Lauren Feighan:</
Coming up on this episode of the Doctor’s Farmacy…
Dr. Mark Hyman:
Often people have two or three autoimmune diseases and it’s stunning to me how traditional medicine doesn’t ask why.
Lauren Feighan:
Hi, this is Lauren Feighan, one of the producers of the Doctor’s Farmacy podcast. In today’s episode, we’ve compiled community questions from Dr. Hyman’s most popular masterclass episodes. He’s joined by his friend and business partner, Drew Pruit, in discussion around the topics of autoimmune disease, sleep and inflammation. Let’s dive in.
Dhru Purohit:
We’re going to go to our community, our YouTube comments, our Facebook comments, Instagram and podcast community that emailed in. We’re going to take a few questions here and we’re going to start off with the first one. My daughter-in-law has scleroderma and keeps trying different diets, but she believes she is dying from it. Are there actual diets to help slow this down? Can people live longer with this condition?
Dr. Mark Hyman:
Yeah. So scleroderma, Drew, is a common autoimmune condition that’s based on the hardening and stiffening of connective tissue. So basically your skin gets tight, your esophagus gets tight and everything it starts to stiffen, you’re like the stiff man, and it’s inflamed. And it’s basically the same exact approach that we take to all autoimmune diseases, is look for the root cause, get rid of the root cause, and do a lot of things to help the immune system to reset and rebalance. And there’s a lot of options out there for people. It’s essentially starting with an autoimmune anti-inflammatory diet, which could be the 10 day detox diet, or it could be a more aggressive version, which is called autoimmune paleo. Autoimmune paleo is essentially getting rid of all the potential inflammatory foods that are not necessarily bad foods, but they can potentially trigger problems.
Dhru Purohit:
Like lectins or nightshades.
Dr. Mark Hyman:
Yeah. So essentially it’s protein and vegetables. You get rid of nuts, which you think is healthy, eggs, which I think is often healthy, but can be a trigger, obviously dairy, gluten, grains, beans. So it’s basically paleo plus. It’s paleo, but no nuts and no eggs. And that can be… And also no nightshades, which can be very inflammatory. So tomatoes, peppers, eggplant, so forth, potatoes. That’s a good place to start. Then working on your gut is really important. Probiotics, anti-inflammatory foods, getting omega-3 fats in, making sure your levels of nutrients are at the optimal level, dealing with stress, exercise, all those things help. And I had a patient who was a doctor who had really bad scleroderma and she came to see me, and a lot of my patients are doctors by the way, and she really did the program and got so much better and her scleroderma halted and even reversed. So yes, the answer is yes. If you understand what’s underneath all these diseases, you can really fix them.
Dhru Purohit:
Yeah. And one thing I’ll add to that. You’ve had Dr. Terry Wahls on your show, and she also talks about how she used the principles of functional medicine to take some of the autoimmune paleo stuff and go even a step deeper. And two things that she shared… And I really recommend everybody go watch that episode, we have a couple episodes with her, we’ll link to it in the show notes. She recommended that she was doing pretty good, she saw a pretty strong reduction in her symptoms, but she really kind of hit a floor where she wasn’t getting any better. And she started bringing in two things that was a game changer for her.
Dr. Mark Hyman:
Organ meats.
Dhru Purohit:
It was organ meets was number one. And then it was making sure that every day she ramped up slowly to having about nine cups of vegetables.
Dr. Mark Hyman:
Yeah. So it’s not only what you don’t eat, it’s what you actually eat.
Dhru Purohit:
Right. Because sometimes people go on a paleo diet, right, and they end up restricting so many things and they’re limited because they react to a lot of stuff-
Dr. Mark Hyman:
No.
Dhru Purohit:
… but slowly ramping up, which takes some time. You don’t want to start off right away. And she’s got a whole process of going into it. So that’s where these layers of how people combine things and share their experiences is very unique because they can be the missing ingredient.
Dr. Mark Hyman:
It’s true. And so just as food can be the cause, it also can be the cure. And within plant foods are these phytochemicals, there’s 25,000 of them and many of them are anti-inflammatory, medicinal, repairative, fix the gut, the microbiome, prebiotics, probiotics. It’s amazing what you can eat. So for her, she really breaks down the food into a number of categories, right? Brassicaceae family, which is all the collard, kale, cabbage. Garlic and onions family, really important. Components with sulfur, detoxifying compounds, Valsartan and other anti-inflammatory compounds. Mushrooms, which are full of these immune-modulating polysaccharides that are anti-cancer, but also have the immune system, and also pre and probiotic foods to help the microbiome, like sauerkraut and various kinds of prebiotic foods like artichokes or juiced artichokes or asparagus or plantains and other foods.
Dr. Mark Hyman:
There’s a way to actually use food as pharmacology. It’s not just, oh yeah, food is medicine, it’s kind of cool. If you eat healthy food, you’ll be healthy. No, no, no. There are a specific components in different foods that regulate different biological pathways and you can optimize those by choosing to eat those foods. And that’s what I do when I go to a grocery store. I’m thinking in my head, okay, where am I going to get my drugs? And I’m like, oh, artichokes. Okay. That has prebiotic fibers, is good for the microbiome, but also has these special compounds that are detoxifying for my liver. Oh gee, I’m going to have Ishitake mushrooms because they have the polysaccharides that are helping my immune system and cancer. And oh, maitake, that’s really good for cancer too. I’m going to have that.
Dr. Mark Hyman:
So I kind of go through, oh, I’m going to get this really good high oleic olive oil, which has got oleic acid and also these olive polyphenols, which are extremely antiinflammatory and help my heart. I’m constantly like looking at the grocery store like a drug store. And that’s, I think, that’s why I call the podcast the Doctor’s Farmacy, with an F.
Dhru Purohit:
All right, Mark. Here’s the next question from our audience member. They’re asking, they have a history of Hashimoto’s in their family and thyroid issues, but their doctor isn’t running their thyroid antibodies, and they want to know, what I’m assuming from this question is, what really should be the complete test and how much do you pay attention to things like thyroid antibodies?
Dr. Mark Hyman:
Yes. So typically as doctors, we’re trained all you do to track thyroid disease is check TSH, which is the thyroid stimulating hormone. If it’s low, it means you’re hyper. If it’s high, it means you’re hypo. And if those show up, then you go further to the next level testing, which is looking at antibodies. But here’s the trick. A lot of people walk around with subclinical hypothyroidism where it’s very kind of minor, but has real significant clinical effects. And large data sets have shown that it increases your risk of death and heart attacks. And subclinical hypothyroidism isn’t really subclinical, it just means it’s not severe, but you can still have depression, fatigue, weight gain, cholesterol issues, skin problems, hair loss, constipation, fluid retention. I mean all the hypothyroid symptoms.
Dr. Mark Hyman:
And we also know that even if you’re a TSH is “normal”, and by the way, the range used to be 0.5 to five. And so doctors wouldn’t even start thinking about looking at anything until it was over five. Well, the American College of Endocrinology came out with a new guideline saying, no, it should be three or three and a half. Right? But what is optimal? Is three optimal. No, it’s probably one, or maybe around between one and two or maybe a little less. So I always check antibodies along with free T3 and free T4, thyroid peroxidase and antithyroglobulin antibodies, because many, many times I’ve seen normal thyroid tests like normal TSA, normal T3, T4 and very high antibodies, and these people are having clinical symptoms, if you pay enough attention.
Dr. Mark Hyman:
And even looking at how we’re doing things now, one in 10 men and one in five women have thyroid problems, are hypothyroid. And half of them are not diagnosed. And the ones who are diagnosed are not adequately treated because they just give them T4, which is the preformed… it’s the precursor for the actual important thyroid hormone, which is T3. They give them T4, like Synthroid. That’s not okay.
Dr. Mark Hyman:
I wrote a book years ago, it was an ebook called the Ultra Thyroid Solution, will link to it, and I go through everything in there. What causes hypothyroidism, what tests you should do, what nutrients you need, what food you should eat, what supplements to take, and how to get to the root cause of it, because it’s often missed. And it’s tragic because it’s like a miracle. It’s like one of my favorite magic tricks. When someone comes in and they have this and that, oh, just take a little of this thyroid. And you’re like, boom, it’s like a light goes on and they feel great. So I think-
Dhru Purohit:
You’ve also done a lot of really good episodes with practitioners who’ve had autoimmune diseases themselves.
Dr. Mark Hyman:
Yes.
Dhru Purohit:
Doctors themself who went on really long journeys.
Dr. Mark Hyman:
Yeah.
Dhru Purohit:
We’ll link to those as well.
Dr. Mark Hyman:
Yeah, for sure.
Dhru Purohit:
All right, Mark. Next question from our community member. What is on the cutting edge when it comes to getting to the root of autoimmune issues and are there any emerging technologies that you’re super excited about?
Dr. Mark Hyman:
Yeah, so much, Drew. It’s so exciting to be a doctor right now. I mean I’m, God, almost 40 years in since I started medical school. God, can I say that? 40 years. Geez. Anyway. But biologically I’m 43. So it’s okay. The truth is that there’s so many exciting advances in our understanding of how to modulate immune function and autoimmune disease. I would say though, that it’s really important to always deal with the foundational basics. Food, toxins, allergens, microbes, stress, diet, really, really, really important. And all the things we talked about are first step.
Dr. Mark Hyman:
Then there’s a bunch of technologies that are emerging that can be really helpful for people who are stuck or have challenges. And one of them is really exciting, which is peptides. Peptides are small molecular-weight strings of amino acids that aren’t long enough to be a protein, but they’re like mini-proteins. They’re called peptides. And they’re signaling molecules that the body normally makes. So for example, thymosin alpha 1 is really an important one that regulates immunity. As we age, our thymus shrinks. As a baby you’ve got a big thymus, and that’s the immune organ and it shrinks as we get older, but you can actually grow it. So thymosin alpha 1 can very helpful in modulating the immune function, helping immune system work better. The whole class of peptide can be effective.
Dr. Mark Hyman:
Second is ozone therapy. Now, ozone, it sounds wacky and crazy. And the ozone layer and whoa, ozone’s dangerous. If you Google ozone, the FDA’s going to tell you it’s going to kill you. Well, yes it will actually, if you breathe it, but so will water, it’s called drowning. So it doesn’t mean it’s bad, it just means you have to put it in the right hole. And so ozone actually is what we call a hermetic therapy, which is a stress, it’s an oxidative stress. So it creates… ozone is O3, and then you inject the gas directly or you can do it rectally or you can give it in a… mix it with blood and then put it back in. And essentially it creates this bounce back effect in the body where it’s like danger, danger, and then all of a sudden the body kicks in its own repair mechanism.
Dr. Mark Hyman:
So it decreases the NLRP3 inflammasome, which is a whole inflammatory cascade that happens. It inhibits NF-kappa B, which is another inflammatory gene transcription factor. It upregulates your antioxidant enzymes, which help control inflammation, like catalase and glutathione peroxidase and superoxide dismutase. Lots of big words, I know. I’m just trying to explain to you how powerful this stuff is. And it also kills stuff. So if you have Lyme disease, viral causes, other things, it can be extremely effective in helping to reduce the burden of those infections. Sometimes we don’t get rid of them completely, but it’s just a matter of like, are they taking over? Like for example, all of us have yeast in our gut, but if it grows too much, you get all these problems, right? So it helps to keep the infections down and it helps to reset your immune system. So it’s very powerful. It was really effective for me.
Dr. Mark Hyman:
And then there’s another, a few other things that are being explored, which I think are really exciting, which is exosomes. Exosomes are little packets of healing compounds that are in stem cells, that the stem cells use to do their magic. So rather than having to take the stem cells, which means sucking your bone marrow, sucking your fat tissue and spending a bazillion dollars, you can spend half a bazillion dollars, it’s still expensive, but it’s probably a 10th the price of stem cells, and actually get these grown in a lab, purified and extracted. And you can take billions of these and inject them into your vein or into different areas of your body, and they help to reset the immune system. They can be very, very effective.
Dr. Mark Hyman:
So exosomes really helped to modulate my immune system and I got dramatically better from the ulcerative colitis symptoms. And I was doing other things, too, but it was part of the solution. And of course people are using stem cells. So, often there’s stem cell treatments for autoimmune disease. So there’s a lot of stuff coming on the pike. It’s very exciting.
Dr. Mark Hyman:
And lastly, there’s a procedure that we’ve been doing a long time in medicine called plasmapheresis. There’s really fascinating advances in understanding how there’s compounds floating around in our blood that actually cause inflammation, that make us age, that we can actually do something about. So plasmapheresis is this technology that is being used now for this purpose, for an autoimmune disease, inflammatory issues. It has been in the past, it is something we do, but it’s coming up as a new treatment for autoimmune disease.
Dr. Mark Hyman:
And it kind of reminded me of this story that’s being emerged, an emerging story around actually longevity, where they’ve sewn together the circulation of young mouse with old mouse. And the old mouse gets the young mouse’s blood and it rejuvenates them and they act like young mouse, like a young mouse. So it’s kind of cool. So it means there’s these components in the blood that are degrading or inflammatory as we age, and we can actually clean them up. I’ve had plasmapheresis. I’m trying all these things on myself. So I’m just seeing how it feels. I’m trying this and that. Maybe that’s why I’m 43 biologically. I don’t know. But I’ve had plasmapheresis, I’ve done exosomes, I’ve done peptides. I’m experimenting.
Dhru Purohit:
Yeah. And a lot of these things are experimental, but we need people to go and try them and we need to popularize them. And the hope is that one day that more people have access to these things.
Dr. Mark Hyman:
Well, what we really need is billions of dollars of research to go into showing how these strategies that are not what I think are medieval practices are continued. So right now, we are basically treating autoimmune disease, except for a few little tricks like biologics, pretty much how we’ve done for the last hundred years, like steroids, prednisone. I mean, they would grind up the adrenal glands in animals and that was where they’d get the cortisol and then they’d give it to patients back in the ’50s as a treatment for autoimmune disease. So we haven’t come that far from that, and it’s unfortunate. But I just had a patient who was diagnosed with this sort of terrible immune syndrome with massive muscle pain all over and joint pain and aching and fatigue, and his doctors were giving him huge dose of steroids and it kind of helped, but I sent him to get treatment with plasmapheresis and exosomes and ozone, and it just was like, it was like a miracle. He dramatically got better.
Dhru Purohit:
Yeah.
Dr. Mark Hyman:
I think we have to kind of look at, what are the first steps we can do? The things that I just mentioned are, what’s down the road, what’s coming, what’s available. Right now, unfortunately, they’re very expensive, but I think this all will get sorted out as we begin to figure this out. Because think about it, if you can take a treatment for $10,000 and get rid of your autoimmune disease, or you have to take a drug that costs $50,000 a year for the next 50 years, what do you think we should be paying for? Right? Right now we pay for the drug for 20, 30, 40, 50 years, but we don’t pay for these other things, which are short-term a little expensive, but actually in the long-term, save a ton of money.
Dhru Purohit:
Right. And as they continue to get more attention, maybe even a little bit of research through spending, awareness, who knows what becomes available to folks. All right, Mark, let’s go to the next one. Any connections between autoimmune and lots of allergies? Somebody who’s suffering from a lot of allergies and has autoimmune.
Dr. Mark Hyman:
Yes. So just to back up a little bit. In functional medicine, we look at the timeline of someone’s illness from before conception, the mother’s health, to what happened in utero, at birth, in the first year of life, in the early toddler years, we look at that whole timeline. And what’s fascinating to me is, and I don’t see this described many places, but there’s a continuum that happens. And the story always goes something like this. Okay, my mother, the pregnancy was fine, born by C-section, not breasted, my gut was a mess as a kid, I had colic, early antibiotics for ear infections, had development of allergies, asthma, eczema, irritable bowel syndrome. This is the story and it’s the same freaking story over and over again. And then that goes on usually in people’s early childhood, teens, twenties starts to get worse. And then by thirties and forties, that’s when autoimmune tends to kick in. And it’s part of that continuum.
Dr. Mark Hyman:
And often when I treat the gut and the autoimmune stuff, the allergy stuff gets better. The sensitivities to foods, to environmental allergen get better. Even in someone who’s got like pollen allergy or tree allergies, you think that wouldn’t get better, but when you fix the gut, everything gets downregulated. There’s a big connection. There’s also an interesting connection with a therapy that sounds really weird, but there’s a lot of research on this and there’s a number of books written about it, and one is called the Epidemic of Absence. And it’s using worms to actually help reset the immune system in the gut, because historically we were all managing all kinds of critters that we lived with in our gut that we kind of had this balance with. And our immune system was always kind of surveying and looking and managing and keeping everything under control.
Dr. Mark Hyman:
Well, now we’ve sort of eliminated all the worms and the parasites, we have clean water, we have sanitation, which is all great, I’m not saying we should go back to eating a lot of worms, but there are a number of studies that look at using a worm therapy, which helps to reset the gut to reduce allergies, but also autoimmunity. And I’ve had some remarkable success. I remember this one kid who was sort of on the Asperger’s autism spectrum who had super high levels of allergies, IgE allergies, which is true allergy, not like a food sensitivity, and like the blood level of thousand, normal’s a hundred, of IgE, which is the antibody for allergies. And we did the worm therapy and it came down to normal and his allergies went away. I was like, wow. Okay. And we’ve seen this in other autoimmune disease. So it’s not my first line therapy, but it is something that I fall back on if we get stuck. And so regulating the gut and regulating those allergies really helps to control inflammation in general and the whole autoimmunity picture.
Dhru Purohit:
Great. So my son has celiac and Graves’ disease. Any tips on supporting and reversing this process? Well, all the things that we just mentioned above.
Dr. Mark Hyman:
Absolutely. Often people have two or three autoimmune diseases, and it’s stunning to me how traditional medicine doesn’t ask, why? Is this just coincidence or is there a reason? Well, yes, celiac will drive Graves’ disease. So if you actually heal the gut with celiac, you often can reverse the Graves’ disease. The problem is that with celiac, often people just get rid of the wheat or the gluten, but they don’t rebuild the gut. And I’ve seen many, many people struggling even after getting off gluten because their guts have been so messed up they need a rehab, they need a remodel in there. And so when you do that, often people will get better.
Dhru Purohit:
Okay. Next question. How bad is alcohol for autoimmune diseases?
Dr. Mark Hyman:
Well, it depends on what alcohol, right? There’s spirits, beer, and wine. Let’s see. The more alcohol you drink, the more it disrupts the microbiome, the more it leads to leaky gut, the more it drives inflammation. So having a shot of tequila here and there probably isn’t a problem if you’re in balance, but if you have an autoimmune disease, alcohol can be a real factor in continuing to trigger the inflammatory response in the body. It is a toxin. The dose makes the poison, obviously. Particularly if you’re drinking beer, which is gluten based, if you’re drinking a lot of wine, which has sulfites, a lot of sugar, can cause dysbiosis and a lot of leaky gut issues and liver problems. So I think, depending on where you are in the spectrum of your health, it’s good to avoid alcohol, particularly if you have autoimmune disease.
Dr. Mark Hyman:
Now, the whole purpose of functional medicine is not to make people’s lives restricted and constrained, and to get off of everything and to live in this bubble. The purpose is to create resilience, to create balance, to create redundancy, metabolic flexibility, and make you robust so you can have a wide variety of things and your body knows what to do. So when I was really sick, I had autoimmune disease, I couldn’t eat anything. I had turkey, brown rice, and broccoli for a year. And I couldn’t eat anything else. And now I can eat anything, everything. I think if I have traditional dairy, like modern cow dairy, I get stomach issues and I get like pimples and congestion. But if I have sheep or goat that’s A2 casein, that’s maybe heirloom strains, that’s pasture raised, I don’t have problems. So it really depends on the quality of the food. But I definitely think the purpose is to create a robust system that makes you resilient and not have to be so restricted.
Dhru Purohit:
All great answers, Mark, thank you for that. So let’s zoom out and do a recap on the topic of autoimmune. If someone is going to start today, first one or two things that they should be thinking about, and next steps, let’s do a recap on some of the stuff that you mentioned.
Dr. Mark Hyman:
I think the first thing to recognize if you have an autoimmune disease is that there is an approach that’s different than what you’re going to hear from your traditional rheumatologist. And it’s easy to start. And if the beginning things don’t work, there’s always plan B, which is seeing a functional medicine doctor, but for many people, a dietary change, some fundamental lifestyle changes and a few supplements can make a huge difference. So what diet? Well, I would recommend an elimination diet. Now, I use one that I created called the 10 day detox diet. And essentially it’s no grains, no beans, no dairy, no sugar, no processed food. And it includes lots of phytochemically-rich plant foods, high quality protein, nuts and seeds, some fruit. And it gets rid of all the junk. And that alone can make a huge difference. Even if it doesn’t get people all the way better, it can dramatically improve symptoms for people.
Dr. Mark Hyman:
The second is make sure you focus on stress and sleep. Those will help your immune system regulate. And the third thing is take a few basic supplements. Vitamin D, fish oil, probiotics, curcumin. Those are easy to take, they’re safe, they’re effective, and they will help your body start to rebuild its natural defenses against inflammation. So I think those are the things that I would say are the top three things. Focus on diet, lifestyle, and a few supplements. If that doesn’t work and after two or three weeks you are still seeing no change, it means you got to dig deeper. It means maybe you have a tick infection. Maybe there’s heavy metals. Maybe you’re exposed to mold. Maybe there’s some more serious gut issues going on like SIBO or SIFO, which is fungal over growth. Maybe there’s a parasite. We have to kind of look deeper. But for most people, that initial approach can make a huge difference.
Dhru Purohit:
You had three things at the beginning of the podcast that you shared, when it comes to the top three mistakes people make when trying to heal their autoimmune disease. So let’s do a little bit of recap on those three things.
Dr. Mark Hyman:
Well, the first is thinking that drugs are only a solution, that immune suppressants, steroids, biologics, chemo drugs are the answer. They’re not. They’re a stop gap if you need them. They can save your life, if it’s really bad. I’m not opposed to using them in the right circumstance, but it ain’t the answer. The second is believing that once you got it, it’s a lifelong sentence. It’s not. And third, it’s complete missing of the root cause analysis for autoimmune disease. And that’s what functional medicine is. It’s a system of thinking about how to navigate the landscape of disease by addressing the root causes and getting rid of them, and identifying the ingredients for optimizing health and immune function that we’re missing and adding those in.
Dr. Mark Hyman:
When you do that, it sounds pretty simple. And it is quite simple in concept. It’s actually remarkable what happens. And this is when I started practicing functional medicine, Drew, I didn’t believe what I was hearing. Like my patients, I was like, try this thing that I heard about, do this elimination diet or take this thing, let’s fix your tummy and see what happens. And then people will call back like, “I’m better.” And I’m like, “Wow. Really? You are, from that? Okay.”
Dhru Purohit:
It was theory that you were learning about, but you were actually getting a chance to see and put into use.
Dr. Mark Hyman:
Yeah, I’m talking about like 30 years ago. And I was like, geez, this stuff works. And it works way better than anything I ever learned in medical school. Because I remember first hearing about it, I’m like, this stuff is just quackery and nonsense, or, it’s genius and I got to figure it out. And so I said, well, it seems pretty low risk to tell people to change their diet and do a few simple supplements and take this and that. Let’s try it.
Dr. Mark Hyman:
And I would say to my patients, look, you got this horrible thing and, yeah, the medications may manage it, but it’s not going away and you feel like crap. So why don’t we try this? It’s a little experimental, but give me a sample of your poop, let’s do your food allergies, let’s check for heavy metals, let’s try these things. Let’s take you down this course and see what happens. And time after time after time. And when I get stuck, it’s usually because I’m missing something and I’m like, oh, maybe you have a latent infection or a tick infection or you have some toxin I didn’t find or there’s some something that I missed. But usually if I’m persistent, I’m like a bulldog and I don’t let go and I kind of keep digging, and I usually find stuff.
Dhru Purohit:
Yeah. And I think that’s really the key, is try to find a doctor, you’re not really taking on new patients right now so don’t throw in a flood over here, but try to really look for a doctor that can continue to dig with you because sometimes it does take some time. People are, what I hear from a lot of functional medicine doctors, including your colleagues at the Ultra Wellness Center, Dr. Liz Baum and Dr. Todd LePine and Dr. George, they say that the patients on average that are coming to them right now are so much more complicated than even five years ago.
Dr. Mark Hyman:
Oh yeah.
Dhru Purohit:
There’s just so many layers. So really find a doctor who can sit with you, talk with you and continue to dig, because there does seem to be a higher burden of things that are contributing to a lot of the diseases that people are suffering with, including autoimmune.
Dr. Mark Hyman:
It’s true. I think we’re living in an increasingly complex world with increasingly challenging inputs that we’re dealing with, whether it’s screen time or disruptions of circadian rhythms or sleep deprivation or chronic stress from the divisive society, the burdens of loneliness in Covid, not to mention the total toxicity of our diet, the overload of environmental toxins. I mean, just the list goes on and on and on. We’re living in the best and worst of times, I mean, it’s a great time to be alive, but it’s also a challenging time to be alive because we’re having to deal with things that we never had to deal with.
Dr. Mark Hyman:
I mean, people say, “Oh, Dr. Hyman, do I need vitamins and supplements?” I’m like, “No, you don’t, you don’t need. Nobody should ever take vitamins and supplements, but only if you meet certain conditions. One, you hunt and gather own your own wild food. Two, you drink pure clean water. Three, you sleep nine hours a night and wake up with the sun and go to bed with the sun. Four, you’re exposed to no environmental toxins and have no chronic stress. And if that describes you, you do not need any vitamins. But everybody else, yeah.”
Dr. Mark Hyman:
And then I think autoimmune disease is one of those challenging diseases that’s so prevalent and thought of in really the wrong way because it’s siloed. There’s a neurologist to deal with the MS. The rheumatologists deal with joint arthritis issues. The gastroenterologists deal with the inflammatory bowel disease. The endocrinologists deal with thyroid problems. And so we don’t really understand the magnitude of this problem. So when you add all the autoimmune conditions together, it’s the number one disease in America, other than obesity. Right? Which by the way is related to it. So the good news is that we really have the capacity to deal with this in a very different way. It’s an exciting time. And if you have an autoimmune, I encourage you to really dig into this topic and take ownership over your own health and be, as my friend Chris Carr said, the CEO of Save Your Ass Technologies Inc., because you’re not going to get it from your typical doctor.
Dhru Purohit:
All right, Mark, is going to bed at the same time every night important? How do you discover what sleep timeframe is right for your body?
Dr. Mark Hyman:
Yeah. I mean, historically we used to go to bed with the sun, wake up with the sun. That’s probably a good thing. And I think the advent of the light bulb and work schedules, it just, it’s kind of screwed us up. So historically, if you really want to look at proper sleep hygiene and the way to set up a good sleep rhythm, is to go to bed at the same time and wake up at the same time every day. And generally the sleep you get before midnight is much better. So I would say 10:00, at least 10:00, maybe 9:30 in the bed, sleep by 10:00, get up at 6:00, 6:30, that will often help you sleep much better, sleep much deeper than if you sort of stay up to one or two in the morning. There are people who’s circadian rhythms are shifted and they may do better as night people versus morning people. That’s okay. But in general, I think it’s really key to sort of establish a good morning routine to get yourself set up for a good night’s sleep the rest of the day.
Dhru Purohit:
All right, next question. Is there a particular reason that we wake up intermittently as we age? And there’s two sub-questions underneath it, which are, is it normal to wake up and go to the bathroom every night? And the second question, what should I do if I’m going to bed early and still suffering from frequent wake ups throughout the evening? So this is all a question around waking up at night, especially it increasing as we age.
Dr. Mark Hyman:
So as we age, a bunch of things happen, right? We tend to have more belly fat. We tend to have loss of muscle. And when that happens is you get higher levels of insulin, more fluctuations in blood sugar and lower growth hormone. And the reason that kids sleep so much and babies sleep so much is they have huge amounts of growth hormone. But when you lose muscle, you lose growth hormone and you get higher cortisol and you get higher insulin. Cortisol will prevent you from sleeping. When you lower growth hormone and raise cortisol and through the aging process, you will actually have disrupted sleep.
Dr. Mark Hyman:
The reason that we do that is because we just don’t… we’re not active enough, our diets aren’t good. And so we’re eating a high starch, sugar diet. We’re not weight training and strength training. But the truth is at any age, you can maintain your muscle mass. I now have way more muscle mass than I did 10 years ago or 20 years ago. And it’s possible if you know what to do. So I’m very focused on maintaining my muscle mass, which helps growth hormone, which helps my testosterone, helps cortisol stay low. Very, very important.
Dr. Mark Hyman:
I think if people are waking up frequently, even if they go to bed on time, there may be something else going on. There may be metabolic issues around blood sugar. There may be chronic stress that’s not really being fully addressed. There may be other factors that cause frequent wakening. As far as urinating at night, depends on when you drink, how late you drink, how much you drink, if you have a prostate issue or not, if you have irritable bladder or not. Normally people can go through the night without peeing. And sometimes you get up once to go pee, it’s not terrible. People can go back to sleep. But if you’re going a lot more than that, it’s worth getting checked out because you could have prostate enlargement, if you’re a man, or cystitis, if you’re a woman. And it’s good to make sure you get that checked. Unless if you’re getting up 2, 3, 4 times a night to go pee, that’s a problem.
Dhru Purohit:
All right, next question. Can a person catch up, so to speak, from a previous night of poor sleep?
Dr. Mark Hyman:
I think yes and no. I mean, I think people anecdotally will say, look, if I didn’t sleep six hours and I sleep 10 the next day I feel better. So I think people will feel better. But the basic medical opinion is that, no, you really can’t catch up on lost sleep. You got to just keep sleeping and then putting sleep in the bank, and actually over time you’ll feel better, but you really have to make sure you’re not creating a lot of sleep debt and that you’re actually sleeping more when you need to, but realize that’s sort of not necessarily going to fix all the sleep that you’ve had. So, it’s not great to say, well, I’m just going to step in, six hours a night or five hours a night during the week, and I’ll sleep 10 hours on the weekend. It doesn’t work like that.
Dhru Purohit:
All right, next question. Does Dr. Hyman use a sleep tracker? And if so, which one?
Dr. Mark Hyman:
Well, I use a lot because I’m kind of skeptical about these things because you do three different sleep trackers, you get three different results. So I use, for example, Oura Ring, I use an app on my phone called Sleep Cycle, I use something called SleepWatch, that’s with my Apple watch. I’m kind of amused at how variable they are. And I don’t really know how accurate they are. I think the Oura Ring is probably the most accurate, it measures heart rate variability, it measures REM sleep, deep sleep, breathing, and so forth, movement. So there’s benefits to it.
Dr. Mark Hyman:
And they’ll give you a sense of what’s happening. Like for example, I know that for example, I have not been drinking alcohol much at all, and the other night I had, somebody ordered a bottle wine at the table and I had a glass, and maybe I had glass and a half of white wine with dinner, and I noticed that night that my heart rate didn’t lower, my temperature didn’t lower, that my sleep was more disrupted. And I’m like, ooh, was it really worth it? I don’t really know if it’s worth it. I don’t really like drinking that much. I prioritize my sleep. So it’s a really important thing.
Dhru Purohit:
Does Dr. Hyman have any tips for moms to help maintain their health while enduring sleep deprivation?
Dr. Mark Hyman:
I mean, yes. Have a good partner who can spell you to get some more sleep. Take a nap when your baby’s napping. That’s what I recommend. And do the best you can to take care of yourself within all of it. Because your quality of parenting is regulated by the quality of your energy and your presence in your family. And if you’re sleep deprived, you’re not going to be a very good company and able to really function at a high level. So prioritizing sleep is important. And figuring out the support you can get at night, whether it’s your spouse or your partner to help spell you and getting naps when your baby’s napping and taking that time is really important. But it is a tough period. And I encourage people to sort of do the best they can, but know it passes.
Dhru Purohit:
All right, next question, which is actually about napping. Do you practice napping? Are there some days where you will embrace napping? And any recommendations for people who find napping difficult to do?
Dr. Mark Hyman:
Yeah. I mean, I used to nap pretty well. Lately I just can’t nap so well. If I’m really tired I may be able to nap. And napping is fine to do. I think it’s fine, if you like to nap. I think it can be… you don’t want to overdo it. 20 minutes, half an hour. If you sleep for long periods of time, it can make you really groggy and it can affect your nighttime sleep. But I think that people who feel like they can and want a nap, it’s so fine. And I think people can often just go down and they wake up 20 minutes later and they’re refreshed, and I think that’s a very good thing to do. I tend to meditate. For me, meditating is like taking a three hour nap sometimes. I just close my for 20 minutes, I wake up completely refreshed.
Dhru Purohit:
All right. Supplements and sleep aids. There’s a few questions about them. Are there any supplements that you recommend? What are your thoughts about melatonin or other things that people might be using at night to help them get better sleep?
Dr. Mark Hyman:
Yeah. There are a lot of things you can do to help improve sleep through supplementation. So magnesium is my first go-to. A lot of people that are low on magnesium, that can cause insomnia. I think melatonin anywhere from half a milligram to up to three milligrams can be a great adjunct to sleep. There’s other amino acid like GABA derivatives and theanine from green tea that can also help. There’s adaptogenic things like ashwagandha, rhodiola. There’s other herbs that can help as well. Valerian, passion flower, magnolia, all these, lemon balm, all these can be very helpful for sleep. So I encourage people to try different things. And people should not probably use chronic sleep aids like benzodiazepines or Ambien, occasional is fine. Like if you’re traveling and you want to sleep on a plane, I’ll use it, but really rarely. And I think it’s important for people to sort of know that these can cause long-term cognitive issues, it can cause long term health consequences.Not getting sleep is also a problem. So it’s a kind of a fine line to figure that out. But I encourage people to sort of try some of these alternative things.
Dr. Mark Hyman:
I wrote an article years ago about the 20 tips on how to get better sleep, including a lot of the supplements, the doses, where to get them and so forth. Also we have a sleep master class that we created, and people can access that. I think it’s free, right, Drew?. So people can just get to the sleep master class and learn more about what to take and what to do and how to regulate their sleep. It’s really important.
Dhru Purohit:
Fantastic. What about CBD? Do you like it and who would you recommend or not recommend try using it?
Dr. Mark Hyman:
Well, CBD is a derivative of the marijuana plant, and people are using combination of CBD or CBD plus THC, which is basically pot. And that can be very effective. Often, when many other things don’t work, people can take capsules or tablets or even smoke vapor or actual marijuana cigarette. That can actually help with regulating sleep and help getting people to sleep, deep sleep. It helps relax them, decrease anxiety. And I found that very helpful as well. I think there’s there’s room for that as a therapeutic tool. There are questions about what’s the long-term consequences of CBD, THC on the brain. But in the meantime, I think it’s a very simple, easy intervention that you can do, they can help with mitigating a lot of sleep issues. And I don’t… And I recommend it to number of my patients. It can be very effective. It doesn’t work for everybody, but it can be very, very good.
Dhru Purohit:
What role do grains play when it comes to inflammation, chronic inflammation in the body? Can grains help or hurt chronic inflammations in the body?
Dr. Mark Hyman:
Great question. Depends on the grain. White flour surely is one of the most inflammatory foods on the planet, whereas ancient grains like Himalayan tree buckwheat may be one of the most anti-inflammatory foods on the planet. So it’s not grains as a whole. It’s which grains, in what form? How were they grown? Where were they grown? What were they grown with? Are they full of pesticides? Are they full of glyphosate? I mean, there’s so many layers of things that will actually determine the answer to that question. In general, though, the way we eat grains in this country is as white flour. 90% of the grains we eat in this country is white flour, very few people eat whole grain foods. Maybe there’s a wholewheat bread, but if you look at the label, it’s mostly white flour and high fructose corn syrup with a few flakes of whole wheat thrown in there. Right? It’s not like the dense breads you get in Europe or Germany.
Dr. Mark Hyman:
So I’m not against grains, but I do think that there are are challenges for people who are eating a lot of flour. It’s probably one of the most inflammatory foods. And if you have a leaky gut, if you have an imbalance in your microbiome, if you’re not having an intact system in your gut, grains can be a problem. So I tend to eliminate grains if I’m really aggressively trying to reduce inflammation, not forever, but for a short period of time to try to reset the system, to heal a leaky gut and get people functional again. If you do that, you also do a number of other things. Because grains are starch, and depending on how much you eat, right, having a half a cup of black rice or a half a cup of buck wheat may not be a problem, but typically we eat huge amounts of grains. And that drives another pathway for inflammation, which is insulin resistance or prediabetes or blood sugar problems.
Dr. Mark Hyman:
And so we have to understand that we have to reduce the starch and sugar in our diet. And one way of that is actually reducing grains. But whole grains can be a part of a healthy diet. It’s just when you get to eat them, who gets to eat them, in what context, with what other foods, and where those grains come from. Are they modern hybridized grains that are full of starch and sugar, or are they ancient grains that have all these phytochemicals and other beneficial properties?
Dhru Purohit:
Next question. How does hormonal balance or imbalance related to inflammation?
Dr. Mark Hyman:
So the biggest driver of chronic inflammation is stress, which drives all kinds of hormonal dysregulation. It screws up your hormones, the sex hormones, your insulin, blood sugar, cortisol, adrenaline, and it really drives huge amounts of inflammation. If you actually are highly stressed, that will drive a lot of the pathology. I mean, insulin is another hormone. That is a big one that drives inflammation. That’s one of the biggest ones. We talked a lot about that. You’ll see people who are taking hormones, for example, estrogen or the birth control pill, and depends on what you’re taking. If you’re taking, for example, Premarin, it raises inflammation in the body. It causes a high CRP. So does the birth control pill. So a lot of people are taking the birth control pill. I’m not saying people should stop the birth control pill, but you want to make sure you mitigate the effects of that.
Dr. Mark Hyman:
I recently did an Instagram Live with the founder of Even, Sarah Morgan, talking about the ways in which, for example, medications deplete nutrients, and affect the body adversely. So for example, if you’re on the pill, the birth control pill, you may need to take certain nutrients to mitigate the effects of that and help reduce inflammation. So certain things I would never take, like Premarin, which is a hormone that drives inflammation, but I certainly you wouldn’t tell everybody it’s stop the birth control pill, but I think you have to know what you’re doing and actually offset the harm by taking the right nutrients to actually mitigate the damage and the inflammation that comes from that.
Dhru Purohit:
Last question here, before we go into final thoughts and conclusions. Can inflammation be tied to our genetics? Are some people more prone to developing markers of inflammation, especially chronic inflammation?
Dr. Mark Hyman:
Absolutely. I mean, we’re all heterogeneous. We have 20,000 genes. We have about 5 million variations in those genes and some of those variations predispose you to inflammation. And we test those. I do that in my actual practice, looking at saliva swabs that measure DNA. And we can look for variations in certain genes that affect the cytokines, like interleukins and [inaudible 00:43:15], other genes. And we can see, oh, you’re someone who, if you get some trigger, is way more likely to be inflamed. So there are people who are predisposed to inflammation, but that doesn’t mean they’re predestined to inflammation. So they need to identify, one, the sources of inflammation in their life and get rid of them. We talked about those. And they need to include anti-inflammatory strategies in their life. And anti-inflammatory diet, more polyphenols, probiotics, antioxidants, and obviously other anti-inflammatory strategies like adequate sleep and exercise and stress reduction, so forth, hot and cold therapies. We just need to upregulate the anti-inflammatory system and calm down the inflammatory system. So yes, there are people who are genetically predisposed, but it doesn’t mean they’re predestined.
Dhru Purohit:
So not everybody will have access to a functional medicine doctor, obviously, if they do, that’s fantastic and amazing. You can go to ifm.org and find somebody in your area. It is often expensive, insurance doesn’t cover it, and it’s not available to everybody, but if you can, it’s a great thing. If you can’t, and for example, they wanted to explore the topic of genetics, a lot of people 23andMe data. Are there any of those websites that you like or would recommend to people that they can plug in their raw data and get back some of these unique markers that they have to pay attention for their own genetics?
Dr. Mark Hyman:
I mean, there are. The Genetic Genie, which is sort of a interpretive guide where you can plug in your 23andMe data, which can be helpful for looking for problems with methylation and glutathione and detoxification and some of the inflammation genes. 23andMe only does a small slice of your genome. It doesn’t look at everything. So we do more clinical testing. And I tend to do that and focus on that. So there may be, there’s so much going on right now in this space, I may not be familiar with it, but there probably are companies that are looking at inflammatory genes that are available to consumers. The question is, what do you do with that information? And I think that’s the challenge for people, is how do you change your diet? What supplements to take? What do you avoid? I mean, it gets a little granular, so it’s usually better to work with someone who’s experienced to understand these tests, how to mitigate your risk and to create a lifestyle that actually helps to reduce inflammation.
Dhru Purohit:
Mark. Well, this has been a fantastic conversation, a lot of material in here on the topic of inflammation. People are so curious about this topic and have so many questions. And I think that we touched on at least a good chunk of those questions. I’m going to pass over to you for some concluding thoughts and to wrap it up.
Dr. Mark Hyman:
Well, and I’m so happy we got to talk about this, Drew, because inflammation is the final common pathway for almost all chronic disease, including depression, including Alzheimer’s, diabetes, obesity, heart disease, cancer, and the list goes on and on. And it is our modern scourge. And if people want to learn more about it, I encourage them to check out that book, Inflamed, which is about not only the biology of inflammation, but the sociopolitical economic drivers of inflammation, which is a little more on the edge, but is a very important book. And I would say that if you feel inflamed, or if you have any diseases or problems that you should get checked out and go down the rabbit hole and figure out why, and not just sort of accept that this is your fate or accept that you have to take these drugs that shut off inflammation, and learn a little bit about how functional medicine can help to unravel the causes and create a plan for you that is anti-inflammatory in your life.
Dr. Mark Hyman:
If you’re listening and you love the podcast and you really know someone, or you have inflammation, share this with your friends and family, we’d love to let everybody know about this, leave a comment. How do you manage your inflammation? What tricks have you learned? And subscribe wherever you get your podcast. And we’ll see you next week on the Doctor’s Farmacy.
Lauren Feighan:</
Hi everyone. I hope you enjoyed this week’s episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you’re looking for help in your journey, seek out a qualified medical practitioner. If you’re looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It’s important that you have someone in your corner who’s trained, who’s a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.
