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The Effects of Diet and Supplementation on Sleep

Diet is affected by sleep and sleep affects diet. In this review, Dr Cliff Harvey explores the effects of dietary changes and supplements on sleep.

Key Points

  • Getting enough total energy from your diet is likely to improve sleep duration and quality
  • Sufficient protein is also likely to improve sleep
  • Specific diets have variable effects on sleep architecture but a broad reading of the research suggests that diets based on mostly unrefined foods improve sleep
  • While diets that include excessive snacks, and especially snacks high in sugar, or diets high in ultra-refined foods worsen sleep
  • Being replete in specific nutrients like vitamins C and D and the minerals zinc and magnesium is also beneficial to sleep

The effects of poor-quality or lack of sleep on health are well documented (see “The Effects of Sleep on Health”). Nutrition and diet influence the quality and duration of our sleep and this effect is ‘bi-directional’,1 meaning that diet and nutrients influence sleep and that sleep affects how we eat. So, this can create a positive or negative cycle of improved or diminished sleep over time, further improving or reducing health.

The Effects of Diet and Supplements on Sleep. By Dr Cliff Harvey

What overall effects do diet and nutrients have on sleep duration and quality?

The assumption is that diet and sleep are closely related. It has been suggested that diets high in ultra-refined foods, sugar and fats, and low in vegetables are associated with reduced sleep driven by increased cortisol (and that this could play a role in the causation of Alzheimer’s disease).2

However, the overall effects of diet and nutrients in observational studies are relatively small. For example, in a study of over 2000 healthy Japanese adults, only small associations were observed for the effect of nutrients vitamins D and B12, and food groups bread, pulses, fish and shellfish[1] on sleep duration in men. While no significant correlations between dietary intakes and sleep duration were observed in women.3

The overall effects of diet and nutrients in observational studies are relatively small

In a study of nurses involved in shift-work, there was no significant association between diet and sleep quality, but there was a significant association[2] between body mass and sleep quality.4 This suggests that the effects of diet and nutrients on sleep is most likely to result from the overall effects of diet on cardiometabolic health (i.e. diabetes, prediabetes, and obesity). Other observational research has shown that poor sleepers have significantly higher body mass and fat mass percentage than good sleepers. It has also been shown that ‘good’ sleepers (6–8 hours per day), achieve greater reductions in fat mass, an effect especially true in women compared to men (−3.6 vs. −2 kg, p = 0.05). Women who reported sleeping more than 6 hours per night also had an increased probability of losing fat mass than women who reported sleeping less than 6 hours.[3] 5

‘good’ sleepers (6–8 hours per day), showed greater reductions in fat mass

In a study of people following the Mediterranean Diet, sleep duration was associated with greater intake of fruits and vegetables, while reduced sleep was associated with unhealthy eating behaviours, including greater intakes of sweets and snacks. Short sleep duration and poor sleep were also associated with an increase in body mass and fat mass.6 A Mediterranean diet itself is associated with better sleep durations (i.e. not too long and not too short) and with better sleep quality.7-9

Data from the National Health and Nutrition Examination Survey Data (2005-16) also suggests that those not meeting their sleep needs are significantly more likely to skip breakfast and/or lunch, while also being more prone to snacking and late-night eating, resulting in higher intakes of energy, carbohydrate, fat, added sugar, and caffeine (mostly from snacks). So, lack of sleep in itself is likely to cause poorer eating habits and increase the known obesogenic (fat-gain) elements of the diet.10


[1] ‘Small’ correlations: r < 0.3

[2] p = 0.0032

[3] OR = 4.47, 95% CI: 1.42–14.04, p = .010 and OR = 5.10, 95% CI: 1.15–22.70; p = .032, respectively

The effects of macronutrient distribution in the diet

Diets containing different macronutrient amounts are suspected to play a role in sleep. Overall though, changes in carbohydrate and fat content (i.e. comparing low-fat to low-carb diets) has resulted in only minor differences in some components of sleep. There is evidence of a trend towards reduced time-to-sleep and short-wave sleep, and increased REM sleep in higher carbohydrate interventions, and greater sleep arousal in low-carb diets.11 However, the results of studies on low-carb or ketogenic diets and sleep have been very variable and show marked differences in effects depending on the degree of calorie restriction, and the time-frame of the study in which sleep quality and length is measured. In a study looking at the low-carb diet score (i.e. those who habitually eat most vs least carbohydrate) lower-carbohydrate diets were associated with better sleep (and reduced depression),12 however, these studies need to be interpreted with caution because they rely on macro content of habitual diets, not low-carb diets per se, and without attention to ‘quality’ of diet.

Changes in carbohydrate and fat content has resulted in only minor differences in some components of sleep

There can also be transient effects of a low-carbohydrate diet on sleep during the adaptation to reduced glucose availability and increased fat and keto-adaptation. This typically resolves in several days. There are sympathetic nervous system effects (‘stress’ responses) during the early adaptation to a ketogenic diet that can affect sleep but qualitative research suggests that the overall effect on sleep, from a ketogenic diet, is a positive one.13

Higher protein diets have shown some positive effects on night-time arousal and wakening.11 It is plausible that this is related to our desire to seek enough protein (protein leverage theory) and this is why protein reduces cravings for all foods. Clinically we commonly observe that where people are not taking in enough energy or protein, sleep duration is shortened in response, a likely consequence of the need to have more daylight hours available to ‘hunt and gather’. Studies have shown no clear differences between higher and lower protein diets of greater or lesser than 2.2 g per kg,14 and this suggests that higher-protein diets (over what we require to thrive) offer no further benefits to sleep. In short, getting optimal protein to thrive is likely to improve sleep, but additional protein is unlikely to further enhance sleep quality or duration.

Clinically we commonly observe that where people are not taking in enough energy or protein, sleep duration is shortened in response

Food types and sleep

There is some evidence that milk, fatty fish, fruit, and increased vegetable intakes promote better sleep.11, 15 Conversely, lower intakes of fruit and vegetables are associated with short and long sleep durations (which are both associated with poorer health), as are markers of fruit and vegetable consumption like carotenoids and vitamin C.16

Other foods containing either high antioxidant levels (kiwi), melatonin (tart cherry) and zinc-containing foods like oysters might help to improve sleep.15 Lower intakes of whole grains and higher intakes of red meat and lower diet quality overall are associated with a greater incidence of obstruction sleep apnoea.17

Lower intakes of fruit and vegetables are associated with worsened sleep

Eating behaviours

In a study of over 2000 children, no significant effects of specific nutrients or foods were shown on sleep, however, ‘unhealthy eating habits and environments’ such as eating alone or in front of the television, was independently associated with sleep as were between meals and after dinner snacking.18

Nutrients and diet

In infants

Both nutrients and timing of nutrients have been reported to influence sleep. In infants, various nutrients have been shown to naturally fluctuate in breast milk with circadian rhythm, and these nutrients such as tryptophan, nucleotides, essential fatty acids and omega-3 fatty acids might impact infant sleep.19

Melatonin

Children with dermatitis often have poor sleep due to the itching and discomfort of the condition. In a study of 48 children with atopic dermatitis, sleep latency (the time taken to get to sleep) was reduced by 21 minutes in those taking 3 mg of melatonin compared to a placebo.20

Vitamin C

Studies have shown an association between vitamin C and improved sleep durations.16 This association has been assumed to be because of overall nutrient sufficiency in a healthy diet containing greater intakes of natural, unrefined foods, especially fruits, berries and vegetables. However, in a study on the application of intravenous vitamin C in dialysis patients (500 mg/5 cc, 3 x per week over 8 weeks) there was a notable difference in night-time itching and restless leg syndrome in the intervention group.  There was also an improvement in subjective sleep quality, sleep latency and daily function between the two groups and sleep disorders were significantly lower[i] in the intervention group.21 This might suggest an independent effect of vitamin C on sleep.

Vitamin D

Vitamin D receptors have been found in the brain regions involved in sleep regulation and this vitamin is known to be involved in regulating the sleep-wake cycle. Low levels of vitamin D are correlated with poor quality sleep and short sleep duration.22, 23 Insufficiency of the vitamin is also suggestive of a lack of daytime circadian patterning,23 in other words, lesser exposure to sunlight (and hence lower vitamin D levels) impairs our normal day-night patterns and thereby reduces sleep. However, supplementation has proven beneficial, and so sufficiency of this vitamin, and not just circadian rhythms, might have a distinct effect on sleep. In a study of vitamin D supplementation (50,000 iu every fortnight) overall sleep scores were improved, as were the subgroups of sleep duration, sleep latency, and sleep quality.24 Additionally, vitamin D deficiency has been associated with poor sleep quality[ii] in heart failure patients.25

Vitamin D levels have also been associated with obstructive sleep apnoea (and with neck circumference, a factor in OSA),26 resulting in poorer sleep in some studies,27 but not others.28 A systematic review of available studies in 2017 concluded that There was a relative insufficiency in serum vitamin D levels among OSA patients. It was unclear whether low vitamin D was a risk factor for OSA or if OSA was a risk factor for low vitamin D and it was also possible that the association between vitamin D and OSA was due to overweight/obesity.29

A 2018 systematic review and meta-analysis has investigated the role of vitamin D and sleep. Lower vitamin D levels were associated with poor sleep quality, short sleep duration, and sleepiness. Subgroup analyses further indicated that serum vitamin D[iii]   of less than 20 ng/mL could significantly increase the risk of unhealthy sleep.30

Magnesium

Magnesium is required for enzymes used in the production of neurotransmitters. It is an agonist of GABA, one of our primary ‘relaxing’ neurotransmitters, and blocks the N-methyl-d-aspartate (NMDA) receptor and so, it’s considered a generally ‘relaxing’ mineral,31 which can improve sleep, especially slow-wave sleep.32 Surveys suggest that a relative magnesium ‘deficiency’ (enough to affect sleep quality) might be common, especially in those with obesity, alcoholism, or advancing age.33 In new-borns serum magnesium levels were correlated with ‘quiet’ sleep,34 while in adults, chronic sleep deprivation results in reduced intracellular magnesium levels which might further affect both sleep and cardiovascular events.35 (Note: Magnesium is intricately involved with preserving cardiovascular tone and heart rhythm).

In a sleep deprivation study of athletes, supplementation of 100 mg of magnesium per day for one month mitigated the reduction in anaerobic threshold and peak oxygen uptake seen in unsupplemented athletes. The authors conclude that “these results indicate that decreased exercise tolerance observed in the sleep-deprived state could be improved by oral Mg administration”.36

In an observational study of  1487 Chinese adults, dietary magnesium was compared to sleep. The average intake of magnesium was 332.5 mg per day. Those in the highest quartile of magnesium intake had ~12% lesser likelihood of falling asleep during the day.37

In a study of 100 adults with poor sleep quality scores,[iv] one group was given a 320 mg magnesium/day supplement as magnesium citrate and the other group a sodium citrate placebo for seven weeks. At baseline, 58% of the participants were consuming less than the U.S. Estimated Average Requirement (EAR) for magnesium. Consuming less than the EAR was associated with significantly higher BMI and plasma C-reactive protein (CRP) concentration (only 40 participants had plasma CRP concentrations higher than 3.0 mg/L (an indication of chronic inflammatory stress)). Overall sleep disturbance scores[v] in the magnesium group improved from 10.4 to 6.6.38

Zinc

Recent research has concluded that zinc serum concentration varies with the amount of sleep, while orally administered zinc increases the amount and the quality of sleep in both mice and humans.39

In a double-blind, placebo-controlled study over 12-weeks both zinc-rich foods and zinc supplemented foods improved the time take to fall asleep and improved sleep quality.40 In a study of intensive care nurses, The total sleep quality, and sleep latency scores for those supplementing with zinc were significantly improved vs a control group. Supplements resulted in significantly higher serum zinc levels than the control group.41

References

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5.         Pagliai G, Dinu M, Casini A, Sofi F. Relationship between sleep pattern and efficacy of calorie-restricted Mediterranean diet in overweight/obese subjects. International journal of food sciences and nutrition. 2018;69(1):93-9.

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14.       Burgess V, Carson C, Ellerbroek A, Axelrod C, Peacock C, Silver TA, et al. High-Protein Diet has no Effect on Sleep Quality and Quantity in Exercise-Trained Men and Women. Journal of Exercise and Nutrition. 2019;2(1):1.

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17.       Reid M, Maras JE, Shea S, Wood AC, Castro-Diehl C, Johnson DA, et al. Association between diet quality and sleep apnea in the Multi-Ethnic Study of Atherosclerosis. Sleep. 2018;42(1).

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19.       Schneider N, Mutungi G, Cubero J. Diet and nutrients in the modulation of infant sleep: A review of the literature. Nutritional neuroscience. 2018;21(3):151-61.

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26.       Fan Z, Cao B, Long H, Feng L, Li Q, Zhang Y, et al. Independent association of vitamin D and insulin resistance in obstructive sleep apnea. Annales d’Endocrinologie. 2019;80(5):319-23.

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32.       Murck H, Held K, Auer DP, Steiger A. Therapeutic sleep deprivation and magnesium: Modulators of the GABA/glutamate equilibrium. Pharmacopsychiatry. 2003;36(05):201.

33.       Nielsen FH. Chapter 31 – Relation between Magnesium Deficiency and Sleep Disorders and Associated Pathological Changes. In: Watson RR, editor. Modulation of Sleep by Obesity, Diabetes, Age, and Diet. San Diego: Academic Press; 2015. p. 291-6.

34.       Dralle D, Bödeker RH. Serum magnesium level and sleep behavior of newborn infants. European Journal of Pediatrics. 1980;134(3):239-43.

35.       Takase B, Akima T, Satomura K, Fumitaka, Ohsuzu, Mastui T, et al. Effects of chronic sleep deprivation on autonomic activity by examining heart rate variability, plasma catecholamine, and intracellular magnesium levels. Biomedicine & Pharmacotherapy. 2004;58:S35-S9.

36.       Tanabe K, Yamamoto A, Suzuki N, Osada N, Yokoyama Y, Samejima H, et al. Efficacy of Oral Magnesium Administration on Decreased Exercise Tolerance in a State of Chronic Sleep Deprivation. JAPANESE CIRCULATION JOURNAL. 1998;62(5):341-6.

37.       Cao Y, Zhen S, Taylor AW, Appleton S, Atlantis E, Shi Z. Magnesium Intake and Sleep Disorder Symptoms: Findings from the Jiangsu Nutrition Study of Chinese Adults at Five-Year Follow-Up. Nutrients. 2018;10(10):1354.

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41.       Gholipour Baradari A, Alipour A, Mahdavi A, Sharifi H, Nouraei SM, Emami Zeydi A. The Effect of Zinc Supplementation on Sleep Quality of ICU Nurses: A Double Blinded Randomized Controlled Trial. Workplace Health & Safety. 2018;66(4):191-200.


[i] p =0.0001

[ii] (odds ratio, 2.22; P = .033).

[iii] 25(OH)D

[iv] Pittsburgh Sleep Quality Index (PSQI) score higher than five

[v] PSQI

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