The Dr. Hyman Show - The Most Important Molecule for Health You Have Never Heard Of: Nitric Oxide with Dr. Louis Ignarro

Episode Date: April 7, 2021

The Most Important Molecule for Health You Have Never Heard Of: Nitric Oxide | This episode is brought to you by BiOptimizers, Thrive Market, and Beekeeper’s Naturals What if I told you one single thing could work as an anti-inflammatory, antioxidant, neurotransmitter, and vasodilator and that it helps promote memory and learning, increase arousal in both men and women, protect against sun damage and skin cancer, and regulate digestive enzymes and hormones? You’d want some of that, wouldn’t you? Well, nitric oxide is capable of all of this and more. Our bodies naturally produce this molecule but, due to lifestyle factors, some of us make more than others. Luckily for us, there are many things we can do to increase our nitric oxide levels and reap the health benefits.  Today I’m honored to sit down and talk with the man who actually discovered nitric oxide, Dr. Louis Ignarro. Dr. Ignarro is a medical research scientist who was awarded the Nobel Prize in Medicine for his breakthrough discovery of nitric oxide and how it positively impacts health and longevity. His groundbreaking research on nitric oxide paved the way for—among other innovations—Viagra. He is an award-winning Distinguished Professor Emeritus of Molecular & Medical Pharmacology at the University of California, Los Angeles, and has his Ph.D. in Pharmacology with over 35 years of experience teaching.  This episode is brought to you by BiOptimizers, Thrive Market, and Beekeeper’s Naturals. Right now, BiOptimizers is offering my community 10% off their CogniBiotics, a brain and mood-enhancing probiotic that contains specifically chosen strains with a high level of research supporting mental health and performance. Just go to cognibiotics.com/hyman and use code hyman10 at checkout. Thrive is offering all Doctor's Farmacy listeners an amazing deal. You will receive an extra 25% off your first purchase and a free gift when you sign up for Thrive Market. Just head over to thrivemarket.com/Hyman.  For a limited time, Beekeeper’s Naturals will ship you a free two-week supply of B.Immune Propolis Throat Spray—you just pay $5 dollars for shipping. To take advantage of this amazing deal, just head over to beekeepersnaturals.com/HYMAN.  Here are more of the details from our interview:  The observation that first got Dr. Ignarro thinking about nitric oxide (6:24) How statin drugs boost nitric oxide (11:28) The link between nitric oxide, inflammation, and antioxidants (14:39) The surprising development of Viagra (16:18) The many beneficial effects of nitric oxide (21:10) How to boost nitric oxide with food and supplements (28:50) How exercise boosts nitric oxide (44:14) Producing nitric oxide with your breath (48:42) Using nitric oxide to treat Covid-19 (54:02) Learn more about Dr. Ignarro and his work at http://www.drignarro.com/. Follow Dr. Ignarro on Facebook @DrIgnarro and on Twitter @DrIgnarro.

Coming up on this episode of The Doctor's Pharmacy. Antioxidants can increase nitric oxide. Why? Because the antioxidants destroy the free radicals that go after nitric oxide to destroy the nitric oxide. So antioxidants will boost nitric oxide simply by stabilizing the molecule. Hey everyone, it's Dr. Mark. If you've been listening to the podcast for long, I'm sure you've heard me talk about the gut-brain connection. Now this powerful link means that an imbalance in the gut can cause a huge range of brain symptoms, including mood imbalances, things like depression, anxiety, which might be a little surprising. But when you consider that 90% of our happiness hormone, serotonin,

is made in the gut and that our gut microbes can influence the vagus nerve, which travels all the way up to the brain, it starts to make sense. This isn't something we can afford to ignore. I mean, 1 in 12 Americans suffer moderate to severe depression. That's over 17.3 million people. And chronic anxiety is experienced by 40 million Americans. Now, anytime I see a patient who has any type of mood issue, I make sure we look at their gut. There's almost always an issue there, whether it's inflammation from a

food sensitivity, lack of beneficial bacteria, or a slew of other factors. When the gut heals, the severity of the difficult emotional problems can actually get better. And that's why I'm so excited to find out about Cognibiotics from BioOptimizers. Cognibiotics is a brain and mood enhancing probiotic that contains specifically chosen strains with a high level of research supporting mental health and performance. Cognitive Biotics also contains 17 nootropic and adaptogenic herbs, which work in synergy with your gut bacteria to boost cognitive function, mood, and improve your stress resilience. This is an amazing combination of probiotics and herbs to help support an optimal gut-brain connection. If you want to support your own gut-brain connection,

BioOptimizers is offering my community a special deal of 10% off. Just go to Cognobiotics.com forward slash Hyman and use the code Hyman10. That's Cognobiotics, C-O-G-N-I-B-I-O-T-I-S.com slash Hyman and use the code Hyman10. Cognobiotics comes with a full one-year guarantee. So try it risk-free and see for yourself how much better you can feel. Starting the morning off right has a huge effect on the rest of the day. Personally, I love having a super nutrient-dense gut healing smoothie for breakfast so I can feel energized, focused, and balanced all day long. I like to use a ton of green leafy veggies, healthy fats like avocados, nuts, and seeds,

a handful of antioxidant-rich berries, and then some good gut foods like prebiotic fibers and collagen peptides. Now, you might have noticed that collagen has gotten a lot of hype lately, and I know a lot of nutrition trends come and go without the science to back them up, but collagen is one we can all actually get excited about.

It's great for supporting healthy bones, nails, skin, and joints. And as we get older, collagen production slows down. So I love using collagen peptides to support connective tissue and my gut health. But quality is key. My favorite collagen is from Primal Kitchen because it's grass-fed and it doesn't have any fillers, artificial ingredients, dairy, wheat, or soy. I get Primal Kitchen collagen peptides at an amazing discount through Thrive. Thrive Market members save an average of $32 on every order when compared to other retailers and they have a huge selection of natural and organic and even regenerative foods. They make it easy to

shop by diet type, get frozen bulk grass-fed meats, wild-caught fish, or even skincare products and cleaning products shipped right to your door all at a huge discount. And right now, Thrive is offering all Doctors Pharmacy listeners a great deal. You'll get an extra 25% off your first purchase, plus a free gift when you become a Thrive Market member. Anytime you spend more than $49, you'll get free carbon neutral shipping. Just head over to thrivemarket.com forward slash Hyman to use the offer. That's thrivemarket.com forward slash Hyman to use the offer. That's ThriveMarket.com forward slash Hyman.

And now let's get back to this week's episode of The Doctor's Pharmacy. Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman. That's pharmacy with an F-A-R-M-A-C-Y, a place for conversations that matter. And you may not know why this conversation is going to matter to you, but it will because it's about everything that matters about your health in terms of longevity, your cardiovascular health, your sexual health, your blood vessel health, and lots more. So we're going to be talking with an extraordinary man, our first Nobel Prize winner on the doctor's pharmacy, Dr. Louis Ignaro, who's discovered nitric oxide, otherwise known as NO. He won the Nobel Prize in Medicine for this, and he discovered how this impacts our health and longevity.

So you want to listen up. You might not really know about this molecule, but you probably do, even though you don't know you do, because if you've heard of Viagra, it's how Viagra works. And so you better listen up, because getting your nitric oxide up is important to getting everything working. So he's a professor emeritus in molecular medical pharmacology at UCLA. He's got a PhD in pharmacology.

And he's just an extraordinary guy who's been teaching. And he's even one of the first speakers at one of the Institute for Functional Medicine's annual conferences. He started up a biotech company that focused on using nutritional supplements to boost the body's nitric oxide production. We're going to hear all about that. So welcome to the doctor's pharmacy. Thank you.

Thank you, Dr. Hyman. It's really great to be here. I look forward to this. Well, you know, I think, you know, I really am so in awe of scientists who spend their life digging into questions that seem so obscure and irrelevant, but end up solving some of our biggest problems. And we were chatting a little bit before this about your tenacity and persistence.

You were very humble and said you weren't that smart, but you worked hard. And I think there's probably a combo of working hard and high intelligence, because nobody gets a Nobel Prize by accident. And you discovered this amazing molecule, nitric oxide, which is key in the cardiovascular system and helps your blood pressure and your blood vessels stay healthy.

So tell us about for those uninitiated medical people, what what is it? And how did you first how did you first get into even thinking about it that led to the Nobel Prize? Yes, well, I'm happy to talk about it. It actually started way back when I was in high school, when I noted that so many people got heart attacks and strokes, whereas an equal number of people were perfectly healthy. And what I was able to see and figure out was that the people who had the cardiovascular disease were obese and also led a sedentary lifestyle. And so I was thinking about it. I had not really taken too many science courses.

And I came up with a hypothesis that maybe maybe our bodies produce a molecule that protects us against high blood pressure, heart attack, and stroke. Some people make this molecule. Some people don't. Well, 15 years went by until I finished graduate school, medical school, and started researching in the laboratory. And it was a roller coaster ride up and down, up and down. And eventually, in the 1980s, I did make that discovery that our arteries actually produce a molecule that lowers the blood pressure and prevents inflammation of the arteries, which means it has the potential, right, of preventing stroke and myocardial infarction. And so after a couple of years of study, very difficult studies, we were able to identify and isolate this molecule,

and it turned out to be nitric oxide. And that was very difficult because, you see, nitric oxide is a gas, just like oxygen or CO2. Is that like laughing gas? Is that what it is? No, no, no. Laughing gas is nitrous oxide, which is N2O, and nitric oxide is NO. And believe it or not, even though the chemistry sounds similar,

they're remarkably different. And so nitric oxide is not laughing gas. It's no laughing matter for sure. It works in very, very low concentrations. Was that a pun? It's no laughing matter, N-O? Right, exactly. So that's how we initially discovered it. Of course, it's more complicated than that. But the point I want to make is that I had an idea before I took my first course in science. I had an idea.

And I shared that with some of my friends, some of my teachers who said, OK, you know, you should be a scientist and see if that's true later on. And that's what I did. So I had an idea. I went after it. When I got my doctorate degree, I did not go after a simple problem to solve in science. I wanted to use something that nobody else had done. I wanted to develop or follow a path that no one else had followed. That's what I had in mind. And so I worked hard, did the necessary experiments,

most of which failed, but certain ones were successful, and that's what led me to the initial discovery of nitric oxide. That's an unbelievable story because you basically hypothesize the theoretical existence of some unknown molecule that no one had ever discovered, and had this crazy idea and went after it. How do you even begin to go, gee, I'm going to go try to find a molecule that no one's discovered? Well, that's why it took 30 years to find. I had no idea where to start. But I remember when I gave my Nobel lecture in 1998 in December in Stockholm. And no one had heard that story before. It's just my own story. But when I was done, in the next three days, the members of the Nobel Foundation were intrigued that I had that idea so many years before. To me, it was a natural idea. People who

are obese and lead a sedentary lifestyle are the ones who get the heart attacks and stroke, and everyone else didn't. And those people were thin and exercising all the time and ate a healthy diet. And so, you know, I mean, I was aware of this way before, as you know. That's amazing. I mean, way before the rest of us you know became aware of healthy lifestyle i want to get into the exact reasons why nitric oxide is so important in our biology and all the different things it does everything from heart health to sexual health yes but uh what's what's fascinating to me is that is that nitric oxide is this very quickly formed and eliminated molecule, but it's so important.

Well, what really struck me was when I started research about the effect of statin drugs, which is the number one selling drugs in the world for lowering cholesterol, and I began looking at the research on cholesterol, it didn't really seem that the cholesterol-lowering effect of the statins was the real reason that it had all the benefit. That you could look at people who had high LDL, but if they didn't have inflammation

and they had these other issues, they'd be fine. And one of the mechanisms of action of statins is it increases something called nitric oxide synthase, which is a enzyme that makes nitric oxide. So I'm wondering what you think about that theory, that maybe it's the effect of nitric oxide and not the cholesterol-lowering issue around heart attack. To me, it just seems like a no-brainer. Well, I'm so happy that you understand that because a lot of people don't. Most physicians don't. I'm a little weird. So all this time, I thought that, you know, the statins work by altering cholesterol metabolism

and on and on. And then but then there were a couple of abstracts, I remember a couple of papers that came out publications. And I heard at a meeting showing that what exactly what you said, that some of these statins can upregulate the enzyme that is create more enzyme NO synthase. And that's the enzyme that makes nitric oxide. So if you have more NO synthase, you have more NO. And, and people reproduce that work. And I remember that I met Joe Goldstein at a meeting. He was one of the guys who shared the Nobel Prize for discovering cholesterol metabolism and their work led to the statins. And I said, you know, you realize that, of course, the bottom line is really nitric oxide. And what did he say? He laughed and said, get out of here, you know, and he walked away. But I think that one of the major effects of the statin drugs is to boost nitric oxide because nitric oxide prevents inflammation of the arterial wall.

That will prevent certain blood cells from coming in to deposit cholesterol plaques and develop atherosclerosis. And that is why our arteries make nitric oxide. We make nitric oxide in order to protect us against hypertension and protect our arteries against inflammation and prevent unwanted blood clotting. Nitric oxide. Very potent that way. So if you prevent unwanted blood clotting, you can prevent a stroke.

If you prevent inflammation of the arteries, that certainly will go a long way to preventing the development of coronary artery disease, right, which causes myocardial infarction or heart attack. Yeah, absolutely. and i think what's striking is you know stands have we call pleiotropic effects they have multiple effects they lower cholesterol they increase nitric oxide they decrease inflammation through other mechanisms and lower c-reactive protein that may be the the real way they work but what's really fascinating to me is is this link between nitric oxide and inflammation. Because anybody who's listened to my podcast or understands my work around the role of food as medicine is that

inflammation is the driver of almost all the major chronic diseases we see today. Heart disease, cancer, diabetes, Alzheimer's, autoimmune disease, all these diseases are driven by inflammation. So it seems like nitric oxide could play a big role in modulating these diseases or influencing diseases. That's exactly correct. Nitric oxide has pretty powerful anti-inflammatory effects. And the reason is that nitric oxide is a free radical, believe it or not. It is a free radical, but it's a fairly safe free radical.

And what free radicals like to do is to interact and find other free radicals so that they can react covalently and take them out. And that's what nitric oxide does. It is an anti-inflammatory because it goes after other radicals, whether it's oxygen radicals, like superoxide, or fatty acid radicals, for example, that hang around in membranes. And by- Rancid fat in your arteries, right? Exactly. And by neutralizing those free radicals, then by definition, nitric oxide is anti-inflammatory.

Actually, we can say that NO is antioxidant. You know, in many cases, believe me, after all the years of research I've been involved with, antioxidant and anti-inflammatory are very similar phrases. It's almost the same thing. Absolutely. It's incredible. So, let's talk about some of the mechanisms because, you know, what was going on with Viagra was fascinating because it was designed to be a blood pressure drug and it didn't really work that great, but it had this side effect that people complained about, or maybe they were celebrating. I don't know.

And that's what happened. And then there's this blockbuster category of drugs, which are these drugs that actually increase nitric oxide. And tell us about this sort of relationship between blood vessel health, blood pressure, blood organ flow, because really where blood goes is where health goes, right? So. Of course, of course. Well, I can tell you a little bit more about Viagra and the development, if you like. I mean, as you said, so when Viagra was first being developed, it was actually tested to see if it could lower the blood pressure in humans. And they found that if they raise the concentration high enough, it was still very safe and could lower the blood pressure.

But unfortunately, or fortunately, depending upon how you look at it, a side effect was produced. And that is all the male volunteers who were in this study developed an erection, whether they wanted to or not. And appropriately, this was noticed by the nurses who were running the study. I didn't want to hear about that. I was on the advisory, scientific advisory work with Pfizer for a long time before, a while back. And so what happened was that Pfizer did not want to deal with this. They had no concept then that this could be a useful drug to treat erectile dysfunction. But because of the side effect, side effect they said listen we're not going to mess with this so they stopped developing the drug to put the drug on the shelf then i published my

work in 1992 in the new england journal of medicine that nitric oxide because we had shown for the first time the neurotransmitter released from the nerves that causes penile erection was not known. That's why no drugs could be developed to treat ED. You didn't know what the neurotransmitter was. How can you develop a drug? So we discovered that the neurotransmitter was a good friend, nitric oxide, which makes good sense, right? It's a vasodilator. And so they read my work and they realized, oh my goodness, our drug works by increasing nitric oxide. So they filed a new drug application. They took the drug off the shelf. They developed it. The FDA fast-tracked it. And in six years, it was marketed as sildenafil or the trade name Viagra.

And what's interesting is that Pfizer invited me six months later because it was just after the Nobel Prize, invited me to their to their pharmaceutical company in England where the work was done and showed me the laboratory where this was done. And you could see all my reprints pasted on a wall and in the laboratory notebooks. It was really great to see this. And from that point on, I'm not sure if you're aware of this, but from that point on, I was given the acronym of the father of Viagra. Yeah. Which is an acronym I don't mind at all, but my mother was alive at the time, and she used to get very upset whenever she heard that. And she would tell me, why don't you tell them to stop that already? Well, I imagine they probably didn't have trouble getting volunteers for that study. So, that's incredible. So, you call it a neurotransmitter, as well as an antioxidant, anti-inflammatory. So it has all

these different effects, right? It's really amazing. When it's released from the nerves, it functions as a neurotransmitter in the erectile tissue of men and women, by the way, but it's also a neurotransmitter in the brain where it's released in certain areas of the brain that promote memory, learning, and information recall. Many scientists believe that dementia, especially Alzheimer's disease, may be attributed to a deficiency of nitric oxide neurotransmitter in the brain.

And what I tell all my young scientists, when I was teaching, I would tell my graduate students that remember this the brain has 10 times more nitric oxide than does any other organ in the body and we don't know why so go after that problem I mean that's a good problem to go after that's amazing so let's just kind of review and then I want to get into the question everybody's thinking about, which is how do I get more of this stuff in my system? So let's see. It dilates your blood vessels and lowers your blood pressure and improves blood flow in your organs.

It prevents clotting, you mentioned, and prevents blockage in the arteries. It's an anti-inflammatory, so it helps keep the healthy arteries. It promotes learning, memory, and information recall. It helps regulate erectile function in men and rousal in women, and other things including affecting, protecting your skin from the sun and skin cancer. And you also mentioned in your work that it promotes digestion by helping the movement of digestive foods and regulating digestive enzymes and hormones. So it's like an incredible molecule that is doing all these things that no one even knew about until you came on the planet.

Isn't that something? I mean, it took somebody to discover that nitric oxide, which had long been known to be a pollutant in the Earth's atmosphere, it took someone to show that our bodies could actually produce it. And once that was identified, everyone jumped on the bandwagon and so many different people discovered so many different effects of NL. But what's miraculous is that one single molecule can exist ubiquitously throughout the body and produce all of these effects. And we've mentioned only half of them. So to me, as a scientist, I find that remarkable. But if you have a chemistry background, which I do, and you look at NO, it's perfectly suited for its job. Why have 25 different chemical molecules in the body, each doing something, when you can have one nitric oxide,

but it has to be regulated because, you know, you don't want to increase blood flow to your legs at the same time that you're creating a penile erection. You know, I mean, in one place it works, another place it doesn't. So it's highly regulated so that it's not working everywhere at the same time. It's incredible. So how do you know if you're low in nitric oxide as a person walking around the street? Well, let me tell you something, sir. If I did not retire and I still had my laboratory, I would invite you to my laboratory to try to work out that problem because no, it's such a difficult problem. It's impossible to measure nitric oxide real time because it's an unstable gas. It has a half-life of about two or three seconds. That's it. As soon as it's made in the body, it works within a second or two, and then it's gone. And that's what you want from a signaling

molecule. You know, you don't want the molecule to hang around forever. You just want it to hang around just for a little bit. But luckily, we're continuously making nitric oxide. If we have healthy arteries, they are continuously making nitric oxide. Unfortunately, we can't measure it. We can measure byproducts. In other words, we can measure nitrite, NO2 minus, and nitrate, NO3 minus, because NO is oxidized. That's how it's broken up. It's oxidized to nitrite and nitrate. So you can measure that. It's good in laboratory animals, but not in humans. Not great. Not great for going to your doctor and having it checked out. Well, because nitrites and nitrates are present in all the foods we eat. If you like beets and

spinach and Brussels sprouts, and you like to eat bacon and so on, all those foods are loaded with nitrite nitrate. So you'll have a very, very high background level. And although it's been attempted, you cannot measure changes in nitric oxide production that way. But symptomatically, there's ways people can know, right? I mean. Sure. Oh, absolutely. So what would be the kind of symptoms people might have?

What we have tied, we meaning the scientific community, not I, but anyone with hypertension that's been examined clinically using invasive methods to measure NO, it's been shown that NO production by the arterial endothelial cells is diminished. Okay. People who are obese have absolutely low levels of nitric oxide produced by endothelial cells. People who lead a sedentary lifestyle, the same. People have been subjected to physical activity, just even minor physical activity, walking fast, riding a stationary bike, and there's ways to measure indirectly nitric oxide production i can tell you about that in a second and that no goes up and the way you measure no indirectly is you put something like a blood pressure cuff on your finger and and it's made tight and then a uh

the blood flow in your arm is stopped just for a few seconds. And then the tourniquet is released. That will cause blood flow to go through the finger. And there's something called blood flow dependent vasodilation. In other words, when you release that cuff and you allow the blood to flow through the hand, the blood flow, because it creates a force against the arteries, that's called shear stress, that stimulates the arteries to make enormous amounts of nitric oxide. That's good because you want to dilate all the blood vessels there that have just been constricted.

So NO is released to dilate the blood vessels and allow blood flow. That's what happens during exercise in all of your skeletal muscle, by the way. But you can measure that flow-dependent vasodilation, and that's a pretty darn good measure of your capacity to make nitric oxide. So if you run that test, which is expensive, you usually have to go to a clinic, whatever, for now anyway, you can determine how much NO you can make. And what we know is that people who lead an unhealthy lifestyle, if I just leave it at that, make substantially less nitric oxide. That's been borne out every time. That's amazing. Hey everyone, it's Dr. Mark.

I'm a strong believer that nature provides us with some really powerful medicines. So if I'm looking to proactively take care of my health, I always look to natural options first. As someone who travels and works a lot, supporting my immune health is always top of mind. So I'm grateful for Bee Immune Propolis Throat Spray from Beekeepers Naturals.

The key ingredient is bee propolis, one of nature's most amazing medicines that bees create to protect their hive. It fights germs and it protects their hive with over 300 beneficial compounds. And it's super beneficial for the human immune system too. When I travel, I use my Bee Immune Propolis Throat Spray before, during, and after flights to give my immune system an extra boost. It's a must for anyone who prioritizes natural wellness. For a limited time, Beekeepers Naturals is offering my listeners an exclusive deal. They will ship you a free two-week supply of Bee Immune Propolis

Throat Spray. You just pay $5 for shipping. Take advantage of this amazing deal. Just head over to beekeepersnaturals.com forward slash hymen. This deal is not available on their regular website. So be sure to go to B-E-E-K-E-E-P-E-R-S natural, N-A-T-U-R-A-L-S dot com slash hymen. Start prioritizing your immune health today. And if you don't love it, they'll refund your $5, no questions asked. You can find Beekeepers Naturals nationwide in over 2,000 stores like Target, Whole Foods, and Sprouts. Now let's get back to this week's episode of The Doctor's Pharmacy.

So everybody's listening and probably wondering, how do I boost my nitric oxide levels? And you talk and you work about a lot of things, nutraceuticals, diet, protein, exercise, breathing, the microbiome, all these things. So I want to get into all this. So let's start with the conversation about diet and nutraceuticals or supplements and how they can affect your nitric oxide production. Okay. So I'll make this as brief as I can. It's clear from the work so many people have done that a healthy balanced diet is the best way to maintain your adequate production and action of nitric oxide. And what do I mean by healthy diet? Yeah. But, you know, and you know all about that. My goodness, that's been your career and your pharmacy and everything else. I mean, we have to eat healthy. What does healthy mean? Stay away from saturated fats. Look, I like a hamburger once in a while. Once every two months, I have a juicy,

fatty hamburger. It's not going to kill me. It tastes good. I get it out of my system. But then I eat fish. Fish is my healthy protein. There are plant proteins, of course, that are healthy. But I stay away from meats most of the time, even chicken. I mean, chicken's okay. But as soon as you start eating the skin of the chicken, forget it. That's loaded with saturated fat. So I like eating fish for my healthy protein. And you do have to have, you know, healthy protein.

But like many diets out there, which I don't want to talk about unless you do have to have, you know, healthy protein. But like many diets out there, which I don't want to talk about unless you do, I do not lower my carbs. I'm a firm believer that you really, that 30% of your diet, you know, should be carbs, but healthy carbs, not potato chips, not packaged food. What do you mean by healthy carbs? Oh, I mean the most colorful fruits and vegetables you can eat. Yes. The most powerful antioxidants. Remember, antioxidants can increase nitric oxide. Why? Because the antioxidants destroy the free radicals that go after nitric oxide to destroy the nitric oxide. So antioxidants will boost nitric oxide simply by stabilizing the molecule. We've done a lot of work on that, but most of it's been done

by everybody else. But the darker the fruit, for example, the better the antioxidant. Pomegranate juice. Everybody knows pomegranate. If you ever get it on a white shirt, you can never get the stain off. That is a dark fruit. Same thing with blueberries, strawberries, any kind of berry. Let's go to the plant family. Spinach. Popeye knew all about nitric oxide before anybody else did. I mean, spinach is very healthy. Kale. My goodness. Kale. Brussels sprouts. Dark green, you know, leafy vegetables. My wife and I have that every single day. I, you know, I just think that those carbs are so important because they're loaded with antioxidants. Yeah. Fats are also important. You need fats for energy, but unsaturated fat. I'm lucky I'm Italian because my parents never used anything but olive oil.

Olive oil. That's what I use. Olive oil. I use olive oil for, I put it in everything except my coffee. Okay. And we use olive oil. And if you want to eat unsaturated fats from food, avocado is one of many good examples. You just have to watch the calories. You know, whenever you're consuming any kind of fat, whether it's saturated or unsaturated, if your goal is to watch your weight, then, you know, just practice a little caloric restriction and you'll be fine. There's my secrets right there. I think you're eating lots of good fish and fruits and vegetables, and that's definitely

a healthy diet, and you're cutting out the starch and sugars and the junk, 100% agree. I think there is some question about the variations in the population, how some people can tolerate saturated fat better than others. And Dr. Ronald Krauss, I actually should have him on the podcast, is one of the leading lipidologists. You might have heard of him or know him. Yes, yes, yes. And, you know, he's challenged some of the orthodoxy about saturated fat.

So, I think there's still a debate about this, but I think you're right. I think there are, like, for example, for me, you know, I'm someone who genetically, I don't think I can tolerate a lot of saturated fat, whereas I've seen other patients do really well. So, it's really like the N of one or personalized medicine on that. I 100% agree. Right, right. So, let's like the N of one or personalized medicine on that. A hundred percent agree. Right. So, so let's talk about the supplements you develop, because I'm really curious about

what can we do? Because the other thing you talk about is protein and, and we haven't really discussed it, but the, the precursor or the building block of, of nitric oxide is an amino acid called arginine, which is found in a lot of foods, including almonds. It's very high in arginine. So tell me about what we can do in terms of the protein we should be eating, like the nitric oxide that's needed, the arginine that's needed to get nitric oxide produced. What are the best sources of that? And then what are the supplements that you've been using to actually help boost nitric oxide levels?

Sure. I think that after we discovered that our arteries can boost nitric oxide levels? Sure. I think that after we discovered that our arteries can produce nitric oxide, another group actually discovered the enzyme, a group from Johns Hopkins discovered the enzyme that makes nitric oxide, and that you refer to as nitric oxide synthase or no synthase. And what they showed was that like any other enzyme, a substrate is required, right? To be converted to product. So the substrate for no synthase is arginine, one of the 20 or so basic amino acids that found in all protein. And so arginine is converted to nitric oxide by this enzyme. And, you know, if you have

an arginine deficiency, you're going to make less NO. If you have excess arginine, you'll be safe, and you'll be able to make, you know, the normal amount of nitric oxide, unless, of course, there are other underlying problems. You can make a lot of NO, but if you're not taking in sufficient antioxidants, if you are obese, especially morbidly obese, then, you know, you can take in all the arginine you want, and your NO levels are not going to be very high. So anyway, arginine is a great amino acid. And, you know, this has come under some criticism. Some people, some scientists say that we have so much arginine in our body, it saturates all the sites. So adding more is not going to increase NO. And I can tell you from our experiments and the experiments of hundreds of

others that nothing could be further from the truth. You know, sometimes we don't understand something in science. That doesn't mean it's wrong. It just means we don't understand it. Right. So we will make more nitric oxide if you take in more arginine. That's been shown in mice and rabbits with atherosclerosis. It's been shown in humans. A lot of great studies conducted in Germany.

So it's good to consume arginine. Various ways you can do it. The richest source of arginine on a weight basis is, as you said, almonds. most, there's a problem there. Because if you eat a cup of almonds, you'll make huge amounts of NO, and you'll wind up with a 50-inch waistline in no time. I mean, it's extremely caloric. But if you eat fish, all protein has arginine. There's a lot of protein. So you can, that's why I always say, Mark, healthy, balanced diet. You know, don't overdo this and overdo that and eliminate this. You know, human beings were not designed for that.

No, but the diet we're eating is very different than your grandparents ate in italy 100 years ago right for sure for sure well what they ate was good because uh you know my father my father smoked camel cigarettes unfiltered for 70 years he died at 96 years old without a cough. Oh, geez. Without a cough. Wow. Well, you know, that's good genetics right there. My mom, same thing. My mom was overweight. She didn't smoke, but she was overweight. She loved her cooking. You know, she died at 91.

So I'm blessed. I probably don't even have to take care of myself and I'll live well. I'll be 80 years old in a few months. That's good. That's good. You know, UBake said i you know i wish i'd known i was going to live so long he lived to be over 100 he says i would have taken better care of myself i love that he smoked and drank yeah i think you have to have the apoe

double two gene to get that they might have the apoe double two and a bunch of other uh longevity genes which is pretty awesome. So good for you. Okay. So what about just taking arginine? What if I just go to the store and take arginine? Is that a good idea? You can do that. When the work was published by us and other groups, oh, I guess in the early 90s or late

90s, I should say, it was clear that arginine was important. So many, many of the companies developed arginine supplements. And at the time, they were very expensive. They put arginine, for example, in capsules and so on. And you have to be careful that way because arginine has a terrible, terrible taste. So either you take it in a capsule or many companies have made formulations of arginine has a terrible, terrible taste. So either you're taking it in a capsule or many companies have made formulations of arginine mixed with, you know, flavors and other substance to make it more palatable so that you could, you know, take a couple of teaspoonfuls and, you know,

make a solution and drink it. And those products have been extremely popular. I think there was a fellow, his name was Dr. John Cook. He was at Stanford in 1998, and he developed something called the Heart Bar, which was a chocolate bar loaded with 6,000 milligrams of arginine. Wow. And I was a good customer. The only problem was that the chocolate bars tasted God awful. I mean, you literally had to close your nose when you ate them, and eventually nobody would buy them. And so, you know, that was the end of the whole thing. That's very funny.

And then we came up with, I worked with the company, we came up with, or they did, with a formulation that was really great. And it's very good tasting. And I've been taking that since July of 2003. Now, is it a powder? Is it a powder? It's a powder. It's a powder that consists of five grams.

That's 5,000 milligrams of arginine. It also has some citrulline, which I'll tell you about in a moment. And then it has, of course, vitamin C in it. And newer formulations will probably contain pomegranate instead because it's a much more powerful antioxidant. And that's the way that works. When we marketed that product, it's really funny, about a year later. What's it called? It's called Nightworks, N-I-T-E-W-O-R-K-S. It's called Nightworks because at the time, we thought, scientists thought that most heart attacks and strokes occurred in the evening hours. And so even though we can't put claims on the bottle that it cures any disease or treats it or whatever,

you can't say anything like that, of course, because of the FDA and the Shaya rules. We just thought that, you know, we said, good for your heart health, that you're allowed to say, and it is. And we just thought, why not take it at night before you go to bed? But now we know that it doesn't make any difference when you take it. As long as you take it, it doesn't make any difference. The levels of NO go up, they stay up. You could take it in the morning. I take it in the morning, every single single morning even once a day is enough to keep it all day long yes more more or less yes i mean clinical studies have not been done those are very very expensive to do and yeah you know i mean didn't feel that you've done animal studies looking if you give arginine to these animals

their levels of nitric oxide yes. Yeah, and it's interesting. We still don't understand it completely. If you give the arginine every day, the N-O synthase enzyme, for some reason, gets upregulated, so there's actually more enzyme. Maybe it's because the enzyme sees more substrate. It thinks we've got to have more enzyme. I don't know. But anyway, that means you get more NO

production and it stays up. Now, if you stop giving the arginine to the animals, takes three to five days and it gradually goes down. So it's very interesting. Amazing. Does it help lower blood pressure or would it help sexual function for people who take it? Okay. Well, now, number one. I know you can't say anything. I have to be careful what I say. But just the theory. You're very famous. Everybody listens to you, including the FDA.

So we got to be careful what we say. And I'm still working for this particular company and I have to be very careful what I say. And also, you know, unless it's tested clinically in a double control placebo controlled trial, which it's not, most supplements have not, you know, what supplement company has $50 million to do a correct study, for God's sakes, you know, nobody does. But yes, I can tell you, because I gave this, I let people, you know, I gave this product to my mother, to many people,

my neighbors in the gym and so on. If you have hypertension, in many cases, this seemed to, you know, lower the blood pressure. But I can't say that it was due to the product, could be a placebo effect. You know, we have no evidence that this product in humans, you know, will lower the blood pressure. But the way I look at it is this. I look at the science. I'm a scientist. I look at the science. This is a perfectly safe product. It makes all the sense in the world that if you give arginine, you're going to make more nitric oxide. Everyone knows that nitric oxide lowers the blood pressure. But I don't want to say that because that means everybody who buys the product is going to be telling everybody else to buy the product

because it lowers the blood pressure. And we can't say that. I understand. It's very heart healthy. That I can say. That's good. All right. So besides the diet and the supplements, there's things that are absolutely increase in blood flow, you know, to the limbs. For example, mice or rats will put on a treadmill, you know, for 30 minutes or whatever, and It was found to have increased nitrite and nitrate, which means it made more NO. More in vivo studies were done. And what it boils down to is this. When you exercise, your heart, your cardiac output goes up.

You're pumping more blood. There's increased blood flow through your working skeletal muscle. Let's take the legs, for example, if you run, or the arms if you weight lift, for sure. What we know now, so I'm jumping 15 years, what we know now is whenever there's increased blood flow through the arteries that go to your skeletal muscle, that increase in blood flow creates a force or pressure, a sheer force against the lining of the arteries. And that triggers no synthase activation. That's well-known, well-worked out hundreds of publications on this. And so within seconds after this increase in blood flow, all your arteries in the skeletal muscle make huge

amounts of nitric oxide. And you know, I mean, mother nature is amazing. Of course you want to make nitric oxide. You want to dilate all the blood vessels in the skeletal muscle to accommodate that onrush of blood. And remember, blood carries oxygen, blood carries nutrients to the muscle, muscle needs it when it's working. Also, for those of us like you and me who work out, we want the blood to wash out of the muscle as well. So that increased blood flow takes out lactic acid and pain producing metabolites. So, you know, to me of all the stories, I think this is the most exciting and I had nothing to do with it. I mean, it's fantastic. You know, that is the most

important way I think our bodies make NO. That is why it is suicidal to lead a sedentary lifestyle. People don't understand how important exercise is. What's your workout routine, Dr. Ignaro? Well, like I said, you know, I will be 80 years old in a few months, in May. You're looking good. You're looking good. For those listening on the podcast, he looks great. Okay. Well, listen to what I do. Okay. We have a pandemic, so no more gym. I don't go to the gym. That was my mainstay. I don't go to the gym. I used to go to spin class. I used to, you know, work out circuits with them using the machines, you know, free

weights, none of that. And I, you know, I'm not going to put all that in my house. So I'm lucky. I live in California. I live in Beverly Hills, Los Angeles area. It's very sunny. It's like 75 degrees out there now. My wife and I go bicycling in the hills of Beverly Hills four days a week. So we do about 110 miles a week on the bike, but we also walk. I used to run. I don't run. I walk fast. I stopped running marathons about eight years ago. I ran 15 marathons before that. And those are real marathons, you know, the 26.2. Oh, my goodness. That's incredible. And that means the last one, you were about 70 something. Yes, I'm the first one was a 64 years old. I think it was about 68 when I ran the last one, my knees gave out. My physician, my orthopedic guy said, Lou, if you want to run

another marathon, that's fine, but I got to give you new knees first. I said, forget it. So I took up bicycling and that's what I do. And I do yoga online. So I devote a lot of hours, a lot of hours per week to my body, you know, because if I'm going to take care of everybody else, I got to take care of me first. If I'm not here, I can't do anything for anybody else. It's the only one we got, right? It's true. We can't trade it in for a new model. All right. So, what about breathing? So, exercise, everybody's got to exercise. That's clear for a lot of reasons. And nitric oxide production is a really good one. Tell us about breathing, because how does your breathing affect this? And I'm going to jump from that to a really exciting idea that you and others have

about treating COVID-19. So let's jump into the sort of breathing part. Okay. Once again, there was a really great study that was conducted, not by me, but by two of my really friendly scientific colleagues in Stockholm, of all places. And they showed about, oh, I don't know, 10 to 15 years ago, that they were looking at asthmatic patients. And to make a long story short, your nasal, the nasal passages, the nasal sinusoidal passages in your nose produce relatively large amounts of nitric oxide gas. Your mouth does not. Only the nose does. And so what they worked out, your nose makes nitric oxide so that when you breathe in, when you inhale through your nose, the nitric oxide does several things. One, it relaxes the

trachea and the bronchioles. In other words, the airways, the airways have smooth muscle. Nitric oxide relaxes smooth muscles, arteries and airways. So the nitric oxide widens the bronchial so you can get more air into your lungs. That makes sense. But also when that nitric oxide gets into your lungs, it dilates the pulmonary arteries. So you'll get more blood flow deep into your lungs to undergo oxygen exchange. And more recently, it was found that that same nitric oxide elicits antimicrobial effects. In other words, nitric oxide is very, very strong in killing bacteria, parasites, and certain viruses. So our lungs are exposed to the outside air. Isn't that right? I mean, we're breathing air. We're taking in germs. We're taking in germs all the time through our nose. So it makes sense that mother nature would design the nose to make nitric oxide so it would go into the lungs when we breathe

to keep those bugs from dividing, replicating, and causing damage inside the lungs. So, those are the three major effects of the nitric oxide in the lungs. But you can activate it through deep breathing, and it's not just any kind of breathing. You have to breathe in through your nose and out through your mouth. Yes. Because you're saying it just happens naturally as you breathe, but we can really magnify that and increase our nitroxide production by how we breathe. Tell us about that. Well, let me put it this way.

Now, I'm not sure whether breathing in through your nose stimulates more NO formation, but what I can tell you is this. If you're breathing in through your mouth and not through your nose, your nose is still making nitric oxide, but it's not getting in your lungs. It's just hanging around there. So the idea, every time you inhale, whenever possible, you should breathe in through your nose. Sometimes if you're running a hundred yard dash or you're climbing a mountain, it's almost impossible to get enough air or oxygen through your nose. So of course, you're going to breathe through your mouth and inhale through your mouth because you got to get the oxygen in, but it's good to have a balance of the two. So, so if you can remember, if people can remember

to breathe in, to inhale through the nose, then they're going to get a lot of nitric oxide benefits in, in the lungs. Now, often I say, you know, breathe out through the mouth. Well, I've been criticized for that because by people who do yoga and they tell me, and I'm not a yoga expert, you know, and they tell me, you know, you should breathe out through your nose as well. You know, I guess it's okay. As long as you breathe in through your nose, I don't care how you breathe out. I think you're good. However, sometimes in yoga, and I've had conversations with people, they'll exhale through the mouth, but they'll do it slowly.

They'll make sounds when you do yoga slowly through your mouth you're giving more time for the nitric oxide which is constantly being made in the nose to build up so that when you do breathe in through your nose you're going to have a lot more nitric oxide amazing in the lung so i was able to satisfy a few yogis with that oh good you don't want to get angry yogis at you. Nothing worse than a pack of angry yogis. All right. So, let's talk about something really fascinating, which is COVID-19, because this is a pandemic that is now, as the recording of this podcast is affected, over 10 million Americans, killed almost a quarter million, globally 50 million. And there's right now clinical trials going on in hospitals using nitric oxide to help us treat COVID-19. So tell us about the mechanism, how it works,

what they're doing, what the studies are showing, if anything. So tell us about that, because I think people really are probably wanting to hear about this. Yes. Well, of course. First of all, inhaling nitric oxide gas as a drug is not new. This was started about 20 years ago. Newborns, many infants are born with pulmonary hypertension. They can't breathe. And very invasive procedures were used to try to save these newborns. And most of them died. But Dr. Warren Zaypal at Massachusetts General Hospital invented the use of inhaled nitric oxide to give to these newborns, and their lives were saved. After a few minutes of breathing nitric oxide, their arteries were

perfect. There was no more hypertension, and they were able to go home in a couple of days. Wow. I mean, it was just a miraculous. That's why I call this nitric oxide the miracle molecule of life. In fact, I'm going to write a book on that, the miracle molecule of life. But let's get to COVID. So when this broke out, actually, we had a form of COVID breakout a number of years ago, and people did in vitro experiments with nitric oxide. It seemed to kill the SARS-CoV-1 virus, I think back in 2008. To make a long story short, then when this pandemic started, my friend Dr. Zaypal, again at MGH, decided to try giving patients inhaled nitric oxide, patients with

severe COVID-19. It worked dramatically. And let me explain because it makes so much sense. Okay. First, we have to understand how does COVID-19 kill people? Well, that virus has to get in the lungs. That's number one. We all know that. That's why we wear masks, practice social distancing. When the virus gets in the lungs, it attaches to where the oxygen is extracted in the alveoli. And the virus tends to then destroy the endothelial lining of the arteries. The endothelium of arteries, and we haven't talked about that, but the endothelial cells of the arteries are the only cells of the arteries that make nitric oxide. So these endothelial cells. Those are the lining of all the blood vessels. The inner lining.

The endothelial cells separate the flowing blood from the smooth muscle, you know, that regulates the contraction and relaxation of the artery. And so the endothelial nitric oxide will dilate the arteries to allow blood to flow through. And as I mentioned earlier, that nitric oxide is also going to relax the bronchioles to have more air in. And one of the protective roles of NO in our body is to kill microbes like viruses. So when the virus destroys the endothelium, these patients die of a massive thrombosis. They get a blood clot throughout the lungs and you cannot reverse that. Remember, nitric oxide prevents blood clotting. If you take away the nitric oxide, you can't prevent the blood clotting.

So these patients die of pulmonary hypertension and a massive blood clotting or thrombosis. Okay. So now you'll give the patients nitric oxide gas by inhalation. What happens? You're replacing the nitric oxide that is no longer available from the endothelial cells. So the NO causes more air to go in because it's relaxing the bronchioles. It eliminates, immediately eliminates the high blood pressure in the lungs. So blood can go deep, deep into the lungs to look for oxygen. And probably most importantly, that steady administration of nitric oxide gas kills the SARS-CoV-2 virus that causes the COVID-19. And after a few days, those patients come out of the ICU,

and after a week or so, they go home. So this is remarkable. So an initial clinical trial was done to reveal this. In fact, pregnant women, very sick pregnant women volunteered to go into the hospital at MGH to have this done. Every single woman was cured. Their babies developed normally. Some of those ladies delivered their babies in the hospital. They tested negative for the virus. And the other ladies went home and had their babies, you know, outside the hospital later, and everyone tested negative. So that initiated a huge clinical trial now going on in five or six institutions worldwide, mostly in the US. And those results, I hope, you know, I don't know, they don't tell me all these things as the FDA controlled should be done by the end of the year. So, so.

But it's already an approved treatment, right? He's using baby, so it's FDA approved as a treatment. Exactly. And is it being used widely? Well, it's hard to give. The problem is to give nitric oxide, you have to have a special delivery device that cleans the nitric oxide before it gets in the lungs.

Nitric oxide is very unstable. If you don't give it properly, it will turn, it will, it'll turn into release of oxidant materials, oxidant, and could kill you. So, so it has to be given by special, you know, professionals, health professionals with special apparatus in hospital. These people are working day and night to develop a more portable method. What it's going to be doing, we hope, is to keep the people out of the ICU. It's going to be given to the staff working in hospitals and clinics as a preventive. In other words, they can breathe a couple times a day and then go into the ICU. And it's being used, and hopefully more of it will be used, and that'll help bridge the

gap between now and the development of an effective vaccine. But, you know, it seems like it's something that's, you know, if there could be some kind of device that would be scalable and usable by the average person who's sick at home, it would be amazing to be able to treat people so they're not afraid of it, they get the virus, they use this inhalation machine, they give nitric oxide, they get over it faster, they don't get really sick, they don't end up in the hospital. Because right now, hospitals are being overwhelmed as we speak. Yeah, I agree. And as usual, you're right on the mark. No pun intended. There are three companies that are developing, and I'm not included, three companies developing

a portable device that actually makes, normally the machines come with big nitric oxide and oxygen tanks, and the two gases are mixed in a special chamber, and you breathe it in and so on. But now portable devices are being made where there's a spark with a special spark plug, iridium spark plug that ignites the air. When you do that, it's like lightning bolts in the sky. When the lightning strikes, it makes nitric oxide in the air. And that NO oxidizes to NO2, nitrogen dioxide, and that's air pollution. That's what makes the air brown. That brown ring you see over New York City and Chicago and maybe Boston once in a while is NO2, you know, nitrogen dioxide. So these portable machines apparently can make nitric oxide safely, and the person can

just take it around and breathe in. And they're working on it, believe me, day and night. So maybe within six months, it'll be available. Now, in closing this discussion about COVID, I want to say something very important about these portable devices. The nitric oxide doesn't just kill coronavirus. The nitric oxide kills influenza virus. So let's think outside the box. Let's think ahead. Five years from now, virtually nobody gets the flu. Why? They're carrying around these nitric oxide devices. Unbelievable. Breathe in nitric oxide once in a while. Isn't science beautiful?

Did you just say that you discovered maybe the cure for the common cold? Not me. Not me. I like to predict things. Well, you discovered nitric oxide and that has led to the treatments using inhaled nitric oxide that could save us from COVID and the common cold and the flu. That's pretty remarkable. That you can go to bed at night feeling really good about, can't you? You know, that's true. There bed at night feeling really good about, can't you?

You know, that's true. There are two things I feel good about. One, the more I see about the development of nitric oxide to save lives, the better I feel because I know that, you know, if I hadn't discovered it to start with, who knows where we would be? You know, you're absolutely right. I don't talk about that. But if you had hidden cameras in the house, you know, you would know that I'm very excited about that.

You'd be walking around smiling all the time. Well, I'm just so thrilled that we got to have this conversation. It's so inspiring. And for those who listen to this and try to remember what we talked about, we talked about this molecule nitric oxide, which we all make, but we can increase through having high quality protein, through almonds, through taking arginine supplements, through exercise, through breathing techniques, and even maybe through the science that you've developed, we can find a real way to treat COVID-19 and other viral infections. It's just tremendous, tremendous work. I'm so

inspired by what you do. I've known about your work for over 20 years, and I just, I'm in awe. And I was so excited when we got to do this podcast together. So thank you so much for joining us, Dr. Naro. And I can't wait till your next Nobel Prize. Yes, very good. Thank you, Dr. Hyman. This has been a great experience for me as well. Thank you.

And thank you. For those of you listening to the podcast and loved it, please share it with your friends and family on social media. I think everybody needs to hear this message. Leave a comment. We'd love to. Thank you. And thank you. For those of you listening to the podcast and loved it, please share with your friends and family on social media. I think everybody needs to hear this message. Leave a comment. We'd love to hear from you and subscribe wherever you get your podcasts. And we'll see you next week on The Doctor's Pharmacy. 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 introduce to you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called

Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets 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 to 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-S, and sign up for the 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. 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 medical

professional. This podcast is provided on the understanding professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional 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.