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to episode 558 with co -founder Sean Lake. Welcome
to the Behind the Shield podcast. As always,
my name is James Gearing, and this week it is
my absolute honor to welcome back onto the show
the head of the Nuffield Laboratory of Ophthalmology
and the Sleep and Circadian Neuroscience Institute
at the University of Oxford, Professor Russell
Foster. Now, if you haven't heard my first conversation
with Russell, it is episode 647, and I highly
recommend that you listen to that. In the second
conversation, we discuss a multitude of topics
from the impact of the pandemic on society, gut
biome, light, moral courage, some optimistic
science when it comes to addressing strokes,
and so much more. Now, before we get to this
incredible conversation, as I say every week,
please just take a moment go to whichever app
you listen to this on subscribe to the show Leave
feedback and leave a rating. Every single five
-star rating truly does elevate this podcast,
therefore making it easier for others to find.
And this is a free library of over 1 ,100 episodes
now. So all I ask in return is that you help
share these incredible men and women's stories
so I can get them to every single person on planet
Earth who needs to hear them. So with that being
said... I welcome back onto the show Professor
Russell Foster. Enjoy. Well, Russell, I want
to start by saying thank you so, so much for
coming back onto the Behind the Shield podcast
today. Oh, well, thank you, James. It's a great
honor and a privilege, of course. Our initial
conversation was about three years ago, and we
discussed a host of topics. Is it that long?
It is. I can't believe it was that long. It's
extraordinary. Yeah, I believe so. August 2022,
if I'm not mistaken. So I'm sure there'll be
a little overlap, but some of these topics are
just going to be worth revisiting. But I think...
if we're talking about mid -2022, the first kind
of icebreaker would be what you have seen in
this world of sleep medicine and this world of
neuroscience as far as the impact of the pandemic
for the last few years. Because obviously at
the time, decisions were made, people were isolated,
we all know that story. But what isn't being
told is what was the ripple effect of that and
what can we learn from maybe doing it a little
differently next time? Yeah, I think that...
The fact that people had to stay inside was a
very significant impact upon sleep and circadian
health in that we live in dim, dark caves. And
what I would urge your listeners to do is to
load onto their smartphone a lux meter. And there's
lots of different apps that are available free.
And you can then get a sense of how much light
we experience inside. Go up to the window and
you see, you know, three thousand, four thousand.
And of course, where you are much more than that
and go outside, you'll be getting one hundred
thousand lux. And yet inside, we'll be lucky
to get. maybe 300, 400, 500 lux. And the clock
needs a very robust exposure to the light -dark
cycle to regulate it. And we were inside. So
we were being cut off from that essential signal
to stabilize the circadian clock and the sleep
-wake cycle. And so I think people's sleep patterns
began to drift. And that's not ideal. And there
was internal desynchrony. So different bits of
the body were doing different things. It wasn't
all beautifully coordinated. I think last time
I used the analogy of an orchestra. You know,
all the different body parts, like the members
of an orchestra, playing at the same time in
this wonderful symphony without that sort of
robust regulation by the light -dark cycle. Everything
starts to play at a slightly different time.
And instead of a symphony, you have a cacophony.
So that was one thing. But I think a very interesting
other observation was the change in people's
patterns of sleep. So what we know is that if
we have the opportunity to sleep longer, sleep
can go into a biphasic or polyphasic mode which
means you go to sleep um you wake up you go back
to sleep again and you can do this several times
throughout the night and this occurs you know
even in young people so so um experiments were
done in the states um where individuals were
placed under 12 hours of dark 12 hours of light
and their sleep pattern became biphasic polyphasic
and these are in young males and so what happened
during the pandemic is that people didn't have
to commute So they gained in many cases, you
know, they saved two hours or four hours on their
daily commute and they didn't have to get up
as early. And so they slept longer. And so despite
this, though, what was so fascinating is people
reported having worse sleep, even though they
had the opportunity to sleep longer. And what
was going on, of course, is that people didn't
know about this biphasic polyphasic pattern.
They'd wake up and they think, oh, my God, you
know, all the horrors of what was going on, you
know, worry about family, friends and the bigger
picture would make it more difficult to go back
to sleep. And they thought, you know, anyway,
well, I must, you know. stop struggling, start
having drinking coffee and doing emails. And
so even though there was greater opportunity
to sleep, the reports were people got worse sleep.
That's because they were unaware of this. It's
perfectly normal to wake up. If you stay calm,
stay relaxed, keep the lights relatively low,
you will go back to sleep. And so those are the
two observations from my side. And I think the
other thing while we're talking about light.
is that unless you get outside, you're not getting
sufficient UVB exposure to make vitamin D. And
there are some suggestions that people became
vitamin D deprived over that period, which, of
course, has a knock -on effect. We know, of course,
the role of vitamin D in bone mineralization
and all the rest of it. but it has a big impact
upon our immune responses. And there's some evidence
on mental health and sleep as well. So taking
vitamin D3 supplement when we have the next horror,
I think was going to be really quite important.
Government recommendations should be take vitamin
D3 supplementation if you're not getting outside.
And to my knowledge, there was no real discussion
of that. and that could have a big uh impact
upon health including our sleep and mental health
what was interesting i say let me rephrase that
what was actually quite disappointing was seeing
the any any topic would turn into like flanders
fields you'd have two you know trenches of extremism
and no real kind of common sense in the middle
in a lot of these areas What is the connection
between stress, lack of sleep and the simple
ability to critically think? Oh, it's profound.
Most people don't have a sleep problem. They
have an anxiety or a stress issue. And that makes
it either difficult to get off to sleep. And
if you wake up getting back to sleep and that
disrupted sleep can have. a really profound effect
upon your ability to process information and
indeed your emotional responses. You become more
irritable, more impulsive, less empathetic, which
I think is absolutely fascinating. You fail to
pick up the social signals from other people,
whether it's work colleagues or family or friends.
Another fascinating area is that the tired brain
remembers negative experiences and forgets the
positive ones. So one's entire worldview is biased
towards the negative. And that's the sort of
the basis for decision making. And so the more
anxious you get, the greater the levels of stress,
the worse the sleep becomes and more disrupted.
And then your ability to process emotional and
cognitive information really does begin to fall
apart. And, yeah, lots of people who have contacted
me since the pandemic said. they they were in
such a black place in terms of their their mood
um and their relationships with others uh it
was a i think a profoundly difficult time and
and at all levels i mean the uk you know kids
were doing classes online and so they were isolated
from their entire peer group and then we throw
them you know into uh university after the pandemic
uh or college and they had to learn the skills
that they would have acquired, you know, sort
of by osmosis, by just interacting with others.
So I think it was a really quite damaging time.
I've made this comment quite a few times recently.
It really saddens me having grown up in myself,
kind of I was young in the 80s and having Blue
Peter and John Craven's Newsround and all these,
you know, programs for young people that were
really teaching us about the world. pulling us
together, the fundraise, you know, for the famine
in Ethiopia, there was Live Aid, there was Comic
Relief. And then you circle around again, kind
of this era now, whether it's COVID, whether
it's Gaza, whatever it is, where there's clearly
something that we all need to stand up and talk
about. And there isn't that compassion. And I
honestly believe that this overstress, undersleep
element of modern society, and especially the
division that we've seen the last few years.
has really hacked at the compassion that I would
argue is at the heart of normal American people,
normal British people. But you're seeing that
really dulled by, I'm assuming, these environmental
elements. Yeah, I think that's a very good point.
Having worked in the States for eight years and
the rest of my life has been in the UK, I agree.
is a kindness and there is a generosity of spirit
and a willingness to help that has become massively
eroded. And I'm not quite sure why. I mean, you
can see this just in the way that people drive
and they won't people, you know, people won't
be let in. And my daughter had an incident just
recently where somebody, she was indicating to
get into the next lane and this person just wouldn't
let her. And she, you know, she pulled over and
she called us. She was crying. She said, why
did he do that? There was no need to behave like
that. And I think this is what many of us are
seeing a lot of. And it really, really distresses
me. For myself, I listened to the morning news
on the radio since undergraduate days. And I
suppose 2021, 2020, I just stopped listening
to the morning news. I wake up now to, in the
UK, Radio 3, which is the classical channel.
And we don't, I mean, we used to religiously
watch the news on the television. We don't, we
don't. Simply do it at all now. And so I do get
some news feeds on my smartphone. But, you know,
it's such an unmitigated drip, drip, drip of
ghastliness that it can really send you into
a state where you don't want to be. And I don't
think it's very difficult. The media have to
do what the media do. But we only get the negative.
We don't hear about. the success stories and
the great scientific breakthroughs all the breakthroughs
in the social sciences or you know new discoveries
and excitement and and i don't understand why
we haven't reoriented our our news channels to
a lot more of those discussions of human success
rather than And clearly we have to be aware of
all the nasty stuff that's going on. But in equal
measure, we have to realize that we are a species
capable of such kindness and such humanity and
such decency that we've got to emphasize that
again, that we haven't lost it. It's there, but
we've got to try and get it back up to the surface.
Yeah, I agree completely. And I post a lot of
those. kind videos online there was one actually
it was a children's bbc one and they had all
these children you know and some were different
races some had special needs but these kids were
just talking about, well, yeah, she runs faster
than me and he likes conkers and I don't like
conkers and they're not seeing the exterior shell.
Of course they see it, they're aware of it, but
that's not the person that they see. And I feel
like that kind of innocence that is inbred in
us and children because of these environmental
pressures are kind of chipped away. But I do
believe that we're at the beginning of an awakening.
I feel like the cracks are starting to show and
there's an urging now, a need to go back to exactly
what we're talking about when we were younger.
I mean, again, for me, it's just simple kindness
and generosity of spirit. You know, I mean, the
person who lives over the road, they sort of
say, shall I take your bins in? Oh, thanks so
much. I'm a bit stiff today. You know, it's that
kind of connectedness that we don't have as much
as we did, I think, in the past. Absolutely.
Well, mentioning, you know, social media and
some of the things that are. adding to this disconnection
before we hit record you talked about the study
that you're you're doing with the government
now on artificial light and then some of the
the myths around devices so you know what what
is the study that you're working on and then
let's debunk some of the misinformation that's
being put out there yeah um so so the the title
it's it's part of a government reporting body
it's an independent but it is funded by by the
government called kumari which is the committee
on the medical aspects of radiation in the environment
and i i was brought into the committee to deal
with a visual bit you know there's lots on sort
of radiation and there's lots on low frequency
you know radio waves and stuff but there was
ironically nobody in that vision bit and because
i'd worked as the science advisor for a House
of Lords report on the impact of light and noise
pollution on human health. There were recommendations
that came from that, so they asked me to join
the committee and then let's get a clear understanding
of what we know and what we need to know about
the impact of light on human health, artificial
light on human health. So I brought a group together,
we meet fairly shortly, of experts and we're
going to take different bits of the subject and
come up with this report. And let me give you
an example. And I have to say that some of my
colleagues in the business of science haven't
been necessarily as helpful as they could have
been. You know, there were reports out there
saying you shouldn't see more than 30 lux of
light. for two hours before you go to bed. Now,
that's really dim light. And if you're an elderly
individual with somewhat reduced sight, let's
say, then wandering around for two hours under
30 lux increases the chance of falls and accidents
and all of that sort of stuff. And that's just
silly. And it's based upon data. Let me give
you one example. And we hear a lot in the media
about you shouldn't look at your light emitting.
tablet your your kindle before you go to bed
and it's based upon a study that got people to
look at a kindle on its brightest light intensity
for four hours immediately before bedtime on
five consecutive nights at the end of that Yes,
there were some effects upon melatonin, but melatonin
is a hormone that modulates sleep. If you actually
looked at sleep -wake timing, sleep -wake timing
was delayed by nine minutes, just statistically
significantly. And one of my colleagues... from
the states said well that may be statistically
significant but biology biologically that's meaningless
and yet you know the headlines from all over
the world is if you look at a kindle before you
go to bed you're going to harm your health and
your sleep now one key point about that experiment
is that prior to that four hours of light exposure
in the evening people were maintained under dim
light 90 lux during the day And what the Scandinavian
group then did was give people 500 to 600 lux
for six hours during the middle of the day. That
abolished all effects of melatonin and sleep
-wake timing. No detectable effect of looking
at Kindle before you go to bed. And this is the
problem. We've got lab -based studies which are
then being extrapolated to the real world. and
it's just not good enough um and if people are
getting out and getting a moderate amount of
light during the day they're going to not sensitize
their their clock in the evening so it's those
sorts of things we also so so what we've got
to do is try and integrate how much light for
how long what its color its wavelength should
be what your light history is have you spent
time outside or are you inside all the time how
old you are it's clear that young people are
more that their circadian system is more sensitive
to light than in elderly people we've got to
take into account seasons and i and i think rather
than you know you stick a bunch of scientists
into a room and you ask them to come up with
recommendations sure they're going to come up
with the recommendations on the basis of the
data we've got and my argument is we don't have
all the data yet and it's a very biased set of
data because it's using assays which may not
be real world and they're all lab based so that's
what I'm trying to do and as I say we're starting
our studies shortly to get that paper together
and hopefully it will define the experiments
that we need to do in the real world and they're
not that difficult. I mean, it's easy now to
measure people's rest activity cycles, how alert
they are, what light exposure they get in a whole
different set of settings. And we can use that
field data, I think, then to genuinely inform
evidence -based guidelines for how we should
expose ourselves to artificial light. and and
it is really important the architects are crying
out for this sort of information it's fascinating
i've been talking to architects over the past
few years and they sort of fall into two groups
one group say oh god light natural light oh i
just ignore it you just build a space and you
just stick electric lights in it and that's it
um it's a nuisance um and and in fact it's quite
interesting there are some proposals for building
a new builds in London, where they limit the
size of the windows hugely because of the fear
of overheating. And with increased warmth in
the environment, you know, they don't want to
use air conditioning in the UK. So they're going
to make tiny, tiny windows. Just madness. And
the other group of architects are, you should
only use artificial light when you can't use
natural light. And so they embrace natural light.
I was at a meeting. early in the year by the
daylight academy and it was uh it was wonderful
they made me a fellow and it's absolutely fascinating
um listening to what the architects are interested
in and what they want and i think we've let them
down we haven't given them the evidence -based
guidelines that we absolutely need Well, I can
just say as a consumer or as an employee, when
you're in a place that has a lot of natural light,
again, as long as it's not overwhelming, then
it's a more pleasant place to be. And what blows
me away in America here, in Florida specifically,
is you'll have one of these big stores, Target,
Walmart, and they'll have no skylights and then
artificial light, which must cost hundreds of
thousands of dollars as well. But it also, you
walk in and you just... don't want to be in there
because it is this kind of you know non -natural
environment whereas you you see some of these
people that have spent a little bit more money
on whatever it is the way that they've designed
their stores and maybe there are like you said
a combination of skylights and some lights because
obviously in the evening you're going to need
the light and you just you want to stay there
whether it's as an employee or whether it's someone
who's just shopping in a shop Absolutely right.
And I'm working on a new book about light and
its impact on health. And there's some sections
on psychology of light and lighting. And the
thing that's so fascinating, again, talking to
the architects, oh, yeah, we can just sort of...
bung in LED lights, which are cheap. They don't
use lots of energy. So it's great. But of course,
where we used to use one incandescent bulb, because
LEDs are so cheap, there's a huge amount of LED
lighting, which of course, multiplies the cost
of the electrical usage. So whilst they individually
are quite cheap to run, because we use them at
high density, you know we're not saving that
much money any longer which goes back to your
point why the hell aren't we letting uh light
light in natural light into our built spaces
um and as i say it's sort of they're a group
of architects they just they no no no they said
i can't deal with it let's just just get rid
of it um fascinating actually completely different
mindset to i think um those of us who like to
live in buildings Yeah. Well, we even have things
called solar tubes in my house. There's two of
them, one in my son's bathroom, one in the laundry
room. And I keep, you know, you'll think, oh,
God, I left the light on. Then you realize you
didn't. Just that one little tube is probably
eight inches, you know, diameter. And it just
illuminates the whole room. It's incredible.
So just those two rooms. What are you saving
just on that? Well, but on the other side, which
is also quite interesting because of the ubiquitous
use of light. Of course, artificial light at
night, Alan, on the animal world is a big problem.
I mean, insect life, bird life. But up until
recently, the work on humans wasn't... so well
developed. Because what people do is they'd use
satellite imagery to calculate the sort of predicted
light exposure of individuals of light at night.
And then they correlate it with incidents of
coronary heart disease. And my criticism of those
studies was, well, you've got to get individual
light exposure. You can't just have a satellite
image, which covers about a mile in area. And
just recently a paper has just been published
where they've measured individual light exposure
and the whole risk of health conditions of keeping
the lights on at night. And actually with thousands
of individuals, and it's quite convincing, there
are impacts upon coronary heart disease. and
emotions and sleep and so i think um yeah we're
getting beginning to get the data that it's not
just the the animal world and indeed the plant
world i mean when plants start to flower for
example um with with artificial light at night
but also on humans so so not connecting with
with the light dark cycle the natural light dark
cycle and just flicking a switch We've got to,
again, tune into that, I think, a lot more than
we have done. And of course, that was going back
to where we started. One of the great problems
with COVID, we're inside and we were almost exclusively
exposed to light at night. Since we spoke, I
came across a study and I had the gentleman on
the show who, and he did a study on, and we've
talked about this in the previous conversation.
most firefighters in america work 56 hours a
week and the usual one is what's called 24 48
24 hours you know at the station so disrupted
or no sleep and then a 48 hour period off and
there's been a push to because things aren't
working recruitment crisis is getting worse and
worse and you know the health crisis and the
mental health crisis and one of the solutions
was do well let's do 48 hours in a row and then
have a 96 hour period Which to anyone who understands
anything about physiology, immediately you just
go, well, that's insane. The problem was this
gentleman did a study and I'm defending him.
He was a volunteer firefighter, never worked
in the career field, and just went in there with
a good heart. And he did the study and oh, actually
the 48 hours in a row is healthier than the 24.
And so what ended up happening when we had our
conversation is the department that he studied
ran. one call a shift and usually slept all night
every shift. Now you have all these urban and
suburban fire departments that took that study
and were like, well, it's healthier, who are
running 20 calls a shift and are up all night.
And what I realized very recently, because they
keep doing this, they keep studying this 56 rather
than, well, the Northeast of America works 42
hours a week. Why don't we study those two and
put them side by side? And so we have a... a
lack of cultural competency in the research of
our profession which i'm seeing is becoming very
dangerous because someone you know little knowledge
is a dangerous thing they grab one study just
like you alluded to and they run with it and
arguably make an already broken system even worse
so What is your kind of perspective on science?
Everyone screams for data. Where is that line,
A, between common sense where a study isn't even
needed and B, where the wrong science can be
latched onto and making things even worse? Yeah,
I think it is complicated. And we do need, I
think the thing that we haven't done is longitudinal
studies. So it's all been very short term. And
as you say, very selected groups. So it is complicated
and what we need to do, and we can do, as I was
alluding to earlier, we can measure rest activity
cycles. We can get a reaction time easily from
a thing on a smartphone. We can look at the impact
of blood glucose really easily. We can look at
stress hormones. And so rather than sort of biting
off bits and chunks of this sort of question,
we need some long term deep dive studies on large
numbers of individuals in different sectors.
And you were saying, you know, comparing the
sort of rural fire engine, fireman, fire person
population versus inner city Chicago or whatever.
with that make some evidence -based conclusions
i think we're all you know it's like the lighting
industry it's like architects all thrashing around
for some data and we'll latch on to data that
can, as you rightly point out, James, can be
profoundly misleading. And so what I'm trying
to do with the impact of artificial light on
human health is get some consensus and identify
what we need to know to get those evidence -based
guidelines, rather than just jumping in with
the best will, as this individual clearly was
trying to do a good job. can be taken out of
context so yes some scientific rigor um and engagement
with the scientific community i think is really
important but but the problem is that these studies
are not cheap and i and i i'm bombarded by people
saying oh you know why don't we do this and can
i can i be and i'd say i'd love to but do you
know it's really expensive because to do it properly
i'm going to have to employ a postdoctoral scientist
or a phd student on of this for three or four
years um to make it coherent and that's really
expensive and i think you know they can say can
you just tack it on can you just add it on to
what you're already doing and you can't you've
got to take it seriously and you've got to regard
as a freestanding you know a set of experiments
and and so yeah we've it's it's sadly um uh it's
throwing money up to get it done properly Well,
the one takeaway that he found, and I'll credit
him absolutely for this because it really opened
the door for this conversation, is bearing in
mind that they didn't get woken up that night,
still somewhat disrupted because the potential
of getting woken up, I think, still keeps you
from a deep sleep. But as you alluded to earlier,
the commute. So we normally start 7, 7 .30, 8
o 'clock in the morning. And a lot of us can't
afford to live anywhere near if we work in a
city. So my commute was like a 75 -minute commute.
So I'm getting up at 5 in the morning to go to
the station. Well, if you've got this 48 -hour
period, day two, you're in the station. If you
didn't get any calls that night, now you've technically
had a longer sleep because you didn't get up
at 5 to go to work. The 48 hour thing still is
a horrible idea. But to take that away, we work
24 hour shifts. That's a dial that we can spin
in any way, shape or form. So now the conversation
is also being, well, then why don't we start
at 11 a .m., 12 noon? So now you wake up, you
have breakfast with your family, you wake up
at a normal time, then you take the kids to school,
then you drive to the fire station. And if you
were at the station. and you just got beat up
all night, you're running calls. Now you can
sleep in an extra hour or two and then get out
at 10 o 'clock, get your rig ready, have coffee
with everyone and then head home. So I know there's
been conversations in the schools, but talk to
me about the way we've always done it as everyone
starts work at eight or goes to school at eight.
What is the conversation now about extending?
wake -up time and the physical and mental health
of whatever population that's affecting? Yeah,
well, there's some rumbles of a discussion. So
I work with colleagues in Western Australia,
up in the northwest in the mining district of
the Pilbara. So they're flying in a fly -in,
fly -out group. They're flying from Perth to
the Pilbara. But their shift starts, let's say,
at 9 o 'clock or 10 o 'clock or whatever. But
as you say, they've had to get up at 4 o 'clock
in the morning to get the bus or the car to get
the plane that then flies them up. And so people
aren't thinking about that part of the commute,
which is, I think, really important. The medics
I work with, they're still... of us that they're
getting better but it's still well you know it's
part of the rites of passage you know you just
got to work through it and and and and you know
again that whole area of sleep is for wimps um
and and uh it's still lingers like a rather nasty
smell out there we haven't got rid of it completely
uh even even in the medical professions um although
they're becoming more aware of it as the new
generation are coming through so i think there
is increased awareness but it's not really taken
the sector that i think is moving the fastest
which i think is fascinating is the business
sector i spend quite a bit of time talking to
various businesses you know about prioritizing
sleep about the opportunities that good sleep
can provide a business um and what bad sleep
will how bad sleep will harm a business you know
i often wonder and i've got no data for it but
you know if we think about the last financial
crash it was a whole bunch of jocks who were
utterly sleep deprived you know and therefore
making i suspect making incredibly poor decisions
and impulsive decisions because they were chronically
sleep deprived, which ultimately cost the world
economy trillions because a bunch of tired jocks
were pushing the wrong buttons. And I think the
business sector have sort of got that and are
beginning to understand how you should structure
a working day, making it more flexible. and taking
into account chronotype, you know, whether you're
a morning type or an evening type. And something
I've long argued is that if you have an international
business, you should voluntarily chronotype your
workforce. So those in, you know, Europe, let's
say it's a European based industry, then the
morning types, you know. look after the asian
markets then the intermediate types and then
the late types are doing the north america markets
and so essentially you're accommodating and you've
got a team which is to some extent, optimised
to the particular time zone, and or certainly
be sensitive to the fact that people will be
working outside of their biological time, which
would allow them to make the most efficient and
sensible decisions. And so, you know, what we
argue for surgeons and surgery was there was
a point saying, yeah, let's have surgeries running
24 hours a day, then we can use the operating
theatres, you know, fully. We can get through
the waiting lists and all the rest of it. And
then I said, well, yeah, but you're going to
need two people to do this because one's got
to check what the other is doing and not making
mistakes. And therefore, you're not going to
have a saviour of costs because sessions are
very expensive, as are all the nursing staff
and all the support that you need to do that.
you know it's still a pretty simplistic view
of of our biology by our by our by our rulers
um they don't get it yet but it it is shuffling
forward and as i say you know i find it fascinating
that most of the talks i'm asked to to give outside
of academia are to the business sector in fact
it was great i i got to i got a trip to um istanbul
uh very recently as a result talking to some
very serious, financially powerful individuals.
And we had a brilliant time. I mean, they're
open to it and open to the discussion. And we
spent a big chunk of a day and a half discussing
the impact and the importance of this. So they're
open to it. And they want to look at ways in
which they can improve performance. In the same
way that another sector, which I'm not directly...
speaking to. But in sports and high performance
athletics, they really are embracing sleep and
timing and all of those sorts of things. To get
that subtle edge is the difference between a
gold medal and a fourth place position. Well,
and that's what's so crazy. Then you flip that
round to police, fire, EMS. I mean, you're talking
about split -second decisions that, you know,
a life is at stake, you know. So this is why
we have it kind of backwards, you know. I think
if the sporting community is using it, we certainly
need to be using it in all the areas where people
could die. I could not agree more, which is why
I'm so happy to chat to you, James, because our
front line, you know, are the... group that we
need to look after in that regard i mean you
were talking about you know the commute home
so um there's a study which i think i may have
mentioned last time in junior doctors you know
57 had reported either having a crash or a near
miss on the drive home in the early hours of
the morning after the night shift you know and
and so why on earth were they not being given
an app for their smartphone that they could detect
whether they were nodding or the car was moving
laterally. And of course, high -end cars have
all this technology built into it, but junior
doctors don't usually have that kind of income.
And the same for nurses and the same for the
other first -line individuals. And so we've got
to do a better job. I mean, the other thing which
I can't remember if we talked about or not, but
vaccination. the impact of a vaccination has
a big effect depending upon how tired you are.
And presumably because how high the stress hormones
are hitting. So if you haven't slept before a
vaccination, then the efficacy of that vaccination
drops really very significantly. And also the
same if you haven't slept significantly after
a vaccination as well. So we should be... prioritizing
that when our frontline staff get vaccination,
they should make sure they're rested in that
period before the vaccination. Otherwise, the
vaccination will drop in its efficiency and they're
the ones that are most vulnerable. It's that
kind of stuff we can do. We know enough to institute
that. It's interesting you say that because during
COVID, my whole platform was just standing in
the middle because there was one truth in all
of that. If you were all in on the vaccines and
you thought that was the be -all and end -all
and masks, then the healthier you are, just as
you alluded to, the healthier and more wet -rested
you are, the higher the efficacy of the vaccine.
If you are completely opposed to the vaccine
and the time developing all that stuff was worrying
you, then again, the health of the individual
determines your resistance to that virus without
any immunization. So there was one truth where
people were fighting in this World War I trenches,
but... The thing was, let's make the nation healthier.
And that's what was so sad is in the US, certainly,
I don't know if it is any different in the UK,
but in the US, that was completely discarded.
It was heresy. I was lauded for daring to say
the underlying health conditions were contributing
to some of these deaths during COVID. But you
come out the other end, and as you said, communities
were split apart. Sleep was disrupted. People
had gained weight. Alcoholism was higher because
everyone was ordering stuff into their house.
And so we came away really worse off and more
vulnerable to the next virus than we did at the
beginning of 2020. Yeah, and it's a very good
point because we weren't going out. It was so
much easier just to check that extra bottle of
whiskey or vodka or gin or whatever. Oh, you
know, because it's too for the price. All those
sorts of offers. And people still haven't recovered
from the increased alcohol consumption since
COVID times. And indeed, and other, you know,
comfort food and comfort eating. It's taking
a long time to get back from that. Circling around
to what you're talking about with the doctors
is interesting. I think it was Sir William Halstead,
if I've got that, William or Edward Halstead.
But anyway, when I did some kind of digging into
air quotes, the way we've always done it, the
crazy residencies that these doctors had stems
back to this surgical surgeon back in, I think
it was the 1800s, if I'm not mistaken, or beginning
of the 1900s. And he would do these. you know,
just marathon residencies, marathon surgeries.
Well, years later, when they were kind of looking
at it again, he was addicted to heroin and cocaine.
So I'm pretty sure I could stay up for 48 hours
if I was loaded with those two. With amphetamines,
yeah. Well, you're absolutely right. And that's
what people do. They will drive, I mean, at a
less severe level, it's driving the waking day
on endless cups of coffee. And then thinking,
oh, I've got to get some sleep. And then taking
alcohol or sedatives to try and reverse that.
And as we discussed last time, they're sedatives.
They don't provide a biological mimic for sleep.
So some of the wonderful stuff that's going on
in the brain, you know, memory formation, the
creation of ideas, the clearance of toxins are
actually impaired by some of these sedatives.
I mean, particularly alcohol is very bad on memory
formation. and processing of information. And
yet that cycle of stimulants and sedatives is
very much the drive, I think, for many frontline
staff. Where was I going to go with that? I just
was about to cycle. Oh, that's what it was. Okay,
let me just write down so I can remove my dramatic
pause there. All right. Well, one more thing
about the business side before we transition.
An interesting thing that's just really kind
of popped up a lot in conversation is out of
the UK. And that is a lot of corporations have
tried the four day work weeks of four, nine hour
days. And it seems like it's had huge success
there in Iceland and some other places. And from
what I understand, there's a higher level of
efficiency, more innovation, and then obviously,
you know, less sick time and those kind of things
as well. So what are you seeing as far as that?
Because as you alluded to. i think if we're going
to look at the thought leaders a lot of times
the business business space is really where the
most you know cut and edge innovations are coming
from yeah i think it's complicated and i think
it depends very much on the nature of the job
um and one of the the the great things that has
evaporated from the scientific community is is
particularly early mid -career people meeting
other early mid -career scientists and forming
that sort of network and those you know interactions
and the creativity of ideas which you can't really
replicate online and so i i think that We in
the university sector have been really trying
to encourage people to get into the lab, get
into the office. But the problem that we face
in Oxford is that the commute in, this is a medieval
city with very little parking and it's expensive.
I mean, you know, for young people to come from
the outskirts into the city is a big deal. And
you think, well, why should I spend two hours?
you know, commuting when I would actually be
more productive if I was in front of my laptop
for two hours. So I think there's a tension.
I think it's early days and I think it needs
to be looked at longitudinally. And it'll depend
upon the nature of the task. I do worry, you
know, we started with that loss of empathy and
generosity of spirit and all the rest of it.
And I wonder if... our isolation from Covid times
spilling into a shorter working week there have
been unintended consequences which is we don't
socialise as much and we perhaps haven't learnt
ways of compromise and the subtlety and the nuances
of having a joke and laughing and so I can see
that it could be extremely useful and very helpful.
But I'm slightly uneasy that there will be unintended
consequences because we are a deeply social species.
You know, that's what we are. We've evolved to
be part of a family and a community. And sitting
in front of one of these screens day after day,
not actually... meeting our colleagues and friends
does worry me a bit. Now, of course, I'm exaggerating.
The proposal is dropping to a four -day week
and that could well make sense. And so it means
that, you know, you've got a bit of extra time.
But I don't want it to go too far. And certainly
in the university sector, we were saying to support
staff, well, you can work. three days out of
five actually in the workplace and now we're
moving away from that and it's much more you're
expected to come in and I think as long as there's
flexibility That makes sense. I mean, I think
particularly if you've got young families, you
know, or you're a carer for elderly parents or
whomever, you know, having the flexibility to
say, look, I've got to do a hospital appointment.
I can work from home and then carry on a bit
further. That's really important. I think that
flexibility is powerful. But I do worry a little
bit about isolating ourselves from... colleagues
uh and and and and and a work environment it's
interesting the more progressive fire stations
now they've built individual rooms for the firefighters
so now you're not getting woken up if you know
we have what we call rescues which are basically
ambulances with fire gear on them and then you've
got you know engines and trucks so if the if
the rescue has a call the engine and the truck
crew don't hear it and they stay asleep i think
it's it's incredible But the problem is, is just
exactly what you're talking about. The danger
is that those crews will go to their individual
rooms, you know, between calls and barely see
each other. So I think there's definitely a happy
medium. It makes perfect sense to protect the
sleep that way. But I think now the leader in
that station has to say, all right, you know,
if you're going to go take a nap, that's fine.
If you know at nighttime, that's fine. But you're
going to call your family. You need a little
quiet. That's fine. But the rest of the time,
you need to be in these communal spaces so that
we can. train, work out, eat together, etc. Well,
particularly in your profession where you're
so reliant on your colleagues for your safety
and the safety of the job that you're doing.
So yeah, I think that bonding is even more critical
than the sorts of things that I do. Now, you
worked with my father a long time ago, and I'm
going to bring up his favorite subject, which
is poo. He is mad about the gut biome. If I want
an hour conversation with my dad, I just start
talking about pooticles. But I think it's a really
important conversation because, you know, the
more we learn about, you know, the brain and
gut health and the more, you know, it's more
evident that there's a huge connection between
the two. So we have certainly where I am sitting
now, we have a population that sadly their nutrition
is very poor. And then, you know, as we alluded
to earlier, you've got sleep deprivation, you've
got stress, et cetera. So, you know, what are
some of the kind of breakthrough? thoughts about
the importance of gut health when it comes to
mental health. Yeah, I think originally when
people started talking about the gut -brain axis
and the role of bacteria, we thought, well, how?
How can that work? And then, of course, depending
upon the bacteria that you've got in the gut
will depend upon your immune response. to those
bacteria and we do know elements of the immune
system can pass the blood -brain barrier and
influence mood and behaviour. We also know that
different bacteria can be very important in the
synthesis of vitamin K, certainly vitamin B,
and they can impact upon health. There's also
evidence that the type of bacteria that you've
got can influence your levels of of dopamine
and serotonin you know really important neural
hormones in in in mental health um and there
was a paper published just very recently and
i thought this is fabulous um and in fact i i've
just been really rereading it again by it was
in general psychiatry And we could send the reference
to anybody who wants to read it. Because what
this study had shown, I think, really very interestingly,
is that there were eight different types of bacteria
which were correlated with higher rates of insomnia.
So the implication is that if you don't have
the right gut biome and you've got a bunch of
bacteria of this particular group, you're going
to have... you're going to be predisposed to
insomnia but in the same way which is so fascinating
is that individuals with insomnia could very
much influence the type of bacteria in their
gut and so there does seem to be a real correlation
between sleep disturbance insomnia and the type
of bacteria that you have and the impact that
you'll have on your gut bacteria so i think it's
a i think it's a very exciting time mechanisms
still we're teasing apart but i mean the thing
that i suppose we were uneasy about when it first
surfaced is that what's the evidence that these
bacteria can actually interact with us and there
were some studies showing that the surface proteins
of some bacteria could interact with the receptors
of our gut lining and could change their biology
which I thought was absolutely fascinating and
now we know which I think is An extraordinary
colleague of mine, Martha Marrow, in Germany,
in Munich, she's got some amazing data, and I
got to see this just recently, of circadian rhythms
in bacteria. I mean, you know, so even these
creatures that we didn't think, you know, we
thought, oh, yeah, sure, the photosynthetic ones,
the green photosynthetic bacteria, but... what
about the others well they seem to have they
have clocks as well and and you can see them
under certain circumstances so i think this is
an immensely exciting area and and and so you
know i think there were some studies that took
immunodeficient mice who had oh no it was it
was mice with who'd had depleted gut bacteria
and they put um bacteria from humans who either
had good sleep or bad sleep from their gut into
the into the mice and you could replicate either
good sleep or bad sleep depending upon in the
mice depending upon the the the donor humans
so there's something going on there really really
interesting i mean Details are still emerging,
but it's fascinating. I love it, actually. So
I share that with you. Thank you. Thank you.
Well, what about the other way, too? Before we
hit record, I was talking about the book that
I wrote, and that really put me almost to a point
of burnout. And I think it was just the actual
workload and the stress and then revisiting some
of the things, going deep as far as the stories.
But that really had a massive impact on my GI
system, you know, and to the point where, you
know, if I'm being completely transparent, if
I had to go, I had to go, you know, certain times.
So kind of flipping it around now, the gut health
impact on the brain. But what about the other
way around anxiety, stress, the impact on the
gut itself? Oh, yeah. Well, absolutely. And the
bacteria that live in that gut. So you're going
to change, you know, gut mobility and the processing
of your food, you know, increased gastric acid
secretion and the knock -on consequences of that.
So absolutely. I mean, it's a bit trite, but
it really does require a holistic approach. And,
you know, if you... Prod one thing, it's going
to wobble through the system. And so we're now
beginning to realize you can't take anything
in isolation. And it's very interesting because,
of course, how do we divide up our medicine?
Intersectors. So you have coronary heart disease.
You have psychiatry who don't often talk to the
people in neurology. I mean, it's just extraordinary.
things that we've been increasingly interested
in is the whole concept of multi -morbidity which
which of course if is if you have one condition
let's say obesity type 2 diabetes you're almost
certainly going to have coronary heart problems
um and a whole bunch of and and possibly mental
health issues as well and so we should stop siloing
our treatments um and start to think about you
know a much more cross sectional treatment to
things like multimorbidity. One of the interesting
things about that, what's the one thing that
we know that can reduce multimorbidity other
than major dietary change and all the rest of
it? Well, it's sleep and circadian health. It's
quite fascinating. A common cross -cutting theme
across multimorbidity is good sleep and circadian
health. Which opens up some exciting opportunities
because it's an additional therapeutic option.
If we can deliver good sleep, good circadian
health, we can tackle a whole raft of different
conditions. Well, this is why when I talk about
the fire service, I always say we don't die of
one thing, we die of everything. And this, I
think, is underlining, obviously, the second
conversation now, why this topic is so important,
is whatever your weakest link is, is going to
manifest. And actually, this is a good segue
to the next area. One thing I've seen a high
prevalence of in arguably very young firefighters
is strokes. I know that's an area that you're
working in now, but have you seen a correlation
between sleep -deprived? groups and incidence
of stroke well we we if we take the extreme situation
of of night shift workers then coronary heart
disease and stroke um uh is is much higher in
that group um and again it goes back to our sort
of analogy of of the orchestra you know if you
think about our biology what it's they've been
evolved to do is deliver the right stuff at the
right concentration to the right tissues and
organs at the right time of day and when you
do that you have an efficient beautifully harmonious
set of biology But if all the bits of the body
are doing things at a slightly different time,
you're going to cause huge metabolic and physiological
stress. And those who are vulnerable to, let's
say, coronary heart disease or stroke, they will
be much more likely to have these conditions.
So, yes, I mean, what we're doing in that space
is using mouse models, is looking at when you
have a stroke. What's the impact of time of day
on the size of the stroke? And what's turning
out to be fascinating is that there's a big time
of day effect, and we think of circadian effect.
And so why is that interesting? Because strokes
happen when strokes happen. But if we know why...
strokes are smaller at one time of day than the
other, we can then say, well, what's the environment
of the brain at that time? What's causing protection
at one time and taking away that protection at
another time? And we think it's early days, but
it's... its antioxidant activity seems to be
quite important in protecting you from the size
of the stroke you'll get. If that turns out to
be true, then whenever you have a stroke, you
can go in, provide the brain with those agents,
let's say antioxidants, which will reduce the
size of the stroke. So I think that that offers,
again, another good example of using circadian
knowledge. to improve our therapeutic interventions,
in this case, in stroke. I should go back. I
think I may have flippantly said, you know, a
stroke whenever it happens. Well, actually, the
chances of having a stroke for most people, there's
about a 50 % greater chance between 6 a .m. and
12 noon. So there's a... German colleagues call
it the... which is the death zone because they
know very well what about this and it's due to
several factors one is that plasma stickiness
the platelets stick together there's a there's
that early morning window when they are really
quite sticky and also in anticipation of wake,
you're increasing blood pressure to send oxygen
and nutrients to a more active body. And the
combination of a sharp rise in blood pressure
and stronger blood viscosity can be a real problem
for ischemic stroke. And when you then take your
anticoagulants or your antihypertensives will
matter enormously. And there's some evidence
suggesting that in these long -acting drugs,
if you take them before you go to bed, they're
still at high enough concentrations to reduce
that stickiness of the platelets and blunt that
sharp rise in blood pressure. But if you take
them in the morning, the time you've got up...
The time you've remembered to take them and the
time they've entered the body and have their
effect, you're past that tosdona, you know, that
death zone. And one study from Spain suggests
that there's over, I think, about a six, seven
year... maybe up to 10 years, that the chances
of stroke were halved by taking your drugs before
you went to bed, your antihypertensives, rather
than taking them first thing in the morning,
which I think is really interesting. So I don't
know the extent to which your young colleagues,
first of all, would be aware that they might
have a problem. in terms of high blood pressure,
because they're young and therefore they think
they're immune to their invulnerable and probably
wouldn't even have it checked out. And if they
are on drugs to improve the chances of surviving
or reducing a stroke, they may be taking the
drugs at perhaps an inappropriate time. It's
difficult, as we said, because, of course, everything
is misaligned. So it's a problem. But I think
awareness and certainly I think the point you
made, which is. even young people are vulnerable
to heart attacks and stroke, should be taken
into consideration and there should be high frequency
health checks in this group. And it's not difficult
to do. And I don't know, I mean, what is the
policy, James, about screening for high blood
pressure and stroke vulnerability in that young
sector? It depends department to department.
Some have pretty good physicals and they'll do
ultrasounds and solid blood work. But a lot of
them, it's the bare minimum. There are recommendations
by our governing bodies that, again, recommend
doesn't mean anyone has to do it. And some of
these are very, very poor. And unless you have
some sort of hypertensive crisis, you may not
even be on the radar. And what you were saying
about, you know, waking up and then having to,
you know, that spike in activity and perfusion,
you think about the firefighter that's woken
up at 2, 3 in the morning and literally goes
from zero to extreme activity. And now they're
dragging hoes or, you know, whatever they need
to be doing. I can see how that viscosity along
with that sudden spike, I mean, a huge, huge
spike would contribute to some of the cardiac
events and the stroke events that we see in our
profession. Yeah. And so what about the concept
of duty of care? Knowing that there is that potential
vulnerability, why are not all young, why are
not all firefighters checked for these things
on a routine basis? Because after all, there
is a moral duty of care, but also it opens up
a service to litigation. You know, I mean, there's
going to be enough. So hang on. You know, why
did you not? You know, I am my occupation. It
means that I'm much more vulnerable to that sort
of incident. Why aren't you screening me for
my my vulnerability to that? So I can imagine
that the employers might be resistant, but also
some employees might be resistant because they
don't want to lose their job. I mean, what's
how does that work out? What we've really seen
is there's a complete resistance to the proactive
approach. So for example, there will be like
a heart and lung bill. So if I get cancer, then
you can show this related to the profession,
then you might get a $50 ,000 payout to your
family when you die. I don't think that's a very...
you know, positive way of doing it. So what we
need to do as a profession is shift to the proactive
approach. And one of the big things that you
and I spoke about last time is this resistance
to the very concept that the work week that we
have at the moment is killing our people. And
then since we spoke, the recruitment crisis just
got worse. So as less and less people wanted
to join the profession, the ones of the left.
are working even longer now so a 56 hour week
you know you get a phone call at 7 30 in the
morning gearing you can't go home and now it's
an 80 hour work week that week you know of you
know like disrupted or no sleep four days of
that week so until they acknowledge the elephants
in the room the herd of them you know with that
then you know i feel like that the other conversations
are falling on even deaf ears but there is a
revolution happening in florida where uh the
last two years since we spoke i think we're up
to nine fire departments now have made this shift
and lo and behold when they fix that now this
conversation of putting in fitness standards
and annual screenings and so when you address
that massive roadblock that is just you know
in my opinion really being used as a tool of
cowardice because If I just deny it, then I don't
have to deal with it, you know, as a leader.
So now that they are starting to deal with it,
it's opening the door to all these other areas
that they can improve simultaneously. So it's
exciting to see these real leaders in the fire
service kind of pushing that forward. That's
really good. And of course, you know, we touched
last time on the educational piece about people
also need to take some responsibility and to
be sensitive to what may be happening to them.
But not just them, but the people they spend
their lives with. So their partners and their
families also need to know about some of the
problems. And I think, again, we touched on last
time. In some sectors, the divorce rate can be
six times higher in the night shift compared
to the day shift. Now, I don't know what the
statistics are like in your area, but I suspect...
Yeah. Yeah. And, of course, I think they're awful.
i remember when we were talking about this sort
of thing again going back to the mining area
in in northwestern australia and we were saying
these are all the things and you know the the
impulsivity the lack of empathy and all the rest
of it and this woman in the audience started
crying and she said i've been so mean to my husband
and you know accusing of all these things and
i had no idea that this was the consequence of
the job he's doing which is trying to put food
on the table for us and and i think i think there's
a very important educational piece for for for
partners and families. It's a problem that is
not just on the individual but it's the broader
community in which they spend their time. Well,
I mean, twofold. Firstly, when we are at the
station, our partners are single parents for
24 hours. If they're wildland firefighters, it
might be, you know, a week, a couple of weeks.
And so you do, you have this kind of shifted
dynamic that way because we come home exhausted,
but they've been, you know, taking care of the
children and their own profession. And so, you
know, you've got that kind of jarring interaction
when we come back. Yeah, it's interesting. One
of the people said, you know, when my partner
comes back, I say, right, I've done my bit. Here's
the child. You take over. And of course, they're
exhausted. They can't do it. But it's that failure
to appreciate the demands of the job. And again,
there's an educational piece here that we must
address. Well, even the ownership. I think this
circles around to my question about critical
thinking and fatigue is I have literally had
people say, we don't want the 24 -72, the 42
-hour workweek. We want the 48 -96, the 56 -hour
workweek. Now, any person who's well -rested
is going to look at that and go, that's ridiculous.
The partners of these people are going to say,
that's ridiculous. You don't want to come home.
an extra day between your shifts. But this is
where I think, you know, with the ownership piece,
we struggle so much. I mean, we talked, I think
we touched on it last time, as far as the impact
of sleep deprivation on obesity and testosterone
and all these other areas too. But when you have
an underslept overstressed population, getting
them to advocate for themselves is so hard because
they cannot critically think. Yeah. Yeah, no,
absolutely. Well, I want to hit one more area
because I know we're getting close to time. Last
time you and I spoke, you told some incredible
stories about some of the blind veterans. And
then you talked about developing a drug that
can initiate the chronobiology when someone doesn't
have the capacity to with the eye. So talk to
me about where you are now. And then what are
some of the hurdles that you're trying to overcome
at the moment? Yeah, so it's been both exciting
and disappointing. So on the basis of the preclinical
work that we've done, the FDA said this is priority
area and you've got orphan drug status, which
is this is very exciting. And this could be used
for non 24 hour individuals, individuals who
cannot lock their internal clock onto the external
light dark cycle. And we then went on and with
our colleagues in Australia showed that the drug
is safe. But we've now fallen into that classic
sort of valley of death that you find for so
many startups, which is we're too tiny for big
pharma because we're asking for about $7 million,
something like that. And they said, well, no,
that's just not, you know, that's the kind of
stuff you find down the back of your sofa. We're
interested in the 50, 100, 300 million type stuff.
But $7 million is too big. for small investors.
So we're still in that valley. One very exciting
piece of news, though, is that the Michael J.
Fox Foundation, who are aware that sleep disruption
is a big issue in Parkinson's, have asked us
to see whether this drug might be useful in,
again, these are preclinical, these are mouse
studies, where there are mouse models of Parkinson's.
Will it improve their rest activity and their
sleep? wake so we're we're we're we are shuffling
forward but you know it's so easy to do the human
trial which is basically you keep people under
dim constant light you give an injection of the
drug at the same time every day do their rhythms
lock on or don't they if they lock on just like
mice and i'm i have every anticipation that they
will um then we've we've we've actually given
black back a sense of time to the time blind
And as I think we said last time, I mean, so
many people have lost their eyes. They say to
me, look, I can cope with the blindness. It's
awful, but I can find ways around it. What I
can't cope with is my body constantly fooling
me about what time of day it is and what I should
be doing when. And so when I should feel hungry
with my family, when I should... try and work.
And I think that's what I want to do for the
last part of my career, is give back a sense
of time to the time blind. And as we probably
also said, it's not just the profoundly blind,
but our work on schizophrenia and other... mental
health conditions and in neurodevelopmental conditions
and in neurodiversity where sleep -wake timing
is a major issue for the individual and the family
or the people they spend their lives with. So
I think there's enormous potential and some further
work has also looked at another drug which Very
exciting because it increases the amplitude of
the circadian oscillation. As we age, for example,
that begins to flatten out, which means that
you don't have the same precision, which is why
sleep is... less robust as we age. Why, for example,
urine production, you know, the hormones underpinning
urine production, you know, produce urine during
the day, not at night, starts to flatten out.
And therefore, you're going to be more disturbed
by wanting to get up and pee at night. metabolic
conditions there's also strong evidence there's
a flattening out of of of metabolic dynamics
and so for example we we were looking on mice
fed on a high fat diet with fatty liver disease
And under a normal diet, when you gave this drug,
all it was doing was increase the amplitude of
the circadian oscillation. You reduce the fatty
liver by a huge amount. So, again, I think there
are exciting things sort of in the pipeline.
But the problem is we still are sort of regarded
as a bit kind of peripheral. Circadian rhythms
and sleep are not thought about as being central
and one of the pillars of health. Which is why,
and we were chatting about this before we started
recording, there's going to be an initiative
in Oxford for a centre for circadian health.
We've got the Sleep and Circadian Neuroscience
Institute, which is fundamental neuroscience
and underpinning. Now we want to embed this knowledge
across the health spectrum. We've talked about
stroke, cardiovascular disease. I mean, there's
metabolism, there's mental health, and we've
got to get... practitioners in these areas utilizing
this knowledge and also fundamental scientists
working with our clinical colleagues developing
new knowledge to to to to solve some of these
problems so yeah it we shuffle forward um but
i remain optimistic um and particularly i think
with this new initiative if we can get a center
for circadian health off the ground and it's
and it will be based in oxford but we'll obviously
have close connections with our colleagues in
australia and japan um and and in germany where
we already have active collaborations um i think
we can probably do something exciting. Change
some ideas, change some attitudes. And of course,
shift work will be a key area. Yeah. This is,
I guess, illustrating the fact that it's not
just my profession, that even in your world,
in the health world in general, that there's
still this kind of poo -pooing of the importance
of sleep. And I think this resistance I'm seeing,
sadly, is because sleep is free. it's going to
be hard to keep selling some of these drugs when
you realize that, as you mentioned earlier, this
holistic approach to exercise, to sleep, the
nutrition truly is the answer to so many areas.
But I know that we've talked about this. I think
we hit it last time. Even the sleep disruption
amplifying issues of autism and some of these
other issues. If we can just get people back
sleeping again from obesity to neurodiversity,
massive impact would that have well i think neurodiversity
is a very interesting area because there's since
last we talked there is much greater interest
in that in that whole area and and it's trying
to understand well why is sleep so difficult
in neurodivergent kids in particular and it's
and it's trying to understand well it's It's
a lack of understanding in some neurodivergent
individuals of picking up the signals for transitioning
from, well, now you should be awake and now you
should be asleep. What are the signs? What are
the things that they need to log on to, to know
that this is what's going? And therefore structure
becomes so very important in those kids. You
know, now, and explain, this is what we're doing.
You now put your night clothes on because, and
it's just making it very, very structured. The
other problem, of course, is that the... Sensory
thresholds for some neurodivergent children are
very different. So they're going to be much more
alert and much more awake because of what's going
on in their environment. And so again, minimizing
noise, minimizing light, keeping stability. Practically,
that's often very tricky in a normal domestic
setting. But these are the things that people
are now beginning to take seriously in trying
to get the sleep for these individuals. Well,
correct me if I'm wrong, isn't the drug that
they usually prescribe, namphetamine as well,
which I'm assuming would dysregulate sleep? Well,
absolutely, yes. I mean, I think this is the
problem because we've got so very few tools that
will regulate sleep and circadian rhythms. We've
got drugs that will sedate you, but that isn't
the issue. We need to regulate those different
systems, not sedate the individual. And that's
that's the I think the exciting future. And I
and I suspect, you know, when I'm long retired,
it's going to be a conversation 20 years from
now that, oh, yeah, it's extraordinary. You know,
these have come on the market. We've just now
transformed this space. And I and I don't I don't
want to imply that a drug is the magic answer.
I'm talking about where we can't use cognitive
behavioral therapy and behavioral change, where
behavioral change. isn't going to work as in
the blind for example um then then drugs could
be useful and and i wouldn't wouldn't propose
that you know you use a drug to to mimic the
effects of light on the clock and keep somebody
on it you you get the situation stable and then
you then you move to sort of behavioral change
and the expo the regular exposure to light and
things like that so i i and it there's one trend
that's alarming me in the States, which is the
use of melatonin gummies for kids. And first
of all, the evidence that melatonin is, well,
it's not, as we discussed last time, it's not
a sleep hormone. It's a mild regulator. But I
do feel uneasy that parents are just giving a
gummy rather than using behavioral approaches.
to allow the child to understand what they need
to do to transition into sleep. Because, you
know, even young kids know what's going on. And
again, we go back to autism, but, you know, a
structure. Now this is what you're doing and
you're winding down. And certainly from my time
in the States, I saw some parents who would put
their kids in front of the telly and it was these
really violent cartoons. And very, very lots
of images, lots of bright and all the rest of
it. And then expect them to go to sleep after
that. It's it's where we go. We come full circle.
Where have we stopped reading a gentle bedtime
story to a child at the end of the day and have
that bonding and that relaxation and the realization
that now it's sleep time? And we seemed we've
lost the. the childhood story, I think, in so
many families. And of course, you can understand
it because so many families are utterly pressure
driven and exhausted at the end of the day. It's
usually the mother or the father that falls asleep
before the child if they do a bedtime story.
Yeah, that's funny. Actually, I used to read
my son, Dr. Seuss, that, oh, the places you'll
go. And he just turned 18 a couple of days ago.
And I put a little social media collage, but
I found a song that had those words. You know,
if I if I just stuck a tablet in front of him,
I would have lost that quality time with him,
that bonding, you know, and that's a chance for
the child to kind of talk about their day and
get anything off their mind before they then
go to sleep. So I couldn't agree more. I mean,
I think even if, you know, you are a very electronic
based family, still carve out, you know, 10 minutes
before the child goes to bed and just pick up
a book. My mother used to sing a song to me,
which is a little man, you've had a busy day.
and i can still remember vaguely her singing
this to me and i actually went online and i got
the score to it and and and i read the words
and and it all came flooding back because that's
how we used to end the day you know a little
man you've had a busy day it's wonderful absolutely
Well, for people listening, your book is lifetime.
I mean, so many things that we spoke about last
time and this time are in here under understanding,
you know, sleep biology in the first place and
then shift work and the chronic effects and the
acute effects and, you know, solutions, you know,
sleep hygiene, so much in there. So for people
listening, where are the best places to find
the book? And then when are you anticipating
the second one coming out? Well, so Lifetime,
it should be available in all good bookstores.
You can order it, of course, through online retailers
like Amazon. And yeah, it's done well. It was
a bestseller in the UK, both in paperback and
hardback, which was really exciting. um the next
book is on um we're still deciding on the title
but it's all about light and a big chunk of it
will be the impact of light on human health going
through i mean i'm fascinated you know and i
really the whole nature of the book started because
um you know you sit around with a bunch of friends
and say okay well tell me how light is generated
in the sun and yeah this is a reasonably well
educated group of people nobody could explain
it So I thought, God, this is fundamental, you
know. And so the book deals with vision, obviously,
and how we detect light and process light. And
to some extent, why we're different from other
animals. So there'll be a comparative, you know,
who are stuff. Then we'll have the vitamin D
synthesis. which is, again, so interesting. You
know, we all think vitamin D is made in the skin.
No, the precursor is made in the skin because
of UVB light, but then it has to go to the liver
and then the kidney to produce the active form
of vitamin D, which means if you have liver disease
or kidney disease, you're going to be vitamin
D deprived. And what's the latest science on
the use of the role of vitamin D? And then, of
course, skin cancer. Then colour psychology,
which is, I think, really incredible. So the
power of red. And so that will be photosynthesis.
Why the production of oxygen by green plants
essentially has allowed complex life to exist
on the planet. And of course, if it weren't for
ozone, which is a form of oxygen, we would be
bombarded with high energy photons from the sun.
killed we all get you know mutations um and and
all the way through to to light and architecture
so i wanted to try and bring all these topics
with a central theme of human health together
it'll be out assuming i can i think the plans
are to try and get it out at the beginning of
2027 so in about a year and a half's time So
if I can peel my finger out and get the revisions
done. Well, just super quickly, I know you've
got to go. With skin cancer, I kind of try and
revert my thinking back to what have we done
most of the time as far as human history. And
there's this culture now where if you step out
the sun for five minutes and you're going to
get sunburned, you're going to get skin cancer.
So slather yourself in these chemicals before
you walk out the door. What are you seeing very
briefly between the connection of sensible skin
exposure, because obviously your skin will tell
you when it's had too much, and skin cancer specifically?
It's tricky. And of course, this is what the
Australians face is a huge dilemma because they
have this slip -slap -slop, which is, you know,
it's all about going out and covering up and
putting... And that makes a lot of sense with
that high, high levels of sun. You don't need
to be out for long to get the vitamin D that
you need. So it does pay to take, obviously,
protection. And the number of skin cancers has
gone up, even in places like the UK. That has,
of course, been associated with increased use
of sunbeds, which are largely unregulated. And
certainly a survey by the European Commission
fairly recently showed that most of the... or
a big chunk of the sunbeds that were being used
were actually producing dangerous levels of ultraviolet
light. So, you know, you should never use a sunbed.
And if you get out there, be careful. And there's
also been a move saying, oh, there's too many
skin checks for melanoma and all the rest of
it. And I chatted, and there's a group of individuals
proposing this. I spoke to the skincare people
in Australia and elsewhere. They said, no, no,
no. Don't ever think about not having regular
skin checks because it will save your life. The
other area, though, that is incredibly interesting
is the development of myopia and short -sightedness.
So in some Southeast Asian countries, in urban
young, the level of myopia is greater than 95%.
So these kids are having to wear corrective spectacles
to get rid of the short sightedness. And there's
now very interesting data showing that time outside
is strongly correlated with the reduction in
the chance of developing myopia. And we were
saying earlier, right at the beginning, you know,
we live in dim, dark caves. And that's the problem.
You know, we're spending all of our time inside
under. low levels of light. And it seems that
that is a serious issue and a serious risk factor
for the development of myopia. So anyway, the
book is trying to pull all these fascinating,
you know, this extraordinary giver of life, sunlight.
I mean, it's made us what we are. And also, you
know, allows us to sample our world through vision
and change our... view of the world depending
on what color we see i mean there's a there's
a whole area of commercial the color psychology
of why you buy certain objects because of the
color and and so i've got i go through the you
know the entire gambit and and i hadn't realized
how difficult the book would be to write of course
and there's lots of stuff on circadian rhythms
and and uh and uh and seasonal rhythms actually
yeah It's interesting you say about the myopia.
My wife just became a doctor of optometry here.
And that's what I've said to her is, you know,
from thinking from an evolutionary point of view.
why is it that so many of us need glasses so
often because from a survival point of view you'd
think that that wouldn't be the case and i'm
and i get you know i was saying to her i guarantee
you a lot of these modern things that we have
now are making this worse and what you've just
said makes perfect sense you know if we're not
having that distal focus or distance focus excuse
me over and over again and the exposure to light
and we're looking at these devices you know a
few inches from our face of course it's gonna
even just from a muscular point of view optically
it's going to change the way that you know the
spectrum of use of that particular organ. Yeah,
the precise mechanisms are not absolutely clear,
but it looks like the role of light releasing
dopamine within the eye, which is changing the
architecture and the shape of the eye. So stop
it elongating, which is causing myopia, and get
it to sort of correct. But the precise mechanisms...
remain unknown, which I think is extraordinary.
When you think of the percentage of individuals
that will need corrective sort of spectacles
around the world because of myopia is in the
billions. And the cost of that to the individual
in the state will be huge. Yet we don't understand
the mechanisms. Amazing. It really is. All right.
Well, for people listening, if they want to learn
more about your work, reach out to you. Where
are the best places online? Yeah, the website,
of course, most websites are a little bit out
of date, but there's websites. But if you do
a Google, then there's sort of various talks
and things I've done that will be online and
available. And of course, if you really need
a question answered, then drop me an email. Brilliant.
Well, I want to thank you so much again for being
so generous with your time. I know you've got
to go now, but it's been another fascinating
conversation. So thank you for coming back onto
the Behind the Shield podcast today. James, always
my pleasure. Thank you so much for inviting me.
And we'll hopefully catch up again soon.