Dr. Bill Lagakos is CEO of Calories Proper and Circadian Medicine Expert. He has a PhD in Nutritional Biochemistry and Physiology with a focus on obesity, insulin resistance, and circadian biology. In this episode we discuss the science behind the body clock and how to optimise your circadian rhythm.
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Dr. Sohaib Imtiaz: Hi guys welcome to another episode of the body clock podcast. Today, I have an amazing guest Bill Lagakos. Sorry for mispronouncing your name. So he’s an expert in the field of nutritional biochemistry and physiology. He’s got a PhD and he’s got specialist interest in circadian biology and Bill has a very interesting kind of up to date with all the latest research. I’ve been falling in on Twitter and I’ve learned quite a lot actually just by reading his tweets. And he’s got a Patreon page as well.
Bill Lagakos: Mhmm. Calories proper.
Dr. Sohaib Imtiaz: Yeah perfect. Yeah. That’s what I follow you on as well. And he’s someone who’s quite approachable. And he’s done a few podcasts. And for Owaves I think the first proper circadian expert we’ve got on our podcast. So it’s exciting for us and first actual give proper insights into circadian rhythms because that’s what Owaves is focusing on. So, Hey Bill how are you?
Bill Lagakos: I’m good thanks. How about yourself?
Dr. Sohaib Imtiaz: I’m well as well. I think I’ve been, my circadian rhythm has been disrupted from all the traveling, but hopefully, you can help me with some insights during this podcast.
Bill Lagakos: Okay. Sounds good.
Dr. Sohaib Imtiaz: For our listeners to start off with, just explain. First of all, a bit about your background and how you became interested in circadian biology and what you’ve done in this field as well.
Bill Lagakos: OK so it’s kind of a I sort of got into nutrition at a pretty young age. It’s kind of accidentally like I was at university and they require you to take a bunch of classes that aren’t in your major to fulfill all these different requirements. And one of them was a nutrition class. So I took that one class. I loved it. I came home for break and I told my parents I wanted to change my major completely. I was in chemical engineering and within a year or two, I wanted to switch to nutrition. Well, so I did that. I did that everybody told me not to do it because you’re going from learning like a pretty high-value trade to something where you know there’s less clear of a future.
But I did it because I liked it a lot and when I finished university I still wasn’t exactly sure what I wanted to do. So I looked into a couple of pharmaceutical companies, but I also applied to graduate school graduate school called me first. So that’s where I went and I had studied ended up getting a PhD in nutritional biochemistry and physiology. My focus there was more on the sort of energy metabolism fatty acid trafficking and after that, I went out to study diabetes and inflammation at University of California San Diego for a couple of years. Best weather that I’ve ever had for you know, ever. I loved that there. Did a short stint in industry, but even when I was in California studying at UCSD all of these studies were popping up like you were looking at I was studying diabetes and the main pathway to diabetes that we were looking into is how can the different aspects of information affect them. But, I kept on coming on all these studies that were showing shift workers and you know policemen that work at night, and some people that work at 24-hour diners.
They’re having an increased risk of diabetes and nobody knew why. So, then I found I sort of reading the circadian rhythms and saying oh well you know this is important. You know it could be more important than the food you eat. So and then there were studies on like sleep restriction which is some way of causing circadian disruption and it’s showing that you know you put two people on an identical weight loss diet, but you let one person sleep five and a half hours, and one person sleep eight and a half hours, and you find out the person that’s sleeping five and a half hours is losing much more muscle and much less fat mass than the other person, and they’re eating the exact same diet. So that’s telling you that something is important with these circadian rhythms. And you know all those things are piling up and piling up in my head. So I said okay I got to study this for real. And then I went over to the Mayo Clinic and started researching missed time feeding, different diets and if that affects various metabolic outcomes and if it depends when you’re eating what time you’re eating and what you’re eating.
Dr. Sohaib Imtiaz: That’s very extensive. You seem to have moved quite a bit and it’s interesting how UC San Diego was where it was the kind of spark in your journey because the founder of Owaves is Royan. He’s an M.D. MBA from UC San Diego.
Bill Lagakos: Yeah. A lot seems to be going on down there.
Dr. Sohaib Imtiaz: Yeah it seems the place to be for kind of health optimization and circadian rhythm because he had a similar pathway he’s doing his MBA and what it is in turn year at medical school. He found how kind of shift work and lifestyle had a big impact on peoples’ not only health but something if you’re not looking clinically from even happiness and kind of mental health.
Bill Lagakos: Yeah yeah.
Dr. Sohaib Imtiaz: I mean you mentioned some things that kind of gear you towards circadian rhythms and it seems that you’re quite observant person obviously getting a PhD. So you’ve got that hunger and that you kind of strive to find the answers to questions which the normal person might not kind of see. So I mean you reworked big institutions like the Mayo Clinic. So did you find that as you were learning more and more there were more questions to be answered or do you feel you’ve been answering the questions you set out to find the answers to?
Bill Lagakos: Well it’s both. It’s both. I mean there are some questions that you can just Google the answer and you can fall down a rabbit hole and this brings up another question. Those other questions that you actually you know I would I was in the lab doing the work trying to figure out the answers there. It’s you know, it’s I’ve been in this field for a couple of years well more than a couple of years now and there’s still questions every day.
Dr. Sohaib Imtiaz: As more and more pop up. So before we dive a bit more deeply into some of the kind of information in diabetes etcetera, I just want to touch upon your day. How do you optimize your day? What’s a typical working day or a normal day for you?
Bill Lagakos: Ok. So my day is pretty much over the past few years I’ve sort of kept on every time I learn of a new study or read a new intervention that has to do with the circadian rhythms and how to optimize health on these various aspects. Like when I say circadian rhythms, it’s not just like one thing. It’s really encompassing a lot of different things. It’s sunlight in the morning. It’s darkness and a little bit of cooler temperature at night. It’s sort of front shifting your caloric intake by shifting I guess giving front loading. So it’s like having breakfast in the morning and not having a big meal late at night. So when I say like circadian rhythm or circadian misalignment it’s basically encompassing all of those things.
So I tried to align my day where I can sort of wake up pretty early in the morning around sunrise have some breakfast. And discovered maybe two years ago all of these skeletal muscle circadian clocks which can be trained by physical activity. So after I have my breakfast I’ll take a walk and try and get some morning sunlight, go to the gym and training the food and trainable circadian clocks. The central clock in your brain which is trained by the sunlight.
The peripheral clocks like in the muscle with exercise and something some other clocks like liver clock is trained with food intake. So I try and cluster as many of those activities in the morning as I can and then just for general health because this has not much to do with circadian rhythms, but also try and go for another walk in the afternoon just because I wrote a blog post on this. I’ve always you know everybody always known that walking is healthy. But, once I actually looked into the studies. I found that it’s weird to talk about walking in terms of dose, but the dose-response of walking is ridiculously low like you just need to go around the block once or twice and you’re going to have a noticeable impact on your metabolic health.
Dr. Sohaib Imtiaz: Oh I didn’t know that.
Bill Lagakos: Once I realized how once I saw how low the dose was like I mean these people could take a walk two times around the block and then have a big meal and their glucose response to that meal is significantly blunted.
Dr. Sohaib Imtiaz: Okay. So even two walks in parks should be encouraged?
Bill Lagakos: Absolutely. Every day.
Dr. Sohaib Imtiaz: Because a lot of people think “Oh I’ve missed the gym.” The intensity in the gym is quite high sometimes and they don’t go for that walk because they’re like what’s a walk going to do? Because you know sometimes you’re tracking on your kind of Fitbit or whatever, Apple Watch and the calorie count doesn’t seem to be that high for walking. But, I mean if you’re if you’re.
Bill Lagakos: I’m saying it’s not just calories. It’s not just calories. It’s total metabolic health.
Dr. Sohaib Imtiaz: And that’s what the insight is because it does. So would the walk be recommended pre-meal or post meal? What would be better?
Bill Lagakos: Well if it’s close to the meal.
Dr. Sohaib Imtiaz: Close to the meal.
Bill Lagakos: It seems safe to say. I mean they’ve tested this. It used to be a post workout meal was better and then a pre-workout meal is better. But you know I grew up in an age where everybody had to have a protein shake after they worked out. But, there’s been a whole bunch of studies that show whether you’re having the protein shake before or after, morning, evening, it doesn’t really matter too much. I still try and time my exercise around meals.
Dr. Sohaib Imtiaz: Okay so you have kind of time specific? So as you said you’re quite morning heavy with you trying to train your circadian clock? So in the morning would you have more protein, carbs or is this just a standard meal or with like a good kind of unprocessed
Bill Lagakos: I would say that. Now I follow something along those lines. Yeah, I try and front load most of my calories. Morning and afternoon and then a little bit light early dinner.
Dr. Sohaib Imtiaz: Ok OK. So you have said you have more calories in the morning than you have later in the day?
Bill Lagakos: Yes. Well if you require breakfast and lunch. Yeah.
Dr. Sohaib Imtiaz: And in terms of your sleep. Do you sleep the same time every day or does that vary?
Bill Lagakos: I sleep well within a few hours after sunset. I mean it varies seasonally. I sleep a little, I think I sleep a little bit longer in the winter, but I try and cut back on I have blue light filters on all my devices because you’re users probably, I mean your listeners probably know that you know artificial light, especially in the New Light range, can really disrupt your circadian rhythms especially at night.
Dr. Sohaib Imtiaz: Yeah. I thought of using those blue light blocking glasses recently. It would really help.
Bill Lagakos: There haven’t been studies on the blue light filters, but the logic seems to be there. And there have been studies on the blue light blocking glasses, and that sort of confirms that you know they’re helpful. I do both.
Dr. Sohaib Imtiaz: That should be translatable. And how often, how far, how many hours before bed would you start using the blue light glasses?
Bill Lagakos: I don’t have a very strict regimen on this because my sleep is generally good. So I’m probably about halfway between sunset and bedtime. I let one other one other connection. A lot of these things are interconnected and sometimes I get confused and I forget some of the connections, but one of the other important is of getting that early morning sunset sunrise. Sunlight is eye view. Then you know glucose responds to a meal. That’s something that’s important.
Melatonin responds to your melatonin secretions at night. I think that’s something that’s important. And so those are two things that I try to be mindful of in what was a study that showed early A.M. sunlight protected your melatonin secretion. So artificial light at night really really adequately and really quickly want melatonin. So that’s like if you get up in the middle of the night to go to the bathroom and your melatonin is taking a hit that’s bad. But there was a study that showed that morning and bright light exposure sort of protected your melatonin at night so that you could withstand a small you know a small burst of light in your melatonin wouldn’t go down as much. So that’s another reason to be getting the sunlight early in the morning.
Dr. Sohaib Imtiaz: That’s really insightful. So you want to be almost optimizing your kind of light exposure when the light is at its greatest in the morning. Noon isn’t as great as when its broad daylight. What about when it’s cloudy or you’re trapped in an office environment? Is any kind of, have you come across any lamps or light?
Bill Lagakos: There are some blue light lamps that have been shown to be helpful. I don’t know if there have been comparative studies, like comparing different bright light lamps, but I know there are some popular ones that people seem to find helpful.
Dr. Sohaib Imtiaz: So for good sleep try and get as much light before noon and then try and avoid artificial light. So there’s a secondary parameter near the bedside. And does it help with mental alertness and productivity?
Bill Lagakos: It helps in a lot of different like a lot of different research groups. They have a different focus. So they’re studying the effects of light exposure on mood, and they’re finding that in seasonal affective disorders in certain cases of bipolar disorder, they can be greatly helped by just treating people with controlling the light exposure.
Dr. Sohaib Imtiaz: Ok. Because when we’re looking at students specifically with Owaves and doing a few studies that we’re starting. Obviously, students are notoriously known for you to know bad sleeping habits. You know partying late in the night, and waking up late missing lectures, and you know you’re kind of dozing off. And you can’t really take in information during lecture.
Bill Lagakos: That’s taken off across the country. There’s all these big movements to well they’re sort of saying to move back the school start times. I’m saying that is a great solution to improve sleep duration. A better conclusion, a better intervention which is not going to be the very popular one, is you know try and get the better earlier. You know we’re as humans as a species we’re not supposed to be staying awake until like 2:00 or 3:00 in the morning. Yeah that’s way too long after sunset.
Dr. Sohaib Imtiaz: So what’s the latest you think you could sleep and still be healthy? Or try and optimize your circadian rhythm? Would you say midnight or way before that?
Bill Lagakos: I go to bed a little bit before that. I think there’s a little bit of you know rooms like some people can get by on like seven hours of sleep. I heard one person actually read a book and the premise was actually justified nine and a half hours. And I said wow nobody sleeps that long. However, the biochemical justification was like You know you need three hours of darkness just to get the most robust melatonin secretion. You need to have at least six hours after that to allow prolactin suppression and an extra 30 minutes for good luck. And all of these things sort of had the effect of doing the opposite of. Usually, seasonally some species ramp up appetite and stuff so that they can gain a little bit more weight to prepare for times of famine or not famine but less food availability. And one of the ways that your body may regulate this is by driving up the appetite for sweets and things. And so if you get that nine and a half hours you don’t really have that happen. OK you’re less kind of likely to be kind of bingeing on things?
Bill Lagakos: Yes. And what I’ve found with working with clients is doing all of these habits, a lot of people have these abnormal cravings that kick in in the late afternoon and all of a sudden they get hungry. And since it’s not really a mealtime you’re not eating real food you’re just snacking on things. And that can lead to an energy surplus and waking or may sort of hinder your weight loss efforts. So by doing all of these circadian behaviors like getting light exposure earlier, a bigger breakfast and really working on sleep quality. What I was finding just sort of anecdotally is those cravings were reduced or completely gone away and people are just waiting to have their regular dinner or having a light early dinner at the time when the cravings would have started. But then you know they don’t have the craving it’s just a meal and it’s dinner and it’s over.
Dr. Sohaib Imtiaz: So you’d be agreeing with Satchidananda Panda’s kind of research in kind of in rats, mice, where time-restricted feeding windows of eight hours to like a maximum twelve hours, how it shows a mass of even the same number of calories consumed, but the fat loss is different.
Bill Lagakos: Yeah I would add two things to that. One, by having the light early dinner, just thinking like what normal people do. And you know two things that I think that can drive up your energy intake to puts you in a surplus which makes you gain weight are desserts and alcohol. And when are they consumed? At night.
Dr. Sohaib Imtiaz: At night. Yeah, they’re socializing.
Bill Lagakos: By yes social. So by having a light early dinner, you’re sort of cutting out those two things, which, I think that’s sort of like an easy step. If somebody is trying to lose weight or trying to get healthier that’s helpful.
Dr. Sohaib Imtiaz: So we’re of coupling behaviors. That’s quite clever actually. Yeah. So overall
Bill Lagakos: Yeah, One other thing back to the panda study you mentioned, is there was another more recent study that compared, so a lot of people get mad at me for saying this that intermittent fasting or those reduced feeding windows when you compare those two continuous energy restriction which is just like you know somebody is going to have a reduced meal window, is that more effective than just having a regular old calorie deficit? And it turns out, no it’s not really. It does help some people stick to the diet. And I’m totally for that, but there was a recent study that got me really excited and I’m enthusiastically anticipating a follow-up, but it showed the eating, the timing of the eating window was sort of important. And in this study, they were very strict. They told people we don’t care what you eat. We have to stop eating at 3:00. I think that’s a little bit too strict. I think you can probably go a couple hours after 3:00. Your point is you’re not having your biggest meal like 8:00 p.m.
Dr. Sohaib Imtiaz: OK. The biggest meal earlier on in.
Bill Lagakos: Yes. So your biggest meal should be like breakfast and lunch have a light early dinner. The point is you’re not having two thousand calories at 8:00 p.m. So what they showed that this study was designed such that they didn’t want people to lose weight. So they had the control group and the early timer eating group and they showed that you know usually in order to improve insulin sensitivity, you have to lose weight. That does the trick every time. Well, I can’t think of any that there might be an exception but I can’t think of at the moment you just have to lose weight.
Dr. Sohaib Imtiaz: I have to lose weight. Yes.
Bill Lagakos: So but in this study, they showed improvements in things since to be in the group that maintains their body weight. They just had an earlier time feeding. So I thought that the meal the timing of the meal window that has a lot of potentials to be very cool in the future because it’s just another thing that you’re not changing what you’re eating. You can eat the same foods.
Dr. Sohaib Imtiaz: Just timing.
Bill Lagakos: Yeah timing. Another thing that I think is a lot of people say this I agree. And most definitely true, adherence to any lifestyle intervention is the most important determinant of your results.
Dr. Sohaib Imtiaz: Consistency.
Bill Lagakos: Yeah consistency exactly. And so if it’s somebody asking you know what’s the best diet to follow and I said well you have to find a diet that you can adhere to and what is the diet that you can adhere to? It is the one you’re eating right now. How do I know that? Because you’re perfectly eating it every day. And that’s the diet that you’re following. So what I would say is we just want to follow that diet and just make minor tweaks that will be, you know, it won’t really disrupt your lifestyle. It won’t really make you have to throw everything in your cupboard out and buy all new food. You know, I would just like to make subtle tweaks here and there because this seems to be where people find adherence.
Dr. Sohaib Imtiaz: They can sustain a sustainable change though. The body clock as you said the organs they seem to have slightly different clocks etcetera. The liver, has its own kind of it metabolizes fats better at certain times and doesn’t metabolize at all I think four AM or something. Could you shed some more light on that? So should you avoid fats at nights? What is the science behind it?
Bill Lagakos: It’s not so much fats. I mean for the longest time everybody myself included was trying to figure out what was the which nutrients were important for training the circadian rhythms, I think for a long time people assumed that would be like carbs and insulin, but then it turns out you know in some cell culture studies they found that even in models of Type 1 diabetes where there is no insulin, food could still train the circadian clocks. So, in terms of that I would say there are differences in insulin sensitivity throughout the day. For example, you can if you take a high carb meal in the morning or at night you’re going to be able to put those carbs into your muscle tissue much better in the morning.
And whereas if you have a big a like an insulinogenic meal in the evening your adipose tissue is more likely to store fat in the evening. So, I mean we’re kind of getting into the nitty-gritty here. It’s very nuanced but those are some of the differences that I find. If you’re going to be like totally circadian dieting those are things some things that I would keep in mind. Like your skull, worded in another way, more simply your skeletal muscle is more insulin sensitive in the morning. Your adipose tissue is more insulin sensitive in the evening.
Dr. Sohaib Imtiaz: So have you read any kind of studies where muscle composition can change solely based on your circadian misalignment?
Bill Lagakos: Again there was that there was a study a Russian study that showed that people that were losing two groups of people one group having shorter sleep than the other group really messed them up in terms of body competition. If you were getting shorter sleep which is another fault in circadian arrhythmia or circadian misalignment, they were losing more muscle and less fat. And once again, you know if I’m trying to help somebody if just sleeping a little bit longer like that’s really easy in a regime who does want to sleep a little bit longer?
Dr. Sohaib Imtiaz: The low hanging fruit.
Bill Lagakos: Yeah exactly. Exactly.
Dr. Sohaib Imtiaz: So would a nap in the middle of the day or what do you think of like the siesta in Spain, do these disrupt your circadian rhythm? Say one day you’re actually tired, a stream of research because if it would then I guess you would go and try to avoid it and just sleep at the right time.
Bill Lagakos: Yeah I mean I think that that’s an easy enough study to do because there are a lot of populations that are consistent napper. But, I don’t know the answer to that. If it’s total amount of sleep in the way, the way I understand it you want one long sleeping block. I mean I could be corrected on that if this research comes out.
Dr. Sohaib Imtiaz: So circadian rhythms a lot of it does have to do with the end of the endocrine system? Because your hormones secrete cortisol in the morning. The hormones are released cause growth hormone a night, are circadian rhythms important because of the endocrine system? What would you say?
Bill Lagakos: Sure absolutely. Just like you said we have that cortisol awakening response where it really ramps up right before we wake up in the morning. You have sunlight also activates dopamine in the morning and a couple of years ago a new diabetes drug came out called Bromocriptine. Well, it was repurposed it used to be it’s used for other things but they found that if you take Bromocriptine first thing in the morning it’s a dopamine drug and that helps reduce people with metabolic syndrome and have high fasting glucose levels and impaired glucose response to meals. This helps to reduce the glucose response. And that’s one of those things like sunlight first thing in the morning also improves your dopamine levels.
Dr. Sohaib Imtiaz: So it’s like a natural way of biohacking, where you know these facts. So you just kind of utilize these to your advantage and I guess technology now can help augment some of these things because I mean technology became the problem, but we can also use it to solve these issues as well.
Bill Lagakos: Yeah. And I think that’s the way we’re going to go because there was like a famous study that showed they put these people out in the wilderness and made them go on a camping trip with no technology and the study lasted a week. But even after just about three days even after three days like their melatonin improved, their sleep quality improved, duration of sleep like everything like instantly got better and I thought that study was awesome. But, like you said you know we’re not all going off the grid.
Dr. Sohaib Imtiaz: We can’t live without. But that’s very interesting. So would you almost even go a bit further and recommend these retreats of sensory deprivation and or kind of. Because people do go by them but there’s normally not like you quoted objective data which shows actually this can be great for your body.
Bill Lagakos: Yeah I would recommend that like a reset. And one other thing that is sort of connected to that is I mean I don’t want to get the wrong impression. I do believe food is important and diet is important. However, a lot since the dawn of time no one I think that we have modern studies so that we should go about the modern studies based all of our information off that. I don’t care what humans did ten thousand years ago. I don’t care what they did a thousand years ago.
I’m not going to do something just because that’s what they did. They got eaten by lions or whatever. So I’m for more you know looking at the current studies when we have them, but from just like a logistic thing or over the course of the past hundreds of thousands of years, humans have lived in all sorts of environments eating all sorts of different diets, different foods, different plants different vegetables and they could survive just fine. We’re here today and people can even go weeks or even months without food and still they’re fine. I mean you think there was one famous example of a very obese person who was monitored by doctors but went like a year without food.
Dr. Sohaib Imtiaz: Well that’s a long time.
Bill Lagakos: Yeah it was a very long time I mean and I’ve definitely know people that will go weeks or months without food and you know come out of it being just fine. Try doing that with sleep and you will literally die
Dr. Sohaib Imtiaz: OK. So sleep is probably the most important thing.
Bill Lagakos: Yeah I mean sleep and more generally, I think that’s why circadian rhythms are like really really important. You cannot go without sleep, but you can go weeks without food and be fine.
Dr. Sohaib Imtiaz: And inflammation. I mean you just want inflammations or is not something that’s linked to kind of circadian misalignment?
Bill Lagakos: Yes. There are correlational studies showing dysregulated I06 and CRP and all these inflammatory cytokines are becoming dysregulated with circadian neighbor.
Dr. Sohaib Imtiaz: OK. So people who are sleeping at 2:00, 3:00 a.m,. waking up having eight, nine-hour sleep waking up midday. I’m thinking.
Bill Lagakos: That’s not bad because especially because what are you doing until 2:00 or 3:00 a.m.. I mean, are you playing with artificial light your smartphone on your computer? That’s like really, taking its toll.
Dr. Sohaib Imtiaz: So even if they’re trying to kind of work out and the eat healthily, that could be the fact thats kind of stopping them from kind of reaching optimized health.
Bill Lagakos: Yeah. It’s either stopping or slowing them down. And it’s one of those things that’s low hanging fruit. If it’s really simple for you to get this thing in line and that will help give you an edge then, I’m all for it. I’m all for giving people all of the edges, but again in the modern environment, there’s so many things working against you, then let’s try and reduce the things working against you and try and take as many edges as you can.
Dr. Sohaib Imtiaz: Yeah, that’s the problem because entrepreneurs, because I’m a doctor by profession, and kind of part of this clinical entrepreneur program, and looking to Silicon Valley in entrepreneurial ways of doing things, entrepreneurs normally think they can do things differently and sometimes that does involve them kind of staying up late and having erratic sleep. That’s not enhancing that creativity or that mental performance and they can be disillusioned because obviously they don’t know about health and circadian rhythms. They think that kind of, they’re working the night when they’ve got no distractions, but really could be harming what they could be achieving. So I think that’s important especially.
Bill Lagakos: Yeah I mean some people are aware of this. I mean I remember I do weird things I’m afraid that sometimes I remember it and it was almost 20 years ago I had a great biochemistry professor. And before one of the exams, he said you know, study today. You know, study tomorrow. Don’t be that guy who’s studying the day before the exam and he stays up all night. And he said that he can guarantee that every hour that you stay up past midnight on the day before the exam, you’re going to go down like a half a grade because that messes up your brain. That stuck with me. So I decided at that point, that day, I said I’m not going to be the guy who’s cramming for exams and then study early.
Dr. Sohaib Imtiaz: Same with me. I mean I’m glad you mentioned that too because a lot of our listeners will be students eventually as well. And that’s something that students seem to think of as being heroes.
Bill Lagakos: But yeah no it’s the opposite you don’t, you shouldn’t be bragging saying I pulled an all-nighter here.
Dr. Sohaib Imtiaz: It’s detrimental to your mental well-being.
Bill Lagakos: Yeah. The only people that can brag about being pulling an all-nighter are like you know nurses, or police officers who have to work the night shift and that’s okay.
Dr. Sohaib Imtiaz: Because obviously, they’re making a sacrifice.
Bill Lagakos: Yeah. It’s not good biologically for them, but you know it’s something that needs to be done for society.
Dr. Sohaib Imtiaz: And with season so like the seasons vary quite a lot climates etc.. Do you think we should be varying the amount we sleep, when we eat, etcetera, for our circadian clock according to this season? So in the summer should we be sleeping later, and winter’s sleeping earlier because the darkness is earlier?
Bill Lagakos: I kind of I kind of do think that. However, again modern society kicks in and we sort of insulated ourselves from that a lot. We have, you know, artificial heating and cooling in our homes. We control the light for the most part. So, if you can optimize those things, sure. I don’t think you’re going to have huge seasonal variations just due to modern life. Life happens.
Dr. Sohaib Imtiaz: Because life is kind of yeah it’s a very, it’s not something you can completely plan and the way things work in system societies we have to be awake in the dark etc.. But try to limit that. Is there like a number of days. I came across I don’t know how evidence-based this is. I remember reading that because the world health organization class nightshift workers as.
Bill Lagakos: Carcinogen
Dr. Sohaib Imtiaz: Yeah carcinogen. And it was classified anyone staying past I think during the exact time 1:00 or 2:00 a.m. this many times a year. I think it was 50 or 60. Yeah. So I mean I guess you could. I don’t know how many times that’s when it. I don’t know how it got to that number. But being quite dangerous. But I found that quite interesting. But with kind of so if I was to ask you, so obviously we’re becoming, the world is becoming smaller. We’re traveling a lot more. Everything going to be exponentially cheaper. So people are traveling a lot more which means a lot more jet lag, a lot more circadian disruption, and it’s almost a market or a kind of need for people to know how to reset their circadian rhythms quickly in new environments because they’ll be flying from the U.K. to Tokyo. Tokyo to somewhere else. And it’s something which we’re facing now, where people are traveling quite frequently. So what would be your top tips in travel? I know east to west, west to east we’re on.
Bill Lagakos: Traveling, traveling from east to west is easy. I used to live in San Diego and I’ll be flying back and forth to New Jersey. And flying to New Jersey was always very difficult. Flying back to San Diego was very easy.
Dr. Sohaib Imtiaz: Why is that?
Bill Lagakos: Well I think it’s because when you fly from east to west it’s sort of you’re taking your regular day and elongating it. So at night, you’re more tired, more likely to fall asleep. Going the other way, you know going the other way flying from California New Jersey, everyone’s trying to go to bed and I’m still wide awake.
Dr. Sohaib Imtiaz: Yeah. OK.
Dr. Sohaib Imtiaz: So you know you end up staying up later, but then you try and get up with everybody at the same time in the morning. So then you’re tired and you can take. They say rule of thumb is for every hour that you go west to east, it takes an additional day to readjust naturally. My tip, which you know definitely hasn’t been studied in clinical trials or anything, would try to control your circadian variables before you leave. So you know, if you’re taking a three hour time difference, then maybe two days before you leave, try and wake up a little bit earlier. Try and go to bed a little bit earlier. So that you’re already in so that some of those variables are already moving in the right direction. So that you got to take the whole full time to adjust and say this you know there are a lot of practical implications of this. One time my company sent me out to Sweden for a conference, and they wasted their money because I was a zombie. You know you can’t, you can’t fly that huge distance and then expect to be recovered in time to be at this academic conference where, you know, you’re supposed to be, your cognitive is supposed to be at 110 percent.
Dr. Sohaib Imtiaz: You’d be better off face timing or something.
Bill Lagakos: Absolutely. So I mean if I had known then what I know now I definitely would’ve prepared for that probably a week in advance.
Dr. Sohaib Imtiaz: I actually tried that. This time I was coming to Dubai and its a three hours difference from the UK. Three to four hours. And I started waking up. So to make that adjustment I did start changing my routine slightly and it did help and so on. So would you sleep on the plane? or would it just depend on the timings of the plane? And eating on the plane? Would it just depend on kind of would you kind of stick to the time zone you were in or where you’re traveling?
Bill Lagakos: I would try. I would try and stick to the time zone where you’re heading. Where we’re going to be.
Dr. Sohaib Imtiaz: Yeah. Because you want to be that. OK. And would you use melatonin to help you sleep?
Bill Lagakos: The one thing would I say melatonin, the two things I say melatonin is good for is one for jet lag, but it hasn’t been studied for that. But two, I deal with a lot of people that have really bad sleep problems and most people want a pill. And hey, if there was a good pill for sleep problems I would have no reservation. The problem is there’s no good pills. I mean I was at a sleep conference just a couple of years ago and they say you know we could prescribe anything and they’re basically no better than alcohol. Any sleep product. So but the only exception is if somebody has a bona fide circadian-related sleep disorder, melatonin works. And Yeah, I always tell people this is worth a try. Take a half a milligram. You don’t have to do this for a long period of time it doesn’t take like three months to kick in. You’ll know if the next morning you wake up feeling refreshed and you know you don’t need a cup of coffee to get you going, then you know you have circadian rhythm-related sleep disorder and we’re going to have to either adjust some behaviors or include melatonin supplementation. Like there are a lot of health behaviors, that we’ve discussed in this conversation, that will support the melatonin production, whereas you won’t really need it.
Dr. Sohaib Imtiaz: You don’t need it so you can have lights etc.. You mentioned coffee actually, thats a good one because coffee is I think increasing a lot in populations. People using caffeine. What’s your opinion in caffeine something that you should use to help your circadian rhythm?
Bill Lagakos: Coffee is OK. I drink coffee because I exercise in the morning and that helps me increase my intensity of the exercise. Caffeine has also been shown to entrain the circadian clock in your liver. And I’m all for coming treatment because I think misalignment of just circadian clocks is sort of what is when they say that when they’re born helping them he says it causes cancer I think it’s causes circadian misalignment. OK. So the only thing I would say is that after the midday, whatever time that is for you and your region, caffeine is been shown to delay your circadian days. I would stick and keep it in the morning.
Dr. Sohaib Imtiaz: Early in the morning. Ok and would it be, is there a certain amount of caffeine? Or just you know, some people don’t drink very kind of black coffee except for quite strong caffeine doses or these energy drinks which have very high caffeine doses as well. Would you say is probably
Bill Lagakos: That that’s up to you. Yes I mean I’m a caffeine wimp. I can have like one small cup of coffee and that’s the one that I have anything more I start sweating.
Dr. Sohaib Imtiaz: OK. So yes it depends on your own kind of threshold. Where you’re comfortable.
Bill Lagakos: And that, there might be some genes involved in that. Some genetic differences.
Dr. Sohaib Imtiaz: Yeah you mentioned genetics that’s another one. So I got my kind of snip sequenced the genome test, the genetic test by company and one of the genes of the clock Gene. Now the variant that was reported back, is I’m a night owl. So what is a chronotype, so chronotypes and genetics. What can you tell us about that?
Bill Lagakos: I don’t know. Well my feeling is if you look at sort of you know with the World Health Organization has said and the physiology of melatonin and glucose tolerance and its intensity, when you look at all of those things together, I think that when they’re telling you you’re having evening chronotype, that’s not really like stay up late, eat a late meal and sleep in. I think that might be like you might be staying up 30 minutes later than me. I don’t think it’s a huge lifestyle switch according to the genetic profile, because I think of humans as a species you know we have sunlight during the day darkness at night. We are not a night owl. We are whatever the opposite is, the morning larks. But within that range, you know you can go plus or minus an hour or two, wait times, bedtimes, and if you want to make that difference between a morning person and an evening person and I’m fine with me saying that somebody and somebody says you know there’s 20 different chronotypes. You know, it’s not just morning. Then I’m saying OK you’re nitpicking down to like the minute.
Dr. Sohaib Imtiaz: The minute. Yeah.
Bill Lagakos: Yeah. But in general, we’re supposed to be awake during the day and sleeping at night.
Dr. Sohaib Imtiaz: And broadly speaking, do you know that sort of famous circadian clock where it kind of shows how cognition is probably best i don’t know ten A.M or, more reaction times are best around two to four, or whatever times that are listed.
Bill Lagakos: What I see with that is these studies that I’m aware of, they have shown that it can be trained. So if you start performing cognitive tasks at a certain time of day and that’s when you get used to doing, you will soon be better doing them at that time of the day. And I mean even more bluntly they’ve shown us with exercise. They’ve shown this with exercise like if they test, if they just come in and test you on day one morning exercise your afternoon exercise most people that haven’t been trained are going to perform better in the afternoon, but within like a week of morning training there is no more difference.
Dr. Sohaib Imtiaz: Ok. That’s very revealing. I didn’t know that. So your body seems quite adaptable and tends to be.
Bill Lagakos: I mean those are sort of blunt measures, but yeah as far as that goes it can be trained.
Dr. Sohaib Imtiaz: OK. And what I was quite interested in when I when I read one of the articles on your Twitter, was on anti-aging and skin. Yeah. Could you tell me about that in the study? Because I’m sure a lot of our listeners are quite interested in keeping youthful and healthy.
Bill Lagakos: Well the skin has its own circadian rhythms which unsurprisingly are regulated by the sun. And it’s cool, it’s because it’s your skin basically during the day when is it being exposed to the sun, sunlight UV rays can damage the DNA in your skin which if it happens excessively, that could lead to skin problems could be even lead to skin cancer. However, if your circadian rhythms are in line, your skin cells aren’t proliferating during the day. During the day, they are just sort of bolstering their defenses against the UV light so that you can get the benefit of sunlight exposure. And then at night when the sun is down we’re not being exposed to the sunlight. So the defense mechanisms are down-regulated and now at night your skin is going to start rejuvenating basically or you know proliferating, making new skin cells and just sort of coincidentally or not coincidentally but it happens on the 24-hour light-dark cycle. So you can mess that up by circadian arrhythmia by like you know all the things we discussed. Sleeping late, artificial light at night, having a big meal late at night that can mess things up from the inside out.
Dr. Sohaib Imtiaz: So if you missed that sleep in that darkness, you could have likely less cell perforation and kind of less collagen and
Bill Lagakos: Yeah. And it’s also less protective.
Dr. Sohaib Imtiaz: And less protective. OK. So it’s not always. So that’s why the timing of sleep is important in kind of light-dark cycle rather than the amounts of sleep. So there are some science behind beauty sleep.
Bill Lagakos: Yes.
Dr. Sohaib Imtiaz: So for people to look younger and have to be kind of getting their sleep right.
Bill Lagakos: Absolutely.
Dr. Sohaib Imtiaz: So have they have they actually done these studies of where they look at images of people sleeping at different times and.
Bill Lagakos: Not to my knowledge. The studies that I’m referencing, that they actually may have been done. I haven’t looked into that. I was just looking at it from a skin health perspective.
Dr. Sohaib Imtiaz: Yes.
Bill Lagakos: Not not sort of what the appearance but like a fancy for skin cancer.
Dr. Sohaib Imtiaz: Yeah.
Bill Lagakos: I would be surprised if they’ve done this.
Dr. Sohaib Imtiaz: Because I mean I guess maybe more kind of cosmetic companies and things. Because I guess maybe then because I know cosmetic companies, a lot of people use skin regimes, dermatologists described, etcetera, and in certain times of the day you have to use different products. So that would be interesting to look into as well.
Bill Lagakos: Yeah. I mean it could be guessing, but I don’t know. I can’t comment on that yet.
Dr. Sohaib Imtiaz: Ok. And coming onto brain health, so we’ve talked about how kind of sunlight helps you be more alert and cognitive performance. So all things like a lot of things kind of like insomnia, brain fog, chronic fatigue syndrome. A lot of these syndromes, there’s a lot of associations with circadian rhythm.
Bill Lagakos: So there is and the more scaring of all those is dementia. Dementia risk is huge in shift workers. There’s all these epidemiological studies that show people with dementia, their family members are saying, Oh they know there’s a wife will say my husband never slept good. And you know, the increased risk for dementia among people that have had more sleep quality for their life. It’s really scary.
Dr. Sohaib Imtiaz: Ok. You’d advocate to try and keep your sleep. So obviously, every single day your life can’t work like clockwork, but as much as you can try and sleep by about half 10:00 11:00 wake up by 6 of 7.
Bill Lagakos: And there something, once you get sleep problems, it’s hard to heal from them. So all of these circadian-related lifestyle behaviors really need to be done every day. And I said I you know it’s OK to have like one bad night sleep, but there are some people that have lifelong sleep problems. And when I say you know you can’t go two weeks without sleep because you die, I also think that there are people that have sleep problems that just mean that we’re going to have to pay attention every single day like you can’t skip a day.
Dr. Sohaib Imtiaz: OK. So it becomes like a habit, that every single day they’re having disrupted sleep.
Bill Lagakos: Yes. Yes. But it important to have it.
Dr. Sohaib Imtiaz: Even when there’s no problems they’ll be up until 3:00 4:00. And it is an increasing trend in society because of these, as we’ve talked about and we’re becoming a 24/7 society would like kind of I don’t know these fast food chains are open 24/7. Now with the remote working, you’re working with people across geographies and people are awake working in the night having meetings. So this will be an emerging or increasing area of concern that needs to be corrected. And the microbiome, that’s a quite interesting emerging field of kind of science and biology. There must be on circadian links to the microbiome as well.
Bill Lagakos: There are and actually there’s a blog post on this just about a week ago, and it’s showing that people with irritable bowel syndrome are more likely to have sleep problems. People with sleep problems are more likely to have gut issues. And all of these things also with mood disorders. It’s all sort of like interconnected. I think the next big questions are going to be OK well which foods are we going to be looking at to feed which species and how is that going to influence circadian rhythms and brain health. The microbiome is a huge field of study.
Dr. Sohaib Imtiaz: So it’s like a chain there’s a knock on effect. One thing leads to another.
Bill Lagakos: Yeah. And you know they all affect each other now and I think that we’re not exactly sure which direction the arrows of causation go in.
Dr. Sohaib Imtiaz: Because they’re still kind of interlinked and by direction.
Bill Lagakos: Yes yes.
Dr. Sohaib Imtiaz: So in that way, so I mean inflammation, brain health, aging, you know insomnia, mental disorders, and a lot of chronic problems which now are the problems of society. So I mean, I’m really the technology and do think there are ways, there’s a lot of apps and I guess technologies now, the technology kind of creates the problem of evolving society, creates a 24/7 society. And now we’re trying to use tech to kind of combat that.
Bill Lagakos: Yeah. I mean we’re not going even to use camping trips to combat it because that’s impractical. Yeah I mean we might need technology to help.
Dr. Sohaib Imtiaz: To help. I mean it’s virtual, I’m just kind of hypothesizing here. You could, I mean, there are certain things that make certain people more sleepy than others, like music or we’re all quite different. I guess you could use virtual reality to kind of simulate calming environments to help people sleep. And so with Owave, our app is trying to kind of obviously can raise the issue of your time and the time you kind of sleep, wake up, is very important to health. And really the thing we’re looking at is mental health being one of the ones that students drop out rates are quite high. And depression anxiety is on the rise. Owaves we working two strands one is kind of a health optimization human performance, where we’re mapping kind of successful individuals because looking a lot of them they have very they wake up quite early.
They go to bed on time. You know, they have set meal times. They exercise. Kind of the five facets of lifestyle medicine, trying to help motivate people if they want to be successful, they can look towards them. Kind of obviously athletes are very healthy people, generally speaking. And with the app we’re trying to obviously change what time zones you know when sunrises when sunset is. And I guess the next frontier is trying to use some form of artificial intelligence to help people, kind of, if it’s safe to say because if something happens in their life where they miss or they miss a meal or circadian misalignment. Because to tell you that it traveled, to help them get back on track as quick as possible.
So that’s, I think we’re where we’re going with the app. We’re talking students and kind of using coaching to help people form more healthy behaviors. As you said, consistency is key. So I think accountability checking in. But, I think you provide a lot of that kind of research and insights behind why we do need to be optimized from a circadian point of view. Did you think a lot of these studies that are done in animals are translatable to humans?
Bill Lagakos: I think some aspects of some of the studies are. I think even when you’re looking at the totality of mouse studies, I think that you can’t just apply them 100 percent directly to the human models, but you can intelligently interpret them.
Dr. Sohaib Imtiaz: Because obviously a lot of the physiology is similar. So you could do that.
Bill Lagakos: You know we’re 85 percent genetically similar to them. So there are certain aspects of the physiology that carry over. But I think that there are a lot of human studies on this on the subject too so I would say, you know if you have a divergent outcome in a mouse and in a human study, then you’d be pretty safe. Yeah, you’re pretty safe to say okay I’m just going to go with the human study.
Dr. Sohaib Imtiaz: Yeah but if they’re showing the same things you can pretty reliably say about most, they’re similar.
Bill Lagakos: Yeah if it’s strong, the same thing, you can do you know further research in the animal model.
Dr. Sohaib Imtiaz: Yeah I’d see if there’s any differences.
Bill Lagakos: So what can you do about it? yeah.
Dr. Sohaib Imtiaz: When you say when you see clients, so say someone’s circadian rhythm is completely disrupted. They have very bad habits. Would you start with incrementally pulling their sleep time back, or would you just make a dramatic shift?
Bill Lagakos: For the former, by far. You know when somebody is sleeping five and a half to six hours a night, you know I would say you know you don’t have to get your sleep up to eight hours tomorrow. I would say you do start today, try 10 minutes 20 minutes or go to bed 20 minutes earlier. Do that for a couple days and see how you feel. See if you’re if it’s actually translating into 20 minutes longer sleep. So are you still waking up at the same time, but going to bed 20 minutes earlier, you can do that for a week and then try another further increment. I mean this is not something that you have yet. Usually, it’s not something I can think. Like somebody sleeping five and a half hours, there’s a reason. And we’ve got to figure it out and got to work back up to a healthier sleep time duration.
Dr. Sohaib Imtiaz: So what you’re saying, so a lot of the people who have chronic problems could, be due to circadian misalignment and correcting that could go a long way to solving a lot of their problems. And on the other side to things, people who want to improve their performance and optimize their health and kind of be as well as they can be. They need to also follow kind of a routine where they kind of have that light exposure early in the day, meal timing or too late you know.
Bill Lagakos: Yeah. And it’s funny I had like sort of like two distinct populations of people. Some people that are very healthy and they want to improve things and sort of the transition from you know 90 percent to 110 percent. And well the people that are coming to you think with like severe health problems and lifestyle problems. So it’s kind of like going through something unhealthy to normal health.
Dr. Sohaib Imtiaz: Yes. What a broad spectrum. So I think as more research comes out on circadian biology and as you yourself and others are doing, its becoming I think since the Nobel Prize was won in 2017, it’s becoming quite an emerging area of research and I think I’m getting tech companies will start trying to look at this as well. Do you feel a lot of advantages will be gained? I mean you know we do more studies of you know F.M.R.I’s and you know looking at brain scans, and you know when people are most creative, or their brains are kind of processing faster, or certain times when they’re feeling more kind of restful, we could probably find a lot of patterns and even with the endocrine system, testosterone peaking, and you know cortisol and then associate different activities at different times. Do you think that’s the future?
Bill Lagakos: For?
Dr. Sohaib Imtiaz: More precision personalized approach?
Bill Lagakos: Yes.
Dr. Sohaib Imtiaz: So so genes are expressed at different times of the day as well. Is that correct?
Bill Lagakos: Yes and there was another good study on this that showed this could affect, their calling it chronotherapeutics or chronopharmacology.
Dr. Sohaib Imtiaz: So that’s exactly what Owaves is trying to do. Yeah.
Bill Lagakos: Yeah. And they were showing that sort of genes involved in cholesterol synthesis are up regulated at night. So you want to take your statin drug at night. You know, a lot of people hate on statin drugs, whatever. But, I think that if you take it at the right time of day you can cut your dose in half, then you’re much less likely to see side effects.
Dr. Sohaib Imtiaz: Ok. So you could be getting the same efficacy with half the dose without the side effects, but just because of timing. Which would be amazing. So that could probably the same thing with other. Even if we talk about maybe macro neutral or like, for example, fruits, vegetables they could have different effects at different times of day.
Bill Lagakos: Yes. Possibly.
Dr. Sohaib Imtiaz: With endurance.
Bill Lagakos: I’m not going to, I’m not going to put it a guess out there, but yes.
Dr. Sohaib Imtiaz: So as we do more research, obviously very tentative at the moment because the research hasn’t been done. So where do you think circadian biology is going? Do you think we can implement this in people’s lives?
Bill Lagakos: Absolutely. I think we already are. And your company alone is sort of going into this territory. I think it’s very important.
Dr. Sohaib Imtiaz: Yeah trying to address this issue. Any ideas that you’ve got that you’d like to see in an app that you think would help people realign their circadian rhythm?
Bill Lagakos: Sure.
Dr. Sohaib Imtiaz: Any ideas that you’d have?
Bill Lagakos: No, I’m not like a computer guy.
Dr. Sohaib Imtiaz: Okay.
Bill Lagakos: But, you know, if somebody has subtle reminders throughout the day of okay well maybe this is slowing you, you could be doing this. And oh okay well you did that yesterday and you felt like crap, so do something different today.
Dr. Sohaib Imtiaz: So they learn that behavior, because we get smarter over time. Any studies or any anything to circadian biology that you want to reference before we wind up, that you think we haven’t discussed?
Bill Lagakos: I think we covered a lot.
Dr. Sohaib Imtiaz: Yeah.
Bill Lagakos: Is it in your notes?
Dr. Sohaib Imtiaz: We’re trying and get those out. My co-host is in charge of that. So I guess we can link a lot of the studies you’ve referenced and that if possible.
Bill Lagakos: Yeah. Yeah. I mean yeah, I think we covered pretty much a huge spectrum of
Dr. Sohaib Imtiaz: I think that’s what’s important to the listeners they like hearing you know why should we be doing this. Because at times, it can be inconvenient, and get in the way of life. Because people are doing things so differently to what they’re what we were habitually used to in previous generations because we’re an on-demand society. You make a plan and you go and that messes up everything. So yeah, I think having you go through the science behind how circadian disruption can dance how it can cause so many problems. I think it motivates people to kind of keep on top of it from the start and day to day be consistent. Have you ever gone through a period of your life where you had circadian, where you were in a phase of circadian disruption?
Bill Lagakos: Not really I mean. I never, I never did shift work. I was never really a super late night owl.
Dr. Sohaib Imtiaz: Yeah it’s the same with me. The night shift I struggled with.
Bill Lagakos: Yeah I mean, I know some people sort of come to study a field. Like a gut expert had chronic gut problems their whole life, so that’s why they study your gut and now they’re the expert. That wasn’t the case for me. And same with nutrition. I was just incredibly interested in nutrition which got me into it. It wasn’t because I had like failing health before that.
Dr. Sohaib Imtiaz: It was a genuine interest that you had.
Bill Lagakos: And that’s the same with circadian biology.
Dr. Sohaib Imtiaz: Yeah same with me in terms of lifestyle medicine. It’s an interest I’ve had and technology as well. The kind of fusion between two. But, I think this has been a really good episode. And we’ve discussed a lot of in-depth kind of parts to circadian biology and how to kind of keep a good circadian rhythm and this is actually our first, I would say, podcast with an expert in circadian biology. This has a lot of weight to our body clocks series. So, thank you for coming on.
Bill Lagakos: Sure. Thanks for having me.
Dr. Sohaib Imtiaz: This be one of our go to episodes where someone who really wants to understand what circadian rhythms are, can turn to. So I think it’s been great and I’m very kind of you for coming on and we’ll obviously be making your O and how you’ve run your day, and we will be putting on our social media so I’ll send you the link. And great having you on and keep doing what you’re doing. I think circadian. I think this will be the year of circadian biology.
Bill Lagakos: Let’s make it happen.
Dr. Sohaib Imtiaz: Let’s do it. Okay.
Dr. Haroom Kazem: Thanks for listening to another episode of the body clock podcast by Owaves. If you enjoyed the show, please leave us a five star rating on your podcast app. Please also remember to download the free Owaves app on the Apple App Store. Please tell your friends and your family. It’s a great tool to help you optimize your life into effectively plan your day. Thanks as always for listening, and I hope you join us again next time.
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