Exclusive Dr. Hyman+ Ask A Doctor: Arthritis, Supporting Children’s Immune Systems, And More

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Hey everyone, thanks so much for tuning in to the newest episode.

My name is Hershel Peretz and I'm the Dr. Hyman Plus Community Manager. And as you know, Dr. Hyman is traveling worldwide and so we of course have Dr. Elizabeth Boham back with us. Hi Dr. Boham.

Hi, Archelle. Great to see you today. Great to be with everyone.

Thank you so much for being here. As many of you know, Dr. Bohime is the Medical Director of the Ultra Wellness Center in Massachusetts, and she's done several deep dives for our community. So you guys are probably very familiar with her, and we're so excited for her to be back today. And so we've collected your top questions from our community. So let's go ahead and get started.

With the first question.

So question number one, what are the reasons and consequences for having low omega-6 fatty acids? We have a member who says, my omega-3s are in great shape, but omega-6 are all below range. What can be done to increase the omega-6s?

There is a few tests that you may have had done that will give you information about both omega-3 levels and omega-6 levels. So there's an omega-3 index that's a test that's a finger prick that tells us about the amount of omega-3s in the red blood cell membrane, and it will also tell us about omega-6 levels and other fats. There's also red blood cell, red blood cell fatty acid analysis that will look at omega-3 levels and omega-6 levels. So you may be, this person may be asking about one of those results on testing. The thing I look at the most is omega-3 levels. That's the thing I'm really focusing on the most. And because there's good literature to show that when our omega-3 levels are between eight and 12%, and that's the amount of omega-3s within the red blood cell membrane. So the percentage of fats that are omega-3 fats within the red blood cell membrane and when they're between eight and 12, there's a lower risk of heart disease. And so it's a really good marker that we're trying to get those omega-3s up to. And remember, your omega-3s are found in your fatty fish, sardines, salmon, ground flaxseed, walnuts. And then that's the thing I'm really looking at. If somebody has on their panel really low omega-6s, there's a couple of things that I may be thinking about. First, it may not be a big problem because sometimes people are a little bit low and it's not a a big issue. But if things are really low in all of the Omega-6s it makes me wonder about digestion and absorption. So sometimes people are just not, their Omega-3s may be okay because they're taking a supplement, but they may not be either eating enough fat in their diet, or they may not be digesting and or absorbing their fat as well, whether they have issues with their gallbladder or digestive enzymes and, or just not getting enough. So remember, Omega-6s are found in a lot of nuts and seeds and healthy fatty foods. They're also found in some unhealthy oils. So we're, you know, we really want to have, we're really trying to move people toward a higher Omega-3 diet anyway, because this, you know, if you eat the standard American diet, you'll get a lot of Omega-6s, unfortunately. But just focusing on lots of nuts and seeds and fatty foods like avocado and healthy oils will, and looking to see, could there be any signs of maldigestion or malabsorption are things you might think about if they really are truly low.

Okay, that's super helpful. I know digestion and absorption are a common issue in a lot of different vitamins, right? So you have to make sure that those are all in play for a lot of things. So thank you so much for that one. Okay, so the next one is, what are all the different forms of glutathione to take in order to increase glutathione levels in the body when someone has both genes GST missing?

Okay, great. So, well, first of all, glutathione, I love glutathione. Glutathione is this master antioxidant and detoxifier. It supports all the detoxification processes in the body and it's a great antioxidant. It helps balance the immune system. Low levels of glutathione have been shown to be associated with people having worse symptoms of COVID and other infections. as well as more allergies and imbalances in their immune system. So glutathione is something I'm reaching for often. Okay. And you can get glutathione by taking the precursors of glutathione as well as taking glutathione directly. When you take the precursors of glutathione, that will include things like NAC or N-acetyl cysteine, as well as glycine. Those amino acids will become glutathione in the body. And in addition, foods that are rich in sulfuraphane. We've talked about this so often because it's like my favorite broccoli sprouts, broccoli, kale, all of those cruciferous vegetables, brussels sprouts, cauliflower are rich in sulforaphane and they help the body with production of glutathione. And that works really well for all of us. You can also take glutathione directly, but if you take a pill that you swallow, it's going to get broken down into those amino acids in the digestive system. And then it's not really that effective, it's really just taking those amino acids. So you want to be giving, you want to take glutathione in a different manner. So one way that we give glutathione is liposomal. That means that it's in a small enough particle that it gets absorbed through the mucosa, through the cheek, or through even the digestive tract without getting digested. So it's a small enough particle that it's going to get absorbed directly into the body. So some forms of liposomal glutathione you'll put in your mouth, you'll hold it there for a while while it gets absorbed into through the cheek into the body. So it's a nice way to give it. It's easy to do. There are also patches and creams of glutathione. I haven't found those to be as effective, but sometimes my patients will use them, especially in children or young, young kids. You can also give glutathione IV. And we also sometimes give it rectally or in a nebulized form. So you breathe it in like through a nebulizer. So there's multiple ways you can give glutathione. The ways I give it the most are the liposomal form that I talked about, and IV. And I find, I mean, people ask a lot about the GST deletions in genes. I mean, there's a lot of genes that are involved in production and utilization of glutathione. So I still use glutathione in those situations, and I also will focus on those precursors to glutathione production, like we talked about, NAC, glycine, sulforaphane, rich vegetables, and sometimes supplementation.

Okay, so one sort of follow up to that, you mentioned the IV form of glutathione. What would be a situation where maybe something like that would be helpful?

Right, so sometimes we have people come in for IV glutathione when they're, when we really want to support detoxification. So the, and we typically give around 2000 milligrams or two grams. It's an easy IV to give. It's, we've also used it for some neurodegenerative issues. So Parkinson's and Alzheimer's Lyme disease, we sometimes used IV glutathione. If somebody's feeling a little under the weather, glutathione is one of those things I always go for myself and with my patients. So, you know, I'll use extra liposomal glutathione if I'm feeling like I'm coming down with a cold or a flu, or people in our office will often give IV in those situations as well.

Okay, perfect. Thank you. So switching topics, this is something that's always on my mind as a parent, but could you speak a little bit about exposing children and obviously adults too, to germs with grounding, going barefoot, being around animals, you know, using hand sanitizers has been, you know, just on the increase, especially since COVID and it's just sort of the easy thing to do. So how do you balance, you know, exposing your kids to germs, which we know is kind of good in certain situations and kind of building up their immunity and all that, and then, you know, making sure they're not at risk for getting something serious?

Absolutely. I think you said it right there, Harshil. balance is key, right? Balance is really key here. There's been lots of research to show that getting out in nature, exposure to dirt, exposure to animals, and exposure to viruses is really helpful for the development of our immune system. So we don't want to be overly clean. A lot of research has shown there's a concern with all of the hand sanitizers and antibiotics, of course, and over cleanliness in our environment. And that that has been one thing that may be contributing to to imbalances in our immune system, more autoimmune disease, less development of the gut immune system. So we do know exposure to infections and viruses is key. I typically avoid hand sanitizer whenever possible and I just wash with soap and I think it's great to expose our kids and all of us to dirt and animals and that may be a really good thing for our immune system.

Okay, definitely balance. Making sure balance is the key, right?

Absolutely.

All right, so is there anything that you would recommend in addition to diet? Because this comes from a Community member who is Faithfully on the Pegan diet and basic supplements to help with severe arthritis. Is glucosamine helpful? And what kind of other things should this person focus on?

Yeah, absolutely. One of the first things I focus on, you know, if somebody's already on a low inflammatory diet, then I just make sure getting enough omega-3 fats. And so that kind of brings us back to that omega-3 index, which I think is a really good tool to assess somebody's level of omega-3s. We typically are giving at least two grams of DHA plus EPA per day and trying to get that omega-3 index between 8 to 12%. So that's some general guidelines there. In addition, there are these components in our fish oil called SPMs. They're called Specialized Pro-Resolving Mediators, and they're the component in fish oil that you can take in addition to the fish oil. You don't take them instead of, you take it in addition to fish oil, but they're the part of fish oil that is very anti-inflammatory. So for some people, we add the SPM on top of their fish oil to get additional anti-inflammatory benefit. And you can take one to two twice a day of the SPM product. And it can be really helpful for some people, really, really helpful. Glucosamine works really well. Glucosamine sulfate's been well studied. It's about 500 milligrams three times a day. And for some people, it works extremely well at lowering inflammation and arthritis development. Some of these supplements will also have chondroitin in it or MSM or even turmeric that has additional anti-inflammatory benefits. if from the diet perspective, we also sometimes will remove nightshades for a period of time. There's a small group of people who get more joint pain and inflammation when they consume nightshade vegetables. That includes your peppers, eggplant, tomatoes, potatoes. Did I say peppers?

Yeah.

Those nightshade vegetables for some people can cause more joint pain. And so what we might do is an elimination of the night shades for about three weeks, see if that makes a difference, and then reintroduce them because they're such healthy foods that if it's not making a difference in somebody's joint pain, I don't want to keep people off of them long term. So we do an elimination for three weeks and then reintroduce them one at a time and really eat them and monitor how you feel. so when you do a reintroduction of a food, you want to introduce one new thing at a time and then have a real serving, like a real serving, not just a little bit, a real serving of that food twice a day for the first day, and then watch how you feel for the next three days. And if you feel fine, then that food should be fine for you and not be contributing. So that's a way to reintroduce it if you do try to do an elimination.

Okay. Super helpful. Trying to see what works best for your body and what, you know, may cause inflammation for you. Yeah. All right, so the next question is about stenosis. So the first question I'm going to ask is, what is stenosis? And then do you have any suggestions for treating stenosis without surgery?

Right, so stenosis just means narrowing. Now, I'm assuming that this person is talking about arterial stenosis, so narrowing in the arteries. And we know that arterial stenosis can contribute to heart attack, right? So if this artery narrows over time or if there's a complete blockage of the artery, then there's not going to be enough blood flow to the heart and that is what can cause a heart attack, right? So I'm assuming there's other types of stenosis, like there could be a stenosis in the spinal column and that may impact a nerve or pain, but I'm assuming we're talking about arterial stenosis here or narrowing in the arteries. the most important thing to do when somebody has some stenosis or plaque in the arteries is we want to work to stabilize that plaque because we know that when the plaque is inflamed, it can rupture and that could cause a blockage of the artery and a heart attack. So think of it as like a pimple. If that pimple is really inflamed and it could rupture, then that's more dangerous. And so we want to stabilize that plaque so it's not as inflamed and we can do that. We know we can do that with lifestyle. Lifestyle has been shown to be very effective for stabilizing plaque, resulting causing that plaque or stenosis to be less inflamed, less concerning for the person. And so when we do that, we're looking at, okay, so what can do that in terms of lifestyle? Of course, good sleep, lowering insulin resistance, lowering blood sugar, all the stuff we talk about, regular exercise, strength training to improve insulin sensitivity, stress reduction techniques, all of these things can be really helpful for stabilizing the plaque, reversing insulin resistance. The other things we look at is we look at inflammation because inflammation can cause the plaque to be more unstable. So we want to work to lower inflammation. We want to look to see if there anything that's causing that inflammation, which could be infections, gingivitis, right, inflammation in the gums. We also pay attention to things like oxidative stress. We know oxidative stress, which is excessive free radicals, will cause more plaque formation because we know that when LDL cholesterol gets oxidized, it can get into the artery lining and cause more of an issue. So we'll look at things that may be contributing to oxidative stress, which could include chronic infections, toxins, heavy metals, other toxins. So those are all the things we're looking at when we're working to reverse or stabilize some plaque or stenosis.

Okay, great. Super helpful.

Well, I hope you enjoyed that teaser of exclusive content that you get every single month with Dr. Hyman Plus. If you want to listen to the full episode and get access to ad-free podcast episodes, plus Ask Mark Anything episodes, plus monthly functional deep dive episodes. I guess that's why we call it Dr. Hyman Plus. Then head on over to the Doctor's Pharmacy on Apple Podcast and sign up for your seven day free trial.

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