OneMedicine Podcast

Rob Lutz 00:02
Hello and welcome to the OneMedicine Podcast with Today's Practitioner. In each episode, we share the expertise of a respected thought leader, some you'll know and others you'll probably meet for the first time. We cover topics important to you, always with a focus on improving the health outcomes of the patients you treat, while expanding your understanding of the many healing modalities being used today.

Rob Lutz 00:21
Hi, I'm Rob Lutz. I'm the host of the OneMedicine Podcast, and with me today is Dr Chris Meletis. We've had him on the show a couple times, and Chris is just great. Love having you on the show, Chris. We've got a lot of great content that you've provided to us over the course of the last year or so, particularly around the endocannabinoid system, and recently posted a webinar that you did on pain and sleep, which is really what we want to talk about here today. For those of you who don't know Chris, I'll give you a quick bio but it's going to be in the show notes. And like I said, he's got a lot of content, a lot of great stuff for you to dig deeper into if you'd like to, on the website Today's Practitioner, I'll include links to that as well. So Chris Meletis is a naturopath, licensed naturopath. He's an educator, international author and lecturer. His personal mission is changing America's health, one person at a time. Chris has authored 18 books and over 200 national scientific articles and journals, including Natural Health, Alternative Complementary Therapies, Townsend Letter for Doctors and Patients, Life Extension, Natural Pharmacy and DNR and several journal articles on pubmed.gov. Dr. Meletis served as Dean of Naturopathic Medicine and Chief Medical Officer for seven years for the National College of Naturopathic Medicine, now the National University of Natural Medicine. He was awarded the 2003 Physician of the Year by the American Association of Naturopathic Physicians. He has a deep passion for helping the underprivileged, and spearheaded the creation of 16 free natural medicine healthcare clinics in the Portland metropolitan area of Oregon. So Chris, welcome to the show, and really appreciate you coming back on to talk about sleep, which obviously is a critical piece of everybody's health, and sometimes overlooked, how I think that can impact lots of other areas of people's health. So we're going to talk about the importance of sleep, some of the challenges and obstacles, I think, to that. Hopefully you'll provide some easy ideas for practitioners to guide their patients and so forth, but I'll turn it over to you to just kind of tee us up what you want to talk about today in that area, and I'll ask questions as we go along. So again, thanks so much, Chris.

Dr. Chris Meletis 02:30
Thank you, Rob, and thank you everybody for listening. So sleep: it can be elusive, and as we get older and/or life happens and stress happens, we have sleep issues. And of course, when we talk to our patients, we have to translate all of our science into English. That's the key to really getting our patients to understand and own our recommendations. And so one of the things I always share with my patients is something you probably do as well, and it's called--looking at the word--restoration. And we want to restore our body; we have to have rest. The first four letters of restore, or restoration, is REST. And if we're not sleeping, we're going to end up with, of course, waxing and waning of multiple pathways, or circadian rhythm, or cortisol pathways, or andoinadal hormone pathways, and sense of pain, sense of aches, and just depression and anxiety and everything else. And so, getting a good night's sleep is so paramount. We all know this individually, let alone as practitioners. So of course, we like to rule out sleep apnea, and I think we've all seen patients in our practice like, wow, that person that came in with a diagnosis of sleep apnea, but they're thin and skinny, and they don't have any of the criteria, but they might be hypoventilating. And then there's the other individuals, which have very severe apnea. They're also thin. Lots of them, of course, are heavier, because it does have something to do with the circumference of your neck. So ruling out sleep apnea. And we always were taught in school, all of us, no matter what our provider final degree was, that we have to stay hydrated. We have to eat well, but the prime directive is oxygenation. So making sure our patients got great oxygen, and thanks now to technologies and the aura ring and our smart watches, we kind of see where we're at with the oxygen levels. So that's foundational. But then the question is, what interrupts our sleep? Pain, a lot of times. It's my neck, it's my shoulder, it's whatever, so we want to address that. But I gave a lecture about a decade ago at the Integrated Health Symposia in New York, and I flew in at 11pm Eastern Standard Time. I'm an Oregonian, so I'm PST or PDT all the way along. So I said, Great, I'm at 11:00. I'm now in New York. I find my room, crash, and my talk is at 7am. I'm an extemporaneous speaker; I have my slides. I'll tell you what the slides mean. But what's interesting is, I'm standing up here waiting for the audience to come in, 300 or 400 medical doctors and other healthcare providers. And as I started, we were talking lots of things about genetics and epigenetics, and I said: How many cells in my body must be tired before I perceive tired? I said: You're welcome to answer. I know you're usually in listening mode, but as we get going here, if anybody knows the answer, how many cells in human body must be tired? We have some 37.2 trillion cells. Not sure who counted those, but it's like, how many cells have to be tired, and are they brain cells? Are they adrenal cells? So how many cells do you have to have that are tired in your adrenal glands before you have adrenal burnout? Or how many cells do you have to have before you perceive at the cerebral level: Oh, I'm tired. And no answer. I said: You're welcome afterwards to tell me if you know the answer. But I can tell you, I know lots of things, but I don't know the answer. I said: Let me ask you another question. And once again, I had none of this planned, but I'm tired, and my adrenal glands are still asleep over in Oregon, even though I was in New York. I held up my index finger amd I said: How many cells in my finger have to hurt before I perceive hurt? Before I perceive pain? I said: You're welcome to chime in. Once again, I don't know the answer. I'm being humble here. And once again, I said: I know lots of things about genetics and epigenetics. So once again, a decade ago, that was cutting edge. And I said: But before we even address that, you might make a recommendation of acetaminophen or ibuprofen or maybe arnica, or you might suggest putting ice on it. But shouldn't I remove the splinter to address the cause, but when it comes back to that pain, have we all not had the splinter in our finger before? And it's been a big splinter and it hurt a little bit, but then we got a baby splinter, all those micro splinters, they hurt more. I said: And have we not been in the kitchen and we get a little cut to our finger with a knife, but then we get a paper cut, and the paper cut hurts more. So a micro splinter can hurt more than a big splinter, and a paper cut can hurt more than a big cut with a knife. And it's like, how much do we know about the human body? How much don't we know? I mean, it's kind of a little on and off. So when it comes to sleep, clearly, we need sleep. We need oxygenation, and we need both quality and quantity of sleep, and one of the things with sleep is, how's your bed partner? If you have a bed partner, or a cat or a dog that's your bed partner and they snore, that's gonna interrupt your sleep. You know the concept of, I'm just gonna throw a pillow over their head? That's actually not ethical. If anybody's wondering about whether it's okay to do that, smothering is not good. It does work, but it's not good. And so it's like, even your partner's sleep habits impact you. So we're going to talk today about sleep and also pain, and I'll let you lead the way. Of course, we're going to talk about the cannebenoid system, and we're going to talk about things which we could do for sleep quality as well, but also pain. Sleep and pain go hand in hand.

Rob Lutz 07:42
Let's talk about what happens to the patient when they haven't been sleeping well for a while? And then we can talk about what maybe is causing that, and what we can do to help address that. But what happens to their body if, let's say, they're talking about a few weeks where they're really just not getting their eight hours, they're not getting the deep sleep or the REM sleep that really helps restoration? What's happening to their body?

Dr. Chris Meletis 08:02
The first thing, and probably the most primary thing, is we're not clearing out our cerebral spinal fluid. We need to drain the brain. So, like we've heard "drain the swamp;" well, we need to drain the brain. If we're not draining our brain with good, restorative sleep, we get toxic metabolites. The other thing is, when you and I are awake and conscious and alert, it takes norepinephrine and epinephrine, adrenaline and noradrenaline, it takes serotonin and dopamine and acetylcholine, which are a memory neurotransmitter, to be alert and awake. Now, if we're not having enough downtime to replenish the presynaptic junctions, then all of a sudden we're more flat, we're more depressed, we're more anxious, we're more forgetful, we're looking to find words. And I don't propose sleep deprivation as a torture, but if I was to run a location to torture individuals, I would not need to waterboard anybody. I would just literally keep them up, and I'll get whatever I want from them, because it's literally torment. And so of all my patients over the last 33 years, sleep deprivation, you get that taken care of, you address that and once again, addressing the cause. Is it anxiety? Is it that they can't shut down their mind, or is it that their body hurts? Recently, I've been having a rotator cuff issue that prevents me to sleep on my right side, and even when I sleep on my left side, it actually--and of course, sleeping on the left side and the right side is better for training the brain than on your back, by the way--then it's like, so now I'm having disruptive sleep. I'm consciously aware of flip-flopping multiple times a night because of discomfort and pain. So what's beautiful about using the endogenous cannabinoid system and natural anti-inflammatories is you're addressing an endogenous process, but also sleep deprivation. We know that shift workers generally die quicker than people that don't work at night, and so that is that disruption of that circadian rhythm. So we all are aware of the amber glasses, so if we're looking at a blue screen at night, we need to--whether it be the television, our phone or whatever--and there's, of course, a dark mode or evening mode on many of the smart devices. But we know we need to prevent that white light or blue spectrum light from going into our eyes. Because our ancestors, if they wanted to do something at night, they got a little fire that had an amber or red hue to it, none of this white, bright stuff. And so when we start throwing off our circadian rhythm, not only do our melatonin levels drop, then, of course, melatonin--we say, oh, that's the thing that helps us sleep--all of your audience and the people I generally talk to know melatonin is so much more than just sleep. It helps with cytokines. In fact, during the COVID era--I think we're done with the COVID era, but I'm not sure--but I'll just put during the COVID era, we learned in the peer review literature--which you can just go to PubMed--melatonin acts as a natural cytokine dampener. Controls those inflammatory pathways. We know it's an antioxidant. We know it helps with immunological function. So we're not sleeping, we're going to be more likely to get ill. We're more likely to not be the most personable individual that we could be, let alone the most competent. And the research shows for those with overt sleep apnea--and we don't have to have overt sleep apnea to be sleep deprived--they're worse, equal or worse than a drunk driver driving. Hmm, decrease of fine motor skills, gross motor skills and executive function with lack of sleep. So, if you haven't been sleeping well, don't make any major decisions. Don't get into a major argument and think you're going to win with your partner. Just say: Okay, I'm going to wait until I can get some sleep under my belt.

Rob Lutz 11:39
I'm going to sleep on this one.

Dr. Chris Meletis 11:41
Literally and figuratively, and I give my patients little hacks. I think we all do as providers. Okay, go with a little piece of paper, put it on your nightstand, have a pen ready, and don't turn on the light, but just write down a word or two so you're not saying all night long: I can't forget that; it's really important for tomorrow. Just jot it down real quick and then, but with the light off, just chicken scrawl, or in our case often, doctor scrawl. And it's like: Okay, that'll be my reminder, the word "the" or "food" or whatever. We just need to shut down our brains and we're out of touch with our ancestral knowledge and our ancestral wisdom where we decompressed. I think you're an avid biker, if I remember?

Rob Lutz 12:22
Yeah, that's right.

Rob Lutz 12:23
How so?

Dr. Chris Meletis 12:23
And bicycling is great; exercise, physical exhaustion. You also connect with nature, unless you're doing it on a Peloton or something in your room. But even then, you can screen nature. But being out in nature and grounding ourselves is important. But once again, inflammation, the endogenous cannabinoid system, all very, very important. And even with pain, which we're going to talk about, pain and sleep, I find that pain is a big pain in the you-know-what when it comes to that sleeping. And so I like to look at what we know and what we don't know about pain. So I would love to talk about how what we used to think about ibuprofen and acetaminophen.--so think Advil and think Tylenol--is that, well, they work on a non-steroidal anti-inflammatory pathway. Yes, on the ibuprofen; the acetaminophen has always been a little bit more nebulous as to how it works, but now we know both of them work via the endocannabinoid system. And so the question is, how does ibuprofen and the endogenous cannabinoid system work? So if you're not in pain and you're blissful and you're asleep, this is good, so let's control the pain. Well, we now know that ibuprofen actually causes fatty acid amide hydrolase, the substance that normally breaks down anandamide, which of course, we know that word anandamide is Sanskrit for bliss, I think for blissful sleep, or counting sheep. And so what we want to do is like, hmm...it actually helps block--this is ibuprofen--helps block the FAAH, which breaks down anandamide. So now all of a sudden I'm augmenting my bliss endocannabinoid or cannabinoid system, and it's like, wow, and I'm more blissful, and I'm not in as much pain. Likewise, on acetaminophen, another mechanism there is it actually works to augment the CB1 receptor. So we know CB1, used to be only central nervous system, and CB2 only periphery within the body. And now we know also about TRPV1, GPR55, onwards and onwards, and 5HA1 and multiple other pathways in which the endocannabinoid system works. But when I'm at conferences, I'm talking about CBD, and I say: Well, of course you know about the endocannabinoid system. No, most of us were not trained in it in school. And if we were, we're more recent practitioners graduates, and they're like: Well, how does that tie into everything? Well, if you're not sleeping, well, your circadian rhythm, we just talked about melatonin. That's going to be askew. But so is your cortisol levels going to be askew, because, of course, that's our waking hormone. So our melatonin is dropping as we go around 3 to 4 in the morning, then up comes a cortisol around 5 to 7 in the morning, and it's waking us up. It helps the hunter-gatherer in us wake up, ancestrally, because there wasn't refrigeration and you were able to get enough energy from the cortisol spike in the morning to mobilize sugar to wake up and either start a fire or hunt and gather. But now we know with the endocannabinoid system that we have something called endocannabinoid deficiency. Dr. Russo did work on this saying: Hey, as we're dealing with our adrenal burnt out patients, and once again if you're adrenal-fatigued and/or adrenal spiking at night, they can't get to sleep because you're kind of wasted, and then you get a little bit of a second wind, the proverbial night owl, well then all of a sudden, we're actually working on a deficit, but I think we're working on the adrenals, but we also must address clinically the endogenous endocannabinoid system. And the fact that if our adrenals are worn out and waxing away, probably a parallel is the endocannabinoid system is also problematic. And when we're stressed, we think adrenals. OK, our adrenals are going to go up. Sadly enough, we think adrenal cortex, only adrenal cortex. Of course, clinically, we were all trained. Well, what about the adrenal medulla? Well, the adrenal medulla is where we make adrenaline and noradrenaline. So we have our adrenal cortex. We got our glucocorticol steroids, cortisol, cortisone, and when we start getting worn out, not only as we just talked about ibuprofen and acetaminophen and how they act by modulating the natural systems of the endocannabinoid system, well, we now know that with the sleep deprivation, the cortisol and endocannabinoid system are also at play, and they did a study of cosmonauts. And they looked at cosmonauts and they said: Okay, we're going to throw you up in space at whatever Gs and with no gravity, definitely an out-of-this-world experience, literally and figuratively. And you're gonna say: Well, they're just like our astronauts. They're military people, so they're pretty gestalt, they've got their stuff together. They've got a strong mindset, because you can't really have or want an anxiety panic attack while you're free-floating up in space. But what is interesting, the anandamide levels of the cosmonauts spiked. That's how they dealt with the stress.

Dr. Chris Meletis 15:51
Because they could feel all gestalt and matter-of-fact: OK, well, it's all robotic. If this happens, they're working their algorithms, and they're just zenned out, and they're very mindful of that process. But their endogenous cannabinoids... So when I work on using CBD, I'm looking at, I'm helping inflammation, I'm helping pain, I'm helping natural processes that we still to this day are not smart enough to know. Of course, we know Mechoulam out of Israel did some additional work from the original studies that were isolation of the CBD and the cannabinoids. I believe it was a Mexican physician from Mexico, and then it was furthered by Mechoulam and his group. But it's like we still don't know anything. I mean, we're babies on this pathway, and so just supporting and nurturing it. And research has shown that 42.5% of respondents actually reported sleeping better using CBD, and this is self-prescribers. And then we as clinicians know we have patients come in all the time and they say: Well, I tried magnesium and it didn't work. Or: I took zinc and zinc did xyz to me. What zinc?

Rob Lutz 18:46
What form?

Dr. Chris Meletis 18:47
What quality? And when it comes to the wild wild west of CBD, finding a high-quality, high-absorption product is really important, and ideally with some beta caryophyllene in it or some other substance. Of course, we know beta caryophyllene is also found in lavender. Well, if you go to the store and by some Epsom salts, you might have lavender in it because of the aromatic effect, but it also has beta caryophyllene in it. And so it's like that synergistic effect of whole plant or broader plant, but also that delivery mechanism. And that's why I like to use a CBD with vesisorb, which delivers 4.4 times more efficacy than just a plain old product that's out on the marketplace.

Rob Lutz 19:29
Something that I was thinking about as you' were talking is this connection between pain and sleep. I understand that if you're sleep deprived, you're probably going to feel more pain. You're going to feel your aches and pains a little bit more, and that's going to make it harder to sleep, or your cortisol levels are going up. It's going to make it harder to sleep. And it's seems like it's a feedback loop that supports whatever dysfunction there might be, if that makes sense.

Dr. Chris Meletis 19:55
It's an amplifier. Yeah, like a stereo amplifier back in the day. You crank up your amp, you get more output.

Rob Lutz 20:01
And if you can't kind of break that cycle, whether it's taking CBD or again, some of these other hacks that you might recommend to a patient, and if you can introduce that and kind of break that cycle, you can get the feedback loop working in your favor. So if you can get them to sleep better, the cortisol levels will probably start to come to start to come down. Their sense of pain and discomfort will probably come down. It'll help them sleep better. So I think that's what I've experienced myself personally. If I focus on my sleep, not just...and yes, I take CBD and a few other things. I take some melatonin. I have tried some CBN, which seems to work pretty well, though for some reason that makes me feel a little groggy. It has a little bit of THC in it, so maybe that's what's causing that. But I feel if I focus on my sleep, it starts to improve. And when I sleep, well, everything improves. Just my day feels so much better.

Dr. Chris Meletis 20:57
And even your metabolism. I mean, everything works better, and that whole draining of the brain is very real. And for those of us that are in the senolytics and healthy aging, anti-aging or whatever--there's no such thing as anti-aging, let's call it healthy aging. As far as I know, if there's such a thing as anti-aging, it's still a secret. But the concept of zombie cells, okay, well, maybe if we're not sleeping, it's not just zombie cells in our brain, but there's zombie cells throughout the entire body, because we're not flushing the proverbial commode of the body to flush it all out. And then we know as adrenals go, so does the thyroid. You can't treat the thyroid without the adrenals if you're being holistic, because if all of a sudden I give somebody thyroid, and let's say you and I are sleep deprived and weren't savvy on how to augment our sleep, so now I'm tired. My adrenals are waxing and waning and they're toast, and now I'm going to support my thyroid. Let's say we were both hypothyroid. And so now all of a sudden, I'm speeding up the body. Now all of a sudden, the metronome that was tick-tock, tick-tock like a sloth. Now we're more normalized, and all of a sudden, we're asking the adrenal glands to see life at the speed limit, because we were under the speed limit before, and now the question is, do our adrenal glands have that capacity to deal with it? So once again, CBD ties into the endocannabinoid system, and it ties into the adrenal glands. And one of my big issues I see with patients is when they get adrenal fatigue or adrenal burnout, we do a four-time salivary cortisol or urine or, if you're very, very conventional, you do an AM cortisol. I don't like the AM cortisol blood draws, because unless you're in the hospital, you have to get out of bed, drive there, and you kind of get yourself going. So I like to have more of a home kind of test where you can roll out of bed, collect your body fluid and measure it. But if you're low in cortisol, the average healthy person makes 20 milligrams of hydrocortisone a day. Well, if you and I get a rash, we put hydrocortisone cream on, possibly, especially if it was really bad rash. Okay, I'm not proposing that's the solution. There's lots of other solutions, right? But it's a solution you can buy over the counter, surprise. Or if you have a tremendous inflammatory response, you'll be given methylprenezolone or prednisone. And so the question is, you're augmenting what your daily allotment is, but your adrenal fatigued, adrenal burnout. And so making your 20 milligrams, let's say you're making 12 or 14 milligrams. Will you have breakthrough pain? Clearly, because, of course, you need 20 milligrams to help quench the daily fire. That's why our bodies ubiquitously make that as most human beings do that are healthy, whatever healthy is. Once again, most of us probably don't make that much. Now, excess amounts are problematic, because it's going to alter our sleep. Insufficient amounts: more body pain, more body ache. And once again, I treat adrenals with, of course, our natural adaptogens and other supportive things and good quality sleep. But I also treat it with CBD to help that pathway. But when treating the adrenals or treating the thyroid, we have to do both, in my opinion, simultaneously.

Dr. Chris Meletis 21:17
Talk about that just a little bit. My niece, she's a college student, very stressful world of academics, wants to do very well, and so she has some anxiety. She is sleeping very poorly right now. And so, I'm just trying to think, what advice could I give her? She's a vegan. She eats pretty well, I think, but she's having a really hard time sleeping. Of course, then she's tired during the day, and she has a fair amount of anxiety, which I think is fairly common these days, especially at that age.

Dr. Chris Meletis 24:32
Well, I definitely would not want to be a young person. I mean, it was hard enough to be a young person when we were young people, and you're still young but I mean, for me, it's like, I remember the '80s in high school, early '80s in high school, and I thought it was stressful. I can't even imagine high school and college these days with all the geopolitical stuff and all the worries. I grew up before there were cellular phones, and I still remember snow on my television, which was, of course, when you had static, and then you would move the little rabbit ears (so it's vegan friendly) and you try to get one of your five television things. We have too much connectivity.

Dr. Chris Meletis 25:10
And I like to always think back to, we give so much accolade to Hippocrates, but also lots of wise women that haven't been given all the credit they need to that have fostered humanity over the years. But it's like: Here's Hippocrates in 400 BCE, and he's walking along and he's just: Okay, I'm zenning out with nature. There's not a whole lot of populace out there in Greece, right? And even though it was a very populous place, it wasn't like now in New York City or LA or even Portland, Oregon, where I live, and it's like, okay, he comes home and his wife says: You don't look like you feel very well. I don't. Well, eat this, it'll make you feel better. So his wife gives him some food, not from a stereotypical perspective, but as a partner. Hey, here's some food, it'll make you feel better. And all of a sudden, I feel better. I should write this down. "Food is your medicine." Who knows how it came but... I give the example, if you and I were walking along on our cell phone, and the other day I was driving, got off the freeway--very, very busy--and into a busy intersection, a gentleman is walking across four lanes of traffic. He had the right-of-way, he had the walk sign, but he's looking at his phone the entire time. You stumble, you can fall and/or you're trusting your fellow human being that may or may not be sleep-deprived to actually stop and not run you over. But if all of a sudden there was a beautiful rainbow, a beautiful butterfly or a burning bush, then all of a sudden, it's like we wouldn't even be able to connect with it, because we were glued to our dopamine fix of our short on Tiktok or Instagram or whatever self-important thing that we have.

Rob Lutz 25:10
Too much.

Rob Lutz 25:27
She's on her device quite a bit. But I live close to the campus. It's UNH--University of New Hampshire--and I drove through there the other day. I've noticed over the last five years--my son is there as well, and he's graduating, finishing up his master's--I couldn't get over how many people, even if they were in a group, how many of them were just looking at their phone, and if it was somebody by themselves, they were definitely just staring at their phone and missing out on the little things, really, because what are they getting from that phone? And so I guess those people are probably in front of their phone, their device, all day long at night, that's raising their cortisol levels. It's stressful or whatever, and they're probably not going to sleep well and won't perform well in school and those types of things.

Dr. Chris Meletis 27:33
And negative feedback, it's much like the song back in my day, and it goes: Blah, blah, blah...tells you about the plane crash with a gleam in her eye. And it's like: Now all we're fed is negative news. Tell me, on which channel do you hear "fireman saves ducklings from storm drain"? "Mother deer reunited with her fawn." There's no channel. I'd watch it just because I want to hear good things, or "this human being helps elderly person load up their car" or whatever. The other day, we were at a little bakery called Grand Central Bakery, here a local. And a homeless gentleman came behind us, and he actually asked the lady while I was ordering: Hey, do you happen to have anything? So of course, this is not about me, but of course I said: Order whatever you want; I got you. Because lest it be us one day, right? But where's the humanity? And I have a saying: #HumaneHumansForHumanity. But if you sit at a restaurant, you and your partner, and you look and say: Hmm, okay, well, I'm looking into your eyes--now, I'm not saying I'm looking into your eyes, but I am actually right now, because we do have a video going along with the podcast--but are you looking into your partner's eyes, or are you looking into your phone while there's a human being in front of you? So many restaurants, you see everybody's on their freaking phone, but be present with the human being present and validate them and have that conversation. Because we're losing our interpersonal skills and our ability to chat. But for your niece, obviously, being vegan, where's her B vitamins? Of course, the low-lying fruit. And I'm going to assume, because she's your niece, she's a dialed-in vegan, but, yeah, is she getting her B12? Is she getting her B complex? We also know that if she happens to be on an oral contraceptive and not Merina, or maybe she's not on any of those, but then all of a sudden, well, that lowers folate levels. Well, that's part of neurochemistry. It also lowers the B vitamins. So one of my questions for all my patients, and I've just learned this over the years, do you remember your dreams two to three times a week? And I preface it with, I'm not going to be Freudian and Jungian; we're not going to analyze that, just yes or no. Do you remember your dreams two or three times a week? If the answer is no, B vitamins. A good, solid B complex, bioactive form, and then all of a sudden they dream. And I will share a story: A patient of mine, Jennifer and her husband David. Jennifer could not remember...she was an executive, very accomplished lady. She was also earning the bacon and baking the bacon, and very involved in her community, and so forth and so on. And she said: I'm not dreaming. I said: Well, that's a reflection of, of course, we know alpha and beta and delta sleep, and so forth. I said: Here's a free bottle--long-standing patient of mine, love her family--and I said: Here's a free bottle of active B vitamins, the benfotiamine, the riboflavin phosphate, the, of course, proper form of folate, the methylene tetrahydrofolate onwards. And I said: I'm going to do something I rarely recommend for anyone, but I want you to take one of these right before you go to bed. And we know B vitamins can be kind of energizing. She actually came back three or four weeks later for some follow-up on blood work and hormonal imbalance and A1C and all that. And I said: Hey, did you dream? She said: Yeah, and it was weird. David was in a Mexican prison, and what's weirder is David also dreamt that he was in a Mexican prison. They had not been to Mexico, and he did not take the B vitamins. It was like some sweat lodge experience. But It's like, wow, she actually was able to defrag. I'm sure, if you haven't dreamt for a while, or I haven't dreamt for a while, we're kind of processing cred and emptying out the filing cabinets, or in today's world, we're cleaning up our desktop and putting things into the proper folder. Sleep is important, just to get rid of all the worries and stress from yesterday and yesteryear, and if you haven't slept for a while, you can't purge and process and somehow put it in a box.

Rob Lutz 31:28
What about sleepwalking? I'm a sleepwalker/talker, especially when there's stressful things going on.

Dr. Chris Meletis 31:36
Other than bondage, how do you help with that? Because, of course, we could tie you down. I've had sleepwalkers. In fact, I've had a sleep baker, and I had a sleep floor scrubber. She would wake up, and she would bake bread while asleep, and she'd scrub her floors, and her kids woke her up while doing that one time, and she was like: Huh, what? And so I don't know if I have an answer for you on sleepwalking, other than, of course, it's a little bit more complex, and what I would be curious about for you is, where's your dopamine levels? Where's your GABA? Where's your glutamate? Where's your serotonin levels? Where's your neuroinhibitory side? Also, where are your histamine levels?

Rob Lutz 32:18
Do some testing, basically.

Dr. Chris Meletis 32:19
What I would say is, I would do a urinary neurotransmitter test just to see what is it uniquely about you, and is there the proverbial smoking gun, is there something out there that's saying: Oh, wow, I'm really wired for sound, because you're breaking through the normal calm sleep and to the point that you're...

Rob Lutz 32:38
I've done it since I was a little kid. Not every night, of course, but I go through phases of a week or so where it's almost every night I sleep walk, sleep talk. I don't really leave the room or anything like that. It's usually I'm saving the family from the draperies or the ceiling fan.

Dr. Chris Meletis 32:53
But maybe what we do is we put down an electric keyboard with a recorder, andmaybe a computer next to you. Maybe you solve the world's problems just right there and we find out you're the next Mozart.

Rob Lutz 33:07
That would be great. I could retire.

Dr. Chris Meletis 33:09
You're not stifled by all the daily worries, so now your neurochemistry is just kind of free-flow.

Rob Lutz 33:16
Getting back to your patients that are challenged with sleep, we've talked a little bit about some of the sleep hygiene things. I think most practitioners probably have that checklist of things to advise their patient. I guess maybe, and so there's supplements you could take. And we talked about melatonin, we talked about CBD, some of the other terpenes that might be involved that could be helpful, different natural supplements to reduce pain and inflammation, like curcumin. But maybe something that could be helpful to a practitioner is, how do we get a patient to make these changes that will help them, right? So, how do we get the kids to turn off their phone or go to bed at the same time every night? Stay hydrated? What do you recommend to help influence the patient to make these types of changes?

Dr. Chris Meletis 34:03
You have kids, as you've shared, and I have kids. I think it's through example a lot. We all learn through example. We're all at some nature followers, consciously or subconsciously. So one of the things my kids, having been a doctor for so many years,my family's been interrupted by my phone. I remember one time in Disneyland, I was getting on the Matterhorn Mountain bobsled ride and the attendant said: You need to put your phone away. I'm in the middle of a call with a patient. So why am I not immersed in... So now I leave my phone in my either back pocket, much like a young person, or I just leave it in the car and hide it in the car, assuming it's not too hot, because then my kids get after a while: You can't leave your electrical devices in a car; it'll get too warm. So I get that little lecture. But I think through example. The phone's not allowed at the table. The phone's not allowed after a certain amount of time. My wife and I have had this conversation; we're watching a little television in the evening, and it's like: Okay, well, am I looking at my phone, or am I there with her, watching the show and chatting about whatever it might be? And so I think part of that's good. The hydration side of things, they say 38% of us underhydrate. We have a low thirst drive, so we'll eat instead of drink. Now the key is not to drink or eat two to three hours before bed. Most of us, and I was one of them, when I was a younger doctor, I went to my ears, eyes, nose, throat guy--expert medical doctor, ear, eyes, nose, throat--and he said: Chris, I think you have GERD. And I said, I don't think I have reflux. I don't have the classical heartburn. I don't have need Mylanta, need whatever. And he said: Chris, who's the doctor? I said: You are, Dr. Lewis. And he said: Okay, now that we got that established. And he also told me I need to do more Tai Chi and eat more salads, way ahead of the curve. It's like, okay, he was correct on both of those accounts as well. Because mindfulness is very important, making time to be mindful, whatever a person's persuasion is, whether it's a structured spiritual belief system, or just mindfully communing with nature, I'm going to wake up in the morning and put my feet, if you're so fortunate, to have grass. I'm going to sit with my feet in the grass and drink my cup of tea or coffee, or whatever it is that you're doing, or lemon water. But I think the other thing is, in his case, he said: I think you have reflux. And of course, he's a medical doctor, so he prescribed protonics for me. And he said: But remember, Chris, of my patients which have irritation of the pharynx, larynx, sinuses, and for me it was tonsils that I was seeing him for. I had my tonsils out at 39 much to my chagrin, but they were a constant problem. It's like, wow, 50% of people have silent reflux. And he said, 25% of my patients have sinusitis, pharyngitis, laryngitis, or GERD, don't know it. So he gave of course the recommendation, don't drink or eat two to three hours before bed. And those, since we're not on video for the audience, here's a water bottle. And so this is an example of a water bottle, and the water bottle has a neck and a mouth to the bottle. That's what we call a neck and mouth to the bottle. Now, since this is a very full bottle, this would be an example of a person that's going to bed with a full tummy. They've eaten within two to three hours, and they lie supine or prone. And of course, the fluid goes up past the lower esophageal sphincter, up into your neck and throat, because you toss and you turn and so forth. So you want to go to bed with very little in your tummy. And that's, I think, a no-brainer. But how do we change people's mindsets of being stressed and worn out? Just share what we're doing and like we all do as providers, these pearls, but also knowing that if you don't go to bed by 10am or, sorry, 10pm, this is when you get your largest amount of growth hormone surge, which is also healthy aging and part of another circadian rhythm between growth hormone and IGF1 and the feedback between the two. So not "Early to bed, early to rise" to the extreme of a farmer or a previous ancestral person that didn't have the blue spectrum lights, but now we need to listen to the body. It has sustained humanity over a period of time. And no matter what a person's belief system is, you can't argue with what has worked for humanity over time. You go to bed, you wake up, you eat, you exercise, and before, once again, all this technology...the way I went to high school, I didn't drive. I was poor. I bicycled three miles there, three miles back, all the way back, there were hills and there was snow, and so, you know that story? I hit snow, rain, sleet. That was me, driving, exercising, all of that. Now, what do we do? We have all the comforts of the modern world, and I think that's one of our biggest issues, that we need to connect with over half the population, which don't have the westernized conveniences, and live like they are in terms of losing some of our technology. The world's not going to end while we're watching...if we don't have our phone with us, and there are ways to set your phone to--if it's really important a family member could break through--silent mode.

Rob Lutz 39:04
Yeah. I think it's hard to kind of suppress. If there's a lot of good food in front of you, not to eat it all. If there's a lot of sugary foods, I think that we're probably evolved to want to eat as much as possible when it's in front of us. Or we've got this stimulating phone with all this great what we think is fun stuff, and so it's hard to put that down, not realizing: Hey, this is going to have an impact over time. And so that can be, I think, challenging.

Dr. Chris Meletis 39:32
And once again, I'm not an anti-vaxxer, and I'm definitely not an anti-technology person, but during the whole COVID era, 5G rolled out, and so you have your 5G signal on. The moment we come home, we turn off our cellular and we just work on our wireless network, right? Because it's like, why would I want a 5G device in my hand? Because we've had sick kitty cats. One had FIP, feline infectious peritonitis, which is fatal. But there's actually a drug analog from Gilead Labs. Gilead Labs is the drug company that made remdesivir that was given in the hospitals. But there's an analog that's been unknown for 10 years in the veterinary medicine world. It's GS something or another. And if you give your cat, which has about 106+ degree temperature, cats are supposed to be a high of 102.5, so we had a sick cat, so we said: Well, we're not going to add a 5G to their burden. So we just went to wireless in our home. Whenever we're home, we turn off our cellular and of course, we're not, of course, inducing our cells, and we're electrical chemicals ourselves, and so are the kitty cats. So why would we introduce our frequency, or whatever to the cats. So I think looking back and say, We know about Roundup, we know about other toxins and pollutants. We try to avoid those, and most of us, as we can afford, go organic. We do all this. So this is just, once again, an unknown variable that is probably not helpful. And the moment we have this conversation with people that we love, that TikTok, Instagram all use algorithms that mess around with our dopamine levels. They give you a feed, a feed, a feed, and it's something you really wanted, that proverbial dark chocolate, whatever, and it's like: No, we're being manipulated. We're being manipulated. We have the too much technology, and also kinking our neck down and forward and looking at our phone. I remember talking to a VP of Nike, because Nike Headquarters was here, and she had chronic neck pain. And when she first came into my practice, she was on Vicodin, which eventually became Norco because they lowered the amount of acetaminophen and the same amount of the hydrocodone. And she said: I need more; my neck hurts. I said: I want you--because she was very proud of herself, she's was my age, and she walked around the Nike campus. She said: I get three or four texts or emails done walking across the campus. Looking down with your neck that hurts, right? And she flew to Paris and New York and China and so forth and so on. And I said: I want you to sit in the airplane with your bag on your lap and a pillow, and I don't want your iPad to be any lower than your eye level, because we do that with our monitors. There's all these things that just seem so intuitive. What's the benefit of functional medicine providers? We talk to our patients, we chat with them, and we can just mention: Hey, eye level, don't be looking down. And once again, it's not good for our neck. Then, of course, we could get the vagal nerve issues. I will say that I love using vagal nerve stem for people with anxiety. I also like using for--back to your niece--a little vagal nerve stem, which is portable. And then also things like a sublingual L-Theanine, a sublingual GABA. Because the moment we're anxious, we're spending money as though we don't have to pay back the credit card. And then what's the counterpart? We use all the brain chemistry, and we've all had this on a fun trip, we have the emotional letdown. Okay, back to the grind. Also you left the brain chemistry on the beach or at Disneyland or wherever. So anxiety, you're blowing your chemistry. And then, of course, there's the letdown. So it's what you used to call this dysthymic, of the ebb and flow. Of course, there's bipolar. Those are extremes. Bipolar 1, bipolar 2, generic bipolar, where you go up, but then there's a down. And so we need to conserve, a penny saved is a penny earned. And I think sharing philosophy with the young people is very important. And us old people, too. Listening to the Stoics, stoicism and the philosophies of you can only do what you can do.

Rob Lutz 43:39
I don't know if you can read that one, but "The Daily Stoic."

Dr. Chris Meletis 43:44
Yes!

Rob Lutz 43:45
I don't know if you have this book. I've read through this, this is maybe my seventh year. I give this to so many people. It is fantastic. It's a quote from Marcus Aurelius or somebody, and then the understanding of the author, Ryan Holiday, who's kind of a relatively famous author in reference to stoic philosophy. It's such a good book. I should get you a copy.

Dr. Chris Meletis 44:10
Thank you. Yeah, and see, I'm a multitasker, so what I do is, when I'm working, I'll either have Mozart playing, and many of you in the audience knows about the Mozart study by Dr. Kamata, MD, PhD, Dr. Kamata, about how it altered TH1, TH2receptors and allergic burden. So my wife came in one time; she said: What are you listening to? Because I'm more of a Kid Rock, hip-hop kind of person, which people would never guess about me. And she said: What are you listening to, classical? And my wife grew up playing the piano. So I said: Yeah. She said: Why? Have you lost your mind? No, actually, there's a study showing that, if you listen to Mozart you're actually going to decrease your allergic response. That was birch tree season here in Oregon, you know the white tree, right? And whatever color car you have is now a lime green color if you're under a birch tree. And she says: Is that helping? I said: Yeah, my arms aren't itchy anymore. Yeah. Once again, if you had told me 20 years ago that music could actually alter the TH1, TH2 receptor, which we didn't even know back then about those levels of the immune system, I would have just thought that was all woo-woo, or hogwash. All of a sudden now there are studies showing that indeed, the harmony or the frequency in which we immerse ourselves, and of course, we can go to 100,000 megahertz, and what its effects are on different kinds of abnormal cells. We are ourselves a frequency. We know for the last, I think, three or four decades now, that fluorescent lights were 10 megahertz off our frequency. And so what about these phones? What frequency are they, and are they in tune with us? So I listen to stoicism and other edifying things. And I personally, much like I tell my young family, adult kids, the news is not going to be edifying for you. I said: If you want to hear the news, I'll come up with the worst case scenario. I'll tell you at dinner without a phone, and you'll see if it hasn't happened, it probably will.

Rob Lutz 46:08
Yeah, right, exactly.

Dr. Chris Meletis 46:10
That's not very stoic of me. I apologize.

Rob Lutz 46:13
So just to kind of, let's wrap things up a little bit here. But we were talking about pain and sleep and what pearls, tell me a little bit more or share with the audience, what are some key takeaways around this discussion? What do you want them to know?

Dr. Chris Meletis 46:29
With the aging, even if we had no blue light spectrum and just ancestrally, with aging, our melatonin levels dropped, and so daily routine of some melatonin at bedtime, I think just makes great sense. I'm not worried with the down regulation of a feedback loop like we would with a pituitary hypothalamic pathway. There's been all this press about if you take melatonin. I'm going to take melatonin, regardless of what the theory is that it might somehow down regulate because it has anti-inflammatory, immunological sides of things. Sadly enough, my younger sister has metastatic breast cancer, and she was just told by a medical oncologist as functional medicine to bump up to 1000 milligrams of melatonin per night. Huge.

Rob Lutz 47:13
1000?

Dr. Chris Meletis 47:14
1000. In my world, 50 to 60 is a pretty stiff dose, right? So I'm not proposing that he's correct or not, but once again, you're using it as a tool, but a daily augmentation making up for...

Rob Lutz 47:27
What would you say is kind of a good target for melatonin, for the average person, they just want to sleep a little bit better?

Dr. Chris Meletis 47:32
I think anywhere from 1 milligram to 5-10 milligrams. And once again, the concept is we like to nudge the biochemistry and don't like to shove it. Just the right amount to get the job done without throwing the body into disarming or altering homeostasis, because even though it's natural, doesn't always make it safe. One of my big lectures that was popular 25 years ago when I was lecturing at the local medical school. And so I think we augment and move the needle on the melatonin side of things. I like to use it with the beta caryophyllene. I like to use it with CBD. I like to use it as a composite to support the endocannabinoid system. There's products out there that offer all of those, because one of the problems our patients have is pill fatigue. I can tell you, I'm looking just on my desk in front of me, proper, I don't know, 12 bottles. And that's not even my active bottles. My active bottles are a surround around my monitor. We won't even tell you how many bottles are there. Well, do I need all those? No. Do I take all of those? Intermittently, but they're here for rapid access. Out of mind, out of sight. But I think was Thomas Edison that said the prime function of the body is to carry around the mind, and none of us want to succumb to Alzheimer's. Alzheimer's is on the rise. We know autism is on the rise. We know Attention Deficit is on the rise. So we have the three As, and because we're now feeding ourselves with shorts off the internet, little snips, little snips, little snips, and our attention has gone down, some people have argued, below goldfish, which I think is about seven seconds. But also we are fed pre-made stories. So I encourage all my young people to immerse themselves into old-time radio. Old-time radio, where you would listen to "Fibber McGee and Molly" or "The Whistler," or "Only the Shadow Knows" or listen to an audiobook and paint your own pictures in your own head and develop some neuroplasticity. And the other big thing that I use with all my patients with anxiety or PTSD or trauma is a program called zingperformance.com. It is a program that trains your cerebellum. And when we learned about our cerebellum back in the day, the cerebellum was: Hey, this is when you start walking. And we know that if we put a kid in a walker before they actually learn how to walk themselves, but one of those little strolling walkers, we actually bypass part of that neurointegration. But the cerebellum is where 70% of our neurons and our entire brain are, even though it is the size of a walnut. So training the cerebellum for athletics, competitive athletics or personal athletics, and training for Attention Deficit, autism. But there's a part of their program--they have multiple versions, it's all now an app, strangely enough, all technology-driven, you an do it on your phone or your tablet--but certain exercises integrate the cerebellum, and there's a philosophy: What fires together, wires together. I will finish on a theory. It's a theory I came up with. I'm probably wrong, but we know that if you're right-handed, you're often stimming your left side, which is very analytical, and so forth. If you're using your left hand, which I think 10% of population might be left-handed upwards, well then you're in your right mind. Pun intended or not. If you're left-handed, you're probably going to argue you're in your right mind. But now, what have we taught all these young people? To use two opposable thumbs. And boy, are they fast. If you try to ever chat with a family member that's young. I was like: Okay, how did you write all those words? I'm still on the third word, because I've got one thumb that works that way. Well, how does all that firing early on in life with these two opposable thumbs alter all the firing and wiring of the brain? And is that one reason the younger generation thinks quite a bit differently? And so back in the day, Elvis Presley was too rad and too much of a nemesis for modern humanity, and there was the Beatles, and there was the Beach Boys. And we always have this generational gap between what's acceptable or not, but there's this huge change in the young person's mind, and is that, in part, the two opposable thumbs integrating and then being fed and not developing the ability to read a story out of a book. I'm still a book guy. I love breaking open a book and reading the black and white. It's training the brain still to be creative and dynamic and wondering if using our opposable thumbs excessively both left and right, is it going to now cause arthritis and overuse syndrome? Yes, but is it also altering the way we think as human beings? It's a philosophy. It's a question. It's a ponderance. It's just something I pondered: How do the things which we do on a daily basis alter who and how we are?

Dr. Chris Meletis 47:33
Well, certainly the foods we eat changes our microbiome, which changes brain chemistry, all sorts of things.

Dr. Chris Meletis 52:26
I'm glad you brought that up, the altered microbiome. They actually did a study that just got published. If you had one antibiotic in the last two years, you're like--don't quote me here--it's like, 20% more likely to be depressed. If you had two antibiotics the last couple of years, you're like, 40% more likely to be depressed, because we know our serotonin is made in our gut largely. Dopamine, still a predominant amount in our gut. That's our contentment. That's our Winnie-the-Poohness, our pot of honey, just content. All these antibiotics. And then I will raise another philosophy of mine, another ponderance. I'm not saying my ponderances are correct, because I do look at my phone, so I'm jaded with all the technology altering my neurotransmitters, but I only use one thumb to text. Back in the day when I was growing up, we would wear a swimsuit in the swimming pool, communal swimming pool, the neighborhood swimming pool. Now, of course, there's swim attire, swim whatever, but you wore a swimsuit, or rather, a bathing suit because you're publicly bathing. And so they chlorinate the water, which kills the bacteria that's coming off one's backside, even, and that's supposedly you're supposed to shower, which most people don't shower the way they recommend. So what happens when we drink a whole lot of chlorinated municipal water? Does that chlorine or chloramide, chloramines alter our microbiome as well? You would think. And of course, the antibiotics in our foods, chicken breasts, other things. So I think, yeah, there's an active process of altering our microbiome. My 18th book that I wrote, which is free on Kindle Unlimited, is called the MMM. It's "Microbial Mucosal Milieu," and it talks about the skin microbiome, the eye microbiome, nasal microbiome, vaginal, pelvic, prostate, blood, brain microbiome, and all these little MMMs contribute to our larger MMM. And so we have all these little microbiomes, little forests, and the whole forest in unison works. And so there's a lot of cross talk that we haven't given credit for. So the book goes over some 254 pages about what we do know in the peer review literature about all these different microbiomes. So if a person has eczema or atopic dermatitis, and they've been told by the standard medical model, take a bleach bath, wipe out your friendly bacteria, because you have all these infected wounds from scratching. Well, how do you reinoculate the skin microbiome? Well, we know about fecal transplants, so I actually have a theory that I came up with, once again, problems with sitting in front my computer so long and listening to Mozart and stoicism as I come up with random thoughts, and it's like, well, I came up with the pajama theory. So let's say you and you mentioned a son that has a master's degree. One of you is super healthy. Another one has a little bit of a skin issue, some eczema, atopic dermatitis. Well, what I would propose, and I'm not diagnosing or treating anybody here that's listening that might not be a healthcare provider. Well, I would encourage the healthier of the two of you with no skin issues, to wear the equivalent of a sweatshirt and sweatpants and then wear them for two or three days, and then give the dirty clothes to the recipient and have them wear your dirty clothes for a few days and reinoculate their skin microbiome. I call it the pajama theory.

Rob Lutz 55:40
I like it. That's very cool.

Dr. Chris Meletis 55:42
And it is somewhat gender-specific. If you're a female, you have a little different skin microbiome in certain parts of the body than a male. But yeah, and it's worked. I've used it with my patients, because how am I going to reinoculate? Why is it disharmonious skin? I can give them all the probiotics internally, but they need to have a reinoculation of the skin microbiome and stop bleaching themselves with a bleach bath.

Rob Lutz 56:04
Wow. Well, thank you, Chris, this was another great podcast, and I love having you on the show. And I think we covered a lot of great stuff around sleep, some good recommendations and advice, both for practitioners or if a patient happens to be listening. I always recommend that if that's the case, you talk to your practitioner. We're not providing medical advice here. But this was great. And again, I will provide some links to the Resource Center with some chapters from your book on the endocannabinoid system. We've got things in there about pain, also about sleep we'll refer to, and also that webinar that we talked about on this topic that we actually just put in the newsletter last week, and so I'll share that as well. But once again, thank you so much, Chris. Really loved having you on the show.

Dr. Chris Meletis 56:48
Thank you. I love being here. I love my rabbit trails, as the audience knows, and I also love learning from my colleagues. So anybody that wants to email me with a pearl or wisdom, I'll incorporate into my lectures, because we're all better together than apart.

Rob Lutz 57:01
I'll include the link to your email address and your website as well. And again, thanks so much, Chris.

Dr. Chris Meletis 57:07
Thank you.

Rob Lutz 57:07
And I'll see you on the next episode, because I'll have you back. Love it. Thank you.

Rob Lutz 57:12
Thanks for listening to the OneMedicine Podcast. I hope you found today's episode interesting and came away with a few insights you can apply to your practice. If you're looking for the show notes, they can be found in the link below. If you want to go deeper on this topic or anything else, please visit todayspractitioner.com and consider registering for our weekly newsletter as well. Thanks again, and I hope you'll join us next time.