Nutritional Keys For Restful Nights

Introduction to Dr. Laurie Marbas 0:00

Hi, everyone. It's Dr. Wells from the Sleep Deep Summit. New approaches in treating sleep apnea and insomnia. I'm really excited to present our next guest. This is Dr. Laurie Marbas. She is a double boarded family medicine and lifestyle medicine physician who's been utilizing food as medicines since 2012. And she's also the host of the Dr. Laurie Marbas podcast, where her mission is to provide resources that are are going to empower you with the knowledge, mindset and inspiration to successfully adopt lifestyle interventions and achieve health and well-being.

And finally, she has The Healing Kitchen, which is an online place to get your questions answered. If you want to start getting healthy, starting with your food. Welcome, Dr. Marbas. Well, thank you. I'm excited to be here. Yeah, it's great to see you. And I love this topic about using food as medicine. It definitely pertains to sleep. So I wonder if you can educate the audience on how you think about food and sleep together. Yeah, absolutely. I think there's many things that affect sleep in chronic diseases.

One of them and when I say chronic disease, I mean a few different things like type two diabetes, hypertension,

Food as Medicine and Sleep Health 1:35

high cholesterol, obesity, all of these things that we're dealing with, which appears to be in a normal state here in the U.S. especially, can definitely have detrimental effects on us, even plus just our lifestyle in general. Right. We're not moving very sedentary. We stay up late. Sleep, I feel, is the first thing that gets slashed especially is coming from ourselves as physicians and being educated in our medical system. But when it comes to food, I think what's really important to understand that it not only just affects sleep, but it also helps your overall health in decreasing and potentially reversing.

Not always, but potentially reversing some of our most difficult and dreaded chronic diseases. And I think diabetes is definitely high in the list, but hypertension, heart disease, high cholesterol, sleep apnea that comes with being overweight. And when you also start eating these foods that are very nourishing, right? So we're getting our micronutrients, we're getting vitamins plated excuse me, phytochemicals, all these amazing things, fiber, all these wonderful things that not only reduce the current state of your chronic disease burden, but they decrease the future risk.

But they decrease a very important thing called inflammation. And when you look at inflammation, it's really kind of the root of so many chronic disease diagnoses. And I think when we look at, for example, heart disease and we can measure this, it's a little bit difficult. I mean, you can measure the what's called hsCRP, and this is typically found you worry about the heart arteries and the inflammation, but we put someone on a whole food plant based diet and they really adopt the ability to eat fruits, veggies, beans, whole grains, nuts and seeds, removing processed foods, removing animal products that contain cholesterol, that contain things that incite inflammation in the body.

You will see a dramatic shift in numbers, but also how they're feeling. One of the first things that people say is, well, I can't believe how better I feel. I have so much more energy. My joints don't hurt. I'm sleeping better, my mood is better. And I have some really fun stories about patients who had depression or anxiety or even schizophrenia, believe it or not, to find that it, the more that they're in line with eating a whole new plant based diet, the better they are in their mental health.

So there's just so many things that come along with really feeding your body really healthy, whole plant foods. You know, that's great information. And I think this term whole food plant based diet is kind of out there as a way to achieve better health. One of the questions that I get a lot from patients is, what do you mean by processed food? And I want to start by educating people one of the kind of shorthand ways that I think about it is look for fiber in food. If there's no fiber, if there's a great ingredients you can't pronounce, that's definitely a processed food.

And I'm curious to know what you would add. Yeah, I think we have to look at processed and in two different categories. I would say there's ultra processed and then there's processed because even beans in themselves being cooked is being processed. Right? So if we go from the oak groats to steel cut oats to, you know, rolled oats to more instant notes, that all that that is all being processed. Now, that's a better choice than eating, you know, the Jack in the Box hamburger in and out or eating fried potato chips and different things like that.

That would be more of the ultra processed foods. Those are the ones that have the chemical compounds in the back that you need an advanced chemical chemistry degree to actually read. So another kind of amazing rule of thumb that's kind of fun to think about is if your grandmother or great grandmother was to read this label, would she be able to recognize these food substances, food substances on the back of this label and if not, you might just want to put it back, you know, and of course, there's other things that they're adding in.

They're adding in added sugars that's going to be now on food labels. You can see that added sugar component. That's very sneaky. They put it in everything. Why do you have to put sugar in marinara sauce or ketchup or. You know, I'm just I'm astounded at where we can find sugar. Sugar, and then also added salt. And again, it's just it's amazing to me all these things that food companies, you know, there's a way we always hear about people talking about big pharma, but there's also the big food that have literally taken our ability or we've handed it over to them.

And so they just came in and took it. But we've handed over the cooking in our homes, right? So many of us go out to eat or we go through drive thrus and we have literally surrendered the ability to feed and heal our families and ourselves in our own kitchen. We have the tools there. It's really not that hard. The food is delicious. The other thing is that this ultra processed food actually hijacks our taste buds, right? So if you have a child, for example, and you start them off with French fries at the age of two or as soon as they can chew, they're getting that salt, probably sugar added in there somewhere.

What Counts as Processed Food 7:10

And now they don't understand that a strawberry should be considered sweet versus, let's say, ice cream. They don't understand that full plant foods or whole foods in general are meant to be what our bodies are craving and should be looking to be digesting. But when we feed our body Franken foods, we get an output that's very different than what people expect. And the other thing that I really like to highlight and it might irritate some people is that we've normalized the state of chronic disease in our country.

We have a sick care system. We don't have a health care system. We initially we always write drugs and prescriptions like my daughter is a physician now she's in her last year of family medicine residency. And nothing's really changed. I mean, we're trying to see the tide of using lifestyle medicine, it's called for and all the guidelines. But so many doctors, the first thing they look for because they're busy. There's a lot of stress, there's a lot of demands on physicians is to write another prescription.

And I'm not saying that prescriptions don't have their place. They absolutely do. And I'm so thankful that we live in a time in society that we can utilize both. And I certainly do utilize both on a regular basis. But it's so much more powerful to see someone actually heal when they actually take control of their life and have the self-efficacy to move forward and make decisions that really will not only affect their health and their lives, but the lives of their children, their family, their friends and neighbors.

That is just tremendous. But ultra processed food is what I'd probably say versus just process, because a lot of foods process in just cooking and of itself. Yeah, and I think what you're saying is a fair dose of common sense to just kind of thinking about, you know, I'm just considering my son's Halloween basket. You know, there's lots of blue things in there and that does not occur in nature. So, you know, I know immediately besides the fact that everything comes in a wrapper, you know, these are foods that are generally should be minimized in the diet or avoided, especially if you've got chronic disease states going along with that.

I want to tap into an area of your expertize. You are a high blood pressure or hypertension expert and high blood pressure and sleep kind of have a bi directional relationship. Can you describe that for us and how how foods may be used to treat high blood pressure? Yeah, I think it's first of all, it's very important to understand that you need to have your blood pressure controlled. I will never forget my my grandmother used to live with my husband and I many years ago, and I was in I think I was in residency.

And she's like, I've just checked your blood pressure. And what was funny was I was like, Well, Grams, your blood pressure is elevated as like, did you take your medicine this morning? You know, I quit taking it last week because my blood pressure got better. And I had the same experience with my granddad. Yeah. Exactly. So it's really important for everyone to understand we need to control our blood pressure and that needs to start with medications in the beginning. And I tell people this can be a bridge and if we incorporate certain lifestyle intervention, we may be able to get off one too, or all medications.

I have one patient that just started working with me that's on five blood pressure medications. And not only is that an amazing amount of medications, but what are the interactions here? So when you look at sleep and hypertension, there's several things going on because hypertension in and of itself is typically asymptomatic. It's not going to be unless you get an acute rise in blood pressure and get a headache or have some vision changes. You're not going to notice it until there's something. Somebody measures it or you're like, Oh, guess what?

You have chronic kidney disease, you have heart failure because of uncontrolled blood pressure, or you end up with a stroke or heart attack. So these are the type of things that we're trying to prevent by controlling the blood pressure, with medications, with lifestyle interventions. So and how that affects sleep, you know, a great one is sleep apnea, right? So if you have sleep at night, you're at higher risk for hypertension and medications can also interfere with sleep. So all this is encompassing.

There's a lot of nuances to it. But when you look at foods I really want to focus in on a couple of things. One is your decreasing inflammation. So inflammation can definitely disrupt sleep. It can also lead to, again, other disease states like diabetes and other things. So let's say that you have uncontrolled diabetes and now you're waking up to go to the urinate in the middle of the night because you've been prescribed medication that increases your urination of glucose. That's just, again, one of the potential side effects of medications or your blood sugar so high that you're urinating every few hours.

I, again, just recently had patients come in with blood sugars that topped out at 400. I put a continuous glucose, monitor them and they did not want to be on medications. We had a little talk that changed. But, you know, but now because she's actually embraced a lifestyle approach and medications, we are weaning down on medications and now she's seeing blood sugars,

Hypertension, Sleep, and Diet 12:40

nice in the range where she should be and she'll be off medications probably in the next month or two months. And so those are the things that can help. And she also really struggled to sleep. Now she's getting better sleep. When you have better sleep, you have less stress. Stress also helps less stress helps with lowering the blood pressure. So there's so many pieces to this. We could go in multiple rabbit holes. But getting back to your question around what foods, there are a couple of foods that have some real promise that I would encourage people to consume regularly, even if you don't have high blood pressure, they just are amazing foods.

And first of all, these are the nitrate rich foods. So that would be something like The Dark Green Weepies, you name them, there's spinach, there's beet greens, there's a rugal, a collard greens, Google a list of dark green leafy veggies in each your heart's content, whichever ones you like, try different ones. Something else is ground flaxseed. So ground flaxseed has been shown. If you're doing around two tablespoons of work, tablespoons that you can see quite a significant drop in blood pressure and it does not take much of a drop of blood pressure.

So to that top, remember that systolic number to see a dramatic decrease in risk of stroke and heart attack. So anything you can do that would be the first thing would be making sure the appropriate are controls and then adding in some foods, but also monitoring salt intake. So we want to keep our sodium to around 1500 milligrams or less per day. And that would include, you know, added salts. I mean, we're so used to eating out and eating again, processed foods that the sodium can creep in anywhere.

And you'll be amazed. People eat 2000, 4500. You know, people do chronometer, which is a way to measure the food that you're eating. And it'll tell you multiple things, not only your proteins and your fats and your carbohydrates, but it'll tell you other things like salt intake, your calcium intake, your iron intake. But that's really interesting to look at the sodium content and people are like, Wow, I didn't realize. And they were wondering why that they're feeling swollen because of water. The body's retaining fluid to balance out this high sodium intake, which raises blood pressure again, which makes you go to urinate in the bathroom in the middle of the night, which disrupts your sleep.

So again, there's several things there. So ground flaxseed, the dark green, leafy vegetables and biscuits, tea is really interesting. There's some really decent evidence there. So I would do one cup, which is eight ounces with one teabag and consume that with every meal three times a day would be fantastic. You'll see a nice little bit of a decline there, but these are all additive effects, right? You can also incorporate exercise, especially isometric type of exercises will actually have been shown to drop blood pressure better than aerobic exercise or just regular resistance training, which you should be doing all especially resistance training.

But the isometrics does remember those PE while squats that we have to do the wall squats. I remember that. Yeah. And it does suckers but they have an amazing way of decreasing your blood pressure. What it's doing is it's decreasing the bristle resistance, meaning your heart is pumping. Right. And so as it's pumping out the blood, there's resistance in the pipes or your arteries. And so when the isometric exercise occurs, it's relaxing those arteries and the blood's able to flow a little bit better.

So again, it's there's so many ways you could do this, but, you know, exercise and of course, sleep is very important for hypertension. And then I would just say, not only is we adding in these healthy whole plant foods, but we're moving some of those foods, especially the ultra processed foods. And I wouldn't say even, you know, the animal products, that's where I tend to lean. The more you are eating, the more of the plant foods, the better off you're going to be in that sense. I totally agree.

And, you know, it's interesting to think about high blood pressure and sleep because, you know, you mentioned somebody that you were treating who is on multiple blood pressure medications. And for cardiologists that are in the know, that is a red flag for an untreated sleep apnea condition. So I very commonly get referrals from cardiologists when the blood pressure cannot be managed to do as sleep study and see if there's a problem with sleep disordered breathing. And the risk runs both ways. You can have high blood pressure is actually a risk factor for obstructive sleep apnea and you lose the nocturnal dipping phenomenon.

So your your blood pressure doesn't dip during the night, as it should. When you talk about a whole food plant based diet, this is kind of an ideal that's very different from the standard American diet, which is very sad. And there's kind of a funny mnemonic there. How would you recommend people get started if they're used to buying processed foods and keeping them in the home? And, you know, the kids are kind of on board with these high, highly palatable foods, but foods that are low in nutrients.

Yeah, absolutely. And I think it really will depend on the person and their current social circumstances. And so if you live alone and you're the only one you're feeding, it's very simple, right? You can either go overnight. Some people just like rip the Band-Aid off. Let's just throw it all out and get started. Others like to take a general, an easier approach, especially when there are other people involved who may actually not necessarily agree with a whole plant based diet. I would say, first of all, look at your current menu, right?

So many of us eat the same foods regularly, even if it's takeout or something else. It's something you can prepare at home. So let's say that you might be eating breakfast, for example, already, that you like oatmeal or you like smoothies. You know, how can you add more of the fruits and vegetables? And, you know, can you move from a regular dairy milk to a nondairy milk? There's so many to choose from. I particularly care like soy. Soy has an amazing health benefits and it's I have no idea why it's been demonized other than people think that phytoestrogens cause they don't it actually works differently.

It competes with our own natural estrogens and it decreases risk for breast cancer, it helps bone health, it helps cholesterol. It's great protein and calcium source anyway. So it's a fantastic resource if you're looking to especially with children, there's a lot of there's healthy proteins and healthy fats and very important for brain growth and development. But you could switch out to a nondairy milk. You could do almond milk, you could do those again. There's lots of things to look on the label because many of those will have added oils or added sugars.

You'd be amazed. But try to eat one that just says soybeans or almonds in water. Another thing you to do is excuse me, look at some of the foods that you maybe have like meat or something in it, and you can replace it with something like illegal or a bean or a lentil. You know, the one thing that's really fascinating is beans are associated with longevity around the world. It's the one food that's the common denominator when you look at all the things called the blue zones. So there's five areas in the in the world, including one here in the United States, believe it or not, in Loma Linda, California, they're Seventh Day Adventists.

So their religion is all about healthy eating.

Starting a Whole-Food Plant-Based Diet 20:45

And so they exercise and they eat predominantly plant based diets and they have in blue zones the highest concentration of centurions, which means that the people who live to be 100, these aren't the people that we expect that are found in nursing homes and unable to care for themselves. They're living independently or with family, but they're still very active. You'll see the mountain gardens, they're walking, they're doing all sorts of things. There's a wonderful documentary series called Blue Zones by Dan Buettner on Netflix.

Actually right now, and I encourage everyone to watch it. It's just a fascinating watch, regardless if you want to embrace a plant based diet. But you'll see the habits that are evolved with these communities in these cultures that people embrace and they naturally live their environment actually makes the healthy choice, easy choice. And that includes eating a lot of plant foods. So whatever you can do in your environment to increase your plant consumption, I can show you here I have literally right here I have soup, potatoes, I have apples, bananas, tangerines, avocados, just in my view right here, kitchens over there was open up my refrigerator door.

There would be strawberries and blueberries and other things that I can easily grab if I want to snack. So those are things that if you put it in front of you, you're more likely to consume, including kids. You know, they see a piece of fruit that they can have ready access to like a banana, for example. They're more likely to consume it than if candy is there or, you know, some kind of potato chips hiding in the pantry. So moving things out of the environment so they're not the easy choice is really important.

When you look at behavioral models like the Fogg behavioral model, the one lever that's really important in behavior is making something harder and you're less likely to do it. So, for example, someone who wants to stop smoking, they don't keep a locally, they have to go drive to the store to pick up Cigarets or if you are having it's a little easier nowadays with the food and the apps and DoorDash, maybe you get rid of the Uber eats up in the DoorDash app and you make a commitment that you're not going to reinstall them, but instead you will have to go drive to get some of those skills that will give you time to be mindful of what you're doing, asking your questions.

Is this really something I want to do? And if you had these thoughts and just kind of having some time to reflect upon them and you still want to choose to consume a processed food, that's okay. Right. But at least you've made this a mindful process and not a mindless process. The other thing that I encourage people to do is looking at recipes beyond just maybe changing meat with beans and other things. Is going online if there's something that you're really enjoying. So I grew up in New Mexico.

I love Mexican food. I remember cooking enchiladas, I think even before I could see over the top, I think having my mom would help me do that. And by age eight, I was actually presenting enchiladas in the recipe, like literally the county fair. So I dig plant based eating, especially in the Mexican realm. So first things I did when I went to the plant based diet 12 years ago was how do I incorporate these delicious flavors that I love but in a healthier way? And the person who is just Google realizes Google plant based enchiladas.

Or you could Google plant based lasagna and you can plant base Ethiopian, plant based Lebanese. It doesn't matter. There's so many recipes. There's so many amazing people doing incredible things with food. I learned something every single day and then you just go through and you look at, okay, that one looks simple, especially if they have simple ingredients and it takes less than 30 minutes to cook. This is fantastic. Leftovers are also really good. You can take leftovers with you to work and those are just some of the beginning ideas for someone who wants to embrace a plant based diet.

Sometimes you can just start with breakfast for a week and then add lunch the next week and then dinner the next week and it's really important to have conversations and communication with those who live within your home, with you seeing the reasons why you value eating a healthier plant based diet or at least a plant predominant diet. And if you're on medications for hypertension or diabetes, it's very important that you speak to your provider or health care provider or physician to let them know that you don't have to tell them that you're eating a plebiscite.

Just say, I'm going to start eating better. I want to eat more fruits and vegetables. And I don't know if this will help my blood pressure or my diabetes, but I really appreciate, you know, keeping a close eye on me and then they can decrease medications as it becomes appropriate, because it's very quickly. I've stopped six units of insulin in 72 hours and someone who fully embraced a plant based diet, I blew my mind. That was the first time I truly recognized the power of the food. You know, what's on the end of your fork is just such a wonder tool that we all have available to us.

It's just a matter of a decision and a different choice. You know, I'm hearing a few things in what you're talking about. One is the mindfulness practice of not only what you're eating, but what you're buying. And, you know, kind of thinking about how that food serves you or works against your health goals. I think that's a great division step. Another thing that I'm hearing is planning ahead, you know, really kind of making these choices deliberately in a way where you have to sit down and kind of strategize and tell.

These are concepts that kind of fall back into your unconscious. It takes a little bit of work initially, but it's it's worthwhile. It's so beneficial. And for those who may be considering making some of these transitions that you're talking about, my question would be for something like hypertension or high blood pressure, how quickly would somebody see a result in their blood pressure once they've converted to a whole food plant based diet? Yeah, that's an amazing question and something that's very important.

And just as one to such a little bit on the obstacles in the planning piece, it's really important that you will find it with any endeavor in life, if you will plan for the obstacles, or at least think about what might inhibit you, or maybe learn from your past, what inhibited you in the past, and think about strategies and ways to go around those or change, you know, change the path that you're walking. You know, there's a great little poem called There's a Hole in My Sidewalk. I think if you're familiar with it, it's it's so basically it's it's like, I don't know, a page long.

It's not very long, but it starts with chapter one. There's a hole in my sidewalk. I walk down it down the sidewalk. I fell and I was so confused. I don't understand why, but it goes to like five chapters. How she kept walking down the same road or the sidewalk and falling in this hole. But at different times, having this realization that she was mindfully or not mindlessly walking down the street and falling in the hole, and by the fourth time, she's like, There's a hole in the sidewalk. She walked around it.

But then by the end she chose a different street. So it just really kind of leans back into understanding that we can learn from our past. There's no reason to feel shame or guilt about it, but learn from our past to make different choices in the future.

How Fast Blood Pressure Can Improve 28:35

We can't use yesterday's solutions for today's problems, you know, because they didn't work yesterday. The problems are still here. So let's look for different solutions. And that kind of gets back to me thinking about the hypertension and if you're using different solutions, something so powerful like lifestyle, medicine and interventions like a whole plant based diet and exercising and getting better sleep, it can happen very quickly. So let's say I have this patient, for example, who is on three, four, five different medications.

It's very important that they have a blood pressure cuff at home and that they're measuring blood pressure before they take medications. And an hour or so after they take medications. And the reason I say both is because before I want to see what their baseline is without all these medications. For example, if I have a patient saying, Hey, Dr. Marbas, my blood pressure is running in the one thirties, let's say, and they're taking four medications. Well, I'm a little bit worried they might bottom out if they take four medications.

Four, maybe we'll stop two and see what the blood pressure does that day. And an hour later, check it in the evening. You know, you want to sit quietly for 5 minutes, use a blood pressure cuff that will sit over the upper arm Omron is a great one. There's and get them like $35 off Amazon and you could check three different blood pressures and average those out and over. You know, give yourself a minute or two between each reading. And that would be a great indicator for you and your physician, your treating physician of what your blood pressure is doing as you're embracing healthier lifestyle options.

And what I tell patients, if you start having symptoms of low blood pressure, which is dizziness upon standing, or let's say that you were feeling really good, you had great energy, and suddenly you're fatigued, you're really tired, like you stand up is not necessarily dizzy, but man, I'm just wiped out. Need to take a nap. Blood pressure might be a little bit low. And it's really interesting. When you eat a plant based diet, you will see heart rate actually start to climb. So heart rate, there are medications, for example, like beta blockers that control the output of the heart by decreasing the beats and the and the number of beats per minute.

Now, some of these medications are required. If you have some type of arrhythmia or you have certain things like atrial fibrillation, those are medications you might need to be on or stay on, but just maybe at a lower dose. So again, it may not be even just stopping because you don't just abruptly stop these on your own. There could be some serious side effects to that. If you're on the diuretic and have heart failure, you want to be very, very mindful and speak to your physician and get their guidance.

But if you're symptomatic, that's a phone call that needs to be dealt with that same day. But if you're starting to see blood pressure and you're not symptomatic trend under 120 on a consistent basis, that's also, I think, in a place where we're ready to pull back on medications because it won't take long before you're starting to shrink even further. So if you start hitting like 120 on top of that systolic blood pressure, I say 4 to 5 days of the week. I think it's probably time to talk to your doctor about decrease in or at least or maybe even consider stopping it.

You're on the lowest dose of medication already. So I'm hearing this can happen pretty quickly to stay on top of your symptoms, you know. Two weeks. Two months. So it's yeah, yeah. And I want to put a plug in for measuring your blood pressure at the same time each day because blood pressure has a circadian rhythm. And it's important to compare that

Where to Learn More and Work With Dr. Marbas 32:15

same time from day to day today. So fantastic information, really actionable steps there. And I really want to thank you for kind of putting out the benefits of the whole food plant based diet, which is going to reduce your inflammation, help your blood pressure, stay lower and more steady and improve sleep, of course, because what you put in is has a relationship with what you put out. And, you know, the the whole idea of how you feel the next day is something that I see all the time. If you are still tired, look at your food.

Look at your food with a discerning eye and decide if you want to make some change. Dr. Marbas, it's been fantastic to speak with you. Can you let us know where to go to find out more information or even work with you? Sure. Absolutely. I am locations in all 50 states and including D.C. So I put you on medical licenses and so I can take care of patients via telemedicine and you can go to Dr. Marbas, (drmarbas.com) that's D R M A R B A S.com and it will describe everything that we do. I have The Healing Kitchen, which provides weekly live chats with myself and someone who provides recipes, names Brittany, Judy.

She lost 70 pounds on a plant based diet. She's only 4'11, so had significant changes. She had sleep apnea, by the way. She had hypertension. She had high cholesterol, and she was young, 23. And that was eight or nine years ago. Now they're expecting their first baby. She's healthy. And so Brittany provides recipes. I provide the medical knowledge and answering questions. We do expert workshops every month, and we're also doing some other fun stuff that's coming in. But I'm also happy to help take care patients independently as well.

Fantastic. Thank you so much. It was a pleasure. Thank you. I thank you for having me. It was it was lovely.