Why When You Eat Matters with Professor Satchin Panda PART 1 | Feel Better Live More Podcast

1. 0:00 – 0:00

   Intro

   1. RCDr. Rangan Chatterjee0:00

      [upbeat music]

2. 0:00 – 2:30

   Show premise and introducing Professor Satchin Panda

   1. RCDr. Rangan Chatterjee0:00

      Hi. My name is Dr. Rangan Chatterjee, medical doctor, author of The 4 Pillar Plan, and television presenter. 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. I'm absolutely delighted to introduce today's guest. In fact, we had such a fascinating conversation that I've decided to split it up into two parts. So today, you can listen to part one of our conversation. My guest is somebody who is a professor at the Salk Institute in California. He's someone who's conducting research that is literally transforming the way we do things around the world. His research is behind why our phones and computer screens dim down to an orange shade at nighttime. He's shown how different genes have a daily rhythm in the way that they function, and he's also known for a lot of research in an area called time-restricted feeding, the whole idea that not only what you eat matters, but when you eat matters as well. He's got a new book coming out. It's called The Circadian Code, and I'm absolutely delighted to welcome to the podcast today Professor Satchin Panda. Satchin, thanks for joining me.

   2. SPSatchin Panda1:37

      Hi, Rangan. Very happy to be on your podcast.

   3. RCDr. Rangan Chatterjee1:41

      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.

3. 2:30 – 5:16

   What circadian rhythms are and how they shape daily function

   1. SPSatchin Panda2:30

      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.

   2. RCDr. Rangan Chatterjee4:27

      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, uh, 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 y- 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.

4. 5:16 – 6:18

   How gene timing led to the question: does meal timing change metabolism?

   1. SPSatchin Panda5:16

      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 five to 10 years. So the next thing we wanted to test is very simple idea.

5. 6:18 – 9:13

   Mouse experiments: same calories, same ‘unhealthy’ diet, different eating window

   1. SPSatchin Panda6:18

      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 has 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, nine 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, uh, 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 measure 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 eight to 10 hours were completely protected from all these diseases: obesity, type 2 diabetes, fatty liver disease, high cholesterol, and cardiovascular disease.

   2. RCDr. Rangan Chatterjee8:31

      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.

   3. SPSatchin Panda8:42

      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

6. 9:13 – 12:20

   Reversing disease and improving performance in animals via time-restricted eating

   1. SPSatchin Panda9:13

      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 mice surprisingly, within few weeks they lose nearly 20% of their body weight, and the disease slowly disappears. Uh, this is, again, another huge surprise because there is no medicine 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.

   2. RCDr. Rangan Chatterjee11:14

      It's just incredible.

   3. SPSatchin Panda11:14

      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 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 eight 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.

7. 12:20 – 15:01

   Clarifying what “high-fat diet” means in the lab context

   1. RCDr. Rangan Chatterjee12:20

      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 wanna clarify there, when, when you say high-fat diets, because I know a lot of people listening will be thinking, you know, well, 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-

   2. SPSatchin Panda12:47

      Yeah

   3. RCDr. Rangan Chatterjee12:47

      ... you're talking about?

   4. SPSatchin Panda12:49

      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 people, 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 or-

   5. RCDr. Rangan Chatterjee13:51

      Sure

   6. SPSatchin Panda13:51

      ... 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.

   7. RCDr. Rangan Chatterjee14:11

      Okay, so there's pretty reasonable amount of sugar there. And 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?

   8. SPSatchin Panda14:26

      No. This is very unhealthy-

   9. RCDr. Rangan Chatterjee14:29

      Unhealthy fats, unhealthy sugars.

   10. SPSatchin Panda14:31

       Yeah.

   11. RCDr. Rangan Chatterjee14:31

       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.

8. 15:01 – 17:32

   Why 24/7 food access may be a key contributor to modern chronic disease patterns

   1. SPSatchin Panda15:01

      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.

   2. RCDr. Rangan Chatterjee17:13

      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, we, we... it would be dark. We'd be probably settling down to actually wind down for bed, right?

9. 17:32 – 21:37

   Nighttime digestion, gut repair, and why late eating can cause gut issues

   1. SPSatchin Panda17:32

      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.

   2. RCDr. Rangan Chatterjee19:24

      Wow.

   3. SPSatchin Panda19:26

      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 passes 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 ul- ultimately lead to, uh, developing allergies, um, to some of the foods that we eat.

   4. RCDr. Rangan Chatterjee20:10

      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 [chuckles] 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 experience 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 when 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?

10. 21:37 – 26:32

    Light as the primary circadian disruptor—and how it cascades into late-night eating

    1. SPSatchin Panda21:37

       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. Uh, but almost in, uh, every day there is one thing that is absolutely going to happen. The sun will rise up. Even if it is 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 twenty-four 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 know 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're 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 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.

    2. RCDr. Rangan Chatterjee25:36

       Yeah. I mean, so and it's just so incredible, you see one bad decision or, or-

    3. SPSatchin Panda25:41

       [laughs]

    4. RCDr. Rangan Chatterjee25:41

       ... well, then maybe not a bad... Well, you, but we, in the concept of health, it, 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, listened to the podcast. Now I, I, I wrote a book called The 4 Pillar Plan where I talk about these-

    5. SPSatchin Panda26:00

       Yeah

    6. RCDr. Rangan Chatterjee26:00

       ... 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.

    7. SPSatchin Panda26:31

       Yeah.

11. 26:32 – 28:26

    Circadian disruption as a form of stress and the role of simple daily boundaries

    1. RCDr. Rangan Chatterjee26:32

       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 i- 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?

    2. SPSatchin Panda26:56

       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.

    3. RCDr. Rangan Chatterjee27:50

       Yeah. It's... I, I'm, you know, I, I'm familiar with your research. I'm, 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?

12. 28:26 – 35:01

    Medication timing (chronotherapy): why dosing time may change efficacy and side effects

    1. SPSatchin Panda28:26

       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. [laughs] 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 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 as a result, now we see more and more, uh, research coming out showing, for example, the timing of taking arthritis drug to reduce arthritis pain has a huge circadian effect. Although the arthritis pain is more intense in the morning, what we're learning is taking the drug at nighttime has much better benefit than taking the drug in the morning. 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.

    2. RCDr. Rangan Chatterjee32:30

       And I suspect from what you were saying, Satchin, we'll, we'll probably in maybe ten, certainly twenty 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 w- 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."

    3. SPSatchin Panda32:50

       Yeah. So that's the, 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 ten percent of the patient population, ten percent 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 will also help to bring back the natural rhythm in blood pressure 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.

    4. RCDr. Rangan Chatterjee34:01

       Ah.

    5. SPSatchin Panda34:02

       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 one 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-

    6. RCDr. Rangan Chatterjee34:35

       Yeah

    7. SPSatchin Panda34:35

       ... when they should take the drug.

    8. RCDr. Rangan Chatterjee34:37

       Yeah, just incredible. Satchin, we could, we could go down lots of deep rabbit holes here, I'm sure.

    9. SPSatchin Panda34:43

       Yeah.

    10. RCDr. Rangan Chatterjee34:43

        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, um, so in animal studies. How are you getting on with actually translating this to humans?

13. 35:01 – 37:35

    Translating time-restricted eating to humans: tracking real eating windows with an app

    1. SPSatchin Panda35:01

       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 ten to twelve 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, we, 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

14. 37:35 – 40:39

    Human intervention results: feasibility, sustained adherence, and the benefits participants valued

    1. SPSatchin Panda37:35

       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, 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 try 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 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.

15. 40:39 – 44:07

    Clinical experience and practical framing: starting at 12 hours and why it feels intuitive

    1. RCDr. Rangan Chatterjee40:39

       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.

    2. SPSatchin Panda40:57

       Yeah.

    3. RCDr. Rangan Chatterjee40:57

       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 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're eating." 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."

    4. SPSatchin Panda42:08

       [laughs]

    5. RCDr. Rangan Chatterjee42:09

       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? So that's why-

    6. SPSatchin Panda42:36

       Exactly

    7. RCDr. Rangan Chatterjee42:36

       ... I think this is such a powerful intervention, 'cause people generally feel better pretty quickly.

    8. SPSatchin Panda42:41

       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, you'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]

    9. RCDr. Rangan Chatterjee43:57

       [laughs] The, the doctor's... The clinician's secrets of, uh, you know, how to actually engage a patient to do what you, you know, what, what you'd actually ideally like them to do. Okay, hey, Satchin-

    10. SPSatchin Panda44:07

        Yeah

16. 44:07 – 47:20

    How listeners can contribute data and episode wrap for part one

    1. RCDr. Rangan Chatterjee44:07

       ... 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, the 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?

    2. SPSatchin Panda44:23

       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-

    3. RCDr. Rangan Chatterjee45:06

       Yeah

    4. SPSatchin Panda45:06

       ... uh, rules. Um, and we don't share the data with any outside, uh, entity.

    5. RCDr. Rangan Chatterjee45:13

       Uh, 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, uh, arguably in the world, very, very reputable. And I think, you know, this is, you know, if you guys want to actually contribute to this research and put your data in, in the show notes, which is gonna be at drchatterjee.com/trf, I think, for time-restricted feeding, so drchatterjee.com/trf-

    6. SPSatchin Panda45:42

       [laughs]

    7. RCDr. Rangan Chatterjee45:42

       ... we'll link to lots of things that, um, me and Satchin s- uh, spoke about and are gonna continue speaking about. But we'll also put a link to that app so you guys-

    8. SPSatchin Panda45:51

       Yeah

    9. RCDr. Rangan Chatterjee45:51

       ... can actually get involved if you want to. [outro music] So that concludes part one of my two-part conversation with Satchin Panda. Hope you guys enjoyed it, found it interesting. There's a lot more tips next week, and we go into a, a whole variety of different areas, so I really think you're going to enjoy it. If you haven't subscribed yet to the podcast, I highly encourage you, press subscribe now on whatever podcast platform you're listening to this on, so you can be notified when part two of this conversation comes out. As always, please do consider sharing this with your friends. Perhaps take a screenshot right now, put it on Instagram, put it on Facebook, put it on Twitter, and do tag me and do tag Satchin, who is only on Twitter, to let us know what you thought. Don't forget, guys, you can pick up a copy of Satchin's book now. It's available on the Show notes page, drchatterjee.com/trf for time-restricted feeding. For those of you who've not picked up a copy of my book yet, The 4 Pillar Plan, a lot of the things I discussed with Satchin are actually in my book. So, you know, do check it out if you get a chance. If you're in America or Canada, the book over there is called How to Make Disease Disappear. And keep your eye out for when part two of this conversation comes out next week. Hope to see you next time. [outro music]

Episode duration: 47:20