Answering Your Questions About Fasting, Liver Cleansing, Allergies, And More - Transcript

Announcer: Coming up on this episode of the Doctor's Farmacy. Dr. Mark Hyman: What is the worst toxin now affecting the liver? You might say pesticides. You might say industrial chemicals. You might say heavy metals, and you would be wrong. The biggest problem affecting the liver is sugar. Hey everybody, it's Dr. Mark Hyman. Welcome to a new series on the Doctor's Farmacy called Masterclass, where we dive deep into topics like inflammation, sleep, autoimmune disease, brain health, and lots more. And today, I'm joined by my friend and podcast host, Dhru Purohit, and we're doing something really special. We are answering community questions that you guys have submitted on a new video app called HiHo. You can follow me on HiHo and submit your questions, and maybe next week, I'll answer your question. So welcome, Dhru. Dhru Purohit: Thanks, Mark. Great to be here. Excited to jump into the questions we have our first one on the topic of fasting and hair loss from Tanya. Let's go ahead with the first question from our community. Tanya: Hi Mark, my name is Tanya Mandich. I am doing intermittent fasting and the ketogenic diet, and I've been losing some hair since August. So wondering what your thoughts are on that? Thanks. Dr. Mark Hyman: Hi. Well, that's a great question. I think intermittent fasting is something that is in vogue. Ketogenic diets are in vogue, and they're not necessarily for everybody. When you have hair loss, there are many, many causes, and it may be related to what you're eating, it may be a coincidence. It may be related to your gut, amino acid intake. Dr. Mark Hyman: Whether you're doing enough protein on a ketogenic diet, sometimes amino acids are critical for hair growth. So you kind of got to look at the whole picture of what you're doing. When someone has hair loss, I tend to look at a number of different things. One, I look at thyroid, that's a big one. First easy one to do, and often, most doctors miss thyroid. It affects one in five women, one in 10 men. Most of them are poorly diagnosed, or not diagnosed, about half of them. And the ones who are diagnosed, often are not treated optimally. Doctors don't tend to check T3, which is really important for T3. And that can be off even if you're on Synthroid or levothyroxine, which is the most common treatment. It may not be enough. You may need to add T3, and that can often be a miracle worker. Dr. Mark Hyman: It can be gluten, gluten is a huge cause. I just ran into someone at a conference, and they're like, my daughter has alopecia, which is a more serious autoimmune hair loss, but that can be a huge cause of it. And she's like, well, my doctor says food has nothing to do with it. And I said, look, go on the National Library of Medicine. Don't listen to me, look at the National Library of Medicine, all the research ever published basically, and it's fit to print, that's been peer reviewed. And have a look, just put gluten and hair loss, and see what you find. Dr. Mark Hyman: And it was like hundreds of articles, or celiac disease and hair loss. So I think many doctors are unaware of the connection between food and hair loss. So it's important to look for leaky gut, for gluten issues, biotin can play a big role. Biotin is made by the bacteria in your gut, so if you have a bad microbiome, you might not be making enough biotin, which is necessary for hair loss. Dr. Mark Hyman: Amino acids are critical. You make sure you're getting enough protein and the right amino acids. And if you're doing ketogenic diet, there may be something going on with your microbiome, or there might be something going on with different factors of what you're choosing to eat or not eat. Because you can be on a healthy ketogenic diet, you can be on an unhealthy ketogenic diet. So I need more information to actually determine what your cause of your hair loss is. But it's important to look at all these factors as you're beginning to think about it. Dr. Mark Hyman: Also for women, it can often be a problem with their endocrine system, hormones. For example, PCOS, which we've covered on the podcast. Polycystic ovarian syndrome is a common cause of hair loss. Women will get high levels of androgens or male hormones. They'll get male pattern kind of hair loss on the top of their head, and that's very concerning for them. They might get hair growth on their face, if that's happening, it maybe a hormonal issue. Dr. Mark Hyman: You don't always have to be overweight for that. It can be often caused by insulin resistance, or prediabetes, or sugar. So there's a lot of things to think about on hair loss, but you kind of got to go dig down the rabbit hole and really take a comprehensive view. Dhru Purohit: That's great, Mark. And I know you've had Dr. Sara Gottfried on your podcast before and in her last book, she talked about the challenges with women in particular being on the ketogenic diet for longer term. So I'm not sure how long the last questionnaire community member has been on it, but that could also be something to look into. And that's a whole interplay of hormones that you were just mentioning. Dr. Mark Hyman: For sure. I mean, your diet plays a huge role in your hormones. And I would say ketogenic diet's interesting. I mean, if you're 300 pounds, type 2 diabetes, for sure, go for it. It's going to take a year, get yourself reset. But when you think about historically what happened to our body, and I just finished writing a book on longevity. And I went deep into this subject. Dr. Mark Hyman: What's interesting is that, historically we would have periods of starvation where there wasn't a lot of food around. So we would go into a ketogenic state, meaning we would use the fat on our bodies to use that for energy. Because you might have 2,500 calories of glycogen, which is carbohydrates stored in your muscle, that'll last you a day. Or you might have 40 or 50, or a 100,000 calories of fat stored in your body. And that'll last you for a long time. Dr. Mark Hyman: So the body is very good at adapting to starvation. But historically, we would go through periods of scarcity and then periods of abundance, summer and winter. And the problem is when you're in a ketogenic state, it's not your body's long-term state. So people talk about cyclical keto, going on and off it. It can be a therapeutic diet. I typically don't recommend it as a maintenance diet for people. Dhru Purohit: All right, Mark. Our next question is from Camille, and she wants to know about liver cleansing. Camille: Hi Dr. Hyman. My name is Camille, and your podcast has helped me immeasurably. Can you please advise the best liver cleanse to use on a daily basis? Thank you. Dr. Mark Hyman: Thank you so much for that question, Camille. It's really important because we all need to learn how to love our livers. They do a lot of work for us. They clean our blood. They keep us healthy. And when they don't work, we get sick. And people think that unless you have liver failure, it's fine, which is not true. The liver needs a lot of support to do its work. And I know this personally because I had mercury poisoning, and I had to take care of my liver if I wanted to get better. Dr. Mark Hyman: The liver requires a lot of support to do its job of detoxification. It also, unfortunately we are in a sea of toxins. So what is the worst toxin now affecting the liver? You might say pesticides, you might say industrial chemicals. You might say heavy metals, and you would be wrong. The biggest problem affecting the liver is sugar. It's the number one cause of liver disease today in America. In fact, it's the number one cause of liver transplants. Dr. Mark Hyman: Dhru, I don't know if I ever told you this story, but I went to a conference on childhood obesity, and it was maybe, maybe eight years ago. And there was a doctor there who was chatting with me in the hall. I'm like, hey, what do you do? He says, well, I'm a pediatric gastroenterological surgeon. I'm like, "What are you doing here?" He said, "Oh, well, we do liver transplants." I'm like, "What do you mean, liver transplants for what?" Dr. Mark Hyman: He said we're now seeing teenagers with cirrhosis of the liver from fatty liver, from eating sugar and soda. And I'm like, you're kidding. This is just horrific. We see kids as little as five years old, with what we call non-alcoholic steatohepatitis, which is basically means fatty liver. And it eventually ends up with scarring the liver and cirrhosis. We think it's alcoholism. It's not, it's sugar and starch. So this is the biggest driver of a toxic liver. Dr. Mark Hyman: So the first thing you need to take care of your liver is really dramatically cut down or cut out starch and sugar. Obviously, alcohol is a problem. You next want to make sure you're avoiding as many toxins as possible. So get rid of the toxins in your food. Obviously, processed food for sure, added as preservatives. But also pesticides and chemicals and food. I am on the board of the Environmental Working Group, and it's important to check which vegetables you're eating that are contaminated. Dr. Mark Hyman: For example, strawberries, which I love, the worst. I would never eat a non-organic strawberry. It's number one on the Environmental Working Group's list of most contaminated fruits and vegetables. You can Google it, You can find that dirty dozen lists, stay away from those. And then there's a clean 15. So if you don't eat organic avocados or bananas, it's okay, right? Save some money there. But for sure, if you're having celery, if you're having nectarines or having strawberries, you do not want to eat those if they're not organic. Dr. Mark Hyman: Next is clean up your house. Your house is one of the biggest source of toxins, both indoor air pollution from off gassing of VOCs and chemicals, whether it's paint or furniture, carpets. I mean, there's so much plastics and chemicals out there. So try to use natural materials in your house, and also household cleaning products. And if you can't make sure you redo everything in your house, get an air filter and clean your air with a HEPA filter. We use one called AirDoctor, which is really great. Dr. Mark Hyman: Next, I would say you want to make sure you are using household cleaning products that are not making you sick. I mean, think about it. When you read these products, if ingested go immediately to the hospital. You don't want those in your house. So the Environmental Working Group has, what are the safe household cleaning products? Skincare products. They have a wonderful database called Skin Deep where you can see, what are you putting on your face? Your lipstick has got lead in it, well, don't use it. If your topical creams have parabens and plastics in them, don't use it. You're absorbing it. If you wouldn't eat it, you shouldn't put it on your skin. Dr. Mark Hyman: And next, you want to make sure obviously the fish and the meat you're eating has low mercury and toxins. And there's again, guides on the So it's a great resource to lower your exposures. The next thing I would do is make sure you're eating foods that upregulate all your detox pathways. So the most important categories of foods are the Brassica or cruciferous vegetable family, which is broccoli, collard, kale, cabbage, Brussels sprouts, that whole family. And the garlic and onions and family. And so I would eat those on a regular basis. For tonight, I'm having broccolini with garlic. So I do it pretty much every day. I make sure I have these foods. Dr. Mark Hyman: Next, you can actually start to do kind of more fancy stuff. You can have green juices, celery juice, watercress juice, cilantro juice. I had had a guy who had heavy metals, and he just juiced cilantro, and had a cup of cilantro juice every day. And cilantro is a great detoxifier that helped his liver flush out the metals, and he got rid of his metals. You also want to eat herbs and spices like rosemary, curcumin, which are like turmeric which are for curries. You want to make sure you have things like rosemary, lemon peel. We throw away lemon peel, but if you get organic lemons, you can kind of... Dr. Mark Hyman: I like to kind of grate the lemon peel and put it in salads. It's great with my kale, pine husk, lemon peel, lemon juice, olive oil, salt and pepper, it's delicious. That's why I like summer because we grow fresh kale. It's really good with the fresh kale. And then once you've kind of upgraded your diet, included all the phytochemicals, and I'm literally just like touching the surface. There's whole books written about this. I just got picked from Icaria, which is in Greece, at one of the Blue Zones. Dr. Mark Hyman: And all day actually, they had this stuff called wild sage tea. And I'm like, wow, what is this stuff? Why do they live to be a 100 years old? Why do they have the longest lived population in the world? I'm like, has it anything to do with the tea? Well, I think it does, because when I looked up the tea and the phytochemical content, it was full of something called epigallocatechins, which are these incredible compounds that are detoxifying, that are antiinflammatory, that help your immune system, that activate those longevity switches. In fact, there's some theory that, and in fact, there's data on this, that these catechins and green tea, and also in this wild sage tea, upregulate glutathione, and help your body detoxify, which is the main detoxifier. Dr. Mark Hyman: Then after you've done all that, obviously exercise is important. Making sure your gut's healthy is important, making sure you're sweating, I call it the three Ps, pee, poop and perspire. You want to make sure you're flushing your system with lots of water, lots of sweating, saunas. I mean, the hot yoga. I was just in New York. I love hot yoga, kind of flushes your system out, moves your lymphatic circulation, all that's great for detox. Dr. Mark Hyman: And then lastly, you want to kind of beef up your supplement measurement. So a good multivitamin, and the reason is... Before I go to those supplements, I just want to kind of loop back to the food. A lot of people don't realize how important amino acids are from proteins. So protein is so important for detoxification because a lot of the pathways, and I'm not going to bore you with all the fancy chemical names. But a lot of the pathways in the liver to get rid of toxins require amino acids. So you have to have a good compliment of amino acids. And if you're just eating plant foods, you might not get those, so important to make sure you're getting enough of the right amino acids. And then supplements. Dr. Mark Hyman: So what should you be taking? A good multi is important, but then there's a number of ones that are really key. Methylation, B12, folic, B6, very critical. Zinc, very critical. Selenium, important for the liver detoxification and boosting glutathione. Magnesium, so you want to make sure you have adequate levels of these nutrients. Then there's all the herbs like milk thistle and other compounds that can really be helpful, curcumin, artichoke. And there's a lot of these compounds, ellagic acid and pomegranate. Dr. Mark Hyman: So there's all these things that we can use as part of our diet and upregulate these pathways that are phytochemicals. And then there's the supercharged ones like glutathione's boosting supplements. Like acetylcysteine, which works so well the government wants to ban it, which makes me laugh. Anything works too good, they want to turn into a drug. I'm like, no, it's just a supplement. Dr. Mark Hyman: And then lipoic acid also is very important, and there's a host of other things, but those are the main things I focus on. And I've learned to incorporate these. It sounds like a lot, but I've learned to incorporate these into my life every day, this morning I had a green juice. I make sure I took a sauna today. I have one in my house, a steam. I'm having broccolini and garlic tonight for dinner. I'm taking my supplements with acetylcysteine, lipoic acid. I have my methylating supplements. So it's I just sort work it into my life. It sounds like a lot, but once you kind of learn how your body works, you kind of just do it automatically. Dhru Purohit: All right, Mark. Super robust answer. Really great and thorough action items that you shared over there. Okay, let's go to the next question that we have here. And this is from Flora. Speaker 6: Hey Dr. Mark, I'm a big fan of your podcast, and I'm looking to help my husband who had some life changing events before we met. He suffers from alopecia areata and restless legs. Just wondering if there was a connection between those two. Dr. Mark Hyman: Oh wow. Great question. Alopecia and restless leg. Alopecia, for those who are listening who don't know what it is. It means, you lose all the hair on your body. No eyebrows, no eyelashes, no pubic hair, no hair obviously on your head, you lose all the hair on your body. That is an autoimmune disease. And that is usually because of gluten. Now it can be other reasons, leaky gut, other factors. And there's other causes of inflammation, autoimmune disease. But we approach it the same way we approach autoimmune disease. Dr. Mark Hyman: And I just remember I had a patient come in once years ago. I [inaudible 00:15:28] it. I do a lot of virtual consults over the years. I would see people in-person and then I would talk to them on the phone, this was before Zoom. And I would help them with their health over the year. Then after this year, this woman came back and she'd gotten off gluten, we'd fixed her gut, and we'd done all the normal functional medicine things. And she was wearing a hat. And she came in wearing a hat, and halfway through the consult, she pulled off her hat and she had a full head of hair. And I was like, what happened here? It was pretty wild. Dr. Mark Hyman: And I've seen this many, many times. And then restless leg syndrome is kind of inflammation of the brain. So it can be often caused by magnesium deficiency, but it's come kind of neurological irritability. And it can be other things like heavy metals, mold, Lyme, other things. And it's very horrible for people who have it, and they can't get comfortable at night. They don't sleep well. You can detect it by sleep studies. Often, I start out with magnesium as a sort of initial treatment, but there are many other things that can cause it that I would check with your functional medicine doctor about, but they may be related, but they may not. Dhru Purohit: Okay. Great. Awesome, Mark. We have a next question here from Mary. Speaker 7: I am a nurse who often works 12 or 16-hour shifts. Trying to stay hydrated and eat healthy is nearly impossible. Any tips? Dr. Mark Hyman: Tell me about it. I get it. I definitely get it. Because I worked in the hospital for years. I delivered babies, worked in the ER, worked overnight shifts, tried to stay healthy, and it's not easy, but now more than ever, it's easier. So honestly, what I would do, it sounds goofy is I would get a CamelBak, which are those little backpacks you could buy for 30, 40 bucks. And it's got a bladder in it. You can fill with water, you can put electrolytes in it. It's got little pockets, you can kind of throw stuff and zippers in it, so you can store a little food in there. And I would carry around your little survival pack. Literally, your hydration pack on your back. You can kind of put it in your mouth, drink water, it clips in so it stays out of the way. Dr. Mark Hyman: And then I would invest in snacks. So I would get things that are high in protein and high in fat. I like nut butter packets. Macadamia nuts are great, they're super high in calories, almonds, walnuts. You can get certain kinds of jerkies, beef bars, grass fed. A lot of grass fed beef, regenerative beef now with jerky, that kind of stuff you can just carry with you. And it's super nourishing, super satisfying. Fat and protein lasts a long time. If you go for the sugar and the carb snacks, you're going to spike your energy and then you're going to crash, and you're going to feel awful and you're going to be hungry. And then you're going to gain weight and become diabetic. So it's not a good idea. And by the way, most nurses are not that healthy, and it's because of the stress of the job, it's because of what you're saying, and it's because of the crappy food in hospitals and lack of access. Dr. Mark Hyman: So it takes a little bit of planning, but I do. I mean, I work in the hospital, Cleveland Clinic, and my drawer is... People laugh at me, but in my drawer in my office, I have enough food for like a week in there. I have canned salmon, I have canned sardines. Nobody wants to come in there when I'm eating them. But I make sure I have all the nut butters, I've little jars, little jars. The jars with the nut butters and a spoon. I can just take a bunch of spoons of it. So there's a lot of ways to hack this. If you want to laugh and have a good time. Go Google on, find the Dr. Hyman's Food Emergency Pack. And there's a whole video of me showing what I put in my pack, but it's kind of fun. It's not easy, but you have to do little planning, and it's totally doable. Dhru Purohit: Yeah. It seems, Mark. Another part of this that Mary's asking about what I'm reading between the lines is also, your community and the people that you work with, a lot of... My brother-in-law's a nurse, and often he'll say that there's always cookies, and there's cupcakes, and there's candy. Sometimes, again, it's all well intentioned. Oftentimes, it's even patients coming in and giving a little care package to the nurses saying, thank you for taking care of my family members. Dhru Purohit: So how do you think about the community component, and wanting to eat healthy, but also not wanting to present yourself as somehow better than the people around you? You just want to do your own thing, but you don't necessarily want to poo poo on their lifestyle if they will choose to eat those foods. Dr. Mark Hyman: I mean, I just lead by example. I don't criticize people. I don't make fun of them. I had lunch with some people I didn't really know very well. And we were at a restaurant, and it was like an Italian restaurant. There was tons of bread. They threw bread on the table. There was pasta, tons of it. It's famous for its pasta. And I'm like, well, what do you guys have that's like protein and vegetables. Oh, we got branzino and we got broccoli rabe, we got some mushrooms, we got some zucchini. I'm like, great. I'll have that. Dr. Mark Hyman: And so they all waited for me to order, and then they... well, they looked around, they ordered all that. And you could tell they wanted the pasta and the bread, they just didn't eat it. So I don't say anything, and I kind of laugh. But it's really the power of peer pressure. And when you see someone who's, wow, how come he has energy? How come he's healthy? How come he's 62, and he isn't got a pot belly, and look like crap? It's because I take care of myself, and I probably run my engine too fast is the truth. I mean, I love life. I like to do things. I enjoy people. And so I often pack too much into a day and into a life, but I still maintain my health. And I do it by just creating these habits that I've started to accumulate over the years. Dr. Mark Hyman: And sometimes I go off the rails for sure, but I come right back. Like today, I was like, okay, I'm going to get back on track. I had a green juice this morning. I had some protein for lunch, and I just, I got my activity in and I worked out, and I took a little steam. So I feel like, it just even though I'm busy, I can kind of fit in the things that help support me. And not every day, but most days. Dhru Purohit: Great, Mark, love that. All right. Our next question is from Emmanuelle in the community. And she has a question about pet allergies, as well as some food allergies that her kids have. Speaker 8: I have allergies to dogs and cats, and was wondering if there's anything I could do to heal from them. My kids also have food allergies, which happen to be severe, anything that could help them? Dr. Mark Hyman: Hmm. Thank you. Thank you for that question. I don't think I've ever been asked that question, but I've seen a lot of patients who have this problem, of both having food and animal environmental allergies. And most people don't think they're connected. And I want to sort of define terms a little bit. Allergy typically in medicine means IgE type 1 hypersensitivity reaction. That means that's the kind of allergy you get when you eat a peanut, and your tongue blows up, you can't breathe and you get anaphylaxis. Or you get a bee sting and you get a hives and swelling up, that's what we call allergy. Food allergy can be that, or it can be what we call a delayed response or a delayed food sensitivity, which is not the same part of your immune system. That's not as severe, it's not like threatening. Dr. Mark Hyman: And you may let's say I don't know, you might have a dairy on Monday, but you might get a headache on Tuesday. So you can't often connect the dots. If you eat a peanut, within a few minutes, you're going to die if you have peanut allergy. So I think we have to sort of define terms. If it's a food sensitivity, that's a little bit different, but what I've found is that there's been a really dramatic increase in environmental allergies, and through food allergies over the last number of decades, three or four decades. Dr. Mark Hyman: And why is that? It's not like we've changed our genes. It's because we've had a toxic environment, because we have a leaky gut, because our diet's bad, stress. All these factors cause increased allergy. And one thing I discovered many years ago was that, I had patients with really severe IgE food allergies, which are real allergies. Dr. Mark Hyman: Well, they also had environmental allergies like dust, or pollen, or animals. But when I treated their leaky gut, when I got their immune system sorted, their overall allergies went down. So their environmental allergies went down, and their overall reactivity went down. And so we were able to really sort that out. Now I'm going to tell you something else that's going to be a little shocking, but it's very fascinating. And it's not actually that wacky because there's a lot of science behind this. In fact, there's a number of books called An Epidemic of Absence, which is about the idea that we co-evolve with bugs in our gut. Dr. Mark Hyman: And if you go to countries where kids grow up in the jungle, or they're in super indigenous tribes or underdeveloped countries or an Amazon, there's no allergies, there's no autoimmunity, it just doesn't exist. What they do have is a lot of worms. And in fact, IgE, which is what I was talking about before, that part of immune system is designed not to make you allergic to peanuts, but to help you kill worms, and manage worms in your belly. Because we didn't have anti-worm medicines, so our immune system kept them in check. Dr. Mark Hyman: And so when we eliminated all these worms and stuff, we started getting autoimmune disease. In fact... And the part of your immune system, the white blood cell that fights these worms called eosinophils is one of your white blood cells, is the same white blood cell that gets activated and causes allergy. And I saw this little kid, and you're going to kind of go, wow, Dr. Hyman, you've really gone off the deep end here. But I'm telling you, this is actually legitimately research field of medicine, which is helminthic therapy, which basically means worm therapy. Dr. Mark Hyman: And this kid was like super allergic, and I'm like, oh, I tried all this normal stuff. It's like, oh listen, I know about this treatment. I know how to get it. It's pretty easy to do, you just swallow this tasteless vial of fluid which has worms in it every two weeks for six months or so. And it often can fix your IgE allergies. And the mother's like, "Okay, anything." And so he took it and his IgE level, which is the antibody that affects the immune system in this kind of allergy, in the hypersensitivity allergy was like a 1,000. It should be like a 100 or less. And in a number of months, it went down from a 1,000 to a 100, to normal. And I was like, holy crap, this stuff works. And I began to start using this on select patients. Dr. Mark Hyman: I don't do this for everybody, but for select patients. And these are actually, it sounds gross, but they're rat tapeworms. They don't actually stay in your system. So they kind of go through, they kind of talk to your immune system. They say, hey guys, it's okay, let's focus on me, ignore the allergens. Like, I'm over here guys, sort of like somebody being kind of a deflector. And it seems to work. And there are actually studies on using it for Crohn's disease, and other colitis diseases, allergies, asthma. Dr. Mark Hyman: And so if you're really interested in this topic, I'd read the book An Epidemic of Absence. There's also, if you want to get a short version of it, the New York Times had an article at the time, you can kind of find it online about An Epidemic of Absence, of the absence of these microbes that we grew up with historically evolutionarily, and that have now been eliminated for the most part. And what the consequences are, which is this increasing allergy. So I think this is maybe a little crazy sounding, but actually it's really not. Dhru Purohit: Yeah. And actually This American Life, one of the top podcasts on a public radio, they did a whole episode on this as well, that we'll link to inside of the show notes, where they had people... Because it's illegal for doctors to prescribe that up here, and you can't really get it, but there's places in Mexico. And I think like one of the world's leaders in it is from Israel, and he's come to America and given some lectures on it as well, and he talked about it. Dr. Mark Hyman: Yeah, in the UK, you can buy them from the UK. Dhru Purohit: Yeah. Wow. So we'll link all those in the show notes. Fascinating. Who knows, maybe in the future we'll have clinics and have worm dispensaries maybe, maybe not. Dr. Mark Hyman: For sure. Dhru Purohit: All right, Mark. We got another question here from Jessica. It goes back to kind of how we originally started the episode, and that's on the topic of fasting. So let's play this question from Jessica. Speaker 9: Hey, Dr. Hyman, what do you think? Is it more beneficial to fast for longer and workout maybe later in the day? Or to get my morning workout in when I feel my best, and have a shorter fast? I would love to hear your thoughts? Dr. Mark Hyman: Well, that's a great question, Jessica. I don't think you have to choose. What my view of life is when there's a fork in the road, take it. So I would say you can design your life so that you can work out in the morning and still have a 14-hour fast. For example, I did that today. I had dinner last night. I maybe finished around 8:00. I got up early at 6:00, went and did my workout. And then around 8:00, 8:30 had some breakfast and a juice, like a green juice. So that was a 14-hour fast overnight. And I got my workout and I didn't have to go through some gyrations to figure out my workout day so I wasn't messing up my fast. Dr. Mark Hyman: So I think it's good to work out in the morning if you feel like it, if you workout late at night, it often can be activating, preventing from you sleeping, jack up your cortisol, blood sugar. So I think you have to feel what's good for you, but I think that it's fine to just for 12, 14-hour fast, if you want to do 16-hour, you can do that. You can just shift your eating schedule a little bit. But I think workout when... People say, "When should I take supplements, doctor?" I say, "When you remember." When should you exercise? Whenever you can. So I think that's kind of the bottom line. Dhru Purohit: Yeah, there may be some nuances there for women, as you mentioned previously, and it's good to find a community of other women that are out there that are also experimenting, and it depends on your life stage and your goals. There's a friend of Mark's, yours. It's in Toronto, who has one of these communities where they talk about fasting, and working out. Dr. Stephanie Estima, she's a chiropractor up there, really sweet woman. And has a whole community called Betty Body. And they specifically are thinking about a lot of aspects of working out. We'll link over there to the community as well. So hopefully that's helpful, Jessica. All right, Mark. The next question here is someone who has high LDL and is confused about cheese. Her name is Kathleen. Speaker 10: Hi, Dr. Hyman. I just finished your book What the Heck Should I Eat? I'm 72 years old with high LDLs, and almost into the diabetic 2 range. I'm confused about cheese. Can you explain that again? Thank you. Dr. Mark Hyman: Fat is something that can raise your cholesterol, saturated fat will raise the LDL cholesterol. But what I'm more concerned about and the thing you said that was most important was that you have type 2 diabetes. So if you look at what matters, it's not the LDL cholesterol, it's the quality of the cholesterol. Is it large fluffy cholesterol, or is it small dense cholesterol? Small dense cholesterol particles, and a lot of them are what causes heart disease. We call this atherogenic dyslipidemia, or basically heart disease causing cholesterol problems. Dr. Mark Hyman: And saturated fat will raise LDL, but it typically also raises HDL. And if you look at the pattern of most people who have heart disease, it's they have high triglycerides, low HDL, small particles, and lots of particles, or something called apo B. These are really the concerns that we should be focused on, not LDL as an isolated number, but as a picture, as part of the overall picture. Dr. Mark Hyman: So I've seen people with a cholesterol of 300, but their HDL is a 100, and their triglycerides are 70, they're fine. And their LDL might be 160, but they have no small particles and their particle number is low. And they just have a lot of large fluffy particles. Because when you look at the cholesterol measurement when you get with your doctor, it's the weight. It's like, is it a golf ball or is it a ping pong ball, right? They're different. Well, ping pong ball doesn't weigh anything, a golf ball's heavy, same size. So you really need to kind of look at the quality of what you're talking about. Dr. Mark Hyman: And so there's a new test. Not really, it's about 40 years old, but most doctors haven't caught on yet. It looks at the lipid particle number and the particle size. From Labcorp, it's called NMR, from Quest, it's called Cardio IQ. It's not that expensive. Your doctor can order it. The problem is they don't want to order it for the most part because they don't know how to interpret it. And they should figure it out, because there's really no other cholesterol test that really is relevant at this point. Dr. Mark Hyman: So I think if you have type 2 diabetes, likely you have to look at these other particle numbers, the particle size, the triglycerides, the HDL. And actually, saturated fat might be good for type 2 diabetics. In fact, work from Sarah Hallberg who sadly just died, she was a friend of mine. An amazing doctor who led up a lot of the work on ketogenic diets and diabetes, and has published lots of research papers on it. Showed through her data that not only were they able to reverse diabetes, type 2 diabetes in 60% of the patients, get a 100% off the main diabetes medication. Get over 90 plus percent of people off insulin, and have an average weight loss of 12%, which is a dramatic amount. I mean, normally, if you get 5% in a weight loss study, that's like everybody's jumping up and down, and thinking so exciting, great results. But it's really, it was a dramatic result. Dr. Mark Hyman: Found when they looked at over, I think 30 biomarkers for heart disease and cardiovascular disease, that none of them were bad, that they all got better by eating a lot of fat. Now, there are some people like me who are skinny. We call them Lean Mass Hyper-responders. I exercise a lot. I have low body fat, high muscle mass. I have some genetics, and my cholesterol will go up. My LDL will go up, and my profile will not be better if I eat more saturated fat. Dr. Mark Hyman: So you have to be careful. And when you say about cheese, saturated fat is what you get in cheese. And now goat and sheep cheeses might be better, but I would not be worried about it. I would be worried about eating conventional dairy though. I would stay away from regular cow dairy. I would stay away from, for sure, if it's not a regenerative raised A2 cow, for sure, don't consume it or anything from it. Goat and sheep are easy to find. We've sheep yogurt, goat yogurt, goat cheese, sheep cheese, easy to find. I would stick with that. Dr. Mark Hyman: But I would really look more carefully at the overall cholesterol profile. And I've written a lot about this. I wrote a book called Eat Fat, Get Thin. I wrote too many pages about it, so you can kind of learn more there. And there's again, more and more articles about this all the time. So I would not be too afraid of cheese particularly, organic regenerative sheep and goat cheese. Dhru Purohit: All right, Mark. Our next question is from Rafi, and it's about dry skin. Speaker 11: Hi, Dr. Hyman. It's a pleasure to talk to you. My question is, I suffer from dry skin very badly, and I would like your advice, and what I should do first. Thank you. Dr. Mark Hyman: Well, thanks, Rafi. Dry skin is not uncommon, and it is relatively easy to treat. Dermatology is so backwards, they treat you from the outside in instead of the inside out. Now it's not necessarily bad to put things on your skin, but you got to start with what's happening on the inside. One of the most common causes of dry skin is omega-3 fatty acid deficiency, which is where you get dry, patchy, flaky skin that comes from not having enough omega-3s, which come from wild fish. Dr. Mark Hyman: So if you're for example a vegan, and you're not taking some kind of fish oil supplement, you're going to get omega-3 fatty deficiency. If you don't eat fish because you don't like fish, or if you don't eat mushroom because you don't like mushrooms. Or you're not having certain compounds in your diet. If you're not having wild herring or sardines, you're going to get omega-3 deficiency. So the first thing to do is look at that, and there's a test called omega-3 index. You can do it from your regular lab, make sure you're not, and just take fish oil. That's the first thing to do. Dr. Mark Hyman: In fact, I remember I had a patient with terrible dry skin. And I told her to, instead of putting cream on her skin, to put a combination of flax and borage oil on her skin, borage is a omega-6 oil. That's actually very anti-inflammatory, great for your skin. Like evening primrose oil is another version of it, and flax oil's omega-3. Literally in the winter, she put on her skin, and her skin turned beautiful. Also, thyroid is a big factor. So I would make sure you check your thyroid gland, and make sure your thyroid is good. Because if you're low on thyroid function, you can get significant dry skin. Dr. Mark Hyman: Those are the two most common reasons. Eczema is another reason. This can be from gut issues from leaky gut, from food sensitivities, often dairy, gluten, big ones. So I tend to think about all these things. And usually people's skin can get beautiful from the inside out. Not only the outside in. Dhru Purohit: Mark, let's do one more last question here. We have a question from Heath in the community who is asking about recommendations from her practitioners to want to put her on medication. Speaker 12: Hi Dr. Mark. I'm a young, healthy 26-year-old female, who has been told multiple times that I need medication for high blood pressure and high cholesterol. They keep attributing it to genetics since my lifestyle would not reflect that I need the medication. I'd love to know your thoughts. Dr. Mark Hyman: So you're talking about high blood pressure. And high blood pressure, high cholesterol, high blood sugar, they often go together and they're often treated separately. And I would say, gee, maybe they're all connected. The truth is they're all connected. And in fact, 88% of Americans have this problem, which is poor metabolic health. And it's manifested by high blood pressure, high blood sugar, and high cholesterol. Or abnormal cholesterol, I should say. And it's almost always caused by too much starch and sugar. Dr. Mark Hyman: So they call it essential hypertension, which means essentially they don't know what causes it. But in fact, it has a very clear cause, it's an inflammatory, oxidative stress disease of the blood vessels. And mostly at times caused by insulin resistance. So I hate to sound like a broken record on these podcasts, but insulin resistance is one of the biggest problems we have today in the world, because it's driven by starch and sugar, and this is what people are eating. And it causes your blood vessel to be inflamed. Dr. Mark Hyman: So I would for sure, make sure you cut out starch and sugar as number one, two and three. I think some people are salt sensitive. So you have to watch for salt for some people. Often, it's not so the salt you're eating, it's a lack of potassium, potassium and salt should be in better balance. And so you can increase your potassium intake by eating lots of fruits and vegetables, and bone broth and lots of vegetable broths, which have lots of potassium. Dr. Mark Hyman: Magnesium deficiency also is a big cause of high blood pressure, it's the relaxation mineral. And we know this as doctors. I mean, when women come in who are pregnant, who have malignant high blood pressure that can cause seizures and kill them and the baby, it's called preeclampsia, what do we do? We give them intravenous magnesium, because it relaxes the blood vessels. So why don't we tell our patients with high blood pressure to take magnesium? I have no clue. So there are many things that cause high blood pressure. It can be heavy metals. It can be kidney disease. It can be a lot of things. So you kind of have to look at the spectrum, but most of the time, you can really get to the root cause and fix people's high blood pressure pretty quickly. Dhru Purohit: Okay. Mark, that's it for today. So thank you for all your in-depth answers, and I'm going to pass back over to you to close us out. Dr. Mark Hyman: Thanks, Dhru. Oh, it's always great doing these with you. And thanks for submitting your questions, I really love to answer them. That's it for this week's Masterclass. So if you love this podcast, share with your friends and family on social media. Leave a comment, we'd love to hear from you. How have you helped your health doing various things we've talked about? And if you subscribe to podcast, please subscribe to this one. And we'll see you next week on the Doctor's Farmacy. Announcer: 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. 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