Sleeping Teens

StickyTeens

Not so long ago, while preparing to give a talk to family doctors, it dawned on me that wellness is a bit like the four wheels of a car. One can argue which wheel matters the most, but they all matter and are closely interconnected.

The four wheels are: how we eat; how we move; how we relax and how we think. Our positive of negative attitude has a huge impact on our wellness and in an era of much more stress, minimal mental resilience in teens is the cause of terrible suffering.

It comes as no surprise that stressed teens, who are too tired to exercise, too addicted to screens, and too busy to sleep, often have very little resources left to function in top gear.

They are also easily attracted to fake food late at night (Buy a burger at a famous drive through outlet, leave it sitting for a year and see how pristine it looks—it seems to me we are facing not just fake news, but also fake food in increasing measures)

Most of us know that to say children are not little adults is like saying the sun rises in the east. They are in fact unique and their needs are different.

According to Dr. Charles Samuels, an internationally recognized expert in sleep disorders, a past president of the Canadian Sleep Society, and the director for Calgary’s Centre for Sleep and Human Performance (CSHP), Canadian children and youth miss the mark when it comes to maintaining a consistent sleep routine.

During a recent interview with this well-respected expert, he underscored that poor quality sleep and not getting enough sleep can put a child at risk for health issues such as obesity, mood disorders, chronic fatigue, irritability and impaired attention.

Adolescents require stable sleep routines. Between the ages 14-17 years, 10 hours of sleep is ideal.

I have coined two terms for problems in teens not getting enough sleep: The Harvard Factor and the Hollywood Factor (The Harvard Factor refers to teens staying up late to study hard so they can get accepted into top universities; the Hollywood Factor—far more common because its way more fun–is the typical teen who tells us there is a huge need to take the latest model of a smart phone to their rooms, because they need it as an alarm clock. Of course parents find it alarming when they discover the teen texting at two in the morning—wide awake)

We are indeed talking about behaviors where teens shoot themselves in the foot by skimping on proper sleep.

Dr. Samuels and the CSHP are about to change that by providing something new to Albertans—easy access to a trained behavioral sleep medicine specialist. To facilitate collaboration between doctors, a primary care doctor can refer, but it is not a requirement to be seen at the CSHP. Self-referrals will be accepted. The cost is covered by government-run funding (Alberta Health).

The program is based on cognitive behavioral methods that have been developed and used in other parts of Canada (Toronto Sick Kids Hospital and Dalhousie)

Dr. Katherine Rasmussen, ND, B.Ed, BA and an expert in CBT working at the CSHP says: “ The demand from a younger population continues to increase for our program.” The CBT program includes stimulus control therapy which reduces anxiety and conditioned arousal behavior at bedtime; it reduces the amount of time spent in bed while improving the quality of sleep; it improves sleep hygiene, pre sleep routines, teaches the importance of minimizing light exposure; helps with getting better at meditation, deep breathing exercises and muscle relaxation and perhaps, most importantly, teaches teens to cope with cognitive distortions (inaccurate thoughts) It is especially useful when depression or stress cause insomnia.

Dr. Samuels correctly states that treating sleep problems in children with medication should be a definite last resort and be done only under close supervision by a physician.

In 32 years of being a pediatrician I can count the times I prescribed medication for sleep almost on one hand. But sadly, teens self-medicate with a product which is easily available, supposedly used by many teens, which is perfectly safe— because its natural —and most importantly, it is legal: marijuana.

This natural “safe” chemical interferes with the quality of sleep in that it interrupts various sleep stages. Eight hours of sleep with the “help” of marijuana and 8 hrs without it is vastly different.

Better Nights Better Days is a Canadian project funded by CIHR and doctors from Toronto and Dalhousie. When visiting http://betternightsbetterdays.ca one will also access You Tube Videos explain the problem and its solutions in much more detail.

A Sport Canada initiative to help young athletes sleep well worth knowing about can be found by visiting www.sportlife.ca/wp-content/uploads/2016/11/Sleep-Recovery-Jan2013-EN.pdf

DR NIEMAN IS A COMMUNITY-BASED PEDIATICIAN WITH 32 YEARS OF EXPERIENCE. FOR MORE ON PEDIATRIC HOLISTIC WELLNESS, SEE WWW.DRNIEMAN.COM

Prebiotics are like dogs

Probiotics

Not so long ago I read a story about a man who spent all his energy to climb up a ladder. It was a long and difficult ladder to climb, but he gave it his best efforts and finally made it to the top…only to discover it was leaning against the wrong wall.

This story illustrates the truth about probiotics. Many parents have been told to give probiotic drops to restore the good bacteria in the large bowel. But does it lead us up the right wall?

We now know that the gut microbiome has changed quite a bit over the past 50 years. In the old days, antibiotics were not as strong, there were fewer classes of antibiotics available, people were consuming real food, high in fiber, caesarean sections were not performed as often as they are today, and the stool pH was lower then, than it is now.

A higher stool pH provides less protection against certain pathogens. It has also been associated with a higher incidence of diaper dermatitis.

Not all probiotics pass the test of time like B. Infantis. I have learned that to say “probiotic” is like saying “dog.” There are many different species and sizes all with different functions and at times vastly different—like the difference between a Great Dane and a Chiwawa.

Researchers from the University of California at Davis studied the impact of a specific probiotic known as Bifidobacterium infantis ( B. infantis) on the gut microbiome and found that if it is given to babies regularly for the first 100 days of life there are many benefits: the stool pH is lower and resembles the pH of healthier fecies in the past; babies were less gassy and slept better, and the babies were at a lower risk for the development of asthma and allergic dermatitis later in life.

The large bowel is covered by mucus. This is known as the mucin layer. In the old days terms such as “leaky gut” brought tears of frustration to the eyes of some traditional allopathic clinicians. Know they know better. It is indeed possible for the integrity of the mucin layer to be improved and thus provide better protection against bacteria and other toxins which may enter the body via the gut. Research confirmed that babies exposed to B. infantis have a stronger mucin layer.

Birth via Caesarian section deprives the baby from getting colonized and swallowing healthy bacteria when passing through the birth canal. Because it is not always clear in advance when a mom will need a Caesarian section, some researchers thought it may help to provide the mom prior to delivery with probiotics, hoping the benefits can be passed on the baby. So far it does not seem to be a good idea.

Though breast feeding is a good idea there is a difference between a baby consuming mom’s milk from the breast and expressed milk from the same breast. The areola area specifically—and not just the nipple—provides additional exposure to ideal bacteria. B. infantis is found in great numbers in breast milk. It is very difficult to provide a similar situation by giving a formula.

Although the research on B infantis specifically looks promising, is there a certain link between a bowel colonized with healthy bacteria and a lower risk of allergies and inflammatory conditions later in life? Perhaps is it more like three minutes with a 1000-piece jig saw puzzle– the final picture is far from certain.

Some medical schools are moving gradually in the right direction in terms of educating future doctors about the good gut. At Stanford, authors Justin and Erica Sonnenburg, both PhD experts in gut health, and internationally respected for their research, wrote a book with the title “The Good Gut” In the foreword Dr. Andrew Weil states “I consider this work essential reading for all health professionals and for everyone interested in a broader understanding of health and wellness”

Because this field is constantly shifting and as new information unfolds at a dizzying speed, the Sonnenburgs provide very useful and comprehensive updates via their website (http://sonnenburglab.stanford.edu/

Many patients tell me they are too busy to sit down with a book or by a computer—they like to learn on the fly and find podcasts more user-friendly. The Exam Room podcast on May 15 is a recent resource I have found very helpful. This podcast specifically focused on how dysbiosis (unhealthy gut bacteria) predispose humans to weight gain.

In a complex world I am increasingly interested in simplicity and common sense. In the context of a healthy gut—for children and adults—I advise more fiber and thus more raw fruits and vegetable which have been shown to improve the production of healthy gut bacteria.

The recent enthusiasm for kombucha consumption requires much more research, before we can be 100% certain of its true usefulness. Meanwhile, enjoy its refreshing taste after a long workout