Exclusive Dr. Hyman+ Ask Mark Anything: Nutritional Testing, Time Restricted Eats, Cholesterol, And More

Hey everyone, it's Dr. Mark Hyman here. My team and I have been working hard on something that I'm so excited to share a little bit about today. It's a revolutionary new platform called Dr. Hyman Plus, which is a premium membership exclusive for my community. With Dr. Hyman Plus, you get a ton of private content and special access that no one else gets. This yearly membership gives you exclusive access to ad-free Doctors Pharmacy podcast episodes, access to all of my docu-series including the Longevity Roadmap and Broken Brain 1 and 2, plus all the bonus content. You get monthly Functional Medicine Deep Dives where one of our doctors goes deep into a health topic to tell you everything you need to know to heal. You'll also get access to a monthly Ask Mark Anything Q&A where I answer the Dr. Hyman Plus Community's biggest health and wellness questions. This Q&A is only accessible with a membership. Because I'm so excited to share this premium membership content with you, I'm releasing a teaser of the brand new Functional Medicine Deep Dive episode diving into one of the most important topics and health. I hope you enjoy it and head over to drhyman.com/plush. That's drhyman.com/plus for more information. Okay, here we go.

Hi, everyone. Welcome to the newest episode of Ask Mark Anything. I'm Hershel Peres. I'm the Dr. Hyman Plus Community Manager. Welcome. And I'm joined by Darcy Gross, one of the producers of the Longevity Roadmap docuseries. And of course, we're here with Dr. Mark Hyman. hello, Dr. Hyman.

Hi, everybody.

Thank you so much, everyone, for submitting your questions this month. We're so excited to have Dr. Hyman answer them. So let's go ahead and get started. So, Dr. Hyman, our first question comes from a community member who actually happens to be also a practitioner. And she wants to know that for the purposes of nutritional testing, is it preferable to do a white blood count testing or a red blood count testing or serum testing? What's the best way to look at the test and what would you recommend?

Oh, it's a very broad question because there's so many different things to analyze when it comes to nutritional testing. And there isn't one answer specific. And unfortunately in medicine, we sort of operate according to what I call the lamp principle, which is we saw this joke of this guy who lost his keys on the street and he's looking for them under this lamp post and his friend comes by and says, what you doing? He says, well, I'm looking for my keys. He's like, well, where'd you lose him? I said, well, I lost him down the street. He said, why are you looking over here? He says, well, the light's better here. So often in medicine, doctors will check blood levels of certain nutrients, which is pretty irrelevant because that's not where you find the right answer. So for example, magnesium is a great example. We test for a serum magnesium. And if it's low, under two, we go you have low magnesium. The problem is it has to be really, really, really, really, really low before you hit that too, because you're tightly controlled. That's why we look at, for example, red blood cell magnesium, which may be better, but there may even be a better test for magnesium. Well, there is. It's the gold standard, which is where you take a big load of magnesium intravenously, and then you measure the urine output of magnesium over the next 24 hours. And if you spill a lot of magnesium, then you're pretty good. You don't need it. If your body sucks on and holds all that magnesium and you don't pee it out, well, then you're low in magnesium. So that's an example of how, you know, even the regular blood tests don't, don't look at. For example, if you want to look at zinc, you know, you can look at plasma zinc, you can look at white blood cells, zinc. If you want to look at for example, B12, you can look at urinary methylmalonic acid, or you can look at, for example, serum B12, but that might not be very accurate to look at serum B12 or maybe folate. You want to have folate. You can do serum folate. Not so helpful. Red blood cell folate, maybe a little bit better. Maybe you should look at homocysteine instead of folate. Maybe you should be looking at urinary form of glutamic acid levels, which is actually a much better indicator of certain types of folate deficiency. And I'm just using these examples. They're big words and stuff, but it's just to help you understand that there is no one way to test nutrients. You know, vitamin D, you certainly can test in the serum. But, but other things you can, if you want to measure vitamin C, it's kind of pretty quickly used up, so you can't really tell very easily. So there are urinary tests, there's red cell, white cell tests, plasma tests, there's, there's even hair testing, believe it or not. So there's a lot of ways to figure out what your nutrient status is, but it's, it's very individual. And then some things you really can't measure. You have to measure the secondary impact of not having those nutrients. So there are a lot of tests we use, for example, organic acid testing, which is a urine test to look at the metabolites. So we can say, oh, you're low in carnitine or B2 or biotin because this pathway is not working. We look at the effects. So it's a complicated answer, unfortunately, and takes years to figure this out. And the science and for practitioners, you can learn it But you have to really do the homework and learn about how to properly test person nutritional status, not just do a regular blood test and say, well, I checked all their B vitamins in their blood, everything's fine.

Well, that's not meaningful. Yeah, that makes a lot of sense. Definitely years of practice as you've had and going into individual patients and what they need. So thanks so much for that answer.

Darcy, over to you for the next question. Yeah, for sure.

Hi, Dr. Mark, how are you today? Hi, Darcy.

Hi. So the next question is kind of changing gears and switching over to time-restricted eating. So I think the first question is to really define time-restricted eating, because it's kind of a type of intermittent fasting, but it's not what we necessarily think of when it comes to intermittent fasting. But specifically regarding taking supplements while you're doing time-restricted eating. So the question is, if we have these supplements that basically need to be taken, let's say, with food, but you're restricting your eating window, do you, like, how would you space those vitamins is it something that you can take too many at once and then your body isn't really absorbing them? Or can you just talk to the timing of supplements when it comes to time-restricted eating?

Sure, sure.

And maybe you can touch on do they break a fast, that kind of thing?

Yeah, so time-restricted eating is essentially a way of eating that you're limiting the window in which you eat. So whether it's six hours, eight hours, 10 hours, and the idea of that is to save your body a rest. We used to call it breakfast. That's the original time-restricted eating. It's a 12-hour fast, at least from six at night till six in the morning. If you eat dinner at six and you don't eat till eight the next morning, that's a 14-hour fast. Okay? That's not that hard to do. And the more extended versions is 16 hours. Now, when you eat food, you are not just eating one thing. you were literally eating thousands of different informational molecules. You're eating protein and all these amino acids and all these fatty acids and different starches and carbohydrates. You're eating vitamins and minerals and phytochemicals and fibers. I mean, you're, you're flooding your body with literally a myriad of molecules all at the same time. And guess what? Your body's super smart. It knows exactly what to do. You don't have to go, gee, I'm only going to eat this carrot because I can't have it with the celery because the celery has this in it and it might, it's like you could eat, you could eat. And so my view, and I think, you know, whether there's good science on this, I don't think it's issue. My view is that I think that you can take supplements whenever you're, whenever you want. Some are better absorbed with food, like the fat soluble vitamins, vitamin D, E, A and K. But, but most things you can take iron better on empty stomach, some things are better with food. So there's some rules about what you can need to eat. with, but in general, your body will figure it out. And if you take a handful of supplements, you can do it, you know, at, you know, at the beginning of the meal, the middle of the meal, end of the meal. What I find is I like to mix, make a supplement sandwich. So basically, I'll eat a little food, throw some man, you know, before, throw some. It's like a club sandwich of vitamins. The reason is, you know, because often, you know, if you eat them at the end of a meal, you might feel them. You might notice they have burps or if the capsules dissolve, you'll taste it. That's just to avoid that, but that doesn't really matter. It's just more of a preference thing.

All right, got it. That makes sense. Over to Herschel for our next question.

Our next question is something that we hear a lot about. It's basically if you've had the testing done to determine what kind of particles you have, how do you change your LDL particles from the small, dense ones, which we know are not great, to the fluffy ones? to reverse atrial calcification. How would you go about doing something like that?

Well, first of all, let's just talk about cholesterol. It's a kind of thing. And, you know, there's a saying in medicine, if all you have is a hammer, everything looks like a nail, right? So if you're a cardiologist and you see a high LVL, all you think of is statin. And, well, that's not fair. They think of other things, but basically it's like, super focused. And the reason is that we have a drug that lowers LDL. Now, if we had a drug that raised HDL and worked at save lives, we'd be prescribing that. So we're basically so hyper focused on cholesterol as the problem that we miss a lot of the real story, which is that heart disease is a complex condition caused by inflammation, which can be caused by many things, including the cholesterol in our blood, which is oxidized, has to be damaged cholesterol in order for you to be having a problem. It can't just be irregular cholesterol because that usually doesn't go to heart disease. It's when it's inflamed and damaged. Second, what is going on with the inflammation in your body? What's going on with your microbiome? What's going on with the other labs that you have, for example, like homocysteine or fibrinogen or LPA or LDL oxidized. And then more importantly, we look at not just the cholesterol numbers that your typical doctor looks at, but we looked at what we call the lipid particle number and size. So when you get your cholesterol test, it's simply the weight of your cholesterol. If your cholesterol is 200, that means it's 200 milligrams of cholesterol per deciliter. So, right, so it's basically a weight of the cholesterol, but it doesn't tell you whether it's made up of big, light, fluffy cholesterol particles or small, dense, little dangerous particles. Because you could have the same number, let's say 200, but you could have, you know, 2, 000 small particles, or you could have zero small particles. Same number. So what's really important is to understand the particle number and the size and the quality of your cholesterol. Turns out that it's actually sugar and starch to drive the bad kind of cholesterol we call atherogenic. which means it creates atherosclerotic heart disease or plaque and heart disease, right? So this is the stuff that actually causes the damage. And so you really want to make sure that you check when you go to the doctor, not just your regular cholesterol profile, but you check the lipid particle number and size. That is the most important type of cholesterol to check. So with that said, if it's bad, if you have what we call atherogenic cholesterol profile, which is essentially a small, dense LDL particles, usually high numbers, small, dense HDL, you want large, light fluffy ones or low LDL, high triglycerides. If you have this pattern of high triglycerides, low HDL and high LDL, but a lot of particles and a lot of small particles, that's the worst kind. And what's causing that is not fat, it's sugar. It's starch and sugar. So processed food, starch and sugar drive what we call insulin resistance, which means your body becomes resistant to the effects of insulin. You end up eating more and more insulin. And what the insulin does, it drives belly fat deposition. It causes inflammation in the liver and the body. It causes the different kinds of triglycerides to be produced that are large, dangerous triglyceride particles. It lowers HDL, it raises triglycerides, it lowers the, sorry, it raises the, the number of total particles and it also makes them smaller. So it's really the pre-diabetes. And, and guess what? 88% of Americans have this problem at some degree or another. It's called poor metabolic health. And so the idea is, is to do the right kind of test, which is an NMR lipid test, or they have cardio IQ from Quest NMR is now through LabCorp. When I started doing it, they had a company called Liposcience. It wasn't even it wasn't even part of the regular lab profiles, but the regular labs now have actually implemented this as part of their lab testing. So if you want to change from the dense, dangerous ones, the light fluffy ones, it's about cutting out sugar and starch and eating good fats. Actually, fat, saturated fat raises the total number a little bit, but actually will make you have more large particles and more HDL. So, the net net benefit is really there. Now it's also personal and individual. So I had a patient once, for example, who was terrible with their cholesterol. She had a really bad cholesterol profile, small particles, triglycerides, low HDL, and ended up having resistance to weight loss and insulin resistance. And I said, look, why don't you just try a ketogenic diet for a little while, let's get off get off. Let's get off all the starch and sugar. And let's add coconut oil and butter, all that stuff that, you know, isn't something probably most of us should be having all the time, but everything dropped. Her cholesterol dropped 100 points from 300 to 200 or triglycerides dropped. I mean, went up, dropped 300 points or HJO went up 20 points or LDL came way down or particles got big, light and fluffy, and she lost 20 pounds. Another guy was then an athlete and he wanted to try ketogenic diet. I'm like, okay, you can try it. Let's track what happens. And it was the opposite. He ate all that food and his fats and everything went bad. So it's really individualized. But the key is exercise, eating low starch and sugar, more good fats, avocados, olive oil, nuts and seeds, some saturated fats are okay as well. And that will really dramatically change the quality of your cholesterol. And you can see this, you can see this happen with people. It's pretty impressive when they change their diets. and they cut up all that stuff, their bodies just respond tremendously.

Yeah, definitely. And actually, you had a great podcast episode with Dr. Boham about this very issue about cholesterol and sort of sorting through it. So we'll make sure that we link to that in the show notes. I'm also going to encourage the Dr. Hyman Plus Community to check out our functional medicine deep dive for May all about heart health as well. And that kind of goes into a little bit of the testing that Dr.

Hyman was just talking about.

So thank you for that.

Well, I hope you enjoy 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 all the content from my docu-series, and of course any future ones we're going to release, plus monthly Ask Mark Anything episodes, plus monthly Functional Medicine Deep Dive episodes, I guess, right? That's why we call it Dr. Hyman Plus. Head over to drhyman.com/plus. That's drhyman.com/plus to learn more. I'll see you there.

Hi everyone. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.