Ruth Patterson, Ph.D. on Time-Restricted Eating in Humans & Breast Cancer Prevention November 3, 2019 83 By William Morgan [Rhonda]: Hello, my friends.Today my guest is Dr. Ruth Patterson, who’s a professor at the UCSD Department of FamilyMedicine and Public Health and leader of the Cancer Prevention program at Moores CancerCenter, UCSD.Thank you, Ruth, for being here.I am very interested in some of the research that you are have been doing for the pastfew years and ongoing, in terms of looking at this interface between metabolism and specificallybreast cancer risk and breast cancer…increased breast cancer recurrence.So when I think, you know, of lifestyle factors that are modifiable and that are actuallyknown to increase breast cancer risk, obesity comes to mind.[Ruth]: Sure.Obesity is definitely one of the big ones, and also physical activity.More recently we’ve become aware of the importance of physical activity.What’s been harder for us to identify is exact types of foods that could reduce risk.In fact, we’ve not really had a lot of success in identifying individual foods or individualnutrients that seem to make a difference.Although, I think there’s more acceptance now, the idea that an entire dietary pattern,let’s say the Mediterranean dietary pattern may, you know, influence risk over decades.So I would say those are the probably top concerns, is diet quality, obesity, physicalactivity, those are the…and even tobacco can increase…some increases breast cancerrisk.So there’s many things individual women can do to reduce their risk.[Rhonda]: I was reading, I think it may be the American Cancer Association had publishedsome statistics on how obesity can increase the risk of breast cancer by twofold.And also, specifically looking at some of the mechanisms by which obesity can increasebreast cancer risk.There were a variety of them including increased inflammation, increased hormone to estrogen,and also increased fasting insulin levels.[Ruth]: Mm-hmm.Yes.I think we’ve known for a long time about sex hormones in particular, estrogen is arisk factor.Because some of our first really successful drugs were based on blocking the action ofestrogen.Estrogen is a growth factor so it appears if we can block that, it can reduce your riskor reduce your risk of recurrence.And we have some pretty effective drugs that have made a big difference.It’s more recently that we’ve realized that other growth factors have the same type ofimpact, and it makes…it’s almost common sense.If estrogen is a growth factor and that increases growth rates of tumors, well, what about insulin?It’s also a growth factor, it encourages metabolism.So we do believe that perhaps high levels of circulating insulin may be really centralto the whole process of developing breast cancer and promoting its growth.And high levels of insulin are definitely found in women who are overweight, if you’reless physically active, and then of course among diabetics often have high circulatinglevels of insulin.So we do…are becoming more aware that sort of that may be kind of a common road wheremany different syndromes lead to the risk…increased risk of breast cancer.[Rhonda]: And so you mentioned that people that are overweight and people that are obesehave higher circulating insulin levels.They also have higher circulating estrogen levels, right?So does fat can secrete?Is it…am I right, fat can secrete estrogen, or is that something that…[Ruth]: Fat can…yes.So that’s pretty central.And then, what we also know is that people who have high levels of insulin have lowerlevels of serum-hormone binding globulin, something called SHBG which binds estrogen.So it can prevent it from being active.So they seem to be related, they’re not just two independent pathways, they actually playoff each other.[Rhonda]: Interesting.And you say…you brought up something that was very I think important, and that is yousaid that these growth factors, they promote the growth of tumor cells, of cancer cells.[Ruth]: Right.That’s in a very general way.[Rhonda]: Right.[Ruth]: Right.[Rhonda]: Yeah, so you’re…Something, you know, something’s causing the initial damage, the cells become damaged and,you know, we have a lot of mechanisms inherent in our cells that can sense damage and saywell, okay, I’m going to die, I’m going to kill myself because if I don’t, may potentiallylead to, you know, a cancer cell.[Ruth]: Right.[Rhonda]: But if you have all these growth signaling factors happening in the presenceof that damage, it’s sort of saying, “Hey, no, no keep going, keep growing, don’t die.Grow, grow, grow.[Ruth]: Yes.[Rhonda]: And, you know, so that’s sort of like I think the combination between thingsthat are causing the damage which possibly high inflammation, so obesity also is associatedwith high inflammation and then, you know, the combination of the inflammation and thehigh insulin, the high insulin like growth factor, the high estrogen it’s sort of likethis detrimental combination of damage and growth signals to allow them to survive.You also mentioned that the serum binding hormone that…[Ruth]: Serum-hormone binding globulin, SHBG.[Rhonda]: Thank you.And you mentioned that binds estrogen and sort of makes it inactive from going to, youknow, activate I guess in breast tissue or whatever tissues.What about also the insulin, so I mentioned the insulin like growth factor pathway whichis separate but from insulin they’re two separate growth factors but they’re also very interconnected.[Ruth]: Yeah.I think the data on…into like growth factors a little less consistent and a little harderfor us to understand.So there’s…we think it’s also playing a role but studies have been…some studieshave found it to be a risk factors and other study haven’t.You’re talking about circulating levels, I’m sure.Because it’s also very complex because there’s receptors for these things on the cells thatmay also play in.[Rhonda]: Right.[Ruth]: So it’s a very complex system which is why we’ve had such a hard time coming upwith cures.It is because all…there’s lots of redundancies and one system affects another system, andso just finding like that magic pill that can turn of all these different related pathwaysis virtually impossible, there’s so many workarounds for our body.[Rhonda]: Right, yeah.[Ruth]: Our body is incredibly resourceful.[Rhonda]: Right.So these three factors that are known, the fasting, high-fasting insulin, the high freeestrogen…[Ruth]: Right.[Rhonda]: …and the high inflammatory markers.[Ruth]: Right.[Rhonda]: So as measured by certain biomarkers like C-reactive protein.[Ruth]: Right.[Rhonda]: So these are all associated with, in some, cases even two to threefold increasedrisk.[Ruth]: Yeah, I say definitely twofold and maybe a little bit more.I think that’s generally what we…what the metric we use, each one of them increasesthe risk individually by twofold.Combination wise we don’t know, it’s probably not quite additive, but they still would havea combined effect too that’s, you know, reason to look at all these different pathways.But those are definitely the three major metabolic pathways that we think feed into.Having kind of fertile soil so that when these DNA changes happen, they’re in a place wherethey’re kind of like fertile soil and more likely to go to an invasive tumor type.[Rhonda]: Okay.And what’s so interesting about this is that, your work, so your work and the work of othersis showing that these three different biomarkers, let’s say, they can be modified by changingyour lifestyle pattern.[Ruth]: Right.Much of my research lately has focused on timing of meals, which I think is a littlebit of a newer hypothesis.We all, you know, evolved to eat during the day when we’re out getting our food and thenfast at night when we’re in a rest state.But now with, you know, modern lighting and with modern lifestyles and short…longerand longer work weeks, you know, our meal patterns less and less resemble the way weevolved to eat.And we believe that it’s very metabolically detrimental to eat a lot of energy and thenright away lay down.You know, what are you doing?You’re laying down, you don’t need to have all the energy on board and all that metabolismgoing on, when actually you should be in a fasting catabolic state.[Rhonda]: And most people probably actually eat one of their largest meals in the evening.[Ruth]: Right.Which is just so counter…and just even in a common sense way, why do you need all thatenergy right before you’re about to become completely comatose?It makes no sense, right?You really need the energy during the day, you know, when you’re busy up walking.[Rhonda]: That’s a very good point.And I think you also mentioned another important point and that is eating during the day whenwe’re supposed to eat, and timing it with our circadian rhythm.[Ruth]: Right.[Rhonda]: Which is the biological clock inside of our…every cell we’ve got a master regulatorand different, you know, tissues which we can talk about in a minute.But that master clock, what’s interesting is that it does…it…you know, between 10%to 15% of the human genome is regulated by these clocks.And about 50% of those genes are involved in metabolism.[Ruth]: Right.[Rhonda]: And humans are the most insulin sensitive upon waking, you know, first thingin the morning.And then as the day goes, insulin sensitivity goes down.And so, you know, eating your biggest meal in the evening when you’re the most insulininsensitive would increase one of those biomarkers you’re talking about.[Ruth]: Absolutely, right.Or just metabolically dysregulate you which is what we’re trying to have regulated metabolism,and that definitely dysregulates it.And the whole circadian rhythm concept is the idea that, as you mentioned, the masterclock is entrained to light, you know, it responds to light.So the master clock’s getting the signal, let’s say, in the evening, you’re done.But if you’re eating, the peripheral clocks like in your liver are going, “No, we’re wakingup, we’re getting energy.”And we believe that when those two clocks are out of sync that that itself leads tosome type of metabolic dysregulation.And we don’t have fully metabolic, you know, or molecular understanding of exactly howthis works.But it’s a pretty solid theory, at least what we’ve seen in animal research.[Rhonda]: Yeah, and so I mentioned to you earlier that I talked about this meal timingwith a collaborator of yours, Dr. Satchin Panda who is at the Salk Institute.And, you know, a lot of his research had focused on elucidating this important regulator ofthe peripheral clocks, meaning the clocks in the non-brain, so the liver, the heart…[Ruth]: Pancreas, right.[Rhonda]: Right.And how, when you eat your first meal or even taking your first non-water beverage startsthat clock.And so, if you start that clock, let’s say you wake up at 7:30 in the morning and youhave a sip of coffee, 7:30 in the morning the clock starts.And he’s shown that eating all your meals within at least a 12 hour time from that whenthat clock starts seems to be very important for, you know, having a good metabolic health.[Ruth]: Right.[Rhonda]: You know, good glucose regulation, good insulin sensitivity, being able to maintain,you know, lean muscle mass and keep fat loss off.But what’s really in my mind, I was trying to understand, and like you mentioned, wedon’t know all the molecular mechanisms between the timing of the two, both the master clockand the peripheral clock, but how they do seem to be working together.So, you know, let’s say someone fasts in the morning, they don’t eat breakfast, they don’teat lunch.And then, so they’re fasting, let’s say, they’re fasting for 12 hours and then they eat a mealright before bed.[Ruth]: Right.[Rhonda]: We don’t know if that’s necessarily going to be as good as fasting during theevening in sync.[Ruth]: We totally don’t think it’s as good.You know, so our research seems to show that two things, one we see great…our biggestreductions in breast cancer, for instance, recurrence, with at least 13 hours of fast.And we really believe that fast needs to start around 7 maybe to 8 p.m. at night.When people talk about breakfast, what I often say is, when you’re talking to people whoskip breakfast, I think skipping breakfast is actually a marker of eating at night.Because if you stop eating early in the evening and don’t eat for 13 hours, when you wakeup you’re starving.You don’t skip breakfast.So a lot of times, I think the research showing that not eating breakfast or skipping breakfastis bad, is actually not studying breakfast, it’s the people who skip breakfast we’re eatinglate into the night.So we think it’s both, it’s that we need a long stretch of time and there might be someimprovements in gut rest or the microbiome.Like, we don’t think that your GI tract also was meant to have food constantly in there,you know?So we think it’s important to have a long stretch of gut rest but that that gut resthappens at night, starting fairly early, 7 or 8 p.m. and then 13 hours after that.So it’s both of those things, either one is not sufficient.[Rhonda]: And the microbes in your gut are also on that circadian rhythm.[Ruth]: Absolutely.Oh, yes, the GI tract is very, very tied to circadian controls.[Rhonda]: Right.You also mentioned another study that you…one of your research kind of said in passing that13 hours of…at least 13 hours of fast was associated with a lower breast cancer recurrence?[Ruth]: Right.[Rhonda]: So, do you mind talking about that study for a little bit?[Ruth]: Yeah.I’d be glad to.So this was a study in about 2,500 breast cancer survivors and they completed over aboutseven and a half years of follow-up, they completed many food records, right?So we collected all this information about what they ate.But then, more recently when this hypothesis came out, we went and dug up all their foodrecords and said, well, how about if we don’t care what you ate, but we just care aboutwhen you ate it?So, we reentered all the data as far as when they started to eat, you know, when they stopped,how long their fasting interval was, how much they ate at night, and then reanalyzed thatdata.And that’s where we found that it seemed at least in this sample of women that the cutpointof 13 hours reduced their risk of breast cancer recurrence by about 40%.It also reduced the risk of mortality by about 20% or a little more than that but that wasnot statistically significant.But it was just trending in the same direction, you know, it’s possible.Because we do believe it’s…although my area of research is breast cancer, we actuallybelieve this dietary pattern could have really positive effects on other diseases and conditions,including Type II diabetes, or liver…fatty liver, NAFLD, also with acid reflux.You know, the first thing they tell you is try to sit up when you go to bed, don’t eata big meal so that which often leads to esophageal cancer.So we actually feel it can have a positive impact on many aspects of metabolism, notjust cancer, it’s just that we’re very interested in teasing out its impact on cancer.[Rhonda]: That’s phenomenal, Ruth, those statistics that you just kind of just threw out there,like 40% reduction in breast cancer recurrence in women that were just simply fasting inthe evening for 13 hours.[Ruth]: Right.[Rhonda]: And that is…[Ruth]: Regardless of what you eat.[Rhonda]: Regardless of what you eat.[Ruth]: It controls for whether you’re overweight or not.[Rhonda]: Wow.[Ruth]: Right.[Rhonda]: Because it’s really not that difficult to…I think it’s much easier to…for peopleto make a modifiable change of just stopping what they’re…you know, stop eating after7 p.m., versus eat all your vegetables, stop eating your…[Ruth]: Right.[Rhonda]: …cake.I mean, people should do that, but just saying.[Ruth]: Yes, I still think diet quality matters, but we’ve done some pilot studies with womenadapting a longer nightly fasting interval.And those studies have been amazing in terms of how simple it was for women to do it.We actually had a little app they used and they would text us, “Starting my fast.”And then we’d text back saying, “Great.Don’t forget, don’t eat again before 8 a.m. or 9 a.m.”You know, and so many participants said, you know, “I never understood percent energy fromfat.It was always so confusing to me, it made me just feel stupid, I didn’t even know howto do it but I just got this.In five minutes I got this, I could do it.”And self-report ways, they reported often sleeping better.And we did it with a group of Latino women, Latinas in South Bay.And they were particularly positive about it, they said, you know, “In my family, ifI tried to change up our entire way we eat, sometimes my family members weren’t that positiveabout that.Where’s our favorite foods?”And she goes, “But this, I could do it right away, it was really simple and it didn’t affectthe family or food ways.So it’s very easy for me to do within our family without disrupting all of our familybehaviors.”They were very positive and often even reported, “I felt so proud of myself, okay, finallyI’m doing something, I feel better, well I’m going to start walking too.”You know, that kind of self-efficacy kind of spread to other health behaviors, whichis our hope.[Rhonda]: Yeah, great.So these women were being more compliant which is…[Ruth]: Well, they feel successful…[Rhonda]: Right.[Ruth]: …instead of feeling like a failure, right?[Rhonda]: Right.[Ruth]: You know, writing down everything you eat, running up the calories, you know,you only can do that for a couple days before you just burn out in the entire exercise.So you feel like, “Oh, I can’t do it,” you know, where this they’re like, “I can do this,”you know?[Rhonda]: Yeah.[Ruth]: So we think it’s incredibly…that some of the value is the simple feasibilityof it.People can understand it and they can generally implement it.Now, we don’t think it necessarily is going to have huge impacts on weight.Like you’re not…probably not going to lose 50 pounds by just making this one change.But we believe it could be an incredible public health intervention where if everybody didit, we could move like the whole disease risk curve down a little bit.And that would have huge impacts on disease risk.You know, which is the alternative is of course we spend millions of dollars trying to helpa small number of very obese people lose weight which is very unsuccessful.But if we could move the entire population this way, to this more healthful pattern,we think that could actually affect disease rates in the United States.[Rhonda]: That’s awesome.You also, just to kind of dive a little bit deeper into some of your more recent research,you mentioned the 13 hour fast overnight and how that was very robustly associated withthe 40% reduction in breast cancer recurrence and non-statistically significant reductionin breast cancer mortality.But you also have looked at some of the biomarkers that are known to increase breast cancer risk.And also there was an effect on some of those biomarkers like inflammation as well, correct?[Ruth]: Mm-hmm.We’ve actually seen probably our most consistent effect on something called Hemoglobin A1C,which is a marker of your average glucose, over about three months.So interestingly enough, we saw the association both in a general sample of women from what’scalled the NHANES survey, it’s a nationally representative survey of women.We saw that women who fasted longer had lower hemoglobin A1C, and then in our own sampleof breast cancer survivors we found the exact same association which means, you know, whichto us means this is probably strong.So that’s one of the reasons we think it might influence…have a huge effect on reducingthe risk of diabetes.As far as inflammation, interestingly enough, we only found that it reduced inflammationamong women who didn’t eat a lot of food late at night.In other words, you know, if you’re fasting interval was 9 p.m. to 9 a.m., it didn’t seemto matter.But if you’re fasting interval was early in the day, like 6 to 6, then it seemed likethe fasting interval reduced CRP, C-reactive protein, this measure of generalized inflammation.So that’s what made us think.It’s not just the 12 hours, it’s the 12 hours only if they start fairly early in the evening.That’s when the positive effects happen.[Rhonda]: Very interesting, very interesting.So you…a couple of points that you mentioned, I just want to circle back to the glycatedhemoglobin you mentioned, that basically fasting in the evening had a pretty robust effectin reducing that.[Ruth]: Yeah.[Rhonda]: And that’s a marker obviously, it’s a marker of your long-term, you know, bloodglucose levels.[Ruth]: Absolutely, they use that to approve diabetes drugs.You know, if a diabetes drug reduces hemoglobin A1C, that’s how it gets approved.So it’s a pretty powerful marker of risk.[Rhonda]: So we’re talking about, for example, metformin…[Ruth]: Yes.[Rhonda]: which is a very…[Ruth]: Any diabetes drugs has to move hemoglobin A1C down a certain amount before it can beapproved.So if we can do this with a non-pharmacologic approach, just rechanging when you stop eatingand the fasting interval, I mean, that’s pretty exciting.[Rhonda]: It’s in the brain.[Ruth]: Yeah.[Rhonda]: Yeah.[Ruth]: It’s really exciting because the truth is all these drugs have side effects, they’renot that pleasant to take.A lot of people simply discontinue them on their own.You know, so pills aren’t necessarily always the answer, and this offers people a lifestylechoice.[Rhonda]: And you mentioned that you’re…there were women that were involved that you hadbasically…they made changes, they started fasting in the evening and they also reducedtheir H1.[Ruth]: In our pilot studies, we were really focused on the feasibility and acceptabilityof it.So we didn’t have any biomarkers, we were testing, could they do it and how hard wasit for people to do.[Rhonda]: Okay.[Ruth]: So that was really a test of…because there’s no point in recommending somethingif people can’t do it.[Rhonda]: Right.[Ruth]: And that…so that’s what we really focused on there, in our personal pilot work,is just could they do it.And truthfully, the vast…they almost all did it and they also all said they would recommendit as an eating pattern to their friends, so they would recommend the study, you know,which told us, okay, this is feasible and this is acceptable.And, you know, that’s what we’re interested in, is not, you know, if it works but it’slike impossible to do, then it’s not a valuable public health intervention.[Rhonda]: Yeah.I was wondering, what I was trying to get at is how quick or how soon do you think itcould change…[Ruth]: Yeah.[Rhonda]: …those…[Ruth]: We don’t have data on that.[Rhonda]: …levels that would…[Ruth]: Right.[Rhonda]: …be very interesting to see…[Ruth]: Yeah.[Rhonda]: …if some of that can be moved pretty quickly or, you know, if it takes longer.I don’t know how quick these other…like metformin works.[Ruth]: Oh, yeah, most of them…the thing about hemoglobin A1C is since it reflectsaverage blood sugar over the past three months, it takes about three months to move it.[Rhonda]: Okay.[Ruth]: Even with a really effective intervention, it just…since it reflects the whole vastthree months of cycling through, you have to go whole three months to see it.[Rhonda]: Red blood cells to turn over.Yeah.[Ruth]:Yeah.[Rhonda]: Right, that makes sense.[Ruth]: Other markers may be faster, but the…you know, because we already know that if youwant to measure these markers, you want people to be fasting.So we know just even one fast, one night’s fast makes a difference, right?[Rhonda]: Right.[Ruth]: If you do one night’s fast, a lot of these markers will be flatter in the morningthan if somebody eats breakfast, right, before they come in.You know, so you’re really…what you’re doing is you’re extending the period of time whereyou have very low basal levels of a lot of these markers.[Rhonda]: Right.I just kind of wanted…All of a sudden something came to my mind because, you know, we’ve been talking a lotabout inflammation and these fasting blood glucose levels, fasting insulin.And it just hit, I remember having a conversation with Dr. Panda, and he mentioned somethingto me that I wasn’t aware of about repair mechanisms and fasting.I knew that repair mechanisms were regulated by the circadian rhythm, and I always knewthat when you sleep is when you’re repairing a lot of damage.[Ruth]: Right.[Rhonda]: But it didn’t occur to me that also when you sleep is when you’re fasting.[Ruth]: Right.[Rhonda]: And he had mentioned that there’s something inherently important about fastingand repair mechanisms.And so, you know, which of course that kind of made me think, wow, that that’s reallyinteresting, I never thought about it like that.But if you think about, you know, that the timing of these repair mechanisms and fastingand how, you’re repairing damaged, DNA repair mechanisms and also these autophagy, clearingaway damaged cells, damaged cells secrete inflammatory mediators.So if you’re clearing away the cells that are damaged and secreting more, you know,inflammatory molecules, then possibly that would, you know, the lower the inflammation.But it’s really interesting how your data suggested that it really had to occur earlierin the evening.[Ruth]: Right.[Rhonda]: Do you have any speculation as to why that is?[Ruth]: Oh, I suppose we really do think that your body works best when its aligned withthe circadian rhythm.But I think that is a really good observation.Certainly, the parallel I tend to think of is, you know, we work out, we actually hurtour muscles.And the muscles don’t repair and get stronger unless we stop.We have to stop, we have to give them a rest period.And the same thing, eating is metabolism, there’s a lot of oxidative damage that happensjust as we eat.And then the theory is that you need a time off from that damage for the repair mechanismsto come in.So it’s an interesting observation in parallel.Personally, I don’t…I think that’s a little molecular for my research, but, yeah, I thinkit’s a good parallel to compare it with like working out.[Rhonda]: Yeah, that is, actually.You know, like you mentioned you need a repair time.Stress can activate stress response pathways that can be beneficial, like in the case ofexercise.[Ruth]: Right.[Rhonda]: But if you keep on stressing yourself…[Ruth]: You actually get weaker.[Rhonda]: Right.There will…You know, repair.[inaudible 00:27:12] stress.[Ruth]: You do need to time off.[Rhonda]: Right.[Ruth]: Right.Exactly.[Rhonda]: What about meal frequency?So is that…did that play a role?So if you’re…I don’t know how long between the fasting and fed state.Let’s say, we’re within the 12 hours in day we’re within that 12 hour…[Ruth]: Right.[Rhonda]: …you know, feeding time, allotted time.Does the amount of meals that we eat within that time matter?[Ruth]: I think it’s a little bit of a separate question.We tried to control for it, in case it did make a difference.Because it makes sense if you’re eating, let’s say 18 hours a day, you’re probably goingto have more eating episodes per day than if you’re only eating for let’s say 10 hoursa day.So just reducing the number of hours that you eat may actually have some impact on howmany eating occasions, which may also relate to disease risk.But we didn’t see that to be a really important determinant of disease risk.So we’re not really…that’s sort of a little bit of a different question, we’re not reallyquite sure.I think that the evidence is really out on meal frequency and disease risk.[Rhonda]: Okay.[Ruth]: And I, you know, if you want my…my gut feeling is that if you keep your eatinginterval fairly short, it may not matter very much.But when your interval is very long, so you’re getting, you know, a meal impact and thena long time with no meal.And then, you know, throughout the day all those spikes might be more detrimental.But the data on that are really unclear at this time.[Rhonda]: Yeah.I think you made some really good points and that is, you know, if you reduce the amountof time that you’re eating, that naturally you would probably then reduce the frequency…[Ruth]: You may reduce the frequency, yeah.[Rhonda]: …that you’re eating.I just remember, I don’t know if this is like one of those wives’ tales where, you know,the smaller number of meals you eat was supposed to lower your blood…you wouldn’t have asbig of a blood glucose.[Ruth]: Right.[Rhonda]: You know, but then again, you’re constantly doing it.So I don’t know, you know?[Ruth]: I think, you know, I know of at least one study in the field that’s actually testingthat.You know, testing five meals a day versus three.So I think they’re starting to realize we don’t really have a good answer to that andtrials are underway to clarify that.[Rhonda]: Okay.One other thing that I was kind of thinking about in the parallels between how this mealtiming is having a pretty profound effect on, you know, for example your…what’s consideredyour long-term blood glucose levels and also to some degree on inflammation, and theseare markers of…these markers are known to be associated with increased breast cancerrisk.But you said that weight loss may not necessarily occur, but what’s interesting, so you maynot…let’s say you don’t change the types of foods you eat but just you’re basicallyonly eating, you know, during a 12 hour window during the day.So that in itself may not cause you to lose weight, or it could.[Ruth]: Or a significant amount.[Rhonda]: Or a significant amount.But what’s interesting is that, on the flip side, weight loss, weight loss itself hasalso been shown to have a positive effect on these same biomarkers.[Ruth]: Yes.Right.[Rhonda]: And so…[Ruth]: So we actually think that some of the positive effect might be independent ofweight loss.You get the positive effect whether or not you lose weight.In our pilot study, women over a month lost about a kilogram, or about a little over twopounds.So we did see a modest weight loss, that’s very modest.But even the mice study that…studies that Dr. Panda does also tend to suggest that theimpacts may be independent, like, it just helps you regardless of whether you lose weightor not.[Rhonda]: Yeah.That’s kind of what I was getting at.[Ruth]: Right.[Rhonda]: It seems as though it may just really be affecting your metabolism and making surethat your timing your food intake with when you are…when your metabolism’s at its best,when you can process…[Ruth]: Right.[Rhonda]: …these, you know, the sugar and the fats and…[Ruth]: Right.[Rhonda]: …just everything that you’re throwing at it.And that seems to be in of itself extremely important, so.[Ruth]: Right.And, you know, we have seen, in our breast cancer survivor study, we definitely saw animprovement in hours of sleep per night when people had a longer fasting duration.And, you know, sleep…bad sleep can also affect biomarkers, and it’s its own risk.So that might be partially…you know, it’s partially working through direct metaboliceffect but it might be working through other behaviors too by improving sleep and gettingmore sleep could also help regulate your metabolism and kind of feed into the positive impacts.Similarly, it’s very interesting but in several mice of studies, they’ve shown big improvementsin spontaneous activity when they’re put on this…when they’re not on this fasting regimen.We don’t necessarily think that if women or humans adopt a prolonged nightly fast they’regoing to start working out at the gym, but there might be some more subtle effects onspontaneous activity which frankly is the majority of the physical activity most peoplehave, is just spontaneous everyday normal activity.So now, the animal studies lead us to believe it can have several behavioral impacts inaddition to the direct metabolic impacts.[Rhonda]: Yeah, that’s very interesting.I wonder if there’s just changing the brain, you know, lots of…[Ruth]: You know, the data is showing that eating a bunch of food and going to sleepdisrupts your sleep, has been around a long time.[Rhonda]: Yeah.[Ruth]: You know, it’s just you don’t sleep well on a full stomach, [inaudible 00:33:01].You know, so it’s kind of…that’s literature’s been out there while.[Rhonda]: I’ve been practicing this time restricted feeding…[Ruth]: Mm-hmm.Yeah.[Rhonda]: …now for…once I, you know, Dr. Satchin Panda’s work was really eye-openingand I, you know, thought well I’m gonna…I usually try to stop, you know, stop eating earlier, like earlier in the day.And it’s a lot easier for me in the winter, fall and winter months when it gets darkerearlier and I’m not working so late.The thing for me is when I’m working late, you know, once you start working later, it’slight out, I’m like, “Oh, I got to keep working, I got to keep working,” then you start tolike extend your workday.[Ruth]: Right.[Rhonda]: And that becomes the issue.[Ruth]: Surprise, Western lifestyle is carcinogenic.In case you didn’t know that, now you do.[Rhonda]: So now we have the bright light exposure in the evening.[Ruth]: Many things about our lifestyle are carcinogenic.[Rhonda]: Right.But I do.It’s really not that difficult to do and I’m…just now I’m…I start the clock once I have myfirst cup of coffee and it’s at, okay, well I got to start cooking dinner, you know, atleast two hours before that or something so that way I’m done.And you don’t…you’re not hungry, you know, you’re not like starving when you go to bed.[Ruth]: Right.[Rhonda]: Some people I think their fear is, well, you mentioned it’s hard to sleep whenyou’re super full, but on the flip side a lot of people have this mentality that ifthey’re really hungry, you can’t sleep.[Ruth]: Right.[Rhonda]: You know?But I think there’s a nice balance between those two, and that is if you just eat something,you know, in a reasonable time, you know, 7, 8 p.m., stop.[Ruth]: I mean, along with that, I have to say I probably think it’s probably best foryou to go to bed at a reasonable hour.[Rhonda]: Right.[Ruth]: You know, not be staying up till 2 in the morning playing video games or whatever,you know, so you know, it can all be synergistic or in a positive way or in a negative way.[Rhonda]: Yeah.I want to kind of shift gears one more time.I think a lot of people have in their minds, at least in the context of breast cancer,many women think about risk factors being genetic, you know, there are certain genepolymorphisms which are variations in the sequence of DNA that alter the function somewhatthat can put a woman at risk.Particularly genes that are involved in repairing DNA damage, specifically in the breast tissue.[Ruth]: Right.[Rhonda]: BRCA1, BRCA2, I think many people are familiar with these genes.But really what your research and what a lot of research out there has shown is that thereare lifestyle factors that play a if not equally important role, and certainly in combinationwith these genetic risk factors would probably be very, very important in modifying breastcancer risk.And not only risk but recurrence.So there are a few types of lifestyle factors that we talked about today that may, you know,dramatically lower a female’s breast cancer risk, and also people out…women out therethat have had breast cancer, certain lifestyles they should adopt in order to lower theirrecurrence.[Ruth]: Right.[Rhonda]: So what do you…if you want to talk about maybe top one.[Ruth]: Yeah, you know, sure.You know, BRCA1 and BRCA2, if you have that gene, you know, polymorphism, that’s a prettyspecial case.And those women are at very high risk of breast cancer and recurrence.And it’s hard to know for that small percentage of women, how much lifestyle matters.But again, they’re a special case, majority of cancers are just sporadic.We think that less than 5% overall of breast cancers are the result of genetic factors.And more like 65% to 75% are the result of lifestyle factors, including obesity, diet,physical activity, and smoking.And alcohol we think maybe for breast cancer.So those are all things you can modify.So the idea that you’re doomed biogenetics couldn’t be more wrong.For the majority…the vast majority of women, it is your lifestyle choices that will makethe biggest difference in your risk, which is not the same thing as saying you’re toblame because a lot of cancers are sporadic, but that there are things you can do to reduceyour personal risk, a lot.[Rhonda]: Well, that’s good news.[Ruth]: Yeah.[Rhonda]: So don’t smoke, moderate drink, you know, don’t drink a lot.Lose weight.[Ruth]: Lose weight if…and even a small amount of weight.Recently there was a study that seemed to show like they saw a huge improvements inmetabolic health in the first 5% of weight loss.And then they said, if you looked at 5% to 10% of weight loss, it’s like it flattenedout.There wasn’t, you know, it isn’t like a linear thing.So it looks like even modest weight loss can really improve your metabolic health.So I think there’s this perception that, well, if I don’t get to model skinny, there’s nopoint in even trying.And I think that’s a really wrong way of looking at weight loss.Five percent weight loss could really make a difference.[Rhonda]: Five percent of your…[Ruth]: Five percent and keep it, you know, keep it off.You know, and maybe in a year or two you might go, “Well, maybe I’ll lose another 5%,” youknow?But, the idea that there’s like some very linear thing going on, I’m not sure the datareally support that.So even modest weight loss, you know, work on the quality of your diet, work on the timingyour diet, get some physical activity, please.You know, avoid long periods of sedentary behavior, all those things combined, goodsleep, you know, and good food choices I think are…that’s the total combination of thingsis the best thing you can work toward.And just make it a lifestyle to always be working on improving those things as yourwhole life.[Rhonda]: I think that’s fantastic advice.And I just want to mention that number again because it really is, you know, the best obviously…noone wants cancer, you know?That…if you can do whatever you can within your, you know, control to give yourself thebest possible chance of not getting cancer…[Ruth]: Right.[Rhonda]: …then really, really, really, really, really you should do it.That’s, you know…[Ruth]: And there’s a super benefit here, is that it likely will reduce your risk ofcardiovascular disease which after all is still the number one killer of women.So, you know, you’re really getting a 360 effect on your risk of all the major killersin America, some unpleasant conditions like diabetes and also, hopefully, just feelingbetter every day.[Rhonda]: Absolutely.And that’s…[Ruth]: Quality of life.Basic quality of life.[Rhonda]: I think there’s been studies showing like weight loss…[Ruth]: Right.[Rhonda]: …improve your mood.You know, inflammations associate with depression…[Ruth]: Yeah.[Rhonda]: …you know, and inflammation associated with obesity.So yeah, you’re right.[Ruth]: Right.[Rhonda]: All these things, quality of life.[Ruth]: Physical activity is associated with reduced risk of depression or amelioratingsome of the effects.So there’s, you know, it’s not like there’s a separate list of things you should do forone disease versus another, it’s like the total benefit package.[Rhonda]: Right.Yeah, they’re all overlapping.[Ruth]: Much more overlapping.We used to not think that as much.We used to think they were completely…here’s the disease pathway for cardiovascular disease,it’s very metabolic, it’s blood pressure, it’s cholesterol.And here’s cancer, and it’s a genetic disease and there are two separate pathways.Now, we see that they’re actually way more overlapping than we ever knew and it’s reallygood news because it means you don’t have to do separate things for each disease.It means the same suite of healthful behaviors can give you 360 protection.[Rhonda]: Well said.And just one last time, that meal timing, women that had breast cancer and had fastedfor at least 13 hours overnight had a 40% reduction in breast cancer recurrence.[Ruth]: Right.[Rhonda]: I think that’s a pretty good incentive for women to set that clock when they putthe first bite of food in their mouth, or the first non water beverage, that clock set,and making sure that you don’t eat food past 7 p.m.[Ruth]: 7, right, or 8.[Rhonda]: 7 or 8.[Ruth]: Satchin Panda’s work was…he did…the most recent article he published which I thoughtwas very good, looked at mice where he just had them do restricted feeding five days aweek, and then all around the clock, you know, kind of break it, the fast, on the weekend.And he saw much of the same effects which means, you know, you don’t also have to beperfect.As long as you most of the time you do it, you don’t need to feel like a failure like,“Oh, I went out, I ate so late,” it’s fine.You know, just pick up the next day and get started again.[Rhonda]: Thank you for bringing that up, because, you know, weekends are when we havethat social pressure.[Ruth]: Right.[Rhonda]: You know, we’re having later dinners, we’re having drinks, you know, so it’s niceto know that at least if the animal studies do translate to the human studies, that wecan at least break the rules or cheat a little bit on weekend.[Ruth]: I think that’s a plus side, is that it’s not about being perfect, it’s about mostlydoing it and you’ll get most of the benefit, right?[Rhonda]: Agreed, agreed.Well, Dr. Ruth, thank you so much for your time and for the phenomenal research thatyou’re doing and…[Ruth]: Thank you.[Rhonda]: …I really look forward to reading more and keeping an open line of discussionwith you to learn more about some of what your research is showing in terms of the mealtiming and breast cancer incidence.[Ruth]: Great.Thank you, Rhonda. CategoryArticlesTagsbrca breast cancer breast cancer risk estrogen fasting inflammation insulin Metabolism Obesity that the time restricted eating tobacco Weight Loss you 83 Comments Brian Urbina says: July 8, 2016 at 7:12 pm This study on fasting was impressive: https://news.usc.edu/63669/fasting-triggers-stem-cell-regeneration-of-damaged-old-immune-system/ There's so many benefits from fasting. I've done it a few times and I find it to be great tool for mental clarity, as well as helping me have a new understanding for food as fuel. Reply Jason Wright says: July 8, 2016 at 7:24 pm Awesome stuff! Reply High Carb Diabetic Ⓥ says: July 8, 2016 at 7:27 pm 3:00 Sad thing is most people don't understand that eating more fat and less carbs actually increases the amount of insulin your body has to produce. Reply Type Password Here says: July 8, 2016 at 8:04 pm uptalking is a plague Reply Angry Baboon says: July 8, 2016 at 8:08 pm Damn I love your videos, if only my nutrition university lectures were this interesting! Reply Apollo Sun says: July 8, 2016 at 8:09 pm Thanks, Doc! You are saving lives one video at a time Reply FoundMyFitness says: July 8, 2016 at 8:27 pm If this video motivates you to give time-restricted eating a try, just a reminder to consider submitting your data (food pictures!) to Dr. Panda's ongoing distributed, mobile-app powered clinical trial, which was mentioned in the previous podcast. You can learn more about that by visiting http://www.myCircadianClock.org. Available for iPhone & Android. Also, make sure to watch the previous interview with Dr. Panda, of course! You can find that here…https://www.youtube.com/watch?v=-R-eqJDQ2nU Reply High Carb Diabetic Ⓥ says: July 8, 2016 at 9:23 pm Great video. I'm going to try introduce the 13 hour fast and start it early enough to get the benefits of better blood sugars. They're already pretty good. But always looking for marginal gains. I do find myself eating big meals at night out of habit more than anything. 38:40 I would have liked Dr Patterson to mention ceasing consumption of all animal products and focus on a whole food, plant based diet as well. Reply oma la says: July 8, 2016 at 9:53 pm the fact that this high fat low carb diet is becoming popular makes me not want to engage in it all I hear these days is keto keto keto. Reply Green Deane says: July 8, 2016 at 10:09 pm What is very clear is that we have to listen to two PhD's for good health information because MD's have got their heads stuffed up their dogmatic dietary nonsense. Reply unknown unknown says: July 8, 2016 at 10:24 pm anything on hemochromotosis? Reply Jon Anderson says: July 9, 2016 at 3:25 am time restriction with curcumin meriva, resveratrol, and greens blended with each of my 2 meals daily has been absolute magic for me. time restriction will slowly adapt your body for ketone flexability and resensitize your body to insulin. this is a partial testimonial. i will not post sources, but i vet my science from nih website. Reply coachreed29 says: July 9, 2016 at 3:55 am I would like to hear discussion on fasting for athletes Reply Peter says: July 9, 2016 at 9:25 am Insulin & cancer. My wife died almost 4 years ago from Stage 4 colon cancer. Her PET scans lit up, which indicated that her tumors were glycolytic and therefore that glucose and insulin likely played a role in the rate of tumor growth YET, in retrospect, her blood levels of insulin and glucose/HbA1c were never tracked. Given the lack of efficacy of the "standard of care" and the grotesque fees that are charged, it is absolutely criminal not to advise patients about diet and to track the metabolic factors which promote tumor growth with aim of minimizing these factors. Reply Petrina Hamm says: July 9, 2016 at 9:28 am Great interview! Thanks Dr. Patrick. Reply ifoundthistoday says: July 9, 2016 at 11:20 am thank you once again Reply Doodle Doodle says: July 9, 2016 at 3:19 pm It was said but not talked about, how eating after meals always makes me sleep. Why? And if lions and other animals always just sleep why is staying active obvious. Reply Rachel Gray says: July 9, 2016 at 3:27 pm Thank you for another excellent video – You are a star :)!!!!! Reply Wayland C says: July 9, 2016 at 6:38 pm I want to see Dr. Rhonda Patrick get involved in (non-competitive) powerlifting 😀 Whatcha think Doc? You know it sounds fun. Reply Chris Namaste says: July 9, 2016 at 6:52 pm Rhonda please stop using the analogy "shifting gears." Shifting gears only has to do with changes of speed not changes of direction. Reply Nicolas Cage says: July 9, 2016 at 7:30 pm I don't get why the fasting must start early in the evening (21:16) in order to reduce inflammation when the circadian clock depends on light and feeding, and both things we control: we get light as soon as we get up and have breakfast and we can turn blue light off at night and stop eating. Maybe that reduction of inflammation is dependent to another clock that has different triggers? Reply antokindness says: July 10, 2016 at 5:25 am THANK YOU VERY MUCH INDEED, dr Rhonda, for your last two video-uploads!So invaluable are your annotations!I will keep on "patreoning" your efforts forever!!!! Reply WarmWeatherGuy says: July 10, 2016 at 3:10 pm At 1:00 she says they have not had a lot of success in identifying individual nutrients that seem to make a difference. If you Google each nutrient and "breast cancer" you will find 5 strong hits: Iodine, Selenium, and vitamins A, D, and K2. Getting enough of each of these can reduce cancer risk by 50%. These are things we're all deficient in. We don't know what would happen if you were to supplement all 5 together. I would like to see a study done with multiple nutrients instead of just one at a time. Reply MoonKrabbit says: July 10, 2016 at 6:51 pm She says, "It's detrimental to eat a lot of energy and then lay down." Has she never watched a nature program on animals where, say, after a pack of lions consume a large kill, and they all lay down for hours and not move as their bodies digest the big meal? She makes other similar statements that, on the face seem intuitive, but are not backed up by science. It's at these points where I question the entirety of what she is saying as a result. Reply MoonKrabbit says: July 10, 2016 at 6:56 pm If genes can be influenced via diet/lifestyle in such a way that results in diseases being delayed or even avoided, why has no one devised a way to combat something simple like male pattern baldness, which is, presumably, 100% gene-related? Once someone devises a way to cure or reverse baldness, then I will believe that affecting genes with diet/exercise to increase longevity is a possibility. Reply MoonKrabbit says: July 10, 2016 at 7:11 pm Dr. Patrick, in her talking head videos, seems to be a big proponent of eating the right foods and even supplements to ensure you are getting enough macronutrients to allow your body to function properly and activate genes that will possibly avoid disease. Yet, she interviews a lot of people who promote fasting and eating as little as food as possible for as long as possible. It's somewhat confusing. Reply Double0Beavis says: July 10, 2016 at 8:07 pm Another great video. Thanks for putting these together! Have you thought about talking to Dr. Valter Longo on your show? He's doing some great work in fasting and ketosis. Reply Dagmara K says: July 11, 2016 at 8:35 am Dr. Patrick, both here and in the last talk with dr. Panda it is mentioned that the clock starts ticking since your first sip of non-water drink but I can't seem to find a reason why. I can understand that in the case of fruit-infused water (some amounts of sugars, citric and ascorbic acid) or coffee (trace amounts of fat) but why would a herbal infusion or tea start the metabolic eating window? Does polyphenols etc also count in? I can't find any answer to that. Reply Marissa Solomon says: July 11, 2016 at 9:31 pm Thanks so much for posting this! I'm 40 year old stage 3 HER2+, ER- PR-, and I know that the study was controlled for obesity, but I missed if it was controlled for type of breast cancer, stage, and age? Most studies I have read about tend to get rather specific, and I know that hormones are mentioned in the interview, which makes me think my specific BC might not be included. Also, I would appreciate the link to this actual study if you could link it. I apologize if anything I'm asking was covered in the interview – my mind still gets foggy from chemo-brain! Thank you so much!!! Reply Steve Wilson says: July 12, 2016 at 11:05 pm Dr. Patrick: I like rigorous exercise, but only have time to go to the gym around 830 or 900pm …or I miss family time. What do I do, eat a large meal before and not eat after the gym? Reply prettycode83 says: July 13, 2016 at 2:54 am Fantastic video! Absolutely loved this! Reply prettycode83 says: July 13, 2016 at 2:56 am Just to clarify the role of fat in estrogen biosynthesis: fat can excrete aromatase enzyme, which in turn convert androgens into estrogen through a process known as aromatization. 🙂 Reply Gene Flynn says: July 13, 2016 at 5:10 pm Would love to see a video/research on meal frequency. Thank you for ALL you do Dr. Rhonda… Reply Jason Dames says: July 14, 2016 at 1:23 pm I loved this video!! It's amazing the research that seems to be across the board the benefits of intermittent fasting!! Thank you Dr Patrick for always putting out such quality information!! I have learned so much and really appreciate how you put up definitions on a lot of the scientific terms.. it has helped gain a great deal of understanding human physiology!! Reply Pilot Beats says: July 17, 2016 at 11:36 pm If you watched this like the vid, she deserves the support !! Also thank you for the content Reply Ascension says: July 29, 2016 at 1:06 pm I'm curious as to why coffee starts that window? As long as you don't add milk or sugar, there shouldn't be an insulin response?I'm asking because currently I'm fasting from 8pm to 2pm and usually drink green tea in the morning (during the fasting time).Also I think remembering something about caffeine increasing insulin sensitivity when consumed in a fasted state, but not when fed. How would you combine that with coffee impacting the feeding window? Reply lovelyjubly7 says: July 30, 2016 at 1:46 pm Dr. Rhonda Patrick – I'm a new listener of yours – fortunately I came across your podcast and now have subscribed to everything else too – I think you are great and your work is fantastic. I was shocked to listen to the lack of micronutrients in today's diet and how many of us are deficient…what do you think about superfoods such as argan oil, matcha tea etc? I like the teen leaf content of your smoothies – but I would love a segment/talk about the current superfood fad..thank you so much for taking the time and effort to make these high quality well researched talks and debates 👍🏼👍🏼 looking forward to many many more xx Reply Carroll Hoagland says: July 30, 2016 at 2:18 pm Nice presentation, as fasting fits in with ancestral life, but the stop eating after 7pm has been around a long time. In addition, breakfast as the primary meal has been promoted. Not sure how to convince the general public … as we are failing to stop "Sugar". Stress is good and the body has a built in system to manage the daily activities and rebuild after stress initiatives. Back in the 60-70's when much of the health movement started, (esp if a student at Berkeley) fasting was popular, and 3-day fasts to test for food allergies was done by many.Good luck with this as "Cancer" is a powerful motivator … and fighting the FDA … ? The problem is that the AMA and NIH have failed the patient … Physicians have abandoned the nutritional approach to patient diagnostics and medicine, simply because they are not trained in nutrition. A key part of the Hippocratic Oath … “I will prevent disease whenever I can, for prevention is preferable to cure… “, has been forgotten … 70 Going On 100. Reply Matt van den Ham says: August 7, 2016 at 8:26 pm It's amazing how obvious and simple it is, but at the same time how few people put fasting at night in to practice. So this video was great for reinforcing that good behavior pattern. On a side note, I've noticed that a lot of thinner people in society tend to eat this way and don't really eat much differently. I've also noticed that a lot of fat/obese people tend to eat mostly at night. Reply Matt van den Ham says: August 7, 2016 at 10:22 pm Another gem, Rhonda! Reply van basten says: August 8, 2016 at 2:30 am Do you think men would also benefit from fasting? Reply Ariel D says: August 11, 2016 at 10:24 pm One of the best Youtube channels about health and just 252 likes. Let`s share and like the videos. Reply Gil Fiazon says: August 26, 2016 at 5:51 am The problem with this is that most people do not want to go catabolic, especially if you are weightlifting and want to keep your muscle. Reply joe bob says: August 28, 2016 at 4:35 am Great show! Rhonda, you are awesome! Thank you so much for putting out all of the info and research you do. Words can't describe what an amazing thing you are doing. Reply Wes RR says: September 29, 2016 at 2:19 pm I omit breakfast. Not that bad, especially on LCHF. Reply Carroll Hoagland says: October 5, 2016 at 12:04 am Good stuff … Dr. Patrick fan … and we know that fasting and TRF are important to the DNA repair cycle … and best done using circadian rhythm as guide as genes do turn on an off depending on daylight factors, so going against that would be counter productive. 70 Going On 100 Reply Michael Davies says: October 20, 2016 at 4:20 pm So…from this perspective, coffee (and most certainly bulletproof/MCT/butter) coffee) "starts the clock" and kicks you out of the fasted state? What are you losing if you drink coffee hours before you eat, or what is meant by "starting the clock"?I know that neither tea, coffee nor BP coffee kicks you out of ketosis, nor does it inhibit autophagy. I doubt it seriously effects insulin. Clearly I don't want to give up my morning coffee if I don't have to. Also, these questions are in the context of a "normal" healthy individual who has been on this path (highly active, ~paleo, intermittent fasting) for a number of years. Reply Tina K.P. says: October 22, 2016 at 11:18 pm Why would the clock start with the first sip of coffee, although coffee has no calories? Reply Sebastian Scott Engen says: October 27, 2016 at 7:20 am Big question!I've been interment fasting around a 6 hour "bingeeating" window for quiet a while now – but my zone of eating is between 11 and 17. Would it be benefitial for me to move it back a few hours – say 7-13? 🙂 Reply Michael says: November 30, 2016 at 9:10 am I'm doing this now and find it easy even if I'm working in the evening, less so with social activity. I can see this being a life long change. Reply hestekjeften says: January 25, 2017 at 7:13 pm Great video! I have one question about supplements, more specifically magnesium & calcium + ashwagandha. These are good to take at night, but will that disrupt the eating window assuming the last meal was earlier in the evening? Reply Fark says: January 30, 2017 at 12:07 pm Really good interview. I will definitely try this out. Reply Auke Vellinga says: February 8, 2017 at 5:56 pm I disagree with her on the part that it doesn't make sense humans eat their largest meal at night. It does make sense. During the day-time we were scavenging and hunting, which was all brought back home in the evening and then cooked into large meals. During the day people probably only snacked. And it definitively doesn't make sense people ate from the moment they woke up. There were no fridges or plastic bags that were able to keep food fresh for long periods of time and that could feed everyone as soon as they woke up. Moreover, in the evening stress levels of the day diminish. And during sleep growth hormone and sex hormones peak, which result in recovery and repair of the stresses of daytime. Those repair mechanisms require amino acids and energy. Additionally, by working out all day glycogen stores are probably depleted to a large extent, eating at night will just refill those stores. Energy doesn't have to be used immediately, humans are pretty efficient in storing energy for later use, that's what we can see in current society. I doubt it's the eating at night. It's simply the long periods of feasting and the short periods of fasting. I'm a big proponent of skipping breakfast and eating most protein at night. ofcourse then you can only drink water in the morning to prevent "the clock" from starting. There's actually studies showing protein pre-bed increase lean mass more than the same amount of protein spread out over the day. It makes sense humans cooked the hunted game in the evening, not during hunting or fighting off neighbours. Reply Laura Floros says: February 11, 2017 at 8:58 pm Love IF. I think it's fascinating to watch the coverage being done on this subject. One point that is confusing is, the "first" sip of coffee breaking the fast. Many people have proven that even having coffee with a splash of cream, coconut oil or butter, will not break the fast; green tea or other calorie free beverages also included. It would be quite helpful if more details or studies involved actual facts on what causes the end of the fast. Being able to have a cup of coffee and continuing the fast makes the process of eating in a food window so much more appealing 😉 Reply Eclectic Monstrosity says: February 21, 2017 at 3:05 am I cannot relate at all to what she is stating at 13:27? Since when do people who eat late at night feel satiated in the morning? Whenever I eat late at night, I am utterly starving in the morning. I know a lot of people who feel this way. Additionally. When I fast with eating in the middle of the day, I am much less hungry in the morning. In fact water fasting kills hunger. Reply Eclectic Monstrosity says: February 21, 2017 at 3:08 am Rhonda, please have Dr. Jason Fung on your show. He promotes long term water fasts and I really would love to see you asking him some in depth, important questions. Particularly in relation to women and pre-menopause. Does it bring on early onset menopause to water fast? Or does that only matter with thin women? Infertility is the question here and not only with super young women. Reply havvasweb says: February 23, 2017 at 3:27 am shoutout from a biochem geek / dietitian… love your videos! on fasting, i love how the research is leading us to follow an ayurvedic diet pattern (breakfast like a king, lunch like a prince, dinner like a pauper…) . I have noted, however, that for many diabetic patients, they may need to eat 1-2 oz of protein at bedtime to stabilize their 4 am blood sugar/cortisol problems, but for most with a decent aic , that isnt necessary and many patients can give that up once their stress is better managed. something i wish you would talk to the dr about is the effect of evening alcohol on blood sugar , appetite, serotonin->melatonin, sleep quality, etc and how that feeds into the er+ ca risk. thank you for being you!! Reply J. Allen says: March 15, 2017 at 8:02 pm I eat dinner by 5pm, next day do a fasted swim, then eat my first meal around 12:30. It's easy as breathing. If you can do it b/c you get 'hangry' you are sugar addicted. Intermittent fast until you don't feel that hunger. It gets ridiculously easy. Reply Ivan B says: May 7, 2017 at 2:29 pm This is a wonderful interview so far Dr Rhonda Patrick. However I must disagree on one point made at the beginning about no specific foods or nutrients shown to substantially reduce breast cancer risk. I think there are two levels of evidence that have shown the contrary. Petri dish laboratory studies and census data or population studies. Dr. Fuhrman references how green tea and mushrooms in particular, mushrooms being natural aromatase inhibitors, have been shown to substantially reduce the risk of breast cancer and I think this is based in Asian populations. So while it's amicable to side on caution regarding findings not being definitive, I think these findings should still be mentioned b/c consuming them certainly can't hurt. Anyway love the information and growth factors talking in the beginning and I will continue to watch this entire video. Your guest overall was very excellent and knowledgeable and you led the interview very fluidly and effectively. You both connected well and had great rapport 🙂 Great work! Reply Hressi Fávitinn says: May 11, 2017 at 7:10 am I would really like to see Rhonda do a video about the importance(or not-importance) of eating at the same time every day when doing time resteicted eating. Been doing it for a few weeks now but as i get up at 5am i have to try and not eat until 8-9ish so that i can eat dinner with the kids at 6-7pm and its hard to eat breakfast at the same point everyday due to work. I wonder if it matters that i eat at 7:30 one day and then at 8 the next day and at 7 the next and so on. Reply Jerry Jenkins says: May 12, 2017 at 1:07 am how I can I get around this on night shift ? can I eat all my food before I go to work while it is still light ? Reply Nick Dino says: July 27, 2017 at 9:45 am am i the only one who whatches Rhonda's videos and almost always gets caught up in the non verbal and underlying awkwardness? I mean just about every video she is awkward and has an unsettling effect on the others. Reply Rosie Jase says: July 29, 2017 at 4:55 pm Thanks for the education. I've been told that I have extremely dense breasts so I'm currently shaking in my boots about the increased risk. I'm thus looking to do anything (sans surgery and medication) to counter this risk. Thanks so much for your help! Reply Rupert Bloomsbury says: August 3, 2017 at 10:55 am Dr Patrick, thanks for your content and channel. I am educating myself through your simple sharing and informative knowledge. Looking forward to the results Reply Kathi Clark says: August 6, 2017 at 7:37 pm So, if we are supposed to eat the largest meal during the day so we'll have energy, why do I immediately get tired and want to sleep as soon as I eat? Food has never given me energy; it just make me lethargic and I will fall asleep instantly after a meal if I can. I have never liked breakfast (I cannot be productive after I eat), and as I get older, I'm less and less inclined to eat lunch, as I want to be safely home before I eat and crash. I eat my dinner around 3pm and don't eat after that, so her theory of late night eating does not explain my lack of hunger in the morning. Is my internal system broken? Reply ana10001000 says: August 11, 2017 at 8:31 am Hi Rhonda. Jus to let you know time restricted eating completely cured my IBS. I eat in 12 hour cycle and had problems in the past with IBS, the symptoms were gone in 1-2 days. Seems my body has more time and energy to digest food better. I know this is not mentioned in the video here or in the JRE podcast where I first heard of this but it was a nice surprise. Maybe this needs to be investigated more? Thank you very much for great health insight over the many JRE episodes and your own channel videos! Reply Akil Joseph says: August 24, 2017 at 1:48 am I think this earlier window is impractical for someone who workouts regularly and eats a post workout meal. I workout after work which ends like 6:30 – 7 pm, one hour to 2 hours workout. The earliest I can eat is like 9 pm. Workout in the mornings is just not doable. So what then. Reply SciSci Toys says: August 27, 2017 at 8:38 am Can someone give me some advice? I was diagnosed with gallbladder polyps which I have to have scanned every few months to make sure they dont grow to >1cm as they can become malignant, also fatty liver, have had GERD/hiatal hernia and anxiety/depression and taken two meds for these two problems for 22yrs bt since the GB polyp diagnoses Ive reduced the meds a lot, I wanted to stop them altogether so I could fast, cause I haven't been able to completely stop taking them I have done intermittent fasting for 18-23hrs in day in order to get into autophagy which I figured could munch on those polyps.BUT … I realised that HGH and IGF1 increases when you do Intermittent Fasting, also when you fast Cortisol and other stress chemicals are raised and can increase blood sugar for example, the worry is that Im doing this to shrink the polyps BUT I wonder if HGH and IGF1 may hamper this goal or make the polyps actually grow instead of shrinking??I take serrapeptase to try and shrink them, also Curcumin, selenium, and vitamins.How can fasting shrink tumors when the body creates HGH and IGF1 in this state? I dont get it. Reply aleolivsp says: January 15, 2018 at 10:50 pm Hello Rhonda, thanks so much for sharing such an important content. I've watched this interview more than once, and I would like to go deeper about the subject of "best time windows to eat". In the interview the point about eating during the day light were emphasized like been most benefitial, and I understood that it makes sense in an evolutionary perspective. Maybe it so for woman, because in the evolutionary focus the main focus for woman was to take care of children (feedding them during day light). In the other hand, man should hunt and doing intense activity after a big meal does not make sense. What do you think? I'm eating only once a day, usualy aroung 7pm, and I´m felling really full of energy Reply chris topher says: January 29, 2018 at 5:43 pm Not everyone who skips breakfast is hungry or cheating, fat adapted individuals understand this is not only do able it's also easy. LCHF Reply Paul DOYLE says: February 5, 2018 at 8:24 am so one can eat fast food and as long as one eats before 8pm all is well? ok sure what BULLS!-!it Reply Ed says: April 4, 2018 at 3:43 pm I'm really enjoying this channel and isn't it amazing that the body is incredibly complex and yet the answers are often very simple?The sulforaphane information I found very interesting, too. Reply Katie • says: April 20, 2018 at 2:41 am I prefer mainly fasting all day and eating at night. My nervous system can rest when I’m all alone in the evening. Seems i can digest everything better Reply Chase Blakeley says: May 22, 2018 at 5:29 pm so what is the best time window for eating? do or don't skip breakfast? Reply sharon brink says: June 24, 2018 at 4:01 am I have read recently about the balance of hormones as important.. looking rather at the relationship and balance of all hormones rather than is one hormone optimal or high..does this come into factor in cancer growth.? Reply MENTES LIVRES says: July 5, 2018 at 5:46 pm Dr. Ronda Patrick is a hottie! Reply Mark Sconce says: August 20, 2018 at 7:35 am Ruth is burned out. Reply SunUp08 says: January 15, 2019 at 11:08 am Everyone is different, but I do extremely well if i eat all my calories in the morning, or at the very most before 2pm. I rarely get hungry throughout the day, until it's almost time to go to bed and I sleep it off then. I tried eating everything in the evening/night but I felt awful and didn't sleep well… and my hunger levels were terrible throughout the day. So, early time restricted feeding most definitely works for me! Reply Adiudicium 1776 says: February 5, 2019 at 7:06 pm Respectfully, I disagree with Dr. Patterson's statement (13:01) that people who skip breakfast eat late at night and those that eat early in the evening wake up starving. I am sure I am not alone when I say I eat my dinner between 1700-1800 and don't eat my first meal until after 11 am due to NOT being hungry when I wake up. I do have a cup of coffee however when I wake up for better and faster mental clarity. Reply Q Jones says: February 18, 2019 at 7:48 pm Step one is to take reasonable actions that will reduce the odds of getting breast cancer Step 2 is increasing the odds that a viable therapy is available by the time you or a loved one gets it. If you are not canvassing and collecting donations for breast cancer research, you are making a strategic error Reply WM P says: April 1, 2019 at 2:02 am DON'T agree with some of her conclusions. Reply Buell Solanka says: May 1, 2019 at 7:39 am What if the body needs a lot of energy in the evening because of repearing during sleep? Reply Mel Toretto says: May 29, 2019 at 10:03 pm I was fasting 14 hrs and eating for 10 hrs. But Dr. Valter Longo does not agree with fasting for more then 12 hrs because of (gallstone problems.) He send Dr. Satchin Panda an email about the matter. I don't know who that hell to believe when they all disagree with each other. I wish they had all this Doctors on a round table to clear all this up. Reply Leave a Reply Cancel reply Your email address will not be published. Required fields are marked *Comment Name * Email * Save my name, email, and website in this browser for the next time I comment.