The Dr. Hyman Show - 5 Easy Ways To Improve Your Health Today

Episode Date: January 14, 2022

This episode is brought to you by Rupa Health, Athletic Greens, and InsideTracker. Wellness is more than just eating right and exercising; it’s also much more than just feeling “okay.” Feeling well means feeling whole, balanced, vibrant, and alive. And there are many moving pieces that we can tap into to feel empowered in our own wellness journey. Functional Medicine looks at the body with a systems-based approach, understanding how all our different parts work together and looking at a symptom as a sign of dysfunction that we need to get to the root cause of, not just tame.  I sat down with Dr. Elizabeth Boham to discuss what it means to get to the root cause of disease and how the principles we practice do exactly that. We talk about the many different parts of healing the whole body, like enhancing detoxification pathways, correcting nutrient deficiencies, supporting the microbiome, and so much more. Dr. Boham is a physician and nutritionist who practices Functional Medicine as part of my team at The UltraWellness Center in Lenox, MA. Through her practice and lecturing, she has helped thousands of people achieve their wellness goals. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the Functional Medicine approach to keeping your breasts and whole body well, a topic she is passionate about as a breast cancer survivor. This episode is brought to you by Rupa Health, Athletic Greens, and InsideTracker. Rupa Health is a place for Functional Medicine practitioners to access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, Great Plains, and more. You can check out a free live demo with a Q&A or create an account at RupaHealth.com. Right now, when you purchase AG1 from Athletic Greens, you will receive 10 free travel packs with your first purchase. All you have to do is visit athleticgreens.com/hyman. InsideTracker is a personalized health and wellness platform like no other. Right now they’re offering my community 25% off at insidetracker.com/drhyman.

Coming up on this episode of The Doctor's Pharmacy. When that calming nervous system is engaged through meditation and yoga and breath work, that our body has the ability to heal. Get some plant foods from every color of the rainbow every day. Get some good red foods like the pomegranate or cranberry. Get something orange and yellow and green, blue, purple, white, tan. Hey everyone, it's Dr. Mark. I know a lot of you out there are practitioners like me, helping patients heal using real food and functional medicine as your framework

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this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. There are many moving pieces that we can tap into to feel empowered in our own wellness journey. Understanding how all our different parts work together enables us to get to the root cause of various issues. For instance, most of us don't recognize that digestive problems can wreak havoc on the entire body, leading to issues ranging from allergies to autoimmune disease, acne, mood disorders, cancer, dementia, and more. This is why having a healthy gut is central to your full body health. In this compilation episode, Dr. Hyman talks to Dr. Elizabeth Bohem about what it means to get to the root cause of disease and how the principles of

functional medicine work to do exactly that. They discuss the role of the gut microbiome, how it can affect digestion, insulin, sleep, and so much more. Let's jump in. Part of the approach of functional medicine medicine we start them on the elimination diet so eliminating all the inflammatory foods gluten dairy processed foods all that stuff and then you remove right that's the remove right the five r's we remove right replace re-inoculate repair repair rebalance yep and and we'll go into each of those because they're really important but the the the the the next step is also there's other things we may need to remove. There's tests we need to do.

Yes. So what kind of tests would you look at as a functional medicine doctor that you wouldn't see at a traditional doctor's office that give us a roadmap of how to treat these patients? Right. So we did a stool test that looked at his microbiome. And what we noticed is that there was an overgrowth of unhealthy bacteria and unhealthy yeast. So he had this, you know, probably because of years of antibiotics, he developed this dysbiosis, this imbalance in the bacteria and yeast. And so there was an overgrowth of the unhealthy things.

It's like weeds, having a lot of weeds in your garden, right? Yeah, right. It's not always like one of those, you think of a stomach infection and you're getting really, really sick, you're throwing up or having diarrhea. This is this, it's an imbalance and it's called dysbiosis, but that imbalance causes a lot of symptoms in people. When you have the wrong bacteria and the wrong yeast levels, you can get a lot of bloating after you eat, You can get a lot of fatigue after you eat. You can get those symptoms of constipation and diarrhea. And that causes this inflammation in the digestive system.

So all of your digestive enzymes don't work well. So you're not breaking down your food well. You're not absorbing your nutrients well. And it becomes this vicious cycle that people are dealing with. And we see all the time. Yeah, it's so powerful. So, you know, when I see this patient, I'm like, okay, you don't have to do all the tests. But sometimes when you get stuck, you look at, you know, various tests that look at antibodies against things that are in the gut that determine a leaky gut.

Right. We call it Cyrex-2 testing, which is a test you can get through a functional medicine doctor. Right, you can test to see if there's leaky gut. I love that test too because it's a great way for us to follow up and see how much we're seeing improvement. Are we doing enough? Are we seeing improvement in their leaky gut or increased intestinal permeability? And then we look at poop testing, where we do thousands and thousands of these tests. And it's so helpful.

And it doesn't just look at the microbiome. It actually looks at the function of the gut. Yes. Like whether there's malabsorption, whether you have no digestive enzymes, whether there's inflammation, whether there's overactive antibodies in there, whether you have imbalances and what we call the short chain fats, which are the food for the colon that are produced by bacteria eating the right kinds of fiber. And if they're low, it means there's an imbalance. Then we look at the microbiome. We look at what grows.

We look at parasites. And then we target and micro-target the things that are out of balance for that person. And it's different for everybody. And we might look at food sensitivity testing. We might look at even things like heavy metals or other things, which can also cause it. I had a patient with ulcerative colitis once and I did everything right. I did the whole 5R. It wasn't working, but I forgot the first part of the R, which is remove. And I thought, well, maybe, you know, heavy metals can cause autoimmunity. Maybe it's a problem. And so I

tested him and he was like wasted away. And he was like, it was terrible. He actually had high levels of mercury. We treated mercury and his colitis went away. Which is phenomenal. So I think it's so powerful. And this case is so important because it really describes how a patient goes to a traditional doctor, is diagnosed with a disease,

irritable bowel syndrome. By the way, anytime you hear syndrome, it means doctors know what the heck is going on. It's just a collection of symptoms that we agree we're going to put in this bucket. And if you have those symptoms, you have this disease, but it's not really a disease. And so that's what functional medicine is. It sort of looks upstream to figure out what the root causes are and personalize the treatment for everybody. And there's common things

that we do like the 5R, but it may be different R's for each patient, right? Right. So for him, we removed the inflammatory foods and we removed the bacteria and yeast. I actually treated him with an antibiotic, a non-absorbed antibiotic and an antifungal. So I treated him with a prescription medication. Yeah, weed killer. So that was the remove, right? And then the replace because he was underweight and because of that inflammation in his digestive system I gave him some digestive enzymes for a short period of time just to help him help it so the food wasn't as inflammatory for him and to help him absorb more nutrients and then we then we worked on re-inoculating right so after we gave him some good probiotics

put in the healthy bacteria put in the healthy bacteria. Put in the healthy bacteria. Some good prebiotics. So we know that there's... What are prebiotics? Prebiotics are the things that help feed the good bacteria. So they're the food for the probiotics. Which is usually what? Like fibers.

Fibers are amazing prebiotics. We know a lot of phytonutrients are prebiotics. So this, I think, is really exciting research when we're looking at our phytonutrients. You know, we know that... What are phytonutrients are prebiotics. So this, I think, is really exciting research when we're looking at our phytonutrients. You know, we know that... What are phytonutrients? Right. So I know it's amazing, right? So our food has minerals in it, it has vitamins, but it also has these things called phytonutrients,

which are these components in our plant foods that have this amazing health benefits for us. So that can include things like ellagic acid that we see in pomegranate that can feed some of the good bacteria, that acromantia that we know can lower inflammation. We know that... Just to back up on that acromantia thing. So when we look at the poop, we can tell if there's like good levels of different bugs. And one of them we look at is acromantia. And it turns out that that is so important for protecting your gut. It helps you keep your biofilm or that little coating over the gut so you don't have a leaky gut. And it's involved in so many autoimmune diseases and response to cancer therapy and metabolic issues and weight. And it's such an overlooked thing. And you can't take a probiotic of it, at least not yet. But you can feed it, the good guys. Right. We can feed it. We can feed it

with all these amazing phytonutrients like what's in pomegranate, the ellagic acid. And also we know that sulforaphane from our cruciferous vegetables feeds the good bacteria. Yeah. So broccoli, collards, kale, but not juicing it. Right. Brussels sprouts, all those good ones. We know that green tea, you know, that has good phytonutrients in it that's good for the digestive system. So we always say to people, you know, get something from every color of the rainbow every day. You know, you get some plant foods from every color of the rainbow every day. Get some good red foods like the pomegranate or cranberry. Get something orange and yellow and green, blue, purple, white, tan.

You know, all those good, healthy plant foods, like our vegetables, our fruits, our spices, our teas, our coffees, really actually are impacting our microbiome, which is fascinating. It's so great. And, you know, just a great anecdote from a colleague of mine, Dr. Lee, who was on our podcast talking about eat to beat disease. His mother had stage four uterine cancer. And being the smart doc he is, he understood from the research that if you have low acromantia,

patients don't respond to the immunotherapy, what they call the checkpoint inhibitors, which is this new form of cancer therapy that helps activate your immune system. So if your gut isn't healthy, you can't actually get the cancer cells to die with the immunotherapy. Right. So basically you die unless you have good bacteria in your gut. And so his mother had stage four uterine cancer and was going to die and wasn't responding. And he gave her pomegranate, cranberry, green tea, all these phytochemicals, got her acromantia levels up, and she was cured of her stage four cancer within a month.

That's a phenomenal story. It's an incredible story. And I think that just shows the power of these plant foods and of getting focused on the gut. Yes. Yes. You know, we call it the 5r i call it the weeding seeding and feeding program so like you weed out the bad things you see it with the good

things and you feed it with good nutrients and all this stuff so it's really it's it's so it's so powerful i i can't tell you you know as a functional medicine doctor for the last 30 years and you you know been doing this almost as long the the results you get from focusing on the gut with so many conditions, whether it's autoimmune or whether it's allergic, whether it's digestive, whether it's your skin issues like acne, eczema, whether it's your mood, whether it's weight metabolism, whether it's migraines, whether it's Alzheimer's, I mean, autism, ADD. It's just amazing when you start to focus in on this. So let's break down the five-hour program for everybody. So we got the remove.

So what are we looking at? We're removing... We're removing unhealthy foods or inflammatory foods for that person. So they can be food sensitivities, things like gluten and dairy, the big ones. Food sensitivities, yeah. And then we're removing... Processed food and junk food, right? Oh, yeah, that's for sure.

And sugars and, you know, excess sugar, which is feeding the wrong bacteria. Yeah. and then we're removing processed food and junk food and sugars and excess sugar which is feeding the wrong bacteria and then we're removing the unhealthy bugs or yeast or viruses a parasite I was on the

red table talk and Jada and her son both had parasites and they both had gut issues for a long, long time. Right. And they thought it was just how they were. Yeah. But with, you know, short little course of treatment, they were both, I've never felt better. Right. And all the other symptoms. Because now you're actually absorbing the nutrients you're eating, which just helps the body heal. Yeah. So, so then, so you, you remove, then we replace, but you might also remove things like heavy metals or stress or toxic people in your life or whatever's giving you a stomach problem.

Right, right, right. Replace means just to replace some of those digestive enzymes if needed, re-inoculate. So the replace also could be like prebiotics, right? So putting in the fibers to feed the gut and to actually maybe use hydrochloric acid sometimes for people who aren't digesting their food as they get older. Yeah, and to help get them off of the acid blockers, which we know are creating a lot of problems because we need that acid in our stomach to digest our food. Okay, let's take a little detour.

So you just mentioned acid blockers. Okay, these are among the most prevalent drugs prescribed today in America. And statins, I think. When I was in medical school in the 80s, we just had those drugs come on the market. The drug reps used to come to us and say, these are very powerful drugs.

Never use them for more than six weeks because they block stomach acid and they'll cause significant problems if you do that long-term. You can cure an ulcer with it. You can fix an acute problem, but never use this. Now people are on this for decades.

And the side effect, which is listed in the manuals that we get as doctors, is that it causes irritable bowel syndrome. So you end up fixing the heartburn, but you get irritable bowel and bloating and bacterial overgrowth and all these problems. Right, because you need the acid in your stomach.

And when you block that acid, then there can be an overgrowth of bacteria where there's not supposed to be. And that can cause all those slew of problems. You also then- Change the pH, you get more yeast issues and all this stuff. And then you're not absorbing your minerals,

so you can get osteoporosis and you're not absorbing your minerals, so you can get osteoporosis, and you're not absorbing your B12, so you can get fatigue and dementia, right? It just goes on and on and on. You don't absorb zinc and magnesium, minerals, calcium, it causes osteoporosis, pneumonia, it causes, you know, irritable bowel. It goes on and on, right? Yeah. It's so, and it takes some work sometimes.

When people have been on an acid blocker for a long time, it takes some work for us to help wean them off because their body has gotten pretty used to it. They start to get their bodies. Their body wants to make acid. So it's working against the medicine. So when you wean them down, sometimes they get more acid production.

It's called rebound. So you actually, it's like, and it's sort of a trick. Like you get off it, but it makes you worse. So you feel like you have to get back on it but it's actually not true and you can actually get off it absolutely we do that all the time we do it all the time so re-inoculate giving all the good prebiotics and probiotics the good bacteria and all the things that feed the good bacteria and then the fourth r is repair how do you know what probiotics to take oh that's a great question i want to know what are you oh my? Oh, that's a great question.

I want to know, what do you prescribe? Oh my goodness, that's such a, that goes on and on. We could talk about that for the next hour. Yes, it's true. Right? There's a lot, there's more and more probiotics on the market every day and all have different roles and different functions. Yeah. And we're just sort of, honestly, I think, you know, we've been doing this forever, but it feels to me like we're at the infancy of this understanding of how to use these in medicine. Yep. So what? I mean, there's some great brands that I trust and I use all the time. But when somebody is, you know, doesn't maybe know what to do, I'll say, you know, get one, go to a reputable place, a reputable pharmacy or a good wellness store pharmacy and get a probiotic.

You know, try it. If it makes you feel worse, then a probiotic you know try it if it makes you feel worse then stop it you know because there's some there's some good bacteria that make people feel worse overgrowth exactly yeah bad bugs growing in there and you put the good bugs in there they have a fight yeah and they cause and so that means we just have to do more work before we can start it yeah so so they got to re-inoculate and then you got the... And then repair. And that's the fourth R. So that's things like giving good protein, good amino acids, which are the building blocks of protein. To repair. Yeah, to help repair that

barrier, that coffee filter. We have to repair it with good protein. And sometimes we'll use amino acids like glutamine that help repair it. We'll give more zinc, whether it's from food sources or as a supplement. Maybe we'll give some vitamin A, which also helps with healing that barrier. It helps with healing the endothelium in the gut. So those are things we will do to repair. And then rebalance, right? That's the fifth R, which is really focused on managing our stress and how we're reacting to the world. Because we know that when our parasympathetic nervous system is engaged, when that calming

nervous system is engaged through meditation and yoga and breath work, that our body has the ability to heal. And it heals better when our body is at rest. I mean, yeah, you just touched on something very powerful, which is that our gut and our brain are connected. There's a whole hard wiring of nervous system. And the gut even has this independent nervous system that actually is like a second brain.

Yeah. And the gut even has this independent nervous system that actually is like a second brain. And so, you know, we often say people with irritable bowel are emotional or anxious or have, you know, just maladaptive emotional coping mechanisms. But it turns out that the irritable bowel actually can cause an irritable brain and lead to anxiety and all these emotional issues. So it's bidirectional. And I think that's a great lever for helping people reset their gut. Absolutely. You know, I just want to share a story because I've been doing this for a long time.

And of course, my, I don't know what it is, curse or blessing, depending on how you look at it, is actually getting really sick and having to figure out what to do to fix myself. Yeah. And I've had a lot of gut issues over the years which is why I really focused on this. The first is when I had mercury poisoning and I tried everything. I did

every functional medicine trick in the book back then and it wasn't working. Until I got the mercury out which disrupts all your enzymes, it disrupts your gut, it causes leaky gut, it causes yeast overgrowth, it screws up the bacteria in your gut. Until I got rid of the mercury from my system, I couldn't get my gut straight. Yeah, because it's impacting your immune system too, right? Yeah, right. And then many years later, I kind of got an issue which was triggered by an antibiotic for a root canal that I had to take called clindamycin, which is known to cause C. diff, which is a terrible bacterial infection that kills like 30,000 people a year.

And I got that. And I was so sick. And Liz would come over to my house. And I was like, it was pretty bad. I'm like, we're all struggling to figure it out. And I had mold in my house and all these other things. But I ended up having colitis. And I had tremendous leaky gut.

And I did my own stool test. And my friend Patrick Hannaway who he worked for the stool test company for many years my colleague at Cleveland Clinic he and I looked at my stool test and we probably between the two of us seen like 20,000 stool tests we're like this is the worst one we've ever seen and everything was screwed up and I had no good bacteria I had low butyrate. I was not digesting. I had tons of inflammation. It was terrible.

And I couldn't really fix it using a lot of the traditional things. And then I started to sort of work on a gut shake, which included a lot of the sort of 5R concepts, right? So I cleaned up my diet, obviously. I got rid of the bad bugs. But I used a combination of these polyphenols from the plants, a pomegranate, cranberry, green tea, also added, you know, glutamine. I added prebiotics, probiotics.

I even added colostrum, you know, which is to help regulate the immune system. And it was like a miracle. I had went from full blown colitis to like normal in three weeks. And I've been great ever since. And it's just like, wow, this is something that people can actually do. It's not that hard. It's not drugs. And the alternatives are really bad drugs, right?

So we want to go to the next case, which was sort of not about people with a gut-centric issue. Because people often think, oh, well, if I have a leaky gut or if I have gut related problems, I'm going to know it. My stomach's not going to be right. I'm going to feel symptoms. But that's true. It's not always the case. So the first case was a guy who did have a typical history of, you know, antibiotics and acne and some infection and then, you know, diet and all this stuff.

And that was pretty clear. But there are many cases where people come in and they have zero gut symptoms, but their gut's a mess and it's causing all these issues. So tell us about your next case of this patient with an autoimmune disease. Right. So this was a 50-year-old woman who came in and she didn't have any real digestive issues that she was paying attention to or that were bothering her. What was bothering her were her joints. So she was having a lot of joint pain, especially in her hands. And she was paying attention to or that were bothering her. What was bothering her were her joints. So she was having a lot of joint pain, especially in her hands.

And she was starting to get a lot of swelling and deformity. And she was diagnosed with rheumatoid arthritis. Really common. Yep. And a rheumatologist wanted to put her on a biologic medication. He wanted to start her on Embril. So by the way, these are drugs that suppress your immune system that can cause life-threatening infections and increase risk for cancer

that cost $50,000 a year. So it's not risk-free and it's super costly and it can save lives and it can be a great rescue medicine if people need it. But most of the time using functional medicine, not all the time, but most of the time, you can figure out the puzzle of why they're sick and fix that and then they get better and they don't need the medication. Right, and she wanted to try it a different way. So she came to see us and said,

you know what, before I go on this medication, can we do it a different way? Can my body heal and can I get to the point where I don't need this medication? And so we did a lot of testing on her. And what we found- And by the way, the testing can sometimes be expensive,

but it's a lot cheaper than a lifelong course of these medicines and the suffering that goes along with it, right? So if you have to spend a few thousand dollars up front to figure it out, you can stop having to pay 50 grand a year for the medication for the rest of your life. And you feel so much better. Yeah. And so we found out that she had increased intestinal permeability. We did that test that you were mentioning earlier, that Cyrex 2, which looks at antibodies against different proteins in the digestive system. And if they're

elevated, it gives us an indication that there's that increased intestinal permeability. And hers was really, really high. Yeah, and she had no symptoms. No, and she had no symptoms, right? And one of the markers on there was high that makes me also think, okay, is there really a gluten issue for this person?

Because we know that that can damage, as you were mentioning earlier, that for people with celiac disease, that really can damage those villi in the intestines and is a major cause for leaky gut. Yeah. Well, just that's an interesting point. You bring up gluten. So even if you don't have celiac, you can still have issues. And one of our functional medicine faculty, Dr. Alessio Fasano, is one of the world's experts on leaky gut and gluten. Yep. And he discovered this because he found that in cholera, when there's a mechanism in the body that actually causes you to have a leaky gut

and sort of get rid of the infection. And it can kill people if it's bad enough, but he realized that the same thing that gets activated in cholera, something called zonulin, is activated by gluten. So gluten causes this protein to be produced that creates a leaky gut. And you don't actually have to have celiac and you could even have what we call non-cell mediated immune response, which is the old ancient immune system that doesn't even use antibodies. So you can't even measure it or test it. Right. Just inflammation. Just inflammation. It's like the difference between a smart bomb and carpet bombing. It's like sort of an ancient part of the immune system just reacts and gets pissed off and inflamed. And that can cause a leaky gut. So

when people have high zonulin levels or, or, or create antibodies, it's meaning there's some issue with the gluten. Yes. Yes. And so, you know, we, we said when we saw her intestinal permeability test, we said, okay, we've really got to focus on these five R's with you. And we went on to find also a bacterial overgrowth. We found a bacterial overgrowth in her digestive system, and we found a bacterial overgrowth in her mouth. So we know that. There's been really interesting studies showing that when there's certain bacteria in the in the oral cavity that have been associated with autoimmune disease so gingivitis or inflammation in the gums from a bacterial overgrowth has been associated with auto autoimmune disease in some

people and I think for her there was we saw that connection because we saw some elevated levels of unwanted bacteria in her mouth and we saw some unwanted bacteria in her digestive system. What does she need, like mouthwash? Dental care? Yeah, you know, I mean, you can treat the bacterial overgrowth in the mouth. You can treat it with certain types of dental care, scaling and root planning. We also used a herbal. She wanted to go the whole herbal route. So we used an herbal rinse for her mouth, an herbal toothpaste and an herbal rinse that helps get rid of the overgrowth of unwanted bacteria. We use some good probiotics that you actually chew and that they

give back good mouth probiotics. Yeah. And we used we also used an herbal regimen that for the digestive system to get rid of that bacterial overgrowth. Because what what they're learning right is that there's certain bacteria that when they cross into the body when they're not supposed to they trigger the immune system and they trigger this not supposed to, they trigger the immune system. And they trigger this autoimmune process. And they trigger that inflammation. And then the body gets confused.

And it starts fighting off its joint space when it's not supposed to. Yeah, and there may be genetics. Like the gene, I think it's DR4 or something, which is associated with increased susceptibility to rheumatoid arthritis in the face of certain gut infections. And we know this from medicine. We were trained in medical school that if you have certain bacteria, like Yersinia, you can get arthritis. Or if you have Entamoeba histolytica, which is a parasite, you can get rheumatoid arthritis. So we learned this as traditional medicine doctors, but we sort of don't pay attention to the fact that it may be more broad

than that. And I think, you know, you also mentioned the overgrowth of bacteria. So I think people might be wondering, well, isn't there a ton of bacteria in your gut anyway? What's the big deal? Right. So, but there's some bacteria that are good. I mean, we can put them in the category of good and some that we don't think are as good and that have been associated with inflammation in the body and autoimmunity. So it's really, it's all about balance, right? It's all about balance. And sometimes the bacteria can go where they're not supposed to go, right? Absolutely. So like the small intestine is where you get most of the leaky gut. And what happens is sometimes those bacteria that shouldn't be there kind of migrate up into the small intestine, which is like 22 feet, and then start to grow. And then when you eat them,

sorry, when you eat certain foods, it causes that food to ferment because the bacteria is there. That's where you get the food baby and the bloating and the distension. And that's a big clue for people. If you have bloating after eating. Yes, that is a big clue. You know, it's not normal. You should not know you have a digestive system until like two minutes before you have to go to the bathroom. You go to the bathroom in five minutes or less and you're done. That's it. But people don't realize that, constipation, the bloating, the weird bowel movements, the diarrhea, the irritable bowel, it's so common. Yeah. So for this woman, we did, of course, the 5R program. We removed gluten.

We removed those bacteria. We used an herbal protocol. And then we re-inoculated, right? We gave a lot of the good bacteria, the pre and probiotics, and we did a lot of nutrients just to help her body heal, right? The vitamin A, the zinc, the colostrum you mentioned before, and really worked with her to help with managing her stress. And, you know, she was able to avoid the biologic medication. Her joints got better? Her joints got better. Her energy got better. The inflammation in her body went down. She actually lost a bunch of weight as a side effect. She was happy with that side effect.

Yeah, it's a good side effect. Yeah, she was happy with that. So she really got much better. So it was exciting to see. Hey, everyone. It's Dr. Mark. Something I get more and more excited about every year is personalized medicine. When I began practicing functional medicine over 20 years ago, it was clear to me we have to look at how unique each body is. Now with the technology advancing in amazing ways,

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the things that you sort of discovered on your own. And I think it's sort of shocking for people to understand that traditional medicine just doesn't even talk about this, right? Right. They're so focused on the cancer at the acute time, which is important, but we've also got to really work on, let's prevent it from coming back. Let's prevent it from coming in the first place. And the dietary advice is terrible you get in cancer centers. I have a friend who was a top radiation oncologist at MD Anderson, which is like the top cancer center in the world. And he was like, our nutritionists, I'm just struggling because they say,

if you have breast cancer, don't eat tofu, but you can load up on ice cream. Right, which is so backwards. Eat the tofu, forget the ice cream. They don't say stop drinking wine or don't eat ice cream or sugar, which is driving the cancer cells. Right, right. Creating a terrain in the body, which is feeding cancer, right? Right. So absolutely, we're looking for all those things that may create a terrain that will feed cancer, whether it's high insulin, high blood sugar, high insulin levels in the body,

high inflammatory markers, so high inflammation in the body, which will drive cancer. Yeah, cancer's inflammatory. People don't realize that. Absolutely, right? So we look for that. We test for markers that measure inflammation and then try to figure out why is there inflammation and what can we do to lower it. For some people it might be the insulin resistance that's driving the inflammation.

For somebody else it may be the gut and imbalances in the microbiome that's driving the inflammation. So we really want to look deeper. Or toxins. Absolutely. So when you go to a traditional oncologist, they're just looking at the pathology. They're not looking at the biology, right? And they don't actually look at the terrain, which is your nutritional status, your stress level, your level of toxins, your sleep, your microbiome, your genetics around. I mean, they look at some genetics, but it's not the

kinds of things we look at, which are more functional things. And not the BRCA gene, which is, you know, it's interesting, you know, the BRCA gene, you know, back in the forties, they sort of had records around this. And then, you know, the risk of cancer was like 30% if you had the BRCA gene. Now it's like 70%. Why is that? Same gene, because the environment's different. Our diet's different, toxic load is more, stress is more, all these other variables are affecting the gene expression. So even if you have the genes, you're not necessarily predestined to get something. Right. So we call the BRCA gene like a high impact gene, right? It increases risk substantially of breast cancer, but so many women don't have the BRCA gene and still go on to get breast cancer. So we also look at these low impact genes, genes that, you know,

we can really influence with the environment. Genes that, you know, that aren't going to cause a huge increase in risk of cancer. But if you've got multiple different ones together, they can influence your risk. And what's most important with those low-impact genes is we can really influence how they express themselves with our environment. So we can influence the expression of some of our genes by eating a diet that's really rich in our cruciferous vegetables and sulforaphane. The broccoli family. Yeah, the broccoli family. And we can maybe influence how these genes work by different supplements or different changes in diet.

So like I had a woman who came to see me. She was 42. And she had an estrogen receptor positive breast cancer. And she went through surgery. And then they did tamoxifen and she came to see me because she wanted to prevent this from coming back, right? So she's like, I really want to figure out why this happened and want to prevent it from coming back. And so we did multiple different, you know, evaluations on her. And one of the things that showed up was when we did some

genetic testing, again, those lowact genes, we found a variation in the COMT gene. And the COMT is a gene that encodes for this enzyme catechol-ol-methyltransferase, which is that. It has to do with what? Yeah, it has to do with methylation, right? But it's been found that methylation just means the transfer of these methyl groups, which come from a lot of our folate, our B vitamins, like folate, which is in all of our foliage, our green leafy veggies, you know? There's a carbon and three hydrogens that has to be shared between different chemicals in the body. And if it's not working, you get all kinds of problems, whether you get cancer, you get dementia, you get heart disease, you get depression.

So these have to be working. Yes. And so if this enzyme doesn't work as well because of your genetic predisposition, then your estrogen in your body doesn't get broken down and gotten rid of as well. It can become more cancer producing. It can change in a way that's less healthy for the body. And so we know that we can influence that gene when we give a diet that's rich in folate, all those green leafy veggies. We can sometimes influence that gene with, we often give like methylated B vitamins.

I think this is- Special forms of B vitamins. When you go to your grocery store, you get folic acid or B12. It may not be the right form to actually activate these things or to bypass these enzymes that aren't working so well in the body. Yeah. I mean, we have a concern about folic acid, which is the synthetic form of folate. So folate can be what we get in our food, right? Our foliage, our green leafy veggies, lots of other foods too. There's a synthetic form called folic acid, which actually has been associated with maybe an increased risk of cancer. There's some concern about this synthetic form. And that's found in a lot of not the highest quality, not the vitamins we use, right? So it's found in some B vitamins and multivitamins that we're not going to choose to use

because for some people, they can't utilize it in their body. What you really want to look for is a methylated form of folate. So this type of folate that's activated, that's found in a lot of our food. Like when we're eating folate-rich foods, it's going to be high in this methylfolate. But if you're taking your supplements, if you're taking a multi or a B complex, you want to look to make sure it's a methylated form of folate.

Because the body, for certain people, that's more necessary than others, but the body has an easier time utilizing it. And that helps with this whole estrogen metabolism process. And just to back up on that, some people think there's something called estrogen. There isn't. There are estrogens.

Yes, that's true. And they're all a little different. And some are more prevalent in early life, some in reproductive years, some in menopause. And they all have to be metabolized by the body. And it's sort of like going down a pinball machine. You don't know where it's going to go. And some people don't have good detoxifying mechanisms for all this estrogen. And then they get sort of estrogen toxicity. And I think, you know, one of the things that's really striking

about what you're saying, particularly in terms of breast cancer, is that, you know, this woman had estrogen receptor positive breast cancer. And what that means is that this is an estrogen sensitive breast cancer. It feeds on estrogen. Right. And so the beautiful thing about functional medicine is that we can one test for all these metabolites and figure out how to change the pinball thing. So it's going down the right pathway to be anti-cancer versus pro-cancer. And we use lifestyle diets, supplements, all kinds of things to do that. But what's really important to understand is that a lot of us are out of balance and we have imbalances in our hormones and we make too much estrogen and maybe not a progesterone. And that leads to symptoms of estrogen overload. And I remember, you know, medical school wasn't a very

nice way to talk about patients, but we remembered how do we remember the profile of someone with uterine cancer? Fat, 40, and fertile, right? Right, which is essentially saying high estrogen. And if you're overweight, you make higher estrogen. Right. Obesity is linked to cancer. It's linked to breast cancer. You know, insulin resistance and prediabetes is linked to breast cancer and many other

cancers. We have this enzyme, aromatase, in our fat cells. And aromatase takes other hormones and turns it into estrogen. And this happens in men and women, right? So when you have more fat cells, you have more aromatase, and so you have more estrogen. And so that then is why, or maybe one of the reasons why, that obesity, having more fat cells, is linked to estrogen-related cancers, which would be

breast, uterine, prostate, is definitely related to this higher estrogen level in the body, for example. So one of the things everybody can do is make sure their body fat percentage is lower. Yeah. Right? Because that helps with lowering estrogen levels. And we actually have a whole strategy for when assessing this in functional medicine which is not what your traditional doctor will do if you go to breast cancer treatment and we have a whole strategy for how to balance out your hormones right yes so things like diet exercise stress reduction working on your microbiome yes the right nutrients getting toxins that screw up your hormones, all these things

fixing your liver. Right. These can all really help. Fiber. Yeah, we really want to pay attention to those xenoestrogens, right? Those are those toxins from the environment that act like estrogen in the body. Yeah. So those are environmental toxins, things we know about like BPA, plastics, parabens,

pesticides. So you put your sunblock on, you get all these parabens, maybe you're causing cancer. Right, right. And because they can bind to their xenoestrogens, they're chemicals from the environment, but they can bind to the estrogen receptor in the body. So they're like hormone mimickers. Yeah.

And they're effective and powerful at extremely low doses. So I'm not that exposed to pesticides or like any damage parabens or whatever. They work in a microscopic dose to have a macroscopic effect. Yep. And they're synergistic. So people say, oh, this one chemical, maybe it's not so bad in animal studies. But we're exposed to hundreds and maybe thousands of these chemicals all at the same time. And our different

abilities to detoxify them affect our risk. And particularly in cancer, we know that these chemicals are associated with cancer. So how when someone comes in with, let's say, breast cancer, what are the kinds of tests we'll do? What are the recommendations you'd make? And you have a whole incredible DVD I encourage everybody to get. Tell us about the DVD. So it's called Breast Wellness and it's tools to prevent and heal from breast cancer. And it looks at the functional medicine approach to breast health. And where can they get that? They can get it at my website, drboham.com. They can also download a free ebook there. I think it's also on Amazon and Vimeo. It's everywhere, right? Actually, it's on our ultrawellnesscenter.com too, yeah.

So what do we do? But so you're looking at that comprehensive approach and treating that individual patient, right? And, you know, we're focusing on, is there toxins that we need to lower? You were mentioning that aspect of toxic load, which I think is really important, you know, because we know that sometimes it's not just one toxin, but it's a little bit of a lot of different toxins. So we can look at things, we can measure things like, is there high oxidative stress, right? That's like free radicals, right? Yeah, right. Which would indicate, which would indicate an imbalance between the antioxidant levels in the body and the free radical production, right radical production. So sometimes when somebody has oxidative stress,

that just means that they've either produced too much free radicals because of toxins or infections, or they don't have enough antioxidants, right? Because they're not eating enough of the phytonutrients that are the plant foods that are rich in antioxidants. And when we see that, when we see that oxidative stress, which we can measure, we really work to lower it with a phytonutrient rich diet. Sometimes we then have to look to see, well, why is it high in the first place? Right? That's asking that question. Is there some infection? Is there some toxin? Because you've

got to figure out why so that you can help with- Insulin resistance, prediabetes. Insulin resistance, yep. Weight, that belly fat. Gut issues. You know, you talk about how you measure the poop of patients with breast cancer. Why is that relevant? Right, because there's... I know, right?

Like, how is the poop connected to... Well, there's a microbiome in the breast. Yes, right. And they're finding that the microbiome in the breast is different in women who have breast cancer. So there's so much more we're going to learn here. But in the gut, we know that if there's an imbalance in the microbiome, there can be an imbalance in this enzyme called beta glucuronidase. It can increase, which can then lead the body to absorb back more of the estrogen and then put you in this situation where you're more estrogen dominant or overloaded. So basically there's like

overgrowth of these bugs that shouldn't be there that produce this enzyme that then when the estrogen is detoxified by the liver and dumped in there in the bile which is how your body gets rid of excess estrogen it sort of unpacks it a little bit and then you end up reabsorbing it and so you get this increased reabsorption of estrogen, high levels of estrogen in breast cancer. So we're looking at that level, we can measure that, and we can measure just the imbalances in the microbiome, which are impacting that level as well as multiple other things in the body. Yeah, I mean, you know, given the view of functional medicine, which looks at root causes and systems, you know,

the fact that antibiotics cause breast cancer is not a surprise. No. And I had, as a kid, I was on multiple rounds of antibiotics for urinary tract infections again and again and again. And then that just was probably the thing that along with some of my genetic predispositions and, and, um, and, uh, some toxins, you know, really allowed my body did not work in an optimal way. Yeah. You know? Yeah, it's so powerful. So we actually, through things like lowering sugar and starch in the diet,

through things like adding certain fibers to help with gut flora, things like certain anti-cancer foods like flax seeds. Yep. We can actually, and broccoli family vegetables you were talking about, we can really have an impact on exercise and stress reduction. We put together a whole plan for people. Yes. It doesn't leave them feeling so hopeless and helpless.

And like, I just have to wait around to my next scan or my next mammogram and cross my fingers and stress out for the next six months or a year. Right. You can actually be empowered to understand what your biology is doing, what the imbalances are, how to fix them. And is there a guarantee you're never going to get cancer?

No. But you're stacking the deck in your favor and you're understanding the imbalances that are driving cancer and you're changing the soil. Changing the soil. And that actually won't allow the cancer to grow. Yeah.

Right? So that's a really powerful model that should be part of traditional oncology. And there are some centers of oncology that are integrating this. Yeah. But it's unusual. Yeah. So let's take the next, you know, a little bit and talk about the next case of a patient who hasn't had cancer, but was terrified because it was tons of cancer in their family.

Right. So this was a 48-year- year old gentleman and he had not had cancer yet, but he had a sister with breast cancer. There was stomach cancer in his family. There was colon cancer in his family and prostate cancer. And so, you know, he wanted to do whatever he could. He wanted to create that terrain where cancer was less likely to grow. And we also did genetic testing with him. Again, not the big genes, but some of those low-impact genes. And we found a variation in one of his genes called the GSTM1, or glutathione S-transferase gene.

Yeah, I got that problem. Yeah, and me too. I'm in that club too. Well, it's interesting. People who have this specific gene actually are much more likely to be in hospitals and sick and have issues right and just to back up before you get too much more into i just want to sort of help people understand you know what genes are so you have like 20 000 genes and it's basically this genetic code

that is a three-letter code is a gene. So you have, let's say, four letters. You know, computers are one to zero. Your biology is four, like it's four, A-C-T-G. So if there's a variation in that code, it may not be a mutation. It's just a slight variation. In America, we spell color C-O-L-O-R. In the UK, they spell C-L-O-U-R.

It's similar, but it has different effects. And that is something we can do something about, right? If you have the gene for Down syndrome, you can't do much about that, right? If you have a gene like for the glutathione, you can influence its function, hence functional medicine, and change the way those genes are expressed through things like diet and exercise and lifestyle and supplements and detoxification, all kinds of strategies that we use. And so we check genes that typically aren't checked and we see where does this person have the potholes and how do we help them avoid them? Yeah. So this, you know, glutathione is this master antioxidant and detoxifier in the body. And we know,

like you mentioned, when people have a defect in this gene, in the GSTM1, they don't tolerate toxins as well from the environment because their body is not as able to make as much glutathione and then use the glutathione to get rid of the toxins. Yeah, so glutathione is like sulfur, smelly, sticky. It's like flypaper. And all the nasty toxins stick to it and then your body gets rid of it. Yes. But if you have low levels, you're screwed.

Right, right. Like me. And one of the reasons you can have low levels is because you have some variations in these genes. And so for people like that, we really want to support. We really want to support. I mean, we want to support detoxification with everybody. But with those people, we really focus on supporting how well they can produce glutathione. And so we will really focus on things like sulforaphane.

Sulforaphane comes from your cruciferous vegetables and it helps the- Broccoli, collards, kale, Brussels sprouts, cabbage. This is like basic stuff in food that actually has powerful anti-cancer compounds. And sulforaphane is one of those. We've studied at Johns Hopkins. They have supplements you can take. We have that on our online store. It's really effective. Yeah. That's actually one supplement I take every day. I mean, there's a bunch I take every day, but that's one I always take because it really, it helps the body with production of that glutathione. And that really, as we said, helps with pulling those toxins out of the body.

And there's other stuff that you could take, like aside from, you know, things like garlic and onions and the cruciferous vegetables. There's a lot of supplements we use in functional medicine that, you know, they're not replacements for a healthy diet, but they have helped to produce different molecules in the body and help different functions yeah so n-acetylcysteine right is one of the building blocks of glutathione and helps increase it in fact you know when i was in the er as a doctor because i worked in the air for years i learned that if someone came in with a liver failure from Tylenol overdose. Yep. We gave him this, quote, drug, which was called Nucramist or N-acetylcysteine, which smelled terrible, tasted terrible.

We made him drink it. Yep. I guess a suicide attempt wasn't enough. And so when I started doing functional medicine, I'm like, wait a minute. This is incredible. This is just a supplement that you can get in the health food store. Yep. And they even are studying it for kidney failure that's caused by dye when you get an x-ray.

Right. And they actually can prevent kidney failure by giving them this, you know, cheap supplement. And I see, right. Yeah. Yeah. So it's really important. I mean, I think that's really important about supplements. You know, I think that what's really, they can be so beneficial when they're targeted and used

for that individual person and what their needs are. And I think that's really sort of a take home here with supplements is that, you know, we can't, well, some people take the kitchen sink. They take a lot of different things and just hoping that one of them is going to be the right one for them. But one of the things we can do, especially with some of this genetic testing we're talking about and some of this evaluation that we're looking at from a functional medicine approach is we can really focus on, okay, for this individual person, what are the ones they

really need to focus on? What's the food they really need to focus on? What are maybe some supplements that they need to focus on to help them get to their optimal health? And that's, I think, when we see them work even better. Yeah. And there's amazing stuff that also is being looked at in terms of detoxification and cancer treatments like high-dose vitamin C IV, which we do at the Ultra Wellness Center, can be

extremely effective as an adjunct treatment to traditional cancer therapy to reduce the risk of the cancer not responding to the chemo or afterwards to prevent it from coming back. So there's so much that can be done. And I think, you know, one last point I want to make is that, you know, we think of the tests we do in medicine as prevention. So a mammogram is prevention. Colonoscopy is prevention. A prostate exam is prevention. They're not prevention. They're early detection. So you have to actually already have the problem before you find it positive, which is good. It's a screening test and you find it early enough, you won't die. That's great. But it's not true

prevention. And what we're talking about in functional medicine is true prevention. Whether you've already had it and you want to prevent it from coming again, or you have a family history you're worried about, you actually can map out what's wrong and fix those things. And it makes a big difference. We now know a lot about metabolism and weight and all the various factors that go into affecting it and how to fix them, where we necessarily didn't know a lot before. But now the more and more we're knowing, we can actually figure out how through food and various strategies help people lose weight. So I want to talk to you about a few cases you had that were interesting about how we saw these patients at the Ultra Wellness Center and what exactly you did to help them figure

out their issues. Yeah, yeah, yeah. So the first person that came in was, or one of the women that came in, she was 55. And she had, she was overweight, about 40 pounds overweight. And she had noted that, you know, her kids had just gone off to college. It was time for her to start taking care of herself. But she had noted that, you know, over the years after her pregnancy, she just slowly started to gain weight. And, you know, she was exercising and taking care of herself.

But, you know, those 30, 40 pounds just slowly came on over the years. And what we noted with her, we did her waist to hip ratio. We saw her waist to hip ratio was elevated, indicating that there was insulin resistance. We also checked a fasting insulin. We saw that it was high, also indicating that insulin resistance. We saw that- When insulin's high, you can't lose weight because it locks the fat in the fat cells. It slows your metabolism. It makes you hungry and crave carbs. And it makes your body store fat. So you're literally creating a total chaotic sabotage of your body when your insulin levels

are high and you're eating all the starch and sugar. Right. So we had to figure out how do we help drop her insulin levels, right? How do we help drop her insulin levels? Well, you know, you can do that when you shift diet because we know that when we eat fat, right, the body doesn't need to make insulin to use that fat. So when you eat carbohydrates, your body makes insulin, you know, and when you eat a lot of the refined processed carbohydrates, your insulin levels spike. So when we shift the diet to one that's a little lower or a lot lower in the refined and processed carbohydrates and more healthy fats, that helps with people with feeling better and not feeling so hungry.

It helps prevent those insulin spikes and it helps us not gain as much weight around the belly. Yeah, it's so important to focus on insulin. And most doctors don't even test your insulin. So you don't even know what it is. Right. But if you check it and it should be less than five, you're good.

And if it's over 10, it's pretty bad. And it can go up to 50, 100 or more. And especially after you eat, it can get worse. Right. And I wish we had a little monitor where we could quickly measure insulin for people. Yeah, we measure it all the time. Like a continuous or more, and especially after you eat, it can get worse. And I wish we had a little like monitor where we could quickly measure insulin for people, like a continuous glucose monitor, a continuous insulin monitor. I think it would be way more interesting. I agree. And I think that, you know, we actually know how to fix it. And, you know, people need to realize

that without insulin, you can't gain weight, right? If you take a type one diabetic whose pancreas is damaged by an autoimmune disease and you look at their symptoms, their weight loss and hunger, they're eating 10,000 calories a day and losing weight. Why? Because without insulin, you can't store the fat. Right. So this is really important people understand. It's so powerful. And that's why strategies that help fix insulin are so key for weight loss for most people. Yeah. Yeah. And, you know, we were so, you know, 20 years ago or so, we were so programmed on that pyramid,

right, where we were making sure we were getting enough grains and... Oh, yeah. Six to 11 servings of bread, rice, serum and pasta a day. That seems like a recipe for disaster. Yeah. And so it really, it caused a lot of high insulin for people and they're having a harder time with, they're feeling hungry all the time and they're having a harder time with weight loss because of it. So sometimes people get really surprised when we pull away, either pull all away the grains or keep them very minimal. They're like, really? I thought I was supposed to eat all of these, right? And that can help, really help with those cravings.

It does. And getting more fat. Yeah, and getting more fat. You could eat so much fat and not gain weight because we used to think that fat made you fat, right? Because that has nine calories per gram versus four for carbohydrates or protein. So if you want to cut out the calories, you just cut out the fat. Yep. Well, that's what happened.

We cut out the fat and had a low fat craze or low fat salad dressing and low fat snack well cookies and low fat muffins. And they were all full of starch and sugar. Yep. And that was the worst thing that could have happened. So when you eat fat, you don't increase your insulin. You actually speed up your metabolism. There's that study by our friend David Ludwig where he basically gave people food. So he knew what they were eating. It was either 60% carbs, 10% fat, or it was 60% fat and 20% carbs. And on the 60% fat eating exactly the same amount of

calories every day, the metabolism increased on a high fat diet. So doing the same level of activity, the people who are the most overweight and insulin resistant, their metabolism increased by 400 calories a day. That's like running over an hour a day without getting off the couch. And that would account for the entire obesity epidemic if we could fix that. So this is a really important strategy. Yeah. And so she then lost, her numbers came down beautifully. Her blood pressure was a little high and it came down. Her insulin came down and she lost about 10 pounds. But she then got a little bit stuck. And I think that's where we shifted things a little bit.

And I think sometimes that's really important is that sometimes the body gets a little used to a certain plan and you have to change things up. And I think that's where intermittent fasting can be really helpful. And so we put her on a program, it's called a 5-2 program, where two days a week she cut down her calories significantly. You know, it was like 500 to 600 calories on those two days because she was really not eating very much on those two days. And she could pick whatever two days she wanted. And the other five days she wasn't as strict. And that's when, you know, her body started to kick in and her metabolism improved. I think probably because of the impact on the mitochondria,

you know, but it was impressive. Well, let's back up and talk about this because, you know, I think there's so much information now online and the media about this whole intermittent fasting thing. And there's lots of different terms like time-restricted eating, intermittent fasting, and fasting-mimicking diets, and ketogenic diets. And it turns out they all do the same thing. And so tell us a little bit about each of these and how they work and why they're so effective. Right. So, you know, time-restricted eating just

means that you're not eating for specific periods of the day, or you are only eating for certain times of the day. So a typical way that somebody will do a time-restricted eating plan is say, okay, I'm only going to eat for eight hours in the day and I'll eat between between 11 and 7 and you fast for six and then you fast for the other 16 I mean even just 12 is good most people eat all day eat all up to the time they go to bed and then they wake up and they like you know eat again I think you're absolutely right I think that is a great place to start with everyone. Because if we can just get people to not eat after dinner, right, they will, their things will improve. Because we know that the food that we're eating later in the evening, that nighttime eating,

will cause more of an insulin spike, right? So we know that that's really important to pay attention to. So saying to people, okay, let's try with at least not eating for 12 hours a day. So, you know. Then you move to 14, then to 16, right? Yep. But, you know, and not everybody needs to go longer, but there's good research with the 12 to 13 in terms of helping with longevity, helping decrease risk of cancer. There's some interesting research on breast cancer and not eating for 13 hours at night.

So I think that that's something that we can really work with a lot of patients to do and say, okay, let's say at six to seven at night, that's when you stop and not eat until the next, you know, the next 7 a.m. time or whatever that is for them. Yeah, there's so much research on this now, you know, and they all do similar things, whether you're time-restricted eating, whether you're intermittent fasting, like, you know, fasting one day a week or the 5-2 program, or whether you're, you know, trying a ketogenic diet, which activates the same systems in the body. All of it does the same thing. It enhances your energy production, your mitochondria health, which is really important. It fixes insulin resistance and gets rid of belly fat.

It builds muscle. It improves your brain chemistry and your cognitive function. It helps your bone density. And it even helps production of stem cells. It reduces inflammation and it reduces your antioxidant burden. I mean, it reduces your oxidative stress. You get more antioxidants produced. So it's a very powerful way of focusing not on what you're eating or how much you're

eating, but when you're eating. And that's a very interesting angle that we really haven't focused on. We always focused on how much, and then we're now focusing on what, because not all calories are the same. And now we have to focus on when. And I think that's a really important thing for people to understand that you, you, there's a lot of ways to hack weight loss that have to do with the right kind of approach. And, and if you're not doing it right, you can kind of get in trouble because, but you need to know what you're doing. And I think there's a lot, uh, that we can share about this and we'll share at the end about how to actually do this. So that's a key thing. So what other things, you know, we had this other patient that you had that was a male who really struggled. He was overweight, about 40 pounds. So tell us about him. Yeah. So, you know, he came in and he

was 55 and he was really struggling with his energy. He was very low energy. He was really frustrated with his sexual function. He noticed he had a low libido. He was having some erectile issues. He had gained these 40 pounds around his belly, but he was really having a hard time with losing that weight. And the higher your belly fat, the lower your testosterone. Yes, because that belly fat has that aromatase enzyme, which takes your testosterone and converts it into estrogen. Yeah, and then they lose the hair on their body. They get man boobs, right? They get breasts.

You know, it's a real thing. It's a real thing. And it's a great motivator for men, right? We know that as your waist circumference goes up, so does issues with erectile dysfunction. So, you know, but we need to give them the tools to be able to lose that weight around the belly, right? So he had all these other issues and you, you know, you sort of figured out that he had insulin resistance too, that we were talking about.

Yeah, I mean, the first thing, the first thing we did with him was put him on like that 10-day reset that you've put together, which really I think is a great jumpstart for people because it can help them say, okay, I'm just going to – I got to try this, but I need the tools. I need the map to do it. Yeah. And it's really motivating because many times, because people were eating inflammatory foods before, or they were eating the wrong foods at the wrong time, right? And they do this and they notice a significant improvement in how they feel. And then they're like, okay, I can really

shift this. I can make a change. So we did that before any tests came back. And the 10-day reset is based on what we've been doing in our center for decades, which is anti-inflammatory, low glycemic, higher fat, phytochemical rich, fiber rich diet. It actually helps to reset your whole biology, not just about weight, but any chronic illnesses or symptoms you have is so effective. Right. Because you're pulling away the inflammatory foods, which for a lot of people, those inflammatory foods are triggering a lot of their...

Right. So it's not like you're suffering. Right. And he felt really motivated. He was really happy. But he actually had a lot of other things going on. So he had lost some weight, but then we also noted, through questions, we found out that, okay, he might have some issues with sleep.

Yeah. He was snoring. His blood pressure was a little high. He had all this waking. So I said, you know what? We really need to get a sleep study on you. And so when we did the sleep study, we found out that he had sleep apnea and you know, so common and underdiagnosed. Yes. And sleep apnea where, where people stop breathing in the middle of the night, even though they don't realize it, right? They're snoring and then they have episodes of apnea where they don't get any oxygen into the body.

That in and of itself triggers insulin resistance. So that causes high levels of insulin in the body, which then, as we've been talking about, causes us to gain weight around the belly. So wait a minute. So what you're saying is if you don't sleep, you get fat even if you don't change your diet. Absolutely. Yeah. This is something people need to realize because people think it's, again, it's about what you eat and exercise. And yes, it is. But there are other factors that have to be looked at that most doctors miss. So often when somebody has sleep apnea or

might have the signs of sleep apnea, you know, they think, okay, I'm just going to lose weight and then it will go away. Right. But so often it's the sleep apnea that's causing the weight gain. And you know, of course it becomes a vicious cycle, but that sleep apnea causes high levels of inflammation in the body and it causes high levels of insulin and it just causes us to put on weight. And it also is one of the biggest causes of high blood pressure. Absolutely. I remember this one guy I had, it was like a lawyer, he was in his fifties and he's like, you know, Mark, I have to work at my desk, but I have a standing desk because, and this is before standing desks were popular, because if I sit down, I fall asleep. And I'm like, you fall

asleep driving home, you fall asleep watching TV, you snore. He's like, yeah, yeah, yeah, yeah. I'm like, you need to have sleep apnea. Let's get you tested. We got him a sleep apnea machine. He lost 50 pounds. Just boom, like that. Putting on a sleep apnea machine every night. Right, right. Because you're actually getting oxygen into the body. So the body's not at stress anymore. And so the insulin levels come down, the inflammation comes down in the body, and then the weight comes off. I think when people have undiagnosed sleep apnea, when it's not being treated, we can do all these great things in terms of shifting their diet and putting them on an exercise regimen and looking for other issues. But if we don't deal with that, it's almost like

I always say to them, it's like you're running against the wind. You're not going to get to your goals. And so we've got to deal with the sleep issues. And like you said, it's so common. And this guy didn't just have sleep issues. He had the insulin issue, he had sleep issue. His thyroid wasn't right, right? Yep, exactly. We checked his thyroid and he had some elevated TSH. He had some low thyroid and he had some thyroid antibodies that hadn't been discovered before. So then we dealt with all this autoimmune stuff going on. And so we took him off of gluten. Well, he was already off because of the reset, but we kept him off of gluten. And so we were working on every aspect of his health. And that's

when he got to his goal weight, right? When we worked on every aspect of his health. And that's when he got to his goal weight, right? When we worked on every aspect of his health. And we helped him also get on a diet that he could maintain forever, right? Which is what the goal is. It's so true. And it's important. We often joke, we say we're holistic doctors because we take care of people with a whole list of problems. And it's often not one thing, it's many things. And, you know, everything's so solid in medicine. So there's a sleep doctor, there's a thyroid doctor, there's a weight doctor. It's like, forget it. You know, in functional medicine, we take a step back and we look at the whole system and we're able to map out. And this is this one guy, another guy who's overweight might have different issues, right? And so we might have to look at

their toxin load or their gut microbiome or their, you know, levels of nutritional status that affect their metabolism. So, you know, we really, really have a very sophisticated lens to look through, to understand what are all the imbalances and all the systems of the body and how they affect any different disease. The truth is, you know, we have so many different illnesses that we diagnose in medicine, but they're all connected by very common root causes. Just like you can send a man to space with an incredibly few simple physics laws, right? Very few laws of physics, and they actually can help you do something incredibly complex. The same way the human body has some basic laws of biology, and we follow those laws, we can help people get better.

It's just learning how to unlock all that. And that's really the beauty of functional medicine. One of the first things we always start with, of course, is dietary changes. So, you know, we'll either put somebody, depending on their history, their story, and where they are and their level of motivation, we either put them on a dairy-free diet or we put them on a gluten-dairy-free diet, or we might put them on a low FODMAPs diet. So FODMAPs, you know, maybe people have heard about FODMAPs. And so it's important for us to just sort of delve into that a little bit. Yeah. What does that mean? What does that mean? Yeah. So FODMAPs foods are fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. And so these are these carbohydrates

that are not completely absorbed for some reason, either because of some maldigestion or just because they're harder to absorb carbohydrates. And then when there's the wrong bacteria in the wrong place, they consume those carbohydrates and produce gas. So, you know, so the oligosaccharides, those are things like wheat and rye and onions and garlic and legumes. Disaccharides are things like lactose and dairy. Monosaccharides are things like fructose, like high fructose corn syrup, like you mentioned, honey and apples. The polyols, those are things like sorbitol and mannitol, the artificial sweeteners and some fruits contain some of these polyols. And so, one of the first things we do is say, okay, maybe we should try a low FODMAPs diet for a period of time. So there are some foods on this list people off of these, these carbohydrates that are fermentable. And, um, and then over time working to reintroduce the,

the healthy ones for that person. Um, the Monash university has a really good website, lots of good resources on FODMAPs foods. And, um, but, but in general, you know, you pull away things like wheat and rye and onions and leeks and cauliflower and apples and dried fruits and sugars and high fructose corn syrups and legumes. And, and, um, you do that for a period of time. Um, not everybody needs to go to that level. And, um, and, and for many people, it's important that they work with somebody who's a nutritionist or somebody who can help them navigate the world with this because it can be, like I was mentioning earlier, you got to figure out what you're able to eat. So let's talk about some of the other sort of approaches besides the dietary restrictions

that we would take. We might get off gluten and dairy, get off grains, get off beans, get off sugars, get off all the things that you mentioned. Then what do you do for the bad bugs? How do you reset the gut? How do you sort of rebuild the gut? Oh, great question. So depending on what's going on in terms of the dysbiosis, right? Dysbiosis just means imbalance in good and bad bacteria and yeast. And depending on what we find is going on, we will treat that. And so we can treat that with a prescription medication. So sometimes we'll use an antibiotic. I know that sounds kind of crazy because you're like-

Counterintuitive, right? Yeah. We're like, wait, we know antibiotics cause dysbiosis. True. But sometimes if people, depending on their level of symptoms, they do, you know, we can improve symptoms with a short course of a non-absorbed antibiotic. So sometimes we'll use an antibiotic for a period of time and then we'll use an antifungal medication. Because you always follow the antibiotic with antifungal? Yeah. I mean, I often do. And again, it depends on what I find with the testing we do

through stool testing and breath testing and their clinical situation. So I often will follow with an antifungal or I'll follow with an herbal medication that includes, there are many different herbs that they have affected both treating bacteria and yeasts. So we can use some herbal regimens. There's a lot of good ones out there that will treat both bacteria and yeast overgrowth. And that's one of the nice things about herbal regimens, I find, is that when you're resetting the bacteria in the gut and the yeast in the gut, they may be a little slower to act, but they sometimes are really effective long-term.

So there's a few herbal regimens that we use very often and some have been really well studied. We also do things that help the body with digesting your food. So whether that's something that increases acid in the stomach like betaine HCL or a digestive enzyme, there's digestive enzymes that are plant-based digestive enzymes. And then there are other digestive enzymes that are, you know, that comes from their porcine, their glandular digestive enzymes. Those things help with, yeah, breaking down your food, your protein, your carbohydrates. They help with breaking them down so that they're not, that they're easier to absorb into the body and less likely to feed the dysbiotic bacteria that we were talking about.

So that's also really helpful. So I think the unique thing about functional medicine is that you not only just get rid of the bugs, but you focus on resetting the whole gut. And whether it's an antibiotic, an antifungalgal and herbs, and I would love you to talk about what herbs, or then you add in enzymes and other pre and probiotics and repair components for the gut. It's what really helps people get better. Right. So tell us about, tell us about the cases. You had a 35 year old guy, had quite a remarkable story. Yeah. So, you know, there's this gentleman, he was 35 and he came in to see us and he was,

he was really frustrated with his bloating. And, you know, he, what he said is that, you know, he felt fine in the morning. And then as the day went on, he became more and more distended. He became more, more bloated in his belly and distended. And so it's really important, as I said, that we get really detailed clues as to his history. He became more bloated in his belly and distended. So it's really important, as I said, that we get really detailed clues as to his history. What really helps many times is when people take that really detailed history and they think about their own timeline.

When did this start? How long has it been going on? Trying to help get the clues as to what, what triggered this to occur for them. Right. And, you know, so we knew that as a child, he had, he had ear infections. So he was on multiple rounds of antibiotics, but then two years ago he developed a pneumonia and he ended up the first round of antibiotics wasn't helpful getting rid of his pneumonia, and he needed a second round of antibiotics. And so we can also need to delve into this, you know, this risk for pneumonia here and everything. But it was, you know, those

recurrent rounds of antibiotics, at that point, since that point, he's been struggling with bloating. So, you know, he's been really, at that point, he started saying, okay, now every time I was eating, I was getting more bloated. And prior to that, he could eat whatever he wanted. He really didn't have to be careful with his diet at all. Now, he noticed if he ate too much dairy, he would get bloating and diarrhea. We did do a SIBO test and it was negative. But while we were waiting for his stool test to come back, we just decided, okay, let's pull away gluten and dairy. You know, he wasn't really ready to go on a full low FODMAPs diet.

And I didn't even know if it was really necessary for him right away. So we said, okay, let's pull away gluten and dairy. And when we did, he had significant improvement in his symptoms, but not complete improvement. He still would, he felt better, but he still was getting some bloating depending on what he ate. And so the stool test came back and it was really interesting. It showed a dysbiosis, right? It showed an overgrowth of many different bacterias and some yeasts. And so we then treated him with an herbal regimen. So we used something that had a combination of different herbs, oregano, berberine. It was a combination product. And he took it for six weeks and he found that extremely helpful. We did add in probiotics. We did wait to add in probiotics until we were done with his herbal

regimen. But once we did, we did add in like a general probiotic and, and there's so much to discuss with probiotics, but he, you know, he found that to be really helpful. And, and, and now he's back to, I mean, he's really is careful with dairy, but, and, and has a really good healthy diet, but he's really much more comfortable all the time now. So. Well, let's, let's talk about that. I mean, probiotics can be problematic. A lot of people are there to bow, they go, oh, I'm going to take probiotics. And they go to the drug store and they go to the health food store and they get

the probiotics and they take them and often they get worse. Yes. So can you explain that there's an important order to doing things and that what would be beneficial at one point might be harmful at another point? I think that's absolutely true. You know, order is really important. And, you know, if somebody does have an overgrowth of bacteria in the wrong place, sometimes probiotics make that worse, you know, and you can get, if you take a probiotic and feel more bloated or your digestion doesn't feel, it feels worse, not better, then that's the wrong probiotic or could be the right probiotic, but at the wrong time.

So it's really important that you're either working with somebody who knows how to recommend what order of things to do it in, or just knowing that if it doesn't feel right to you, put it on hold. There's lots of different brands of probiotics out there and quality of probiotics out there. Some probiotics have dairy in them. And so for people who are dairy sensitive, they don't work. Other ones don't. There are also some strains of probiotics that can, of themselves, depending on the milieu, increase the amount of bloating for certain people. It's hard for me to say, well, take this one because it doesn't work for everyone. But just know that if you try one and it makes you feel worse, put it aside. And it may be that it's just not the right one for you or it's one to try at a later date after you've gotten rid of the dysbiotic bacteria. Some people get a probiotic and they feel better right away. And then that's great.

Wow. Yeah, it's complicated. So if you're struggling with this, don't lose heart. There's a lot of things. I mean, you even mentioned histamine intolerance. There's a lot of things that cause problems, which we've covered a lot on the podcast. But the key is that if you suffer from bloating, if you have this food baby, if you're really miserable and uncomfortable, all that, there is a way to kind of get through it and fix it. You also, I think you had one other case of a woman who was 25 and was also struggling. Yeah.

So, yeah. I mean, she was also- Kind of classic history, kind of. Lots of antibiotics for, she had acne. So, she was on lots of antibiotics for, you know, between the ages of 17 and 22. And this is what we were talking about before. Her bloating was so significant at this point that it was preventing her from doing things. She wasn't, you know, getting out during the day. She wasn't seeing friends all the time. She also couldn't eat as much. So, um, and just with her body type, if she wasn't eating enough calories or enough protein, she was starting to lose weight and she was getting underweight. She was also losing lean muscle mass. And this then creates this vicious cycle, because if you don't have enough nutrients coming in, then the body can't heal. I always talk to

people about that. People are always restricting foods, which the elimination diets can be so helpful. But sometimes if we're eliminating, eliminating, I, you know, the elimination diets can be so helpful, but sometimes if we're eliminating, eliminating, eliminating, and then not getting an enough nutrition, then the body can't heal. And this is what was happening with her. She was eliminating so much that she was, um, she was, you know, she was wasting, you know, her lean muscle mass was decreasing. She was feeling more weak. Um, and she Because if you feel bad when you eat, you don't want to eat. And so you just didn't lose weight. So she was just not eating.

And she was more constipated. We did a SIBO test on her. It was positive. It was positive for both methane and hydrogen SIBO, but much more positive for the methane positive SIBO. And what we know- We'll talk about that. So we do this testing, which is you breathe in, you breathe in this,

you just drink this liquid that tends to cause the fermentation, right? And then you breathe into this bag and you can tell whether it's hydrogen or methane and each are different. And they actually respond to different treatments. So it's important to know which type of gas you're producing because that means it's different bacteria. And so you need different drugs or different herbs for different bacteria. That's so true. That's so true. So what we know is that the methane-producing bacteria are more likely to cause constipation, right? They're more likely to impact the motility in the digestive system and cause more constipation. And so the hydrogen producing bacteria are more likely to cause diarrhea. Now that's not always the case. Like sometimes people have, you know, their testing

looks one way and it doesn't always match up. But in general, we see the methanobacteria, the methane producing bacteria, more likely causing a constipation picture and bloating. And so you're right. So sometimes we, you know, the medication, there's a typical medication that is used, prescription medication that's used for SIBO called Xifaxan. But when you find the methane producing, it typically works better when you use it with neomycin together, you use both together. And she also did well when we put her on that low FODMAPs diet. We really pulled away. She needed a nutritionist on board because as we were mentioning,

she was becoming underweight. So she really needed somebody to guide her through. And as you know, at the ultra wellness center, you know, uh, where we've got all our nutritionists working with all our patients, which is wonderful. And so, you know, they, they were really, you know, her nutritionist was really helpful to, um, guide her through the pulling away of the foods that were making her feel worse, but then getting her the nutrition she needed. And then slowly transitioning over time so she could add back in those healthy, higher FODMAP foods, right? Like the onions and cauliflower and fruits that we want to be able to add back in when possible., after we treated her and got rid of that dysbiosis,

she started to feel so much better and nutritionally she responded well, right? She was able to digest and absorb her food better, which is really important because when there's that imbalance going on, you're not digesting well, you're not absorbing well, she was getting weaker, right? So she was able to, she was able to digest and absorb better and she was nutritionally getting stronger and healthier and her gut was healing and we could add back in uh those good healthy um higher FODMAP foods and she was able to tolerate it's quite it's quite amazing how many people really struggle with this and yes you know how hard it is for people to overcome this and how traditional doctors really aren't

that great at addressing this. And that there really is a new way to do this, more comprehensive way using kind of the approach of functional medicine and getting people the kind of support they need to kind of rebuild their whole gut. Because it's not just about taking the antibiotics and that's it. It's really about a whole gut healing and repair approach that's with functional medicine and also the right kinds of testing and everything. So I think it's super important to understand for people listening that this is not something you have to live with your whole life. This is not just who you are. That, you know, it's really, really important to

actually dig in and figure it out and get to the bottom of it. You made such a great point there, Mark, about the comprehensive approach. And I think that's what we need more of in healthcare. And it's really important in this situation that people get all of that comprehensive care with having a nutritionist on board, somebody they can check in with regularly, that's really following up with how they're doing and really digging in and finding that underlying root cause for them. It's so much more successful than that knee-jerk approach. One of the most common reasons that women have hair loss that's hormonally related with in terms of their female hormones is when they develop this process of

polycystic ovarian syndrome or PCOS and insulin resistance because their hormones shift in their body and they start to have higher levels of testosterone and DHEA. And so then their hair starts to change. They'll notice that they may have a receding hairline. They'll notice some thinning on the top of their head. They also may notice that they're growing hair in places that they don't want to, right? On their chin, on their belly. Their normal fine hair on their chin and belly is starting to get darker and harder. And they, you know, so that can be a sign. Let me say go bald and grow a beard.

It's just no fun. It's terrible. It's no fun. It's terrible. You get it in the places you don't want it and you lose it in the so that can be a sign. Let me say go bald and grow a beard. It's just no fun. It's terrible. It's no fun. It's terrible. You get it in the places you don't want it, and you lose it in the place you want it. Yeah, it's no fun. And so what you're saying is that this thing of insulin resistance,

and we'll get to about what's causing that in a minute, causes your testosterone to go up if you're a woman, and your DHEA, which is another hormone that's like an androgenic or male-like hormone that actually causes hair loss. So this isn't really a hormonal ovarian problem per se, right? It's not like a sex hormone problem, although it becomes that, right? We call it polycystic ovarian syndrome, but it's really a dietary problem.

Right, because it's driven by insulin resistance. It's driven by that high level of insulin that occurs when we're eating the wrong foods, when we're eating that really processed, refined carbohydrate diet, when we're eating a lot of high sugar foods. There are also some toxins that are associated with insulin resistance, like BPA, certain pesticides. So changes in the microbiome have been associated with insulin resistance, which is fascinating. But a very common reason in this country is the poor diet. So the sugar and the starch, which we eat about 152 pounds of sugar and 133 pounds of flour,

which is almost a pound a day per person per year. if you're doing that and you have this belly fat, it's causing your insulin levels to go up, which then screws up your sex hormones and leads to the hair loss. Right. And it causes this polycystic ovarian syndrome, which is this whole bunch of stuff going on where women will notice they're losing hair on the top of their head. They're growing hair where they don't want it. But it also messes up their period. They'll notice their periods are all out of whack. They're irregular. And then for some women, they have problems with fertility. Yes.

And it's this cascade. So the hair loss is telling us, you know, I mean, they may be most concerned about the hair loss, but there's all sorts of other issues that this can lead to. Your belly fat is basically causing you to lose the hair on your head. Yeah. So this is fascinating and i think that that we really see a lot of this and it often can be reversed and i and i feel horrible when i you know it's not hard to uh see when you're trained right i see women who have little belly fat hair is thinning and i just want to go up to them and say hey just cut out the sugar and the starch, eat good fats, your hair will come back. But you can't go up and just do that to people.

But it's like it makes me so mad because I know how hard it is for people to suffer with hair loss. It affects their self-esteem, affects their mood, their sense of well-being, their attractiveness. And so I think it's a real issue for a lot of people. And I think it's so fixable. And it's often, the stage is often set when they're so young, right? So we see this a lot when at a young age, they're getting fed, they're being given food for whatever reason that's really refined and processed or too high in sugar.

And then it just leads to this cascade that is, you know, hard in terms of, like you said, their self-esteem and their, you know, causes that the waking around the belly and the hair loss. And it can be, that stage can be set at such a young age, unfortunately. Yeah. And there's really a, you know, a way to diagnose it that we use in functional medicine, because sometimes it's a little tricky to diagnose. They're not all following the same pattern. But if you do a glucose tolerance test measuring insulin, you can see high insulin levels. That's the most sensitive. You can look at testosterone, free testosterone, DHA, other things that we look at to help something called DHT. So we look at a

very comprehensive hormone panel that looks at your risk of having this PCOS issue. You look at your FSH, LH, which are hormone levels from your brain, and they can be altered. So we basically get a very different picture. And then we kind of dig into why. Is it your diet? Like you said, is it, you know, the BPA from all the plastics that we consume? Is it gut issues? There may be other factors that are driving it, but it's really important to sort of dig into that, and then it's easy to treat with diet and lifestyle, sometimes some supplements. Let's talk about thyroid, because that's a big issue.

We've covered thyroid before, but I would like really to sort of dive into this issue, because it's often overlooked, and it's often subtle, and it's often confused with just sort of aging or normal decline that we see in people. So how common is thyroid and, you know, how do we do it differently in functional medicine and how is it related to hair loss?

Yeah. You know, one of the most common signs of an underactive thyroid is shifts in your hair. So we see more thinning of the hair. The hair can become more dry and brittle and the eyebrows can shift. So when you see that loss of the outer third of somebody's eyebrows, you're thinking thyroid. But a lot of the part of your eyebrow just kind of disappears. Yeah. Yeah. And you're like, okay, I've got to really pay attention to this. I've got to look deeper at this person's thyroid. And like you said, it can be really subtle because sometimes if you just do a TSH for screening and you don't get a good enough detailed history,

TSH might look fine, which is the thyroid stimulating hormone, which is the standard screening test. Sometimes thyroid issues are missed. And so we often- Sometimes or- Often. I mean, listen, it affects one in five women. Yes. And one in 10 men. Yes.

And 50% are undiagnosed. Crazy. And of those who are diagnosed, I would say probably half of them are not adequately treated. Right. And so we're seeing a pandemic, honestly, of thyroid issues in this country. And the causes are many, right? It could be gluten. It could be environmental toxins.

It could be genetics. There's a lot of factors. Nutritional deficiencies, vitamin D, selenium, so forth. But we know how to deal with these differently in functional medicine. We look at it differently. And so if you go to your doctor and you get your TSH level, which is all they'll do, if it's quote normal, even if it's in the high normal range, they'll go, you're fine, nothing to do. But it may cause a lot of really vague symptoms, including thinning of the hair, hair loss, cracked nails, dry nails,

brittle nails, dry skin, constipation, fluid retention, muscle cramps, fatigue, morning tiredness, low sex drive, high cholesterol, you know, depression, cognitive function issues. I mean, you just go on and on and on. That was a good list. I mean, they're all like big, subtle little things. And it's sort of like the frog that gets put in cold water and you turn the heat up slowly and they boil to death because they just feel like they slowly kind of accumulate the heat. That's what's happening with thyroid. People just don't, it's not sort of obvious, right? It's not like you have an obvious traumatic symptom. And giving people the right

treatment often can not only help their hair, but everything else. So it's really important to get the right test, which then includes the thyroid TSH. But what other things will we look at? We'll look at the free T3, we'll look at the free T4. So the T4 is one thyroid hormone, but then your body has to convert it into T3, which is the active thyroid hormone. And so we want to look and see how much T3 do you have? Are you making that conversion well? Because we know that when people have deficiencies in selenium, iodine, vitamin A, just to name a few, that conversion won't happen appropriately.

And then there's also genetic reasons why people don't make that conversion. So their thyroid levels, their T4 and their TSH may look okay, but that active form of thyroid may be low. And we look at thyroid antibodies too. Absolutely. So the doctors won't often look at thyroid antibody until the TSH is high. Right. Which is kind of late because I see people with normal levels of thyroid on the test, but their antibody levels are really high. I had a patient

like that yesterday. Yep. And she had all these vague symptoms and the doctor's like, oh, you don't really need to treat it. I'm like, no, no, you are symptomatic because you're having an autoimmune disease against your thyroid. So in treating the no, no, you are symptomatic because you're having an autoimmune disease against your thyroid. So in treating the thyroid, we sometimes use thyroid replacement, but we often look at what the cause is, right? Is it the gut? Is it toxins? Is it heavy metals? Is it pesticides? Is it low levels of vitamin AD, selenium and iodine? Is it something else like gluten, which can cause autoimmune disease for thyroid in many, many patients? So we do a really deep dive in functional medicine. And I've written a little report called the ultra thyroid solution years ago, probably still up to

date, which looks at how we can actually deal with this differently. But it's so important to think not just, oh, it's normal because, you know, even our lab tests aren't showing us what's optimal, right? You know, if you're two years old or 92 years old, it's kind of the same range, right? And it's very different. And even the traditional endocrinologists go, well, you know, we used to have a level of five being abnormal for TSH, now it's three and a half. But what's really optimal? Is it one?

Is it two? You know, is it 0.7? I don't know. It's probably not three, right? Right. So how do we tweak everything to be ideal? And I think you can do that. And you sometimes don't need to give thyroid replacement.

You can use other functional medicine approaches, but sometimes you do. And it can make a huge difference with hair loss. Absolutely. So let's talk about another factor, which I think is so important, which is diet and hair loss. So you mentioned some nutritional deficiencies. We'll get to those, but let's talk about diet and the role it plays and some of the big triggers that you could be eating and also things you're not eating that you need that also could trigger hair loss.

Yeah. I mean, I think that one of the biggest triggers is gluten. Gluten can definitely be associated with hair loss, especially when people have celiac disease or early celiac disease or a lot of inflammation because of the gluten that they're eating. This is not everybody who's eating gluten, but for some people, it's resulting in them not having optimal digestion and absorption of their food. And so then hair loss is just one of the side effects that we see. So it can be you have a full-on autoimmune disease like alopecia areata, which is hair loss everywhere, totalis. And that can be from gluten.

It's causing autoimmune disease, one of the manifestations of celiac. But you don't actually have to have celiac in order to have this problem. You can have non-celiac gluten sensitivity and still have the hair loss. Absolutely. And then the other thing we see is if you're not eating enough protein, we often, or if you're not digesting and absorbing it well enough, which is actually something I see probably more frequently, is that people might be eating enough, but they're just not absorbing it because of an autoimmune disease in their stomach, parietal cell antibodies, or because they've got inflammation in their gut and that's resulting in their digestive enzymes

not working well. And so in a sense, they have low protein levels in their body. When we check for amino acids, we see low amino acid levels. And so when somebody, that's probably one of the biggest benefits I see with hair is when I treat people with amino acids. Yeah. Then your regular doctor is not measuring your amino acid levels, right? We check that in functional medicine here at the Ultra Wellness Center. It's not a test you're going to get at your regular doctor, but I do see that and I see low amino acids. And like you said, it's either they're not eating adequate protein or more likely they're

not absorbing and digesting it very well because their guts are. Yeah. And, and, and so for those people, when we give them amino acids, like a complex or sometimes specific amino acids and you give them between meals, I see huge benefits for their hair. Like that's where they go. Oh my gosh, my hair is so much better because, um so much better because of those amino acids. Absolutely. Absolutely. And there are other nutrients that are also important. One of them is biotin, which is produced by bacteria in your gut. So if you're an unhealthy gut, you might not be getting adequate levels, but that can also be

helpful, right? Yeah. When biotin is low, a lot of times people will see that their hair is breaking or they also notice their nails are breaking because they're more fragile or dry in a sense. And biotin, that's why biotin is helpful for some people with problems with their hair. Absolutely. And I think you mentioned a few other things that are really important to check for people that often are not checked, right? Like your iron status, your ferret and level is very, very important. Particularly menstruating women or people have gut issues. If you have gluten issues, you may not absorb iron and that can also be an issue, right? Absolutely. And, you know, a lot of times, you know, this is something I see a lot that people will come in and they've just had a CBC done. They've just had their hemoglobin and hematocrit checked and their doctor says, well, you're not anemic and they don't necessarily go to the next level

and do a full iron panel. And that full iron panel gives us a lot more clues. So you can, you know, I'll often do a full iron panel to look to see what's somebody's ferritin, what is their iron saturation? Because you need to, there's never one perfect test, right? And so we need to really look at all of the tests together with the clinical picture to help figure this thing out sometimes. And so ferritin is the marker of iron stores in the body. And we want that ferritin in general to be, you know, around 50 to 70. You don't want it to be too high because that's not good, but you definitely don't want it to be too high because that's not good, but you definitely don't want it to be too low.

And so especially if somebody is more low iron, low ferritin, and they've got hair loss, often we're working to get that ferritin up to 50 to 70, maybe seven to help with that hair regrowth. I think what you said is really important because the nutritional doctors, when they do testing, they look at sort of the first layer. Yeah.

And if that looks okay, they'll sort of move on, right? Oh, you're not anemic. Right. So your iron must be fine. But when you look at your blood count, right, your hematocrit, hemoglobin, it's sort of like measuring what cash you have in your pocket.

Not what's in your bank account, right? Yeah. The ferret is like your iron stores, how much savings you have in case you need more iron. But even if you're not anemic, it really turns out that low iron in stores, like low ferritin, can lead to fatigue, insomnia, hair loss, and just other mild symptoms that are often ignored. Right. You need iron for your thyroid, that T3, that active thyroid to be produced.

You also need iron in your mitochondria for you to make ATP from your energy. There's so many metabolic processes that require iron in your body. And it's a long time to become anemic from low iron, it takes a long time for many people to actually see those low hemoglobin hematocrit, low, you know, anemia from being low in iron. You know, it can take years. And often if we just are doing a CBC, we're missing what's going on with that person's iron status. Right. So we've gone through the list. We found a lot of hair losses from sugar and starch and insulin resistance, pre-diabetes and PCOS. It can be from thyroid issues.

It can be from inadequate protein intake or absorption because of gut issues. It can be from low levels of certain nutrients and vitamins like selenium, thyroid, iron, vitamin D, vitamin A, and more. And yet, you know, we see this as a problem. So often they can be pretty readily dealt with when people are really frustrated and are not getting good answers. So what do we do with the ultra wellness in here? And you want to, you want to share a case of a patient, this young woman who, who became a vegan and ended up having hair loss. So talk about that because a lot of people are vegan. They think it's healthy for them. And there are some real risks to that. Yeah.

So, you know, she came to see me when she was 35 and she had been vegan for the last three years. But, you know, the reason she came in was because of the hair loss and she really wanted to address it. And when I gathered all her history, I realized that she had become vegan three years ago for both the environment and for her own health. And it was over the last year that she started to notice that her hair started to not look she had become vegan three years ago for both the environment and for her own health. And it was over the last year that she started to notice that her hair started to not look the same. It was getting thinner. It was looking drier. She was also noticing her nails getting more brittle.

And she was frustrated with this because she thought she was doing what was right for her health. And so why was her hair not looking as good? And so when we did some lab work, we did some serum amino acid levels and we did that full iron panel. And we found that her serum amino acids were low. So as we've spoken about, amino acids, when protein gets broken down, it gets broken down into amino acids. So amino acids are those building blocks of protein. And amino acids are easier for the body to digest and absorb. You know, if you're having a problem with digestion and absorption, they're already broken down. So when we looked at her serum amino acids, which is a special test we can do, she was low across the board. She also had a ferritin of six. So we were talking before about how we want it,

you know, maybe 50 or a little higher for hair regrowth. She was definitely iron deficient. Which is not uncommon because a lot of the absorbable iron comes from meat, heme iron. Right. Right. Right. So, you know, when somebody has been vegan for a while, they have to be a little bit more careful about certain things. And many times, like you said, it takes a while for us to start to see signs of deficiency if people aren't being really careful with their diet and some of their nutrients. So they have to pay more attention to iron. They have to pay more attention to zinc. They have to pay more attention to omega-3s. They have to pay more attention to protein. Vitamin D. Yep. Yes. And so sometimes, you know, especially if they're eating out or eating quickly or not really being very careful with their diet, we start to see these deficiencies.

And this is what we saw with this woman. So she was low in protein, low in amino acids, and low in iron. Is it any amino acids or the branch chain amino acids? You know, for her, we saw it across the board. We saw the branch chain were low, but we also saw some of those amino acids or the branch chain amino acids? You know, for her, we saw it across the board. We saw the branch chain were low, but we also saw some of those amino acids that build neurotransmitters were low, like tryptophan. So we saw lots of different amino acids being low. The branch chain seem to be more important for hair, right?

And where do they come from? They come more from animal protein, right? They do. Yeah. So a lot of the protein from beans and grains has lower levels of certain amino acids that are really critical for, for building muscle and also hair growth. Yes. And so, you know, if you are a vegan, you probably need to supplement with additional amino acids in the form of branched chain amino acids or other things you're

not getting. And I think, you know. And I think there's really good data. I know there's a lot of propaganda out there and a lot of different controversies. But you and I have done this for decades. And we're not philosophically opposed to being vegan. But we do see the consequences in people who have been vegan for a while of initially they'll do better because they're getting off of the American crappy diet. But if you just got on a whole food diet and it wasn't vegan, you'd probably do as well. And then they end up with these late stage deficiencies, whether it's B12, amino acids and so forth, loss of muscle. And it can be concerning. And it really

isn't really good for their health over the long term unless they really are diligent about supplementing with those things that they're missing. You know, and what we did is we talked to her about ways that she could feel good about her health and the environment and add in animal protein. And, you know, when, you know, she listened to more of what you've been talking a lot about. Becoming a regentarian. Yeah. And, you know, she switched to more of that pegan diet where she added in some animal protein. We also, for a while, supplemented with iron and amino acids because though over time her

diet was going to help her get what she needed, she really needed a boost right now. She was really deficient and she needed a boost right now. So we gave her a good source of iron as a supplement. We gave it with some vitamin C to help with absorption. We gave her some of the amino acids between meals to help with absorption. And she noticed huge improvements right away in terms of her hair. That's incredible. We had another patient with slightly different issues because hair loss is not hair loss

is not hair loss. And this was another young woman who was 35, but starting to look like a guy losing all her- It was a totally different picture, right? So she was another 35-year-old woman who came in to see me, but she was really frustrated because she was seeing her hair was, she had this receding hairline. She was losing hair on the top of her head. And so when we started to dig deeper, we also realized that she was having irregular periods. Her periods were irregular.

She had to start to go get laser therapy for the hair on her chin and her belly because it was getting darker and thicker. So she was frustrated with that. She had been trying to get pregnant over the last year and she hasn't gotten pregnant yet. So she was really concerned about her fertility as well and the fact that her periods were irregular. And so she also noted that about 10, 15 years ago, she gained some weight and that she has not been able to lose.

Where was the weight? It was around her belly. Oh, yeah. Yeah. So when we did her waist to hip ratio was a little bit high. It was at, you know, 0.85. And we want for women, their waist to hip ratio to be less than 0.8. And, you know, she fit that classic picture of polycystic ovarian syndrome of insulin resistance causing her hair loss. And so she, you know, it was really important for her when we focused with her diet is we pulled away those

simple refined carbohydrates. But you also found like you measured her blood levels of insulin, which most doctors don't do. And it's the kind of stuff we look at at the Ultra Wellness Center here. And you found what? Her fasting insulin was 15, you know, and she was 35. It should be five, right? Five or less. And 15 is definitely too high. And we did do a glucose tolerance test with her, which her one and two hour insulin went up into like 150 to 200. So it was definitely, she was making way too much insulin. And that was why she was having a hard time with losing the weight. That was why her hormones were all out of whack.

Her testosterone was a little high. Her DHEA was a little high, triggering this male pattern hair loss, triggering the shift in her periods and her fertility. And so for her, that key was, okay, we've really got to pull away those refined and processed carbs. For her, we even pulled away some of those whole food carbohydrates that, you know, aren't necessarily bad foods, but they were bad for her right now. You know, so some of the- So just an important point to say, because some foods are good, but they may be bad for you, depending on what's going on with your health.

Right. And when you have insulin that's so high, you know, you really don't tolerate a lot of the carbohydrates, even if they're healthy carbohydrates like brown rice and buckwheat and quinoa. They're fine to have incorporated into a good healthy diet. But when your insulin is so high, we often drop those lower because that helps that insulin drop lower, which then helps the female hormones rebalance, helps you lose weight, helps your- Hair grows back. Hair grows back. Stop the hair on your face.

Yep. Your periods start to get more and more regular. And for her, she saw good improvement in her hair. And then, you know, her hormones rebalanced. She was able to get pregnant, you know, all because of shifting her diet. And sometimes it's the additional things that you wouldn't think of, or that traditional doctors don't look at that can affect insulin resistance.

And in this case, she had, you measured something called BPA, which is pretty unusual to measure, but it's something you can look at in your urine. So what is BPA and why does it have to do with insulin resistance and hair loss? BPA is that hard plastic, right? That bisphenol A that was used

and is used in so many of our hard plastics. And they realized... Lining cans and water bottles and it's banned in Europe. Right. Right. I mean, they realized this at Tufts when they were doing research on breast cancer, and they realized that the test tube was influencing their results because there was something in the test tube. And that's when they realized, oh, there's the plastic in the test tube called BPA, and that was really impacting their results. And so these are xenoestrogens. These are estrogens from the environment that impact your estrogen receptor. But what we're learning is that BPA also can cause insulin resistance and diabetes, totally associated. So toxins can cause diabetes.

Yes. Whether it's lead or mercury, arsenic, BPA, other plastics, environmental toxins. We know that environmental toxins are a huge factor. So people may have more complex stories. It may not just be that they're eating sugar and starch. They may have these other issues and often they're overlooked.

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introduce to you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter.

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