The Undeniable Link Between Sleep And Chronic Disease

Robert Lufkin, MD

Yeah. Hi. Hi. Can I call you Audrey or please call me Rob if you want?

Audrey Wells, MD

Let’s do it. Let’s do it. All right.

Robert Lufkin, MD

So I’m so happy to be here. Audrey, this is great. Thank you for including me in your program. I’m excited to hear the other speakers as well.

Audrey Wells, MD

Yeah. You know, this is just so in line with my passion for sleep medicine and really highlighting the benefits that healthy sleep can afford every single person who takes the time and energy to put into fixing their sleep. And I want to tap into your expertise about longevity because one of the things that I talk about a lot is the way that investing in your healthy sleep is like an insurance policy for later on in life. Would you agree with that?

Robert Lufkin, MD

Absolutely. Absolutely. And for me, there’s so much about sleep that I wasn’t aware of, even as in training as a doctor and then as a practicing physician. There’s such a revolution in the knowledge about our understanding of sleep quantity and quality. That’s why I’m so glad to see you doing this wonderful summit, just to help us all learn more about it.

Audrey Wells, MD

And, you know, I always feel like I’m learning, too. This is a product of my life’s work. And, you know, I want to ask you first of all, about this concept of longevity. So will you define it so that people can really get a grasp on what you mean when you talk about aging well and longevity?

Robert Lufkin, MD

Yeah. Well, first of all, longevity is just, it’s how many years you live, right? It’s a very simple concept. And if that’s all we do, that’s probably not enough, because you tell people, hey, you’re going to live an extra 10 years and they go, well, is that 10 years more in the nursing home or 10 years more with chronic diseases where I’m disabled and infirmed? So any time we talk about longevity and lifespan, then we usually want to mention health span as well. So lifespan is the number of years that you live. Healthspan is the number of healthy years that you live. And if we’re going to increase the lifespan with longevity, we want to be sure. And it’s implied that we want to be sure and increase the health span as well. And today, there’s been a revolution in our understanding about longevity, so that finally these things are really possible that we can do signify and things that really change are expected lifespan.

Audrey Wells, MD

I agree with this concept. You know, you don’t want to necessarily live longer if that quality of life is low. So when we talk about your health span, I think that really underscores the point that we want to spend the last 10 years of our life enjoying life, being active, being social and, you know, really enjoying our health and vitality. I wonder if you can talk about the way chronic disease erodes our longevity. What does that take away from us?

Robert Lufkin, MD

Yeah, basically, when you look at longevity, it’s how long we live. One way you can see what determines that length is to look at the diseases that kill us all. And statistically, we go on the web. They’re published every year. And it’s the same five diseases that account for 80% of our deaths. Statistically, we’re most likely to die of cardiovascular disease, Alzheimer’s disease, cancer, and a couple of others. But the ones I mentioned are the chronic diseases that are associated with aging. And so these chronic diseases literally determine our longevity because they determine when we die. But to your point, the fact that these diseases come on most for the most part over a gradual period of time and begin to erode our health span that these basically take away from our quality of life. So no matter how long we live, if we don’t have a good quality of life, it’s not a good thing.

Audrey Wells, MD

Yeah. And you know, we were talking before I hit the record button about your book, Lies I Taught in Medical School, which is a fantastic title. And I was saying that on the first day of my medical school, which was at the University of Michigan, I remember that concept that about half of what I was going to learn would be outdated. And we’re always trying to catch up. This was 20 years ago for me. What kind of lies did you teach in medical school?

Robert Lufkin, MD

Yeah, I love that. I love that concept in the title. It does attract attention. It’s a little bit of clickbait, but I wanted people to pay attention to hopefully get the message there. But there are a number of lies that I came across through my own personal journey with chronic diseases. When I got hit with several of them, when I had, when I still had youngsters in elementary school and I was prescribed for prescription drugs for each of those four diseases. And I realized that you know, this wasn’t going to end well, basically having the diseases at such a young time. And so it forced me, even as a medical school professor, to reexamine the concepts that I had and what people I had been teaching, what other people are teaching. And I began to drill down in the literature and looked at some of the most recent articles that are now, you know, these are peer-reviewed controlled studies. And it showed how the thinking has changed, especially about these four chronic diseases that I had. And I changed my lifestyle basically, the foods I ate, you know, exercise, stress and of course, sleep. When I changed all those, interestingly, I went back to see my doctors and they said, wait a minute, something’s wrong here. I can’t believe it. You know, you’ve reversed your disease and you no longer need the prescription. So basically, long story short, I was able to reverse all four of those diseases with these lifestyle changes. And in studying this, and this is nothing that I discovered or invented, it’s other smarter people that I have made these discoveries, but it’s just not very well known in the scientific literature. And today even my colleagues are still teaching things that, in my opinion, are incorrect.

You know, basic concepts about these chronic diseases and these chronic diseases are all linked by common mechanisms that underlie that drive longevity and aging and all these chronic diseases and that sleep is a factor. And but at the basic level, it’s metabolic problems, it’s insulin resistance, it’s inflammation. And these cause all of the chronic diseases I have, they cause all the diseases that create our limit, our longevity, and the importance was making making this information known to people. And so, for example, many people still teach that a calorie is just a calorie. And if you want to lose weight and weight is a problem in our society, up to half of adults are overweight or obese and it’s growing. And obesity can be a precursor for metabolic dysfunction, diabetes, and all the diseases I mentioned. But the simple idea that a calorie is a calorie, if you want to lose weight, you just exercise more and eat less. That’s been proven to be wrong but it’s still being taught and it’s it’s not working for people to lose weight. There are much better ways of doing it if we understand the metabolism and other concepts related to it in the book. I go through each chapter is one of the lies and the chapters. I’ll give you the chapter titles and you can plug into lies. But it basically, hits each of those diseases, we do obesity, we do diabetes, we do hypertension, we do cancer, Alzheimer’s disease, cardiovascular disease, and then ultimately longevity. And there’s a lie or a misconception and associated with each one of those that I that I go into.

Audrey Wells, MD

You know, I think one of the points that I really want to highlight here is the idea that a person who’s interested in aging well and having a long health span has a lot of control over how that goes. These lifestyle changes that you’re talking about are something that a person can learn about and implement and literally change the course of their health. And oftentimes, I don’t think that power is really, people aren’t really stepping into that power enough and relying too much on medications, pills, and not skills. So I really love it that you’re highlighting that getting information, getting empowered with knowledge is something that you can use as a tool to affect your own course.

Robert Lufkin, MD

Yeah, absolutely. That was probably the biggest takeaway of this whole experience. I mean, there are a lot of longevity drugs out there. Your rapamycin, your metformin, your acarbose, you know, other things like stem cells, and there are a lot of things you can do. But the most powerful longevity effect of all beyond all of those is related to our lifestyle, nutrition, exercise, stress, and of course, sleep. All those things play a key role in longevity. And what just blew me away was how big a role it was. And not only for longevity but for even chronic diseases. I will argue that lifestyle is a more important factor than any of the prescription drugs you could take. In other words, you could, if you have type 2 diabetes and you need insulin, you could take the insulin to to control your hypoglycemia. But I  mean, you shouldn’t stop it without a doctor, without a doctor’s help. But it is possible in the majority of patients with type two diabetes to reverse their type 2 diabetes with dietary interventions and also controlling the rest of their lifestyle, including sleep. But once you do that, the insulin resistance can be reversed. And then you go off those medications and you can control it with lifestyle. Many of the medicines that we prescribe for those chronic diseases treat the symptoms of the disease. You know, hypoglycemia with insulin. Or if I put a stent in my heart with a heart attack, you know, in the coronary arteries to open up the blood vessels, everybody that thinks that’s a cure for a heart attack. Of course, it’s not. It doesn’t change the overall survival. It may keep me from dying in the moment, but I will still go on to die of a heart attack eventually because it doesn’t change the underlying disease. To do that, we need to reverse lifestyle factors and metabolic health, insulin resistance, and all these things. And the beauty of it is we all control our lifestyle. We get to choose every single day where we wake up in the morning, we get to choose what we’re going to eat, what we’re going to exercise, you know, how much, and we can control the stress and set our sleep goals as well.

Audrey Wells, MD

Yes. And I think really grounding ourselves in that message that we can decide how we’re going to eat, how we’re going to sleep, and how we’re going to move. Those are fundamental to our long-term health. I want to circle back to something that you said before one of the lies that you taught was that a calorie is just a calorie. A very popular topic right now is these weight loss medications, these injectable GLP-1 medications, and then there’s Tirzepatide, which is also GLP-1 and GIP dual agonist medication. And now I am boarded and sleep medicine and obesity medicine. So I’ve got kind of a double interest in this. And my concern with these medications thins is that without the foundation from healthy nutrition, physical activity, and good sleep practices, the effects of the medication could be too fast and also come with muscle loss. There’s a connection with muscle loss and longevity. Can you elaborate on what that is?

Robert Lufkin, MD

Yeah, I mean, muscle loss is one of the phenotypes of the appearance of aging. We all, when we see old people, we see, you know, gray hair, we see loss of hair, we see wrinkles, but we also see frailty or sarcopenia as it’s sometimes called in the medical expression, where people lose weight and they just sort of waste away. And that’s one of the problems with aging and when people become more frail they lose their vitality. They can’t exercise as much for a number of metabolic reasons. Muscles contribute to glucose metabolism. When you don’t have as much muscle, that’s a bad sign. You’re able to fall down and you can fracture your hip, which is a fatal injury in many elderly patients. Eventually, they don’t survive it. So frailty is a real problem in muscle wasting. That’s why any of these longevity strategies, things like turning down mTOR with either rapamycin or with lifestyle with intermittent fasting, dieting, and certain sleep strategies affect mTOR as well. MTOR is the mass survival protein that is really, the strongest candidate associated with if there ever was a longevity effect it would be on mTOR. But with mTOR, the important thing is that when we turn it off to increase longevity, the concern was that we would we would trigger muscle wasting. But the important thing is that when we turn more down, we don’t get muscle wasting. We actually, the muscles are maintained. Drugs like rapamycin which turned down mTOR do not result in muscle loss and frailty. So that keeping an eye on muscle wasting and with the obesity drugs I mean there’s a lot of potential problems with those. And but muscle wasting as you pointed out, is one of the is one of the important ones.

Audrey Wells, MD

So how can people maintain their muscle mass, maybe in the face of taking an obesity medicine drug or even in just getting older as the years go by, we tend to lose our lean muscle? What do you recommend?

Robert Lufkin, MD

Yeah, I mean, I was on my longevity journey with my chronic diseases. I had a dad bod. I was sort of maybe you know, maybe 10 pounds overweight. I wasn’t actually, I hadn’t crossed over into the overweight mark, but all my muscle definition was gone ahead extra fat there. And I was able to reverse that when I adopted the lifestyle factors, the lifestyle features that reverse my chronic diseases. They also reversed the fat accumulation. But the importantly, I didn’t do it without, with muscle loss and I kept the muscle loss. And the approach I used was, as you know, as an obesity doctor, the three main macronutrients, fat, proteins, and carbohydrates all affect the fat-storage hormone insulin very differently. And what I did was that insulin causes our body to store fat. And that’s what was causing my body to accumulate fat. So my approach for my my dietary approach was just to avoid the macronutrients that drive fat storage, which were carbohydrates, which are also nonessential. The other two, you don’t really want to cut back on proteins or fats because those are essential. And so I went to a low carbohydrate diet, which is also called a ketogenic diet in some form. So I began going into ketosis a lot. And the interesting thing about ketosis is, or a low carbohydrate diet my insulin levels went down, so my insulin resistance dropped, my inflammation dropped and my appetite actually goes away too when you’re in ketosis. So it was very easy to begin intermittent fasting, which I which I do now. And for me I love it. I have one meal a day when my kids come home from school at lunch and dinner time. And the rest of the day I just, you know, I work out. I do my other activities of daily living. But the key thing is I’m not seeing muscle wasting. I’m just seeing the fat loss. It’s possible with these lifestyle strategies, even reducing caloric intake to preserve muscle mass.

Audrey Wells, MD

Yeah. You know, I’m right there with you with intermittent fasting. It’s a plan that I adhere to. I’ve been successful with it and it fits very nicely into my lifestyle. I also have sort of a family dinner at night and I do kind of a 20-and-four split, so I have a four-hour eating window. And, you know, this works for so many people and it can help keep insulin levels down, which promotes utilization of those fat stores. So, you know, for people who are looking for a sustainable and long-term solution, dietary, dietary wise, intermittent fasting, I think represents a really nice choice.

Robert Lufkin, MD

And what if I could do one thing just to follow up with that, one thing that was interesting is that I’d love your take on it when I began intermittent fasting and this nutritional shift, I noticed my sleep dramatically changed and I was able to sleep the whole night. I got much better sleep. I would wake up naturally in the morning without an alarm clock. And it just seemed to have a balancing effect on my sleep as well, which was unexpected.

Audrey Wells, MD

Yeah. You know, this is commonly seen and I would say there’s probably a couple of points that I would bring up. One is that carbohydrates, especially late at night, are not very well metabolized. So that can lead to some sleep disruption, nighttime awakenings, waking up to go to the bathroom, and even acid reflux. If you’re having any sort of spice or garlic with the meal that can be competitive with your sleep. The other thing is, you know, there’s a certain component of circadian timing that comes with nutrient ingestion, optimizes. And so if you’re eating earlier in the day, during the biological day, the circadian day, your dietary enzymes are primed to be efficiently taking care of that meal. And it leaves you feeling robust. You’re not sort of dragging after the meal. You’re not sort of having episodes of hunger pains come up or anything. And I think a lot of people find that so reassuring and it cuts back on all the psychological chatter that can happen when people are trying to lose weight or change their dietary habits. So just having that soothing reassurance to your brain that this is the new pattern now goes a long way toward making these types of eating patterns sustainable.

Robert Lufkin, MD

Yeah. It makes sense.

Audrey Wells, MD

Yeah. So as we close here, I wonder if you can maybe leave us with the highlights of what people can expect when they read your book. How might that help them to improve their health span?

Robert Lufkin, MD

Yeah, that’s just, what my book is kind of my story, what worked for me and was a revelation for me and hopefully it will, other people will be able to benefit from it. But again, what we mentioned before was just that it’s not about necessarily going to a doctor and getting a pill, although, you know, we’re both doctors, we’re both you know, there is a place for that with certain but for these chronic diseases that we all face and that are probably going to kill us in the long term and determine our longevity. The real wake-up call and the message I would like everyone to get is the power that they hold in their own hands by the choices they make in their lifestyle. And again, as I said earlier, the beauty of it is every morning we wake up, we get to choose what lifestyle we want and we can we can start fresh every day.

Audrey Wells, MD

I love that. And really highlighting people’s empowerment as they determine what their health looks like is such an amazing message. Thank you so much, Dr. Lufkin. It’s been a pleasure to speak to you today.

Robert Lufkin, MD

Thanks, Audrey. And thank you for doing this summit. I’m really looking forward to hearing the other speakers as well.

Audrey Wells, MD

Fantastic. Take good care.

Robert Lufkin, MD

Likewise.