It's not uncommon for individuals to report sleep disturbances when initiating a ketogenic diet. This article delves into the intricate relationship between the ketogenic diet and sleep quality, drawing upon scientific studies and expert opinions to provide a comprehensive understanding of the topic.
Introduction to the Ketogenic Diet
The ketogenic diet, often referred to as the "keto" diet, is characterized by a significant reduction in carbohydrate intake coupled with a substantial increase in fat consumption. This dietary shift aims to induce a metabolic state known as ketosis, where the body primarily utilizes fat for energy instead of carbohydrates. When the body has fewer carbs to convert to energy, it breaks down fat into ketones.
The Conflicting Evidence: High-Fat Diets and Sleep
Research on high-fat diets and their impact on sleep yields mixed results. Some studies suggest that consuming abundant fats may improve sleep quality, while others indicate that high-fat diets are linked to more disruptive sleep patterns and difficulties falling asleep.
Emerging Research: Ketogenic Diets and Sleep Benefits
Despite the conflicting evidence surrounding high-fat diets in general, a growing body of research specifically explores the effects of ketogenic diets on sleep. These studies suggest that this very low-carb, high-fat diet may offer benefits for sleep, potentially through weight loss and other mechanisms.
A recent study on the effects of keto found that adhering to this eating plan helped reduce daytime sleepiness in a group of obese patients. Previous studies have found similar results, along with increases to REM sleep. Other research has shown ketogenic diets increase REM sleep and sleep quality in a group of children with epilepsy.
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The Role of Adenosine: A Key Brain Chemical
Emerging research indicates that ketogenic diets may influence a crucial brain chemical involved in sleep regulation: adenosine. Adenosine accumulates in the body throughout the day, contributing to feelings of reduced alertness and wakefulness, ultimately promoting deeper slow-wave sleep at night. Caffeine's ability to block the effects of adenosine is one important way it delivers us that stimulating, alertness-producing mental boost.
Further research is needed to fully elucidate the relationship between ketogenic diets, adenosine, and sleep.
The Impact of Carbohydrate Restriction
The shift away from carbohydrates and toward protein may explain these sleep issues. Carbohydrates increase levels of the amino acid tryptophan in the brain, which helps facilitate sleep when it converts to serotonin. Serotonin is necessary for the body to produce the sleep hormone melatonin. Protein, on the other hand, increases levels of tyrosine, an amino acid that triggers the production of stimulating, alerting brain chemicals, including epinephrine and norepinephrine.
The Importance of Carbohydrate Quality
When it comes to carbohydrate intake, quality matters. Diets that derive their carbohydrates from healthy, fiber-rich whole foods-as opposed to sugars and processed starches-are associated with better sleep. The Mediterranean diet, which emphasizes whole foods, lean proteins, fresh vegetables and fruits, a moderate amount of grain-while minimizing sugars-is linked to improvements in insomnia and other sleep problems.
The Double-Edged Sword of High-Protein Diets
High protein diets have also shown both benefits and drawbacks for sleep. Some studies show consuming greater amounts of protein is linked to longer sleep times, more consistent sleep patterns, and higher sleep quality. Other research suggests higher protein intake is linked to shorter sleep amounts.
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The Overlooked Manifestation of Glucose Transporter Type-1 Deficiency Syndrome
Sleep disorder is an overlooked manifestation of glucose transporter Type‐1 deficiency syndrome.
The Impact of Weight Loss on Sleep
Losing weight will help you sleep better. A diet that helps you get safely to a healthy weight and stay there will benefit your sleep. Your risks for obstructive sleep apnea and other sleep disorders will go down. You’ll sleep more comfortably, and wake with more energy for the day. But keep this in mind also: losing weight at the expense of a sound, consistent sleep routine is not a smart strategy.
Dietary Changes and Sleep Alterations
Any dietary change can alter your sleep. Our eating and sleeping lives are deeply connected. What and when we eat affects our circadian rhythms, our gut health, our energy levels, and the hormones and biochemicals that stimulate and sedate us. If you’re starting on a new diet, be aware your sleep may change at first. Be prepared to pay extra attention to how you’re sleeping.
Ketogenic Diet and Sleep in Women with Overweight/Obesity
A study was conducted to investigate the short-term effect of VLCKD on sleep quality in women with overweight/obesity and if any changes, to identify the predictive factors that through VLCKD modified sleep quality. Based on animal evidence, it was hypothesized that VLCKD could play a role in improving sleep quality in subjects with overweight/obesity.
Methods
The study design was an uncontrolled, single-center, open-label pilot clinical study. Participants were recruited from the Obesity Unit at the University “Federico II” of Naples between May 2021 and November 2022. The study involved two visits: one at the beginning and another after 31 days of following a VLCKD. The study received approval from the Federico II Ethical Committee (file no. 50/20) and was conducted according to the World Medical Association’s Code of Ethics (Declaration of Helsinki) for human studies. All women were informed about the study’s objectives and design and provided their informed consent.
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The study retrospectively focused on data from only Caucasian women with overweight/obesity who wanted to lose weight but had previously failed at dieting. Comprehensive medical information was collected from all participants, and their physical activity levels at baseline were evaluated. Individuals eligible for this study satisfied the following criteria: women aged 18-69 years, body mass index (BMI) 25.0-50.9 kg/m2.
Women who met the requirements to participate in the study were put on a VLCKD with the use of replacement meal and which involved three stages: active, re-education, and maintenance. The VLCKD was based on a commercial weight-loss program (New Penta, Cuneo, Italy), which restricted total daily energy intake to less than 800 kcal and consisted of 13% carbohydrates (< 30 g/day), 43% protein (1.2-1.5 g/kg ideal body weight), and 44% lipids (mostly from extra-virgin olive oil).
The quality of sleep was evaluated using the validated questionnaire Pittsburgh Sleep Quality Index (PSQI). This questionnaire consists of seven sessions, including as subjective sleep quality, habitual sleep efficiency, sleep medication use, sleep duration, sleep latency, sleep disturbances, and daytime dysfunction. Each of these seven components is given equal weight and is rated on a scale of zero to three, with three indicating the most negative response on the Likert Scale. The PSQI score is a global score ranging from zero to 21, and poor sleep quality was defined as a PSQI score of 5 or greater, while good sleep quality was defined as a PSQI score of less than 5.
Results
Three hundred and twenty-four women with overweight or obesity who met the necessary criteria were included for statistical analysis. In addition to the expected general improvement of anthropometric parameters and body composition, VLCKD improved significantly SQ, as demonstrated by the improvement of all parameters included in the PSQI questionnaire (p < 0.001). Both at baseline and after 31 days of active stage of VLCKD, the PSQI score was significantly associated with BMI, waist circumference, fat mass, fat free mass (p < 0.001 for all) and hs-CRP (p = 0.023). PhA was negatively associated with PSQI score only at baseline (p < 0.001). ∆% PSQI positively correlated with ∆% BMI, ∆% fat mass, ∆% hs-CRP (p < 0.001 for all) and negatively correlated with ∆% fat free mass (p < 0.001), and ∆% PhA (p = 0.031). In the multiple regression analysis ∆% fat mass represented the only predictor of changes in SQ after VLCKD.
Conclusion
The study on the ketogenic diet and sleep drew on previous research that suggested that being on a very low-calorie ketogenic diet can effectively manage obesity. Findings from the study show that adopting a very low-calorie keto diet did lead to better slumber for participants in the study.
Keto Insomnia: Addressing Sleep Disturbances
Keto insomnia refers to sleep disturbances that some people experience when adopting the keto diet. Not everyone on the keto diet will experience insomnia. Struggling to Stay Awake? Managing keto insomnia involves adopting strategies to ease the transition and support good sleep hygiene. Gradual changes to the diet, adequate hydration, and incorporating sleep-friendly practices are among the best approaches to mitigate the potential impacts of the keto diet on sleep.
Precautions and Potential Risks
While the keto diet may work for some, it’s essential to understand its associated risks. In the short term, some people experience the “keto flu,” including headaches, fatigue, and stomach discomfort. Those with certain health conditions should be especially careful: the keto diet is not safe for people with pancreatic diseases, liver conditions, thyroid problems, gallbladder disease, or those who have had their gallbladders removed. It is also not recommended for pregnant people or those with a history of eating disorders. If you’re considering starting the keto diet, it’s critical to consult your doctor first. Although the diet may promote weight loss and other benefits, it may not be safe for everyone.
The Broader Perspective: Diet and Sleep
Some prior research has examined how diet and nutrition can directly affect sleep. Could diet be the answer to your sleep woes?
Ketogenic Dietary Therapies and Sleep: A Scoping Review
Sleep problems are common in neurological conditions for which ketogenic dietary therapies (KDTs) are recognised as an effective intervention (drug-resistant epilepsy, autism spectrum disorder, and migraine). Given the composite framework of action of ketogenic dietary therapies, the prevalence of sleep disturbance, and the importance of sleep regulation, the present scoping review aimed at identifying and mapping available evidence of the effects of ketogenic dietary therapies on sleep.
Methods
A comprehensive web-based literature search was performed retrieving publications published to June 2023 using PubMed and Scopus, yielding to 277 records. Twenty papers were finally selected and included in the review. Data were abstracted by independent coders.
Results
High variability was identified in study design and sleep outcome evaluation among the selected studies. Several changes in sleep quality and sleep structure under ketogenic dietary therapies were found, namely an improvement of overall sleep quality, improvement in the difficulty falling asleep and nighttime awakenings, improvement in daytime sleepiness and an increase of REM sleep.