Sleep, Autoimmunity & and Your Immune System with Dan Pardi – Episode 25

Sleep, autoimmunity & and your immune system with Dan Pardi.

Dr. Ruscio, DC interviews Dan Pardi, CEO of Dan’s Plan, in this episode of the podcast. Dan is an entrepreneur and researcher with the Psychiatry and Behavioral Sciences Department at Stanford, and the Departments of Neurology and Endocrinology at Leiden University in the Netherlands. Dan and Dr. Ruscio, DC discuss circadian rhythms and how sleep affects the immune system, the gut and may contribute to autoimmunity.

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Welcome to Dr. Ruscio, DC Radio, discussing the cutting edge of health, nutrition, and functional medicine. To make sure you’re up today on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor.

Now, let’s head to the show!

Dr. Michael Ruscio, DC: Hey, folks. Welcome to Dr. Ruscio Radio. This is Michael Ruscio. I am here with my good friend and extremely well spoken colleague, Dan Pardi. Hey, Dan, welcome to the show.

Dan Pardi: Mike, thank you so much for having me. It’s great to be on.

DR, DC: So glad to have you here. For those of you who don’t know Dan, I want to let him give his credentials and background in a second. But, I was teasing him before we got on the call. He is probably the best spoken, or most well-spoken person I know. And so, today I will probably sound like I can barely speak English next to Dan’s eloquent poise through which he speaks. So, I will just preface that everyone – prepare to have your opinion of me drop by a few points…

(laughter)

DR, DC: …and (your) opinion of Dan elevated by a factor of 10.

DP: Pressure.

(laughter)

DR, DC: No, no pressure now, Dan. We are going to talk about sleep, the immune system, and autoimmunity. But before we jump in, can you give us a few tidbits about your background, what you are doing, and all that good stuff?

DP: Yeah, sure. So, currently I am a researcher. I work with the departments of neurology and endocrinology at Leiden University in the Netherlands – it’s great group of people that I work with. I got involved with them because I have been doing narcolepsy research, or I’ve been involved with it, for over a decade. I met this group…at Leiden, there are some of the best diagnostician of difficult cases of narcolepsy in the world. They have good understanding about sleep beyond narcolepsy, too, but that’s how I introduced to the group.

And, I also work with behavioral sciences, and Jamie Zeitzer circadian biology lab at Stanford. And so, I have a really unique situation where I spent a little time in the Netherlands – not very much physically, but most of my time at Stanford, as far as research goes. I have a nice international collaborative group that is supporting me in the work I am doing and that I’ve got to learn from. So, I feel very fortunate with that situation with the way it’s set up.

And I’ve also been working at something called Dan’s Plan or years. So, my dad was diagnosed with cancer – I was doing cancer research at the time, looking at how lifestyle will influence its progression. So I felt like I was in a unique position to help him and, of course, I tried as much as I could. So, we would sit and I would tell him all this information about the connection between lifestyle and cancer development, and he would listen proudly. But he just wasn’t able to do anything – he wasn’t able to make the changes that I’d hoped he would. When he passed away, it made me really think about what is really necessary in order to affect somebody’s behavior? Because you can’t change for somebody, and information alone is not really enough, oftentimes. And a lot of health objectives in the world seem to operate under that principle – that if people just had the right information, then that’s all they need. And when we don’t see the outcomes that we would want from a dietary style or really anything everything, then we think, ‘Well, maybe people are stupid, they didn’t listen, the information was wrong;” when we just weren’t using all of the behavioral tools at our disposal that we know about that can actually get somebody to maintain the amount of noncompliance necessary in order to get all of the benefits. Because, there is a great thing – knowing without doing is the same thing as not knowing.

DR, DC: Right, I like that.

DP: Yeah, and actually it’s funny because it happens to professors a lot as well – some times you can know too much, it gives you this analysis paralysis, where you just know too much to feel confident to go in any one direction.

DR, DC: Right, right.

DP: That can be a problem, too. So, anyway, that got me thinking about, ‘OK, how can we construct a behavior model that can help people address lifestyle, which is really the cause of most modern health disorders – about 80 percent or more. What were really dealing with is trying to help people establish an effective daily health pattern that they can sustain throughout life. It does not mean that you don’t have specific issues that can be addressed along the way. But, for the most part, we all need to develop the skills on how to maintain a personal health practice which is the sum total of all the efforts we make, to make sure we are meeting all the environmental and lifestyle inputs that our body really requires to function well.

DR, DC: Sure.

DP: And that was the genesis of my efforts towards this, and we’ve been working on it for several years, and I love what I do.

DR, DC: Awesome. Well, it’s always hard working with family. I think any practitioner or just health enthusiast listening to this has been frustrated at one point trying to give family or friends advice.

DP: So true.

DR, DC: You are definitely not alone in that.

Sleep summary

DR, DC: One of the bedrock principles of healthy lifestyle would be sleep. Can you give us the summary of some of the important pieces regarding sleep? And then we will follow the summary with discussing the details.

DP: Sure. When we are talking about sleep, we are really talking about sleep and circadian rhythms. Circadian rhythms are these repeatable, 24-hour processes that affect all of ourselves, all of our tissues in her body. Sleep, in fact, is a circadian rhythm.

DR, DC: Circadian – does that literally translate to sun? Is that the translation of circadian? Or does it mean day?

DP: Circadian means ‘about 24 hours’.

DR, DC: Gotcha.

DP: About a full cycle around the…

DR, DC: And just for people listening, to clarify – typically, when we say circadian – and please correct me if I’m wrong here, Dan – we are kind of referring to our day/night, or light/dark rhythms, right?

DP: That’s right. Yeah, so that’s…a good way to begin thinking about them is thinking about the light/dark cycle and our sleep/wake cycle. But it also is the cycle, the cyclic activity, across a 24-hour period of behavioral patterns, of physiological patterns, of gene transcription patterns. So, there are basically patterns that our body go through, so we are on a clock, and our cells do a certain behavior or activity at a certain time of day. And in other parts of the day, they are doing something else. So, that’s a really important point to make – we are going to come back and talk about some of that stuff in a bit.
Now for sleep, sleep is, of course, critical as well. When we are talking about sleep, we are really talking about sleep and wake patterns. So, over the course of a 24-hour day, how much time are you spending within the sleep period? How much time are you spending in the wake period? And, the things that I matter for sleep are timing, intensity, and duration.

So, duration is easy – over the course of a 24-hour period, how much time do you spend asleep. Timing is really important – it’s are you sleeping within the same phase every night. If you usually go to bed at, let’s say, midnight and you wake up at eight, how consistent are you with having your sleep occur within that phase? Or, does it switch, which a lot of young people, let’s say in the weekends – Thursday/Friday/Saturday night – you go out, you are out two-three-four-hours longer. So you are going to bed a lot later. And even if you are getting eight hours of sleep – meaning you are sleeping in, this sleep will not be as productive at making you feel restored, at actually restoring the body than it would be if you were sleeping within that same phase. So timing really matters as well. And then the last part is intensity, or the continuity of sleep – the concatenation of different stages.

So, there are a lot of different stages that the body and brain will go through over the course of any sleep period. And how they interact with one another is also important for sleep to be productive. And so, those are the things that really matter as while.

So, what I am going to talk a little bit about today is not only…we can talk more about sleep, so whatever questions you have, I am happy to address those. We can also talk about how sleep affects the immune system, and the health of our gut.

So, when these rhythms get out of sync, these circadian rhythms I was mentioning earlier, then bad things can happen, including gut inflammation, dysbiosis, autoimmunity. So, I know these are topics that your audience really keen to hear. So, I am happy to dive in anytime.

DR, DC: I would really like to dive more into the immune and gut connection. One of my main motivations here is, spending my days in the clinic, people are generally compliant with dietary and dietary interventions. Yes, lifestyle interventions – yes, but maybe not as much as diet. And one of the things I think isn’t given its deserved recognition is the importance of sleep. So, I’d love how this is something to refer patients to to get a little bit of a kick in the butt in terms of motivation for making a little bit more effort toward having healthy sleep patterns. So yeah, why don’t we dive in with the sleep…or where would you rather start? The sleep immune-or the sleep-gut connection? What do you think is the better starting point?

Circadian rhythms explained

DP: Probably the sleep-immune. And in order to do that, I’ll tell you a little bit more about how circadian rhythms are controlled. Sound good?

DR, DC: Yeah, yeah.

DP: OK. So, there is a master clock in our brain. The scientific term is called the suprachiasmatic nucleus. It is a group of cells and this group of cells contains were considered circadian genes – clock genes, cryptocorynes, period genes. All these different genes that will then produce gene products that will affect the activity of hormone release of our central nervous system patterns – lots of things are then affected by what proteins are produced and when. The way that activity pattern is set requires an input from our environment. So, the main synchronizer of these rhythms is light coming in the eye. We have these in the back of the eye; we know we have a retina, and we have rods and cones. Most people have heard of those. They do a very specialized function – they turn light into a nerve signal which, if you think about that for a few moments, it’s pretty amazing. That nerve signal will go back to the primary visual cortex, where we turn light into images and we can see. It is something that we take for granted, and if you just think about it for a moment, it’s absolutely miraculous.

In the mid-90s a researcher named Ignacio Provencio discovered that there was a different type of cell, (the) opsin cell, in the retina that does something very similar to rods and cones. It can transduce a photo stimulus into a nerve signal. But instead of going back to the visual cortex, it goes back to the master clock, via something called the retinal hypothalamic track. These groups of cells are called intrinsically photosensitive retinal ganglion cells. They are sensitive to light and they communicate right back to that master clock. This is really really critical. Actually, I cannot stress – I’m just going to say this up front: I cannot stress how important synchronizing our circadian rhythms are to our overall health of our bodies. My guess is that over the next five or 10 years, what is known in circadian biology departments is going to permeate into mainstream culture, and it is going to become one of the most important things that we pay attention to for our own health. That’s a big statement and I’m pretty conservative when I come to making any sort of statement like that.

DR, DC: I know you are, yeah.

DP: But, the more that I read about this, the more it is true – the more I find it’s true or feel that it is. So, really what you have is then two levels of synchronization – you’ve got light coming into the eye, and the type of light is then going to synchronize that master clock, to let it know, ‘OK, it’s daytime; do daytime activities. Then you’ve got a second level of synchronization: you’ve got cells, these clock cells, and pretty much every tissue throughout the body. They are then synchronized by the master clock. So, you have these two levels of synchronizations – master clock with light environment, and then cells throughout the body synchronized by the master clock, OK?

So now, let’s pause for just a moment and let’s think, because, Mike, you and I are part of this ancestral health movement, there is good and bad about it, but, undoubtedly, I think this is where we need to be headed. It is understanding more natural patterns of living and understanding how they affect our biology. Our lifestyles move at the pace…at the speed of light. It’s so easy to start to live differently than we have ever lived as human beings by the introduction of something like an iPad, cell phones, and high-definition televisions…

DR, DC: And some of these are good and some of these are bad. I would think that one of the points that I just want to emphasis here would be light, right? Exposure to light. One of things that comes to mind, and maybe you can give your quick opinion on this, but I’ve read several studies that have shown that night-shift workers, for example, have a shorter life expectancy than people that worked a day shift. One of the primary proposed mechanisms for that is disruption of the circadian rhythms by their activity and also by their exposure to light, and how too much exposure to light when you should be sleeping can really throw off a lot of these cellular functions like you are outlining.

DP: Yeah, I will take this opportunity to make an important point. So, part of…I’ll step back. With Dan’s Plan, we try to help people live as an intelligent eater, an enduring mover, and a restorative sleeper. I’ll just talk about the restorative sleeper, but these are aspirational concepts

So, the restorative sleeper wakes refreshed and feels alert all day, everyday. OK, cool. How do I do that? Well, we talk a little bit about what are the determinants of a good sleep? Timing, intensity and duration. But also maintaining smart light rhythms day, evening and night. All right, that’s the point I’m getting at. A lot of your audience might have already heard that blue light is not necessarily good for you. But, it’s only not good for you in the evening. It’s really good for you during the day. Blue light is…so those cells in the eye that I mentioned are really responsive to blue light – that is the wavelength that they are most responsive to. And so, essentially, blue light is providing a daylight signal. When we are indoors, which we are 90 percent of our time now is spent indoors – as I am right now, as we are talking on this call – that is now a common part of modern pattern, being indoors all day long. And you would be surprised by the difference of light intensity between normal indoor light that doesn’t feel dark – it feels normal – and stepping outside onto a bright-lit day. It’s orders-of-magnitude different. So, indoors it’s maybe 5000 lux – lux is a unit of measure of light intensity. You go outside, it’s over 100,000 lux. So, if you think about that amount of photons hitting the eye – the signal that the brain is getting that is really robustly, that it’s day – where, if you are indoors all day long, it’s not getting a very robust signal that’s it’s day. That means that there is less anchoring effect for your rhythms – since it didn’t have a very strong daylight signal, it’s not entirely sure if it is day or night. That means that when you’re getting artificial light from e-readers, high-definition televisions, opening your refrigerator, and having the lights on in your house, all of that it at night means that your brain is more susceptible to take that light signal and think, ‘OK, now it’s day’. It’s going to shift all of your rhythms as though you were experiencing some degree of jet lag.

Why is that important? Well, it’s important in two different ways: it is important for physiological perspective, and it’s also important for cognitive and behavioral perspective. So, from a cognitive/behavioral perspective, things under circadian control are things like memory, cognition, thinking speed, information processing, right? So, that’s really important to how well you think and perform during the day, also mood. But then, physiologically you have things like cell cycle growth and repair processes, behavioral patterns like digestion and when you’re hungry and not. And so, what ends up happening under the normal pattern of modern life is we had de-synchronized rhythms. Imagine a symphony (and) a bunch of different instruments – imagine what it sounds like when they are all playing in sync and its beautiful. Imagine now if they are all playing on a slightly different time, and there’s no synchrony there at all, right? It’s total discordance. Because these, you have – kind of playing with this analogy a little bit – that orchestra playing in synchrony is critical, because when it does play synchrony, it has the ability to basically produce these time signatures so the body knows to say, ‘OK. This is the metabolic signature that my body is getting right now.’ That’s going to act like a lock, a key into a lock. And it’s going to tell my cells, ‘Do this at this time.’ But, if that whole signature is off, and the key doesn’t really match, then things can get really wacky. We can talk a little bit about specifically how that happens in the gut, and you’ll get a little more clarity about what I mean here but…

DR, DC: That’s actually a great…one of the points you made I just wanted echo briefly – and we can get into more detail here in a moment. But, one of the studies that I sent you recently was a study showing that jet lag induces pretty marked shifts in the gut microbiota in subjects [1]. So, it’s interesting to hear that. We can have a jet lag-like effect from too much exposure to blue light at night time. So yeah, these things are…we are documenting these things, and we are really starting to appreciate on a more mechanistic and physiological level that there are multiple layers of negative affect that accrue when we don’t try to honor this day/night circadian rhythm.

DP: That’s right. Yeah. And the nice thing, though, and the sad thing is that this is under our control for the most part. We don’t need to spend all day out outside in order for us to get adequate stimulation of daytime light in order to synchronize our rhythms. We don’t have to then completely live in the dark in the evening in order to get the benefit of, you know, having reduced light in the evening. We can do things that block blue light, we can put dimmer switches around their homes – these are some actionable steps that everybody should take. And so, you are having to…look at this from a behavioral perspective: what do we need to actually be healthy? It’s having the skills and the knowledge to say, ‘OK, these are things that really matter, and these are ways that I am going to proactively either modify my environments, use these tools whether your glasses at night, not wearing glasses during the day…these are all things that you can, with knowledge, do the right behavior consistently. They end up being what I call the mundane but meaningful. They are not something that you are going to necessarily post on Facebook. Because it is like, ‘I ran a mile or a marathon in X time. That’s super fast.’ It’s just like these little behavioral practices, habits that you build in your life. Once you do them, then it’s normal. And it makes a world of difference. The nice things is that because there’s a physiological effect and a cognitive/behavioral effect, the cognitive effect is actually good feedback to let you know that there is something else going on in your body, as well.

So, because if our rhythms get de-synchronized, then you are going to feel sluggish, you are going have, maybe, a suppressed mood, you are going to feel less optimistic. Well, the same thing is that happening in your gut. The same sort of impairments are taking place in your gut that you may or may not feel. It might take awhile for you to feel them when things break, but a lot of people that are listening to your podcast probably are dealing with some sort of issue that they’re looking for resolution for. So, that’s…we will talk a little bit specifically about the connection between immunity and sleep now.

Immunity and sleep

DR, DC: Yeah, let’s jump into that, then.

DP: Yeah, cool. So it’s kind of been conventional wisdom for a long time that, if you are fighting an infection, you should get more sleep. Is there truth to that? We’ve kind of known surprisingly little about the connection for quite a while. Now we know that there are several factors that are released in response to infection that will actually modify how awake you can feel, and the type of sleep you get. One of those is microbial products, like lipopolysaccharide – these are things that can enter into the bloodstream from the gut, particularly if you have a leaky gut, but that’s not entirely required. With a low dose of these lipopolysaccharide, it can stimulate the production of slow-wave sleep. Slow-wave sleep is a type of robust sleep where the body…it’s the deepest stage of sleep; lots of important things happen there. But, we all know, if you’ve been sick, your sleep can be really disrupted or you can sleep like a ton of bricks.

DR, DC: Sure.

DP: Now, if you have a high dose of lipopolysaccharides, that can actually disrupt sleep. So, it is dose-dependent, but it does have an effect on sleep. Then, in response to the infection, you also have the production of different cytokines. So, there is interleukin 1, interleukin 6, tumor necrosis factor, TNFalpha, and alpha interferons. All of these are independently going to have an influence on, basically, the sleep/wake circuitry within the central nervous system. So, they are going to then affect the transmission of different neuropeptides, neurochemicals, neurotransmitters that are going to make you feel either alert or sleepy. When you do have a high amount of interleukins that are circulating from things like interleukin 6 or interleukin 1, it’s going to make you feel sleepy. In fact, when we eat a really large meal, one of the… it’s often thought, ‘Oh, carbohydrates are what make me sleepy after a big meal.’ Actually, a big meal itself can have an immune response, and the generation of some of the cytokines can make you feel sleepy just based off of the size of the meal itself. So that’s kind of an interesting factoid there.

This is this interaction; this is this multidirectional interaction between hormones that are produced, neurotransmitters, substances that are being stimulator generated or produced in response to an infection, or products of the infection itself, that can all modify how sleepy you are, or how much sleep you are getting, making either good or bad. But generally, when we do have an infection…and also there’s this a thermo- regulation component as well…maybe you have a fever. But generally, a lot of people, when they have an infection that is serious enough, you will feel sluggish, right? You don’t have the energy, and you also will sleep longer. But everybody knows you know can get a terrible night sleep as well. I’ve made that point.

That is a high-level perspective of what that connection…how that connection manifests in a real-world way to perceive and interpret it.

DR, DC: So, to of you recapitulate that: if people have disruptions in their circadian rhythm, whether it’s not sleeping at the right time, or having too much light at night, or a inconsistent sleep, that can cause, essentially, leaky gut. And then that leaky gut can cause inflammation. And byproducts of that inflammation, and some of the leaky gut byproducts, can cause you to feel fatigued and tired. Would that be accurate to say that way?

DP: You know, Mike, you broke up when you said that, so I didn’t really catch it. If you want to say it again.

DR, DC: Oh sure, yeah. I’ll say it again. I just want to restate that to try to solidify it. And please correct if I am reinstating anything incorrectly. But, if someone has a disrupted circadian rhythm, whether it be inconsistent time to bed each night, or too much light at night, that can then cause leaky gut. And byproduct of the leaky gut would be inflammation, and also some of these other compounds that leak through the gut. And those can cause you, essentially, to feel fatigued?

DP: Yeah, so I’m going to talk about the first part of what you said now, or at some point here. Generally, the first point that I mentioned was just as connection that, when you have an infection, the body has an immune response, and not immune response can affect the central nervous system centers that are affecting how awake you feel, and then, also, how much how much sleep is generated, and then the type of sleep that is generated. So, that is the high level.

But no, you are right. I haven’t mentioned this yet, but circadian rhythms do have a huge influence on the inner workings of our gut, probably with a lot more detail and depth than we even understand. But, I’ll give you in an overview here.

Sleep, the gut and inflammation

DP: In our gut we have another interleukin; it’s called interleukin 17. At normal levels, it fights bacterial and fungal infections. So, it’s was really good to keep our gut healthy. But, if you have interleukin 17 over activity, then this can cause inflammation. A little bit is great, and too much is not good.

DR, DC: Sure.

DP: So, if you have shifted circadian cycles, then – which you actually can induce with things like jet lag, right? So, in experimental protocols where they’ve given animals…where they are studying mice and they say…because they have very similar systems, interleukin systems that humans do, so it’s a good model to study for this. But if you take them and you shift their clock by six hours every four days, they are, basically, never synchronized – they are always trying to catch up. What ends up happening is you will produce twice the amount of interleukin 17 in the intestines and spleen, all right?

Now, that ends up being potentially very problematic, right? Because, if you have too many, then this immune defense begins to cause illness rather than prevent it, right? So, you end up with this low-grade inflammation, and that can lead to all sorts of problems in your gut.

What I will mention, too, by the way: don’t think of jet lag as just you flying to New York and back, or to Paris and back, it’s just your clock shifting. It has nothing to do with you actually, physically going…

DR, DC: Being on the jet, no.

DP: Actually, there might be some component to that. But, if you usually go to bed at 10 p.m., but you go to bed at 1 or 2 a.m., that’s equivalent to you basically going into jet lag for night. And I know this well, because when I was younger, I would go out all the time, as normal young people would do. And I’d always focus on getting eight hours of sleep. But my clock would shift really drastically on Thursday-Friday-Saturday night, and I felt miserable – miserable because I got into…I did it so frequently that I got into this pattern where my body was never catching, and I was in pretty bad state for a while. There’s something called your tau, which is the length of your own internal rhythm. So, circadian rhythm means about 24 hours, and actually most people’s internal rhythms are longer than 24 hours. So, if you were to put somebody in a light-free environment – so, total darkness – what would happen is …and this research has been done – you end up with this circadian draft, where now somebody starts to produce a cycle that might be 27 hours, or 30 hours even – that’s called your tau, your own, internal length of your own daily pattern.

So, people who are completely blind have this – although some people that are partially blind don’t because they might have functional retinal ganglion cells, but they don’t they don’t have functional rods or cones or optic crack issue. So they can’t see, but actually have fine circadian rhythms. But other people who are totally blind, they are going to have this issue. Let’s say, you know, Mike, I’m totally blind and you’re not, and we are totally synced up. So right now, it is 2:24 (p.m.). And a week from now, you are going to be at…at the same time, it’s going to be 2:24 (p.m.) for you. But, it might be 2 a.m. for me, right, because my rhythm is drifting every single day, every single day. And that’s, basically, the state that I was putting myself in because I wasn’t getting enough environmental input. This is, again, another way to think about it and step back and think, ‘You know, major problems with the health today is we really are dealing with a natural factor deficiency disorder.

In a way it was good; I suffered from it because I was basically sleepy all of the time, and I never felt very alert after a period of doing this for a year or two. And, I had a sleep study. I had sleepiness that was the same magnitude of somebody who had narcolepsy. It took me about three months once I learned to get my rhythms back on track. And I will never forget it because it was a really miserable experience. I had no idea what he was going on, and I was worried that something I did…I had no idea. All I know is that, I couldn’t even read a paragraph because my mind was so sleepy that I just felt like falling asleep constantly. To some degree, a lot of people are dealing with some circadian rhythm issue disorder right now.

DR, DC: And for some people, they may want to chase down something more exotic, like a chronic viral infection, or some kind of inflammatory disorder. That may certainly be an issue, but my clinical hierarchy is always to start with the simplest stuff first, right? So, getting your diet in order and your sleep in order should definitely be addressed before reporting to a clinician’s office. Because your case encapsulates, the answer may be resolved, or maybe found within some of those simple interventions.

DP: Absolutely. You know, once you start to get onto some more medical therapeutics, then it can be a problem if you start to address it artificially and partially, but you are basically blocking some of the feedback that can guide you to better behavior. It’s funny. I’m not trying to be self-promotional here, but I was on the Freakonomics podcast the other day.

DR, DC: Nice.

DP: Huge audience. Yeah, really happy – it’s out now; you can go take a listen to it. It’s just a segment. We talked for an hour-and-a-half, but then it’s like a couple lines. But, it was really cool. I was talking about sleep, and wake and light, and at the end, Stephen Dubner, who is just such a great storyteller, says, “Gosh, he makes it sound so easy, doesn’t it?” Because a lot of it…it’s a two-part series, and they were talking about people and their sleep issues beforehand. It didn’t feel like it was any sort of condescension, but I thought about it afterwards and I said, ‘You know, it should be easy.’ If you are doing…unless you are dealing with a clinical sleep issue, like, for example, narcolepsy – they are missing a protein in their brain so they have a different situation that they are dealing with. But if you’re not, then if you are not providing the stimulation that the body and the brain need in order to function well, then you are going to experience some issues. But if you do, then you should probably function well. It’s almost surprised to us that it should be easy. It’s oh my gosh, he makes getting sleep sounds so easy. But should it be hard, you know?

DR, DC: Right. It really shouldn’t be hard. But, I think you’ve got to get some of your ducks in a row to help make the sleep process easier. That’s something I want to come back to in a minute, which are some practical tips for people, simple things they can do to try to get their clock in sync and help them have an easier and more regenerative sleep.

Diseases affected by sleep

DR, DC: But before we do that, can you provide us with some information on what some of the studies show in terms of diseases that are either made better or worse from lack of sleep or having adequate sleep?

DP: Oh, gosh. You know, really there is no part of the body that is protected by not getting adequate sleep or by mistimed circadian rhythms. That shouldn’t be too much of a surprise. But with insufficient sleep you see cardiovascular disease, coronary-artery disease, hypertension, stroke, metabolic disease, whether this is Type 2 diabetes mellitus, obesity, dyslipidemia, cancers – you see really drastic increases in cancers, particular with circadian misalignment. You see immune dysfunction, as we are talking about. Your ability to fight infection…

DR, DC: Chime something in real quick about breast cancer. I see a number of studies showing that women that have retinal blindness, so they essential can’t sense light, have a significantly lower incidence of breast cancer. I’ve heard that the proposed mechanism for this is these women never did (have) over simulation from light, because they can’t sense light. One of the things light will do is shutdown melatonin production. It’s been theorized that the antioxidants and other protective effects of melatonin actually protect against breast cancer. I don’t know what the results are – I apologized – but I’ve even caught wind of some critical trials where they’ve used melatonin for preventing breast cancer recurrence. So, it’s another thing that support this whole importance of sleep.

DP: Yeah, so melatonin is a darkness hormone. It is produced through this multi-synaptic loop from light entering the eye. So I mean by that is, when light does come into the eye, particularly if it’s a certain type, a certain sufficiency of intensity and it’s a certain wavelength, meaning blue light, then it is going to block the production of melatonin. Melatonin is a darkness hormone more than it is a sleepiness hormone because even nocturnal animals will have high levels of circulating melatonin at night. It is more a response to darkness than it is necessarily a sleeping hormone. So it can have different effects on different species, depending on if they are corpuscular, if they are diurnal, if they are nocturnal. So, when is their activity pattern?

But, we are, if you think about it, we’re getting a lot of low-intensity light during the day. So, it’s enough even in a room to suppress melatonin production, unless it’s really dim. In the evening, the artificial light is usually sufficient to suppress melatonin production. And we’re also getting about 20-percent less sleep than we were 60 years ago. So, what that means is that, where before – particularly if there was a seasonal component to this – you might be getting 12-14, 10 hours of darkness per day. Now, if only spending 6 1/2 hours of time in bed per night, than most of that time is going to be the environment with the rest of that period, of the 24-hour period, is going to be have light in it. So, we are only getting 6 1/2 hours of melatonin production instead of 10 to 14, which is a huge difference…a huge difference. Like you said, melatonin not only is going to influence…it does have a slight soporific effect or sleep-inducing effect. It does tell the master clock, ‘Yes, it is nighttime; make the activity of these clock genes really robust for nighttime activity, which is really important. But it also, like you said, acts as a really powerful antioxidant, it can affect leaky gut, it’s been shown to affect cancer progression, particularly breast cancers. It does a lot of other things body, as well.

Helpful tips to improve sleep

DP: So, you know, somebody, ‘Should we be taking melatonin production?’…oh, excuse me, ‘Should we be taking exogenous melatonin?’

DR, DC: Right. Maybe just working on your sleep might be a more powerful way to do that, and to optimize antioxidant status.

DP: Control your light environment, yep. So, turn down environmental lights in the evening. If you are going to watch TV or use your computer, really consider getting blue-blocking glasses and wearing them. When you are blocking the blue light, your creating what’s called circadian darkness or virtual darkness. It means that you can see, but you are also not telling the brain that it’s day. So, you can be up and watching Game of Thrones, but you are also not going to be telling the brain that it’s daytime out. You are basically going to be producing more melatonin, you’re going to be keeping your rhythms aligned. But you’ve got to wear them regularly

But even if you don’t wear them super regularly, I still think that there could be a benefit of wearing them just pretty frequently. Because then, at least you are going to have some days where you are producing a lot more melatonin than others. But, you also might have a little bit more fluctuation within what time of day your brain thinks it is. I’m kind of still ruminating on that idea. Like, if you are not going to wear them really consistently, should you at all? I still think that I would say probably it’s good to wear them pretty consistently. So, I put my glasses on two hours before bed. And, I even got a pair that I think is decent enough where I will wear them even if I a out at dinner. The ones you can get online are not the most attractive in the world. But, you know, if you don’t feel comfortable wearing them out, just wear them them when you are at home.

DR, DC: Sure. And so, that’s a great segue point to some simple lifestyle things people can do to help with this. I’ll jump in with a few and see if we can knockout most of the important ones. Light – definitely really important. I use on my computer and on my cell phone, I use a blue light filter at night. I also dim the lights. Even in my bedroom, I have a full-spectrum light bulb I use during the day. And then I actually switch the light bulb at nighttime to a very yellow, soft white light bulb. So, I do as much as I can to weed out any sort of blue light at nighttime, by blue light filters or using a more-yellow light bulb and also dimming the lights.

I try to do less TV, and one of the reasons for that is, as I understand it, there is a system called your zeitgeber. How do you pronounce that, Dan? I am sure I am butchering that.

DP: Oh god, I am sure that I am too. But, zeitgebers are…

DR, DC: I know another stimulus for that…so this would be similar to light, as I understand it, is people, is human and social interactions. It’s possible that if you are watching TV and seeing a lot of people on TV – I am speculating here, but – if you are seeing a lot of people on TV, especially if you are seeing violent things being done by or two people on TV at nighttime, that may really be a negative in terms of your sleep health. So, I think TV as much as you can try to avoid it. Nighttime is probably a really good bet.

On the flip side of that, trying to have exposure to light and some movement and some interesting people in the morning. One thing I would throw out there as a challenge to people listening to this who, maybe, aren’t feeling as healthy as they’d like, for two weeks try to – when you get up fairly early, fairly close to when you get up – try to get outside and get a little bit of activity, and preferably do it with a friend. So maybe doing a short walk outside in the morning with a friend. You will get light, you’ll get activity, and you will get that exposure to people, which has a modulating effect on your circadian rhythms. So, those are a few big ones from my side of table.

Another one that you mentioned earlier, Dan, I want to definitely restate, is a clearing of any infections. I can’t count how many patients have come in with disrupted sleep. We find something like Candida, yersinia enterocolitis, SIBO, some other sort of gut infection or gut inflammatory disorder. When we clear that up, the first thing people say, ‘Ah jeez, Doc. I am sleeping so much better.’ We didn’t do anything else – just clean up the gut, clean up the chronic infection. And sleep just gets so much better. So, those are a few things that I recommend. Dan, anything to add to that?

DP: I think those are great points. What I mentioned is certainly not comprehensive, but there are a lot of things that can disturb your sleep, especially things that are happening in your body. If you have some GI distress from any number of reasons, that can cause you to wake up at night. That sort of sleep fragmentation – it can be this vicious circle, because if you are waking up a lot at night, that can make it harder for you to fight infection, which can make you sicker. So, like you said, sometimes the best you can do is identify the cause of, like you said, if it’s SIBO, any number of GI issues, address that. I completely believe that could solve all of your sleep issues, if that’s the primary cause of your sleep disturbance.

There are other things like not having too much caffeine too late in the day. Not having too much alcohol close to bed. All of these things are known to disrupt your sleep – alcohol will make you fall asleep faster, but, as it’s metabolizing, it will alert your central nervous system and make your sleep lighter. So, the time of the night when you are getting your deepest sleep, which is really important for physical restoration, you’re actually going to be in a lot lighter stages. You’re not going to is not going to get the benefit that you’d like.

There’s also some new research looking at slow-wave sleep. So, slow-wave sleep is the deepest sleep that the brain and the body get. From .4 to 1 Hz, that type of slow-wave sleep, which is…when I say hertz, it’s the electrical pattern that is shown, when you undergo something called an electroencephalography – you’re monitoring brainwave activity from the outside during the sleep study. So, if you’ve ever had one done, the sleep study is called a polysomnogram. One of the things they are measuring is electrical activity of the brain. During this state where you are getting that exact hertz of brain wave activity, you are also clearing from the brain what can amount to these neurotoxic substances if they accumulate – beta-amyloid. What is interesting, talking about vicious cycles – so, your brain clears beta-amyloid most efficiently during that type of slow wave sleep.

DR, DC: Which is, just to clarify for people, one of the main plagues implicated in Alzheimer’s disease.

DP: That’s right. Yeah. When the part of the brain that is generating that type of slow wave sleep – it’s called the medial prefrontal cortex. When you don’t get adequate sleep for a long enough period of time, the accumulation of beta-amyloid, and then suppress slow wave sleep from occurring – which is now going to be a really pathological process, where you might not be getting very much slow wave sleep at all, and you might be on a slow decline towards mild cognitive impairment, dementia, Alzheimer’s. And it can take awhile to happen, but, yeah, it is happening; we see that quite often.

DR, DC: Well, if that doesn’t motivate you to work on your sleep, I don’t know what will. Boy, that’s a scary one. And so, no Irish coffee before bed; that wouldn’t be a good pre-bed drink?

(laughter)

DP: Yeah, I guess that’s the worst combo.

(laughter)

Best and worst things Dan has done for his health

DR, DC: Well, Dan. I want to bring us to a close here. But there is one thing what is more thing I’d like to ask you that I am trying to ask all of my guests. And to give you the preface to this, we talk a lot about health, and definitely sounds health practices are incredibly important. But sometimes we get so caught up in the healthy stuff, we can become neurotic with health. We can actually become less healthy because were are so neurotic about health and we forget how to have fun and to lighten up and just live and be in the moment.

So, I’d like to ask you what the best thing and the worst thing that you’ve done for your health in the past weeks has been?

DP: Let’s see. So the best thing that I’ve done for my health…

DR, DC: Besides talking to me, which I am sure is very uplifting and everything.

DP: It always has this pacifying…this general salubrious feeling that I get…

DR, DC: I put you to sleep, pretty much.

(laughter)

DP: Gosh, OK. So, I think that I’ve been maintaining a really regular indoor cycling practice on Sundays, so I am going to point to that. I love mountain biking right now because I’ve got a little baby boy who is two years old – it works really well for my wife and I to…basically, I do a class in the morning on Sundays, and then she comes to the one right after me. So it’s actually two parts – it’s taking the class and then getting to spend a little time with him, where we just go look at trains and turtles. Both of those…I wonder what is actually healthier. Probably both – incredibly health promoting. It’s actually having a regular practice, where I know I am going to be getting…I’m going to be doing something that I am committed to. It feels so good. I look forward to it. That’s a really excellent thing. So, my Sundays are entirely reserved for that. Well, not the whole day, but the mornings usually. So, that’s been great.

And I will tell you that, even as much as I talk about sleep, and I promote it, and try not to be a hypocrite – in fact, I wrote a blog describing my health practice for 2014, where I analyzed my physical activity, I analyzed my sleep, I analyzed my weight. And you can go take a look at that. It’s called ‘2014 Health Practice Report’. So, you can see I put my money where my mouth is. I do the things that I promote.

But, it’s still so easy to not get sleep, for one reason or another. Whether it’s something social, or a little bit of insomnia for your mind just working on something. And so, the last couple of weeks I’ve had a little bit of insomnia just because I got a lot of stuff on my plate, which I all love. And sometimes turn off bit late, which means I don’t really shut down for a couple hours after I want to go to bed.

DR, DC: Sure.

DP: And, you know, it’s kind of like, ‘Avoid all stress.’ You know, sometimes life has stress in it. It’s how you deal with it. I know that this is something that I’ve made the decision. I’m not surprised by this – I’ve made the decision to do this. I think that the way that I am going to respond to it is by making sure that it’s, like, (an) even higher priority when I do have control over, which I’m doing.

That’s kind of thing: you can make mistakes a lot, but it’s how you responded to them. I don’t try to be perfect, but I try to make sure that my average pattern is really, really solid.

DR, DC: Sure, and I think there’s probably an ancestral component to that, meaning that our more indigenous predecessors I’m sure went through periods where there was some stress, and sleep wasn’t as good.

DP: Totally.

DR, DC: And then they went into a recovery period. Also, if you’ve got a lot of other good supports in your life, like diet, exercise, and good social relations, and a purpose, then I think probably have the best odds to mitigate the negative effects. There is even some research suggesting this [2] – I hate citing animal data; I really try to limit my things to human studies as much as possible, but this animal study is important in this context. They disrupted the sleep cycles of two groups of rats. One group of rates was being fed a high-fat/high sugar diet – which, of course, is not healthy for the rats. And the other half were being fed your standard healthy rat chow. And, it was only the rats that were eating healthy and had the sleep disruption that showed deleterious changes in their gut microbiota. So, there is some evidence that maybe supports that if you have other healthy practices, you can more so absorb and ameliorate some other stresses like sleep or what have you.

DP: I think that’s absolutely true…absolutely true. Just taking a ‘which way is the wind blowing’ kind-of sample in my own mind from what I’ve seen looking at the interaction between lifestyle factors and ultimate influence on health. It does mater for sure.

DR, DC: And it kind of comes back to that allostatic load concept – how much stress can you put on an organism before some system breaks. And, of course, the more stressors you can take off, the more resilient you will be to an additional stressor.

DP: Yeah, that’s right. That’s right.

More helpful tips to improve sleep

Dr. Rusico, DC voice over:
Hey, everyone. I just wanted to interject here. There were a few things that Dan and I didn’t get a chance to cover that are practical tips that I think can really help with sleep. So, I just wanted to rattle those off now really quickly. One really important concept for sleep is regulation of blood sugar. One of the things that can make it hard for people to either fall asleep or more commonly to be able to stay asleep can be imbalances in blood sugar. And so, there are a couple things you can do to help with this. One thing that can be helpful with sleep is adrenal support. If your adrenals are going into fatigue, and you don’t have adequate cortisol production at night – and your blood sugar can go low at nighttime. This will cause you to wake up. The main mechanism and the main reason for this is because, if your body can’t bring up blood sugar with cortisol, it will use adrenaline instead. And adrenaline, of course, is a very stimulating hormone. That can be one of the reasons people wake up in the middle of the night – their mind is racing, they are thinking and they can’t fall back asleep.

So, adrenal support can help with that.

Now, other things that can also help with that are having a snack when you wake up – because, if your blood sugar is low, whether because of adrenal issues or other issue, a snack can help to balance out that blood sugar. How much carbs should you have? How much protein or fat should you have? I find it is best for people to play with that a little bit. I’ve noticed that a little bit more of a carb-rich snack works well for me. But that’s certainly not for everybody. So, play around a little bit with the snack that you eat to see what type of meal – either heavier, more of a protein/fat type of meal, or a lighter, more carb-rich meal tends to work better for you.

That same thing can apply before you go to bed. If you do have a tendency toward low blood-sugar, having a snack before bed kind of puts a little bit of fuel in the tank and helps keep your blood-sugar up, preventing it from crashing. Again, you may do better with a lower-carb meal, or higher-carb meal, or snack that is, to help with sleep.

And we did mention this, but I just wanted to reiterate stimulants. Excessive stimulants is definitely something that can be a problem for sleep. Coffee, caffeine, any other type of stimulates can definitely be a problem. So, that’s kind of a no-brainer, but you may want to cut those back if you are not sleeping well.

OK, hope this helps. Thanks.

Episode wrap-up

DR, DC: Cool. All right, my man. Well, this has been a very call, as I knew it would be. Is there anything you want to close with, and anything you want to make people aware of? In terms of projects or things that you are working on?

DP: Oh, yeah. Sure. Let’s see, first of all, thank you for having me on. I really appreciate it. I think you are doing great work, so it’s an honor to be here. I learn a lot from you, so I just want to thank you for all the effort you are making.

If anybody wants to check out Dan’s Plan, you can go there and sign up for free. There are some tracking devices that… everything we are doing is trying to help you with your pattern, your daily pattern. It’s nice to get that feedback because then you can kind of check in. I think of these trackers like Fitbits, ect., as…it’s not like it’s tracking what you are doing. But I think of them as performance enhancing devices. By wearing them and engaging with them, you are engaging more with your health practice. And that can help – over the course of the year, that could mean that you are averaging closer to 10,000 steps per day versus six or seven (thousand). That quantity difference could be meaningful. So, that’s what I would say – go check it out, see what you think. We are going be making some very big changes later this year, so we are going to be launching a whole new version of the site with a new brand and everything. I am very excited about it. So stay tuned for that. But anybody that signs up know will get all of the notifications for it. Who knows, you might even see Mike Ruscio on there.

DR, DC: Hopefully, one day, you know, if I keep on the road I am on, maybe you’ll have me on there.

(laughter)

DR, DC: I cut my chops here. And just for people who haven’t heard of Dan’s Plan, maybe a short summery of what that is – it’s essentially an unbelievable tool that helps you integrate some of your lifestyle practices, especially if you are using some kind of a tracking device like a Fitbit. It’s a platform that integrates all that data together and helps you gauge where you are at, where you should be, and some actions you can take to become healthier. Right? Is that a halfway decent summery?

DP: It really is. So, there are so many health applications that are always trying to get you perform better, more. If you can run a six-minute mile, you should be running a five-minute-and-forty-five-second mile. You know, not really. There is a difference between performance and health. What I am interested in is are you maintaining a pattern that’s going to yield health long-term. Again, is the summery of your weekly exercise adequate in terms of what we best know about the amount of physical activity that going to keep you healthy? Are your daily steps – which isn’t an exercise but a measure or low-intensity physical activity- is that adequate? There is a dual benefit of some activity but also counteracting sedentary behavior. Are you getting into be on time? Are you spending enough time in bed? I use these tools myself regularly. One way to mis-perceive them is to say, ‘Well, it’s only for a novice, and once you learn the importance, then they no longer have value.’ Totally not true. Actually, they can help somebody that doesn’t have necessarily a lot of information on all of the neurobiology of sleep. Or they can help somebody that is a professor in it. It’s actually just helping you stay mindful with are you meeting your own daily health goals on a regular basis? That’s the only thing that gets you…well, it’s one of the…actually, I’d say it’s the primary thing gets you real results. So, I would say check it out. Use it to your advantage. It’s a tool that’s out there. And, you know, I am happy to take any questions from people – there are ways you can get in touch with us. You can write comments on the blog. We love interacting with anybody that’s kind of thinking about how to work this into their lives.

DR, DC: Cool, cool. I’m sure some people will check that out – it’s definitely a great tool for tracking all those daily activity steps, and exercise, and sleep, and all that good stuff. Yeah, I love what you are doing over there. I’m excited to see your launch of the update of the platform; I know you’ve been working hard on that. So, yeah. Maybe we will have you back on when that launches. You can give us a walk-through to some of the cool bells and whistles you’ve added in.

DP: That would be awesome. Thanks, man. I would love to come back.

DR: Absolutely. Well, Dan, thank you so much. And good luck with the new launch and we will talk again soon.

DP: OK, Mike. Take care.

DR, DC: All right. Good-bye.

Thank you for listening to Dr. Ruscio, DC Radio today. Check us out on iTunes and leave a review. Visit DrRusso.com to ask a question for an upcoming podcast. Post comments for today’s show and sign-up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.