Hello everyone, and welcome again to the Sleep Deep Summit. New Approaches For Beating Sleep Apnea And Insomnia. I am your host, Dr. Audrey Wells, and I am super excited about the next guest.

This is Dr. Heather Hammerstedt, who is an emergency medicine physician who also holds specialized board certification in lifestyle medicine, as well as additional training in integrative nutrition and health coaching.

In fact, she got her health coaching certificate way back during medical school when she realized there was a huge hole in our medical education around food and mindfulness and exercise.

So at this point, she is a real expert with thousands of hours deep diving into food and weight and weight loss. And she has put together a kick ass lifestyle transformation blueprint to get women to long term health without products or BS.

Welcome, Dr. Hammerstedt. Thanks for having me. It's a pleasure to talk to you. And I want to start out with this interesting concept of eating mindfully.

Can you explain what that means? Yeah. I mean, I think so many of us like, just we put a lot of like emotion and importance into food, which I think can be a good thing, can also be something that distracts us from the purpose of food.

And so I like to practice every once in a while, like really sitting down and consciously enjoying my food for what it is. You know, our food comes to us from a long, long path from where it was grown and how it was processed and where it comes to us from it.

And I think it's important for us to nurture that in a way when we're eating. And I think that it brings to us a couple of different opportunities that way.

One is we usually eat slowly when we're being more mindful about it, but we also probably eat less as well. I feel like there's a couple different kind of stages of learning to eat mindfully.

I think that the first stage that most of us are in most of the time is sort of like an and unaware sort of like unconsciously incompetent sort of way of eating.

So you're in like an eat repeat cycle and you don't realize that your attention is not even on the food that you're eating. And sometimes that ends up you end up feeling a little bit hopeless about your eating process.

The next step is sort of being uncertain. So I'm realizing that I have decision points that I can make with my food and that I can make mistakes and I can be inconsistent.

But I can also realize that the food that I have in front of me is there for a reason. The next step is sort of becoming more aware. So I'm not dieting, I'm not bingeing.

All I'm doing is realizing that my food in front of me is here for me and that I can taste it and I can feel it and all the sensations that I have and really putting that energy into that food.

And then I think the most mindful stage that you can be is sort of, I can manage my food, I can feel confident about handling that. I'm aware and I'm curious and I'm accepting of the food that's brought to me and that it's bringing me kind of what I want in terms of how it makes my body feel.

And that's a that's kind of a lot to start out with. But I think that I think really when it comes down to it is like, can you sit with your food and really take from it what it's trying to give you and can you bring yourself the food that you want and is it bringing you what you're hoping it is?

Excellent points. And you know, I think at its foundation, food. Food is fuel. I've heard that a lot. Food is fuel in my world of sleep, medicine for people who are not sleeping well for a number of causes.

I notice that people often turn to food for energy or even to stay awake. For example, if someone is having trouble with driving, there's a tendency to snack on sunflower seeds or something that's crunchy and that can kind of promote a little bit of awakening or arousal.

Do you also also see that with your groups who are trying to get more mindful around food? I think food and sleep are pretty integrally related to each other.

It's pretty as a pretty complicated topic. I do think that the act of eating can keep you awake, and I think that's what you're bringing up in terms of like you have a long drive and you know you want to keep yourself.

So some sort of energy. I do know that the hormonal shifts that you have, one eating can definitely can definitely affect your sleep. So carbohydrates in particular, even the good complex carbohydrates that we talk about do have sort of been a wake signals.

So we often recommend people really have those complex carbohydrates at least 2 to 3 hours before trying to go to sleep. But I do I definitely do think that that especially is key.

I do also know that we can have some cortisol and growth hormone shifts kind of extend the later in the evening, the more that you're eating before you go to bed.

Absolutely right. And I think for anybody who's listening to this or watching these videos, it's really important to underscore that stopping food intake 3 hours before bed is what's recommended.

Also, because, you know, your digestive processes are an awake activity or a daytime activity, and those tend to be significantly less prominent overnight.

So even the way that you process glucose or secrete insulin changes. Another thing that I have seen is for people who tend to snack late or eat late, the choice of their food is quite different compared to the morning.

Would you agree with that? No. Yeah, for sure. I mean, I think there's something about those highly palatable, processed, high fat, high salt, high sugar foods that, you know, the old men and the lab coats created for us to especially want to buy.

Those things are definitely the things that you're going to want later at night. And I think being conscious of that and as we're on the topic of mindfulness, being mindful of the fact that that is how those products were created specifically for that purpose is important in terms of how to make your choices.

Definitely. You know, I think that the highly processed food has an addictive quality. It's hitting our reward systems unfairly. And, you know, at the end of the day, when your brain is tired, you're not as well able to inhibit those impulses towards snack food.

Yeah. I mean, so you're you're hitting it right on the money. So to get a little bit nerdy about it, what you're talking about with those reward systems is really that dopamine surge that we get, that feel good hormone that we get, and that is specifically met with things that we like to do right.

So people who get addicted to gambling or people get addicted to cocaine, people who get addicted to highly palatable foods, it's the same thing. So if you're late and the day you've had a hard day, you're parenting, you're working, you're running around, you're doing errands, you're doing all the things.

And then you have an opportunity at night to, like, suddenly stop and your dopamine is going to be depleted from that busy day. And what are you going to do to refill it?

Is it binge watching a show? Is it eating potato chips? Is it what you know, what is it for you? And I think, again, we're talking specifically today about mindful eating is I think the most important thing is to understand how your brain and your body are working around this so that you can, like, have that moment of being like, Oh, I know what my brain's doing to me.

Like, is this how I want to feel that, like, depletion? Is this the choice that's best for me? And if we don't even know that that is something that our body is doing to us, then yes, we're reaching into the cabinet to eat because that's what we're doing.

It's automatic. Your brain is telling you to do it. It's not like your fault is just what your body is doing. But if you have that underlying knowledge to be able to take that half step and be like, Oh yeah, right.

I heard Dr. Audrey and Dr. Heather talking about this. This is why my body is doing that. That's so true. And I think it's really interesting to note that dopamine in your brain has a circadian rhythm and there is a dopamine decrease in the evening, which everybody has, presuming they're sleeping overnight.

And so, to your point, just understanding and having that awareness can really help you to make different choices in the moment and not kind of get overrun with the urges.

I've never heard of anybody going for a midnight snack and chewing on some celery. It's really like the ice cream in the cookies in that. Yeah. I wonder if.

That midnight snack can really like can really throw you off though. I mean, I get it. Why that happens. And we've all had that moment where we can't sleep and we get up and we try to distract ourselves with food.

I would really recommend that you try to distract yourself with T or distract yourself with water or distract yourself with like a ten minute yoga or a ten minute stretch before trying to go back to sleep.

Because really the change of like as you said earlier, you know, our bodies are made to digest during your awake cycles. And if you eat and go back to sleep, your body is maybe will not let you go back to sleep because it's thinking it's awake, you know, those kind of things.

Absolutely. And I think that doing those things in advance, making a plan for yourself will help you to kind of have that on the tip of your tongue when you run into trouble with sleeping.

Yeah. I wonder if you can tell us more about kind of getting into this place of mindfulness with eating. Do you have any specific exercises or programs that you can offer?

Yeah. So I think the first thing that I think is the most important is really understanding what hunger is. And it's not. I mean, I could talk about this for hours, but like, you know, there's there's social hunger, right?

Like I always eat in this situation, right? There's kind of psychological hunger, right. Like we were just talking about, like the the need to buffer whatever emotion or to refill that dopamine that you have.

Those aren't real hunger. And then there's actual bio hunger, like your body does not know where to get its fuel from next. Right. Or I have not taught my body that it can go in and get fuel from our fat cells and from our liver.

And that's that real hunger that you're feeling. And I think that, first of all, mindfully being able to understand which one of those sensations that you're having and how to fix that, whether it's with food or not, with food is the first step.

And that is just practice, practice, practice. It's really stopping before you make that choice to eat about like, what is it that I'm actually feeling right now?

And is this the right choice for me? It can be a very sophisticated thing, but I do recommend that people really try to think about that. If it is actual bio hunger.

I think my very favorite in the simplest exercise is to really follow what I call the hunger scale. And this is out there. I'm not I didn't create it, but I think that it is one of my most favorite things.

If you think of like like I think of it like an arch, like a half a half wheel and you have minus ten. Like you're ravenous, like you haven't eaten in days and like your body is like disintegrating because you're so hungry.

And the plus ten is like, I cannot get up from the table cause I am so full and if you try to think of that scale and then starting to eat when you're at minus four and stopping eating when you're plus four and like really living in that kind of pie right there of your, of, of feeling satiated, great feeling like I got the fuel that I need.

My body feels good, but I could still get up and jog down the street if I needed to kind of feeling. And I find that that's that that has really guided me and guided many, many, many holistic clients about kind of really where to kind of mindfully sit yourself.

And that means that sometimes you may not eat when everyone else is eating. And you know what? That's okay because everyone's body is a little bit different.

And giving yourself that grace, giving your kids that grace, giving your partner that grace of like let's really like think about what I need right now.

Like, I know it's dinner time, but I. It turns out I'm really not hungry, so I'll sit and enjoy and sit with you and be with you guys. But, like, now is not the time for me to eat.

I think is can be really important. So that hunger scale is probably the most easiest and simplest thing to really try to get to understanding how your body is feeling and what you need to do about that.

I think if you do choose to eat, one of my favorite things to do is to either drink a very hot or a very cold drink before eating it. It can kind of turn on your stomach in a way of like bringing your attention down to your body and getting out of your head a little bit and really like feeling what it is that's going on in there.

First off, if you drink a pint of water before you eat, you probably are going to eat about 500 calories less at that meal. That's just like generally known.

But when it comes to mindful eating, I think the most important thing is not necessarily that number, but sort of like, okay, here I am. Once you do start eating, really, I think I try to take my first bite with my eyes closed because it's really silly, but I feel like it helps me really slow down and feel the texture and the taste in different parts of my mouth and really feel how it feels when it kind of gets down into my stomach and then putting down my fork between between bites, like using chopsticks, something making it more difficult so that you have to eat a little bit more slowly, I think is really helpful as well.

I think anything that helps you really just slow down and like feel the food that you're eating. I always like tell our whole clients who are in for mostly for weight wellness issues and what's that like the that of course you're going to have food that is like that you hadn't planned and that maybe isn't like really like on what your what your goal is.

And I call it a joyful eat because I'm like, if you're going to have it like love it, right? Like, sit down, taste it, enjoy it. Like make that decision that you made like worth it.

And that's like the best part of mindful eating is like really loving the opportunity of that food. And when it's bringing you. And also not having a distraction while you're eating it.

Right, that can take away from your joy. There are so many great points. I just want to recap a little bit so it seems like naming it helps a lot. Naming the hunger, is it social hunger?

Is it hunger because you're bored or overwhelmed or stressed or is it real biological hunger where your body is asking for food? And then once you kind of determine that you want to proceed with eating, one of your main points is to really slow things down and work in breaks to your meals.

So as you pointed out, close your eyes with the first bite, internalize the feeling of the food, and do kind of a a U-turn like a why? Oh, you turn inward to see how does this food taste?

Is this what I want right now? And if you're slowing down your eating, that also helps your hormones that are released with digestion to kick in and signal satiety or fullness more quickly.

So I love all of that. Yeah, I love the U-turn. I'm going to borrow that. Yeah. I like to say that we do that at night. You know, when you're lying there in the dark and the quiet, you do a U-turn inside and that is helpful for getting to sleep.

I want to shift gears a little bit and talk about something that's really kind of out there in the media and is more and more known as being a significant contributor to health, and that's the microbiome.

So we have the gut microbiome. We have a nasal upper airway microbiome, a lower airway microbiome, skin microbiome. But in in the case of food, what we're primarily interested in is how to have a healthy gut microbiome.

Yeah. So again, I give like 90 minute lectures on this, so I'm going to give some high points. I think the important thing, the bigger picture in terms of microbiome, like what are we talking about here?

We're talking about the fact that there are trillions of bacteria that live in our gut that are working for us or against us, depending on how we have chosen to feed them.

And I'm sure that you can talk forever about the gut microbiome and how that affects your sleep, and that is like your wheelhouse. Mine is the fact that like how we choose to fuel our bodies fuels these gut microbiome.

And the gut microbiome is not only going to, you know, have your gut be healthy in terms of like your bowel movements and your digestion. But it is going to change how you make your mood hormones.

It's going to change how your skin looks. It's going to change how your hair grows. It's going to change like literally everything about you. And I think it's what's so exciting over the last five years is really seeing so much of this being discovered by our colleagues who are doing research on this.

And I can only imagine where it's going to go. But the simplest part is that you have kind of good bacteria and you have bad bacteria. And simplistically, the good bacteria are the ones that are going to help kind of moisture, your serotonin and your and your gut health and your immune system and your skin and your aging and those fuel off of very variety of colors of complex carbohydrates and vegetables as well as fermented foods.

The bad bacteria are going to fuel themselves off of highly processed, highly palatable foods like we were talking about earlier, that high fat, high sugar and high salt foods.

And so if you're just thinking about like you're not just feeding yourself, you're feeding these trillions of little like bacteria that are like living in your gut in there and you're choosing your future.

You're choosing what you are, shifting your your body and your health span to be based on what you're feeding. So it's not just about the scale. It's not just about what you can pinch around your waist.

This is literally you are fueling those gut bacteria to fully fuel your future. In a way. I really love that because it speaks to how the choices we make today are going to affect us later on.

And that's true no matter what aspect of health you're talking about. One of the questions that I get a lot are is can't I just take a probiotic pill or a prebiotic pill to get things normal with my gut microbiome?

I think that so first off, that I think about pro and prebiotics. And as I separate them out in my brain of being like probiotics are like a capsule of like several million little bacteria that I can take that is going to supplement what the balance of that good versus bad bacteria in my body.

And I think that that is has a very good use and is very necessary in certain parts of our lives. I think of probiotics, of being the the food that is fueling the bacteria.

So the actual nutrients that we are taking in that are fueling the bacteria that are already there. So there are two very different things in both very important in terms of a prebiotic like we should like when I prescribe antibiotics from the emergency department, like I go through this with everybody and everyone's probably rolling their eyes like, why is this currently doctor talking to me about vegetables?

But if you get prescribed an antibiotic, you absolutely need to be very on point with your prebiotic food, right? Very colorful vegetables. You eat the rainbow, you make sure you have fermented foods to really fuel the good bacteria that are being targeted by that antibiotic that is very necessary for whatever bacterial infection that you have.

And I say that you should go on a probiotic for at least 12 weeks after the antibiotics are complete now. And if you're not on antibiotics, I also think this is very important that those vary in the the colorful variety of vegetables and that fermented food is very anti-inflammatory and is going to unprocessed yourself enough that you're going to feed back to the gut microbiome in the way that it wants to be fed.

As I was talking about feeding those good ones and not the bad ones. So can you have a crappy diet full of highly processed foods, highly palatable foods that the men in the lab coats all made for us and take probiotic pills?

And will it be better? Yeah, I don't know. I think what you're doing is you're just adding more bacteria into the mix and is a couple million of them in a pill really going to like change that spectrum of of what's in your gut that much if you're still feeding the bad ones.

So I think that answered your question for sure. And that clarification was great because there is a difference between prebiotics and probiotics, fermented foods.

I think of kimchi, I think of sauerkraut, those types of things. And, you know, there's some question out there, I think, about what is good food, what is processed food, lab coat food.

I think of it as like anything with a food label. But I'm sure that you can elaborate too. Well, I think I'll get even simpler. How's that? Yeah, I think if it was grown or if it was born, you can eat it.

Got it? Yeah. So, like, things with chemicals and additives and preservatives and, you know, all the things that are difficult to pronounce on the food label is processed.

Food. Yeah. And I think, you know, I think if you're going to buy things that come in a box or in a can, the less amount of ingredients means that it's less processed.

So trying to find a food label of five or less ingredients is a good rule. I think also just like, you know, the food science studies out there is that if you take something that is very healthy, you think of like a carrot, right?

And you process it into something else, even if it's now carrot cake. Right. It is drastically different for your body. So anything that is being done to a food is going to change what nature intended for it to be as a nutrient for us.

And so just thinking about that, like who messed with it and what did they do with it? Did I want that right? And so really, you know, lifestyle medicine is primarily our data is primarily around whole food in mostly plant based research.

And I think that thinking of that whole food aspect of that is really important. You know, how did it how was it grown? Is it how close is it to that right now is going to make sure that you're not getting the mostly pro-inflammatory responses from processing food that we get?

Absolutely. And great explanation. I think that's really accessible and a healthy dose of common sense to, you know, what you put in your body will give you energy if it is less processed closer to the way that nature built it.

Yeah, in my world, timing is everything. So I think of things on a 24 hour cycle and because of this I wanted to get a chance to ask you how you feel about time restricted feeding, also known as intermittent fasting.

Yeah, no, I think that that when when it comes down to nutrition, there's three boxes. The way you think about things, you think about why you're eating, which we already talked about a little bit.

We talk about what you're eating, which we also just talked about. And and then when you're eating, those are the three things, the why, the what in the when when it comes to when everyone's a little bit different.

I think that time restricted eating or I don't love the word restricted it makes it restriction equals rebellion right there and our brains. But intermittent fasting also is a scary word for a lot of people.

Fasting scares a lot of people away. But when it comes down to it, choosing the time period in which you are going to eat can be very important for a lot of different reasons.

Number one, it is part of mindful eating right. You are choosing exactly when you want to fuel your body and when you are going to not fuel it. And I think that can be a really powerful thing in terms of not just losing weight, but also having a different relationship with your food and also getting some food freedom, meaning like the food doesn't control you.

You are the one who are making the choice about what and when you want to be eating it. I think it can be pretty powerful. I think I don't like people to try to intermittent fast without really dialing in the why and the what.

First, because you can only eat within a certain period of time and still eat really crappy food. Right? And that's not the point of this. The point of this is like, how am I fueling myself in a healthy way and why am I doing it?

So I think really getting to that, why really digging into like why you've let food control you, why you understand whether or not you're hungry or not, why you're making the behavior changes that you want to be making, that that's like super number one important because anyone can tell you to go on a diet, right?

But you have to like really understand yourself too in order to stick with it and not get into that rebellion phase that I sort of mentioned a minute ago.

And then what? Like you need to be on an unprocessed plan, I think, before intermittent fasting is going to be really helpful for you. If you eat those highly palatable, highly processed foods, you are going to like spike your insulin and then it's going to drop like really fast and then you're going to want do your body is going to want to feed itself again, the point of intermittent fasting.

And again, I could talk about this for hours is like really teaching your body that it knows how to get fuel where you've already stored it. You know, when you eat, where you use the glucose you took in and then the rest of it, you put into your liver, you put it into your fat cells.

If you're just continually feeding yourself, you're never learning how to go get those and bring them out and recruit them. So you only do that by processing your food and being satisfied enough with your food being full long enough because you're eating good fats and good protein and good complex carbohydrates to be able to like level yourself off along, to not eat for 15, 16 hours and your body can go get that glycogen and and break down those fatty acids and keep you sustained.

And it's not going to know how to do that if you are eating pizza and donuts and then just not eating for 24 hours, that's just it's it's not the point.

Yeah. What you're talking about is a real long term approach. These are lifestyle changes that are meant to be sustainable over time. And I love that idea of sort of teaching your body that it's okay to have a period without food so that your body learns to dine in, so to speak, and, you know, mobilize those fat stores that people are often trying to get rid of.

All of this has been incredibly helpful, and I wonder if you have any final thoughts. Yeah, well, I just wanted to say thank you. I just I love talking about food and I love talking about, you know, how to be mindful about that and really understanding how our brains and our bodies are working around this topic.

Because so often, you know, everything out there is like I want to lose 5 pounds or how to lose 20 pounds fast. And like they don't like they don't get into like what's so interesting about our bodies and our brains.

And I think if we really understand this about ourselves and we get into it and really like get it, then like we're making this choice for ourselves for a longer, healthier health span throughout our life.

Not just what I look like or what the scale tells me, it will get you there if you unprocessed your food and you are conscious about when you're eating and why you're eating and what you're eating.

Yes, the scale will move the most important part is like, what is that bringing you from a metabolic health standpoint for how what your life is going to look like and preventing all sorts of metabolic disorders, diabetes, cardiovascular disease, cognitive decline, all those things down the road that are directly related to how you are fueling yourself today.

And I think that when people really have that label go off in their in their heads about like, oh, right. Like that's why I'm making this choice for myself today.

That's why I'm going to move my body like that today. That's why I'm going to concentrate on how Dr. Audrey tells me I get my 7 to 9 hours of nightly sleep.

Right. Like these are the things that are they seem so simple, but they don't feel simple if it's just someone telling you to do it, once you figure it out on your own and you really internalize it, then that's where that real behavioral change can happen and where we get that long term metabolic health from.

So refreshing to hear that and right back at you. I mean, this work is important and what you just described is truly an investment in your whole body health, which I know so many people value and strive for.

So this is how you do it, everybody. This is how you engage and, you know, look inward and understand why you're making these choices around food, around exercise and around sleep.

Dr. Heather, can you tell us where people could find you if they want to work with you? Yeah, sure. Our website is a wholisthealth.com. That's W-H-O-L-I-S-T I chose that name because in medicine we're a gastroenterologists and hospitalist and labories and this is our whole body.

So here, that's what we do at Wholist. I'm @mommaemdoc on Instagram @wholisthealth on Instagram and we have a 10,000 person Facebook group called the Midlife Wellness Collective, where we talk all things food and mindset and metabolic health.

So come join us. That's awesome. And I think I fit into that midlife category as well. So the know, it's been a pleasure to speak to you today. Thank you so much for all your encouragement and your wisdom.

Really appreciate.

Heather Hammerstedt, MD

The Link Between Mindful Eating, Gut Health, And Quality Sleep