The Dr. Hyman Show - Exclusive Dr. Hyman+ Ask Mark A Doctor: Melatonin, Weight Loss, And More

Episode Date: September 26, 2023

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Hey podcast community, Dr. Mark here. I'm so excited to offer you a seven-day free trial of my revolutionary new platform called Dr. Hyman Plus. For seven days you get special access to all the private content included in Dr. Hyman Plus entirely free. It's so easy to sign up. Just go to Apple Podcast on your phone and click try free button on the Doctors Pharmacy podcast. You'll get exclusive access to ad-free Doctors Pharmacy podcast episodes and functional medicine deep dives where a practitioner dives into topics like heart health, muscle health, insulin resistance, and more to help you understand the root cause of specific ailments and walk you through the steps to improve your health today. You'll also get access to all my Ask Mark Anything Q&As where

I answer the community's biggest health and wellness questions. Because I'm so sure you're going to love this platform, I am offering you free access to all of this content for seven days and a teaser of my brand new Ask Mark Anything episode. Head on over to the Doctors Pharmacy podcast on Apple podcast and sign up for your free trial. Okay, here we go. Hi, everyone. Thanks for tuning in to another episode. My name is Herschel Perth. I'm the Dr. Hyman Plus community manager. And I'm actually here today with Dr. Elizabeth Boham. Dr. Hyman is traveling the world right now, as many of you know, and so we thought it'd be fun to invite his colleague and friend, Dr. Elizabeth Boham, in to answer the questions. As you guys may know, Dr. Elizabeth Boham is the

medical director of the Ultra Wellness Center in Massachusetts, and you may have also seen her on many of our deep dives here on Dr. Hyman Plus. So welcome, Dr. Boham. We're so glad to have you here today. Thank you, Herschel. It's so great to be with you and to be with everyone. Thanks for having me. Yes, we're so excited. So we've collected all of our top questions from our community, so let's go ahead and get started. So usually start off with a personal question. And so we know that you recently attended the IFM, the Institute of Functional Medicine's annual conference. And we kind of want to know what's a hot topic that you heard about or learned about that you're super interested in and maybe want to learn more about

or are curious about? Yeah, you know, it was just one of the best, you know, every year we go to the IFM annual conference and this year was also great. It's a great way to get together with other people that do functional medicine and to learn about like the latest research in medicine and what we can apply in functional medicine. And this year was also wonderful. One of the great lectures that I attended was with a dentist, Dr. Doug Thompson and a physician, Ellie Campbell. And they did a great lecture on the connection between the mouth and the body.

And this is something we do focus on at our practice all the time, but it's always good to learn some more of the newest research and to remind ourselves, this is something you always want to think about. You know, we want to ask our patients and I do ask my patients all the time, you know, when's the last time you went to the dentist? How is your oral care? Are you flossing or using a water pick? You know, do you have signs of gingivitis or your gums bleeding? Because we know that when there's a lot of excessive bacteria in the mouth or gingivitis

or inflammation in the mouth, that that actually is associated with inflammation in the body. They've even seen certain bacteria from the mouth in the plaque of arteries in the heart so that we know that it's a major driver, gingivitis is a major driver of heart disease. But we also know that, you know, certain bacteria in the mouth can drive autoimmune conditions, such as this bacteria porphymonis gingivalis has been associated with rheumatoid arthritis, right? So there's a definite connection between the oral microbiome and the body, the rest of the body. And these guys, this lecture really highlighted that again, and pointed out that if we see signs of inflammation,

so let's say you get a high C-reactive protein in your blood work, and you can't figure out where it's coming from, or you've got some inflammation in your body, and you can't figure out where it's coming from, you've got to think about the mouth. Is there some hidden infection in there, inflammation? And it really also just highlights the importance of good oral hygiene, brushing, flossing, using a water pick, having a good, healthy diet. We know that when our diet is really rich in phytonutrients and fiber and plant foods and just healthy foods, we have better teeth and gums. And so that's really important. You know, there are times, you know, they even, and they brought this up in this lecture and,

you know, I think this is an area of really exciting new research. You know, there are times we'll use like probiotics that are really directed at the mouth and the oral microbiome. We may use things like CoQ10 to help with gingivitis or certain phytonutrients. So that was one of the highlights from that lecture and that time. That's amazing. I mean, I just feel like we know that there's some importance, but now you're just seeing what great importance it is. So that's amazing to hear all about that.

We'll be curious to see where that goes and learn more about that as more information comes out. Absolutely. So our next question is about sleep. So we know sleep is critical and obviously the quality of sleep is super important. And we've heard a lot about melatonin recently. Is that something that can be used every single night? Should it be used every single night? And if we start using it, is it something that shuts down in our body? Like

meaning will our body stop producing it? And if that's the case, is magnesium a better idea? Yeah, that's, it's such a good question. Melatonin is a hormone that's produced in the brain by the pineal gland. And it's, you know, the hormone melatonin helps with our wake and sleep cycle with our circadian rhythm. So think about it. It's really good for maintaining a normal sleep weights, wake cycle from a, from a good news perspective. We don't really think there's any reason to be concerned that if you use it nightly, that

it's going to decrease your own body's production. So there's really no concern of regular use for melatonin, especially in adults. I think we need a little more research on melatonin for kids and long-term use. And we don't have enough research with pregnancy, of course, because there's never enough research with anything in pregnancy. But, but in general, I think it's, I'm feeling very confident with and comfortable using melatonin, but, but remember the, what it really helps with is our sleep wake cycle. So the best reason to use melatonin is if you're having a hard time falling asleep, or if you've been traveling and you've, you know, changed time zones. And then you typically want to use melatonin about an hour before bedtime,

half an hour to an hour before bedtime. Some people may need some melatonin because we do know your melatonin levels can decrease with aging. We also know that for people who are working at night, like doing shift work, or are on their computer too much in the evening, or looking at their phone in the middle of the night, that bright light or the light at night can really decrease your melatonin production. So, you know, of course, we want to work on good sleep hygiene, but for those people, melatonin may be really effective and helpful. Typical doses of melatonin, we'll usually use 0.3 milligrams. So 0.3 milligrams, so less than one milligram, up to three milligrams is a very typical dose of melatonin that we use when we need to help somebody get to sleep or they're shifting their, their, their time sleep-wake cycle.

And there are times when we'll use higher doses, 10 milligrams, 20 milligrams for cancer prevention, 20 milligrams has been used for reflux and treating reflux. But if you're going above three milligrams, you know, or, and of. But if you're going above three milligrams, you know, or and of course, if you're using it on a regular basis, you want to let your doctor know it's good that they kind of have a sense of what you're using and, and why you're using it. And it's good to have these so they have all the information about your about your health, but always focus on, you know, the importance of good sleep hygiene, not looking at your phones at night, not turning on bright lights at night, not looking at the computer in the middle of the night. All of these

things can really disrupt sleep hygiene and melatonin production. So the question, the other question you asked was about magnesium. Magnesium is great for calming the body. So especially, so that helps with getting to sleep for some people. It helps with staying asleep for a lot of people as well. And just getting a more restful night's sleep. Magnesium glycinate is a really well-absorbed magnesium. It's not going to, for most people, it doesn't loosen up your stools. So it won't cause diarrhea for most people. And it's really well-abs well absorbed and works great for sleep. You can use other forms of magnesium like citrate

as well if you also need to loosen up your stools. But but a magnesium glycinate type is really well absorbed and works well for calming the body. And the other thing I sometimes use to help people stay asleep is 5-HTP. 5-HTP is a derivative of tryptophan and it is, helps with staying asleep. The only thing you have to worry about with 5-HTP or worry is not the right word, but you know, if you're on any sort of medication for mood, antidepressants, or any sort of medication that is, that is impacting mood, you want to really talk to somebody, a physician or healthcare provider before you start it, because there can be some interactions there. But melatonin is wonderful for a lot of people. So perfect. That's so helpful. Thank you. Thank you for all that. So kind of navigating something that you

just mentioned is that, you know, we have a lot of people that are doing different shifts, including night shifts. So this question came from someone who's a night shift nurse, and they wanted to know, do you have any tips for navigating intermittent fasting, or time restricted eating if you are someone that works in a night shift position? And if you want to change your lifestyle, like how do you put that into place? Yeah, right. So there are a lot of people working the night shift and you can still be healthy working the night shift. I know there's so much that we talk about, about, you know, the sleep weight cycle and night shift workers and how it can be unhealthy, but there are ways that you can do it in a more healthy way. That's absolutely true. So, so let's say this person's working 7pm to 7am, right? So they're working 7pm to 7am. The most important thing for both this person working nights, as well as for all of us is to not eat, you know, for about an hour or two before bedtime. We want to, that really helps with getting a better night's sleep. If you go to sleep full or with heavy food, we often don't

sleep as well. So you want to have a lighter meal before, before bedtime and don't eat a couple hours before bedtime. So let's say that you wake up at seven, sorry, let's say it's 7am, you're off of work, right? So then you may want to try to eat by like 7.30am so that you can go to sleep by 9am and get those eight hours of sleep, ideally, right? So you might wake up at 5pm, get in some good exercise before you have to be back at work if you're working the next day as well. And the other thing we always talk about for both shift workers, as well as all of us is that when we break our fast, we want to do it in a really healthy way. So you want to have you don't want to just grab a muffin, you want to have a good source of protein, fat and fiber at every meal, especially at that meal where we're breaking our fast. So

that breakfast meal, and it doesn't have to be breakfast food. You know, you can eat dinner food or breakfast food or whatever, as long as you've got a good source of protein, fat, and fiber. So you're balancing your blood sugar. There's a lot of times the issue with people who work nights is the quality of food around, you know, sometimes it's just really stinky, you know, it's even worse than what's available during the day. You know, I can remember back when I was doing my internship in the hospital and working in the middle of the night, and, you know, what, what do you what is available? So nothing good. So it's so that's really important to, to prepare your food ahead of time, you know, do some food preparation, bring your food with you

and think about, you know, having that main meal in the middle of your shift, maybe around midnight. So then that meal that you have before, like that two hours before bedtime is a lighter meal. So yeah, there's ways you can do it and be healthy too. Perfect. No, that's super helpful. And you're right exactly. And in a hospital at nighttime, it's like, I feel like the only thing that's there like donuts, cookies, or, you know, candy. So preparation is key. All right. So our next question is about what is glymphatic function? And is there a way to measure it? Right, right, right. So the glymphatic system is the brain's detoxification system, right? It's the way that the brain cleans up

and eliminates metabolic waste that accumulate during the day. But this happens during your sleep. The glymphatic system is mostly active at night during your sleep. So again, one of the most important reasons that we're focusing on sleep and rest. And there's, they found that, that, that the glymphatic system helps to get rid of this, this metabolic waste, preventing things from neurological diseases, Alzheimer's disease. And, um, you know, it's, as I said, it's part of that detoxification system. They are measuring it in research. So they are doing like MRIs to look at the glymphatic system. But as far as I know, clinically, we are not measuring it yet. But it's just another reason that we have to say, okay, we've got to give our body time

to rest and sleep because there's a lot of healing that occurs during those hours at night. And if you're, you know, one of the things I know that people come to me all the time about is with this worry that, oh my goodness, I'm not sleeping well. And, oh, no, now my glymphatic system is not going to be working well. Right. And so the things we know about sleep is that when we worry about it, that does not help. Right. That is really it does. It can be very counterintuitive when you wake up in the middle of the night and you sit there and you go, oh no, now I'm not, my metabolism is going to be a mess and my lymphatic system is not going to work. So worrying about it does not help. And we don't want our brain to go there. So we want

to have some good tools to help calm down our body and get back to sleep. Good breathing exercises, breath work exercises, relaxation exercises. And if it's something that's really, you're really struggling with, you know, there's been some really good research looking at cognitive behavioral therapy. So working with a psychologist and doing some cognitive behavioral therapy around sleep. So if there's somebody who specializes in sleep, it can be really, really helpful and, and, and beneficial to, to start working with somebody. Oh, that's super, super helpful. Um, I, you know, I think that it's important to, like you said, just know about what that is and how it works in your body. And then of course, um, do your best

to implement the measures. So perfect. Thank you. Um, so we're onto another question. This was also mentioned in young forever, and I want to make sure I'm saying it right. Is it senolytic? Yes. Okay. Yeah. All right. So what are senolytic therapies and what's their purpose? So senolytic therapies are either their compounds, whether they're natural compounds or even now they're coming up with some pharmaceutical medications that may act as senolytics and they can kill zombie cells. So remember zombie cells or senescent cells are these cells in our body that are just not working well anymore. So they are still present in our body, but they didn't die as they were supposed to. They've lost their ability to divide. And unfortunately, they can't work as like normal

cells do for tissue repair and regeneration. And they do produce a lot of things like cytokines and these inflammatory markers that can cause this inflammatory cascade in the body. And that inflammatory cascade has been associated with all sorts of diseases of aging. So it's been associated with dementia and Alzheimer's, heart disease, even sarcopenia and cancer. So we don't want to have these zombie cells. And these senolenex can help with getting rid of and killing and getting rid of these zombie cells. And so some of the things that have been really shown to be really helpful is the phytonutrients. So let me back up for a second. One of the things we know that causes these zombie cells to occur is oxidative stress. So, you know, whenever I hear that term oxidative stress, I think, okay, excessive free radicals. Why may somebody have excessive free radicals? It may be because they don't have enough antioxidants or phytonutrients to squelch these excessive free radicals. You also may get a lot of

excessive free radicals, oxidative stress because of things like toxin exposure, heavy metals, chronic infections, chronic inflammation, and all these things can damage DNA in the body and cause these zombie cells. So again, that brings us back to the power of food because these phytonutrients, phytonutrients are these components in our plant foods that help the plant survive in nature. But we also know that these phytonutrients can help get rid of excessive free radicals. They can also help with lowering inflammation in the body. And some have been shown to have this senolytic activity in the body, right? So things like curcumin, quercetin found in apples and onions, fisetin in strawberries and cucumber, resveratrol, urolifin in A, EGCG in your green tea, right? So all of these things have these powerful activities in our body and can help us get rid of the zombie cells and do all sorts of other good things for us as well. So what's the goal for phytonutrients, right? It's

eight to 12 servings in a day. And remember your phytonutrients include your vegetables, your fruits, your spices and teas and coffees. So eight to 12 might seem like a lot, but when you're using spices in a lot of your cooking and lots of vegetables, vegetables and stews and soups, you can really get in that eight to 12. You want to think about getting something from every color of the rainbow every day, something red and orange and yellow and green and blue and purple and white and tan to get all of these great phytonutrients. And people say, well, what's a serving size? It really depends on the phytonutrient we're talking about. So if it's coming from a spice,

it may just be a teaspoon or even less if it's a dried spice. If it's coming from a spinach that hasn't been cooked yet, it may be a cup is a serving. So it really does depend. It's somewhere in there that's considered a serving, but eight to 12 is what your goal is to help get rid of these zombie cells. Perfect. Helpful information. Definitely something that we all need to keep in mind for every single day. And I feel like, you know, one of my favorites on that list is green tea, because I feel like it's such an easy thing to do, even if you're busy, just add it into your day. So I'm definitely going to add the rest of those in as well. So the next question comes from a community member who has been eating the vegan diet and lost a lot of weight and trying to implement all the measures

that you know, you would Dr. Hyman suggest, And he wants to know, what do you recommend to remove excess skin from weight loss? Is there a surgery the only way? And if so, what kind of surgery should he look into? Yeah, well, first of all, congratulations on the weight loss. That's outstanding. We all know how much of it how hard that can be. And it takes a lot of work and that's great. So congratulations. And what I would say is everybody is different. You know, some people, when they lose a lot of weight, depending on the amount of elastin in their skin, if they lose a lot of weight, sometimes they'll have this excess skin. And, and for some people, depending on the amount of weight they lost,

it can be a good amount of excess skin. And it doesn't, you know, over time, it will reduce somewhat for some people, but not everybody's different in terms of how much it sort of comes back into, you know, reduces in terms of size. So there is a procedure called body contouring that plastic surgeons will do, and that will remove excess skin. You know, if you are thinking about body contouring or plastic surgery to remove the excess skin, when you meet with the plastic surgeon, you want to really ask a lot of good questions. Like ask about, you know, what are your, really make clear what your expectations are. Make sure that you guys are on the same page, that that surgeon can meet your expectations. Maybe talk to other people who've had the surgery so you can get a sense of the healing time because it is a major surgery.

And there are, you know, there it's not, you know, major surgeries aren't always smooth. There are side effects, things can go wrong. And you want to make sure you understand all of that up front, you know, the risks and the benefits, you want to make sure you understand all of that up front, you know, the risks and the benefits, and you can make a good decision for yourself. And also remember the importance of a good healthy diet, because that helps with healing, that helps with your skin in general, just, you know, working better and coming back with, you know, resolving better with the weight loss. But also if you do go ahead and have surgery, the importance of zinc and vitamin C for healing. And sometimes I'll even add that in for a few months after surgery, just to help with excess, to help more with the healing process.

The other thing people always ask me, well, what can I do to make my skin look better? Like if I have creepy skin, or I've lost some weight or I have excess sagging skin, the key here is strength training. This is true for all of us. The more we improve our lean muscle mass, the better our skin looks, the less saggy and creepy, is that what we call it?

Creepy, the less it is. And so that's really important to be really focusing on your strength training, you know, at least two times a week for 20 minutes. Some people we do even more, what you want to really work to build that lean muscle mass, not only for your metabolism and to prevent weight gain again, but also just to make everything, you know, look better and your skin to look better. Perfect. Super, super helpful. All right. So our next question is about, is it semi-glutides I think, and it's what is your opinion on using a semi-glutide for A1C management?

Can it lead to excessive weight loss? And is a semi-glutide, is that basically what's been in the news? Is that Ozempic? Is that, you know, one of the categories of that drug? Yeah. So semiglutide is ozempic. There are other medications in this category. Monjarno, Wagovi are some other ones that are in this category of medications. They are called GLP-1 receptor agonists. And so what they do is they mimic the GLP-1 hormone in the body. And that hormone is been found to help slow food movement through the stomach and also helps with insulin production. So that, that when, when GLP-1 is stimulated in the body, that slows down the movement of food through the stomach,

and it secretes some insulin. So when these medications are used, a lot of times people feel more full because everything's moving through their digestive systems more slowly, and they can help with maintaining blood sugar or lowering blood sugar for somebody with diabetes because it secretes insulin and slows the movement of food through the digestive system. So, okay, what do I think about these medications? I mean, that's a really good question because everybody wants to try them. What I will say is I've been working in the field of weight and weight loss for 30 plus years, and many medications have come and gone, or some are

still around. And, you know, there's no easy, perfect medication, we want it to be easy and perfect. But there's, there are side effects, you know, some of the side effects for these Glyc-1 receptor agonists have included, there's some, there's some question about increased suicidal ideations, meaning that you're thinking about hurting yourself or killing yourself, which is a huge concern. Of course, we need more research to really figure this all out. But there's also a big concern around the weight loss in general. So sometimes we're seeing that some people are losing a lot of lean muscle mass. And long term, that's a big concern because our lean muscle mass, remember, is what really

keeps our metabolism going. And so when we lose a lot of lean muscle mass, our metabolism slows down. And so if these medications are really causing a lot of lean muscle mass loss, the question is, what's going to happen long-term. If you go off these medications, are you going to just regain all that weight because your metabolism has slowed down? What's really going to happen long-term? Are you going to need to take this medication forever and ever? So, I mean, there are definite concerns. I think that's what's important is you've got to look at the risks and the benefits

and what's going on and what kind of things you've done from a lifestyle perspective when you're making that decision. Like, would it be a helpful, a helpful thing for you? So, so, so, so people will say, well, what else can I do? Right. What else can I do? I mean, I think the number one thing we need to work on with everybody is prevention, you know, preventing the weight gain in the first place. Weight loss is very hard for some people. And so we have to recognize that and really be on top of prevention, especially with our kids. You know, our kids, if whatever we can do to prevent the weight gain in the first place with our kids, keeping them really active, keeping junk food out of the house is really important. And then, you know, many of us are

in the situation where we need some assistance and we're like, okay, but I've gained the weight, what do I do now? Right. And there is some research looking at the probiotic acromantia. Acromantia is a really good, healthy bacteria in our digestive system. And it's actually been shown to trigger that GLP-1 receptor as well and slow food and the insulin blood sugar response after a meal. So that's some really interesting new research, which I think is fascinating. And we're going to learn more and more about the microbiome and how that impacts blood sugar and weight as years go on. The other thing I use all the time is glucomannan.

It's a fiber that you take with your food, you know, and it can slow the blood sugar response. It can slow the digestion. It can slow that insulin response. And it works really well, you know, in a similar mechanism that the, that these medications work as, as well. So there's some other things we can do too. Yeah, no, definitely helpful, especially because, you know, all of sort of the, you know, news articles and headlines out there, like, you know, Ozempic, Ozempic, you know, the miracle

drug. And then it's like, I think people aren't looking into the side effects and it's like, hold on just a second. Let's see where this is kind of going and what happens long-term. So super important to consider all of those things. We always jump on that like next new fancy drug or surgery to be the answer to it all, right? And then time and time again, it comes back to the same things that we always know are

important that you guys talk about every single day. Well, I hope you enjoyed that teaser of exclusive content that you get every single month with Dr. Hyman Plus. If you want to listen to the full episode and get access to ad-free podcast episodes, plus Ask Mark Anything episodes, plus monthly functional deep dive episodes, I guess that's why we call it Dr. Hyman Plus, then head on over to the doctor's pharmacy on Apple podcast and sign up for your seven day free trial. Hi, everyone. 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.