In Blog, Diet, Exercise, Health Professionals, multiple sclerosis, Research, Wahls Research

Crucial ZZZs: How Quality Sleep Nourishes the Autoimmune System

Diet and Sleep Quality

How is your sleep? Ever since I was a teenager I have struggled with sleep. During college, medical school, and residency, I thought that sleeping 4-6 hours a night was an advantage. I had a lot of studying to do so I thought it was helpful to not sleep so much. Now I know better. Sleep is important for our mental health and our brain health. I will give a few tips for improving sleep and a link about a research study later in the article.

The majority of patients with multiple sclerosis (MS), over 70%, have sleep problems! 1,2 People with MS are more likely to have restless leg syndrome (the urge to move their legs at night while trying to sleep), disorders of REM (dream) sleep, painful muscle spasms at night, and obstructive sleep apnea. In addition, people with MS may have difficulty falling asleep, staying asleep, or awakening too early.

What sleep problems do you have? What have you tried to improve your sleep? Many MS patients take melatonin to help improve their sleep. I have found it be helpful and have taken it for years. Melatonin is a hormone made by the pituitary gland that increases during periods of darkness and is associated with sleep. Notably, melatonin levels are low in people with MS and other neurological disorders. 3,4 Melatonin, in addition to supporting the initiation and maintenance of sleep, has anti-oxidant and anti-inflammation properties. 3,4

Melatonin to support sleep

To support better production of melatonin at night, I encourage my patients to go outside and look at the clouds and sky to increase daylight exposure to the retina early in the morning. 5 I also encourage sleeping in darkness or with a sleep mask at night. 5 If my patients are still having problems falling asleep, I have them add supplemental melatonin one to two hours before they want to fall asleep.

Diet changes to support sleep

What we eat and drink also influences sleep. Alcohol consumed before bedtime reduces sleep quality and sleep quantity. 6,7 That matches my observation as well. I found that drinking a glass of wine with my evening meal negatively impacted my sleep. Eliminating it from evening meals improved my sleep. Eating too close to bedtime also negatively impacts sleep. 8 I recommend having two hours between your last meal and going to bed. Consuming a high protein meal that is low in added sugars will also improve sleep quality. 9 There is a strong relationship between glucose metabolism, insulin resistance, and elevated blood sugars and poor sleep. 10 Ketogenic diets improve slow wave sleep and improve glucose metabolism. 11,12 Ketogenic diets improve insulin sensitivity and glucose control and have been associated with better mood and higher quality of life in MS patients. 12-15 The Paleolithic diet has also been associated with better insulin sensitivity and glucose control, better mood, and higher quality of life in MS patients. 14,16-19 For those reasons, I advise my patients with sleep issues to adopt either a ketogenic or modified Paleolithic diet to improve their sleep and improve their quality of life.

Participate in a diet study comparing modified Paleolithic and ketogenic diets

We are activity recruiting for a clinical trial, “Efficacy of Diet on Quality of Life for Individuals Diagnosed with Relapsing-Remitting Multiple Sclerosis” MS. We are comparing a time-restricted olive oil-based ketogenic diet and a modified Paleolithic diet to the usual diet. We are looking for people aged 18-70 who are willing to be randomized to one of the three diets. They must come to Iowa at months 0, 3, and 24. Learn more about the study here. This page includes a link to a survey to determine if you are eligible for this study.

Learn about future studies

You can also be added to our database to learn about other studies in the future here. We periodically conduct survey-only based studies that people can participate in from anywhere in the world. We also periodically include other disease states in our studies.

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  2. Bhattarai JJ, Patel KS, Dunn KM, Brown A, Opelt B, Hughes AJ. Sleep disturbance and fatigue in multiple sclerosis: A systematic review and meta-analysis. Mult Scler J Exp Transl Clin. Jul-Sep 2023;9(3):20552173231194352. doi:10.1177/20552173231194352
  3. Sanchez-Barcelo EJ, Rueda N, Mediavilla MD, Martinez-Cue C, Reiter RJ. Clinical Uses of Melatonin in Neurological Diseases and Mental and Behavioural Disorders. Curr Med Chem. Nov 20 2017;24(35):3851-3878. doi:10.2174/0929867324666170718105557
  4. Skarlis C, Anagnostouli M. The role of melatonin in Multiple Sclerosis. Neurol Sci. Apr 2020;41(4):769-781. doi:10.1007/s10072-019-04137-2
  5. Brown TM, Brainard GC, Cajochen C, et al. Recommendations for daytime, evening, and nighttime indoor light exposure to best support physiology, sleep, and wakefulness in healthy adults. PLoS Biol. Mar 2022;20(3):e3001571. doi:10.1371/journal.pbio.3001571
  6. Ayre E, Scholey A, White D, et al. The Relationship between Alcohol Hangover Severity, Sleep and Cognitive Performance; a Naturalistic Study. J Clin Med. Dec 3 2021;10(23)doi:10.3390/jcm10235691
  7. Sharma R, Parikh M, Mishra V, Zuniga A, Sahota P, Thakkar M. Sleep, sleep homeostasis and arousal disturbances in alcoholism. Brain Res Bull. May 2022;182:30-43. doi:10.1016/j.brainresbull.2022.01.022
  8. Smith HA, Betts JA. Nutrient timing and metabolic regulation. J Physiol. Mar 2022;600(6):1299-1312. doi:10.1113/JP280756
  9. Pattnaik H, Mir M, Boike S, Kashyap R, Khan SA, Surani S. Nutritional Elements in Sleep. Cureus. Dec 2022;14(12):e32803. doi:10.7759/cureus.32803
  10. St-Onge MP, Cherta-Murillo A, Darimont C, Mantantzis K, Martin FP, Owen L. The interrelationship between sleep, diet, and glucose metabolism. Sleep Med Rev. Jun 2023;69:101788. doi:10.1016/j.smrv.2023.101788
  11. Jain SV, Glauser TA. Effects of epilepsy treatments on sleep architecture and daytime sleepiness: an evidence-based review of objective sleep metrics. Epilepsia. Jan 2014;55(1):26-37. doi:10.1111/epi.12478
  12. Merlino G, Garbo R, Dal Bello S, et al. Ketogenic diet may improve sleep quality and daytime somnolence in patients affected by multiple sclerosis. Results of an exploratory study. Sleep Med. Dec 2023;112:181-187. doi:10.1016/j.sleep.2023.10.016
  13. Brenton JN, Banwell B, Bergqvist AGC, et al. Pilot study of a ketogenic diet in relapsing-remitting MS. Neurol Neuroimmunol Neuroinflamm. Jul 2019;6(4):e565. doi:10.1212/NXI.0000000000000565
  14. Lee JE, Titcomb TJ, Bisht B, Rubenstein LM, Louison R, Wahls TL. A Modified MCT-Based Ketogenic Diet Increases Plasma beta-Hydroxybutyrate but Has Less Effect on Fatigue and Quality of Life in People with Multiple Sclerosis Compared to a Modified Paleolithic Diet: A Waitlist-Controlled, Randomized Pilot Study. Journal of the American College of Nutrition. Jan 2021;40(1):13-25. doi:10.1080/07315724.2020.1734988
  15. Brockhoff JD, Bereswill S, Heimesaat MM. The impact of ketogenic diet on the onset and progression of multiple sclerosis. Eur J Microbiol Immunol (Bp). Oct 13 2023;13(2):29-36. doi:10.1556/1886.2023.00020
  16. Irish AK, Erickson CM, Wahls TL, Snetselaar LG, Darling WG. Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2017;7:1-18. doi:10.2147/DNND.S116949
  17. Wahls TL, Titcomb TJ, Bisht B, et al. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin. Jul-Sep 2021;7(3):20552173211035399. doi:10.1177/20552173211035399
  18. Villa AT, Tu BH, Titcomb TJ, et al. Association between improved metabolic risk factors and perceived fatigue during dietary intervention trial in relapsing-remitting multiple sclerosis: A secondary analysis of the WAVES trial. Front Neurol. 2022;13:1022728. doi:10.3389/fneur.2022.1022728
  19. Shemirani F, Titcomb TJ, Saxby SM, et al. Association of serum homocysteine, folate, and vitamin B(12) and mood following the Swank and Wahls elimination dietary interventions in relapsing-remitting multiple sclerosis: Secondary analysis of the WAVES trial. Mult Scler Relat Disord. Jul 2023;75:104743. doi:10.1016/j.msard.2023.104743
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