The Dr. Hyman Show - Is Leaky Gut, Magnesium Deficiency, Or Diet Causing Your Migraines?

Episode Date: December 19, 2022

This episode is brought to you by Rupa Health, Thrive Market, and InsideTracker.   Migraines are very common and, for many people, they can be debilitating, reducing the quality of life. Some may be so severe that the only option for getting through them is to rest in a dark room. The Functional Medicine approach to treating migraines looks beyond the head to assess the health of the entire body and find the root cause.   In today’s episode, I talk with Dr. Elizabeth Boham and Dr. Todd LePine to explore various ways we can use this approach to eliminate migraines. We discuss healing the gut and dietary changes, and I also speak about how low levels of magnesium have been linked to migraines. Dr. Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing, she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing.   Dr. Todd LePine graduated from Dartmouth Medical School and is board certified in Internal Medicine, specializing in Integrative Functional Medicine. He is an Institute for Functional Medicine certified practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. LePine’s focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring the natural balance to both the mind and the body. His areas of interest include optimal aging, bio-detoxification, functional gastrointestinal health, systemic inflammation, autoimmune disorders, and the neurobiology of mood and cognitive disorders. Dr. LePine enjoys skiing, kayaking, hiking, camping, and golfing in the beautiful Berkshires and is a fitness enthusiast. This episode is brought to you by Rupa Health, Thrive Market, and InsideTracker.  Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com. Thrive Market is an online membership-based grocery store that makes eating well convenient and more affordable. Join today a thrivemarket.com/hyman to receive $80 off your first order. InsideTracker is a personalized health and wellness platform like no other. Right now they’re offering my community 20% off at insidetracker.com/drhyman. Full-length episodes of these interviews can be found here: Dr. Elizabeth Boham  Dr. Mark Hyman   Dr. Todd LePine

Coming up on this episode of The Doctor's Pharmacy. The results you get from focusing on the gut with so many conditions, autoimmune, acne, weight, metabolism, migraines, ADD. It's just amazing when you start to focus on this. Hey everyone, it's Dr. Mark. As a busy doctor with multiple jobs, I'm all about tools that make my life simpler. And since testing is something I rely on to help almost all my patients, I was really excited to learn about Rupa Health. Hormones, organic acids, nutrient levels, inflammatory factors, and gut bacteria are just some of the many things I look at to find the most effective path to optimal health for my patients. But that means I'm placing orders through multiple labs, which is just an overall

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This is really a very much needed option in the functional medicine space that I'm so excited about. You can check out our free live demo and a Q&A or create an account at rupahealth.com. That's R-U-P-A health.com. Now, time and again, I've had my patients tell me they're too busy to eat as healthy as they like. And that's when I ask them how much time they spend on email or social media. I like to tell them if they have time to scroll, they have time to shop online for healthy foods. With Thrive Market, you can order all your favorite healthy pantry staples, snacks, household and body care goods, and so more, and have it delivered right to your door. Thrive Market is an online membership-based grocery store that makes eating well convenient and more affordable.

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Hi, this is Lauren Fee and one of the producers of The Doctor's Pharmacy podcast. Migraines can be a very debilitating condition that interfere with day-to-day life for many people. And they can range in severity with some migraines being more stubborn than others. Often migraines can be resolved by identifying imbalances in the body and making lifestyle changes that resolve the root cause of the migraines, whereas for others, taking a multi-pronged approach while working in conjunction with a skilled healthcare practitioner is what is needed most. In today's episode, we feature three conversations from the doctor's pharmacy on various approaches to healing the root cause of migraines. Dr. Hyman speaks with Dr. Liz Boehm on the functional medicine approach to treating a

leaky gut. Dr. Hyman speaks about the importance and role of magnesium, and he also speaks with Dr. Todd Lapine on dietary changes that can often relieve migraine symptoms. Let's jump in. Functional medicine has been thinking about this for decades. And now there's a microbiome revolution, everybody's talking about it, there's huge industry development around it, everybody's talking about probiotics and this and that. And we've been focusing for decades on the simple fact that most of our chronic illnesses start in the gut.

Yes. And whatever the name of the problem you have, whether it's migraines or whether it's depression or whether it's diabetes or obesity. I mean, I had a guy. Or rheumatoid arthritis. Or rheumatoid arthritis or autism or whatever. You got to start with the gut. Yes.

And traditional medicine, like leaky gut is not a thing. Like you go to the doctor, if you have arthritis, they're like, how's your gut? You go to your cardiologist, how's your gut? Even though there's so much research showing the connection. You don't get trained. And so there's this huge gap right now where the science has advanced so far, but the practice hasn't. And in functional medicine, we've been really great at actually getting the memo that the gut is at the center of our health. Right. So for years, right, we've learned about that five-hour program with functional medicine and how helpful that can be to heal the digestive system

and then heal all these symptoms or diseases that somebody has. Yeah. I mean, it's amazing. I was talking to the CEO of Cleveland Clinic recently and he was telling me about studies that he'd heard about that had used fecal transplants in autistic kids and taking the poop out of a healthy kid and putting them in an autistic kid and the kid's autism goes away. It's phenomenal. I mean, that's not true for all kids with autism. No, but it's phenomenal.

Yes. It's amazing. Or they're doing transplants from people who are thin to people who are diabetic and their blood sugar gets better. Right. I mean, I had a guy once who was a really great patient and he was very poorly controlled diabetic on lots of medications. And we worked on his diet. It helped a lot. Took it down from like 200 to like the 120s or so. But I never could get it all the way down. He wanted a really good diet and exercise. And he was telling me he had a bunch of digestive issues.

And so I said, you know, why don't you take some charcoal and do this and do that? And he called me back. He says, I don't know what happened, but my blood sugar went to 90. Right. So we absorbed all the toxic crap in his gut that was causing inflammation, that was causing his blood sugar imbalance. And these are the kinds of things that we do every day in functional medicine, but that are not part of traditional care and people are missing out on. Right, right.

When we're saying, why is this going on? How do we get to that underlying root cause for that individual person? So you've got some amazing cases. And I think I'd like to sort of get into it because you know people don't understand how so many of our issues come from the gut and how easy it is to diagnose it and treat it and we use tests that traditional doctors just don't do like we have a different set of lenses a different set of filters that we can sort through information and data and ask questions that traditional doctors can't. Like, how do you measure a leaky gut? How do you look at the

microbiome in the gut? How do you look at the digestive function in the gut? How do you actually start to treat it in a different way? And I think your first case is just so rich with a story that is so common that I just love you to share this because I think everybody's going to resonate with this story. And by the way, I've never seen this patient as your patient, but I've literally seen the same story a hundred times or maybe 500 times or a thousand times in my back. It's so common. It's the same freaking story.

Right. So tell us about this person. So it was a 24-year-old gentleman who came in to see me and was really struggling over the last year with his digestive system. He was having a lot of bloating and gas, pain in his stomach. Every time he ate, he was having diarrhea. And sometimes he was getting constipated. And he went to his traditional GI doctor.

And they told him, you have irritable bowel, but he wasn't getting any better, right? And he was just really, because he was having so much stomach pain, he had lost some weight. So he wasn't, you know, he was on the thin side to begin with, but because he was having stomach pain when he ate,

he wasn't able to eat as much, and he was even losing more weight. He was feeling really weak and tired and sad, depressed. was having stomach pain when he ate, he wasn't able to eat as much, and he was even losing more weight. He was feeling really weak and tired and sad, depressed, right? And so for him, well, for everyone, the timeline is so important, right? That's what we learn in functional medicine is the gathering that information, learning about that individual patient's story, seeing their timeline. So we start with a history with the mother and her pregnancy and the birth and whether they breastfed and whether they took antibiotics,

whether they were sick as a kid, what happened, when they were introduced to food, when they got gluten, when they got dairy. We ask all these questions. So when someone comes in with irritable bowel, the average GI guy is not asking all these questions. So why do we ask all those questions? Because for this gentleman, for example, he really didn't have stomach pain before a year ago, but what we found out is that when he was a kid, he had

ear infections. Probably because he was eating dairy. Probably, right? So it's such a common connection. Oh my God. I remember once being in the ER, Liz, and this patient came in and this little boy was coming back, like a toddler was coming back over and over to the ER with ear infections and just so inflamed and I said how was he like like did you breastfeed yeah so when did he start getting the ear infections well we started formula

and dairy and milk and I'm like oh okay and this is even before I knew about functional medicine I know and I was like well maybe you shouldn't eat dairy. Yeah. And the kid was fine, you know? Right. That's such a common connection. I mean, even my son, when he started dairy, he got asthma and eczema. It's unfortunately such a common connection. So for this child, he had a lot of ear infections and eczema. And so he was on antibiotics about once or twice a year in his childhood. And he

really didn't think that was very much. He's like, that's not, you know, that wasn't too much, but you know, it makes a huge impact on the microbiome as we're learning. And then he started to have acne as a teenager, maybe because of dairy more, right? Or some of the imbalances in the microbiome, right? When you screw up the gut with antibiotics or a C-section or lack of dairy more, right? Or some of the imbalances in the microbiome, right? When you screw up the gut with antibiotics or a C-section or lack of breastfeeding, then you get often more acne. Yes.

We treat acne from the top in as opposed to the inside out, which is actually where it works much better. And this gentleman was given low-dose antibiotics for two years. So then he took even more antibiotics. And so this history of antibiotics sort of set him up. And about a year ago, he had some sort of stomach bug.

So some probably viral stomach infection. And then since that time, he started to have all these digestive issues and was losing weight. And so- Which is a common story. People are- So common, like you said. This sort of smoldering a bunch of insults over the course of their life. Maybe they're a C-section.

They had antibiotics as a kid. They took acne antibiotics. They were eating a crappy diet, whatever. And then all of a sudden, something happens and then boom, the body can't take it anymore and it creates some kind of disease. Yeah. But if you look at the story, you can often map out exactly how this happened. That connection with his acne, with his asthma, with his digestive issues, with those antibiotics,

that's that story we often see. And we're not making this up. There's so much science that shows that your gut microbiome plays a role in acne and eczema and asthma that it plays. I mean, we're actually doing this at Cleveland Clinic now. We're studying asthma and looking at how the microbiome plays a role and how it affects inflammation, all these various factors that most doctors

just don't pay attention to. Right, so with him, as we do with most of our patients, we do food first, right? So we said, okay, we've gotta really focus on this person's diet and help him start feeling better right away so he can start to eat more and regain some of his strength. So we pulled away inflammatory foods. We took them off of gluten and dairy while we were waiting for tests to come back. Sometimes we will do some tests that

look at, of course, we'll test for celiac disease or- Which is a big cause of leaky gut. Yep. That's for sure. Probably the number one. And he didn't have that, but- By the way, you don't have to have celiac disease to actually have a problem, right? You can have what's called non-celiac gluten sensitivity. I would estimate it probably affects 20% of the population. And I think if you look at the antibody levels, you can get a clue, which most doctors don't look at. I read a study that autistic kids and schizophrenic patients often

have, 20% of them have antibodies to gluten. And it may not be full-blown celiac. Absolutely. And even, you know, regardless of, even if people are negative totally for celiac, if they have increased intestinal permeability, they start reacting to a lot of different foods. So then you start to see with that leaky gut, as we talked about before, right? The coffee filter and things are coming through, then the body's reacting to lots of foods that it maybe never reacted to before. So they're not true allergies, they're more like sensitivities. Sensitivities. And because of, and the real thing is it's because of this increased intestinal

permeability. So our job is we have to heal that increased intestinal permeability. So our job is we have to heal that increased intestinal permeability so that they don't have to be so restrictive with their foods. I mean, we still always want them to be on a healthy diet, but we wanna relax those restrictions over time. Most of the time we can. Yeah, and so as part of the approach of functional medicine,

we start them on the elimination diet. So eliminating all the inflammatory foods, gluten, dairy, processed foods, all that stuff. And then you remove, right? That's the remove. Right. The five R's, remove, replace, re-inoculate, repair, rebalance. And we'll go into each of those because they're really important. But the next step is also there's other things we may need to remove. There's tests we need to do. So what kind of tests would you look at as a functional medicine doctor that you wouldn't

see at a traditional doctor's office that give us a roadmap of how to treat these patients? Right. So we did a stool test that looked at his microbiome. And what we noticed is that there was an overgrowth of unhealthy bacteria and unhealthy yeast. So he had this, you know, probably because of years of antibiotics, he developed this dysbiosis, this imbalance in the bacteria and yeast. And so there was an overgrowth of the unhealthy things. It's like weeds, having a lot of weeds in your garden, right? Yeah, right. It's not always like one of those, you think of a stomach infection and you're getting really, really sick, you're throwing up or having diarrhea. It's an imbalance and it's called

dysbiosis, but that imbalance causes a lot of symptoms in people. When you have the wrong bacteria and the wrong yeast levels, you can get a lot of bloating after you eat, you can get a lot of fatigue after you eat, you can get those symptoms of constipation and diarrhea. And that causes this inflammation in the digestive system. So all of your digestive enzymes don't work well. So you're not breaking down your food well, you're not absorbing your nutrients well. And it becomes this vicious cycle that people are dealing with. And we see all the time. Yeah, it's so powerful. So, you know, and when I see this patient, I'm like, okay, you don't have to do all the tests,

but sometimes when you get stuck, you look at various tests that look at antibodies against things that are in the gut that determine a leaky gut. Right. And we call this Cyrex-2 testing, which is a test you can get through functional medicine. Right, you can test to see if there's leaky gut.

I love that test too, because it's a great way for us to follow up and see how much we're seeing improvement. Are we doing enough? Right. Are we seeing improvement in their leaky gut or increased intestinal permeability? And then we look at poop testing, like, you know, where we do thousands and thousands of these tests and it's so helpful. And it doesn't just look at the microbiome,

it actually looks at the function of the gut. Like whether there's malabsorption, whether you had no digestive enzymes, whether there's inflammation, whether there's overactive antibodies in there, whether you have imbalances in what we call the short chain fats, which are the food for the colon

that are produced by bacteria eating the right kinds of fiber. And if they're low, it means there's an imbalance. Then we look at the microbiome, and we look at what grows, we look at parasites. And then we target and micro-target the things that are out of balance for that person, and it's different for everybody.

And we might look at food sensitivity testing, we might look at, and even things like heavy metals or other things which can also cause it. I had a patient with ulcerative colitis once and I did everything right. I did the whole 5R. It wasn't working. But I forgot the first part of the R which is remove. And I thought, well, maybe, you know, heavy metals can cause autoimmunity. Maybe it's a problem.

And so I tested him and he was like wasted away and he was like, it was terrible. He actually had high levels of mercury. We treated mercury and his colitis went away. Which is phenomenal. Yeah. So I think it's so powerful. This case is so important because it really describes how a patient goes to a traditional doctor, is diagnosed with a disease, irritable bowel syndrome, by the way, anytime you hear syndrome,

it means doctors know what the heck's going on. It's just a collection of symptoms that we agree, we're gonna put in this bucket, and if you have those symptoms, you have this disease. But it's not really a disease. And so that's what functional medicine is. It sort of looks upstream to figure out what the root causes are and personalize the treatment for everybody. And there's common things that we do like the 5R, but it may be different R's for each patient, right? Right. Hey, everyone. It's Dr. Mark. Now, something I get more and more excited about every year is personalized medicine.

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Right. So for him, we removed, you know, the inflammatory foods and we removed the bacteria and yeast. I actually treated him with an antibiotic, a non-absorbed antibiotic and an antifungal. So I treated him with prescription medication. Yeah, weed killer. So that was the remove, right? And then the replace. Because he was underweight and because of that inflammation in his digestive system, I gave him some digestive enzymes for a short period of time just to help him, to help it

so the food wasn't as inflammatory for him and to help him absorb more nutrients. And then we worked on re-inoculating, right? So after we gave him some good probiotics. Put in the healthy bacteria. Put in the healthy bacteria. Some good prebiotics, right? So we know that there's- What are prebiotics?

Prebiotics are the things that help feed the good bacteria. So they're the food for the probiotics. Which is usually what? Like fibers. Fibers are amazing prebiotics. We know a lot of phytonutrients are prebiotics. Which is usually what? Like fibers. Fibers are amazing prebiotics. We know a lot of phytonutrients are prebiotics. So this, I think, is really exciting research when we're looking at our phytonutrients. You know, we know that-

What are phytonutrients? Right. So I know it's amazing, right? So our food has minerals in it. It has vitamins. But it also has these things called phytonutrients, which are these components in our plant foods that have this amazing health benefits for us. So that can include things like ellagic acid that we see in pomegranate that can feed some of the good bacteria, that acromantia that we know can lower inflammation.

We know that- Just to back up on that acromantia thing. So when we look at the poop, we can tell if there's like good levels of different bugs. One of them we look at is acromantia. And it turns out that that is so important for protecting your gut. It helps you keep your biofilm or that little coating over the gut so you don't have a leaky gut. And it's involved in so many autoimmune diseases and response to cancer therapy and metabolic issues and weight. And it's such an overlooked thing and you can't take a probiotic of it, at least not yet.

But you can feed it, the good guys. We can feed it. We can feed it with all these amazing phytonutrients like what's in pomegranate, the ellagic acid. And also we know that sulforaphane from our cruciferous vegetables feeds the good bacteria. Yeah. You know?

So broccoli, collards, kale, but not juicing. Right. Brussels sprouts, all those good ones. We know that green tea, you know, that has good phytonutrients in it that's good for the digestive system. So we always say to people, you know, get something from every color of the rainbow every day. You know, you get some plant foods from every color of the rainbow every day. You know, you'll get some plant foods from every color of the rainbow every day. Get some good red foods like

the pomegranate or cranberry. Get something orange and yellow and green, blue, purple, white, tan, you know, those, all those good, healthy plant foods that we, you know, like our vegetables, our fruits, our spices, our teas, our coffees, really actually are impacting our microbiome, which is fascinating. It's so great. And just a great anecdote from a colleague of mine, Dr. Lee, who was on our podcast talking about eat to beat disease. His mother had stage four uterine cancer.

And being the smart doc he is, he understood from the research that if you have low acromantia, patients don't respond to the immunotherapy, what they call the checkpoint inhibitors, which is this new form of cancer therapy that helps activate your immune system. So if your gut isn't healthy, you can't actually get the cancer cells to die with the immunotherapy.

So basically you die unless you have good bacteria in your gut. And so his mother had stage four uterine cancer and was gonna die and wasn't responding. And he gave her pomegranate, cranberry, green tea, all these phytochemicals, got her acromantia levels up, and she was cured of her stage four cancer within a month. That's a phenomenal story.

It's an incredible story. And I think that just shows the power of the plant foods and of getting focused on the gut. Yes, yes. You know, we call it the 5R. It's an incredible story and I think that just shows the power of the plant foods and of getting focused on the gut. Yes. Yes. You know, we call it the 5R. I call it the weeding, seeding and feeding program.

So like you weed out the bad things, you seed with the good things and you feed it with good nutrients and all that stuff. So it's really, it's so powerful. I can't tell you, you know, as a functional medicine doctor for the last 30 years and you, you know, been doing this almost last 30 years, and you've been doing this almost as long, the results you get from focusing on the gut with so many conditions, whether it's autoimmune, or whether it's allergic,

whether it's digestive, whether it's your skin issues like acne, eczema, whether it's your mood, whether it's weight, metabolism, whether it's migraines, whether it's Alzheimer's, I mean, autism it's weight, metabolism, whether it's migraines, whether it's Alzheimer's, I mean, autism, ADD. It's just amazing when you start to focus on this. So let's break down the five-hour program for everybody. So we got the remove.

So what are we looking at? We're removing- Removing unhealthy foods or inflammatory foods for that person. So they can be food sensitivities, things like gluten and dairy, the big ones. Food sensitivities, yeah. And then we're removing- Processed food and junk food, right? Oh yeah, that's for sure. And sugars and excess sugar, which is feeding the wrong bacteria. And then we're removing the unhealthy bugs or yeasts or viruses or- You might have bacterial overgrowth,

yeast overgrowth, a parasite. I was on the Red Table talk and Jada and her son both had parasites and they both had gut issues for a long, long time. And they thought it was just how they were. But with a short little course of treatment, they were both, I've never felt better. And all the other symptoms got better. Because now you're actually absorbing

the nutrients you're eating, which just helps the body heal. Yeah, so then you remove. Then we replace. But you might also remove things like heavy metals or stress or toxic people in your life or whatever's giving you a stomach problem. Right, right, right. Replace means just to replace

some of those digestive enzymes if needed, re-inoculate as we. So the replace also could be like prebiotics, right? So putting in the fibers to feed the gut and to actually maybe use hydrochloric acid sometimes for people who aren't digesting their food as they get older. Yeah, and to help get them off of the acid blockers, which we know are creating a lot of problems because we need that acid in our stomach to digest our food. Okay, let's take a little detour. So you just mentioned acid blockers. Okay,

these are among the most prevalent drugs prescribed today in America and statins, I think. When I was in medical school in the 80s, we just had those drugs come on the market. The drug reps used to come to us and say, these are very powerful drugs. Never use them for more than six weeks because they block stomach acid and they'll cause significant problems if you do that long-term. You can cure an ulcer with it. You can fix an acute problem, but never use this. Now people are on this for decades. And the side effect, which is listed in the manuals that we get as doctors, is that it causes irritable bowel syndrome. Right.

So you end up fixing the heartburn, but you get irritable bowel and bloating and bacterial overgrowth and all these problems. Right. Because you need the acid in your stomach. And when you block that acid, then there can be an overgrowth of bacteria where there's not supposed to be. And that can cause all those slow problems. You also then-

Change the pH. You get more yeast issues and all this stuff. And then you're not absorbing your minerals so you can get osteoporosis and you're not absorbing your B12 so you can get fatigue and dementia, right? It just goes on and on and on. You don't absorb zinc and magnesium, minerals, calcium, it causes osteoporosis, pneumonia, it causes, you know, irritable bowel. It goes on and on, right?

And it takes some work sometimes when people have been on an acid blocker for a long time it takes some work for us to help them off because their body has gotten pretty used to it they they start to get their bodies their body wants to make acid so it's it's working against the medicine so when you wean them down sometimes they get more acid production rebound so you actually yeah it's like and it it's like, and it's sort of a trick, like you get off it but it makes you worse so you feel like you have to get back on it. I got to get back on it. But it's actually not true and you can actually get off it.

Absolutely. So we do that all the time. We do it all the time. So re-inoculate, giving all the good prebiotics and probiotics, the good bacteria and all the things that feed the good bacteria. And then the fourth R is repair. How do you know what probiotics it take? Oh things that feed the good bacteria. And then the fourth R is repair. How do you know what probiotics to take?

Oh, that's a great question. I don't know. What are you prescribing? Oh, my goodness. That's such a, that goes on and on. We could talk about that for the next hour. Yes, it's true. Right?

There's more and more probiotics on the market every day. And they all have different roles and different functions. And we're just sort of, honestly, I think, you know, we've been doing this forever. But it feels to me like we're at the infancy of this understanding of how to use these in medicine. Yep. So what- I mean, there's some great brands that I trust

and I use all the time. But when somebody is, you know, doesn't maybe know what to do, I'll say, you know, get one, go to a reputable place, a reputable pharmacy or a good wellness store pharmacy and get a probiotic. You know, try it.

If it makes you feel worse, then stop it, you know, because there's some good bacteria that make people feel worse. Well, they have bacterial overgrowth. Exactly. If you have bad bugs growing in there and you put the good bugs in there, they have a fight and they cause lots of bloating. And so that means we just have to do more work before we can start it.

So. So they got to re-inoculate and then you got the. And then repair. And that's the fourth R. So that's things like, that's like giving good protein, good amino acids, which are the building blocks of protein. To repair. Yeah, to help repair that barrier, that coffee filter, right?

We have to repair it with good protein. And sometimes we'll use amino acids like glutamine that help repair it. We'll give more zinc, whether it's from food sources or as a supplement. Maybe we'll give some vitamin A, which also helps with healing that barrier. It helps with healing the endothelium in the gut. So those are things we will do to repair. And then rebalance, right? That's the fifth R, which is really focused on managing our stress and how we're reacting to the world. Because we know that when our parasympathetic nervous system is engaged, when that calming nervous system is engaged through

meditation and yoga and breath work, that our body has the ability to heal. And it heals better when our body is at rest. I mean, yeah, you just touched on something very powerful, which is that our gut and our brain are connected. There's a whole hard wiring of nervous system, and the gut even has this independent nervous system that actually is like a second brain. And so we often say people with irritable bowel are emotional or

anxious or have just maladaptive emotional coping mechanisms. But it turns out that the irritable bowel actually can cause an irritable brain and lead to anxiety and all these emotional issues. So it's bidirectional. And I think that's a great lever for helping people reset their gut. Absolutely. You know, I just want to share a story because I've been doing this for a long time. And of course, my, I don't know what it is, curse or blessing, depending on how you look at it, is actually getting really sick and having to figure out what to do to fix myself.

Yeah. And I've had a lot of gut issues over the years, which is why I really focused on this. The first was when I had mercury poisoning. Yeah. And I tried everything. I did every functional medicine trick in the book back then, and it wasn't working. Right. And until I got the mercury out, which disrupts all your enzymes, it disrupts your gut, it

causes leaky gut, it causes yeast overgrowth, it screws up the bacteria in your gut. Until I got rid of the mercury from my system, I couldn't get my gut straight. Yeah. Because it's impacting your immune system too, right? Right. And then I, many years later, I kind of got an issue which was triggered by an antibiotic for a root canal that I had to take called clindamycin, which is known to cause C. diff, which is a terrible bacterial infection that kills like 30,000 people

a year. And I got that. And I was so sick. And Liz would come over to my house and I was like, it was pretty bad. I'm like, we're all struggling to figure it out. And I had mold in my house and all these other things, but I ended up having colitis and I had tremendous leaky gut. And I had mold in my house and all these other things. But I ended up having colitis and I had tremendous leaky gut. And I did my own stool test. And my friend Patrick Hannaway, who worked for the stool test company for many years, my colleague at Cleveland Clinic, he and I looked at my stool test. And we probably, between the two of us, seen like 20,000 stool tests. We're like, this is the worst one we've ever seen.

And everything was screwed up. And I had no good bacteria. I had low butyrate. I was not digesting. I had tons of inflammation. It was terrible. And I couldn't really fix it using a lot of the traditional things. And then I started to sort of work on a gut shake, which included a lot of the sort of 5R concepts, right? So I cleaned up my diet, obviously. I got rid of the bad bugs. But which included a lot of the sort of 5R concepts, right? So I cleaned up my diet, obviously. I got rid of the bad bugs. But I used a combination of these polyphenols from the plants, a pomegranate, cranberry, green tea. Also added, you know, glutamine. I added prebiotics, probiotics. I even added colostrum, you know, which is to help regulate the immune

system. And it was like a miracle. I went from full-blown colitis to like normal in three weeks and I've been great ever since and you know it's just like wow this is something that people can actually do it's not that hard it's not drugs and the alternatives are like really bad drugs right so you know we we we want to go to the next case which was sort of not about people with a gut-centric issue because people often think, oh, well, if I have a leaky gut or if I have gut-related problems, I'm going to know it. My stomach's not going to be right.

I'm going to feel symptoms. But it's not always the case. So the first case was a guy who did have a typical history of antibiotics and acne and some infection and diet and all this stuff. And that was pretty clear. But there are many cases where people come in and they have zero gut symptoms, but their gut's a mess and it's causing all these issues.

So tell us about your next case of this patient with autoimmune disease. So this was a 50-year-old woman who came in and she didn't have any real digestive issues that she was paying attention to or that were bothering her. What was bothering her were her joints. So she was having a lot of joint pain, especially in her hands. And she was starting to get a lot of swelling and deformity. And she was diagnosed with rheumatoid arthritis. Really common. Yep. And her, a rheumatologist wanted to put her on a biologic medication. He wanted to start her on Embril.

So by the way, these are drugs that suppress your immune system that can cause life-threatening infections and increase risk for cancer that cost 50,000 a year. So it's not risk-free and it's super costly and it can save lives and it can be a great rescue medicine if people need it. But most of the time using functional medicine, not all the time, but most of the time you can figure out the puzzle of why they're sick and fix that. And then they get better and they don't need

the medication. Right. And she wanted to try it a different way. So she came to see us and said, you know what, before I go on this medication, can we do it a different way? Can I, can I, can I, can my body heal? And can I get to the point where I don't need this medication? And, and so we did a lot of testing on her and what we found. And by the way, the testing can sometimes be expensive, but it's a lot cheaper than a lifelong course of these medicines and the suffering that goes along

with it, right? So if you have to spend a few thousand dollars up front to figure it out, you can stop having to pay 50 grand a year for the medication for the rest of your life. And you feel so much better. Yeah. And so we found out that she had increased intestinal permeability. We did that test that you were mentioning earlier, that Cyrex-2, which looks at antibodies against different proteins

in the digestive system. And if they're elevated, it gives us an indication that there's that increased intestinal permeability. And hers was really, really high. Yeah, and she had no symptoms. No, and she had no symptoms, right? And one of the markers on there was high that makes me also think, okay,

is there really a gluten issue for this person? Because we know that that can damage, as you were mentioning earlier, that for people with celiac disease, that really can damage those villi in the intestines and is a major cause for leaky gut. So. Well, just that's an interesting point.

You bring up gluten. So even if you don't have celiac, you can still have issues. And one of our functional medicine faculty, Dr. Alessio Fasano is one of the world's experts on leaky gut and gluten. And he discovered this because he found that in cholera, when there's a mechanism in the body that actually causes you to have a leaky gut and sort of get rid of the infection. And it can kill people if it's bad enough, but he realized that the same thing that gets activated in cholera, something called zonulin, is activated by gluten. So gluten causes this protein to be produced that creates a leaky gut. And you don't actually have to have celiac. And you could even have what we call non-cell mediated immune response, which is the old

ancient immune system that doesn't even use antibodies. So you can't even measure it or test it. Right. Just inflammation. Just inflammation. It's sort of like, it's like, you know, the difference between a smart bomb and like, you know, carpet bombing, you know, like it's and carpet bombing. It's like sort of an ancient part of the immune system just reacts and gets pissed off and inflamed. And that can cause a leaky gut. So when people have high zonulin levels or

create antibodies to zonulin, it's meaning there's some issue with the gluten. 50% of Americans are not getting enough magnesium. And why is that? It's because there's a decrease in our diet and the magnesium in our foods because of processed foods. The soils are not able to actually give the plants the magnesium because they're so depleted and lack organic matter that the bacteria in the soil help the plants extract the magnesium from the soil. We drink a lot of coffee, alcohol, sugar, all which deplete magnesium. We're stressed, stress depletes magnesium.

So there's a lot of reason why we have low magnesium. And it's super common. And it's so common that it's linked to heart disease. It's linked to so many chronic illnesses. And the costs are huge. So what are the signs of magnesium deficiency? Now, when I first started learning about this, I was shocked because I had treated all sorts of problems when I was in medical school, when I was a resident, as a doctor,

and so many symptoms we didn't even think of as being related to magnesium, but they are, like muscle cramps or muscle twitching, insomnia, anxiety, irritability, sensitivity to loud noises, palpitations in your heart, constipation, spasms in your butt, anal spasms, headaches, migraines, fibromyalgia, chronic fatigue, high blood pressure, PMS, menstrual cramps, irritable bowel, all these and lots more are connected to magnesium. It's a critical mineral. It's involved in over 600 or 700 different chemical reactions in the body. It is the fourth most abundant mineral in your body.

And it plays a role in so many different chemical reactions that if you don't have enough of it, your body starts not to work. So anything that's irritable or twitchy or crampy, it's likely magnesium deficiency. And that's why I call magnesium the relaxation mineral, because it just relaxes everything. Think about taking an Epsom salt bath, which is magnesium sulfate. It relaxes you at night and it relaxes your muscles and it helps form muscles because it helps the recovery of the muscles. Your muscles need magnesium in order to relax. So it's super, super important and it works on so many different levels in the body. So, and I, you know, when I was in medical school, it's kind of a joke because, you know,

it's kind of the last resort we use when nothing else was working and none of the drugs worked. So for example, if someone came in with a heart attack and they went into an arrhythmia where their heart was just beating out of control, we give them all these drugs, epinephrine, this drug, that drug. And then at the last resort, if nothing else works, we give them intravenous magnesium. Why don't we do that first? Or if, for example, they're having seizures and they're, for example, from preeclampsia, which is a pregnancy condition, what do we do? We give them, which is, you know, irritability of the brain, we give them magnesium. Or if a woman comes in in preterm labor, like, you know, where their butyrus is contracting, then all of a sudden, it's an emergency, right? The baby's going to deliver. We give them intravenous magnesium as a treatment. If someone

is constipated and their bowels are not,ated and their spasm basically are not going, we give them magnesium citrate. If we're doing a colonoscopy prep, we give them magnesium or milk of magnesium. You might've heard about that. So we use it all the time in life-threatening situations in the emergency room, in the ICU, in the cardiac intensive care unit. And it's kind of makes me laugh that we don't think about using it just everyday medicine. So there's over 116,000 different medical references on magnesium. And because it's not a drug, nobody's pushing it. You don't really hear that much about it, but it's super common. Apparently 65% of people admitted to the ICU, the intensive care unit, have magnesium deficiency.

So if you want to stay out of the ICU, take magnesium. It also seems to be about 45% of the population is not getting enough magnesium in their diet. And if you check your blood magnesium level, it's not that great because that 99% of the magnesium is in your cells. So by the time it's low in your blood, you're really screwed. So the key is to do red cell magnesium, but there's also another test called magnesium loading, but it's such a safe mineral. Unless you have kidney failure, you can't hurt yourself with it. You'll just get diarrhea if you take too much of it. So why are we so deficient? Well, I mentioned a little bit of the reasons.

Most of the foods we can eat contain no magnesium. What do you get magnesium? Nuts, seeds, grains, and beans, and greens. And not the staples of most people's diet. All the processed food has no magnesium. Sugar in our refined diet has no magnesium. So it's really low in most of the foods we eat. And a lot of what we do, like I said,

we drink too much alcohol, we drink too much coffee, we have soda, like colas are full of phosphoric acid that depletes magnesium. Often if you're sweating a lot, like I exercise and I sweat a lot, I make sure I take electrolytes because I want to replenish my magnesium. Stress, I read a study about Kosovo during the Balkan War. And if you had high levels of stress, people would excrete more magnesium. They literally pee it out. So antibiotics are a factor. Diuretics, people you take for high blood pressure. High blood pressure is blood vessels that are too spasmy and magnesium helps relax them. But one of the drugs we use is a diuretic to really kind of remove fluid from the body.

But that causes you to lose magnesium. So it's kind of weird. So there's a lot of things that are a factor. But most of the problems we have are just because of our crappy diet and our lack of magnesium in our foods. So make sure you get plenty of those foods like nuts, seeds, avocados, beans, dark chocolate. That's a good one. Dark chocolate's a good one for magnesium.

And also sea vegetables, seaweed. I encourage you to eat seaweed. Great. Great source of magnesium. Now, you need a lot of other minerals and vitamins with magnesium to make them work, like B6, vitamin D, selenium. So you need those all to kind of work together as a team. And we want to make sure we don't keep losing magnesium. So cut down on the alcohol, the sugar,

the coffee, the colas, learn how to relax. Meditation is super powerful. And make sure you look at your drugs. A lot of people talk about, you know, nutrient drug interactions, like, oh, we shouldn't be taking this because, you know, oh, don't take too much of vitamin K or whatever because you're taking a blood thinner. Okay, fine. That's right. But what about the other way around? The drugs interfere with your vitamins and minerals. So, like, if you're taking an acid-blocking drug, you're going to prevent B12 absorption and even magnesium and zinc absorption. Or if you're taking a diuretic, you can lose magnesium. So, you want to make sure that you reduce your drugs if you can, or switch to different drugs that are not

depleting the nutrients, or that you actually take the nutrients as a replacement. Now let's talk about supplements, because I think that we need to be thinking about how do we get enough magnesium. So diet is first, right? Getting rid of the things that cause you to lose magnesium is second. And then we need to be taking probably 300, 400 milligrams a day. I take about 400 or 600. I take it at night. It's great for sleep. It's great for insomnia. It's great for muscle cramps. It's great for constipation. It's great for headaches. It's great for anxiety. It's great for palpitations. It's great for so, so many things. But you might need more. I mean, some people need up to a thousand milligrams. I have to tell you a quick magnesium

story of a patient. She was a radiation oncology resident. So she was a doctor and she suffered terrible migraines. And she came to see me and she started talking about these migraines that were so bad she had to take, you know, narcotics and Zofran, which is like a chemo drug for nausea. And she still could barely function. And she was going to have to quit her residency. And she worked all this time to be a doctor, but she couldn't function. I says, OK, well, now as a functional medicine doctor, I just don't want to know about her headaches.

I want to know about everything. So I started talking about all of her symptoms. It's, oh, anxiety, palpitations, muscle cramps, constipation. I said, how often do you go to the bathroom? She said, I'm pretty regular. I said, well, how often do you go? She was like, go every week. I'm like, what do you mean? That's not regular. So it's regular for me. I go every week. I'm like, no, you're supposed to go every day or two or three times a day. By the way, that's how often you're supposed to go. And so she was severely magnesium depleted. I gave her a thousand milligrams or even more over a number of days, and she dramatically

changed. Her headaches went away, her constipation went away, her palpitations, her anxiety, her insomnia, her muscle cramps all went away by getting enough magnesium. Now, what kind of magnesium should you take? They're not all the same. If you take magnesium carbonate or magnesium oxide, those are things you'll get in a drugstore maybe in crappy cheap magnesium, but it's not absorbed well. So you want to get chelated magnesium. You want to get magnesium glycinate or citrate if you tend to be more constipated. Magnesium threonate is great

for the brain. There's many, many different kinds of magnesiums that you can take, but do not take the carbonate or the oxide or the gluconate. Those tend not to be very well absorbed. Now, if you take too much magnesium citrate, you'll get diarrhea. So you want to use magnesium glycinate. You take other minerals in a multi-mineral complex. Also, hot bath is great. Epsom salt baths. I love that every night, especially in the winter with some lavender drops. It really relaxes me. Magnesium relaxes me and I just drop right off to sleep. So magnesium, Epsom salt baths are great. And one caveat, if you have kidney disease, you can take too much magnesium. So you want to be careful there. But work with your doctor about that. I had a patient who came in and his story was that he first developed migraines starting around at the age of five which is interesting okay so so when you have a history of somebody

who's having headaches i mean it's not normal for a five-year-old to have headaches that makes me sort of think okay this person may have a mitochondrial issue and that may be what's going on early on in their story. Also, interestingly, the patient noticed when he was telling me his story that he would get the worst headaches on the weekends. And on further asking him, it turned out that on the weekends he didn't drink coffee. So what he was getting was a caffeine withdrawal headache. Right. Now, this is probably one of those things that because caffeine is a double edged sword. We actually use caffeine to treat migraines.

And if patients take like over the counter medications like Excedrin migraine, guess what's one of the major ingredients in there is caffeine. In fact, I had a patient. I'll never forget this. It was a woman who had refractory migraines. And it turned out that she actually was getting rebound headaches from daily use of excedrin migraine and so she would have to take the excedrin migraine to prevent the the withdrawal effect from the caffeine so it was like a cat chasing a snail so that's not great because that's got talent well it's great it's great for the company because they keep selling it right liver problems right yeah exactly yeah so so this this

patient was caffeine sensitive so some of the treatments you can actually abort a migraine with uh caffeine but you can also trigger a migraine so it's this sort of a double-edged sword uh in terms of uh the the effect of caffeine but typically if i have somebody who's got migraines i get them off of all alcohol all caffeine uh and give them some magnesium just that's that you can shoot from the hip and just do that and you know you can make a big a huge impact so that was an interesting uh with the patient and this particular patient also had a history of developing an egg allergy at age 21 which was interesting like why you know what's going on why did all of a sudden develop an egg

allergy in addition to that uh the patient said that they would develop the itching with eggs and then also itching with bananas. Oh, wow. Right. Which then sort of makes me think about, is there a problem with histamine and histamine detoxification? There are specific genes in the body that have to do with histamine synthesis and also histamine detoxification. And you can do some esoteric testing on that to see, because histamine, I definitely think, plays a big role in migraines.

So what is histamine, Todd? Well, histamine is the drug, or not the drug, it's the compound that is naturally found in the body. And it is actually a neurotransmitter. It's also involved in allergies. So when we have spring you know uh spring allergies or uh allergic rhinitis we treat that with an antihistamine right all right now this is sort of interesting and i'll talk about this one it's made by your white blood cells it's right it's

well it's yeah it's made but it's also made by gut bacteria it's found in food it's it's uh made by the uh the white blood cells, specifically the mast cells. And there are certain receptors for histamine. So there's, I think, there's like four receptors for histamine. And interestingly, when you block histamine, what happens to you? You fall asleep. You ever take Benadryl, right? That Benadryl puts you to sleep.

So histamine actually activates the the body it wakes the body up um so it's it's it's actually works as a neurotransmitter also it's involved in allergies and itching and and things like that so so histamine is is one of these things hives or things you can get hives exactly yeah so histamine definitely plays a it's one of the things that can play a role in in uh migraine headaches and headaches. So how do you approach a patient who's got histamine sensitivity? How do you diagnose it first? How do you treat it? Well, one of the things that you can do is put somebody on a low histamine diet

because a lot of the foods that we take in can be high in histamine. Normally, our body will just sort of deal with excess amounts of histamine. But when the gut bacteria is out, like if you have SIBO, you'll have problems with histamine breakdown or histamine degradation, or certain bacteria will actually be making high levels of histamine, which in turn can affect the brain and your neurological system. Incredible. Yeah.

Yeah, I've seen histamine treatment when you do it in the right patient by both dietary changes. Also, there's all kinds of supplements that can help, like quercetin, even medication like cromalin that people can take orally, histis, which is various supplements that help with modifying the histamine response and getting the diet low in histamine people can really have radical transformations in their health it's not something most doctors think about or do yep and it's tricky to do but it can be really effective yeah yeah and this in this particular patient when i did the testing on him lo and behold he had

significant uh sensitivity to gluten which he was totally unaware of and it never really worked with a nutritionist sometimes you know they'll say, I worked with a dietitian. And, you know, a regular dietitian is, I mean, they're not really all that helpful. Having a nutritionist who's trained in functional medicine can really look at the diet beyond just, you know, calories and the macronutrient proteins fat and carbohydrates is very very important so in this particular patient the organic acid testing showed a higher need for the B vitamins showed some evidence of dysbiosis which is imbalances of the gut bacteria had significant gluten sensitivity some

leaky gut on testing had low normal magnesium was technically normal but it was on the low side of normal so these are all the different things that you can fix and then on a stress testing had high levels of cortisol interesting it was very very interesting um and then uh the other thing that i found on the patient i'm not really sure because i'm actually still working on that because i was going to deal with that later is high levels of mercury, very high levels of inorganic mercury in this particular patient. And then the other thing, which is also really interesting is I did genetic testing. I like to do genetic testing because it can really sort of, it's like lifting the hood on your car. It can sort of tell you what's going on below the scenes. And the thing about genetics of migraine is there's not really one migraine

gene. And we can test for these SNPs and variations, but this particular patient had a variation in the genetics, the polymorphisms of a G-coupled protein, which has to do with serotonin and stress resiliency. So this person's genetic makeup was such that he was more prone towards the effects of stress. It was a particular gene called HTR1A, which is on the testing that we do with a DNA mind test. And I found that really sort of interesting. Otherwise, the patient had good genes, like good detox genes, good COMT genes, etc., but had problems with stress and the patient's history was consistent with that that stress was one of the big triggers for that

particular patient so um you know you know stress management is huge for everything that we see in in patients who walk through the door i mean we're all everyone everybody is affected by stress you know we just you watch the news and you get stressed right that's why i don't have a television exactly and and so anything that we can do to help people to manage and modulate and detoxify the stress goes a long long way huge huge huge i think that's right but you know this case brings up something really important about functional medicine because you listed a whole litany of things it wasn't just magnesium wasn't just a gut it wasn't just histamine it wasn't just this and that it was a lot of different things exactly and and you know functional medicine is really about being a medical detective and looking for all the various factors because traditional

medicine is okay you have this one disease that you treat with one drug instead of saying oh where are all the imbalances in the system? Let me correct all those. Because if you correct two out of six, patient might get a little better, but not really. Right. You have to deal with all six. Exactly.

And I think that's really the beauty of functional medicine. We're not treating the disease, we're treating the patient and all their unique variations in their story. And there are no two people who are the same. So when someone comes with a migraine, it's a blank slate. then i have to figure out what kind of migraine and what are the various factors and is it hormonal is it magnesium is it the gut is it the mitochondria is it is it uh food additives and is it histamine and i'm and maybe all of them exactly right i hope you enjoyed today's episode one of the best ways you can support this podcast

is by leaving us a rating and review below. Until next time, thanks for tuning in. Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. 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

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