Exclusive Dr. Hyman+ Ask Mark Anything: Stomach Acid, LDL Cholesterol, and More

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

Hi, Darcy.

Hi. Darcy's one of the producers of the Longevity Roadmap docuseries. And of course, we're here with Dr. Mark Hyman. Hi, Dr. Hyman. Hi, how's it going? Going well. So we're here to ask Mark anything. So let's go ahead and get started. So we have a fun one to start with, and we're going to need to know what is at the top of your plate. What song do you have on repeat? And I'll tell you why. So that everybody can go to Spotify or Apple Music and download it immediately. So you got to let us know. which one is it?

Oh, well, I would say, you know, my top of 2022 was as by Stevie Wonder, one of my favorite songs ever, which is, you know, the one of the lines in there, I'll be loving you always. But it's got a great little stance in there about how, you know, we are exactly where we're supposed to be and we can heal ourselves if we kind of pay attention to what's going on and how our troubles often are the answers to our problem. So it's really, it's actually a great song.

Love it, love it. And is that the one that you continue to have on your playlist or do you have a new one for 2023?

You know, I kind of, I'm kind of just listening a lot to the Dead and Company, actually. I'm dating myself, but I love Eyes of the World. That's one of my favorite songs. And Franklin's Tower probably would be right up there. It'd be the most listened to song. It's like that Grateful Dead song, Roll the Way the Do. It's like really great.

Awesome. So we know everyone's on their way right now to download. So thank you for sharing that with us. And we'll go over to Darcy for the next one. All right.

So jumping right in, the next question is all about stomach acid. So we've talked on previous Ask Me Any Things about having too little stomach acid, too much stomach acid, which sounds kind of crazy, but it's It happens. But how do you know? How do you know if you have too much, too little? And then of course, if you could just reiterate what the functional medicine approach to treating that would be.

Well, there's, you know, sort of goes into the whole topic of reflux, heartburn, digestion. As we get older, we tend to get less stomach acid, something called achlorhydria or low stomach acid. And there are tests, Heidelberg test, which is a kind of a fancy test. You have to do in a hospital to look at your stomach acid. And often when you have low stomach acid, you're not absorbing nutrients as well. You're not absorbing particularly vitamins like B12 minerals, and you can end up pretty nutrient deficient. So being aware of this as a problem in medicine is important and most doctors don't really understand or how to treat it. There are specific treatments. People will often notice that if they have low stomach acid, they might have bloating, they feel poor digestion, they might have undigested food in their stool, they might feel like they're just, you know, just uncomfortable after they eat. And that's, that's a problem. There is a, a test you can do to kind of see whether or not there's a problem. And we, we can kind of treat you with this compound called beta beta dine hydrochloride or B-A-T-A-I-N-E, not like beta dine, like the antiseptic, but the beta dine hydrochloride. And that actually can be taken before you eat. And we often will do a loading challenge where you start with, you know, one pill, go to two, three, four, five, six, seven, eight, nine, 10, whatever, until you start to feel a little warmth or burning in your stomach. That's kind of your dose. So some people initially may need like three, four, five, six, capsules, sometimes you, you know, you may need less. And then you can use that before meals and see how it affects your digestion. Often we combine that with digestive enzymes as well. So it's a way for people to sort of see if that's a problem. There may be younger people who can get it as well, and it, it's often under diagnosed. There's, also too much stomach acid, which can, you know, often be from, you know, poor diet and, and reflux is something I've written a lot about. Uh, you can go on my, on my Dr. Hyman blog and you'll find a, probably a dozen articles about reflux. I've written a textbook chapter on it for, or, and a functional medicine approach to reflux. And it can be a very, easily treatable problem if you remove the foods that tend to be an issue, which are the, the things that conventional medicine recognizes like caffeine, alcohol, spicy foods, tomato based foods, citrus foods, fatty foods, fried fried foods, those tend to sort of trigger things. And I know, for example, if I go and have a pizza or something off a street, which I almost never do, I'll get heartburn. Like, it's not hard to get heartburn as soon as you eat the wrong stuff. So it's often fixing your diet. Then there's, you know, looking a little bit deeper. It could be a bacterial overgrowth, fungal overgrowth. Could it be a problem with low magnesium status? Could it be H. Pylori bacteria? uh, could it be a food sensitivity like gluten or dairy or other things? So there's, there's other triggers for it and then you have to treat the cause. Um, and obviously removing the bad foods that are causing it and sometimes, you know, treating the underlying issues like H pylori with a antibiotic or a series of herbs. So there's, there's many ways to actually address this. Uh, I detail them a lot and we can, you know, kind of go through some of it, but it's, you know, I'll use glutamine, which can be very helpful if you have stomach acid as a, as a substance. I, I actually often use a cocktail for metagenics called called the Glutagenics, which is glutamine and aloe and licorice. And you can also take licorice chewable licorice tablets called DGL or deglycyrrhizated licorice, which doesn't raise blood pressure, takes out of some of the things that can cause a problem with licorice, but it actually allows you to sort of soothe and coat your stomach like Tums. So you can take that before you eat as well. So those are some of the suggestions that I have for people, but there's.

There'S a lot more. Yeah, for sure. That's super helpful. Thank you, Dr. Hyman. And over to you, Herschel.

So we know in previous episodes you talked about what someone can take after surgery to sort of help them with the recovery, but do you have any specific nutritional recommendations that can help following an orthopedic surgery? So for example, this community member had a knee replacement surgery. Is there anything they should have to promote, let's say, bone health versus like cartilage repair?

Yeah, I mean, it's, it's, it's really mostly the same, which is providing your body with the raw materials to help it heal, which is particularly adequate protein because your body has much higher protein needs after surgery for tissue repair, a high quality protein, often animal protein or whey protein. Want to make sure you're taking plenty of zinc, vitamin C, vitamin E, glutamine, which can be really helpful in, in, tissue and healing repair. Uh, so those are sort of some of the most important things like bone broth is a great substance that has a lot of minerals and nutrients as well as lots of extra protein. So there's some simple things you can do there. I think, you know, really dealing with some of the inflammatory stuff can be important. So a lot of herbal therapies I'll use like Zyflamend, which is a cocktail of different anti-inflammatory herbs or curcumin, Boswellia, which is another, another herb also known as frankincense that can be very helpful for inflammation and joint issues. There's actually there's a product called Root. I think I have a friend of mine made it, which is kind of like a natural anti-inflammatory and it's got ginger and ergothioneine and turmeric and berberine, which are all sort of natural anti-inflammatory compounds. So there's all sorts of stuff with what I like to call Root. Can't really see it, but, or.

We'll be sure to put the link in the show notes so that you can that's super helpful. Thank you. Over to you, Darcy.

Awesome. Similarly, the next question is in a general way, which foods help repair cells and set cells up for regeneration? So, for example, skin burns or skin issues if you're trying to heal or help your cells repair, which foods or how would you approach that?

Well, you know, your body is really intelligent and it has built in systems for repair, healing, renewal, regeneration, and they have to just be fed. And so, you know, one of the things, you know, we, we did see in medical school, I think I've talked about this before, when people really have poor diets, their tissue is really bad. When you sew them together, they don't, basically the, the sutures just kind of pull through the tissue. It doesn't hold. And, and we, we had a really kind of derogatory name for it in medical school. It basically is a people who like really crappy diets. And it's amazing what happens on the inside, not just on the outside in terms of how you look. So, having really high quality nutrition is important, as we just talked about, and lots of protein if you're healing and repairing, good quality fats, omega-3 fatty acids are essential for tissue repair, zinc, vitamin A, vitamin C, glutamine, we talked about. All these things are really important for the body to repair and heal. So, making sure you have adequate micronutrients, micronutrients in the form of protein, fats, and also making sure you're cutting out all the stuff that's going to be inflammatory, like all the ultra processed food, sugar, starches are all really the things that tend to cause poor wound healing.

Yeah, thank you. That's helpful. Over to you, Herschel.

So there's always different diets that are out there in the news, and of course our community wants to know what you think about all of them. So this time they're asking about the mind diet. Do you The mind diet and how does it compare to the Mediterranean diet? Is there anyone who should consider this mind diet?

Yeah, absolutely. The mind diet is based on some research that was done. And it basically it stands for Mediterranean dash diet intervention for neurodegenerative delay or mind. And the Mediterranean diet is essentially people are familiar with it's like fish and olive oil and nuts and seeds and lots of vegetables. all those are really, really important. And the dash diet, it tends to be a lower sodium diet. It's designed for diet, dietary approach to stop hypertension, DASH. And this is designed to sort of be combined with the Mediterranean diet as a way to help improve cognitive function. So there's been some interesting data on this. Looking at, there was a Rush Memory and Aging Project where they looked at people who are free of dementia, then they put them on checked and they followed their dietary questionnaires and they could see if, you know, their diets were either brain healthy or not healthy. And, and it wasn't an interventional trial, but the people who ate more toward the Mediterranean dash diet approach were actually better in their cognitive function. So it's, you know, old grains, it's lots of veggies, it's six servings of green leafy vegetables a week, lots of nuts, beans, berries, poultry, fish, olive oil, and getting off of the junk, which is obviously the sugar, the starch, processed food, fried foods and all that. So I think it's helpful. What I would say is, I always joke and say compared to what? So if we look at kind of the American Heart Association or Diabetic Association diet compared to the standard American diet, it's better. but is it better than, for example, a well-designed food is medicine, sort of a functional medicine, anti-inflammatory diet? Probably not.

Right.

And so when you look at, for example, data on Alzheimer's and cognitive function using ketogenic diets might even actually be better. So, yes, while this is an improvement and, and it certainly leads people towards better cognitive function, I don't think it's the end-all for, for the best diet for your brain. It's, it's certainly a better diet than the standard American diet, but I think and the data was impressive, it was very helpful, and it's not a rigid diet, it's just sort of some guidelines around what I just mentioned. So I think I'm not super impressed with it, to be honest with you, and I wouldn't use it as a way to treat my patients who have neurodegenerative disease, but I think it's definitely an improvement on their traditional crappy American diet.

Yeah, that's super helpful, and I think that's such an important point when you say compared to what? So, I appreciate that input on that. Darcy, over to you.

All right, next question. What causes LDL cholesterol to oxidize? And of course, the follow up is, are there certain diets that promote more or less oxidation of LDL?

Absolutely. So basically, what is oxidation? What is LDL? Let's just start there. So LDL is your LDL cholesterol. This is one of the types of cholesterol your body makes to and, and it's one that seems to be associated with higher risk of heart disease when it's high. The problem, you know, but, but when you look at the data really carefully around LDL, it's not actually elevated LDL. It's a problem. It's, it's the overall pattern of cholesterol and it's the quality of the LDL. So if it's large, fluffy LDL particles, not so much a problem. It's small, dense LDL. It's a problem. And that has to do with the fact that we're eating a high, a diet high in starch and sugar that, that causes the small particles. And those are the dangerous particles. The other part that we need to remember is that the LDL only becomes a problem if it's oxidized. What is oxidation? That's when your car rusts or oil turns rancid or you're, you've got, you know, I don't know what's the other example of it, your skin wrinkles, right? Those are all signs of oxidation. And, the oxidized LDL becomes damaged, essentially rancid cholesterol in your blood. And that's what tends to activate your inflammatory system. So there was a really interesting recent paper that showed that even if your cholesterol was high, if your inflammation levels were low, your risk of cardiovascular disease was really insignificant. So it's not just the LDL, it's the inflammation. And oxidized LDL causes a lot of inflammation, and then that causes problems with plaque formation. so the key to, to preventing oxidation is to reduce things that cause oxidation, which is like a broken record here, but it's our processed Ultra processed high sugar and starch diet that's low in phytochemicals and healthy food. So it's, when you're eating a diet that's highly inflammatory, that's high in sugar and starch and refined oils, you're gonna get into trouble. And also, if you have a lot of Omega sixes, they tend to oxidize, and your cholesterol can be oxidized because of these.

So that's a problem.

So you want to make sure you, you eliminate all that junk culture processed food, starch, sugar, junk food, and eat more high quality fats, have more fruits and vegetables, more nuts and seeds, some whole grains, you know, beans, good stuff, basically real food. And then, you know, the LDL 10 not to be oxidized. And you can actually measure this. I just did my cholesterol panel and I have no oxidized LDL. I have no myeloperoxidase. I have low CRP. I have low IL-6, all the inflammatory markers that you, you want to be low, minor main or low, thank God. So, and I don't have any oxidized LDL, which I always check. So it's important to kind of check it and you can measure it. And even if your cholesterol seems normal, if it's oxidized, it means you need to pay attention to that. And taking antioxidants can be helpful, but it's, it's, it's not necessarily the only way to do this because the antioxidants, you know, that your body makes are actually more powerful. So boosting the source of those who having, for example, things that boost glutathione in your diet, like the broccoli family and garlic and onions can be really helpful. So making sure you're you're up regulating your body's own antioxidant systems is key.

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