Blood Clots: A Functional Medicine Approach with Dr. Elizabeth Boham

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

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Welcome to the Doctor's Pharmacy.

I'm Dr. Mark Hyman. That's Pharmacy with an F for conversations that matter. And you might have been hearing news about blood clots and COVID. Well, blood clots are a common problem. They cause a lot of problems for a lot of people and they don't really get talked about too much from a perspective of functional or integrative medicine. So we're gonna dive deep into that today with none other than our medical director at the Ultra Wellness Center, Dr. Elizabeth Boham, an extraordinary physician who who worked with me for over 20 years. Can you believe that? She's a nutritionist, trained as a nutritionist, as an exercise physiologist, and a doctor, and a fellowship in nutrition as a doctor as well. So she's kind of everybody's doctor's doctor. She's contributed to lots of textbooks and trains physicians all over the world and is in the media, and is just an extraordinary doc. And I'm so happy to have you back.

Thanks, Mark.

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

Yeah, and Marc, it's personal for me too. I've had a couple of clots in my veins in my lifetime. We can talk about it later, which is, I was like, oh my gosh, why would I be getting this at the age of, it was about 12 years ago, I had a clot in my subclavian vein, so in my upper chest arm area. and we can talk a little bit more about that. But it was like, oh my gosh, what's going on? And what can we do to, what could I do to prevent it in the future? But it's really important that our blood clots, we need it to clot, right? If our blood didn't clot, we would bleed to death. So our body has all these mechanisms in place so that our blood does clot and we don't bleed to death. But if it causes a clot that blocks off an artery or a clot that blocks off a vein, that can be really, really dangerous, as you mentioned. A clot that blocks off an artery can cause a heart attack or stroke, and a clot that blocks off a vein, you can get a deep vein thrombosis like a DVT, or like you mentioned with your mom, a pulmonary embolism that is is very, very serious. And so, and it's very common, you know, for, for DVTs, our lifetime risk is, is somewhere between two and five percent in our lifetime for everybody for, in terms of their risk for getting a DVT in their lifetime. And as you mentioned, many different things can cause this. Right. So when somebody's on bedrest, there's an There's an alteration in blood flow in the body. So when somebody's on bedrest, there's more risk for the blood because the blood is staying in one spot. There's more risk for it to just clot in that area. Long airplane flights, right? A change in activity, injury to the lining of the vessel. So, which may have been the situation in my case. I was doing CrossFit and I was doing handstand push-ups. And I think that I injured my handstand push-ups.

That's impressive.

Well, yeah, but I probably, yeah, I don't know, maybe it was or not, I don't know. But maybe there was some injury in the vein that was between the clavicle and first rib, you know, that sort of was one piece of the puzzle to trigger this clot to occur. So injury to the vessel. And then of course, anything that changes your body's risk for clotting. So that can be a genetic. Some people are more at risk for clotting because of genetics. Some people develop a hypercoagulable state in their body because of cancers or autoimmune conditions. So those are just some of the reasons that we see an increased risk of clotting for some people.

Yeah, and so these are problems that are pretty common. And I think the traditional approach is basically give you blood thinners and aspirin, but there's a lot of things that we can do to sort of reduce our risk, right? And I think you mentioned a bunch of them. I think we talked about the risk factors, right? The bed rest, the surgeries, long as it's flying, lack of exercise, trauma, injury, pregnancy, taping on the pill, you know, hormone therapy, testosterone therapy, being dehydrated, cancer, all the autoimmunity, all these reasons cause your risk of clotting to go up. But if you've addressed those, you know, there's a lot you can do. So what are the kinds of things you advise your patients around this in terms of prevention? Because it's pretty common.

Yeah, I mean, it's, you know, when people have had a history of a clot or they're at risk for clotting or they have a family history of it, or, you know, we talk a lot about, okay, what can we do for prevention? you know, when somebody's on a long-distance flight, you talk to them about making sure they're well hydrated on that flight. They're getting up periodically. They're walking around like every half an hour. You want to be drinking in general. You want to drink at least.

Half.

Of your weight in pounds in water a day. So, at least for that, if you're 150 pounds or so, that's at least 70 ounces of water a day, you know, just in terms of getting enough fluid and being well hydrated. Because when the blood is thicker, it's more likely to clot. So staying hydrated is really important. So birth control pills, you know, when young women get clots, a real large reason is oral contraceptive use. It's a three to five time increased risk for polycystic ovaries. That's a lot. Yes, when you're on the birth control pill. And especially for certain groups of people on the birth control pill. Of course, there's gonna be genetics and we can talk a little bit more about that, but smokers, people who have insulin resistance. So if you have polycystic ovarian syndrome, if you're overweight, if you've got that weight gain around the belly, if you're older, if you're an older woman, All of those things make the birth control pill even a higher risk for getting blood clots. Hormone therapy can increase your risk two times.

Like if you're a woman and you're taking post-menopausal hormone therapy, yeah.

Yeah, depending on how it's done, right? So that's one thing that we really work with women on is getting, if they are gonna take hormone therapy, is a healthier version. We know that the We've talked about this in other podcasts that some of the oral estrogens can increase inflammation in the body and may cause more of a risk or depending on the amount of increase that you're giving somebody that may have more of a risk than some of the other formulations. If you get a blood clot, one of the things with me that they, because of my own cancer history, of course, when I had the, the subclavian DVT, everybody, they did a full cancer workup because for an unprovoked DVT, you've got a one in, you know, 10% of those people have underlying cancer that has either they either had known about or they hadn't known about. So cancer does cause this hypercoagulable state. And so, you know, it's often part of that it should be. it is part of that full workup when you get this, when you get a blood clot. And luckily, I did not have a recurrence at that time. So, but, you know, that was, that is something that's looked for. And autoimmunity, you know, so antiphospholipid syndrome, which is an autoimmune process. So autoimmunity can, can impact your risk. Weight, as we talked about, you know, if you're overweight. Yeah, overweight, metabolic syndrome, that process in the body that's really inflammatory, you know, that increases our risk of so many different things, it also increases our risk of blood clots as well.

Amazing. So tell us from a perspective of functional medicine, there's a lot of different things we do rather than just like give you a blood thinner, which you may need, but there are a lot of things to do to keep your blood vessels healthy. And it's not something we really talked about. And one of the keys of the matrix is you know, your transport system, which is your lymph and your circulation. And keeping your blood vessels healthy is really important. They get very inflamed for various reasons, our diet, you know, stress, lack of exercise, toxins, and that leads to cardiovascular disease. And so keeping your blood vessels healthy in general is important. So let's talk about one of the ways we know that we can really accentuate and improve the function of our, our blood vessels.

Yeah, you know, so, so we're always looking for signs of inflammation in the body and oxidative stress. because both inflammation and oxidative stress can cause damage to that endothelial lining, to that lining of our blood vessels, right? So we really are saying, okay, anything that's increasing inflammation or oxidative stress, we need to lower. So as we've mentioned already, we're paying attention to signs of insulin resistance, metabolic syndrome, right? That whole process increases inflammation and oxidative stress. in the body. And it's really important and critical to work on reversing in people to improve their overall health, including decreasing their risk. We also pay attention to genetic variations or genetic SNPs. So, you know, there are a few genes. So, like high-risk genes, low frequency high risk genes like factor 5 Leiden mutation, which really is a, it increases risk of blood clotting or prothrombin gene mutation, which increases risk of blood clotting. But we also look at some of those genes that we know increase risk of blood clotting but are more common. So they're considered, they're considered higher frequency but lower impact. So they don't increase risk of clotting to the extent of like a factor 5 Leiden gene mutation would, but they do have an influence on somebody's risk of so we're paying attention to those snips, those variations that are common, not as much of an impact, but if you take it as part of a whole picture, do have an impact like the MTHFR gene mutation or some of the genetic mutations that impact how somebody metabolizes their own estrogen. Because hormones, as we mentioned, with hormone, like oral contraceptives or hormone therapy, do impact a person's risk. So how they metabolize and process those hormones are important for us to pay attention to and make note of. And so that includes things like the, as I mentioned, the MTHFR gene, the C-O-M-T gene, some of the other hormone metabolizing genes that we look at. You know, we also pay attention to just the milieu in the body that also influences our hormone levels. So our microbiota, which influences our hormone levels, you know, that we've talked about a lot. And so, and as I mentioned, anything that's increasing inflammation in the body, we always start with diet first, right? So there's a lot of phytonutrients, right? Those are the components in our plant foods that create a lot of color in our plant foods that have a lot of benefit in our overall health and well-being. And so our phytonutrients, things like our flavonoids, things like our phenols, they can influence our risk of blood clotting. They can lower inflammation in our body. They can lower oxidative stress. So, for example, garlic has anti-inflammatory properties and anti-platelet properties. We know foods that have quercetin in it. Those are things like kale and broccoli and capers and berries and apples. They can reduce the clumping of our platelets and clotting. Flavonoids, anthocyanins, things like quercetin can also as well.

That's great.

Yeah, so what we're always working with our patients on is getting in lots of color in their diet, you know, eating from the rainbow, getting something, you know, that's some plant foods that have red in it and orange and yellow and green, blue, purple, white and tan, you know, getting lots and lots of phytonutrients in their diet every day. So, you know, 8 to 12 servings of those colorful plant foods every day can help with many different things, including decreasing inflammation in the body and decreasing our body's ability to clot.

Incredible. So really there's a lot you can do to protect them, taking the phytochemicals, the flavonoids, quercetin which works against COVID, catechins which is from green tea, dark chocolate, red wine, pears, apples, all that stuff and rutin which is amazing and apple peels, garlic you mentioned, and of.

Course omega-3 fats, right? So those are really important. Of course omega-3 fats, yes.

Yeah, like fish oil, ground flax seed, yeah. so what are the stories of patients you've dealt with this and had some success in using this approach?

Well, you know, I talked about myself a little bit. So, you know, this was about 12 years ago. And as I said, I was doing handstand push-ups and the next day I started to develop some redness in my arm. And then as the days went on, it progressed and my arm got swollen. And our nurse Nina at the time, she said to me, Liz, I think you need to go see a doctor. And I'm like, yeah, this isn't going down. This is crazy. So, Nina is great, you know? So she's like, push, you know, like, yeah, I think I gotta go see a doctor. And we found a blood clot in my subclavian vein. So it's this process called Paget-Schroetter syndrome, which is just the location of the blood clot that I had. And they had to go in and break it down. But one of the things that When I started to look at this whole process for me, I realized that it happened at a time of my cycle where I was higher in estrogen and with my history of breast cancer and looking at my genetic SNPs, I knew that this was an area I had to continue to work on is how do I break down my estrogens in a healthier way. And focusing on things like sulforaphane and DIM. staying really well hydrated, that methylation support that I needed support with the methylated B vitamins was really the areas that I said, okay, I really need to focus on. But I have another patient where there was some other areas that we needed to look at that we can talk about as well.

Yeah, tell us about the other one.

Yeah, so this was a 35-year-old woman and she had a DVT in her leg. And she came to see us. It was resolved at the time she came to see us, but she said, you know, I really, what can I do to decrease this from coming back? You know, I was 35 and I don't want this to come back again. Yeah. And she had a full workup for malignancy cancer that was negative. She had a full workup for those genes that we were talking about, those high impact genes, and they were negative. Um, and, you know, so we took a full history and timeline from her. And what we, what we realized or what she knew, she was on birth control pills at the time and when she got the blood clot. So they took her off of the birth control pills. Um, and as we talked about, that does increase a person's risk. Um, but, but it makes me think, it makes me pause and say, okay, what else does that tell us? Right? Okay. So is she, how is she metabolizing not only the estrogen in the birth control pills, but also her own body's estrogen now that she's off of the birth control pills? Because we know that how you metabolize your estrogen impacts your risk of breast cancer and endometriosis and uterine cancer. Right? So we really wanted to delve into that with her. We did a special stool test. We did this stool test that looked at this one marker that looked at the imbalances of the good and bad bacteria and looked at this one marker called beta-glucuronidase. Beta-glucuronidase is this enzyme in the digestive system that can cleave your estrogen that's bound to this this substance called glucuronic acid, which is the way that the body packages your own estrogen to get rid of it, helps to get it out of the body. We know that when people have this high level of beta glucuronidase in their digestive system, that can cleave that estrogen glucuronic acid and allow it to get reabsorbed and help contribute to an estrogen-dominant like picture, which is what she had. Right? And so we had to really work on shifting that microbiota because when one of the main causes of this imbalance is dysbiosis, is an imbalance in the good and bad bacteria. So, you know, we worked with her to shift that dysbiosis. We actually used an herbal agent to lower that bacteria. We also use something called calcium d-glucarate, which is a substance that can can bind to the estrogen and help it get eliminated from her body. And we added that in. And then we also did some other genetic testing. So not just those high-impact genes that she was negative in, but we did some of those lower-impact, more common gene SNPs and found out that she had a variation in this MTHFR gene. that is associated with blood clots. It is associated with a higher homocysteine level with a higher need for these methylated B vitamins. And so we added that in to her regimen. In addition to sulforaphane and DIM that helps with estrogen metabolism, cruciferous vegetables, we focused really on high folate foods, which is just lots lots of foliage, lots of green leafy vegetables, and things that helped her body with metabolizing and breaking down her estrogen as well as just other toxins in her body. Yeah, well, this is kind of mind-blowing what you're saying. I just want to unpack a little.

Bit because, you know, you hit so many points. But what you're seeing is, you know, in traditional medicine, you know, you've got a blood clot issue, you treat the blood clot, you give a blood thinner, and that's going to the end of the story. what you just narrated was a perspective about thinking of the body as one integrated unit. And, you know, you treated the gut bacteria in order to treat the gut, the blood clot, which doesn't make sense given what we learned in medical school. But when you unpack it, you go, wait a minute, everything is connected. So there's a condition which you're describing this woman had, which is estrogen dominance, which occurs a lot of women in their 30s and 40s where they get excess estrogen because they're not ovulating, because they're eating too much sugar, because they have too much belly fat, because they're eating toxins in their food, like pesticides that stimulate estrogen production. And so you get, you know, heavy periods, fibroids, PMS, all these things. And for you, that was a clue. There was something out of balance with her. And looking at the stool, like thinking about that, your estrogen has to get metabolized and excreted. and removed from your body, but it's kind of packaged up like in a little present. But what happens is when it hits the estrogen goes through your liver and out your bile duct and into your intestines, it hits those bacteria that have this clostridial and other bacteria that have made it to this enzyme that basically unwraps the estrogen from its little gift package. And so all of a sudden, all that extra estrogen gets reabsorbed. in the body creating even more estrogen and more risk of clotting.

Right?

So that's like a fascinating story. And so treating the estrogen dominance was by getting rid of the bad bugs, by, I mean, who would think to treat a blood clot with an antibiotic? But maybe that's the right approach in this case. And that's the way functional medicine works. You know, you're often doing things that are completely out of the box. and outside the realm of that specialty, but it's actually how the body works. And you can have five people with blood clots and they might have five different reasons. And so they don't all get treated the same. And this woman's a great example of how, you know, you connect the dots between all of the things that may be going on with her and looking in places that most doctors don't look. And that's really the beauty of functional medicine. It's really why we do what we do. And it's so satisfying because we see people get better from all sorts chronic issues that just are not well dealt with with traditional care. And that's what we do at the Ultra Wellness Center. We have like five docs and how many nutritionists? We have four or five nutritionists. I can't keep track. And, you know, great staff and we see people from all over the world and it really is satisfying to see how people from these issues can really overcome them. And it's just such a pleasure to do this. And Liz, you've been such a great podcast guest and a doctor at our center and just thrilled to have you back on the podcast. and for those of you who've been loving this podcast, share with your friends and family. Love to hear from you. Leave a comment, maybe how you've dealt with your issues around blood plots and subscribe wherever you get your podcast.

And we'll see you next week on the doctor's Pharmacy.

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

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