Why Rhythm Is The Key to Health with Dr. Todd LePine

Coming up on this episode of the Doctor's Pharmacy.

You know, we have rhythms in nature. We have the rising of the sun and the setting of the sun and then the lunar cycles and we have the months and the seasons and the year. So, it only makes sense that our body has its own cycles and own seasons.

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Decades ago, I read a book about how light dramatically influences our health. because of its impact on our circadian rhythms. Ever since, I've been fascinated with the research around light exposure and how we.

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Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman. That's Pharmacy with F-F-A-R-M-A-C-Y, a place for conversations that matter. and if you've ever felt out of sync or out of balance, well, this probably is the conversation you should listen to because it's about what we call Chronobiology, which is, in other words, our circadian rhythms and our biological rhythms, which we mostly ignore. And today we're having a special episode of the Doctor's Pharmacy with Dr. Todd LePine. It's our house call episode where we dive deep into issues in the functional medicine space and help you understand your body in a new way. and understand how to access health using the framework of functional medicine.

Welcome, Todd.

Thank you, Mark. This is a great topic.

So, years ago, our mentor, Sid Baker, who's one of the genius minds in medicine, my belief in the 20th, 21st century, basically wrote this book called the Circadian Prescription. And he was the first one who really talked about the role of rhythm in health. So, can you tell us why rhythm and circadian rhythms and chronobiology is actually so important and what is, it all about anyway.

All right. Well, you're absolutely right. I read the book that Sid Baker wrote, the Circadian Prescription. That's sort of where the sort of light bulb went off my head saying, this is really important stuff. And, it's sort of the fourth dimension of health, which is time and understanding that we have rhythms in nature. We have the rising of the sun and the setting of the sun and then the lunar cycles and we have the the months and the seasons and the year. So it only makes sense that our body has its own cycles and own seasons and understanding that we have these internal clocks and we actually have genes, they're called clock genes, and they have to synchronize just like an orchestra. It's got a lot of different pieces. You know, we were talking earlier in a podcast about how many different chemical reactions are going on in the body. You have chemicals being made, you have chemicals being broken down, you have chemicals being detoxified, and you have all these rhythms going on in the body and they're happening. in harmony, if you will. And just like when you have an orchestra, in order for an orchestra to make really good music, what do you need? You need a conductor. And this is understanding that the body's conductor is synchronizing the whole body in terms of the liver and the heart and the muscles and digestion, all of those factors. So our body's ability to have a good rhythm is key towards health. And I learned this early on when I was in private practice, 'cause you probably had some patients like this too, Mark, is the patients that I could never, ever help to get better, no matter what they came in for, were shift workers. I'll never forget it because I was so frustrated. They came in and they were tired, they had diabetes, they had brain fog, they couldn't lose weight, you name it. and I'm banging my head against the wall and then lo and behold, I figured out, you know what? Shift work is not good for you because don't mess with Mother Nature. You don't want to be eating when you should be sleeping and vice versa. That's really the bottom line. And, what happens is when you disrupt those circadian rhythms, and we know this ourselves, if you've ever had jet lag, you know that you don't feel good when you have jet lag. And, that's a sort of an acute example of a circadian rhythm gone bad. You know, you're talking about breaking bad. Well, that's really breaking bad. Yeah, it's not a good thing. And so understanding shift work and jet lag really sort of will highlight the importance of getting your body into a good rhythm. And the things that are key for getting your body into rhythm, the primary thing is light. and what I would say is that most people are not getting enough light and specifically sunlight. Now, we do have patients, Mark, that they have what we call seasonal affective disorder. So, if you live in a high enough altitude or latitude, you can get seasonal affective disorder and that's where you don't get enough light and all of a sudden you start feeling lethargic and tired and depressed because the sun really affects your whole rhythm. And, there's a part of the brain called the suprachiasmatic nucleus and your eye is literally like the metronome to the body. It keeps the, the body in sync. So there are certain, and the German term is called Zettgerber, which is the, the, gets the, the clock synchronized. Light is the key thing. So I always tell my patients that when you wake up, try to get exposure to sunlight early on within 20 to 30 minutes of Awakening. And that exposure to light helps to get all of your, your body clocks in sync, if you will, so that the orchestra can produce really good music. So, light is a key thing. And then, one of the other key things is the timing of your food. And, what we're finding out now is it's not only what you eat, but it's when you eat. And, I can remember, Mark, when you were at Canyon Ranch, you always had the big saying which, you know, eat breakfast like a king, lunch like a queen, and dinner like a pauper. And, that's so, so true. Yeah, yeah, exactly. Very, very, very true.

That's right.

And one of the things that you'll see in patients who have problems losing weight is that they're eating when they should be sleeping. They're eating these late meals, big meals late at night, or they're sort of randomly having their food. It's also very important to time your food. So, each day you're having your meals at approximately the same time so that your body gets into a really good rhythm. and it's better to front load your care.

Right, it's reminding me like, you know, these people live to be like 100 and whatever. They all have a routine. They have the same thing every day. They do exercise every day. They have like their little schedule.

And I think there's something to be said about that.

There's something to be said, exactly, yeah. I mean, honestly, Todd, you know, COVID is the first time in my adult life, really, that I've been able to be in a rhythm. In a good rhythm. In a good rhythm. Because when I was younger, you know, I was working as a family doc and staying up all night and working the ERs and, and then traveling for decades, different time zones, different hotels, not having a rhythm or routine, it really.

Took a toll on my health.

And since COVID almost last year now, I've been more or less stationary and have been able to develop routines of taking care of myself, of eating, sleeping, working out. It's incredible how important chronobiology is to our health.

It absolutely is. I can remember you speaking about doing night shifts because I can remember when I was doing in private practice and I used to do a call at night. It's one thing to be up at night when you should be sleeping. It's another thing to be up at night and you're dealing with someone who's having a life or death situation, a heart attack, heart failure, cardiac arrhythmia. So, I can remember distinctly that there was a big change in my health when I had to do call over extended periods of time. And not only was I up at night, but I was actually pumping out a lot of stress hormones. I was reaching—were you reaching for food at night, Mark, when you're on call? Yeah, give me some food. What are you doing? Reaching for sugary things, things that pick your your energy up. So, it's really-- oh, sure.

I mean, you get high levels of ghrelin when you're not getting enough sleep.

Which makes you crave starch and sugar and carbohydrates for sure.

I was doing that.

Yeah, reach for those donuts and whatever else you can find in the hospital, right?

Yeah, it was pretty bad. Yeah, so, you know, what's interesting also is you talk about the effects on timing of eating, sleeping, all the things we're doing, exercise. They're important. And what's also really striking is that the light thing you talked about was really important. The disturbances are a light, meaning we are exposed to artificial light in times when we should be not at night. And one of the books that I read years ago was called Lights Out. Lights Out. It was a fascinating book about how our health has degraded since the invention of the light bulb. Absolutely. That we stay up late at night. And now we're worse than the fricking light bulb. We've got the screens, the TVs, devices with all this blue light that's causing us to shut down melatonin production, affect our sleep and our quality of our energy. So, there's a lot of things that disturb that.

Absolutely. You hit the nail on the head. In fact, I have some extra slides which they can post for the podcast about light pollution. And, there's some interesting slides looking from satellite imagery looking from the 1970s, 1980s, 1990s, and 2000s. What you see is the whole world's lit up at night. it's very, very hard to find places at night. And I experienced this firsthand. I'll never forget it when I was giving a lecture down in New York City. And it was like about 10 o'clock at night and I was going to be lecturing the next day. So I said, well, I'm just going to go down and I'll walk the streets of New York and I was, I'm out in Times Square. So if you've ever been in Times Square late at night, guess what? It is all lit up and whatever. And it's like, you got all the lights. Oh, my God. Right. So I'm like, you know, I'm out there walking from like a maybe about 10 o'clock to 11:30. I go back to my room, there was no way I could sleep. I mean, I just, I was, I could not sleep the entire night because all my melatonin was suppressed by all the LED lights on Broadway. It was like, that was like a, somebody hit me in the head with a, with a hammer saying, yeah, wake up here. Lights are not good for you at night.

Yeah, for sure.

Yeah.

So, and what's also interesting is, you know, even, even, you know, more traditional medicine is coming around to this and, In chemotherapy, we're now learning that there are times where different cancers respond to different chemo drugs and the timing of cancer therapy has a huge impact on the outcomes with patients, which is really striking.

It took the words right out of my mouth. In fact, there was actually a recent article that we're talking about, When's the best time to give a vaccination? Some people are getting the coronavirus vaccination. That's another topic unto itself. But it's thought that it's probably better to give a vaccination later on in the day because early on you have a jump up in your cortisol. Cortisol suppresses your immune system. And it's thought that if you give a vaccination earlier in the day, you may not have as robust of an immune response to the vaccination. So for those people who want to get any type of vaccination, it's probably better to delay it till about three o'clock or so.

Oh, the afternoon. Okay, good.

Yeah.

So, so people often in medicine, my experience in traditional medicines, we don't get taught how to reset people's rhythm and the key aspects of resetting people's rhythm and the importance of rhythm in our health. And I think why don't we go through, you know, for example, a patient that might have had a disturbed rhythm and how do you help restore their rhythm? What are the kinds of things we think about? What do you test for? and how do you start to treat them?

Yeah. So, so typically you can have patients who have, you know, like a delayed sleep onset or a circadian rhythm disturbance. And, you know, sometimes what you'll, I'll have patients do is I'll have them, you know, if they're going to bed at like five o'clock in the morning, what I'll have them do is stay up the entire day until they're completely really tired and go to bed at like six or seven o'clock the following evening. Sometimes you also have to work, have a patient work with a behavioral therapist to change their behavior. I think naturally Actually there are some people that are what I would call morning people and people who are more night owls. There's a natural tendency of that, especially teenagers tend to want to stay up later at night. But in general, you want to get into the rising and the setting of the sun. So I usually tell people, when you look at the animal kingdom, what do the animals do? When the sun rises, they get up, they start tweeting, the birds run around, and they start finding their food. and when it's dark out, what do the animals do? They go to sleep. They don't sit up watching television. They're not on their smartphones and they're not raiding the refrigerator. So the things to do is at least first get people aware of the fact that they're being sleep deprived. And in addition to being out of sync, what's oftentimes happening with people nowadays is they're not getting enough sleep. So sleep deprivation is probably epidemic in the United States. and what do we do nowadays that people are tired? We give them amphetamine, right? We just pump them up with either amphetamine or caffeine and just like, let's say keep going. What we do know is that you can take young, healthy college kids, and if you sleep deprive them and only let them sleep for maybe four or five hours, within a matter of three days, they start becoming insulin resistant, which is like a form of prediabetes. So getting enough sleep and getting deep restorative sleep are really, really key. And part of the ability to do that is to have a good circadian rhythm. Another thing which I also wanted to talk about, Mark, is as it relates to the circadian rhythm is that there's a timing of when your body does things. And one of the most important things for me personally is to sleep in a cool room. I oftentimes will leave the window open and my room is pretty darn cold. And when you think about that from a, in fact, I think there are some companies out there that have these things called cooling mats. They basically have a chill pad and they basically lower your body temperature.

I have that, the cooler. I have that. Yeah.

No, again, just look at nature. I mean, if we didn't live in a house, if we were living the way Mother Nature designed us out in caves or whatever, the temperature goes down at night and our bodies cool off. And that's a very, very good thing to get your body into a deep, deep sleep. So keeping the temperature of the room too high at night is not a good thing for your circadian rhythm also.

Yeah, absolutely. So, waking at the same time, sleeping at the same time, making sure you get exposed to 20 minutes of morning light, making sure you're eating in rhythmic times, that you're not eating three hours before bed, that you don't exercise in the evening, that you get rid of all the blue light at night and use your blue blocker glasses and get off your screens. It takes time to retrain the circadian rhythms, but when you do, your overall well-being is so much higher. Sometimes we use herbs to help reset the adrenals because the adrenals really get screwed up in the whole we'll use melatonin and we'll use adrenal support to help people kind of recover from it.

Dr. Absolutely. And the other thing that I do—and this is actually, I think, epidemic in the young kids because I'm still recovering from some knee surgery that I had done because of a ski injury. And I'm going to the gym and there are several young people in there who are literally addicted to their phones. They are on their phones as they're exercising and they're texting and typing and doing all this stuff. And one of the things that I see in young people is that they are constantly checking their phones throughout the night. They're waking up and they're on social media and they're— I tell people, you turn your phone off and don't touch it in the entire night. Done. Put it in another room if you need to because it's literally— I mean.

You put it airplane mode.

I mean, it's terrible. It really is. It really is. And, it's like, you know, oh, I'm awake. I might as well just, you know, go on to Facebook or go on to social media or Twitter or whatever the heck they're doing.

And, it's toxic. It's very, very toxic.

For a whole bunch of different reasons.

I mean, or worse, they'll leave their phone on so with the notifications. So they'll wake up at their text. So they wake up with their notifications.

Right, right, right.

And I call, sometimes I forget my nephew is in a different coast, whatever. I'll text them late at night. If I'm in Hawaii and he's like in California, I'm like, it's three in the morning and he's like answering my freaking texts.

And I'm like, what are you doing awake?

Exactly, exactly.

Yeah, yeah, yeah. So how would we begin to think.

About testing people's circadian rhythm?

Well, there's like, as you mentioned, the adrenals test. So we know that our adrenal glands produce cortisol and cortisol cortisol being the major one. And we have a thing called a cortisol awakening response. This is our get up and go hormone. It's the hormone that rises in the morning. There's a big peak in it, and then it gradually decreases as they goes on. And we do testing for checking for adrenal function throughout the day, and especially with that cortisol awakening response or they call it the car. And that rise should be about 50% or higher and it also should be very low at nighttime. And sometimes when you see that cortisol awakening response being blunted, then you know that there's a problem with the circadian rhythm. And then if you also see that cortisol response high up at night, those are people who oftentimes can't fall asleep because they're sort of wired. They need something to control that. So that's one way of doing it. Another thing that I do is I also will check melatonin levels. so melatonin is the hormone of darkness, and it's a hormone. You can get melatonin as a over-the-counter supplement. It comes usually typically one to three milligrams. And I. I really almost never give a patient melatonin without checking their melatonin levels. Or some people, for whatever reasons, either age or a pituitary or pineal problems, where they're not producing enough melatonin. so I don't use melatonin willy-nilly even though it's actually quite safe. There are certain circumstances where I'll use it. Things like jet lag. I oftentimes will use that myself if I'm going to go through several time zones to help to reset my body clock. But checking melatonin levels is another thing that can be very, very helpful to make sure the person's body is in good sync. The other thing which is also really important is exercise. this is a fascinating, a little, I call it a little scientific trivia, is that our bodies, we talked about the mitochondria, mitochondria really relate to energy. And mitochondria take food and make food into ATP or adenosine triphosphate. So adenosine is the base molecule and we stick three phosphate groups onto it. And ATP is the fuel that runs our body. And as we have activity throughout the day, our ATP goes gets broken down into ADP or adenosine diphosphate, and then into adenosine monophosphate, and then into adenosine. And as those metabolic processes happen, our adenosine levels actually build up in the body. And that rise of adenosine is one of the things that induces sleep. And interestingly, caffeine, which we all know keeps you up, blocks adenosine. That's probably one of the major ways in which caffeine will actually keep people up at night is it's acting as an adenosine blocker. and for people who are caffeine sensitive, we do some testing, but people oftentimes will know that, but we can determine by genetic polymorphism testing if somebody is a slow metabolizer or intermediate metabolizer of caffeine, because caffeine in general has a half hour about six hours. So if you have a cup of coffee at six o'clock at midnight, half of it's still going to be in your body. So if you're a real ultra slow metabolizer of caffeine, you might want to have one cup of coffee, no more than two. really early in the day because that's still going to be in your body late at night and blocking adenosine's action.

Yeah, so incredible. So, this whole area of chronobiology and circadian rhythms so important. People are really excited, interested about this topic. I encourage you to check out our mentor's book, the Circadian Prescription. And, also, think about your own life. If you're feeling out of sorts or out of balance, what is your rhythm like? And, is that a source of some of your dis-ease? or unhappiness or mood issues or sleep issues or energy issues. And often when we focus on the chronobiology piece and our rhythm, it can lead to profound healing for people. So it's often a neglected aspect of well-being, but I think it's super important. And Todd, thank you so much for sharing your wisdom about this on the Doctor's Pharmacy and this special episode of the House Call. We love hearing from you. If you've been listening to the podcast, please share. your thoughts about your own rhythm issues with us and leave a comment, subscribe wherever you get your podcast, share with your friends and family, and we'll see you next time on the Doctor's Pharmacy.

Great. Thanks, Mark.

Hey, everybody, it's Dr. Hyman.

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