Hey everyone! Hope you had a fulfilling month. 
**If you are a physician and have navigated the path from “poor health” to “good health,” we want to interview you! We’re talking burnout, mental health, physical health, etc. Our goal is for physician to be the experts, and models, of good health. Please see study information below. 

• What does it mean to be healthy? Is burnout a real thing? Are physicians actually health experts – If so, why are so many of us not very healthy? 
• We are looking for physicians who have made the transition from poor health to good health. This could mean overcoming burnout, overhauling physical health, or any other interpretation of going from unhealthy to healthy. We would like to look for patterns and provide this evidence to all healthcare professionals as a potential model for improving health. This will lay groundwork for future interventional studies. 
• If interested in participating, see the study overview information below. Sign up for an interview day/time on the Doodle Poll https://doodle.com/poll/942v84d2f8xievvz?utm_source=poll&utm_medium=link 

Here are some ideas for wellness practice:

Real Paper

• Check out this brief article summarizing scholarly research on the differences in effectiveness between reading on a screen versus paper. The take home point, when reading nonfiction, ie for retention, it is slightly better to read on real paper. 

Fermented Tea?

• Check out Pu-erh tea. Seems to be popping up all over the place lately. All the usually benefits of tea (polyphenols, light caffeine, theanine) plus potential probiotic effects. It is a black tea, makes just about the strongest cup of tea I have had with one bag. One of the Amazon reviews for this brand said you should never drink this tea ‘out of a bag’ but that this was the best brand if you don’t want to spend a ton of money on ‘cakes.’ Some deep internet rabbit holes on Pu-erh.

Workout Ideas

• If you are looking for workout ideas, check out the Practice of Wellness daily workout page. Brian Ferguson (active duty Air Force) posts daily workouts that are cross-training style, with alternatives depending on the equipment you have. This week is a lighter schedule so a nice time to ease in. 

Music

• Super cool, complicated instrumental track from artist St. Germain, album St. Germain. I just play this song over and over. Almost too interesting to listen to in the background while reading/writing. 

Study Session

• Ok this guy is taking Deep Work too far. I hope he got an A. See the Tweet here.

Light and Darkness

• Many readers may have heard of the so called Dark Triad of personality traits: 
1. Narcissism: grandiosity, pride, egotism, and a lack of empathy.
2. Machiavellianism: manipulation and exploitation of others, an absence of morality, unemotional callousness, and a higher level of self interest.
3. Psychopathy: continuous antisocial behavior, impulsivity, selfishness, callous and unemotional traits (CU),and remorselessness.
Multiple studies have validated this concept, correlating dark triad traits with many outcomes. Spoiler alert, we all have exhibit these traits sometimes.  
• But the cool, uplifting surprise is this: A team of researchers, including Scott Barry Kaufman, decided to study the inverse of this, naming their character traits the Light Triad. How beautiful. Here are the features:
1. Faith in Humanity: he belief that, generally speaking, humans are good.
2. Humanism: the belief that humans across all backgrounds are deserving of respect and appreciation.
3. Kantianism: the belief that others should be treated as ends in and of themselves, and not as pawns in one’s own game (named after Immanuel Kant).
• Go out there and try to tap into your Light traits, spread some kindness today. 

Light and Sleep

• We all want a good night of sleep. Optimal quality and quantity of sleep correlates with mood, anxiety, heart attacks, cancer, living longer, and a bunch of other outcomes. If you struggle with sleep, do not start by reaching for a pill or supplement. Light is a drug. The few papers I discuss below cover a very narrow slice of the literature on light exposure and sleep.
• Chang et al in studied evening use of eReaders. Nighttime screen use reduced melatonin levels, led to longer sleep latency (takes longer to fall asleep), less following morning alertness, and later timing of circadian clock (takes longer to fall asleep tomorrow night!). 
• Crowley et al studied office workers during summer and winter. Season (ie. sunrise) had very little impact on baseline schedules. Subjects had more morning light on workdays than weekends (due to earlier wake times and the morning commute). Big take home point, melatonin secretion (your brain telling your body it is time to go to sleep at night) depended heavilyon the timing of first light exposure of the day, even very dim light (10 lux). The overall amount of bright light exposure might not be as important as timing of light for onset of melatonin (overall amount of light is probably very important for sleep quality, see below). 
• The next paper by Cajochen studied subjects who volunteered to stay awake for 40 hours straight. They compared 3 groups based on light exposure while awake: dim light vs bright white light vs bright blue-enriched white light. At the end of the 40 hours, both bright light conditions led to better sleep than dim light. So if you are planning to work long hours, ie night shift, it is actually good to get exposure to bright light during the night. This supports other data on the importance of daytime (sun)light exposure to help you sleep at night. I would argue that you should limit light exposure a the end of the shift and leading up to going to bed in the morning. 
• Wams et al found that people with later first light exposure (10 lux) had more awakenings during subsequent sleep. Later light exposure had shorter latency to first REM sleep. Less light exposure had subsequently higher percentage of REM sleep. So slow wave “restorative” sleep was higher in those with more and earlier light exposure. See below:
“These novel ambulatory PSG findings are the first to highlight the direct relationship between light and subsequent sleep, combining knowledge of homeostatic and circadian regulation of sleep by light. Upon confirmation by interventional studies, this hypothesis could change current understanding of sleep regulation and its relationship to prior light exposure.”
“Later chronotypes are generally exposed to later light and less time outdoors. This probably results in lower light exposure, and probably a reduction in exposure to approximately 460–490 nm photons, which are important for entraining the circadian system. 
“Because humans have on average an intrinsic circadian period longer than 24 hours (24.2 hours), they need advancing (morning) light to entrain to the 24-hour day. Exposure to lower light intensities indicates reduced zeitgeber strength and oscillatory theory predicts that this will result in a later (lagging) phase angle of entrainment when intrinsic period is greater than 24 hours. This later phase angle of entrainment may then be further amplified by artificial light in the evening.”  

TL;DR: When you wake up, get a bright light on your face as early as possible to set yourself up for a good night of sleep. But, if you want to stay up late that night, wait a little while before light exposure. You can also use bright lights later in the day / night to help stay awake.  

Quotes

The future is already here, it is just not evenly distributed.
― William Gibson

Before you heal someone, ask him if he’s willing to give up the things that make him sick. 
– Hippocrates. How is this quote not all over the curriculum in medical school??

Physician Path to Wellness 
Study Information
UofL IRB #21.0178
Objectives
1. Determine what the terms ‘healthy’ and ‘burnout’ mean to physicians. 
2. Determine what behaviors, beliefs, and system changes facilitate the transition from poor health/burnout to thriving in physicians

Methods
We plan to conduct in-depth, semi-structured qualitative interviews with physicians to learn about their respective journeys towards optimal wellness. Study personnel will conduct Zoom interviews that will be recorded, transcribed, deidentified, and then destroyed.