ZOE Science & Nutrition - How to make your body clock work for you
Episode Date: September 1, 2022In today’s world, we increasingly live our lives late into the night. Whether it's work obligations, socializing, or being glued to a screen, we ignore the sun's rise and fall. But most of us are ...unaware that a clock is ticking away inside us. It uses light to keep time and tells us when to sleep and eat. Should we listen? Or is this biological clock simply a relic from a past time? In today’s episode, Jonathan speaks to a leading authority to unravel the latest science that reveals that this body clock, or circadian rhythm, has a dramatic impact on our health, weight, and mental wellbeing: Russell Foster is an Oxford University scientist who has dedicated his life to studying circadian rhythms. He’s a world leader in the field and the author of Lifetime: the new science of the body clock. Download our FREE guide — Top 10 Tips to Live Healthier: https://zoe.com/freeguide Timecodes: 00:00 - Intro 00:12 - Topic introduction 01:23 - Quickfire questions 02:30 - What is the biggest myth about our body clock that drives Russell crazy? 03:19 - What are circadian rhythms? 06:41 - Why do they matter to us? 10:32 - How does your body sync its clock? 14:07 - How does the circadian rhythm influence sleep? 15:18 - What happens if we don’t live alongside our circadian rhythms? 21:26 - What should night workers do? 26:45 - Does your circadian rhythm change when going through menopause? 29:42 -Is there a circadian rhythm for our gut? 33:12 - Will it damage our long-term health to continuously be awake by our small children? 35:15 - Summary 36:14 - Goodbyes 36:36 - Outro Episode transcripts are available here. Get Russell’s book here. Follow Russell: https://twitter.com/oxscni Follow ZOE on Instagram: https://www.instagram.com/zoe/ This podcast was produced by Fascinate Productions.
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                                         Welcome to ZOE Science and Nutrition,
                                         
                                         where world-leading scientists explain how their research can improve your health.
                                         
                                         In today's world, we increasingly live our lives late into the night.
                                         
                                         Whether it's work obligations, socializing, or glued to a screen, we ignore the sun's rise and fall.
                                         
                                         But most of us are unaware that a clock is
                                         
                                         ticking away inside us. It uses light to keep time and tells us when to sleep and eat. So should we
                                         
                                         listen? Or is this biological clock simply a relic from a pastime? The latest science reveals that
                                         
                                         this body clock, or circadian rhythm, has a dramatic
                                         
    
                                         impact on our health, our weight and our mental wellbeing.
                                         
                                         Even our immune system has a strong 24-hour cycle.
                                         
                                         Today you'll find out how your circadian rhythm impacts your life, and learn some simple steps
                                         
                                         you can take to be more alert, sleep better, and lower your risk of disease.
                                         
                                         I'm joined by Professor Russell Foster, an Oxford University scientist who has dedicated
                                         
                                         his life to studying circadian rhythms.
                                         
                                         He's a world leader in the field and the author of Lifetime, the New Science of the Body Clock.
                                         
                                         Russell, thank you so much for joining me today.
                                         
    
                                         Why don't we, as always, start with a quick fire
                                         
                                         round of questions from our listeners. And the first question was, are circadian rhythms
                                         
                                         important for our health? Incredibly important.
                                         
                                         All right. If I take medication at a different time of day, will it change how effective the
                                         
                                         medication is? Yes. There are over a hundred different drugs with a known time of day, will it change how effective the medication is? Yes. There are over 100 different
                                         
                                         drugs with a known time of day effect. Which I think is extraordinary. Is exposure to light
                                         
                                         from digital devices in the evening really bad for us? No. Oh, that's going to be a shock. We'll
                                         
                                         definitely dig into that later. Is it possible for me to improve my sleep without drugs?
                                         
    
                                         Absolutely. Should we let our teenagers sleep in?
                                         
                                         Ideally not, but you've got to be pragmatic. Okay. And finally, is it true that some people are night owls who can stay up later than the rest of us? Absolutely true.
                                         
                                         Wonderful. Well, look, I'm really looking forward to getting into that. I think there
                                         
                                         are a whole bunch of answers that many of our listeners are already going to be quite surprised about.
                                         
                                         Russell, what is the biggest myth about our body clock that drives you crazy?
                                         
                                         Oh, Jonathan, I think that's fairly straightforward, which is that we're all the same,
                                         
                                         and that we all have the same temporal structure. And that does drive me crazy because, of course,
                                         
                                         we have the concept of the chronotype, which is essentially you can be a morning person, an intermediate person, or an
                                         
    
                                         evening person. This changes as we age. This changes depending upon our genetics. This changes
                                         
                                         depending upon whether we see morning light or evening light. We are very much not the same
                                         
                                         creature. And there's huge diversity across humans, you know, and we probably
                                         
                                         all know from our own friend circle or family circle, there are people that like to get up
                                         
                                         early and go to bed early. And at the other end of the spectrum, people love to go to bed late
                                         
                                         and get up late. Brilliant. Really wonderful to have you here. Circadian rhythms, you know,
                                         
                                         the body clock as it's called, what are they and why do they matter to us?
                                         
                                         Let's start with why do they matter? If you think about our biology, what it has to achieve is the
                                         
    
                                         right substances at the right concentration delivered to the right tissues and organs at
                                         
                                         the right time of day. And it's the sort of temporal time structure that is delivered by
                                         
                                         our circadian system, our body clocks,
                                         
                                         that allow us to do this, that allow us to essentially optimize our biology. So they're incredibly important. Essentially, they influence every aspect of our physiology and behavior.
                                         
                                         What they are has turned out to be really fascinating. We've sort of known about
                                         
                                         rhythmicity for a very long period of time. The first sort of description of a circadian rhythm goes back to about 1729 in plants with
                                         
                                         a rhythmic opening and closing of leaves under constant conditions, under constant darkness.
                                         
                                         In fact, this French astronomer popped a plant in a cupboard and would peek in from time
                                         
    
                                         to time.
                                         
                                         Is that right?
                                         
                                         I never knew that.
                                         
                                         I assumed it was only the light that caused the flowers to move. That was the assumption. The light-dark cycle
                                         
                                         drives this rhythmic behavior. But in fact, and he was completely puzzled by this. There must be some
                                         
                                         internal mechanism. And he was dead right. And it took us quite some time to try and understand what
                                         
                                         that mechanism was. I mean, in the early days, we knew that there was a master clock within the brain, in the hypothalamus, an area called the suprachiasmatic nuclei,
                                         
                                         mercifully abbreviated to SCN. And it comprises about 50,000 cells. And when I started in the
                                         
    
                                         business, it was assumed that circadian rhythms were the product of cell-cell interactions,
                                         
                                         a sort of a circuit property that would generate a 24-hour oscillation in
                                         
                                         electrical activity. And then, I mean, it was so exciting because people had isolated individual
                                         
                                         SCN neurons and shown that they would tick away in a dish on their own in terms of electrical
                                         
                                         activity and indeed turning on and off of genes. So to make sure I'm following this, this really
                                         
                                         is the clock, is it? So deep inside my brain is this little thing which is going
                                         
                                         tick-tock. Is that a way to think about it or have I made it too simple?
                                         
                                         No, no, it is the master clock. And now we know that a bunch of genes which are turned on make
                                         
    
                                         their proteins, those proteins form a complex, and then they enter the nucleus and turn their
                                         
                                         genes off. The proteins are then
                                         
                                         degraded, and then the whole cycle starts again. So there's a molecular feedback loop. And we
                                         
                                         thought that it was only SCN cells that had this capacity. And then a wonderful chap called Uli
                                         
                                         Schibler, who's based in Switzerland, showed that actually lots of different sorts of cells have a clock.
                                         
                                         So you can think of a master clock within the brain coordinating the rhythmic behavior of
                                         
                                         literally billions of individual cellular clocks throughout the organ systems of the body. So you've
                                         
                                         got this incredible hierarchy. I mean, it's sort of a bit, the analogy I've sort of used is it's a
                                         
    
                                         bit like the master clock in the brain is a conductor of an orchestra.
                                         
                                         She is producing a rhythmic temporal signal from which the rest of the orchestra, the
                                         
                                         body, takes its reference cue.
                                         
                                         And so we're not flowers.
                                         
                                         So I guess it makes sense that the sun goes away, they close and the sun comes up, but
                                         
                                         we're not flowers.
                                         
                                         Why is this so important to us?
                                         
                                         Why do we need to have this clock and this change? Why
                                         
    
                                         aren't we just sort of constantly on like my computer, right? It doesn't change.
                                         
                                         Yeah. If you think about it, we sit on a planet that revolves once every 24 hours,
                                         
                                         and that revolution produces profound changes in light and temperature. And essentially,
                                         
                                         all life on the planet, almost all life, including some types of bacteria,
                                         
                                         have evolved a clock which can anticipate
                                         
                                         these different changes and gear up physiology and behaviour
                                         
                                         in advance of the change,
                                         
                                         let's say in advance of when we wake up in the morning,
                                         
    
                                         our glucose metabolism is increasing,
                                         
                                         our stress hormones are rising,
                                         
                                         our blood pressure is rising,
                                         
                                         in anticipation of increased activity
                                         
                                         when we actually are awake. Now if we just waited until the lights came on, it was dawn, and we then
                                         
                                         triggered this process, we would have wasted two to three hours of transition where we wouldn't
                                         
                                         be able to work effectively and optimally. So what a clock is allowing us to do is anticipate these predictable changes in the
                                         
                                         environment and get our physiology up and prepared in advance so we don't waste any of the opportunities
                                         
    
                                         that the changed environment provides. Got it. So what you're saying is we shouldn't think of
                                         
                                         ourselves as like a computer or a car which you turn on as instantly available to do whatever the
                                         
                                         thing is. Actually, it can take us hours to be in the optimal place to deal with the stress of trying to convince my girl to go to school in the
                                         
                                         morning i can't just switch it on is what you're saying yeah i need a couple of hours of prep to
                                         
                                         be ready to deal with that and that that is true for many of the processes that go on in our body
                                         
                                         and so you need to know sort of where you're going to be in a few hours it's no no good to just be like, oh, off on, you know, just deal with the environment as
                                         
                                         it is.
                                         
                                         Well, that's right.
                                         
    
                                         I mean, again, you could think of it a bit like an engine.
                                         
                                         It will be like going from first gear into reverse.
                                         
                                         You know, you can't do it.
                                         
                                         You have to go through the stages.
                                         
                                         Otherwise, you destroy the engine.
                                         
                                         And, you know, it's so important to appreciate that the different states of wake and sleep
                                         
                                         are just
                                         
                                         so very, very different.
                                         
    
                                         Our metabolism is utterly different.
                                         
                                         Our ability to process food, our drugs, everything is changing.
                                         
                                         Our cognitive abilities, our ability to process information in the early hours of the morning
                                         
                                         is worse than if we consume sufficient alcohol to make us legally drunk.
                                         
                                         We're that impaired.
                                         
                                         So say that again, Russell, you're saying first thing in the morning,
                                         
                                         I am as impaired as if I was legally drunk?
                                         
                                         Around about four to five o'clock in the morning. Yes. Before the clock has started to wake you up,
                                         
    
                                         your ability to process information is that impaired. And so, you know, the serious point
                                         
                                         is if you're driving a car at four or five o'clock in the morning, as many people have to do
                                         
                                         after coming home for the night shift or getting the family off to that sort of ferry and the early
                                         
                                         holiday, your ability to drive that car is worse than if you consume sufficient alcohol to make
                                         
                                         you legally drunk. So it's a big deal. That's amazing. And I think many of us assume that
                                         
                                         this is just because we're really tired, right? So, you know, four in the morning, most of the time, we probably haven't gone to sleep or we've woken
                                         
                                         up incredibly early. I think you're saying that isn't just because I'm tired. It's actually to
                                         
                                         do with the body clock's point I'm in. Is that correct?
                                         
    
                                         Exactly. And in fact, if you haven't slept, it gets worse. So it's a double whammy. And often we refer to sleep and circadian rhythm disruption, SCART, because it's very
                                         
                                         difficult to, in many cases, tease apart the two.
                                         
                                         And in fact, what sleep deprivation will do is actually make the sort of the impairment
                                         
                                         by the clock even worse.
                                         
                                         So that 4am window where you're naturally at your lowest cognitive abilities
                                         
                                         will be made worse if you hadn't slept properly over the preceding few days.
                                         
                                         There'll be a lot of people listening to this call who do shift work. So they're not on a
                                         
                                         regular pattern. And there are others who travel across time zones. And we had a lot of questions
                                         
    
                                         for both of these. So I think all these people know how powerful the body clock is. And I think
                                         
                                         anyone listening who's ever gone across many time zones has sort of had that strange experience.
                                         
                                         How does your body synchronize between this? So how does my body know that it's now the middle
                                         
                                         of the afternoon and not the morning? Okay. So we talked about this master clock
                                         
                                         regulating this sort of billions of individual cellular clocks. And this temporal
                                         
                                         structure is of absolutely no adaptive value, fine-tuning biology to the demands of the day
                                         
                                         and the night, unless it's set to the external world. And so we know that the light-dark cycle,
                                         
                                         the dawn-dusk cycle, is the most important signal. And there are receptors in the eye
                                         
    
                                         which detect this light and then regulate the
                                         
                                         internal molecular clockwork. Now, what's turned out to be extraordinary is that the receptors in
                                         
                                         the eye that detect light for the clock are different from the ones that we use for vision.
                                         
                                         So the visual cells, the rods and cones, give us our sense of space. But we discovered that this third
                                         
                                         photoreceptor within the eye, a photosensitive retinal ganglion cell. So the cells within the
                                         
                                         retina that form the optic nerve are called the ganglion cells. And one out of every hundred of
                                         
                                         those cells is directly light sensitive and projects to the master clock within the brain.
                                         
                                         And I think this has been some of your own work, hasn't it?
                                         
    
                                         Sort of untangling exactly this.
                                         
                                         How long have we known about that these extra senses exist?
                                         
                                         Is this something we've known about for hundreds of years?
                                         
                                         No, not at all.
                                         
                                         In fact, when we first sort of proposed it at about 91,
                                         
                                         and it took about a decade to convince my colleagues,
                                         
                                         I remember in one presentation I gave,
                                         
                                         I sort of said, so these data are consistent
                                         
    
                                         with the fact that there's another receptor within the eye. And somebody at the back stood up and
                                         
                                         looked at me and I thought they were going to ask a question and they just shouted, bullshit.
                                         
                                         And it was quite shocking as a young researcher. But in a sense, what it does is bludgeon you
                                         
                                         in to do better and better experiments. Just to decide for a minute, I think many people listening to this call will be really surprised
                                         
                                         because they won't have been involved in the process of scientific discovery. And I think
                                         
                                         there is this idea that it's all carried out in an extremely civilized fashion. Everybody
                                         
                                         just looks at the data and says, this is, you know, you're laughing already.
                                         
                                         Yeah, we are.
                                         
    
                                         This is clearly what comes. But actually, I have rarely seen, you know, you're laughing already. But actually, I have rarely seen, you know, two people more
                                         
                                         impassioned than two experts in the same area disagreeing about something that almost nobody
                                         
                                         else in the world actually even understands. Well, it is like that. And of course, what it
                                         
                                         does is it drives you to do better experiments and then produce an iron cast set of data supporting
                                         
                                         your hypothesis. And so yeah, we finally in a couple of back-to-back
                                         
                                         science papers in 1999, convinced the world, I think, that there was another receptor. And that
                                         
                                         led to a lot of interest from other groups around the world. We showed it in the mouse, other people
                                         
                                         showed it in the rat and in monkeys that there is this photosensitive retinal ganglion cell. And so,
                                         
    
                                         you know, it's so exciting because you kind of thought that the eye was the best understood bit of the central nervous system. We studied it for
                                         
                                         150 years. Surely we can't have missed an entire class of light sensor. Well, we had. And I think
                                         
                                         that's part of the joy of doing science. So you've explained like we've got this master body clock.
                                         
                                         It sounds like light is central for helping to keep it on track.
                                         
                                         Can you help to explain a bit how this body clock then influences our body?
                                         
                                         And I guess the most obvious thing to start with is sleep, which I think is what we think
                                         
                                         about.
                                         
                                         So how does this fit together?
                                         
    
                                         Okay, you ask a really central question.
                                         
                                         One of the big questions in the field at the moment is, you know, what are the signals
                                         
                                         from the master clock that are coordinating the rest of the body? And we know that the sympathetic nervous system, that bit of
                                         
                                         the nervous system that is sort of under involuntary control, that is regulating sort of heart rate and
                                         
                                         a whole bunch of other sorts of things, it's via those projections which are influencing the
                                         
                                         activity of organs and cells. But there are also humoral chemical messengers that are produced
                                         
                                         by the master clock that are regulating various tissues. So we don't fully understand. There are
                                         
                                         direct nervous connections. There are hormonal outputs. And we're just sort of working our way
                                         
    
                                         forward. We do know, for example, that the classic sort of rhythmic change in metabolism that you see
                                         
                                         is if you cut the nervous
                                         
                                         connections to key organs, such as the liver, for example, then the rhythmic changes in the liver
                                         
                                         don't occur. So we know that the neural connections are very important, but it's not the only thing.
                                         
                                         There are other chemical messengers. And so what happens if we don't live alongside our circadian
                                         
                                         rhythms? You've described this pattern where it's getting me all
                                         
                                         ready and it makes me ready for breakfast and it makes me ready to go out and do things and ready
                                         
                                         for sleep. What happens if we just say, ah, you know, the circadian rhythm was for our ancestors.
                                         
    
                                         I've got electric light now and I've got fun things to do. What happens if I ignore it?
                                         
                                         Well, and of course, we go back to your original question, which I didn't answer,
                                         
                                         which is what happens with jet lag and shift workers. And of course, we go back to your original question, which I didn't answer, which is what happens with jet lag and shift workers.
                                         
                                         And of course, you eventually get over jet lag because you are exposed to light in your
                                         
                                         new time zone, picked up by those amazing receptors that lock then the internal clock
                                         
                                         onto the new light-dark cycle.
                                         
                                         But it can take a day for every time zone you've crossed to fully synchronise.
                                         
                                         So it can take quite some time.
                                         
    
                                         And the question many people ask, of
                                         
                                         course, is, well, why don't night shift workers adapt to the demands of working at night? And
                                         
                                         that's always been the assumption. But the problem again is light. So in the factory or the workplace,
                                         
                                         there's relatively dim light levels, but then the individual will experience bright natural light on
                                         
                                         the drive home or indeed on the drive in to work and the clock will always defer to the brighter light signal, which is invariably the environment, as daytime.
                                         
                                         And so in fact the clock of night shift workers and day shift workers is broadly the same.
                                         
                                         We're locked onto the same light-dark cycle.
                                         
                                         Now experiments have been done where individuals have been exposed to brighter light in the
                                         
    
                                         workplace, about 2,000 lux, which is a measure of light intensity, and then actually hidden
                                         
                                         from light during the day.
                                         
                                         And just like jet lag, they eventually adapted to the night shift.
                                         
                                         The problem is that's not a practical solution for most individuals.
                                         
                                         So that's the mechanism, but
                                         
                                         what are the problems? And what's emerged, I think, over the past few years is the appreciation
                                         
                                         that our sort of emotional responses, our cognitive responses, and our physiology and health
                                         
                                         can be profoundly affected by not doing the right thing at the right time. So in terms of emotional responses,
                                         
    
                                         we see fluctuations in mood, irritability, loss of empathy. We fail to pick up the social signals
                                         
                                         from other individuals and we lose empathy. Risk-taking and impulsivity will do stupid and
                                         
                                         unreflective things when we're not synchronized. We also, combined with sleep loss, the brain
                                         
                                         forgets the positive experiences and remembers the negative ones. So circadian rhythm disruption
                                         
                                         and sleep loss means that you're basing your decisions upon your negative rather than your
                                         
                                         positive memories, which I think is so important. And then, of course, you can slide into using excessive
                                         
                                         amounts of caffeine to keep you awake and then trying to reverse that when you want to go to
                                         
                                         sleep with excessive alcohol. There's the failure to multitask, your concentration goes, your
                                         
    
                                         communication, your decision-making skills all fall apart, and you, again, lose social connectivity.
                                         
                                         So those are the short-term things that many of us have
                                         
                                         experienced to some degree. But what you get in long-term night shift workers and indeed
                                         
                                         individuals such as long-haul pilots and air crew are sort of this sort of cardiovascular problems,
                                         
                                         heart disease for example, altered stress responses, lowered immunity. One really
                                         
                                         interesting set of studies
                                         
                                         showing that with multiple time zone crosses, the immune system is disrupted and you're less able to
                                         
                                         fight off bacterial infection, for example. And it may be the basis for why there are higher rates
                                         
    
                                         of cancer in long-term night shift workers. Very important studies on night shift nurses
                                         
                                         showing higher rates of breast cancer, colorectal cancer, for example, and in long haul pilots, prostate cancer.
                                         
                                         Metabolic abnormalities such as diabetes 2 and obesity.
                                         
                                         And finally, the big one, depression and psychosis are made much worse by sleep and circadian rhythm disruption.
                                         
                                         So to answer your question briefly.
                                         
                                         That doesn't sound very good, Russell.
                                         
                                         No, it's not. It's terrible. I mean, it's quite clear that this disruption is so much more
                                         
                                         inconvenient than feeling tired at the wrong time of day. This has a massive impact.
                                         
    
                                         Well, it's interesting, isn't it? Because I think that's what you tend to think about is,
                                         
                                         I've had a bad night or it's really tough to be doing night shift. I just want to clarify this because are you saying that even if I was sleeping properly,
                                         
                                         so let's say I'm doing a night shift, I've done it for long enough, or I'm good enough at it that
                                         
                                         I am getting sleep during the day. So it's not that I'm not sleeping. These things are actually
                                         
                                         a result of being against my circadian rhythm. They're not just because I'm tired and lack of sleep is causing this.
                                         
                                         Well, it's the double whammy.
                                         
                                         So essentially, you're on the night shift,
                                         
                                         your whole biology is saying
                                         
    
                                         you should be in the sleep state.
                                         
                                         So what do you do about it?
                                         
                                         Well, the body's response
                                         
                                         is to over-activate the stress axis
                                         
                                         so that you can function at least at some level.
                                         
                                         You can't expect peak performance, incidentally,
                                         
                                         but you can function at a certain level for a certain amount of time. The problem is the night shift worker then who's
                                         
                                         chronically sleep deprived and who's worked against their body clock, then they go home and
                                         
    
                                         they try and sleep and the clock is saying, hang on, no, it's daytime, you should be awake. So the
                                         
                                         sleep pressure is very high and will induce a certain level of sleep, but it's not coordinated
                                         
                                         with the clock. So the sort of quality and the duration of the sleep that you get during the day Pressure is very high and will induce a certain level of sleep, but it's not coordinated with
                                         
                                         the clock.
                                         
                                         So the sort of quality and the duration of the sleep that you get during the day is not
                                         
                                         comparable to the sort of sleep that you get under a natural sort of sleep-wake cycle.
                                         
                                         So you can't necessarily completely separate the two because they fit together so much
                                         
                                         is what you're saying.
                                         
    
                                         Sleep and circadian rhythm, this is one of the fundamental things that should be happening
                                         
                                         on this 24-hour clock. Yeah, and these two systems interact, which is why we came up with this term
                                         
                                         SCARD, sleep and circadian rhythm disruption, because classically, as in the case of night
                                         
                                         shift work, it's very difficult to disentangle the different contributions of sleep deprivation
                                         
                                         and circadian misalignment. In fact, they reinforce each other and make it much worse. That is a rather miserable story for listening to this and you're getting ready to go
                                         
                                         to your shift work, which lots of people listening to this podcast will do. I just wanted to dig in
                                         
                                         a minute to some of those things because they sounded quite scary. Many of the people who do
                                         
                                         shift work, after all, are working in healthcare. So there will be nurses and doctors and they will
                                         
    
                                         be having to make life and death
                                         
                                         decisions in the middle of the night, right? So I luckily never have to do this, but that happens.
                                         
                                         You said something about the risk-taking and the brain only remembering sort of negative
                                         
                                         memories. Could you explain a bit more sort of what's going on there? And then I guess,
                                         
                                         is there anything we can do about it if you are in these situations?
                                         
                                         So, for example, after extended periods of time on the night shift, your vigilance drops hugely.
                                         
                                         And this can impact the safety of your journey home. Study from the UK showed that 57% of junior doctors had either had a crash or a near miss on the drive home after the night shift. So what can we do?
                                         
                                         Well, we can provide vigilance devices that clip onto the dashboard that will map head nod or eye
                                         
    
                                         roll. And in fact, high-end German cars are building this technology in routinely so that
                                         
                                         if you are likely to fall asleep, there's an alarm that goes off and wakes you up. Now, that's a sort
                                         
                                         of a simple life-saving device. You can increase the
                                         
                                         amount of light in the workplace because increased light increases alertness and makes you less
                                         
                                         likely to fall asleep. And so we need to look very carefully at light levels in the workplace itself.
                                         
                                         Knowing that there's poor physical and mental health associated with things like night shift
                                         
                                         work, we could institute a high frequency health checks for the workforce, catching potential early risk cancers,
                                         
                                         obesity, diabetes too, before these become chronic and potentially irreversible conditions.
                                         
    
                                         This is simple stuff. Knowing that there are higher rates of obesity, diabetes too,
                                         
                                         metabolic abnormalities, what kind of food do we provide our night shift workers?
                                         
                                         Well, it's fast food, high fat, high sugar.
                                         
                                         We should actually make available for our night shift workers protein rich, easy to
                                         
                                         digest snacks.
                                         
                                         That's the sort of thing that the body can cope with and is not going to predispose to
                                         
                                         these metabolic abnormalities.
                                         
                                         I think also many night shift workers don't appreciate some
                                         
    
                                         of the consequences of what's going on. And it's not just those individuals, but it's also the
                                         
                                         people they share their lives with. So studies from the States have shown that in some sectors,
                                         
                                         the divorce rate is six times higher in night shift workers compared to day shift workers.
                                         
                                         So we've got to provide education
                                         
                                         so that people understand the consequences.
                                         
                                         They can look out for those problems,
                                         
                                         not just in themselves,
                                         
                                         but so that their partner will appreciate
                                         
    
                                         that the person, this wonderful, loving person
                                         
                                         they married hasn't turned into a monster.
                                         
                                         It's an inevitable consequence of doing this particular job.
                                         
                                         So education is important.
                                         
                                         And Russell, that sounds all quite profound. So it sounds to me, you know, maybe the other
                                         
                                         follow on is, we should be trying to minimize the number of people who are having to work
                                         
                                         in conflict with their body clock. These are not minor things you're talking about, right?
                                         
                                         These are pretty shocking.
                                         
    
                                         I think that's right. And I think that just because we can, should we? And I think we need
                                         
                                         to ask that question very carefully.
                                         
                                         And of course, so many people don't want to do night shift.
                                         
                                         It's an economic driver.
                                         
                                         Many women, for example, many nurses, the only way to have a family and a career often
                                         
                                         is to do night shift work.
                                         
                                         So you can get the kids off to bed, you go on the night shift, you're back to get them
                                         
                                         off to school.
                                         
    
                                         And then you struggle, you know, trying to sleep during the day and all the rest of it.
                                         
                                         So there are really severe economic drivers, but we need to try and mitigate some of this risk.
                                         
                                         Where possible, we need to avoid it.
                                         
                                         But there are unavoidable areas, as in our frontline staff, our policemen, our ambulance crews, our doctors and nurses.
                                         
                                         A very interesting study, which is even adding a yet another whammy to our frontline staff, our policemen, our ambulance crews, our doctors and nurses. A very interesting study,
                                         
                                         which is even adding a yet another whammy to our frontline staff, and particularly during the
                                         
                                         recent COVID, it's been shown that vaccination is far less effective, you don't get a robust
                                         
                                         antibody response, if your circadian rhythm disrupted immediately before the vaccination
                                         
    
                                         or afterwards, probably because of increased levels
                                         
                                         of stress hormone. Those stress hormones will suppress the immune system and therefore the
                                         
                                         vaccination isn't as effective. So before we vaccinate our frontline staff, we should ensure
                                         
                                         that they've had a period of rest and relaxation immediately prior to the vaccination.
                                         
                                         And presumably that suggests that if I've messed up my body clock at this point,
                                         
                                         then just my immune system in general is not going to work as well, which is bad,
                                         
                                         not only for infectious diseases, but we know for things like cancer and all the rest of it.
                                         
                                         Yeah, absolutely. Some very interesting studies. And of course, this needs to be built into medical
                                         
    
                                         programs. I was talking about this at the weekend at a meeting, that a stable circadian sleep-wake timing will increase outcomes, long-term survival in cancer patients.
                                         
                                         And the difference between stable sleep-wake versus disrupted sleep-wake was something
                                         
                                         like in two years, 70% survival versus 40% survival.
                                         
                                         So these are big effects that we should be building into our health programs.
                                         
                                         That's amazing.
                                         
                                         So Russell, I'd love to talk about how the circadian rhythm is changing during our lives.
                                         
                                         So is it true that there's a real change in your circadian rhythm at the point when, for example, you go through menopause, which is where we've had a lot of questions?
                                         
                                         Yeah, the changes during menopause are related primarily to the changes in the estrogen and progesterone,
                                         
    
                                         those two key hormones that cycle across the menstrual cycle.
                                         
                                         Now, estrogen has been associated with increased sleep, broadly speaking, and progesterone,
                                         
                                         greater relaxation.
                                         
                                         So these are really important hormones.
                                         
                                         And so in fact, you know, you get many women find just around the time
                                         
                                         of ovulation, they're more relaxed, they get better sleep. But premenstrual, before menstrual
                                         
                                         bleeding, when estrogen and progesterone alone, then you get greater levels of anxiety and
                                         
                                         potentially depression and irritability. And so there's that premenstrual things.
                                         
    
                                         And is that actually affecting the body clock at this time? Or is this?
                                         
                                         So it's probably a more direct effect of the
                                         
                                         hormones. What we do know is that the circadian system is fundamentally important in the release
                                         
                                         of the neurohormones in the brain regulating the pituitary gland, the release of the key hormones
                                         
                                         from the pituitary gland that then arrive at the ovary and indeed the testis. And indeed,
                                         
                                         the response of those organs to those
                                         
                                         hormones is all being regulated by the clock, which is why in, again, night shift workers and
                                         
                                         indeed air crew, you find disrupted menstrual cycles, more difficulty getting pregnant. And
                                         
    
                                         indeed, there's a statistical, although not hugely, there's not been many studies, but a greater risk of miscarriage.
                                         
                                         And in fact, if you're undergoing IVF, the recommendation is not to do lots of transmeridian
                                         
                                         flight or indeed do night shift work.
                                         
                                         So we know the clock is extremely important in reproduction.
                                         
                                         In males, for example, there's a morning rise in testosterone.
                                         
                                         And it's at that time of day that sperm motility
                                         
                                         and sperm activity is the most efficient.
                                         
                                         Whether that directly correlates with conception is unclear, but certainly, you know, you predict
                                         
    
                                         that it would be important.
                                         
                                         So the clock is embedded in a lot of these things, but in terms of the menopause, it's
                                         
                                         more of a direct effect of those changing hormones, which are driving
                                         
                                         temperature, relaxation, and sleepiness, which is a great problem. And what's so frustrating is that
                                         
                                         this is such an important impact on women. And yet there's very little intervention, there's very
                                         
                                         little that one can do about it. There have been studies which have suggested that if you use good
                                         
                                         sleep hygiene, the sorts of things I've just talked about, then you can actually get better sleep and you can sort of get through
                                         
                                         the menopause and the premenopause perhaps more effectively. But there's no magic bullet, sadly.
                                         
    
                                         HRT in some women has been shown to improve sleep, but not for all.
                                         
                                         Is there a circadian rhythm for our guts? Clearly, we talk a lot about nutrition
                                         
                                         and the microbiome. Is there something that the circadian rhythm has to tell us about
                                         
                                         how we should think about eating? Yes, and this is a really important area.
                                         
                                         So the empirical evidence shows that if we have a constant infusion of glucose throughout the day,
                                         
                                         our ability to clear that glucose is much more efficient during the first
                                         
                                         half of the day and it tails off towards evening and then becomes pretty inefficient. So in fact,
                                         
                                         you're getting rid of glucose very effectively during the first half of the day, but less
                                         
    
                                         effectively during the second half of the day. And of course, by having higher levels of glucose,
                                         
                                         you can generate glucose intolerance and you're on the way to type 2
                                         
                                         diabetes. Other experiments have shown that if you load your calories at breakfast and lunchtime
                                         
                                         versus lunchtime and evening, you know, let's say 2000 calories, which were designed to promote
                                         
                                         weight loss, the weight loss was much more effective during the first half, if you had
                                         
                                         your calories during the first half of the day, rather than the second half of the day.
                                         
                                         So there's this circadian modulation of our metabolism.
                                         
                                         So you think, well, hang on, this is crazy.
                                         
    
                                         I mean, society now often misses breakfast, it'll often have a lunch at the workplace.
                                         
                                         And then finally, after the commute home, you have your large meal.
                                         
                                         But this large meal in the evening is a recent occurrence in human behaviour.
                                         
                                         In the medieval period, the breakfast and lunch, you know, those great banquets we all think of, you know, in the Tudor period, were at lunchtime.
                                         
                                         They weren't in the evening.
                                         
                                         And so our changed eating habits have been relatively recent, driven by the aristocrats.
                                         
                                         So a show of wealth was illuminating your house with candles.
                                         
                                         And it's worth bearing in mind until, you know, 19th century, a candle was the equivalent
                                         
    
                                         of a working man's daily wage.
                                         
                                         They were incredibly expensive.
                                         
                                         And so many of the working people, they followed the natural light-dark cycle, whereas
                                         
                                         the aristocrats started eating later. And that sort of trickled down in more recent years to
                                         
                                         much of society eating later in the evening. And that's the worst possible thing that we could be
                                         
                                         doing. So if possible, and I again know it's complicated because of the way we structure
                                         
                                         our lives and the commute and all the rest of it, try big breakfast, nice lunch, minimum bowl of soup in the evening.
                                         
                                         And I think I would just add that we see this quite personalized. We definitely see that these
                                         
    
                                         are averages and many of these experiments have done. And there are people actually where we see
                                         
                                         quite flat responses and others where we see this most strongly. Interestingly, on average,
                                         
                                         you see this change with age. And we haven't separated that from circadian rhythm, but I guess part of what you're
                                         
                                         suggesting is if your circadian rhythm is maybe not as strong as it was, then also your control
                                         
                                         between this may not vary as much across this time. But Jonathan, you also raise a very important
                                         
                                         point because most experiments, like the sort I've discussed on metabolism, have been undertaken in university
                                         
                                         undergraduates, volunteers, and they've usually been males. And so it's good that you raise this
                                         
                                         because many of the times we're extrapolating from healthy young males to the rest of society,
                                         
    
                                         including females, and that simply may not be appropriate under certain circumstances.
                                         
                                         So yeah, the data are great for healthy young males, but we need studies in other demographics and also between
                                         
                                         men and women. Final question I'd like to ask, because we've got a lot of questions about this.
                                         
                                         What about those of us who have or have had small children waking us up in the night,
                                         
                                         sometimes for very long periods of time? That seems to be disrupting one's circadian rhythm
                                         
                                         quite badly. Is that going to damage our long-term health in the same way you described as night
                                         
                                         shift? And if so, what do we do about it? It's unclear. You know, for such a prevalent
                                         
                                         experience, there's not been a huge amount of research on it. So I suppose what I would say
                                         
    
                                         is that the first few weeks and months when a newborn arrives,
                                         
                                         because of the need to pack on the calories, then there will be the need to feed throughout the night.
                                         
                                         But that diminishes fairly quickly.
                                         
                                         The trouble is that many young children become very dependent upon that type of physical contact.
                                         
                                         And they will wake up and seek comfort, whereas actually they don't
                                         
                                         need food. And so what I think has to be, and it's very much a personal issue, you have to then sort
                                         
                                         of start being fairly disciplined and developing a robust sleep-wake structure for the youngster.
                                         
                                         And the sorts of things that we've been talking about,
                                         
    
                                         you know, dark bedrooms and the right temperature and a very clear structure. And again, I'm cautious in this regard because I'm not a paediatrician. But I think you have to be very
                                         
                                         careful about always going to the child, making sure the child is okay, but they will seek
                                         
                                         attention. And it's not necessarily always good for them. And it's not necessarily always good for the parent. And this is because your message is fundamentally getting to a really
                                         
                                         healthy body clock is so important for our health. And so as we think about things we want to do for
                                         
                                         our children, as well as for ourselves, you're basically saying on average, that this is one of
                                         
                                         the things that you want to try and gift your children. That's right. I mean, I know others would disagree, but that would be my personal view.
                                         
                                         Russell, thank you so much.
                                         
                                         I think there's so many topics that I wanted to get into, but we haven't been able to cover
                                         
    
                                         all of them this time.
                                         
                                         We always try and do in this podcast is for me to try and do a quick summing up of the
                                         
                                         many different things we've covered.
                                         
                                         We started by saying just how important the body clock is.
                                         
                                         And this matters because if we're living outside of the way the body clock setting,
                                         
                                         there are a lot of negative outcomes. And that if we move outside this, and some of us have to,
                                         
                                         because for example, we're night shift workers, they're very profound impacts. And I think you
                                         
                                         also said that as we go through aging, this tends to mean that the circadian rhythm is not as good.
                                         
    
                                         And in particular,
                                         
                                         we talked about women going through menopause, where you'd have not only the circadian rhythm, but really these changes in these hormones leading to really significant disruption of sleep,
                                         
                                         which obviously has a lot of the impact that you were talking about. And I think the other
                                         
                                         key takeaway for me is just how personalized a lot of things is that you've talked about,
                                         
                                         you know, another example where there isn't just a one-size-fits-all
                                         
                                         approach. Absolutely. And different doesn't have to be bad. And stop worrying about one's sleep
                                         
                                         and enjoy it and embrace it. Brilliant. Russell, thank you so much. I enjoyed it very much.
                                         
                                         I really enjoyed the book as well. And I hope we'll get you to come back again and talk us
                                         
    
                                         about some more of the ongoing research. I'd love to. And of course, we haven't even touched on when to take your medications for the best
                                         
                                         effect.
                                         
                                         See what we can unpack next time.
                                         
                                         Let's do that.
                                         
                                         Maybe a whole podcast just on that.
                                         
                                         Okay.
                                         
                                         Russell, thank you so much.
                                         
                                         Great pleasure.
                                         
    
                                         Thank you.
                                         
                                         Bye-bye.
                                         
                                         Thank you to Professor Russell Foster for joining me on Zoe's Science and Nutrition
                                         
                                         today.
                                         
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