Maggie Ward:
Honestly, I don’t focus so much on the scale because we know the scale doesn’t tell you your body composition so with everyone I’m really saying watch how your clothes fit, especially around that midsection right.
Dr. Mark Hyman:
Welcome to the Doctor’s Farmacy, I’m Doctor 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 care about nutrition and food you’re going to love this conversation because it’s about how food is medicine and how we can use food to help solve so many of our chronic health issues. And our guest today is none other than my nutrition director at The UltraWellness Center, Maggie Ward, who’s been working with me for 12 years, which is hard to believe. 12 years Maggie.
Maggie Ward:
I know.
Dr. Mark Hyman:
She’s got a masters degree in nutrition from Bastyr University and she focuses on using whole foods in medical nutrition therapy, which is actually what we should all be doing. Treating people with food, because it works far better and far faster than most drugs. She is a registered dietician as well and she has worked in Brooklyn and many other places and she’s really focus on the very difficult cases that we have at the UltraWellness Center. People suffering from digestive issues, food sensitivities, inflammatory problems. She focuses also on pediatrics nutrition and sports nutrition, because she’s an athlete herself and you don’t want to get caught running with her because she’ll leave you in the dust.
Maggie Ward:
Not anymore.
Dr. Mark Hyman:
She’s really been the main stay of our nutrition practice at the UltraWellness Center and I’m just so glad to have her on this special episode of the Doctor’s Farmacy called House Call. And in this series I sit down with my colleagues at the UltraWellness Center to discuss how we as functional medicine physicians and nutritionists tackle specific conditions that are tough to treat, but that we do extremely well with. So welcome Maggie.
Maggie Ward:
Thank you. Thank you for having me, I’m really excited to do this especially in these days of social distancing at least we’re connecting a little bit here with our loved ones outside of our homes, so thank you for having me.
Dr. Mark Hyman:
Yeah, that’s true. We probably get to see each other more on Zoom.
Maggie Ward:
I know, I feel like that.
Dr. Mark Hyman:
[crosstalk 00:02:09]
Maggie Ward:
We are connecting more, which is good.
Dr. Mark Hyman:
No, this is great. So we’re going to dive right in because what we do at the UltraWellness Center Lenox, Massachusetts is we focus on how to use food as the core therapy. Now, I probably can’t guarantee this is true, but I do believe that I am the first practice, the UltraWellness Center was the first practice in the country, maybe in the world, where you could not see the doctor unless you agreed to see the nutritionist. You can not get a doctor’s appointment without also having a nutrition appointment because food is medicine. And if food is medicine how can I treat patients without a nutritionist. So that is why it’s such essential part of our practice and we do everything from general nutrition to really focused nutrition for medical therapy for all sorts of different conditions. And were going to talk about how we personalize our food intake, or personalize our diets. We use genetic testing, we use laboratory testing, we look at nutritional profiles and we’re going to talk about various kinds of approaches that we use in functional medicine to get granular about how to treat troubled problems. So Maggie, tell us a little bit about this first patient that you’ve had that you wanted to share a little about what their struggle with around reflux.
Maggie Ward:
Absolutely. [crosstalk 00:03:23]
Dr. Mark Hyman:
Which is a big one.
Maggie Ward:
Yeah, right, right. And you know, this case I picked because it’s probably common to what we see. I mean we see a little bit of everything especially at the UltraWellness Center, but I think it’s a kind of common theme especially for people that come to see me just for our nutrition or one of our nutritionists.
Maggie Ward:
So this woman, she’s a 64 year old woman who I’ve been working with for a while dealing with some weight gain, that was one of her main concerns, I mean mild, about 20 pounds overweight kind of came on around menopause for her. But she also had a very long history of reflux, had been on different medications.
Dr. Mark Hyman:
Heartburn right?
Maggie Ward:
Right, heartburn.
Dr. Mark Hyman:
We used to call it heartburn, now we call it reflux.
Maggie Ward:
Reflux, yeah.
Dr. Mark Hyman:
And there’s a whole industry of drugs and it’s like the third most commonly prescribed class of drugs out there were the acid blocking drugs. Little purple pill, right?
Maggie Ward:
Right. And many you can get right now over the counter too. So many people are taking it even without a doctors prescription and sometimes needed for short term, but unfortunately a lot of people have been on this medications a long time and I think we see the negative impact of that so much at our center.
Maggie Ward:
So she had a long history of the reflux and also dealing with lower energy. She’s been on many diets, which we hear so often. People come to us trying many, many different things and the common theme I hear so much is just that way of eating just want sustainable. And honestly we use the word diet to just kind of have that language, but I really don’t like that word because I think we tend to think of food as black and white, we’re either on a diet or we’re off a diet. And initially we might be asking people to walk a kind of a finer line with the food choices to get them feeling better quicker, but ultimately eating whole foods, kind of balancing those macronutrients, eating every maybe four hours once you’re eating during the day. I mean those are things that you kind of want to make your life style and that’s ultimately what we really talk about, is how do you make this sustainable for you.
Dr. Mark Hyman:
So this reflux case is so common, the number one reason that people go to the doctor in America is for digestive problems and reflux is right up there among them. So what are the causes that you see Maggie, for heartburn and reflux which is so common in our patient population and in the country?
Maggie Ward:
I think it’s multiple things. I mean from a dietary stand point when we know a lot of the foods that can cause indigestion and reflux. Dairy is a big one, gluten’s a big one. So we do a lot focusing on taking out those foods that might be more irritant to the gut and difficult to digest.
Dr. Mark Hyman:
These aren’t like allergies, true allergies necessarily. They might be sensitivities where people…
Maggie Ward:
More like sensitivities, exactly. I mean people definitely do definitely have true allergies, but what we see is just different ways your immune system can react. Or even intolerances, where you just don’t digest the food well, right? Dairy’s a good example that where lactose eventually gives everyone an issue and can cause things like reflux and bloating and gas. So that’s definitely a big one. I mean, obviously working with providers doing more testing around breath testing and stool testing. Get a sense of dysbiosis, it’s a very common things that we see.
Dr. Mark Hyman:
So what’s dysbiosis, Maggie?
Maggie Ward:
So dysbiosis is when you’re bacteria’s out of balance in your body and can often be in the wrong place. You know we see…
Dr. Mark Hyman:
In your gut usually.
Maggie Ward:
Right, right, in your gut. Many people what we see they have that small intestinal bowel overgrowth, what we call the SIBO. And bacteria and even yeast can move further up into the upper GI and definitely cause a lot of distress there. [crosstalk 00:06:47]
Dr. Mark Hyman:
So [crosstalk 00:06:48], normally there’s a lot of bacteria in your lower intestine, in your lower [organs 00:06:54].
Maggie Ward:
Correct.
Dr. Mark Hyman:
But not so much in your small intestine. You’ve got 22 feet of small intestine that starts at the end of your stomach and when the bacteria migrate up for different reasons. Motility issues, low magnesium, stress, whatever, you end up with this overgrowth of bugs in the small intestine and so when the food hits there it should be sterile, but when there’s bacteria in there they go to town, right? They go to town and they ferment the starchy foods that you’re eating and you get this thing called a food baby. Everybody knows what that is. You eat and you get this bloating and discomfort and that’s called SIBO which is a very horrible condition that so many people suffer from.
Maggie Ward:
Right, right. And that’s what I tell people. I mean, all bacteria produce gas. It’s one thing if it’s down in your colon and you can release it. When it’s up in your upper GI I mean it can cause a lot of discomfort. So we see that a lot, and I think that is again a big issue with the reflux. Also motility issues. I work with a lot of people talking about how you eat, slowing down, chewing your food well, doing some deep belly breathing before you eat to kind of relax that vagal nerve that runs along the whole digestive track. I think that goes a long way. I have had multiple people tell me just by slowing down and chewing better their reflux has gotten a lot better.
Dr. Mark Hyman:
Yeah. Well about when you’re stressed your sympathetic nervous system is your fight or flight nervous system and one of the things it does is shut down your digestive system because when you’re running away from a saber tooth tiger you don’t want to be digesting your food, you want all the blood to go to your muscles and be able to run as fast as you can and so that’s what happens when you eat under stress and this is why these practices you’re talking about deep breathing, taking a pause, I call it take five. Just take five breaths before every meal and see what happens. It’s a very powerful reset. In fact well what was interesting when I was writing my book UltraMetablism I found that there was this paper that showed that the sympathetic nervous system it connects to the fat cells. So this is the stress response and when your stressed it inhibits the fat cells, metabolism, so literally slows your metabolism. So being stressed literally can slow your metabolism and make you gain weight.
Maggie Ward:
Right, right and you know from an evolutionary stand point that makes sense. I think we’re all designed to hold on to our fat, our calories, to kind of get through those famines, get through those times of stress, but unfortunately in this day in age it’s usually working against us.
Maggie Ward:
So what I did with this woman to start because she really wasn’t aware of if certain foods really bothered her around the reflux. She said alcohol for sure and more stress she would notice it. So we started with an elimination diet and that is taking out a lot of the common food sensitivities just so what we’ve seen epidemiologically, what we see clinically. So we took out… and I’ll go a little bit more into that.
Maggie Ward:
We took out gluten grains but I actually encouraged her to take out all grains just because she was dealing with that extra and we know blood sugar and higher insulin levels from too many carbohydrates definitely can get in the way of losing that weight. So I just had her take out all grains and many people feel better for multiple reasons doing that. No added sugars, obviously flour. We took out dairy, second in line usually of what people are reacting to. Eggs, corn and also alcohol. Now she liked her glass of wine at night and I just said you know lets take a break from that and see how you feel from it and then we can kind of look at that again of maybe adding that back in. She also had a fair amount of caffeine in her diet. She was drinking about three cups of black tea. So some people can handle that, some people can’t, but it definitely can be an irritant.
Maggie Ward:
So we took all that out. Talked about how do we balance our blood sugars, eat lower carb, make sure you get enough protein. What I really focus on, especially for women, is really not losing weight, it’s really shifting your body composition because you don’t want to lose your lean muscle mass. We really want to preserve and if anything build that. So I really was focusing on getting sufficient protein, especially when you exercise we know when you eat sufficient protein after you exercise that’s that window in which you’re really going to support muscle growth, right? Because your proteins going to everything. All your organ needs, your detox system, your immune system. So building protein and I feel like is kind of a lowest on the priority list for the body, but if you get sufficient protein after you work out it really helps support that lean muscle mass.
Maggie Ward:
And this woman was also diagnosed with osteopenia, so I really wanted a…
Dr. Mark Hyman:
That’s low bone density right?
Maggie Ward:
Exactly. So I want to make sure we were doing things to support her bones and good healthy muscle is probably the most important thing around supporting bone health. So we worked on that and I did do some testing with her. I wanted to get a little better sense of what nutrients might be impacting her given that she’s got this fatigue. I had started her on just a [crosstalk 00:11:48].
Dr. Mark Hyman:
Hold on a second, wait. Before you get into the testing. So she basically started with an elimination diet, getting rid of common food sensitives and triggers and we know traditionally in medicine that for reflux we tell people to avoid alcohol, caffeine, spicy foods, tomato based foods, citrus food and so forth, but it often goes further than that. There may be other triggers, like dairy and gluten are very common and often they’re not on that list that typical doctors use. And then she was also on this drug Nexium, which is one of those powerful acid blocking drugs. And when I was in medical school these drugs just came out, about 30 plus years ago and we were told by the drugs reps never keep people on this more than six weeks. These are super powerful drugs that can disrupt gut function. They’re good for healing ulcers, but do not keep people more than six weeks on these drugs and now people are on them for years and years and we know that they cause all sorts of problems. So they might stop your heartburn, but one of the most common quote side effects is irritable bowel. A side effect. Because we…
Maggie Ward:
Right, because we need that stomach acid, right?
Dr. Mark Hyman:
And you change the PH and so you get different bugs growing, you might get yeast overgrowth in your gut, you might get small intensional bacterial overgrowth like we were talking about or SIBO. You might also develop nutritional deficiencies which why I think it’s so important, the testing you talk about is so important because when you are taking an acid blocker you are inhibiting the ability of your body to absorb things like B12 and magnesium and zinc and calcium so you end up with osteopetrosis as a result of taking acid blockers. You end up with SIBO. You end up with even the increase risk of pneumonia and all sorts of other health issues and I think most people don’t understand the danger of these medications and how now they’re just over the counter so people think they’re fine and safe to take for a long time but they really aren’t. And most of the time, like most of the time when we see patients with reflux it’s just a slam dunk easy fix by changing their diet.
Dr. Mark Hyman:
And then of course if there’s other issues we might have to dig deeper. Maybe there’s SIBO that needs to be treated, maybe they have H. Pylori which is a bacteria that can cause ulcers but I can also cause heartburn and reflux. So we have to be a little bit of detectives, but the basics work so well and that’s why these nutrition focused appointments that we do at the UltraWellness Center are so helpful for people. They often don’t actually need to see a physician at the end because they’re better just from shifting their diet.
Maggie Ward:
Absolutely, and she’s a great example of that. I mean I did start her on some supplemental support in the beginning. We used a product called DGL Plus which is deglycerized licorice. It’s in the family of these [inaudible 00:14:22] herbs and what they do is, they’re nice because they help with those symptoms or reflux, but they’re helping to build up that mucosal layer which is a very top layer on the digestive track. So they are working now to start healing the gut, which is we’re always in functional medicine looking for what is at the root cause. So starting on that. And especially for someone, as you know being on these medications for so long it’s hard to get off of them. [crosstalk 00:14:47]
Dr. Mark Hyman:
Yeah, they’re designed like that.
Maggie Ward:
Right.
Dr. Mark Hyman:
They’re designed… literally, if you take the medications and you try to stop you will immediately get worse because you get what we call rebound acid production and that causes worsening the symptom. Oh, I need it, I need it. There’s a way to taper slowly off it using these additional things you’re talking about Maggie, like DGH Plus that are helping to coat the stomach. We use glutamine, in Japan they use Glutamine for example. Aloe, licorice, as ways of helping the gut get soothed while you’re tapering down on these medications.
Maggie Ward:
Right, right. And I think you know, we find so much good success using those and then people can start weaning off of them. So we did that and we actually did a [hydros 00:15:30] fish oil too just because for overall kind of inflammation. And a B complex again around her energy because those B vitamins, and going back to these medications that lower stomach acid, something like B12 is often impacted because it needs a certain acidic environment and other factors to have good absorption.
Maggie Ward:
So we started with that, again the testing. She did an organic acid test which is a urine test that we can do and it’s really my favorite nutritional test that’s out there because it’s looking at this kreb cycle which is the energy cycle that happens inside your cells, inside your mitochondria. So its basically where your food gets converted into energy and you can measure the different steps in this cycle and we know the nutrients that run these steps, so by looking at these markers there these functional, basically looking at the function of these nutrients to get a sense if certain nutrients are low.
Maggie Ward:
And I think that’s some of the limitations sometimes with just straight forward conventional testing for something like B12, it often is going to pick up a deficiency.
Dr. Mark Hyman:
Yeah, unless it’s pretty bad, right?
Maggie Ward:
Right, exactly. Unless it’s pretty exasperated, but with this testing it’s really saying, okay is that B12 that you have in your system is it doing what it’s supposed to be doing. So she did that test.
Maggie Ward:
The other thing I wanted to point out, and this is more of a medical piece, but in the packet that we ask clients to fill out and patients fill out there’s many, many questions that we ask and she had said that she snores at night. So I didn’t get into that much in that first appointment, but I did when I sent her, her plan. I said you can talk to your doctor about maybe doing a sleep study because she also had high blood pressure, that weight was there, we know that sleep apnea and things can cause weight gain along with the blood pressure and her fatigue. She said she was sleeping a fair amount, but when you’re tired you start thinking okay how good is that sleep? So I think that where…
Dr. Mark Hyman:
I want to stop you there for a sec…
Maggie Ward:
Sure.
Dr. Mark Hyman:
… because I think what people should understand is that sleep apnea is very common. It’s underdiagnosed. It causes high blood pressure, it causes pre diabetes, and the treatment with CPAP or breathing machine that helps you stop the snoring and opens your airways at night literally will help people lose weight, lower blood pressure and feel better without even changing their diet.
Dr. Mark Hyman:
I remember this guy who was a lawyer and he told me that he was struggling to lose weight and I said “tell me about your life, what do you do?” He goes, “well I’m a lawyer, I work. I have to work at a stand up desk.” I’m like, “why?” He said, “well if I sit down I fall asleep.” I’m like, hmm. “do you store at night?” Well now he says “I snore,” I’m like, “okay let’s get a sleep study.” We got him a sleep study, he had sever sleep apnea. We got CPAP treated, he lost 50 pounds without doing anything else, just simply fixing his sleep.
Maggie Ward:
Right, right. And that’s the thing. I think food is always going to part of the solution for people, but many times there’s multiple variables and you have to kind of be a detective and I think that what we do in functional medicine is look at these other pieces. I mean there might be things I can’t really address from a nutritional stand point, but I can guide people. Talk to your physician, look at this, look at that and it’s amazing what gets missed when you meet with your physician. [crosstalk 00:18:41].
Dr. Mark Hyman:
Yeah, this organic acid test you mentioned is so important. I think in traditional medicine we use this test, but it’s usually looking for genetic inborn errors of metabolism in children who have weird problems with metabolic path ways, but we use this test in a different way. Looking at functional status. Looking at more small deviations that indicate problems with nutrient deficiencies or different pathways that aren’t working or inflammation that we can pick up or troubles with detoxification. We can look at this test to determine whether you have bacterial overgrowth or yeast overgrowth in your gut because you’re seeing molecules that are produced by these bad bugs in your gut that then show up in your urine. So this is one of my favorite functional medicine tests and again it’s something we don’t use in traditional medicine, it’s whats really unique about functional medicine and our work at the UltraWellness Center and the nutritionists can do this on their own because they understand how to interpret these metabolic pathways.
Dr. Mark Hyman:
Hi everyone, it’s Doctor Mark Hymen. So two quick things. Number one, thanks so much for listening to this weeks 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 Marks 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, supplement recommendations, recipes or even gadgets and I use a few of those. And if you’d like to get access to this free weekly list all you have to do is visit drhymen.com/picks. That’s drhymen.com/picks. 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 drhymen.com/picks. That’s P-I-C-K-S, to sign up free today.
Dr. Mark Hyman:
So what happened to this patient after the first time you saw her and put her on the elimination diet and did these treatments?
Maggie Ward:
Right. So five weeks later we followed up and her reflux was gone, so that’s in five weeks. And she had weaned off of the… she was on I think Pepcid at the time when I spoke with her and she was taking the DGL. She was taking it pretty regularly, but between the diet and just starting that DGL I think made a huge shift for her. I was surprised to see it because it can take a little while again for people to really start feeling better and get off those medications, but she did it quite quickly. She was down seven pounds which is a lot in five weeks. You don’t want to lose weight too quickly so that’s a really good amount of weight to lose in five weeks.
Dr. Mark Hyman:
Wait, wait, is that true? Is that true? You don’t want to lose weigh too quickly because I think that there’s controversy about that.
Maggie Ward:
Yeah, I mean I think it depends on the person. I mean I think initially you can get a pretty rapid weight loss just by dropping your carbohydrates. We know inflammation you hold on to water and fluid and can gain weight from that, so I think when you take out these more inflammatory foods you’ll see this kind of rapid weight loss initially and that’s a good thing. So initially you can easily see a quick drop, but I think in the long run it’s different for everyone, but generally I like to see a slow decline in weight because again, especially with women I want to make sure they’re maintaining the lean muscle mass. So are they getting enough calories? Are they getting enough protein? Honestly, I don’t focus so much on the scale because we know the scale doesn’t tell you your body composition, so with everyone I’m really saying watch how your clothes fit especially around that midsection, right. That’s that weight build up right around the belly, that tire that we always call it and when you lose that, that’s not muscle, you’re losing the right type of weight.
Maggie Ward:
I mean I can’t tell you how many times over the years people say, “you know, Maggie, I haven’t lost any weight.” I’m like, “well how are your clothes fitting?” “Oh, I went down two pants sizes.” I’m like, “you are losing weight, you’re losing the right type of weight.” And so it’s such a better barometer and it’s less stressful.
Dr. Mark Hyman:
And it can go the other way too. My wife has been working out and she says her clothes still fit her great, but she’s gained almost 15 pounds of muscle.
Maggie Ward:
Right, I mean when I’m in my best shape I weigh my most because I’ve got more lean muscle mass on me, so yeah that’s again where the scale can be deceiving.
Dr. Mark Hyman:
So we see in this patient is reflux clear up pretty quickly, usually with diet and then if sometimes we need to dig deeper, but we really help people taper off these medications. We help them transition to supplements that can help mitigate it. We look for other factors, whether it’s nutritional deficiencies or bacterial overgrowth or yeast overgrowth that can be a problem we treat those things and it’s just such a rewarding practice at the UltraWellness Center because we see these people who struggle for years who think they have something wrong with them that they have to live with forever. They just don’t. I mean reflux is not a normal state for a human being.
Maggie Ward:
Right, right.
Dr. Mark Hyman:
It’s not. And then you found some other stuff and you replaced nutrients and then what happened?
Maggie Ward:
Yeah, so what came back in the urine acid test is that she was low on B12. I kind of suspected it as well as B6 and B6 is really important in that energy cycle. It also helps us make our neurotransmitters, those chemicals in our brain. So if you don’t have enough B6 it can affect mood and cognition.
Dr. Mark Hyman:
Yeah, your serotonin, right? Your happy… people take [crosstalk 00:23:50].
Maggie Ward:
Serotonin, your dopamine, right. So and I had already started her on a B complex so I just reinforced really important for you to be on that because we’re repleting these nutrients. She also came back low Coenzyme Q10, which is a really important molecule in producing that cellular energy. And we do produce it, but I suspect maybe from… she had been on statins years ago for higher cholesterol she came off because she didn’t feel well on them and had more fatigue and we know that what happens with a lot of these statin medications is they’re blocking the production of this molecule. So I added in some Coenzyme Q10. It’s hopefully something she won’t need to be on long term, but I wanted to do it to kind of bump up that energy for her. So that was really helpful to see that in that testing.
Dr. Mark Hyman:
Yeah, and so then she just needed the DGL occasionally, so symptomatically, but she noticed that she feels better off the gluten which was driving the reflux and her joints felt better. The arthritis felt better, right?
Maggie Ward:
Right, right. So that’s in that second phase after we met we talked about how do you reintroduce. So that’s really, I find there’s a lot of great tests out for food sensitivities and we do use the, but I still think the gold standard is take a lot of these things out that we know are problematic, see how you feel and then slowly reintroduce and that’s where I think you get that aha moment of I didn’t think I felt better off of dairy, but I added back in cheese or whatever it might be and those symptoms came back. So I find it really helpful. It’s just working with people to slowly reintroduce it. So there’s a really more systematic way of doing that. So what she found, we walked through that and when we talked again after she had done the reintroductions that’s where gluten she said I definitely don’t feel well, my joints. And I see that quite a bit with gluten, her joints were hurting her again. She had osteoarthritis in her knee and her reflux she said she definitely feels better, and that might be the flour and stuff, where we get our gluten.
Maggie Ward:
She did reintroduce some dairy and she found goat cheese, if she had it maybe two or three times a week she was okay, but on a daily basis she wasn’t digesting it as well.
Dr. Mark Hyman:
Well so essentially you mentioned goat cheese because we have changed our cows so much over the last 100 years. We used to have all these strange varieties and then traveled around the world and you see these funny looking cows all over the place. Here’s there’s the same old white and black Holstein cows and they’re bred in a way that has produced a milk that contains high levels of a form of casein which is the protein in milk called A1 casein and this tends to be more inflammatory, it also tends to cause more digestive problems. And when you look at sheep or goat cheese or milk they are A2 casein, which is far better tolerated, less inflammatory. I noticed the same thing, if I have goat or sheep cheese I’m good. If I have cheese that’s not a goat cheese or sheep cheese or I have milk or any kind of dairy products it’s a problem. So I get congested, I get digestive issues and I think most people will notice a difference. So you’re right, it’s not all or nothing, dairy or no dairy. [crosstalk 00:27:01].
Maggie Ward:
And there’s often a tolerance level. I think even if she had goat cheese everyday she’d maybe start feeling symptoms, but she found what her tolerance level is and being able to have goat cheese twice a week it definitely adds some nice pleasure to your eating so I think that’s important.
Dr. Mark Hyman:
And this speaks to the whole idea of personalized nutrition and precision nutrition, personalized medicine. I think this is what we do at the UltraWellness Center. So I think this is very…
Dr. Mark Hyman:
Maggie, I want to get to the next case because we really do so much around digestive health at the UltraWellness center and if people are suffering from any kind of digestive issues, whether it’s reflux or irritable bowel or something more serious, colitis, I just had a patient text me yesterday saying I gave her this cocktail of a shake that essentially was gut healing shake and she’s [inaudible 00:27:47] blood, they were going to take out her colon. I mean they literally were going to take out her colon and now she’s completely fine and it’s great because we know how to actually use the principles of functional medicine to restore health and balance. And that’s what you did in the next patient, you did a very personalized approach to figuring out what this particular woman who was very overweight needed to deal with her risk factor for obesity and diabetes. So can you tell us about the second patient?
Maggie Ward:
Sure. So this is a 48 year old woman. She had a very long history of being overweight, started pretty young. When I met with her she was at least about 80 pounds overweight and a strong family history for obesity as well as diabetes. She had a fair amount of joint pain, she said her ankles and her knees she often would get joint pain and her doctor had said she had some osteoarthritis. She had a very high stress job, I want to say she was a lawyer I think. So just working a lot and pretty intense and she would drink alcohol, even smoke a little bit occasionally kind of just as a social smoker for her stress outlet. She also did a lot of exercise which is typically we think of as a good thing, but she liked those really high intense spin classes and things like that and I think maybe that was setting her up to have a little bit more inflammation and joint pain.
Maggie Ward:
And she had followed very restrictive diets over the years, very lower calorie even taking things for her metabolism and we know so often that can have a negative impacts on people and helping them lose weight in the long run and keep it off. So…
Dr. Mark Hyman:
Yeah, I mean it’s so interesting to see how we deal so differently and the nutritionists at the UltraWellness center deal so differently with weight. Because historically it’s all been about calories. Calories in, calories out. Eat less, exercise more and if you don’t succeed it’s because you don’t have willpower. And we take a very different approach at the UltraWellness center with our nutrition approach to weight and metabolism which is to try to figure out what is right for that person, and this was a very unique case because you did some testing that allowed you to zero in on what her particular metabolism required in order to actually optimize her health and we don’t really put people on diets. We teach them how to create health and the conditions that they’re suffering from, the weight, their symptoms get better as a side effect of using the principles of function medicine to create health for people.
Maggie Ward:
Right, right. So I mean we did some basic low carbohydrate, obviously that tends to work really well for a lot of people. I got her on a good fish oil and things for her inflammation. She hadn’t been eating seafood. Some basic things like hurcumin which is from turmeric which is a really good anti-inflammatory, but then I wanted her to do some DNA testing because of her family history and really get a better sense of what might be working against her somewhat in losing weight.
Maggie Ward:
So and the area of [nutralgenomics 00:30:41] it’s rapidly evolving. I think we try to be cautious and aware of there are a lot of things we don’t know yet, but the beauty is just over in the last 10 years there’s been so much research done in this area and we’ve been working with laboratories that I think are really weighing the research. These are genetic variations, which we call skips that seem to really have a significant impact on outcome and have some good research indicating that. So we’ve really kind of done our diligence in trying to find good lab tests to go look at in this nutritional genomic component.
Dr. Mark Hyman:
Yeah, I mean I think there’s a lot of companies out there offering genetic testing around nutrition that say take this test and here’s what [inaudible 00:31:25] you should take, here’s what you should be eating and it’s often not in the context of the bigger picture of what’s going on with that person health and life. So the functional medicine approach at the UltraWellness Center we really look at the whole picture and the DNA testing is one part of that. It can help guide us into specific recommendations. So it’s not just here take this test and do these things. It’s varied through the filter of functional medicine.
Maggie Ward:
Right, right. And even with DNA testing you always want to take that into account with the clinical picture, right? So if someone has some of these symptoms that would connect with some of these genetic variations that’s when you really focus on it. So you don’t want to ever look at one thing in a silo, you really look at the whole person.
Maggie Ward:
So I followed up with her six weeks later and she had been doing better with the lower carbohydrate diet. It’s something she had tried before. We were really careful obviously with those higher food sensitives that often can cause inflammation too.
Dr. Mark Hyman:
So when you say low carbohydrate diet I just want you to focus on that for a minute because I think there’s a lot of controversy about it. There’s a lot of confusion about what that means. Broccoli’s a carbohydrate, are you not eating broccoli? So define what you mean.
Maggie Ward:
Right. It’s a carbohydrate, but it’s got a lot less carbohydrates per serving that a higher more what we call starchy food would have and a lot of these are good foods, but…
Dr. Mark Hyman:
It’s starch and sugar that are the real problem, right?
Maggie Ward:
Right. They’re will break down quicker. They will raise blood sugar quicker. So those are the carbohydrates we’re more careful with. Things like broccoli, or leafy greens, yes they do have carbohydrates but very small amounts and they have a lot of vitamins and minerals and things that help us metabolize those carbohydrates that are in there. So [crosstalk 00:33:02].
Dr. Mark Hyman:
Yeah, I mean I always joked that carbohydrates are the single most important thing for a longterm health and longevity and so jokingly say that because [inaudible 00:33:12] you know I’m like an anti sugar and starch, but the plant foods are made from carbon that’s why they’re called carbohydrates. I mean that’s what they do, they take the carbon from the atmosphere, the carbon dioxide, they breathe it in because we breathe it out, it goes into the plant and that’s what the structure of most plants is, is carbohydrates made from carbon, but it’s not the quickly rapidly digested carbs that David Kessler calls fast carbs. These are slow carbs and they have a very different effect. So we’re not telling people to have a truly low carb diet in the sense of the volume of foods, but most of the volume of food they’re eating is going to be carbohydrates in terms of a plant rich diet, but it’s getting rid of the starch and sugar. Is that right?
Maggie Ward:
Right, right. And I do kind of break it down too like percentage of the amount of calories I think they would need. So I think for her I did about 30 percent of her calories from carbs, which is pretty low, but given her history and the diabetes in her family I thought that was most appropriate and we did little bit of higher fat and again, good quality more anti-inflammatory fats because there’s a big difference there too compared to that processed fats and some of the saturated fats.
Maggie Ward:
So that’s what we initially did and she did see some benefit, not a whole lot of weight loss, but again her around her middle she had lost about two inches and she felt like her joints were getting at little bit better and I’m sure that’s because inflammation was coming down and the right type of weight was coming off.
Maggie Ward:
But her genetic testing was really, really interesting. There were a few things really stood out. She needed a lot of support with detoxification. And in this day and age I’m really focusing on detox support with everyone, but some of the people we see are from a genetic stand point have a lot more of an impact from those toxins in the environment and it’s an area you’ll really want to focus on because it can cause weight gain. And as women and our hormones, and our estrogens and we do carry more fat in general. We have I think more of that impact from these toxins. So I really shifted my focus over to her really thinking about foods and other things we could do to support detox. Moving those bowels well, sweating. While exercise was good, but we can do saunas and things like that.
Dr. Mark Hyman:
So food… Maggie, two things. One, there’s a whole class of these compounds that we’re identifying that are obseogens. They’re environmental chemicals that come from our water, from air, from plastics, from cosmetics, from pesticides. These are compounds that seem to interrupt metabolism. So toxins cause weight gain, right? I did right about this because I was seeing this in my patients and then the literature is just increasingly abundant about how these environmental toxins are driving obesity and diabetes. So the fact that you found this on this patient really allowed you to really customize her diet.
Dr. Mark Hyman:
So what were the specific foods that you recommended that helped the detoxification pathways for this patient?
Maggie Ward:
Right. Plants. You know, but mostly cruciferous vegetables. We know a lot of the compounds in there like sulfur, sulfonmethane push these pathways known as sulfation through the liver, so a really important pathway to support and that was a genetic market that came up is that she had issues with sulfation and so…
Dr. Mark Hyman:
So what are this cruciferous vegetables you’re talking about?
Maggie Ward:
Sort of your broccoli and your cauliflower, cabbage, kale. There’s quite a bit and I only [crosstalk 00:36:31]…
Dr. Mark Hyman:
Brussels sprouts, kohlrabi.
Maggie Ward:
Brussels sprouts, actually yeah, broccoli sprouts too is some of the richest source you can get. Get these sprouts too. And you know I think yes you can take this in a pill, and I did actually recommend it for her, a form of sulfonmethane but I’m sure there are compounds in our food that we have not discovered and work synergistically. So I never want to say take a pill over a food. It’s food and then if you can add in a pill. So we really ramp that up. We did more allium foods, which are your garlic, onions, leaks, scallions. There’s quite a bit in that family. A lot of reasons why they’re good for you, but they’re high in sulfur so they support the sulfation pathways.
Maggie Ward:
And again, also getting enough protein. I think many people that we see because they’re need more support with detox or their immune systems compromised, everything’s built from these amino acids. We talked so much about glutathione being this really powerful detox molecule that we make in our body and it’s a tripeptide, it’s very amino acid. So when you have more of those building blocks you can support those detox pathways.
Dr. Mark Hyman:
And can you get those from plant proteins or is it more animal proteins?
Maggie Ward:
You can. I mean I do a combination and it really depends I think on each person and what diet they feel comfortable with, so we fine tune it. But whatever amount of protein I’m recommending I find a way to get them up to that based off what they feel they do best with.
Dr. Mark Hyman:
[inaudible 00:37:55], you know whey protein has been traditionally recommended to help boost glutathione and these detoxification pathways, but people often don’t tolerate it, but I found there’s a goat whey protein which some patients do a lot better with. So you can kind of pack the system a little bit.
Maggie Ward:
Right, right. And yeah, I mean whey as you know has so much research on it behind not just detox support, but athletic performance, cachexia that you see a lot in when you get that wasting of the muscle and things like cancer. So I do recommend it and often around those workouts, again getting enough protein after you exercise to support repair and muscle growth. So yes, whey can be an excellent source of these proteins.
Maggie Ward:
So we really dialed in there and focused on the detox support. The thing that I found the most interesting and really helped me fine tune her diet was that she had at least two genetic markers that indicated she had a harder time metabolizing fat. So breaking down her fat stores, expending energy from that, and just not doing as well with fat and…
Dr. Mark Hyman:
So eating fat or her own fat tissue?
Maggie Ward:
Both. Both. She had more fat receptors on that when she eats fat she’s going to be more likely to store it. And that I found really helpful because typically we’re really watching those carbs and I think still for her it was important, but that’s why I kind of tweaked her diet. I brought that fat down a little bit and brought the protein up a little bit more. So we just adjusted those macro nutrients and I really wouldn’t have had that insight without this genetic testing.
Dr. Mark Hyman:
What happened when you customized that for her? Did you see a better result?
Maggie Ward:
She started doing better. She started doing better. And I think too it was also she was nourishing herself. She was getting enough calories. We were focusing on detox and we were also focusing on stress reduction. She had that alcohol and the smoking as her outlet which now she knew from a genetic standpoint she really doesn’t do well with that. So it gave her that extra motivation to let those things go and find other outlets around her stress. And that’s what I find too, there’s certain genetic markers that come back so often for people that indicate they’re not doing well with their stress. They have a bigger impact from their stress hormones like cortisol and adrenaline. And like you were just saying that stress also brings up your blood sugar, it impacts those fat cells. So we really focused in on, okay you have this job, but what are some more healthy outlets to help minimize that impact of stress on your body that’s more helpful for you. And I think she just seeing and explaining that it just gives so much more information about themselves and motivation to make a change.
Dr. Mark Hyman:
And the genetic testing is interesting because this is not a genetic testing that’s say well, you have down syndrome or you have some hard fix genetic disorder. These are traits that can get expressed and can be changed by your lifestyle or by various supplements or other interventions. So these help us as functional medicine practitioners to personalize our approach.
Dr. Mark Hyman:
For example, I have a gene that makes it difficult for me to methylate which means I can’t convert the folate that I might get from food into the active form so I need an extra special kind of folate. Or I also have the gene that prevents me from detoxifying. So I’m always eating every day at least a cup or two of cruciferous vegetables. And I also take Acetylcysteine because I know my genetics and I can personalize this approach.
Dr. Mark Hyman:
And I think this is what we do at the UltraWellness Center and these are simple tests, they just use a little cotton cheek swab and put the thing in the test tube and send it and it’s really simple and its so effective in helping people understand where their… I call them pot holes. Where are the things where you might have a predisposition to a problem, and then how do you customize it both in terms of dietary customization, but also what supplements you may need, what things you really want to be aware of in terms of diet and other lifestyle factors.
Dr. Mark Hyman:
So I think it’s such a powerful tool for us in functional medicine. We don’t test very gene, we test the most common things that we can do something about, that have an impact that can be modified through lifestyle. Whether it’s the type of exercise you do, the type of diet you’re eating, whether the supplements you’re taking, whether maybe you should be more aware that you want to avoid for example, certain types of chemical or pesticides. You’re not good at detoxifying. Or charcoal broil [cell 00:42:18], if you have a certain lack of an enzyme or a week enzyme then you should probably be charcoal grilling your vegetables even. Forget the meat. And I think this is something we can determine from these tests and it really helps us personalize the treatments.
Maggie Ward:
Right, right. And that’s what we say, your genetics is in your destiny you can alter how that gets expressed and you always use that expression, food has information. It can support certain pathways, it will turn on and off genes. That either can be helpful or be detrimental and obviously we’re supporting turning them on in a way that’s going to be helpful for us. And I think it’s…
Dr. Mark Hyman:
I mean the genes load the gun and the environment pulls the trigger, right?
Maggie Ward:
Right, right.
Dr. Mark Hyman:
So that’s something we can modify.
Maggie Ward:
And I think it’s empowering. A lot of people get worried about I don’t want to know my genetics, but they’re thinking about some of these high penetrance genes like you were saying that you can’t always alter that much, but these you can. You can do things to lower your stress, you can do things to support detoxification, you can take supplements around methylation which we do so much. And actually that’s one of the things I added in for her was more methylation support given some of her genetics. So it just I think was very empowering to make some of these changes. And I think it validated a lot of what she’s dealt with over the years. Not that it’s just that she’s not exercising enough or that she’s eating wrong, she had these things that she wouldn’t have known about otherwise and needed to eat in a way and actually exercise in a way then she had been doing. So I tweaked her exercise and kept some of that high intensity in there, but doing more yoga and stretching and recovery and hiking. Things that were less stressful on her body in general, but also it helped with recovery and stuff too.
Dr. Mark Hyman:
That’s so great.
Maggie Ward:
Because there was some variations saying she was a little high risk for some injuries too, so…
Dr. Mark Hyman:
So Maggie, you’re in the nutrition…
Maggie Ward:
We fine tuned her exercise.
Dr. Mark Hyman:
Yeah, I mean Maggie you’re the nutritionist [inaudible 00:44:07] such a great job at the UltraWellness center and now maybe you could just spend a minute sharing the kinds of services that we offer that could help people customize their nutrition and deal with many chronic health issues, not just weight, but all kinds of issues. That actually is the first step even before you might need an actual medical consult.
Maggie Ward:
Absolutely. And a lot of people when they contact us initially the people up front will help try to determine have you worked with a nutritionist, what are you dealing with? Maybe that’s the best place to start. And we’ve aways been able to do more phone, remote consults. So that’s also helpful for people, especially in this day in age of COVID-19. So we offer just initial consults just with nutrition and doing a lot of the stuff we just talked about. You don’t have to do testing, but again if you’re able to and want to really get a little more information we offer different nutritional testing, genetic testing, food sensitivity testing. So really depending on the person and what they want.
Dr. Mark Hyman:
Because there’s a lot of things you can do without even having to actually see the doctor that allows you to personalize and customize your nutrition.
Maggie Ward:
Right. Absolutely. And then if we get to a certain place and there’s still things going on that’s when I’ll say it’s probably good to connect with an integrative or functional doctor and give them some direction around that. And I also guide them, again we were talking about doing the sleep study to look at that possible sleep apnea and also say talk to your doctor about getting some of these other tests and many doctors are willing to work with their patients if they request these things. So we try to partner too with their physicians, so we do that. We’re actually with everything going on and having to work more remotely we’re putting together different packages now for people to do nutrition that incorporates more than one consult and also some testing. So it kind of is a bundle deal and trying to make it as affordable as we can for people with everything going on right now, so that’s coming out.
Dr. Mark Hyman:
So should people go to the UltraWellness Center website? UltraWellnessCenter.com, there’s a get started tab then they can learn about all these different approaches?
Maggie Ward:
We are in the midst of doing that, so that should be up and running very soon. I just with Lisa, one of our other nutritionists we just wrote a blog about nutritional genomics so check that out. That should be up very shortly. So yeah…
Dr. Mark Hyman:
And then we’ll post it on the show notes, we’ll post the links of how to actually access the UltraWellness Center and all the various nutrition consults and services we have in the show notes that are accompanying the podcast.
Maggie Ward:
Great. Yeah, so and we’re adjusting that website with everything that we’ve been dealing with, with COVID-19. So a lot of updates. So definitely check that out. And you can always call the office, they will walk you through the different things that we have available and try to connect you with the service that they think will be best for you.
Dr. Mark Hyman:
Well thank you. And thank you Maggie for being so great and sticking with me for 12 years.
Maggie Ward:
You’re welcome. It’s been an honor.
Dr. Mark Hyman:
We’re going to be keep working together a long time I think, you’re just the best. And the nutritionists we have are just world class and they have a unique perspective because they work among the leading functional medicine doctors in the world and learn so much from them and there’s a collaboration. We learn so much from you. And we work together with our patients in a very unique way, so I’m so really thrilled that you joined us on The Doctors Farmacy in this special episode of House Call. If you love this podcast please share it with your friends and family on social media, leave a comment we’d love to hear from you. Subscribe wherever you get your podcasts and we’ll see you next time on The Doctors Farmacy.
Maggie Ward:
Thanks Mark, stay safe.
