The Dr. Hyman Show - Exclusive Dr. Hyman+ Ask Mark Anything: Pancreatic Health, 5R Protocol, And More

Episode Date: May 24, 2022

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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 of Ask Mark Anything. My name is Herschel Perth and I'm the Dr. Hyman Plus Community Manager. And I'm joined by Darcy Gross. Hi, Darcy.

Hi. And she's one of the producers of the Longevity Roadmap docuseries. And of course, we're here with our expert, Dr. Mark Hyman. Hi, Dr. Hyman. Hello, everybody. Thanks for joining us today. And so we've collected all of the questions

from our community and we're here to ask Mark anything. So let's ahead and get started so dr hyman our first question is about the pancreas what does it do in our body what's its function and what's the best way to have you know good pancreatic health great question most people have no idea what it does. It's essentially an endocrine organ producing hormones and an exocrine organ producing enzymes and other things we need to digest our food. So it's kind of got a dual function. The endocrine part is producing insulin. There's beta cells in the pancreas that are special insulin producing cells. So when you eat carbohydrates or sugar, it actually secretes a little bit of insulin to help keep the blood sugar down and put the fuel into the cell. So it's almost like the key that unlocks the door to your cells and lets the glucose and other free fatty acids into the cells, which is an important thing.

That's an important function. And a lot of times we flog our pancreas because we eat way too much sugar and flour. As I've said a million times, we eat about a pound of flour and sugar a day per person in America. And that is driving the insulin levels higher and higher and higher. We can insulin resistant. And that is the beginning of the end of all of us leading to obesity, diabetes, cancer, heart disease, dementia, infertility, depression. I could go on and on. So insulin's not bad. It's just what's the Goldilocks dose? The lower, the better, the less insulin, the better. As little as you need to do to get the job done is what you want. And basically you're fasting in the student. So it should be less than five. If it's over 10,

I'm worried. If it's over 20, you're in big trouble. That's the endocrine or the hormonal function. And then there's the exocrine function, which is secreting enzymes to digest your food through the pancreatic duct, which dumps into your intestine. So the beta cells dump it into your blood. Then there's a little duct called the pancreatic duct that goes into your intestines through the sphincter of Odie, which is a medical thing we learned. I don't know why I remember that from anatomy, but I do. And basically it excretes this pancreatic juice into your small intestine as the food's coming in to help digest the food. And one of the most important is pancreatic elastase. Pancreatic elastase is a digestive enzyme that is important in digesting protein and many other things. Now, certain conditions like cystic fibrosis, people have pancreatic problems and they can't produce the enzymes and they end up needing to get prescription

enzymes like Creon or other prescription pancreatic enzymes, lipase, amylase, proteases. And a lot of people here, I take digestive enzymes. Well, yes, a lot of people do take digestive enzymes and often in medical clinics, GI clinics, and in functional medicine doctors, we really often measure pancreatic elastase because often people are having pancreatic insufficiency. It's not a true, like a cystic fibrosis patient where they just don't make any, it's just a little bit low. And that means they have trouble digesting their food. They can get bloating. They have undigested food in their stool. And so for those patients, we can use either plant-based or animal-based enzymes. Often the animal-based enzymes, if you have very, very low pancreatic elastase are important. And we measure this on a stool test. I use one called

GI effects by Genova. We've been using it for years and we measure pancreatic elastase. If it's under 500, it's not great. If it's like under 200, you're in trouble. So that's when we start to start to prescribe pancreatic enzymes to help patients digest their food while we're trying to get to the root cause of why it's a problem. So very, very important. Pancreas also can be affected by a lot of things. Alcoholism can cause pancreatitis, which is a terrible condition, a pancreatic inflammation, and it can be deadly and scar up your pancreas, which you don't want to do. Also the pancreas can be affected by stones from the bile duct. So if you're eating a diet, you know, you produce potentially a lot of bile stones. I can get, one can get stuck in the, the, uh,

the out that sort of outlet of the pancreatic, um, duct, which is connected to the biliary duct or the bile duct. So they kind of go together and they come out in the same spot. But if the bile stone gets in and blocks the pancreas and you can get pancreatitis, that's bile stone pancreatitis. That's really bad. So you need, you need to get that fixed. Like you go to the emergency room and it's super painful. There's weird things like spider bites that'll cause pancreatitis. And sometimes you will have high levels of, of amylase and lipase that are related to some other pancreatic injury that happens, trauma or something

like that. So supporting your pancreas is basically don't flog it with sugar and flour. Make sure you're eating a whole foods, healthy diet. And if you are having digestive issues, you might want to see a functional medicine doctor, get a pancreatic elastase. Your regular doctor can measure that as well. They might say it's normal, but I know I would say what's normal versus optimal. And we've had this conversation normal in America.

It's normal to be obese because every like, you know, 75% of people are overweight. So it's normal. It doesn't mean it's optimal. So we want what's the optimal. And I think optimal is over 500 on the pancreatic last days. And so it's often a therapy we use in functional medicine to help people while they're actually healing their gut and bridging back to a normal gut function. Great. That's super helpful. Thank you so much, Dr. Hyman. And over to Darcy. Yeah. So kind of speaking to healing your gut.

And this is really one of those fundamental things that's really practiced a lot in functional medicine, but not so much in conventional medicine. But our next question has to do all with the five R protocol. So of course, please walk us through what exactly these five R's are and how, how you implement it in patients, the ones like who would need it and how you work through those steps. If you can have any steps that are overlapping or yeah. Thank you. Okay. This is sort of the, the bread and butter of functional medicine is the five-hour program and gut healing. And I'll unpack it for you. Cause you know, we, we started doing this way before even the word microbiome was a thing. We talked about dysbiosis and we talked about gut function and we did all kinds of stool testing.

And so we were, we were deep in it in in the you know what, long before it was fashionable. And we designed a program that was based on the science and also clinical experience to help reset the gut. And it's super important to do that for people in the right way, in the right order. If you do the right thing in the wrong order, you can make people really sick. For example, if someone has bacterial overgrowth in their gut and you give them probiotics, it's like a war. So the bad guys are fighting the good guys and people are just miserable. So you can't do that.

So what are the five R's? The first R is to remove. And that means removing anything that might be bothering the gut. So it could be foods. It could be bacteria. It can be removing anything that might be bothering the gut. So it could be foods, it could be bacteria, it can be yeast, it can be parasites, it can be worms, it can be drugs, right? So on the food front, we really put people on a gut healing elimination diet. And that is eliminating all the potential irritants, which would be gluten, dairy, sugar, alcohol, but also maybe we go a little further and we cut out grains and beans, which are hard to digest.

We maybe say only eat cooked food. We say, you know, don't eat an extreme elimination diets. We might say, don't eat eggs. We can do testing and look for food sensitivity testing. It's not food allergies, which is where you get a peanut allergy and your tongue swells up and you get shortness of breath and you could die. That's anaphylaxis. That's not what we're talking about. We're talking about low grade inflammatory responses to food that we don't know we have because we just feel like that all the time. Like if someone's standing on your foot, you don't know you stand on your foot till you get off. Right? So, so we take people on elimination diet and that's the first thing. Second thing,

and we can do testing to determine, you know, how to customize it a little better. Second thing is when we look at the gut busting drugs, antibiotics, steroids, the oral birth control pill, anti-inflammatory drugs like Advil, aspirin. Also acid blocking drugs are the worst. They really screw things up. They help with heartburn, but heartburn is really a lifestyle disease. And we treat it with a drug and it stops all the acid being produced, which means we don't digest our food well and ends up causing irritable bowel syndrome. So we trade reflux for IBS, which is kind of dumb. And it also can create a risk for community acquired pneumonia, osteoporosis. I mean, I've written a whole textbook chapter about this. So it's really

not a great drug for long-term use. And when I was in medical school, they were like, Hey guys, this drug just came out. It's super strong. You can only give it for six weeks for healing an ulcer. Do not keep it longer than that. And now it's the third leading drug of all time. And it's, you know, these class of drugs, the acid blockers, uh, like Prilosec, Prevacid, Afsofex, Nexium, all that. And, and, and, and they're given for years and years and years. And then, you know, it causes mineral absorption, magnesium, zinc, B12 deficiency. I mean, it's bad. So we get rid of the gut busting drugs.

We get rid of the food sensitivities and then, uh, and then we got to think about what's in there. So we do testing. So for example, I work with a patient now who has a parasite called blastocystis, which is, you know, not a terribly mean one, but it can cause a lot of irritable bowel and bloating and digestive issues. And so we have to sort of get rid of things first. I get rid of parasites and worms first. And then, then we look to see if there's bacterial overgrowth. So we'll do a test, for example, called a breath test, where we have people drink a certain kind of a fluid. It's got hydrogen, a certain kind of sugar essentially. And then you see what happens when that gets into their small intestine. Now people can, can produce hydrogen gas or methane gas.

So we think cows produce methane. Well, humans do too if they eat the wrong food, just like cows. So methane and hydrogen are gases that get produced. And this is when people walk around feeling like they have a food baby. They just feel bloated, distended, uncomfortable. They eat and they look like they're three months pregnant. And that's usually a sign of what we call SIBO or small intestinal bacterial overgrowth because your bacteria is supposed to be sterile. A cow or the bacteria often migrate up from the large intestine

for different reasons, stress, heavy metals, constipation. I've seen people with tick infections, like Babesia. So there's a lot of reasons for it, but we try to get to the root of it. And then they also can have SIFO, which is small intestinal fungal overgrowth. And fungal overgrowth is not that uncommon and often occurs because of antibiotic overuse, because of high sugar intake, alcohol intake. So you get a combination of SIFO and SIBO and parasites. This particular patient has all three. So what's the order?

How do you figure it out? Well, you have to treat the parasite first. Then you have to get rid of the SIBO. You have to get rid of methane or hydrogen because it's a little bit different in treatment. We use a combination of non-absorbed antibiotics and herbs to keep the bacterial down. Then we'll use antifungals, prescription and herbal. And I wish we could only use herbal, but in my experience, in order to really reset the gut, we need to get all the bad guys out.

And I, you know, we call it the five R program. I renamed it to call the weeding, seeding and feeding program. So you weed out all the bad stuff. You see it with the good stuff and you feed the gut to heal it. So it's, it makes it a little simpler, but, but I'll go through all the five steps. Um, the, so the first thing is elimination diet, get rid of the drugs, get rid of the bugs. Then the next step is, uh, replace. Uh, so that would mean replace digestive enzymes. We were just talking about pancreatic function. Well, if you have low pancreatic elastase, if you have low hydrochloric acid, you need to provide those as a bridge to help the gut heal and digest food while it's healing. Because if you, for example, if you are trying to fix the gut and then your pancreatic elastase is low, you have low hydrochloric acid, and then you're eating

food, it's starting to ferment again. It's starting to grow the bad bugs again. And it's, you've got a whole like, you know, problem in there. It's like weeds. And in fact, there are some conditions that can get so bad with that. They call it auto brewery syndrome. It's a described medical phenomenon where people can literally get drunk from the alcohol produced from the fermentation of the starch in their gut by these bacteria. So literally they can have a blood alcohol level and get pulled over for drunk driving. So that's kind of interesting. Anyway, fun fact. The other thing that you need to do is not only replace digestive enzymes, hydrochloric acid, you might need to replace prebiotics. So prebiotics are basically fibers

that are the food for the good guys. Now, if you have a ton of bacterial overgrowth or fungal overgrowth, and you give prebiotics, you will make someone extremely sick because you'll feed the bad guys. So you kind of got to clear out the bad guys first, and then you can start providing these prebiotic foods. And you can use prebiotic foods like plantains, artichokes, Jerusalem artichokes, asparagus have prebiotics in them. And there's a lot of great foods. Jicama is a great prebiotic food. So you can start including these in your diet. And then you can take actual prebiotics, which are inulin, acacia fiber, other fibers that are really, really helpful in fertilizing the good

stuff. There's a product called Biimmune, which is a prescription, not a prescription, but a supplement, prebiotics. So prebiotics are really important, but you have to use them in the right time, the right way. 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 Podcasts 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.