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Episode 8
The Doctor's Farmacy: House Call

Is Anxiety All in Your Head, Or Is It In Your Body? with Dr. George Papanicolaou

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

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

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

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The body and brain are one interconnected system, which means you can’t treat anxiety effectively by using only drugs or psychotherapy. You need to treat the body, because the body and brain are one interconnected system. Unfortunately, conventional medicine plays the name and blame game. It says, you are “anxious;” you need an “anti-anxiety” medication. But saying you are anxious explains nothing about why you have anxiety. Functional Medicine takes a different approach. By taking a detailed history and personalized approach, it seeks to get to the root of the issue.

In this episode, Dr. Hyman sits down with his colleague, Dr. George Papanicolaou, to discuss how they treat patients suffering with anxiety.

George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital. He is also an Institute for Functional Medicine Practitioner. Upon graduation from his residency he joined the Indian Health Service. He worked on the Navajo reservation for 4 years at the Chinle Comprehensive Medical Facility where he served as the Outpatient Department Coordinator. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He practiced with a philosophy centered on personal relationships and treating the whole person, not just not the disease. He called that philosophy “Whole Life Wellness”. Over time as the healthcare system made it harder for patients to receive this kind of personal care Dr. Papanicolaou decided a change was needed. He began training in Functional Medicine through the Institute of Functional Medicine. In 2015, he established Cornerstone Personal Health – a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou to join The UltraWellness Center in 2017.

In this conversation, Dr. Hyman and Dr. Papanicolaou discuss:

  • The conventional medicine vs Functional Medicine approach to treating anxiety
  • Why making yourself more psychologically resilient makes you more physically resilient
  • How Dr. Papanicolaou treated a patient with panic attacks, difficulty focusing, and bloating
  • DNA testing to determine how your genes might be influencing anxiety
  • How gut issues, including SIBO, IBS, and gluten sensitivity, can lead to anxiety
  • Urine peptide testing
  • How Dr. Papanicolaou treated a patient with, anxiety, brain fog, hair loss, and fatigue
  • How anxiety can be related to hormones and autoimmune issues

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

Guest

 
Mark Hyman, MD

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

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

 
Dr. George Papanicolaou

Dr. Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital, Abington, Pennsylvania. He is also an Institute for Functional Medicine Certified Practitioner. Dr. Papnicolaou established his own practice: Cornerstone Personal Health dedicated to the Functional Medicine Model. Dr. Hyman invited him to bring his expertise and twenty years of experience to the UltraWellness team. He specializes in treating the root causes of many conditions including Neurodegenerative disorders, ADHD, PANDAS/PANS, gut and hormone health.

Show Notes

  1. “Dr. George Papanicolaou | Medical Specializations”
  2. “The Wrong Gut Bugs Can Make You Fat and Sick (and How to Fix Them)”
  3. “How Functional Nutrition Can Help You Heal”
  4. “Stimulating the Vagus Nerve”
  5. “Top 5 Lifestyle Changes to Combat Anxiety and Depression”
  6. “Magical Magnesium”
  7. “How to Naturally Support a Child with Anxiety”
  8. “The Simple Way to Defeat Depression, Overcome Anxiety, and Sharpen Your Mind”
  9. “Overcoming Postpartum Depression”
  10. “The Myth of Diagnosis”
  11. “10 Steps to Reverse Autoimmune Disease”
  12. “10 Strategies to Eliminate IBS and Create Good Gut Health”
  13. “How Do I Naturally Balance Female Sex Hormoness?”

Transcript

George Papaniclolaou:
We do know that the bacteria in our gut makes serotonin for us. So one of the things we want to think of when we’re looking at people with anxiety is let’s look at their gut.

Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy in this special episode of House Call and today we’re talking about anxiety. If you have anxiety and you suffer from anxiety, it may not be what you think it is. We often think it’s in our head, but turns out it may be somewhere else. And today that’s what we’re going to dig into with Doctor George Papaniclolaou, one of my colleagues here at the Ultra Wellness Center. Extraordinary physician who is doing such great work here and taking care of patients in such a way that we are just seeing extraordinary results. So welcome, George.

George Papaniclolaou:
Mark, it’s a pleasure to see you in the flesh. Particularly during these times.

Dr. Mark Hyman:
Six feet away.

George Papaniclolaou:
We are six feet away and everybody is wearing masks besides us. So we’re good.

Dr. Mark Hyman:
Yeah. So I’m so excited to talk about this topic because years ago I wrote a book called The UltraMinds Solution, which is how to fix your broken brain by healing your body first. And what I discovered through my years of functional medicine practice was that when I was treating my patients for their physical problems; their digestive issues, their hormonal imbalances, their food sensitivities, whatever it was, nutritional deficiencies, that they would report back to me, “God, my anxieties gone.” “My depression’s gone.”

George Papaniclolaou:
Right.

Dr. Mark Hyman:
“My ADD is so much better.” “My OCD is better.” “My Bipolar symptoms are better.” “My memory’s better.” And I’m like, “Well, what’s going on here?” And I began to really think about it and realize that we talk about the mind/body effect, which is sort of an incorrect way of thinking about it. And it made me talk about the body/mind effect, which is how the body affects the brain.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
But neither of those really explain what’s going on. It’s really a system. Your body is a system. The body affects the brain. The brain affects the body and it’s this complete synergistic system and if you don’t think about it realistically you’re actually going to treat people by dealing with the downstream symptoms and not the upstream causes.

George Papaniclolaou:
Absolutely.

Dr. Mark Hyman:
So I began to really learn about how these physical issues can explain psychological symptoms and how we often attribute psychological or emotional problems to symptoms that are really physical. And then when you treat the physical cause, all these problems go away. That doesn’t mean we don’t all have psychological issues.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
But it’s a lot easier to deal with them once you’ve cleared up all the garbage that’s actually causing these symptoms.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
Just an example everybody knows. If you are tired and you haven’t slept you can’t focus as well, you feel depressed, you’re more irritable.

George Papaniclolaou:
Have sex-

Dr. Mark Hyman:
I mean is that because you’re depressed or you have dementia? No. It’s because you didn’t sleep. Right? And that’s an easy example, but there’s so much more that we know about actually how the body affects the brain. And we’re going to dig into that today with Doctor George particularly about anxiety. And so traditionally in medicine, when you have anxiety what’s the general approach that we have?

George Papaniclolaou:
The general approach is you’ve got five minutes to see your patient. They tell you anxiety and great. You’re on an SSRI or some other anxiolytic.

Dr. Mark Hyman:
What’s that?

George Papaniclolaou:
An SSRI is a serotonin specific reuptake inhibitor and all it does-

Dr. Mark Hyman:
It’s an antidepressant. Prozac.

George Papaniclolaou:
It’s an antidepressant. It’s Prozac. It’s Lexapro. It’s citalopram. It’s all those things that everybody out there is taking.

Dr. Mark Hyman:
All the -am’s.

George Papaniclolaou:
Yep. It’s the -am’s. Basically all they do is they allow the serotonin that’s in your brain to do its work longer, but it doesn’t account for why isn’t there enough serotonin in the brain to begin with?

Dr. Mark Hyman:
Great question. That’s the difference between regular medicine and functional medicine.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
Instead of us going, “Oh. The cause is not enough serotonin. Let’s get the serotonin up.”

George Papaniclolaou:
Right.

Dr. Mark Hyman:
No. The cause isn’t there is not enough serotonin. The cause is something else that’s causing the serotonin not to be okay. So what’s causing the low serotonin?

George Papaniclolaou:
Right. Right. So that can be any number of things, but the first thing you need to do is ask the question. Why? Why isn’t the serotonin elevated? So we do know that the bacteria in our gut make serotonin for us. So one of the things we want to think of when we’re looking at people with anxiety is, “Let’s look at their gut.” And we always talk about the gut/brain connection.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
And that’s a very tight connection. So the difference between functional medicine and the conventional approach to anxiety is that we are going to say … And I know I do this and have been doing this for years. Anxiety is just a symptom of other problems. In the cases that we’re going to go over, anxiety was a part of their presentation, but it allowed me to get into their history and figure out what was causing it. And in both these next cases we’re going to see that there are multiple things causing it. It’s never one thing.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
So that’s the difference.

Dr. Mark Hyman:
So you mean it’s not just a Prozac deficiency?

George Papaniclolaou:
It’s not a Prozac deficiency, Mark. It is not. It’s usually a deficiency or it is an addition of a toxin into the system that can either be a relationship, or it can be a xenoestrogen, or it can be [inaudible 00:05:30] mercury, or it can be bacteria, but it’s never just anxiety.

Dr. Mark Hyman:
Right.

George Papaniclolaou:
And it’s never just one thing.

Dr. Mark Hyman:
Right. Right. So that’s the other thing.

George Papaniclolaou:
It’s a number of thing.

Dr. Mark Hyman:
We often sort of are reductionist in our approach.

George Papaniclolaou:
Oh yeah.

Dr. Mark Hyman:
In traditional medicine we go, “Well, you have anxiety. That’s what’s causing you to feel anxious.” No that’s just the name of what your symptoms are. The causes are multiple. Right?

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
I mean maybe it’s one thing. Maybe it’s just you got too much lead in your system, but it’s often many, many different things that are all reflecting that imbalance in your system. And that’s the difference between functional medicine and traditional care, is functional medicine says, “How do we restore balance in this system?”

George Papaniclolaou:
Right.

Dr. Mark Hyman:
How do we take out the things that are causing imbalance and how do we add the things that are going to restore balance?

George Papaniclolaou:
Right.

Dr. Mark Hyman:
And that’s the difference. And we use a very in depth set of tools both through a detailed history and ask a lot of questions that normally don’t get asked. Like were you breast fed?

George Papaniclolaou:
Right. Right. It’s a timeline.

Dr. Mark Hyman:
Do you eat too much tuna fish?

George Papaniclolaou:
Right. It’s a timeline. Yeah.

Dr. Mark Hyman:
And these are the questions we ask that are different. And then we do diagnostic tests in functional medicine that are helping us to reveal causes. Not just sort of do you have some terrible disease? What we want to know … Like most of the tests, you go to your doctor. They go, “All your tests are fine. You must be fine.” Well, the tests that your doctor does typically are only abnormal if you’re really sick. Like for hospitalized patients you’ll see a normal electrolyte, or a normal kidney function, or a normal liver. Like unless you’re really sick, these tests are pretty normal.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
So we look at a different set.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
Pull the veil back. I mean there are thousands and thousands of metabolites in your blood. And to think that you know what’s going on by looking at 30 or 40 on a typical blood test is a joke.

George Papaniclolaou:
Right. And in fact, Mark we don’t … Most doctors won’t even get a blood test for anxiety. They don’t see it as anything other than a psychological event.

Dr. Mark Hyman:
Right.

George Papaniclolaou:
Or and a biochemical event, it’s reductionist.

Dr. Mark Hyman:
Right.

George Papaniclolaou:
It’s no serotonin in the brain, serotonin reuptake inhibitor works for you. Great. And that’s it.

Dr. Mark Hyman:
Or Valium.

George Papaniclolaou:
And we do know by now that they don’t work. That they’re very ineffective and you really don’t get to the root cause of the problem. I mean people suffer through anxiety. They go from one anti-depressant or anxiolytic to another, never getting to the root cause until they come to us.

Dr. Mark Hyman:
Sometimes they do help with symptoms. They do.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
And they can be life saving, but you got to go deeper.

George Papaniclolaou:
Absolutely.

Dr. Mark Hyman:
And at the Ultra Wellness Center here in Lenox we go deeper. I mean now we’re doing all virtual consults, which is great. So if you’re a new patient, you want to come and see us, you don’t have to schlep all the way to Lenox. We can do it all virtually and you can get the tests you need. And we work with a great team. We have doctors, nutritionists-

George Papaniclolaou:
It’s really been interesting and amazing. It’s almost like you have more focus and more of the attention of the patient. There’s a whole different dynamic that occurs that has its own benefit when you do it by Zoom.

Dr. Mark Hyman:
Yeah. We do Zoom. Right. Yeah.

George Papaniclolaou:
And I’ve asked my patients afterwards, “How was this for you?” And not one person has complained. They’ve always said, “I felt connected to you Doctor Papaniclolaou. I got what I was looking for.” So it’s been really a positive experience all around.

Dr. Mark Hyman:
It’s true. I did my first five patients last week doing Zoom. And it was like, “Wow. This is awesome.”

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
It’s great.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
And I think it’s not the same as being in person, but it was really quite good.

George Papaniclolaou:
Yeah. Yeah.

Dr. Mark Hyman:
So I feel like we really have the ability to take care of patients and particularly now more than ever, people are feeling anxiety. People are feeling worried and there are real things. Right?

George Papaniclolaou:
Right.

Dr. Mark Hyman:
You lose your job. Your economic resilience is threatened by what’s happening in the economy. Your fear of getting sick and your health issues. I mean so these are real psychologically hard times.

George Papaniclolaou:
Oh yeah.

Dr. Mark Hyman:
But you can become more psychologically resilient by making yourself more physically resilient.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
So you become less victim to the waves of emotional stress that we’re having and learn how to sort of manage it. And I think I’m feeling it, you’re feeling it, we’re all feeling it. I have to work every day to regulate that and I do it by taking care of the physical things. If I don’t workout, if I don’t get outside, if I don’t sleep enough, if I don’t eat okay like I don’t feel as good.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
And I’m actually more susceptible to the emotional imbalances that occur because of the reality of what’s happening in the world right now. And I think this is a perfect time for people to start to focus in on their own health because not only will it make it less likely that they get COVID-19, but they actually can really deal with issues that have been going on for a long time. And they have the time and you can actually deal with the lifestyle issues much easier. Not traveling. I mean for me, I’m traveling more. Get in the car.

George Papaniclolaou:
I agree. I agree. It’s been a renewal for me and a lot of my friends. We’ve talked about it. It’s the opportunity. I think a lot of people, deep down, is sort of happy that the world has slowed down a little bit.

Dr. Mark Hyman:
Yeah. It was so fast before.

George Papaniclolaou:
Yeah. And you’re like, “Wow. I don’t have to wake up on Saturday and do like a soccer tournament for the whole weekend. And I don’t have to be rushing off to all these practices at night. Or to this class.” And I have noticed a difference in my own kids. They are more relaxed.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
I’m home and you’d think there’d be more tension, but we’re actually getting along more. We’re playing board games. We’re playing chess again. My 24 year old is home. And it’s been very enjoyable. What has been really important though … And that’s why I chose these anxiety cases.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
Number one, I love being a sleuth. I love being a medical detective. That’s what I love functional medicine.

Dr. Mark Hyman:
That’s what functional medicine is.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
You nailed it. Right.

George Papaniclolaou:
Right. And so I get to tell you these … I have disease mysteries this morning. All right. So it starts out with anxiety, but that anxiety is that really the culprit or is there a secret, hidden person or character in this plot that’s causing the problem? Right.

Dr. Mark Hyman:
You’re like the Sherlock Holmes of medicine.

George Papaniclolaou:
And I love you. So that’s-

Dr. Mark Hyman:
So tell us about this patient. He was 32 when he came in.

George Papaniclolaou:
Yeah. So we’re going to jump to the case. We’re going to forget about what I was going to tell you about COVID-19 and getting ritual and routine. We’ll go right to the case. So, yeah. So he’s a 32 year old and he came in with his partner, his wife. His major complaint was I have panic attacks particularly at night and when I’m having panic I’m also feeling bloated and distended.

Dr. Mark Hyman:
Oh. Interesting.

George Papaniclolaou:
And that was his main reason for coming in. He has these panic attacks and then during the day, “I’m finding I’m having a harder time getting my work done. I become a really intricate part of the business that we do and a lot of responsibility has been placed on me and I’m finding it harder to get work done. I can’t concentrate. I can’t focus and I’m getting anxious.”

Dr. Mark Hyman:
Wow.

George Papaniclolaou:
Okay. That’s the fundamental story. I want to know where it all started. So we do the timeline. We go backwards. Oh. It turns out with this young man who’s 32, that his problems started a long time ago. He had a really bad diet growing up. Sugar tooth, sad, standard American diet, ate a lot of sugar. Was having problems in school early on. Developed school phobia and then anxiety that was so debilitating he had to stop his first year of high school.

Dr. Mark Hyman:
Wow.

George Papaniclolaou:
I mean, no. His senior year of high school. So then he went to college where he had a little bit more control. Oh. And he found some friends who had Adderall and he tried Adderall.

Dr. Mark Hyman:
Oh.

George Papaniclolaou:
And bingo.

Dr. Mark Hyman:
That’ll help.

George Papaniclolaou:
And bingo. He was-

Dr. Mark Hyman:
We used to call it speed in college.

George Papaniclolaou:
So he actually did well through college, but after college he had successful years until one year they went traveling and he developed a really bad gastrointestinal infection and shortly after that he started gaining lots of weight. And that’s when the anxiety, and the panic, and everything started to multiply until they came to the office.

Dr. Mark Hyman:
So as a traditional psychiatrist, you go there. You say, “I have anxiety. I have panic attacks.” They’re not like, “Well, did you have travelers diarrhea? Did you get bloating and was it connected to your gut? Let’s look at your poop. Maybe that’s where the answer is.”

George Papaniclolaou:
Right. So there’s this thing that I call pattern recognition. The reason why I go back to get all these clues is because all of those clues together start to create a puzzle, or almost a Rorschach, and I have to then have a pattern recognition and say, “Oh. This is starting” … because of the experiences I have with people, I begin to see these patterns. And I can start to see that you know what? Yeah. There’s something going on in this guy’s gut.

Dr. Mark Hyman:
Yes.

George Papaniclolaou:
And there’s some sleep issue going on here.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
It’s not just anxiety. It’s not just, “I can’t sleep.” There’s something else going on. So in his particular case I understood the pattern of ADHD and I saw that as an early issue for him. And that also clues me into, “Where am I going to look? Where does that come from?”

Dr. Mark Hyman:
Because again ADD is a symptom.

George Papaniclolaou:
Yeah. It’s a symptom and there are a lot of culprits. There are a lot of things and facets to ADHD that come into play and one of the things I thought about with him is what is his DNA going to tell me? What is his DNA going to tell me about his brain that predisposes him to ADHD, panic, and anxiety? So I knew that, okay. I’m going to do some tests [crosstalk 00:14:44]-

Dr. Mark Hyman:
Wait. Wait. Wait. Wait. So you’re saying that your DNA controls your mood, anxiety, and your-

George Papaniclolaou:
It can.

Dr. Mark Hyman:
Hey everybody. It’s Doctor Hyman. Thanks for tuning into the Doctors Farmacy. I hope you’re loving this podcast. It’s one of my favorite things to do. And introduce to you all the experts that I know and I love and that I’ve learned so much from, and I wanted to tell you about something else I’m doing which is called Mark’s Picks. It’s my weekly newsletter and in it I share my favorite stuff from foods, to supplements, to gadgets, to tools to enhance your health. It’s all the cool stuff that I use and that my team uses to optimize and enhance our health. And I’d love you to sign up for the weekly newsletter. I’ll only send it to you once a week on Friday’s, nothing else I promise. And all you do is go to doctorhyman.com/picks to sign up.

Dr. Mark Hyman:
That’s doctorhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I’ll share with you my favorite stuff that I use to enhance my health and get healthier, and better, and live younger longer. Now back to this weeks episode.

George Papaniclolaou:
Your DNA predisposes you to different conditions and states of being.

Dr. Mark Hyman:
So we actually, at the Ultra Wellness Center, do a swab, a cheek swab, where you just take a little basically Q-tip and rub it against your cheek, stick it in a vial, send it to the lab. And it’s called DNA Mind.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
So tell us about what is this DNA Mind and what did his show?

George Papaniclolaou:
So the DNA Mind is going to actually look at genes, the blueprints that your body uses to make amino acids and proteins that are going to be the basis for communication in your brain. They can determine mood, they can determine cognition, they can determine memory and-

Dr. Mark Hyman:
So you can tell if you’re more likely to be anxious, or more likely to be depressed, or more likely to be an addict, or yeah.

George Papaniclolaou:
Exactly. So DNA Mind will look at the area. They’ll look at the genes in multiple different areas that can impact neurodegeneration, your mood, and your addictive qualities.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
And so we look at very specific genes that are well researched and we understand that if they do have variations, what those variations will mean and then it inform-

Dr. Mark Hyman:
What we can do about it.

George Papaniclolaou:
And then it informs we what I can do about it.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
Those genes are actionable.

Dr. Mark Hyman:
Right.

George Papaniclolaou:
You get a 23 and Me, you get 5,000 genes.

Dr. Mark Hyman:
Yeah. Yeah.

George Papaniclolaou:
You don’t know what 4,999 of them do.

Dr. Mark Hyman:
Right. Right.

George Papaniclolaou:
DNA Health only tests actionable genes in critical areas.

Dr. Mark Hyman:
Okay. So this is really an important point because people are talking about DNA and personalized medicine and most of it’s noise. Right? So we actually have genes that are common in the population that have clinical impact, that we know a lot about, and how to modify the expression of those genes and change what’s going on so that you have a positive clinical outcome as opposed to just checking your 20,000 genes and I don’t know what half of them mean or 99% of them mean like you said. I mean there’s one in particular that is very common when people have anxiety. And what is it?

George Papaniclolaou:
MTHA4.

Dr. Mark Hyman:
And there’s also another.

George Papaniclolaou:
And COMT.

Dr. Mark Hyman:
COMT. Catechol-O-methyltransferase. And that’s a big mouthful, but essentially that gene-

George Papaniclolaou:
He’s really good.

Dr. Mark Hyman:
That gene is involved in metabolizing the stress hormones, adrenaline.

George Papaniclolaou:
Yeah. The catechol-

Dr. Mark Hyman:
The catecholamines. Right.

George Papaniclolaou:
Stress hormones.

Dr. Mark Hyman:
So the adrenaline, noradrenaline, epinephrine.

George Papaniclolaou:
Dopamine. Dopamine.

Dr. Mark Hyman:
Dopamine.

George Papaniclolaou:
Yep.

Dr. Mark Hyman:
And if those can’t be properly processed by the body you get a build up.

George Papaniclolaou:
Mm-hmm (affirmative).

Dr. Mark Hyman:
Of these stress hormones.

George Papaniclolaou:
This is a great point.

Dr. Mark Hyman:
So you feel really like anxious.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
And I mean even one of my staff members have this gene and she was giving me an IV the other day and she was like so nervous.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
And I said, “You must have that gene.” And she was like, “I do.”

George Papaniclolaou:
She does.

Dr. Mark Hyman:
And I’m like, “But then you can fix it, right?” How do you fix it?

George Papaniclolaou:
Right. Oh. How do you fix it? Oh. Okay. So-

Dr. Mark Hyman:
It’s one thing to know you have it.

George Papaniclolaou:
Yeah. So let’s go back to him because this is a perfect segue and then let me tell you how I fixed it with him. So what was really interesting is that I, with that pattern recognition at the first visit, I understood that he’s got ADHD. And the way that he described his personality, I thought he had a dopamine deficiency. So I put him on-

Dr. Mark Hyman:
And dopamine is one of the neurotransmitters that helps you focus, pay attention.

George Papaniclolaou:
And the COMT gene has an impact on that because you can either metabolize your dopamine very quickly and keep it at a low level or you don’t metabolize it at all, like the norepinephrine, and you’ll have high levels of it. So each one of those conditions has a phenotype or a way that you’re going to appear if you have that. So in his case, he sort of like was distant and didn’t feel emotion all the time. And he had a hard time with focus in general. So I thought that he had … my pattern recognition. At the first visit he left with something called L-Tyrosine. L-Tyrosine is a precursor to dopamine. And I told him-

Dr. Mark Hyman:
It’s like a building block.

George Papaniclolaou:
A building block for dopamine.

Dr. Mark Hyman:
L-Tyrosines an amino acid.

George Papaniclolaou:
Correct. Correct.

Dr. Mark Hyman:
It’s a building block for these neurotransmitters.

George Papaniclolaou:
Correct.

Dr. Mark Hyman:
Which is actually protein.

George Papaniclolaou:
Exactly. So interestingly enough, when he comes back for his six week follow up to go over all his labs, one of the things he wrote in his medical update to me was that, “I’m not depressed but I’m like feeling things I’ve never felt before and I’m a lot more tearful and a lot more emotional and I’m a lot more engaged emotionally with people.” Well, why? Because he’s getting dopamine in his brain that he hasn’t had for a long time. And now that dopamines allowing him to experience and feel emotion that he didn’t have before and he’s able to concentrate better.

Dr. Mark Hyman:
See. This is a perfect example of functional medicine because it talks about how we personalize based on genes, based on a persons lifestyle, and based on their levels of their labs. I mean we really create a customized approach for each person to target in like a medical detective on the things that make the most difference.

George Papaniclolaou:
Yeah. Yeah.

Dr. Mark Hyman:
And you just gave him a simple amino acid but it’s like wow. How simple was that? But it was knowing that you needed to do that, that was the key.

George Papaniclolaou:
Yeah. And here’s the cool thing. When I looked at his DNA to go over those results with him, he had the COMT defect that over processed his acids that made dopamine and norepinephrine. So it matched up.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
So his genes matched up with his clinical picture.

Dr. Mark Hyman:
Matched up with his clinical picture.

George Papaniclolaou:
And he responded appropriately to the dopamine precursor. So I thought that was fascinating.

Dr. Mark Hyman:
But I thought there were other things going on in his gut that you mentioned that were relevant. So how does his gut play a role in his brain health?

George Papaniclolaou:
Okay. So this is always the favorite area. So he had what we call small intestinal bacterial overgrowth. That’s when bacteria that should not be living in the small intestine is there and it can cause bloating and distension and that’s what he was having. That’s what was waking him up in the middle of the night.

Dr. Mark Hyman:
And you got a food baby.

George Papaniclolaou:
You have a food baby. He was eating foods that were fermenting in his small intestine and they would cause that gas that would really cause him discomfort and wake him up in the middle of the night [crosstalk 00:21:47]-

Dr. Mark Hyman:
So like when you got apple cider and like the bugs grow in there and it creates like the thing. Like you open it up and it like explodes, right?

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
So like that.

George Papaniclolaou:
Absolutely. And so he was also gluten sensitive. So we do a test to look for gluten sensitivity. So now you have-

Dr. Mark Hyman:
And that can also cause anxiety and depression.

George Papaniclolaou:
Exactly. So now you have gluten and you have overgrowth of bacteria. The two of those can disrupt the epithelial barrier membrane in the intestine. Basically your intestine is a hollow tube and then the first layer is a layer of cells. That’s that barrier.

Dr. Mark Hyman:
It’s only one cell thick.

George Papaniclolaou:
It’s one cell thick.

Dr. Mark Hyman:
Like one cell between you and a sewer basically.

George Papaniclolaou:
Right. Basically it. And it’s very tightly controlled. So the cells can separate and close. Separate and close to let things in and keep things out. So in his particular case, he has two things going against him. He has gluten sensitivity which is going to lead to leaky gut. He has bacterial overgrowth that’s going to lead to leaky gut.

Dr. Mark Hyman:
And creates inflammation.

George Papaniclolaou:
You have leaky gut, you have leaky brain. So you have two things possibly going on with him. The leaky brain causes general neuroinflammation and then the overgrowth-

Dr. Mark Hyman:
So wait. Wait. Wait.

George Papaniclolaou:
I’m sorry. Yeah.

Dr. Mark Hyman:
What you’re saying is that when you had bad bugs growing in your gut and you’re getting gluten, it inflames your brain?

George Papaniclolaou:
Yep. It does.

Dr. Mark Hyman:
Wow. Okay.

George Papaniclolaou:
Yeah. It inflames your brain because what happens is, is that you can have an autoimmune response that can be triggered against neural tissue from the gluten and also from the inflammation you cause in the gut. That inflammatory response can be generalized and affect the brain.

Dr. Mark Hyman:
I mean a lot of people call SIBO, irritable bowel syndrome, right?

George Papaniclolaou:
Right.

Dr. Mark Hyman:
Now we have a better name for figuring out what it’s caused by. And not all irritable bowel is SIBO, but what we found was that when I was in training. And I’m sure it was like this for you George.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
We were taught that people with irritable bowel syndrome were psychologically impaired. That they were anxious. And that’s what was causing their gut issues.

George Papaniclolaou:
I’m embarrassed to say that-

Dr. Mark Hyman:
And we had this pejorative called the functional bowel disease which wasn’t like functional medicine. It was just like meaning it’s like we had this sort of secret code where we call it supratentorial, which means it’s in your head. Right?

George Papaniclolaou:
Right.

Dr. Mark Hyman:
And so it was kind of a medical inside joke and it was very judgemental and pejorative.

George Papaniclolaou:
It was. It was.

Dr. Mark Hyman:
And what we found was that actually it’s the opposite. And this was published in the New England Journal years ago where they looked at people with irritable bowel. And what it does, it triggers inflammation, irritation in the gut and because there’s a gut/brain connection and there’s a huge nervous system that connects your gut to your brain, that it feeds back to the brain and creates an irritable brain. So it’s not the irritable brain that’s causing the irritable bowel. It’s the irritable bowel that’s causing the irritable brain.

George Papaniclolaou:
Exactly.

Dr. Mark Hyman:
That’s a very different frame of thinking about it.

George Papaniclolaou:
And also-

Dr. Mark Hyman:
And that means you can fix it by fixing the gut which is what you did with this guy.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
So tell us about that.

George Papaniclolaou:
So we fixed his gut. And the other connection there too, Mark is when you have an imbalance of bacteria, remember up to 70% of your serotonin can be made in the brain. And serotonin does have a big impact on your mood. So he had multiple things going against him all stemming from the gut. And so basically with the gut, we … And I don’t want to get too much into the treatment for what we did for him, but we do-

Dr. Mark Hyman:
We’re not. Tell us about what you did.

George Papaniclolaou:
So-

Dr. Mark Hyman:
So how do you treat the gut like that that fixed the brain?

George Papaniclolaou:
So the first thing you do, you alter diet. So you put patients on, what we call, a low Low-FODMAP diet. And these are foods that are easily fermentable. So we take them off these foods and we put them on foods that are going to be easier for them to digest, not ferment.

Dr. Mark Hyman:
So you’re not basically feeding the bad bugs their favorite food which is starch and sugar.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
Processed foods. And so we do that. And then we also give them some probiotics. And you have to be careful with probiotics because they are a bacteria and you are treating a bacterial overgrowth. So I’m very careful about-

Dr. Mark Hyman:
Except they want to kill the bad guys first, right?

George Papaniclolaou:
Yeah. You want to kill the bad guys first, but we do know that sometimes, some people with SIBO respond well to probiotics, but you have to be careful which ones you use. I’ll tend to use spore based antibiotics.

Dr. Mark Hyman:
Because then they tend to fight in there.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
You get a problem.

George Papaniclolaou:
Yeah. So it’s a careful balance, but it’s basically change the diet. Then we give them some nutrients like glutamine that will help heal that barrier lining. And then we use antibiotics to get rid of the bacteria. And those antibiotics can be herbal protocols. Sometimes I will use pharmaceutical grade depending on what organisms, what gases are being produced by what organisms.

Dr. Mark Hyman:
Yeah. So we actually look at breath testing to see what’s growing. Is it hydrogen? Is it methane? And then we can customize our herbal treatments or even our prescription drugs which can clear out the bad guys. So we got to do this, what we call, weeding, feeding, and seeding the program. Which is we basically get rid of the bad guys, we seed it with the good guys, and we feed the gut to get it healthy. We call it the Five R program.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
And it’s something we do really well here at the Ultra Wellness Center and it’s amazing how many things it can fix. So in this case, the patient had more psychological issues. ADD and-

George Papaniclolaou:
And the bloating.

Dr. Mark Hyman:
Anxiety.

George Papaniclolaou:
The SIBO was driving part of the anxiety. It was sort of like, again, you have this genetic predisposition, you’re under lots of stress which is one driver, you’ve developed SIBO. And stress can be one of the causes of SIBO.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
Then he also had the gluten sensitivity, caused a leaky gut. And there was another piece to this, is that he had sleep apnea.

Dr. Mark Hyman:
Yeah. Before you get to that.

George Papaniclolaou:
I’m not going to go into it.

Dr. Mark Hyman:
It’s really interesting.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
It’s really interesting. I want to talk about sleep apnea because it’s a big issue, but the gut issue is so interesting because now in medicine we are understanding for example, people take antibiotics, they get depression. That if your gut flora is off it can cause psychological symptoms, which we didn’t really know before. And I wrote this book 12 years ago. Like it was published in 2009, but I wrote it like 12 years ago. And I wrote about the discoveries I was making from a clinical perspective of what happened when I treated peoples gut around anxiety, OCD, ADD.

George Papaniclolaou:
It improves.

Dr. Mark Hyman:
Depression, it’s amazing. Right? And it doesn’t mean that that’s the cause of everybody’s anxiety. It was a cause of his anxiety. I just remembered another patient who I remember came in and he was like, “Everyday at 3:00 I get terrible panic attacks. I’m so anxious. I feel like I’m going to die. I’m sweating. I can’t breathe. My heart’s racing.” I’m like, “Oh. Well tell me about like what’s going on in your life?” And he goes, “Well, I work on Wall Street and I like work hard all day. I don’t eat much and then like at night I eat a lot and I drink a lot. Then I go to bed and I wake up and I’m not hungry. So I don’t eat again until late. And then every day I get this pain.”

Dr. Mark Hyman:
I’m like, “Maybe you’re hypoglycemic.” Right? So why don’t you eat breakfast. Don’t eat so late. Stop drinking. Like panic attacks went away.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
So that was his problem, but this guy was different.

George Papaniclolaou:
He’s different.

Dr. Mark Hyman:
Everybody’s different. Just because you say you have anxiety or panic attacks, doesn’t necessarily mean … And somebody else it may be truly from … Like I have a friend who is in war zones and has PTSD and that’s what caused his panic. So it’s very different for everybody.

George Papaniclolaou:
And it is. I chose him too because I don’t want everybody to think that your anxiety always is going to be just your SIBO. It’s never just one thing. This was a contributor to a gentleman who had a genetic predisposition, but he also had some metabolic findings as well.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
He had things that we call kryptopyrroles and he had urine peptides.

Dr. Mark Hyman:
Wow. What is that?

George Papaniclolaou:
So I got to tell you.

Dr. Mark Hyman:
Now these are not tests you get at traditional doctors.

George Papaniclolaou:
No. You do not get these at traditional doctors.

Dr. Mark Hyman:
I mean there are ways of looking at brain function through the urine that are so helpful. What are the things you’re producing? So tell us about them.

George Papaniclolaou:
Yeah. So urine peptides, when you break down your dairy products like milk, you break them down into whey and casein, but you break them down into other proteins and some even things that are smaller than proteins called peptides.

Dr. Mark Hyman:
That’s less than 100 amino acids.

George Papaniclolaou:
50.

Dr. Mark Hyman:
50?

George Papaniclolaou:
Yeah. It’s less than 50.

Dr. Mark Hyman:
I thought it was 100. Okay.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
What do I know?

George Papaniclolaou:
I mean I’m not going to argue everything.

Dr. Mark Hyman:
I don’t know. Whatever. It’s been a while since I took biochemistry.

George Papaniclolaou:
So you have these peptides. And so if you break them down into certain peptides, particularly with milk you break them down into casomorphins and these are these peptides that can cross your blood/brain barrier and then they have an opiate like effect on the brain which can affect mood, cognition, and memory.

Dr. Mark Hyman:
So it’s like you’re stoned all the time on heroine.

George Papaniclolaou:
He had really high peptides in his urine.

Dr. Mark Hyman:
Oh.

George Papaniclolaou:
He also had some-

Dr. Mark Hyman:
Now wait. Wait. Wait.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
So this is not an allergy to dairy.

George Papaniclolaou:
No.

Dr. Mark Hyman:
This is a whole different reaction.

George Papaniclolaou:
No. His body just makes this.

Dr. Mark Hyman:
It’s not a sensitivity. It’s his digestion wasn’t working and he couldn’t digest the dairy proteins. So they were partially digested. They were getting absorbed across the leaky gut. They went to his brain and had morphine like effects that change his cognition behavior and then you can see them coming out in the urine because they’re excreted in the urine.

George Papaniclolaou:
Bingo.

Dr. Mark Hyman:
So it’s really a different way of looking at this than traditional medicine.

George Papaniclolaou:
Yeah. And you’re not going to get this at conventional doctor. You’re just not. And so then I also checked him for kryptopyrroles. So what are kryptopyrroles? Well, your red blood cells break down periodically and when they break down they have iron in them and that iron has to be metabolized. Everybody does it. One of the metabolites is a krypotopyrrole. Well, kryptopyrroles are benign and they’re going to go out and in through your blood stream and into your urine and leave the body, but if you happen to be a person who breaks down too much of your iron into kryptopyrroles and you have lots of kryptopyrroles … When kryptopyrroles leave the body, they take B65 and Zinc with them.

Dr. Mark Hyman:
Mm-hmm (affirmative).

George Papaniclolaou:
B6 and zinc are really critical co-factors to neurotransmitter function in the brain. And you won’t get it on a blood test because it’s intracellular loss. And this test is what we call a functional test.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
And it tells you what’s happening that is due to the defect or the lack of B6 and the lack of zinc.

Dr. Mark Hyman:
This is really what we call nutritional psychiatry.

George Papaniclolaou:
Right. It is. And his kryptopyrroles were way off the charts. And so I can’t reverse that, but I can supplement him with B6 and zinc.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
And we find when we do, we take care of urine peptides and we take people off their dairy to avoid those and we give them their zinc and their B6 back, we add to the benefit. We fixed his gut. He take care of his urine peptides. We take care of his kryptopyrroles. And now we’re putting all these pieces together and he’s getting better.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
It’s just never one thing.

Dr. Mark Hyman:
And by the way, in order to convert tryptophan, which you get in your diet to serotonin the enzymes require vitamin B6.

George Papaniclolaou:
Yes.

Dr. Mark Hyman:
So maybe it’s not Prozac he needs, but B6. Right.

George Papaniclolaou:
Exactly.

Dr. Mark Hyman:
I think that’s really important. So this is such a great case. You had ADD that got better. You targeted him with supplements like fish oil and other neurotransmitter support. You got his gut fixed.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
You got his sleep apnea fixed. It’s so great. This is such an amazing case and I think-

George Papaniclolaou:
Mark, I just got to say one thing.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
The sleep apnea piece is like another critical piece.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
I just have to say the one thing about sleep apnea is that … What sleep apnea is, is it’s pauses in your breathing that happen intermittently and frequently when you’re sleeping. And when that happens, you have a lack of oxygen to your brain and you have disrupted sleep so that your brain can’t do important things. One of the important things that happens with sleep apnea is it impacts REM sleep the most. And REM sleep is where you’re consolidating memory. And if you’re not getting REM sleep, it’s going to make it harder for you to function the next day. Not only are you going to be fatigued, but that part of your brain responsible for memory isn’t going to be working as well.

George Papaniclolaou:
You’re going to forget your keys. You’re going to forget your tasks. You’re going to read something and forget what you just read. And that’s sleep apnea. And it’s underdiagnosed. And we think that only obstructive sleep apnea, which is one of two forms of sleep apnea, only occur in obese people, but it can occur in thin people because it’s not just the weakness of muscles in the throat that cause it, but also the upper airway.

Dr. Mark Hyman:
And your airway’s narrow anyways. Yeah.

George Papaniclolaou:
And so he had sleep apnea and he had been snoring all his life. Point being his sleep apnea-

Dr. Mark Hyman:
Maybe it’s ADD and anxiety was probably related to his sleep.

George Papaniclolaou:
You always steal my thunder, Mark.

Dr. Mark Hyman:
No it’s good. I just like reading your mind.

George Papaniclolaou:
Yeah. You read my mind. So it’s-

Dr. Mark Hyman:
I slept last night. So like I’m …

George Papaniclolaou:
It’s very possible that his snoring as a kid was driving his ADHD. Right?

Dr. Mark Hyman:
Mm-hmm (affirmative). Mm-hmm (affirmative).

George Papaniclolaou:
And has you age we have a lot of adults that are being diagnosed with ADHD. Some of them had it all their life. Some of them are developing it because of their sleep apnea. So we fixed his sleep apnea. We fixed his urine peptides. We fixed his kryptopyrroles. We fixed his gut. We got him off of gluten. We reduced inflammation in his brain and his body. Not only is he feeling better, but we just helped him to create a floor plan for the rest of his life that’s going to keep him from chronic disease and let him perform at his highest level.

Dr. Mark Hyman:
Well, that’s the other really important point you’re making is in functional medicine we don’t just keep people on forever. We give them the roadmap of how their body works on a personalized level, how to take care of it for life, and how to optimize it.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
I mean if they need a tune up we can see them periodically, but most of the time we give people the ability to fix the things that have been going wrong. We teach them how to take care of their bodies based on their own unique characteristics and then they do great. Part of the problem in functional medicine is you don’t often get longterm patients because they get better. And then like, “What happened to you? Why didn’t you ever call me?” And he’s like, “Oh. I was better.” I was like, “Oh. You were? Oh great.” It’s like I’ll find out like five years later and they’ll call me for something. I’m like, “What happened to you?”

George Papaniclolaou:
I know. That’s been hard for me because in my traditional practice of family practice I raised a generation of patients, two generations of kids and families, and I saw people over and over and over again.

Dr. Mark Hyman:
With the same problem.

George Papaniclolaou:
With the same problem giving medicine.

Dr. Mark Hyman:
You manage their disease.

George Papaniclolaou:
Managing them with their medicines and so we had a really good relationship. Right? Here people get better and then you don’t hear.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
They’re gone.

Dr. Mark Hyman:
It’s part of the problem.

George Papaniclolaou:
They’re out the door.

Dr. Mark Hyman:
Yeah. We don’t manage diseases.

George Papaniclolaou:
Right. Yeah.

Dr. Mark Hyman:
We want to get rid of them.

George Papaniclolaou:
Get rid of them.

Dr. Mark Hyman:
And that’s the beauty of functional medicine.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
Most of the time you can do this. We have a little bit of time left. I want to go through this next case. It’s so great.

George Papaniclolaou:
Okay.

Dr. Mark Hyman:
It’s another woman with anxiety, and brain fog, hair loss, and fatigue. So tell us quickly about her.

George Papaniclolaou:
Yeah. I’ll tell you quickly about her. So the key piece to her is that … Very healthy woman who had her symptoms of anxiety, fatigue, and hair loss start probably about 10 months after, I think, her last baby was born.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
And so again, I said, “So when do you think this all started?” We look for the trigger. And once we can find a trigger, “When’s the last time you felt healthy?” That’s a starting point for me to start looking for clues. It’s like playing Clue. Did it happen in the library? Did it happen in the kitchen? Did it happen in the garage? So getting that first point where she thinks her life changed, that being 10 months after pregnancy, first big clue because women can get an autoimmune thing called post partum thyroiditis which is an autoimmune process. So with hair loss and fatigue I’m thinking-

Dr. Mark Hyman:
And brain fog.

George Papaniclolaou:
And brain fog. I’m thinking there’s at least an autoimmune process going here. So I got that first clue going.

Dr. Mark Hyman:
And it turns out he had problems right?

George Papaniclolaou:
She did, but another key part was her irregular periods. So she had been having irregular periods for most of her life. And she had lots of PMS. And around those periods of time she’d have brain fog. So I started thinking about hair loss, fatigue, anxiety. She’s a 42 year old woman. I started thinking about her hormones. I started thinking about all the stress she’s under with her kids. Cortisol relationship to estrogen, relationship to thyroid. I knew there was a hormonal piece. And she had recurrent hives. Means yeah. Definitely something autoimmune is going on because we know hives can come from autoimmune processes, can come from stealth infection. We’re going to look there.

Dr. Mark Hyman:
Got it.

George Papaniclolaou:
And it can come from the gut.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
Right? Candida in the gut. Okay. Interestingly enough. Get her hormones back. She’s estrogen dominant.

Dr. Mark Hyman:
What does that mean?

George Papaniclolaou:
Estrogen dominant means that you can have normal levels of estrogen and progesterone but relative to one another, estrogen can be much higher than the progesterone. And estrogen is really good for a woman. Gives her nice thick hair, makes her skin look beautiful. It helps her maintain her vivaciousness and her energy, but when you have way too much of it and not enough progesterone then it can cause bad things. It can have an impact on your thyroid because it blocks thyroid hormones from getting to the receptors and doing their job. It can cause fat deposition and lead to insulin resistance and it’s much easier to try and lose weight. If you’re estrogen dominant, you’re going to be that patient that says, “I do everything Doctor Papaniclolaou.”

Dr. Mark Hyman:
Yeah and I can’t lose it.

George Papaniclolaou:
“I can’t lose some weight.” When I find that they have irregular periods-

Dr. Mark Hyman:
Well that’s how they make cows fat for slaughter, right? The steer, they give them estrogen.

George Papaniclolaou:
And you and I have talked about this. PMS is not normal.

Dr. Mark Hyman:
No.

George Papaniclolaou:
It’s not correct. And why?

Dr. Mark Hyman:
And it affects 75% of women.

George Papaniclolaou:
Right. And why?

Dr. Mark Hyman:
It’s not a normal condition.

George Papaniclolaou:
So why do you get it? One of the big things is xenoestrogens. So xeno means guest, or stranger, or foreigner. I like to call it stranger.

Dr. Mark Hyman:
Like xenophobia.

George Papaniclolaou:
Yeah it’s like xenophobia. Because women who have xenoestrogens have stranger danger. I call it stranger danger because now you got these strangers created a dangerous environment for you. And what’s that dangerous environment? Estrogen dominance lead to stimulation. It creates a cancer causing zone.

Dr. Mark Hyman:
Yeah.

George Papaniclolaou:
And it increases your risk for breast cancer, estrogen positive breast cancers. And so it’s really a big issue. And when you have that many women having PMS, and a lot of those women can have estrogen dominance, it’s a very important topic.

Dr. Mark Hyman:
And the symptoms are common. Like they get heavy bleeding because you have more estrogen which more blood.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
More clots.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
You get pre-menstrual migraines. You get breast tenderness and food retention. Really common symptoms for PMS.

George Papaniclolaou:
And guess what this woman had? She had endometriosis.

Dr. Mark Hyman:
Which is another symptom of … And that’s an autoimmune disease.

George Papaniclolaou:
Right. Yeah. Estrogen stimulates the breasts so you can get fibrocystic breast disease. It stimulates the uterus so you can get uterine fibroids which is a build up of uterine muscle tissue and you can get endometriosis. She had the endometriosis.

Dr. Mark Hyman:
Which is estrogen tissue, like uterine tissue, growing in other parts of your body?

George Papaniclolaou:
Right. It can grow inside your uterus, outside of your uterus, on your ovaries, and even attach itself to your intestines. So she had this estrogen dominance along with this underline autoimmune issue. And then I thought well her gut is an issue. She didn’t complain about her gut until I started asking questions about it. And all of a sudden, “Oh yeah. I do get bloating and I do get distention. And I do have a food baby every once in a while.” All right. Well, it’s sounding like SIBO. So okay.

Dr. Mark Hyman:
That reminds me of that patient who was like, “You have trouble with your digestion?” “No.” “Are you regular?” She goes, “Yeah. I’m regular.” And so I said, “How often do you go?” She goes, “Once a week.” I said, “That’s not regular.” She said, “It’s regular for me. I go every week.” I’m like that just … people think of it as normal and it’s just not normal.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
Well, it may be normal for her, but it’s not optimal.

George Papaniclolaou:
Yeah. Yeah. You learn to live with what you got.

Dr. Mark Hyman:
Yeah. So she in her mind didn’t think she had gut problems even though she did when you dig into the story.

George Papaniclolaou:
Right. So here’s where it all comes together is that when we get her testing back, we do something that’s called a complete diagnostic stool analysis. And it looks at your complete gut microbiome and it will measure different bacteria and all the different species, but it also can find candida. Now since I suspected that-

Dr. Mark Hyman:
Or yeast.

George Papaniclolaou:
Or yeast.

Dr. Mark Hyman:
I mean there’s different forms. It’s not all candida. There are all kinds of species that you can find.

George Papaniclolaou:
Yeah different yeast that can grow in the gut. And so I tested her for the most common one which is candida. And it’s hard to find. So I did an antibody test. I did her stool test and I looked for one of her organic acid tests that we do. Found her positive in all three. What does candida do? Candida metabolizes progesterone.

Dr. Mark Hyman:
Mean it breaks it down so you have less.

George Papaniclolaou:
It breaks it down. You have less. So here’s an estrogen dominant woman who is candida causing her hives, and her fatigue, and her brain fog partly. And it’s chewing up her progesterone, increasing and making her estrogen dominance worse. And estrogen dominance itself, those high levels of estrogen can cause anxiety. It can cause depression, mood swings, brain fog, and all the things that she was experiencing.

Dr. Mark Hyman:
Yeah. That’s amazing.

George Papaniclolaou:
So everything tied together with her. So I fixed her gut. I get rid of her candida. Her hives go away. And then I start treating her estrogen dominance. And with estrogen-

Dr. Mark Hyman:
Now you fixed the gut and the hives go away. You just said that like that or whatever, but people suffer terribly with hives and have terrible yeast issues.

George Papaniclolaou:
I know.

Dr. Mark Hyman:
And it can be debilitating. I had this woman. She had this angioedema thing which is like hives on steroids. It’s like terrible. And she had a terrible gut. Same thing. She had terrible yeast issues. We clean up her diet. We fixed her gut. We got rid of the yeast and like it just went away. And she went from like this bloated, inflamed person to just looking beautiful and normal.

George Papaniclolaou:
It’s shocking.

Dr. Mark Hyman:
And it’s so easy actually when you know what’s going on. Instead of taking all these antihistamine drugs, and steroids, and epinephrine shots. It’s like it’s such a mess when you look at traditional approaches to this. And when you dig in, it’s different for different people, but when you find out what the issue is, it actually resolves pretty quickly.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
She wasn’t even coming complaining of that.

George Papaniclolaou:
No. That’s the point. Both of these cases came in with anxiety as one of their top two complaints. And that’s what you said. I’m sorry. That’s what you said. I was tapping. So anxiety, it’s never just anxiety. It’s just never one thing. And it’s the body affecting the brain. And so she was just a really good case that everything sort of seemed to connect. And she also had gluten sensitivity. Her hair loss was a big issue. She had alopecia areata, which is an autoimmune process. So with the hair loss-

Dr. Mark Hyman:
And gluten is one of the biggest causes of that.

George Papaniclolaou:
Exactly. It can actually drive the body to make antibodies against the hair follicles in your scalp and you lose them. And what’s the conventional treatment for that? Steroid injections.

Dr. Mark Hyman:
Yeah. I’ve had patients like literally go bald.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
And then we figure out it’s gluten. They get off gluten and within months it all comes back and they get like a full head. I had this one patient come in kind of with a big hat and a scarf. And like she was kind of playing a trick on me because I hadn’t seen her in a while and she was completely bald last time I saw her. And she lifted her scarf up and she had a big full head of hair. I’m like that is just amazing.

George Papaniclolaou:
Oh. That is cool. Yeah. And so within six months this woman’s hair actually started slowing down and by six months she was growing hair back.

Dr. Mark Hyman:
So you did a lot of things for her. You treated the gut. You got rid of the yeast. You got the estrogen balanced. How do you do that?

George Papaniclolaou:
So estrogen balance. So basically you want to help her metabolize her estrogen better. So there are different compounds that we can use. So I used one of those compounds called diindolylmethane. You can also use-

Dr. Mark Hyman:
And what is that? It sounds like a big word. Like a big drug, but it actually comes from?

George Papaniclolaou:
Broccoli.

Dr. Mark Hyman:
Broccoli. It’s a broccoli pill basically.

George Papaniclolaou:
Yeah. Yeah.

Dr. Mark Hyman:
And why is that so great? Because?

George Papaniclolaou:
It helps with detox.

Dr. Mark Hyman:
Yeah. So broccoli contains these compounds called?

George Papaniclolaou:
He’s quizzing me.

Dr. Mark Hyman:
No. I’m not.

George Papaniclolaou:
In front of all these people, I’m getting quizzed.

Dr. Mark Hyman:
Yeah. I’m trying to like get you to share. So it creates the ability in the body to detoxify the estrogen is what you said?

George Papaniclolaou:
Yeah. Right. Yeah.

Dr. Mark Hyman:
And it helps with these compounds that are called glucosinolates and sulforaphanes and [crosstalk 00:46:18].

George Papaniclolaou:
Right.

Dr. Mark Hyman:
So diindolylmethane is one of those compounds and it’s been actually shown to reverse cervical cancer. It helps with hormone imbalance, detoxify estrogen. It’s amazing.

George Papaniclolaou:
Right. So I detoxify her estrogen. So I get her estrogen down by metabolizing it better. And we can also use something called Calcium-D-glucarate which will bind it. And so then-

Dr. Mark Hyman:
Also getting rid of sugar, and starch, and processed sugar helps a lot. Right?

George Papaniclolaou:
Right. Yeah. I was going to end with and of course we changed her diet. We put her on an autoimmune paleo diet, but going back to the estrogen dominance. And then depending on the woman, she might need a little bit more help. So then I want to increase her progesterone. So I’m getting her estrogen’s down. I am increasing her progesterone by getting rid of her candida, but she might need some help. So I might give her something like chaste berry. So chaste berry is-

Dr. Mark Hyman:
It’s an herb.

George Papaniclolaou:
It’s an herb. Vitex?

Dr. Mark Hyman:
Vitex. Yeah.

George Papaniclolaou:
Yeah. So it’s called Vitex and it will actually help promote your body to make more progesterone. And sometimes I might need to use some low level progesterone crème.

Dr. Mark Hyman:
Topical.

George Papaniclolaou:
Topical just before her cycle. Or yeah. So that can help. And we did those things for her and her periods … She no longer had breast tenderness. She wasn’t having heavy bleeding and things just really … This was a remarkable case.

Dr. Mark Hyman:
It seemed like a miracle, but it’s not.

George Papaniclolaou:
No.

Dr. Mark Hyman:
It’s just good functional medicine. And what’s fascinating is she was 42. And what happens with women as they enter their 40s, their cycles start to change. They don’t ovulate every time. They get lower progesterone. They have more stress. Their diet breaks down. So you end up with these estrogen dominant patients and they get fibroids, and heavy bleeding, and irregular cycles, and migraines. And this stuff is so easy to fix using a functional medicine approach.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
So I think-

George Papaniclolaou:
These are exciting cases.

Dr. Mark Hyman:
These are very amazing cases. And it just sort of shows you that through the lens of functional medicine, you can have insights into the root causes of why people have common symptoms with uncommon solutions. Except in functional medicine they are common solutions.

George Papaniclolaou:
This is true.

Dr. Mark Hyman:
[crosstalk 00:48:24] forever. And [crosstalk 00:48:25] the corona center here, we were so lucky to be able to use this model to treat our patients. And now we’re actually doing it all virtually which is awesome. So we can actually help you whether you live in Timbuktu, or whether you live in New Jersey, or Russia. We can actually help you from a remote distance and we have a great team of doctors, nutritionists. We have physician assistants, and health coaches, nurses. Really are capable of taking care of these issues remotely and we just love helping people because it’s so satisfying and fun for us.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
The sad part is we don’t get to see them as much because they get better, and leave, and go live their lives, which is what we want anyway but you can feel a little lonely sometimes. But I think we really want people to understand that they don’t have to suffer.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
That there are so many people needlessly suffering from chronic problems that have solutions that you just need to know how to dig a little deeper for. And that’s why functional medicine is the future of healthcare. This is not some fringe approach.

George Papaniclolaou:
No, not at all.

Dr. Mark Hyman:
It’s not alternative medicine. It’s not integrative medicine. It’s looking at the biology we have through the lens of systems thinking and systems medicine and biology. And that gives us really a leg up on everybody else. To be able to understand the complexity of human biology but understand that there are common themes that we can fix. The gut, and optimized nutrition, and optimized hormones, and deal with different imbalances. And we do that so easily and well. And it’s just so satisfying. And George, you’ve been such a great addition to the Ultra Wellness Center. And I’m just so happy to have you here and helping these patients. These are such amazing cases.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
And it makes our job so fun. Most of the time being a doctor is tough because you get incremental benefit and you can help people suppress symptoms and they do okay, but you’re constantly managing them. They don’t just get better.

George Papaniclolaou:
Yeah.

Dr. Mark Hyman:
And I think that’s the unique part about functional medicine is that there is a way out for so many people who suffer needlessly. And I just encourage people not to just accept the status quo. Understand that there’s a different way.

George Papaniclolaou:
And don’t accept a diagnosis. And don’t accept a single treatment for your diagnosis particularly if you’re not getting better. Or you’re just being maintained. Remember that there are doctors like us, there are functional medicine doctors here at the Ultra Wellness Center, that are going to realize that we have to ask the question why. We have to unpack the mystery of those integrated systems that require so much support and they work so well together, but when they’re out of sink things can go wrong and we can figure that out. Don’t accept the status quo, as Mark has said. And seek help with a good functional medicine doctor. And we’re always willing to do that here at the Ultra Wellness Center.

Dr. Mark Hyman:
That’s right. You can go to ultrawellnesscenter.com.

George Papaniclolaou:
Yeah. Yeah.

Dr. Mark Hyman:
You can go to the get started page, learn about all our services, and we’re just so happy to help. And I think for those listening, just remember, you’re not alone out there.

George Papaniclolaou:
You’re not alone.

Dr. Mark Hyman:
Suffering from all this stuff. That there are solutions and sometimes it takes a while for people to find the right place, but I just hope you understand that if you have some diagnosis just don’t accept that. If you have anxiety, or if you have PMS, or you have irritable bowel, or whatever it is, hives. These are just symptoms. They’re not diseases.

George Papaniclolaou:
Right.

Dr. Mark Hyman:
Diseases are these labels, these names we give to things that really have no connection often to what the cause is. And so functional medicine’s really about digging deep into the causes, sorting through all that. And we just are just so happy to be able to do this kind of healthcare. It’s really the future of medicine.

George Papaniclolaou:
Yeah. Don’t accept the coverup. You have hives and your doctor says, “Hey, take [zizo 00:51:55] for the next 10 years.” That’s a coverup.

Dr. Mark Hyman:
Which by the way costs like $20,000 a year.

George Papaniclolaou:
Yeah. Yeah. That’s a coverup. Get help.

Dr. Mark Hyman:
Yeah, great. All right. Well you’ve been listening to The Doctor’s Farmacy. Our special episode of House Call with Doctor George Papaniclolaou. And we’re here at the Ultra Wellness Center sharing a lot about what we’re doing. We’re just excited to share this with you. 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 Doctor’s Farmacy.

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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