Answering Your Questions About Autoimmune Disease, Optimizing Sleep, And Inflammation

Coming up on this episode of the Doctor's Pharmacy.

Often people have two or three autoimmune diseases and it's stunning to me how traditional medicine doesn't ask why.

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The producers of the Doctor's Pharmacy Podcast. In today's episode, we've compiled community questions from Dr. Heiman's most popular masterclass episodes. He's joined by his friend and business partner Drew Proett in discussion around the topics of autoimmune disease, and inflammation. Let's dive in.

We're gonna go to our community, our YouTube comments, our Facebook comments, Instagram and podcast community that emailed in. We're gonna take a few questions here and we're gonna start off with the first one.

My daughter-in-law has scleroderma and keeps trying different diets, but she believes she is dying from it. Are there actual diets to help slow this down? Can people live longer with this condition?

Yeah, so scleroderma drus is a common autoimmune condition that's based on the hardening and stiffening of connective tissue. So basically your skin gets tight, your esophagus gets tight, and everything starts to stiffen and you're like the stiff man and it's inflamed. And it's basically the same exact approach that we take to all autoimmune diseases is look for the root cause, get.

Rid of the root cause, and do.

A lot of things to help the immune system to reset and rebalance. And there's a lot of options out there for people. It's essentially starting with an autoimmune anti-inflammatory diet, which could be the 10 day detox diet, or it could be a more aggressive version, which is called autoimmune paleo. Autoimmune paleo is essentially getting rid of all the potential inflammatory foods that are not necessarily bad foods, but they can potentially trigger problems. Like lectins or nightshades. So essentially it's protein, paleo and vegetables, you get rid of nuts, which is, you think is healthy eggs, which I think is often healthy, but it's gonna be a trigger. Obviously dairy, gluten, grains, beans. So it's basically paleo plus it's paleo, but no nuts and, and no eggs and, and that can be, and also no night shades, which can be very inflammatory. So tomatoes, peppers, eggplant, so forth, potatoes. That's a good place to start. Then working on your gut is really important. Probiotics, anti-inflammatory foods, getting omega-3 fats in, making sure your levels of nutrients are at the optimal level, dealing with stress, exercise, all those things help. And I had a patient who was a doctor who had really bad scleroderma and she came to see me and a lot of my patients are doctors, by the way. and she really did the program and got so much better and her scleroderma halted and even reversed. So yes, the answer is yes. If you understand what's underneath all these diseases, you can really fix them.

Yeah, and one thing I'll add to that, you've had Dr. Terry Walls on your show, and she also talks about how she used the principles of functional medicine to take some of the autoimmune paleo stuff and go even a step deeper. And two things that she shared, and I really recommend everybody go watch that episode, We have a couple episodes with her. We'll link to it in the show notes. She recommended that she was doing pretty good. She saw a pretty strong reduction in her symptoms, but she really kind of hit a floor where she wasn't getting any better. And she started bringing in two things that was a game changer for her.

Organ meats?

It was organ meats was number one. And then it was making sure that every day she ramped up slowly to having about nine cups of vegetables.

Yeah.

It's not only what you don't eat, it's what you actually eat.

Right.

Because sometimes people go on a paleo diet, right? And they end up restricting so many things and they're limited because they react to a lot of stuff.

No.

But slowly ramping up, which should take some time. You don't want to start off right away. And she's got a whole process of going into it.

Yeah.

So that's where, you know, these layers of how people combine things and share.

Their experiences is very unique because they can be the missing ingredient. It's true. And, and, and so just as food can be the cause, it also can be the cure. And within plant foods are these phytochemicals, there's 25,000 of them and many of them are anti-inflammatory, medicinal, reparative, fix the gut, the microbiome, prebiotics, probiotics. It's amazing what you can eat. So for her, she really breaks down the food into a number of categories, right? Brassica family, which is all the collard kale cabbage, the garlic and onions family, really important components with sulfur, detoxifying compounds. versatin and other anti-inflammatory compounds, mushrooms, which are full of these immune modulating polysaccharides that are anti-cancer but also help the immune system, and also pre and probiotic foods to help the microbiome, like sauerkraut and various kinds of prebiotic foods like artichokes, or just some artichokes or asparagus or plantains and other foods. So there's, there's a way to actually use food as pharmacology. It's not just, oh yeah, food is medicine. It's kind of cool if you eat healthy food, you'll be healthy. No, no, no. There are specific components in different foods that regulate different biological pathways, and you can optimize those by choosing to eat those foods. And that's what I do when I go to a grocery store. I'm thinking in my head, okay, where am I gonna get my drugs? You know, I'm like, oh, artichokes. Okay, that has prebiotic fibers. It's gonna microbiome, but it also has these, these special compounds that are detoxifying from my liver. oh gee, I'm gonna have these shiitake mushrooms 'cause they have the polysaccharides that are helping my immune system and cancer. And oh, maitake, that's really good for cancer too. I'm gonna have that. So I kind of go through, oh, I'm gonna get this really good oleic high oleic olive oil, which has got oleic acid and also these olive polyphenols, which are extremely anti-inflammatory and help my heart. So I'm constantly like looking at the grocery store like a drugstore.

And that's, I think, you know, that's why I called the podcast, the Doctor's Pharmacy with an F. All right, Mark, here's the next question from our audience member. They're asking they have a history of Hashimoto's in their family and thyroid issues, but their doctor isn't running their thyroid antibodies. And they want to know, what I'm assuming from this question is what really should be the complete test and how much do you pay attention to things like thyroid antibodies?

So typically as doctors we're trained, all you do to track thyroid disease is check TSH, which is the thyroid stimulating hormone. If it's low, it means you're hyper. If it's high, it means you're hypo. And if those show up, then you go further to the next level testing, which is looking at antibodies. But here's the trick. A lot of people walk around with subclinical hypothyroidism, where it's very kind of minor, but has real significant clinical effects. And large data sets have shown that it increases your risk of death and heart attacks and subclinical hypothyroidism isn't really subclinical. It just means it's not severe, but you can still have depression, fatigue, weight gain, cholesterol issues, skin problems, hair loss, constipation, fluid retention, I mean all the hypothyroid symptoms. So, and we also know that even if your TSH is quote normal, and by the way, the range used to be 0.5 to 5, and so doctors wouldn't even start thinking about looking at anything until it was over 5. Well, the American and College of Endocrinology came out with a new guideline saying, no, it should be three or three and a half. Right? But what is optimal? Is three optimal? No, it's probably one or maybe around between one and two or maybe a little less. So I always check antibodies along with free T3 and free T4, thyroid peroxidase and antithyroglobulin antibodies. Because many, many times I've seen, quote, normal thyroid tests like normal TSH, normal T3, T4, and very high antibodies. And these people are having clinical symptoms if you pay enough attention. And even in, you know, looking at how we're doing things now, you know, one in 10 men and one in five women have thyroid problems or hypothyroid, and half of them are not diagnosed. And the ones who are diagnosed are not adequately treated because they just give them T4, which is the preformed, it's the precursor for the actual important thyroid hormone, which is T3. They give them T4. like Synthroid. That's not okay. So I, I wrote a book years ago. It was a ebook called the Ultra Thyroid Solution. We'll link to it. And I go through everything in there. What causes hypothyroidism, what tests you should do, what nutrients you need, what foods you should eat, what supplements to take, and how to get to the root cause of it. Because it's often missed and it's tragic because it's like a miracle. It's like one of my favorite magic tricks.

When someone comes in and they have this and that, oh, just take a little thyroid and you're like, boom.

It's like. light goes on and they feel great. So I think- We've also done a.

Lot of really good episodes with practitioners who've had autoimmune diseases themselves. Doctors themselves. Yes. We went on really long journeys. We'll link to those as well.

For sure.

All right, Mark, next question from our community member. What is on the cutting edge when it comes to getting to the root of autoimmune issues? And are there any emerging technologies that you're super excited about? Yeah, so much, Drew.

It's so exciting to be a doctor right now. I mean, I'm, you know, God, almost 40 years in since I started medical school. God, can I say that 40 years?

Geez.

Anyway, but biologically, I'm 43, so it's okay. The truth is that there's so many exciting advances in our understanding of how to modulate immune function and autoimmune disease. I would say though that it's really important to always deal with the foundational basics. Food, toxins, allergens, microbes, stress, diet, really, really, really important. And all the things we talked about are first step. Then there's a bunch of technologies that are emerging that can be really helpful for people who are stuck or have challenges. And one of them is really exciting, which is peptides. Peptides are small molecular weight strings of amino acids that aren't long enough to be a protein, but they're like mini proteins. They're called peptides. And they're signaling molecules that the body normally makes. So for example, thymus in alpha one is a really an important one that regulates immunity. As we age, our thymus shrinks. If it's a baby, you've got a big thymus and that's the immune organ and it shrinks as we get older, you can actually grow it. So thymus and alpha one can be very helpful in modulating immune function, helping your immune system work better. So there's a whole class of peptides that can be effective. Second is ozone therapy. Now ozone sounds wacky and crazy and the ozone layer and whoa, ozone is dangerous. If you Google ozone, the FDA is going to tell you it's going to kill you. Well, yes, it will actually if you breathe it. But so water, it's called drowning. So it doesn't mean it's bad, it just means you have to put it in the right hole. And so ozone, ozone actually is what we call a hormetic therapy, which is a stress. It's an oxidative stress. So it creates ozone is O3, and then you inject the gas directly, or you can do it rectally, or you can give it in a, mix it with blood and then put it back in. And essentially it creates this, this bounce back effect in the body where it's like, danger, danger. And then all of a sudden the body kicks in its own repair mechanism. So it decreases the NLP, NLRP3 inflammasome, which is a whole inflammatory cascade that happens. It inhibits NF-kappa B, which is another inflammatory gene transcription factor. It, it, it upregulates your antioxidant enzymes, which help control inflammation like catalase and glutathione peroxidase and superoxide dismutase. Lots of big words. I know. I'm just trying to explain to you how powerful this stuff is. And, and it, it also kills stuff. So if you have Lyme disease, viral causes, other things, it can be extremely effective in helping to reduce the burden of those infections. Sometimes we don't get rid of them completely, but it's just a matter of like, you know, are they taking over? Like, for example, all of us have yeast in our gut, but if it grows too much, you get all these problems, right? So it helps to keep the infections down and it helps to re reset your immune system. So it's very powerful. It was really effective for me. And then and then there's another, a few other things that are being explored, which I think are really exciting, which is exosomes. Exosomes are little packets of healing compounds that are in stem cells that the stem cells use to do their magic. So rather than having to take the stem cells, which means sucking your bone marrow, sucking your fat tissue, and spending a bazillion dollars, you can spend half a bazillion dollars. It's still expensive, but it's like probably a 10th the price of stem cells. and actually get these grown in a lab, purified and extracted, and you can take billions of these and inject them into your vein or into different areas of your body, and they help to reset the immune system. They can be very, very effective. So exosomes really help to modulate the immune system, and I got dramatically better from the ulcerative colitis symptoms, and I was doing other things too, but it was part of the solution. And of course, people are using stem cells. So often there's stem cell treatments for autoimmune disease. So there's a lot of stuff coming down the pike. It's very exciting. And lastly, there's a procedure that we've been doing a long time in medicine called plasmapheresis. So there's really fascinating advances in understanding how there's compounds floating around our blood that actually cause inflammation, that make us age, that we can actually do something about. So plasmapheresis is this technology that is being used now for this purpose for autoimmune disease, inflammatory issues. It has been in the past, like it is something we do. but it's coming up as a new treatment for autoimmune disease. And it kind of reminded me of this story that's being emerged, emerging story around actually longevity where they've sewn together the circulation of young mouse with old mouse. And the old mouse gets the young mouse's blood and it rejuvenates them and they act like young mouse, like a young mouse. So it's kind of cool. So that means there's this, plasma free. I've had plasma free. I'm, I'm trying all these things on myself. So I'm just seeing how it feels. I'm trying this and that. Maybe that's why I'm 43 biologically. I don't know, but I'm done plasma free. I've done exosomes, I've been baptized. I like experimenting. Yeah.

And a lot of these things are experimental, but we need people to go and try them and we need to popularize them. And the hope is that one day that. more people have access to it.

Well, what really needs billions of dollars of research to go into showing how these strategies that are not what I think are medieval practices are continued. So right now, you know, we're basically treating autoimmune disease except for a few little tricks like biologics, pretty much have we done for the last 100 years, like steroids, prednisone, I mean, they would grind up the adrenal glands of animals, and that was where they get the cortisol and then they'd give it to patients. back in the 50s as a treatment for autoimmune disease. So, like we haven't come that far from that and it's unfortunate. But I just had a patient who was diagnosed with this sort of terrible autoimmune syndrome with massive muscle pain all over and joint pain and aching and fatigue and his doctors were giving me huge doses of steroids and it kind of helped. But I sent him to get treatment with plasmapheresis and exosomes and ozone. and it just was like a miracle. He dramatically got better. So I think we have to kind of look at what are the first steps we can do. The things that I just mentioned are what's down the road, what's coming, what's available. Right now, unfortunately, they're very expensive, but I think this all will get sorted out as we begin to figure this out. Because think about it, if you can take a treatment for $10,000 and get rid of your autoimmune disease, or you have to take a drug that costs $50,000 a year for the next 50 years, What do you think we should be paying for? Right now we pay for the drug for 20, 30, 40, 50 years, but we don't pay for these other things which are short term a little expensive, but actually in the long term save a ton of money.

Right, and as they continue to get more attention, maybe even a little bit of research, they're spreading awareness, who knows what becomes available to folks.

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Episode of the Doctor's Pharmacy. All right, Mark, let's go to the next one. Any connections between autoimmune and lots of allergies?

Somebody who's suffering from a lot of allergies and has autoimmune. Yeah, so just to back up a little bit, In functional medicine, we look at the timeline of someone's illness. From before conception, the mother's health, to what happened in utero, at birth, in the first year of life, in the early toddler years, we look at that whole timeline. And what's fascinating to me is, and I don't see this described many places, but there's a continuum that happens. And the story always goes something like this. Okay, my mother and the pregnancy was fine. born by C-section, not breastfed, my gut was a mess as a kid, a colic, early antibiotics for ear infections, a development of allergies, asthma, eczema, irritable bowel syndrome. This is the story and it's the same freaking story over and over again. And then that goes on usually in people's early childhood, teens, 20s starts to get a little worse. And then by 30s and 40s, that's when autoimmune tends to kick in. And it's part of that continuum. and often when I treat the gut and the autoimmune stuff, the allergy stuff gets better. The sensitivities to foods, to environmental allergens get better. Even if someone's got pollen allergy or tree allergies, you'd think that wouldn't get better, but when you fix the gut, everything gets down regulated. And there's a big connection. There's also an interesting connection with a therapy that sounds really weird, but there's a lot of research on this and there's a number of books written about it, and one is called the Epidemic of Absence, and it's using worms to actually help reset the immune system in the gut because historically we were all managing all kinds of critters that we lived with in our gut that we kind of had as balance with. And our immune system was always kind of surveying and looking and managing and keeping everything under control. Well, now we've sort of eliminated all the worms and the parasites. We have clean water, we have sanitation, which is all great. I'm not saying we should go back to, you know, eat a lot of worm, but there are a number of studies that look at using worm therapy, which helps to reset the gut to reduce allergies but also autoimmunity. And, I've had some remarkable success. I remember there was one kid who was sort of on the Asperger's autism spectrum who had super high levels of allergies, IGE allergies, which is true allergy, not like a food sensitivity, and like the blood level of 1000, normal is 100 of IGE, which is the antibody for allergies. And, we did the worm therapy and it came down to normal. and his allergies went away. I was like, wow, okay. And we've seen this in other autoimmune disease. So it's not my first line therapy, but it is something that I fall back on if we get stuck. And so regulating the gut and regulating those allergies really helps to control inflammation.

In general and the whole autoimmunity picture. Great. So my son has celiac and Graves disease. Any tips on supporting and reversing this process?

Well, all the things that we just mentioned above. Absolutely. So you know, often people have two or three autoimmune diseases. And it's stunning to me how traditional medicine doesn't ask why? Like, is this just coincidence or is there a reason? Well, yeah, celiac will drive Graves disease. So if you actually heal the gut with celiac, you often can reverse the Graves disease. The problem is that with celiac, often people just get rid of the wheat or the gluten, but they don't rebuild the gut. and I've seen many, many people struggling even after getting off gluten because their guts have been so messed up. They need a rehab, they need a remodel in there. And so when you do that, often people will get better.

Okay, next question. How bad is alcohol for autoimmune diseases?

Well, depends on what alcohol, right? There's spirits, beer and wine.

Let's say.

The more alcohol you drink, the more it disrupts the microbiome. The more it leads to leaky gut, the more it drives inflammation. So having a shot of tequila here and there probably isn't a problem if you're in balance. But if you have an autoimmune disease, alcohol can be a real factor in continuing to trigger the inflammatory response in the body. It is a toxin. The dose makes the poison, obviously. But particularly if you're drinking beer, which is gluten-based, if you're drinking a lot of wine, which has sulfites, you know, a lot of sugar can cause dysbiosis and a lot of leaky gut issues and liver problems. So I think depending on where you are in the spectrum of your health, it's good to avoid alcohol, but if you have autoimmune disease. Now, if you, the whole purpose of functional medicine is not to make people's life restricted and constrained and to get off everything and to live in this bubble. The purpose is to create resilience, to create balance, to create redundancy, metabolic flexibility and make you robust so you can have a wide variety of things and your body knows what to do. So when I was really sick, I had autoimmune disease. I couldn't eat anything. I like had turkey, brown rice, and broccoli for a year. Like, and I couldn't eat anything else. And now I can eat anything, everything. I think if I have traditional dairy, like modern cow dairy, I get stomach issues and I get, like, pimples and congestion. But if I have sheep or goat, it's A2 casein, it's maybe heirloom. strains that's pasture raised, I don't have problems. So it really depends on the quality of food, but I definitely think the purpose is to create a robust system that makes you resilient and not have.

To be so restricted. All great answers, Mark. Thank you for that. So let's zoom out and do a recap on the topic of autoimmune. If someone is going to start today, first one or two things that they should be thinking about and next steps, let's do a recap on some of.

The stuff that you mentioned. I think the first thing to recognize if you had an autoimmune disease is that there is an approach that's different than what you're gonna hear from your traditional rheumatologist. And it's easy to start. And if the beginning things don't work, there's always plan B, which is seeing a functional medicine doctor. But for many people, a dietary change, some fundamental lifestyle changes, and a few supplements can make a huge difference. So what diet? Well, I would recommend an elimination diet. Now, I use one that I created called the 10 Day Detox Diet. And essentially it's no grains, no beans, no dairy, no sugar, no processed food. And it includes lots of biochemically rich plant foods, high quality protein, nuts and seeds, some fruit, and it gets rid of all the junk. And that alone can make a huge difference. Even if it doesn't get people all the way better, it can dramatically improve symptoms. for people. The second is make sure you focus on stress and sleep. Those will help your immune system regulate. And the third thing is take a few basic supplements, vitamin D, fish oil, probiotics, curcumin. Those are easy to take. They're safe, they're effective, and they will help your body start to rebuild its natural defenses against inflammation. So I think those are the things that I would say are the top three things. focus on diet, lifestyle, and a few supplements. If that doesn't work and after two or three weeks you're still seeing no change, it means you got to dig deeper. It means maybe you have a tick infection, maybe there's heavy metals, maybe you're exposed to mold, maybe there's some more serious gut issues going on like SIBO or SIFO, which is fungal overgrowth, maybe there's a parasite. We have to kind of look deeper.

But for most people, that initial approach can make a huge difference. You had three things at the beginning of the podcast that you shared when it comes to the top three mistakes people make when trying to heal their autoimmune disease. So let's do a little bit of a recap on those three things.

Well, the first is thinking that drugs are the only solution, that immune suppressants, steroids, biologics, chemo drugs are the answer. They're not. They're, they're a stop gap if you need them. They can save your life if it's really bad. I don't, I'm not opposed to using them in the right circumstance. but it ain't the answer. The second is believing that once you got it, it's a lifelong sentence. It's not. And third, it's complete missing of the root cause analysis for autoimmune disease. And that's what functional medicine is. It's a system of thinking about how to navigate the landscape of disease by addressing the root causes and getting rid of them and identifying the ingredients for optimizing health and immune function that we're missing and adding those in. So when you do that, it sounds pretty simple and it is quite simple in concept. It's actually remarkable what happens. And this is when I started practicing functional medicine, Drew, I didn't believe what I was hearing. Like my patient, I was like, try this thing that I heard about, do this elimination diet or take this thing and fix your tummy and see what happens. And people come back like, I'm better. I'm like, wow, really? You are from that? Okay.

It was like theory that you were learning about, but you were actually getting a chance to see and put it into use.

I'm talking like 30 years ago, and I was like, geez, this stuff works. And it works way better than anything I ever learned in medical school. Cause I remember first hearing about 'em, like, this stuff is just quackery and nonsense, or it's genius, and I gotta figure it out. And so I said, well, it seems pretty low risk to tell people to change their diet and do a few simple supplements and take this and that. Let's try it. And I would say to my patient, Look, you've got this horrible thing and yeah, the medications may manage it, but it's not going away and you feel like crap. So why don't we try this? It's a little experimental, but give me a sample of your poop. Let's do your food allergies. Let's look for heavy metals. Let's try these things. Let's take you down this course and see what happens. And time after time after time, and when I get stuck, it's usually because I'm missing something. And I'm like, Oh, maybe you have, you know, like a latent infection or a tick infection, or you have some toxin I didn't find, or there's some, something that I missed. But usually if I'm persistent, I'm like a bulldog and I don't let go and I kind of keep digging and I usually find stuff.

Yeah, and I think that's the really the key is try to find a doctor, you know, you're not really taking on new patients right now, so don't throw in a flood over here, but try to really look for a doctor. that can continue to dig with you because sometimes it does take some time.

People are what I hear from a.

Lot of functional medicine doctors, including your colleagues at the Ultra Wellness Center, Liz Bohem, Dr. Liz Bohem, and Dr. Todd Lapine, and Dr. George. They say that the patients on average that are coming to them right now are so much more complicated than even five years ago. There's just so many layers. So really, find a doctor who can sit with you, talk with you and continue to dig because there does seem to be a higher burden of things that are contributing to a lot of the diseases that people are suffering with, including autoimmune.

It's true. I think, you know, we're living in an increasingly complex world with increasingly challenging inputs that we're dealing with, whether it's, you know, screen time or disruptions of circadian rhythms or sleep deprivation or chronic stress from the divisive society, the burdens of loneliness and COVID, not to mention the total toxicity of our diet, the overload of environmental toxins. I mean, just the list goes on and on and on. So, you know, we're living in the best and worst of times. I mean, it's a great time to be alive, but it's also a challenging time to be alive because we're having to deal with things that we never had to deal with. I mean, people say, oh, Dr. Hyman, do I need vitamins and supplements? I'm like, no, you don't. you don't need, nobody should ever take vitamins or supplements, but only if you meet certain conditions. One, you hunt and gather on your own wild food. Two, you drink pure clean water. Three, you sleep nine hours a night and wake up with the sun and go to bed with the sun. Four, you're exposed to no environmental toxins and have no chronic stress. And if that describes you, you do not eat any vitamins. But everybody else, yeah. And then I think autoimmune disease is one of those challenging diseases that's so prevalent and thought of in really the wrong way, you know, because it's siloed. There's a neurologist deal with the MS, the rheumatologist deal with joint arthritis issues, the gastroenterologist deal with inflammatory bowel disease, the endocrinologist deal with thyroid problems. And so we don't really understand that the magnitude of this problem. So when you add all the autoimmune conditions together, it's the number one disease in America. other than obesity, right, which, by the way, is related to it. So the good news is that we really have the capacity to deal with this in a very different way. It's an exciting time. and if you have an automy duea, I enurage you to really dig into this topic and take ownership over your own health and be, as my friend Chris Carr said, the CEO of Savior As Technologies, In.. So ' you're not going to get it from your typical doctor.

Mark is going to bed at the same time every night important? How do you discover what sleep time frame is right for your body?

Yeah, I mean, historically, we used to.

Go to bed with the sun and wake up with the sun. That's probably a good thing, you know?

And I think the advent of the light bulb and work schedules, it's just, it's kind of screwed us up. So historically, you know, if, if you really want to look at proper sleep, hygiene and the way to set up a good sleep rhythm is to go to bed at the same time and wake up at the same time every day. And generally the sleep you get before midnight is much better. So I would say 10 is at least 10, maybe 9:30 in the bed, asleep by 10, get up at 6:00, 6:30.

That will often help you sleep much.

Better, sleep much deeper than if you sort of stay up to 1 or 2 in the morning. But there are people who are whose circadian rhythms are shifted and they may do better as night people versus morning people. That's okay. But in general, I think it's really a key to sort of establish a good morning routine to get yourself set up for a good night's sleep the rest of the day.

All right, next question. Is there a particular reason that we wake up intermittently as we age? And there's two sub questions underneath it, which are, is it normal to wake up and go to the bathroom every night? And the second question, what should I do if I'm going to bed early and still suffering from frequent wakeups throughout the evening. So this is all a question around waking up at night, especially at increasing as we age. So as we age, a bunch of things happen, right?

We tend to have more belly fat, we tend to have loss of muscle. And when that happens, you get higher levels of insulin, more fluctuations in blood sugar and lower growth hormone. And the reason that kids sleep so much and babies sleep so much is they have huge amounts of growth hormone. But when you lose muscle, you lose growth hormone. and you get higher cortisol and you get higher insulin. Cortisol will prevent you from sleeping. So when you, when you lower growth hormone and raise cortisol and through the aging process, you will actually have disrupted sleep. The, the reason that we do that is because we just don't, we're not active enough. Our diets aren't good. And so we're eating a high starch sugar diet. We're not weight training and strength training. But the truth is, at any age, you can maintain your muscle mass. I, I'm very, I'm now I have way more muscle mass than I did 10 years ago or 20 years ago. and it's possible if you know what to do. So I'm very focused on maintaining my muscle mass, which helps growth hormone, which helps my testosterone, helps cortisol stay low. Very, very important. I think if people are waking up frequently, even if they go to bed on time, there may be something else going on. There may be, there may be metabolic issues around blood sugar. There may be, you know, chronic stress that's not really being fully addressed. There may be other factors that cause frequent awakening. as far as urinating at night, you know, depends on when you drink, how late you drink, how much you drink, if you have a prostate issue or not, if you have, you know, irritable bladder or not. Normally, people can go through the night without peeing. Sometimes you get up once to go pee. It's not terrible. People can go back to sleep. So I think, but if you're going a lot more than that, it's worth getting checked out because you could have, you know, prostate enlargement if you're a.

Man or cystitis if you're a woman. And it's good to make sure you.

Get that checked because unless you're you know, if you're getting up two, three, four times a night to go pee, that's a problem.

All right, next question. Can a person catch up, so to speak, from a previous night of poor sleep?

I think yes and no.

I mean, I think, you know, people.

Anecdotally will say, look, if I didn't sleep six hours and I sleep 10 the next day, I feel better. So I think people will feel better.

But.

But the, the basic medical opinion is that, no, you really can't catch up on lost sleep. You've got to just keep. you know, sleeping and then putting sleep in the bank and, and actually, you know, over time you'll, you'll feel better, but you really have to make sure you're, you're not creating a lot of sleep debt and that you're actually sleeping more when you need to, but realize that that's sort of not necessarily going to fix all the sleep that you've had. So, you know, it's not great to say, well, I'm just going to step.

In, you know, six hours a night.

Or five hours a night during the week and I'll sleep 10 hours on the weekend.

It doesn't work like that. All right, next question. Does Dr. Hyman use a sleep tracker? And if so, which one?

Well, you know, I use a lot because I'm kind of skeptical about these things because, you know, you do three.

Different sleep trackers, you get three different results.

You know, so I use, for example, Oura ring. I'll use a app on my phone called Sleep Cycle. There's something called Sleep Watch. That's with my Apple Watch. And, you know, I kind of amused at how variable they are and I, and how, I don't, I don't really know how accurate they are. I think the aura ring is probably the most accurate. It measures heart rate variability. It measures RAM sleep, deep sleep, breathing and so forth, movement. So there's benefits to it. And it'll give you a sense of what's happening. Like, for example, I know that, for example, I don't, I have not been drinking alcohol much at all. And the other night I had, you know, somebody ordered a bottle on the table and had a glass, and maybe I had glass and a half of white wine with dinner. And I noticed the next, that night that my, my heart rate didn't lower, my temperature didn't lower, that my sleep was more disrupted and like, ooh, is.

It really worth it?

I don't really know if it's worth it. I don't really like drinking that much. And, you know, I prioritize my sleep, so it's. It's a really important thing.

Does Dr. Hyman have any tips for moms to help maintain their health while enduring sleep deprivation?

I mean, yes. Have a good partner who can spell you to get some more sleep. Take a nap when your baby's napping. that's what I recommend. And do the best you can to take care of yourself within all of it, because, you know, your quality of parenting is regulated by the quality of your energy and your presence in your family. And if you're sleep deprived, you're not going to be a very good company and able to really function at a high level. So prioritizing sleep is important and figuring out the support you can get at night, whether it's your spouse or your partner. to help spell you and getting naps when your baby's napping and taking that time is really important. But it is a tough period and I encourage people to sort of, you know, do the best they can, but know it passes.

All right, next question, which is actually about napping. Do you practice napping? Are there some days where you will embrace napping? And any recommendations for people who find napping difficult to do.

Yeah, I mean, I used to do.

A nap pretty well.

Lately, I just can't nap so well. If I'm really tired, I might be able to nap. And napping is fine to do. I think it's fine if you like to nap. I think it can be, you know, you don't want to overdo it in 20 minutes, half an hour. If you sleep for long periods of time, it can make you really groggy and it can affect your nighttime sleep. But I think that people who, who feel like they can and want to nap, it's so fine. And I think, you know, people can often just go down and they wake up 20 minutes later and they're refreshed. And I think that's a very good thing.

I tend to meditate.

For me, meditating is like taking a three-hour nap sometimes. Like I just close my eyes for 20 minutes, I wake up completely refreshed. All right.

Supplements and sleep aids. There's a few questions about them. Are there any supplements that you recommend? What are your thoughts about melatonin or other things that people might be using at night? to help them get better sleep.

Yeah. So, there are, there are a lot of things you can do to help improve sleep through supplementation. So, magnesium is my first go-to. A lot of people are low in magnesium that can cause insomnia. I think melatonin, anywhere from half a milligram to up to three milligrams can be a great adjunct to sleep. There's other amino acids like GABA derivatives and theanine from green tea that can also help. there's adaptogenic things like ashwagandha, rhodiola, there's other herbs that can help as well. Valerian, passionflower, magnolia, all these lemon, lemon balm, all these can be very helpful for sleep. So I encourage people to try different things. People should not probably use chronic sleep aids like benzodiazepines or Ambien, occasional it's fine. Like, if you're traveling and you want to sleep on a plane, I'll use it, but really rarely, rarely. And I think it's important for people to sort of know that these can cause long-term cognitive issues. It can cause long-term health consequences. Not getting sleep is also a problem. So, you know, it's a kind of a fine line to figure that out. But I encourage people to sort of try some of these alternative things. And I think, you know, I wrote an article years ago about, like, the 20 tips on how to get better sleep, including a lot of the supplements, the doses, where to get them and so forth. Also, we have a sleep masterclass that we created and people can access that. I think it's free, right, Drew? So, people can just get to the sleep masterclass and learn more about what to take, what to do, and how to regulate their sleep. It's really important.

Fantastic.

What about CBD?

Do you like it and who would you recommend or not recommend? Try using it.

Well, CBD is a derivative of the marijuana plant. and people are using combination of CBD or CBD plus THC, which is basically pot. And that can be very effective. And I, you know, often when many other things don't work, people can take, you know, capsules or tablets or even smoke vapor or actual, you know, a marijuana cigarette. And that, that can actually help with regulating sleep and help getting people to sleep deep sleep. It helps relax them, decrease anxiety. and I found that very helpful as well. So I think there's room for that as a therapeutic tool.

And, you know, there are questions about.

What'S the long-term consequences of CBD, THC on the brain. But in the meantime, I think it's a very simple, easy intervention that you can do that can help with mitigating a lot of sleep issues. And I recommend it to none of my patients. It can be very effective.

It doesn't work for everybody, but it can be very, very good. What role do grains play when it comes to inflammation, chronic inflammation in the body? Can grains help or hurt chronic inflammations in the body?

Great question. Depends on the grain. White flour surely is one of the most inflammatory foods on the planet, whereas ancient grains like Himalayan Tattari buckwheat may be one of the most anti-inflammatory foods on the planet. So, it's not grains as a whole, it's which grains in what form, how are they grown, where were they grown, what were they grown with, are they full of pesticides, are they full of glyphosate? there's so many layers of things that will actually determine the answer to that question. In general though, the way we eat grains in this country is as white flour. 90% of the grains we eat in this country is white flour. Very few people eat whole grain foods. Maybe there's a whole wheat bread, but if you look at the label, it's mostly white flour with high fructose corn syrup with a few flakes of whole wheat thrown in there. It's not like the dense breads you get in Europe or Germany. so I I'm not against grains, but I do think that there are, are challenges for people who are a lot of eating a lot of flour. It's probably one of the most inflammatory foods. And if you have a leaky gut, if you have an imbalance in your microbiome, if you're not having an intact system in your gut, it grains can be a problem. So I I tend to eliminate grains if I'm really aggressively trying to reduce inflammation, not forever, but for a short period of time to try to reset the system to heal the leaky gut and get people functional again. And if you do that, you also do a number of other things because grains are starch and depend on how much you eat, right? Having a half a cup of black rice or a half a cup of buckwheat may not be a problem, but typically we eat huge amounts of grains and that drives another pathway for inflammation, which is insulin resistance or pre-diabetes or blood sugar problems. And so, we have to understand that we have to reduce the starch and sugar in our diet. And one way of that is actually reducing grains. But whole grains can be part of a healthy diet. It's just when you get to eat them, who gets to eat them, in what context, with what other foods, and where do those grains come from? And are they modern hybridized grains that are full of starch and sugar, or are they ancient grains that have all these phytochemicals and other beneficial properties?

Next question, how does hormonal balance or imbalance related to inflammation?

So the biggest driver of chronic inflammation is stress, which drives all kinds of hormonal dysregulation. It screws up your hormones, the sex hormones, your insulin, blood sugar, cortisol, adrenaline, and it really drives huge amounts of inflammation. So if you actually are are highly stressed, that will drive a lot of the pathology. I mean, insulin is another hormone, that is a big one that drives inflammation. That's one of the biggest ones we talked a lot about that. You'll see people who are taking hormones, for example, estrogen or the birth control pill.

And it depends on what you're taking.

If you're taking, for example, Premarin, it raises inflammation in the body. It causes a high CRP. So does the birth control pill. So a lot of people are taking the birth control pill. I'm not saying people should stop the birth control pill. but you want to make sure you mitigate the effects of that. And recently did an Instagram Live with the founder of Even, Sarah Morgan, talking about the ways in which, for example, medications deplete nutrients and affect the body adversely. So, for example, if you're on the pill, the birth control pill, you may need to take certain nutrients to mitigate the effects of that and help reduce inflammation. So, certain things I would never take, like Premarin, which is hormone that drives inflammation, but I certainly wouldn't tell everybody to stop the birth control pill, but I think you have to know what you're doing and actually offset the harm by taking the right nutrients to actually.

Mitigate the damage and the inflammation that comes from that. Last question here before we go into final thoughts and conclusions. Can inflammation be tied to our genetics? Are some people more prone to developing markers of inflammation, especially chronic inflammation?

Absolutely. I mean, we're all heterogeneous. We have 20,000 genes. We have about 5 million variations in those genes, and some of those variations predispose you to inflammation. And we test those. I do that in my actual practice looking at saliva swabs that measure DNA, and we can look for variations in certain genes that affect the cytokines like interleukins and TNF-alpha and other genes. and we can see, oh, you're someone who, if you get some trigger, is way more likely to be inflamed. So there are people who are predisposed to inflammation, but that doesn't mean they're predestined to inflammation. So they need to identify, one, the sources of inflammation in their life and get rid of them. We talked about those. And they need to include anti-inflammatory strategies in their life, an anti-inflammatory diet, more polyphenols, probiotics, antioxidants, and obviously other anti-inflammatory strategies like adequate sleep and exercise and stress reduction and so forth. So hot and cold therapies, we just need to upregulate the anti-inflammatory system and calm down the inflammatory system. So yes, there are people who are.

Genetically predisposed, but it doesn't mean they're predestined. So not everybody will have access to a functional medicine doctor. Obviously, if they do, that's fantastic and amazing. You can go to ifm.org and find somebody in your area. It is often expensive, insurance doesn't cover it, and it's not available to everybody, But if you can, it's a great thing. If you can't, and for example, they wanted to explore the topic of genetics, a lot of people have 23andMe data. Are there any of those websites that you like or would recommend to people that they can plug in their raw data and get back some of these unique markers that they have to pay attention for their own genetics?

I mean, there are the Genetic Genie, which is sort of an interpretive guide where you can plug in your 23andMe data, which can be helpful for looking for problems with methylation and the thione and detoxification and some of the inflammation genes. 23 me only does a small slice of your genome. It doesn't look at everything. So we do more clinical testing, and I, I tend to do that and focus on that. So there may be, there's so much going on right now in the space. I may not be familiar with it, but there probably are companies that are looking at inflammatory genes that are, are available to consumers. The question is, what do you do with that information? And I think that's the challenge for people. How do you change your diet? What supplements to take? What do you avoid? I mean, it gets a little granular. So it's usually better to work with someone who's experienced to understand these tests, how to mitigate your risk, and to create a lifestyle that actually helps to reduce inflammation.

Mark, well, this has been a fantastic conversation. A lot of material in here on the topic of inflammation. People are so curious about this topic and have so many questions. And I think that we touched on at least a good chunk of those questions. I'm gonna pass it over to you for some concluding thoughts and to wrap it up.

Well, you know, I'm so happy we got to talk about this, Drew, because, you know, inflammation is the final common pathway for almost all chronic disease, including depression, including Alzheimer's, diabetes, obesity, heart disease, cancer, and the list goes on and on. And it is our modern Scourge. And if you want to learn more about it, I encourage them to check out that book, inflamed, which is about the, not only the, the biology of inflammation, but the sociopolitical economic drivers of inflammation, which is a little more on the edge, but is a very important book. And I would say that if you feel inflamed or if you have any of these diseases or problems, that you should get checked out and go down the rabbit hole and figure out why. And not just sort of accept that this is your fate or accept that you have to take these drugs that shut off inflammation and learn a little bit about how functional medicine can help to unravel the causes and create a plan for you that is anti-inflammatory in your life. If you're listening and you love the podcast and you really know someone or you have inflammation, share this with your friends and family. We'd love to get everybody to know about this. Leave a comment. How do you manage your inflammation? What tricks have you learned?

And subscriber every year podcast.

And we'll see you next week on the doctor's Pharmacy. Hey, everybody, it's Dr. Hyman. Thanks for tuning into the doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to DrHyman.com/picks to sign up. That's DrHyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

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