Is Brain Fog Caused By Your Microbiome? with Dr. Todd LePine - Transcript

Dr. Todd LePine(00:00): Certain foods may trigger brain fog and it is something that I think is intimately connected to the gut. Dr. Mark Hyman(00:11): Welcome to the Doctor's Farmacy. I'm Dr. Mark Hyman and that's Farmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And today we have a special episode of the Doctor's Farmacy house call with one of my colleagues from the UltraWellness Center, Dr. Todd LePine. You probably know him by now. He's an extraordinary physician. He's been a doctor of functional medicine longer than I have, which is a long, long time. He graduated from Dartmouth Medical School. He teaches all around the world. He's one of the smartest guys I know and he's just an awesome physician. And we get to talk about some really interesting cases today. Dr. Mark Hyman(00:43): Today, we're going to talk about brain fog. Now that's not something I learned about in medical school. There was no class on brain fog. There was no ICD-10 diagnostic code for brain fog, but it is a real thing that people experience and most doctors dismiss. In traditional medicine, we don't really have a way of thinking about it actually, except it is really, really common. And when people have it, they know what it is. I've had it. I'm sure you've had it. And it's not a fun thing. You feel like you're walking through silly putty. You can't focus. You can't think. Your brain is all foggy and it's very difficult to get through the day. And there's so many different causes of it. Dr. Mark Hyman(01:21): Talk to me in general about... Let's just sort of skip the part where what traditional medicine does with brain fog because maybe they'll give you an antidepressant, maybe they'll, I don't know [inaudible 00:01:30] ignore you, but what would be the major reasons that we're seeing this pandemic of brain dysfunction and brain fog today? Dr. Todd LePine(01:41): Brain fog is really a symptom sort of like cough. Cough can be caused by a cold, bronchitis, pneumonia, postnasal drip, asthma, a whole bunch of things, so you got to figure out, okay, what's driving it? And there is no ICD-10 code for brain fog. You might call it altered mental status, but oftentimes it's transitory and that's the really interesting thing. And I've seen patients where they'll get brain fog when they're in a certain building, they'll get brain fog after they've had a certain meal, certain foods may trigger brain fog. And it is something that I think is intimately connected to the gut. I think the, and we'll talk about that with this particular case, is gut fermentation is oftentimes a cause for brain fog. Dr. Mark Hyman(02:26): That means like bugs fermenting the food you're eating, creating all this nasty byproducts that makes you feel drunk? Dr. Todd LePine(02:32): Absolutely. I don't know, Mark, if you've had patients who've had... This is a really interesting thing because I have patients come in and they say, "I feel like my gut is just like bloating and I'm fermenting," and that's exactly what's happening. There is a condition, I just recently had a patient who had auto brewery syndrome and I've seen that- Dr. Mark Hyman(02:46): So you have your own like beer factory in your gut? Dr. Todd LePine(02:48): Exactly. When you want to make beer, what do you do? You take sugar and you add yeast to it and you can actually produce alcohol. And I've had a couple of cases where it was missed. And it's actually not just the recent findings that it's not just yeast in the gut that do this, but also Klebsiella bacteria. Both bacteria and yeast can actually produce these compounds, which are toxins. Alcohol is a toxin. That's why when you get drunk, you're intoxicated and you'll actually produce alcohol and other toxins, which affect your brain. Dr. Mark Hyman(03:17): It's interesting. I never really had that insight before you said that word, intoxicated, you're- Dr. Todd LePine(03:22): Toxic. Dr. Mark Hyman(03:23): Toxic. Dr. Todd LePine(03:23): Yeah, toxic, exactly [inaudible 00:03:25] intoxicated. Dr. Mark Hyman(03:26): I was like wow, okay. Dr. Todd LePine(03:26): That's how I explain it to the patients. Dr. Mark Hyman(03:28): Took me 60 years to figure that out. Dr. Todd LePine(03:29): [crosstalk 00:03:29]. Exactly. Dr. Mark Hyman(03:33): But I think that what you're saying is very true. I've had two times in my life when I've had severe brain fog. One was when I had mercury poisoning, 30-25 years ago. And my gut was a mess then because the mercury poisoned, my God, I had terrible bloating, distension, diarrhea. And the second time was more recently when I had mold toxicity and I had C. diff and I also had colitis and gastritis and my whole gut was a mess. And I had severe brain fog and it was pretty debilitating, could barely focus, answer an email, talk to somebody- Dr. Todd LePine(04:04): Oh yeah, you can't concentrate. Dr. Mark Hyman(04:05): You can't concentrate at all. And people think, oh, that's just sort of in your head. It's not in your head, maybe in your stomach. Dr. Todd LePine(04:12): Well, it's manifesting in the head. That's the whole thing and we have these artificial boundaries between the brain and the body and the mind and they're all interconnected and brain fog, it's a real phenomenon. And then you have to sort of figure out what's doing it? The other thing that is interesting that I see with some people with brain fog is just gluten and dairy. And I tell patients that one of the most addictive foods is pizza. And the reason for that is that pizza has gluten in it. Dr. Mark Hyman(04:40): It's true. You can eat a whole pie. Dr. Todd LePine(04:43): I'll tell you. It's one of it's one of the foods that I'll occasionally indulge in, but I don't have it that often because it's not the best food for you, but- Dr. Mark Hyman(04:50): You have my cauliflower pizza with goat cheese and cauliflower crust. Dr. Todd LePine(04:53): Yeah, right. You can make a healthy pizza. Exactly. Yeah. The two foods, which are interesting, is that gluten and dairy both get broken down. The proteins in those get broken down into casomorphins and gluteomorphins. And casomorphins are the ones from dairy and gluteomorphins are from gluten. And those have morphine like effects. So you literally become a little- Dr. Mark Hyman(05:15): High. Dr. Todd LePine(05:16): Yeah, you get a little high, you get a little foggy in the brain and it also can cause cravings and it can sort of make you sleepy, you eat it and then you get a little sleepy from it also. When children drink breast milk, they go to sleep after, they conk out. That's because of the morphine-like action in milk. Dr. Mark Hyman(05:37): That's true. I think it can be our diet. It can be food sensitivities like gluten and dairy, which are really common and often people going on an elimination diet will have an immediate relief of brain fog, which is something that you don't know you have until you don't have it anymore sometimes. People just think of this sort of slow decline of their cognitive function, they're not that it's actually something that can be reversed and it can be reversed very quickly. The second thing is the factors that are in the gut, bacterial overgrowth, yeast overgrowth, we call dysbiosis that can also lead to a lot of cognitive issues because your gut's connected to your brain. And that causes this effect when the bugs are out of balance and it drives inflammation and then you get inflammation in the brain essentially is what causes brain. Dr. Todd LePine(06:24): Absolutely. Well, the other important thing and I think I talked about this last time is that the blood flow from the gut has to go through the liver. And the reason for that is to filter all of the toxins that are there. So there's a lot of immune cells, the Kupffer cells in the liver and a lot of filtering processes and detoxification takes place in the liver prior to the blood from the gut then going into the systemic circulation. Sometimes you'll have, in addition to leaky gut, you'll have problems with detoxification in the liver itself. And an example of that is the condition hepatic encephalopathy, which is brain fog. That's essentially- Dr. Mark Hyman(07:04): Well, talk about that. What is that for people who don't know what that sounds like a big word. Dr. Todd LePine(07:09): And I think I mentioned this before and it was one of the things that really stuck with me is when I worked at the VA hospital, there was a lot of alcoholics. And when you're an alcoholic, you basically turn your liver into a pickled liver. Dr. Mark Hyman(07:21): You trash your liver. Dr. Todd LePine(07:21): You trash your liver and then you're not able to detoxify. And I would typically see this over and over where patients had cirrhosis of the liver and their liver was not able to detoxify. And then when they would eat foods, especially high protein type meals, they would get hepatic encephalopathy and literally go into a coma. Dr. Mark Hyman(07:39): They would literally get delirium, confusion- Dr. Todd LePine(07:42): Absolutely, Dr. Mark Hyman(07:42): Brain fog- Dr. Todd LePine(07:43): Brain fog. That's like brain fog on steroids. Dr. Mark Hyman(07:46): And the reason is it was coming from their gut. And what I found so striking when I started learning about functional medicine was that here was a condition in medicine that we knew how to treat by fixing the gut. We gave people antibiotics to sterilize their gut, to kill the bacteria that caused all these byproducts that made people have basically delirium or encephalopathy and brain fog. It was like, wow, the gut is connected to the brain. Dr. Todd LePine(08:15): Totally, totally connected to the brain. Absolutely. And in some cases, there have been cases of people actually having psychosis from gut dysfunction. Dr. Mark Hyman(08:26): You mentioned auto brewery syndrome. I remember reading a case of a woman who was arrested for driving under the influence and it turned out she wasn't drinking, but she had a high blood alcohol level that was coming from her gut. Dr. Todd LePine(08:41): It's a very real phenomenon. You have to think about it and the way that you actually test for that, it's actually quite simple, is you just have somebody to do what I call a pancake challenge. You basically some pancakes full of carbs, throw some maple syrup on it, eat it and get blood draw at .0, eat the meal and then half an hour, hour later check you alcohol level Dr. Mark Hyman(09:00): Is like a fun medical test. The pancake challenge. Dr. Todd LePine(09:02): I call it the pancake challenge. Dr. Mark Hyman(09:06): We've talked about the gut, we've talked about gluten, dairy, food sensitivities. There are other reasons, too. Infections? Dr. Todd LePine(09:13): Infections can do that. Another one that is- Dr. Mark Hyman(09:16): Tick infections. Dr. Todd LePine(09:17): Oh, absolutely. Tick infections are- Dr. Mark Hyman(09:20): Lyme- Dr. Todd LePine(09:21): I would say that that's in addition to brain fog, you get a lot of cognitive dysfunction, too. Memory issues- Dr. Mark Hyman(09:27): It's more severe. Dr. Todd LePine(09:28): It's a much more severe. The one thing that I see a lot is allergies. I call it the allergic brain and you can have food allergies that can potentially do that or even environmental allergies or mold. And the high levels of histamine because histamine actually acts as a neurotransmitter and I've seen this in a number of patients. I've had some patients with another condition, which we're seeing more and more of is mass cell activation syndrome. It's sort of a buzz diagnosis now, but it's a very real phenomenon. And it is related to the mass cells, which are the types of immune cells in the body and the interstitial, the sort of the spaces between the cells where they reside, and they release lots of histamine. And if anybody's ever had hay fever, you see the typical picture of a person of hay fever, they're like this, like half asleep and they're walking through a fog. Hay fever is an example of brain fog and antihistamines can actually have a benefit with that. Dr. Todd LePine(10:28): Naturally, things like [inaudible 00:10:30] nettles can also be very helpful. And you probably have used it, this is something that I've been using more is the drug cromolyn sodium, which I've had some amazing success with that in more difficult cases. I wouldn't necessarily go to that for my first choice. Dr. Mark Hyman(10:47): What Todd's talking about is this drug that's used for asthma and allergies that is usually inhaled. Dr. Todd LePine(10:53): Yeah, usually inhaled. Dr. Mark Hyman(10:54): But there's a version you can take orally that before you eat inhibits your white blood cells from releasing histamine and creating an allergic response. And I often found it extremely effective for some patients. Dr. Todd LePine(11:05): Exactly. Dr. Mark Hyman(11:07): Todd, talk about this patient that you had that had really bad brain fog. This was a guy who'd come to see who worked a lot, who was under a lot of stress and that could be easily dismissed as oh, you're just stressed and tired, but yet you went deeper. What did you find? Dr. Todd LePine(11:19): Well, he actually came into me and he had already seen a variety of different doctors. And the background is that the gentleman as a child had lots of allergies and asthma. He had ear infections, bronchitis also developed some sinusitis type symptoms. He had multiple rounds of antibiotics. And I always emphasize to patients that when you have an immune dysfunction look for the gut because the 60% to 70% of your immune system is in the gut. And just like with what's going on with the COVID virus or the COVID-19 syndrome that we're seeing by coronavirus is it's not the virus or the bacteria itself that causes the problem. It's our immune system's response to it. And in general, we want to have, I call it, a balanced immune system. We want our immune system to be idling, basically just sort of sitting there and okay, we're enjoying planet earth. We're going out for a walk. We're not reacting to the- Dr. Mark Hyman(12:19): It's not underreacting or overreacting. Dr. Todd LePine(12:20): Exactly. Underreacting or overreacting. And when you overreact, we call that an autoimmune disease. When you underreact, we call that AIDS. Dr. Mark Hyman(12:29): AIDS or cancer. Dr. Todd LePine(12:30): AIDS or cancer. Dr. Mark Hyman(12:30): Or overreaction is allergies or immune. Dr. Todd LePine(12:34): And I think we talk about a weak immune system or strong immune system. It's really, I think, an intelligent and a balanced immune system. That's how I like to think about it. And that's related to immuno-tolerance, which is what the gut does. When we have a healthy gut, we have an immune system that is tolerant to lots of things and you can eat certain things, you can go out in the environment, you're not going to react to dog dander and all these other things. Some people have genetic predispositions towards being more atopic or allergic, but having a healthy gut, especially early on, the priming of the gut is so critical. Having a vaginal birth, being breastfed, not introducing certain foods like gluten early on in life- Dr. Mark Hyman(13:19): Living on a farm. Dr. Todd LePine(13:21): Living on a farm, exactly, being exposed. Dr. Mark Hyman(13:23): You get exposed to a lot of- Dr. Todd LePine(13:23): And crawling around in the dirt and literally putting dirt in, I call it, your body's immune system samples planet earth. Planet earth is a very dirty place. There's lots of bugs and all kinds of things and your body learns to be immunotolerant. And one of the things that I also focus on is part of the immune system just called the T-reg cells. The T-reg cells are like the conductor in the Boston Symphony Orchestra. You've got the wind section over here and the horns over here and they keep everything in balance. And the T-regs are really, really critical and what we're finding- Dr. Mark Hyman(13:59): They're regulatory cells. Dr. Todd LePine(14:00): They regulate. They regulate the whole balance of the immune system and the T-regs that we find out, two things that are really simple that people can use to upregulate your T-regs to keep things in balance are fibers, fibers in the diet. Fibers are the key things that help with regulation of that. And then also, which I use it quite a bit in the patients that I see is vitamin A. Vitamin A helps to downregulate the immune system. It helps to keep the T-reg cells in place. Dr. Mark Hyman(14:31): This guy came in with brain fog and he had a lot of stress, but he also had other things. He had mold exposure. Dr. Todd LePine(14:37): Well, he was working in a building and they found out that he was in a water damaged building, unknown to him, and he had a mold exposure, which you've been experienced yourself. Dr. Mark Hyman(14:46): Been lucky enough to have. Dr. Todd LePine(14:51): A lot of people are in older buildings. You don't know, you might buy the building and there's water damage. You don't even know what's there. Dr. Mark Hyman(14:58): 50% of buildings have water damage in America. That's a lot. Dr. Todd LePine(15:01): Really? Dr. Mark Hyman(15:02): Yeah. Dr. Todd LePine(15:02): Wow. That's a lot. He came to me and he had the diagnosis of mold toxic... In fact, he actually learned about this through one of your podcasts. I think you were talking with David [Asprey 00:15:14]. Exactly. It was the moldy podcast. So that's how he sort of went down that road. And he got treated with a variety of different therapies. He got some IV glutathione, he got some ozone therapies and other interventions, and he got about 50% better. And then within several months he sort of went back to where he was. He was also, again, not sleeping much because he was doing a lot of litigation. It was a lot of stress. He wasn't sleeping well. Dr. Todd LePine(15:47): The big thing that I see with patients with conditions like immune dysregulation is stress and lack of sleep is a stressor, probably the number one stressor. If people aren't getting a deep restorative sleep, that is a stress to the immune system. Dr. Mark Hyman(16:02): Huge. Dr. Todd LePine(16:03): And I was trying to sort of emphasize that you can do that for like one or two days, but you can't do that on an ongoing basis. Really, really important. I've always emphasized getting good, deep restorative sleep with patients. I emphasized that with him. When he came in, he also had a lot of digestive symptoms. He was actually on a whole bunch of inhalers. He was unlike a Breo, Spiriva, Ventalin, on Xolair injections, Flonase for his sinuses. He also had- Dr. Mark Hyman(16:35): Xolair is a very expensive like $20,000 a year, tense immune suppressing medication. And he still wasn't better? Dr. Todd LePine(16:42): He still wasn't better. No, exactly. And that actually worked by stabilizing mast cells, which you can actually naturally do [inaudible 00:16:49] actually can help high-dose [inaudible 00:16:51] can be very helpful for a mast cell stabilization. Dr. Mark Hyman(16:53): Also good for COVID. Dr. Todd LePine(16:59): Exactly. When he came in here, I did a thorough workup on him and I did retest him for mold and he did have some mold, but I compared it to his previous labs and it wasn't that bad. I empirically treated him with some binders to sort of help, but he had already moved out of the moldy building that he was in. Dr. Mark Hyman(17:15): You get out of the moldy environment and then use these binders to help get the mold toxins out of your system that [crosstalk 00:17:22]- Dr. Todd LePine(17:21): Right, because the mycotoxins, they do tend to recirculate in the body, the enterohepatic recirculation, so they'll get reabsorbed by the body. Dr. Mark Hyman(17:30): And what are the kind of binders you use? Dr. Todd LePine(17:32): In him, I actually used very natural things. I used Medi-Clay and I also used to activated charcoal. That was pretty much it. Dr. Mark Hyman(17:40): These are things that don't get absorbed that's sucking all the bad stuff out. Dr. Todd LePine(17:43): Oh yeah, exactly. You worked in a emergency room, right? Dr. Mark Hyman(17:46): Yeah. Dr. Todd LePine(17:47): Somebody would overdose on drugs, we'd give them charcoal. Dr. Mark Hyman(17:50): That's right. You make them drink black charcoal [crosstalk 00:17:52] black teeth. Dr. Todd LePine(17:52): And every now and then, they'd vomit up on you and you'd be all black. We've been there, done that. Dr. Mark Hyman(17:57): Yes we have. This guy had also other stuff. He had gluten issues and a lot of gut issues. Dr. Todd LePine(18:05): Yeah. And unfortunately, when he went to the previous doctors who did help him out, they didn't go deep enough, they didn't sort of get all the pieces of the puzzle. They did not check him for gluten sensitivity, which he markedly was gluten sensitive. And also I did the Cyrex testing on him for gluten and Cyrex for leaky gut and both of those were markedly positive, Dr. Mark Hyman(18:27): Those are tests that we use at the UltraWellness Center that are a little bit different than traditional food testing that looks at antibodies that aren't true allergy, but there are reactions that a immune system is having against foods and we can tell what you should and shouldn't eat based on what's causing an immune response. Dr. Todd LePine(18:42): Exactly. And then also did stool testing on him. I did, what I think is sort of the state of the art, the GI map test, which does quantitative PCR for the DNA of bacteria, yeast, viruses, parasites, and he had probably one of the worst cases of dysbiosis I've ever seen. Dr. Mark Hyman(19:01): That's imbalanced gut. Dr. Todd LePine(19:02): Imbalance. A lot of imbalances. I tell patients that everybody has hundreds of different kinds of bugs in their gut and they're a little bit like weeds in a garden. No garden does not have weeds. You just don't want too many weeds. And the interesting thing about the digestive track and bacteria is that there is a phenomenon which is known as quorum sensing and quorum sensing means that when certain bacteria has reached a critical level, they start acting as bad actors. An example of that is like a Clostridium difficile. When patients get antibiotics and they wipe out the good guys, the bacteria, the C. difficile, somehow or another sense that there's not enough cops around and they take over the place and they start producing toxins. Same thing happens in this particular case, he had one of the highest levels of pseudomonas bacteria that I've ever seen. And we typically see that in patients with cystic fibrosis. He had a bacterial dysbiosis, that organism plus other organisms. Dr. Mark Hyman(20:01): And he had a lot of guts symptoms, right? He has sticky poop and- Dr. Todd LePine(20:05): Yes, exactly. Yep. Exactly. A lot of mucus. And in my opinion, that mucus, that sticky mucus is a biofilm. That's where the bacteria live. They live in that biofilm layer and antibiotics and such are very difficult to penetrate that. Dr. Mark Hyman(20:21): You're not having a smooth log that just comes out clean. There may be some problems in there. Dr. Todd LePine(20:24): Exactly. And he also had yeast overgrowth, which was not unexpected- Dr. Mark Hyman(20:28): Because of all the antibiotics he had. Dr. Todd LePine(20:30): Oh yeah, absolutely. Absolutely. Dr. Mark Hyman(20:31): And the acid blocker he was taking for heartburn Dr. Todd LePine(20:33): He was on a proton pump inhibitor. I hate them. Dr. Mark Hyman(20:37): They are good and bad. They can take be helpful, but I remember when I was in medical school, we talked about this in the podcast, we were told they just came out and they were like, these are very powerful drugs. You don't want give to any patient more than six weeks. It shuts down acid production. It's risky longterm. And now everybody's on it for life. Dr. Todd LePine(20:53): They're over the counter. They're over the counter. Dr. Mark Hyman(20:54): Over the counter and for life. And it causes all sorts of destruction in the gut. It causes you to not absorb your nutrients. It causes overgrowth of yeast, it changes the pH. It causes- Dr. Todd LePine(21:02): Leaky gut. Dr. Mark Hyman(21:03): Leaky gut. It causes irritable bowel. Dr. Todd LePine(21:05): Osteoporosis. Dr. Mark Hyman(21:06): Osteoporosis, pneumonia- Dr. Todd LePine(21:08): B-12 deficiency. Dr. Mark Hyman(21:09): Yeah, there we go, we can keep going. Dr. Todd LePine(21:10): It's a great way to keep the business going, isn't it? Dr. Mark Hyman(21:12): Yeah, I wrote a textbook chapter on reflux and it was like looking at all the data. It was like, holy cow, this is not good. Dr. Todd LePine(21:19): Exactly. And unfortunately, they're handed out like Pez candy and patients stay on them long term. Dr. Mark Hyman(21:23): Come on, what's wrong with Pez candy? I used to eat that all the time. I had my little Pez dispenser. Those of you who are younger, you might not know what this is, but it's a little candy dispenser device with little cute cartoon character on the top and- Dr. Todd LePine(21:35): Donald Duck or- Dr. Mark Hyman(21:36): You just pull it open and then this little candy would pop out. It was so fun to eat. Dr. Todd LePine(21:44): It was. Dr. Mark Hyman(21:44): I quit when I was like eight. This guy had all this stuff and he had gut issues. He had gluten issues, he had mold issues. And what I find really important to emphasize is that in functional medicine, it's about looking at the whole system and not just treating one thing. And often it's many things at the same time because when the system breaks down, lots of things break down. Oh, this guy has gluten issues. Well, getting off the gluten wouldn't fix him or just fixing the mold wouldn't have fixed him or just fixing his gut wouldn't have fixed him. You've got to deal with all these various things. And you had another thing that you found on him as well, right? Dr. Todd LePine(22:18): Yeah. Dr. Mark Hyman(22:19): His sinus issues. Dr. Todd LePine(22:20): Sinus issues, exactly. He actually had sinus surgery for that. And it was a really big thing. And in fact, I actually just recently downloaded a paper from a PubMed on the nasal microbiome. We have bacteria on our skin. We have it in our mouth. We have in our digestive track, in the vagina, in the sinuses. They're- Dr. Mark Hyman(22:41): Everywhere. Dr. Todd LePine(22:41): They're everywhere. They're everywhere. And so disruption of the nasal microbiome can also cause brain fog. Typically, you see that a lot- Dr. Mark Hyman(22:50): And all the steroids he was taking up his nose and everything was affecting him that caused- Dr. Todd LePine(22:53): And also, it's a dark, moist environment. A lot of patients who have chronic sinusitis, it's actually been shown not so much to be bacterial as it is to be a yeast- Dr. Mark Hyman(23:03): Fungal. Dr. Todd LePine(23:03): Fungal origins. You have to really think about that. In his case, he needed surgery. He actually had sinus surgery that helped a little bit, but it didn't clear up the problem, which is really a dysfunctional nasal microbiome. I actually treated him with a Neti Pot nasal saline irrigation. There are certain machines- Dr. Mark Hyman(23:30): Yeah, I like the Sinupulse machine. It's like a water pick for your nose. Dr. Todd LePine(23:33): Exactly. Dr. Mark Hyman(23:34): Put a saline in there and it rinses it out. Dr. Todd LePine(23:36): Rinses out, right. For people who do have chronic sinus issues. And then in his case, I actually used Silvercillin, which is not a colloidal silver, but it's a silver sol. And silver is actually a great anti-microbial and I used that in him with great success. It was really very, very effective. Dr. Mark Hyman(23:53): Silver is also something that kills bugs. Dr. Todd LePine(23:56): Kills bugs. Dr. Mark Hyman(23:56): And put up it your nose and it'll help deal with whatever latent infections are there. Dr. Todd LePine(24:00): Exactly. And in this particular paper that I was talking about, which is discussing the nasal microbiome, they were actually making a proponent to actually use probiotics, things like lactobacillus, up into the nasal passages to recolonate the nose. Dr. Mark Hyman(24:15): Incredible. Would be like fecal transplant up your nose. Dr. Todd LePine(24:18): Exactly. And Dale Bredesen, who's been a leader in looking at the various causes for Alzheimer's, talks about the nasal sinus passages as a problem when you have chronic inflammation in the sinuses being a risk factor for Alzheimer's because that is directly. Dr. Mark Hyman(24:36): Chronic inflammation. Dr. Todd LePine(24:37): Chronic inflammation, exactly, and it goes right up into the brain. Dr. Mark Hyman(24:39): You also did this nasal treatment. You also treated gut. What did you do for his gut? Dr. Todd LePine(24:46): Obviously, we put him on an elimination diet, also- Dr. Mark Hyman(24:49): So you go him off the gluten? Dr. Todd LePine(24:50): Got him off of gluten, exactly. Dr. Mark Hyman(24:52): Starchy foods that ferment. Dr. Todd LePine(24:54): Sort of low yeast, low mold type diet. I actually did not treat him with antibiotics. I treated with antimicrobial botanicals. I also used oral silver, which I'll sometimes use in conjunction. And I also continued with binders, the activated charcoal and then another product GI Detox. And it was pretty remarkable his success. Within a month, he said like light bulb went on in his brain. Dr. Mark Hyman(25:27): You mentioned a product called GI Detox, which is something we use. It actually has charcoal and clay in it. It actually helps to bind up all the nasty things that get produced by these bad bugs when they're fermenting the foods that you shouldn't be eating. It's fascinating. You looked at this holistically from a functional medicine perspective, which is really quite different than most people. The fact that this patient had gluten and mold and imbalanced gut flora and sinus issues was the reason for his brain fog. But if you take 10 people with brain fog, we might have 10 different reasons. Dr. Todd LePine(26:06): Absolutely, just like you have 10 different reasons for a cough. Dr. Mark Hyman(26:08): Mine was mercury. That didn't show up in this guy. It's important. I think this is the thing that's so different about functional medicine is that we don't just stop thinking at the symptoms we go, what's the cause of the symptoms. Dr. Todd LePine(26:20): Absolutely. Dr. Mark Hyman(26:21): If you have rheumatoid arthritis or you have a headache or migraine, a migraine isn't a diagnosis, it's a symptom. It's a certain type of headache. Dr. Todd LePine(26:31): Absolutely. Dr. Mark Hyman(26:32): And so we really have to look at the different causes for each individual. It's very personalized and- Dr. Todd LePine(26:39): Absolutely, totally personalized. Dr. Mark Hyman(26:41): And it's often treating it not just one thing, it's treating multiple things in the right sequence to get people better. Dr. Todd LePine(26:46): Exactly. Dr. Mark Hyman(26:47): And so he was building on getting rid of the mold and getting out of the environment and ozone and glutathione, which certainly help. But then there were other things, right? He got to get off the acid blocker. He had to get up all these nasal sprays that were suppressing his microbiome and his nose. He had to- Dr. Todd LePine(27:01): Get sleep. Dr. Mark Hyman(27:01): He had to get sleep. He had to- Dr. Todd LePine(27:03): Had to manage stress. Dr. Mark Hyman(27:04): Had to manage stress. He had to irrigate his sinuses and use natural antimicrobials that kill the bad bugs in there. He had to reset his whole gut system and get rid of the pseudomonas and build all this together in a protocol, which it sounds complicated and sometimes it is, I guess- Dr. Todd LePine(27:19): It is. Dr. Mark Hyman(27:19): But that's what we do in functional medicine. And it's a very unique approach that is the future of healthcare. It's not something that most physicians are learning in school. It's something that is actually working far better than most traditional therapies for these kinds of things. If you have an acute problem, you go to the hospital. I had atrial fib, you got to go to the hospital and I get my electrical system fixed. It's fine. But I think if you have these weird symptoms that nobody can fix or that they're trying to medicate, it just doesn't work that well. Dr. Todd LePine(27:51): Yeah. And you really bring a very good point because regular mainstream medicine has its place. You break a bone, you have a heart attack, you have a stroke, there's definitely places for acute care medicine. But when it comes to chronic care medicine, I would almost venture to say that the mainstream approach, which is either the scalpel or using expensive potentially toxic medications, is actually doing more harm than good in most circumstances. It really is. It's unfortunate, but it really is. And then what happens is then one drug is layered onto the next drug, especially like in these young people with ADD and depression and stuff like that. They come in with polypharmacy. And I talked about iatrogenic imperfecta, which is that the patients are getting problems related to the doctor's treatments. That's the big issue these days. Dr. Mark Hyman(28:42): And the thing about functional medicine is it's agnostic when it comes to therapy. Sometimes we use medications when it's appropriate, but it's usually around finding the cause and treating the cause. If someone has a parasite, you might use a parasite medication. If someone has Lyme disease, you might use an antibiotic. But if that's not the right treatment, you don't do it because it's the only thing you have. That's the thing. We have a very limited toolkit in traditional medicine and functional medicine expands that toolkit and expands the map of how we figure out what's wrong with people. Dr. Todd LePine(29:08): Exactly. You have to map it all out. And the matrix, what we use as a intellectual way of framing how we see the problem, helps is like a pilot's checklist. Okay, well let's see, how is the immune system working? How is the gut working? How are the hormones working? We look at all those different systems in the body and we do both traditional testing and specialized testing to help us. We're not guessing. I always tell patients, when you see me, you're coming in to see me because you've got an issue that nobody's else has been figuring out. And you went to the Mayo Clinic and the Scripts Clinic and Harvard and you name it. And they're throwing up their hands, oh, here, take an antidepressant and see you later. I see that so many times and we have to explore and lift up the rocks and shine the light on places that haven't been looked at before. Dr. Mark Hyman(29:59): That's right. The kinds of tests you're talking about, the food sensitivity testing, the mold testing, the gut testing. These are things that are definitely outside the box, but they are the future. This is how the body works, whether we like it or not. There was a recent textbook that was published at Harvard called Network Medicine, talking about the paradigm shift that's happening now around the body being this biological network and system. And that's really what functional medicine is, it's the application of this to what's happening today. And it's so powerful. And I think people out there are suffering from all sorts of cognitive issues. We did the broken brain series and whether it's ADD or dementia or depression or brain fog or whatever it is, there's usually a reason. That doesn't happen for no reason. And that's when we're good. We're good at being detectives and finding the reasons. Dr. Todd LePine(30:43): Exactly. Yeah. And it's interesting because I was actually a chemistry major when I went to Holy Cross College. And then when I went to medical school after I did my residency, I did my training in internal medicine. I'm a board certified internist. That's my specialty. And invariably, I'll meet someone and say, "Well, what is your specialty?" And it's so funny and sometimes- Dr. Mark Hyman(31:07): I specialize in humans. Dr. Todd LePine(31:10): And they always say, "What kind of doctor are you?" And I say, "Well, I'm a good one." Dr. Mark Hyman(31:13): A good one, right. Dr. Todd LePine(31:14): And it's sort of funny. And then if I actually say the term functional medicine, they get like this blank stare, "Well, what is functional medicine? Dr. Mark Hyman(31:21): What is it, right. Dr. Todd LePine(31:23): I've coined the term. I call myself, I say, "I'm a psychoneuroimmunoendogutologist." Dr. Mark Hyman(31:29): That's good. That's good. Dr. Todd LePine(31:30): Which is basically understanding that it's all related. The psycho is the brain, neuro- Dr. Mark Hyman(31:35): You forgot [inaudible 00:31:36] in there. Dr. Todd LePine(31:36): Yeah, exactly. Dr. Mark Hyman(31:37): And you forgot mito in there. Dr. Todd LePine(31:40): And mito, yeah right. Dr. Mark Hyman(31:41): Mitochondria. Dr. Todd LePine(31:42): It's all interconnected. It's this unified organism and there's a- Dr. Mark Hyman(31:47): It's an ecosystem. Dr. Todd LePine(31:48): It's an ecosystem. Dr. Mark Hyman(31:49): Everything impacts everything else. Dr. Todd LePine(31:51): And the beautiful thing about the body is that if you give it the right environment and a tincture of time, in most cases, the body is pretty good at self healing. If you give it fresh air, if you give it sunlight, if you give it exercise- Dr. Mark Hyman(32:08): If you take out the bad things. Dr. Todd LePine(32:09): Take out the bad things. Exactly. You take out the bad things, put in the good things and a tincture of time, the body is actually pretty good at healing. Dr. Mark Hyman(32:16): It's true. Dr. Todd LePine(32:17): There are some cases where we don't fully understand the human genome. We do testing for genetics and we can get insight into genetics. I'll actually talk about that in the next podcast. But I'm very optimistic that when we start to combine artificial intelligence and big data sets that we're going to start seeing some of these cases that are really complicated and saying, oh, this is what's going on with them on a genetic level or a mitochondrial level and- Dr. Mark Hyman(32:47): That's right. Dr. Todd LePine(32:48): Be able to dial it in a little bit better. Dr. Mark Hyman(32:50): That's what we do. We do pattern recognition. You've seen thousands and thousands of cases and you see these patterns and you can recognize. And then you sort of know where to go with the testing and figure out what's going on. I play a game with myself, I don't know if you do this after being in this so long, is I try to write down everything I possibly think is going on with this patient and what the test results are going to show and then I get the test results and 90% of it I actually figured out before I even got the test because once you've done so much of it, you see those patterns. Dr. Todd LePine(33:17): And everyone now and then there's curve balls. Dr. Todd LePine(33:19): I always- Dr. Mark Hyman(33:20): I get all the curve balls myself. Dr. Todd LePine(33:22): I get curve balls and sliders and the knuckle balls. Dr. Mark Hyman(33:25): I was the curve ball. My own health issues were just curve balls and that's what got me learning about this. Well, Todd, this has been such a great conversation. I think those of you listening, who struggle with these issues, it's tough, but there is hope. And I feel that people need to learn about functional medicine and you're welcome to come to the UltraWellness Center. We're now doing all virtual consultations. If people want to come virtually, we don't have to have you come here anymore. We can do the testing and go to to learn more about our practice. We have an incredible team of physicians and nutritionists, physicians assistants, and nurses who are supported by an incredible administrative team. And we take care of people from all over the world, helping solve these complex problems. If you would like to learn more, just go to Thanks for listening to this podcast. I hope you enjoyed it. If you'd like to share it with your friends and family on social media, we'd love to hear from you, please leave a comment. Subscribe wherever you're getting your podcasts and we'll see you next time on the Doctor's Farmacy.