The Dr. Hyman Show - How To Eat And Optimize Your Hormones For Quality Sleep: Part II Of Dr. Hyman's Sleep Master Class

Episode Date: November 1, 2021

This episode is sponsored by Rupa Health and Thrive Market. The food you eat has a direct impact on the quality of your sleep. Through balancing your blood sugar, boosting your sleep nutrients, and supporting your gut health, you can turn something you do three times every single day into an opportunity to radically transform your sleep. And the same goes for supporting your hormones, which are absolutely crucial to quality sleep. In part II of Dr. Hyman’s Sleep Master Class, Dr. Hyman is joined by Dr. Mark Burhenne, Dr. Mary Pardee, Dr. Judy Hinojosa, Dr. Afrouz Demeri, and Mike Mutzel to discuss how nutrition and hormones impact your sleep. If you’d like to watch the whole series, you can sign up for free at www.drhyman.com/sleep. Mark Burhenne, DDS is a bestselling author and a family and sleep medicine dentist who focuses on patient-centered and preventative dental healthcare. He is the creator and author of AsktheDentist.com, a website dedicated to exploring the mouth-body connection for better overall health.   Dr. Mary Pardee is a Naturopathic Medical Doctor, Certified Functional Medicine Doctor, and founder of modrn med who specializes in integrative gastroenterology and hormone balancing in Los Angeles, California.   Dr. Judy Hinojosa is a licensed Naturopathic Medical Doctor and the lead physician and founder of Vitality Wellness Clinic. Dr. Judy has received higher level postgraduate education in Environmental Medicine, Intravenous Nutritional Therapies, Natural Hormone Balancing, Ozone Therapy, Lyme Disease and Mycotoxin Illness, and has completed in-depth training in Energy Based Medicine.   Dr. Afrouz Demeri is a licensed board-certified Naturopathic Medical Doctor specializing in integrative, Functional Medicine for women. Dr. Afrouz finds the root cause for hormonal imbalances, thyroid disorders, stress, weight or digestive issues, fatigue, depression, and anxiety.   Mike Mutzel earned his B.S. in Biology from Western Washington University, completed his M.S. in Clinical Nutrition from the University of Bridgeport, and is a graduate of the Institute for Functional Medicine’s (IFM) Applying Functional Medicine in Clinical Practice (AFMCP).   This episode is sponsored by Rupa Health and Thrive Market. Rupa Health is a place for Functional Medicine practitioners to access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, Great Plains, and more. Check out a free live demo with a Q&A or create an account here.    Thrive Market is offering all Doctor's Farmacy listeners an extra 25% off your first purchase and a free gift when you sign up for Thrive Market here. 

Coming up on this episode of The Doctor's Pharmacy. The winning combination for keeping any meal to keep your blood sugar balanced and keep yourself from crashing later in the day is healthy fat and protein and fiber in the morning. Hey everyone, it's Dr. Mark. I know a lot of you out there are practitioners like me helping patients heal using real food and functional medicine as your framework for getting to the root cause.

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I travel all the time. So at this point, I have packing down to a science. I know exactly which grab-and-go food items and personal care products I like to bring, and I always keep them on hand so I'm ready for my next trip. I used to run around before every trip trying to find what I needed, which meant going to different stores, spending too much time packing. And now, I use Thrive Market, and I get everything in one place shipped right to my door. Here's a little snapshot of what I like to travel with.

Food is, of course, first on my list. I always order some of the Ayoba grass-fed biltong jerky, which is so yummy. Royal Hawaiian Orchards Organic Macadamias, because it's super full of fat and protein, and I love that they make me feel full and easy to carry and don't go bad. And there are also super handy pouches of Thrive Market brand pitted green olives. I want to splurge and bring a treat. I'll grab some Hugh chocolate too. And in my

toiletry bag, I bring some Schmitz deodorant, some all terrain herbal armor bug spray, a tin of raw elements, SPF 30 natural sunscreen, and a bar of Dr. Bronner's peppermint castile soap. Thrive also carries so many other things that makes packing for a trip easier, and I'm sure you'll find your own personal favorites. Thrive has two different membership options. I went with a 12-month because it comes down to $5 a month, and I'm constantly ordering stuff. Plus, it's 30 days risk-free. But you can also sign up for a monthly membership. If you join Thrive Market today, you'll get 25% off your first order and a free gift.

Just go to ThriveMarket.com forward slash Hyman. That's T-H-R-I-V-E market.com slash Hyman for 25% off plus a free gift. Now let's get back to this episode of The Doctor's Pharmacy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. Today we are featuring part two of Dr. Hyman's sleep masterclass. You'll hear from Dr. Mark Bruhena, Dr. Mary Pardee, Dr. Judy Nahosa, Dr. Afrooz Dameri, and Mike Mutzal about how nutrition and hormones impact your sleep. If you'd like to watch the entire series, you can sign up for free at drhyman.com forward slash sleep. We hope you enjoy this episode and tune in next Monday for part three. Have you ever had a big heavy meal before bed and then had a poor night's sleep?

How about a few drinks before bed followed by a night of snoring or tossing and turning? Or maybe you deprioritize eating whole balanced meals and that blood sugar dysregulation kept you up and hungry at night, maybe even gave you night sweats. Most of us have experienced the direct effects of food and alcohol on sleep. But what we eat and when we eat has a profound impact on our sleep in more ways than you know. Today, our experts are going to walk you through the importance of nutrition and how we eat and when we eat and how that can be a powerful tool or a foe depending on the choices we make. We're also going to dive into the world of gut health. How does our sleep impact our gut and how does our gut impact our sleep? We'll find out in this lesson.

I truly believe that the two most common culprits threatening your sleep-wake cycles are unregulated blood sugar levels or poor nutrition status and chronic stress. We're going to talk about our chronic stress in the upcoming lessons, but for now, let's turn to our experts for a lesson in nutrition, blood sugar, and sleep. Nutrition affects our sleep in so many different ways. One of the biggest things that I see is when women come into the practice and they're actually restricting their calories. So they're just not eating enough food. I call this under eating and a lot of women and men are under eaters. What happens when you don't eat enough calories is that you actually get a reduction in your slow wave sleep. This makes a lot of sense from an adaptive perspective. Slow-wave sleep is when we produce about 70% of our growth hormone.

Why would we need to produce growth hormone if we're not building tissues, right? If you're in a catabolic state, meaning you're not eating enough calories, the last thing you need is a hormone that helps you build tissues. However, growth hormone is essential you build tissues. However, growth hormone is essential for so many other things, and if we're not getting the benefits of growth hormone, then it's really detrimental to our health. Growth hormone is needed for bone mineral density as well, decreasing fat mass, improving lean body mass, and overall anti-aging. So if you're restricting your calories too much, I would say less than 1500 for a woman

is not enough calories for sure, then you're not getting the benefits of growth hormone and the benefits of slow wave sleep. The other factor of nutrition is going to be your ability to regulate your blood sugar levels. Blood sugar regulation is key when it comes to nutrition and this is something that I hammer home all the time because it can make a huge difference in your cognitive performance, your emotional regulation, and your overall health. You see, most of the neurotransmitters in your brain actually require stable blood sugar levels to be produced and released. These are things like dopamine, serotonin, GABA. These are your happy neurotransmitters, your motivation neurotransmitters. Everything that's gonna affect your mood throughout the day

relies on a stable blood sugar all day long. However, blood sugar also affects your sleep at night. So if somebody comes into the office and they say, you know, it's really weird, I wake up at 3 a.m. every single night and I have no idea why. A little bell goes off in my head and it says, okay, likely a low blood sugar issue. This is because if your blood sugar declines,

your body's natural response is to increase cortisol and adrenaline. These are two hormones that can be literally life-saving. They increase your blood sugar in response to low blood sugar levels. They want to get you back up to baseline. However, these two hormones are also responsible for waking us up in the morning. And you don't want to be woken up at 3 a.m., which is exactly what happens when blood sugar dips at night. So a lot of individuals aren't aware that they have a blood sugar issue and they're waking up out of survival. Their brain is actually waking them up because their blood sugar has dropped and their adrenals, if they're not working well, is releasing a little bit of adrenaline. And it's that adrenaline

that wakes you up to say, please go eat. Now, some people will say, I wake up and I'm hungry. And that's a clear sign that their blood sugar was probably low. But sometimes that's not the case. They're still just in bed and they're flip-ping, and they're trying to fall back asleep, and they can't. Sometimes people will say I woke up to urinate. But it's not truly that the urination woke them up, it's that they wake up, and then they think they have to go urinate. So blood sugar is a huge one. And one of the tests for that is I actually say, please have a handful of nuts or have some sweet potatoes or some quinoa or something like a complex carbohydrate right before you go to sleep. And just try this for a few nights.

And you'll be amazed at how many people say, I slept a lot better when I eat right before bed. Now, usually we tell people don't eat before bed, you know, but if someone has an adrenal issue and they eat dinner at 6 or 7 p.m., the sugar from that meal lasts about six hours. And then after that, your liver has to kick in and get that sugar out and use it so that your brain sustains that nice blood sugar throughout sleep. If it can't do that, and let's say your liver is not working well, and that doesn't mean

you have liver failure, but let's say that process is difficult to do, or your adrenals can't release cortisol, which is a glucocorticoid. The whole purpose of cortisol, which is your stress hormone, is to help the body maintain that blood sugar. If it can't do that, it releases that adrenaline, that's going to wake you up. So how do you fix that? You don't want to go and just keep having sugar before bed or these complex carbs, you have to look at your blood sugar control throughout the day. And that starts from your breakfast to every meal. So one of the things I recommend for my patients, especially if they're women, and they've been on the keto diet, which I find a lot of them feel great, they've lost a lot of weight, but they can't sleep well. And it's because they have no

carbs. And we need carbs, we need a little bit of carbs, and it can absolutely affect your sleep if you're not getting enough carbs. So sometimes I'll say either cycle some carbs in, or make sure that you're having a complete meal, or have a handful of something right before bed and see if that's the issue. So finding out the cause of that is much better than taking an Ambien or taking a sleeping aid because that's not fixing the problem. What your ideal plate should look like for blood sugar stabilization is this. Half of your plate should be non-starchy vegetables. These are things like spinach, kale, arugula, broccoli, cauliflower. All of these things are really, really potent in antioxidants,

vitamins, and minerals that we need for sleep, which we'll talk about soon. But they're also lower in carbohydrates, so you're not getting spikes in blood sugar that can then lead to dips later on. A quarter of your plate should be those starchy vegetables. These are things like sweet potatoes, yams, squash, all of that good stuff, I say about a quarter of your plate should be comprised of that. You're going to change the amount based on your goals and your body type. So some people can eat way more carbohydrates than other people, and it should be based on your carbohydrate tolerance. Your physician or your doctor can help you work out what that is for you. But you don't want to be gaining weight and you don't want to be losing weight, and that's one that you can tailor based on that. The last quarter of your plate is going to be composed of your protein source. And this can be anything from grass-fed beef, pasture-raised chickens, wild-caught

salmon. Any of those things are going to make about the palm size of your hand for protein. Now protein is essential for sleep health for a few reasons. And one of those reasons is that tryptophan is the precursor to 5-HTP, which is the precursor to serotonin, which then gets converted to melatonin. And melatonin is going to help you fall asleep at night. So really, the tryptophan from your protein is the building block for melatonin for sleep quality. The other reason that protein is important is what we just talked about. It's really important for blood sugar regulation. So you need enough protein in your diet to help

regulate your blood sugar throughout the day so that you don't dip too low at night. The last component of your plate is going to be fats. So things like olive oil, ghee, coconut oil. You need at least one to two tablespoons of fat on all of your meals to help stabilize your blood sugar and produce enough of the omega-3s that help reduce inflammation, which then also help affect your sleep quality. Sometimes having a high elevation of sugar can wake you up, as well as a low glucose can wake you up. And I see this a lot with my patients that have diabetes. I'm going to share this example. One of my male patients, a 48-year-old male, Steven, he came to see me and he was already diagnosed with sleep apnea, but he had very high blood pressure, had atherosclerosis already, so he was building plaque in his arteries,

and he had uncontrolled diabetes. His hemoglobin A1c was 9, which should be, again, less than 5.7. And hemoglobin A1c measures how one manages glucose over a period of three months. So his levels were very elevated. He was on metformin. He was on prescription medications. He was taking supplements. He was taking alpha lipoic acid. He was doing curcumin. He was doing cinnamon and chromium. He was doing all the tips we tell our patients to take for managing sugar. He was exercising one hour a day.

And he wasn't really, he was on a keto diet. So he wasn't even having any carbohydrates. And his sugar levels on waking up were consistently high. His shirt, Stephen said that in the morning on waking up, his fasting glucose was always over 300. And he couldn't get it to come down. And despite everything he was doing. So the clue here was that he had sleep apnea. And he was not using his CPAP machine.

So when I asked him, are you using your CPAP machine? He said, no, I hate the machine. I don't want to use that. He actually believed that he didn't have sleep apnea. He said, it's just the test is wrong. And his wife was at the appointment and she said, no, he wakes up. I can hear him snoring, choking, gasping for air at night. So he sleeps much better when he has the sleep apnea, when he has the CPAP machine for the sleep apnea.

So the connection here is that Steven didn't realize the importance of sleep. When he doesn't sleep at night, his insulin levels go up. And when the insulin goes up, the glucose levels also increase. So we end up with insulin resistance. The cortisol levels go up. And when the insulin goes up, the glucose levels also increase. So we end up with insulin resistance. The cortisol levels go up because the body is under a lot of stress. And the more cortisol you have at night, it signals the cells to release more glucose. So the glucose goes up, and then the cells are not conversing with each other. Insulin is not hearing glucose. So we have to put more and more and more insulin. So he has ended up with insulin resistance and diabetes that is uncontrolled. And he wakes up, he couldn't

understand why do I wake up with such high glucose level? He said, I go to bed, my glucose is 85. I don't eat through the night. And then I wake up with a level of 300. What's going on at night? And I see this a lot in my patients that have diabetes. And the key factor here is the sleep. He's not resting at night. It's becoming a stressful process. He's developing more insulin resistance. The body's under a lot of stress. When we don't sleep, it becomes a greatly stressful process to our body. One of the worst stressors for our health is not sleeping. The body goes under a lot of stress. Adrenaline goes up. Epinephrine goes up. Cortisol.

And it's all signaling that the body to go on sympathetic overdrive, which means pull more glucose from the storage, pull glucose from the cells. But the body doesn't know what to do with this glucose. So it's just an elevation. She's not burning the glucose at night. So once we made the connection, he saw the importance of sleep and sugar management. He started using his CPAP machine. And we also guided him to do some of the exercises to strengthen up. And he also got a mouthpiece to help from time to time.

If you want to take a break from the CPAP machine, he had a dentist made a mouth guard unique for him to help him keep that palate higher and the tongue relaxed so he could get more air in. So the CPAP machine sometimes can be uncomfortable for people. They do have a pillow for him as well. So he rotated from now and just using the SIPA machine and working with bringing more breath into the airways, without changing anything else, he was sleeping. And his hemoglobin A1C levels had dropped down to 6.4. So it was a drastic change. He was already exercising. He was already eating right.

But in here for him, he wasn't sleeping and nothing else changed. So for a lot of patients that have uncontrolled glucose or are pre-diabetic, getting quality and restful sleep is really important for them. There are a few key nutrients that we need for sleep. So let's start with iron. Iron is a nutrient that we need for virtually every process in the body. And that's because iron's job is to attach to our red blood cells. It holds oxygen. It holds oxygen and it delivers it to all of our cells in the body for energy production. So iron is crucial in general health. Iron is also needed as a cofactor for melatonin production though. And so when we say we need iron for health, we have to think about who doesn't

have enough iron. And menstruating females are one of the main groups of people that don't get enough iron. Or they get enough iron, but they're bleeding monthly, so they're losing too much iron. This is why every female who is premenopausal should be getting their ferritin levels checked. Ferritin is your storage form of iron. And if your ferritin levels are below 30 nanograms per deciliter, this means that you don't have enough iron to optimally function your mitochondria and produce hormones like melatonin. So a ferritin level of less than 30 is actually not deficient. It doesn't mean that you have a frank anemia, but you still might not be functioning optimally. If you have a frank anemia, meaning your hemoglo not be functioning optimally. If you have a frank anemia,

meaning your hemoglobin, hematocrit, red blood cells are low, then you definitely need more iron. You need to be including iron-rich foods in your diet, things like spinach, red meat, liver, or you need to be supplementing with an iron as well. Now there's other factors that are called methylation factors that are important for sleep quality. These are things like B5, B6, and SAMe. These are a few of your methylation cofactors. Methylation is the process of adding a methyl group to a compound to either turn it on, turn it off, or excrete it from the body. Methylation is well known by the gene mutation MTHFR. So MTHFR is a gene that codes for your body's ability to methylate. And it's well known that MTHFR has a variety of effects on the body. However, I think that these are weighted way too heavily. Some people get the diagnosis of an MTHFR SNP mutation and they think

that all bets are off and they're not going to be able to detoxify, to sleep, to produce neurotransmitters, or to balance their hormones. This is not the case at all. Having an MTHFR mutation only means that you have to be extra careful about implementing lifestyle and dietary changes to prevent the expression of that MTHFR mutation from ever even coming to fruition. So what this means is eating a bunch of leafy greens. Three cups per day of leafy greens can help reduce the expression of MTHFR mutations. Other things are improving sleep quality, which we're talking about. Also reducing stress levels can really help minimize the expression of MTHFR. Now when we talk about B vitamins, one other B vitamin that's essential in sleep is B12.

B12 is one of the vitamins that we need for virtually every process in the body. We need it for energy production. We need it to produce new red blood cells. We also need it for methylation. So B12 has been linked to your ability to have appropriate sleep quality as well as sleep duration. B12 has been one of the most studied nutrients for sleep optimization. You can get B12 through your diet in forms like clams, beef, liver. However, vegans and vegetarians are much more likely to be deficient in B12 complexes because they're coming from animal sources. So vegetarians and vegans need to get their B12 levels checked and ensure that they have coming from animal sources. So vegetarians and vegans need to get their B12 levels checked and ensure that they have adequate levels for sleep. The last nutrient I

want to talk about is vitamin D. Vitamin D is essential for sleep for a few reasons. Vitamin D receptors have been found in the brainstem and when vitamin D docks to these receptors, it increases the production of acetylcholine. Acetylcholine is the neurotransmitter that's needed to induce the paralysis that occurs naturally during sleep between phases. Now, we're not really sure why that paralysis occurs, but we're sure that it's there for a reason and we need it for high quality sleep. And did you know that about 40% of the U.S. population is deficient in vitamin D? This is a huge number. That's almost half of the population being deficient in a key nutrient. And when I see that somebody is deficient in vitamin D, I not only want to supplement them with vitamin D to get their levels back, but I also want to consider are they also deficient

in sunlight? So vitamin D deficiency is one key that people are not getting outside enough and getting sunlight. And we know that sunlight exposure is the driving force, the number one driving force to regulate your circadian rhythm. So if you're not getting enough vitamin D, you're not getting enough sunlight, your circadian rhythm is likely thrown off. So the best thing that you can do is aim for two 30-minute sessions outside per day to get your vitamin D level up, but also to get that sunlight exposure in. Now let's talk about our gut health. Our gut bacteria regulate many of our body's functions, from creating vitamins to controlling our immune system

to our brain function, and of course, our metabolism and weight. They are critical to our long-term health. Unfortunately, modern living and our bad lifestyle choices have been hard on these little bugs in our gut. The standard Western diet is impoverished of the things our beneficial gut bacteria are required to thrive. All the chemicals from processed foods, the environmental toxins we take in like glyphosate, only make the situation worse. Our guts become damaged when we eat a processed diet that's high in sugar and starch

and don't eat enough of the right fiber and the right prebiotics, or take too many gut busting drugs like antibiotics, acid blockers for reflux, anti-inflammatory drugs, hormones, and lots more. Think of your gut as an inner garden. Just as with any garden, when you let the weeds take over, you get into trouble. Now let's hear from our experts. Serotonin is another neurotransmitter that we talked about that is a precursor for melatonin. Serotonin typically is needed, and it can be stimulating, right?

That's what people take in their antidepressants, or they're trying to get the serotonin levels to stay high in their body. But sometimes there's a huge link between depression and serotonin deficiency, which causes insomnia. Or is it the other way around? Is it that the low serotonin caused the insomnia, which then leads to the depression? I'm going to group them all together and say serotonin is huge for sleep. And one of the things I use in practice to see if this is the cause of the sleep issues or the sleep maintenance issues is give patients the

precursor to serotonin as a trial to see if this theory is correct. And that's 5-HTP or HTP. 5-HTP is a supplement that we can readily get. Obviously, talk to your doctor because you cannot take it if you're on SSRIs or medications that also increase the level of serotonin in the body. But serotonin is made in the gut. And what we're seeing is this epidemic of the microbiome of the gut being off, which again, we've seen when you don't sleep well, different bugs grow and that can throw it off. But also the bugs in your gut, like E. coli and enterococci, they actually make 5-HTP. So if you have an imbalance in your gut and you have that dysbiosis, we're still in that, is the chicken or the egg? Is the insomnia causing that? Or is the change

from our food and the environmentally toxic world we're living affecting the microbiome of the gut? And that's making us depressed, low 5-HTP, low serotonin, low maratonin, and making us not sleep well. Other neurotransmitters that we have are GABA and glycine and L-theanine. So these neurotransmitters are called inhibitory versus excitatory. So we have two kinds. The ones that stimulate you, they wake you up, such as dopamine, Turing, and then we have the ones that calm you down to allow you to rest and sleep. Similar to what we talk about with the parasympathetic and the sympathetic nervous system, we have neurotransmitters that allow us to be sharp, alert, focused, and we have neurotransmitters that allow us to calm and relax at night. So GABA is probably one of the most important neurotransmitters.

GABA is a natural, we call it as a natural Xanax, is the relaxer for the body. And GABA is also produced in the evening. GABA, the neurotransmitter GABA is also made by the bacteria, by your friendly bacteria in your gut. So if someone doesn't have a healthy gut or a healthy microbiome, they're not going to make enough GABA in their body. And lack of GABA leads to a lot of anxiety for patients. So neurotransmitters, also L-theanine is another one that calms the brain and calms one's cortisol level. So L-theanine is used to reduce cortisol and calm all that stress in the brain.

So L-theanine and GABA are some very important neurotransmitters that if someone is low on, they're going to experience a lot of anxiety and not be able to cope with stress. So serotonin is very connected for depression support and L-theanine and GABA for anxiety. So those are the neurotransmitters that I always want to make sure my patients have proper levels in order to support pathways of sleep. And again, when we don't sleep, we don't regenerate those neurotransmitters. So it's, again, it's the cycle. The lack of them causes you not to be able to fall asleep, but not sleeping also depletes the body from it. So it's a lot of times when we have a broken cycle of sleep, we do have to supplement with GABA, with L-theanine, with 5-HTP or melatonin

to allow the brain to reset and calm at night until the body starts to make it on their own. We have to correct the gut biome. We have to work with diet, with the gastrointestinal tract, clear whatever's not right in the gut, work with food in order to shift that. But often it's like, where do you start? You do have often, I find that I have to supplement my patients until they can sleep because once they can sleep, they can make a lot of these nutrients on their own. They can heal and reset. So it's a step that often has to be done. In Chinese medicine, everything starts in the gut. And what we love in Western medicine is you will see patients when they have a sleep

disorder and they don't have sleep apnea or they can't figure out what it is, they'll either get sent to the gastroenterologist, they'll get sent to the psychiatrist or the psych, you know, and get a medication for anxiety, depression, or be labeled as mood disorder causing the sleep issues. But one of the main things I see is these people have digestive issues, you know, and so it's not that digestive issues cause insomnia or insomnia causes, because every single system in your body is connected. So it's not just this, we love to say the gut brain access or the heart this access, but there is an access between every single part of you. And everything starts from the gut because all your nutrients come from the gut. And one of the most important things I look at deficient in almost every patient I see are minerals. And minerals come from our soil, from our vegetables. And they're so much lower nowadays than what they used to be.

So we find a lot of our patients, almost everyone I see doesn't have enough magnesium, which is a smooth muscle relaxant, which is so important for sleep. Zinc, iodine, copper, manganese, all these minerals, even iron, iron deficiency is a huge cause of issues with sleep, especially restless leg syndrome. So they've done research finding your ferritin levels, which is a indirect measure of iron, your stored iron levels, if they're below 50, the cutoff is usually 10 or 20, really pretty much lower. But if it's below 50, they found that you're going to have more restless leg syndrome. And when they increased the iron stores to 60, they found that that improved. So minerals, which come from the

way you absorb and digest and assimilate food, which is all your digestive system, is huge for sleep. And often I will use minerals for patients at nighttime or in the evening. I'll say, stop your multivitamin. So vitamins are more stimulating. I like vitamins to be taken in the daytime. And I like to take my minerals separately and have patients take minerals at the nighttime. I always also find there's a yin and yang to everything energetically. And so vitamins are more yang, right? They're supposed to vitamin B12, it gives you energy.

And then magnesium and a lot of the minerals supposed to calm your nervous system down. So gut health, a lot of times it doesn't have to be that you have diarrhea or constipation or SIBO or an actual huge disorder. It might just be that you're not digesting very well. And I've seen this when I eat heavy and I'm bloated or I can't just don't feel good at night. That will absolutely have an effect on the quality of my sleep because my body's role at night is to clean the cells and repair DNA, repair the cells,

especially in the gut, which usually turn over every three days. But if my gut doesn't have the nutrients, the body needs to do that, or it's full of food or alcohol, and it can't do that, I'm going to have poor sleep, which then makes my digestive system weak the next day. There's certain strains of probiotics that, you know, there's some research showing that can have an effect on sleep or people who are more anxious or have this, these lower. And so sometimes we'll use that. Or sometimes I'll say if they're okay with yogurt, to have yogurt in the evenings and see how

well they sleep. Even if they have a dairy issue, sometimes I find yogurt is okay for a lot of my patients because it's already fermented and the protein's been broken down. But it's really for the probiotics in there that I'm trying to assess. Is the gut affecting the brain, which is telling the body to sleep? So one of the things that we can do for helping digestive flow of juices is making sure you're very relaxed and in an almost a meditative state before you eat. So looking at your food to the point where you are salivating. So that I know if you're salivating there's probably

other juices coming out elsewhere. And spitting your food out once and just seeing how can you tell what you just ate? So did you chew really well? And it all starts in the mouth. If someone does have low stomach acid, and some signs might be that they crave sugar after they eat, you know, or they feel really heavy if they have a lot of protein like meat, or they even avoid meat because they feel so full after they eat. That could be a sign of low stomach acid.

SIBO might be the same thing. It's bacteria is coming in because it's not very acidic. Or even if someone tells me they drink a lot of water with their meal, well, they're diluting a lot of that stomach acid. One of my favorites is to use bitters, herbs that are bitters, Swedish bitters. So me just saying bitters, I started to salivate, right? So my brain knows that if there I started to salivate, right? So my brain knows that if there's something bitter in my mouth, juices are going to come out, stomach acid

comes out, ginseng, radicchio, a lot of these, even Italian salads are bitter to help them digest the heavy meal or the meat they might eat. Apple cider vinegar, you know, that you can put in a little bit of water and have a shot of that before you eat, or taking actually digestive enzymes like HCL, pepsin, vial, but talk to your doctor about that. A lot of people get worried, oh, I don't want to get dependent on taking digestive enzymes. And I always say it is so much better to take something that's going to actually break down the food that you just spent money on or made to get the nutrients, right? Well, that's why you're eating is really to give your body a message. And if that message can't even make it there, because it didn't even get, you know, broken down, then we're worrying about the wrong thing. So it's more important to make sure you

have enough stomach acid. And as we age, stomach acid production goes down, it does not go up. So if someone gets put on an acid blocking agent at the age of 60, it's not because they have too much acid, it's just not possible. It's because the sphincter is loose. And that acid is coming up, or it's because they don't have enough stomach acid. And that food that came in there is sitting there in their stomach, it's not getting digested. And now it's backing up. And that's what's causing that burn. So I would say for digestive health is really looking at what you're eating throughout the day and taking a digestive enzyme or apple cider vinegar or bitters before meals to really see if that can help. Taking minerals at night can help and making

sure your water is clean and you're not drinking with your meals and alkalining, you know, that stomach acid that's supposed to burn your finger. If I put my finger in your stomach when you're eating, it should burn. But I'm probably going to say it won't because you're having a lot of things with it. Keeping alcohol and fruit away from meals to make sure, again, that food gets digested. If you have to have a drink and you're used to having drinks at night, please keep it away from bedtime. So it absolutely has an effect on sleep quality. So have it earlier. Have it at 6 p.m.

You know, cut it off at 7pm. So that by 10pm, your liver's had enough time to get that alcohol out of the system. Having problems in our biome can actually cause us to have anxiety and insomnia. So it goes both ways. Either the biome itself can cause you to stay up at night or the lack of sleep can impact your biome. So let's first talk about how having potentially an imbalance in our gut flora will keep you up at night. Having a flora that is depleted of the essential immune soldiers that come out to help you fight infections and detoxify environmental pollutants.

If you're low on your microbiome and your flora is not right, you are likely to have overgrowth of other infections and other microbes such as yeast. I see very commonly in my clinic that people that struggle with candida or SIBO, which is small intestinal bowel overgrowth, and parasites as well, can have a lot of issues with sleep. So when the biome is not happy, you're going to see that a patient, as a result of the biome not being strong, because there's a connection of another infection in there, the imbalance happens in the gut where you're not able to fall asleep. So first, patients that have parasites can have actually quite a bit of a problem falling asleep.

I'm going to give you a case study story. One of my patients that came to see me as a 25-year-old female, Jennifer came to see me and she had had trouble with bloating, gas. She was having a lot of diarrhea, canker sores. She was having acne. She had some hemorrhoids, a lot of gut issues. So it was obvious that something was going on with her gut. And she had already seen three gastroenterologists. She even had a colonoscopy. She had seen from time to time even bloating her stool, and they couldn't figure out what it was. She had even changed her diet. She wasn't eating gluten. So they had worked up her gut issues. And on taking her history, she mentioned that she was

having a lot of insomnia. And she said that she had trouble falling asleep, but she would always wake up also in the middle of the night with racing thoughts, a lot of anxiety. Her body was just up and she couldn't fall asleep. She also mentioned that she had a very difficult time around the full moon. That's when her body had the most difficulty staying asleep and falling asleep. And she said her anxiety was just really increased around the full moon. So on knowing her history, I had her do a stool panel to see what would show up. And when we do a stool panel, we like to do a comprehensive analysis to know what's the biome doing. I was very interested to see what's her microflora.

Does she have enough digestive enzymes? Is she lacking nutrients to modulate inflammation? Is the gut toxic? And we're also reading parameters for parasites, tapeworms, yeast, bacterial infections. So when her stool panel came back, she showed up with extremely high levels of parasites, and she also had her flora was one of the worst cases of seeing someone very empty under their biome. Their flora was very depleted. You can actually measure. So her little soldiers were down. She had an overgrowth of parasites and very low markers of her flora. And she had a lot of inflammation markers. Calprotectin levels were really high. Beta-glucuronidase were really high. Those are two inflammatory markers that show up when someone has inflammation in the gut. So I could see clearly that we have a case of a patient here that has a gut infection

that's not sleeping as a result of the biome keeping her, the parasites waking up. Parasites also tend to wake up at night. A lot of the bacterial overgrowth wakes up at night. The gut cleanses at night. How we mentioned that we detox our lymphatic system, the brain, the liver, the gut is ultimately the final place where all toxins that we have pulled out of the body go through. And the gut wakes up to detoxify. So the gall bladder we mentioned between 11 p.m. to 1 a.m. is the most active. So it's pulling all the toxins from the liver, it's clearing infections, it's clearing any toxicity, and the gall bladder is dumping all that bile into the large,

into the small intestine to be given to the large intestine. Later on, before we wake up in the morning, that's when the large intestine is the most active. But through the night, it's detoxifying. So when we have an imbalance of flora, the flora wakes up at night to clean house. So it cleans out the intestinal tract. And if there was an overgrowth

of a bacteria or a parasite, it's going to wake your body up because there's a lot of enzymatic activity and it causes a lot of inflammation. So someone waking up is the gut-brain connection. You're waking up because there's an imbalance in the flora. So with my patient, she had parasites. We did a parasite cleansing regimen for her and finding out what the source was of the parasites how she got exposed to it and really replenished the flora after we healed some of her leaky gut issues but removed the the infection we were able to support her to giving her a lot of also prebiotic and probiotic foods and when it comes to rebalancing one's flora, if someone has an infection in the gut or just not the best balance flora, I really love to use food to heal

the gut. I do love using probiotics, which are great, but a lot of patients, sometimes they can't tolerate even probiotics. Their gut might be too sensitive. So I love to use prebiotic foods and some of the ones I had her do were chicory root chicory is actually is a form of dandelion so you can get it in the green form and saute so she was eating chicory root daily I love to use artichokes

so getting some artichokes even if you get some organic frozen artichokes and saute with onions cooked onions are very healing for the gut and the flora. So it will increase your probiotic density. Also doing asparagus is another one to add to the diet and garlic and onions. So she was eating daily these foods. And then we did a lot of probiotic foods.

So I was having her eat sauerkraut in her meals, just about a tablespoon at lunch and a tablespoon at dinner. And as we're including all these foods to feed the biome and killing the parasites, we put her in an herbal protocol to kill the parasites. Within four months, all parasites can be hard to get rid of. But within four months, about 80% of the load of the parasitic load was gone. She obviously also did some colonics and some sauna.

But increasing her flora and getting rid of the parasites, her sleep changed significantly. That's the only change we did was to treat her gut. And her body was able now to fall asleep. By the fourth month, she was no longer waking up during full moon. She said she was actually afraid of the full moon because she knew she was going to be up and her anxiety was going to be up, but her body was able to rest. And eventually, by just getting the volume and the flora up to normal, her inflammation markers came down in her stool panel and she was able to regain back her sleep. Anxiety went down. So this is a clear case of how gut imbalances can really alter the sleep cycle because the

volume is not happy. But the other way happens as well. If you're not sleeping enough, if we're lacking sleep, if we're not conscious of our sleep cycle and really shorting our sleep, we are going to see that our gut gets very unhappy. And the studies are showing how lack of sleep depletes the amount of flora. And they did a study in Japan where they were tracking students that were in med school and they were about to take their exams. And a month prior, they were measuring, they were tracking their sleep, their stress level, and patients that got symptoms on volume and patients that, and gut symptoms and volume, and patients that were getting

full sleep, the full seven to eight hours before their exams, were able to perform better. Obviously, their brain function was better, but their volume, their microbiome were higher. Their levels were higher in their gut. They were healthier. Versus the group that was lacking on sleep, their microbiome was the levels were changing, and they saw the level of toxins in the gut increase. So the bacteria itself can actually get quite stressed out. And if it gets stressed out, it secretes a lot of enzymes that can trigger anxiety for the body, It makes it harder to fall asleep. So the lack of sleep will also change your microbiome.

It will rob your biome. And that starts a whole cascade of problems with we can't digest foods anymore. We're not making healthy neurotransmitters. Gas, bloating, learning is compromised. So they follow the students that got the full sleep and the students that didn't get the full sleep. And so that didn't get the full sleep and saw a change in their volume. So we can truly impact gut health by the amount of sleep we get. And this is very important for patients that have IBS, patients that have IBD, inflammatory bowel disease.

Some of these conditions are hard to diagnose. A lot of my patients that have IBS, they have poor sleep. And by correcting their sleep, you always see the gut healing. The gut is able to regenerate and cleanse properly at night and have better flora. And again, the liver's cleansing at night. So they're all working together. When you talk about the body, you can't really separate it. You have to look at as the whole totality that it is. And gut health is really essential here in connection to sleep. So what we eat and when we eat matters as well as the quality of our gut health. Here are some steps you can take today to balance your blood sugar and to optimize your nutrition and gut health for better sleep.

There's a saying that goes, eat breakfast like a king, lunch like a prince, and supper like a pauper. That means you eat your biggest meal early in the day and your lightest meal at night. We typically eat our heaviest meal at night when our bodies are least capable of handling it. Now, you don't necessarily need to have your first meal early in the morning. Some folks practice time-restricted eating or what's called intermittent fasting and have their first meal around 10 30 or 11. That's fine if it works for you. What I don't recommend is having your first meal at noon or 1 p.m and your last meal at 8 30 or 9. Try eating breakfast earlier in the day and your last meal before 7 whenever you can. Next, try to keep at least a 12

hour window between your last meal of the day and your first meal of the next day. This means if you eat your last meal at seven, your first meal the next day at breakfast, literally breaking the fast would be at the earliest 7 a.m. Speaking of breaking your fast, what you eat, especially in the morning for your first meal, is really important. The winning combination for keeping any meal to keep your blood sugar balanced and keep yourself from crashing later in the day is healthy fat and protein and fiber in the morning instead of carbs and sugar, which is what most Americans eat for breakfast in the form of cereal, bagels, bread, muffins, you know what. For example, a great breakfast could include eggs with lots of veggies and an avocado

or a protein shake with greens and nuts in it. Also keep that combination of healthy fats, protein, and fiber for lunch and dinner too. My general rule is that 75% of your plate by volume should be plant foods. I call that plant-rich eating. Things like kale, arugula, broccoli, peppers, brussel sprouts, lots more. And then you want about a fist size full of protein. That's like your palm essentially, and a healthy servings of fat. For me, I like to have a big green salad with wild canned salmon for lunch. I drizzle a bunch of olive oil For me, I like to have a big green salad with wild canned salmon for lunch. I drizzle a bunch of olive oil on top. I don't worry about the fat. For your best sleep,

you want to avoid foods that spike your blood sugar and then fuel cravings and get you on this vicious roller coaster. And that means you should avoid things like processed sugars and refined carbohydrates from bread and pasta and other flour products. If you're gonna eat grains, eat whole food grains, not flour or ground grains, whole grains like wild rice, black rice, quinoa, millet, buckwheat. You wanna eat foods that are rich in the nutrients that help your sleep. Things that our experts discuss such as vitamin C,

iron, magnesium, zinc, and make sure your vitamin D levels are optimal and that means at least 45 to 75 nanograms per milliliter. If they are lower you might need to supplement. Now unfortunately many of us, probably 80% of us, are insufficient or deficient in vitamin D. As our experts mentioned, some individuals might be experiencing blood sugar dysregulation at night and if you get up between 1 and 3 a.m. and you're hungry or you suspect low blood sugar is causing your sleep problems or you're having hot flashes at night, try having a

little bit of sweet potato or maybe some almond butter before bed and see if that helps. When it comes to caffeine, have your last cup of coffee or black or green tea before noon. Now, if you're sensitive to the effects of caffeine, you might want to quit it altogether. You might be able to have a little green tea later in the afternoon, but keep the coffee and black tea for the morning. If you're sensitive to caffeine or you're dependent on coffee to get up in the morning, I want you to consider weaning off it for a bit. Try going from multiple cups to one cup, then half a cup, maybe a quarter cup,

then switch to green tea so you taper off and you don't get that caffeine withdrawal headache. Just try it for a few weeks and see if your sleep improves. Now, as mentioned, there are a few important things we can do when it comes to improving our digestion and our gut for optimal sleep. First, as Dr. Afroos mentioned, be present with your food. You shouldn't be multitasking when you eat. You should be just eating. Also, listen to your mother's advice and chew your food. This is going to allow you to create some strong digestive fires that you need to absorb the nutrients in your food.

In fact, your enzymes in your mouth start the digestion process before you even swallow. So make sure you chew. Also, consider taking bitters or digestive enzymes. Next, avoid gut damaging foods. Things like processed sugar, refined carbs, artificial sweeteners, refined oils from soybean and canola oil, and all kinds of food additives and chemicals and thickeners that mess up your gut. You can also increase your consumption of polyphenols. These are all the colorful compounds that give fruits and vegetables their color. Recent research is starting to unveil the importance of polyphenols for the gut. Now, when my gut was damaged a few years ago from antibiotics

and mold, I had put together a protocol to repair my microbiome. And one thing I've been doing is upping my polyphenol intake. I've been using cranberry and pomegranate concentrate in my smoothies combined with a full gut protocol. And so far, I've been feeling awesome. If you suspect deeper gut challenges, you'll want to work with a good functional medicine practitioner to identify if you're dealing with something like small intestinal bacterial overgrowth or fungal overgrowth or parasites and they can help you design a protocol to heal your gut. You might have noticed that there's one key factor that connects all the different topics we've been discussing in this sleep masterclass.

What is that factor? It's our hormones. Our hormones help us maintain optimal health and they keep us happy, focused, and peaceful unless they're out of balance. Then the opposite. They control everything from your stress response through your adrenal glands, to your blood sugar balance, to your pancreas, to your thyroid hormone via the thyroid gland, to your sexual behavior and function through our reproductive organs. Hormones are also there to control our growth and our sleep and our mood and lots more. Unfortunately, most of us are living out of harmony with our natural biological rhythms, which is causing an epidemic of hormonal dysregulation. Understand how and why these systems get out of balance,

and you're going to go a long way toward understanding why Americans are so depressed and tired and overweight. The symbiotic relationship between sleep and hormones holds the key to unlocking better health and better sleep. So many of our hormones are affected by sleep. And actually, a lot of them are affected by our circadian rhythm. They're pulsated depending on where we are throughout the day. So I want to start first, though, by talking about some of the hormones that influence our metabolism. You see, insulin, leptin, ghrelin, all of these are hormones that influence our appetite and our metabolism throughout the day.

And they're also based on our circadian rhythm, so they're going to be affected by our sleep patterns. One of the easiest ways to see how our hormones are affected by our sleep is to take a subset of subjects that we know have a dysregulated circadian rhythm. These are night shift workers. So night shift workers are often studied so that we can see the effects of sleep and sleep quality that have on our body, our hormones and everything else. One study looked at shift night workers

and they found that they have a greater incidence of cardiovascular disease, diabetes, and obesity. These are all disease processes that are related to your metabolism. So we know how important not only sleep duration, but the timing of sleep is on your metabolic health. Let's talk about thyroid hormone first and how that affects your metabolism. So your thyroid hormone sets your metabolic set rate, meaning that every single cell on your body has a receptor to your thyroid hormone,

and when that thyroid hormone docks on the receptor, it sets your metabolism for that cell. So your thyroid produces two hormones. It produces T4 and T3. These are both thyroid hormones, and it produces mostly T4 in terms of volume. However, T4 has to be converted to T3, which is active thyroid hormone. You see, T3 is actually the one that docks and produces the effects on your cell. T4 is not turned on yet. What's interesting with sleep is that melatonin, which is produced during sleep, helps activate that transition from T4, inactive thyroid hormone, to active thyroid hormone, T3. So sleep is essential at setting your metabolic rate. The other thing we have to consider with hormones is insulin resistance and insulin sensitivity. So insulin sensitivity occurs at

night. Your body becomes more sensitive to insulin during sleep. This is so profound that if you look at people who are sleep deprived, what you see is that they have a decrease in insulin sensitivity. So just one single night of sleep deprivation causes a 40% reduction in your ability to handle your glucose. Insulin sensitivity also helps regulate your craving. So we'll talk about that when we talk about appetite, but it's really important for your metabolism. Cortisol is another hormone that's related to your metabolism. And when cortisol is increased for a prolonged period of time, meaning that maybe you have a chronic stressor that's bothering you, this is when we see an issue with cortisol and metabolism. You see, cortisol should be highest

in the morning, which is natural. It gets you up, gets you going. However, when you have that prolonged increase in cortisol, your body thinks it's under stress. Say, for instance, a tiger is coming at you. Your body wants to increase cortisol so you have enough fuel to run away from it. The issue is, though, our stressors never require us to run away anymore. So what we're left with is high glucose levels, high blood sugar levels for prolonged periods of time, which then cause that insulin resistance that we talked about before. Sleep also has a huge impact on our appetite. So when we talk about metabolism, we're really talking about weight maintenance and we have to talk about appetite.

So we have a few appetite hormones. We've got leptin. Leptin makes us feel satiated, feel full. Ghrelin, on the other hand, is your hunger hormone. So when ghrelin increases, hunger also increases. These two hormones are paired with our circadian rhythm. So we know that if you don't have enough sleep at night, you're not going to produce enough leptin. And without enough leptin, you're not going to feel satiated. The reverse is true as well. You're going to be producing too much ghrelin with sleep deprivation. And an overabundance of

ghrelin means that you're hungrier. So you're hungrier and you don't have the satiety feeling. This is going to increase your craving for food in general. We also know that with sleep deprivation, you're more likely to consume sugar. So that's gonna have a direct effect on your appetite and our craving levels over time. Sleep is so important because it's where we repair biologically.

So there's various hormones that increase and decrease throughout the day. And in my estimation, one of the reasons why I think sleep is so important is because human growth hormone and much of the repair that goes on within the brain, Matthew Walker speaks eloquently about this, all the different neurochemicals and neurotransmitters

that are created through wakefulness within the brain and also the body are detoxified, eliminated various neuronal pathways that help us with consolidating memories happen during REM sleep and while we're sleeping. And so much of this so-called neurologic pruning that occurs within our brain occurs while we're sleeping. Human growth hormone, HGH, is our anti-aging hormone. And why this is so important is it has a variety of effects on the body that help reduce our aging capacity.

So human growth hormone is produced during night mostly. In fact, 70% is produced during sleep. And this is only if you're getting quality sleep. This happens during slow-wave sleep. This is the phase of sleep cycle where it's restorative and helping our body repair physically for the next day. It's also known that growth hormone is released within the first 70 minutes of falling asleep. So we'll talk about how alcohol affects your sleep later, but note that if you have disruptions in early phases of sleep due to alcohol consumption,

then you're likely not producing enough of that growth hormone. The effect that growth hormone has on the body is extraordinary. Growth hormone increases your lean body mass. It also helps you burn fat for fuel. Growth hormone improves bone mineral density and overall protects your body from aging. So this is one more reason why we need to prioritize sleep to optimize our hormones. So I myself had experienced many problems with sleep. It actually started when I was very young. And I recall being seven, eight, nine years old and having a lot of difficulty falling asleep. I recall being up until like one and two in the

morning. And this pattern for me continued as I got older. And really, it wasn't until my late 20s that I got my true first night of sleep. And growing up, I had a lot of anxiety. There was a lot of anxiety in my body. I had a lot of fear. And many, many issues caused that. And as I got older, my sleep became worse and worse. And it was very difficult for me to close my eyes and feel safe. There was a lot of a lack of safety as I was sleeping. And I remember feeling a lot of anxiety

and my mind was just racing. My mind couldn't calm down. And I was literally afraid of the dark. So I couldn't fall asleep easily. I had to sleep with the lights on. And there was really no proper sleep. So as I got older, I just assumed this was a normal pattern. And I grew up with a lot of fatigue. So as I slept so little during the evening, in the morning, I would wake up very tired. It was very difficult for me to wake up. I remember my parents during the weekend, they had to wake me up often and literally shake me to wake up because I could not wake up on my own. I wanted to just sleep and my body was so fatigued. And as I got older, it wasn't until my 20s, I realized that I had a progesterone deficiency

in my body. And progesterone is a very important hormone that allows the body to calm down, to relax. It supports sleep. And my progesterone levels for a female in her 20s should have been somewhere around 7 to 10, and I had a progesterone level of zero. So my body was very empty of this very important hormone that allows the body to relax and reset. And it wasn't until I started treating my hormones where I really started to sleep. And I remember the first night that I slept after I had taken some natural compounded progesterone. And I woke up the next day feeling so alive. I didn't know people could actually feel this good in the morning.

So that's when I started my journey of understanding how I had really struggled with insomnia my whole life growing up. And it wasn't until my late 20s where I started to understand sleep and treat it and see how important it was and how it really changed everything around my life, how I felt in the day, in the daytime. I wasn't sleepy anymore during the afternoon. My mind shifted, my concentration, my ability to think, to remember. I remember in school when I couldn't sleep at night, I would go to school and I had trouble remembering. Actually, my first year of school in first grade, the teachers thought I had a learning disability. They said she can't read. And it wasn't until second grade that I learned how to read because my body was so deprived of sleep. And it wasn't really a learning disability.

It was just lacking true sleep and not resting my body. So that was my personal journey really with sleep that actually led me to understand my body better and find ways to heal my body in more natural ways. So I always say progesterone is like the chill pill neurotransmitter for your brain. It keeps you calm. It is the precursor to cortisol. So that's the one that comes before your stress hormone. So if you are stressed or your brain thinks you're stressed, it's going to take up and convert that progesterone to cortisol so that you can survive and be alert

and not sleep. So think of it as like caveman times when there was a threat, you couldn't sleep, you had to protect the family. And so it would convert that progesterone and have the higher nighttime cortisol. But you might see this happening more with women just before their cycles. So I see, I'll ask them, you know, how is your sleep a week or two before your period? And if it's going down, and it's not as deep, or you're more moody, and you're irritable, you know, it's not just PMS, there's a reason. And it's often because there's not enough of that progesterone hormone, or they relatively have too much of the other one, estrogen, and there's an enough of that progesterone hormone, or they relatively have too much of the other one, estrogen, and there's an imbalance of those two. So progesterone deficiency is huge.

And I'm a huge advocate of looking at that, especially for menopausal, perimenopausal women, who'll come into my practice, and they'll have heavy periods, they're tired throughout the day, and they're not sleeping very well, and they're waking up. And I'll ask them, have you had a sleep issue in the past? And they'll say, no, I always slept really well. But gradually, with hormonal changes, now they're finding that their sleep quality isn't as good. So let me share a story. One of my patients that came to see me, Iris came to see me. She was at age 54, and she had gone through menopause.

Her cycles had stopped already. So she was about two years post-cycles, and she had been working with other doctors on her sleep. She originally had had some hot flashes, some changes in her energy, her mood, and all of that had been addressed by giving some hormone replacement therapy. But her progesterone levels, when she came to see me, they were at a zero. And ideally, even for a female that's going through perimenopause or menopause, I still want to raise her levels to about a five and seven, between five and seven to give her that quality of sleep and rest and relaxation.

So when she came to see me, she had had terrible insomnia. She was not falling asleep until 1am, up every hour, and waking up early, very tired. So she had some fatigue, and she did have anxiety and depression. She was managed for the most part, but she was just not optimal. And she had tried many therapies for her sleep and could not see results. So I ran the progesterone pathways for her. I also checked her estrogen levels, and she was taking a little bit of estrogen. She had been giving a sublingual estrogen and a cream of progesterone. And her body was just, the levels were not raising, even though she was on hormone therapy, which naturally estrogen and progesterone. And her body was just, the levels were not raising, even though she was on hormone therapy, which naturally estrogen and progesterone will help women with

falling asleep, encourages the sleep cycle, her levels were still not rising, which would explain why she couldn't fall asleep. So on doing further analysis, we found out that she actually has some deep gut issues. A lot of the hormones are being created after menopause. Your adrenal glands have to support, but the gut is very important in helping you also regenerate the healthy hormone in the gastrointestinal tract. So she had actually quite a bit of parasites and a lot of yeast. And her estrogen metabolism is the other test I run with her, which measures one's ability to break down hormones. And even though she was taking a very low dose of estrogen, her body was not breaking down her estrogens, and her metabolism was off. She was making a lot of bad estrogen versus good estrogen. So

she's a patient that had very high bad estrogens with no progesterone. Even though she was being supplemented, the levels were not going up in her body that would support her sleep. So what I had to do with Iris is I had to help her cleanse her liver so her body can metabolize estrogens better. And this is why when environmental medicine comes into practice that we had to help her change a lot of the estrogens that were coming into her body through outside sources, which are called xenoestrogens. They're the toxic estrogens. So things such as plastics have and behave like estrogen. So anything that's BPA, plastic water bottles, BPA can be also in your clothing on materials around your house, so tupperware. So we change a lot of her BPA in anything that contain BPA in her regimen. Phthalates and parabens are the two that increase

bad estrogens in the body. And phthalates and parabens are toxicants that are often used to make makeup. You find them in shampoos, in conditioners, in any beauty products or personal care products. And I measured her xenoestrogens and her levels were very elevated for her, which was leading to the higher bad estrogen. And when she had that bad estrogen, it was suppressing her progesterone that she was taking to support her sleep. So her body was not able to use even the hormones that she was given because her liver was too taxed. So we had to go through a process of cleaning out any bad estrogens, bad hormones, and then cleaning out her gut. So cleaning out the infections that she had.

And it wasn't until her gut and her liver were better when she was able to actually start absorbing now the progesterone and utilizing the bacteria in her gut, the liver, both communicating with each other, allowed her to change that equation. She was no longer estrogen dominant, but she was able to get the progesterone levels up. And her progesterone levels slowly came up. I did switch her from a cream to an oral capsule, sustained release capsule that stays in the body through the evening.

And she was able to fall asleep easier, go to bed and stay asleep throughout the evening. So for her, the key was that she was missing progesterone in her body. And even though she had attempted herbals to increase progesterone, such as Vitex or Chase Tree, she had taken a homeopathic, she had done acupuncture, many modalities that would help. She could still not raise those progesterone levels, but it really had to do with her gut health, liver health. And once we cleaned that, her progesterone levels, but it really had to do with her gut health, liver health. And once we cleaned that, her progesterone levels came up. So it took her about five months. And within five months, her levels had gone up to about a five, which I was

very happy from a zero. And she started to sleep. Her body started to go into their relaxation, the parasympathetic mode, the resting mode, and the brain started to rest and heal. So her mood actually increased drastically. Progesterone, for a lot of women that go through menopause or perimenopause that experience anxiety and depression, most doctors are putting them on antidepressants or Xanax. And progesterone is your natural alternatives, like your natural Xanax, your natural antidepressant. And it really is a modulator for the brain. It helps increase the serotonin levels and GABA levels.

One of the quickest ways to get someone's anxiety levels down is to give them some natural bioidentical progesterone, which also increases GABA in the brain. So her depression and anxiety clear by increasing her progesterone, but many patients do take progesterone, but often the body doesn't register that has entered the body because there's blocking mechanisms such as gut or liver. If they're not working well, the hormones cannot be properly balanced. So I see this very commonly in my clinic. The hormonal changes are happening, and insomnia happens, anxiety happens, depression. And this is out of our control in a way because the hormones are being lost in the quality of sleep. The amount of sleep will change. So for women, some can handle natural progesterone. Obviously, I advise you to see a practitioner

for that to get tested and understand your levels. And there's many gentle ways to supplement. You can do Vitex, and you can do a natural support. You don't have to do a replacement of hormones, but your liver has to be working correctly, and your gastrointestinal tract has to be working correctly in order to absorb the hormones. But a case of deep anxiety and insomnia will be connected to low progesterone. And it's not only connected to women that are in perimenopause, but also younger women. There's this belief that only older women have hormone changes. And I personally had my levels tested in my mid-20s, and I had zero progesterone. So that was contributing to my anxiety, to depression, to insomnia. So younger women, women that have PCOS, polycystic ovarian syndrome,

there's a correlation as their ovaries are not ovulating, they're not making progesterone. Progesterone is made when we ovulate and it's the hormone that helps us also have healthy cycles, prevents us from having estrogen dominance. So a lot of women that have PCOS have insomnia and anxiety. And you can be in your teens and have zero progesterone. I've seen this women in their 20s or 30s. So an overactive mind, it's a sign of low progesterone. Women that have restless leg syndrome tend to have low progesterone as well. So I see this in my 20, 30-year-olds. I also had a lot of restless leg before I got my progesterone back into alignment. And a restless leg is when the nervous system is overstimulated

and normally shows up at night. So your limbs, it could be happening in your arms, but it's mostly in your legs. They become activated, the nerves are overstimulated, and they're shaking, and the body naturally has the desire to move. So how do you know you have restless leg? It's just a clinical diagnosis. There's no measurable test. But if you feel the sensation of your legs are itching, moving, or you need to move, it can come as a nervous pain inside deep into the legs. That is a diagnosis of restless leg syndrome. And it keeps people up at night. A lot of young women wake up in the middle of the night because their legs are shaking and you have that need to get up and move. And when we get up and move and when we get get up and move the nervous system rebalances itself um and then you can make it go away but it really disrupts

the sleep so progesterone a low progesterone level um can lead to restless legs because the nervous system is not nourished progesterone is the hormone that nourishes your nerves it helps the brain it helps the sleep but also your uh all your nerves are run through your body, neuropathies. A lot of people have nerve pain, can have low progesterone levels. So a treatment for restless leg for women would be to help her raise her progesterone levels and also mineral deficiencies. That's a very important one. Having low levels of magnesium, calcium, or potassium, any problems in the mineral department

can make it more difficult for the nerves to properly communicate with each other. So a low magnesium would be associated with restless leg. Be also conscious that a low progesterone would be because of high levels of stress. So stress management and moving through life in positive ways. There's the autonomic nervous system and research is showing now that we can actually retrain our nervous system and we need to help increase the resilience of our nervous system. So we want to put it on a bit of a training to help realign the HPA axis to help also the vagus nerve. The vagus nerve is one of the most important nerves that helps you activate the parasympathetic,

that yin relaxation state for the mind, for the brain to go to sleep at night. And if we can work with our vagus nerve, we can do a lot of work through breath work. So I love also talking a lot about breath because through breath work, you're love also talking a lot about breath because through breath work, you're able to activate that HPA axis to help it work better. So the brain is communicating better with the adrenals and with the ovaries and also help heal the vagus nerve.

The vagus nerve is the nerve that comes from the spine in the back in the cervical area. And then it's running both sides, right and left, and is communicating with organ systems to help us calm and relax. It helps us with digestion. It helps activate the parasympathetic nervous system. So it's involved with breathing, with sleep at night. The vagus nerve also helps the adrenals. And a lot of people that have adrenal fatigue tend to have a compromised vagus nerve or gut issues like IBS or diarrhea. Food allergies can be a problem with your vagus nerve. So breathing techniques are very helpful to help someone activate the parasympathetic state of the body, which is what we need to be in when we go to sleep at night.

So testosterone is a hormone that's produced by men and women. It's not just produced by men, and it's essential in our motivation drive, also our sex drive and libido, but our ability to recover from exercise and maintain lean body mass. All of these things are what we need testosterone for. What's interesting is that the majority of your testosterone is actually produced during sleep. So 39% of men over the age of 45 are deficient in testosterone. That number is huge and it's only growing. I see a ton of men come into the practice. They're in their 30s, early 40s, and their testosterone levels are below 200. This is not acceptable. Let's talk about what testosterone levels should be, though. So, optimal testosterone levels for a man are above 600.

For women, I like them to have free testosterone levels, meaning the bioavailable testosterone of at least one to two. Their total testosterone levels should be about 20 to 30. When I do replacement therapy for a woman, I'm aiming almost more towards 60. So there's a lot of different factors for women that have to be taken into consideration, and that's where working with a doctor who understands hormones is really important. Now we know where testosterone should be, but let's talk about how sleep affects testosterone and how we can optimize our testosterone levels by enhancing quality sleep. So there's been some studies done on obstructive sleep apnea. This is when you wake up at night and you can't breathe. So it actually wakes you from your sleep because

you have a decrease of oxygen consumption, which might be due to a variety of factors. It could be due to your head and neck muscles. It could be due to you being overweight, and so your airway is narrowed. The research found that in people with obstructive sleep apnea that were put on a CPAP machine to help restore oxygen levels, these individuals had higher levels of sexual desire and improved sexual function. So for men, that means erections. Now, we know that this is all so important in health because you need to have optimal sexual health. You also need to have optimal testosterone levels for health and longevity.

Let's take Todd's case for example. So Todd is a 50-year-old man. His testosterone is 240. He is pre-diabetic, so he has an elevated blood sugar level, and he's also exhausted and overweight. So Todd has come into the practice, and what we found is that he has obstructive sleep apnea. So what we did is we put him on a CPAP machine,

and he comes back in six months. His testosterone has increased. He is no longer pre-diabetic. He has more energy than he has had in years. And this is all from the use of a CPAP machine and just correcting his sleep issue, which is sleep apnea. One of the misconceptions is that you have sleep apnea just because you're overweight.

However, you can be overweight because you have sleep apnea. And that has to do with the relationship of just needing oxygen throughout the night to be able to have a metabolism that's healthy and a sleep cycle that's really healthy. So we need to correct both things in order to help people obtain optimal health. Obviously, women have much lower testosterone levels than men, but testosterone is the hormone that allows for women to also relax at night. It's the hormone that strengthens our adrenal glands. And if we have proper adrenal function, we're able to regulate our cortisol levels better. And I see this in my clinic when patients have low testosterone levels.

Often it's the first hormone, one of the first hormones that tends to drop before going into menopause. So women in their mid-30s and 40s coming with problems of insomnia, they haven't really lost their cycles yet. They're not in menopause. They're still making estrogen. They're not having hot flashes. But they're coming in with a concern of insomnia and also problems with concentration, with thinking, with memory, problems with maintaining muscle mass, and problems with their libido. And often I see with patients, this is the case that their testosterone level is going to be depleted. I had one of my female patients, she was just in her mid-30s and she came in with inability to sleep she was not able to put muscle mass on she was working out cleaning eating very

clean exercising and her body was just gaining weight and her she couldn't build muscle she was very frustrated uh that despite lifting weights the muscle was not forming. She also had a very low libido and increased anxiety as well in her case. But insomnia was a big part of her complaint. So on running her hormones, we know that she's not in menopause at this point. We run her hormones and her progesterone level was actually normal for her. Her estrogens were great she had no problems in the metabolism of estrogens her problem was that she had a low testosterone level and for a female i like the levels to be somewhere between depending on the test um somewhere i'd run a 35 to a 50 her level came back as at a two so a level of testosterone that is that depleted is going to greatly impact one's brain

and ability to reset the nervous system. She also was having difficulty building muscle. Testosterone helps you maintain muscle mass, but it also supports bone health. So it prevents someone from getting osteoporosis. Very important for the aging of the brain. Testosterone is neuroprotective. It protects the brain from aging. Patients that age quicker in their brain and they have more Alzheimer's, dementia, people that have more insomnia problems tend to have a connection with low testosterone. As we saw earlier with some of my male patients, again, through REM sleep, we make a lot of testosterone. So we saw earlier with some of my male patients, again, through REM sleep, we make a lot of testosterone. So this patient had very low testosterone. And as a result of

the lack of sleep, she wasn't getting REM. She wasn't being able to build her levels. So in her case, it was actually quite easy to get the body restored back into alignment. We did supplement some bioidentical testosterone, but I also changed her lifestyle, what she was doing. Exercise, changing how she was exercising was very important. Through resistance training or HIIT training, women are able to build more testosterone than doing cardio, continuous cardio., it really matters what kind of exercise one can do to rebuild their body. But testosterone is often misunderstood and just seen as men needing it. But most women, one of the fastest ways that I can help a patient get back into sleep is to

replenish and help them create more testosterone in their brain, in their adrenal glands, in their ovaries. So through sleep, the patient was able to, once she got to really sleep better, she was able to regenerate more testosterone on her own. And again, the testosterone was used just temporarily until she was back to normal. And then the brain gets that mechanism going where it mixes on testosterone through sleeping time. So it's a very important hormone to talk about. Now, there are a few key principles to follow when it comes to hormones. Obviously, if your hormones are suffering because of your lack of sleep, you should understand by now that prioritizing sleep is one of the most important things you can do. Late nights at the office, drinking coffee at

night, drinking too much alcohol, staying up late can wreck your hormones. So first and foremost, prioritize your sleep. And that means you should have a bedtime and try to stick to it daily. Now, when it comes to optimizing your hormones for better sleep, there are a few things that you can do. First, eat a hormone balancing diet. And this means a diet that is low in sugar and high in healthy fats and proteins. Now, my own testosterone went up 500 points when I cut out processed sugars and carbs and started eating more healthy fat. Next, bulk up on fiber. Ground flax seeds provide optimal fiber and lignans, which are phytochemicals in the flax seeds, which help balance your hormones. Even

two tablespoons a day to a shake or a salad can help you. It also helps your digestion. You wanna eat fiber-rich organic fruits and veggies, and lots of veggies. Also be sure to poop daily. Constipation is bad for your hormones. Take magnesium citrate and vitamin C

and probiotics and flax seeds every day to help you go to the bathroom every day. Next, limit or remove alcohol. Excess alcohol can compromise your liver and kidney function, which inhibit detoxification and create lots of hormonal imbalances. They create high triglycerides and off fatty liver, although sugar is the worst cause of fatty liver. Alcohol can also interfere with the beginning stages of sleep,

which are essential for growth hormone, which helps repair your tissues and body and keeps you young. Also, you want to avoid xenoestrogens. You can find these toxic xenoestrogens everywhere. In skincare products, plastics, processed food, conventionally raised food, pesticides, and household items. I mean, I don't want to scare you, but the key here is to eat organic foods as much as possible. Choose clean skincare products. When you visit the Environmental

Working Group's website at ewg.org, you can find their their skin deep guide and you can also choose which household products are safe to use and which body care products are safe to use. Instead of using plastic containers or water bottles use glass or stainless steel bottles or containers. Breast cancer has been associated with regular consumption of alcohol as well as exposure to chemicals and plastics, and exposure to light at night, which we talked about in lesson two. In fact, all the things that we discussed to help optimize your sleep will help you prevent cancer. Next, prioritize exercise. Exercise helps balance your hormones. It reduces toxic estrogens in your body. It increases testosterone, which helps you lose fat and build muscle. You need to find out what works for you. I like a

mixture of cardio, high intensity interval training, and twice a week I try to play sports with friends or do yoga. Finally, manage your stress. Stress is probably the number one thing that wrecks your hormones and your sleep. Active relaxation does not mean watching Netflix for five hours straight. You want to do something, especially before bed, that is really relaxing and doesn't stimulate your mind in a way that causes worry. You can meditate. You can listen to calming music, you can take a hot bath with Epsom salt, you can get a massage, foot rub, you can use topical magnesium or oral magnesium,

all these things help to reduce your stress levels. My wife and I like to listen to music and play backgammon before bed and take a hot bath with Epsom salt and lavender oil, brings us together, connects us, and also helps us sleep really deeply. There are lots of things you can do to wind down and lower your cortisol, which is the stress hormone.

And guess what? Scrolling through Instagram is not one of them. Unless, of course, it's my Instagram feed. Just kidding. Now, if you suspect hormonal dysregulation, I always recommend working with a practitioner to test and not guess. You can discuss these tests with your physician. In our next lesson, we're going to discuss an overlooked and vital component of our sleep health,

environmental toxins. We're going to show you ways to reduce your toxic burden at home so you can improve your sleep. I'll see you there. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing,

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I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com forward slash pics to sign up that's drhyman.com forward slash pics p-i-c-k-s and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer hi everyone I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that

it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.