Exclusive Dr. Hyman+ Ask Mark Anything: Pancreatic Health, 5R Protocol, And More

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Hi everyone. Thanks for tuning in to another episode of Ask Mark Anything. My name is Herschel Perth and I'm the Dr. Hyman Plus Community Manager. and I'm joined by Darcy Gross.

Hi, Darcy.

Hi.

And she's one of the producers of the Longevity Roadmap docuseries. And of course, we're here with our expert, Dr. Mark Hyman. Hi, Dr. Hyman. Hello, everybody. Thanks for joining us today. And so we've collected all of the questions from our Community and we're here to ask Mark anything. So let's go ahead and get started. So, Dr. Hyman, our first question is about the pancreas. What does it do in our body? What's its function? And what's the best way to have.

You know, good pancreatic health? Great question. Most people have no idea what it does. It's essentially an endocrine organ producing hormones and an exocrine organ producing enzymes and other things we need to digest our food. So it's kind of got a dual function. The endocrine part is producing insulin. There's beta cells in the pancreas that are special insulin producing cells. So when you eat carbohydrates or sugar, It actually secretes a little bit of insulin to help keep the blood sugar down and put the fuel into the cell. So it's almost like the key that unlocks the door to your cells and lets the glucose and other free fatty acids into the cells, which is an important thing. That's an important function. And a lot of times we flog our pancreas because we eat way too much sugar and flour, as I've said a million times, we eat about a pound of flour and sugar a day per person in America, and that is driving the insulin levels higher and higher and higher. We can insulin resistant. And that is the beginning of the end of all of us leading to obesity, diabetes, cancer, heart disease, dementia, infertility, depression. I could go on and on. So insulin, not bad, it's just, what's the goal of the Lox dose? The lower the better, the less insulin the better. As little as you need to do to get the job done is what you want. And basically you're fasting and should be less than five. If it's over 10, I'm worried. If it's over 20, you're in big trouble. That's the endocrine or the hormonal function. Then there's the exocrine function, which is secreting enzymes to digest your food through the pancreatic duct, which dumps into your intestine. So the beta cells dump it into your blood. Then there's a little duct called the pancreatic duct that goes into your intestines through the sphincter of Ody, which is a medical thing we learn. I don't know why I remember that from anatomy, but I do. And basically it excretes this pancreatic juice into your small intestine as the food's coming in to help digest the food. And one of the most important is pancreatic elastase. methylmalonyl-CoA is a digestive enzyme that is important in digesting protein and many other things. Now, certain conditions like cystic fibrosis, people have pancreatic problems and they can't produce the enzymes and they end up needing to get prescription enzymes like Creon or other prescription pancreatic enzymes, lipase, amylase, proteases, and a lot of people here, I take digestive enzymes. Well, yes, a lot of people do take digestive enzymes and often in medical clinics, GI clinics, and then functional medicine doctors. We really often measure pancreatic elastase because often people are having pancreatic insufficiency. It's not a true, like, see us, like a cystic fibrosis patient where they just don't make any. It's just a little bit low. And that means they have trouble digesting their food. They can get bloating. They have undigested food in their stool. And so for those patients, we can use either plant-based or animal-based enzymes. Often the animal-based enzymes, if you have very, very low pancreatic elastase, are important. And we, we measure on a stool test. I use one called GI Effects by Genova. Been using it for years and we measure pancreatic elastase. If it's under 500, it's not great. If it's like under 200, you're in trouble. So that's when we start to start to prescribe pancreatic enzymes to help patients digest their food while we're trying to get to the root cause of why it's a problem. So very, very important. Pancreas also can be affected by a lot of things. Alcoholism can cause pancreatitis, which is a terrible condition of pancreatic inflammation and it can be deadly. and scar up your pancreas, which you don't want to do. Also, the pancreas can be affected by stones from the bile duct. So if you're eating a diet, you produce potentially a lot of bile stones, one can get stuck in the outlet of the pancreatic duct, which is connected to the the biliary duct or the bile duct. So they kind of go together and they come out in the same spot. But if the bile stone gets in, it blocks the pancreas and you can get pancreatitis. That's bile stone pancreatitis. That's really bad. So you need, you need to get that fixed. Like you go to the emergency room and it's super painful. There's weird things like spider bites that'll cause pancreatitis. And sometimes people have high levels of, of amylase and lipase that are related to some other pancreatic injury that happens, trauma or something like that. So supporting your pancreas is basically don't flog with sugar and flour, make sure you're eating a whole foods healthy diet. And if you are having digestive issues, you might want to see a functional medicine doctor, get a pancreatic last days. Your regular doctor can measure that as well. They might say it's normal, but I know I would say what's normal versus optimal? And we've had this conversation normal in America. It's normal to be obese because every, like, you know, 75% of people are overweight, so it's normal. It doesn't mean it's optimal. So we want what's optimal? And I think optimal is over 500 on the pancreatic last days. and so it's often a therapy we use in functional medicine to help people while they're actually healing their gut and bridging back to a normal gut function.

Great, that's super helpful. Thank you so much, Dr. Hyman. And over to Darcy.

Yeah, so kind of speaking to healing your gut, and this is really one of those fundamental things that's really practiced a lot in functional medicine, but not so much in conventional medicine. But our next question has to do all with the 5R protocol. So of course, please walk us through what exactly these five R's are and how you implement it in patients, the ones like who would need it, and how you work through those steps if you can have any steps that are overlapping or- yeah, of course.

Yeah.

Thank you.

Okay, this is sort of the bread and butter of functional medicine is the 5R Program and Gut Healing. And I'll unpack it for you because, you know, we started doing this way before even the word microbiome was a thing. We talked about dysbiosis and we talked about gut function and we did all kinds of stool testing. And so we were deep in it in the, you know what, long before it was fashionable. And we designed a program that was based on the science and also clinical experience to help reset the gut. And it's super important to do that for people in the right way, in the right order. If you do the right thing in the wrong order, you can make people really sick. For example, if someone has bacterial overgrowth in their gut and you give them probiotics, It's like a war. So the bad guys are fighting the good guys and people are just miserable. So you can't do that. So what are the five R's? The first R is to remove. And that means removing anything that might be bothering the gut. So it could be foods, it could be bacteria, it can be yeast, it can be parasites, it can be worms, it can be drugs, right? So on the food front, we really put people on a gut healing elimination diet. And that is eliminating all the potential irritants which would be gluten, dairy, sugar, alcohol. But also, maybe we go a little further and we cut out grains and beans, which are harder to digest. We maybe say only eat cooked food. We say, you know, don't eat in extreme elimination diets. You might say don't eat eggs. We can do testing and look for food sensitivity testing. It's not food allergies, which is where you get peanut allergy and your tongue swells up and you get shortness of breath and you could die. that's antifungal axis. That's not what we're talking about. We're talking about low grade inflammatory responses to food that we don't know we have because we just feel like that all the time. Like if someone stand on your foot, you don't know, you stand on your foot till you get off.

Right.

So. So we take people on elimination diet. That's the first thing. Second thing, and we can do testing to determine, you know, how to customize it a little better. Second things, when we look at the gut busting drugs, antibiotics, steroids. the oral birth control pill, anti-inflammatory drugs like Advil, aspirin. Also, acid blocking drugs are the worst. They really screw things up. They help with heartburn, but heartburn is really a lifestyle disease. And we treat it with a drug, and it stops all the acid being produced, which means we don't digest our food well and ends up causing irritable bowel syndrome. So we trade reflux for IBS, which is kind of dumb. And it also can create risk for community acquired pneumonia, osteoporosis. I mean, I've written a whole textbook chapter about this, so it's really. not a great drug for long-term use. And when I was in medical school, they're like, hey, guys, this drug just came out. It's super strong. You can only give it for six weeks for healing and ulcer. Do not give it longer than that. And now it's the third leading drug of all time. And it's, you know, these class of drugs, acid blockers, like Prilosec, prevacid, abs effects, nexium, all those. And, and, and, and they're given for years and years and years, and it, you know, causes mineral absorption, magnesium, zinc, B12 deficiency. I mean, it's bad. So we get rid of the gut busting drugs, we get rid of the, the food sensitivities. and then we got to think about what's in there. So we do testing. So for example, I work with a patient now who has a parasite called Blastocystis, which is not a terribly mean one, but it can cause a lot of irritable bowel and bloating and digestive issues. And so we have to sort of get rid of things first. I get rid of parasites and worms first, then we look to see if there's bacterial overgrowth. So we'll do a test, for example, called a breath test where we have people drink a certain kind of fluids, got hydrogen, certain kind of sugar essentially. And then you see what happens when that gets into their small intestine. Now, people can produce hydrogen gas or methane gas. So we think, you know, cows produce methane. Well, humans do too, if they eat the wrong food, just like cows. So methane and hydrogen are gases that get produced. And this is when people walk around feeling they have a food baby. they just feel bloated, distended, uncomfortable, they eat and it looks like they're three months pregnant. And that's usually a sign of what we call SIBO or small intestinal bacterial overgrowth because your bacteria is supposed to be sterile. A cow of the bacteria often migrate up from the large intestine for different reasons, stress, heavy metals, constipation. I've seen people with tick infections, like Babesia, so there's a lot of reasons for it. but we try to get to the root of it. And then they also can have SIFO, which is small intestinal fungal overgrowth. And fungal overgrowth is not that uncommon and often occurs because of antibiotic overuse, because of high sugar intake, alcohol intake. So you get a combination of SIFO and SIBO and parasites. This particular patient has all three. So what's the order? How do you figure it out? Well, you have to treat the parasite first. Then you have to get rid of the SIBO. You have to get rid of methane or hydrogen because it's a little bit different treatment. We use a combination of non-absorbed antibiotics and herbs to keep the bacterial down. Then we'll use antifungals, prescription and herbal. And I, and I wish we could only use herbal, but in my experience, in order to really reset the gut, we need to, to get all the bad guys out. And I, you know, we call it the 5R program. I, I renamed it to call the weeding, seeding and feeding program. So you weed out all the bad stuff, you see it with the good stuff, and you feed the gut to heal it. So it's, it makes it a little simpler. But I'll go through all the five steps. So the first thing is elimination diet, get rid of the drugs, get rid of the bugs. Then the next step is replace. So that would mean replace digestive enzymes. We were just talking about pancreatic function. Well, if you have low pancreatic elastase, if you have low hydrochloric acid, you need to provide those as a bridge to help the gut heal and digest food while it's healing. Because if you, for example, if you are trying to fix a gut and then your pancreatic elastase is lower, you have low hydrochloric acid, and then you're eating food, it's starting to ferment again, it's starting to grow the bad bugs again. And it's, we've got a whole like, you know, problem in there. It's like weeds. And in fact, there are some conditions that can get so bad with that, they call it auto-brewery syndrome. It's a described medical phenomenon where people can literally get drunk from the alcohol produced from the fermentation of the starch in their gut by these bacteria. So literally you can have a blood alcohol level and get pulled over for drunk driving. That's kind of interesting. Anyway, fun fact. The other thing that you need to do is not only replace digestive enzymes, hydroxy acid, you might need to replace prebiotics. So prebiotics are basically fibers that are the food for the good guys. Now, if you have a ton of vascular overgrowth or fungal overgrowth and you give prebiotics, you will make someone extremely sick because you'll feed the bad guys. So you kind of got to clear out the bad guys first, and then you can start providing these prebiotic foods. And you can use prebiotic foods like plantains, artichokes, Jerusalem artichokes, asparagus have prebiotics in them. And there's a lot of great foods. I, jicama is a great prebiotic food. So you can start including these in your diet, and then you can take actual prebiotics, which are inulin, acacia fiber. other other fibers that are really, really helpful in fertilizing the good, good stuff. There's a product called bi immune, which is a prescription, not a prescription, but a supplement, prebiotics. So prebiotics are really important, but you have to use them in the right time, the right way. Well, I hope you enjoyed that teaser.

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