This is Part 2 of a 3 part series on how to avoid playing life on "Expert+ Mode"
Training to be a physician is an interesting practice in hypocrisy. The goal is to learn how to prevent and care for pathologic conditions. Yet, the training is so grueling and rigorous that most medical students and residents are chronically exhausted, don’t get enough exercise, and fueled by whatever is most convenient. Because this is happening during prime years of health (mid-twenties to early-thirties), the damage is not always obvious. In short, we become unhealthy in our quest to learn how to help people be healthy.
Everyone knows sleep matters, and yet, 35% of Americans get less than 7 hours per night of sleep. It is well established that adequate sleep makes it easier to stay at a healthy weight, decreases risks of common chronic conditions, and keeps our immune system healthier. Executive functioning may be how we pay the highest price when we are tired. Sufficient sleep results in decreased stress and improved attention, memory, and mood.
Hydration is a low-hanging fruit with a high return. Dehydration results impaired cognitive function - inattention, executive functioning, and motor coordination are all reduced (Wittbrodt et al). The literature about cognitive ability during short term fasting is nuanced, but malnutrition clearly creates cognitive penalties (Landini et al). Being "hangry" is not just a social joke; being hungry diminishes emotional regulation and executive functioning. Short term fasting can also diminish ability to sustain cognitive tasks over longer periods of time.
As with sleep, the physical benefits from exercise to our bodies are well-defined. But movement isn't only about the heart; the effects also extend to our brains. Aerobic exercise improves our cognitive flexibility, planning, and impulse control. It improves communication and sharpens decision-making. Strength training is neuroprotective, increasing Brain-Derived Neurotrophic Factor (BDNF), which supports survival and growth of brain cells and is crucial for neuroplasticity. Exercise results in improved attention control, working memory, and mood while also reducing stress hormones.
I recently heard a great analogy: Stop treating your body like a rental. We need to own them, which means proper maintenance and upkeep are essential for both short and long term performance. I’m far from perfect in this quest, but some small changes have created sustainable habits to reduce my cognitive friction:
9 PM Wind-Down Alarm: This isn't a sleep now command, but it does remind me that I prioritize sleep. I don’t start another show or keep scrolling on my phone.
Treadmill Bribe: I have certain favorite TV shows that I only watch while on the treadmill (looking at you Bridgerton!). This turns the chore into a reward.
Sensory Hydration Strategy: If plain water feels tedious, use non-caffeinated herbal tea in the afternoon to provide hydration without the boredom.
Single-Task Eating: Avoid scrolling or watching TV while eating. Focus on enjoying your food or your companion. In addition to reducing mindless overconsumption, it provides a true break for your brain.
The fact that sleep, exercise, and diet are important is not a revelation. When we’re busy, being able to find time in the day to sleep, exercise*, and attend to our bodies feels like (yet another!) impossible task to add to our pile. My insight is that paying attention to and making little changes in the care of our "machine" results in massive dividends in cognitive output, reducing friction, increasing productivity, and keeping you from playing life on "Expert+ Mode".
*Exercise is a particularly sticky category for me because I don’t feel great during or after exercise or find any significant difference in my sleep. In fact, I usually hate doing it. BUT - I keep at it because it is an investment in my cognitive output and overall motivation each day, in addition to the established longer term physical health benefits.
References:
Dehydration Impairs Cognitive Performance: A Meta-analysis.
Matthew T Wittbrodt, Melinda Millard-Stafford.
Med Sci Sports Exerc. 2018 Nov;50(11):2360-2368.
Food for thought: The impact of short term fasting on cognitive ability.
Austin Landini, Michelle Segovia, Marco Palma, Rodolfo Nayga Jr.
PLoS One. 2024 Nov 25;19(11):e0312811.