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Episode 85
The Doctor's Farmacy

The Power Of Food To Heal Everything From Autoimmune Disease To Traumatic Brain Injury

Open the Podcasts app and search for The Doctor’s Farmacy. If you’re viewing this site on your phone, you can just tap on the

Tap the subscribe button and new shows will be added to your library.

If you’re using a different device, our show is available on the following platforms.

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One of the reasons Functional Medicine is so transformative is that it recognizes disease does not occur in isolation. 

If one part of the body is compromised the entire body is thrown out of balance. SIBO, or small intestine bacterial overgrowth, is a great example of this. It rarely occurs on its own, and is often paired with a number of other issues, from neurological symptoms to migraines, arthritis, and more. When we focus on healing the gut in these instances, the entire body shifts for the better. This week on The Doctor’s Farmacy I’m joined by Dr. George Papanicolaou to talk about the Functional Medicine matrix as a framework for healing, as well as his own journey in overcoming a traumatic brain injury.

Dr. George and I jump into this week’s episode by discussing the Functional Medicine matrix as a construct for getting to the root of disease. We talk through the example of SIBO, sharing success stories and some really interesting and unique healing paths for different patients dealing with the same diagnosis. 

We also get into the importance of functional testing and how he used it to help his own daughter overcome extreme fatigue. Diet is always part of the equation too, and we talk about gluten, autoimmunity, and how when treating his own brain injury he had to take what he thought was an already healthy diet to a new level for more dramatic healing.

With just a few simple shifts we can help people feel better right away, which works as a catalyst towards long-lasting sustainable health. Dr. Papanicolaou and I talk about the different ways that can look, for everything from gut and hormone imbalances to depression, OCD, and more, on this week’s episode.

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

In this episode, you will learn:

  1. The 4 principles of osteopathic medicine and what attracted Dr. Papanicolaou to become a DO before he discovered Functional Medicine
    (3:51 / 6:05)
  2. Why prevention, as thought about it in conventional medicine, is really early detection
    (9:15 / 11:29)
  3. Treating SIBO and how the Functional Medicine Matrix is used to identify issues and create health
    (15:05 / 17:19)
  4. Leaky gut, why SIBO is rarely seen in patients by itself, and how to test for it
    (24:55 / 27:09)
  5. Patient cases in which Dr. Papanicolaou and I have treated gut issues
    (30:26 / 32:40)
  6. The reason why people get so-called “food babies”
    (34:15 / 36:29)
  7. The 5 R’s of Functional Medicine
    (37:56 / 40:10)
  8. Why Functional Medicine uses genetic and toxicity testing not regularly used in conventional medicine
    (46:19 / 48:33)
  9. Gluten as the trigger for autoimmune disease, how sugar and starch can cause hormonal issues, and Dr. Papanicolaou’s experience treating his teenage daughter’s fatigue
    (58:20 / 1:00:34)
  10. Dr. Papanicolaou’s personal experience with brain injury and how he healed himself
    (1:07:10 / 1:09:24)


Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

Dr. George Papanicolaou

Dr. Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital. Over time as the healthcare system made it harder for patients to receive personal care, Dr. Papanicolaou decided a change was needed. He began training in Functional Medicine through the Institute of Functional Medicine. In 2015, he established Cornerstone Personal Health—a practice dedicated entirely to Functional Medicine. In August 2017, I invited Dr. Papanicolaou to join The UltraWellness Center and we’ve been successfully helping people together ever since.

Transcript Note: Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. George Papanicolaou: I’m not interested in finding out if you have early disease, I’m interested in helping you create a disease free or cancer free life.

Dr. Mark Hyman: Welcome to the Doctor’s Farmacy, I’m Dr. Mark Hyman and that’s Farmacy with an F, F-A-R-M-A-C-Y. A place for conversations that matter, and if you’d suffered from any chronic illness or know someone in your family or friend who has a chronic problem that nobody can figure out and fix, this is a conversation that matters for you. And it’s because we’re here at the UltraWellness Center, my practice where we’ve been doing functional medicine for 15 years with our leading doctors, and our doctor today is Dr. George Papanicolaou, who is an extraordinary physician. He’s joined our practice recently but he’s been a doctor for a while now, probably what? 25, 30 years?

Dr. George Papanicolaou: It’s been 22 years.

Dr. Mark Hyman: 22 years, all right.

Dr. George Papanicolaou: Yeah.

Dr. Mark Hyman: He’s a graduate of the Philadelphia College of Osteopathic Medicine. He’s board certified in family medicine. He is also certified as a functional medicine practitioner through The Institute for Functional Medicine. He went to the Indian Health Service after graduation. He worked on the Navajo Reservation for four years, the Chinle Comprehensive Medical Facility. And I actually also worked in the Hopi Reservation, so we were kind of neighbors back there. He founded the Cornerstone Family Practice in Rowley, Massachusetts in 2000.

Dr. Mark Hyman: His philosophy was centered on personal relationships, treating the whole person, not just the disease, which is really at the center of what we call functional medicine. He called this philosophy Whole Life Wellness. Now, over the time that he had in the healthcare system, he found it harder and harder for patients to receive the kind of personal care within the existing model, which is why he came and joined us at the UltraWellness Center a number of years ago. And we’re so excited to have him here, he’s been working with our patients, doing a phenomenal job, and welcome George.

Dr. George Papanicolaou: Mark, it’s a pleasure. Thank you for that introduction. It’s always exciting to talk about what we do here at the UltraWellness Center, and how this model of functional medicine can impact people’s lives in so many ways.

Dr. Mark Hyman: It’s true. I mean, I think that’s the thing I experience here over and over. It’s just the miracles that happen every day. People who come from all over the world with chronic diseases, which nobody else can figure out, and we collectively here probably have 60 plus years of clinical experience in functional medicine. And given that functional medicine has only been around for 25 years, that’s a lot of years.

Dr. George Papanicolaou: It’s a lot of years. Yeah.

Dr. Mark Hyman: And we have extraordinary experienced team of nutritionists and navigators, and doctors, and nurse practitioners, Pas, and we are doing things that are not being done in most centers in the world.

Dr. George Papanicolaou: Absolutely not. Correct.

Dr. Mark Hyman: Talk about how you came into this journey. You’re not an MD, you’re a DO?

Dr. George Papanicolaou: Yeah.

Dr. Mark Hyman: So tell us what is the DO and why did you go to DO school, and how is that different than traditional medicine?

Dr. George Papanicolaou: Sure. As we talked about earlier, I’m a very curious person and so I’ve always looked at my life very curiously. Why am I doing and being where I’m at in medicine right now? And I think it starts out because I’m just innately a empathetic person. I’ve always been connected to people. I’ve always felt deeply for people, particularly dispossessed people, whether it be disease or whether it be socioeconomic, I’ve always had a draw for people. And I’ve always been very curious and I believe in intelligent design, and I believe everything is interconnected, and everything has a plan and a purpose that gets beyond her understanding, and is a huge mystery, which always leads me to ask the question, why? And that is one of the key elements that I think I bring to care and we bring to care here at UltraWellness Center. We are always asking why, we are always looking for that answer.

Dr. Mark Hyman: It’s true. Yeah. Functional medicine is about the why, not the what. Not what disease you have and what drug do I need, but why is this happening? What’s the root cause?

Dr. George Papanicolaou: Why? With really the osteopathic medical school was the principals that Andrew Taylor Still would outline in 1872, I think, right around there, and here are the four principles, they’re very interesting. One is, that the body is completely integrated and has the ability to regulate and heal itself. That’s number one.

Dr. Mark Hyman: That’s true, right?

Dr. George Papanicolaou: Absolutely.

Dr. Mark Hyman: That the body basically wants to be healthy, right?

Dr. George Papanicolaou: Right.

Dr. Mark Hyman: That’s a very profound idea, which is-

Dr. George Papanicolaou: This is 1872. Then he goes on and says that all the systems of the body are interconnected.

Dr. Mark Hyman: Another amazing idea, not what we learn in traditional medical school, that there are all these different parts and we have to treat each part in a specialist for the part.

Dr. George Papanicolaou: Absolutely. And so there’s no functional medicine in my mind at that point, but I hear these principles and they’re really resonating with me. So then the third principle is that the structure and function of the body are connected from membrane to hormone to… They’re all connected. You cannot disengage the mechanical structure, the biochemical structure from the function of the body. Those are the three top principles. His fourth principle is the one that really made me pause as this principal was this, if you do not account for the first three principles when you are designing your treatment plan for a patient, it’s irrational.

Dr. Mark Hyman: That’s fantastic. I mean, that is really, in a way-

Dr. George Papanicolaou: I thought you’d like that.

Dr. Mark Hyman: The same way framework as functional medicine, which is the body’s an interconnected system, that everything works together, and then you can’t really heal people from chronic illness unless you’re actually thinking about how everything is connected.

Dr. George Papanicolaou: Exactly, right.

Dr. Mark Hyman: Which is the opposite of how we’re trained in medical school. And you were saying, when you’re in medical school, you basically got a lobotomy-

Dr. George Papanicolaou: No, you stole it, I should have told you that. You stole my thunder, man.

Dr. Mark Hyman: Well, tell us about what that means.

Dr. George Papanicolaou: So when I was in Osteopathic medical school, and you experienced it when you went to medical school. You have your first two years of basic science.

Dr. Mark Hyman: The brain wash.

Dr. George Papanicolaou: But the basic science part was cool because you get to learn about how everything is connected, to the biochemistry, the pathology, the microbiology, the physics of everything. And you’re excited and then you go into your clinicals and that’s where the lobotomy happens. It’s like all of this interconnectedness that we learned, even in osteopathic medical school there is still that disconnect. It went down to make the diagnosis, treat the disease. And quite honestly, as my career went on in medicine and I started being driven further and further from that ideal I had when I first went to medical school, I became more disenchanted with the medical system.

Dr. Mark Hyman: Yeah. Well, I think that’s true. I think we really are in a way disconnected from the basic biology, and functional medicine comes back right to the most elemental things we learned in the first year as a medical school. How we make energy from food and oxygen, how our immune system works, how our biochemistry works. I mean, biochemistry was that class you took in the first year of medical school, you gutted your way through it, you hope you pass and then you forgot about all of it. But in a sense, functional medicine brings all that back, so you have to learn about-

Dr. George Papanicolaou: Absolutely.

Dr. Mark Hyman: -the way in which your body works. So we’re interested in the mechanisms and the causes, not just the name of the disease and the symptoms. And that’s really the problem in medicine is we’re focused on geography, where is it in your body? Is it your stomach? Is your head, but your headache might be caused by something going on in your microbiome.

Dr. George Papanicolaou: Yeah, we have a lot to talk about. So exactly. So when you’re practicing conventional medicine, with my mindset, and I was trying to build this whole life wellness program. I was writing nutrition programs for my patients. I was writing physical fitness programs. I was helping people periodicize their training, helping them plan for events. And that was really great stuff, but as time went on, Mark, here’s something really interesting that warped. One is, is that I was being pushed more and more by insurance companies and health plans to meet these metrics.

Dr. George Papanicolaou: They’re trying to measure quality of care and I had to meet these prevention metrics, but the prevention metrics were really measurements of disease once it was out of the box. Did you get all your women to get mammograms? Did you get all your young ladies to have their chlamydia test? Did they all get their pap smears? We’re looking for disease out of the box. We’re not helping people create a cancer free zone in their body. A woman would ask me, “So what do you think about mammograms versus thermography Dr. Papanicolaou?” I would say, “I’m more interested in-”

Dr. Mark Hyman: Didn’t you invent the pap test Papanicolaou?

Dr. George Papanicolaou: Well, I could feel you would bring that up, I was waiting for a good answer. So, yeah but-

Dr. Mark Hyman: That was your uncle, right?

Dr. George Papanicolaou: No, he’s not my uncle, but I will tell you that-

Dr. Mark Hyman: There’s a pap test.

Dr. George Papanicolaou: Yeah. If you give me a briefly aside for this little story. I had to have surgery at the Hospital for Special Surgery, it’s right next to Cornell. So a lot of people saw my name. I had nurses coming from other floors to come up to see if I was related to George Nicholas Papanicolaou, George James Papanicolaou. So my dad told me, and don’t hold me to this audience, but my dad told me that we’re like second cousins once we moved or something like that. We may or may not be, okay.

Dr. Mark Hyman: You get loyalties from every podcast-

Dr. George Papanicolaou: [crosstalk 00:08:55]. I’m just saying, it doesn’t really matter how we’re relating because I get no loyalties, that’s [inaudible 00:09:02]. But the first person or two that asked me I said, “I think we’re second cousins once we moved, and they left the flight at Iowa. I came up all of here to hear that.” So the third person that came in I said, “Yeah, he’s my granddad.”

Dr. Mark Hyman: Well see, that’s very funny.

Dr. George Papanicolaou: Yeah, but I get back to her.

Dr. Mark Hyman: What you just said was very profound, which is that prevention as we think about it in traditional medicine-

Dr. George Papanicolaou: That’s [crosstalk 00:09:22]-

Dr. Mark Hyman: -is absolutely not prevention, it’s early detection.

Dr. George Papanicolaou: Exactly.

Dr. Mark Hyman: Do a colonoscopy so you can find a polyp or an early cancer, do a pap test so you can find early cancer, do a mammogram so you can find early cancer. How about not getting cancer in the first place?

Dr. George Papanicolaou: And that’s where it goes back to as you’re saying, about the mammography. I would say to them, I’m not interested in finding out if you have early disease, I’m interested in helping you create a disease free or cancer free life or zone. And we talked about hormones a little bit later. We’ll talk about estrogen and Xenoestrogens, and how that creates that environment for women that were more likely to get cancer, but that’s going back to the point we need to prevent, not just detect.

Dr. Mark Hyman: Yeah, and I think that’s where people get confused about because doctors don’t learn how to truly prevent, they learn how to detect. And what functional medicine is, it’s really a science of creating health. So when you create health, you don’t allow a disease to show up. If you create a healthy system, which is going back to osteopathic training, it’s what functional medicine is. You absolutely don’t have to worry so much about disease when you create health because the diseases often just go away as a side effect of creating health, you create an inhospitable environment.

Dr. Mark Hyman: And we see this over and over again with diabetes and chronic illnesses where we actually figure out how to build and create the body’s functional systems and treat the whole system. The diseases just get better without actually treating.

Dr. George Papanicolaou: They do.

Dr. Mark Hyman: I don’t treat disease anymore, and that’s what we do with the UltraWellness Center here, we don’t treat diseases, we create health and as a side effect, their symptoms go and the diseases go away.

Dr. George Papanicolaou: Yeah, and it’s hard work. When I practiced traditional medicine, it got to a point where you weren’t required to think necessarily too deeply because you have specialist, everything got siloed, right?

Dr. Mark Hyman: That’s right.

Dr. George Papanicolaou: We learned that basic science of interconnectedness. We learned all the beauty of the organicity of the body and how it can heal itself, and then we forget it. And then not only do we lobotomize it in terms of our science and thinking, we do it as a system. We break it all up into organ systems and then we’re in trouble because now one silo is not talking to the next. I would refer somebody for a rheumatologic problem, very bright doctor would see my patient. And if it wasn’t a rheumatologic problem, the patient came back and told me, “Nothing he can do for me, told me to go back to you.”

Dr. George Papanicolaou: I didn’t get even an idea of where else I should look or a collaboration of here’s what I did find and here’s what you might want to look next but it’s not in my purview. It was isolated silos. So starting to think about functional medicine, it’s really hard… Well, before we think about functional medicine, it’s really hard for a patient when they’re sick to get better if nobody’s integrating the whole message, all the data. And so as a family doctor, I took a lot of pride and I put a lot of emphasis in being that quarterback for my patient, and trying to get as much of that information to integrate a good health plan for the patient.

Dr. George Papanicolaou: Hopefully to get them better, then to help them not only be better, but to optimize the performance. And in functional medicine we do that, and here’s the really cool part is we have the time to do it. You don’t have the time to do it-

Dr. Mark Hyman: It’s true, we do have time in [crosstalk 00:12:48]-

Dr. George Papanicolaou: -in conventional medicine. So you have silos, you have no time, and now you’re treating really chronic disease and you just can’t do it.

Dr. Mark Hyman: So I think the point you bring up is really important because when we’re trained in traditional medicine, the rheumatologists do their thing and they just focus on the autoimmune stuff. The gastroenterologists focus on their lane, and the neurologists focus on their lane, and on and on, and people go from doctor to doctor and they’re super frustrated because they have all these symptoms. And when people come in with 10 or 15 different diagnoses, I’m like, “Is this just a coincidence or?” and they’re all treated separately.

Dr. Mark Hyman: The addicts are treated by the migraine doctor, their rheumatology doctor treating their joint pain, their gastroenterologist is treating their IBS, and so on and so on. And they’re getting different drugs for every different symptom. And instead of going, “Well, gee, is this just a coincidence or is there something linking all these things together and how do we think differently about them?” And that’s what functional medicine is. It’s a way of thinking differently. So you mentioned the rheumatology issue and you mentioned the gut. The microbiome is one of those areas that is blowing apart our traditional concepts.

Dr. Mark Hyman: So the microbiome is this ecosystem of bugs in our gut. It’s trillions of bacteria. It outnumbers ourselves by 10:1, it outnumbers our DNA by 100:1. And it’s been linked to everything from auto immune disease to cancer, to heart disease, to diabetes, to obesity, to autism, to Alzheimer’s, the list goes on and on. So when you go to the rheumatologists, they don’t go, “How’s your poop?” But we do. All right?

Dr. George Papanicolaou: We absolutely do.

Dr. Mark Hyman: So let’s talk about the gut in connection to some of these diseases. We treat something a lot that’s called SIBO. Now, when I went to medical school, this wasn’t even a thing, but essentially, it means small intestinal bacterial overgrowth, which means bad bugs growing in the small intestine where there should be sterile that have an impact on our health. So what are the symptoms? How would people know they have it? And what kinds of problems are they connected to? And let’s get deep to what our approach to diagnosing and treating it is going to be.

Dr. George Papanicolaou: Sure. So I just want to be a little cautious here because we’re jumping right into talking about a disease, right? SIBO-

Dr. Mark Hyman: Yeah. Well, it’s not a disease, it’s a phenomena.

Dr. George Papanicolaou: It’s a phenomena.

Dr. Mark Hyman: That actually causes all sorts of other problems.

Dr. George Papanicolaou: We do have to give things labels, but it is a phenomena that’s connected to many different parts of our body. And getting somebody better involves the whole lifestyle spectrum and involves us using something in the functional medicine realm that we call the matrix. And the matrix is looking at, not diagnoses but conditions.

Dr. Mark Hyman: Let’s talk about the matrix. Tell us more about that. What is the matrix? How does it differ from traditional diagnosis? And why do we use it?

Dr. George Papanicolaou: For me to tell you about the matrix, you have to swallow the red blue with the blue pill, which one do you want to swallow?

Dr. Mark Hyman: [crosstalk 00:15:32]. I think I’ll take the red pill.

Dr. George Papanicolaou: Okay, take the red pill, that’s the right pill. So anyhow, now I can tell you about the matrix. So the matrix is basically a construct that we have in our minds where when you start telling me I have headaches, I have fatigue, I have belching, I have bloating, I have a diagnosis of Hashimoto’s thyroiditis-

Dr. Mark Hyman: Migraines or?

Dr. George Papanicolaou: -migraines.

Dr. Mark Hyman: Lupus or whatever.

Dr. George Papanicolaou: They don’t become the endpoint, they become part of the narrative of your disease. And we put it together into a story we call the matrix, and so we look at assimilation, which is the gut. We look at energy that takes us from an idea of fatigue. We rattle it down on our brain to, what are the things in the body that control energy? And so we think about mitochondria when we think about energy. We think about toxins, how do toxins influence the rest of your wellbeing? We think about our transport system, our blood vessels, our lymph drainage and the connection between lymph drainage in the brain and your gut, leaky gut, leaky brain, things that we’ll talk about.

Dr. George Papanicolaou: And we think about the hormonal system, our neurotransmitters to adrenals, to thyroids. And we place this all in our mind in this matrix, this paradigm of thinking, and then we make the connections. We say, “Okay, what’s SIBO? Okay, well it’s going to be symptoms, bloating, distension, I feel like you’ve used the term food baby, there’s something always in my gut.”

Dr. Mark Hyman: Yeah, when you have food baby, sometime you feel your belly bloat up, that’s called SIBO.

Dr. George Papanicolaou: Right, that is SIO. You don’t feel like you fully evacuate when you have a bowel movement. You’re fatigued, you get depressed and you can actually feel your depression is related to how your gut feels. That food baby, I’m anxious, I feel depressed, it impacts my body-

Dr. Mark Hyman: And it can link to all sorts of other diseases, right?

Dr. George Papanicolaou: Yeah, fatigue. And then when we think about fibromyalgia, we need to think about the gut and what’s been impacted there. And we think about Parkinson’s, 50% of people with Parkinson’s actually have SIBO. Now-

Dr. Mark Hyman: Asthma.

Dr. George Papanicolaou: And we don’t know-

Dr. Mark Hyman: Autoimmune diseases.

Dr. George Papanicolaou: We know there’s an observational connection there, we don’t know anything about causality, but it’s something you have to consider when you’re thinking about other diseases. So there’s fatigue, the brain fog, the potential inflammation and joint pain, all of the gut issues, that SIBO. And a lot of SIBO, we don’t know all the causes. There used to be some standard ideas what the causes were, but now we know that it’s hard to determine. So the use of proton pump inhibitors and other acid blockers-

Dr. Mark Hyman: It’s acid blockers like Prilosec, Prevacid, all that stuff.

Dr. George Papanicolaou: All that stuff. And then we have stress plays a major role. And so that’s some of the cause, that’s what SIBO can look like. And now how do we address it? How do we get people-

Dr. Mark Hyman: [crosstalk 00:18:21] backup for a second. You mentioned these acid blockers because they’re given out like candy, you can buy them in the drug store, they’re over the counter now and people think they’re safe and fine. I remember when I went to medical school they just came out and we were told by the drug reps, these are very strong drugs. They completely shut down acid in this time, like you’d never want to give them more than six weeks and now people are on them for six decades.

Dr. Mark Hyman: And what they do is pretty frightening. Literally, they will help your heartburn, but the side effects, which are not really side effects, they’re effects, we just don’t like them, so we call them side effects, are bloating and diarrhea, and distension, all the SIBO symptoms. And by the way, they cause osteoporosis and pneumonia, and prevent B12 absorption and zinc absorption, and mineral magnesium absorption. So they’re not exactly the safest things on the planet.

Dr. George Papanicolaou: I just have to say this, Mark, is that, this is the concern we all have for medicine when we’ve been unplugged, and this is the issue, is that we have pharmaceutical companies that provide medications to our patients to support sick lifestyle that perpetuates disease.

Dr. Mark Hyman: I love those advertisements on T.V. where they’re like, “Don’t worry, eat your leg sausage and peppers, and don’t worry, just take this Prevacid or they’ll say, take the purple pill,” it’s ridiculous.

Dr. George Papanicolaou: It is, but on the functional medicine side, here’s where the hard work is, changing the lifestyle to make it a healthy lifestyle so people can be healthy, prevent disease. If they do get sick, then we help them change lifestyle because that can impact disease more than anything else. And then for people who are well, have gotten better, we can use lifestyle to optimize their aging. And again, using a term I’ve heard you use age young, and that’s part of what we do here at the UltraWellness Center. It’s a whole spectrum, prevent, treat and then help people optimize and age young.

Dr. Mark Hyman: Yeah. My goal is to die young as late as possible.

Dr. George Papanicolaou: So back to the SIBO. So once we make that… Now, how do we make the diagnosis? So I always tell people tests are good, but there’s no perfect test. And your cognition, your doctor’s ability to think through problems is the most important thing that they can do for you.

Dr. Mark Hyman: Well, that’s what we do in functional medicine, we are thinking differently.

Dr. George Papanicolaou: Thinking, all the time.

Dr. Mark Hyman: My mentor, Sidney Baker, was one of the leading medical minds in the last century who’s really pioneered a lot of the visionary concepts of functional medicine, and he says, “We’re in the name it, blame it and tame it game.” We name and blame, we name the disease, then we blame the name for the problem and then we tame with the drug. So we say, “Oh, you’re sad and hopeless and helpless, you have depression, that’s what’s wrong with,” you know it’s just the name of what’s wrong with you, it’s not the cause. Then we go, “I know what you need, you need anti-depressant.” And that’s like, it just doesn’t make sense to set up what we do in functional medicine, it’s called thinking and linking.

Dr. George Papanicolaou: Right, think and link constantly.

Dr. Mark Hyman: Everybody thinks you treat the same disease with the same treatment. And in functional medicine, you’re going to have 10 people with migraines-

Dr. George Papanicolaou: Treat everyone differently.

Dr. Mark Hyman: And everybody is different.

Dr. George Papanicolaou: Absolutely.

Dr. Mark Hyman: 10 people with lupus, and everybody’s treated differently because you’re looking at what the root cause for them is, and I think that’s really profound. I want to get back to the SIBO thing, but I just want to come back to the matrix because that’s such a key concept. You described all these biological networks, assimilation which is the gut, defense and repair, the immune system, energy, how we make energy, detoxification, our transport system, our circulation, our communication systems, hormones or transmitters, or structural system, and all those are influenced by our lifestyle. By our thoughts, our feelings, our relationships, our diet, our exercise, sleep, all those things.

Dr. George Papanicolaou: Intrinsic relationship.

Dr. Mark Hyman: Yeah. And then they’re also influenced by external factors, toxins, allergens, bad bugs, stress, poor diet, and those impact our genes to change the expression. And so we have basically our inputs that are our problem and our lifestyle, and that cause disturbances in these systems. And no matter what disease you have, we use this model, and every single chronic disease and many acute disease are caused by disturbances in our biological systems. And that is what functional medicine is so unique at diagnosing and treating in a totally new way.

Dr. George Papanicolaou: Absolutely. And so it’s that constant work around the matrix. And one of the things that I said earlier is functional medicine is hard medicine. It’s hard for the doctor, it’s hard for the patient.

Dr. Mark Hyman: Yeah, because you think you have to think.

Dr. George Papanicolaou: Right, and you’re constantly thinking and as you treat, the environment of the patient changes, so you begin to the treatment plan and the patient comes back with a particular response, and that response will based on what is their lifestyle, what part of their lifestyle have they been able to change? Because it’s a real struggle for people to change lifestyle. That’s hard work. And then what are their genetics and how are their genetics? because we use a lot of genetic testing here that help us identify that. And so once they come back and they’ve responded to our first step of treatment, then we go around the matrix again and we rebalance, and we look, okay-

Dr. Mark Hyman: It’s like tailoring, adjusting every time they come in.

Dr. George Papanicolaou: Every, it’s like a fine watch and you’re just constantly working the gears, asking questions, having them tell their story again, retell their story. I can’t tell you how many times I have sat in an hour and a half initial visit, only to have the patient come back over a zoom or a physical visit to the office, and I ask them the same questions, and all of a sudden they’re in a different place and I get a different answer that opens up a whole new realm of thinking about their disease, their health, and even their goals for their life. So every time I go around the matrix, I get that person better and better, and better.

Dr. Mark Hyman: So we don’t treat 155,000 diseases, we just work with optimizing our biological systems in the matrix. That is the key to functional medicine. So that in a way it’s very simple, but it’s also very unique because each patient is different. And for the patient, some of the changes are hard because we’re asking people to change their diet or take different supplements, but the truth is that it’s actually end so much suffering and helps them so much that people are so excited about it.

Dr. George Papanicolaou: Oh, they get it.

Dr. Mark Hyman: And they do it. And so it’s actually in many times very easy for patients to change because they see the results so quickly. So let’s talk about the SIBO. Let’s go back to the SIBO and talk about these cases. I think we should share some cases.

Dr. George Papanicolaou: We should.

Dr. Mark Hyman: Give an example of what we’re talking about, it’s sort of abstract.

Dr. George Papanicolaou: I would say that very rarely do I see SIBO by itself, and why is that? Because Mark, you’ve already talked about, it’s the microbiome. When the microbiome is assorted as it is in SIBO and you have these bacteria growing where they shouldn’t grow. And so you’re now changing how food is processed, you are changing where it’s processed and you’re changing the body’s ability to absorb it. And what we know about the microbiome is those bacteria actually train our immune system.

Dr. George Papanicolaou: They’re very closely related to our immune system and our immune system identifies antigenic material from the bacteria and the bacteria is able to tell the immune system, here’s what you need to be worried about, here’s what you don’t need to be worried about. And so when we alter that gut immunity, we can create inflammation and we create inflammation, we begin to break down that membrane that’s responsible for opening and closing and letting good compounds and good nutrients in and keeping the bad guys out.

Dr. George Papanicolaou: When that breaks down, we have leaky gut, and now all of a sudden our immune system starts to see proteins that have not been completely processed down to the peptide level that they’re accustomed to, and they start making antibodies against commonly eaten foods. So now this person with SIBO is sensitive to a plethora of foods that they eat every day, which they might not be allergic to those foods, but they’re sensitive to them. So now they’re not eating. So they’re coming with all these symptoms, it gets exacerbated by almost everything they eat in their diet. Because now the disease process-

Dr. Mark Hyman: But they’re eating and they don’t know what to do not eat because they just, everything bothers them, right?

Dr. George Papanicolaou: Right. And so now they can come in, they’re sick. Now that your immune system is triggered, they have muscle aches, they have joint pains, they have brain fog because now they’re having-

Dr. Mark Hyman: Fatigue.

Dr. George Papanicolaou: -they have fatigue. Their mitochondria being affected, their brains are inflamed, they’re being effected. So now this person comes in and they may say to me, “I have brain fog, I have this, I have that.” I get the whole story and I hear the gut, always start in the gut, right? So now what do we do? They tell me their symptoms, we order a test, it’s called a small intestine [crosstalk 00:27:17]-

Dr. Mark Hyman: Before you’re in the test answer, I just want to recap, because what you said was so profound, which is that-

Dr. George Papanicolaou: I like being profound. Thank you.

Dr. Mark Hyman: No, I mean it’s a total frameshift. So most doctors don’t think much about the gut unless you have direct digestive symptoms, and even when you do, they treat it in a very linear way. But what you’re saying is when those bugs that should be in our Leiden tests and migrate up to the small intestine for various reasons, it causes an imbalance in there, and that leads to a breakdown in the barrier which causes this leaky gut.

Dr. Mark Hyman: And then all of these foreign proteins and bacterium components leak into the system. Your immune system goes, “Oh, that’s not me,” and it starts creating a response and then you get systemic inflammation, which is why you get brain fog and muscle aches and fatigue and joint pain, all these things, skin rashes, eczema, acne, whatever. And people think these are all not connected, but they’re all connected. So-

Dr. George Papanicolaou: They are connected. That’s why SIBO is such a great topic to start with, because it connects the entire matrix.

Dr. Mark Hyman: So tell us how we test for it and let’s get into a case.

Dr. George Papanicolaou: So testing will be with a breath test. It’s called the SIBO breath test, and we starve you for a day. Basically we want to start out those bacteria that are living in the small intestine, so they become metabolically inactive. And then you wake up in the morning and you take some lactulose-

Dr. Mark Hyman: Which is like a non-absorb sugar.

Dr. George Papanicolaou: Non-absorb sugar. But before you do that, you breathe into a little balloon and then we put that aside as your baseline test. Then you drink the sugar drink and now the bacteria like, “Wee, we got some food, we’re excited, we’re starving out, thought we’re doomed.” And then they get very metabolically active and then within 30 minutes or 60 minutes when they’re metabolically active, they start producing the exhaust of their metabolism, hydrogen and then sometimes methane, and even sometimes sulfur gases.

Dr. Mark Hyman: So it’s not just the cows that are burping method?

Dr. George Papanicolaou: Nope.

Dr. Mark Hyman: Humans are-

Dr. George Papanicolaou: Nope, Uncle Art’s been [crosstalk 00:29:06]

Dr. Mark Hyman: If you have SIBO, you’re contributing to climate change, is that it?

Dr. George Papanicolaou: Yep. That was going to be when we get to the magic one question, I’ll talk about my wife, Beniher. So-

Dr. Mark Hyman: There’s and also other tests like urine test, you can look at metabolites.

Dr. George Papanicolaou: Right, yep. You can look at, yeah. So we can look at metabolites that will show us markers for dysbiosis in the gut using an organics test. So in organics tests is when we look at all the organic acids that are products of your metabolism. And so we’re able to tell, we know what should be in the metabolism appropriately. And we can look at organic acids and we do that as a part of our GI work.

Dr. Mark Hyman: Which is a test that traditional doctors don’t do. They’ll do the traditional breath tests, but they’re not going to do an organic acid test.

Dr. George Papanicolaou: Right. The organic acid test or something even more advanced called an ion profile that looks at all of your amino acids. And that’s important when I do a SIBO workup because if I look at your amino acids and you’re depleted, then I know you’re really in trouble with your SIBO because you’re not getting good nutrition.

Dr. Mark Hyman: You’re not absorbing.

Dr. George Papanicolaou: You’re not absorbing. And then I can see markers of inflammation on the ion test. The organic acids are really critical because there are things that the bacteria produce that will end up in our urine that indicate to us that, wow, those things are in the urine because you have bacteria overgrowing or don’t belong in your gut. And now we find out-

Dr. Mark Hyman: Well, I think you’re right. I’m going to jump in with a case. I guess you remind me of a little girl I saw years ago who was nine years old and she was a pretty, little sweet looking girl who was a monster, like a terror. She would constantly get kicked out of class. She literally couldn’t make it home on the bus without the bus driver having a stop 10 times to settle her down. She was violent. She would rip pictures apart, of her family at home. She would terrorize her sister. And I’m like, “What’s going on with this girl?”

Dr. Mark Hyman: And we did a whole workup and we found her organic acid test and we found she had massive levels of overgrowth of bacteria and she had overgrowth of yeast, which is not called SIBO but SIFOs or Small Intestinal Fungal Overgrowth. And what I did was I gave her an antibiotic and an antifungal and literally the girl completely transformed. So when you think you’re treating a psychiatric disorder with antibiotics and antifungals, how does that make sense? Well, it makes sense when you understand the connections between the gut and the brain.

Dr. Mark Hyman: I mean, this was over 10 years ago and I remember writing about it in the Ultra Mind Solution. They were like, “Wow, the gut is so connected.” I had another one with OCD, the same thing. She had high levels ammonia and she had severe OCD, she wouldn’t pick up anything off the floor. I gave her an antibiotic and literally she became a neat freak. It was the weirdest thing.

Dr. George Papanicolaou: Oh yeah, no. So in those cases, in the cases I’ve seen, SIBO is very commonly related to neuropsychiatric disorders. So when I have people with memory loss, brain fog, ADHD… Just as you said, I’ve had multiple patients of mine.

Dr. Mark Hyman: Autism, depression.

Dr. George Papanicolaou: Autism. The first thing we do is treat their SIBO, change their diet and within the first six weeks we’re starting to see significant change in their behaviors with ADHD and in their verbal abilities with autism kids. I was going to talk about a fibromyalgia case, but I will talk about ADHD… actually in the anxiety depression case.

Dr. Mark Hyman: Talk about both of them.

Dr. George Papanicolaou: Yeah, I’ll talk about them. Why? There are so many cases I could choose from. There is a recent case from a patient from a different part of the world actually, came in and they were having lots of difficulties with their child, very bright siblings but this particular child was having a lots of issues with impulsive behavior, tension in the classroom, moodiness, to the point where there the child would speak of not wanting to live anymore. And so I went through all of their symptoms and the biggest thing that this child had difficulty with was the bloating and distension. That was constant.

Dr. George Papanicolaou: Mom noticed it from almost day one of life. So we did not only do the SIBO breath tests, but we did something called a GI map test which we’ll look at while using DNA and PCR technology. We look at all of the bacteria in your gut, the major colonies, major species, look for Candida and then also look for markers of inflammation. Those two tests on this patient indicated severe disruption of the balance of the micro biome. The patient was put on a brief elemental diet, which is a diet that takes out most foods.

Dr. Mark Hyman: All the foreign protein.

Dr. George Papanicolaou: All the foreign proteins. And then was put on an auto-immune paleo diet. And it’s very difficult to put a kid on a diet like this.

Dr. Mark Hyman: It basically starves a lot of the bad bacteria.

Dr. George Papanicolaou: Absolutely.

Dr. Mark Hyman: So instead of feeding them of starch and sugar and carbs which they love, you’re giving them less of that.

Dr. George Papanicolaou: Right. And we combined it with a low FODMAP diet to make sure that the child got all the nutrition they need.

Dr. Mark Hyman: The FODMAP is like what? That’s like-

Dr. George Papanicolaou: Those are long chain sugars that get fermented very quickly by bacteria. And when you eat them and you have small intestinal bacterial overgrowth-

Dr. Mark Hyman: You get a very big food belly; you’re like nine months pregnant.

Dr. George Papanicolaou: Right. And the food baby is this basically, you’re fermenting food where you shouldn’t be. Food’s meant to be fermented in the large intestine. And that’s like Florida, right? But what’s happening with small intestinal bacterial overgrowth is bacteria up in Maine and the food’s coming in the Maine. Maine’s not ready for gas. So now, all of a sudden, you’ve got this gas where it doesn’t belong geographically, you feel very uncomfortable.

Dr. George Papanicolaou: And it starts to impact everything we talked about, your nutrition, your inflammation, and that translate to that gut-brain connection. The brain gets affected. That’s why we see so much benefit when we treat diseases like SIBO and dysbiosis in our patients with neuropsychiatric disorders from ADHD to OCD to anxiety and depression. And you’ve noticed it. I know we’ve talked about even like Parkinson’s and other disease processes that will stabilize once we start addressing gut issues.

Dr. Mark Hyman: What happened to this kid then?

Dr. George Papanicolaou: We had the six week follow up and we had started treating… It was actually not the six week follow-up. But at six week follow-up we went over all the testing and we started the second part of the nutrition plan. Once we started the nutrition plan and I used some natural herbs to get rid of some of that overgrowth-

Dr. Mark Hyman: So sort of antibacterial herbs.

Dr. George Papanicolaou: Antibacterial herbs that come in different compounds that we use. Eight weeks later that child’s behavior, the mood swings, were completely gone. Completely gone, the impulsivity was drastically reduced and the teachers were saying he was now paying attention in class. And that was just with food,-

Dr. Mark Hyman: That’s remarkable.

Dr. George Papanicolaou: -no stimulants.

Dr. Mark Hyman: Are these herbs like oregano and [inaudible 00:36:06] and thyme and things like that?

Dr. George Papanicolaou: Absolutely.

Dr. Mark Hyman: Yeah, powerful stuff.

Dr. George Papanicolaou: Yeah. And so that’s the SIBO story. It’s like a brain connection that’s so powerful.

Dr. Mark Hyman: Yeah. I actually brought back some bad memories because when you talked about the food baby, when I got sick from mercury poisoning almost 30 years ago, one of the things mercury does is it interrupts all your enzymes and your function. So my gut became very dysfunctional. And I remember literally having food babies all the time. I literally almost couldn’t eat anything without my stomach blowing up and feeling like someone just pumped my intestines up like a bicycle tire.

Dr. Mark Hyman: And that at that point of time, we didn’t really think about SIBO. We didn’t really name it and we weren’t really aggressively treating and I was trying things that I thought would work, but it was really tough. Until I got rid of the mercury, I couldn’t get rid of the SIBO. So often there’s something underlying, right? There’s often a root cause. I’ve seen people with gut issues that maybe were caused by Babesia, for example, it was a tick infection-

Dr. George Papanicolaou: Yeah. Oh, absolutely. So [Lyme 00:37:02] disease-

Dr. Mark Hyman: -which can paralyze the gut.

Dr. George Papanicolaou: Right. So if I have a SIBO patient who’s not getting better I think two things. One is I think about Lyme disease because one of the symptoms of Lyme disease, and is a trigger to test somebody for Lyme, is when they get Bell’s palsy. Lyme disease can affect the nervous system, and so Bell’s palsy is when you have your facial nerves paralyzed and it can be caused by Lyme. The same thing can happen in the gut. You can get a paralysis and a dysfunction of the migrating motor complexes and now the peristalsis of the intestine is declining. The intestine won’t move. Now these bacteria can stay there and populate. So, again, it’s all these things that’s impacting.

Dr. Mark Hyman: And that’s the thing. When you go to a traditional gastroenterologist he might say, “Okay, we do the breath test. You have SIBO. Take these antibiotics, forget about the yeast stuff. And I’ll see and hope, cross fingers.” And there are so many times it fails because they’re not getting to the root cause. The root cause may not be SIBO. It might be something that’s causing the SIBO like Lyme or like mercury or something else.

Dr. George Papanicolaou: And there’s something else too going back to lifestyle. When I can’t get a person better with SIBO and I start going around the matrix again, are you sleeping, are you exercising, how’s your marriage, how your relationship, do you have a toxic relationship. Because the people that I’ve done everything for, I’ve given them a bone broth and colostrum and elemental diets. They’re not getting better. It’s the fifth R. We use the five Rs, right? We use remove, repair, restore, and… I can’t remember four.

Dr. Mark Hyman: It’s remove, replace, reinoculate, repair and-

Dr. George Papanicolaou: Rebalance.

Dr. Mark Hyman: -rebalance.

Dr. George Papanicolaou: And the rebalance piece, the fifth R, I call it fifth R. It’s the fifth R. It’s getting people to rebalance their lives. And that is basically are you dealing with your stress. The people that aren’t dealing with their stress, aren’t getting their sleep, aren’t exercising-

Dr. Mark Hyman: What does stress have to do with the intestines?

Dr. George Papanicolaou: That’s another podcast.

Dr. Mark Hyman: Come on, give us a nugget here.

Dr. George Papanicolaou: Okay, so stress. Stress is probably the start of all disease. It impacts everything from your hormones in your own body. But stress actually creates some neuro-chemical changes in your brain and there’s a communication between your brain and your micro biome.

Dr. Mark Hyman: And your gut, it’s called the second brain.

Dr. George Papanicolaou: It’s the second brain. Some people think the gut was the first brain-

Dr. Mark Hyman: Maybe.

Dr. George Papanicolaou: -and that our brain only developed once mitochondria we’re starting to make energy for us and then were able to use that energy to make a second brain that allowed us to reason and so forth. However, once you have that gut-brain connection, stress can actually… we have this Vegas nerve. It’s a super highway from the gut to the brain and there’s actually-

Dr. Mark Hyman: It’s the relaxation nerve.

Dr. George Papanicolaou: It’s the relaxation nerve. And your brain can communicate anxiety and stress to your gut micro biome and actually change the makeup of your gut micro biome.

Dr. Mark Hyman: Yeah, and your nervous system.

Dr. George Papanicolaou: Right, and your nervous system.

Dr. Mark Hyman: The stress hormones literally paralyze your gut, your sympathetic nervous system and your fight or flight. You don’t want to be digesting your food when you’re running from a tiger. You want your gut to shut down so you don’t have to poop or do anything else. So your gut shuts down and that’s what happens. We live in a state of chronic stress, then our guts not working.

Dr. George Papanicolaou: It’s not working. And then now you create that environment for SIBO to develop.

Dr. Mark Hyman: Yeah. I was talking about SIBO and I just remembered this patient I had a few weeks ago. What a striking case. She came in with what we call vestibular migraines, which is essentially a migraine from hell where your room is spinning around, you’re in bed, you’re nauseous, you can’t get up. And she had it like 25 days a month. And she was a really smart young woman who wanted to go to graduate school and was basically in bed. And so I started not just asking about her headaches, and she’d seen like 45 doctors, seen neurologists and everybody and she was on this medication, nothing was working.

Dr. Mark Hyman: So I’m like, “What else is going on?” “Well, I’m bloated all the time and my belly is distended.” And I could see she was puffy and swollen. She gained a bunch of weight, she was severely depressed, she was anxious. And I’m like, “This is not a messed up person. This is a person whose biology is messed up.” And I said, “Well, let’s just try to put you on a clean diet.” Eliminated all the allergic foods. I gave her a non-absorbed antibiotic and antifungal, basic nutrients, very simple. And I waited for a test to come back.

Dr. Mark Hyman: And she came back in and the first time she came in she had to leave the door open. She was so anxious. Her system was so in fight or flight she couldn’t even be in the room. She stood up, she was pacing around. I’d never had a patient like that. She came back six weeks later, she looked like a different person. I mean, not only was all the inflammation gone out of her body, all the fluid, not only did she lose 20 pounds, but her gut was normal and she hadn’t had a migraine. She’s was completely better. She maybe had one or two very mild headaches.

Dr. Mark Hyman: And when I got her test back, yes, she had SIBO and I could anticipate based on her history what was going on. But that’s a case where she had been seeing doctor after doctor, after doctor. And these are the kinds of patients we see here where I often joke, because we’ve been here for about 15 years. Before that, I worked at Canyon Ranch. I was the medical director and always joked I was a resort doctor, the doctor of last resort. And that’s the kind of patients what we see here where I joke I’m a holistic doctor because I take care of people with a whole list of problems.

Dr. George Papanicolaou: Right.

Dr. Mark Hyman: And the treatment for this is all the things you mentioned. It’s diet-

Dr. George Papanicolaou: Right. We start with diet. It’s really a diet lifestyle. And by the time patients get to me, as I said before, SIBO is just part the whole complex. Because once you’ve affected diet, then you’re effecting how your hormones are working, your auto-immunity and so forth. So we always start with diet because we can impact all the systems with a good diet. So diet we can include a FODMAP diet, it can include elemental diet, it can include an autoimmune paleo. And our nutritionist here at Ultra Wellness Center, we work very closely with.

Dr. George Papanicolaou: And when a patient is here, after I see them, I will consult with our nutritionist and we will customize the diet plan for each particular patient that has SIBO. It’s not always going to be the same diet.

Dr. Mark Hyman: That’s really important, what you just said. We here at the Ultra Wellness Center work as a team.

Dr. George Papanicolaou: Absolutely.

Dr. Mark Hyman: And, tell us a little bit about that.

Dr. George Papanicolaou: Yeah. We have a team from the first phone call to your first visit and beyond. Each team is made up of a navigator, a nurse and a nutritionist and a doc. And we meet every week, multiple times a week, and we discuss cases; and we discuss the cases that are coming to our center, cases that we’re working on and we’re constantly collaborating and we’re always trying to answer that question we’re always asking why and how. And so our team, from the first visit, the navigator will identify what your needs are and then you’ll get a phone call from our nurse practitioner who will do a collaborative pre-visit.

Dr. George Papanicolaou: A whole hour you’ll spend, before you even get here, going over your case. And we’ll get all your documentation, we’ll get a summary from the nurse practitioner. I review all of that before the patient even gets here and I will review that case with my nutritionist even before I go in the room to see the patient for the first time. So before I even come in the room with a patient, I’ve actually gone over all the data they sent in, it’s been reviewed by a nurse practitioner who’s actually interviewed the patient, I get that summary. I talk about the case with my nutritionist. I actually begin to create the patient’s matrix before they come in for their visit.

Dr. George Papanicolaou: So when I’m sitting there, I am now getting them to fill in all the blanks, answer any questions, any pieces of the puzzle that I haven’t been able to figure out yet. And an illustration I will use with my patients is I’ll say, “Look, we get patients from all over the world and they’re usually very complex, and usually been to many other doctors. And they bring me this big sack and they empty and it’s puzzle pieces. It’s the pieces they’ve collected from all their other medical workups.”

Dr. Mark Hyman: And we connect the dots.

Dr. George Papanicolaou: “And we put those puzzle pieces down and we try to piece them together. And by the end of that first visit, I can see where the gaps are.” I can’t tell if it’s a lion or a tiger or a bear or an elephant but I can start to get a picture. And at that point we make the decision, here’s some more testing we need to do, here’s more information I need to get and here are some things we’re going to try based on what you’ve tried before and what might be a good starting point for you. It’s always nutrition and it’s always lifestyle change.

Dr. Mark Hyman: Food first. Yeah, food first. When I started this practice 15 years ago with the Ultra Wellness Center, I think we probably were the first practice where it was mandatory to see a nutritionist if you wanted to get an appointment.

Dr. George Papanicolaou: Right.

Dr. Mark Hyman: Because if food is medicine, then, how do we practice without nutrition? Just like imagine taking a prescription pad away from your doctor.

Dr. George Papanicolaou: Absolutely.

Dr. Mark Hyman: I don’t even know where my prescription pad is anymore at the time because I barely use drugs, because I don’t need to. I’ll use them if I need to, but I don’t usually need to.

Dr. George Papanicolaou: That’s absolutely correct. And now I’m in the same situation. I went from using them a lot to barely using now.

Dr. Mark Hyman: And you also mentioned testing. Now, people think, “Oh, well, all tests are the same. My doctor worked me up, he did all the tests, everything was normal and everything is fine.” What do you have to say to that?

Dr. George Papanicolaou: Conventional testing is one thing. It’s very one dimensional. Again, it doesn’t look at the root cause of disease. So one thing that we do a lot of is we do genetic testing. And we don’t do a 23andMe. You get 5,000 genes, we don’t know what 4,900 of them do. Right? And we don’t know how to make clinical connections. But we use a company that looks at eight very important biologic systems and the most important potential variance.

Dr. Mark Hyman: Yeah, things that are common that you can do something about them and make a clinical impact.

Dr. George Papanicolaou: They’re actionable. They’re actionable genes, what we call single nucleotide polymorphisms. Just basically when one gene is altered in a way that the gene will still be a blueprint to make an enzyme or a protein the protein or enzyme that’s made might not be as effective.

Dr. Mark Hyman: Or has a different functionality.

Dr. George Papanicolaou: A different functionality. It might do what it’s supposed to do really fast, it might do what it’s supposed to be really slow and that will impact how you will function. So doing that genetic testing allows us to see what your blueprints are, and you have baseline variants that if we alter your lifestyle and alter your nutrition can support those variances so they optimize and now your body’s functioning better, your immune system is functioning better, your ability to stop oxidation improves, your ability to turn good inflammation on and turn it off when it’s done.

Dr. George Papanicolaou: That can be improved because they can be affected by those blueprints. So genetic testing is a critical part of what I do for all my workups. And then another test that we do is we check for toxins.

Dr. Mark Hyman: Yeah. So what you’re saying is we’re starting to look down through the matrix. We’re looking at these biological systems and dysfunction or imbalances that aren’t ‘diseases’ through testing that isn’t available really in most places or, for sure, through conventional medicine. And that’s where we find the answers, right? I once was doing a study, Amino Electron Vitamins, and I had to figure out how many chemical reactions they were because all chemical reactions depend on vitamins and minerals.

Dr. Mark Hyman: And there’s 37 billion chemical reactions every second in the human body. That’s 21 zeros. Okay, how many blood tests do you get from your doctor? 30?

Dr. George Papanicolaou: Yeah.

Dr. Mark Hyman: You get your chem screen, your CBC, your cholesterol. And we think, “Oh, well, that’s fine. So you’re healthy.” But the truth is those are only [inaudible 00:49:01] diseases.

Dr. George Papanicolaou: Yes, yes, yes. Yeah, if we want to talk about testing, we can just go down that cholesterol route and we can just talk about the debacle that is for our patients. With the testing that’s done, it’s very one dimensional and one layer that it doesn’t really look at cardiovascular risk at all. So testing that we do, it starts to get into those deeper levels that really impacts the function of the body. Looking at toxins, we live in a toxic world. It’s not a matter of do you have toxins, just how many do you have.

Dr. George Papanicolaou: Persistent pollutant toxins that will just camp out in your fat and just leach into your system and alter how your mitochondria work, alter how your immune system works. Great case that I had, it’s a gentleman who has Alzheimer’s. He was seen in a very large institution in Boston and he was diagnosed at the age of 56 with moderately advanced Alzheimer’s. He had a basic evaluation with a spec scan and he was told he had Alzheimer’s. He was given a pill that we know doesn’t work for more than 18 months to stabilize it. Right? He was given a-

Dr. Mark Hyman: It doesn’t work even for 18 months.

Dr. George Papanicolaou: I was just trying to be generous. And then-

Dr. Mark Hyman: And that’s not our [inaudible 00:50:09]. This is basically in the major medical journals. The pills trials almost don’t work.

Dr. George Papanicolaou: Yeah, these don’t work. Then, he was given start behavioral therapy and cognitive therapy. Again, hasn’t been proven to do anything to slow the progression or improve cognition at all. So he’s at a major institution, given those two things to do. He is a very, very active gentleman with a great deal of huge responsibilities in his life, a very dear man. And he comes here for the first visit and you see these issues and so we start talking and I start testing. So we do the tests.

Dr. George Papanicolaou: Let’s look at the gut. Let’s see if there’s toxins. Let’s find out about your hormones. All right, let’s see if you have any autoimmunity. We do specific autoimmune testing to see if your body is making auto antibodies against brain tissues.

Dr. Mark Hyman: Why would you do that? Because Alzheimer’s is what?

Dr. George Papanicolaou: Alzheimer’s is a multifaceted multi-causality disease.

Dr. Mark Hyman: It’s inflammation of the brain.

Dr. George Papanicolaou: It’s inflammation in the brain, yes.

Dr. Mark Hyman: Because that’s what driving it.

Dr. George Papanicolaou: Right. And there’s lots of things that can cause an inflammation, so we’re going to look for everything that can cause inflammation. And there’s also a disruption of normal function that might be distant. So what effect does having a low testosterone have on the brain? Testosterone has a big impact on the brain. It can have an impact on inflammation. It can have an impact on how the pituitaries in the hypothalamus is secreting other hormones, how those hormones will work, how your neural transmitters that may work. Here are some of the things we found with this gentleman. He had a mercury of 120.

Dr. Mark Hyman: Oh, wow. Now put it in perspective like zero is normal-

Dr. George Papanicolaou: Zero to four.

Dr. Mark Hyman: -and anything over 10, I worry about. 20 is bad and 120 is… A handful of people that you see over the course of decades have 120.

Dr. George Papanicolaou: Yeah. Yeah, very, very few people. Mercury level. Testosterone level.

Dr. Mark Hyman: From where?

Dr. George Papanicolaou: Fish, water, air. But largely-

Dr. Mark Hyman: Was he a big fish eater?

Dr. George Papanicolaou: He was a fish eater in his lifetime. And, again, he wasn’t an extraordinary fish eater but if you look on his detox genes he had a lot of variants that made him susceptible to not being able to detoxify as well as he should.

Dr. Mark Hyman: Exactly.

Dr. George Papanicolaou: You and I here, we eat any sushi the whole week.

Dr. Mark Hyman: Not me. I got those same genes.

Dr. George Papanicolaou: Okay, you got those same genes.

Dr. Mark Hyman: That’s why I got mercury poisoning.

Dr. George Papanicolaou: Okay, great. I can eat it. I don’t have an issue with mercury. Right? My mercury wasn’t high at all. And I love fish. I eat a lot of fish.

Dr. Mark Hyman: Oh, so jealous.

Dr. George Papanicolaou: Okay, well… So mercury. His testosterone level was 150. At his age, his testosterone level should be 600 on average.

Dr. Mark Hyman: 800, 900 is normal.

Dr. George Papanicolaou: 600 to 800. Yeah, right?

Dr. Mark Hyman: 150 is like-

Dr. George Papanicolaou: Nothing.

Dr. Mark Hyman: -about what a woman has almost.

Dr. George Papanicolaou: Exactly. So, his testosterone was low, his mercury was bad and, of course, there was SIBO and he had dysbiosis. So not only did he have-

Dr. Mark Hyman: His gut was all messed up.

Dr. George Papanicolaou: His gut was all messed up. And then finally on top of it, he tested positive for Lyme disease. So that’s another thing that we do here at the Ultra Wellness Center. It’s you can’t practice functional medicine without coming across Lyme disease almost every day. It’s stealth infections, Lyme disease and the co-infections that can be found with it along with other viruses are a big part of what impacts people. He had Lyme disease.

Dr. Mark Hyman: So we had four strikes against him.

Dr. George Papanicolaou: And so here’s this really interesting, we arranged for him to get some really intensive Lyme disease treatment at another clinic in Germany where they do hypothermia and they give IV antibiotics by making somebody really warm. That’s when the bacteria get most susceptible to antibiotics. And so at that really high temperature, about 107 degrees, they’re going to put an IV infusion of an antibiotic in and fight the infection.

Dr. Mark Hyman: Yes, I did that. I went to Saudi and I had hyperthermia and I have Lyme disease and Babesia and I had night sweats all the time. And I did the treatment and it kind of went away. And I’ve seen this case after case. Now, it’s not something that’s available in the United States but it can be very powerful treatment.

Dr. George Papanicolaou: Yeah. In his particular case, we chose that direction because of the degree of the severity of what he was facing. So we wanted to, “Let’s just hit this hard, hit it fast.” It was something we really believed in. So we arranged for him and I worked with his doctors at the St. George clinic and then we treated his mercury. We started treating his testosterone using, first, getting him to sleep better, working on his nutrition. I always like to work on lifestyle before I start treating directly with hormones.

Dr. George Papanicolaou: Then, we added in some hormones that would benefit his testosterone levels. And at six months he had stabilized, so he had not worsened. About the eighth month mark when we saw where he was at, he was still working and he’d noticed that his memory had not gotten any worse than it had been. And so we’re continuing to work, it’s a story that’s ongoing, but really, really exciting because-

Dr. Mark Hyman: I mean, that’s important to say that this is a progressive disease because usually your later people are a lot worse. Right?

Dr. George Papanicolaou: I was thrilled that at eight months he wasn’t worse.

Dr. Mark Hyman: And were his numbers better?

Dr. George Papanicolaou: [inaudible 00:55:34], absolutely. His testosterone levels were up to like 500 at that point, mercury level was coming down. Mercury can be hard to bring down and it can take a period of time. But I do like to remind people, he was very excited to know there are things I can work on. See, he left a large institution with things to do that weren’t going to work. He was sort of hopeless.

Dr. Mark Hyman: This is a really important point with functional medicine. Alzheimer’s is a diagnosis, it’s not the cause.

Dr. George Papanicolaou: No.

Dr. Mark Hyman: And functional medicine helps you figure out what that is not. It doesn’t mean everybody with Alzheimer’s has those things, although they’re common. But tick infections, heavy metals, hormonal issues, gut issues, things you can actually treat. And I think this is such a big difference between functional medicine, what we do here at the Ultra Wellness center in Lenox, Massachusetts, and what people get when they go to a traditional physician. They’re not having somebody pull back the hood and look underneath and see what’s going on and they go, “Oh, I know what’s wrong with you. You have Alzheimer’s.” No, that’s just the name of the problem. Now, let’s start to figure out what’s going on. And that’s beautiful.

Dr. George Papanicolaou: We see everything here. We see autoimmune disease from Hashimoto’s Thyroiditis to Ulcerative Colitis, to Rheumatoid Arthritis. We see Alzheimer’s disease, ADHD, autism. We see people with-

Dr. Mark Hyman: It doesn’t matter what diagnosis you have because we treat the system not the symptoms of disease.

Dr. George Papanicolaou: Exactly. Exactly.

Dr. Mark Hyman: And when you do that whatever they have has a chance of significantly getting [inaudible 00:57:02].

Dr. George Papanicolaou: And that’s the point I want to make. We see everybody with everything from every age and we end up being able to help them more than the specialist did, because we’re looking at everything and we’re getting to the root cause. And so in a course of a week, I can see a two year old or a three year old with autism and I can see a 62 year old with ALS. I can see a woman with depression, no libido, fibromyalgia, and it’s all in my purview. And it’s all really exciting.

Dr. Mark Hyman: It’s a really exciting point. People say, “Well, do you treat this? Do you treat that?” And I’m like, “I treat things I’ve never seen.” I never had a patient with vestibular migraines before. I don’t know that much about it other than the basics, what I learned in medical school, but I know how to treat the body. I know how to treat the system. I know how to treat a human being and look for the root causes. And when you do that, even if you don’t exactly understand the disease, it’ll often dramatically improve or reverse completely.

Dr. George Papanicolaou: Absolutely. But I like to let people know it’s hard work. It’s good work. It’s really good hard work.

Dr. Mark Hyman: It’s certainly not like, “Take this pill and see you in six months.” You have to change your diet, you have to take care of your lifestyle issues. You have to take things to help reset your system. Treat your gut, do the hormones, treat the Lyme.

Dr. George Papanicolaou: An example I think is a good one is my own daughter. She started having… And I have permission from my daughter actually. She said, “Are you going to say my name?” I said, “Do you want me to?” She said, “Yeah.” So my daughter, Isabelle. So my daughter, Isabelle. She started having her period and in the first year of her cycle she was very irregular and she was really getting more and more fatigued. So it was around school time, it was August, she goes to her pediatrician.

Dr. Mark Hyman: Gives the pill.

Dr. George Papanicolaou: No, no, no, no. My wife goes with her and my wife she’s very attentive to these health issues and nutrition. And so she sat in the visit and she came back and she shook her head George. She said, “I am done. I am so done. I told him that Isabelle had fatigue, never once asked her what she eats then talked a bit nutrition whatsoever.” Basically barely asked her about her period other than to know that it was irregular; and really basically said, “You just started your period, give it some time. You’re an adolescent, you sleep more you’re going to be fatigue. It’s part of the natural process.”

Dr. George Papanicolaou: So I’m thinking, “No.” So I wanted to know. I know my daughter’s diet is hard. As we try in our home, my wife and I eat whole foods. She will tend towards carbs and sugars, outside the home and even inside the home. So I had a lot of suspicion, from watching her in our house, that she was having issues around her diet and nutrition. So the first thing I wanted to do was find out if she was having any food sensitivities, so we did some IGG antibody testing which looks at food sensitivities not necessarily food allergies. So IGE looks at food allergies-

Dr. Mark Hyman: Like you have peanut allergy or something.

Dr. George Papanicolaou: Peanut allergy, that’s anaphylaxis.

Dr. Mark Hyman: You’ll know it.

Dr. George Papanicolaou: You eat it, you turn blue.

Dr. Mark Hyman: But IGG is like you might not know or you might-

Dr. George Papanicolaou: You eat a Strawberry-

Dr. Mark Hyman: You know you had it on Monday and on Wednesday got a headache.

Dr. George Papanicolaou: Right. Strawberry on Friday night and Sunday you have red cheeks. That’s sensitivity. Now, you can have sensitivities and you never make the connection to food. My daughter had huge sensitivities to gluten. Gluten is a really bad thing, we’re going to talk about it in a second. Milk, egg and then multiple other foods which cause that whole leaky gut syndrome.

Dr. Mark Hyman: So she had leaky gut.

Dr. George Papanicolaou: She had a leaky gut. Checked her thyroid. Your TSH should be, in general… If you look at numbers 4.5 or less, hers was 5.8.

Dr. Mark Hyman: Yikes. That’s like low thyroid.

Dr. George Papanicolaou: I checked her thyroid antibodies, when the body begins to make antibodies against self tissue. My daughter had antibodies against her thyroid.

Dr. Mark Hyman: Wow. Again-

Dr. George Papanicolaou: 14 years old, right? And she was told-

Dr. Mark Hyman: And most doctors don’t check antibodies. They’ll just check the TSH and if it’s around normal they’ll just say it’s fine.

Dr. George Papanicolaou: Right? And her CBC, her blood count. We have hemoglobin ematocrito, two numbers you look at to see if you have enough blood. Blood carries oxygen. Oxygen is required to make energy. Energy gives you energy. If you don’t have it, you’re fatigued. And she was fatigued. These tests were not done.

Dr. Mark Hyman: She was anemic?

Dr. George Papanicolaou: She was anemic. Her hemoglobin was 9.9.

Dr. Mark Hyman: Oh, that’s really low.

Dr. George Papanicolaou: It should be 13 to 14, right?

Dr. Mark Hyman: Yeah. That’s like down like three pints.

Dr. George Papanicolaou: No, these lab tests were available to the conventional doctor. So now here’s my daughter, [inaudible 01:01:42] all this going on. So the first thing we’re going to do is we’re going to change your diet. But here’s the key thing, the gluten piece. See, that gluten sensitivity triggers everything. As we know, gluten can be a trigger for your gut to make something called zonulin, and zonulin is the molecule that opens and closes those gates in that membrane that protect your body from what’s in the lumen of your gut.

Dr. Mark Hyman: In the intestines.

Dr. George Papanicolaou: Right, in the intestines.

Dr. George Papanicolaou: So when you’re sensitive to gluten and you start to trigger that, you create this leaky gut. That’s when you really open up that door, as we talked about, for auto immunity and malnutrition. And then on top of that, she was having these bleeds. The last thing I checked, Mark, was her hormones.

Dr. Mark Hyman: Well before you [inaudible 01:02:28], I just want to recap that because that’s important. So gluten basically damages your gut lining which then causes leaky gut. But it also prevents iron absorption, which is why she was anemic. It also triggers autoimmunity, particularly thyroid autoimmunity. So in a lot of people Hashimoto’s is caused by gluten. So when you dial back you can get to the root cause and see what happens.

Dr. George Papanicolaou: Right. Okay. And then on top of that, as a quick aside, I checked her hormones and you can do this ratio between your progesterone and your estrogen. When a woman’s irregular like that, you should really check that because if you have a relative elevated estrogen compared to progesterone, it’s called estrogen dominance. And estrogen dominance can impact your cycle. It can make it irregular and it can make it very heavy. It can lead to a lot of PMS and depression and it can last for half of the month.

Dr. Mark Hyman: Okay.

Dr. George Papanicolaou: Okay, so all this was going on.

Dr. Mark Hyman: And by the way, 75% of women have PMS. That is not a normal condition of women.

Dr. George Papanicolaou: No, it’s not.

Dr. Mark Hyman: It’s because of our diet, our stress, our lifestyle, our gut.

Dr. George Papanicolaou: Or food.

Dr. Mark Hyman: Food. So many things drive it.

Dr. George Papanicolaou: Or food that has hormones in it, the whole issue with hormones in our food.

Dr. Mark Hyman: And guess what’s the biggest driver of high estrogen levels? Sugar.

Dr. George Papanicolaou: Sugar and hormones in our food.

Dr. Mark Hyman: And starch.

Dr. George Papanicolaou: Exactly. So my daughter is a perfect example of the modern diet despite – believe me I’ve got to say this – parents who eat really well, have a garden in the backyard and do some-

Dr. Mark Hyman: Teenagers are temporarily psychotic.

Dr. George Papanicolaou: But it’s part of the point I want to make, and this is the point. It’s that she’s fortunate to have me as her dad because if she didn’t have me she could’ve gone a decade or two decades thinking, “Hmm, that’s just me.” Only in her 30s after a baby or before a baby or in a stressful time to just completely break down and all of a sudden have Hashimoto’s or Rheumatoid or some other immunologic disorder could have been prevented. Right?

Dr. Mark Hyman: And this is what happens. I’ve seen this over and over in patients. They start out and you can track their history. We called it the timeline in functional medicine. We track, okay, this person was born by C-section. Their gut doesn’t get developed in the micro biome. They had antibiotics early on because of ear infections, disrupts our micro biome. Maybe they developed some acne or maybe they got some allergies and then they get, maybe, thyroid issues when they’re 20. When in their 30s, they start getting autoimmunity like Rheumatoid Arthritis. And it’s the same freaking story almost every time.

Dr. George Papanicolaou: Yeah, all the time.

Dr. Mark Hyman: And you can track it back. So the fact that you got your daughter early is a huge thing and that allows her to then, maybe, develop normally and not develop these autoimmune diseases and so forth that we see in so many people.

Dr. George Papanicolaou: Yeah. Here’s one of the things I want to say about functional medicine. Applying everything that we discover as we ask these questions why and we do these advanced testing that you’re not going to get at another center is not easy. Right? And I know firsthand what it’s like to have to change the lifestyle, not only my daughters but in my own when I dealt with my brain injury. But with my daughter having to help her sleep better, create a sleep ritual, help her to learn how to meditate, help her to make good food choices, that is not easy work.

Dr. George Papanicolaou: And so at the Ultra Wellness center, we also have coaches. We have coaches that will come alongside of you and will hold you accountable, work with you, they help you devise strategies over a long period of time to change these lifestyles. We know habits don’t change for at least three months. How can we anticipate that some of the most critical things that are going to make you healthy are going to happen in two weeks, six weeks or eight weeks? It could take three years. I like to remind people that.

Dr. Mark Hyman: Yeah. Well, what’s fascinating too is that what I see here is that it’s not as hard as you might think because when we put people on a regimen… And I do this pretty aggressively to get them feeling better fast because I figure if they can have the experience of feeling good even if there’s more work to do they’re going to do it. In other words, in 10 days or two weeks by changing your diet and doing a few simple things you often see profound differences.

Dr. George Papanicolaou: That’s true.

Dr. George Papanicolaou: And it doesn’t take forever. So there is work to create sustainable lifestyle change, but if you get people to do an aggressive change quickly… Like if you’re allergic to five things and you stop one of them, you’re not going to feel better. If you stopped three of them, you’re not going to feel better. You’ve got to stop all five. And that’s why we do the kind of work we do here. We get people to actually quickly shift their biology, because we know how to do that with functional medicine. And then they go, “Oh my God,” like this woman who got rid of her migraines, whose gut normalized, who lost 20 pounds, who had energy back, whose anxiety and depression went away. She’s going to be motivated to stick to the program.

Dr. George Papanicolaou: Oh, absolutely.

Dr. Mark Hyman: It’s not going to be so hard.

Dr. George Papanicolaou: Yeah. Yeah.

Dr. Mark Hyman: You mentioned something briefly I want to come back to, which is your brain injury. You just sort of slipped that in there. Tell us what happened. It’s happened actually while you’ve been working here and it was kind of a shock for you and for all of us, so tell us about that.

Dr. George Papanicolaou: Yeah. I was doing Cross Fit one morning and if anybody knows anything about Cross Fit you’d think, “Oh, he was doing some crazy thing. He deserved to get injured.” No, that’s not what happened. I just wanted to do a pull up. But we have these things called the racks; and so you go to a rack, you go to do a pull up. But every other station in the rack has another bar that sticks out. It’s called a kipping bar. It’s a way you can do a pull up using your momentum. When I was talking to the instructor I got into the rack, the cage, and I wasn’t looking to see which one I was in.

Dr. George Papanicolaou: I just looked up, saw my bar, went to do a pull up and hit my head on the kipping bar. Now, I’ve hit my head a lot worse in my lifetime and I didn’t make too much of it. 20 minutes later, I was jumping off and on box and I got the worst headache of my life. That was on Thursday before Christmas 2017. And it turned out, over the next four days, that the headaches would come and go but get worse and worse and worse. I ended up going to the emergency room that I used to work in when I first came to our community and the nurse recognized me. And I put my head down at the triage desk and couldn’t even look up. And I said, “Elaine, I have the worst headache of my life.”

Dr. Mark Hyman: That’s a line in medicine you learn means what.

Dr. George Papanicolaou: So, here I am in the emergency room that I worked in when I first started practicing medicine and I hear myself say that. And as the words are coming out of my mouth I’m saying, “You have a subarachnoid hemorrhage.”

Dr. Mark Hyman: An aneurysm.

Dr. George Papanicolaou: Well, and it turned out to be I did not have an aneurysm.

Dr. Mark Hyman: So it was just that you banged your head and you got-

Dr. George Papanicolaou: Well, here’s the story. They get the CAT scan. 20 minutes later I’m in an ambulance, I’m headed down to Beth Israel.

Dr. Mark Hyman: And what that means is you have a bleed in your brain.

Dr. George Papanicolaou: I have a bleed in my brain. So basically it was a bleed in center of my brain. It was leaking out of a blood vessel and it creates this huge headache. So when you’re in an emergency room and somebody tells you, “This is the worst headache of my life,” the first thing you think of as a subarachnoid hemorrhage that could possibly be an aneurysm. In my case, it turned out… They did a 3D CT Angiogram of my brain, which is a really cool thing. They can map out every blood vessel in your brain and you see these blood vessels and then they rotate it and they can look for aneurysms.

Dr. George Papanicolaou: And they did it that night and the neurosurgeon came in and said, “I have great news for you. You don’t have any aneurysm, because if you did that changes everything.” I had what’s called a perimesencephalic bleed so it’s right in front of the ponds or the midbrain. It’s usually very isolated. And here’s what he said to me, it had nothing to do with you hitting your head.

Dr. Mark Hyman: Really.

Dr. George Papanicolaou: He said they can [inaudible 01:10:14] he says there’s usually spontaneous and there’s no link directly to trauma. There’s no link to anything.

Dr. Mark Hyman: But you had to heal your brain after that. How did you heal you brain?

Dr. George Papanicolaou: I was told, after three days in a neurosurgical intensive care unit which is like a… it’s a strange place for a person with a brain injury because they’re waking up every two hours-

Dr. Mark Hyman: Oh my God.

Dr. George Papanicolaou: -to make sure that-

Dr. Mark Hyman: Are you awake? Are you alive? No, I’m trying to sleep to heal my brain.

Dr. George Papanicolaou: So on the third day, my wife-

Dr. Mark Hyman: The worst place to go if you want to get better is the hospital.

Dr. George Papanicolaou: So the day after Christmas, I missed Christmas day-

Dr. Mark Hyman: Oh, wait. I got to tell you a funny story. I recently had an arrhythmia and I had to go and get treated and I had to stay overnight in the hospital. And the bed that I was on was designed to prevent bedsores for people that don’t move, but it literally went on every half hour. We’re like blah, blah, boom, boom. [inaudible 01:11:04] going to wake me up and I couldn’t sleep. I actually pulled the plug on the bed so I could sleep but then the bed deflated and it was like sleeping in, basically a… Oh my God, a depression in the bed. It was the worst.

Dr. George Papanicolaou: Oh, man. Yeah, I remember having my compression stockings when I went to have my hip replaced. They had the compression stockings on that whole first night and every 20 minutes it would go [inaudible 01:11:24].

Dr. Mark Hyman: Yeah. It’s a great way to wake up the patient.

Dr. George Papanicolaou: So, anyhow, so much for helping us sleep and regenerate. I leave the ICU, my wife rescued me the day after Christmas and said, “You’re just coming home.” So I came home and I was told, “You’ll get better with time.” That was it, you’ll get better with time. Of course, I’m here and I’m talking to you and I’m talking to Todd and I’m talking to Liz and I’m doing my own reading and I’m learning – and I understood this before my own brain injury – that, number one, I better make sure my guts in the order because I just had inflammatory process in my brain.

Dr. George Papanicolaou: That’s going to affect lymph drainage. It’s going to affect the blood brain barrier which protects my brain. If I have leaky gut, I’ve got leaky brain. And after trauma you have an autoimmune response; and that autoimmune response, if your gut isn’t healthy, could be quite dramatic. And now on top of your brain injury, you’re having auto immunity which is going to prevent you from healing well. So I started doing some different things. One of the things that you really want to try and do is you want to make sure that, again, you go to the gut, make sure your guts healthy and you’re eliminating any inflammation that you can have.

Dr. George Papanicolaou: So, I really cleaned up my diet. And when you’re sick you begin to realize, “Ah, maybe my diet wasn’t as good as I thought it was.” And I made some significant changes. I went gluten free and all of a sudden that bloating I’d get occasionally that, some of those GI things I’d been ignoring, went away. I went gluten free. Really a big deal. I started using really high dose fish oil because there are studies that show higher doses of fish oil can really help in the-

Dr. Mark Hyman: Brain injury.

Dr. George Papanicolaou: -brain injury. Improving neuronal regenesis membrane. Omega3 is very important for membrane integrity. So I went up to 10 grams per day.

Dr. Mark Hyman: That’s like 10 pills, almost.

Dr. George Papanicolaou: Yeah, I was taking a lot of fish oil. The real first inflection point though was my sleep. Brain injuries definitely impact your ability to sleep, so I needed to really find ways to work on my sleep. I tried melatonin which will trigger your body into the right rhythmic pattern. But it just triggers you to get into sleep, it won’t necessarily maintain it. I was really having a hard time maintaining sleep. So I started working with a advanced medical provider who grows organic hemp and he was able to create a combination of CBD THC with botanicals specifically to help me sleep.

Dr. George Papanicolaou: When I started using that and I started to sleep, that was the first time I started to feel like I might get better. Because up to that point I was depressed, flat, really had to work hard for memory recall. Everything I did took me so much longer to get done. I mean, I was working 24 /7 just to keep up with stuff that should’ve been done in six hours. So, that was the big first inflection point. And I also started taking lithium orotate which is known to increase BDNF, which is miracle grow for the brain. So BDNF helps with neurogenesis. It also helps your neurons speak to each other.

Dr. George Papanicolaou: It makes those transactions occur faster and allows more neurons to combine at a junction to talk to each other. So I started using that. But then the next big major inflection point was when I’d started meditating. I had never meditated. And I came across a book just serendipitously. I use Amazon Books as a library and I was just flipping through different things, and I’ll look up some things on Amazon. And I found a book and I started using this technique and I started as… Can I mention the book?

Dr. Mark Hyman: Sure.

Dr. George Papanicolaou: Yeah. So it was Stress Less Accomplish More by Emily Fletcher. And I think you-

Dr. Mark Hyman: She’s been on my podcast guys.

Dr. George Papanicolaou: Right. Did you write the forward for that?

Dr. Mark Hyman: I did.

Dr. George Papanicolaou: Right. That’s what I thought. I opened the forward, I’m like, “Oh my heavens, Mark wrote the forward for this. It must be a good book.” So I started listening.

Dr. Mark Hyman: She was my meditation teacher.

Dr. George Papanicolaou: Yeah, so I started listening to it and she narrates her own book. It was just amazing. And she went through the science of meditation and what it actually physically does to the brain. It increases the thickness of the connection between the right and the left brain called the Corpus Callosum. It increases the size of your hippocampus.

Dr. Mark Hyman: Decreases inflammation.

Dr. George Papanicolaou: Decreases inflammation, decreases the size of your medulla giving you more control over your anger and frustration. When I started meditating, that was a huge inflection point. My focus became clear, my worries, my negative self talk resolved. I was able to take a huge step forward.

Dr. Mark Hyman: And you know it’s not just for people with brain injury.

Dr. George Papanicolaou: No, it’s for everybody.

Dr. Mark Hyman: We all sort of have chronic brain injury from chronic stress, so that is a way to actually fix it.

Dr. George Papanicolaou: There were things that I could actively do but the critical pieces were get the sleep, get the nutrition in order, get the sleep in order. And then I did things that were known to enhance healing. And I will say, and I will have to emphasize what you just said, meditation isn’t just for injury. Meditation should be taught as part of basic life hygiene for your entire physiology.

Dr. George Papanicolaou: Like hooking in meditation.

Dr. George Papanicolaou: Yeah, it’s huge. And then I was able to have enough energy to start exercising and so I started running. Running of all the exercises increases BDNF, miracle grow for the brain, more than any other exercise. So running is not something I had done for a long time but my wife encouraged me to do it; and I’ve been running and that just really gives me a lot of mental clarity.

Dr. Mark Hyman: So great.

Dr. George Papanicolaou: It’s work.

Dr. Mark Hyman: But the truth is you can heal from brain injury.

Dr. George Papanicolaou: Absolutely.

Dr. Mark Hyman: And I think our traditional approaches are lacking and I think this is one of the things we do.

Dr. George Papanicolaou: And if I had known then what I know now I would have forced myself to exercise earlier, because some new research has come out that says with brain injury particularly concussion don’t wait to start exercising. Actually when you start exercising sooner in modulated ways you’ll enhance recovery.

Dr. Mark Hyman: Fantastic. Well, this has just been the most extraordinary discussion ranging from brain injury to gut injuries to Alzheimer’s.

Dr. George Papanicolaou: There’s so much more we could talk about. There’s just so much more. We can’t stop.

Dr. Mark Hyman: Yeah, we see so many cases here at the Ultra Wellness Center that have really been difficult for people to live through, and we help them navigate to what’s going on and we help them diagnose it in the right way. And, George, you’re just such a fantastic physician. The work you do here is so important. Any last thoughts on what you want to share with our audience?

Dr. George Papanicolaou: Yeah. Are you to ask me that question about if I was [inaudible 01:18:15] for the day?

Dr. Mark Hyman: Yeah. I basically-

Dr. George Papanicolaou: Don’t ask me yet. Don’t ask me yet. I just want to make sure because this is going to meter my answer. I would say working here is an extraordinary experience because we’re working with people that have a real vision for helping patients really get to the root cause and get better. And if we can do that in six weeks, great. But if it takes us three years, we’re there for the long run and we’re constantly working at it. So just the dedication of the entire center and staff to working towards getting people healthy using the functional medicine model has been an extraordinary experience.

Dr. George Papanicolaou: And having colleagues that we can talk about cases and help each other answer those why questions and get people better just multiplies my effort exponentially.

Dr. Mark Hyman: That’s true, we do. We work together, we review the research, we’re always looking at the latest things. We’re looking at new diagnostics, new therapeutics, we’re going over cases together. It’s really a pretty amazing place.

Dr. George Papanicolaou: It is. And I would be remiss if I didn’t say one of the big impacts that we have on patients here is when it comes to food. Food is huge. And it’s interesting because throughout my entire career, even before I was fully engaged in the functional medicine model, I would always tell my patients the path to health is a path that leads to a 10 by 10 or 20 by 20 raised bed organic garden in your backyard. Grow your own food. Grow it without toxins, eat it. And then have your kids help you grow that garden. Have your kids help you harvest that, show your kids how to now take that food and prepare whole food meals. I was telling my patients that for the last 18 years.

Dr. Mark Hyman: That’s so good.

Dr. George Papanicolaou: And so food, I think, is really critical to our health. And I think if we really… And I’ve heard you talk about this and I think if we grow our own food and we demand food to be healthier from the makers of food we can change the world.

Dr. Mark Hyman: Absolutely.

Dr. George Papanicolaou: We can change the world.

Dr. Mark Hyman: Amen to that. Well, thank you George for being on the podcast. Dr. George Papanicolaou at the Ultra Wellness Center. Here we are recording right from the center. It’s just great to have you. If you want to learn more about our practice, go to; and if you love this conversation, please share it with your friends and family on social media. Subscribe wherever you get your podcasts. Leave a comment, we’d love to hear from you, and we’ll see you next time on the Doctor’s Pharmacy.

Dr. Mark Hyman: Hey everyone, it’s Dr. Mark Hyman. So two quick things. Number one, thanks so much for listening to this week’s podcast. It really means a lot to me. If you love the podcast, I’d really appreciate you sharing with your friends and family. Second, I want to tell you about a brand new newsletter I started called Mark’s Picks. Every week I’m going to send out a list of a few things that I’ve been using to take my own health to the next level, this could be books, podcasts, research that I found, supplementary recommendations, recipes or even gadgets – and I use a few of those.

Dr. Mark Hyman: And if you’d like to get access to this free weekly list, all you have to do is visit That’s I’ll only email you once a week, I promise, and I’ll never send you anything else besides my own recommendations. So just go to, that’s P-I-C-K-S to sign up free today.

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If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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