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

1. 0:00 – 3:31

   What Inflammation Is and Why It Isn't Simply Bad

   1. RCDr. Rangan Chatterjee0:00

      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?

   2. RSRoger Seheult0:25

      Yeah, I think probably the best way to put it in terms that a lot of people, a lot, many people can grasp what inflammation is, i- inflammation, I see it as, uh, 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. Uh, it- 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 wanna make there is that inflammation is simply a sign that something is going on, something is... A, a process is occurring in the body, whether it's fighting a, a, an infection. And if that infection is not being cleared up, then that inflammation will be chronic. Uh, imagine, uh, [laughs] imagine construction. W- I live in Southern California, and it seems as though there's always road construction going on here in, in, uh, 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. Um, if I put it in terms of, of the body, uh, whether or not there's an infection, there's inflammation. Whether or not there are cells that are damaged and those cells are being, um, uh, repaired by your immune system, there's gonna be inflammation. A- 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 wanna have it excessively. You don't wanna have it more than you need to have. A- and so it's, it's a tricky situation. You wanna have the inflammation that you need to have to do the things that you wanna do, like if you wanna build a house you have to have construction and something that goes along with it. But on the other hand, as soon as you don't need it, you want it gone.

   3. RCDr. Rangan Chatterjee2:13

      Yeah.

   4. RSRoger Seheult2:13

      And, um, and, and that's really important. And there are processes that we're gonna talk about in this, in this, uh, podcast that are going to show how we can have these processes occur and, and have the inflammation go away when we don't need it so that it doesn't lead to these diseases.

   5. RCDr. Rangan Chatterjee2:32

      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? Uh, and I think it's... I, 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.

   6. RSRoger Seheult3:06

      It, 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, [laughs] and everything fat and lipids was bad, but what 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, are, uh, you know, essential fatty acids and you need them in moderation. So it's, it's, you're right, it's much more nuanced.

2. 3:31 – 10:00

   Sleep Quantity, Circadian Rhythm and Light

   1. RCDr. Rangan Chatterjee3:31

      In terms of the lifestyle things that we can try and focus on to help reduce inappropriate inflammation in our bodies, um, a framework I often use is what I call my 4 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 world, they're 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. And 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?

   2. RSRoger Seheult4:27

      Yeah, this is, this is really big. Um, so I'm a, a sleep, a certified physician. Uh, in the United States we're boarded in sleep medicine, and, uh, I, I did some extra training to do that. I'm also a pulmonary and critical care specialist and, uh, boarded in internal medicine. I have a practice, a cl- 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, it's, it's this sort of pigeonholed, 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, uh, 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, uh, in the Western world is that people that want to sleep but they, they just, the, aren't getting enough of it, and it's because they choose not to. Um, a- and of course there's people that will be listening to this and say, "Well, what about me? I, I wanna sleep more, but I just can't fall asleep." And those are people we call insomniacs, and we can talk about, uh, ways to handle that as well, but it, 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, a very important process. We are just now finding out in the last 20, 30 years now in terms of research that's very solid that if people don't get enough sleep- The processes in their body are just not gonna be completed that need to happen. Um, 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, 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, uh, 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 gonna have problems where you're gonna want to try to go to sleep, but your body is not gonna be ready for sleep. Now, l- let me tell you what probably the most common problem is with circadian rhythms. Circadian rhythms, which I, as I mentioned, are, uh, regulated in this suprachiasmatic 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, I don't wanna use too much because it, 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, uh, or you had to start a fire. These were things that were, you know, pretty involved. Now, it's just the flip of a switch. It's turning on the television. And the, 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 10:00 or 11:00, or 8:00 or 9:00, 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, uh, it would be great if we could just sleep in later, but the, uh, 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, a 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 they're not going to bed late. And as a, 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. Uh, 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.

   3. RCDr. Rangan Chatterjee9:27

      Yeah.

   4. RSRoger Seheult9:27

      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, Rangan, is, is the number and amount of hours of sleep that you should get if you're able to get this. And the, 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.

3. 10:00 – 13:49

   What Sleep Loss Does to the Body and Inflammation

   1. RCDr. Rangan Chatterjee10:00

      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?

   2. RSRoger Seheult10:08

      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, um, or what happens if we don't get that sleep. So let's put it that way. Uh, 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. Um, but what they did was they-

   3. RCDr. Rangan Chatterjee10:34

      With a bit of extra cash.

   4. RSRoger Seheult10:34

      E- exactly, exactly. Um, so what they did was they, 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. Uh, w- we call that an all-nighter here in the US. 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 a all-nighter. They'll cram as much, uh, information into their brain as possible. And, um, they measured hundreds of different, uh, proteins, uh, and, and, um, uh, 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, bas- basically every cell of your body and tells your body when to produce things and when not to produce things. And, and, uh, you know, generally, proteins have this circadian rhythm 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. Um, immune proteins that are involved with fighting cancer. All of these things were completely put out of whack by just pulling one all-nighter. Um, and so the, the question is, is if this is happening on a regular basis, are there effects downstream? A- and we already know the answers to these, uh, uh... ... questions. We know that people who are night shift workers over many, many years can have increased risks of cancer and increased metabolic problems. So the question you, you ask is, why do we need seven hours of sleep? I, I can't tell you, uh, aesthetically, uh, you know, uh, 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, uh, it's, there's, there's sort of, uh, 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 gotta clean up, otherwise you're gonna come back the next day to a mess. And what that cleanup is, kinda 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, uh, that were building up in, in patients just, uh, as a normal run of the day, if you didn't get enough sleep, there was a, a s- 5%, 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 gonna 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, uh, among other things as well, but, but these are the aspects that we're talking about.

   5. RCDr. Rangan Chatterjee13:49

      Uh,

4. 13:49 – 25:08

   Insomnia, Anxiety and Not Stressing About Sleep

   1. RCDr. Rangan Chatterjee13:49

      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?

   2. RSRoger Seheult14:02

      Absolutely, yeah. So, um, uh, you know, IL6, tumor necrosis factor, these are... You'll, you'll hear these be mentioned again and again. These are surrogates for inflammation.

   3. RCDr. Rangan Chatterjee14:11

      Yeah.

   4. RSRoger Seheult14:11

      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 a signal that this is not a good situation.

   5. RCDr. Rangan Chatterjee14:26

      Yeah. And I guess the whole, you know, the, the underlying theme of this conversation is inflammation, uh, how do we prevent chronic unresolved inflammation going on in the body, which in turn is gonna help reduce the likelihood that we're gonna 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, and I guess at this point, Roger, I think it's worth just really pausing on two points, because something I've learnt 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 it's happened in the past. Um, you know, young mothers, young parents who are unable to sleep 'cause 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, "W- Are you saying that my job's gonna 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 wanna share information, we want people to prioritize their sleep, lower their inflammatory burden, but at the same time, we've gotta be careful, don't we, that we don't stress people who can't sleep out?

   6. RSRoger Seheult15:48

      Oh, I can't agree with you more. In fact, this is exactly where I was gonna go next, and, and it seems like our minds are, are-

   7. RCDr. Rangan Chatterjee15:53

      Yeah

   8. RSRoger Seheult15:54

      ... 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, 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, uh, for those that can't sleep, is, is the, um, the, 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, uh, you know, a, a wedding or a divorce or a, a, 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. Um, and then, but here's the key. The key point are per- 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, uh, meaning it's their brain. It's what they're actually-

   9. RCDr. Rangan Chatterjee17:20

      Yeah

   10. RSRoger Seheult17:20

       ... trying to think. I'll, I'll give you an example. Imagine, uh, you were asked to go onto stage, uh, at Carnegie Hall. I guess in, in Great Britain it would be, uh, the Royal Albert Hall.

   11. RCDr. Rangan Chatterjee17:30

       Yeah.

   12. RSRoger Seheult17:30

       Imagine you're about to go onto Royal Albert Hall, and you're being asked to play a Beethoven sonata. Uh, imagine the stress involved with that. It's on television. You're, you're there. Perhaps even the Queen is there listening.

   13. RCDr. Rangan Chatterjee17:42

       [laughs]

   14. RSRoger Seheult17:43

       Um, [laughs] you know, the stress. Now, now i- 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.

   15. RCDr. Rangan Chatterjee17:53

       [laughs]

   16. RSRoger Seheult17:53

       It's not gonna happen. A- and this is exactly what a lot of people are having to do, and I see this all the time, uh, practically speaking, in patients that come to see me. They say, "Doc, I, I'm in the kitchen. Uh, 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, they're wide awake. They're activated. And what's happened is they're, they've associated everything in that bedroom with- ... the anxiety of the struggle of, of that battle that they d- they take with them every night of trying to go to bed. So there's, the last thing I wanna do is make that anxiety worse. So what we typically do is we de- decatastrophize. We say, "Look, you haven't been sleeping for, for years. Uh, you're still alive. [chuckles] 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 per- 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, 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 t- tonight, and I'm gonna try to get as much sleep as I possibly can." And then, you know, their circadian rhythm is not ready for them to go to, to bed until 10:00 or 11:00 at night because that's what they've been used to, and they get in bed at 8:00. Now, what are they gonna do? What are you g- what's gonna happen to the human body [chuckles] if you go to bed at 8:00 and your body's not ready to sleep till 11? Well, you're gonna be awake for three hours, and that's gonna cause more anxiety, and you're gonna be even more awake, and you're gonna associate with your bedroom. A- and, and Rangan, this is just one example of-

   17. RCDr. Rangan Chatterjee19:48

       Yeah

   18. RSRoger Seheult19:48

       ... 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.

   19. RCDr. Rangan Chatterjee20:16

       Yeah.

   20. RSRoger Seheult20:16

       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, uh, decatastrophization. It's all sort of included under something called cognitive behavioral therapy for insomnia, or CBTI. And, uh, a lot of people can do this, uh, psychologists can do it, sleep physicians. But I, 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.

   21. RCDr. Rangan Chatterjee20:47

       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, is that what tends to happen?

   22. RSRoger Seheult21:34

       [sighs] Um, it, it's a wide range. I have some people that have not done this.

   23. RCDr. Rangan Chatterjee21:39

       Right.

   24. RSRoger Seheult21:39

       Um, and it all depends on the referral, uh, uh, the referral, uh, patterns that you see. A- as you know, you have some, uh, physicians that will refer very early. You'll have some physicians that'll-

   25. RCDr. Rangan Chatterjee21:49

       Yeah

   26. RSRoger Seheult21:49

       ... work on things. Um, and I... But I have seen very, very difficult patients where I've, I've sat down and I've gone through it, and, and, uh, 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're, they've, they really haven't done much. I, 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, a handout or a sheet, in other words, that you can find, uh, 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, 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-

   27. RCDr. Rangan Chatterjee22:39

       Yeah

   28. RSRoger Seheult22:39

       ... 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, uh, going to sleep. Get out of bed, get out of the bedroom so you're not associating these, uh, insomniac, uh, um, issues with the bedroom. Um, but there's a lot more of those there-

   29. RCDr. Rangan Chatterjee22:59

       Yeah

   30. RSRoger Seheult22:59

       ... and, and we can go over those, but that's basically the low-hanging fruit.
5. 25:08 – 34:46

   The Bedroom, Environment and Personal Sleep Struggles

   1. RCDr. Rangan Chatterjee25:08

      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, 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.

   2. RSRoger Seheult25:48

      Yeah, this is, this is the amazing stuff. I mean, there is a, there is a whole sea of subconscious that we are-

   3. RCDr. Rangan Chatterjee25:55

      Yeah

   4. RSRoger Seheult25:55

      ... not even realizing. Um, when you go into the bedroom, uh, I, I have this talk with, with many of my patients. Um, uh, and, 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- there's billions of people on this planet that don't have kitchens and bedrooms.

   5. RCDr. Rangan Chatterjee26:17

      Yeah.

   6. RSRoger Seheult26:17

      They live in one-room houses, and they seem to get [laughs] 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- 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 differ- differ- uh, difficulties with sleep are a, a television in there.

   7. RCDr. Rangan Chatterjee26:37

      Yeah.

   8. RSRoger Seheult26:37

      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 [laughs]

   9. RCDr. Rangan Chatterjee27:04

      [laughs]

   10. RSRoger Seheult27:04

       If, 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, uh, the news, the disasters happening. This is just gonna increase anxiety.

   11. RCDr. Rangan Chatterjee27:28

       Yeah.

   12. RSRoger Seheult27:28

       No, it's better to shut all of that off and go to bed.

   13. RCDr. Rangan Chatterjee27:32

       Yeah. Completely agree. It's, um, what people do, uh, before they [laughs] go to bed's really, really interesting. I had another thought, and it was based upon 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, that's quite a lot of pressure as well, isn't it?" That actually we've dedicated a room in our apartment or our house where we are going to sleep, whereas-

   14. RSRoger Seheult28:04

       Yeah

   15. RCDr. Rangan Chatterjee28:04

       ... you know, for, 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.

   16. RSRoger Seheult28:20

       Yeah, it's, it's true. Um, it, the, it certainly could lead ourselves to having, uh, these disadvantages. Uh, 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, at, uh, in the day and work at night. Um, it allows them to, uh, n- 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-

   17. RCDr. Rangan Chatterjee28:55

       Yeah

   18. RSRoger Seheult28:55

       ... with having a room dedicated to that, because then you can do things that you need to do for sleep. But it's a, it's a very interesting point.

   19. RCDr. Rangan Chatterjee29:00

       Yeah. No, I completely agree. Lots and lots-

   20. RSRoger Seheult29:02

       Yeah

   21. RCDr. Rangan Chatterjee29:02

       ... 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. Um, 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?

   22. RSRoger Seheult29:28

       Well, I, I think our audience would be happy to know that [laughs] I, I am no bastion of, of sleep efficacy here, uh [laughs] . Um, you know, for those that aren't aware, Rangan, 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-

   23. RCDr. Rangan Chatterjee29:45

       Yeah

   24. RSRoger Seheult29:45

       ... uh, there's, there's medical school, and then there's residency [laughs] . Um, and, uh, as a critical care physician, I spent probably the better portion of my 20s staying up, uh, late into the night and getting up very early in the morning to take care of very sick patients. Uh, and so, um, I got used to very quickly going through the barriers of, 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 a, as a critical care physician, that sort of comes part and parcel. Um, but we weren't really taught at the time of what the, uh, consequences were of that, but I think we're starting to find out more and more.

   25. RCDr. Rangan Chatterjee30:30

       Yeah.

   26. RSRoger Seheult30:30

       That's not to say that now, uh, you know, being, uh, now I'm out of training and I, uh, am able to take, uh, probably better care of that. Um, 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 11:00. I probably should go to bed earlier. But on days when I can, I get those six, seven hours, at least seven hours of sleep, that's what I aim to do. Uh, and that's just, we're just talking about quantity. We haven't talked about quality of that sleep, uh, as yet. We haven't talked about, uh, the stages of sleep. We haven't talked about sleep apnea, which is a, 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.

   27. RCDr. Rangan Chatterjee31:12

       Well, we're gonna talk about those things, 'cause 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 dev- that sleep deprivation really hit you? A- and I... And why I'm asking it is because as you were describing residency there, I was taken right back to this moment-

   28. RSRoger Seheult31:38

       Yeah [laughs]

   29. RCDr. Rangan Chatterjee31:39

       ... where, you know, we were doing... Well, I started work on, on that particular... Well, the day before, I started work at 8:00 in the morning. I was, I was covering a, uh, a renal ward, a 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, it hits 8:00 AM, so you've been there for 24 hours now.

   30. RSRoger Seheult32:06

       Yeah.
6. 34:46 – 50:10

   Shift Work, Circadian Timing and Shifting Your Clock with Light

   1. RCDr. Rangan Chatterjee34:46

      And, and of course we, you know, we look back and we are sort of looking back fondly. Well, not fondly.

   2. RSRoger Seheult34:52

      [laughs]

   3. RCDr. Rangan Chatterjee34:52

      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-

   4. RSRoger Seheult35:09

      Yeah

   5. RCDr. Rangan Chatterjee35:09

      ... who work shifts, who work, you know, regularly changing shifts. And perhaps we could talk about that in relation to circadian rhythms because, you know-

   6. RSRoger Seheult35:18

      Yeah

   7. RCDr. Rangan Chatterjee35:18

      ... 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 shift, 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?

   8. RSRoger Seheult35:51

      Well, I, I, there's no question. So we have enough trouble with people who have day, daytime jobs. Um, 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 the nocturnal shift, they really have to turn their night into day and their day into night. The problem that you bring up [laughs] is just, is when you throw a monkey wrench into the whole thing and say that, you know, one day you're gonna be working the day shift and, uh, 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," uh, because this type of scheduling we know is the hardest to adapt. Uh, I would say if you couldn't, uh, change the, 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, 'cause it's easier for our circadian rhythm to become later and later, uh, in the day. Um, but it's still [laughs] very, very difficult. I mean, I've always called it-

   9. RCDr. Rangan Chatterjee36:47

      So, so does that, does that, does that mean-

   10. RSRoger Seheult36:48

       Yeah

   11. RCDr. Rangan Chatterjee36:48

       ... if you're on a day shift, let's say an 8:00 till 5:00, 8:00 AM till 5:00 PM, let's say.

   12. RSRoger Seheult36:53

       Yeah.

   13. RCDr. Rangan Chatterjee36:53

       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 10:00 AM till a 7:00 PM, and then the-

   14. RSRoger Seheult37:02

       Correct

   15. RCDr. Rangan Chatterjee37:02

       ... week after a midday to a night? So pushing it that way is easier for us to adapt to.

   16. RSRoger Seheult37:07

       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 and 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, and really that's the underlying pinning of, of a, 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, a big issue.

   17. RCDr. Rangan Chatterjee38:16

       Yeah, that is something I think, well, I guess about seven years ago now, when I started to become aware of the research that Satchin Panda was doing in the Salk Institute around time-restricted eating, it really got my attention, thinking, "Oh, this is fascinating."

   18. RSRoger Seheult38:34

       It is.

   19. RCDr. Rangan Chatterjee38:34

       "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.

   20. RSRoger Seheult38:48

       Yeah.

   21. RCDr. Rangan Chatterjee38:48

       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?

   22. RSRoger Seheult39:00

       [laughs]

   23. RCDr. Rangan Chatterjee39:00

       Or is that something that is kind of accessible to them, you know, privately, for, for example?

   24. RSRoger Seheult39:06

       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. Uh, there is a temperature, uh, well, I should mention the circadian rhythm can affect body temperature, although it's not as, uh, clean, um, as other measurements like, uh, melatonin, um, and, and things of... And, 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, uh, if you were able to, to measure it. Uh, I think probably one of the best things to do is simply just try to measure when you feel tired. Um, when you start to feel tired is, generally speaking, what we call the dim light melatonin onset. And, uh, usually, uh, seven or eight hours from there is when you would wake up, and it may be about instead of seven or eight hours, maybe about five. About five hours would be when we would expect the temperature nadir. So let me give you some times here. Let's say that you feel tired at around 11:00 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, 7:00 or 8:00 in the morning. Your dim light melatonin onset would be... Or sorry, your, um, temperature nadir, which is the lowest that your temperature is, would be around 5:00 or 6:00. And, and that's how we would pin down, uh, how, where, where your circadian rhythm is. Um, in, in college students, uh, 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 their circadian rhythm is. This is how we kind of do it in, in the, the sleep research. But there are more sophisticated ways of doing it that are pro- probably not available to your listeners on a regular basis. So trying to figure out where that is is important and, um, 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.

   25. RCDr. Rangan Chatterjee40:55

       Well, I guess the take home there for me is, let's say you are someone with a relatively stable work routine, uh, and a stable lifestyle, q- relatively predictable from week to week. Then I can see real benefit in knowing, 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."

   26. RSRoger Seheult41:29

       You can, um, or you can actually shift it and move it. Um, I, I think that's, that may be... Well, let, 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 11:00 at night, uh, but they've got to get up at 6:00 in the morning because they've got to get to work and they've got a, uh, a traffic, uh, to, to take care of, and they've got to be to work by 7:00 or 8:00 in the morning. So they go to bed at 11:00. Maybe they don't fall asleep till about 11:30 or so. And so they're getting up at 6:00, 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 10:00? Well, we already know that if they go to bed at 10:00- And their circadian rhythm is not ready for sleep till 11:30, they're gonna be spending an hour and a half in bed concerned about their insomnia, getting anxiety, and it may turn into a, a bigger problem, as we've just mentioned. So why can't we just simply tell the clock and, and, and turn the clock back as, if you will, from, uh, 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, a major area of research is w- this, how light affects not only chronobiology or the, the circadian rhythm, but also affects our wellbeing, our mood, all sorts of things.

   27. RCDr. Rangan Chatterjee42:50

       Yeah. So what does that look like when a patient comes in to see you, um, and you wanna change their light exposure, or you wanna 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, uh, and I guess-

   28. RSRoger Seheult43:09

       Yeah

   29. RCDr. Rangan Chatterjee43:09

       ... at the moment, we as humans, we, we don't get enough light in the daytime, we're inside, 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?

   30. RSRoger Seheult43:21

       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 wanna 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, 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 s- in sync with the day." And so this is a- 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 wanna 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, uh, 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, uh, i- in that situation would be important. The converse is also true. So when you get home at night, um, turning down the lights, making... Using the, using that option of having dimmers-
7. 50:10 – 1:00:51

   Sleep Stages and Obstructive Sleep Apnea

   1. RCDr. Rangan Chatterjee50:10

      Well, I definitely wanna get to stress. I definitely wanna get to the timing of our food intake. But before we leave sleep, you've 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 are these different phases so important?

   2. RSRoger Seheult50:32

      Yeah. So if you look at sleep, it's not just a on-off switch. There are, there, there are different waves that we see in the brain, and we've named these parts of sleep based on these waves. There are very slow, high amplitude waves that we see early on in the night p- particularly. We call this delta wave sleep or slow wave sleep. And then we see, uh, 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 at toward the end of the night and slow wave sleep toward the beginning of the night, have completely different, uh, purposes, and they do completely different things. Uh, slow wave sleep is very physically restorative. Uh, it's associated with growth hormone secretion. This is a, 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 wanna 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, 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. Uh, unless, of course, they're experiencing sleepiness at 10:00 at night and just not taking advantage of it. But taking advantage of sleep early in the night is, uh, is, is very important. Um, now, REM sleep, on the other hand, has, uh, potentially completely different, uh, aspects. We're a little bit less clear on that. But we do know that this is where we dream.

   3. RCDr. Rangan Chatterjee52:39

      Yeah.

   4. RSRoger Seheult52:39

      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 is, 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 happened to you the day before or that, that day. Um, and that's, that could very well be what it, 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. Uh, it's just not gonna be as purposeful as we used to get when we were infants. You, you've heard the term sleep like a baby, right? Uh, these babies can sleep like, like the dead. Um, it's because they're either in slow wave sleep or in REM sleep, one or the other. And as we get older, it, 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, 10 hours of sleep in some cases. We could alt- we could talk about secondary education and how that's impacting sleep, but that's a different topic. We need quantity of sleep- But Rangan, we also need quality sleep as well.

   5. RCDr. Rangan Chatterjee54:27

      Mm-hmm.

   6. RSRoger Seheult54:27

      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, o- 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, the s- 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, a- 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 s- uh, 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, uh, CPAP machines that can open that up, masks, dental devices that advance the tongue forward, uh, because it's a, 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, of treating this. You should do this with a, a physician. But the point is, is that there's many people out there that don't realize that they have sleep apnea.

   7. RCDr. Rangan Chatterjee56:41

      Yeah.

   8. RSRoger Seheult56:41

      The signs of which could be they're getting enough sleep numerically, uh, 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. Um, 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, uh, in those patients. So I, I put this out there because it's a very common thing, and people, uh, 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, I would say that if you have daytime, excessive daytime sleepiness, f- 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. Uh, if you're having issues with snoring, if you're overweight, these are all signs put together that you may have obstructive sleep apnea.

   9. RCDr. Rangan Chatterjee57:57

      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 doctor, 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-

   10. RSRoger Seheult58:23

       Yes

   11. RCDr. Rangan Chatterjee58:23

       ... 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?

   12. RSRoger Seheult58:35

       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, 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, uh, 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 ki- [laughs] it's almost like you haven't had your favorite meal in years, and then you get to sit down, and [laughs] you eat that. And, and literally, the entire night of somebody getting treatment for the first time, I've seen basically just REM sleep. It's like it- 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-

   13. RCDr. Rangan Chatterjee59:55

       Wow

   14. RSRoger Seheult59:55

       ... in years."

   15. RCDr. Rangan Chatterjee59:56

       Sorry to interrupt. 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.

   16. RSRoger Seheult1:00:08

       Uh, it's not for everybody, but, um, it certainly, uh, it certainly happens. I, I can tell you personally that even though my BMI, body mass index, um, is in the normal range, I have sleep apnea myself. And I, I'm not obese. I, I just, that's just the way my neck-

   17. RCDr. Rangan Chatterjee1:00:27

       Right

   18. RSRoger Seheult1:00:27

       ... is des- was designed. Uh, it's just my anatomy. I, I have the genetics that I inherited that make me susceptible to getting, uh, 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, that I'm not doing something to them that I wouldn't do to myself.

   19. RCDr. Rangan Chatterjee1:00:46

       Yeah.

   20. RSRoger Seheult1:00:46

       So it's, uh, it's, uh, something that I deal with as well.

   21. RCDr. Rangan Chatterjee1:00:49

       Yeah. Well, thank you for sharing that. Um-

   22. RSRoger Seheult1:00:51

       Yeah.

8. 1:00:51 – 1:04:41

   Sleep Trackers: Helpful or Anxiety-Inducing?

   1. RCDr. Rangan Chatterjee1:00:51

      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?

   2. RSRoger Seheult1:01:13

      [laughs] Good. It's exactly the question that I have, uh, for these trackers. I think the trackers are actually numerically and, uh, they're very accurate. I, 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. Um, but the question is, is really in your question, and that's what we've discussed about here, is we could 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, uh, someone that would look at and seeing whether or not they're sleeping, is 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-

   3. RCDr. Rangan Chatterjee1:02:23

      Yeah

   4. RSRoger Seheult1:02:23

      ... in- in- increase anxiety, and as a result of that, actually be counterproductive.

   5. RCDr. Rangan Chatterjee1:02:28

      Yeah. I, I agree. And it, 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, s- 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 kinda 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... And they can be great. I have got one. You know, I, I have used an Oura 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-

   6. RSRoger Seheult1:03:23

      Yeah

   7. RCDr. Rangan Chatterjee1:03:23

      ... 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, uh, I guess there, there's many ways to interpret that. I kind of feel it depends on the individual, because some people probably can use it in a very helpful way. Um, so, but I, but I think it's a, uh, 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?

   8. RSRoger Seheult1:03:55

      Yeah. It's, it's, it's true. And, and, uh, another example I can, I can say on a, on a, on a, uh, continuum, is these trackers that can measure your heart's rhythm. And, and for most people, they can look at that heart rhythm and they wouldn't know, you know, a P wave from a, a, 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, uh, 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.

   9. RCDr. Rangan Chatterjee1:04:28

      Yeah.

   10. RSRoger Seheult1:04:29

       If, if there's a lot of, uh, 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.

9. 1:04:41 – 1:12:34

   Stress, Cortisol Resistance and Immunity

   1. RCDr. Rangan Chatterjee1:04:41

      Well, we've spent a lot of time discussing sleep and its role in inflammation. I really wanna move on now to stress if, um, if that's-

   2. RSRoger Seheult1:04:51

      Yeah

   3. RCDr. Rangan Chatterjee1:04:51

      ... okay. Because, you know, stress is this big catch-all term, isn't it, you know? Uh, w- 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-

   4. RSRoger Seheult1:05:11

      [laughs]

   5. RCDr. Rangan Chatterjee1:05:11

      ... there has been another event which has taken over the world. [laughs] Um, so-

   6. RSRoger Seheult1:05:16

      Yeah

   7. RCDr. Rangan Chatterjee1:05:16

      ... when we're looking at inflammation, how does stress fit into that? What does the science tell us?

   8. RSRoger Seheult1:05:23

      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, 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, 'cause 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 wanna 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 wanna 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, uh, 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. Uh, 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, uh, a wedding, a, a divorce, a, 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 s- uh, str- uh, effects from stress in that situation, but there was also issues in terms of infection. So what they did was they, they took these subjects that had a blunted response, and then they subjected them to rhinovirus, which is basically a common virus that causes the 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.

   9. RCDr. Rangan Chatterjee1:09:23

      Yeah, super fascinating. And, 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 described 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, or the, or the receptor. It just doesn't work as well. So if we're using... If we're exposing ourselves to too much stress, then the, 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.

   10. RSRoger Seheult1:10:40

       E- exactly, and, and let me just add to that, because, uh, we, 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, 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. Uh, 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's cells, instead of being brand new, ready to go off the assembly line, we're dealing with last year's [laughs] version, version 1.0, because our immune system hasn't dealt with these damaged cells. Um, 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. The 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, 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.

10. 1:12:34 – 1:25:31

    Fear, Exercise Intensity and the J Curve

    1. RCDr. Rangan Chatterjee1:12:34

       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?

    2. RSRoger Seheult1:12:49

       Oh yeah, I'm reminded of a really interesting study that, uh, was done by, uh, Jennifer Heisz at the, uh, McMaster University, where she took students, uh, 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, 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 your good grade in college is based on doing well. Th- 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, uh, at McMaster University to three different, uh, thr- three different groups. There was one group where they did nothing. It was just, you know, do whatever you wanna do, and study for your exams. And the second group was a low-intensity exercise or moderate-intensity exercise group where they exercised, uh, 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 .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... uh, the second group, moderate exercise, ex- except instead of moderate exercise, they did high-intensity exercise, still 20 minutes a day, still three times a week, uh, except they got their heart rates almost close to about 100% 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, uh, inventory, uh, depression score. And they also looked at, um, uh, cytokines. So they looked at IL-6. They looked at, um, uh, 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, uh, 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, 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, uh, at the government level, internationally, politics, all of this sort of stuff, that we're gonna have some major issues with depression as a result of fear and anxiety. There's a well-established connection between fear, anxiety leading to depression, and we saw that very clearly in this study. Um, in terms of in this control group, there was also increases in, uh, tumor necrosis factor, um, and there was also a drop in, uh, IL-6, which is one of the, uh, one of the, uh, cytokines that's involved with fighting infections. But let's look at the other two groups, moderate intensity and s- and severe intensity or h- uh, 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 Beck Depression Inventory Scale score. So what did 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 wellbeing and also your physical wellbeing. 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 we're sh- what Jennifer Heisz showed here in this study is something that we have known for years in the high athlete 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, uh, 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, um, 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, 100th of a second can make the difference between a gold medal and not even getting on the podium, they're gonna 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, is well-versed. You have to make sure that you have time for rest. And we could go over the, the, the studies and, 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, um, you know, nutrition, diets, all of these sorts of things. But, but the point here that I wanna 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 [laughs] we're all-- If you can imagine the letter J, okay? And we're at the very beginning of that letter J. We're, we're all couch potatoes sitting on our couch watching television, watching, um, the news channels talk about how everything is going downhill. Um, 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 inflami- inflammation goes down. Your, uh, your, your wellbeing improves. Your Beck 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. Rangan, this, this explains why sometimes we hear about people being in the hospital from COVID, and we say, "Well, they were a marathon runner."

    3. RCDr. Rangan Chatterjee1:21:03

       Yeah.

    4. RSRoger Seheult1:21:04

       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 gotta 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.

    5. RCDr. Rangan Chatterjee1:21:39

       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.

    6. RSRoger Seheult1:22:47

       [laughs]

    7. RCDr. Rangan Chatterjee1:22:47

       Right? So I think that really puts a bit of perspective for people. It really gives some encouragement. And, and I, 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, 'cause 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 a night. So it is quite nuanced, isn't it, really, when it comes down to each individual?

    8. RSRoger Seheult1:23:44

       It, it is, and, uh, I can tell you, being a physician, I see people all the time that, um, simply just can't walk for 20 minutes a day either because they have joint problems, knee problems, or, or, or, or things of that nature. There are ways of getting around that. So if you, if you can't walk, how about a, a stationary bicycle? You don't have to worry about balance. You don't have to worry about falling over. You get on, on the, on the stationary bicycle if you can, if you can have access to one. A lot of, 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 wanna 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- Uh, 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-

    9. RCDr. Rangan Chatterjee1:24:53

       Yeah

    10. RSRoger Seheult1:24:53

        ... uh, in terms of that, uh, for those people that can't exercise.

    11. RCDr. Rangan Chatterjee1:24:56

        Yeah. Fascinating. We- we'll save that for another time, because that sounds-

    12. RSRoger Seheult1:24:59

        Yeah

    13. RCDr. Rangan Chatterjee1:24:59

        ... really, really interesting. So so far we've, we've talked about sleep, you've given some practical advice on sleep. We've 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 wellbeing. 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.

11. 1:25:31 – 1:30:40

    Rest, Community and the Seven-Day Rhythm

    1. RSRoger Seheult1:25:31

       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, 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, a day off a week, uh, where I basically disconnect from all of the, the, the, the, the worries of work and all of these sorts of things. And I, 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 queue 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 queue is, is, is done, uh, to be able to just relax and detach, guess what? You're never gonna have that. You're, 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 on my work queue, and I'm gonna be able to, 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 religio- 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, a support system there, knowing that there are people that can help you. Um, this is so important. We, we are, uh, 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, uh, 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, uh, 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, uh, with people with-

    2. RCDr. Rangan Chatterjee1:28:19

       Yeah

    3. RSRoger Seheult1:28:19

       ... the same disease. So, uh, th- I think this is a huge area that, uh, for some people is, is, is obvious, for others are, 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, a tremendous amount of benefit that can be gotten from that type of program. The other thing that I would, I would mention, I, we, 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, circaseptan rhythm-

    4. RCDr. Rangan Chatterjee1:28:54

       Yeah

    5. RSRoger Seheult1:28:54

       ... where, uh, we've talked about last time where ev- And, 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, 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-

    6. RCDr. Rangan Chatterjee1:29:25

       Yeah

    7. RSRoger Seheult1:29:26

       ... uh, no matter what culture it is.

    8. RCDr. Rangan Chatterjee1:29:27

       Oh, I love that. 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, 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 and culture to fight against that. I remember as a kid that the supermarkets weren't open on a Sunday.

    9. RSRoger Seheult1:30:04

       That's right.

    10. RCDr. Rangan Chatterjee1:30:04

        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, ev- any day, and we don't have that natural downtime built in. So I think that'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.

12. 1:30:40 – 1:41:06

    Time-Restricted Eating and Inflammation

    1. RCDr. Rangan Chatterjee1:30:40

       Again, we're talking about inflammation. I guess the immune system is absolutely [laughs] 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.

    2. RSRoger Seheult1:31:01

       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, um, the, some of the, the research that's been coming out. A- and it goes along with exactly what we've been talking about. It, 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.

    3. RCDr. Rangan Chatterjee1:31:26

       Yeah.

    4. RSRoger Seheult1:31:26

       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 wanna put it, uh, s- specifically. And if you're doing something that never allows your body to take out the trash, y- why would we expect the trash to be taken out? A- and so what, what we're talking about here is a, a term that's been used, intermittent fasting. I prefer time-restricted feeding as, as a, as a 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. Uh, 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 p- the, the thing that you've gotta 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 to 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, uh, 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. But 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, uh, glucose, proteins that regulate, um, uh, appetite, uh, things that regulate, uh, metabolism, inflammation, obesity, fats, proteins, how all of these things are, are dealt with, uh, blood flow to the stomach. Uh, these are just, just some of the few things that we're talking about. When those things are constantly then l- 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, 'cause 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.

    5. RCDr. Rangan Chatterjee1:34:31

       Mm.

    6. RSRoger Seheult1:34:31

       What we're noticing is that if we restrict that period of time to about eight or 10 hours a day, then we start to see some amazing things in terms of transformation in the body, in terms of metabolic, uh, improvement, in terms of, uh, im- improvement with inflammation, in terms of actually, according to a new study that came out of China, reducing even hemoglobin A1Cs in diabetes.

    7. RCDr. Rangan Chatterjee1:34:59

       Yeah.

    8. RSRoger Seheult1:34:59

       So there's, there's just tremendous, uh, amounts of in- of information. You tell me where you wanna go [laughs] uh, and where, what you wanna talk about.

    9. RCDr. Rangan Chatterjee1:35:07

       Well, I mean, th- that's fa- super fascinating. Appreciate you sharing that.

    10. RSRoger Seheult1:35:13

        Yeah.

    11. RCDr. Rangan Chatterjee1:35:13

        It's, it, 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?

    12. RSRoger Seheult1:35:30

        Yeah.

    13. RCDr. Rangan Chatterjee1:35:30

        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 [laughs] 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, I would see incredible improvements, whether it's in reducing weight, blood sugar control, sometimes sleep quality gets better sometimes-

    14. RSRoger Seheult1:36:17

        Yeah

    15. RCDr. Rangan Chatterjee1:36:17

        ... 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?

    16. RSRoger Seheult1:36:45

        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. Um, a- as I mentioned, this study that, that recently was just published, uh, out of China looked at, uh, 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. And the arm was, "Hey, look, eat as much as you want any time of day and, and we'll see how things go." And these were diabetics. These were people with already diagnosed diabetes. And as we know with diabetes, there's, uh, amazing amounts of unfortunate inflammation that can cause coronary disease, that can cause heart attacks, strokes, all sorts of, of problems. Uh, and then the other group, the intervention group, they said, "Look, we're gonna limit your meals to just 10 hours a day." And, and that actually is, is pretty good because I've seen studies where they did it to eight hours a day.

    17. RCDr. Rangan Chatterjee1:37:54

        Yeah.

    18. RSRoger Seheult1:37:54

        But no, they did it 10 hours a day, and they specifically allowed them to eat from 8:00 in the morning until 6:00 PM, 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 8:00 in the morning. And they were basically asked to eat well before 6:00 so that their sort of fed state, they were done by, uh, 6:00. And so you've got now from 6:00 in, in the evening all the way through to 8:00 the next morning where there's no food, there's not even a snack. Uh, nothing. Nothing goes into your mouth except for water and maybe a little bit of, 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. Uh, somebody has elevated glucose for a l- for a period of time. That glucose can bind with the hemoglobin and stay on there, and we use that in medicine to, uh, 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 effect 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, I think that's astounding.

    19. RCDr. Rangan Chatterjee1:39:56

        It, it, 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 [laughs] it's po- potentially saving them a bit of money 'cause 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 'cause I kind of feel intermittent fasting is a bit confusing sometimes. You know, what does it actually mean? Whereas time-restricted 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?

13. 1:41:06 – 1:47:21

    Practical Eating Windows and Final Recommendations

    1. RSRoger Seheult1:41:06

       Yeah. It, and it's really, um, it's really important to be able to look at their lifestyle. So for me, uh, some weeks I'm in the intensive care unit, um-

    2. RCDr. Rangan Chatterjee1:41:15

       Yeah

    3. RSRoger Seheult1:41:15

       ... from 7:00 in the morning to 7:00 at night. I don't get home till late. And so you, you don't want to be shifting this around. You want to sort of pick something and go with it. So, uh, uh, there's really two variants of this. The, the, 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. It also has issues here. So, um, the, 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, a lunch or a very early dinner, or you flip it the other way around and say that you're gonna skip breakfast, have a lunch, um, being the first meal of the day at around 12:00. And then eating relatively early in the evening, early enough, like maybe around 6:00 or 7:00 so you're well within that 8 to 10-hour window, but then give you at least three hours before you go to bed at night. I think those are the two, uh, uh, systems that seem to make the most sense from a, from a, a practical standpoint that it's gonna be most common. But everybody's got to sort of figure this out for themselves-

    4. RCDr. Rangan Chatterjee1:42:41

       Yeah

    5. RSRoger Seheult1:42:41

       ... and see what works for them.

    6. RCDr. Rangan Chatterjee1:42:43

       Yeah.

    7. RSRoger Seheult1:42:43

       Um, this is the thing. It's, it's very personal.

    8. RCDr. Rangan Chatterjee1:42:46

       Yeah, 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 8:00 AM till 6:00 PM, um, window worked for my friend Bob, but actually that ain't gonna work for me. There's no way-

    9. RSRoger Seheult1:43:04

       Right

    10. RCDr. Rangan Chatterjee1:43:04

        ... that's gonna work with my school run, kids, job," and I, I kinda 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 wanna thank you once again. You- 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. Um, you have a, a brilliant way of simplifying information and sharing it with people, so I wanna thank you once again for that. Um, 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?

    11. RSRoger Seheult1:44:06

        Yeah. Let's see. 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 gonna 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, uh, eight to 10 hours, if you haven't done so already. Making sure that you're looking at your personal, um, uh, schedule and incorporating exercise somewhere. Better to do it in the morning if possible, but in the, uh, in the evening time is better than not doing it at all. I think exercise is really important. It also helps with sleep as well. Um, we've also talked about, um, uh, mental stress, and especially now that we're going into this period of time, uh, again, potentially with the pandemic, um, and, uh, and all of the things associated with it and 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, um, nobody is going to do that. Uh, there- there's a lot of demands that are being asked of you, especially if you're in a, a productive, uh, environment, if you're, uh, at a job. Um, no one's ever gonna say, "Hey, you need to take some time off." You need to make some time for that yourself, otherwise it's not gonna happen. So I think, uh, 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, 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, uh, is gonna sway us back and forth. We have to be able to say, "No, I'm not gonna eat during these hours, uh, because I need to do my time restricted eating. No, I, I'm not gonna 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, 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, our spouses, our friends, and say, "Hey, this is what I wanna do. Hold me accountable. Make sure I'm doing these things." Because I think we all wanna do it, but sometimes, uh, as they say, the, uh, uh, the spirit is willing, but the flesh is weak.

    12. RCDr. Rangan Chatterjee1:46:39

        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, uh, I really look forward to the day where we get together in person.

    13. RSRoger Seheult1:46:56

        Yeah, I'm looking forward to that as well. That'll involve a transatlantic trip, but I think it'll be well worth it.

    14. RCDr. Rangan Chatterjee1:47:01

        [upbeat music] 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.

    15. SPSpeaker1:47:09

        It's like a vaccination, a natural vaccination, great blood flow. There is no cortisol, no oxidative stress going on. This is the way nature meant it to be

Episode duration: 1:47:21