Answering Your Questions About Inflammation, Cystic Acne, Diabetes, And More

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

Back pain is really a huge factor in this country and it costs so much in terms of medical care, in terms of disability, productivity losses, and the beautiful thing is there's just really simple things you can do to fix it. Hey everyone, it's Dr. Mark.

Like many of you, I'm terrifically busy throughout the week. I'm a doctor, a podcast host, a writer, a speaker, a father, and on top of all those commitments, I have to make time to prioritize my own health along with the health of my patients. because I have so much on my plate, I value tools that make my life easier. And I'm sure you can relate. And that's why I'm really excited to share with you today a little bit about Rupa Health. When I treat my patients, I look at a lot of indicators such as hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, all to dig deep down to find the root causes that prevent those patients of mine from optimizing their health and wellness. But that means I'm usually placing orders through multiple labs, which is just overall pain. Plus it makes keeping track of results more difficult for me and my patients. But all that changed when I started using Rupa Health. Rupa Health is a place for functional medicine practitioners to access more than 2,000 specialty lab tests from over 20 labs like Dutch, Vibrant America, Genova, Great Plains and more. Rupa Health helps provide a significantly better experience for both you and your patients. It's 90% faster than ordering tests one by one and it lets you simplify the process of getting the tests you need. this is great for me because like most practitioners, I'd rather be spending that time with my patients and not doing administrative work. And that's the great benefit Rupa Health provides. This is a much needed option in the functional medicine space. It means better service for you and your patients. You can check out a free live demo with a Q&A or create an account at Rupahealth.com that's R-U-P-A-H-E-A-L-T-H dot com. There's a reason I'm 62 years old and healthier than ever. and it's because I put a lot of effort into optimizing my health. And I know that if you're listening to this podcast, optimizing your health is important to you too. Like me, you're probably doing your best with your diet to get good nutrients into your body and limit the damage done by toxins. Now, one of the keys I found to eating the right things is monitoring your glucose intake. Poor glucose control is tied to all kinds of issues like weight gain, fatigue, diabetes, Alzheimer's, heart disease, and stroke, just to name a few. But it can be hard to know exactly how much glucose you're getting in your diet how your body responds to it. But I have found a solution that I'm excited about sharing with you. It's Levels continuous glucose monitors. Now, I've been using Levels to track and understand my own unique metabolic data. I just stick the small glucose monitor onto my skin and the data starts transferring to my smartphone immediately. And it's helped me learn a lot about what foods work best to support my health and vitality based on my own physiology. In fact, I had one time where I thought, oh, I'm eating a really healthy meal and it was super delicious and it was really not too starchy. chewy or sugary, but I ate a ton of food. I way overate because my friend ordered so much of this delicious food. And it was all farm raised and great and healthy, but eating a giant amount of food also spikes your blood sugar and your insulin levels. And we were both laughing because our levels monitors both showed levels of blood sugar over 150, which I'd never seen before. So I learned to moderate my food intake and not go overboard. Now, if you're interested in learning more about levels, go to levels.link/Hymen. They've got a super well researched in-depth blog that I recommend checking out if you want to learn even more about topics like metabolic health, longevity and nutrition.

Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman and welcome to a new series we're doing on the Doctor's Pharmacy called Masterclass where we dive deep into popular health topics including inflammation, autoimmune disease, brain health, sleep, lots more. And today, my friend and my business partner, my podcast co-host, Drew Proffitt and I are doing something really fun. We're answering community questions that you have submitted by a new app called HiHo. You can follow me on HiHo and you can submit your questions there and maybe you'll see them on the podcast here. So thanks for joining us and Drew, thanks for doing this with me.

I love it.

Yeah, absolutely, Mark. This is definitely one of our most popular series. People love hearing your hot takes on all different topics. Speaking of different topics, we actually Coincidentally for good or for worse, we had a question that was submitted through our High Ho community about back inflammation that somebody had. And I'm picking that one first because we're actually recording this and you're in New York City. You want to give a little context of just, you know, what's going on with you? I think people like to hear a.

Little bit about what's going on in your life.

Your back is acting up, so share a little bit more about it.

Sure. So, I don't know, you know, I was a yoga teacher before I was a doctor. I was a family doctor and I went to a small town Idaho. I was pretty in shape before running yoga. I was a young doctor, had a family, two kids, and I lived in this house on the top of this mountain. In Idaho, we basically chopped her on wood, everything was like wood stoves. I was stupid and basically carried huge amounts of wood in the really bad body mechanic posture out in front of me like 50 pounds at a time, back and forth, because I was lazy and didn't want to take too many trips. and it blew out a disc. I blew out a disc. And that was when I was 32. And I had to have emergency surgery. And it left me with sort of chronic limp. And the surgery kind of went bad and that it kind of, the disc got recompressed. And I recovered from it. I went to China, had back acupuncture. And it was quite amazing how much the acupuncture helped. And I've been pretty good. I mean, super fit, I exercise, I ran for most of my life. I stopped probably five, six years ago, ride bikes, tennis, yoga, hike, water ski, I mean pretty much ski, do it all. And I've been doing pretty good. And a couple of years ago, I did something stupid again and chopped wood. And somehow I think I need to stay away from wood, fire stoves and chopping wood. And I had another disc go out because my back was kind of all funky. And because of the first injury because I've been limping for 30 years. And I never let it stop me. I just kept going. and so I had that surgery, there was a complication, and I kind of recovered from that pretty well. I did a lot of rehab, TB12, and I did a lot of regenerative medicine, which is quite amazing as a therapeutic intervention for chronic orthopedic injuries. And I'll explain what that is in a minute because a lot of us sort of struggle with aches and pains that are arthritis or injuries. mostly for me, it's my stupidity, but I think the truth is that there's a lot of therapies out there that have been developed in the last few decades that are incredibly different than what you get when your traditional doctor treats you and are extremely effective. And so the kinds of things that I, you know, for regular back pain, I mean, yoga is amazing, stretching is amazing, moving is amazing. I mean, and also, massage and various kinds of treatments can be very helpful, acupuncture. So those are really helpful for most people with back issues. But then there's people who have really more serious problems, more serious injuries, they need a little extra help. And that's really where regenerative medicine comes in. And it's sort of an extension of functional medicine. Functional medicine actually helps to regenerate the body's own healing systems. That's what's so beautiful about it. It activates our healing systems. And so the body has all these things in it that are our healing systems. that get turned on when there's an injury. Like if you cut your skin, how does it heal? I mean, it's not easy to think about, well, how do you make new skin? Or if you cut half your liver out, you can grow it back. How does that work? Well, it works because you have stem cells and stem cells contain little healing packets of information that they produce, that they release when there's a problem. And they go and kind of do all the repair. It's like a construction crew that comes in, you know, and fix everything and inside those, those stem cells are things called exosomes. These little tiny packets of healing factors that get released. So, you can use exosomes in regenerative medicine. They also use placenta. Placenta is just full of healing factors. So, nobody dies from it. It's just basically the placenta gets thrown away usually. They say, throw it away. We get saved. And the compounds in it are so reparative, so anti-inflammatory. They're amazing. We call placenta matrix. There's other stuff in the anesthetic fluid that they call amniofix. And these are even orthopedic surgeons or neurosurgeons sometimes. So this stuff can be injected in areas of pain, inflammation. So I had a lot of that done. And also there's things like PRP injections, plasma lysate, and even other things like peptides can be injected, ozone can be injected as all therapeutic tools. and then of course there's this really cool technique called hydrodissection, which essentially releases the stuck muscles, nerve fibers, and the fascia. So they all get kind of stuck together with inflammation, injury, and they can kind of get separated out so that the nerves don't get so irritated and compressed. And that really is a lot of pain. So I've had all that done. It was really like a miracle because I'd been on and off in back pain for 30 years and doing that really relieved the pain. What I got going on now was just come another injury from scuba diving where I did something stupid and kind of turned wrong and I got a little bit of a disc irritation, but I'm getting that dealt with again with some of these regenerative therapies later today. And I think that, you know, it's really amazing because I, you know, it's like we're entering an era of medicine where, you know, not only are we able to sort of replace joints, but we're able to actually activate our body's own repair system to activate cartilage regeneration, repair tissues. And so I'm kind of excited about this whole era because a lot of times people struggle with being active because they have various injuries. And I've never let that stop me because I've always learned how to manage it and how to do things to help me recover and repair. But back pain is really a huge factor in this country and globally, and it costs so much in terms of medical care, in terms of disability, productivity losses, and the middle thing is just really simple things you can do to fix it. So there's different kinds of workouts, exercises, stretches, but it's this regenerative medicine field is just emerging as a really powerful tool. It's not so much covered by insurance yet, but I think it will be soon.

Well, thanks for that context, Mark. And obviously, I'm sorry that you're in a little bit of pain right now.

But I know our podcast community appreciates you.

Yeah. So if you see me wiggling around, that's why. Well, I think that was a great overview from what you went through. I'm going to play this first question here on that topic of back inflammation. Let's see. You probably covered most of it, but let's see if there's anything else additional that you might want to add. So I'm gonna pull up that question right now.

Hi, Dr. Hyman. I was wondering if you could address inflammation in the back, which causes impingement on nerves. Thank you. And that can be for different reasons. You can have inflammation that comes from arthritis and bony compression. You can have it from a disc bulging. You can have it from just overall just kind of stagnation in the back. So acupuncture can be extremely helpful. Cupping can be extremely helpful. Various kinds of therapy, physical therapy can be really helpful. I've actually worked a lot with Tom Brady's training and rehab program called TB12. And there they have amazing results and I found incredible results using that plus the regenerative medicine. So there's a lot to be done and people really don't have to suffer if they really know what to do. Also magnesium is really important for general back pain and spasm if you have achy backs. Epsom salt baths are great. Hot and cold therapy is amazing. So there's a lot of ways to do it yoga.

I think the very low cost interventions can really make a big difference. Fantastic. All right, thanks for that, Mark. We're gonna switch from back inflammation over to intermittent fasting. And this question is from Judith.

Hi, Dr. Mark. Quick question on intermittent fasting. I'm hearing too many sides of the story, good, bad, and ugly. Can you give us some advice? It's so funny. I was in Washington, DC yesterday working on I work with the Food Fix campaign to fix our food system and our food policies. And I was talking to one of the senators and he started asking me about intermittent fasting. I thought, wow, this is really good. We're getting all the way over there. So let's just sort of start with the top. And Mark, before you jump in, if.

I could add in a little bit of subtext, part of what I'm hearing that she's saying is that, you know, you have some people that a few years ago when a lot more research was coming out on intermittent fasting, it's like it's the cure for everything. Everybody should do it. Nowadays, we've done episodes you've had some people on that are talking about how some people have to be mindful of it and maybe women in particular in their prime years of being able to prime fertility years. So there's a lot of nuances that are there and I think that's leaving a lot of people confused. So we'd love to have you jump in on that.

For sure, for sure, for sure. So I think let's just sort of start out with like, what is it what are the definitions? What does it do? Who is it for? Why is it important? So, you know, there's a lot of terms thrown out there. Time restricted eating, intermittent fasting, ketogenic diets, fasting, mimicking diets. All of these approaches are attempts to give the body a break from eating, an attempt to trigger these ancient pathways that get activated when we're starving. so our body's really, like, smart, because when we're out hunting, Gathering, and if, you know, we would find a big patch of berries or some fruit tree, we just gobble it up and we'd gain a lot of weight, and we'd pack it on, and then there'd be a time of scarcity. And then we would use our body's ability to burn fat to deal with lack of calories from carbohydrates to actually activate these healing repair systems. so recycling proteins and recycling parts and using energy from different sources. And it's quite impressive, the systems that we have. So all these techniques are designed to do that. So time-restricted eating means eating within a fixed time window. It can be eight hours, 10 hours, 12 hours, so that would be like a 12-hour fast, 14-hour fast, 16-hour fast. That's something you do every day, and we should do every day. Like nobody should eat within 12 hours of their last meal after going to bed. That's just a given because it gives your body a chance to repair and heal and clean up and do the work it needs to do at night. That's really key. And you can extend it to 14 hours. So if you have dinner at 6:00 and you finish then, you eat 8:00 in the morning, that's 14-hour fast. If you have dinner at 6:00, you eat at 10:00 in the morning, that's a 16-hour fast. So it's not that hard to do. But some people, it's not ideal for if you're very thin, if you're, again, maybe trying to get pregnant, if you're having a very fast metabolism like some people like I do, if I do two extended periods of that, I'll start to drop too much weight. Probably shouldn't say that in public, but anyway, that's what happens. When you tune up your metabolism, you actually can actually do really amazing things with your diet without having to suffer. So I'm able to actually learn how to fix my biology in a way that it's very, very active in terms of its metabolism. So time restricted eating, then there's intermittent fasting, which may mean anything from a 24 hour fast or a 36 hour fast to a 10 day fast or a week long fast, three week fast. Those are intermittent fast or prolonged fast. Then there's fasting mimicking diets, which is essentially an 800 calorie diet a day for five days. It's been studied a lot by Walter Longo, who's one of the leading longevity researchers. A lot of his work's been funded by the NIH. That also seems to have amazing profound effects on reducing inflammation, reversing metabolic dysfunction, cancer treatment, so many different things. They all activate these pathways. How does it work and what should we do and who's it for and who's it not for? I just read a study last week or two weeks ago. It was so depressing. You know, I mean, just this context, when I graduated medical school, not a single state had an obesity rate over 20%. Now, almost all are about 40%, which is scary. And 40% of kids are overweight. And not even that, but even if you're not overweight, a lot of people are not metabolically healthy. They have high blood sugar, high cholesterol, high blood pressure, they have overweight tummies, they have heart attacks or strokes. So, it's basically only 93% of people, actually 93.2% of people, are metabolically unhealthy. It's more than 9 out of 10 Americans don't meet the criteria where they don't have high blood pressure, high blood sugar, high cholesterol, are not overweight, or haven't had a heart attack or stroke. That's terrifying to me as a doctor and as someone who uses food as medicine, it's an emergency. So these techniques really help to fix that problem. They fix your metabolism by triggering these ancient starvation mechanisms and basically, I think I covered this maybe in an earlier podcast, but there's basically four nutrient sensing pathways. And I just finished my book on longevity called Young Forever. And it was so amazing to understand how these ancient systems are embedded in our genes and our biological pathways. And that by really just smart hacks, little simple techniques you can do, you can activate these longevity pathways. that are also increased metabolism pathways. And two of them sense excess calories and food and protein. Two of them sense lack or starvation. So insulin signaling pathways are related to eating too much starch and sugar, those get activated. And that's really what we have an epidemic of. People just eat too much starch and sugar, activates this insulin pathway all the time. And so we're always having insulin on. Now, you need insulin to some degree because if you don't have it, you can't utilize energy and so forth. But you don't want it going all the time because it's like the fat storage hormone. It's like miracle grow for your fat cells. So you don't want that on all the time. So making sure you have these periods of breaks where you're not stuffing yourself or eating all the time or having snacks at night or having a lot of carbohydrates and starch, that will shut down the insulin signaling pathway. Then there's mTOR. which you may not have heard about, but essentially it senses protein and as well as carbohydrates and sugar. And again, if you're always flooding your body with food, you can't have a time when this pathway is quieted down. When it's quieted down or silenced, mTOR causes something called autophagy, which is essentially where we eat ourselves. Auto means self and beige means to eat, right? And so basically, It's a self-cannibalism system that recycles old parts, creates these little lysosomes. It's just sort of like Pac-Man go on to old bits and proteins and cells and kind of redigest them and then kind of recycle. It's like your recycling plant. And so it's really important to do that, especially if you don't, if you don't getting enough food, you have to recycle stuff because it's like, you can't get new stuff from your diet, so you have to recycle. So this is a really important longevity switch. You know, these also, when they're, when, when you kind of reduce the the times of eating, like what I was mentioning, you also activate other pathways. You increase mitochondrial formation, you increase DNA repair, you increase your anti-inflammatory pathways. So you shut down inflammation, which is so linked to everything, especially aging. The other two pathways are sensing scarcity. That has to do with sirtuins. You might have heard about that related to red wine and resveratrol. And that's one of the things that activates NAD. You might have been hearing about NAD as a compound that the body makes from vitamin B3 and other things that actually is involved in energy production, but it also activates sirtuins to do DNA repair, increase mitochondrial production, and also function and also reduce inflammation. And so it has, it also improves insulin sensitivity. So there's all these secondary benefits. And then the last one is called AMPK that is activated by, by lack of, you know, sugar and stuff. When you take metformin, for example, this is a drug that's being studied for aging, it activates the NPK, which actually puts in this process to reverse insulin resistance, which is great. All these things are really important. When we do any of these things, they're really, whether it's time restricted eating, intermittent fasting, keto diet, fasting mimicking diet, they all do more or less the same thing. They all basically activate our longevity and health pathways. The key is to activate these in the right way. But it's like Goldilocks. You don't want too hot or too cold. I mean, if you're always flooding the body with calories and starch and sugar and protein, you can't repair and heal. But if you don't have enough energy, you're going to die. If you don't have enough protein, you can't build muscle. So you kind of have to have, you know, oh, you should be vegan because you're going to shut off mTOR and that's really great and no protein and it's not so simple because you need to build muscle. Muscle is the currency of longevity. and without it, you can't build muscle, particularly certain vegan proteins are low in leucine. So there's ways to be vegan and be healthy, but it's trickier. So I think that's sort of how I think about it. It's like these intermittent fasting, all these different dietary hacks are all about playing with ancient longevity switches.

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Episode of the Doctor's Pharmacy. Yeah, I think you said something interesting, which is the Goldilocks zone. I think there's a tendency that when People find out about something, they can go to one extreme. And then sometimes, you know, there's a recent study that was published on fasting where most of the headlines that were covering this study and we'll link to it in the show notes were talking about, you know, intermittent fasting has no impact on weight loss. That was sort of like the study headlines. I don't know if you saw this. This was like a couple of months ago, Mark. But if you dig deeper into the study, you find out that there there's actually a lot more nuances. So on one side you have the media that might sensationalize things. On the other side, you have people who can sometimes get a little bit too extreme. And like all things, there's a lot of nuance that's there and we have to personalize it appropriate to us. So if you have some concluding thoughts for Judith, Mark, on just basics of fasting for somebody that's looking to get started, what would it be?

I mean, I think the simplest thing is just try a 14-hour fast and once a week, you know, for a week, every day and see what happens. Do you lose weight? Do you feel better? Then try a 16 hour fast, see how you feel. There's no one size fits all for everybody. So I think it's really important to see what your body does, how you feel, what your energy is, what happens to your metabolism. And also same thing with intermittent fasting. If you want to take a longer fast, a 24 hour, 36 hour fast once a week or every couple of weeks, not a bad idea. I just met with somebody who did 10 day fast. It was amazing. So, you know, I think there's a lot of ways to actually help people reset, but it's really It's really about listening to your own body. If I do a 10-day fast, I'd be like wasted away to nothing because I have no reserves. But, you know, that's okay for me. I'm happy to be that way. Other people, you know, might be overweight or have diabetes. I mean, they can do a three-week fast at a time.

So it's really listening to your own body. Yeah. And on the topic of listening to your own body, I think another aspect of that is like the seasonality, like the seasons of the year. Right now we're in the thick of summer. Talk to me about how sort of for you as an example, you're a very social person, you have a ton of friends, you're traveling a lot right now during the summer, how does your meal time differ in the summer compared to let's say the fall or winter months? Is there any changing? Do you notice yourself eating later? Are you just cool with that because it's just part of the process and it's part of enjoying summer?

Yes, absolutely. I think in the summer essentially I'm more active but I also eat more fruit because it's like peaches and things that I don't get to eat normally. So, I think there is a sort of a natural increased activity with also increased produce. And, I still don't eat a ton of fruit, but I think I let myself indulge a little bit more in things in the summer because I'm also very much more active and it just sort of naturally all works out.

All right, Mark, let's jump into the next question. This question that we have is on type 2 diabetes right up your wheelhouse. I'm going to pull it up over here. And this question is from Maria.

What are your thoughts about managing type 2 diabetes or pre-diabetes with only eating a large amount of fruits, vegetables, and grains as opposed to the conventional method? Thanks. You know, I think it's such a challenging space out there because, you know, there's one camp that says the only way to reverse diabetes is to go vegan and eat fruits, vegetables, grains, and beans. and other groups like, well, the only way to reverse diabetes is to go keto. And then there's everybody in between. I'm sort of in the middle. I think there's a lot of evidence that people switching from a highly processed American processed American hormonal diet to a whole foods plant-based diet do better. They really do. If you take out all the junk and you put in fruits and vegetables, whole grains and beans, Yes, 1000% people will improve their metabolism, feel better, have more energy. The question is how long can they sustain that and what happens over time if you do that? And how far can you get? I think it's very, very hard to be a healthy vegan. It's very hard. And I know this because I see patient after patient struggling with this and struggling with their weight because they're eating in this life, unless you have a personal chef who's creating super nutrient dense, high fiber, high quality protein, good fats, lots of vegetables, what are you going to eat? You go to a restaurant, you go somewhere to buy something. It's hard to buy healthy vegan food, so you're ending up with more starchy carbohydrates, more grains, more refined flours. That just makes everything worse. I think, yes, we need a lot more fruits and vegetables, and yes, half our plate should be, or 75% of our plate should be plant foods. But for diabetics, the science has really crystallized this, and this is really called the carbohydrate-insulin hypothesis. There's a beautiful scientific paper released last year by a leading scientist from Harvard and heads of many, many professional associations challenging the old idea that metabolism and weight loss is about calories in, calories out. And the quality of the calories is what matters the most. And carbohydrate calories, whether they come from sugar or flour, which below the neck are the same, right? Or from whole grains or beans, they do have more starch. So it's not that they're bad necessarily, but in order to get the same, for example, protein that you'd get from a four-ounce piece of chicken, you have to eat like two cups of quinoa. That's a lot of food and most people don't eat that much. Then, of course, it comes a lot of extra calories and extra starch. I've been most impressed with the data from the group that was working with Virta Health looking at ketogenic diets. You have to understand when you see a 5% weight loss, or a half a point drop in A1C in a diabetic, you think, wow, this is a great intervention. When you use a ketogenic diet, you see 12% weight loss on average. You see 100% of people get off the main diabetes medication, which is oral hypoglycemics, 90% get off insulin, and 60% completely reverse type 2 diabetes. and I'm talking about people who are not just mildly diabetic, I'm talking about really advanced type 2 diabetics. And I've seen this over and over again. I've written about it in my books. This patient Janice, I always talk about it, who had a BMI of 43, type 2 diabetic. And we basically, you know, she was on insulin for years and in three days she was off her insulin. In three months she was off her medication. A1C went from 11 to 5.5. 11 is like, you should probably be in the hospital. and five and a half is kind of normal. It's a logarithmic scale, so it's not like, you know, 1-2-3-4-5-7, it's 1-10-100-1000. So that's kind of a scale. It's a different kind of scale. So that's a big, big change. And she didn't go on a keto diet, but she did cut out grains and beans and fruit, except for berries and sugar, and ate lots of good quality fat. It was mostly fat, lots of vegetables, and some small amounts of high quality protein. And it was just amazing to see what happened to her. So, I think we see this over and over again if we do the right thing. And there may be variations. Not everybody is the same. Some people do fine with more grains and beans, others don't. I literally had a patient yesterday, I was like, Look, I'm a vegan, but I can't lose weight. I got this weight around my gut. And I'm like, okay, well why don't we get a continuous glucose monitor and put it on you and see what happens? Maybe if you eat lentils, you're fine. but if you eat kidney beans, you're not. Or maybe if you have, you know, black rice, you're okay. But if you have brown rice, you're not. So everybody's different, and, and we have to see how you respond. But at the end of the day, you know, I, if I, if I'm treating someone diabetic, I take them off grains and beans. I put them on fruits and vegetables, high quality protein, lots and lots of fat, avocados, olive oil, nuts and seeds, even, even saturated fabrics. Most of these patients can be fine. And if it's from high quality grass-fed animals, that's fine. So, I think we now know actually how to reverse diabetes. I was in Washington this week, you know, advocating for policy changes. I was talking about, once with the White House, with congressmen, senators, the USDA, you know, and it was interesting, you know, talking to one of them won't name who they are, but, you know, it was like, oh, well, you know, I said, really, we need to focus on the quality of the food we're delivering. You know, it's not all about just providing calories for hungry people. It's about what calories. and then she's like, well, there's a lot of debate about what quality is. I said, well, not really. I mean, if you really, if you really kind of get below the noise, everybody agrees that we should be eating more whole food. Everybody agrees we shouldn't be eating processed food, except, of course, the makers of processed food. So I think, I think, you know, there's a, there's a pretty good consensus on what comprises a healthy diet.

And the disagreements are really around the margins. Okay, Mark, that was great. Let's go to our next question here that we have on the topic of cystic.

Acne. Hi, Dr. Hyman. What are your thoughts on the long-term use of spironolactone to manage cystic acne? And what are the alternative options? Okay, so cystic acne, I think for that question, is a really nasty condition. It's not like regular pimples. It's like deep pimples that form scars and can be really hard and thick. and inflamed. There's a lot of different causes for it. What you're talking about is a medication that's used in people with a condition we call PCOS. We've talked about this on the podcast before, polycystic ovarian syndrome, which is really driven through insulin resistance or prediabetes. We know generally acne is caused by mainly two things. I would maybe add three. One is sugar, no doubt about that at all, insulin resistance, and PCOS is part of that. Two is dairy, and particularly modern dairy tends to cause a lot of inflammation and acne. And three is, I think, alterations in the microbiome, and often it can be yeast overgrowth or inflammatory bugs. And so those are the main reasons people get acne. So in terms of spironolactone as a medication, it's fine to use sometimes because women who have PCOS can have facial hair, they can lose hair on their head, they can get infertility, their periods are wacky. And so it's used as a treatment for acne. I'm not opposed to it, but it's much better to try to deal with the cause. So the diet I just talked about for diabetics would be the approach. So intermittent fasting or chemotherapy and eating, you know, cutting out starch and sugar and carbohydrates, for the most part, eating good fats. I mean, obviously, my joke always is that the majority of your diet should be carbohydrates. the most important thing you need for long-term health and longevity. And what I'm talking about is fruits and vegetables. Like vegetables are carbohydrates. Broccoli is a carbohydrate. Asparagus is a carbohydrate. That's fine. But so is a bagel. That's not fine. I don't, I mean, honestly, Drew, I don't, I don't, I was kind of always almost like, I was sort of embarrassed to go to the Senate and the Congress. I was, I was going through the cafeterias and It was terrifying. I mean, it was Dunkin Donuts, Baskin Robbins. There was all this sugary stuff, sodas, chips. I mean, I guess they use it to fuel all the staffers to work 20,000 hours a week, but it was just scary to me. I think everywhere you go, there's all these highly processed foods that are really driving so much of the problem. If you can get rid of all that, if you can actually start to eat the way we talked about my 10-day detox is very, very helpful. It can be great for cystic acne and then you might need other treatments. There's other treatments that can be used more sort of functional medicine approaches to dealing with the microbiome, to fixing yeast issues, dealing with insulin resistance, to improving the overall metabolic health to reduce the acne and obviously getting with sugar.

So, going back to your story about Congress and the cafeteria. So what'd you end up eating?

Me. Actually, I didn't. I had water. And I actually, for lunch, we ran over to this club. It was a very old club. We've been there for 65 years. Kind of a private Republican club. And not, not, no, no, I don't listen. I Democrat Republican. My friend Rick Warren's like, you know, I'm not right wing or left wing. I'm for the whole bird. Otherwise, you fly around in circles. So, like, I had great meetings with you know, Republican centers or Democratic centers and congressmen. So I feel like we just got to work all together to fix this. But I went to this club and they had, they had, it was this crab salad. And so basically they, you know, they had crab salad and I just got extra crab. And then I'm like, I want extra broccoli, extra asparagus. So I put like extra broccoli asparagus and tomatoes and a too small of wood on there.

It's all pepper and I eat the crab and was really good. So that was my lunch. Yeah, pretty much anywhere you can go. you can always find an okay salad. I'm not always gonna say that it's great. And you can add protein and fat to it. And that's like pretty much a go-to, like regardless of where you are in the world, except for India. It's very hard to find a salad. They don't keep a lot of fresh greens there. So that's always a challenging thing that I have when I go visiting there.

Thank God. Thank God. Otherwise you're gonna get like dysentery if you eat that. I'm Mark. Why do you cook food when you go to those countries?

Yeah, I hear you on that.

And, it's amazing in India, it's really interesting, they have so many spices and the spices basically kill a lot of the bacteria. So, it's really, it's actually very smart.

Let's actually follow up a little bit more on your comments about meeting with people and meeting with senators, Congress folks. What do you think are some of the key priorities? You know, when you try to eat the whole whale, it's very hard to like make progress, but Yes. What are some of the first pieces that could be bitten off to actually start seeing change? Is it schools? Is it changing our health incentives and reimbursement systems? So yeah, what are your thoughts on that? For sure, for sure.

Thanks. Well, thanks for asking. You know, it was a fun week in Washington. And, you know, I said, I was at the White House yesterday and I'm like, look, we don't want to boil, we don't want to boil the ocean. We got to just figure out the win of a win. She goes, well, maybe it's getting so hot out, we can't boil the ocean. It's like the temperature records are up the chart this week. I'm part of a group that I started called the Food Fix Campaign, which is a nonprofit educational group and also advocacy group to help policy shift. And we really have a very focused agenda for now. So we have a lot of policy initiatives we're working on. Everything from child labeling of food and regenerative agriculture, which we sort of need to fix just to both improve soils and improve the quality of food and revitalize rural communities and economies. But this week we really focus on the agenda for the White House Conference on Hunger, Nutrition and Health. And you have to realize, like, this is a conference that hasn't happened for over 52 years. The last one was under President Nixon. It established a lot of our nutrition policies over the last 50 years, and we need to update them. And by the advocacy of my friend, Dariush Mozaffarian, the Dean of Tufts School of Nutrition Science and Policy, and my team and others, we've advocated for this White House Conference to bring together all the stakeholders to come up with a set of recommendations that can be implemented through regulatory channels or legislative channels to move the ball down the field and actually update our policies to address the fact that most of the diseases we see today are caused by food that are chronic diseases that are cured by food. So I was very hopeful around that. And we really, you know, focused on a couple of things. So a number of years ago, I worked with my friend Tim Ryan, who's a congressman, Rosa DeLauro, who's now head of the Appropriations Committee in the Congress. and we got them to commission the GAO, which is the Government Accountability Office, to do a report on what's the state of our policies related to chronic disease and nutrition. And, you know, I wrote a book about this. I've written about this for, I think the first time I wrote about it, I think it was 2005 in my ultra metabolism book a long time ago. And it's gotten a lot worse since then. And basically, I thought, you know, it was bad that there were a lot of policies that didn't work together, there's a lack of coordination, things were across purposes. I was like, okay, when I got there, I was like, holy cow. There were over 200 policies, 21 agencies, often completely working in odds with each other. So, for example, the USDA says, eat half your plates as fruits and vegetables, but only 0.45% of agricultural supports go for what we call Special crops, which means fruits and vegetables, and most of it's for apples. Or we say, don't eat sugar, sweetened beverages and sodas and our dietary guidelines that the USDA puts out, but then they, with the SNAP program or the food stamp program, we fund $10 billion for the soda or 40 billion servings a year for the poor. So there's all this stuff going on like that. And so we basically got this report and as a result of the report, the government accountability office recommended to Congress they start a federal entity to address chronic disease and nutrition, which has never existed. Believe it or not, we don't have anywhere in government that's addressing the fact that chronic disease and food are connected. It's amazing. Even though it's over 80% of our health care costs, one in three Medicare dollars is on diabetes, it's the biggest driver of all health care expenditures. And yet there's no organization in the government that's trying to address this problem. So we got based on this report, we worked with Congress and we got this entity established, hopefully with HHS, and it passed through the House, so it was passed through the House bill of appropriations to establish this entity, and then the Senate has to pass it, but I think it will. So we met with a lot of senators to talk to them about it and how we kind of need to move this forward. So that actually will establish an umbrella organization within the government to address all of the challenges we see around our food policy. So it's really, it's like the big tent that everybody can get in and actually deal with all this stuff. So that's a really key focus. The second we really focused on was integrating nutrition into medical care, whether it's food pharmacies, produce prescriptions, medically tailored meals, whether it's reimbursement for nutrition lifestyle education and programs like we do at Cleveland Clinic, there's a lot of levers to pull in that space and we have a whole set of guidelines around that. So how do we integrate nutrition into medical care for chronic disease? You think it would be a thing, but it's not. And the third thing was how do we change medical education? Because right now, as you've said to doctors, well, I want you to practice nutrition in your care of chronic disease. They're not going to know what to do. And so they're like, well, eat better, exercise less. I mean, exercise more, eat better and exercise more. I'm like, well, that doesn't really help. I mean, that's not a useful bit of information. Eat what and exercise how much and where? And so I think we really are trying to build sort of some sneaky ways leveraging for the government's power to induce licensing organizations like medical licensing, nutrition, licensing for physician assistants and various kinds of healthcare providers. to have nutrition questions on their licensing exams. Because for example, my daughter's in medical school and very little nutrition. And so they're just teaching to the test. They're just making sure they can pass the National Board exams, pass their licensing exams. And so they don't really study this because it's not part of the exams. So making part of the exams, all of a sudden the curriculum changes in every medical school across the country overnight. And then we're also focused on graduate medical education because the government spends 17 billion with a B dollars supporting graduate medical education like residency programs, fellowship programs, and there's no strings attached. It's like, here's the money, do what you want, and it's federal money. So it's like, well, we could say, okay, look, if you want to graduate primary care specialists, they have to be trained in nutrition and chronic disease, but it's pediatrics or internal medicine, family medicine, some of the specialties like cardiology, endocrinology, you can't get your fellowship or your residency training if you don't include these things. So we're working on all these different levers and Washington is very tricky because it's like, what can you do? What are the incremental steps you can make to get things done? How do you get bipartisan support? You know, I met with, you know, people on both sides of the aisle and, you know, it was great. And I just was so hopeful because, you know, I was meeting with a center from Arkansas Public Center Fox, I was so supportive of regenerative agriculture, sort of understood the problem of our refined starchy calories and carbohydrates, really wanted to help and do something about this. And it was just very encouraging to me. So I feel like, you know, we're actually moving in the right direction. I don't think these conversations are going to happen a few years ago. So I'm really hopeful and I think we're going to move the ball down the forward to really implement food is.

Sin through our nonprofit as well as regenerative agriculture. No, that's great, Mark. And I think everybody can follow along. You mentioned Food Fix. We'll have the link to that in the show notes. Foodfix.org and they can subscribe and stay up to date with all the work that you guys are doing in Washington, DC.

Yeah, I mean, the conference is going to be in White House conference is something everybody can help support. And, you know, we put out a social media post about getting people to give comments. And it was amazing how many people commented. on these issues and that we're able to then present to the White House and present to Congress. And this is what they want to hear. They want to hear constituents. They want to know what the citizens think. And so it's really important to get your voice heard. It seems like it may not make a difference, but it makes a difference. And so we're going to be doing a lot more in the next month to talk about the White House conference, how you can all be involved, how you can watch it online, but how you can communicate with your your lawmakers to encourage them to move forward in this direction.

Awesome, Mark. Well, that's all the questions that we have for today for the time that we had allotted. And I want to give a special shout out to some of our members of our Dr. Hyman Plus community who are here listening on our live taping over here. Thank you guys all for being here and Herschel for coordinating. So I'll pass it back over to you, Mark, to go ahead and conclude us out.

Well, thank you all for listening and being part of this special masterclass series. on the Doctor's Pharmacy. It's a chance for me to really share my views and my thoughts and I just really am grateful that you're all interested and thank God for listening. And that's really good for this week. Make sure you submit your questions on hiho and maybe I'll answer them in an upcoming masterclass. And if you enjoyed this podcast, please share with your friends and family on social media, subscribe wherever you get your podcast and we'll see you next week on the Dr. Pharmacy. Hi everyone.

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