[00:00:00.000] - Dr. Lemanne

If you're unfortunate enough to have certain types of cancer, the time of day that you receive your treatment may affect how well the treatment works, whether it works at all, and how many side effects you have. 

You have found your way to the Lemanne-Gordon podcast where Docs Talk Shop. Happy eavesdropping. I'm Dr. Dawn Lemanne. I treat cancer patients.

[00:00:31.460] - Dr. Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:00:35.260] - Dr. Lemanne

We've been in practice a long time.

[00:00:37.580] - Dr. Gordon

A very long time.

[00:00:39.250] - Dr. Lemanne

We learn so much talking to each other.

[00:00:41.130] - Dr. Gordon

We do. What if we let people listen in?

[00:00:50.030] - Dr. Lemanne

In this episode, Dr. Gordon and I discuss how strengthening one of life's most basic rhythms, that of alternating light and dark, is crucial for not only the quality of our sleep, but also for decreasing our cancer risk and improving brain health. The effect of our daily light-dark rhythm is not trivial. If you are in treatment for cancer, for instance, it might matter the time of day you receive your treatment. We discuss how to repair a disrupted circadian rhythm, for example, after a night of disturbed sleep rather than spend the next day napping to catch up, it might be best to resume a healthy rhythm by turning in on time the next night. Lost sleep also causes high blood glucose, insulin resistance, and carbohydrate cravings the very next day. We do reveal, however, the best way to recover from that meal of too many carbs. Go for a brisk walk. This will instantly bring down the blood glucose. If you're under treatment for breast cancer, exercise a little more vigorously and at least three times a week, because exercise during breast cancer chemotherapy increases your chances of survival. We wrap up this episode with some life hacks we use with ourselves and our patients to ensure the optimal quality and timing of our oh-so-valuable time asleep.

[00:02:24.270] - Dr. Lemanne

I need a piece of paper to use as a filter. So you want to know what the ambient light is in the room right now?

[00:02:29.950] - Dr. Gordon

I do because- I have an app for that.

[00:02:33.840] - Dr. Lemanne

It's on my smartphone. Let me pull it up here and I'll give you the number in a minute. Because we were just talking about, yes, we know that if you try and sleep under a spotlight or even sleep exposed to street light, that affects your quality of sleep and your subsequent health.

[00:02:52.810] - Dr. Gordon

And we were talking about how low the light level is when you're out on a starry night without a moon and what lux level that is. Because, of course, in our human evolution, a starry night without the moon on is the darkest environment we were exposed to during the process of evolution.

[00:03:20.560] - Dr. Lemanne

Well, in this room that is a little bit dim, the room I'm in right now, it's got a light and there are a couple of windows with window dressings on them. I'm getting about 300 lux, which is dim.

[00:03:31.640] - Dr. Gordon

That is dim. The study I found that looked at the lowest level of light exposure, the lux level was 100, which I bet if your overhead lights were turned at... I bet actually 100 lux is significant. And they described it as a room that you could walk around, but if you really wanted to find a new way in the dark, you would want to have your light on or light your phone dial and use it as a flashlight, your watch dial or the flashlight on your phone. So I bet 100 lux is actually more light than most starry nights would be my guess. If that's 300 in the room you're in.

[00:04:16.750] - Dr. Lemanne

Well, next time I'm in a starry night, I will whip out my app and see what we've got going.

[00:04:23.030] - Dr. Gordon

Yeah. And I'd like you to share that app with me because I used to have one and I don't have it anymore. So if you let me know what that is.

[00:04:29.130] - Dr. Lemanne

The one I'm using is It's called light meter. I put it on my iPhone. And you need to have a piece of paper as a diffuser. I think that makes it less accurate because I'm not using a really constant piece of paper each time. I just grabbed a piece of paper from my briefcase here. But it gives me the general idea. And one of the things that I find really fascinating is that we can't tell how bright something is. Our eyes adjust so rapidly and so well by our pupils constricting an opening that the amount of light that reaches our retina stays pretty constant in dim light or really bright light. And so, for instance, if you got doors with this little lux meter that I have on my iPhone at noon and put a piece of notebook paper as a diffuser on it, I'll get... I got 300 lux in here in this dim-ish room, which I can easily walk around in. Outside, I can get 100,000 lux. A hundred thousand. I think that's right. Maybe I'm off by a factor of 10, but it's orders of magnitude more than indoors. And yet we don't perceive that much difference between indoors and outdoors.

[00:05:41.780] - Dr. Lemanne

It's somewhat, but not...

[00:05:43.090] - Dr. Gordon

Not that order of magnitude.

[00:05:45.190] - Dr. Lemanne

So we adjust really, really well. And so we can't tell. Our eyes just adjust and say, we need this much light. And so they open and shut the windows, basically. So we get that much.

[00:05:57.780] - Dr. Gordon

Interesting. We have poor perceptive abilities when it comes to the level of light, because our eyes have excellent perceptive ability and know how to respond.

[00:06:08.450] - Dr. Lemanne

They just fix it for us.

[00:06:09.490] - Dr. Gordon

They fix it for us, yeah. Well, the reason I wanted to know the level of lux is because I was curious and looked around, talking about how light at night affects our subsequent health. The lowest level of light exposure I found that was studied There was a small group of 20 folks who were studied in 100 lux versus totally dark. And so that's not very much, but it's maybe more than a dark night outside. And the group exposed to the light had elevated heart rates throughout the night. So if you're tracking your sleep at night, one of the things most sleep trackers include is your pulse rate. Oh, your heart was elevated. It took a long time to drop last night. It also affects your heart rate variability, diminishes your heart rate variability, and affects people's metabolic health. So they have some degree of insulin resistance in the morning. And that was all while they were tracking melatonin. It wasn't sufficient light to diminish people's levels of melatonin, but it was enough to affect what we use as markers of sleep quality and enough to affect metabolic health the next day.

[00:07:36.360] - Dr. Lemanne

And I think, why should we care about this? And the answer is, it will floor you. I mean, I don't think it'll floor you. You probably think about this day and night, especially at daytime, I hope. But how much light you're exposed to It affects whether you're going to live or die of cancer, heart disease, dementia, diabetes, all those things, and how well you respond to cancer treatment depends on what time of day, how much light there is around, that you've been given the treatment?

[00:08:16.530] - Dr. Gordon

Wait, how you respond to your chemo. So the other things I knew- That's a wait, what? I think we should talk about all the other issues that you brought up. But Is it the light in the room or the light overnight when you sleep? Or what are you talking about how light affects your response to chemo?

[00:08:38.290] - Dr. Lemanne

I'll back up a little bit. Your circadian rhythm, your entrainment with the light and dark cycles of the day, how well you're entrained. And for most of us, that means we are awake in the daytime when it's light and we sleep at night when it's dark. If we're entrained that way, which we should be, the time of day, and if you're unfortunate enough to certain types of cancer, the time of day that you receive your treatment may affect how well the treatment works, whether it works at all, and how many side effects you have.

[00:09:10.900] - Dr. Gordon

And it differs by gender. And do oncologists ask you about your... I mean, is it standard for everybody? Does 9:00 AM chemo work better than 4:00 PM chemo?

[00:09:25.930] - Dr. Lemanne

For men. For women, 4:00 So I'm talking about a 2000, I believe it was a 2007 study by Levy et al, published in Lancet Oncology. And what they found were that in patients with cancer, I believe it was colon cancer, who were undergoing platinum-based chemotherapy. Usually the drug used is something called Oxaloplatin. They probably also used 5-FU. It may have been more based on the 5-FU. We'll have to look that up, and I'll put this in the show notes, this study by Levy et 2007 Lancet Oncology. But the upshot was that men responded better when their, I believe it was Flora urusil 5-FU was given in the morning, and women responded better when In there, five a few was given in the afternoon, late in the day. And for both groups, the side effects were lessened when the drug was given in the morning for men and in the afternoon for women. So not only did the drug work better when it was given at the right time of day for the gender, it also did less damage to normal cells, which is what we call side effects. So again, I believe this was gastrointestinal cancers, and I believe the drug was an anti-metabolite called 5-fluorouracil, nicknamed 5-FU.

[00:10:50.510] - Dr. Lemanne

I'll look that up and I'll put that study in the show notes, but that was one of the seminal studies that looked at what's called chrono chemotherapy, which means matching the chemotherapy dosing schedule to our circadian rhythm.

[00:11:12.220] - Dr. Gordon

I hear that and I jump on it and say, all women should be scheduled at this time of day, and all men should be scheduled at this time of day, no matter what cancer. And I think there is a tendency because we are so lost out in the ocean without a raft when we are facing cancer, most of us would have that feeling to generalize. And I think you're saying, really, it can't truly be generalized yet.

[00:11:37.080] - Dr. Lemanne

So all cancers are different. And in fact, cancers of the colon are different, whether the colon is something like five or six feet long. And if the tumor is near the rectal end. It has a different biology and different treatment needs, even different drug needs, than a colon cancer that starts up near the appendix at the beginning of the colon in the secum, the part of the colon called the secum. Those are different diseases. They have different risk factors and all sorts of differences, and different, as I mentioned, drug sensitivities. And so, yes, and this study was done only in one set of patients with one type of cancer, looking at one particular drug. So we can't generalize at all. But it does give us the idea that, wow, maybe these things do make a difference.

[00:12:24.860] - Dr. Gordon

Yes. And if someone were setting up a study for a particular chemotherapeutic agent, it might be interesting to try and include that as a variable. Oh, it didn't really work that well when we gave it to anybody at 10:00 in the morning. But if we picked eight or four, it worked really well.

[00:12:41.480] - Dr. Lemanne

And that will probably never be done because cancer treatment studies using chemotherapy and using an old fashioned trial designed called the randomized controlled trial, which is now, I think, needing to be retired in many cases, especially as the gold standard. Of course, it's important, but it performs so poorly in oncology that we need to rethink it. I forgot what I was going with it.

[00:13:12.880] - Dr. Gordon

Why the trials are not going to be done with that little detail I wanted inserted. Yes, thank you.

[00:13:18.350] - Dr. Lemanne

I wandered off there. But yes, because I get so excited about the randomized controlled trial being called the gold standard.

[00:13:24.600] - Dr. Gordon

I know. We're going to talk about that next time, okay? Okay.

[00:13:27.490] - Dr. Lemanne

It makes me mad. But yeah, The trials won't be done. So we'll have to do them ourselves, and we will. One of my goals is to make every single cancer patient an N-of-one trial. And I'm not the only one who thinks that way. There are more and more oncologists and other scientists who are working to develop trial designs using each patient as their own control. Is this working? Is this not? If not, move on to the next treatment.

[00:13:57.970] - Dr. Gordon

And we really will devote an episode to talk about this because it's fascinating. But we will also in this episode put a link to the book that you helped come to public light about a cancer treatment, a cancer patient using an N of one approach.

[00:14:15.060] - Dr. Lemanne

Oh, the book is named N of One.

[00:14:16.810] - Dr. Gordon

Yeah, it's pretty easy, but we'll still put a link to it. The circadian rhythm, when we talk about it, it is so complicated because there's your Yes, it's our human adaptation that our bodies are geared up to face the world when the world is light, and we are geared up to recover and restore ourselves when the world is dark. And that did raise the question we were talking about beforehand. If there are planets that have parts of the planet that are always light or always dark, do those people, whatever they are, aliens, not have circadian rhythms? Because every part of our planet, of course, except really the poles, don't go. They're either pretty much... Well, that's not really true. Anyway, there's our body's adaptation to exposure to light and exposure to dark. There are chemicals There's different styles that change that way. There's suitability to different circadian rhythms, and then there's interruption to the circadian rhythms by either anxiety, you can't sleep at night, how should you approach that? Or you're staying in a motel that doesn't have curtains and there's bright lights outside. And how does that affect all the influences that come on our naturally, environmentally entrained circadian rhythms?

[00:15:45.080] - Dr. Lemanne

Well, there are other rhythms besides circadian rhythms, biological rhythms. There's seasonal rhythms. So for instance, cancer diagnosis go in seasons, and we think maybe the growth of cancers varies by seasons as well. And I wanted to say as another aside, I think this thinking about space aliens, what their biology might be is a really powerful way. It's a powerful thought experiment and a powerful way to start to look at our own biology from outside the fishbowl rather than from inside. And so, yeah, I think that's a really valid way of thinking about things. And I think that's a good... I really like that. You're so smart.

[00:16:27.690] - Dr. Gordon

I love talking to you. I don't have any answers. I just like, oh, well.

[00:16:31.520] - Dr. Lemanne

You ask the right questions. That's good.

[00:16:33.920] - Dr. Gordon

If the dark and light... Because there was one study I read, and I'm not going to find it immediately while we talk, that was talking about sleep loss and diminution of sleep quality by exposure to light at night. And there's lots to say about that. But it impaired you more if it disrupted your adherence to your normal circadian rhythm. So by what What I mean by that is I typically go to bed at 9:00 or 9:30, and I get up at 5:30 to 6:30 every morning. And if I have a terrible night of sleep, the best thing for me the next night, well, even that day, would still be to get up at 5:30 or 6, the normal time I get up, not stay in bed longer because then I am fast forwarding, jump forwarding my whole circadian rhythm. If I try and keep my circadian rhythm as much as possible, have any I might take in the middle of my daytime rather than close to my next bedtime, it has a less bad effect than if you have a bad night of sleep and then get off kilter with your circadian rhythm. And everybody's circadian rhythm seems to be pretty variable, except for something you told me earlier today about camping.

[00:17:53.690] - Dr. Lemanne

Well, yeah. So people will sort themselves into, I'm a morning person, I'm an evening person, I'm in the middle. I haven't met anybody that says I'm in the middle. They'll say I'm in the morning, I'm a morning person. But when we actually look a little more closely, people do pars out into several groups more than two. But after one week of sleeping outdoors and waking up with the sun, everyone becomes a morning person. It's after seven days. And the circadian rhythms very much lock into that sunrise and sunset rhythm in everyone, every single human being. So we are built to respond to light and dark cycles and respond very strongly. And just missing a few hours of sleep makes a normal person diabetic the next day. Now, the diabetes goes away when they get a good night's sleep following that. But I think that's a pretty remarkable... I think if people knew that, that might really impress upon them how important it is to really get to sleep. And of course, they are frankly diabetic. If they want to improve things. It's becoming clearer that type 2 diabetes is completely reversible. It's not a chronic, progressive disease, as the ADA used to say, that requires more and more medications.

[00:19:15.740] - Dr. Lemanne

It's reversible with stringent lifestyle measures. One of those lifestyle measures is regular deep sleep that starts early in the evening, as soon as it gets dark. So, yeah, I think if people understood that sleep loss and messes with the circadian rhythm immediately and immediately makes you sick the next day in measurable ways, we can check it in your blood. We can And see that your blood sugar is much higher with the same food. I think that would be very impactful for people. I think that would be helpful.

[00:19:54.430] - Dr. Gordon

Well, one of the studies that I think I read this in Matthew Walker's book, Why We Sleep, which got me particularly interested in all the little nitty-gritty details of sleep, was they had people at a residential retreat, and they purposely restricted the sleep, shortened. So I think there's two ways to impair the quality of sleep. But right now, I'm just talking about restricting the sleep. They didn't let them sleep as long. I think it was five hours versus seven or eight. And they were all exposed to the same buffet And they counted the calories those people ate the next day. And they ate several hundred more calories, the group that was sleep-restricted the night before. And they thought they were all there for the cognitive test, which they did take in the ensuing hours. And of course, that showed a difference as well. But just so evident, their tendency to diabetes, meaning their insulin... So their sugar goes up, their insulin goes up, everything goes up when they get this diabetes Eats from one night of bad sleep?

[00:21:02.290] - Dr. Lemanne

They become insulin resistant.

[00:21:03.730] - Dr. Gordon

Insulin resistant. So if you have good insulin sensitivity, you eat a cookie and it goes into your system and you feel its effects and it feels good. And if you're used to that and you eat a cookie and the insulin doesn't work, so the sugar is just floating around your system and not going into the places it likes to work, you're going to eat another cookie.

[00:21:23.990] - Dr. Lemanne

Right. Your brain is sensing that you're not getting enough energy from your food. So the brain's answer always eat more food, which is detrimental for the overall metabolic health. Yeah.

[00:21:37.850] - Dr. Gordon

And I would say, and I've read this more for cognitive effects, but even if you let people have a good seven hour, eight hours of sleep every night, but you have half of them sleep in a room with some degree of light in it. Or the study I remember reading was a risk of breast cancer in women who slept in rooms with no shades and lived near neon lights. So this was actually after I just had a trip to New York and wondered, how the heck am I going to sleep in this bed in this person's generously offered living room when there's all this neon light outside? I wasn't even focused on the noise. It was the light that bothered me. And so I looked it up and I believe, and you're the person to ask about this, that that increases breast cancer risk.

[00:22:31.980] - Dr. Lemanne

So light at night exposure has been studied quite extensively and is associated. These are associative studies. We can't try to give somebody breast cancer, but associative studies, so they're not as powerful, statistically. But there is a connection, an association between exposure to light at night and breast cancer risk. And it seems to be mediated through metabolic issues. So again, the blood sugar insulin resistance duo rears its head in this particular scenario as well. So if you have poor sleep, you're going to be mildly diabetic the next day. And the more you do that, the greater your risk, the more you're diabetic, either in length of time or depth of diabetes, the greater your risk of breast cancer, especially in the premenopausal setting. So that's premenopausal breast cancer is typically a little bit more deadly than postmenopausal breast cancer. And the etiologies vary a little bit. We don't completely understand the differences, but there is some strong connection with glucose regulation.

[00:23:47.690] - Dr. Gordon

Now, when we talk about the metabolic processes that may be associated with or increase your risk of breast cancer, I always lump those together in my mind. Breast cancer, colon cancer, and prostate cancer as the most insulin responsive cancers, and prostate probably is off the table for younger people. But I wonder, isn't that true for colon cancer, too?

[00:24:14.240] - Dr. Lemanne

So colon cancer and prostate cancer, a little bit different. They're all a little bit different. So I don't lump them together in the same way, although I might if I weren't treating them, because the differences may be less important in that case. But So yes, so rectal cancer in particular related to glucose instability. So big peaks in glucose and insulin seem to predispose people to rectal cancer more than cancer in other parts of the colon.

[00:24:46.810] - Dr. Gordon

Interesting. Because, if I have patients who are in continuous glucose monitors, I never think the peaks are bad as long as they go down pretty quickly, meaning they have insulin sensitivity, they make insulin and it works. But just having high peaks that sometimes during the day their blood sugar is really high would increase somebody's risk for rectal cancer.

[00:25:13.700] - Dr. Lemanne

I think so. And we have to sort this out a little bit more, but certainly the more the peaks of insulin and also the area under the curve. So the longer your insulin is high, of course, that's going to be problematic. So a person with, Frank, type 2 diabetes, their insulin level will be really high, and the glucose level will be high, too. But the insulin level being high is the main problem in type 2 diabetes. And that is a growth factor for cancer, many cancers, especially distal or rectal colon cancers.

[00:25:45.540] - Dr. Gordon

And do you... So I measure fasting insulin in everybody. And I don't think that's common practice now, but of course, all of us who do it think it should be common practice. But what I don't measure routinely, but do in some circumstances, is insulin-like growth factor one. So do those increase risk? And I think they both respond to area under the curve of elevated blood sugar. Do they impact cancer risk differently? Talking about breast cancer, colon cancer?

[00:26:20.640] - Dr. Lemanne

I used to say, sure, IGF1 levels are really important. And now I'm not so sure because we haven't looked at the excursion of IGF1 levels throughout We don't know how much they go up or down throughout the day. Does it rise with a meal? Does it go away with exercise? How much does it waver? In other words, from high to low within a day? And just checking it every few months once, maybe like checking the glucose level once every few months, not really very useful. And so I'm not sure I would be as firm in my answer as I might have been a couple of years ago about that. So what I've been doing is putting continuous glucose monitors on a lot of my patients that I worry about this with. And we actually look at the excursion of glucose. And ideally, the fasting glucose gets down into the 70s at some point during the day, usually at the early morning hours, around the time you wake up after the longest part of your daily fast. And hopefully the glucose excursion, the highs after meals, don't go higher than 140 in someone who- They go up to 140?

[00:27:33.680] - Dr. Lemanne

And in some people, you want it to stay down to 120. So if I have an athlete or something like that and they eat a carb meal and they want to go work out afterwards, which is a good way to lower your blood glucose, if you're going to eat carbs, eat them right before you go work out, please. And they might go up to 140. And I think that's okay because they're stimulating M4, they're building muscle. The fuel from the carb load is going to go to building muscle muscle glycagen and will preserve some of the protein for muscle protein synthesis, et cetera. So it's probably good for those people. But for someone who's sedentary and who doesn't exercise a lot, I really don't want that blood sugar to go up over 120.

[00:28:15.620] - Dr. Gordon

Because it's more likely to stay for a longer period of time, whatever it goes up to.

[00:28:22.410] - Dr. Lemanne

Yeah. So that's one of the rhythms I think is really important. If you're going to eat carbs and you have a tendency to high blood sugar, And you just have to have a carb meal of some sort. Go ahead, but wear your continuous glucose monitor and make sure that you're going for a big, brisk walk right after. I mean, as soon as you put your fork down, don't go do the dishes or read a magazine or something, let your food to just put that fork down and go out the front door and walk, briskly, and watch that blood sugar flatten out and not go up high. You'll use it up right then and there. So it's a nice way to have your donut. Don't eat donuts. Don't eat donut. But if you do, that's a way to mitigate the damage.

[00:29:04.990] - Dr. Gordon

Isn't it true? And I remember reading this when I became interested in this whole area intently with Gary Taub's book, Good Calories, Bad Calories, that came out, wow, now, like 15 or more years ago, more than that. And one of the things he pointed out and he relied upon was that that's also true right after vigorous exercise.

[00:29:28.700] - Dr. Lemanne

So I think you have to check. I'm not convinced with that. Put the glucose monitor on and see. Different people are different. And it depends. It's going to depend on gender. It's going to depend on your sleep deprivation status the night before. It's going to depend on how much muscle mass you have and how fit you are overall. It's going to depend on how much you've been exercising or fasting in the days before you do this little test on yourself. So no, I really am backing away from giving specific dietary theory advice without data, without measuring. So I will measure now with a continuous glucose monitor what's happening to your blood sugar.

[00:30:10.670] - Dr. Gordon

That would be great to take it, to eat whatever carb. So I do think it's important to eat carbs somewhere around exercise, and perhaps I'm going to have to switch it to just before. The benefit of eating carbs just before you exercise is you will make some insulin. And as you go to exercise, that growth hormone will not be tending so much to make fat cells as it will- Or cancer cells. Or cancer cells, thank you, as it will tend to make muscle cells and stimulate the growth of new bones. So I don't like people's insulin to be too low, or I don't like their IGF1 to be too low. That's one of the things that the metabolic bone specialists really measure. So if you eat before you exercise, your body doesn't know you're going to exercise. So it makes insulin, and everything just works very quickly and behaves in a good way while you exercise. But after you exercise, your blood sugar will go up. And this is a really good question, how long it stays up, because the idea is that the muscle cells, because they're so hungry and depleted of their carb stores, glycogen, don't ask insulin to usher glucose into the muscle cells.

[00:31:28.490] - Dr. Gordon

The idea is that your blood sugar is going go down on its own and you won't have much insulin. But if you're somebody who chronic... Yeah, we need chronic insulin meters.

[00:31:37.230] - Dr. Lemanne

Yeah, wouldn't that be nice? Yeah.

[00:31:39.300] - Dr. Gordon

Did you see it was in a medical newsletter today or yesterday that pretty soon you'll no longer need a doctor's prescription for a continuous glucose monitor.

[00:31:51.610] - Dr. Lemanne

I have heard that. Yes, yes. I can't wait. I've been writing those right and left and yeah, I'll be happy to put down my pen.

[00:32:00.380] - Dr. Gordon

Do you have a favorite continuous glucose monitor that you recommend for people?

[00:32:05.020] - Dr. Lemanne

Right now, I've been using the FreeStyle Libre 3 because it's continuous. The FreeStyle Libre 2, you have to push a button to get a reading, and so you have to remember to do that. Oh, that's annoying. Yeah. And so the Libre 3 will just check it. I think it's every five minutes, something like that, and record it. So I find that useful. But I haven't explored all of the possible meters out there, but that's the one I'm happening to use right And I'd say that's what I've been doing, too.

[00:32:32.680] - Dr. Gordon

And I like the read out you get on your phone. And it's very helpful and very helpful to share with patients. No, that's... Yes, your A1c is not that bad, but do you see your blood sugar is always sitting at 128? That's not really a good thing. But it would be wonderful if we could get your insulin at the same time.

[00:32:53.770] - Dr. Lemanne

I really like the combination of checking the The fasting insulin and the fasting glucose. But yes, if we could have the insulin in real-time, that would be wonderful. I want to go back to the exercise thing and eating the carbs. Carbs and cancer don't mix Well, but after you've exercised for 2 hours, this is a study done in college students who were healthy, they were... Some blood was taken out before they had an exercise session and it was dropped in some cancer cell cultures, and the cancer cell cultures were pretty agnostic to it. They kept growing. But then they exercised these young gentlemen, I think they were 20-year-old males, vigorously for almost an hour, I think 40, 45 minutes, something like that, and then immediately took their blood again and dropped it in the cancer cell cultures, and the cancer cells died. In other words, the exercise session immediately turned these college students' blood into chemotherapy Trophy, basically. Cancer cell killing medication. And the effect dwindled after about two hours. So I think the effect lasted two hours.

[00:34:10.590] - Dr. Gordon

So you had to exercise for two hours?

[00:34:12.580] - Dr. Lemanne

No, no, no, no, no. So two hours, they could keep blood out, and they would still see the effect for 2 hours after the exercise, and then taking blood out of their arms more than 2 hours after the exercise session, the effect was no longer seen.

[00:34:24.770] - Dr. Gordon

And I may have missed it. Did you say how vigorous the exercise was?

[00:34:29.860] - Dr. Lemanne

Is vigorous, yes.

[00:34:30.990] - Dr. Gordon

Vigorous exercise.

[00:34:32.000] - Dr. Lemanne

Yes, I would have to look up to see exactly how vigorous, but it wasn't a mall walk. Okay. All right. We're probably talking... Usually, these studies are done on exercise bicycles, something like that, because you can measure the output pretty precisely. And things like that. So it's probably something pretty hard, sweaty, heavy breathing, exercise on an exercise bicycle for about 45 minutes, I'm going to say, although I'll look this up and I'll put the study in the show notes, too. But the The idea is that exercise is all good. It reverses the bad effects of eating a carb meal. If you're going to have a carb meal again, you want to go exercise right afterwards. You're going to kill some cancer cells and do some other good things and still have your carbs.

[00:35:15.000] - Dr. Gordon

And whether or not you've just eaten a carb meal, the vigorous exercise has a cancer-resisting potential. Oh, yeah. And did you say what cancer cells those I don't remember. But I'm sure there are studies that have associations between vigorous exercise. I know that that is considered to be a way to reduce your breast cancer risk.

[00:35:44.040] - Dr. Lemanne

And also to improve the treatment of efficacy. So there was a really nice Canadian study in women with breast cancer undergoing chemotherapy that showed that doing three 45 minute vigorous exercise sessions per week, and this was I believe it was aerobic and weight and resistance training, improved their survival. So this is a really powerful study. It was done about 10 years ago in Toronto. And it showed that the women who exercised during their chemotherapy. All right? So don't rest. If you're on chemotherapy, please don't go rest. Go exercise three times, 45 minutes. It will improve the efficacy. It will improve how well the chemotherapy works against your cancer and will help save your life.

[00:36:30.720] - Dr. Gordon

So some people have told me that they're very wiped out during chemotherapy, and I've never really asked the specifics. Are you wiped out that day, the next day? Are there three days in the week where you wouldn't be so totally wiped out and you could go on with your chemotherapy? And I'm sure you're going to tell me it varies.

[00:36:49.710] - Dr. Lemanne

So the worst days are the first three days or so, probably day two and three, and then it gets better. And the women who exercise, the more they exercise, the less cancer and chemotherapy-related fatigue they have. There are a lot of studies showing that. So the worst thing you can do for cancer and chemotherapy-related fatigue is rest.

[00:37:10.380] - Dr. Gordon

Probably true for a lot of fatigue issues. I mean, I certainly know that my nights of sleep are always better if I've worked out vigorously that day.

[00:37:21.330] - Dr. Lemanne

Certainly, yeah. You need the rest after you've exercised. Then you can rest. But the exercise has got to be put in there at the part of it.

[00:37:27.930] - Dr. Gordon

And are there... Would you say that's generally true for almost all kinds of cancer in chemotherapy?

[00:37:34.970] - Dr. Lemanne

So again, no. So one of the most common cancers is breast cancer. So we have a lot of patients that we can study. And the breast cancer drugs are different than cancer drugs for other types of cancer. So I think people may think of, and why shouldn't they? Why would they think about cancer at all? If unless you have to, you don't want to, please don't. Please don't. But chemotherapy is not a monolithic entity. There are hundreds of different drugs, and they all have different side effects. And it's varied as the difference between Pepto-bismol and Tylenol. I mean, they're just not related.

[00:38:10.930] - Dr. Gordon

But they're in the same aisle of the drug store. They are. That's it. Well, I want to go back to the light at night issue and the circadian rhythm of it. And of course, people are exercising during the day, but that's a poor segue. But anyway, I want to go back a little bit to the light because the effects on a totally passive level, you have to go out and do this vigorous exercise. That is something you commit yourself to and you get way more bang for your buck than what I'm about to talk about. But there are a lot of little things you can do at night. And the whole exposure, the idea of exposure to light at night is fairly new in human history. I mean, when did we really start having widely available other than candlelight? Not for more than the last 100 years, am I right?

[00:39:08.990] - Dr. Lemanne

Well, there were bonfires.

[00:39:10.380] - Dr. Gordon

I think people have been...

[00:39:12.330] - Dr. Lemanne

We love fire. And we like to sit around and look, stare into a campfire at night is very hypnotic, and people do that for fun. So maybe that. Does that work for you?

[00:39:24.100] - Dr. Gordon

So it's interesting that more of the research recently has been-But that's red light, remember? Right. I was going to say the studies have been recently on artificial light at night. Artificial light, sure. And they do say there's a difference between the wavelengths of the warmer and the versus the blue light, but it's also the consistency of it. I mean, you could have a, I think it's going to get thunder stormy this afternoon, and if my electricity doesn't go out, but the house gets dark, I'm going to have lights on, I'm going to have my computer on and check my email. I'm going to turn on the television and see what show I can stream. We have so much more constant artificial light exposure as humans than we did as little as 150 years ago. Even then, we may have had bonfires. We didn't have a bonfire every night. So people were exposed to candlelight before that. And I think it's just one of the things about the modern world that we think, is that part Is that part of modern world's deleterious effects on our health?

[00:40:37.680] - Dr. Lemanne

Yeah, I think so. And I think there are plenty of studies that show that, and they're mediated by the effect on the glucose-insulin axis.

[00:40:47.920] - Dr. Gordon

And I'm not sure... So a couple of the other impacts that I'm not sure are related to that is artificial outdoor light at night increases stroke risk. And that was in the Journal of Stroke. And that was just earlier this year. And I'd have to go through the whole study to see if that's mediated as well by the response to insulin. But the effects on our brains are more mediated by the change in our quality of sleep with exposure to light at night. So they did this very interesting study, a group at Cardiff University, and this was a little over a year ago. And they wanted to know... They wanted to know if you were benefited by really not having your eyelids exposed to light at night. And they did this study in a very clever way. And they had people young to medium age, 18 to 35, I think. And everybody wore an eye mask. But for half the non-intervention group, it was goggles, that they had a frame of an eye mask around their face. But the ambient light that they were exposed to, which was low, intervention could land on their eyelids.

[00:42:19.270] - Dr. Gordon

And the other group had completely intact eye masks. And the group with the eye masks, an intact mask, not goggles, had had better cognitive performance the next day. And the variables that they could measure were the greater time spent in slow wave or deep sleep, which is part of So much happens during that time of sleep. We do our brain house cleaning. We change around some information into long term storage and improve our memory. But that eye mask at night, even with a little bit of ambient light, does change your brain's resilience in the face of a not totally dark room. That was a really circuitous sentence. Did that make any sense?

[00:43:09.050] - Dr. Lemanne

Yeah, it does. And that's so interesting. I used to use an eye mask. I mean, it's such a It's a wonderful fix. If you want to have darkness at night, wear an eye mask or wear something over your eyes. But I found an eye mask after a while just not that comfortable. I don't like all the rubber bands and things. So I use actually a watch cap and I just pull it down over my eyes. And I make sure that it's loose enough so that it's comfortable on everything. And it's not too fuzzy. I used to have a really fuzzy one that got a little... Pieces of lint in my eye. That was not such a great idea.

[00:43:39.400] - Dr. Gordon

But yeah, I worked that out. What a great alternative.

[00:43:42.960] - Dr. Lemanne

Yeah, I miss it if I don't have my hat at night because of the light.

[00:43:49.120] - Dr. Gordon

The other little... So I think of there being three sleep tools that people have at hand, and they have been minimally studied with varying degrees of success. Eye masks work, but as you pointed out, you have to have something comfortable for you or that sensation is going to wake you up at night. The other thing, and they tested this in an ICU, not very many patients, they couldn't keep it up for very long. I think it was maybe 50 patients. And they tested them with and without, and they didn't just use a sleep mask. They also used earplugs. And if they had a sleep mask and earplugs, their levels of melatonin went up and their perceived quality of sleep went up. And as anyone who's been in an ICU knows, it's impossible to sleep in an ICU. And the third little sleep hack that I like, but I've since learned, is really is mixed results, and some people do hate it, is to find a comfortable mouth tape. Have you ever taped your mouth shut at night?

[00:44:53.440] - Dr. Lemanne

No, but I'm not a mouth breather.

[00:44:56.060] - Dr. Gordon

I'm not a mouth breather either, but that doesn't mean your mouth doesn't open at times a little bit at night.

[00:45:03.930] - Dr. Lemanne

I'm sure.

[00:45:04.860] - Dr. Gordon

Okay. Right. One of the details I learned at this delving into brain health seriously, obviously, sleep apnea is a huge injury to people's brain. And if you have sleep apnea, you have to take care of it. And most people think of, oh, well, I don't have the body build. I'm an athlete. I'm sure I don't have sleep apnea. Actually, the number two population for having a risk of sleep apnea is athletes, because if you're working out hard, rowing your boat or riding your bicycle, you're breathing through your mouth.

[00:45:36.860] - Dr. Lemanne

Interesting.

[00:45:37.870] - Dr. Gordon

So you change your airway path, the path, the sturdiness of your airway by breathing a lot through your mouth. So at night, the athlete's mouth falls open. They don't do a big gasp and shatter because it's not an obesity influence. It's a frailty, it's a flabbiness of the airway influence. Ones, they're getting less oxygen. Their oxygen levels slowly go down, and only when they reach a certain level, they close their mouth and turn over. But it's an easier fix. So many people don't know they have it, and they may not even snore.

[00:46:15.890] - Dr. Lemanne

So you do use mouth tape, right? And do you use special tape, or are you just going to the little tape dispenser on your office desk and taping up?

[00:46:25.550] - Dr. Gordon

The first night I did it, I used surgical tape, and that lasted about three minutes. I mean, I never even fell asleep. Why?

[00:46:32.940] - Dr. Lemanne

It was so uncomfortable?

[00:46:34.100] - Dr. Gordon

You overdid it, huh? Well, it goes from one side of your... Angle of your mouth all the way along your lips to the other, and it's a complete closure of your lips. So one of my patients told me that they had found a mouth tape that works. So I bought that one because sometimes taping your mouth really does improve your sleep apnea, and then you don't need a CPAP, which you've been fighting with your sleep doctor about for a year anyway, because that's so uncomfortable for you.

[00:47:06.530] - Dr. Lemanne

So was this something you bought at the drug store? And what was it called?

[00:47:08.920] - Dr. Gordon

I bought it on Amazon, and it's called... It's A-Z-A-Z-A are, and it is X-shaped. And it's not a square X. There's a long axis and a short axis. And I have the long one across the middle of my mouth.

[00:47:29.400] - Dr. Lemanne

No, I You mean from top to bottom, you put the long axis by your nose?

[00:47:32.630] - Dr. Gordon

So like right now. Nose to chin? Nose to chin. And I'm doing that right now.

[00:47:37.260] - Dr. Lemanne

And for our listeners, she sounds pretty funny. She's got her finger up over her mouth.

[00:47:42.850] - Dr. Gordon

Right. But you can, if you need to, breathe a little bit through the side of it.

[00:47:46.320] - Dr. Lemanne

You can stop doing that.

[00:47:47.630] - Dr. Gordon

Okay, let me get the point.

[00:47:49.030] - Dr. Lemanne

You can stop doing that.

[00:47:50.840] - Dr. Gordon

I don't like the axis going the other way, but some people do like it better. But it's not as suffocating and And the first night I put it on, I thought, also, no way am I going to be able to sleep with this on my mouth all night. And by the time I went to sleep, I didn't even notice it. I woke up in the morning completely forgetting that I had tape on my mouth. I went to talk. Anyway.

[00:48:16.490] - Dr. Lemanne

Well, so did this show up on your... You wear an aura ring, right? I wear a Whoop band to measure my sleep and look at the sleep architecture and everything. Did you see any improvements?

[00:48:27.040] - Dr. Gordon

I definitely sleep better on And the nights I wear the tape. So sometimes I'm traveling or something, and I forget to take the tape with me.

[00:48:35.990] - Dr. Lemanne

Now, if you have a cold, do you wear the tape?

[00:48:38.900] - Dr. Gordon

I don't remember what a cold is like. Okay. One of the illnesses that just doesn't plague me.

[00:48:46.590] - Dr. Lemanne

Oh, I'm sold. Okay.

[00:48:48.730] - Dr. Gordon

But I'm not sure it's from the mouth tape. But I have patients who've been unable to use it. They say, I just can't. It's too It's suffocating for me. I don't breathe well enough through my nose to have that suffice for me. And other people have told me they have other mouth tapes. So this is not a solo promotion of that one, but just my N of one, Dawn, is that a Zazar mouth tape works great for me.

[00:49:20.180] - Dr. Lemanne

Okay, well, thank you for that. I'll give that a try. I use earplugs and I put my hat on over my eyes at night, but I haven't tried the the mouth tape. I'll give it a go. I'll report back.

[00:49:34.160] - Dr. Gordon

But it is important to report because I thought, Oh, good. I'm just going to add that to my trio that I give, triad that I give everybody, which I'm going to amend to a quadruped, but I'll say in a second. So I do recommend everybody who's got sleep troubles to try an eye mask, to try ear plugs, and to try mouth tape. But it's very important to be critical about each one separately because more than the other interventions, which the eye masks were uncomfortable for you, or they pushed on your eyes and you knew to get rid of it, the mouth tape can very subtly lower your oxygenation. And if you test it independently, you will know that. But if you do all three things at once, two things might improve your sleep. The mouth tape might not improve your sleep. So it is great to have some sleep tracker, mine or yours.

[00:50:26.490] - Dr. Lemanne

Now, your Aura ring does measure your oxygen saturation overnight, correct?

[00:50:30.630] - Dr. Gordon

It does. And yours does as well, right?

[00:50:32.220] - Dr. Lemanne

Yes, the Whoop Band does do that.

[00:50:34.120] - Dr. Gordon

And there is another app that I just learned about, I think it's called Looky, but I'm going to check that out and put that in the show notes if that's really true. So it is important to check and really validate that it works for you because it's not as uniformly... I think an eye mask is either neutral or beneficial, depending on I think I have a patient who says, I'm not going to put shades up. I have a full skylight in my room, and I love to lie in bed and look at the night sky, which is great. But now, in addition to asking everybody how long they sleep, is there a bedroom cool? I'm really going to ask everybody about their light exposure at night because I'm impressed by this whole conversation we're having that it may be true for you that even a little bit of light at night, even a hundred lux, and that phone app light meter, is going to tell me how much is in my very poorly curtained bedroom at night. I'm going to check that tonight. That a little bit of light at night may adversely affect your health, and you might really work to find something you can use to cover your eyes at night.

[00:51:47.790] - Dr. Lemanne

Yeah, and it doesn't have to be a $1,000 drapery remake. Oh, good. Maybe a watch cap or some eye shades.

[00:51:57.490] - Dr. Gordon

Watch cap is a great idea.

[00:52:00.000] - Dr. Lemanne

Well, do you want to know something else about circadian rhythm? I do. That's scary. Oh, scary. Yeah, it's about meal timing and when we eat and when cancers grow. So it was a really interesting study done, published, I think about a year or so ago, showing that breast cancers metastases at night. That's when they spread. So what that means to me, and there's a lot of data showing that So eating a late supper is detrimental to our circadian rhythm and increases the risk of cancer, diabetes, all sorts of- Can I ask you a question about what you mean, specifically?

[00:52:40.050] - Dr. Gordon

If I go to bed at nine o'clock, is seven o'clock a late dinner for me, or does that still count as an early-ish dinner?

[00:52:46.910] - Dr. Lemanne

So, yeah. So studies have answered that question. So a lot of the studies are looking at eating at midnight. Some of them are looking at eating at eight or nine. Some of them are looking at finishing supper by four or five. And basically the overarching message from these studies is finishing early. And by early, earlier is always better. Finishing the last meal early. And the last meal should be the smallest meal. And by early, there's a couple of ways to think about it. We could talk about three hours before you go to bed. And that would mean that so if somebody goes to bed at 11, maybe they can have supper at 8.

[00:53:26.820] - Dr. Gordon

But finish by 8.

[00:53:28.030] - Dr. Lemanne

But finish, forks down by 8. That's probably not ideal because people who eat at eight o'clock don't live as long, and they have more cancer, more heart disease, more diabetes than people who finish eating by five. And it may be that even earlier, now this It's not as clear, but it may be that even earlier is better. But what I tell people that we know for sure now is that supper should probably be the smallest meal of the day in terms of calories.

[00:53:58.060] - Dr. Gordon

Which it usually isn't for most Most people, it's the largest meal in terms of calories.

[00:54:01.780] - Dr. Lemanne

But the supper should be one third of your day's calories or less. And so that's a small meal. More like what we consider a snack, an apple and a piece of cheese or something like that. Not meat, potatoes, vegetables, dessert.

[00:54:19.130] - Dr. Gordon

Or maybe just the meat, right?

[00:54:21.010] - Dr. Lemanne

Maybe just the meat. And yeah, because we're also less... We're more insulin resistant in the evening than we are in the morning. And another study that was really interesting talking about looking at meal timing. The later a woman eats breakfast, the later in the morning she eats breakfast, the higher the risk of breast cancer.

[00:54:42.060] - Dr. Gordon

Whoa.

[00:54:43.190] - Dr. Lemanne

And I think that There's a big fad right now for intermittent fasting, which I think is really interesting, and people should explore that. But again, as we get more data, we'll refine our recommendations. That one really surprised me. And so it's more powerful. If you're going to have a long daily fasting period, at least 13 hours is what I recommend, it's much more important to make sure that your dinner is early than to make your breakfast late for your health.

[00:55:14.950] - Dr. Gordon

And I would second that for your brain. Oh, really? Oh, yes. And people don't do that because sometimes for your brain or your genetics, we really want you to have an even longer fast, 13, 14, 15 hours. But the three hours before you go to bed at night is particularly vital for your brain because eating close to bedtime keeps your digestion feeding your brain all night. So your brain never puts up the closed for night early cleaning sign and does its nightly repair job running the glymphatic system, which cleans the brain. So particularly for the brain, you want to eat at least three hours before. And Yeah, earlier would be better. And if you compress yourself to two meals, oh, I'm going to have a late breakfast, which now I know increases your risk of breast cancer. That's something I'm going to repeat several times, I bet, in the ensuing week to patients. But if you compress yourself to just two meals, you get the more common adverse side effect of intermittent or time-restricted eating, which is people eating insufficient protein.

[00:56:27.500] - Dr. Lemanne

Well, I would say if you're going to compress your eating window, you're right. And I think then in that case, you want people to have more meals in their eating window so that they can get their protein in. So maybe they'll have two or three small meals in that eating window with a lot of protein in each eating episode. But you certainly don't want to do that right before you go to bed and then feed all those metastasizing cancer cells, making it easy for them to get around and find new homes.

[00:56:59.480] - Dr. Gordon

And We have learned from Rhonda Patrick's gene analysis. We have melatonin receptor genes, and we probably have millions of them. But the two that she reports on is that, and I refer them, I talk to patients about them by calling them farmer's hours. If you keep farmer's hours, which means early to bed, early to rise, early breakfast, early dinner. If you have certain genetic predispositions, if you vary from farmer's hours, you're more likely to either have metabolic disease, risk of obesity, type 2 diabetes, insulin resistance. That's the melatonin receptor 1B. Melatonin receptor 1A, if you vary from your farmer's hours and you have variants in the melatonin 1A gene, you're more likely to have Alzheimer's disease.

[00:57:55.500] - Dr. Lemanne

Very interesting. Do you recommend melatonin for some of your patients? And how much, if so?

[00:58:00.740] - Dr. Gordon

I recommend melatonin for all my patients, 50 or over. And of course, we have an episode about melatonin that people can go listen to. I recommend a dose between 1 and 15 milligrams, and pretty much the higher end of the dose they can take without feeling it the next day is the way I put it. So start with 3, go up to 6. If 10 helps you sleep more and doesn't have you hung the next day, 10 is fine, as I believe I've learned with some partial reassurance from your opinion about melatonin.

[00:58:37.570] - Dr. Lemanne

Yeah, it's one of the most studied supplements in oncology, and the data are positive. It seems to be beneficial.

[00:58:46.990] - Dr. Gordon

And I think you have sometimes your patients even on higher doses than that.

[00:58:50.410] - Dr. Lemanne

Is that right? So I use a melatonin protocol for radiation protection. So if a patient is going to have a big scan, like a CT scan, I have them take, depending on their size, 100 or 200 milligrams of melatonin. And we use the liquid formula because you don't want to take a bunch of pills. That's a lot of pills, even if they're 10 milligram pills. So the liquid formulations are good for this application and take it about 15 minutes before the scan because it's liquid is going to be absorbed almost immediately and be at high levels in the bloodstream about 15 minutes later. And make them sleepy. But the body clears melatonin pretty quickly, it's gone within an hour or two. And so I tell them to get a ride. And also, if they want to, have a nice Espresso afterwards and things will be just fine. And it also may improve the response to radiation therapy, which is counterintuitive if you think it protects you from radiation. But it seems to improve the response to radiation therapy in certain cancers. Well, perhaps it- That's a big discussion. There's some nuances to that.

[01:00:02.000] - Dr. Gordon

But you can imagine because you've talked and you've told me years ago that fasting around chemotherapy helps the chemotherapy because you're really smart human cells say, I'm going to sleep because I'm not getting any food. And the cancer cells don't do that. So you can imagine something about responding differently than your other cells do to chemo as well, your melatonin.

[01:00:29.160] - Dr. Lemanne

Radiation may be helpful.

[01:00:34.200] - Dr. Gordon

Well, circadian rhythm. Aha. What a complex topic. And it's amazing that it's something that We can observe circadian rhythms and everything from plants to fruit flies to humans. It's very difficult to actually study and get hard data, but we're coming around. I'm coming around. I I've already had the feeling, and now you've added, I've made a bunch more notes. I need to really talk to some of my patients about having regular circadian rhythms, and perhaps it'll benefit them in many ways by shifting them earlier in the day.

[01:01:15.400] - Dr. Lemanne

Before we end, I wanted to get your opinion on wearables and using those to look at sleep specifically. Is that something you recommend to some of your patients? I've had mixed feelings about that. Some patients are really interested in gadgets and just some are just not. But I do think that the measurement provides you with such good information, gives you a lot of power over your habits. When you see it in lights on your wrist. This is a good night of sleep or this is a really crappy night of sleep. And here's how you're suffering today. I think that that helps people shift their behavior.

[01:01:58.370] - Dr. Gordon

I do recommend. And so for many people who complain that they're tired all the time, I'll start by having them borrow our office aura ring and use it.

[01:02:10.080] - Dr. Lemanne

You have an office aura ring?

[01:02:11.730] - Dr. Gordon

Yeah, we have a couple of them because you have to have different sizes.

[01:02:14.410] - Dr. Lemanne

I might be dropping by your office.

[01:02:15.750] - Dr. Gordon

You can borrow it. It would be interesting for you to wear an aura ring and compare it to your Whoop. And I know there's benefits to Whoop over many of the other-They all have their good points. Good or bad. But I'd say, there is, speaking I was just referencing genetics. There's a gene that talks about whether you're better as a placebo responder or a nocebo responder.

[01:02:39.120] - Dr. Lemanne

You mean one or the other?

[01:02:40.120] - Dr. Gordon

Yeah. So it's the COMT.

[01:02:41.480] - Dr. Lemanne

So if you have one, you will not be good at the other and vice versa?

[01:02:45.140] - Dr. Gordon

That's right. And I think people who are placebo responders, I get come up in the morning, I think, oh, I really didn't sleep that well last night. And I look at my aura tracking, I say, oh, yes, I did. I slept great. And it totally improves my day. And if you're somebody who looks and says, Yeah, but it's not as good as it was the night before. What's wrong? I'm going to be exhausted today if you respond more to the... Because every night is complex. There is no night that that is a perfect, at least at my age, there's never that is a good and perfect night. Every night has its good points and bad points. So the problem with these wearables, which we've heard about, is that people get fixated about them, and they They're glued to them, and it can ruin their day if it says they have a bad night of sleep.

[01:03:37.940] - Dr. Lemanne

So you have to know yourself before you decide to put yourself under the influence of one of these devices.

[01:03:45.090] - Dr. Gordon

Right. And surrender it if it's ruining your life.

[01:03:49.160] - Dr. Lemanne

Interesting.

[01:03:51.060] - Dr. Gordon

And if someone looks back on one of our other earlier episodes, I don't think we knew this at the time, but you know one of the best things you can do besides being a a cheerful person and just getting over it, if you think you did have a bad night of sleep?

[01:04:05.490] - Dr. Lemanne

No, it just makes me mad to hear that I have to be cheerful and get over it.

[01:04:10.380] - Dr. Gordon

So instead...

[01:04:11.600] - Dr. Lemanne

Now, what else did you say?

[01:04:12.890] - Dr. Gordon

I was going to say instead of opting to... I know, because if it's really bad, it's hopeless. But creatine monohydrate, increasing your dose of creatine will help you recover from a bad night of sleep. Yes.

[01:04:24.700] - Dr. Lemanne

You have talked me into creatine. I use it almost every day. I've I've noticed, though, that if I'm in a certain place, I can have a bad night of sleep with too much creatine.

[01:04:35.170] - Dr. Gordon

And that is true, and that is one of the known side effects from it. Oh, really? And if somebody is having that trouble, reach out to me and I will...

[01:04:44.280] - Dr. Lemanne

What How would you tell those people?

[01:04:45.840] - Dr. Gordon

Oh, it's a complicated-I have a friend who has trouble with creatine sometimes.

[01:04:49.530] - Dr. Lemanne

She just can't get a good night's sleep with it. What should I tell her?

[01:04:54.230] - Dr. Gordon

You tell her. Well, I would tell her, first of all, start with the best creatine. Which is? So CreaPure, and Thorn Research makes it, but so do other supplement manufacturers. That's what I have.

[01:05:06.430] - Dr. Lemanne

I mean, that's what my friend has.

[01:05:08.040] - Dr. Gordon

That's what your friend has. And then I'd say there are different trial strategies. One of them is starting with a very, very low dose and working your way up to five grams. And if that still happens, you really may need to have two doses during the day, each of two or three grams. And that seems to work for many people. So just fooling around with the dosing. And it may be that you can never get past three grams, and that's still better for you than zero.

[01:05:39.420] - Dr. Lemanne

Is the time of day?

[01:05:41.360] - Dr. Gordon

Yes, the time of day would matter. So it would be better to take it in general in the morning. Right now I'm thinking I need to race home because I forgot it this morning. Okay. Well, we could go on and on about circadian rhythm because it affects a lot aspects of our life. But we should just go about our lives. And so I can go home and take my creatine.

[01:06:04.720] - Dr. Lemanne

Yeah, that sounds like a good plan. I'll go home and take my melatonin, but I'll wait till tonight.

[01:06:09.170] - Dr. Gordon

Okay. Good talking to you.

[01:06:12.430] - Dr. Lemanne

Hey, take care.

[01:06:13.470] - Dr. Gordon

You, too. You have been listening to the Le Monde Gordon podcast, where Docs Talk Shop.

[01:06:21.700] - Dr. Lemanne

For podcast transcripts, episode notes and links, and more, please visit the podcast website at docstalkshop. Com. Shop.

[01:06:30.450] - Dr. Gordon

Com. Happy eavesdropping.

[01:06:41.030] - Dr. Lemanne

Everything presented in this podcast is for educational and information professional purposes only and should not be construed as medical advice. No doctor-patient relationship is established or implied. If you have a health or a medical concern, see a qualified professional promptly.

[01:06:57.940] - Dr. Gordon

We make no warranty as to the accuracy, adequency, validity, reliability, or completeness of the information presented in this podcast or found on the podcast website.

[01:07:10.030] - Dr. Lemanne

We accept no liability for loss or damage of any kind, resulting from your use of the podcast or the information presented therein. Your use of any information presented in this podcast is at your own risk.

[01:07:24.460] - Dr. Gordon

Again, if you have any medical concerns, see your own provider or another qualified health professional promptly.

[01:07:31.310] - Dr. Lemanne

You must not take any action based on information in this podcast without first consulting your own qualified medical professional. Everything on this podcast, including music, dialog, and ideas, is copyrighted by Docs Talk Shop.

[01:07:49.000] - Dr. Gordon

Docs Talk Shop is recorded at Freeman Sound Studio in Ashland, Oregon.