Simple Ways To Upgrade Your Health

Coming up on this episode of the Doctor's Pharmacy.

Most of the curriculum in medical school is driven off of licensing exams. What you need to know to pass a test to become a doctor. And if there's zero on nutrition, that's what they're going to learn. Zero on nutrition. If you're a healthcare provider practicing functional medicine, you know how hard it can be to keep up to date with all the specialty lab tests that are available to you. Well, I have a solution for you. Rupa University. Over 20,000 practitioners go through Rupa University courses each year to learn from industry experts about specialty tests like GI MAP, Dutch Complete, Organic Acids, and many others. and the best part is all their courses are completely free. Every week they host free live classes. And then if you want to dive deeper into a specific topic, you can attend a paid six week bootcamp. So if you're a healthcare provider who wants to learn more about functional medicine and testing, you owe it to yourself to go check it out today. Go to rupauniversity.com to sign up for a free live class or bootcamp. We all have food emergencies every once in a while when we need some quick, convenient calories in between meals. And that's why it's a good idea to have some healthy options on hand for when you need them. I do all the time. And you might think I think that grabbing a couple of protein bars would be the perfect portable healthy option, but you know that most, quote, health food bars on the market today are filled with refined sugar, weird artificial sweeteners, sugar alcohols. There's a serious need for actually healthy protein bars. And thankfully, my friends at Paleo Valley have come through. They've created superfood bars which are loaded with nutrients without added sugars. Their delicious superfood bars are sourced from only the highest quality organic ingredients while avoiding any harmful sugars you'll see in all the rest. Right now, Paleo Valley is offering my listeners a deal. You can get 15% off the entire store at paleovalley.com/hyman so be sure to stock up for your food emergencies today that's paleovalley.com/hyman hi this is Lauren feen.

One of the producers of the doctors Pharmacy the food we eat how much energy we have and how well we sleep are three fundamentals that can make or break our health with every bite food carries information that programs our biology for better or worse down to a cellular level. For instance, nutrients like B vitamins, vitamins C and E, iron, magnesium, selenium, and many more are part of producing ATP within the mitochondria, the powerhouse of our cells. And our sleep quality not only affects how we function and behave the next day, it also affects our immune system, food choices, and risk of disease. In today's episode, we feature three conversations from the Doctor's Pharmacy from our Masterclass series with Drew Proett. Dr. Hyman and Drew speak about food as medicine, why a caffeine break may give you more energy, and the importance of high quality sleep to prevent chronic illness. Let's jump in.

There is no more powerful lever you can pull to change your biology in real time. And I'm not talking about something that takes decades or even weeks. Literally days or minutes, you are changing your biology with every single bite of food. And that's because food is not just calories. It was just energy and fuel. It's just gasoline. It would be fine. You'd burn it. Doesn't matter what you eat. You could eat Doritos, you could eat Coca-Cola have a Coca-Cola you could have a broccoli, it doesn't matter. But what we now know is that food contains, particularly plant foods, contain powerful compounds that drive your biology and help you stay healthy and prevent reverse disease. So what is food anyway? Like people don't understand food. Oh, it's just energy, it's just calories. Yes, it's calories. They go, oh, it's protein, fat and fiber and carbs. Yes, it's all that, but what kind of protein? What's the quality? What's the quality of the carbohydrate? Is a carbohydrate from a broccoli sprout the same as a carbohydrate from a can of soda? Well, obviously not, but they're both carbohydrates. what about fat? Is the fat from margarine or Crisco the same as a fat from fish oil? No, they're both fats, profoundly different effects on your biology. Same thing with fibers, all kinds of different fibers, soluble, insoluble, different effects on your microbiome. So everything depends on the quality of the food you eat and the information in the food. The second thing is that there's this class of compounds that are in plant foods and actually also, by the way, in animal foods. believe it or not, called phytochemicals. These are plant-based compounds. Phyto means plant, phytonutrients, phytochemicals. They are regulatory molecules that I think have been critical in our evolution. And I actually, I've never heard anybody talk about this except, besides me, except David Sinclair, who's one of the leading aging researchers on the planet at Harvard. And, I call it something different than he does, but I think we've evolved with these plants to help us run our biology. I call it symbiotic phytoadaptation. We've literally adapted our biology to use the plants to work with us to create health. And, they're all the compounds you might have heard about that are kind of healthy compounds in food like resveratrol or curcumin or green tea extracts like catechins. maybe the broccoli spouts, sulforaphane, these are all these compounds in plants that are their defense mechanisms. They're their mechanisms to stay healthy and protect themselves against disease and predation and adversity. And why should we be using these molecules in our biology? Well, because we've evolved eating these plants and so our bodies are lazy. We don't make vitamin C because we can get it from food. so we don't make these compounds, but they're critical to our long-term health. You're not going to get a deficiency disease in the sense of a vitamin deficiency, but you're going to get chronic illness if you don't eat these plant compounds. And there's 25, 000 of them. The Rockefeller Foundation is spending hundreds of millions of dollars to create the periodic table of phytochemicals and how they work with our bodies, what they do. I've written a lot about this, and they regulate every single system in our body. You know, we're going to go into how that works. But one of the important things to understand is that these phytochemicals are not just found in plants. New research from Dr. Fred Provenza and Steven Van Vuuren, who's at Duke and now is at the Utah State University, have found that animals eating a wide variety of wild and even domesticated but of a wide variety of plants contain those compounds from the plants in their milk and meat. So, if you eat a regeneratively raised grass-fed meat, that's been eating maybe 20, 50, 100 plants, it's very different than eating a cow that's fed the silage in a factory farm. It's full of ground up animal chicken feathers and Skittles and who knows what the hell else, plus corn and refined oils and all kinds of weird stuff they put in it. Very different composition of the protein in a factory farm meat than a regenerative cow, for example. or a wild elk or whatever. And we know this is true even from interventional studies that if you eat protein for protein, gram for gram, the same amount of wild meat versus feedlot meat, it has profoundly different effects on your biology, even though it's the same grams of protein, the same calories and everything else is the same. So we have to sort of expand our idea of food from just being fuel and energy to being information that regulates everything in our biology that determines health and disease, whether we're gonna live a long time or die quickly, and that's really the power of food.

Mark, let's talk about the seven systems of functional medicine and how we think about food impacting or interfacing with all of those seven systems. This is something that hasn't been talked about a ton, but you've written a little bit about it and I think it would be useful in the context of today's conversation.

Well, you know, maybe you can put in the show notes, but for my last book, the Pegan Diet, I wrote 15,000 words explaining how this works. Unfortunately, It was too long for the publisher, so it got mostly taken out. But we have that content. I'm happy to share it in the show notes. People who want to learn about food is medicine, we can provide that.

Let's make a PDF and people can download it.

Yeah, I think, yeah, for sure. I think it'd be great. So here's the meta view. Our current view of disease is outdated. It's based on symptoms, it's based on diagnoses. You have heart disease, you have cancer, you have autoimmune disease, you have dementia. It tells you nothing about the cause. It's just a name. It's like saying, well, I have a headache. What's causing your headache? Did you get hit in the head with a hammer? Do you have a brain tumor, an aneurysm? You have a migraine? Did you eat gluten? Do you have a cold? Do you have a flu? Like what's causing your headache? Saying you have a headache doesn't mean anything. And it's the same for every disease, whether it's depression or cancer or heart disease or diabetes. Just the name tells you what the symptoms are. It doesn't tell you the root cause. and when we look at the reimagining of medicine through the lens of functional medicine, systems biology, network medicine, this is the future of what's happening. Okay, this is not my idea, this is not Dr. Hyman's view of the world. This is actually what's happening in the science. At Harvard, they published a textbook called Network Medicine, describing this phenomena of the radical change that's gonna happen as we begin to understand the root causes, the multifactorial causes of disease, and the multiple things we need to do to correct that disease. And I'm so excited about this because it's actually finally hitting mainstream science. It's not hitting mainstream medicine yet. It's still on the fringes and unfortunately they're gonna take a while because it takes about 20 years from scientific discovery to implementation in medical practice or longer. And, this is a big paradigm shift. So, who knows? Maybe we'll have a fast one or a slow one, I don't know. Anyway, the key is that the body is organized in a very different way than we learned in medical school. It's not organized into organs and specialties. it's organized into these seven basic systems that are the functional networks in your body that control every single thing in your body. So every disease that exists today, I mean, obviously not getting hit by a car, I mean, that's a different kind of thing. But pretty much every disease is determined by imbalances in seven basic functional systems in your body that are controlled by your genes, by your environment. and your lifestyle. So all that dynamic interaction between your genes, environmental lifestyle is regulating these systems and is determining whether they're in balance or out of balance. And the single biggest thing you can do every day to positively or negatively affect these seven systems is picking what you eat properly. If you pick the wrong foods, you're gonna damage these systems and cause inflammation and damage to your microbiome and impaired detoxification and hormonal dysregulation and all kinds of stuff happens as you eat the wrong foods. And we'll go through each one. so what are these seven systems? There's your gut, we call that assimilation, your immune system, your defense and repair, your energy system, how you make energy in your cells from food and oxygen, your detox system, how you get rid of internal, external waste, your transport system, which is your circulation, lymph, your communication system, which is hormones, neurotransmitters, other messenger molecules, peptides, all kinds of stuff, your structural system, which is your biomechanical structure, your body, your musculoskeletal system all the way down to the subcellular structures of your cells and your membranes. And those are all affected by your lifestyle, your diet, and various insults like toxins and allergens and microbes and radiation, all kinds of stuff. So our goal is to figure out what are these seven systems, where are they out of balance, how do you get them in balance? That's the key to understanding disease and the key to fixing what's wrong with most people. What is so beautiful about food is that we're finally understanding how food interacts with each of these systems. I'm going to take you quickly through an example of each one, positive and negative. But gut, if you eat our Western processed diet, you're going to grow really nasty bugs in there, and those bugs are going to produce really nasty compounds that make you sick and even make you gain weight. If you eat the right kinds of foods full of polyphenols and fiber and probiotic foods like sauerkraut, you're eating cranberry and pomegranate, you're having prebiotic foods like asparagus and plantain and through some artichokes and artichoke hearts, these are going to help create a healthy microbiome. So you can harm or heal the system by choosing the foods you eat. Your immune system, the same thing. Our diet is very inflammatory. We eat sugar, processed food, refined oils. These are highly inflammatory foods that are driving our biology towards inflammation, which is at the root of most disease. On the other hand, if you eat a whole foods, plant-rich, anti-inflammatory, phytochemical dense, high fiber diet, you're gonna be reducing inflammation. If you are looking at energy, for example, if you eat an excess of calories but not enough nutrients, which is what most Americans do, and this is kind of frightening actually, we should look at it, we were eating about 500 calories more per person per day than we did about 50 years ago. All that has to be processed. and it's processed in these little energy factories like your car engine called the mitochondria. And these mitochondria are very sensitive to an overload of sugar and starch and chemicals and processed foods. If you're dumping all that in there, you're going to slow down your energy production. On the other hand, if you're having good fats and you're having phytochemical rich foods and antioxidants in your diet, you're going to be helping the energy production and detoxification is another great example. If we're eating foods that are full of pesticides and chemicals and all kinds of stuff and that are full of sugar, which is damaging liver. By the way, one of the biggest cause of liver failure in the world is sugar, fatty liver. It's the biggest problem affecting 90 million Americans. If you're eating all that, it's damaging your liver. But if you're eating, for example, broccoli sprouts or lemon peel or green tea or any number of these plant compounds, probably called plant-based polyphenols and phytochemicals, they upregulate your detoxification system. So if you I, every day I make sure I have at least a cup or two of some family in the broccoli collards, kale, brussels sprouts, cabbage, broccoli and so forth, kohlrabi. And I try to include that in my diet on a regular basis, which actually helps to enhance detoxification. Same thing with circulation, lymphatic flow. You know, you want to make sure you're having foods that are, that are not making your circulation sluggish and inflamed, which is processed food. And you're eating lots of phytochemical rich foods. Same thing with hormones. If you're eating, for example, a lot of sugar, and starch, you're driving insulin up, you're driving your adrenaline up, your stress hormones up. If you eat a whole foods, plant-rich diet, a Pegan diet, you're doing the opposite to your hormones. You're balancing your hormones. We know, for example, that if women are eating a lot of sugar, they actually can get a lot of estrogen and that causes them to have all kinds of hormonal issues and infertility and menstrual irregularities and all kinds of problems. and that can be fixed, for example, by having them eat lots of fiber and flax seeds and soy foods and things with lignans in them that actually help to balance the hormones and getting rid of all that food. Same thing with your structure. If your structure is abnormal, you're not going to be healthy. We used to have a terrible word. It was kind of pejorative that we used in medicine when we were operating on people who are pretty unhealthy and had crappy diets because their tissue tissues would just fall apart in your hand. So you'd be operating them and you try to sew them together, and this tissues were just like fall apart. We call it PPP, piss poor protoplasm, which is terrible. But doctors, you know, have to, I guess, keep themselves amused while they're dealing with really difficult situations. And it's because their nutrition was so bad that their tissues and their structure was so bad. Whereas now, you know, and you can, you can, if you take some with a healthy diet and you can look at their tissues, they're very different and they stick together well. They're structurally sound. And I can go into way more examples, but food influences every single one of these things. So every bite of food you take changes your gene expression, your epigenome, which controls the master switches around aging, longevity, it affects your microbiome, your hormones, your immune system, your brain chemistry, your structure. Everything is affected by the quality of the food you eat. That's why the most important thing you need to understand around food is medicine is that food is information and what information or what code are you putting in your body? If you're putting putting corrupt code in your operating system, your software is going to be glitchy and that's called disease. And if you're putting good code in, you're going to have, you know, a really awesome functioning operating system, which is going to create health and vitality. And food is the single most important thing that can do that.

Mark, there was a great stat that you shared in Food Fix and also the marketing that you were doing around the book about just how many chronic diseases and deaths from chronic diseases every year have been attributed back to largely food. Can you share that stat with us and walk us through some of that information?

Yeah. Well, there's the Global Burden of Disease study that was been done. It's a really profound study. It's still ongoing. It's massive study. It's constantly collecting data. And the study was shocking. For the first time in history, obesity and chronic disease that's caused by food outstrips smoking as the number one cause of death in the world. And I think conservatively it's estimated that it kills 11 million people a year. Now think about it. I mean, if 11 million people died every year from something else, we would be up in arms trying to deal with it. If, for example, there was a new virus or something that was killing 11 million people. We like COVID, look what we've done with COVID We go crazy trying to deal with COVID We're not even talking about this. We're not even addressing the fact that in America, we are a minority of the world's population, about I think 5% and make up up to 20% of the COVID cases and deaths. Why? We have the best healthcare system in the world because we're the unhealthiest population driven by our modern American diet. and so when you look at the globally, you know, the deaths from chronic disease, it's about double that of infectious disease. So we have about, you know, probably 40, 50 million people a year dying globally from chronic disease. And some of it's smoking, for sure, like lung diseases, but the majority of it is actually somehow related to diet. So diet is the number one killer in the world. And what's amazing to me is that The number one killer is food, and yet the National Institute of Health, our government's research organization, spends almost nothing on nutrition and chronic disease. It's staggering. And I'm involved with a campaign that derived from the book called the Food Fix Campaign. It's a nonprofit that I created to drive policy change. And one of the things we're advocating for is a National Institute of Nutrition. which many other countries have, we don't. Hi, it's Dr. Mark. Well, you probably heard me talk about how much I love infrared saunas on the podcast. They're great for muscle recovery, calming the nervous system, circulation, and immune system support. I also understand that not everyone has room in their budget or their home for a full infrared sauna experience, but that doesn't mean you have to miss out on all the benefits of infrared light therapy. My friends at Higher Dose have an entire line of products designed to provide the same benefit as a sauna at a fraction of the size and cost. Their line includes the bestselling detoxifying infrared sauna blanket, which is really cool. And I use it at the end of the day to kind of just chill out. Very quick. I can listen to podcasts with it. The grounding infrared PMF mats, which are great for pain and inflammation with 20 pounds of crystal therapy and a rejuvenating red light mask. I like to use the PMF mat after I get home from a long flight. It really helps my body relax and sleep better than ever. Whether state of the art products, you can enjoy relaxation, detoxification, stress relief anywhere, anytime. So elevate your wellness scheme today by going to higherdose.com You can use the promo code HYMAN to check out and save 15% off site wide. That's higherdose.com and the promo code is HYMAN. Just go to higherdose.com/hyman and get your higher dose product today. I'm all about streamlining my daily health routine to be as powerful and yet simple as possible. And that's why I love AG1 from Athletic Greens. Because when it comes to my health, I want it all. I want my gut to function great, my brain to feel sharp, my immune system to be strong, my body to feel energized and able. and being in my line of work, I know that means I need optimal levels of nutrients, which is one scoop of ag1. I get 75 high quality vitamins, minerals, Whole Foods Source superfoods, probiotics and adaptogens to support my entire body. Even with a really healthy diet is hard to hit the mark for all our nutrient needs. So I feel better knowing that I have some extra help from ag1. Unlike other supplements and powders out there, ag1 is third party tested. and made without GMOs, nasty chemicals, or artificial anything. And it tastes great, kind of like a tropical green drink. I like it on its own mixed with water, but it also works really.

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Episode of the Doctor's Pharmacy.

Well, that begs the question, you know, why don't you think, especially here in America, why don't we have that? And why is food largely ignored by conventional medicine? It's, you know, most doctors, as you know, most people, most human beings for that matter, are good natured. They want to help people, they want to make a difference. But why is it that we've lost sight of the impact of food when it comes to health?

All I have to do is look at the medical school curriculum. I mean, I had nutrition. It was about a couple of hours devoted to quasis your core, marasmus, syrphthalmy and rickets, which are vitamin deficiency diseases you see no longer in the developing, in the developed world and rarely in the developing world anymore. It was an art, sort of like historical. tour through the history of vitamin deficiencies. And, there was no mention of anything related to chronic disease. It was just staggering. And yet, food is the number one cause of chronic disease, the number one cure, and doctors are nothing about it. So, they're completely uneducated. The last place you want to go to get advice about nutrition is your doctor. Unless, you know, there's someone like me who spent their life studying nutrition. But, it's really a problem. And so, we have this blind spot. The other thing is that doctors don't believe that it works. Why? They go, well, you're a little overweight, your cholesterol is a little high, why don't you improve your diet or your blood pressure so high? Why don't you eat healthy, exercise and come back in three months and we'll decide what to do. Now, that means almost nothing to people. What does eat healthy mean? What does have a balanced diet mean? What does eat in moderation mean? nothing to most people. They have no clue about how to navigate the nutritional landscape we live in. And we live in a toxic nutritional landscape where the easy choice is the worst choice for you. And the harder choices are, are, are good for you. In other words, you have to go hunting, gather to find something healthy to eat, which is tough. So, I mean, I've traveled all over America, and it's like, it's bad out there. I mean, unless you get into some pockets where there's some awareness and Consciousness and good food, it's mostly a nutritional Wasteland. And so doctors really can't be faulted because it's not part of their curriculum. And one of the efforts I've been involved with is called the Mean Rich Act, which is a act in Congress to fund nutrition education. The other thing we need to do is to actually change licensing exams so that doctors cannot become a doctor unless they pass a test which includes a whole section on nutrition. Now, I hate to say this, Drew, but most of the curriculum in medical school is driven off of licensing exams. What you need to know to pass the test to become a doctor. And if there's zero on nutrition, that's what they're going to learn, zero on nutrition. So if you make 10% of the questions nutrition related and chronic disease related, guess what? The medical schools are going to have to include it in their curriculum. So we have a long way to go to fix this, but the other thing is that doctors don't actually ever see it work. And like, you know, if I have a patient with heart failure and kidney failure and liver failure and diabetes, and I say to a doctor, well, I'm going to reverse all that using food, they're going to go, good luck, buddy. I mean, I, you know, I don't, I've never seen it.

Can't happen.

In fact, I had one patient at Cleveland Clinic who came to see me who was overweight, diabetic, high blood pressure, kidney failure, and he followed everything I said. He lost a bunch of weight. His kidneys reversed, his heart failure got better. His, his cholesterol normalized, the blood sugar normalized. Everything was correct. he went to see his kidney doctor and his doctor was like, what the heck did you do? I've never seen this before. I've never seen kidneys actually improve. We can slow it down, we can medicate it, we can manage it, but they are untrained in how to use food as a drug. And it's not the same for everybody. It's not like one diet fits everybody. What I treat an autoimmune patient with is different than I'll treat a diabetic patient with, different than I might treat an Alzheimer's patient with, different than I'll treat someone who's got chronic fatigue, it's very, very different depending on what is going on. And, I literally, just like there's hundreds or thousands of drugs, there's thousands of different permutations of diet that can be personalized and prescribed as a drug that works better, faster and is cheaper than any drug on the planet.

Let's switch over to some practical takeaways. People are always curious, what does Dr. Hyman and what are some of the top foods that he might want to call out that are super beneficial to be including in the diet, especially if somebody doesn't have these foods or isn't eating them in the right quantity. So you already gave us one previously. You talked about the broccoli family and the importance of cruciferous vegetables that are there and how you try to at least get one serving of those a day. Are there any other foods like that that you think of as being super healing to your overall health that you'd also recommend to the listeners of the podcast?

For sure. I mean, it's so second nature to me now, Drew, but when I go to the drugstore, I mean, the pharmacy, I mean, the grocery store, which I actually think of as my drugstore, I go through the vegetable aisle and I go through the grocery store and I'm like looking at all the drugs. I'm like, oh, I want this drug and I want that drug. Okay, this olive oil has got high polyphenols because, you know, it's special olive oil and it has the ability to be antiviral and it actually helps my blood vessels and arteries. So, oh, here's a mushroom. This shiitake mushroom or my talking mushroom is going to help my immune system. Oh, this artichoke over here, this one's a prebiotic food and the artichoke plus it helps my up regulate my detox pathways. Oh, and, and this particular fiber, this prebiotic fiber from plantain, if I like plantain, actually going to help my microbiome. Oh, this one. It's got extra CoQ10 in it and it's gonna help my mitochondria. Oh, I'm gonna get this fat because this fish oil helps to improve my membranes and help my structural system. And so, it's kind of a, I'm probably annoying to go shopping with because I have this, if you could literally have like the thought bubble in my head over in my head as I'm going to the grocery store, you see what I'm thinking. And it's so fun. And I think I break it down into a bunch of categories. there's protein, fat, carbs, and fiber. And then there's the phytochemical world. And then there's the seven systems in our biology. So I literally, every day I'm eating the best quality of the protein, fat, and fiber and carbohydrate. But I'm also thinking about how do I, oh, how do I help my detox system? How do I help my microbiome? How do I help my immune system? How do I do that? And so I'm picking the foods from from the grocery store that are helping me with each of these aspects. For example, I had kudzu noodles, which are amazing. Kudzu is a Japanese starchy thing that they made into noodles. But they're not like starchy noodles. They actually are incredibly helpful for your microbiome and gut soothing and healing. Or I'll have like the Shirataki noodles, which are made from cognac root, which have zero calories but are an incredible prebiotic and also help to slow the absorption of sugar and glucose. So I can have pasta without actually having any guilt. So I, I think about this as I'm going through grocery. I think about, okay, I'm gonna, I'm gonna look at the vegetable world. I'm gonna buy all the colors. I'm gonna buy prebiotic foods, which are the fibers. I'm gonna buy, I mentioned a few of them. We're gonna, I'm gonna buy probiotic foods. I'm gonna include maybe some sheep yogurt, or I'm gonna have a, a sauerkraut. or get pickles or I'm gonna have seaweed because it's full of minerals or I'm gonna have these class of phytochemically rich foods that are full of polyphenols to help my microbiome and buy pomegranate or I'm gonna get some cranberries and throw my smoothie. So I'm literally thinking about how do I, for each of these foods that I'm buying, what is it doing to my body and how do I construct a diet that tastes yummy and is delicious but also is the right medicine? and so I think about, should you want colorful fruits and vegetables, you want mushrooms, you want the right quality protein. So that would be obviously you can have plant proteins, which are fine, but you also, I think most people will need animal proteins in the form of regenerative raised beef or, or other animal products, fish, chicken, but should be organic and regenerative and fats. You want to have all the good fats, olive oil, avocado oil, fish oil. Those are really the basic foundational things. And then that's all that's in my kitchen. And also, I have nuts and seeds, so I like lots of nuts and seeds. I buy mushrooms, I buy nuts and seeds, I buy colorful fruits and vegetables.

I buy the right fats, I buy the right proteins, and it's just second nature to me now. 20 to 30% of all patient visits for primary care are related to fatigue, the chief complaint being fatigue. When you saw patients, again, in your other life prior to being a functional medicine doctor, and they would come in, with the complaint of fatigue, what were you trained to look at and ask them and what were you looking for as the source of what the fatigue was?

Yeah, well fatigue is obviously a catch-all basket of symptom that doesn't really specifically denote a particular disease, but it depends on the fatigue. So, we'd look for thyroid issues, we'd look for certain vitamin deficiencies like B12, we would look for chronic illnesses like cancer, we would look for heart disease, we would look for common things that are, we find in medical practice. But most of the time, you know, it's, doctors wouldn't find anything. They'd say, you,'re depressed. Take some Prozac.

That's basically what we would do. You'd be looking for, just to clarify, you're looking for things that are, like, blatantly wrong that would show up on.

A lab report or had a diagnosis. Is that what I'm hearing? Exactly.

Exactly.

Exactly. So it would be, it would be like stuff that Typically see like thyroid or B12 or, you know, things that are common in medicine, but that we don't really, we don't really have a system of thinking about fatigue very well when we're looking at, you know, what I tend to look at now when I'm looking at fatigue.

So then contrast that when somebody comes into your office now and you still are a practicing doctor, you're not taking on new patients, but there's still patients that are under your care. And they come to you and they say, Dr. Hyman, I'm suffering with fatigue. What kind of questions are you asking yourself and them and what type of tests are you running to help get to the actual root cause of what could be contributing to their fatigue?

You got a few hours? I mean, yeah, so I think fatigue is a rabbit hole and I obviously became an expert in fatigue when I had chronic fatigue syndrome. And, you know, there's layers. There's obviously the superficial layers of things we look at. But in functional medicine, we only need to ask two questions to learn everything we need to know about somebody. One is, what is it that is bothering your system? What is it that you have that you need to get rid of so your body can function properly? What's causing an imbalance? Second is, what does your body need to thrive that you need more of, whether it's sleep or vitamins, whatever? So what's the list that I go through in my mind when I'm thinking about diagnosing? I think about the five things that are the cause of most, almost all imbalances in the body that combined with their genetics. One is our diet. So, really poor nutrition has a huge role in energy, stress, and that can be physical or psychological stress. Toxins, and those are all sorts of toxins from environmental toxins, pesticides, heavy metals, internal toxins, metabolic toxins. Next is allergens. So something you're, is inflaming your body.

It could be a food allergen or.

Sensitivity or an environmental allergen. And the last is toxins. That can be heavy metals, mold. And then the last thing we look at are microbes. So microbes are not only what's in your gut, but also Lyme disease, viruses, ticks. So covid, you know, right now, everybody's got covid. That's a huge thing that causes fatigue. Epstein-Barr virus can cause a chronic fatigue syndrome. chronic Lyme disease, tick infections, mold toxins, all these things we tend to look at very carefully. Of course, there's, there's, there's physical things like lack of sleep, which is, I can put under the stress category. It's a physical stress, and that, that can also be caused by sleep apnea. So we look for all those things. We test for all those things based.

On a person's story.

So if someone says, you know, I don't eat fillings and I don't ever eat fish in my life, I'm not going to check their Mercury. But they go, yeah, I've had sushi five times a week for the last 10 years. I'm like, oh, we better check your Mercury. so I, you know, I live in an endemic area for ticks, well, which is pretty much the whole world. I check for ticks. So it's really about looking at their overall picture, their overall symptoms, looking for Clues about what's really driving it. Is it their gut? Is it an infection? Is it mold? Is it a hormonal imbalance? Is it, you know, some kind of stress? What's going on? So I really am very careful about drilling down into all those. And we'll look at diagnostic tests. It can look at all that. We'll look at the full nutritional evaluation, hormonal evaluation, gut evaluation. look for mold, look for toxins, and allergens, and much more. And we'll see often what the cause.

Is and we'll be able to fix it.

You know, not everybody has access to all the tools in the toolbox of what a functional medicine doctor might use as diagnostics that are out there. What percentage of generalized fatigue? I know I'm using an umbrella term, but what percentage of generalized fatigue can be improved. And this is your estimate, right? Just asking you for your best estimate from simple things that people can do at home that they're in control over.

I mean, a lot. I mean, most people do not understand that all their habits and their lifestyle drive their energy and how they feel. And so I basically teach people through an experiment on them.

Right?

So let's try this for 10 days, two weeks, see how you feel. so you take out the bad stuff, you put in the good stuff. That's actually all functional medicine is about. So what's the bad stuff? Processed food, junk, you know, lack of sleep, you know, excess stress, lack of movement. I pick all those things out, and I, I take out caffeine, alcohol, sugar, and, and make sure people are, are really eating a clean diet, which is super important. The Pegan diet, let's say, sometimes even, like, the 10-day detox, which is more of a an elimination diet to get rid of all the inflammatory foods and all add in all the good foods and so forth. So that's the first step. The second thing would be, you know, to try simple things like a good multi fish oil, vitamin D, often that can help replete any deficiencies that can cause a problem. I'll often, if, you know, with the regular conventional doctors, you can do a lot of blood tests. So you can look at thyroid, you can look at nutritional levels, you can look at vitamin D and many, many other things. So I would look at all that stuff. as a conventional doctor. And then I would look at, you know, what are the things that they can do, like just gentle exercise to start with. Look at their sleep habits. How do we fix those? What do we, what's wrong with this? Sleep apnea. Can we fix that? What else can they do? They can do hot and cold treatments. Really simple things can make a huge difference. So between cleaning up your diet, exercise, stress reduction slash meditation, yoga and sleep, and then some of these hormetic therapies that we talked about, like hot and cold treatments. Those are all basically free or what you're already paying with your food. So I encourage people to try those things first. And, and then usually if there's, if there's a lifestyle reason, it'll get better. And if not, then they'll need to go on and start digging. And, and depending on what your symptom complex is, we dig in different places. But, but it is a solvable problem.

All right.

I want to talk about blood sugar and how blood sugar can be related to energy levels and blood sugar management and being on the roller coaster ride of blood sugar. But before we do that, you've talked about caffeine a couple times. Now, people get scared anytime you talk about caffeine, especially I have a lot of friends that are new parents and it's kind of like caffeine is part of the thing that's helping them just get through the day. You do drink caffeine. And so give us the context around caffeine. When is it that it falls into the category of zapping your energy. And when is it beneficial and you can take advantage of some of the healthy properties that have been discovered through research around caffeine and specifically coffee?

I go on and off it and I'm always curious what happens when I come off it. I always have more energy, which is paradoxical. I obviously don't get the kick in the morning. And recently I went off coffee for a couple of months and my alternative was wake up, and go in an ice cold shower. And I can tell you, that'll wake you right up. Or I would in a cold dip. They had a cold dip where I was over the holidays. And that was amazing. It just, like, woke me right up, and I didn't need coffee. So if you're looking for that initial morning Buzz, there's other ways to get.

It, which is as close as your shower or about them. So just to clarify, just, just to jump in, because I want to make sure I parse it out. So it's not that you're poo-pooing caffeine. kind of hearing from you and knowing you a little bit is that you're talking about the importance of getting off of it every so often so that you understand what your baseline is because caffeine can hide a lot of challenges that people have that are brewing in their system. Yeah, I mean there's a lot of variation how people metabolize caffeine.

So there's fast and slow metabolizers. There's people that can have a cup of espresso and go to sleep and be fine. Other people have one cup of coffee in the morning and they're bouncing off the walls and have palpitations. panic attacks and anxiety. So it really depends on the individual and what your metabolic pathways are. And we measure those through genetics so we can actually look at that. But the— the— the truth is that it's just— it's worth an experiment for yourself to see how you feel. Now, if most people can tolerate a cup of coffee or two in the morning and that's fine, I probably wouldn't have one after the morning cup. I certainly wouldn't have one in the afternoon and definitely not in the evening. Now, you may be one of those super fast metabolizer. It doesn't bother you. You're fine. You like to have an express after dinner. Go ahead. but know your body because it ultimately can catch up with you. So I encourage people to try to just limit their caffeine a cup a day but also to go on a caffeine holiday and see how they feel because it might actually give them way more energy.

That's great. We actually have a protocol that we put together based on some advice that you have on how you can do a coffee fast. We'll link it in the show notes and people can follow that and also why you would wanna do that. Okay, let's go to blood sugar management. Give us the big picture overview on blood sugar management. Your first big number one best seller was all on this topic. And tell us why blood sugar is so connected to what we perceive internally as our energy going up and down throughout the day.

Well, you know, we recently partnered with a company called Levels, which is a fascinating company that measures continuous glucose throughout the day. So you're measuring your glucose all the time and you can see depending on what you're eating, it's going up and down. And we recently did a podcast with Casey Means, who founded it, and it was fascinating to see the foods that just jacked your sugar up and down. And when your sugar is going up and down, you're on a roller coaster of energy and crash and refuel.

And that's where people end up with.

This tremendous amounts of weight gain and fatigue and, and, you know, buzzes and mood issues and all kinds of other health complications. So sugar is really nasty. And if, if you understand it's a.

Drug, if you understand it's very powerful, if you understand that if you use.

It, it has to be used as a drug. Like, you wouldn't drink a bottle of tequila at a sitting. You might have one little shot or two in the context of a meal. And I think, you know, you can have sugar. It's not saying I don't ever have sugar, but I think it's when you have it, how you have it, with what you have it, and how much you have. So I think for most people, trying to sort of reset their energy levels, cutting out sugar and starch and eating protein and vegetables for a week doing the 10-day detox diet essentially is an amazing way to actually recalibrate their metabolism.

Their brain chemistry, and their energy. Yeah, we have a podcast and you've done one as well. I've done one where we actually talk about the top 10 most popular foods that will spike your blood sugar and put you on this roller coaster that you have a super high high and then you end up having a crash afterwards. And for a lot of people who go through the standard 3:00 PM, 2:00 PM, 4:00 PM, midday crash, it's often because of what they're eating early in the day. So doing something like levels could give you insight on what you're eating and how that's throwing your blood sugar off.

We're just recognizing the dangers of sleep deprivation in terms of its risk for chronic illness, heart disease, cancer, diabetes, Alzheimer's, depression, anxiety, mood disorders of all sorts.

So it's a real thing.

And I think if we don't take it seriously, we're going to be missing the boat on a very important intervention. helping to address some of these chronic diseases that goes far beyond diet or exercise. The other thing that happens is your brain at night has a system of cleaning, cleaning and repair. So you need to have the, what we call the lymphatic system working. The lymphatic system is like the lymph system of the brain. That's recently been discovered, and it's so important. It really is activated at night. So if you're not sleeping at night, you're not clearing out the brain waste, and you're going to have a brain full of sludge and waste products that are metabolic waste and toxins. So it's so important for that particular reason too to make sure you have adequate good sleep.

I know there's a little bit of controversy around this and a lot of different opinions, but from your perspective, how many hours of sleep should we be shooting for in the evening? I mean, it's very individual.

Some people do fine on six hours, some people need nine hours, and you need to find out what your number is. Everybody's different. but the amount of sleep where you can feel good and energetic and your quality of sleep is deep. I mean, if you sleep six and a half hours and it's like, you know, a ton of deep sleep, a ton of REM and really reparative, and that might be enough for some people. Other people might need nine. I need about eight. My nine, I love if I can get it. But it really makes you feel much more vibrant and healthy and functional. So I think, you know, it's certainly more than, than seven, ideally, and probably between seven to nine hours is a good amount. And again, as I said before, you know, the last century, about half of us, I mean, sorry about the average age of the average number of hours of sleep a night was like nine hours. Now it's seven or less.

All right, next question. What are commonly overlooked issues that drive poor sleep, unexpected things, things that people may not know that expand on that first list that you gave us when we were opening the episode?

Yeah, I mean, I think people don't.

Understand the role of their overall pattern.

Of being and living.

So first thing is when you wake up, you should get 20 minutes of sunlight without sunglasses on because it resets your pineal gland, which is makes melatonin and regulates your circadian rhythm. So we want to keep our circadian rhythms in balance. The second thing is, you know, our diet plays a huge role. And, and particularly, you know, if we're eating a diet that's, you know, high in starch and carbohydrate, we're having fluctuations in blood sugar. we may actually even at night get hypoglycemia, and that can really disturb our sleep. We can get night sweats. You know, men often get night sweats, too, but that's often usually low sugar. And then the cortisol spikes, and you get a spike in sugar in the morning. So that's a real problem. I think the other thing is, you know, people are probably consuming a lot of alcohol, caffeine, sugar, all these disturbed sleep, chronic stress. You know, if you're not actually discharging stress, a lot of people go to bed tired and wired, and a lot of people have adrenal issues, so. they're pushing so hard in their life that they actually don't have a chance to reset and relax their nervous system. And that leads to incredible amounts of cortisol production, cortisol disturbs sleep. I mean, if you take prednisone for whatever reason, it's going to mess up your sleep. So stress plays a huge role. Exercise. I mean, you don't want to exercise too late in the day. That can often activate you. So. So there are, you know, a lot of things that can drive poor sleep. Lack of magnesium, which is common in the country. If we don't need magnesium in the forms greens and beans, nuts and seeds that we end up with magnesium deficiency which affects about 45% of the population and people don't sleep well when they have low magnesium. It can be irritable, cause irritability and tension and stress and then plus caffeine and chronic stress and smoking, a lot.

Of other things will cause magnesium depletion. So, you wanna make sure you're getting plenty of magnesium. Talk about sleep in your life. What are the things that now at the age that you're at and your schedule, what are the things that throw your sleep off and what are the effects that you notice in your performance the next day when your sleep is thrown off?

No, yeah, I mean it's huge. I mean if I'm traveling, you know, I'm trying to stay in one place longer but it depends on the bed and the pillows, the sound, the noise, the temperature. I mean I can get, messed up. And given all the years of screwing with my schedule and sort of staying up all night, I definitely have sleep issues. But I've learned how to actually mitigate them by, you know, making sure I do a bedtime wind down ritual, by making sure I take my bedtime supplements like magnesium, a little melatonin, and. And. And if I don't get quality sleep, I notice in the next day, I can't focus, I can't think. My brain is, like, distracted. It's hard for me to be present with other people. It's hard for me to feel motivated to do anything. I notice as I get a little depressed. I mean, but it's not, I know I'm not depressed. I just know it's a sleep like a sleep. So I, I think, you know, very attentive to sleep. But I think, you know, sometimes it's hard, you know, when you're out with.

Friends and you're traveling, you're on vacation.

It'S a little tricky, but mostly I, I'm pretty good about getting to bed by 10, 9 30, 10, sometimes a little bit later and try to sleep, you know, read a little bit. I have a, I have a, a light, which is a reading light that's a kind of an amber light that has no blue light in it. It's kind of to leave the light bulb on. on the bed, so I try to calm down from the light. I have blue blocker glasses at night I use, that really helps. And so that all benefits me.

Talk to us about how conventional medicine typically treats poor sleep when a patient is going through it and contrast that with functional medicine and how a functional medicine doctor would look at addressing poor sleep quality with a patient.

So from a traditional medical point of.

View, I mean, there are reasons for people's lack of sleep that a conventional doctor will look at, whether it's sleep apnea, restless leg syndrome, there's sleep studies that doctors do that can be very revealing. A lot of people have undiagnosed sleep apnea. The ultra Wellness Center, we now have a home sleep study kit, which allows people to kind of get tested and do it at home, which is great. However, you know, often there's really very little to do from a conventional perspective other than recognize basic sleep hygiene. And then there's a CBT sort of approach, cognitive behavioral therapy, which helps people deal with sort of the mental aspects of insomnia. And that can be very effective. Cleveland Clinic has an online program called SOMReST, which is available. So there's a lot of really useful conventional approaches to help people reset their sleep.

However, there may be a lot of.

Other causes from a functional medicine perspective for sleep disruption.

The traditional medicine just says, oh, do therapy or take these sleep pills or.

Practice better sleep hygiene.

But they don't really say, well, why is your sleep disturbed in the first place?

This is why we're so effective in functional medicine. Because we don't want to know just what you have. Insomnia. We don't know why. Why you're not sleeping. Is it because your thyroid's not working? Is it because you have chronic stress and adrenal burnout? Is it because you have low magnesium? Is it because your microbiome is inflamed and causing inflammation in your brain? because you might be hypothyroid, which can cause a little bit of sleep disruption or is it because you have a bad sleep environment or because your sleep habits are terrible or because, you know, we go through all the underlying root causes. And then we dress those, whatever they might be. You know, it's amazing to me, Drew, I never would have thought this was the thing, but when we put people on the 10-day detox diet, when we put people on elimination diet and get rid of processed food, sugar, dairy, gluten, grains, etc. It's amazing how many people report, oh, my sleep got so much better. I'm sleeping so much deeply. I feel so much better. I'm like, well, wow, I don't know about that. But I think what happens is there's inflammation in the brain and inflammation will interrupt sleep. And when you start to live an anti-inflammatory life, you actually will end up.

With a much better sleep quality. Little anecdote is that my dad many years ago, when we put him on a version of the 10-day detox, and he had been eating bread his whole life because he grew up vegetarian and still was vegetarian when he was doing the program. One interesting thing that he noticed is that when he had cut bread out of his diet, he noticed this chronic back pain that he had at night that would make it harder for him to fall asleep went away because the inflammation went away. And that then made it easier for him to fall asleep. And so he got a better night's rest.

There you go.

Talk to us about another patient and a case study that you can think of where sleep was the missing link that allowed them to get into a better state of health. Anything that comes to mind?

Well, I have two. what?

What was this guy who was very smart editor of a major, major sort of Sunday kind of magazine newspaper? I mean, you would all know what it was. And, you know, his team was like, he's just falling asleep all day in the office. I'm like, it's terrible. He's not. He's not able to function. Well, it's annoying. I'll fall asleep in meetings.

Well, tell me about your life.

He says, well, I drink, you know. 12 Cokes a day and have 12.

Cups of coffee a day. I'm like, oh, okay. Well, maybe caffeine is a problem.

So we got him off the caffeine and we put him on an anti-inflammatory diet. And it was amazing. He just completely turned around and was able to, you know, be able to function again. There's another case I remember. Young. Well, not young. He was about a 50 year old. He's young to me now, but 50 seems very young to me.

That'S all.

And he was a lawyer.

And I'm like, well, tell me how you're doing.

He's like, well, I want to lose weight. I'm kind of overweight. And he had, yeah, the big belly and pre-diabetes and I'm like, well, tell.

Me about your life.

And he said, well, you know, I said, you sleep okay? Oh, yeah. But, you know, during the day, I.

I use a stand-up desk.

And this is before stand-up desk where even a thing. And because if I sit down, I'll fall asleep. while I'm working. And I'm like, wow, okay, you probably have sleep apnea. So I said, let's test you for sleep apnea. And he sure enough had sleep apnea. We put him on a CPAP machine, which is a breathing machine to sort of stop CPAP.

He literally lost 50 pounds just like.

That and felt so much better. And, you know, we corrected these underlying issues around sleep and metabolic Health. The thing is, if you don't sleep, you also crave carbohydrates, you crave sugar, you crave, you know, all the junk that's going to make you gain weight. And we know this even from studies on young, healthy adult college males who were not overweight when they deprived them of two hours sleep a night compared to the control group, the ones that had the two hour sleep deprivation ended up having higher levels of ghrelin, which makes you hungry. And PYY was lower, which is the appetite suppressing hormone. And so they had hormonal changes that made them crave more carbohydrates, eat more food, be hungrier. gain more weight. And so really the key to often healthy metabolism and weight is actually sleeping.

A lot of people at night notice that their mind is running and it just won't get quiet and that impacts their sleep. I know you have a lot of experience with meditation and different protocols that you've used either personally or recommended to people in the past, but is there something that you could suggest That those individuals could try when it comes to winding down at night and getting ready for bed. Absolutely.

I mean, I think, you know, we.

Think about it's kind of silly. We like, go, go, go. We're answering emails at 11 o'clock at night. You know, looking at our screens, we're engaged in all kinds of stressful, emotional, psychological things with your own work or whatever. And then we're like, okay, lights out, boom, go to sleep.

And people are exhausted, but they'll often.

Fall asleep and then often wake up frequently because they got the stress hormones going in their body.

So I I think really having a.

Sleep ritual at night is so important for me. It's. It's very important. I get off screens at least a couple hours before bed. I I often will take a hot bath with Epsom salt and lavender, which calms my nervous system down. I'll put the little kind of Amber light that has no. It's like a reading light that has no blue light. Turn all the other lights off. I'll read a little bit in bed and. And the reading and the calming down just calms it down. The other thing I can do often is I'll. I'll write a little before bed. So I'll literally dump out whatever in my head. I'll just write it all out and I'll just completely purge anything that is a negative thought pattern in my head or my worries for tomorrow, what happened that day, whatever, whatever, and I just try to let go. And the other thing you can do is a little yoga stretching before bed, a little deep breathing exercises before bed, get a little massage before bed, you know, all those things can help. you know, if you're a partner, you can rub each other's feet. That's a very relaxing thing to do. I have a Theragun. I'll often use that to kind of relax my muscles and nervous system. You have to find out what's right for you, but it really requires some level of decompressing and unwinding before you get into bed. Because if you just plop into bed after running 100 miles an hour, it's like you're not gonna fall asleep or you're asleep or you'll fall asleep because you're exhausted and then you wake up. because you're under chronic stress.

You chatted about this earlier, but talk about your morning routine and how crucial it is for you to set up your circadian rhythm for the rest of the day. What are the things that you do that you found work well in the morning that end up helping you have better sleep at night?

I mean, I think the key is, you know, I tend to meditate in the morning for 20 minutes. I'll have a cup of tea or maybe I'll have coffee, and I'll do a little journaling and writing and just sort of get myself grounded for the day. And then I'll often try to take a walk or be outside in sunlight for 20 minutes without sunglasses on to reset my circadian rhythms. And, and then I'll have, you know, a very low starch sugar breakfast, mostly protein and fat, you know, their avocados, eggs and olive oil, or I'll have a protein shake that I make of fat in it. That really helps me. sort of set up my system for the day so I'm not craving the wrong foods and I'm actually keeping my system in balance.

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in.

Hey everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

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