Answering Your Questions About Inflammation, Cystic Acne, Diabetes, And More

Mark Hyman, MD

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Announcer: Coming up on this episode of the Doctor's Farmacy. Dr. Mark Hyman: Back pain is really a huge factor in this country and it costs so much in of medical care, in terms of disability, productivity losses. And I mean, there's just really simple things you can do to fix it. Dr. Mark Hyman: Welcome to the Doctor's Farmacy. I'm Dr. Mark Hyman and welcome to a new series we're doing on the Doctor's Farmacy, called Masterclass, where we dive deep into popular health topics, including inflammation, autoimmune disease, brain health, sleep, lots more. And today my friend and my business partner, my podcast co-host Dhru Purohit and I are doing something really fun. We're answering community questions that you have submitted by a new app called HiHo. You can follow me on HiHo and you can submit your questions there and maybe you'll see them on the podcast here. So thanks for joining us and Dhru, thanks for doing this with me. I love it. Dhru Purohit: Yeah, absolutely Mark. This is definitely one of our most popular series. People love hearing your hot takes on all different topics. Speaking of different topics, we actually coincidentally, for good or for worse, we had a question that was submitted to our HiHo Community about back inflammation that somebody had. And I'm picking that one first, because we're actually recording this and you're in New York City. You want to give a little context of just what's going on with you. I think people like to hear a little about what's going in their life. Dr. Mark Hyman: Oh my God. Okay. Sure, sure. Dhru Purohit: Your back is acting up, so share a little bit more about it. Dr. Mark Hyman: Sure. So, I don't know. I was a yoga teacher before I was a doctor. I was a family doctor and I went to a small town in Idaho and I was pretty in shape before, with running and yoga. And I was a young doctor, had a family, two kids and I lived in this house on the top of this mountain. And in Idaho, we basically chopped our own wood. Everything was wood stoves. And I was stupid and basically carried huge amounts of wood in a really bad body mechanic posture out in front of me, 50 pounds at a time back and forth, because I was lazy and I didn't want to take too many trips and it blew out a disc. I blew out a disc and that was when I was 32 and I had to have emergency surgery and it left me with sort of chronic limp and the surgery kind of went bad, and the disc got recompressed and I recovered from it. Dr. Mark Hyman: I went to China, had back acupuncture and it was quite amazing how much the acupuncture helped and I've been pretty good. I mean, super fit, I exercise. I ran for most of my life. I stopped probably five, six years ago, ride bikes, tennis, yoga, hike, water ski. I mean pretty much ski, do it all, and I've been doing pretty good. And a couple of years ago, I did something stupid again and chopped wood. And somehow, I think I need to stay away from wood fire stoves and chopping wood, and I had another disc go out because my back was kind of all funky because of the first injury, because I've been limping for 30 years. And I never let it stop me, I just kept going. And so I had that surgery where there was a complication and I kind of recovered from that pretty well. Dr. Mark Hyman: I did a lot of rehab, a TB12 and I did a lot of regenerative medicine, which is quite amazing as a therapeutic intervention for chronic orthopedic injuries. And I'll explain what that is in a minute, because a lot of us sort of struggle with aches and pains that are arthritis or injuries. I mean, mostly for me, it's my stupidity, but I think the truth is that, there's a lot of therapies out there that have been developed in the last few decades, that are incredibly different than what you get when your traditional doctor treats you and are extremely effective. And so the kinds of things that I ... For regular back pain, I mean yoga is amazing. Stretching is amazing. Moving is amazing. I mean, and also, massage and various kinds of treatments can be very helpful, acupuncture. Dr. Mark Hyman: So those are really helpful for most people with back issues. But then there's people who have really more serious problems, more serious injuries, that need a little extra help. And that's really where regenerative medicine comes in, and it's sort of an extension of functional medicine. Functional medicine actually helps to regenerate the body's own healing systems. That's what's so beautiful about it. It activates our healing systems. And so the body has all these things in it that are healing systems, that get turned on when there's an injury. Like if you cut your skin, how does it heal? I mean, it's not easy to think about, well how do you make new skin? Or if you cut half your liver out, you can grow it back. How does that work? Dr. Mark Hyman: Well, it works because you have stem cells and stem cells contain little healing packets of information that they produce, that they release when there's a problem, and they go and kind of do all the repair. It's like a construction crew that comes in and fix everything. And inside those stem cells are things called exosomes, these little tiny packets of healing factors that get released. So, you can use exosomes in regenerative medicine. They also use placenta. Placenta is full of healing factors. So, nobody dies from it. It's just basically the placenta gets thrown away usually. So instead of throwing it away, we get it saved and the compounds in it are so reparative, so anti-inflammatory. They're amazing. We call it Placental Matrix. Dr. Mark Hyman: There's other stuff from the amniotic fluid they use, they call AmnioFix, and these are even known with orthopedic surgeons or neurosurgeons sometimes. So, this stuff can be injected in any areas of pain, inflammation. So I had a lot of that done and also there's things like PRP Injections, plasma lysate, and even other things like peptides can be injected, ozone can be injected, as they're all therapeutic tools. And then of course, there's this really cool technique called hydrodissection, which essentially releases the stuck muscles, nerve fibers and the fascia. So they all get kind of stuck together with inflammation and injury, and they can kind of get separated out, so that the nerves don't get so irritated and compressed and that really means a lot of pain. So I've had all that done. It was really like a miracle, because I had been on and off in back pain for 30 years, and doing that really relieved the pain. Dr. Mark Hyman: What I got going on now, was just kind of another injury from scuba diving where I did something stupid and kind turned wrong, and I got a little bit of a disc irritation, but I'm getting that dealt with again with some of these regenerative therapies later today. And I think that it's really amazing, because it's like we're entering an era of medicine where not only are we able to sort of replace joints, but we're able to actually activate our body's own repair system to activate cartilage regeneration or repair of tissues. And so I'm kind of excited about this whole era, because a lot of times people struggle with being active because they have various injuries. And I've never let that stop me, because I've always learned how to manage it and how to do things to help me recover and repair. But back pain is really a huge factor in this country and globally, and it costs so much in terms of medical care, in terms of disability, productivity losses. And maybe you don't think there's just really simple things you can do to fix it. Dr. Mark Hyman: So there's different kinds of workouts, exercises stretches, but this regenerative medicine field is just emerging as a really powerful tool. It's not so much covered by insurance yet, but I think it will be soon. Dhru Purohit: Well, thanks for that context Mark. And obviously, I'm sorry that you're in a little bit of pain right now, but I know our podcast community appreciates you. Dr. Mark Hyman: Yeah. So if you see me wiggling around, that's why. Dhru Purohit: Well, I think that was a great overview from what you went through. I'm going to play this first question here on that topic of back inflammation and let's see. You probably covered most of it, but let's see if there's anything else additional that you might want to add. So I'm going to pull up that question right now. Kerry: Hi Dr. Hyman. I was wondering if you could address inflammation in the back, which causes impingement on nerves. Thank you. Dr. Mark Hyman: There can be for different reasons. You can have inflammation that comes from arthritis and bone compression. You can have it from a disc bulging. You can have it from overall, just kind of stagnation in the back. So, acupuncture can be extremely helpful. Cupping can be extremely helpful. Various kinds of therapy, physical therapy can be really helpful. I've actually worked a lot with Tom Brady's Training and Rehab Program called TB12, and there, they have amazing results. And I found incredible results using that plus the regenerative medicine. Dr. Mark Hyman: So there's a lot to be done and people really don't have to suffer, if they really know what to do. Also, magnesium is really important for general back pain and spasm. If you have achy backs, Epsom salt baths are great. Hot and cold therapy is amazing. So there's a lot of ways to do it, yoga. I think there're very low cost interventions that can really make a big difference. Dhru Purohit: Fantastic. All right, thanks for that Mark. We're going to switch from back inflammation over to intermittent fasting. And this question is from Judith. Judith: Hi, Dr. Mark. Quick question on intermittent fasting. I'm hearing too many sides of the story, good, bad and ugly. Can you give us some advice? Dr. Mark Hyman: It's so funny. I was in Washington D.C. yesterday working on our work with the Food Fix Campaign to fix our food system and our food policies. And I was talking to one of the senators and he started asking me about intermittent fasting. I was like ... I thought, "Wow, this is really good. We're getting all the way over there." So, let's just sort of start with the top framework- Dhru Purohit: And Mark, before you jump in, if I could add in a little bit of subtext. Part of what I'm hearing that she's saying is that, you have some people that a few years ago when a lot more research was coming out on intermittent fasting, it's like, it's the cure for everything. Everybody should do it. Nowadays, we've done episodes. You've had some people on, that are talking about how some people have to be mindful of it and maybe women in particular, in their prime years of being able to ... Of prime fertility years. So there's a lot of nuances that are there and I think that's leaving a lot of people confused. So would love you to have you jump in on that. Dr. Mark Hyman: Yeah. For sure. For sure. For sure. So I think let's just sort of start out with, what is it? What are the definitions? What does it do? Who is it for? Why is it important? So, there's a lot of terms thrown out there, time restricted eating, intermittent fasting, ketogenic diets, fasting mimicking diets. All of these approaches are attempts to give the body a break from eating, an attempt to trigger these ancient pathways that get activated when we're starving. So our body's really smart, because when we're out hunting, gathering and if we would find a big patch of berries or some fruit tree, we'd just gobble it up and we'd gain a lot of weight and we'd pack it on. And then, there'd be a time with scarcity, and then we would use our body's ability to burn fat, to deal with lack of calories from carbohydrates, to actually activate these healing repair systems. So recycling proteins and recycling parts and using energy from different sources. It's quite impressive the systems that we have. Dr. Mark Hyman: So, all these techniques are designed to do that. So time restricted eating means, eating within a fixed time window. It can be eight hours, 10 hours, 12 hours. So that would be like a 12-hour fast, 14-hour fast, 16-hour fast. That's something you do every day and we should do every day. Nobody should eat within 12 hours of their last meal, after you're going to bed. That's just sort of given, because it gives your body a chance to repair and heal and clean up, and do the work it needs to do at night. That's really key, and you can extend it to 14 hours. So if you have dinner at 6:00 and you finish then, you eat at 8:00 in the morning, that's a 14-hour fast. If you have dinner at 6:00, you eat at 10:00 in the morning, that's a 16-hour fast. Dr. Mark Hyman: So it's not that hard to do, but some people, it's not ideal for. If you're very thin, if you're again, maybe trying to get pregnant, if you're having a very fast metabolism like some people, like I do. If I do two extended periods of that, I'll start to drop too much weight. Probably shouldn't say that in public, but anyway, that's what happens. When you tune up your metabolism, you can actually do really amazing things with your diet, without having to suffer. So I'm able to actually learn how to fix my biology in a way that it's very, very active in terms of its metabolism. So time-restricted eating, then there's intermittent fasting, which may mean anything from a 24-hour fast or 36-hour fast to a 10-day fast or a week long fast, three-week fast. Those are intermittent fast or prolonged fast. Dr. Mark Hyman: Then there's fasting mimicking diets, which is essentially an 800 calorie diet a day for five days. It's been studied a lot by Valter Longo, who's one of the leading longevity researchers. A lot of his work's been funded by the NIH. And that also seems to have amazing profound effects on reducing inflammation, reversing metabolic dysfunction, cancer treatment, so many different things. So they all activate these pathways. So how does it work and what should we do? And who's it for and who's it not for? Dr. Mark Hyman: Well, I just read a study last week or two weeks ago kind of was so depressing. I mean, just in context, when I graduated medical school, not a single state had an obesity rate over 20%. Now almost all are about 40%, which is scary. And 40% of kids are overweight. And not even that, but even if you're not overweight, a lot of people are not metabolically healthy. They have high blood sugar, high cholesterol, high blood pressure. They have overweight tummies. They have heart attack or strokes. So there's basically only 93% of people, actually 93.2% of people are metabolically unhealthy. It's more than nine out of 10 Americans don't meet the criteria, where they don't have high blood pressure, high blood sugar, high cholesterol, are not overweight or haven't had a heart attack or stroke. That's terrifying to me as a doctor. And as someone who uses food as medicine, it's an emergency. Dr. Mark Hyman: So these techniques really help to fix that problem. They fix your metabolism by triggering these ancient starvation mechanisms. And basically, I think I covered this maybe in an earlier podcast, but there's basically four nutrient sensing pathways. And I just finished my book on longevity called, Young Forever. It was so amazing to sort of understand how these ancient systems are embedded in our genes and our biological pathways. And that by really just smart hacks, little simple techniques you can do, you can activate these longevity pathways, that are also increased metabolism pathways. And two of them sense excess calories and food and protein. Two of them sense lack or starvation. So insulin signaling pathways are related to eating too much starch and sugar, those get activated. And that's really why we have an epidemic up. People just eat too much starch and sugar, activate this insulin pathway all the time, and so we're always having insulin on. Dr. Mark Hyman: Now you need insulin to some degree, because if you don't have it, you can't utilize energy and so forth. But you don't want it going all the time, because it's like the fat storage hormone. It's like miracle grow for your fat cells. So you don't want that on all the time. So making sure you have these periods of breaks, where you're not stuffing yourself or eating all the time, or having snacks at night, or having a lot of carbohydrates and starch. That will shut down the insulin signaling pathway. Then there's mTOR, which you may not heard about, but essentially it senses protein and as well as carbohydrates and sugar. And again, if you're always flooding your body with food, you can't have a time when this pathway is quieted down. When it's quieted down or silenced, mTOR causes something called Autophagy, which is essentially where we eat ourselves. So auto means self and phagy means to eat, right? Dr. Mark Hyman: So basically it's a self cannibalism system that recycles old parts. It creates these little lysosomes. It's just sort of like Pac-Man, coming on to old bits and proteins and cells and kind of re-digest them and then kind of recycle. It's like a recycling plant. And so it's really important to do that, especially with the thing, if you are not getting enough food, you have to recycle stuff, because it's like you can't get new stuff from your diet, so you have to recycle. So this is a really important longevity switch. These also, when you kind of reduce the times of eating like I was mentioning, you also activate other pathways. You increase mitochondrial formation. You increase DNA repair you increase now your anti-inflammatory pathways. So you shut down inflammation, which is sole link to everything, especially aging. Dr. Mark Hyman: The other two pathways are sensing scarcity. That has to do with sirtuins. You might have heard about that, related to red wine and Resveratrol. And that's one of the things that activates, and NAD. You might have been hearing about NAD is a compound that the body makes from Vitamin B3 and other things that actually is involved in energy production, but it also activates sirtuins to do DNA repair, increase mitochondrial production and also function, and also reduce inflammation. It also improves insulin sensitivity. So it has all these secondary benefits. And then the last one is called AMPK that is activated by lack of sugar and stuff. So, when you take Metformin for example. This is the drug that's being studied for aging. It activates AMPK, which actually puts in this process to reverse insulin resistance, which is great. Dr. Mark Hyman: So all these things are really important. And when we do any of these things, whether it's time restricted eating, intermittent fasting, keto diet, fasting mimicking diet, they all do more or less the same thing. And they all basically activate our longevity and health pathways. So the key is to activate these in the right way, but it's like Goldilocks. You don't want it too hot or too cold. I mean, if you're always flooding the body with calories and starch and sugar and protein, you can repair and heal. But if you don't have enough energy, you're going to die. Or if you don't have enough protein, you can't build muscle. So you kind of have to have ...If at all, you should be vegan because you're going to shut off mTOR and that's really great, and no protein and it's not so simple, because you need to build muscle. Muscle is the currency of longevity and without it, you can't build muscle. Particularly certain vegan proteins are low on leucine. So there's ways to be vegan and be healthy, but it's trickier. Dr. Mark Hyman: So I think that's sort of how I think about it. It's like these intermittent fasting, all these different dietary hacks are all about playing with these ancient longevity switches. Dhru Purohit: Yeah. I think you said something interesting, which is the Goldilocks zone. I think there's a tendency that when people find out about something, they can go to one extreme. And then sometimes, there's a recent study that was published on fasting, where most of the headlines that were covering this study and we'll link to it in the show notes, were talking about intermittent fasting has no impact on weight loss. That was sort of the study headlines. I don't know if you saw this. This was like a couple months ago, Mark. But if you dig deeper into the study, you find out that there's actually a lot more nuances. Dhru Purohit: So on one side you have the media that might sensationalize things. On the other side, you have people who can sometimes get a little bit too extreme. And like all things, there's a lot of nuance that's there and we have to personalize it appropriate to us. So if you have some concluding thoughts for Judith, Mark on just basics of fasting for somebody that's looking to get started, what would it be? Dr. Mark Hyman: I mean, I think the simplest thing is just try a 14-hour fast for a week, every day and see what happens. Do you lose weight? Do you feel better? Then try the 16-hour fast, see how you feel. There's no one size fits all for everybody. So I think it's really important to see what your body does, how you feel, what your energy is, what happens to your metabolism. And also the same thing with intermittent fast. If you want to take a longer fast, a 24-hour or 36-hour fast once a week or every couple of weeks, not a bad idea. I just met with somebody who did 10-day fast. That was amazing. Dr. Mark Hyman: So, I think there's a lot of ways to actually help people reset, but it's really about listening to your own body. If I do a 10-day fast, I'd be wasted away to nothing, because there's no reserves, but that's okay for me. I'm happy to be that way. Other people may be overweight or have diabetes. I mean, they can do a three-week fast, it'll be fine. So it's really listening to your own body. Dhru Purohit: Yeah. And on the topic of listening to their own body, I think another aspect of that is the seasonality, like the seasons of the year. Right now, we're in the thick of summer. Talk to me about how sort of for you, as an example, you're a very social person, you have a ton of friends, you're traveling a lot right now during the summer. How does your mealtime differ in the summer compared to, let's say, the fall or winter months? Is there any changing? Do you notice yourself eating later? Are you just cool with that? Because it's just part of the process and it's part of enjoying summer. Dr. Mark Hyman: Yes, absolutely. I think, in the summer it's interesting. I'm more active, but I also eat more fruit, because it's like peaches and things that I don't get to eat normally. So I think there is sort of a natural increased activity with also increased produce. And I still don't eat a ton of fruit, but I think I let myself indulge a little bit more in things in the summer, because I'm also very much more active and it just sort of naturally all works out. Dhru Purohit: All right Mark, let's jump into the next question. This question that we have is on Type 2 Diabetes, right up your wheelhouse. And I'm going to pull it up over here, and this question is from Maria. Maria: What are your thoughts about managing Type 2 Diabetes or Prediabetes with only eating a large amount of fruit, vegetables and grains, as opposed to the conventional method? Thanks. Dr. Mark Hyman: I think it's such a challenging space out there, because there's one camp that says, "The only way to reverse diabetes is to go vegan and eat fruits, vegetables, grains and beans." Another group's like, "Well, the only way to reverse diabetes is to go keto." And then there's everybody in between. I'm sort of in the middle. So I think there's a lot of evidence that people switching from a highly processed, American processed, American horrible diet to a whole foods, plant based diet do better. They really do. And if you take out all the junk and you put in foods and vegetables, whole grains and beans, yes. 1000% people will improve their metabolism, feel better, have more energy. The question is how long can they sustain that? And what happens over time, if you do that? And how far can you get? Dr. Mark Hyman: I think it's very, very hard to be a healthy vegan. It's very hard. And I know this, because I see patient after patient struggling with this and struggling with their weight, because they're eating ... In this life, unless you have a personal chef who's creating super nutrient dense, high fiber, high quality protein, good fats, lots of vegetables, what are you going to eat? You go out to a restaurant. You go somewhere and buy something. It's hard to buy healthy vegan food, so you're ending up with more starchy carbohydrates, more grains, more refined flours, and that just makes everything worse. Dr. Mark Hyman: So I think yes, we need a lot more fruits and vegetables. And yes, half our plate should be, or 75% of our plate should be plant foods. But for diabetics, the science has really crystallized this. And it's really called the carbohydrate insulin hypothesis. And there's a beautiful scientific paper released last year by leading scientists from Harvard and heads of many, many professional associations, challenging the old idea that metabolism and weight loss is about calories in calories out. And the quality of the calories is what matters the most. Dr. Mark Hyman: In carbohydrate calories, whether they come from sugar or flour, which below the neck, or the same, right. Or from whole grains or beans, they do have more starch. So it's not that they're bad necessarily, but in order to get the same, for example, protein that you'd get from a four ounce piece of chicken, you have to eat like two cups of quinoa. So that's a lot of food and most people don't eat that much. And then of course, it comes with a lot of extra calories and extra starch. So I've been most impressed with the data from the group that was working with Virta Health, looking at ketogenic diets. And now you have to understand when you see a 5% weight loss or a half a point drop in A1C in a diabetic, you think, "Wow, this is a great intervention." Dr. Mark Hyman: When you use a ketogenic diet, you see 12% weight loss on average. You see a 100% of people get off the main diabetes medication, which is oral hypoglycemic. 90 plus percent get off insulin and 60% completely reverse Type 2 Diabetes. And I'm talking about people who were not just mildly diabetic. I'm talking about really advanced Type 2 Diabetics. And I've seen this over and over again. I've written about in my books. This patient Janice, I always talked about, who had a BMI of 43, Type 2 Diabetic, and basically, she was on insulin for years. And in three days she was off her insulin. In three months, she was off her main medication. Her A1C went from 11 to 5.5. 11 is like, you should probably be in the hospital and 5.5 is kind of normal. And it's a log rhythmic scale. Dr. Mark Hyman: So it's not like, one, two, three, four, five, six, seven. It's one, 10, 100, 1,000. So that's kind of the scale, it's a different kind of scale. So that's a big, big change. And she didn't go on a keto diet, but she did cut out grains and beans and fruit, except for berries, and sugar. And ate lots of good quality fat. It was mostly fat, lots of vegetables and some small amounts of high quality protein. And it was just amazing to see what happened to her. So I think we see this over and over again, if we do the right thing. And there may be variations, not everybody is the same. Some people do fine with more grains and beads others don't. Dr. Mark Hyman: I literally had a patient yesterday. He's like, "Look." He goes, "I'm a vegan, but I can't lose this weight. I got all this weight on my gut." And I'm like, 'Okay, well why don't we get a continuous glucose monitor and put it on you and see what happens? Maybe if you eat lentils, you're fine. But if you eat kidney beans, you're not. Or maybe if you have black rice, you're okay. But if you have brown rice, you're not." So everybody's different, and we have to see how you respond. But at the end of the day, if I'm treating someone diabetic, I take them off grains and beans. I put them on fruits and vegetables, high quality protein, lots and lots of fat, avocados, olive oil, nuts and seeds. Even saturated fats, most of these patients can be fine. And if it's from high quality grass-fed animals, that's fine. Dr. Mark Hyman: So I think, I think we now know actually how to reverse diabetes. I was in Washington this week, advocating for policy changes. I was talking about this with the White House, Congressman, Senators, the USDA, and it was interesting. I was talking to, I won't name who they are, but it was like, "Oh well, I think really, we need to focus on the quality of the food we're delivering. It's not all about just providing calories for hungry people. It's about what calories." And then she's like, "Well, there's a lot of debate about what quality is." I said, "Well, not really. I mean, if you really kind of get below the noise, everybody agrees that we should be eating more whole food. Everybody agrees you shouldn't be eating processed food, except of course, the makers of processed food." So I think, there's a pretty good consensus on what comprise a healthy diet and the disagreements are really around the margins. Dhru Purohit: Okay Mark, that was great. Let's go to our next question here that we have on the topic of cystic acne. Diana: Hi, Dr. Hyman. What are your thoughts on the long-term use of spironolactone to manage cystic acne? And what are the alternative options? Dr. Mark Hyman: Okay. So cystic acne, I think for that question, is a really nasty condition. It's not like regular pimples. It's deep pimples that form scars and can be really hard and thick and inflamed, and there's a lot of different causes for it. And what she was talking was a medication that's used in people with a condition we call PCOS. We talked about this on the podcast before, Polycystic Ovarian Syndrome, which is really driven through insulin resistance or prediabetes. We know generally acne is caused by mainly two things. I would maybe kind of add three. One is sugar, and no doubt about that at all. Insulin resistance and PCOS is part of that. Two is dairy, and particularly modern dairy tends to cause a lot of inflammation and acne. And three is I think, alterations in the microbiome, and that often can be yeast overgrowth or inflammatory bugs. And so tho those are the main reasons people get acne. Dr. Mark Hyman: So in terms of spironolactone as a medication, it's fine to use sometimes because women who have PCOS can get facial hair, they can lose hair on their head, they can get infertility, their periods are wacky. And so, it's used as a treatment for acne. I'm not opposed to it, but it's much better to try to deal with the cause. So the diet I just talked about for diabetics would be the approach. So intermittent fasting or time restricted eating, cutting out starch and sugar and carbohydrates for the most part, eating good fats. I mean, obviously, my joke always is that, the majority of your diet should be carbohydrates. They're the most important thing you need for long term health and longevity. And what I'm talking about is fruits and vegetables. Vegetables are carbohydrates, broccoli is a carbohydrate. Asparagus is a carbohydrate. That's fine, but so is a bagel. That's not fine. A donut. Dr. Mark Hyman: I mean, honestly Dhru, I was almost ... I was sort of embarrassed to go to the Senate and the Congress. I was going through the cafeterias and it was terrifying. I mean, it was Dunkin' Donuts, Baskin-Robbins. There was all this sugary stuff, sodas, chips. I mean, I guess they use it to fuel all the staffers to work 20,000 hours a week, but it was just scary to me. And I think everywhere you go, there's all these highly processed foods that are really driving so much of the problem. So if you can get rid of all that, if you can actually start to eat the way we talked about. My 10-day detox is very, very helpful. It can be great for cystic acne. And then, you might need other treatments. There's other treatments that can be used more sort of functional medicine approaches to dealing with the microbiome, to fixing these issues dealing with insulin resistance, to improving the overall sort of metabolic health to reduce the acne, and obviously getting rid of sugar. Dhru Purohit: So going back to your story about Congress and the cafeteria, so what'd you end up eating? Dr. Mark Hyman: Me? Well actually, I didn't. I had water and actually for lunch, we ran over to this club. It was a very old club. It's been there for 65 years, kind of a private Republican club and I don't know. I'm not Democrat or Republican. My friend Rick Warren's like, "I'm not right wing or left wing. I'm for the whole bird. Otherwise, you fly around in circle." So I had great meetings with Republican Senators or Democratic Senators and Congressmen. So I feel like we just got to work all together to fix this. But I went to this club and they had ... It was this crab salad. And so basically, they had crab salad and I just got extra crab. And then I'm like, "I want extra broccoli, extra asparagus." So I put extra broccoli, asparagus and tomatoes and put some olive oil on there and salt and pepper. And I eat the crab and it was really good, so that was my lunch. Dhru Purohit: Yeah, pretty much anywhere you can go, you can always find an okay salad. I'm not always going to say that it's great. And you can add protein and fat to it, and that's like pretty much a go-to. Regardless of where you are in the world, except for India, it's very hard to find a salad. They don't keep a lot of fresh greens there. So that's always a challenging thing that I have when I go visiting there. Dr. Mark Hyman: Thank God. Thank God, otherwise you're going to get dysentery, if you eat there. Dhru Purohit: All right Mark. Dr. Mark Hyman: It's the way you cook food when you go to those countries. Dhru Purohit: Yeah, I hear you on that. Dr. Mark Hyman: And it is amazing. In India, it's really interesting. They have so many spices and the spices basically kill a lot of the bacteria. So it's actually very smart. Dhru Purohit: Let's actually follow up a little bit more on your comments about meeting with people and meeting with Senators, Congress folks. What do you think are- Dr. Mark Hyman: Yeah. Dhru Purohit: Some of the key priorities? When you try to eat the whole whale, it's very hard to make progress. But what are some of the first pieces- Dr. Mark Hyman: Yeah, yeah, yeah. Dhru Purohit: That can be bitten off to actually start seeing change? Is it schools? Is it changing our health incentives and reimbursement systems? So yeah, what are your thoughts on that? Dr. Mark Hyman: For sure. For sure. Thanks. Well, thanks for asking. It was a fun week in Washington and I say I was at the White House yesterday and I'm like, "Look, we don't want to boil the ocean. We got to just figure out the winnable wind." She goes, "Well, maybe it's getting so hot out, we can boil the ocean." It's like the temperature records are off the chart this week. So, I'm part of a group that I started called, The Food Fix Campaign, which is a non-profit educational group and also advocacy group to help policy shift. And we really have a very focused agenda for now. So we have a lot of policy initiatives we're working on. Everything from chart labeling of food, regenerative agriculture, which we sort of need to fix. It's about improve soils and improve the quality of food and to revitalize our communities and economies. But this week, we really focused on the agenda for the White House Conference on Hunger, Nutrition and Health. Dr. Mark Hyman: You have to realize, this is a conference that one, hasn't happened over 52 years. The last one was under President Nixon and established a lot of our nutrition policies over the last 50 years and we need to update them. And by the advocacy of my friend Dariush Mozaffarian, the Dean of Tuft School of Nutrition Science and Policy, and my team and others, we've advocated for this White House Conference to bring together all the stakeholders to come up with a set of recommendations that can be implemented through regulatory channels or legislative channels, to move the ball down the field and actually update our policies to address the fact that most of the diseases we see today are caused by food, that are chronic diseases that are cured by food. Dr. Mark Hyman: So I was very hopeful around that, and we really focused on a couple things. So a number of years ago, I worked with my friend Tim Ryan, who's a Congressman, Rosa DeLauro who is now Head of the Appropriations Committee in the Congress. And we got them to commission to GAO, which is the Government Accountability Office to do a report on what's the state of our policies related to chronic disease and nutrition. I wrote a book about this. I think the first time I wrote about it, I think it was 2005 in my Ultra Metabolism Book a long time ago. And it's got a lot worse since then. And basically I thought, "It was bad that there were a lot of policies that didn't work together and there's a lack of coordination. Things were cross purposed." I was like, "Okay." Dr. Mark Hyman: When I got the report, I was like, "Holy cow." There were over 200 policies, 21 agencies often completely working in odds of each other. So for example, the USDA says, "Eat half your plate as fruits and vegetables." But only 0.4, 5% of agricultural supports go for what we call specialty crops, which means fruits and vegetables and most of it is for apples. Or we say, "Don't eat sugar sweetened beverages and sodas." In our dietary guidelines with the USDA pass out, but then, for our SNAP Program or a Food Stamp Program, we fund $10 billion for the soda or 40 billion servings a year for the poor. Dr. Mark Hyman: So there's all this stuff going on like that. And so we basically got this report and as a result of their report, the Government Accountability Office recommended the Congress, they start a federal entity to address chronic disease and nutrition, which has never existed. Believe it or not, we don't have anywhere in the government, that's addressing the fact that chronic disease and food are connected. Okay, it's amazing. Even though it's over 80% of our healthcare costs, one in three Medicare dollars is on diabetes. It's the biggest driver involved healthcare expenditures. And yet there's no organization in the government that's trying to address this problem. Dr. Mark Hyman: So based on this report, we worked with Congress and we got this entity established, hopefully with HHS and it passed through the House. So it's passed through the House Bill of Appropriations to establish this entity, and then the Senate has to pass it, but I think it will. So we met with a lot of Senators to talk to them about it and how we kind of need to move this forward. So that actually will establish an umbrella organization within the government to address all of the challenges we see around our food policy. So it's like a big tent that everybody can actually deal with all this stuff. So that's a real key focus. Dr. Mark Hyman: The second we really focused on was integrating nutrition into medical care, whether it's food pharmacies, produce prescriptions, medically tailored meals, whether it's reimbursement for nutrition, lifestyle, education, programs like we do at Cleveland Clinic. There's a lot of levers to pull in that space, and we have a whole set of guidelines around that. So how do we integrate nutrition into medical care for chronic disease? You think it would be a thing, but it's not. And the third thing was, how do we change medical education? Because right now, if you've said to doctors, "Well, I want you to practice nutrition in your care for chronic disease." They're not going to know what to do. And so, they're like, "Well, eat better, exercise less." I mean, exercise more. "Eat better, exercise more." I'm like, "Well, that doesn't really help." I mean, that is not a useful bit of information. Eat what? And exercise how much? And where? Dr. Mark Hyman: So I think we really are trying to build sort of some sneaky ways leveraging for the government's power to induce licensing organizations like medical licensing, nutrition, I mean licensing for physician assistants and various kinds of healthcare providers to have nutrition questions on their licensing exams. Because for example, my daughter's in medical school and very little nutrition, and they're just teaching to the test. They're just making sure they can pass the National Board Exams, pass their licensing exams, and so they don't really study this because it's not part of the exams. So making it part of the exams, all of a sudden, the curriculum changes in every medical school across the country overnight. Dr. Mark Hyman: They were also focused on the Graduate Medical Education, because the government spends $17 billion with a B, supporting Graduate Medical Education, like residency programs, fellowship programs, and there's no strings attached. It's like, "Here's the money. Who do you want?" And it's federal money. So it's like, well we could say, "Okay look, if you want graduate primary care specialists, they have to be trained in nutrition or chronic disease, whether it's pediatrics or internal medicine, family medicine, some of the specialists like cardiology, endocrinology. You can't get your fellowship or your residency training, if you don't include these things." So we're working on all these different levers and Washington is very tricky, because it's like, "What can you do? What are the incremental steps you can make to get things done? How do you get bi-partisan support?" Dr. Mark Hyman: I met with people on both sides of the aisle and it was great. And I just was so hopeful because I was meeting with the Senator from Arkansas and Republican Senator Foxx that was so supportive of regenerative agriculture, sort of understood the problem of our refined starchy calories and carbohydrates, really wanted to help and do something about this, and it was just really encouraging to me. So I feel like we're actually moving in the right direction. I don't think these conversations were going to happen a few years ago. So I'm really hopeful and I think we're going to move the ball down forward to really implement food [inaudible 00:40:16] through our non-profit as well as regenerative agriculture. Dhru Purohit: No, that's great Mark, and I think everybody can follow along. You mentioned Food Fix. We'll have the link to that in the show notes. Dr. Mark Hyman: Yeah. Dhru Purohit: Food fix.org and they can subscribe and stay up-to-date with all the work that you guys are doing in Washington, D.C. Dr. Mark Hyman: Yeah. I mean, the White House Conference is something everybody can help support. And we put out in a social media post about getting people to give comments and it was amazing how many people commented on these issues and that we're able to then present to the White House and present to Congress, and this is what they want hear. They want to hear constituents, they want to know what the citizens think. And so, it's really important to get your voice heard. It seems like it may not make a difference, but it makes a difference. And so, we're going to be doing a lot more in the next month, and talk about the White House Conference, how you can all be involved, how you can watch it online, but how you can sort of communicate with your lawmakers, to encourage them to move forward in this direction. Dhru Purohit: Awesome Mark. Well, that's all the questions that we have for today, for the time that we had allotted. And want to give a special shout out to some of our members of our Dr. Hyman+ Community, who are here listening on our live taping over here. Thank you guys all for being here and Herschel for coordinating. So I'll pass it back over to you Mark, to go ahead and conclude us out. Dr. Mark Hyman: Well, thank you all for listening and being part of this special Masterclass Series on the Doctor's Farmacy. It's a chance for me to really share my views and thoughts. I just am grateful that you're all interested and thank you all for listening and that's really it for this week. Make sure you send me your questions on HiHo and maybe I'll answer them in an upcoming Masterclass. And if you enjoy this podcast, please share with your friends and family on social media. Subscriber on wherever you get your podcast and we'll see you next week on the Doctor's Farmacy. Diana: 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.