The Dr. Hyman Show - Answering Your Questions About Muscle Loss, Low Sex Drive, PCOS, And More

Episode Date: July 18, 2022

This episode is brought to you by Rupa Health, Thrive Market, and InsideTracker. Today, as part of my Masterclass series, I’m answering questions submitted by my community through the video app HiHo. I am joined by my good friend and podcast host, Dhru Purohit, to discuss how to reduce your biological age, what to do if you have a low sex drive, the Functional Medicine approach to treating osteoporosis, and much more. Find a link below to follow me on HiHo and we may select your question for a future episode! Dhru Purohit is a podcast host, serial entrepreneur, and investor in the health and wellness industry. His podcast, The Dhru Purohit Podcast, is a top 50 global health podcast with over 30 million unique downloads. His interviews focus on the inner workings of the brain and the body and feature the brightest minds in wellness, medicine, and mindset. This episode is brought to you by Rupa Health, Thrive Market, and InsideTracker.   Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com.   Thrive Market is an online membership-based grocery store that makes eating well convenient and more affordable. Join today at thrivemarket.com/hyman to receive an extra $80 of free groceries with your first order.   InsideTracker is a personalized health and wellness platform like no other. Right now they’re offering my community 20% off at insidetracker.com/drhyman.   In this episode, we discuss (audio version / Apple Subscriber version): What do high homocysteine levels mean? (3:44 / 00:52)  Tips to reduce our biological age (17:23 / 13:42)  The connection between grip strength, muscle loss, and aging (23:15 / 18:46)  Causes of low sex drive and how to correct them (28:19 / 23:42)  The root cause and treatment for PCOS (32:44 / 28:04)  The Functional Medicine approach to osteoporosis and increasing bone density (37:47 / 33:42)  Follow me on HiHo here! Mentioned in this episode: True Diagnostics Nordic Labs Why Muscle Is the Key to Longevity with Dr. Gabrielle Lyon Are We Eating Too Much (Or Not Enough) Protein for Good Health with Dr. Gabrielle Lyon

Coming up on this episode of The Doctor's Pharmacy. One of the biggest drivers of aging is muscle loss. Muscle gets replaced by fat. And if you actually have muscle, it's like a ribeye steak instead of a filet mignon. Hey everyone, it's Dr. Mark. Like many of you, I'm terrifically busy throughout the week. I'm a doctor, a podcast host, a writer, a speaker, a father.

And on top of all those commitments, I have to make time to prioritize my own health along with the health of my patients. Because I have so much on my plate, I value tools that make my life easier. And I'm sure you can relate. And that's why I'm really excited to share with you today a little bit about Rupa Health. When I treat my patients, I look at a lot of indicators such as hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, all to dig deep down to find the root causes that prevent those patients of mine from optimizing their health and wellness. But that means I'm usually placing orders through multiple labs, which is just overall pain. Plus it makes keeping track of results more difficult for me and my patients. But all that changed when I started using Rupa Health. 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. Rupa Health helps provide a significantly better experience for both you and your patients. It's 90% faster than ordering tests one by one, and it lets you simplify the process of getting the tests you need. This is great for me because like most practitioners, I'd rather be spending that time with my patients and not doing administrative work. And that's the great benefit Rupa Health provides. This is a much needed option in the functional medicine space. It means better service for you and your patients. You can check out a free live demo with a Q&A or create an account at rupahealth.com. That's R-U-P-A-H-E-A-L-T-H.com.

I travel all the time. So at this point, I have packing down to a science. I know exactly which grab and go food items and personal care products I like to bring. And I always keep them on hand so that I'm ready for my next trip. I used to run around before every trip trying to find what I wanted, which meant going to different stores and spending too much time packing. And now I use Thrive Market and I get everything in one place shipped right to my door. Here's a little snapshot of what I like to travel with. Now food is of course first on my list. I always order some of the Ioba grass-fed biltong jerky, broil Hawaiian orchards organic macadamia nuts, and these super handy pouches of Thrive Market brand pitted green olives, which are so yummy.

If I want to splurge and bring a treat, I'll grab some Hugh chocolate too, which I love. For my toiletries bag, I'll bring some Schmitz deodorant, some all-terrain herbal armor bug spray, a tin of raw elements SPF 30 natural sunscreen, and a bar of Dr. Bronner's peppermint castile soap. Thrive also carries so many other things that can make packing for a trip easier, and I'm sure you'll find your own personal favorites. If you join Thrive Market today, you'll get $80 worth of free groceries. Just go to thrivemarket.com forward slash Hyman, that's T-H-R-I-V-E market.com slash Hyman to get this amazing offer. Now let's get back to this week's episode of The Doctor's Pharmacy. Hey everybody, it's Dr. Mark Hyman. Welcome to a new series on The Doctor's Pharmacy. Hey everybody, it's Dr. Mark Hyman and welcome to a new series on

The Doctor's Pharmacy called Masterclass, where we dive deep into popular health topics including inflammation, autoimmune disease, brain health, longevity, sleep, and lots more. And today, my friend and podcast host Drew Prowett and I are doing something really fun. We're answering community questions that you guys have submitted by a new app called HiHo. Now you can follow me on HiHo and submit your questions there and maybe you'll see them right here on the Dr. Pharmacy podcast. All right, Mark, pleasure to be here with you. Excited for today's conversation. We got a bunch of great questions from the app. I'm going to key up the first one on high homocysteine levels from Danielle in the community. Hi, Dr. Hyman.

I have a quick question. My homocysteine level is consistently high. Right now it's at a 4.7. I am gluten-free and I'm a vegan. Please help me. Any suggestions would be wonderful. So high homocysteine, what the heck is that? You've probably never heard of it.

Your body has thousands and thousands of molecules, millions literally of compounds that are running around your body. One of the most important ones is called homocysteine. Now, for those who don't know what that is, essentially it's a measure of how your body is handling the B vitamins. So if you are deficient in certain B vitamins like B6, folate, and B12, it can actually be high. And that's a problem because high homocysteine is in itself, you know, maybe causing more oxidative stress and more inflammation or more other

problems like heart disease, dementia, cancer, depression, but it actually is caused by a number of different things that we can actually address clinically. So when I see someone with a high homocysteine, I'm concerned because it means that they might be at risk for heart disease, cancer, dementia, depression, and many other things, birth defects, for example. And, you know, just how do we sort of learn all about this and how do we sort of start to figure out about this? Well, there's a guy named Kilmer McCauley who's written numerous scientific papers on this, a number of books about this, and was the first person to really introduce the idea that this could be a problem.

And there's a severe genetic disorder called hyperhomocystinemia, which is an extreme version of it. And in this extreme version, kids who are 10 years old will get heart attacks and strokes because their body can't process the homocysteine properly, and they end up in a lot of trouble. So most people don't have that. But about 20 to 35% of people have some variations in their genes that make them need extra folate or a special kind of folate or extra B12 or B6 and special forms of those nutrients. And so I very consistently look at this. And the data is a bit confusing because I think if you look at the science, it's not clear. Not everybody agrees about how big of an issue is for heart disease or this or that. But pretty much everybody agrees it should be in the optimal range.

If your level, for example, is over 14, your risk of dementia is 50% higher. Now, that's a pretty big risk. And the question is, what is it? How does it work? It really is important because it regulates one of the most important biochemical processes in your body. We call it methylation. Now, it's a big mouthful, but essentially what it means is there's a, is this chemical compound called methyl groups,

carbon and three hydrogens called CH3. But think about this, like the, the currency of your body, like dollars, like we, we use dollars to spend and buy things and exchange currency in the, in the, in the economy and in the body, these methyl groups are constantly being exchanged for all these biochemical processes, including our DNA regulation. And we've heard about epigenetics, and we've heard about the idea that we can actually regulate our epigenome through doing lifestyle changes, through diet. And all of the epigenomes function in large part is determined by these methylation patterns. And we call it DNA methylation. And the longevity test that we can look at and tell us, for example, I'm 62, but I did my DNA methylation patterns. I'm 43, according to my DNA epigenome, which is kind of cool. So it has played a huge role in a lot of different diseases. Now,

if it's high, you need to kind of figure out why. Do you have the genetic problems? And I pretty much test most of my people who have hemocysteine looking at a number of different genes. And we do, there's many methylation genes. And one of the main ones is called MTHFR. There's also ones called CBS or MTR. And they all regulate different enzymes. So basically what happens in your body is that you have to convert one chemical to another chemical. And those processes happen through an enzyme or a catalyst that converts one molecule to another. And these catalysts depend on the right nutrients. All the cofactors, all the helpers for the enzymes are vitamins and minerals. And so the B vitamins, B6, folate, and B12 are critical for regulating all these methylation pathways. And if they're insufficient

for you, and I mean for you because some people might need 400 micrograms of folate. Some people might need four milligrams or 10 times that amount of folate to regulate the same enzyme because they have a functional difference. I'm not going to call it a defect. It's just a difference. We're all varying. We all have these variations in our genes that require us to have different amounts of different nutrients. In fact, one third of our entire DNA codes for enzymes. And all those enzymes need helpers and vitamins and minerals. And there's variability in the function of those enzymes that requires you to have higher amounts of certain of these nutrients. So let's get back to the homocysteine question. So if you have a high homocysteine, it means you might have one of these genetic problems.

You might need more B6, folate, B12. And I look at a whole complex of genes when I test people, not just one or two. And you can go to 23andMe and do that. And they'll actually give you all your methylation genes. You can actually upload it to this thing called Genetic Genie and see what your methylation patterns are and whether you have these problems. So there's a lot of kind of cool ways you can kind of figure it out yourself. And I'll just tell you a quick story of a patient of mine. I know some very cool patients at issues with this.

One of them was a woman who helped with the movie Fed Up. And she was struggling for years to try to get pregnant and have a baby. And she was the director of the movie. And she ended up having miscarriage after miscarriage after miscarriage. And then she finally got pregnant and delivered a baby with no brain. We call it anencephaly. It's pretty awful. And, in fact, a lot of the work around this was discovered in China,

and I actually heard a lecture when I lived in China because in Harbin, which is the northern part of China, it's cold in the winter. It's north of Beijing. It's kind of near Siberia, basically. And they don't grow a lot of vegetables in the winter there. They don't have hot houses back then. They don't have like, I mean, like greenhouses. And so basically, in the winter, they don't have vegetables. Now, in China, everybody gets married when? Chinese New Year. When is that?

February. When is that? In the middle of winter when there's no green vegetables. And where does folate come from? Foliage. The word folate comes from the word foliage or greens, essentially. So they don't eat greens all winter. And what they found was a really high rate of birth defects we call spina bifida,

which is a defect in the spinal column. It's so important in regulating so many things, including the development of the spinal cord in a baby. And that's why all prenatal vitamins have extra folate, but they have to have the right kind of folate. So they basically discovered that there was this link between the B vitamins and these birth defects. Now she had this problem of having these miscarriages, which was caused by this gene she had, we call MTHFR. I'm not going to give you the chemical name, but it's kind of a big thing, but it's MTHFR. And it's a gene that regulates an enzyme that you need to actually convert the folate that you eat from

food into the right form of the folate that your body can use. Well, it turns out she had this gene and she read one of my articles and she then ended up taking it to her doctor and said, hey, can you please test me for this? And she definitely had this gene. He said, well, just take folate. And she's like, no, no, Dr. Hyman said in this article, I have to take this special form of folate called methylfolate. Well, he's, I don't know about that, but she did it anyway. And then when I met her, she literally had this, we were going around New York city doing PR for the movie. And she had a perfectly formed, beautiful little 10 month old baby that occurred only because she actually found out about this and took the right vitamin that was based on this methylation pattern. And she had this high homocysteine.

So it's that powerful. And another person person who had dementia, and same thing. They weren't able to actually do their proper methylation, end up with dementia, and I gave them the right B vitamins, and their dementia went away. Another guy I met who was like 50 years old who had everybody in his family died of heart attacks in their 50s, and he was terrified. And I checked, and he had a super high homocysteine, and he ended up having this gene as well. And so we treated him with the right kind of folate.

Now, what are the things that affect this methylation process? Genetics we talked about, and there's tests like 23andMe you can do. I use in my practice something called DNA Health from Nordic Labs, which is a thing that doctors can order. Diet plays a huge role, right? If you're not eating enough greens, you're not getting enough folate if you're not eating the fruits and vegetables greens and beans and fruit you're not getting b6 b12 and folate but also it comes from i mean by the way the best source of all these nutrients is liver and i was a kid we were very poor we lived in queens in new york and and we used to eat chicken livers and onions and rice for dinner. I thought it was a gourmet meal.

But it was because we were poor. But actually, it really is one of the most nutritionally dense foods on the planet. So egg, yolks, meat, liver, oily fish, lots of sources of B12, foliage, folate. So you want to make sure you have plenty of these foods in your diet. There's also things that can cause too high homocysteine like sugar, too much processed fats, coffee. Alcohol is a big one. Kidney failure also. And a lot of our food is irradiated. That can deplete the nutrients in the food. So they may be lower in B vitamins. Smoking, if you're a smoker, really messes up your methylation, high homocysteine. If you have gut issues, you might not absorb these nutrients. Like if you have Crohn's disease or if you have

a leaky gut or damaged gut, you might not absorb these nutrients like B12 in particular. If you're older, you might have low stomach acid and you can't absorb B12. If you are like, I don't know, the Brazilian Americans taking acid blocking drugs like Pepsid and Prevacid and Prilosec and these drugs, they block stomach acid, which you need to absorb B12. So that can be an issue. And also certain medications in addition to these acid blockers like methotrexate, which they use for cancer, autoimmune diseases, the birth control pill, B6 deficiency, high blood pressure pills like diuretics, like hydrochlorothiazide, Dilantin, which is used for seizures, all affect these B vitamins. And then if you have kidney failure, like I said, thyroid issues, cancer, pregnancy, all these things, and toxins also.

So really, there's a lot of reasons it can get screwed up. So how do you check if you're doing okay? Well, check your blood count. You know, you can check your blood count and see if you have a high level of something called MCV. That means your red blood cells are too big. And if they're too big, it may mean you have a full liter B12 deficiency. And that's an easy, cheap test. Homocysteine, you can check, obviously. The level should be six to eight. And most labs say, you know, 14 or less is normal. No, that is not normal. That's not optimal. That's the range of the population, but that doesn't mean that we have a healthy population. If you were a Martian and you landed in America

in 2022, you'd go, oh, 75% of us are overweight. It's normal to be overweight. It's definitely not normal to be overweight. You can look at urinary levels of methemonic acid or blood levels, certain amino acids. But it's really important to optimize your methylation process. So dark leafy greens, things like bok choy, Swiss chard, kale, watercress, spinach, dandelion, mustard, collard greens, beet greens, also really great. Get the B vitamins. We talked about seeds like sunflower seeds, fish and eggs, beans and walnuts, dark greens, almonds, and so forth. Avoid processed food, canned food, which is a plea to B vitamins. Avoid caffeine, alcohol. Don't smoke, obviously. If you're taking medications, be careful with those medications and make sure you're getting enough of the vitamins.

For example, if you take these acid-blocking medications and you take B12, it's not going to work. You need to be 12 shot. Your gut plays a big role. Fix your gut. We talk a lot about that in a lot of our podcasts. So those are the ways you can optimize your methylation. And this is such an important part of your biology. It's one of the central hubs of all your biology. So I talk about this a lot. I work with my patients a lot about it. But if you have a high level of cystitis, it's for sure concerning and you got to deal with it. All right, Mark, a bunch of follow-up questions off of that. Let's go into the first one. You mentioned you took this test that helps you look at your biological age. I believe it's from a company called True Diagnostic.

We have a link to it inside of the show notes. No affiliation with them, just a test that you've been doing. And also one of your colleagues and one of my friends, Dr. Kara Fitzgerald used this test in her study that she published in the journal of aging on how actually through following a very similar program that, you know, you talk about, she was able to reverse people's biological age over the course of eight weeks through lifestyle and dietary interventions. So the question is if somebody came back and they were shocked by their score, maybe they're 40 and their true biological age showed back as being 50, what are some of the things that they could do to start bringing that biological age down? And how does some of those recommendations play into your answer of the last question. Well, funny you should ask you because I just finished writing a book on it called Young's Forever, where I basically answer that question about how do we reverse our biological age? And just a little background on the whole concept. There's a guy named Stephen Horvath who's a scientist who looked at the epigenome. Now, the genome is your genes.

You can't control your genes. You got them from your mother and father and they're fixed. Maybe soon we'll be able to edit out our genes and use CRISPR and gene editing tools, which is coming down the pike. But for now, it's not really available. But what is available is the epigenome manipulation. Now, the epigenome is like the piano player. Now, on a piano, you got 88 keys, that's it. But think about what you can do on a piano. You can have Mozart, You can have The Grateful Dead. You can have jazz. You can have ragtime, right? You can have folk music. It's like that. The epigenome is a piano player. And the epigenome is controlled by everything that you do. We call the exposome, everything that you're exposed to in your life, your thoughts, your feelings, your diet, exercise, stress, sleep, environmental toxins, your relationships,

everything affects your epigenome. So you have massive control over that by the quality of your life and your lifestyle and by doing the things that actually help to improve it. And you mentioned Kara Fitzgerald. She didn't use really anything except a very aggressive, and I call it aggressive. It's not really aggressive. It's what I eat all the time, but it's an aggressive dietary intervention, which isn't just the Mediterranean diet, which is great, but it's like an upregulated version of that based on functional medicine. It's a very powerful anti-inflammatory diet, but also specifically included foods, a lot of foods, which are designed to improve

methylation, improve this process we've been talking about for a while, and this podcast. So basically, in the study, what they did was they focused mostly on diet. They had a few other lifestyle interventions they did, which helped, like stress reduction and exercise and so forth, but it was mostly diet. And what they found was that in eight weeks, they were able to reverse their biological age by three years, which is mind-blowing when you think about that. And imagine if you did that for a year. I mean, I don't know, would you get, you know, with A52 divided by 8, I'm terrible at math, but anyway, you get the idea. It's a lot of age reversal now. You know, there's a limit to it, but it's really

impressive to see what you can do when you actually upregulate this process of proper DNA methylation. So that's what's kind of exciting. And in the book that I wrote, Young Forever, it's really about how do you work on your biological age, not just through diet, but through exercise, through meditation, through eating a phytochemical-rich diet, through various supplements and compounds that we can now take like NMN or NAD. So there's really a lot of strategies, even hormesis, which is this whole idea that what little stresses that we can take on our system that don't kill us, make us stronger, whether it's exercise or cold therapy or hypoxia or hyperthermia or whatever.

We kind of are coming up with the can stress the system a little bit. I mean, hyperbaric oxygen therapy is another kind of stress where you put yourself under pressure with a lot of oxygen in a tank. And they actually dramatically increase telomere length, which is a measure of your biological age. They actually killed a lot of the zombie cells, or we call senescent cells, which increase inflammation in the body. So they're able to kill zombie cells and increase telomeres almost more than any other intervention. And that's just by applying oxygen under a high pressure, like two atmospheres of pressure. So there's a lot of really cool technologies out there that we now are learning about that can help us reverse our biological age. That's fantastic. You also mentioned, you know, looking at your DNA and getting an understanding

of it. There are friends of yours that Nordic labs that basically took your DNA analysis. And, uh, you know, we are friends with them and we've done some fun projects. You know, they're not a sponsor of this podcast. You just mentioned it. So I thought we'd link it up in the show notes below. They go through your genetic tests and talk about the insights that you took away from it. So they made a whole little video and put it on a website. So we'll link to it below. If anybody's curious about that test and what some of the insights you got, you can check that out in the show notes. We'll make sure to link to it.

Hey, everyone. It's Dr. Mark. You're unique, which means your health and wellness plans should be unique too. But it can be tough to optimize your health and nutrition programs because it's often difficult to get the data you need. And even if you do get your numbers, you actually have to understand them and then be able to make meaningful action based on them. This is where InsideTrackers comes in. InsideTracker is a wellness tracker that uses science and technology to deliver ultra-personalized

healthcare guidance. They can analyze your blood, your DNA, your lifestyle habits, and then give you actionable recommendations to help you meet your health and wellness goals. They'll tell you what you need to do and why, and you can track your progress and adjust your plan based on real-time feedback from your own body. Since 2009, their science team at Harvard, Tufts, and MIT have been bringing personalized nutrition and wellness to the world with their powerful evidence-based digital platform. InsideTracker is simple, customizable, and most importantly, it's based on you and your body. If you're curious about getting your own health program dialed in to meet your unique needs, I highly recommend checking out InsideTracker.

Right now, they're offering my community 20% off at InsideTracker.com forward slash Dr. Hyman. That's I-N-S-I-D-E-T-R-A-C-K-E-R dot com slash D-R-H-Y-M-A-N. And you'll see the discount code in your cart. Something that I want to get your insights on that's also, again, surprise, surprise, on the topic of longevity is this idea of grip strength, right? Why is it that grip strength, do you think, has been so associated with being, as far as I understand, one of the top, if not the number one marker of somebody's lifespan here on earth. So what is about grip strength? Well, I think grip strength is just an indirect marker of your overall muscle mass and strength, right? So if your grip strength is weak, it's a sign that you have sarcopenia, which is muscle loss, and that you can't do the things that you like to do, whether it's open a jar or just the basic activities of daily life.

So one of the biggest drivers of aging is muscle loss, and it's not really talked about it. We don't really learn much about it in medical school. We don't learn what to do about it. We go exercise and eat well. But it's such a profound science when you look at what happens as you start to lose muscle. So grip strength is sort of an indicator of your overall level of strength in sarcopenia. And if you have sarcopenia, you're kind of screwed because it's not just that you get weak muscles, but muscle is the currency of aging. If you don't have muscle, you're going to age fast. Why? Because muscle gets replaced by fat. And if you actually have muscle, it's like a ribeye steak

instead of a filet mignon. And you don't want that. I mean, you might want to eat a ribeye steak, but you certainly don't want it for your muscle. Why? Because when you are marbleized muscle, you are actually producing lots of damaging compounds. You actually create lots of inflammatory compounds and increase inflammation. And we know that aging is an inflammatory process. We call it inflammation. It also makes you insulin resistant, which we know is one of the key features of aging, where you become more resistant to the effects of insulin and diabetic and pre-diabetic. It also increases cortisol and

stress hormone levels, which age us and shrinks your brain to make you demented. It lowers growth hormone, which is necessary for repair and healing. It lowers testosterone, which is necessary for keeping your muscle and for sexual function. So it really creates a whole cascade of problems when you have low muscle mass. And that's sort of, we've had another podcast where we talked about protein and the importance of protein as we get older, because we have to maintain our muscle mass. If we're going to stay healthy as we age, we need muscle mass. And Drew, I don't know if you know this,

but the major reason people go into nursing homes is not because they're sick. It's because they can't do their daily activities. They can't tie their shoes. They can't get out of bed. You can't get out of a chair. That's because they've lost muscle. And if you are listening to this, I encourage you to sit in a chair, like a kitchen chair, and don't touch the chair and keep your back straight and just try to sit up out of your

chair without actually bending forward. And if you can't do that, it means you probably have weak muscles and you better get on it. Yeah, it's so true. And unfortunately, in this world that we live in today, it's not like a long, slow decline in this thing where one day you wake up and say, you know what? I'm having a hard time getting up. I'm having a hard time tying my shoes. I think I need to now being in a nursing home.

It's usually you're in the kitchen. You've lost so much muscle mass you don't really know. And this activity you used to do, which is getting on top of the stool to put the dishes away at the top of the shelf, you end up slipping and falling and you can't catch yourself because your grip strength isn't good.

You don't have enough muscle mass. You fall and you break your hip. And that's how most people end up in these situations. It's very tragic. It's happened to family members of mine before, and it's very unfortunate and it's a very tough thing. You know, I heard a statistic from one of your colleagues that you introduced me to Dr. Gabrielle Lyon, who was on my podcast recently, and you've done some podcasts with her too. We'll link to those in the show note. She said for a woman 65 plus who falls from, you know, who falls and has like a hip fracture, less than 50% of them will ever end up walking again. That's terrifying. And that should be terrifying for people who are listening.

Well, it's even worse than that, Drew. It's like getting a terminal diagnosis of metastatic cancer in terms of your longevity. If you get a hip fracture, your risk of death is as high as that of getting a terminal cancer diagnosis with stage four metastatic cancer. Wow. That's nuts. And I know that there are a lot more companies and solutions and people that are talking about how do you make working out, strength training, of course, diet. You did our whole last podcast that we did together was about dietary interventions and protein. And I'm just excited to see that to really make this a national focus for individuals. You know, it's never too late to start making movement a regular

part of your lifestyle. All right, Mark, I want to continue on this topic of longevity, but bringing up and tying back into something that you had mentioned, which is this idea of sexual health. A lot of people notice that as they get older, that their libido starts to go down. That could show up in the form of erectile dysfunction or just actually not craving, you know, wanting, you know, physical intimacy. Of course, intimacy is a spectrum and there's all sorts of different types, but specifically when it comes to our sexual drive, what have you known as a practicing functional medicine doctor about how things like inflammation and our modern lifestyle take a toll and are some of the root causes behind a low sex drive as people age?

Well, I mean, this is a complicated subject because there's many aspects to this. There's relational aspects. There's the intimacy aspects. For women, often the biggest sex organ is between their ears. So it's really a complicated subject. And it's all about the relationships as well as their biology. So I'm going to focus a little bit on the biology for a minute. And I know you all listening might think this is just because I'm focused on sugar and my whole life's focused on talking about sugar and insulin resistance as a big factor in everything.

But the truth is that sugar is one of the biggest problems with our sexual health. And what are you talking about, Dr. Hyman? men. And women, it's a little bit different. But for men, what happens is that as you increase your sugar and starch intake, you develop what we call belly fat, visceral fat, the organ fat, or you get the little poochy stomach, or maybe you got a big stomach. And that causes the production of huge amounts of inflammation, as we talked about, but it also increases something called aromatase, which actually converts estrogen, testosterone into estrogen. So you end up actually having high levels of estrogen. And so you become more like a woman, your testosterone levels go down, your estrogen levels go up, and you basically lose desire and lose function. The other thing

that happens within some resistance is it's the biggest driver of hardening of the arteries. And the small blood vessels are the ones affected often first. And guess where they are? In your penis. So those you get literally hardening the arteries in the penis and the lack of blood flow affects circulation. That's why Viagra and those drugs work is because they increase blood flow and circulation by increasing nitric oxide, which dilates the blood vessels, which is not a bad thing. I learned how a lot of people

continue to have healthy sex lives, but the key is figuring out the cause, not just taking Viagra because eventually it won't work, right? So you've got to focus on the cause. And so a lot of the times as we age, as we talked about when you lose muscle, you lower testosterone. When you increase fat in your body, you lower testosterone. In fact, there are a lot of great ways to increase testosterone. Weightlifting

is a powerful way to increase testosterone. Eating more fat. And by the way, your sex hormones are made from fat. And in fact, cholesterol is the building block of testosterone and all the sex hormones. So if you're taking a statin, for example, it can really lower testosterone and sex function. So you've got to look at the whole picture of what's going on with that person. And of course, there are other complications that might affect your health, like thyroid function certainly affects libido and sex drive and your testosterone, as we mentioned. And so you kind of got to look at the whole picture of what's happening with somebody. But I think for most of the people I see, it has to do with this problem of insulin resistance, which affects almost nine of the 10

Americans. And for women, it's a little bit different. They go through menopause and their hormones change. They may have vaginal dryness, which may affect their desire and function and cause pain. But many, many women post-menopausal continue to have really healthy sex lives. And sometimes they need a little help. They might need a little vaginal estrogen. They might need a little testosterone to help them with libido. But by working with people's lifestyle and diet

and lowering the starch and sugar, increasing the good fats, doing strength training, kind of tweaking some of the hormonal things. Often people can really regain sex function once it's lost or actually just continue to have a healthy sex life well into their 60s, 70s, 80s, and even 90s. And I've seen people, I mean, surprising. I had a woman come to me who was 88 years old. She's like, I'm in a new relationship.

Can you help me out here? And I'm like, sure. And we got her, we got her going again. So, you know, I think, I think, you know, we just have these weird ideas in our culture about sexuality and aging, but you can continue to have a healthy sex life well into your late life. Well, you know, there's something important that you said that a lot of functional medicine doctors talk about is that actually for men, erectile dysfunction is one of the first indicators of cardiovascular issues that are going on in the body. It's like a leading indicator, the canary in the coal mine.

Absolutely. I mean, so exactly. So if you're having trouble there, it's good to look at your heart for sure. All right, Mark, we're going to go into our next question here from Jules in our community. And she's asking about PCOS. I'm just curious if you have any recommendations for someone who's been diagnosed with polycystic ovarian syndrome. I am interested in learning about what diet you recommend, as well as exercises you feel would be beneficial.

So Drew, you know, PCOS stands for polycystic ovarian syndrome. And when I was in medical school, we learned about an obstetrics and gynecology. The truth is, it's not a gynecological problem. It's a nutritional problem. And what happens is that women who have high levels of starch and sugar in their diet and have some genetic predisposition to insulin resistance, prediabetes, which is pretty much almost everybody except for a few lucky people. I mean, if you're basically someone who tends to gain belly fat

when you eat starch and sugar, and by the way, all of us can force ourselves to be like that. When I went to Italy a few years ago and I kind of went on a binge, I'm like, I'm a hell of it. I'm just going to eat bread and pasta and pizza and drink wine. And I got a little tummy. So even I can get that if I'm not careful. But it's pretty common.

And it basically happens when you eat a lot of starch and sugar, you get high levels of insulin. And that affects your hormones in a really adverse way. So women tend to get high levels of estrogen. They get anovulatory cycles, meaning they don't ovulate and make progesterone. So their estrogen progesterone ratio gets way off. They have heavy periods. They get acne, which is for more testosterone, and they get hair loss on their head. So you'll see women with like kind of balding in the head on the top. You'll see they'll have a beard, literally, the bearded woman syndrome. They'll get facial hair. That's all we call polycystic ovarian

syndrome, at least infertility and all kinds of problems for women. So it is really primarily a nutritional problem. And unfortunately, it's treated by the birth control pill, by giving women all kinds of weird hormonal shots. And most of the time, it can be treated usually in nutritional therapies. And that means a diet that's lower in starch and sugar, higher in fat, good fats like olive oil, avocados, nuts and seeds, and so forth. And by really eliminating all that kind of processed junk that we eat that's causing this epidemic of insulin resistance. There's also some really interesting data on certain like kind of forms of B vitamins. One of them is inositol, which people might have heard about, but it is in a B complex usually. And a particular form

called D-chiroinositol, which has been used in the research and is published in the New England Journal of Medicine. So it's not like some alternative medical journal. This is the top medical journal in the world. If you're American, if you're British, it's the Lancet and they have a fight about that. But basically, it's a top medical journal showing that giving this nutritional compound can help regulate insulin. And when I work with patients in my practice, I use the same approach I do with someone who's got diabetes, for example. Ketogenic diets can be helpful. Fixing people's gut can be helpful. A lot of hormones are regulated through the gut. And we know, for example, that if you

have a bad microbiome, you can produce more, for example, Clostridia, which is a bacteria that can increase estrogen levels and cause some of this estrogen progesterone imbalance. So, you know, it's a horrible problem for women to have. It's really common. It's not always women who are obese or overweight. Sometimes women who are not can have this. So it's not always entirely because people are eating junk food and sugar, but most of the time it is, and it can be really well addressed. Many women, for example, have been resistant to getting pregnant and have infertility. And Dr. Walter Willett, who's one of the most revered nutrition scientists in the world at Harvard School of Public Health, wrote a book called The Fertility Diet, which was all about

this issue of insulin resistance and infertility and polycystic ovarian syndrome, which is super common. So I think it's really, honestly, poorly treated by obstetricians and gynecologists. I was talking to somebody recently, and they were like, you know, my internist was like, saying really how shocked they were to realize how much food played a role in chronic disease. I'm like, oh my God, finally people are getting it. It's like, and I see more and more conventional doctors getting the idea that nutrition should play a role in our medical school curriculums and should be part of our therapeutic practice. So it's kind of coming. I've been, you know, pushing the rock uphill for the last 30 years. I think

finally we might be on the downhill side and then getting more common. But it is a really treatable condition. It creates a lot of misery for a lot of women. But I would encourage people to think about really looking at ways they can handle it through diet and lifestyle. And then certain supplements and nutrients play a big role. All right, Mark, our next question comes from the HiHo app. And this is Tammy, who has a question about osteoporosis. Looking for your suggestions for osteoporosis in a woman who is in her 60s. I was told hormones is too late for hormones, and I don't want to take the drugs.

So we'd love to hear what you have to say. Thanks. You know, osteoporosis is really a common problem. And as we chatted about earlier, one of the challenges is if your bones get thin and weak and you fall and break a bone, particularly a hip as you get older, it's like getting a terminal cancer diagnosis in terms of your risk of death. So it's really quite shocking. I think 50% of people who get a hip fracture die within a year. So that's not great. So you really don't want to get osteoporosis. And historically, you know, we really

didn't have a lot of it because most of us were out there working hard, using our bodies and eating a very nutrient-dense diet. And unfortunately, the dogma has been that if you want to prevent osteoporosis, you have to drink a lot of milk and take a lot of calcium. Unfortunately, that's not true. And the got milk ads were taken off the air and out of magazines because the FCC, the Federal Trade Commission, which regulates truth in advertising said, there's no data. You have to stop advertising. And by the way, these ads were part of a campaign that's a government-sponsored program called the Checkoff Program, which partners with industry to help, quote, do research on various nutritional

and agricultural products. But unfortunately, it's used to actually promote products. It was a kind of a government-sponsored program with the Dairy Council that put these ads out without a lot of data. Now, you don't take my word for it. You simply need to Google milk and health. And Walter Willett and David Ludwig are the authors, Harvard researchers, who reviewed all the science and published it in the New England Journal of Medicine, again, the top medical journal in the world, showing that not only was milk not good for your health, not only was milk not good for fractures, but your risk of fracture went up by 9% for every glass of milk you had. So it's actually the opposite. Also, calcium supplements, not so great either. And it's not about the calcium you're eating, it's the calcium

you're losing. So if you look at what really makes the most difference for bones, it's vitamin D. And if there's one thing I would say to you is make sure your vitamin D levels are 50 to 75. That is so important. And I say what your vitamin D levels are, not what vitamin D amount you should take, because it's different for everybody. Some people might get there with a thousand units of vitamin D. Some people might get there with 5,000 or maybe 10,000 based on their genetics or their absorption or various issues. So don't think that milk's going to help you, number one. Take vitamin D, number two. And number three, understand that you need to have not only the right nutrients in your diet, but you need to exercise. And before I get

into the exercise piece, I just kind of want to come back to this calcium issue. If you look at calcium intakes, for example, in Africa, I mean, they might have three, 400 milligrams of net calcium intake a day, but they actually have very, very strong bones. Now, if you look at American intake, they're saying take 1,500 milligrams of calcium a day. Well, it doesn't matter how much you're taking in. It matters how much you're losing. And we have a calcium-losing environment. What do I mean by that?

Well, if you have sugar, if you have caffeine, if you have alcohol, if you have soda, it's the worst. Like the colas particularly have phosphoric acid in them. That causes you to lose tremendous amount of calcium. If we eat an acidic diet, which is processed food and sugar and so forth, that acidity causes you to lose calcium. So you're basically peeing out your bones, literally peeing out your bones in your urine. And we actually can do a test to measure this. I do this with women who come to see me last year. So I measure their urine levels of certain markers that tell me that their bones are dissolving and are coming out in their urine. So it's really, really important to not look at the total calcium intake, but the net calcium retention. So you could

be, for example, taking in 300 milligrams of calcium and losing 200, that means you're up 100. If you're taking in 1500 and you're losing 1700, you're down 200. So it really matters what your net calcium absorption versus your net calcium losses. And then all those things I mentioned are the things that cause calcium loss. And there's lots more. So really important to look at your diet as a key factor and making sure you're eating a nutrient-dense diet, making sure you're not doing the things that cause you to lose calcium, and make sure you're taking adequate vitamin D. Now, you say, well, why do I need vitamin D? Because, you know, hunter-gatherers never had vitamin D and they didn't have bad bones and why do I take vitamin D? Well, sure. If you want to go around in a loincloth naked outdoors most of the time,

you know, hunting and gathering and getting sun exposure on your whole body, go ahead. Or if you're going to be living in a coastal area, if you're eating only wild, wild fatty fish all the time with lots of vitamin D, okay. If you're hunting and gathering and eating like tons of wild mushrooms, you're probably okay. But most of us don't do that. So most of us live and work inside and we need plenty of vitamin D and we can get it through vitamin D supplements. Unfortunately, I think we have to take them. It's one of the most important things we need to do. It also helps so many other things like immune function and COVID prevention and many other things. In fact, one study I think was from Israel, they found out their vitamin D levels were over 50, there was zero deaths from COVID. So it's a really critically important nutrient.

So you kind of have to make sure you're not actually losing calcium, that you're actually getting vitamin D, and that you're then exercising. So you can do all the right things, but if you actually are not exercising, it's like putting all the ingredients for soup in a pot on the stove, but not turning on the heat, right? You're not going to make soup. It's just going to bunch of ingredients in the soup with no, I mean, in the pot with no soup. So you have to turn on the heat and that's exercise. And I've seen women, even at 70 years old, take seriously exercise. One of them started like a vinyasa yoga practice, like a power yoga practice. She increased her bone density by 10%, which is more than any of

the drugs you'll see. Now, you mentioned you don't want to be on hormones, it's too late for the hormones. Well, that's not true. You can sometimes use hormone therapy like estrogen, progesterone, testosterone. And by the way, testosterone is a great bone builder. And a lot of women have low testosterone and women can actually take testosterone. Women have testosterone, men have estrogen. It's not like it's sort of a binary thing. It's just that women tend to have more estrogen, obviously, and men have more testosterone, but you have to have the right balance for your sex. So you can, through a number of lifestyle factors, really, really improve your bone density at any age. Now, there's certain things that

really tend to cause osteoporosis that are concerning that may not be thought of, like, for example, leaky gut and gluten. Gluten is a huge factor because it causes all kinds of problems in the gut, absorption, and a lot of osteoporosis risk comes from gluten issues, which, by the way, may affect up to 20% of the population in some level of gluten sensitivity, or we call it non-celiac gluten sensitivity. Like 1% has true celiac and that they're really at risk, but even the non-celiac gluten sensitivity people have an issue. So, you know, you want to make sure you're really taking your bone health seriously. And that's why, you know, I've really doubled down on my exercise and strength training. And I really focused on it.

And I really, I made sure that I really take adequate vitamin D and exercise. And my bone density, it keeps increasing, which is amazing. So even as I get older, I get better. Those are all great. And thank you for taking all those questions. I want to pass it back to you to go ahead and conclude us for today's episode. Well, thanks, Drew. It's been awesome.

Thanks for submitting your questions. I love hearing from everybody. That's it for this week's masterclass. And make sure you submit your questions on HiHo, and maybe I'll answer them in the next upcoming masterclass. And if you love this podcast, please share with your friends and family, subscribe wherever you get your podcasts, and we'll see you next week on The Doctor's Pharmacy. 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

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my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database.

It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.