Transcription
As you know, over the last several weeks, we've kind of, kind of gotten into a little bit of a format for this Tuesday afternoon. Today is Tuesday, November 17th, and we are going to do the first part of our stream. Today is going to be what we call the Metabolic Classroom, or Dr. Bickman's Laboratory. I know Rich loves, yeah, we need a little jingle, Jack, when you say Dr. Bickman's Metabolic Classroom, and then it's got to be like some little, you know, some little music to as an intro. But let's pretend there was some clever little 80s synth music, and and then I'll, I'll roll into this.
So this is always, you know, a topic of, of hopefully of interest to everyone who's listening, um, but always going to be centered around human metabolism, and often centered around the primary problem when metabolism isn't working well, which is insulin resistance. Just remember, everyone, insulin controls the fuel the body uses, what type of fuel it uses, how much it's using it, whether it wants to store some of the energy or nutrients, or burn them, and how they're burned. So insulin has its hand very firmly on the levers of nutrient metabolism and more in the body. And so it's always a matter of, of it ought to be a matter of thought, or a matter of wonder, what are the inputs that are controlling how insulin is then controlling human metabolism?
And one of the very strong inputs, much of what we always focus on, justifiably, will be the food we eat. That is a topic we will always come back to because it is the elephant in the room. It is the main driver of insulin. Now, there are other inputs that matter, and I think it's important for our, um, for everyone attending, everyone zooming in, or or watching, to to appreciate. One of the main ones is stress. I'll always say that stress is one of the key pillars of causing insulin resistance.
Now, let's go one level deeper. What is one of the main foundations that this pillar of stress is built on? And sleep deprivation is a big one. It's a big one because of its impact on insulin resistance, which we'll look at in, in a cup, highlighting a couple manuscripts in particular. But it's also a big one because it's just so darn prevalent these days. The prevalence makes it so relevant, where so many people are sleep deprived due to, um, well, just poor sleep hygiene. And I would say even parsley hygiene has a lot to do with food. And not to, I promise, I'll get to the manuscripts in a moment. I just feel compelled to mention this. I have found that the single most relevant variable that will predict or determine whether I have a good night of sleep or not will be whether I go to bed stuffed with food, very, very full, or whether I go to bed a little lean. You know, I ate a modest dinner and I didn't snack into the evening. If I go to bed with a full stomach, my sleep is going to be terrible, as opposed to going to bed, you know, relatively leaner, or, you know, not too, you know, comfortably full, but not stuffed. That'll make all the difference.
Now, what happens then? So this particular study that we'll include in the notes, so that's called "Sleep Restriction for One Week Reduces Insulin Sensitivity in Healthy Men." Yes, that is an unfortunate aspect of many studies, um, where they just included males in this. There are other studies that mixed, um, and had men and women in it. This one was just really easy and lucid to get through, so I picked it just for the sake of convenience and highlighting the relevance. So what they did was take these healthy individuals, these healthy subjects, and they, who they tested their insulin sensitivity and a handful of other markers over several days when they were in bed for 10 hours. Now, that, of course, that doesn't mean they were sleeping straight for 10 hours, but they had that ample window of, of sleep. And so that was considered a baseline. And so they measured their insulin sensitivity. They also measured, relevant to stress, and this is why I'm, this is why I put sleep deprivation in, in that category of stress. They measured, they measured the stress hormones. And the prototypical, the poster child stress hormones are epinephrine and cortisol. Those are the key stress hormones that really underlies every stress response. If someone's experiencing emotional stress, or physical stress like an illness, or even they're exercising too much, these stress hormones, cortisol and epinephrine, will start to increase. Now, they're doing all kinds of things throughout the body, but one of the main effects that they have, especially with cortisol, is to push up glucose. It's that fight-or-flight mechanism where, you know, historically, ancestrally, the body, these hormones would be helping mobilize glucose and flush the blood with energy, fatty acids and glucose, in order to fuel us getting away, you know, from whatever the danger was, or or addressing the danger head-on. That is a process that gets somewhat hijacked when it comes to sleep deprivation.
So they had them sleep well. They got a baseline. What's their insulin sensitivity? What are their stress hormones, specifically epinephrine and cortisol? And then they had them do a few days of restricted sleep down to five hours per night. Now, many people listening may think, well, that's what I get all the time. I'm always getting five hours of sleep. In fact, I'm very sensitive to that because I typically go to bed around ten, and I am often wide awake at three, almost five hours on the dot, and then it takes me some time to fall back asleep. So I look at this manuscript and see some of myself reflected. And what they did as the intervention, regardless, five hours, that was, they restricted them to five-hour windows of sleep for several days, and then they did, but not, not indefinitely. It was just a handful of days, and then they did a measure of insulin sensitivity again, and a measure of these hormones again.
Now, let's look at the hormones first in table one, and I'll hold it up here. So some people that are curious about statistics, they'll appreciate this. When they looked at the cortisol number, here's the cortisol, and here is the epinephrine, in fact, norepinephrine as well. Those are the two catecholamines. They found P values, in other words, the differences were less than .001, and in some instances, less than .0001, including cortisol. And so there was a huge, a hugely significant increase in cortisol and epinephrine. And remember, especially cortisol, cortisol is determined, it's, it is called a glucocorticoid. Its main action is considered to be a pushing up of glucose. And so now, of course, you have this war between insulin and cortisol. Cortisol is pushing the glucose up, insulin is trying to push it down. And so we get into this sort of vicious cycle. As long as cortisol keeps pushing, insulin has to work harder and harder, increasing or reducing its efficacy. And that's what we see. I won't, I won't hold it up again, that's just too awkward. That if anyone is able to, that's what we're having our team been put, uh, the link to that study in in the stream, so people could click through and look. Yep.
So on, on figure, in figure 3, that's where they really detailed like an hour-by-hour change, in fact, 30-minute by 30-minute change in the cortisol levels. And from the very beginning of doing this new test, after a few days of five hours a night, the cortisol was immediately higher. And in some, at some time points, it was twice as high than the people who were in the same person when they were compared to when they were getting a full night of sleep. And then in this study, they did something called a continuous or a euglycemic hyperinsulinemic clamp. That is the gold standard. That is considered the best way of measuring insulin sensitivity. And they found that insulin sensitivity was significantly compromised in these people. So that's the study. Just a few days of sleep restriction down to five hours per night resulted in significant elevation of stress hormones and a significant, um, significant reduction in insulin sensitivity.
Now, one other study that, that we'll provide the link to in the show notes, was interesting because it looked at it in a different perspective, which I'll elaborate. Now, hormones, all hormones have some degree of, of a circadian rhythm. They're supposed to. They ebb and flow throughout a 24-hour period. Sometimes they ebb and flow in a more macro level, you know, in a longer period than just 24 hours, but cortisol follows a pretty typical 24-hour period. When people were sleep deprived, and it needs to, hormones need to go up and down. Insulin is also, it's no exception to this. They're supposed to come and go up, ebb and flow in order to function properly. What they found in the sleep-deprived patients was it had compressed the variation. There was no longer this cortisol up and down in this kind of this big flowing pattern. It compressed it. And so rather than going like this, it went like this, but it was constantly elevated. It was much, much higher than it was before. So we were compressing it and pushing it up over the course of a 24-hour period with sleep, um, deprivation. So really reflective of a cr, what's becoming sort of a constant, a continuous elevation in cortisol. And once again, that's making insulin work all that much harder. But cortisol has even more effects, not that I'll get into that now necessarily, but it results in the destruction of collagen in the skin, it can break down muscle, it can break down bone. In fact, all of this is to get those proteins, to break them down into amino acids, to give them to the liver so the liver can make more glucose. So cortisol will wreck the body just to produce more glucose, of course, all the time creating more and more insulin resistance.
Now, one last comment, and this is funny because I just disclosed that on this very long drive, I'm probably going to take some Diet Dr. Pepper. Often, when someone is sleep deprived, they will then try to make up for that by taking caffeine. Which, which I get. Caffeine is a stimulant. In fact, it's the most widely consumed addictive drug in, in the world, uh, due to habits. In fact, probably more now than, uh, than ever before, because of our sleep deprivation. While that will help you feel more alert, it also will, in fact, potentially increase, uh, cortisol even more, which is when it comes to, you know, perhaps the sleep deprivation-induced effects on insulin resistance, the caffeine may, in fact, compound the problem. Now, I'm not telling people, I would just say this, don't continue to rely, if you've been relying on caffeine to make up for your poor sleep deprivation, don't, uh, don't, don't, don't focus on the caffeine as a solution. The solution needs to be better sleep habits, you know, dimming the lights, and I would say very especially, don't snack into the evenings. So don't again, don't rely on caffeine to continue to fix what is truly a sleep hygiene problem. A fix to sleep, you know, maybe hopefully temper that caffeine down a little bit, all in an effort to help cortisol come down, and then metabolic health improves.
Great. Ben, I got a couple questions, uh, and I would imagine Rich and Carly do too. But so as you describe that, maybe I'm oversimplifying this, but you describe the cortisol kind of this ebb and flow of cortisol, and then its battle with insulin. It sounds pretty much like the same thing with glucose or sugar and insulin's battle. Is it? Yeah, yeah, you're right. That's a great observation. Some of what cortisol, so cortisol has a direct effect on cells making them insulin resistant, and it has that indirect effect by causing the liver to be dumping glucose into the blood, which is then causing the pancreas to be dumping insulin, and it just becomes a sort of escalating war there. But independent of the glucose, you can just take pure cells in a, in a little petri dish and start treating it with cortisol molecules, cortisol-like molecules, and the cells will start to become insulin resistant. And there's no change in glucose. Of course, this is an isolated cell system, and even still, the cortisol will directly antagonize or, or start to block insulin from doing what it wants to at the cell. So there's that direct effect and an indirect effect given its effects on glucose.
Well, we don't, we don't talk a ton about that with our, I don't know, Carly, do we talk, what are the questions like from our, from our students and our clients with regards to sleep? I think when things are working really well, it's not a topic of conversation very often. Um, but when things aren't working, stress and sleep are two of the things we often will ask about. Um, I had one client who, when sh, when her husband was in town, this is kind of funny, but when her husband was in town, her ketones would register around a 0.6 millimolar per liter. Um, when he's out of town, she would be roughly a 1.6. Okay. So when he was in town, because of back pain or something, she wouldn't sleep. And her lack of sleep was like, we just like it was just explained to us, raise her cortisol, affecting your glucose, in turn ruining your ketones. So I think one of the topics too, you know, repairing your sleep habits and getting yourself in the best place you can is is optimal. But every once in a while, everyone will have a bad night's sleep. And I think starting to recognize your body and how it responds to things like this is super important. Um, for instance, if you have a night where you just don't sleep well, for some odd reason, you're going to notice the next day, you're probably going to be a bit hungrier. That can happen because your insulin hasn't regulated well. And knowing that after you've had a bad night's sleep to expect that can help so that you don't kind of sabotage your habits and, you know, and go out and eat a bunch of food because your glucose has been spiked and your, your insulin is high. Um, so I think sleep's a really important topic.
Yeah, one of the things I wanted to ask you about was, I think I remember reading this in your book, um, that napping longer than 20 minutes, yeah, can create insulin resistance, right? So, yes. So there's a, there's a diminishing return, right? Yeah, that's right. So I'm glad you brought that up. Yeah. So there could be a danger in someone who sleeps poorly and then they think, well, I'm gonna make up for it by napping for two hours during the day, and that was, in fact, found to exacerbate the problem. There's a kind of narrow, although napping on a short end, act can help. And so what might be strategy, and I don't know of any evidence on this, could be that the person can compress a nap and take like a 20-minute nap in the late morning, maybe then a 20-minute nap in the early afternoon. You know, maybe two short naps won't do the damage that a longer nap would. But yeah, don't, don't necessarily look for a big nap to help try to make up for hours that won't, metabolically speaking, that won't solve the problem. Yeah.
Rich, what, uh, you work with a lot of our coaching clients, Rich. What kind of questions come up with you in terms of sleep and insulin resistance? Well, first, I want to tell Ben that he's got a new chapter in his book called "It's Raining Men," and the cause, the true, the real cause of insulin resistance, yeah, is when your husband comes sleeps in the same bed as you. Yeah. Jack, you know, when we, when we talk to our clients about about plateauing and like Carly talked about how they may be struggling, it's typically, you know, either medication related, sleep patterns, stress, you know, lack of exercise. You know, as they, as they really start to dial in their nutrition and they're not seeing the progress they'd like to see, that's where we go. Yeah, is the stress and sleep patterns? Well, it sounds like it's a huge contribution to why we're sick and fat today. You know, we don't talk, we always talk about food being the culprit and the cure, and for the most part, that's the case, and we talk about that a lot. But we don't talk as much about sleep deprivation and the, uh, the problems associated with that. So appreciate you bringing that to the forefront today, Dr. Bickman. Yep, yep. My pleasure. Hopefully, everyone listening learns a thing or two.
I have one other question, if I can ask. Yeah. Um, so I believe I heard from Rob Wolf, I'm thinking that was one of the interviews I listened to. He was talking about some hormone that your body regulated specifically best throughout the day during that first sleep cycle after you've gone to bed. And I can't for the life of me remember what exactly it was that he was talking about, but he was explaining that this was the very reason why going to bed with a somewhat empty stomach was so important was because like, you know, exponentially that first sleep cycle is when your body regulates this one hormone. It wasn't insulin or something obviously. Could it have been? It could have been ghrelin. Does that sound right? I think it was something I wouldn't remember as easily. I don't know. I'll have to, knowing Rob, I'm sure it was right. Whatever, whatever you're referring to, I'm sure, I'm sure it was accurate. I'll have to find it and let you know. Yeah, find that, Carly, and bring it to our next discussion. That would be interesting to find out.
Before we leave the topic of sleep, let's just take one or two more minutes. You mentioned, Dr. Bickman, the idea of not going to bed on a full stomach. And I know for me personally, if I eat a good-sized lunch and then a small dinner, and even eat that dinner fairly early, like 5 p.m. or whatever, there's no question that I sleep better than if I eat a bigger dinner and eat that dinner even a little later, say six, seven, you know, eight o'clock. Definitely a difference. So you mentioned that as one factor. Are there other factors that the three of you have seen with our coaches or from a metabolic perspective, Dr. Bickman, that would help people get better sleep? Lower the temperature. My wife won't like me saying that at all. Um, it's a constant battle at the thermostat, but keep the temperature well as low as comfortable for the family. But it's better to have a cooler room and a warmer blanket. Um, frankly, that's a huge part of it. In fact, that's even a part of why someone sleeps poorly when they go to bed with a full stomach. If you've eaten foods that spike your glucose, that will spike your temperature. That glucose specifically will spike your body temperature during night, during the night, and that is without a doubt one of the reasons that is a contributing factor for the poor, for the poor sleep. So keep the temperature down, you know, whatever is comfortable. Carly, Rich, any thoughts? Yeah, Jack, I'm guessing our addiction to our phones and light in general is a real problem. Yeah, that's been, that's been a topic, the whole blue light thing, which is part of the spectrum of the sun, um, that you shouldn't be seeing late at night. And we're getting a lot of it by, you know, holding screens up to our face, which is an easy remedy too. Yeah, I've heard that. Yeah, I mean, one of the easiest is shift the phone to night mode, which is so common these days. But even still, Steven, still, that's bright. And so, yeah, you've just got to have that discipline. And I know it's hard. I do not say this in any sort of condemning way. It is hard to just turn the phone off and put it down and then read a book by, by the light of a, of a, you know, a lamp. Yeah.
Hey, hey Ben, is sleep completely a lifestyle issue, or is there some genetics too? Oh, there are. Yeah, yeah. I sleep like a rock. Yeah. There is a genetic component. Like, take any Bickman, and they're going to tell you the same thing I've been telling you, where, uh, where we just are kind of anxious sleepers. We wake up. And then, so yeah, there's absolutely something genetic, including people who can, although this is uncommon, and I don't know that it applies to me, um, in fact, I'm sure it doesn't. There are people who can, in fact, thrive on a narrower sleep window than the average person. Many people think that they can, but that's not common. So it's not as common as some people think. Well, we have a big joke in our family, Ben, that, uh, my wife is a terrible sleeper because she just can't turn her brain off. Well, yeah, my kids say I don't have a brain, so it's easy for me to turn my brain off. I go right to sleep. Yeah, yeah. You're the, you're the scarecrow in that relationship, right? Well, thank you, Ben. That was really informative. We don't talk often enough about sleep, so I'm glad you picked that topic today. Any other last thoughts about sleep? We're going to move on and take some other questions from our viewers. Any other thoughts on sleep? No, I'm kind of tired of this subject. Okay. Oh, hey, you know, you know, when, when I first told the group what manuscript I wanted to highlight, Rich has been working on a little pun for the last week, and that's all he could come up with. That's it, baby. Jennifer, one of our viewers right now, commented and said, uh, she appreciated the, the discussion about sleep. She said, I'm a health coach, and I'm actually leading a book club discussion about your book, Dr. Bickman. So I thought I'd hold this up for a second while we get sick by Dr. Bickman. If you go to insuliniq.com, at the top, in our navigation, there's a little tab called About Dr. Bickman, and you can read more about his book there and listen to a little video where he goes over what's in the book, if that's of interest to you. There's some links there in case you want to read his book. So glad to have that. That's wonderful. Yeah, thank you. That's wonderful. Yeah, thank you, Jennifer, for that comment as well. Uh, let's see. We got some questions. Let me throw off, start throwing a few out here from from Emmy.
A lot of people who fast seem to have sleep quality issues. Is that the case? Just fasting? I, it sounds like you just said, not really. Yeah, I'm not seeing that in our clients. Yeah. So I don't know of any manuscripts that have been published on that. I wonder whether there's something to be said for someone with with anxiety and eating disorders and that that strong correlation to sleeping poorly, because those two things can go quite hand in hand with all of those things. But no, I don't know of a study that that has looked at putting someone starting fasting and tracking their sleep. So I, I cannot speak to that with any sort of definitive observation. Okay. And yeah, anecdotally, I would say one of the things if you are fasting a lot, um, some people will get heartburn, which typically goes away when you lower your carb intake and eat low carb, high fat. But on a fast, sometimes that can come back and that can upset some, some, you know, faster's sleep. So just sleeping tilted a little bit, tilted can help that. But that's the only thing I know. Yeah. Thanks, Emmy, for that question.
From from Sunshine. And by the way, Sunshine, this is an awesome name. S-U-N-S-H-Y-N-E. What a great name. All right, from Sunshine. I'm 47 years old. I'm in ketosis. I really don't need caffeine, but need compressed sleep. Five to six hours. Is that okay? Any more sleep and I'm just up every other hour. Yeah. Well, I can, I can relate to that. Uh, um, this is, there's, there's, I would say if you feel good, you genuinely are feeling fine, you're staying alert throughout the day, you're engaged, then then you clearly are are thriving and and doing well. And that much sleep, the average person won't, I would think. But some, there really are some people who can do it and do it very well and feel perfectly fine. Okay. Yeah. So no danger there if she's feeling good. Sounds like.