Sleep and obesity: Some totally uninformative research

They admit that it enables no causative inferences

People who sleep fewer than six hours a night – or more than nine – are more likely to be obese, according to a new government study that is one of the largest to show a link between irregular sleep and big bellies. The study also linked light sleepers to higher smoking rates, less physical activity and more alcohol use.

The research adds weight to a stream of studies that have found obesity and other health problems in those who don't get proper shuteye, said Dr. Ron Kramer, a Colorado physician and a spokesman for the American Academy of Sleep Medicine. "The data is all coming together that short sleepers and long sleepers don't do so well," Kramer said.

The study released Wednesday is based on door-to-door surveys of 87,000 U.S. adults from 2004 through 2006 conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. Such surveys can't prove cause-effect relationships, so – for example – it's not clear if smoking causes sleeplessness or if sleeplessness prompts smoking, said Charlotte Schoenborn, the study's lead author. It also did not account for the influence of other factors, such as depression, which can contribute to heavy eating, smoking, sleeplessness and other problems.

Smoking was highest for people who got under six hours of sleep, with 31 percent saying they were current smokers. Those who got nine or more hours also were big puffers, with 26 percent smoking. The overall U.S. smoking rate is about 21 percent. For those in the study who sleep seven to eight hours, the rate was lower, at 18 percent. Results were similar, though a bit less dramatic, for obesity: About 33 percent of those who slept less than six hours were obese, and 26 percent for those who got nine or more. Normal sleepers were the thinnest group, with obesity at 22 percent. For alcohol use, those who slept the least were the biggest drinkers. However, alcohol use for those who slept seven to eight hours and those who slept nine hours or more was similar.

In another measure, nearly half of those who slept nine hours or more each night were physically inactive in their leisure time, which was worse even than the lightest sleepers and the proper sleepers. Many of those who sleep nine hours or more may have serious health problems that make exercise difficult.

Many elderly people are in the group who get the least sleep, which would help explain why physical activity rates are low. Those skimpy sleepers who are younger may still feel too tired to exercise, experts said.

Stress or psychological problems may explain what's going on with some of the lighter sleepers, experts said. Other studies have found inadequate sleep is tied to appetite-influencing hormone imbalances and a higher incidence of diabetes and high blood pressure, noted James Gangwisch, a respected Columbia University sleep researcher. "We're getting to the point that they may start recommending getting enough sleep as a standard approach to weight loss and the prevention of obesity," said Gangwisch, who was not involved in the study.

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Ecstasy may be the best way to treat PTSD

At last the incurably traumatised may be seeing the light at the end of the tunnel. And controversially, the key to taming their demons is the `killer' drug Ecstasy. Thalidomide is back in use so everything is possible

An Ecstasy tablet. That's what it took to make Donna Kilgore feel alive again - that and the doctor who prescribed it. As the pill began to take effect, she giggled for the first time in ages. She felt warm and fuzzy, as if she was floating. The anxiety melted away. Gradually, it all became clear: the guilt, the anger, the shame.

Before, she'd been frozen, unable to feel anything but fear for 10 years. Touching her own arms was, she says, "like touching a corpse". She was terrified, unable to respond to her loving husband or rock her baby to sleep. She couldn't drive over bridges for fear of dying, was by turns uncontrollably angry and paralysed with numbness. When she spoke, she heard her voice as if it were miles away; her head felt detached from her body. "It was like living in a movie but watching myself through the camera lens," she says. "I wasn't real."

Unknowingly, Donna, now 39, had post-traumatic stress disorder (PTSD). And she would become the first subject in a pioneering American research programme to test the effects of MDMA - otherwise known as the dancefloor drug Ecstasy - on PTSD sufferers.

Some doctors believe MDMA could be the key to solving previously untreatable deep-rooted traumas. For a hard core of PTSD cases, no amount of antidepressants or psychotherapy can rid them of the horror of systematic abuse or a bad near-death experience, and the slightest reminder triggers vivid flashbacks.

PTSD-specific psychotherapy has always been based on the idea that the sufferer must be guided back to the pivotal moment of that trauma - the crash, the battlefield, the moment of rape - and relive it before they can move on and begin to heal. But what if that trauma is insurmountable? What if a person is so horrified by their experience that even to think of revisiting it can bring on hysterics? After hysterics, the Home Office estimates that 11,000 clubbers take Ecstasy every weekend. Could MDMA - the illegal class-A rave drug, found in the system of Leah Betts when she died in 1995, and over 200 others since - really help? Dr Michael Mithoefer, the psychiatrist from South Carolina who struggled for years to get funding and permission for the study, believes so. Some regard his study - approved by the US government - as irresponsible, dangerous even. But Mithoefer's results tell a different story.

MDMA was patented in 1912 by the German pharmaceutical company Merck. To begin with, it was merely an intermediate chemical used in creating a drug to control bleeding. In the 1920s MDMA was used in studies on blood glucose as a substitute for adrenaline. The Merck chemist Max Oberlin concluded that it would be worth "keeping an eye on this field". Still, no further studies were carried out until 1952, when the chemist Dr Albert van Schoor tested the toxicity of MDMA on flies. "Flies lie in supine position, then death," he recorded.

MDMA's therapeutic potential wasn't realised until 1976, when the American chemist Alexander Shulgin tried it on himself. He noted that its effect, "an easily controlled altered state of consciousness with emotional and sensual overtones", could be ideal for psychotherapy, as it induced a state of openness and trust without hallucination or paranoia. It quickly became known as a wonder drug, and began to be used widely in couples therapy and for treating anxiety disorders. None of these tests was "empirical" in the scientific sense - no placebos, no follow-up testing - but anecdotally the results were almost entirely positive.

Word, and supplies, of the new "love drug" got out, and in the early 1980s it became popular in the fashionable clubs of Dallas, LA and London, where it was known as Ecstasy, X or "dolphins". As use became widespread, the US authorities panicked, and by 1985 MDMA was an illegal, schedule-1 drug. UK laws were even tighter: MDMA, illegal under the 1971 Misuse of Drugs Act, was categorised class A in 1977, carrying a sentence of up to seven years for possession.

Criminalisation put paid to MDMA research almost overnight, at least until Mithoefer's current programme began. But it didn't stop the ravers. The drug was popular in the late 1980s and early 1990s for its energising, euphoric effects. There are no official figures for that period, but the Home Office estimates that in 2006/7, between 236,000 and 341,000 people took Ecstasy. Experts say the drug is far less fashionable now than in its heyday in 1988, the second so-called "summer of love".

The MDMA used in the studies - the drug Dr Mithoefer gave Donna and other patients - was the pure chemical compound, not the black-market Ecstasy bought by recreational users. "A lot of Ecstasy pills aren't MDMA at all," says Steve Rolles of the drug-policy reform group Transform. "They may be amphetamines, or unknown pharmaceuticals, or they can be cut with almost any drug in pill or powder form. That's when you magnify risks associated with taking a drug that's already toxic. Plus, people use it irresponsibly, mixing it with other drugs, not drinking enough water or drinking too much."

The images of Leah Betts and Lorna Spinks lying in hospital on life-support, bloodied and bloated, are familiar to all of us - we know drugs cost lives. But has MDMA's reputation been tarnished so badly that its potential medical value has been overshadowed? That question is the reason that Donna agreed to speak to The Sunday Times about her MDMA treatment. "It's so important people know what it did for me, what it could do for others," she says. Her voice trembles: it isn't easy to talk about what she went through.

In 1993, Donna was brutally raped. She was a single parent living in a small town in Alaska, working as a dental nurse for the Air Force. She was due to work an early shift the next day and her two-year-old daughter was staying with a friend for the night. She was alone at home. At midnight she opened the door to a stranger who said he was looking for his dog. He asked if her husband was at home, and a second's hesitation was enough. He burst in, backing her up against the fireplace in the living room. Donna picked up a poker to defend herself. He said: "If you co-operate, I won't kill you. I've got a gun." And he reached into his jacket....

Donna had never taken Ecstasy before. "I was a little afraid, but I was desperate. I had to have some kind of relief. I didn't want to live any more. This was no way to wake up every morning. So I met Dr Mithoefer. I said, `Doctor, I will do anything short of a lobotomy. I need to get better.' " That's how, in March 2004, Donna became the first of Mithoefer's subjects in the MDMA study. Lying on a futon, with Mithoefer on one side of her and his wife, Annie, a psychiatric nurse, on the other, talking softly to her, she swallowed the small white pill. It was her last hope.

"After 5 or 10 minutes, I started giggling and I said, `I don't think I got the placebo,"' she recalls. "It was a fuzzy, relaxing, on-a-different-plane feeling. Kind of floaty. It was an awakening." For the first time Donna faced her fears. "I saw myself standing on top of a mountain looking down. You know you've got to go down the mountain and up the other side to get better. But there's so much fog down there, you're afraid of going into it. You know what's down there and it's horrible.

"What MDMA did was clear the fog so I could see. Down there was guilt, anger, shame, fear. And it wasn't so bad. I thought, `I can do this. This fear is not going to kill me.' I remembered the rape from start to finish - those memories I had repressed so deeply." Encouraged by the Mithoefers, Donna expressed her overwhelming love for her family, how she felt protected by their support and grateful for their love. MDMA is well known for inducing these compassionate, "loved-up" feelings. For Donna, the experience was life-changing.

So what happened when she went home? Was she cured? She sighs. "I don't know if there's such a thing as a cure. But after the first session I got up the next day and went outside, and it was like walking into a crayon box - everything was clear and bright. I did better in my job, in my marriage, with my kids. I had a feeling I'd never had before - hope. I felt I could live instead of exist."

Mithoefer's study, which looks set to cost $1m by the time it finishes in four years' time, is scrupulously monitored. Doblin had 1,000g of MDMA made specially, each gram costing $4. Mithoefer had to obtain a licence from the Drug Enforcement Administration (DEA), which keeps track of exactly how much MDMA each licence-holder has, and periodically checks the stocks for purity. A defibrillator must be kept in the building at all times in case of cardiac arrest, and an emergency nurse must be present during the treatment session. Once the study is complete, it will be subject to peer review. Then, all being well, Mithoefer hopes to see MDMA therapy available on prescription, administered in controlled surroundings, in 5 to 10 years. ...

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