The Dr. Hyman Show - Blood Clots: A Functional Medicine Approach with Dr. Elizabeth Boham

Episode Date: October 4, 2021

Blood Clots: A Functional Medicine Approach | This episode is sponsored by Rupa Health and ButcherBox Blood clots are a fairly prevalent issue that can become very serious if not treated promptly. They can occur as a result of injury to the lining of the blood vessels or lack of mobility for an extended period of time. And while the traditional approach to treatment is using a blood thinner or aspirin, Functional Medicine focuses on the prevention of blood clots as well as treatment options, which may include healing the gut, reducing inflammation, and supporting genetics. In this episode, Dr. Hyman discusses this topic with Dr. Elizabeth Boham. They explore how health conditions such as cancer, autoimmune disease, metabolic syndrome—and even certain genetics—may increase the risk of blood clotting. They also share their personal experiences with blood clots and how they work with patients to prevent and treat them. 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. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the Functional Medicine approach to keeping your breasts and whole body well. This episode is sponsored by Rupa Health and ButcherBox. Rupa Health is a place for Functional Medicine practitioners to access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, Great Plains, and more. You can check out a free live demo with a Q&A or create an account at RupaHealth.com.  For a limited time, new subscribers to ButcherBox will receive ground beef for life. Sign up today and ButcherBox will send you 2 lbs of 100% grass-fed, grass-finished beef free in every box for the life of your subscription. Just go to ButcherBox.com/farmacy. In this conversation, Dr. Hyman and Dr. Boham discuss: Dr. Hyman and Dr. Boham’s personal experiences with blood clots The causes of blood clots How other conditions and genetics increase the risk of blood clotting The traditional approach to treating blood clots Reducing risk of blood clots using preventative measures The importance of keeping blood vessels healthy by reducing inflammation and oxidative stress How a colorful diet can be protective Case study of a 35-year-old woman with blood clots Additional Resources The Most Important Molecule for Health You Have Never Heard of: Nitric Oxide How Leaky Gut is Making Us Sick and Driving Chronic Inflammation with Dr. Emeran Mayer Postmenopausal Hormones: Helpful or Harmful? With Dr. Elizabeth Boham

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the next episode of The Doctor's Pharmacy. Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman. That's pharmacy with an F, a place for conversation as a matter. And you might have been hearing news about blood clots and COVID. Well, blood clots are a common problem. They cause a lot of problems for a lot of people and they don't really get talked about too much from a perspective of functional or integrative medicine. So we're going to dive deep into that today with none other than our medical director at the Cultural Wellness Center, Dr. Elizabeth Boham, an extraordinary physician who worked with me for over 20 years. Can you believe that? She's a nutritionist, a trained nutritionist, is an exercise physiologist, and a doctor,

and a fellowship in nutrition as a doctor as well. So she's kind of everybody's doctor's doctor. She's contributed to lots of textbooks and trains physicians all over the world and is in the media, and is just an extraordinary doc. And I'm so happy to have you back. Thanks, Mark. It's great to be with you. Okay, so let's get into clotting. Now, everybody's been hearing about COVID and clotting and how it's causing clotting and strokes, but this is a bigger issue for people. And it's quite common. And, you know, I, I know, I know it personally. Um, I, uh, my mother was in the hospital before she died and she was getting, you know, her fluid taken off because she had a little heart failure and they did not get her out of bed. And I

kept calling her every day to get out of bed, get out of bed, get out of bed. And she wouldn't. And she didn't have any help and they were understaffed. And when she came home a week later, she died of a pulmonary embolism because she got a blood clot in her leg that lobbed off and went into her lungs and compromised her breathing and she died. So it's very personal for me. And I know there's so much we can do to prevent it. So let's talk about, you know, clotting and the sort of common issues. How do we avoid it? How do we prevent it? And what really is going on with all this clotting stuff? Yeah. You know, and Mark, it's personal for me too. I've had a couple of, of, uh, clots in my veins in my lifetime. Um, we can talk about it later, which is,

you know, I was like, Oh my gosh, where, why would I be getting this at, you know, at the age of, you know, it was about 12 years ago, I had a, a clot in my, um, subclavian vein. So in my, um, upper chest arm area and, um, and, and we'll, we can talk a little bit more about that. But yeah, I was like, Oh, my gosh, what's going on? And what can we do to, to, what could I do to prevent it, you know, in the future? But you know, you know, it's really important that our blood clots, we need it to clot, right? We, we, if we didn't, if our blood didn't clot, we would bleed to death. So our body has all these mechanisms in place so that our blood does clot and we don't bleed to death. But if it causes

a clot that blocks off an artery or a clot that blocks off a vein, that can be really, really dangerous, as you mentioned. A clot that blocks off an artery can cause a heart attack or stroke. And a blood clot that blocks off a vein, you can get a deep vein thrombosis, like a DVT, or like you mentioned with your mom, a pulmonary embolism that is very, very serious. And it's very common. For DVTs, our lifetime risk is somewhere between 2% and 5% in our lifetime for everybody in terms of their risk for getting a DVT in their lifetime. And as you mentioned, many different things can cause this, right? So when somebody's on bedrest, there's an alteration in blood flow in the body. So when somebody's on bedrest, there's more risk for the blood because the blood is staying in one spot. There's more

risk for it to just clot in that area. Long airplane flights, right? You know, a change in activity, injury to the lining of the vessel. So, which may have been the situation in my case, I was doing CrossFit and I was doing handstand pushups. And I think that I injured the vein. Oh my God, handstand pushups, that's impressive. Well, yeah, but I probably, I don't know, maybe it was or not, I don't know. But maybe there was some injury in the vein that was between the clavicle and first rib, you know, that sort of was one piece of the puzzle to trigger this clot to occur. So injury to the vessel. And then of course, anything that changes your body's risk for clotting. So

that can be a genetic. Some people are more at risk for clotting because of genetics. Some people develop a hypercoagulable state in their body because of, you know, cancers or autoimmune conditions. So, you know, those are just some of the reasons that we see an increased risk of clotting for some people. Yeah. And so, you know, these are problems that are pretty common. And I think, you know, the traditional approach is, you know, basically give you blood thinners and aspirin or, but, you know, there's a lot of things that we can do to sort of reduce our risk, right? And I think you mentioned a bunch of them. I think we talked about the risk factors, right? The bed rest and surgeries, long distance flying, lack of exercise,

trauma, injury, pregnancy, taping on the pill, you know, hormone therapy, testosterone therapy, being dehydrated, cancer, autoimmunity, all these reasons cause your risk of clotting to go up. But if you've addressed those, you know, there's a lot you can do. So what are the kinds of things you advise your patients around this in terms of prevention? Because it's pretty common. Yeah. I mean, it's, you know, when people have had a history of a clot or they're at risk for clotting or they have a family history of it, or, you know, we talk a lot about, okay, what can we do for prevention? So, you know, when somebody's on a long distance flight, you know, you talk to them about making

sure they're well hydrated on that flight. They're getting on that, you know, they're getting up periodically. They're walking around like every half an hour. You know, you want to be drinking in general. You want to drink at least half of your weight in pounds in water a day. So, you know, at least like for that, if you're 150 pounds or so, that at least 70 ounces of water a day, you know, just in terms of getting enough fluid and being well hydrated, because when the blood is thicker, it's more likely to clot. So staying hydrated is really important. So birth control pills,

you know, when young women get clots, a real large reason is oral contraceptive. You know, it's a three to five time increased risk for clots. Yes, when you're on the birth control pill. And especially for certain groups of people on the birth control pill. Um, and especially, especially for certain groups of people on the birth control pill, of course, there's going to be genetics. And we can talk a little bit more about that, but smokers, people who have insulin resistance. So if you have polycystic ovarian syndrome, if you're overweight, if you've got that weight gain around the belly, you know, if you're older, if you're an older woman, all of those things make the birth control pill even a higher risk for getting blood clots. You know, hormone therapy, you know, can increase your risk two times.

Like if you're a woman and you're taking postmenopausal hormone therapy, yeah. Yeah, depending on how it's done, right? So, you know, that's one thing that we really work with women on is getting, if they are going to take hormone therapy, is a healthier version. You know, we know that the, we've talked about this in other podcasts, that some of the oral estrogens can increase inflammation in the body and may cause, you know, more of a risk, or depending on the amount of increase that you're giving giving somebody that may have more of a risk than some of the other tough formulations. If you get a blood clot, you know, one of the things with me that they, because of my own cancer history, you know, of course, when I had the subclavian DVT, everybody, they did a full cancer workup because for an unprovoked DVT, you've got a one in 10% of those people have underlying cancer that has either, they either had known about or they hadn't known about. So, cancer does cause this hypercoagulable state. And so, you know, it's often part of that, it should be. It is part of that full workup when you get a blood clot. And luckily, I did not have a recurrence at that time. But, you know, that is something that's looked for. And autoimmunity, you know, so antiphospholipid syndrome, which is an autoimmune process. So autoimmunity can impact your risk. Weight, as we talked about, if you have that

overweight metabolic syndrome, that process in the body that's really inflammatory, that increases our risk of so many different things, it also increases our risk of blood clots as well. Amazing. So tell us from a perspective of of functional medicine there's a lot of different things we do rather than just like give you a blood thinner which you may need but there are a lot of things to do to keep your blood vessels healthy and it's not something we're really talking about one of the keys of the matrix is you know your transport systems which is your lymph and your circulation and keeping your blood vessels healthy is really important. They get very inflamed for various reasons, our diet, stress, lack of exercise, toxins, and that leads to cardiovascular disease. And so keeping your blood vessels healthy in general is important.

So let's talk about what are the ways we know that we can really accentuate and improve the function of our blood vessels? Yeah. So we're always looking for signs of inflammation in the body and oxidative stress because both inflammation and oxidative stress can cause damage to that endothelial lining, to that lining of our blood vessels, right? So we really are saying, okay, anything that's increasing inflammation or oxidative stress, we need to lower. So as we've mentioned already, you know, we're paying attention to signs of insulin resistance, metabolic syndrome, right? Those, that whole process, it increases inflammation and oxidative stress in the body. And it's really important and critical to work on reversing in people to improve their overall health, including decreasing their risk.

We also pay attention to genetic variations or genetic SNPs. So there are a few genes, like high-risk genes, low-frequency high- risk genes, like factor V Leiden mutation, which really increases risk of blood clotting or prothombin gene mutation, which increases risk of blood clotting. But we also look at some of those genes that we know increase risk of blood clotting, but are more common. So they're considered higher frequency but lower impact. So they don't increase risk of clotting to the extent of like a factor V Leiden gene mutation would, but they do have an influence on somebody's risk of clotting. So we're paying attention to those SNPs, those variations that are common,

not as much of an impact, but if you take it as part of a whole picture, do have an impact like the MTHFR gene mutation or some of the genetic mutations that impact how somebody metabolizes their own estrogen. Because hormones, as we mentioned, with hormone like oral contraceptives or hormone therapy do impact a person's risk. So how they metabolize and process those hormones are important for us to pay attention to and make note of. And so that includes things like the, as I mentioned, the MTHFR gene, the COMT gene, some of the other hormone metabolizing genes that we look at. You know, we also pay attention to just the milieu in the body that also influences our hormone levels. So, our gut microbiota, which influences our hormone

levels, you know, that we've talked about a lot. And so, and as I mentioned, anything that's increasing inflammation in the body, we always start with diet first, right? So there's a lot of phytonutrients, right? Those are the components in our plant foods that create a lot of color in our plant foods that have a lot of benefit in our overall health and well-being. And so our phytonutrients, things like our flavonoids, things like our phenols, they can influence our risk of blood clotting. They can lower inflammation in our body. They can lower oxidative stress. So, for example, garlic has anti-inflammatory properties and anti-platelet properties.

We know foods that have quercetin in it. Those are things like kale and broccoli and capers and berries and apples. They can reduce the clumping of our platelets and clotting. Um, flavonoids, uh, anthocyanins, um, uh, things like, uh, quercetin, um, can, can also as well. That's great. Yeah. So, so what we're always working with our patients on is getting in lots of color in their diet, you know, get eating from the rainbow, getting something for, you know, that's some plant foods that have a red in it and, and orange and yellow and green, blue, purple, white, getting something, you know, that's some plant foods that have red in it and orange and yellow and green, blue, purple, white, and tan, you know, getting lots and lots of

phytonutrients in their diet every day. So, you know, eight to 12 servings of those colorful plant foods every day can help with many different things, including decreasing inflammation in the body and decreasing our body's ability to clot. Incredible. So really, there's a lot you can do to protect them, you know, taking the phytochemicals, the flavonoids, quercetin, which works against COVID, catechins, which is, you know, from green tea, dark chocolate, red wine, pears, apples, all that stuff, and rutin, which is amazing, and apple peels, garlic, you mentioned, and of course, omega-3 fats, right? So those are really important. Of course, omega-3 fats, yes. Yeah, like fish oil, yeah, ground flax seed. Yeah.

So what are the stories of patients you've dealt with this and had some success in using this approach? Well, you know, I talked about myself a little bit. So this was about 12 years ago. And as I said, I was doing handstand pushups. And the next day, I started to develop some redness in my arm. And then as the days went on, it progressed and my arm got swollen. And our nurse, Nina, at the time, she said to me, Liz, I think you need to go see a doctor. And I'm like, yeah, this isn't going down. This is crazy. So Nina was great, you know, so she's like, push, you know, like, yeah, I think I got to go see a doctor. And we found a blood clot in my subclavian vein. So it's this process called Paget-Schroeder syndrome, which is just the

location of the blood clot that I had, and they had to go in and break it down. But one of the things that when I started to look at this whole process for me, I realized that it happened at a time of my cycle where I was higher in estrogen. And with my history of breast cancer and looking at my genetic snips, I knew that this was an area I had to continue to work on is how do I break down my estrogens in a healthier way? And, you know, focusing on things like sulforaphane and DIM, staying really well hydrated, you know, that methylation support that, you know, that I needed support with the methylated B vitamins, you know, was really, you know, the areas that I said, okay, I really need to focus on. But I have another

patient who, where there was some other areas that we needed to look at that we can talk about as well. Yeah. Tell us about the other one. Yeah. So this was a 35 year old woman and she had a DVT in her leg and she came to see us. It was, it was resolved at the time she came to see us, but she said, you know, I really, what can I do to decrease this from coming back? You know, I was 35 and I, you know, I don't want this to come back again. Yeah. And she had a full workup for malignancy, cancer that was negative. She had a full workup for those genes that we were talking about, those high impact genes, then they were negative.

And, you know, so we took a full history and timeline from her. And what we realized or what she knew, she was on birth control pills at the time and when she got the blood clot. So they took her off of the birth control pills. And as we talked about, that does increase a person's risk. But it makes me think, it makes me pause and say, okay, what else does that tell us? Right? Okay. So is she, how is she metabolizing not only the estrogen and the birth control pills, but also her own body's estrogen now that she's off of the birth control pills, because we know that how you metabolize your estrogen impacts your risk of breast cancer and uterine and endometriosis and uterine cancer, right? So we really wanted to delve into that with her. And we did a special stool test. We did the stool test that looked at this one marker,

that looked at the imbalances of the good and bad bacteria and looked at this one marker called beta-glucuronidase. And beta-glucuronidase is this enzyme in the digestive system that can cleave your estrogen that's bound to this substance called glucuronic acid, which is the way that the body packages your own estrogen to get rid of it, helps to get it out of the body. We know that when people have this high level of beta-glucuronidase in their digestive system, that can cleave that estrogen, glucuronic acid, and allow it to get reabsorbed and help contribute to an estrogen-dominant-like picture, which is what she had, right? And so we had to really work on shifting that microbiota because one of the main causes of this imbalance is dysbiosis, is an imbalance in the good and bad bacteria.

So, you know, we worked with her to shift that dysbiosis. We actually used an herbal agent to lower that bacteria. We also use something called calcium deglucurate, which is a substance that can bind to the estrogen and help it get eliminated from her body. And we added that in. And then we also did some other genetic testing. So not just those high impact genes that she was negative in, but we did some of those lower impact, more common gene SNPs and found out that she had a variation in this MTHFR gene. And that is associated with blood clots. It is associated with a higher homocysteine level, with a higher need for these methylated B vitamins. And so we added that in to her regimen. In addition to sulforaphane and DIM that helps with estrogen metabolism, cruciferous vegetables,

we focused really on high folate foods, which is just lots of foliage, lots of green leafy vegetables, and things that helped her body with metabolizing and breaking down her estrogen as well as just other toxins in her body. Yeah. Well, this is kind of mind-blowing what you're saying. I just want to unpack a little bit because you hit so many points. But what you're seeing is in traditional medicine, you've got a blood clot issue. You treat the blood clot. You give a blood thinner. And that's kind of the end of the story.

What you just narrated was a perspective about thinking of the body as one integrated unit. And you treated the gut bacteria in order to treat the blood clot, which doesn't make sense given what we learned in medical school. But when you unpack it, you go, wait a minute, everything is connected. So, there's a condition which you're describing this woman had, which is estrogen dominance, which occurs a lot of women in their 30s and 40s where they get excess estrogen because they're not ovulating, because they're eating too much sugar, because they have too much belly fat, because they're eating toxins in their

food like pesticides that stimulate estrogen production. And so you get heavy periods, fibroids, PMS, all these things. And for you, that was a clue there was something out of balance with her. And looking at the stool, like thinking about that, your estrogen has to get metabolized and excreted and removed from your body. But it's kind of packaged up like in a little present. But what happens is when it hits, the estrogen goes through your liver and out your bile duct and into your intestines, it hits those bacteria that have this clostridial

and other bacteria that have beta-glucuronidase, this enzyme that basically unwraps the estrogen from its little gift package. And so all of a sudden, all that extra estrogen gets reabsorbed in the body, creating even more estrogen and more risk of clotting, right? So that's like a fascinating story. And so treating the estrogen dominance was by getting rid of the bad bugs, by, I mean, who would think to treat a blood clot with an antibiotic? But maybe that's the right approach in this case. And that's the way functional medicine works. You know, you're often doing things that are completely out of the box and outside the realm of that

specialty, but it's actually how the body works. And you can have five people with blood clots and they might have five different reasons. And so they don't all get treated the same. And this woman's a great example of how, you know, you connect the dots between all of the things that may be going on with her and looking in places that most doctors don't look. And that's really the beauty of functional medicine. It's really why we do what we do. And it's so satisfying because we see people get better from all sorts of chronic issues

that just are not well dealt with with traditional care. And that's what we do at the Cultural Wellness Center. We have like five docs and how many nutritionists? We have four or five nutritionists. I can't keep track. And, you know, great staff. And we see people from all over the world. And it really is satisfying to see how people from these issues can really overcome them. And it's just such a pleasure to do this. And Liz, you've been such a great podcast guest and a doctor at our center and was thrilled to have you back on the podcast. And for those of you who've been loving this podcast, share with your friends and family, love to hear from you, leave a comment, maybe how you've dealt with your issues around blood

clots and subscribe wherever you get your podcasts. And we'll see you next week on The Doctor's Pharmacy. Thank you, Mark. subscriber every year podcast and we'll see you next week on the doctor's pharmacy thank you mark 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.

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