Why Routine Is Key To Sleep: Part I Of Dr. Hyman's Sleep Master Class

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

All the things that we do during the day, our habits, the time we exercise, the foods we eat, when we eat, all influence how much we sleep and the quality of our sleep. Hey everyone, it's Dr. Mark. I know a lot of you out there are practitioners like me, helping patients heal using real food and functional medicine as your framework for getting to the root cause. What's critical to understanding what each individual person and body needs is testing, which is why I'm excited to tell you about Rupa Health. Looking at hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, and so many other internal variables can help us find the most effective path to optimize health and reverse disease. But up till now, that meant you are usually ordering tests for one patient from multiple labs. and I'm sure many of you can relate how time consuming this process was and then it could all feel like a lot of work to keep track of. Now there's Rupa Health, a place for functional medicine practitioners to access more than 2000 specialty labs from over 20 labs like Dutch, Vibrant America, Genova, Great Plains and more. Rupa Health helps provide a significantly better patient experience and it's 90% faster, letting you simplify the entire process of getting the functional medicine lab tests you need and giving you more time to focus on patients. This is really a much needed option in functional medicine space and I'm so excited about it. It means better service for you and your patients. You can check it out and look at a free live demo with a Q&A or create an account at RupaHealth.com that's R-U-P-A-Health.com Now so many of my patients ask me how I manage to work multiple jobs, travel frequently, well not so much anymore, and spend time with my family and still focus on my health. I know it can seem hard to eat well when you've got a lot going on, but the trick is to never let yourself get into a food emergency and to stay stocked up with the right things to support your goals. So recently I discovered Paleo Valley Beef Sticks. I keep these beef sticks at home and at the office so I know that whenever I'm in a food emergency, I have a healthy and delicious option to keep me on track. It's no secret that I have high standards when it comes to what I put in my body and Paleo Valley Beef Sticks checks all the boxes. they're gluten-free, grain-free, dairy-free, soy-free, and non-GMO. Plus, they use 100% grass-fed and grass-finished beef, which not only adds to the flavorful taste, but it also means they're free of any harmful antibiotics or hormones that you'll find in most meat. With grass-fed beef, you'll get more nutrients than you would with beef fed with grains, things like higher levels of omega-3 fats that help reduce inflammation, and more B vitamins and other antioxidants to support your body's converting food into energy, and also more of the fat soluble vitamins that are beneficial for a healthy heart. Plus, instead of being processed with chemicals and other questionable ingredients, these beef sticks are naturally fermented, so you get gut friendly probiotics with every bite. How cool is that? Right now, Paleo Valley is offering my listeners 15% off your entire first order. Just go to paleovalley.com/hymen to check out all their clean paleo products and take advantage of this deal. That's paleovalley.com/hymen. I definitely recommend stocking up on the grass-fed beef sticks to keep in your house, in your car, and in your office. It's one of my favorite tricks to staying healthy while on the go. Alright, now let's get back to this week's episode of the Doctor's Pharmacy.

Hi, this is Lauren Fiahon, one of the producers of the Doctor's Pharmacy podcast. Today we are featuring part one of Dr. Hyman's Sleep Masterclass. You'll hear from Dr. Mark Brouwen, Dr. Mary Pardi, Dr. Judy Nihosa, Dr. Afrouz Demeri, and Mike Mutzel about the fundamentals of sleep and your circadian rhythm. If you want to watch the whole series, you can sign up for free at drhyman.com/sleep. We hope you enjoy this episode and tune in next Monday for part two.

There's something you do every single day that can dramatically impact your health, can help keep you happy, lean, keep your blood sugar balanced, improve your sex drive, and more. And I'm not talking about what you eat, I'm talking about sleep. Unfortunately, in this stressed out, super busy, hyper caffeinated modern world, most of us are not sleeping and when we are sleeping, we're not sleeping well. Among the numerous responsibilities we juggle every day, the quality of our sleep often takes the back burner and those repercussions show up in our health. The idea that sleep is for the weak and that we need to burn the candle at both ends in order to be successful is slowly killing us and just wrong. One study found that just one partial night's sleep could create insulin resistance, which is pre-diabetes, which then leads to diabetes and many other problems. Others show that poor sleep contributes to cardiovascular disease, like heart attacks, to depression and mood disorders, to poor immune function and frequent infections, and to lower life expectancy. Sleep is how our body repairs itself. Simply put, sleep is a major cornerstone for an energetic, joyful, and healthy life. Now, I know it's easier said than done to get quality sleep, and as a doctor, With a family and 10 jobs and multiple clinics and lots of travel, I've skipped out on sleep more times than I'd like to count, and I always pay for it. I realize that lack of sleep adversely affects my health. If I don't sleep well, I'm anxious. I'm just not as nice to the people around me. I start to crave junk food. Yep, I even eat carbs when I don't get enough sleep. I just don't show up to be my best self. Now, I know many of you can relate. In my practice, sleep problems are abundant. Insomnia, sleep disorders, sleep apnea, every day I have at least one patient that tells me they get poor quality sleep and this lack of sleep is interfering with their lives. Now, I created this course because I believe that sleep is the most underappreciated aspect of health and wellness. And although it might seem as though getting good sleep is as simple as putting your head on the pillow and Closing your eyes is actually much more complex than that. With five trusted experts, we're gonna walk you through the pillars of sleep so that you can start getting the sleep your body deserves and that your body needs today. We'll walk you through all the major sleep disorders and why sleep is so important. We'll also talk about conditions caused by lack of sleep, as well as key areas of our health that affect our sleep, such as our gut health, our nutritional status, our hormones, our immune system, environmental toxins, and lots more. And finally, we'll take you through a 10-day sleep reset designed to focus on the most important parts of creating better sleep. No one is immune to sleep deficiency. Did you know that over half of Americans report getting bad sleep? And it's probably more than that considering people ignore their sleep challenges. You see, sleep disorders have become an epidemic. So let's dive into the sleep disorders. Sleep disorders go far beyond the question of do I have sleep apnea or not? Sleep disorders actually exist on a spectrum and even catching minor symptoms that you have now can prevent you from developing things like sleep apnea in the future. So let's talk about why sleep is so important and the spectrum of sleep disorders.

60 million Americans complain about insomnia. They can't go to sleep. Half of Americans complain about being very tired. The problem with that stat, of course, is that, and I speak for myself, when I had sleep apnea, not knowing it, I never complained that I was tired. I would maybe take a nap or I would just deal with it. So that number, that 50% number, could be much higher. This is a 411 million $1.5 billion problem in the United States. I mean, healthcare costs are through the roof, they're increasing. If we could just fix the sleep, we could drop these numbers and these stats. And here's the stat that you may find surprising, that 75% of people that suffer from depression also have a sleep disorder. There are some researchers, there's one in Berkeley, there's one in England, that are seeing something more than that. They're seeing a 100% correlation between some form of mental illness or mental disorder, mental health issue, and they're seeing sleep, a sleep disorder that's related to it. So figure 70%, maybe even 100%.

Sleep is essential for health for so many reasons. And when I talk to my clients, the first thing I talk about is the hierarchy of the foundations of health. So foundations of health means your nutrition, your exercise, your sleep, stress reduction, all of these things that we have to take into account. But on the top of that pyramid is sleep. It's before nutrition, it's before exercise, it's before supplementation for sure. And the reason behind this is it affects every single cell in our body.

Without sleep, we couldn't, after two weeks of not sleeping, they've done studies, people cannot go on. People feel completely depleted and Everything changes. Sleep touches every part of us. So when we sleep, we're resetting our nervous system. We're letting the brain reset. We hit the reset button. The brain is detoxing at night. So it's making sense of everything that happened during the day. During sleep, our immune system heals. Patients can't heal from an immune condition if they don't have quality sleep. During sleep, we also are allowing our body to detoxify When it comes to liver toxins and environmental toxins, this is how we pull a lot of our toxins out is through resting. When we're sleeping, hormones, certain hormones increase, like human growth hormone and melatonin levels, testosterone levels go up, which allows your body to grow, to transform, to create new cells for children growing up. As they're growing up, you need to sleep in order to create more growth hormone. Without it, we couldn't develop, we couldn't create new cells. So sleep touches really every part of us, our gut function, our intestinal tract is very connected to us having proper sleep. Without sleep, our volume, our flora, our microbiome actually becomes more toxic and more depleted. So the sleep button that we hit at night is shutting it all down. We change our state of our mind, our state of our body to reset everything within us. And I have never seen a patient that was in good health that was not sleeping. So in reality, you can't heal someone or really achieve health if you're not getting proper sleep. So I would say from anything that my patients, when they come to see me, one of the number one conditions that I see people for in my clinic are insomnia or sleep issues, and without addressing their sleep, they're not going to be able to heal. They can't balance their hormones. They can't lose weight. Women that have trouble with weight problems, they are not gonna be able to heal and manage their metabolism if they don't get enough sleep. It also impacts our heart health. So there's a huge connection of lack of sleep with leading to heart disease, strokes, heart attacks, also a tendency towards diabetes. When we sleep, we're resetting our insulin, our glucose pathways, and without proper sleep, patients become pre-diabetic. and eventually diabetic. So as you can see, sleep touches every endocrine system, every organ in our body, detox function, immune resetting, and impacts our mood greatly. People that don't sleep have more problems with anxiety, depression, concentration problems, learning problems, attention deficit disorders. So sleep touches all parts of us.

So there's two types of sleeping issues that we have. Either you can't fall asleep, and that's called sleep onset insomnia, or you have a hard time staying asleep. These are called sleep maintenance insomnia. So those are the people who say, I have no problem falling asleep, I'm exhausted, but then I wake up around two or one, or I wake up early every morning. That's a very common one I hear nowadays. I'm up at five or four and I can't fall back asleep. Some people have both, but the majority of our patients will say that they have more of an issue with one or the other. So for sleep onset insomnia, those are the patients, as you can imagine, like my story, if something acutely happens, you have conflict, a stressor, a deadline, a presentation, a test. So mentally or emotionally, if you're aroused or stimulated or worried or stressed, that's going to make you not be able to fall asleep. So typically I see six causes for sleep onset insomnia. The number one would be sleep hygiene, which you've all heard of. Every magazine out there, they list the things that we should all be doing to avoid being able to fall asleep easily. So sleep hygiene is things like not having bright lights at night, not eating too late, not having stimulants like watching TV or having your iPad or your iPhone on, things like that. So sleep hygiene is probably the number one thing I work on with patients to make sure first and foremost, do you have all these down? Second would be mental emotional stressors. So things like worrying, you know, scheduling some worry time or having a notepad by your bedside to just dump everything that's in your head onto that piece of paper. And sometimes this is much easier said than done. So you might have a death in the family. You might have someone who's had, who's in, you know, the hospital and you can't be there and you're worrying about that. It's not going to be that easy, but often conflicts and emotional or mental stressors are reasons why people aren't falling asleep. Other causes might be the heart. So in Chinese medicine, we talk about two causes for sleep issues. And people who have a difficulty falling asleep, we say in Chinese medicine, there's a disharmony of the digestive system which affects the heart. I won't get into that too much, but it's very interesting to look at herbs that actually have double-blind placebo-controlled studies done in Chinese medicine. And a lot of these herbs are helping the spleen and the stomach, which then help tonify the blood for the hearts. Because the heart at night when you sleep rests. The heart rate goes down, the blood flow goes down, and the heart tries to get all that blood to the periphery because you've been standing up all day and getting it to your fingers, your toes, and it's supposed to have sort of a rest. You can imagine if your mind is very active, that the heart, or if let's say you have digestive issues and not getting really good quality blood to that heart, that it's going to have issues. So that's another reason why some people might have sleep onset issues. So that's number three. Number four, we talked about stress. And so stress isn't always worrying and having things on your mind. Stress in medicine we call cortisol and testing your cortisol is huge. Some people have high nighttime cortisol and that might make them not fall asleep. even low cortisol, super low cortisol. You actually need a little bit of cortisol at night to be able to fall asleep. And sometimes people's adrenals are just flatlined and they have very, very little cortisol, and that can also be a stressor to the body. Obviously, pain is another one. Restless leg syndrome is another one. Restless leg, I would say, can be both. Sometimes people will say they feel like they have things crawling on them. They need to get up and they need to stretch. that might be one, but if it's happening in the middle of the night, they might not even be aware of it. Poor circadian pathways and rhythms. So I always say sleep is not about nighttime, it's about daytime and that diurnal pattern of the up and down of your day and that cycle. So if your circadian rhythm is off and you've been almost too on all day, it's gonna be hard to turn off at night.

The most common sleep disorder is insomnia. It seems that even though this is an innate thing that we don't really need to learn, that it's built into us, the rhythm of sleep and, and the capability, the ability to sleep is, is in us neurologically, we still can't sleep. And that's, as I mentioned earlier, that's half of, of America. We can't sleep. I mean, what's going on there? That's not right. Maybe it was 10. That would be understandable, but. So insomnia is the largest, biggest category as far as sleep disorders. Right behind that, of course, is obstructive sleep apnea or sleep disorder breathing, and that is the obstruction of the airway, of air getting in and out of your airway. And you're not able to breathe at night. And as you get closer to deep sleep, these muscles that give you tone in the airway collapse. only your diaphragm is working, your heart muscle is working, of course. And when that collapse occurs, that paralysis occurs, the collapse of the airway is more likely, especially as you get older, especially after menopause, and then you start waking up and then you can't attain that deep reparative sleep that we all require. And insomnia actually is linked to not sleeping well enough. That may seem counterintuitive, but people that are very tired, sometimes can't fall asleep. So the question is, is why are we seeing more of this collapse of the airway? This is below the upper part of the pharynx. This is past the tongue. If you look at sleep endoscopy type of images, that's a moving image of someone that is asleep, you'll see this airway. The airway is frightening when you first see it. A good airway is maybe the size of the opening of a tapioca straw. it can get smaller than that. And that's during waking hours. That's when the muscles around that airway have tone. So what happens when you're on your back, you've got your heavy mandible and your tongue pushing back on the upper part of the airway, that whole airway is being compromised and you've lost the tone on the muscles that allow it to be pulled together. This again is the Bernoulli effect, being pulled together by a big volume of air coming through the mouth. so why is that happening more? I mean, and our ancestors didn't have this issue. Well, it goes to the fact that our airways are developing. They're into a smaller space. The bone structure, the capsule or that box that I referred to, the airway box, is smaller. Hence, given the amount of tissue that would grow there normally has less room for it to exist in that space. So our airway is getting smaller. We are developing, or evolving, if you want to say, into a species with a retrognathic jaw. Our foreheads, our heads are supposed to be enlarging a little bit. Our brain capacity is supposed to be increasing. I see very little signs of that, but the jaw is getting smaller. And because of that, our airway is literally under attack. It is under fire, and it can't function the way our ancestors airways did.

So let's talk about sleep apnea. Sleep apnea is actually a very common condition that I see in my clinic. And a lot of people believe that sleep apnea only happens with older patients or overweight patients. And that is not true. Sleep apnea actually can happen with young adults, with women, even children can have sleep apnea. And what is a sleep apnea? So sleep apnea is when breath is paused, is stopped during sleep. There are episodes throughout the night where instead of breathing normally and getting air through your airways to your lungs, this process stops temporarily and pause of sleep of apnea can actually last somewhere between 10 to 20 seconds. And patients can have constant pauses, constant episodes of sleep apnea. There's many kinds of sleep apnea. The most common is obstructive sleep apnea, but there's also a central sleep apnea, mixed sleep apnea. But obstructive sleep apnea is what we see in the majority of my patients. And with obstructive sleep apnea, what's going on in there? So the air, literally the air that we're breathing that were meant to get through our nose, go down the passages, go down to your throat and enter your lungs. somewhere in this process, the breath stops. And we call it obstructed because it's an obstruction that's happening. So it's either the air is not flowing through the nasal cavity, maybe it's not going down correctly through the pharynx, through the throat, maybe there's a blockage in the tonsils, in the throat, and then the air doesn't reach the lungs. So during sleep, when we're sleeping, where the body the autonomic nervous system controls this breath. We're not meant to be thinking about breathing. So as a pneumatic process, as we sleep, we're breathing correctly. Whenever we have an obstruction in this process, sleep apnea occurs. And what causes sleep apnea? There's many causes of it. So in the obstructive, I have seen patients that have sleep apnea because they have chronic seasonal allergies. Sometimes their allergies are so bad their environment they're living in can be polluted, toxic, or they have seasonal allergies to the outside. outside pollens that it blocks their sinuses and they can get quite a bit of congestion and start experiencing sleep apnea as a result. They can also occur when someone has very enlarged tonsils. So even a child, I've seen children that have very enlarged tonsils from chronic strep infections or chronic viruses, also eating the wrong diet, having a lot of dairy and sugar can inflame someone's glands. and the obstruction of the gland at night can cause episodes of sleep apnea. We also see this as patients get older, which is true. As we get older, our risk of sleep apnea is higher. What it's going on is that the muscles that are surrounding the airways, the breathing space, all these muscles in the inside, including around your throat, they start to collapse. Even the tongue starts to collapse. so the tongue can fall back and obstruct the airway. So air is now flashing through. So somewhere in this process, the air is not moving through, but as we are getting older, the tonality of our muscles, our muscle tone, it starts to decrease and everything starts to fall into each other. So when we're sleeping, it is common that a young adult can have just an episode of sleep apnea, if they have drunk a lot of alcohol. So when someone drinks a lot of alcohol, the body over sedates and the central nervous system doesn't regulate our system as well. So you're overly relaxed for that period of time and everything just drops and falls back in closing the airway. So alcohol can cause a lot of episodes of sleep apnea for patients. And if you have a sleep apnea, drinking alcohol is probably the worst thing you can do because your already encouraging a problem that exists in your body.

Now, I wanna take a moment to talk about our breath. In our day-to-day life, we rarely think about our breath, and yet how we breathe is vital to our sleep and our health. Ideally, we breathe through our nose throughout the day and when we're sleeping. Yet, have you ever looked at your partner or someone sleeping near you and noticed that their mouth was wide open while they were asleep? Well, this is pretty common, and the problem is that When we're breathing with our mouth and not our nose, we aren't getting quality sleep. When you breathe through your nose, you're more likely to activate the part of your nervous system that controls deep rest and digestion. That's your parasympathetic nervous system versus your sympathetic nervous system, which is your fight or flight response. So breathing through your nose makes you feel relaxed and calm, and it prevents a host of issues. Now let's turn back to Dr. Mark Burhenne for a lesson on mouth breathing.

And upper airway resistance syndrome. I think, and in my practice, I see a 30% rate of sleep disorder breathing. And the national stats are between, I've seen as low as 6% to about 20%. And I think this is what's happening. I think a lot of this is flying under the radar. And I think there are three reasons for that. One is UARS, upper airway resistance syndrome. That is a condition that most young, thin, healthy, premenopausal women have. A lot of Asian women that come to America and start eating the Western diet seem to get it very quickly. It flies below the radar because you're not exhibiting apneus or hypopnea. Apneus is no breath for more than 10 seconds while you're sleeping. Hypopnea is a low volume breath for more than 10 seconds. And those are all considered interruptions. cause you to be alarmed, your body to be alarmed. You're not breathing the way you normally should be. The upper airway resistance syndrome, there are something called the RERAs. It's a respiratory effort related kind of interruption. And it's even less of a volume of reduction in volume of breathing, but it's enough to wake up the person. My point is that a lot of these sleep studies don't pick up on that. And that's a shame because those women will get full on obstructive sleep apnea suddenly when they reach menopause or even perimenopause because their drop in estrogen and progesterone, which are hormones that are actually protective of the airway muscles, is such a sudden drop that all of a sudden they've caught up with their male husband or male partner. He's been snoring gradually all along and then all of a sudden women catch up suddenly when menopause appears. What is mouth breathing? Mouth breathing is someone who is taking in all the air through their mouth at night when they sleep, during the day, obviously when we talk and we eat and less so when we're eating, because if we're good nose breathing, we can eat and breathe through the nose. But typically, if someone cannot breathe through their nose, they are mouth breathing. And mouth breathing leads to all sorts of dental stuff like higher cavity rate, drier mouth, increased incidence of gum disease. But it goes beyond that. It goes beyond the dental implications. The most important one, I think, is the regulation of your breathing rate. And at night, that's important. I use a device, a ring that measures that, and I can actually measure the difference or see the difference between my forced nose breathing by taping and not being able to tape because I'm congested, I can actually see that reflected in my results the next morning in terms of respiratory rate, heart rate, and even heart rate variability. So if you're breathing through your mouth, you're breathing in a different way. You're breathing in a way that is not conducive to feeling well.

So.

To make it simple, if you can breathe your nose, you're not over breathing CO2. Breathing is as much bringing air in than it is as well expelling CO2. And if that mix isn't correct and optimal, which nose breathing tends to do on its own, then your blood pH will change, it will become more acidified. That will, because the base of the brain is looking at CO2 levels in the bloodstream, not O2 levels, to determine how quickly you should breathe, it's going to want you to start breathing faster to get rid of some of that acidosis. And, but if you're mouth breathing, then you're borderline hyperventilating. So that can have an effect on your brain. It can have an effect on your sleep, which in turn will have an effect on your brain. and your body. So mouth breathing is something that is unbelievably overlooked, but so actionable. And it's as simple as taping your mouth shut with the right tape. Now, there are some people that cannot breathe through their nose, and that's another great reason to try mouth taping to see if you are one of those people. And if so, that can be corrected. These are things that will help you sleep better. It'll also be something that makes you feel better during the day, just being able to use your nose for what it was meant to do, and that is to take in air and to expel air as well properly. In mountaineering, when the partial pressures get very low at high altitude, it's very important to breathe properly. As an athlete, it's very important to breathe properly. But when we're sitting around, a lot of people think, oh, it doesn't matter how we breathe. It does.

You just heard about something called mouth taping. This might be a new concept to you. We're going to dive into mouth taping and ways to start breathing through your nose later in this course. For now, I just want you to understand the importance of breath. So the key to getting better sleep lies in addressing the root cause of our sleep challenges. Are we having difficulty breathing at night? Is stress preventing us from better sleep? Is it our hormones, our blood sugar, our allergies or environmental toxins affecting us? In this course, we're going to talk about each of these root causes. But before we dive into that, let's talk about the stages of sleep. This is important information that will help you understand what happens each night when we shut our eyes.

Sleep starts off with stage one, which is very short. It only makes up about 3% of your sleep, and this is just the transition into sleep. Stage two is actually the majority of your night is spent in stage two, and this is when your heart rate slows down, your breathing rate slows down, and you start the recuperation process of sleep. Now, stages three and four are also known as delta or deep sleep, and this is slow wave sleep. So this is when your body starts to heal any of the physical traumas that have occurred. In slow wave sleep, you also filter out all of the unnecessary information that you accumulated throughout the day, the billboards that you the commercials, the TV shows, everything that you don't need is kind of dropped in stages three and four of sleep. Now REM sleep is your rapid eye movement sleep pattern, and this is when you have a paradoxical reaction occur. Your heart rate increases, there's increased sympathetic tone, and REM sleep is important for memory consolidation. So you're taking things from your short-term memory, things that you tried to learn during the day, and you're putting it into your long-term memory. This is why REM sleep is so important for mental health. Waking up without anxiety or irritability is also dependent on your REM sleep patterns.

So these are the three stages of sleep that are very important for us to understand. And in conversation with my patients, we are always trying to increase the amount of deep sleep, REM sleep. More than quantity, quality is really important. Of course, the ideal for an adult is between seven to nine hours of sleep and everyone has unique demands. I have patients that do great with six and a half to seven hours as they get older and patients that need nine to ten hours. You can have the same 50 year old patient that needs different amounts. So a lot of it has to do with their physiology, what their demands are of the body, but achieving the deep state and REM is ideal. And if light sleep, light sleep, you're going to actually wake up in the middle of the night through light sleep. And that is normal. Tossing, a little toss and turn is part of what's important for sleep. This can create actually a lot of anxiety for my patients when they think they have to just close their eyes and open their eyes the next morning. And the body's not meant to do that. So there's that you're going to do that if you're in deep state of sleep or REM, but during the light phases, you're going to have some shifting of positions, some turning, and that is normal as long as your body is falling back into sleep. that's what's expected. So teaching people that if they wake up a little bit during the night and they fall back to sleep, that is normal. We're meant to be in the lighter state and that is a healthy part of our system. Our sleep cycle is not something that should be continuously managed. If patients just want to close their eyes and open their eyes the next day, this is why we see a lot of people doing prescription medications. You will get that with a prescription med, but with proper sleep, you still might have a little waking up your body that is part of the light sleep cycle. As part of our sleep cycle, the body goes between the deep state, the light, the REM within 90 and a 90-minute cycle. And this keeps happening throughout the whole night. Most of the deep sleep is actually achieved in the earlier hours of the night. When your parents told you to go to bed early, yes, it's true. We should be going to bed earlier. If you're sleeping by 11:00 PM between 11:00 to 2:00 is when we are able to achieve the deeper state of sleep. So someone that goes to bed every night after 2:00 AM, their body naturally is not gonna hit that deep state of sleep. So getting to bed earlier is very important for that reason. So that state of deep sleep, light, light deep REM changes goes every 90 minutes. And the longer you are sleeping, the more you go into REM. So your REM cycles increase more throughout the evening. So when you're about to wake up, you might be hitting your longest state of REM, and that's when you're dreaming the most. So a lot of people that have an alarm clock to wake up, if the alarm wakes you up and you are in the middle of a dream state, that's when you're hitting the REM. and patients ask me about dream recall and they say, I just can't remember my dreams. So most people, if they're hitting REM sleep, are having some state of dreaming, but they're probably not going deep enough in the REM that they can recall their dreams. And remember that memory is processed and integrated and sharpened during the REM phase. So if they are not getting enough REM, they're not going to recall a lot of their dreams. But most people do dream. It's just they're recalling and their ability to spend on REM. So tracking someone's sleep is interesting because when you track sleep, you're able to see how much time someone spends on REM versus deep and light states of sleep.

That was a brief lesson in the stages of sleep. And I know this is a lot of information, but it's important to understand why sleep is so important and how sleep can impact everyone at any stage of life. The good news is that the earlier we catch these problems, the better. And It's almost never too late to fix our sleep. I know what it's like personally to get really bad sleep. When I was dealing with some serious health issues, I felt wired and tired pretty much every day. My body needed sleep, but there was so much dysfunction and disharmony in my body that I couldn't actually fall asleep. My mind was racing, my heart was racing. I would wake up multiple times throughout the night. Now, I know so many of you can relate, but I don't want you to stress out about your lack of sleep. I want you to arm yourself with all the knowledge and the tools that you need in order to get better sleep. Now, we've been able to do miraculous things with advancements in technology. We're able to communicate with and work with people all over the world. We're able to run entire businesses from the comfort of our home. We're able to stay in touch with loved ones, regardless of where they are in the world. However, these advancements have also come with a big price. We have now extended our days significantly with the use of our phones, our tablets, computers and laptops. And this means we no longer leave our work at the office and pack it up at 5 o'clock. We're able to work well into the night by keeping all of our lights on and exposing ourselves to blue light from our devices, which is not good. Unfortunately, this is damaging to our health and our sleep. Now, in this lesson, we're going to talk about your circadian rhythm. A circadian rhythm is a natural internal process that regulates our sleep-wake cycles. This 24-hour internal clock is influenced by lots of things, mainly light and our eating habits. Our circadian rhythm also influences our lifespan. That's right. The more in alignment we are with our natural rhythms, the healthier we will be. In her book, Chasing the Sun, author Linda Geddes explains that almost half of our genes are under circadian control, including ones associated with every major illness investigated so far, including cancer, Alzheimer's, type two diabetes, coronary heart disease, schizophrenia, and obesity. Circadian rhythm expert Dr. Satchin Panda says our genes are no longer our master conductor. Our behavior is the master conductor of all our internal rhythms. This is good news because it means that we are not at the mercy of our genes. Our behavior and the things that we do daily and habitually can transform our health, our genes, and our sleep. It turns out that more often than not, sleep problems are not just a nighttime problem, they're a daytime problem. All the things that we do during the day, our habits, the time we exercise, the foods we eat, when we eat, all influence how much we sleep and the quality of our sleep.

So your body works on something called the circadian rhythm, and this is your internal clock. So how this works is light exposure goes into your eye, it hits your retina, and from the retina, it's transmitted to the suprachiasmatic nucleus. This is an area of the brain where serotonin is going to be produced into melatonin. This is also where your pineal gland is. Melatonin production is going to make you feel sleepy and it's going to help you actually fall asleep. Now, on the flip side, your circadian rhythm is also regulated by cortisol. Cortisol is your wake up and get up and go hormone. Cortisol gets a really bad rap, and I'm not sure why, because it's essential in your health. This is the one that makes us actually want to feel like we can do things throughout the day. It's our driving factor. So this balance between melatonin and cortisol is what makes up this circadian rhythm. Now, the circadian rhythm is important for a bunch of reasons, but first I want to talk about one of the most important driving factors behind the circadian rhythm, and that's light exposure. Light exposure is actually more important to your circadian rhythm than melatonin production. which most people don't know. One study looked at three groups. They put people into three different groups. One of them was an exercise group. The other one was a light exposure group. So these people got light exposure within five minutes of waking from a light box. And then the other group was a sleep hygiene group. So they just educated this group about what really can help you with sleep. After a prolonged period of time, they tested this group and see which one did the best. And what they found was really interesting. The group that did the worst was actually the sleep hygiene group. This group decreased their sleep duration throughout the length of the study. The exercise group found a 17-minute improvement in sleep duration, but the light exposure group that got that light box within five minutes of waking saw a 54-minute increase in sleep duration throughout the length of the study. That's incredible. Prolonging sleep by a full hour every night can do wonders to your overall health. So bright light promotes sleep in a few different ways. And the two mechanisms that are well established are its antidepressive effect, as well as its ability to shift your circadian rhythm. So we know that sleep is really important at preventing depression. And we know that depressed individuals actually have poorer sleep. so this is one reason why light exposure during the day might be essential to promoting sleep at night. Light has also been shown to shut down the pineal gland's production of melatonin. So you actually need light exposure during the day so that you're not producing melatonin, so you're not groggy all day long. And you can think about this like in the sitcom, the mom comes in, opens up the curtains and exposes the child to light so that they wake up and they get out of bed so that they can go to school.

School.

And this actually has a physiological mechanism behind it because you need that light exposure to come in, to hit the retina, to actually shut off melatonin production so that you're not sleepy all day long. And this is one of the reasons why light exposure trumps almost everything when it comes to sleep hygiene. And it's the driving force behind your circadian rhythm. Most of us don't get enough light exposure during the day. The average American gets about 20 minutes of light exposure throughout the day. So I want to start challenging you. If you want to regulate your circadian rhythm, then you need to be exposed.

To light 30 minutes, twice a day, minimum. Once I realized through studying the circadian clock system what I was doing to my own health, I just made it a simple tip, a simple routine where I don't have to think about it. First thing in the morning, don't get on your phone, don't check email, don't do any of that. Just step outside. And, you know, I travel a lot, sometimes 70 flights a year. I haven't been in a situation where I've been unable to do this. You know, even in a hotel in New York, Seoul, South Korea, I mean, wherever, I've been able to just get out and it really kickstarts your body's circadian rhythm. Now, I know this sounds like a weird tip because most people are like, okay, you're doing this in the morning, but I have problems with sleep. and this is where, again, it circles back to this whole circadian clock system that we've been talking about. You have to entrain and get the gears of the clock working right in the morning to foster the neurochemicals and the biochemical changes to create that sleep pressure so that when the evening comes, you're tired. And again, a lot of people are not getting light in the morning. They're getting in their car, they're getting in the subway, they're going right to work, they're not exercising, maybe some days they're having breakfast, maybe some days they're skipping breakfast, right? So you can start to see how the peripheral clocks are getting confused because the mealtime is all over the place. The central clock is not getting that adequate sunlight and the good light to keep things going. So there's a mismatch between the circadian clock system, which ultimately will help to create the hormonal milieu that causes us to not only feel sleepy, but to actually stay asleep, the hormones melatonin, adenosine, these different neurochemicals that help us not only get to sleep but also help our brain and our body recover from the day that we, when we're awake. So super important.

So we often hear melatonin being an essential nutrient for help patients fall asleep, and it's true. With our circadian rhythm, as we are exposed to light in the daytime, to sunlight, to direct light. Our circadian rhythm, which is our mechanism, our biological clock that regulates our sleep cycle, the exposure of light allows our brain to start getting ready for building melatonin in the evening. So in the morning, the body knows that the light is stimulating to not make melatonin at that time. but it preps itself for the evening. So as the light goes down, if we're living in the natural rhythm of nature, if there was no light around us or electricity, the evening, the darkness triggers the pineal gland to release melatonin. So melatonin is a, we call it, it's a neurotransmitter, but also a hormone, so a neurohormone that it's an essential part of helping us fall asleep at night. So without the proper night and darkness surrounding us, the pineal gland is not able to create enough melatonin, yet it needs the sun in the morning and it needs the darkness at night. So as melatonin is released, that naturally helps the body fall asleep and it encourages the sedation in the body. And the more we sleep, the more melatonin we make. so melatonin is a really important antioxidant for the brain. Melatonin is not only helpful to help you keep sleep, but is one of the most important antioxidants to keep the brain healthy and young. It's really an anti-aging nutrient, or I like to call it graceful aging nutrient. With melatonin is being shown that as patients with, as we age with chemicals around us, environmental toxins, We can end up with what's called a leaky brain. The blood-brain barrier gets slightly broken and it allows for all the toxins to go into the brain and we end up with a toxic brain. Melatonin actually helps patch up these little holes. So melatonin is an antioxidant, but it also helps heal that brain layer. So sleeping at night is essential for healing a leaky brain. and often patients that are not getting enough sleep, they're not going to get enough melatonin. And as we get older, naturally our melatonin production drops. So it is essential as someone is aging that they could supplement with some melatonin, sublingual melatonin, oral melatonin. But melatonin levels should be titrated slowly if you're going to consume melatonin. And I also prefer to have patients do what's called a sustained release formula so it can stay in your body through the evening if melatonin is going to be used. A lot of my patients say, I take melatonin. It doesn't help me. The problem is that they're not, they're using a quick dissolve versus the sustained release in their body. So that it's, that it can make quite a big difference. So melatonin is one of the most important nutrients. Again, it's antioxidant. It has been shown to be have anti-cancer properties. When patients have low melatonin levels, tumors can grow faster. So part of a cancer regimen, patients will always go on melatonin to help the immune cells. So it's also helping the immune system and it does have anti-cancer properties. So now that we understand the importance.

Of daylight in the morning to really entrain and optimize our body's circadian clock system, another element and this the flip side, the yin and the yang of light is darkness. and darkness really fosters sleep pressure. The downside is, unless you live out in the country, a lot of us know that it's virtually impossible to get pure dark. And so it's important to change your home environment. I know a lot of people are probably like, oh my gosh, you want me to eat healthy organic food and move and exercise and all that, and now you need to modify our home, and that's really important. So one of the things that I figured out For a long time, the compact fluorescent light bulbs were considered more energy efficient than the incandescent or the older style light bulbs, but they're very blue in terms of their hue and the wavelength of light that they emit. And again, that sends signals to our central circadian clock system that it's morning time. And so it's very important for people to switch back to these incandescent light bulbs or kind of also called the Edison light bulbs. And people will notice it's much more of an orange type hue, which is actually the color spectrum and wavelength that the sun in the evening will emit. And so that's going to signal to our brain more adenosine and release of melatonin, decreased cortisol and different wakefulness hormones because it's not just about the neurotransmitters, it's about the peripheral hormones as well. And so again, modifying your home, customizing the home, and having some really good boundaries around tech, computers and television. I think that's especially for business owners and parents. And now that work is pretty much 24/7 for most people, access to email and all that. I mean, it's a blessing and a curse, right? We can work mobile and remotely, but work is always with us. And I think the biggest thing that people can do is put their phone and having, and I learned this from Arianna Huffington, she has, she she puts her phone to bed, right? It's a great tip, right? A lot of us, you know, we, and what I mean by putting your phone to bed is airplane mode, put it away. It's create these, really it's boundaries around tech. You know, as we talked about, tech's amazing. We can't live without tech and texting and being able to communicate with people in the world. But it's also a curse in that it's very stimulating. It's triggering that uncertainty, that dopamine release. And it's also emitting light. And so, you know, you can change the hue and the color, you know, on your iPhone and the accessory and the settings. Maybe we can do a demonstration. That's what I personally do. You can wear blue light blocking glasses, but just having, you know, hard stops around when you stop tech. And for me personally in our house, we recommend to our clients as well, 8:00 p.m. It's like, no matter what, unless there's a like a catastrophe or family emergency, phones go in this drawer, they're charging, we can get to them in the morning, whatever it is that's pending can wait, and we go for an evening walk. And so that's just a great way to like, again, you're having building in these routines and these habits.

So the cue for melatonin, we all know, comes from darkness. And so I often tell my patients, if I walk into your bedroom in the middle of the night, I should be able to walk into like nothing. Like I cannot see anything. It's pitch black and I will walk into walls. if I have to get to the bathroom. So I am a super, super Nazi. Like every little light is blocked in my room and my kids' room. And one thing I hate about hotels is all these little tiny gadgets and all their lights, and I'm the one putting all the pillows on everything and blocking everything so that it is completely pitch black. And what I love is in school we learned about this article and the study they did where people think if they cover their eyes and they have a mask on that their melatonin will get released, but they actually put some light at the toe of the person under the COVID and they found that the melatonin levels come down. So there are receptors for melatonin throughout our whole body. It's not just about putting an eye mask on at night. And look at nature. I mean, blue light we know gives us energy. That's what tells your brain, it's morning, wake up. That's what tells your the little tiny area in your hypothalamus, release cortisol, get the energy up so that this person can perform. Sunsets are orange and red for a reason, so that orange-red light is what tells your brain, Please bring that cortisol down. And the opposite of cortisol is melatonin. Get that hormone up so that we can get sleepy, and throughout the night that melatonin should still be high. So it's not just for sleep onset, it's for sleep maintenance. antenae. And that all has to do with that circadian rhythm that I talked about that is probably so off now with all our technology and modern world where we're not getting that light and that sunset. And one of my favorite things to do when you're out and if you can is go and watch the sunset every night and the sunrise. That will absolutely reset your circadian rhythm. You know, if you're really struggling with sleep, Just do this for two weeks and it will reset something that you cannot reset with food, you cannot reset with drugs, you cannot reset with all these gadgets that we have. But seeing the sunrise and sunset is what we used to do. You know, that's how we got up and that's how we knew to go back to sleep or go camping, you know, go out in nature, like just book a week or two off and not be surrounded by all these artificial light that is affecting us. sleepiness.

When we talk about circadian rhythm, we also have to talk about sleep drive. This is another factor that helps us fall asleep at night. So sleep drive is driven by this adenosine molecule. Adenosine is produced after glucose is metabolized by the cell. One of the byproducts is something called adenosine. And as the day goes on and as your metabolism continues, you build up adenosine. Adenosine builds up and up and up just like you get more hungry, more hungry, more hungry until you eat. It's similar with your sleep drive. You get more tired, more tired, more tired until 10:00 p.m. comes around and you fall asleep. So this sleep drive is really important. There's things that affect sleep drive and then there's things that actually promote sleep drive and we're going to talk about a lot of those throughout this course. Caffeine though looks really, really similar to adenosine. It's only a few molecules off. This means that caffeine can go and attach to those adenosine receptors and block them so they don't have their effect. This is why caffeine can keep us up and energized because it's blocking our sleep drive. It's blocking our ability to feel sleepy even if it's at night. Now, caffeine has about a seven hour half-life. This means that it's in your system for a really long time. There's a ton of people that are drinking caffeine past 2 p.m., even past 6 p.m. or having a nighttime coffee before bed. And while if those individuals are still able to fall asleep, they might not be getting quality sleep. So this is something you have to take into consideration. I recommend that people stop consuming caffeine by noon to 2:00 PM so that they can fall asleep at a normal time around 10:00 PM without the caffeine in their system.

In Chinese medicine, there's a belief that we have a circadian rhythm and every organ in your body has a physiological clock. so your kidneys have a physiological clock, your heart, your brain, your liver. And the liver's physiological clock, and what that means is that physiological clock is when the organ is the most active. That's when the organ cleanses itself, it has the most energy to regulate itself and go into homeostasis. So the liver's biological clock is between 1:00 and 3:00 AM. the gallbladder is between 11 and 1, and between 11:00 p.m. to 3:00 a.m. that window where we should be sleeping is where actually where the body is doing the most detox. And we're not even counting the brain yet. The lymphatic system is active at night. So there's suddenly three systems that are very active, and then the lymphatic system wakes up at night, 60% more active. So the body goes into a full mode of detoxification at night. is being busy all day, processing, digesting, breathing, helping you operate, think, live life. And then when you close down the body to rest at night, the body is very smart and it has its own ability to self-regulate and dump the waste out. So if we don't properly sleep at night, we're not able to remove the toxins that our body needs to clear off in the evening. so let's go back a little bit to the liver. So the liver is the most active between 1 to 3 a.m. And many of my patients that come in to see me, they say, I always wake up at 1 a.m. or 2 a.m. or 3 a.m. If you're waking up during those times, your liver is detoxing, is doing what it's meant to do, but it means that there's too many toxins that are waking your body up. So we're supposed to be sleeping through that time. The body's not being meant to be waking up through that detox period. When the body wakes up during those times, there's an overcharge, there's too much, what we call Yang energy. There's the Yin and Yang. The Yang energy is that there's too much fire, too much toxicity, too much inflammation in that liver that is waking, is calling all systems to come help, and your body naturally wakes up during that time. So an increased exposure to toxins through our environment is going to attack our systems. And this is why let's talk about alcohol. When patients drink alcohol, they don't sleep as well. Their brain is not hitting REM sleep, but also their liver is up at night trying to break down all the alcohol molecules. So the body is busy detoxifying.

Long story short, there's this master operator, the master circadian central clock system, and then the peripheral clocks. are influenced by non-light mediated factors, for example, meal timing, exercise timing, things along those lines. And so let me just give you an example of how you can perturb both your central clock and your peripheral clocks. Let's say you eat, say, your biggest meal at midnight, right? For example, your peripheral clocks, like within your GI tract, are saying, hey, like this is a when we're normally sleeping, you're eating food. So then the tissue is literally kind of getting confused as to what time of the day it is. And that's going to have negative feedback inhibition on the entire circadian clock system. And so long story short for people to understand, the take-home message is when we eat, like the meal intervals, that consistency when we eat has a big influence on that night's sleep and also our entire circadian clock system. And so I think it's important to talk about this because at present, intermittent fasting varies one meal a day, time-restricted feeding are very hot strategies that a lot of people are implementing to improve their health, potentially enhance longevity, but they can also be strategies when used appropriately to foster deep sleep. because if you're having your meals, let's say you just do two meals a day or even three meals a day, keep it very simple for most people, your body starts to anticipate. It's called the cephalic phase of digestion. So your body is anticipating that food coming in, and this is partly mediated by this circadian clock system. And so if we just get the peripheral clocks in sync with the central clock, then we can start to foster deep restorative sleep. And then When, say, 9:30, 10:00 comes around, people then are, their bodies are saying to them, Hey, it's time to go to bed. You know, instead, you know, certain people will tell you like, I would love to go to bed at 10:00, but I'm just wired. Even though I'm tired, I'm wired because the circadian clock system is imbalanced. The adrenals are raising cortisol and noradrenaline, for example, when they shouldn't be. Those hormones should be down because they should be higher in the morning. and there's a lot of reasons why that can be. It can be from light exposure, being on the computer, watching stressful, you know, television news, you know, caffeine, things along those lines. But a, another big part of that could be missed and imbalanced meal timing. And so I like to underscore that as a, you know, a sleep enhancing strategy. A really good question comes up is, what's the best time to eat to enhance .. Foster deep sleep. And I'm a little bit biased. You know, I used to do endurance athletics, semi-pro bike racing and the mantra among cyclists, because in cycling, you want to be strong, but you also need to be lean. Like your power to rate ratio really governs like literally who wins the Tour de France or not. And so an easy way to do that is to get in your calories that you need earlier in the day and stop eating as early as you can. Like, so athletes would train, you know, early in the morning, have a big lunch, and then cut off. So they're fasting for a large part of the day. And so I think for a lot of people, and again, I like to just add a little caveat here, context, I don't want people to change anything if what they're doing is working, only if these things are not working. So if you're struggling with sleep, if you're struggling with body composition, then try this. Try eating earlier in the day and starting your fast, if you will, your last meal, as early as possible. And what I've found through promoting this online, and this isn't just me talking about it, I report some of the time-restricted feeding studies that have been conducted by major universities throughout the world in the past 10 years, is they've found that early time-restricted feeding enhances things like autophagy. It affects favorably mTOR, which is a growth factor that can be linked with cancer and other diabetes and obesity and neurologic disorders by eating earlier in the day and starting your fast earlier, that coincides with these peripheral clocks that we've been talking about within the GI tract, within the liver, within the muscle tissue. It seems that our GI tract, about right now when we film this at 10:00 a.m., roughly, it's when our GI tract and our juices and our motility is at its peak. It starts around 10, depending upon the study that you read between 10 and 4, is when you're digesting to function is optimal to receive a meal. Now, what are most people doing? They're eating at 8:00 PM, 9:00 PM. They're going out on the weekends, after the bars, they have pizza, you know, things like that. And they wonder why their health is kind of a wreck and why they can't sleep. So yeah, to make a long story short, I think there's a lot of evidence emerging, and I think it's a great tool if people have the ability to have the willpower to cut off their feeding window. early enough.

So let's take all of this and put it into practical steps you can take today. First, I want to ask you some questions about your daytime routine. Do you get outside in the morning or do you go from your house to your car to your office to the gym and then back home? I mean, if you go to the gym, that's good, but it's not that. Can you today commit to spending about 15 minutes outside every morning without sunglasses so the light hits your eyes and goes into your pineal gland, which regulates your circadian rhythm. Can you eat your lunch outside? Can you take a few walks throughout the day? A few times a week, can you exercise outside instead of inside? I mean, even if it's cold outside, it's so important to spend some time outdoors. In the winter, I still prioritize time to go outside. I go cross-country skiing. I go for long walks in the neighborhood or in the woods. It's good for my body, it's good for my brain, and it's great for my sleep. Getting sunlight is also vital for one other very obvious reason, vitamin D. Now, deficiencies in this vitamin affect over half the population and has been linked to many cancers, to high blood pressure, heart disease, diabetes, depression, fibromyalgia, chronic muscle pain, bone loss, and autoimmune diseases like multiple sclerosis. Several studies have shown that low levels of vitamin D in the blood are associated with more sleep disturbances, less sleep, and poor quality sleep. For now, I want you to commit to this: before you check your phone or turn on your favorite podcast, the Doctor's Pharmacy, obviously, I want you to step outside, even if it's just for a few minutes. Maybe you'll go for a quick walk or a jog. Maybe you'll meditate outside. Maybe you'll enjoy a cup of tea or coffee on your porch. Whatever it is, take a few minutes in the morning to embrace the power of sunlight. Now let's talk about your nighttime routine. Are you still looking at screens until you fall asleep? Do you keep all the bright lights in your home on until you fall asleep? Do you work in bed? I want you to commit to this. Spend one to two hours for bed without screens, you won't believe how powerful this simple action can be when it comes to your sleep. If for some reason you can't commit to avoiding screen time before bed, I recommend wearing blue blocking glasses. Although nothing will be better than avoiding screens completely before bed, they can help. Also, if you have to look at your computer or laptop at night, also download something called F.Lux, L-U-X, which eliminates blue light from your screen. That's F.Lux. As far as light in your home, I like using orange or red bulbs, or simply dimming lights in my house. Sometimes, if it's safe, I use candlelight. Remember, when it's dark, melatonin, often known as the sleep hormone, is synthesized by our pineal gland right here. Now, if we're constantly exposing ourselves to light at night, it's going to be a problem. In her book Chasing the Sun, author Linda Geddie says, It's important to dim our nights and to brighten our days. And this means getting more sunlight during the day, especially in the morning, and minimizing our exposure to light, especially artificial light at nighttime. This might be one of the most important tips for resetting your circadian rhythm. Next, let's talk about when you sleep and when you wake up. Can you commit to going to sleep and waking up at roughly the same time every day? I know it's not always possible, but for me, 90% of the time, I try to get in bed by 10:00 and I'm up at 6:00. And if I break this routine for a couple of days, I definitely feel it. Now, while it might seem boring to have this routine, it's a great way to set your circadian rhythm and to optimize sleep. And finally, let's talk about when you eat. We're going to get into this more in the next lesson, but for now, I want you to commit to enjoying your last meal at least three hours before bed. If dinnertime falls around 6 or after, try to keep this meal lighter and your heaviest meal in the midday or the morning. This might seem completely abnormal to your typical routine, but it's a great way to prepare your body for bed. Also, if you enjoy coffee or tea, try to have your last cup before noon or at the latest before 2:00. And if you're caffeine sensitive, you might try quitting it altogether. In the next lesson, we're going to talk about what to eat. We're going to dive into all things nutrition, including balancing your blood sugar and how to time your meals to get better sleep. We're also going to talk about the connection between our and our gut and our gut health and our sleep. We'll see you then. Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. and in it, I share my favorite stuff, from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks P-I-C-K-S and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

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