The Dr. Hyman Show - Supplements: Useful Or Useless? with Dr. Elizabeth Boham

Starting point is 00:00:00 Coming up on this episode of The Doctor's Pharmacy. A lot of supplements out there are not great because they're not giving the right type of nutrients within the supplement. Hey everyone, it's Dr. Mark Hyman here. I wanna talk to you about how I make time to read all the books on my list. I love books and I'm constantly reading

Starting point is 00:00:19 at least two to three at any given time. And when I get really busy, I turn to audiobooks. My love of learning, reading, and listening to audiobooks has been critical in my ongoing journey to become the happiest, healthiest version of myself. And one of my favorite activities is getting in the car with my wife and going for a long drive

Starting point is 00:00:36 while listening to one of our favorite books on my Audible app. I always revisit my favorite classic, Walden by Henry David Thoreau. This book made such an impact on me and the way I view the world That I love to listen to it over and over again I take away something new every time I return to this book And Audible makes it so easy to do

Starting point is 00:00:55 They have thousands of titles to pick from And their app is super easy to use And you can download everything to your phone or your tablet To listen to while you're going for a walk or cooking or going for a drive Today audible.com has a special offer for the doctor's pharmacy listeners Download everything to your phone or your tablet to listen to while you're going for a walk or cooking or going for a drive. Today, Audible.com has a special offer for the doctor's pharmacy listeners. That's you. You get two free credits for books when you sign up for your 30-day free trial. Just go to audibletrial.com forward slash Dr. Hyman.

Starting point is 00:01:19 That's audibletrial.com forward slash Dr. Hyman. That's just Dr. Hyman. All right, now let's get back to this week's episode. Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman, and that's pharmacy with an F-F-A-R-M-A-C-Y, a place for conversations that matter. And if you've ever worried if you should take vitamins, if you're nutritionally deficient,

Starting point is 00:01:41 or if it's all a bunch of hooey, this podcast is going to be very interesting to you because it's with my friend, colleague at the Ultra Wellness Center, the medical director here, Dr. Elizabeth Boham, on this special episode of The Doctor's Pharmacy we call House Call. And we dive deep into issues around functional medicine and how to treat difficult problems that aren't getting better using traditional care. So welcome, Liz. Thank you, Mark. Thanks for having me.

Starting point is 00:02:08 Liz is a doctor's doctor. She is a MD. She's an RD, nutritionist, and she's an exercise physiologist. And she's one of the leading thinkers, teachers, and faculty in functional medicine around the world. She's taught in South Africa, London, and all over the United States. She's a key part of our faculty at the Institute for Functional Medicine. And she's been my colleague here forever at the Ultraluna Center. We've worked together before that at Kenya Ranch for 20 plus years now. It's amazing. And I don't think you look any different than you did 20 years ago. Neither do you. I mean, maybe a few more gray

Starting point is 00:02:38 hair. So welcome, welcome. We're going to talk today about nutrition and nutritional deficiencies and nutritional testing and why we should be concerned about these. So Liz, from a traditional medical point of view, we were trained that you should be able to get all your nutrients from food, that supplements are often a waste of money and just create expensive urine. How do you address that? You know, I remember, and in my training, it was the same, right? Like I was trained to say, let's focus on food first, right? Which we always do. We always want to focus on food first. And not to really, you know, supplements aren't

Starting point is 00:03:19 going to be that helpful and don't use them. And, you know, I remember, I remember when I first took a multivitamin, a good multivitamin. So this was after my nutrition training, after I was an RD, after I was, it was probably when I was at Canyon Ranch. And you were even a nutritionally trained MD. Yes. So you did a fellowship in nutrition as a doctor. So, you know, I, I, you know, I was always trying to get all my nutrients from food and teaching my patients to get all of my, their nutrients from food. And so I remember taking

Starting point is 00:03:51 a really good quality multi all of a sudden going, wow, all I have all this energy that I didn't realize I didn't have, right. It was, it made a huge difference for me. And I think in a lot of ways, multis are almost the least important supplement we give, but it for, for me and I think in a lot of ways malt eyes are almost the least important supplement we give but it for for me and for so many of my patients sometimes even a multi can be can make a huge difference and I think what what is really important to pay attention to with supplements is that when we use them in a personalized approach when we're testing when we're we're using them based on what that individual person needs not just saying okay, okay, everybody take this, which sometimes that's helpful too, but really figuring out for that individual person, what are they deficient in?

Starting point is 00:04:33 Where do they need to focus? That can make a huge, huge difference for how they feel. It's so true. And I think we're taught that we should really get everything from food, but there's been a lot of problems with our food supply. That's true. You know, we, aside from us eating mountains of processed food, which has got no nutrients, except things that are fortified, right?

Starting point is 00:04:50 Yes. Enriched. Why do they enrich it? Because it's impoverished to start with, right? And on top of that, the way we grow our food in soil that's depleted because of industrial farming techniques, because of the fertilizers and chemicals that literally destroy the microbiome of the soil, which is needed to extract nutrients from the dirt, from the soil that the plants can use, which then we eat. We've seen 50% reduction in nutrient levels like magnesium and other minerals in our vegetables

Starting point is 00:05:19 over the last 50 years. So if you're eating broccoli today and you ate it 50 years ago, it's a different food. It's a different broccoli. And then you're shipping them over long distances. The average apple you eat has been in a storage house for a year, right? And they're refrigerated, kept in storage or transported. So they lose nutrition. And we're also living a lifestyle that depletes our nutrients. Yep. We're drinking too much alcohol, smoking, eating processed

Starting point is 00:05:48 food, which by the way, in order to actually metabolize your food, the way your food is metabolized is requiring vitamins and minerals to run that. As cofactors for all those enzymes, right? To run the food through your metabolic factory. You can't, it's like the assembly line. If you don't have the nutrients, you can't run the food through. Right. And so you get more depleted. And then we have all these drugs we take that deplete our nutrients. Yes.

Starting point is 00:06:15 Medications. And then, so we have all these reasons why we're nutritionally deficient. So talk to us about what are we seeing in America? And then we'll talk about what we're seeing here at the Alt Wellness Center, because we don't just guess here, we test. Yes. And it's shocking, honestly, to see the level of nutritional deficiencies in who you think would be a well-nourished, healthy person. So tell us about the kinds of nutritional deficiencies we're seeing at scale in America and why they're so important.

Starting point is 00:06:42 I mean, if you just look at what people are eating, we're seeing that 68% of Americans are not getting enough magnesium. And so 68% are not meeting the RDI, the recommended dietary intake. And we have to remember that that RDI was set for just sufficiency. So, you know, not having a deficiency in magnesium. So what that means is those recommendations are not set at what is optimal either for that individual person. So they're just the minimum requirement in a sense. So 68% of us are not getting enough magnesium. 40% are not getting enough zinc. 78% are not getting enough folate. Maybe even 90 plus percent are not getting enough of the omega-3s

Starting point is 00:07:26 in their diet. So we're seeing significant nutritional deficiencies and that's leading to so many issues in terms of chronic disease and also just feeling awful, right? Yeah. So what's fascinating to me is, you know, when I started learning about all this, you know, I learned about nutrition in medical schools. Like, okay, vitamin C prevents scurvy and vitamin D prevents rickets and vitamin A prevents, you know, 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? Right. And there's 37 billion, billion chemical reactions that happen in the body every second.

Starting point is 00:08:19 37 billion, billion. That's crazy, right? I don't even know what that is. It's like a, cause a billion, you know, I don't know. A lot. It's like a, it's a billion, you know, I don't know. It's a lot. And every single one of those chemical reactions requires helpers. And the helpers are. Co-factors.

Starting point is 00:08:34 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,

Starting point is 00:09:05 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. So how much vitamin C do you need to not get scurvy? Probably 60 milligrams. 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. And it's different for each person, like you're saying, based on our genetic makeup and everything else going on in our body, not just our genetics, but what other diseases we're dealing with, how we digest and absorb our nutrients. I mean, so many things impact our nutritional needs.

Starting point is 00:09:46 Yeah. It's so true. Your gut microbiome determines what's going on with your nutritional levels. I mean, you may not be producing the vitamins in your gut, like vitamin K or biotin because you have a bad gut. So 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, 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 know, you and I have been in this field for a long time and, you know, it's easy to be sort of a little bit arrogant and think that, you know, the traditional doctor, well, you know, 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

Starting point is 00:10:29 we test people. And I think despite doctors saying this, you know, 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.

Starting point is 00:11:03 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 and 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. They're genetic variations that impact what they need.

Starting point is 00:11:39 Right. And so it just sort of lumps everybody into one category. Yes. 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.

Starting point is 00:12:03 It will absolutely be different. So 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, an aspirin doesn't do anything, right?

Starting point is 00:12:28 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.

Starting point is 00:13:07 Comprehensive of program, right? So, um, let's talk about how we learn in our practice, the ultra wellness center about what people's nutritional status is. How do we, how do we figure that out? Well, so we do, we, 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?

Starting point is 00:13:29 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. You know, we look at their diet intake. The nutritional physical exam, i just want to pause because you teach that course as at the institute for functional medicine and it's 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

Starting point is 00:14:00 have the vitamin deficiencies you get little cracks in your mouth called chelosis yeah 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.

Starting point is 00:14:16 You know what that one is? Yes. Tell us about that. So when you're, if you, 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,

Starting point is 00:14:32 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.

Starting point is 00:14:43 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. So that's the first thing. 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.

Starting point is 00:15:04 We know that magnesium, 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.

Starting point is 00:15:20 We take a detailed history. So by actually questionnaires, you can determine what your nutritional deficiencies are. So I wrote my book, Ultra Mind. I literally had questionnaires in there. How do you know if you're zinc deficient, vitamin E deficient, magnesium deficient, folate deficient, you know, so forth. And you can, you can actually do these questionnaires and you're going to 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 vegan, you're thinking more about, okay, I've got to really

Starting point is 00:15:49 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. 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.

Starting point is 00:16:31 Building blocks of protein, yeah. Yep. And it tells us about omega levels, omega-3 levels, omega-6 levels. It tells us about mineral levels. It tells us about all those steps of the mitochondria, you know, 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

Starting point is 00:17:04 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. You can check your blood levels of omega-3s, pretty good. But you want to check in the right way. Some like folate or B12 or magnesium,

Starting point is 00:17:43 not so much. And I think you mentioned magnesium 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. Yep.

Starting point is 00:17:58 But the true test is something called a magnesium loading test. Yeah. Which is what? So you give magnesium and then you collect urine for a magnesium loading test. Yeah. 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,

Starting point is 00:18:14 that will impact how much magnesium that spills over into their urine. It's not a test we do very often, but 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 on to it and nothing comes out in the urine, they're pretty low. Yeah.

Starting point is 00:18:29 And you were mentioning folate and B12. I see this all the time. People come in with a B12 level that their doctors did, and it's normal. And so then they go, okay, I don't need B12. But many times, that's not really telling us about functional markers of B12 or what is sufficient for that individual person. So we'll do things like methylmalonic acid and homocysteine.

Starting point is 00:18:51 They're more functional markers of the B vitamins that give us a lot more information than just a serum level of a vitamin. So in other words, is it doing what it's supposed to do in the body? And if it's not, you're going to see a backup of these other compounds that we don't normally test. Exactly. But, you know, doctors, just check your B12, folate, they're fine to see a backup of these other compounds that we don't normally test. Exactly. Doctors, just check your B12, folate, they're fine. You may not be fine. Yes.

Starting point is 00:19:09 And I've seen many patients who are not fine and who have very severe deficiencies and often you can tell if someone needs a certain type of a nutrient. Looking at their genetics and their blood tests, you can tell if they need this form or that form of the nutrients. So it becomes very sophisticated in an approach to functional medicine. I mean, I think that's a great example of where a lot of supplements out there are not great because they're not giving the right type of nutrients within the supplement. So for example, if a supplement is less expensive, they may use folic acid in the multivitamin. And not everybody, because of their genetic makeup, can utilize folic acid and use it for what the body needs folic acid for, folate for. So folic acid is a synthetic form of folate.

Starting point is 00:19:57 They may increase risk of problems. Yes. Increased risk maybe of cancer, right? So not everybody can take folate and the form of folic acid and utilize it if they have a shift in this, if they have a genetic variation called the MTHFR gene, and there's others as well. And so those are things we look at as well. And when we use vitamins, we use really good quality ones, ones that are more, the body's more able to utilize like a methylfolate form. And that makes a huge difference for people. Yeah. And in so many aspects, actually picking the vitamin, right? It's not just the form of the nutrient, but is it the form that's bioavailable? Is it absorbed?

Starting point is 00:20:36 What is in with it that can prevent its absorption? What exactly is it? So you can say, I need magnesium. I'm just going to go to the store and get some magnesium. It's usually magnesium oxide, which is really cheap magnesium. It's in most supplements, but doesn't really get absorbed very well and may not be effective. Right. So magnesium oxide and also magnesium citrate, right? They're more likely to pull water into the gut. And so they'll loosen up the stools.

Starting point is 00:20:58 For some people, they need that, and that's good. But it's not as well absorbed as like a chelated form of magnesium, like magnesium glycinate, which is much better absorbed into the body. So depending on what you're using your magnesium for, you know, you want to be making sure you're choosing the right one. Yeah. So what's different about here at the Ultra Wellness Center, what we do in functional medicine is that there's a really deep understanding of the role of nutrition and nutrients in health. And what's so important about these is it's not that they're single function compounds, right? So if you take a drug, it usually hits one pathway, does one thing, right? When you take magnesium, it affects 300 different enzymes and has many, many other functions in the body. It's phenomenal. Magnesium is an amazing mineral,

Starting point is 00:21:44 and it's so good for us in so many ways. And when people are magnesium deficient, we see all sorts of issues from depression, anxiety, muscle cramps, hypertension, asthma, restless leg syndrome, diabetes, more insulin resistance. So magnesium is so- Don't forget constipation. Oh my goodness. I forgot constipation. Headaches. Headaches. Yep. Right? Migraines. Yeah. Twitchy muscles. People get twitchy eyes. Yeah. I had a lot of twitchy eyes in residency. I love magnesium. It helped my twitchy eye.

Starting point is 00:22:18 So people get treated for all these problems, right? They get treated for constipation. They get treated for... And the sort of ironic thing about magnesium is that it's used all the time in medicine as a last resort, right? So when a woman comes in who's in preterm labor and their uterus is contracting like crazy, they get IV magnesium. If a woman is high blood pressure in pregnancy, they come in, they're about to have a seizure, they give them IV magnesium. Why? Because it works better than anything else. If someone's having a cardiac arrest and arrhythmia, when all the other drugs fail, they give them IV magnesium as the last step because it helps to relax the heart muscle. So I call it the relaxation mineral. So anything that's twitchy, irritable, or tense,

Starting point is 00:22:57 whether it's anxiety, insomnia, constipation, muscle cramps, twitchy blood vessels, high blood pressure, twitchy heart, which is palpitations, twitchy emotions, which is anxiety. All these things are related to insufficient magnesium. And they're treated, take Xanax for anxiety, take a laxative for constipation, take a migraine pill for your headache, take this or that for this or that. And it's unfortunate because this is such a simple solution. And we know it's a vicious cycle, right? We know that chronic stress, when we're under chronic stress, that that causes our body to excrete more magnesium in the urine. So we become more deficient in magnesium. Chronic stress, who's got that? I know, right? So then you become more deficient in magnesium.

Starting point is 00:23:41 Stressless time right now. And then you get more anxious, and then you use up more of your magnesium. So we know that when we're dealing with chronic stress, we're using up our magnesium, we're excreting more magnesium and we need even more magnesium because that was what helps us feel calm. And so it's...

Starting point is 00:23:59 We'll go through all the things that actually cause us to lose magnesium. So, I mean, we... Stress. Stress, a big one. It's huge. I remember one study I read of Kosovo, and they did magnesium studies, and they found that people in Kosovo, under all that war and stress, they had really huge amounts of excretion of magnesium, whereas people who weren't in that environment didn't. We know that people who take like proton pump inhibitors.

Starting point is 00:24:25 Acid blockers. Acid blockers, yeah. I mean, like Protonix and Prilosec and Nexium and all those drugs. Yeah, that decreases your magnesium absorption. So, you know, just depending on your medication, that can deplete your body of magnesium. Diuretics. Yep. Blood pressure pills, which you need magnesium to control your blood pressure.

Starting point is 00:24:43 You're taking a pill that causes you to lose magnesium. Right. Again, that vicious cycle that we see all the time. Yeah. Alcohol. Alcohol depletes your body of magnesium and all the B vitamins. So I think that's important. Smoking. Well, nobody's into smoking. Sugar. Yeah. And my favorite of all of them, yeah right coffee causes magnesium loss so you live an american lifestyle where you're drinking coffee drinking alcohol lots of stress you have uh you know probably a pretty crappy diet and then you take a proton pump inhibitor you take an acid blocker you're eating a crappy diet and then on top of that you're eating a very low magnesium diet so talk about how that plays a

Starting point is 00:25:25 role. You know, magnesium is in so many of our foods. Magnesium's in our... Well, not the foods we actually eat. Well, yeah, but it's in our nuts and seeds, our beans and legumes, our vegetables. Greens. Greens, yep, our vegetables. And it's in whole grains like quinoa and buckwheat. So it's in a lot of our food. But when you take, for example, brown rice and you make it white rice, you deplete, about 90 plus percent of the magnesium is released or is lost in that processing. And they don't spray that back on. They'll spray back on some B vitamins, but not the magnesium.

Starting point is 00:26:00 So when people are eating refined and processed foods, they're getting a more magnesium deficient diet. So even sometimes people don't even realize they're getting refined and processed foods. I mean, sometimes people are like, I have a healthy diet, but they, they forget about that piece of toast at breakfast or the crackers at lunch that are made up of, have white flour in them and that are, are more magnesium deficient. So, um, and as we get older, we can't really eat as many calories as we used to, so we're more likely to have problems over time as well. I think the diet is so magnesium deficient.

Starting point is 00:26:35 Our lifestyle is so magnesium depleting. And so we're kind of getting it from both ends. Yes. And we see this as one of the most common problems in our practice that is undiagnosed. And the patients think we're geniuses because all these problems they've suffered from just go away. And they're like, wow, how did you know? Well, it's not that hard.

Starting point is 00:26:57 It's just good medicine. And we know, I mean, this is not functional medicine. It's just medicine. And it's often being missed. And let's talk about the patient you had and talk about what happened with this patient. Because I think putting a face on this is going to be very helpful. So I had a 68 year old woman who came in to see me and, you know, she was really struggling with chronic pain. She had anxiety, she had hypertension. So she had elevated blood pressure. She was pre-diabetic. She had restless legs. So she couldn't, she had poor sleep and her legs were like, you know, she couldn't really calm down at night because her legs were sort of twitchy, like we were talking

Starting point is 00:27:33 about. And she had constipation. So she had all these signs. Anxiety. Headaches. Blood pressure. Yes. So, you fatigue. Yeah, yeah. So she came in and she said- Not the average patient we see here at the Altura Center. I know, right. And of course, we did a comprehensive program for her. But so many of her symptoms were pointing to low magnesium. So we did a comprehensive program.

Starting point is 00:27:57 We changed her diet. She's like one of those people who felt like she was on a really good, healthy diet. But when you look deeper, especially for her level of activity, she was wasting calories, right? She was wasting calories on that piece of toast at breakfast and crackers at lunch and a little bit of cake at dinner, right? So she wasn't eating, you know, she had a lot of vegetables in her diet. She had a lot of good, healthy foods in her diet. But she also had some of these other things that just took away from the nutrient density of her diet. So I always work with all my patients on nutrient density, because I think that's

Starting point is 00:28:29 such an important point, right? You want to have, you want to be choosing the foods that have the most nutrients per calorie. And, and especially as we get older or depending on our level of activity, we really can't waste a lot of calories on foods that have poor nutrient content or low nutrient density. In my first book, we call it the nutrient to calorie ratio, which is how many nutrients per calories you're getting. So broccoli has a lot of nutrients, very few calories. Coca-Cola has a lot of calories, but no nutrients. Right. So for her, we worked on shifting her diet. We did an elimination diet for her because

Starting point is 00:29:06 that she also needed, you know, to pull away some common inflammatory foods, but we then shifted instead of, you know, choosing a piece of toast at breakfast, we had, um, we had her have some sweet potatoes with her, with her omelet. And then at lunch, instead of having crackers, we put some quinoa on her salad. Ways that you get more nutrients per calorie and more magnesium, right? And we also gave her magnesium though. She was at a point where we needed- Her tanks were so low. Yeah. Her tank was low and we needed to supplement. So we gave her both the type of magnesium that helped increase her bowel movements because she was constipated. And we gave her the magnesium glycinate that's better absorbed. So we gave her both. And it was really helpful.

Starting point is 00:29:50 She had improvement in her blood pressure. She definitely had improvement in that restless leg. So she slept better. She had improvement in her pain. Her pain decreased significantly. She had improvement in her headaches. So it's really, it's a magical mineral. And, you know, if I saw her today, because, you know, we're doing more IV magnesium now at the Ultra Wellness Center. You know, we have a combination of called Ultra Calm, which has IV magnesium in it. You know, we can use that right away to see, okay, is this going to help with somebody's headaches or help them feel more calm and less anxious. I've had people in my office with headaches or migraines and literally give them a shot of magnesium and it's like that goes away instantly. Yeah. That's very powerful and that's I mean I was joking we that's what we do like in a cardiac arrest and the hearts not going we give them intravenous

Starting point is 00:30:35 magnesium we give them IV magnesium for preterm labor or for you know preventing seizures with high blood pressure I mean it's so powerful and it's one of my favorite things to me. I've had IV magnesium have you had it, it's so powerful. And it's one of my favorite things. I've had IV magnesium. Have you had it? It makes you feel like warm and relaxed and calm. It's the most amazing thing. It's like instant value without all the side effects. Yeah. And it's safe for most people. It's really safe for most people. People with kidney issues, so renal insufficiency, on dialysis, kidney issues, you have to be careful. You want to be really working. We always want to you know, kidney issues, you have to be careful. You

Starting point is 00:31:05 want to be really working. We always want to work with your doctor, but you have to be more careful. But for most people, you know, it's a safe mineral that we can use. You also talked about briefly the different forms of magnesium. So this is another aspect of nutritional therapy that we do in functional medicines. It's very customized. So this person might do better with magnesium glycinate because they may have more detoxification issues. They might not have constipation. They might be prone to diarrhea. You can use this for, if you have more constipation issues, you might use magnesium citrate. If they're more neurologic issues, you might use magnesium threonate, which has a better neurologic profile. So it's a very personalized, customized approach. And we make sure the

Starting point is 00:31:43 nutrients don't have junk in them, fillers, impurities, that the potency is there. We use very rigorous evaluation of the companies we use to actually figure out which supplements. Right. I mean, you mentioned like so often people go, oh, I need magnesium. And they just grab one and they take it and then they start getting diarrhea and then it didn't help. And then you're like, and they're like, oh, this is crummy because it's just not the right, it's not the right form. It's not a good quality. Yeah. And we didn't even talk about menstrual cramps and all that stuff. I mean, you know, another patient I had, she was a 30 year old woman who was really struggling

Starting point is 00:32:14 with PMS. So she was, for the week before her period, she was really irritable. She was feeling more angry and sad. She had more cramps with her period. She had lots of cramps that were keeping her in bed for a couple days when she got her period. And magnesium was really effective for her. We could give magnesium for the, you know, I gave it to her all the time. She didn't need the citrate form, so I just gave her a magnesium glycinate.

Starting point is 00:32:44 And that really helped her throughout her whole month just feeling more calm and it helped decrease the amount of PMS she had and then when she was getting her period we gave her even a little more magnesium glycinate and that helped with the cramping too and so and she just felt she just felt better I mean we know that magnesium deficiency is associated with depression. You know, we know that it impacts this NMDA receptor in the brain probably, and that may be the connection with depression. And so when we give magnesium, we can decrease the amount of depression. And for some people, I mean, it's not, it's not the cure all for all depression, but for some people it's even better than an antidepressant, you know, depending on

Starting point is 00:33:24 what's going on. So it's very personalized and but for some people it's even better than an antidepressant, you know, depending on what's going on. Well, that's the whole point. It's very personalized. And while magnesium might for some person, it may not work for another person. I just want to share a story. I remember this magnesium patient I had, she was a doctor. She was a radiation oncology resident at Mayo Clinic, seeing the best doctors in the world. She had incapacitating migraines. I mean, just was on narcotics and any vomiting medication used for chemotherapy. And she was constantly going off work and just struggling. And she wasn't like a sort of emotionally unstable person who was, she was just having these debilitating migraines. So I took her history. I'm like, okay, what else is going on? Because this is what we do in functional medicine.

Starting point is 00:34:06 It's like, oh, let's focus on your migraines. No, let's focus on the rest of you, because that's where the clues are. So what did she have? The usual. She had severe constipation. I said, do you have regular bowel movements? She goes, yeah, I got regular bowel movements.

Starting point is 00:34:18 I said, how often do you go? She goes, once a week. I'm like, that's not regular. She goes, regular for me, I go every week. And she just thought that was normal right she had palpitations which is the irritability of the heart she had anxiety she had insomnia she had muscle cramps she had all these things that were like neon flashing lights of magnesium deficiency and if you go to a medical textbook you will read that those are the symptoms but somehow it's nutrition so doctors just don't pay attention i don't understand so i'm like all right let's just try magnesium see what happens and i gave her a lot

Starting point is 00:34:56 and i said take enough to make sure you go and she needed like over 2 000 milligrams a day which is a lot most people need you know 200 400 right you know 600 uh it was a lot. Most people need 200, 400, 600. It was a lot. And she started going to the bathroom, her palpitations went away, her insomnia went away, her anxiety went away, and her migraines went away. And she could go back and do her career as a radiation oncology doctor. And you're like, wow, that was easy. But it's really finding out how to navigate to that issue, which is exactly what we do in functional medicine. It's so different than traditional care. We have a different roadmap that focuses on the cause and not just the symptom.

Starting point is 00:35:33 Constipation is a symptom. Muscle cramps are a symptom. Headaches are a symptom. Depression is a symptom. It's not the cause. And not everybody. It's magnesium for each of these problems. Absolutely.

Starting point is 00:35:44 But it's important to figure out how do you navigate to the root cause. And that's what we do in functional medicine. And we do it through a very detailed set of questions, history, which we have you fill out. And then we do another detailed set of questions in person. But now we do it all on Zoom, too. So we have virtual care. Anybody from anywhere in the world can see us here at Delta Wellness Center. And then we do appropriate testing. So rather than guests, we test. And it's

Starting point is 00:36:10 extraordinary how much nutritional deficiencies we see. I just recalled a patient recently as a vegan. I was struggling with his health. He was 20 years old. And I was like, oh my God, this is a very wealthy, well-to-do guy from a good family. And I'm thinking, this guy's not malnourished. He's eating food. He had no omega-3 fats. He was severely B vitamin deficient. He was severely vitamin D deficient. He was magnesium deficient. He was iron deficient. He was selenium deficient. I was like, whoa. And your body can't heal, right? You know, when you're deficient in so many things, your body's not going to heal. You know, that digestive system's not going to heal. Your skin's not going to heal.

Starting point is 00:36:48 Yeah. And we talked about like the magnesium and 300 different enzymes. But each one of those, they're multifunctional substances that are designed to support your body's normal functions, which is very different than drugs. Right. Right. And there are some you have to be careful with. You can OD on, right?

Starting point is 00:37:02 You can take too much vitamin D. You can take too much selenium, too much vitamin A. But certain things... Too much iodine. Too much iodine, too much iron. Some people take really high doses. Yeah. So you can get in trouble.

Starting point is 00:37:14 But a lot of the stuff is water-soluble vitamins like the B vitamins. People coming in with their B12, they're taking B12, their B12 levels are off the roof. And the doctor says, oh, you're B12 toxic. I'm like, no, no. Right. Your body just pees out what you don't need. It's non-toxic. It's fine. Right. Exactly. Exactly. So a lot of times if serum B12 is high because somebody's on a supplement, I might still keep them on that B12 if it's really appropriate for them. Like they have, their methylmalonic acid was once too high, meaning

Starting point is 00:37:41 that they needed B12 or maybe they don't absorb B12 well. We've talked a lot about parietal cell antibodies in the past in other podcasts, and we know that impacts how you absorb B12. So sometimes they still need to stay on B12, even if their levels look okay of serum B12. And sometimes they might not be able to absorb it in their gut, so they might need it under the tongue, or they might need a shot. Injections, yeah. Right.

Starting point is 00:38:04 So it's very personalized, very customized, And it's really, you know, when there's this whole backlash against vitamins in the research, I think it just makes people feel like nothing works. And I think when you're looking at these large populations, these large studies, the effects kind of get washed out and it's unfortunate. The other issue is people get hooked on the nutrient of the day. Yes. And then you can get into trouble. So we saw that with what we call the carrot study, which was there was an awareness that people who ate more carotenoid-containing vegetables,

Starting point is 00:38:37 like carrots and sweet potatoes, had less lung cancer. So they did a study. Well, let's take people who are at high risk of lung cancer, who are smokers, and let's give them lots of beta carotene, which is one of hundreds of carotenoids that's naturally found in food. And it sort of belied a lack of understanding of how these nutrients work. They work as a team. So antioxidants, which is beta carotene, is only effective if there's other antioxidants. So it's like passing a hot potato. You need vitamin C and vitamin E and liposuccin and glutathione and the carotenoids. All of them

Starting point is 00:39:16 work together. And if you just do one, you're going to kind of increase the hot potato, but there's no way to hand it off to. And then these patients actually got more cancer. Some people go, oh, taking B vitamins or beta carotene causes cancer. Well, not exactly. It's just more complex, right? Yeah. So I think we have to be careful with these studies. And when you look at smaller studies, we look at interventional studies, they often show in the right patients, it can be profoundly effective. And I know with our patients, they are profoundly effective in terms of how they can be so helpful for energy, how they can be so helpful for depression, how they can be so helpful for their digestive system, how they can be so helpful for healing in the body and skin. And so we see it every single day in our practice, how powerful these nutrients can be when used

Starting point is 00:40:04 appropriately. Yeah. And I think it's just not taking mega doses. It's taking the right amount for you to optimize your health. And that's the other issue is it's not just the minimum amount for the RDA. People say, oh, in the bottle it says 200% of the RDA. That's dangerous. I'm like, no, that's the minimum amount you need so you don't get scurvy or rickets. That's not going to help you create optimal health. Optimal health, right. Even in the RDI, it says you need maybe, you need maybe, you know, 30 units of vitamin

Starting point is 00:40:27 D so you don't get scurvy, but you can take up to 4,000. And there's this whole idea, which is, I love it, just this long latency deficiency disease. So we know if you acutely don't have vitamin C, you get scurvy. Or if you acutely don't have vitamin D, you get rickets. But what happens if you don't have vitamin D at a high enough level over your lifetime? You get cancer. You get osteoporosis, you get muscle loss. That whole triage theory, right? That Bruce Ames has really done research on and shown that if, if, you know, we know that if, when the body is insufficient in a nutrient, right? You may not

Starting point is 00:40:58 have a deficiency like of vitamin C causing scurvy, but if you have insufficiency for long periods of time, the body's going to use, it has this triage theory going on, which is what Dr. Bruce Ames, who's one of the real pioneers and researchers in nutrition and nutritional science, has shown that, you know, the body then uses the vitamin C, what it really needs it for acutely, but then may not have enough to do some of those lower level functions in the body. So you then- Maintenance and cleanup. Yeah.

Starting point is 00:41:29 So over years and years and years, you start to get chronic disease and you don't feel as good. Yeah. Yeah. I love his concept of a metabolic tune-up and that just a moderate amount of the right nutrients for your life stage and age really helps you get a metabolic tune-up and avoid a lot of the consequences of unhealthy aging, which is pretty cool. I certainly know they've helped me. I know they've helped you. And I think that they will help so many patients, but it's important to

Starting point is 00:41:56 understand what your particular issues are, what your needs are. And that's really what we do here at the Ultra Wellness Center is help people figure out what their issues are because everybody's different. It's personalized nutrition, it's precision nutrition and personalized medicine. And by doing that through the way we approach patients holistically, through systems approaches, through the kinds of diagnostics and testing we do, we really can get an incredible set of data that help us to get people better when they're not getting better from a lot of other approaches. Absolutely. It's the future of nutrition, right? It is. Well, if you've been listening and you're interested in coming to see us, we'd love to see you here at the Ultra Wellness Center. Just go to ultrawellnesscenter.com

Starting point is 00:42:34 and you can now see us virtually through Zoom, which means you don't even have to get out of your bed and you can come right and see us. We'll even send someone to your house to draw your lab test if you want, so you don't have to leave your house. And we'd love to help you and anybody you love. So check us out at the UltraWellnessCenter.com, at UltraWellnessCenter.com. And if you love this podcast, please share it with your friends and family on social media. Leave a comment. We'd love to hear from you and tell us about your experience with nutritional deficiencies and supplements. We'd love to hear about it. And of course, subscribe wherever you get your podcasts and we'll see you next time on The Doctor's Pharmacy. Thank you, Mark.

Starting point is 00:43:20 Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff

Starting point is 00:43:40 from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to tools to enhance your health it's all the cool stuff that I use and that my team uses to optimize and enhance our health and I'd love you to sign up for the weekly newsletter I'll only send it you once a week on Fridays nothing else I promise and all you do is go to drhyman.com forward slash pics to sign up that's drhyman.com forward slash pics P I C K, and sign up for the

Starting point is 00:44:06 newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode. Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified Thank you. medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.

The Dr. Hyman Show - Supplements: Useful Or Useless? with Dr. Elizabeth Boham

There aren't comments yet for this episode. Click on any sentence in the transcript to leave a comment.