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Episode 2
The Doctor's Farmacy: House Call

What Is Leaky Gut And How Can You Treat It? with Dr. Elizabeth Boham

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.

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Most of us (including most doctors) do not recognize or know that digestive problems wreak havoc in the entire body, leading to allergies, arthritis, autoimmune disease, rashes, acne, chronic fatigue, mood disorders, autism, dementia, cancer, and more. So having a healthy gut means more than simply being free of annoyances like bloating or heartburn. It is absolutely central to your health. It is connected to everything that happens in your body. That is why Functional Medicine almost always starts helping people treat chronic health problems by fixing their gut.

In this mini-episode, Dr. Hyman is joined by Dr. Elizabeth Boham to review two patient cases focused on treating the gut.

Elizabeth Boham is a physician and nutritionist who practices functional medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the functional medicine approach to keeping your breasts and whole body well.

In this episode, Dr. Hyman and Dr. Boham discuss:

  • What is leaky gut, and why does it lead to so many other health issues, including food sensitivities?
  • How our diet, food supply, over-reliance on antibiotics, acid blockers, steroids, and more can lead to leaky gut
  • Using stool testing and Cyrex testing to assess gut health.
  • The ‘5R’ program (remove, replace, reinoculate, repair, and rebalance) that Functional Medicine uses as a guide to treat chronic issues.
  • Remove stressors: get rid of things that negatively affect the environment of the GI tract including allergic foods and parasites or other bad bugs such as bacteria or yeast. This might involve using an allergy “elimination diet” to find out what foods are causing GI symptoms or it may involve taking drugs or herbs to eradicate a particular bug.
  • Replace digestive secretions: add back things like digestive enzymes, hydrochloric acid, and bile acids that are required for proper digestion and that may be compromised by diet, drugs, diseases, aging, or other factors.
  • Reinoculate. Help beneficial bacteria flourish by ingesting probiotic foods or supplements that contain the so-called “good” GI bacteria such as bifidobacteria and lactobacillus species, and by consuming the high soluble fiber foods that good bugs like to eat, called “prebiotics.” Probiotics are beneficial microorganisms found in the gut that are also called “friendly bacteria.” Use of antibiotics kills both good and bad bacteria. Probiotics in the form of supplements or food are needed to re-inoculate the gut. Fermented foods, such as yogurt, miso, and tempeh are food sources of probiotics. Prebiotics are nondigestible food ingredients that selectively stimulate the growth of beneficial microorganisms already in the colon. In other words, prebiotics feed probiotics. Prebiotics are available in many foods that contain a fiber called inulin, including artichokes, garlic, leeks, onion, chicory, tofu, and other soy products. Grains such as barley, flax, oats, and wheat are also good sources of prebiotics. Another good prebiotic source is a supplement called “fructo-oligosaccharide” or FOS.
  • Repair. Help the lining of the GI tract repair itself by supplying key nutrients that can often be in short supply in a disease state, such as zinc, antioxidants (e.g. vitamins A, C, and E), fish oil, and the amino acid glutamine.
  • Rebalance. Pay attention to lifestyle choices – sleep, exercise and stress can all affect the GI tract.

For more information visit drhyman.com/uwc

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

Show Notes

  1. “Is Your Digestive System Making You Sick, and Fat?”
  2. “How to Feed Your Gut”
  3. “A New Approach to Autoimmune Disease”
  4. “Lab Spotlight: Testing for Food Sensitivities”
  5. “The Wrong Gut Bugs Can Make You Fat and Sick (and How to Fix Them)”
  6. “Top 5 Diet Changes for Autoimmunity”
  7. “Gut & Digestive Health”

Transcript

Dr. Elizabeth Boham:
We always say to people, “Get something from every color of the rainbow every day.” Get some plant foods from every color of the rainbow every day.

Dr. Mark Hyman:
Hey everybody, it’s Dr. Mark Hyman, welcome to this special episode of The Doctor’s Farmacy, that’s Farmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. I call this special episode, House Call. In this series I’m going to sit down with my colleague and friend, The UltraWellness Center physician and medical director, Dr. Elizabeth Boham, who is what every physician should be. She is a registered dietician, an exercise physiologist, and an MD, which is a unicorn, as I said before. We’re going to talk about how as functional medicine docs we tackle specific conditions in our practice every day, that’s very different from how traditional medicine takes care of it. Today we’re going to talk about leaky gut, which is something that is starting to be in the awareness of traditional medicine, but they still don’t have a clue how to diagnose it and how to treat it. So tell us first, what is leaky gut?

Dr. Elizabeth Boham:
Yeah. So many people are saying the word leaky gut, leaky gut, but officially, the official medical term is increased intestinal permeability. I love to draw a picture for all my patients when they come in to really show them what we mean by increase intestinal permeability.

Dr. Mark Hyman:
Yeah. I failed art in the eighth grade, so I just show them Google images.

Dr. Elizabeth Boham:
That’s good. That’s good, I don’t know, I’m still drawing each time.

Dr. Mark Hyman:
No, I go to Google images.

Dr. Elizabeth Boham:
That’s very smart. So we know there’s this one cell layer, right? There’s that one cell layer, the endothelium that divides the inside of the intestine, right? So where the food is, and all sorts of other things, the inside of your intestine.

Dr. Mark Hyman:
Basically your GI tract is a tube that’s literally outside of your body.

Dr. Elizabeth Boham:
Right.

Dr. Mark Hyman:
I mean, it’s a protective tube that you put food in, and all the stuff goes in, and it comes out the other side. It’s literally not really part of your body in the sense that it’s-

Dr. Elizabeth Boham:
But the stuff inside isn’t yet in your body, right?

Dr. Mark Hyman:
Yeah, right.

Dr. Elizabeth Boham:
But there’s that cell layer that has to determine what should come into my body, right, and what shouldn’t. What’s been properly digested food, has this protein been broken down enough yet? Should this come in, should I absorb this, or should this stay out? So that barrier.

Dr. Mark Hyman:
Yeah, it’s like a filter, it’s like a coffee filter.

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
You don’t want the grounds getting into your coffee, but you want the good stuff getting in. That’s sort of how your gut is supposed to work.

Dr. Elizabeth Boham:
Yeah, that’s great. Yeah, absolutely.

Dr. Mark Hyman:
When it doesn’t it’s like you have holes in your coffee filter and stuff leaks through.

Dr. Elizabeth Boham:
Right.

Dr. Mark Hyman:
Why is that a problem?

Dr. Elizabeth Boham:
Right, because that stuff leaking through that might be a food particle that’s not digested enough yet, or it could be a bacteria, or a bug, a fungus, or something that shouldn’t be getting into the body, some of the not so good bacteria. When those things that get into the body when they’re not supposed to, then they can trigger all sorts of other symptoms in the body, and that might be symptoms of inflammation. So somebody might feel joint pain, or asthma, congestion. It may trigger, and there’s been a lot of studies to show this, it can trigger autoimmunity, right?

Dr. Mark Hyman:
Yeah, allergies, autoimmunity.

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
Asthma, all kinds, fibromyalgia.

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
What’s interesting is that most diseases that are chronic diseases are inflammatory diseases.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
Right? Heart disease, cancer, diabetes, Alzheimer’s, stroke. I mean, these are all inflammatory diseases, even depression is an inflammatory disease of the brain. ADD is inflammation of the brain, autism is inflammation of the brain. So what’s really interesting about this gut issue is that when that barrier breaks down, and you have basically like an area the size of a tennis court if you laid your intestines out flat, and it’s one cell thick. So you’re basically one cell away from a sewer on the other side.

Dr. Elizabeth Boham:
It’s such an important cell, right?

Dr. Mark Hyman:
Yeah, and that can get damaged, and when that does things leak in, like you said, and you got 60% of your immune system right under that layer, which then reacts to whatever is coming through that’s not supposed to come through.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
So your body is actually doing its job creating the inflammation.

Dr. Elizabeth Boham:
Yep.

Dr. Mark Hyman:
It’s just that your gut is leaky and there’s stuff getting in you shouldn’t be getting in.

Dr. Elizabeth Boham:
Right, and then you start to not feel so good, right?

Dr. Mark Hyman:
Yeah.

Dr. Elizabeth Boham:
Like you mentioned, fatigue, or brain fog, or joint pain, or swelling in the body. We see a lot of people holding onto water, or swelling, or congestion, or asthma, and then that whole cycle of autoimmunity also.

Dr. Mark Hyman:
Yeah. So it’s really one of the most prevalent problems.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
So why are we having all this leaky gut problem?

Dr. Elizabeth Boham:
Right. That’s a great question, right? And it’s so much because of our crummy food supply.

Dr. Mark Hyman:
Oh, what do we know about that?

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
If you’re listening to me that’s all I talk about.

Dr. Elizabeth Boham:
Our crummy food supply that we’ve been putting a bunch of pesticides and antibiotics into, which is just shifting our microbiota.

Dr. Mark Hyman:
Like glyphosate.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
From the Roundup, the weed killer that’s on almost all our GMO foods, and even wheat products, is one of the biggest damagers of your microbiome. Forget that it causes cancer, whether you can argue that or not, but it does. It disrupts your microbiome.

Dr. Elizabeth Boham:
Right, right. We of course are trying as physicians not to prescribe as much antibiotics for our patients, but so many of us have taken unfortunately too many antibiotics, and then our food supply, right? We’re using so much antibiotics in our food supply to grow bigger cows for example, and that’s just shifting that whole microbiota in our gut.

Dr. Mark Hyman:
It’s true. I read a paper recently about emulsifiers in food, which is used in all processed food to make it thick, or solidify it, hold it together, and these emulsifiers like carrageenan, and xanthan gum, they even have this thing called microbial transglutaminase, which is basically bacteria made gluten, if you can believe that. The reason it’s called gluten is because it’s like glue, so it makes things stick together.

Dr. Elizabeth Boham:
Right, stick together.

Dr. Mark Hyman:
It makes the food stick together, right?

Dr. Elizabeth Boham:
Mm-hmm (affirmative).

Dr. Mark Hyman:
But it’s highly damaging to the gut. So you’ve got all these processed food ingredients in food that are linked to autoimmunity.

Dr. Elizabeth Boham:
Yep.

Dr. Mark Hyman:
Right? So it’s not even … And then of course the starch, and the sugar, the processed oils, all damage your gut. Then of course the lack of fiber, the lack of phytochemicals in our diet, the lack of good foods, prebiotic foods, probiotic foods. I had sauerkraut for lunch yesterday. I mean, we don’t eat that stuff, and it’s so important, and we’ve seen so much damage to our gut because of all of these various factors in our diet. Then of course there’s the acid blockers that we take for everything, the antibiotics, as you mentioned, hormones can mess up your gut bacteria, steroids can do it. So you end up with … Antibiotics obviously. End up with this horrible cascade of people with gut issues. It’s the number one reason people go to the doctor.

Dr. Elizabeth Boham:
We’re seeing so much of it now. It’s crazy, isn’t it? I mean, so many people are coming in with digestive issues, and symptoms of inflammation in their body, but it’s really common. Even if people are coming to us for other reasons.

Dr. Mark Hyman:
Yeah.

Dr. Elizabeth Boham:
We’re seeing okay, it’s the gut and we’ve got to start with the gut and pay attention to what’s going on there.

Dr. Mark Hyman:
Functional medicine has been thinking about this for decades, and now there’s the microbiome revolution. Everybody is talking about it, there’s huge industry development around it, and everybody’s talking about probiotics, and this and that, and we’ve been focusing for decades on the simple fact that most of our chronic illnesses start in the gut.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
Whatever the name of the problem you have, whether its migraines, or whether it’s depression, or whether it’s diabetes or obesity. I mean, I had a guy-

Dr. Elizabeth Boham:
Or rheumatoid arthritis, right?

Dr. Mark Hyman:
Rheumatoid arthritis, or autism, whatever, you got to start with the gut.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
In traditional medicine, leaky gut is not a thing. You go to the doctor if you have arthritis, and they’re like, “How is your gut?” Or go to your cardiologist, “How is your gut?”

Dr. Elizabeth Boham:
Even though there is so much research showing the connection.

Dr. Mark Hyman:
We don’t get trained.

Dr. Elizabeth Boham:
Right.

Dr. Mark Hyman:
So there’s this huge gap right now where the science has advanced so far but the practice hasn’t. In functional medicine we’ve been really great at actually getting the memo that the gut is at the center of our health.

Dr. Elizabeth Boham:
Right. So for years, right? We’ve learned about that 5R program with functional medicine, and how helpful that can be to heal the digestive system, and then heal all these symptoms or diseases that somebody has.

Dr. Mark Hyman:
Yeah. I mean, it’s amazing. I was talking to the CEO of Cleveland Clinic recently and was telling me about studies that he’d heard about that had used fecal transplants in autistic kids, and taking the poop out of a healthy kid and put it in an autistic kid, and the kid’s autism goes away.

Dr. Elizabeth Boham:
It’s phenomenal.

Dr. Mark Hyman:
I mean, that’s not true for all kids with autism.

Dr. Elizabeth Boham:
No, but it’s phenomenal.

Dr. Mark Hyman:
Yes, it’s amazing. Or they’re doing transplants from people who are thin to people who are diabetic and their blood sugar gets better.

Dr. Elizabeth Boham:
Right.

Dr. Mark Hyman:
I mean, I had a guy once who was a really great patient, and he was very poorly controlled diabetic, on lots of medications, and we worked on his diet, it helped a lot. Took it down from like 200 to the 120s or so, but I never could get it all the way down, even with a really good diet and exercise. He was telling me he had a bunch of digestive issues. So I said, “You know, why don’t you take some charcoal, and do this, and do that?” And he called me back and he says, “I don’t know what happened but my blood sugar went to 90.” So we absorbed all the toxic crap in his gut that was causing inflammation, that was causing his blood sugar imbalance, and these are the kinds of things that we do every day in functional medicine but that are not part of traditional care and people are missing out on.

Dr. Elizabeth Boham:
Right, right. When we’re saying, “Why is this going on?” How do we get to that underlying root cause for that individual person?
Speaker 3:
Hi everyone, hope you’re enjoying the episode. Before we continue we have a quick message from Dr. Mark Hyman about his new company, Farmacy, and their first product, the 10 Day Reset.

Dr. Mark Hyman:
Hey, it’s Dr. Hyman. Do you have FLC? What’s FLC? It’s when you feel like crap. It’s a problem that so many people suffer from and often have no idea that it’s not normal or that you can fix it. I mean, you know the feeling. It’s when you’re super sluggish, your digestion is off, you can’t think clearly, or you have brain fog, or you just feel run-down. Can you relate? I know most people can, but the real question is, what the heck do we do about it? Well, I hate to break the news, but there is no magic bullet. FLC isn’t caused by one single thing, so there’s not one single solution. However, there is a systems-based approach, a way to tackle the multiple root factors that contribute to FLC, and I call that system the 10 Day Reset.

Dr. Mark Hyman:
The 10 Day Reset combines food, key lifestyle habits, and targeted supplements to address FLC straight on. It’s a protocol that I’ve used with thousands of my community members to help them get their health back on track. It’s not a magic bullet, it’s not a quick fix, it’s a system that works. If you want to learn more and get your health back on track, click on the button below or visit getfarmacy.com. That’s getfarmacy, with an F, F-A-R-M-A-C-Y.com.
Speaker 3:
Now back to this week’s episode.

Dr. Mark Hyman:
So you got some amazing cases, and I think I would like to sort of get into it because people don’t understand how so many of our issues come from the gut and how easy it is to diagnose it and treat it, and we use tests that traditional doctors just don’t do.

Dr. Elizabeth Boham:
Yep.

Dr. Mark Hyman:
We have a different set of lenses, a different set of filters that we can sort through information and data and ask questions that traditional doctors can’t, like how do you measure leaky gut. How do you look at the microbiome in the gut? How do you look at the digestive function in the gut? How do you actually start to treat it in a different way? I think your first case is just so rich with a story that is so common, that I’d just love you to share this because I think everybody is going to resonate with this story.

Dr. Elizabeth Boham:
Right.

Dr. Mark Hyman:
By the way, I have never seen this patient, it’s your patient, but I’ve literally seen the same story a 100 times, or maybe 500 times, or a 1000 times in my practice.

Dr. Elizabeth Boham:
Right, right, right. It’s so common.

Dr. Mark Hyman:
It’s the same freaking story.

Dr. Elizabeth Boham:
Story, right?

Dr. Mark Hyman:
So tell us about this person.

Dr. Elizabeth Boham:
So it’s a 24 year old gentleman who came in to see me, and who is really struggling over the last year with his digestive system. He was having a lot of bloating, and gas, pain in his stomach every time he ate. He was having diarrhea and sometimes he was getting constipated. He went to his traditional GI doctor and they told him, “You have irritable bowel.” But he wasn’t getting any better, right? He was just really … Because he was having so much stomach pain he had lost some weight. He was on the thin side to begin with, but because he was having stomach pain when he ate, he wasn’t able to eat as much, and he was even losing more weight, he was feeling really weak and tired, and sad, depressed, right? So for him, well, for everyone the timeline is so important, right? That’s what we learn in functional medicine, is gathering that information, learning about that individual patient’s story, seeing their timeline.

Dr. Mark Hyman:
So we start with a history with the mother and her pregnancy, and the birth, and whether they breastfed, and whether they took antibiotics, whether they were sick as a kid. What happened when they were introduced to food, when they got gluten, when they got dairy? We ask all these questions. So when someone comes in with irritable bowel, the average GI guy is not asking all these questions.

Dr. Elizabeth Boham:
Right.

Dr. Mark Hyman:
So why do we ask all these questions?

Dr. Elizabeth Boham:
Because for this gentleman, for example, he didn’t really have stomach pain before a year ago, but what we found out is that when he was a kid he had ear infections, and he had asthma.

Dr. Mark Hyman:
Probably because he was eating dairy.

Dr. Elizabeth Boham:
Probably, right? It’s such a common connection.

Dr. Mark Hyman:
Oh my god. I remember once being in the ER, Liz, and this patient came in and this little boy keeps coming back, a toddler was coming back over and over to the ER with ear infections, and just so inflamed. I said, “Did you breastfeed?” Yeah. So when did he start getting the ear infections? Well, when we started formula, and dairy, and milk. I’m like, “Oh, okay.” And this was even before I knew about functional medicine.

Dr. Elizabeth Boham:
I know.

Dr. Mark Hyman:
And I was like, “Well, maybe you shouldn’t eat dairy.”

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
And the kid was fine, you know?

Dr. Elizabeth Boham:
Right. That’s such a common connection. I mean, even my son when he started dairy he got asthma and eczema. It’s unfortunately such a common connection. So for this child he had a lot of ear infections and eczema, so he was on antibiotics about once or twice a year in his childhood, and he really didn’t think that was very much. He’s like, “That wasn’t too much.” But it makes a huge impact on the microbiome, as we’re learning. Then he started to have acne as a teenager, maybe because of dairy more, right? Or some of the imbalances in the microbiome, right?

Dr. Mark Hyman:
In the gut, right. When you screw up the gut with antibiotics or a C-section, or lack of breastfeeding, then you get often more acne.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
We treat acne from the top in, as opposed to the inside out, which is actually what works much better.

Dr. Elizabeth Boham:
This gentleman was given low-dose antibiotics for two years, so then he took even more antibiotics. So this history of antibiotics sort of set him up, and about a year ago he had some sort of stomach bug. So some probably viral stomach infection, and then since that time he started to have all these digestive issues and was losing weight.

Dr. Mark Hyman:
Which is a common story.

Dr. Elizabeth Boham:
It’s so common, like you said.

Dr. Mark Hyman:
People have this sort of smoldering a bunch of insults over the course of their life. Maybe they were a C-section, they had antibiotics as a kid, they took acne antibiotics, they were eating a crappy diet, whatever, and then all of a sudden something happens and then boom, the body can’t take it anymore, and it creates some kind of disease.

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
But if you look at the story you can often map out exactly how this happened.

Dr. Elizabeth Boham:
That connection with his acne, with his asthma, with his digestive issues, with those antibiotics, that’s that story we often see, right?

Dr. Mark Hyman:
And we’re not making this up.

Dr. Elizabeth Boham:
No.

Dr. Mark Hyman:
There’s so much science that shows that your gut microbiome plays a role in acne, and eczema, and asthma, that it plays … I mean, we’re actually doing this at Cleveland Clinic now, we’re studying asthma and looking at how the microbiome plays a role and how it affects inflammation, all these various factors that most doctors just don’t pay attention to.

Dr. Elizabeth Boham:
Right. So with him, as we do with most of our patients, we do food first, right? So we said, “Okay, we’ve got to really focus on this person’s diet and help him start feeling better right away so he can start to eat more and regain some of his strength.” So we pulled away inflammatory foods. We took him off of gluten and dairy while we were waiting for tests to come back. Sometimes we will do some tests that look at, of course we’ll test for celiac disease or-

Dr. Mark Hyman:
Which is a big cause of leaky gut.

Dr. Elizabeth Boham:
Yep, that’s for sure.

Dr. Mark Hyman:
Probably the number one.

Dr. Elizabeth Boham:
And he didn’t have that but-

Dr. Mark Hyman:
By the way, you don’t have to have celiac disease to actually have a problem, right?

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
You can have they call it non-celiac gluten sensitivity.

Dr. Elizabeth Boham:
Yep.

Dr. Mark Hyman:
I would estimate it probably affects 20% of the population, and I think if you look at the antibody levels you can get a clue, which most doctors don’t look at. I read a study that autistic kids and schizophrenic patients often have, 20% of them have antibodies to gluten.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
And they may not be full-blown celiac.

Dr. Elizabeth Boham:
Absolutely, and even irregardless of, even if people are negative totally for celiac, if they have increased intestinal permeability, they start reacting to a lot of different foods.

Dr. Mark Hyman:
Yeah.

Dr. Elizabeth Boham:
So then you start to see with that leaky gut, as we talked about before, right? The coffee filter and things are coming through, then the body is reacting to lots of foods that it maybe never reacted to before.

Dr. Mark Hyman:
So they’re not true allergies, they’re more like sensitivities.

Dr. Elizabeth Boham:
Sensitivities. The real thing is it’s because of this increased intestinal permeability. So our job is we have to heal that increased intestinal permeability so that they don’t have to be so restrictive with their foods. I mean, you still always want them to be on a healthy diet, but we want to relax those restrictions over time, most of the time we can.

Dr. Mark Hyman:
Yeah. So as part of the approach of functional medicine, we start them on the elimination diet.

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
So eliminating all the inflammatory foods, gluten and dairy, processed foods, all that stuff, and then you-

Dr. Elizabeth Boham:
That’s remove, right?

Dr. Mark Hyman:
Yeah, we remove.

Dr. Elizabeth Boham:
That’s the remove in the 5R.

Dr. Mark Hyman:
Right, the 5Rs. Remove, replace, reinoculate.

Dr. Elizabeth Boham:
Repair.

Dr. Mark Hyman:
Repair.

Dr. Elizabeth Boham:
Rebalance.

Dr. Mark Hyman:
And rebalance.

Dr. Elizabeth Boham:
Yep.

Dr. Mark Hyman:
We’ll go into each of those because they’re really important, but the next step is also there’s other things we may need to remove. There’s tests we need to do.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
So what kind of tests would you look at as a functional medicine doctor that you wouldn’t see at a traditional doctor’s office that give us a roadmap of how to treat these patients?

Dr. Elizabeth Boham:
Right, so we did a stool test that looked at his microbiome. What we noticed is that there was an overgrowth of unhealthy bacteria and unhealthy yeast. So he had this probably because of years of antibiotics he developed this dysbiosis, this imbalance in the bacteria and yeast. So there was an overgrowth of the unhealthy things.

Dr. Mark Hyman:
It’s like weeds, having a lot of weeds in your garden, right?

Dr. Elizabeth Boham:
Yeah, right. It’s not always one of those, you think of a stomach infection and you’re getting really, really sick, you’re throwing up or having diarrhea. This is this, it’s an imbalance and it’s called dysbiosis, but that imbalance causes a lot of symptoms in people. When you have the wrong bacteria and the wrong yeast levels, you can get a lot of bloating after you eat. You can get a lot of fatigue after you eat, you can get those symptoms of constipation and diarrhea, and that causes this inflammation in the digestive system so all of your digestive enzymes don’t work well. So you’re not breaking down your food well, you’re not absorbing your nutrients well, and it becomes this vicious cycle that people are dealing with and we see all the time.

Dr. Mark Hyman:
Yeah, it’s so powerful. When I see this patient, I’m like, “Okay, you don’t have to do all the tests.” But sometimes when you get stuck you look at various tests to look at antibodies against things that are in the gut that determine a leaky gut. We call it Cyrex 2 testing, which is a test you can get through functional medicine doctors.

Dr. Elizabeth Boham:
Yeah, you can look. Right, you can test to see if there’s leaky gut. I love that test too because it’s a great way for us to follow up and see how much we’re seeing improvement. Are we doing enough? Are we seeing improvement in their leaky gut or increased intestinal permeability?

Dr. Mark Hyman:
And then we look at poop testing.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
Where we do thousands and thousands of these tests, and it’s so helpful. It doesn’t just look at the microbiome, it actually looks at the function of the gut.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
Whether there’s malabsorption, whether you have no digestive enzymes, whether there’s inflammation, whether there’s overactive antibodies in there, whether you have imbalances in what we call the short-chain fats, which are the food for the colon and are produced by bacteria eating the right kinds of fiber, and if they’re low it means there’s an imbalance. Then we look at the microbiome, we look at what grows. We look at parasites. Then we target and micro target the things that are out of balance for that person, and it’s different for everybody. I might look at food sensitivity testing, we might look at … Even things like heavy metals or other things which can also cause it. I had a patient with ulcerative colitis once and I did everything right, I did the whole 5R, it wasn’t working, but I forgot the first part of the R, which is remove. I thought, “Well, maybe heavy metals can cause autoimmunity, maybe it’s a problem.” And so I tested him and he was wasted away, and it was terrible. He actually had high levels of mercury. We treated his mercury and his colitis went away.

Dr. Elizabeth Boham:
Which is phenomenal, yeah.

Dr. Mark Hyman:
Yeah. So I think it’s so powerful, and this case is so important because it really describes how a patient goes traditional doctor, is diagnosed with a disease, irritable bowel syndrome. By the way, anytime you hear syndrome it means doctors don’t know what the heck is going on. It’s just a collection of symptoms that we agree we’re going to put in this bucket, and if you have those symptoms you have this disease, but it’s not really a disease. So that’s what functional medicine is, it sort of looks upstream to figure out what the root causes are, and personalize the treatment for everybody. There’s common things that we do, like the 5R, but it may be different Rs for each patient, right?

Dr. Elizabeth Boham:
Right. So for him we removed the inflammatory foods and we removed the bacteria and yeast. I actually treated him with an antibiotic, a non-absorbed antibiotic and an antifungal. So I treated him with prescription medication.

Dr. Mark Hyman:
Weed killer.

Dr. Elizabeth Boham:
Yeah, weed killer. So that was the remove, right?

Dr. Mark Hyman:
Yeah.

Dr. Elizabeth Boham:
And then the replace, because he was underweight and because of that inflammation in his digestive system I gave him some digestive enzymes for a short period of time just to help him, help it so the food wasn’t as inflammatory for him and to help him absorb more nutrients. Then we worked on reinoculating, right? So after we gave him some good probiotics.

Dr. Mark Hyman:
Put in the healthy bacteria.

Dr. Elizabeth Boham:
Put in the healthy bacteria. Some good prebiotics.

Dr. Mark Hyman:
Prebiotics, yeah.

Dr. Elizabeth Boham:
Right. So we know that there’s-

Dr. Mark Hyman:
What are prebiotics?

Dr. Elizabeth Boham:
Prebiotics are the things that help feed the good bacteria. So they’re the food for the probiotics.

Dr. Mark Hyman:
Which is usually what?

Dr. Elizabeth Boham:
Like fibers. Fibers are amazing prebiotics. We know a lot of phytonutrients are prebiotics. So this I think is really exciting research, when we’re looking at our phytonutrients. We know that-

Dr. Mark Hyman:
What are phytonutrients?

Dr. Elizabeth Boham:
I know, it’s amazing, right? So our food has minerals in it, it has vitamins, but it also has these things called phytonutrients, which are these components in our plant foods that have this amazing health benefits for us. So that can include things like ellagic acid that we see in pomegranate that can feed some of the good bacteria, that Akkermansia that we know can lower inflammation. We know that …

Dr. Mark Hyman:
Just to back up on that Akkermansia thing. So when we look at the poop we can tell if there’s good levels of different bugs, and one of them we look at is Akkermansia, and it turns out that that is so important for protecting your gut.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
It helps you keep your biofilm or that little coating over the gut so you don’t have a leaky gut, and it’s involved in so many autoimmune disease, in responsive cancer therapy, in metabolic issues, in weight, and it’s such an overlooked thing and you can’t take a probiotic of it, at least not yet, but you can feed it the good guys.

Dr. Elizabeth Boham:
Right, we can feed it. We can feed it with all of these amazing phytonutrients like what’s in pomegranate, the ellagic acid. Also we know that sulforaphane from our cruciferous vegetables feeds the good bacteria.

Dr. Mark Hyman:
Yeah, so broccoli, collards, kale, but not juicing.

Dr. Elizabeth Boham:
Right, brussels sprouts, all those good ones. We know that green tea, that has good phytonutrients in it that’s good for the digestive system. So we always say to people, “Get something from every color of the rainbow every day.” Get some plant foods from every color of the rainbow every day. Get some good red foods like the pomegranate or cranberry, get something orange, and yellow, and green, blue, purple, white, tan. All those good healthy plant foods, like our vegetables, our fruits, our spices, our teas, our coffees, really actually are impacting our microbiome, which is fascinating.

Dr. Mark Hyman:
It’s so great. Just a great anecdote from a colleague of mine, Dr. Li, who was on our podcast talking about eat to beat disease. His mother had stage four uterine cancer, and being the smart doc he is, he understood from the research that if you have low Akkermansia patients don’t respond to the immunotherapy, what they call the checkpoint inhibitors, which is this new form of cancer therapy that helps activate your immune system. So if your gut isn’t healthy, you can’t actually get the cancer cells to die with the immunotherapy.

Dr. Elizabeth Boham:
Right. Isn’t that fascinating?

Dr. Mark Hyman:
So basically you die unless you have good bacteria in your gut. So his mother had stage four uterine cancer and was going to die, and wasn’t responding, and he gave her pomegranate, cranberry, green tea, all these phytochemicals, got her Akkermansia levels up and she was cured of her stage four cancer within a month.

Dr. Elizabeth Boham:
That’s a phenomenal story.

Dr. Mark Hyman:
Yeah. It’s an incredible story, and I think that’s just sort of the power-

Dr. Elizabeth Boham:
Of these plant foods.

Dr. Mark Hyman:
Of the plant foods and of getting focused on the gut.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
We call it the 5R, I call it the weeding, seeding, and feeding program. So you weed out the bad things.

Dr. Elizabeth Boham:
Yeah, simpler.

Dr. Mark Hyman:
You seed it with the good things, and you feed it with good nutrients and all that stuff. So it’s really, its so powerful. I can’t tell you as a functional medicine doctor for the last 30 years, and you’ve been doing this almost as long, the results you get from focusing on the gut with so many conditions, whether it’s autoimmune, or whether it’s allergic, or it’s digestive, whether it’s your skin issues like acne and eczema, whether it’s your mood, whether it’s weight, metabolism, whether it’s migraines, whether it’s Alzheimer’s, I mean, autism, ADD. It’s just amazing when you start to focus in on this.

Dr. Mark Hyman:
So let’s break down the 5R program for everybody. So we got the remove. So what are we looking at removing?

Dr. Elizabeth Boham:
Removing unhealthy foods or inflammatory foods for that person.

Dr. Mark Hyman:
So they can be food sensitives, and gluten and dairy are the big ones.

Dr. Elizabeth Boham:
Yep, food allergies, food sensitivities, yeah. Then we’re removing-

Dr. Mark Hyman:
The processed food and junk food, right?

Dr. Elizabeth Boham:
Oh yeah, that’s for sure, and sugars, and excess sugar, which is feeding the wrong bacteria.

Dr. Mark Hyman:
Yeah.

Dr. Elizabeth Boham:
Then we’re removing the unhealthy bugs, or yeasts, or viruses, or fungi.

Dr. Mark Hyman:
[crosstalk 00:27:20] Bacterial overgrowth, yeast overgrowth, a parasite.

Dr. Elizabeth Boham:
Yep.

Dr. Mark Hyman:
I was on the Red Table Talk, and Jada and her son both had parasites and they both had gut issues for a long, long time, and they thought it was just how they were.

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
But with a short little course of treatment they were both, I’ve never felt better, and all the other symptoms got better.

Dr. Elizabeth Boham:
Because now you’re actually absorbing the nutrients you’re eating, which just helps the body heal, right?

Dr. Mark Hyman:
Yeah. So you remove.

Dr. Elizabeth Boham:
Then we replace.

Dr. Mark Hyman:
But you might also remove things like heavy metals, or stress, or toxic people in your life, or whatever is giving you a stomach problem.

Dr. Elizabeth Boham:
Right. Replace means just to replace some of those digestive enzymes if needed. Reinoculate as-

Dr. Mark Hyman:
So the replace also could be like prebiotics, right? So putting in the fibers to feed the gut, and to actually maybe use hydrochloric acid sometimes for people who aren’t digesting their food as they get older [crosstalk 00:28:17].

Dr. Elizabeth Boham:
Yeah, and to help get them off of the acid blockers which we know are creating a lot of problems because we need that acid in our stomach to digest our food.

Dr. Mark Hyman:
Let’s take a little detour. So you just mentioned acid blockers.

Dr. Elizabeth Boham:
Uh-huh (affirmative).

Dr. Mark Hyman:
Okay, these are among the most prevalent drugs prescribed today in America, other than statins, I think.

Dr. Elizabeth Boham:
Mm-hmm (affirmative).

Dr. Mark Hyman:
When I was in medical school in the ’80s, and we just had those drugs come in the market. The drug reps used to come to us and say, “These are very powerful drugs. Never use them for more than six weeks because they block stomach acid and they’ll cause significant problems if you do that long term.”

Dr. Elizabeth Boham:
Right.

Dr. Mark Hyman:
You can cure an ulcer with it, you can fix an acute problem, but never use this. Now people are on this for decades.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
And the side effect, which is listed in the manuals that we get as doctors, is that it causes irritable bowel syndrome. So you end up fixing the heartburn but you get irritable bowel, and bloating, and bacterial overgrowth, and all these problems.

Dr. Elizabeth Boham:
Right, because you need the acid in your stomach, and when you block that acid, then there can be an overgrowth of bacteria where there’s not supposed to be, and that can cause all those slew of problems.

Dr. Mark Hyman:
Changes with the age, you get more yeast issues and all this stuff.

Dr. Elizabeth Boham:
And then you’re not absorbing your minerals, so you can get osteoporosis, and you’re not absorbing your B12 so you can get fatigue and dementia, right? It just goes on, and on, and on.

Dr. Mark Hyman:
Yeah, you don’t absorb zinc, and magnesium, and minerals, calcium, it cause osteoporosis, pneumonia, it causes irritable bowel.

Dr. Elizabeth Boham:
It goes on and on, right?

Dr. Mark Hyman:
Yeah.

Dr. Elizabeth Boham:
It takes some work sometimes, but when people have been on an acid blocker for a long time, it takes some work for us to help wean them off.

Dr. Mark Hyman:
To get them off, yeah.

Dr. Elizabeth Boham:
Because their body’s gotten pretty used to it. They start to get … Their body wants to make acid, so it’s working against the medicine, so when you wean them down sometimes they get more acid production.

Dr. Mark Hyman:
It’s called a rebound. So you actually, and it’s sort of a trick. You get off it, but it makes you worse, so you feel like you have to get back on.

Dr. Elizabeth Boham:
I got to get back on it.

Dr. Mark Hyman:
But it’s actually not true, and you can actually get off it.

Dr. Elizabeth Boham:
Absolutely.

Dr. Mark Hyman:
So we do that all the time.

Dr. Elizabeth Boham:
We do it all the time. So reinoculate, giving all the good prebiotics and probiotics, the good bacteria and all the things that feed the good bacteria. Then the fourth R is repair.

Dr. Mark Hyman:
How do you know what probiotics to take?

Dr. Elizabeth Boham:
Well, that’s a great question.

Dr. Mark Hyman:
I want to know what [inaudible 00:30:30].

Dr. Elizabeth Boham:
My goodness, that’s such a … That goes on and on. We could talk about that for the next hour.

Dr. Mark Hyman:
Yes, it’s true.

Dr. Elizabeth Boham:
Right?

Dr. Mark Hyman:
There’s more and more probiotics in the market every day, and a lot of different roles and different functions, and we’re just sort of … Honestly, I think we’ve been doing this forever, but it feels to me like we’re at the infancy of this understanding of how to use these in medicine.

Dr. Elizabeth Boham:
Yeah. I mean, there are some great brands that I trust and I use all the time, but when somebody doesn’t maybe know what to do, I’ll say go to a reputable place, a reputable pharmacy or a good wellness store pharmacy and get a probiotic, try it. If it makes you feel worse, then stop it, because there are some good bacteria that make people feel worse, you feel more-

Dr. Mark Hyman:
[crosstalk 00:31:17] Have bacterial overgrowth [crosstalk 00:31:18].

Dr. Elizabeth Boham:
Exactly.

Dr. Mark Hyman:
If you have bad bugs growing in there and you put the good bugs in, then they have a fight, and they cause lots of bloating.

Dr. Elizabeth Boham:
So that means we just have to do more work before we can start it.

Dr. Mark Hyman:
Yeah. So you got the reinoculate and then you got the …

Dr. Elizabeth Boham:
And then repair, and that’s the fourth R. So that’s things like, that’s like giving good protein, good amino acids, which are the building blocks of protein, sometimes-

Dr. Mark Hyman:
To repair.

Dr. Elizabeth Boham:
Yeah, to help repair that barrier, that coffee filter, right? We have to repair it with good protein. Sometimes we’ll use amino acids like glutamine that help repair it. We’ll give more zinc, whether it’s from food sources or as a supplement, maybe we’ll give some vitamin A, which also helps with healing that barrier. It helps with healing the endothelium in the gut. So those are things we will do to repair. Then rebalance, right? That’s the fifth R, which is really focused on managing our stress and how we’re reacting to the world, because we know that when our parasympathetic nervous system is engaged, when that calming nervous system is engaged through meditation, and yoga, and breath work, that our body has the ability to heal, and it heals better when our body is at rest.

Dr. Mark Hyman:
I mean, yeah. I think that you just touched on something very powerful, which is that our gut and our brain are connected. There’s a whole hardwiring of nervous system, and the gut even has this independent nervous system that actually is like the second brain.

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
We often say people with irritable bowel are emotional or anxious, or have just maladaptive emotional coping mechanisms, but it turns out that the irritable bowel actually can cause an irritable brain and lead to anxiety and all these emotional issues. So it’s bidirectional and I think that’s a great lever for helping people reset their gut.

Dr. Elizabeth Boham:
Absolutely.

Dr. Mark Hyman:
I just wanted to share a story, because I’ve been doing this for a long time, and of course my … I don’t know what it is, curse or blessing, depending on how you look at it, is actually getting really sick and having to figure out what to do to fix myself. I’ve had a lot of gut issues over the years, which is why I’ve really focused on this. The first was when I had mercury poisoning, and I tried everything. I did every functional medicine trick in the book back then, and it wasn’t working, until I got the mercury out, which disrupts all your enzymes, it disrupts your gut, it causes leaky gut, it causes yeast overgrowth, it screws up the bacteria in your gut. Until I got rid of the mercury from my system I couldn’t get my gut straight.

Dr. Elizabeth Boham:
Yeah, because it’s impacting your immune system too, right?

Dr. Mark Hyman:
Yeah, right. Then many years later I kind of got an issue, which was triggered by an antibiotic for a root canal that I had to take called clindamycin, which is known to cause C. diff, which is a terrible bacterial infection that kills like 30,000 people a year, and I got that. I was so sick.

Dr. Elizabeth Boham:
I remember.

Dr. Mark Hyman:
Liz would come over to my house, and it was pretty bad. I’m like, we’re all struggling to figure out.

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
I had mold in my house, all these other things, but I ended up having colitis, and I had tremendous leaky gut, and I did my own stool test, and my friend Patrick Hanaway who he worked for the stool test company for many years, my colleague at Cleveland Clinic. He and I looked at my stool test, and we probably between the two of us seen like 20,000 stool tests, right? This is the worst one we’ve ever seen. Everything was screwed up. I had no good bacteria, I had low butyrate, I was not digesting, I had tons of inflammation, it was terrible. I couldn’t really fix it using a lot of the traditional things, and then I started to sort of work on a gut shake, which included a lot of the sort of 5R concepts, right?

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
So I cleaned up my diet obviously. I got rid of the bad bugs, but I used a combination of these polyphenols from the plants, pomegranate, cranberry, green tea, also added glutamine, I added prebiotics, probiotics, I even added colostrum, which is to help regulate the immune system, and it was like a miracle. I went from full-blown colitis to normal in three weeks.

Dr. Elizabeth Boham:
Yeah, I remember that.

Dr. Mark Hyman:
I’ve been great ever since, and it’s just like wow, this is something that people can actually do, it’s not that hard, it’s not drugs. The alternative are really bad drugs, right? So I want to go to the next case, which was sort of not about people with a gut centric issue. Because people often think, “Oh well, if I have a leaky gut or if I have gut related problems, I’m going to know it. My stomach is not going to be right, I’m going to feel symptoms.”

Dr. Elizabeth Boham:
That’s true.

Dr. Mark Hyman:
But it’s not always the case. So the first case was a guy who did have a typical history of antibiotics, and acne, and some infection, and then diet and all these stuff, and that was pretty clear. But there are many cases where people come in and they have zero gut symptoms but their gut’s a mess and it’s causing all these issues. Tell us about your next case of this patient with an autoimmune disease.

Dr. Elizabeth Boham:
Right. So this was a 50 year old woman who came in and she didn’t have any real digestive issues that she was paying attention to or that were bothering her. What was bothering her were her joints. So she was having a lot of joint pain, especially in her hands. She was starting to get a lot of swelling and deformity, and she was diagnosed with rheumatoid arthritis.

Dr. Mark Hyman:
Really common.

Dr. Elizabeth Boham:
Yep. Her rheumatologist wanted to put her on a biologic medication. He wanted to start her on Enbrel.

Dr. Mark Hyman:
By the way, these are drugs that suppress your immune system.

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
That can cause life threatening infections and increase your risk for cancer, that costs 50,000 a year. So it’s not risk free and it’s super costly, and it can save lives, and it can be a great rescue medicine if people need it, but most of the time using functional medicine, not all of the time, but most of the time you can figure out the puzzle of why they’re sick and fix that, and then they get better and they don’t need the medication.

Dr. Elizabeth Boham:
Right, and she wanted to try it a different way. So she came to see us and said, “You know what? Before I go on this medication, can we do it a different way? Can my body heal and can I get to the point where I don’t need this medication?” So we did a lot of testing on her, and what we found was she-

Dr. Mark Hyman:
By the way, the testing can sometimes be expensive, but it’s a lot cheaper than a lifelong course of these medicines and the suffering that goes along with it, right?

Dr. Elizabeth Boham:
Mm-hmm (affirmative).

Dr. Mark Hyman:
So if you have to spend a few thousand dollars upfront to figure it out, you can stop having to pay 50 grand a year for the medication for the rest of your life.

Dr. Elizabeth Boham:
And you feel so much better.

Dr. Mark Hyman:
Yeah.

Dr. Elizabeth Boham:
So we found out that she had increased intestinal permeability. We did that test that you were mentioning earlier, that Cyrex 2, which looks at antibodies against different proteins in the digestive system, and if they’re elevated it gives us an indication that there is that increased intestinal permeability, and hers was really, really high.

Dr. Mark Hyman:
Yeah, and she had no symptoms.

Dr. Elizabeth Boham:
No, and she had no symptoms, right? One of the markers on there was high that makes me also think okay, is there really a gluten issue for this person, because we know that that can damage, as you were mentioning earlier, that for people with celiac disease that really can damage those villi in the intestines and is a major cause for leaky gut.

Dr. Mark Hyman:
Yeah. Well, that’s an interesting point, you bring up gluten. Even if you don’t have celiac you can still have issues. One of our functional medicine faculty, Dr. Alessio Fasano, who is one of the world’s experts on leaky gut and gluten, he discovered this because he found that in cholera, there’s a mechanism in the body that actually causes you to have a leaky gut so they get rid of the infection, and it can kill people if it’s bad enough, but he realized that the same thing that gets activated in cholera, something called zonulin, is activated by gluten. So gluten causes this protein to be produced that creates a leaky gut, and you don’t actually have to have celiac, and you could even have what we call non cell-mediated immune response, which is the old ancient immune system that doesn’t even use antibodies, so you can’t even measure it or test it.

Dr. Elizabeth Boham:
Right, it’s just inflammation.

Dr. Mark Hyman:
Just inflammation. It’s like the difference between smart bomb and carpet bombing. It’s just sort of an ancient part of the immune system just reacts, and gets pissed off, and inflamed, and that can cause a leaky gut. So when people have high zonulin levels or are creating antibodies to zonulin, it’s meaning there’s some issue with gluten.

Dr. Elizabeth Boham:
Yes. Yes, and so we said when we saw her intestinal permeability test, we said, “Okay, we’ve really got to focus on these 5Rs with you.” And we went out to find also a bacterial overgrowth. We found a bacterial overgrowth in her digestive system, and we found a bacterial overgrowth in her mouth. So we know that. There’s been really interesting studies showing that when there’s certain bacteria in the oral cavity that had been associated with autoimmune disease. So gingivitis or inflammation in the gums from a bacterial overgrowth has been associated with autoimmune disease in some people, and I think for her we saw that connection because we saw some elevated levels of unwanted bacteria in her mouth and we saw some unwanted bacteria in her digestive system.

Dr. Mark Hyman:
What did she need, like mouthwash? Dental care?

Dr. Elizabeth Boham:
Yeah, I mean, you can treat the bacterial overgrowth in the mouth. You can treat it with certain types of dental care, scaling and root planing. We also used a herbal, she wanted to go the whole herbal route. So we used an herbal rinse for her mouth, an herbal toothpaste and an herbal rinse that helps get rid of the overgrowth of unwanted bacteria. We used some good probiotics that you actually chew and that they give back the good-

Dr. Mark Hyman:
Mouth probiotics.

Dr. Elizabeth Boham:
Mouth probiotics, yep.

Dr. Mark Hyman:
Cool.

Dr. Elizabeth Boham:
And we also used an herbal regiment for the digestive system to get rid of that bacterial overgrowth, because what they’re learning is that there are certain bacteria that when they cross into the body when they’re not supposed to, they trigger the immune system.

Dr. Mark Hyman:
Yes.

Dr. Elizabeth Boham:
And they trigger this autoimmune process, and they trigger that inflammation, and then the body gets confused, and it starts fighting off its joint space when it’s not supposed to.

Dr. Mark Hyman:
Yeah, then maybe genetics. The gene, I think is DR4 or something, which is associated with increased susceptibility to rheumatoid arthritis in the face of certain gut infections.

Dr. Elizabeth Boham:
Yes.

Dr. Mark Hyman:
We know this from … We were trained in medical school that if you have certain bacteria like Yersinia you can get arthritis, or if you have Entamoeba histolytica, which is a parasite you can get rheumatoid arthritis. So we learned this as traditional medicine doctors, but we sort of don’t pay attention to the fact that it may be more broad than that, and I think you also mentioned the overgrowth of bacteria. So people might be wondering, “Well, isn’t there a ton of bacteria in your gut anyway? What’s the big deal?”

Dr. Elizabeth Boham:
Right, but there’s some bacteria that are good. I mean, we can put them in the category of good, and some that we don’t think are as good and that have been associated with inflammation in the body and autoimmunity. So it’s really it’s all about balance, right? It’s all about balance.

Dr. Mark Hyman:
Yeah, [crosstalk 00:42:50] the bacteria can go where they’re not supposed to go, right?

Dr. Elizabeth Boham:
Absolutely.

Dr. Mark Hyman:
So the small intestine is where you get most of the leaky gut, and what happens is sometimes those bacteria that shouldn’t be there kind of migrate up into the small intestine, which is like 22 feet, and then start to grow, and then when you eat certain foods it causes that food to ferment because the bacteria is there, that’s why we get the food baby, and the bloating-

Dr. Elizabeth Boham:
Yep, the bloating, yep.

Dr. Mark Hyman:
… and the distinction, and that’s a big clue for people. If you have bloating after eating.

Dr. Elizabeth Boham:
Yes, that is a big clue.

Dr. Mark Hyman:
It’s not normal. You should not know you have a digestive system until two minutes before you have to go to the bathroom, you go to the bathroom in five minutes or less and you’re done. That’s it, but people don’t realize the constipation, the bloating, the weird bowel movements, the diarrhea, the irritable bowel, it’s so common.

Dr. Elizabeth Boham:
Yeah. So for this woman we did of course the 5R program. We removed gluten, we removed those bacteria, we used an herbal protocol, and then we reinoculated, right? We gave a lot of the good bacteria, the pre and probiotics, and we did a lot of nutrients just to help her body heal, right? The vitamin A, the zinc, the colostrum you mentioned before, and really worked with her to help with managing her stress. She was able to avoid the biologic medication.

Dr. Mark Hyman:
Her joints got better?

Dr. Elizabeth Boham:
Her joints got better, her energy got better, the inflammation in her body went down, she actually lost a bunch of weight as a side effect, she was happy with that side effect.

Dr. Mark Hyman:
Yeah, it’s a good side effect.

Dr. Elizabeth Boham:
She was happy with that. So she really got much better, so it was exciting to see.

Dr. Mark Hyman:
We see this all across the board. When we start focusing on the gut and the leaky gut, whether it’s allergies, or asthma, or migraines, or autoimmune diseases, or colitis. I mean, it’s amazing how powerful it is, and this is the one thing that functional medicine has focused on that traditional medicine has almost uniquely ignore. I remember when I was at Canyon Ranch probably 25 years ago, and I was talking to a bunch of doctors, they were guests there and we were having a dinner, and I started talking about leaky gut, and there was an allergist there, and she’s like, “That is just such garbage and nonsense. It’s not true.” And now it’s really different, and now there’s enormous amounts of research going on about the gut microbiome, and about leaky gut, and now they’re looking at treating in the ICU. It’s like wow, we’ve really taken a huge turn in the last 30 years.

Dr. Elizabeth Boham:
Right, right, right.

Dr. Mark Hyman:
It’s really great, but I think again, if you’re suffering from any kind of inflammatory issue, if you’re having any kind of cognitive behavioral mood issue, if you’re struggling with any kind of sinus or allergy stuff or any gut stuff, you got to find a doctor who really understands how to work with the gut in a way. The truth is it’s not that hard. It’s once you figure it out and how to navigate. But we need to sort of just review what we talked about because it’s so compelling, and I think that most people don’t really grapple with this idea, but that leaky gut is a thing, that it causes a whole range of conditions that we just talked about. That traditional medicine ignores it, that there’s really great tests for it, right? There’s really great tests to look at food sensitivities, at your microbiome, and your gut, and all the factors, overgrowth of bacteria, yeast, parasites that’ll tell you exactly what you need to do. Then you use functional medicine to fix the problem using this 5R approach, which we kind of went through with these patients. Even diabetes is caused by leaky gut, right?

Dr. Elizabeth Boham:
Yes, yes.

Dr. Mark Hyman:
Because the metabolic toxins get in the system, and anything that drives inflammation causes weight gain.

Dr. Elizabeth Boham:
Right, those lipopolysaccharides, right? That have been tied with-

Dr. Mark Hyman:
Right, and there’s a whole, a lot of science about this. So it’s pretty exciting. Then people can start to change what they’re eating, to include more prebiotic foods, to include probiotic foods, more fiber foods, more phytochemicals and phytonutrients. They can do things to help their gut repair using enzymes or prebiotics, and using gut repair nutrients, like we talked about, vitamin A and C. So all, sort of vitamin, A, D, and gluten … Sorry, glutamine, not gluten, and zinc. That really is an incredible roadmap for people to heal their gut and to heal all of these chronic conditions, and this is what we do at The UltraWellness center day in and day out. We’ve been doing it for 25 years together, 15 years at The UltraWellness Center. I think I just want people to understand that they don’t have to just suffer. People just suffer needlessly when there are ways to heal these problems that are quite different from what you get in traditional medicine. That’s what we do at the UltraWellness center in Lenox, Massachusets. We have four incredible doctors, two PAs. Well, I’m one of the doctors, so I can’t call myself incredible.

Dr. Elizabeth Boham:
Oh yeah, you’re incredible.

Dr. Mark Hyman:
But I think I’m okay, I think I do all right. We have an incredible team of nutritionists, and we see people from all over the world to deal with these chronic issues, and we’d love to welcome you there. You go to drhyman.com/uwc, that’s for UltraWellness Center, drhyman.com/uwc.

Dr. Mark Hyman:
So it’s been great having you, Liz, on this week’s House Call of Doctor’s Farmacy. I really loved the conversation. It’s just so deep and beautiful, and I hope people get something out of it. If you enjoyed this minisode of The Doctor’s Farmacy share with your friends and family on social media, subscribe wherever you get your podcasts, leave a comment. I’d love to hear from you, and we’ll see you next time on The Doctor’s Farmacy.

Dr. Elizabeth Boham:
Thank you, Mark.

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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