The Dr. Hyman Show - 5 Steps To Get To The Root Cause Of Your Symptoms

Episode Date: July 15, 2022

This episode is brought to you by Athletic Greens and InsideTracker.   This myth is pervasive throughout medicine: if you know the name of your disease, you know what’s wrong with you. In truth, diagnoses are just names we associate with a collection of symptoms. They tell us nothing about why someone has those symptoms—the root causes of the “disease.” Functional Medicine seeks to dig deeper to look for the root cause of symptoms.   In today’s episode, I talk with Dr. Elizabeth Boham, Dr. Todd LePine, and Dr. George Papanicolaou about how patients miss out on true healing when the root cause of their symptoms is not addressed.   Dr. Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing, she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing.   Dr. Todd LePine graduated from Dartmouth Medical School and is board certified in Internal Medicine, specializing in Integrative Functional Medicine. He is an Institute for Functional Medicine Certified Practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. LePine’s focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring the natural balance to both the mind and the body. His areas of interest include optimal aging, bio-detoxification, functional gastrointestinal health, systemic inflammation, autoimmune disorders, and the neurobiology of mood and cognitive disorders.   Dr. George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is board certified in Family Medicine from Abington Memorial Hospital. He is also an Institute for Functional Medicine Practitioner. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He practiced with a philosophy centered on personal relationships and treating the whole person, not just not the disease. He calls his philosophy “Whole Life Wellness.” Over time, as the healthcare system made it harder for patients to receive this kind of personal care, Dr. Papanicolaou decided a change was needed. He began training in Functional Medicine through the Institute of Functional Medicine. In 2015, he established Cornerstone Personal Health, a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou joined The UltraWellness Center in 2017.   This episode is brought to you by Athletic Greens and InsideTracker.   Right now when you purchase AG1 from Athletic Greens, you will receive 10 FREE travel packs with your first purchase by visiting athleticgreens.com/hyman.   InsideTracker is a personalized health and wellness platform like no other. Right now they’re offering my community 20% off at insidetracker.com/drhyman.   Full-length episodes of these interviews can be found here: Dr. Elizabeth Boham Dr. Todd LePine Dr. George Papanicolaou

Coming up on this episode of The Doctor's Pharmacy. People don't understand how so many of our issues come from the gut and how easy it is to diagnose it and treat it. And we use tests that traditional doctors just don't do. Hey everyone, it's Dr. Mark. People are always surprised when I tell them that even with a whole foods diet rich in plants, we can still be nutrient deficient. And addressing nutrient deficiencies is one of the lowest hanging fruits for optimizing our health and feeling better at any age. And that is why I'm a huge fan of AG1 from Athletic Greens. Since our soils are

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Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. The most common approach to treating patients in conventional medicine typically starts and ends with treating their symptoms. However, in functional medicine, practitioners understand that healing the body starts with healing the gut. In fact, the gut and the tons of bacteria that reside within it regulate many of our bodily functions, from creating vitamins to controlling our immune system, our brain function, and of course, our metabolism and weight. If the underlying cause of our symptoms is not addressed, they will typically return over and over again. In today's episode,

we feature three conversations from the doctor's pharmacy on the ways in which functional medicine treats the whole person instead of just their symptoms. Dr. Hyman speaks with Dr. Elizabeth Boehm on why the gut is at the center of health, with Dr. Todd Lapine on why functional medicine looks at the whole body to support mental health, and with Dr. George Papanikolaou on getting to the root cause of autoimmune disease. Let's dive in. Most of our chronic illnesses start in the gut. Yes. And whatever the name of the problem you have, whether it's migraines or whether it's depression or whether it's diabetes or obesity. I mean, I had a guy with rheumatoid arthritis or autism or whatever. You got to start with the gut. And traditional medicine, like leaky gut is not a thing.

Like you go to the doctor, if you have arthritis, and they're like, how's your gut? Or go to your cardiologist, how's your gut? Even though there's so much research showing the connection. You don't get trained. And so there's this huge gap right now where the science has advanced so far, but the practice hasn't.

And in functional medicine, we've been really great at actually getting the memo that the gut is at the center of our health. Right. So for years, right, we've learned about that five-hour program with functional medicine and how helpful that can be to heal the digestive system and then heal all these symptoms or diseases that somebody has. Yeah. I mean, it's amazing. I was talking to the CEO of Cleveland Clinic recently and he was telling me about studies that he'd heard about that had used fecal transplants in autistic kids

and taking the poop out of a healthy kid and putting it in an autistic kid and the kid's autism goes away. It's phenomenal. I mean, that's not true for all kids with autism. No, but it's phenomenal. Yes, it's amazing. Or they're doing transplants from people who are thin to people who are diabetic and their blood sugar gets better. Right. I mean, I had a guy once who was a really great patient and he was very poorly controlled diabetic on lots of medications.

And we worked on his diet. It helped a lot. Took it down from like 200 to like the 120s or so. But I would never get it all the way down. It was a really good diet and exercise. And he was telling me he had a bunch of digestive issues. And so I said, you know, why don't you take some charcoal and do this and do that? And he called me back. He says, I don't know what happened, but my blood sugar went to 90. So we absorbed all the toxic crap in his gut that was causing inflammation, that was causing his blood sugar imbalance. And these are the kinds of things that we do every day in functional medicine, but that are not part of traditional care and people are missing out on. Right, right. When we're saying, why is this going on? How do we get to that

underlying root cause for that individual person? So you've got some amazing cases. And I think I'd like to sort of get into it because people don't understand how so many of our issues come from the gut and how easy it is to diagnose it and treat it. And we use tests that traditional doctors just don't do. Like we have a different set of lenses, a different set of filters that we can sort through information and data and ask questions that traditional doctors can't. Like, how do you measure a leaky gut? How do you look at the microbiome in the gut? How do you look at the digestive function in the gut? How do you actually start to treat it in a different way? And I think your first case is just so rich with a story that is so common that I just love you to share this because I think

everybody's going to resonate with this story. And by the way, I have never seen this patient as your patient, but I've literally seen the same story a hundred times or maybe 500 times or a thousand times in my back. It's so common. It's the same freaking story. Right. So tell us about this. So it was a 24 year old gentleman who came in to see me and was really struggling over

the last year with his digestive system. He was having a lot of bloating and gas, pain in his stomach. Every time he ate, he was having diarrhea and sometimes he was getting constipated. And he went to his traditional GI doctor and they told him you have irritable bowel. But he wasn't getting any better, right? And he was just really, because he was having so much stomach pain, he had lost some weight. So he wasn't, you know, he was on the thin side to begin with. But because he was having stomach pain when he ate, he wasn't able to eat as much.

And he was even losing more weight. He was feeling really weak and tired and sad, depressed, right? And so for him, well for everyone, the timeline is so important, right? That's what we learn in functional medicine is the gathering that information, learning about that individual patient's story, seeing their timeline. We start with a history with the mother and her pregnancy and the birth and whether they breastfed and whether they took antibiotics, whether they were sick as a kid, what happened, when they were introduced to food, when they got gluten, when they got dairy. We ask all these questions.

So when someone comes in with irritable bowel, the average GI guy is not asking all these questions. So why do we ask all those questions? So, you know, because for this gentleman, for example, you know, he really didn't have stomach pain before a year ago. But what we found out is that when he was a kid, he had ear infections. Probably because he was eating dairy. Probably, right?

So it's such a common connection. I remember once being in the ER, Liz, and this patient came in and this little boy keeps coming back and like the toddler was coming back over and over to the er with ear infections and just so inflamed and i said how was he like like did you breastfeed yeah so when did he start getting the ear infections when we started formula and dairy and milk and i'm like oh okay and this is even before i knew about functional medicine. I know. And I was like, well, maybe you shouldn't eat dairy. And the kid was fine, you know? That's such a common connection. I mean, even my son, when he started dairy, he got asthma and eczema.

It's unfortunately such a common connection. So for this child, he had a lot of ear infections and eczema. And so he was on antibiotics about once or twice a year in his childhood. And he really didn't think that was very much. He's like, that's not, you know, that wasn't too much. But, you know, it makes a huge impact on the microbiome as we're learning. And then he started to have acne as a teenager, maybe because of dairy more, right? Or some of the imbalances in the

microbiome, right? When you screw up the gut with antibiotics or a C-section or lack of breastfeeding, then you get often more acne. And we treat acne from the top in as opposed to the inside out, which is actually where it works much better. And this gentleman was given low-dose antibiotics for two years. So then he took even more antibiotics. And so this history of antibiotics sort of set him up. And about a year ago, he had some sort of stomach bug. So some probably viral stomach infection. And then since that time, he started to have all these digestive issues and was losing weight.

And so... Which is a common story. People are... So common, like you said. This sort of smoldering a bunch of insults over the course of their life. You know, maybe they're a C-section. They had antibiotics as a kid. They took acne antibiotics.

They got, you know, they were eating a crappy diet, whatever. And all of a sudden, something happens and then boom, the body can't take it anymore. And it creates some kind of disease. Yeah. But if you look at the story, you can often map out exactly how this happened. That connection with his acne, with his asthma, with his digestive issues, with those antibiotics, that's that story we often see. And we're not making this up. There's so much science that shows that your gut microbiome plays a role in acne and eczema and asthma that it plays. I mean, we're actually

doing this at Cleveland Clinic now. We're studying asthma and looking at how the microbiome plays a role and how it affects inflammation, all these various factors that most doctors just don't pay attention to. Right. So with him, as we do with most of our patients, we do food first, right? So we said, okay, we've got to really focus on this person's diet and help him start feeling better right away so he can start to eat more and regain some of his strength. So we pulled away inflammatory foods. We took them off of gluten and dairy while we were waiting for tests to come back. Sometimes we will do some tests that look at, of course, we'll test for celiac disease or- Which is a big cause of leaky gut.

Yep. That's for sure. Probably the number one. And he didn't have that, but... By the way, you don't have to have celiac disease to actually have a problem, right? You can have what's called non-celiac gluten sensitivity. I would estimate it probably affects 20% of the population. And I think if you look at the antibody levels, you can get a clue, which most doctors don't look at. And I read a study that autistic kids and schizophrenic patients often have 20% of them have antibodies to gluten. And it may not be full blown celiac. Absolutely. And, and even, you know, irregardless of, even if, if people are negative, totally for celiac, um, if they have increased

intestinal permeability, they start reacting to a lot of different foods. So then you start to see with that leaky gut, as we talked about before, right? The coffee filter and things are coming through. Then the body's reacting to lots of foods that it maybe never reacted to before. So they're not true allergies. They're more like sensitivities. Sensitivities. And because of, and the real thing is it's because of this increased intestinal permeability.

Yeah. So our job is we have to heal that increased intestinal permeability so that they don't have to be so restrictive with their foods. I mean, we still always want them to be on a healthy diet, but we want to relax those restrictions over time. Most of the time we can. Yeah. And so as part of the approach of functional medicine. We start them on the elimination diet.

So eliminating all the inflammatory foods, gluten, dairy, processed foods, all that stuff. That's remove, right? That's the remove in the 5R. Right, the 5R is remove, replace, re-inoculate, repair, and rebalance. Yep. And we'll go into each of those because they're really important. But 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? 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 know, 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. We call it Cyrex-2 testing, which is a test you can get through functional medicine doctors. Right, you can test to see if there's leaky gut. I love it cyrex 2 testing which is a test you can get you can look

right is there 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 seeing improvement right are we doing enough right um are we seeing improvement in in in their leaky gut or increased intestinal and then we look at poop testing like you know 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, like whether there's malabsorption, whether you had no digestive enzymes, whether there's inflammation, whether there's overactive antibodies

in there, whether you have imbalances in 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, you know, 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 gonna put in this bucket, and if you have those symptoms, you're gonna 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 Rs for each patient, right? Right, right, so for him, we removed, you know, 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 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, to help it so the food wasn't as inflammatory for him and to help him absorb more nutrients. And 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 right so we know that there's a box prebiotics are the are the things that help feed the good bacteria so they're the food for the probiotics which is usually what like

like fibers fibers are amazing prebiotics we know a lot of phytonutrients are prebiotics so this I think lot of phytonutrients are prebiotics. So this, I think, is really exciting research when we're looking at our phytonutrients. What are phytonutrients? 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. Right. But you can feed it the good guys. 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. Right. Brussels sprouts, all those good ones. We know that green tea, that has good phytonutrients in it that's good for the digestive system. So we always say to people, get something from every color of the rainbow every day. 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, those, all those good, healthy plant foods that we, you know, 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 immunotherapy. Right.

So basically you die unless you have good bacteria in your gut. 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.

Of the plant foods and of getting focused on the gut. Yes. Yes. I, you know, we call it the five R 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 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 allergies, food sensitivities, yeah. And then we're removing- Processed food and junk food, right? Oh yeah, that's sensitivities. Yeah. And then we're removing. Processed food and junk food. 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 the unhealthy bugs or yeasts or viruses.

You might have bacterial overgrowth, yeast overgrowth, a parasite. Yep. You know, 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 then, so 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 as we... 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, you know,

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 slow problems. 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 B12 so you can get fatigue and dementia, right? It just goes on and on and on. Dr. Yeah. You don't absorb zinc and magnesium, minerals, calcium, it causes osteoporosis, pneumonia,

it causes irritable bowel. Dr. It goes on and on, right? Dr. Yeah. Dr. 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 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. 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. 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. So 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 it takes? Oh, that's a great question. I want to know, what do you prescribe? Oh my goodness, that goes on and on. We could talk about that for the next hour. Yes, it's true.

Right? There's more and more probiotics in the market every day. And they all have different roles and different functions. 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. I mean, there's some great brands this understanding of how to use these in medicine. Yeah. 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, get, 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 stop it, you know, because there's some good bacteria that make people feel worse. Well, they have bacterial overgrowth. Exactly.

If you have bad bugs growing in there, and you put the good bugs in there, they have a fight, and they cause lots of bloating. And so that means we just have to do more work before we can start it. Yeah. So you've got to re-inoculate, and then you more work before we can start it. Yeah. So. So you got to re-inoculate and then you got the. And then repair.

Yeah. And that's the fourth R. So that's things like, that's 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, right? 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, is, is at rest. I mean, yeah, I think that, you know, you just touched on something very powerful, which is that our, our gut and our brain are connected. There's a whole

hard wiring of nervous system in our gut even has this independent nervous system that actually is like a second brain. And so we often say people with irritable bowel are emotional or anxious or have 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. The whole field of functional medicine came out of the field of psychiatry with Abraham Hoffer's discovery that you could treat schizophrenia using nutrients and helping to improve the biochemistry of the brain. And then Linus

Collingwood's seminal paper, Orthomolecular Psychiatry and Science Magazine in 1969, which talked about the perspective of how do you straighten molecules? In other words, how do you correct the imbalances or dysfunctions in your biochemistry? That's called orthomolecular, which means to straighten. And that has really led to the whole field of functional medicine. And we then expand on that with our understanding of the role of inflammation in the brain. And many schizophrenic patients have high levels of, for example, gluten antibodies. About 20% of schizophrenics have antiglycan antibodies in their bloodstream. When you take the gluten away, they do better. That causes brain inflammation.

And when you do autopsy studies on people with Alzheimer's or autism or schizophrenia or depression, you find that their brains are inflamed. So, you know, when you start to think about that, it's like, wait a minute, we are treating this completely incorrectly. And this is what was classical traditional medicine. You treat the symptoms, not the cause. And functional medicine is really about the cause and why, not just what disease you have, but why do you have it. And in the case of these brain disorders, it's often not obvious. And the problem may be far away from the brain. It might be in the gut, or it might be in your diet, or it might be a toxin, or it might be an infection, or it might be mold. And it might be all sorts of things that we are

kind of missing the boat on. And so we have this potential to sort of rethink our whole approach to brain science. That's what's so exciting when we see the work of guys like Dale Bredesen or others and nutritional psychiatrists like those at Harvard and metabolic psychiatrists at Stanford. They're doing work in this field and understanding the connection between the brain and some of these systemic processes. Yeah, absolutely. And when you take a schizophrenic and you look at them with a PET scan, the positive emission tomography, what you'll see is their brain lights up. And that's because their microglia, which is their immune cells in the brain, are literally on fire.

And unless you actually treat that, a schizophrenic is at high risk for developing dementia down the road because their fire is not being put out. And this, Mark, is I'm going to mention this because when I was I actually have done some lectures for American Academy of Anti-Aging Medicine on neuroinflammation. And in the process of preparing for that, I came up against some really fascinating things. One is that when you look at the genetics of schizophrenia, there's, they did this whole genome wide association studies of saying, well, what gene or what genes are associated with schizophrenia? And they did what's called a Manhattan plot. And on chromosome six, it sort of stood out like a, you know like the Empire State Building. And what they found out is that on chromosome six, chromosome six is highly involved with the immune system. So that tells us that

a lot of patients who have schizophrenia have an issue on chromosome six related to the immune system. And what I'm going to tell you next is absolutely positively fascinating. And this sort of blew me away. There were two case reports. And remember, case reports are just like a doctor observing, okay, this is interesting. Look what happened. You know, why did this happen? And the two case reports were this. And this tells you, you know, how the immune system is intimately involved in schizophrenia. One is a patient had refractory schizophrenia and developed some type of cancer and needed a bone marrow transplant. The refractory patient with schizophrenia got a bone marrow transplant.

A bone marrow transplant is basically giving you a new immune system. After he got the bone marrow transplant, guess what happened to his refractory schizophrenia? It was gone. What happened? Gone. Wow. It completely cleared up because it changed his immune response to whatever it was responding to. I don't know. But his refractory schizophrenia went away. On the flip side, there was another

gentleman who also needed a bone marrow transplant. He got his bone marrow from his brother who had schizophrenia. Guess what happened to him? He caught schizophrenia. He got schizophrenia. Wow. That's pretty amazing. That's pretty amazing. Yeah. It is amazing. I was blown away by that. And I think that, you know, people who are doing, you know, I'm a clinician, I'm seeing patients, but those case reports are really, really seminal to change how we think about how we see these conditions. I also found it fascinating that, you know, we talk about the gut microbiome and how that's so important related to the immune system, is that when you do stool transplants, you can literally transplant or infect a person and make them skinny, or you can transplant stool and make them fat. We can go both ways. They're doing this with autism and Parkinson's, right? They're

actually doing fecal transplants with autism and with Parkinson's and seeing real changes in the brain function. That blows my mind when you think about that. It does blow my mind. And the thing about this is we are still in the nascent period of really understanding this because it's not like, you know, you take this one chemical or you take this one probiotic and everything's fixed. It's a very, very complex array. And, you know, we have hundreds of different microbes and bacteria and viruses in the gut. So it's going to take us a while to figure this all out. But, you know, I think we're also in a very good stage where, you know, we have, you know, massive computing power and we have artificial intelligence. And I think that we're going to probably approach these areas of understanding neuroinflammation and really difficult to treat conditions like ALS, like schizophrenia, like Parkinson's and such.

And we're going to be able to biohack them. And Alzheimer's, right, Alzheimer's. That's another thing, though. You're bringing up one of my favorite things. So for years, Mark, what did neurology focus on with Alzheimer's? It was what? It was amyloid plaque, right? Amyloid plaque, all you've got to do is get rid of the amyloid and you get rid of Alzheimer's, right?

It didn't work out so well. So you get rid of cholesterol and you get rid of Alzheimer's. That's right. So you get rid of cholesterol and heart disease. Right. So guess what? The plaque, the beta amyloid plaque that was found in the brain, guess what that actually is? That's an antimicrobial peptide. The brain is producing beta amyloid in response to some type of organism, be it a virus, a bacteria, or a fungus. So when we see that, those are the footprints of a organism that the body is trying to attack. Yeah, absolutely. And I think, you know, we actually probably should have Rudy Tanzi on the podcast. He's a scientist at Harvard who specializes in Alzheimer's and he's

discovered the microbiome of the brain. So literally there are viruses, yeast, bacteria in the brain, which we thought was sterile that may be triggering this cascade of inflammation. And then the question is, where does this come from? And it seems like a lot of it may come from the gut, which is crazy. How does it get from your gut to your brain? But it does. And it triggers this sort of neuroinflammation that's driving things like Alzheimer's. You know, I think, I think we often get stuck on one thing though, right? In, in medicine, we stuck, it's stuck on it's this or it's that. And I think the important thing people remember is whatever your diagnosis is, it doesn't immediately tell you what the cause is. So you could have 10

people with Alzheimer's, they could have 10 different causes. And in one person, you could have three or four or five different causes, right? And I just remember one patient I had who was seven years old, really pretty significant. You know, Alzheimer's, not bedridden at this point, but pretty non-functional, also depression, and was struggling really badly. He was former CEO of his company, a family-run business, couldn't function anymore. Behavior was changing. His kids, grandkids, family didn't want to hang out with him anymore because he was acting inappropriate. And it turned out he had so many things going on. I mean, the biggest thing he had was high mercury, which he lived in Pittsburgh and had exposed to all the steel plants. And they

use coal ash for fertilizing land and they put it on the streets in the winter instead of sort of salt for the icy roads. And he also had a mouthful of fillings. And he also had a terrible history of irritable bowel for 30 years and was on stelazine, which is like an antipsychotic. So it's like a relaxant for your gut, which is terrible. But he had terrible gut issues and bacterial overgrowth and leaky gut and gluten sensitivity. And he also had insulin resistance. He had prediabetes. So essentially, he had all these problems, heavy metals, microbiome issues. And he had insulin resistance or prediabetes, which we know drives inflammation in the brain.

They're calling Alzheimer's, you know, often type three diabetes. And he had all these other biochemical issues genetically like methylation problems and, and which are the B vitamins. We're also driving inflammation in his brain because he wasn't able to produce antioxidants and glutathione. And when we started to address all these things, got the mercury out we fixed his gut we cleaned up his diet we got rid of the sugar and starch we optimized his b vitamins he literally came back from the dead like rip and we call and was able to function go back to work be a functioning member of his family again this is someone who would have just been said okay you have alzheimer's and you are going to be a nursing home and that's the end of that and it was pretty miraculous to see that

it woke me up to how by really being being diligent with these patients, you can really help them either completely recover or dramatically recover. And I've seen, you know, the spectrum from, you know, in the tough cases of autism, Alzheimer's, you know, it depends how much they've got going on, how far down the road they are, but you see amazing stuff. But things like depression, bipolar disease, you know, mood disorders, it's often remarkable how quickly the brain responds, ADD. And it's something that we just, you know, unfortunately are not thinking about that well in traditional medicine. And that's really why we do what we do at the Ultra Wellness Center. And we've treated nearly thousands and thousands of patients in this way. And we now do stuff virtually too, which is kind of fun. So we can

see people from all over. And we have a great team of physicians and nutritionists and practitioners who really help guide people through this space. Because what kills me, Todd, and I'm sure it kills you, is you hear story after story. And I'm sure you get this all the time. Hey, could you help this one? Could you help that one? Or my mom or my dad or my sister or my friend. And people are just struggling to find answers. And when you know, when you hear the story, you go, oh, God, I know what's wrong with this person. But it's because we have a certain set of filters or lenses that we look at. And it's so gratifying. Can you think of any other cases that you want to share that sort of illustrate this? Yeah, I mean, I think I'd mention this.

This is a fascinating case. And I really can't 100% prove it, but I talked about it when we talked about the oral systemic health connection is the connection with the mouth. And there's some really good evidence of the particular bacterium, which is a bad actor, and it's called Porphymonis gingivalis. And I have seen this in a number of patients who have had early Alzheimer type symptoms. You can also see this oral bacteria in patients with rheumatoid arthritis. So looking for this with DNA of the mouth organisms. And again, you know, this is to me is a really fascinating thing. You know, somebody says, well, Alzheimer's runs in our family. Well, poor Fremontis gingivalis may run in your family.

You may be spreading the bacteria from person to person. And this bacteria, which is found in saliva, it stimulates the immune system in genetically susceptible individuals and can really lead to profound neuroinflammation. And in one patient in particular who I saw, he had Lewy body dementia, which is another form of, you know, inflammation. Lewy bodies, because on anatomical examination of the brain, they find these little things, they call them Lewy bodies, right? It doesn't mean that they understand it. It's just Lewy found it, and that's why they named Lewy body after Lewy. And that's actually what Robin Williams had. Robin Williams had Lewy body after Lewy. And, and when I, when I, and that's actually what, that actually is what Robin Williams had. Robin Williams had Lewy body dementia with Parkinson's. You know, so we call it,

we call it Parkinson's. We put it in this neat little category and then we call it Alzheimer's or we call it dementia. And we put it in this little category and then we call it Lewy body. And they're all sort of this interacting, overlapping kinds of things. And yeah, they can have different clinical presentations, but as you said, there can be many, many factors that go into the origin of this neuroinflammatory process. And diet plays a huge role. If you don't have the right nutrients, you don't have the right fatty acids, you're going to be more prone to all of your cellular membranes have omega-3 fatty acids. If you're not able to make the compounds in the body, which are called pro-resolving mediators or SPMs, and you actually have this as a supplement now, these are actually quite fascinating compounds.

The SPMs are selected pro-resolving mediator compounds. They're basically turbocharged fish oil. And certain people, some people can't take their omega-3 fatty acids and turn them into these compounds. And clinically, I have found them, they either work really well or they don't work. I don't know about you, Mark, but these are other things that you can use as a nutraceutical to help turn off inflammation in someone who's got some chronic inflammation. Not to say if you take it, it's going to help with Alzheimer's per se, but it's one of the

other tools that we can use to modulate the inflammatory response in the body. Yeah, so true. You know, we often in traditional medicine don't know how to evaluate the brain properly because we're just looking at the brain, but we have to look systemically. And that's really what we do in functional medicine. And, you know, Dale Bredesen coined the term a cognoscopy, like a colonoscopy, but for your brain. And it's looking at all the things we've been talking about, looking at diet, looking at nutrient levels, looking at hormones, looking at toxins, at the microbiome in the gut, looking at infections, looking at mold,

looking at allergens, looking at the overall health of the person and seeing what of those things are driving adverse consequences for the brain and for brain function. And any individual, the same cause might cause different things. So one person might cause schizophrenia, another person might cause Alzheimer's, then the person might cause depression. So we really have the tools to look at a true cognoscopy. And then the question is, how do we help the brain repair? How do we set up the conditions for the brain repair? So let's talk about how, from a traditional functional medicine point of view, we actually treat these people. Because it's a pretty systematic approach that addresses

diet and lifestyle and also some of these underlying causes. Yeah. I mean, so we, as you mentioned, Mark, we do a lot of the testing. So we'll do organic acid testing, which is checking for the nutrient metabolites that are found in the body. We'll also do gut microbiome testing, looking at all of the different bacteria, viruses, yeast, parasites potentially in the body. We'll look at markers for leaky gut. The other test that we'll, I do is a leaky brain, you know, just like you can have leaky gut, you can markers for leaky gut. The other test that I do is a leaky brain. Just like you can have leaky gut, you can have a leaky brain. There's actually a test for that. Cyrex Laboratories does the blood-brain barrier test. You can check also for neuro-autoimmune markers

with the Cyrex 7X test. Again, you can do gut microbiome testing. The one that I like to use is the GI map test because I think it's it's quantitative PCR. So I find it to be very helpful. I think the whole GI realm area is an area that we're just learning. And there's going to I think as time goes on, these tests are going to get better and better. But I find that to be very, very helpful to distinguish what's going on inside the person that I have. The other thing which I think is also really, really critical, Mark, is sleep. And this is something that I really emphasize to people is that when our bodies sleep, our brains take out the garbage. OK, and I'll guarantee you when you have a patient who's got a neurodegenerative condition, one of the first things that you'll see is disruptions of their sleep.

And what happens is during the day, you know, our brain only comprises two percent of our body weight, but it can it uses 20 percent of our body's energy, which means that there's a lot of metabolic activity. And what happens throughout the day is we get metabolic waste products that build up in the brain, and our brain flushes them out during deep delta sleep. If we don't get that deep sleep, we can't flush the brain and take the garbage out in the brain. And those toxins build up, those things that metabolic byproducts, misfolded proteins, inflammatory molecules, amyloid, et cetera, build up in the brain and can affect how the person's cognition is, their memory, their mood, et cetera. It's amazing. Yeah. And I think the diet is such a huge role too in the brain. I mean, we see that the diet we're eating is a highly inflammatory diet in this country

of processed foods, inflammation that are driven by sugar and starch, excess refined oils, all the lack of things that are anti-inflammatory, the whole foods with all the phytochemicals in them and the nutrient-dense foods. So we're eating a diet that's super inflammatory. So this is the first thing. And often dairy and gluten are among the worst. And then we focus on how do we get the right nutrients? Because if you're low in certain nutrients, whether it's the antioxidant nutrients or

the B vitamins, your body needs these nutrients to regulate your immune system, to function, whether it's zinc or vitamin A or selenium or vitamin D, vitamin C, all these are really necessary for proper regulation of immune function. So getting adequate levels of these is key. Also, we really get people on an elimination diet if we suspect or we test that they have sensitivity to certain foods. We treat the underlying infections if we find them directly with antibiotics if we need to, antivirals, or sometimes we'll use herbal therapies or things like ozone and other approaches to deal with infections. We'll fix the gut off them directly with antibiotics if we need to, antivirals, or sometimes we'll use herbal therapies or things like ozone and other approaches to deal with infections. We'll fix the gut. Often that's a big issue. So we have a whole functional medicine approach to fixing the gut. We've

talked about a lot on this podcast. And then we'll address whatever toxins that are there and help you eliminate the toxins through a really focused detoxification program. And so building on the framework of functional medicine, we can identify in each individual which of these things are the problem, and then we can start to map the right treatments for that person. And it's so gratifying when you see this in people's lifelong depression gets better. I mean, there was a woman who was severely depressed, who was in and out of psychiatric hospitals on lots of medications. Her marriage was falling apart. She wasn't able to really work at work anymore. She was about to

get fired from her job. Very overweight, diet, obviously high in sugar, starch, and processed foods. And she did the Daniel Plan, which is a faith-based wellness program, but it's based on a whole foods, anti-inflammatory, pegan-ish diet, essentially. And she said at the six-week reunion, she's like, Dr. Hyman, after three days of changing my diet, my depression went away. And I've been on piles of medications, in and out of hospitals, admitted for severe depression in hospitals many times in my life, and it's just gone. And I'm like, she goes, is that possible? I'm like, yeah, it's possible. If whatever you're eating was triggering the inflammation in your brain, you stopped it. Yes. So it's really a sort of untapped reservoir of tools and tests and therapies that traditional medicine, psychiatry, neurology, you're just not

using and is really where the money is. Well, and you bring up a really good point, Mark, because I, you know, I often ask my patients who are seeing a psychiatrist and I'm not going to bash psychiatrists, but I think the profession of psychiatry is in the dark ages. I can't remember the last time a psychiatrist that I've seen has done a blood test or examined the patient. And I think that a lot of psychiatrists would actually do a good job if they actually took a psych course in neurology to really understand how the brain is working. So if you're a psychiatrist and you're seeing a patient and you are not utilizing a good nutritionist,

preferably a functional medicine nutritionist, if you're not doing some blood testing and you're not actually examining your patient, you may be doing more harm than good. And it's not. And the other my the other, my pet peeve about the psychiatric world is that we are now medicating young children in ways that are unexplored. We're doing poly pharmacy in the young poly pharmacy in the old with these neuropsych drugs that are advertised on television. And it is a complete, if you will, excuse my French. It is awful. It's a, it's a, it's a terrible thing in this country. And I'll stand up here and I'll shout from the rooftops because this is a bad

thing that we're doing to the brains of our people, the brains of our young kids. This is something that we should not be doing, period. No, I mean, it's true. We really are relying on downstream treatments. So when the neurotransmitters go awry, whether it's depression or autism or Alzheimer's or ADD, we go, well, how do we fix the neurotransmitters? And the question isn't how do we fix the neurotransmitters? The question is, why are the neurotransmitters so screwed up in the first place? And it's because of these phenomena. And one of the great examples I'll see is that the basic driver of inflammation is diet. But there are other factors. And anything that causes inflammation can interfere with our enzyme function and throughout our bodies.

And there's a key step in converting serotonin, I mean, tryptophan into 5-hydroxy tryptophan into serotonin, which is the happy mood chemical. And when you get a high-level inflammation in the body, the enzyme is sort of blocked. And you end up with this byproduct called kinyurate. I don't know if I'm pronouncing it right. I almost read it. I don't remember what I said. Kinyurinic acid, right. Yeah, kynurenic acid.

And that level goes up, and you can actually measure it in these patients. And you see when they have high levels of these quinolinate or kynurenic acid, it indicates inflammation. And you know that the serotonin pathway is being screwed up, and it's bypassinging and producing these toxic molecules that cause inflammation in the brain. And so one, by getting rid of the inflammation, two, by giving the helpers for these chemical reactions, you can often really help improve the cognitive function of the brain. But it's really about the inflammation. And that's what's so different and striking about it. You know, the traditional approach to autoimmune disease is you use suppressive medications. Or in this case, you take out the thyroid or you nuke it. But in functional medicine, we really look at the root

causes, and there are many, there are environmental toxins, and they play a huge role in thyroid disease, whether it's heavy metals or pesticides or chemicals. We look at the gut, as you mentioned. We look at food institutes like gluten. Yeah, I think I said earlier, hormones. Hormones, stress. We look at the HPA axis, which is the-

Which is the stress hormones. The stress hormones. And so we know that cortisol is going to have an impact on your immune system and autoimmunity. And if you're under chronic stress, like most people are, and certainly over the last year and a half with COVID, people were under an enormous amount of stress. That's why we started to see a lot more death, you know, from other causes as well, particularly heart disease during this phase, because that has, you know, stress has a big impact on heart disease, chronic infections, as you said, environmental toxins, nutrient imbalances. What kind of nutrients are playing a role in thyroid disease?

So moving, yeah, we can talk about that because that moves sort of into treatment. We want to support a really healthy thyroid. So you're thinking about things like iodine. You're thinking about selenium. You're thinking about zinc. You're thinking about vitamin C, vitamin E. These are- Vitamin B and A.

B and A all support a good healthy thyroid. And if you're low in any of those, that will impact the healthier thyroid and your immune system. So you're going to be way more susceptible to any type of autoimmune process in the thyroid. There's really a 360 approach that looks at all the root causes, very similar to what we do in general with people, but we specify it for the thyroid. And I think that we do testing like stool testing, organic acid testing, hormone testing, adrenal testing, toxin testing, heavy metal testing, checking for iodine, vitamin D levels. These are things that you don't typically get at a traditional doctor's office. And the Ultra Wellness Center here in Lenox, we've been doing this for

decades and we really see amazing results. Well, it's always getting to the root cause. You know, we always look for the root cause in functional medicine here at the Ultrawanna Center. Everything's designed, all the tests that we do, all the work that we do, and the way we think about things is to get to the root cause. And we know that it's an autoimmune process that drives thyroid disease, particularly Graves in this case that we're talking about. And 75% to 80% of your immune system is in your gut.

It's called GALT, gut-associated lymph tissue. And so why? Because you have everything that you eat has organisms on it, has compounds in it that can potentially threaten your health. So your immune system has to be on high alert all the time, making sure that there's no disruption, nothing gets into your system that could cause you to be ill. So we look at the gut microbiome and the function of the gut almost first and foremost when it comes to autoimmune diseases, because that's where you're going to find the majority of the triggers. So the gut is always a key thing to think about because 70% of your immune system is in your gut. And if you have an autoimmune disease,'ve treated that hasn't had some gut issue that had to be dealt

with, that was part of reducing their autoimmune process and getting them into remission. Okay then. Wow. And what's really fascinating is that it just recalls this patient of mine who was about a 40-year-old woman who had Graves' disease and was struggling and did not want to be on medication long-term and was willing to do whatever it took. And she turned out she had real gluten issues. She had terrible gut issues. And she had parasites. I mean, we did a really aggressive gut repair program.

And we optimized her health and her vitamin D. And we improved her diet. And what was amazing was that her antibodies for Graves went to zero. Her thyroid normalized. And she's completely fine now and off medication, which is just really striking to me because that's something I never learned was possible in medical school. Yeah. And, you know, I've had a case where, again, you get to the root cause and yeah, was gut a major issue? Sure. But in my particular case, it was a woman who's 55

years old. She came with a diagnosis of Graves, like I said, many do, and she just didn't want to, you know, do the traditional therapies. So when she came in, she was also menopausal within the last two years. Uh, and she, uh, um, that was the main, the other main issue with her. So, um, and although she had gut issues, she had bloating and distension and constipation, some of the stools. So with her, one of the things that works when you want to treat somebody, it's perfectly appropriate to try to understand the mechanism and the pathway of the way the organ works. In this case, thyroid, TPO, thyroid peroxidase is an enzyme that's blocked with a

pharmaceutical agent that is very harmful. Botanical agents can oftentimes, because we get many of our medicines from botanicals, so botanical agents can oftentimes be very effective. In this particular case, L-carnitine can act as a thyroid peroxidase inhibitor. And so using L-carnitine was one of the first things I did with this particular woman. And before our next follow-up, she was already beginning to have some relief from her symptoms just using L-carnitine. And then because she was menopausal, estrogen can have an impact on your autoimmune state. So balancing hormones is really important.

When you think about hormone replacement, there's always been a concern, particularly with women, about the possible impact on the breast and breast cancer. What I will say is that there are now studies that are showing that early in menopause, using hormone replacement for a short period of time can have a very beneficial impact on brain aging. There's reduction in Alzheimer, development of Alzheimer's for women who have estrogen early in their menopausal state. Interesting.

It also reduces the autoimmune state because estrogen does play a role in balancing the inflammatory and anti-inflammatory sides of the immune response. So I actually put on a hormone replacement. I wonder if that's why you see most of the case of autoimmune disease in women. Yeah, in 40 to 50, you know, 40 to 60 range. So I balanced her hormones. And then of course, you know, we worked on her gut microbiome, which is always a critical piece. Yeah. And, you know, the other thing you did was you got her off gluten and you put her on an anti-inflammatory diet. Yep. Right. Yep. And you gave her the raw materials for helping her. Yeah.

And I, you know, I, yeah. And I think it's really important when we say we work on the gut. We have to remember that when we work on the gut, we have a very programmatic approach that can be adopted and adapted to the various conditions people have. But it's that 5R approach. It's basically, let's find out what may be a trigger. So there are triggers to, there are some bacterial and parasitic triggers to thyroid autoimmunity.

One of them happens to be blastocystis hominis, which is a parasite that has been implicated in triggering antibodies that will go after the thyroid. So- That's interesting, because that patient that I mentioned, that's what she had. She had this parasite. Yeah. Which we're going to talk about on another podcast. Yeah, we are.

So, when we look at the gut, we're going to look and so we're going to need to, we know we need to look at the gut carefully. So, talk about, you know, what is really driving this problem and what is Graves? What is hyperthyroidism? And what does it do to people? How do they feel? And how do people know they have it? Right.

So hyperthyroidism is when the thyroid gland is producing way too much thyroid hormone. That's T3 and T4. And so when they're being overproduced, then you're going to have symptoms that are going to cause you to lose weight, feel sweaty, have palpitations, be anxious, have thinning hair, lose your hair, have thinning nails. Graves' disease happens to be the most common. It's about 60% to 70% of people with hyperthyroidism are graves. It happens to about 1 in 200 people, women more than men, 10 to 1. And it usually peaks around in the ages of 40 to 60 years old, but it can happen younger. So that's the overview of Graves' disease. Now, the most, as you said-

What are the symptoms? The symptoms are some of the ones I just mentioned which are going to be uh weight loss sweating thinning um thinning nails hair loss um palpitations skin palpitations when it gets really bad atrophib yep and when it gets really bad you can have heart failure you can have a hormone imbalance and you can have anemia yeah those are some. And insomnia. People can't sleep. I had a friend call me who was like, I can't sleep. I don't know what's wrong.

Yeah. And we get to our history. He's like, and I lost 20 pounds and I wasn't trying. I'm like, oh, okay. Yeah. You know. And she had grids. Yeah.

So most people, as you said, have hypothyroidism. It's less common. I think 1% of thyroid disease or 2% is hyperthyroidism and Graves' is the most common. But when you have it, it can be really debilitating and it can be really hard to treat. And as you said earlier, in conventional medicine, the treatments haven't changed in 50 years and they're quite harsh. Functional medicine really gives us a great opportunity to get to the root causes of what triggers graves and allows us to then treat our patients in ways that make sense for the biology and their life environment. Yeah. So it's really, you know, the symptoms can be quite dramatic for people, right? Absolutely.

As you mentioned, some of the complications are serious. It's not just about having a racing heart or insomnia or diarrhea. You can get eye damage, so your eyes can bug out of your head. Right. You can get heart failure, right? Yeah. That can happen. And the reason why that happens, and I think we're going to have to just jump right into this part of it, is the autoimmune process. Graves is an autoimmune disorder, just like Hashimoto's, which causes hypothyroidism. And so you can't get away from talking about thyroid disease without talking about our immune system, autoimmunity, why we have it, why it's getting worse, and what some of the major triggers are. So the eye disease is actually antibodies that are being made against your thyroid.

They're called thyroid stimulating hormone receptor antibodies or T-RABS. And they're made specifically against the receptors on the thyroid. So when those antibodies hit those receptors, it doesn't destroy those receptors. It actually triggers them to make more thyroid hormone. But it's a very nonspecific interaction, and those antibodies can also trigger like antigens in other parts of the body. They happen to be in the eye, where there are thyroid-stimulating receptors, and also in the lower extremities. So you can get the deposition of all these antibodies in the eye that cause the Graves eye disease and also pre-tibial myxedema.

And that's because- That's like food retention in your legs. Food retention in your legs where you get a destruction of the tissue underneath the skin of the tibia or your shin. And you can see it gets thickened and fluid filled and it's not nice looking and it's not nice feeling. So those are the things that are the hallmarks of Graves. And they're all related to that autoimmune antibody response. What's interesting also is that autoimmune diseases often come in clusters. And with Graves, you see people off on the other autoimmune diseases, right? You do. Like what?

So some of the other autoimmune diseases can be, you can actually get Hashimoto's. Hashimoto's is one of the other autoimmune diseases. You can have low and high at the same time? You can. You can definitely have that. You can have diabetes uh which is an autoimmune type one diabetes type one diabetes um vitiligo right that's where you lose all the pigment in your skin yep anemia and and autoimmune things like arthritis from arthritis lupus right yep and then and then and then what's interesting is also celiac disease so there's a well there's a link between celiac disease because gluten is a is a huge trigger for autoimmunity

particularly creating antibodies against the thyroid okay so so so that's a kind of a good overview of the prevalence of it what the symptoms are what the complications are um and you sort of it's not it's often not that hard to diagnose when people are that sick, you can kind of tell. But it's subtle sometimes. What tests do doctors do to find out traditionally whether you have it? Yeah. So we, the, the, and we're going to get to what are the tests we do in functional medicine that are quite different. So, yeah. So the traditional test that you, how you find it is looking first at your thyroid function. So you're going to be looking at somebody. The key thing is the clinical symptoms, right?

It's not always tests. It's people come in and they have symptoms. Then you have to start to use your medical cognition and everything you know about medicine to figure out, okay, what do I think is going on? Well, once you realize what the symptoms are, then you start to understand, you know, this is the thyroid. So you're going to look at the thyroid and you're looking at what we call the TSH, which is a thyroid stimulating hormone. And if that's really, really low, that means that the thyroid is producing way too much thyroid hormone.

And your pituitary gland is being suppressed. So it doesn't make enough of this thyroid-stimulating hormone. Let me just back up for a second. Your pituitary gland drives your thyroid. Yeah. And it sends a signal to the thyroid. It's called the thyroid-stimulating hormone. So your thyroid-

TSH. Yeah, TSH. And so your thyroid is sort of lazy. And so it has to be reminded to work. So the pituitary's responsibility is to send out this signal all the time. So you're going to have a certain normal level of TSH reminding the thyroid to work. And as long as it's doing its job and nothing's impairing it from doing its job, then it's going to function great and it's going to make thyroid hormone, T4 and T3. T4 and T3 go to the cells. Now, T3 is the active form of thyroid hormone. And inside the cell, T4 gets converted to T3. Then it goes into the nucleus where it causes the DNA to start to transcribe and make enzymes and proteins that

upregulate metabolism. And that's exactly what it's supposed to do. Now, if you don't make enough thyroid hormone, then you're going to experience hypothyroidism and a slowdown of your metabolism. And if you make too much, you're going to have a uptick in your metabolism and everything that goes along with that. And that's called hyperthyroidism. So what happens is- And what are the tests? So the tests. So when we go for the test, the TSH is going to be suppressed if the thyroid is making too much. The pituitary is going to stop sending the signal. So the feedback system tells your TSH shut off, and then the other hormones go up. Yep.

But there's also antibodies we check, right? So once you realize they have hyperthyroidism, then you want to check for antibodies. And the main one you check for is thyroid stimulating hormone receptor antibodies. And if those are positive, it's 99% sensitivity and specificity for Graves' disease. That's the main test. There's also a radioactive iodine test, right? Yeah, so after you do that, you can do a radioactive uptake to see if the person has maybe some other reason

for having that hyperthyroidism, which can be an adenoma or multinodular toxicoider. And so what do doctors, once people are diagnosed with this, what are the treatments? Because it seems like they haven't really changed much since 40 years since I graduated medical school. Yeah, they haven't changed much and they're pretty harsh. And, you know, one, you know, so there's methimazole, which is basically a thyroid peroxidase enzyme inhibitor.

Thyroid peroxidase is the enzyme that the thyroid uses to bind iodine together to make thyroid hormone. And so it blocks that. And so you just reduce the production. Methimazole can have some significant, and polythiourasol, PTU, particularly can have some very impactful side effects, like hepatic toxicity. And you're going to be on them for 18 months, up to 18 months to get into remission. And so they're not really, they can be harsh and they can have lots of adverse reactions. Most of the people that I see in the ultra wellness center, they come to me with graves. I don't have to make a diagnosis. They come. And the reason why they come is they don't want to be on methimazole and they don't want to have iodine. The next therapy

is radioactive iodine destruction of the thyroid. So basically nukes your thyroid gland. Yeah, basically nukes it. So you're going to get I-131, which is iodine tagged with a radioactive molecule. And when it's iodine, so now this radioactive material gets absorbed into the thyroid that wants to use that iodine. But then that radioactive material breaks down to xenon and xenon destroys the thyroid or parts of it and reduces the production of thyroid hormone. Again, pretty harsh. You're radioactive and you're not, you know, you can't breastfeed, you can't be around kittens, you can't touch people. For a while. Not your whole life.

It can be up to two weeks of the treatment. And then finally, there's just take the thyroid out. So basically like nuke it, take it out or poison it. 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 introducing 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. And in it, I share my favorite stuff from foods to supplements,

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