Answering Your Questions About Muscle Loss, Low Sex Drive, PCOS, And More

Mark Hyman, MD

Full Transcript

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Speaker 1: Coming up on this episode of The Doctor's Farmacy. Dr. Mark Hyman: One of the biggest drivers of aging is muscle loss. The muscle gets replaced by fat. And if you actually have muscle, it's like a rib eye steak instead of a filet mignon. Dr. Mark Hyman: Hey, everybody. It's Dr. Mark Hyman. Welcome to a new series on The Doctor's Farmacy called Master Class, where we dive deep into popular health topics including inflammation, autoimmune disease, brain health, longevity, sleep, and lots more. And today my friend and podcast host Drew [inaudible 00:00:32] and I do something really fun. We're answering community questions that you guys have submitted by a new app called HiHo. Now you can follow me on HiHo and submit your questions there, and maybe you'll see them right here on The Doctor's Farmacy podcast. Dhru Purohit: Hi, Mark. Pleasure to be here with you. Excited for today's conversation. We got a bunch of great questions from the app. I'm going to key up the first one on HiHo assisting levels from Danielle in the community. Danielle: Hi, Dr. Hyman. I have a quick question. My homocystine is consistently high right now. It's at a 4.7. I am gluten free and I'm a vegan. Please help me. Any suggestions would be wonderful. Dr. Mark Hyman: So homocystine. What the heck is that? You've probably never heard of it. Your body has thousands and thousands of molecules, millions literally, of compounds that are running around your body. One of the most important ones is called homocystine. Now for those who don't know what that is, essentially, it's a measure of how your body is handling the B vitamins. So if you are deficient in certain B vitamins like B6 folate and B12, it can actually be high. And that's a problem because high homocystine is in itself maybe causing more oxidative stress or more inflammation or more other problems like heart disease, dementia, cancer, depression, but it actually is caused by a number of different things that we can actually address clinically. So, when I see someone with a high homocystine I'm concerned because it means that they might be at risk for heart disease, cancer, dementia, depression, and many other things, birth defects, for example. Dr. Mark Hyman: And just how do we sort of learn all about this and how do we sort of start to figure out about this? Well, there's a guy named [inaudible 00:02:23] who's written numerous scientific papers on this. A number of books about this and was the first person really introduced the idea that this could be a problem. And there's a severe genetic disorder called hyperhomocysteinemia, which is an extreme version of it. And in this extreme version, kids who are 10 years old will get heart attacks and strokes because their body can't process the homocystine properly and they end up in a lot of trouble. So, most people don't have that, but about 20 to 35% of people have some variations in their genes that make them need extra folate or a special kind of folate or extra B12 or B6 and special forms of those nutrients. Dr. Mark Hyman: And so I very consistently look at this and the data's a bit confusing, because I think if you look at the science, it's not clear, not everybody agrees about how big of issues for heart disease or this or that. But pretty much everybody agrees that should be in the optimal range. Now, if your level for example is over 14, your risk of dementia is 50% higher. Now that's a pretty big risk. And the question is, what is it? How does it work? It really is important because it regulates one of the most important biochemical processes in your body. We call it methylation. Now it's a big mouthful, but essentially what it means is there's this chemical compound called methyl groups, carbon and three hydrogens called CH three. When think about this, like the currency of your body, like dollars. Dr. Mark Hyman: Like we use dollars to spend and buy things in exchange currency in the economy. And in the body, these metal groups are constantly being exchanged for all these biochemical process, including our DNA regulation. And when you've heard about epigenetics and we've heard about the idea that we can actually regulate our epigenome through doing lifestyle changes, to diet, and all of the epigenomes function in large part is determined by these methylation patterns. And we call DNA methylation and the longevity test that we can look at and tell us, for example, I'm 62, but I did my DNA methylation patterns. I'm 43, according to my DNA epigenome, which is kind of cool. So it has played a huge role in a lot of different diseases. Now, if it's high, you need to kind of figure out why you have the genetic problems. Dr. Mark Hyman: And I pretty much test most of my people who have high homocystine looking at a number of different genes. And we do, there's many methylation genes. One of the main ones is called MTHFR. There's also ones called CBS or MTR, and they all regulate different enzymes. So basically what happens in your body is that you have to convert one chemical to another chemical, and those processes happen through an enzyme or a catalyst that converts one molecule to another. And these catalysts depend on the right nutrients. These all the cofactors, all the helpers for the enzymes are vitamins and minerals. And so the B vitamins, B6 folate and B12, are critical for regulating all these methylation pathways. And if they're insufficient for you, and I mean for you because some people might need 400 micrograms of folate, some people might need four milligrams or 10 times that amount of folate to regulate the same enzyme because they have a functional difference. Dr. Mark Hyman: I'm not going to call it a defect. That's just a difference. We're all very in, we all have these variations in our genes that require us to have different amounts of different nutrients. In fact, one third of our entire DNA codes for enzymes and all those enzymes need helpers and vitamin and the minerals. And there's variability in the function of those enzymes that requires you to have higher amounts of certain of these nutrients. So let's get back to the homocystine question. So if you have a high homocystine, it means you might have one of these genetic problems. You might need more B6 folate, B12. And I look at a whole complex of genes when I test people, that's just one or two and you can go to 23andMe and do that. And they'll actually give you all your methylation genes. You can actually upload it to these thing called genetic genie and see what your methylation patterns are and whether you have these problems. Dr. Mark Hyman: So you, there's a lot of kind of cool ways you can kind of figure it out yourself. And I'll just tell you a quick story about, of a patient of mine. I know very, some very cool patients had issues with this. One of them was a woman who helped with a movie Fed Up and she was struggling for years to try to get pregnant and have a baby. And she was the director of the movie and she ended up having miscarriage after miscarriage after miscarriage. And then she finally got pregnant and delivered a baby with no brain. We call that anencephaly. It's pretty awful. And in fact, a lot of the work around this was discovered in China. And I actually heard a lecture when I lived in China because in Harbin, which is the Northern part of China, it's cold in the winter. Dr. Mark Hyman: It's like north of Beijing. It's kind of near Siberia basically. And they don't grow a lot of vegetables in the winter there. They don't have hot, they don't enough hot houses back then. They don't have like, I mean, like greenhouses. And so basically in the winter, they don't have vegetables. Now in China, everybody gets married when? At Chinese New Year. When is that? February? When is that? In the middle of winter when there's no green vegetables and where does folate come from? Foliage, the word folate come from the word foliage or greens essentially. So they don't eat greens at all winter. And what they found was there a really high rate of birth defects, we call spinal bifida, which was a defect in the spinal column. It's so important in regulating so many things, including the development of the spinal cord in the baby. Dr. Mark Hyman: And that's why all prenatal vitamins have extra folate, but they have to have the right kind of folate. So they basically discovered that there was this link between the B vitamins and these birth defects. Now she had this problem of having these miscarriages, which was caused by this gene. She had, we call MTHFR. I'm not going to give you the chemical name, but it's kind of a big thing, but it's MTHFR. And it's a gene that regulates an enzyme that you need to actually convert the folate [inaudible 00:08:34] from food, into the right form of the folate that your body can use. Well, it turns out she had this gene and she read one of my articles and she then ended up taking it to her doctor and said, Hey, can you please test me for this? And she definitely had this gene. Dr. Mark Hyman: He said, Well, just take folate. And she's like, No, no, Dr. Hyman sent this article. I have to take this special form of folate called methylfolate. Well, I don't know about that, but she did it anyway. And then when I met her, she literally had this, we were going around New York City doing PR for the movie, and she had a perfectly formed beautiful little 10-month-old baby that occurred only because she actually found out about this and took the right vitamin that was based on this methylation pattern. And she had this high homocystine. So it's that powerful. And another person who had dementia and same thing, they weren't able to actually do their proper methylation. They ended up with dementia and I gave them the right B vitamins and their dementia went away. Another guy I met, who was like 50 years old, who had everybody in his family died of heart attacks in their fifties. Dr. Mark Hyman: And he was terrified and I checked and he had a super high homocystine and he ended up having this gene as well. And so we treated him with the right kind of folate. Now, one of the things that affect this methylation process, genetics we talked about and there's tests like 23andMe you can do. I use in my practice, something called DNA Health from Nordic labs, which is something that doctors can order. A diet plays a huge role, right? If you're not eating enough greens, you're not getting enough folate. If you're not eating the fruits and vegetables, greens and beans and fruit, you're not getting B6, B12, and folate. But also that comes from, I mean, by the way, the best source of all these nutrients is liver. And I was a kid, we were really poor. We lived in Queens in New York and we used to eat chicken livers and onions and rice for dinner. Dr. Mark Hyman: I thought it was a gourmet meal, but it was because we were poor [inaudible 00:10:24] else. But actually it really is one of the most nutritionally dense foods on the planet. So egg yolks, meat, liver, oily fish, lots of source of B12, foliage, folate. So you want to make sure you have plenty of these foods in your diet. There's also things that can cause too high homocystine like sugar, too much processed fats, coffee. Alcohol is a big one, kidney failure also. And a lot of our food is irradiated that can deplete the nutrients in the food. So that may be lower in B vitamins. Smoking, if you're a smoker really messed up your methylation. High homocystine. If you have gut issues, you might not absorb these nutrients. Like if you have Crohn's disease or if you have a leaky gut or damaged gut, you might not absorb these nutrients like B12 in particular. Dr. Mark Hyman: If you're older, you might have low stomach acid and you can't absorb B12. If you are like, I don't know. The bazillion Americans taking acid-blocking drugs like Pepcid and Prevacid and Prilosec. And these drugs, they block stomach acid, which you need to absorb B12. So that can be an issue. And also certain medications in addition to these acid blockers, like methotrexate which use for cancer, autoimmune diseases; the birth control pill, B six deficiency; high blood pressure pills like diuretics, like hydrochlorothiazide; Dilantin, which use for seizures all affect these B vitamins. And then if you have kidney failure, like I said, thyroid issues, cancer, pregnancy, all these things and toxins also. So really there's a lot of reasons it can get screwed up. So how do you check if you're doing okay? Well, check your blood count. Dr. Mark Hyman: You can check your blood count and see if you have a high level of something called MCB. That means your red blood cells are too big. And if they're too big, it may mean you have a full liter B12 deficiency. And that's an easy, cheap test. Homocystine you can check obviously, the level should be six to eight. And most labs say 14 or less is normal. No, that is not normal. That's not optimal. That's the range of the population. But that doesn't mean that we have a healthy population. If you are a martian and you land in America in 2022, you'd go, oh, 75% of us are overweight. It's normal to be overweight. It's definitely not normal to be overweight. You can look at urinary levels of [inaudible 00:12:38] acid or blood levels, certain amino acids, but it's really important to optimize your methylation process. Dr. Mark Hyman: So dark leafy greens. Now things like bok choy, Swiss, chard, kale, water crest, spinach, dandelion, mustard, collard greens, [inaudible 00:12:54] greens. Also really great. Get the B vitamins. You talked about seeds like sunflower seeds, fish and eggs, beans and walnuts, dark greens, almonds, so forth. And avoid processed food, canned food, which is depleting B vitamins. Avoid caffeine, alcohol, don't smoke obviously. If you're taking medications, be careful with those medications and make sure you're getting enough of the vitamin. For example, if you take these acid-blocking medications and you take B12, it's not going to work. You need a B12 shot. Your gut plays a big role. Fix your gut. We talk a lot about that in a lot of our podcasts. So those are the ways you can optimize your methylation, and this is such an important part of your biology. It's one of the central hubs of all your biology. So I talk about this a lot. I work with my patients a lot about it, but if you have a high homocystine, that's for sure concerning, and you got to deal with it. Dhru Purohit: All right, Mark. A bunch of follow-up questions off of that. Let's go into the first one. You mentioned you took this test that helps you look at your biological age. I believe it's from a company called True Diagnostic. We have a link to it inside of the show notes, no affiliation with them. Just a test that you've been doing. And also one of your colleagues and one of my friends, Dr. Kara Fitzgerald, used this test in her study that she published in the journal of aging on how actually through following a very similar program that you talk about, she was able to reverse people's biological age over the course of eight weeks through lifestyle and dietary interventions. So the question is if somebody came back and they were shocked by their score, maybe they're 40 and their true biological age showed back as being 50, what are some of the things that they could do to start bringing that biological age down? And how does some of those recommendations play into your answer of the last question? Dr. Mark Hyman: Well, funny, you should ask, Drew, cause I just finished writing a book on it called Young Forever where I basically answered that question about how do we reverse our biological age and just a little background on the whole concept. There's a guy named Steven Horvath who's a scientist who looked at the epigenome. Now the genome is your gene. You can't control your genes. You got them from your mother and father and they're fixed. Maybe soon we'll be able to edit out our genes and use CRISPR and gene editing tools, which is coming down the pike. But for now it's not really available, but what is available is the epigenome manipulation. Now the epigenome was like the piano player. Now on a piano, you got 88 keys, that's it. But think about what you can do on a piano. You can have Mozart, you can have the Grateful Dead. Dr. Mark Hyman: You can have jazz. You can have rag time, right? You can have folk music. It's like that. The epigenome is a piano player and the epigenome is controlled by everything that you do. We call the [inaudible 00:15:29], everything that you're exposed to in your life, your thoughts, your feelings, your diet, exercise, stress, sleep, environmental toxins, your relationships, everything affects your epigenome. So you have massive control over that by the quality of your life and your lifestyle and by doing the things that actually help to improve it. And you mentioned Kara Fitzgerald. She didn't use really anything except a very aggressive, and I call it aggressive. It's not really aggressive. It's what I eat all the time, but it's an aggressive dietary intervention which isn't just a Mediterranean diet, which is great, but it's like an upregulated version of that based on functional medicine. It's a very powerful anti-inflammatory diet, but also specifically included foods, a lot of foods which are designed to improve methylation, improve this process we've been talking about for a while and this podcast. Dr. Mark Hyman: So, basically in the study, what they do is they focus mostly on diet. They had a few other lifestyle interventions they did which help, like stress reduction and exercise and so forth, but it was mostly diet. And what they found was that in eight weeks they were able to reverse their biological age by three years, which is mind-blowing when you think about that. And imagine we did that for a year. I mean, I don't know, would you get with a [inaudible 00:16:41] 52 divided by 8, I'm terrible at math, but anyway, you get the idea. It's a lot of age reversal. Now it is a limit to it, but it's really impressive to see what you can do when you actually upregulate this process of proper DNA methylation. So, that's what's kind of exciting. Dr. Mark Hyman: And in the book that I wrote Young Forever, it's really about how do you like work on your biological age, not just through diet, but through exercise, through meditation, through eating a phytochemical-rich diet, through various supplements and compounds that we can now take like NMN or NAD. So it's really, there's really a lot of strategies, even hormesis, which is this whole idea that what little stresses that we can take on our system, they don't kill us, make us stronger, whether it's exercise or hot and cold therapy or hypoxia or hyperthermia or whatever we kind of are coming up with that stress the system a little bit. I mean, hyperbaric oxygen therapy is another kind of stress where you put yourself under pressure with a lot of oxygen in a tank. And they actually dramatically increased telomere length, which is a measure of your biological age. They actually killed a lot of the zombie cells, or we call [inaudible 00:17:49] cells, which increase inflammation in the body. Stable to like kill zombie cells and increase telomeres almost more than any other intervention. And that's just by applying oxygen under a high pressure, like two [inaudible 00:18:00] of pressure. So there's a lot of really cool technologies out there that we now are learning about that can help us reverse our biological age. Dhru Purohit: That's fantastic. You also mentioned looking at your DNA and getting an understanding of it. There are friends of yours that, Nordic Labs, that basically took your DNA analysis. And we are friends with them and we've done some fun projects. They're not a sponsor of this podcast. You just mentioned it. So I thought we'd link it up in the show notes below, they go through your genetic test and talk about the insights that you took away from it. So they made a whole little video and put it on a website. So we'll link to it below if anybody's curious about that test and what some of the insights you got, you can check that out in the show notes, we'll make sure to link to it. Mark, something that I want to get your insights on that's also, again, surprise, surprise on the topic of longevity, is this idea of grip strength, right? Why is it that grip strength do you think has been so associated with being as far as I understand one of the top, if not the number one, marker of somebody's lifespan here on earth? So what is about grip strength? Dr. Mark Hyman: Well, I think grip strength is just an indirect marker of your overall muscle mass and strength, right? So if your grip strength is weak, it's a sign that you have sarcopenia, which is muscle loss and that you can't do the things that you [inaudible 00:19:30] do, whether it's open a jar or just the basic activities of daily life. So one of the biggest drivers of aging is muscle loss. And it's not really talked about it. We don't really learn much about it in medical school. We don't learn what to do about it. We go exercise and eat well, but it's such a profound science when you look at what happens as we start to lose muscle. So grip strength is sort of an indicator of your overall level of strength in sarcopenia. And if you have sarcopenia, you're kind of screwed because it's not just that you get weak muscles, but muscle is the currency of aging. Dr. Mark Hyman: If you don't have muscle, you're going to age fast. Why? Because muscle gets replaced by fat. And if you actually have muscle, it's like a rib eye steak instead of a filet mignon, and you don't want that. I mean, you might want to eat a rib eye steak, but you certainly don't want it for your muscle. Why? Because when you are immobilize muscle and you are actually producing lots of damaging compounds. You actually create lots of inflammatory compounds and increased inflammation. And we know that aging is an inflammatory process. We call it inflammaging. It also makes you insulin resistant, which we know is one of the key features of aging, where you become more resistant to the effects of insulin and diabetic and prediabetic. It also increases cortisol and stress hormone levels, which age us, and shrinks your brain to makes you demented, it lowers growth hormone, which is necessary for repair and healing. Dr. Mark Hyman: It lowers testosterone, which is necessary for keeping your muscle and for sexual function. So it really creates a whole cascade of problems when you have low muscle mass. And that's sort of, we've had another podcast where we talked about protein and the importance of protein as we get older, because we have to maintain our muscle mass. If we're going to stay healthy, as we age, we need muscle mass. And, Drew, I don't know if you know this, but the major reason people go in into nursing homes, it's not because they're sick it's because they can't do their daily activities. They can't tie their shoes. They can't get out of bed. They can't get out of a chair. That's because they've lost muscle. And if you are listening to this, I encourage you to sit in a chair, like a kitchen chair, and don't touch the chair and keep your back straight and just try to sit up out of your chair without actually bending forward. And if you can't do that, it means you probably have weak muscles and you better get on it. Dhru Purohit: Yeah, it's so true. And even if you, and unfortunately in this world that we live in today, it's not like a long, slow decline in this thing where one day you wake up and say, you know what? I'm having a hard time getting up. I'm having a hard time tying my shoes. I think I need to now be in a nursing home, it's usually you're in the kitchen. You've lost so much muscle mass. You don't really know. And this activity used to do, which is getting on top of the stool to put the dishes away at the top of the shelf, you end up slipping and falling and you can't catch yourself because your grip strength isn't good. You don't have enough muscle mass, you fall and you break your hip. And that's how most people end up in these situations. It's very tragic. Dhru Purohit: It's happened to family members of mine before, and it's very unfortunate and it's a very tough thing. I heard a statistic from one of your colleagues that you introduced me to, Dr. Gabrielle Lion, who was on my podcast recently and you've done some podcasts with her too. We'll link to those in the show note. She said for a woman 65 plus who falls and has like a hip fracture, less than 50% of them will ever end up walking again, that's terrifying. And that should be terrifying for people who are listening. Dr. Mark Hyman: Well, it's even worse than that, Drew. It's like getting a terminal diagnosis of metastatic cancer in terms of your longevity, that if you get a hip fracture, a risk of death is as high as that of getting a terminal cancer diagnosis with stage four metastatic cancer. Dhru Purohit: Wow. That's nuts. And I know that there are a lot more companies and solutions and people that are talking about how do you make working out, strength training, of course diet you did our whole last podcast that we did together was about dietary interventions and protein. And I'm just excited to see that, to really make this a national focus for individuals. It's never too late to start making movement a regular part of your lifestyle. All right, Mark, I want to continue on this topic of longevity, but bringing up and tying back into something that you had mentioned, which is this idea of sexual health. A lot of people notice that as they get older, that their libido starts to go down. That can show up in the form of erectile dysfunction or just actually not craving, wanting, physical intimacy. Of course, intimacy is a spectrum and there's all this sort of different types. But specifically when it comes to our sexual drive, what have you known as a practicing functional medicine doctor about how things like inflammaging and our modern lifestyle take a toll and are some of the root causes behind a low sex drive as people age? Dr. Mark Hyman: Well, I mean, this is a complicated subject, cause as many aspects to this. It's relational aspects, there's the intimacy aspects, for women often the biggest sex organ is between their ears. So it's really a complicated subject and it's all about the relationships as well as their biology. So I'm going to focus a little bit on the biology for a minute. And I know you, all listening might think this is just cause I'm focused on sugar and my whole life sort of focused on talking about sugar and insulin resistance as a big factor in everything. But the truth is that sugar is one of the biggest problems with our sexual health. What are you talking about, Dr. Hyman? Well, especially for men, and women it's a little bit different, but for men what happens is that as you increase your sugar and starch intake, you develop what we call belly fat, visceral fat, that organ fat, you get the little pooch stomach, or maybe you got a big stomach. Dr. Mark Hyman: And that causes the production of huge amounts of inflammation as we talked about. But it also increases something called [inaudible 00:25:25], which actually converts testosterone into estrogen. So you end up actually having high levels of estrogen. And so you become more like a woman, your testosterone levels go down, your estrogen levels go up and you basically lose desire and lose function. The thing that happens within some resistance is it's the biggest driver of hardening the arteries and the small blood vessels are the ones affected often first and guess where they are, in your penis. So those you get literally hardening the arteries in the penis and the lack of blood flow affects circulation. And that's why Viagra and those drugs work is because they increase blood flow and circulation by increasing metric oxide, which dilates the blood vessels, which is not a bad thing. Dr. Mark Hyman: How a lot of people continue to have healthy sex lives. But the key is figuring out the cause, not just taking Viagra because eventually it won't work, right? So you've got to focus on the cause. And so a lot of the times as we age, as we talked about, when you lose muscle, you lower testosterone. When you increase fat in your body, you lower testosterone. In fact, there are a lot of great ways to increase testosterone. Weight lifting is a powerful way to increase testosterone, eating more fat. And by the way, your sex hormones are made from fat. And in fact, cholesterol is the building block of testosterone and all the sex hormones. So if you're taking a statin, for example, it can really lower testosterone and sex function. So you've got to look at the whole picture of what's going on with that person. Dr. Mark Hyman: And of course there are other complications that might affect your health. Like thyroid function certainly affects libido and sex drive, your testosterone as we mentioned. And so you kind of got to look at the whole picture of what's happening with somebody. But I think for most of the people I see it has to do with this problem of in some resistance, which affects almost nine out of 10 Americans. And for women, it's a little bit different. They go through menopause and their hormones change. There may have vaginal dryness which may affect their desire and function and cause pain. But many women postmenopausal continue to have really healthy sex lives. And sometimes they need a little help. They might need a little vaginal estrogen. They might need a little testosterone to help them with libido, but by working with people's lifestyle and diet and lowering the starch and sugar, increasing the good fats, doing strength training, kind of tweaking some of the hormonal things, often people can really regain sex function once that's lost or actually just continue to have healthy sex life well into their sixties, seventies, eighties, and even nineties. Dr. Mark Hyman: And I've seen, I mean, surprising I had a woman coming who was 88 years old, she's like, "I'm in a new relationship. Can you help me out here." And I'm like, "Sure." And we got her going again. And so I think we have these weird ideas in our culture about sexuality and aging but you can continue to have a healthy sex life well into your late life. Dhru Purohit: There's something important that you said that a lot of functional medicine doctors talk about is that actually for men erectile dysfunction is one of the first indicators of cardiovascular issues that are going on in the body. It's like a leading indicator. The canary in the coal mine. Dr. Mark Hyman: Absolutely. I mean, so exactly. So if you're having trouble there, it's good to look at your heart for sure. Dhru Purohit: All right, Mark. We're going to go into our next question here from Jewels in our community. And she's asking about PCOS. Jewels: I'm just curious if you have any recommendations for someone who's been diagnosed with polycystic ovarian syndrome. I am interested in learning about what diet you recommend as well as exercises you feel would be beneficial. Dr. Mark Hyman: So, Drew, PCOS stands for polycystic ovarian syndrome. And when I was in medical school, we learned about an obstetrics and gynecology. The truth is it's not a gynecologic problem, it's a nutritional problem. And what happens is that women who have high levels of starch and sugar in their diet and have some genetic predisposition to insulin resistance prediabetes, which is pretty much almost everybody except for a few lucky people. I mean, if you're basically someone who tends to gain belly fat, when you eat starch and sugar, and by the way, all of us can force ourselves to be like that. When I went into Italy years ago and I kind of went on a binge and like, "I'm the hell with it? I'm just going to eat bread and pasta and pizza and drink wine." Dr. Mark Hyman: And I got a little tummy. So even I can get that if I'm not careful, but it's pretty common. And it basically happens when you eat lot of starch and sugar, you get high levels of insulin and that affects your hormones in a really adverse way. So women tend to get high levels of estrogen. They get anovulatory cycles, meaning they don't ovulate and make progesterone. So their estrogen progesterone ratio gets way off. They have heavy periods, they get acne, which is from more testosterone and they get hair loss on their head. So you'll see women with like kind of balding in their head on the top. You'll see them, they'll have a beard, literally the bearded woman syndrome. They'll get facial hair. That's all we call polycystic ovarian syndrome, at least infertility and all kinds of problems for women. Dr. Mark Hyman: So it is really primarily a nutritional problem. And unfortunately it's treated by the birth control pill, by giving women all kinds of weird hormonal shots. And most of the time it can be treated usually in nutritional therapies. And that means a diet that's lower in starch and sugar, higher in fat, good fats like olive oil, avocados, nuts, and seeds, and so forth. And by really eliminating all that kind of processed junk that we eat that's causing this epidemic of insulin resistance. There's also some really interesting data on certain like kind of forms of B vitamins that one of them is inositol, which people might not heard about, but it's in a B complex usually. And a particular form called [inaudible 00:31:21], which has been used in research and is published in the New England Journal Medicine. Dr. Mark Hyman: So it's not like some alternative medical journal. This is the top medical journal in the world. If you're American, if you're British it's [inaudible 00:31:32] and they have a fight about that. But basically it's a top medical journal showing that giving this nutritional compound can help regulate insulin. And when I work with patients in my practice, I use the same approach I do with someone who's got diabetes, for example. A ketogenic diets can be helpful. Fixing people's gut can be helpful. A lot of the hormones are regulated through the gut. And we know for example that if you have a bad microbiome, you can produce more, for example, clostridia, which is a bacteria that can increase estrogen levels and cause some of this estrogen progesterone imbalance. So, it's a horrible problem for women to have is really common. Dr. Mark Hyman: It's not always the women who are obese or overweight. Sometimes women who are not can have this. So it's not always entirely because people are eating junk food and sugar, but most of the time it is, and it can be really well addressed. Many women, for example, have been resistant to getting pregnant and have been fertility. And Dr. Walter Willard, who's one of the most revered nutrition scientists in the world at Harvard School of Public Health, had wrote a book called the fertility diet, which was all about this issue of insulin resistance and infertility and polycystic ovarian syndrome, which is super common. So I think it's really honestly poorly treated by obstetrician and gynecologists. I was talking to somebody recently and they were like, my internist was saying really how shocked they were to realize how much food played a role in chronic disease. Dr. Mark Hyman: I'm like, oh my God, finally, people are getting it. It's like, and I see more and more conventional doctors getting the idea that nutrition should play a role in our medical school curriculums and should be part of our therapeutic practice. So it's kind of coming. I've been pushing the rock up hill for the last 30 years. I think finally we might be on the downhill side and then getting more common. But it is a really treatable condition. It creates a lot of misery for a lot of women, but I would encourage people to think about really looking at ways they can handle it through diet and lifestyle and then certain supplements and nutrients play a big role. Dhru Purohit: All right, Mark. Our next question comes from the HiHo app. And this is Tammy who has a question about osteoporosis. Tammy:: Looking for your suggestions for osteoporosis in a woman who is in her sixties. I was told hormones is too late for hormones, and I don't want to take the drugs. So would love to hear what you have to say. Thanks. Dr. Mark Hyman: Osteoporosis is really a common problem and it's, so we chatted about earlier. One of the challenges is if your bones get thin and weak and you fall and break a bone, particularly a hip, as you get older, it's like getting a terminal cancer diagnosis in terms of your risk of death. So it's really quite shocking. I think 50% of people who get a hip fracture die within a year, so that's not great. So you really don't want to get osteoporosis. And historically, we really didn't have a lot of it because most of us were out there working hard using our bodies and eating a very nutrient dense diet. And unfortunately the dogma has been that if you want to prevent osteoporosis, you have to drink a lot of milk and take a lot of calcium. Unfortunately, that's not true. And the Got Milk? ads were taken off the air and out of magazines because the FCC, or the Federal Trade Commission, which regulates truth in advertising said, there's no data. You have to stop advertising. Dr. Mark Hyman: And by the way, these ads were part of a campaign that's a government sponsored program called the checkoff program, which partners with industry to help go do research on various nutritional and agricultural products. But unfortunately it's used to actually promote products. It was a kind of a government sponsored program with the dairy council that put these ads out without a lot of data. Now, you don't take my word for it. You simply need to Google milk and health and Walter Willard and David Ludwig are the authors, Harvard researchers who reviewed all the science and published it in the New England Journal of Medicine. Again, the top medical journal in the world, showing that not only was milk not good for your health, not only was milk not good for fractures, but your risk of fracture went up by 9% for every glass of milk you had. Dr. Mark Hyman: So it's actually the opposite. Also calcium supplements, not so great either. And it's not about the calcium you're eating, it's the calcium you're losing. So if you look at what really makes the most difference for bones, it's vitamin D and if there's one thing I would say to you, it's make sure your vitamin D levels are 50 to 75. That is so important. And I say, what your vitamin D levels are not what vitamin D amount you should take, because it's different for everybody. Some people might get there with a thousand mil units of vitamin D. Some people might get there with 5,000 or maybe 10,000 based on their genetics or their absorption or various issues. So don't think that milk's going to help you, number one. Take vitamin D, number two. And number three, understand that you need to have not only the right nutrients in your diet, but you need to exercise. Dr. Mark Hyman: And before I get into the exercise piece, I just kind of want come back to this calcium issue. If you look at you, look at calcium intakes, for example, in Africa. I mean, they might have three, 400 milligrams of calcium intake a day, but they actually have very, very strong bones. Now there, if you look at American intake, they take 1500 milligrams of vitamin D, of sorry, of calcium a day. Well, it doesn't matter how much you're taking in. It matters how much you're losing. And we have a calcium losing environment. What do I mean by that? Well, if you have sugar, if you have caffeine, if you have alcohol, if you have soda, it's the worst, like the colas particularly have phosphoric acid in them that causes you to lose tremendous amount of calcium. If we eat an acidic diet, which is processed food and sugar and so forth, that acidity causes you to lose calcium. Dr. Mark Hyman: So you basically peeing out your bones, literally peeing out your bones in your urine. And we actually can do a test to measure this. And I can, I do this with women who come to see [inaudible 00:37:47] measure their urine levels of certain markers that tell me that their bones are dissolving and are coming out in their urine. So it's really, really important to not look at the total calcium intake, but the net calcium retention. So you could be, for example, taking in 300 milligrams of calcium and losing 200, that means you're up a hundred. If you're taking in 1500 and you're losing 1700, you're down to a hundred. So it really matters what your net calcium absorption versus your net calcium loss is and that, and then all those things I mentioned are the things that cause calcium loss. And there's lots more. So, really important to look at at your diet as a key factor and making sure you eat nutrient dense diet, making sure not doing the things that cause you to lose calcium and make sure taking adequate vitamin D. Dr. Mark Hyman: Now you say, well, why I don't need vitamin D because hunter gatherers never had vitamin D and they didn't have bad bones. And why do I take vitamin D? Well, sure. If you want to go around in a loin cloth, naked outdoors most of the time, hunting and gathering and getting sun exposure on your whole body, go ahead. Or if you're going to be living in a coastal area, if you're eating only wild, fatty fish all the time with lots of vitamin D. Okay. If you're hunting and gathering and eating like tons of wild mushrooms, you'll probably be okay, but most of us don't do that. So most of us live and work inside and we need plenty of vitamin D and we can get it through vitamin D supplements. Unfortunately we have, I think we have to take them. It's one of the most important things we need to do. Dr. Mark Hyman: It also helps so many other things like the immune function and COVID prevention and many other things. I mean, in fact, one study I think was from Israel. We found out their vitamins D levels were over 50. There was zero death from COVID. So it's a really critically important nutrient. So you can, you kind of kind of have to make sure you're not actually losing calcium, that you're actually getting vitamin D and that you are then exercising. So you can do all the right things. But if you actually are not exercising, it's like putting all the ingredients for soup in a pot on the stove, but not turning on the heat, right? You're not going to make soup. It's just going to bunch of the ingredients in the soup with no, I mean, in the pot with no soup. So you have to turn on the heat and that's exercise. Dr. Mark Hyman: And I've seen women even at 70 years old take seriously exercise. One started like a Vinyasa yoga practice, like a power yoga practice. She increased her bone density by 10%, which is more than any of the drugs you'll see. Now you mentioned you don't want to be on hormones. It's too late for hormones. Well, that's not true. You can sometimes use hormone therapy like estrogen, progesterone, testosterone. And by the way, testosterone is a great bone builder. And a lot of women have low testosterone and women can actually take testosterone. Women have testosterone, men have estrogen. It's not like it's sort of a binary thing. It's just that women tend to have more estrogen, obviously, and men have more testosterone, but you have to have the right balance for your sex. So you can do a number of lifestyle factors really, really improve your bone at any age. Dr. Mark Hyman: Now, there are certain things that really tend to cause osteoporosis that are concerning, that may not be thought of like, for example, leaky gut and gluten. Gluten is a huge factor, because it causes all kinds of problems in the gut and absorption. And a lot of osteoporosis risk comes from gluten issues, which by the way, may affect up to 20% of the population in some level of gluten sensitivity or we call it non celiac, gluten sensitivity. Like 1% has true celiac and that they're really at risk, but even the non celiac, gluten sensitivity people have an issue. So you want to make sure you're really taking your bone health seriously. And that's why I've really doubled down on my exercise and strength training, and I really focused on it. And I really, I made sure that I really take adequate vitamin D and exercise and my bone density it keeps increasing, which is amazing. So even as I get older, I get better. Dhru Purohit: Those are all great. And thank you for taking all those questions. I'm going to pass it back to you to go ahead and conclude us for today's episode. Dr. Mark Hyman: Well, thanks, Drew. It's been awesome. Thanks for submitting your questions. I love hearing from everybody. That's it for this week's Master Class. Make sure you submit your questions on HiHo and maybe I'll answer them in the next upcoming Master Class. And if you love this podcast, please share with your friends and family. Subscribe wherever you get your podcast. And we'll see you next week on The Doctor's Farmacy. Speaker 7: 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.