Exclusive Dr. Hyman+ Ask Mark Anything: Ketogenic Diet & Diabetes, Exercise Intolerance, And More

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Hi everyone, welcome to this month's episode of Ask Mark Anything. My name is Hershel Perth and I'm the Dr. Hyman Plus Community Manager and I'm joined by Darcy Gross, one of the producers of the Longevity Roadmap docuseries. Hi, Darcy.

Hey.

We are here with our expert, Dr. Mark Hyman. Hi, Dr. Hyman.

Hi.

So we have gathered all of your questions this month and we are ready to ask Mark anything. So let's go ahead and get started. So our first question is about the ketogenic diet. We've heard so many great things about that diet and basically how it can benefit people, but the question that comes from our Community is, Is this something that someone that has type 1 diabetes should try? And is there anything that they should look out for if they're going to go ahead and try that keto diet with type 1 diabetes?

Yes, yes, yes.

Great question. So for type 2 diabetes, the ketogenic diet, hands down, is the number one treatment and it exceeds the power of all the treatments combined. In fact, it does things that no other treatment available today can do. And this is the work out of the project that was established with Sarah Halberg and Sammy, it's Virta Health, which is an online ketogenic diet platform that helps type 2 diabetics cure diabetes, even advanced type 2 diabetes. With that said, it's generally safe for type 2 diabetics to do this. Type 1 diabetes is quite different. Type 2 diabetics have too much insulin. Type 1 diabetics have no insulin. and so it's a really tricky thing. And diabetics who are type 1 are tend to be more fragile in the blood sugar fluctuations and the response to insulin. You can often have type 1 and type 2 combined. If people are, you know, jacking up their insulin doses in order to eat more carbs and sugar, they're going to gain weight and they're going to, you know, basically have a type 1, type 2 diabetes scene, which I've seen quite a lot. In the old days, Dr. Jocelyn, in the Jocelyn Diabetes Center at Harvard, Dr. Jocelyn was, you know, famous endocrinologist back in the day, in the 1920s. these. And the way they treated type 1 diabetics back then before banning discovered insulin was extremely high fat ketogenic diets. So literally they would put them on 70 fat or more, 70, 75 fat, 20 protein, 5% carbs. And it literally kept these patients alive, which is a miracle. The problem is if you're, if you're type 1 diabetic and you go on a ketogenic diet, you know, you, you're prone to getting into ketoacidosis, which is a life-threatening condition where your ketones spiral out of control and it can cause dehydration and all kinds of metabolic kidney metabolic complications. So it's a, it's a life-threatening condition. So you have to be very, very careful. If you're under medical supervision, you have to really know what you're doing. You have to be very dialed into your lifestyle. I have a good friend who's a doctor. She's a type one diabetic, and she was on a ketogenic diet, and she's, that's how she manages her diabetes and, and. what's even more remarkable is that she's a vegan, vegan keto, vegan keto, which is really hard to do, like really hard to do because you need protein and fat and not starch and carbs. And most vegan food is carbs. So she managed to figure it out. And she'll only need a couple units of insulin. The most diabetics will need 20 units of insulin a day as a baseline. That's sort of our baseline, you know, you know, production 15 to 20 units. Um, when you start needing more like 30, 40, 50 units, 60 units a day, it means you're, it means you're insulin resistant or you're eating way too much carbs. and she was able to get her insulin needs almost down to zero simply by using a ketogenic diet. And then she's, you know, but you have to really manage your fluid intake, your electrolyte intake. You have to follow up with a doctor. You have to know what you're doing. But it can be an effective way and you don't even have to be full keto. You can just be an extremely low carb type one diabetic. For example, 10-day detox diet is about 50 fat, you know, probably 20% protein, 30% carbs. It's a little bit more, you know, or maybe 25% protein, 25% carbs. It's a little bit better, but I think, you know, you really want a higher fat diet, like olive oil, avocados, nuts and seeds, you know, depending on your metabolic profile, even, you know, good saturated fats are fine from grass-fed meats and fish fat and all, even coconut oil, MC2, all those are fine. So I think, I think it's, it's a, it's a tricky thing, but it can be very helpful. And I think there's a spectrum of approaches that involves full-blown keto to sort of a modified keto or just a low carb, higher fat diet?

Yeah, that makes a lot of sense. Thank you. Thank you for that answer. Darcy, over to you for the next question.

Yeah, super interesting. Thank you. So switching gears a little bit, the next question was about exercise intolerance. What exactly could cause something like that? And I guess, what is it? Exercise intolerance, it sounds kind of like an excuse, but I know that there's way more to it than that. and of course, what should we do if somebody's experiencing exercise intolerance?

Exercise intolerance is not that uncommon, and I've had a number of patients with this, and I really found a good hack to fix it. Exercise intolerance can come from a number of reasons, right? It can come from some chronic illness, it can come from being out of shape, it can come from having, you know, really low fitness levels and so forth. But for the most part, it's a mitochondrial problem and people who exercise and feel crappy after, it's either because they have some acquired or inherited mitochondrial issue or potentially because their adrenals are not working. And if people are chronically stressed and have adrenal exhaustion, they will develop exercise intolerance exercise and they'll feel worse afterwards. So those are the two main reasons. For the adrenal issues, it's really about resetting your joints. You don't want to do strenuous exercise. You want to do light exercise, walking, yoga, those kinds of things to start. getting your circadian rhythms in balance, waking up and sleeping at the same time, getting off of sugar and starch and processed foods, making sure you're taking enough vitamin C and zinc and B complex vitamins and B5 or pantothenic acid, using adaptogenic herbs, things like ginseng, rhodiola, Siberian ginseng, ashwagandha, all these are really adaptogenic herbs that help to reset the adrenals, meditation, all these tools are really helpful. the mitochondrial stuff is a little more interesting. And these are people who will exercise and like, people get that, you know, Runners High, they just don't get it. And they feel crappy after these one, take a nap. So the key is to identify what's really the, the true source of the problem is. And it can be an acquired mitochondrial. It could be heavy metals, it could be inflammation from something, it could be infection. So there's a lot of causes mold. It was important to look at what are the causes of it, but some people just have sluggish mitochondria. And what I'll found is if I give them a a cocktail, a mitochondrial cocktail to boost their energy production, they won't have that post-exercise fatigue. And, you know, the mitochondria essentially are the little energy powerhouses of your cells that take oxygen and calories and they burn them just like a car engine takes in gasoline and air intake the engine and combusts it in the engine and produces energy to drive the car. The energy that we produce is ATP, very important, and that requires the properly functioning mitochondria. And there's a lot of steps. It's like an assembly line that builds the energy your body uses for every chemical and every other reaction in your body. And that requires things like CoQ10, lycopene, acetyl cysteine, B vitamins, riboflavin, and niacin. All the key B vitamins, magnesium, creatine, sulfate, a lot of glutathione, all these are really important in the steps to make energy. And so if you give a cocktail of these things beforehand, like an hour before, citrulline, carnitine, amino acids, and so forth, branched amino acids, you literally can jack up the motor, MCT oil, all really dramatically helps. So I put people on a mitochondrial cocktail before exercise and they just have really dramatically improved tolerance of exercise and.

Don'T have that post-exercise crash. Yeah, interesting. Is the mitochondrial cocktail available like as a supplement?

Is it something that we can link to or- yeah, there are, yes. Yeah, so we can kind of put a list of what the products are, but I think that there are some combination products, like one called M Mitochondrial NRG by Designs for Health. I like that one a lot. It contains all the various cofactors, the B vitamins, all the mitochondrial support nutrients. But sometimes you need a higher dose. So sometimes you need to take a 5 grams of creatine, you need to take a teaspoon of the amino acid complex. It's called, I think it's called amino acid complex by Thorne. You take a 500 milligrams of acetyl carnitine, 200 milligrams of CoQ10. and that will, plus your regular B vitamins, that will often really help to prevent any of this post-exercise fatigue.

Yeah, super interesting. Thank you so much, Dr. Hyman.

Of course.

And over to Herschel for our next question.

Yes, and thank you also for listing out all those supplements. I know that all our community is always looking for detailed answers as to exactly how much and what to take. So thanks for that. Our next question is about regenerative agriculture. So we've heard you talk about that quite a bit on different podcasts. and one of our community members wants to know is that besides being a dedicated consumer, what else do you think someone can do to support regenerative agriculture?

Well, I think that regenerative agriculture is a really important advance in our understanding of how to grow food in an ecological way. Just as though functional medicine is an ecological system of healing, it's very much like regenerative agriculture. And in functional medicine, we treat the root cause, we deal with the underlying health of the host. In other words, if we make your body so healthy, disease can't show up. So regenerative medicine is very much like regenerative agriculture, which is creating a healthy host by optimizing nutritional levels, optimizing hormone levels, optimizing the gut microbiome, and making basically an unfriendly place for disease. Same thing with the regenerative agriculture. It's about treating the soil and not the plant. Instead of pouring chemicals, which are like drugs, right? When you put chemicals like drugs on disease, rather than that, we treat the host. In the conventional agriculture, they put all kinds of chemicals on the plants. pesticides, herbicides, fertilizers, instead of dealing with the soil, which is what you should be doing. So regenerative agriculture is really about dealing with the soil. And I think, you know, there's a lot of things you can do for wanting to support regenerative agriculture. There are increasing the brands out there that are producing products. I would encourage you to buy those products. There's, there's companies that are actually investing in regenerative agriculture Solutions on a business level. So you can invest with those companies. You can encourage your congressmen and senators to actually vote for policies that support, you know, breaking down some of the log jams around regenerative agriculture. Like, for example, if you're a farmer and you want to plant cover crops, you get penalized by the government if you're crop insurance, which is actually doing the right thing that you get penalized for. So there's a lot of really antiquated policies that need to get updated. So you can become, you know, an activist, you can work with certain non-profits like kiss the ground or carbon underground. So there's a lot of opportunities or even our foundation, which is our nonprofit, which is a food fix campaign to help drive food policy changes and leverage education and policy shift in Washington. So there's a lot of ways to get involved. But, you know, if you read my book, food fix, I have a whole bunch of things that people can do. There's, if you go to foodfixbook.com, there's a food fix action guide with all kinds of individual actions that people can do. So, you know, you can just start, for example, with a compost pile in your backyard. you can maybe create a compost in your community. You can, you know, look focus on maybe building some community gardens and getting your community involved. Or maybe you can even do, you know, more activist stuff. For example, in your local community, make, make the local governments put in ordinances that mandate composting. So there's all kinds of stuff you can do, but I think it's important to start where you feel comfortable and where, where you can easily connect to.

Yeah, that makes a lot of sense. So we'll put the link to your book, so that people can get more ideas from there. But thank you for that detailed answer. Well, I hope you enjoyed that teaser.

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