The Dr. Hyman Show - Is Your Metabolic Health Suffering? How to Identify Your Weak Metabolism, and How To Fix It

Episode Date: April 8, 2024

View the Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Often, when patients have high cholesterol or high blood pressure, the treatment focus is on statins or anti-hypertensive medications. However, these are just the symptoms of poor metabolic health, which requires a closer look at the root cause and a treatment model that reflects that. In this episode, Dr. Hyman speaks with Dr. Elizabeth Boham and Dr. George Papanicolaou about our lifestyle choices that affect our cholesterol levels, blood pressure, and waist circumference. This episode is brought to you by Rupa University, AG1, and Momentous. Rupa University is hosting FREE classes and bootcamps for healthcare providers who want to learn more about Functional Medicine testing. Sign up at RupaUniversity.com. Get your daily serving of vitamins, minerals, adaptogens, and more with AG1. Head to DrinkAG1.com/Hyman and get 10 FREE travel packs + FREE Welcome Kit with your first order. Head over to livemomentous.com/mark for 20% off creatine, collagen, and all of their best-in-class products.

Coming up on this episode of The Doctor's Pharmacy. But it's our belly fat, because when we get insulin resistant, we gain more weight around our belly, and we know that visceral fat, the apple shape, is more inflammatory. It secretes all these inflammatory markers and increases inflammation in the body.

Hey, it's Dr. Mark. It seems that every day, more and more patients come into my office bringing ever-increasing amounts of healthcare information with them. And I love it when this happens because it means more people are taking ownership of their own health, but it also means I have to stay on top of my game. So as a healthcare practitioner, how do you make sure that when a patient walks into your office and says, Hey,

I really want a Dutch complete and a GI map that you have the right answers and the tools. The answer is Rupert University. They are the number one educational Institute where over 20,000 practitioners a year learn about functional and specialty lab testing. Not only do they have absolutely free live classes hosted every week, but they bring in industry experts to teach in-depth six-week boot camps on all the most popular functional medicine tests and topics. If you want to up-level your knowledge of functional lab tests, make sure to visit rupainiversity.com. No matter your genetics or lifestyle choices, as humans, we all share the same basic needs like adequate nutrition, for example. But with the industrialization of agriculture and toxins in our environment, it's getting harder and harder

to get your body the nutrients it needs through food alone. And that's where AG1 comes in. AG1 is a foundational nutrition supplement that supports your body's universal needs like gut optimization, stress management, and immune support. Since 2010, AG1 has led the future of foundational nutrition, continuously refining their formula to create a smarter, better way to elevate your baseline health. I drink AG1 every morning and I consistently feel more energetic throughout the day. I even recommend it to all my family and friends because of the results I've seen personally. If you want to take ownership of your health, it starts with AG1. We have an exciting new offer for my listeners. Right now, AG1 is offering my audience a full year supply of their

vitamin D3 K2 liquid formula free with your first purchase. They're also going to give you five free travel packs as well. Just go to drinkag1.com forward slash hyman to get your free supply for a year of vitamin D3 and K2 and five free travel packs with your first purchase. Again, that's drinkag1.com forward slash Hyman. Hey everyone, Dr. Hyman here. Poor metabolic health driven by insulin resistance is the largest underlying cause of early death in the world, making it the canary in the coal mine, not just for type two diabetes, but a multitude of illnesses such as Alzheimer's, heart disease, cancer, obesity, and even some cases of infertility and depression. So how do we know if we're not metabolically healthy? There are three primary markers we look at to determine if we're metabolically

fit or not. Cholesterol, blood pressure, and waist circumference. In today's episode, we feature three conversations from the doctor's pharmacy about what functional medicine doctors look for to determine sound metabolic health and how to improve these markers. I talk with Dr. Elizabeth Boham about how lifestyle choices impact cholesterol numbers with Dr. George Papanikolaou about high blood pressure and why salt is not the cause. And finally, we feature Dr. Boham again, talking about the significance of belly fat and how to measure waist circumference. So please join us for these conversations with my great team from the Ultra Wellness Center. Let's jump right in. There's a lot of lifestyle that impacts the size of your LDL particles. Are they small and dense

and dangerous or are they big and fluffy and not so dangerous? There's always a genetic component, but then there's our lifestyle. And we know that that metabolic syndrome where people are insulin resistant, gaining weight around the belly, they typically have lower HDL. They typically have higher triglycerides, but they also typically have more of these small dense LDLs, which are more concerning. And so lifestyle makes a huge impact on the size of those LDL particles. And which part of your lifestyle? What's the biggest thing? The diet.

Your diet. What diet causes you to have the dangerous kind of cholesterol? Sad diet. The standard American diet, right? That's the one that's full of carbohydrates and sugar and refined and processed foods and lots of alcohol and simple sugars. It's the starch and sugar that drives it. And what does that do to the body that causes these particles? And it actually leads to the high triglycerides, the low HDL, the small particles. Right. It's that whole process of insulin resistance.

And it results in this really unhealthy pattern. We sometimes get clues of that with a standard lipid panel. We sometimes get clues when somebody has a low HDL, that's the one you want higher. And for men, you want it at least over 40. And for women, at least over 50. And then if that triglycerides are over- I'm like 50 and 60. I'm more aggressive than you.

Yeah. Well, that's really true. Like what's optimal, right? What's optimal, right? If your cholesterol's HDL is 40, probably not optimal. It should be over 50. It really should. You're right.

It's not optimal. I'm a tough customer here. And then the triglycerides, you want at least under 150. Or what would you say? What's optimal? 70. There you go for triglycerides. So if your triglycerides are over 100, you're definitely flirting with danger.

And there are, you know, there's some genetics involved. And we'll talk about the genetics in a minute. But it is usually a sign of increased carbohydrate load. And I don't mean broccoli. I mean like flour and sugar. Absolutely. You can get some sense of if somebody is prone to metabolic syndrome, insulin resistance with that.

But then the particle size testing also gives us a lot of information. The NMR, for example, gives you something called your insulin resistance score. So you can get a sense based on the analysis of the particles of cholesterol that you have, how at risk you are for insulin resistance. So it's just one more piece of the puzzle. And I see people with a cholesterol of 150 who have like 2000 particles of LDL, which should be under a thousand, who have like 900 particles of small LDL, which should be under a thousand, who have like 900 particles of small LDL, which should be under 300, ideally, probably less than 90 is perfect. And you see that often. And yet their doctor, well, your cholesterol is 150, it's fine. And so you really can get duped

by just looking at the total numbers. If it's 300, it might be fine. If it's 150, it might be highly dangerous to you. And it's not so easy without looking at the specific tests. So it's super important. And so what you mentioned is that insulin resistance is the driver of this, which is prediabetes, metabolic syndrome. And to some degree or another, 88% of Americans are metabolically unhealthy and have some degree of this. 50% have prediabetes or type 2 diabetes.

Like every other American has diabetes or prediabetes. That's crazy. 75% overweight. And every one of those people is some degree of poor metabolic health. So if this is true, what else does this diet do that accelerates heart disease? Because we now know that it's not just the cholesterol. Like I said, you could have cholesterol 300 and be fine. There's a special ingredient you need in order to cause the heart disease. What is that special ingredient? So it's inflammation and oxidative stress. Yeah.

So inflammation seems to cause everything these days, from depression to cancer to heart disease to diabetes to everything else. So what is the cause of the inflammation in these patients with insulin resistance? A lot of times, I mean, there's many things, right? But it's our belly fat. When we get insulin resistant, we gain more weight around our belly. And we know that the apple shape is more inflammatory. It secretes all these inflammatory markers and increases inflammation in the body. And so when we get that waist hip ratio better, that inflammation goes

down. So basically what you're saying is that fat around your belly is not just holding up your pants, that it's an immunologically active organ. It produces these molecules we call adipose cytokines. You've heard of the cytokine storm with COVID. Well, it's that same chronic cytokine storm that's being released from these fat cells in your belly. I mean, you have fat in your legs or your butt. It's not going to do that. These fat cells in your belly. I mean, you have fat in your legs or your butt. It's not going to do that. These fat cells in your belly are super inflammatory. So then you get the inflammation, which leads to oxidative stress, which then causes what problem with the cholesterol? Right.

So when your LDL cholesterol gets oxidized. What is that? Think of oxidative stress like excessive free radicals or rusting in the body. But we're always making free radicals in many different cellular processes in the body. But when there's too many of them or you don't have enough antioxidants to squelch those free radicals, so if your diet's not rich enough in the polyphenols or those phytonutrients or your vegetables, then what happens is you get more oxidative stress and that oxidative stress can shift. And it's that oxidized LDL that's more damaging and more likely to cause plaque buildup that will lead to heart disease.

So it's basically rancid cholesterol in your bloodstream. That's the problem that gets oxidized, which is like you said, rusting or apple turning brown or your skin wrinkling from too much sun. These are all signs of oxidative. But this happens inside of you and it leads to this inflammatory process, this oxidative stress, and that's what causes the heart disease. You know, some of the interesting studies I've seen, like the Jupiter study, very big trial from Harvard on heart disease.

It's fascinating to me that people had high LDL, but no inflammation, had very low risk. People had high inflammation, but kind of okay cholesterol, they were at risk. And those with high cholesterol and high inflammation had the most risk. So I think we have to be focused on inflammation, what's causing that. And it may be that the statin drugs, turns out, the benefits may not have a lot to do with cholesterol lowering. But they're anti-inflammatory. They're very powerful anti-inflammatory drugs, which is called a side effect. But it actually works.

Now, there's a lot of better ways to get rid of inflammation besides taking statin drugs. How do you decide from a functional medicine perspective, how to work these patients up to decide whether that should go on a drug or whether you just do lifestyle? How do you figure that out? It is a complex process, right? Where we're taking a really detailed history and we're looking at more than just those numbers. We're looking at what are their markers of oxidative stress? We can measure oxidized LDL. We can measure 8-hydroxydeoxyguanosine and lipid

peroxides. All of these biomarkers that give us a sense of, is there oxidative stress? And by the way, these kinds of tests are not things you'll typically get at your regular doctor. You know, at the Ultra Wellness Center here in Lenox, Massachusetts, we do functional medicine, which takes a deeper dive into the root causes, into these diagnostic tests, which are not available usually through your traditional doctor. They may not be interested in or know what to do or how to interpret even fasting insulin, which they don't even do. So we really are excited to help people figure out how to look at their risk and design a strategy that's

personalized for them using functional medicine. And we see people from all over the world at the Ultra Wellness Center doing like Zoom consults now. So it's pretty easy to get access. It's fascinating because there's so many pieces to the puzzle. And so when you find somebody with high oxidative stress, you ask that question, why? Why is there high oxidative stress? Is it their poor diet? Is it inflammation? Is it their microbiome? Is it their poor diet? Is it inflammation? Is it their microbiome? Is it a toxin? Heavy metals or some other solution? Yes. All this smoke, the wildfires in California, that increases risk of cardiovascular disease. Absolutely. It's really important to think about all the different things that can lead to oxidative stress and inflammation, and then try to tease out what is it for that

individual person that we need to focus on. So I think that's important for some people and a lot of Americans. There's so much that's lifestyle related, but for some people, their lifestyle is great and it's more toxin related that we really need to work on that. Or like you mentioned, the microbiome is an area that's fascinating. We're learning so much about how it influences inflammation in the body. Microbiome in your gut, as well as microbiome in your mouth, right? And gingivitis. We've known for years that that impacts risk of heart disease because of its inflammatory properties. So those are important things that we need to really investigate and look at.

Yeah, so true. You know, I'm just thinking about how we work with these patients. So we look at all these diagnostic tests that may not be looked at. We look at their overall cardiovascular risk, their family history. We may look at diagnostic tests. We may send them for a heart scan, look at calcium, product ultrasound, look at particle size, look at inflammation markers, oxidative stress markers, the microbiome, heavy metals. We might look at other factors like homocysteine, which looks at B vitamin status. We look at lipoprotein A and a bunch of other factors that give us a more rounded picture of what's going on. So we're not just focused like a laser on cholesterol. And the reason it seems to me that we are so hyper-focused on cholesterol is we have a good drug to treat it,

right? So it's all pharmaceutical driven, whereas when you look at the data, two-thirds of all people entering into an emergency room with a heart attack have either prediabetes or diabetes, and most of them are undiagnosed. Right. So when you say- So two-thirds of heart attacks are from sugar, not cholesterol issues. And we're just focusing on cholesterol. It seems like we're missing the mark here. We often are.

And when we're saying, okay, this is high. I mean, so many people come back with high on their lab work. And it doesn't necessarily, like you've said, mean it's anything to be concerned about. And then there's so many people who come back without that H, that high level, and they do need to be concerned. Statins have a role, but let's talk about the statins for a minute, because it's very controversial. Like any drug, there are benefits, there are risks, there are side effects, and there's the right patient for the job, right? So how do you come to sort of decide what you should do with a patient?

You really want to get a good detailed family history. There are some people who are at very high risk of vascular disease. And for people who have a strong family history, which means that if you have a first degree relative, which would be a parent or a sibling who has had an early heart attack. So for a man less than 55 or a woman

less than 65, that means they've had diagnosed heart disease because of plaque at an early age, you know, that those people who have that type of family history need to be more careful. Or were they smokers? Were they very overweight? Did they have diabetes? Like what are the other factors? So I always look at that as well because- You have to. I remember my grandfather, you know, everybody in his family, like I think he had nine siblings, everybody had heart attacks in their 50s. You know, they all had bypasses, heart attacks, and they weren't like significantly overweight, but they were pretty high risk as a family. And he was deaf. So he couldn't hear, he really couldn't get a job,

like a white collar job. So he had a blue collar job, which was basically loading big bundles of New York Times onto the trucks from the conveyor belt. So he was constantly working out all day long and was very, very strong and healthy. And every night he would go out in Queens and he would walk down the street and feed all the alley cats. So he walked every night after dinner, which we now know is a very good way to improve your health. He didn't really get heart disease until his 80s, right? And they all got it in their 50s. And his diet wasn't the best, right? But still, even with simple lifestyle things, it can make a big difference. So what are the consequences of high blood pressure? Why should we care if our blood

pressure is high? Because it's a silent killer, we call it. Yeah, that's the key. It's a silent killer. You don't know you have it. People won't know they have it. And what it causes, it's one of killer, we call it. Yeah, and that's the key. It's a silent killer. You don't know you have it. People won't know they have it. And what it causes, it's one of the leading causes of heart disease that's considered like heart attacks, congestive heart failure, arrhythmias, which is abnormal electrical activity in your heart that can lead to critical events. It's a big cause of all kinds of heart disease.

Yeah, heart disease. It causes end-stage renal disease. Kidney failure. Yep, kidney failure and stroke. Stroke creates a great deal of mortality and morbidity for adult population. Even blindness, right? Hypertensive. Microvascular disease and blindness.

It leads to dementia because of its effects on the vascular system in the brain. Yeah. And also affects things lower down, right? Yeah. Like sexual function. Oh, yeah. Right. Your blood vessels get problematic in your sexual organs.

You're not doing things normally. Microvascular disease in the penis can definitely result in rectal dysfunction, and that's not a good state. Nobody likes that. It also causes stiffening and hardening of your arteries, and you get vascular problems in your legs and blood flow issues. Peripheral artery disease is a major issue, and particularly if you have diabetes, then you have two things that you have to deal with, the diabetic changes that create the peripheral vascular disease and also the hypertension. And you can get literally blood flow issues. You need amputations. So this is a serious problem. Very serious. And a billion people have it. In America, a lot of people have it. Yeah. Right? Yeah. 50 to 75 million Americans. Absolutely. And growing.

And how many people are actually treated well? It's probably like 14 million out. Absolutely. And growing. And how many people are actually treated well? It's probably like 14 million out of those 50 to 75. Yeah. Treatment, as we talked about that, treatment is primarily medication. It's not always effective. It has lots of side effects. And there's so many other ways to treat hypertension besides just using pharmaceutical agents. Hey everyone, Dr. Mark here. Now I'm a big proponent of supplements because our food just isn't as nutritious as it once was. But how do you decide between all the different supplement brands out there? Which brands should you choose and who should you trust? And that's really the key, isn't it? Trust is everything when it comes to supplements. That's why I choose Momentous. Their products are developed in collaboration with leading experts like Dr. Andrew Huberman and Andy Galpin, and they're used by 90% of the teams in

the NFL, as well as nearly 200 pro and college locker rooms. Moreover, their unparalleled commitment to rigorous third-party testing and independent certification means you can be sure that what's on the label is what's in the product and absolutely nothing else. I take Momentous Collagen and Creatine Daily, two supplements that work together to repair and power the body. Momentous Collagen is a clinically researched formula that delivers 15 grams of collagen to support type 1, 2, and 3 collagen in the body. Momentous Creatine uses Creatine Monohydrate, the gold standard in creatine supplementation. Together, they help me keep my body well-oiled and running smoothly. So if you're like me and you want to take supplements that are made by and used by the best in the world, go to livemomentous.com forward slash

mark for 20% off creatine, collagen, and all their best-in-class products. That's livemomentous.com, L-I-V-E-M-O-M-E-N-T-O-U-S.com forward slash mark for 20% off. We have determined that by treating people's blood pressure with medications that people do reduce their risk of these complications. So it's important to understand that if you have high blood pressure, you need to treat it. Absolutely. And whether it's with the things we're going to talk about or medication, you can't let it go. And it's something you should do as a preventive strategy. You can go to the drugstore, they have blood pressure machines, you can stick your arm in,

or you can buy one for next to nothing in the drugstore, 29 bucks, and you can monitor your blood pressure. Now, part of the problem with diagnosing blood pressure is that it's often hard to know if you have high blood pressure because one, it fluctuates all day long. Two, just getting one blood pressure reading in the doctor's office may not really tell you what's going on. You might have white coat hypertension, meaning you get nervous and stressed. It goes up. I mean, when you exercise, your blood pressure goes up. When you're stressed, your blood pressure goes up. Well, what's your average blood pressure? So one of the diagnostics we do is a 24-hour blood pressure test, which I found really effective because you can see what's happening when they're sleeping, when they're

active, when they're inactive, and you get a really good sense of what their pattern is day, night, and average. And that'll tell you what your real risks are. So doing 24-hour ambulatory monitoring is something that is really important to do, particularly if you have any concern that the readings you're getting in your office are inappropriate. And you mentioned white coat hypertension, and that is not uncommon. It actually is fairly common. And so we'll oftentimes recommend ambulatory blood pressure readings. And that gives us the clearest picture possible. Yeah, it's true. And sometimes you can just get a cuff at home and have people monitor the blood pressure up a day, and that'll help too. I want to just dig into a little bit before we get talking about the

difference with functional medicine and traditional medicine, right? Traditional medicine is you check your blood pressure, it's high, you get medication, you monitor it. We call it essential hypertension. Now, there are other causes of hypertension that we know of that are kidney diseases and other problems. But for the most part, people call it essential hypertension, which I joke and I say it means essentially we have no idea what's causing it. But we know that's not true. We know that's not true. So everything has a cause. Nothing is just random. If you have diabetes, it's not a random event. It's not like, oh, I got a virus. Something happened. Now, we know some of the major causes of high blood pressure are never addressed. And the two biggest ones that I see treating patients is insulin resistance and sleep apnea.

So one of the biggest factors is insulin resistance, which is an epidemic in this country. We have one in two Americans that have prediabetes or type 2 diabetes, 75% are overweight, 42% are obese, and they all have some degree of trouble regulating their blood sugar, which just causes them to get belly fat. And that belly fat is such a big factor in driving all sorts of diseases, everything from high blood pressure to cancer to heart disease to to diabetes, to dementia, to depression, and so on. But the insulin resistance drives inflammation. And it drives inflammation throughout the body because those belly fat cells aren't just sitting there holding up your pants.

They're dynamic hormonal and immune organs. Your belly fat is an immune organ and it drives inflammation throughout your body that causes oxidative stress, which is really what causes rusting. So it's like your arteries and your pipes are rusting and stiffening called hardening the arteries. And that happens as a result of this inflammation and oxidative stress. And so insulin resistance is probably the biggest cause of that today in America. And it's really driven by diet. So I think people don't understand how powerful

that is. Diet is very powerful. And you mentioned the adiposity we have around our waist. I call it toxic waist dump of the body. That fat just does have a metabolic effect that is toxic to the body. And as you said, it creates the hardening of the arteries, which is one important cause of high blood pressure. The other big thing is often misdiagnosed. And by the way, insulin resistance affects so many people. 90% are not diagnosed. Absolutely. So the way you diagnose it is you do a test for insulin and blood sugar.

And it's a fasting glucose tolerance test that I do on almost every patient. Yeah. And this is the other test. It's a little more advanced where you take a sugar drink, basically drink the equivalent of two Cokes, check your blood sugar and insulin fasting, and then every one in two hours after. But most doctors just check blood sugar, but that's a very late fight. You want to check insulin early on. Yeah. And even doing a fasting insulin isn't going to give you an answer. It'll help. Yeah. But by the time your insulin goes up, fasting,

it's already down the road pretty far. Right? So I agree. And then we have this other issue, which is sleep apnea, which is so underdiagnosed. Yeah. So sleep apnea, there are about 25 million Americans that have sleep apnea. It is underdiagnosed. It's not just a disease of people that are overweight, but you also can have upper respiratory anatomy and muscular relaxation that even if you're thin, you can have obstructive sleep apnea. Yeah. You have a narrow palate, small airway, you have sinus issues. And when you have sleep apnea, that means you're just not getting enough oxygen to your body, particularly your brain, also to all your blood vessels and your cortisol levels rise. And then

you get into that whole cycle you talked about before, which is an inflammatory cycle, which is an oxidative stress cycle, which can lead to hardening of the arteries. And when you're not getting oxygen to those blood vessels, then they actually can't perform the work they need to do and create the energy they need to have.

And so they can't contract and expand the way they should. And that can result in high blood pressure. It also drives insulin resistance. So if you have sleep apnea, it also causes you to be pre-diabetic. Weight gain, yeah, it causes weight gain. Independent of what you're eating, weight gain. It causes weight gain, it leads to insulin resistance, it leads to diabetes, which complicates

everything. I mean, I had this guy who couldn't lose 50 pounds. He was a lawyer, and he said, look, I need to lose some weight. I don't know what to do. I'm trying to eat right. It's not working. I'm trying to exercise. I said, what's your life like?

He said, well, I'm a lawyer, and I work really hard, but every day I have to stand up at my desk. I can't sit down. And this was before standing desk. Right. And I'm like, why? He says, well, if I sit down, I fall asleep. Right. And I'm like, gee, maybe you have sleep apnea. So if you're falling asleep at work, if you're falling asleep in front of the TV, if you feel tired during the day, if your wife says you're snoring, now there's apps you can get that actually record your snoring. So you can see because people don't believe it. Oh, I don't snore. I love that app, by the way. It's one called Sleep Cycle that I like.

It's recording your snoring. And it's something that is easy to treat. There's different methods. Sleep happens. But it is a treatable condition. And the weight loss then will happen and you'll feel better. So that's really important. I just want to talk about a few other causes

that I think are really important and worth noting, because those are the two biggest ones, but there's a lot of other ones. People who are nutritionally deficient in certain things can cause high blood pressure, like magnesium. Right. Studies show that a very large percentage

of people in our country have low magnesium. 45% of people have low magnesium, which is- And you know, magnesium, it's not magic, but when we replace magnesium in patients, we see amazing things happen. We see blood pressure come down. We see them being able to sleep better. We see muscle twitching and cramping go away. We see mood improve. Magnesium has a very important role in the body and certainly plays a big role in lowering blood pressure. Yeah, but I call it the relaxation mineral. It's funny how in medicine we have these blind spots, but when I was training in obstetrics and gynecology, I was a family doctor. I deliver

lots of babies. There's this common condition that women get called preeclampsia, which is high blood pressure in pregnancy. And when they come in and their blood pressure's high, which can cause seizures, the treatment isn't high blood pressure pills because they don't tend to work. We give them intravenous magnesium to relax their blood vessels and save their life. So we sort of, and it's just a strange thing to me.

We don't think about it that way. The other thing that is important is omega-3 fats and fish oil because it helps relax your blood vessels, make them more pliable. But there's other causes that we also see. For example, environmental toxins, heavy metals in particular, lead and mercury are really common. They're underdiagnosed. And when you go on your high blood pressure visit, your doctor's not checking your mercury and lead levels, not even your blood and probably not on the most important tests, which we do with the Ultra Wellness Center,

which is a challenge test where we give people a drug to pull out the metals, the key later, and then we check their urine and see how much dumps in there. And if they have high levels, that's often a big factor as well. And I think you're really hitting on all the things that I think about. And I tell people when they come to me and hypertension is part of what they want me to work with. I said, we're going to get your hypertension better by not treating your hypertension. We're not going to treat your hypertension. We're going to treat everything else that's causing your hypertension. We're going to find the sleep apnea. We're going to find the nutritional deficiencies. We're going to work on your stress levels. We're going to help you lose weight. When you lose

weight, I mean, you actually are going to drop your blood pressure. I think the number is per pound. I think for every two pounds you lose, you drop your blood pressure by a millimeter mercury. So if you lose 20 pounds, you can drop your blood pressure by close to 10. So diet is so key. You know, we create a program called the 10 day reset, which you can find and get pharmacy.com. We put a thousand people through it, track their blood pressures. It was incredible. Their blood pressures dropped an average of 20 points in 10 days. Well, if you think about it,

if you think about that, most Americans are at least 25 pounds overweight or, you know, so let's say it's better than medication results. Exactly. You, if you get them to drop that 25 pounds, they're going to drop the blood pressure by near 15 millimeters of mercury. Yeah. We have insulin resistance, sleep apnea, low magnesium, low omega-3 fats, which about 90% of Americans have. You have heavy metals, environmental toxins. And we now are learning that the gut microbiota, the microbiome in the gut, if it's altered through our bad processed diet and all the nasty drugs we take, it actually causes

inflammation throughout the body that drives high blood pressure. Anything that causes inflammation or oxidative stress will cause high blood pressure. And the thing that struck me as I, and this is stuff that's in the traditional medical literature, is that high blood pressure is an inflammatory disease. And we treat it like a plumbing problem. We do. Going back to the nutritional piece, a little potassium can be another reason why you can have high blood pressure. And that speaks to where do you get potassium? You get it from green leafy vegetables. So having a vegetable-based diet is very, very important. I love my green smoothie in the morning. Absolutely. Yeah. More kale.

So this is very important. I think people also think about salt. So people think high blood pressure is salt, but what's the deal with salt and high blood pressure? Is it something we should worry about? Is it as big a deal as we thought? It's not something everybody needs to worry about. There are certain populations that are going to be more salt sensitive than others. And so we can actually do genetic tests and we do them here at the Ultralama Center that lets us know if you have those genes that make you more sensitive to salt, more likely to have high blood pressure. So we do need to be concerned about it in certain populations and limit it. Salt actually, it's the salt we add to our food that is the problem because it's processed. All the natural nutrients are taken out of it. It can be iodized and iodine

can cause problems. So- Well, it's not the salt that we personally add in our kitchen. It's the salt that's added in factories to process food. Yeah, exactly. It allows huge amounts of intake of salt because how do they make junk ingredients taste edible? Salt, fat, sugar. Yeah, and sugar and processed fats, right? Yeah, so we know that. But if you get really good salt, sea salt that you've purchased, that actually has nutrients in it, that can be valuable to you. Minerals and so forth. Yeah, exactly. So these are some of the

common causes we see, and they're often things that aren't looked at. When you go to your doctor with a high blood pressure, they're not checking your heavy metals, they're not checking your insulin resistance, they're not checking necessarily sleep apnea, although some might be thinking of that as just good medicine. You know, it's interesting. They're not checking your magnesium or anything. And the reality is, is that when I was practicing private medicine before I started functional medicine years ago, I was being graded on if I had a high blood pressure patient, if I had them on certain medications to lower the blood pressure. So my reimbursement was based on whether or not I was using medication, not whether or not I was finding the root cause

of the problem, not whether or not I was helping somebody lose weight, not whether I was counseling them on how to lower their stress with meditation. That didn't drive it. And so in contrast to what we do in functional medicine, we focus on making those changes that really get to the root of the problems and the causes we just talked about. Talk about this fat, particularly, we call it VAT or visceral adipose tissue or belly fat or organ fat or whatever you want to call it, but it's fat around your organs, your liver, your kidneys, your intestines. It's in that organ compartment. What's it doing that's different than regular fat? I was also so blown away when that study came out all those years ago. And I use that example for patients all the time. Like we can't just

liposuction this away and your blood pressure is not going to come down. Like you think, oh, if I can just liposuction it away, then my diabetes will go away. But it doesn't work like that, right? Because you're not getting to that deep adiposity and that deep belly fat. And that deep belly fat is really inflammatory. What we realized is that deep belly fat. And that deep belly fat is really inflammatory. What we realized is that deep belly fat produces all sorts of inflammatory markers, interleukin-6 and tumor necrosis factor. So it actually results in increased inflammation in the body. And it is associated with increased insulin resistance. And that high level of insulin and the high level of inflammation are really drivers for all of these processes to get out

of whack in the body, for the cholesterol to get out of whack, for your inflammation in your arteries to get out of whack, for cancer to like to grow. And so it's that deep fat that's absolutely. And that deep fat is not just hanging out. It is metabolically active, as we've talked about before. And if you always like to talk about it, it's metabolically active. It's not just sort of sitting there. It's really doing a lot. Not just holding up your pants?

It's an endocrine organ that's doing it. No, right? It's actually doing things. And it's producing all these chemicals and hormones, and it's increasing the inflammation in your body. And so if there's one thing that people can focus on, like if you're, you know, you kind of, sometimes people get overwhelmed with all these messages in health, right? Like, oh my goodness, what do I do? What diet do I follow? What should I work on? Where do I focus? And sometimes people

get overwhelmed and they almost give up. We see that all the time. And this is like the basic thing that everybody can focus on. You know, I, even for myself, I do a lot of these self-care things, right? I try to all the time, right? But, you know, this is an area that we can all focus on that can improve our health. If we just pay attention to what's our waist circumference and what's our waist to hip ratio, because that's telling us how much belly fat we have. I think that's right. I often joke and say there's a simple test you can do

to figure out if you have this problem. It's called the mirror test. You take off your shirt, you look in the mirror, you jump up and down. If your stomach jiggles, you probably have it. And the truth is 88% of Americans have it. It's our metabolic unhealthy. That's because they have this visceral fat. It's making them unhealthy and causing all these other problems that we see as separate, right? Oh, I have high blood pressure. Oh, I have high cholesterol. Oh, I have high blood sugar.

But they're all the same problem. Or I have low sex drive or low testosterone, or I have pimples and poor periods and sleep apnea and whatever the things are that we're suffering from, we see them as all separate, but they're all connected by this. And with COVID now, the vulnerability of this population with visceral fat has just been highlighted. 63% of hospitalizations could have been prevented if people had better metabolic health and ate better food. So we're going to talk to him about what causes it and how we start to diagnose it. What are the ways we can diagnose it properly?

You mentioned the waist to hip ratio. That's a simple test. Tell us about that. And then let's talk about some of the blood tests that you see that may seem like other stuff, but are clues to you having bigger belly fat. The waist to hip ratio is a great measurement that we can all do and repeat on our own. So what you do is you get your waist circumference and to find the right place for your waist circumference, it's in between your lowest rib and you find your upper

hip bone and then you put the tape measure in between and that's considered your waist circumference. It's like your belly button pretty much, right? Yeah. You know, and that's considered your waist circumference. And then your hip circumference. Yeah. You know, some people's belly button hangs down or is in a different place. So it's, it's not always the belly button, but it's, it is around that area. Yeah. And then their hip circumference is considered over the greater trochanter. But if you don't know where that is, I always say to people go over the largest part of your hip because that just makes your number look better. So you want to, you know, get the biggest hips circumference as you can have. Not that you want to, you know, you want to be way overweight, but it's, you pick the biggest hips circumference to determine your

waist hip ratio. If you can't figure out where that greater trochanter is. The goal for Caucasians is to have a waist circumference less than 35 inches for women and less than 40 inches for men. For Asian and Indian ethnicities, it's stricter, less than 31 inches for women and less than 37 inches for men. And that waist to hip ratio is a great measurement to do. So for women, you want to be less than 0.8. And for men, less than 0.9 is the waist-hip ratio you want to have. So you want a smaller waist than hip, of course. And the neat thing, this is a really simple test you can do and something you can check every month. You can redo your waist-hip ratio every month and watch your progress and say, okay, what

am I doing? What do I need to do? And it's a really inexpensive way to figure out, is this a problem for me? That's really huge. And I think it's also important what you said. People of Indian or Asian descent can have significant visceral fat and all the complications from it at much lower weights. If you look at their weight,

weight might be perfect. It might be less than 25, 23 in their body mass index, which 25 or more is overweight, but they may be full of this visceral fat and they can be diabetic. They can be thin and they look thin. We'll call them skinny fat. So they have the same issues as someone who is overweight, but they're just over fat. Yes. Or toffee, right? Thin on the outside, fat on the inside. So if you are a smaller person, then that's where also that waist to hip ratio can be really helpful. And you're right. No test is ever perfect. So for some people, the waist circumference or the waist to hip ratio isn't giving us all of the information. There's a lot of other biomarkers that of course, tell us that somebody has too much visceral adiposity,

that somebody is carrying too much weight around the belly. If we see a high C-reactive protein or marker for inflammation, it makes us wonder, okay, do they have metabolic syndrome, insulin resistance, visceral adiposity? If we see that fasting insulin greater than five, that's when we say, okay, this is something we have to pay attention to. If we see too many small dense LDL cholesterol particles, we've spoken about that before. That's a sign that somebody has insulin resistance or visceral adiposity. We also check for things like oxidative stress, too many free radicals being produced, that's a sign. If their liver function tests are high, or they have signs of fatty liver, that can also be because of

this visceral adiposity or gout, high uric acid, that can also be because of this, or that pattern in cholesterol, the high triglycerides, low HDL, all of these things give us information and say, okay, this person is struggling with metabolic syndrome, insulin resistance, or probably because of visceral adiposity. And you often notice all these things abnormal at the same time, right? So you see a pattern and it's really pretty easy to diagnose when you know what to look for. So you get inflammation, you get abnormal cholesterol, you get high blood sugar, high insulin, lots of oxidative stress, your liver. These are all things that seemingly are treated like separate problems, but they're all connected to this visceral fat.

And what's amazing is to watch them improve when we make shifts or changes in somebody's lifestyle. There's lots of things that can contribute to this from toxins in the environment to shifts in the microbiome to poor diet, you know, having a nutrient poor diet, eating too many refined carbohydrates and simple sugars, not getting enough exercise, poor diet, having a nutrient-poor diet, eating too many refined carbohydrates and simple sugars, not getting enough exercise, poor sleep, too much stress can all contribute to it. But when we shift somebody's lifestyle and when we make shifts in these issues that they're dealing with, we see these markers, these biomarkers improve significantly. So it's really fun to watch. We see it improve all the time.

So I'm going to get into the causes a little more deeply in a minute, but there is another test that we often do, which I like a lot. And it's sort of the gold standard. It's called the DEXA body composition test. And it's like a x-ray, a very low dose x-ray. I mean, you have to basically take 50 of these to equal one flight across the country from New York to California in terms of radiation. And it measures the compartments of your body, your arms, your legs, your belly, and can tell you what the fat is, where it is. And it's pretty compelling. There's also MRI technology that does this, CT technology, liver fat measurements.

So there's a lot of ways to look at this, but it is really the central problem of our time. And there are many causes, but the major cause is our ultra processed high starch sugar diet. That's the biggest cause because that drives insulin and insulin drives all the available fuel that you've eaten into your fat cells in your belly. And then it keeps the fat there, prevents this breakdown process called lipolysis of your fat. And it produces all these inflammatory compounds and it screws up your hormones and it makes you hungry all the time. And it slows your metabolism. So it's the worst possible thing. And it's really driven predominantly

by that. So we know that a high carbohydrate in the sense of starch and sugar diet, because, you know, vegetables are carbohydrates, so you can eat as much of those you want, is the biggest driver of this. But there are other causes, and you mentioned a few of them. So let's kind of go through some of the unusual things that might be driving this, whether it's microbiome, toxins, and other things that drive inflammation. Just in the terms of the most common cause, right? I get so concerned when I see a young child, maybe like eight or nine, and their parents are buying them a muffin and a sugary coffee drink or sugary beverage for breakfast. And I'm like, oh no, it's just a setup. It's a

setup for them to have problems for their whole life. And I think that it's important that people take care of those basics, like you mentioned. Sometimes people are doing, or they feel like they're doing everything right. And there's hidden reasons for why they start to develop visceral adiposity and that belly fat when they're really doing a lot of things correctly. And one of the things that I find that people don't realize is what happens when they start to lose lean muscle mass as they get older, we might be exercising a good amount every day. But if we're not working really hard to maintain that good lean muscle mass, what happens after the age of 25 is we slowly lose lean muscle mass. And then it's just so much easier for the body to put on excessive fat. And we know that having good lean muscle mass and exercising really keeps our insulin sensitive.

And so that's one thing that slowly catches up with people and they become more insulin resistant over time. And you mentioned toxins, you know, unfortunately there's been multiple toxins associated with this visceral adiposity. So I want to underscore what you just said. I want to underscore what you just said, because you basically said something really important around muscle loss when you get older and muscle loss could be a thought of as replacing muscle with fat. So you could be the same weight at 65 than you are at 25, but be twice as fat. And that fat in your muscles, not just in your belly, is also this poor metabolic fat. And it leads to this increasing

phenomena with all the consequences that we see of disease. So I feel like this is a really important thing that people understand. So exercise, basically strength training, building muscle and aerobic exercise, even interval training will help improve metabolic function and help keep this insulin resistance at bay as we age, because it is something that affects almost everybody as you age, unless you do something actively about it. So let's talk about toxins. You do, You do have to work really hard at it. I mean, it's so much easier when you're younger to maintain your lean muscle mass. And as you get older, it's really work. And people are like, I do go for a walk every day. And I'm like, it's not enough for you right now. And getting in two days a week where you really

are working on resistance type exercise, there's so many ways you can do that. That really can make a big difference. So toxins, BPA is a toxin that's been unfortunately associated with visceral adiposity, fatty liver, metabolic syndrome, and BPA, bisphenol A is that hard plastic that is pervasive, unfortunately, in our environment and has been associated with breast cancer, but it's also been associated with insulin resistance. So I think it's important that we recognize that there are a lot of toxins out there that are impacting our insulin sensitivity and possibly through how it damages our mitochondria. And there is more to it sometimes than just our food intake. And we always really have to dig and look for that when we're working with our patients.

For sure. We call these things obesogens. You know, they're petrochemical toxins. They're even heavy metals I've seen. So we really have to be alert to people are not losing weight and they're not successful doing the basics. Stuff of diet and lifestyle change. What else is there?

And there are other things like the microbiome. So maybe you can share a little bit about that and what we're learning. Oh, the microbiome, I think is so fascinating, right? I mean, there's going to be so much more that we're going to learn over time. And I don't think we have it obviously all figured out, but we know that there's certain bacteria in our digestive system that are associated with less inflammation and a healthier weight. And there's certain bacteria in our digestive system that are associated with more inflammation in the body and having an easier time with weight gain. It's fascinating the association between the microbiome and this whole process of insulin

resistance. And so when somebody comes in, and we're trying to figure out what's going on with them, we want to work on all angles here. And, you know, we want to ask those questions of what's going on in your digestive system, and how are your bowel movements? And how do you feel after you eat? And are there foods that you're not tolerating? Because we can work to manipulate that to help improve somebody's metabolism. And also, you know, anything that causes inflammation, right, could cause weight gain. So people might be having food sensitivities that are causing it, or they're exposed to mold in their environment, or they have latent infections. Because anytime there's inflammation, it drives insulin resistance independent of the cause. So the biggest cause is sugar and starch.

Those are the two biggest things that are driving inflammation. But there are a lot of other things that people need to think about that also do it. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at DrMarkHyman. And we'll see you next time on The Doctor's Pharmacy.

I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free Mark's Picks newsletter at drhyman.com forward slash Mark's Picks. I promise I'll only email you once a week on Fridays and I'll never share your email address or send you anything else besides my recommendations. These are the things that have helped me on my health journey, and I hope they'll help you too. Again, that's drhyman.com forward slash Mark's Picks. Thank you again, and we'll see you next time on The Doctor's Pharmacy. This podcast is separate from my clinical practice at the Health and Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the Chief

Medical Officer. This podcast represents my opinions and my guests' opinions, and my work at Cleveland Clinic and Function Health, where I'm the Chief Medical Officer. This podcast represents my opinions and my guests' opinions, and neither myself nor the podcast endorses the views or statements of my guests. 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 your help in your journey,

seek out a qualified medical practitioner. You can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com. If you're looking for a functional medicine practitioner near you, you can visit ifm.org and search find a practitioner database. It's important that you have someone in your corner

who is trained, who's a licensed healthcare practitioner and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public. In keeping with that theme, I'd like to express gratitude to the sponsors that made today's podcast possible.