Dr. Elizabeth Boham (00:00):
A lot of supplements out there are not great, because they’re not giving the right type of nutrients within the supplement.
Dr. Mark Hyman (00:11):
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman and that’s Farmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you’ve ever worried if you should take vitamins if you’re nutritionally deficient, or if it’s all a bunch of hoo-ey, this podcast is going to be very interesting to you, because it’s with my friend, colleague at the UltraWellness Center, the medical director here, Dr. Elizabeth Boham.
Dr. Mark Hyman (00:33):
On this special episode of The Doctor’s Farmacy, we call House Call, and we dive deep into issues around functional medicine and how to treat difficult problems that aren’t getting better using traditional care. Welcome, Liz.
Dr. Elizabeth Boham (00:46):
Thank you, Mark. Thanks for having me.
Dr. Mark Hyman (00:48):
Now, Liz is a doctor’s doctor. She is a MD, she’s an RD nutritionist, and she’s an exercise physiologist, and she’s one of the leading thinkers, teachers, and faculty, in functional medicine around the world. She’s taught in South Africa, in London, and all over the United States. She’s a key part of our faculty at the Institute for Functional Medicine, and she’s been my colleague here forever at the UltraWellness Center. We’ve worked together before that at Canyon Ranch, for 20-plus years now. It’s amazing, and I don’t think you look any different than you did 20 years ago.
Dr. Elizabeth Boham (01:16):
Neither do you.
Dr. Mark Hyman (01:18):
Maybe, a few more gray hair.
Dr. Mark Hyman (01:20):
Welcome, welcome. We’re going to talk today about nutrition and nutritional deficiencies and nutritional testing and why we should be concerned about these. Liz, from a traditional medical point of view, we were trained that you should be able to get all your nutrients from food, that supplements are often a waste of money, and often just create expensive urine. How do you address that?
Dr. Elizabeth Boham (01:47):
I remember, and in my training, it was the same. I was trained to say, “Let’s focus on food first,” which we always do. We always want to focus on food first. “Supplements aren’t going to be that helpful, and don’t use them.”
Dr. Elizabeth Boham (02:04):
I remember when I first took a multivitamin, a good multivitamin. This was after my nutrition training, after I was an RD, after I was… It was probably when I was at Canyon Ranch.
Dr. Mark Hyman (02:15):
And you were even a nutritionally trained MD.
Dr. Elizabeth Boham (02:17):
Dr. Mark Hyman (02:17):
So, you did a fellowship in nutrition as a doctor.
Dr. Elizabeth Boham (02:22):
I was always trying to get all my nutrients from food and teaching my patients to get all of their nutrients from food, and I remember taking a really good-quality multi, all of a sudden going, “Wow. Oh, I have all this energy that I didn’t realize I didn’t have.” It made a huge difference for me. I think, in a lot of ways, multis are almost the least important supplement we give, but for me and for so many of my patients, sometimes even a multi can make a huge difference.
Dr. Elizabeth Boham (02:53):
I think what is really important to pay attention to with supplements is that when we use them in a personalized approach, when we’re testing, when we’re using them based on what that individual person needs, not just saying, “Okay, everybody take this,” which, sometimes that’s helpful too, but really figuring out for that individual person, what are they deficient in, where do they need to focus, that can make a huge difference for how they feel.
Dr. Mark Hyman (03:19):
Yeah, it’s true. It’s so true, and I think we’re taught that we should really get everything from food, but there’s been a lot of problems with our food supply.
Dr. Elizabeth Boham (03:24):
Dr. Mark Hyman (03:25):
Aside from us eating mountains of processed food, which has got no nutrients, except things that are fortified, right? Enriched. Why are they enriched? Because it’s impoverished to start with. On top of that, the way we grow our food, in soil that’s depleted because of industrial farming techniques, because of the fertilizers and chemicals that literally destroy the microbiome of the soil, which is needed to extract nutrients from the dirt, from the soil, that the plants can use, which then we eat. We’ve seen 50% reduction in nutrient levels like magnesium and other minerals in our vegetables over the last 50 years. If you’re eating broccoli today and you ate it 50 years ago, it’s a different food.
Dr. Elizabeth Boham (04:03):
It’s a different broccoli.
Dr. Mark Hyman (04:04):
And then you’re shipping them over long distances. The average apple you eat has been in a storage house for a year, right? And they’re refrigerated, kept in storage, they’re transported, so they lose nutrition, and we’re also living a lifestyle that depletes our nutrients. We’re drinking too much alcohol, smoking, eating processed food, which, by the way, in order to… We’ll talk about this, but in order to actually metabolize your food, the way your food is metabolized, is requiring vitamins and minerals to run that food-
Dr. Elizabeth Boham (04:40):
As cofactors for all those enzymes, right?
Dr. Mark Hyman (04:42):
Right. To run the food through your metabolic factory, you can’t… It’s like the assembly line. If you don’t have the nutrients, you can’t run the food through, and so you get more depleted. Then, we have all these drugs we take that deplete our nutrients, medications, so we have all these reasons why we’re nutritionally deficient.
Dr. Mark Hyman (05:01):
Talk to us about what are we seeing in America, and then we’ll talk about what we’re seeing here at the UltraWellness Center, because we don’t just guess here; we test.
Dr. Elizabeth Boham (05:08):
Dr. Mark Hyman (05:09):
And it’s shocking, honestly, to see the level of nutritional deficiencies in who you think would be a well-nourished, healthy person.
Dr. Mark Hyman (05:17):
Tell us about the kinds of nutritional deficiencies we’re seeing at scale in America and why they’re so important.
Dr. Elizabeth Boham (05:22):
If you just look at what people are eating, we’re seeing that 68% of Americans are not getting enough magnesium, and so 68% are not meeting their RDI, the recommended dietary intake, and we have to remember that that RDI was set for just sufficiency, so not having a deficiency in magnesium. What that means is those recommendations are not set at what is optimal, either, for that individual person, so they’re just the minimum requirement, in a sense.
Dr. Elizabeth Boham (05:54):
68% of us are not getting enough magnesium, 40% are not getting enough zing, 78% are not getting enough folate, maybe even 90-plus percent are not getting enough of the Omega-3s in their diet. We’re seeing significant nutritional deficiencies, and that’s leading to so many issues in terms of chronic disease, and also just feeling awful, right?
Dr. Mark Hyman (06:18):
Yeah. What’s fascinating to me is-
Dr. Elizabeth Boham (06:20):
Feeling like crap.
Dr. Mark Hyman (06:21):
… when I started learning about all this, I learned about nutrition in medical schools. “Okay, vitamin C prevents scurvy and vitamin D prevents rickets and vitamin A prevents blindness and B vitamins prevent this and that.” I never really understood why they were important other than preventing deficiency diseases, which is why we first learned about them, was from these diseases. Then, I began to understand this and beginning to think about, what do vitamins and minerals actually do in the body?
Dr. Mark Hyman (06:52):
There’s 37 billion-billion chemical reactions that happen in the body every second. 37 billion-billion.
Dr. Elizabeth Boham (07:00):
Dr. Mark Hyman (07:01):
I don’t even know what that is. It’s a [kajabillion 00:07:04], [kabajillion 00:07:04], I don’t know. It’s a lot.
Dr. Elizabeth Boham (07:05):
A lot? It’s a lot?
Dr. Mark Hyman (07:06):
And every single one of those chemical reactions requires helpers, and the helpers are-
Dr. Elizabeth Boham (07:13):
Dr. Mark Hyman (07:14):
Are vitamins and minerals.
Dr. Elizabeth Boham (07:15):
Vitamins and minerals, yeah.
Dr. Mark Hyman (07:16):
And one of the other shocking things I learned was that our DNA, one third of our DNA, codes for enzymes. Enzymes are catalysts that convert one molecule to another, so all these chemical reactions I talked about all need catalysts, or enzymes. One third of our entire genetic material is coding for these enzymes, and there’s variations in how they work that make one person require more or less of a different nutrient, right?
Dr. Elizabeth Boham (07:45):
Dr. Mark Hyman (07:46):
For example, you need more B vitamins if you have certain variation. You might need more folate or B12 or B6, and if you take the normal amount, quote the RDI, which is not the optimal amount to create health; it’s the minimum amount necessary to prevent a deficiency disease. So how much vitamin C do you need to not get scurvy? Probably 60 milligrams. How much vitamin C do you need to optimize your immune system to not get COVID? Probably 4,000 milligrams.
Dr. Elizabeth Boham (08:12):
And it’s different for each person, like you’re saying, based on our genetic makeup and everything else going on in our body. Not just our genetics, but what other diseases we’re dealing with, how we digest and absorb our nutrients. So many things impact our nutritional needs.
Dr. Mark Hyman (08:26):
Yeah. It’s so true. Your gut microbiome determines what’s going on with your nutritional levels, and you may not be producing the vitamins in your gut, like vitamin K or biotin, because you have a bad gut.
Dr. Elizabeth Boham (08:36):
Dr. Mark Hyman (08:37):
It’s so fascinating to me, and really, functional medicine, our focus is on nutrition as the first line of therapy, and it’s both using food as medicine, but also understanding the role of key nutrients in playing a role in how they function.
Dr. Mark Hyman (08:53):
You and I have been in this field for a long time, and it’s easy to be a little bit arrogant and think that, as a traditional doctor, “Well, people need food, they don’t need vitamins, waste of time, waste of money.” But we get humbled by seeing actually what happens when we test people.
Dr. Elizabeth Boham (09:10):
Dr. Mark Hyman (09:11):
I think, despite doctors saying this, when you look at the data, I think 72% of doctors recommend supplements to their patients, and 79% take them themselves. Whatever they’re telling you, it’s interesting. We see studies that show, “Oh, vitamin D doesn’t affect heart disease or cancer, and Omega-3 fats don’t really benefit heart disease or cancer preventions.” We see these studies that are conflicting all the time.
Dr. Elizabeth Boham (09:40):
I think that happens for so many reasons, why those studies are conflicting. One is because we’re putting everybody in that same group, so we’re not personalizing the approach. It depends on people’s health status, how they’re digesting, absorbing, how their nutritional status in general. Are they deficient to begin with? What are their genetic needs? That really impacts how somebody shifts or improves from when we give them those nutrients.
Dr. Elizabeth Boham (10:08):
I think that one of the biggest issues with research is we’re not looking at individual variations and snips in somebody’s makeup, their genetic variations that impact what they need. It just lumps everybody into one category.
Dr. Mark Hyman (10:24):
Yeah, if someone, for example, had a vitamin D receptor gene that made them require high dose of vitamin D, and you took 100,000 people and you saw them taking vitamin D, well, you think they were taking enough, but it might not be enough for that person, and if you actually took that subset and you studied them and you gave them the right amount to get their blood levels optimally, it might be different.
Dr. Elizabeth Boham (10:46):
It will absolutely be different. We know with fish oil, for example, if people are eating a couple servings of good, fatty fish a week, then fish oil supplements might not be as helpful for them, but when people aren’t eating that, then fish oil supplements make a huge difference and help lower triglycerides and decrease risk of heart disease. We know that it really is dependent so much on your individual diet, as well as all those other things we’ve spoken about.
Dr. Mark Hyman (11:06):
Yeah, it’s true. I always say, “If you don’t have a headache, an aspirin doesn’t do anything.” If your Omega-3 levels are already good and you take Omega-3, it doesn’t do anything. I think the studies are challenging, and like you said, it’s hard to distinguish what the overall health of the patient is, and so if these patients are eating crappy diets, if they’re smoking, they’re drinking, they’re not exercising, taking a vitamin’s not going to help them. They’re not that powerful in that sense. If you clean up everything and then you add them in, they can be extremely effective and powerful.
Dr. Mark Hyman (11:38):
That’s not to say that if you’re overweight and unhealthy you shouldn’t take supplements, because I think they will help, but they work much better if you clean up house first.
Dr. Elizabeth Boham (11:47):
Comprehensive program, right?
Dr. Mark Hyman (11:49):
Yeah. Let’s talk about how we learn in our practice, the UltraWellness Center, about what people’s nutritional status is. How do we figure that out?
Dr. Elizabeth Boham (12:01):
We look at it from multiple different angles, right? First, it starts with a physical exam. What is their waist-to-hip ratio? How are they holding onto weight in their body? Then, we look for signs of nutritional deficiencies. Maybe their hair is dry or their skin is dry or they have spots on their nails, which could indicate zinc deficiency. We look at their diet intake. What are they-
Dr. Mark Hyman (12:23):
Wait, the nutritional physical exam, I just want to pause, because you teach that course at the Institute for Functional Medicine, and it’s fascinating when you learn as a doctor what the clinical signs are of vitamin deficiencies, right? We know the obvious ones. For example, if you have scurvy, you get no-gum issues, right? If you have B vitamin deficiencies, you get little cracks in your mouth called cheilosis. If you have white spots on your nails, you might be zinc deficiency. For example-
Dr. Elizabeth Boham (12:48):
Bumps on the back of your arms or dry skin, we think about vitamin A a lot, we think about zinc.
Dr. Mark Hyman (12:54):
Yeah. My favorite test is a vitamin D. You know what that one is?
Dr. Elizabeth Boham (12:58):
Mm-hmm (affirmative), yes.
Dr. Mark Hyman (12:59):
Tell us about that.
Dr. Elizabeth Boham (13:01):
If you bang on somebody’s leg and they have pain, then that could be a sign that they’re low in vitamin D.
Dr. Mark Hyman (13:06):
If you take your thumb and you press right now on their shin bone, and if it’s tender, then it means you’re probably vitamin-D deficient, because it makes your bones soft.
Dr. Elizabeth Boham (13:16):
Dr. Mark Hyman (13:16):
I take vitamin D, so my bone doesn’t hurt at all when I press on it.
Dr. Elizabeth Boham (13:19):
You’re pressing right now?
Dr. Mark Hyman (13:20):
Dr. Elizabeth Boham (13:21):
Oh yeah, mine doesn’t hurt, either.
Dr. Mark Hyman (13:22):
There you go.
Dr. Elizabeth Boham (13:23):
I’m taking my vitamin D.
Dr. Mark Hyman (13:24):
I’m taking my vitamin D. You can do those simple tests. There’s a lot of things, clinically, you can figure out that are signs of nutritional deficiency. That’s the first step.
Dr. Elizabeth Boham (13:30):
And I think that’s really important to look and examine, because biomarkers are not perfect, which are lab tests, but they can be very helpful, but they’re not perfect at determining everybody’s nutritional deficiencies. For example, magnesium. We know that magnesium is, we talked about, it’s a very common deficiency, but sometimes, the serum magnesium and red blood cell magnesium can be normal, and somebody can still be deficient in magnesium and would benefit from more magnesium, whether it’s dietary or supplement-wise.
Dr. Mark Hyman (14:00):
That’s the other thing. We take a detailed history, so by actually questionnaires, you can determine what your nutritional deficiencies are. I wrote my book UltraMind, I literally had questionnaires in there. How do you know if you’re zinc-deficient, vitamin-D deficient, magnesium-deficient, folate-deficient, so forth? You can actually do these questionnaires and you’re going to get a pretty good sense if you’re deficient or not.
Dr. Elizabeth Boham (14:21):
And then you look at their diet, too. You look to see what they’re eating and what they’re not eating. When somebody’s a vegan, you’re thinking more about, “Okay, I’ve got to really look for B12, I’ve got to really look for issues with iron, I’ve got to really think about zinc and the Omega-3 fats,” because they’re more common deficiencies-
Dr. Mark Hyman (14:39):
Than vitamin D.
Dr. Elizabeth Boham (14:39):
Yeah, if you’re not eating any animal-
Dr. Mark Hyman (14:41):
Iodine, because you don’t eat fish, right?
Dr. Elizabeth Boham (14:44):
Yep. There’s things we have to think about depending on what their diet is like and their digestive system. We do a comprehensive approach, and the biomarkers can be really helpful too. They’re not perfect, but-
Dr. Mark Hyman (14:55):
Like blood tests, or what other tests we do.
Dr. Elizabeth Boham (14:57):
Yeah, so we can look at blood, we look at urine. We do this panel called the ION panel, and it’s this all-over nutrition panel. It gives us so much good information. It tells us about amino acid levels. Those are the components of protein in the blood.
Dr. Mark Hyman (15:12):
The building blocks of protein, yeah.
Dr. Elizabeth Boham (15:13):
Yep. And it tells us about Omega levels, Omega-3 levels, Omega-6 levels, it tells us about mineral levels, it tells us about all those steps of the mitochondria and the steps of the Krebs cycle, which need nutrients to work properly, like you were talking about. Those cofactors, the vitamins and minerals that help those reactions work so we can take our food and turn it into ATP or energy. So, when we have deficiencies in certain nutrients, we’ll see shifts in this panel called the organic acid testing, which, that’s really helpful.
Dr. Mark Hyman (15:48):
It’s a urine test.
Dr. Elizabeth Boham (15:49):
It’s a urine test. Yeah.
Dr. Mark Hyman (15:50):
That’s really important. So, what you’re saying essentially is that we use a lot of different kinds of testing, because your typical doctor will check your blood levels, but if you check your blood levels of folate or magnesium, they go, “Oh, it’s fine.” You’re not necessarily fine. So, each nutrient requires a very different approach depending on the nutrient. So, vitamin D? Yeah, you can check your blood level of vitamin D. You ought to check the right one, but it’s pretty good. Right? You can check your blood levels of Omega-3s, pretty good. But you want to check in the right way. Some, like folate or B12 or magnesium, not so much.
Dr. Elizabeth Boham (16:25):
Not so good, right?
Dr. Mark Hyman (16:26):
You mentioned magnesium. That’s a really good point. So, a lot of doctors will check magnesium. Now, if it’s low on a regular blood test, it means you are in big trouble.
Dr. Elizabeth Boham (16:33):
You’re really low.
Dr. Mark Hyman (16:34):
You’re really low.
Dr. Elizabeth Boham (16:34):
Dr. Mark Hyman (16:35):
And then you can check red cell magnesium, which is a little bit better, but the true test is something called a magnesium loading test, which is what?
Dr. Elizabeth Boham (16:45):
So, you give magnesium, and then you collect urine for a period of time, so that magnesium, depending on the level of sufficiency that somebody has in their body, that will impact how much magnesium that spills over into their urine.
Dr. Mark Hyman (16:59):
Yeah, it’s not a test we do very often, but if you really want to know, you got to give someone a load of magnesium. If they pee it out, they’re good. If they hold onto it and nothing comes out in the urine, they’re pretty low.
Dr. Mark Hyman (17:09):
Hey, everybody, it’s Dr. Hyman. Thanks for tuning in to The Doctor’s Farmacy. I hope you’re loving this podcast. It’s one of my favorite things to do, and introducing you to all the experts that I know and I love and that I’ve learned so much from.
Dr. Mark Hyman (17:20):
And I want to tell you about something else I’m doing, which is called Mark’s Picks. It’s my weekly newsletter, and in it, I share my favorite stuff, from foods, to supplements, to gadgets, to tools to supplement your health. It’s all the cool stuff that I use and that my team uses to optimize and enhance our health, and I’d love you to sign up for the weekly newsletter. I’ll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to DrHyman.com/picks to sign up. That’s DrHyman.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.
Dr. Mark Hyman (18:03):
Now, back to this week’s episode.
Dr. Elizabeth Boham (18:04):
And you were mentioning folate and B12. I see this all the time. People come in with a B12 level that their doctor did, and it’s normal, and then they go, “Okay, I don’t need B12.” But many times, that’s not really telling us about functional markers of B12 or what is sufficient for that individual person, so we’ll do things like methylmalonic acid and homocysteine. They’re more functional markers of the B vitamins. They give us a lot more information than just a serum level of a vitamin.
Dr. Mark Hyman (18:32):
So, in other words, is it doing what it’s supposed to do in the body, and if it’s not, you’re going to see a backup of these other compounds that we don’t normally test.
Dr. Elizabeth Boham (18:40):
Dr. Mark Hyman (18:40):
But doctors just check your B12, folate, “They’re fine.” You may not be fine. And obviously, many patients who are not fine and who have very severe deficiencies and need different type… Often, you can tell if someone needs a certain type of a nutrient. Looking at their genetics and their blood test, you can tell if they need this form or that form of the nutrient. So, it becomes very sophisticated in an approach of functional medicine.
Dr. Elizabeth Boham (19:04):
I think that’s a great example of where a lot of supplements out there are not great, because they’re not giving the right type of nutrients within the supplement. For example, if a supplement is less expensive, they may use folic acid in the multivitamin. Not everybody, because of their genetic makeup, can utilize folic acid, and use it for what the body needs folic acid for, folate for. Folic acid is a synthetic form of folate that’s in-
Dr. Mark Hyman (19:33):
And it may increase risk of problems.
Dr. Elizabeth Boham (19:35):
Yes, increase risk, maybe, of cancer. Right?
Dr. Mark Hyman (19:37):
Dr. Elizabeth Boham (19:37):
So, not everybody can take folate in the form of folic acid and utilize it if they have a shift in this… if they have genetic variation called the MTHFR gene, and there’s others as well. So, those are things we look at as well, and when we use vitamins, we use really good-quality ones, ones that the body’s more able to utilize, like a methylfolate form. And that makes a huge difference for people.
Dr. Mark Hyman (20:02):
Yeah. And so many aspects, actually, of picking the vitamin, right? It’s not just the form of the nutrient, but is it the form that’s bioavailable? Is it absorbed? What is in with it that can prevent its absorption? What exactly is it? So, you can say, “Well, I need magnesium. I’m just going to go to the store and get some magnesium.” It’s usually magnesium oxide, which is really cheap magnesium. It’s in most supplements, but doesn’t really get absorbed very well and may not be effective.
Dr. Elizabeth Boham (20:25):
Right. Magnesium oxide, and also magnesium citrate, they’re more likely to pull water into the gut, and so they’ll loosen up the stools. For some people, they need that and that’s good, but it’s not as well absorbed as a chelated form of magnesium like magnesium glycinate, which is much better absorbed into the body. So, depending on what you’re using your magnesium for, you want to be making sure you’re choosing the right one.
Dr. Mark Hyman (20:49):
Yeah. So, what’s different about here at the UltraWellness Center, what we do in functional medicine, is that there’s a really deep understanding of the role of nutrition and nutrients in health, and what’s so important about these is, it’s not that they’re single-function compounds, right?
Dr. Mark Hyman (21:04):
If you take a drug, it usually hits one pathway, does one thing, right? When you take magnesium, it affects 300 different enzymes and has many other functions in the body.
Dr. Elizabeth Boham (21:16):
It’s phenomenal. Magnesium is an amazing mineral, and it’s so good for us in so many ways, and when people are magnesium-deficient, we see all sorts of issues from depression, anxiety, muscle cramps, hypertension, asthma, restless leg syndrome, diabetes, more insulin resistance. So, magnesium is so-
Dr. Mark Hyman (21:37):
Don’t forget constipation.
Dr. Elizabeth Boham (21:39):
Oh my goodness, I forgot constipation!
Dr. Mark Hyman (21:40):
Dr. Elizabeth Boham (21:41):
Dr. Mark Hyman (21:42):
Dr. Elizabeth Boham (21:42):
Dr. Mark Hyman (21:43):
Twitchy muscles. Some people get twitchy eyes.
Dr. Elizabeth Boham (21:46):
Yeah, I had a lot of twitchy eyes in residency. I love magnesium. It helped my twitchy eye.
Dr. Mark Hyman (21:53):
So, people get treated for all these problems, right? They get treated for constipation, they get treated for… This ironic thing about magnesium is that it’s used all the time in medicine as a last resort. Right?
Dr. Elizabeth Boham (22:05):
Dr. Mark Hyman (22:06):
So, when a woman comes in who’s in preterm labor and their uterus is contracting like crazy, they get IV magnesium. If a woman is high blood pressure in pregnancy, they come in, they’re about to have a seizure, they give them IV magnesium. Why? Because it works better than anything else. If someone’s having a cardiac arrest and arrhythmia, when all the other drugs fail, they give them IV of magnesium as a last step because it helps to relax the heart muscle.
Dr. Mark Hyman (22:29):
I call it the relaxation mineral, so anything that’s twitchy, irritable, or tense, whether it’s anxiety, insomnia, constipation, muscle cramps, twitchy blood vessels, high blood pressure, twitchy heart, which is palpitations, twitchy emotions, which is anxiety. All these things are related to insufficient magnesium, and they they’re treated… they’ll take Xanax for anxiety, take a laxative for constipation, take a migraine pill for your headache, take this or that for this or that. And it’s unfortunate, because this is such a simple solution.
Dr. Elizabeth Boham (23:01):
And we know it’s a vicious cycle, right? We know that chronic stress, when we’re under chronic stress, that that causes our body to excrete more magnesium in the urine, so we become more deficient in magnesium. So, we’ve got-
Dr. Mark Hyman (23:13):
Chronic stress? Who’s got that? What do you mean?
Dr. Elizabeth Boham (23:14):
I know, right? So then, you become more deficient in magnesium.
Dr. Mark Hyman (23:16):
We live in a very stressless time right now.
Dr. Elizabeth Boham (23:18):
And then you get more anxious, and then you use up more of your magnesium, so we know that when we’re dealing with chronic stress, we’re using up our magnesium, we’re excreting more magnesium, and we need even more magnesium, because that was what helps us feel calm.
Dr. Mark Hyman (23:35):
Well, go through all the things that actually cause us to loses magnesium.
Dr. Elizabeth Boham (23:41):
Dr. Mark Hyman (23:42):
Stress is a big one.
Dr. Elizabeth Boham (23:42):
… is huge.
Dr. Mark Hyman (23:44):
I remember, but I just interrupted. I remember one study I read of Kosovo, and they did magnesium studies, and they found that people in Kosovo under all that war and stress, they had really huge amounts of excretion of magnesium, whereas people who weren’t in that environment didn’t.
Dr. Elizabeth Boham (23:58):
We know that people who take proton-pump inhibitors-
Dr. Mark Hyman (24:01):
Acid blockers like Pepcid and-
Dr. Elizabeth Boham (24:01):
Acid blockers, yep.
Dr. Mark Hyman (24:04):
… like Protonix and Prilosec and Nexium and all those drugs.
Dr. Elizabeth Boham (24:07):
Yeah, that decreases your magnesium absorption, so just depending on your medication, that can deplete your body of magnesium
Dr. Mark Hyman (24:15):
Dr. Elizabeth Boham (24:15):
Dr. Mark Hyman (24:16):
Blood pressure pills, which you need magnesium to control your blood pressure, and you’re taking a pill that causes you to lose magnesium.
Dr. Elizabeth Boham (24:21):
Right. Again, that vicious cycle that we see all the time.
Dr. Mark Hyman (24:24):
Dr. Elizabeth Boham (24:24):
Dr. Mark Hyman (24:25):
Dr. Elizabeth Boham (24:27):
Alcohol depletes your body of magnesium and all the B vitamins, so I think that’s important.
Dr. Mark Hyman (24:31):
Smoking. Well, nobody’s into smoking. Sugar.
Dr. Elizabeth Boham (24:37):
Dr. Mark Hyman (24:38):
And, my favorite of all of them, coffee.
Dr. Elizabeth Boham (24:41):
Dr. Mark Hyman (24:41):
Right? Coffee causes magnesium loss. So, you live an American lifestyle where you’re drinking coffee, you’re drinking alcohol, lots of stress, you have probably a pretty crappy diet.
Dr. Elizabeth Boham (24:52):
And then you take a proton-pump inhibitor, you take an acid blocker.
Dr. Mark Hyman (24:54):
Take an acid blocker because you’re eating a crappy diet. And then, on top of that you’re eating a very low-magnesium diet. So, talk about how that plays a role.
Dr. Elizabeth Boham (25:01):
Magnesium is in so many of our foods. Magnesium’s in our-
Dr. Mark Hyman (25:04):
Well, not the foods we actually eat.
Dr. Elizabeth Boham (25:05):
Well, yeah. But it’s in our nuts and seeds, our beans and legumes, our vegetables.
Dr. Mark Hyman (25:09):
Dr. Elizabeth Boham (25:10):
Greens, yep. Our vegetables, and it’s in whole grains like quinoa and buckwheat. So, it’s in a lot of our food, but when you take, for example, brown rice and you make it white rice, you deplete… about 90-plus percent of the magnesium is released or is lost in that processing. And they don’t spray that back on. They’ll spray back on some B vitamins, but not the magnesium, so when people are eating refined and processed foods, they’re getting a more magnesium-deficient diet.
Dr. Elizabeth Boham (25:42):
And sometimes, people don’t even realize they’re getting refined and processed foods. Sometimes, people are like, “I have a healthy diet,” but they forget about that piece of toast at breakfast or the crackers at lunch that are made up of… have white flour in them and that are more magnesium-deficient. And as we get older, we can’t really eat as many calories as we used to, so we’re more likely to have problems over time, as well.
Dr. Mark Hyman (26:05):
I think the diet is so magnesium-deficient, our lifestyle is so magnesium-depleting, and so we’re getting it from both ends. And we see this as one of the most common problems in our practice that is undiagnosed, and the patients think we’re geniuses because all these problems they suffer from just go away, and they’re like, “Wow, how did you know?” I’m like, “It’s not that hard. It’s just good medicine.” I mean, this is not functional medicine; it’s just medicine, and it’s often being missed.
Dr. Mark Hyman (26:39):
Let’s talk about the patient you had, and talk about what happened with this patient, because I think putting a face on this is going to be very helpful.
Dr. Elizabeth Boham (26:49):
So, I had a 68-year-old woman who came in to see me, and she was really struggling with chronic pain. She had anxiety, she had hypertension, so she had elevated blood pressure, she was pre-diabetic, she had restless legs, so she had poor sleep and she couldn’t really calm down at night because her legs were sort of twitchy, like we were talking about, and she had constipation. So, she had all these signs-
Dr. Mark Hyman (27:14):
Dr. Elizabeth Boham (27:14):
Anxiety, she had that too.
Dr. Mark Hyman (27:16):
Headaches, high blood pressure.
Dr. Elizabeth Boham (27:17):
Dr. Mark Hyman (27:17):
Dr. Elizabeth Boham (27:20):
Yeah. So, she came in and she said-
Dr. Mark Hyman (27:21):
The average patient we see here at UltraWellness Center.
Dr. Elizabeth Boham (27:24):
I know, right? And of course, we did a comprehensive program for her, but so many of her symptoms were pointing to low magnesium. So, we did a comprehensive program, we changed her diet. She’s one of those people who felt like she was on a really good, healthy diet, but when you look deeper, especially for her level of activity, she was wasting calories. She was wasting calories on that piece of toast at breakfast and crackers at lunch and a little bit of cake at dinner, right? She had a lot of vegetables in her diet, she had a lot of good, healthy foods in her diet, but she also had some of these other things that just took away from the nutrient density of her diet.
Dr. Elizabeth Boham (28:01):
So, I always work with all my patients on nutrient density, because I think that’s such an important point, right? You want to be choosing the foods that have the most nutrients per calorie, and especially as we get older or depending on our level of activity, we really can’t waste a lot of calories on foods that have poor nutrient content or low nutrient density, right?
Dr. Mark Hyman (28:24):
Yes, true. In my first book, we call it the nutrient-to-calorie ratio, which is how many nutrients per calories you’re getting. So, broccoli has a lot of nutrients, very few calories. Coca-Cola has a lot of calories, but no nutrients, right?
Dr. Elizabeth Boham (28:36):
Right. So, for her, we worked on shifting her diet. We did an elimination diet for her, because she also needed to pull away some common inflammatory foods, but we then shifted. Instead of choosing a piece of toast at breakfast, we had her have some sweet potatoes with her omelet, and then at lunch, instead of having crackers, we put some quinoa in her salad, ways that you get more nutrients per calorie, and more magnesium, right? And we also gave her magnesium, though. She was at a point where we needed-
Dr. Mark Hyman (29:08):
[crosstalk 00:29:08] tanks were so low.
Dr. Elizabeth Boham (29:08):
Yeah, her tank was low, and we needed to supplement. So, we gave her both the type of magnesium that helped increase her bowel movements, because she was constipated, and we gave her the magnesium glycinate that’s better absorbed. So, we gave her both. It was really helpful. She had improvement in her blood pressure, she definitely had improvement in that restless leg, so she slept better, she had improvement in her pain, her pain decreased significantly, she had improvement in her headaches. Really, it’s a magical mineral.
Dr. Mark Hyman (29:40):
Dr. Elizabeth Boham (29:41):
If I saw her today, because we’re doing more IV magnesium now at the UltraWellness Center, we have a combination called UltraCalm, which has IV magnesium in it. We can use that right away to see, “Okay, is this going to help with somebody’s headaches, or help them feel more calm and less anxious?”
Dr. Mark Hyman (30:00):
That’s true. I’ve had people in my office with headaches or migraines, and literally give them a shot of magnesium and it’s like that goes away instantly.
Dr. Elizabeth Boham (30:05):
Dr. Mark Hyman (30:06):
That’s very powerful. I was joking with you. So, we do in a cardiac arrest and the heart is not going, we give them intravenous magnesium, we give them IV magnesium for preterm labor or for preventing seizures with high blood pressure. It’s so powerful. It’s one of my favorite things. I’ve had IV magnesium. Have you had it? It makes you feel warm and relaxed and calm. It’s the most amazing thing. It’s like instant Valium without all the side effects.
Dr. Elizabeth Boham (30:29):
Yeah. And it’s safe for most people. It’s really safe for most people. People with kidney issues, so renal insufficiency, on dialysis, kidney issues, you have to be careful. You want to be really working… Well, you always want to work with your doctor, but you have to be more careful. But for most people, it’s a safe mineral that we can use.
Dr. Mark Hyman (30:48):
You also talked about, briefly, the different forms of magnesium. So, this is another aspect of nutritional therapy that we do in function medicine, so it’s very customized. So, this person might do better with magnesium glycinate, because they may have more detoxification issues, they might not have constipation, they might be prone to diarrhea. You have more constipation issues, you might use magnesium citrate. If there are more neurological issues, you might uses magnesium threonate, which has a better neurologic profile.
Dr. Mark Hyman (31:14):
So, it’s a very personalized, customized approach, and we make sure the nutrients don’t have junk in them, fillers, impurities, that the potency is there. We use very rigorous evaluation of the companies we use to actually figure out which supplements you should take.
Dr. Elizabeth Boham (31:28):
Right. You mentioned, so often, people go, “Oh, I need magnesium,” and they just grab one and they take it, and then they start getting diarrhea, and then it didn’t help, and then they’re like, “Oh, this is crummy.” It’s just not the right form. It’s not a good quality.
Dr. Mark Hyman (31:41):
Yeah. And we even talked about menstrual cramps and all that stuff.
Dr. Elizabeth Boham (31:46):
Another patient I had, she was a 30-year-old woman who was really struggling with PMS, so for the week before her period, she was really irritable, she was feeling more angry and sad, she had more cramps with her period, she had lots of cramps that were keeping her in bed for a couple days when she got her period. And magnesium was really effective for her. We could give magnesium for the… I gave it to her all the time. She didn’t need the citrate form, so I just gave her a magnesium glycinate, and that really helped her throughout her whole month, just feeling more calm, and it helped decrease the amount of PMS she had, and then when she was getting her period, we gave her even a little more magnesium glycinate, and that helped with the cramping, too. And she just felt better.
Dr. Elizabeth Boham (32:37):
We know that magnesium deficiency is associated with depression. We know that it impacts this NMDA receptor in the brain, probably, and that may be the connection with depression. So, when we give magnesium, we can decrease the amount of depression for something people. It’s not the cure-all for all depression, but for some people, it’s even better than an antidepressant, depending on what’s going on.
Dr. Mark Hyman (33:00):
That’s the whole point. It’s very personalized. While magnesium may work for some person, it may not work for another person.
Dr. Mark Hyman (33:05):
I just want to share a story. I remember this magnesium patient I had. She was a doctor. She was a radiation oncology resident at Mayo Clinic, seeing the best doctors in the world. She had incapacitating migraines. Just was on narcotics and anti-vomiting medication used for chemotherapy, and she was constantly going off work, and just struggling. She wasn’t an emotionally unstable person; she was just having these debilitating migraines.
Dr. Mark Hyman (33:37):
So, I took her history. I’m like, “Okay, what else is going on?” Because this is what we do in functional medicine. It’s not like, “Oh, let’s focus on your migraines.” No, let’s focus on the rest of you, because that’s where the clues are. So, what did she have? The usual. She had severe constipation. I said, “Do you have regular bowel movements?” She goes, “Yeah, I got regular bowel movements.” I said, “How often do you go?” She goes, “Once a week.” I’m like, “That’s not regular.” She goes, “Regular for me; I go every week.” And she just thought that was normal.
Dr. Mark Hyman (34:04):
She had palpitations, which is irritability of the heart. She had anxiety, she had insomnia, she had muscle cramps. She had all these things that were neon flashing lights of magnesium deficiency, and if you go to a medical textbook, you will read that those are the symptoms, but somehow, it’s nutrition, so doctors just don’t pay attention. I don’t understand.
Dr. Mark Hyman (34:25):
So, I’m like, “All right, let’s just try magnesium and see what happens,” and I gave her a lot. I said, “Take enough so they make sure you go.” And she needed over 2,000 milligrams a day, which is a lot. Most people need 200, 400, 600. It was a lot. And she started going to the bathroom, her palpitations went away, her insomnia went away, her anxiety went away, and her migraines went away, and she could go back and do her career as a radiation oncology doctor.
Dr. Elizabeth Boham (34:52):
Dr. Mark Hyman (34:52):
And you’re like, “Wow, that was easy.” But it’s really finding out how to navigate to that issue, which is exactly what we do in functional medicine that’s so different than traditional care. We have a different roadmap that focuses on the cause and not just the symptom. Right? Constipation’s a symptom, muscle cramps are a symptom, headaches are a symptom, depression’s a symptom. It’s not the cause.
Dr. Mark Hyman (35:15):
And not everybody, it’s magnesium for each of these problems, but it’s important to figure out how do you navigate to the root cause, and that’s what we do in functional medicine, and we do it through a very detailed set of questions, history, which we have you fill out, and then we do another detailed set of questions in person. But now we do it all on Zoom, too, so we have virtual care. Anybody from anywhere in the world can see us here at the UltraWellness Center. And then we do appropriate testing, so rather than guess, we test.
Dr. Mark Hyman (35:45):
It’s extraordinary how much nutritional deficiencies we see. I just recall a patient recently who’s a vegan, was struggling with his health. He was 20 years old, and I was like, “Oh my god.” This is a very wealthy, well-to-do guy from a good family, and I’m thinking, “This guy’s not malnourished, he’s eating food.” He had no Omega-3 fats, he was severely B-vitamin deficient, he was severely vitamin-D deficient, he was magnesium-deficient, he was iron-deficient, he was selenium-deficient. I was like, “Whoa.”
Dr. Elizabeth Boham (36:15):
And your body can’t heal, right? When you’re deficient in so many things, your body’s not going to heal. That digestive system’s not going to heal, your skin’s not going to heal.
Dr. Mark Hyman (36:23):
Yeah, and we talked about the magnesium and 300 different enzymes, but each one of those, they’re multifunctional substances that are designed to support your body’s normal functions, which is very different than drugs. Right?
Dr. Elizabeth Boham (36:34):
Right. Mm-hmm (affirmative).
Dr. Mark Hyman (36:35):
And there are some that you have to be careful with, you can OD on. Right? You can take too much vitamin D, you can take too much-
Dr. Elizabeth Boham (36:40):
Dr. Mark Hyman (36:41):
… selenium, too much vitamin A. But certain things-
Dr. Elizabeth Boham (36:44):
Too much iodine.
Dr. Mark Hyman (36:45):
Too much iodine, too much iron.
Dr. Elizabeth Boham (36:47):
Some people take really high doses, yep.
Dr. Mark Hyman (36:48):
So, you can get in trouble, but a lot of the stuff is water-soluble vitamins, like the B vitamins, people just coming in with their B12, they’re taking B12, and their B12 levels are off the roof, and the doctor’s, “Oh, your B12-toxic.” I’m like, “No.” Your body just pees out what you don’t need, it’s nontoxic, it’s fine.
Dr. Elizabeth Boham (37:02):
Right. Exactly. So, a lot of times, if serum B12 is high because somebody’s on a supplement, I might still keep them on that B12 if it’s really appropriate for them, like their methylmalonic acid was once too high, meaning that they needed B12. Or maybe they don’t absorb B12 well. We’ve talked a lot about parietal-cell antibodies in the past in other podcasts, and we know that impacts how you absorb B12. So, sometimes, they still need to stay on B12, even if their levels look okay of serum B12.
Dr. Mark Hyman (37:33):
And sometimes, they might not be able to absorb it in their gut, so they might need it under the tongue, or they might need a shot.
Dr. Elizabeth Boham (37:37):
Dr. Mark Hyman (37:38):
Right. So, it’s very personalized, very customized, and it’s really… When there’s this whole backlash against vitamins and the research, I think it just makes people feel like nothing works. And I think, when you’re looking at these large populations, these large studies, the effects kind of get washed out, and it’s unfortunate.
Dr. Mark Hyman (37:57):
The other issue is people get hooked on the nutrient of the day. Right? And then you can get into trouble. We saw that with what we call the carrot study, which was… there was awareness that people who ate more carotinoid-containing vegetables like carrots and sweet potatoes had less lung cancer, so they did a study. Well, let’s take people who are high-risk of lung cancer, who are smokers, and let’s give them lots of beta-carotene, which is one of hundreds of carotenoids that’s naturally found in food. And it sort of belied a lack of understanding of how these nutrients work. They work as a team.
Dr. Mark Hyman (38:38):
So, antioxidants, which is beta-carotene, is only effective if there’s other antioxidants. So, it’s like, say, a hot potato. You need vitamin C, you need vitamin E, and lipoic acid, and glutathione, and the carotenoids, all of them work together, and if you just do one, you’re going to increase the hot potato, but there’s nowhere to hand it off to, and then these patients actually got more cancer. So then, “Oh, taking beta-carotene causes cancer.” Well, not exactly. In certain patients-
Dr. Elizabeth Boham (39:07):
It’s just more complex, right?
Dr. Mark Hyman (39:09):
Yeah. So, I think we have to be careful with these studies. And when you look at smaller studies, we look at interventional studies, they often show, in the right patients, it can be profoundly effective.
Dr. Elizabeth Boham (39:19):
And I know with our patients, they are profoundly effective in terms of how they can be so helpful for energy, how they could be so helpful for depression, how they could be so helpful for their digestive system, how they could be so helpful for healing in the body and skin. So, we see it every single day in our practice how powerful these nutrients can be, when used appropriately.
Dr. Mark Hyman (39:40):
Yeah, and I think it’s just not taking mega-doses; it’s taking the right amount for you to optimize your health. And that’s the other issue. It’s not just the minimum amount for the RDA. People say, “Oh, on the bottle, it says 200% of the RDA, that’s dangerous.” I’m like, “No, that’s the minimum amount you need so you don’t get scurvy or rickets. That’s not to help you create optimal health.”
Dr. Elizabeth Boham (39:56):
Optimal health, right.
Dr. Mark Hyman (39:58):
Even in the RDI, it says you need maybe 30 units of vitamin D so you don’t get scurvy, but you can take up to 4,000. And there’s this whole idea which I love, it’s just this long-latency deficiency disease. So, we know if you acutely don’t have vitamin C, you get scurvy, or if you acutely don’t have vitamin D, you get rickets. But what happens if you don’t have vitamin D at a high enough level over your lifetime? You get cancer, you get osteoporosis, you get muscle loss.
Dr. Elizabeth Boham (40:24):
Right. It’s that whole triage theory that Bruce Ames has really done research on and shown that if we know that if… When the body is insufficient in a nutrient, you may not have a deficiency, like of vitamin C causing scurvy, but if you have insufficiency for long periods of time, the body’s going to use… It has this triage theory going on, which is what Dr. Bruce Ames, who’s one of the real pioneers and researchers in nutrition and nutritional science, has shown that the body then uses the vitamin C what it really needs it for acutely, but then may not have enough to do some of those lower-level functions in the body. So, you then over-
Dr. Mark Hyman (41:04):
Maintenance and cleanup.
Dr. Elizabeth Boham (41:04):
Yeah. So, over years and years, you start to get chronic disease and you don’t feel as good.
Dr. Mark Hyman (41:09):
Yeah. I love his concept of a metabolic tune-up, and that just a moderate amount of the right nutrients for your life stage and age really helps you get a metabolic tune-up and avoid a lot of the consequences of unhealthy aging, which is pretty cool. I certainly know they’ve helped me, I know they’ve helped you, and I think that they will help so many patients.
Dr. Mark Hyman (41:30):
But it’s important to understand what your particular issues are, what your needs are, and that’s really what we do here at the UltraWellness Center, is help people figure out what their issues are, because everybody’s different. It’s personalized nutrition, it’s precision nutrition, and personalized medicine. And by doing that, through the way we approach patients holistically, through systems approaches, through the kinds of diagnostics and testing we do, we really can get an incredible set of data that help us to get people better when they’re not getting better from a lot of other approaches.
Dr. Elizabeth Boham (42:00):
Absolutely. It’s the future of nutrition, right? [crosstalk 00:42:02]
Dr. Mark Hyman (42:02):
Dr. Mark Hyman (42:03):
If you’ve been listening and you’re interested in coming to see us, we’d love to see you here at the UltraWellness Center. Just go the UltraWellnessCenter.com, and you can now see us virtually through Zoom, which means you don’t even have to get out of your bed, and you can come right and see us. We’ll even send someone to your house to draw your lab tests if you want, so you don’t have to leave your house. We’d love to help you and anybody you love, so check us out at the UltraWellness Center at UltraWellnessCenter.com.
Dr. Mark Hyman (42:29):
And if you loved this podcast, please share it with your friends and family on social media, leave a comment; we’d love to hear from you. And tell us about your experience with nutritional deficiencies and supplements; we’d love to hear about it. And of course, subscribe wherever you get your podcasts, and we’ll see you next time on The Doctor’s Farmacy.
Dr. Elizabeth Boham (42:54):
Thank you, Mark.