Owaves scientific advisor and circadian rhythm scientist Dr. Ben Smarr recently published an article on body clock and college student performance. Listen to Drs. Haroon, Sohaib and Royan dissect his illuminating article and discuss the novel concept of “chronocounseling”.
Dr. Haroon Kazem: Thanks for joining us on another episode of the Body Clock Podcast. This is Dr. Haroon and I’m joined remotely with doctors Royan and Dr. Soheb. Today’s focus is going to be the body clock and mental health and we’re gonna be diving into a couple pretty awesome studies, as everybody is aware of nowadays I’m sure, mental health is a very big issue, whether in the United States or around the world, it’s affecting individuals on every level of society from the lowest to the highest to the most lazy to the most busy.
I think it’s a really important topic that needs further discussion and further research to correlate with overall vitality, well-being. Are people happy nowadays-is that in turn leading to them living healthier lives or is it the opposite? And I think the show today is going to be very informative for those that aren’t caught up to the current events when it comes to mental health.
But I’m sure many have heard of the recent celebrity suicides, they probably have family members who are right now currently stressing probably worrying quite a bit about all sorts of different issues, and the one area that isn’t fully understood is how the body clock and our natural circadian rhythms play into the way that we feel mentally. So I’m gonna go ahead and segway to Dr. Sohaib here and whenever you’re ready sir.
Dr. Sohaib Imtiaz: Yeah. As Haroon pointed out, quite correctly, mental health is huge these days we have so many news stories and there’s actually increasingly emphasis globally on mental health, the recognition of mental health and coming up with population level strategies to combat the ill effects of mental health. So guys I was doing a bit of reading and the World Health Organization actually says that depression is ranked as the single single largest contributor to global disability, which you can imagine, that’s huge and with anxiety being sixth.
So globally with some stats but three more than 300 million people suffer from depression so it’s a massive global health issue and it’s important to find out the etiological factors, what’s causing these mental health problems and why are they growing? So I’m sure there’s many factors as we’re all aware.
I’m actually on psychiatric placement at the moment, so it’s-been seeing quite a few cases. But specifically for our podcast, as you point out, Haroon, we want to be focusing on the body clock, circadian rhythm disruption and how that links in with potential disruptions to your mental health. So we’ll be touching on a few papers during this podcast which really deep dive into some of the trends and some of the research that’s come out on what’s been happening with people, specifically young students. Royan, would you like to start?
Dr. Royan Kamyar: Sure. You know, Sohaib, thanks for pointing out these global statistics. I think I’ve heard that once before but just to hear it again that is kind of something you don’t really realize, you know, day to day that the number one debilitating issue on the planet is depression, right? I mean, we hear so much about heart disease, we hear so much about cancer but you really don’t get the same amount of, you know, sort of mind space or thought or the same degree of attention, media attention or however you want to put it around the issue of depression.
Dr. Sohaib Imtiaz: That’s reflected you’re right. Because in-we’re talking about the confines of digital health, the two big, kind of, market segments for digital health companies and apart from type 2 diabetes and obesity being closely linked to that, mental health is a big one.
Dr. Royan Kamyar: Right. Those are other categories that get so much more attention: obesity and diabetes and I think, you know, and right before I get to I think one of the main reasons, the other thing to realize when you give a statistic like 300 million people worldwide with depression, you know, think about all the countries that aren’t willing to make the diagnosis of depression-right-or don’t even have it in their vernacular, in their language.
There’s no word for depression. And so, you know, those are probably just mostly Western based countries producing those statistics. I don’t know but I’m guessing and so the problem probably goes much much deeper. I think one of the reasons is stigma, right? So that’s a big factor for an under-diagnosis and I think it’s also a big reason it’s not part of the mainstream dialogue as much as it needs to be or should be with a statistic like this. That it’s the number one worldwide debilitation, you know? So I think that’s changing. We have people like Michael Phelps that are coming out about their depression and he’s he’s talking openly about how he was suicidal.
We all know that he had an issue with alcohol and drug abuse, he was put into rehab for that, he had a couple DUIs, he said he spent 30 hours in bed-no one knew-straight, right? Yeah. So that’s why, yeah, he is a big advocate of technology and wearable sensors that, you know, people that he cares about can detect that and help or intervene. So I guess that would be something we discuss later on in the podcast. But Sohaib, on your segway to me, you talked about the demographic we’re going gonna be focusing on for today’s discussion, which is college students and we have a Time article, right? So we’ll include this in the show notes on our website.
So the Time article from this spring-so it’s pretty fresh-“record numbers of college students are seeking treatment for depression and anxiety. But schools can’t keep up.” And again, you have some, I would say, really earth shattering statistics in the third paragraph of this article: “between 2009 and 2015, the number of students visiting counselling centers increased by about 30 percent on average, while enrollment grew by less than 6 percent.” That’s according to a 2015 report by the Center for Collegiate Mental Health. “In spring 2017, nearly 40 percent of college students said they had felt so depressed in the prior year that it was difficult for them to function.” 40 percent. That’s almost one out of every two college students. And then-.
Dr. Sohaib Imtiaz: That’s a lot.
Dr. Royan Kamyar: Right. And sixty one percent of students said they felt they had felt quote unquote “overwhelming anxiety” in the past year. And that’s according to an American College Health Association survey of more than sixty three thousand students at ninety two schools. So there’s a problem. And so what did you guys think? You’re fresher out of college than I am, frankly. College-Go ahead.
Dr. Sohaib Imtiaz: I mean. Exactly. So for now obviously we’re focusing on the mental health side of things which obviously lead into the performance in neurocognition which we will discuss later but definitely in university there’s definitely a culture, so we call a university in Britain,call the same thing in America because obviously you do want to miss out on the social side of things, so you are staying up later, you know, having fun, enjoying yourself and then you obviously-university life dictates how you kind of run your day. It’s more based on your social cues rather than an optimized date according to your health.
So I was actually trying to find out why why could these-because we do know, we’ve established in previous episodes how we’re getting less sleep, sleep times have become later, so our circadian rhythm has been shifted, but I was trying to think of the underlying mechanism and something I remember coming across was that obviously we’re aware that serotonin is one of the neurotransmitters which makes us feel happy. So so even if we think about daylight alone, so daylight varies according to season.
And people know that in the winter as people-some people suffer from Seasonal Affective Disorder, where they’re feeling down in the winter because dark and there’s less daylight more darkness. So what I was proposing, what I was thinking during my research was that perhaps people waking up later or sleeping later, they’re more-they’re less exposed to daylight so they’re less exposed to daylight. We know that once when sunlight hits our skin serotonin is actually produced and serotonin makes us feel happy.
A lot of mental health problems actually stem from a dysfunction in the amount of serotonin you’re producing. I mean, because it’s a serotonin, tryptophans, which are actually found in chocolate as well, so you feel happy when you have chocolate. But so it could be it could be due to that lack of serotonin release due to, you know, less daylight exposure hitting our skin, less exposing ourselves less so to daylight. What would you think about that guys?
Dr. Haroon Kazem: You know I I’m a strong believer in the whole somato-psychic, psychosomatic concept or dynamic. I 100 percent believe there is a component, a physiological component involved that you know whether we are unbeknownst to it or not directly affects our mood and our attitudes.
I’ve heard it from patients of my own a lot of the time exactly what you said verbatim that when they used to live in places that don’t get quite as much sunlight that not only was it like a mood change in terms of like feeling down and not really as vibrant but also physically in terms of like pain and discomfort the body would sort of emit these sort of signals to you know patients where they would realize like, “hey I’m hurting and I’m not feeling good because of the environment and because of where I am.”
So I strongly think that there is a component of that and I think it also-it’s somewhat utilized in terms of like, patient rehab and care in most hospitals nowadays, I think they’re on to the fact that if you use natural light when it comes to helping a patient heal up, it will typically speed up the healing process as well as make it overall more enjoyable. Royan, have you experienced anything like that?
Dr. Royan Kamyar: I agree that, you know, light, they consider one of the greatest anti-depressants and we know there’s a direct causation. Well, let’s say, strong enough correlation that, at least for seasonal affective disorder, it’s kind of widely agreed upon that there’s a positive link between shortened exposure to daylight and depression-depressive symptoms. I think for the college epidemic that we’re seeing, most folks would probably argue that it’s a multifactorial situation going on here, but again, I think a lot of the factors are related and I do think circadian rhythms are a huge underlying problem.
Just to give you an example of what I’m talking about, a lot of people will just finger point at technology and social media and yes, we know, as we discussed in prior episodes that technology has the blue light blue light phenomenon right where it’s delaying melatonin release and delaying people’s sleep, so that’s a physiological consequence which can link back to circadian rhythms. So maybe that’s the same argument but people also say that social media allows for increased bullying. It’s a 24/7 type of bullying that’s brand new, it doesn’t stop when students leave the classroom and it follows them at home.
Dr. Haroon Kazem: Yeah.
Dr. Royan Kamyar: And there’s the FOMO concept, right? Fear of missing out, which a lot of scientists, psychologists really believe is playing a role here. If you go on Instagram, everyone’s life looks better than yours, right? And so-
Dr. Haroon Kazem: Hashtag-sorry to interrupt but hashtag living my best life.
Dr. Royan Kamyar: Yeah, yeah. So-
Dr. Sohaib Imtiaz: Actually Royan, you know at university, some people would wake up at 5:00 p.m. if they’ve had, you know, consecutively on many days so, in the UK, if you just in the winters when university is mostly on exams, is to get up by 4:00. So you could technically go days without seeing any daylight.
Dr. Royan Kamyar: Well.
Dr. Sohaib Imtiaz: So I mean that’s quite scary actually. But it’s true, most students do live that life until work forces them to readjust, even then. It’s sleep deprivation is the whole new topic. Royan, you posted a very good article recently actually which I’m kind of lateral thinking here but it was that link between night shift workers and the changed in the gut microbiome or changing gut to inflammation sensitivity.
So there’s a lot of research and you know the the brain gut axis and people are saying almost how the lack of diversity and gut flora can be caught-is a constant factor for mental health problems like depression and anxiety developing. So if we think laterally here could we be saying that your circadian rhythm gets disrupted which means that your gut flora is less diverse or less balanced or disrupted in some way and that could be leading, due to the brain gut axes link, to these disorders being more prominent in this regulation.
Dr. Royan Kamyar: You know I think I think we have to be careful here because so basically you bring up a really good point which is there’s a huge trend around thinking that the same way that everyone at one time very recently thought anything and everything that was wrong with you or right with you could be traced back to your genome to your DNA-right-now there’s different arguments. What’s the new DNA? And actually, ironically enough, you know, one of the pioneers in the field, Satchin Panda, that we’ve all been reading his research.
Dr. Sohaib Imtiaz: Of course.
Dr. Royan Kamyar: And his book on circadian rhythms, he calls it the circadian code so he is he is literally trying to make the argument that this is the new genome-right-and the new genetic code and this is the reason why everything that’s right with you is right with you and everything that’s wrong with you is wrong with you. That’s great for a marketing and PR standpoint if you’re trying to get more attention to your cause.
And to Satchin’s credit, you know, what he’s doing is getting the attention of the NIH. Francis Collins was tweeting studies that he’s not necessarily writing but directly related or contributing to these authors work, etcetera, etcetera. So he’s helping create this movement around circadian rhythms, a lot of that same phenomenon is happening with microbiome and so the argument here is that inside of us there is I don’t know how many trillions of bacteria and bacterial cells and that we’re actually mostly comprised of bacteria, single celled organisms versus you know actually eukaryotic cells, so we’re more bacterial than human which is just bizarre to think about. And so if you start, you know, I don’t wanna say believing that, let’s say recognizing that-if you start realizing that then almost everything can be traced back to your flora and whether or not you have the right set of flora or the wrong.
I think, I mean, the reality is something is truly there because we have world class scientists now, you know, researching and defining this argument. But there is this, I think, I hate to use the word kind of lazy temptation to as soon as one of these branches of science erupts, that we attribute every-anything and everything to that. And so I know, you know, a researcher in circadian rhythms that she’s always quoting the systems theory, right? And the systems theorist, you know, I think a lot of them are in Europe or UK, Sohaib, so maybe you’re familiar with this train of thought, you know. But basically there’s this-
Dr. Haroon Kazem: Oh you know-
Dr. Royan Kamyar: -and so we had a conversation with Reagan, who will be joining us as a co-host in a future podcast. She’s a d o mph and she’s a huge pioneer of lifestyle medicine. And we were talking about the difference between lifestyle medicine and functional medicine, right? And functional medicine, she was saying a key difference is there is a temptation to say, “okay you’re deficient and this type of nutrients or, you know, vitamin or mineral-and so we’re just going to supplement you with that to get you-make you better.” I think that’s sort of what we’re seeing here. That’s, you know, as opposed to looking at things as a system and saying “circadian rhythms are a contributing factor, yes, but so are genomics.” So our microbiome, there’s a temptation just to gravitate to one thing and then put all areas in that direction.
Dr. Sohaib Imtiaz: So as Royan also pointed out, everything is very multifactorial. So with the mental health problems I guess we’ll have to like, the lifestyle medicine approach enough to look at the nutrition. Are they exercising? Are they sleeping right? Are they relaxing? Have they got social connections? And that’s, I guess, where Owaves comes in because it helps you live a balanced life. And what we found in people living more balanced lives and less likely to suffer from symptoms of anxiety or depression.
So so if we’re looking at it less from a kind of a disruption in your circadian rhythm point of view we could be saying that it just could be due to not having your lifestyle factors being optimized. So a solution for these young adolescents, if we’re saying that’s not university or change in their circadian rhythms, it could actually just be the fact that they’re not-they’re not giving themselves time to exercise in the week which boosts, you know, and produces endorphins, makes them feel good, they’re not eating plants which are rich in Vitamin B 12, etc. which also makes you feel good. You know-
Dr. Royan Kamyar: I wanna add-sorry-I want to add to your point that you’re making right now which is, you know, there’s a great quote in here from a director from Columbia University Clinic for Anxiety and Related Disorders named Anne-Marie Al-Banna is one of the people they interviewed in this article. “Elementary and high school’s so much about right or wrong,” she says “you get the answer right answer or you don’t. And there’s lots of rules and lots of structure.”-so this is getting to your point-“now that life is more free floating there’s anxiety.” And then and here’s the really the nail on the head. “That’s perhaps why for many students, mental health issues creep up for the first time when they start college. The average age of onset for many mental health issues including depression and bipolar disorder is the early 20s.”
Dr. Haroon Kazem: Oh wow.
Dr. Sohaib Imtiaz: Okay, so that’s quite insightful actually. So so we’re saying that the structure-so actually, if I look at anecdotal evidence, sometimes in life if you can-that’s why I think being an on to being an entrepreneur sometimes for some people a lack of structure can mean that it kind of disrupts what they’re doing because they don’t they don’t plan anything. But for some people they can thrive in that scenario because they can be like, “okay, I’m gonna do my work now.
But it means I can go to the gym then, I can sleep when I want on time.” So so it depends I think on then on your personality type. Because I think for some people structure works but for others, they would prefer what they can do so they can do stuff when it’s best for them. What do you think about that? Because I know the later article that we discussed talks about how people like different wake times and sleep times.
Yeah, I, you know, I strongly think that structure provides a huge cushion to actual real life. I think this is seen very much so when it comes to like athletes at all different levels. The moment that they’re no longer on whatever team or playing whatever sport it is, you know, I wish since we’re looking at anecdotal evidence here, like I know a lot of athletes myself and I could tell you for a fact that you know the personality changes the moment there’s no longer that the title and that structure around them.
And I think it leads to an even bigger question question in itself and the fact that like is it the system that’s broken, like is it-it’s multifactorial and so we must be, you know, referencing the entire system itself. And it’s pretty evident here, you know, based on the next study that we’re going to get into very soon with the quantitative data that we can reference there but it seems very much like this is a societal problem in the sense that, you know, from the very beginning, are we doing things the right way or are we just setting up the youth of our country to basically live a very stressful and anxious life from the very get go?
Dr. Sohaib Imtiaz: However though, a lack of flexibility, say, because we can’t plan days but say you got exam season, you know, sat you’ve taken extra classes. Due to those factors, it could mean that, okay you’ve not exercised for two weeks. That could be the underlying issue of why you’re feeling different or you’re more susceptible or vulnerable to falling into depression. You know, convenient foods are there. So you know you’re more likely to, you know, gain weight etc.
Body image issues. I mean I think that’s where that’s where life-that’s where Lifestyle Medicine acknowledges kind of holistically the five different areas because it could just be one thing that leads to another in a bi directional link. So that’s why I think mentioning Owaves, I think everyone’s body body clock-not body clock, body plan could be different. So what works for one person might work for another but what works with someone at a certain time might not work, say, in exam season.
You might have to readjust your body plan. So so like Owaves app helps you design your day to day activities. So I think it would get boring, say, if we lived the same day plan every single day of our lives. What do you guys think?
Dr. Haroon Kazem: Absolutely. Could you-Sohaib, you elaborate on the five categories that lifestyle medicine-.
Dr. Sohaib Imtiaz: Lifestyle medicine primarily focuses on nutrition being one, two physical activity, three being sleep, four being social connectedness and five being relaxation. So there kind of five factors of what underpins most of your health promoting activities. But, I mean, we could be like robots and plan the same thing, but unfortunately life throws different scenarios at us and if we can-if we’re able to react to them in real time and readjust so we still, within that week get those activities which prevent us from being vulnerable to having mental health issues.
Dr. Royan Kamyar: Right. I think you’re getting at it right there. Yeah sorry.
Dr. Sohaib Imtiaz: And that’s why Owaves, I think it’s so transformative because it’s not just the day-because if it was an app with just one day plan, I mean, you could just do it on a piece of paper. The fact that you can change, according to your current situation, the context, the future you’ve changed jobs, you know, something happens in your family you know even even like business factors , so you know your gym closes early, you can you can kind of adopt with all these factors you can kind of come up with the whole the best plan for you for that week or that day.
Dr. Royan Kamyar: Right. And eventually get coaches involved or have some AI recommendations as well.
Dr. Sohaib Imtiaz: Exactly, I mean, that would be the perfect solution I think for everyone everyone is trying to find that optimized solution but I think behavioral economics should be good to mention here we make decisions we’re very irrational and I think the people who can make the best decision in each scenario are the ones who end up being more successful to a degree.
Dr. Royan Kamyar: I think I think there’s, we have three, actually two main topics to discuss. One before we get to the data the data analysis article, done on a major university with 14,000 students, I just want to pile on the multifactorial theory here or the systems theory.
Dr. Sohaib Imtiaz: Yeah.
Dr. Royan Kamyar: And so another another reason why we can be seeing so much depression is the cultural way that we treat depression which is much different than diabetes or pre diabetes, right? If if if a physician sees sugar in your urine or on your morning glucose test, they’re going to immediately put you on a program to address that and you’re going to treat it as a number and you’re going to not have any shame about it or any significant shame that would actually block you seeking treatment or refilling your prescription or whatever else the case may be.
With depression and mental health it’s much different. So in the same Time article this week, probably the last time I referenced it here, there’s a student Emmanuel from McGill University in Montreal and he said that he was too proud to get help, right? And so this is sort of how males probably and I’m sure this happens with females too but males especially there’s a cultural pride or.
Dr. Haroon Kazem: Stigma.
Dr. Royan Kamyar: Right, exactly. It says he became overwhelmed by the workload, felt lost in his classes. He was one as one student out of hundreds and began ignoring assignments and skipping classes and that was just his quote: “I was totally ashamed of what had happened. I didn’t want to let my parents down so I retreated inward.” His second semester, he didn’t attend a single class and then he withdrew from school that April and it says here that, mental health is actually the number one reason why students leave university. So, you know, I think the reality is behind the depression epidemics, depression and anxiety epidemics we’re seeing today, it is multifactorial.
You can’t put your finger on one place because immediately another reason will emerge that’s either related or potentially even not. But the fact is there’s more than one thing going on. But that doesn’t mean that we’re hopeless or that there’s no solution. And so Sohaib, you’ve already been getting to that point. With lifestyle medicine and with how technology can intervene. I think one one thing we can do before we kind of full fledged into solution is go through this article.
So here’s the second article that we we read to kind of prepare for this discussion. And it actually comes from one of our scientific advisors at Owaves, his name is Ben Smarr, he’s a postdoc at UC Berkeley, he works with a researcher at Northeastern Illinois University where the study was actually done on almost 15 thousand students actually, so fourteen thousand eight hundred ninety four students.
Dr. Sohaib Imtiaz: That’s a lot.
Dr. Royan Kamyar: Yeah. And basically what they did is they used the what they call learning management system so, you know, these students all have one main interface to get in on-in and out of their university, let’s say electronic records and over a three point four million data points or log ins, it reveals that the majority of the students in this Midwestern campus-which is actually identified as the most diverse in the region in terms of ethnicity etc.
Students experience social jetlag, and we’ll explain what that is correlated with decreased performance. The majority of students, the majority of students experience social jetlag correlated with decreased performance. So who wants to try to give sort of a layman’s definition of social jetlag? And then we can start talking about this study and then bringing it back to solution which is where Sohaib had this-
Dr. Sohaib Imtiaz: Social jetlag, okay. So the best way to define it. So social jetlag is where, so we’ve obviously got so how society works. There’s a sudden you know a time where most things occur and normatively, we expect certain activities to be set at certain times. So a social jetlag is basically where your natural circadian rhythm or how you’re waking up or running your day is out of sync with how society is forming that that day. So due to that you feel fatigued, less alert, you’re basically not optimized. So that’ll be my definition of social jetlag.
Dr. Royan Kamyar: I think that’s perfect. Yeah I’m just going to borrow from Ben here for my answer which is cheating but it’s on the first sentence of the second paragraph of his article: “misalignment between an individual’s circadian phase and their environment due to social position. It’s called social jetlag” and they abbreviate abbreviate it SJL. “It’s becoming more common and has been tied to many increased disease risks.
Currently western school schedules tend to be optimized for the earlier chronotype or circadian rhythms so like they call them morning lurks a late chronotype students are at great greater risk for persistent social jetlag relative to their academic environment. And this appears to result in decreased academic performance across the spectrum from primary school, high school, college and even on to medical and professional school.”
Dr. Haroon Kazem: And for those that don’t know what the word means a chronotype is a person’s natural inclination with regard to the times of day when they prefer to sleep or when they’re the most alert or energetic and I really liked the term that that’s used in the article of, “Is it social imposition?”
You could also, you know, you just give that an AKA, like having to be in class, having to go to school, having to go to work, having to wake up at a time when you really don’t want to or when your body doesn’t want you to and it’s like, you know, it’s one of the big reasons why everyone’s reaching for the cup of coffee in the morning, taking energy supplements, whatever you name it.
Dr. Royan Kamyar: As a fellow UC Berkeley graduate, I can appreciate the rebellious nature of that statement. Definitely crying for social change here. It’s a good thing.
Dr. Sohaib Imtiaz: Because this is about performance. I mean because like, you don’t, it almost begs the question. So say I say whatever time lectures, I’ll say 9:00 o’clock someone who’s not optimized, if you gave them an extra hour in bed, could they retain that information given to them throughout the day in less time, which would mean would they almost be better off getting to university, missing their first lecture and still learning more because they come in in a more alert state?
Dr. Haroon Kazem: I think so. I think this study, you know, pretty clearly like demonstrates that there is an advantage to working on your own natural body clock versus having to align it with this, you know, standardized be in class at 8:00 a.m. and you might even be here as late as midnight tonight. I feel like that that in itself is something that needs to be looked at much more closely.
Dr. Royan Kamyar: So this article says they found that each-on average each student is about 30 minutes socially jet lagged and the greater the amplitude, the stronger the decrease in performance. So there is a quote unquote dose dependency happening here, which is always a further sign of significance of an actual result, positive results in the study.
And again they’re talking about learning and attention deficit. So this is how-this is why, you know, we think this is still relevant for the topic of mental health because not only are we talking about A’s and B’s or D’s and F’s, but if you’re talking about attention and ability to perform and then comparing yourself to your peers-right-we know from the time article that was a huge reason why people feel depressed because-we talked about FOMO-and if you’re if you’re used to be valedictorian but now you’re in a classroom full of valedictorians.
Dr. Haroon Kazem: Yeah.
Dr. Royan Kamyar: You know. And maybe the attributing factor is your chronotype and your disadvantaged because, you know, what this study shows is that owls are actually disadvantaged throughout the day, even the evening and the night because because of their almost permanently internal desynchronized, right?
So they had this persistent, what they call it persistent instability from a student’s schedule because basically even if the night owl has an evening class on a Tuesday, let’s say, the fact that on most days they have morning classes which take them out of rhythm, they can’t synchronize enough they can’t stabilize enough to maximize the value of having the evening class. Does that make sense?
Dr. Haroon Kazem: Yeah., I think in the article it says that when they take away the effective time of day that owl showed a significant disadvantage compared to larks and finches at all times of day. So is that -is that-is that something that’s, you know, individual specific? Is that how is that how somebody’s, you know, just, you know, biologically built or is that a result of habit over time? I wanted to know what you guys thought because I consider myself an owl somewhat so.
Dr. Royan Kamyar: Right. We talked about that in last episode and how difficult it is to determine there are very highly credible and respected scientists and there’s, you know, proof that there are genotypic links to being a morning lark, for example, or having a higher disposition for night owl behavior. But what we discussed last time is that the environmental factor-right-the social imposition, if you will, is so strong that it can turn a morning lark into a night owl, right?
Sohaib talked earlier in the episode about the social pressure of staying out late with your friends. Like, if you want to find a girlfriend, you’re probably-your odds of success are probably better if you’re if you’re a night owl and there’s there’s actually articles that show that night owls have much wider and stronger social networks. So it’s absolutely true. And even Till Roenneberg, who’s one of the world’s leading scientists on the topic, she does not advise people to necessarily become a morning lark just because the objective health benefits are traditionally better for that group. You’ll say, “no, if you want to reproduce and find the right mate then you should probably, you know, be social and say, go out at night.” So, you know, and-I got lost. What are we talking about?
Dr. Haroon Kazem: I mean, it makes perfect sense. I think ultimately it goes back to showing how, you know, all of this is so, you know, there’s so many levels to all this. And it’s really just identifying, I guess like, what are the key levels or like the biggest influencers or impacters that we can identify to hopefully, you know, level things out or maybe even the playing field for those that don’t like waking up at 6 a.m. every day.
Dr. Sohaib Imtiaz: So another thing that I was discussing, some of the articles we shared, was some say say you are waking up at 6am every day like you said, Haroon. The weekends, you wake up late or you’ve slept later, you know, to make up time on your sleep, you know, feel a bit more rested. But in some people, what happens is they end up feeling quite fatigued and, you know, brain fog et cetera.
So there’s a study I was looking at where they did on-they looked at rats-obviously it’s not fully translatable to humans-but what they found was that chronic circadian disruption led to a reduction in the complexity of the neurones which are basically what is used for attention cognitive flexibility and executive function, so they actually proved that in rats, circadian rhythm disruption was a contributor to neurocognitive deficits. So you may not be mentally as sharp once you do disrupt your circadian rhythm as you otherwise might be if you have a regular time.
Dr. Haroon Kazem: Sure, it makes perfect sense. I mean, if we can see that in an animal model, you know, we’re a much more complex model to look at. And I feel like you see it on every level. You see it on-in this case we’ve been kind of diving into academic performance-but you probably also see it in terms of social, you know, how you manage your relationships and how how good of a family man or woman are you and how well are you doing at work, you know-.
Dr. Sohaib Imtiaz: Yeah, regulation.
Dr. Royan Kamyar: Yeah. Yeah. Unfortunately, none of us are neuroscientists but would be good to bring one on a future show. But I think a huge assumption here we’re making and I think we’re making it pretty comfortable, given our level of training here and our research and space which is-there’s a huge link between learning, attention, memory, and mood. These things are all very related. We’re talking about neurocognitive capabilities, you know, these all fall sort of under the umbrella-right-mood and cognition. But in terms of the exact, you know, regions of the brain and the the proof of-or the depth that these links, et cetera, you know, I’m not the best expert to speak on.
Dr. Sohaib Imtiaz: So if we’re establishing this, what can night owls do to, you know, give themselves that, you know, overcome that disadvantage? I mean, because you know students are very competitive, even though-I think the increasing role of no tropics which we should do an episode on if we’re using some substances to enhance academic performance-but if if sleep or just the timing of that classes is disadvantaging them, what can we really do?
Dr. Royan Kamyar: Perfect perfect segue way to a solution part of this-right-which is what I think we’ll end on, is the technology pieces and what can we do to make things better? There’s a really nice ending to their discussion, to their summary which I’m just going to read from: “either at large scales or with more detailed personal data, such work has the potential to enable data based personal counseling”-and they call it chrono counseling in the article-“with within the education sphere, similar to efforts being used to generate personal predictive medicine in the clinical sphere.”
So instead of precision medicine and clinics, they’re talking about precision counseling, which is beautiful. It’s a brand new concept. “There are many non-trivial problems between the current state of knowledge and the realization of this goal. But”-and here’s the significance of the study-“the benefits to individuals and societies stemming from enhancing education by enabling individuals to take advantage of their own biological rhythms are surely substantial.” I love that.
Dr. Haroon Kazem: Yeah.
Dr. Sohaib Imtiaz: Yeah, brilliant. Brilliant.
Dr. Haroon Kazem: It’s, you know, I totally agree and, you know, I feel like there’s gonna be lots of different schools of thought on how to best fix this this issue or, sort of, to level the playing field. I mean, personally, I feel that this is a societal issue in terms of like this idea of like being up super early in the morning and, you know, the school bus is gonna be outside your door at seven thirty so you better be there you’re not gonna be in class-that whole concept and just to quote from the study again over here.
Basically, what it notice was that: “in both cases, the sign of regressions changed with regards to social jetlag and both models found that phase advance on class days”-which I guess basically means waking up earlier-“significantly correlated with decreased performance.” So that being said, I was never a fan-and I still am not a fan-of having to be awake half, you know, half awake, if that even. And, you know, hyped up on, you know, stimulants like coffee and caffeine and God knows what else college students are doing nowadays, you know, Adderall.
Dr. Royan Kamyar: Right, right.
Dr. Haroon Kazem: Right? And so I feel like personally-
Dr. Royan Kamyar: Another huge contributing factor, right? Multifactorial.
Dr. Haroon Kazem: Yeah.
Dr. Royan Kamyar: Increase increase in this kind of usage.
Dr. Haroon Kazem: Absolutely, man. It’s like a rainbow of problems, really. But I just feel that like the one thing that, you know, students could do-and this probably applies to people who have really busy work schedules and family schedules as well-is to stay organized and I realize that the only relief from anxiety and stress that, you know, I experienced when I was in grad school and even in my undergraduate was being organized and I just I feel like that’s why Owaves is such an awesome app, just for the fact that, like, it at least gives you perspective so that you can know if you’re being organized and it gives you a broad picture so that you can get in there and, you know, hash things out to be more efficient with time so that you’re, you know, just scheduling things the right way.
Even though it sucks to be awake, you know, if you have to do it the class is only being offered at that one section that whole semester quarter, you know, something like Owaves is pretty nice to be able to just look at and say hey like, “Whoa, man I am probably watching TV way too late, now that I think about it every single night and that is causing me to lose that extra hour of sleep in the morning. That’s thrown off my whole day the day the day after.” So.
Dr. Royan Kamyar: I think, you know, I think that’s a good softball-it’s kind of a curveball-but I think I can try to hit that in terms of, you know, how it Owaves becomes part of the solution. And here’s what I mean by that is you know here, we’re making I think very reasonable arguments that the epidemics defined in the Time magazine article are multifactorial, right? So a huge chant and call of lifestyle medicine is treat the cause but giving people broccoli doesn’t fix the stereotypical male roles of not seeking help when you need it, right?
Dr. Haroon Kazem: Yeah.
Dr. Royan Kamyar: And so, you know, again, I think basically what we’re trying to do or what I think I think first of all, what we have to say upfront is because the problem is so complicated-and we haven’t even gotten to, you know, there’s a huge argument now that you have the DNA codes, we talked about circadian codes. What about the zip codes? The socioeconomic issues, the food deserts out there, the abused families, right?-Okay, so, you know, Owaves can’t fix all of that. There’s no silver bullet no one single person, service or platform, you know, is gonna be able to solve all these problems. But I think there can be what Dan Buettner calls-right-so he’s the the the National Geographic research fellow that did the Blues Zone studies.
Dr. Haroon Kazem: Oh yeah.
And they found out-yeah well, it’s not just a TED talk, it’s a series of National Geographic articles, he has books on the subject now, he speaks at the American College of West medicine events, he works with Dr. Oz on creating blue zones in America. I think it started in Iowa which is kind of like the baking capital of the world and sort of grew up from there. But basically he says, you know, it’s not-what we’re talking about here is not a silver bullet. We’re talking about silver buckshot, okay?
And so what Owaves is trying to do is take the buckshot approach that, you know, lifestyle medicine has proven works, right? So we have Dean Ornish, who’s the pioneer in the space-among many other pioneers-but what he did is he proved that that magic recipe, that Sohaib laid out, nutrition, stress management, social, love, sleep, and exercise actually can prevent, treat or even reverse many of the chronic diseases of today. He hasn’t done it for mental health. Maybe because of some of the issues we brought up, it doesn’t get necessarily the attention it deserves. But he did it for heart disease, he replicate the results in diabetes, he did it four major types of cancer, they did it for aging and longevity-right-to show that telomirrors actually grew in length.
We have every reason to believe-and there’s plenty of evidence to suggest and there’s more and more coming out-with links to mental health-right-lifestyle-the link between lifestyle medicine and health is actually very strong. Exercise, nutrition, all these things that are correlated. So and really what I think Owaves is doing, which is unique, is saying that when a patient walks into your clinic and you tell them that they have a high blood pressure or that if they tell you their mood is bad and you say, “Okay well, you know, I want you to go and take your blood pressure from 130 over 95 and, you know, make it 120 over 80 or less.”
Right? Like eliminating mercury. That’s not something that they’ll easily comprehend and it’s not very actionable information. Same thing if they have a low mood and you tell them, “well well-Geeze-you know, here’s some medications I want you to take, you know, once or twice a day, you know, for the rest of your life.” What’s missing there is giving the patient some sense of control and participation in their treatment and the ability to make their own life better without depending on extrinsic factors, substances, etc. What Owaves does it says, “the one thing that’s in your control, that you can actually move the needle on in terms of your disease risk or your disease state is time.”
And we know that time is a fundamental factor in the cause and progression of disease because we’re talking about the circadian rhythms and chronototypes, etc. And that’s something that-as opposed to millimeters of mercury-I can control where my hours and minutes go. If I really need to go to the gym right now, I can make that happen or I can start running around the house. Right? So I can control my hours and minutes, I can’t control or pull a lever on my millimeters of mercury, so it’s more understandable and ultimately actionable for the patient. And really what we’re talking about here is time management as relates to health.
Dr. Haroon Kazem: Excellent, man. And I know that you said that so eloquently. I’m in full agreement.
Dr. Sohaib Imtiaz: Very comprehensive solution and that also brings me-like, other apps at the moment, there is a problem with mental health because people aren’t going to see professionals. If we look at the top grossing self care apps which are Headspace and Calm which are helping people to meditate, focus, relax, you know, and a lot of people who are suffering from symptoms of depression, anxiety actually are resorting to these apps.
So there’s a unfixed solution which these digital therapeutics are trying to fix. If you look at Calm’s year on year growth at the moment it’s about 80 percent, which is very high, which shows the user adoption is very high. That means people want a solution which is convenient, easy, and they can use. And still, they’re not perfect solutions because all they tell you-they help you to focus and meditate when we know mental health is linked to the whole spectrum of lifestyle medicine.
Dr. Royan Kamyar: Yes.
Owaves addresses each kind of-looks at each part of your day and each part of-all five factors and tries to tell you that, “where are you missing out on.? Are you incorporating all those factors?” So that that’s where it differs and if we talk about mental health as well with emerging technologies, I think virtual reality is one. So Dr. Keith Grimes is actually one of the doctors in the UK who’s doing a lot of research in VR and he sent me some, he sent me some research on meta analysis and different applications of VR.
And one of them was a meta analysis on anxiety disorders and they did a study and what they found was that-so virtual reality exposure therapy was as effective as cognitive behavioral frameworks and behavioral therapies for anxiety disorders. So there’s even a potential application for exposing patients to certain triggers that make them feel anxious, ect. and helping with a cognitive restructuring to make them feel calm in those situations. So I think VR is one of the big emerging technologies in the space that we should watch out for. And that’s why I think Owaves can come in because there’s so much happening in the tech space but Owaves brings together all the lifestyle factors.
So if it could even help you recommend the latest technologies which can enable you to live a healthier life for each aspect, so I think that would be truly make a difference to the more majority the population if it could, you know, recommended a VR experience, tell you, you know, what wearable to track, you know, even mood because I think there’s mood wearables coming out as well as that correct, which looks at your vitals and even your voice? I think Heart of America has a startup-I’ve forgotten the name-but it almost assesses depression before you you you’re clinically diagnosed with depression, it can predict by the changes of the tone of your voice.
Dr. Royan Kamyar: Digital biomarkers. Basically, whatever the problem your Alexa can pick up.
Dr. Sohaib Imtiaz: Yeah. So I think there’s huge potential there.
Dr. Royan Kamyar: You know, just, I don’t know if you remember, the Time article, they actually had an example from Columbia University with the virtual reality exposure therapy.
Dr. Sohaib Imtiaz: Yeah, definitely. Yeah.
Dr. Royan Kamyar: So and they said some of those scenarios-
Dr. Sohaib Imtiaz: I remember.
Dr. Royan Kamyar: Yeah. Some of those scenarios are, like a professor unwilling to budget on a deadline or a roommate who has littered their dorm room with stacks of empty pizza boxes and piles of dirty clothes. It’s one hundred fifty dollars per group therapy session on Columbia. And here’s a quote from a student went through it. Hashimoto who used to be our software said, “the scenarios can be challenging to confront but the minute it’s over it’s like, ‘wow. Okay, I can handle this.'” She still goes to weekly therapy but-okay, it just goes on on her sort of prognosis here. But yeah I think that’s kind of cool. I know, Sohaib, you’re very keen on VR.
Dr. Sohaib Imtiaz: Yeah. Tech, generally tech wearables, AI, IVR, anything, I think it’s coming quite quickly but on a consumer level, everyone’s quite unaware. So we do we do need a system which helps, kind of, triage people to like, you know, use this app at prescribing, you know, VR. Obviously, a lot of the research is quite early at the moment and as it develops there’ll be more of a need for that. But each factor, you take a factor like, you know, part of your life where you’re struggling with it, like Clayton Christiansen.
We discussed him-his Jobs to Be Done theory, right? So any problem in life or you can you could view it as a health problem as well like smoking for example. That’s your problem. How do you fix it? And that involves behavior change but also can be enabled by a tech solution. But to find out which tech solution which is the best, we need more data, we need we need visibility of all these startups that are kind of working independently in this space but they just don’t have the visibility for the normal consumer to be able to, you know, go into a big like, Walmart and buy a wearable and know that “this is going to happen my mental health,” whatever.
Dr. Royan Kamyar: Sure. Discovery and distribution.
Dr. Sohaib Imtiaz: Exactly. That’s that’s where it’s at. It’s just too fragmented. Too many things happening as a consumer. Unless you’ve got a special insight-interest in these things, you’re never going to know it exists.
Dr. Haroon Kazem: Yes. And I think just like a lot of other habits that we have, you know, like our mood is something that, you know, we can-to a certain degree-train and sort of, you know, adapt to certain circumstances and just like any other muscle our brain is a muscle to to a certain extent and a lot of the lot of the people who claim to not-never stress out or at least, you know, manage it really well, from what I’ve noticed is they’re very proactive about, you know, training their minds in whatever way works best for them.
I feel like you see that a lot even in the sense of like these are sort of like brain game apps that are supposed to keep you sharp and sort of make sure that, you know, like you’re still dotting all your I’s and crossing all your T’s even when you’re really old. And I just feel like a similar sort of thing would be very helpful. Which, Sohaib, you could probably comment on this, it’s probably already available, it might even be those apps that you mentioned.
Dr. Sohaib Imtiaz: I mean, there’s a few, Lumosity’s one that’s been on the market for a while. There’s quite a few but the problem, what happens is because it’s so much information being thrown at consumers, patients, they end up opting for none. Because when we have too many options we can’t make a decision.
Dr. Royan Kamyar: Analysis paralysis.
Dr. Sohaib Imtiaz: Yes. The less options we have, the easier it is for us to make decisions. So we just avoid it and be like, “Okay, this is not worth it. It’s too much to think about too much information overload.” But when we have like-
Dr. Royan Kamyar: Well speaking of which-Sorry.
Dr. Sohaib Imtiaz: Yep.
Dr. Royan Kamyar: I was gonna say, so we probably don’t in that case because you said that we don’t want to overload our listeners with options.
Dr. Sohaib Imtiaz: Exactly.
Dr. Royan Kamyar: So we’re gonna make a pitch for Owaves here. We actually have some clips from people that suffer from depression or mental health. There’s Brandon-right-there’s Brandon from Salt Lake City, Utah. I don’t know if you guys have heard this: “as someone who is challenged with measured depressive disorder. I am frequently at odds with myself over finding balance. This app has assisted me in my recovery in so many ways.
It has not only helped me chart a balanced life for myself but it has also allowed me to engineer flexibility into that plan.” We also have a quote from Jasmine in Columbus, Ohio. “You may not be familiar with what a mental illness can truly be like but you literally lose track of time and can never be on time for anything and will see a whole day go by and not get things done. Owaves helps me run my day instead of my day running me.”
So and we actually get a lot of people who really just like the visual nature of the app and, you know, these are people especially with ADHD or attention disorders and, you know, there’s arguments-there’s very sound arguments being made that, you know, half of society if not more is almost distractable by nature, by survival, right? I mean, to watch CNN or BBC-right-there’s so many points of education. It’s almost like a survival trait to be able to use all that at once.
Dr. Sohaib Imtiaz: Yeah. Owaves is very good, very good user design, very clear, not too much information. It’s quite easy to use and it’s quite easy on the eye as well. Especially with the new emoji incorporation. So I think people like that.
Dr. Royan Kamyar: Well here’s the final-sorry, I didn’t mean to interrupt this time.
Dr. Haroon Kazem: Oh no you’re fine. Go, Royan. Go ahead.
Dr. Royan Kamyar: Oh Okay. So here’s the final pitch is, you know, we actually have evidence from three branches of psychotherapy. The first is a formal type of cognitive behavioral therapy. It’s called behavioral activation treatment. And basically what it is, Sohaib, is it’s actually prescribing lifestyle medicine activities into your calendar. Is basically what Owaves is doing. There’s actually a body researchers B isn’t Boy, BAT, behavioral activation therapy. It’s a subtype cognitive behavioral therapy that already shows efficacy towards depression with or without medication. So you can imagine-yeah. You know, it’s basically the anticipation of that event, the prioritization of these events that are already identified as healthy and joyful to you personally, it’s usually done in tandem with a therapist. Right.
Dr. Sohaib Imtiaz: So you can prescribe activities into your day.
Dr. Royan Kamyar: Yes!
Dr. Sohaib Imtiaz: So yeah, it’s similar to-in the UK a few months ago the social prescribing in family medicine physicians were kind of surprised by what? Social prescribing. Owaves is doing that in the digital sense.
Dr. Royan Kamyar: Sorry. “Social prescribing?”
Dr. Sohaib Imtiaz: Social prescribing. So it’s a patient-because what we don’t recognize here in the UK that people live holistically so now they’re saying family medicine physician should be like, “Okay, you you go at six o’clock to dance,” in whatever they agree to. There’s a dance session here or there, you know.
Dr. Royan Kamyar: Yes, exactly.
Dr. Sohaib Imtiaz: Whatever. So it’s called social prescribing, here. It’s a very new concept. In the last few months, it’s got some publicity and the research suggested that we need to be social prescribing.
Dr. Royan Kamyar: Oh right. I think that was in the Economist or BBC.
Dr. Sohaib Imtiaz: Yes, the BBC and I think Economist covered it as well.
Dr. Royan Kamyar: And so you can imagine-let’s let’s just think about-so basically there’s three I’m gonna go through here but no one’s behavioral activation treatment, which I just discussed. You know, chronotherapy is actually another leg of it and this is where circadian rhythms is more directly focused on, optimizing people’s circadian rhythm has huge positive effects on mental health. Again, specifically depression, there’s a lot of data, especially for Seasonal Affective Disorder. So once you schedule these lifestyle activities onto your calendar, your planner, you optimize them according to circadian rhythm, that produces what we would imagine to be augmented effects and that’s what we hope to prove with Reagan, our co-host, our future co-host. She’s going to help lead the clinical pilot study on that.
Dr. Haroon Kazem: Oh, wow.
Dr. Royan Kamyar: Right. And actually-yeah. And we’ll talk more about that later as we go through. And that will actually be done on college campuses by the way. And then-I’m sorry?
Dr. Sohaib Imtiaz: Very immersive. Very good, that would be very good research. I mean, directly with the people suffering from the problems.
Dr. Royan Kamyar: Right. You know, and for all the reasons we’ve talked about on this podcast. And then finally there’s actually a third category called social rhythms therapy, which I won’t get too much in deep on but it’s actually more tied into the social rehab type of treatment you were discussing. It’s more socially directed.
Dr. Sohaib Imtiaz: Okay.
Dr. Royan Kamyar: Yeah.
Dr. Sohaib Imtiaz: I mean you’ve covered everything there.
Dr. Royan Kamyar: I didn’t mean to do that but what I did mean to say is that there’s actually evidence based-it’s not just purely theoretical.
Dr. Sohaib Imtiaz: Exactly. Which is good because, I mean, if you leave one part and value goes, you have to cover each each section and that’s because people do suffer from all three.
Dr. Haroon Kazem: Well, hey guys. We’re in about an hour and a couple of minutes.
Dr. Sohaib Imtiaz: Okay.
Dr. Haroon Kazem: This was an awesome episode. I mean, I feel like anybody listening would pick up so much. We got-we have so many awesome topics still to cover, you know, in reference to the body clock. I think we’re still going to be doing another episode on video gaming and its effects, the gig economy, more on functional medicine and the microbiome. I really enjoyed this conversation, boys. I feel like we definitely need to touch on this again in the future but I’m going to go ahead and say we should probably call it since we’re right right about the hour mark. Is there any last comments or anything else you’d like to say?
Dr. Royan Kamyar: Thank you.
Dr. Sohaib Imtiaz: Thanks a lot.
Dr. Royan Kamyar: Yeah, I’m sorry if I took us in a rabbit hole there at the end but I got a little Owaves happy.
Dr. Sohaib Imtiaz: No I was really good because I it tied in everything of how Owaves actually-we talk on mental health but what can they do about it, is it just a plan or is actual-which is amazing the studies that are being done, I mean, it really adds a lot of value to Owaves. So perfect ending.
Dr. Haroon Kazem: That was awesome, man.
Dr. Sohaib Imtiaz: Just stick in the listeners mind. “Okay, now I’ve got this problem. There’s a solution they’ve discussed and everything, but what can I do?”
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