Dr. Todd LePine:
We have rhythms in nature. We have the rising of the sun and the setting of the sun, and then the lunar cycles, and we have the months and the seasons in the year, so it only makes sense that our body has its own cycles and own seasons.
Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman. That’s farmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. If you’ve ever felt out of sync or out of balance, well this probably is the conversation you should listen to because it’s about what we call chronobiology, which is in other words, our circadian rhythms and our biological rhythms, which we mostly ignore. Today we’re having a special episode of The Doctor’s Farmacy with Dr. Todd LePine. It’s our house call episode where we dive deep into issues in the functional medicine space and help you understand your body in a new way and understand how to access health using the framework of functional medicine. Welcome, Todd.
Dr. Todd LePine:
Thank you, Mark. This is a great topic.
Dr. Mark Hyman:
So years ago our mentor, Sid Baker, who is one of the genius minds in medicine, in my belief, in the 20th, 21st century, basically he wrote this book called Circadian Prescription, and he was the first one who really talked about the role of rhythm in health. So can you tell us why rhythm and circadian rhythms and chronobiology is actually so important? And what is it all about, anyway?
Dr. Todd LePine:
All right. Well, you’re absolutely right. I read the book that Sid Baker wrote, The Circadian Prescription. That’s sort of where the light bulb went off in my head, say, “This is really important stuff.” It’s sort of the fourth dimension of health, which is time. And understanding that we have rhythms in nature, we have the rising of the sun and the setting of the sun, and then the lunar cycles, and we have the months and the seasons in the year, so it only makes sense that our body has its own cycles and own seasons. And understanding that we have these internal clocks, and we actually have genes, they’re called clock genes, and they have to synchronize. Just like an orchestra, it’s got a lot of different pieces. We were talking earlier in the podcast about how many different chemical reactions are going on in the body. You have chemicals being made, you have chemicals being broken down, you have chemicals being detoxified, and you have all these rhythms going on in the body, and they’re happening in the harmony, if you will. And just like when you have an orchestra, in order for an orchestra to make really good music, what do you need? You need a conductor. And this is understanding that the body’s conductor is synchronizing the whole body in terms of the liver and the heart and the muscles and digestion and all of those factors.
Dr. Todd LePine:
So our body’s ability to have a good rhythm is key towards health. I learned this early on when I was in private practice, because you probably had some patients like this too, Mark, is the patients that I could never, ever help to get better, no matter what they came in for were shift work. I’ll never forget it because I was so frustrated. They came in and they were tired, they had diabetes, they had brain fog, they couldn’t lose weight, you name it, and I’m banging my head against the wall, and lo and behold, I figured out, you know what? Shift work is not good for you because don’t mess with mother nature. You don’t want to be eating when you should be sleeping and vice versa. That’s really the bottom line. What happens is when you disrupt those circadian rhythms… And we know this ourselves. If you’ve ever had jet lag , you know that you don’t feel good when you have jet lag. That’s sort of an acute example of a circadian rhythm gone bad. You’re talking about breaking bad? Well, that’s really a form of breaking bad. Yeah, it’s not a good thing. So understanding shift work and jet lag really will highlight the importance of getting your body into a good rhythm.
Dr. Todd LePine:
And the things that are key for getting your body into rhythm, the primary thing is light. And what I would say is that most people are not getting enough light, and specifically sunlight. Now we do have patients, Mark, that they have what we call seasonal affective disorder, so if you live in a high enough latitude, you can get seasonal affective disorder. That’s where you don’t get enough light, and all of a sudden you start feeling lethargic and tired and depressed, because the sun really affects your whole rhythm. There’s part of the brain called the suprachiasmatic nucleus, and your eye is literally like the metronome to the body. It keeps the body in sync. So there are certain… And the German term is called [German 00:04:52], which gets the clock synchronized. Light is the key thing. So I always tell my patients that when you wake up, try to get exposure to sunlight early on, within 20 to 30 minutes of awakening, and that exposure to light helps to get all of your body clocks in sync, if you will, so that the orchestra can produce really good music. So light is a key thing.
Dr. Todd LePine:
And then one of the other key things is the timing of your food. What we’re finding out now is it’s not only what you eat, but it’s when you eat. And I can remember, Mark, when you were at Canyon Ranch, you always had the big saying, which “Eat breakfast like a king, lunch like a queen, and dinner like a pauper.” And that’s so, so true.
Dr. Mark Hyman:
Yeah.
Dr. Todd LePine:
Yeah. Very, very, very true. And one of the things that you’ll see in patients who have problems losing weight is that they’re eating when they should be sleeping. They’re eating these late meals, big meals late at night, or they’re sort of randomly having their food. It’s also very important to time your food, so each day you’re having your meals at approximately the same time so that your body gets into a really good rhythm. And it’s better to front-load your calories-
Dr. Mark Hyman:
Right. It’s reminding me of these people live to be like a hundred and whatever, they all have a routine. They have the same thing every day. They do exercise every day. They have their little schedule, and I think there’s something to be said about that.
Dr. Todd LePine:
There’s something to be said, exactly. Yeah.
Dr. Mark Hyman:
Honestly, Todd, COVID is the first time in my adult life really that I’ve been able to be in a rhythm.
Dr. Todd LePine:
In a good rhythm. Yeah.
Dr. Mark Hyman:
In a good rhythm. Because when I was younger, I was working as a family doc and staying up all night and working in the ERs, and then traveling for decades, different time zones, different hotels, not having a rhythm or a routine. It really took a toll on my health. And since COVID, almost last year now, I’ve been more or less stationary and been able to develop routines of taking care of myself, eating, sleeping, working out. It’s incredible how important chronobiology is to our health.
Dr. Todd LePine:
It absolutely is. Now I can remember you speaking about doing night shifts because I can remember when I was doing in private practice, and I used to do call at night. It’s one thing to be up at night when you should be sleeping. It’s another to be up at night and you’re dealing with someone who’s having a life or death situation, a heart attack, heart failure, a cardiac arrhythmia. So I can remember distinctly that there was a big change in my health when I had to do call over extended periods of time, and not only was I up at night, but I was actually pumping out a lot of stress hormones. I was reaching… We’re you reaching for food at night, Mark, when you’re on call, like “Yeah, give me some food. What are you doing,” reaching for sugary things, things that pick your energy up? So it’s really-
Dr. Mark Hyman:
Oh, sure. Sure. You get high levels of ghrelin when you’re not getting enough sleep, which makes you crave starch and sugar and carbohydrates. For sure, I was doing that.
Dr. Todd LePine:
Yeah. Reach for those donuts and whatever else you can find in the hospital, right?
Dr. Mark Hyman:
Yeah. Yeah. I was pretty bad. Yeah, so what’s interesting also is you’re talking about the effects on timing of eating, sleeping, all the things we’re doing, exercise, they’re important. And what’s also really striking is that… The light thing you talked about was really important, that disturbances in our light, meaning we are exposed to artificial light in times when we should be not, at night. One of the books that I read years ago was called Lights Out. Fascinating book about how our health has degraded since the invention of the light bulb, that we stay up late at night. And now we’re worse than the freaking light bulb. We’ve got the screens, the TVs, devices with all this blue light that’s causing us to shut down melatonin production, affect our sleep and our quality of our energy. There’s a lot of things that disturb that.
Dr. Todd LePine:
Absolutely. You hit the nail on the head. In fact, I have some extra slides, which I can post for the podcast about light pollution. There’s some interesting slides, looking from satellite imagery, looking from the 1970s, 1980s, 1990s, and 2000, and what you see is the whole world’s lit up at night. It’s very, very hard to find places at night… And I experienced this firsthand. I’ll never forget it when I was giving a lecture down in New York City. It was about 10:00 at night and I was going to be lecturing the next day, so I said, “Well, I’m just going to go down and I’ll walk the streets in New York,” and I’m out in Times Square. So if you ever been in Times Square late at night, guess what? It is all lit up and whatever, and it’s like you got all [crosstalk 00:09:22] lights. Right. So I’m out there walking from maybe about 10:00 to 11:30. I go back to my room, there was no way I could sleep. I could not sleep the entire night because all my melatonin was suppressed by all the LED lights on Broadway. That was like somebody hit me in the head with a hammer, saying, “Yeah, wake up here. Lights are not good for you at night.”
Dr. Mark Hyman:
Yeah, yeah. Yeah, for sure. Yeah, so key. What’s also interesting is even more traditional medicine is coming around to this. In chemotherapy, we’re now learning that there are times where different cancers respond to different chemo drugs and the timing of cancer therapy has a huge impact on the outcomes with patients, which is really striking.
Dr. Todd LePine:
Took the words right out of my mouth. In fact, there was actually a recent article that were talking about when’s the best time to give a vaccination. Some people are getting the coronavirus vaccinations, that’s another topic unto itself, but it’s thought that it’s probably better to give a vaccination later on in the day because early on, you have a jump up in your cortisol. Cortisol suppresses your immune system. It’s thought that if you give a vaccination earlier in the day, you may not have as robust of an immune response to the vaccination. So for those people who want to get any type of vaccination, it’s probably better to delay it to about 3:00 or so.
Dr. Mark Hyman:
Oh, in the afternoon. Okay, good.
Dr. Todd LePine:
Yeah. Yep.
Dr. Mark Hyman:
So people often in medicine, in my experience, in traditional medicine, is we don’t get taught how to reset people’s rhythm and the key aspects of resetting people’s rhythm and the importance of rhythm in our health. Why don’t we go through, for example, a patient that might’ve had a disturbed rhythm, and how do you help restore their rhythm? What are the kinds of things we think about? What do you test for? And how do you start to treat them?
Dr. Todd LePine:
Yeah, so typically you can have patients who have delayed sleep onset or a circadian rhythm disturbance, and sometimes what I’ll have patients do is I’ll have them… If they’re going to bed at like 5:00 in the morning, what I’ll have them do is stay up the entire day until they’re really tired and go to bed at like 6:00 or 7:00 the following evening. Sometimes you also have to have a patient work with a behavioral therapist to change their behavior. I think naturally there are some people that are what I would call morning people and people who are more night owls. There’s a natural tendency of that, especially teenagers tend to want to stay up later at night. But in general, you want to get into the rising and the setting of the sun.
Dr. Todd LePine:
I usually tell people, “When you look at the animal kingdom, what do the animals do? When the sun rises, they get up, they start tweeting, the birds run around, and they start finding their food. And when it’s dark out, what do the animals do? They go to sleep. They don’t sit up watching television, they’re not on their smartphones, and they’re not raiding the refrigerator.” So the things to do, at least first get people aware of the fact that they’re being sleep deprived. And in addition to being out of sync, what’s oftentimes happening with people nowadays is they’re not getting enough sleep. So sleep deprivation is probably epidemic in the United States. What do we do nowadays if people are tired? We give them amphetamine, right? We just pump them up with either amphetamine or caffeine and just say, “Oh, keep going.” What we do know is that you can take young, healthy college kids, and if you sleep deprive them and only let them sleep for maybe four or five hours, within a matter of three days they start becoming insulin-resistant, which is a form of pre-diabetes. So getting enough sleep and getting deep restorative sleep are really, really key. And part of the ability to do that is to have a good circadian rhythm.
Dr. Todd LePine:
Another thing which I also wanted to talk about, Mark, as it relates to the circadian rhythm, is that there’s a timing of when your body does things. One of the most important things for me, personally, is to sleep in a cool room. I oftentimes will leave the window open, and my room is pretty darn cold. When you think about that from a… In fact, I think there are some companies out there that have these things called cooling mats. They basically have a chill pad, and they basically lower your body temperature-
Dr. Mark Hyman:
Yeah. I have that, the Ooler. I have that. Yeah.
Dr. Todd LePine:
Yeah. Again, just look at nature. If we didn’t live in a house, if we were living the way that Mother Nature designed us, out in caves or whatever, the temperature goes down at night and our bodies to cool off. And that’s a very, very good thing to get your body into a deep, deep sleep. So keeping the temperature of the room too high at night is not a good thing for your circadian rhythm also.
Dr. Mark Hyman:
Yeah, absolutely. So waking at the same time, sleeping at the same time, making sure you get supposedly 20 minutes of morning light, making sure eating in rhythmic times, that you’re not eating three hours before bed, that you don’t exercise in the evening, that you get rid of all the blue light at night and use your blue blocker glasses, and get off your screens. It takes time to retrain the circadian rhythms, but when you do, your overall well-being is so much higher. We use herbs to help reset the adrenals, because the adrenals really get screwed up in the whole… We’ll use melatonin and we use adrenal support to help people kind of recover from it.
Dr. Todd LePine:
Absolutely. And the other thing that I do, and this is actually… This is, I think, epidemic in the young kids… Because I’m still recovering from some knee surgery that I had done because of a ski injury, and I’m going to the gym, and there are several young people in there who are literally addicted to their phones. They are on their phones as they’re exercising and they’re texting and typing and doing all this stuff. And one of the things that I see in young people is that they are constantly checking their phones throughout the night. They’re waking up and they get right on social media, and they’re… I tell people, “You turn your phone off and don’t touch it in the entire night. Done. Put it in another room if you need to because it’s literally-”
Dr. Mark Hyman:
Yeah. Put it in airplane mode. It’s terrible.
Dr. Todd LePine:
It really is. It really is. It’s like, “Oh, I’m awake. I might as well just go onto Facebook or go onto social media or Twitter or whatever the heck they’re doing,” and it’s toxic. It’s very, very toxic for a whole bunch of different reasons.
Dr. Mark Hyman:
At worst, they’ll leave their phone on still with the notifications, so they’ll wake up at their texts or they wake up with their notifications.
Dr. Todd LePine:
Right, right, right. Yes.
Dr. Mark Hyman:
Sometimes I forget my nephew is on a different coast, whatever, I’ll text him late at night, if I’m in Hawaii and he’s in California, I’m like, it’s 3:00 in the morning, and he’s answering my freaking texts. I’m like, “What are you doing awake?”
Dr. Todd LePine:
Exactly. Exactly. Yeah, yeah. Very interesting.
Dr. Mark Hyman:
So how would we begin a thing about testing people’s circadian rhythm?
Dr. Todd LePine:
Well, there’s, as you mentioned, the adrenals test. We know that our adrenal glands produce cortisol, cortisol being the major one, and we have a thing called a cortisol awakening response. This is our get up and go hormone. It’s the hormone that rises in the morning, there’s a big peak in it, and then it gradually decreases as the day goes on. And we do testing for checking for adrenal function throughout the day, and especially with that cortisol awakening response, or they call it the CAR. That rise should be about 50% or higher, and it also should be very low at night time. Sometimes when you see that cortisol awakening response being blunted, then you know that there’s a problem with their circadian rhythm. And then if you also see that cortisol response high up at night, those are people who oftentimes can’t fall asleep because they’re sort of wired. They need something to control that. So that’s one way of doing it.
Dr. Todd LePine:
Another thing that I do is I also will check melatonin levels. So melatonin is the hormone of darkness, and it’s a hormone. You can get melatonin as a over-the-counter supplement. It comes in usually typically one to three milligrams. I really almost never give a patient melatonin without checking their melatonin levels. Some people, for whatever reasons, either age or pituitary or pineal problems, where they’re not producing enough melatonin. So I don’t use melatonin willy nilly, even though it’s actually quite safe. There are certain circumstances where I’ll use it, things like jet lag. I oftentimes will use that myself if I’m going to go through several times zones to help to reset my body clock. But checking melatonin levels is another thing that can be very, very helpful to make sure the person’s body is in good sync.
Dr. Todd LePine:
The other thing which is also really important is exercise. And this is a fascinating, I call it a little scientific trivia, is that our bodies… We talked about the mitochondria. Mitochondria really relate to energy. Mitochondria take food and make food into ATP, or adenosine triphosphate. So adenosine is the base molecule, and we stick three phosphate groups onto it. And ATP is the fuel that runs our body. As we have activity throughout the day, our ATP gets broken down into ADP, or adenosine diphosphate, and then into adenosine monophosphate, and then into adenosine. As those metabolic processes happen, our adenosine levels actually build up in the body, and that rise of adenosine is one of the things that induces sleep.
Dr. Todd LePine:
And interestingly, caffeine, which we all know keeps you up, blocks adenosine. That’s probably one of the major ways of which caffeine will actually keep people up at night is it’s acting as an adenosine blocker. For people who are caffeine sensitive, we do some testing, which people oftentimes will know that, but we can determine by genetic polymorphism testing if somebody is a slow metabolizer or a intermediate metabolizer of caffeine. Because caffeine in general has a half-life of about six hours, so if you have a cup of coffee at 6:00, at midnight half of it’s still going to be in your body. So if you’re a real ultra slow metabolizer of caffeine, you might want to have one cup of coffee, no more than two, really early in the day because that’s still going to be in your body late at night and blocking adenosine’s action.
Dr. Mark Hyman:
Yeah. So incredible. So this whole area of chronobiology and circadian rhythms, so important, and people are really excited and interested about this topic. I encourage you to check out our mentor’s book, The Circadian Prescription, and also thinking about your own life. If you’re feeling out of sorts or out of balance, what is your rhythm like? Is that a source of some of your dis-ease or unhappiness or mood issues or sleep issues or energy issues? And often when we focus on the chronobiology piece and our rhythm, it can lead to profound healing for people. It’s often a neglected aspect of wellbeing, but I think it’s super important.
Dr. Mark Hyman:
Todd, thank you so much for sharing your wisdom about this on The Doctor’s Farmacy in this special episode of a house call. We love hearing from you. If you’ve been listening to this podcast, please share your thoughts about your own rhythm issues with us and leave a comment, subscribe wherever you get your podcasts, share with your friends and family. We’ll see you next time on The Doctor’s Farmacy.
Dr. Todd LePine:
Great. Thanks, Mark.
