Are you a late-night snacker? Do you sometimes get home late and push dinner back to 8 or 9 PM? Perhaps you've heard somewhere that eating right before bed is "bad for you"? Is this true? Does the timing of our eating have any impact on our health? How can we know??
RELAX! Your Doctor Friends have got you covered. To start off the new year (and following our trend of starting January episodes with "resolution-adjacent" topics), Jeremy did a deep dive into the data behind "chrono-nutrition". CHRONO= time, and NUTRITION= well... nutrition. Put them together and you've got the concept of following your body's circadian rhythm to time out your eating habits!
What happens when we eat late? Does it affect our sleep? What about our metabolism? Is there benefit to changing up our eating times? Your Doctor Friends have scoured the evidence and would love to present you with a little "book report" to help you decide what works best for YOU.
Listen to the end for our "dessert" topic, where Julie discusses the new FDA-approved home testing for sexually-transmitted infections!
HAPPY NEW YEAR, FRIENDS! It's great to be back :) - J&J
Resources for this episode include:
An October 2023 article from Clinical Nutrition about chrononutrition using NHANES data.
A NYT article titled "Is It Bad to Eat Late at Night?".
The CDC website for the National Health and Nutrition Examination Survey (NHANES).
A January 2023 article from Verywell Health about chrononutrition.
A May 2023 article from Verywell Health titled "Is Eating Before Bed Bad For You?".
The NIH webpage discussing circadian rhythms.
An NBC News article from November 2023 titled "Will first FDA-approved at-home test for gonorrhea, chlamydia ease the epidemic?".
The FDA news release regarding its approval of the "Simple 2" gonorrhea and chlamydia home test.
Link to the "Let's Get Checked" website for the "Simple 2" at-home gonorrhea and chlamydia home test.
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[00:00:00] Jeremy Alland: Julie, happy new YDF year. Oh, happy new YDF year to you. How was your time away from the pod? It was good.
[00:00:07] Julie Bruene: It was restorative.
[00:00:09] Jeremy Alland: That's a great word. Sure, thanks. Mine was great too. I spent time with family. I ate food. I celebrated the holidays. I went on vacation. And this past week, I isolated with COVID.
You're starting off strong, Jeremy. Yeah, JN1's all the rage. So I jumped on board. Well, good. Get out of your system. It's fine. But what better way to do a podcast than to have COVID isolation and do it from a podcast studio? Yeah,
[00:00:31] Julie Bruene: it's daylight right now. This is fun. So,
[00:00:34] Jeremy Alland: to transition to our first new episode of the year, I want to ask you, when do you generally eat your last bite of food at night?
[00:00:41] Julie Bruene: jeez. I used to be better at this. Especially after we talked to Kristen Holmes. What
[00:00:45] Jeremy Alland: defines us better?
[00:00:47] Julie Bruene: Truth. Okay. I don't know. It depends. It depends on how late I work. So like my husband and I have weird schedules. Sometimes we don't get home until 8 or 9 o'clock at night. So sometimes we're not eating until around then.
So sometimes that answer is I'm done eating at 9. 30. Other times, like if it's the weekends or I'm not working, it might be, I don't know, 7 or 8. But I like to have my snacks. I like to have my
[00:01:07] Jeremy Alland: bedtime snacks. I was about to say, I can tell you mine is frequently after nine o'clock. Okay, good, good, good, good.
And it's not dinner necessarily, but we are the celebrate that we got the kids down to bed, have some nice dessert snacks after nine o'clock at night. And I don't apologize for it, but this episode is going to be a little enlightening for both of us, I think. One of the more common New Year's resolution categories is to eat.
better. We covered this a lot in 2023 with our resolution series. I think we can all agree that this feels like a moving target, you know, what does that even mean? What does eat better mean? Yeah. Who knows? It better than I was doing before. So one suggestion that seems to keep showing up in my feed, I don't know if it does in viewers, whether it be in your whoop app or like on Instagram or Tik Tok is to stop eating late at night.
And it got me thinking. Does the timing of our food intake really matter? Does it matter, like, when I eat my food? So, today I want to explore that. I want to explore not what we eat, but when we
[00:02:05] Julie Bruene: eat. I think that's great. I find this really interesting, especially since we talked to Kristen Holmes about it, because I think you're going to tell me a fair amount of data about why or why not this may matter to us.
But yeah, I, it's, it's something that I bring up with patients from time to time, especially when we're talking about improving sleep quality. So I won't step on your toes there if that's a part of the talk today, but I find this is going to be a great topic for me because it's one that I've personally thought about quite a bit.
And And I'd like to know what the evidence shows. So I'm here for it, man. Let's do
[00:02:34] Jeremy Alland: it. I'm with you. I was excited to explore it because I think about it a lot, too. We're going to explore topics like whether there are ideal times to eat food, if fasting for periods of time is important, and is eating late bad for us.
Does that all sound good to you, my friend? Sounds awesome. I'm here for it. Let's get the new year going.
Welcome to Your Doctor
[00:02:54] Julie Bruene: Friends, the show that teaches you to sniff out the garbage and answers all the questions that you wish you could call or text your doctor friend. My name's Julie Bruene and I'm I'm
[00:03:03] Jeremy Alland: Jeremy Alland, and we are two physicians who work at a nationally ranked practice and take care of some of the world's greatest athletes.
We know that you have questions, and we want to help. We want to be your doctor friends! Julie have you ever heard of the term chrononutrition? No, I have not. Neither had I. I've never heard of it before, but I have now. Okay. And this does not appear to be terminology created for media. This is an actual, if you go to PubMed, chrononutrition does exist, but I thought it was defined pretty well in an article on verywell.
com. They said chrononutrition, aka time restricted eating, looks at the impact nutrition has on your metabolism via your body's circadian rhythm. So everybody remembers circadian rhythms, your body's internal clock. It governs the cycle of physiologic and biologic processes like sleep, body temperature, and mental alertness.
The thought process is that eating on a schedule that better works with your natural rhythms may benefit your well being. That's what Chrono Nutrition is trying to say. Okay. We've talked about circadian rhythms on the pod before with Kristen Holmes, as you mentioned, from WHOOP, and this actually becomes a big part of our conversation with Dr.
Naomi Perel in an upcoming episode on Lifestyle Medicine in a World with Ozempic, so this can be maybe our on ramp to that episode. So definitely tune in to that one later this month, because it's really interesting to hear what has changed in how we think about metabolism and weight loss from even their Our first interview with her episode three.
Totally. There's just a lot of change since that time. So quick refresher on circadian rhythms because I think it's important for this conversation. Circadian rhythms are the physical, mental, and behavioral changes related to the day night cycle. So light and dark have the biggest influence on the circadian rhythms.
We often reference them with Sleep like going time zones whenever you're traveling when I was going to Italy the past time and it was like, how do I? I have to sleep all the way there. Yes on the plane to be able to wake up and on the way back. I'm
[00:04:54] Julie Bruene: screwed Yeah And I feel like so many people Come to us talking about sleep is sort of like an ancillary effect of other things that's going wrong in their life Like it's a I don't feel good.
I don't sleep. Well if I knees hurt, I don't sleep well, if I have too much stress, I don't sleep well, and it just seems like this big mushroom cloud effect and Yeah, I'm curious to see where you're going to lead me down to talk about circadian rhythms and sleeping and how that that correlates to eating schedules too.
[00:05:18] Jeremy Alland: Yeah, well, and circadian rhythms also come up a lot with shift workers. Yeah. You know, and people who work at night versus the day and such. But one of the things that's really important about Circadian rhythms and to orient us to the episode today is that it's not just light and dark that play an influence on circadian rhythms, food intake, which is important for today, stress, physical activity, social environment and temperature can also affect your rhythms.
So why does that matter? Well, circadian rhythms influence important functions in our body, such as sleep patterns, hormone release, so that's a huge part of this, appetite and digestion, and then our body temperature. So to tie this all together as we set the stage, circadian rhythms are super important for our well being, and when we eat, we can affect our circadian rhythms.
Okay. Have you ever thought about your eating based on your circadian
[00:06:03] Julie Bruene: before? Sort of, but really it's more, I'm I'm more animalistic in my eating. I'm just like, me hungry now. Gonna shove food in my mouth so I'm not irritated anymore. I tend to be a more of a reactive person than a proactive person when it comes to my food intake needs and there's a lot of reasons behind that.
Yeah, no, the short answer is no, it's usually just like, why am I mad? Oh, that's why. Eat something, you dork.
[00:06:31] Jeremy Alland: Julie eats when hanger shows up. That's her circadian rhythm. That's not wrong. You're not wrong. The, you know, for me, I feel like I've thought about this a lot in the past, but mostly in the terms of like, don't skip breakfast.
Remember how that's like always been a huge recommendation is don't skip breakfast because that's bad for you. That's how I've thought about it with circadian rhythm. I haven't thought about it. in my head is that was circadian rhythm thinking, but I was always like, don't skip breakfast because when you wake up, you need to have breakfast.
But a lot of this episode is going to focus not on that. It's going to focus on the other end of it. And I don't, I personally have never really thought about what time I'm eating at night. And we
[00:07:03] Julie Bruene: don't have to go super deep into this because we're talking more about the opposite of like our eating habits before it, like at nighttime or in bedtime.
But is there data? Is there something I should be knowing about how breakfast is way? But I don't eat breakfast at all. I drink coffee and then I eat. Like, probably when I get to work. I, and I feel like, for my thing, it was when I eat breakfast, I'm so damn hungry, like, mid morning. And maybe it's just, I should be eating different things for breakfast, potentially, but for me, it's like, annoying that I'm like, ugh.
I feel like I have more, I have more hanger needs in the mid morning if I have breakfast, so. I don't know.
[00:07:34] Jeremy Alland: Everybody's different. Yeah, I mean, we'll definitely get into later why you're what you're doing right there is, is killing your longevity. No, I'm just kidding.
[00:07:43] Julie Bruene: No, there actually
[00:07:44] Jeremy Alland: isn't. I think what you bring up is interesting because chrono nutrition, from what I can tell Spends a lot less time focusing on specifics in terms of what time you're eating the specific meal and more about the overall time.
And so I'll give you an example. It still seems to be a developing concept, but I really like the description that was in this very well article by Dr. John Hawley, who is the Director of Exercise and Nutrition Research at Australian Catholic University. Melbourne, Australia, he said it boils down to reducing the window of time that you eat.
So for example, if you eat breakfast at 7am and then you eat dinner at 8pm, the goal is to shorten that time frame of 13 hours down to 11 or 10 hours. Okay. So to go back to what you were saying is you don't like to eat breakfast, fine, but what time are you eating your first meal and what time are you eating your last meal?
And then trying to shorten that window. Cool. I'm into that. At this point, you also may be thinking, at least I was, and maybe the person listening is thinking, our YDF following is listening, this is just intermittent fasting, right? Are we just doing an intermittent fasting
[00:08:43] Julie Bruene: episode? Kind of sounds like it from the last thing you said, of just like only having a certain period of time during the day where you're consuming stuff.
I think it's
[00:08:50] Jeremy Alland: debatable because I think all of this stuff is a little bit amorphous. I think, you know, there's a lot of overlap between all of these things, especially in the nutrition world. There's just a lot of overlap between all of it. But Dr. Holly emphasized in this piece that it's not the same thing as intermittent fasting because he says fasting actually upsets the notion of chrononutrition because periods of prolonged food restriction and chronic energy restriction Ignore the body's circadian rhythm.
So his direct quote was there is an Absence of meals and intermittent fasting whereas time restricted eating is all about maintaining the normal circadian profile throughout the day. Got it So I think what he's emphasizing is intermittent fasting says don't eat food don't eat meals during a certain period of time and have Certain amount of time between it and what?
Chrono nutrition is saying is figure out what your circadian rhythm is and eat along that aspect. And maybe they would be the same. Like there's a chance I think that intermittent fasting and your chrono nutrition could be the same, but there's also a chance that it wouldn't.
[00:09:46] Julie Bruene: That does make sense. And I can't recall if it was Dr.
Perella or if it was Kristen Holmes that was, that were telling us it's probably smart to have, 12 hours at least of the day that you're not consuming and usually that's like you're after your last meal until you, you know Sleep for your hopefully at least eight hours or whatever and then have your morning or first daytime Eating if chronodietrition
[00:10:09] Jeremy Alland: says that we should all be shortening our windows of time So we should be taking our 14 hours of eating and making it 12 hours Where should I find those two hours in general for the u.
s. Population? Where am I eating too many hours
[00:10:21] Julie Bruene: of food? I'm gonna say probably at nighttime in the
[00:10:24] Jeremy Alland: PMs. I like your hypothesis. Luckily, there was a recent study to help us figure this out. Okay, love. Are you familiar with the National Health and Nutrition Examination Survey? I think so. That sounds familiar.
The acronym is N H A N E S. Yes. Yes. Yeah. So, I think it is really important for us to maybe orient everybody. YDF community to this survey because a lot of recommendations that we get about our health are derived from this survey. Agreed. And I don't know if everybody is completely familiar with it. So the National Health and Nutrition Examination Survey is a program of studies designed to assess the health and nutritional status of adults and children in the United States.
The survey is unique because it combines interviews, so questions, but also physical examinations, so people actually get exams. It is a major program of the National Center for Health Statistics, which is a part of the CDC and has the responsibility for producing vital and health statistics for the nation.
So it began in the 1960s and it examines a nationally representative sample of about 5, 000 people per year. The people are located in counties across the country, 15 of which are actually visited each year for an interview that includes demographic, socioeconomic, dietary, and health related questions.
And then it also consists of an exam that has medical, dental, and physiologic Measurements as well as laboratory tests administered by highly trained medical personnel. So pretty comprehensive stuff that's done just on random people. Do you know if
[00:11:46] Julie Bruene: it's the same people? I mean, it's not the same people every time.
It's every time they do the survey. It's different human
[00:11:52] Jeremy Alland: beings. I can't tell you off the top of my head if there's ever been somebody that's been repeated, but the concept is is that they're taking a sample of 5, 000 people across the country different every year. And by doing that longitudinally, they're going to get a big sample of the United States and our health.
So, now, findings from the survey are used to determine the prevalence of major diseases and risk factors for diseases. So, if we say this many people in the United States have type 2 diabetes, Some of that comes from this information or if we say this many people are at risk for developing a hypertension You know, some of it may come from this information.
So a lot of you know, look, this is a big deal here Information is used to assess nutritional status and its association with health promotion and disease prevention. So they're taking people's Habits and then they're associating it with health promotion as well as disease prevention So when somebody says you should do this because it is associated with decreasing this some of that comes from these associations Where they say for these 5 000 people the people who stayed up past 7 p.
m Ended up having less colon cancer. So you should stay up, not stay up past 7 p. m. Obviously that was made up, but you get what I'm saying. Yeah, I get the idea. The findings are also the basis for national standards for such measurements as height, weight, and blood pressure. So when we talk about like what are the averages, they actually get them through this.
And data from the survey will be used in epidemiologic Excuse me. Epidemiologic studies and health sciences research, which helped develop sound public health policy, direct and design health programs and services and expand the health knowledge for the nation. So in summary, it's important. And I think honestly, I'd encourage everyone who's listening.
If you haven't to go to the site, we'll put that in the show notes and explore the data. It's presented in ways that you know, non medical people can interpret. You certainly don't have to spend hours there. But I think being familiar with where this information is I What it is and how you can access it from time to time is really good because I think as you start to get a background of where these studies are coming from, then you can get an idea of where this data was coming from and then follow it over time,
[00:13:46] Julie Bruene: especially when you're looking at health headlines and things that pop up in the news.
I bet a lot of them are going to reference this and that's why you're bringing it up of like, according to N. Haynes, blah, blah, blah, blah, blah. And now, now you'll know that and be like, Oh, I know what that is. And to be honest with you, my opinion is that that sounds like a legitimate bit. You know, epidemiologic sort of widespread public health statistic, pretty legitimate way of gathering information.
I mean, I'd love to battle with a statistician about that and see if maybe I'm wrong. But to me as as a sports medicine physician in 2020 for. I think that seems like a legitimate way to gather information, especially if it's done consistently and longitudinally and is taking a slice of the U. S.
population that seems pretty random. I don't know. I think it sounds
[00:14:29] Jeremy Alland: legit. To further clarify that Julie, this is just data that's collected. It's not interpreted per se. Right. The studies themselves are the ones where you're hearing about it. So you made a good point. This references NHANES. These are people who then, this is public.
Data so people can then access this data to do studies on so they're like i'm going to use n haynes data to find out an answer to a question and so then within that you would want to have a statistician say is this person interpreting the data correctly so it actually can bring this all back because there was a study that recently came out in the journal of clinical nutrition in october of 2023 titled comprehensive assessment of chrononutrition behaviors among nationally representative adults Insights from NHANES data.
So basically they looked at data from 2003 to 2018 within NHANES and they were doing a comprehensive assessment on chrononutrition behaviors. So when people ate and when they didn't eat and when they had most of their calories and so on and so forth and then subcategorizing it by like did men do more or Did white people do more so much?
I'm going to send you three key findings from this study and you're going to enlighten us. Okay? Okay. Sounds great. So I'm going to send it in the chat. I love
[00:15:38] Julie Bruene: enlightening. Okay. 35 percent of us adults had long eating windows lasting 13 hours or more. So you told me before that Dr. Holly was saying maybe it should be more like it.
10 or 11? 11, 12, 11?
[00:15:51] Jeremy Alland: Yeah, he was saying shorten it. And so we haven't in this episode really defined what the ideal would be, but this is establishing that over a third of us are over 13
[00:16:00] Julie Bruene: hours. Is that supposed to be bad? I don't know. Sounds great. Next one. 59 percent of individuals consumed calories after 9 p.
m. I am part of that 59%. Probably almost. Almost
[00:16:11] Jeremy Alland: every day. Yeah. And what calories are those? Cause mine is usually dark chocolate. Yeah. Or
[00:16:16] Julie Bruene: like, again, like I'm a bad water drinker. I drink a lot of kombucha. So I have like kombucha by the side of my bed. That's like my, like, Ooh, I wake up in the middle of the night and I'm thirsty.
I'll have a swig of kombucha. So I mean like that counts as calories, I guess, but yeah, but it's also like snacks. It's like. trail mix or yeah, chocolatey things or not dinner, sometimes dinner, sometimes late dinner. I would
[00:16:35] Jeremy Alland: like to again remind people as we read these stats that it's not supposed to establish whether this is good or bad, it's supposed to orient us to where we currently are.
Although I immediately
[00:16:43] Julie Bruene: get defensive, do you notice that? Excuses and such and that's a giggling.
[00:16:50] Jeremy Alland: Last stat that you're going to share with us.
[00:16:51] Julie Bruene: 36 percent of daily energy intake is consumed during dinner meals. Okay, that certainly sounds about right
[00:16:57] Jeremy Alland: for me. What that is saying is, is not 36 percent of us, but the average person is consuming roughly 36 percent of their daily energy intake towards the end of the day, rather than the beginning of the day.
Sounds about right to me. One other thing I want to point out from there was that over that 15 year span, there was only a 2 percent reduction in the time of eating window. So basically no change, even though I know that when I ask around, everyone seems to know that eating late at night is bad for you, but over that 15 years it wasn't like we saw Wow, actually, oh, 10% of the, the window going down by 10%.
So people are clearly decreasing their window. Naturally it stayed the same, more or less for the 15 years between you seven. So we're not changing as a
[00:17:36] Julie Bruene: population, it was oh three to 18, right? Correct. Got it.
[00:17:39] Jeremy Alland: Alright. So it seems that if we're going to buy into Chrono Nutrition and we can decide whether we're gonna do that or not later, but let's just say.
For argument's sake, we're going to buy into this and we're going to shorten our window. Nighttime eating is where we should start, at least based on this data from this study. Would you agree? Yes. Nighttime eating, believe it or not, is actually an area where we have some decent research because in nutrition, it's very difficult to find places with decent research.
So here's some things that research in general has suggested for night time eating. Eating close to bedtime is linked with worse acid reflux. We've heard that before, right? You eat closer to bed and then you lay down flat and you can get worse reflux. The closer a person eats before bedtime, so the closer you eat to bedtime, the more likely you are to wake up through the night.
So that's what you mentioned with sleep. The recent study showed people who snacked after 9pm, you and me, had higher hemoglobin A1Cs, which to refresh everybody is the three month average of glucose that we test for when screening for diabetes. So if you snack after 9pm, there was an association to a higher A1C.
Okay. Carbohydrates consumed at night result in greater blood sugar spikes than those consumed during the day. So if you have the same carbohydrates at night than you do during the day, your blood sugar spikes more. And there is a proposed mechanism for this. Melatonin, which is our sleep promoting hormone that we're all familiar with, it decreases the release of insulin.
So when you have increased melatonin, you're going to have suppressed insulin. So your blood sugars are going to be higher.
[00:19:04] Julie Bruene: Which makes sense. I mean, like, if you're winding down and trying to just, like, be completely immobile for eight hours, then that would make sense that your, your body wouldn't be needing a bunch of sugar.
[00:19:14] Jeremy Alland: that it makes sense because then we should be following our circadian rhythms. I think that jives. It makes good
[00:19:19] Julie Bruene: sense. It does make good sense.
[00:19:21] Jeremy Alland: Phil Skiba. The ski instructors that we had in, in, on our vacation were from England and Olive loved the accent that her Josh had. Yeah, cute.
Make good sense. It's cute. These increased blood glucoses. So the thought process here is that having increased blood glucoses, and then also some associative data, so data where you examine a large population of people, 800, 1000, 1500 people, and say, of the people who eat late at night, who has an association with increased weight gain.
So between having increased blood glucoses and associative data, there's thought process that eating late at night also promotes Gaining weight or at
[00:19:59] Julie Bruene: least there's some associative connection there, but may not have
[00:20:02] Jeremy Alland: causality It still requires a lot more study and and that's why I said all of that, but there's association I think many of us have that in our heads that if we eat and then immediately lie down that's bad for Are a lot of things but weight as well.
So there was an interesting study from 2022 that I want to describe Dr. Frank Shearer at Brigham's in Boston and his colleagues asked 16 overweight or obese adults to live in a laboratory and They had their meals. It's just a weird
[00:20:27] Julie Bruene: sentence at first. I know, right? Go live in a laboratory. Like, no thanks.
Yeah. It was
[00:20:32] Jeremy Alland: a Holiday Inn Express. Well done. Also known as a laboratory. Yes. They had their meals, exercise, and sleep carefully regimented. So all of the subjects followed two different schedules. They did, they followed two different eating schedules, each for six days. One schedule allowed for breakfast soon after waking, lunch at midday, and dinner in the early evening.
And then the other shifted meals four hours later. with supper around 9 p. m. Okay. Nothing else changed. Okay. The participants consumed the same amounts of nutrients and calories on both routines, yet on the later meal schedule, they felt hungrier than they did on the earlier one. At the same time, because they took blood tests, their levels of hormone leptin, which is the hormone that signals fullness, was lower throughout the day, and their levels of ghrelin, which is the hunger hormone, the one that tells us we're hungry, was higher.
They also burned fewer calories.
[00:21:22] Julie Bruene: That was the Late
[00:21:24] Jeremy Alland: shifters. Correct. So the late shifters had lower amounts of the thing that said you're full, higher amount of things that says you're hungry, and burned less calories than the people who were eating earlier in the day. So, let's emphasize this was only 16 people.
I don't have the demographic data on them, but they were overweight and obese. It was randomized to you know, two different groups, but larger, more long term study is needed. But it does appear like through everything I've said to this point, not just this last interesting study, that there's a strong enough pattern to me to say that eating at night is bad.
Do you agree? But it's interesting that it was
[00:21:56] Julie Bruene: in their entire day was
[00:21:58] Jeremy Alland: shifted. Yeah. It's bad for you overall. Just it's bad for your wellness.
[00:22:01] Julie Bruene: No, my point is like, it wasn't just that they had their last meal later. It was that they had all of their meals later. So again, like you could make an argument to say like, well, maybe eating breakfast later was the thing that made it bad.
Not the nighttime eating.
[00:22:13] Jeremy Alland: Probably not. It could be. Yeah. So I guess in theory, they all had the same chrono. Nutrition window, I guess they all probably had the same 12 hours, but they shifted the 12 hours later So in this case eating at night is bad is the suggestion out of that one Not just having a larger window got it or I guess eating breakfast later but then if you had a shorter window and ate break this study didn't look at having like if you had No breakfast like Julie Bruni, just your coffee until you get to about 11 a.
m., but then you decided you were going to have dinner at 6 p. m. or 7 p. m. and then not eat after that. So now your window is really short right now that what's that an eight hour window. What would the outcome of that be? That'd be interesting to look at too. I don't know how many people could survive on that eight hour window though.
Isn't that what intermittent
[00:22:53] Julie Bruene: fasting kind of is? Is this that you're shortening the window as much as possible? I think
[00:22:56] Jeremy Alland: so, except for the fact that again, like it just kind of, this is where like there's a lot of overlap and maybe having. Somebody who specializes in intermittent fasting could weigh in, but again, I think it can be intermittent fasting, but again, intermittent fasting isn't trying to look at your actual circadian rhythms, which is why I think in this study where they just shifted it the four hours, I think the sleep schedules were the same.
And so in this case, they went off the circadian rhythm versus if these people are people who wake up four hours later and then shifted everything. Maybe it wouldn't be that big of a deal in terms of like your circadian
[00:23:27] Julie Bruene: rhythm. That's sort of my thought process too because I tend to be a little bit of a later go to bed queen.
So that's sort of the part of the reason why I have those shifts as well. But I think, you know, and there's probably some talk to have when we finally have our like dedicated sleep episode that we've talked about having for so long about, and there's seems to be good data. And another thing that we talked about with Kristen Holmes was consistent bedtimes is probably better for your sleep quality.
And we know if we get better sleep quality than the rest of our health predictive things go a lot better as well that we've seen. So interesting.
[00:23:58] Jeremy Alland: I'm just two days a week, Julie, you start clinic later, you have a later morning start, you know, my stuff. So on those days, if you went to bed later, I do before those, the night before and woke up later, And then had meals that were based on that.
circadian rhythm. Sure. And then eight dinner later because of that, it may be fine. Yeah. Right. So if you had dinner at 9 p. m. but you don't go to bed until midnight or 1 a. m. Midnight. Yeah. But then you're waking up at 9 a. m. and then having breakfast at 11 a. m. maybe you're fine. But the, the other issue is, is that on Wednesday.
You shift the other
[00:24:32] Julie Bruene: way. Correct. And then I just end up going to bed way too late. Yeah. Now I'm sleep deprived and I'm hungry. So it's not good. This is
[00:24:40] Jeremy Alland: challenging. It's like, I know we don't live in a vacuum. It's challenging, but it's interesting to think about, right? Because certainly I do think. Just like we've talked about, we have an upcoming episode on the gut microbiome.
Like some of these, these things that are developing that seem like they're going to be major influences in our health as we start to learn more. It really feels like the circadian rhythm, which has been around forever and is not news to anybody, has really taken hold as like, we need to pay attention to this for not just like sleep.
It controls a lot of things.
[00:25:08] Julie Bruene: Yeah. And to understand how it works for not just like for every single human being, but for you in particular, and what, if you can create consistent habits. that support it and that are kind of naturally follow it. That seems, I don't know, that seems like that would hold water, that that could be another kind of way to fall into those health promoting behaviors
[00:25:26] Jeremy Alland: a bit better.
Totally. So I did reach out to our lifestyle medicine guru, Dr. Naomi Perella about this. She agreed as well. She said nighttime eating is in capital I S. a problem. She recommends to her patients a clear 12 hours of fasting overnight most days. So she recommends 12
[00:25:43] Julie Bruene: hours. Yeah. And that's what I was my recollection before.
I think it was Naomi that had mentioned it because I remember knowing this for a long time and that changed my habits and especially it was like, okay, the days that I'm going to go to bed later, if I have snack at 10, then I probably won't eat till 10 the next morning. And which works for me. Cause I'm not really a breakfast person anyway.
So, okay. I like that. The problem is that nighttime right now is three o'clock. Nighttime is three o'clock. here. So do you mean it is dark outside or do you mean the general times that you would consider the evening? Like that's my problem with this.
[00:26:14] Jeremy Alland: Yeah. So now this is the, the subsequent episode. Now, now you're part two where we have to bring on the circadian rhythm expert that says for people who live in the Northern hemisphere where we are, they night cycles get off during seasons.
Do we have to adjust our, our eating habits based on that now because our circadian rhythm has changed. So, but that's like the 300 level course, Julie, we're in the 100 level course right now. I
[00:26:35] Julie Bruene: know it's just It's too hard. Yeah. I've asked the question, what is nighttime? What is sky? What is light? It's getting very, very esoteric here on your doctor friends.
[00:26:48] Jeremy Alland: We're now existential. So, all right, let's wrap this up with some advice on how we can actually, like, if we've decided that we, for 2024, we're going to make a resolution that says we're going to decrease nighttime eating and that you can decide if you want to do that or not based on this episode. YDF. I think.
In general does not have a strong stance that anybody you need. This is a personal decision Yeah, but let's just say you've decided that that's important to you Here are some things that I think would help I would say try to avoid eating three to four hours before bedtime That's
[00:27:17] Julie Bruene: too many hours
[00:27:18] Jeremy Alland: I can do two that is more than just for your circadian rhythms that is in addition with the Reflux and then waking up at night and all the other things that that is associated with if you find that difficult You knew I was going to say, I knew you were going to say you couldn't do that.
So if you find that difficult, start with the time you eat breakfast regularly and then count backwards around 12 hours and try to stop by then. That makes sense. If you have to eat after that time, there are times where like, you're like, I just need to eat for whatever reason. Your regular eating
[00:27:49] Julie Bruene: schedule got disrupted because you were too busy during the day or you were, something was very different or you were traveling or whatever.
Like, and I'm like, I didn't really have any dinner at, and now it's nine and I'm. I'm freaking hungry and I don't want to go to bed starving because I'm not going to sleep well because I'm hungry, you know,
[00:28:04] Jeremy Alland: or if you're like me, you did have dinner, but it was at six o'clock and now it's later and you want to eat something.
So avoid high carbohydrate and high fat foods. eat small nutritious foods higher in protein. So some examples of this would be like plain Greek yogurt, hummus, nut butters, you know, ones that are not full of sugar, right? Make sure you're not getting nut butters that are just slammed with sugar. You want
[00:28:29] Julie Bruene: natural nut butters.
No Nutella, not Nutella. That doesn't count. Yeah. I know there's hazelnuts in it, but it's basically
[00:28:34] Jeremy Alland: frosting. I also recently learned that Nutella is packed with palm oil, which is its own other episode of how that's killing the world. So sure. And then whole grains would be another one. So, you know, stuff that we probably would be recommending throughout the day too, but really emphasizing at night that those are the things that you'd probably digest the best and not cause those high blood sugar spikes and keep you satiated.
So, and the last recommendation would be to listen to our upcoming episode with Dr. Perella about her perspectives on our metabolism in today's world, because Her perspectives are very interesting, and this is a really nice on ramp to kind of like how she is seeing lifestyle medicine and metabolism and nutrition in our current world, which includes more information on circadian rhythms and more information on metabolism and ozempic and all of those other things.
Last recommendation is listen to that upcoming
[00:29:21] Julie Bruene: episode. I love those recommendations. I think that's great. And really, to be honest with you, like this is a health behavior that I would consider continuing or changing based on not so much about like weight loss or weight maintenance. And I think on your doctor friends, we, we lean towards heavily towards weight, neutral healthcare delivery.
And And I think it's sort of like, it's not so much as like, here's one way to like, one weird tip that the doctors want you to know to like, get rid of your belly fat or whatever. It's more like, hey, this is something that the data may show us that at least has a benefit on sleep efficiency. And I think that's always great.
And there's, there's really no argument to say like, It's okay to keep having shitty sleep. It's fine. Like, if there are things that we can make relatively small changes that don't hurt you, and it provides some data or some, there's some data that shows that this can, this can promote better sleep where you stay asleep longer.
You're not waking up, you have better sleep quality. I think that alone is worth it. So
[00:30:22] Jeremy Alland: that's my thought. I'm going to try this. Yeah. And I will report back on how it affected me. I'm going to try at least for maybe the next month or two. This is my, my dry January. I'm going to try to not eat after a certain period of time.
I have to figure out what with that time is going to be, but I think that that study. That was done where they made the people live in that laboratory of Holiday Inn Express. Yes. The thing that stood out to me, and again, I, I agree with you that whether you're trying to lose weight or not, like this is way beyond what I would like the take home to be is that weight loss or maybe even a better description would be like a lack of weight gain is lower down on the list of things that I think is important with this.
Sure. This change, but the fact that people, you know, we know that leptin and ghrelin are, are huge. Impactful hormones that we're learning more and more about on a regular basis and the fact that people had food Later at night that affected their whole day of hormonal balance of ghrelin and leptin I think is really interesting because I think you know Like why was I so hungry or why was I?
Not full or and you even mentioned earlier with you like I skipped breakfast because if I eat breakfast then i'm like hungrier throughout the day And again, so like the shift in those hormones is really, really interesting. So I'm interested to see how it affects myself. I'm interested to see more research come out, but I'll report back on what it does to me.
Yeah. And you
[00:31:34] Julie Bruene: don't know until you try it. And if there's not really any data that shows this is going to harm you, like it's not going to hurt you to try this for a couple weeks or a month. And if you notice, like, I don't know, it didn't really seem to. I didn't seem to see any return on investment on it, then just go eat your pudding before nighttime if you want.
Or, if you feel like, oh man, I kind of see a correlation between like, I, you know, I slept better, I felt more refreshed, or my, my fitness tracker told me my sleep wasn't total shit the past month, like, huh. All right. Well, maybe that's something. Yeah,
[00:32:02] Jeremy Alland: I wasn't so hungry during the day. I felt like I was more satiated.
I wasn't craving the processed carbohydrates I usually do at 2 p. m. or I didn't need the caffeine that I always have at 1 p. m. that I usually do. Stay away from my caffeine, sir. And, and the pudding you were referencing was plain greek yogurt, correct?
[00:32:18] Julie Bruene: Sure. That, no, not, it's not British pudding. I'll say that.
[00:32:21] Jeremy Alland: Okay. Well, that's it for the entree that we ate before 9 p. m. tonight. And, uh, we'll be right back with, with a little dessert. So. We'll be right back.
[00:32:33] Julie Bruene: All right, we're back. So, Jeremy, I'm going to make this fit into our sort of like, it's January, let's talk about resolution type topics. And follow with me because I'll take you there, okay? Okay. This is also something that, that I like to keep things topical and I like to react to stuff that I find interesting when it comes across my feed or my inbox
[00:32:52] Jeremy Alland: or whatever.
I have this image of the cat hanging that says, hang in there.
[00:32:57] Julie Bruene: Stay with me. I haven't led you that far astray in the past. So we have good track record together. And that goes for you too, dear listeners. Don't change the podcast yet. No, it's worth it. Okay. So I came across an article by NBC news titled, will the first FDA approved at home tests for chlamydia and gonorrhea ease the epidemic?
[00:33:16] Jeremy Alland: resolution is this going to get at?
[00:33:18] Julie Bruene: Well, you'll get to it. I think, spoiler alert, I think it'll just be people taking stock of their. sexual health risks and deciding to maybe become curious about home testing,
[00:33:30] Jeremy Alland: potentially. I love it. Okay. Let's all get less chlamydia and gonorrhea over 2024 and maybe protect spreading it by having home tests.
Is that where we're going? Totally.
[00:33:40] Julie Bruene: Yes. Okay. What are our SMART goals, Jeremy, for reducing STI risk? Let's do that. It is very specific. It is quite measurable. Alright. So, but apparently diagnoses of gonorrhea, chlamydia, and syphilis have soared in the past two decades. And a lot of public health experts argue that this is at least partially driven by the dismal funding of the CDC's budget to fight the spread of STIs during the past couple of decades.
Clearly the CDC has had at least one big public health Global public health problem that took up a lot of issues back in 2020 and then beyond, but there's a lot of people who have been talking about for the past couple of decades that STI prevention and public health sort of support has been pretty, pretty
[00:34:25] Jeremy Alland: poor.
Yeah, well, there was the peak in STI with HIV, right? I mean, so like, yes, HIV started to get attention and finally was given. the attention it deserved with treatments and preventions. And then it kind of felt like, okay, we're winning that battle, so we don't have to do STIs anymore.
[00:34:41] Julie Bruene: I think if you talked to an infectious disease specialist or a public health specialist, they'd be like, whoa, whoa, whoa, whoa, whoa, we're, we're doing stuff, you know?
But I think, yeah, from an outsider's Or, you know, just like a general physician or a healthcare person's perspective. It does kind of feel that way. I don't disagree with you. I didn't realize until reading the article that at home testing for STIs even existed. Did you know
[00:35:03] Jeremy Alland: this? Like it exists already?
Yeah. And it's legit? It's not like homeopathic stuff? That's what
[00:35:08] Julie Bruene: sort of this article is talking about. FDA approved home testing? Correct. That's the big asterisk. So I guess home tests for STIs are already available over the counter. I searched. Which was embarrassing. I wanted to do it in like
[00:35:20] Jeremy Alland: incognito mode.
Did you clear your search
[00:35:22] Julie Bruene: history? On my, on my laptop and phone that's owned by our practice, which is probably not very smart, but who cares? None of they, none of they business. But yeah, so Everly Well has a quote male and quote female test kit for it's, there's a couple different options. There was one that tests for gonorrhea, chlamydia, syphilis, hepatitis C, trichomonas, and HIV.
You can do all of those. Guess how much that one costs. Is it urine? It's urine and a swab. For that one, it's urine and a swab. Like a mouth swab? No, that's an interesting part. We'll get to that too. This is a dessert episode, but it's a little bit of a larger dessert because I just found this interesting.
[00:35:56] Jeremy Alland: I didn't realize that you could test for HIV and like hepatitis through a swab and urine. Interesting. How much do I think that costs? 500. It might
[00:36:04] Julie Bruene: also be if it is with HIV, I'd have to look at this test again. There may be a finger stick blood, like a little blood that you put on a card thing. That makes more sense to me.
Yes, yes, yes. Sorry. That one is a swab. I think it's a swab urine and a blood like a little, no, it was 169 bucks for those like five pathogens. And then, or you can test. just for gonorrhea and chlamydia, and that one is just a urine test. That makes sense. For guess how much? 50 bucks. 69 dollars. Did they pick that number on purpose?
I know you were going to say something about that. That's bullshit. Moving on. But the FDA, which has not previously sought to enforce regulation or require that the manufacturers apply for formal approver, approval, like can't vouch for the accuracy of those tests. What? Yes. So recently the FDA released their first approved gonorrhea chlamydia at home test.
It's called the simple two, which you can get at some, it's called letsgetchecked. com. I've seen billboards for this. Have you seen, you'll probably see them now that I mentioned it, that there's like go to letsgetchecked. com and like look at your options for STI testing at
[00:37:07] Jeremy Alland: home. You're going to get a lot of those in your social media now that you've been googling this stuff.
[00:37:10] Julie Bruene: Yeah, yay. So this test via letsgetchecked. com, which is gonorrhea and chlamydia. only and it's just a urine test is 99 bucks. So it's a little bit more expensive than the Everly Well one, but it is FDA approved. And to be clear, it's only this test that's FDA approved. Although if you go on, let's get check.
com, you can get like the more comprehensive tests like that five. Person the five things that was like the swab and the blood is available there too. I think it's 149 And that's FDA approved as well. No, it is not. It's just the GC. Just the gonorrhea chlamydia Okay is FDA approved and this just happened within the last like month or so that this is like now FDA approved you can do it It costs 99 bucks.
It's not, to my knowledge, covered by insurance, but you can use your FSA and HSA accounts for this. The interesting thing was, it's 99 bucks, but if you want to subscribe and save, and you get a new test every three months, that one costs 69.
[00:38:06] Jeremy Alland: 30. Man, you should be meeting with somebody to figure out why you need to subscribe and save to that.
[00:38:10] Julie Bruene: Exactly! I was like, what? No? Also, the other part of
[00:38:13] Jeremy Alland: this is It's the third thing you should ask on your first date with somebody is, Do you subscribe and save to the Uh, gonorrhea and chlamydia. To
[00:38:19] Julie Bruene: the simple two. Yeah, right. Yeah. If it's positive, the company connects you with a virtual visit or an opportunity for a virtual visit with a healthcare provider to discuss treatment strategies.
And the cost of that visit is 39. So, okay, you know, interesting. Previously, HIV was the only other sexually transmitted infection to have an FDA approved at home test. So HIV testing at home, FDA approved, already exists. This is the second vaccine. STI testing at home that's FDA approved that's ever existed.
Makes sense? It does. Some public health officials and advocates expect that greater FDA oversight will help sort of legitimize home STI testing and making it easier to get like insurance coverage and actually sort of expanding its use and make maybe making people use it more. However, the other side of that is there's a consortium of LGBTQIA sexual health advocates that they have kind of objected to this policy proposal.
So basically the FDA said like there's Myriad at home testing that exists already that has no federal regulation. So like, like when we've talked to Dr. Stukas in the past, how you can do like those home, like, am I allergic to everything tests? Like many of those are not FDA approved. You can just be a company and say, look, this is a test and here you go.
And you say, you give us your. You give us your, your biologic fluids and we test them and we give you a result back. But there's no federal regulatory guidelines. And so basically the FDA, FDA is thinking about pushing more of like, these exist so much, we should probably be maybe enacting some standards.
And making it a little more difficult for those companies to do that. And there's some pushback one way or the other.
[00:39:56] Jeremy Alland: Is there like an FDA approved logo? You know how like things have to have an organic logo on them if they actually Yeah, I think
[00:40:01] Julie Bruene: it's just the big FDA thing. A central worry from like the sort of the sexual health advocates is that the expense of meeting the FDA's demand could drive some companies out of the STI self testing market and otherwise drive up the cost of the test, which clearly it already has a little bit.
I mean, this test is 99 bucks. And the other one that you can get online is 69 bucks. So something to be said there, but I would pay the extra 30 to know that, that there's more assurances that it's accurate. I would like to know that if my negative means negative and my positive means positive. So interesting thought processes.
[00:40:34] Jeremy Alland: And these are not covered by
[00:40:35] Julie Bruene: insurance. No, but you can use. like flex mending stuff for it. Apparently that was what on their web on their website.
[00:40:40] Jeremy Alland: You said that the one that was not FDA approved did not publish their accuracy statements. I
[00:40:45] Julie Bruene: don't know they might but it's hard to know like what's the vetting process for that?
Okay, it's at least not backed by the FDA. There's also concerned that the newly approved tests. So this simple to that's just gonorrhea and chlamydia doesn't cover syphilis. which apparently the increase of syphilis has gone up exponentially. Syphilis requires a finger pricked blood sample. And syphilis has gone up 74 percent since 2017.
There was 177, 000 new syphilis cases in 2021. And the One of the major concerns, there's many major concerns about syphilis, but then congenital syphilis is when brand new newborn babies getting it can be lethal and terrible. And so there's a lot more increased risk of, or prevalence of newborn syphilis, which is a very, very big bad problem.
So their part was like, well, it doesn't cover syphilis, which is. Not great. And their other concerns is that the simple two test is urine only. If you're going to check other things, the only way that they're approving it is by vaginal swabs. So their point was like, it's not really well suited to address gay and bisexual men's needs because they're really testing effectively only infections that have come from vaginal intercourse because they're not recommending that their swab based tests be oral or anorectal swabs.
So some just thoughts there as well. But really the simple two tests doesn't really matter. The one that's FDA approved is just a urine test. So they're talking about I think like other, other tests that are available
[00:42:08] Jeremy Alland: on their website. It's interesting. It seems cost prohibitive to me. It just kind of feels like the people who would want, I'm not saying nobody would buy this.
I think a
[00:42:15] Julie Bruene: lot of people buy them already. And people would rather not go into the doctor's office because it's too difficult to go to the doctor's office. And even if you have good insurance, you're still paying co pays and you have to find time and go there. And who wants to wait for four weeks to see their doctor if they think they have the
[00:42:29] Jeremy Alland: clap?
I don't think you have to wait four weeks to see your doctor if you're worried about that. I think most people go to urgent cares or or if you call your doctor and just say, you know, like i'm worried about a sexually transmitted illness, I think that they would get you in immediately. I think it's more so not wanting to call up somebody and say you're worried that you have a sexually transmitted illness or shame or, or things like that.
But like, it's still 150 bucks. I mean, I'm sure there's college kids that can afford that. I'm not sure how often they're going to
[00:42:55] Julie Bruene: buy it. Or yeah, I mean, if you're plugged in with your, a student and you have student health. You know, some type of coverage, but I, I think there's a lot of hidden costs that if you don't have great insurance or you don't have insurance or your deductible hasn't been met, that I think doing STI screening could be prohibitively expensive.
And this is maybe a more cost effective option. You think of like even just an urgent care, you're still going to get a bill for labs. You're still going to get a bill for the, that visit. You still have to go there and do it. It might be great to be like, Oh, I can order this thing off of a website and I get it for a hundred bucks.
And then I have someone that gives me treatment for it and then I'm done. I get what you're saying, but I think that in the end the cost effectiveness may be on this side of things and I don't have to like rearrange my schedule or take off time from work or talk to a human being other than like if it's positive.
[00:43:41] Jeremy Alland: What's interesting is like it feels like to me that the thing that would limit somebody's Access to the tree or to the testing, which is why this test exists is access. You want people to have access to the test, which is great, right? I think if more people had the ability to test, you would have less hopefully transmission because if somebody was worried, they had it.
They've got a positive like, okay, well, I'm not going to have sex and I'm going to get treatment versus not wanting to go get tested and then possibly being at risk or having tertiary complications, meaning like gonorrhea and chlamydia can spread and cause worse problems or syphilis can cause worse problems.
Yeah. In your own body. Right. I think of this going down the route of like maybe like a forhymns. com where. Sure. Like why couldn't this turn into like just a telemed visit where you're getting a discreet visit and then they shipped you the test and then you send the test back and it's all covered under insurance, that kind of thing.
And I think that's where
[00:44:30] Julie Bruene: this is going and I think that's why letsgetchecked. com which doesn't sponsor us in any way or anything. It's just who I saw and this
[00:44:36] Jeremy Alland: is. That's an amazing sponsor. Why can't we have that? Isn't it?
[00:44:38] Julie Bruene: I know, right? And it's who. it's, this is the only one that the FDA is approving that test.
I'm assuming that if that goes well, they're probably going to approve more of them, which is great. What you're saying is exactly what they're doing. It's basically like choose what type of testing you can have. The simple two, which is the FDA covered one, which is just gonorrhea and chlamydia. And then there's a five and then there's like an eight testing thing.
And then baked into that, it turns into, if you want to meet with a healthcare provider virtually, it only costs this much more. And then we'll just send you treatment. We'll, we'll send you a prescription to your Pharmacy or something if it's applicable. Cool. So you're what you're saying is what's happening here.
And I think what's interesting is okay Well now the FDA is deciding to throw their hat in the ring and say we're gonna regulate this And some people are like that's awesome. Good. It gives some legitimacy to it So it's not just like everybody can do it and you want to make sure that there's standards But it's also some other people saying like, okay Well, let's make sure we do this right so it doesn't become prohibitively expensive or it it makes it harder for people to access So that's the argument here, but I think it's It's cool and interesting and I didn't even know this
[00:45:36] Jeremy Alland: stuff existed.
I didn't either. And it seems like the theme of the day is that things that happen after 9pm are not good for our wealth. Or, are not good for our health. Or wealth. So, don't eat after 9pm in most of these. Infections are probably happening after 9 p. m. Oh, God. I connected the two. Did you see that? This is like
[00:45:55] Julie Bruene: Gremlins.
Happy New Year, everybody. This was fun. I'm so glad, just in general, as an aside, so glad to be with you recording again in the New Year, Jeremy. This is so fun. I feel very energized. We're super excited about bringing y'all some really kind of fun, new content and playing around with different ways of organizing it and sort of meeting everybody where they're at as far as what are and trying to get more feedback from our listeners to talk about like, what are you interested in?
What do you want to hear about? We'll, we'll do the book reports for you and then just spit it out and give you the information that we think is relevant and helpful to you. And there's, I feel like you, you got the opportunity to talk about your own happiness and gratitude being a part of this partnership and a part of this cool podcast.
And now I get to, cause now it's 2024 and. I think I'm very excited about what we're moving ahead and doing. We're not going to
[00:46:44] Jeremy Alland: play around. We do really need the reviews and the subscribes. So yes, please. Any sort of clicks that you can do and spreading it to your friends really helps your doctor friends and the YDF community
[00:46:54] Julie Bruene: grow.
I thought don't spread it to your friends. You should get tested first and then you don't
[00:46:58] Jeremy Alland: have to. Oh, that's really good. That's really good. What we're going to say is the only thing that you're allowed to consume after 9 p. m. is this podcast. Listen to your doctor friends.
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