsr.12084. [↩] [↩]
2. Zingone F, Siniscalchi M, Capone P, Tortora R, Andreozzi P, Capone E, Ciacci C. The quality of sleep in patients with coeliac disease. Alim.ent Pharmacol Ther. 2010 Oct;32(8):1031-6. doi: 10.1111/j.1365-2036.2010.04432.x. [↩]
3. Zingone F, Siniscalchi M, Capone P, Tortora R, Andreozzi P, Capone E, Ciacci C. The quality of sleep in patients with coeliac disease. Alim.ent Pharmacol Ther. 2010 Oct;32(8):1031-6. doi: 10.1111/j.1365-2036.2010.04432.x. Epub 2010 Aug 16. [↩] [↩]
4. Krause’s Food, Nutrition, & Diet Therapy. 10th Edition. Kathleen Mahan, Sylvia Escott-Stump. 2000. W.B. Saunders Company. [↩]
5. Grandner MA, Jackson N, Gerstner JR, Knutson KL. Sleep symptoms associated with intake of specific dietary nutrients. J Sleep Res. 2014 Feb;23(1):22-34. doi: 10.1111/jsr.12084. [↩]
6. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
7. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
8. Zingone F, Siniscalchi M, Capone P, Tortora R, Andreozzi P, Capone E, Ciacci C. The quality of sleep in patients with coeliac disease. Alim.ent Pharmacol Ther. 2010 Oct;32(8):1031-6. doi: 10.1111/j.1365-2036.2010.04432.x. [↩]