Ask Mark

Hey, everybody, it's Dr. Mark Hyman. How y'all doing? Welcome. We have this wonderful new format we're using called a live Q&A, and we're doing this for my whole community. We're calling it Ask Mark, and it's where I take questions from my text community and invite those people to come join me live and ask their questions. Now, we have about 10 to 12 people today that's going to join us to ask their question, and if you want to ask a question in the future, you can text me at 413-225-8995. That's 413-225-8995 and use the hashtag AskMark. And my team might pick you in the future to ask your question. Now, I can't give medical advice, right? But I can give big picture advice about how I would think about maybe various health challenges or questions. And today's AskMark is sponsored by Thrive Market. Now, Thrive is one of my favorite all-time places to go where I do my shopping to get really high quality organic ingredients at wholesale prices. It's sort of like Costco meets Whole Foods meets Amazon. It's pretty awesome delivered right to your door, especially in this age of COVID It's really great resource and it's also important for you to eat healthy because that's how you prevent really getting sick from COVID You also get an extra 25% off your first purchase and a free gift when you join Thrive Market today. So just go to thrivemarket.com/hymanfb that's thrivemarket.com/hymanfb. All right, let's jump in with our first guest today. Our first guest is Wilmer. Welcome, Wilmer. How you doing, Dr. Hyman?

Thank you for having me.

Good, of course. What's your question?

What vitamins do you recommend people take.

And in what dosage, like a daily vitamin or multiple vitamins or something like that? Yeah, great question. I get this all the time. Should I take vitamins? Do they work? Are they just creating expensive urine? And what should we know about vitamins? And I've written a lot about this. I've studied about this for decades and more importantly, I've seen tens of thousands of patients and have done extensive nutritional testing on these patients. And I can tell you it's shocking to me the level of nutritional deficiencies that we see today in America. We think we're the most overfed country, which we are, but we're probably one of the most undernourished as well. We have a diet that's very high in calories and very low in nutrients. In fact, 90 plus percent of Americans are deficient in one or more nutrients at the minimum level to prevent deficiency. So like how much vitamin C do not get needs to get scurvy? Not very much, like maybe 30 milligrams. And 10% of the population is deficient at that level. How much vitamin D do you need to not get rickets? Well, it's not very much 30 units, but still a lot of people are deficient. And the truth is that we need a lot more vitamin D. Half the population is deficient in magnesium. Zinc is a huge deficiency. Iron is a deficiency. Omega-3 fats, which is maybe 90 plus percent of Americans are deficient in omega-3 fats, which come from fatty fish and wild food, which we don't eat anymore. So there's widespread deficiencies. In fact, I just had a patient the other day, she was a vegan and she was massively B12 deficient, massively vitamin D deficient, protein deficient, omega-3 deficient. She was in bad shape and she felt like crap. So I think what's really important to understand that we have the technology, one, to understand the prevalence of this, and two, to treat this. So people think, well, what do vitamins do, right? Anyway, so I'm just going to kind of give you a little background, then I'll answer your question. Vitamins are essentially the grease that lubricates the wheels of your biology and your metabolism. Essentially what it does is it goes in there and is acting as a helper for every chemical reaction in your body. So every chemical reaction needs a helper. And that helpers are the enzymes and those enzymes need helper enzyme helper factors called co-factors or co-enzymes. Those are vitamins and minerals and they literally control thousands of chemical reactions in your body every second. There's 37 billion billion chemical reactions every second in your body and a lot of those require nutrients, most of them require nutrients. And it's not like a drug where it just says one thing like magnesium regulates over 200 different chemical reactions, zinc, same thing. Vitamin D controls hundreds of reactions and enzymes and many other immune functions, as well as gene expression. So really, really important to understand that these have an important role and they're not just going to create expensive urine. Now, with that said, people want to eat a nutrient dense whole foods diet, but because of the fact that we grow food in nutrient poor soils, we transport over long distances, we store it for a long time, the, the, the varieties we pick are low in nutrients because they, all the nutrients and bread, bread out so we can have more starch and sugar in the, in the, in the plants or make them, you know, fit better in a box or store better, not bread, they're not bred for nutrient density or flavor. And so we end up getting a diet, even if we're trying to eat a whole foods diet, that may not be as optimal. So I really recommend that everybody get a good multivitamin, vitamin D, fish oil, and probably for most magnesium that should cover it for most people. And if you want to add a probiotic, that's awesome. But those three things, if you add a vitamin D, fish oil, and a multivitamin will cover 90 plus percent of your needs. And I recommend good quality stuff. I don't think that we have really good regulations in this country. So there's a lot of variety in terms of the, the standards that are used. And you could buy a bottle of stuff at CVS or Costco, and it looks like it's fine. But if you take it to a lab and analyze it, it actually may not have any of the listed ingredients at the doses that they have. They might have not the right forms of the nutrients. They might not be the most absorbable forms. Like a lot of magnesium that's used is magnesium oxide, which is essentially very poorly absorbed as opposed to magnesium citrate or glycinate. So the form of the nutrient plays a huge role. And then, of course, there's all the fillers, additives, allergens, dyes. I mean, you go get your Centrum vitamin. It's got all kinds of weird color in it that you're going to take for 50 years. It's got tin in it for some reason, you know, titanium. So there's a lot of weird stuff that they put in, in. a lot of vitamins. You want to get really high quality stuff because it's like food, you want the best stuff for your body. And so there are professional brands that I use, and there's a lot of great brands out there. You have to do your homework, but they should really have no additives and fillers. They should be in bioavailable forms and nutrients. They should be in the kinds of the, we know that the forms that we can actually use in our bodies as opposed to something like magnesium oxide. And you should make sure that they have no contaminants. They're tested by third parties. and then free of all the allergens and additives and weird crap. So I think it's a bit of homework to figure it out. I've curated on my website a lot of the best brands and products that I think are worth looking at and trying. And often they're professional brands, so there's a little higher quality. They might be a little more expensive, but often you can get those basic supplements for a very low amount of money.

Perfect. Thank you. Sure.

You know Maggie, hi, how are you?

Hi, how you doing?

Good. How's it going? Good.

Good. I lost power. It's a little wonky here in Philadelphia, but we're on. Okay. Did I jump with my question?

Yeah. What's your question?

My question is, what's your opinion? How do you feel about the organic sugar substitutes like Truvia, and Stevia?

Well, what you're talking about are more natural, not necessarily organic, right? Because they're organic. Yeah. And I think there's a whole class of these out there. There's Stevia, there's monk fruit, and there's other kinds of sweeteners out there, sugar alcohols. They're all quite complicated. I've written a lot about them in the books like Food, what the Heck Should I Eat? and other books. But the key here is to understand that if you're going to use some of these sweeteners, there's usually a reason why. And the reason for most people is that, well, the reason for most people is they're addicted to sugar. So when people are starting to, okay, that's fine. But I mean, I'm not saying you, I'm just saying in general, the reason most people say, well, I can't have sugar, but can I have this? Can I have that? What about honey? What about this? What about that? What about what about stevia? What about this and that? And the first thing I say to people is it's really important to unhook your biology from the imbalance and hormones that drives cravings because that's going to make you overeat, it's going to make you want more sugar. So even if you have something that's a fake sweetener, it's going to trigger a hormonal response in your body. It's like Pavlov's dog. You ring the bell and the dog starts salivating even if there's no food.

Right?

You just think of the bagel and you can start to produce insulin and you can start to actually drive all the systems in your body to gain weight. Same thing, you know, these sweeteners are often a thousand times sweeter than regular sugar. And so I tend to really avoid most of them. Sometimes I'll use things like monk fruit, which is a very safe and non-nutritive plant-based sweetener that's good. most of the things you're talking about like Truvia, Stevia, Truvia and Purvia are made by Coke and Pepsi and Cargill, which are huge companies that have extracted a lot of the natural alkaloids from the plant. And usually when you eat a whole plant, it's a complex thing that has a lot of multiple benefits. And we start to sort of take out little ingredients and sort of make it a science project. We don't really know what happens. and I think we do need more research on things like Stevia to understand what its impact is on biology, metabolism. And it may not be as bad as regular sugar, but it's definitely not a free food. You know, I think in it, and it's just going to perpetuate the cravings and the hunger of all of them out there. I think monk fruit and Stevia are probably the best. I would probably use whole plant Stevia. It's a little bit more bitter. What they've taken out is the bitterness from the pure Via and the, and the Trivia, which are made by Coke and I've seen Cardiol. So, I would say be sort of judicious in what you're using. And, if you really want something and you're only having a little bit and you put half a teaspoon of sugar in your coffee, that's not going to be a problem. I'd rather people eat that than actually weird artificial sweeteners. Because, when you look at the data on artificial sweeteners, they literally have been shown to increase the risk of diabetes, obesity, they screw up your microbiome, You know, so it's a lot of you start playing with, you know, you know.

The other ones would be better than like, you know, the the nutrients.

Yes, for sure. For sure it's better. For sure it's better. It's a continuum, right? So you want to just stick with whole foods as much as you can.

Okay. Thank you.

I think we have Ashley coming up.

Hi.

Oh, this is not Ashley, but okay. How do you say your name?

Trusty.

Trusty, nice to meet you. Where are you?

I am in Seattle, Washington. And how are you, doctor?

I'm good. I'm fine.

And the first thing I would like to say is thank you so much for raising awareness. You are an inspiration and your books have changed my life. Thank you so much for that.

Thank you.

My question is that a lot of healthy recipes call for canned ingredients like canned coconut milk, artichokes, beans, and sardines. So are all these safe for consumption?

Yeah. So, I mean, we've been canning as a human beings for a long time, right? As a way of preserving food, as you often in glass jars or other forms of canning. The cans that have been used historically were tin cans. They were lined with special plastic lining that had BPA in it. And there's been a move toward removing a lot of these plastics that can have adverse metabolic and hormonal effects and other toxic effects on the body from the cans. So you can be a little bit smarter about looking at which cans you're using and make sure that they have BPA-free on the label so that you know that it's not full of BPA. I think, you know, canned sardines, canned mackerel, coconut milk, canned tomatoes, those are okay. I think, I think if you're getting whole foods, it's okay. I would say, you know, stay away from packaged or processed food. And, and those clearly are processed at a certain level, but they're minimally processed. They're still resemble their original form, right? I mean, when you get a can of sardines, it looks like sardines, you know, coconut milk looks like coconut milk, tomatoes look like tomatoes, right? It's not like some weird science project. So I think it's really important for people to stick with really whole foods and not eat a lot of weird stuff. But you have to be careful with a lot of canned prepared foods. They're often very high in sodium, they're very high in sugar, canned fruit and canned soups. And those are things to be really cautious about. But I would not worry about using canned foods if they're BPA free in your diet.

Okay. And there are additional things added to the canned foods as well sometimes. So should I also look out for that?

Yeah, I mean, look, it's the same principle. If you read the label and we should not just look at the nutrition facts, we should be looking at the ingredient list. If you see an ingredient on there that you don't recognize or that you wouldn't have in your cupboard, you probably shouldn't eat it. If it says BHT in it, if it says BHT, that's a preservative, butylated hydroxy toluene, it's banned in Europe. Why would you want to put that in your food? So, pretty much any—my rule is if.

You wouldn't have it in your cupboard.

And wouldn't put it in your salad dressing or sprinkle on your vegetables or whatever, you probably shouldn't eat it.

Okay, thank you doctor.

Sure.

Hi Dr. Mark.

Oh Ashley, hi, how you doing?

Hi, I'm good, I just want to say it's such an honor to meet you and I just graduated with my.

Degree in nutrition and you were a.

Big inspiration for me in school.

Thank you.

So my question is, what is the functional medicine approach to acid reflux?

Oh boy, well you know that's a great question. I've written a lot about that. In fact, I wrote a whole textbook chapter for a medical textbook on how to treat acid reflux years ago. There's many articles I've written that are on our drhyman.com website and the blogs. You can just go reflux or heartburn and you'll find them. And then I have a number of podcasts we've done in the doctor's pharmacy that go through a really detailed approach because I think if you want to really get a deep dive, you might want to go into some of those resources. The Doctors Pharmacy Podcast are great because we'll go through cases and essentially what functional medicine focuses on is the cause. Now, when I was in medical school, we used to call it heartburn. And then they developed drugs like the acid blockers, the PPIs or protonix, prevacid, parolosec and so forth, nexium mass effects. and these, these became among the most popular drugs ever. I think they're the third largest selling drugs after lipid drugs like statins and antidepressants or psychiatric drugs. And, and, and, and what they do is they shut down stomach acid, which relieves symptoms. But then you get a whole series of secondary consequences. You get malabsorption of vitamin B12, of zinc, of magnesium, you get osteoporosis, you can get bacterial overgrowth in your gut, and you can get irritable bowel syndrome, pneumonia. It's not great. And so the question is, rather than just saying, oh, you have this reflux and heartburn, take this drug, what's the cause? The functional medicine is always about figuring out the cause. And for reflux, it could be a number of things. One, it could be your diet. That's usually the biggest thing, right? So the obvious things, and most gastroenterologists will tell you, Avoid spicy food, tomato food, citrus foods, avoid fried foods, avoid eating late at night, avoid alcohol, caffeine. That's awful. But that can help. The other ones that are not often thought about are gluten and dairy. Those can be really significant for people with reflux. So I would really try an elimination diet, like the 10-day reset. You can go to getpharmacy.com to learn more about it. But essentially it's a 10-day reset where you take out all the bad stuff, you put in the good stuff, and I would say 9.8 times out of 10, it'll go away. Okay. And then you can start to add stuff back and see what's going on. But there are other reasons. You could have, for example, magnesium deficiency. Magnesium is required for the relaxation of the sphincter to let the stomach relax and everything out instead of coming back up. So that's really important. It could also be bacteria called H. pylori, which is an infection that happens in your stomach that can tend to cause reflux, heartburn, and is really one of the main cause of ulcers. It can also be other things that may be problems in your lower gut like bacterial overgrowth or fungal overgrowth. So we go through a very systematic approach of dietary change and of looking at your nutritional status, of looking at infections and so forth. And we can get a pretty good idea of what's going on. And then we help people by improving their diet and we also use a number of different supplements that can help, like licorice is great, not the kind of Twizzlers, but the kind of licorice powder called deglycerozized licorice, which actually helps to coat the stomach. Sometimes we use aloe or glutamine is used a lot, for example, in Japan, which is an amino acid that can help calm the stomach down. So we use a lot of natural supplements like that. There may be other things we do as well. So it's a pretty effective treatment. One of the most effective things we do in functional medicine is deal with gut issues, including reflux and irritable bowel.

Okay, well, thank you. I didn't realize there could be so many different causes, wow.

Yeah, yeah, yeah. So I would check out my articles in the podcast and you'll see, this is really a short description, but there's a lot of approaches in functional medicine that really work for reflux.

Okay, thank you so much.

Of course. I think we have, Leanna. Hi.

Hi, how are you? It's really exciting to speak with you. I've learned so much from your podcast, especially during this pandemic. And one of the things that I was looking more into is Omega-3s. So my question's related to that. I was looking into some supplementation, both for myself and for my one and a half year old. and we eat omega-3 fatty fish probably one or two times a week, but I felt that I probably needed a bit more, especially in the future and the future pregnancy. So I was just looking into it and got a bit overwhelmed with the type of fish oil cod liver oil coming up a lot, but related to that, I came across a study published in 2018 by the University of Granada that linked long-term use to liver damage and it was done in rats, but I came across that so I was a bit concerned so I thought I'd ask you about that.

Well, that's a great question. First of all, we're not rats. And second of all, I'd love to see that study because I wonder about the dosages of it and how the form of a form of it and so forth. And then, you know, I think, you know, you have to be really careful when you look at those studies of what they mean and put in the context of the overwhelming amount of data, right? So you do one small rat study done somewhere in the Caribbean and in a third world medical school, is that a reliable source of information? Probably not. And then we look at all the other data about this importance of omega-3 fats for neurologic development for, I mean, this has been babies. We found if babies breastfeed, their IQ points are seven points higher because the breast milk contains DHA, which is an important omega-3 fat for the brain. you cannot get from plant food, although you can get it from algae. And so it's really important that you have adequate levels as a mother. If you're breastfeeding or if you're planning to get pregnant, you want to fill up the tank beforehand. And you want to be careful with fish. You can have small fatty fish like salmon, mackerel, anchovies, herring, sardines. Those are great sources of omega-3 fats are low in toxins and low in mercury. But I do think that most people would benefit from taking fish oil. and I think in the context of, you know, an overall healthy diet, I mean, you, I mean, it's not going to protect you if you're eating crap and you're taking fish oil and so forth. But I can't tell you how common omega-3 fat deficiency is, especially in people who don't eat fish or in people who are vegans or vegetarians. They're often extremely low. And it's really important for not only neurologic development, but for your heart health, for your brain health. for your skin, for your immune system to regulate inflammation, for your nails, your hair. I mean, it's really one of the most important components of our biology that we can only get from food. So I think, or supplements. And I think, you know, there's a lot of good stuff out there. The supplements I'd be careful with, you want to make sure you're identifying the company's practices of where they Source it from, what type of conditions are from, how do they process it, do they distill it, is it purified? Do they test it after they manufacture to make sure there's no contaminants because fish are pretty nasty right now given the pollution unleashed on the world. And it's important for us to be really cautious and careful about how we consume fish or fish oil.

Does it matter what kind of fish or other type of fish?

Yes, smaller fish is good. Anchovies, sardines, herring, mackerel, those are good. Sometimes they're salmon. There's a number of different companies that source from different places. You just want to make sure that whatever they do, they go through a process of testing and impurities and toxins.

Okay, thank you.

All right, I think we have Christy.

Hi.

Hi Christy, how are you?

I'm wonderful. Just had my first vaccine shot this morning.

Oh, how do you feel?

Over 65. Yeah. Trying to be part of the solution. So my question to you, doctor, is, For a senior citizen, in particular a woman over the age of 65, how much potassium do you recommend we take per day?

Well, potassium is one of the key minerals in our biology. It's sodium, potassium, chloride. I mean, these are really important as part of our electrolytes and regulating our cell chemistry. It's really critical. Our diet typically has been historically very high in potassium and very low in sodium. I mean, the word salt has its roots in salary, and you're not worth your weight in salt. It was a really rare commodity that was really precious back in the day before you could just go to the grocery store and buy it. Our diet was mostly plant foods, which are extremely high in potassium. So the best way to get adequate amounts of potassium is to eat a lot of plant foods. And a hack that you can use is to make vegetable broth to make soup. So you can put a ton of veggies, especially like root veggies, carrots, potatoes, and you boil it all up, greens, boil it all up, you strain it, and you drink that extremely high in potassium.

And magnesium too.

Yeah, they also have magnesium and other minerals and so forth. And if you do bone broth, you can add in the vegetables and you can get both the protein and the potassium. But I don't think that most people should be taking potassium on a regular basis unless you have some issue. If you're on blood pressure medication and you're losing potassium because of the medication or if you have kidney issues or maybe some cautions there around potassium. So I think for most people, it's not a supplement I do recommend. For me personally, if I'm working out a lot and I'm sweating a lot, I will take electrolytes as a sort of a supplement through liquid electrolytes or you can take capsules. Those are important to replenish your hydration, intracellular hydration, because you can drink a lot of water, but the water will dilute your blood if you drink too much of it. But if you drink it with electrolytes, you're going to feel much better, you'll have more energy, and you'll be much.

More able to function. Dr. So just quickly of equal concern is how much magnesium, because I know I bought on your site the magnesium that you had recommended, but I wasn't sure for older women if I should up.

The dose or lower the dose. Dr. Of magnesium? Yes. Dr. Yeah, magnesium again, really an important mineral. I mean, I call it the relaxation mineral half of the Americans are deficient in it. The things that cause magnesium loss are sugar, caffeine, alcohol, stress, all of which are staples in the American lifestyle. And, the sources of magnesium are greens and beans and nuts and seeds, which again are really minimal parts of the American diet. So, we're kind of in a situation where we're not eating the things that we need to be eating to conserve and build magnesium in our systems and we're eating too many things we're drinking the things that are causing us to lose magnesium. So I think most people would benefit from some level of magnesium. And the symptoms of low magnesium are really important to pay attention to for people. And they're so common that people don't even link them to magnesium. It could be muscle cramps, it could be headaches, insomnia, palpitations, anxiety, constipation, right? Irritability, panic attacks, all that could be caused by low magnesium and it's often just missed by doctors. And, it's sort of funny because we use magnesium all the time in medicine when things are kind of really tight and spasmy and irritable, right? When people come in with preterm labor or they have high blood pressure in pregnancy or when they have an abnormal heart rhythm in the emergency room and they're about to die, that's the last drug we give them was the drug, right? Of magnesium intravenously through a shot. So, I think we are definitely a society that needs a lot more magnesium than we're getting. and we're all drinking coffee and it's just we're so depleted in it. And I think taking, you know, 2 to 400 milligrams a day of magnesium is good for most people. I think 200 to 400 or 2 to 400.

200 to 400. Okay.

Okay. Yeah. And sometimes more 600, depends on the person. You know, if you have a lot of magnesium deficiency symptoms, you might need more if you're really constipated, you need more. And there's different forms. For example, if you tend to be constipated, Magnesium citrate is the best form. If you tend to have loose bowels and diarrhea, then magnesium glycinate may be better tolerated. And there's other forms of magnesium that have to do with brain and cognitive function like magnesium threonate. So it gets complicated, but I do think that just taking a bit of magnesium from most people is probably a good idea.

Okay, I'm in. Thank you.

Horace, I think next we have Jeffrey. Hi, Jeffrey. Nice to meet you. Nice to meet you too.

Enjoyed the longevity map presentation. That was great there.

Oh, thank you. Thank you. My team had a lot to do with that.

Yeah, you have a great team and very inspiring there. So anyway, my question is, I've been helping out a friend and so how do you help people who are stuck in destructive habits, but they're afraid of learning about their health status and they're also fearful of the expenses that are not covered by traditional medical coverage.

You know, my advice to you is people have to want to do it, right? I think, you know, you see people you love, you see them struggling, you see them with challenges, you see them with health issues, you know, they can be helped by doing this or that. and they don't do it, they don't believe in it, they don't want to do it, they're nervous about it. And, you know, I think there's only so much you can do, really. And I think the, the key is to live by example. You know, if you focus on your health and all of a sudden you look 10 years younger and you've lost 20 pounds and you're, you know, feeling great, then they're going, what are you doing? I want some of that. That might be the best way in. Because if you try to bang people over the head with it, you know, you, you really You really can't. It reminds me about that joke of how many psychiatrists does it need to change the light bulb? One, but the light bulb has to want to change.

So diet and exercise, I would think, would be the first steps.

Listen, I would say that for most conditions, with a few exceptions, for most conditions for most people in America, really using food as medicine, exercise as medicine, sleep as medicine, and stress reduction as medicine are the most powerful drugs by far. It's so powerful. It works so quickly and it's so easy to do. I mean, just using something like the 10-day reset, which we've created for people, which is an easy 10-day experience, so anybody can do anything for 10 days, then you know, okay, well, I'm not spending a lot of money for tests or for seeing the doctor or doing anything. I'm just changing my diet. I'm doing a few lifestyle changes. and I'm doing it for 10 days, and I'm going to commit to it, and I'm going to see what happens. It's shocking what happens. It's shocking. I've had patients within three days get off their insulin. I've had history of decades long migraines go away. All sorts of problems get better. In fact, we did a survey of people who did the diet program and 62% reduction in all symptoms from all diseases. There's no drug on the planet that can do that. Whether you have rheumatoid arthritis or migraine headaches or irritable bowel or you have, you know, whatever you have, it is the first place to start. And I think most people understand the power of food is medicine and the way in which it can literally transform your health very quickly. You know, it doesn't take a long time to see the benefits. Two or three days, you'll start to see by day four or five, and by day 10, you're like a new person. And then you can decide, oh, do I want to go back to eating what I was eating and feel like crap? Or do I want to change my life? And then they can decide. I don't judge people for whatever they want. If people want to have Twizzlers and eat Skittles all day and have sheet cakes for dinner and drink a bottle of wine, that's their choice. I can't judge them for that. But I do hope that people understand that their quality of life is so impaired and their enjoyment of life is so impaired and that there's an easy way to overcome that, which everybody has access to. And it's really your fork.

So, well, it sounds like maybe I should partner with them for 10 days and kind of just do it with them. That's, you know, be, you know, like you say, that's a great idea.

That's a great idea. Rick Warren, who I used to work with, said, everybody needs a buddy, you know? And I always say getting healthy is a team sport, right? So I think that's really the best advice is that we do better together. and that by helping people through example and by doing it with them makes it a lot easier.

Sounds good. Thanks for your advice.

Sure, and I think we have Veronica next.

Hi, Dr. Roman, how are you? Nice meeting you.

Nice to meet you too. How are you doing?

Good, great. I'm in Miami, Florida, so enjoying the weather. And I wanted to thank you because you've been very inspiring and this year I'm planning to open my healthy cafe here in Miami. So I'm working towards that. I'm learning about nutrition. We're working very hard to be able to open this.

Fantastic.

Great.

Congratulations.

Thanks. And it's days. And I wanted to know if it's something that I can do that I need to do every day or if it's something that I can do maybe three, four times a week, if I have to do it every week or if I can do be more relaxed in some weeks and then try start again the following week. How does that work?

Yeah, I mean intermittent fasting, first of all, for those who are listening, not sure what that is. It means many things. And there's a lot of terms thrown around. I think what you're talking about is what we call time restricted eating, which is eating in a short time window, let's say eight hours in the day or 10 hours. You basically eat with from noon to eight o'clock or you eat from 10 to 6 p.m. And that's called time-restricted eating. Then there's true intermittent fasting, which is where you literally might fast for 24 hours or 36-hour, 48-hour fast. You might do that once a week. And there's other approaches as well. But those are the two main things people think about. I think you're talking about time-restricted eating. And the answer is anytime you give your body a break, it does help to reset things. So it's fine to do it three times a week. You don't have to do it every day. and depending on your metabolism, your biology, what your needs are, if you're very thin and underweight, for example, if you're a woman, you probably don't want to do that. Or if you're a guy, you don't want to do that. But if you're very overweight and you're trying to reset your metabolism, it might be really helpful. So I think it doesn't have to be every single day. It doesn't have to be all the time, but you can cycle in and out of it and you can do it three days a week. You can fast 24 hours a week if you want. There's a lot of options for people in terms of resetting them. But the reason this works and the reason people are talking about it is that intermittent fasting or time-restricted eating essentially reset your biology in a number of ways. One, they improve your metabolism by fixing insulin resistance. So they help you burn fat and they increase muscle building. They increase your mental acuity and cognitive function. They reduce inflammation, they increase antioxidant systems, they increase your stem cell production, they help you build bone density. So there's a lot of benefits to giving your body a break from being constantly fueled with food. We used to call it breakfast. That means breaking the fast, right? You don't eat. I said for at least a 12-hour period. Everybody should be giving themselves 12 hours between dinner and breakfast. It shouldn't be too hard. If you eat dinner at seven, that's eating breakfast at seven in the morning, right? It's not hard. But most people can eat all night, they have snacks, they don't give themselves breaks, they eat during the day all day. People, I mean, we've invented snacking this country, which is insane. It's just a big way to sell junk food. I mean, there's no really need for snacks if you eat good meals every day. So I think people really should dial back on the frequency of eating and the amount of eating throughout the day and at night. So the best thing you could do just to simplify for people is do a 12-hour overnight fast. Don't eat anything three hours before bed. Don't snack and eat three good meals a day. That will take care of 80% of the problem. And if you want to get more aggressive, you can certainly do a 10-hour fast or a 10-hour eating window or an eight-hour eating window, which means you fast for 14 to 16 hours a day. but it's not as hard as you think. I mean, if you eat dinner at six o'clock at night, you can eat at eight o'clock the next morning. That's a 14 hour fast. It's people think it's all so difficult and so forth, but it's really, you know, it's not that hard. And it has so many benefits for our health. And I think we should get off the train of, like, I need to eat all the time, you know, that's just crazy.

And one question related to this, if that, if you have Cravings in between meals, it means that you have to re we think what your meal was, right? That there's something missing there?

Right.

Okay.

Right. So here's a great study that was done by a friend of mine, David Ludwig at Harvard, where he took overweight young boys and he fed them three different breakfasts, which had identical calories. Remember, it's identical calories. One was oatmeal, sort of instant oats, the other was steel cut oats, and there was eggs, an omelet. And then he put him in a room and said, Whenever you're hungry, push this button. and then he had them hooked up to blood draw and they were able to check their blood every hour or so. What they found was fascinating. The kids who ate the oatmeal in the morning, which is carbohydrate starch, which is what we eat in America for breakfast, cereal, oatmeal, muffins, bagels, you know, that French toast, pancakes. I mean, this is the worst possible way to start your day. And it's the beginning of the end of health for most people, and especially obesity. and he found that these kids ate 81% more food that day. They were hungrier. Not only were they hungrier, and they remember they were eating the same amount of calories, right? They were hungrier. Not only that, but their blood sugar was higher, their insulin was higher, their stress hormones were higher. So literally when you eat oatmeal, and people think oatmeal is so healthy, if you eat steel cut oats, it was like 50% more food. It was still not as bad as oatmeal, but it was not that great. the carbohydrate load just causes them to be hungry and it creates literally a stress response in the body. So just like if you were scared by a tiger chasing you, you produce adrenaline and cortisol. The same thing happens when you eat carbohydrate and sugar, which is kind of shocking. And then the stress slows your metabolism down because you don't want to be digesting your food or anything when you're scared from a tiger. So it creates a vicious cycle. So that alone should make you avoid the starchy foods in your diet and sugary foods. And if you eat protein and fat, you'll almost never be hungry. I have a protein shake in the morning. I just had mine earlier. I'm in Hawaii, so it's early here. And I put protein and fat in there and I don't even want to eat till the afternoon. And it's incredible how if you choose the right breakfast, if I had muffin or if I had pancakes or French toast or a bagel, I'd be hungry by 11 or 10 o'clock.

Okay, makes sense. Thank you so much.

Of course, good luck with your cafe. I think next we have Rebecca.

Hi, Dr. Mark. Oh, hi, Dr. Mark. It's so nice to chat with you. Yeah. Good, how are you?

Great.

Well, I'm the mom of an 18 month old child and I just know what your favorite quick toddler snacks or foods are?

Well, you know, I, I always have a pet peeve about children's food in America because, you know, what do kids in Japan eat? They eat raw fish and seaweed. Right? What are kids in Indonesia? They eat Indonesian food. There's no kids menus, there's no Lunchables, there's no go-gerts, there's no. happy meals, right? This is stuff that has been invented by our food industry to sell product and is literally driving an obesity epidemic in children. 40% of kids are overweight. One in four teenage boys has diabetes or pre-diabetes. I mean, this wasn't even a thing when I was in medical school 30 years ago. There was no such thing as type 2 or type 1 diabetes. It was juvenile and adult onset. But then the kids started getting diabetes at three years old. We had to change it to type two. And so, I'm not a big snack kind of guy. I think kids should eat real food, whole food with their meals and whatever their parents are eating and not have special kids food or kids menus or a special meal for the kids that eats macaroni and cheese and pizza and chicken nuggets and that's just french fry. I mean, it's just why, I mean, you wouldn't feed this stuff to your dog. why do you feed it to your kid? And this is when they're growing, developing, and they're getting healthy. With that said, I would say if you're looking for healthy snacks, I would focus on ones that have more protein and fat or ones that are from Whole Foods. And I would use Thrive Market. Go to thrivemarket.com, and there's an offer for, I think, a 25% off your order as part of this Ask Dr. Mark. And they have all sorts of great products on there. great discounts that are, you can trust that are safe and that are made from whole food ingredients. Now, they still have sugar and stuff, so you want to be careful about sugar in some of the products. There's ones that are made from whole fruit, but you can get really yummy stuff by going to thrivemarket.com and picking out some of the more healthy snacks. Like there's dried fruit and there's nuts and there's all kinds of thing there. So I would check that out. I think we lost Rebecca, but we have Sue B. Oh, no, there she is.

She's back. I had a good, I don't know.

Did you have any more questions about the snacks? Did you hear what I said?

I'll have to listen to it back later, but thank you.

I basically said, yeah, I basically said go to thrivemarket.com and look at the healthy snacks. Okay, absolutely will.

Yeah, thank you so much.

Sure. All right, now we have Sue B. Hi.

Thanks for taking my question today.

Yeah, sure. How are you doing, Sue?

I'm doing well. And you?

Good. Great. Great. What's your question?

I've asked it a number of times. I'm real happy that it got picked today. I'm wondering, aside from all of the lifestyle recommendations, are there any safe and effective meds that you suggest to your clients, your patients, who have osteoporosis?

Yes. Okay, so at a high level, it's important to understand what the cause of osteoporosis is. So medications tend to be stopgap measures, last resort, and I'll get to the medications in a minute. But we do know a lot about bone metabolism, and we know there are things that cause you to lose bone and there's things that cause you to build bone. And before you start taking drugs, you have to focus on those. For people, it's essential. First is understand the things that cause you to lose bone. And, you're not going to like this list, but I'm just going to give it to you. I didn't make it up. I didn't design the body. I'm just the interpreter, so don't get mad at me. It's caffeine, alcohol, sugar, particularly sodas, particularly dark sodas with phosphoric acid in them, like colas. It's stress, it's lack of activity. and it's anything that drives inflammation because we're understanding that osteoporosis is also partly an inflammatory problem. So you have all these, you have unfortunately all these different things that are going on in your biology that you have control over. And then things that build bone are the right nutrients, right? And you need to have, make sure you have adequate vitamin D. That's like one, two, and three. And most of us are low in vitamin D. And you need at least a level in your blood of 45 to 60. or 70 at least to be adequately replete with vitamin D. And you can't guess by just knowing what you're taking because most people need it between two to four to 5,000 units to get that level. And then of course there's vitamin K2 and there's boron, silica, zinc, magnesium. There's a lot of nutrients that are really important for bone health that you can take as supplements, but also in food. And I think people should be really focused on, you know, like people are focused on calcium. You notice I didn't mention calcium. There's not a lot of great evidence that calcium is in and of itself that great for preventing fractures. In fact, dairy doesn't actually prevent fractures. That's a whole nother topic. You can kind of listen to my podcast on that with Dr. David Ludwig at the doctor's pharmacy, where he kind of reviewed a lot of the research on this. Actually, the more milk you drink, the higher your fracture risk is. It's not necessarily lower despite all the propaganda and the got milk ads, which were just propaganda. They weren't based on science. so I think it's important to understand that you need to take the right nutrients and the right foods. I think greens, nuts and seeds with lots of minerals, chia seeds are great, tahini is great with calcium, chia seeds have more calcium per serving than a glass of milk, dark green leafy vegetables are a great source, tahini which is from sesame seeds is a great source of calcium as well. So you can include those in your diet. And then exercise is critical. And strength training, weight training, I personally have switched over to bands, to loop bands and handle bands. And, it's just incredible how much strength and muscle and bone strength you can build by doing this. And, I think most people don't really recognize how powerful that is. And, now the way I explain is if you eat right, you do all these things. It's like putting all the ingredients for the soup in the pot. But, unless you exercise, it's like not turning the flame on. If you don't exercise, the soup doesn't cook, right? And so we need to really focus on that, particularly as we get older, muscle mass goes down, bone mass goes down, risk of fracture goes up. We have something called not only osteoporosis or osteopenia, but we have sarcopenia, which is muscle loss, and that creates a whole cascade of inflammation and poor metabolic health. So, the best way to fix that is through the exercise. And then, if all those still are a problem and your bone density is still going down, by the way, I've had people, increase the bone density by 10% by doing all the things I just said, which is more than any medication will do. And then there's the next tier. So then there's hormonal therapy, whether it's estrogen or testosterone can be very effective even in women for building bone health. And then there's various classes of drugs. There's the bisphosphonates like, you know, there's Fosamax and others. So there's other drugs that we can use like that have been used, but they often may not create the best quality bone. There's also injectables that are used once a year. There's tamoxifen, a version of that called, oh geez, I'm forgetting the name, but it's a estrogen receptor selective estrogen receptor drug that actually helps to build bone but it may cause uterine cancer. There are also, yeah, so there's also, there's a lot of downsides with these drugs. So I mean, I think they can be used as a stop gap, but the quality bone may not be as good. They do help, but again, all these other things work better and I would really focus on those.

So you do eventually, if a person does all the lifestyle things that you described and eats well and sleeps enough and meditates and exercises and all of those things and has osteoporosis still, you do eventually then recommend those bisphosphonate drugs. Are they safe?

I think yeah, for the most part they're pretty safe, but I don't think they're super effective. If you look at the data, there's just marginal benefits and there's questions about side effects, quality of bone. So yes, as a part of an overall regimen, I might add that if someone's got severe osteoporosis, no doubt, but it's sort of the last step at the end of a long road.

Okay. All right.

All right, we have another person coming up next. Peggy, hello Peggy, how are you?

Good, how are you?

I'm fine, what's up?

I love your work, I thank you. Read, listen to a lot of it. I just spent 10 days on two antibiotics because I had a gum infection and I want to know how to get my gut microbiome back to be healthy.

Well, I think it's very important people realize we really are destroying our microbiome through the overuse of antibiotics in this culture. There's about 240 million prescriptions written every year, about eight or nine million pounds of antibiotics that are prescribed. And I think we really should be careful about when we use them. And sometimes you do need them for sure. So I'm not against antibiotics, but they should be used cautiously. With that said, you really should be focused on making your gut healthy while you're taking them by having probiotics during the time of antibiotics and even after. And, I've created a whole protocol for my patients, which is a gut rebuilding protocol, and we've actually turned into a product which will be out soon called Gut Food, which you'll be able to find on getpharmacy.com, that's G-E-T-F-A-R-M-A-C-Y.com, and essentially it's a combination of four main ingredients that I've found over the years have really been key to feeding your gut bacteria and rebuilding your gut. One is a classic compound called polyphenols. And you can just include these in your diet. Things like pomegranate, cranberry, green tea, any kind of dark, colorful, pigmented plant foods are super helpful, but particularly the pomegranate, green tea, and cranberry, which you can add to a smoothie. You can get pomegranate powder, green tea powder, cranberry powder, and put that in your smoothies. The next is prebiotics. and prebiotics are really important to feed the good guys and they can be eaten in foods like asparagus, artichokes, Jerusalem artichokes, jicama, seaweed, and so forth. There's a lot of those I write about in my book as well. So making sure you take prebiotics. A third is probiotics. So making sure you take high quality probiotics, usually probably 25 to 50 billion. You might also need something called saccharomyces, which is another type of probiotic to help rebuild the gut after antibiotics. And that also is effective in preventing antibiotic associated diarrhea. And, the last thing that's in our little cocktail, which you may not need for antibiotics, is immunoglobulin. So, it's like colostrum. It's made from either bovine sources, there's other ways to get it, but essentially.

That helps to regulate immunity in the gut.

So, this is our super- how do you spell that? Lita. Immunoglobulins? Oh, immunoglobulins. It's like antibody. It's like colostrum. It's like colostrum for breast milk. sort of passive, we call passive immunity. And so we produce all these together in a product called Gut Food, which will hopefully be out soon, and sort of make it easy for people, but you can still do it without that. But those are the principles that I would say really should be focusing on to rebuild your gut.

Okay. Can I ask you one quick other question?

Sure.

If my vitamin D level is around 80, Is that too high?

No. The reference range goes usually up to 100, but if you're a lifeguard and you're sitting outside all summer, your level can get up to 200 and it's not toxic. Levels that are much, much higher can be, but there have been studies where they've given people 10,000 units a day for three months and there's just very little toxicity. So unless you're getting into a product that's mislabeled that has super high doses or you're taking it inappropriately, Vitamin D toxicity is extremely rare.

Okay, thank you very much.

All right, and last question is from Sue as well. So hello, Sue. We'll get your question.

Hello, nice to meet you. I'm thrilled to meet you.

Thank you, good to meet you.

Thank you for all your books and your commitment to so many people to make them better. So thank you. I have a question. I'm going to open up just a little bit about myself very briefly. But I was diagnosed with multiple myeloma just recently by one oncologist and another one, a second opinion.

What's that? We only have about two minutes before we have to go.

Okay. Okay. So anyway, I'm in an MGUS stage of multiple myeloma cancer. My question is, for people out there who have cancer, is it not good to have dairy and meats in your diet?

That's a great question. There's a lot of information out there about this that's making people confused. For example, the China study, which was a large population-based study that has a lot of flaws that basically stated that dairy and and then meat, they extrapolated that to be carcinogenic. And I would say that there is potentially with dairy an increased risk of cancer. And then this has been shown in other studies as well. I'm not sure it relates to MGUS or myeloma, but it actually can increase something called IGF-1, which is an insulin-like growth factor that feeds cancer cells. So I would definitely eliminate dairy. As far as meat goes, I don't think the evidence is there to to shy away from meat, but I would definitely say make sure you eat the right meat, particularly grass-fed, grass-finished if you can, to challenge with regular meat. But I think that's the short answer to your question.

Great. Thank you so much.

Oh, my pleasure. Thank you so much for joining us today, Sue. And thank you everybody today who joined Ask Dr. Mark, our live Q&A. That's our show for today. If you want to ask me a question in the future, just text me at 413- 225-8995 with the AskMark and my team might pick your question for one of our future calls. Also, I want to give a special shout out to our sponsor and thank you so much Thrive Market for sponsoring Ask Dr. Mark today. Thrive always provides the best quality, highest quality products at the lowest cost. They've been so supportive of my new book, the Pegan Diet. They've created a special Pegan Diet's favorites list with a ton of favorite foods. from Thrive. And, by the way, my Pegan Diet book, the Pegan Diet, is coming out February 23rd. Make sure you grab your copy. It's for sale now online wherever you get your books or however you get your books. It's not in the bookstores yet, but you can get a pre-order online and it's the Pegan Diet. You can go to peganDiet.com, learn more about it and get your bonuses. But, Thrive Market is pretty awesome and they've created a whole Pegan Diet favorites list so you can make it really easy. Plus, they're offering my community an exclusive offer to get an extra 25% off your first purchase and a free gift when you join Thrive Market today. And to get your 25% off and your free gift, go to thrivemarket.com/hymanfb. That's thrivemarket.com/hymanfb. And if you missed the live stream, don't worry, we'll be airing it on the Doctor's Pharmacy Podcast soon. Thanks for joining us.