Exclusive Dr. Hyman+ Ask Mark Anything: Homocysteine, Gallbladder Health, And More

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Hi, everyone. Welcome to another episode of Ask Mark Anything. My name is Herschel Perthes. I'm the Dr. Hyman Plus Community Manager. and I am joined by Darcy Gross. Hi, Darcy.

Hi.

Who's one of the producers of the Longevity Roadmap docuseries. And of course, we're here with our expert, Dr. Hyman. Hi, Dr. Hyman. Hey, everybody. Thanks for being with us today. And so, of course, we've collected all of your questions this past month, and we're here to ask Mark anything. So let's go ahead and get started. Our first question is about homocysteine. So what is homocysteine? And if someone has elevated levels, what should they do about it?

I agree.

You know, first I would say to the community, you know, the questions that you're putting forth are really great. They're impressive. They kind of reflect the high level of knowledge and intelligence and curiosity. It's fun for me to answer them. So I actually am really grateful for this and keep up the good questions. So it's awesome. So what is homocysteine and why should we care? And if it's up, what do we do? Okay, this is like, this could be like a whole hour lecture. And I, what I would encourage everybody to do in with link to it is to go Google or maybe, we'll link to it. The article I wrote on methylation, just put in hymen and methylation, which is a big mouthful, but it's M-E-T-H-Y-L T-A-O-N. Okay. So basically in your body, think about your body as this big, you know, soup of chemicals and chemical reactions and pathways. And essentially there's a core hub of your biochemistry that has to do with this process called methylation and sulfation. And if that's not working, everything gets screwed up. So you might have heard about biological clock, for example. I just did my biological clock. I'm 62, but my biological age is 43. How do they know that? It's through patterns of DNA methylation. Methylation is the process of transferring methyl groups, which is a carbon and three hydrogens. And this happens bazillions of times a second all throughout the body, and it's involved in energy production, detoxification, neurotransmitter formation, DNA function, reading genes, turning genes on and off, dealing with inflammation, dealing with oxidative stress. I mean, it's just everything is connected to this, right? So when the system is working, then you end up with a lot of biochemical mess. Homocysteine is a marker of a functional marker of a problem with methylation involving key vitamins B6, B12, and folate. Now, why does this happen? Why is there problems with methylation? Why are there problems with a high homocysteine? Homo cysteine elevations are not uncommon and it can be partially genetic. So for example, one third of our entire DNA codes for enzymes. Those enzymes are catalysts for chemical reactions. And these happen all like, you know, millions of times a second. So, or more, probably billions. And these chemical reactions are going on all the time and all these enzymes need helpers. All the helpers are vitamins and minerals. And, and these enzymes are not all the same in everybody. So there's variations in the enzymes we call polymorphisms, which means a different shape or a different kind, right? A different form. And so if you have, for example, an enzyme gene that produces one third of all your DNA codes for enzymes. So one of them codes for an enzyme called MTHFR or methylene tetrahydrofolate reductase. Say that five times fast. Come on, Darcy, come on, Herschel, let's go. But no, I'm just kidding. You don't have to. But anyway, this particular enzyme. If you have a version of it, it may not work as well as another version, which means you may need a higher level of the catalyst, the vitamin, let's say folate, that actually turns this enzyme on or makes it work. But you can, for example, take higher levels of folate or you can take methylfolate. You kind of skip the step. so you add a methyl group to the folate and you can take that as a supplement. And it's really important because the homocysteine levels are high. It's linked to heart attacks, to cancer, to strokes, to dementia, depression, so many different things that are critical birth defects. I think I might have told this on a different podcast, but I had a, A patient who had done Fed Up with me. Did I talk to you guys about this?

You might have on a podcast, but not on a Nasmark Anything episode, so feel free to tell us.

Okay, I do so much talking, so I don't remember. But anyway, I was in this, I did this movie Fed Up years ago. And there was a director of the movie who I got to meet and then it was about obesity in America. It was really good. It's on Netflix. You should for sure check it out, watch it with your kids. But she was with me on the book tour, I mean, on the movie tour, and she had a baby with her and she was breastfeeding. We were like going to the different TV shows and all that. And she was in the backseat breastfeeding and she said, Mark, I have to tell you a story. I'm like, oh, what? She's like, well, I had so many miscarriages, like, I don't know, six, seven miscarriages. And I ended up also having this baby that had anencephaly, which means there was no brain. so it was like a baby with no brain, doesn't last. And I read your article on methylation, the one I just talked about. And she said, I went to my doctor and I said, I think I have this problem because it's linked to miscarriages. And it actually was discovered and birth defects like spina bifida. And the doctor was like, she's like, I want you to do this test for this enzyme. MTHFR for this gene and see if I had this problem. And sure enough, she did. She's like, oh, just take folic acid. It's like, no, no, no. Dr. Hyman said, I haven't take methylfolate. Can I take that? She's like, he's like, okay. So she takes that, and then she has this perfect, beautiful baby, which she'd been trying for years and years. And I first learned about this actually phenomena when I was in China in 1994, and I heard this scientist talk about the researchers who studied birth defects. 'Cause in northern China, in Harbin, which is north of Beijing, it's kind of near Mongolia, it's freezing up there. They don't have a whole foods. Basically winter comes and there's not a single green thing to be seen. And folate comes from the word foliage. So it's in greens and a lot of other things. So they don't eat any of that. And then of course in the Chinese New Year, is when everybody gets married, apparently. And so they found that, you know, of course when you get married, you know, things happen and then babies come like nine months later.

And.

They had this huge increase in those babies in spina bifida and neural tube defects, which is terrible. And that's kind of how they figured out that folate is something that we have to give to pregnant women or women who are even prenatally or antenatally before they even get pregnant, so protect against birth defects. So you think about like a vitamin that is powerful enough to prevent miscarriages and birth defects. Also, if it's elevated, if homocysteine is elevated, you know, at 14, for example, your risk of dementia is up by 50%. But it's linked to everything from depression to cancer to DNA problem. It's just, It's such a critical part of our biology. So you need to be sure you're taking a good B complex. It's just a good insurance. There's no risk to it. Ideally, methylated forms. You can bypass this step. Not everybody needs it, but we do genetic testing. We can look at all the methylation variations. And, you know, some affect B6, some affect B12. So B6, there's something called CBS or cysteine, beta-synthase or MTRR, which , methylene tetra, I know it's, MTR, I forget what it says, where it's basically a B12 pathway. So all these, all these different steps in the methylation cycle, it's like a, it's like a, it's like a, it's like a, it's like an assembly line. So all, every step is needed and there's different vitamins that activate different enzymes at each step to actually make the whole thing work. So you really need to, to take this seriously. And, and I, I, I have a problem with it personally. Um, and it, you know, if you, if you have high, high levels, it's, it's hard to, to detoxify, and that's probably why I got heavy metal toxicity. So now I got under control, but it's like you got, you gotta measure it and you gotta test it and you gotta take the right nutrients from it.

Thank you. That's so, that's so helpful. Thanks for that detailed story. And that was amazing to hear about the director or the lady that was on, you know, on your tour and then read your article.

How incredible.

Yeah.

Thank you.

Darcy, over to you. I know you're working you guys for a long time, but I still haven't told you all my stories, so I.

Gotta keep you entertained. Well, yeah, I feel like I learned something new every time. And I think what I'm learning every time is that all these things that like kind of happen to you and then you then teach the rest of the world about it. So thank you for sharing your journey. Okay. Okay. But you know what?

I think I'm over this. Like I don't want to get any more illnesses.

Yes.

Yes. I don't want to get any more problems. I'm good. I'm like, I can read, I can read the science and I can translate it.

I don't need to actually get the thing anymore.

That's good. Well, that's why you're so well. I've had mercury, I've had mold, I've had lime, I've had Babesia. I've had gut issues, colitis, C diff. I mean, you know, I've had the whole thing. And, you know, I guess that's what God wanted me to do, was to sort of really know this from the inside out. So it made me a better doctor, but it was not fun.

No, definitely not. But now you're going to be writing about longevity, so everybody's looking forward to it.

So there you go.

Yes, thank you.

All right.

Nancy over to you.

Yeah.

All right. Well, the next question is all about your gallbladder. So of course, what does the gallbladder do? And then specifically, what are the implications of having your gallbladder removed? Is there anything that you should do to supplement in that case? Is there anything that you should be mindful of, i.e. like fats or fat-soluble vitamins, things like that? Anything else that you should consider for gallbladder health, but also if you've had your gallbladder removed?

Yeah, for sure. So gallbladder disease is rampant in America, the biggest cause is I'll let you guys guess. What's the biggest cause?

Processed food.

Sugar and sugar.

Sugar, yeah.

Sugar.

So diabetics have extremely high rates of gallbladder surgery. So eating crappy food causes just trouble with your liver and increases gallbladder disease. So your gallbladder basically takes the bile that your liver makes and it stores it in the gallbladder. There's like a little tiny sack. And then, you know, when you have a meal and you need to squirt out some bile to digest the fat and the meal, it squirts it out through the bile duct and you end up, you know, digesting your food. And it's great when you eat a crappy diet and all that, you're gonna get gallstones and gallstones. can cause inflammation of the gallbladder. They can be small and get stuck in the gallbladder duct. The common bile duct can cause really bad problems. They can cause liver failure, pancreatitis. I mean, it's not fun. You get gallbladder inflammation, cholecystitis, you can get infected gallbladder, and it can be bad. And so, A lot of people need gallbladder surgery. Again, if they took care of themselves, they probably wouldn't, but let's just say you need the gallbladder surgery, then what? Well, your bile still is being made by your liver, it's still going through into your small intestine, through your common bile duct. The gallbladder was removed, you're not removing the bile function completely, although you might have less bowel stores and function. So some people do need to take digestive enzymes like lipase and protease. Ox bile is something I'll prescribe, which is, you know, extra bile. So that can often be helpful if people are having trouble digesting fats and so forth. I wouldn't eliminate fat or anything like that. I would try to figure out how to eat in a way that's whole foods, healthy diet, avocado oil, olive oil, nuts, seeds, you don't restrict fats. But you wanna eat in a way that is in combination with the right supplements or adjustments to sort of make it work.

Well, I hope you enjoyed that teaser of exclusive content that you get every single month with Dr. Hyman Plus. If you wanna 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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