The Dr. Hyman Show - Are You Pre-Diabetic? | Know Your Numbers

Episode Date: October 13, 2023

This episode is brought to you by Joovv and AG1. Metabolic dysfunction is the largest health crisis facing the world today and our greatest limitation on longevity. An estimated 93% of Americans are in poor metabolic health and an estimated 88 million—more than a third of the adult population in the United States—have prediabetes. Of those, more than 84% have no idea they have a blood sugar problem, and yet up to 70% will develop diabetes within 10 years.  In today’s episode of a new series I’m calling Know Your Numbers, I dive deep into metabolic health. I discuss what you should measure to understand your metabolic health in a whole new way, the difference between conventional and optimal lab ranges, and much more.  You can test your metabolic wellness with Function Health, a company I co-founded. It has been a lifelong dream for me. Function is the first-ever membership that includes over 100 lab tests and personalized insights from globally renowned doctors based on your results. Join Function by securing your spot on the waitlist at functionhealth.com to get access.  This episode is brought to you by Joovv and AG1. For a limited time, Joovv is offering all my listeners an exclusive discount of $50 off their first order. Just go to Joovv.com/FARMACY and apply my code FARMACY. Head to drinkAG1.com/HYMAN to receive 10 FREE travel packs of AG1 with your first purchase. Here are more details from our interview (audio version / Apple Subscriber version): What factors create poor metabolic health? (6:36 / 4:18) The importance of measuring insulin levels (7:22 / 5:42)  The difference between normal and optimal lab ranges (9:38 / 7:26)  Measuring and understanding your A1C levels (11:25 / 9:16) Why you should measure uric acid and leptin (14:19 / 12:12) Cholesterol testing beyond the standard lipid panel (16:04 / 13:56)

Coming up on this episode of The Doctor's Pharmacy. The truth is that 93.2% of Americans are in poor metabolic health. Meaning what? Meaning they have some degree of insulin resistance and are somewhere in the spectrum from pre-diabetes or pre-pre-diabetes to type 2 diabetes, right? And that means they have either high blood sugar, high blood pressure, high cholesterol,

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And right now, Athletic Greens is giving away 10 free travel packs with your first purchase. All you have to do is visit athleticgreens.com forward slash Hyman. Again, that's athleticgreens.com forward slash Hyman. Again, that's athleticgreens.com forward slash Hyman. And now let's get back to this week's episode of The Doctor's Pharmacy. Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman, a place for conversations that matter. And today I'm excited to bring you a new series in our doctor's pharmacy called Know Your Numbers. It's a groundbreaking new podcast series that's going to help you understand your body and

your health in a whole new way. Our focus is on getting to the bottom of what's happening inside your body through lab testing and empowering you with a path to get yourself sorted once you find out what's going on. We talk about what are the right ranges, not just what the reference range says, but what's the optimal range for you, what correlations are between the biomarkers, what it means, and how do you create a personalized roadmap for your health. In this series, we're going to be diving into a whole set of lab tests you might not have heard about and often are overlooked by traditional doctors, but we're going to explain why they're important, why you need to know them. In a perfect

world, you know, I could see millions of patients, billions of patients and share with them what I know when I've learned over 30 years of practicing functional medicine. But the truth is I'm just one guy, one doctor, and our conventional healthcare system is already overburdened and most doctors are not looking at health proactively or preventively. They're waiting until something happens. Basically, wait until a problem goes wrong, then try to figure out what it is, then give a drug. And if that drug doesn't work, you give another drug.

And if that doesn't work or cause side effects, you know, hopefully they just sort of figure out another thing. But it's kind of a mess. And so the key is, how do we create a proactive strategy around our health? Now, in this new podcast series around Know Your Numbers, I'm excited to share with you what really should be looked at and what's really going on under the hood. And in order to actually get people access to their own biology, and I believe we need to democratize people's healthcare, we need to give people agency and sovereignty over their health so that they know what's going on.

It's not just a doctor's job. And you're smart enough, I believe, to know exactly what to do when you find out what's going on with your body. Now, we have wearables that give us everything from our temperature to our oxygen saturation, our heart variability, our sleep metrics. I mean, pretty much everything you'd want to know from our wearables. Why should it stop there? And our skin, why don't we go inside our bodies and find out what's really going on? And so I recently co-founded a company called Function Health.

It's a revolutionary new way to understand and manage your health. It starts with a comprehensive set of labs that I do repeatedly to help figure out what's going on and get a really big roadmap of what's going on with their biology. And it's basically over a hundred biomarkers that you get checked every year. All the results are delivered in an easy to use dashboard that tracks your numbers over time and can show you insights about how you're changing for good or bad, what your biomarkers mean. So we're building function to democratize much of what I do to give you the keys to your own health and to put control back in your hands. This is the most powerful approach to health I've seen in my career as a doctor, and it's the most

crucial step you can take for your health today. So it's really important that you have to realize that you're the CEO of your own health, that you are the one in charge. Most of health does not happen in a doctor's office. It happens where we live, work, eat, play, and pray. So the waitlist for Function now is open and Function is live across the United States. We're inviting new members to join our waitlist every day. And if you're interested in taking control of your health, make sure you secure your spot on the waitlist right now by visiting functionhealth.com. Okay, let's get started with the first episode of Know Your Numbers. All right, the first set of numbers that are important,

and by the way, there's not like one number that you look at that's the right number. It's the profile. It's the pattern in the data that's going to give you a sense of what's really going on. So I look at not just one biomarker, but I look at patterns of biomarkers and what they tell me about people's health. And the biggest problem facing America today is poor metabolic health. It's essentially a condition that affects 93.2% of Americans, and most of them have no freaking clue. In fact, if I said, do you have good or bad metabolic health? You might not even know what I'm talking about, or you might go, yeah, I'm overweight. Maybe my metabolism is not so good. But the truth is that 93.2% of Americans are in poor metabolic health. Meaning what?

Meaning they have some degree of insulin resistance and are somewhere in the spectrum from pre-diabetes or pre-pre-diabetes to pre-diabetes to type 2 diabetes, right? And that means they have either high blood sugar, high blood pressure, high cholesterol, have had a heart attack or stroke, or are overweight. So that's only 6.8% of us that are healthy and won't have abnormal tests. And that's what we're finding. By the way, people have already gone through and measured their biomarkers, and we're seeing overwhelmingly, even in younger age groups, real abnormalities in metabolic health. So what are the things we look at? When we look at things

that your doctor may already look at, like blood sugar, that's great. But by the time your blood sugar goes up, your horse is way out of the barn. I mean, the problem is that by the time you see elevations in blood sugar, you've already probably been in poor metabolic health for a decade or two and your body has compensated for it, and your blood sugar only goes up when you stop compensating for it. So what else should you measure to know what's going on with your metabolic health? Well, the single most important test I think that you need to know about your health, and particularly for longevity and your rate of aging, is something called insulin. Now, sadly, even though I've been measuring this for 30 years, and it's very inexpensive,

but for the most part, people don't look at insulin. Yet, when you look at the scientific literature, elevated insulin levels are extraordinarily predictive of bad health outcomes, diabetes, heart attacks, strokes, cancer, dementia, you name it, pretty much everything related to aging. So high insulin levels are easy to measure, but almost never measured. So I'm going to ask you to think about all your doctor's visits. And when was the last time your doctor said, I measured your insulin and here's the problem. And in fact, unless you're going to a functional medicine doctor or someone who sort of does what I do, you're probably not going to get that test.

And yet it's so essential because your insulin starts going up before your blood sugar goes up. And it keeps your blood sugar down for a long time. So by the time your blood sugar starts going up, you're in trouble. So that's really important. And it's an easy test. And it's important to understand how to interpret it. Because when you look at, for example, blood sugar, the reference ranges are screwed up, right? It says if you're under 100, you're okay.

If you're 100 to 126, you have prediabetes. And if you have over 126, you're type 2 diabetic. Okay, fine. That's fine. But like what if your blood sugar is 95? Is that okay? Or 99 or 97 or 91? Probably not.

In fact, when you look at the literature, your risk goes up in a linear fashion, starting at a blood sugar of 85 fasting. And this is from a large Israeli cohort where they looked at basically rising blood sugars and increased risk of heart attack, strokes, and death. And it was just a perfect straight line. So what is the optimal range? So when you look at it, just to kind of give you a little background on knowing your numbers, when you look at reference ranges on a lab that you get from your doctor, it'll say, here's the low end and the high end of the range. How do they come up with that number? They come up with that number based on statistics. And what they use is

something called the standard deviation. So basically, when you look at a number, it's two standard deviations from the mean. The mean is sort of the middle range of the population, but it basically includes about 96% of the population, right? So 2% on either end is outside the two standard deviations from the mean, and everybody else is, quote, normal. But let's just take America, for example. If you landed in America and you were a Martian, you would basically conclude that it's normal for people to be overweight because 75% of people are overweight. Well, it's normal, quote, normal, but it's not optimal. And so the question is, what is the optimal ranges in which you have vibrant health?

Not do you not have some terrible disease, right? By the time your blood sugar starts going over 100, you're already in trouble. But maybe it should be 70 to 85. You know, how about your insulin? If you look at a blood reference range on insulin, it'll say, you know, 5 to 15 or 20. Well, that's ridiculous. Your ideal insulin should be less than 5. If it's 5 to 10, you're borderline.

If you're over 10, you're in trouble. And I see this over and over as an easy test to measure. The doctors are missing that it's going to give them a clue about what is really going on metabolically with their health. So insulin is so important. You've heard me talk about insulin probably until you're sick of me talking about insulin on the podcast and my books, but it is one of the most important things. And it's a simple biomarker that's almost always missed by your traditional doctor. So what else should you be looking at? Well, you should be looking at your A1C. Now, most doctors look at hemoglobin A1C after someone's already diabetic in order to track therapy.

Now, A1C is basically a measurement of sugars and proteins glomming together to form these damaged things, basically these damaged hemoglobin. Basically, it's called glycation it's it's like a a chemical reaction that occurs between sugars and proteins and you'll see it for example on on the crust of a bread or crispy chicken skin or creme brulee that's not good and that's fine if you're eating it but you don't really want to eat too much of that anyway it's called the advanced glycation end products or ages a-g-e-s that bind to rages r-a-G-E-S, that bind to rages, R-A-G-E-S. So aging causes raging,

which causes aging. So you get the picture. These guys come up, acronyms are very funny. But anyway, the whole point here is that hemoglobin A1C is an indicator that your blood sugar is on average too high. And so it should be a level of under five and a half. Now, it used to be that we used to say six was diabetes, and then they moved it to six and a half. But the range between 5.5 and six, that's kind of in the pre-diabetic range. Now, is it better to be lower? Yes, probably better to be around five or 5.1 or around that. Most people aren't that because their blood sugars are just too high. But if it starts to go up, it's a sign that there's a problem. Now, like I said, you can

have perfectly normal blood sugar, perfectly normal A1C, and still be in really bad shape. And I'll just give you an example of a patient I had years ago. She was very overweight, and I checked her numbers, and I was like, wow, I think you're going to be diabetic. And I checked her numbers and I was like, wow, you know, I think you're going to be diabetic. And I said, let's do a glucose tolerance test and measure insulin and glucose. And now, by the way, most people who are doctors do not measure glucose tolerance tests unless you're pregnant at 28 weeks or if they think you have diabetes, which is silly. We should be all doing that test if there's any indication of any overweight problem or metabolic health issues. There's indirect ways to figure out what's going on, but I think if you're concerned,

it's really the gold standard. And what you do is you give yourself the equivalent of two Coca-Colas worth of glucose, and then you measure glucose at fasting one in two hours, or you can do it at 30 minutes, one in two hours, and fasting. But most doctors, when they do that test, will never do an insulin test, but that's the most important. So this patient basically had perfectly normal fasting glucose, a perfect one-hour glucose, and a perfect two-hour glucose. Never went high at all, never went over 120. And her A1C was perfect, but her insulin was like 50 fasting, and it went up to 200 and 400 after the sugar drink. So her insulin was just 50 fasting, and it went up to 200 and 400 after the sugar drink.

So her insulin was just working overtime to keep her blood sugar normal. So you've got to kind of check insulin, A1C, and glucose. But you've got to look at the whole picture. Now, what else can you use to determine your risk and what's going on metabolically? Well, often and overlooked in a very important test is called uric acid. Now, people might have heard about this. If you have high uric acid, you can get gout. and that's what people know about it. You can also get uric acid kidney stones. But uric acid is a compound that's produced in the body in the course of

metabolism, particularly in the course of metabolism of fructose. Now, fructose is fine if you're eating it in fruit, but most of the fructose we consume in this country is in the form of high fructose corn syrup. So maybe between 55 to 75% fructose, and it's free fructose. It's not bound like in sugar. If you have table sugar, it's fructose and glucose, but they have a chemical bond. Well, in high fructose corn syrup, it's free fructose, and that creates a huge load in the liver, which doesn't raise your blood sugar, but it actually causes fatty liver, insulin resistance, and diabetes through another mechanism, and it increases uric acid. So if you have high uric acid, it's a sign of inflammation, it's a sign of metabolic poor health, and it's an easy test to measure. Another test is leptin. Leptin is a very important test because leptin

is the hormone that actually tells you you're full. Now, sometimes it doesn't work. Just like you have insulin resistance where you end up with higher and higher levels of insulin to try to get your blood sugar normal because your cells become resistant to the effect of insulin because you're eating too much sugar and starch, kind of like the boy who cried wolf. The same thing happens with leptin. You can get leptin resistance. And so often you'll see high leptin. You can get leptin resistance. And so often you'll see high leptin levels in people who are overweight, not because their appetite system's working great and

it's making them feel full, but it's because they are inflamed and their brain is not responding properly and they're having to produce more and more leptin. It's not working though. So that's another clue. So these are all really simple tests. Another really important test is a measure of your cholesterol. Now, not the typical cholesterol that you get at your annual checkup. Most people get that. It's pretty standard. But that's like, you know, kind of, I would say, what the analogy would be, Newtonian physics to quantum physics. It's just, it's old school. It describes things in sort of a way that's useful, but it doesn't really give you the full picture. And recently I had Ron Krause on the podcast who was a scientist and

lipidologist who basically discovered that cholesterol wasn't just HDL, LDL, total cholesterol, triglycerides, but the quality of the cholesterol matter. Those numbers that you get on your annual test are just the weight. Like basically how much if you weighed it, how much would it weigh? How many milligrams per deciliter? In other words, how many milligrams in a deciliter of blood of cholesterol do you have? It's like 200 or 300, right? But the, the, it doesn't tell you whether it's like, if you have a box, you know, that's a certain weight, you could, it could have, you know, 10 big beach balls or a thousand golf balls. And, and those have a very profoundly different effect on your health. Now, why is this important in terms of your metabolism? Because the size and

the number of your particles is an indirect indicator of your metabolic health. When you have insulin resistance, prediabetes, metabolic syndrome, it's all the same thing. And by the way, what does that even mean? It means people who have belly fat. It means people who have high blood pressure. It means people who have high fasting blood sugar, but not 126. It means they have a low HDL, high triglycerides, increased waist size. That's all what we call metabolic syndrome. But this test is so important because you can do through a simple cholesterol test that can look at other markers of your lipid quality that

really matter, like lipid particle size, whether your LDL is small or large, whether your HDL is small or large, whether you have larger or small triglycerides, how many particles you have. And that gives you a really good sense of your overall state of metabolic health and whether you're insulin resistant. So you can have a totally normal cholesterol, like 150, but it can be made up of all these small particles and be far more dangerous for you than if your cholesterol was 250. So it's really important to look at these measures. And sadly, Dr. Ron Krause discovered this over 40 years ago, I think.

And still, there's very little uptake in the healthcare system, I think, even though it's not really much more than a normal cholesterol panel. And I think he said maybe 1% of the tests done in America are this, maybe less, I would guess. But it is the gold standard in my mind for how to look at cardiac health and for how to look at metabolic health. There's also other markers that are included in function health, which also indicate risk. So ApoB is another type of cholesterol particle that we don't typically look at that often, but it also is a direct measure of the type and quality of your cholesterol particles. So if you have more insulin resistance, if you have poor metabolic health, if you have higher triglycerides, more small particles, you'll see more ApoB particles, and that's

dangerous. And this is also something you can do something about. We also look at HSCRP, which is C-reactive protein. Now, one of the things you should know is that if you're obese or overweight or at poor metabolic health, by definition, you're inflamed. And we know that inflammation is the real driver of all age-related diseases, heart disease, cancer, diabetes, dementia. So when you look at CRP, it gives you an indicator of whether or not you are having this smoldering, silent killer of inflammation. And you may not feel it. It's not like a sore throat or a sprained ankle, but it's really dangerous. And when you combine high CRP with poor metabolic health, with bad cholesterol, it's kind of a deadly combo. So getting your CRP checked is really important. That's also part of it. We also look at other markers for cardiac and metabolic

health, like lipoprotein little a. So it's really important that you understand how to correct these things. And the beautiful thing about function is that we provide you with a roadmap based on your particular biomarkers. For example, with insulin resistance, we know that things can be very helpful. Things like berberine or green tea or other nutrients like lipoic acid or magnesium or chromium or biotin, all can be very helpful in regulating blood sugar. And then, you know, if you do need more aggressive help, we'll say, gee, your A1C is like 12. You better get in to see the doctor today because you're in trouble and you could end up in ketoacidosis if you don't get this treated. But for most people, this is something that can be managed.

It's a slow smoldering problem. And then you can recheck your biomarkers and actually see what happens. So it's really important to understand that metabolic health is the biggest threat or poor metabolic health is the biggest threat facing America today and increasingly globally. It's primarily caused by our ultra-processed high sugar starch diet and sedentary lifestyle. And I've seen this over and over my patients. And it's not about taking a pill or getting a shot. It's about understanding the root cause and fixing that, which is what functional medicine is all about. It's what functions about and why it's so important. So this is a really short snippet of why it's

important to know your numbers, particularly these numbers, because I think most people don't know these numbers about themselves. And it's shocking to me that given the science we have, that we don't do this. And what I'm saying is not alternative medicine. It's not integrative medicine. It's just good medicine. It's what all doctors should be doing. And it's based on the existing scientific evidence. Now, what happens is that we have

scientific evidence, but it takes decades and decades for it to translate into clinical practice. Like I said, Ron Krauss figured out this stuff about lipid particles 40 years ago, and still it's not being done. This stuff about insulin is not new news. Gerald Rieven discovered this, again, 30, 40 years ago, more, I think now. And I bet he's dead already. He discovered it when he was a young man. And this is really what's facing us today in America, which is this disaster of poor metabolic health. So it's important to know these numbers, and you're not going to typically get them at your doctor. So like I said before, if I could see millions of patients, I would, but I can't. So with Function Health, we're hoping to democratize much of what I do, offering you

the keys to your own health. And for my career as a doctor, this is really the most powerful approach I've seen. It's the most impactful thing you can do for your health, which is take ownership of it, which is understand what's going on inside, which is knowing your biomarkers, not just the wearables, which are great, but let's go under the skin. We're looking at over 100 data points on a repeated basis that help you figure out what's going on. Now, a function fills gaps in our really strained healthcare system because, you know, doctors are busy. They're putting out fires. I think we have 130,000 doctor shortage. We have nursing shortages. We just don't have enough physicians and practitioners to deal with the incredible degree of chronic disease we have in America. Six out of

10 of us have a chronic illness, 75% overweight, one in two have diabetes, 93% are metabolic unhealthy. I mean, we don't have enough healthcare providers to go around. So we need a different model. And this is really why I helped co-found Function Health. And it provides you with an all-in-one set of over 100 lab tests that cover everything from hormones to heart testing, to thyroid, to nutritional testing, to heavy metals, and lots more. And now, many of the test doctors just don't do, and they should be doing them, but they're just kind of trying to deal with the reality of what they have to deal with, which is just putting out fires.

So you don't have to deal with burdensome insurance. You don't have to get lost in complicated medical records. You don't have to Google your results to find out what it means. Function offers clear, understandable results that are tracked over time. They give you actionable advice that enable you to see how your body's changing and make informed decisions about how to optimize your health. And guess what? You can get all of it for just $499 for a year, and that covers the cost of over 100 lab tests. You know, so many people have already joined Function. We have lots of people on the wait list ready to take control of their health,

and we're inviting new members on every day. So to transform your health, visit functionhealth.com right now to get your spot on the wait list. So thanks for tuning in to this new Dr. Pharmacy podcast series called Know Your Numbers. I hope you've enjoyed it. If you liked it, share with your friends and family. I bet they need to know about their metabolic health. Leave a comment.

How have you learned about your numbers? And what has that changed for you? And we'll see you next week on the Doctors Pharmacy. Hey, everybody. It's Dr. Hyman. Thanks for tuning into the'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 and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements, to gadgets,

to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll send it to you once a week on Fridays. Nothing else, I promise. And all you do is go to drhyman.com forward slash pics to sign up. That's drhyman.com forward slash PICS to sign up. That's drhyman.com forward slash PICS, P-I-C-K-S, and sign up for the newsletter, and I'll share with you 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 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.