The MAIN CAUSES Of Inflammation & How To REDUCE IT TODAY! | Roger Seheult

inflammation is at the heart of many of the different conditions that we struggle with these days heart disease cancer depression strokes alzheimer's whatever it is we know that inflammation often sits at the heart right at the start of this conversation i wonder if you could explain to people you know how do you see inflammation what is it and why is it so important yeah i think probably the best way to put it in terms of a lot of people a lot many people can grasp what inflammation is inflammation i see it as imagine you're building a house or imagine you're constructing a road inflammation in terms of that and the processes that are going on inside your body is simply the the the construction it's the it's the hassle it's the it's the materials it's all of those things that are associated with the processes that are going on in the body of course it's a lot more complicated than that but the point i want to make there is that inflammation is simply a sign that something is going on something is a process is occurring in the body whether it's fighting a an infection and if that infection is not being cleared up then that inflammation will be chronic imagine imagine construction i live in southern california and it seems as though there's always road construction going on here in in southern california all the time and that's how it feels it feels like there's always congestion because there's blockage of the roads if i put it in terms of of the body whether or not there's an infection there's inflammation whether or not there are cells that are damaged and those cells are being repaired by your immune system there's going to be inflammation and so inflammation is sort of uh you have this love-hate relationship with inflammation because inflammation is necessary to get things done but you don't want to have it excessively you don't want to have it more than you need to have and so it's it's a tricky situation you want to have the inflammation that you need to have to do the things that you want to do like if you want to build a house you have to have construction something that goes along with it but on the other hand as soon as you don't need it you want it gone and um and and that's really important and there are processes that we're going to talk about in this in this uh podcast that are going to show how we can have these prostheses occur and and have the inflammation go away when we don't need it so that it doesn't lead to these diseases it's neither good nor bad is it it it just is it's a response as you say it's a signal i guess it depends what is the context of that inflammation what is the dose of that inflammation and does that inflammation go away once it's done the necessary repair job and i think it's i think often we think of these things as either good or bad you know i don't want inflammation in my body it's a bad thing it causes heart disease cancer alzheimer's strokes but it's not that is it it's much more nuanced and complex than that it's it's exactly right you know it's not this on off switch it's not good or bad it's not like this is bad we need to get rid of it i mean a number of years ago we talked about lipids and fats and everything fat and lipids was bad but where we're starting to learn now of course and we've known for a long time that certain lipids omega-3s omega-6s these are our you know essential fatty acids you need them in moderation so it's you're right it's much more nuanced in terms of the lifestyle things that we can try and focus on to help reduce inappropriate inflammation in our bodies a framework i often use is what i call my four pillars of health food movement sleep and relaxation four core aspects of health that i think not only have the most impact on how we feel uh and how we're able to operate in the there are also four things that we have quite a high degree of control over not everyone of course but a lot of us do so i thought those four pillars might be a good way to try and look through the lens of what we can do to help reduce inflammation i thought we might start with sleep because sleep is something you have you know a great deal of expertise on um how do you see the relationship between sleep and inflammation yeah this is this is really big um so i'm a a sleep certified physician in the united states we're boarded in sleep medicine and i did some extra training to do that i'm also a pulmonary and critical care specialist and boarded internal medicine i have a practice a clinic i work in the hospital and so i actually see patients and treat them and they come to me with all sorts of problems with sleep you know sleep is it's it's this sort of pigeon-holed uh corner of medicine but let's face it you do this for you know a good eight hours a night hopefully and uh people have all sorts of problems with sleep so where do we start with sleep i think um there are problems with sleep in terms of quantity and there are problems with sleep in terms of quality and people who don't get enough sleep it may be that they want to sleep and they're just not getting enough time i think probably the most common problem that we see in the western world is that people that want to sleep but they they just aren't getting enough of it and it's because they choose not to um and of course there's people that will be listening to this and say well what about me i i want to sleep more but i just can't fall asleep and those are people we call insomniacs and we can talk about ways to handle that as well but it's it's complicated so let's talk about probably the lowest hanging fruit as i like to call it with sleep so sleep is a very important process we are just now finding out in the last 20 30 years now in terms of research it's very solid that if people don't get enough sleep the processes in their body are just not going to be completed that need to happen there are certain times of the day for each individual person that are best for sleep and that's based on something called the circadian rhythm circadian rhythms is something that's controlled in the brain in a tiny little nucleus called the suprachiasmatic nucleus that controls all of the little clocks in all of the cells of your body it's sort of the master clock now we could get into some a lot of details and a lot of specifics about how to measure where each person's clock is but let's just start off with the very basis if if your clock is not aligned with your body and what you're doing on a daily basis you're going to have problems where you're going to want to try to go to sleep but your body is not going to be ready for sleep now let me tell you what probably the most common problem is with circadian rhythms circadian rhythms which i as i mentioned are regulated in this super chiasmatic nucleus of the brain get inputs from various different aspects of your life these are what we call zeitgebers this is a a term that i don't want to use too much because it really just doesn't lead anywhere but there are things that that are you do in your life that tell your brain what part of the day it is and this could be you know just food it could be social interaction but the most the most powerful input to your brain is light and nothing has changed probably more dramatically in the human being in the last 100 200 years is the input of light into the human body with the advent of electricity light bulbs uh media screens all of these sorts of things we have dramatically changed the the amount of light coming into our eyes at specific parts of the day you know it used to be that if you wanted to have light in your eyes after sunset you had to light a candle or you had to start a fire these were things that were you know pretty involved now it's just a flip of a switch it's turning on the television and the problem is is that because of our culture we're getting a lot of light exposure in our eyes and as a result of that and we can get into the details but what this is doing is it's telling our brain when we're seeing bright light at night that it's actually still day and so what that does is it delays it pushes back it causes our circadian rhythm to think that it's actually earlier in the day and therefore we won't sleep until later on and so instead of going to sleep perhaps maybe at nine or ten or eight or nine because we're exposing our eyes to bright light we're now not ready for sleep until much later in the evening now of course it would be great if we could just sleep in later but the demands of our culture the demands of the day require us to get up at a certain set point on an alarm clock and so one of the first things that i would mention in low-hanging fruit is that many people's circadian rhythms are delayed and as a result of that they're trying to go to bed and not going to bed late and as a a result of that is we're seeing that sleep time so we're talking about quantity right now sleep time is sufficiently or severely reduced if you were to go to the united kingdom's sleep association i know in the united states where i work we have the american academy of sleep medicine and it will show you for specific ages what is the recommended number of hours of sleep that you should get and for adults it's seven to eight hours at the minimum of sleep per night and so one of the first things we'll talk about ringing is is the number and amount of hours of sleep that you should get if you're able to get this and the lowest hanging fruit there is getting at least seven hours of sleep now we can talk about why that is and what what's going on in the brain uh and what's going on in the body but that's the first thing that i would i would tee up yeah well let's do that i mean why is that number so important and you know what is going on in the body when we get that amount yeah so uh there are several processes that are occurring scientists don't know why it is exactly uh why we sleep in general but we certainly are becoming much more aware of why or what happens if we don't get that sleep so let's put it that way there was a study that was done a number of years ago and it always seems to be done these kind of studies on college students because i think they're the ones willing to do this exactly exactly um so what they did was they they they had them do something that they probably are already doing anyway right they're in college so they they had them pull all-nighter we call that an all-nighter here in the u.s i don't know what you call it there in great britain but it's basically what students do right before a test they'll pull up all nighter they'll cram as much information into their brain as possible and they measured hundreds of different proteins and and blood tests and things of that nature after they did this quote-unquote all-nighter and it's very interesting because the circadian rhythm that i'm talking about is not only something that regulates sleep but as i mentioned it's in every base basically every cell of your body and tells your body when to produce things and when not to produce things and and you know generally proteins have the circadian rhythm and of production and what was amazing is proteins that that were not just you know regular proteins that are involved in the everyday aspect of your life some of them were but some of them were very very important glucose regulation that may have an impact on diabetes immune proteins that are involved with fighting cancer all of these things were completely put out of whack by just pulling one all-nighter and so the the question is if this is happening on a regular basis are there effects downstream and we already know the answers to these uh questions we know that people who are night shift workers over many many years can have increased risks of cancer and increase metabolic problems so the question you ask is why do we need seven hours of sleep i can't tell you uh aesthetically uh you know philosophically why we need seven hours but i can certainly tell you what happens if you don't have it uh and when you don't have it we we see increases in uh perturbations in these uh proteins for one there was another study that was done that looked at what we believe is the cause of alzheimer's disease it's the buildup of these proteins in the brain so when your brain is working and doing things it's there's there's sort of toxins and byproducts if you will of that use during the day and what happens at night is is that these proteins and these things need to get taken away it's kind of like you know you're working in a in a workspace and at the end of the day you've got to clean up otherwise you're going to come back the next day to a mess and what that cleanup is kind of like janitorial at night is sleep it's an interesting aspect but if you don't get enough sleep researchers showed that these beta pleated sheets which were what these proteins were that were building up in in patients just as a normal run of the day if you didn't get enough sleep there was a five percent uh reduction in the amount of clearance of these beta pleated sheets so you can imagine over a long period of time if you're not getting enough sleep what this is going to do to various different aspects of your body so we talked about metabolic we talked about cancer fighting we talked about alzheimer's disease all of these things seem to be tied to a lack of sleep among other things as well but but these are the aspects that we're talking about and i guess a lot of that will be mediated through inflammation because when we haven't slept well the next day if we measure the blood we can see all kinds of inflammatory markers going up can't we absolutely yeah so um you know il-6 tumor necrosis factor these are you'll hear these be mentioned again and again these are surrogates for inflammation so i don't want you to think that these markers or these these inflammatory markers are innately bad they have a role they they have a job to do but when you see them elevated chronically over a long period of time that's a surrogate or signal that this is not a good situation yeah and i guess the whole you know the underlying theme of this conversation is inflammation how do we prevent chronic unresolved inflammation going on in the body which in turn is going to help reduce the likelihood that we're going to get sick as we get older and what you're beautifully demonstrating is that a lack of sleep is actually going to make you more inflamed the following day and i guess at this point roger i think it's worth just really pausing on two points because something i've learned over the past few years of trying to promote the importance of sleep is sometimes when we do this without realizing it we can induce anxiety in people um which i know that i know has happened in the past um you know young mothers young parents who are unable to sleep because their kids are up they often hear things like this and they get really panicked or as you say shift workers shift workers might hear that and go are you saying that my job's going to increase the risk of me getting cancer so i think if we just take a slight aside there to try and address some of those things because we want to share information we want people to prioritize their sleep lower their inflammatory burden but at the same time we've got to be careful don't we that we don't stress people who can't sleep out oh i can't agree with you more in fact this is exactly where i was going to go next and it seems like our minds are are melded here um so so 90 of what i deal with when patients come in with insomnia and this is exactly right uh is the problem of anxiety about the fact that they can't sleep and so this is a huge problem so i set the groundwork and we did it very well uh of showing that you need sleep but 90 of what i see with patients that come in in the clinic with insomnia is trying to deconstruct their anxiety about their lack of sleep because one of the worst things that you can have when you can't sleep is to have anxiety about not being able to sleep um what happens and we call this the three ps in insomnia for those that can't sleep is is the um the uh precipitating or i should say the predisposing factors so this is you know type a personality then there is the uh precipitating factor which is whatever it was that caused them not to sleep whether it was a you know a wedding or a divorce or a gaining of a job or a loss of a job all of these can precipitate you not being able to sleep because of stress and then but here's the key the key point are perpetuating factors what is it that people are doing in their sleep that is making them continue not to be able to sleep well one of those perpetuating factors is related to anxiety in fact we call it psychophysiological insomnia meaning it's their brain it's what they're actually trying to think i'll give you an example imagine uh you were asked to go on to stage at carnegie hall i guess in in great britain it would be the royal albert hall imagine you're about to go onto royal albert hall and you're being asked to play a beethoven sonata imagine the stress involved with that it's on television you're there perhaps even the queen is there listening um you know the stress now now instead of a piano instead we put a bed and we ask you to do the very same thing except go and sleep in this bed it's not going to happen and this is exactly what a lot of people are having to do and i see this all the time practically speaking in patients that come to see me they say doc i'm in the kitchen i feel sleepy i feel like i'm ready to go to bed i say wonderful i'm ready to go to bed and what they do is they go down the hall and they go into their bedroom and and now they can't fall asleep they they're wide awake they're activated and what's happened is they've they've associated everything in that bedroom with the anxiety of the struggle of of that battle that they do they take with them every night of trying to go to bed so there's the last thing i want to do is make that anxiety worse so what we typically do is we de-catastrophize we say look you haven't been sleeping for for years uh you're still alive you're doing okay you're probably gonna be okay this is this is not gonna be a disaster for you and then what we start to do is we start to show them where the behaviors in their life have actually caused them to not be able to get a good night's sleep and then what's happened is they've catastrophized it to the point where they've built up this perpetuating situation where they'll never be able to get good sleep unless we actually deconstruct some of those things and and what are some of those things um very briefly it would be things like oh no i i need to get more sleep and uh what do i need to do i know what i'm gonna do i'm gonna go to bed early tonight and i'm gonna try to get as much sleep as i possibly can and you know their circadian rhythm is not ready for them to go to bed until 10 or 11 o'clock at night because that's what they've been used to and they get in bed at eight o'clock now what are they gonna do what do you what's going to happen to the human body if you go to bed at eight o'clock and your body's not ready to sleep till 11. well you're going to be awake for three hours and that's going to cause more anxiety and you're going to be even more awake and you're going to associate with your bedroom and rangan this is just one example of the things that we do that build up bad behaviors that cause insomnia and so what my job is as a sleep physician is to listen to the patient listen to what they're doing try to find cues and then try to deconstruct what's happened and reverse those bad uh behaviors so that they can get some sleep and once they start to get a confidence that they can go to sleep the anxiety level comes way down yeah and then they're able to go to bed go to sleep and then sleep for those seven or eight hours eventually there's a number of things that we do called sleep restriction therapy decatastrophization it's all sort of included under something called cognitive behavioral therapy for insomnia or cbti and a lot of people can do this psychologists can do it sleep physicians but i'm glad that you bring that up because that's as i said 90 of what i do as a clinician is try to deconstruct that anxiety i guess when people come to see you as a sleep physician is it fair to say that a lot of the more i guess simple measures that people can adopt have already been tried so let's let's take caffeine for example um we can talk about caffeine and its effect on sleep for sure but many people understand that although it's very individual that caffeine can absolutely make us alert if we have it too late in the day it can keep us up so when people come to your door have they usually tried reducing coffee and tea or even eliminating it are they already at the point where hey doc i've tried everything i've listened to every podcast i've read every book i've tried everything that people have recommended is that what tends to happen um it's a wide range i have some people that have not done this and it all depends on the referral uh uh the referral patterns that you see as you know you have some uh physicians that will refer very early you'll have some physicians that will work on things um and but i have seen very very difficult patients where i've i've sat down and i've gone through it and and the referring physician has done everything that i would have tried and there's just a few tools left that i have and those are are are some of these tough cases that i i have to deal with sometimes but other times no they've they've really haven't done much i think i think probably one of the best things to do for those of people out there that have difficulty with sleep there's um there's a handout or a sheet in other words that you can find on the american academy of sleep medicine it's also probably there in the uk and in europe and in any country that they're in it's basically called a sleep hygiene uh handout or a sleep hygiene document and it has a list of about maybe 15 to 20 different recommendations and it and it goes over some of the things that we've talked about like avoiding coffee in the afternoon making sure that you only go to bed when you're sleepy making sure that you're never in bed longer than 15 minutes without going to sleep get out of bed get out of the bedroom so you're not associating these uh ensomic issues with the bedroom um but there's a lot more of those there and and we can go over those but that's basically the low-hanging fruit yeah i mean i think uh certainly if i share my experience here i've often found that simple things can make a huge difference for sleep for some people and and often it's not just doing one if we take the swiss cheese model that you mentioned the first time you came on my show i really feel that applies to sleep as well some people will try one thing won't they they'll try oh i tried the caffeine thing didn't make a difference so i'm going to go back to my usual caffeine intake now i'm going to try not looking at screens for an hour before bed oh it's not that uh now i'm gonna try and and bring my evening meal earlier but i find with sleep possibly more than anything else that i see it's about small things in a number of different areas would you agree with that is that sort of the approach that you adopt as well absolutely yeah this is exactly the situation i tell i tell my patients i say look we're going to be making a lot of changes here and i don't want you to get uh discouraged about the number of changes that we're making because all of these things are adding up in fact it may be more of a gestalt where uh where the the sum of the products is greater than the products themselves here um so realize that if we get on track that some of these things may not need to be there for 100 of the time forever but getting you back on track one of the major things that we we think about here in sleep medicine is what we've just talked about where anxiety the the being anxious being not being worried about sleep those people that are worried about sleep that make mountains out of molehills once we can give them the confidence to get back to bed and going back to sleep we have just brought those perpetuating factors below the threshold and now a lot of those things that they were doing before that were not causing the problem they could even some in some cases go back to and not cause the problem with sleep so yes trying to give them the confidence of going to sleep is really important i remember early on in my career roger a few patients would come in telling me that they were struggling to sleep in their bedrooms but on further sort of investigating it was clear that if they were in front of the television in the evening in in their so in their living room they could easily doze off in front of their you know in front of their favorite soap or whatever they were watching and i thought well this is interesting they can't sleep in their bedroom yet they can they can sleep when they don't want to in front of the television and i just remember that early on thinking there's something else at play here because clearly they can sleep but for whatever reason the environment is not allowing them to yeah this is this is the amazing stuff i mean there is a there is a whole sea of subconscious that we are not even realizing um when you go into the bedroom i i have this talk with with many of my patients um and it's and it's kind of geared to the way we live in the west um this may not be geared to a lot of people i mean we're here we're talking about a bedroom and we're talking about a kitchen there's billions of people on this planet that don't have kitchens and bedrooms they live in one-room houses and they seem to get they seem to get along fine probably probably better because they don't have a lot of the stresses that we have in the west but for those who do live in the west and we have a room dedicated to where we sleep um what i hate to see in patients who have different different difficulties with sleep are a television in there um is is their work in there their laptop in there reading i know a lot of people like to read and they find it helps them to go to sleep that's fine what i'm talking about are those that have difficulty falling asleep i tell them to get everything out of that bedroom that has nothing to do with sleep because i want there to be a very strong signal when you go into that bedroom your body understands that you're there for one thing and one thing only uh well maybe two things and if you if you don't get one of those you get the other at least you you're it's a win-win right um but the point is is that i don't want your brain confused that it's time to work i don't want your brain confused that it's time to watch television and let's face it late night television is probably the worst thing for being able to sleep you're either watching you know the news the disasters happening this is just going to increase anxiety no it's better to shut all of that off and go to bed yeah completely agree it's um what people do uh before they go to bed really really interesting i had another thought and it was based on what you said about people um around the world and how you know in the west we have a room dedicated to sleeping and for the first time in my life i i just thought wow that's quite a lot of pressure as well isn't that actually we've dedicated a room in our apartment or our house where we are going to sleep whereas you know for for you know hundreds of thousands of years we probably didn't have a particular bedroom did we where we put all the pressure on so there's that kind of subconscious pressure that builds up even if we're not really thinking about it yeah it's it's true um it it certainly could lead ourselves to having uh these disadvantages but but i i see i see there are some advantages there in terms of people who for instance and this is changing the subject a little bit people who as you mentioned before sleep uh in the day and work at night it allows them to uh the term i like to use is winterize but it's not winterizing like we do when it gets cold it's it's nocturnalizing if you will their room so they can make sure that no light is getting in and so there are some advantages with having a room dedicated to that because then you can do things that you need to do for sleep but it's it's a very interesting point yeah no i completely agree lots and lots of advantages how do you cope with this yourself because from what i gather from our email contact you have quite different schedules from week to week depending on what your job requires of you so as a sleep physician as someone who knows the importance of sleep how is your sleep and how easy do you find it to practice when your schedule is changing all the time well i think our audience would be happy to know that i i am no bastion of of sleep efficacy here uh um you know for those that aren't aware rang and what we you and i and and hundreds of thousands of other physicians around the world have to go through to get where we are uh there's there's medical school and then there's residency and as a critical care physician i spent probably the better portion of my 20s staying up late into the night and getting up very early in the morning to take care of very sick patients and so um i got used to very quickly going through the barriers of sleep and and uh having to do that sort of stuff i have no idea what kind of effect that had on my body i guess i'll find out later in life but um this is what we have to do as physicians to take care of very sick patients and as i as a critical care physician that sort of comes part and parcel um but we weren't really taught at the time what the consequences were of that but i think we're starting to find out more and more that's not to say that now you know being now i'm out of training and i i'm able to take uh probably better care of that what i've what i've found myself doing at the end of all of that is still going to bed you know pretty late around 11 o'clock i probably should go to bed earlier but on days when i can get those six seven hours at least seven hours of sleep that's what i aim to do and that's just we're just talking about quantity we haven't talked about quality of that sleep as yet we haven't talked about the stages of sleep we haven't talked about sleep apnea which is a huge problem in terms of quality of sleep as well but um yeah it's it's something that uh we we could all work on well we're going to talk about those things because there's a lot of people who who struggle with them um i'm i'm genuinely interested as a fellow physician working in a different country do you have any moments that you recall where that sleep derail that sleep deprivation really hit you and i and why i'm asking it is because as you were describing residency there i was taken right back to this moment where you know we were doing well i started work on on that particular well the day before i started work at eight in the morning i was i was covering a arena award at kidney wards and i was on call so i remember it was one of those nights where it didn't stop all night you know you hope for a little hour or two where you can get away and just put your head down it just went all night and then the following morning you know it hits 8am so you've been there for 24 hours now yeah and i was quite junior thinking oh maybe my scene is going to let me go a bit early today because i am really tired there was nothing like that i remember that afternoon about 4 4 30 p.m i just remember i was on the motorway the m60 around manchester it's the ring road around manchester in the northwest of england and there was horns everywhere and basically we were in a traffic jam um i must have whilst in that traffic jam it must have been so tired that i just actually fell asleep and then suddenly all the cars are moving and everyone's horning me and i remember having the living daylight scared out of out of me i was so scared what has just happened could that happen again um so i'm interested for you do you have any moments like that you remember where sleep deprivation could have been really really serious i i was kind of lucky in that i lived pretty close to the hospital that i generally was at but i i do remember some some and it's very similar to your experience where we would come in at seven o'clock or we'd come in at five o'clock in the morning to pre-round we'd stay the whole day and the whole night and then through the next day until about four or five rounding on patients and making sure they were they had the workups in place and then going home and realizing sometimes where when i got home that i don't remember actually driving home it was sort of auto mechanical but but there was this story that i did hear about um in residency from another uh resident this was a surgical residence and um they had both come in they were so tired uh and the resident and the attending the resident was the one in training the attending of course is the is the supervising physician they were leaving at night and i think they left at the same time and the uh the residents at a stoplight kind of rear-ended the uh the attending in front of her and i think that was a a wake-up call uh it wasn't it wasn't a a severe accident fortunately but it was kind of a fender bender we call it uh but no this this is the sort of the stuff that would happen um and we would just the in the united states the uh they actually had to implement uh back in around 2003 uh something called an 80 hour work week and you're thinking 80 hours that's like double the amount of time that you're supposed to be that a full-time person would be working they have to actually limit they actually have to place in put in place rules that would make sure that residents were not working more than 80 hours in a particular week uh to limit how much they were working and a lot of people don't realize that that's the issue that goes on in medicine um but that's exactly what we have to go through and of course we you know we look back and we are sort of looking back fondly or not funnily i guess we're laughing a little bit but that is in some ways underplaying just how serious those things could have been for me for your colleagues for you i mean this is really quite serious and this is actually probably what is still going on although the hours have come down there's many people who work shifts who work you know regularly changing shifts perhaps we could talk about that in relation to circadian rhythms because you know if you were on night shifts permanently that would be one thing but if you know one week you're on days the next week you shift forward by four hours for your shifts then the week after you're on night shifts it's very very hard to adapt isn't it especially if you have friends and family and then so who are not on those shifts so in order for you to interact with them and exist with them and have some form of life you probably have to live slightly outside your new circadian rhythm so you know any sort of things you can share there for people at all well i i there's no question so we have enough trouble with people who have daytime jobs that gets multiplied when we have people that have do the nocturnal shift and i have to tell them very specifically that they if they're working a nocturnal shift they really have to turn their night into day and their day into night the problem that you bring up is just is when you throw a monkey wrench into the whole thing and say that you know one day you're going to be working the day shift and then you'll be working the night shift the first thing i tell them is see if there's another way that you can do this scheduling because this type of scheduling we know is the hardest to adapt i would say if you couldn't change the scheduling probably the next best thing to do would be to make sure that as the shift progresses that the shift gets later and later because it's easier for our circadian rhythm to become later and later uh in the day um but it's still very very difficult does that mean if you were on a day shift let's say in eight till five eight a.m til 5 p.m let's say are you saying that if you can and you have to change shift then the following week maybe see if you can go then to a 10 a.m till 7 p.m and then the week after a midday to a night so pushing it that way is easier for us to adapt to it is and and the reason why it is is because we have a circadian rhythm which literally means about a day it's actually longer than a day and so that's why we find it so much easier to do things later as we progress than it is to do things earlier as we progress so that would be the that would be the one thing i would say if you really can't change it you're really dependent on that job financially uh to do that that's what i would do but it's it's better if you can arrange it uh with your with your supervisors your boss your employer to to have it consistent and really that's the underlying pinning of a theme of what a lot of what we're talking about which is inflammation but but also there's a lot of processes that we'll talk about today that have to do with simply the fact it's not what you're doing it's not what you're eating it's not what you're whether you're sleeping or not or how long although we've talked about that it's when you're doing it and we're starting to find more and more that when you do something has almost as much impact if not the same as what it is that you're doing and so that can that's really a big issue yeah that is something i think what i guess about seven years ago now when i started to become aware of the research that sachin panda was doing in the salk institute around time-restricted eating it really got my attention thinking oh this is fascinating this is really really interesting that we can get all kinds of benefits when people don't change what they eat they simply change when they eat and yeah there's a lot of research coming out and we will definitely get to that because i know you're very passionate about this as well roger but in terms of circadian rhythms you mentioned earlier on in this conversation that there is a way that you guys can measure where our clock is so what does that look like for people is that something they do in a specialist sleep clinic or is that something that is kind of accessible to them you know privately for example yeah that it's it's uh it can be done uh it's based on temperature because temperature is one of the ways that we can measure there is a temperature i should mention the circadian rhythm can affect body temperature although it's not as clean um as other measurements like melatonin and things of and a lot more research driven types of tests that they would do in a research lab but for an everyday person uh taking their temperature um could do it if you were able to to measure it i think probably one of the best things to do is simply just try to measure when you feel tired when you start to feel tired it's generally speaking what we call the dim light melatonin onset and usually seven or eight hours from there is when you would wake up and maybe about instead of seven or eight hours maybe about five about five hours would be when we would expect the temperature nader so let me give you some times here let's say that you feel tired at around 11 o'clock at night and you would normally wake up if you didn't have to get up for work uh let's say at around uh seven or eight o'clock in the morning your dim light melatonin onset would be sorry your um temperature nader which is the lowest that your temperature is would be around five or six and and that's how we would pin down uh how where your circadian rhythm is um in in college students again we mentioned college students they would actually put a rectal probe in when they're doing this and continuously measure their core body temperature as a way of trying to figure out where the circadian rhythm is is how we kind of do it in in the the sleep research but there are more sophisticated ways of doing it that are probably not available to your listeners on a regular basis so trying to figure out where that is is important and you'll probably if you can nail it down to within an hour or two i think that's that's a reasonable thing to do well i guess the taken there for me is let's say you are someone with a relatively stable work routine and a stable lifestyle relatively predictable from week to week then i can see real benefit and knowing [Music] you know what is that time where melatonin starts to rise what is that time where i start to feel sleepy because once you're empowered with that knowledge instead of fighting it you can start to go well maybe i can just shift my lifestyle around it and sort of start to live in harmony with it you can um or you can actually shift it and move it um i think that's that may be well let's let's think of a scenario here let's let's take a probably a very common scenario where somebody goes to bed at 11 o'clock at night uh but they've got to get up at six in the morning because they've got to get to work and they've got a a traffic to take care of and they've got to be to work by seven or eight o'clock in the morning so they go to bed at 11 maybe they don't fall asleep till about 11 30 or so and so they're getting up at six so they're getting less than the seven hours of sleep on a regular basis how is it what what could they do to make sure that they are going to bed at 10. well we already know that if they go to bed at 10 and their circadian rhythm is not ready for sleep till 11 30 they're going to be spending an hour and a half in bed concerned about their insomnia getting anxiety and it may turn into a bigger problem as we've just mentioned so why can't we just simply tell the clock and and turn the clock back as if you will from 11 o'clock to 10 o'clock there are things that we can do to actually shift that circadian rhythm and a lot of that involves light and this is really a major area of research is what this how light affects not only chrono biology or the circadian rhythm but also affects our well-being our mood all sorts of things yeah so what does that look like when a patient comes in to see you and you want to change their light exposure or you want to alter it a little bit to help shift their their rhythm you mentioned i think in our last conversation we spoke about light in the morning you know and i guess at the moment we as humans we we don't get enough light in the daytime we're in sides and we get too much in the evening so what are some of those sort of practical things that you say to your patients to help them change that well and this is this is exactly uh the point so um most as we'll see most patients that i see in my clinic don't have a problem with falling asleep too early they have a problem with falling asleep too late and the reason is as you mentioned is we get far too much light in the evening and not enough light in the morning and that's important because light in the morning advances the circadian rhythm meaning that you'll go to bed earlier you'll feel like you want to go to bed earlier you'll feel like you'll want to go to bed at 10 as opposed to 11 because your circadian rhythm is becoming more advanced it's coming earlier in the day whereas night or exposure of light at night is going to do the opposite it's going to delay your circadian rhythm think about this from a teleological standpoint if your brain is seeing light late at night you're telling your brain it's still daytime i need to adjust my rhythm later because it's still day here at night whereas the other is if you're seeing light in the day early you're saying oh wow the day has already started i need to advance my my circadian rhythm so i can be in in sync with the day and so this is already wired into your brain all you need to do is just apply the appropriate stimulus so what does this mean this means getting up in the morning the first thing that you want to do when you get up in the morning is turn on the lights as brightly as you can any lights in the house anywhere where you are make sure that things are bright make sure the curtains are open if you can even go outside even if it's a cloudy day even a cloudy day anyone who knows photography and f-stops and and apertures will know that even on a cloudy day there's probably more light outside than there is inside the house and so going outside exposing your eyes to bright light i know uh that some of us who live at higher latitudes uh this time of year may not have a lot of light and that's still going outside if it's dark outside then turning on the lights inside the house in that situation would be important the converse is also true so when you get home at night turning down the lights making using the using that option of having dimmers is really nice and turning down the lights as low as you can while still being safe is going to help move your circadian rhythm in a number of ways to make it earlier and so you're going to bed earlier at night you're getting more sleep and you're still able to get up in the morning get to your job and and have a productive day yeah i know i love it roger it's so so clear so practical and i think it really highlights something that many people don't think about the idea that what you do first thing in the morning can absolutely influence the quality of your sleep that night when you're gonna feel sleepy that night often we think about sleep purely in those one or two hours before bed don't we whereas this is beautifully demonstrating that you know a good night's sleep starts the minute you wake up exactly and and so let's let's sort of work backwards and look at a full case here just briefly imagine somebody that has no idea about what's going on has no idea about this they're just basically going along with what the societal pressures are they have a job and they are under a lot of stress this describes a lot of people today they they have to get up at six o'clock in the morning they've got to get to work they go to work they come home um they have kids they have to do their homework with they've got uh bills they have to pay they may have some work from uh to do from work that they are still working on and so they leave the lights on it's bright uh at night and they are doing their work they're getting up to about 10 or 11 they do this for a number of weeks and what's happened during that time is they've shifted their circadian rhythm later as a result of this so now they don't feel tired until 11 or 12 o'clock at night they they start to fall asleep at 11 or 12 o'clock at night um and they're getting up at six in the morning they're not getting enough sleep they feel tired and they say you know what i'm not getting enough sleep i need to go to bed earlier so they they make a point of trying to go to bed at nine or ten at night but because their circadian rhythm is not in link with that they've now caused the situation where they're going to bed they're not able to fall asleep they're becoming more anxious about it their anxiety levels go up and they can't fall asleep and this is sort of a self-fulfilling prophecy and um and so what we have to do this is what i do as a sleep physician is i look at all of this and i say okay this is what we're going to do you're not going to go to bed until 11 o'clock at night because that's when you're going to sleep i de-catastrophize i take away the anxiety and then i ask them to do this light stimulation where they're exposing their eyes to bright light in the morning they're not exposing their eyes to bright light at night we shift the circadian rhythm back now they're getting plenty of sleep they feel better they have more they're more productive and we've just basically done stuff they had no idea that they were doing this to themselves but if we follow some very simple rules of making sure that we're not exposing our eyes to bright light at night making sure that we're shutting down making sure we're doing the opposite in the morning you can see that by consciously pushing back against the societal pressures and making sure that we're protecting those areas we can maintain homeostasis and high productivity and having good sleep yeah i think what a lot of people appreciate about you i mean you have a great way of explaining things simplifying things um for doctors and for the public but you always give a very balanced viewpoint which i've always really warmed to which is this is what the science says that's what i would recommend but i understand that life gets in the way sometimes and you know if you can't do it always don't beat yourself up yeah exactly exactly and for me that just speaks to someone who has got an incredible amount of clinical experience because that is real life isn't it that's not just looking at the science it's also converting that science into something practical for people that they can actually use to improve the way that they feel because that's what it's all about isn't it it's about how do we take that science and convert it into practical action right otherwise we're just basically uh i don't know we're we're putting the the process as the goal instead of using the process as to getting to a goal and the goal is having a healthy life with good quality and that's the key and if we take these rules and make them the the goal then that's not a good quality of life nobody wants to live strictly according to rules uh for no particular reason i mean we're using these as tools the tools aren't what we're trying to do the tools are just ways of getting there i definitely want to get to stress i definitely want to get to the timing of our food intake but before we leave sleep you mentioned a couple of things before the different phases of sleep which we've not discussed and sleep apnea so we've spoken about these rhythms how do they play into these different phases of sleep and and why these different phases so important yeah so if you look at sleep it's not just uh on off switch there are there are different waves that we see in the brain and we've named these parts of sleep based on these waves they're very slow high amplitude waves that we see early on in the night particularly we call this delta wave sleep or slow wave sleep and then we see this part of sleep later on where it's very irregular the respirations are very irregular and the body becomes paralyzed and we call that rapid eye movement sleep or rem sleep and that's we feel that these two are these two types of sleep rem sleep toward the end of the night and slow wave sleep toward the beginning of the night have completely different purposes and they do completely different things slow wave sleep is very physically restorative it's associated with growth hormone secretion this is a very interesting aspect of this particular type of sleep because growth hormone for many years was considered to be the the fountain of youth uh in terms of of what it did it did so many things in our body that was associated with feeling young and and and vibrant and having physical uh prowess that it's this early sleep that's really uh important a lot of research has been going into this aspect of sleep which is slow wave sleep and if you want to get this type of sleep it's it's available to you generally speaking early on in the in the night so again being able to get to bed early being able to get to bed early and have your circadian rhythm ready for you to go to bed early i think that if a lot of people in our audience all of a sudden decided to go to bed early they wouldn't be getting that benefit because what they need to do is simultaneously shift their circadian rhythm back unless of course they're experiencing sleepiness at 10 o'clock at night and just not taking advantage of it but taking advantage of sleep early in the night is is very important now rem sleep on the other hand has potentially completely different aspects we're a little bit less clear on that but we do know that this is where we dream and so how many people in the audience first of all dream number number one number two it's it's usually when you're dreaming it's right before you wake up in the morning and and that goes along with what we know which is rem sleep toward the end of the night it's felt that rem sleep is is not physically restorative like delta wave or slow wave sleep but in fact this is mentally restorative it's a way of repackaging the memories of the day before you may notice that sometimes you dream about things that happen to you the day before or that that day um and that's that could very well be what is what it is that's going on these all have have purpose uh they're doing something we don't know exactly what happens if we don't have it but we do know that as we get older the natural tendency for people as they get older is that slow wave sleep kind of gets less and less and rem sleep kind of gets less and less and what we're left with is this kind of uh generic sleep we call stage two sleep which is okay it's just not going to be as purposeful as we used to get when we were infants you've heard the term sleep like a baby right these babies can sleep like like the dead it's because they're either in slow wave sleep or in rem sleep one or the other and as we get older it's natural for that to happen we also have less sleep efficiency as we get older these are things that normally happen that we can talk about but the point is is that yes we need good quantity of sleep as we talked about seven hours at least and by the way that goes up for school-aged children nine ten hours of sleep in some cases we could all we could talk about secondary education and how that's impacting sleep but that's a different topic we need quantity of sleep but rang we also need quality sleep as well and so making sure that we get the full spectrum and making sure that we're getting slow wave sleep and rem sleep and allowing for that to happen um now what the other thing that you mentioned that we can talk about is sleep apnea which is you know of all of the things that i see in sleep medicine the majority of my time is spent on obstructive sleep apnea we could spend a whole hour talking about it but let me just give you a little bit of a brief synopsis sleep apnea is where when you go to sleep your airway muscles go to sleep and when your airway muscles go to sleep they can contract they can get smaller so that your airway gets smaller when you're breathing in those uh the pressure in the lumen of of your airway this the hole that you're breathing through can sometimes become negative pressure and that's because you're sucking air in and that can sometimes bring the airway so close that it actually touches each other in which case you'll have snoring uh or it'll completely collapse so that no air gets down into your lungs and obviously you can imagine if no air is getting into your lungs for an extended period of time your oxygen levels in your body will drop that will wake up your brain in the brain stem which monitors oxygen and that will then send a signal up to the upper part of your brain to say hey we've got a problem here oxygen levels are dropping that will then cause your brain to arouse out of its sleep and send a very strong sympathetic nervous system to your body to wake up in some sense so that your airway muscles open up air starts to move in again oxygen levels go back up and your body settles down for another cycle of sleep and then the cycle happens again and again over and over and over again the treatment of this is to keep that airway open there's several ways of doing that now we have cpap machines that can open that up masks dental devices that advance the tongue forward because it's a dental device that moves your jaw forward and because your tongue is attached to your jaw that moves forward there's there's many different ways of of treating this you should do this with a physician but the point is is that there's many people out there that don't realize that they have sleep apnea the signs of which could be they're getting enough sleep numerically seven hours of sleep but they still feel tired in the morning they may have morning headaches they generally are obese but they don't have to be they can also have high blood pressure that's treated with multiple medications and still the blood pressure is not coming down these are all sort of underlying signs that sleep apnea may be there and there's emerging evidence pretty sound evidence that sleep apnea is associated with a bunch of outcomes that we don't like heart heart attacks strokes hypertension all sorts of things and that treating the sleep apnea may actually be beneficial at reducing those things in those patients so i put this out there because it's a very common thing and people may have it they may not think that they they may say oh i don't snore i'm not having those problems and so therefore i don't need to worry about it i would say that if you have daytime excessive daytime sleepiness falling asleep very easily just sitting and watching television uh if you're having morning headaches when you get up in the morning um if someone tells you that you stop breathing at night that's that's pretty sure if you're having issues with snoring if you're overweight these are all signs put together that you may have obstructive sleep apnea yeah i really appreciate you sharing that because it may be that someone listening or watching this goes wait a minute that sounds like me maybe i should make an appointment with my daughter go to a sleep clinic or it may be that they recognize it in a family member or a friend who's struggling and i think the information you just shared will allow someone to sort of potentially help someone else in their life as you say it's really really common uh so yeah thank you for that what do you know in sleep apnea in obstructive sleep apnea are particular phases of sleep affected more than others or is it quite variable depending on the patients a good question so the issue with the different phases because we are depending on the tonicity of the airway to try to keep it open because during rem sleep all of these skeletal muscles become very relaxed we typically see the worst sleep apnea during rem sleep and as a result of that we will see that there are major drops in oxygen saturation towards the end of the night when we do these sleep studies as a result they don't last in rem sleep very long and what's very interesting and i see this all the time is we'll have a patient for years and years have have very bad sleep apnea and then we'll make the diagnosis and we'll put them on treatment and it's amazing what you see is it's as if the brain was asking for rem sleep for years and years and years and it's it's kind it's almost like you haven't had your favorite meal in years and then you get to sit down and you eat that and literally the entire night of somebody getting treatment for the first time i've seen basically just rem sleep it's like they've been lacking it for years and it's now just making up for it and i've i've had patients come back and see me after that and they say wow that is that was like the that was the the most amazing night i've sleep of sleep i've had in years sorry interrupts if you are enjoying this content there's loads more just like it on my channel so please do take a moment to press subscribe hit the notification bell and now back to the conversation it's not for everybody but um it certainly uh it certainly happens i can tell you personally that even though my bmi body mass index is in the normal range i have sleep apnea myself and i'm not obese i just that's just the way my neck is this was designed uh it's just my anatomy i i have the genetics that i inherited that make me susceptible to getting a sleep apnea so i i wear a cpap mask and i it's helped me in in talking to my patients as well that i can i can relate to them they can relate to me i'm not doing something to them that i wouldn't do to myself so it's uh it's something that i deal with as well yeah well thank you for sharing that um what is your view on trackers because they're all the rage these days aren't they you know whether it's on your phone or on your ring or on your wrist you know um what what is your view have you got much experience with them and you know are they helpful for most people or are they unhelpful and anxiety-inducing would you say it's exactly the question that i have for these trackers i think the trackers are actually numerically and uh they're very accurate i i don't have any doubts about their ability to measure what they're saying that they're measuring i think they do a very good job at measuring activity at the different types of sleep because they can measure this and the data that i've seen has shown that they they work very well but the question is is really in your question and that's what we've discussed about here is we can talk about how you need sleep how you need to make sure that you're getting enough sleep but the flip side of that is is it anxiety provoking do you become fixated on these numbers and if you're not meeting these numbers does it cause anxiety and cause you to have problems uh falling asleep the type of person that would go out and buy a tracker someone that would look at and seeing whether or not they're sleeping it's the type of person who's actually worried about their sleeping and so i i have the same concern i think that you do in that if you're out there and you're placing too much emphasis on the on the numbers you can miss the forest for the trees and increase anxiety and as a result of that actually be counterproductive yeah i agree and and it reminds me a bit of blood pressure monitors because i find with my patients who ask me doctor should i get a home blood pressure monitor well for some patients it's the best thing in the world they do it once a week or twice a week it motivates them to stay on board with their lifestyle changes when it starts to creep up but for the other half they're looking at it four times a day and they're getting anxious each time and that's sending their blood pressure up and making them even worse and so i kind of feel that as technology gets better and better i think there is a potential problem i think many people have these trackers and they're actually they can be great i have got one you know i have used an aura ring i i go for months without wearing it but then i'll put it on again for a couple of weeks but if i wear it for too long you know you can find yourself getting a bit obsessed with you know what is the number or sometimes you think you've had a great night's sleep and you feel good and you see a really poor score and it makes you feel bad or the other way around is you haven't had a good night's sleep you know i guess there's many ways to interpret it i kind of feel it depends on the individual because some people probably can use it in a very helpful way um so but but i think it's a i think it's a point that we need to be discussing a lot more across medicine across society you know how good are these trackers are they helpful or are they unhelpful yeah it's it's true and another example i can i can say on on a on a continuum is these trackers that can measure your heart's rhythm and and for most people they can look at that heart rhythm they wouldn't know you know a p wave from a t wave um which is probably good because there's a little bit of distance but for those that want to know um i think that's fine where i i think that's it's a great idea is it can detect atrial fibrillation which of course is a risk factor for stroke and alert the patient to that as well so i think it depends on how it's done if if there's a lot of numbers that you can get wrapped up in it may not be a good thing because you get fixated on these numbers that by themselves may not have the clinical meaning that uh that that you might think they do well we've spent a lot of time discussing sleep and its role in inflammation i really want to move on now to stress if um if that's okay because you know stress is this big catch-all term isn't it you know uh we know that many people are feeling incredibly stressed they were actually even in 2018 2019 even back then the world health organization called stress the health epidemic of the 21st century of course since then there has been another event which has taken over the world um so when we're looking at inflammation how does stress fit into that what does the science tell us oh the connection is is is very tight unfortunately so stress as we mentioned is uh or inflammation as i'm sorry as we mentioned is this kind of this smoke or this fire or this construction that has to happen uh whether or not uh you know has to happen in our bodies to make sure that we're doing the processes that we're doing but we don't want it for longer than that if we look at stress and see its effects with inflammation the the it becomes very apparent very quickly so there's a number of of researchers to give you an example here uh at in pittsburgh that looked at stress and inflammation and and the immunity specifically how this affects immunity because i think that's a big thing as well we all know about cortisol cortisol is a hormone in the body that gets released during stressful situations it's a stress hormone um and i want to make sure that i'm using the word stress here appropriately there is stress that we feel mentally and there is stress that's going on in the body and i want to make sure that when we talk about stress we're talking about that specifically so when there is stress in the body physically there is that stress hormone cortisol which is released from the adrenal gland and one of the physiological downstream effects of cortisol uh they found was a way that it shifts the number of white blood cells there's there's different types of white blood cells not to get too technical there are white blood cells called neutrophils and there are white blood cells called lymphocytes and the ratio of these two uh to give you an example changes when cortisol levels go up there's supposed to be more neutrophils when cortisol levels go up and this is a natural response that is mediated through the cortisol receptor so cortisol hits the receptor this receptor then causes this downstream effect of neutrophils going up and lymphocytes going down what they found these researchers was that when this happened if the subject was under a lot of mental stress so stress from every day stress from a wedding a divorce a loss of a job a gain of a job it doesn't matter any kind of stress that they no longer saw neutrophils going up and lymphocytes going down there was a completely blunted response and what they determined was is that the receptor was no longer transmitting the the the signal of that cortisol binding to it in other words this was known as cortisol receptor resistance this receptor resistance was the result of stress and not only were there uh straight uh effects from stress in that situation but there was also issues in terms of infection so what they did was they took these subjects that had a blunted response and then they subjected them to rhinovirus which is basically a common virus that causes a common cold and what they found was that cold symptoms appeared more commonly in those patients that had this blunted response in other words this cortisol receptor resistance so here is direct evidence that people something that we know all all the time we know this innately we know that if you're under stress you're more likely to get infected but we can actually see now the results of where cortisol is supposed to have a downstream effect this downstream effect is gotten rid of and it's exactly in these patients who have stress that gets rid of this downstream effect because of receptor resistance that causes these people to have more symptoms of the rhinovirus infection so here's an example where inflammation stress immunity all sort of come together and cause this kind of interaction yeah super fascinating and i guess for many people they are becoming more and more familiar with this idea of insulin resistance that this hormone that does many things including keeping your blood sugar stable if we insult the body you know year after year with highly processed foods pro-inflammatory foods all kinds of things then actually the the body becomes resistant to that hormone but the way you just describe that study is it's sort of saying it's sort of saying it's the same thing for stress we can become resistant to stress hormone you know the receptor it just doesn't work as well so if we're using if we're exposing ourselves to too much stress then that the response in the body starts to get blunted and i think i think that's something that's not commonly known because many of us think we can get away with pushing it every single day every single week month after month but you're showing with just that one study and i know there are many others that it has a direct response on your immune system a direct response on how inflamed you are so managing stress is clearly another key strategy at trying to keep our inflammation levels down exactly and let me just add to that because we think of it in terms of infections things from coming from the outside to infect our bodies and how to fight those things from the outside there are other things that our immune system has to deal with on a daily basis it has to deal with basically the garbage that our cells make in fact cells become damaged and those cells that become damaged have to be dealt with and if they're not dealt with these damaged cells accumulate and it looks our body starts to look like a trash dump if our immune system is not taking away the trash taking away the dead cells so that new cells can replace it we have a problem there as well so imagine somebody with chronic stress imagine someone who's not allowing their immune system to do the things that it needs to do our body cells instead of being brand new ready to go off the assembly line we're dealing with last year's version version 1.0 because our immune system hasn't dealt with these damaged cells and so this is something that goes on all the time in our body and our body sets certain times we'll talk more about this when we talk about time restricted feeding there are certain times that are scheduled in our body for these processes to occur their body sets aside time based on these clocks that are in every cell that is run by the suprachiasmatic nucleus that says okay we're awake we're doing stuff this is not the time to put out the trash this is not the time to have janitorial coming in after business hours we need to work work work work but then when the time comes to allow janitorial to come in to allow our immune system to go in and see what needs to be taken down and broken down so that new things can take their place if we're not allowing that to happen why would we believe that those things are going to go away on their own they don't and and we need to have that time to be able to do that what about a different kind of stress fear fear itself is not necessarily a helpful thing for your immune system to work well so are you familiar with any research on fear and how that plays into our immune system oh yeah i'm reminded of a really interesting study that uh was done by uh jennifer heiss at the mcmaster university where she took students that were in the last six weeks of their term and uh boy if you wanna if you wanna incite fear think about this here you're a college student you're at the end of the term six weeks to go you have your major exams your career is based on on getting a good grade in college and you're good grading colleges based on doing well there's fear there uh there there is anxiety there's no question about it and and what they did was they randomized these students at mcmaster university to three different uh three different groups there was one group where they did nothing it was just you know do whatever you want to do and study for your exams and the second group was a low intensity exercise or moderate intensity exercise group where they exercise three times a week and uh they they got their heart rate up to about 75 of their maximum predicted heart rate for those that don't know your maximum predicted heart rate is 220 minus your age and so if you take that number multiply it by 0.75 that's kind of where they would get their heart rates up to and they did it for about 20 minutes a day three times a week for six weeks the last six weeks of the term and then in the in the third group they did the same thing as they did in the first group the second group moderate exercise except instead of moderate exercise they did high-intensity exercise still 20 minutes a day still three times a week except they got their heart rates almost close to about a hundred percent of their heart rate so very intense exercise and then what they did was they looked at depression scores so the beck inventory depression score 2 which is a very well validated uh inventory depression score they also looked at cytokines so they looked at il-6 they looked at tumor necrosis factor alpha and they measured these in these three groups so what do you think happened the first thing that was really interesting to me in this study was when they looked at the control group the control group went from about well there was a change of about six points in the beck inventory depression scale score what does that tell you that tells you that after six weeks of immersing yourself in a stressful situation where your career where your livelihood is dependent on a score you can quickly become depressed uh in that kind of a situation just in six weeks now we're headed into our second year of this pandemic and so it should be no surprise to people that all of the things just with just the coronavirus itself family members also what's going on with at the government level internationally politics all of this sort of stuff that we're going to have some major issues with depression as a result of fair and anxiety there's a well-established connection between fear anxiety leading to depression and we saw that very clearly in this study in terms of in this control group there was also increases in tumor necrosis factor and there was also a drop in il-6 which is one of the uh one of the cytokines that's involved with fighting infections but let's look at the other two groups moderate intensity and and severe intensity or a high intensity exercise which one of those two do you believe did better in terms of mitigating the effects of fear and anxiety well it was some it was the it was the moderate intensity group the moderate intensity group not only did not have an increase in depression they actually had a reduction in depression actually went in the other direction in other words in the moderate intensity exercise group actually also in the uh in the high intensity exercise group they had a reduction in their back depression inventory scale score so what do we learn we learned that exercise is really important in situations where you have chronic fear and anxiety it can do a tremendous amount in terms of your mental well-being and also your physical well-being but in terms of anxiety and perceived stress so when you asked the subject do you feel like you're under stress the moderate intensity exercise group actually did better than the high intensity exercise group and that was actually the same for the cytokines the reduction in tumor necrosis factor alpha was greatest in the moderate intensity exercise group and what was what jennifer high showed here in this study is something that we have known for years in the high athletes population so the the elite athlete population the population of athletes that go to the olympics we've known this for a very long time and that is this that people with high intensity exercise have actually higher levels of stress have higher levels of inflammation have higher levels of of stress hormones than those in the low and moderate intensity groups and so as a result of this there has been a number of of papers of research that has been published on how to mitigate the infection risks in these high intensity athletes think about this this is this is not political this is not uh there's no agenda here the only agenda is that these governments want to send their athletes to the olympics to win the gold medal and when you know a hundredth of a second can make the difference between a gold medal and not even getting on the podium they're going to stick with the science and what the science says is that you've got to make sure that everything is well timed everything is uh as well versed you have to make sure that you have time for rest and we could go over the the studies and the recommendations but many many papers have looked at this very stressful group uh these high intensity athletes and what you'll see is the recommendations there are the same recommendations that we've given so far on this podcast in terms of sleep in terms of making sure that we avoid infections in terms of making sure that we're getting enough you know nutrition diets all of these sorts of things but but the point here that i want to make about getting back to your first question which is about fear and anxiety is one of the major prescriptions that i would advocate for for everybody at this point is to get out and to exercise there's this j-hook uh this j-curve i should say um uh approach whereas we're all if you can imagine the letter j okay and we're at the very beginning of that letter j we're all couch potatoes sitting on our couch watching television watching um the news channels talk about how everything is going downhill that's not a good place to be as soon as you get off the couch and start exercising and start doing something 20 minutes a day three times a week you're gonna go down the j goes down okay and as a result of that your influence inflammation goes down your uh your your well-being improves your back inventory depression scale scores start to improve as it reaches a certain point though that if you start to do more intense exercise you could actually get some reversal of that improvement where it goes back up and even higher as you would see in these high intensity groups ranging this this explains why sometimes we hear about people being in the hospital from covid and we say well they were a marathon runner i mean these are you know marathon runners yes these are the people that are at actually at most risk why because they have chronic inflammation going on in their body because they are exerting themselves so much so the key here is what is a good recipe for fear and anxiety among other things number one moderate exercise don't feel like you've got this huge barrier that you've got to overcome and be like these elite athletes that you see on television no just getting up off the couch and and having a regular routine is so important thank you for sharing all that because i think it's such a key point isn't it when we talk about movement and physical activity for health it's like well how much do i need to run a marathon do i need to be hitting the gym high intensity you know for one hour sessions five times a week no the research that you're sharing is saying that actually you don't have to do that you just need to get up move go for a brisk walk maybe 20 30 minutes three times a week you can get a lot of the benefits from doing that so i hope that is really empowering for people who may feel that they don't have time money inclination to go you know and really push it and i guess that really speaks to one of the wider problems we have now in terms of health messaging is you know for all the benefits social media does have in terms of sharing health information sometimes we can feel as though we're not doing enough or that you know a 20-minute walk three times a week is not enough because this influencer is killing it for an hour every single day right so i think that really puts a bit of perspective for people it really gives some encouragement and i don't know how you found this roger um one thing i've always tried to do with my patients is help them understand what is the right dose of exercise for them to help them with their physical health their mental health reducing stress reducing anxiety in the context of their lifestyle you know are they killing it at work they're not getting enough sleep every night yet they're still trying to push it really hard in the gym or you know because often i say well look maybe you're much better off with yoga two or three times a week to help you balance all that excess stress that's in your life whereas someone else may may be okay pushing it a bit harder because they don't have let's say a hugely stressful life or they have time to get eight hours of sleep at night so it is quite nuanced isn't it really when it comes down to each individual it is and i can tell you being a physician i see people all the time that simply just can't walk for 20 minutes a day either because they have joint problems knee problems or or things of that nature there are ways of getting around that so if you if you can't walk how about a stationary bicycle you don't have to worry about balance you don't have to worry about falling over you get on on on the stationary bicycle if you can if you can have access to one a lot of of places have access to gyms if you if you can do this and you can simply you know put your feet on those pedals and turn them for 20 minutes uh you know obviously if you have a heart condition you want to make sure that you get cleared by your physician uh first before you do that but um but there are a lot of things you can do there's even and i i you know we probably don't have time to get into this too much but i'm i'm interested in looking at the cardiovascular equivalence of perhaps even using a sauna or using a spa it's well known that when you get into these into these hot uh tubs or into these saunas that that raises the heart rate and it raises circulation it may have the same benefits uh in terms of that for those people that can't exercise yeah fascinating we'll save that for another time because that sounds really really interesting so so far we've we've talked about sleep you've given some practical advice on sleep we mentioned stress and fear you've mentioned how um moderate exercise can absolutely massively reduce your risk of getting infections improve how your immune system functions improve your well-being before we get onto food then to finish off what other things can people do or do you recommend to help them reduce that stress in their life which of course can be very very hard yeah i mean it so so the question is is why do we have fear in the in the first place and if you you know and i'm i'm informed a little bit by by my upbringing as well is is being able to have a place to put those kinds of burdens so there's the spiritual aspect which is well known in medicine um and and what we do and and having that ability to to rest so as a seventh-day adventist i take a day off a week uh where i basically disconnect from all of the the the the worries of work and all of these sorts of things and i would i can't see why anyone wouldn't do that i mean a lot of times we have to do things there's stuff that has to be done outside and that list never goes away there's never a point in my life where my work cue is zero and i can say i'm done i can go away and so if you're waiting for that period of time where your work cue is is is done uh to be able to just relax and detach guess what you're never gonna have that your you as a human being are gonna have to take the initiative and say here's a period of time during which i am not going to be working in my work queue and i'm going to be able to disconnect from society and actually take care of myself and have a a place where i can develop um you know whether it's spirituality or religion religiosity these sorts of things where i can improve my family relationships these are so important when when we look at the research people who do well people who live longer if you look at the the research that dan buettner has done um with the blue zones i mean there is there's always a connection of community it's not just your immune system it's not just your sleep it's also your connection to people around you knowing that there's a a support system there knowing that there are people that can help you um this is so important we we are you know there's this expression no man is an island unto himself and so from this we look at the community we look at uh our connections to people outside of ourselves we look at our parents our children our our relatives our you know our spiritual leaders our god whatever that is in each one of our lives and making sure that we have time for that that has a tremendous effect on our ability to process fear of being able to process um you know anxiety and actually there are practical ways that that can be helpful uh obviously if there's a specific problem that you don't know how to deal with if you're part of a community maybe that can be helpful in actually taking care of the problem but if it can't you know we know that people who have uh diseases they do better when they're in support groups with people with the same disease so uh i think this is a huge area that uh for some people is is obvious for others are not so obvious and so i'm glad that you uh you you uh pointed that out and and asked that question because i think that there's a tremendous amount of benefit that can be gotten from that type of program the other thing that i would i would mention we mentioned this last time as well is this whole idea about circadian rhythms and our ability to make sure that we're doing what we're doing we've talked about the circadian rhythm there's also this um circuseptin rhythm where we've talked about last time where and scientists have looked at this the biology where there is whether it's our heart rate whether it's our our body temperature there is this seven day cycle that's sort of built into our cells and built into our body and and we don't know why this is the fact but uh for some reason we seem to go every seven days i mean i have my ideas spiritually about why that's the case uh but if you look in nature there seems to be this need for every seven days to take a break uh no matter what culture it is i love that it's so so interesting and i really appreciate you sharing your own upbringing and your own culture because of course culture plays into health massively in terms of our understanding our practices what we consider normal and it again speaks to society and how society is in many ways working against us we we've kind of had these periods of downtime eroded out of our lives so it takes people like you to have a really strong upbringing culture to fight against that i remember as a kid that the supermarkets weren't open on a sunday you couldn't go and buy your shopping on a sunday so you everyone knew you had to get all the shopping done before sunday was a family day right you're not out and now we've got i'm sure it's you know probably coming from america but malls that are open 24 hours a day seven days a week you know you can shop wherever you want every any day we don't have that natural downtime built in so i think it's a great point i really appreciate you sharing that and i think that fits nicely to the final sort of point of discussion at least for this conversation which is timing of food intake again we're talking about inflammation i guess the immune system is absolutely linked with inflammation um you shared some of your philosophy around diets last time but instead of focusing on what we eat i thought this time we could focus on when we're eating and what the benefits are when we eat in certain time periods yeah this is uh this is probably more than anything we've talked about today a game changer because this is relatively new information as you as you mentioned uh uh some of the the research that's been coming out and it goes along with exactly what we've been talking about it's what we're about to talk about now is not what we're eating we've we've talked about that and many people have talked about that it's simply when you're eating that can have a tremendous impact and it goes again about what we're talking about where there's certain times of the day that your body is quote taking out the trash if you want to put it specifically and if you're doing something that never allows your body to take out the trash why would we expect the trash to be taken out and so what what we're talking about here is a term that's been used intermittent fasting i prefer time restricted feeding as as a as an answer and what we're really saying here is that are we allowing our bodies to be in an unfed state long enough to do what it needs to be doing so let's let's talk a little bit about this when you eat something obviously you're eating it takes you about maybe half an hour or an hour to eat and then after you're done eating the the thing that you've got to understand is that your body is now completely different in terms of the metabolism in terms of the proteins that are being activated than it was before you ate that food and it will stay in that quote fed state for a good two three four hours um until you stop eating and then and then after about two or three four hours it then starts to go back into its quote unfed state and so you can think about this in terms of two states your body has a fed state and it has an unfed state and obviously we need to eat we need to get calories but if we spread the meals out in the day so that they're very far apart and we never allow our body to go into its unfed state we extend the fed state of our 24 hours and we limit the unfed state well what we're finding out is that that has tremendous consequences as we talked about before when you eat there are certain proteins proteins that regulate uh glucose proteins that regulate appetite things that regulate metabolism inflammation obesity fats proteins how all of these things are are dealt with blood flow to the stomach these are just just some of the few things that we're talking about when those things are constantly been left on there are certain metabolic problems that occur so imagine uh someone who grazes every day they've got snacks out and they eat and they eat constantly they've got this they're constantly putting things in their mouth they are essentially feeding the entire day and the only time that they don't feed is when they're sleeping at night so let's talk about since we don't have a lot of time let's talk about what are the things that is emerging what is the emerging data the emerging data is that having a a restricted time of the day where you eat and outside of that where you don't eat any calories so what what could you do outside of that time you could drink water because there's no calories in water you could even put some lemon in the water if you wanted to i think that's that's fine but not eating any calories as soon as you would have calories you're breaking your fast what we're noticing is that if we restrict that period of time to about eight or ten hours a day then we start to see some amazing things in terms of transformation in the body in terms of metabolic improvement in terms of improvement with inflammation in terms of actually according to a new study that came out of china reducing even hemoglobin a1cs in diabetes so there's there's just tremendous uh amounts of of information you tell me where you want to go and what you want to talk about well i mean that's fine super fascinating i appreciate you sharing that it's it's so simple isn't it actually at its core what you're talking about there it's like basically saying that we're not designed to constantly be digesting foods that's kind of it in a nutshell isn't it really we need these periods of time where the body is able to focus on other things rather than just digesting yet it seems like such an alien concept in this modern culture where we you know eat so much so regularly so late in the evening as well and this is something actually roger i've been utilizing with my own patients for many years now and um you know initially there was only really animal studies there to suggest that this could work well and with some patients i thought well there seems to be a reasonable amount of evidence i can't really see the harm here to try this with some of my patients and i would see incredible improvements whether it's in reducing weight blood sugar control sometimes sleep quality gets better sometimes when people are practicing time restricted eating irritable bowel syndrome symptoms can often get better so from a practical perspective i've seen huge improvements um specifically around inflammation then which is the sort of broad topic of this conversation although we have you know gone into quite a few different areas do you see value with time-restricted eating specifically for inflammation and immune function as well oh yeah absolutely so um in terms of of inflammation let's look at the surrogates of diabetes hemoglobin a1c because that is one of the manifestations of of inflammation as i mentioned this study that recently was just published out of china looked at a number of patients that were randomized this was a randomized controlled trial and they tried to blind it as much as they possibly could obviously the the subjects knew uh what arm they were in but the people assessing them uh were were blinded as to which arm they were in the arm was hey look eat as much as you want any time of day and and we'll see how things go these were diabetics these were people with already diagnosed diabetes and as we know with diabetes there's amazing amounts of unfortunate inflammation that can cause coronary disease that can cause heart attacks strokes all sorts of problems and then the other group the intervention group they said look we're going to limit your meals to just 10 hours a day and that actually is is pretty good because i've seen studies where they did it to eight hours a day but no they did it 10 hours a day and they specifically allowed them to eat from eight o'clock in the morning until 6 p.m okay so that's that's reasonable now now again that means that their first bit of food that they had in the morning was no no not before 8 o'clock in the morning and they were basically asked to eat well before six o'clock so that they're sort of fed state they were done by uh six o'clock and so you've got now from six o'clock it in the evening all the way through to eight o'clock the next morning where there's no food there's not even a snack nothing nothing goes into your mouth except for water and maybe a little bit of of lemon juice if you wanted to have that with it but no calories whatsoever so what they found was astounding they were allowed to eat as much as they wanted they just had to eat it between these hours and what they found was that there was a drop a 20 drop in the hemoglobin a1c let me let me explain what the hemoglobin a1c is it's a it's a measure somebody has elevated glucose for for a period of time that glucose can bind with the hemoglobin and stay on there and we use that in medicine to measure the average blood sugar over the last three to four months in these patients so this was a study that went over about a 12-week period of time so in 12 weeks these patients these subjects in this study were able to drop their hemoglobin a1c by 20 that's more than medications could do alone that's that's the effects of just we're not even saying to change your diet they didn't say to change their diet they didn't say to change the amount of food they were eating they just asked them to eat it more concentrated in the day and have a longer period of time where there was no food going into the mouth i think that's astounding it is incredible and you know the big thing i think as you describe that is coming full circle to the start of our conversation it doesn't cost any money for people does it it's like it's potentially saving them a bit of money because they're snacking less in the evening um but it's not necessarily it's not only the money it's that it's not necessarily requiring a huge lifestyle upheaval a brand new diet i need to learn to cook new new foods it's like saying okay well hold on a minute maybe don't worry about that at the moment just keep eating what you're eating just change the window in which you're eating it and i think it's it's got such potential a message like that i'm like you i prefer the term time restricted eating to intermittent fasting because i kind of feel interested in fasting it's a bit confusing sometimes you know what does it actually mean whereas time results in eating i think can be very very clear what sort of recommendations do you make if you've started making these recommendations with your patients when it comes to time restricted eating yeah it and it's really um it's really important to be able to look at their lifestyle so for me some weeks i'm in the intensive care units um from seven o'clock in the morning to seven o'clock at night i don't get home till late and so you don't want to be shifting this around you want to sort of pick something and go with it so there's really two variants of this and here are the rules number one is you don't want to have your feeding anywhere close to the time that you're sleeping um that's that's the important thing there and usually you want it maybe a good three to four hours um before you go to bed so eating close to the time that you go to bed is not a good idea for a number of reasons if you eat close to the time that you go to bed that can increase the risk of gastroesophageal reflux it can increase the risk of aspiration and also has issues here so the two ways is either having breakfast very early in the morning uh maybe about an hour or two after you get up um and that's hard to do depending on when you get up uh and then having a a lunch or a very early dinner or you flip it the other way around and say that you're going to skip breakfast have a lunch being the first meal of the day at around 12 and then eating relatively early in the evening early enough like maybe around six or seven so you're well within that eight to ten hour window but then give you at least three hours before you go to bed at night i think those are the two uh systems that seem to make the most sense from a from a practical standpoint that is going to be most common but everybody's got to sort of figure this out for themselves and see what works for them this is the thing it's it's very personal yeah i completely agree i think the research in this area is simply just growing by the week in terms of the potential benefits but then it's converting that and going okay well i know the kind of 8 a.m till 6 p.m um window work for my friend bob but actually that ain't gonna work for me there's no way that's gonna work with my school run kids job and i i kind of feel most people are able to find something that works for them in the context of their lifestyle so it's definitely worth people experimenting um roger i want to thank you once again you're so generous with your time of course you make fabulous videos for people on medcram where you're trying to educate the public and doctors about all kinds of aspects relating to our health you have a brilliant way of simplifying information and sharing with people so i want to thank you once again for that just to finish off today then we've been talking about inflammation we've been talking about i guess primarily these four pillars sleep stress exercise and foods have you got any final words of wisdom for people who are watching or listening and thinking you know i'm worried about chronic inflammation i don't want to get sick when i get older what are some of the sort of top things that i can do and focus on to keep me well yeah so let's just let's just review some of those things is making sure that you're getting bright light exposure in the morning making sure that you are not getting bright light exposure in the evening this is going to allow your circadian rhythm to to advance and allow you to get that sleep that you're going to need and not have the anxiety of not falling asleep at night is making sure that you're restricting your feeding or i should say eating to um 10 hours at 8 to 10 hours if you haven't done so already making sure that you're looking at your personal um schedule and incorporating exercise somewhere better to do it in the morning if possible but in the in the evening time is better than not doing it all i think exercise is really important it also helps with sleep as well we've also talked about mental stress and especially now that we're going into this period of time again potentially with the pandemic and and all of the things associated with it all the things that are going around in the world is making sure that you're part of a community making sure that you're giving time for yourself to rest and to recuperate and to recover because nobody is going to do that there's a lot of demands that are being asked of you especially if you're in a productive environment if you're at a job no one's ever going to say hey you need to take some time off you need to make some time for that yourself otherwise it's not going to happen so i think those are the low-hanging fruit there rangan it's uh it's um it's up to us to do it and here's the other thing is we have to make sure and you'll notice this in a lot of these things that we've talked about today is that our frontal lobes have to be able to sort of say yes and no we have to sort of take control of the situation otherwise society is gonna it's gonna sway us back and forth we have to be able to say no i'm not going to eat during these hours because i need to do my time restricted eating no i'm not going to get up and and look at television or look at the thing because this is not the right thing to do so for those of us that have that very strong internal locus of control these are the things that we can do for a lot of us and you know i may be one of those we don't have a very strong internal locus of control what we can do is we can talk to our loved ones our spouses our friends and say hey this is what i want to do hold me accountable make sure i'm doing these things because i think we all want to do it but sometimes as they say the uh the spirit is willing but the flesh is weak yeah as you say no man is an island we're gonna all need help from time to time a little help from our friends a little bit of help from our community roger thank you for all the incredible work you're doing my audience absolutely love what you have to share and i really look forward to the day where we get together in person yeah i'm looking forward to that as well that'll involve a transatlantic trip but i think it'll be well worth it if you enjoyed that conversation all about inflammation i think you are really going to enjoy this one four things that you can focus on to help prevent disease it's like a vaccination and natural vaccination great blood flow there is no cortisol no oxidative stress going on this is the way nature manager be

Channel: Dr Rangan Chatterjee

Views: 813,633

Keywords: the4pillarplan, thestresssolution, feelbetterin5, wellness, drchatterjee, feelbetterlivemore, ranganchatterjee, 4pillars, drchatterjee podcast, health tips, nutrition tips, health hacks, live longer, age in reverse, self help, self improvement, self development, personal development, motivation, inspiration, health interview

Id: 63synatP-D4

Length: 107min 21sec (6441 seconds)

Published: Thu Dec 16 2021