Announcer:
Coming up on this episode of The Doctor’s Farmacy.
Dr. Mark Hyman:
In America, we have an over abundance of calories, but a deficiency of nutrients. The average American basically has an extra 500 calories a day that’s available to them because of the increased production of our agricultural system in the last 50 years.
Dr. Mark Hyman:
Hey, everybody, it’s Dr. Mark Hyman. Welcome to a new series on The Doctor’s Farmacy called Masterclass, where we dive deep into popular health topics including inflammation, autoimmune disease, brain health, sleep and lots more. Today I’m joined by my guest host, my good friend, my business partner and host of the Dhru Purohit Podcast, Dhru Purohit. We’re going to be diving deep into the topic of weight loss resistance. Who out there is having trouble losing weight? Let me see, probably a couple hundred million people, so this is going to be a good one, Dhru. Welcome.
Dhru Purohit:
Thanks, Mark. It’s a topic that I know a lot of people are very curious about, and you actually wrote a guide, and we’re going to be walking people through that guide. These are eight reasons according to the world and the framework of functional medicine, that you’ve seen thousands of patients over the years, that many of the patients that have challenges losing weight would fall into one or more of these categories. So before we dive deep into each one individually, let’s give an overview of the eight that are there.
Dr. Mark Hyman:
Absolutely. So, Dhru, I wrote this guide because so many times people think it’s just their fault. They’re eating too much, not exercising enough, and we think it’s food that’s causing us to be overweight. After 30 years of practicing functional medicine, I can tell you for a fact that it’s not always food. It’s surprising to people. So I wrote this guide called Beyond Food: Other Causes of Weight Gain and Damaged Metabolism. There are eight main categories. The first is nutritional imbalances. We’re overfed and undernourished. We eat too many calories and not enough nutrients. When we’re nutrient deficient, we crave more food and eat more food. We can get into that.
Dr. Mark Hyman:
The second is our microbiome. It turns out our gut microbiome is hugely important in regulating metabolism and weight. The next is inflammation, which can have many, many causes. So anything that causes inflammation will make you gain weight, even a virus or a toxin or mold, even if you are not eating a lot. I had, for example, a patient who lived in a moldy apartment. She gained 50 pounds just from the toxic inflammation from the mold.
Dr. Mark Hyman:
Next are environmental toxins. That can be anything from pesticides to mercury, heavy metals. They damage your metabolism and prevent you from actually efficiently burning calories.
Dhru Purohit:
Many are called obesogens.
Dr. Mark Hyman:
They’re called obesogens. That’s right. Environmental toxins are a big one. Also, problems with our mitochondria, and these can be genetic. They can be acquired, but our mitochondria are the little factories that make energy. So that’s when we say our metabolism is slow. It kind of is true when you have poorly functioning mitochondria or these energy factories.
Dr. Mark Hyman:
The next are communication problems, hormone problems. Insulin, thyroid, stress hormones, sex hormones all go out of whack, and they can cause weight gain. For example, if you are eating foods that make you estrogenic or if you’re exposed to environmental toxins that increase estrogens in your body, that’ll make you gain weight. That’s how they make cows gain weight before they slaughter them. They inject estrogen pellets into their ear, and the male steers, and they actually make them gain weight by giving them estrogen.
Dr. Mark Hyman:
The next one is your genes, and people say, “I’m genetically predisposed.” Well, some people are. They’re more likely to gain weight given, for example, a certain carbohydrate [inaudible 00:03:30], like the Native Americans were thin and fit and healthy, but we introduced all this processed food and white flour and sugar. I call it the white menace, and they all of a sudden became the fattest population in the world other than the Samoans.
Dr. Mark Hyman:
Then, lastly, it’s something that we don’t think of very often, but obesity can be contagious. It’s not infectious, but it can be contagious because it turns out that your social networks determine so much about your health, your friends, your community. If your friends are overweight, you’re far more likely to be overweight even if your parents aren’t overweight. So your social networks are more important than your genetic networks in terms of determining your obesity and health in many, many ways.
Dhru Purohit:
Great. So these are eight reasons that are out there. We’re going to walk through them a little bit more in-depth. So reason number one, starting with that, nutritional imbalances, overfed and undernourished. Walk us through that and how you would determine whether or not a patient would fit in that category.
Dr. Mark Hyman:
Well, there’s a condition called pica, which is a condition that kids often will get where they eat dirt. They eat dirt because they’re iron deficient, so their bodies are looking for the nutrients that they’re not getting. In America, we have an overabundance of calories but a deficiency of nutrients. The average American basically has an extra 500 calories a day that’s available to them because of the increased production of our agricultural system in the last 50 years. Where does that go? That goes into all the processed food.
Dr. Mark Hyman:
We also are seeing massive nutritional deficiencies. Over 90% of Americans have a deficiency in one or more nutrients at the minimum level to prevent deficiency. So how much vitamin C do you need to not get scurvy? Not very much. How much vitamin D do you need to not get rickets? Not very much, but 10% are deficient in vitamin C. 80% or deficient in vitamin D. 90-plus percent are deficient in omega-3 fats. Magnesium is very important in metabolism, zinc. These often are very, very low. People say, oh, we live in America, and people aren’t malnourished. Nonsense, we are, and I see this every day in my practice because I test.
Dr. Mark Hyman:
When you look at the studies of obesity, it’s fascinating. The most obese are often the most nutrient deficient. You think, oh, these people are so fat. They’re going to be well nourished. They’re not. They’re actually malnourished. They’re overfed and undernourished, and they have massive nutritional deficiencies. So often, when we correct those deficiencies, people will actually rebound. One, they’ll stop wanting to eat all that extra food, because, basically, they were looking for love in all the wrong places. They’re looking for nutrients, so they keep eating more and more food.
Dr. Mark Hyman:
One study by Kevin Hall was fascinating, where he took a group of people and let them eat processed food as much as they want or whole foods as much as they want. The people who ate the processed food ate 500 calories more a day because they were not getting what they needed from the food. So even if it’s subconscious, it’s still happening. So that’s why nutritional deficiencies play a big role.
Dhru Purohit:
So processed food is both addictive, but also your body’s probably saying, “We need to eat more, eat more, eat more,” because it’s not getting all the things that it needs.
Dr. Mark Hyman:
Yeah.
Dhru Purohit:
Let’s go into reason number two. The gut microbiome imbalances and bad bugs are a big part of this. How does something like having the wrong, quote, unquote, gut microbiome impact our ability to gain or lose weight?
Dr. Mark Hyman:
It’s shocking Dhru. I mean, the data is just mounting every day about the importance of the microbiome in our health in general, particularly in obesity. First, what is the microbiome? It’s the whole ecosystem of bugs that lives in your gut. It’s 10 times as many cells as your own cells. It’s 100 times much DNA, so you might have 20,000 genes. There might be 2 million or 4 million genes in the bacterial genes in your gut, and they’re all doing stuff. If they’re bad bugs, they’re doing bad things. If they’re good bugs, they’re doing good things. Probably up to a third to half of all the metabolites in your blood comes from bacteria. So you’re actually in direct relationship to your microbiome, and the quality of your microbiome determines the quality of your health and weight.
Dr. Mark Hyman:
Just a couple of quick amazing studies. One was they did a study where they looked at animals, rats, and they transplanted the poop from a fat mouse to a skinny mouse. The skinny mouse gained weight without changing how much they ate. That’s a mind blower, because it’s not all about calories. They’ve also transplanted poop from healthy people into diabetic patients and reversed diabetes and made them lose weight. We know, for example, there’s a phenomena called metabolic endotoxemia, so when you have bad bugs in your gut, it produces metabolites or toxins … We call it lipopolysaccharides, a big medical word, or LPS. It gets absorbed across the gut. Your immune system goes, “Ah! What’s that? That’s foreign. That’s a toxin. That’s a bacterial toxin. I’ve got to do my job. I’m going to turn out the army of cytokines.”
Dr. Mark Hyman:
We’ve heard about cytokines, cytokine storms. Cytokines are the messenger molecules of your immune system. Those cytokines then inhibit the insulin receptor, so they basically block the effect of insulin. When that happens, your blood sugar goes up, and your body goes, “Ooh, I need more insulin,” so you start pumping up insulin. Well, what’s the effect of insulin? Insulin makes you gain weight. So the microbiome literally can make you gain weight through activating inflammation in the body.
Dr. Mark Hyman:
It also can cause leaky gut and food sensitivities, because we often get damage to our gut lining, the barrier breaks down. We leak in food particles and bacterial toxins, and those food particles … Again, the body’s like, “What’s that? That’s not me. I better kick in inflammation.” Well, inflammation recruits all these cells that bring in fluid and make you gain weight. So it’s not only food retention, but you also get the insulin resistance. So it creates this vicious cycle. Most of us have a pretty bad microbiome. Why? Because we live in a gut busting culture. C-sections, lack of breastfeeding, antibiotics, steroids, environmental toxins, acid blocking drugs, Advil drugs, hormone pills like the birth control pill all screw up our microbiome. So we are living in a culture where the majority of Americans has really bad guts, and that is also predisposing to obesity.
Dhru Purohit:
Super fascinating, Mark. All right, we’re going to jump into reason number three, inflammation and immune function. Talk how inflammation and how our immune system works could be connected to weight loss.
Dr. Mark Hyman:
We touched a little bit about this with the microbiome, which is a big cause of inflammation, but anything that causes inflammation will interrupt insulin signaling, which will cause you to gain weight and store fat.
Dhru Purohit:
What are some common things that cause inflammation to the body?
Dr. Mark Hyman:
So the common things besides the microbiome would be viruses. We’ve seen viruses actually cause obesity. We’ve seen toxins cause inflammation, environmental toxins, mold toxins. I mentioned the young woman who I saw, for example, who lived in a moldy apartment, and she gained 50 pounds. I had another patient who was working out like crazy. She was a health and fitness trainer and coach, and she had 40 extra pounds on her she could not get rid of. We looked at everything. It turned out she had really high levels of mercury, and when we chelated the mercury out, she lost 40 pounds just like that. I still hear from her periodically. She’s doing great.
Dr. Mark Hyman:
Food allergens, also a big one, food sensitivities. Gluten and dairy are big ones. They cause a lot of weight gain. Processed food, ultra processed food is high in omega-6s, low in omega-3s, low in fiber, low in phytochemicals, also drives inflammation. So all of those things can drive inflammation, and it’s important to be a detective and figure out what is it. Why is someone struggling with weight? Well, it could be mold. It could be mercury. It could be a virus. It could be their microbiome. It could be a food allergen.
Dhru Purohit:
Sleep apnea.
Dr. Mark Hyman:
Sleep apnea. Well, that’s another whole category, yeah, exactly. That’s more hormonal. But, yes, all those will have impact on your weight gain.
Dhru Purohit:
Let’s go into number four, environmental toxins. What’s the impact of environmental toxins on our ability to gain or lose weight?
Dr. Mark Hyman:
Dhru, I started writing about this a long time ago. One of my first books was called Ultrametabolism, and one of the chapters in there was Love Your Liver, because if you don’t understand, one, how to avoid toxins and, two, how to increase your ability to get rid of toxins, it’s going to have a bad effect on your health, but particularly on your metabolism. Since I’ve written that book … It was 17 years ago. God, really? 17 years ago. It’s scary to say that. But there has been so much research about the correlation between environmental toxins and obesity, and they’re called obesogens, as you mentioned earlier. These are compounds in the environment, pesticides, herbicides, environmental chemicals. There’s 80,000 environmental chemicals introduced in our world and our food supply that all can interfere with our metabolism and cause us to gain weight, even in the absence of extra calories.
Dr. Mark Hyman:
In the average newborn, for example, there’s 287 known environmental chemicals, whether it’s phthalates, PCBs, dioxin, flame retardants, Teflon, and, of course, all the heavy metals and pesticides and herbicides all in the umbilical blood of a baby before they even take their first breath because we live in such a polluted world, and they’re getting those through their mother. So try to, one, reduce your exposures, and the Environmental Working Group is a great resource for that, EWG.org, for how to reduce it in your skin care and in your home care products, in your food and meat and all the fish, everything you’re eating. There’s a lot of ways to boost your own detox system by filtering your water, by having clean air in your environment, having filtered water, and helping your body detox with certain foods like the broccoli family and the garlic and onion family. Also, certain supplements can really help, like selenium, zinc, vitamin C, B complex, things that boost glutathione like milk thistle, N-acetylcysteine, alpha lipoic acid. These are just supplements that you can take that help boost detox, but I’ve found that getting people detoxified is hugely important for helping improve their metabolism.
Dhru Purohit:
Great. Let’s go into that, speaking of metabolism, troubles with your energy production system.
Dr. Mark Hyman:
So we basically have to take the food we eat and the oxygen we breathe, and we have to turn it into useful energy we call ATP. That’s our fuel, our gasoline. In your body, in every cell, there’s hundreds to thousands to tens of thousands of these little energy factories called mitochondria that basically process oxygen and calories, and the output is energy to run everything. If it stops, you’re dead, so really important. But these little mitochondria are so sensitive. They have their own DNA. They get damaged easily, if they’re exposed to environmental toxins or inflammation or all that list of stuff we talked about, they’re exposed to too many calories, processed calories like sugar, processed fats. They don’t do very well, and so they end up actually degrading. The decline of our mitochondria and our mitochondrial function is a key factor in the rapid decline and aging we see in a lot of people in America.
Dr. Mark Hyman:
The good news is you can actually help your mitochondria function better, one, by getting rid of all the things that damage the mitochondria, but, two, by doing things that help boost it, whether it’s diet, certain things like a very low-glycemic diet, calorie restriction. Time restricted eating is a great way to make your mitochondria healthy. It recycles the parts and cleans up old junk, through a process called autophagy, which means self-eating or self-cannibalism, really. Then we know we can increase the function and the effectiveness of mitochondria through certain kinds of exercise. HIT training, which is high-intensity interval training, which is where you do wind sprints, where you go really fast for 35, 40, 50, 60 seconds, and then you slow down for three minutes. Also, strength training, which builds both muscle mass and improves muscle function, so all of that’s really important. Then there’s nutrients that help mitochondria too you can take, so those are all ways you can actually help fix the mitochondria.
Dhru Purohit:
Great. Let’s go to reason number six, bad communication, and this relates to hormones.
Dr. Mark Hyman:
Well, we live in a world in which people have so many hormonal issues, thyroid issues, adrenal issues, sex hormone issues, insulin issues, and we talked about the insulin a little bit. Let’s just start with thyroid. This is often missed, and the problem is that doctors don’t do the right test. They’ll do a TSH, which is a screening test, but often it misses people who have low-grade low thyroid functioning. So they might have low T3, which is really important. They might have thyroid antibodies. So you’ll often miss the problem, and this affects so many people. It affects 1 to 10 men and 1 in 5 women have low thyroid function. So that really is a slow metabolism. So you have to have the right tests, so you want to make sure you get the right test for your thyroid, and that’s TSH, free T3, free T4, and thyroid antibodies. All this is going to be in the show notes. We’re going to have the guide. You’re going to have everything in there you need.
Dr. Mark Hyman:
You want to make sure you eat right for your thyroid. You want to eat foods higher in selenium, which is important for converting T4 to T3, which is the active hormone. You want to make sure you have enough omega-3 and zinc and vitamin D. Vitamin D’s important for activating the thyroid function in the nucleus, which is where T3 works, on the nucleus of your cells to activate genes that increase your metabolism. So you need all … If you have low vitamin D, you’re not going to have good metabolism. You need to take the right thyroid hormones if you’re low, which is a combination of bioidentical T3 and T4. So that’s thyroid, really, really, really common, like I said, 1 in 5 women, 1 in 10 men.
Dr. Mark Hyman:
By the way, about 50 percent are not diagnosed, and the ones who are diagnosed and are on thyroid treatment are often on the wrong treatment for them because they don’t check T3. They might have low T3, and they still are not perfectly better, so they need to be more tuned up. I wrote a report called the ultra thyroid solution years ago, which I think is still pretty current and relevant. That would be a good resource for people, and we’ll tag to that also.
Dhru Purohit:
So under hormones, there’s also this category of stress. Now stress is one of those often overlooked things. People know that they can get things like a stress ulcer when they’re really stressed out in life, but a lot of people don’t know or realize that stress can actually play a role in weight gain.
Dr. Mark Hyman:
It’s so true. When I first started learning about that, it was a shock. Why would stress make you gain weight? I had this patient whose daughter lived in Israel, and she was so stressed all the time because it was back in the days when there was really bad fighting at Gaza and the intifada. There were bombs going off all the time, and she was worried to death for her daughter. She gained 40 pounds, and she couldn’t lose it. When her daughter came back to America, she lost all the weight because she stopped worrying. We know that stress does a number of things. One, it increases cortisol, which is a stress hormone. Cortisol makes you fat. It basically causes you to be hungrier, so you eat more. Anybody on prednisone or steroids knows this. I’ve been on them for various reasons, and they do cause these problems. It makes you eat more. It makes you hungrier. It causes you to gain belly fat, lose muscle mass. You get skinny arms and legs and a big fat belly. This is what stress does.
Dr. Mark Hyman:
There’s a phenomenon called Cushing’s syndrome, which is from a tumor that produces too much cortisol. It’s not because of what you’re eating or stress, it’s just a tumor that is benign but produces too much cortisol, and you get this phenomenon in people who are giant bellies, skinny arms and legs, big hump on their neck. Skin breaks down. Everything breaks down. So that’s what stress does, and not only that, when you eat under stress, you actually aren’t able to absorb the nutrients that you need. We know this is true. We also know, if you’re eating under stress, that there’s nerves that connect your brain to your fat cells. So, literally, your fat cells are listening to your thoughts. When you’re stressed, your fat cells stop doing what they’re supposed to do, and they start storing more fat. So if you want to gain weight, eat under stress, basically. So it’s important to learn techniques of relaxation, yoga, meditation, massage, hot baths, saunas, whatever works for you. Play, have fun.
Dr. Mark Hyman:
The next issue in hormones is your sex issues. Sex hormones are a big thing, and for men, as they start to get older, their testosterone goes down, so they lose muscle. They gain fat. That just creates a vicious cycle where they’ll actually start to gain more weight and, for example, can actually turn into women, honestly. They basically get breasts, and they lose all the hair on their bodies. They basically become soft skinned because they produce too much estrogen from all this fat in their body.
Dr. Mark Hyman:
Women, they also get in trouble because they get problems with too much estrogen. We live in an estrogen dominant world. Why? Because sugar causes high estrogen through its effect on fat cells. Environmental toxins cause high estrogen. Stress can cause high estrogen. So dairy can cause high estrogen. So there’s a lot of things that we’re exposed to that are causing us to have high levels of estrogen in our female population. When you have high estrogen, it makes you store fat. So having estrogen balance is really important, and it’s a whole nother podcast on how to do that. But, essentially, it’s alcohol, sugar, processed food. Get rid of them. Eat more whole foods, vegetables, soy, whole soy foods, flax seeds, cruciferous vegetables. Also, make sure you exercise, and don’t drink too much alcohol because that’s an issue. All those things can really help. Those are the big issues around the hormones and the communication.
Dhru Purohit:
Great. Let’s go into number seven, genes. Now you often talk about how our genes are not our destiny. That doesn’t mean that we should completely ignore our genes and the role that they play in predisposing us to certain things. So let’s talk about our genes.
Dr. Mark Hyman:
So I read a study once where there were basically 32 genes that contribute to obesity. If you had all 32 genes, which is almost impossible, it would only account for 22 pounds of extra weight, not the massive obesity we see today in America. So what’s going on? Well, there are certain people who have genes who predispose them to insulin resistance, to being carbohydrate intolerant. If you’re one of those people … And these are a lot of people on the planet, people who were never really exposed to much sugar who, really, are recently out of a hunter gatherer world, Native Americans, Pacific Islanders, Middle Easterners, people who are East Indian, even Chinese, all potentially are at high risk of developing insulin resistance compared to someone not. For example, if I have a can of soda with 40 grams of sugar, my blood sugar will go up like this, and my insulin will go like this. If you’re a Native American and you have exactly the same thing, it can go skyrocketing, with exactly the same input because of their genes. So if you have genes that predispose you to being carbohydrate intolerant, that’s probably the biggest risk.
Dr. Mark Hyman:
There’s another set of genes that may be a problem, which is dopamine genes in the brain. They’re genes that help control your dopamine function. Dopamine is the motivation neurotransmitter. It’ll actually make you focus and pay attention, but it’s also the pleasure stimulator, so heroin, cocaine, all that stuff, food addiction, all that is driven through dopamine. So there are people who have variations in their dopamine receptors that make them less sensitive to dopamine, so they need more and more stimulus to get pleasure, alcoholics, heroin addicts, people who are food addicts. All that is really related to this incredible genetic variation that can cause people to be more addicted to sugar and processed foods. So there’s a lot of genetic factors, but those are the big ones.
Dhru Purohit:
With the genetics, if I’m hearing you clearly, it’s not that genetics … we should completely ignore it, and you should be aware of more your genetic lineage. There’s different tests that are out there that you often will recommend. Can you name a couple of labs or places that you talk about?
Dr. Mark Hyman:
I mean, I think there are a lot of good genetic tests out there. I use one called DNA from Nordic Labs [crosstalk 00:23:42]
Dhru Purohit:
DNA LIFE, DNA Health.
Dr. Mark Hyman:
DNA LIFE. They have DNA Health. They have DNA food ones. There’s a whole panel that they do which is really on food. It’s fascinating to look at. But the truth is, if you want to fit into your jeans, J-E-A-N-S, you have to fit into your genes, G-E-N-E-S, right? So we have to understand that … And I had a patient yesterday. It was a really wonderful 22-year-old young woman who I’ve known since she was 9 years old, who was struggling with her weight since she was a little girl. She is not someone who’s eating Doritos and soda and processed food. She’s just extraordinarily carbohydrate intolerant. So her fasting insulin level was so high. It should be under 5. When it’s over 10 I get worried. Hers was 30. I’m like, this girl, she’s struggling. So when she looks at a cookie, she’s going to gain weight. When she looks at a bagel, she’s going to gain weight. So the key is, for a certain subset of people, you kind of have to accept, okay, I’m a celiac. I’m glute intolerant. I can’t really eat wheat, even if I like it. There is a reality to that. Or I’ve got an anaphylactic reaction to peanuts. I can’t eat peanuts. It’s the same kind of thing. There are certain people, genetically, who are intolerant to carbohydrates, which is really the biggest driver of obesity.
Dhru Purohit:
Because we’re still learning a lot more about these and the genetic tests are not perfect, they give us some idea but they don’t give us the full idea, it’s more being aware of it. But you can still work on all these other areas that we’ve listed in these eight reasons. Let’s go to the last reason, Mark. This one’s one that often surprises people, and it’s our environment, specifically our social network and friend group.
Dr. Mark Hyman:
Well, we don’t think we can catch obesity, but the truth is we can, because our behavior is determined by our social networks, by our peer group, by peer pressure. We all want to belong. We all want to be included. We all want to connect. So if all your friends are drinking green juices and going to yoga and jogging all day, then you’re probably going to be thin. If all your friends are eating processed food and drinking soda and sitting on the couch watching Netflix binges, you’re probably going to be overweight. The day on this is so clear. Christakis, from Harvard, has published this in the New England Journal and other places, that if you have friends that are overweight, you’re 171% more likely to be overweight. If your sibling or your parents are overweight, you’re only 40% more likely to be overweight. So it’s a massive … four times the risk of being overweight if your friends are overweight. So what’s the-
Dhru Purohit:
Even more so than your partner, your spouse.
Dr. Mark Hyman:
Well, spouses tend to kind of go together. I think that’s-
Dhru Purohit:
Which is crazy that even your friends … And that makes sense, right? We want to impress our friends. We want to be like our friends. They’re our peer group. Our friends have even more influence over our health and obesity even more so than our spouse and our parents and kids.
Dr. Mark Hyman:
It’s so powerful. So just as obesity is contagious, so is health. I’ll just tell a quick story because I think this was so enlightening for me. I went to Haiti, and I saw how Paul Farmer, who started Partners In Health cured TB and AIDS in one of the worst places on the planet, where most people make less than a dollar a day, and half the people don’t have sanitation. There was rampant TB and AIDS, and everybody in the public health community had given up on these people because they need to take drugs at a certain time. There was cures for it, for AIDS and TB, or to manage them at least for AIDS, but they weren’t able to take them. It was just too big of a hurdle. So he figured out that it wasn’t a medical problem. It was a social problem. He called it structural violence, the social, economic, political conditions that drive disease. So he said, “Well, I’m going to build a network of community health workers that are their friends and their neighbors and their peers that are going to go make sure they’re taking their medication. They’re going to help them get clean water. They’re going to make sure they do what they need to do,” and it was extraordinarily successful.
Dr. Mark Hyman:
I thought, geeze, wait a minute, obesity is also contagious. It’s also a social disease. It’s not a medical problem; it’s a social problem. We live in an incredibly toxic environment, a toxic nutritional landscape. I mean, I went to the airport this morning to come to Los Angeles where we’re recording today, and I’m like, what am I going to eat? It’s like, thank God I brought a pound of macadamia nuts and some fruit in my bag that I could eat for breakfast. Otherwise, I’d be stuck eating some garbage. Even the, quote, healthy places are really hard to find anything good, so we live in a horrible landscape. I decided, well, maybe if obesity was contagious, maybe health was contagious too.
Dr. Mark Hyman:
So long story short, I work with Rick Warren, a pastor at Saddleback Church. We had 3,000 people. We met every week in small groups of six or seven, eight people. They supported each other to live better lives, and from a spiritual perspective. But I said, “Why don’t we use those groups to create health?” He’s like, “Great idea, because we’re a very overweight church. I’m overweight, and we need to do something.” So he was willing to let us actually create a program called the Daniel Plan in the church, and we changed the environment in the church. We basically got all the cafeteria to change their food. We got rid of the pancake breakfast and the ice cream socials and all the junk and the soda in the environment, and they started creating programs like Jog for Jesus and everything. In a year, they lost a quarter of a million pounds and got super healthy and got rid of so much medications. One guy said he was in the hospital nine times last year, on a pile of meds. Now I’m not on anything, and I’ve never been to the hospital in a whole year. So that’s the power of social networks to drive changes in behavior and health.
Dhru Purohit:
Powerful.
Dr. Mark Hyman:
I would say friend power is more powerful than willpower.
Dhru Purohit:
It’s so true, it’s so true. Just taking one step in the right direction by even starting a book club or potluck or something that allows you and the people around you to get together and practice health, going on a morning hike. That’s something that I do with my friends here in LA. All right, Mark, this is part of the podcast where we go into community questions. These are a list of questions that your audience has submitted in, and we’re going to jump right into it. So the first question is, “How do I lose weight as a woman after 40? I’ve got 10 pounds to lose that suddenly appeared around my waist line after I turned 40, mostly in the love handle area. I have a petite frame, normal BMI, and I’m typically pear shape, but now I have this thicker middle that doesn’t seem to want to budge. I want my cute figure back. Please help!!” Wow, a very energized community member.
Dr. Mark Hyman:
There you go. Here’s the thing. I always go back to first principles. So what are those eight causes that are beyond food? It could be a lot of things. What happens is, when we go through perimenopause, is they start to see this estrogen-progesterone imbalance. They stop ovulating. Their estrogen levels will increase in ratio to their progesterone, and they all start putting on weight. Or maybe their thyroids go a little wacky. Or maybe they have kids they’re dealing with, and then their parents are getting older. They’re in the middle of their career cycle. So you’ve got these multiple stressors happening at the same time. Or maybe there’s other factors involved like muscle loss. We tend to lose muscle as we get older. If we lose muscle, our metabolism slows down. So even starting at age 30, we start to decline. You have to work on keeping muscle up, and that’s through exercise, strength training, and having adequate protein.
Dhru Purohit:
So she could even still be eating the same diet that she ate when she was 30, but because she’s losing muscle mass or not working out as much or doesn’t have good metabolic health, then all of a sudden she’s putting on weight more so than previously.
Dr. Mark Hyman:
Exactly.
Dhru Purohit:
Now it can be a little overwhelming, all those eight areas. Some of them you might need to work with an open-minded or functional medicine type doctor to dig into those. But would you say that there’s one category? In this case, what would be one of the first ones that would be the most obvious to look at, and putting aside the context of somebody eating too much, because we’ve already talked about [crosstalk 00:31:42]
Dr. Mark Hyman:
I think, for a perimenopausal woman, it’s this hormonal mess that happens. The thyroid goes off, stress hormones go off, estrogen and progesterone imbalances, and then you become more insulin resistant. So you’ve got four hormones that are just going wacky that are causing you be more likely to gain weight. So you have to look at all of that and get those imbalances in order for them to start to shift and stay healthy and lose weight.
Dhru Purohit:
Let’s go to the next question that we have from the community, question two. It’s about CGMs. I’ll try to do my best to summarize. It’s a little long. “I’ve been using a CGM for six weeks, eating clean, no caffeine, no gluten, no dairy, no sugar, mostly just organic grass-fed meats, nuts, a little dark chocolate. None of these things spike me, but I only lose two pounds every week, and then I gain it all back. It’s infuriating. I drink a lot of water. I try to do a sauna every few weeks and take a hot bath once a week. What is happening? PS, I am in complete adrenal fatigue, so when I’m stressed, which I have four kids and a grandbaby, it’s constant. I notice that if I walk and eat within the first 90 minutes of waking up, I do better with my spikes.”
Dhru Purohit:
So somebody who’s eating well, they’ve been on a CGM for a while. They feel like they have a pretty good diet. They lose a little weight, and then they gain it all back. Some of the questions or things that they should be exploring.
Dr. Mark Hyman:
Well, it sounds like she gave it away, four kids and a grandbaby, constantly drawing on her attention and stress, that can be a big factor. So often the doorway to actually resetting your nervous system and putting you in a state of calm will help to actually drop the weight. So it sounds kind of unfair, but you have to start thinking about other factors than just what you’re eating. If your sugar’s not spiking and it’s not insulin, is it something else? It could be any one of the eight things we talked about. But for her the thing that seems most likely is stress.
Dhru Purohit:
In addition to stress, just chatting about this, we’ve had a lot of people that are experts in metabolic health on my podcast and your podcast. One of the consistent themes is that, just because you’re on a CGM and maybe you’ve cleaned up your diet, if you don’t know what your fasting insulin is, you may not know how insulin resistant you are. So especially if you’ve been eating a particular way for a long period of time, your fasting insulin could be in the non-optimal category. So even though your glucose isn’t spiking, your insulin still hasn’t come back down to an optimal or normal category. Can you talk about that?
Dr. Mark Hyman:
Yeah. I mean, first of all, even with stress, you’ll get a spike in glucose.
Dhru Purohit:
She’s saying here that her glucose isn’t spiking. She’s saying it’s pretty balanced, but in general.
Dr. Mark Hyman:
I’m just saying, I played tennis the other day, and I had my glucose monitor on, and I only had a little bit of a protein shake before, so my sugar was 90 when I started. I finished playing tennis, and I’m like, “I’m going to check it. It’s going to be great.” It was 146. I’m like, what the heck?
Dhru Purohit:
Which, by the way, happens to me sometimes. I know when I do a high-intensity workout, that obviously spikes up your glucose, and that’s the good type of stress that’s there. But go ahead with your tennis story.
Dr. Mark Hyman:
So any kind of stress will cause you to release glycogen from your muscles, to create what we call gluconeogenesis, where your liver starts to produce sugar, and will create a spike. Now she maybe or may not be picking it up, but also increased insulin levels. Maybe her glucose is going up but her pancreas will pump out insulin, and that’ll keep your sugar down, but you’re getting the effects of high insulin. So it’s not the glucose that makes you fat or gain weight; it’s the insulin, which is a fat storage hormone. Because in order for fuel to get in your cells, it needs the gate open, and insulin opens the gate so that glucose and free fatty acids can get into the cell, which makes you gain weight. So if you have high insulin and your sugar’s normal, you could still be in big trouble. I had many patients like this where I’m like, God, their blood sugar’s perfect. Their A1C is performance. Then I check their glucose, like this young-
Dhru Purohit:
You check their insulin, you mean.
Dr. Mark Hyman:
I check their insulin, like this young girl. Her A1C was 5.2, which is perfect blood sugar. Her fasting blood sugar was 90, pretty good. But her fasting was 35. I’m like, whoa, this girl is not going to lose weight as long as her insulin’s high, because what happens is, when you have high insulin, essentially, it locks the fat in the fat cells, and it can’t get out. So it causes lipogenesis, which means fat storage, and inhibits lipolysis, which means fat breakdown and fat metabolism. So it’s a problem.
Dhru Purohit:
It’s a problem, and it’s often one of the most overlooked areas because most people, their doctor doesn’t even order the test. It’s a pretty cheap test, it’s a pretty cheap test.
Dr. Mark Hyman:
It’s a very cheap test. It’s available everywhere, and it’s shocking to me in 2022 that not every single person gets this test. Because if I would say, what is one test that you could do to determine a person’s risk of obesity, heart disease, cancer, dementia, diabetes … I mean, these are all the things that are the worst problems. We’re checking people’s cholesterol. We’re checking their A1C. We’re checking all this other stuff. Nobody checks insulin. If I had my druthers, I would actually check it 30 minutes after a big mean or a glucose tolerance test, because even fasting, it could be normal at the beginning, but it will rise after you eat something. So taking what we call a postprandial or after eating insulin test is the most accurate way to see what’s going on, and that’s predictive of heart attacks and death and weight gain, belly fat, all of it.
Dhru Purohit:
So I feel like that’s an important note, because I think that these eight reasons are super important. You work on them all the time. Before somebody goes on a deeper wild goose chase, I think it is important to even start off with the basics of, do you have your fasting insulin? The great thing is that [inaudible 00:37:38] just recently announced that you can actually get a metabolic panel that includes fasting insulin, and they’ll send a phlebotomist right to your door. We have the link to it below in the show notes. So, yes, environmental toxins, yes, mold, yes, all these other things that we listed. But if you don’t know your fasting insulin, let’s not get too fancy yet before we have some of the basic markers.
Dr. Mark Hyman:
Agreed, agreed, agreed.
Dhru Purohit:
Great. Let’s go to number three, the third question that we have from our audience. How does the adrenal fatigue or HPA access dysfunction affect weight loss?
Dr. Mark Hyman:
Well, we talked a lot about this with the stress response. So if your adrenals are not working, you’re either producing too much cortisol or you’re not producing enough, your body will go into an altered metabolic state. So for most of us, the beginning stages of stress is higher cortisol stress hormone levels, which then causes all the downstream effects of insulin increased, blood sugar increased, blood pressure increased, muscle loss and wasting, bone loss and wasting, fat storage, inflammation, which is sort of counterintuitive because cortisol is actually supposed to shut down inflammation. But it actually can lead to inflammation through a bunch of secondary mechanisms. So if it’s a short-term stress, that’s fine. If it’s chronic, long-term, unmitigated stress, that’s when you get into trouble.
Dhru Purohit:
All right, next question. What amount of carbs per day is accessible in weight loss management?
Dr. Mark Hyman:
It depends. It depends on your genetics. It depends on your body composition. It depends on your age. It depends on your overall health.
Dhru Purohit:
How much muscle mass you have, your fasting insulin.
Dr. Mark Hyman:
How much muscle mass you have. So, for example, if you’re a Native American or a Samoan, it’s probably close to zero. I mean, by the way, Dhru, there are essential amino acids, without which you would die. There are essential fatty acids without which you will get very sick and have a deficiency disease, but there are no essential carbohydrates. They’re not required for life at all. Even though we hear, “Oh, well, our brain requires 25% of our glucose, and we have to have sugar for our brain,” that’s just nonsense. Our brain runs way better on fat.
Dhru Purohit:
Your body will make its own glucose.
Dr. Mark Hyman:
Your body will make its own glucose from protein and other things. So the truth is that we don’t require them for life. That said, depending on your genetics, some people like Native Americans and African Americans, Asians, East Indians, Samoans, Pacific Islanders all are much more likely to be carbohydrate intolerant. That’s why we see Hispanic populations which often are mixed with native populations from Mexico and other places and African Americans having such disproportionate levels of obesity and diabetes and problems. Why they’re so disproportionately affected by COVID is because they’re carbohydrate intolerant, and they’re really struggling with actually dealing with the underlying biology that they’ve been handed.
Dr. Mark Hyman:
Like this young girl, she’s carbohydrate tolerant. I would say she needs to be pretty much off grains, off beans, off sugar, off most fruit, and she’ll do fine, or even be keto and it would help her. But other people who are fit, who have good muscle mass, who exercise a lot, who … For example, like me, I kind of have to eat sweet potatoes and have some whole grains occasionally because my body … I’m not bragging or anything, but I have very low body fat. I’m not insulin resistant. My metabolism is great. Essentially, if I don’t eat some carbohydrate, I won’t do as well. I’ll lose too much weight. So it’s really about finding what’s right for you. There is no magic number, what’s the amount of carbohydrate you should eat. If you’re type 2 diabetic on insulin, the answer is probably 5% or less of your diet.
Dhru Purohit:
Really, just to clarify because we’ve done so many episodes on this, we’re really talking about the refined carbohydrates that are there.
Dr. Mark Hyman:
Yeah, exactly.
Dhru Purohit:
So this woman, even in her case, probably a true ketogenic diet where she’s actually producing ketones and stuff, if she’s having a lot of vegetables and things, we’re not talking about … We’re talking about a plant-rich keto diet.
Dr. Mark Hyman:
Exactly. My joke is I said, “The single most important thing you need for long-term health and vitality is carbohydrates.” They’re like, “What od you mean, Dr. Hyman?” I’m like, “Well, vegetables.”
Dhru Purohit:
Yeah, vegetables, exactly.
Dr. Mark Hyman:
Phytonutrients. We should be eating a ton of phytonutrients, and that’s why the Pegan Dit is 75% plant rich diet, with lots of colorful fruits and vegetables.
Dhru Purohit:
All right, next question from the community, Mark. “I work out three days a week and do yoga two to three days a week. I eat healthy whole foods and never eat fast foods or processed foods. I fast and do 16, 18 hours, mostly, and I eat two meals a day, but I never seem to lose weight. I just don’t understand why.
Dr. Mark Hyman:
Well, now hopefully you do, because we’ve covered the eight reasons beyond food that are responsible for unexplained resistance to weight loss. So I’d encourage you, without knowing much more of your history, to actually go explore some of these areas. Maybe it’s a food sensitivity. Maybe it’s a microbiome issue. Maybe you’ve got heavy metals. Maybe your thyroid’s not working. Maybe there’s an estrogen-progesterone imbalance, something in that realm of non food related causes of obesity is probably what’s going on. So you want to dig down into all of those.
Dhru Purohit:
Also, to add into this, this plays into the societal level, is that, what’s your definition of ideal weight? What’s your definition of that? That goes into, maybe you don’t need to lose weight. There’s nothing wrong with wanting to actually have the motivation to lose weight, but we just want to bring that in because sometimes people have maybe unrealistic ideas. Everybody should be able to lose whatever weight that they want to lose and be able to pursue that aspect, but there is a component in our different life stages. If you just gave birth and are a mom, it’s going to take a little bit of time for you, and there will be fundamental changes that happen to your body where maybe you actually just don’t end up losing a certain amount of weight that’s there.
Dr. Mark Hyman:
Well, that’s a good point, Dhru. I think the number of weight is not the most important number. We use a surrogate number called body mass index, which is basically your height and weight kind of normalized. So if you’re 300 pounds but you’re 7 feet tall and a basket player, that’s not a problem. But if you’re 5 feet tall and 300 pounds, that’s a problem. So that’s one problem. The problem with the body mass index though is that it doesn’t account for your body composition. So if you’re a jacked muscle builder, body builder, if you’re the Rock or if you’re Shaquille O’Neal, you’re going to have a high body mass index. It might be 35. It’d be considered obese, but you’re not. You’re fit. Your metabolism is good, and you’re very lean. You just have a lot of muscle, which makes you have more weight in relation to your height, but you don’t really have a weight problem, even if you’re, question, overweight technically.
Dr. Mark Hyman:
Also, distribution matters. So not only the size and so forth and the muscle mass, but the body composition, which is how much of your body’s made up of fat or of muscle. So, for example, if you’re 25 and a woman, your body composition should be 20 to 30 percent. If you’re a guy, 10 to 20 percent. That’s normal, meaning 20% fat or 10% fat. But if you’re 65 and you’re the same weight as you were when you were 25, you could have lost half your muscle and be requiring half the calories to actually stay the same weight. This is a big problem for people. It’s called sarcopenia, which is the loss of muscle, and they end up looking thin, but they’re actually fat. They’re what we call skinny fat or a metabolic obese normal weight. They have all the same risks of chronic disease as people who are actually overweight.
Dr. Mark Hyman:
So it’s a real problem in America, and there’s so much we do to cause our muscles to waste. We’re sedentary. We don’t exercise, but also the food we eat and the stress we’re under. Stress causes muscle loss, and sugar causes muscle loss, so you’re in this vicious cycle of stress and sugar, which is basically our diet in America, and you’re in this crazy world where we’re not exercising like we used to as hunter gatherers. So it’s just a perfect storm for a metabolic disaster and for slow metabolism. So you’ve got to check body composition, and I love that test. It’s basically a machine that uses x-ray technology in a very, very low dose. It’s like going through an airport scanner. It basically measures where the fat is and how much fat and how much muscle. It’s the same machine we use for, for example, using bone density testing, and anybody can do it. So I love that test.
Dhru Purohit:
A lot of gyms have it.
Dr. Mark Hyman:
There are different ways to measure body composition. That’s the best, gold standard way is a DEXA scan, but there’s scales you can use. They’re not that accurate, but they’re good enough. So it’s worth trying to look at your body composition to see what’s going on if you actually are over fat and under lean.
Dhru Purohit:
I’d like to toss out another thing that’s there as a recommendation for the audience. You had her on your podcast, Mark, Byron Katie. She has some incredible content out there about accepting reality, and there’s this one-
Dr. Mark Hyman:
Loving what is, she calls it, loving what it is.
Dhru Purohit:
Loving what is, loving what is and not being in resistance with life. There’s both the motivation to want to change things, which is a beautiful thing, and then there’s the acceptance that this is the way the situation is right now. A lot of times in our life when we don’t have acceptance, we create stress internally. Why isn’t my body better? Why do I not have less weight? My body is against me. We create all these stories, and these stories are not helpful for our health, and there’s a really beautiful video that I saw many years ago that Byron Katie had on this topic for a woman who felt that her story was, “My body has too much weight.” Byron Katie walks her through her four questions and helps her understand that her body is only there for her. It’s not there against her. Now, of course, you could throw a layer of functional medicine on top of that, which is, do you want to change the underlying environment to help your body do better what it wants to do? Great. But that can be done without having this heavy resistance on the way that things are now. So I’ll send that to the team, and we’ll include that in the show notes.
Dr. Mark Hyman:
That’s great. I love Byron Katie. She’s quite an amazing human being, and her perspective of looking at your life and going, “Are my beliefs true? Is what I believe actually true, and what I’m saying? Can I know it’s absolutely true? How would I feel without that thought? How would I change that thought to make it different?” It’s a powerful, simple set of four questions that allows you to look at your beliefs and question them in a way that can free you from some of those really imprisoning thoughts that keep us struggling.
Dhru Purohit:
Who’s to say that you have more weight? Is it because Cal Newport, who’s a past of yours on the podcast … Is it because you’ve been on Instagram all day and you’ve been seeing all these people who are in bikinis-
Dr. Mark Hyman:
Anorexic.
Dhru Purohit:
… or whatever?
Dr. Mark Hyman:
Who are bulimic and anorexic Instagram models.
Dhru Purohit:
Or were blessed with great genetics, or, actually, that’s their main job. They work out all the time. They may not be happy, but they work out all the time. They watch every single thing they eat. They might be miserable. You don’t know. You don’t know what they’re going through. So we want to just make sure that we keep all these things into mind when we’re thinking about the story of I need to lose extra weight.
Dr. Mark Hyman:
The other thing I would say about weight … And we didn’t really talk about this, and it’s sort of implied in the stress area. But it’s a really deep conversation about trauma. In my experience, and I think the literature supports this, that if you have a lot of trauma or sexual abuse or psychological or physical trauma, that it correlates with chronic disease and with obesity. Most people who have really severe obesity, there’s some level of trauma. One in four women in America have been sexually abused. I was a victim of incest myself. So I understand what this is like. I think that we basically need to help people identify the trauma, and sometimes it’s buried, and they don’t know it. They don’t remember it. They don’t feel it.
Dr. Mark Hyman:
So there’s really an exciting body of work emerging in the psychiatric field that is totally disrupting everything we thought about trauma. It’s using things like psilocybin, which is magic mushrooms, or MDMA, which is also known as ecstasy, which sound like party drugs. But they’re used therapeutically in a therapeutic context to help people work through trauma, or ketamine therapy or stellate ganglion blocks or other kinds of therapies that can be very powerful in resetting the nervous system in ways that help to deal with the trauma. Yesterday, I was talking to a patient who was sharing with me … because actually she had so much trauma, and she had been struggling with her weight a little bit.
Dr. Mark Hyman:
But I sent her to get therapy, and she ended up having a life changing experience. She was bulimic, for example, and she said, “When I came back from the journey that I did, from the work I did with this woman, I literally stopped being bulimic. My whole nervous system changed.” Every time I talked to her, she was in a hyper vigilant state all the time, every consult I had with her. This was the first time I talked to her she was grounded and stable.
Dr. Mark Hyman:
So there’s a lot of doorways into healing trauma, but I encourage people to think about trauma and look at the work of Gabor Mate, who I think I will have on the podcast soon, and really look at some of the wisdom of trauma film he made. He also wrote a book called the, I think, Hungry Ghost something, something about hungry ghosts. We’ll put it in the show notes. But it’s important to start to investigate that, because that might be part of your weight issues too.
Dhru Purohit:
Mark, I think that’s a perfect note to end on with the questions. So let’s do a recap of the eight reasons that we talked about, and we’ll go ahead and conclude from there.
Dr. Mark Hyman:
Well, thanks, Dhru. It’s been a great conversation. I hope it’s been enlightening for people because a lot of stuff that happens around weight is people blame themselves. They’re doing all the right things, and it’s still not working. What’s going on? That’s really why I wrote a lot about the issue of weight loss resistance. Just to summarize, the first is nutritional imbalances and deficiencies. Second is changes in your gut microbiome. A third is anything that causes inflammation. The fourth is environmental toxins. The fifth is trouble with your mitochondria and energy metabolism. The sixth is bad communication, which includes your thyroid, sex hormones, stress hormones. We talked a lot about that, trauma included in that. The seventh is fitting into your genes, G-E-N-E-S, learning what your genetics are and how to actually live in a way that’s adapted to that.
Dr. Mark Hyman:
Lastly is the role of your social networks and how obesity’s contagious and how to actually start to build networks and social containers that actually support your health. Find friends that are healthy. Go to places where there are people focused on doing healthy stuff like gyms or yoga classes or different restaurants or bars, where there’s actually good stuff. So I think that’s really important.
Dhru Purohit:
Those are all great things, and I’m glad we did this episode. The add on to this is that the science is always evolving, and you always have new and interesting guests during your podcasts that have their own take on it, who might say, “We need a little bit more protein to help us build with muscle mass, and that could be a factor into weight loss.” So if you’re trying a lot of these things, I would add in … And if something feels like it isn’t working, just continue to dig a little bit, but dig without all the stress that’s attached to the story. Slowly, slowly, you’ll start to make progress on it.
Dr. Mark Hyman:
For sure. Well, thanks, Dhru. This has been great, great conversation. Thank you all for listening to our masterclass and The Doctor’s Farmacy. If you love this episode, share it with your friends and family on social media. Leave a comment. How have you dealt with weight loss resistance, and what have you discovered worked for you? We’d really love to hear. Leave comments, and subscribe wherever you get your podcasts. We’ll see you next week on The Doctor’s Farmacy.
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