How To Treat And Prevent Colon Polyps Using Functional Medicine - Transcript

Dr. Elizabeth Boham: I say that the most important colonoscopy is to get your first one, because that really lays the groundwork. And if you're, unfortunately some people do have a higher rate risk of making lots of polyps or making these concerning polyps. And you want to know that at a younger age. Dr. Mark Hyman: Welcome to the Doctor's Farmacy. I'm Dr. Mark Hyman and that's Farmacy with an F a place for conversations that matter. And today we're having a special house call episode with Dr. Elizabeth Boham, my colleague at the Ultra Wellness Center where we do functional medicine better than anybody I think. Of course, I shouldn't say that, but it's kind of what I think. And she's just an incredible doctor and we're going to talk about colon polyps today. She's a physician an MD and RD and exercise physiologists issues, teachers all over the world and trains other doctors around functional medicine. And it's just an all around great human being. Dr. Mark Hyman: And today we're going to talk about something really fun, which is colon polyps and colon cancer, which is unfortunately really common and takes people's lives. And like one of my closest friends died because she didn't have a colonoscopy and it was just a horrible thing. And and we now know so much about what causes them and what to do about them. But it's far more than just getting your colonoscopy and that's what's so exciting. We're going to talk about why we get polyps, who gets them, what to do about them, to prevent them, and what do you do if you get them? So welcome, Liz. Dr. Elizabeth Boham: Thank you, Mark. Thanks so much for having me. It's great to be with you all. Dr. Mark Hyman: So first of all, before you started, what's the big deal with polyps? Because we're told to get colonoscopies every two years, five years, 10 years, depending on who you are. We're told that, these are big deals, but we really never talk to about how to really think about them from a functional medicine perspective in terms of prevention or treatment. It's just about going to the colonoscopy, cutting it out or if you have colon cancer, cutting that out and taking chemo and radiation. But there's a whole other world of thinking around this that allows us to be much more targeted in our approach to preventing and treating these things. So talk about what are polyps. Why do we get them? How often, how common are they? And what's sort of the general thinking about them. Dr. Elizabeth Boham: Absolutely. So polyps are these growths that occur in the inside of your intestines. So in your colon, you can get these growths that are polyps and there's all sorts of different shapes and types of polyps, from adenomas to hyperplastic polyps. And all of that really influences how risky the polyp is in terms of it turning into colon cancer. So a percentage of these polyps can become cancerous and cause colorectal cancer. And as you mentioned, unfortunately, there's a increased rate of colorectal cancer. It's the second leading cause of cancer death in the United States. And unfortunately we're seeing real precipitous increase in young people getting colon cancer. And it's hit home for me, unfortunately a few times with some really close friends of mine. And, and so it's something that we want to think about how do we prevent these abnormal growths from occurring and that, especially the ones that can become dysplastic or cause cancer in the body. Dr. Mark Hyman: And there are things that are so common, right? We see such a high percentage of the population having this. And I've had my colonoscopy and thank God, I didn't have any polyps, but it's really common to have these it'd be expressed in our population. And I sort of remember medical school learning about this guy named Dennis Burkitt, who was a scientist from the U.K. who went to Africa and he studied the fact that there was such a difference in the populations of those hunter-gathers versus the ones who are still African, but who migrated to the city and were having an urban life and adopted a lot of Western habits. And when he found was that there was like no colon cancer and no chronic disease in this group of indigenous, basically hunting-gathering populations who are eating their traditional diet. Dr. Mark Hyman: And when they looked at the people in the cities who were adopting a Western lifestyle and diet, they had way more cancers and way more chronic disease. And the thing that he found was fascinating was that the main difference was that the stool weight, in other words how much did your poo weigh essentially, what a job to do that, was for the hunter-gatherers two pounds a day. Whereas for the people who were living in the Western society, it was basically a few ounces. It was like four ounces. So that's pretty funny. And I think that speaks to the importance of diet in regulating what happens in the gut and how we're beginning to understand the role of our current Western diet in driving so many of these diseases. Dr. Mark Hyman: And I think the thing about polyps is that they basically can get converted into cancer. They're like pre-cancerous things. It like getting a Pap test. It's like a, pre-cancer by doing a colonoscopy, but they grow very slowly. They often are incidental. You don't notice so you have them until often it's too late. Like my friend who had colon cancer, she basically had no clue until she started having really bad symptoms and this giant cancer was blocking her rectum. But you don't want to wait until that stage. You want to think about how do you proactively prevent it. So touch talk about some of the risk factors that we know for colon polyps and colon cancer. Dr. Elizabeth Boham: Well, one of the things you were just talking about in terms of the size of the weight of the stool, it really is fiber, right? We know that. What are those people doing that have the larger stools? They're eating lots more fiber and high, high, high fiber diet is great because it's helping to pull toxins out of this, out of the gut. So that those carcinogens can't spend as much time touching the wall of the intestine and causing those shifts or changes in the cells that can go on to cause cancer. That's just one of the things that fiber is doing. And so a high fiber diet has been associated with a decreased risk of colon, colorectal cancer. So more and more and more fiber. So fiber we get from our beans and legumes, nuts and seeds, ground flax seed, vegetables, those are all high fiber foods. Dr. Elizabeth Boham: We know, as we get older, our risk increases for polyps and colorectal cancer. We know that as we gain weight, as our BMI increases, especially that belly fat, that belly fat increases inflammation in the body. That causes an increased risk of colorectal cancer. We know that lack of physical exercise increases our risk, and it may be because when we exercise that helps improve the transit time, it helps the food move more quickly through the bowels. So when people have less exercise, they don't have as regular bowel movements, essentially. So lack of physical exercise, there's probably more to it than that in terms of improvement in insulin sensitivity and all sorts of things. But we know smoking increases risk of colorectal cancer, excess alcohol intake, eating too many processed foods, eating too many processed foods that have been treated with antibiotics or meats grown with antibiotics, a diet that's low in vitamin C, low in antioxidants. Dr. Elizabeth Boham: And if you have a family history of polyp production or a family history, or you yourself have had previous polyps that increases your risk as well and inflammatory bowel disease, because there's, that creates more inflammation in the intestines. So there's many things we know that increase our risk of polyp production and increase our risk of colorectal cancer. And then there's a lot of exciting things we're going to talk about during this podcast in terms of the microbiome and how we can shift it, and that's going to, we're going to just learn more and more about that as well. Dr. Mark Hyman: So true. You mentioned, I would say the obvious things, right? The insulin resistance and pre-diabetes, which is a huge driver of cancer and people aren't realizing that it's not just heart disease or diabetes, but then when you add sugar and starch, it drives cancer, particularly colon cancer, breast cancer, prostate cancer, pancreatic cancer, a lot of the common cancers. And the fact that we look at this whole issue of diet and cancer. One of the things I want to sort of dive into, aside from the thing you talked about, needing more vitamin C and more fiber and getting off of processed foods and all of that, and getting more active and increasing fruits and veggies. Dr. Mark Hyman: I want to talk about the issue of meat and colon cancer for a minute. Because the big reason that we're told to not eat meat, one of the big reasons is because of its association with colon cancer. And so I sort of want to dig into that a little bit because when you look at the research, it's a little more nuanced. And I've looked carefully at this because I don't want to eat meat if it's going to give me colon cancer. But I also sort of want to understand what the science says. And what's your perspective on the issue of meat and slash processed meat. And is there a difference in what should we be thinking about and how does this all work? Dr. Elizabeth Boham: I think there's absolutely a difference with types of meat and I think we need to, there needs to be more research to explore this area further. But what we do know is that when people have a higher rate of processed meats in their diets, so hotdogs and deli meats and that there, that it at high rates, that there is some association with colorectal cancer. But what I think is important and as you've spoken about before, is that teasing out what is, how is that associated with other lifestyle factors is important. And what is the rest of the diet look like and how much vegetables is that person getting and how is that meat produced and then processed that really influences things. So I think what's important and unfortunately, a lot of our meats are given high doses of antibiotics to cause that meat to those animals to grow faster and get bigger, faster. Dr. Elizabeth Boham: So there's, it makes sense that that antibiotic fed, those antibiotic fed animals are going to influence our microbiome and our risk for cancer. Dr. Mark Hyman: Absolutely Dr. Elizabeth Boham: But I don't think it's so simple, like you said. I think it's way more nuanced than that. And it's not just that you can't eat meat because there's a lot of good things in meat. There's a lot of good nutrients and iron and that are harder for people to absorb when to get when they totally avoid those foods. So I think it's really critical that people are focused on the grass fed, the healthier forms and to balance their proteins, not just get all animal protein. I think vegetable proteins are a wonderful thing to have in your diet as well because of all the fiber they provide. Dr. Mark Hyman: Absolutely. And I think that one of the things that I wanted to highlight is that, is it a distinction between meat and sort of grass fed meat. And there's also a difference between meat and processed meat. And I think this is really important for people to know. When you look at the data, this was data from the IPCC, I think, which was the group that looks at the risks of cancer, an international research group in the U.N., that is independent scientists. And when they looked at the data and they're looking mostly at observational data, right? So you have to understand the state is improved cause and effect. They found that there was about a 20% increase in your risk of colon cancer, if you basically ate bacon every day. And so the- Dr. Elizabeth Boham: Yeah, I think it was like five strips, right? Dr. Mark Hyman: Five strips of bacon every day, your whole life. Dr. Elizabeth Boham: I think it was five strips a day. It was five strips one day. Dr. Mark Hyman: Your risk goes up by 20%. And that seems like a lot. First of all, if you're looking at observational study, unless the risk goes up by 200%, you're probably not seeing a cause and effect relationship, although there are theoretical mechanisms for it. However, when you look at the absolute risk, the background risk in the population of getting colon cancer is 5%. When they saw with the processed meat, mainly five strips of bacon a day for the rest of your life, which nobody's going to do, I think, I'm certainly not. The risk goes up to 6%, which is a 20% increase. So this is where the statistics get super confusing for people. And there is a difference between relative risks, which is the relative increases is 20% from five to 6%, right? Dr. Mark Hyman: But if you look at the absolute increase risk, it's 6%. So if you want to eat a piece of bacon or meat, that's processed once in a while, is that going to cause colon cancer? I don't think so. And there's another caveat here is that it's not only what you're eating, it's what you're eating it with. And if you look at the data, for example, from Maasai warriors and from Morocco's population that needs a lot of meat and the Maasai live on basically milk and meat. One of the distinguishing features is they cook the meat or they drink the milk with tons of spices and the spices and the marinades actually change the quality of the interaction with your biology of the meat and actually mitigate a lot of the potential risks. So I'm not one of those guys that meat is terrible, it's going to cause cancer because I think the data is really weak. Dr. Mark Hyman: And I think we have to put in perspective and I'm certainly not going to five pieces of bacon a day. I might have some pasture raised pork bacon once a month, or I don't remember the last time I had it actually maybe once every six months, but it's something that we should be really focused on is not just what we're eating as one isolated nutrient, which is this whole nutritionism reductionism view. But what are we, what is the overall context of our diet? And I want to get into that with you next, because changing the composition of your microbiome is key to actually reducing your risk of colon cancer. Dr. Elizabeth Boham: Absolutely. And I don't think people recognize how critical it is to feed the good bacteria with certain foods, right? So we know that phytonutrients, those are the components of our plant foods, really feed the good healthy bacteria in the gut. We know that things like pomegranate can, has substances in it like ellagitannins, which feed the good healthy bacteria in the gut, one bacteria called Akkermansia, which can lower inflammation. We know that we can feed it with things like pomegranate. We know that things like green tea, green tea is phenomenal in its anti-angiogenic, antioxidant capacity. But it also has the ability to epigenetically suppress or epigenetically increase tumor suppressor genes. And that can therefore increase glutathione production, decrease risk of cancer. Dr. Elizabeth Boham: And so what other things were eating with the meat, and the beans, and the chicken, and that all those phytonutrients are critical. Getting eight to 12 servings of phytonutrients a day is critical. And you mentioned spices. They've done studies with mice and shown that curcumin, that spice, which is the phytonutrient in turmeric, right? That can cause less polyp production in mice. So having a diet rich in spices, rich in these polyphenols, rich in these phytonutrients, really can influence our overall health, but because of how it feeds the microbiome. Dr. Mark Hyman: It's incredible. What's really fascinating too, Liz, is that there's a particular compound in the gut that's so important for overall gut health and it's called butyrate. And it's produced by this bacteria in your gut when they consume things they like to eat, like fiber and certain kinds of fiber increase butyrate, which is what we call a short chain fatty acid. Now that's a big mouthful, but essentially this is the fuel for the intestinal tract. And essentially you're in this symbiotic relation with bacteria where you're feeding them and then they're producing fuel for you. The key finding though, was that this butyrate, when it's in high concentrations, turns on the tumor suppressor gene. So it literally shuts off the genes that cause cancer, which is kind of staggering. So eating fiber, well, eating fiber, that's great, whatever, whatever. But the truth is that honestly we can modify our microbiome and increase these short chain fatty acids by simply providing the raw materials we need, which is kind of exciting. Dr. Mark Hyman: And we're going to go more into how do we create a healthy microbiome and how do we create a better environment. There are some other factors that relate to it such as B vitamins and so forth. But before we get into that, I want to kind of just loop back and talk about how people can evaluate this because it's more than just a colonoscopy. There's a lot of interesting new tests and diagnostics that we haven't really talked about, that I love. Share about how we screened for colon cancer and polyps. Because, polyps might not be able to be detected from tests that look at colon cancer, for example, like a stool blood test or a DNA test. Because those might not really detect just mild polyps, precancerous polyps. But let's talk about what the tests are that we should be looking at. Dr. Elizabeth Boham: Well, one of the things I wanted to mention first, and it is one of the tests we do all the time is we can measure that butyrate level, which is phenomenal. You were mentioning how butyrate has been associated with a lower risk of colorectal cancer. So when you have more butyrate, which is a postbiotic, which gets produced when our probiotics are good bacteria consume prebiotics fiber, we make these, we make this butyrate. And we can measure butyrate. We can measure it in the stool and then we can watch it improve when we improve the milieu in the digestive system. We know that butyrate, as you are mentioning, is so critical for healing the lining of the epithelium, the lining of the intestines, so that cancer is less likely to grow. We know that butyrate can lower inflammation in the intestines and it can really help improve that barrier function and improve the immune system within the intestines. Dr. Elizabeth Boham: So that may be some of the reasons that butyrate has been associated with high levels of butyrate or good levels of butyrate have been associated with lower risk of colorectal cancer. And so I think it's something that we test all the time and I think it's really a helpful thing to evaluate. I think you were also speaking about the tests that we do to screen for colorectal cancer, right? So the general recommendation is to do colorectal screening testing, like a colonoscopy between the ages of 50 and 75. Now some organizations have really lowered that to 45 because we are seeing, unfortunately, this increased rate of colorectal cancer in younger populations. So some people are recommending that we start screening at 45 all the way to 75. And a colonoscopy is a good screening test. Dr. Elizabeth Boham: And you, when you do a colonoscopy, you can look for polyps and if they're there remove them. Which is great because if that polyp was going to go on to become a colon cancer, you can remove it and prevent that from happening. So it's a good test that I always encourage people to do. People don't, a lot of times people are hesitant to do it, but it really is good. And I say that the most important colonoscopy is to get your first one, because that really lays the groundwork. And if you're unfortunately some people do have a higher rate risk of making lots of polyps or making these concerning polyps. And you want to know that at a younger age. Dr. Mark Hyman: Absolutely. So getting those tests, and there's a DNA testing you can do for some of the markers of colon cancer that are available now, there's Cologuard. So there's some interesting tests that are available, but at bottom line you do need a colonoscopy. And I think if you have a family history, if you're at risk, there may be even earlier indications for it. So it's super important. Now, what is our approach from a functional medicine perspective? Because typically from a traditional medicine perspective, you do a colonoscopy, you go in, you just cut the thing out and you go, okay, I'll see you later, come back in two years, I'll do another one. Hopefully you don't get another polyp. And that's we call that active surveillance. And to me, it's, I think it's inactive. It's doing nothing and waiting and hoping, instead of going, gee, why did I get the polyp in the first place? And how do I prevent that from happening? Dr. Mark Hyman: And that is the difference between functional medicine and traditional care. We're always thinking about the why, and not just the what, not just do you have a colon polyp but why do you have it? And how do we understand the biology underneath it? How do we test for what's going on that's causing it? Would your doctor, who's a gastroenterologist, look at your butyrate levels? No, they're not going to do that stool test. At the Ultra Wellness Center, we do do those tests. And we do see these factors in much more refined relief and can actually figure out what to do in a personalized way to help people really improve their overall health and get this better. So let's talk about how do we make the body completely inhospitable to cancer and the particularly colon cancer and colon polyps in general? Dr. Elizabeth Boham: How do we create a terrain where cancer is less likely to grow? And the first thing I always focus on is lowering inflammation. You want to lower inflammation locally within the intestine and lower inflammation systemically within somebody's body. And so you can measure inflammation by looking at things like C-reactive protein. By looking at somebody waist to hip ratio, because that abdominal fat creates inflammation. You can measure if there's inflammatory markers in the stool. And you can get a sense of somebody's level of inflammation by their diet that they have because some diets are more pro-inflammatory. And that's one of the first places we work to shift is creating, shifting a patient's diet to one that's more, anti-inflammatory more rich in phytonutrients, rich in plant foods, rich in fiber, rich in omega-3 fats and lower in sugars and refined carbohydrates. Dr. Elizabeth Boham: And so inflammation is one of the things I really look at testing wise and when you're looking at somebody's situation. We also work to lower insulin levels. We work to lower toxin levels in their body. We pay attention to their microbiome. And what kind of, are we seeing inflammatory bugs in their gut? Are we seeing the bugs that are associated with lower levels of inflammation in their digestive system? So we evaluate their microbiome and of course we pay attention to those lifestyle factors that really impact somebody's risk of developing cancer. Dr. Mark Hyman: And, there's those things we mentioned are really key. Getting insulin down, getting your toxic load down, improving the health of microbiome, dealing with the things that drive inflammation, right. We talked about how to build some certain good bacteria by providing the different kinds of fibers, soluble or insoluble fibers. There's prebiotic fibers, there's probiotics. You can take butyrate. There's all the phytochemicals in food we're talking about that help. All the spices we can include in it. I love making spicy foods. I make tons of things. I use all kinds of spices. And I think that is a great way to increase the phytonutrient content and reduce inflammation. You mentioned green tea and pomegranate or cumin. The broccoli family is fascinating. The broccoli family is one where, they've actually literally measured broccoli in the urine, where the byproducts of broccoli in the urine in large populations. If we're going to China and find that those who have the highest levels of these chemicals from broccoli and their urine had the lowest levels of cancer. Dr. Mark Hyman: And that's because it helps us to activate the genes and suppress cancer. It activates our detoxification system. It helps reduce inflammation. And it's powerful. Flaxseeds are also great, as you mentioned, and they have lots of benefits in terms of doing things. Fermented foods, probiotics. All these things are things that we can include in our general wellbeing and lifestyle program that helped to reduce our overall risk. And we might be even being able to be soon in a much more targeted way with the microbiome. Able to treat people with specific compounds, whether it's adding more butyrate or whether it's particular bacteria like bifidobacterium and amylase, which is low, and people have colorectal cancer to basically targeted probiotic therapies for various things. Dr. Mark Hyman: So I'm sort of excited about what's happening in this world of the microbiome, because what's going on is people really can upgrade their microbiome through all of these things we just discussed. One of the challenges though for people is constipation. And that is something we're not really talking about, but it is associated with increased risk of colon cancer. And of course it makes sense, because there's all this junk in there and it's toxins and crap literally is causing all these adverse biochemical reactions and activation of cancer genes if we don't really get rid of the poop that's in there on a regular basis. And that that's really, really important. Dr. Elizabeth Boham: I was just going to mention if the stool, if the longer it is in contact with the cells in the colon, the more likely those toxins within the stool are able to damage the cell lining of the colon and trigger the inflammation or the start of cancer production. So having good regular bowel movements is really critical and we can improve that with butyrate, actually, as a supplement can help people have better bowel movements, more fiber absolutely, ground flax seeds, chia seeds, more fiber in their diet, more water in their diet, as well as probiotics. I'm sure you've found this too. When you give certain blends of probiotics to people, the healthy bacteria, whether it's because it's lowering inflammation, that helps with them being, having better regularity as well. So there's so many things we can do to be helpful there. Dr. Mark Hyman: And so let's go through a case because maybe I'll illustrate a little bit better. And the reason I want to share this case with everybody is because it explains how in functional medicine, we do different diagnostic tests. We're able to do different therapies and be much more deliberate, personalized, and proactive about optimizing function. And really, it goes back to this idea, traditional medicine being very much like the old model of a single pill for a single disease. And in functional medicine, we don't focus so much on that we focus on the underlying terrain. So how do you make your body inhospitable to disease or cancer? And this is really what you've done with this guy, which is pretty amazing. Dr. Elizabeth Boham: So like you said, you don't want to just wait for the, your next colonoscopy. We want to be proactive to do whatever we can do to prevent the production of polyps or colon cancer. So this was a 40 year old gentleman who came in because he wanted to prevent, he wanted to be proactive. He wanted to prevent colon cancer. And the reason he was so interested in preventing it is unfortunately he had a strong family history of colon cancer. His father had colon cancer and his uncle had colon cancer in their sixties. And so he wanted to do, he was I want to be proactive. I want to do whatever I can to decrease my risk. And so that's exactly what we worked on. We got a really detailed history and worked on where for him we needed to make improvements. Dr. Elizabeth Boham: One of the things we found out when we got his detailed history is he was only having a bowel movement every third day. And so that made me concerned because of what we just spoke about how if the stool is just sits there longer than it has a higher risk of causing inflammation or damage and in the cells inside the intestine. And so we want to have people having at least one bowel movement a day. And so we did a stool analysis on him and his stool analysis showed that he was low in that short chain fatty acid butyrate. And we know as we talked about that low levels of butyrate have been associated with an increased risk of colorectal cancer. So I said this is where we want to focus because a lot of other, a lot of his other risk factors were in good control. Dr. Elizabeth Boham: He had good insulin levels. His blood sugar was good. His weight was good. He was active. He was exercising. He had a pretty good healthy diet. But I knew we needed to focus on bumping up his butyrate level. So we focused on increasing his fiber intake and giving him those, that fiber, that food to feed the probiotics so they would make more butyrate, that short chain acid, short chain fatty acid butyrate. So we really worked to shift his diet to get in those eight to 12 servings of phytonutrients a day and gave him some ground flax seed and really increased his fiber intake. Dr. Elizabeth Boham: And that was really what made a difference. I also did give him some probiotics. I gave him a good general probiotic blend. And I also gave him some actual butyrate because his levels were low and we wanted to be more proactive. And so after six months or so, we rechecked his stool. He started to have regular bowel movements every day, and we rechecked his stool and we could see his butyrate level improve and the level of good bacteria improve in his stool test. So that was really satisfying. And he's doing really well. This is a few years later now, and he's doing well and we hope to keep him doing well for many, many more years. Dr. Mark Hyman: There's one of the things that was interesting was that sort of reading about the case, you, it was, you were able to give targeted probiotics that are studied. So I think I'll just take yogurt or just take fermented food, but there are specific varieties of bugs that have been shown to do really different things. For example, lactobacillus KCI BL23 or lactobacillus [inaudible 00:32:35] and CFM have antitumor properties. So they modulate immunity, they lower inflammation. They inhibit the bad bugs from growing. They help the gut barrier function. And there are other bacteria like [inaudible 00:32:47], plantarum and various E. coli, which sounds like a bad bug, but it's actually, there's one in there also. Make a huge difference. So in addition to doing those probiotics, you also give them prebiotics fibers and fermented foods. We also advise them on how to cut down some of the toxins, right? Dr. Mark Hyman: The nitrates in his diet, the processed meats, the getting rid of pesticides, by eating organic, getting rid of antibiotics in his diet. And also the other thing that's really important people don't realize, and I'm a bad guy for this because I love to grill, but it's not good for you. And the heterocyclic amines in the charred meat is a big cause of cancer. But, the biohack here is if you sort of marinate your meat in a vinegar or lemon or lime or some type of acidic solution and add a lot of spices, it really seems to mitigate that, but you don't want to eat blackened stuff, basically. Dr. Elizabeth Boham: Not too often, right? Dr. Mark Hyman: So Liz, this has been a great conversation about a very common condition that affects millions of people that causes so much unnecessary death. And the truth is, this is one of the cancers that nobody should die of. This is a totally preventable cancer in terms of death. I mean, maybe we'll still get polyps or early cancer, but by proper screening, by looking at some of the other things that are setting your risk up, that we look at and functional medicine such as your microbiome or your nutritional status or toxin exposures, insulin resistance, we really take a holistic 360 view of this. And we work on the biological terrain. We don't want to create a container in which our bodies, which disease grows or cancer grows. So that's the beauty of functional medicines. Its the beauty what we do with the Ultra Wellness Center. And now we're doing a lot of virtual consults because of COVID, which has allowed to see a lot more people and we're building our staff. Dr. Mark Hyman: So we know we'd love to help you have any concerns about cancer, family history, whether it's prevention or whether it's you've already had cancer. You want to prevent it from coming back, or you actually have it in want to get a supportive approach. We really can be guides on that process. And we'd love to see you. It's pretty exciting field now, functional medicine, because we have so many more tools than we used to. And we have so much more insight than we used to. And even since we've been doing this and the microbiome in the last 30 years, it's just that the research in this has exploded. And now we're able to be so much more sophisticated about our targeted approaches. And it goes way deeper than what you'll get from traditional medicine. And I'm just so honored to work with you, Liz, and other team members at the Ultra Wellness Center to offer these kinds of services to the population. And it's really gratifying because you just see people change and get better and improve. And I just feel sort of grateful. Dr. Elizabeth Boham: It is fun. Thank you so much, Mark. Dr. Mark Hyman: Well, thanks for this great conversation about colon polyps, probably not everybody's favorite topic. If you love this podcast, please share with your friends and family, leave a comment. Maybe you suffered from colon polyps or figured out a way to figure it out. We didn't talk even about some of the things related to methylation and B vitamins, but there's a lot of things we can do in addition for this. Maybe you've discovered what works for you. Subscribe wherever you get your podcasts. And also check out my new Dr. Hyman Plus which is a subscription service for exclusive content for me and my team about everything you could imagine. And it's super exciting. So check it out and we'll see you next time for another episode of House Call and the Doctor's Farmacy.