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

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hello my friends today my guest is dr.
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Ruth Patterson who’s a professor at the
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UCSD department of family medicine and
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public health and leader of the cancer
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prevention program at Moores Cancer
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Center at UCSD Thank You Ruth for being
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here I am very interested in some of the
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research that you are have been doing
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for the past few years and ongoing in
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terms of looking at this interface
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between metabolism and specifically
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breast cancer risk and breast cancer
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increased breast cancer recurrence so I
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know when I think you know of lifestyle
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factors that are modifiable and that are
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actually known to increase breast cancer
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risk obesity comes to mind
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sure obesity is definitely one of the
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big ones and also physical activity more
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recently we’ve become aware of the
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importance of physical activity what’s
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been harder for us to identify is exact
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types of foods that could reduce risk in
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fact we’ve not really had a lot of
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success in identifying individual foods
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or individual nutrients that seem to
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make a difference although I think
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there’s more acceptance now the idea
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that an entire dietary pattern let’s say
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the Mediterranean dietary pattern may
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you know influence risk over decades so
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I would say those are the probably the
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top concerns is diet quality obesity
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physical activity those are the thing
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and even tobacco can increase some
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increases breast cancer risk so there’s
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many things individual women can do to
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reduce their risk I was reading I think
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it may be the American Cancer
01:43
Association had had published them to
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statistics on how obesity can increase
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the risk of breast cancer by by twofold
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and also specifically looking at some of
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the mechanisms by which obesity can
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increase breast cancer risk they were
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there were a variety of them including
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increased inflammation increased hormone
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to estrogen and also increased fasting
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fasting insulin level
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yes I think we’ve known for a long time
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about sex hormones in particular
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estrogen is a risk factor because some
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of our first really successful drugs
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were based on blocking the action of
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estrogen estrogen is a growth factor so
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it appears if we can block that it can
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reduce your risk or reduce your risk of
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recurrence and we have some pretty
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effective drugs that have made a big
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difference it’s more recently that we’ve
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realized that other growth factors have
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the same type of impact it makes it’s
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almost common sense if estrogen is a
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growth factor and that increases growth
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rates of tumors
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well what about insulin it’s also a
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growth factor it encourages metabolism
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so we do believe that perhaps high
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levels of circulating insulin may be
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really central to the whole process of
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developing breast cancer and promoting
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its growth and high levels of insulin I
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definitely found in women who are
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overweight if you’re less physically
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active and then of course among
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diabetics often have high circulating
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levels of insulin so we do are becoming
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more aware that sort of that may be kind
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of a common Road era where many
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different syndromes lead to the risk
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increased risk of breast cancer and so
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insulin so you mentioned that people
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that are overweight and people that are
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obese have higher circulating insulin
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levels they also have higher circulating
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estrogen levels right so does fat can
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secrete is it am i right that can
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secrete estrogen or is that something
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that can yes so that’s pretty central
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and then what we also know is that
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people who have high levels of insulin
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have lower levels of serum hormone
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binding globulin something called shbg
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which binds estrogen so it can prevent
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it from being active so there seem to be
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related they’re not just two independent
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pathways they actually play off each
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other and you say you brought up
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something that was very I think
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important and that is you said that
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these growth factors they promote the
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growth of tumor cells of cancer cells
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that these are right that’s in a very
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general way right yes you
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or something you know something’s
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causing the initial damage the cells
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become damaged and you know we have a
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lot of mechanisms inherent in our in our
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cells that can sense damage and say well
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okay I’m going to die I’m going to kill
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myself because if I don’t may
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potentially lead to you know a cancer
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site but if you have all these growth
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signaling factors happening in the
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presence of that damage it’s sort of
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saying hey no no keep going keep growing
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don’t die grow grow grow yeah and you
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know so that’s sort of like I think the
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combination between things that are
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causing the damage which possibly high
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inflammation so obese obesity also is
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associated with high inflammation and
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then in the you know the combination of
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the inflammation and the you know high
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insulin the high insulin like growth
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factor the high estrogen it’s sort of
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like this detrimental combination of
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damage and growth signals to allow them
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to survive you also mentioned the the
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serum binding hormone that zoom hormone
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binding to hemoglobin and globin yeah
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HPG thank and you and you mentioned that
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buyings estrogen and sort of makes it
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inactive from going to you know activate
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I guess in breast tissue or whatever
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tissues
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what about also the the insulin so I
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mentioned the in some like growth factor
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pathway which is separate but from the
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insolence from the from insulin there
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are two separate growth factors but
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they’re also very interconnected yeah I
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think the data on into like growth
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factors a little less consistent and a
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little harder for us to understand so
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there’s we think it’s also playing a
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role but studies have been some studies
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have found it to be a risk factors and
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other study haven’t you’re talking about
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circulating levels I’m sure because it’s
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also very complex because there’s
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receptors for these things on the cells
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that may also play in right so so it’s a
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very complex system which is why we’ve
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had such a hard time coming up with
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cures it is because all there’s lots of
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redundancies and one system effects
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another system and so just finding like
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that magic pill that can turn
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all these different related pathways is
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virtually impossible there’s so many
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workarounds right our body our path is
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incredibly resourceful right so these
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three so these three factors that are
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known the fasting high fasting insulin
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high free estrogen right and the high
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inflammatory markers so it as measured
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by certain biomarkers like C reactive
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protein so these are all associated with
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in some cases even 2 to 3 fold increased
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risk yeah it’s definitely twofold and
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maybe a little bit more I think that’s
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generally what we with the metric we use
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each one of them increases the risk
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individually by twofold combination wise
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we don’t know it’s probably not quite
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additive but they still would have a
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combined effect too that’s you know
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reason to look at all these different
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pathways but those are definitely the
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three major metabolic pathways that we
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think feed into having kind of fertile
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soil so that when these DNA changes
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happen they’re in a place where they’re
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kind of like fertile soil more likely to
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go to an invasive tumor type okay and
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what’s so interesting about this is that
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your work what your your work and work
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of others is showing that these these
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three different biomarkers let’s say
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they can be modified by changing your
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your lifestyle pattern right a much of
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my research lately has focused on timing
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of meals which i think is a little bit
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of a newer hypothesis we all evolved to
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eat during the day when we’re out
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getting our food and then fast at night
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when we’re in a rest state but now with
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you know modern lighting and with modern
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lifestyles and short longer and longer
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work weeks you know our meal patterns
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less and less resemble the way we
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evolved to eat and we believe that it’s
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it’s very meta metabolically detrimental
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to eat a lot of energy and then right
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away lay down you know what are you
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doing you’re laying down you don’t need
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to have all the energy on board and all
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that metabolism going on when actually
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you should be in a fasting catabolic
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state most people probably actually eat
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one of their
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largest meals in ravening right it which
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is just so counter and just even in a
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common-sense way why do you need all
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that energy right before you’re about to
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become completely comatose it just it
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makes no sense right you really need the
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energy during the day you know when
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you’re busy up walking that’s a very
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good point and I think you also
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mentioned another important point and
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that that is eating during the day when
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we’re supposed to eat and timing it with
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our circadian rhythm right which is the
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the biological clock inside of our every
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cell we’ve got a stir regulator and
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different you know tissues which we can
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talk about in a minute but that master
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clock what’s what’s interesting is that
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it does it regularly now between ten
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fifteen percent of the human genomes
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regulated by this these clocks and about
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fifty percent of those genes are
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involved in metabolism right and humans
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are the most insulin sensitive upon
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waking you know first thing in the
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morning and then as the day goes insulin
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sensitivity goes down and so you know
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eating your biggest meal in the evening
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when you’re the most insulin insensitive
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would increase one of those biomarkers
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that you’re lugging about right or just
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metabolically just regulate you which is
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what we’re trying to have regulated
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metabolism and that definitely just
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regulates it and the whole circadian
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rhythm concept is the idea that that as
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you mentioned the master clock is
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trained to light you know it responds to
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light so the master clocks getting the
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signal let’s say in the evening you’re
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done but if you’re eating your the
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peripheral clocks like in your liver are
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going no we’re waking up we’re getting
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energy and we believe that when those
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two clocks are out of sync that that
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itself leads to some type of metabolic
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dysregulation and we don’t have fully
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metabolic you know or molecular
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understanding of exactly how this works
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but it’s a pretty solid theory and at
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least what we’ve seen in animal research
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yeah um so I mentioned to you earlier
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that I talked about this this meal
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timing with a collaborator of yours Tony
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satton panda who’s the Salk Institute
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and you know he he a lot of his research
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had focused on elucidating this
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important regulator of the peripheral
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clocks meaning the clock signal and the
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non brain so the libera or the heart is
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right right and how when you eat your
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first meal or even taking your first
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non-water beverage starts that clock
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mm-hmm and so if you start that clock
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let’s say you wake up at 7:30 in the
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morning and you have a sip of coffee
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7:30 in the morning the clock starts and
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he’s shown that eating all your meals
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within at least a 12 hour time from that
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when that clock starts seems to be very
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important for him you know having a good
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metabolic health right you know good you
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know glucose glucose regulation good
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insulin sensitivity being able to
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maintain you know lean muscle mass and
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keep fat loss off but what’s really in
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my mind I was trying to understand and
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like you mentioned we don’t know all the
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molecular mechanisms between the timing
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of the to both the master clock and the
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peripheral clock but how how they do
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seem to be working together so you know
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let’s say let’s say someone fasts in the
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morning they don’t eat breakfast they
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don’t eat lunch and then so they’re
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fasting let’s say they’re fasting for 12
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hours and then they eat a meal right
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before bed right we don’t know if that’s
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necessarily going to be as good as
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fasting during evening oh we in sync we
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totally don’t think it’s as good you
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know so our our research seems to show
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that two things one we see great be our
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biggest reductions in breast cancer for
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instance recurrence with at least 13
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hours of fast and we really believe that
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fast needs to start around 7 maybe to a
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p.m. at night people when people talk
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about breakfast what I often says when
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you talking to people who skip breakfast
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I think skipping breakfast is actually a
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marker of eating at night because if you
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stop eating early evening and don’t eat
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for 13 hours when you wake up you’re
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starving you don’t skip breakfast so a
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lot of times I think the research
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showing that not eating breakfast or
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skipping breakfast is bad
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is actually not studying breakfast it’s
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the people who skip breakfast we’re
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eating late into the night so we so we
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think it’s both it’s that we need a long
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stretch of time and there might be some
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improvements in gut rest or the
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microbiome like we don’t think that your
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your GI tract also was meant to have
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food constantly in there you know so we
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think it’s important to have a long
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stretch of gut rest but that that gust
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happens at night starting fairly early
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7:00 or 8:00 p.m. and then 13 hours
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after that so it’s both of those things
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either one is not sufficient and the
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microbes in your gut are also on that
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ascertain absolutely oh yes the GI tract
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is very very tied to circadian controls
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right you also mentioned another study
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that you just you’re one of your
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research kind of set in passing that 13
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hours of at least 13 hours of fast was
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associated with a lower breast cancer
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recurrence so do you mind talking about
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that study for a little bit I’d be glad
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to so this was a study in about 2,500
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breast cancer survivors and they
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completed over about seven and a half
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years of follow-up they completed many
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food records right so we collected all
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this information about what they ate but
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then more recently when this hypothesis
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came out we went and dug up all their
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food records and said well how about if
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we don’t care what you at 8 but we just
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care about when you ate it so weari
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entered all the data so I was when they
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started to eat you know when they
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stopped how long their fasting interval
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was how much they ate at night and then
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reanalyze that data and that’s where we
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found that it seemed at least in this
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sample of women that the cut point of 13
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hours reduce their risk of breast cancer
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recurrence by about 40% it also reduced
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the risk of mortality about about 20% or
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a little more than that but that was not
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statistically significant but it was
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just trending in the same direction you
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know it’s possible because we do believe
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it’s although my area of research is
15:27
breast cancer we actually blew this
15:29
dietary pattern could have really
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positive effects on other disease
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and conditions including type 2 diabetes
15:36
or liver fatty liver NAFLD also with
15:42
acid reflux you know don’t you know the
15:45
first thing they tell you is try to sit
15:47
up when you go to bed donate a big meal
15:48
so that which often leads to at the Safa
15:51
Geel cancer so we actually feel it can
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have a positive impact on many aspects
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of metabolism not just cancer it’s just
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that we’re very interested in teasing
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out its impact on cancer that’s that’s
16:04
phenomenal with the statistics that you
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just kind of just threw out there like
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40 percent reduction in breast cancer
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recurrence in women that were just
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simply fasting in the evening for 13
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hours right and that is a Ritz nard
16:19
‘less of what you eat guys what you
16:21
trolled for whether you’re overweight
16:22
and Wow
16:23
right because it’s really not that
16:26
difficult to I think it’s much easier to
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for people to make a modifiable change
16:33
of just stopping what they’re you know
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stop eating after 7 p.m.
16:37
versus eat all your vegetables stop
16:40
eating by your cake I mean people should
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do that but dieting yes I still think
16:45
diet quality matters but we’ve done some
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pilot studies with women uh adapting a
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longer a nightly fasting interval and
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those studies have been amazing in terms
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of how simple it was for women to do it
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we actually had a little app they used
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and they would text us starting my fast
17:06
and then we’d text back saying great
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don’t forget don’t eat again before 8
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a.m. or 9:00 a.m. you know and so many
17:14
participants said you know I never
17:15
understood percent energy for fat it was
17:18
always so confusing to me it made me
17:20
just feel stupid I didn’t even know how
17:22
to do it but I just got this in five
17:24
minutes I got this I could do it and
17:27
self-report ways they are reported often
17:30
sleeping better and we did it with a
17:34
group of Latino women Latinas in South
17:39
Bay and they were particularly positive
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about as I said you know in my family if
17:44
I tried to change up our entire
17:46
that way we eat sometimes my family
17:49
members weren’t that positive about that
17:51
where’s our favorite foods it she goes
17:53
but this I could do it right away it was
17:56
really simple and it didn’t affect the
17:57
family or food ways so it’s very easy
18:00
for me to do within our family without
18:02
disrupting all of our family behaviors
18:04
they were very positive and often even
18:07
reported I felt so proud of myself okay
18:09
finally I’m doing something I feel
18:11
better well I’m going to start walking
18:12
too you know that kind of self-efficacy
18:14
kind of spread to other health behaviors
18:17
which is our hope yeah great so these
18:20
women were being more compliant which is
18:22
well they feel successful instead of
18:24
feeling like a failure right you know
18:26
writing down everything you eat running
18:28
up the calories your life you only can
18:30
do that for a couple days before you
18:31
just burn out in the entire exercise so
18:33
you feel like oh I can’t do it you know
18:36
where this they’re like I can do this no
18:38
yeah so we think it’s incredibly that
18:41
that some of the value isn’t is the
18:43
simple feasibility of it people can
18:46
understand it and they can generally
18:48
implement it now we don’t think it
18:50
necessarily is going to have huge
18:52
impacts on weight like you’re not
18:53
probably not going to lose 50 pounds by
18:55
just making this one change but we
18:57
believe it could be an incredible public
19:00
health intervention where if everybody
19:03
did it we could move like the whole
19:05
disease risk curve down a little bit and
19:07
that would have huge impacts on disease
19:10
risks you know which is the alternative
19:12
is of course we spend millions of
19:14
dollars trying to help a small number of
19:16
very obese people lose weight which is
19:19
very unsuccessful but if we could move
19:21
the entire population this way to this
19:23
more healthful pattern we think that
19:25
could actually affect disease rates in
19:27
the United States it’s awesome yeah you
19:30
also just to kind of dive a little bit
19:33
deeper into some of your more recent
19:35
research
19:35
you mentioned the 13 hour fast overnight
19:38
and how that was very robustly
19:40
associated with the 40% reduction in
19:41
breast cancer recurrence and non
19:43
statistically significant reduction in
19:45
breast cancer mortality but you also
19:48
have looked at some of the biomarkers
19:50
that are known to increase breast cancer
19:52
risk and and it also there was a fact on
19:55
some of those biomarkers like
19:57
inflammation as well correct
19:59
we’ve actually seen probably our most
20:01
consistent effect on something called
20:05
hemoglobin a1c which is a marker of your
20:09
average glucose over about three months
20:11
so interestingly enough we saw the
20:13
association both in a general sample of
20:17
women from what’s called an Ann Haynes
20:19
survey so a nationally representative
20:21
survey of women all we saw that women
20:23
who fasted longer had lower hemoglobin
20:27
a1c and then in our own sample of breast
20:29
cancer survivors we found the exact same
20:31
Association which means you know which
20:33
as to us means this is probably strong
20:35
so that’s one of the reasons we think it
20:37
might influence I have a huge effect on
20:41
reducing the risk of diabetes as far as
20:45
inflammation interestingly enough we
20:48
only found that it reduced inflammation
20:50
among women who didn’t eat a lot of food
20:54
late at night in other words you know if
20:57
if you’re fasting interval was 9 p.m. to
21:01
9 a.m. it didn’t seem to matter but if
21:04
you’re fasting interval was early in the
21:06
day like 6 to 6 then it seemed like the
21:09
fasting interval reduced CRP so it got a
21:12
c-reactive protein this measure of
21:14
generalized inflammation so that’s what
21:17
made us think it’s not just the 12 hours
21:20
it’s the 12 hours only if they start
21:23
fairly early in the evening that’s when
21:25
the positive effects harem interesting
21:26
very interesting so you a couple of
21:28
points that you you mentioned I just
21:31
want to circle back to the the glycated
21:32
hemoglobin you mentioned that basically
21:37
fasting the evening had a pretty robust
21:41
effect in reducing ana and and that’s a
21:43
marker obviously it’s a marketer marker
21:45
of your long-term you know blood glucose
21:47
levels absolutely they use that to
21:49
approve diabetes drugs you know if a
21:51
diabetes drug or zu8 hemoglobin a1c
21:54
that’s how it gets approved so it’s a
21:56
pretty powerful marker of risk so we’re
21:59
talking about for example metformin yes
22:01
which is a very many any diabetes drugs
22:04
has to move hemoglobin a1c down a
22:06
certain amount before it can be approved
22:08
so if we can do this with a non
22:10
pharmacologic approach
22:12
just changing when you stop eating and
22:15
the fasting interval I mean that’s
22:17
that’s pretty exciting yeah and really
22:19
exciting because the truth is all these
22:21
drugs have side effects they’re not that
22:23
pleasant to take a lot of people simply
22:26
just continue them on their own you know
22:28
so pills aren’t necessarily always the
22:30
answer and this offers people a
22:31
lifestyle choice and you mentioned that
22:34
your there were women that that were
22:37
involved that you had basically instant
22:39
they made changes they started fasting
22:42
in the evening and they also reduced
22:45
their hh1 um in our pilot studies were
22:49
we were really focused on the
22:51
feasibility and acceptability of it so
22:53
we didn’t have any biomarkers we were
22:55
testing could they do it and how hard
22:57
was it for people to do okay so that was
22:59
really a test of because there’s no
23:01
point in recommending something that
23:03
people can’t do it right and that so
23:04
that’s what we really focused on there
23:06
and our personal pilot work is just
23:09
could they do it and truthfully the vast
23:11
they almost all did it and they also all
23:13
said they would recommend it as an
23:15
eating pattern to their friend so they
23:16
recommend the study you know which told
23:18
us ok this is feasible and this is
23:20
acceptable and you know that’s what
23:23
we’re interested in is not you know if
23:25
it works but it’s like impossible to do
23:28
then it’s it’s not right it’s not a
23:29
valuable public health intervention yeah
23:31
I was wondering what I was trying to get
23:33
out is how quick or how soon do you
23:36
think it could change
23:38
yeah those we don’t have levels that
23:40
would right be very interesting to see
23:42
if ISM and that can be moved pretty
23:43
quickly or you know if it takes longer I
23:47
don’t know how quick these other like
23:49
metformin works oh yeah most of them the
23:52
thing about hemoglobin a1c is since it
23:54
reflects average blood sugar over the
23:56
past three months it takes about three
23:57
months to move it even with a really
23:59
effective intervention it just since it
24:02
reflects the whole right you months of
24:04
cycling through you have to go salts to
24:06
see it yeah yeah right that makes sense
24:09
other microbes may be faster but the you
24:12
know because we already know that if you
24:14
want to measure these markers you want
24:16
people to be fasting so we know just
24:17
even one fast one nights fast makes a
24:20
difference right right if you do one
24:22
nights fast a lot of these markers are
24:24
will be flatter in the more
24:26
than if somebody eats breakfast right
24:27
before they come in you know so you’re
24:29
really what you’re doing is you’re
24:30
extending the period of time we have
24:32
very low basal levels of a lot of these
24:34
markers right I just kind of wanted I
24:40
all of a sudden something came to my
24:42
mind because you know we’ve been talking
24:44
a lot about inflammation and these
24:46
fasting blood glucose levels fasting
24:48
insulin and it just hit I remember
24:51
having a conversation with dr. panda and
24:54
he mentioned something to me that I
24:57
wasn’t aware of about repair mechanisms
25:00
and fasting I knew that repair
25:03
mechanisms were regulated by the
25:06
circadian rhythm and I always knew that
25:07
when you sleep is when you’re repairing
25:10
a lot of damage but it didn’t occur to
25:13
me that also when you sleep is when
25:15
you’re fasting right and he had
25:16
mentioned that there’s something
25:18
inherently important about fasting and
25:22
repair mechanisms and so you know which
25:25
of course that kind of made me think wow
25:27
that that’s really interesting I never
25:29
thought about it like that but if you if
25:31
you think about you know that the timing
25:33
of these repair mechanisms and fasting
25:35
and how you know you’re repairing
25:37
damaged DNA repair neck repair
25:39
mechanisms and also these etapa gee
25:40
clearing away damaged cells damaged
25:44
cells secrete inflammatory mediators so
25:47
if you’re if you’re clearing away the
25:49
the cells that are damaged and secreting
25:51
more you know inflammatory molecules
25:53
then possibly that would you know the
25:55
lower the inflammation but it’s really
25:56
interesting how your data suggested that
25:59
it really had to occur earlier in the
26:01
evening right yeah any speculation as to
26:03
why that oh um I suppose we really do
26:07
think that and that your body works best
26:10
with it’s aligned with the circadian
26:12
rhythm but I think that is a really good
26:15
observation
26:18
certainly it the parallel I tend to
26:20
think of is you know we work out we
26:22
actually hurt our muscles and the
26:25
muscles don’t repair and get stronger
26:27
unless we stop we have to stop we have
26:29
to give them a rest period and the same
26:31
thing eating is metabolism there’s a lot
26:34
of oxidative damage that HAP’s just as
26:36
we eat and then the theory is that you
26:39
at a time off from that damage for the
26:43
repair mechanisms to come in so it’s an
26:45
interesting observation in parallel
26:47
personally I don’t that’s a little
26:49
molecular for my research but yeah it’s
26:52
I think it’s a it’s a good parallel to
26:54
compare it with like working out yeah
26:56
that is actually a you know like like
26:58
you mentioned you need a repair time
26:59
stress can stress can activate stress
27:03
response pathways that can be beneficial
27:04
like in the case of exercise but if you
27:07
keep on stressing yourself you actually
27:09
get weaker right there bang you know
27:11
repair and you do need to them off right
27:14
right exactly what about meal frequency
27:16
so is that did that play a role so if
27:19
you’re I don’t know how long between the
27:21
fasting and fed state let’s say we’re
27:23
within the 12 hours in day we’re within
27:26
that 12 hour but you know feeding time a
27:28
lot of time does the amount of meals
27:31
that we eat within that time matter I
27:34
think it’s it’s a little bit of a
27:36
separate question we tried to control
27:38
for it in case it did make a difference
27:41
because it makes sense if you’re if
27:43
you’re eating let’s say 18 hours a day
27:47
you’re probably going to have more
27:48
eating episodes per day than if you’re
27:50
only eating for let’s say 10 hours a day
27:52
so just reducing the number of hours
27:55
that you eat may actually have some
27:57
impact on how many eating occasions and
28:03
which may also relate to disease risk
28:05
but we didn’t see that to be a really
28:09
important determinant of disease risk so
28:13
we’re not really that’s sort of a little
28:15
bit of a different question we’re not
28:16
really quite sure I think that the
28:18
evidence is really out on meal frequency
28:22
and disease risk and I you know if you
28:27
want my my gut feeling is that if you
28:30
keep your eating interval fairly short
28:33
it may not matter very much but when
28:35
your interval is very long so you’re
28:38
getting you know a meal impact and then
28:39
a long time with no meal and then
28:41
you know throughout the day all those
28:43
spikes might be more detrimental but the
28:47
data on that are really unclear at this
28:49
time yeah I think I think he made some
28:51
really good points and that is you know
28:54
if you if you reduce the amount of time
28:56
that you’re eating that naturally you
28:59
would probably then reduce the you maybe
29:01
frequency I 18 I just I just remember I
29:04
don’t know if this is like one of those
29:06
wives tales where you know the this the
29:10
smaller number of meals you eat was
29:11
supposed to lower their blood it you
29:13
wouldn’t have as big a blood glucose
29:15
right you know but then again you’re
29:17
constantly doing it so I don’t I don’t
29:19
know you know I think you know I know of
29:22
at least one study in the field that’s
29:23
actually testing that you know testing
29:26
five meals a day versus three so I think
29:28
they’re starting to realize we don’t
29:30
really have a good answer to that and
29:31
and trials are underway to clarify that
29:34
okay one other thing that I was I was
29:39
kind of thinking about in the parallels
29:41
between how this meal timing is having a
29:43
pretty profound effect on on you know
29:47
for example your what’s considered your
29:49
long-term blood glucose levels and also
29:51
to some degree on inflammation and these
29:53
these are markers of these these markers
29:56
are known to be associated with
29:58
increased breast cancer risk but you
30:00
said that weight loss may not
30:02
necessarily occur but what’s interesting
30:03
so you may not let’s say you don’t
30:06
change the types of foods you eat but
30:09
just you’re you’re basically only eating
30:11
you know during a 12 hour window during
30:13
the day and you know so that so that in
30:16
itself may not cause you to lose weight
30:18
or or a good economic or significant
30:21
amount but what it is what’s interesting
30:23
is that on the flip side weight loss
30:26
weight loss itself has also been shown
30:29
to have a positive effect on these same
30:31
biomarkers yes and and so so so we
30:35
actually think that some of the positive
30:37
effect might be independent of weight
30:38
loss you get the positive effect whether
30:40
or not you lose weight in our pilot
30:42
study women over a month lost about a
30:45
kilogram or about a little over two
30:46
pounds so we did see a modest weight
30:49
loss that’s very modest but but even the
30:53
mice study
30:55
that studies that dr. panda does also
30:58
tend to suggest that the impacts may be
31:00
independent like it just helps you
31:03
regardless of whether you lose weight or
31:05
now yeah that’s kind of what I was
31:07
getting at it’s as though it seems as
31:09
though it may just really be affecting
31:11
your your metabolism and and making sure
31:14
that your timing your food intake with
31:18
when you are when your metabolisms at
31:20
its best when you when you can right
31:21
process these you know the sugar and the
31:24
fats and right just everything that
31:26
you’re throwing at it and and that seems
31:29
to be in of itself extremely important
31:31
so and you know we have seen in our
31:34
breast cancer survivor’ study we
31:35
definitely saw an improvement in hours
31:37
of sleep per night when people had a
31:39
longer fasting duration and you know
31:42
sleep bad sleep can also affect
31:44
biomarkers and it’s its own risk so that
31:47
might be partially you know it’s
31:49
partially working through direct
31:51
metabolic effect but it might be working
31:53
through other behaviors too but
31:55
improving sleep and getting more sleep
31:56
could also help regulate your metabolism
31:59
and kind of feed into the positive
32:01
impacts similarly it’s very interesting
32:04
but in several months studies they’ve
32:06
shown big improvements in spontaneous
32:09
activity when they’re put on this when
32:11
they’re not on this fasting regimen
32:14
we don’t necessarily think that if women
32:16
or humans adopt prolong nightly fast
32:20
they’re going to start no working out
32:22
the gym but there might be some more
32:25
subtle effects on spontaneous activity
32:27
which frankly is the majority of the
32:30
physical activity most people have is
32:32
just spontaneous everyday normal
32:34
activity so no the animal studies lead
32:38
us to believe it can have several
32:39
behavioral impacts in addition to the
32:42
direct metabolic impacts yeah it’s very
32:45
interesting I wonder if there’s just
32:46
changing the brain you know yessum it’s
32:50
you know the data is showing that eating
32:52
a bunch of food and going to sleep
32:53
disrupts your sleep it’s been around a
32:55
long time you know it’s just you don’t
32:58
sleep well on a full stomach just period
33:01
over out you know so it’s kind of that’s
33:04
literature’s been out there
33:05
while I I’ve been practicing this time
33:10
restricted feeding now for once I you
33:13
know dr. Santa such an pandas work was
33:16
really eye-opening and I we you know
33:17
thought well I’m gonna
33:18
I usually try to stop you know stop
33:22
eating earlier like earlier in the day
33:25
and it’s a lot easier for me in the
33:27
winter fall and winter months when it
33:30
gets darker earlier and not working so
33:31
late the thing for me is when I’m
33:33
working working late you know when you
33:35
start working later it’s light out I’m
33:37
like oh I got to keep working I gotta
33:39
keep working then you start to like
33:41
extend your workday and that becomes the
33:43
issue surprised western lifestyle is
33:46
carcinogenic in case you didn’t know
33:48
that now you do now we have two bright
33:50
light exposure and evening many things
33:52
about our lifestyle are carcinogenic
33:54
right i but i do i i’m it’s it’s really
33:59
not that difficult to do and i’m just
34:01
now I’m startled OCH once I have my
34:03
first cup of coffee and then it’s at
34:05
okay well I got to start cooking dinner
34:06
you know at least two hours before that
34:08
or something so that way I’m done and
34:11
it’s you don’t you’re not hungry you
34:13
know you’re not like starving when you
34:15
buy bed some people I think their fear
34:16
is well you mentioned it’s hard to sleep
34:19
when you’re super full but on the flip
34:21
side a lot of people have this mentality
34:24
that if they’re really hungry they can’t
34:26
you can’t sleep right you know but I
34:28
think there’s a nice balance between
34:30
those two and that is if you just eat
34:32
something you know in a reasonable time
34:35
you know 7 p.m. stop I mean along with
34:38
that I have to say I probably think it’s
34:40
probably best for you to go to bed at a
34:42
reasonable hour you know I not be
34:43
staying up till 2:00 in the morning
34:44
playing video games or whatever you know
34:47
so it you know it can all be synergistic
34:49
or in a positive way or in a negative
34:52
way yeah I want to kind of shift gears
34:55
one more one more time I think a lot of
34:58
people have in their minds at least in
34:59
the context of breast cancer many women
35:02
think about risk factors being genetic
35:06
you know there are certain gene
35:09
polymorphisms which are variations in
35:12
the sequence of DNA that alter the
35:13
function somewhat that can put a woman
35:16
at risk particularly genes that are
35:18
involved
35:18
repairing DNA damage specifically in the
35:21
breast issue Brico one briquette – I
35:23
think many people are familiar with
35:25
these jeans but really what your
35:30
research and what a lot of research out
35:33
there has has shown is that there are
35:35
lifestyle factors that play a it’s not
35:39
equally important role and certainly in
35:42
combination with these genetic risk
35:44
factors would be very very important in
35:47
in modifying breast cancer risk and and
35:49
not only risk but recurrence so there
35:52
are a few types of lifestyle factors
35:55
that we talked about today that may you
35:58
know dramatically lower a female’s
36:01
breast cancer risk and also people out
36:03
women out there that have have had
36:05
breast cancer certain lifestyles they
36:07
should adopt in order to lower their
36:09
recurrence right so what do you if you
36:11
if you want to talk about maybe though
36:12
up one sure um you know Braca one and
36:16
two if you have that gene you know
36:18
polymorphism that’s a that’s a pretty
36:22
special case and those women are at very
36:25
high risk of breast cancer and
36:27
recurrence and it’s it’s hard to know
36:29
for that small percentage of women how
36:31
much lifestyle matters but again they’re
36:33
a special case majority of cancers are
36:36
just sporadic we think that less than
36:39
five percent overall of breast cancers
36:41
are the result of genetic factors and
36:43
more like sixty five to seventy five
36:46
percent are the result of lifestyle
36:48
factors including obesity diet physical
36:53
activity in smoking and alcohol we think
36:56
maybe for breast cancer so those are all
36:58
things you can modify so the idea that
37:01
you’re doomed biogenetics couldn’t be
37:04
more wrong for the majority the vast
37:05
majority of women it is your lifestyle
37:08
choices that will make the biggest
37:10
difference in your risk which is not the
37:12
same thing as saying you’re to blame
37:13
because a lot of cancers are sporadic
37:15
but that there are things you can do to
37:18
reduce your personal risk a lot well
37:21
that’s good news
37:22
yeah so don’t smoke Matra moderate drink
37:26
don’t you know don’t drink a lot
37:29
lose weight lose weight if in even a
37:32
small amount of weight recently there
37:35
was a study that seemed to show like
37:36
they saw huge improvements in metabolic
37:39
health in the first 5% of weight loss
37:42
and then they said if you looked at five
37:43
to ten percent of weight loss it’s like
37:45
it flattened out there wasn’t you know
37:47
it isn’t like a linear thing so it looks
37:50
like even modest weight loss can really
37:53
improve your metabolic health so I think
37:55
there’s this perception that well if I
37:57
don’t get to model skinny there’s no
37:59
point in even trying and I think that’s
38:01
a really wrong way of looking at weight
38:04
loss 5% weight loss could really make a
38:06
difference 5% 5% and keep it you know
38:09
keep it off you know and maybe in a year
38:11
or two you might go well me male is
38:13
another 5% you know but the idea that
38:16
there’s like some very linear thing
38:18
going on I’m not sure the data really
38:19
support that so even modest weight loss
38:22
you know work on the quality of your
38:24
diet work on the timing your diet get
38:26
some physical activity please you know
38:29
avoid long periods of sedentary behavior
38:32
all those things combined good sleep you
38:35
know and good food choices I think are
38:37
that’s the total combination of things
38:41
is the the best thing you can work
38:42
toward and just make it a lifestyle to
38:45
always be working on improving those
38:46
things as a your whole life I think
38:49
that’s fantastic advice and I just want
38:53
to mention that number again because it
38:55
really is you know the best obviously
38:57
know what no one wants cancer you know
39:00
that that if you can do whatever you can
39:03
within your you know control to give
39:07
yourself the best possible chance of not
39:10
getting cancer right then really really
39:13
really really you should do it that’s
39:15
you know and and there’s a super benefit
39:18
here is that it likely will reduce your
39:20
risk of cardiovascular disease which
39:22
after all is still the number one killer
39:24
of women so you know you’re really
39:26
getting a 360 effect on your risk of all
39:30
the major killers in America some
39:32
unpleasant conditions like diabetes and
39:35
also hopefully just feeling better every
39:38
day absolutely and the quality of life
39:40
basic quality of life I think there’s
39:42
been studies
39:43
knowing there’s been studies showing
39:44
like weight loss right mode no
39:46
inflammations associate with depression
39:48
yep you know an inflammation associate
39:50
with Abbey City so yeah you’re right
39:51
well these things like gravity it’s
39:53
associated with reduced course of
39:55
depression or ameliorating some of the
39:57
effects so so there’s you know it’s not
40:00
like there’s a separate list of things
40:03
you should do for one disease versus
40:05
another it’s like the total benefit
40:07
package yeah they’re they’re all over
40:09
overlapped much more overlapping we used
40:11
to not think that as much we used to
40:13
think they were completely diseased
40:14
here’s the disease path row for
40:16
cardiovascular disease it’s very
40:17
metabolic it’s blood pressure it’s
40:19
cholesterol and here’s cancer and it’s a
40:22
genetic disease and there are two
40:23
separate pathways now we see that
40:25
they’re actually way more overlapping
40:27
than we ever knew and it’s really good
40:29
news because it means you don’t have to
40:31
do separate things for each disease it
40:33
means the same suite of healthful
40:36
behaviors can give you 360 protection
40:38
well said and just one last time that
40:44
meal timing women that had breast cancer
40:47
and had fasted for at least 13 hours
40:49
overnight had a 40 percent reduction in
40:52
breast cancer recurrence right I think
40:53
that’s a pretty good incentive for women
40:55
to to set that clock when they put the
40:58
first bite of food in their mouth of the
41:00
first non you know water beverage you
41:03
know that clock set and and making sure
41:06
that you don’t eat food you know by 7:00
41:08
p.m. 7:00 right or 8:00 7:00 right
41:12
Sachin pandas work was he did the most
41:15
recent article published which I thought
41:17
was very good looked at mice where he
41:20
just had him do restricted feeding five
41:22
days a week and then all around the
41:25
clock you know kind of break it the fast
41:27
on the weekend and he saw much of the
41:29
same effects which means you know you
41:31
don’t also have to be perfect it’s on
41:33
you most of the time you do it you don’t
41:35
need to feel like a failure like oh I
41:37
went out it’s so late it’s fun you know
41:40
just pick up the next day and get
41:41
started again thank you for bringing
41:42
that up
41:43
because I you know weekends or when we
41:45
have that social pressure right you know
41:47
we’re having later dinners we’re having
41:49
drinks you know so it’s nice to know
41:52
that at least if
41:54
the animal studies do translate to the
41:56
human studies that we can at least break
42:00
the rules or cheat a little bit on on
42:02
weekend I I think that I think that’s a
42:05
plus side is that it’s not about being
42:07
perfect it’s about mostly doing it and
42:11
you’ll get most of the benefit right
42:13
agreed agreed
42:14
well dr. Ruth thank you so much for your
42:18
time and for the phenomenal research
42:20
that you’re doing and thank you I really
42:23
look forward to reading more and and
42:26
keeping an open line of discussion with
42:28
you to learn more about some of what
42:30
your your research is showing in terms
42:32
of the meal timing and breast cancer
42:33
incidence okay thank you
42:43
you
This episode features Dr. Ruth Patterson, a professor in the UC San Diego Department of Family Medicine and Public Health as well as Associate Director of Population Sciences and leader of the Cancer Prevention program at Moores Cancer Center at UC San Diego Health. In this nearly 45-minute conversation, we talk about… • The importance of time-restricted eating as a practical public health intervention, mostly for it’s ease of implementation, that may have a widespread impact on disease risk. • Why you should probably make sure your time-restricted eating window occurs earlier in the day, rather than later. • How the first 5% drop in weight loss can have disproportionately large effects on the metabolic factors associated with breast cancer risk when compared with subsequent weight loss. • The association of longer fasting durations beginning earlier in the evening and improved sleep in humans, as well as spontaneous physical activity in their day-to-day lives. • The relationship between metabolism and breast cancer risk. • The effect of lifestyle factors, such as obesity, physical activity, what and even when you eat, whether or not you smoke tobacco… and how even modest changes, such as consuming food earlier in the day and only during an 11-hour window, can decrease breast cancer risk and recurrence by as much as 36%. • The importance of starting your fast earlier in the evening, and how an earlier eating window has been shown to correlate to reductions in inflammatory markers. • The association of higher circulating insulin levels with breast cancer risk, and how insulin itself has an important relationship with estrogen by affecting the levels of sex-hormone binding globulin. • The dangers of having a cellular environment that is inflamed, as the case is with the obese, and simultaneously having elevated cellular growth signals, which is also characteristic of the hormonal milieu of the obese. • The surprisingly small role heredity plays in determining overall risk of breast cancer when compared to lifestyle factors. • How healthful lifestyle habits, like choosing to eat during the right window, ultimately helps us trend our risk for many of the diseases of old age in the correct direction instead of influencing only one or another. ▶︎ Learn more about Dr. Ruth Patterson, including some of her key publications: http://publichealth.ucsd.edu/jdp/?pag… Links related to FoundMyFitness:
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