How to Improve Metabolic Health with HIIT, Circadian-Timed Eating, & Sleep

so glad to be here I want to thank the organizers at a4m for inviting me to speak um I spoke at longevity fest last December it was amazing so I'm super pumped to be here today talking all about metabolic health and we're really going to we're going to focus on what I think are three major lifestyle factors that can play a pretty big role in metabolic health so we're going to be talking about sorry we is this not working all right we'll be talking about high-intensity interval training which is a very time efficient way to

um get your heart rate up to improve insulin sensitivity glucose homeostasis uh glucose transport mitochondrial function and we're going to talk a little bit about exercise snacks that can be strategically timed and how that can play a profound role in glucose homeostasis we're going to talk about circadian timed eating so why it's important to avoid late night eating what the effects of melatonin are on insulin Tim restricted eating and circadian misalignment and then we're going to jump into sleep and the profound metabolic effects of sleep restriction on metabolic Health as well as some behavioral changes

that can be implemented to improve metabolic health so let's start with high-intensity interval training so as I mentioned this is a very time efficient way to uh get your heart rate up and exercise so it involves very short bouts of intense exercise one uh we're talking about heart rate up at at least 75% max heart rate followed by periods of recovery there's a lot of different protocols we're going to discuss but there have been lots of studies talking and and showing um that high intensity trting can improve glucose homeostasis in insulin sensitivity um it also

decreases fat Mass improves body composition and enhances mitochondrial function so a meta analysis of 50 different randomized control trials compared high-intensity interval training to moderate intensity continuous exercise so this would be exercise that's at a lower intensity the kind of intensity where you can have a conversation but you maybe still breathy sometimes called Zone two and um this is a longer duration type of exercise so high-intensity interval training outperforms moderate intensity continuous exercise at decreasing insulin um resistance it also improves hba1c levels so the long-term biomarker for elevated blood glucose levels it leads to a

decrease in body weight and also significantly lowers fasting blood glucose levels again this is 50 different randomized control trials and another systematic review of many different randomized control trials has found that again high-intensity interal training outperforms moderate intensity continuous exercise at improving cardiorespiratory Fitness improving diastolic and systolic blood pressure improving HDL triglycerides and fasting glucose lowering oxidative stress improving adoptin and insulin sensitivity as well as beta cell um function to produce insulin it increases pgc1 Alpha which is a biomarker for mitochondrial biogenesis which we'll be discussing in a little bit and it also improves cardiac

function and this is all better than moderate intensity continuous exercise so it really provides a opportunity for people to have a time efficient way of improving metabolic health and part of that is because when you get your heart rate up high when you are putting in the effort you are you're you're putting a strong stress on your mitochondria and your muscle and your mitochondria are unable to produce energy quick enough to keep up with the demand and so your your your muscle cells shift to using glucose as a source of energy through glycolysis and that

ends up producing lactate which was thought to be a byproduct a metabolic byproduct well decades couple of decades ago Dr George Brooks at the University of California in Berkeley um was one of the Pioneers to find that lactate generated from exercise is anything but a byproduct so steady state lactate levels are less than one millimar when you when you crank up the intensity of exercise you can go anywhere up to 15 17 Miller and that lactate it gets in circulation and it's consumed by other organs it goes into the brain it goes into the heart

it goes back into the muscle it goes to the kidneys it goes to the liver and it's serving a a very utilizable source of energy so it lactate can be used you know and converted into um acetyl COA and used by energy by the mitochondria but probably one of its most important roles is as a signaling molecule it's a way for your muscle to connect to to uh communicate with other organs and other tissues and one of its signal roles is back in the muscle it's increasing the translocation of glucose 4 Transporters to the cell

surface of the muscle glute for Transporters and so lactate gets back into the muscle it it's it's basically telling the muscle hey we're using a lot of glucose here for energy so we need to bring more glucose in and the way it does it is by increasing glute for Transporters at the muscle and I mentioned um lactate levels go up during this int exercise that's very transient so after about 20 minutes when exercise stops your lactate levels go back to Baseline because all these other organs including the muscle are consuming it so quickly however the

increase in glucose for Transporters stays you know elevated for up to 48 hours with the first 24 hours being the most robust so you're getting a long-term effect from that signaling from lactate back to the muscle to increase glute for Transporters and that is why uh high-intensity interval training is so potent and Powerful at improving glucose homeostasis so there was an another metaanalysis of 36 randomized control trials that were looking at optimal conditions of high-intensity training for improving body composition and so it's been identified that the duration of of of the hit workout hon interal

training workout eight weeks is optimal for for improving body composition the frequency is at least three sessions a week and the intervals are 60 seconds of 60 seconds or less of the robust intense you know interval followed by about 90 seconds of recovery and this leads to improvements in um reducing fat Mass cycling and running was the best at at doing that also improving per body fat so body fat reduction and that was the best with running and then then um increasing fat-free Mass which includes muscle and the best at that was actually cycling so

these are some of the optimal conditions for improving body composition with respect to high-intensity interval training protocols we're going to talk about how high-intensity of interval training can regulate mitochondrial function but before we talk about that I think it's important to recognize that people with metabolic syndrome insulin resistance obesity and type 2 diabetes have been identif I to have pretty profound disregulated mitochondria so the mitochondria and skeletal muscle from people with type two diabetes and obesity have been found in multiple studies to to respire about 40% less than skeletal muscle cells from people that do

not have type 2 diabetes or people that are lean so they they mitochondria are dysfunctional and subsequent Studies have also identified structural defects in the mitochondria so mitochondria from people with type two diabetes are fragmented so mitochondria are typically they form a very connected Network this sort of look like rachelli spaghetti and um that's a really beautiful network of mitochondria that you know are able to um undergo respiration and do their functions um quite robustly when when mitochondria become really fragmented they are dysfunctional they they can't you know utilize or even produce energy very well

and they're on their way to basically dying and causing cells to die so there's a very intricate connection between structure of mitochondria and the function of mitochondria and that's important because vigorous exercise high intensity exercise has been shown to increase this repair process C in mitochondria known as mitophagy so when exercise is intense enough it increases the nutrient sensing protein kyes ampk it activates it and this causes the mitochondria to send the signal that they need to repair themselves and so mitochondria can be sort of dysfunctional or they can be really dysfunctional so mitophagy can

clear away an entire dysfunctional mitochondria to be used and recycled or it can clear away pieces of A Dysfunctional mitochondria so when that ex when you're doing that acute exercise your mitochondria if you have a dysfunctional one the the mitophagy pathway gets activated and the mitochondria fizzes off it kind of goes to this mitochondrial fision process and that damaged part of the mitochondria then goes and is recycled to through the lone and then you what you have is a long-term effect of after doing you know routine high-intensity exercise you then have more healthy functional mitochondria

because you're just getting rid of the damaged part of the mitochondria if the mitochondria is dysfunctional enough you're going to get rid of the whole mitochondria and by the way the amp kise pathway many of you are probably thinking well that's act that's a nutrient sensing pathway it's activated during periods of fasting and that is true um amp kindness is activated during periods of fasting and fasting is a powerful signal for inducing autophagy and mitophagy however in this particular study people that did this high-intensity vigorous exercise for 30 minutes it did not matter if they

had fasted for 16 hours or not there was no difference in the mitophagy so in other words the exercise itself was such a strong signal for activating mitophagy that it didn't matter if they had not fasted for 16 hours because it was so powerful on top of the repair process high intensity unal training is one of the most robust exercise modalities that can increase mitochondrial biogenesis so the growth of new mitochondria increasing mitochondrial volume so you're having this double whammy effect where you're getting repairing of the mitochondria getting rid of the unhealthy parts and then

you're increasing the growth of new mitochondria so one of the reasons high-intensity interval training is very good at increasing mitochondrial biogenesis compared to let's say moderate cont um continuous exercise is because lactate that's generated from that vigorous exercise is a signaling molecule to activate the protein that very much regulates mitochondrial biogenesis and skeletal muscle pgc1 Alpha so again lactate is playing that signaling role it's it's generated by the muscle it's taken back up by the muscle and then it's communicating with the muscle it's saying hey we can't make energy fast enough because this exercise is

so intense we need more mitochondria to be able to do that so it's an adaptation to the vigorous intensity exercise and that adaptation is making more mitochondria which is obviously very beneficial for not only people with type 2 diabetes metabolic syndrome obesity but also everybody so it Inc so MIT biogenesis improves um Energy Efficiency in mitochondria and also is associated with other benefits like decreased atrophy and in improved exercise endurance as well so there's a whole host of benefits with increasing mitochondrial biogenesis so a lot of the high-intensity inval training protocols that were used in

these systematic analysis and these meta analyses were um evidence-based hit protocols so Tabata is one that's used that's a 202 on 10sec off interval 20 seconds at the highest intensity you can do you're going all out and then you're resting for 10 seconds and that's repeated eight times for a total of a 4minute workout in some cases the Tabata protocol was repeated twice the wing gate um hit protocol is another very commonly used one and that is a 30second allout Sprint followed by four minutes of active recovery where you're your low intensity and then you

do that four to six times that's about a 20 minute or so workout and then there's the conventional workout it's the one minute on one minute off so you're going as intense as you can for one minute and then you have one minute of very light active recovery and then you repeat that 10 times so that's a 20-minute workout it is hard but it's very very effective at improving a variety of metabolic parameters and then there's the clinical workout also known as the Norwegian 4x4 which I like to call it because the Norwegian ski team

often uses this hit protocol for their training it's a 4minute interval where you're going as intense as you can for four minutes and then you have light recovery for three minutes so you're going very very light getting your heart rate down and that's repeated four times so it's about a 25 minute workout so let's let's just talk a little bit about exercise snacks which is a type of high intensity aable training workout it involves doing something at vigorous intensity you know a vigorous intensity um heart rate for one to two minutes and they're often called

exercise snacks because you can just do them whenever throughout the day and I think this is very relevant because I just came across a study a couple of weeks ago that showed 10 10 body weight squats okay 10 for every 45 minutes was more powerful at improving gluc glucose homeostasis than a 30 minute walk so I feel like that is it's just it kind of puts it in context because how easy is it to get up and do 10 body weight squats right every 45 minutes I mean it doesn't get easier than that and there's

also a reason to strategically time these exercise snacks either 30 minutes to an hour before a meal or 30 minutes to an hour after after a meal so the E so the so the timing of these exercise snacks has been shown in several studies people with type 2 diabetes or insulin resistance to really improve their glucose regulation after a meal so their postprandial gluc glucose regulation and their glucose disposal was improved again because getting that high-intensity exercise where you're generating some lactate it's increasing glute forward Transporters at the muscle and that is then you know

causing glucose to come into the muscle it's lowering the burden of your pancreas to have to produce insulin and it's improving glucose homeostasis so exercise snacks around meals uh is an easy way to improve post postprandial glucose regulation and glucose homostasis it's obviously very relevant for people with type 2 diabetes but also I think for everyone exercise snacks has also been associated with a decrease in all cause mortality so there have been very large studies um out of the UK bio Bank data where people are wearing accelerometers and um they're part of the vigorous intensity

sorry vigorous intermittent lifestyle activity um studies that have been done vpa they're called and what those Studies have identified is that people that do one to two minutes of vigorous intensity exercise and these are things like just sprinting up the stairs rather than taking the escalator or walking up the stairs and they do this this like a 1 to two minute high-intensity burst and they do this three times a day that's associated with a 50% reduction in cardiovascular related mortality 50% reduction it's also associated with a 40% reduction in cancer related mortality and all cause

mortality so cancer cardiovascular disease these are all diseases that are associated with metabolic disregulation so implementing exercise snacks I think is one of the easiest ways to get you know get a little bit of exercise get your heart rate up get that lactate generated increase your glucose Transporters but also just improve your mood to break up your sedentary time you know so being sitting at your desk for a couple of hours is sedentary and being sedentary is an independent risk factor for certain diseases like cancer so I mean we've all been sitting here for what

an hour at least I say we get up and we do a minute of body weight squats body weight squats all right ready okay I'm going to get this timer going we're going to do a whole minute I'm saving you the high knees all right here we go so we're going to do body weight squats we're going to try to get the heart rate up and we're going to do it for one minute try to go low if you can you want to feel the burn and your quads go sideways there keep going we're not

even at 30 seconds yet okay we're halfway are you guys getting your heart rate up are you feeling it 15 seconds left five 4 3 2oo all right so a out of breath feeling good increase the blood flow to the brain but more importantly glute four Transporters okay so we're going to shift gears and we're going to talk a little bit about circadian meal timing all right all right okay so as everybody here knows aerating Rhythm uh we're all dial creatures here more active during the day less active in the evening right our metabolism is

also on a Arcadian Rhythm we are more insulin sensitive earlier in the day and later in the evening less insulin sensitive part of that so let me talk about a study that I think is pretty um telling in terms of insulin sensitivity and glucose regulation throughout the day so participants were given the same exact meals in the morning in the afternoon or in the evening okay so same macronutrient composition same caloric content everything the same and participants were much more insulin sensitive in their first meal given in the morning compared to their evening meal and

I think part of this has to do with our circadian rhythm and as we get later in the day melatonin so back in like the early 2000s about 2009 a lot of studies started coming out in the genetics world where the variation a VAR a certain variation in the Melatonin receptor 1B was identified to be a pretty high risk factor for developing type 2 diabetes and for uh having basically insulin disregulation so people were not producing insulin correctly and it was very perplexing to scientists at the time because melatonin was thought to be just this

hormone that is produced by the pineal gland that is regulating our sleep it's quieting down our brain telling us it's time to get sleepy right it's making us tired well it turns out out after more studies started to investigate this that we have melatonin receptors on our pancreas on our pancreatic beta eyelid cells and the Melatonin receptors the 1B receptors are sensitive to melatonin people with that Gene variation had a hypers sensitive receptor where little bits of melatonin were enough to really kind of activated and so it turns out melatonin is also quiting down our

pancreas at night and telling our pancreas we don't have to produce so much insulin it's nighttime we're not going to be eating and so there's a systemic effect of melatonin not only on our brain but also on our other organs that are you know important for metabolism and I think this is a really good reason to think about when you're going to have your last meal and why it is detrimental to engage in late night eating so our bodies naturally produce melatonin about three or so hours before our natural bedtime so it's a good rule

of thumb to make sure that you have finished your last meal you finished eating before that time so you know before three three hours before your natural bedtime it's really just a A good rule of thumb to kind of make sure you're done eating that when you wake up in the morning you're ALS also still producing some melatonin for about the first hour now bright light exposure can inhibit that so it can hasten the clearance of the melatonin but also I think it's a good idea to wait about an hour after you first wake up

before you start taking in your meal so bright light exposure we'll talk about also it's very important for regulating our Cadian Rhythm and that's important for re you know sleep but generally speaking I think just aligning your meals with your circadian rhythm it makes sense when you think about the role of melatonin you know in in quieting down our brain and also our pancreas it makes a lot of sense why you don't want to be eating late at night so just as a as a you know I think an aside here having glucose levels in

the normal range but on the high normal range so high normal glucose was associated in um UK bio data with higher incidents of atrophy in the hippocampus so the part of the brain involved in learning in memory so people that just had higher than they were on the high end of normal had more atrophy in their hippocampus than people on the low end of normal so this is in the absence of any clinical type 2 diabetes really sort of highlighting the importance of everyone considering their metabolic Health even if you don't have type two diabetes

even if you're not you know pre-diabetic you just you want to make sure that your your glucose regulation is you know the best it can be circadian misalignment now so many of you may have come from like me the West Coast or perhaps Europe and um you're out of sync with your circadian rhythm so circadian misalignment refers to when your natural internal clock is out of sync based on a behavioral pattern so this is very common with jet lag it's very common in shift workers who are up in the night in the evening working and

eating um it's also very common in people with erratic sleep behaviors so there's been studies done where people our participants are they're circadian misaligned so they're out of sync so they they're basically their their sleep and meals are shifted by about 12 hours and when that happens people have about a 6% increase in their glucose they have they make 22% more insulin they have decreased leptin levels so that's the hormone involved in being satiated and their postprandial glucose levels are in the pre-diabetic range only by shifting their their circadian you know clock by 12 hours

so it has a profound effect being circadian misaligned exercise can help with that especially high-intensity interval training but also time restri restricted eating so Tim restricted eating refers to eating all your food in a restricted window of time instead of just eating ad libum right throughout the day and typically Tim restricted eating is anywhere between 6 to 10 hours of an eating window and the rest is fasting there's been a lot of work done by Dr sat and panda on time restricted eating in shift workers um he's done some work on firefighters showing you know

the these firefighters that are up all night if they eat their food in a time-restricted eating window you know eight8 hours 10 hours that it improves their metabolic biomarkers so there's been a lot of meta analyses done on Tim restricted eating and how it improves metabolic Health now Tim restricted eating does not mean you have to reduce your calorie intake but we're going to talk about in a minute people that are naturally doing Tim restricted eating tend to do that because they're skipping snacks or they're skipping their dessert or they're skipping a meal so um

when people do end up reducing their calorie intake along with time-restricted eating they end up losing weight and losing um fat but independent of calories so if they do not change their caloric intake but they are practicing time-restricted eating it can improve glucose regulation insulin sensitivity it can lower blood pressure um and so there's a lot of metabolic parameters that are improved with just the Tim restricted eating now as I mentioned people that do practice time restricted eating so there's been there's been multiple studies looking at even just a 10-hour window which isn't even that

restricted people that are doing a 10-hour time restricted eating window not not a controlled trial but just like you tell them to do it they end up reducing on average about 200 calories a day again because typically people are skipping snacks or meals and so that does lead to weight loss and it reduces uh waist size body fat percentage and also reduces visceral fat which is the Deep Fat that surrounds your organs that's secreting pro-inflammatory cyto kindes and hormones that play a role in type 2 diabetes metabolic syndrome but also you know emerging evidence indicates

visceral fat plays a role in cancer as well um time restrict eting also lowers blood pressure it improves lipid profiles and improves the hba1c glucose biomarker early Tim restricted eating so this is typically people that end their last meal at about 400 p.m. usually early Tim restricted eating is about a 6-h hour window so it's it's it's a shorter eating window people that do early Tim restricted eating without reducing their calorie intake dramatically improve a variety of of metabolic parameters insulin levels are improved insulin sensitivity is improved beta cells are more responsive to gluc glucose

the improvements in blood pressure were so profound that they were equivalent to some anti-hypertensive treatments so that was a big finding of that study and then ex oxidative stress levels were also improved and this is early Tim restricted eating there's been a meta analysis of about 12 randomized controlled trials looking at early time restricted eating again this was this was defined at stopping your your last meal at about 400 p.m. and then comparing it to late later time restricted eating so people that were you know stopping their meals not at 4 but a little bit

later and all the eating windows were either six four Sorry 4 to 10 hours and early time restricted eating does have more profound effects on glucose regulation largely because again we're more insulin sensitive earlier less insulin sensitive later once the Melatonin starts to kick in again that just it gets it gets much worse so early time restricted eating can improve fasting blood glucose levels and um insulin resistance more than late later time restricted eating but it also has a more profound effect on the the blood pressure regulation so lowering blood pressure late Tim restricted eating

can sort of maintain blood pressure but it doesn't improve it like the early time restricted eating and both early and late improve lipid profiles as well as fasting glucose and insulin resistance just early does it a little bit more robustly so I think there's pretty strong evidence that if you are circadian misaligned jet lag for example if you're a shift worker or just people that are you know wanting to sort of try to to optimize their their glucose homeostasis as much as possible certainly people with you know metabolic uh dysfunction May benefit from Tim restricted

eating along with the high intensity anable training and the 10 body weight squats every 45 minutes okay so let's talk about the last topic I want to discuss um this this morning and it has to do with poor sleep and how most of us I think are aware when we don't get a good night's sleep we don't feel cognitively on game our mood is affected we feel lethargic not we don't have as much energy but I'm not sure that most people realize the profound effect that even mild sleep restriction has on our metabolic health and

glucose regulation and this is extremely relevant because about onethird of people in the United States do not meet the recommendations which is 7 to 9 hours of sleep per night for sleep and um again this is very relevant for jet lag I mean there's a lot of there's a lot of relevance here for poor sleep so mild sleep restriction this is one to three fewer hours of sleep per night so I mean one it's not a lot doing that three nights in a row can increase fasting insulin levels it can lead to higher insulin concentrations

elevated fasting um uh gluc glucagon levels and also it decreases insulin sensitivity again this is just getting one hour less of sleep a night for three nights I mean how many of us have probably even done that at this conference right I mean it's very easy and very applicable and and it's having a profound effect on metabolism sleep debt is the the cumulative effect of of sleep restriction right so this is when you're having multiple days of the Sleep restriction so in this case it was four sorry three days of 4 hours less of sleep

per night that led to 40% slower glucose clearance 30% decrease in glucose Effectiveness so this is independent of insulin similar to diabetes and 30% um lower insulin response so this is really indicating early diabetes and these are healthy people this healthy people after just three nights of having four hours less sleep at night very profound effect on on metabolism there's been large meta analysis done on longitudinal studies looking at type 2 diabetes risk and sleep duration and it's been identified that the optimal range of sleep for the lowest type 2 diabetes risk is 7 to

n hours of sleep at night so going below 7 hours or above 9 hours were both associated with increased risk for type two diabetes so the 7h hour threshold getting less than 7 hours of sleep at night uh was associated with increases in fasting insulin increases in glucose levels homo IR was elevated um higher hba1c and then also visceral fat was increased as well so again getting less than S hours of sleep a night which a lot of people do routinely and speaking of the elevated hb1 A1C I think this is really important most of

you probably realize that but when you are constantly having elevations in blood glucose levels this leads to Advanced glycation end products or ages as they're called and it's certainly a huge problem in people with type 2 diabetes because they are constantly having glucose disregulation and their elevated U blood glucose levels but generally speaking when you have the hb1c high you are talking about glucose reacting with lipids and proteins through the reaction including collagen and this is all inside of our blood vessels Our arteries you know our MIT myocardium making you know surrounding our heart when

you have those Advanced glycation end products forming it stiffens that collagen okay col HBA whenc levels turn over after about what 120 days your collagen is in there forever so what happens is you you have those Advanced cation end products there's if it's in your blood vessels it stiffens the blood vessels and this leads to hypertension plays a big role in hypertension when it's happening in the arteries and you know the in the in The myocardium this this decreases cardiovascular compliance and it really plays a role in the stiffening of your heart with age and

so these adven cation end products increase the risk of cardiovascular disease heart attacks and hypertension so having these elevations in your blood glucose level and you know subsequently the hba1c biomarker which biomarks that is is so much more than just type two diabetes risk it's it's cardiovascular health and it's really a cumulative effect that that plays a role um as we age there are a variety of mechanisms that have been identified for how short sleep and you know mild sleep restriction can uh cause dysfunctional metabolism so there's we're going to talk about decreased insulin signal

in adipocytes we're going to talk about lower beta cell sensitivity to glucose we're going to talk about impaired glucose absorption in muscle and liver and then changes in satiety hormones so there's been some studies looking at sleep restriction this is about four hours of sleep a night for four days it decreased insulin signaling in adipocytes by 30% so I mean your ADP your atopos sites are one of the major SNS aside from muscle for glucose disposal right storing storing it as fat you know for energy but a 30% reduction in in in cellular insulin signaling

ataides is I mean you're talking about these are healthy people this is like a healthy person immediately becoming obese or immediately becoming type two diabetic after just four days right of sleep restriction so it's very profound in terms of metabolic Health Sleep loss so sleep mild sleep loss even um it does promote an obesogenic profile W and so a lot of work has been done out of Eve van couter lab and um she's looked a lot at these these hunger hormones satiety hormones so after 2 days of 4 hours less sleep leptin levels go down

so people are not feeling satiated by their food because leptin regulates satiation um and their gin levels increase so it's a double whammy gin is the hunger hormone it tells you you're hungry and so they're getting this continual hunger so Global hunger ratings go up Global appetite goes you know up so people are not satiated by their food and they're hungry throughout their day and um again e Eve van counter's work has shown that people eat more so they're and they're and they're consuming foods and have cravings for processed foods highly refined sugars salty foods

um you know processed fats and fatty foods so they're eating up to 45% more of those process unhealthy foods and their H their hunger ratings are 24% higher so they're eating even more than they would if they were getting a good night's sleep so I think it's pretty clear that sleep restriction poor sleep does cause dysfunctional metabolism and so the question is can you fix your sleep and improve metabolic health so there are Vari there's a couple of evidence-based ways we're going to talk about improving sleep both of them involve good sleep hygiene so good

sleep hygiene is really the foundation of good sleep and there's a variety of factors that are like a checklist of it and I didn't include all of them but some of the main ones here are using light smartly so bright light exposure first thing in the morning at least 30 minutes is one of the most important ways to reset your circadian rhythm so that you become sleepy at a normal time very very important for re setting circadian rhythm but also important for stopping that melatonin production when you're first waking up right also avoiding bright light

blue light exposure in the evening after Sunset right blue light is what is inhibiting melatonin production in our eyes um it's it's through our eyes actually not in our eyes but it's it's inhibiting um melanopsin which then is involved in in you know the signaling of producing Mel melatonin to make us sleepy and so you want to avoid blue light either by having light dimmers or different color lights maybe red or orange also glasses you can wear to filter it out but also real realize that screens are full of bright light blue light as well

so you know turning down the screens maybe avoiding screens at night is another good idea also making sure your room is dark because there's been studies showing that even a little bit of ambient light coming in disrupts SLE managing temperature is important so part of what melatonin is doing besides making you sleepy is it's lowering your B core body temperature and this is part of the Circadian rhythm it's important for good sleep and so you want to make sure you're not sleeping in a really hot room and there's many ways that you can obviously maintain

your bedroom temperature optimizing meal timing is also important so in in addition to the importance of avoiding eating you know like 3 hours before your bed time because of the Melatonin production it also improves your sleep so this has actually been some work by Dr sain Panda uh at the sulk Institute as well he's identified from large studies that he's done that people that stop eating 3 hours at least three hours before their bedtime sleep better and that's also partially because you're not digesting I mean digesting is a lot of it's an energy consuming process

right that's happening while you sleep uh so it makes sense that it would also disrupt sleep somewhat regular exercise so again this is all these are all tied together so the exercise is also a very powerful zeit giber so you know just routine exercise is also really important for resetting the Circadian rhythm and helping you just get on that Rhythm and go to bed at a a normal time and then monitoring caffeine intake caffeine shifts the circadian clock by 45 minutes so if you're drinking a cup of coffee that's 45 minutes of a cc circadian

shift and then you have another cup of coffee that's 45 minutes of a circadian shift right and so you're going to be going to bed hours later if you're drinking four cups of coffee particularly if it's you know afternoon um obviously there's a lot of individual variation between the way we metabolize caffeine so yeah there's some individual variation but generally speaking it still shifts circadian um Rhythm by by about close to an hour so sleep extension is one of the evidence-based ways that's been shown to improve sleep and this involves really just adjusting your bed

times to increase the sleep time so either going to bed earlier or sleeping in both of those it also involv olves a lot of consultations with Sleep Experts and then sleep hygiene recommendations like we just discussed and so there's been meta analyses looking at sleep extension in people that are short sleeper so they're getting fewer than seven hours of sleep per night and when they undergo this um this type of Behavioral change when they're doing engaged in sleep extension they for every hour additional that they're sleeping per night they improve their insulin sensitivity regardless of

their body weight they improve normalize their hormones leptin and gin they have reduced appetite right they're not getting so hungry their sugar intake goes down and their caloric reduction goes down and they lose weight so all all these things of course the the sugar intake and reducing the calories it's all regulated by the the satiety hormones which again if you're increasing your sleep you can you can basically flip that switch to to kind of help regulate them back and normalize them back the other type of evidence-based way for improving sleep is a certain type of

cognitive behavioral therapy for insomnia cbti this is probably one of the most used well-known and effective ways to improve insomnia it involves a variety of factors I'm not going to go in depth on but stimulus control is the main one so that means the bed is only associated with sleep so no watching TV in your bed no scrolling on your phone no doing any anything screens on your bed bed is for sleeping only so it's stimulus control it involves sleep restriction which is a little ironic um paradoxical but so that means if you're laying in

your bed and you're tossing and turning and you're up for an hour or two or three it means getting out of your bed and going into another room dark room like your your living room couch and laying there and you do some relaxation techniques that are you learn about and then wait till you get sleepy and then go back into the bed so again bed is for Sleep only it also involves implementing a variety of the Sleep hygiene factors that we talked about sleep educ education and again some relaxation techniques So Meta analyses of cbti

have also been shown to improve metabolic Health in people with insomnia including improved hba1c impove improved blood pressure of course their Sleep Quality and insomnia factors and all those things improve as well so it's pretty clear that people that have poor sleep that are in have insomnia that are short sleepers if they work on fixing their sleep they improve their metabolic health but there are situations where it is challenging to sleep longer stay you know to sleep in to do to all all these things because maybe you're a new parent right and you have to

wake up and your sleep will be compromised there's absolutely nothing you can do because of it there's other things as well right I mean jet lag things like that so there is another way to improve metabolic Health even when you're not sleeping optimal and that takes this full circle back to the beginning of the talk with high-intensity enable training so high-intensity enable training has shown to be a very robust way to um improve metabolic Health when you are sleep restricted so there's um been studies that have shown that high-intensity interval training if you do three

sessions over five days of also being sleep restricted so sleeping four hours less at night you can still improve your Cadian Rhythm you can still improve your glucose tolerance your mitochondrial function and um biomarkers of MIT contal function mitochondrial biogenesis and you know I mean this is important because again the glucose regulation so you're doing that high-intensity Nal training well part of the way that that high intensity train I mean part of the way that sleep restriction impairs glucose regulation is it makes your muscle less responsive to glucose and so what is high-intensity interal training

doing it's doing the exact opposite right it's increasing glute for Transporters and it's bringing the glucose into your muscle so you're really countering some of that negative effect of poor sleep on on on your muscle even doing high-intensity Level Training before you know you're going to be sleep restricted so I got on my pelaton yesterday I went hard right before I got on my flight from California I knew I was going to lose some sleep because it's three hours ahead in Florida and doing doing high-intensive training before you're going to be sleep restricted still mostly

rescues the high BL High blood glucose and acute insulin resistance that's caused by Sleep restriction so yet again just really important um with respect to tools that we have at our disposal to help mitigate some of the effects of you know chronic sleep loss or even acute sleep loss both a lot of those protocols again are the ones we've discussed the Tata the Wingate conventional one minute on one minute off and the Norwegian 4x4 hit protocol a lot of a lot of hit protocols out there that people can do or you just do your exercise

snacks as well I mean that also has been shown to increase um glucose homeostasis as I mentioned the 10 body weight squats and I do want to mention one last study before we end on time and that is again I there's lots of of data out there to be harvested from the the UK biobank data and there's been studies that have identified people that sleep fewer than 7 hours or greater than 9 hours a night are have have a higher all cause mortality However if those people are physically active and they're getting and they're meeting

the guidelines for physical activity 75 minutes a week of intense vigorous exercise or 150 minutes a week of moderate intensity exercise they do not have a higher all cause mortality they have the same mortality risk as someone that's getting good sleep yet again exercise can forgive a lot of sins and there's no reason to not do a time efficient type of high-intensity emal training workout it's it's you know time efficient it's easy exercise snacks there's there's all the evidence there we just have to implement it make it part of your hygiene like you brush your

teeth every morning you do your hit so in conclusion I think there's three really powerful tools we have to improve our metabolic health I talked about the vigorous intensity exercise high-intensity interal training making it part of your your personal hygiene also trying to eat your meals in accordance with your circadian rhythm A good rule of thumb stop eating 3 hours before bed because of that melatonin production it's nice to have a pretty restricted time Window 8 10 hours and then also making sure we optimize our sleep and having good sleep and that can be anything

from um the bright you know good sleep hygiene and all those things we talked about to people that have problems and doing things like cbti or sleep extension and certainly back to the exercise again to help and with that thank you so much for staying here and listening to me talk for an hour I hope you guys enjoy the rest of the conference and um thanks [Applause]