Underweight, Overtired, And Malnourished: How To Get Your Health Back On Track

Mark Hyman, MD

Full Transcript

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Speaker 1: Coming up on this episode of The Doctor's Farmacy. Dr. Elizabeth Boham: It's really sad just to see the level of malnutrition that we are seeing. And I think that because our food is so processed and devoid of nutrients, and people are just eating more and more of it to get what their body needs, that's why we're seeing so much obesity. So the first thing we always focus on with people is to say, make sure that everything you are eating is as nutrient rich as possible. Dr. Mark Hyman: Hey everyone, it's Dr. Mark. Now, I don't think there's anything better than waking up feeling super rested and relaxed and energized. And when we get high quality sleep, this is normal. But when we don't, our simple day-to-day tasks can feel impossible and our health really kind of suffers. And that's why I'm always looking for ways to upgrade my sleep routine. And the bamboo sheet set from Cozy Earth is my new favorite way to get an amazing night's rest. 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And they can get an extra 10% off of that $99 by visiting hellotushy.com /hyman, that's hellotushy.com/hyman for 10% off. Now let's get back to this week's episode of The Doctor's Farmacy. Dr. Mark Hyman: Welcome to the Doctor's Farmacy. I'm Dr. Mark Hyman, that's Farmacy with an F. And today we're going to talk about malnutrition, which you might think is a problem for the developing world, but turns out that almost every American is malnourished in one way or the other. And we're going to talk about why, we're to talk about how to diagnose it, and what to do about it, and why it's such a big factor in so many underlying health conditions, and it's often missed by traditional medicine. Dr. Mark Hyman: So we're going to take a functional medicine perspective on this today in our special episode of Doctors Farmacy called House Call. And, again, I welcome back Dr. Elizabeth Boham, my colleague and friend, and the Medical Director of the UltraWellness Center, extraordinary physician, an RD, an MD, a exercise physiologist. She's an incredible team member on our team and faculty of the Institute for Functional Medicine, and does so much to advance the field of nutrition, science and functional medicine around the world. So welcome back, Liz. Dr. Elizabeth Boham: Oh, thank you, Mark. It's great to be with you. Dr. Mark Hyman: Okay. So we think of malnutrition, when we went into medical school, we learned all about it. We learned about kwashiorkor and marasmus and xerophthalmia and rickets and beriberi and pellagra and all these frigging diseases that we don't really see in the West, and that are really increasingly rare, because of improved access to food nutrition. And so we kind of pretty much got that as our understanding of malnutrition. And we were told that, basically, food provides all the nutrients you need. You don't need vitamins and supplements, makes expensive urine, and we should just not follow on that track. And study after study comes out, showing how this interventional trial with Omega-3 or folate or this or that doesn't work. Dr. Mark Hyman: And so the average consumer's left wondering what's going on, because it's clear that our diets depleted and that people are eating a lot of crap, and that there's a lot of poor nutrition going on, but is there really a pandemic of malnutrition which can show up in someone who's thin or someone who's extremely overweight? So talk about what the state of our nutrition and malnutrition is in America today and why we should all be concerned about being malnourished and what that means for our overall health. Dr. Elizabeth Boham: Yeah. So when we're malnourished, it means we're not getting the proper nutrients that we need for our body to function properly. And there's so many... that's like our vitamins, our minerals, our phytonutrients, even our protein, our healthy fats. And you're absolutely right, we see undernutrition or malnutrition in people who are underweight, but also in people who are overweight, and that's called obesity malnutrition. And unfortunately it's becoming more and more prevalent, not just in the United States, but worldwide. Dr. Elizabeth Boham: And so, one of the things that is important to recognize is that at least a quarter, at least 27% of our daily caloric intake in the United States is high in calories and low in nutritional density. So that means- Dr. Mark Hyman: Is that- Dr. Elizabeth Boham: ... that for the average American... I know, and it's got to be more than that, but it's at least a quarter of their calories are coming from nutritionally, poor, deficient foods. And so it's no wonder we're seeing more and more malnutrition, and that's leading to everything from fatigue to hair loss, to dry skin, to acne, to not getting over colds and flus like you should, having an increased risk of getting sick, just feeling crummy as well, to osteoporosis and chronic disease, heart disease, stroke, cancer, diabetes. Dr. Elizabeth Boham: And of course, all the issues with mood and focus and memory that we're seeing as well. So I think it's important that we pay attention to all of these micronutrient deficiencies that we see. And unfortunately, we're seeing really commonly in this country as well as worldwide. Dr. Mark Hyman: Yeah. I mean, there's so many reasons for it. So there's one, where we're eating mostly processed food, right? Which by definition is nutrient poor and calorie rich, so we're basically, overfed and undernourished, and we can get too many calories and not enough nutrients. The second is that we're eating diets that are from soils that are poor in organic matter, which is the microbiome of the soil, and the carbon in the soil and that is required to extract the nutrients from the soil that the plant will eat and then we will eat. So our overall quality of our food has been so affected by the change in agriculture and the depletion of our souls. Dr. Mark Hyman: The other reason is that we're breeding foods to increase shelf stability and starch content and drought resistance and all these good things that have a consequence of increasing the carbohydrate content, decreasing the nutrient content and actually breeding out nutrients. Dan Barber from Blue Hill, which is Stone Barns is his agricultural ranch in upstate New York, but Blue Hill is a great restaurant. He's a chef who says, "Look, we need to put flavor back in the food, because we get these weird foods like butternut squashes that kind of orange, but they're kind of tasteless and the taste is where we want to move to, but it turns out the taste and nutrition go together." Dr. Mark Hyman: So the more nutrient dense something is the more phytochemicals there are, the more nutritious it is. And the fact is that in addition to just the fact that we're seeing this changes in our food supply, through the growing of the food and the breeding of the food and also the processed food. We're also seeing that people are, are really massively, nutritionally deficient in this country. Dr. Mark Hyman: And I was shocked to read these studies years ago about the NHANES surveys. These are surveys that the government does looking at blood testing and checking people out, thousands and thousands of people, it's sort of the background research that's going on in nutrition all the time. And they found that over 90% of us are deficient in one or more nutrients at the minimum level to prevent deficiency disease. So it's like how much vitamin C do you need not get scurvy? Not very much, and yet 10% of us are deficient in that. How much Omega-3 defense do you need? Well, 99% of us are deficient in that. How much vitamin D do you need not to get Rickets? Well, not much 30 units, but how much you need for optimal health, maybe a 1,000, two, four or 5000, and 80% of us are deficient in vitamin D. 50% in magnesium, probably, about the same in zinc. Iron is a big deficiency issue. Dr. Mark Hyman: And so we're seeing these massive deficiencies, folate, B12, and it's because of all these various factors that we talked about. And before we get into how we test this and what it causes and why it's so important, I just want to point out something that was sort of shocking for me to learn. Dr. Mark Hyman: I remember, Liz, you and I probably went to the same lecture by Bruce Ames, back at the Institute for Functional Medicine, one of the conferences, and this is a nutritional scientist. He's one of the leading scientists in the world. He's in his 80s now. He's published more papers, I mean, God, I don't know. And he said, "one third of our DNA codes for enzymes." Enzymes are helpers that make all our biochemistry work and without the enzymes, your biology grounds to help. But those enzymes also need helpers. Dr. Mark Hyman: And the helpers of the enzymes are these phytonutrients and vitamins and minerals. So if our diet is low in these, we may be having functional deficiencies that may not show up on a regular blood test. But if you look at the biology and the biochemistry, it's like your biochemical machinery is just grinding to a halt or is malfunctioning, or has got all kinds of roadblocks in it, which affect your health long-term. And we have these long latency deficiency diseases that we might not think of as related to a deficiency, for example, if you get osteoporosis, well, you might get Rickets. If you don't have vitamin D enough in the short run, but in the long run, you're going to get osteoporosis or cancer or a whole host of other problems. Dr. Mark Hyman: So we need to really rethink our view of what is malnutrition and why. So many of us are in need of assessment and treatment of these nutritional deficiencies and how profoundly they affect our health, because each of these nutrients doesn't just do one thing. They literally can do hundreds of things. Magnesium, for example, is a mineral, which is really depleted in our diet that then regulates over 200 different enzymes. So does zinc, vitamin D controls hundreds of genes and various biochemical processes. So we kind of think of these as more of just like, oh, I just need this vitamin whatever these are critical parts of our biology. Dr. Elizabeth Boham: Oh, so well said, Mark. And like magnesium, like you mentioned, at least half of us are not getting the recommended intake of magnesium. And as you mentioned, the recommended intake is just the minimum somebody needs, not necessarily what do you need for optimal health? And so when we start looking, we see nutritional deficiencies all the time. And so, it's really important that we start to really look and investigate for this, because these are areas we can have a huge impact on somebody's health. I mean, if you just say to somebody, well, that person was iron deficient and you start giving them a diet higher in iron or some supplements of iron, they feel so much better. Dr. Elizabeth Boham: And it's the same thing with all of these other nutrients. When we start to really bump up B vitamins, people can feel tremendously better. If we give them more vitamin A and Omega-3 fats, their skin improves tremendously. So there's a lot of things we see these connections with. We see low zinc and a disrupted immune system, so people with low zinc, they may be more prone to infections, but also more prone to allergies and asthma. So there's so many connections we see with these nutritional insufficiencies. And as you mentioned, the recommended intakes of these nutrients were based on what was just necessary to prevent a disease, but not necessarily what is important for optimal health and wellbeing. Dr. Elizabeth Boham: So when somebody comes into the UltraWellness Center, one of the things we do is, every person that sees the doctor has to work with the nutritionist as well. And so we assess their intake, what are they eating? What's their nutrient intake like? But then we also have to assess how are they digesting and absorbing, because it's not just what you're eating, but how are you digesting and absorbing those nutrients? And then we do a really careful analysis of somebody's nutritional status. Dr. Elizabeth Boham: So you can look at functional markers of B vitamins and get a really better understanding of what somebody needs. You can really look at levels of fatty acids, fat-soluble vitamins in their body. You could get a good sense of mineral levels in their body, protein levels, amino acid levels, and all of these things are important to assess, so you get a sense of not only is the person eating enough, but are they digesting and absorbing well enough to assimilate these nutrients and have enough in their body? Dr. Elizabeth Boham: And of course, some people just genetically need more. That's what's so fascinating about nutrigenomics right. We're learning about how some people just need more vitamin D than other people, their blood level may look fine, but they may do better with more, and the same thing with things like vitamin A. So there's genetics that are involved here as well, that influence our individual need. So this is an area that we can really influence significantly and help people's health improve. Dr. Mark Hyman: Yeah. You know what's fascinating is some of the data I've seen about why we are so overweight, and what's fascinating, and they've done controlled trials with this, where they'll take people and say, "Okay, eat as much as you want of nutrient dense food, like eat 14,000 avocados or 10 pounds of broccoli or 20 chickens or whatever, you can eat as much as you want." And then they say, "Okay, another group, you eat all this other food, which is the typical American diet, which is more processed food, and you can eat as much as you want." Dr. Mark Hyman: And what they found was that the people who ate the processed food were hungrier and they ate 500 calories more a day, which is interesting that when you eat nutrient depleted food, you want more food. And this is the body's natural intelligence trying to accommodate for looking for nutrients, but they're looking in the wrong places. We remember this thing we learned about in medical school called Pica, which is where kids will eat dirt if they're iron deficient. Just like animals will go to a salt lick or lick... I mean, I remember be in Bolivia and Peru, on the beach, and there was this mineral rich deposits on the beach, and the birds and the animals just were flocking to go get these minerals and nutrients, which they knew they needed. Dr. Mark Hyman: Well, we try to do the same thing, except when we go to get the Twinkies or we get the Doritos, or we get the whatever, Coca-Cola, there's nothing in there. And so we keep looking and looking and looking, we're looking in the wrong place for the nutrients that we need to optimize our health. And I'm just so frustrated with even highly educated doctors, nutritionists, and even the government is just not talking about this sort of incredible pandemic we're having of malnutrition in this country. Dr. Mark Hyman: In fact, some of the most rampant malnutrition is in the most obese populations, especially, in kids. Now, I mean, I'm shocked when we rarely get virgin patients in our clinic, which is what I mean by virgin is someone who's not already focused on their health, who's not already eating well. We already really get the people who are trying to do all the normal stuff. So we get the cases that are the hardest cases, but a few times in my career, I've had these sort of virgin patients who just show up and they're like, "Well, I'm just the average Joe. And I'm eating an American diet." Dr. Mark Hyman: This one kid, well, he had ADD, and I was just like blown away by the level of deficiencies that this kid had, and his poor nutrition, because he ate junk food and processed food. He had severe Omega-3 deficiencies, severe folate deficiency, B6 deficiency, zinc deficiency, magnesium deficiency, vitamin D deficiency. And I was like, "Wow." And then he had all these other things in his blood, like trans fats and all this inflammatory stuff, and I was like, "This is just incredible that we're seeing this level of malnutrition in America today." Dr. Elizabeth Boham: Yeah. And I think you're absolutely right. It is impressive, negatively, impressive. It's really sad just to see the level of malnutrition that we are seeing. And I think that because our food is so processed and devoid of nutrients and people are just eating more and more of it to get what their body needs, that's why we're seeing so much obesity. So the first thing we always focus on with people is to say, "Make sure that everything you are eating is as nutrient rich as possible." Dr. Elizabeth Boham: Because unfortunately, like you mentioned, our mineral deficient soil and the farming practices and everything, it's really stacked up against us, so we really need to think about it. You don't want to waste your calories on food that doesn't have all the nutrients that your body needs, because that's just going to help you feel better and help everything work better and help our skin look better, and help make it easier to maintain a healthy weight, and have better energy, and be able to go out for a run, and be able to focus in school. Dr. Elizabeth Boham: I mean, it's impressive what we see when we just clean up somebody's diet, but also, do those special evaluations to really look and see. And I am like you, I'm always amazed by the deficiencies we see, and what gets missed, when somebody just goes in for their yearly physical, and they have a CBC and a metabolic panel, and people aren't looking, yeah. Dr. Mark Hyman: Doctor says, "All your tests are fine." Dr. Elizabeth Boham: Exactly. Dr. Mark Hyman: "Your great, everything's good. Don't worry. I'll see you next year." But when you lift up the hood and you look underneath, which is what we do with the UltraWellness Center. We test for Omega-3 fats. We test for vitamin D. We test for zinc. We test for magnesium. We test for the B-vitamin pathways, B12, folate, B6. We do all sorts of sophisticated testing using blood and urine. We look at the genetics that are involved in nutritional status. I mean, how do we know if you need more folate or these B vitamins or whatever, vitamin D? Dr. Mark Hyman: You might have unique needs that we can actually test for by looking at some of these enzymes that are requiring you to have increased amounts of these nutrients. And what's really exciting to me is we really have the potential to really change the health of America by focusing on nutrition quality. Dr. Mark Hyman: In my first book called, Ultra-prevention, I talked about the nutrient to calorie ratio, like how many nutrients, how many calories? Coca-Cola is terrible, there's no nutrients, tons of calories. Broccoli is awesome, there's tons of nutrients, no calories. So it's pretty simple way of thinking about it, but it helps you sort of crystallize the fact that we need to really upgrade the quality of our diet and to do the right diagnostic tests. What I'd like to do, Liz, just for a mental exercise is to go through with you the common nutritional deficiencies and talk about, how they show up for us, in terms of symptoms and signs. Dr. Mark Hyman: Now, you are really critical in the nutrition curriculum at the Institute for Functional Medicine. You're an RD as well as an MD, and you help design the nutrition physical exam, which is a kind of a novel concept for a lot of people. But in Cleveland Clinic, we started teaching it to the medical students, which was great. And essentially, it's a way of looking at what are the common ways we can tell, for people listening, how do you know if you're nutrient deficient? Dr. Mark Hyman: I mean, yes, you can go to a functional medicine doctor. Yes, you can come to the UltraWellness Center. You can see one of us, we can get all the testing, but there's some simple things that you can do to test, and simple questionnaires that you can fill out to figure out, are you deficient in D or zinc or B vitamins or Omega-3 fats? So take us through some of them, let's just start with Omega-3s, magnesium, and vitamin D. Those are big ones that we see. Tell us about how you would clue in people, whether they had a risk for that and whether that's a problem. Dr. Elizabeth Boham: So Omega-3 deficiencies are so common, in fact, we check so many people for their Omega-3 levels. So we do a finger prick that is called an OmegaQuant. And what that measures is the amount of Omega-36s within the red blood cell membrane. And even with people on fish oil supplementation, or people who eat good amount of fatty fish, salmon and sardines, we still see low levels. We still see them being below what we optimally want them to be at. So you want to be at a least eight percent of your red blood cell membrane made up of those Omega-3 fats. So I'm amazed at how frequently we see that, but what signals to me, okay, we've got to think about Omega-3s, other than everything, we think about it so much? Dr. Elizabeth Boham: But if people have brain issues, problems with focus and cognition and mood, memory issues, we think a lot about Omega-3s. We think about Omega-3 fats when people have inflammatory disorders like asthma, because low levels of Omega-3s can result in increased inflammation in the body. And we think about Omega-3s when we're dealing with people with issues with their hair and their skin. If their hair is dry, if their skin is dry, if they've got the bumps on the back of their arms. I'm thinking, okay, what's their Omega-3 levels like? Dr. Mark Hyman: Chicken skins, we call it, right? Dr. Elizabeth Boham: Chicken skin, right? Dr. Mark Hyman: Yeah. Dr. Elizabeth Boham: Yeah. Are they not getting enough? Or are they not absorbing enough? So those are the reasons... Of course, if their cholesterol pattern looks bad, if they look like they have signs of insulin resistance, high triglycerides, low HDL, I'm thinking, what's their Omega-3s, I've got to give them more. So those are just some of the reasons why I know I need to give somebody more Omega-3 fats. Dr. Mark Hyman: Yeah, right, if you have dry itchy, scaling skin or flaking skin, or crack brittle nails. My nails are so strong, because I take Omega-3 fats. Ear wax, you have really hard ear wax, dandruff, joint pain, constipation, like you said, mood, attention, memory, blood pressure issues, PMS, all these things are kind of clues that you might have a deficiency. And then, of course, we test through the Omega check or other lab tests, so that's really helpful. So you can, literally, by virtue of just looking at your own symptoms, tell a lot about what's going on. Dr. Mark Hyman: So let's talk about magnesium, which is so common to be deficient. Dr. Elizabeth Boham: Oh, yeah. Dr. Mark Hyman: And it's one of those miracle things in functional medicine where you like, it's easy to diagnose, if you know what you're looking for. And it creates such a dramatic change in people's own health and feeling. It's not just, somebody should take vitamins or I don't feel anything. Magnesium is one of those things where I'm like, "Oh, my God, it changed my life." So how do we know from a symptom point of view, if you have low magnesium and how do we actually test for it? Dr. Elizabeth Boham: Yeah. So what do people feel like when they have low magnesium? They may come in with headaches, anxiety, muscle cramps, high blood pressure, more irritability, trouble with sleep. Those are all signs that you may be low in magnesium. Constipation, so those are all signs that you may be low in magnesium. And you can check magnesium levels, we look at a red blood cell magnesium level, and that can be somewhat helpful, but serum magnesium is very well-regulated by the body. So it's typically not a very good biomarker to let us know if somebody is low in magnesium, so many times when people have irritability and headaches and constipation- Dr. Mark Hyman: Similar to what your doctors test, is usually not the right one, right? Dr. Elizabeth Boham: Yeah. That's true. Dr. Mark Hyman: The one that your doctor gives you- Dr. Elizabeth Boham: That is true. Dr. Mark Hyman: ... normally, is not the right test is what you're saying, right? "Oh, your magnesium is fine." Well, maybe not. Dr. Elizabeth Boham: Yes. Exactly. And this is one that- Dr. Mark Hyman: Sorry, I interrupted you. Go ahead, because I- Dr. Elizabeth Boham: ... we need to. No, you're good. This is one that we need to actually, sometimes just treat based on symptoms. So when somebody is having a hard time with sleep or they're irritable, or they're anxious, or they're having muscle cramps or constipation, we will add in some magnesium. And magnesium's important to look at the type of magnesium, because some types of magnesium are going to loosen up the stool like magnesium citrate and oxide are going to pull water into the intestines and cause more loose stool. So some people don't need that, and so they want to go more toward her magnesium glycinate, which is a little bit better absorbed magnesium and less likely to loosen up the stool. But you also want to just talk about magnesium rich foods, so really just getting more whole foods is critical. Dr. Mark Hyman: Like what? What has magnesium? Dr. Elizabeth Boham: Oh, my goodness. Yes, so magnesium is in lots of our whole foods, in our vegetables, it's in our whole grains, brown rice has a lot more magnesium than white rice or Kasha buckwheat. Those whole grains, quinoa, have magnesium. Beans and legumes- Dr. Mark Hyman: Nuts. Dr. Elizabeth Boham: ... have magnesium. Nuts and seeds have magnesium. Yes. Great sources of magnesium. Dr. Mark Hyman: Yeah. What's fascinating, you mentioned some of the symptoms, they just reminded me of some patients, remember said, Sid Baker said to us, "Anything that's spasms or twitches or is irritable in the body is probably a magnesium deficiency problem." And I think this is so common and we just completely disregard magnesium as a real clinical problem. But if it's one of those medicines, we do use a lot in traditional medicine, we use milk of magnesia for constipation. We use IV magnesium. If people are in the emergency room, and they have a coded. In other words, they've died. If we're trying to bring them back to life and stabilize their heart, we'll use IV magnesium. Dr. Mark Hyman: If women come in with preterm labor and an irritable uterus and spasm-y uterus, we give them magnesium to stop the preterm labor. If they're having preeclampsia, which is essentially, a seizure like disorder, which is spasm of the brain and the blood vessels, high blood pressure, we give them magnesium. Magnesium is basically the relaxation mineral. I mean, if you have restless leg, if you have palpitations, like you said, headaches, if you have reflux, if you're sensitive to loud noises, if you're constantly triggered by stress, you lose magnesium, and what's fascinating is what causes us to lose magnesium besides just not eating it from coffee, I mean, from the food eating is actually stress and caffeine and alcohol. Dr. Mark Hyman: So a lot of the things that Americans just sort of survive on, which is caffeine, alcohol, and stress causes depletion of magnesium. So it's kind of one of those miracle things that we give people, magnesium, all these symptoms tend to go away, their constipation, the irritability, the cramps, the palpitations super, super powerful intervention. So let's talk about vitamin D. How do you know if you're vitamin D deficient? Or did you want to say something else about magnesium? Dr. Elizabeth Boham: No, let's go on to vitamin D, I like that. So vitamin D we think a lot about when we're talking about bone density. So if somebody is, has a fracture that we're not thinking why they just get that fracture or we think a lot about vitamin D when with mood. So if somebody has low mood, we think about a vitamin D deficiency. In addition, if people have bone pain and body pain. So we can check for vitamin D by doing a blood test for vitamin D, but you can also just press on their shinbone, and if they have pain, when you press on their shinbone, you're like, "Okay, this may be signs of low vitamin D. So vitamin D is something we're looking for often because it improves our immune system. It improves our bone density. It improves our mood. And it can be pretty darn powerful. Dr. Mark Hyman: Yeah. It's interesting people don't think about, how do you test for vitamin D? But like you said, people have seasonal affective disorder or having muscle weakness or tender bones. One of my favorite tests is, as part of nutrition physical, is you take your thumb and you press it on your shin. And if you feel tenderness on your shin or softness, that is a sign of vitamin D deficiency, because you'll get tender bones or osteomalacia. And obviously, if you're living inside working inside, if you don't live in Florida or Texas or California, you really are at high risk of vitamin D... Probably 80% of the population, I mean, even with like, COVID, your risk of COVID is up, if you have low vitamin D and if it's good, you have lower risk of getting sick. Dr. Mark Hyman: Anybody who's dark skinned will have a lower vitamin D level. If your older, your skin doesn't convert to vitamin D. So through a medical history, you can tell so much about whether someone's at risk for vitamin D. And of course, testing is so critical, and it really pennies a day to replace it, and it makes such a huge difference for people. So, I mean, we could go on and on about all the vitamin deficiencies, zinc and other ones, but magnesium, vitamin D, Omega-3 fats, such critical nutrients that we're deficient in and are often clinically so relevant and can make such a difference for people when we actually optimize those levels. Dr. Mark Hyman: So, Liz, why don't we go from there, we can talk about this day, let's go through a couple of cases of people who are nutrient deficient and what you found and how it turned out for these patients. Dr. Elizabeth Boham: So I wanted to talk about a few patients who were underweight or were having a hard time maintaining the weight, because this is a struggle for a group of people as well. So often people are wanting to lose weight, but we definitely see patients who are having a hard time maintaining a good weight. And so, I have a couple examples of patients who are actually underweight, struggling with gaining weight and as a result, they're having a lot of nutritional deficiencies. So the first one here is a 60-year-old woman, and she had been thin her whole life. And she came in with a recent 10 pound additional weight loss, more weakness and diarrhea. And because of her age and her weight loss, it was really important that I made sure that she was up to date with all of her screening tests. Dr. Elizabeth Boham: She had her colonoscopy. She had a good physical exam and mammogram, and all of that was fine. So there wasn't any underlying cancer that was involved in this weight loss, but we did a stool test, and we found signs on her stool test that she had malabsorption and maldigestion. And so then I was like, well, why is that? And what we saw was there was an imbalance in the bacteria, in her stool. She had dysbiosis, which means not having enough of the good bacteria and having an overgrowth of some unhealthy bacteria. And this resulted in a lot of local inflammation, which was then impacting how her body could digest and absorb her nutrients. So then we did this full nutritional panel, which looked at her amino acids, her fat-soluble vitamins, her minerals, her functional B vitamin status, her fat levels. Dr. Elizabeth Boham: And we found that so many of those were low. Her amino acids were low, even her cholesterol was low. Usually we want a lower cholesterol, but her LDL cholesterol was very low, concerningly low, and it was probably because of this maldigestion, malabsorption. Her zinc markers were low. Her red blood cell magnesium was low. Her iron was low. And so what's important to recognize is when there is this imbalance in the good and bad bacteria, the inflammation it created for her resulted in improper digestion and absorption, so we needed to treat that imbalance. And so we gave her an herbal regimen that treated the imbalance of the bacteria and yeast that we saw. We replaced her good bacteria with a lot of probiotics. We really helped her get on a diet that was easier for her to digest and absorb. Dr. Elizabeth Boham: We pulled away inflammatory foods like gluten and dairy and other inflammatory foods, and we gave her a lot of nutrients. We replaced her vitamins and minerals with supplements, but we also gave her IV nutrition, because sometimes when there's so much inflammation in the digestive system, really giving some IV nutrition helps somebody feel better. We gave her a lot of amino acids, which are the building blocks of protein that are easier for her to absorb. And what she was able to do was started to regain some weight. She started to have better energy and she started to feel better and her digestion improved. So it was really a great outcome. When we started to look, we saw lots of nutritional deficiencies. Dr. Mark Hyman: So Liz, how did she respond to the intervention? And in terms of her symptoms and [crosstalk 00:36:20]- Dr. Elizabeth Boham: She did really well. Yeah. When we treated her dysbiosis, her diarrhea went away, we gave her extra zinc and these herbs, and that helped her diarrhea go away. We gave her probiotics and then we started repleting her nutritional levels. And she just felt so much better. I mean, her energy improved, her mood improved, her strength improved. And she was just really grateful that we were able to intervene. And so, I think what's important here is to recognize that sometimes people need a lot more than the basic nutrition that you can get through food. And sometimes people even need a lot more than we can get from supplementation and, and giving things like IV nutrition can be really beneficial and that helped her significantly. Dr. Mark Hyman: So are you saying that vitamins don't cause expensive urine? Dr. Elizabeth Boham: I'm just so amazed sometimes at how beneficial they can be. I mean, what's really important is that we test to see what that person needs, because multivitamin can be helpful sometimes, especially if it just happens to replete something, somebody is deficient in. But when you do a very specific approach to evaluating what that individual needs, and repleting what they specifically need, we see tremendous improvement, in terms of people's symptoms. So I think that's really important, is that personalized approach we see much better improvement from. Dr. Mark Hyman: Yeah, I was true. And we're looking at personalized testing using tests that aren't really typically done at traditional doctors. We're looking at organic acids, fatty acids, mineral levels, vitamin levels. Organic acids, look at all kinds of pathways and how those are affected by nutrients, and so we get a really deep view of what's going on. And then we also can do genetic testing. It looks at how your nutrient needs may be different based on your genetics. So it's really an exciting time where we have a deep dive possibility on people's nutritional status. Dr. Mark Hyman: And at the end of the day, your quality of nutrition determines the quality of your health. And, aside from just the macro nutrients and the phytochemicals, it's really important to understand these real common nutritional deficiencies, and how much they can clinically benefit people. So Liz, tell us, in terms of this next case you had, a little bit of a different story about a 35 year woman who basically was underweight and sort of had no ability to absorb B12, and how we look at some of the B vitamin issues. Because these are also very common B12, folate, B6. These pathways, for various reasons, become impaired or genetically are needing more nutrients, or we're taking drugs that have blocked the absorption of these vitamins, or we're taking... A lot of drugs really... Dr. Mark Hyman: People talking about, "Oh, the vitamins are going to screw up your drugs." Well, the other side of the coin is that taking drugs often causes vitamin depletion. Taking diuretics, you lose magnesium, for example, or potassium or taking certain drugs, you lose B6 or folate so or B12. So tell us about this next patient. Dr. Elizabeth Boham: Yeah. So this was a 35-year-old woman and she had been tired her whole life. She's always struggling with low energy. And she came in underweight, and she ate a lot whenever she could, but she never really put on weight. And she also felt bloated after every meal. She always felt bloated. So she had been tested for SIBO, that's small intestinal bacterial overgrowth, and she tested positive and she was treated. Then her symptoms came back, unfortunately. And so all of this bloating then resulted in her having a hard time, maintaining her caloric intake because she would get full so easily because she got bloated. So we ended up checking her for these parietal cell antibodies. So the parietal cells are the cells in your stomach that produce acid, and so, because she kept getting this small intestinal bacterial overgrowth, I said, "Hmm, I wonder why." Dr. Elizabeth Boham: And we wanted to look to see if she had something that was decreasing her body's ability to make acid, because acid in the stomach is very important for preventing the overgrowth of bacteria that shouldn't be there from being there. So we found that she had this autoimmune condition, which were these parietal cell antibodies, and parietal cells are necessary for production of acid in the stomach that help you digest your food. But they also are necessary for production of something called intrinsic factor, which allows your body to absorb B12. And so, we ended up also finding out that her methylmalonic acid was elevated, which is a biomarker for low B12. And so, we ended up giving her body some acid to help her digest her food, but we also gave her some injections of B12. And what was amazing was how much better she felt when she got B12 shots. Dr. Elizabeth Boham: She also came in for IV B vitamins and B12, and that was helpful, but that the IV or the intramuscular injections of B12 made so much difference for her. And it's important that we found this, because having these parietal cell antibodies increased risk of fatigue, as we noted, B12 deficiency, other mineral deficiencies, osteoporosis over time, and weight loss and malnutrition. So she really did much better when we repleted the acid and repleted these B vitamins. And as I said, we needed to go even beyond supplementation and use IV or intramuscular injections as well. Dr. Mark Hyman: Yeah. And sometimes people do need the extra intravenous nutrition, and we do that at the UltraWellness Center and provide a lot of IV nutrition. It can really help people who have compromised guts or people who are particularly need in certain nutrients can make a huge difference for people. And these pathways are just so, so important. And I encourage people to really take seriously the fact that that malnutrition is common, that there are really, unfortunately, very little in traditional medicine that focuses on this aspect of health. And yet it's probably one of the most critical aspects that makes the biggest difference clinically. Dr. Mark Hyman: And we see this in our patients all the time when you tweak their level of nutrition and optimize these pathways. And it's very personalized, and that's how we do it at the UltraWellness Center, the outcomes are just sort of staggering. And then we recheck and we can see the levels come up and they feel better. And it all is so satisfying and gratifying. Dr. Elizabeth Boham: Absolutely. It's so fun to do, because we find it, like you said, we discover it very frequently, which is always surprising to me, and patients do so much better. And it's not that difficult to shift with all of the IV nutrition, intramuscular nutrition, and supplementation that we can provide for people. Dr. Mark Hyman: And the other thing I would just mention is, at the end is, once you've determined someone has a deficiency, you don't just tell them to go get any supplement at any random store. You want to take the right form of the nutrient. You want supplements that have been tested for purity and potency. You want supplements that are made in factories that follow good manufacturing practices for pharmaceutical standards. And you want to make sure it's the right form of the nutrient that's [inaudible 00:43:56] and absorbable. For example you say, "Oh magnesium deficient, I'm going to go get magnesium at the local drug store." Well that might be the cheapest form of magnesium called magnesium oxide. There may be fillers in it and additives and colors and dyes and preservatives and all this weird crap, lactose and gluten, and who frig knows, excuse me, who knows what's in there. Dr. Mark Hyman: And so we really need to be smart about picking the right products. And that's also what we do with the UltraWellness Center is we have curated the best products, the right forms. And then, I'll use magnesium as a great example, you need magnesium glycinate or citrate or threonate or do you need magnesium aspartate. I mean, all of them have different roles in the body, and so we really are very expert in helping people navigate to that. Dr. Mark Hyman: So thank you so much, Liz, for this deep dive into the world of malnutrition, which is something we really thought we overcame in America, but we really haven't. And I think focusing on nutrition security, as opposed to just food security is an important part of our thinking in healthcare and also in policy. Dr. Mark Hyman: And if you guys loved this podcast, please share with your friends and family, leave a comment, tell us what you struggled with in terms of nutrient deficiency. We'd love to hear and how you fixed it. Subscribe wherever you get your podcasts. And if you're interested in more content information from us and deep dives, check out Dr. Hyman plus, which is our new subscription service with deep dives with our functional medicine team with UltraWellness center with me and questions and answers, and tons of free content, and it's exclusive to members and hopefully, we'll see you there. And if not, we'll see you next week on another episode of The Doctor's Farmacy. Dr. Mark Hyman: Hey everybody, it's Dr. Hyman, thanks for tuning into The Doctor's Farmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love, and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements, to gadgets, to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else I promise. And all you have to do is go to drhyman.com/picks to sign up, that's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter. And I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Speaker 1: Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. 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