The Dr. Hyman Show - The 5R Protocol That’s Helping People Reverse Disease Naturally

Episode Date: June 2, 2025

Many chronic health conditions—such as IBS, asthma, and autoimmune disorders—can be traced back to imbalances in the gut. Disruptions to the microbiome caused by antibiotics, poor diet, food sensitivities, and environmental exposures can lead to inflammation, malabsorption, and increased intestinal permeability (leaky gut). Addressing gut health through a structured Functional Medicine approach called the 5R’s of gut repair—removing harmful triggers, replacing missing digestive factors, reinoculating with beneficial bacteria, repairing the gut lining, and rebalancing lifestyle factors—can restore balance and improve systemic health.  In this episode, I discuss, along with Dr. Elizabeth Boham and Raja Dhir, the Functional Medicine approach to healing the gut and why the gut is at the center of imbalances in the body, including many health conditions. Dr. Elizabeth Boham is Board Certified in Family Medicine from Albany Medical School, and she is an Institute for Functional Medicine Certified Practitioner and the Medical Director of The UltraWellness Center. Dr. Boham lectures on a variety of topics, including Women’s Health and Breast Cancer Prevention, insulin resistance, heart health, weight control and allergies. She is on the faculty for the Institute for Functional Medicine. Raja Dhir is the co-founder and co-CEO of Seed Health, a microbiome science company developing innovative probiotics and living medicines to advance human and planetary health. He specializes in translating cutting-edge microbial research into impactful products and leads Seed Health’s academic collaborations with institutions such as MIT, Harvard, Stanford, Caltech, and the NIH. Raja co-chairs Seed’s Scientific Board alongside Dr. Jacques Ravel, guiding research across microbiology, immunology, genetics, and ecology. He also directs LUCA Biologics, a company focused on the vaginal microbiome and women's health, and oversees SeedLabs, which drives environmental initiatives. Through this work, Raja plays a key role in accelerating microbiome-based solutions from discovery to market. This episode is brought to you by BIOptimizers. Head to bioptimizers.com/hyman and use code HYMAN10 to save 10%. Full-length episodes can be found here: What Is Leaky Gut And How Can You Treat It?How to Select a Probiotic and the Future of the MicrobiomeHow To Do The 10-Day Detox

Coming up on this episode of the Dr. Hyman show. When you have the wrong bacteria and the wrong yeast levels, you can get a lot of bloating after you eat, you can get a lot of fatigue after you eat, you can get those symptoms of constipation and diarrhea, and that causes this inflammation in the digestive system, so all of your digestive enzymes don't work well. When I was just starting my medical journey as an emergency room physician,

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by my personal practice, there's simply not enough time for me to do this at 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. And if you're in need of deepening your knowledge around your health journey, check out my membership community, the Hymen Hive.

And if you're looking for curated and trusted supplements and health products for your health journey, visit my website at drhyman.com for my website store for a summary of my favorite and thoroughly tested products. Now people don't understand how so many of our issues come from the gut and how easy it is to diagnose it and treat it. And we use tests that traditional doctors just don't do. Like we have a different set of lenses, a different set of filters that we can sort through information and data

and ask questions that traditional doctors can't. Like how do you measure leaky gut? How do you look at the microbiome in the gut? How do you look at the digestive function in the gut? How do you actually start to treat it in a different way? And I think your first case is just so rich with a story that is so common that I just love you to share this because I think

everybody is going to resonate with this story. By the way, I have never seen this patient as your patient, but I have literally seen the same story a hundred times or maybe 500 times or a thousand times in my bracket. It's so common. It's the same freaking story. Right. So tell us about this person. So it was a 24-year-old gentleman who came in to see me and was really struggling over the last year

with his digestive system he was having a lot of bloating and gas pain in his stomach every time he ate he was having diarrhea and sometimes he was getting constipated and he he went to his traditional GI doctor and they told him you have irritable bowel. But he wasn't getting any better, right? And he was just really, because he was having so much stomach pain, he had lost some weight. So he wasn't, you know, he was on the thin side to begin with, but because he was having stomach pain when he ate, he wasn't able to eat as much and he was even losing more weight he was feeling really weak and tired and sad depressed right and so for him the time well for everyone the

timeline is so important right that's what we are we to learn we learn in functional medicine is the gathering that information learning about that individual patient story so, seeing their timeline. So we start with a history with the mother and her pregnancy and the birth and where they breastfed and where they took antibiotics, where they were sick as a kid, what happened when they were introduced to food, when they got gluten, when they got dairy. We ask all these questions so when someone comes in with an irritable bowel, the average GI guy is not asking all these questions.

So why do we ask all those questions? Because for this gentleman, for example, you know, he really didn't have stomach pain before a year ago, but what we found out is that when he was a kid, he had ear infections. So he had asthma. Probably because he was eating dairy. Probably, right?

So it's such a common connection. I remember once being in the ER, Liz, and a patient came in, and this little boy keeps coming back, and like a toddler was coming back over and over to the ER with ear infections and just so inflamed. And I said, how was he like, did you breastfeed? Yeah. So when did he start getting the ear infections? Well, we started formula in dairy and milk.

And I'm like, oh, okay. And this is even before I knew about functional medicine. I know. And I was like, well, maybe you shouldn't eat there Yeah, yeah, it was fine. You know, right. It's that's such a such a common connection I mean even my son with when he started dairy got asthma and Eczema it was it's it's unfortunately such a common connection. So for this child, he had a lot of ear infections and and and and eczema and so he was on antibiotics about once or

twice a year in his childhood and he really didn't think that was very much yeah he's like that's not say you know that wasn't too much but you know it makes a huge impact on the microbiome as we're learning and then he started to have acne as a teenager maybe because of dairy more right or or some of some of the imbalances in the microbiome, right? When you screw up the gut with antibiotics or a c-section or lack of breastfeeding, then you get often more acne. Yes. You know, we treat acne on the from the top in as opposed to the inside out, which is actually where it works much better. And this gentleman was given low-dose antibiotics for two years. So then he took even more antibiotics

and so this history of antibiotics sort of set him up and about a year ago he had some sort of stomach bug. So some probably viral stomach infection and then since that time he started to have all these digestive issues and was losing weight. And so... Which is a common story. People are... So common, like you said. ...have this sort of smoldering a bunch of insults over the course of their life.

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

We we often see and we're not making this up There's so much science that shows that your gut microbiome plays a role in acne and eczema and asthma that it plays I mean, we're we're actually doing this at Cleveland Clinic now. We're studying asthma and looking at how the microbiome plays a role and how it affects inflammation, all these various factors that most doctors just don't pay attention to. Right, so with him, as we do with most of our patients,

we do food first, right? So we said, okay, we've gotta really focus on this person's diet and help him start feeling better right away So he can start to eat more and regain some of his strength So we pulled away inflammatory foods. We took them off of gluten and dairy while we were waiting for tests to come back You know, sometimes we will do some tests that look at of course. We'll we'll test for celiac disease Or which is a big cause of leaky gut. Yep, that's for sure

Probably the number one. And he didn't have that, but- By the way, you don't have to have celiac disease to actually have a problem, right? You can have, they call it non-celiac gluten sensitivity. I would estimate it probably affects 20% of the population. And I think if you look at the antibody levels, you can get a clue, which most doctors don't look at.

And I read a study that autistic kids and schizophrenic patients often have, 20% of them have antibodies to gluten. And it may not be full-blown celiac. Absolutely. And even, you know, regardless of, even if people are negative totally for celiac, if they have increased intestinal permeability, they start reacting to a lot of different foods. So then you start to see with that leaky gut as we talked about before, the coffee filter

and things are coming through, then the body's reacting to lots of foods that it maybe never reacted to before. So they're not true allergies, they're more like sensitivities. Sensitivities. And because of, and the real thing is it's because of this increased intestinal permeability. So our job is we have to heal that increased intestinal permeability so that they don't have to be so restrictive with their foods. I mean, we still always want them to be on a healthy diet, but we want to relax those restrictions over time.

Most of the time we can. Yeah. And so as part of the approach of functional medicine. We start them on the elimination diet So eliminating all the inflammatory foods gluten dairy processed foods all that stuff and then you remove right? That's the remove in the five R is we remove right replace reinoculate repair balance, yep, and then we'll go into each of those because they're really important but the the The next step is also there's other things we may need to remove.

There's tests we need to do. So what kind of tests would you look at as a functional medicine doctor that you wouldn't see at a traditional doctor's office that give us a roadmap of how to treat these patients? Right. So we did a stool test that looked at his microbiome. And what we noticed is that there was an overgrowth of unhealthy bacteria and unhealthy yeast. So he had this, you know, probably because of years of antibiotics, he developed this dysbiosis, this imbalance in the bacteria and yeast.

And so there was an overgrowth of the unhealthy things. It's like weeds, having a lot of weeds in your garden, right? Right. It's not, it's, it's not always like one of those, you think of a stomach infection and you're getting really, really sick, you're throwing up or having diarrhea. This is this, it's an imbalance and it's called dysbiosis, but that imbalance causes a lot of symptoms in people. When you have the wrong bacteria and the wrong yeast levels, you know, you can get a lot of bloating after you eat, you can get a lot of fatigue after you eat, you can get those symptoms of constipation and diarrhea and

and that causes this inflammation in the digestive system. So all of your digestive enzymes don't work well. So you're not breaking down your food well, you're not absorbing your nutrients well, and it becomes this vicious cycle that people are dealing with and we see all the time. Yeah, it's so it's so powerful So so, you know, you know when I see this patient like, okay You don't do all the tests, but sometimes you get stuck you look at you know, various tests to look at antibodies against things that that are in the gut that Terminal leaky gut right we call this sirex to testing which yeah test you can get you can look right Is there you can test to see can look right, is there,

you can test to see if there's leaky gut. I love that test too because it's a great way for us to follow up and see how much we're seeing improvement. Right. Are we doing enough? Right. Are we seeing improvement in their leaky gut or increased intestinal? And then we look at poop testing. Like you know where we do thousands and thousands of these tests and it's so helpful and it doesn't just look at the microbiome, it actually looks at the function of the gut. Whether there's malabsorption, whether you have no digestive enzymes, whether there's inflammation, whether there's overactive antibodies in there, whether you have imbalances in what we call the short-chain fats, which are the food for the colon that are produced by bacteria

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

we might look at, and even things like heavy metals or other things which can also cause it. I had a patient with ulcerative colitis once and I did everything right. I did the whole 5R, it wasn't working. But I forgot the first part of the R which was removed and I thought well maybe heavy metals

can cause autoimmunity, maybe it's a problem. And so I tested him and he was like wasted away and it was terrible. He actually had high levels of mercury. We treated mercury and his colitis went away so I just phenomenal yeah so I think it's it's so powerful this case is so important because it really describes how a patient you know goes to the show doctor is diagnosed with the disease irritable bowel syndrome by the way anytime you hear syndrome it means doctors know what that's going on it's just a collection of symptoms that

we agree we're gonna put in this, and if you have those symptoms, you're going to have this disease. But it's not really a disease. And so that's what functional medicine is. It sort of looks upstream to figure out what the root causes are and personalize the treatment for everybody. And there's common things that we do, like the 5R, but it may be different Rs for each patient, right? Right.

So for him, we removed the inflammatory foods, him we removed you know the inflammatory foods And we removed the bacteria and yeast I actually treated him with an antibiotic a non-absorbed antibiotic and an antifungal So I treated him with a prescription medication So that was the remove right and then the. Because he was underweight and because of that inflammation in his digestive system, I gave him some digestive enzymes for a short period of time, just to help him, to help it so the food wasn't as inflammatory for him

and to help him absorb more nutrients. And then we worked on re-inoculating, right? So after we gave him some good probiotics. Put in the healthy bacteria. Put in the healthy bacteria. Put in the healthy bacteria. Some good prebiotics. Prebiotics, yeah. Right?

So we know that there's... What are prebiotics? Prebiotics are the things that help feed the good bacteria. So they're the food for the probiotics. Which is usually what? Like fibers. Fibers are amazing prebiotics. We know a lot of phytonutrients are prebiotics.

So this I think is really exciting research when we're looking at of phytonutrients are prebiotics. So this, I think, is really exciting research when we're looking at our phytonutrients. You know, we know that... What are phytonutrients? Right. So I know it's amazing, right? So our food has minerals in it, it has vitamins, but it also has these things called phytonutrients, which are these components in our plant foods that have this amazing health benefits for us. So that can include things like ellagic acid that we see in pomegranate that can feed some of the good bacteria that acrimansia that we know can lower inflammation. We know that

just just to back up on that acrimansia thing. So when we look at the poop, we can tell if there's like good levels of different bugs. Yeah, one of them we look at is acrimansia And it turns out that that is so important for protecting your gut It helps you keep your biofilm or that little coating over the guts You don't have a leaky gut and it's involved in so many autoimmune diseases and response to cancer therapy and Metabolic issues and weight and it's such an overlooked thing. You can't take a probiotic of it at least not yet right but you can feed it the good guys we can feed it we can feed it with all these amazing phytonutrients like the

what's in pomegranate the elegyl agic acid and also we know that sulforaphane from our cruciferous vegetables feeds the good bacteria yeah you know so broccoli collards, but not juicing. Right, Brussels sprouts, all those good ones. We know that green tea, you know, that has good phytonutrients in it that's good for the digestive system. So we always say to people, you know,

get something from every color of the rainbow every day. You know, get some plant foods from every color of the rainbow every day. Get some good red foods like the pomegranate or cranberry Yeah, get something orange and yellow and green blue purple white tan You know those all those good healthy plant foods And that we you know like our vegetables our fruits our spices our teas our coffees really actually are impacting our microbiome Which is is fascinating so great and you know, just a great anecdote

from a colleague of mine, Dr. Lee, who was on our podcast talking about E2B disease. His mother had stage four uterine cancer, and being the smart doc he is, he understood from the research that if you have low acrimansia, patients don't respond to the immunotherapy, what they call the checkpoint inhibitors,

which is this new form of cancer therapy that helps activate your immune system. So if your gut isn't healthy, you can't actually get the cancer cells to die with the immunotherapy. So basically you die unless you have good bacteria in your gut. So his mother had stage four uterine cancer and was going to die and wasn't responding and he gave her pomegranate, cranberry, green tea, all these phytochemicals got her acrimansia levels up and she was cured of her stage four cancer within a month.

That's a phenomenal story. It's an incredible story and I think that just shows the power of the plant foods and of getting focused on the gut. Yes, yes. We call it the you know, we call it the five bar I call it the weeding seeding and feeding program So like you weed out the bad things you see it with the good things and you feed it with good nutrients and stuff

So it's really it's it's so it's so powerful I can't tell you you know as a functional medicine doctor for the last 30 years and you you know been doing this Almost as long the the results you get from focusing on the gut with so many conditions, whether it's autoimmune or whether it's allergic, whether it's digestive, whether it's your skin issues like acne, eczema, whether it's your mood, whether it's weight, metabolism, whether it's migraines, whether it's Alzheimer's,

I mean autism, ADD, it's just amazing when you start to focus on this. So let's break down the the 5-hour program for everybody. So we got the remove, so what are we looking at? We're removing unhealthy foods or or inflammatory foods for that person. So they can be food sensitivities, things like gluten and dairy, the big ones. Food allergies, food sensitivities, yeah. And then we're removing processed food and junk food. Oh yeah, that's for sure. And sugars and you know, excess sugar, which is feeding the wrong bacteria. Yeah. And then we're removing the unhealthy bugs or yeasts or viruses. You might have bacterial overgrowth, yeast overgrowth, a parasite. You know, I was on the Red Table talk and Jada and her son

both had parasites and they both had gut issues for a long, long time. And they thought it was just how they were. But with a short little course of treatment, they were both, I've never felt better. And all these other symptoms come up. Because now you're actually absorbing the nutrients you're eating,

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

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

Uh-huh. Okay, these are among the most prevalent drugs prescribed today in America. Yes. Other than statins, I think. When I was in medical school in the 80s, we just had those drugs come on the market. The drug reps used to come to us and say, these are very powerful drugs. Never use them for more than six weeks because they block stomach acid and they'll cause significant problems if you do that long term. You can cure an ulcer with it, you can fix an acute

problem but never use this. Now people are on this for decades and the side effect which is listed in the manuals that we get as doctors is that it causes irritable bowel syndrome. So you end up fixing the heartburn but you get irritable bowel and bloating and bacterial overgrowth and all these problems. Right, because you need the acid in your stomach. And when you block that acid, then there can be an overgrowth of bacteria where there's not supposed to be.

And that can cause all those slow problems. You also then- Changes the pH, you get more yeast issues and all this stuff. And then you're not absorbing your minerals, so you can get osteoporosis, and you're not absorbing your B12, so you can get fatigue and dementia, right?

It just goes on and on and on. Yeah, you don't absorb zinc and magnesium, minerals, calcium, you cause osteoporosis, pneumonia, it causes, you know, ear well bowel. It goes on and on, right? Yeah. And it takes some work sometimes. When people have been on an acid blocker for a long time

It takes some work for us to help them off because their body has gotten pretty used to it They they start to get their bodies their body wants to make acid so it's it's working against the medicine So when you wean them down, sometimes they get more acid production rebound So you actually yeah, it's like and it's sort of a trick like you get off it, but it makes you worse So you feel like you have to get back on it, but it's actually not true and you can actually yeah, it's like and it's sort of a trick like you get off it, but it makes you worse So you feel like you have to get back on it But it's actually not true and you can actually get off it. Absolutely. We do that all the time We do it all the time. So re inoculate giving all the good prebiotics and probiotics The good bacteria and all the things that feed the good bacteria and then the fourth are is repair

I don't know what probiotics it take. Oh, that's a great question The fourth R is repair. How do you know what probiotics it takes? Oh, that's a great question. Ha ha ha. I wanna know, what are you prescribing? Oh my goodness, that's such a, that goes on and on. We could talk about that for the next hour. Yes, it's true.

Right? There's more and more probiotics on the market every day, and they all have different roles and different functions. Yeah. And we're just sort of, honestly, I think we've been doing this forever, but it feels to me like we're at the infancy of this understanding of how to use these in medicine.

Yep. So what? I mean, there's some great brands that I trust and I use all the time, but when somebody doesn't maybe know what to do, I'll say, go to a reputable place, a reputable pharmacy or a good wellness store pharmacy and get a probiotic, try it, if it makes you feel worse, then stop it. Because there's some good bacteria that make people feel worse. You feel more. Exactly.

If you have bad bugs growing in there and you put the good bugs in there, they have a fight. Yeah. And they cause lots of bloating. And so that means we just have to do more work before we can start it. Yeah. So. So you got to re-inoculate and then you got the and then repair. Yeah, and that's the fourth hour

So that's things like that's like giving good protein good amino acids Which are the building blocks of protein sometimes hair? Yeah to help repair that barrier that that that coffee filter, right? We have to repair it with good protein and sometimes we we use amino acids like glutamine that help repair it. We'll give more zinc, whether it's from food sources or as a supplement. Maybe we'll give some vitamin A, which also helps with healing that barrier. It helps with healing the endothelium in the gut. So those are things we will do to repair. And then rebalance,

right? That's the fifth R, which is really focused on managing our stress and how we're reacting to the world. Because we know that when our parasympathetic nervous system is engaged, when that calming nervous system is engaged through meditation and yoga and breath work, our body has has the ability to heal and it heals better when our body is is is at rest I mean yeah you know you just touched on something very powerful which is that our our gut and our brain are connected there's a whole hard wiring of nervous system in our and the gut even has this independent nervous system that actually is like a second brain.

Yeah. And so, you know, we often say people with irritable bowel are emotional or anxious or have, you know, just maladaptive emotional coping mechanisms. But it turns out that the irritable bowel actually can cause an irritable brain and lead to anxiety and all these emotional issues. So it's bidirectional and I think that's a great lever

for helping people reset their gut. Absolutely. You know, I just wanna share a story because I've been doing this for a long time and of course my, I don't know what it is, curse or blessing, depending on how you look at it, is actually getting really sick and having to figure out what to do to fix myself.

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

it causes leaky gut, it causes yeast overgrowth, it screws up the bacteria in your gut. Until I got rid of the mercury from my system, I couldn't get my gut straight. Yeah, it's impacting your immune system too, right? Right, and then I, many years later, I kinda got an issue which was triggered by an antibiotic for a root canal that I had to take called clindamycin,

which is known to cause C. diff, which is a terrible bacterial infection that kills like 30,000 people a year. And I got that. And I was so sick. And Liz would come over to my house and I was like, it was pretty bad. I'm like, we're all struggling to figure it out.

And I had mold in my house and all these other things, but I ended up having colitis and I had tremendous leaky gut. And I did my own stool test. and my friend Patrick Hannaway who He worked for the stool test company for many years my colleague at Cleveland Clinic He and I looked at my stool test and we probably the between the two of the scene like 20,000 stool tests like this is the worst one we've ever seen and Everything was screwed up and I had no good bacteria, I had low butyrate,

I was not digesting, I had tons of inflammation, it was terrible. And I couldn't really fix it using a lot of the traditional things. And then I started to sort of work on a gut shake, which included a lot of the sort of 5R concepts, right? So I cleaned up my diet, obviously, I got rid of the bad bugs,

but I used a combination of these polyphenols from the plants, a pomegranate, cranberry, green tea, also added glutamine. I added prebiotics, probiotics. I even added colostrum, which is to help regulate the immune system. And it was like a miracle. I went from full-blown colitis to like normal in three weeks.

There's so many probiotics out there. You know, you go to the grocery store, you go to the health food store. There's ones in the fridge. There's ones not in the fridges, but this strain was that strain. Like nobody knows what's going on. Even most doctors have no clue what's going on. So can you, can you define like what's a probiotic and and you know whether we should actually be taking probiotic supplements because you know we've been taught for example that you know you take probiotics they don't really take up residence here they just kind of pass through and do little things and they go on is do they colonize or they not does it matter it matter? And should we be thinking about probiotics from a basic health maintenance perspective?

Should we all be taking them? How do we pick the right probiotic? And should we just be eating sauerkraut and kimchi and forget about probiotics? Can you help us unpack some of that? I think probiotics are fascinating in the sense that anytime a piece of news or press comes out that says probiotics don't work or they don't do this,

it seems that probiotic usage goes up. And so I can't explain it, but people love them, people use them, but the science and the understanding and the development of them is very confusing and varied. And so just to start with some definitions, probiotics are defined as live organisms that confer a health benefit to their host. It's a very simple definition.

Gregor Reed chaired the panel at the UN that wrote it in 2001. At its core, probiotics are, you know, and not a new discovery or not a new hypothesis. You know, typically they were, in the early 1900s, organisms that were isolated that were found to be beneficial and benefit has changed over the years dramatically. I mean, back then it was just keeping your food sterile or safe from pathogens that could be considered a

benefit and preventing you from getting sick from what you eat could be considered a benefit. Today, people look for a lot more complex things. So what is it intended to do and what is the health benefit? That's the question that you have to ask. Anytime you hear the word probiotic, that's what you have to say right back. Say, okay, so it's a live organism. Yes or no. You'd be surprised. Many times they're not live or they're not guaranteed to be live or they don't make it to your colon alive. And so there's a whole spectrum of even that live part. And part two is, okay, so beneficial. What are they beneficial for? What are they going to do? What is the basis for

if they're beneficial or not? I think people confuse probiotics sometimes with fermented foods, which have a very different definition. Fermented foods are microbially metabolized food matter that carry a microbial load. And so that actually was just defined by, in a nature review this year for the first time. And they're both good. They both can be good, or they both could do nothing. It really depends on what you're looking at. So fermented foods are different from probiotics, but sometimes fermented foods can be probiotic. And sometimes probiotics can be fermented foods, but it depends on what they are and what you're trying to accomplish. Classically, probiotics have been lactobacillus and bifidobacterium. Two years ago, the scientific

community convened and said, okay, this is way too generic. And so Lactobacillus actually was broken into about 200 subclasses and was completely renamed. And so we don't really use Lactobacillus anymore, but there's way more genus and species variation now from what was originally called Lactobacillus. Bifidobacterium, at least Lactobacillus and Bifidobacterium, at least lactobacillus and bifidobacterium and streptococcus I would add as the third, are the three class of probiotics

that have been used in food in Japan, in Europe, and predominantly in North America. And so almost every probiotic product that is a microbial product that's standardized will contain or derive some version of these or it's going to come from soil. So that's kind of the landscape, right? When you hear probiotics and we'll get to the cases at the edge a little bit after. I do not think that most people in the absence of any gastrointestinal or gut microbiome related.

People that I call like your super healthy individuals that exercise well, but not too much. They're not elite athletes because that carries its own risk or not over endurance athletes. People that eat virtually no processed foods and that have no environmental toxins in their environment. You've talked before where you can even find that in ways that you wouldn't expect if you could talk about later.

So if you're kind of living in the wild, if you're growing all of your own food, if you're regulating contaminants in your water supply and in the soil of the food that you're eating, and you're eating a very diverse plant and animal based diet,, I think that you're in more or less peak performance. And lastly is you didn't have heavy antibiotic usage either early in life or at any period throughout your life or periods of disruption and recolonization from the built environment, which means you didn't move to a big city or an urban dwelling place and change your microbiome away from what you would get in the countryside or in a more agrarian

or a more kind of wilded environment. So these people that meet those conditions, I would say, you probably are doing just fine. You don't need to do too much. And a simple microbiome test will tell you, you know, what you need, what you don't need to do too much. And a simple microbiome test will tell you what you need, what you don't need. The converse of all of those are people that live in kind of more of the modern world. And so you're getting, you know, you're bathing using modern and eating modern foods or packaged foods or foods bought from a grocery store. You're drinking beverages which are contained in some container. You're generally using urban infrastructure and you may or may not have gastrointestinal or related to gut microbiome

maladies. This is kind of that area that I want to focus on where I say probiotic usage is the most impactful. It could be the strongest and it could be the most helpful. My hypothesis why is that people that are in this environment actually have a very low microbial inoculation. So I don't know if when you're in medical school, you heard this theory that actually they were giving people with IBS or IBD helmets, they were giving them like known worms basically. And they found that actually it was very effective.

And I don't know if it was an urban tale or not, but the idea is that, remember what I said about being born inflamed, right? That an active immune system has to be active or has to be inactive, and that's very context dependent. So I've actually even heard many in the field and on this podcast talk about the indigenous

microbiome or the hunter-gatherer microbiome and kind of define it as this optimal state, but optimal for who? If you took this microbiome and you transplanted it to an urbanite living in New York City, that person would probably get very sick. I remember when the Amerindian project was happening, it was Maria Gloria Dominguez-Bella, it was Marty Blazer, a lot of the missing microbes people that were involved in characterizing the northern Amazonian microbiome and actually they went for six weeks to go live like them and see how their microbiome shifted. This was an experiment from the mid to late 2000s. And I remember Gloria telling me that she could do everything. She could follow all of their practices except for she snuck a little toothbrush with her and snuck away to brush her teeth every night because that's the one thing she couldn't give up. But you know that's that's what it means. That's what it means to live like that. It means that you're taking it all.

So with probiotics, I mean, there's a lot out there. And what's important to think about, if people are trying to choose a probiotic, how do they evaluate it? For example, when people are choosing a vitamin, I'm very clear with them. They need to make sure that the product is in the right form. So in other words, the right version of that nutrient.

For example, if you're taking folic acid, maybe you need five methylfolate, as opposed to just folic acid. Or if you need magnesium, maybe you need magnesium glycinate or magnesium threonate instead of magnesium oxide which isn't well absorbed. Second you need to make sure that what it says on the label is actually what's in the bottle that things are third-party tested to be there for both purity and potency. In other words there's no contaminants or toxins and it

actually is what it says on the bottle that there's no weird stuff in it like allergens fillers, excipients, colors, dyes, sugar, lactose, gluten, all that stuff can be in vitamins and I and I think you know it has to be bioavailable in terms of the form it also has to be absorbable so if it's in a crushed tablet that's under tons of pressure, it might be the right everything, but you might not digest it. So tell us about, how do we think about probiotics? Because you know, should we be taking hundreds of different strains?

Should we just take one? How do we know what's good? How do we know? I mean, if you buy something in the store, it says 50 billion units on the bottle. Is it actually that? Like, how do we know? What you would be thinking about?

It's a very simple rule of thumb for people is there's two major classes of probiotics. One is targeted for a specific indication. I want to lose weight. I want to improve my mood. I want to signal to improve my skin. They're very different microbes that work on these different axes.

And they're usually very specific. So it's not necessarily a bunch of bugs that will do that. But you could find ones that are very targeted, that have that targeted effect. And so I think that this is bucket one. Bucket two is your general. Well, I just want to stop there for a second. That's an incredible statement you just said, was that there are different strains of probiotics

that have different effects for different diseases and conditions. And some may be good for your skin. Some might be good for your brain. Some may be good for your immune system. Some might be good for your heart. Some might be good for your metabolism, regulating your blood sugar. I mean, it's quite interesting, the differential ability to determine which probiotic is good for which thing. And that is something that's pretty new. I mean, it's almost like personalized probiotics. Well, you're not gonna get that from one or two bacteria.

And so you have to either only take one benefit you're looking for, or you have to take a more complex consortia. And so it's not that you need a hundred strains, but if you want to maximize the outputs, you generally want to see more microbes adding up together to create broader spectrum effects. So there is a kind of network effect, if you

will, going on on which probiotics you take and for what purpose you are taking them. That second category of probiotics is, well, what is your know, you hear all the time somebody say, oh, well, I take, I get my probiotics from kimchi or I get my probiotics from a nutritional shake or well, you get back, you get one or two strains of bacteria or you get kimchi organisms, but you can't say that that is going to therefore be equal to a strain which is proven to signal to you to the gut barrier or a strain that regulates cholesterol uptake or a strain that works on evacuation disorders to relieve constipation. I mean all of these are different mechanisms and they're coming from different strains. That's why again I think I want to emphasize consortias are so important. Which bacteria? I mean when you say consortia, I mean a lot of different strains that have a lot of strains yeah together together. So keep going on on how we know to pick the right one or the right strains then. So now you've kind of asked your first sequence of questions. Do I want a broad spectrum consortia

for many different things, or do I want something more targeted? From there, you need to assess if what you're picking is good. And there's three layers to it. There's purity, there's potency, and there's efficacy. Purity means that there's the bacteria which are Ulysses and none others. It's very simple and that's done by very good quality control. So you're sequencing at the level of individual genes, all the bacteria in your product, you

know them, you get a fingerprint every time you do a fermentation, every time you do a production you get a fingerprint and you know that those organisms are there and nothing else is there. And so this is the most important question to ask from a sake of purity. Potency is not just what's written onto the label because that can be very misleading. So there's products in Japan that say that we have one trillion organisms or a yogurt starter culture from Australia that says we have one trillion bacteria. There's kind of your and you know V.S.L. three kind. Your gastro intestine gastro enterologist recommended probiotics that are 300, 400 billion, where you see these big,

big numbers on them, but you have very kind of high die-off, either very high die-off when it comes into your stomach right away, or it's typically only one strain or one species. Even if there's listed eight or nine different strains on the label, it's predominantly one. The number one gastroenterologist recommended Probiotic has nine strains listed on its label, I believe, or eight, but it's 96% yogurt starter culture and the rest are small, like tiny byproducts. Potency is very important. Potency is very, very important, but at the level of throughout the entire gastrointestinal tract is something that I take very seriously. In other words, you could take a probiotic, it looks good in the bottle, everything's in there, but you eat it, take it as a pill and it gets digested in your stomach and kills everything.

Yeah, or what's never even, what's listed is never even alive by the time it makes it. And so maybe you see 100 billion written on the label, but there's 99% die off by what reaches the colon. So you're not gonna get much organic acid production with 99% die off before it even gets where it needs to go. So the back, here you have to make sure you know you're taking a multi multiple consortium of what you call consortium of bacteria that all have different scientific evidence behind

them because there's a lot of stuff out there that doesn't. But there's a lot of evidence around a number of bacteria that have very specific effects on the GI tract, on the immune system, on heart health, on metabolic health, on immune health. So we can use that data to start to design probiotics that actually make sense. I want to walk you through how to do this. I'm going to teach you how to hit the reset button, reboot your system, and to optimize your biology to help your gut, help your detox system, help your immune system, help reset your nervous system and it's powerful. So if you want to really see how your body can feel and get rid of

what we call FLC syndrome, I would do this. Most people are like the frog that's in cold water where you turn the heat up slowly and it starts to boil to death. We just kind of get used to it and think it's normal. These symptoms are not normal. I want to do this with a junior high school once and the teachers are like, well, we might have to get permission from the parents to see if it's safe. Maybe they don't want their children doing this. I'm like, what is it safe to eat fruits and vegetables and nuts and seeds and protein

and cut out sugar and starch and processed food? I mean, they should get a note that it's permission to eat the junk food that they have to. It's the opposite. But anyway, yes, very safe. Anybody can do this. And some people, by the way, need more certain things or other things but but basically it's a very universal approach to resetting your system. A second pillar aside from what you need the food is really important and by the needy approaching the morning you need to make

sure you get rid of sugar and starch in the morning super important when making will start their diet their day with carbs which is the worst thing you can do with sugar sweetened coffee, teas, cereals, muffins, big old breads. Done. Second pillar are your daily habits. The strategy of mom's a pattern of eating and living that puts your body back in rhythm, it helps you reset your nervous system. And there's two really important habits part of the ten-day detail. One is when you eat and also when you sleep. Let's talk about when you eat. Now when you eat might be as important as what you eat. So many of us don't eat in the right pattern. We tend to

you know, eat all day long, we can snack, we can eat before bed, we snack late at night. It's kind of bad. So basically when you eat is very important research shows that doing that Can really be bad for your health if you eat at night So the first is make sure you give yourself at least 12 to 14 hours between dinner and so dinner is six Breakfast at eight. That's a 14 hour fat. Okay, if you eat at six and then you keep snacking all night That doesn't help, right? And it's the most simple form

of what we call timer-trick-and-eating. And it's basically giving your body a rest and getting the body to reset. And I wrote a lot about this in my book, The Young Forever, but basically there's a whole process at night that happens called autophagy, clean up, or care. You want to eat your body, the ability to do that. The next is food. Now you can do a breakfast if you're eating, you know, for example, you want to eat your body, the ability to do that. The next is food.

Now you can do a breakfast if you're eating, you know, for example, there at six and breakfast at eight or so, that's a 14 hour fast. Really important to have protein in the morning or not carbs and sugar. Also not eating three hours before bed is really important. So most people eating that after dinner, don't do that. Have at least three hours of time you eat and you go to sleep. That way you will lose weight, your body can repair and yield, instead of trying to digest and store the food. What about sleep? Sleep is one of the most underrated pillars of health. It's probably

even before exercise, meditation, maybe even before nutrition. Because when you don't sleep well, you're going to eat sugar, arms, you're going to need more. So you want to focus on sleep and restore your rest. We know that getting in a routine of waking and sleeping can help with that deeper and more restful sleep. So try to take the same mid-time every night, try to get off your screens for an hour, two before bed, keep your room dark, use blue-blocked glasses, keep your room dark and cold, probably 5 to 6 to 8. Very important because your body does much better with sleep at night.

Try to relax at night with meditation, do a god imagery, do breath work, stretching, journaling, gratitude practice, whatever you like. But do something. Very important. So your evening routine should be like set a bedtime of 6 to 10 days. Turn your phone off and get out of your bedroom. Turn the TV off for at least an hour before you go to bed time is six, go over 10 days, turn your phone off and get out of your bedroom. Turn the TV off for at least an hour before you go to bed. And then use the time at night to read, to journal, meditate, to connect with people

you love and just kind of wind out. Oh, and the third is extra support we need on the journey, right? Now, we all need nutrients. They're called vitamins because they were vital amines, vital to life. And so we've seen a dramatic reduction in the nutrient density of our food, our organic matter has gone out of our soil, nutrients can't be extracted, foods travel long distances, we have muddy crops with your bread to actually breed out the nutrients and in the starch and, and, and, you know, yield. And so foods aren't as nutritious as they once were. And probably 90% of Americans, according to the government

own surveys are deficient in one or more nutrients at the minimum level, prevent deficiencies. How much vitamin do you need? You need to not get rickets? Not very much, like 30. How much you need for optimal health? Probably 3,000 to 5,000. So we need to really probably focus on nutrients and even with a perfect diet, because none of us are hunter-gatherers anymore, all kinds of food that we never ate and nutrients depleted.

We need the basics. So we need a basic set, some's a multivitamin mineral foundational. Magnesium, a lot of us are deficient, probably 45% are low or deficient in magnesium, involving over 300 different enzymatic reactions. Sleep is important, helps you relax your nervous system at night, help you calm down. Also people get constipated sometimes

when they change their diet. So taking magnesium citric can help. And lastly, vitamin D. It's also a fish oil, but vitamin D is really important. Vitamin D over 80% is low, deficient in vitamin B. It's involved in so many different things in the body. So really important. And it's your mood, muscle function, helps your brain, your energy,

um, inflammation, autoimmunity. It's just super important. And most of us are low. Fish oil is also important. And I, I often recommend fish oil to people or omega-3 fats. So what are the program steps in the 10-day diet? What should be the tips? And then we're gonna go to the first step is to eat

from the 10-day detox of food lifts for 10 days. So eat what is all you need. Whole foods, you know, whole food based shake in the morning. You could add, you know, protein powder, grass protein if you want to have a grass protein called super simple protein. But you really need to make sure you have good breakfast. Second is commit to daily habits, right?

Pick your designated eating window, right? You want a 12 to 14 hour night fast, which means eating within a 10 or 12 hour window. Don't snack before bed. Try to have the same bedtime, get off your technology an hour or two before practice some active relaxation, huge impact on your health. Step three is adding the supplements that you don't have to do this, but I really encourage people to have a multivitamin magnesium, vitamin D and can be fish oil and we're going to list which products you should take in the show notes so you have it all listed there.

Also, what you should eat and what you should avoid during your 10-80 talk, let's go through that. So here's a full food list. You can, you know, we're gonna have it in the show notes. You can take it with you to the store. It's in the book, the 10-80 talk. It's in the 10-80 cookbook. But essentially, here's what you should eat

and what you should actually get rid of. What you should eat is protein. You need to eat right, protein, right? So grass-fed or originally raised meats is great. You can have a path to raise lamb, beef, bison, venison, elk, grass-fed beef, industry-raised chicken, turkey, duck, all that's fine. What you should avoid is can basically raise chicken and poultry and eggs and so forth. industry is chicken, turkey, duck, all that's fine.

What you should avoid is conventionally raised chicken and poultry and eggs and so forth. And by the way, you can also have eggs, they're naturally raised eggs. Meat get rid of all processed meats, deli meats, all conventionally raised feedlot meats, get rid of all that. But buy fish and seafood. Lots of small fish are good, big fish are bad, right? Big fish like swordfish, tuna, fillet, sea bass, halibut, most of small fish are good, big fish are bad. Big fish like swordfish, tuna, sea bass, colobit, most farmed fish are pretty bad for you. What you should be consuming are

things like the colobit, small wild salmon, sardines, anchovies, herring, mackerel, black cod, shrimp, scallop, trout, all other things, as I said, pastries, eggs are fine, non-organic, regular eggs are. What about nuts and seeds? Very important. Almonds, basil nuts, cashew nuts, hazelnuts, macadamia, pecans, pine nuts, pistachios, walnuts, all that's great.

You can have cacao nids, chocolate, not actually chocolate, but where chocolate comes from. Seeds are great, chia seeds, flax seeds, hemp seeds, pumpkin seeds, sesame seeds, sunflower seeds, pumpkin seeds, all great. Nut butters also great. So unsweetened nut butters, so almond, cashew, pecan, macadamia, I love macadamia.

Walnut, all that's great. You also eat beans if you're a vegan and you want to do this. You can use GMO free or non-GMO tofu or tempeh as your protein. What you should avoid are nuts. They're with sugar. They are cooked in oils that are basically candy and stuff. A lot of nut butters have sugar, hydrogenated fats.

Peanut butter, peanuts can be okay but I would say mostly avoid peanuts because they have aflatoxin, often arancin and so you want to be careful with that. What about oils and fats? Well the ones you want to use are organic avocado oil. You can use organic coconut oil for cooking, grass-fed ghee. If you want to use tallow, lard, duck fat, chicken fat, that's okay as long as they're pathetraise or regenerative race. For salads, you can use different kinds of oils like almond oil, black salt, hemp oil, and olive oil. And you can cook with olive oil, but only like tomato sauces

and things like that. I think they're not high in sesame oil, but only like tomato sauces and things like that. Things that are not high heat. Sesame oil, tahini is great as well, great fat. Sesame seed kind of tastes like walnut oil. Those are flavorful oils, they're not main oils. But you want to avoid the traditional oils. All the seed oils like canola oil, partially hydrogenated oils, margarine, peanut oil, soybean oil, sunflower oil, safflower oil, trans fats, vegetable oil, vegetable shortening, all that stuff. What about veggies? What should you eat?

Well, you want to stick with lots of non-starchy veggies or orange chokes. Are organic if you can. I use the Dirty Dozen guide from the environmental working group, ewg.org. Tell you which are the clean 15, meaning you can eat things that are not organic or the Dirty Dozen, which you can definitely not eat if they're not organic. But I love asparagus, artichokes, avocado, bean sprouts, broccoli, brussels sprouts, cabbage, cauliflower, celery, cucumber, eggplant, garlic, ginger, hearts of palm, harabi, lychee greens, mushrooms, all kinds, onion, peppers, radicchio, radish, rutabagas, all the kind of stuff.

Seaweed is great, lots of minerals, shallots, summer squash, tomatoes, turnips, zucchini. List goes on, we have all in there. You can have some things like sweet potatoes. I like the Japanese purple sweet potatoes with your squash, carrots, pumpkin. All that's fine. I mean, carrots are fine because unless you're drinking carrot juice or that problem, but basically try to limit to like one serving which like half a cup a day. What you should be avoiding is corn or potatoes mostly. A little you know

some of the little fingerling potatoes or the pruning potatoes, purple potatoes. What about dairy? You can eat pasture raised butter or ghee but I encourage you to get all dairy including sheep and goat which are mostly fine for people but I encourage people to get all other. If you're having, I encourage you to get all dairy including sheep and goat which are mostly fine for people But I encourage people to get all other if you're having Be encouraged you have make sure it's grass-fed or we're generally raised what about bees well you can have green beans You're gonna have green peas You can have a non-gmo Organic soy that's just tofu or tempeh

You know That beans you can have snow peas, but otherwise definitely no beans. What about grains? No grains at all. So even healthy grains, quinoa, buckwheat, things like that, I can really get off all of that. Why? Because it just shuts down the insulin response,

helps you lose weight, reduce inflammation. Not that these are all bad, but eventually you'll have them back. But basically get rid of all the other grains. Wheat, barley, rye, right? Emerald millet, stuff. Oh, it's everything. Get rid of it.

Fruit, fruit can be okay, but small amounts. Non-hyglycemic grains. So, organic blackberries, blueberries, raspberries, kiwis, lemons, limes, raspberries, all that's fine. Not too much, right? You know what I mean? Like, you know, two pounds of blueberries, but you can have half a cup of it.

One together with all the other fruit, all the high glycemic fruit like bananas, pineapple, melons, cherries, grapes is the worst. Even fruits that you think, you know, maybe good for you are actually good for you, right? Whether it's, you know, peaches, pears, nectarines, cherries, for example, but you don't want to eat them while you're on the 10-day diet. You want to really shut down the blood sugar and cholesterol. What about sugar sweeteners? Sorry, the tip. You can sometimes add a little bunk food or stevia. You have in the shake. We have, but generally tend to avoid all that stuff.

Um, also just get them all the other part of things, the street nurse, sugar, all that stuff. If you have to ask me if you're basic, right here, um, then what should you be drinking? Well, lots of water herbal tea, green tea, uh, caffeine. That's okay. A little green tea is fine. It'll be going to stop be sparkling water, mineral water,

all the way to avoid alcohol, coffee, bottled water, poppy, soda, obviously sugary beverages. Basically that's the program. So if you eat that way for 10 days, you know simple habits, your body is going to totally transform and you're going to see just how food is impacting your health, which is something most people don't have a clue about. That's why I love this so much. Now after the program, it's really important that you do it for 10 days or 21 days or 10

weeks or 10 months. You have to be smart about getting getting offset or you can get a big trouble. Because when you go off of foods that are inflammatory, foods you're learning to and then you reintroduce them, you can get all worse symptoms. Let's say you had migraines before and they're gone, wow you're gonna get a doozy of a migraine. Let's say you had gut issues before, you had a real problem. Let's say you had sinus congestion from eating dairy and then you eat it again, you might get a sinus infection. So you really have to be smart.

So if you're feeling great and you wanna continue and you have a lot of weight to lose, say you have immune disease, say you just wanna you're feeling great, you wanna continue, no problem. You continue it, continue to do it. You can do it for another 10 days, you can do it for another 10 months.

It's totally safe to eat. It's pretty much how I eat most of the time are the occasion grains and meats. Do you have a question about my favorite books, supplements or recipes? Then sign up for my free Mark's Picks newsletter at drheimann.com slash Mark's Picks, where I'll share all of this information with you

and so much more. You'll get emails from me every Friday with recommendations on things that have helped me on my health journey, and I hope they can help you too. Thank you so much again for tuning in. We'll see you next week on the Dr. Hyman Show. If you love this podcast please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to

hear your comments and questions. Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more Thank you so much again for tuning in We'll see you next time on the Dr. Hyman show This podcast is separate from my clinical practice at the Ultra Wellness Center my work at Cleveland Clinic and function health where I am Chief medical officer this podcast represents my opinions and my guests opinions neither myself nor the podcast Endorses the views or statements of my guests

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