The Dr. Hyman Show - Are Thyroid Issues, Hidden Infections, Or Poor Sleep At The Root Of Your Mystery Symptoms?

Episode Date: April 24, 2023

This episode is brought to you by Rupa Health, InsideTracker, and Paleovalley. My job as a Functional Medicine doctor is to be a medical detective—to investigate and address the root causes of problems (not just the symptoms),  help people fix the underlying problems that cause their symptoms, and recreate balance in the whole system. Rather than ask “what drug should I use to treat the symptom?” I ask “what is causing the symptom in the first place?” In today’s episode, I talk with Dr. Elizabeth Boham, Dr. Steven Phillips and Dana Parish, and Dhru Purohit about why it’s important to thoroughly investigate to get to the root cause of symptoms. 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. Steven Phillips is a renowned, Yale-trained physician, international lecturer, and media go-to expert. Well-published in the medical literature, he has treated over 20,000 patients with complex, chronic illness from nearly 20 countries. Dr. Phillips experienced firsthand the nightmare of an undiagnosed, serious infection after nearly dying from his own mystery illness. He figured out how to save his own life when 25 doctors could not. Dana Parish developed Lyme-induced heart failure as a result of being improperly diagnosed by some of the “top” doctors in the country—and had her life saved by Dr. Phillips. A chart-topping Sony/ATV singer/songwriter who has written songs for artists like Celine Dion and Idina Menzel, she has become a major voice in the world of chronic illness. Her popular column on Huffington Post has been read by more than one million people globally. 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, InsideTracker, and Paleovalley.  Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 35 labs. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com. InsideTracker is offering my community 20% off at insidetracker.com/drhyman. Paleovalley is offering my listeners 15% off their entire first order. Just go to paleovalley.com/hyman. Full-length episodes of these interviews can be found here: Dr. Elizabeth Boham Dr. Steven Phillips and Dana Parish Dhru Purohit

Coming up on this episode of The Doctor's Pharmacy. It affects one in five women, one in 10 men, and 50% of the time it's not diagnosed. Hey everyone, it's Dr. Mark. Now I know a lot of you out there are healthcare practitioners like me, helping patients heal using real food and functional medicine as the framework for getting the root cause of the issues. Now in my practice, this often means looking at lots of internal variables to find the most effective path to optimize health and reverse disease. But up until now, that meant we were usually ordering tests for one patient from multiple labs. Now, I'm sure many of you can relate to how time-consuming and complicated lab ordering can be

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when you sign up at InsideTracker.com slash Dr. Hyman. So head over to InsideTracker.com slash Dr. Hyman to save today. And now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. So many people are suffering from chronic mystery illnesses. They've tried doctor after doctor in search of a diagnosis that can provide them with answers. And yet for many, good health remains out of reach. In today's episode, we feature three conversations from the doctor's pharmacy on places that doctors often fail to look at closely when treating patients with stubborn, chronic symptoms. Dr. Hyman speaks with Dr. Elizabeth Boehm on the effects of thyroid

imbalance and how to properly assess it, with Dr. Stephen Phillips and Dana Parrish on hidden infections that may be lurking in the body and causing harm, and with Drew Proitt on why sleep deprivation is a precursor to chronic illness. Let's dive in. How prevalent is this problem of low thyroid function? You know, it's so prevalent. We see it all the time with our patients. You know, we see people who are really obviously low thyroid, and then we see people who are kind of that their thyroid numbers might be normal, but they have symptoms of low thyroid. So that would include things like hair loss.

They feel cold all the time. They're constipated. They feel low energy. Maybe they've lost hair at the outer part of their eyebrow. Yeah. And they've dry skin and they just feel crummy. Depression. Depressed. Yes. Trouble concentrating, focusing, muscle aches. Yep. Fatigue. Yep. Getting tired in the morning. Yeah. All these weird things that people suffer from they think are quite normal, but they're not.

And they're clues. Right. They're clues to say, okay, we've got to look deeper. We've got to figure out why are they not feeling well? And then we've got to figure out, is it their thyroid?

Yeah. And it affects one in five women. It's so common. And one in 10 men. And 50% of the time, it's not diagnosed. And I would say probably 80 to 90% of the time it's not treated properly.

That's true. So like you might be one of the 10% that's got it nailed, but most of you, even if you have thyroid issues, you still may have symptoms. And the doctor's like, well, you're fine. You're on thyroid. Don't worry about it. Right, your TSH looks normal.

I think we're doing everything we need to do. Yeah, so what are the problems with the traditional way we treat thyroid in America or around the world? I think the first thing that as functional medicine docs we recognize is that we're not asking that question why, right? So we're not looking for that underlying root cause, which so often helps us when we're treating our patient because it helps us figure out for them, for that individual person, what do we need to do to help their thyroid work better? So is it because of a nutritional deficiency? We know that we need iodine and selenium and iron and all sorts of good amino acids, right? Vitamin D, just to get the thyroid to work on your cell, you need vitamin D

to help it actually send the message to your DNA to do what it's supposed to do. And 80% of us are deficient in vitamin D. Yes. Yes. And so if people aren't eating enough of certain foods, we might see nutritional deficiencies, or maybe if their digestive system is a mess, they're not absorbing their nutrients well. So we have to ask that question, why? Because sometimes that will just help the thyroid work better when we help support it nutritionally. Or maybe it's an autoimmune condition, like you mentioned, Hashimoto's. And then it gets us thinking of a lot of different things, right? It gets us thinking about, well, why does this person have autoimmunity? Isn't it the most common autoimmune disease?

Yeah, it really is. What causes it? Well, you know, the body, when in an autoimmune condition, the body starts to fight itself off, right? So it starts to, it looks at the thyroid gland and says, okay, I'm going to fight you off. I'm going to attack you. And when it attacks the thyroid gland, the thyroid gland doesn't work as well. And so then you get low, well, in many cases you get a low thyroid. So what causes the autoimmune disease is the big question. We always ask in functional medicine.

That's it. Why? Right. And everybody's different, right? For one person, it may be gluten. We know gluten is associated with a lot of Hashimoto's thyroiditis. Not all, but some. My experience is you look at thyroid antibodies and you compare it with the gluten antibodies

in that patient. And my thinking is about 30% of the time, it could be related to gluten. What do you think? Yeah, I think it could be, it could be, it might even be a little higher. Yeah. But it depends because the patients we're seeing, so we might be seeing more patients who have a lot of different digestive issues going on. And so I might see it even a little more frequently. We call that selection bias. People who are sick select to come see us. They have more stuff for sure.

But we always think about the digestive system, right? You've got autoimmunity. You've got to think about what's going on in the digestive system. But then you think about could there be an overgrowth of bacteria? Certain bacteria in either the digestive system or other parts of the body have been shown to trigger autoimmunity in some people. Yeah. We know that.

We're going to talk about that on another podcast. So stay tuned. We're going to talk about the gut and leaky gut. Okay, we'll do that. We know that imbalances in iodine, actually excessive amounts of iodine. Can shut down the thyroid. Yeah. So, you know, Hashimoto's, because it's, you know, it was found first in Japan where they

have lots of iodine. So we know iodine is important for the thyroid, but too little is not good, but too much is also not good. So we pay attention to that. And toxins, of course, right? Toxins can be triggers for autoimmune disease in some people. Yeah. So you'll say that the thyroid is a yellow canary of our body, that the yellow canary

was the coal miners to bring the yellow canary into the mine. And if it dropped dead, they knew the air was bad. They had to get out. Right. So it was an early warning sign. And the thyroid is like that. And it seems to be extremely sensitive to disruption from heavy metals, from pesticides, the plastics and everything. Yeah. Fluoride. Fluoride. Yeah. So yeah, fluoride in the water. All these things can disrupt our thyroid function.

And often your doctor never even looks for them. Absolutely, right? They say, okay, you know, we're just going to look at the TSH. And if it's in the normal range, you're fine. Or we're going to give you medication to get it in the normal range, but not really look a lot deeper. Yeah. So what is the difference in the testing that...

Oh, there's one other thing I wanted to bring up, which I remember reading about in the New England Journal of Medicine, was a lady who thought that bok choy was healthy. And she ate like two pounds of raw bok choy a day and she went into a hypothyroid coma. And people are having kale juice. Talking about goitrogens.

Yeah. There's a whole kale craze. It's a great point. And people are juicing it and it's raw and raw cruciferous vegetables can be a problem. Right. If you're eating a lot of raw broccoli and cabbage and if you're having raw Brussels sprouts or raw bok choy, kale. Eating it in a level that's beyond just like a normal food portion.

Yeah. Right? But as you mentioned, if you cook it, if you cook it, you get rid of a lot of that goitrogenic potential, the part that's going to interfere with thyroid function. Yeah. So you don't have to be concerned when you have cooked cruciferous vegetables, but it's that, like you said, juicing. So should I worry about having a kale juice every day?

It's a good question. Depends how much kale you put in it right well i'd like to drink green juices and most of them i mean a little bit of kale is fine careful about it and it depends on the person of course right yeah right you're what about soy so you know that's a good question too you know i i think that if if um because a lot of people like soy is really bad it interrupts your thyroid it's dangerous you should eat it I think if we're going with you know non-gmo organic soy as a whole food like edamame and tofu then I'm and I'm not a certain tempeh I'm not concerned yeah traditional soy foods that have been used for centuries, right? Yes. Miso, tempeh, tofu, natto. The fermented soy too, right?

Yep. You know, soy sauce. I mean, those are fine. It's when we're drinking a quart of soy milk a day that's a problem. Or when you're having all these fake soy foods that are processed or soy burgers and you're eating stuff that's sort of weird, frankenfood. Or like the texturized soy protein that they put in cereals and bars just to get that protein content up.

We, you know, we don't. Yeah, a little wonky. That's stuff I, yeah, I tell people to stay away from. Okay, so you're someone who comes in, you feel tired, you're constantly depressed, your skin's dry, your hair's falling out, you don't have a sex drive anymore, you can't concentrate. And you go to a traditional doctor, they'll just test one thing. What do they test?

Right. So they typically test your TSH. Okay. So what is that? Your TSH is your thyroid stimulating hormone. And there's a feedback loop in the body. So if your thyroid level is low, then the body will get triggered to make more TSH. And that comes from your brain, from your pituitary gland. Yeah, and then that TSH will say, okay, make more thyroid.

So if the TSH is high, then the doctor says, okay, your thyroid is underactive and we need to treat it. So that's typical. That's the only thing they test. Often, often. And I think of your functional medicine doctor, it's a very different approach. So what kind of things would you look at?

We always start with a full thyroid panel where you look at TSH, but you look at free T3 and free T4. So free T4 is one thyroid hormone that's floating around in your body, but then the T3 is the active form that your body needs for all the thyroid functions to occur. So we look at all three of those at least. And then we often look at thyroid antibodies. And sometimes we'll even do things like reverse T3 and the reverse T3, total T3 ratio. And what does reverse T3 tell you? So the reverse T3 is a thyroid hormone that the body,

when the body is, I always think of it almost as the brake that the body, when the body is, it's, it's, I always think of it almost as the break that the body, yeah, that the body puts on itself. So when the body is saying, okay, I've got to slow myself down, it takes some of its T3, which is your active thyroid hormone, and it converts it to reverse T3, almost in a way to slow down our metabolism. It's a protective mechanism I think of, right? And it makes sense that we have that in times of stress. A lot of things will actually trigger that that are not actually good, right? That's very true. So like if there was a major stress going on, you'd want to have that mechanism in place so you didn't starve to death. But with a lot of chronic stress, which we see a

lot these days, we can sometimes see high reverse T3. And the other thing we see a lot that causes that high reverse T3 is sometimes toxins. So it can be a sign that we've got to look deeper and say, okay, is this person under a lot of chronic stress? How is their adrenal gland functioning? How are they, are they working to activate that parasympathetic nervous system, that calming nervous system, which helps the body heal. And then we look for toxins. Yeah. In the gluten issues. We look for everything that is imbalancing the thyroid. So we look for nutritional deficiency. Do you have selenium deficiency, iodine deficiency? Are you low in zinc? Do you have low omega-3 fats? Do you have yeast in your gut? Do you have heavy metals? Do you have pesticide exposure, toxin exposures? So we

take a very detailed history that your traditional doctor would not do to really look at the broad spectrum of what's causing it. Because we could just treat the symptoms of the thyroid, but maybe we may not need to do that. And I've seen many patients where you fix these other things and their thyroid gets better. Absolutely. And it's so powerful when you see that.

It's like, oh, I don't need to do thyroid. I can actually fix the upstream cause. Yeah. It's pretty impressive when that happens. And the last thing you were talking about was antibodies. So tell us about what antibodies are and why we should look at them and why the traditional doctors don't look at them. I'm not sure why they don't look at them enough. But the antibodies are giving us a signal that the body is attacking its own thyroid. And it's a sign that there's autoimmune disease going on in the body. And we've got to figure out that question. You know, why is that? Why is that going on? And,

and, you know, so I had a woman who came in to see me, and she, she was 40. And she had been struggling with all those symptoms we talked about with low thyroid. You know, she was cold all the time. You know, her hands were cold. She was gaining weight. She was tired. She was constipated. She was losing hair. Her eyebrows were thinning. Sound familiar to anybody? I know, right? So I'm like, okay. But then her primary doctor did her TSH and it was normal. So we then went deeper. Can I stop you for a second? So what I was trained, and I'm sure you were trained the

same way, was you only check TSH. If that's normal, then you don't do anything else. And what's normal is a range of like 0.5 to 5, which is a massive range that actually doesn't reflect even our current understanding on most reference ranges on the lab tests that even the American College of Endocrinologists says if it's over three and a half, we should be worried. Right. And many, many studies are saying people between one and two feel the best, right? Right. And I remember, you know, because I always do all the tests. I don't do reverse T3, but I do TSH, T3, T4, and the thyroid antibodies. Because what I've learned is that even if all those are normal, TSH, T3, T4, you can have elevated antibodies.

Yes. And people who have those feel better when they get on thyroid. Very true. And I went to a conference years ago at Harvard, and it was a traditional medicine conference, and the endocrinologist was talking about thyroid. And he said, look, if your antibodies are elevated, they should be treated because they're probably symptomatic,

and you treat the patient, not the lab test. But in traditional medicine now, we're more treating the lab test, not the patient. And I think that's really important. And the physician sometimes thinks, well, I'll just wait until these antibodies damage the thyroid enough, and then I'll treat. Right. Right? That's not the way they, you know.

It's like once the TSA starts to go up. I'm going to wait until. But we say, okay, no, there's so much we can do. A hundred percent. There's so much we can do right away. Yeah, I remember this patient came in once with blood sugar like 115, and 126 is diabetes, 100 is prediabetes. And I'm like, God, did your doctor say anything about your high blood sugars?

Oh, yeah, he checked it out. What did he say? He said, well, when it gets to like 126, we'll treat it with medication. And I'm like, no, this is the perfect time to treat you. So tell us about this case. So she came in and she wasn't feeling good at all, but her TSH was normal. So we did the full panel and we saw that her thyroid antibodies were elevated. And so then we had, what was her TSH and the rest of abnormal or not really? No, her TSH was pretty normal. You know, I can't remember

exactly. It might've been a little on the high side, but I don't even know if it was. I think everything looked really normal, but she had those thyroid antibodies. And so I had to ask that question, why? Why do you have these thyroid antibodies? And then it brought us down this whole pathway of what's going on with her digestive system, what's going on with food sensitivities. Was there any signs of increased intestinal permeability. And so we pulled her off of gluten. And you know, we measured things like her iodine level and her selenium level just to get the right balance. And we actually we gave her some thyroid hormone, we gave her some glandular thyroid hormone, I used armor thyroid on her, which is a combination of T4 and T3.

And she started, she really responded well. She felt better. She noticed her hair starting to come back in, you know, her skin starting to be less dry, her bowel movements improving. And so, you know, that, you know, I think it's important that we take that step and go a little deeper. And people don't often realize how bad they're feeling until they start feeling better on this stuff, right? And I think just to back up a little bit, you know, you did something which was kind of unusual, controversial, and most traditional endocrinologists

would scoff at, which is you used a combination of T3 and T4 in a hormone that comes from pig that is the entire thyroid combination of hormones, including T2, which we're going to talk about, that is actually really important to replace your own. Because you make a complex array of hormones, and often the T4 can't get converted to the T3 in your body, which is the active hormone. Right.

So even if you're taking T4, which is what most doctors recommend, like Synthroid or Lavoxel or any of these, and they're not terrible, but they're just challenging because you actually may not be giving the person the T3 that they really need because their body's not able to make it as well. Right. So then we ask that. So some people, as you mentioned earlier, feel fine on T4 thyroid hormone. That's like Synthroid or, you know, so they do okay with it, but a large percentage of people don't. And that might be because they have deficiencies in nutrients that help the body go from T4 to T3, right? So they might be deficient in iodine or selenium, as we mentioned, in vitamin A or iron and zinc.

We talked about that earlier, that they can't make that conversion as easily. And so the medicine doesn't work as well for them. Or it may be because they have a variation in a gene. We know there's this gene. It's kind of a really interesting, low-impact type of gene. So what that means is that it can... Not going to kill you. Right. Thank, it can... Not going to kill you. Right. Thank you. It's not going to kill you, but it can make you not feel so good. And it helps us

know how to treat people. So the gene is this DIO2 gene that encodes for this enzyme, the DI2 enzyme, which helps the body convert T4 to T3, you know, especially in the brain, but also in all throughout the body and make that active T3 thyroid hormone. And what we're learning is that some people have this gene variation. And so when you give them just T4 thyroid hormone, they don't get the benefit. And studies have shown even when lab work looks normal, so even if their T3 looks normal, even if their TSH looks normal, that they do better when you give them some T3, which could be like a glandular thyroid hormone like Armour, which is a combination of T4

and T3, or it could be a synthetic T3. We sometimes use like Cytomel and we'll add that to Synthroid, for example, or a T4 and T3, or it could be a synthetic T3. We sometimes use like Cytomel and we'll add that to Synthroid, for example, or a T4. And so sometimes we see those people who just start to feel better in terms of especially mentally, energy-wise, mood-wise, they really start to feel better finally. I don't realize that depression is related to thyroid. And that, you know, often psychiatrists in treatment-resistant depression, when drugs don't work, they'll give them T3 as a treatment for depression.

They've been doing that for a long time. That's not anything new. Right, right. But it's like weird for the rest. And also, you know, the T4 thyroid replacements, there are challenges with that because there's often fillers, things like lactose and gluten even. Right. Could be other reasons why people don't feel well on those. Yeah. So those are important to recognize. And a lot of the

traditional doctors really scoff at the use of glandulars, like West thyroid, nature thyroid, arm and heart. Why is that? And should we be worried? You know, I don't think so. I think maybe it's maybe during their training or many years ago, there was a question of regulation of those or the dosage. But I don't find that to be a problem at all, that we can definitely regulate dose with our patients. It's very reproducible in terms of the medication. And I mean, a good portion of our patients, I think we've talked about this before, right? We'll say like, maybe was it 80% of our patients or a good portion of our patients do really well when we use a glandular. I mean, there are some that don't. There are some where that might actually cause more autoimmunity, maybe for some,

or they just don't feel good on them. And we use synthetic, but for a good portion, it works really well. Hey everyone, it's Dr. Mark here. If you've been following me for a while, you know that I often talk about how eating organ meats is so good for your health. Now, I know it can be hard to work them into your diet, but when we don't eat things like liver, kidney, and heart regularly, we're missing out on wonderful sources of essential nutrients. Organ meats are nature's multivitamins and the richest sources of natural vitamin A, B vitamins, and minerals that we have. But liver isn't everyone's first choice for a delicious meal, which is why my friends at Paleo Valley created their Grass-Fed Organ Complex supplement.

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Tell us how you kind of figured this out. How did you come up with this hypothesis and what made you interested in this idea of chronic infections and autoimmune disease? Because even though we know in medical school, we learned a few autoimmune disease may be related to infections, it wasn't really a predominant thing. Right. So, thank you. So, I've been in practice since 96 and I started treating lots of Lyme patients. And at that point, Lyme wasimmune illness just kind of evaporated. And I

would see it time and time again. And it wasn't all Lyme. I was looking for other chronic infections and finding them. And then I came upon the realization about the fact that there's this precipitous rise in chronic and autoimmune illness around the world has been like this slowly exploding pandemic rather than as opposed to COVID, which has just taken the world by storm. This has kind of just crept up on us over the last 30 years. And it's shockingly common. And because it is siloed, because it's between different medical specialties, no one's really putting the pieces together about why is this happening? Because the infections have been here forever. And like you mentioned, we're living in an increasingly toxic environment. I think that a lot of us are less able to deal with infections that are common in the population. So what happened to you? I mean,

tell us about your journey with chronic infection. What didn't happen to me? What happened to you? A lot. Yeah, I went through the mill. So I first got Lyme, just regular garden variety Lyme, like so many people do that live in Connecticut. And it was a moderate case. It wasn't dramatic. It didn't disable me. But I realized by going to many infectious disease doctors and ultimately ending up in the office of doctors like myself, Lyme doctors, that there's real discordance among the medical community on how they approach chronic illness. And no one seemed to know what was going on. I gradually got better and I had many relapses. And it wasn't a three-course of doxycycline that got me better. And then I was really fine.

I still had occasional relapses, but I was a healthy guy. I could run like five miles. I could play tennis all day and work six days a week, which I did for many, many years. Then in 2010, while I was sleeping, I got spider bites, and I didn't think anything of it. And with those spider bites, a couple months later, my body exploded with arthritis all over, rapidly progressive to literally every joint in my body, especially my spine. And I went to 25 doctors that couldn't help me. I went to other doctors like myself who thought it was maybe prior Lyme, but I was the only one that's saying it wasn't. And none of the antibiotics that helped me

previously helped me for this case. And I went to a rheumatologist who diagnosed me with rheumatoid arthritis and spondylitis, which is arthritis of the spine. And it progressed very rapidly within six months, despite treatment with different medications, including many antibiotics. I couldn't walk. And I ended up not walking for almost two years. I had to give up my practice for two and a half years. I was completely bedbound for about a year and a half. And I almost died on many occasions. I lost 50 pounds. I couldn't turn over in bed. I couldn't sit up on my own. I needed 24 hour home care. I got severely anemic. And I had fevers 102 every night. It just, it was a dire

situation. And I figured it out in the last minute and put it all together and I saved my own life. And it's not just like saved my life, I'm back to a full life. And I, back in practice since 2013, you know, I lecture all over the place before COVID, traveling around the world and, you know, not limited in any way. And when I went back to my three top rheumatologists when I recovered and I told them, you know, this is how I got better. it change how you practice like no I'm glad you got better but we're not gonna not gonna change tell us more what what actually got you better what you did to recover what was the root of cause because functional medicine is really about looking at the root causes of disease and this is really

what you're doing you're looking at not just a label that people get like rheumatoid arthritis but what's underneath it and how do we fix that? I went to regular doctors and I went to functional medicine doctors as well. Like I said, I went to every specialist I can find and I did the elimination diets. I didn't find any heavy metals or anything like this. She wasn't able to help me to be perfectly honest. And I took lots of antibiotics that flared me up, but didn't get me better. And really it came down to that my infection was Bartonella, which is a antibiotic refractory infection, and it needed really just specific antibiotics. And that's what got me better. I took lots and lots of herbs that didn't help. And at first, I wasn't a believer that herbals were helpful. And then I took my first herb to rock my world,

and it caused this huge heart somber and massive improvement. And that was liposomal artemisinin. And I was like, oh, so that's how an herb is supposed to work. And then I ended up getting tremendous benefit from liposomal oil of oregano and my second herbal and then monolaurin. So there were a few supplements and herbals that were found really, really beneficial. But primarily for me, it was antibiotics. It was things like doxycycline and rifampin and Bactrim. Yeah. So those antibiotics are strong antibiotics, but Bartonello is really one of those tough infections. It's one of those tough infections that's often hard to find and hard to treat. And so people suffer for years from leading things

like this. And I've seen people literally for decades have problems and then you treat them and they get better. It's pretty miraculous. No, I went back to a rheumatologist and they looked like I was a Martian. I mean, one was delighted that I got better. One treated me like it can't be, like in disbelief. And I did a little dance in front of him to try and convince him. I mean, because he saw me not walking and I was like, look, I'm dancing. I'm not a good dancer. And then one was just looking like I was a one-off, like I'm a one-in-a-million case. And she's like, look, one-in-a-million things happen. I'm like, I'm not one-in-a-million. I mean, my mommy told me I'm special when I'm a kid, but I don't think I'm one-in-a-million.

And I think there are other people that have very similar things. Yeah. Yeah, that's funny. I remember we were talking at Harvard and I was presenting about a case of autism that had dramatically turned around and um one of the pediatricians there was like well you know this might just be a case of spontaneous remission and then one of the other doctors well dr hyman said like five cases of spontaneous remission his practice is here so far yeah if you if you understand what what the roots are um and you also talk about in the book your dad who had pretty bad heart failure

and needed a heart transplant. No, he did not need a heart transplant. He was going to need one, right? So what was sort of the discovery there? Tell us about your dad. That's what galvanized my interest in doing what I do. It wasn't my own case. Like I said, my case of Lyme was pretty moderate and I wasn't planning on doing this as a career. But when I started learning about this, my heart, my father had had a case of what they thought was a viral meningitis in 1975. And then shortly after that

became a nonspecific heart palpitations and it got just worse and worse. Then he turned to atrial fibrillation, a specific type of arrhythmia. And then he went into heart failure and we took him to all the best doctors in New York city and all the top teaching hospitals. And we don't skimp. We went to the best and they all couldn't save him. And, um, he got worse and worse. He had ejection fraction between 10 and 20. They said that, um, his lifespan would be measured in months without a heart transplant. And I was just finishing up my residency at Yale. I was doing Lyme research. I'd already had some experience with Lyme personally. And I was like, looked it up and I was like, holy crap, Lyme can do this. So I went to the cardiologist. I said, you know,

Lyme can do this condition, dilated cardiomyopathy. Can we evaluate him? And he rolled his eyes and discounted the whole thing. And they published a study in 2015 where they looked at people with his type of condition, his type of heart failure, went in and did heart muscle biopsies on all of them and found that 20% had Lyme DNA. They made a point in the study to say that almost two-thirds of them had negative Lyme tests. So if you don't really have a big suspicion about what these infections can do, you're going to miss it. And I've treated about 50 cases. See, what you just said is really important. I want to emphasize it. You say that 20% of the

biopsies in the heart muscle were positive, but two-thirds of the people who had the positive test had a negative blood test. So in other words, you can get a blood test, it can look fine. Your doctor says your labs are fine, you don't have Lyme, but actually if you look deeper, you can actually find it because it may not always show up in the regular lab test. It's an important point. Yeah, but you have to ask yourself, who goes and gets a heart biopsy to diagnose Lyme? Like it's the silliest thing. Like, you know, the tests are antiquated, they're like 40 years old. I would say I won't get on a 40 year old app plan. I'm not going to trust my health to outdated technology with blood testing. But long story short, he wouldn't

evaluate him because the guy, my dad never had arthritis and he didn't have Bell's palsy. He's a, you're a doctor now do it. I was just, you know, a fresh out of school basically. And I basically treated him. And his heart function completely normalized. He's 88 years old now. He never needed a heart transplant. He's not in heart failure at all. And that's the story.

That's incredible. So what you're saying is essentially you cured an incurable condition, according to traditional medicine, with treatment of his Lyme disease, which was causing his heart failure. And I think this is important to underscore because so much of what we see in my world and your world, people who are suffering from chronic illnesses who just don't get better, bounce from doctor to doctor, and are often misdiagnosed because doctors often don't have a framework for looking at root causes. And, you know, functional medicine is this framework for looking whether it's heavy metals, which I've had, or Lyme disease, which I've had, or Babesia, which I've had, or mercury, which I've had, or mold, which I've had. These are things which are typically ignored by traditional doctors. Even diet, for God's sake, which is more obvious,

is often also ignored as a root cause of so many chronic illnesses. And I think what you're talking about is that there is hope for people who suffer and who struggle if they can figure out how to get to the right person, which is not always easy. But to even advocate for yourself and say, look, I've got this problem, but I'm not giving up, and I'm going to kind of dig until I find what's going on. And, yeah, it could be a number of different things from a perspective of causes that can cause the same syndrome.

So you can have rheumatoid arthritis, but it could be heavy metals, it could be gluten, it could be Lyme, it could be Bartonella, it could be all kinds of things. But we basically just lump everybody into the same category. Oh, you've got rheumatoid arthritis, or you've got this or that disease. And we go, we know what to do. We give you the drug for that disease, but it doesn't really speak to the cause. And that's really what you guys have been talking about. It's so refreshing to hear you talking about that. So Dana, I want to jump to you for a cause. And that's really what you guys have been talking about. It's so refreshing to hear you talking about that. So Dana, I want to jump to you for a minute. You got sick and you also

developed a Lyme-induced heart failure and you're a pretty young woman. And you sort of talk about how you got a tick bite and a rash and everything kind of went downhill from there. And you went to doctor to doctor until you kind of found Dr. Phillips and got treated. So tell us, tell us about your story and how you ended up being treated by Dr. Phillips and what happened to you and how you got better. Sure. So it was the summer of 2014. I was truly at the prime of my life. You know, I just signed a brand new deal with Sony and just wrote their songs for Celine and I was supposed to be traveling all over the place. And I was incredibly happy. So I say that because when doctors start saying like, it's in your head, or you're making it up, or you want, you know, you just want attention, like those kinds of things are

absolutely insane to me, because so many people are like me, where they get really derailed at the prime of their lives. And nobody would make this stuff up. It's absolutely devastating. So I got a tick bite. I saw the rash. I got it within five days. I caught it because I knew when I got back from New Jersey and got back to Manhattan where I lived and I saw it. I was lucky that I was in the minority that saw the bite and the rash on my shoulder. Most people never see it. And many strains of Lyme do not produce a rash and many other tick-borne infections produce no rash. So that's an important thing for people to know. So I went right over to urgent care.

I knew it was Lyme. They knew it was Lyme. They gave me three weeks of doxycycline, an antibiotic, and said, you'll be fine. Go on with your life. They also told me not to Google Lyme and that I would get scared and that I don't want to be a crazy Lyme person. That was a clue that something really weird was going on. I had no idea that this very common ubiquitous infectious

disease that drives a pandemic of illness was a political hotbed. I had no clue. So I do take the doxycycline. I try to move on with my life. And three months later, I wake up all hell broke loose. The first symptom was that my breast had swollen overnight. I had all these fibrocystic changes and extreme pain. Went to the internist, she sent me she panicked. She sent me to an oncologist that day at Mount Sinai. He ruled out cancer. He agreed my breast was swollen and he agreed this was weird. Didn't know why. Just knew it wasn't cancer. Sent me on. I went to go on to have fibromyalgia, you know, exercise induced, incredible weakness. I was a little gym in my building. I did my same lame workout that I do all the time. And just one day, my arm stopped working in the midst of all

this literally couldn't lift a fork, couldn't feed myself, couldn't walk my 29 pound dog. And I went on to have incredible body pain, brain fog, visual disturbances, anxiety, depression, intrusive, suicidal ideation, where I literally couldn't stop thinking about jumping out my window, but I didn't want to, but I couldn't stop. It was something, it was like a monster took over my brain and my body. I went on to see three infectious disease doctors, tons of internal medicine and the oncologist and sports medicine, and nobody had any answers.

And what the, you know, I would ask them, especially the ID guys, you know, could this be related to the tick bite? No. Why not? Because you took the three weeks of doxy and it's cured a hundred percent of the time and the test tube with doxy. Okay. That's actually totally not true. The other reason that one of them gave me, this is my favorite, you know, this well-known doctor at NYU said to me, because I went to medical school. So I'm like, well, ticks carry other infections too. You know, is there anything else? I was pushing them at some point. I said, do you want to test me for inflammatory markers? Like anything? He goes, that's a pretty good idea.

Okay. Well, this is my third visit with you. You know, are you kidding me? So I went on to have this horrible experience until December when I went into heart failure. And then everybody like really got serious, really believed me. I mean, I do think some of them thought it was in my head because I had so many weird, disparate, migrating symptoms that doctors are when they don't understand something, they put you in the psychiatric bucket. You know, that's, that's a theme. I think, of course, you know that very well. So and when you when you have these things, you do feel crazy, because nobody can give you any help. And also the fact that it's changing all the time. And every day, it really feels crazy. So then, in December, I went into into heart failure my ejection fraction was 40 percent under 50 is considered heart failure for people don't know and yeah yeah and and it was no i mean

i was so healthy before all this so then thank god i had a friend who knew about dr phillips and seen him testify at some hearing and like knocked it out of the park and said, you know, you got to go see him. He's brilliant. And he's the only person I would see if I was in your position. So I went to him and he saved my life. And, you know, within like two months of seeing him, my heart failure totally resolved. And he did talk to the Mount Sinai cardiologist who had been very concerned about it did take my heart failure seriously, just didn't know the cause. And Steve really educated him about, you know, Lyme carditis. He didn't really even know very deeply about it. He was interested and he was educable. He was the only one but he was and I really appreciate that. But I was treated with

a rotating course of antibiotics, antimicrobials, Chinese, I did a Chinese herbal protocol as well called the Zhang protocol. There are plenty of them of different Chinese medicines you can take. That was the choice I made because I lived in Manhattan and it was in the city and I could see them. And anyway, they, you know, Dr. Phillips like really came in and got me better. It was a miracle. Yeah. Well, you know, Dr. Phillips like really came in and got me better. It was a miracle. Yeah. Well, you know, I hear this story so much that people, you know, often suffer and they

really struggle with trying to figure out how to get the right treatment. But, you know, I think what you're speaking to is, is the need to think deeply about rethinking medicine and rethinking how we approach disease. What are the consequences of chronically not getting enough sleep? Is it just that you're tired or are there deeper issues that can have almost like permanent damage on the body? Absolutely. I mean, I think we're just recognizing the dangers of sleep deprivation in terms of its risk for chronic illness, heart disease, cancer, diabetes, Alzheimer's, depression, anxiety, mood disorders of all sorts. So it's a real thing. And I think if we don't take it seriously, we're going to be missing the boat

on a very important intervention in helping to address some of these chronic diseases that goes far beyond diet or exercise. The other thing that happens is your brain at night has a system of cleaning and repair. So you need to have what we call the lymphatic system working. The lymphatic system is like the lymph system of the brain. It's recently been discovered and it's so important. It really is activated at night. So if you're not sleeping at night, you're not clearing out the brain waste and you're going to have a brain full of sludge and waste products that are metabolic waste and toxins. So it's so important for that particular reason too, to make sure you have adequate good sleep. I know there's a little bit of controversy around this and a lot of different opinions,

but from your perspective, how many hours of sleep should we be shooting for in the evening? I mean, it's very individual. Some people do fine on six hours. Some people need nine hours and you need to find out what your number is. Everybody's different, but the amount of sleep where you can feel good and energetic and your quality of sleep is deep. I mean, if you sleep six and a half hours and it's like, you know, a ton of deep sleep, a ton of REM and really reparative, and that might be enough for some people. Other people might need nine. I need about eight or nine. I love if I can get it, but it really makes you feel much more vibrant and healthy and functional. So I think, you know, certainly more than seven ideally, and probably between seven to nine hours is a good amount.

And again, as I said before, you know, the last century, about half of us, I mean, sorry, the average number of hours of sleep a night was like nine hours. Now it's seven or less. All right, next question what are commonly overlooked issues that drive poor sleep unexpected things things that people may not know that expand on that first list that you gave us when we were opening the episode yeah i mean i think people don't understand the role of their overall pattern of being and living. So first thing is, when you wake up, you should get 20 minutes of sunlight without sunglasses on, because it resets your pineal gland, which makes melatonin,

regulates your circadian rhythm. So we want to keep our circadian rhythms in balance. The second thing is, you know, our diet plays a huge role. And particularly, you know, if we're eating a diet that's, you know, high in starch and carbohydrate, we're having fluctuations in blood sugar. We may actually even at night get hypoglycemia, and that can really disturb our sleep. We can get night sweats. You know, men often get night sweats too, but that's often usually low sugar. And then the cortisol spikes, and you get a spike in sugar in the morning.

So that's often usually low sugar and then the cortisol spikes and you get a spike in sugar in the morning. So that's a real problem. I think the other thing is, you know, people are probably consuming a lot of alcohol, caffeine, sugar, all these disturbed sleep, chronic stress. You know, if you're not actually discharging stress, a lot of people go to bed tired and wired and a lot of people have adrenal issues. So they're pushing so hard in their life that they actually don't have a chance to reset and relax their nervous system. And that leads to incredible amounts of cortisol production, cortisol disturbed sleep. I mean, if you take prednisone for whatever reason, it's going to mess up your sleep. So stress plays a huge role. Exercise. I mean, you don't want to exercise too late in the day. That can often activate you. So there are a lot of things that can drive poor sleep, lack of magnesium,

which is common in the country. If we don't eat magnesium in the forms of grains and beans, greens, sorry, greens and beans, nuts and seeds that we end up with magnesium deficiency, which affects about 45% of the population. And people don't sleep well when they have low magnesium, it can be irritable, cause irritability and tension and stress. And then plus caffeine and chronic stress and smoking, a lot of other things will cause magnesium depletion.

So you want to make sure you're getting plenty of magnesium. Talk about sleep in your life. What are the things that now at the age that you're at and your schedule, what are the things that throw your sleep off? And what are the effects that you notice in your performance the next day when your sleep is thrown off? No, yeah. I mean, it's huge. I mean, if I'm traveling, you know, I'm trying to stay in one place longer, but it depends on the bed and the pillows, the sound, the noise, the temperature. I mean, I can get messed up. And given all the years of screwing with my schedule and sort of staying up all night,

I definitely have sleep issues. But I've learned how to actually mitigate them by, you know, making sure I do a bedtime wind-down ritual, making sure I take my bedtime supplements like magnesium, a little melatonin. And if I don't get a quality sleep, I notice in the next day, I can't focus. I can't think. My brain is a lot distracted. It's hard for me to be present with other people. It's hard for me to feel motivated to do anything. I know I get a little depressed, but it's not, I know I'm not depressed. I just know it's the sleep, like a sleep.

So I think, you know, very attentive to sleep. But I think, you know, sometimes it's hard, you know, when you're out with friends and you're traveling you're on vacation it's a little tricky but mostly i i'm pretty good about getting to bed by 10 9 30 10 sometimes a little bit later and try to sleep you know and read a little bit i have a i have a light which is a reading light that's a kind of an amber light that has no blue light and it's kind of to leave leave the light bulb on on the bed. So I try to calm down from the light. I have blue blocker glasses at night I use. That really helps. And so that all benefits me. Talk to us about how conventional medicine typically treats poor sleep when a patient is going through it and contrast that with functional medicine and how with functional medicine,

and how a functional medicine doctor would look at addressing poor sleep quality with a patient. So from a traditional medical point of view, I mean, there are reasons for people's lack of sleep that a conventional doctor will look at, whether it's sleep apnea, restless leg syndrome, there's sleep studies that doctors do that can be very revealing. A lot of people have undiagnosed sleep apnea. At the Ultra Wellness Center, we now have a home sleep study kit, which allows people to kind of get tested and do it at home, which is great. However, you know, often there's really very little to do from a conventional perspective other than, you know, recognize basic sleep hygiene. And then there's a CBT sort of approach, cognitive behavioral therapy, which helps people deal with sort of the mental aspects of insomnia. And that can be very effective. Cleveland Clinic has an online program. There's called SomRest, which is available. So there's a lot of really useful conventional approaches to help

people reset their sleep. However, there may be a lot of other causes from a functional medicine perspective for sleep disruption. The traditional medicine just says, oh, do therapy or take these sleep pills or practice better sleep hygiene. But they don't really say, well, why is your sleep disturbed in the first place? This is why we're so effective in functional medicine because we don't want to know just what you have. Insomnia, we don't know why. Why are you not sleeping? Is it because your thyroid's not working?

Is it because you have chronic stress and adrenal burnout? Is it because you have low magnesium? Is it because your microbiome is inflamed and causing inflammation in your brain? Is it because you might be hypothyroid, which can cause a little bit of sleep disruption? Or is it because, you know, you have a bad sleep environment? Or because your sleep habits are terrible? Or because, you know, we go through all the underlying root causes and then and then we and then we dress those whatever they might be you know it's amazing to me

Jerry I never would have thought this is the thing but when we put people on the 10-day detox diet when you put pill on elimination dying you're gonna you know processed food sugar dairy gluten grains etc it's amazing how many people before oh my sleep got so much better I I'm sleeping so much deeply. I feel so much better. I'm like, well, wow, I don't know about that. But I think what happens is there's inflammation of the brain and inflammation will interrupt sleep. And when you start to live an anti-inflammatory life, you actually will end up with a much better sleep quality. A little anecdote is that my dad, many years ago, when we put him on a version of

the 10-day detox, and he had been eating bread his whole life because he grew up vegetarian and still was a vegetarian when he was doing the program, one interesting thing that he noticed is that when he had cut bread out of his diet, he noticed this chronic back pain that he had at night that would make it harder for him to fall asleep, went away because the inflammation went away. And that then made it easier for him to fall asleep. And so he got a better night's rest. There you go. Yeah. Talk to us about another patient and a case study that you can think of where sleep was the missing link that allowed them to get into a better state of health. Anything that comes to mind?

Well, I have two. One was this guy who was a very, editor of a major, major sort of Sunday kind of magazine newspaper. I mean, you would all know what it was. And, you know, his team was like, he's just falling asleep all day in the office. I'm like, it's terrible. He's not able to function well. It's annoying. He'll fall asleep at meetings. Well, tell me about your life

he says well i drink you know 12 cokes a day and have 12 cups of coffee a day i'm like oh okay well maybe caffeine is a problem uh so we got him off the caffeine and we put him on an anti-inflammatory diet and it was amazing he just completely turned around and was able to you know be able to function again uh there's another case i remember a young uh, well, not young, he was about a 50-year-old. He's young to me now, but 50 seems very young to me. It's all relative. And he was a lawyer. And I'm like, well, tell me how you're doing. He's like, well, I want to lose weight. I'm kind of overweight. And he had, you know, the big belly and prediabetes. And I'm like, well, tell me about your life. And he says, well, I said, do you sleep?

I go, yeah, but during the day, I use a stand-up desk. And this is before a stand-up desk where you must think. And because if I sit down, I'll fall asleep while I'm working. And I'm like, wow, OK, you probably have sleep apnea. So I said, let's test you for sleep apnea, and he sure enough had sleep apnea. We put him on a CPAP machine, which is a breathing machine to sort of stop CPAP.

He literally lost 50 pounds just like that and felt so much better, and we corrected his underlying issues around sleep and metabolic health. The thing is, if you don't sleep, you also crave carbohydrates, you crave sugar, you crave, you know, all the junk that's going to make you gain weight. And we know this even from studies on young, healthy adult college males who are not overweight when they deprived them of two hours sleep a night compared to the

control group, the ones that had the two hour sleep deprivation ended up having higher levels of ghrelin, which makes you hungry, and PYY was lower, which is the appetite-suppressing hormone. And so they had hormonal changes that made them create more carbohydrates, eat more food, be hungrier, gain more weight. And so really the key to often healthy metabolism and weight is actually sleeping. A lot of people at night notice that their mind is running and it just won't get quiet and that impacts their sleep. I know you have a lot of experience with meditation and different protocols that you've used either personally or recommended to people in the past, but is there something that you could suggest that those individuals could try

when it comes to winding down at night and getting ready for bed? Absolutely. I mean, I think, you know, when you think about it, it's kind of silly. We like go, go, go. We're answering emails at 11 o'clock at night. We're looking at our screens. We're engaged in all kinds of stressful, emotional, psychological things with our work or whatever. And then we're like, okay, lights out, boom, go to sleep. And people are exhausted, but they often fall asleep, but then often wake up frequently because they got the stress hormones going in their body. So I think really having a sleep ritual at night

is so important for me. It's very important. I get off screens at least a couple hours before bed. I often will take a hot bath with Epsom salt and lavender, which calms my nervous system down. I'll put the little kind of amber light that has no, it's like a reading light that has no blue light, turn all the other lights off. I'll read a little bit in bed and the reading and the calming down just calms it down. The other thing I can do often

is I'll write a little before bed. So I'll literally dump out what's ever in my head. I'll just write it all out and I'll just completely purge anything that is a negative thought pattern in my head or my worries for tomorrow what happened that day whatever whatever and I just try to let go uh and the other thing you can do is a little yoga stretching before bed a little deep breathing exercises before bed get a little massage before bed you know all those things can help um but you know if you're a partner you can rub each other's feet. That's a very relaxing thing to do.

I have a Theragun. I'll often use that to kind of relax my muscles and nervous system. You have to find out what's right for you, but it really requires some level of decompressing and unwinding before you get into bed because if you just plop into bed after running a hundred miles an hour,

it's like you're not going to fall asleep. 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.

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