Why When We Eat May Be More Important Than What We Eat with Professor Satchin Panda

Satchin Panda 0:00 There are nearly 110 different disease conditions which may arise from circadian disruption. Or conversely, there are nearly more than 100 diseases where just taking care of the, your daily rhythms by paying attention to when people eat or when people sleep, how much they sleep, will substantially, significantly reduce the disease risk.

Dr. Rangan Chatterjee 0:23 [upbeat music] Hi, my name is Rangan Chatterjee, GP, television presenter, and author of the bestselling books The Stress Solution and The 4 Pillar Plan. I believe that all of us have the ability to feel better than we currently do, but getting healthy has become far too complicated. With this podcast, I aim to simplify it. I'm going to be having conversations with some of the most interesting and exciting people, both within as well as outside the health space, to hopefully inspire you, as well as empower you with simple tips that you can put into practice immediately to transform the way that you feel. I believe that when we are healthier, we are happier, because when we feel better, we live more. Hello, and welcome back to episode 81 of my Feel Better, Live More podcast. My name is Rangan Chatterjee, and I am your host. Now, today's episode is all about our circadian rhythms, and why when we eat may be more important than what we eat. Now, this is actually a re-release of a previous two-part conversation way back on episodes 20 and 21 of this show, which first came out almost 18 months ago. Many of you at that time significantly changed your behavior on the back of what you heard, and I've decided to re-release this as one complete conversation for a number of reasons. Firstly, since episode 77 with Linda Geddes just a few weeks back on the importance of lights for our health, many of you have asked me for more information on our circadian rhythms. Now, given how much this podcast has grown over the past 12 months, most of you listening to it these days will not have heard this conversation previously. Secondly, many of you have actually asked me to re-release these previous two episodes as one complete conversation rather than having it split up into two. Even if you have heard this conversation before, over one year ago now, I strongly suspect it will be worth revisiting, as the information in it is simply incredible. Today's guest is the one and only Professor Satchin Panda. He's a scientist at the Salk Institute in California, and is conducting research that is literally transforming the way people all over the world live. His research is behind why many of our phones and screens dim down to an orange shade at night. He has also shown how different genes have a daily rhythm in the way that they function, but he's probably best known for his research in an area called time-restricted eating, the idea that when we eat may be as important as what we eat. There is so much amazing information in this episode. I really think you're going to enjoy it, and I think it is highly likely to make you think carefully and potentially question when exactly you are putting food inside your mouth. 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There is less scuffing and less molding to any individual's foot. And this is what I've been doing for years now, passing on my own kids' shoes to siblings, cousins, and friends. There is less scuffing and molding to any particular individual's feet. And so for the past few years now, I literally pass on my own kids' shoes to siblings, cousins, and friends. If you wanna take advantage of this offer, get your 20% off Vivobarefoot shoes by going to vivobarefoot.com/livemore. Now, onto today's conversation. Satchin, thanks for joining me.

Satchin Panda 6:42 Hi, Rangan. Very happy to be on your podcast.

Dr. Rangan Chatterjee 6:45 Satchin, I think you are doing some of the most important work in terms of, you know, really hardcore research that is getting translated into real-life clinical practice. I've... You know, I first came across your research probably about four years ago or so, and I've been pretty obsessed with following it ever since actually. So I was delighted that we got the opportunity to lecture together last September in Iceland. Um, but, you know, I think there's so much we could talk about, but, you know, as I said in the introduction, you know, you are doing a lot of the research that is helping us understand what a circadian rhythm is and how important our body's daily rhythms are. I wonder if you could maybe explain to the people listening what exactly is a circadian rhythm?

Satchin Panda 7:34 Yeah, circadian rhythms are daily cycles in sleep, work, um, eating, fasting, and even our ability to do exercise, physical activity, all of these rhythms that we experience on a daily basis. So the term circadian comes from a Latin word that means, uh, nearly 24 hours. And, uh, the reason why we have these rhythms is these are controlled by circadian clocks that are present in almost, in every organ, in every cell, and in every brain parts of, of us. So having said that, if you lock me inside a room with sufficient access to food and a bed, but no clue about timing, then circadian clocks inside my body will produce these rhythms so that I will go to bed around 9:00 every night. I'll wake up around the same time, say, 6:00 or 7:00 in the morning, and this will continue even though I have no access to timing cue. So that's the beauty of these circadian rhythms, that our body is programmed, pre-programmed to go through these daily cycles of sleeping and waking up. Our gut hormones in the morning and the digestive juice rise up in anticipation of food. In the middle of the day, our brain is at its peak performance, so we can do more complex task. In the afternoon, our muscles are more pre-programmed to do, um, much better athletic performance. And almost every brain chemicals, every neurotransmitters, every hormone goes through these daily rhythms. So, uh, the most obvious circadian rhythm that we all experience is the daily sleep-wake cycle. But that's just, uh, the tip of the iceberg, and there are many other rhythms that go on inside our body.

Dr. Rangan Chatterjee 9:31 Yeah. Wow. It's incredible that we've got these, these natural rhythms. And, you know, for me as a, as a practicing clinician seeing patients and looking at the research, it's interesting that a lot of the time, you know, we look at what's the best diet to eat, or we look at, you know, all kinds of things, you know, in terms of calorie consumption a- and all sort of different things. But for many years, we've never factored in time, you know, when are we eating these things? We've, we've just factored what we're eating, not when we're eating. And, and I think that's what drew me to your research initially. It was certainly some mice studies that I saw that you, you showed beautifully how when you restrict the eating window, a lot of different changes happen. I wonder if you could tell me how you, how you even started to think about that and actually start to research this area?

Satchin Panda 10:20 Yeah, so it started almost 20, 20 years ago, um, when the new technology to look at genes when they turn on and off became available. I became curious about what time of the day or night different genes in our liver, in our brain turn on and off. And what we began to see, uh, was a very simple observation, that many genes that are involved in absorbing nutrients, breaking them down, metabolizing them, and supplying nourishment to our body, they go through daily circadian rhythm. So that means at a certain time of the day or night, our body may be much better in handling a big meal or breaking down toxins than other time of the day. But that was just an idea that came from looking at genes. But trying to test that in real life took another 5 to 10 years. So the next thing we wanted to test is very simple idea.

Satchin Panda 11:21 If our liver, if our gut is better primed to digest and use these nutrients at certain time, is it better if we align eating time to that time? So to do that experiment, we went back to a very simple experiment that is done almost 11,000 times in other labs. And that is, if you give mice, um, some high-fat diet or high-fructose diet or high-sucrose diet, any diet that actually they like, they will eat it. Uh, and then within few weeks, 9 to 10 weeks, these mice become obese, diabetic, they have cardiovascular disease, they have fatty liver disease, and of course, obesity. And what we, uh, a simple observation that we made, and other people have also noticed, is when we gave mice this kind of diet, just like when we have yummy food, then we tend to eat even, even though we are not hungry, and we might eat in the middle of the night. Similarly, mice also wake up from the middle of their sleep, and they would eat that And we know that, um, when we sleep our gut is not functioning well, it's not primed for digestion, our liver is not primed for digestion. So we did a simple experiment where we divided the mice to two groups, identical set of mice from the identical, from the same moms, born in the same room, with the same microbiome. One group got to eat this high fat, high sucrose diet whenever they want, and the other group got the same unhealthy diet, but that was aligned to their circadian rhythm. So they ate all that food within eight hours in the first experiment, and then later in 10 to 11 hours. And every week we measured the food intake, so these two groups of mice were eating the same number of calories from the same food. But to our surprise, the mice that ate within 8 to 10 hours were completely protected from all these diseases: obesity, type-2 diabetes, fatty liver disease, high cholesterol, and cardiovascular disease.

Dr. Rangan Chatterjee 13:34 Satchin, that's, that's just g- in- incredible. Just, just to highlight that, you're saying that the mice had the same diet, the same amount of calories, simply the time that they had them was restricted?

Satchin Panda 13:45 Yeah, exactly the same number of calories. Means we didn't even reduce the number of calories and, uh, we didn't even change the diet, and we repeated this experiment three, four times before I could really believe it, because this goes right against what we know in nutrition research for last 150 years: that the amount of calories and the quality of calories matter. And for the first time we realized that if you align your eating time with

Satchin Panda 14:17 your circadian rhythm, when your liver, when your gut is primed to digest that food, is, has this huge health benefit. And, uh, that was, uh, really surprising. And then the next step that we did was we said, "Well, we can prevent the disease. What if the mice already have the disease?" So in the second set of experiments, we take mice which are already obese, diabetic, have fatty liver disease, have high cholesterol, high fasting blood glucose, and the only thing that we do is we don't change their diet. We restrict their diet to 10 hours. Sometimes even up to 12 hours works. And, um, this might surprisingly, within few weeks they lose nearly 20% of their body weight and the disease slowly disappears. Uh, this is s- again, another huge surprise because there is no medication out there that works in mice that will take care of all this disease simultaneously within such a short period of time without any adverse side effect. So that's another question that came to us. What if these mice are eating, uh, within a short time and are fasting for such a long time, are they physically fit? Can they actually do some of the complex task? So we put them on exercise treadmill, and again, the next surprise came. That is, these mice that were eating high fat diet only for eight to nine hours, maximum 10 hours, they could outrun mice that were eating healthy diet, but at random time of the day or night. So here is another example where the timing of food intake can optimize performance on a endurance test. And now these mice, just by controlling time, they can outform- outform mice that are on healthy diet.

Dr. Rangan Chatterjee 16:17 It's just incredible.

Satchin Panda 16:18 Then the third thing that we did was, you know, as we get older, our neuromuscular junctions weaken, and then we don't have much motor coordination and, uh, we are prone to falls. So we put these older mice that have gone through time restricted eating, this, um, we call it time restricted eating, and we put them on a accelerating rotorod. This is essentially balancing on a rotating drum. It's a very simple test for mice. And to our surprise, again, these mice actually stayed on the rotating drum for a very long time. And, uh, nowadays almost any... We have gone back, repeated the experiment in many different strains of mice to make sure that this is not a strain effect, both genders of mice, and we always find the same outcome. That is, if mice eat all their food within 8 to 10 hours, um, then they're completely prevented from all of this disease, and it actually improves their physical performance, it improves their mental health, et cetera.

Dr. Rangan Chatterjee 17:23 It's just, it's just absolutely incredible. You're right, it absolutely flips what we have always known and what we've always been taught. It just turns it on its, on its head. Um, I, I just want to clarify there, when, when you say high fat diets, because I know a lot of people listening will be thinking, you know, w- you know, there's this, you know, lots of, lots of things in the media about, you know, fat and carbs and all these kind of things. When you say high fat, is that the, the chow that mice get, high fat, high sugar? Is that, is that the diet-

Satchin Panda 17:50 Yeah

Dr. Rangan Chatterjee 17:50 ... you're talking about?

Satchin Panda 17:52 Yeah, so the high fat diet that we use in the lab, uh, this diet is, uh, very similar to the Western diet, what people actually eat in the Western countries. So that is on an average around 45% of fat, calories from fat. 20% calories come from sucrose or simple sugar, and then 10 to 15% calories come from protein. Um, so that's the composition of this, uh, diet. And sometimes we can even go up to 65% calories from fat. This is very different from what people consider ketogenic diet, not pe- uh, scientists consider ketogenic diet. Because in mice, a ketogenic diet means the number of calories coming from fat should be 90% or higher, and that's a very difficult diet to even, uh, produce and maintain from mice because 90% fat, um, is almost, uh, liquid, uh-

Dr. Rangan Chatterjee 18:55 Sure

Satchin Panda 18:55 ... pretty semi-solid, so it's very hard to handle. So there is a difference between this, uh, when I say high fat diet, it's usually somewhere between 45% to 65% of calories coming from fat and, um, usually this diet also has 20% calories coming from sucrose.

Dr. Rangan Chatterjee 19:14 Okay, so there's pretty reasonable amount of sugar there. And i- is this refined and processed fats? The reason I'm asking that is, so I don't want people listening to get confused if they're having things like olive oil and avocados and, and olives. It- we're not, we're not talking about that kind of fat, are we?

Satchin Panda 19:29 No, this is very unhealthy-

Dr. Rangan Chatterjee 19:32 Unhealthy fats, unhealthy sugars.

Satchin Panda 19:34 Yeah.

Dr. Rangan Chatterjee 19:35 Yeah. So Satchin, it's incredible, the benefits you've shown in mice is, is just phenomenal, that if you do nothing else and just change when you eat, um, you know, you can, you can improve blood sugar, you can improve your weight, your fitness, all kinds of things that people up and down the country in the UK, but across the US and all over the world, are looking to do. Everyone's looking for that simple solution. But your research could have some quite profound public health implications.

Satchin Panda 20:05 Yeah. I mean, when I looked at, um, epidemiology of chronic disease and how it changed over last century, um, if nutrition quality has a huge impact, then we would have seen that certain countries or certain cultures that eat more, say, uh, refi- sorry, carbohydrate diet, or certain cultures that eat a high fat, uh, diet, then they would have had a high proportion of this chronic metabolic disease, which is not true. Means if you go back to, say, 100, 150 years ago, uh, then epidemiology of chronic disease, metabolic disease, was not confined to certain culture, and it was also rare, uh, even in many different cultures. So the common denominator, uh, of all these cultures that are eating, say, high carb diet or high fat diet or, um, any other different types of diet, was people had access to very little access to food at night, because staying up at night under light was very expensive. Even in the middle of 19th century, it would take almost half a month of salary of a average income family in the UK to buy enough, uh, fuel to light up the home for three to four hours in the evening. So people used to eat largely during daytime, and very little food was consumed after evening. So that's why what we think is the one of the contributor, I won't say this is the only one, [laughs] one of the contributors to rising, um, epidemiology of obesity, diabetes, and chronic disease, is our ability to have access to food 24/7. And when we have access to food for 24/7 and food becomes more than nutrition, it becomes a way we socialize, it's the way we even, uh, cope with stress, then eating at the wrong time, uh, can lead to disruption of the circadian rhythm, and that can lead to disease.

Dr. Rangan Chatterjee 22:16 I guess if we think about this on an evolutionary level, it would make sense, wouldn't it, that when it gets dark at night, you know, you know, thousands of years ago, we wouldn't really have that ability to actually eat at that time. You know, it w- it would be dark. We'd be probably settling down to actually wind down for bed, right?

Satchin Panda 22:35 Yeah. So, uh, so that's why even our circadian rhythm has programmed itself and our different organs to, to be in that rhythm. For example, um, starting from digestion, start from even chewing our food. As we chew our food in our mouth, we have saliva that, uh, begins the digestion process, and we now know that the saliva production itself has a circadian rhythm, so it slows down at night. So very first step is saliva production slows down. The second step is as the food hits the, um, stomach, then the stomach produces various digestive juice, including stomach acid, and those things also begin to slow down at night. Uh, it's a little bit complicated because what happens, in the evening the stomach produces excessive acid. Uh, that might be a evolutionary program because since we are not likely to eat anything in the evening, if something goes into the stomach, it's likely to be pathogenic bacteria or something. And since our body would be sleeping, maybe this is a defensive mechanism to produce an excessive acid in the evening. And then just like our brain sleeps, our intestine actually slows down, so intestine doesn't pump the food down the digestive tract at night. So, um, the digestion process itself slows down. The reason being, throughout the day, digestion and moving the food through our digestive tract causes a lot of damage to the lining, stomach lining or intestinal lining, and that has to be repaired. Almost one-tenth, uh, of our stomach lining is repaired and replaced every night.

Dr. Rangan Chatterjee 24:28 Wow.

Satchin Panda 24:29 And just like you cannot repair a highway when the cars and trucks are moving, we cannot repair our, uh, gut if we eat at night. So that's the whole reason why the circadian clock in gut slows down food passage so that it can repair the gut lining. So now we can see, starting from the process of chewing the food to getting the food inside our stomach to pumping it through the digestive tract, has a strong circadian rhythm, and that's why eating at nighttime, uh, also causes various gut problem, gut inflammation, and that might al- ultimately lead to, uh, developing allergies, um, to some of the foods that we eat.

Dr. Rangan Chatterjee 25:14 Yeah. I, I mean, this is just so incredible to... It, it really sort of resonates with someone who, like myself, who- who's been seeing patients so many years now, that a lot of the problems you talk about, even, you know, digestive problems at night, heartburn, um, difficulty digesting food when they eat late, it, it all starts to make sense when you look at it through the lens of your research in the circadian clock. Because, you know, the stomach acid going up in the evening, that's incredible, and yes, I love that evolutionary explanation that actually we wouldn't be eating then. So [laughs] if something's coming, coming through our mouth, then it's probably not good for us, and we need to have a, a defense against it. And I'm finding the more... You know, as I get more and more experienced as a clinician, I, I think about evolution a lot more and, and think about, well, what purpose would this have served? Why, you know, why, why is this displaying now and it never displayed itself in the past? How would that have helped us in the past? You know, when we think about our stress response, that's a classic example of how a stress response worked very well for us when we were being attacked by a tiger. But if we're being attacked by emails and to-do lists and workloads, it, it has a very different response. So, so yeah, it's, it's super interesting. Satchin, you know, when we think about the circadian clock, you know, what are the factors in our lifestyle that have the most influence on it?

Satchin Panda 26:40 Yeah, so the biggest factor, um, is light. And if you think about it, almost, um, all life forms on our planet have evolved and have adapted to this planet under a very predictable light-dark cycle. Um, you might think, well, uh, the weather is very different on different days. Sometimes it's sunny, sometimes it's rainy, uh, sometimes it might snow. But almost in, uh, every day there is one thing that is absolutely going to happen. The sun will rise up. Even if it's cloudy, there will be enough light outside, and sun will s- go down in the evening, and there will be darkness. So that's why almost in every living organism on this planet, the circadian clock predicts and also responds to light. So that means that different, in different seasons, as the sunrise time changes, the circadian clock also has to adjust to this changing sunlight, sunrise time. But in modern society, after the invention of electric lighting, and with light available throughout 24 hours, our brain clock gets confused. Uh, so that's the first thing that happens. After evening, of course, the brain clock will anticipate maybe one or two hours of twilight time, but then beyond that, when it sees light, then it gets confused. It thinks night hasn't happened. And, uh, so there is sleep disruption, so we reduce our sleep. And as we known now from sleep research, a sleep-deprived brain cannot make the right decision. And when we think about decisions, we always think about making a decision about, say, um, jobs or whether going out, whether to buy this, buy that. Uh, but we make hundreds of decisions throughout our day about what to eat, how much to eat, and when to eat, what combination of food to eat. So the sleep-deprived brain, um, again, makes two errors in deciding about food. One is when our brain is sleep deprived, evolutionarily, uh, at nighttime we are supposed to get sleep, and when we woke up, when we got up from our sleep, it is mostly in response to a danger. So a b- sleep-deprived brain always thinks that there is a danger. And to cope with the danger, it tells our appetite brain center to eat more because we need that energy to fight the danger. So we tend to eat more when we have less sleep, when we go to bed late at night. Second thing that happens is we also make bad decision about food. We don't reach out for healthy food, healthy snacks at night. Our brain actually needs energy-dense diet, snacks, and those kind of stuff. So then, uh, it

Satchin Panda 29:47 kind of goes into a spiral because once we eat late at night, then the clock in our gut and liver, they get confused. They think whether it's breakfast time or lunchtime, so they have to drop the repair and rejuvenation process that has to happen every night. Instead of doing that, they go back to digesting food and trying to push this food down the digestive tract. So as you can see, um, so light is the primary disruptor of circadian rhythm, and then it confuses the brain. Then we tend to eat late at night, which is under our control. Th- this is where we can stop the, stop the dis- disruption going into a spiral. And then that triggers our peripheral clocks in liver and gut to think that this is not night yet, and it stops the repair process.

Dr. Rangan Chatterjee 30:40 Yeah. I mean, so and it's just so incredible. You see one bad decision or, or-

Satchin Panda 30:44 [laughs]

Dr. Rangan Chatterjee 30:44 ... well then, maybe not a bad... Well, you, but we, in the context of health, uh, you, you would have to say one bad decision leads to another bad decision, leads to another one, and then you're in this vicious cycle where people struggle to make behavior change. And it's fascinating. You know, I I, I sort of, you know, listeners to the podcast know I, I, I wrote a book called The 4 Pillar Plan where I talk about these-

Satchin Panda 31:03 Yeah

Dr. Rangan Chatterjee 31:03 ... four core components of health that we've got the most control over. So food, sleep, stress, exercise. But I did sort of caveat that in the book where I sort of spoke about your research and how, how much of a factor that time is and when we do these things is very important as well. But it's just interesting to me that those four pillars that I talk about are all affected when we are out of sync with our body clock. So, you know, y- you know, eating late, for example, that will affect your sleep.

Satchin Panda 31:35 Yeah.

Dr. Rangan Chatterjee 31:35 You sleep worse. You don't crave fruit and vegetables the morning after you've slept. You crave sugary food. You feel tired. Uh, you don't want to exercise, but also your stress hormones are up the night after you haven't slept. So in, in fact, I'd go as far as saying, and, and I wonder what you think about this, not living in harmony with your circadian rhythm in some ways would be a stress, right?

Satchin Panda 32:00 Yeah. There's a big stress, and that's what we also see. The stress response, um, I mean, hormonally, all the stress hormones do go up when circadian rhythm is not in sync. So I think the biggest, uh, the bigger, bigger question is this, that we are going to live in this society where we'll have access to light and food throughout twenty-four hours, and having some awareness about circadian rhythm will actually help us to make some simple decisions about, say, when to turn down our light, when to prepare ourself to go to bed, and when to close the kitchen, uh, so that we can, uh, bring this, uh, rhythms back into our life. Uh, so I really love your four pillar plan because that helps us to, uh... That, that's a nice framework to connect basic science research to translation.

Dr. Rangan Chatterjee 32:54 Yeah. It's... I, I'm, you know, I, I'm familiar with your research. I'm always blown away when I read it, but just talking to you, it's just incredible hearing all these various factors in terms of how, you know, we've got all these multiple clocks. It's not just that, you know, the sleep-wake cycle, is it? Our gut's got its own body clock, our eyes, our, you know, our liver. You know, I fi... I... There was a study a couple of years ago which came out suggesting that, um, the time that we give our drugs to our patients, the pharmaceutical drugs, may have to change depending on what organ they're planning to target. Do you... Are you familiar with that?

Satchin Panda 33:30 Yeah. So, uh, that's a very emerging area in circadian rhythm research. Recently, we just completed a study where we find that nearly 80% of our genes, um, s- rise up and, uh, then fall down or have a circadian rhythm in different parts of the organ. So when we think of 80% of genes are circadian, that also implies that nearly 80% of the drugs, um, that target different genes should have a peak time for performance and also a peak time for adverse effect. [chuckles] And, uh, this is an idea that has been floating around for very long time, starting from actually late '70s, because people noticed at what time of the day cancer patients got the cancer drug or the chemotherapy had a huge impact on their prognosis, whether they get cured, um, quickly or they took long time. And starting from then, there has been a lot of, uh, research in cancer field particularly because now we know that almost every organ's circadian clock does one thing in common, that is to repair DNA damage and to reduce redox stress. So almost every cell, as it functions, it produces a little bit of what we call reactive oxygen species or internal toxin of the cell. It's almost like the garbage of any house that needs to be taken out. And, uh, during this process, DNA also gets damaged, and that has to be repaired. And most of the cancer drugs are directed against, uh, damaged DNA or as... or affect some aspects of this toxin production or DNA damage. So that was the earliest clue. But as we learn more and more about circadian rhythm, we now know that almost every process involved in inflammation, nutrient metabolism, various hormone functions are also circadian. So now we know, for example, uh, arthritis pain that affects a very large proportion of older individuals. Uh, the pain is more severe in the morning. We have more joint pains in the morning. The joints are swollen up. But what is surprising is taking the medication in the morning doesn't help that much. In fact, taking the medication in the night before, just before going to bed, seems to have much better effect, um, to reduce morning pain. To take it one step further, we realize that, and we, most doctors know that our cortisol levels begin to rise at nighttime and reaches its peak level in the morning. And cortisol levels, high cortisol level, um, helps us to fight some of the pain. So the second phase of... the second generation of these drugs are slow-release formulations that a person can take at bedtime, but the drug will begin to get into the bloodstream around midnight or later. And those drugs have even much better efficacy than taking the drug that start to, uh, get into their bloodstream in the evening. So these are some of the very early examples that timing the drug has a huge impact in reducing- uh, adverse side effect and improving efficacy

Dr. Rangan Chatterjee 37:05 And I suspect from what you were saying, Satchin, we'll, we'll probably in maybe 10, certainly 20 years, I imagine, we'll look back and think, "Oh, what we, we said patients could take the drugs at any time." You know, we didn't, you know, I, I, I imagine we'll, we'll have a time where we think, "No, of course, you've gotta- if you're taking this drug, you take it at this time. You're taking this drug, you take it at that time."

Satchin Panda 37:25 Yeah. So that's a, that's, that's where medicine might go in future, and we think, uh, some of the chronic diseases that are going to, that are affecting more than 10% of the patient population, 10% of the adult population, uh, where we'll see huge impact. For example, blood pressure medication. We know our blood pressure has a natural circadian rhythm. It should go down when we sleep. So blood pressure lowering drugs taken at bedtime, uh, will do two benefits. One is it'll help reduce blood pressure, but at the same time, it'll also help to bring back the natural rhythm in blood pressure, and that should happen. Uh, so this is, these are some of the very simple examples, and as we learn more and more about how medications work, for example, the next generation of, uh, diabetes medications that are coming to market are these SGLT2 inhibitors. And, um, what is interesting is there are some small studies done to see the efficacy of these SGLT2 inhibitors taken in the morning or the evening, and at low dose, it seems to be more effective in the evening than in the morning.

Dr. Rangan Chatterjee 38:36 Ah.

Satchin Panda 38:37 So these are some of the low-hanging fruits, and what I'm really excited about is, uh, the technology that's also coming on board. So just like we have insulin pumps for type 1 diabetics that are in a closed loop system, uh, they measure the blood glucose level and infuse insulin, just imagine if we have the same kind of drug pumps that will infuse the right drug in the right dose at the right time, even in the middle of our sleep. Then we don't have to depend on patient's memory [chuckles] of-

Dr. Rangan Chatterjee 39:10 Yeah

Satchin Panda 39:10 ... when they should take the drug.

Dr. Rangan Chatterjee 39:12 Yeah, just incredible. Satchin, we could, we could go down lots of deep rabbit holes here, I'm sure.

Satchin Panda 39:18 Yeah.

Dr. Rangan Chatterjee 39:18 Um, one thing I do wanna cover, and probably we'll bring this, bring it back to here for the, for the remainder of the interview if I can, is w- you mentioned some of your time restricted feeding studies in mice, and so in animal studies. How are you getting on with actually translating this to humans?

Satchin Panda 39:37 Yeah. So initially, when we published those studies, uh, there were many people who were skeptical for a couple of reasons. Some people think that, uh, most humans eat all of our food within 10 to 12 hours in three or four meals, uh, so it may not have significance to human population. So to address that question, uh, we started asking this in a different way. We asked, "When do people actually eat, and what is the definition of food?" Surprisingly, we don't know what is, uh, w- we haven't defined what is a meal. So is, uh, say, eating a banana considered a meal? Or having half a can of, uh, fruit juice or a cup of coffee or tea with milk and sugar, is that food? So to address this, uh, we came up with a very simple solution. We developed an app called My Circadian Clock, uh, that anyone anywhere in the world can actually go to this website, mycircadianclock.org, and fill out a few questions to comply with, um, ethics committee and the way we do medical research, and then can download the app and, uh, snap a picture of what they're eating or drinking, and we do the rest. And from this, uh, research, what we're finding is nearly 50% of adults in Western countries eat for 15 hours or longer. So that means if their first cup of tea with milk and sugar happens at 6:00 in the morning, then the last sip of wine or last sip of milk might happen at 9:00 at night or later. And why this is important for us is when we put mice on a 15-hour diet, they eat everything within 15 hours, we see that they slowly become more prone to metabolic disease. They s- they'll slowly become obese and diabetic. So through this app now, we have more granular insight into when people eat. And it's not only a problem in the Western countries. We also find a similar trend in countries like India, China, Singapore, et cetera, where we find people actually spread their calories over a very long period of time throughout the day, sometimes 15, 16, even 18 hours. The second thing that we did is we asked, "Is it a modifiable behavior?" And that's extremely important because, for example, if we come up and say, "Eating only fruits is good for you," can people change all their diet to fruits? May not be possible. So we wanted to see if we ask people, "Try to eat everything within 10 hours window," can they do it? And if they do it, then what happens? So through the app, again, we provide them educational material and health tips so that they know why they're doing certain things, why they're trying to change, why changing their eating pattern and eating everything within 10 hours is good for them. And when we did that, what we find is people... Of course, the first set of experiments is always done on, uh, not extremely unhealthy people, but moderately unhealthy people who have, uh, maybe, um, slight increase in weight, overweight people, not extreme obesity. What we found, uh, surprisingly, was, yes, it's a modifiable behavior. People found it relatively easier to adapt because they were not going to buy new diet They didn't have to carry a l- um, a pen and paper or an app to count how many calories they are eating. Uh, they just had to remember what time was their first meal, and then count 10 hours and try to eat everything within that 10 hours. And they tried to eat the same, maintain the same 10 hours window every day. And after 16 weeks, what we found is these people lost a, a good amount of weight, 4 to 5% of body weight. And then in the next, uh, year or so when we didn't have any contact with these people, we wanted to see whether they can maintain that habit. And surprisingly, they did maintain that habit. They maintained their weight loss. At the same time, uh, the third surprise came [laughs] when we asked them, "Why did you stick to this diet pattern? Was it weight loss?" And the reason was no, it was not weight loss. [laughs] The reason was they felt more energetic throughout the day, they slept much better, and they didn't have much acid reflux or heartburn. And then we realized on a daily basis, what actually affects us, what bothers us is a good night of sleep, feeling more energetic throughout the day, and, um, not having that heartburn, uh, having that stomach, uh, pain, uh, stomach, um, uncomf- un- being uncomfortable with your gut at night. So we have taken it now one step further. Now we have a large study where we have thousands of people, tens of thousands of people from all over the world. They're sharing their data, and we're learning a lot about what kind of other diseases this time restricted eating of 10 hours will help. And we find some people can even go down to eight hours, and some hover around 11 to 12 hours. But, uh, any interval s- from eight to 12 hours is good enough if people can stick to it, and we're finding benefits from metabolic disease to even some cases, um, um, some inflammatory disease.

Dr. Rangan Chatterjee 45:14 Wow. I mean, Satchin, that's, you know, if I can just sort of relay what I find in practice, and I've probably been utilizing time restricted feeding with my patients, I'm gonna say for at least three years now I think. I think since I read y- read, I think one of your 2014 papers.

Satchin Panda 45:32 Yeah.

Dr. Rangan Chatterjee 45:33 I think it made a lot of sense to me, and I also felt that i- intuitively it sort of makes sense, uh, that we're not designed to eat [laughs] from 6:00 AM to 10:30 PM. That makes sense. And I, I also felt that I can't really see any downside to this intervention, so I felt very comfortable recommending it. Um, and I've seen some incredible results. Uh, the first thing I find is that compliance is really good. I mean, I, for, for, for patients who are really struggling with a lot of different problems, I often start with just 12 hours. I say, "Guys, can you just restrict, y- just keep eating what you eat," saying, "Yes, I do try and change their diets, of course." Um, but I say, "Guys, just focus not on, not so much on what you're eating, but when you're eating." And I think 12 hours, for example, which would be, let's say breakfast at 7:00, finishing dinner by 7:00 or 8:00 till 8:00, I find most of my patients can do it. Um, a- and even when I restrict it down to 10 hours, I think most of them actually can do it. But it, it is really interesting you're seeing that the compliance is there, um, which is just incredible. But also, I've also seen this, when people do that, they come back and say, "You know what? I'm sleeping better. You know, I've got, I've got more energy."

Satchin Panda 46:44 [laughs]

Dr. Rangan Chatterjee 46:44 And one thing I've learned in many years as a doctor is that, you know, patients aren't gonna do what you ask them to do just because you tell them to do it for more than a few weeks, you know, maybe a month, right? They're only gonna continue, by and large, you know, I'm making a, a very broad statement, when they start to feel better. And they go, "Yeah, I'm, I'm, I'm gonna keep going with that." And I'm probably the same as a human being, you know?

Satchin Panda 47:11 [laughs]

Dr. Rangan Chatterjee 47:11 So that's why I think this is such a powerful intervention, 'cause people generally feel better pretty quickly.

Satchin Panda 47:16 Yeah, absolutely. Um, and then also it's very intuitive, and it is in alignment with, uh, many of the recommendations that doctors already make. For example, um, most physicians and most researchers agree that, um, one should set aside eight hours in bed. Um, means if you, if you're in bed for eight hours, at least you'll sleep well for seven, seven and a half hours. So of course, those eight hours you're not going to eat. It's also a common sense not to eat within two hours before going to bed at least. 'Cause many people know that if they have a big meal, they go to bed, they cannot sleep well. So now you add that eight plus two or three hours before going to bed, we're already 11 hours you should not be eating. And then as soon as you wake up, of course, give yourself one hour to do your usual stuff, and then prepare some good healthy breakfast. So in that way, it's very easy to achieve a 12 hours eating or 12 hours fasting window. And then the reason why we ask people to try to target 10 hours is if they, if they, if they try 10 hours, then maybe they will end up in 11 or 12. [laughs]

Dr. Rangan Chatterjee 48:33 [laughs] The, the doctor's, the clinician's secrets of, uh, you know, how to actually engage [laughs] a patient to do what you, you know, what, what you'd actually ideally like them to do. Okay, so actually-

Satchin Panda 48:43 Yeah

Dr. Rangan Chatterjee 48:43 ... you know, I'm sure people will be listening there and saying, "You know, I've got a lot of, I've got listeners all over the world," but there's a, a huge part of, of the listenership is in the UK. Um, can they also access this app and put their data in to help you collect your research?

Satchin Panda 48:58 Yes. Uh, actually now our ethics committee has approved us to, uh, capture data from anywhere in the world, uh, as long as they have a smartphone that runs, uh, on Apple iOS or Android device. And has a camera option, so then they can share their data. And I must emphasize that there are a lot of diet apps out there. Um, but a lot of them capture the data for, of course, for commercial purpose. But here, uh, all the data that we capture is, um, de-identified, anonymized, and is put in a HIPAA compliant, um, server with, uh, the latest, um, privacy-

Dr. Rangan Chatterjee 49:41 Yeah

Satchin Panda 49:41 ... uh, rules. Um, and we don't share the data with any outside, uh, entity.

Dr. Rangan Chatterjee 49:49 And Satchin, I'm gonna, I'm just gonna highlight that for people who don't know, the Salk Institute, it's where, where Satchin does his research, it is one of, you know, the most prestigious and well-known research institutes ar- ar- arguably in the world. Very, very reputable. [upbeat jingle] Just taking a quick break in today's conversation to give a shout-out to the sponsors of today's show. Athletic Greens continue their support of my podcast. To be really clear, I absolutely prefer that people get all of their nutrition from foods, but for some of us, this is not always possible. Athletic Greens is one of the most nutrient-dense whole food supplements that I've come across, and contains vitamins, minerals, prebiotics, and digestive enzymes. So if you are looking to take something each morning as an insurance policy to make sure that you are meeting your nutritional needs, I can highly recommend it. For listeners of this podcast, if you go to athleticgreens.com/livemore, you will be able to access a special offer where you get a free travel pack box containing 20 servings of Athletic Greens, which is worth around 70 pounds, with your first order. You can check it out at athleticgreens.com/livemore.

Satchin Panda 51:01 No, I mean, this is the way where, in the modern, uh, clinical studies should go, because what we realized is another thing, that most of the clinical control, clinical studies are done in maybe 20 or 30 or maybe 50 very reputable clinical centers throughout the world. And all these studies are done on people who live within 20 to 30, or maybe maximum 50 kilometers from the clinical center. So then what you practice as physician, or what we usually tell people, is based on a very small number of people who live within very small, very close distance from these clinical centers.

Dr. Rangan Chatterjee 51:40 And if you think ab- if you think about it, we kn- certainly in the UK, you know, we know that socioeconomic groups change depending on, you know, where you are, for example. So, you know, in some cities, for example, it's right in the center of the city, it's lower socioeconomic groups, and as people go out to the suburbs, it's more affluent socioeconomic. You know, more-

Satchin Panda 51:59 Yeah

Dr. Rangan Chatterjee 51:59 ... uh, more, more, more affluent areas, and so that will obviously skew which population you're pulling in. That's, yeah, that's super interesting.

Satchin Panda 52:08 Yeah. So that's one reason. We, we thought in this way, we can actually get very representative samples and we will know what kind of challenges people have, um, in their work. So, for example, nearly, nearly all clinical studies exclude, uh, people who do shift work. Uh, whereas now we can collect data from people who do day and night shift, 24-hour shift, emergency workers, and we can see what kind of challenges they have in adapting, say, 10 hours time restricted eating or t- 12 hours, and what they can do. The second thing why I'm very excited about the, this way of doing research is, um, when I go to do a research, do a study in my mouse room, I cannot ask the mouse how is he feeling. [laughs] Whereas humans, they give us feedback. For example, this idea that time restricted eating improves sleep. Uh, we have done maybe, uh, dozens of mice. We have put dozens of mice in time restricted eating, but they never told us that they were sleeping better [laughs] . But it's only the humans who came back and told us, and then now we are going back and asking, "Why is that happening?" Similarly, acid reflux, we never thought [laughs] because mice also don- don't tell us. So this is another reason why when somebody downloads the app and then finds some benefits after time restricted eating, and in the app there is a feedback feature, they can just write a sentence saying, "Well, I have this condition and this is helping me," then we take that information and come back, go back and see what is the scientific basis? And this gives us new ideas, new hypothesis, to go back and do basic science research.

Dr. Rangan Chatterjee 53:55 That is incredible. So you're, you're learning from w- the feedback, and, and that feedback, you're now going back into the lab to try and figure out why that might have happened. Which actually, if you think about it, that's what any good clinician or researcher should really do as well, if you think about it. You know, I've... I remember as a, as a, maybe five, 10 years ago, as a, as a, as a doctor, hearing stories from patients say, "Oh, when I do this, I get better." And I think, "Well, that's interesting. I've not really learnt about that." And you keep hearing the story, you go, "That's interesting. I wanna find out why that intervention is working for those patients"-

Satchin Panda 54:28 Yeah

Dr. Rangan Chatterjee 54:28 ... rather than saying, "Oh, it's... Oh, that's rubbish. You shouldn't be doing that." It's like, well, you're telling me that's working. I now need to figure out why is that working? So, uh, I ca- I can see why the app would be so beneficial.

Satchin Panda 54:38 No, that's the most fascinating part of, uh, doing this, uh, research this way. We, we are learning a lot of stuff. Um, so actually, that prompted me to go back and ask, uh... Because there, we found people with various conditions, for example, people who had depression, bipolar disorders or anxiety, even night eating syndrome, um, arrhythmia, cardiac arrhythmia, uh, they all came back and w- we would hear one or two stories like this, and then, uh, this is kind of at the background noise level. And then when we hear the same thing happening in half a dozen or a dozen different people, then we go back and, and the first thing we do is we read the literature. Is it reported that people who do chronic shift work, are they predisposed to this kind of disease? Or is there a animal model where if you put the animals in disturbed condition, does it happen? Or animals or humans who have a mutation in circadian rhythms in, does it happen? So when we put this together, what we're finding is there are nearly 110 different disease conditions which may arise from circadian disruption. Or conversely, there are nearly more than 100 diseases where just taking care of the, your daily rhythms by paying attention to when people eat or when people sleep, how much they sleep, will substantially, significantly reduce the disease risk and disease burden.

Dr. Rangan Chatterjee 56:02 Well, Satchin, let's, let's, let's, let's sort of dive into that if we can. This is, this is-

Satchin Panda 56:06 Yeah

Dr. Rangan Chatterjee 56:06 ... you know, y- you're basically saying that many of the diseases that are now afflicting people or the complaints are in some way reflected to their circadian rhythm or whether they're living in harmony with that or not. So what are some of those things? Are people listening are gonna go, "Yeah, that's... Okay, great. What can I do?" So you're saying a, a time restricted window. Do we know if it's better to eat early and finish early or, um, you know, eat breakfast late and finish late? I mean, I certainly know what I think on that, but I, I just wonder do you, do we know yet, uh, which is better?

Satchin Panda 56:40 Yeah, so it's, it all goes back to people's lifestyle. So for example, some people, they go to bed very late because of the work or because of the family issues they have, and then they also wake up very late in the morning, say 8:00 or 9:00 in the morning. And for them, we cannot come back with a simple, uh, universal, uh, rule that one should eat breakfast at 6:00 AM or 7:00 AM. So what I feel is, uh, maybe after you wake up, give yourself at least an hour before you have your first cup of tea or coffee or breakfast. That is also another, another reason why that is important is as we wake up, sometimes we wa- we wake up to an alarm clock. So although our body, our brain wakes up, many of our hormones that keep us asleep, they haven't gone back to the state where we should be awake. Very simple example is melatonin. A melatonin levels rise throughout the night, and that helps us to stay in sleep. And when we wake up in response to our alarm clock, we wake up, but then the melatonin hormone doesn't listen to that alarm clock. [laughs] It is still high, and it takes another hour or so to come back to baseline, to low level. And when we eat that first bite when the melatonin level is pretty high, then just like melatonin makes our brain to sleep, it also makes our pancreas to sleep. So that means in response to that breakfast, we may not, our body may not produce enough insulin to take care of the, to process that food.

Dr. Rangan Chatterjee 58:19 So wait an hour before having anything is, is one sort of take home tip for people.

Satchin Panda 58:24 One, wait at least an hour. And some people, they don't feel hungry, uh, they might have had a big meal last night, so at least one hour is a good rule. And, uh, then you can start counting your 10-hour window. So if somebody is waking up at 8:00 and having breakfast at 9:00, then 10 hours will bring him to, him or her to 7:00 PM at night, in the evening for last bite. And the reason why we say 10 hours is a good target is, uh, sometimes things happen. You may be delayed, you may be stuck in traffic, or you may have to come home and prepare food. So even if you go to 11 hours, uh, you are not booted off this island of time restricted feeding. [laughs] You're still-

Dr. Rangan Chatterjee 59:05 But you, you... But, but I think you said earlier on that really anywhere between 8 and 12 hours, we know-

Satchin Panda 59:10 Yeah

Dr. Rangan Chatterjee 59:10 ... you're gonna get a lot of the benefits.

Satchin Panda 59:12 Yeah. So, uh, there is, there are some differences that we find in mice. Of, of course, we haven't done the experiments, um, as rigorously in humans. So what we find is when mice eat between 8 to 10 hours, um, within that 8 to 10 hours window, then they have a tremendous benefit on their endurance. Um, so their muscle function is much better. They can outrun, uh, uh, mice that eat healthy diet any time. They will stay on, um, a, a treadmill for more than two hours. But if they eat somewhere between 11 to 12 hours, then all the other health benefits are there, but they s- it slightly reduces their endurance benefit, and we don't un- we don't understand why. Uh, so now they will stay on the treadmill maybe an hour, hour and a half. And why this is important is as we get older, our muscle performance weakens, but at the same time, our heart is also full of muscle, so our cardiac arrhythmia slightly goes up as we age. So what we found in mice and also in Drosophila fruit flies is when we, when they have a certain time interval, then that cardiac arrhythmia is reduced and they can have high endurance. So some people who want to improve their cardiac performance or endurance, then they may suit for 10 hours or something and then self-experiment a little bit to see whether that suits them, and they may stay w- between 8 to 10 hours. And for people, uh, for other people who find it much, uh, easier to stick to 10 to 12, then 10 to 12 is better for them.

Dr. Rangan Chatterjee 1:00:59 Do we know how low you can go? I mean, s- I know many people listening will be wondering, well-

Satchin Panda 1:01:03 [laughs]

Dr. Rangan Chatterjee 1:01:04 ... you know, 'cause I, I know when I lecture about your research, people always say, "Yeah, but what happens if I do six hours, or what happens if I eat for four hours?" Do we, do we know anything about that?

Satchin Panda 1:01:12 [laughs] Well, unfortunately, we cannot do this kind of research in, uh, in mice for long period of time because when we reduce our time interval, then mice also eat less, so we get the double benefit of caloric restriction and time restriction.

Dr. Rangan Chatterjee 1:01:27 Right.

Satchin Panda 1:01:28 And from scientific studies point of view and academics, we need to differentiate that. We also don't know the very long-term effect of this caloric restriction on circadian rhythm, uh, but at least the mouse experiments, on the other hand, have, um, given us the clue somewhat indirectly. And let me kind of take a couple of minutes to explain this. Uh, there are a lot of caloric restriction studies in literature, very well done from many different labs from all over the world, where mice are given, uh, 70% of calories, uh, 70% calories of what they usually need in a day. And this calories, this food is given at certain time of the day, maybe at 10 o'clock in the morning, or sometimes at 5:00 in the evening. And we know that the caloric restricted mice live longer than mice, uh, that eat their normal diet ad libitum. So that has led to this idea that caloric restriction increases longevity, improves health, in, in many, many numerous studies. One simple thing that many caloric restriction studies did not pay attention to is when do these mice eat their food? [laughs] And now what is becoming very clear is all the CR studies, caloric restriction studies, also involve time restriction. That means these mice eat all their food within four to six hours. So that means this four hours time restriction or six hours time restriction kind of studies have already been done in mice, and those studies have shown that the mice eat slightly less, and they live longer, and they have many other health benefits. But having said that, [laughs] I cannot just go and tell people they should eat, uh, between four and six hours. The reason being, I see time restricted feeding or time restricted eating as a public health or a, um, solution to many of the disease or as a family solution to being in sync. Um, so when I say a 10 hours or 12 hours time restricted eating, I feel that everyone from a five to 8-year-old to 80-year-old living in the same house can follow the practice, and when the eating time is synchronized, it also brings back family time together, and this is kind of a way of life that's way beyond trying to improve your personal health. It's a family health. It's a community health.

Dr. Rangan Chatterjee 1:04:02 Satchin, I love that. I love that. I mean, that is, it's such a, it's a s- it's a simple, it's one thing that you change, and it has so many knock-on benefits, doesn't it? It's for the whole family. As you say, you know, sitting round a table eating together. Um, a- and w- and again, but we know that has many benefits, not only for physical health in terms of how, and how much you eat, but also in terms of social health and emotional health. And actually, on the, on the very first BBC, uh, documentary that I, I ever was involved with, um, a, a program called Doctors in the House, which first, this first episode aired in, in 2015, and, um, I think you can still see it on YouTube actually, on my YouTube channel. It's, it's still there. But it's, we, we used time restricted feeding. I think it was either 10 or 11 hours. But it was interesting. They would all, they, they put up the times on their fridge.

Satchin Panda 1:04:49 Yeah. [laughs]

Dr. Rangan Chatterjee 1:04:50 And they would sit around, and they, they'd end up eating all their dinners together because it was a family thing. We were all doing it together. You know, it's not that I'm doing my time restricted feeding and you're doing yours. The family, the, the, the mom, the dad, the daughter, they all did it together, and that's, obviously, when you were talking about public health changes, it's very hard to make behavior change in isolation. It's much easier when it's everyone around you is doing the same thing as well, right?

Satchin Panda 1:05:15 Yeah. So that's why I think we are always thinking about a simple behavior change that will have, uh, multiple effects, domino effect. And I think this time restricted eating is one, that simple behavior change that will have, uh, both, uh, uh, benefits for social health, family, bringing the family together, bringing family health to forefront, uh, all of this together. And the way I compare time restricted eating of 10 hours or 12 hours to other practices that we do on a daily basis, it's almost like brushing your teeth to take care of your teeth, uh, dental health. And we do it every day. We don't even think about whether there is a cheat day. Can I cheat on brushing my teeth? Uh, well, you can cheat, but [laughs] it's not a pleasant experience. But at the same time, once in a while, we go to the dentist because we need a deep cleansing, deep cleaning. So similarly, maybe once in a while somebody can go back to, say, six hours or eight hours time restricted eating for a few weeks, a couple of weeks, or for six weeks, but then we'll come back to, say, um, eight, 10 to 12 hours time restricted eating for the rest of the, uh, time in the year. So... [laughs]

Dr. Rangan Chatterjee 1:06:25 It's actually, do you know what I find incredible about this? You're, you're at a cutting edge research institute. You are one of the world's most cutting edge scientists at the moment in terms of what you're, what work you're doing.

Satchin Panda 1:06:35 Thank you.

Dr. Rangan Chatterjee 1:06:35 Yet some of these concepts have been part of human culture for donkey's years, right?

Satchin Panda 1:06:41 Yeah.

Dr. Rangan Chatterjee 1:06:41 You know, uh, traditional Chinese medicine have always spoken about that different organs have different times, and we need to optimize our lifestyle to suit what our organs are doing. Traditional Indian medicine, Ayurvedic medicine, has also talked about these, these things. And, and I find it incredible now how we're getting modern cutting edge science to almost echo what I think a lot of humans may well have known for a long period of time.

Satchin Panda 1:07:07 Yeah. So I think, uh, if you think about it, humans are a very creative bunch, and we have lived on this planet for more than 100,000 years, so we have made those observation on a daily basis. We have figured out that when we eat does, uh, have a huge impact. We have figured out that our daily rhythms, daily organ, our organs have daily rhythms. So I'm not surprised, um, that there are, there is a lot of traditional wisdom behind it. And what modern science is helping us is to put the foundation to have a deeper understanding into it so that we can not, we can not only combine it with the lifestyle, we can also combine it with medications, surgery, or what time we should be taking our flu vaccine. All of this can be now integrated to that framework.

Dr. Rangan Chatterjee 1:08:01 Yeah. And, and, and you mentioned, you know, once in a while, like we never really forget to brush our teeth, and once in a while we'll go to the dentist. You know, I remember, I think my mum when I was growing up, you know, once a week, or I think it was once a week, she would fast. You know, almost... You know, again, I'm not saying that people need to do this, I just find it interesting how a lot of these concepts have been there culturally in, in certain, in, you know, in certain places around the world. Um, Satchin, I, I find this so fascinating, this area, I can't even tell you. Um, a few

Dr. Rangan Chatterjee 1:08:31 things I just wanna quickly fire through-

Satchin Panda 1:08:32 Yeah

Dr. Rangan Chatterjee 1:08:32 ... if we can. Caffeine, you mentioned, you know, wait an hour.

Satchin Panda 1:08:36 Yeah.

Dr. Rangan Chatterjee 1:08:36 Uh, this is a big question for everyone because, you know, everyone likes their morning cup of coffee, or certainly in the UK, cup of tea. Um, what's the deal there? When you say time restricted eating window-

Satchin Panda 1:08:47 Yeah

Dr. Rangan Chatterjee 1:08:47 ... do you mean fluids as well, and do you mean caffeine?

Satchin Panda 1:08:50 Yeah, so time restricted eating window includes all food, and I always tell people to, to limit their coffee to that window for most regular people, uh, coffee and tea. So there are two reasons. One is, as soon as you wake up, if you need coffee to really get out of your bed, that's a warning sign that you're not getting enough sleep. Um, so if you really need that coffee to open your eyes, then maybe you have to try to go to bed little early to, uh, reduce that urge. Second is, if you really have to have that coffee, then, or coffee or tea, then you can try, um, without milk and sugar, because at least that will reduce the chance of your pancreas waking up, 'cause that's when your insulin response is pretty low because your melatonin may be still high.

Dr. Rangan Chatterjee 1:09:43 So a black tea or a black coffee m- is okay outside the eating window-

Satchin Panda 1:09:46 Is okay

Dr. Rangan Chatterjee 1:09:47 ... for some people, but it's when you add sugar and milk and cream and that sort of thing.

Satchin Panda 1:09:50 Yeah, particularly in the morning. And then what I say is, um, usually our body clears half of the caffeine within six to seven hours. So that means even if we had coffee at noon, then half of that caffeine is still in our system by 6:00 or 7:00 PM. So that's the reason why some people cannot go to sleep if they have coffee or tea in the afternoon.

Dr. Rangan Chatterjee 1:10:16 And, and just to, just to emphasize a point, if half of that coffee is in your system at 6:00 PM-

Satchin Panda 1:10:21 Yeah

Dr. Rangan Chatterjee 1:10:21 ... a quarter could still be in your system at midnight.

Satchin Panda 1:10:24 Yeah.

Dr. Rangan Chatterjee 1:10:25 Which is, you know, no one would have a quarter q- well, some people do, but, you know, we, we know that that's possibly not a good idea. That's incredible. So that's even at, at midday.

Satchin Panda 1:10:33 Yeah. So that's why, uh, what I say is, uh, the rule of thumb is, is to not have tea or coffee after lunch, uh, if you want to have a good night's sleep. So now you can see that this is all, uh, there is a domino effect. Somebody having late afternoon coffee, um, will likely go to sleep relatively late, or will not have deep sleep at night. And then in the morning, of course, this person is waking up, um, with insufficient sleep and will need another cup of coffee just to wake up. [laughs] And so this cycle will continue unless somebody really makes an effort. So what I s- uh, tend to say is, try this in the weekend because in the weekend, if you cut down on one cup of coffee or tea, it's likely that your brain will react and will give you a mild headache, and in the weekend you have time to deal with that headache. And then in the weekday, try to continue that and you'll see that you may go to sleep much better, and then you can wean yourself from excessive coffee.

Dr. Rangan Chatterjee 1:11:37 Yeah. Okay. That is a absolutely fantastic tip, and uh, this, this, it's amazing how many of these recommendations we're talking about actually were separate chapters in my book. It's, it's just incredible. Like, like one of, one of them is called Enjoy Your Caffeine Before Noon.

Satchin Panda 1:11:51 [laughs]

Dr. Rangan Chatterjee 1:11:52 Um, so I'm like saying, "Guys, if you love it, enjoy it, fine," but, but, but for me, I think, because I've seen it so many times, past noon-

Satchin Panda 1:11:59 Yeah

Dr. Rangan Chatterjee 1:11:59 ... I've seen problems. And, and no one... And people are so attached to coffee and caffeine that so many people say, "Oh, you know, it doesn't affect me. It doesn't affect me." And when they start reducing it, they suddenly see-

Satchin Panda 1:12:10 Yeah

Dr. Rangan Chatterjee 1:12:10 ... how much things starts improve. I don't know if you've seen that at all.

Satchin Panda 1:12:14 Oh, yeah, I do that, uh, once a year. I actually, um, completely stop caffeine for two to three months, and that's when, that's the golden time [laughs] because that's when I get very deep sleep and very restorative sleep, and also my general anxiety... Not anxiety, I would say my focus level goes up pretty high, so I can really stay focused on what I'm writing or what I'm, um, researching on. So I see all that benefit and, and once in a while it's good to have that self-experimentation to try and do something. It means getting off of coffee will give me maximum couple of days of headache. I'm not going to die. [laughs]

Dr. Rangan Chatterjee 1:12:56 No. It's a stimulant, right? It's a stimulant that we're, it's a-

Satchin Panda 1:12:58 Yeah

Dr. Rangan Chatterjee 1:12:58 ... it's a drug actually that many of us are taking every day multiple times. And-

Satchin Panda 1:13:03 Yeah

Dr. Rangan Chatterjee 1:13:03 ... you know, you s- it's interesting, you get better sleep, you're more productive. All these things that actually, you know, people think that coffee makes them alert and makes their acuity, you know, their, their sort of sharpness go up. But there was a, I think it was a great study from, uh, 2011 from Bristol University that suggested that all it does is bring you back [laughs] up to the same level as if you never drunk it in the first place.

Satchin Panda 1:13:25 Yeah.

Dr. Rangan Chatterjee 1:13:25 And I found that study, although I didn't like it, I thought, I think this is probably true, actually.

Satchin Panda 1:13:29 Well, coffee has a very different, uh, history. I mean, so if you go back to the history of coffee, um, uh, this was the key for bringing coffee houses in the Middle East, for example. And, uh, there's a nice, uh, article about how coffee houses started in Istanbul, and the evening social activity was around coffee. And, uh, then for some people, particularly for people who had to wake up early and do the shift work, early morning shift, uh, for them, coffee was a great medicine. They would actually wake up and they wake up their life in the morning. [laughs]

Dr. Rangan Chatterjee 1:14:04 Yeah, incredible. Satchin, could I just... You know, w- what, there's a, there's a, there's a tale out there, m- if, an old wives' tale, if you will, that one hour of sleep before midnight is worth two hours... Oh, actually, is it the, is it the other way around? Basically, [laughs] I can't remember the phrase. I think it's one hour before midnight is worth two hours afterwards, in the sense that, you know, there's a lot of talk about growth hormone release, and actually if we're sleeping before midnight, we get more of that. Is, is there any truth in that at all? And, or are you not familiar with that sort of research?

Satchin Panda 1:14:34 Well, that is, uh, uh, growth hormone, uh, almost every hormone in our body has a circadian rhythm, and growth hormone is one of them that, uh, goes up, uh, in the first half of our sleep. And it also goes up when we have an empty stomach before sleep. So if you combine those two, then going to bed early has a huge benefit on growth hormone release. Another indirect, it's kind of a social, um, constraint that we have. Um, irrespective of what time we go to bed, because of our job, because of, uh, our children go to school or something else, we all have to wake up before, say, 7:00 or 7:30. So in that way, indirectly, if you go past midnight to go to your bed, then you are reducing the number of hours you sleep, and that has been shown in multiple studies, epidemiological studies, that people who go to bed later actually get less sleep. So when they get less sleep, they also get less growth hormone. And when, when you have less growth hormone, of course, for people like us who are past our, um, 20s, we are not growing. But growth hormone does another very important thing. It actually repairs. A lot of the repair that happens in our body is driven by growth hormone. Most of the stomach lining repair that happens every night is partly driven by growth hormone. So in that way, going to bed early has a huge impact on having better growth hormone spike and having m- better repair, uh, throughout our body.

Dr. Rangan Chatterjee 1:16:07 Yeah. Absolutely incredible. Well, Satchin, you have, uh, been working hard, obviously, in your lab, but I'm pretty excited that your book is about to come out, uh, all over the world and, and, and here in the UK. Uh, it's called The Circadian Code. What can people... What are they gonna find out when they, when they, when they get your book? What can they, what are they gonna learn? Is it, are you gonna sort of talk about research, talk about practical tips for them? Yeah, can you tell me a little bit about the book and what's gonna be in it?

Satchin Panda 1:16:33 Yeah, so the book is, uh, really my first attempt to, uh, let people, both the general public and also healthcare practitioner or healthcare workers, uh, to learn a little bit about circadian rhythm. So it's a nice mix between, uh, what are the science behind, um, circadian rhythm and how people can use this science in very simple way, uh, by timing when they should eat, when they should sleep, and what they should eat. There are also a few things about what they should eat. Uh, when they should exercise, because we don't have too much time to exercise. Can we have a peak time, p- uh, time when we can exercise maybe less and get more benefit? And, uh, the book also talks about how to take care of your circadian rhythm to reverse some of the diseases. Uh, so it goes from simple heartburn to cancer. Um, and throughout the book, we also have examples of people who have used very simple tricks to, um, to nurture their circadian rhythm and get the wisdom of the body and what they have achieved. So, uh, this is a, a very interesting book that goes back and forth between science and how to use the science of circadian rhythm in real life.

Dr. Rangan Chatterjee 1:17:51 Wow. Satchin, having, having seen you speak on, uh, both on your amazing videos on the internet, but also, uh, speaking alongside you and watching your talk, and it was just phenomenal and breathtaking, I can already get a sense that actually this book is gonna have, you know, you know, personal story and anecdote weaved alongside science and, and cutting edge research. So I absolutely cannot wait to get it. Guys, for those of you listening, I, I really would recommend you follow Satchin, um, uh, on, on Twitter, and, you know, really I think this is one of the most important scientists currently in the world in terms of doing research that can actually transform what we do with our patients and, you know, transform the way that you're living your life. And for, for me, what's, what's really key is that a lot of what Satchin's research is bringing to us, that I'm starting to use with my patients, is that, you know, it's pretty achievable. It's, it's pretty achievable. A lot of these suggestions you make are free of charge. They don't cost any money. You know, they, it, it's, it's very, very accessible for people, and I'm, you know, I'm, I'm delighted that you, you could spare some time, and I'm, you know, gonna be getting that book the first day it comes out, and I, I'd encourage you guys to get, to get this book as well, The Circadian Code. Again, guys, w- I'm gonna link to, uh, Satchin, I think you're mostly on Twitter, is that right? Or do you do any-

Satchin Panda 1:19:09 Yeah.

Dr. Rangan Chatterjee 1:19:09 Yeah. I'll link to all of it, uh, in the show notes. Satchin, one thing I didn't get to ask you, and I, and I know a lot of people will be listening and wondering, you know, what about shift workers? You know, are there potentially there are some tips in the book for shift workers, or are there any simple things that shift workers can do to apply the principles that you have, um, you know, that, that, that your research has brought out?

Satchin Panda 1:19:29 Yeah, so the shift work is a very challenging, uh, work, but at the same time, shift workers, uh, are superheroes, because just like superheroes, [laughs] when we are asleep, they are the ones who are awake. They, uh, take care of our health. They take the sick ones to the hospitals. But at the same time, shift work has a huge toll on our body. So we're trying, uh, now a couple of studies on shift workers. The first one is on, uh, firefighters, uh, because firefighters, um- In the US, they have 24-hour shift. So they're on for 24 hours, and then off 24. It goes for four cycles, and then they get four days off. Um, what we're trying to figure out is, can they do, uh, time restricted eating, at least on their off days, to build up resilience, to build up vitality, to build up their repair capacity, so that when they do this very grueling shift work, it doesn't have a lasting adverse impact on their, um, body. The second thing we're trying to see is whether they can still adapt some of the principles. Of course, they have to stay awake 24 hours, or at least they will wake up six, seven times, sometimes 10 times throughout the night to respond to emergencies. But at the same time, can they at least stick to eating within, say, 10 to 12 hours during their on days when they're working, um, that is aligned to their work schedule? And for firefighters, we're trying to do that for the daytime. For some of the shift workers who are going to work at nighttime and stay on that shift for a week, uh, we'll see whether they can stick to it for, um, the nighttime when they're awake. And then we're also giving them tips how to sleep well during off days or sleep well during daytime when they get an o- opportunity to sleep. And these are, again, very simple, uh, tips, and sometimes many of them, they can easily adapt. And we'll monitor these, uh, firefighters, San Diego firefighters, for up to one year. Uh, there'll be 150 firefighters in our study, [laughs] and we're really super excited because, uh, we'll hook them up. They're already hooked up with continuous glucose monitors, so we'll see meal by meal, and depending on the stress level, how many emergency calls they're taking, how their body's responding in terms of glucose. Uh, they will also have a continuous activity and sleep tracker, a light exposure tracker, all of this. So, uh, we're excited about that, but at the same time, through our My Circadian Clock app, we see a lot of shift workers, um, emergency room physicians, um, and, uh, emergency responders who, uh, drive, uh, say, ambulances, they're already adapting some aspects of circadian clock or eating pattern, and they're finding many benefits.

Dr. Rangan Chatterjee 1:22:26 That's fantastic because, as you say, you know, night shift workers are a, a critical part of society. They, they help us in so many ways, whether it's hospitals, whether it's paramedics, whether it's the fire-

Satchin Panda 1:22:35 Yeah

Dr. Rangan Chatterjee 1:22:35 ... um, engine staff, you know? So it's very important that we can look after them and actually give them some really useful, practical tools to help them improve their health. Satchin, final question now. I have changed my own habits dramatically based upon your research. So, you know, I- I'm sort of pretty diligent. Most of the time it's sticking. You know, I stick to a, to a restricted eating window, and it, and it varies a little bit, but, you know, I, I sort of normally manage to do 11 hours or, you know, at the very, at the very most 12 hours. I, I kind of think in my head, at least if I've got that 12-hour gap without any food going through my s- my system, that's a good thing. You know, have you-

Satchin Panda 1:23:15 [laughs] Yeah

Dr. Rangan Chatterjee 1:23:15 ... since you started doing this research and seen all these incredible benefits, has that changed your behavior and your family's behavior?

Satchin Panda 1:23:23 Oh, yeah. Um, my behavior changed right away. In fact, not only mine, uh, almost, uh, everyone in our lab, when they saw these mice, [laughs] th- these mice change their behavior. So I try to stick within, uh, just like you, within 11 hours, and sometimes I slip towards 12 hours. And, um, now I have a new criteria of how important your research is. It should not only change your own behavior, it should be convincing enough to change the behavior of your spouse and your mother. [laughs]

Dr. Rangan Chatterjee 1:23:55 Wow.

Satchin Panda 1:23:56 And I've been suc- [laughs] I've been successful [laughs] in both fronts. And, uh, actually, my mother, who was, uh, pre-diabetic a couple of years ago, now she eats within 10 hours, and blood sugar has completely gone back to normal. She's very active, and, uh, she's approaching 70, and she's still healthy. She doesn't take any medication. And-

Dr. Rangan Chatterjee 1:24:18 That's incredible

Satchin Panda 1:24:18 ... uh, recently, um, I also achieved another milestone, and that is I could convince my mother-in-law. So this is the mother-in-law test for your research. [laughs]

Dr. Rangan Chatterjee 1:24:28 [laughs] And she's now doing it?

Satchin Panda 1:24:30 She's doing it. So she's, she's-

Dr. Rangan Chatterjee 1:24:33 Yeah

Satchin Panda 1:24:33 ... actually more, uh, diligent than me. So she does, um, nine to 10 hours max.

Dr. Rangan Chatterjee 1:24:39 Yeah.

Satchin Panda 1:24:39 And she's finding a lot of health benefits. Again, she, she's also without medication, so she's completely healthy, um, and has no complication.

Dr. Rangan Chatterjee 1:24:50 Yeah. And obviously, you know, y- y- you mentioned your mother's story with pre-diabetes. I've seen this as well in my clinic, you know. If, if they, you know... Yes, y- you know, the bulk of what they've done is restrict their eating window, and that in itself has had benefits. So for people listening, I'd really encourage you guys to, to, to, to think about giving it a go for a week or two. Just, just see how you feel, you know? Just, you start to feel the difference.

Satchin Panda 1:25:13 Yeah.

Dr. Rangan Chatterjee 1:25:14 One thing people might be thinking is, "Yeah, I get it. I'm gonna try and do 10 hours or 11 hours." What happens if, you know, one day a week or two days a week, you know, I'm on a business meal out and I eat late, so I come back late? Does it matter, um, if you can't do it every day?

Satchin Panda 1:25:29 Yeah, actually, we have even, uh, done that in our lab. So we have given mice one or two days off day [laughs] in a week, and we still see that if they're sticking to, say, nine hours time restricted eating, uh, during the weekdays, nine to 10 hours, then going off for one or two days in the weekend still maintains the benefit. For humans, actually, for us, it's very different. What happens is, once you're used to eating all your food within, say, 10 to 12 hours, one day if, personally, if I eat way past that window, first thing is I'm not hungry really to eat that food And second is if I eat that food, I can really feel that the food just st- stays there in my stomach, doesn't get digested. So next day I don't feel like eating breakfast. So I'll, automatically I'll delay my breakfast and then I, my body kind of, uh, responds saying that, "What you did was not good. [laughs] Don't try to do it again."

Dr. Rangan Chatterjee 1:26:29 Yeah.

Satchin Panda 1:26:29 So, [laughs] so you kind of learn from the wisdom of your body. Your body will tell you not to do it again. [laughs]

Dr. Rangan Chatterjee 1:26:36 Yeah, and I've, I've experienced this myself, but I've, I've also heard from some of my friends that if you eat really late at night, sometimes in the morning you, you almost feel as though you've got a hangover, uh, even though, even if you haven't drunk any alcohol. But just from eating at the wrong time, you can really start to mess all these systems up and feel awful the next day.

Satchin Panda 1:26:54 [laughs] Yeah. So some of our, uh, participants actually have given it a name. They call it food hangover. So if you eat very late at night, the next day you have this food hangover, and you don't feel like eating, and you are groggy. Your mind is foggy. [laughs]

Dr. Rangan Chatterjee 1:27:10 Bit like jet lag, right? It's a bit like what happens when you're jet lagged.

Satchin Panda 1:27:13 Exactly. Yeah. So half of the jet lag is just eating at the wrong time.

Dr. Rangan Chatterjee 1:27:17 So therefore, is a tip to, I mean, are, are there some take homes here that people can take if they're traveling a- across time zones?

Satchin Panda 1:27:25 Yeah, so that's another thing that I even personally do. I try to avoid food in flight, and try to sleep as much as I can. Even though I'm not into sleep, I, uh, my eyes closed, my ears closed, uh, my system is resting. And then when I reach the new time zone, I just have my first breakfast and dinner to the new time zone timing. I just follow that timing. And that helps a lot in beating jet lag.

Dr. Rangan Chatterjee 1:27:52 Yeah. Wow. Satchin, look, I've said to you, "last question," about five times now, so that really is gonna be the end of this-

Satchin Panda 1:27:58 [laughs]

Dr. Rangan Chatterjee 1:27:58 ... uh, conversation. I've really enjoyed, um, chatting to you about all these, you know, different areas. I, I wanna thank you that, for doing this research because I, I re- I genuinely do believe that you and your team are helping to create really big change in the, in the health of people all around the world. So thank you for that, and thank you for giving up your time today. Professor Satchidananda Panda, thank you.

Satchin Panda 1:28:20 Thank you, Rangan. I'm really glad that I'm on your show, and you are doing something very critical because we as scientists, we do all this research, but getting this research to the mass is something that we don't do well because we don't have that opportunity. So for you, giving me this opportunity to be on your show actually is, uh, is that missing link that you are filling out for many scientists. So I'm really, really thankful to you. Thank you. [upbeat instrumental music]

Dr. Rangan Chatterjee 1:28:52 That concludes today's episode of the Feel Better, Live More podcast. So what did you think? I think the information Professor Panda shares is frankly incredible, and actually what I love the most is how actionable the advice is. For me, I almost always eat all of my food within a 12-hour eating window. I have experimented with shorter windows, but find that 12 hours works super well for me and is very, very sustainable. This is also what many of my patients report back to me. Just a quick word of caution. If you have Type 2 diabetes and are on any blood sugar lowering medications, it is worth talking to a healthcare professional before you go for prolonged periods without eating. As always, please do have a think about one thing that you can apply from what you heard today into your own life. Are you going to have a go at changing your eating window? Have you already done so and experienced benefits? Whatever it is, please do let Satchin and I know on social media. You can find Satchin on Twitter. It's @satchinpanda. That's S-A-T-C-H-I-N panda. You can also find him on Instagram @satchin.panda. So please do tag us. Please let us know. And if you can, use the hashtag FBLM so that I can easily find your comments. If you wanna continue your learning experience now that the podcast is over, please do visit the show notes page. That is gonna be drchatterjee.com/81. Satchin's book is available to buy now. It's called The Circadian Code: Lose Weight, Supercharge Your Energy and Sleep Well Every Night. It is a brilliant book. You can get a link to purchase it on the show notes page as well. Again, drchatterjee.com/81. Many of the things that we discussed today on the show, including a 12-hour fast, enjoying your caffeine before noon, and even sitting around a table once a day to have a meal, a lot of these things are topics that I wrote about in detail in my first book, The 4 Pillar Plan. I talk through patients who have put these things into practice and describe a lot of the benefits. So if you are interested in learning more, please do pick up a copy of that book. It is available in paperback, E-book, but also as an audiobook, which I am narrating. I know there are many international listeners of this podcast. If you live in the USA or Canada, just a quick note that that first book of mine, The 4 Pillar Plan, is available in the USA and Canada. But it has a different title, How to Make Disease Disappear. Now, if you do enjoy my weekly shows, please do consider supporting them by leaving a review on Apple Podcasts or whichever platform you listen to podcasts on. It really does make a difference. You can also help me spread the word by taking a screenshot right now and sharing with your friends and family on your social media channels. You can also do it the good old-fashioned way and simply tell your friends and family about the show. I really do appreciate your support. A big thank you to Richard Hughes for editing and Vidanta Chatterjee for producing this week's podcast. That is it for today. I hope you have a fabulous week. Make sure that you have pressed subscribe, and I will be back in one week's time with my latest episode. Remember, you are the architect of your own health. Making lifestyle change is always worth it, because when you feel better, you live more. I'll see you next time. [upbeat instrumental music]