Dementia, The Ketogenic Diet & Low Thyroid: Answering Your Health Questions | Mark Hyman

Even if I've never seen a case of this particular disease before, I know what to do because I'm not treating the disease. I'm treating the body. I'm treating the system.

I'm creating health. The first question that we have from Gary in your community who asks about Lewy body dementia. And we're going to tee up his video clip over here.

My mother passed from Lewy body dementia, as did my comedy and adult childhood idol, Robin Williams, who was suffering when he passed. I'd like to know everything you know. Are there any successful treatments? Have people rebounded? Is there any potential cures? Well, Gary, thank you so much for that question. And sadly, I've had a lot of opportunity to treat Lewy body patients, but the good news is there's something you can do about it. And Lewy body, for those people who don't know what it is, is a form of dementia that's sort of a combo between Parkinson's and Alzheimer's. so it's like dementia with a lot of motor features. So it affects this part of the brain called the basal ganglia, which controls motor function, but also has far-reaching effects throughout the brain. And, you know, when we talk about dementia, there's no such thing as dementia. There are dementias, and they're all different and they have different causes. Even, for example, Alzheimer's may have very different causes. Dale Bredesen, we've had on the podcast, has talked a lot about the various causes, whether it's inflammatory triggers, mold, toxins, lime, blood sugar issues, insulin, nutritional deficiencies, hormonal dysregulation. There's all these things that drive brain dysfunction. And so there's dementia that's classified as Alzheimer's, dementia that's Lewy body, dementia that's called vascular dementia from little mini strokes. At the end of the day, we have to think broadly about what the root causes are. So while on the pathology, it may look the same. In other words, when you take someone's brain, you cut it open after they die, you look at it, you're going to see the same pattern of cellular dysfunction and the same kinds of pathology on the slides amongst all the people with Lewy body or amongst all the people with Alzheimer's or amongst all the people with vascular dementia. But that doesn't mean the causes are the same. So, you know, while I've seen patients with Lewy body, they're different. from each other. And I'm just recalling one in particular who was quite disabled, who I got pretty late in the process. And when the functional medicine approach, even if I've never seen a case of this particular disease before, I know what to do because I'm not treating the disease, I'm treating the body. I'm treating the system. I'm creating health and I'm removing all the impediments to health and adding all the ingredients for health. And when I do that, the body's innate healing system starts to act it starts to repair and start to renew and heal. And it's actually shocking to me, you know, because I'm so brainwashed still by medical school, I'm so brainwashed to think that, oh, this is impossible. Even though I kind of know after 30 years of practicing functional medicine that it is, I'm still sort of shocked when I try this stuff and it actually works. And I'll just sort of share a case of a patient that'll sort of help you illustrate what we can do and what we did find and what actually matters. This patient was about 85 years old, a woman. who really was struggling. And when she was brought to me, she was unable to walk. She was in a wheelchair because of the motor dysfunction. She came to my office. We had to have three people pick her up. And she was a little lady. We had three people literally pick her up to stand on the scale to weigh her. And she was unable to run her business Affairs. She had really a very large, successful business and was on the board and was heavily involved and was just no longer functioning. She couldn't go out anymore. She couldn't socialize anymore. She was really homebound and wheelchair ridden. Wheelchair, is that written? Wheelchair bound. Wheelchair bound.

And.

She was referred to me by a friend and her son and her and I talked for a bit and she really had trouble speaking. She had trouble talking because of the motor effects. And I was like, well, gosh, I don't know if there's anything I can do, but let's take a look. so it turned out, even though she was thin, she was diabetic and her blood sugar was very poorly controlled because she ate a lot of carbohydrates. So she may not have been overweight, but she was over fat and under lean. In other words, she was a book called metabolically obese, normal weight. She was thin on the outside, but fat on the inside, and all the metabolic parameters around blood sugar were just way off. And she had also a lot of gut issues and had never really had normal bowel movements. Was severely constipated, uses colonics and enemas and laxatives for years and years and years. and then she had all these weird other things. She had all these migratory rashes all over her body, which were yeast infections on her skin, on her breasts and everywhere. And she kept getting these shots from her doctor for energy, which were steroid shots, which is, I think, criminal. Yes, it's great to have if you're climbing Mount Everest and you're going to die, you take a steroid shot like Decadron, adrenaline shots, you can get off the mountain. but it's not meant to be used for people who are just a little tired. It's basically the stress hormone and it causes the brain to shrink, it causes diabetes, it causes all kinds of muscle wasting, hormonal dysregulation, low growth hormone. I mean, it's just a disaster to be taking on a regular basis. So this was contributing to her problem. And she also was really significantly nutritionally deficient in many, many nutrients, including B12, folate, B6. so she had tremendous gut issues, she had diabetes, and she had significant nutritional deficiencies and hormonal dysfunction. And so I kind of looked at the whole picture and I said, well, let's just start to rebuild your system from the ground up. So the first thing we did was clean up her gut. And it turned out she had tremendous amounts of yeast from all the steroids and antibiotics she'd been on. She was severely constipated, which can go along with yeast overgrowth or what we call SIFO, small intestinal fungal overgrowth. which is similar to SIBO, which is small intestinal bacterial overgrowth. She was bloated, distended, uncomfortable. And so we got her gut normalized. I gave her antifungal, I gave her probiotics, I gave her a whole gut repair program, gave her magnesium, I took away all the laxatives and got her on MCT oil, vitamin C, magnesium, which really helped bowel movements. And so she started normalizing her gut, which is great. And then we actually also addressed the blood sugar. So we put her on a modified ketogenic diet, extremely low carbohydrate, higher in fats, and the brain loves this. And particularly in Alzheimer's and Parkinson's, there's really good data showing that a ketogenic diet can be really helpful symptomatically. And I've had many other patients with Alzheimer's. When they get pretty bad, I'll often try a ketogenic diet when I see them slipping. And it's remarkable. It's like the light bulb goes on in their brain because the brain works much better on fat than sugar, which kind of contradicts everything I learned in medical school, which is that your brain takes up 25% of your energy requirements. as glucose, sugar. So you need sugar for your brain. Actually sugar is poison for your brain. Yes, you need energy for your brain, but that energy can be obtained through very low glycemic diets and particularly through ketones, which are much more efficient and cleaner burning fuel than sugar and can be derived from things like MCT oil, which is a great source of fat that actually turns into ketones in the body and helps mitochondrial function. The other part of dementia, Parkinson's in particular, and Lewy body, is that it's a mitochondrial problem, which is an energy problem. So there's an energy deficit inside the cells, which makes it difficult to move and think and do all the things we want to do. So I basically cleaned up her gut. I got her diet sorted to be extremely low glycemic, full of phytochemicals, super high in fat, very low sugar, starch, and and her blood sugar normalized, her gut normalized. And then I started up regulating some of these B vitamin pathways that have to do with brain chemistry that can be contributing to dementia like B12 deficiency. She was on acid blockers, all kinds of drugs I had to take her off of. It was, these people are in poly pharmacy. I once visited a patient at home, was a mother of a friend, another patient, and she was on 22 different prescription drugs, which is terrifying. And all the drug interactions and all the side effects. And, I mean, I don't even know how that happens. It's like you see one doctor, they give you a drug, you see another doctor, they give you a drug, and nobody's talking to anybody else. It's kind of the failure of modern medicine. And so I clean up her gut, I got her blood sugar under control, I optimize her pathways around methylation, B vitamin status, and I also gave her some hormonal support. Her thyroid was off, her sex hormones were low. So I basically just kind of tuned her up. I just optimized her systems from a functional medicine perspective. And I didn't know what would happen. I thought, oh, well, hopefully she'll feel better. At least she'll be going to the bathroom and her blood sugar is controlled. It was a miracle, literally a miracle, Drew. I went to visit her at her apartment in New York, made a house call, and I was shocked. She literally got up out of her wheelchair and she walked down the hall unassisted. And I was like, holy cow. Her verbal fluency increased. She was able to get back and do her business. She recorded another album. She wrote a book. It was like, what happened to her? And I really, I really learned so much from this case because just by applying these foundational principles about restoring health in the gut, in hormones, in blood sugar, in mitochondria, and also optimizing these pathways around biochemistry that are so important for brain function that have to do with methylation and sulfation, detoxification, she really improved so dramatically. And, you know, I wouldn't have thought this was possible, but the good thing about her was that she had a team. so she had a full-time nurse 24/7, she had somebody cooking for her, she could afford what I was asking her to do and had the setup to do it at home. And by simply following the principles, and by the way, Benjamin Franklin said it very well, an ounce of prevention is worth a pound of cure. So, an ounce of prevention is early on, you don't have to do much to stay healthy, but if you're really, really sick, you need a pound of cure. and so she was kind of needing the pound of cure. So it was a very intensive program, but she did it and the results were really remarkable. And I think that, you know, people out there listening need to be aware that while we're seeing rising cases of dementia and Parkinson's and Lewy body, and it seems hopeless right now because traditional medicine has just failed at this. There's been, I think, over $2 billion of studies over 400 clinical trials, studying all sorts of drug interventions, and every single one of them has failed. Even the new drug that, quote, got approved is a joke. It's super expensive. It doesn't really have make that much difference. It's like incremental, right? So, oh, I'm going to keep you out of the nursing home an extra three months. That's a blockbuster drug. No, it's terrible. It's like, that's not a metric. So the metric is, can you get back to life? Can you do the things you like to do? Can you socialize? Can you, you know, walk and you talk and you think and you. be engaged in your life in a meaningful way. And that's the result she got. And I think, you know, people listening might think, oh, God, that's crazy, Dr. Hyman. That can't be true. That's just an anecdote. Where's the science? Where's the proof? Blah, blah, blah. And I would just say to you, you know, if there's one case like this, then doesn't that merit a lot of investigation? We should be literally pouring billions of dollars of federal money into these kinds of research projects. And yet, it doesn't get funded because like, oh, we have to study everything separately. Well, well, let's just study blood sugar. Okay, let's just treat mitochondria. No, no, let's just treat the gut. No, let's just give the B vitamins. No, let's just, this one thing. And I'm like, no, the body's a system. If you want to grow a plant, you know, well, I'm just going to give it sunlight, but no soil or water. Or I'm just going to give it soil, but no water or sunlight. I'm like, no, you need, you need all the things that are required for health. It's like, well, let's just see what works. water is good for you, so we're just gonna have you drink water for a year and see what happens. Well, you'll die. You know, like, okay, we're just gonna, eating is good, vegetables are good for you. So all you're gonna do is eat vegetables, but you can't drink water. Well, you're gonna die. So, like, we have to understand that the body is an ecosystem, and that's what functional medicine is all about. It's about helping restore the ecosystem of body to a more balanced state and optimizing the functional systems that determine our health. So, if you're out there and you have dementia or you have someone with dementia in your family or Lewy body or Parkinson's, it's a lot of work, but it can be dealt with more effectively. And it's one of the most satisfying.

Parts of my practice because people get their life back. So many layers there, Mark.

I have a thousand files before you.

Let's go right into it. So number one, thank you for sharing that story. I hadn't heard that one. And that was a really beautiful and touching story. So a few themes that I want to get a chance to pull back from. Number one, you mentioned Dale Bredesen has been on your podcast before. You've had many conversations with him. He has a network called Recode, I believe, where he has a whole list of practitioners all around the country that are trained in his protocol. Is that one step? If somebody is in this position or has been diagnosed early, should they consider, you know, going to them? Obviously, we don't have any formal affiliation besides being a fan, right? Just want to make that clear for everybody.

But is that one step to go find the right practitioner? For sure.

For sure.

So Dale is an amazing guy. He's a research neurologist. So he's a neuroscientist who worked at the Buck Institute on Aging and was an academic scientist. And his wife was a doctor as well, but she was a functional medicine doctor, and she was always pushing him a little bit. And I think my book, UltraMind Solution, came out in 2009, and he read the book, and he, through reading the book, realized that the things that I was observing clinically and the results I was getting clinically were the things that he was seeing in the laboratory on the bench that hadn't quite reached clinical practice yet, but actually it had through functional medicine. And that led him down this path of rethinking everything he's doing and looking as a neurologist, as an Alzheimer's expert, as a dementia expert, looking at these principles and starting to apply them. And so he started to apply them in a kind of a loose way, and he started seeing these results. And after patient, after patient, he got very serious about it, and he's really taken this work and created not just the books he has written, including the last one, I think the first survivors. I think there is like- First survivors of Alzheimer's.

Yeah.

Right, first there are survivors of cancer, there are survivors of heart attacks, but who is a survivor of Alzheimer's? Well, there are survivors now. And, I have had many of them in my practice. So, he basically took that science and combined it with the principles of functional medicine and created a scalable model online and in person to find out what's going on with you. And it's called Recode. So, you know, we might have a few differences around the edges here and there, but we're like 98% aligned. And I think he's done a great job of making this widespread and accessible and, and to, to just hear him talk and hear him share the stories. And actually, there's a documentary that they were making years ago. I saw it. I don't know what happened to it, but it really was about all these Alzheimer's survivors and dementia survivors, and it's like, okay, well, if that's true, then, you know, why? Why aren't we actually doing this at scale? And it's just like everything else. I mean, we know the cure for diabetes is better food, and that's not a controversial idea. And yet, insurance doesn't pay for it. Doctors don't know what to do with the information, and they just keep prescribing drugs. So, you know, we're in the same situation with. With pretty much everything else that works in medicine that isn't mainstream. It's. It's just marginalized because. of perverse financial incentives because doctors don't understand it because the research infrastructure doesn't fund the kinds of research that shows how systems approaches work. They're very much reductionist. So let's look at this one drug for this one pathway for this one disease and see if it works when we keep everything else normal. But that's just not how our bodies work.

That's a big part of this podcast and the work that you do, even separate from, you know, you have a nonprofit that does advocacy work and trying to lobby Congress, foodfix.org, if people want to check it out. But I would say that this podcast that you've created is also advocacy work because how change happens in society is by the spread of ideas. So somebody who's a research assistant somewhere and part of a grant application team, here's a podcast because their sister or mother is suffering from something. And all of a sudden it puts a little seed in their head that there's a different approach. They get excited, they talk to their, you know, manager, you know, at their research clinic or university, they start to say maybe there's something that's there and that's how momentum gets started or a doctor's listening here and they're treating a high profile patient. That patient decides to start talking about your work or how they've been influenced by the principles of functional medicine and momentum builds momentum. So a big part of this is just spreading enough education so people get excited enough to wanna look. 'Cause if you try to go direct to the source and convince people, it goes back to that standard max plank quote that people know so well, changes in medicine happened one funeral at a time. Well, I think he said science, but changes in science and medicine happened one funeral at a time.

Yeah, basically the quote is science doesn't advance by convincing your opponents and helping them see the light, but because they eventually die and a new generation grows up that's familiar with it. That's actually the quote.

It's basically one funeral at a time. Yeah, one funeral at a time. And it was funny because I know you're studying Longevity, Elon Musk was interviewed a couple of weeks ago and he was like, the person was asking him, you know, all your friends or your contemporaries, Jeff Bezos and this person, all the billionaires are exploring longevity and they're putting hundreds of millions of dollars in the space. Why are you not? And he said, you know, the hardest thing that we have right now is that society actually progresses because the old guard dies and then a new generation comes in with the new approach. And I don't know if we want a bunch of people living a long time who have old ideas, they're going to end up suppressing everybody else. I thought that was an interesting take.

On the old guard. I take that personally, actually. I don't want to be sent out to pasture. I got a lot of spilling the beans, giving still. So I'm never going to call it quits.

Yeah, please don't.

I get it. It was interesting, you know, I don't think age is necessarily a factor. mindset and that mindset 100%. You know, when I was at Cleveland Clinic, they were doctors in their 70s and older who were extremely open and curious and really connected to functional medicine. And then there were younger doctors who weren't. And, and it, you know, but there, there was just an ossified mindset among certain people, and it's usually out of ignorance or fear. And people don't necessarily know or they're, they're unfamiliar with it, and. So, I don't know if age is really the determinant.

It's more, I'm going on record, I'm not an ageist. I have nothing against anybody at any age, both younger or older. This is really about having a youthful mind at any age. Youthful mind. And a youthful mind is an open mind. It's a mind that wants to learn. It's a mind that's open to the idea that we're going to change our opinions sometimes. And that's actually how we get better. And if you look back at key moments in your life, those key moments of either really good things or really often challenging things, they kind of, if you leaned into the lesson, they opened your mind a little bit and you saw things in a different perspective.

So, absolutely. That reminds me of a Groucho Marx quote. He said, Be open minded, but not so open minded that your brains fall out. So I think having a good skeptical, critical mind is important, but also being open to exploring ideas that may be unfamiliar or may seem ludicrous, but actually turn out to be right. You know, as I'm researching my book, on longevity, I actually was sort of talking about this whole idea of the microbiome and how the microbiome plays such a huge role in all disease, even aging. And I suppose referencing the work of Eli Metchnikoff, who won the Nobel Prize in the early 1900s for the discovery of macrophages, which are a type of white blood cell. But he also had this theory that disease was caused by imbalances in the gut and that that was driving immune problems and inflammation and heart disease. And he was initially sort of you know, respected because he was a Nobel Prize winner, but eventually was ridiculed for his work. And people pretty much thought he was crazy. And yet now 100 years later, they're like, oh, yeah, the microbiome, it's connected to everything. So it's, you know, it takes 100 years, 120 years sometimes to figure out a great reminder.

And still, nonetheless, we have to track on and keep on moving and push in whatever way. If we're a drop in the ocean, let's be the best drop that we possibly can be. Mark, a couple other clarifying points on your answer back to Gary, which was really robust. You know, you talk about the ketogenic diet and a lot of people think immediately, you know, bacon, eggs and a ton of red meat. But really what you're talking about with keto is much different. Can you just clarify with that and how you've adopted keto into being something that is not all the detrimental things that come from missing key elements?

Yeah, I mean, I think people misunderstand keto. For example, it's not a high protein diet at all. It's actually moderate protein, high fat, low carbs. And, you know, it's fascinating is this book I read years ago called Undaunted Courage about the Lewis and Clark expedition. The food that they used to cross America and discover America in the early 1800s sent out way by Thomas Jefferson to see what was out there and go west was pemmican, which is a Native American food that's made up of mostly fat. It's rendered bison fat and a little bit of protein, bison meat, and berries. So it's basically like 70% fat, 20 something percent protein, and the rest is small amounts of berries and carbohydrate. And wait, one pound of that.

That's a good question. Like, how are they eating that?

Is it all blended together? Like, how do all the ingredients- no.

No, they make a bar.

They make a bar. It's like a bar.

It was the original protein bar.

It was the original protein bar. I think I have your next business idea. You should re-release this protein. Well, actually, it's funny because I just was in Antarctica, and I met this incredible man who's coming on the podcast, Colin O'Brady, who literally summited every mountain in the world at the, at the top peak in the, on every continent, I think, in like a hundred days. And he literally skied across the South Pole, crossed Antarctica with, pulling a sled behind him with all his gear. And he literally came up with these bars that were like the same kind of idea, very high fat, these kind of similar pemmican bars. So, so those are ketogenic, and, and it doesn't have to be unhealthy, so. the typical view of ketogenic is it's like saturated fat and butter and cream and eggs and bacon, but no, it doesn't have to be that. It should be a very high plant rich diet with lots of good fats, avocados, olive oil, nuts and seeds, and some saturated fat actually can be good for some people. For some others it may not. And we've talked about this in the podcast. People like me, who are thin and lean athletic, often have a paradoxical reaction with saturated fat where they actually get a worsening of their cholesterol. Whereas other patients who are very overweight and inflamed and diabetic, They do amazing like the people in the Virta Health studies where they were literally reversed 60% of the diabetics type two advanced to type two diabetes, people on insulin on lots of drugs completely reversed it with a ketogenic diet. So it really depends on the person. And I think you can eat a very healthy ketogenic diet that's full of colorful plant foods, that's full of good fats, that has moderate protein, healthy protein, and then You can do very well with it and it can be a very health promoting diet. The real question is, do you stay on it all the time? And I think we haven't really come up with the answer yet. There's a whole concept of cyclical keto, which involves going on and off it. Yesterday we did grand rounds at Cleveland Clinic with Dr. Valter Longo who's been on the podcast who's studying the effects of a fasting mimicking diet where he talks about these periodic cyclical stresses where you eat like you're starving so that he does it with a very low calorie diet, 800 calories a day, but it all can be accomplished with ketogenic diets that you go on and off of. So, we're still kind of learning about this. I just saw a New England Journal paper pop today. I haven't got to read it yet on time-restricted eating and weight loss. So, we're still doing a lot of research learning about this, but I do think that it's probably not good to be on all the time. but it can be very therapeutic and it can be used in certain cases. Cancer, for example, they're using ketogenic diets and curing stage four melanoma and pancreatic cancer, which are incurable diseases before now. And they're using it for brain tumors like glioblastoma, for Alzheimer's, for autism, for Parkinson's, for diabetes, for people with seizure disorders. In fact, that was the first medical use of a ketogenic diet when nothing else works. This is part of what I learned in medical school. It wasn't a kind of a new fad. The discovery was that these kids who were on a ketogenic diet, when no seizure medication would work, would stop their seizures by eating a ketogenic diet. Because the brain does much better on fat and it's not so irritable and inflamed.

That's great. And I think one of the key themes in addition to clarifying that is really we're talking about a massive reduction in sugar, which is primarily coming from all these refined carbohydrates. And I'm guessing that your patient that you were talking about before, a good chunk of her diet in addition to all the things that she was dealing with, the gut issues, et cetera, was probably heavily reliant on a lot of these processed carbohydrates.

Yeah, I mean, she was eating a lot of rice and sugar and sweets, not exactly good for the brain. And I think, you know, even, I mean, I just got, and we're gonna have this person on the podcast. I'm very curious to hear what she has to say, but there's a new book coming out. in June 2022 called the Great Plant-Based Con, which takes apart a lot of the vegan ideology and challenges a lot of the science. I don't know what it says yet, but I'm very curious about it. I kind of got a whiff of what it's about and I'm going to have a look through it and we're going to have an interesting conversation about it. But, I just think we have to be really smart about our diet. and personalize it. It has to be focused on quality, it has to be focused on food as medicine, it has to be personalized in a way to match the issues that you're struggling with or just for promotion of your health. So it's really, that's really why I wrote Food, What the Heck Should I Eat? and the Pegan Diet, because I wanted to have a place where people can go and find a coherent view of an inclusive way of eating that actually also promotes health.

Okay, before we go into the next question, last final question off of what Gary was saying, he mentioned Robin Williams. Were you a Robin Williams fan?

Heck yes.

Anything that you want to mention about?

Mark and Mindy, yes. Actually, I met his son not too long ago.

And I, yeah, he's launched a new supplement company, right?

Yeah, yeah, yep. And he's actually interesting, I think.

He.

Works with another friend of mine. And it was just, it was heartbreaking because I saw, I don't know if you all saw the movie, there was a documentary on it. and it broke my heart because I felt like he didn't have to suffer. There was a way out. He just didn't know about it and nobody around him knew about it. And it's just so, it's so just makes me angry honestly, Drew. And I talked to my daughter who's in medical school right now and she has a friend who's in medical school with her and she's got all these inflammatory weird autoimmune symptoms and she's been to doctor after doctor, a specialist, and she's still miserable and nobody can give her answers. and they don't want to look, they don't know what to do. And I'm like, well, this is not hard to solve. I mean, there are root causes of inflammation in the body that linked to autoimmune disease and all the symptoms she's having. And you just need to go through them. It's not that hard. It's toxins, allergens, microbes, infections like ticks, microbiome, diet, stress. I mean, it's a short list of things.

And as a functional medicine doctor, my job is to be a detective and to find out what's at the root of the problem and not just cover over the symptoms. Yeah, and the last note that I'll mention about that, Robin Williams, all the resources in the world, a well-off individual from well-deserved, a lifelong career of making people laugh and smile and cry and all those things. So he had resources financially and still yet even, and the patient that you mentioned, luckily she got connected to you and the Ultra Wellness Center. But so many people even with resources struggle to get the right care and if you're lucky enough to have resources, and most people in the world are not, that's why it's even more important to go back to your original statement, which is about prevention. If we can think about these things, if we can integrate them and not wait till we get sick, we don't have to hope and wish that even if you have the education, you need a little bit of a nest egg to even sometimes pursue these things. We're not gonna lie. It's expensive sometimes, right? You were mentioning she had a cook. functional medicine tests, other things. So, prevention, prevention, prevention, practicing these things now so we don't end up in that position in the future.

I mean, that's the problem, Drew, is that we don't get taught how our bodies work. We don't get taught how to create health. We don't get taught the practices and tools that are easily available to all of us that are inexpensive and accessible that we can use every single day to maintain our health. And, you know, I've learned more and more as I've been doing this work for decades and I keep improving and I keep getting better and I keep fine tuning myself and I use myself as sort of a guinea pig. But it's really amazing to see, you know, now I'm 62 and I feel stronger, healthier, younger than I did at 42. And even pictures, when you look at me, pictures back then, I look younger and better now, which doesn't even make any sense because it was 20 years ago, but that's possible. I mean, I have a few more gray hairs, but, you know, that's from all the hard work.

All right, Mark, we're gonna tee up the next question. Mark, I'm a huge fan.

Thanks for doing this.

My question is, what is it about fried foods, even if you're just frying them at home?

What is it about them that makes.

Them so harmful to the internals of a human?

Eric, thanks for that question. You know, I like french fries like everybody else, but there's a problem when you deep fry foods and it has to do with multiple changes that happen to the fats, to the sugars and the proteins in the food you're cooking. So let's just sort of start, let's say with French fries, because that's something that is probably the most common fried food that people eat. I think there's like five top vegetables. Potatoes are one of them and it's in the form of French fries. So literally it's one of the most ubiquitous foods we eat. And French fries are delicious, right? But they're crunchy, but they're made from starch. and there's also proteins in the potatoes. And when you deep fry them, they form something called acrylamide. Acrylamide is a carcinogenic toxin that forms from the combination of these sugars and proteins and fats fried at a high temperature. So, it's really, really dangerous. And yet, it's in all fried foods. The other thing that happens is you know, we've changed the fat we use to use highly oxidized fat. So before, and there's a great Malcolm Gladwell podcast about this, about why McDonald's french fries used to taste better is because they fried them in beef tallow. Tallow is beef fat, like lard, right? Except from a cow. And that's what they use to fry the McDonald's french fries. And when we, when we, you know, when we used to make pie crusts we use lard. So, we used solid animal fats for frying, which are much more stable, less oxidizable, and much safer to use for high temperature cooking. But now, then we switched by the way to partially hydrogenated fats or trans fats, which was a disaster, which killed literally hundreds of millions of people, 100,000 millions of people, over the years, been ruled not as safe to eat by the FDA, although it's still everywhere. I mean, I went to the supermarket the other day and I saw Crisco and all the hydrogenated fat products. I'm like, what is it still doing here? In 2015, seven years ago, the government said we shouldn't be eating this. It's not safe. And yet, they've given the food industry a long runway and a lot of loopholes to keep selling this stuff. So that was bad. And then they switched to now to refined vegetable oils or seed and bean oils. which are also extremely unstable. They're polyunsaturated fats and under high temperature, they oxidize. Now, what is oxidation? Well, that's the process of fats going rancid or your apple turning brown that's left out in the air, your avocado turning brown, or your skin wrinkling. That's oxidation. And when that happens, it creates a cascade of effects inside your body that creates inflammation, damages your tissues, and in fact, your cholesterol is really not a problem unless there's oxidized cholesterol in your blood. So if you want to cause heart attacks and all the downstream effects of metabolic diseases, eat fried food. And what was really interesting was a study that came out that a single fast food meal with fried foods had immediate effects on your arteries, causing them to stiffen and harden and reduce blood flow. so we really need to be smart about what we're eating. Do I ever eat a french fry? Yes. But I really don't make it a habit. And it has to be a very special french fry. And if you want to, you know, make french fries, you could bake them in the oven. You can have sweet potato fries or bake. There's a lot of ways to do it that are less harmful. But I think it's important. Other things, air fryers. I never really used one of those. I mean, I don't know how it works, but seems like a good idea. I don't know if you still get the problem, because what happens is you also get these, these we call ages, advanced glycation end products, which are just, just damaged protein. It's like creme brulee, the crispy thing on top, or the crust of a bread or a crispy skin. It's proteins and sugars interacting to form these products called ages or advanced glycation end products. And, and they bind to these receptors on your cell called rages. So we're raging or aging, literally. I think it was a smart acronym, and, and that creates inflammation through the body. aging and basically cellular destruction. So it's really important to limit your intake of these foods as much as possible. And I like crispy this and that like the next person, but I really try not to eat it.

Yeah, that's great, Mark. I'll add in a couple of things to that. I have used an air fryer and I know for a lot of people who do enjoy fried foods, immediate easy step is switch to an air fryer. Don't be deep frying and other things. Even sometimes people would go out and a lot of people who'd say, well, I only have fries on the weekend or fried food on the weekend, say, well, get an air fryer at home, 'cause that's gonna be better at least, but I haven't seen the deep studies or I don't know if anybody's done it to know, like you said, is it that much better? But I can tell you that fried food is my kryptonite. And I feel like I have a stealth virus. I've talked about it with a few functional medicine doctors, maybe even like you can have stealth viruses in your tonsils and other stuff that under a lot of stress, and it takes a lot of stress. But when I eat fried food immediately, my entire throat swells up. I have my nodules, my tonsils, everything kind of swells up a little bit. Yeah. So I pretty much stay away. What's that?

It creates inflammation.

Creates inflammation.

That's basically what I was saying.

It creates inflammation.

Yeah.

So for me, I'm like the canary in the coal mine. I can see it immediately show up. But when I have it with the air fryer, which, again, is much more of a treat, not a regular thing in my diet, doesn't happen to that same degree. So great answer on that. All right, Mark, so I'm going to tee up our next question from Jeanine from Delaware, my home state. Hi, Dr. Mark.

My name is Jeanine Fusco-Lano from Delaware. Thanks for all you do. Do you recommend a company like Viome or EverlyWell to find out what your triggers are in terms of inflammation and possibly weight gain? Thank you so much. Janine, thanks for your question. And I think the head of that question is really, should we be excited about self-testing? Should we be able to actually democratize testing and allow people to find out what's going on inside their bodies, whether it's through food allergy testing or stool testing or blood testing or saliva testing? And I strongly believe that people should be empowered with their own health data. that people are smart enough, capable enough, and with the right guidance and information, they can actually take this information and make meaningful changes to their life and health from it. And I really believe this strongly. And I've been trying to get people to own their data for a long time. And I've been doing diagnostic testing. And when I was in medical school, the doctor never, never gave the results of the test to the patient. They said, oh, your lab tests are fine, your cholesterol is fine, your blood chemistry is fine, your blood count is fine. I'm like, okay, but don't you think the patients should be able to have a recovery of their own report? So I really strongly believe that we should be empowered with our own health data. We should be able to actually self-test and self-diagnose whenever possible. However, there are a lot of companies out there producing all sorts of diagnostic tests that are getting a little ahead of themselves, I think. So there's food testing around genetics and nutrigenomics, there's food sensitivity or allergy testing, there's stool test companies out there. and they're all different. What I would say is, you know, as someone who's spent the majority of my life looking deeply into diagnostics and testing to find out what's going on with people, they're all over the place. So, you know, I, I give an example. I have, you know, we do split sampling on testing, but I have, I have a lot of quantified self devices just to try them out. So I have an aura ring, I have a Apple watch, I have an eight sleep bed. I have, you know, different sleep apps, sleep watch. I have all this stuff. and it's amusing to me 'cause I'll run them all at the same time on the same night and the same thing. I mean, I'll come up with like really different results. I'm like, they're not so far off, but they're like, wow, this is interesting. You said I got nine hours. You said I got seven hours. You said my sleep was 80%. This one said my sleep was 90%. I'm like, and so we really still in an era of fine tuning the diagnostics. And I would say these diagnostic tests should be used with caution. You shouldn't over interpret them. Certainly if you wanna do sort of a food allergy or sensitivity test and you find something you wanna try to elimination diet for a little while, fine. Some of the stool testing companies go a little far. They look at the microbiome itself, which is, you know, what are the bugs in there? And that's helpful, but you know, you've got up to a thousand different bugs. They do all kinds of different things. It changes literally with every meal. So if you take your poop on Monday or take it on Wednesday, it's going to be different. Even, we've done this, even within the same stool sample, you can sample different parts of the stool, which may represent different meals that you've had. and they're all different. So you can send literally the same poop from the same person on the same day to the lab, the same lab, and get three different results. So you kind of have to take it with a grain of salt and understand the context of the test and not over interpret the test. I literally just went over somebody's test result, which told them to stop eating a lot of really healthy foods, which I. I just don't agree with. I think we're really not there in connecting the dots between. oh, you've got this particular bacterial profile in your gut. You shouldn't eat these 12 foods that actually are pretty healthy, like avocados or almonds or whatever. Like, I can understand saying, well, don't eat, you know, processed food and don't eat sugar. And, you know, you know, that's fine. But I think it's a little bit of an overreach. I think we'll get there. We're learning. And it's not to say that, that we, we actually should ignore those results. It's just that we have to understand them in the context of our overall life and preferences and diet and health. So that's kind of how I see them. They're, they're, they're guideposts, but they're not, this is, you know, this is the gospel.

And I always feel, Mark, a good functional medicine doctor, and there's, there's a lot of them that are, that are out there, and a lot of them that also do, like, remote work with patients these days. They'll help you understand that the best case scenario from some of these tests, especially stool tests, is you're looking for not so much the individual food that works for or doesn't, that's very hard to do unless if you have a specific allergy that's there, but most people are dealing with sensitivities and other stuff, they're gonna more help you see is there a lot of leaky gut, for example. They're looking at the trends and the themes, and if a lot of foods flag, especially in a particular category, as being, you know, triggering some sort of antibody response or immune response, then that might be an indication that, okay, there's leaky gut, we need to dig in a little bit deeper, we need to go in that area. So they're taking these themes and trends, not so much the individual foods, as you mentioned, it doesn't really feel like we're there.

Yeah, I mean, I would agree and I would add to that, that the question is not what foods are you sensitive to or allergic to, is why are you so sensitive? And fix that. The goal isn't to create more restriction, but create more resilience for people so they can tolerate a more wider variety of foods without having the problem of making them sick. So I think that often gets missed and I think they, these tests are overinterpreted and say, oh, I'm allergic to these things. No, you're not allergic, you're sensitive. And two, if you don't deal with the reason you're sensitive, you're not necessarily gonna fix the problem just by eliminating the foods. So it's much more complex than that. And I think the testing kind of gives people a false sense of what's right or wrong and what to do and not do. But it's a much more deeper conversation about how do we heal our microbiome? How do we heal our gut?

How do we prevent leaky gut? How do we actually reduce food sensitivity? It's not increase restrictions on our diet. All right, Mark, our next question is from Melissa who has a question about leaky gut, which we just talked about. Hi, Dr. Hyman.

So I was recently diagnosed with subclinical hypothyroidism and leaky gut.

I was wondering if there are some ways in which I can heal my.

Leaky gut other than just taking the.

Right probiotics and removing food sensitivities from my diet.

Thanks. Well, thank you, Melissa, for your question about low thyroid function, what we call subclinical hypothyroidism. But I don't even think that's the right word and how it connects to food sensitivities and leaky gut. So subclinical means you don't have symptoms, but there's something wrong. The truth is most people with low grade thyroid problems do have symptoms, but they're just subtle. So low thyroid symptoms can be fatigue, depression, insomnia, constipation, muscle cramps, muscle twitching, you know, menstrual difficulties, high cholesterol, you know, all kinds of things that are just, we think, are, quote, normal, but they're not. So I do think it's important for people to get it properly treated. the question is what's the cause? Low thyroid function is a symptom, what's the cause? And it could be many things, right? It can be heavy metals, it can be environmental toxins which are really common as triggers for autoimmune thyroid disease, but it also can be what's going on in your microbiome. And the truth is that the microbiome and leaky gut are really important in discovering what often the root cause are for autoimmunity. So if you have autoimmune thyroid disease, which is may be the case. And by the way, I wrote a whole sort of e-book called the Ultra Thyroid Solution, which details exactly what you should do in terms of what diagnostic tests you should have, what the diets you should be on, what nutrients are important, what vitamins you should take, what thyroid you should take, how to properly look at things. And if the doctor, for example, isn't looking at your thyroid antibodies and looking at all the thyroid tests, including TSH, free T3 and free T4, they're not actually getting a full picture. And you may actually have sort of borderline elevated TSH, which means low thyroid, but if you have elevated antibodies, it means you have an autoimmune disease. And that's really important to know because Hashimoto's or the autoimmune disease that causes low thyroid function is often caused by gluten. It can be caused by other things, my remal tox, but also caused by gluten. Now, how does that work? Well, gluten increases something called zonulin in the gut. And Alessio Fasano, who we've had on the podcast, who's one of the world's experts on celiac and gluten, is at Harvard. he first studied this phenomenon in cholera and discovered that in cholera the body produces something called zonulin, which is this protein that causes the cells in the gut lining to come apart and creates leaky gut, which is where you get diarrhea and you can't, it just creates a mess and people, that's why people die from cholera. But he also found that gluten causes the same thing, not to the same degree, but it causes increases in zonulin which drive the gut to become leaky. When the gut's leaky, basically you're allowing food proteins and food particles and bacterial toxins to leak across the lining of the gut, not go through the cells, but between the cells and go right into the immune system. Because 60% of the immune system is right there. And so I would say a fair bit of my patients with Hashimoto's or low thyroid have elevated gluten antibodies. Now, they might have full blown celiac or they might, but even if you don't have full blown celiac and you have antibodies, it means there's something wrong. It means one, you're exposed to gluten, two, you're have a leaky gut, and three, that your immune system got pissed off and created antibodies like they do to COVID, right? So if you have any antibodies, there's a problem. Now, the question is, is it clinical? Are you having symptoms? Should you worry about it? Depends on your symptoms and overall degree of health, but for many people, it can be a big factor. So the key is one, find out what the triggers are. Is it gluten? Is it something else? Two, rebuild your gut. Now, that involves one, a program that I jokingly call the weeding, seeding and feeding program. And in functional medicine, we call it 5R. But that's a little more complicated. Essentially, the idea is we did all the bad stuff. Get all the foods that are triggering you, all the bad bugs out, small bacterial overgrowth, fungal overgrowth, parasites, whatever you got, and then seed the gut with healthy bacteria, probiotics and so forth and feed it with prebiotics and healing nutrients and polyphenols, things like zinc and omega-3 fats and vitamin A and vitamin D and all kinds of things that are important, glutamine to help repair the gut lining. So when we do that weeding and seeding and feeding program, it literally can repair the leaky gut and become much, you can be much more resilient. When I was really sick with chronic fatigue syndrome, 20 plus years ago, I couldn't eat anything. I literally would eat anything. My stomach would blow up like a balloon. I would feel sick. I'd get dark circles under my eyes. I'd get rashes on my tongue, sores all over my body. And I was so reactive to the foods I was eating. And I had to eat, like, turkey, broccoli, and brown rice for, like, a year because I couldn't eat anything.

And.

And then I learned how to fix my gut, and I actually had to fix the Mercury that was causing the leaky gut, because, like I said, there's a lot of things that can cause it. For me, it wasn't gluten. It was mercury. And until you figure out what the issue is, you can't fix it. And whether, for example, you might have hypothyroidism, and you might have leaky gut, but the cause might not be food sensitivities, it might be the result. Food sensitivities occur as a result of leaky gut. They can also, gluten can cause a leaky gut. So it's a little complicated, but so can other things like mercury for me was causing a leaky gut that made me sensitive to all the foods. So you have to kind of go back and think about how do you repair the gut? And we've had many podcasts about how to heal your gut, whether it's inflammatory bowel disease, whether it's irritable bowel, whether it's reflux, these are really common problems. In fact, the most common problems people go to the doctor with are gut problems. So the good news is we know how to do this now. Unfortunately, I just saw a patient yesterday, Drew, and it was very disturbing to me. He was a young 18-year-old man who suffered gut issues his whole life, was on lots of antibiotics, born by C-section, and was always bloated, distended, constipated, and he was treated for bacterial overgrowth, which was the right thing to do. because he had SIBO, but they just gave him antibiotics for two weeks and they said, okay, see you later. And they didn't do any of the gut rebuilding protocol, which is really important because I see many people, even with full-blown celiac, that don't get fully better unless you repair their gut lining and repair the leaky gut, which isn't going to happen, especially from just getting rid of gluten.

You have to fix the whole microbiome. You know, I want to give a shout out to one person in our network, Isabella Wenz, thyroid pharmacist, has a lot of free thyroid resources.

You have your thyroid ebook, which is great.

It hasn't been updated in a little bit a while, so like, you know, getting some of the latest information.

But it's still, it's still pretty, it's still pretty accurate.

The foundations are there. The foundations are there.

Yeah, for sure.

The foundations are there. Mark, any program, you know, this is one of the challenges is that do you feel that gut protocols when it comes to that weeding, seeding, and feeding, do you feel like there are any standard protocols that are available or books that go deep into it and kind of guide you through that process or is it so specific that really people need to work or think about working with a practitioner if they can?

That's a great question, Drew. I mean, I think the basics people can do. And I think, you know, we created an e-book called the Irritable Bowel Solution, which is really about using diet and a number of supplements to help with resetting your gut. And that works for a lot of people. And I can't tell you how many people who I've seen who, who I've never seen. I mean, who I've met, who I've never seen, who said, I followed the program, I did the 10-day detox, I did what you said, and I got better. And so a lot of people can get better without seeing a doctor. The problem is, if you have something that needs to be treated, right? If you have heavy metals like I did, or if you have a parasite that needs to be treated, or you have really bad SIBO or SIFO, you need medication. You kind of need to work with a doctor. But for many people, you can use diet and herbs and lifestyle and have.

A huge impact on your gut health. All right, Mark, our last question for today, who's asking about H. Pylori.

Hi, I test positive for H. Pylori. I've tried to clear it twice with antimicrobials under the supervision of my doctor, but it's not working. I still test positive. Is there another way? H. Pylori is a bacteria. It's really common that causes ulcers, but it can also cause, we call it dyspepsia or indigestion, heartburn reflux. And I'll tell you a little bit about the backstory on it, 'cause it's kind of fascinating. this bacteria was seen for years by gastroenterologists on biopsies. And they thought I was just this kind of innocent bystander, and it wasn't really causing any of the GI symptoms that they were treating. And we used to think ulcers were stress and emotional issues. We used to cut the vagus nerve. I literally would cut the nerves to the stomach as part of the treatment in surgery to get rid of ulcers. And it was terrible. And we'd give people acid blockers and all kinds of stuff, and people would have to have surgery and bleeding. It was. It was. It was. quite a scary disease. Then we discovered these drugs called PPIs or acid blockers and things like Tagamet and Pepcid and Zantac, which really helped. But there was a scientist, not even a scientist actually, a doctor, a gastroenterologist named Barry Marshall from Australia who had this crazy idea that this bacteria wasn't just a bystander but was actually the cause of ulcers called Helicobacter pylori. and he's like, look, I think this is the cause. And all of his colleagues made fun of him. They laughed at him. So he did an experiment, which seems really crazy, but it really worked. So he got. He got a beaker full of this bacteria. He drank it first before he had one of his friends, who's a GI doctor, scope him. So they did a whole exam. They took pictures, they looked at his stomach, and then he drank this stuff. They waited a while, and then he got ulcers. and they were like, by the way.

Can I just interject one second? I feel like doctors back in the day were so gangster, they would do experiments like that. They were like, this was not that long ago.

This was not even that long ago, Drew. This was like, not even that long ago. This was like, you know, this is since I graduated from medical school. So it's not that long. Wow. Although that was a long time ago. And, and it wasn't like this was in 1905. This was like in, I think, the 80s and our 90s and any and he basically drank the beaker, got the ulcer, got scoped again, and then he said, well, I'm gonna give myself antibiotics, I'm gonna cure it, and then my ulcer's gonna go away. And he basically did that. He basically gave himself ulcers through this drinking the bacteria, and then he cured it with antibiotics. And this really fulfills the criteria for a causation using this concept of Koch's postulates, which is a scientific term for basically this guy, the scientist, Cocktou basically discovered how we prove that a bacteria caused an illness. So anyway, that was fascinating. And he ended up winning the Nobel Prize for this discovery. So since that time, now it's kind of standard of care. And we can test for H. Pylori through multiple ways. We can test through a stomach biopsy, which they actually do when they do Scopes. When they do an endoscopy, they'll put a scope down your throat and they stick in your stomach and they can take a biopsy and they can send it to the lab and they can see it. or you can do a breath test where you drink this liquid that the bacteria ferment and you can actually do a breath test, which is probably the most accurate to see if you have an active infection. Or you can do a stool antigen test where you're looking for the, like, like we now have antigen tests for COVID, it looks for the protein on the, on the bacteria and can actually measure it. And that's a stool test. And lastly, there's antibody testing. which tells you that your body is creating antibodies against it, like antibodies to COVID. The problem with the antibody testing, it doesn't tell if you had an infection or you have an infection. So, you know, your cells, immune cells have memory. That's why when you get the measles vaccine or when you get the COVID vaccine, your body remembers you had an exposure to that bacteria or that virus and it prevents the infection by creating antibodies against it. So, the.

At least that's how it should work.

Yeah, right. That's how it should work.

Right.

But the antibodies don't tell you if you have an active infection, so you have to know what you're doing. Now, you're asking, you've treated this with antibiotics. You've been tested. I don't know what tests you had. I don't know actually what happened, but. But what happens is often it's also contagious. So if your partner or your spouse or your lover, you know, has it and they may be asymptomatic, and if you're in bed with them, you're gonna get it again. So it may not be that you didn't cure it, it may be that you got reinfected with it. So you have to kind of figure out who's in your intimate circle and get them tested too, and they have to be treated too or else you're gonna get it to recur. Now, there are cases where it's recurrent and it may be because the treatment protocols are not effective. And there's many different protocols, but it usually involves an antibiotic or two, and an acid blocker. So it's kind of an important protocol to follow for two weeks, but it may not work. Just like antibiotics don't work for all infections and it may be resistant or maybe a strain of each player doesn't respond to this particular cocktail. So you might have to try two or three different cocktails of drugs to actually work. But I would encourage you to make sure you're not in the bed or making out with somebody who might have it and get tested first.

Mark, you know, I have a couple of friends, dear friends of mine, who have struggled with H. pylori over years. And first, I want to even add that a lot of functional medicine doctors will tell people that I think the estimates are, you know, 40 to 60% of the population has H. pylori.

Is that about accurate? It's common, yes.

And then not everybody's symptomatic. Right, not everybody's symptomatic. So there are people that are symptomatic and there's people that are not. Now, the friends of mine over the years that have tried a lot of these standard protocols, antibiotics, and the H. Pylori ends up coming back in that process, they also end up destroying their gut and they end up with a lot of other symptoms on top of.

The H. Pylori symptoms.

That's a thing, right? And, that's sort of a vicious cycle that I'd love to get your take on because it's like, okay, do I go back to the doctor and destroy my gut again or do I build up my resilience enough, change my diet, change my gut microbiome so at least.

I can manage H. Pylori? Yeah, I mean, I would say yes, and also that there are herbal formulas and regimens at work that I've used. So, people don't want to take antibiotics or I'll try it first. So, mastic gum and certain kinds of zinc and certain kinds of herbs and licorice and there's cocktails of stuff that actually have been effective in my clinical experience. It doesn't mean everybody will respond to them, but it's often worth trying the herbal forms of treatment first. and seeing if that works.

And yeah, because that's a whole rabbit hole. We'll link to a couple articles. I'll go look up some that some of your peers or maybe even you have written, and we'll put them in the show notes to have additional resources for people who want to continue to dive further. Mark, those are our questions that we have here for today. So I'm going to pass it over.

To you to go ahead and close us out. Andre, thank you so much. And everybody, thank you for your questions. I really love hearing from you. I love hearing the questions. I think there are answers that often are not available easily to people who are struggling with really chronic problems with a sleuthy body or low thyroid function or H pylori or whatever you're struggling with. And I think that's the beauty of functional medicine, that it's really a map for how we navigate this territory of chronic illness that up to now we really haven't had a good map for. And, and that's really the purpose of the whole field of functional medicine is to help people deal with these chronic issues. So I'm just really glad you've offered your questions, and I'd like to hear more of them, and I love answering them.

So.

This is awesome. If you love that last video, you're gonna love the next one. Check it out here. We need to really look at the facts about what's happening with our food supply, with our nutrient levels, both in our food and in our bodies, and the consequences that for our health. So I always say, you know, I don't think anybody needs supplements, but only under certain conditions. One, you have to hunt and gather.