Blood Clots: A Functional Medicine Approach - Transcript

Dr. Elizabeth Boham: Anything that's increasing inflammation or oxidative stress, we need to lower. How they metabolize and process those hormones are important for us to pay attention to.

Dr. Mark Hyman: Everybody's been hearing about COVID and clotting and how it's causing clotting and strokes, but this is a bigger issue for people and it's quite common. I know it personally, my mother was in the hospital before she died and she was getting her fluid taken off because she had a little heart failure and they did not get her out of bed and I kept calling her every day to get out of bed, get out of bed, get out of bed, and she wouldn't. She didn't have any help and they were understaffed. And when she came home a week later, she died of a pulmonary embolism because she got a blood clot in her leg that lobbed off and went into her lungs and compromised her breathing and she died. So it's very personal for me and I know there's so much we can do to prevent it. So let's talk about clotting and the common issues. How do we avoid it? How do we prevent it? And what really is going on with all this clotting stuff?

Dr. Elizabeth Boham:Yeah, and Mark it's personal for me too. I've had a couple of clots in my veins in my lifetime, we can talk about it later, which is ... I was like, "Oh my gosh, why would I be getting this at at the age ..." It was about 12 years ago, I had a clot in my subclavian vein, so in my upper chest arm area, and we can talk a little bit more about that, but I was like, "Oh my gosh, what's going on? And what could I do to prevent it in the future?" But it's really important that our blood clots, we needed to clot, if our blood didn't clot, we would bleed to death. So our body has all these mechanisms in place so that our blood does clot and we don't bleed to death, but if it causes a clot that blocks off an artery or a clot that blocks off a vein, that can be really, really dangerous, as you mentioned. Dr. Elizabeth Boham:A clot that blocks off an artery can cause a heart attack or stroke, and a clot that blocks off a vein, you can get a deep vein thrombosis like a DVT, or like you mentioned with your mom, a pulmonary embolism that is very, very serious. And it's very common, for DVTs, our lifetime risk is somewhere between 2 and 5% in our lifetime for everybody, in terms of their risk for getting a DVT in their lifetime. And as you mentioned, many different things can cause this. So when somebody's on bedrest, there's an alteration in blood flow in the body, so when somebody is on bed rest, because the blood is staying in one spot, there's more risk for it to just clot in that area. Long airplane flights, a change in activity, injury to the lining of the vessel, which may have been the situation in my case. I was doing CrossFit and I was doing handstand pushups and I think that I injured a vein- Dr. Mark Hyman: Oh my god, handstand pushups? That's impressive. Dr. Elizabeth Boham:Well, yeah, but I probably, I don't know, maybe it was or not. I don't know, but maybe there was some injury in the vein that was between the clavicle and first rib that was one piece of the puzzle to trigger this clot to occur. So injury to the vessel, and then of course, anything that changes your body's risk for clotting. So that can be genetic, some people are more at risk for clotting because of genetics. Some people develop a hypercoagulable state in their body because of cancers or auto-immune conditions. So those are just some of the reasons that we see an increased risk of clotting for some people. Dr. Mark Hyman: Yeah, and so these are problems that are pretty common. And I think the traditional approach is basically give you blood thinners and aspirin, but there's a lot of things that we can do to reduce our risk and I think you mentioned a bunch of them. I think we talked about the risk factors, the bed rest and surgeries, long distance flying, lack of exercise, trauma, injury, pregnancy, being on the pill, hormone therapy, testosterone therapy, being dehydrated, cancer, autoimmunity, all these reasons cause your risk of clotting to go up. But if you've addressed those, there's a lot you can do. So what are the kinds of things you'd advise your patients around this, in terms of prevention? Because it's pretty common. Dr. Elizabeth Boham:Yeah. I mean, when people have had a history of a clot or they are at risk for clotting, or they have a family history of it, we talk a lot about, okay, what can we do for prevention? So when somebody's on a long distance flight, you talk to them about making sure they're well-hydrated on that flight, they're getting up periodically, they're walking around like every half an hour. You want to be drinking, in general, you want to drink at least half of your weight in pounds in water a day. So if you're 150 pounds or so, at least 70 ounces of water a day just in terms of getting enough fluid and being well-hydrated because when the blood is thicker, it's more likely to clot. So staying hydrated is really important. Dr. Elizabeth Boham:So birth control pills. When young women get clots, a real large reason is oral contraceptive. It's a three to five time increased risk for clots- Dr. Mark Hyman: That's a lot. Dr. Elizabeth Boham:... when you're on the birth control pill. And especially for certain groups of people on the birth control pill. Of course, there's going to be genetics, and we can talk a little bit more about that, but smokers, people who have insulin resistance. So if you have polycystic ovarian syndrome, if you're overweight, if you've got that weight gain around the belly, if you're an older woman, all of those things make the birth control pill even a higher risk for getting blood clots. Hormone therapy can increase your risk two times. Dr. Mark Hyman: Like if you're a woman and you're taking post-menopausal hormone therapy. Dr. Elizabeth Boham:Depending on how it's done. So that's one thing that we really work with women on is if they are going to take hormone therapy, is a healthier version. We've talked about this in other podcasts, that some of the oral estrogens can increase inflammation in the body and may cause more of a risk, or depending on the amount of increase that you're giving somebody, that may have more of a risk than some of the other formulations. If you get a blood clot, one of the things with me, that because of my own cancer history, of course, when I had the subclavian DVT, they did a full cancer workup because for an unprovoked DVT, 10% of those people have underlying cancer that they either had known about or they hadn't known about. Dr. Elizabeth Boham:So cancer does cause this hypercoagulable state, and so it's often part of that — it should be — it is part of that full workup when you get a blood clot. And luckily, I did not have a recurrence at that time, but that is something that's looked for. And auto-immunity, so anti-phospholipid syndrome, which is an auto-immune process. So auto-immunity can impact your risk. Weight, as we talked about, if you- Dr. Mark Hyman: If you're over weight. Dr. Elizabeth Boham:Yeah, overweight, metabolic syndrome, that process in the body that's really inflammatory, that increases our risk of so many different things, it also increases our risk of blood clots as well. Dr. Mark Hyman: Amazing. So tell us, from a perspective of functional medicine, there's a lot of different things we do rather than just like give you a blood thinner, which you may need, but there are a lot of things to do to keep your blood vessels healthy. And [it's not something really 00:09:04] talked about, and one of the keys of the matrix is your transport systems, which is your lymph and your circulation, and keeping your blood vessels healthy is really important and they get very inflamed for various reasons, our diet, stress, lack of exercise, toxins, and that leads to cardiovascular disease. So keeping your blood vessels healthy, in general, is important. So let's talk about, what are the ways we know that we can really accentuate and improve the function of our blood vessels? Dr. Elizabeth Boham:Yeah, so we're always looking for signs of inflammation in the body and oxidative stress because both inflammation and oxidative stress can cause damage to that endothelial lining, to that lining of our blood vessels. So we really are saying, okay, anything that's increasing inflammation or oxidative stress, we need to lower. So as we've mentioned already, we're paying attention to signs of insulin resistance, metabolic syndrome. That whole process increases inflammation and oxidative stress in the body and it's really important and critical to work on reversing in people, to improve their overall health, including decreasing their risk. Dr. Elizabeth Boham:We also pay attention to genetic variations or genetic snips. So there are a few genes, like high-risk genes, low-frequency high-risk genes, like factor V Leiden mutation, which really increases risk of blood clotting, or prothrombin gene mutation, which increases risk of blood clotting. But we also look at some of those genes that we know increase risk of blood clotting, but are more common, so they're considered higher frequency, but lower impact. So they don't increase risk of clotting to the extent of like a Factor V Leiden gene mutation would, but they do have an influence on somebody's risk of clotting. Dr. Elizabeth Boham:So we're paying attention to those snips, those variations that are common, not as much of an impact, but if you take it as part of a whole picture, do have an impact, like the MTHFR gene mutation or some of the genetic mutations that impact how somebody metabolizes their own estrogen. Because hormones, as we mentioned with oral contraceptives or hormone therapy, do impact a person's risk. So how they metabolize and process those hormones are important for us to pay attention to and make note of. So that includes things like, as I mentioned, the MTHFR gene, the COMT gene, some of the other hormone metabolizing genes that we look at. We also pay attention to just the milieu in the body that also influences our hormone levels. So our gut microbiota, which influences our hormone levels, that we've talked about a lot. Dr. Elizabeth Boham:And as I mentioned, anything that's increasing inflammation in the body. We always start with diet first. So there's a lot of phytonutrients, those are the components in our plant foods that create a lot of color in our plant foods, that have a lot of benefit in our overall health and wellbeing. So our phytonutrients, things like our flavanoids, things like our phenols, they can influence our risk of blood clotting. They can lower inflammation in our body, they can lower oxidative stress. So for example, garlic has anti-inflammatory properties and anti-platelet properties. We know foods that have quercetin in it, those are things like kale and broccoli and capers and berries and apples, they can reduce the clumping of our platelets and clotting. Flavonoids, anthocyanins, things like quercetin can also as well. Dr. Mark Hyman: That's great. Dr. Elizabeth Boham:Yeah, so what we're always working with our patients on is getting in lots of color in their diet, eating from the rainbow. Getting some plant foods that have red in it and an orange and yellow and green, blue purple, white, and tan. Getting lots and lots of phytonutrients in their diet every day. So eight to 12 servings of those colorful plant foods every day can help with many different things, including decreasing inflammation in the body and decreasing our body's ability to clot. Dr. Mark Hyman: Incredible. So really there's a lot you can do to protect, taking the phytochemicals, the flavanoids, quercetin, which works against COVID, catechins, which is from green tea, dark chocolate, red wine, pears, apples, all that stuff, and rutin, which is amazing, and apple peels, garlic, you mentioned, and of course, omega-3 fats. So those are really important. Dr. Elizabeth Boham:Of course, omega-3 fats. Yes. Yeah, like our fish oil, ground flax seed. Yeah. Dr. Mark Hyman: So what are the stories of patients who've dealt with this in and had some success in using this approach? Dr. Elizabeth Boham:Well, I talked about myself a little bit, so this was about 12 years ago and as I said, I was doing handstand pushups. And the next day I started to develop some redness in my arm and then as the days went on, it progressed and my arm got swollen and our nurse, [Nina 00:14:51], at the time, she said to me, "Liz, I think it needs to go see a doctor." And I'm like, "Yeah, this isn't going down. This is crazy." Nina was great. I'm like, "Yeah, I think I got to go see a doctor," and we found a blood clot in my subclavian vein. So it's this process called Paget-Schroetter Syndrome, which is just the location of the blood clot that I had and they had to go in and break it down. Dr. Elizabeth Boham:But one of the things that when I started to look at this whole process for me, I realized that it happened at a time of my cycle where I was higher in estrogen and with my history of breast cancer and looking at my genetic snips, I knew that this was an area I had to continue to work on, is how do I break down my estrogens in a healthier way? And focusing on things like sulforaphane and DIM, staying really well hydrated, that methylation support that I needed support with, like the methylated B vitamins, was really the areas that I said, "Okay, I really need to focus on." But I have another patient, where there was some other areas that we needed to look at that we can talk about as well. Dr. Mark Hyman: Yeah, tell us about the other one. Dr. Elizabeth Boham:Yeah, so this was a 35-year-old woman, and she had a DVT in her leg and she came to see us. It was resolved at the time she came to see us, but she said, "What can I do to decrease this from coming back? I was 35 and I don't want this to come back again." And she had a full workup for malignancy, cancer, that was negative. She had a full workup for those genes that we were talking about, those high-impact genes, and they were negative. Dr. Elizabeth Boham:So we took a full history and timeline from her and what we realized, or what she knew, she was on birth control pills at the time when she got the blood clot, so they took her off of the birth control pills. And as we talked about, that does increase a person's risk. But it makes me think, it makes me pause and say, "Okay, what else does that tell us?" How is she metabolizing not only the estrogen in the birth control pills, but also her own body's estrogen now that she's off of the birth control pills, because we know that how you metabolize your estrogen impacts your risk of breast cancer and endometriosis and uterine cancer. So we really wanted to delve into that with her. Dr. Elizabeth Boham:We did a special stool test, we did the stool test that looked at this one marker that looked at the imbalances of the good and bad bacteria, and looked at this one marker called beta-glucuronidase. Beta-glucuronidase is this enzyme in the digestive system that can cleave your estrogen that's bound to this substance called glucuronic acid, which is the way that the body packages your own estrogen to get rid of it, helps to get it out of the body. We know that when people have this high level of beta-glucuronidase in their digestive system, that can cleave that estrogen glucuronic acid and allow it to get reabsorbed and help contribute to an estrogen dominant like picture, which is what she had. So we had to really work on shifting that microbiota because one of the main causes of this imbalance is dysbiosis, is an imbalance of the good and bad bacteria. Dr. Elizabeth Boham:So we worked with her to shift that dysbiosis. We actually used an herbal agent to lower that bacteria, we also used something called calcium-D-glucarate, which is a substance that can bind to the estrogen and help it get eliminated from her body and we added that in. And then we also did some other genetic testing, so not just those high-impact genes that she was negative in, but we did some of those lower impact, more common gene snips, and found out that she had a variation in this MTHFR gene. And that is associated with blood clots, it is associated with a higher homocysteine level, with a higher need for these methylated B vitamins. And so we added that in to her regimen, in addition to sulforaphane and DIM, that helps with estrogen metabolism, cruciferous vegetables, we focused really on high foliate foods, which is just lots of foliage, lots of green leafy vegetables, and things that helped her body with metabolizing and breaking down her estrogen, as well as just other toxins in her body. Dr. Mark Hyman: You want to know my secret for living a long and happy and healthy life? Well, all I have to do is check out my weekly newsletter, Mark's Picks, where I share my favorite tips for health, longevity, wellbeing, and lots more, check it out at the link below. Dr. Mark Hyman: Yeah. Well, this is mind-blowing what you're saying. I just want to unpack a little bit because you hit so many points. But what you're saying is, in traditional medicine, you've got a blood clot issue, you treat the blood clot, you give a blood thinner, and that's kind of the end of the story. What you just narrated was a perspective about thinking of the body as one integrated unit and you treated the gut bacteria in order to treat the blood clot, which doesn't make sense, given what we learn in medical school. But when you unpack it and you go, wait a minute, everything is connected. So there's a condition, which you're describing this woman had, which is estrogen dominance, which occurs in a lot of women in their thirties and forties, where they get excess estrogen because they're not ovulating, because they're eating too much sugar, because they have too much belly fat, because they're eating toxins in their foods, like pesticides that stimulate estrogen production, so you get heavy periods, fibroids, PMS, all these things. Dr. Mark Hyman: And for you, that was a clue there was something out of balance with her and looking at the stool ... Like thinking about that, your estrogen has to get metabolized and excreted and removed from your body, but it's kind of packaged up like in a little present. But what happens is when the estrogen goes through your liver and out your bile duct and into your intestines, it hits those bacteria, this [Clostridia 00:21:41] and other bacteria that have beta-glucuronidase, this enzyme that basically unwraps the estrogen from its little gift package. So all of a sudden, all that extra estrogen gets reabsorbed in the body, creating even more estrogen and more risk of clotting. That's a fascinating story, and so treating the estrogen dominance was by getting rid of the bad bugs by ... I mean, who would think to treat a blood clot with an antibiotic, but maybe that's the right approach in this case. Dr. Mark Hyman: And that's the way functional medicine works. You're often doing things that are completely out of the box and outside the realm of that specialty, but it's actually how the body works. You can have five people with blood clots and they might have five different reasons, and so they don't all get treated the same. And this women's a great example of how you connect the dots between all of the things that may be going on with her and looking in places that most doctors don't look. And that's really the beauty of functional medicine, it's really why we do what we do and it's so satisfying because we see people get better from all sorts of chronic issues that just aren't well dealt with, with traditional care.