FoundMyFitness - #026 Ruth Patterson, Ph.D. on Time-Restricted Eating in Humans & Breast Cancer Prevention

Episode Date: July 8, 2016

Dr. Ruth Patterson Dr. Ruth Patterson, a professor in the UC San Diego Department of Family Medicine and Public Health as well as Associate Director of Population Sciences and leader of the Cancer Prevention program at Moores Cancer Center at UC San Diego Health. In this episode, we chat about: (00:00) Introduction (03:33) Lifestyle modifications that reduce breast cancer risk  (11:18) Modern life disrupts our circadian rhythm, causing us to eat at odd times (14:31) Women who practiced time-restricted eating with a 13-hour fasting window had a 40 percent reduced recurrence of breast cancer (23:03) A longer daily fasting window lowers hemoglobin A1C, earlier fasting reduces inflammation (28:24) Giving your metabolism time-off allows the body to repair itself (30:48) Does eating frequency matter while practicing time-restricted eating? (35:04) Daily fasting improves sleep quality and increases physical activity  (38:27) Genetic risk factors for breast cancer (40:54) Modest lifestyle changes can really lower your breast cancer risk If you're interested in learning more, you can read the full show notes here: https://www.foundmyfitness.com/episodes/ruth-patterson Join over 300,000 people and get the latest distilled information straight to your inbox weekly: https://www.foundmyfitness.com/newsletter Become a FoundMyFitness premium member to get access to exclusive episodes, emails, live Q+A's with Rhonda and more: https://www.foundmyfitness.com/crowdsponsor

Howdy folks, Rhonda here. Today's episode features Dr. Ruth Patterson, a professor in the UC San Diego Department of Family Medicine and Public Health, as well as Associate Director of Population Sciences and leader of the Cancer Prevention Program at Moore's Cancer Center at UC San Diego Health. If you enjoyed my last episode with Dr. Satchin Panda, I have good news. This will also be a great episode for you, since we talk about some similar ideas, but focus more on the human side of things, especially when it comes to time-restricted

eating since Dr. Patterson does primarily clinical research. In this 45-minute podcast, we talk about the importance of time-restricted eating as a practical public health intervention, mostly for its ease of implementation that may have a widespread impact on disease risk. Why you should probably make sure your time-restricted eating window occurs earlier in the day rather than later, how the first 5% drop in weight loss can have disproportionately large effects on the metabolic factors associated with breast cancer risk when compared to subsequent weight loss. The association of longer fasting durations beginning earlier in the evening and improved sleep in humans, as well as spontaneous physical activity in their day-to-day

lives, the relationship between metabolism and breast cancer risk, the effect of lifestyle factors such as obesity, physical activity, what and even when you eat, whether or not you smoke tobacco, and how even modest changes such as consuming food earlier in the day and only during an 11-hour window can decrease breast cancer risk and recurrence by as much as 36%. The importance of starting your fast earlier in the evening and how an earlier eating window has been shown to correlate to reductions in inflammatory markers. The association of higher circulating insulin levels with breast cancer risk and how insulin itself has an important relationship with estrogen by affecting the levels of sex hormone

binding globulin. The dangers of having a cellular environment that is inflamed, as the case is with the obese, and simultaneously having elevated cellular growth signals, which is also characteristic of the hormonal milieu of the obese. The surprisingly small role heredity plays in determining overall risk of breast cancer when compared to lifestyle factors, and how healthful lifestyle habits like choosing to eat during the right time window ultimately helps us trend our risk for many of the diseases of old age in the correct direction instead of influencing only one or another. All right, so before we launch right into the podcast. If after listening to this podcast, you find you're absolutely fascinated with the

concept of time-restricted eating and decide that you want to give it a try, don't let your data points go to waste. Go to Mycircadian clock.org. That's M-Y-C-I-R-C-A-D-I-N-C-L-O-C-K. Install the Android or iPhone app, commit to trying out this new style of eating for at least 14 weeks, and commence sending pictures of your food. This is a really cool way to try out a new lifestyle habit and actually contribute your data to scientific research in the process. You can also learn a little bit more about how this all works by listening to my last podcast with Dr. Sotchen Panda. Once you're done with that, go to foundmyfitness.com and enter your email in the newsletter signup form. I try to get one email out once a week that's loaded with insightful information that is worth

at least a thousand times the price of admission, which is in this case the little bit of initiative and trust it takes to get you typing your email into that subscription box. Once again, you can find my newsletter at found my fitness.com. That's F-O-U-N-D-M-Y-F-I-T-N-E-S-S dot com. Without further ad-D-D-B-D, enjoy the podcast. Hello, my friends. Today my guest is Dr. Ruth Patterson, who's a professor at the UCSD Department of Family Medicine and Public Health

and leader of the Cancer Prevention Program at Moore's Cancer Center at UCSD. Thank you, Ruth, for being here. I am very interested in some of the research that you have been doing for the past few years and ongoing in terms of looking at this interface between metabolism and specifically breast cancer risk and increased breast cancer recurrence. So when I think of lifestyle factors that are modifiable and that are actually known to increase breast cancer risk, obesity comes to mind. Sure. Obesity is definitely one of the big ones and also physical activity. More recently, we've become aware of the importance of physical activity. What's been harder for us to identify is exact types of foods that could reduce risk. In fact, we've not really had a lot

of success in identifying individual foods or individual nutrients that seem to make a difference, although I think there's more acceptance now of the idea that an entire dietary pattern, let's say the Mediterranean dietary pattern, may influence risk over decades. So I would say those are probably the top concerns, is diet quality, obesity, physical activity. Those are the things. And even tobacco can increase some increases breast cancer risk. So there's many things individual women can do. do to reduce their risk?

I was reading, I think maybe the American Cancer Association had published some statistics on how obesity can increase the risk of breast cancer by twofold. And also specifically looking at some of the mechanisms by which obesity can increase breast cancer risk. There were a variety of them, including increased inflammation, increased inflammation, increased hormone to estrogen and also increased fasting, fasting insulin levels. Yes, I think we've known for a long time about sex hormones in particular, estrogen as a risk factor because some of our first really successful drugs were based on blocking

the action of estrogen. Estrogen's a growth factor, so it appears if we can block that, it can reduce your risk or reduce your risk of recurrence. And we have some pretty effective drugs that have made a big difference. It's more recently that we've realized that other growth factors have the same type of impact. It's almost common sense. If estrogen is a growth factor and that increases growth rates of tumors, well, what about insulin? It's also a growth factor.

It encourages metabolism. So we do believe that perhaps high levels of circulating insulin may be really central to the whole process of developing breast cancer and promoting its growth. and high levels of insulin are definitely found in women who are overweight, if you're less physically active, and then, of course, among diabetics often have high circling levels of insulin. So we are becoming more aware that sort of that may be kind of a common road where many different syndromes lead to the risk, increased risk of breast cancer. And so insulin, so you mentioned that people that are overreuthers, overweight and people that are obese have higher circulating insulin levels. They also have higher

circulating estrogen levels, right? So, fat can secrete estrogen? Am I right? Fat can secrete estrogen, or is that something? That can, yes. So that's pretty central. And then what we also know is that people who have high levels of insulin have lower levels of serum hormone binding glabulin, something called SHBG, which binds estrogen. So it can prevent. it from being active. So there seem to be related. They're not just two independent pathways. They actually play off each other. And you said you brought up something

that was very, I think, important in that is you said that these growth factors, they promote the growth of tumor cells, of cancer cells. These are... Right. That's in a very general way. Right. Yeah. So you're... Something you know, something's causing the initial

damage. The cells become damaged. And you know, we have a lot of mechanisms inherent in our cells that can sense damage and say, well, okay, I'm going to die. I'm going to kill myself because if I don't, may potentially lead to a cancer cell. But if you have all these growth signaling factors happening in the presence of that damage, it's sort of saying, hey, no, no, keep going, keep growing, don't die, grow, grow, grow. And, you know, so that's sort of like, I think the combination between things that are causing the damage, which possibly high inflammation, so obesity

also is associated with high inflammation. And then in the, you know, the combination of the inflammation and the, you know, high insulin, the high insulin, like growth factor, the high estrogen, it's sort of like this detrimental combination of damage and growth signals to allow them to survive. You also mentioned the serum binding hormone. Seum hormone binding. Serum hormone binding. Yeah, that's it.

That's it. Thank you. And you mentioned that binds estrogen and. sort of makes it inactive from going to activate, I guess, in breast tissue or whatever tissues. What about also the insulin? So I mentioned the insulin-like growth factor pathway, which is separate, but from the insulin, they're two separate growth factors, but they're also very interconnected. Yeah, I think the data on insulin-like growth factor is a little less consistent and a little harder for us to understand.

So we think it's also playing a role, but some studies have found it to be a risk factors and other studies haven't. You're talking about circulating levels, I'm sure, because it's also very complex because there's receptors for these things on the cells that may also play in. So it's a very complex system,

which is why we've had such a hard time coming up with cures. is because there's lots of redundancies and one system affects another system. And so just finding like that magic pill that can turn off all these different related pathways is virtually impossible. There's so many workarounds for our body. Our body is incredibly resourceful. Right.

So these three factors that are known, the fasting, high fasting insulin, the high free estrogen and the high inflammatory markers. So as measured by certain biomarkers, like C-reactive protein. So these are all associated with, in some cases, even two-to-three-three-fold, increased risk. Yeah, definitely two-fold and maybe a little bit more. I think that's generally what we, the metric we use, each one of them, increases the risk individually by two-fold.

Combination-wise, we don't know, probably not quite additive, but they still would have a combined effect, too. That's, you know, reason to look at all these different pathways. But those are definitely the three major metabolic pathways that we think feed into. having kind of fertile soil so that when these DNA changes happen, they're in a place where they're kind of like fertile soil, more likely to go to an invasive tumor type. Okay. And what's so interesting about this is that your work, so your work and work of others is

showing that these three different biomarkers, let's say, they can be modified by changing your lifestyle pattern. Right. Much of my research lately has focused on timing of meals, which I think is a little bit of a newer hypothesis. We all evolved to eat during the day when we're out getting our food and then fast at night when we're in a rest day. But now with modern lighting and with modern lifestyles and longer and longer work weeks, our meal patterns less and less than less resemble the way we evolved to eat. And we believe that it's very metabolically detrimental to eat a lot of energy and then right away lay down. You know, what are you doing? You're laying

down. You don't need to have all that energy on board and all that metabolism going on when actually you should be in a fasting catabolic state. And most people probably actually eat one of their largest meals in the evening. Right. Right. Which is just so counter, just even in a common sense wait, why do you need all that energy right before you're about to become completely comatose? It makes no sense, right? You really need the energy during the day, you know, when you're busy up walking. That's a very good point. And I think you also mentioned another important point in that that is eating during the day when we're supposed to eat and timing it with our circadian rhythm, which is the biological clock inside of our every cell. We've got a master regulator

and different tissues, which we can talk about in a minute. But that master clock, what's interesting is that it does, it regularly, you know, between 10 to 15 percent of the human genome is regulated by these clocks. And about 50 percent of those genes are involved in metabolism. Right. And humans are the most insulin sensitive upon waking, you know, first thing in the morning. And as the day goes, insulin sensitivity goes down. And so, you know, eating your biggest meal in the evening when you're the most insulin insensitive would increase one of those biomarkers that you're talking about. Right. Or just metabolically disregulate you, which is what we're trying to have regulated metabolism, and that definitely disregulates it. And the whole circadian rhythm concept is the

idea that, as you mentioned, the master clock is trained to light. You know, it responds to light. So the master clock's getting the signal, let's say, in the evening, you're done. But if you're eating, the peripheral clocks, like in your liver, are going, no, we're waking up. We're getting energy. And we believe that when those two clocks are out of sync, that that itself leads to some type of metabolic dysregulation. And we don't have fully metabolic or molecular understanding of exactly how this works. But it's a pretty solid theory, at least what we've seen in animal research. Yeah, you, so I mentioned to you earlier that I talked about this meal timing with a

collaborator of yours, Dr. Sachin Panda, who's at the Salk Institute. And, you know, he, a lot of his research had focused on elucidating this important regulator of the peripheral clocks, meaning the clocks in the non-brains, the liver. or the heart. Right. And how when you eat your first meal or even taking your first non-water beverage starts that clock. And so if you start that clock, let's say you wake up at 7.30 in the morning and you have a sip of coffee, 7.30 in the morning, the clock starts. And he's shown that eating all your meals within at least a 12-hour time from that when that clock starts seems to be very important for having a good metabolic health.

good, you know, good glucose regulation, good insulin sensitivity, being able to maintain, you know, lean muscle mass and keep fat loss off. But what's really, in my mind, I was trying to understand. And like you mentioned, we don't know all the molecular mechanisms between the timing of the two, both the master clock and the peripheral clock. But how they do seem to be working together. So, you know, let's say someone fasts. in the morning. They don't eat breakfast. They don't eat lunch. And then, so they're fasting, let's say they're fasting for 12 hours and then they eat a meal right before bed. Right. We don't know if that's necessarily going to be as good as fasting during the evening

in sync. We totally don't think it's as good. You know, so our research seems to show that two things. One, we see great, our biggest reductions in breast cancer, for instance, recurrence with at least 13 hours of fast. And we really believe that fast needs to start around 7, maybe to 8 p.m. at night. People, when people talk about breakfast, what I often say is when you're talking to people who skip breakfast, I think skipping breakfast is actually a marker of eating at night. Because if you stop eating early in the evening and don't eat for 13 hours, when you wake up, you're starving. You don't skip breakfast. So a lot of times I think the research showing that not eating breakfasts or skipping breakfast is bad, is actually not studying breakfast.

It's the people who skip breakfast were eating late into the night. So we think it's both. It's that we need a long stretch of time, and there might be some improvements in gut rest or the microbiome. Like, we don't think that your GI tract also was meant to have food constantly in there. So we think that it's important to have a long stretch of gut rest, but that that gust rest happens at night. starting fairly early, 7 or 8 p.m., and then 13 hours after that. So it's both of those things,

and either one is not sufficient. And the microbes in your gut are also on that circadian risk? Absolutely. Oh, yes. The G.I. Track is very, very tied to circadian controls. Right. You also mentioned another study that one of your research, you kind of said in passing that 13 hours of, at least 13 hours of fast, was associated with a lower breast cancer recurrence. So do my talking about that study for a little bit? Yeah, I'd be glad to. So this was a study in about 2,500 breast cancer survivors, and they completed over about seven and a half years of follow-up. They completed many food records, right? So we collected all this information about what they ate. But then more recently, when this hypothesis came out,

we went and dug up all their food records and said, well, how about if we don't care what you ate? But we just care about when you ate it. So we reentered all the data as far as when they started to eat, you know, when they stopped, how long their fasting interval was, how much they ate at night, and then reanalyze that data. And that's where we found that it seemed at least in this sample of women at the cut point of 13 hours reduced their risk of breast cancer recurrence by about 40%. It also reduced the risk of mortality by about 20% or a little more than that, but that was not statistically significant, but it was just trending in the same direction. You know, it's possible because we do believe it's, although my area of research is breast cancer, we actually believe

this dietary pattern could have really positive effects on other diseases and conditions, including type 2 diabetes, or liver, fatty liver, N-A-F-L-D, also with acid reflux. You know, don't, you know, the first thing they tell you is try to sit up when you go to bed. don't eat a big meal. So that, which often leads to esophageal cancer. So we actually feel it can have a positive impact on many aspects of metabolism, not just cancer. It's just that we're very interested in teasing out its impact on cancer. That's phenomenal, Ruth, those statistics that you just kind of just threw out there, like 40% reduction in breast cancer recurrence in women that were just simply fasting in the evening for 13 hours. Right. And that is,

Regardless of what you eat. Regardless of what you eat. And controlled for whether you're overweight or not. Wow. Right. Because it's really not that difficult to, I think it's much easier to, for people to make a modifiable change of just stopping what, you know, stop eating after 7 p.m. Versus, eat all your vegetables. Stop eating your cake.

I mean, people should do that. But I'm saying. Yes. I still think diet quality matters. But I'm saying. We've done some pilot studies with women adapting a longer nightly fasting interval. And those studies have been amazing in terms of how simple it was for women to do it. We actually had a little app they used and they would text us starting my fast.

And then we'd text back saying, great, don't forget, don't eat again before 8 a.m. or 9 a.m. And so many participants said, you know, I never understood percentage of the fat. It was always so confusing to me. It made me just feel stupid. I didn't even know how to do it. But I just got this. In five minutes, I got this. I could do it.

And self-report ways, they reported often sleeping better. And we did it with a group of Latino women, Latinos, in South Bay. And they were particularly positive about it. I said, you know, in my family, if I tried to change up our entire way we eat, Sometimes my family members weren't that positive about that. Where's our favorite foods? And she goes, but this, I could do it right away. It was really simple, and it didn't affect the family or our food ways.

So it was very easy for me to do within our family without disrupting all of our family behaviors. They were very positive and often even reported. I felt so proud of myself, okay, finally I'm doing something. I feel better. Well, I'm going to start walking, too. You know, that kind of self-efficacy kind of spread to other health behaviors, which is our hope. Yeah. Great. So these women were being more compliant, I mean, which is... Well, they felt successful

instead of feeling like a failure, right? You know, writing down everything you eat, running up the calories. You know, you only can do that for a couple of days before you just burn out in the entire exercise. So you feel like, oh, I can't do it. You know, where this, they're like, I can do this, you know? Yeah. So we think it's incredibly that some of the value is the simple feasibility of it. people can understand it and they can generally implement it. Now, we don't think it necessarily is going to have huge impacts on weight. Like you're probably not going to lose 50 pounds by just making this one change. But we believe it could be an incredible public health intervention where if everybody did it, we could move like the whole disease risk curve down a little bit. And

that would have huge impacts on disease risks, you know, which is the alternative is, of course, we spend millions of dollars trying to help a small number of very obese people lose weight, which is very unsuccessful. But if we could move the entire population this way to this more healthful pattern, we think that could actually affect disease rates in the United States. That's awesome. You also, just to kind of dive a little bit deeper into some of your more recent research, you mentioned the 13-hour fast overnight and how that was very robustly associated with a 40% reduction in breast cancer recurrence and non-statistically significant reduction in breast cancer mortality.

But you also have looked at some of the biomarkers that are known to increase breast cancer risk. And also there was an effect on some of those biomarkers like inflammation as well, correct? We've actually seen probably our most consistent effect on something called hemoglobin A1C, which is a marker of your average glucose, over about three months. So interesting enough, we saw the association both in a general sample of

women from what's called the N. Haines survey, so a nationally representative survey of women. We saw that women who fasted longer had lower hemoglobin A1C. And then in our own sample of breast cancer survivors, we found the exact same association, which to us means this is probably strong. So that's one of the reasons we think it might influence, have a huge effect on reducing the risk of diabetes. As far as inflammation, interestingly enough, we only found that it reduced inflammation among women who didn't eat a lot of food late at night. In other words, you know, if your fasting interval was 9 p.m. to 9 a.m. It didn't seem to matter. But if you're fasting interval was early in the day, like six to six, then it seemed like the fasting interval

reduced CRP. So it could see C-reactor protein, this measure of generalized inflammation. So that's what made us think. It's not just the 12 hours. It's the 12 hours only if they start fairly early in the evening. That's when the positive effects happen. Very interesting. So a couple of points that you mentioned, I just want to circle back to the glycated hemoglobin you mentioned, that basically fasting in the evening had a pretty robust effect in reducing that. And that's a marker. Obviously, it's a marker of your long-term, you know, blood glucose levels. Absolutely. They use that to approve diabetes drugs. You know, if a diabetes drug resutes hemoglobin A1C, that's how it gets approved. So it's a pretty powerful marker of risk.

So we're talking about, for example, metformin. Yes. Which is a very... any diabetes drugs has to move hemoglobin A1C down a certain amount before it can be approved. So if we can do this with a non-pharmacologic approach, but just changing when you stop eating in the fasting interval, I mean, that's pretty exciting. Yeah. It's really exciting because the truth is all these drugs have side effects. They're not that pleasant to take. A lot of people simply just continue them on their own.

So pills aren't necessarily always the answer, and this offers people a lifestyle choice. And you mentioned that there were women that were involved that you had basically, they made changes. They started fasting in the evening. And they also reduced their H-1. In our pilot studies, we were really focused on the feasibility and acceptability of it. So we didn't have any biomarkers. We were testing, could they do it? And how hard was it for people to do? Okay. So that was really a test of, because there's no point in recommending something. if people can't do it. Right.

And so that's what we really focused on there in our personal pilot work is just could they do it. And truthfully, the vast, they almost all did it. And they also all said they would recommend it as an eating pattern to their friends. So they would recommend a study, you know, which told us, okay, this is feasible and this is acceptable. And, you know, that's what we're interested in. It's not, you know, if it works, but it's like impossible to do, then it's not, it's not a valuable public health intervention. Yeah. I was wondering what I was trying to get out is how quick or how soon do you think it could change those levels.

That would be very interesting to see if it's something that can be moved pretty quickly or, you know, if it takes longer. I don't know how quick these other like metformin works. Oh, yeah. Most of them, the thing about hemoglobin A1C is since it reflects average blood sugar over the past three months, it takes about three months to move it. even with a really effective intervention, it just, since it reflects the whole last few months, it's like you're cycling through, you have to go a whole three months to see it. Yeah. Yeah.

Right. That makes sense. Other markers may be faster, but, you know, because we already know that if you want to measure these markers, you want people to be fasting. So we know just even one fast, one night's fast makes a difference. Right. Right. If you do one nights fast, a lot of these markers will be flatter in the morning than if somebody

eats breakfast right before they come in. You know, so you're really, what you're doing is you're extending the period of time where you have very low basal levels of a lot of these markers. Right. I just kind of want to, all of a sudden something came to my mind because, you know, we've been talking a lot about inflammation and these fasting blood glucose levels, fasting insulin. And it just hit, I remember having a conversation with Dr. Panda. And he mentioned something to me that I wasn't aware of about repair a me. mechanisms and fasting. I knew that repair mechanisms were regulated by the circadian rhythm, and I always knew that when you sleep is when you're repairing a lot of damage. But it didn't

occur to me that also when you sleep is when you're fasting. And he had mentioned that there's something inherently important about fasting and repair mechanisms. And so, you know, which, of course, that kind of made me think, wow, that's really interesting. I never thought about it. that. But if you think about, you know, the timing of these repair mechanisms and fasting and how you're repairing damage, DNA repair mechanisms, and also these atopathy, clearing away damaged cells. Damage cells secrete inflammatory mediators. So if you're clearing away the cells that are damaged and secreting more, you know, inflammatory molecules, then possibly that would, you know, the lower the inflammation. But it's really interesting how your data suggested that it really

had to occur earlier in the evening. Do you have any speculation as to why that is? I suppose we really do think that your body works best when it's aligned with the circadian rhythm. But I think that is a really good observation. Certainly the parallel I tend to think of is we work out, we actually hurt our muscles. And the muscles don't repair and get stronger unless we stop. We have to stop. We have to give them a rest, period. And same thing, eating is metabolism. There's a lot of oxidative damage that haps just as we eat. And then the theory is that you need a time off from that damage for the repair mechanism to come in. So it's an interesting observation in parallel. Personally, I don't think that's a little molecular for my research. But yeah, I think it's a,

it's a good parallel to compare it with, like, working out. Yeah, that is actually. You know, like you mentions you need a repair time. Stress can activate stress response, pathways that can be beneficial, like in the case of exercise. Right. But if you keep on stressing yourself, there will be no. Right. There will be no repair.

You do need time off. Right. Yeah, exactly. What about meal frequency? So is that, did that play a role? So if you're, I don't know how long between the fasting and fed state. Let's say we're within the 12 hours in day. We're within that 12 hour, you know, feeding time.

a lot of time. Does the amount of meals that we eat within that time matter? I think it's a little bit of a separate question. We tried to control for it in case it did make a difference because it makes sense if you're eating, let's say, 18 hours a day, you're probably going to have more eating episodes per day than if you're only eating for, let's say, 10 hours a day. So just reducing the number of hours that you eat may actually have some imp. on how many eating occasions, which may also relate to disease risk. But we didn't see that to be a really important determinant of disease risk. So we're not really, that's sort of a little bit of a different question.

We're not really quite sure. I think that the evidence is really out on meal frequency and disease risk. Okay. And I, you know, if you want, my gut feeling is that if you keep your eating interval fairly short, it may not matter very much. But when your interval is very long, so you're getting, you know, a meal impact, and then a long time with no meal, and then, you know, throughout the day, all those spikes might be more detrimental. But the data on that are really unclear at this time. Yeah, I think you made some really good points, and that is, you know, if you reduce the amount of time that you're eating, that naturally you would probably then reduce the frequency that you're eating. I just remember, I don't know if this is like one of those wives' tales where, you know, the smaller number of meals you eat was supposed to lower your blood, you wouldn't have as big of blood glucose.

Right. You know, but then again, you're constantly doing it. So I don't know, you know. I think, you know, I know of at least one study in the field that's actually testing that, you know, testing five meals a day versus three. So I think they're starting to realize we don't really have a good answer to that. And trials are underway to clarify that. Okay. One other thing that I was kind of thinking about in the parallels between how this meal timing is having a pretty profound effect on, you know, for example,

your what's considered your long-term blood glucose levels, and also to some degree on inflammation, and these are markers of, these markers are known to be associated with increased breast cancer risk. But you said that weight loss may not necessarily occur. But what's interesting, so you may not, let's say you don't change the types of foods you eat, but just you're basically only eating, you know,

during a 12-hour window during the day, you know. So that in itself may not, cause you to lose weight or or a significant amount or significant amount but what is what's interesting is that on the flip side weight loss weight loss itself has also been shown to have a positive effect on these same biomarkers yes and and so so so we actually think that some of the positive effect might be independent of weight loss you get the positive effect whether or not you lose weight in our pilot study women over a month lost about a kilogram or about a little over two pounds

So we did see a modest weight loss. That's very modest. But even the mice study that studies that Dr. Pandot does also tend to suggest that the impacts may be independent. Like it just helps you regardless of whether you lose weight or not. Yeah, that's kind of what I was getting at. It seems as though it may just really be affecting your metabolism and making sure that you're timing your food. intake with when you are, when your metabolism's at its best, when you can process these, you know, the sugar and the fats and just everything that you're throwing at it. And that seems to be in and of

itself extremely important. And, you know, we have seen, in our breast cancer survivor study, we definitely saw an improvement in hours of sleep per night when people had a longer fasting duration. And, you know, sleep, bad sleep can also affect biomarkers. And it's its own risk. So, that might be partially, you know, it's partially working through direct metabolic effect, but it might be working through other behaviors too. By improving sleep and getting more sleep could also help regulate your metabolism and kind of feed into the positive impacts. Similarly, it's very interesting, but in several of studies they've shown, big improvements

in spontaneous activity when they're put on this, when they're not on this fasting regimen. We don't necessarily think that if women or humans adopt a prolongnately fast, they're going to start working out the gym. But there might be some more subtle effects on spontaneous activity, which frankly is the majority of the physical activity most people have, is just spontaneous everyday normal activity. So, the animal studies lead us to believe it can have several behavioral impacts in addition to the direct metabolic impacts. Yeah, that's very interesting. I wonder if there's just changing the brain, you know, lots of... You know, the data showing that eating a bunch of food and going to sleep disrupts your sleep has been around a long time. You know, it's just you don't sleep well on a full stomach, just period, overall, you know. So it's kind of, that literature has been out there for a while.

I've been practicing this time-restricted feeding now for once I, you know, you know, you know, Dr. Satchan Ponda's work was really eye-opening and I, you know, thought, well, I'm going to, I usually try to stop, you know, stop eating earlier, like earlier in the day. And it's a lot easier for me in the winter, fall and winter months when it gets darker earlier and I'm not working so late. The thing for me is when I'm working late, you know, when you start working later, it's light out. I'm like, oh, I got to keep working. I got to keep working. Then you start to, like, extend your work day. And that becomes, the issue. Surprise. Western lifestyle is carcinogenic. In case you didn't know that, now you do. So now we have the bright light exposure and the evening. Many things about our lifestyle are carcinogenic. Right. But I do, I'm, it's really not that difficult to do. And I'm just now, I start the clock once I have my first cup of coffee and then it's okay, well, I got to start cooking dinner, you know, at least two hours before that or something. So that way I'm done. And it's, you don't, you're not hungry.

You know, you're not like starving when you go to bed. Some people, I think their fear is, well, you mentioned it's hard to sleep when you're super full. But on the flip side, a lot of people have this mentality that if they're really hungry, you can't, you can't sleep. Right. You know, but I think there's a nice balance between those two, and that is if you just eat something, you know, in a reasonable time, you know, 7, 8 p.m. stop. I mean, along with that, I have to say, I probably think it's probably best for you to go to bed at a reasonable hour. or not be staying up till 2 in the morning, playing video games or whatever. So it can all be synergistic or in a positive way or in a negative way.

Yeah. I want to kind of shift gears one more time. I think a lot of people have in their minds, at least in the context of breast cancer, many women think about risk factors being genetic. You know, there are certain gene polymorphisms, which are variations in the sequence of DNA. that alter the function somewhat, that can put a woman at risk, particularly genes that are involved in repairing DNA damage specifically in the breast tissue. Brick-O-1, brick-a-two, I think many people are familiar with these genes. But really what your research and what a lot of research out

there has shown is that there are lifestyle factors that play, if not equally important role, and certainly in combination with these genetic risk factors would be very, very important in modifying breast cancer risk. And not only risk, but recurrence. So there are a few types of lifestyle factors that we talked about today that may, you know, dramatically lower a female's breast cancer risk. And also people out, women out there that have had breast cancer, certain lifestyles they should adopt in order to lower their recurrence. Right.

So what do you, if you want to talk about maybe the top one? Sure. You know, Braca 1 and 2, if you have that gene, you know, polymorphism, that's a pretty special case. And those women are at very high risk of breast cancer and recurrence. And it's hard to know for that small percentage of women how much lifestyle matters. But again, they're a special case. Majority of cancers are just sporadic. We think that less than 5% overall of breast cancers are the result of genetic factors,

and more like 65% to 75% are the result of lifestyle factors, including obesity, diet, physical activity, and smoking, and alcohol, we think, maybe, for breast cancer. So those are all things you can modify. So the idea that you're doomed by your genetics couldn't be more wrong. For the vast majority of women, it is your lifestyle choices that will make the biggest difference in your risk, which is not the same thing as saying you're to blame because a lot of cancers are sporadic, but that there are things you can do to reduce your personal risk a lot. Well, that's good news. Yeah. So don't smoke, moderate drink.

Don't, you know, don't drink a lot. Lose weight. Lose weight. And even a small amount of weight, recently there was a study that seemed to show like they saw huge improvements in metabolic health in the first 5% of weight loss. And then they said if you looked at 5 to 10% of weight loss, it's like it flattened out. It wasn't, you know, it isn't like a linear thing. So it looks like even modest weight loss can really improve your metabolic health. So I think there's this perception that, well, if I don't get to model skinny, there's no point in even trying.

And I think that's a really wrong way of looking at weight loss. 5% weight loss could really make a difference. 5% of your... 5% and keep it. You know, keep it off. You know, and maybe in a year or two, you might go, well, maybe I'll lose another 5%. You know, but the idea that there's, like, some very linear thing going on, I'm not sure that data really support that.

So even modest weight loss, you know, work on the quality of your diet, work in the time of your diet, get some physical activity, please, you know, avoid long periods of sedentary behavior, all those things combine, good sleep and good food choices, I think, are, that's the total combination of things is the best thing you can work toward and just make it a lifestyle to always be working on improving those things, your whole life. I think that's fantastic advice. And I just want to mention that number again because it really is, you know, the best, obviously, no one wants cancer. You know, that, that, if you can do whatever you can within your, you know, control to give yourself the best possible

chance of not getting cancer, then really, really, really, really, really, really, really, you should do it. That's, you know. And there's a super benefit here is that it likely will reduce your risk of cardiovascular disease, which, after all, is still the number one killer of women. So, you know, you're really getting a 360 effect on your risk of all the major killers. in America, some unpleasant conditions like diabetes, and also hopefully just feeling better every day. Absolutely.

Quality of life. Basic quality of life. I think there's been studies showing, there's been studies showing like weight loss and improved mood, you know, inflammations associated with depression, you know, and inflammation is associated with obesity. So yeah, you're right. All these things. Your quality of life.

Physical activity is associated with reduced risk of depression or ameliorating some of the effects. So there's, you know, it's not like there's a. separate list of things you should do for one disease versus another, it's like the total benefit package. Yeah, they're all overlapping. Much more overlapping. We used to not think that as much. We used to think they were completely disease. Here's the disease pathway for cardiovascular disease. It's very metabolic. It's blood pressure. It's cholesterol. And here's cancer. And it's a genetic disease. And there are two separate pathways. Now we see that they're actually way more overlapping than we

ever knew. And it's really good news because it means you don't have to do separate things for each disease. It means the same suite of healthful behaviors can give you 360 protection. Well said. And just one last time, that meal timing, women that had breast cancer and had fasted for at least 13 hours overnight had a 40% reduction in breast cancer recurrence. Right. I think that's pretty good incentive for women to set that clock when they the first bite of food in their mouth or the first non, you know, water beverage, you know, that clock's set and making sure that you don't eat food, you know, past 7 p.m. 7 or 8? 7 or 8.

Satchen Panda's work was he did the most recent article he published, which I thought was very good, looked at mice where he just had them do restricted feeding five days a week and then all around the clock, you know, kind of break it the fast on the weekend. and he saw much of the same effects, which means, you know, you don't also have to be perfect. As long as you most of the time you do it, you don't need to feel like a fill. You're like, oh, I went out. It's so late. It's fun. You know, just pick up the next day and get started again. Thank you for bringing that up.

Because, you know, weekends are when we have that social pressure. Right. You know, we're having later dinners. We're having drinks. You know, so it's nice to know that at least if the animal studies do translate to the human studies, that we can at least break the rules or cheat a little bit on weekend. I think that's a plus side is that it's not about being perfect. It's about mostly doing it, and you'll get most of the benefit.

Agreed, agreed. Well, Dr. Ruth, thank you so much for your time and for the phenomenal research that you're doing. Thank you. I really look forward to reading more. and keeping an open line of discussion with you to learn more about some of what your research is showing in terms of the meal timing and breast cancer incidents. Great. Thank you, Ron.

That's a wrap. A reminder for those of you that want to contribute your time-restricted eating data points to real human research. You can sign up to participate via your mobile phone at my circadian clock.org. Thank you for listening, and an especially huge thank you to Dr. Ruth Patterson for taking a few moments out of her probably already jam-packed day to talk to you. me so that I could share this conversation with you. And if you like what I'm doing with this channel, you can help me keep the ball rolling by pitching in a few bucks. This channel is funded by supporters like you and even small amounts like the cost of a salad, a few avocados, or a cup

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