[00:00:00.000] - Dr. Lemanne
If you have colorectal cancer and you exercise and you have a structured exercise program, this was presented at ASCO 2025, this was called the Challenge Trial. And they showed that a three-year structured exercise program after colon cancer treatment, reduced disease recurrence by 28% and death by 37%. These are numbers that rival chemotherapy. Seriously. It might be slightly better than chemotherapy. It doesn't mean you shouldn't take chemotherapy. You should do both. You want everything you can throw at a colorectal cancer diagnosis. But what that was, moderate to challenging exercise for less than an hour a day.

[00:00:45.820] - Dr. Gordon
Oh, that is so doable.

 [00:00:48.480] - Dr. Lemanne
But another 2025 study by the Schaar Institute, S-C-H-A-R, found that marathoners and ultra marathoners between the ages of 35 and 50 and without any hereditary risk for colon cancer in particular, had a huge number of advanced colonic adnomas, the precursors to colon cancer, compared to people who are not athletes. You have found your way to the Lemanne Gorton podcast, where Docs Talk Shop. Happy eavesdropping. I'm Dr. Dawn LeMans. I treat cancer patients.

 [00:01:36.920] - Dr. Gordon

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

 [00:01:40.880] - Dr. Lemanne
We've been in practice a long time.

 [00:01:42.520] - Dr. Gordon
A very long time.

 [00:01:44.860] - Dr. Lemanne
We learn so much talking to each other.

 [00:01:46.960] - Dr. Gordon
We do. What if we let people listen in?

 [00:01:51.940] - Dr. Lemanne
In this episode, Dr. Gordon and I discuss what might be our favorite medication—exercise—and  the relationship between exercise and health. Of course, it's no surprise to our audience that exercise is important for health for people of any age at any fitness level. You also will know that Dr. Gordon and I both prescribe exercise, and it's one of the most important parts of our routine patient care. Today, though, we dive into something that has surprised us both, the hazards of too much exercise. Exercise may have a dark side, and there are times that we should think twice about exercise and our exercise habits. We might need to tweak our exercise routines to get the most benefit from the time we do spend being active, and we certainly want to avoid over-exercising. So join us as we pour over some of the details. Enjoy this episode.

 [00:02:58.760] - Dr. Gordon
I think I've always I've not had a great sense of smell, but for a couple of years after COVID, I couldn't smell my jasmine in the backyard.

 [00:03:10.140] - Dr. Lemanne
Oh, that's a loss. Yes, jasmine is just magnificent.

 [00:03:13.740] - Dr. Gordon
I can smell that again now. I'm working on it. It's coming back. You know the other news about Alzheimer's this week, which is of, excuse me, interest for me because it coincided with another article that came out this week, but the Alzheimer's pertinent one was observing that it takes very little exercise to reduce the risk of Alzheimer's.

 [00:03:42.060] - Dr. Lemanne
Oh, that's going to be such good news.

 [00:03:45.030] - Dr. Gordon
Isn't that good news? And so I don't have a watch that does this. But you know a lot of people have watches that tell them how many steps they take a day. And everybody's always shooting for, I believe, 10,000 steps.

[00:04:00.000] - Dr. Lemanne
Well, I have a Whoop band, and it tells me. And my iPhone, if I just wear it in my pocket, will tell me how many steps I'm taking. It's trying. It gives me a step count. It doesn't match my Whoop band, which I think is more accurate.

 [00:04:14.920] - Dr. Gordon
My daughter found out that this accuracy is impaired if you're pushing a stroller and not swinging your arms. Devices you wear on your wrists and hands don't count it as well. Anyway, what is your...

 [00:04:28.300] - Dr. Lemanne
My Whoop band says I need 6,000 steps a day. But I also do other forms of exercise.

 [00:04:33.350] - Dr. Gordon
Yes, you do, which will get into the other part of what we're going to talk about. But for Alzheimer's, this study showed that really as little as 5,000 steps a day is one of these, oh, my goodness, this is a modifiable risk for Alzheimer's. If you are, and I'm sure you probably have known people, I know people in my personal life and my professional life who somehow switch to a more sedentary lifestyle. Maybe they move into an apartment, maybe their walking partner can't walk anymore, and they go downhill cognitively. But if they could figure out a way to get in as little as 5,000 steps a day, there seems to be a statistically significant reduction. It's an association, obviously. They haven't done the trial yet. So how we get medical information for our listeners is people observe things in life. And somebody got this idea, I think activity may improve things, so they observe it in people. And if there appears to be an association, wow, the people who walked more did have less Alzheimer's, then you have to test to see if it was that or the fact that they took creatine before they went for their walk.

 [00:05:54.950] - Dr. Gordon
What made the difference? So we don't have it for sure, but it is an observed risk modifier.

 [00:06:02.680] - Dr. Lemanne
I think that's really helpful. And you can start getting into causation with just associations. If you have what's called a dose-response relationship, So if you increase the input and get more of the desired output or undesired, whichever you're looking at, you can start to infer a causal relationship between the two. And that brings me to a question for you is, so 5,000 steps, you can see a difference, but does that mean that 5,000 steps is all you need or is more exercise better in terms of decreasing Alzheimer's risk or an association between... Is there an association between more exercise and a decreased risk of Alzheimer's? And is there too much at any point? I know that you've told me that's what you want to talk about today. So for our listeners, I'm priming things here.

 [00:07:04.820] - Dr. Gordon
But I will say just in terms of Alzheimer's, from two points of view, when they look at this, and again, pretty much just observational, it really does. And what they're measuring is not only clinically less Alzheimer's, but less Tau accumulation in the brain and then just less cognitive impairment on testing.

 [00:07:29.370] - Dr. Lemanne
So healthy So brain tissue and better objective performance.

 [00:07:34.440] - Dr. Gordon
Yes, both those. And it does more is better in this number of steps for Alzheimer's, and that is observed and cataloged for risk reduction looking forward. If somebody has Alzheimer's, I actually recommend, and this is where it can get into the topic we're going talk about a little bit today. I don't think you can walk too much. I think the more you walk around in a nice way and chatting with somebody and doing these 5,000, 7,500, 10,000 steps a day, That's all good, and that is really just part of life. If you have, I meant should be.

 [00:08:24.340] - Dr. Lemanne
I'm interested in evolution, and I once heard an evolutionary scientist say, The reason that we have brains, and the reason plants don't have the brains, is because brains are the organ of movement. So if you have a brain, you can move around through the world and through your environment and look for food and get away from predators and things like that. If you're just stationary like a plant, you don't need a brain. So that just made that tickled because the idea that you can't walk too much, I think evolution. Evolution agrees with you.

 [00:09:02.740] - Dr. Gordon
Evolution agreed. But if you actually have Alzheimer's, I'm going to ask you to do two other kinds of exercise, and one of them involves resistance, weight training, exercise, lifting things, because your muscle mass accumulation and efficacy of using it correlates very well with your brain volume, literally, and your brain function and longevity.  And you and I, I think, are both fans of doing some weight lifting type of exercise, body weight, yoga, or actually lifting heavy weights in the gym. But the other thing I ask my Alzheimer's patients to do is to do some exercise that is high intensity. And that could be running if they're younger and healthier than my knees are. What other kinds of... A cycling, other kinds of intense exercise that people can do along the lines, looking almost like a competitive athlete, at least for a few moments while they do it.

 [00:10:13.710] - Dr. Lemanne
Well, you can do that. Just find a little hill to walk up quickly. So walk up as fast as you can, up a steep hill for 30 seconds. Oh, that'll be pretty intense for most people.

 [00:10:23.500] - Dr. Gordon
That'll be pretty intense.

 [00:10:24.770] - Dr. Lemanne
Yeah, intense. When I think of intense, tell me what you tell patients, but I tell patients, you should feel like you're breathing very, very hard and that your heart is pounding hard almost out of your chest as long as you've been checked for heart disease before you start everyone by your doctor or health care practitioner. But it should be There should be some... You should be pushing into the discomfort zone for short periods so that when you stop, you feel actually invigorated. Don't overdo, but it should be pretty intense and a little bit out of your comfort zone.

 [00:10:59.600] - Dr. Gordon
Yeah. Yeah. And I'd say my suggestions are slightly different verbiage, but really the same message, which is once you're warmed up, go as hard and fast as you can, but look at your watch. And if you're going for 30 seconds, I bet you can go harder and just go for 15. That's fine. You're not challenging the clock. You're challenging your capacity. So same thing. Ramp it up for a while and then totally recover before you do it again. The reason this is important in Alzheimer's is that in Alzheimer's disease, there is often a contributor of... Our blood sugar goes up gradually as we age. Our response to insulin goes down gradually as we age. And the more of that deterioration we have, the harder it is on our brains. And the exercise that best reverses that age-related insulin resistance is high intensity, but in intervals.  Just what you said, don't do it for too long, just go up the hill. I tell them to go as hard and fast as they can, and if it should be less than 30 seconds, 15 to 30, something like that. So that's actually asking them to have a clock, whereas I think you're giving them a more subjective assessment measure, which is a good idea.

 [00:12:24.440] - Dr. Gordon
I'm going to incorporate that into my next set of instructions. Thank you very much, Dr. Lemanne.

 [00:12:32.900] - Dr. Lemanne
Well, tell us a little bit about, I know you've been looking into this, what you found out about too much exercise? I think most people may not have thought about that. It's not relevant to most of us. It's not to me. But talk a little bit about what does too much exercise do? Is more always better? And how do we know if we're exercising too much?

 [00:12:58.120] - Dr. Gordon
Well, on a very mundane level, you know sometimes that too much exercise is not always a good thing. I mean, you do have to live your life and not just exercise. But something that's come up in... So starting with the extreme, Competitive professional athletes are evidently training much more than they did 20 years ago. So looking at athletes, their measures of their own physical capacity on a momentary test and their performance in sports. Like, look at how much faster people are running than they used to. Professional athletes, they're pushing the envelope about, Could I be doing Could I be doing a little bit more exercise? Could I work out a little harder? And what has been found is that, and this was somewhat in response to general official health guidelines about what's the optimal exercise. So for the Alzheimer's, 5,000 steps a day is the minimal exercise. What's optimal is more than that. But when you do even more than that, there's some evidence that that is actually pushing past the window of benefit for your heart and cardiovascular system and going into the area of cardiovascular risk. 

 [00:14:30.340] - Dr. Lemanne
Well, now, how much exactly for our listeners do we know?

 [00:14:35.860] - Dr. Gordon
They do have an idea about this. Before we go on, may I ask you a quick favor? Hit the subscribe button. You're hitting that subscribe button really, really matters. You're making sure cutting-edge ideas that matter to you move to the center of medical discourse, where they belong. Thank you. If you think about you're walking along and you're having a chat with your friend, they can measure that in METS. And METS is a metabolic measure, and I bet you actually know what that is.

 [00:15:17.480] - Dr. Lemanne
I confess, when you told me what we're going to talk about, I looked this up because this is something that I really am interested in. A MET hour is one hour of an activity scale to how many times above your resting metabolic rate your body is working. And adults are advised to get 10 to 20 met hours of moderate activity per week. What does that mean? That means about 30 minutes of brisk walking Five days a week. Brisk walking, which is considered a 3. 5-mile-per-hour pace, which is pretty darn fast. It is. I find that difficult to sustain for a long.

 [00:15:57.370] - Dr. Gordon
At this age, I must say that's true. It used to be true.

 [00:16:00.440] - Dr. Lemanne
I'd rather be... I mean, maybe I could jog at that pace, but it's hard to walk at 3. 5 miles. It's almost you want to start jogging anyway, just because it's awkward. There's a study, a 2025 study in the journal Circulation, which is put out by the American Heart Association.

And they talk about walking 30 to 40 minutes a day, six days a week. And that's about 13 miles per week, which is two to two and a half miles each day, up to 7. 5 hours per week for 60 to 65 minutes per day, seven days a week. And that goes up to about four miles per day, seven days a week. So somewhere in between there, two miles a day for six days a week to four miles a day for seven days a week at 3. 7 miles per hour is the sweet spot for at least heart health. More than that. So more than four miles a day for seven days a week at a pretty fast clip, you start to see some heart disease. The ordinary heart disease, coronary artery calcifications are higher in people who do that amount of exercise.

 [00:17:20.120] - Dr. Lemanne
So that's what I think there's a little bit of information about how much exercise. So two miles a day to 4 miles a day, 6 or 7 days a week at a fast clip is probably the sweet spot.

 [00:17:33.900] - Dr. Gordon
But I think most of the actual athletes that are doing this are not really just walking.

 [00:17:40.000] - Dr. Lemanne
Oh, no, no, no. If you do more than this, which these athletes are, then you start seeing some issues. Well, yeah, go ahead. Tell us about that.

 [00:17:49.130] - Dr. Gordon
You gave a really good measure there that somebody could apply to their life and the exercise they do. But you can actually measure how hard is somebody working out in their 30 30-minute sprint bicycle ride or 30-minute running all out or in their hurdles event or in their rowing event. And this is the first this article from 2016 is the only article I've ever seen that has a picture of a rower in it. 

But they've measured people up to achieving 30 METS of exertion, which I can't even imagine that would be like running a walk Walking fast all day, seven days a week. I'm not really sure how they would really do that. But what competitive athletes used to be measured up to the rate of exertion that you and I could achieve in a vigorous effort over the week, and now they're getting up to way more than that and even up to twice that measure. So in terms of METS, more than 15 and even up to 30. But that's where they see all sorts of things going on in their heart. One of the studies I found interesting was an increased risk of calcification.

 [00:19:07.280] - Dr. Gordon
Now, they know on a very small anatomical level, some of the benefits of exercise. You should be having really good function of the endothelium, the lining of your blood vessels. When you exercise, you generate a lot of nitric oxide. And nitric oxide is the gardener that tends the lining of the inside of our blood vessels. Athletes are supposed to have great endothelial function. You work out your heart. So instead of having a floppy, out of shape heart muscle, If you're a well-timed athlete, you have a sturdier heart. Your heart beats accelerates from very highs, and if it does that on a regular basis, it also knows how to get very low. So when I was a competitive rower, my resting pulse was 48 to 52, and now it's more like 60. But that's good to take your heart out for a spin like a hot rod and then let it really totally rest and recover when you're not doing that. So all those wonderful things that you can get from the right amount of even fairly intense exercise can be pushed too far. So Yes, despite the nitric oxide. You can get a calcification in your arteries.  

 [00:20:35.200] - Dr. Gordon

You can get dysfunction or malformation of the different chambers, the muscles in your heart. And there's a greater risk for cardiac arrhythmia. Because I think probably everybody's heard of the one that seems to be the most annoying but still common for people as we age is atrial fibrillation.   

 [00:20:54.280] - Dr. Lemanne
And more than annoying, actually.

 [00:20:55.960] - Dr. Gordon
Yes.

 [00:20:56.520] - Dr. Lemanne
Leads to earlier mortality and dementia.

 [00:20:59.560] - Dr. Gordon
And strokes, both silent and very observable strokes. And it's why somebody who has atrial fibrillation, they should be on a blood thinner until they get it fixed, and they should pursue whatever means they can to not have atrial fibrillation all the time. And sometimes that means traveling because older people are not necessarily the favorite candidate of those who try to reverse atrial Atrial fibrillation. Have you seen that in your...

 [00:21:33.420] - Dr. Lemanne
Atrial fibrillation and cancer are related. What? And so if a lot of doctors, when they see a new onset atrial fibrillation, will look for a hidden cancer. And because the inflammation is a cause of atrial fibrillation, and inflammation can be upregulated either by a cancer or by the body's response to cancer. So yes, atrial fibrillation in cancer is a thing, and we look for it. And atrial fibrillation itself, I believe, is associated with cognitive decline if it's constant. Beyond the microstrokes, I think the intermittent blood pressure changes create some issues in terms of what's called reperfusion injury and those kinds of things. So atrial fibrillation is bad news, but it's very common. One out of four people in the United States eventually are diagnosed with atrial fibrillation.

 [00:22:28.820] - Dr. Gordon

I had no idea was that. I would have said it's really common, one out of 10, one out of four. And is that...

 [00:22:36.730] - Dr. Lemanne
A lifetime risk. Yeah.

 [00:22:38.800] - Dr. Gordon
So there's two ways that people see atrial fibrillation, what's called either paroxysmal atrial fibrillation, where people have to wear a monitor to detect that, oh, yeah, for half an hour, a Saturday morning, you are in A-Fib, and then again, Tuesday afternoon, or there's people who are constantly in A-Fib.

 [00:22:57.840] - Dr. Lemanne
We think that it progresses from paroxysmal once in a while, just a few palpitations to longer runs of palpitations, and then those extend. And eventually, the heart just doesn't go back into normal rhythm. So we think there's a progression there from intermittent paroxysmal to continuous chronic atrial fibrillation. And certainly, once you've got something like that going on, it behooves you to see if it can be reversed. And there are certain procedures where doctors can actually enter through one of the blood vessels into the inner chambers of the heart, try to find the area of irritation of the rhythm and ablate it so that the rhythm goes back to slip back into the normal patterns. And that's really important if it can be done. It can't always be done.

 [00:23:51.980] - Dr. Gordon

It can't always be done, and it can't always be done by the first person you consult.

 [00:23:57.740] - Dr. Lemanne
Oh, that is so true. You know, boy. Yeah. Talk a little bit about that, what's been your experience with.

 [00:24:04.460] - Dr. Gordon
I have two people locally who were told they were not candidates, and I could see why. One of them did try it twice locally with a cardiologist. They said, We're not going to do it a third time. The other one, they said, We don't do it with someone with sarcopenia and kidney disease. And my third one, a person I know is a friend who they couldn't really figure out where She would... Anyway, three people who had fairly constant atrial fib for quite a while until they, one of them traveled to Texas, one of them traveled to Southern California from here, and one of them went to a different department at Stanford.

 [00:24:47.160] - Dr. Lemanne
So they basically went to hospitals that had doctors who did a large number of these and had very deep experience with ablation procedures. Is that what you're saying?

 [00:24:57.860] - Dr. Gordon
Absolutely. And specialized in people that needed extra monitoring because they had high risk. She has kidney disease and other things. And the reversal made such a difference in the quality of her life. One woman told me, I no longer have asthma and emphysema.

 [00:25:22.160] - Dr. Lemanne
Because her heart was functioning better.

 [00:25:24.120] - Dr. Gordon
Because her heart was functioning. And she'd been using... She'd been diagnosed and treated And some of the medications for asthma are ones you wouldn't want to take constantly if you didn't need to. She doesn't need them anymore because she's back in a normal heart rhythm. So, yes. Okay, we took a circuitous detour. I think that's important, though. Going through atrial fibrillation, really.

 [00:25:50.500] - Dr. Lemanne
Yeah. I was interested to hear what improvement in quality of life fixing atrial fibrillation can Oh, the ability.

 [00:26:01.100] - Dr. Gordon
Yeah, the ability to go for a walk and not collapse halfway through or for the next day and a half because you have a heart that behaves in more of a normal way. Thank you, heart.

[00:26:13.800] - Dr. Lemanne
When you told me we were going to talk about this, I looked some things up. Do you want to hear some statistics I found? I do. Okay. So running more than 5 to 6 miles per day or 35 to 40 miles per week for over 10 10 years or 3,000 met minutes per week, which is five hours per week of vigorous activity, like running at 6 miles per hour, which is a 10 minute per mile pace, actually increases the incidence of atrial fibrillation up to five fold. Oh. All right. And So I thought that was a market increase. It's a lot. That's a lot. Yeah. So there's a lot more coronary recalcifications in those people and a lot more atrial fibrillation.

 [00:27:15.420] - Dr. Gordon
And then again, both of the things you just said contribute to muscles in the heart either overgrowing and getting thick and just not functioning as well as the squeezing device that our heart is.

 [00:27:33.250] - Dr. Lemanne
I think the thought is with these endurance athletes is that the atria actually gets stretched and that tears some of the fibers and the muscle fibers, and they scar up. And in the atria, the upper chambers of the heart, that's where the electrical conduction starts. So if you interfere with the wiring of the atria, you will increase your risk of rhythm problems. And there's another thing that's interesting about exercise. Can we take a detour to cancer?

 [00:28:07.130] - Dr. Gordon
Let's take a detour to cancer.

 [00:28:09.260] - Dr. Lemanne
So if you have colorectal cancer and you exercise, and you have a structured exercise program. This was presented at ASCO 2025. This was called the Challenge Trial. And they showed that a three-year structured exercise program after colon cancer treatment, reduced disease recurrence by 28% and death by 37%. Now, these are numbers that rival chemotherapy. Seriously. It might be even a little bit slightly better than chemotherapy. It doesn't mean you shouldn't take chemotherapy. You should do both. You want everything you can throw at a colorectal cancer diagnosis. But what that was was moderate to challenging exercise for less than an hour a day.

 [00:29:08.860] - Dr. Gordon
Oh, that is so doable.

 [00:29:11.450] - Dr. Lemanne
But, and this really threw me, I was really surprised. Another 2025 study by the Schaar Institute, S-C-H-A-R, found that marathoners and ultramarathoners between the ages of 35 and 50 and without any hereditary risk for colon cancer in particular, had a huge number of advanced colonic adnomas, the precursors to colon cancer compared to people who are not athletes. 

 [00:29:44.840] - Dr. Gordon
But you're talking about marathon runners.

 [00:29:46.920] - Dr. Lemanne
I'm talking about marathoners and ultramarathoners. 

 So exercise at a vigorous rate in normal amounts, we're not talking sedentary here, we're talking pretty hard exercise, decreases the risk of colon cancer recurrence in people who've had colon cancer. But if you're an ultra marathoner or a marathoner and you're young, it may increase your risk.

 [00:30:09.640] - Dr. Gordon
That is, so I must say- By a lot.

 [00:30:12.720] - Dr. Lemanne
A lot. So 41% had an adenoma at that age, and the usual is 15 to 25 %. So that's quite a bit more. And 15 % had advanced adenomas. And I think that's because really, I don't know, we don't know, but if you made me try to take a guess as to why that would be, is if you do long periods of exercise, many areas of your body become ischemic, and one of the areas that becomes ischemic is the gut. Blood is shunted away from the gut to the muscles so that you can exercise for long periods of time. And perhaps that injures the gut and a repeated injury might be problematic. It certainly is in other tissues can lead to cancer. So for instance, smoking and lung cancer, repeated injury of the lung every cigarette. So maybe it's something like that. We don't know. But I thought that that is a really important place where that U-shaped exercise curve comes in.

 [00:31:19.680] - Dr. Gordon
It comes in again. I must say, and this may be a bias on my part because I could never do what they do, but people who are long distance runners who run. I think I did one 5K race. But people who do longer runs, half marathons and marathons, I think a fair proportion of them look to me to be sarcopenic. And I have always presumed that they have low muscle mass because they're not doing something like lifting weights as well. But what you just said suggests to me maybe they don't absorb food, even if they do eat during their run, but they may spend a fair amount of their day with their colon having diminished perfusion, their gut in general, not just their colon, there's several parts to the gut, but having diminished circulation to the gut, I wonder if that impairs caloric absorption in an efficient way.

 [00:32:18.440] - Dr. Lemanne

That's an interesting question.

 [00:32:20.620] - Dr. Gordon
Don't you think a lot of runners look too skinny?

 [00:32:24.080] - Dr. Lemanne
Well, they certainly are thinner than usual. But apparently We Americans think normal is thin.

 [00:32:36.700] - Dr. Gordon
With your GLP-1 drug in your back pocket, right?

 [00:32:40.090] - Dr. Lemanne
Yeah. So we underestimate But we underestimate. We think someone who's overweight is normal weight and someone who's obese is just overweight. Because if we actually run the numbers, it's like, oh, no, you're in that category.

 [00:32:56.620] - Dr. Gordon
Well, I think you and I bandied back and forth a little But another paradox about exercise, and correct me if I'm wrong, but I think we were talking something about the relationship between exercise and loss of sleep.

 [00:33:15.000] - Dr. Lemanne
Oh, that's an interesting one. Let's talk about that. You want to talk about that? Yeah. One of the things that is really worrisome is when someone sleeps less than six or seven hours a night chronically, their risk of cancer goes way up. So does exercise in that circumstance, is it helpful or is it harmful?

 [00:33:40.600] - Dr. Gordon
So there have been some studies that we're not looking at cancer, but we're looking at the common observation, and this is in Matthew Walker's book, Why We Sleep, that I read not long after it came out quite a while ago. And they took a group of people in a conference conference setting and subjected half of them to a diminished night of sleep. They had to stay up later and wake up earlier. And all they did was observe the people's behavior at the buffets the subsequent days. And when you don't have enough sleep, you over eat carbohydrates , raise your blood sugar, impair your insulin sensitivity, and tend to put on weight when don't eat enough. And that has been observed that just when not in an experimental setting, but that sleep loss definitely changes the metabolic of your glucose tolerance and also can impair your ability to make muscle.

So to process the proteins that you want in a healthy way yields the ground to your desire, craving for more sugar-related food, which makes you fatter and more likely to get diabetes. And in that situation, exercise seems to mitigate that tendency for sleep loss to send you to the wrong end of the buffet table.

 [00:35:19.960] - Dr. Lemanne
Oh, that's good to know. I think that one of the problems with sleep loss is that it decreases agency, which in plain English is willpower. And the ability to make decisions, forego immediate gratification for better gratification later, et cetera, for higher reward later. That goes out the window with sleep loss because it requires energy. Oh, that's interesting. Brain energy. There's neurotransmitters that relate to that.

 [00:35:49.920] - Dr. Gordon
Does that explain donuts? Morning donuts?

 [00:35:53.290] - Dr. Lemanne
I think it does. Good. We can go home now. And So it may be hard for people who have been sleep-deprived to actually get up the agency to go exercise instead of eating that donut. It's probably not going to happen. But there's a mouse model called the APC, Min+ Minus Mouse Model. And they restricted their sleep for 4 hours to 4 hours or less per day, and then had them exercise.     And this study found that sleep loss nullified or even reversed the immune and carcinogenic anti-carcinogenic effects of regular exercise. So in other words, it made it worse for these mice to exercise if they were chronically sleep-deprived.

 [00:36:53.480] - Dr. Gordon
Oh, wait, the exercise in a sleep-deprived mouse...

 [00:36:56.850] - Dr. Lemanne
Made things worse.

 [00:36:57.960] - Dr. Gordon
Made things worse.

 [00:36:59.680] - Dr. Lemanne
But I think that there's some nuance here. And I think what I'm telling my patients now, and I'm sure this will change as I get better and new information, but what I tell patients now is we do it day by day. And I, as you know, I ask my patients to wear sleep trackers, exercise trackers, those kinds of things. And we look, you're sleep-deprived, you missed, you only got three hours of sleep last night. All right, go for a walk. Let's see if your heart rate variability improves more it gets worse. If it starts to get worse, go in and take a nap. If it's getting better and your stress is going down, you're great, keep going, et cetera. We actually look. And I think that that's where the answer to these kinds of questions, where there are two correct answers. I think all of these studies, they're not lying, and they didn't do bad studies. It's just that there's different situations, and all the variables aren't apparent. There's a lot of opacity in these situations that we can't see through at this point. And so we can actually look at each person individually and see right now, looking at their tracker.

 [00:38:11.000] - Dr. Lemanne
Are you getting better? Are you getting worse? And one of the beautiful markers for that biomarker is heart rate variability.

 [00:38:17.840] - Dr. Gordon
That's a wonderful one. And actually now I want to pull out my phone right now and see if my... I don't think my Oura Ring tracks that during the day. I think it just tracks it at night when I sleep.

 [00:38:29.800] - Dr. Lemanne
A lot of things just track at night. There are certain apps like HeartMath   that you can use that clips on your ear and attaches to your smartphone. You can look at your heart rate variability in real-time. And those are great for answering a question like this, like what do I need to do right now? Do I need to take a nap or do I need to go for a little walk?

 [00:38:50.020] - Dr. Gordon
That is a great idea. I recommend, so as part of the protocol for reversing Alzheimer's, we have people do physical recovery, physical Physical exertion, physical recovery, mental exertion, mental recovery. And the mental recovery we recommend is the HeartMath app because it's so easy to use. Isn't it? Yeah. If you want to change your heart rate variability, it tells you to breathe in a certain way and it says, Oh, you're not paying attention right now. How about coming back to what we were doing? In a nice way and tells you what your heart rate variability is. But how wonderful to have it as a tool. I'm not going to sit down and do it right now, but I can wear the little device for a minute or two and see what it just says where I am. That's brilliant. I'm going to start thinking about... I'm going to try that out. I have a heart math at home.

 [00:39:47.400] - Dr. Lemanne
Yeah, I have one, too. I don't use it all the time, but I use it once in a while, and I recommend it for patients who are interested in those kinds of things. It's not for everyone. Some people just aren't ready or able or built to do tracking, that tracking and intervention.

 [00:40:04.620] - Dr. Gordon
What is... I just have to do this because I try to put a plug in this in almost every time I open my mouth and talk about anything. But if you had a bad night's sleep, what What's one thing you might do to try and get yourself better through the day?

 [00:40:20.040] - Dr. Lemanne
Yeah. Oh, boy. One thing I do is take 20 grams of creatine. I think that's the answer you're looking for.

 [00:40:28.240] - Dr. Gordon
Well, my question was about the dose. But yes, I've been telling people, if you could only take one supplement in life, it should be creatine. And I'm not sure I entirely agree with that, but it makes a point in the moment, and I get it. So I was going to say 10 grams of creatine. Will you say a little bit about 20 grams for sleep recovery?

 [00:40:49.720] - Dr. Lemanne
Well, I follow a lot of the health bros on the Internet, and one of my favorite health bros, and I think yours, too, is Dr. Rhonda Patrick, who's not a bro at all.

 [00:41:06.800] - Dr. Gordon
She's a sis.

 [00:41:10.640] - Dr. Lemanne
I'm sorry if I got the pronouns wrong. One of the things that she's been looking at, and she does a lot of deep research, and it's excellent, is creatine. She talks about that, and she's had some interesting guests on, and I've looked into their research. Right now, everything seems to add up with 20 grams a day for older women, especially in the sleep-deprived state. Now, I will change that if and when new data suggests or my own personal experience for me suggests that's not the right dose. But I believe, and maybe I'm wrong, maybe it's placebo effect, but I believe I can feel a difference when I'm sleep-deprived and use creatine or don't use creatine in ways that suggest that creatine is very beneficial. And I use CreaPure. I have switched from types that don't use CreaPure to using CreaPure. I don't have a lot of data that suggests that that's super important, but it's something to consider, and people can look into that. That's the supposedly purest form of creatine, which different brands will put into their creatine bottles and put their own labels on it. I want people to I understand that. So, yeah, I do.

 [00:42:32.860] - Dr. Lemanne
I recommend it, and I use it myself. I'm watching the research and we'll update my use and recommendations as that comes out.

 [00:42:44.350] - Dr. Gordon
Yes, Stay tuned. There will never be a final answer to this. There's always going to be new information. How much do you take? I aim for typically about the dose based on weight and bump it up a little bit. So I take between seven and 10 grams of creatine a day.

 [00:43:06.120] - Dr. Lemanne
Do you notice if you miss for a few days?

[00:43:10.180] - Dr. Gordon
Miss? My creatine?

 [00:43:12.040] - Dr. Lemanne
Okay. All right.

 [00:43:13.240] - Dr. Gordon
No, I'm in fact not traveling with it when I'm going out of town this weekend, so we'll see. But I don't know that... There are so many moving parts.

 [00:43:22.840] - Dr. Lemanne
Wait a minute, you're not taking it? Why? Because they'll stop you at the TSA as checker.

 [00:43:27.580] - Dr. Gordon
No, I'm realizing now that I say this, oh, I I have a great way to actually pack it. We're trying to go light, but yes, and I've got CreaPure in little envelopes. I get my creatine monohydrate in a much more mundane way. I get it in bulk because I can't stand buying things in plastic containers over and over again. And bulksupplements. Com is a good source, typically third-party tests well for their different powder supplements. Okay, good to know. And that works well for me. I do want to say we're saying all this stuff about how you recover from bad sleep, but you can't plan. It's so important to not just say, Oh, I don't care if I don't sleep well, because I can always take some creatine and then go for a run later in the day if my heart math says it's okay. We need to prioritize sleep.

 [00:44:20.060] - Dr. Lemanne
We do. And one thing that I've noticed is that Whoop, Band, they have those little AI coach that comes with your app, and it tries to personalize your recommendations based on... There's a little journal where you can write down that you've taken creatine that day, and they match up your sleep with There's a lot of various other parameters, and they give you advice. And Mike Whoop always says, You should always get up at the same day, same time every morning.

 [00:44:53.580] - Dr. Gordon
Which is, I do believe that.

 [00:44:55.440] - Dr. Lemanne
Well, and then Whoop also grades your sleep, and then we'll tell you which items in your lifestyle are affecting your sleep, either good or bad. One of the bad things for me is if I get up at the same time every day, I have a lower recovery rate. And I figured out why, and that's because if I really need to sleep in a little bit to get a little bit more rem sleep or something like that, you tend to get more in the second half of the night. I need to pay attention to that. It matters for my actual heart rate recovery, heart rate variability. So some of these rules, which are in general good, may not be applicable to absolutely everyone. So you need to track your own response to these variables, like should I sleep in? Should I not? I'm going to sleep in when I can, if I feel like it, because I know that if I don't, if I don't listen to my body, which says stay in bed another hour, I will have a lower heart rate variability that day. No no matter what the rules, even the Whoop app rules.

 [00:46:02.740] - Dr. Gordon
So I think I could generalize a little bit here because I think in general, you are somebody who does not have trouble falling asleep. And just the idea that you could decide to stay in bed an extra An hour?

 [00:46:17.880] - Dr. Lemanne
I have a normal life and I have to go to work and everything like that.

 [00:46:21.900] - Dr. Gordon
I know, but I could wake up at 5: 30 and say, Oh, I'd really like another hour of sleep, but I can't go back to sleep.

 [00:46:28.700] - Dr. Lemanne
Because you can't sleep or Because you have to get up to take care of some responsibility.

 [00:46:32.500] - Dr. Gordon
No, because I can't go back to sleep once I really have that morning. I can go back to sleep if I wake up at 2: 00 in the morning, but I can't go back to... So two things. I have a harder time going to sleep in general. Sleep is, I would say, my long term health challenge more than anything else. And I adhere to the cognitive behavioral therapy suggestion that for me who might have trouble going to sleep, I should get up at very close to the same time every day, if not exactly the same time. I don't think you have that trouble of sometimes not being able to go to sleep.

 [00:47:08.580] - Dr. Lemanne
Oh, I can go to sleep. I typically fall asleep pretty quickly once I get in bed and turn out the lights. That's not an issue. In the morning, if I wake up at 5: 30 and have to go to the bathroom or something like that, I will be able to go back to sleep if I need to.

 [00:47:23.820] - Dr. Gordon
Could you bottle that and share a little bit of it with me, please?

 [00:47:29.400] - Dr. Lemanne
Yes, it's called glycine.

 [00:47:31.080] - Dr. Gordon
I do glycine, too. Okay.

 [00:47:32.880] - Dr. Lemanne
So for our listeners, glycine is known to aid sleep. And one of the ways that it does this, which is really interesting, is that it decreases the urge to urinate at night.  

Yes. So you should bottle that up. And the dose is three grams. It's a lot. And to get that effect. So people can try that if their doctors think that it's safe for them. It should be. It's the the most common amino acid in your body, and your body makes a lot of it. It's pretty safe. But do check before you do anything you hear us talk about on this podcast with your own doctor.

 [00:48:10.700] - Dr. Gordon
Two little random comments about glycine is that It's also a precursor for the neurotransmitter GABA. So it not only helps you stay asleep by reducing the urge to urinate, but by enabling your body to make more GABA during the night as you metabolize your glycine. And there's a test I do There are people that's nicely covered by Medicare, but it's a simple collect the urine in the morning and send it off for testing a nutrient assay, and it tests by how well the nutrients are working in your body. And by the urine metabolites, not what is the level of B12 in your body, but is it working the way it should? And it also gives a little survey of amino acid adequency and glycine deficiency by about 3,000 milligrams a day is by far the most common. Which is three grams, people. Which is three grams, is by far the most common amino acid deficiency.

 [00:49:09.180] - Dr. Lemanne
Interesting. What's the name of this test?

 [00:49:11.740] - Dr. Gordon
It's called... So you think of the word metabolism and change the SM to an X. So I call it Metabolomix.And Genova Diagnostics offers it, and it's not expensive. So Medicare covers it, and Med Advantage and other private insurance partially covers it. And it's fascinating because it tests nutrient adequency, including amino acids. It gives you both supplement suggestions and food suggestions. I need alpha-lipoic acid. I can't stand to take one more pill. Oh, but I do like to eat liver and look at what it says about liver. That's interesting.

[00:49:45.900] - Dr. Lemanne
Give me a pill, please.

 [00:49:47.000] - Dr. Gordon
I knew you were going to say that. I did that for you. I thought of yours. I had my liver pate this morning.

 [00:49:54.980] - Dr. Lemanne
Well, liver pate is actually pretty good. There you go. I like liver pate.

 [00:49:58.200] - Dr. Gordon
I will bring you some at the office because I always have pints of it in the house. All right.

 [00:50:05.340] - Dr. Lemanne
Sorry, I said anything.

 [00:50:06.940] - Dr. Gordon
Don't worry. It also tests for toxicity from either gasoline or plastics, and it tests for toxicity, antioxidant capacity, and it tests for oxylate tolerance.

 [00:50:20.540] - Dr. Lemanne
My goodness. This is the Swiss Army knife of analysis.

 [00:50:25.290] - Dr. Gordon
I love it. I think everybody... I'd like to do it on each of my patients once a year. And the After you've done it, and I've worked with somebody about it once or maybe twice, they can look at the results themselves and figure out what to do. They don't need doctor guidance because it's so well organized how it presents the information. So yes, plug for Genova Diagnostics.

 [00:50:45.990] - Dr. Lemanne
There you go. Wow. 

[00:50:48.380] - Dr. Gordon
Well, I think we've covered the pros and cons of sleep, of exercise, of glycine, of heart rate variability, of getting up at the same time. Is there anything else that is sitting as a bee in your bonnet this morning?

 [00:51:02.520] - Dr. Lemanne
No, I think I won't be running more than 40 miles a week, but I can be walking up hills for 15 to 30 seconds. Fast.

 [00:51:18.660] - Dr. Gordon
Little brisk bouts of it. Yes.

 [00:51:20.520] - Dr. Lemanne
Yes. Over and over. See you there. Once or twice a week.

 [00:51:22.750] - Dr. Gordon
Yes. Sounds good.

 [00:51:24.690] - Dr. Lemanne
Always good. And I'll look forward to that bucket of liver.

 [00:51:29.500] - Dr. Gordon

 I'll bring you a whole bucket. Don't worry. Good talking to you. See you next time. Bye, Deborah. Bye.

 [00:51:37.840] - Dr. Lemanne
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 [00:52:07.780] - Dr. Gordon
You have been listening to the Lemanne Gordon podcast, where Docs Talk Shop.

 [00:52:13.740] - Dr. Lemanne
For podcast transcripts, episode notes and links, and more. Please visit the podcast website at docstalkshop.com

 [00:52:22.760] - Dr. Gordon
Happy eavesdropping. 

 [00:52:23.310] - Dr. Lemanne
Everything presented in this podcast is for educational and informational 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.

 [00:52:50.000] - Dr. Gordon
We make no warranty as to the accuracy, adequacy, validity, reliability or completeness of the information presented in this podcast or found on the podcast website.

 [00:53:02.100] - Dr. Lemanne
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 [00:53:16.560] - Dr. Gordon
Again, if you have any medical concerns, see your own provider or another qualified health professional promptly.

 [00:53:23.420] - 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.

 [00:53:40.840] - Dr. Gordon
Docs Talk Shop is recorded at Freeman Sound Studio in Ashland, Oregon.