Doctor Reveals How THESE FOODS Will COMPLETELY HEAL THE BODY | Elizabeth Boham

There are some people who should not do a ketogenic diet. How do you know if you're carbohydrate intolerant? Many times people are able to add back in foods that they were once intolerant to. One of the first things we always focus on with our patients is balancing blood sugar and making sure at every meal they've got a good fat source, a good protein source, and a good fiber source. If you eat a diet, let's say for breakfast you have pancakes with syrup and orange juice, those carbohydrates are very quickly absorbed. That food is very quickly absorbed and what will happen is the blood sugar will go up quickly and your insulin will go up quickly. And we know that that process creates a lot of inflammation for the body. It causes us to gain weight around the middle, but it also causes the inflammatory markers in our body to increase. And that can make us not feel so good, feel more sick, sluggish or sad, but over time it can also increase inflammation in the brain. It can increase these things called AGEs or advanced glycosylated end products that has been associated with problems with memory and dementia over time. So we really want to avoid spiking the blood sugar and avoid spiking the insulin levels in the body. How do you know if you're carbohydrate intolerant and you need to cut back on carbohydrates. We will test fasting blood sugar and fasting insulin, and if the fasting blood sugar is elevated or the fasting insulin is greater than five, then we get concerned that somebody may have some issues with carbohydrate tolerance. The other way that we know that somebody has metabolic inflexibility or they're not tolerating carbohydrates well is that when they are on a healthy food plan, that is good healthy foods and whole foods, that they're not losing weight. They may be holding onto too much weight around the midsection. If you have a waist to hip ratio that's higher than it should be for women that's greater than 0.8, for men a waist to hip ratio greater than 0.9 is too high. And that's a sign that there may be problems with how you tolerate carbohydrates and you may have to cut back even further. on those when you're with your diet. The neurotransmitters are proteins in the body that create a signal in between your nerve cells. So they help your nerve cells tell the other nerve cell information. So these proteins are really important for us to feel good. So some neurotransmitters include serotonin, dopamine, and GABA. to just name a few. And our diet has a big influence on how well these neurotransmitters are produced. And the first thing we always focus on is protein because you need to have enough protein in your diet to be able to produce these neurotransmitters. So you eat protein and that gets broken down into amino acids. So amino acids are the building blocks of your protein. So then your body takes these amino acids and turns them into neurotransmitters. so if you're deficient in protein, if you're not getting enough protein in your diet, the body may not have enough of these amino acids to make your neurotransmitters. And so things like serotonin, serotonin is like that feel-good neurotransmitter, right? That helps you feel calm and happy, it helps you get a good night's sleep, it helps lower pain in the body. And so we know that one of the things we need to focus on is making sure you're getting enough protein in your diet to support the production of the serotonin, for example. So I always focus with people, I say, so let's first make sure you're getting enough baseline protein in your diet. And a general rule is one gram of protein for every kilogram of ideal body weight. So what your body weight should be in pounds divided by 2.2 will give you your kilograms. Right? Or what your body weight is divided by 2.2. That gives you your body weight or ideal body weight. And then, then you'll say, okay, I would need one gram of protein for every kilo. And so for somebody who's around 150 pounds, that's about 70 kilograms of protein that they should be eating in a day. And we make sure that they divide up that protein equally throughout the day and not just have it all at night because you really need it during the morning and the mid midday. Whenever you're eating, you want to have a good protein source. What I recommend for most of my patients is that they balance their animal and vegetable protein. So good sources of animal protein would be eggs and chicken and fish and good sources of vegetable protein would include things like beans and legumes and nuts and seeds. So you want to balance both during the day. So a typical day might be a vegetable omelet for breakfast. and at lunchtime you may have lentil soup because the lentils are a good source of protein and at dinner some salmon and vegetables with some quinoa for example. That's a great way to have some protein at each meal of the day. What we'll often do in terms of testing is to look to see if somebody has signs of insulin resistance or pre-diabetes or issues with carbohydrates. We'll look at their waist to hip ratio, we'll look at their fasting blood sugar, we'll look at their fasting insulin, We'll look at hemoglobin A1C, and sometimes we'll do some particle size testing of their cholesterol. When we're looking to see if people have issues with foods like food allergies or food intolerances, first of all we'll do a celiac panel to rule out celiac disease, which is a significant intolerance to gluten or where gluten starts to cause an autoimmune reaction in your body. We will often also do food sensitivity testing, and those are an IgG or an IgE reaction to food, more of a delayed reaction to a food that we can get some information about with food sensitivity testing. All food allergy and food sensitivity testing has false positives and false negatives. So there's no perfect test out there. Food allergy testing is typically done with looking at IgE or immediate reactions to foods. Food sensitivity testing measures IgG and IgA reactions to and is more of a delayed reaction. So there's no perfect test out there, but food sensitivity testing can help us guide patients to decide what foods they should do a trial of elimination from their diet. What we typically do is combine food sensitivity testing with an elimination diet. Elimination diets are really the gold standard to help us determine if a food is causing a symptom. so what we do is you remove the foods that you're either concerned about or the foods that you tested positive for on food sensitivity testing for a period of at least three weeks. So you remove those foods for three to six weeks, you see how the body is feeling, and then you can start to reintroduce one food at a time. What you notice on a lot of food sensitivity testing is a lot of things will come up that really aren't causing symptoms for the body. So that's called a false positive. It comes up on the test as an issue, but it's actually not causing symptoms in your body. So when you start to reintroduce the foods, if you're not getting symptoms from the food, then you can go ahead and eat that food without issue. Now with food allergy testing, it's a little bit different. If you've ever have a history of an anaphylactic reaction to a food, then you don't necessarily want to reintroduce without the assistance of a physician or a medical provider to help you through that process. You know, we always go back and we say, okay, if somebody has a lot of sensitivities to foods, we have to work on healing the gut, right? So we put them on a five-hour program to work to heal the digestive system. Many times over years, you know, over months and years, the digestive system should heal. And many times people are able to add back in foods that they were once intolerant to and now they can consume. The 5R program is the basic program we use to help with healing the digestive system that the Institute for Functional Medicine put together. And in the 5R program, the first R is remove. And what that means is you want to remove any foods that are causing the gut inflammation and any infections that may be causing the gut inflammation. So if somebody has an overgrowth of yeast or a bacteria, we have to work to remove that. So that's remove. The second R is replace. And what that means is we need to replace digestive enzymes or things that help the body digest their food. When the body is reacting to a lot of the foods and you're getting inflammation from food, then if we use something that helps the body digest those proteins, a digestive enzyme or something like betaine HCL, those things will help break down the protein so the body doesn't react to those foods as much. And then when the gut has healed, that person doesn't necessarily need to always stay on a digestive aid, but that's replace. Re-inoculate is the third R, and that just means giving the body probiotics. So we'll give patients probiotics, the good healthy bacteria, or prebiotics, the things that help feed the good healthy bacteria.

The fourth R is repair.

And so when we're working to repair, we'll add things like glutamine, different vitamins and minerals like zinc and vitamin A that help repair that barrier in the digestive system. And the fifth R is rebalance. And what's important to recognize is that the amount of downtime you give the body the time that you give the body for rest and renewal and healing, breath work, relaxation exercises, meditation, all is very helpful for the body to heal and is necessary for the gut to heal as well. In order to help personalize diet, we'll often do testing that looks at vitamin, minerals, and fatty acid levels in the body. So we'll look at their nutritional status. We can test everything from omega-3 levels using an omega-quant test, which is very helpful. I find that test really helpful for following up and making sure somebody's getting enough of the essential fatty acids in their diet. We can do tests that look at mineral levels in the body, amino acid levels, protein levels in the body as well. And then finally we'll do testing that looks at your genetic variations that impact your individual needs for different vitamins and minerals and support. So there are some genes that can impact your underlying need for different vitamins and minerals and different nutritional support. So if you have a variation in a methylation gene, that may result in you needing more methyl folate that comes from your foliage, your green leafy veggies, and some people might need an additional supplement when they have those genetic variations. We may see variation in your glutathione genes, the genes that have an impact on how you detoxify. And if that's the case, we may give more support in that area. Supplements, things like NAC or glutathione or supplements that help the body with producing glutathione. So if we find somebody is deficient in a mineral, a vitamin, an amino acid, and essential fatty acid, we always start with diet first because there's so much you can get from your diet and that's very important to start first with diet. But many times people have either because of genetic reasons or digestive reasons and they're not absorbing optimally or they're so deficient in an area that they do better if we support with some supplementation for a period of time. So I'm often adding in supplements essential fatty acid supplements or extra vitamin D or extra methylated B vitamins or extra zinc and minerals to help the body heal. So if it's going from a state of deficiency, sometimes it needs a little bit more support to get to its optimal state. I had a lot of silver fillings placed when I was a kid. I probably had 11 or 12 mercury fillings in my mouth. And when I first started working for Mark Hyman, Mark would say to me, you know Liz, you've got to get those amalgams out. And I resisted because as so many people realize, it's a lot of work to go and have them replaced and it costs money and you're not really sure of how much it's going to help. I finally did some testing that showed, okay, I really should have them removed. I wasn't detoxifying very well because of genetic reasons and maybe some of just my nutritional status and my needs. And so I went through the process of having my amalgams replaced. I made sure I went to a dentist who would take precautions and do it in a safe manner. And they placed a dental dam so that the mercury, when they were pulling it out of my mouth, it wouldn't get back into my body. They placed oxygen on me so I wouldn't breathe in the mercury vapor. And we broke it up and did my mouth in sections because, as I said, I had a I had over 11 silver amalgams that needed to be done. And I also supported my own body's detoxification system. I took extra NAC, I took extra glutathione in a liposomal format and supported my own body through the process. After I had my amalgams replaced, I actually did a little bit of a detox protocol. I didn't actually do chelation therapy, but I did a detox protocol that used some glutathione, liposomal vitamin C, and a binder to help with removing any mercury that had gotten released in my body. And I've got to tell you, I felt so much better afterwards. It took me about six months or so, but I started to notice a big difference in my neurological system, in my recall, in my energy, and especially in my immune system. it made a big difference in my overall health. With all of my patients, I always focus on stress reduction and stress management. We all need support in that area. It's really at the base of the matrix. It's at the foundation of good health. It's doing something for yourself every day to calm down the body. And some people need more support than others, but we all need to be doing something for ourself every day that helps with calming down the body. and maybe that's going to a yoga class or doing 15 minutes of breath work or doing a meditation app. Very, very important for lowering cortisol levels in the body and helping with the body's ability to heal. We know that when cortisol levels are high, our body's in this fight or flight space and the body's not really working on healing. So doing what we can to engage that parasympathetic nervous system, that calming nervous system, is really critical for the body to be able to heal and regenerate. And that includes the brain as well. So another way that we often personalize the diet is with intermittent fasting. Some people do really well when we cut down the number of hours that they eat in a day. So intermittent fasting can mean a whole bunch of things.

There's many ways that you can do.

Intermittent fasting or time-restricted feeding. In general, a lot of research has shown that if you don't eat for at least 13 hours overnight, that that can have beneficial effects in the body. It can lower oxidative stress, it can help improve the mitochondria, it may even improve BDNF. BDNF is a substance in the brain that's really good for our neurological system. It helps our neurons connect and communicate with each other really well. and higher levels of BDNF have been associated with lower depression, lower dementia. So we want to do whatever we can to improve our BDNF. And intermittent fasting, as well as exercise, are two things that we can do that may increase our BDNF levels. There's a lot of ways that we can do intermittent fasting. Some people do longer fasts at night.

So.

Some patients will really respond well to doing a fast for like 16 hours at night. What a lot of patients are doing though are they're skipping those morning meals. And what we know is that as the day goes on, the nighttime meals are more likely to cause that spike in insulin and blood sugar. So we really want to be cutting off eating by like 6 o'clock at night maybe, that may have better benefit for mitochondria and for insulin resistance. resistance, health. Not everybody does well with intermittent fasting, so you really have to pay attention to how your body feels and what your body needs. So it's not something that I recommend across the board. But if somebody's been doing a good, healthy, low glycemic, whole foods diet, and they're not reaching their goals, and we see this a lot. So patients will be doing, they're like, I'm doing everything right. I'm exercising well, and I'm following the diet, but I'm not losing the stubbom weight around the midsection, that may be a time where we say, okay, let's try some intermittent fasting or some low calorie intermittent fasting. So I've had some patients that a couple days a week, they've cut back their calories to like 500 to 600 calories two days a week. So that'd be low calorie intermittent fasting. The other days they would have more of their regular eating plan and just restrict eating for 12 hours at night. and those two days of low calorie eating has been something that's really kicked their metabolism into gear and helped them with the weight loss. Sometimes patients will have more metabolic inflexibility and what that means is they don't tolerate their carbohydrates as much as they should or as much as they used to. And so for some patients we may have to lower the carbohydrates more for them to reach their goals. Sometimes with patients who have issues with neurological disease or they have Alzheimer's disease or seizures, epilepsy, Parkinson's disease, we may try a ketogenic diet. A ketogenic diet is a diet where we remove a lot of carbohydrates. So it's a very, very low carbohydrate diet. Maybe only only 20 to 50 grams of total carbs in a day. And the amount that somebody needs to eat really varies based on their genetics and who they are and what they have going on. But it's a very low, low carbohydrate diet. And what the ketogenic diet is doing is it's stimulating the body by lowering the carbohydrates so significantly, it's stimulating the body to take its fat, fat that, that it's eating or fat from the body and turn it into ketones for energy. Those ketones then are used for energy as opposed to the carbohydrates. So when you lower the carbohydrates significantly, then the body will reach for those ketones for energy. And there's been some good research to show that for some people, that's very helpful. So when we know for epilepsy or seizure disorders, a ketogenic diet can significantly, for some patients, help lower the amount of seizures that they're having. There are some patients also with dementia or Alzheimer's disease or other neurological diseases that will benefit from a very low carbohydrate ketogenic diet. What I recommend for people though, if they're going to try a true ketogenic diet, is that they work with somebody. They work with a nutritionist, who, and a medical professional who can really help them learn how to monitor themselves. Because you need to monitor the amount of ketones you're producing and you need to do some blood work periodically to make sure that this diet is safe for you. There are some people who should not do a ketogenic diet. So the first group of people are people who have elevated triglycerides. So on your cholesterol test, if your triglycerides are over a thousand, then you want to definitely stay away from a ketogenic diet. We also recommend that people who have issues with their gallbladder, that they should really be careful on a ketogenic diet. With patients with type 1 diabetes who are on insulin, they have to be very carefully monitored or avoid a ketogenic diet. Mitochondrial dysfunction occurs when there's been damage to the mitochondria. mitochondria. And if you remember back to biology, the mitochondria are the powerhouse of your cells. We have mitochondria in many cells in our body, or most cells in our body, and these are these organelles, these small organelles that take our food and they turn our food into ATP or energy. So there's the Krebs cycle that lives in the mitochondria, and that's what takes our food and turns it into ATP or energy. So when there's been damage to the mitochondria, they're not working properly and that's what we call mitochondrial dysfunction. One of the main things that causes mitochondrial dysfunction is a poor diet or a diet that has a lot of junk food in it. The reason we call junk food junk food is because it has a lot of calories. Junk foods have calories but not not a lot of nutrients in them. And you need to have a lot of nutrients for the body to take your food and turn it into ATP or energy. You need to have enough vitamins and minerals. So when you're eating a diet that's high in foods that don't have a lot of these vitamins and minerals but is high in calories, that's one of the major reasons that people have problems with their mitochondria. You can also have problems with your mitochondria because of toxins like heavy metals or pesticides, you can have issues with your mitochondria after you have an infection, like a big infection, and you can have issues with your mitochondria if you're not doing enough exercise as well. Genetic variations can also impact how well somebody's mitochondria works. When a patient comes to see me and they're feeling a lot of fatigue or muscle pain, achiness when they walk up the stairs, maybe they have signs of multiple sclerosis, or Alzheimer's disease, dementia, Parkinson's disease, migraine headaches, or just headaches in general, I think about the mitochondria. When patients come with chronic fatigue, all over body fatigue, we think a lot about the mitochondria and what we can do to help improve the mitochondria. And we ask that question of why, why is the mitochondria not working as well as it should be? Testing for mitochondrial dysfunction is is something we can do here at the Ultra Wellness Center and we do it all the time. We'll do a urine test often that looks at urine organic acids and it's a test that looks at all the different steps of the Krebs cycle and can give us an indication if somebody's having problems with their mitochondria. We can also do tests that look at oxidative stress markers. Oxidative stress is something that can damage the mitochondria and so if we see high levels of these free radicals or oxidative stress, then we can infer that there may be a problem with the mitochondria. Finally, we'll do tests that look at functional markers of B vitamins. So things like methylmalonic acid and homocysteine. These are blood tests that can tell us if somebody has enough of these B vitamins like B12 and B6 and folate. And B vitamins are critical for the the functioning of the mitochondria because B vitamins are cofactors. They're cofactors that help the steps of the Krebs cycle work properly. So if a patient has signs of mitochondrial dysfunction, whether it's signs of clinical mitochondrial dysfunction or based on testing, then the first thing we do is we say we've got to clean up the diet. So we put somebody on a whole foods diet. We take away a lot of that junk food that is devoid of the vitamins and minerals that the body needs. And that's so we put people on a diet that's really rich in vitamins and minerals and these co-factors that help the mitochondria work better. So the first thing we always do is focus on diet. We also focus a lot on self-care other aspects of self-care exercise is really important for helping to increase and improve mitochondrial function. So we know we can increase the number of mitochondria people have in their muscles through exercise. We can increase the amount of mitochondria that somebody has when they do more exercise. So getting somebody to increase the amount of exercise they're doing is something we focus on. Well, the American College of Sports Medicine recommends about 150 minutes of cardiovascular exercise a week and two days a week of strength training. It's important that we look at where the patient's at. So if they're not doing a lot of exercise, we just say, okay, let's get out and get walking and get moving again and get in a half an hour of walking a day. And if somebody's been doing a lot of exercise but needs more support for the mitochondria, we may increase the intensity of the exercise and add in something like high intensity interval training or HIIT. to help increase those mitochondria even more. Most importantly, when we're working with a patient with mitochondrial dysfunction, we have to ask that question of why. Why is there issues with the mitochondria? Is there a toxin? Is there an infection? Is there some medication that they're taking that is causing damage to the mitochondria? And so we need to work to remove those things so that the mitochondria can heal. Many times supplementation also helps. You know, a good multivitamin, a good B complex, some vitamins that have some CoQ10 in it, or things like phospholipids, like phosphatidylcholine, can be used to support the healing of the mitochondria as well. Almost 20 years ago, I was diagnosed with a invasive triple negative breast cancer. And so for treatment, I went through surgery and chemotherapy and radiation. And many times when people have fatigue after chemotherapy, it's because of the damage that the chemotherapy has done to the mitochondria in the body. And I definitely had that fatigue. I remember having a lot of all over fatigue, but I also had significant muscle fatigue. So when I would walk up the stairs, my muscles would ache. I would have this this muscle ache that was, I would have this ache in my muscles that was really difficult to handle. And so I realized over time, and as I learned more about functional medicine, that, you know, I was having issues with my mitochondria and I needed to work to really support them. And so how was I able to support them? The body is, you know, has its own innate ability to heal. So when When we just give it time, sometimes it's able to really just heal on its own. So time is very important. Many times that fatigue just gets better over time and everybody realizes that. I recognize that and a lot of patients do after chemotherapy. The other thing that I focused on and I focus on with my patients is really just all those aspects of self-care. Giving your body time to rest and sleep and regenerate. Make sure you're getting a diet that's rich in whole foods. And I also added in some of those mitochondrial supplements, things like B vitamins, CoQ10, phosphatidylcholine that really helped my mitochondria heal and that fatigue go away. If you're going through treatment for chemotherapy, one of the best things that I found that was helpful was to stay active, as active as I could. so sometimes you just feel really tired and you don't want to really do much activity and you just want to rest, but moderate exercise is really helpful. So whatever you're able to do, maybe it's going for a 20 minute walk, you don't want to necessarily, if you're not up to it, do intense exercise, but if you can do some moderate exercise that helps you feel better, it helps lift your mood, and we know that people that do some moderate exercise, do better. They have better survival post cancer and they do better with the treatment. So whatever you can do in terms of exercise, maybe go to a yoga class or as I said, do some walking outside, maybe some Pilates, very helpful. And then focus on getting, you know, as I said, more whole foods in your diet. So, you know, making the right food choices more often. The other thing that helped me significantly when I went through chemotherapy was Reiki. I had a woman who did weekly Reiki sessions on me and that energy work was very helpful for my symptoms and it helped me heal significantly. We don't have any practitioners here at the Ultra Wellness Center that do Reiki, but I refer patients to do Reiki all the time. When we're working with somebody with their diet, we do some of the basics with everyone, right? taking away the junk food, going toward a whole foods diet, adding in healthy fats for brain health and overall health. And we make sure that we're balanced, that they're balancing their blood sugar so that at every meal they have some good healthy fats, some good protein source, and that they're not taking in a lot of added sugar and they're getting a lot of fiber. So at every meal you want to make sure you've got a good fiber source, that you've got a good protein source, and you've got a good healthy fat source. And that helps balance your blood sugar. So those are the basics. But then we have to look deeper and say, okay, does somebody need to have to go a little bit deeper with their diet?

They estimate that 20 to 30% of patients who come into their primary care doctor's office come in with the chief complaint of fatigue.

So I'm tired.

I'm tired. And so it's a lot of us. It's a lot of people that we see, a lot of people we see here at the Ultra Wellness Center. One of their main reasons they want to come in is I'm tired and I want to feel better. So I think functional medicine is really well, I think it's great for whatever we're working on, but I think it works really well with fatigue. In conventional medicine, all of our training, we were really focused a lot on acute care medicine and not enough on chronic conditions. And definitely we're not often given. Physicians aren't often given enough time to really delve into a topic like fatigue, which can be so complex. So one of the great things in functional medicine is we really focus on getting that timeline of the patient's history, which is so important because it really helps us determine what's going with that patient, why do they have that fatigue? And I think that's really critical. And one of the great things about functional medicine is we talk about their timeline, which just means, you know, their whole life story. You know, what was their life like as a child? Even when they were a fetus, you know, what kind of illnesses did they have when they were younger? How did they feel when they were in their 20s? All of that really influences what's going on now and how we work work with them when they come in saying, I have fatigue, I'm tired.

You're right. And I think this is something that I had the insight about decades ago with functional medicine, that when we were trained in medical school, we were trained to create an exclusive history. In other words, focus on the problem. If it doesn't seem like it's related to that problem, then you just ignore it. So if someone comes in with heartburn and they also have a rash and a headache, you go, well, you go to the headache doctor, you go to the skin doctor, I'm gonna take care of your heartburn. And we don't connect the dots. Functional medicine is an inclusive history where we look at every possible symptom, every possible exposure, where you were born, when you were born, whether you're breastfed, whether you took antibiotics, whatever it is. And we try to connect the dots and see that, what you call the timeline of how this all leads to the person being sick in this moment. And when you do that, you often get to see the answer. And the patient goes, oh yeah, when this happened when I was 23, then I got, oh yeah, I was in Thailand and I got sick and I never been the same. And so we begin to hear these stories and you begin to connect the dots. But when you go to a traditional doctor with fatigue, what do they do?

Yeah, right. They get a battery of tests. Maybe they'll do a quick physical do some of the basic tests, and then a lot of times those basic tests look normal. I mean, that's what patients come to me all the time with. Yeah, my tests were normal. And they said, maybe you had some depression. And I don't blame-- the Prozac is.

The treatment for depression. I mean, for fatigue.

Maybe you had a little depression. It's not that we're, you know, they don't blame physicians for that. They're given a very short amount of time to deal with this very complex symptom.

You're basically anemic, you have low thyroid, or you are depressed, or maybe you have cancer that we have to look for. But there's a short list and if those things don't pan out, there's not a lot to offer. Yeah, and you- Well, they give you Ritalin. Or maybe they give you Provigil. There's drugs, but they often don't work.

So, I mean, I think what's great with functional medicine is we really, as I talked about, take that really detailed timeline and history and look to connect the dots. And we're wondering, okay, what's going on, of course, with that person's lifestyle? Of course, we're paying attention to sleep and diet and exercise and stress, but we're also thinking about all the different systems in the body and how they're influencing somebody's energy level. So everything from is that person dealing with a chronic infection? Right? So chronic infections we've gotta think about and delve through.

Like Lyme disease or a virus.

Absolutely, right? Yeah.

And they're not acute infections. They're these things that are lingering, smoldering things that don't make you acutely ill.

But that are staying there affecting your overall health. That can happen a lot of times, right? And sometimes acute infections turn into chronic infections and sometimes people just have these smoldering infections in the digestive system that can really wear their body down, an overgrowth of yeast or some bacteria. And the body's just chronically having to fight that and it's exhausting. So your microbiome can make you tired.

If it's not healthy.

Absolutely. If it's not healthy, we see that all the time.

Yeah.

Right?

And then of course we're paying attention to the mitochondria, that's the powerhouse of those cells that take your food and turn it into ATP. to peer energy. And so there can be many reasons why that's, those, those organelles aren't working well. And so we're thinking about that. Toxins.

Sugar.

Yes. Infections, just genetic variations. And I think that's another thing that's really important that we pay attention to is, is, you know, do, does this person have some variations in their, in their genetics that are influencing their energy and their requirement? for certain nutrients. We of course pay attention to hormones, the thyroid hormone, the adrenal hormones, the female and male hormones. We really are looking at all aspects of somebody's health. And that, I think, is really helpful to determine, okay, what is the cause for this individual person? Yeah, because fatigue doesn't really mean a whole lot.

And then I'm tired, and it could be caused by so many things. For me, it was mercury. It was mold and then it was my gut. And then, you know, I think I've become an expert in fatigue because I had chronic fatigue syndrome, which is like the most extreme version of it, where you can barely drag yourself out of bed and barely function, you have brain fog. I mean, that's the extreme version of it. But it's really a continuum and we can really drive people to a solution by being these medical detectives that look at all these variables that people really don't look at.

It's so important to ask those questions, right? Of how long has this been going on? Did it just start? Has it been your lifelong, you know, have you been life, your whole life been a little more tired than, you know, your somebody, you know, other people that you know, you know, you're always feeling a little tired or is it some acute change that happened? When did it happen? Are you tired all the time? Are you tired certain times of the day? Are you tired in certain locations, right? And not and others when you think about things like toxins and molds. So there's so many interesting questions that we have to ask. And so one of the things at the Ultra Wellness Center that we do is we've got one of our PAs will take a really detailed history before you even see the doctor that helps us. So 40 minutes or even more getting your whole story. Well, first you fill out a whole a whole patient packet, which is long and extensive, then the PA gets a long history from you, and then we get a lot of time with you as well. And all of that really helps to put together your individual story, which is really what's helpful.

You see all these patterns, right? You see all these patterns, you connect the dots, you see how things are linked up, and then you can decide to dive into different areas of testing, right? You say, well, you know, I had that tick bite when I you know, five years ago, and I've never been right since. Or, you know, like I love tuna fish and I live on Martha's Vineyard and I eat swordfish every other week. And, you know, you go, maybe it's mercury or, you know, you ask other questions related to their, for example, hormones. Well, you know, how's your libido and sex life? And if you're a guy, your testosterone goes down, that could be it. Or maybe your thyroid is not working. Or maybe, you know, we look at your nutritional status because, you know, vitamin D can cause fatigue if you're low in vitamin D. So we kind of really do a comprehensive map based on your story and that directs us to exactly what to test. And what are the kinds of things that you found are the common drivers of fatigue for patients?

Oh, there's so many and we can go through a few cases, but nutritional deficiencies, huge. You'd think that we were adequately, we had adequate nutritional status, but so many of us don't, whether it's because of digestive issues and we're not absorbing well or just inadequate intake or we're dealing with some sort of chronic toxin exposure that's wearing down our body.

Or eating processed food or the soil is depleted. Oh my goodness, right. Or stored for, I mean the average.

Apple you eat has been stored for a year.

Yeah, absolutely. Go pick an apple from a tree.

And go eat one that's been in a warehouse for a year. Very, very different experience. Yeah, so I mean of course we're seeing nutritional deficiencies. I see a lot of genetic variations that influence somebody's energy level. We see digestive issues that influence energy level. We see chronic infections and of course toxins.

Heavy metals.

Heavy metals. You know what I think is really great, some patients even come in with their timeline, you know, and sometimes that's so helpful because they write down, you know, over the years when certain things happened in their health history. And then you can look at that and again, start to see some of these patterns.

Yeah. And so, when I remember when I had chronic fatigue, I went to doctor after doctor after doctor, and they're like, well, there's nothing wrong or your testosterone or this is a little off or that's a little off, but nothing really. And take some Prozac, here's something for sleep. And it's so frustrating as a patient to go through this litany of doctors and not really getting an answer. and I think that fatigue you don't often treat directly because you can take Provigil which will sort of make you more awake or you can take Ritalin or Adderall which is like a stimulant to help you have more energy. But those are sort of like beating a dead horse. You have to figure out what's really going on. And I think when I first sort of discovered what happened with me was the Mercury was the thing that that was driving it. And it created a whole cascade of problems. So it affected my gut, it affected my immune system. So I was chronically inflamed. I started developing all these rashes and all these sores and all these things where my eyes would look like a raccoon if I ate certain foods, I'd get bloating. And I also developed real cognitive issues and real trouble thinking and focusing and fatigue. And I realized that these insults that happen affect all these different systems in your body. So when you're diagnosing someone with fatigue, it's all the other symptoms and all the other pieces that give you the clues about what's really going on for this person. So it's not like one treatment for fatigue. There's dozens and dozens depending on what you find with that story.

Right, and that mercury for you just depleted your glutathione stores and that then influenced all these other aspects. the effects of your health. Yeah, right.

Poison my mitochondria. And, you know, it turned out I had a gene that affects my muscle enzymes, my energy cycle in my mitochondria. Yep. And at least to have an easier ability to be damaged by it, which is why I had this elevated thing called CPK, which is a muscle enzyme. And it was this abnormal test, but it wasn't really so severe that it was a disease, but it wasn't normal. They're like, I don't know what's wrong. But we can figure that out using the roadmap of functional medicine.

I think it's so interesting how some people just need more support than others in certain areas. And we talked about this on another podcast about supplements, and I think that's what the key is, is when you figure out for that individual person where they need that extra support in a personalized way, it makes all the difference in the world.

I remember I was giving a lecture, in your ranch one year. And I'm like, this guy's like, you know, I'm always tired. I don't know what to do. I said, how many hours you sleep? He's like, six. I'm like, sleep eight.

That'll be $500 please.

Sometimes it's just that simple, right?

I'm like, sleep. So, yeah, quality of sleep also matters. You know, sleep apnea is another cause.

It's often very undiagnosed in patients. Often undiagnosed and something we have to look for, you know, we look for the signs of sleep apnea from somebody snoring, not remembering their dreams, their blood pressure being elevated, they're not having a harder gaining weight, right? Because it causes the weight gain, it causes you to gain weight around your belly, signs of insulin resistance and metabolic syndrome, that high fasting insulin, the high waist to hip ratio. You know, all those things make us think, okay, we got to think about sleep apnea. And then when we examine them, sometimes you can see clues on exam and it's It's critical that we diagnose it and treat it because it makes a huge difference in not only how somebody feels, but their risk for all sorts of diseases, right? From diabetes to heart disease to, you know, sudden death for that matter.

I mean, it's-- yeah, sudden death, that's.

Not a good outcome.

No, that's not good. So Liz, you had a couple of cases I want to share with everybody. And this 35-year-old woman with weight gain and diabetes, and tell us about her and how she presented. and what you found and how you worked up her case and what you did with her.

So this woman came to see me when she was 35 and she had obesity and type 2 diabetes and depression and heartburn. She had a lot of other things too, but those were some of the main issues. And actually, the reason she came to see us was because her depression medication wasn't working and she's like, I really need to find another way to deal with this. So she had, when we looked at her timeline, right, she started gaining weight when she went to college in her 20s and started to put on a bunch of weight. Enough weight also, and maybe she was at that point making a lot of the wrong food choices, she also started to get some heartburn. And in her 20s, so she was put on a PPI. She was put on the acid blocker when she was in her 20s. And she was still on that same acid blocker now, 15 years later. So she was put on the acid blocker in her 20s for her reflux.

And those medications, when they came out, they were not designed to be taken forever. They were six weeks for an ulcer. We were told they are very powerful drugs that suppress acid production in the stomach that cause long-term complications. And they do. But we now have them for sale over the counter. And doctors prescribe them like candy, and they have serious complications if they're used liberally like that.

Absolutely.

Instead of figuring out why you have heartburn in the first place.

The person got off it because the heartburn kept coming back. So here she was 15 years later. And then she slowly, after college, the weight just kept coming on. So she just kept gaining more and more weight. Her health was just deteriorating in a way. She just got more and more tired. And then in her later 20s, she started to have some depression. And she was, you know, she was tried on a bunch of different antidepressants and they didn't really make any difference. And then a couple years before she came to see me, she was diagnosed with type 2 diabetes. So she wasn't yet on her any medication for diabetes. She was trying to control it with diet, but her blood sugar was high enough to get the diagnosis of diabetes and she's only 35. Wow. and she just wasn't feeling good. So she said, you know what, I've got to try a different way. So she stopped her antidepressants 'cause they weren't doing anything and came to see us. And so for me, looking at her timeline and putting together, connecting the dots, when I see somebody with fatigue and depression and on a PPI, on an acid blocker for so long, you know, one of the things I really think about is protein and what is that person's protein status.

Why is the acid blocker a problem for protein?

Right, so you need acid in your stomach to break down your food and it starts acid also encourages a lot of our digestive enzymes to work, which is all really necessary for the body to break down its protein into amino acids that you can absorb and then when the body absorbs those amino acids, they get used in the body for all sorts of different things from healing your skin to making muscle but also they're used to make your neurotransmitters.

Your happy new mood chemicals.

Absolutely, right? So they make your serotonin and your dopamine and your GABA which help you focus and have energy and feel happy.

That sounds good.

Yeah.

Focus energy and feel happy. I want some of that.

So when When you take an acid blocker, you're decreasing your ability to break down your food and break down your protein and pull all those really important amino acids from your food. And for some people, and depending on the length of time you're on it, it can have a huge impact.

It also impairs other nutrients like B12, which also is a big cause of fatigue and depression.

Dr. B12, it impairs the absorption of a lot of your minerals. we see people develop osteoporosis after years of being on these acid blockers. So people will have low zinc, low calcium, low magnesium.

And zinc is more important than ever with COVID-19 because it helps to inhibit the viral attachment and replication.

Yeah, so important for your immune system. Right, so I saw that she had this depression, the fatigue, the acid blocker and I go, oh, I wonder what's going on with her protein. So we do this cool test where it looks at plasma amino acids, which are those building blocks of protein in your body. So you can measure your amino acids in your blood.

And we did.

So we measured her amino acids and she was low in lots of amino acids. I wasn't surprised. And you think I'm seeing a protein.

How can she be low in amino acids? We don't see protein malnutrition in America, but we do see large numbers of patients with very low amino acids for a variety of reasons.

Right, right.

And so, you know, I suspect with her that the acid blocker was a huge reason for that, that she just wasn't breaking down her food well and absorbing her amino acids well. And so one of the things we were able to do was give her some of these amino acids for the period of time. so we gave her a complex of amino acids. And then I also gave her some amino acids that were really focused on production of neurotransmitters. So things like tryptophan, 5-HTP, tyrosine, GABA, these things that help the body with production of those neurotransmitters. And you have people take the amino acids between meals because it helps with, it's better absorbed that way. And that was really helpful for her. You know, that helped her energy. She noticed a tremendous difference in her energy. It actually helped her hair. That wasn't, you know, she wasn't coming in complaining about it. It helped her hair.

It helped her hair, right?

Yep. And it helped her mood. So it made a big difference in the depression. So she was started to be more active and move more. And then of course, we wanted to wean her off of the acid blocker. And with the type 2 diabetes, we also needed to work a lot on her diet also, of course. So we put her on a low glycemic diet. We took away all the refined carbohydrates and the simple sugars and made sure she was getting good quality protein when she was eating and good healthy foods. And with that shift in diet, we've been slowly able to wean her off of the acid blocker.

Which is again another one of the things we've talked about on the podcast which is reflux or heartburn. And it's such a problem. These medications are in the top three of all medications prescribed in the world and they're very powerful and strong and they do have this negative impact on causing everything from small bowel overgrowth and digestive issues, they cause irritable bowel, mineral deficiencies, osteoporosis, pneumonia and so forth. But what's interesting is that the way they're designed makes it almost impossible to get off of them. And you have to know what you're doing. So you have to sort of deal with the causes of what the reflex is, which is often diet. Sometimes it's a bacteria. But then you have to slowly taper it off. There's something called rebound that happens. So you basically stop it and you get a flood of acid. and that causes more heartburn. So you really have to know what you're doing. And people think, oh, I've tried to stop, but I can't. For those listening, I want you to understand that there is a way to get off of these drugs, but you can't just stop it like that. You have to know what you're doing, and you have to figure out what the cause is.

So like you said, you're changing your diet. Absolutely. She doesn't need it anymore. Yep. Right? And well, you know, she needed it less and less, but we still needed to wean her, like you said, because there's that rebound that occurs when you you've been on it for a long time. So we did have to wean her and use some other things to help with, you know, we used a little DGL. We had to use some other things to help her digestion in addition to diet. And we were able to, you know, wean her off of it. So in the long run, her absorption of her protein is going to be better. So her mood is going to be better. So, you know, and of course now her blood sugar is getting way much better and she's losing weight. and she's feeling happier, you know, it's pretty phenomenal.

So fixing her gut and giving her some amino acids, that's not something that most doctors will do when someone comes in with depression or fatigue, but it's really how we approach patients at the Ultra Wellness Center and really the beautiful thing about the model of functional medicine, because it can help so many people with, you know, challenging issues that nobody can figure out. Absolutely, absolutely, and it's fun to do, you know. It's so fun, yeah, it makes it medicine interesting because I remember I used to work in the emergency room for years and I found it really boring. And how can you say it's boring to work in the emergency room? There's all this excitement and this and that. I'm like, well, once you've learned the recipe for everything, what's the recipe for asthma or back pain or heart attack or stroke or someone who's got, you know, needs to be intubated or someone who comes in with a fracture, whatever, dislocated shoulder, it's like a cookbook recipe. So, you just look at the nurse and you go, heart attack treatment, stroke treatment. They know, you have to write the orders, but it's like everybody knows what's going on. There's no thinking involved. You make, you know, it's a kidney stone, you do this. And most of the things you see in the emergency room are relatively common and relatively easy to diagnose. And occasionally there's a puzzling case, but it's kind of boring. And I found that functional medicine is a constant puzzle. that you have to figure out everybody's different. It's totally personalized. Talk about precision medicine, personalized medicine, precision nutrition, personalized nutrition. That's what we do. That's what this is about. And no two people are the same. And you could have somebody else coming in with depression and fatigue and diabetes and they could have a different story.

With different factors and different causes. And I think that's why so many physicians are turning to functional medicine. because, you know, of course they have this inquisitive mind and they want, they're problem solvers and they want to look at how all the patterns come together. And I think that's really what has attracted a lot of people to the training because it's getting us back to really, you know, looking at that whole person and the individualized person. It's true.

I think there was some tech conference out west where they said, you know, functional medicine was sort of one of the leading trends in medicine and healthcare. So I think that's true. So you have another case, Liz, 50-year-old woman who also had been fatigued her whole life and, you know, been working hard. And tell us about her and what was going on with that. Because it was a little bit of a different story.

Absolutely. So she was 50 when she came to see me, and the real reason she came in was her weight. She had started to put on weight, and she was frustrated with it. So she came in because she's like, I, I want to get some of the weight off. But she also noted that she had significant fatigue. It wasn't fatigue that kept her from working. So she was actually a worker. She was very successful with her job and she had worked her whole life and she sort of pushes through, you know, and but more fatigue than, you know, other people around her. She'd note, you know, even when she said even when she was a kid, she had more fatigue than her friends. And she would want to sleep more and, you know, rest more and not exercise as as much. So she noted she had fatigue her whole life. But over the last few years it had gotten worse. And with the weight gain she said, let me go in, let's deal with this. So she came in to see us. As I said, she works all day, she'd come home, she'd cook dinner, she'd have a couple glasses of wine to calm down, and just got up the next day and did it again. So I thought that was really interesting when you hear that on somebody's timeline, right? That long history of fatigue. It makes you think about different things, right? And also hers was like not the level of fatigue. I mean, she still was functioning, but just not at her optimal. So, you know, I started thinking, okay, let's look at her genetic makeup. Let's look at her genetic makeup. So we did a genetic panel that looks at, you know, some snips, some variations in somebody's genetic makeup that can influence diseases that they get, as well as influence need for different nutrients or supplements. And so one of the things we found out is that she had a homozygous variation with the MTHFR gene.

That's a mouthful.

I know.

What is that?

Break that down for us.

So the MTHFR gene is a gene that encodes for an enzyme. Methyltetrahydrofolate reductase enzyme.

Another mouthful.

Yeah, and that enzyme is involved in methylation or transfer of methyl groups, which is involved in multiple different processes in the body. Everything from detoxification to making your neurotransmitters, to energy production. So it's involved in so many pathways in the body.

Yes, it's basically like this process where you take the carbon and three hydrogens, which is called a methyl group. And I think of like the currency of the body where there's all these chemical reactions happening, literally billions of reactions happening every second. And one of the main ones that is going on is this process of called methylation, which is a transfer of these groups. And there's genes that regulate the nutrients that are involved in pathways, the enzymes that regulate these chemical reactions. And so you can have variations in your ability to do that that can have impact on your health. And that's what you're talking about.

Absolutely. You know, it's been associated with depression. People who have a homozygous variation of this gene, the MTHFR gene, have an increased risk of depression. They have an increased risk of fatigue. They have an increased risk of misCarriages, neural tube defects, and so it's significant. There's been a lot of research on this gene. It's fairly interesting and it impacts lots of different systems in the body. And that enzyme needs B vitamins. So B vitamins are really crucial for that to all work well. And we know that when people have this genetic variation, they can't take folic acid that's a synthetic form of folate that's in a lot of supplements. They can't take that, activate it, and utilize it.

Or even the stuff you get from food sometimes, right?

Yeah, some of the stuff from food too. I mean, a lot of food is naturally methylated, but a lot of our processed food has had folic acid sprayed onto it. It's fortified.

It's fortified.

The body can't really utilize it. It can't activate it and utilize it in the body. and so people, you know, like- and.

Commercially it can become toxic. Absolutely. Cause problems. So if you actually think you're doing something good taking folic acid and you have this problem, you're actually doing harm.

Right, right. They're saying that it may build up in your tissue, might increase risk of cancer. There's a lot of things that we're looking at with that. So, you know, we always focus on the better quality supplements that include a better form of folate, the methylfolate. That was really important. for her in this situation. We also gave her a good multivitamin, a good B complex, and we increased the folate in her diet with all the foliage, the folate rich foods, the green leafy vegetables, but all your vegetables are rich in folate, so we increased those in her diet. And we also dealt with, we cut back on her alcohol because alcohol uses up your B vitamins.

She was drinking two glasses of wine a night to calm down, right?

Mm-. Mm-. You know, a lot of times, you know, people have these genetic variations, but they can express themselves in different times of your life depending on what else is going on.

So.

You know, probably what happened with.

Her is over years of just drinking a little too much alcohol, it became more of an issue because she was wearing down her B vitamins and she needs those B vitamins for that methylation process to occur. So both of the things came together. She had her genetics and her environment and they made the fatigue even worse. We often see that gene express itself or people have problems when they go to college, for example. So kids that have that genetic variation and then they go to college and start drinking more and then they start having problems with depression. That's a kind of a pattern that we sometimes see because you've got the change in diet, maybe not eating as much vegetables, then you're drinking more water.

But mom's not there making you eat your veggies.

And, you've got that genetic variation and then there's so many things that come into play. But I think it's important when you look at that timeline that helps us give us those clues.

Yeah, so true. One of the other big causes we see is just what people are eating. If you're eating a nutrient-depleted, ultra-processed diet with tons of sugar, and inflammatory foods, it tends to cause you fatigue.

We see that all the time. You know, people eating the wrong foods at the wrong time, eating a lot of refined processed foods, causing their blood sugar to spike and then it drops, not eating enough protein. I mean, there's so much with diet that has a huge impact. And like you mentioned, the inflammatory foods, so foods that may be causing inflammation for that person. and gluten and dairy and so... Those.

Are the big ones.

Those are the big ones. And so a lot of times we'll do one of the biggest tools we have in our toolkit is that comprehensive elimination diet. And it can be really helpful for patients. They work with our nutritionists and get on a really good try an elimination diet. And many times patients will say, I started to feel so much better.

Yeah.

And my energy improved.

So true. actually, you're going to be running an online group Zoom elimination diet that's five weeks guiding you through that whole process so people can try it and experiencing it. And, you know, I found this, you know, classically using elimination diets for decades in functional medicine is probably the most powerful tool we use to sort of reset people. And, and nine times out of ten, it works. If it doesn't, it means there's something else, maybe. maybe they're low thyroid, maybe they're heavy metals, maybe they have Lyme disease, maybe there's something else going on. But maybe 8 out of 10 to 9 out of 10 people will see a dramatic change in their health in a very short time. And it's a great test. And it's a great test. It's a great test. You know, that's why I wrote the book, the 10-Day Detox Diet and created the program called 10-Day Reset, which is a basically program you could do at home with online support where you eliminate the bad stuff, put in the good stuff, and you get to see what happens. you know, we always joke about something called FLC syndromes when you feel like crap and that includes being tired and that often goes away very quickly and we sort of looked at a group of a thousand people who went through this and there was a 62% reduction in all symptoms from all diseases in just 10 days. Not to mention weight loss and blood pressure coming down and blood sugar coming down. You know, it's so funny to me as a doctor that Even the smartest people don't connect what they eat with how they feel.

All the time.

We see that all the time. It's incredible to me.

And I think if you get people to just try something, so look, this isn't forever, just do it for 10 days.

Yep.

You see what happens. They go, Whoa, you know, I didn't even know I could feel so good. And one of my patients said, Dr. Hyman, I didn't know I was feeling so bad till I started feeling so good. And I think we were used to that, you know, elephant standing on our toe our whole life. and when it gets off, I go, oh, wait a minute.

It doesn't have to feel so bad all the time. Yeah, it's phenomenal. It is, I think, the best tool we have. And like you said, so many patients, they just get better with just the change in diet, which is phenomenal. And it's a great thing to try.

Yeah, so I think people come to accept things like fatigue, oh, that's just me, or, I'm just tired, or I'm stressed, or this or that. And I think what you're saying is that, There is a way to navigate for each person to what the causes are and then figure out a personalized plan to fix those causes. And in one patient, it was getting her off the acid blocker, giving her amino acids. In another patient, it was figuring out she had this genetic variation, needed special forms of B vitamins to increase her neurotransmitter function and her overall sense of well-being. It's what makes functional medicine is so much fun is being able to actually look at these puzzles and figure out for each person what it is. Because fatigue is just a symptom. It doesn't tell you what's going on. And I think it's one of those symptoms that we do really poorly with in traditional medicine. Unless you've got like a low thyroid.

Or you've got anemia, you know, and they can give you iron or a thyroid pill. And it has to be really low. Really anemia. Really low.

Because the borderline stuff a lot of times, as you know, it's missed all the time, right? If you loved that last video, you should check out the next one for sure on getting to the root cause of all disease.

I was so ill at my nadir, I could not sit up as I am now. I had, we didn't have problems with brain fog, difficulty with memory, focus.