Dr. James DiNicolantonio:
Even if you go and eat “real food”, if it’s not from a regenerative farm, there are four main minerals that are now depleted in both animal foods and plant foods across the board, and that’s magnesium, calcium, copper and iron.
Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman. That’s Farmacy with an F. A place for conversations that matter. If you ever thought about the fact that you might be deficient in certain nutrients, well, this is the podcast you want to listen to because we’re going to talk about minerals today. We’re going to talk about it with James DiNicolantonio, who’s an incredible researcher, scientist. He’s just prolific, and is constantly helping me understand the world of nutrition, minerals, and all kinds of stuff related to nutrition and health. So welcome James.
Dr. James DiNicolantonio:
Thanks, Mark. Great to be back on.
Dr. Mark Hyman:
Yeah. James is a doctor of pharmacy. He’s a cardiovascular research scientist. He’s known internationally for his work on health nutrition and has actually testified in front of the Canadian Senate on the harm of added sugar. No surprise that’s harmful. He’s an associate editor of the British Medical Journal’s Open Heart, and on the advisory board of many other medical journals. He’s authored over 250 publications in the scientific literature, and the author of five best-selling books, including The Salt Fix, which challenges our ideas about salt, Superfuel, which I think he wrote with Joe Mercola about fat in the diet, and Longevity Solution, The Immunity Fix and The Mineral Fix, which is what we’re going to talk about today, which is minerals. Thanks, James, for being on The Doctor’s Farmacy.
Dr. James DiNicolantonio:
Thanks for having me, Mark. It’s great to be with you.
Dr. Mark Hyman:
Okay, so when we think about food, we think about protein, fat, carbs, maybe fiber, and we talk about vitamins and minerals, but most of us don’t recognize how deficient we are. You wrote that it’s estimated that one in three Americans are deficient in at least 10 minerals, I mean insufficient deficient. How does this happen? Why are we so deficient? Tell us more about this rampant pandemic we’re having, it seems, of nutritional deficiencies, even in a world of abundant calories and food.
Dr. James DiNicolantonio:
Well, that’s a great way to put it. It really is a pandemic. It really almost started in 1940. There’s three primary reasons why most of us are actually deficient in about 10 minerals. The number one reason is the foods that we eat are now just simply more nutrient depleted compared to 50 to 80 years ago, because of how we grow our food. The second reason is 60% of our calories come from processed foods, flour, sugar, seed oils, which essentially that eliminates 80-100% of the minerals in those products. Then the third factor is that, at least for the majority of adults in the United States, most of them have at least one chronic health condition, which either that condition depletes us of minerals, or the medications used to treat those disease states deplete us of minerals. So we can sort of take a deep dive into each one of those to sort of explain to people what’s happening.
Dr. Mark Hyman:
Yeah, and then I wanted to also get into not only why we’re so deficient, but what does that mean for biology and how does that show up clinically or symptom wise, because it’s not just an idea that, oh, I’m deficient in certain minerals. These minerals are key for our biological functioning, and when they’re not in adequate amounts in our body, we get problems, we get symptoms and conditions/diseases. It’s important to sort of think about why we’re so deficient, but also how do we diagnose it and what do we do about it, because it can make a huge difference in people’s health. I’ve seen using minerals in my practice over the last 30 years in functional medicine be one of the most powerful things to help improve people’s overall well-being and health. Let’s drop down and just go through each one of those four points because I think it’s important. Why is the food less nutritious than it was 50 years ago, and what does it have to do with the way we grow it?
Dr. James DiNicolantonio:
Right, that’s a great point. There’s two main reasons why. One is that we now grow food for yield, so essentially we are growing plants and animals quicker, whether we’re fattening up a cow and slaughtering them at 14 months instead of two to three years. So the animal or the plant simply does not have the time to actually take up all the nutrients. It’s literally more diluted in nutrition, whereas if we were to [inaudible 00:04:25] an animal that had lived for years, it would have had much longer to actually extract nutrients from the diet, so that’s number one.
Dr. James DiNicolantonio:
The other is the phosphorus fertilizers that are being used that inhibits the uptake of numerous minerals. Clinical studies have shown if you take, let’s say for example raspberries, and you use those phosphorous fertilizers, that decreases the calcium and magnesium by 30%, the boron by 30%, and same thing with zinc. So it’s kind of shifting away from regenerative farming, and more to these mono cropping increasing yield, and it’s leading to these nutritional dilutions compared to just 60 years ago.
Dr. Mark Hyman:
Yeah. Also, aside from the fact that we breed for yield and not flavor or nutritional density, which is one problem, and aside from the fact that, because of the increased carbon dioxide in the atmosphere, the plants are eating that and they grow more carbohydrates, become more starchy and less nutritious and less protein and minerals, and then the soil has been damaged so much by all these compounds you talk about, even things like glyphosate, it kills the microbiome of the soil. And there’s a symbiotic relationship between the soil microbes and the plant, because the microbes and the organic matter in the soil are required to extract the nutrients from the soil to put in the plant. So even if the soil’s full of nutrients, if soil’s dead and there’s no organic matter, no microbes, the plant can’t get access to those nutrients.
Dr. James DiNicolantonio:
Exactly. That’s 100% correct. For example, there are some studies suggesting that glyphosate will inhibit the uptake of minerals into the plants. The acidity of the soil also reduces the uptake of those minerals. So you may not necessarily see a reduction in the mineral content of the actual soil, although we know the topsoil is obviously much more nutrient depleted. But even in those instances, if the soil is more acidic or you have glyphosate, in the plant there’s a reduction in its uptake of nutrients.
Dr. Mark Hyman:
Yeah, and the second point you made was we’re eating processed food. 60% of our calories, basically, is deliberately stripped of all of its nutrients, and then it’s fortified with stuff because they’ve taken it all out. We actually first saw signs of vitamin deficiency when we started to polish rice. It was interesting, it was given to the chickens in prisons in Europe, and then to the prisoners, and they all got really sick, and it was because of the vitamin deficiencies. The same thing’s happening now. Then we say, we have to enrich the flour or enrich the rice. But that’s silly. Why not eat the whole food, which has all the nutrients? But we now are seeing a massive depletion of our diet in these minerals. What are the top minerals that we’re depleting in our food because of our eating processed food?
Dr. James DiNicolantonio:
Yeah. Well, even if you go and eat “real food”, if it’s not from a regenerative farm, there are four main minerals that are now depleted in both animal foods and plant foods across the board, and that’s magnesium, calcium, copper and iron. Copper’s been the worst. Vegetables have lost about 75% of their copper. Animal foods like meat have lost 50% of their copper. Then you have 80-90% of copper lost in cheese, and we’ve lost almost all of it in milk. So really trying to source regenerative agriculture crops and foods and animals from regenerative farms is going to be much more nutrient-dense. So really finding those local farmers that are using real, natural manure, that are not using these phosphorus, artificial NPK fertilizers and glyphosate, is really going to make a tremendous difference just from the real foods that you’re eating, not even talking about the processed foods.
Dr. Mark Hyman:
That’s a good way to help with that. The other thing you mentioned was chronic disease and also medication causes mineral depletion, and we are now … what are the data? Six out of ten of us have one chronic disease, and four out of ten have more than one. I think, what was it, 81% of Americans over 50 or something are on one or more medications. 80% of Americans. What is all that disease and drugs doing to our mineral status?
Dr. James DiNicolantonio:
Well, exactly right, that most of us are sick. What ends up happening is basically you’re not able to absorb nutrients well if you have a damaged gastrointestinal tract, for one. So many people are suffering from gluten intolerance, celiac disease, Crohn’s, ulcerative colitis. If you have damage to the gastrointestinal tract, which many of us do from eating these processed foods, you can’t even absorb the minerals. Even if you are able to absorb them, we require insulin to drive numerous minerals into the cell, including magnesium and potassium, and we know 75% of the U.S. population is insulin resistant and has high insulin levels. So you can’t even get the minerals into the cell as well when you’re insulin resistant, and if you have elevations in your insulin levels, that kicks out magnesium and calcium in the urine as well.
Dr. Mark Hyman:
Wait, wait, wait. Just to unpack this, you basically eat a lot of sugar and starch, your insulin goes up, and you start to pee out minerals, like magnesium.
Dr. James DiNicolantonio:
Yeah. You can’t even drive them into the cell to utilize them. You could be taking all the magnesium or calcium or potassium that you would like to take in a day, but if you don’t fix the insulin resistance, you’re never going to get the full driving of those nutrients into the cell where it actually is needed to work.
Dr. Mark Hyman:
Amazing. Then the other thing, you have the chronic diseases which then cause your minerals to become depleted, you have soils which are not good, which allows us to not get the minerals, we have processed food, which just by nature has no minerals, and then we take medications, which often are mineral depleting. In medical school, we all learn, oh, give someone a diuretic for high blood pressure, or for heart failure you have to give them potassium because the medication causes potassium to leach out in the urine, but also causes other minerals, like magnesium. So talk about this general idea.
Dr. Mark Hyman:
We talk about, oh, be careful taking those supplements, it can interfere with your medications. But the opposite is also true, that whatever medications you’re taking may be causing massive nutritional deficiencies, whether it’s an acid blocker causing B12 deficiency, or certain antidepressants causing B6 deficiency or the diuretics causing magnesium deficiency. So talk about the minerals and the depletion of our nutritional status by the medications. What are the top medications that cause the problems, and what do they do?
Dr. James DiNicolantonio:
Well, one of the first medications a doctor will throw someone on if they have high blood pressure is something called a thiazide diuretic, something like hydrochlorothiazide or chlorthalidone, indapamide are some of the names that some people may be familiar with. You’re right, the medical community thought for a long time, and they still think this, that the potassium depletion, you just give these people more potassium. But it’s really the magnesium depletion that these thiazide diuretics are causing that is causing the body to not be able to hold onto potassium. So 80% of people who are on a thiazide diuretic for six months or longer are deficient in magnesium, 80%. And it’s one of the most prescribed medications in the United States.
Dr. Mark Hyman:
What’s so fascinating about that is that magnesium lowers blood pressure, so you’re kind of getting rid of the very mineral that you need to keep your blood vessels relaxed and not have high blood pressure. In fact, that’s what we give women when they come in with high blood pressure from pregnancy, we call it preeclampsia, the treatment is intravenous magnesium.
Dr. James DiNicolantonio:
Right, exactly. Before we had all these types of medications, we used to treat many health conditions with magnesium, including preeclampsia. There have been many clinical studies that show that live birth rates are much better, especially if you start earlier on in your labor, or pre-term, with magnesium supplementation. So it really is one of the missing minerals in the diet. It’s said that 50% of people with high blood pressure or heart disease have magnesium deficiency, and half the population isn’t even getting the RDA for magnesium. What’s interesting, what we talk about in The Mineral Fix-
Dr. Mark Hyman:
Before you go onto that, the RDA, for everybody listening, is the minimum amount you need, or they call it RDA, but the minimum amount you need to prevent deficiency diseases. It’s not how much you need for optimal health. It’s like how much do you need so you don’t get scurvy for vitamin C, or rickets for vitamin D. It’s not really the amount your body needs for optimal functioning. It’s so important to re-think our approach to nutrition based on optimal performance and function rather than simply prevention of deficiency diseases, which is what our whole medical training has been around vitamins. The interaction between the drugs and the nutrients is a really big deal, like you’re saying with thiazide diuretics, but there’s other examples of other nutrients that get depleted. What are a few other examples of common medications and the nutrients that they deplete?
Dr. James DiNicolantonio:
Well, another common medication is proton pump inhibitors, which are prescription “acid-suppressing therapies”, as well as antacids over the counter. There’s actually-
Dr. Mark Hyman:
They’re a leading class of drugs, by the way. After statins and antidepressants, it’s the third leading class of drugs.
Dr. James DiNicolantonio:
Exactly, and if you have heartburn or reflux, most doctors will just throw these at you, and you’re not really supposed to be on them for longer than two to three months at the most. Doctors usually just put people on these for years, and they started noticing that people were becoming deficient in numerous minerals, particularly magnesium, and now there’s an actual black box warning that these medications can lead to magnesium deficiency, an actual black box warning.
Dr. Mark Hyman:
A black box warning is on the label a pharmacist has to put, this black box that says if you take this medication, this is going to happen to you, or this may happen to you. You might get magnesium deficiency. This is kind of a big deal for that to happen.
Dr. James DiNicolantonio:
Right, exactly. That’s the crux of the book, The Mineral Fix, is that the RDA does not match the optimal intake for nutrients. Most people understand that things like refined sugar or refined carbs and seed oils are bad for their health, but what a lot of people do not realize is that if you do not hit optimal intakes for nutrients, that is just as damaging to your body.
Dr. Mark Hyman:
Wow, that’s a big sentence. If you are avoiding all the crap and you still don’t have optimal levels of nutrients in your body, it’s still harmful to you, right?
Dr. James DiNicolantonio:
It’s extremely harmful. I mean, what was really interesting was one study. They put women on a diet that contained 100 milligrams of magnesium. Within just a few weeks, a third of those women developed atrial fibrillation and atrial flutter. So you can induce arrhythmia simply by lowering the magnesium content of the diet, and you can see these types of harms with numerous nutrients. They’ve done this with copper as well. This is actually what’s really scary. We have the RDA completely wrong for copper. It was set based on essentially just one or two balance studies, and they forgot to actually test mineral losses through sweat. They didn’t think copper was lost through sweat, so they just looked at urine and stool copper loss for the RDA for copper. Well, it turns out that we lose about 0.3 milligrams of copper through sweat per day, and so the RDA doesn’t even actually maintain balance for likely half of the population. There are studies that show that if you even go slightly above the RDA, if you put someone on, let’s say, one milligram of copper per day, you can induce insulin resistance, high cholesterol, high triglycerides, all these problems that you would induce with a high sugar diet, simply by eating a low amount of copper.
Dr. Mark Hyman:
Wow, that’s incredible. So we’ve got copper, magnesium. What are the other common minerals that we’re low in, and what are the impacts of those?
Dr. James DiNicolantonio:
The top 10 minerals are really boron, manganese, potassium, magnesium, calcium, zinc, selenium, even molybdenum. When it comes to immune health, we all know that zinc and selenium are extremely important, and simply being deficient in selenium can essentially turn non-virulent viruses into something that could potentially kill you.
Dr. Mark Hyman:
Well, you know, there’s a fascinating study on COVID in China where they looked at areas where there was high selenium in the soil versus low selenium, where people were tending to be deficient in selenium. I think they had five times higher risk of ending up in the hospital or dying, or three times higher risk. It was a dramatic difference between the adequate and the deficient selenium groups. That’s just one mineral. We have many, many minerals that are all dynamically interacting together that regulate thousands of different biological functions.
Dr. Mark Hyman:
People think, oh, vitamins and minerals are just not really that important, or you can get it all from your food, or we’re not really that deficient. How could we be deficient? We’re such a well-nourished country, there’s so much obesity. But there’s actually a phenomenon of the more obese you are, the more mineral, nutrient, vitamin deficient you typically are, even vitamin D. It’s sort of striking to see this paradox of obesity and malnutrition going together. We really have this moment to sort of look at our biology and go, wait a minute, how do we optimize it, because it’s not simply about getting adequate levels, it’s about getting optimal levels, and that has a profound effect on our overall biology. So tell us a little bit more about why these deficiencies drive disease. You mentioned a little bit about it, but give us some practical examples of, if I’m deficient in X or Y, what will I see as a doctor in my practice?
Dr. James DiNicolantonio:
Well, if you think about, let’s talk about brain health for example. If you want to actually create the three feel good neurotransmitters, serotonin, noradrenaline, norepinephrine in the brain, and dopamine, there’s enzymes in the brain that require minerals to actually create serotonin, and then also form the melatonin from serotonin. They depend on magnesium, zinc, calcium, iron, copper. If you are deficient in those minerals, most doctors don’t even look or test for that. They simply just give you [inaudible 00:18:43], or if you can’t sleep, they will simply give you a pill to help you sleep. But if you’re deficient in any of those minerals, the enzymes can’t even convert tryptophan eventually to serotonin and melatonin. So a lot of these issues with sleep, anxiety, mood disorders, depression, are literally being driven by these mineral deficiencies.
Dr. Mark Hyman:
Yeah, that’s incredible. I mean, I’ve seen so much in my practice. This one patient, not a doctor report, but she had classic signs of magnesium deficiency. She was a doctor, radiation oncology resident actually, worked at Mayo Clinic, had seen the top headache specialist, had intractable migraines, was on narcotics and Zofran, which is like a chemo, anti-nausea drug. I talked to her, and I said, “Tell me about your other symptoms besides the migraines.” I said, “How’s you’re digestion?” “Oh, I’m pretty regular.” I’m like, “Well, how often do you go to the bathroom?” She’s like, “I’ll go once a week.” I’m like, “That’s not regular.” She goes, “Regular for me. I go every week.” I’m like, “No, you’ve got to go every day.” I said, “Tell me the other symptoms you have.” “I have anxiety, I have insomnia, I have palpitations, I have muscle cramps, I have bad menstrual cramps.”
Dr. Mark Hyman:
These are all signs of magnesium deficiency. If you’re alert to it, and it may be other things, like sensitive to loud noises, or irritability, and anything that’s sort of spasms, twitchy or irritable, is typically a sign of magnesium deficiency, and that’s because magnesium is a relaxation mineral. When I gave her magnesium, I literally had to give her 2,000 or more milligrams a day in order to get her to start going to the bathroom and relieve her headaches. It was amazing. Once we gave her the magnesium, all of her symptoms went away. What causes magnesium deficiency, besides not getting it in your diet, is things like caffeine and stress. I remember one study in Kosovo where they looked at magnesium levels in the urine, and they found high levels in people who were really stressed.
Dr. Mark Hyman:
You can’t really test for it in a way that most doctors test for it. It’s not really adequate. Maybe would you mind just sharing a little bit about the challenge we have with testing and how we can diagnose these mineral deficiencies? Because people are like, “I’m listening to this, and I’m like, do I have mineral deficiencies? Is it causing my health issues?” How do you diagnose it, because typically, traditional medicine is pretty crappy at diagnosing nutritional deficiencies, and particularly around minerals?
Dr. James DiNicolantonio:
Right. That’s a good question, and part of the problem is some of these minerals are what are called acute phase reactants, meaning if you have inflammation in the body, the levels of those minerals will either go up or down, depending on inflammation. So for example, if you are inflamed, zinc will go down, selenium will go down and iron will go down, and you may not be deficient, but the inflammation’s driving it down. On the flip side, inflammation will actually increase copper levels, so you could be deficient in copper, but the inflammation is driving your levels up because it’s an acute phase reactant. The other problem is most minerals do not sit in the blood. They’re mostly in the tissue or the bone, so take magnesium for example. 1% of your entire body’s magnesium is actually in blood. 99% is in things like muscle and bone, and of course we’re not going in and taking a sample of someone’s bone or tissue to test for magnesium deficiency.
Dr. James DiNicolantonio:
So what are some of the best ways to actually look for mineral deficiencies that people can actually do? It’s really actually looking to see if you’re at the lower end of normal on a blood test. What happens with mineral deficiencies, you don’t typically fall below the actually normal threshold unless you are significantly deficient. But what will happen is you will go from a middle point of normal, just to the lower end of normal. And if you’re sitting on that lower end of normal, especially if you have a low amount coming out in the urine, that is highly indicative of mineral deficiency.
Dr. Mark Hyman:
Yeah, that’s a great point. I think we, in medicine, we’re learning lab tests, and we see, okay, this is the normal range. But when you understand what normal means, it’s a statistical number based on the population. So, if I were to land in America from Mars, and I go, hmm, what’s the normal weight of Americans? Well, given that 75% are overweight, it’s normal to be overweight. That doesn’t mean it’s optimal. And in addition, we use this sort of two standard deviations, meaning we use a wide bell curve for figuring out what’s normal. So you could be 2 or 92, and it’s still the same reference range, right? Maybe it should be one standard deviation should be where we think it’s optimal, and anything outside, above or below, is a problem. I think we’re learning this in medicine, that disease is not just an on or off phenomenon. It’s a continuum.
Dr. Mark Hyman:
You might, for example, see blood sugar being normal up to 100, but in fact we know that if your blood sugar is over 87, according to Israeli studies, that your risk goes up of heart disease and death in a linear way. So 88 is worse than 87, and 90 is worse than 88. And the same thing with nutrition. We don’t want too much. We want to make sure we have optimal levels. Magnesium is an interesting phenomenon. When I started practicing, magnesium was one of those miracle drugs that I started using in functional medicine. It’s incredible. It would help people to sleep, with all sorts of issues.
Dr. Mark Hyman:
It’s hard to test, because the typical thing I learned in medical school was just check the serum magnesium level. If you’re seeing it’s low and abnormal, which is like two, then you’re worried. But by the time it gets there, you’re already pretty depleted. Then you look at red cell levels, which is a little bit better, which is what’s in the cells, because typically magnesium is more in the cells, but that also isn’t perfect, although it can be a little bit better. Then there’s the real test, which is a magnesium loading test, where you basically deplete the body of magnesium, you don’t take it for a while, you give a big magnesium load, and then you collect the urine for 24 hours, because that will tell you how much spills out. If you hold all the magnesium in your body, that means you’re pretty deficient, if you don’t pee it out. Nobody does that test. There are other indirect tests. We use organic acid testing and so forth. Amino acids, we can sort of indirectly tell whether there’s some nutritional deficiencies, but it’s really tough.
Dr. Mark Hyman:
Hey, everybody, it’s Dr. Hyman. Thanks for tuning into The Doctor’s 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. 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 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 Fridays. Nothing else, I promise. All you need 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. Now, back to this week’s episode.
Dr. Mark Hyman:
Besides magnesium, what other tests, if you’re wanting to know what your nutritional status is, do you just go to a regular doctor and get regular tests? What are the best tests for the top things like selenium, zinc, magnesium we talked about, copper?
Dr. James DiNicolantonio:
The best test that has actually been matched against the gold standard, IV magnesium load, is actually mononuclear blood cell magnesium levels.
Dr. Mark Hyman:
The white cell level. White blood cell.
Dr. James DiNicolantonio:
Yeah, it’s called mononuclear blood cell. It’s the only blood test that I’ve ever seen that actually correlates well with the IV magnesium load, which is the gold standard for testing for magnesium deficiency. That, typically, though is not ordered by your doctor, and that’s the problem, right, is that you would think the first thing that all of us would know is we would have a list of 20, 30, 40 vitamins and minerals, and we would understand if we’re deficient or not. And our doctor would first instantly say, okay, you’re deficient in 10 minerals. Here’s the foods you need to start eating to replace those.
Dr. James DiNicolantonio:
They don’t do that. They just say, high cholesterol, high blood sugar, high blood pressure, here’s this pill, this pill and this pill, and they send you on your way. That’s the problem. We need to get health insurance companies to pay for and reimburse for vitamin and mineral tests, because you can do hair analysis, it’s not perfect, but that is a three month reflection of blood, so that’s a potentially better way for numerous minerals. You always want to have serum as well, and you want the serum to be not on the lower end of normal. Then you can also do many other tests, but typically it’s white blood cells that you look at for minerals, whether it be neutrophils or leukocytes, leukocyte copper, neutrophil zinc are some of the best tests to actually get for those minerals.
Dr. Mark Hyman:
And people can do that through the regular lab test?
Dr. James DiNicolantonio:
Typically doctors don’t do that. There’s certain companies that specialize in those type of tests, and some have their own unique methods for doing this. That’s the problem. We don’t have insurance companies demanding or paying for these better tests for minerals, so most people are stuck with serum. You just want to make sure you’re definitely not at the lower end of normal on serum.
Dr. Mark Hyman:
Yeah. Great. Okay, so we’re seeing that there’s massive deficiency, we probably need to take something. How do these nutritional deficiencies, micronutrients have on our health span and life span in terms of longevity and premature aging, and how do we get to avoid premature aging and increase our longevity?
Dr. James DiNicolantonio:
What we need to understand is everybody focuses on macronutrients, right? How much carbohydrates versus how much fats. You have people that are high carb, people that are low carb. They forget that it’s the minerals that determine how well you actually convert those macronutrients into energy, how well your muscle can grow, how much ATP you can produce. Everything is dependent on it. I kind of laugh when people say it’s all about calories with weight loss, when literally your fat burning machinery depends on minerals. Some people can be eating a low calorie diet, but a micronutrient deficient diet. You’re going to gain much more weight than someone who is eating more calories but are getting more minerals, because your fat burning machinery will actually work better.
Dr. James DiNicolantonio:
Take magnesium, for example. You cannot activate ATP without magnesium. It binds to ATP, it cleaves to terminal phosphate, and it releases energy. Everything depends on ATP. Magnesium is required to produce protein, DNA, RNA. I don’t know a single function in the body that does not work without ATP and protein and DNA. So literally everything depends on minerals. Like you had said, magnesium is the relax mineral. It prevents calcium from actually accumulating in the arteries. One sign of mineral deficiency is coronary artery calcification, which a lot of docs are starting to use, versus just cholesterol tests.
Dr. Mark Hyman:
Yeah. So how does mineral deficiency cause the calcium to deposit?
Dr. James DiNicolantonio:
Essentially magnesium is nature’s calcium channel blocker, and it prevents the endothelial cells that are lining the arteries from accumulating calcium. So there is this balance we talk about in the book. It’s not also just about the overall amount of minerals you’re getting, it’s the balance between them. You don’t want to have really more than a two to three to one ratio of calcium to magnesium. Otherwise you’re going to start getting issues because the balance is off.
Dr. Mark Hyman:
Yeah. Interesting. So the thing we often hear about, let’s just talk about some of these chronic age-related diseases, is high blood pressure’s an issue. We’re taught that we should not be eating salt or having too much salt because it can cause high blood pressure. Yet you challenge that whole hypothesis. We’ve had you talking about this before on an Instagram Live or a podcast. You wrote this book called Salt Fix, which challenges our notion of salt being the enemy and the evil that we thought it was, although it is for some people. Can you kind of break down in just sort of a short nugget, what is the right thinking about salt? Where have we gone wrong and how do we fix it?
Dr. James DiNicolantonio:
If you eliminate refined carbs and sugar, you make sure you’re getting enough magnesium, you make sure you’re getting enough potassium, only 1% of the population would probably actually have a significant rise in blood pressure with a normal salt intake. In other words, it’s not the salt. The problem is the sugar and the refined carbs that are causing you to over-retain salt.
Dr. Mark Hyman:
Yeah.
Dr. James DiNicolantonio:
It’s really not a problem for most people if they fix those three underlying causes, and that’s sort of what I discuss in The Mineral Fix and The Salt Fix.
Dr. Mark Hyman:
The three causes being again …
Dr. James DiNicolantonio:
Of over-retaining salt would be insulin resistance, low potassium, low magnesium intake.
Dr. Mark Hyman:
Okay, so this seems so easy to fix. You get magnesium, you get potassium, which we get from vegetables and plant foods, right, and you cut out the starch and sugar. As a doctor, what’s interesting, when I tell people to cut out starch and sugar, what happens is the body starts to dump huge amounts of salt, and you get all kinds of “side effects” from going on a low carbohydrate diet, including feeling achy, tired, wiped out, and it’s like essentially having electrolyte depletion. The reason that you’re doing it is not because your body’s doing something wrong. It’s because before you were having so much sugar and starch, your body was holding on to all this salt, and suddenly it dumps fluid and salt, which is a good thing, but you have to make sure you’re getting adequate salt while you’re doing that, because if you don’t, you’re going to feel like crap, so it’s really important for people who do switch their diets to understand.
Dr. Mark Hyman:
The same thing happens with the keto flu, this whole idea of the keto flu. You go keto, you cut out carbohydrates, you get sick like the flu, but that’s because of the mineral depletion from the dumping of the salt from the lower levels of insulin, which is after you cut out the starch and sugar. So it’s a really important idea. But there are people who are salt sensitive and have salt-sensitive hypertension, right? The African-American community has more of that. Is that fair to say?
Dr. James DiNicolantonio:
Yeah, they do have more, but typically it’s because their dietary potassium, magnesium is very low, and they eat high amounts of high carbs and sugars. What’s interesting, you give those people metformin, and you help fix their insulin resistance, and you actually fix most of their salt sensitivity. So in The Mineral Fix and The Salt Fix especially, we cover a couple of those clinical studies. You give salt sensitive people metformin, or you put them on a lifestyle better diet, and you fix their insulin resistance, they’re no longer salt sensitive. So really, one of the best measures of insulin resistance is if you’re salt sensitive.
Dr. Mark Hyman:
Interesting. Interesting. Yeah, I see a lot of my patients, as soon as they change their diet, boom, their blood pressure comes down and they have to start peeling off the medications because their blood pressure drops too low. It’s sort of paradoxical to think that actually maybe it’s not the salt, it’s the lack of potassium and magnesium, which are rampant deficiencies, and potassium comes from mostly plant foods. So you say, oh, eat a banana for potassium, but if you just make a big vegetable broth or make a good soup, even seaweed, I like to put seaweed in the soup, that helps you get a lot of potassium and extra minerals, so it’s really important. Seaweed’s a great source of minerals, isn’t it?
Dr. James DiNicolantonio:
Yeah. No, it absolutely is. That’s a good point that just being a little bit low in potassium can cause you to over-retain salt, and so again, it’s this balance. You need to make sure. Typically what I do, I probably get four grams of potassium per day and four grams of sodium. I don’t have high blood pressure, and it dramatically improves my performance. Most people don’t really utilize salt correctly.
Dr. Mark Hyman:
Before you go on, just the average recommendation is two grams or les for salt, right? It’s two and a half.
Dr. James DiNicolantonio:
Right.
Dr. Mark Hyman:
So you’re saying to me twice the amount of salt that our current experts are recommending, but you also eat a lot of potassium and it seems to balance out.
Dr. James DiNicolantonio:
Exactly. The typical American’s only consuming maybe two and a half grams of potassium, and that’s the problem. If they bump that up to about four grams, then most of those individuals wouldn’t have an issue with a normal salt intake. I mean, I’ve published numerous papers on why we recommend such a low intake of salt, and it’s strictly based on blood pressure. But they never look at the other surrogate markers that are actually worsened on a low salt diet. For example, you may have a slightly lower blood pressure, but that’s not necessarily good. I can dehydrate you and tell you to only drink two ounces of water per day and lower your blood pressure. So to think that that one surrogate marker is the most important is really just narrow focused. But if you look at the harms, like stress hormones, aldosterone, renin, angiotensin II, those artery-stiffening hormones, they all increase with a low salt diet. If you go below three grams of sodium per day, all those stress hormones increase. So we [inaudible 00:35:42] picture.
Dr. Mark Hyman:
Yeah. That’s great. It’s really helpful. Historically, as hunter-gatherers, we probably had one to one sodium and potassium. Now we have a ten to one sodium to potassium, and that’s coming primarily from processed food. I always say it’s not the salt or sugar you add to your food, it’s the sugar or salt that’s added by corporations, that’s hidden in your food, that’s the problem. I mean, you probably wouldn’t be able to tolerate that much salt if you just put it on your food, but when it’s sort of buried in tasteless refined ingredients, it kind of makes it all taste good, but it’s actually killing you.
Dr. James DiNicolantonio:
Right. Getting a normal salt intake is actually one of the best ways to reduce sugar cravings, because one of the survival mechanisms that we had, you can see this in animals. When they’re depleted, how do they know to go to a salt lick and actually eat salt? How do they actually do that, right? It’s because their reward center in the brain is actually hyper activated. That’s what happens in humans as well. If you don’t get enough salt, your reward center’s hyper activated, and you get more of a dopamine response to things like sugar, Adderall or any type of addictive substance. So low salt can literally drive sugar addiction.
Dr. Mark Hyman:
That’s incredible. All right, let’s talk about COVID-19, because we’re in the middle of this pandemic, and it’s clear that minerals play a role in the prevention, and potentially even treatment of COVID. We did see with our government recommendations, they’re not including all these guidelines about how to upgrade your nutrition or improve the quality of the food you’re eating or taking supplements. Although I was sort of surprised when President Trump had COVID, they put him in the hospital, and the New York Times they report, oh, he’s taking zinc and he’s taking vitamin D. They actually were practically applying it in the hospital, but they’re not telling Americans to do this. Talk about what are the key nutrients that can worsen COVID outcomes if you’re deficient and what we should do about it.
Dr. James DiNicolantonio:
Yeah I put together a pretty good chart in some of the books on the top nutrient deficiencies and how much they actually increase the risk of having a poor outcome or dying from COVID. The top nutrient deficiency would be vitamin D. Essentially if you are significantly vitamin D deficient, you’re at a up to 15 fold higher risk of dying from COVID, and [inaudible 00:38:04] times higher risk of having a poor COVID outcome. Selenium and zinc sit, as you said, somewhere between a three to five fold higher risk of having a poor COVID outcome or dying from COVID if you’re deficient in those minerals.
Dr. James DiNicolantonio:
I love this example that we … There was a non-virulent RNA virus called coxsackievirus. It causes hand, foot and mouth in some kids, but in adults it doesn’t do much unless you’re selenium deficient. If you’re selenium deficient and get coxsackievirus, you end up with keshan disease cardiomyopathy, and you potentially die from the virus because you’re selenium deficient. And we treat these people by just giving them selenium. So this would obviously translate to other RNA viruses as well. So we have a clear past example that mineral deficiencies can lead to fatal outcomes from an RNA virus. So why this isn’t being talked about with COVID is beyond me.
Dr. Mark Hyman:
It is incredible. The selenium study from China was so fascinating about COVID-19 and the dramatic changes in outcomes just based on one mineral. And zinc also. How does zinc play a role in immunity, and what is the role of zinc in the body?
Dr. James DiNicolantonio:
There’s two different mechanisms. Zinc lozenges have a direct anti-viral effect in reducing viral replication and penetration into the cell. That’s why there’s these “zinc ionophores” that are trying to get more zinc into the cell as well. Then you have zinc that just controls numerous immune cell health, and they utilize zinc for helping to kill viruses. Actually, magnesium is probably one of the most important because the ionic magnesium in immune cells actually controls their receptors to be able to attack viruses. Zinc, magnesium, selenium is important for the antioxidant functions. We kind of think of vitamins as being the antioxidants in the body, but it’s actually the minerals because they actually control our antioxidant enzymes. There’s copper, zinc superoxide dismutase, which it’s the superoxide anion that depletes us of our nitrogen oxide. So not getting enough minerals can actually reduce nitric oxide and increase blood pressure.
Dr. Mark Hyman:
Let me unpack that for a minute, because I think people aren’t necessarily going to get that. Basically your body has its own antioxidant system, and there’s some very powerful antioxidants, like superoxide dismutase, catalase and so forth. In order for these things to function, they need the right amounts and the right types of nutrients. So you’re saying copper and zinc are important for, or selenium and copper are important for superoxide dismutase, and selenium is important for glutathione peroxidase. So there’s a lot of these important antioxidants that our bodies make that are way more powerful than any antioxidants you can take by taking a supplement. And they need the right levels of these minerals to function. What you’re saying is that 80% of us are deficient in these nutrients, and yet we’re not taking advantage of this knowledge from science to actually upgrade our own immune and antioxidant systems.
Dr. James DiNicolantonio:
Exactly. What’s actually really interesting is three billion years ago, when algae was producing oxygen, and this is where oxidative stress even comes from, is the actual change in the atmospheric oxygen by things like blue-green algae. The first antioxidants that they used against the defense of their own production of oxidative stress was iodine and selenium in the algae. Minerals were actually the first antioxidants in the first lifeforms on earth. What’s really interesting, even protection of the mitochondria depends on minerals. So superoxide dismutase is not just in the blood and helping the cytosol. In the actual mitochondria, there’s something called manganese superoxide dismutase, where it attacks the mitochondria, and we know that’s the powerhouse of the cell and produces ATP. So if you can’t protect your own mitochondria because you’re nutrient depleted, you cannot protect yourself from oxidative stress.
Dr. Mark Hyman:
Yeah, which is a big deal. Now with COVID, we’re really seeing the need for increased levels of some of these nutrients like selenium and zinc. Talk about iodine, because we all were eating iodized salt. There was a big problem with goiters and thyroid issues because of massive iodine deficiency in history, so we decided to supplement salt with iodine. But now people are eating iodine-free salt and sea salt. When I recommend the Redmond Salt from Real Salt from Redmond … How do we have to think about iodine in the 21st century? I’m now seeing, when I test people, iodine deficiencies and I’m sort of surprised about it, but I think it might be because of our change in our dietary consumption of the type of salt we’re eating. Talk about why it’s a problem and what we should be taking. Should we be taking iodine salt? Should we be adding iodine? Should we be eating more seaweed or fish? What should we be doing?
Dr. James DiNicolantonio:
Well, that’s a great question. One of the primary reasons that a lot of people don’t realize is we actually lose a lot of iodine through sweat. So we don’t just lose salt, we lose iodine, and I think that’s one of the keys. We lose about 15 micrograms per hour of exercise. So if you’re not consuming a natural salt that contains the iodine, you are then just simply becoming depleted, and we know that iodine controls our thyroid hormones, right? Iodine literally makes up T3, T4, and that controls our metabolism. So you could literally have low thyroid functioning, not only from a lack of nutrients, particularly iodine, but also salt because salt is required to drive iodine into the thyroid organ. It actually moves a lot of other nutrients as well, salt. The reason why we are likely deficient in iodine is A, our salts are typically depleted in it, unless you’re consuming a healthy, something like a Himalayan or Redmond, or you’re just over-exercised and you’re losing that iodine through sweat.
Dr. Mark Hyman:
So do you think we should be taking iodine supplements? Should we be …
Dr. James DiNicolantonio:
There’s kind of this narrow therapeutic range with iodine, so you have to be careful because typically the sweet spot is about 150 to 250 micrograms per day. But you start getting into the 300 or 400, and you can actually start increasing the risk of thyroid disorders and autoimmune issues. Selenium is actually what’s really important too, with thyroid health, right? In order to activate the thyroid hormone, selenium is required to do that. It depends on your overall intake. If you’re eating a lot of pastured eggs and you’re getting a lot of good sources of iodine, maybe you don’t need it, but if you’re not eating good amounts of iodine, then yeah, you probably want to either get it through supplementation or through a salt that actually contains it. But there is that narrow therapeutic range with iodine. You’ve got to be a little careful.
Dr. Mark Hyman:
Talk about the food we should be eating and the minerals that are in the food. Let’s break down the foods by the top minerals that we see are deficient. Sort of outline. Give us the top ones. Then sort of quickly go through what are the foods that these minerals are found in and how do we increase our intake of those?
Dr. James DiNicolantonio:
That’s a really good question. How I sort of build my diet is I start with about 10 to 12 ounces, let’s say, of pastured red meat. Typically, I like to actually do bison or elk or venison because that’s true ancestral meat, and those meats actually have about 50% more minerals than even grass-fed cattle. There’s numerous reasons for that. We don’t need to go into that, but I try to eat true ancestral meat. Then I try to build things off of that, because if you’re not getting a little bit of red meat, it’s going to be very difficult to get the B12, the protein, the zinc and the iron, because those four nutrients are packed in animal foods. Once you have that down, then you can build and start adding plant foods to that.
Dr. James DiNicolantonio:
Plant foods are really great for things like potassium and magnesium. That’s the key. And calcium. A lot of people are deficient in calcium, potassium, magnesium, and it’s like try to get those greens into the diet, because they’re very, very high, like kale and spinach are high in potassium, calcium, magnesium. Magnesium is very, very low in most animal foods.
Dr. Mark Hyman:
And it’s also high in beans and greens and nuts. A lot of magnesium in nuts, right?
Dr. James DiNicolantonio:
Yes. And some fish has a decent amount of magnesium. Actually, what I love is lobster and crab, because A, it doesn’t really destroy our ecosystem like fishing does. The fishing industry destroys the ecosystem, but it’s great sources for copper, magnesium, iodine, selenium. Then a lot of people do really well with just an ounce of pastured liver per day for the copper, folate and vitamin A. Just adding a little bit of pastured liver is a great source for those nutrients. You can get folates and vitamin A through pastured eggs. I think most people should be consuming a little bit of pastured eggs as well, because that brings vitamin D. It’s very difficult to get vitamin D in the diet unless you’re consuming pastured eggs. They’re also good sources of lutein, zeaxanthin, omega threes as well. So I like to have some, three to four pastured eggs per day, some pastured red meat, one ounce of liver or a half ounce of liver per day, and then you can do your plant foods for magnesium, potassium and calcium.
Dr. Mark Hyman:
Yeah. And the liver has actually more vitamin C than carrots or apples. It’s amazing. For a 100 gram portion, for example, of an apple, you get seven milligrams of vitamin C. With beef liver, you get like 27 milligrams of vitamin C. So actually it is probably the most powerful superfood on the planet, believe it or not, and is higher in most nutrients and minerals than plant foods.
Dr. James DiNicolantonio:
What’s interesting, too, is that stressed out animals actually produce up to 10 times more vitamin C. So if we were actually hunting an animal, we would be stressing that animal out incredibly, and its production of vitamin C would have been much higher. We don’t typically eat fresh meat, but we’ve sort of lost our vitamin C through that mechanism. We sort of buy supermarket foods that have been hanging for two or three weeks, and that doesn’t have nearly as much vitamin C as a fresh kill would have. The key is to try to eat as fresh as possible when you can.
Dr. Mark Hyman:
So basically you’re outlining grass-fed or wild meats, a little bit of liver, pastured eggs, lots of greens, vegetables, and also nuts and seeds. I mean selenium is high, for example in Brazil nuts and zinc is high in pumpkin seeds. I mean, iodine is high in seaweed and obviously fish. So by understanding where these come from, you can start to create a diet that is actually more nutrient dense. But you’re often saying that that’s not enough. Even if we figured out how to eat all the foods … I once had a patient, she was obsessed. She was like, “Look, I don’t want to take any vitamins, so I’m going to have my three Brazil nuts a day, my 17 pumpkin seeds and …” She figured it all out. I guess that’s okay to do, but make sure you check and test to see that you’re actually using and absorbing it. Assuming we’re doing all the great dietary changes that help us upgrade our mineral intake, who should be taking supplements? What should we be taking? How do we get these and upgrade our mineral levels?
Dr. James DiNicolantonio:
Right. That comes down to the difference between are you getting the RDA, and are you getting an optimal intake? And what’s your diet actually made up of? What’s interesting is you only need about 150 milligrams of magnesium to live per day, but the optimal intake sits more around 700 milligrams. So it’s a three, four fold difference between just maintaining balance and having optimal intakes of minerals. The same thing with copper and selenium and the list goes on and on. So whether you’re building your diet appropriately, like some of the foods that we talked about, and hitting optimum nutrient intakes, then maybe you don’t need to supplement as much.
Dr. James DiNicolantonio:
But most people are still going to be lacking boron and manganese, because those nutrients are very, very difficult to source in the diet. So probably those would be great to take. And a lot of people are deficient in magnesium, even eating good amounts of the foods we talked about. I love to drink mineral waters for that reason. Natural mineral waters, like Gerolsteiner, which is high in magnesium and calcium and bicarbonate to offset some of the acidosis from the animal foods that I consume. It’s a really good bioavailable source of minerals as well.
Dr. Mark Hyman:
Yeah. The key is to one, make sure your diet is upgraded. Just to review, magnesium is found in nuts and seeds and greens and beans. Selenium is high in Brazil nuts, pumpkin seeds and oysters have high zinc, and all protein as you mentioned. Iodine you can get from fish or seaweed. Some of these other hard to get minerals, you sometimes need to use mineral waters or supplements. Should everybody be taking a multi-mineral supplement? Should we be taking more of some of the other minerals? Should we be testing first before we take minerals, or should we just assume it’s okay to take them? What’s your sense?
Dr. James DiNicolantonio:
This is really interesting. They did a study. They looked at the typical diet. 50% of the population was deficient in things like magnesium and calcium. Then they gave them a multivitamin and mineral. Almost the same amount of people were still deficient because typical multivitamins and minerals don’t add back the key nutrients that are missing in our diet, like magnesium, like calcium, like copper. So it’s like the multivitamin and mineral doesn’t get you there for a lot of those that are still deficient.
Dr. Mark Hyman:
Yeah.
Dr. James DiNicolantonio:
[crosstalk, 00:52:39] people take the right things like calcium or magnesium or even copper because of that. So I do think a lot of people probably would benefit from actually taking not just a multivitamin and mineral, but separate minerals, especially things like selenium, zinc, because it’s typically not high enough, as well, in those types of multis.
Dr. Mark Hyman:
So why would you say you need extra? Because you’re not getting a high enough dose, is what you’re saying. But if you got a good dose as a multi-mineral, you’d be okay. But the things that I think are most important for people to take are magnesium. That’s a miracle supplement. Zinc is another common one that I’ll clinically use. Calcium, often I think people can get from their diet if they upgrade to things like chia seeds and tahini and sesame seeds and other things that have really powerful mineral content. I think that sometimes we’ll give extra iodine or chromium or boron, depending on the clinical situation. But what you’re saying is we sometimes need to take separate minerals because of this, and we need to measure our levels and we need to upgrade our diet, and that will help to address this rampant mineral deficiency in our society.
Dr. James DiNicolantonio:
Exactly.
Dr. Mark Hyman:
I think the other thing people don’t realize is oh, you know, I’m going to take this medication and it’s going to work on this single pathway, doing this one thing. A proton pump inhibitor for acid blocks this one pathway in your stomach. The problem is that these are not like drugs. Nutrients are multi-functional substances that literally affect dozens to hundreds of different biological processes every second. You have 37 billion billion chemical reactions every second in your body, and every one of those reactions needs an enzyme, and the vitamin and minerals are the helpers for those enzymes. So magnesium might help regulate hundreds of different enzymes, all doing the things like you mentioned, whether it’s keeping your blood pressure good or your brain function or your DNA regulation. I mean, all these things are so critical to our biology, and we’re low in these nutrients. Even small amounts can have profound effects, I mean, really profound effects.
Dr. Mark Hyman:
Just an example, I used to work in the emergency room. We had this incredible scene where people would come in with alcoholism and they’d be completely wiped out, drunk and have never eaten food. They’re very nutrition deficient. They get thiamine deficiency and they have encephalopathy, which means they’re basically psychotic. You just give them a vitamin, and the psychosis goes away overnight, literally. That’s the power of these nutrients. At incredibly small doses, they can have profound biological effects.
Dr. James DiNicolantonio:
Right. I mean, we didn’t even know about these issues until we started polishing rice, or until people started doing these abnormal things to their bodies. Then all of a sudden, you just give thiamine to someone and all of a sudden, right, it goes away. Sometimes health really is that simple. It’s just in the vitamin or mineral that you’re deficient in.
Dr. Mark Hyman:
Well, this is such a great conversation. I think we really need to pay attention, now more than ever, given this idea that we’re more nutrition deficient than ever, the COVID is actually exposing that, and we have over nutrition of starch and sugar, and under nutrition of real nutrients. In your book, The Mineral Fix, how to optimize our mineral intake for energy, longevity, immunity, sleep and more, is out now. It’s great. It’s on Amazon. Go there and get it. It’s called The Mineral Fix. It will really enlighten you. It’s a big book. I think of it as like a Bible for minerals. Whoa, this is a big book. It’s going to cost me extra money to ship it home from [inaudible 00:56:23]. I think we just can really, by tweaking our nutrition, particularly in micronutrients, can have a profound effect. And they don’t just make expensive urine, like we all were taught in medical school.
Dr. Mark Hyman:
So James, thank you for the work you do. Thank you for being so obsessive about nutrition and studying the literature and translating it for all of us. Your work is really quite amazing, and all the scientific papers you write are just fabulous. I’ve learned so much from them. Continue what you’re doing.
Dr. Mark Hyman:
For those of you listening, if you’ve enjoyed this podcast, please share with your friends and family. Subscribe wherever you get your podcasts. Leave a comment. Tell us how you’ve been affected by mineral deficiencies and what you’ve learned about it. We’d love to hear from you, and we’ll see you next time on The Doctor’s Farmacy.
