The Dr. Hyman Show - Struggling with Magnesium Deficiency? Here’s How to Fix It

Episode Date: October 21, 2024

80% of us aren’t getting enough magnesium—and this impacts everything from migraines to muscle cramps, blood pressure, and even stress levels. On this episode of “The Doctor’s Farmacy,” I share insights from top experts like Dr. Todd LePine, Dr. George Papanicolaou, and Dr. Elizabeth Boham on how magnesium impacts your overall well-being. Learn why standard tests often miss a magnesium deficiency, how to get tested properly, and which foods and supplements can help you restore your levels. Don’t ignore this crucial mineral—your health depends on it. View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Full-length episodes of these interviews can be found here: How Magnesium Deficiency Impacts Your Health | Know Your Numbers The Functional Medicine Approach To Ending Migraines Treating The Underlying Causes Of High Blood Pressure with Dr. George Papanicolaou Supplements: Useful Or Useless? with Dr. Elizabeth Boham This episode is brought to you by Rupa Health and Big Bold Health. Streamline your lab orders with Rupa Health. Access more than 3,500 specialty lab tests and register for a FREE live demo at RupaHealth.com. Big Bold Health is offering my listeners 30% off their first order of HTB Rejuvenate Superfood. Head to Bigboldhealth.com and use code DrHyman30.

Coming up on this episode of The Doctor's Pharmacy. The American Academy of Neurology gives magnesium a level B rating as probably effective for the prevention and treatment of migraines. So often when someone comes in with a migraine to the emergency room, I would give them intravenous magnesium because it relaxes all that spasming blood vessels in their head and helps them relax. Hey everyone, it's Dr. Mark. As a functional medicine professional, I'm always on the lookout for innovative solutions

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Before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for a summary of my favorite and tested products. Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework

to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just trump right in. Why is it a problem?

Well, about 20% of the population is living with overt magnesium deficiency. This is full-blown magnesium deficiency. and that's like one in five people. That's a lot of people. Subclinical or insufficiency, not true deficiency, which you see on a lab test, but insufficiency can affect up to 80% of the population. Now, why is this important? Well, unlike drugs, which work with one pathway and one particular reaction in the body, magnesium and most vitamins and minerals, by the way, work on hundreds and hundreds of different pathways. And magnesium is involved in over 600 enzymatic reactions in your body.

Now, enzymes help convert one molecule to another, critical for everything. And it basically influences every single one of our biological systems, which is why it can cause symptoms all over the place, from your brain to your heart, to your gut and constipation, to menstrual issues and cramps and muscles. I mean, it's literally everything. And in low levels or suboptimal levels impact every area of our health, increase our risk for chronic disease. So it's not just kind of annoying symptoms like muscle cramps. It puts you at big risk for serious illnesses. Now, it really probably should be considered a public health crisis, but most physicians don't test for it. It's not on your regular blood panel you get every year. If they do agree to test for it, they'll likely run what we'll call a serum magnesium test. That's what I learned in medical school. But it's not really the indicator of

what's happening in your body. It's like this joke I often tell when I'm giving lectures. This guy dropped his keys on the street and his friend comes over and sees him looking under this lamppost. He goes, well, why, what are you looking for? What are you doing? He says, well, I'm looking for my keys. He said, where'd you drop them? He said, well, I dropped them down the street. But he said, why are you looking over here? He says, well, the light's better here under the lamppost. So that's how medicine is. It's easy to test serum magnesium, but it's not the right way to find out if you're low or not. I mean, if it's low on serum magnesium, you're really, really low. By the time it gets low, you're in trouble. Now, in a perfect world, I'd have the chance to see millions of patients, but the truth is I'm just one doctor. Over 30 years of seeing

millions of biomarkers in tens of thousands of patients, I've come to understand that much is being missed by conventional healthcare. We often wait until we have symptoms or diseases, then we get tested, but the transition from wellness to illness can often be detected decades before any symptom or diagnosis. I want people to have access to their own health data and the ability to engage in self-care and lifestyle practices that I believe can optimize their health and reverse the trajectory of chronic diseases that now affect six in 10 Americans and accounts for over $4 trillion in healthcare costs. And that is why I recently co-founded Function Health, where I'm the in healthcare costs. And that is why I recently

co-founded Function Health, where I'm the chief medical officer. Function is a revolutionary way to understand and manage your health through lab testing that you are often not getting through your healthcare system. All the results are delivered in an easy-to-use dashboard that tracks your numbers over time and gives you actionable insights for every biomarker. The best test, which is really not practical, is something called a magnesium loading test, which is a 24-hour urine test. And you basically give people magnesium IV, and then you collect their urine for 24 hours, and you see what spills out. And if they don't spill anything, it means they're low in magnesium. If they spill out a lot, it means their body's good, and they can get rid of what they don't

need. The next best test, and what we do we do with function health is called the red blood cell magnesium level. Now, this is not as good as the magnesium loading test, but it's pretty good. And it gives you a sense if you're insufficient or low. And people should be over five. And often we see levels much lower than that. Okay. So what does magnesium do? Why should you care? As I mentioned, I call it the relaxation mineral. I think about Epsom salt, right? right that's magnesium sulfate you soak in a hot bath your muscles get relaxed you don't have soreness it just basically relaxes everything and again it controls over 600 different enzyme reactions it helps in the production of atp which is the thing that makes you move and grow and do everything you do it's basically the energy of life um and it's it's really the key to making

energy in the body uh and and often when you see low magnesium, and I've had this before, it can be something that's found in chronic fatigue syndrome, fibromyalgia. Often if you have insulin sensitivity issues, in other words, you're insulin resistant and your blood sugar is not good, it could be low magnesium. And magnesium is very much involved in blood sugar regulation. Also, it's involved in regulation of vitamin D in the body, the activation and transport of vitamin D. It's important not just for muscle health and contraction and relaxation of muscles, but also bone strength and bone density. It's also critical in making hormones such as testosterone, progesterone, estrogen is important in the sense

of neurotransmitters in your brain. It's involved in calming and relaxation and inhibits the release of what we call excitatory neurotransmitters. It's also involved in DNA repair. It's involved in fluid and electrolyte balance, right, with calcium, sodium, potassium, and hydration, which is why it's often an electrolyte. So it's really important for electrolyte replacement. It's critical for heart, right? I mean, having a healthy heartbeat, blood pressure, high blood pressure is basically tightness of the arteries and the blood vessels,

and so magnesium is used in relaxation. We actually, when we have patients with really severe diseases, this was so interesting. When I trained as a doctor, it was kind of a last resort drug, right? It's a mineral, but it was a drug that we used when things didn't work or nothing else worked, for example. So if you're in every ICU, in every cardiac unit, in every emergency room, it's on the crash cart, which is basically what we use when we resuscitate a person who basically has their heart stopped and stopped breathing.

And when none of the drugs work, the last thing we give to stop a cardiac arrhythmia, which is the rapid beating of the heart that can kill you, we use intravenous magnesium. We use it to treat preterm labor. If someone comes in in early labor, we give themous magnesium. We use it to treat preterm labor. If someone comes in in early labor, we give them IV magnesium. If someone has high blood pressure in pregnancy, called preeclampsia, and that causes seizures, we give them intravenous magnesium,

and we only use it when everything else has failed, but it shouldn't really be like that. We also use it for bowel prep. If you're constipated, it's basically one of the best treatments, milk and magnesium, you heard of that. And it also is used to prep for colonoscopies, such as magnesium citrate, which makes you really go. So it's used in everything in the body. We use it in medicine a lot. It's just kind of one of those

things that doctors don't really think about as a problem for people when they come in with all these symptoms. So the question is, why are we deficient, right? Well, 75% of Americans aren't eating enough magnesium in their diet. Where does it come from? Dark greens, beans, right? Well, 75% of Americans aren't eating enough magnesium in their diet. Where does it come from? Dark greens, beans, nuts, seeds, seaweed. People don't eat that. You know, it's declining soil quality. It's resulted in almost a 50% decline in magnesium in fruits and vegetables over the last 50 years.

There's been a dramatic decline. So I think it's really concerning. Also, you know, about 25% of kids are magnesium deficient, which is very concerning to me too, because it's critical for their bodies and to grow. Another thing is ultra-processed foods deplete magnesium. So 60% of our diet is ultra-processed food. 67% of kids' diets, food processing reduces magnesium in the food by up to 80%. Also, if we eat a lot of high starch and sugar foods, which is our standard American diet or SAD diet,

those foods deplete magnesium. So the more sugar you eat, the more starch you eat, the more you lose magnesium. It increases the rate of excretion of magnesium, and that's not good. So you eat sugar and starch, pee out magnesium. Also, the recommended levels are to prevent deficiency diseases.

The RDA, we call the RDA, is about 300 to 420 milligrams. It's just too low. It's said to prevent deficiencies, but it's not really about optimal health. And about half the population doesn't even get the minimum amount you need to prevent deficiency. And globally, it's a huge problem as well. In a study of healthy university students in Brazil, they consumed an average of about 215 milligrams of magnesium and 42% have low levels in healthy, quote, healthy college students. Also, there's a number of groups that are higher risk for magnesium deficiency. So if you're in one of these groups,

you got to pay attention. If you're pre-diabetic or diabetic, if you're low in magnesium, it increases the risk of various things like eye damage or retinopathy, neuropathy, nerve damage, kidney disease, and blood vessel disease. It's really critical in regulating our blood sugar. For women, it's involved in estrogen regulation, metabolism, detoxification, and deficiency is present in about 80% of pregnant women and 55% of women with hormone-related issues. Think about that. You know, I mean, if you're pregnant and 80% of women are deficient, it's one of the biggest causes of preterm labor is low magnesium level. So if you have low preterm labor or you have high blood pressure in pregnancy, like I said

before, we treat you with intravenous magnesium. So why not take magnesium? Also, you can get constipated when you're pregnant too. So it helps with all that. 84% of postmenopausal women with osteoporosis had low magnesium. So this is just a rampant problem. As you get older, you're not so good at absorbing things. It's another group that has a risk. So you don't absorb it. You excrete more magnesium. If you have certain age-related diseases that cause low magnesium, certain medications we'll talk about in a minute can lower magnesium levels and make

you pee out magnesium, often things that are used to treat high blood pressure like diuretics. If you look at hospitalized patients, 65% of people who are critically ill who are admitted to the ICU or intensive care unit were magnesium deficient. And with COVID-19, we saw also those who had the highest magnesium intake had the lowest levels of inflammation and had 70% lower odds of developing severe symptoms. So just taking magnesium can reduce the inflammation if you get COVID and reduce your risk of having severe COVID by 70%. That's amazing. And this is completely safe. Unless you have kidney failure, it's an incredibly safe mineral to take. Now, the other thing you should know is most doctors don't think about it

unless you're in an extreme situation like we talked about, whether you have preterm labor and arrhythmia or having seizures from pregnancy or high blood pressure in pregnancy. We just don't think about it. But we should. And again, as I mentioned, if it's tested, it usually is a serum magnesium, which doesn't reflect whole body. It's only about 1% of the magnesium in your body. 99% is in your tissues, your bone, muscle. The body has really tight regulation methods for magnesium and it pulls from the reservoirs in your bone or muscle if you need to keep levels stable. So if your whole body is depleted, it's going to be hard to replenish. And normal serum magnesium levels are about 1.8 to 2.3,

but I think anything under two is linked to increased health risks and optimal levels should be over two. So if you're getting a serum magnesium, it should be over two, but I don't like that. I like the red blood cell magnesium. So functional medicine looks at this a little bit differently. We look at comprehensive testing, look at what's going on with all their biomarkers, and we look at red blood cell magnesium. It's a way more accurate reflection of whole body magnesium. It measures intracellular magnesium, which is where often it needs to be to do the job. It reflects the magnesium content of muscles and bones. It has a longer half-life. It's less prone to fluctuations from your diet, and it correlates with clinical symptoms. So it's a really good biomarker that is part of the function panel

that you're not getting when you go to your regular doctor. We're sure it's not on your annual panel, and it's probably not on any panel that they do at all if you're going to measure magnesium. The other things you can kind of look at in relation to magnesium that are part of the function panel include kidney tests like creatinine and BUN, vitamin D levels, because low levels are often associated with low levels of magnesium absorption, just like calcium absorption. Calcium levels are also interacting, potassium levels, low levels of potassium or calcium can be an indicator of low magnesium. If you're high in sodium, another clue that you might have a low magnesium, if your blood sugar is high or your insulin is high or A1c, your average blood sugar is high, blood sugar control, that's a sign of low magnesium. So a

lot of things you can look at to kind of get a clue that you might be magnesium deficient. Another hormone that's important that you should look at is parathyroid hormone. We also think it's important to look at that. And magnesium can be involved in the release of parathyroid hormone. We also think it's important to look at that. And magnesium can be involved in the release of parathyroid hormone from the parathyroid gland in the neck. And if your parathyroid levels are low, you're going to have low magnesium. So it's important to look at all this stuff. Look at your EKG, look at your heart function. So there's a lot of ways to look at magnesium, but the key is a red blood cell magnesium to start. What are the root causes of having an abnormal magnesium or low magnesium?

Well, our diet, right? Our sad diet or standard American diet, as I mentioned, salt and sugar make you pee out magnesium and starch. Phosphorus also, that's in soda, right? Colas, particularly food additives. And all these things are used in ultra processed foods. And that causes us to basically pee out magnesium. Coffee and alcohol also make us lose magnesium. And too much calcium from supplements, not a good idea either. Stress, another one. Chronic stress is a big factor because obviously when you have magnesium, your nervous system is relaxed, your body's calm. When you are stressed, you actually pee out magnesium. Those living in Kosovo during the Warren One study

had higher cortisol levels, which is a stress hormone, and lower magnesium levels. Also, if women have heavy periods, it's another factor that can cause low magnesium. Malabsorption issues, if you have celiac, inflammatory bowel disease, colitis, Crohn's, if you have diarrhea, you lose magnesium. If you have diabetes and you're peeing too much, you lose magnesium. If you have kidney damage, you'll have magnesium issues. Also, if you sweat a lot, like you do saunas, exercise, go on a hot climate, you're going to, without electrolyte replacement, get into low magnesium states. Again, over-supplementation with calcium, you don't want to do that. And then a few other things can cause you to have magnesium issues. One is having aluminum from antacids and cookware,

food additives, drinking water, deodorant, all that will potentially affect your magnesium. Drugs, a lot of drugs, as I mentioned, affect magnesium levels. So these are common drugs like diuretics, which are used in high blood pressure, which is often a low magnesium issue, certain antibiotics, steroids. I mentioned the cortisol will make you lose magnesium, used for inflammatory disorders. Acid-blocking drugs we use for reflux are horrible because they block acid, but you need to absorb minerals such as magnesium. And other deficiencies of nutrients like vitamin B6 or vitamin D or selenium often will cause us to have low magnesium. All right, so what are the things we talked about?

Let's just kind of go over those. What are the things we should be worried about that can be related to magnesium deficiency? Well, cardiometabolic disease, type 2 diabetes, as I mentioned. In one small study, they looked at the intracellular magnesium status of patients with diabetes, and it was depleted over 30% of patients. And now this problem affects 93% of the population, to some degree or another. Heart disease, another big category. If you have coronary artery disease, and this is the Rotterdam study, looked at 10,000 people,

report a 36% greater risk of death from heart attacks and a 54% greater risk of sudden cardiac death in those with low serum magnesium levels. So that's really concerning. So if you have low magnesium, you're 54% greater to die from sudden death, 30% greater risk of having a heart attack. That's bad. If you have high blood pressure, often a clue that you might be low in magnesium because magnesium relaxes blood vessels and improves flexibility. If you have palpitations, a rapid heartbeat, again, magnesium could be the cure. Heart attack, strokes, and blockage in your arteries. Again, studies show that, this was a cross-sectional study published

in Nutrition Metabolism and Cardiovascular Disease, show that otherwise healthy Koreans with the lowest serum magnesium had two times the risk of having calcium buildup in their heart, which is a huge clue that there's atherosclerosis or plaque development. And also it can involve calcium metabolism. There's too much calcium, not enough magnesium. It's a problem. You've had a stroke. Those with highest versus lowest magnesium intake had a 40% reduction in all-cause mortality versus the lowest intake. So basically, if you had high intake of magnesium and ended up with a stroke, you're going to have a 40% reduction in your risk of death after. That's pretty good. It's low magnesium, linked to cataracts. It's linked to headaches, obviously. In fact, American Academy of Neurology

gives magnesium a level B rating as probably effective for the prevention and treatment of migraines. So often when someone comes in with a migraine to the emergency room, I would give them intravenous magnesium because it relaxes all that spasming blood vessels in their head and helps them relax. Did you know that plants produce over 8,000 molecules called polyphenols that are linked to better metabolic health, better immune health, and even longer lifespan? Polyphenols have names like rutin and quercetin, and research shows they can target pathways in our cells linked to longevity. And one of my favorite absolute ways to get a daily boost in key polyphenols is by consuming

grain- and gluten-free Himalayan tartary buckwheat. This plant has been revered for thousands of years for its medicinal properties, and recently a company called Big Bold Health has brought organic Himalayan tartary buckwheat into the United States. My favorite way to get the natural goodness of all Himalayan tartary buckwheat's polyphenols, along with fiber, vitamins, and minerals, is Himalayan tartary buckwheat sprout powder, which is loaded with hundreds of times more polyphenols than conventional

buckwheat and goes great in smoothies and shakes or as a sprinkle on a meal. I put it in my smoothie every single morning. Right now, you can get access to 100% American-grown USDA organic Himalayan tarty buckwheat sprout powder from my friends at Big Bold Health and get 30% off your first order. Just go to bigboldhealth.com and use the code DrHyman30. That's B-I-G-B-O-L-D health.com with the code D-R-H-Y-M-A-N 3-0. Okay, let's talk about some of the nutrients because there are some key nutrients that are often low in people who have migraines. Absolutely. What's the number one nutrient that you would be thinking? I would say magnesium. Yeah, magnesium. Now, the interesting thing, now this is also another thing where you can sort of connect the dots here is

magnesium, which is such a powerful, you know, it's involved in like 500 enzyme pathways in the body is magnesium. When you get to a high enough level is actually a calcium channel blocker. And guess what? Guess what doctors use to prevent migraines? Calcium channel blockers. It's a natural muscle relaxant. Yeah. It's actually, I remember, you know, when I was an ER doctor, it was one of the things we use. When none of the drugs worked,

we would use IV or intravenous magnesium for migraine patients. Remember that? Absolutely. And you, well, and not only that, but we use, uh, in the, in the ER, we use IV magnesium for, uh, heart arrhythmias, uh, you know, uh, life-threatening ones like Torsad de Pointe and, and, uh, VTAC. Uh, we also use it for, uh uh status asthmaticus yeah all right use it for preeclampsia it's a very powerful uh element it's a relax it's a relaxant and and what you're saying is funny to me because i remember you know when you learn these these acls courses the advanced cardiac life support and how to run a code and bring people back from death when their heart's not working and they use all these drugs drug drug drug drug drug and the last thing if nothing else works they use magnesium why don't

you use it first right and then like if someone's got heart's not beating right you give magnesium and it fixes it or people are coming in in preterm labor or have like this preeclampsia which is high blood pressure pregnancy with seizures they use ivy magnesium they use yeah it's and as asthma like you said to relax the lungs they use iv magnesium uh it's pretty funny even for people who are constipated they give them milk of magnesia so it's kind of it's funny doctors don't really think about it and most of us about 40 of us are low or deficient in magnesium oh yeah and i remember this one patient i had who was a radiation oncology resident back when we were at canyon ranch and she was just debilitated with migraines. She had the worst migraine. She was on narcotics and Zofran, which is like a chemo drug that's used for nausea. It was that severe. She could barely work and she came to see me and

I started asking her questions. And this is how you find things out in functional medicine. You try to connect the dots. So, usually you can find out from a story if it's a premenstrual migraine if it's a food related migraine if it's a this is why you're saying we can actually figure this out as functional medicine doctors and and turned out you know i started asking her questions and she had muscle cramps she had constipation i said how can you go to the bathroom are you regular she goes yeah i'm regular i said how can you go she was like go every week i said that's not regular she's regular for me i go every week. I said, that's not regular. She's like, regular for me. I go every week. You know, severely constipated, muscle cramps, headaches, insomnia, irritability, anxiety, palpitations, sensitive and loud noises.

These were all symptoms of low magnesium. And so it turned out she needed like normal doses 200, 400 milligrams. She needed like 2,000, 3,000 milligrams a day of magnesium and literally her migraines went away. Yeah. And that's sort of her constipation and all those other symptoms. So it's often really, often very simple if you know what to do. People who are nutritionally deficient in certain things can cause high blood pressure. Yeah. Like magnesium.

Right. So, and magnesium, you know, studies show that, you know, there's 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. And you know, 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 pressure visit your doctor's not checking your mercury and lead levels not even your blood and probably not on the most important test 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 you know you're 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 find the nutritional deficiencies we're going to work on your stress levels we're going to help you lose weight you know when you lose weight i mean you actually are going to drop your blood pressure i think i think the number is um per pound i think uh 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 that 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 uh it was incredible their blood pressures dropped an average of 20 points yeah no in 10 days well if you think about 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 their blood pressure by you know near 15 millimeters of mercury yeah so so we have 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 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 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. And 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. piece a little potassium can be another reason why you can have um high blood pressure and and that speaks to where do you get potassium get it from green leafy vegetables so having a you know having a vegetable-based diet you know is is is very very important and my green smoothie in the morning absolutely yeah you know more kale more kale yeah so this is very important i think people also think about salt so people think high blood pressure, 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's 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 Ultra Wellness 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 um it can be iodized and iodine can cause problems so it's not the salt that we personally add in our kitchen it's the salt that's added in factories to processed food yeah exactly huge amounts of intake of salt because how do they make junk ingredients taste edible salt yeah and sugar and processed fats right yeah so we know that and but if you get really good salt um

you know sea salt um that you've purchased that'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 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. That's just good medicine.

It's interesting. They're not checking necessarily sleep apnea, although some might be thinking of that. That's just good medicine. They're not checking your magnesium. When I started learning about all this, I learned about nutrition in medical schools. Like okay, vitamin C prevents scurvy, and vitamin D prevents rickets, and vitamin A prevents blindness, and B vitamins prevent this and that.

And I never really understood why they were important other than preventing deficiency diseases, which is sort of why we first learned about them was from these diseases. And then I began to understand this and began to think about, you know, what do vitamins and minerals actually do in the body? And there's 37 billion, billion chemical reactions that happen in the body every second. 37 billion billion. That's crazy, right? I don't even know what that is.

It's like a, it's a billion, you know, I don't know. A lot. It's a lot. And every single one of those chemical reactions requires helpers. And the helpers are. Co-factors. Are vitamins and minerals. Vitamins and minerals, yeah.

Right? And one of the other shocking things I learned was that our DNA, one third of our DNA codes for enzymes. So enzymes are catalysts that convert one molecule to another. So all these chemical reactions I talked about all need catalysts or enzymes. One third of our entire genetic material is coding for these enzymes and there's variations in how they work that make one person require more or less of a different nutrient right so some for example is you need more B vitamins if

you have certain variation you might need more folate or b12 or b6 and if you take the normal amount quote the RDI which is not the optimal amount to create health it's the minimum amount necessary to prevent a deficiency disease. Yes. So how much vitamin C do you need to not get scurvy? Probably 60 milligrams. How much vitamin C do you need to optimize your immune system to not get COVID? Probably 4,000 milligrams, right?

And it's different for each person, like you're saying, based on our genetic makeup, right? And everything else going on in our body, not just just our genetics but what other diseases we're dealing with what other how we digest and absorb our nutrients i mean so many things impact our nutritional needs yeah it's so true your gut microbiome determines yeah what's going on with your nutritional levels and you may not be producing the vitamins in your gut like vitamin k or buy it and because you have a bad gut so exactly it's so fascinating to me. And really, in functional medicine, our focus is on nutrition as the first line of therapy. And it's both using food as medicine, but also understanding the role of key nutrients

and playing a role in how they function. So you and I have been in this field for a long time. And it's easy to be sort of a little bit arrogant and think that the traditional doctor, well, people eat food, they don't eat vitamins, waste of time, waste of money. But we get kind of humbled by seeing actually what happens when we test people. And I think despite doctors saying this, when you look at the data, I think 72% of doctors recommend supplements to their patients and 79% take them themselves.

So whatever they're telling you, it's interesting that, you know, and we see studies that show, oh, vitamin D doesn't affect heart disease or cancer and omega-3 fats don't really benefit heart disease or cancer prevention. So we see these studies that are conflicting all the time. You know, I think that happens for so many reasons, right? Why those studies are conflicting. One is because we're putting everybody in that same group. So we're not personalizing the approach. And so it depends on people's health status, how they're digesting, absorbing, how their nutritional status in general, are they deficient to begin with? What are their genetic needs? So that really impacts how somebody

shifts or improves from when we give them those nutrients. So I think that one of the biggest issues with research is we're not looking at individual variations and SNPs in somebody's makeup, their genetic variations that impact what they need. And so it just sort of lumps everybody into one category. Yeah, so someone, for example, had like a vitamin D receptor gene that made them require a high dose of vitamin D and you took 100,000 people and you saw them taking vitamin D,

well you think they're taking enough, but it might not be enough for that person. And if you actually took that subset and you studied them and you gave them the right amount to get their blood levels optimally, it might be different. It will absolutely be different. So, and we know with fish oil, for example, if people are eating a couple servings

of good fatty fish a week, then fish oil supplements might not be as helpful for them. But when people aren't eating that, then fish oil supplements make a huge difference and help lower triglycerides and decrease risk of heart disease. So we know that it really is dependent so much on your individual diet as well as all those other things we've spoken about. That's true. I always say, if you don't have a headache and aspirin doesn't do anything, right? If your omega-3 levels are already good and you take omega-3, it doesn't

do anything, right? So I think the studies are challenging. And often, like you said, it's hard to distinguish what the overall health of the patient is. And so if these patients are eating crappy diets, they're smoking, they're drinking, they're not exercising, taking a vitamin is not going to help them. They're not that powerful in that sense, right? If you clean up everything and then you add them in, they can be extremely effective and powerful. So that's not to say that if you're overweight and unhealthy, you shouldn't take supplements because I think they will help, but they work much better if you clean up house first.

Comprehensive program, right? So let's talk about how we learn in our practice at the Ultraluna Center about what people's nutritional status is. How do we figure that out? Well, so we look at it from multiple different angles, right? First, it starts with a physical exam. You know, what is their waist to hip ratio? How are they holding on to weight in their body? Then we look to look for signs of nutritional deficiencies. Maybe their hair is dry or their skin is dry or they have different spots on their nails, which could indicate zinc deficiency. We look at their diet intake. Wait, wait, wait. The

nutritional physical exam, I just want to pause because you teach that course at the Institute for Functional Medicine. And it's fascinating when you learn as a doctor what the clinical signs are of vitamin deficiencies, right? So we know the obvious ones that, for example, if you have scurvy, you get no gum issues, right? If you have the vitamin deficiencies, you get little cracks in your mouth called chelosis. If you have white spots in your nose, it might be zinc deficiency.

If it's, for example- Bumps on the back of your arms, you know, or dry skin. We think about vitamin A a lot. We think about zinc. Yeah. And my favorite test is a vitamin D test. You know what that one is? Yes.

Tell us about that. So when you're, if you bang on somebody's leg and they have pain, then that could be a sign that they're low in vitamin D. Yeah. So if you take your thumb and you press right now, ready to go, press right now on their shin bone. And if it's tender, then it means you're probably vitamin D deficient because it makes your bone soft.

Now I take vitamin D, so my bone doesn't hurt at all when I press on it. You're pressing right now. Yeah, mine doesn't hurt either. Yeah, you go. I'm taking my vitamin D. I'm taking my vitamin D. So you can do a simple test. So there's a lot of things clinically you can figure out that are signs of nutritional

deficiency. That's the first step. And I think that's really important to look and examine because biomarkers are not perfect, which are lab tests. But they can be very helpful, but they're not perfect at determining everybody's nutritional deficiencies. For example, magnesium. We know that magnesium is, as we talked about, it's a very common deficiency, but sometimes the serum magnesium and red blood cell magnesium can be normal and somebody can

still be deficient in magnesium and would benefit from more magnesium, whether it's dietary or supplement-wise. Well, that's the other thing. We take a detailed history. Oh, yes. So, by actually questionnaires, you can determine what your nutritional deficiencies are. So, I wrote my book, Ultramind.

I literally had questionnaires in there. How do you know if you're zinc deficient, vitamin D deficient, magnesium deficient, folate deficient, you know, so forth. And you can actually do these questionnaires and you're gonna get a pretty sense if you're deficient or not. And then you look at their diet too. You know, you look to see what they're eating and what they're not eating. You know, when somebody's a vegan, you're thinking more about, okay, I've got to really look for B12. I've got to really look for issues with iron. I've got to really think about zinc and the omega-3 fats because they're more common deficiencies, you know, yeah, if you're not eating any animal. Iodine, because you don't

eat fish, right? So there's things we have to think about depending on what their diet is like and their digestive system. So we do a comprehensive approach and the biomarkers can be really helpful too. They're not perfect. Like blood tests or what other tests? Yeah. So we can look at blood. We look at urine. We do this panel called the ION panel. And it's this all over nutrition panel. It gives us so much good information. It tells us about amino acid levels. Those are the components of protein in the blood. Building blocks of protein. Yep. And it tells us about omega levels, omega-3 levels, omega-6 levels. It tells us about mineral us, it tells us about omega levels, omega three levels, omega six, six levels. It tells us about mineral levels. It tells us about all those steps of the mitochondria

and the steps of the Krebs cycle, which need nutrients to work properly. Like you were talking about those cofactors, the vitamins and minerals that help those reactions work. So we can take our food and turn it into ATP or energy. So when we have deficiencies in certain nutrients, we'll see shifts in this panel called the organic acid testing, which, you know, that's really helpful. It's a urine test. It's a urine test.

So that's really important. So what you're saying essentially is that we use a lot of different kinds of testing. Yes. Because your typical doctor will check your blood levels. But if you check your blood levels of folate or magnesium, they go, oh, it's fine. You're not necessarily fine. So each nutrient requires a very different approach depending on the nutrient. So vitamin D, yeah, you can check your blood level of vitamin D. You got to check the right one, but it's pretty good. Yes. Right. You can check your blood levels of omega-3s. Pretty good, right?

But you want to check in the right way. Yes. Some like folate or B12 or magnesium. Not so much. Not so good, right? And I think, you know, you mentioned magnesium. It's a really good point. So a lot of doctors will check magnesium.

Now, if it's low on a regular blood test, it means you are in big trouble. You're really low. You're really low. And then you can check red cell magnesium, which is a little bit better. But the true test is something called a magnesium loading test, which is what? So you give magnesium and then you collect urine for a period of time. So that magnesium, depending on the level of sufficiency that somebody has in their body, that will impact how much magnesium that spills over into their

urine. It's not a test we do very often, but if you really want to know, you got to give someone a load of magnesium. If they pee it out, they're good. If they hold onto it and nothing comes out in the urine, they're pretty low. 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.

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