Exclusive Dr. Hyman+ Ask A Doctor: Sleep Apnea, Covid-19 Vaccine, And More

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Hi everyone. Thank you so much for tuning in to today's episode. My name is Melanie Harrelson and I am one of the producers of the Doctors Pharmacy podcast.

Cast.

I'm joined by a familiar face, Darcy Gross, one of the producers for the Longevity Roadmap docu-series. Dr. Hyman is currently traveling, but we are so excited to have his colleague and friend, Dr. Elizabeth Boham, back to answer your questions this month. As many of you know, Dr. Boham is the Medical Director of the UltraWellness Center in Lenox, Massachusetts, and has done several deep dives for our community as well as our AMAs.

So Dr. Boham, we're so excited to have you back for this month's episode, welcome. Thank you, Melanie. It's great to be with you and Darcy and all of the listeners. So great to see you all.

So we've collected our Community's top questions and we are here to ask you anything. So let's get started with the first question.

Great.

So the first question is about organ meats and liver, specifically. Can you talk about the benefits of organ meats and specifically liver? And if supplementation is a good option if you don't want to eat liver or other organ meats and if there's any specific brands of supplements that you recommend, as well as any dosage recommendations?

Okay, great. Yeah, organ meats, you know, organ meats like liver, kidney, heart, they are actually a really good source of nutrition. They're very nutrient dense and rich in many nutrients such as the fat soluble vitamin A or retinol. They're also rich in a lot of minerals, B vitamins, B12, B6. coenzyme Q, carnitine, creatine, and lots of those things I just mentioned really support the mitochondria, which helps with production of energy. And so they really are a nutrient-packed food source. Liver is especially high in vitamin A. Vitamin A in the fat-soluble form or the retinol is really important for our eyesight, our immune system, our skin turnover, and And so it's a really great source of that as well. You can get your vitamin A from either the fat-soluble form, which you see in organ meats, or also fish and other meats, chicken, cod liver oil, eggs. But you can also get your vitamin A from your beta-carotene. But when you get it, that's from your squashes, your vegetable foods, your carrots. But when you get your vitamin A from beta carotene, the body has to then convert it into retinol. And not everybody converts it as well or as easily. That depends on your genetics. It depends on your thyroid function. It depends on some of your other nutritional status. So getting retinol from a food source is really a great, great thing to do to help with skin turnover, healing the gut, acne, the immune system. So So, you know, eating liver is actually a great idea for all of those reasons. If you're not a fan or you want to also supplement with a supplement, there's a lot of good ones out there. You want to look for one that's organic, pasture-raised meats. I like Designs for Health, Paleo Valley, Ancient Nutrition, all really good brands. And in terms of dose, just follow what's on the so many of them will say like six capsules a day. And that's what I would recommend if you're going to supplement.

Okay, awesome. Thank you so much.

Absolutely.

All right, and over to our next question. So this question comes from a community member who recently had a sleep apnea test. So this test was done overnight at a hospital and the results came back as severe obstructive sleep apnea. so in response, she also did an at home test, but the results came back as mild obstructive sleep apnea. So a couple questions with that. What are the main differences between an at home test versus doing one in a clinical setting? And considering these different results, what type of treatment might you consider? And like, essentially, what's your approach to sleep apnea?

Absolutely. You know, sleep apnea is a really important thing that we should be looking for and screening for. What it means when somebody has sleep It means they have breaks in their, in, or episodes at night when they're sleeping where they're not getting oxygen into the body. They're having apnic episodes when oxygen is not coming into the body. And that is, is really significant. It can cause many health issues. It can cause increase in insulin resistance and weight gain. It causes a lot of inflammation in the body. It can change the size and the structure of your heart. So it actually increases risk of sudden death. and it can cause arrhythmias or irregular beats in the heart. So it is something serious that we really need to screen for and evaluate in patients who are at risk. So what may be some of your signs and symptoms that say, okay, I should get checked for sleep apnea. Maybe you feel tired all the time, you're gaining weight, you are doing everything right but unable to lose weight. Maybe somebody says you snore because snoring is a partial blockage in the airway and sometimes when people snore, they actually at times have this full blockage or apneic episode. Maybe you don't feel rested when you wake up in the morning, or you could fall asleep at any moment, or your blood pressure is increasing. All of these things may be signs and symptoms to say you should get screened for sleep apnea. And so the question is, so how best to screen? So an in-hospital sleep study is really the gold standard. It is a very comprehensive event. and they do many tests to see is this person having apnic episodes and how many are they having, how low is their oxygen going? Do they have other issues with sleep like restless leg? So it's a very comprehensive exam and that's more accurate than the at home tests. So at home sleep studies can be done, they're less expensive, they are easier to do, you don't have to go sleep somewhere strange, but they're not as accurate as the in-hospital sleep studies. sleep studies. So at home tests in general will underestimate the amount of apnea somebody has. So I would definitely in this situation trust your in-hospital sleep study for this patient and be treated because so often people think, oh, if I lose weight, maybe my sleep apnea will get better. But often it's the sleep apnea that's causing the weight gain or other things that are causing the increased risk for sleep apnea such as an comick variation. Like some people are just more at risk based on their own anatomy. So I would definitely trust the in-hospital one and get treated. And it's definitely something we always are thinking about at the Ultra Wellness Center and with our patients is do they have signs and symptoms of sleep apnea and testing for it.

Awesome. That's super helpful. And over to you, Melanie.

Okay. So the next question is about glycoprotein and advanced glycation end products. so there's a few questions here. So the first one is, can you first explain what they are and how do you lower glycosylated proteins? And then I can kind of add in the other two questions after that. Okay.

So, so glycoproteins are when a carbohydrate attaches to a protein. So if you've got a lot of carbohydrates or a high blood sugar, you can have more glycoproteins. Advanced glycosylated end products are when those glycoproteins are formed and those advanced glycosylated end products can have been found to damage your vasculature. So the endothelial lining, they can cause more plaque production in the arteries around the heart or in the arteries that are going to the brain. So that can increase your risk of heart disease and stroke. and also we know that these advanced glycosylated end products will decrease the amount of nitric oxide in the arteries. And nitric oxide is really important for those arteries to relax. So when you have increased advanced glycosylated end products, then what ends up happening is you can have increased blood pressure and increased erectile dysfunction, for example.

Okay, is it possible to lower the glycosylated proteins?

So yeah, absolutely. The biggest way that we lower glycosylated or the age is the advanced glycosylated end products is we work on lifestyle, right? So we work to lower the amount of glucose that you have, the amount of carbohydrates that are around that can damage these proteins in the body. In terms of of testing. So how do you know if you're lowering it? So they do check for a lot of these glycosylated proteins in research, but from a clinical perspective, the major test that we do that is an actual measure of these glycosylated proteins is the hemoglobin A1C. So when you have blood work done and you have a hemoglobin A1C, that's actually measuring the glycosylation of hemoglobin. And that means the amount of glucose that's been bound to to that hemoglobin over the last three months because your red blood cells turn over every three months. So it's a way of knowing what your blood sugar has been over the last three months. And so we're really working, of course, if we see that's high, we're saying, okay, we've got to lower the amount of refined and processed foods. Of course, we're lowering the amount of high fructose corn syrup, sugars, carbohydrates. We're working to increase your lean muscle mass and exercise so you improve your insulin sensitivity and your blood sugar you can also lower the advanced glycosylated end products by doing some shifts in terms of your food preparation. So we know that when food is cooked very fast at a high temperature, you can form more of these advanced glycosylated end products. So grilling, for example, or frying is associated with higher levels of AGEs being formed. So low slow, low temperature cooking is good. And we also know that when you eat a diet that's rich in phytonutrients, right? We always talk about eating the rainbow and getting all the colors, all the colorful vegetables and spices in your diet, that that's really good at blocking or lowering these advanced glycosylated end products in the body.

Okay. Would that be, like, for example, with an air fryer, would that be a concern too? like, same thing with like grilling and frying?

It's a good question about the air fryer. I mean, we think that there's a less age is being formed in the air fryer versus on a grill or in high temperature fats.

Okay. And then just to clarify, so if you're trying to test to see what your numbers are in a lab test, is it the HA1 the HA1BC, is that the number you're looking at or is it a different number you're looking at?

So we don't have, there's a lot of tests done in research on this, but in the clinic, the only real test that we have now is the hemoglobin A1C that's directly measuring an advanced glycosylated end product. You can get an indirect assessment when you look at markers of oxidative stress, but that's not like a direct measurement.

Okay, perfect. All right, awesome. Thank you. All right, Darcy, over to you.

All right. So switching gears a little bit, our next question is about the COVID-19 vaccine. So is there any research currently on how the COVID-19 vaccine affects the gut microbiome? And a follow-up question would be, does the health status of the gut microbiome affect the efficacy of the vaccine?

Do we know? So it's a great question. It's really interesting. There is a lot of research being done on how the vaccine and of course how COVID impacts the microbiome. We do know that getting the infection does impact the microbiome, right? And definitely impacts the GI system. So people can have symptoms of nausea and diarrhea and abdominal pain. And we do know that our gut microbiome impacts how sick we get from COVID So they've been looking at the gut microbiome and how sick people get when they get exposed to COVID and they notice that when people are low in Akkermansia, one of those really healthful probiotics in the gut that we always talk about, or even the bifidobacteria, that they're more likely to get more sick from COVID or even to get COVID. So there is an association with certain microbes and how sick somebody gets. And their thought is that that may have to do with the short chain fatty acids that these good healthy bacteria produce and that those short chain fatty acids which help with healing the gut that come from the good bacteria may modulate our immune system in a way. And so that that may be one of the connections. And they're always looking at, okay, how well does somebody respond to a vaccine? Right. That's looking at our vaccine immunogenicity. So how well when you get a vaccine, how many antibodies do you produce? And we know that there's a lot of things that impact how well a vaccine works, right, from the amount of stress you're under when you get the vaccine. So people who are under more stress, they've looked at caregivers, people under more stress, they won't produce as many antibodies. to the vaccine after they get a vaccine. The other thing they've looked at is if you've needed to take an antibiotic prior to a vaccine, how that impacts the amount of antibodies you produce. So let's say you had strep throat and you were given an antibiotic a few weeks before you got a vaccine. They've done research to show that with the flu vaccine, with influenza, if you've gotten an antibiotic within the six months prior to getting that vaccine, that the response you have to the vaccine is not as good. You don't mount as much, you don't make as many antibodies, so you won't be as protected from the vaccine than if compared with people who didn't need antibiotics for the six months before. And they've been also doing that research with the COVID vaccine as well. So we more research with the influenza vaccine to date, but they are also looking at how antibiotics impact our response to the COVID vaccine. So the theory is that that is tied in with the gut microbiome, 'cause the antibiotics shift the gut microbiome for that period of time and influence how well we respond when vaccinated. So all of that really just reminds us about the importance of taking care of our gut microbiome, right? So really eating a diet that's rich in fiber and phytonutrients to feed all the good bugs in the gut. Avoid antibiotics unless they're necessary and really, really focus on the fermented foods and the fiber to help with supporting a good, healthy microbiome.

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