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After a month-long hospitalization from COVID-19, a once-independent older adult struggles to complete daily tasks. They can’t make breakfast without getting fatigued or focus on reading the paper. They’ve been in physical therapy for months and are not making the progress they think they should be making. Depression is starting to set in. Family members wonder if they should consider a care home.
On a wet morning, an avid mountain biker loses control and is knocked out. They’re hospitalized and initially make great strides in recovery. Months later, however, physical therapy hasn’t fully resolved their feeling of being off-balance. They’ve been avoiding biking, and even walking or running, because they’re terrified of falling again.
Physical rehabilitation alone isn’t working for these patients, and it’s beginning to feel like recovery either won’t come or won’t end. These are circumstances in which a rehabilitation psychologist may be useful to guide them through the process of rehab and recovery, says Brigid Waldron-Perrine, Ph.D., a rehabilitation psychologist at Michigan Medicine.
“You don’t get a manual that comes with your injury that tells you how to navigate returning to your usual pattern of functioning,” said Waldron-Perrine, who is also an associate professor of physical medicine and rehabilitation at U-M Medical School. “In many cases, there are cognitive, behavioral or emotional barriers to progress that patients may not understand or know how to manage. As experts in human functioning, that’s where we can be useful guides.”
What is rehabilitation psychology?
Around 25% of Americans — more than 60 million people — have some type of disability. And millions of people are evaluated each year for traumatic brain injury, stroke, heart attacks and other conditions that can affect a person’s mobility, cognition or other forms of functioning.

Pharmacogenetic testing was associated with nearly a two-fold (89 per cent) increase in remission rates compared to treatment as usual in a Centre for Addiction and Mental Health- (CAMH-)led clinical study just published in the journal Translational Psychiatry.
The 52-week double-blind study, comparing pharmacogenetic testing guided treatment to treatment as usual, is the first of its kind in Canada and involved 276 patients who had been previously diagnosed with treatment-resistant depression, meaning that their condition had not improved after trying at least two antidepressant medications.
“Remission, or full recovery from symptoms, is one of the most challenging endpoints to achieve when treating major depressive disorder,” said senior author Dr. James Kennedy, Head of the Tanenbaum Centre for Pharmacogenetics at the Campbell Family Mental Health Research Institute at CAMH. “The findings from this study contribute the first randomized, controlled data in Canada to the growing body of evidence of the clinical value of combined multi-gene pharmacogenetic testing.”
Pharmacogenetics is based on the premise that each person may metabolize or respond to medications in different ways based on their own individual genetic profile. That can mean that patients given the same dosage of an anti-depressant medication may have very different levels of it in their bodies, or that some patients may be able to tolerate higher doses of a drug without debilitating side effects based on their genetics. Through customized genetic testing via a cheek swab, pharmacogenetics can help select appropriate drugs and dosages for each patient with the fewest side effects in the shortest period of time.
“Myriad Genetics is proud to support this important study that advances our knowledge of the utility of pharmacogenetic testing in Canadian patients suffering from treatment-resistant major depressive disorder,” said Jay Elliott, Vice President of Medical Affairs at Myriad Genetics. “Although the CAMH trial was underpowered, it is encouraging that the results largely replicate prior studies in American patients, reinforcing the generalizability of pharmacogenetic testing for depression across health care settings.”
“Using pharmacogenetics for treatment-resistant depression we can be much more precise about exactly which drug will suit each person’s unique blueprints for the bodily systems that usher the drug into the brain and enable it to fight depression,” said Dr. Kennedy. “It’s very personalized to each individual.”
At the recommendation of her doctor, Toronto lawyer Cara Sweeny turned to pharmacogenetics at CAMH after not responding to a variety of medications for depression and anxiety. After genetic testing determined her body could tolerate — and in fact needed — three times the standard dose of one anti-depressant drug, she was given the higher dose and within two months her mood improved dramatically.
“I have this very specific memory of one day just opening up my back door to let my dog out, just an ordinary thing, and I felt that feeling of happiness that starts in your gut for the first time in a really long time,” says Sweeny, 52.
While the findings of this Canadian study are considered preliminary because of the sample size, they mirror the results of a much larger American pharmacogenetics clinical trial that reported a 51 per cent increase in remission rates for major depression compared to treatment as usual.
“Pharmacogenetic tests are currently not covered by public health plans in Canada,” added Dr. Kennedy. “The average healthcare savings following pharmacogenetic testing, per depression patient, are over $3,000. If half of the 1.6 million Canadians with depression could get the test, savings could total $2.4 billion per year. Patient suffering during trial-and-error prescribing would be reduced. These study findings should be considered by health policy decision makers, as they provide further impetus for implementation of reimbursement by public payers.”
Funding for the study was provided by Assurex Health Ltd. (now affiliated with Myriad Genetics), CAMH, Ontario Genomics and Genome Canada.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder that affects as many as 30,000 people in the United States, with 5,000 new cases diagnosed each year. It weakens muscles over time, impacting physical function and ultimately leading to death. There is no single cause for the disease and no known cure. However, Johns Hopkins Medicine researchers have found a possible window of opportunity during ALS treatment to target astrocyte abnormalities — a subtype of cells in the central nervous system that provide a structure to metabolically support neurons and fine-tune neuron network signaling.
The research team believes that astrocytes are actively involved in the death of motor neurons, which are cells in the brain and spinal cord that allow people to move, speak, swallow and breathe by sending commands from the brain to the muscles that carry out these functions.
“We think this is particularly important because the astrocyte dysfunction is active after symptom onset in patients with ALS,” says Nicholas Maragakis, M.D., professor of neurology at the Johns Hopkins University School of Medicine and medical director of the Johns Hopkins ALS clinical trials unit. “This finding may enable us to target abnormalities in astrocytes for ALS treatment.”
In their study, published March 21 in the Proceedings of the National Academy of Sciences, researchers analyzed brain and spinal cord tissues from patients with ALS and observed that a particular astrocyte protein, connexin 43, acts as an open pore that sends toxic factors to the motor neurons from the astrocytes. The pore was particularly active in patients with ALS who have a family history of the disease and those who contracted the disease in a sporadic fashion.
The research team was also able to develop stem cell lines from patients with ALS and develop them into astrocytes. They found that these astrocytes induced motor neuron death through hemichannels (proteins that provide pathways for the movement of molecules among cells).
“This is a new pathway that we have shown to be present in ALS tissues, animal models and patient-derived stem cells,” Maragakis says. “It’s also exciting that this particular hemichannel protein seems to be elevated in spinal fluid from patients with ALS and could serve as an important biomarker. This is a true precision medicine approach toward the disease.”
Maragakis says pharmaceuticals are being developed that could block this hemichannel. During the study, his team showed that tonabersat, a drug originally developed for treatment of migraine and epilepsy, could block astrocyte-induced motor neuron death in human ALS stem cell lines and animal models.
This study, Maragakis says, offers increasing evidence that astrocytes play a role in the spread of ALS. Next, the team will try to establish why this hemichannel is so active in ALS astrocytes, giving them a better understanding of how the disease progresses. Maragakis says it’s equally important because it furthers his team’s work to identify new drugs that can block this particular hemichannel, serving as future therapeutics for ALS.
The study was funded by the ALS Association, the Maryland Stem Cell Research Fund, the Robert Packard Center for ALS Research at Johns Hopkins, the U.S. Department of Defense and the National Institutes of Health.
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Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.

VAGINA OBSCURAAn Anatomical VoyageBy Rachel E. GrossYour vagina is a mystery, an enigma, a world that has been largely uncharted, underestimated and misunderstood since the start of humankind. It holds more secrets than the Sphinx and can seem more distant than Mars, more unfamiliar than the ocean floor. Because, until recent decades — when people with vaginas have made painstaking headway into the realms of science and health — the pursuit of such knowledge has been left to men. To put it lightly, they blew it.As Rachel E. Gross proves in “Vagina Obscura,” the impact of this neglect cannot be overstated. Taking readers on an expansive journey across continents, cultures, centuries and even species, Gross reveals a stunning disparity in Western medicine and academia: While huge amounts of money and dedication are poured into the understanding of penises, the female body is disregarded. Like lore, this misinformation and shame are still being passed down to girls today.Gross experienced this “knowledge gap” firsthand at 29, when she was prescribed what was “basically rat poison” to treat a bacterial infection in her vagina. It was then that she realized “I knew almost nothing about how my vagina worked” — and that no one else really does either.She cites Darwin’s journal entry declaring that a woman’s purpose was to be “a nice soft wife,” “an object to be beloved and played with. Better than a dog anyhow.” Freud, who admitted he knew little about womankind (that “little creature without a penis”), would influence gynecology through the 20th century, and even today.Not until 1993 did a federal mandate require that “women and minorities” be included in clinical trials. Only in 2014 did the National Institutes of Health start a branch to study vulvas, vaginas, ovaries and uteruses. And in 2009, the bioengineer Linda Griffith opened America’s first and only lab (at M.I.T.) to research endometriosis. “My niece who’s 16 was just diagnosed,” Griffith says in the book. “And there’s no better treatment for her — 30 years younger than me — than there was for me when I was 16.”In the 1980s, medical textbooks called endometriosis “the career woman’s disease” — language that had been recirculated for generations. A century earlier, coinciding with first-wave feminism in Europe, doctors — buttressed by Freud’s 1895 “Studies on Hysteria” — suggested that higher education and careers “might siphon blood from their uteruses to their brains.” In the 1870s, higher education was thought to “shrivel a woman’s ovaries and keep her from her motherly duties.”Of course, the word “hysteria” — derived from the Greek hystera, or womb — has been used to degrade women for centuries, as one of the first mental health conditions attributed only to them. Gross adds to this history the recent argument that hysteria was endometriosis all along. If true, “this would constitute one of the most colossal mass misdiagnoses in human history,” according to a 2012 paper by Iranian endometriosis surgeons, one that “has subjected women to murder, madhouses and lives of unremitting physical, social and psychological pain.”Gross takes on a herculean task, exploring female anatomy from a medical, social and historical perspective, in eight chapters ranging in topic from the glans clitoris to the egg cell to the vaginal microbiome. Some passages skew medically dense and might be wince-inducing for the squeamish. But Gross manages to make palatable the sawing of cadavers and the injecting of silicone into two-pronged snake vaginas, without undercutting the gravity of their resulting revelations.She achieves this by way of personal stories, like those of Miriam Menkin, the first researcher to fertilize a human egg outside the body; the OB-GYN Ghada Hatem, who performs clitoral restoration surgery on women who have endured genital cutting; Aminata Soumare, a young Frenchwoman whose clitoris was excised when she was a baby in Mali; and the gynecologist Marci Bowers, who has elevated gender-affirming surgery to an art form, prioritizing the construction of a functioning, sensitive clitoris.And it is no wonder that the clitoris has been “demonized, dismissed and left to the trash heap of history.”An organ that exists almost entirely beneath the body’s surface, it was termed “membre honteux,” or “the shameful member,” by a French anatomist in 1545. Because, extraordinarily, it is the only human organ whose primary function is pleasure.VAGINA OBSCURAAn Anatomical VoyageBy Rachel E. GrossIllustrated. 307 pp. W.W. Norton & Company. $30.

SharecloseShare pageCopy linkAbout sharingThis video can not be playedTo play this video you need to enable JavaScript in your browser.The first lockdown was “devastating” to some children needing speech therapy in north Wales, according to a new report.A probe by North Wales Community Health Council (NWCHC) found the progress some children made in their speech was lost.The therapy sessions for children stopped almost completely in March 2020 and did not start again until September 2020.Betsi Cadwaladr health board, which runs the NHS in North Wales has apologised for the disruption. It said staff were working hard to help everyone who missed out. The report discovered some youngsters dropped out of the system completely, and were unable to begin sessions again until later than September 2020, when their parents contacted the health board with concerns.’We’re so proud of how Bertie bounced back’How two elite sportsmen learned to live with a stammerWhy women may wait decades for an ADHD diagnosisSpeech and language therapy sessions are provided to children and adults to help them communicate. Therapists also work with people who have learning disabilities and adults who have had a stroke, as well as helping people who have difficulties eating and swallowing. ‘Need help’Image source, Getty ImagesSix-year-old Ed, from St Asaph, in Denbighshire, said: “Speech and language therapy is when people help you to do sounds like ‘th’ and ‘n’. “I need help to do the ‘s’ sound because when I do it, it doesn’t come out right.”Ed’s mother, Karen, said: “When the pandemic started, there was no contact at all. “Lockdown was hard for all of us, but something could have been offered during that early period.”I’m hopeful the problem can be corrected, but what’s begun to happen as he gets older is that other children have begun to make comments.”‘Wait and see’Karen was worried her son’s confidence could be affected. She said: “That was something we’d hoped to avoid with early intervention, but now it’s a case of wait and see.”He’s now due to start speech and language therapy sessions again in April, but I had to push hard to get them.”Many parents told the health council they understood the March 2020 lockdown was difficult for everyone.But they also said more could have been done to continue some form of contact with children using video conferencing.’Lost progress’Image source, Getty ImagesNWCHC chief, Geoff Ryall-Harvey, said many parents felt their children lost services at a crucial stage and this was compounded by not seeing other children. “Some parents felt that their children had lost all progress made in previous months and that the effect upon their child’s development had been devastating,” he said. “Parents acknowledged that the pandemic had presented everyone with extreme challenges and that it had been necessary to redeploy staff to deal with vaccinations and care for sick patients in hospital.”However, they also felt that more could have been done to continue contact with children using the service, albeit in a limited way, using video conferencing and digital technology.”Betsi Cadwaladr health board’s acting therapies and health sciences executive director, Gareth Evans, said: “We acknowledge and apologise for the disruption caused to our patients during Covid-19.”In order to keep patients and staff safe, we followed Welsh government directives to suspend planned care at critical peak times during the pandemic.”A third of our speech and language therapy staff were redeployed during the first wave of the pandemic to support essential services such as staffing Covid wards.”‘Welsh-speaking therapists’Once “attend anywhere” technology was available, Mr Evans said essential outpatient speech services began again, either in person or virtually. “We established the highest level of virtual patient activity in the health board and helplines for paediatric patients were also set up to provide a direct link to professionals for families,” he added. Mr Evans said a Covid recovery plan was being implemented which included extended and flexible clinics, more remote appointments and prioritising patients affected by the pandemic.He added that speech and language therapy was recognised as a shortage profession in the UK and they were redoubling their efforts to recruit new staff, including Welsh speaking therapists.”We are also working hard to retain our valued staff with flexible working arrangements to support work-life balance and the introduction of wellbeing champions,” he said.’Vital for development’The Royal College of Speech and Language Therapists (RCSLT) said the pandemic created other problems for children, who missed out on day-to-day interaction with others during the initial lockdowns.Philippa Cotterill, of RCSLT Wales, said: “For a period of time, children were really disrupted in all the activities they do – going to school, seeing wider family, going to different places and doing different activities.”These are all things which are vital for children’s development, and children who have difficulties, those might be more complicated than previously.”More on this story’Children behind in speech and understanding’Call for wider kids’ speech supportShouting ‘helps people with Parkinson’s’

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesWe have the technology to start a new era in medicine by precisely matching drugs to people’s genetic code, a major report says.Some drugs are completely ineffective or become deadly because of subtle differences in how our bodies function.The British Pharmacological Society and the Royal College of Physicians say a genetic test can predict how well drugs work in your body. The tests could be available on the NHS next year.Your genetic code or DNA is an instruction manual for how your body operates. The field of matching drugs to your DNA is known as pharmacogenomics.It would have helped Jane Burns, from Liverpool, who lost two-thirds of her skin when she reacted badly to a new epilepsy drug.She was put on to carbamazepine when she was 19. Two weeks later, she developed a rash and her parents took her to A&E when she had a raging fever and began hallucinating. The skin damage started the next morning. Jane told the BBC: “I remember waking up and I was just covered in blisters, it was like something out of a horror film, it was like I’d been on fire.” Image source, Jane BurnsHer epilepsy medicine caused Stevens-Johnson syndrome, which affects the skin and is far more likely to happen in people who are born with specific mutations in their genetic code. Mrs Burns says she was “extremely, extremely lucky” and said she supports pharmacogenomic tests.”If it saves your life, then it’s a fantastic thing.”Nearly everyone is affectedJane’s experience may sound rare, but Prof Mark Caulfield, the president-elect of the British Pharmacological Society, said “99.5% of us have at least one change in our genome that, if we come across the wrong medicine, it will either not work or it will actually cause harm.”More than five million people in the UK get no pain relief from codeine. Their genetic code does not contain the instructions for making the enzyme that breaks codeine down into morphine and without it, the drug’s a dud.The genetic code of one in 500 people puts them at higher risk of losing their hearing if they take antibiotic gentamicinPharmacogenomics is already used for some medicines. In the past, 5-7% of people would have a bad reaction to the HIV drug abacavir and some died. Testing people’s DNA before prescribing the drug means the risk is now zero.Scientists have looked at the 100 most prescribed drugs in the UK. Their report says we already have the technology to roll out genetic testing to guide the use of 40 of them.The genetic analysis would cost about £100 and could be done using either a sample of blood or saliva.Initially, the vision is to perform the test when one of the 40 drugs is prescribed. In the long term, the ambition is to test well ahead of time – possibly at birth if genetic testing of newborns goes ahead, or as part of a routine check-up in your 50s. Precision”We need to move away from ‘one drug and one dose fits all’ to a more personalised approach, where patients are given the right drug at the right dose to improve the effectiveness and safety of medicines,” said Prof Sir Munir Pirmohamed, from the University of Liverpool.”What we’re doing is really going to a new era of medicine, because we’re all individuals and we all vary in the way we respond to drugs.” He said that as we age and are prescribed more and more drugs, there’s a 70% chance that by the age of 70 you will be on at least one drug that is influenced by your genetic make-up. Lord David Prior, the chairman of NHS England, said: “This will revolutionise medicine.”He said pharmacogenomics “is the future” and “it can now help us to deliver a new, modern personalised healthcare system fit for 2022”.Follow James on Twitter

Some migrants who refuse will be detained and placed in removal proceedings, according to directions given to homeland security officials.WASHINGTON — The Biden administration is requiring coronavirus vaccines for some undocumented migrants at the southwest border, a policy change that comes days before the administration’s next review of a public health order that has limited immigration during the pandemic.Under the plan, officials will start vaccinating undocumented migrants without proof of vaccination who are apprehended by border officials, but not expelled under the public health order, in seven areas including San Diego, El Paso and the Rio Grande Valley. A description of the plan was shared with The New York Times.According to directions given to senior homeland security officials on Sunday, if single adults refuse to be vaccinated, they will be detained and put into deportation proceedings. If they request asylum and cannot remain in detention, they will be released with a monitoring device “with stringent conditions.” If migrant families refuse vaccination, they will also be given monitoring devices with the same conditions.The White House has said little about whether it will soon lift the public health order, which the Trump administration put in place at the start of the pandemic. The order, known as Title 42, gives border officials the authority to turn back migrants seeking to enter the United States so that they do not spread the coronavirus here, a precaution that public health experts have called unnecessary.The Centers for Disease Control and Prevention is supposed to review whether the rule is still necessary at this stage in the pandemic, and issue a decision in the coming days.The administration’s decision to start vaccinating some undocumented migrants appears to be an acknowledgment that there are measures other than the public health order that can be taken to minimize the spread of the coronavirus across borders. A Department of Homeland Security spokesman said vaccinating immigrants in the department’s custody is a “public health best practice.” The spokesman did not explain why the department had waited so long to put that practice in place with regard to undocumented migrants, many of whom come from Central America. Planning for these vaccinations has been in the works. In November, the administration put out a request for a short-term contract to provide Covid-19 vaccinations at points along the southwest border.Previously, the administration has resisted vaccinating undocumented immigrants, despite multiple proposals from the Department of Homeland Security over the past year on how to do it. President Biden’s domestic policy adviser, Susan Rice, has privately raised concerns that it would provide an incentive for more undocumented migrants to try to cross the border, according to three current and former government officials with knowledge of the ongoing discussions, who spoke on condition of anonymity to discuss internal deliberations.Noah Gottschalk, the global policy lead at Oxfam America, said that argument makes little sense.“Based on our work in the regions and places that people are coming from, that would have absolutely nothing to do with people coming,” he said. “People have access to vaccines. They are coming because they’re fleeing persecution.”Inside the Homeland Security Department, officials have been planning for Title 42 to end in early April. They expect large crowds of migrants as a result, exceeding the already-high numbers that have been crossing without documentation in recent weeks.Since President Biden has been in office, there has been a significant spike in the number of migrants crossing the southwest border, many fleeing poverty and persecution. The administration has used the public health rule to expel migrants a little more than half of the time, allowing in others with humanitarian exemptions.Migrant children who arrive at the border without a parent or guardian have been exempted from the rule and allowed to enter. The administration has been offering vaccinations to eligible migrant children in government shelters for months; Immigration and Customs Enforcement has also been offering vaccinations to immigrants in detention. And the administration has been vaccinating asylum-seeking migrants who are waiting in Mexico until the United States makes a decision on their case.Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, said vaccinations should have been offered to all undocumented migrants apprehended on American soil.“There’s no actually valid argument to not vaccinate people at the border, especially when our vaccination rates are the lowest that they’ve been in the United States and we’re actually throwing vaccine in the trash,” Dr. Adalja said. “If they don’t do this, they would rather put vaccine in the trash can than put it into a migrant’s arm, is basically what that amounts to.”Critics of the order say it is being used to control the influx of undocumented migrants. The Biden administration, which has relied heavily on scientific evidence to justify many other health precautions during the pandemic, has not produced data that shows undocumented migrants play a significant role in spreading the coronavirus.In a ruling regarding the use of the policy, a panel of judges on the U.S. Court of Appeals for the District of Columbia Circuit noted the lack of data.“We are not cavalier about the risks of Covid-19. And we would be sensitive to declarations in the record by C.D.C. officials testifying to the efficacy” of the public health order, the panel wrote earlier this month. “But there are none.”They added: “From a public-health perspective, based on the limited record before us, it’s far from clear that the C.D.C.’s order serves any purpose.”The White House and Homeland Security Department have consistently said the public health order is issued at the sole discretion of the Centers for Disease Control and Prevention.“It is not a matter of immigration policy,” Alejandro N. Mayorkas, the Homeland Security secretary, said on March 17. The C.D.C. determines the order’s necessity, he said, “on a public health basis, depending on where we are in the arc of the Covid-19 pandemic.”Mr. Mayorkas pointed to the spread of variants in other countries. While Covid case numbers are falling in most of the United States, an Omicron subvariant, BA.2, is fueling an increase in cases in Europe and could cause another surge here, although it does not appear to be causing widespread severe illness.The administration has been fighting in court to keep the public health order in place for migrant families, even though many are already exempted from it. The same appeals panel that noted earlier this month that the C.D.C. had not presented any evidence justifying the order also ruled that the administration could not use it to expel families to countries where they would face persecution or torture.Lawyers were supposed to file a status update last week, but instead asked for an extension until after the C.D.C. decides whether to keep the rule in place.Zolan Kanno-Youngs

Is Covid Sparing Africans? The Mystery Matters.Stephanie Nolen 🇸🇱 Reporting from Sierra LeoneThen I learned that Sierra Leone — and other countries in the region — have had plenty of Covid exposure. A study of blood samples found 78 percent of people have Covid antibodies (although few are vaccinated). The World Health Organization says it’s at least 65 percent across Africa.But in many places (like here) there’s no testing, so no cases are counted. Maybe people are dying, but not counted?

New research from Mayo Clinic shows that lack of sufficient sleep combined with free access to food increases calorie consumption and consequently fat accumulation, especially unhealthy fat inside the belly.
Findings from a randomized controlled crossover study led by Naima Covassin, Ph.D., a cardiovascular medicine researcher at Mayo Clinic, show that lack of sufficient sleep led to a 9% increase in total abdominal fat area and an 11% increase in abdominal visceral fat, compared to control sleep. Visceral fat is deposited deep inside the abdomen around internal organs and is strongly linked to cardiac and metabolic diseases.
The findings are published in the Journal of the American College of Cardiology, and the study was funded by the National Heart, Lung and Blood Institute.
Lack of sufficient sleep is often a behavior choice, and this choice has become increasingly pervasive. More than one-third of adults in the U.S. routinely do not get enough sleep, in part due to shift work, and smart devices and social networks being used during traditional sleep times. Also, people tend to eat more during longer waking hours without increasing physical activity.
“Our findings show that shortened sleep, even in young, healthy and relatively lean subjects, is associated with an increase in calorie intake, a very small increase in weight, and a significant increase in fat accumulation inside the belly,” says Virend Somers, M.D., Ph.D., the Alice Sheets Marriott Professor of Cardiovascular Medicine, and principal investigator of the study.
“Normally, fat is preferentially deposited subcutaneously or under the skin. However, the inadequate sleep appears to redirect fat to the more dangerous visceral compartment. Importantly, although during recovery sleep there was a decrease in calorie intake and weight, visceral fat continued to increase. This suggests that inadequate sleep is a previously unrecognized trigger for visceral fat deposition, and that catch-up sleep, at least in the short term, does not reverse the visceral fat accumulation. In the long term, these findings implicate inadequate sleep as a contributor to the epidemics of obesity, cardiovascular and metabolic diseases,” says Dr. Somers.
The study cohort consisted of 12 healthy people who were not obese, each spending two 21-day sessions in the inpatient setting. Participants were randomly assigned to the control (normal sleep) group or restricted sleep group during one session and the opposite during the next session, after a three-month washout period. Each group had access to free choice of food throughout the study. Researchers monitored and measured energy intake; energy expenditure; body weight; body composition; fat distribution, including visceral fat or fat inside the belly; and circulating appetite biomarkers.
The first four days were an acclimation period. During this time, all participants were allowed nine hours in bed to sleep. For the following two weeks, the restricted sleep group was allowed four hours of sleep and the control group maintained with nine hours. This was followed by three days and nights of recovery with nine hours in bed for both groups.
The participants consumed more than 300 extra calories per day during sleep restriction, eating approximately 13% more protein and 17% more fat, compared to the acclimation stage. That increase in consumption was highest in the early days of sleep deprivation and then tapered off to starting levels during the recovery period. Energy expenditure stayed mostly the same throughout.
“The visceral fat accumulation was only detected by CT scan and would otherwise have been missed, especially since the increase in weight was quite modest — only about a pound,” Dr. Covassin says. “Measures of weight alone would be falsely reassuring in terms of the health consequences of inadequate sleep. Also concerning are the potential effects of repeated periods of inadequate sleep in terms of progressive and cumulative increases in visceral fat over several years.”
Dr. Somers says behavioral interventions, such as increased exercise and healthy food choices, need to be considered for people who cannot easily avoid sleep disruption, such as shift workers. More study is needed to determine how these findings in healthy young people relate to people at higher risk, such as those who are already obese, or have metabolic syndrome or diabetes.
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Materials provided by Mayo Clinic. Original written by Terri Malloy. Note: Content may be edited for style and length.