#3: WHO NEEDS SLEEP?...
with Drs. Dean & Ayesha Sherzai
Getting a good night’s sleep at a fire station is like trying to do homework at a rock concert. Dream on! For most of us, sleep can be elusive, interrupted, and hard to come by in our tech-heavy, fast-paced world. But good sleep is crucial for brain health, allowing our main operating system to repair and reboot. This week, Rip introduces Joe to husband-wife neurologists Dean and Ayesha Sherzai, leading physicians and researchers on brain health and the prevention of Alzheimer’s.
“Assume you have bad genes and then live in a way that reduces your vascular risk”, says Dr. Dean Sherzai before sharing how plant-based nutrition, exercise, sleep, mental activity and stress reduction all play pivotal roles in our ability to thrive.
Learn tips for getting a good night’s sleep even if your life circumstances are working against you. Be inspired by some positive news about Alzheimer’s and dementia - and hear simple actionable steps we can all take today to avoid this kind of demise.
.A unique husband and wife team on the cutting edge of brain science, Dr. Dean and Dr. Ayesha Sherzai are dedicated to educating people on the simple steps to long-term health and wellness through their work as Directors of the Alzheimer’s Prevention Program at Loma Linda University Medical Center, with patients, as well as through online writing, videos, and books.
There is a tsunami of diseases of the brain such as Alzheimer’s, stroke and Parkinson’s disease permeating our culture. In our own communities and families, we all have known at least one person suffering from these illnesses and in many cases seen the fallout first-hand. There is no treatment for these diseases, and the emotional, financial and social burden is immense. These diseases are thieves, stealing time, money and ravaging the minds of our loved ones. The Sherzais see scientists and physicians working furiously to find a cure or these diseases, and in this frantic race against time somehow, the big picture is usually lost among the molecules and chemicals related to the diseases.
As Directors of the Alzheimer’s Prevention Program at Loma Linda University Medical Center, the Sherzais, through research and their extensive collective medical backgrounds, work to demystify the steps to achieving long-term brain health and the prevention of devastating diseases such as Alzheimer’s and dementia.
Transcript of Episode 3: Who Needs Sleep?
Rip Esselstyn: Hey, it's Rip Esselstyn. If you're jumping in midstream into the podcast, I would encourage you, go back to episode one, where we meet Joe Inga and this way chronologically it will have a much better flow and make more sense.
Joe Inga: I mean, I never have a good night in the firehouse. You're not resting well there. You're always on edge. You never know what's gonna happen, so-
Rip Esselstyn: Yeah.
Joe Inga: I'm a little tired.
Rip Esselstyn: So trying to get a good night's sleep at the firehouse is virtually impossible. The alarm is going off anywhere between three to six times between midnight and 7AM. The guys are laughing, snoring, throwing pillows at each other. It's really hard to quiet your mind because you never know when the tone is gonna go off and what you're gonna have, whether it's a medical emergency, whether it is a high rise that's a barn burner of a fire. So sleeping at the firehouse ... It's like trying to do your homework at a rock concert.
Joe Inga: I've been sleeping better when I do sleep but like I said I've been working like crazy the last couple of weeks. I haven't been on my 24 hour schedule. I've been on like four shifts and then overtime and stuff like that so it's been a little chaotic. That's one of the things that's difficult as you know with being a fireman. There's no consistent sleep, you know? You come home, sometimes you don't end up sleeping very well or you don't get any sleep at work and now you're in a deficit and it takes a couple days to recoup.
Rip Esselstyn: Sleep is crucial for brain health and for many of us in America in 2019, with all the distractions, the white noise and everything, it's very elusive and it's hard to come by but it's vital for protecting our minds. The people that have the most definitive research, really on the planet have become good friends of mine, Dean and Ayesha Sherzai from Loma Linda and they've got the hard science on how we can all treat and even avoid Alzheimer's and I'll bet you anything these guys can help Joe out.
Rip Esselstyn: I'm Rip Esselstyn. I'm the founder of Engine2 and I am going to be working with Joe Inga. He's an amazing firefighter, father. He's just a really amazing human being and we are going to go on an amazing journey and witness Joe transform before our very eyes from somebody whose health has spiraled out of control to somebody that is going to take back his health. What I have done in order to take Joe on this journey is I have marshaled together some of the most amazing doctors, inspirational leaders, to help work with Joe and possibly yourself. Listen in as Joe is absolutely transformed from a couch potato to a veritable sweet potato triathlete in less than six months. Episode after episode Joe gains momentum and confidence and all the tools and tricks to what it means to become a plant strong man. I can't wait to have you listen in on this journey. Welcome to plant strong.
Rip Esselstyn: One of the things that we know, especially from the amazing research from Dean and Ayesha Sherzai with brain health is that it's really imperative that we do our best to get 7-8 hours of sleep every night. I visited the Sherzais at their home in Redondo Beach and we talked about brain health, why sleep is so crucial to rescue our brains, and how they could best help Joe.
Ayesha Sherzai: I am Ayesha Sherzai. I am a neurologist and co director of the brain health and Alzheimer's prevention program at Loma Linda University. I am privileged to be here with you, Rip.
Dean Sherzai: I am Dean Sherzai, the co director of brain health and Alzheimer's prevention program at Loma Linda University. Again, we are so privileged part of this journey with you.
Rip Esselstyn: When you say brain health I know it's like dementia, Parkinson's, and then stroke, but is Alzheimer's a subset of dementia?
Dean Sherzai: It is. Dementia is the umbrella category and by definition dementia is whenever you have enough cognitive decline where you can't do one of your daily activities such as driving or finances or taking care of your medication. By definition this is dementia. I'm not talking short term, long term. But Alzheimer's is the biggest category. 60-70% of all dimensions is Alzheimer's.
Rip Esselstyn: So when doing my research, what I discovered, especially in reading your amazing book the Alzheimer's solution, is that every chronic disease out there is kind of plateauing or on the decline whereas the one that is going up like an absolute arrow is Alzheimer's. In your book you mentioned how in the last decade it has increased almost 87% and then also that in 2016 that it was the sixth leading cause of death in the United States. These are alarming statistics.
Ayesha Sherzai: It is. It is. It's quite scary and obviously we are aging as a society. We are getting older and older and there are treatments, symptomatic and disease modifying treatments for all the other diseases now. People take medication for blood pressure or for diabetes so they are surviving these diseases. They're not thriving, they're sick, but they are surviving them. The one disease that is just devastating has been Alzheimer's disease and since we wrote the book of the numbers have climbed even more. Mortality or death due to Alzheimer's disease in the last 15 years has climbed to 123%. No matter what your political proclivities are, no matter what your affiliation is with any organization, we all need to be concerned about this disease because it's going to hit us like a tsunami very soon.
Rip Esselstyn: Then you guys have the unmitigated tenacity to try and tell the medical establishment and us in your book that 90% of Alzheimer's can be prevented. Right? That seems utterly amazing. Is that in fact the case?
Dean Sherzai: The numbers are coming to us from the genetic studies. The new techniques such as GWAS or genome wide analysis, we know we have identified about 25 to 30 genes that have been associated with Alzheimer's. Of those 3% are the kind of genes that would be called high penetrance, meaning if you have the gene you are going to get the disease, but the majority of chronic diseases of aging the genes determine the range and lifestyle determines within that range how far or how close you are to getting the disease. For Alzheimer's 3%, Presenilin 1, Presenilin 2, and APP, these three genes. If you have them you are going to get the disease before age 65 to 70. That only constitutes 3% of Alzheimer's. These other genes are not Alzheimer's genes. They are vascular response genes, immune response genes, garbage disposal genes. That should be a clue. If you have bad genes for those things that means don't do the kind of activities that challenge your vascular response, challenge your immune response, challenge your garbage disposal, waste removal.
Dean Sherzai: If you have good genes you can do a little more but still you are at risk. I tell people, "Assume you have bad genes and live in a risk away in which you reduce your vascular risk." What is that? Your immune response and garbage disposal, and we found four things we found that affect those the most are nutrition, exercise, stress or stress reduction, and sleep. If you take care of those four things plus the one other that doesn't affect those but it's incredible mental activity 90% of Alzheimer's can be pushed back. That's remarkable.
Rip Esselstyn: We are working with, in New York City, his name is Joe Inga. Joe is climbing on board this whole food plant-based lifestyle. He's trying to turn his health around but he gets up 5 to 6 times a night between midnight and seven. He's got a young kid at home, six-month-old, and that I think also a two-year-old. Is there any way if you are sleep deprived that you can recover from that?
Ayesha Sherzai: It's important for Joe to know that he can't really continue that kind of lifestyle for long. There have been studies that have showed that people who are shift workers who are up at night and they are sleeping at day or they have interrupted sleep, if it becomes chronic and if it's long term it significantly damages the brain. So for a short period of time because of work or any other responsibilities are fine, the brain is able to repair itself. We need consistent sleep, at least 7-8 hours sleep each night, each one of us. Sleep has two purposes, two main purposes.
Ayesha Sherzai: The first one is memory consolidation, so all the information we get from our environment every single day actually goes into the right file folder and cabinet in our brain so it's easier for us to retrieve it the next day. That happens when we have an intact sleep architecture, we have to go through each stage and when we don't that process gets disrupted and there have been studies when people don't sleep well they actually score less in their tests the next day even when they prepared very well for it. Even one night of sleep deprivation raises the level of beta-amyloid protein, which is the bad protein associated with Alzheimer's disease in the cerebrospinal fluid. One night of bad sleep does that.
Rip Esselstyn: It raises it, but does that mean it's actually depositing it?
Ayesha Sherzai: It raises it. Yeah, the body is actually not able to get rid of it. We are supposed to get rid of it but when we don't get a good night sleep it's interrupted, our body doesn't get rid of it. Which brings us to the second function of sleep, which is getting rid of waste products. We have these cells that are called janitor cells and they get activated when we sleep. The function of these janitor cells are to go and get rid of the broken parts of the brain. You know, after so much function there's always a broken part. It gets rid of it. It cleanses the brain in many words.
Ayesha Sherzai: This janitor cell, or microglia, it goes completely haywire when we don't get enough sleep and instead of getting rid of the junk and the broken parts it starts eating away at healthy parts. That's why when people don't have a consistently good sleep pattern they have smaller brains, shrunken brains in MRI studies. When we say this people usually say, "Well, what do I do? I take medication?" Medication is usually good in short-term quick fix, but long term it always has to be lifestyle. It has to be cognitive behavioral therapy. It has to be sleep hygiene. There's so much. We could probably talk for two hours about sleep hygiene.
Rip Esselstyn: You're right. So we have talked about janitor cells and garbage disposal cells and sleep hygiene and I think it's important that we now define these terms. When we are talking about janitor cells we are talking about cells that just like a janitor are basically sweeping up and cleaning up the mess that has been made during the day. The garbage disposal cells are very similar and what they do is they basically get rid of the unwanted and unfettered cells that we have accumulated over the course of the day as well. When we are talking about sleep hygiene what the Sherzais are talking about here is what are the condition and the surroundings of your sleep environment?
Rip Esselstyn: These are things that we all can control and they need to be consistent night after night. These are things like the temperature of your room, what are you wearing or not wearing to bed, what kind of sheets are you sleeping in. Are the old sheets, new sheets, 100% satin, cotton, etc. Then of course white noise. Do we want to have white noise in the background to kind of suit without any potential distractions and noises? Then darkness. Is it pitch black? Do we like to have a little light? What is our preferences is there.
Rip Esselstyn: I'm telling you, for me the pillow is so paramount to me getting a good sleep. I am also an absolute princess in the bedroom. I have got to have complete and utter darkness. It's so dark that you can't see your hand in front of your face.
Ayesha Sherzai: Same here, absolutely.
Rip Esselstyn: I have sheets that have to be changed every 3 to 4 days. They have to be silky smooth. I've got to have the white noisemaker on.
Ayesha Sherzai: Okay, great.
Rip Esselstyn: I love the white noisemaker.
Ayesha Sherzai: Great. It helps a lot.
Rip Esselstyn: And the temperature. It has to be turned down preferably. I love 60 if possible. I burn hot at night. I know you do too.
Dean Sherzai: Absolutely. You're absolutely right. And the pillow, you're right. We've actually talked about this. As we get older, as far as the spine is concerned the neck is most affected as we get over so they has to be a pillow that actually contours to the neck. Again, when you're young ... I rumor going to these field trips and I would sleep on a rock. It didn't matter. Now if the pillow is not right I feel I'm pretty sensitive as well. Way more than Ayesha is.
Ayesha Sherzai: He's a princess too.
Rip Esselstyn: The thing about pills, because I know so many people that are on Ambien or something like that. It doesn't allow you to go through that full cycle.
Dean Sherzai: Correct. The most important part of sleep is going through that cycle several times a night and going through it properly and sleep medications, almost all of them affect those cycles so you might be sleeping but you're not consolidating memory, you're not cleaning the brain. You're not detoxifying the brain. Sometimes it's necessary just to break the process of sleep deprivation but it cannot be long term. The other side of the coin is that you can almost get everybody to have a good sleep pattern over time, over months, over six months, seven months. They have to go through this hygiene and cognitive behavioral therapy.
Dean Sherzai: The problem is we are all immediate seekers and doctors don't help that because when we go through four years of college, four years of medical school, four years of residency, and fellowship and everything we come out almost with a sense of urgency or pressure on us that whenever somebody comes into the room I have to give them a pill to reverse something immediately. All those pills have side effects and we act as though these pills are supposed to be with you for the rest of your life. In fact, one of the problem is doctors don't strategize people get people off pills. That should be the goal. What we say is it's our job is to get you off pills.
Rip Esselstyn: Bravo.
Dean Sherzai: Pills short-term, but long-term it has to be the more difficult job of sleep hygiene and cognitive behavioral therapy, which almost always works.
Rip Esselstyn: Well if sleeping pills aren't the answer and it's almost impossible to change your schedule like it is for Joe what's a guy like Joe to do to get a better nights sleep and keep his brain healthy using the sleep therapy and cognitive therapy you're talking about?
Dean Sherzai: YOu have to first understand all the elements that go into sleep deprivation but one of the first things you can do is create a pattern. A pattern is critical. You go to bed at the same time, you wake up at the same time. It's okay if it's altered, over eight hours later you wake up and even if you didn't get any sleep last night don't take a nap. Don't take a nap because forces you the next night to go back to the cycle. It might not happen that next night or the following night but everybody eventually falls into a cycle so pattern is critical.
Dean Sherzai: The second thing people can view as far as improving sleep is to figure out what affecting their sleep. Three things, nutritionist affects sleep. Our food, for good and bad. Environment affect sleep, good or bad. And behavior. Behavior is one of those we talked about, going to bed same time. Another thing about behavior is things like light, with computers, with phones. Having the TV on until the last second. All those things turn on your circadian clock, which actually affects sleep. Eliminate as much of those visual distracters as possible before sleep and do meditation or whatever needs to be done to kind of calm you down. It really helps. The environmental things do matter, especially as you get older. When you're young like you, Rip, you go to bed and you're out. But most people as they get older several phases of sleep are altered, especially the first phase. Going to sleep is affected.
Dean Sherzai: It's important to change light. Reduce light as much as possible. Sound is critical. Reduce sound as much as possible. Then the cool thing, temperature. Your body requires a little cooler temperature than you thought, so cool down the room and see where it's comfortable. As we get older those things matter. The food thing is critical. Food is not what you think. It's not eating too close to sleep time. When you're young ... I was eating big meals five minutes before sleep and I would be out. Now as you get older your digestive system gets slower. Although it's not making noise as the system is working and that keeps you up. Some of the things that he can introduce into his life and he will see significant changes.
Ayesha Sherzai: I think for Joe it's important for us to mention because he is a firefighter, so the regular lifestyle things that we just talked about don't really apply to him as much as it would for somebody who is not a firefighter and for people who are firefighters or nurses who have night shift workers, they all have concerns about their sleep and they are all really, really worried about the consequences of this disrupted sleep pattern to their brain health and usually what we say, and this would be a message for Joe, is don't worry. Don't make it a lifelong thing. Try to see if you can have breaks in between these patterns of destructive sleep. The brain is pretty forgiving, so if you haven't addressed the other factors in NEURO, eating a really clean whole food plant-based diet, exercising, keeping your stress at bay, and then pushing your brain to just keep as active as possible, you can connect to your purpose. Don't worry about it, you're doing a great job and you're going to be just fine.
Rip Esselstyn: You do what you can the best that you can.
Ayesha Sherzai: Exactly, because a lot of us we probably might not score as well in one area or the other but it's about that comprehensive multifaceted approach that makes the biggest difference rather than pigeonholing yourself into one aspect of it at times.
Rip Esselstyn: What I would like to do now I was I would love to jump into your five-step plan, NEURO. It's a brilliant acronym.
Ayesha Sherzai: N stands for nutrition. There is a lot of clutter and noise about nutrition out there as you know, Rip. We promote a whole food, plant-based, no oil, low salt diet. The same kind of diet that is heart healthy is brain healthy as well. It's incredibly important for people to understand that the brain is the most active organ in the body. We sleep but our brain doesn't sleep. It continues to function 24/7, and at any point it consumes 25% of our body's energy. It's only about 2 pounds but it consumes 25% of our body's energy. Everything that we eat and everything that we don't eat affects the brain. It either builds the brain or breaks the brain and so it's incredibly important to supply it with the right kind of nutrition and building blocks.
Ayesha Sherzai: From all the studies that have been done all over the world for almost 8 decades, whether it's the Mediterranean diet or the MIND diet or the DASH diet, and you just name the diets that have been studied over and over again, when you look at the components that are brain healthy it's the plants.
Rip Esselstyn: Come to one of our Engine2 immersion programs. We have five and seven day programs in the red rock mountains of Sedona, Arizona or in the black mountains of Asheville, North Carolina. You'll be there with my mom, my dad, and my sister Jane. This all-star cast of plant strong experts, dietitians, nutritionists, physicians, trainers. You'll be surrounded with like-minded people that are trying to reclaim their lost health that are they are to discover a lost part of themselves and we want to awaken that within you and we do it with exercise, we do with amazing world class lectures, we do it with food that is just over the top delicious. You will find something that you never knew existed within yourself and it has just been some of the most gratifying and rewarding work that I have done over the last 10 years and I recommend each and every one of you, come give yourself this gift of health and immersion with us. So if you're interested come to engine2.com and just click on events.
Rip Esselstyn: The other thing that the Sherzais talk about, they have this acronym that's called NEURO. The N is nutrition, the E is exercise, the U is unwind. So what are you doing to kind of relax, meditate, kind of cleanse yourself of the stress in your life? What are you doing when you're not at the firehouse?
Joe Inga: I am usually at home taking care of my five-year-old after school because my wife works or I'm drawing. I'm also an artist as well.
Rip Esselstyn: Nice.
Joe Inga: I do like chibi cartoon things and that was part of my addiction recovery. I never took art classes. I never drew, but when I went for help I was just sitting and doodling and somebody said, "You got a talent here." That's what I took is my hobby. I've done some work for Marvel and upper deck doing trading cards. I did my first year of [commentions 00:23:16], I did three commentions and then I got an email from them, "Hey, do you want to do trading cards?" My friends were like, it took me 10 years to get that gig. I do that and it keeps me the ... Calms me down and stuff.
Rip Esselstyn: How often would you say you do your drawing a day?
Joe Inga: I would say on and off for a few hours a day. If I'm at home maybe a little bit longer. I've been practicing comic inking kind of stuff, so sometimes I will just go in my room and take out one of the practice drawings and then I will just ink. Even if it's for five minutes in a kind of clear my head for a couple minutes and I can get back to whatever I was doing.
Rip Esselstyn: Tell us about the best ways to unwind. Is it meditation?
Dean Sherzai: Unwind to us means increasing your stress, not reducing your stress. It doesn't mean that you don't reduce stress but the focus should be on increasing good stress. So at the center is identifying good stress and identifying bad stress. That's why in every room in our house there's a whiteboard, then the kids define what good and bad stress is for them that day, that week, that month. Good stress are things that are driven by their mission, by their goals, by the passion, by their purpose, that there is a chance of success and its pleasurable and all of that stuff. Bad stress is things that they have very little control over and they don't see the light at the end of the tunnel and all that.
Dean Sherzai: It has to be specific. You write it down and the goal is to increase the good stress and reduce the bad stress. Good stress actually builds brain and it's critical. It's the most protective factor for the brain. Bad stress, they both are processed by the same parts. The limbic system of the brain, which is the emotional brain, defines the stress when the frontal lobe says, "Oh, this stress over a while is just not feeling good." It sends messages continually to your hypothalamus, which then sends the messages to the pituitary, and the pituitary is the hormone immunological center of the universe. It's definition, how you define your good and bad stress, is critical. Because every minute you actually start accumulating the bad stress it releases different kinds of chemicals into your body and into your brain.
Rip Esselstyn: Isn't it amazing how the body knows the difference? I think also we intuitively kind of know when we are stressed out and it doesn't feel healthy and when it's a stress that feels like it's a good stress.
Dean Sherzai: Yes, exactly.
Ayesha Sherzai: There's always a joy associated with good stress too, and it's not continuous. You know, whenever you put yourself your project ... You're doing that right now. You're traveling all over the place, you're probably not getting enough sleep, you're thinking all the time, you're taking notes. That's good stress but you know that it's connected to your purpose and you know that it's going to end up in this incredible gift. That joy is what perpetually energizes you to push yourself harder and harder and harder and that brain of yours, the cells are constantly making connections so that's a good stress.
Rip Esselstyn: I can feel them connecting right now.
Ayesha Sherzai: Yeah, yeah.
Dean Sherzai: In fact, there is no other way to connect the brain cells. It's not little Sudoku or these little games. It's activities that are driven by your purpose and you're challenging your brain.
Rip Esselstyn: Under unwind, what are some of the things you guys do?
Ayesha Sherzai: I think we have both been in situations where the bad stress completely discombobulated us and we realized it fast and we let go of it. There's a lot of good stress in our life and I think the research that we do, the community reach out, the everything. Even seeing our patients and keeping up with this high-energy, fast-paced life. All of this is connected to a goal, to a purpose. It sounds bombastic but we actually have a family meeting and we have vision and a mission statement and our mission statement is to reduce suffering in this world. When you have that as your mission in life cut down the goals into small doable projects on a daily basis and see how much you can take. That's why we have so many whiteboards because we put all the projects, put all the things that we need to do on a regular basis and we check them off. The joy that we get for checking those off, that's like a dopamine release in your brain. Check, check, check, yes, yes, yes, do this, do that.
Ayesha Sherzai: Then having the kids do the same thing, whether it's promoting health in children, talking about whole food plant-based diet in their book, or being concerned about the environment and seeing how what we do on a regular basis connect with everything else that is important in life that's our cognitive activity and good stress.
Dean Sherzai: There are several steps. One of them is identify the good and bad stress in your life as driven by your purpose, but in small, really measurable increments and follow that. Make sure you can check them off. That's where the success component comes in. My steps are going to be different from another person's steps but if you teach people to identify their steps you just created a path to success.
Rip Esselstyn: Creating a healthy body and brain, it's a process. It takes time, it takes dedication. It's not a sprint. It's a marathon. Right now, Joe, he's putting in the time, he's putting in the effort, he's looking at this like it's a marathon, and he's starting to see results.
Rip Esselstyn: How you been doing since I last saw you in New York?
Joe Inga: I've been great. I'm about six weeks in, I'm down about 22 pounds. I feel great. Things have been great.
Rip Esselstyn: Obviously Joe still has a ways to go but he is getting there and he has got my support every step of the way on this marathon of his and make no mistake about it, so do you. Together we can all be plant strong and learn to NEURO our brains for optimal brain health. I love the shirts. I love their research. I love NEURO, so we will definitely be covering most more of the Sherzais in future episodes.
Rip Esselstyn: I am Rip Esselstyn and I want to thank you for listening. My hope is that this podcast has inspired you to take control of your health through a plant strong lifestyle. I also want to thank my co creator of the podcast, Scott Battishill with 10-Percent Media, Laurie Kortowich, my producer extraordinaire and Engine2 director of events. Tina Nole and Larj Media for podcast production and creative direction, and Brandon Curtis for never minding living in the barrel and everything in between. Thanks for Whole Foods Market for giving me a platform for the last decade. Special thanks to Joe Inga for your courage to take control and change your life and for allowing us to share your story along the way. Lastly I want to thank my father and mother, Dr. Caldwell B. Esselstyn Jr. and Anne Crile Esselstyn and all the plant strong pioneers who have been pushing this boulder uphill for more than three decades. As they say, we are standing on the shoulder of giants.
Rip Esselstyn: If you're digging the podcast I want you to rate us, I want you to review the show, and I want you to spread this message with friends and family. We want to get this message out to as many people as possible. Join us on all of our social channels, either on Engine2 or Rip Esselstyn, whether it's Instagram, Facebook, or Twitter. Until next time, peace, Engine2, and keep it plant strong.