Eating for Better Sleep & Metabolic Health — Full Transcript

[00:00] What was it that they ate that day that

[00:02] impacted how they slept that night? And

[00:05] we found that higher intakes of fiber

[00:09] were associated with more deep sleep,

[00:11] higher intakes of saturated fat, less

[00:13] deep sleep, and then more refined

[00:15] carbohydrates, simple sugars, more

[00:18] arousals. You're not getting deep

[00:21] slow-wave sleep, REM sleep as much as

[00:24] you would otherwise.

[00:26] >> Welcome to the Huberman Lab Podcast,

[00:27] where we discuss science and [music]

[00:29] science-based tools for everyday life.

[00:35] I'm Andrew Huberman, and I'm a professor

[00:37] of neurobiology and ophthalmology at

[00:39] Stanford School of Medicine. My guest

[00:41] today is Dr. Marie-Pierre St-Onge, a

[00:44] professor of nutritional medicine at the

[00:46] Institute of Human Nutrition at Columbia

[00:48] University School of Medicine.

[00:50] Today we discuss how you eat impacts

[00:53] your sleep, and how you sleep impacts

[00:55] what you eat, as well as how your body

[00:57] utilizes food depending on how you

[00:59] slept. Now, we've talked about food, and

[01:01] we've talked about sleep many times

[01:03] before on this podcast, but Dr.

[01:05] St-Onge's work is unique because she

[01:07] runs one of the few laboratories in the

[01:08] world to look at the bidirectional

[01:10] relationship between sleep and food. For

[01:13] instance, you'll learn how even modest

[01:14] sleep deprivation increases hunger, but

[01:17] differently in men and women. In men, it

[01:20] happens to increase the hormones that

[01:21] drive the desire to eat, whereas in

[01:23] women, it reduces naturally made

[01:24] peptides such as GLP, which suppress

[01:27] hunger. Today's discussion gets into the

[01:29] specific actionable items that you can

[01:31] do to improve your sleep and the way

[01:33] that your body handles food and hunger.

[01:35] We talk about the role of sleep in

[01:37] regulating blood sugar, cortisol levels,

[01:39] overall metabolism, and cardiometabolic

[01:42] health. Now, because Dr. St-Onge's

[01:43] research focuses on sleep and nutrition,

[01:46] but she's also spent a significant

[01:47] amount of time studying how specific

[01:49] nutrients impact overall health and not

[01:51] just sleep, we also talk about that. I'm

[01:54] certain that you'll come away from

[01:55] today's episode with a lot of new

[01:56] information you haven't heard elsewhere,

[01:58] as well as with the intention to make

[02:00] small or perhaps even large changes in

[02:02] behavior and nutritional choices that

[02:04] the science tell us can significantly

[02:06] improve your sleep, your metabolism, and

[02:08] overall health. Before we begin, I'd

[02:10] like to emphasize that this podcast is

[02:12] separate from my teaching and research

[02:13] roles at Stanford. It is, however, part

[02:15] of my desire and effort to bring

[02:17] zero-cost to consumer information about

[02:18] science and science-related tools to the

[02:21] general public. In keeping with that

[02:22] theme, today's episode does include

[02:24] sponsors. And now for my discussion with

[02:27] Dr. Marie-Pierre St-Onge. Dr.

[02:29] Marie-Pierre St-Onge, welcome.

[02:31] >> Thank you for having me.

[02:33] >> Sleep impacts how and what we eat and

[02:36] how and what we eat impacts sleep.

[02:39] That's a different perspective than I

[02:40] think most people take. I think most

[02:41] people are familiar, however, with

[02:44] not getting the best night's sleep,

[02:46] maybe feeling like their

[02:48] impulsivity to eat quote-unquote bad

[02:50] foods is a little higher, and then also

[02:53] hopefully familiar with

[02:55] having a great night's sleep and feeling

[02:56] like we're just kind of in control in a

[02:58] different way.

[03:00] Maybe you could just kind of share for

[03:01] us what's really going on beneath that

[03:03] experience and when subtle or

[03:06] not-so-subtle chronic sleep loss, so not

[03:10] an all-nighter necessarily, but you

[03:12] know, 45 minutes less here, 90 minutes

[03:14] less there, etc., etc., how that plays

[03:17] out in terms of our nutrition, and then

[03:19] we'll go in from the nutrition side to

[03:21] sleep.

[03:21] >> Sure. So, there's a couple of questions

[03:24] that you have in there, actually, about

[03:27] the extent of sleep loss and how that

[03:29] influences your food intake, what we see

[03:33] in the general population versus what we

[03:35] do in the lab to address causality. So,

[03:39] let me start with, you know, the

[03:40] population-based studies, right? So,

[03:43] when I started being interested in in

[03:46] sleep, it was coming from an obesity

[03:48] angle. My PhD is in nutrition. I trained

[03:51] as a postdoc in

[03:53] body composition, obesity research. And

[03:56] we were getting a lot of information

[03:58] from population-based studies that

[04:00] people who sleep too little

[04:03] have a higher body mass index than

[04:06] people who get adequate amount of sleep.

[04:09] Then it became there is a higher

[04:11] prevalence of people with obesity in

[04:14] this short sleep

[04:16] uh group.

[04:18] Then studies evaluating changes over

[04:22] time

[04:23] seeing that people who don't sleep

[04:25] enough tend to gain more weight. There

[04:28] was a famous uh Nurses' Health Study

[04:30] that I really like to cite uh when I

[04:32] give talks that was published in 2006

[04:35] where uh they tracked nurses over 14

[04:39] years and those nurses that reported

[04:42] sleeping 5-6 hours had much higher rate

[04:46] of weight gain over that 14-15 year

[04:49] period than the nurses who had reported

[04:51] sleeping 7 or 8 hours per night.

[04:54] So those are observations that we get

[04:56] from large-scale population studies,

[04:58] cohorts.

[05:00] But, you know, what they what those

[05:01] studies tell us is that things are

[05:03] happening

[05:05] at a point in time or may influence

[05:07] something that's happening over time,

[05:10] but not necessarily that one causes the

[05:13] other, right? So I started um my work in

[05:17] this field trying to uncover whether

[05:20] sleeping too little actually causes

[05:23] weight gain.

[05:25] And so in my opinion, because I was

[05:27] coming from a lab where I trained in the

[05:29] measurement of energy balance, so how

[05:31] much energy how much energy you eat

[05:33] versus how much energy you burn, I was

[05:35] like, well, if sleep leads to obesity,

[05:39] leads to weight gain, it has to impact

[05:42] this energy balance

[05:44] regulation. So it's either that we eat

[05:47] more than we should

[05:49] or that we exercise less. We burn less

[05:53] or we

[05:54] eat more or maybe it's a combination of

[05:56] the two. Let's try this out and and see.

[06:00] So my first my first study my first NIH

[06:03] grant the big R01s, you know, was to

[06:07] look at exactly at this. So we had

[06:09] people who had adequate sleep

[06:12] and we brought them in the lab and we

[06:14] asked them in a crossover design. So

[06:18] half of the participants started out

[06:20] sleeping adequately. So they we gave

[06:22] them a 9-hour time in bed opportunity

[06:25] or we asked them to sleep too little. So

[06:28] they had a 4-hour time in bed

[06:29] opportunity, very short. But we did this

[06:32] for 5 nights.

[06:34] And then we took all sorts of

[06:36] measurements in a controlled feeding

[06:38] condition. So for the first 3 days, we

[06:42] told our we had our participants eat the

[06:44] exact same thing regardless of how much

[06:47] time in bed they slept they got at

[06:48] night.

[06:49] And then we measured appetite regulating

[06:51] hormones. We did neuroimaging

[06:54] uh to really get at isolating the impact

[06:57] of sleep duration on appetite regulating

[06:59] hormones and and um

[07:02] neuronal responses to foods. And then

[07:06] on the last day, we let them self-select

[07:08] their food intake and we measured that

[07:10] in the lab. From that study, we showed

[07:14] that in men specifically, uh we saw an

[07:17] increase in ghrelin

[07:19] in response to the short sleep. So this

[07:21] hormone that triggers food intake.

[07:24] In women, we saw a reduction in GLP-1,

[07:28] interestingly enough. Glucagon-like

[07:29] peptide-1. So the satiety hormone was

[07:32] reduced as a result of short sleep in

[07:34] women. And then when we measured their

[07:37] food intake in the lab, they ate 300

[07:39] calories more in the short sleep

[07:41] condition than the

[07:43] when they got their regular adequate

[07:46] sleep of at least 7 and 1/2 hours, a

[07:48] little more than that

[07:50] per night.

[07:52] Then you were asking about, you know,

[07:54] brain responses.

[07:56] We looked at neuronal responses to food

[07:59] stimuli.

[08:00] We found upregulation in reward centers

[08:03] of the brain

[08:05] in the context of sleep restriction

[08:06] compared to the context of adequate

[08:08] sleep. So all together really building a

[08:11] case that when you don't sleep enough at

[08:13] night, you have both physiological

[08:16] signals to eat more for men or

[08:20] not stop eating in women that lead to

[08:24] greater food intake that's also could be

[08:27] impacted by

[08:29] just pleasurable centers that are

[08:31] activated to a greater extent as a

[08:33] result of insufficient sleep.

[08:35] >> Amazing. This sex-specific split in the

[08:38] data, if I have it correctly, that when

[08:40] men are sleep-deprived, so getting 4

[08:43] hours per night,

[08:44] the

[08:45] signals that drive appetitive desire to

[08:49] eat are higher. In women, it's more that

[08:51] the break

[08:52] on eating, on satiety, is reduced.

[08:55] >> Exactly.

[08:55] >> Okay. As far as I know, the GLP pathways

[08:58] are not

[08:59] divergent by by sex, but of course I'm

[09:02] not deeply versed in that literature. Is

[09:04] there any evidence that GLPs are

[09:06] functioning different in men and women

[09:08] like circadian wise or anything like

[09:10] that or this just this was just a

[09:12] fortuitous outcome or as I say a

[09:15] incidental outcome?

[09:16] >> This was an incidental outcome. We

[09:18] really didn't know what to expect. We

[09:20] didn't really know at all that

[09:22] we'd see sex differences

[09:24] >> Mhm.

[09:25] >> because there had been prior studies and

[09:28] prior studies had shown that ghrelin was

[09:31] increased as a result of sleep

[09:32] restriction. They also showed that

[09:34] leptin was reduced as a result of sleep

[09:36] restriction.

[09:38] And when we got our data, we analyzed

[09:41] our data with

[09:42] all of our participants together.

[09:46] And there was no effect.

[09:48] >> [clears throat]

[09:48] >> And that was surprising, and people

[09:50] would say, "Don't you know? Don't you

[09:51] know sleep restriction

[09:54] increases ghrelin?"

[09:56] Like,

[09:56] "Well, I guess I don't know because in

[09:58] our study it doesn't." But

[10:01] then we saw these sex-specific

[10:03] differences, and it made sense then that

[10:05] in the full sample, when we had an equal

[10:07] number of men and women, we saw no

[10:10] effect on ghrelin because there was no

[10:11] effect

[10:12] in women, but there was an effect in

[10:13] men, which was reproducing what others

[10:16] had found because all the prior studies

[10:18] had been done in men only.

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[12:39] Whenever I'm sleep deprived, though four

[12:41] or five hours of sleep I consider sleep

[12:43] deprived. I used to pull all-nighters

[12:45] years ago. Now, I avoid them at all

[12:47] costs. But, whenever I have that

[12:49] experience,

[12:50] I feel like

[12:52] my whole body to some extent is in a low

[12:54] level of pain.

[12:56] It's a kind of it's like central ache.

[12:58] Like you just And and I wonder uh

[13:00] extent to which people eat to overcome

[13:03] like to kind of quell the the pain of

[13:05] sleep deprivation. Maybe people react

[13:07] differently to sleep deprivation. Maybe

[13:09] their subjective experience of it is is

[13:10] very different. But, what do you think

[13:12] is happening in that uh in that short

[13:15] relatively short amount of sleep that's

[13:16] missing? What is getting reset? Is it

[13:19] neural? Is it endocrine? It's obviously

[13:22] all those things, but what do you think

[13:23] is the the switch that allows people to

[13:25] enter a a day in a in a much more

[13:27] healthy fashion or or a sick essentially

[13:30] in a slightly sick fashion.

[13:32] >> In our study, it was actually a 50%

[13:34] reduction in sleep because when they had

[13:36] 9 hours sleep opportunity, they slept

[13:39] around 7 and 1/2. And when they had the

[13:42] They were all people who had screened to

[13:44] sleep at least 7 measured by actigraphy.

[13:47] So, and on average they get 7 and 1/2.

[13:50] And in the sleep restricted condition,

[13:53] they got on average about 3 hours and 50

[13:56] minutes.

[13:57] >> So, it's like staying up late working on

[13:58] a deadline then trying to catch an early

[14:00] flight.

[14:00] >> Yeah.

[14:01] >> brutal.

[14:01] >> It's pretty brutal. Yeah. And that was

[14:03] maintained, you know, they had 5 nights

[14:05] of that. So, that

[14:06] >> 5 nights of that.

[14:07] >> Yeah.

[14:07] >> Were they coming unglued mentally, too?

[14:09] That I think I would feel terrible after

[14:12] that kind of stretch.

[14:14] >> That Yeah, they were done. Like there's

[14:15] no way anyone would want to keep keep

[14:17] coming for that. But they were in the

[14:19] lab. They were under supervision the

[14:20] whole time. We didn't let them go out on

[14:22] their own.

[14:23] Uh so, they were well supervised to make

[14:25] sure that nothing

[14:26] nothing would happen to them.

[14:27] >> No naps?

[14:28] >> No naps. Nope.

[14:30] Nope. Uh but so, what happens is I think

[14:33] there's some

[14:35] subconscious need to to eat more when

[14:39] you're sleep deprived. There's also, you

[14:41] know, there's a thermic effect of of

[14:43] food, right? So, it gives you a jolt of

[14:44] energy to eat something. So, people know

[14:47] that. You eat it wakes you up in a way.

[14:50] You know, neuronal signaling that that

[14:54] enhances uh pleasurable and reward

[14:57] centers of the brain where, you know, if

[14:59] when also fatigue sets in and now it's

[15:01] like do you really have want to have

[15:03] this

[15:04] conversation with yourself about what to

[15:06] choose at the buffet table?

[15:08] You know, it

[15:09] there's fatigue. And uh and others have

[15:12] shown also that sleepiness tends to

[15:15] correlate with all of this. That there's

[15:17] these

[15:18] triggers for more pleasurable food

[15:21] consumption with um with the sleep

[15:23] restriction. It's been reproduced.

[15:25] There's been so many studies

[15:27] and they all you know, agree to to the

[15:30] extent of overeating. You know, a

[15:32] meta-analysis showed 250 to 400 calories

[15:36] of overeating.

[15:37] >> Which might not sound like much, but

[15:39] when you start layering that in day

[15:40] after day and you think, you know, 3,500

[15:43] excess calories more or less for a pound

[15:45] of body weight and then you start when

[15:46] people accumulate that over time if

[15:49] they're in a night shift condition or

[15:51] new parents or tending to a sick

[15:54] relative or just final exams. Like it

[15:56] it's a real thing.

[15:57] >> It's a real thing. Naima Covassin in

[16:00] 2022 published a paper where

[16:03] they had sleep restriction about 5 hours

[16:05] per night versus 7 and 1/2 hours per

[16:08] night for 2 weeks and participants

[16:10] gained half a kilo in a 2-week period.

[16:13] So, you do nothing and you just you

[16:15] know, sleep less and gain gain almost

[16:18] a pound in 2 weeks.

[16:20] >> It strikes me that, you know, for a long

[16:22] time in the stress research, the idea

[16:24] was when people are stressed they reach

[16:26] for kind of quote unquote comfort foods,

[16:28] carbohydrate and typically starch fat,

[16:31] starch fat sugar combination foods to

[16:33] comfort them and and the the just-so

[16:35] story was always that

[16:37] okay, well, you know, cortisol's main

[16:40] role is to deploy glucose and so people

[16:42] are doing this as a way to bring excess

[16:44] energy and and it all kind of fits

[16:46] together. What is the relationship

[16:48] between these forms of sleep deprivation

[16:50] that you work on and stress? Is it

[16:52] really a way of of I'm not saying just

[16:54] inducing stress cuz I think sleep is its

[16:56] own thing, but it's stressful just to be

[17:00] less than adequately rested independent

[17:02] of the things coming at you in life,

[17:04] right? Is what you're studying stress?

[17:06] >> So, if you're thinking about

[17:07] physiological stress measured by

[17:09] cortisol levels in that study, actually

[17:11] cortisol wasn't

[17:13] changed.

[17:14] >> In the short sleep.

[17:15] >> in the

[17:15] >> sleep.

[17:16] >> Tell me more about that. I'm fascinated

[17:17] by circadian rhythms and cortisol. So,

[17:19] what is it what is that what is that

[17:20] mean?

[17:21] >> There was no difference between the two

[17:22] conditions adequate sleep or short sleep

[17:25] on cortisol levels in our

[17:26] >> For 5 days of sleep restriction at

[17:28] basically 4 hours a night. So, cortisol

[17:30] still peaking in the in the morning,

[17:33] still dropping in the evening.

[17:35] >> Yeah.

[17:35] >> Wow, that's very surprising to me.

[17:37] >> I don't know. I don't know if it's the

[17:38] contacts of, you know, being in the lab

[17:42] where everything's safe, taken care of

[17:44] for them. There's nothing outside to

[17:48] aggravate

[17:49] >> Mhm.

[17:49] >> this. [clears throat]

[17:50] So, I don't know. Maybe when you're in

[17:51] the context of sleep restriction, but

[17:54] also dealing with

[17:56] your daily life

[17:58] >> Mhm.

[17:58] >> you're needing to take care of your

[17:59] kids, they're needing to get to work,

[18:01] needing to do all of the activities of

[18:03] daily living, maybe then that becomes,

[18:06] you know, the the added stressful.

[18:08] >> So, the message is if you

[18:10] suffer

[18:12] less than adequate sleep, get someone to

[18:14] take care of it.

[18:15] >> Everything else.

[18:16] >> You better be [laughter] in a spa.

[18:17] >> Exactly. Exactly.

[18:19] >> [clears throat]

[18:19] >> No, I and I'm not challenging the

[18:20] result. I just find it really

[18:21] interesting. I would have thought that

[18:22] basal cortisol levels would would go

[18:24] awry.

[18:25] >> Well, in that study also, we didn't see

[18:27] any effect on glucose or insulin.

[18:29] Nothing.

[18:30] Nothing.

[18:32] The curves were superimposable.

[18:36] >> Wild.

[18:37] >> They were eating the exact same food at

[18:39] the exact same time, exact same

[18:42] quantity. The only thing we changed was

[18:45] the amount of sleep opportunity they got

[18:47] at night. So, to me, this means that

[18:50] it's a combination of different things

[18:52] that causes the metabolic abnormalities

[18:54] that we notice in free-living

[18:57] populations. People aren't isolated,

[18:59] they're not in a box where they're not

[19:01] sleeping enough, and they're choosing to

[19:04] eat higher-fat, higher-sugar,

[19:06] higher-salt poorer diet

[19:10] that then triggers a worsening and maybe

[19:13] compounded by the lack of sleep even

[19:16] worsening of of those cardiometabolic

[19:19] outcomes because we did a follow-up

[19:22] study to this this severe sleep

[19:24] restriction study. So the reason why we

[19:25] did that was because exactly for this

[19:27] reason because we did not find any

[19:30] adverse impact on glucose or insulin or

[19:33] lipid profile.

[19:35] And we're like so what is it then? Why

[19:37] is it that in population-based studies

[19:40] we find that people who sleep too little

[19:43] have higher risk of cardiovascular

[19:46] disease, higher risk of hypertension,

[19:47] higher blood pressure, higher risk of

[19:49] type 2 diabetes. So

[19:52] because we had seen that food choices

[19:55] were different that they ate a diet that

[19:58] was higher in calories, higher

[20:00] in fat and saturated fat, we thought

[20:02] maybe if you're in a free-living

[20:05] situation

[20:06] that's when you start to see those

[20:08] cardiometabolic outcomes because it's

[20:10] compounded by

[20:12] maybe

[20:13] more sedentary behavior and

[20:16] alterations in in food choices and and

[20:19] diet.

[20:20] So the follow-up study then was to

[20:23] recruit good sleepers, people who sleep

[20:26] at least 7 hours per night verified by

[20:29] actigraphy, who answer on questionnaires

[20:31] that their sleep quality is good. And

[20:35] then to take these people and say okay

[20:37] now you're either going to continue your

[20:42] excellent sleep or

[20:45] you're going to now

[20:47] go to bed an hour and a half later so

[20:50] that you get an hour and a half

[20:51] reduction in sleep. Because when we

[20:53] screen people to sleep at least 7 hours

[20:56] per night, they sleep about 7 and a

[20:57] half.

[20:58] And reducing by an hour and a half gets

[21:01] to 6 hours which is short sleep,

[21:03] insufficient

[21:05] on average what people who don't get

[21:07] enough sleep get?

[21:09] >> They're missing a full sleep cycle.

[21:10] >> Yeah, pretty much. And

[21:13] uh and they can sustain that for

[21:15] prolonged periods because that's what

[21:17] people report in in population-based

[21:19] studies. And now, when we did that,

[21:21] we saw that insulin resistance was

[21:25] increased after 6 weeks of sleep

[21:28] restriction compared to adequate sleep.

[21:30] We saw insulin sensitivity was reduced.

[21:34] It was worse, actually, in

[21:35] postmenopausal women compared to

[21:37] premenopausal women. We saw blood

[21:39] pressure uh was increased. Uh so, those

[21:43] cardiometabolic outcomes were adversely

[21:45] impacted in free-living mild sustained

[21:48] sleep restriction for 6 weeks. 6 weeks

[21:51] was something else, also.

[21:52] >> [laughter]

[21:53] >> It was uh it was tough.

[21:54] >> I can only imagine.

[21:56] Wow, okay. Because my mind always

[22:00] goes to, all right, well, we wake up in

[22:02] the morning because of an increase in

[22:03] cortisol, that's circadian, and it's not

[22:05] related to sleep, per se, it just kind

[22:07] of overlaps with the end of the night's

[22:09] sleep. If that's independent of sleep,

[22:12] and cortisol drives glucose release, we

[22:14] know this. At least in the first study

[22:16] you described, glucose levels weren't

[22:18] altered. You said it was isocaloric, so

[22:20] people were it's not like they're eating

[22:22] more. They're the hormones that are

[22:25] driving the desire to eat more are

[22:27] elevated.

[22:28] >> But we didn't let them eat more, yeah.

[22:30] >> Right. But you didn't let them. I think

[22:31] that's a a key thing that you you

[22:33] pointed out before, but I think we want

[22:34] to uh underscore. And then, of course,

[22:36] the GLP

[22:38] uh levels in women being reduced, it's

[22:40] not that that they were able to eat, as

[22:42] we say, ad libitum, and then they happen

[22:43] to eat more, but they gained weight. So,

[22:46] what's kind of the action end of things

[22:48] that causes them to gain weight if

[22:50] they're basically in an isocaloric diet?

[22:52] And I have a I have a I have an idea

[22:54] what it might be, but I'm I'm curious

[22:56] what the answer is.

[22:57] >> Yes, I think they're they're more

[22:59] sedentary.

[23:00] >> During the day, less

[23:03] >> Right.

[23:03] >> Less spontaneous activity. Because we

[23:05] also did a study to look at energy

[23:07] expenditure. That's really difficult

[23:09] actually to measure, in my opinion,

[23:11] energy expenditure. There's multiple

[23:13] components to energy expenditure.

[23:16] Uh but we did a study where this was a

[23:19] small study. We were enrolled only women

[23:22] for that, and we have a metabolic

[23:23] chamber

[23:24] >> [snorts]

[23:24] >> at Columbia where that we were able to

[23:26] use for this. Uh so this small room in

[23:30] which we keep people, and we measure

[23:32] minute by minute oxygen consumption and

[23:34] carbon dioxide production. And we were

[23:37] able to show that energy expenditure is

[23:40] actually increased in the context of

[23:43] sleep restriction in the metabolic

[23:45] chamber.

[23:46] >> [snorts]

[23:46] >> Because

[23:48] it's more costly energetically to remain

[23:51] awake

[23:53] than to fall asleep.

[23:54] So energy expenditure when participants

[23:57] were awake was identical in both

[24:01] [clears throat] conditions, regardless

[24:02] of how much sleep they got the night

[24:03] before.

[24:04] >> So is fidgeting, movement? Cuz we've

[24:06] talked before on this podcast about the

[24:08] non-exercise thermogenesis. It's a big

[24:10] number. I mean, you people who fidget a

[24:12] lot, bounce their knee a lot. I mean,

[24:13] sometimes these people are burning 1,500

[24:16] calories more per day. And everyone

[24:17] goes, "Oh my god, how could that

[24:18] possibly be?" But I mean, that's a lot.

[24:20] That's at the extreme. But it is kind of

[24:22] interesting to observe people out in the

[24:24] world. And you sometimes see that people

[24:27] who are very, very lean, very let's just

[24:30] say thin and lean. Nowadays, who knows

[24:31] because of the GLPs, etc. But they tend

[24:34] to have a lot of spontaneous movement.

[24:35] They tend to stand up quickly. They tend

[24:37] to walk quickly. Well, you're from New

[24:38] York, so everyone there walks faster

[24:39] than out here. But it's a real thing,

[24:42] you know? Whereas some people, like me,

[24:44] are kind of more middle of the curve.

[24:45] But you know, I sit a bit more still

[24:47] unless I'm very caffeinated. These

[24:48] things add up over time in ways that I

[24:51] think most people underestimate.

[24:54] >> Yeah, so for us it was about 5% of

[24:57] energy

[24:58] increased. But it it and it it ended up

[25:02] being about 90 calories, nowhere close

[25:04] to the 300 calories that uh

[25:06] more of intake they they got over a over

[25:09] a day in the prior study. So it's still

[25:12] an imbalance towards a positive energy

[25:13] balance when we do the math.

[25:16] But there is an increase in um in energy

[25:19] expenditure.

[25:21] Again, in the confines of metabolic

[25:23] chamber, which you know, for most people

[25:25] is the equivalent of the size of their

[25:26] bathroom.

[25:27] >> Right.

[25:27] >> Right? Where you have like a bed, a

[25:29] table, and a sink, a toilet, that's it.

[25:31] So you can't can't do much in there.

[25:33] >> But you can do studies, quote unquote,

[25:36] out in the wild with um actometry or

[25:38] what or uh

[25:39] >> Yeah, digraphy, doubly labeled water.

[25:41] Yes.

[25:42] >> A little while ago I saw a study that

[25:44] said that if you are one night sleep

[25:45] deprived, like you get one or two hours

[25:47] less

[25:48] uh sleep than normally

[25:50] you would get to feel rested, that it's

[25:52] actually advantageous to exercise

[25:54] because it offsets some of the um

[25:56] increase in inflammation.

[25:57] >> Mhm.

[25:58] >> But then if you're going multiple nights

[25:59] that way, exercising on a regular basis

[26:01] when sleep deprived, it just sets up a

[26:03] um susceptibility to illness,

[26:05] susceptibility to injury, and so forth.

[26:08] How much of what you observe in the

[26:10] under the conditions of sleep

[26:11] deprivation do you think are downstream

[26:13] or upstream of this thing that we just

[26:16] call inflammation? Like is this just

[26:18] like a body wide response and there are

[26:20] a bunch of things that have gone awry

[26:21] and and so like a bunch of systems are

[26:24] dysregulated or can we pinpoint, okay,

[26:26] when you're sleep deprived,

[26:29] this is what this is what's happening.

[26:31] Cuz I think if if women knew that their

[26:33] GLPs were down when they're down on

[26:35] sleep, so that they should expect that

[26:37] they would feel less satiety. If men

[26:40] knew that their ghrelin levels were

[26:41] elevated when they're down on sleep,

[26:44] that they're going to feel hun-

[26:45] hungrier.

[26:46] And we have a pretty big prefrontal

[26:48] cortex, most people anyway, and we can

[26:50] intervene simply on the basis of

[26:52] knowledge.

[26:53] >> I think that's what's empowering. And I

[26:55] think about this sometimes, too, when

[26:57] I'm

[26:57] when I'm

[26:59] thinking about, you know,

[27:01] my my diet at times, right? I'm like,

[27:03] "I Do I really want to eat this or is it

[27:05] because I really didn't sleep last

[27:07] night?" Right? So, you can you can make

[27:08] you can ask yourself these questions.

[27:10] Take a pause and say, "Okay,

[27:13] do I really want, you know, dessert?

[27:16] Or

[27:17] is it just that I'm tired and, you know,

[27:19] I should just

[27:20] I'm fine. I don't need it."

[27:22] >> Mhm. [clears throat]

[27:23] >> So, if you if you step back and think

[27:25] that maybe part of it is because you

[27:27] didn't sleep well the night before, then

[27:29] you can

[27:30] make your appropriate choices, right?

[27:32] Say "Okay

[27:33] I probably don't need the the extra

[27:35] calories right now.

[27:37] Or or maybe you say, "You know what?

[27:39] I had a really bad night last night. And

[27:41] those extra calories,

[27:43] I don't really care because they're

[27:45] going to make me feel good and I need

[27:47] some pick-me-up."

[27:49] But, you know,

[27:51] that's it Oh, that's all the choices to

[27:53] make, right? You know, because mood

[27:55] comes into comes into play, as well. So,

[27:59] >> Well, ultimately, that brings us to the

[28:01] the other direction of the equation,

[28:03] right? How does what we eat impact our

[28:06] sleep? This is something that I think

[28:07] most people have heard about in the

[28:09] context of try not to eat too close to

[28:12] bedtime.

[28:12] >> Mhm.

[28:13] >> Um this is an active debate in many

[28:15] households, actually. Some people seem

[28:17] to be fine eating close to bedtime and

[28:19] sleeping and even if they track their

[28:21] sleep. Other people, it really disrupts

[28:23] their sleep. I'm interested in both the

[28:26] timing of food intake relative to sleep,

[28:28] but also the content of the food and how

[28:31] it impacts sleep.

[28:32] >> Mhm.

[28:32] >> What's known about that, either from

[28:33] your work or from other work?

[28:35] >> When we started this conversation, I was

[28:36] telling you about these population-based

[28:38] studies, you know, cross-sectional

[28:41] data where two things happen at the same

[28:43] time and you

[28:44] you know, you you don't really know

[28:45] causality. They happen at the same time,

[28:48] and I think early on

[28:50] in this field we started thinking about

[28:53] sleep as the promoter of food intake or

[28:58] as a sleep causing changes in diet,

[29:03] exercise,

[29:04] but didn't really think that maybe it's

[29:06] the other way around or maybe the other

[29:07] way around is just as plausible.

[29:10] So I started thinking about that and

[29:13] said, "Well, what if what if we took the

[29:15] other approach? What if we looked at

[29:17] diet and examined how diet influenced

[29:22] future sleep?"

[29:24] And my first paper in this field was

[29:27] using data from the Multi-Ethnic Study

[29:29] of Atherosclerosis. It's actually

[29:32] kind of hard to find good cohorts that

[29:34] have good nutrition data,

[29:37] good sleep data, and data over over

[29:42] years, right? So MESA, Multi-Ethnic

[29:44] Study of

[29:45] Atherosclerosis, is one of those great

[29:47] cohorts that we have in the here in the

[29:48] US that has all of the above. So I

[29:52] paired up with a colleague of mine,

[29:54] Susan Redline in Boston, and

[29:56] she's principal investigator on their

[29:58] sleep ancillary study, and we asked the

[30:01] question of diet quality and its impact

[30:04] on sleep duration, insomnia symptoms,

[30:07] and we found that having a diet that

[30:11] more closely aligns with the

[30:12] Mediterranean diet was associated with

[30:14] better

[30:16] probability of having adequate sleep and

[30:18] reduced

[30:19] insomnia symptoms in this cohort. So

[30:21] then it launched a whole

[30:23] field of study really to to keep looking

[30:26] at this, and we've looked at this in

[30:28] different studies and different cohorts.

[30:30] Actually,

[30:31] earlier this year we published data from

[30:33] the Women's Health Initiative, another

[30:35] large large cohort with good diet data

[30:38] and and sleep information. We took a

[30:41] really really nice approach in this

[30:43] longitudinal analysis. I don't know.

[30:45] Usually when we do longitudinal studies,

[30:48] we exclude people who have the condition

[30:51] at baseline, right? So if you're trying

[30:53] to see this factor at baseline, how does

[30:57] it influence hypertension 10 years

[31:00] later? You usually exclude people who

[31:03] have hypertension at baseline because

[31:04] you want to see the development of

[31:06] hypertension. In this case, we're

[31:08] looking at insomnia symptoms, but

[31:10] insomnia is one of those conditions

[31:13] that's not necessarily

[31:15] static. It resolves, right? So you can

[31:18] have insomnia and then a few years later

[31:21] not have insomnia.

[31:24] Or you can

[31:25] not have insomnia now and develop

[31:27] insomnia. So what we did is we broke our

[31:30] down our participants into two groups.

[31:32] The people who had

[31:35] no insomnia at baseline

[31:38] and at 3 years follow-up,

[31:41] participants who had insomnia at

[31:43] baseline but not at 3 years follow-up.

[31:46] So they were in the healthful sleep,

[31:49] improving sleep. And then the other

[31:52] group was all those women who had

[31:54] insomnia at baseline and at 3 years, and

[31:57] no insomnia at baseline but insomnia at

[31:59] 3 years. So they were the persistent

[32:02] insomnia, progressing towards poor sleep

[32:06] group. And we found that

[32:08] the women who had a diet that was more

[32:11] closely aligned to the Mediterranean

[32:13] diet, but we also looked at

[32:15] an American type of diet profile called

[32:18] the DASH diet, the Dietary Approaches to

[32:20] Stop Hypertension. Women who had a

[32:23] dietary profile closer to those two

[32:24] types of diets, healthful diets, were

[32:27] less likely to have hypertension

[32:31] insomnia at 3 years.

[32:32] >> And the DASH diet is what?

[32:34] >> Dietary Approaches to Stop Hypertension

[32:36] developed to

[32:38] reduce prevent hypertension, reduce

[32:41] blood pressure in people by increasing

[32:44] intakes of fruits and vegetables, nuts

[32:45] and seeds, consuming low-fat dairy, more

[32:48] plant-based types of diet and and can be

[32:53] has been tested in a low salt or regular

[32:56] salt profile.

[32:57] >> How did those work out? I'm just

[32:58] curious. Do you recall if the low salt,

[33:00] high salt

[33:01] condition

[33:02] >> There's salt sensitivity, so there are

[33:03] some people who are very sensitive to

[33:05] salt and so having a reduced salt diet

[33:08] will really improve their blood

[33:09] pressure.

[33:10] >> Mhm.

[33:10] >> Others not so much, but the DASH diet,

[33:13] regardless of its salt content, did

[33:15] better than the equivalent non-DASH.

[33:18] Which would be your average, you know,

[33:20] American diet.

[33:21] >> Whatever that is.

[33:22] >> Yeah, higher in saturated fats and

[33:24] sugars and

[33:25] >> Which seems to be changing now because

[33:26] of the GLPs. I feel like that's, you

[33:29] know,

[33:30] maybe that's a skewed perspective, but I

[33:32] feel like the

[33:33] the typical American diet is it might

[33:35] not be changing so much in content, but

[33:37] in volume it seems like people are

[33:38] eating less. Certainly the snack food

[33:39] companies, from what I understand, are

[33:41] struggling. Alcohol companies, that's a

[33:43] different issue, but that they're

[33:45] certainly have

[33:46] sales are way, way down, but it seems

[33:49] like people's appetites are down.

[33:52] >> Well, GLP-1s will do that, right?

[33:53] >> Yeah.

[33:54] >> Yeah.

[33:54] >> And we were talking about this the other

[33:55] day here, uh

[33:57] how many Americans have tried a GLP. The

[34:00] estimates are anywhere from like one in

[34:02] seven, some people say it's it's more.

[34:05] >> Mhm.

[34:05] >> pretty incredible.

[34:06] >> pretty high.

[34:07] >> But this is interesting. So, how people

[34:09] eat impacts their sleep, I'm sure the

[34:12] listeners and I also am thinking, okay,

[34:14] but people who are eating a

[34:16] Mediterranean diet, right? Olive oils,

[34:18] fish, you know, fruits, vegetables,

[34:21] they are probably more apt to walk more,

[34:24] exercise more, socialize more, all of

[34:26] How do you separate out the variables in

[34:28] a study like that?

[34:29] >> Uh well, so So population-based studies

[34:31] we adjust for a bunch of covariates,

[34:33] right? We have all these questionnaires

[34:35] that are given out to people asking them

[34:38] about their race, occupation,

[34:40] socio-demographic,

[34:42] socioeconomic status, and then we adjust

[34:45] we adjust for um different illnesses

[34:48] that they may have, depression, uh

[34:50] physical activity level,

[34:53] uh

[34:54] So we try to take all this into into

[34:56] consideration. Obviously, we there's

[34:58] always unmeasured factors that you can't

[35:01] control for, social interactions like

[35:03] you

[35:04] um you mentioned. It's usually not

[35:07] captured very well. It's not something

[35:09] that we we can adjust for. But one thing

[35:12] that we did in my lab uh going back to

[35:14] that original study

[35:17] was to look at uh

[35:20] how diet influence sleep at night in the

[35:22] participants in our inpatient study.

[35:26] So we took

[35:28] the 9-hour time in bed opportunity

[35:31] phase, only that one.

[35:34] >> [snorts]

[35:34] >> In the 4-hour time in bed opportunity,

[35:36] participants were very efficient. There

[35:38] was not much variability in sleep

[35:40] duration in in that phase. They slept as

[35:42] much as they could in that 4-hour

[35:44] opportunity.

[35:45] But in the 9 hours, there's variability

[35:47] there. Some people got more or less. So

[35:49] we wanted to see if food intake was

[35:53] related to their sleep at night. That

[35:55] study

[35:56] we had polysomnography assessments of

[35:59] sleep every single night.

[36:01] Like I mentioned, we had uh controlled

[36:04] diet initially, and then we let them

[36:06] self-select their food intake. So we

[36:08] took a very systematic approach to

[36:10] evaluating how diet could influence

[36:12] sleep in that study.

[36:14] We said first of all

[36:17] was the diet that they chose different

[36:19] than the diet that we gave them.

[36:21] First step, right? It was. So they ate

[36:24] almost 450 calories more. They ate 33%

[36:28] more saturated fat.

[36:30] Uh little less protein, I believe, a

[36:33] little more carbohydrates. Not much, but

[36:35] it it was different. So, I was like,

[36:37] "Okay, so so there's difference between

[36:39] the diets." Okay, now,

[36:41] was their sleep at night different

[36:44] when they were eating the diet that we

[36:45] fed them compared to when they

[36:47] self-selected?

[36:50] And it did it was different. It wasn't

[36:52] different in terms of duration, but it

[36:55] was different in time it took them to

[36:57] fall asleep, which was

[36:59] almost over 70% longer to fall asleep

[37:02] when they self-selected their diet.

[37:04] And their slow wave sleep, so deep

[37:07] sleep, was shorter. I think it was about

[37:10] 23 20% shorter

[37:13] when they self-selected their diet

[37:14] compared to what we had given them.

[37:17] >> Was timing of food intake impacted

[37:19] because when I think of what impacts

[37:22] what reduces

[37:24] slow wave deep sleep, it's eating too

[37:26] close to bedtime.

[37:27] >> Mhm. So,

[37:29] we did not take that into consideration

[37:32] in that study. We didn't We didn't look

[37:34] at that. We had their

[37:36] their food intake profile and didn't

[37:39] specifically look in that

[37:41] phase when when was their last eating

[37:43] period. But it could have been different

[37:45] than

[37:46] in the controlled feeding condition

[37:48] because in the controlled feeding

[37:49] condition, they had set meals at

[37:51] specific times. But they all went to bed

[37:53] at 10:00 p.m.

[37:54] Then the other question was, "Okay,

[37:57] what was it that they ate that day that

[37:59] impacted how they slept that night?"

[38:02] And we found that higher intakes of

[38:06] fiber were associated with more deep

[38:08] sleep.

[38:10] Higher intakes of saturated fat, less

[38:12] deep sleep. And then more refined

[38:14] carbohydrates, simple sugars, more

[38:17] arousals. So, when we talk about

[38:19] arousals in the context of

[38:21] polysomnography, it doesn't necessarily

[38:23] mean full-on waking up or awakening. It

[38:26] really means going from a deeper to

[38:28] lighter stage of sleep, so you may still

[38:30] be asleep throughout the night, but

[38:33] you're not getting deep slow-wave sleep,

[38:37] REM sleep as much as you would

[38:39] uh otherwise.

[38:41] >> Do you create a buffer between your last

[38:45] bite of food and the time you go to

[38:46] sleep, you personally?

[38:48] >> Me personally? Yes.

[38:50] >> Is it an hour, 2 hours, 3 hours?

[38:52] >> I personally like to eat my last meal at

[38:55] least 3 hours before going to bed. And I

[38:57] know there's variability there.

[38:59] Different people have different uh

[39:00] tolerance. You mentioned right before

[39:02] that uh

[39:03] you know, some people may be later

[39:04] chronotypes, but you

[39:06] what we know

[39:08] is that eating earlier

[39:11] is better overall. For cardiometabolic

[39:15] health, eating earlier is better. Me

[39:17] personally, I feel I feel better by

[39:20] eating earlier. If I eat too close to

[39:22] bedtime I

[39:25] I get I get hot.

[39:26] >> Right. Yeah, it's [laughter] a it's a

[39:27] thermic effect of food.

[39:29] >> don't want to be cooling off when we go

[39:30] to sleep.

[39:31] >> Exactly. Exactly.

[39:33] >> I'd like to take a quick break and

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[40:51] subscription.

[40:52] There seems to be something asymmetric

[40:54] about sleep

[40:56] requirements in my experience, and I

[40:59] don't think I'm alone in this.

[41:01] Whereby

[41:03] if I go to bed at

[41:05] 10:00 p.m., I get into bed at 9:30, fall

[41:07] asleep at 10:00, I need about 6 and 1/2,

[41:09] maybe 7 hours to feel completely rested.

[41:11] That's how long I'll sleep, wake up

[41:13] without an alarm, feeling great.

[41:16] If I go to bed at midnight,

[41:18] I find I could sleep till

[41:20] 9:00 and still not feel completely

[41:23] rested. So, there's some weird sleep

[41:25] inertia stuff going on there, etc.

[41:28] The old adage is every hour before

[41:30] midnight is worth two after, but is

[41:32] there any real data to support that, or

[41:34] is this just all subjective and

[41:36] conjecture?

[41:37] >> I'm not sure there's data to support

[41:39] that. I haven't seen anything. But, what

[41:41] I can say from what you're saying is

[41:44] that if you usually go to bed at 9:30,

[41:46] 10:00, and then all of a sudden you go

[41:49] to bed at midnight, now you're kind of

[41:51] out of line with your personal circadian

[41:53] system, right? And it's always harder to

[41:57] to get a good night's sleep if you're

[42:00] not going with your internal clock or

[42:03] your internal circadian

[42:05] preference.

[42:06] Um this is what happens with shift

[42:08] workers, right? For example, they they

[42:10] they're not sleeping at night, They're

[42:12] trying to sleep during the day. They're

[42:15] trying to sleep during the day where

[42:16] their melatonin is low or it should be

[42:19] when it's high. So, they're fighting

[42:21] their circadian system. So,

[42:23] yes, they should they should be getting

[42:25] 7 hours, but they're not getting 7 hours

[42:28] because the body's not designed to be

[42:31] sleeping during the daytime hours. Plus,

[42:34] then you have you know, everything else,

[42:36] right? That

[42:37] >> Right. The light, the stress.

[42:38] >> noise, the kids, the whatever life that

[42:41] that happens during the daytime when

[42:42] everybody else is awake and you're

[42:44] trying to sleep.

[42:44] >> Yeah, the only thing I can think of

[42:46] that's an advantage to being nocturnal

[42:48] is the quiet.

[42:50] >> [laughter]

[42:50] >> I used to sometimes shift to a nocturnal

[42:52] schedule during holidays in graduate

[42:54] school when everyone go home because I

[42:56] lived my my parents lived relatively

[42:59] close to where I went to graduate

[43:00] school, so I could afford to just just

[43:01] go home for Christmas, right? Just that

[43:03] day or a couple of days and everyone

[43:06] else had to travel. So, I could invert

[43:07] my schedule. It just kind of drifted

[43:09] that way.

[43:10] >> Yeah.

[43:10] >> I promise that's the only advantage of

[43:12] going to bed at 4:00 a.m. and

[43:15] sleeping until, you know, 3:00 p.m. at

[43:17] least for typical people. Your brain

[43:20] gets into a kind of weird space when

[43:22] you're inverted from the rest of the

[43:24] world.

[43:25] >> Well, the things you do when you're a

[43:26] grad student. I would be the opposite,

[43:28] right? I I'd wake up at 4:00 a.m. and

[43:30] then study because I felt like all of

[43:32] the hours of studying before the sun

[43:34] rose were like extras.

[43:37] >> Interesting.

[43:37] >> Extra time for me.

[43:38] >> extra. You felt like you were extra

[43:40] sharp at those hours?

[43:41] >> Extra sharp. I could study and then, you

[43:43] know, I got that time done and then, you

[43:45] know, breakfast, but then I crashed

[43:48] later in the afternoon.

[43:49] >> the problem. The 1:00 2:00 p.m. crash.

[43:51] Um, has your work explored napping at

[43:54] all? I'm a believer in naps and

[43:55] non-sleep deep breaths, yoga nidra type

[43:57] things, meditation. Do naps factor into

[44:00] this diet, nutrition, hunger equation?

[44:04] >> So, we I done research on napping per

[44:07] se. For me, there a lot going on with

[44:10] napping. I don't think we have very good

[44:12] data to be able to say what's

[44:14] appropriate about napping. What we do

[44:17] know is that

[44:19] you don't want to nap too close to

[44:22] bedtime because

[44:24] you want to build sleep pressure

[44:25] throughout the day. And if you're

[44:27] dissipating the sleep pressure, the

[44:29] sleep need too close to bedtime, then

[44:30] you're not going to be able to fall

[44:31] asleep when time

[44:33] time comes to go to bed at your usual

[44:35] hour.

[44:36] And then, you know, you get into this

[44:38] vicious cycle, and it's it's not

[44:40] helpful. But, you know, there are some

[44:42] studies that say, "Well, what should you

[44:44] do if you can't sleep enough at night

[44:46] and you're feeling tired?" You know,

[44:47] should you sleep?

[44:49] The

[44:50] recommendations are that you should make

[44:51] it a short nap, 30 minutes, no more than

[44:54] an hour, early enough in the day, if

[44:57] possible, so that you can have

[44:59] sufficient time to rebuild that sleep

[45:01] pressure to be able to fall back asleep

[45:04] well when time comes.

[45:06] But then there's also this this whole

[45:08] question about

[45:10] what's a nap for?

[45:12] Right? Like why are you sleepy? Of

[45:15] course, if you if you pulled an

[45:16] all-nighter, it's easy to to know. But

[45:19] if if you had sufficient sleep or

[45:22] sufficient opportunity for sleep at

[45:24] night and you're waking up and you're

[45:25] not feeling refreshed, and not feeling

[45:26] like you had good quality sleep, and

[45:28] then you're not able to maintain

[45:30] alertness throughout the day, and you

[45:32] need a nap,

[45:35] I think you should you should check to

[45:36] see like what's going on at night. Like

[45:38] why are you not getting that good good

[45:40] enough sleep?

[45:41] >> I'm chuckling because my post-doc

[45:42] advisor sparked this huge debate. It was

[45:45] a big lab. And we had a couple of people

[45:48] in the lab who liked to nap at their

[45:49] desk. These were people that could just

[45:50] like put their head down and and nap at

[45:52] their desk in the afternoon. You'd walk

[45:53] in, they'd be napping, and then they'd

[45:54] wake up and keep working. Everyone was

[45:57] working very hard. And he had this

[45:59] theory

[46:00] uh

[46:01] that if you're napping, it's because

[46:03] you're sleep deprived. That like napping

[46:05] is unhealthy, you know. And it it

[46:07] sparked a big debate. And people because

[46:10] it were a bunch of nerds, people bring

[46:11] data in like, "No, you know, at the

[46:13] sleep lab at Stanford says that naps can

[46:15] be healthy." And I think it you what you

[46:17] just described summarizes I think that

[46:19] the takeaway. I'm a believer in the

[46:21] short nap. But but I'm one of these

[46:23] people that can sleep anywhere, anytime,

[46:24] which may be reflective of sleep

[46:26] deprivation.

[46:27] >> Maybe, yeah.

[46:27] >> Do you find that like when you're going

[46:29] to design a study or when you're going

[46:31] to like really work, like this 4:00 a.m.

[46:33] time, that it's a time of calm or are

[46:35] you like a lazy Are you Do you feel like

[46:37] your mind is moving fast or you're kind

[46:39] of in this like flow zone or whatever

[46:41] you want to call it?

[46:42] >> I'm very focused.

[46:44] >> Mhm.

[46:45] >> Uh, very efficient.

[46:48] So, I try to be really attentive at my

[46:51] task. I try to take take breaks once in

[46:55] a while, but uh

[46:57] most of the time it's it's very

[46:59] efficient.

[47:01] Get to the task and get it done.

[47:03] >> Earlier you were talking about biking in

[47:05] the work. You strike me as somebody who

[47:06] I always think of people who I'm always

[47:08] impressed by colleagues like this that

[47:09] their life is kind of like a step

[47:10] function. They wake up and it's like

[47:12] they're into the day and then it's down,

[47:14] right? Yeah. Interesting. I think some

[47:16] of us are more like this.

[47:17] >> But I think it's important to have a

[47:19] little bit of both though. I think it's

[47:21] important to have downtime,

[47:24] you know,

[47:25] speed time,

[47:27] to to not just be go go go go go. Like

[47:30] you were asking about

[47:32] my personal you know,

[47:35] actions. And

[47:37] at one point

[47:39] I was running a lot for exercise.

[47:42] And uh

[47:43] I felt like my whole life was just

[47:46] running all the time.

[47:47] >> Your brain, too?

[47:48] >> Yeah, yeah. Run to get my kids to

[47:49] school, run to work, get work done, run

[47:52] to then run for fun. Run, run, run. And

[47:55] then I thought, "Okay, I got to need to

[47:58] >> [snorts]

[47:59] >> I think I need a breather. And so I

[48:01] started incorporating yoga into my uh

[48:04] my exercise routine. I think that's I

[48:07] think that's good. Actually, when I was

[48:08] a grad student, I thought yoga was

[48:10] stressful because I couldn't [laughter]

[48:12] stand in those poses.

[48:14] >> Exactly.

[48:15] >> Yeah.

[48:15] >> Yeah.

[48:15] >> But I think yoga evolved. I think the

[48:17] yoga that I do now, it's not as static

[48:20] >> Mhm.

[48:21] >> as the yoga I was doing when I was a

[48:23] grad student. I think it evolved to be a

[48:24] little more active than uh than back

[48:27] then. I see the benefit to having, you

[48:30] know the

[48:31] both types of uh exercise.

[48:34] >> Thanks for being willing to explore

[48:36] that. You know, the I'm not an Ayurvedic

[48:38] practitioner, but the Ayurvedic folks,

[48:40] they'll talk about people like more

[48:41] fire, more more earth, where, you know,

[48:43] and and I think it's just a different

[48:45] lens and nomenclature on

[48:48] there's a kind of array of phenotypes.

[48:50] But when we talk about this thing,

[48:51] sleep, it becomes very prescriptive,

[48:53] right? It's like we all need 6 to 8

[48:56] hours. I mean, I actually, from what

[48:58] you're saying today, six sounds like

[49:00] insufficient is what I'm hearing. I'm

[49:01] probably a little sleep deprived is what

[49:03] kind of hearing.

[49:04] >> So, you know, a colleague of mine just

[49:05] published a paper in nature about

[49:07] biological clocks and aging in different

[49:10] organs. And the sweet spot really was 6

[49:13] and 1/2 to about 7 and 1/2 8 hours for

[49:18] optimal

[49:19] aging. Once you get to below that, it's

[49:22] basically U-shaped, right? So, too much

[49:24] of one thing is not good, too too little

[49:26] is is not good. You want to be in the

[49:28] sweet spot most most organs for uh

[49:32] optimal aging was in this 6 and 1/2 to

[49:34] 7.8. And it differed a little bit by men

[49:37] and women, depending on which organs he

[49:38] was looking at. Uh a little longer for

[49:41] women. Um some of the curves were

[49:44] different, where, you know, some are

[49:46] more pronounced U-shapes in in men than

[49:48] women in different organs. So,

[49:51] uh very interesting paper.

[49:52] >> Mhm. Came out last week or 2 weeks ago.

[49:54] >> I'll have to check it out. Um, what

[49:56] other uh sex differences uh are known to

[49:59] exist in sleep requirements, sleep

[50:01] dynamics that from your work or from

[50:03] other work? This is not something we've

[50:04] really covered on the podcast.

[50:06] >> No.

[50:07] >> No, I mean, well, not in in any

[50:09] sufficient amount of detail.

[50:10] >> Yeah.

[50:10] >> Yeah.

[50:11] >> So, women tend to sleep a little longer

[50:13] than men across lifespan. Although, you

[50:16] know, if you ask women about their

[50:17] sleep,

[50:18] they don't rate their sleep as very

[50:20] good. Um, more women than men report

[50:22] having difficulties with sleep,

[50:24] insomnia, for example, insomnia

[50:26] symptoms. More women than men say they

[50:29] have difficulty falling asleep,

[50:31] difficulty maintaining sleep uh across

[50:34] the adult lifespan.

[50:35] >> Why do you think that is?

[50:36] >> There could be some physiological

[50:37] effects, right? Some hormonal effects.

[50:39] Women uh don't sleep the same across the

[50:41] menstrual cycle.

[50:43] Uh there's discomfort at different

[50:45] times.

[50:46] Uh and then there's different

[50:47] responsibilities, different social roles

[50:49] that come into play uh that may

[50:51] influence women differently than men.

[50:54] But, you know, we were working on a on a

[50:57] review paper actually about hypertension

[50:59] and and sleep and sex differences. And,

[51:02] you know,

[51:03] women are more sensitive to the impact

[51:06] of poor sleep on different metabolic

[51:08] outcomes than men. So, for blood

[51:10] pressure, at lower sleep apnea, for

[51:13] example, at lower thresholds of sleep

[51:16] apnea, their blood pressure would be

[51:17] higher

[51:18] uh than men. So, I think that there

[51:21] needs to be uh for sure a lot more

[51:23] research in this area to be able to

[51:24] uncover, you know, these these

[51:27] differences. And then, you know, knowing

[51:29] that there are these differences to

[51:30] start

[51:32] probing uh women about their sleep. Last

[51:35] year, we published um a scientific

[51:37] statement for the American Heart

[51:38] Association about multidimensional sleep

[51:40] health. And we concluded by uh

[51:42] recommending clinicians that they

[51:45] actually ask their patients about sleep.

[51:47] And not ask a question a targeted

[51:49] question, just ask their patients,

[51:51] "How's your sleep?" Because if you start

[51:53] asking about, "Oh, how much sleep do you

[51:56] usually get at night?" Then you tell the

[51:59] person that the only thing that matters

[52:00] is how many hours of sleep you got at

[52:02] night. That's not all sleep is about,

[52:05] right? Sleep is not just about the

[52:08] number of hours that you got, but it's

[52:10] also about

[52:12] the regularity, the quality, your

[52:14] satisfaction with it. Uh you're There's

[52:17] nighttime experiences, there's daytime

[52:19] experiences from sleep. When you wake up

[52:21] from sleep, are you feeling refreshed?

[52:24] Are you feeling like you had Are you

[52:26] satisfied with how much the sleep you

[52:27] got the night before? During the day,

[52:30] are you staying alert? Are you vigilant

[52:33] during the daytime hours

[52:35] uh from your past sleep experience. So,

[52:37] having this open-ended question, maybe

[52:40] maybe clinicians uh won't have time for

[52:43] for uh for the answer, but, you know, it

[52:46] allows the their patient to actually

[52:48] tell them what's bothering them about

[52:50] their sleep.

[52:51] >> Mhm.

[52:52] >> Then you can get to something like, you

[52:53] know, my my spouse keeps kicking me

[52:56] because I'm snoring too loud. Then, "Oh,

[52:58] well, maybe we should test you for sleep

[53:00] apnea."

[53:00] >> Does apnea always include snoring? Yes.

[53:04] So, are there some people who don't

[53:05] snore who have apnea?

[53:07] >> I don't think so. You stop breathing,

[53:09] and then there's this gasping

[53:11] sound that

[53:13] people make when they uh they awaken

[53:15] from that.

[53:16] Or they get aroused from from this

[53:19] breathing interruption.

[53:20] >> I feel like so many people have apnea

[53:22] and don't realize it. Not because I'm

[53:23] sneaking into their rooms at night and

[53:24] listening to if they snore, but it is

[53:27] just remarkable how many people I speak

[53:29] to who say, "Yeah, I found out I had

[53:31] apnea because I saw that I was snoring

[53:33] because they started monitoring their

[53:35] sleep." And there's generally a snoring

[53:37] index on these. Or now there are free

[53:39] apps that can just record you while you

[53:40] sleep. So, I know a lot of people are I

[53:43] don't mouth tape uh when I sleep, but I

[53:46] I did I do uh sometimes use one of these

[53:48] nose strips that kind of pulls the

[53:50] nostrils out a bit. That certainly it's

[53:53] reduced the amount of snoring

[53:55] >> That will reduce the amount of snoring,

[53:57] but the sleep apnea is from the throat,

[54:01] right? So, the closure in the throat

[54:03] that it uh that uh obstructs

[54:06] the trachea and that's what then prompts

[54:10] the awakening and breathing and then the

[54:12] sound that comes from there. Actually,

[54:14] weight loss is typically like the first

[54:17] line treatment if someone has excess

[54:19] weight to start losing weight, that

[54:20] might help with the uh with sleep apnea.

[54:24] And then there's CPAP which yes, people

[54:26] don't like, but if they are at a lower

[54:28] weight where the apnea is milder, the

[54:31] pressure may be

[54:33] not as uh

[54:34] not as high, so that might be helpful

[54:37] for comfort.

[54:39] I have a colleague of mine who does uh

[54:41] sleep apnea surgeries. So, implantables

[54:43] are also

[54:44] >> Oh.

[54:44] >> If people think they might have apnea,

[54:46] is it just get a CPAP, pop that thing

[54:48] on? Is that the best line of of entry?

[54:50] >> I think they should uh they should get

[54:52] tested.

[54:53] >> So, how do we How does one do that? Cuz

[54:55] that's the problem.

[54:56] >> if you're

[54:58] suspecting that you may have sleep apnea

[55:00] because you've been told that you snore,

[55:02] because you wake up and you're not

[55:04] feeling refreshed, and you're feeling

[55:05] sleepy during the day, I think you

[55:07] should talk to your doctor about this

[55:09] and definitely, we have polysomnography

[55:12] is the first line you know,

[55:14] is what we use to detect um sleep apnea.

[55:17] But, there's in-home sleep testing that

[55:19] can be done, so you don't have to stay

[55:21] overnight in a lab for for uh to get

[55:24] tested for this, and uh and your doctor

[55:26] can prescribe that test very easily.

[55:29] >> How come we can't just go buy a CPAP on

[55:31] Amazon?

[55:32] >> Because you need to have the the the

[55:34] pressure

[55:36] determined for you, right? So, you need

[55:37] to know what kind of pressure to apply

[55:39] and you know, how to set it up. Uh it's

[55:42] not as as simple as just you know

[55:44] >> Okay. All right, fair.

[55:46] >> You need it it needs to have the proper

[55:47] settings and someone needs to tell you

[55:49] which setting to use because then that's

[55:50] where you run to the trouble of having

[55:52] the wrong settings and and not being

[55:54] effective.

[55:55] >> Yeah, I just know from having done this

[55:56] podcast long a while that like if people

[55:59] think, "Okay, I got to go to my doctor.

[56:01] I got to find out or convince them that

[56:03] I have apnea. Then they have to like

[56:06] write me a script for a CPAP. Then I got

[56:07] to buy a CPAP which I'm guessing is not

[56:09] cheap."

[56:10] >> I'm not sure.

[56:11] >> I I don't think they're very

[56:12] inexpensive. They might The price might

[56:13] have come down. And I got to sleep with

[56:15] this thing on my face like looking like

[56:17] Darth Vader so I don't sound like Darth

[56:19] Vader.

[56:20] I just think very few people are going

[56:22] to do it. So, somebody out there should

[56:23] like come up with an at-home solution to

[56:25] this. Something like apnea seems

[56:27] important enough to daytime wakefulness,

[56:29] cognitive function, longevity, metabolic

[56:31] like it works out to so many things that

[56:34] I feel like it

[56:35] >> If you use

[56:36] >> it deserves a like a public health

[56:37] messaging.

[56:38] >> Yeah, if you use it well and you feel

[56:40] better during the day, that's a that's

[56:42] reinforcing, right? To keep using it.

[56:45] And and get treated for it.

[56:46] >> Let's talk about food and nutrients.

[56:48] You've done a substantial amount of work

[56:50] here in this area and I have a bunch of

[56:52] questions. But first I want to talk

[56:53] about kefir.

[56:54] >> Yeah.

[56:55] >> I love Bulgarian full-fat plain yogurt,

[56:59] but it's right next to the kefir.

[57:01] >> Uh-huh.

[57:01] >> And I'm always like, "Do I get the

[57:02] kefir?" Well, I don't know. I love the

[57:03] Bulgarian full-fat plain yogurt. So, I

[57:05] haven't tried the kefir yet. What's

[57:07] special about kefir and why are why did

[57:09] you study kefir?

[57:10] >> Kefir we we studied because it was a

[57:13] fermented dairy product, uh probiotics.

[57:16] We figured, you know, maybe it will

[57:18] improve uh cholesterol synthesis based

[57:21] on its impact on short-chain fatty

[57:23] acids. So, that was a the the subject of

[57:25] my uh master's thesis.

[57:28] Over that study,

[57:29] uh that was when I was at McGill. We

[57:32] were recruited men that had mildly

[57:34] elevated cholesterol levels. We gave

[57:36] them two cups per day

[57:39] versus just regular milk for a month.

[57:42] >> So, two cups like two mugs like this?

[57:44] >> Two cups like the measuring cup.

[57:46] >> Okay.

[57:46] >> Yeah.

[57:47] >> Okay.

[57:47] >> Um like 500 ml.

[57:49] >> Okay.

[57:50] >> And uh

[57:52] and we measured their

[57:54] the amount of cholesterol they they

[57:56] produced at baseline and point in both

[57:59] phases and there was no effect. It was a

[58:02] null study. It was one of those.

[58:04] It was hard to get published.

[58:07] >> Mhm.

[58:07] >> Kept at it and and we got it published,

[58:10] but yeah.

[58:10] >> So, these fermented yogurts and things

[58:13] they don't do anything for

[58:15] for cholesterol levels.

[58:16] >> At least in our study, in this

[58:18] population, at this level, with this

[58:20] comparison

[58:21] >> Mhm.

[58:22] >> didn't have any effect.

[58:23] >> What's your general thought about uh low

[58:25] sugar fermented foods? I don't know if

[58:26] kefir uh qualifies as low sugar, but

[58:29] based on Justin Sonnenburg's work at

[58:30] Stanford and others I've been I've been

[58:32] a really bullish on this idea of

[58:35] sauerkraut kimchi uh

[58:38] full-fat Bulgarian yogurt. Fermented

[58:40] foods are are interesting.

[58:42] >> Yeah.

[58:42] >> Are you a proponent in general?

[58:44] >> I'm a proponent. Yeah, absolutely. I

[58:46] think it's important to feed your gut. I

[58:48] think that uh the gut microbiome is uh

[58:50] getting a lot of attention for all sorts

[58:52] of, you know, uh

[58:54] health benefits.

[58:56] So, I think that that's something that's

[58:58] uh that's is important. So, also

[59:00] it's important to

[59:01] also consider that, you know, for that

[59:04] study, right? Our main outcome was

[59:06] cholesterol synthesis, but there's so

[59:08] many other things we could have looked

[59:10] at that we didn't look at, right? And

[59:13] maybe it didn't have any impact for

[59:15] cholesterol synthesis, but maybe

[59:20] glycemic control might be better or for

[59:25] gut inflammation it would be better.

[59:27] But, you know, you you pick your

[59:29] outcomes, right? You study something and

[59:31] the

[59:31] >> This is the challenge of doing

[59:32] controlled science.

[59:33] >> Yeah, yeah, yeah.

[59:34] >> So, the opposite end of the like

[59:37] X, what used to be called Twitter,

[59:38] science, where like people just like

[59:40] report anecdotes, but

[59:42] actually anecdotes of that sort have

[59:44] become very powerful now in the public

[59:45] health space, for better or worse. Like

[59:47] people, you know, because

[59:49] I

[59:50] we can look at any study and say, "Well,

[59:51] that's a very artificial circumstance."

[59:53] You say, "Well, intentionally, because

[59:54] we're trying to isolate variables."

[59:56] >> Right, right, right, exactly.

[59:57] >> People get frustrated. "Oh, that's an

[59:58] observational study." Well,

[1:00:01] uh I'm going to continue to eat

[1:00:02] low-sugar fermented foods every day. I I

[1:00:04] I do think in a study like the one you

[1:00:07] described, occasionally there's just

[1:00:09] there's

[1:00:10] Let me state this differently.

[1:00:11] Historically, in science, there's been a

[1:00:14] lot of interesting discoveries that have

[1:00:16] come from

[1:00:17] researchers designing a study to look at

[1:00:19] one thing and then kind of noticing,

[1:00:21] "Oh, like all the subjects feel better

[1:00:23] or sleep better or their skin they

[1:00:25] they're reporting things that then lead

[1:00:27] to an another another line line of

[1:00:29] inquiry, but you moved on from kefir.

[1:00:32] Tell me about this um this paper. I was

[1:00:34] intrigued by this when I looked over

[1:00:36] your CV. The uh a weight-loss diet that

[1:00:38] includes a coffee beverage enriched in,

[1:00:41] let me try this, mannan

[1:00:43] oligosaccharides.

[1:00:44] >> Yeah.

[1:00:44] >> Okay. All right, long word. Leads to a

[1:00:46] greater loss of adipose fat tissue than

[1:00:49] placebo beverage in overweight men.

[1:00:51] >> Yeah.

[1:00:52] >> Tell me about this study and what these

[1:00:54] mannan oligosaccharides are and if

[1:00:57] somebody wants to lose weight, should

[1:00:58] they be including this in their coffee?

[1:01:00] >> So, this was industry-sponsored research

[1:01:03] that I did. Um they wanted to replicate

[1:01:05] a study that had been done in a

[1:01:08] different country

[1:01:09] >> [snorts]

[1:01:09] >> because they wanted to replicate the

[1:01:10] findings. So, we did this study. Uh it

[1:01:13] was basically a placebo-controlled

[1:01:15] study. We got we were provided um

[1:01:19] coffee mannan oligosaccharides. So,

[1:01:20] these are extracted from spent coffee

[1:01:23] grounds. So, it was basically sachets,

[1:01:25] right? So, a white packet. One had the

[1:01:29] coffee mannan oligosaccharides, the

[1:01:30] other one didn't. We gave it to our

[1:01:33] study participants. We measured their

[1:01:34] body composition. We found an effect on

[1:01:38] body composition in men, not in women.

[1:01:40] >> Hm.

[1:01:41] >> And so, that was the end of that

[1:01:42] product.

[1:01:43] >> Really? They wouldn't market it just

[1:01:44] because [clears throat] it only had an

[1:01:45] effect in men?

[1:01:46] >> Yeah. Yeah, they were like

[1:01:47] >> I assure you there are many men who

[1:01:48] would love to drink a coffee drink and

[1:01:49] lose weight as a consequence.

[1:01:51] >> to be our market, you know.

[1:01:53] >> But, do we know what the ingredients

[1:01:54] were?

[1:01:54] >> It was

[1:01:55] mannan oligosaccharides. Just the

[1:01:57] extracted Yeah, so it was just basically

[1:02:01] a product that was

[1:02:02] tasted like coffee, strong coffee.

[1:02:05] But, it didn't have the caffeine or

[1:02:07] anything like that. It just had this

[1:02:09] this mannan oligosaccharide that was

[1:02:10] extracted from coffee.

[1:02:12] >> So, this substance comes from coffee

[1:02:15] ordinarily, but coffee is very low low

[1:02:18] calorie.

[1:02:18] >> Right. But, it's from the spent grounds.

[1:02:20] So, you No one really

[1:02:22] consumes this really because you know,

[1:02:25] when you brew your coffee, you're

[1:02:28] you're not getting it to know.

[1:02:29] >> Can you buy it? Can people get it?

[1:02:32] >> I don't think so. I'm not sure.

[1:02:34] >> So, what What do you First of all, how

[1:02:35] much weight did they lose relative to

[1:02:37] the

[1:02:37] >> It was statistically significant. Yeah.

[1:02:39] >> Hm.

[1:02:40] Okay. I was intrigued by it cuz I

[1:02:41] thought there's there's something that I

[1:02:43] mean, you studied It's interesting you

[1:02:45] say kefir

[1:02:46] mannan oligosaccharides from coffee.

[1:02:48] >> Yeah.

[1:02:48] >> Now, I'm going to ask you about ginger.

[1:02:50] >> Well, when I was in a graduate student,

[1:02:52] I was interested in functional foods.

[1:02:54] >> Mhm.

[1:02:55] >> And I was interested in those foods that

[1:02:57] provide health benefits beyond their

[1:02:59] nutritional value.

[1:03:01] >> Mhm.

[1:03:01] >> Right. So, kefir

[1:03:03] is a fermented dairy product. It would

[1:03:06] We were studying it for its a functional

[1:03:09] benefit on cholesterol synthesis.

[1:03:12] That's not

[1:03:14] a

[1:03:14] uh that's not a function of dairy,

[1:03:17] right? Dairy is you consume it for bone

[1:03:20] health, right? So, it's the basically

[1:03:22] when we talk about different claims that

[1:03:24] foods have, you know, there is those

[1:03:26] structure function claims, like

[1:03:28] consuming dairy contains calcium that's

[1:03:30] good for your bones, and then there is

[1:03:33] um functional

[1:03:34] claims. Those functional claims are

[1:03:36] health claims, we call them, that say,

[1:03:38] "Okay, well, health claim there's a

[1:03:40] health claim for oats, for example,

[1:03:41] right? So, consuming fiber from oats

[1:03:45] uh reduces cholesterol levels."

[1:03:46] >> That's been demonstrated.

[1:03:47] >> Yes. So, that's that's a health claim.

[1:03:49] That's an approved health claim. That's

[1:03:52] why you see the hearts on some boxes of

[1:03:54] cereal,

[1:03:55] but that's different than

[1:03:57] fiber

[1:03:59] is good for maintaining regularity,

[1:04:01] right? So, anyways, I was interested in

[1:04:03] in functional foods for health benefits

[1:04:05] beyond their their nutritional content.

[1:04:08] And so,

[1:04:10] uh we we study kefir for I study kefir

[1:04:13] for my master's degree, and then for my

[1:04:15] PhD, studied uh medium-chain

[1:04:17] triglycerides,

[1:04:19] um and then um

[1:04:21] ginger, that was uh that was something

[1:04:24] that I that I uh offered to a grad

[1:04:27] student at Columbia. It was interesting

[1:04:29] because uh the McCormick company

[1:04:33] had an advertisement in uh one of the

[1:04:35] nutrition journals, and they were going

[1:04:37] to donate

[1:04:38] um spices for research.

[1:04:41] So, I was like, "Okay." They had a list

[1:04:42] of different herbs and spices that they

[1:04:44] were going to donate for research, and I

[1:04:46] had a grad student, and I said, "Take a

[1:04:48] look at this list,

[1:04:50] come back to me, see if there's

[1:04:52] something in there that we should

[1:04:55] test in the lab

[1:04:56] based on the things that I do. Don't

[1:04:58] come to me with something that's, you

[1:04:59] know, that I don't study, but and then

[1:05:02] he did some research, and came back, and

[1:05:05] he said, "I think we should study

[1:05:06] ginger." And I was like, "Okay, and to

[1:05:07] do what?" He was like, "I think, you

[1:05:09] know, for energy expenditure,

[1:05:11] look at thermic effect of food. So, it's

[1:05:14] like "Okay."

[1:05:15] So, so we did this study. I had some

[1:05:17] some funds that I could use for him to

[1:05:19] do that and uh

[1:05:20] >> What did the study look like?

[1:05:21] >> A study where we looked at the thermic

[1:05:22] effect of food.

[1:05:23] >> Like, so people ate ginger root with the

[1:05:26] spice in their food. What was

[1:05:27] >> We dissolved ginger powder in warm

[1:05:30] water.

[1:05:32] And so, that was one beverage and then

[1:05:34] uh in the crossover, again, crossover

[1:05:36] design. So, next time when they came, it

[1:05:38] was just hot water.

[1:05:39] >> And how many times a day are they

[1:05:40] drinking it?

[1:05:41] >> This was a one-time one-time uh

[1:05:44] consumption period. And we looked at the

[1:05:46] thermic effect of food over a 6-hour

[1:05:48] period. So, again, they're they're under

[1:05:50] this um

[1:05:52] we call it metabolic hood, right? So, a

[1:05:54] little bubble. And we measure their uh

[1:05:56] oxygen consumption, carbon dioxide

[1:05:58] production for I think it was 4 or 5

[1:06:01] hours.

[1:06:01] >> significantly elevated.

[1:06:03] >> Mhm.

[1:06:03] >> With ginger.

[1:06:04] >> With ginger.

[1:06:05] Yeah.

[1:06:06] >> Wow.

[1:06:06] >> So, we think through the capsaicin

[1:06:08] receptor, there's an increase in the

[1:06:10] thermic effect of food. So, yeah. So, I

[1:06:12] was interested to see are there little

[1:06:15] things that we could do, little changes

[1:06:17] we can make to our diet to boost energy

[1:06:20] expenditure relative to intake, you

[1:06:22] know, just to tip the scale because

[1:06:25] many adults over the course of their

[1:06:27] life lifetime gain weight.

[1:06:29] And it's not a big imbalance in calories

[1:06:33] on a daily basis that leads to

[1:06:37] 10 lbs of weight gain over 10, 15 years,

[1:06:40] right?

[1:06:41] >> more. Now, again, the GLP's are coming

[1:06:42] in and adjusting with Yeah, I'm very

[1:06:44] interested also in foods that have

[1:06:48] impact beyond their, you know, known

[1:06:51] known roles. I mean, the the problem is

[1:06:54] in this area, in the functional foods

[1:06:55] area, not the problem with your work,

[1:06:57] but the is that there are a lot of wild

[1:06:59] claims that go unchecked. Like, oh, you

[1:07:02] know, walnuts are shaped like a brain

[1:07:04] and therefore they're good for your

[1:07:05] brain or, you know, which is I'm they

[1:07:07] have certain things in them which are

[1:07:09] brain beneficial, but it's not related

[1:07:11] to the shape of the food. So, you get

[1:07:13] there's a that area I feel of nutrition

[1:07:16] has been

[1:07:17] um marginalized on the basis of the kind

[1:07:20] of like

[1:07:21] quackery associated with it. But, of

[1:07:23] course, there are interesting things in

[1:07:25] different [clears throat] foods. I do

[1:07:26] think that the

[1:07:28] the Sonnenburg and colleagues work on

[1:07:29] low-sugar fermented foods has been very

[1:07:31] informative for lowering the

[1:07:33] inflammatome even more than fiber.

[1:07:36] I mean, actually in that study, this is

[1:07:38] kind of the like even Justin will kind

[1:07:39] of downplay this a little bit. He's a

[1:07:41] colleague, so I can say he

[1:07:42] in the fiber group, when they compared

[1:07:44] to low-sugar fermented foods, and then

[1:07:45] they measured the inflammatome, they did

[1:07:47] a crossover design also. Within the

[1:07:49] fiber group, there was a fair number of

[1:07:51] people who their inflammation went way,

[1:07:53] way up when they consumed more fiber.

[1:07:56] But, in the low-sugar fermented group,

[1:07:58] or when they were in that group, it was

[1:07:59] it was

[1:08:00] always on average reduced.

[1:08:03] Some people who increase their fiber

[1:08:05] intake their

[1:08:06] inflammatome decreases. For a lot of

[1:08:08] people, it increases. Which is not to

[1:08:10] say that fiber is bad, but I think now

[1:08:11] we're starting to think about like

[1:08:12] different types of fibers.

[1:08:14] >> I was going to ask.

[1:08:15] >> Yeah. They didn't control for that. They

[1:08:16] just said increase the number of

[1:08:18] servings each day. And and I know a lot

[1:08:20] of people don't like to eat fibrous

[1:08:22] foods because they don't feel good after

[1:08:24] they eat them. It's like it's not that

[1:08:26] they don't taste good, and I think

[1:08:27] there's this whole like histamine story

[1:08:29] that needs exploration. I think foods

[1:08:32] and the healthy foods needs better

[1:08:34] parsing.

[1:08:35] >> Yeah.

[1:08:35] >> In my in my opinion.

[1:08:36] >> Yeah, I I mean, there was also

[1:08:38] habituation. You don't go from consuming

[1:08:42] 6 g of fiber per day to 25.

[1:08:44] >> them up, but but I have to say they

[1:08:46] ramped them up pretty high. Like, even

[1:08:47] the low-sugar fermented foods, I think

[1:08:48] they got them up to like four servings

[1:08:50] per day. It's a lot of kimchi. You're

[1:08:52] not familiar with it. Like, it can be a

[1:08:54] little hard on the gut.

[1:08:56] >> Yeah.

[1:08:56] >> I actually take an enzyme. I think it's

[1:08:58] called DAO.

[1:09:00] Very inexpensive. A little It's like a

[1:09:02] tiny tiny pill that

[1:09:04] that for digesting histamines.

[1:09:06] >> Mhm.

[1:09:06] >> Cuz I noticed after I had whey protein

[1:09:08] or I had broccoli or something I would I

[1:09:10] would get kind of sleepy. I was like,

[1:09:11] "What is this?" And I

[1:09:13] a colleague at Stanford, Sean Mackey,

[1:09:15] who's our head of our pain center, said

[1:09:17] that he had gut pain at one point. He's

[1:09:19] a pain doctor, directs the pain center,

[1:09:21] and he figured out by

[1:09:24] elimination and trial and error that it

[1:09:26] was onions and other

[1:09:27] histamine-containing foods because it

[1:09:28] avoids histamine-containing foods. I'm

[1:09:30] not about to give up the things I just

[1:09:32] described. Onions I can do without, but

[1:09:34] So, I think that there's a there is food

[1:09:36] to have real effect.

[1:09:38] >> Mhm.

[1:09:38] >> So, kefir, these manno-oligosaccharides,

[1:09:41] I have to confess I'm a little

[1:09:42] disappointed cuz like here it looks like

[1:09:44] it has like a cool effect, but they

[1:09:45] didn't they didn't want Now can't get

[1:09:47] them. I'm not going to eat coffee

[1:09:48] grounds.

[1:09:49] I'd like to take a quick break and

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[1:11:23] In your work or in your observation or

[1:11:25] in your curiosity, what other foods are

[1:11:26] kind of intriguing to you?

[1:11:28] >> Someone had a really

[1:11:30] great question for me at the Obesity

[1:11:33] Society meeting a couple of years ago. I

[1:11:36] was showing data that we had just

[1:11:38] obtained in the lab that showed that if

[1:11:40] you eat foods later in the day, your fat

[1:11:44] oxidation is reduced. So, this is a

[1:11:47] study that we're doing. We had

[1:11:49] participants on a controlled diet, and

[1:11:52] they started eating 1 hour after waking

[1:11:54] up, and they had a 10-hour eating

[1:11:56] window, or they started eating 5 hours

[1:11:59] after waking up, so 4-hour delay

[1:12:01] relative to the other condition. Again,

[1:12:04] same thing for a a 10-hour window

[1:12:06] 10-hour window.

[1:12:07] We gave our participants the exact same

[1:12:09] foods. Same foods, same quantity, same

[1:12:13] timing between meals. And this was done

[1:12:15] in a metabolic chamber.

[1:12:18] And the meals, especially the meals

[1:12:21] later in the day,

[1:12:23] that were consumed late relative to the

[1:12:25] earlier version of those meals, led to

[1:12:28] less fat oxidation.

[1:12:31] And someone in the audience

[1:12:33] stood up and said, "So, would you then

[1:12:37] recommend that people eat medium-chain

[1:12:39] triglycerides

[1:12:41] in their evening meal as opposed to, you

[1:12:44] know,

[1:12:45] a different type of of fat?"

[1:12:48] And my eyes just went like this because,

[1:12:51] you know, my

[1:12:52] the my time studying medium-chain

[1:12:54] triglycerides was, you know, 15 to 20

[1:12:57] years ago. I was like, "Wow, this person

[1:12:59] knows my that work that I've done and

[1:13:02] now is applying it to this work that I'm

[1:13:04] doing currently." And I thought that was

[1:13:05] fascinating and I think that, you know,

[1:13:07] timing of intake of different foods and

[1:13:09] how it influences metabolism is

[1:13:12] something that's uh that's fascinating

[1:13:14] to me.

[1:13:15] >> I confess, I'm a like first bite of food

[1:13:18] around 11:00 a.m. person. I'm trying to

[1:13:20] eat breakfast these days and then kind

[1:13:22] of shift things earlier. All it's really

[1:13:24] done is added a meal cuz I I take my

[1:13:26] last bite of food usually around 8:00

[1:13:27] p.m. I just can't seem to get

[1:13:30] much earlier.

[1:13:32] But,

[1:13:34] I and many other people have wondered

[1:13:36] whether it's best to eat more towards

[1:13:38] early day or whether or not it's just

[1:13:39] overall caloric load. You're saying that

[1:13:42] it does indeed make a difference.

[1:13:43] >> It makes a difference, yeah.

[1:13:44] >> You want to shift most of your caloric

[1:13:46] intake to the first like two-thirds of

[1:13:48] your waking day.

[1:13:49] >> Roughly.

[1:13:50] >> Mhm. Yeah.

[1:13:51] >> As opposed to the last two-thirds.

[1:13:53] >> Yes.

[1:13:53] >> Mhm. Yeah.

[1:13:54] >> [clears throat]

[1:13:54] >> So, in that study, 1 hour after waking

[1:13:57] up, so let's say basically 8:00 a.m. to

[1:13:59] 6:00 p.m. is our eating window. I mean,

[1:14:01] this is a 10-hour eating window. It's

[1:14:03] short. It's not, you know, our typical.

[1:14:04] So, it could be

[1:14:06] 8:00 a.m. to 7:00 p.m.

[1:14:07] >> That seems pretty

[1:14:08] >> That's reasonable.

[1:14:09] >> Yeah. Yeah, versus

[1:14:11] >> 12:00 p.m. to 10:00 p.m.

[1:14:14] >> The New York schedule.

[1:14:15] >> Yeah, the New York schedule.

[1:14:16] >> that Yeah, well, I I sort of chuckle cuz

[1:14:18] when I go to New York, like it's like if

[1:14:19] you go to dinner at

[1:14:21] 5:30, 6:00, you're kind of alone in the

[1:14:23] restaurant.

[1:14:24] >> Yeah, the early bird special.

[1:14:26] >> Yeah, depends on time of year. In In

[1:14:28] California, it's it's kind of in it's

[1:14:30] the early shifted.

[1:14:32] >> Yes.

[1:14:32] >> But, that's just more reflective of

[1:14:33] culture, I think. In Europe, they they

[1:14:36] eat very late often. Depends on where.

[1:14:38] >> I I I was saying before we we started, I

[1:14:42] was on a Fulbright uh program last year

[1:14:45] in in Spain. And uh I would joke with my

[1:14:48] with my colleagues there because they

[1:14:50] eat very late. And even the children eat

[1:14:52] very late. And I was like, "Okay, well,

[1:14:55] you feed me, then you feed the children.

[1:14:57] >> Right. [laughter] Right.

[1:14:58] >> Then you have your dinner because they

[1:14:59] can have dinner at 10:00 and 11:00 p.m.

[1:15:01] and the children ate 9:00 p.m. and I was

[1:15:03] like,

[1:15:04] >> Can't be good.

[1:15:06] If you my dad's from Argentina, if you

[1:15:08] go to a restaurant in Buenos Aires at

[1:15:11] 9:00 p.m.,

[1:15:12] you're not going to see many people. At

[1:15:14] 11:00 p.m., you'll see people in their

[1:15:15] 70s and 80s and they're up early the

[1:15:17] next day. They nap in the afternoon.

[1:15:19] >> Yeah.

[1:15:20] >> I don't know how healthy they are as a

[1:15:21] country on average, but haven't looked

[1:15:23] at the data, but very, very late shifted

[1:15:26] culture.

[1:15:26] >> Well, there has been studies in Spain

[1:15:28] that have looked at timing of eating and

[1:15:29] their impact on weight management. I'm

[1:15:32] thinking of work by Marta Garaulet,

[1:15:35] where she showed that in her

[1:15:37] weight loss program, the participants

[1:15:40] who have lunch, so their big bigger meal

[1:15:42] is is lunch, who have their lunch

[1:15:44] earlier in the day, have better weight

[1:15:47] loss than those who have their lunch

[1:15:49] later in the day.

[1:15:50] So, you know, even in those cultures

[1:15:53] where they have they tend to eat late,

[1:15:55] they still find that eating earlier

[1:15:58] tends to be better for you.

[1:15:59] >> I was very, very relieved when

[1:16:02] Alan Aragon, who's a I consider one of

[1:16:05] the best public educators on the topic

[1:16:07] of protein and nutrition, body

[1:16:08] recomposition, he's formally trained in

[1:16:11] this, reassured me that, you know,

[1:16:14] nowadays there's a lot of interest in

[1:16:15] getting like protein rations. It's

[1:16:16] probably over done a little bit, but the

[1:16:18] people are striving to get more

[1:16:19] high-quality protein, but that

[1:16:22] except in rare circumstances where

[1:16:24] people are really trying to optimize

[1:16:26] every bit of muscle protein synthesis,

[1:16:28] 95% of the effect

[1:16:31] of getting enough protein can be

[1:16:32] accomplished by having like two meals.

[1:16:34] >> Mhm.

[1:16:35] >> Maybe a little snack. That you don't

[1:16:36] have And they can be

[1:16:38] evenly distributed or unevenly

[1:16:39] distributed. You know, I think a lot of

[1:16:41] people are feeling this protein pressure

[1:16:43] and like, "Oh, I got to eat another meal

[1:16:45] late in the day or I have to force

[1:16:46] myself to eat breakfast in order to get

[1:16:48] their protein ration." It turns out the

[1:16:50] whole notion that you could only

[1:16:52] assimilate like 30 g per meal is is

[1:16:54] totally false. It turns out you can

[1:16:56] assimilate up to 100 g. Now, there are

[1:16:58] conditions that set that up like

[1:17:00] exercise etc. but I find that very

[1:17:03] liberating. Like you could have

[1:17:04] breakfast and an early dinner

[1:17:06] >> Mhm.

[1:17:06] >> with a snack in the middle. You could

[1:17:08] miss breakfast, have lunch and an early

[1:17:10] dinner. What I'm hearing from you,

[1:17:11] however, is that you really want to

[1:17:13] avoid the

[1:17:14] the the big even or just late dinner.

[1:17:17] You just don't want to eat too close to

[1:17:18] bedtime.

[1:17:19] >> Correct.

[1:17:19] >> Okay.

[1:17:20] >> Yeah.

[1:17:20] >> What about these

[1:17:22] MCTs, medium chain triglycerides? These

[1:17:24] were very popular in the health and kind

[1:17:25] of biohacking space a few years ago, the

[1:17:28] um the whole bulletproof coffee notion,

[1:17:30] MCTs, butter coffee and that's more or

[1:17:33] less faded away. I don't see a lot of

[1:17:36] people

[1:17:38] putting oil in their coffee these days

[1:17:40] or coconut. What are some of the known

[1:17:42] benefits of MCTs? Where do you find them

[1:17:45] and what what brought you to them as a

[1:17:48] research topic?

[1:17:49] >> This was a topic for my PhD

[1:17:51] dissertation. So, my PI got a grant

[1:17:55] looking at the medium chain

[1:17:56] triglycerides. He had done prior work on

[1:17:59] this

[1:18:00] but what we did was use purified MCT

[1:18:03] oil. So, this is only

[1:18:07] liquid oil that contains eight carbon

[1:18:10] and 10 carbon chain fatty acids.

[1:18:13] Those are not very common in our general

[1:18:16] food source. So, it was purified

[1:18:19] extracted oil that we then

[1:18:22] gave our participants. We had created

[1:18:24] this functional oil

[1:18:27] that contained flaxseed oil also to be

[1:18:29] able to get some more some omega-3 fatty

[1:18:31] acids in there.

[1:18:33] We had added plant sterols because that

[1:18:35] was a big

[1:18:36] big focus of my lab at McGill plant

[1:18:39] sterols for cholesterol reduction and

[1:18:42] reduce risk of cardiovascular disease.

[1:18:45] And

[1:18:46] but the idea was to evaluate the impact

[1:18:49] on energy expenditure because the way we

[1:18:53] process medium chain triglycerides is

[1:18:55] different than how we process long chain

[1:18:58] triglycerides. So the

[1:19:01] 12 14 16 and up carbon chains. So the

[1:19:05] medium chain triglycerides they travel

[1:19:07] directly to the liver they get

[1:19:08] metabolized we burn them off more

[1:19:11] readily than the long chain

[1:19:13] triglycerides that travel across the

[1:19:15] peripheral circulation get deposited in

[1:19:17] adipose tissue and the sort.

[1:19:20] And so what we did what we found we did

[1:19:22] two separate studies in men and women in

[1:19:25] both men and women there was an increase

[1:19:27] in thermic effect of food so you burned

[1:19:29] slightly more calories

[1:19:31] from the the meal that contained medium

[1:19:33] chain triglycerides compared to the meal

[1:19:35] that contained your standard fat. For my

[1:19:37] PhD the first study we did we did in

[1:19:40] women.

[1:19:42] And we were trying to match the

[1:19:43] saturated fat content of the diets

[1:19:46] because

[1:19:47] medium chain fatty acids are by default

[1:19:51] saturated or

[1:19:53] C80 100.

[1:19:55] So I said okay we're going to try to

[1:19:58] compare that to a

[1:20:00] saturated fat matched control comparison

[1:20:04] and we used beef tallow.

[1:20:06] It was a lot of beef tallow.

[1:20:08] Uh [gasps]

[1:20:10] participants were not happy with that

[1:20:12] diet.

[1:20:12] >> eat it direct like spoonfuls of beef

[1:20:14] tallow?

[1:20:15] >> put it on to mashed potatoes. You know

[1:20:18] when you're when you're doing studies

[1:20:19] like this where you're trying to control

[1:20:21] the diet and you want to isolate one

[1:20:23] aspect of it right and we gave real

[1:20:25] foods half of the total fat of the diet

[1:20:28] came from

[1:20:30] the

[1:20:31] the medium chain containing versus and

[1:20:33] the beef tallow so it's like 20% of your

[1:20:36] fat from

[1:20:37] one of the two. So you have to pour it

[1:20:39] mask it somehow.

[1:20:41] And

[1:20:42] there's also this issue about laxative

[1:20:44] effect of MCT oil that that we had a few

[1:20:46] participants who initially felt a lot of

[1:20:49] gargling

[1:20:51] when like just gargling from their

[1:20:53] stomach from from consuming MCT because

[1:20:56] it was a lot early on. It resolved.

[1:20:59] >> Mhm.

[1:20:59] >> So after a few days it was fine. It was

[1:21:01] a one week one month I mean four week

[1:21:03] study. So

[1:21:05] after a few days no one dropped out for

[1:21:08] you know any GI issues.

[1:21:10] >> Okay, that's reassuring.

[1:21:11] >> Yeah. So beef tallow it was initially

[1:21:15] beef tallow because it has a lot of

[1:21:19] saturated fat is solid at room

[1:21:21] temperature.

[1:21:23] So as soon as your food started to

[1:21:25] get a little colder it would kind of gel

[1:21:29] on your plate.

[1:21:30] >> Mhm. Yeah, it's sort of like if you

[1:21:31] bring french fries home from a

[1:21:33] restaurant that used tallow and then you

[1:21:34] like put it in the fridge cuz you

[1:21:35] thought you wanted them as leftovers the

[1:21:37] next day they're sort of like in this

[1:21:39] like stuck to bottom of container

[1:21:41] configuration. Yeah, it's not very

[1:21:42] appetizing.

[1:21:43] >> Not a feeling. No, there's like it's

[1:21:45] white all underneath that.

[1:21:46] >> always goes into the trash.

[1:21:47] >> Yeah. A couple of women felt it gave

[1:21:50] them headache just the smell of it you

[1:21:53] know.

[1:21:53] >> So with the MCT's big significant

[1:21:56] increase in thermic effect of food?

[1:21:57] >> That was statistically significant.

[1:21:58] Yeah.

[1:21:59] It was about

[1:22:01] 45 to 50 60 calories.

[1:22:04] >> Oh, I thought you were going to say

[1:22:05] percent increase.

[1:22:06] >> No, no, no. So it's it's a small change

[1:22:08] but it was

[1:22:11] if you're going to use this versus that

[1:22:13] you're getting a little boost here if

[1:22:14] you repeat this a few times in a day

[1:22:17] because when we measured the thermic

[1:22:19] effect of food we measured it only after

[1:22:21] over one meal but repeated over three

[1:22:25] meals per day over a certain period of

[1:22:27] time, we did find changes in body

[1:22:29] composition, improvements in

[1:22:31] in weight status with medium-chain

[1:22:33] triglyceride consumption.

[1:22:35] >> Lean mass to to fat mass ratio.

[1:22:37] >> Interesting.

[1:22:38] >> And then we did follow-up study of a

[1:22:41] weight loss study with medium-chain

[1:22:43] triglyceride. This time around it was

[1:22:44] just purified MCT oil, not added with

[1:22:47] other types, versus olive oil,

[1:22:50] which is much more acceptable, and found

[1:22:52] greater weight loss with MCT.

[1:22:54] >> Based on what you're saying, it's

[1:22:55] reasonable if somebody wants to improve

[1:22:58] weight loss. I'm hearing a sort of a

[1:23:00] constellation of things. Shift your meal

[1:23:02] timing to in the first two thirds or so

[1:23:04] of your day,

[1:23:05] which sounds like it will also improve

[1:23:07] sleep, which will also improve

[1:23:09] uh

[1:23:10] >> Your your ability

[1:23:11] >> appetite and food regular satiety and

[1:23:13] hunger signals. What is it like a

[1:23:15] tablespoon or two of MCT per day? Is

[1:23:18] that kind of what this looks like for

[1:23:19] the typical person?

[1:23:21] >> Yeah, about that.

[1:23:22] >> Okay.

[1:23:22] >> Yeah.

[1:23:22] >> In place of some other oil, not in

[1:23:25] addition.

[1:23:25] >> Not in addition, correct.

[1:23:27] >> Okay. Some ginger.

[1:23:28] >> Yeah.

[1:23:29] >> Are they additive? Are they synergistic?

[1:23:31] >> I think they could probably be additive

[1:23:33] because I think that the impact is

[1:23:34] through different mechanisms. Obviously,

[1:23:37] no one's tested that

[1:23:39] you know, it's interesting

[1:23:40] you bring it up this way cuz it makes me

[1:23:42] think of

[1:23:43] David Jenkins and the portfolio diet. It

[1:23:45] actually made the New York Times uh

[1:23:47] I think it was

[1:23:48] in December or November.

[1:23:50] >> The portfolio diet was a diet he

[1:23:52] designed for maximal cholesterol

[1:23:55] reduction.

[1:23:56] >> Mhm.

[1:23:57] >> So it was initially designed to have

[1:24:00] four specific foods. So it was high in

[1:24:02] soy protein, nuts, plant sterols, and

[1:24:05] soluble fiber.

[1:24:07] >> Yeah, it's going to be a tough one to

[1:24:08] get past most of the American public.

[1:24:09] I'll tell you as a as a public health

[1:24:11] educator, I don't care if it comes out

[1:24:13] in the New York Times or Wall Street

[1:24:15] Journal, the New Yorker, and everything

[1:24:17] in between. People hear soy.

[1:24:19] >> Yeah.

[1:24:20] >> Nuts they like, but easy to overeat.

[1:24:22] >> Mhm.

[1:24:22] >> They hear plant sterols and like they're

[1:24:25] they're

[1:24:26] they're someplace else.

[1:24:27] >> This diet was went on a head-to-head

[1:24:29] comparison with lipid-lowering

[1:24:32] agent, right? Like a

[1:24:34] >> Like a statin.

[1:24:35] >> Yeah, yeah, yeah. They had the same

[1:24:37] uh cholesterol reduction as a statin.

[1:24:40] >> As a statin.

[1:24:40] >> Yeah.

[1:24:40] >> The portfolio.

[1:24:42] Interesting name. People are definitely

[1:24:45] unhealthy in this country and if you if

[1:24:47] they can lower blood lipids

[1:24:50] >> Yeah. They've expanded it to uh

[1:24:52] to be more flexible. So, it's not just

[1:24:55] soy protein now, it also includes

[1:24:57] legumes. They've added monounsaturated

[1:24:59] fats, so olive oil.

[1:25:01] >> You know, when I look at a diet like the

[1:25:03] portfolio diet, which I you just I only

[1:25:05] know what you just told me about it. I

[1:25:07] think about the the current food

[1:25:10] uh

[1:25:11] uh suggestions by by the FDA, which are

[1:25:14] you know, we could call it kind of um

[1:25:17] it emphasizes um

[1:25:19] unprocessed minimally processed food.

[1:25:21] So, I think that's a step in the right

[1:25:23] direction, certainly. We look at these.

[1:25:26] The issue that always comes up for me is

[1:25:28] I think, okay, in in a more plant-based

[1:25:30] um grain-heavy nut diet, it's very easy

[1:25:33] for people to overeat calories based on

[1:25:36] this whole like amino acid protein

[1:25:38] foraging hypothesis. This idea that we

[1:25:40] eat until we get enough of the amino

[1:25:42] acids we want. Like a like a

[1:25:44] a chicken breast or something and a

[1:25:46] couple eggs or or or four eggs or

[1:25:49] something is very satiating.

[1:25:51] >> Mhm.

[1:25:51] >> Whereas we can eat a lot of grains and

[1:25:53] nuts before we kind of go, okay, that's

[1:25:55] enough. There seems to be this issue

[1:25:57] like how do how do you

[1:25:58] ensure cardiometabolic health

[1:26:00] >> Mhm.

[1:26:01] >> while quelling hunger.

[1:26:02] >> Mhm.

[1:26:03] >> You can't have people walking around

[1:26:04] hungry all the time. And the GLP's help

[1:26:06] with that. And it does get down to sort

[1:26:08] of like do you include animal-based

[1:26:09] foods or not often?

[1:26:11] >> So, how do you think just from a public

[1:26:13] health perspective that we can reconcile

[1:26:16] this? Cuz clearly the highly processed

[1:26:18] food diet is not going to work. The

[1:26:19] standard American diet that I think that

[1:26:21] is fading away. But now there's this

[1:26:23] kind of polarization of like are we

[1:26:24] going to go mostly plants, grains, nuts,

[1:26:26] and kind of think low saturated fat,

[1:26:28] blood lipids improving, or we going to

[1:26:30] think like

[1:26:32] you know, more

[1:26:33] protein satiety.

[1:26:35] Do you see where I'm getting at here?

[1:26:37] Like I feel like this is this is the

[1:26:38] contour of things.

[1:26:39] >> Yeah. Well, I I think that

[1:26:42] there's there's no reason to pit one

[1:26:44] another against the other, right? So

[1:26:46] like this one on one. But what's

[1:26:48] important is that also having a diet

[1:26:52] that's more plant-based, is higher

[1:26:54] volume, that's filling. It's hard to eat

[1:26:59] a lot of food. So if your

[1:27:01] food volume is high, but does not

[1:27:04] provide as much calories, you'll get

[1:27:07] that

[1:27:08] satiety from the food volume, and then

[1:27:10] you

[1:27:10] you put in some some nuts, helps to

[1:27:14] prolong the satiety because then you get

[1:27:16] some protein, some healthful fats. And

[1:27:19] so I think that's important. I'm not

[1:27:21] saying animal products are bad. I think

[1:27:24] they're they're important for a diet. I

[1:27:27] think they're important for health. It's

[1:27:28] just a matter of portion size and making

[1:27:31] sure that

[1:27:33] there's not over emphasis on animal

[1:27:36] products over plant-based products

[1:27:37] because we know that plant-based

[1:27:38] products are so much healthier in terms

[1:27:41] of heart health,

[1:27:43] reduction of

[1:27:45] >> type 2 diabetes, cancer risk, another

[1:27:48] metabolic diseases.

[1:27:49] >> Yeah. Well, I'm right there with you. I

[1:27:50] love fruits and vegetables. I'm a huge

[1:27:52] fan of

[1:27:53] I do eat meat. Half Argentine, I mean,

[1:27:55] you know, but and chicken and I'm not a

[1:27:57] big fan of fish. I keep working on this,

[1:27:59] but I can't seem to quite get there, but

[1:28:01] but I I don't eat them in excess.

[1:28:04] The things that I feel are very very

[1:28:06] easy for people to overeat are starch

[1:28:07] fat or starch sugar fat combinations.

[1:28:11] >> Mhm.

[1:28:12] >> It's just like the the brain and gut

[1:28:14] respond with

[1:28:16] signals that scream more. You just It's

[1:28:18] very hard for people to do like a slice

[1:28:20] of pizza. I I love pizza. It can be

[1:28:22] done, but it's just very hard for people

[1:28:24] to do. It's like it it the the stop

[1:28:26] signals just are all pushed down and the

[1:28:29] go signals are are all go.

[1:28:31] >> So, are we reducing white foods as much

[1:28:32] as possible as well?

[1:28:34] >> White foods?

[1:28:34] >> Yeah. So, the

[1:28:36] white flour, white rice, white pasta,

[1:28:38] white, you know, things that

[1:28:39] >> Mhm.

[1:28:39] >> [clears throat]

[1:28:40] >> not as colorful. You know, if you're

[1:28:42] eating a slice of bread and it just

[1:28:43] dissolves in your mouth.

[1:28:45] >> It's sugar.

[1:28:46] >> Not so good.

[1:28:46] >> This is more of a editorial reflection

[1:28:48] again, but it's also I was looking at

[1:28:49] the history of nutrition in this

[1:28:51] country. Oh, you're Canadian by birth,

[1:28:52] right? I detected that, right?

[1:28:55] And [snorts]

[1:28:56] I don't know what the the sort of

[1:28:57] traditional fare is in Canada, but if

[1:28:59] you look at the history of food in the

[1:29:02] United States, it's never been

[1:29:04] particularly healthy. The foods that we

[1:29:06] consider like American foods, like

[1:29:09] hamburgers, hot dogs, with french fries,

[1:29:11] corn dogs, fried chicken, donuts. Like

[1:29:13] we've never been healthy about food.

[1:29:15] People probably just moved a lot, ate

[1:29:17] less, smoked a lot more, which is an

[1:29:19] appetite suppressant, but gives you

[1:29:20] cancer, kills you. We've never been

[1:29:24] that healthy with respect to food. Maybe

[1:29:26] food volume was more in check. But if

[1:29:28] you look at traditional food in

[1:29:32] you know, in Europe, probably in I mean,

[1:29:34] Canada, what what sort of the are the

[1:29:36] foods nourishing and healthy? I think

[1:29:38] we're sort of in this like delusion that

[1:29:40] like we were once healthy about food in

[1:29:42] this country. We were never healthy

[1:29:43] about food. The food was always pretty

[1:29:46] weak in terms of nutritional status

[1:29:47] except for fruits, vegetables, and some

[1:29:50] animal parts.

[1:29:51] >> Yeah.

[1:29:51] I think portion size

[1:29:53] has a lot to do with it, too. So, I know

[1:29:56] um

[1:29:57] moving from Canada to the US, you know,

[1:29:59] all the go to restaurant, the portion

[1:30:01] sizes are so big. Uh it would never have

[1:30:03] occurred to me to

[1:30:05] take home doggy bag with for

[1:30:08] at a restaurant ever.

[1:30:10] And then here it's like kind of have to

[1:30:12] or else

[1:30:13] you know, you're throwing away half your

[1:30:14] plate or unless you're finishing the

[1:30:16] whole thing. So, portion size I think is

[1:30:17] a big one. And also the foods are

[1:30:19] different in a way. We're talking about

[1:30:21] yogurt.

[1:30:22] >> [snorts]

[1:30:23] >> So, there are two things. When I moved

[1:30:25] to the US, the first thing the dietitian

[1:30:27] at my work told me was

[1:30:29] do not buy bagged bread.

[1:30:33] I was like, "Okay. What does that mean?

[1:30:35] Don't buy bagged bread? Like I That's

[1:30:36] what I always do." No, she says, "You go

[1:30:38] to the grocery store, you go to the

[1:30:40] bakery section, they'll cut it up for

[1:30:41] you, you ask what you want. Don't buy

[1:30:43] bagged bread." I was like, "Okay. I'm

[1:30:45] not going to buy bagged bread." So,

[1:30:46] apparently she was talking about like

[1:30:48] too many additives, too many too much

[1:30:50] sugar whatever.

[1:30:52] Okay.

[1:30:53] We're talking about like the bread that

[1:30:54] just melts in your mouth. It's

[1:30:56] So, and then the other thing was uh

[1:30:59] yogurt. I used I ate yogurt quite a bit.

[1:31:02] And then the yogurt in the here in the

[1:31:04] US

[1:31:05] tasted sweeter to me. The same thing,

[1:31:08] the same yogurt.

[1:31:11] Canada, here are the same name, the same

[1:31:13] everything.

[1:31:15] It was sweeter.

[1:31:16] And I didn't know why, but then it

[1:31:19] occurred to me that, you know, foods are

[1:31:22] formulated in different ways in

[1:31:24] different countries to appeal to the

[1:31:26] population of that country. So, yogurt

[1:31:28] was one where it's a little less sweet

[1:31:30] in Canada than in US and it was less

[1:31:33] sweet even than

[1:31:35] in in Europe than Canada and US. So,

[1:31:38] there's things like that that don't

[1:31:40] necessarily help.

[1:31:41] >> Yeah. Yeah, we we love our um sugars and

[1:31:44] fats

[1:31:45] in the United States. And and I think we

[1:31:47] paid a substantial health debt as a

[1:31:50] consequence. I mean, now

[1:31:52] again, I don't have the numbers on this,

[1:31:53] but with Wegovy and Ozempic and the

[1:31:54] other GLP-1s, I've never tried them, but

[1:31:57] a lot of people are finding it

[1:31:59] much easier, if not easy, to lose weight

[1:32:01] that they just couldn't before they just

[1:32:03] could not control their appetite.

[1:32:04] >> Mhm. And they're just not as interested

[1:32:06] in these foods. There's this argument

[1:32:07] that maybe they're not as interested as

[1:32:09] in everything in life and that's a

[1:32:11] important question that needs to be

[1:32:12] resolved.

[1:32:13] >> do things that think that things are

[1:32:14] changing. I think we're finding a lot

[1:32:16] more, you know, for example, the yogurt,

[1:32:18] right? There was a lot more plain yogurt

[1:32:19] options than there were,

[1:32:21] you know, when I first moved to the US.

[1:32:23] So, there's, you know,

[1:32:25] >> Things are changing. It's been There's

[1:32:26] been a lot of resistance and I think

[1:32:28] that the the resistance has been um

[1:32:33] sociological

[1:32:35] in the sense that um

[1:32:37] you know, there there's been a

[1:32:38] resistance to people being healthy.

[1:32:41] There really has, you know, that there's

[1:32:42] this idea that like if you're eating

[1:32:44] clean, you have an eating disorder. I

[1:32:46] did an episode about eating disorders. I

[1:32:48] talked to a lot of experts in this

[1:32:50] including the group at Columbia Med that

[1:32:52] works on eating disorders. You know, the

[1:32:54] frequency of anorexia, the most deadly

[1:32:56] psychiatric illness of all the

[1:32:57] psychiatric illnesses, hadn't realized

[1:32:59] that, is not increasing as a function of

[1:33:01] social media or magazines or anything.

[1:33:03] It's been very steady for maybe hundreds

[1:33:05] of years. It's a real neurological

[1:33:06] issue.

[1:33:08] There's obviously social pressures and

[1:33:09] things like that, but what I discovered

[1:33:12] in in like talking to experts like

[1:33:14] Joanna Steinberg at

[1:33:16] Columbia and others is that you know,

[1:33:19] like

[1:33:20] there is this So, that was about

[1:33:21] anorexia, but what I'm about to say is

[1:33:23] separate. There's this notion that if

[1:33:24] you're going to be thoughtful about what

[1:33:26] you eat, you know, or maybe you're not

[1:33:27] going to eat too late, or you're going

[1:33:28] to skip dessert. Or until a few years

[1:33:31] ago, like if you're not going to drink

[1:33:32] alcohol, like there's something wrong

[1:33:34] with you. Like that that you're being

[1:33:35] restrictive somehow. I think again it's

[1:33:38] kind of like the parallels to

[1:33:40] Europe are kind of interesting that were

[1:33:41] that the contrasts to Europe are

[1:33:43] interesting where there's a lot of

[1:33:45] social convention built up around food

[1:33:47] that was healthy.

[1:33:49] And I think in the United States the

[1:33:50] social conventions built up around food

[1:33:52] and alcohol were pretty unhealthy. It

[1:33:54] was like everyone does this. Like

[1:33:55] everyone eats hot dogs at the game. Like

[1:33:57] and hot dogs at a baseball game are a

[1:33:59] great thing. It's like a nothing is

[1:34:00] as American as that except maybe apple

[1:34:02] pie, right? But there's this when people

[1:34:05] start making choices in in the direction

[1:34:07] of their health it was and to some

[1:34:09] extent it still is a there's this

[1:34:11] quieter undercurrent of well like are

[1:34:14] you being restrictive? Like are you

[1:34:16] really going to live like that? But then

[1:34:18] you look at the the health outcomes. And

[1:34:20] culturally until a few years ago it was

[1:34:22] considered very not okay to say that

[1:34:24] obesity obesity was a health risk.

[1:34:26] >> Mhm.

[1:34:27] >> And now the open discussion about

[1:34:28] obesity and metabolic health as as like

[1:34:30] a real health risk.

[1:34:32] >> Mhm.

[1:34:32] >> I think now we're kind of like in the

[1:34:34] actual discussion that for a long time

[1:34:35] it was like

[1:34:38] Speaking of which and um kind of things

[1:34:39] outside the box uh there's a paper on

[1:34:41] your CV that I could not help but ask

[1:34:44] about. Snack chips fried in corn oil

[1:34:47] alleviate

[1:34:48] >> Mhm.

[1:34:49] >> cardiovascular risk factors when

[1:34:51] substituted for low-fat and high-fat

[1:34:53] snacks.

[1:34:53] >> Yep.

[1:34:54] >> What?

[1:34:54] >> Mhm.

[1:34:55] >> What?

[1:34:56] >> Yes.

[1:34:56] >> Tell me the data. I believe you. I'm

[1:34:58] just like what

[1:34:59] This is wild.

[1:35:00] >> This was funded by Frito-Lay. At that

[1:35:03] time they had changed the oil that they

[1:35:06] were using to fry their corn chips. So

[1:35:10] this was Doritos, Fritos, Cheetos, and

[1:35:13] Tostitos. It's all the to- to- to-

[1:35:16] >> all the e- e-

[1:35:16] >> All the e- e-

[1:35:17] And so they had changed to corn oil. And

[1:35:19] I'm like this is an oil that's higher in

[1:35:21] polyunsaturated fats than what we

[1:35:23] usually have.

[1:35:24] >> they using before?

[1:35:26] >> I'm not sure. I forget.

[1:35:27] >> But it wasn't tallow.

[1:35:29] >> I don't think so. Like does it make a

[1:35:30] difference? Is it going to improve

[1:35:33] health if people choose those

[1:35:36] snacks compared to other snacks?

[1:35:38] So we had three arms in that study.

[1:35:41] Uh each person went through each of the

[1:35:44] three arms. It was for 25 days. The

[1:35:48] question was

[1:35:49] okay, let's say you have a choice for a

[1:35:51] snack today. And you're going to go to

[1:35:54] the vending machine

[1:35:55] and you have your option. Do you eat a

[1:35:58] low-fat, high-carbohydrate snack, a

[1:36:02] high-fat,

[1:36:03] high-monounsaturated high-saturated

[1:36:05] snack, or those chips?

[1:36:09] So, you just pick one and that's that.

[1:36:11] So, I think we gave It was two snacks

[1:36:13] today

[1:36:15] for for 25 days. It was a rotation, so

[1:36:17] they had four Yeah, they had four

[1:36:19] different uh chips. So, it's two one

[1:36:21] day, two the next day, like that for 25

[1:36:24] days and then the controls.

[1:36:26] And yeah, the the the better lipid

[1:36:29] profile

[1:36:30] was the one with

[1:36:32] was the one from the the corn chips.

[1:36:35] They had the better lipid. Yeah. And

[1:36:37] they had less uh lipoprotein little A,

[1:36:40] which is another you know, factor

[1:36:42] cardiometabolic risk factor.

[1:36:44] >> Data or data?

[1:36:45] >> Data or data.

[1:36:46] >> Well, I know that in the head-to-head

[1:36:47] comparison of seed oils, of which corn

[1:36:49] is,

[1:36:50] >> Right?

[1:36:50] >> with saturated fat, this is where it

[1:36:53] kind of the contention starts to

[1:36:55] erupt. Where

[1:36:57] there are many studies now, I think,

[1:37:00] showing that when you substitute

[1:37:01] saturated fat with seed oils, that

[1:37:04] cardiometabolic

[1:37:05] risk factors go down and this is true,

[1:37:08] right? Well, by the way, I'm just going

[1:37:09] to say I I I avoid seed oils actively

[1:37:12] cuz I like olive oil and butter.

[1:37:14] >> Mhm.

[1:37:14] >> Mostly olive oil.

[1:37:16] I avoid seed oils. I don't like the way

[1:37:17] they taste. I love olive oil.

[1:37:19] >> Okay.

[1:37:19] >> And there's some health effects of olive

[1:37:21] oil and I eat small amounts of butter

[1:37:23] and

[1:37:23] I so I just like duck the whole

[1:37:26] controversy, right? And uh you have to

[1:37:28] make sure you're getting real olive oil,

[1:37:30] but that can be done.

[1:37:31] When you look at the studies that

[1:37:32] compare saturated fat to seed oils, you

[1:37:35] do see

[1:37:36] uh better outcomes for seed oils. But

[1:37:38] then there's this crowd that comes in

[1:37:40] and says, "But that's on a backdrop of

[1:37:43] reasonably high carbohydrate intake.

[1:37:46] When you start replacing some of those

[1:37:47] carbohydrates with lower carbohydrate

[1:37:50] diet and increasing protein intake so

[1:37:52] not keto but kind of like lower-ish

[1:37:54] starch and sugar then maybe that

[1:37:56] balances out okay. But the big

[1:37:58] contention seems to be around the

[1:37:59] processing of these seed oils. This idea

[1:38:02] that when especially when you make

[1:38:03] things like chips that when you take

[1:38:06] fats and you combine them with

[1:38:07] carbohydrate and you heat them up a lot

[1:38:09] that you create factors that

[1:38:11] are not good for the body. What is the

[1:38:13] evidence for against that?

[1:38:15] >> Also different oils have different smoke

[1:38:17] points, right? So each oil should be

[1:38:20] used for its appropriate usage, right?

[1:38:22] So cooking process.

[1:38:25] So

[1:38:26] I think that's that's where, you know,

[1:38:28] people think that they should be using

[1:38:30] one type of oil for everything that they

[1:38:32] do.

[1:38:33] But some oil like you wouldn't put

[1:38:36] flaxseed oil for example and and heat it

[1:38:38] up to very high

[1:38:41] uh temperature.

[1:38:42] >> Are you a fan of flaxseed oil?

[1:38:44] >> I'm a fan of every liquid oil. I use

[1:38:46] I've no no personal

[1:38:49] >> You seem very healthy.

[1:38:50] >> restriction on the

[1:38:52] on the types of oils. I think that, you

[1:38:54] know, oils are that remain liquid at

[1:38:56] room temperature

[1:38:58] that should be your your your barometer

[1:39:01] for what's better to use. I'm also not

[1:39:04] saying that people should avoid butter

[1:39:07] like the plague, right? So all in

[1:39:09] moderation is is okay.

[1:39:12] >> Is there any reason to

[1:39:15] I just can't find the argument for why

[1:39:17] anyone would replace olive oil with a

[1:39:21] seed oil.

[1:39:23] >> Olive oil has a lower smoke point than

[1:39:25] than other seed oils. So peanut oil for

[1:39:28] example has a higher smoke point. So you

[1:39:29] can fry in peanut oil. You wouldn't fry

[1:39:32] anything in olive oil.

[1:39:33] >> I wouldn't eat anything fried.

[1:39:34] >> Well

[1:39:35] >> Yeah.

[1:39:35] >> So that's that's a different

[1:39:38] reason. But like, you know, so depending

[1:39:40] on how you want to use your oil then,

[1:39:42] you know, also some people find, you

[1:39:44] know, olive oil in baked goods might

[1:39:45] impart stronger taste. So, depending on

[1:39:48] the type. So, some of them are more

[1:39:50] flavorful, right? And so, they're more

[1:39:52] fragile, let's say, and they'll impart

[1:39:55] flavors to different different foods

[1:39:57] where they're not supposed to be.

[1:39:59] >> So, you're you're not seed oil averse,