Sunday, September 24, 2023

CONCLUSIVE EVIDENCE REGARDING MASKS: Protection or not???

 

Do Masks Protect You? Here's the Conclusive Evidence

Analysis by Dr. Joseph Mercola 
September 22, 2023

The Cochrane Library - the gold-standard independent research organization - has been reviewing the use of physical interventions to reduce respiratory illnesses like COVID and influenza since 2010. Here's what their 2023 updated report has to say about medical and surgical masks.

STORY AT-A-GLANCE

  • Dr. Anthony Fauci is making the media rounds again, saying he hopes people will comply if mask recommendations return
  • In January 2021, the U.S. Centers for Disease Control and Prevention ordered the wearing of masks on public transportation. A court order issued in mid-April 2022 ultimately blocked enforcement of the order. So, it has now been legally clarified that the CDC cannot mandate anything. They can only make recommendations, which Fauci also recently confirmed
  • The 2023 Cochrane review of “Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses” found masking had no effect on confirmed infection rates. The review also found no difference between medical/surgical masks and N95/P2 respirators
  • Fauci is still doubling down on masking, saying masks work “on an individual level” even though randomized controlled trials show it makes no difference on the population level
  • If mask recommendations are renewed this fall, do not comply


From the start of the COVID-19 pandemic, health experts have been unable to unify around a cohesive message about face masks. A virtuoso of contradiction, Dr. Anthony Fauci — then-director of the National Institute of Allergy and Infectious Diseases (NIAID) and a prominent face of the White House COVID-19 response team — publicly flip-flopped on the usefulness and need for masks multiple times.

The First Recommendation Was the Correct One

In January 2020, he said "Americans shouldn’t be wearing masks because they don’t work." This stance was reiterated in March 2020, when he stated1 that "people should not be walking around with masks" because "it’s not providing the perfect protection that people think that it is."

At the time, the U.S. Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services agreed, as did Dr. Amesh Adalja, a Johns Hopkins Public Health expert,2 and Surgeon General Jerome Adams, who took to Twitter urging Americans to stop buying masks, saying they are "NOT effective,"3 and that if worn or handled improperly, face masks might actually increase your risk of infection.4

Logically, only symptomatic individuals and health care workers were urged to wear them. However, by June 2020, universal mask mandates had become the norm and we were told we had to wear them because there may be "asymptomatic super-spreaders" among us — another lie.

By July 2020, Fauci claimed his initial dismissal of face masks had been in error and that he’d downplayed their importance simply to ensure there would be a sufficient supply for health care workers, who need them most.5

Triple Masking and Other IQ Tests

Fast-forward a few weeks, and by the end of July 2020, Fauci went to the next extreme, flouting the recommendation to wear goggles and full face shields in addition to a mask, ostensibly because the mucous membranes of your eyes could potentially serve as entryways for viruses as well.6

This, even though a March 31, 2020, report7 in JAMA Ophthalmology found SARS-CoV-2-positive conjunctival specimens (specimens taken from the eye) in just 5.2% of confirmed COVID-19 patients (two out of 28).

Toward the end of November 2020, the asymptomatic spread narrative was effectively destroyed by the publication of a Chinese study8 involving nearly 9.9 million individuals. It revealed not a single case of COVID-19 could be traced to an asymptomatic individual who had tested positive. Still, the propaganda machine churned on, ignoring the evidence at hand.

Around December 2020, recommendations for double-masking emerged,9 and this trend gained momentum through extensive media coverage as we moved into the first weeks of 2021.10 That two masks would be more effective than one is just "common sense," Fauci told CNBC in January 2021.11

Undeterred by scientific evidence and logic, by the end of January 2021, "experts" started promoting the use of three12,13 or even four14 masks, whether you were symptomatic or not.

The suggestion to self-asphyxiate turned out to be one step too far, however. In the face of public ridicule, other experts encouraged the return to common sense, as impaired respiration can worsen any number of health conditions.

True to form, while promoting the concept of double-masking as recently as January 29, 2021,15 by February 1 that year, Fauci conceded, "There is no data that indicates double-masking is effective," but that "There are many people who feel … if you really want to have an extra little bit of protection, ‘maybe I should put two masks on.’"16 In other words, the suggestion is based on emotion, not actual science.

Fauci also went from promising a mask-free existence once the vaccine rolled out, to insisting that mask-wearing was still necessary after vaccination because vaccine-resistant variants might pop up, to proposing we might need to wear masks every flu season in perpetuity.

The fact is, Fauci knew masks cannot block viruses and that claiming otherwise was unscientific. He told the truth in a private email to a colleague back in February 2020, in which he stated that masks are "not really effective in keeping out viral particles, which are small enough to pass through material."17 Masking people up reinforced the idea that we were living in dangerous times though. It fed people’s fears, and that’s the effect they were after.

Fauci Hopes People Will Mask Up Again

As we head into fall, Fauci is now making the media rounds again, saying he hopes people will comply if mask recommendations return. Why media still believe that people will listen to Fauci is a mystery of its own. In a September 2, 2023, CNN interview, Fauci said:18

"I would hope that if we get to the point that the volume of cases is such and organizations like the CDC recommends — CDC does not mandate anything — recommends that people wear masks, I would hope that people abide by that recommendation ..."

Funny he should say that. Recall the CDC not only mandated but ORDERED the wearing of masks on public transportation in January 2021. However, as noted on the CDC’s website,19 the order became unenforceable due to a court order, issued in mid-April 2022.

Remember that when the CDC renews its mask recommendations. They can’t mandate or order you to do anything. Also remember that Fauci just confirmed the CDC has no authority to do anything but make recommendations.

Gold Standard Science Review Found No Benefit

Cochrane Reviews have long been recognized as the gold standard in evidence-based health care as their analyses look at the whole body of published science, and every few years, reviews are updated to include the latest research findings.

For example, reports on "Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses" — which includes mask wearing — were published in 2009,20 2010,21 2011,22 202023 and January 2023.24

During 2020 and most of 2021, mask proponents tried to cast doubt on studies showing that masks had no impact on the spread of respiratory viruses because they weren’t specific to COVID-19.25

This was actually irrelevant because masks cannot block viruses that are much smaller than the gaps in the fabric, and SARS-CoV-2 is even smaller than the flu virus. Still, the lack of COVID-specific trials kept the counterarguments going. That all changed in January 2023 however. By then, COVID-specific mask trials had been conducted, and all were included in the Cochrane Library’s systematic review.26

In all, the 2023 update added 11 new randomized controlled trials (RTCs) and cluster-RCTs to their previous 2020 analysis, bringing the total number of RCTs to 78. Six of the 11 were conducted during the COVID pandemic, and three looked at the spread of COVID-19 specifically.

Yet, as in previous reviews, there was no evidence to support mask wearing. The SARS-CoV-2 virus, it turns out, behaves just like other influenza viruses and easily penetrates these barriers. As noted by the authors:27

"Medical or surgical masks — Ten studies took place in the community, and two studies in healthcare workers.

Compared with wearing no mask in the community studies only, wearing a mask may make little to no difference in how many people caught a flu-like illness/COVID-like illness (9 studies; 276,917 people); and probably makes little or no difference in how many people have flu/COVID confirmed by a laboratory test (6 studies; 13,919 people)."

Type of Mask Makes No Difference

In summary, the 2023 Cochrane review found that surgical masks did not significantly reduce the risk of flu-like/COVID-like symptoms in the general population. Surgical masks also did not affect the risk of laboratory-confirmed influenza and COVID.

So, masking had no effect on confirmed infection rates (which are more important than self-reported symptoms). The review also found no difference between medical/surgical masks and N95/P2 respirators. So, none of the new studies changed anything. Masks failed to prevent influenza transmission before the pandemic, and they still fail to prevent respiratory infections, including COVID.

By late February 2023, The New York Times even allowed the publication of an opinion piece by conservative columnist Bret Stephens titled, "The Mask Mandates Did Nothing. Will Any Lessons Be Learned?"

"When it comes to the population-level benefits of masking, the verdict is in: Mask mandates were a bust," Stephens wrote. "Those skeptics who were furiously mocked as cranks and occasionally censored as ‘misinformers’ for opposing mandates were right. The mainstream experts and pundits who supported mandates were wrong.

In a better world, it would behoove the latter group to acknowledge their error, along with its considerable physical,28 psychological,29 pedagogical30 and political31 costs ... The Cochrane report ought to be the final nail in this particular coffin."

CDC Director Made False Statements About Cochrane Review

It has not become the final nail in the coffin, though. In her February 2023 congressional testimony, then-director of the CDC Dr. Rochelle Walensky doubled down on the CDC’s mask orders, arguing that the Cochrane analysis only relied on a "small number" of COVID-specific trials — as if more would somehow change the results.

It’s rare to be able to say that science has conclusively shown something to be true, but we’re as close as we can get to absolutes when it comes to mask wearing. On top of that lame argument, she falsely claimed the Cochrane Library editor-in-chief had "retracted the summary of that review,"32 which never happened.33

The editor, Karla Soares-Weiser, did however add a comment to the review stating, "The original Plain Language Summary for this review stated that ‘We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed.’ This wording was open to misinterpretation, for which we apologize."34

But nothing was retracted. The plain language summary states that to this day. Moreover, while Soares-Weiser claimed that interpreting the results as "masks don’t work" was an "inaccurate interpretation," and that an accurate interpretation would be that "the results were inconclusive," the lead author, Dr. Tom Jefferson, insists the findings were unequivocal.

"There is just no evidence that they (masks) make any difference. Full stop," he told investigative journalist Maryanne Demasi.35 And N95 masks are no better. "Makes no difference," Jefferson said.

Did Cochrane Library Editor Succumb to Pressure?

Soares-Weiser added her "apology" to the review after being contacted by New York Times columnist, Zeynep Tufekci, who’d rebuked Jefferson’s statements in a March 10, 2023, article titled "Here’s Why the Science Is Clear that Masks Work."36

"Tufekci argued that despite no high-quality data, we could conclude, based on poor evidence, that masks DO work," Demasi wrote.37 In a September 8, 2023, Substack article, science journalist Paul Thacker added:38

"In my own communication with Cochrane scientists, they find Tufekci’s behavior boorish and unprofessional.39 In retrospect, it’s clear that Tufekci colluded with Cochrane’s Soares-Weiser, who runs the organization, but was not involved in the mask review.

After the two canoodled earlier this year, Soares-Weiser rushed out a public statement to please Tufekci and New York Times editors, but has had to hire the pricey consulting firm Envoy to deal with the fallout and scientists’ concerns over her leadership style.

Scientists have demanded that Soares-Weiser explain why she talked to Tufekci about their review, and published a statement criticizing it, without first consulting them ... 

It’s obviously embarrassing to Cochrane that they are now spending money on a consulting firm to clean up the mess Soares-Weiser created with review scientists. Her actions have even caught the attention of Johns Hopkins researcher Marty Makary, who tweeted40 that Cochrane is now caving to political pressure from partisans who want the science to conclude that masks work ...

At the time that Tufekci published her essay, Jefferson sent her editors a letter pointing out numerous errors. The paper chose to ignore this. But Jefferson set the record straight yesterday during an interview with Michael Smerconish, who hosted Jefferson on his radio program.41

Jefferson pointed out in the interview that powerful people in public health, like Anthony Fauci, could have ended all the controversy over mask use by funding large studies to draw more conclusive results on masks.

‘The whole story of the pandemic, since 2020, is that nobody (or very few people) have stepped forward and filled that gap,’ Jefferson said.

Institutions in the United States are now starting to implement mask policies, Jefferson noted, without offering any proof to people that they work. ‘How are they going to justify this?’... ‘We could find no evidence that masks make a difference,’ Jefferson told Smerconish ..."


Smerconish also interviewed Jefferson in a CNN segment, September 9, 2023, asking him point blank, "Do masks work, in your opinion, in stopping the spread of COVID?"

Jefferson pointed out that none of the three COVID-specific trials found a beneficial effect of masking. "It is impossible to show that something DOESN’T work," he added. The science of masking looks at "is it more likely than not" for it to work, "and at the moment, there’s no evidence of that being the case" Jefferson said, adding:

"I can’t tell you if they work or not, but it’s more likely than not that they don’t work."

Fauci, the Science Denier

Smerconish also interviewed Fauci,42 asking him to comment on the Cochrane review’s findings, and Jefferson’s comment to Demasi, that policymakers were basing their mask recommendations on "nonrandomized studies, flawed observational studies."43

Indeed, the primary piece of "evidence" for the CDC’s original mask recommendation was an anecdotal story about two symptomatic hair stylists who interacted with clients while wearing masks in the salon. Of the 67 clients who agreed to be interviewed and tested, none tested positive for SARS-CoV-2, which according to the CDC was evidence that the masks prevented spread of infection in a real-world setting.44

"How do we get beyond the finding of that [2023 Cochrane] review?" Smerconish asked Fauci. Fauci’s response? There are "other studies" that show masks work "at an individual level," Fauci said, adding, "When you’re talking about the effect on the epidemic ... as a whole, the data are less strong."

Of course, Fauci didn’t cite any of the "individual level" studies he’s referring to, but with that comment he basically confirmed Jefferson’s conclusion that decisions were indeed based on nonrandomized studies and flawed observational studies — like the anecdotal hair salon "study" — not gold-standard RTCs.

Despite that, Fauci again doubled down, telling Smerconish "There is no doubt masks work. Different studies give different percentages of advantage of wearing it, but there's no doubt that the weight of the studies … indicate the benefit of wearing masks."45

Jefferson Responds to Fauci’s Comments

At Demasi’s request, Jefferson responded to Fauci’s comments:46

"So, Fauci is saying that masks work for individuals but not at a population level? That simply doesn’t make sense. And he says there are ‘other studies,’ but what studies? He doesn’t name them so I cannot interpret his remarks without knowing what he is referring to.

It might be that Fauci is relying on trash studies. Many of them are observational, some are cross-sectional, and some actually use modelling. That is not strong evidence. Once we excluded such low-quality studies from the review, we concluded there was no evidence that masks reduced transmission."

As mentioned earlier, Fauci went from disparaging mask wearing in January through March 2020, only to make an abrupt about-face weeks later. At the time, he defended his flip-flopping saying, "When facts change, I change my mind." But as Jefferson told Demasi, none of the facts had changed:47

"There were no randomized studies, no new evidence to justify his flip-flop. That’s simply not true ... What Fauci doesn't understand is that cloth and surgical masks cannot stop viruses because viruses are too small and they still get through."48,49,50

In conclusion, Demasi writes:51

"As it stands, the Cochrane review will continue to be the subject of attacks because it presents a major roadblock for implementing masking policies. Jefferson says he doesn’t know what motivates people to ignore the facts.

‘Could it be part of this whole agenda to control people’s behavior? Perhaps,’ he speculated. ‘What I do know ... is that Fauci was in a position to run a trial, he could have randomized two regions to wear masks or not. But he didn’t and that’s unforgivable.”

Mask Harms Revealed

While we have no evidence showing masks prevent the spread of COVID, we do have evidence showing mask wearing can cause harm. For example, in its December 2020 interim guidance on masks,52 the WHO noted that mask disadvantages included "a false sense of security," and that:

"Several studies have demonstrated statistically significant deleterious effects [of masks] on various cardiopulmonary physiologic parameters during mild to moderate exercise in healthy subjects and in those with underlying respiratory diseases."

A German registry of reported effects among children found 68% experienced some sort of impairment, such as irritability, headache, poor concentration, reduced happiness, reluctance to go to school, general malaise, impaired learning and fatigue.53

Other investigations have revealed children are exposed to potentially dangerous elevations in carbon dioxide when wearing a face mask,54 and health care workers who wear masks for six or more hours have been found to be at higher risk of respiratory infections due to mask contamination.55 A dozen different volatile and potentially hazardous chemicals have also been identified in medical masks.56

Research57 by German physician Dr. Zacharias Fögen has also linked mask mandates to significantly higher COVID-19 case fatality rates. "These findings suggest that mask use might pose a yet unknown threat to the user instead of protecting them, making mask mandates a debatable epidemiologic intervention," he concluded.

He proposed this as-yet unidentified threat might be related to a phenomenon called the "Foegen effect." The general idea is that breathing through a face mask forces deep re-inhalation of virions, which might make COVID-19 infection more likely and/or more severe. He suspects mask wearing may also exacerbate the effects of long-COVID for the same reason. In addition to the above, prolonged mask wearing has been linked to:58

Facial alkalinization, dehydration and enhanced skin barrier breakdown, which can increase your risk of bacterial infections

Increase in headaches and sweating

Decreased cognitive precision

Medical errors

Interference with social learning in children

Obscured nonverbal communication

Distorted verbal speech

Removal of visual cues, which is detrimental to people with hearing loss

Do Not Comply

In closing, Florida Gov. Ron DeSantis has already vowed to not enforce any federal mask mandates that might come down the pike, and hopefully, other states will follow suit.

But even if they don’t, remember that CDC can only make recommendations. They cannot order you to do anything. At this point, it’s imperative that everyone simply say "no" and peacefully refuse to comply with mask wearing, because it’s impossibly to comply your way out of tyranny, which is what the COVID spectacle has always been about.


Sources and References

Friday, September 22, 2023

Sleep Dysfunction and the Microbiome

 


Sleep is a dynamic process that affects every system of the body, and the interplay of different environmental and lifestyle factors influences sleep quality and architecture.1 

Recent research suggests that some of these factors may influence sleep via the microbiota-gut-brain axis, both directly and indirectly.1-3 What is the connection between lower sleep quality and quantity and a dysbiotic gut microbiome? What emerging interventions targeting the microbiota-gut-brain axis may be beneficial for the treatment of impaired sleep patterns?

From a young age, microbial communities within the body interact with the sleep-wake cycle in a complex manner.1The gut microbiome, which produces a variety of metabolites and compounds with neuroactive and immunomodulatory properties, including short-chain fatty acids, secondary bile acids, and neurotransmitters, may affect brain function and behavior through the microbiota-gut-brain axis.4 These microbial products are also involved in sleep physiology.3 While the mechanisms underlying the microbiota-gut-brain axis are not fully understood, some evidence has suggested that neuroendocrine, immune, and metabolic pathways may regulate interactions.3

Growing evidence reports a positive correlation between sleep efficiency and the diversity of the gut microbiota from childhood through adulthood.3 For example, a recent study of 143 largely Caucasian children ages 3-4 found that children with a high total nighttime sleep duration (average 9.48 hours), greater sleep efficiency, and less time awake at night showed a higher relative abundance of Bifidobacterium and Bacteroides.5 Both bacteria have been linked to sleep-related neurochemicals in previous studies, such as serotonin and its precursors tryptophan and gamma-aminobutyric acid. In the 2022 study by Wang et al, five taxa showed greater abundance in children who had shorter night-time sleep duration, less sleep efficiency, and longer waking time, including Blautia, Coprococcus, and other Lachnospiraceae.5

Evaluating individuals with healthy sleep quality, a 2020 pilot study of 28 young adults by Grosicki et al found higher proportions of the abundance of Blautia and Ruminococcus (belonging to Firmicutes), lower proportion of Prevotella(belonging to Bacteroidetes), and higher ?-diversity of the gut microbiota among individuals reporting superior sleep quality.6 Researchers hypothesize that sleep quality may be positively correlated with the ratio of Firmicutes/Bacteroidetes and microbial diversity.3,6

A 2021 cross-sectional pilot study found that adult short sleepers have different microbial composition, such as an increased abundance of the bacteria Pseudomonas (0.14% vs. 0.08%) in feces and a lower abundance of Sutterella(0.38% vs. 1.25%) compared to normal length sleepers.1,7 Interestingly, Sutterella has been associated with lower relative abundance in patients with depression and may play a role in the microbiota-gut-brain axis.7 Several other studies indicate that a lower sleep quantity and quality are associated with a dysbiotic gut microbiome characterized by a lower microbial diversity, an increase of pathogenic microbiota, or the loss of beneficial microbes.4,8-9

Sleep-Related Disorders & the Microbiome

 OBSTRUCTIVE SLEEP APNEA (OSA)

OSA leads to fragmented night sleeping and daytime sleepiness due to episodes of obstruction of the upper airway; it is accompanied by repeated sleep fragmentation and forced awakening from sleep due to airway collapse.1,3Studies suggest that those suffering from OSA may have a prolonged N1 stage and a shortened REM sleep stage.3

Evidence suggests that intermittent hypoxia may result in changes to the gut microbiota, including increased Firmicutes richness and decreased Bacteroidetes richness, as well as decline in ?-diversity.3,10 A 2020 pilot study in children with OSA showed a significant decrease in gut microbial diversity compared to healthy children and an increase of inflammation and gut barrier disruptor–related strains.1,3,11 In 2019, Ko et al found gut microbial dysbiosis, in varying degrees, in adults with OSA-hypopnea syndrome.1,12 Specifically, short-chain fatty acid–producing bacteria was decreased and the level of interleukin-6 was increased compared to controls.1,12

More recently, a 2023 prospective case control study of 48 Chinese adults age 18-65 found that the severity of OSA was related to differences in the structure and composition of the fecal microbiome.13 Enriched Fusobacterium, Megamonas, and Lachnospiraceae_UCG_006 and reduced Anaerostipes was found in patients with severe OSA. Enriched Ruminococcus_2, Lachnoclostridium, Lachnospiraceae_UCG_006, and Alloprevotella was found in patients with high intestinal barrier biomarkers. Lachnoclostridium and Lachnospiraceae_UCG_006 were the common dominant bacteria of OSA and intestinal barrier damage. Fusobacterium and Peptoclostridium were independently associated with apnea-hypopnea index. The dominant genera of severe OSA were also associated with glucose, lipids, neutrophils, monocytes, and BMI.13

INSOMNIA

A range of psychiatric and inflammatory disorders as well as metabolic syndromes are comorbid with insomnia.2,14Marked changes in gut microbiota diversity and composition was found by Liu et al in 2019 among 10 chronic insomnia patients compared to 10 healthy controls.1,15 A later study by Li et al observed a decrease in microbiome diversity in acute and chronic insomnia patients, with greater effects on bacterial diversity found in patients with disordered sleep.1,13 These individuals also show an increase in the inflammatory cytokine interleukin-1?.13 Both of these studies noted that an increase of Bacteroidetes phylum could be a biomarker to identify insomnia.1

A 2022 multiomics analysis reveals that the composition and structure of gut microbiota and metabolism in insomnia patients differs from healthy controls.14 Compared to healthy controls, the relative abundances of Lactobacillus, Streptococcus, and Lactobacillus crispatus were significantly increased in people with insomnia. (Lactobacilli possess several health-ameliorating attributes, including alleviation of chronic diseases, immune system stimulation, pathogen protection, and nutritional physiology.)14 Five metabolic pathways in patients with insomnia differed between the two groups as well, including glycerophospholipid metabolism; glutathione metabolism; nitrogen metabolism; alanine, aspartate, and glutamate metabolism; and aminoacyl-tRNA biosynthesis.15Researchers also found that IL-1? levels were significantly higher in insomnia patients while TNF-? was significantly reduced; the changes in the level of IL-1? and TNF-? were associated with some specific bacteria and metabolites, such as Prevotella amnii, Prevotella buccalis, Prevotella timonensis, and Prevotella colorans.15

Clinical Applications: Microecological Therapy

A novel treatment strategy referred to as microecological therapy has emerged, featuring several potential interventions targeting the gut microbiota to improve sleep quality and quantity.3 The targets of this therapy include regulating the abundance of specific bacterial groups, microbial metabolites, intestinal barrier function, and host immune response. Evidence suggests that microbiota manipulations like dietary interventions and the use of probiotics may be beneficial for the treatment of impaired sleep.3

PROBIOTICS

Although probiotics are transient visitors, they play a role in shifting the overall balance of the microbiome, modulating the immune system, and decreasing inflammation.18 Consuming probiotics in foods or supplements may encourage colonization of commensal organisms over time.18 Studies suggest that probiotics may improve sleep latency, sleep quality and duration, sleepiness upon wakening, and recovery from fatigue.19-21

A 2023 systematic review and meta-analysis of six studies showed significant improvement in sleep quality of 343 healthy adults with mild to moderate stress as an effect of daily consumption of L. gasseri compared to controls (-0.77, 95% CI -1.37 to-0.16, P=0.01).21 In addition to the cumulative beneficial effect shown using the PSQI global score, four of six studies reported a statistically significant positive effect of L. gasseri on sleep quality as indicated by at least one of the Pittsburgh Sleep Quality Index component scores (sleep latency, duration of sleep, sleep disturbance, and daytime dysfunction due to sleepiness).21

In a group of 94 healthy medical students from Japan studying for national exams, researchers found that sleep latency prolongation was less in the intervention group that received Lacticaseibacillus casei strain Shirota.4,19 EEG measurements also showed that, as the examination approached, the time spent in NREM stage 3 sleep was reduced in the placebo group but maintained in the intervention group. In this double-blind, randomized, placebo-controlled trial, researchers also found a reduction of the mean Pittsburgh Sleep Quality Index (PSQI) score, indicating improved sleep quality among the intervention group compared to the placebo group.4,19 

In a 2018 randomized crossover study, 40 adults aged 20-64 consumed either Lactobacillus helveticus or placebo for four weeks.4,20 Sleep efficiency was measured as the total time spent in REM and NREM sleep divided by the total time from sleep onset to awakening. The researchers found that sleep efficiency significantly improved in the intervention group compared with placebo, including improved sleepiness on awakening, onset and maintenance of sleep, dreaming, and recovery from fatigue. It is important to note that the intervention group also received theanine, which has stress-reducing effects, while the placebo group did not.4,20

MEDITERRANEAN DIET

Nutritional imbalances are potential contributors or causes of several chronic conditions, and nutrition-based interventions are fundamental components of many therapeutic strategies used to combat chronic illness and restore optimal health. These personalized treatments may include therapeutic food plans like the Mediterranean diet, a plant-based, antioxidant-rich, unsaturated fat dietary pattern that has been consistently associated with lower rates of disease and total mortality.22 Studies indicate that greater adherence to the Mediterranean diet may be associated with adequate sleep duration and with several indicators of better sleep quality. For example:

  • In 2018, Castro-Diehl et al found that a Mediterranean-style diet was associated with adequate sleep duration and fewer insomnia symptoms.23,24 This cross-sectional, multi-ethnic study of 2,068 adults with atherosclerosis found that compared with individuals who currently reported a low aMed score, those with a moderate-high aMed score were more likely to sleep 6-7 vs. <6 hr/night (p <0.01) and less likely to report insomnia symptoms occurring with short sleep (vs. no insomnia or short sleep alone; p <0.05). An increase in aMed score over the preceding 10 years was not associated with sleep duration or insomnia symptoms. However, compared with those with decreasing aMed score, individuals with an unchanging score reported fewer insomnia symptoms (p ?0.01).23,24
  • In a 2019 cross-sectional study of 1,314 Southern Italian adults, a higher adherence to the Mediterranean diet was associated with a higher likelihood of adequate overall sleep quality (highest vs. lowest quartile, OR=1.82, 95% CI: 1.32, 2.52).25 Interestingly, in a sub-analysis of this study, researchers found the benefit of the Mediterranean diet on sleep latency was observed in normal and overweight individuals (highest vs. lowest quartile of adherence score, OR=2.30, 95% CI: 1.49, 3.54) but was not evident in the obese (highest vs. lowest quartile of adherence score, OR=1.12, 95% CI: 0.33, 3.79).22,25
  • In a 2021 cross-sectional study of 2,169 Costa Rican adults (1,600 men and 569 women), the association between sleep duration and adherence to the Mediterranean diet differed between men and women. In women only, a lower adherence to the Mediterranean diet was associated with shorter sleep duration, a finding that researchers say was primarily driven by lower consumption of fruits, vegetables, and legumes.26 However, the literature is inconsistent regarding whether associations between sleep and diet are gender based. For example, a 2020 study conducted among young adults 21 to 30 years old found that men with lower fruit and vegetable intake had a higher risk of insomnia as compared to women.26,27

Functional Medicine Considerations

Taken together, these studies illustrate the important connection between the gut microbiome and sleep patterns. Screening patients for sleep disorders is encouraged as a regular practice in functional medicine, and there are a range of effective lifestyle interventions for patients suffering from poor sleep. A close working relationship between clinician and patient can help identify sleep troubles early on so that they may be targeted with behavioral and lifestyle therapies to prevent or reverse further damage.

References:

  1. 1) Wang Z, Wang Z, Lu T, et al. The microbiota-gut-brain axis in sleep disorders. Sleep Med Rev. 2022;65:101691. doi:1016/j.smrv.2022.101691
  2. 2) Sen P, Molinero-Perez A, O’Riordan KJ, et al. Microbiota and sleep: awakening the gut feeling. Trends Mol Med. 2021;27(10):935-945. doi:1016/j.molmed.2021.07.004
  3. 3) Han M, Yuan S, Zhang J. The interplay between sleep and gut microbiota. Brain Res Bull. 2022;180:131-146. doi:1016/j.brainresbull.2021.12.016
  4. 4) Haarhuis JE, Kardinaal A, Kortman GAM. Probiotics, prebiotics and postbiotics for better sleep quality: a narrative review. Benef Microbes. 2022;13(3):169-182. doi:3920/bm2021.0122
  5. 5) Wang Y, van de Wouw M, Drogos L, et al. Sleep and the gut microbiota in preschool-aged children. Sleep. 2022;45(6):zsac020. doi:1093/sleep/zsac020
  6. 6) Grosicki GJ, Riemann BL, Flatt AA, Valentino T, Lustgarten MS. Self-reported sleep quality is associated with gut microbiome composition in young, healthy individuals: a pilot study. Sleep Med. 2020;73:76-81. doi:1016/j.sleep.2020.04.013
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