Reversing sleep deprivation

We’ve all occasionally (or regularly) suffered from sleep deprivation.

A late night out with friends, a Netflix binge, the consequences of jet lag or stress related tossing and turning in bed.

Whatever the reason…the occasional lack of sleep is compensated for by your body and the cure is returning to good sleep the next night…simple.

However paying back the sleep debt you owe after a period of chronic sleep deprivation is another matter entirely and has far more pernicious effects on your body.

Research suggests the only way to recover from the effects of chronic sleep deprivation is to (obviously) get the amount of sleep you need for an extended period of time. Reversing short term sleep deprivation can take days or even up to a week. Chronic deprivation may take months…

In the world of sleep medicine, researchers like to call this process “repaying your sleep debt”. Whilst some argue the negative implications of the initial debt that has accrued can never be fully repayed..it certainly can be brought down to manageable amounts where long term health isn’t significantly impacted.

For example, if you need 8 hours sleep per night and only get 5 hours sleep on one certain night….doing the math suggests you’ll need 6 days of 8.5 hours sleep to “repay” the lost 3 hours.

With chronic sleep deprivation, you’re fighting an insurmountable wave and can’t possibly look to “make up” this persistent debt you’re racking up. And don’t even think about making up for lost sleep during the week by sleeping in on weekends…this is another whole can of worms which results in a dysregulated sleep/wake cycle.

Occasionally not getting enough sleep is investable and part of our modern life so the best way to mitigate the deleterious effects of poor sleep is to practice these very basic sleep habits 80% of the time:

1) Avoiding exercise too close to bed

2) Keeping somewhat regular bedtimes and wake times

3) Avoiding strong sources of artificial light whilst in bed

4) Getting plenty of natural light in the first hour of waking

Failing to deliver

From a young age it was drilled into me in secondary school then university and later as a doctor that I should be busy and take on work, be proactive and look to “overachieve”.

This stood me good stead in my early years where my responsibilities were few in number…so juggling sporting, music and academic success as well as going out with friends seemed doable! I was a strong swimmer, good at cricket, played the violin for the school orchestra and topped most of my classes…

This appetite to do more and say yes to everything continued into doctor life.. again with somewhat of a decent ROI until I hit my 5^th year as a doctor….

That particular year I was balancing pre-existing research work (and medical research is notoriously laborious with many weeks – months spent on redrafting manuscripts etc), stuff going on at home, getting used to a new hospital and a new job role as a higher surgical trainee and learning how to do increasingly complex surgical procedures and various other life stressors (night shifts etc.)

A senior surgeon in the hospital asked if I would take on some additional research work for him….being the perennial “say yes to everything” guy I was trained to be…I accepted this burden on top of my increasingly wobbly mountain of work.

4 weeks later and with minimal progress made on this new work…I was struggling to fit the work into my schedule so I made the decision to cut it and told this surgeon I could no longer work on it and he should look for someone else.

I made excessive apologies for this and even offered to help find a replacement for me…

He flew off the handle. Tore me to shreds. He made the rest of my 9 months of my year in that hospital a nightmare at every chance he could.

It was a hard lesson but finally I learned the value of saying no. Don’t lose your sanity to fuel someone else’s desires.

AI cancer errors….

ChatGPT has taken the world by storm and there are increasing uses for AI in medicine with some sharing the notion it’ll soon replace doctors….

That may be true in specific cases or at least replace automation tools currently in place but one key area where AI is unlikely to be the sole driver any time soon might be in formulation cancer treatment plans…

Researchers at Brigham and Women’s hospital, in a new study, found that cancer treatment plans generated by ChatGPT were full of errors.

The new study, published in the journal JAMA Oncology revealed how when asked to generate treatment plans for a variety of cancer cases, one-third of the large language model's responses contained incorrect information.

The study also noted that the chatbot had a tendency to mix correct and incorrect information together, in a way that made it difficult to identify what was accurate.

This is the concern with AI language models – they are built to present information in a confident manner even if that information is fabricated or a hallucination!

I do believe the future of healthcare will be dominated by AI enhanced software and applications; we already have evidence of that in breast cancer screening for example but these accuracy issues suggest generative models are some way from replacing doctors in the near future.

Hookworm therapy to prevent Type 2 Diabetes?!

Perhaps the idea of being infested with hookworms sounds more like torture than an experimental medical treatment but hear me out….

A two-year human trial conducted by James Cook University (JCU) hookworms were shown to prevent the development of type 2 diabetes in high risk participants

All trial participants had risk factors for developing cardiovascular disease and type 2 diabetes and the trial showed that hook-worm treated recipients received considerable metabolic benefits from infestation with 20 larvae…

This doesn’t mean you should go and hunt out parasitic worms to chow down on….not all hookworms are created equal. These were low dose, lab farmed human hookworms. In fact, this study follows on from researchers using hookworms to successfully treat chronic conditions such as Inflammatory Bowel Disease and Coeliac disease

In this double-blinded trial, 40 participants aged 27 to 50, with early signs of metabolic diseases, took part. They received either 20 or 40 microscopic larvae of the human hookworm species Necator Americanus…another group took a placebo.

“Metabolic diseases are characterized by inflammatory immune responses and an altered gut microbiome,” said Dr Pierce. “Previous studies with animal models have indicated that hookworms induce an anti-inflammatory response in their host to safeguard their own survival.”

As an intestinal parasite, the best survival skill is to keep the host healthy, which will provide a long-term stable home with nutrients ‘on tap.’ In return, these hookworms earn their keep and a stable host environment by suppressing inflammation (which is the hallmark of many metabolic disease and disruption of the gut microbiome).

While the small, round worms can live for a decade, they don’t multiply unless outside the body, and good hygiene means transmission risk is very low.

As for the results, those with 20 hookworms saw a Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) level drop from 3.0 units to 1.8 units within the first year, which restored their insulin resistance to a healthy range. The cohort with 40 hookworms still experienced a drop, from 2.4 to 2.0. Those who received the placebo saw their HOMA-IR levels increase from 2.2 to 2.9 during the same time frame.

These lowered insulin resistance values are demonstrative of clinically and statistically significant improvements.

Interestingly, those with the worms also self-reported better moods and overall felt healthier than those in the placebo group.

A wider international trial is incoming…watch this space to hear more about a hookworm coming to a gut near you!

Smiling for the camera around the world:

Everyone knows the English (and other countries where this is the dominant language) say “cheese” as a trigger for smiling before a photo but going down the rabbit hole of different countries’ alternatives for cheese threw up some interesting ones.

A lot of countries just use their own native word for cheese, for example the Greek say “tyri”, Russian “Syr”, Polish “ser”..theres also the Hindi “paneer” which refers to a specific kind of cheese.

A lot of languages use different food items, the Swedes say “omelett”, the Bulgarians say “Zele” (cabbage), the Danes “appelsin” (orange) and the Germans just say whatever they wan! (Spaghetti, Wurst)…continuing on the photographic gastronomical delights; the Tunisians says “couscous”, Iranians “apple”, Koreans “kimchi” and the Chinese say “eggplant”. The Spanish say “patata” (potato) and the French have a fun one and say “oustiti” (marmoset). The Hungarians use a word that means little bird but is pronounced like the English “cheese” – “csiz”.

Life updates

It’s a 3 day weekend in the UK (bank holiday Monday) but it’s been a quiet albeit sleepless one for me.

My dog has just had eye surgery, so he’s stuck in one of those dog cones.. so he can’t scratch his post surgery wounds around his eyes. I’ve slept on the kitchen floor with him the last 2 nights because his bowels are slightly loose after his general anaesthesia and all the medication he’s on.

Last night I was woken up at 12am, 2am, 4am, 6am and 6:30am because he wanted to go into the garden for a night time number 2. He’s feeling pretty sorry for himself so his bark has been missing these last 2 days but here’s to hoping the monster makes a full recovery in the next few days!

My book “This Book May Save Your Life” finally has a cover so I’m excited to share that with you in due course! (if this is the first time you’re hearing about the fact I have written a book, you can pre-order your copy here:

I have finally pulled up my socks and am getting back into making longer videos and deep dives into health topics on my YouTube channel. I really enjoy making short videos but nothing beats the nuance and detail you can provide in science on a longer form video. I recently covered Ozempic in my latest video…so if that interesting you.. go check it out!

I’ve had some incredibly interesting guests on my podcast recently – I can’t wait to share the conversation I had in particular with Tasha Ghouri (model, podcast and ex-Love Island star BUT also a massive advocate for the deaf community)…we talk about all things hearing loss so keep eyes and ears out for that!