STRESS & LACK OF SLEEP Is Destroying Your Brain & CAUSING MIGRAINES! | Mark Hyman & Todd LePine

There are certain foods which can trigger a migraine. So is it the food that's doing it or is it something in the food or it's how the food is actually being metabolized?

I would say migraines are among the worst condition that people can suffer from but from a functional medicine perspective, they're probably the easiest things to treat. Wouldn't you say Dr. Lippe?

Absolutely, yeah, exactly.

So how do we think about this condition in traditional medicine? What is the normal approach to diagnosis and treatment and what's wrong with it?

Well, the interesting thing is, When I look back, I can remember when I was practicing mainstream medicine, I always looked at migraine patients and there were so many different things that were offered by mainstream medicine for migraines. And it sort of made me question, like, there's no such thing as one migraine. There's so many different flavors of migraine. You can have a patient who has periodic migraines, you can have someone who's got menstrual migraines. So to me, that was telling me that migraines, there's a lot of pathways to developing what we call a migraine or another, you know, they also call it a vascular headache. And I found it really is an interesting approach to know that each individual, their presentation for migraine is unique. The interesting thing is I would never treat two migraine patients the same because they all have different features.

So, that speaks to a very central idea in functional medicine, which is this. Just because you know the name of your disease, it doesn't mean you know what's wrong with you, right? Yeah, absolutely. You have a migraine. That just describes people who have a certain type of headache with certain types of symptoms like light sensitivity, noise sensitivity, maybe on one side, maybe visual pre-aura symptoms, nausea, vomiting. These are just the typical things. Okay, you have a migraine. And then there's, then we divide into classical migraine and this migraine. And they're all just different ways of describing the kind of migraine, but none of them tell you the cause. So functional medicine is about focusing on the cause, which is what you're talking about, these different flavors. Exactly. There may be up to 29 different factors that can drive a migraine. And traditional medicine just uses a one size fits all approach.

So what is the typical approach to treating migraines? Well, in mainstream medicine, it's really just basically a board of therapy. You know, you might take Advil or Aleve or an Cedrin, you might take a triptan, you might take an opioid.

Like imitrex or something.

Imitrex, yeah, imitrex, exactly. Or opioids in severe cases, steroids in other cases. So it's basically treated abortive therapy, which is that when you get an attack, you treat that attack. And for people who get them more frequently, it's about trying preventive therapies. And they're all over the place. I found that actually quite interesting when I was looking at how do neurologists approach migraines, know, these headache neurology specialists and they use everything. They throw everything in there. They they'll throw in beta blockers. They'll throw in calcium channel blockers there to prevent migraines. To prevent migraines, exactly. So so the preventive role is really important, I think, because when you look at someone who's suffering from migraines, I mean, people can lose a lot of work over over migraines. They got. Oh, it's absolutely and sometimes for some people it might be two, three days or a whole week that's lost. They're just like, you, they gotta stay in bed and, uh turn uh, turn the lights on and just wait till the whole episode passes. And then other medications that are used in mainstream medicine are anti-seizure medications.

Yeah.

I mean, you know, it's- so antidepressant.

Seizure medications, blood pressure medications. Calcium channel blockers.

Yeah, all the stuff that they're kind of throwing at you.

Antidepressants, tricyclic antidepressants, you name it. And, there's no way to actually figure it out. You sort of like, it's like spaghetti on the wall.

He's not just try this, try that, try this.

And I can't tell you how many patients I've seen who've been through the whole mill of these medications and it.

Might help a little, it might- Botox.

They're using Botox now. They're using botulinum toxin. Yeah, well, that's just to paralyze the muscles in the back of the head, right? Exactly, yeah. Right. So, it is a terrible condition. I've had people who've had chronic daily.

Migraines or 20 days a month and it's just so awful for people. Especially in women, women tend to have a little more, I think, in general, women, I'd probably see more women with migraines than as opposed to men. And then women also get menstrual migraines, which is another sort of flavor of migraines, which is another, probably related to estrogen detoxification. So it really is, and it's actually, it really keeps me on my toes in functional medicine when I see a migraine patient, 'cause it's not like, oh, here's your problem, you know, just do this and it's fine. I've got to like play detective. I've got to figure out what are the factors that are driving that person's unique presentation of their migraines.

That's absolutely right because what we do in traditional medicine is, okay, you have this type of headache and I ask these questions and it meets these criteria for what a migraine headache is according to the neurological society criteria. But once you make the diagnosis, there's no more thinking involved. It's like, okay, here's the cocktail of drugs I get to pick from. Start with these, try this, that doesn't work, we'll try this. and it's just like it's kind of a merry-go-round of drugs and it often is so difficult for people to get better because they're not asking the right questions. So in functional medicine, we don't just name and blame, which is what our mentor, Sydney Baker talks. We name it, blame it and tame it. You name the disease. Say, oh, you have a migraine. That's why your head hurts. No, that's not why your head hurts. That's just the name of why your head hurts. And then we try to tame it with a drug. instead of actually figuring out the cause. So let's talk a little bit from a functional medicine perspective about what the causes are. And let's get into some cases because I think we've both seen so many cases. It's one of the most satisfying things for me as a doctor to actually treat because it's so easy usually. And people do so, so well with simple approaches that deal with the root causes.

Yeah, absolutely.

So tell me what what are the things that you think of when you're coming to see these patients that could be driving the migraines?

Well, one of the things that I think is missed by a lot of mainstream doctors, even neurologists, is to understand the role that mitochondria play in migraines. So interestingly, mitochondria, which are the powerhouses of the cell, they basically is where our body consumes food, we produce energy from that food in the form of ATP. and mitochondria are not really tested by mainstream medicine. They are not well understood, something that you learn about in medical school and then you forget about it. And the interesting thing is that people who have migraines also have a higher incidence of seizures. And that's why to some degree, anti-seizure medications can actually have efficacy in some patients who have migraines. So there's a real important to realize that connection between mitochondrial dysfunction and migraine.

Mitochondria make energy in your cells.

Make energy in your cells. In fact, I've actually seen some patients, interestingly, who, and I don't see, I don't treat children, but I've seen some adults. When I go into their history, they had a history of what is called cyclic vomiting syndrome. And so that's where a young kid is vomiting for no particular reason. And it turns out, cyclic vomiting syndrome is actually a mitochondrial problem. And as a person gets older, they sort of grow outgrow that vomiting. episodes, but they actually then present with migraines. And interestingly, the gut is connected to the brain. So a lot of people can have what we call abdominal migraines.

Yes, exactly. Right, right.

Yeah.

This reminds me, Todd, I had a patient who struggled with headaches and migraines, and she had terrible SIBO, which is overgrowth of bad bugs in your small intestine that was causing all this fermentation and creates these toxic byproducts that were clearly creating inflammation in the brain.

And we treated her gut with antibiotics to cure migraine. But who would, who would have thought.

Of that as a neurologist, right?

Exactly.

Yeah.

And it's also the other interesting, we're going to talk about that in one of the upcoming episodes is on histamine, the role of histamine. And that's actually a very interesting thing when you look at histamine because people who have SIBO, they actually have bacteria that are producing toxins like you're talking about. And one of the problems is excess amounts of histamine. So normally our bacteria will degrade histamine. and we have enzymes that do that and there's all different these different pathways. And when you look at some people who have migraine headaches, there are certain foods which can trigger a migraine. So is it the food that's doing it or is it something in the food or it's how the food is actually being metabolized? So that's a really a key important feature is that the connection between the gut, our food and the brain.

Yeah. I mean, it is such a big problem, Todd. the amount of people with migraines, over 10 million people have migraines. It costs about $17 billion a year to society in healthcare costs, just direct healthcare costs, that's medications, emergency room visits, hospitalizations, doctor visits, testing, and then even managing the side effects. And then the loss of productivity to employers, because like you're saying, is $15 billion, about half that's so huge. due to absenteeism and the other half is due to just people being on the job but not, being at the job but not on the job, you know, they're just sort of there but not functioning. Absolutely. And so, you know, over the years of functional medicine, I've seen so many patients and like you said before, there's so many different flavors. Tell us about some of the other flavors because we went through the mitochondria and let's just go to go down the list of what are the most common things because, you know, like there.

Could be 29 things but there's a.

Few that are really common. Stress.

Stress. Stress, okay. Tell us about stress in mitochondria. So, so, so stress. stress by itself does not cause any diseases, but stress can turn the volume up on all different kinds of conditions. We see that in autoimmune conditions. So how our bodies respond to stress and some people have, I would call it a genetic predisposition to be more stress resilient and some people don't. And some people are more prone to the effects of stress and time after time, you know, you see these people who they'll go through a very stressful period and all of a sudden they get a full-blown migraine. Well, what is that? You know, what's going on there? I think it is how that person perceives the world and how they detoxify their stress. Absolutely. And that's why beta blockers, which block adrenaline, which you get high levels of stress, makes a big difference.

So things like yoga, meditation.

Exactly. And then also sometimes when you have patients who have migraines and you measure their cortisol levels, they've got higher levels of cortisol. So that's telling you they have more chronic stress. And they sometimes will be type A where they're very, very driven. those kinds of things.

So you mentioned gut issues a little bit earlier and I think that's another big one and not just SIBO, but there are a lot of symptoms that people get that could be related to leaky gut and food sensitivities, which seem to be a huge factor with migraines that are really undiagnosed. We know traditionally that people say scientists and doctors say stay away from tyramine foods, cheeses, foods that contain certain chemicals like MSG or aspartame. So there are some recommendations, chocolate, FE and there are doctors who do say some of these things and that can be helpful for some patients. But it goes much deeper than that. There's like food sensitivities and gluten. So tell us about, you know, how that, how that works. Yeah.

Well, I think that, you know, the connection between the gut and the brain is huge and the, the leaky gut component. You oftentimes will see leaky gut in patients who have increased risk for, for migraines. It, it, there's a, there's definitely a two-way communication that's going on there. And again, you know, sleep is another thing that plays a huge role. So lack of sleep is huge in migraines. So when you look at, when somebody comes to see me, you know, I ask them, how's your stress level? How are you sleeping? And what are you eating? And who are you feeding? Which is, you know, what's going on with the gut bugs? Yeah. You have patients who will tell you that when they eat certain types of foods, like sugar, they'll have, it'll trigger a migraine. Yeah. It's huge. And, I suspect that some of those foods are actually affecting the gut microbiome in a very rapid fashion that's causing migraines.

Yeah.

One of the biggest things I've seen.

I'm sure you probably noticed this too, is that gluten tops the list when it comes to migraines. If anybody has a migraine, the simplest thing to do is an elimination diet. Absolutely. And get rid of the most common allergens, gluten, dairy, eggs. And, I've seen so many people, I had one woman, married to a mafia Don and she had headaches for 40 years. It was incapacitated in bed very often and it turned out that it was eggs. Now, we found this on a food sensitivity test and that's not to say everybody's migraine is caused by eggs but hers seemed to be triggered by eggs. She stopped the eggs and her migraines in a way. So, I think everybody's different like you said. We have to treat the person, not the disease. I think Thomas, I mean, what is it? William Ulcer said that, you know, we should treat the person who has the disease, not the disease that the person has. And I think that's, that's the mistake we make in medicine. So doing elimination diet, getting food sensitivity testing, checking for gluten, that's all important. The chemical triggers, you know, we talked a little bit about that. Talk more a little bit about some of these chemical triggers that we notice. with migraines.

You mean like exogenous chemicals?

Things like aspartame, artificial sweeteners, food additives, sulfites for example.

I would say that those are basically excitotoxins. There are certain types of foods which can cause excess activity like monosodium glutamate. You get excess glutamate in the brain because glutamate gets converted into glutamate which is an excitotoxin. So definitely there are those types of foods and even if you actually, if you give somebody glutamine, which we use a lot to help with patients, I've had these patients who they'll, they'll, they'll metabolize their glutamine directly into glutamate, and you'll get taking glutamine, it'll be just like taking MSG.

They'll get very, you know, agitated and get a headache. Aspartame is bad.

I've seen so many patients who, oh.

Aspartame, yes, wig back those diet sodas and they get.

We have somebody in the White House.

Who does about, I think about 10 a day. I don't know if he's getting migraines, but he's giving everybody else a headache. But I think that, that I think you're right. I think we, we have really look at these things. The nitrates that are in, for example, deli meats, sulfites that are commonly added to salad bars. You know, I mean, no, you're just keep the vegetables fresh or the dried fruit and wine, tyramine, which is in chocolate, cheese. These are really significant. So, getting rid of all the processed food, all those chemicals, super important. Hey, everybody, it's Dr. Hyman. Thanks for tuning into the doctor's pharmacy. I hope you're loving this podcast. It's one 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/pix to sign up. That's DrHyman.com/pix, 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. Now back to this week's episode. Let's talk about hormonal factors because these are really common. and often, you know, women, we see this whole phenomena of premenstrual migraines. How do you know if this is an issue for you with your patients? Oh, you just by history.

I mean, the history will tell you that. And I typically will see that those types of patients who have menstrual migraines tend to have problems with estrogen detoxification. Yeah. So, you know, as men, you know, our hormones tend to stay relatively stable. We are, they go up in the morning, but they're pretty stable. Women's hormones, you know, they go up and down like the tides and and that's normal, that's part of the menstrual cycle. So when women are menstruating, they have these, some women have great fluctuations in hormones, and when the body is done with those hormones, unless you're pregnant, the body has to detoxify those hormones. And there are certain pathways that help with estrogen detoxification. And when women have problems with those pathways, one of the genes that's important in there is the catechol-O-methyltransferase or COMT gene. And typically that gene, is oftentimes associated with increased sensitivity to pain. It's also associated with increased sensitivity to migraines, seizures, and headaches. So it's definitely one of those pathways that you wanna support for the detoxification or the methylation of- With B vitamins, like B6, B12. Magnesium. Magnesium.

And, you know, often the classic story that I've seen with these premenstrual migraines is women get like PMS symptoms. So they get bloating, fluid retention, they get cravings, irritability, breast tenderness, menstrual cramps, and they get heavy bleeding. These are signs of sort of too much estrogen and not enough progesterone. And I remember one patient who had a migraine, literally in my office, and I had a sample tube of topical progesterone that I had been given by the company that made it. And I literally said, well, let's just try this. And I took the progesterone, I just put a little cream on her arm, rubbed it in, and her headache went away right there in the office. It was the most striking thing I'd ever seen. And I think we often will prescribe topical progesterone or other things to help, we'll prescribe dietary changes, help with PMS, detoxifying these hormones can be really helpful. And also using an overall strategy of diet and exercise and stress reduction to balance women's hormones, because I think they're totally influenced by diet. Even the microbiome.

Well, it's interesting you say that because I remember distinctly when I had a patient, when I was practicing mainstream medicine who had menstrual migraines and the only thing that worked for her was Xanax. Now, Xanax is a benzodiazepine, which is a tranquilizer. Yeah, like Valium. Exactly. And it works on the GABA receptors. And guess what? Progesterone works on that system.

That's why progesterone is so powerful. So just to recap that, what you're saying is basically progesterone is women's natural value. Exactly. and it works in the brain on these receptors called GABA that Valium works on and makes you relax, which actually helps women sleep, calms her nervous system, deals with some of this mood fluctuations that happen with high estrogen. And, by the way, our whole lifestyle drives estrogen, right? Sugar, stress, lack of exercise, bad gut microbiome, environmental toxins, all these things will drive dairy, for example, drives excess hormone and estrogen production, being overweight, sugar, all those things can be managed easily with lifestyle and diet. Okay, let's talk about some of the nutrients because there are some key nutrients that are often low in people who have migraines.

What's the number one nutrient that you would be thinking of? I would say magnesium. Yeah, magnesium. Now, the interesting thing, this is also another thing where you can sort of connect the dots here is magnesium, which is such a powerful, you know, it's involved in like 500 enzyme pathways in the body, is magnesium, when you get to a high enough level, is actually.

A calcium channel blocker.

Guess what doctors use to prevent migraines?

Calcium channel blockers. It's a natural muscle relaxant. Yeah. It's actually, I remember when I was an ER doctor, it was one of the things we used. When none of the drugs worked, we.

Would use IV or intravenous magnesium for migraine patients. Remember that? Absolutely. And not only that, but in the ER, we use IV magnesium for heart arrhythmias, life-threatening ones like torsades de pointes and B-TAC. We also use it for status asthmaticus. Yeah. All right? You use it for preeclampsia. It's a very powerful element. It's a relaxant.

And what you're saying is funny to me because I remember, you know, when you learn these ACLS courses, the advanced cardiac life support and how to run a code and bring people back from death when their heart's not working and they use all these drugs, drug, drug, drug, drug, drug. And the last thing, if nothing else works, they use magnesium. Why don't you use it first? And then, like, if someone's got Heart's not beating, right? You give magnesium and it fixes it. Or people are coming in in preterm labor or have like this preeclampsia, which is high blood pressure in pregnancy with seizures. They use IV magnesium. They use- yeah, and asthma, like you said, to relax the lungs. They use IV magnesium. It's pretty funny. Even for people who are constipated, they give them milk of magnesium. So, it's kind of- it's funny doctors don't really think about it. And most of us, about 40% of us, are low or deficient in magnesium. Oh, yeah. And, I remember this one patient I had. who was a radiation oncology resident back when we were at Canyon Ranch. And she was just debilitated with migraines. She had the worst migraines. She was on narcotics and Zofran, which is like a chemo drug that's used for nausea. It was that severe. She could barely work. And she came to see me and I started asking her questions. And this is how you find things out in functional medicine. You try to connect the dots. So usually you can find out from a story if it's a premenstrual migraine, if it's a food related migraine, if it's a, this is why you're saying we can actually figure this out as functional medicine doctors. And it turned out, you know, I started asking her questions and she had muscle cramps, she had constipation. I said, how can you go to the bathroom? Are you regular? She goes, yeah, I'm regular. I said, how can you go? She was like, go every week. I said, that's not regular, she says regular for me, I go every week. You know, she's severely constipated. Muscle cramps, headaches, insomnia, irritability, anxiety, palpitations, sensitive and loud noises. these were all symptoms of low magnesium. And so it turned out she needed, like, normal dose is 200, 400 milligrams. She need, like, 2, 000, 3, 000 milligrams a day of magnesium. And literally her migraines went away. Yeah. And that's sort of her constipation, all those other symptoms. So it's often really, often very simple if you know what to do. Yeah, absolutely.

Yeah.

Are there other nutrients that you would.

Think of that might be helpful? Because you mentioned mitochondria, and there's a couple of nutrients there that can really. Yeah. I mean, there's, there's. some of the key nutrients are vitamin B2, riboflavin. Yeah, vitamin B6 and also CoQ10. Those are probably some of my key mitochondrial nutrients that really can have an impact along with magnesium. Yeah.

So really, like, tell us about some of your cases that you've had experience with that have really kind of changed your thinking and have helped you understand.

Well, I had a patient who came in and his story was that he first developed migraines starting around at the age of five, which is interesting. Okay? So when you have a history of somebody who's having headaches, I mean, it's not normal for a five-year-old to have headaches. That makes me sort of think, okay, this person may have a mitochondrial issue and that may be what's going on early on in their story. Also, interestingly, the patient noticed when he was telling me his story that he would get the worst headaches on the weekends. and on further asking him, it turned out that on the weekends he didn't drink coffee. So what he was getting, it was a caffeine withdrawal headache. Now this is probably one of those things that, 'cause caffeine is a double-edged sword. We actually use caffeine to treat migraines, and if patients take over-the-counter medications like Excedrin migraine, guess what's one of the major ingredients in there is? Caffeine. Caffeine. In fact, I had a patient, I'll never forget this, it was a woman who had refractory migraines, and it turned out that she actually was getting rebound headaches from daily use of Excedrin migraine. And so she would have to take the Excedrin migraine to prevent the withdrawal effect from the caffeine.

So it was like a cat chasing its tail.

That's not great, 'cause that's got tolerance. Well, it's great for the company, 'cause they keep selling it, right? Cause liver problems. Right, yeah, exactly, yeah. So this patient was caffeine sensitive. So some of the treatments, you can actually abort a migraine with caffeine, but you can also trigger a migraine. So it's this sort of a double-edged sword in terms of the effect of caffeine. But typically, if I have somebody who's got migraines, I get them off of all alcohol, all caffeine, and give them some magnesium. Just that's what you can shoot from the hip and just do that and you can make a huge impact. So that was interesting with the patient. And this particular patient also had a history of developing an egg allergy at age 21, which was interesting. Like, why did all of a sudden develop an egg allergy? In addition to that, the patient said that they would develop the itching with eggs and then also had itching with bananas.

Oh, wow. Right.

Which then sort of makes me think about, is there a problem with histamine and histamine detoxification? There are specific genes in the body that have to do with histamine synthesis and also histamine detoxification. And you can do some esoteric testing on that to see, because histamine, I definitely think, plays a big role in, in migraines.

What is histamine, Todd?

Well, histamine is the drug, or not the drug, it's the compound that is naturally found in the and it is actually a neurotransmitter. It's also involved in allergies. So, when we have spring allergies or allergic rhinitis, we treat that with an antihistamine. Right. All right. Now, this is sort of interesting and I'll talk about this one.

And, it's made by your white blood cells.

It's also made by gut bacteria. It's found in food. It's made by the white blood cells specifically. The mast cells, exactly. and there are certain receptors for histamine. So there's, I think there's like four receptors for histamine. And interestingly, when you block histamine, what happens to you? You fall asleep. You ever take Benadryl? Right. That Benadryl puts you to sleep. So histamine actually activates the body and wakes the body up. So it's actually works as a neurotransmitter. Also, it's involved in allergies and itching and things like that. So histamine is one of these things.

You can get hives or things like that.

You can get hives. Exactly. Yeah. histamine definitely plays. It's one of the things that can play a role in, in migraine headaches. And how do you approach a patient.

With who's, who's got histamine sensitivity?

Well, you, you, you.

How do you diagnose it first?

Yeah, well, yeah.

And how do you treat it?

His. And, well, one of the things that you can do is put somebody on a low histamine diet because a lot of the foods that we, that we take in are, can have, they can be high in histamine. Normally, our body will just sort of deal with excess amounts of histamine. But when the gut bacteria is out, like if you have SIBO, you'll have problems with histamine breakdown or histamine degradation, or certain bacteria will actually be making high levels of histamine, which in turn can affect the brain and your neurological system.

Incredible.

Yeah. Yeah.

I've seen, you know, histamine treatment when you do it in the right patient by both dietary changes. Also, there's all kinds of supplements that can help, like Quercetin, even medication like Cromolyn. that people can take orally, histamine, which is very supplements that help with modifying the histamine response and getting the diet low in histamine. People can really have radical transformations in their health. And so something most doctors think about or do. Yep. And it's tricky to do, but it can be really effective. Yeah. Yeah.

And this, in this particular patient, when I did the, the testing on him, lo and behold, he had significant sensitivity to gluten, which he was totally unaware of, and it never really worked with a nutritionist. Sometimes, you know, they'll say, well, I worked with a dietician and, you a regular dietitian is, they're not really all that helpful. Having a nutritionist who's trained in functional medicine can really look at the diet beyond just calories and the macronutrient proteins, fat, and carbohydrates is very, very important. So in this particular patient, the organic acid testing showed a higher need for the B vitamins, showed some evidence of dysbiosis, which is imbalances of the gut bacteria, had significant gluten sensitivity, some leaky gut on testing, had low normal magnesium. It was technically normal, but it was on the low side of normal. So these are all the different things that you can fix. And then on a stress testing had high levels of cortisol. Interesting. It was very, very interesting. And then the other thing that I found on the patient, I'm not really sure because I'm actually still working on that because I was going to deal with that later. is high levels of mercury, very high levels of inorganic mercury in this particular patient. And then the other thing which is also really interesting is I did genetic testing. I like to do genetic testing because it can really sort of, it's like lifting the hood on your car. It can sort of tell you what's going on below the scenes. And the thing about genetics of migraine is there's not really one migraine gene and we can test for these SNPs and variations. but this particular patient had a variation in the genetics, the polymorphisms of a G-coupled protein, which has to do with serotonin and stress resiliency. So this person's genetic makeup was such that he was more prone towards the effects of stress. It was a particular gene called HTR1A, which is on the testing that we do with a DNA mind test. And I found that really sort of interesting. Otherwise, the patient had good genes, like good detox genes, good COMT genes, et cetera, but had problems with stress. And the patient's history was consistent with that, that stress was one of the big triggers for that particular patient. So, you know, stress management is huge for everything that we see in patients who walk through the door. I mean, we're all, everybody is affected by stress. You know, we just, you watch the news and you get stressed, right? That's why I don't have a television. Exactly. And so anything that we can do to help people to manage and modulate and detoxify the stress goes a long, long way. Huge, huge, huge. I think that's right. But you know, this case brings up.

Something really important about functional medicine because you listed a whole litany of things. It wasn't just magnesium, it wasn't just the gut, it wasn't just histamine, it wasn't just this and that. It was a lot of different things. Exactly. And you know, functional medicine is really about being a medical detective. and looking for all the various factors. Because traditional medicine is okay, you have this one disease that you treat with one drug. Instead of saying, oh, where are all the imbalances in the system? Let me correct all those. Because if you correct two out of six, patient might get a little better, but not really. You have to deal with all six.

Exactly.

And I think that's really the beauty of functional medicine. We're not treating the disease, we're treating the patient and all their unique variations in their story and there are no two people who are the same. So when someone comes to the migraine, it's a blank slate. Then I have to figure out what kind of migraine and what are the various factors and is it hormonal, is it magnesium, is it the gut, is it the mitochondria, is it food additives, and is it histamine and maybe all of them. Exactly.

Right?

Yeah. And so this is really what's so beautiful about our approach here at the Ultra Wellness Center, which by the way now during COVID we're taking all virtual patients. We can see people from anywhere in the world. you have to schlepp all the way here. And we know we have an incredible team of physicians here and physicians assistant, nutritionists. We've all been doing this for close to 30 years now, which isn't scary to say.

And we're still learning.

And we're still learning. And it's just, you know, that's the thing about functional medicine. It's just, it constantly pushes you to discover and learn because you're not just learning a rote approach to this diagnosis. Like that patient who had the migraine with all the magnesium deficiency and all those other symptoms, she was at the Mayo Clinic. saw the top doctors there. She went around all the headache clinics in the world. I mean, she saw everybody, did everything, and all they cared about was her headache. They didn't want to know about her constipation or her muscle cramps or her irritability or insomnia or any of that.

Or stress being married to a mafia don.

Well, no, that was somebody else. That was not the doctor. That was somebody else. It was one of the good fellows. And so it's really important for people to understand we're suffering out there from headaches and even regular headaches. headaches can respond to this as well. But, you know, migraines are the most severe and disabling kind of headaches. And I just. I just remember this patient I saw was a 24 year old young woman who was a nurse who wanted to become a nurse practitioner, brilliant young woman who was in bed because she had vestibular migraines, which is a certain kind of migraine that makes you not only have a headache and be nauseous, but, like, the room spins around. Like, when you're in your beach and you spin around circles so you can't stand up anymore. anymore. It's like that. And she was just miserable. Now, she got every treatment for the migraines, every kind of headache drugs, every neurologist, nothing worked. So I started asking her about, like, other stuff. Well, she was very depressed. She was anxious. She had severe bloating. She had acne, she had fluid retention, she had all these other symptoms. And it turned out she had really severe SIBO or bacterial overgrowth and severe food sensitivities. as well as a bunch of other stuff and magnesium and this and that. And I literally just really focused on treating her gut and her food sensitivities and supporting her a little bit of magnesium and some other things. And literally within a very short time, within six weeks, she not only, like, had all her migraines go away.

Yeah.

Not only did she lose 20 pounds, but her depression, anxiety and everything else went away.

Yeah.

I mean, the gut can lead to all that stuff. so it's so unfortunate that we don't think in this comprehensive way with traditional medicine, 'cause so many people suffer unnecessarily.

Yeah, it's interesting to talk about that because it reminds me, I've actually, I think I've seen it in a couple of cases, is there are some patients who have H. Pylori, which is specific bacteria, and H. Pylori, if you clear H. Pylori in some migraine patients, their migraines go away, which is sort of very, very interesting. It doesn't happen in everyone, but if you do the testing for H. Pylori and if you find it and a.

Patient'S got migraine, you go ahead and treat it, it can make a big difference. Yeah, so I just think you're right, Todd. I mean, it's really just spending the time to ask the right questions, to do the right kinds of tests. So what are the kind of top tests that you might think you wanna?

Well, like we said, checking for magnesium and specifically red blood cell magnesium, 'cause magnesium needs to be the intracellular form. So a lot of times patients are tested for regular magnesium. It's the RBC magnesium is what you really should check for. And then we'll do the testing for gluten sensitivity, Cyrex 3 is my favorite. And we'll also do testing for increased intestinal permeability, organic acids, gut microbiome testing can be helpful. I mentioned genetic testing, but the genetics play a smaller role. But it's interesting because there really is no one gene for migraines. The only thing I would tend to say is that if you're suspicious for mitochondrial issues, checking for mitochondrial that can be helpful. That can be very hormonal testing.

Yeah. Hormonal testing.

Exactly.

Hormonal testing. Yeah. So we have a lot of tricks and tests that you wouldn't necessarily see.

At a regular doctor's office to help.

Us sort through what's going on. Cortisol testing. Cortisol testing. Exactly. Cortisol testing. Hormone testing, nutritional testing. Absolutely. Food sensitivity testing. I mean, it's so, it's so, so important. So I, I feel like when I see a migraine patient, I'm so happy. Yeah.

Right.

Because I'm like, oh, same doc. This is easy. be, you know, and they're going to be so happy and they look good. But it really isn't, it really isn't that we're that smart. It's just that we're looking through a different lens that allows us to see the problem in a unique way that's individual to that patient. Exactly.

And personalized medicine. It's, it's, it's the epitome of personalized medicine because there are probably no two migraine patients that I will treat the same. They're, they're all unique. And I'll do a little, you know, there's a sort of a basket of things that you'll do, but you tweak that to that individual patient based upon their history, their testing and everything else. And that's the fun part about it.

So what's like, if you're just saying, you know, to somebody who's listening and they're like, well, I don't really know any functional medicine. I want to just try some stuff on my own. What would be, like, the top few things you would tell a patient to try?

Let's say, you know, your cousin had migraines and they didn't want to come in and see you. What would you tell them? Well, first thing is get good sleep. Most people are sleep deprived. And, and actually, because lack of sleep is a stressor. And we talked about stress being a big trigger for migraines. so getting into a good sleep-wake cycle, modulating and detoxifying stress, meditation, whatever different forms that you use for.

Relaxation.

Relaxation, exactly. Adding magnesium and then the simple dietary changes, gluten, sugar, dairy, those are the big three. If you remove those from a patient's diet, it can make a huge difference.

Performance.

I think those are probably some of the key things that you can do. Yeah, I agree.

I think it's so simple. Just clean up your diet, gluten, dairy.

Sugar, processed food, all the additives, chemicals. Yeah, you're absolutely right because the excitotoxins, a lot of those things that are added to foods that you may not even be aware of. The best thing to do is buy.

Foods that doesn't have labels on it, right? There you go. Right, there you go. Exactly. An avocado doesn't have a nutrition facts label or an ingredient it's just an avocado. Right, right, right. I agree. So, you know, that's something people can try, elimination diet. You know, we have something called the 10-day reset, which is really easy to do. You can go to getpharmacywithanf.com that is a really simple approach to just cleaning up your diet for a week or 10 days. And often you'll know very quickly. I mean, if your migraines are two or three times a month, you might have to do it longer. But if you get regular migraines every week or more, you'll see a difference.

Magnesium's super slam dunk, easy thing to do.

Getting stress reduction in sleep so easy.

And the other thing is that oftentimes for some people who have really bad migraines, you don't, sometimes you know, it's not as though they're never gonna have a migraine the rest of their life. But if they do get a migraine, it's not disabling. It might be very infrequently and if they get it again, it's very mild and it may be triggered by something, but it's really nowhere near as bad as when they first started. So it's not like I'm gonna cure your migraine. migraines, this individual may be susceptible to having migraines. For sure. And when you make all these changes, their life is much better because they cannot function. And if they get a migraine, it's not disabling, it's mild, it's infrequent, it's.

Not a big deal.

And then they learn what are the triggers for that. Absolutely.

And they can avoid them. Yeah. Interesting. Have you ever had a migraine? I have not.

I've had some headaches, but I've never had a migraine. Thank God. It's interesting. It's fun, I can imagine. Yeah, I very rarely get a headache and I've never had a migraine. However, when I was working at Canyon Ranch, there was one time, it was right before lunch, I all of a sudden had these jagged sparkling lines in my field of vision. And I'm like, where does this- I'm having a stroke.

What's going on?

So I was actually having, because migraines you can have an aura with a migraine. An aura is what you get before you get a migraine. And for whatever reason, I only had it once. I had a migraine aura. And I didn't get a headache, but I knew exactly what it was. And I said, oh, this is interesting. Now I know what the patient are experiencing before they get a migraine. And I had it once, didn't have a headache, never had it again. Don't ask me why I had it. You know, it could have been, maybe I was, you know, low in blood sugar or, I don't know, stressed out or I don't know what, but it was just sort of sitting there and I was in it. It was a good experience because now I can understand what it's like for.

A person to, you know, have a migraine aura. Well, if you've been listening to this podcast and you've had headaches or migraines, Don't fret because following these simple ideas can have a profound effect. If you get stuck and you need more help, we're here at the UltraWellness Center to help you. Just go to ultrawellnesscenter.com, we can see you virtually. And it really, sometimes it's a bit of a detective job, but simple things to try, like we said, diet, elimination diets, magnesium, sleep, stress reduction, certainly a place to start. It is something that has caused so much suffering. I mean, 10 million people have it. probably collectively it costs $50 billion a year to society. It's a big deal. And some things are hard to deal with. If you have certain cancers, that's really tough. But migraines are easy slam dunk for functional medicine. So if you have a migraine, I hope you never have to have it again after listening to this. What would be the major reasons that we're seeing this pandemic of brain dysfunction brain fog today?

So, you know, brain fog is really a symptom sort of like cough. So cough can be caused by a cold, bronchitis, pneumonia, postnasal drip, asthma, a whole bunch of things. So you've got to figure out, okay, what's driving it? And there is no ICD-10 code for brain fog. You know, you might call it, you know, altered mental status, but oftentimes it's transitory, and that's the really interesting thing. And I've seen patients where they'll, you know, get brain fog when they're in a certain building. building. They'll get brain fog after they've had a certain meal, you know, though certain foods may trigger brain fog. And it is something that I think is intimately connected to the gut. I think the, and we'll talk about that at this particular case, is gut fermentation is oftentimes a cause for brain fog.

I mean, it's like bugs fermenting the food you're eating, creating all this nasty.

Byproducts that you're eating. Yeah, and I, I don't know. I Mark, if you've had patients who've had, this is a really interesting thing because I have patients come in, they say, I feel like my gut is just bloating and I'm fermenting and that's exactly what's happening. So, there is a condition. I just recently had a patient who had auto-brewery syndrome. Yeah. And I've seen that. So, you have your own beer factory. Exactly. So, when you want to make beer, what do you do? You take sugar and you add yeast to it and you can actually produce alcohol. And I've had a couple of cases where it was missed and it's actually not just The recent findings is it's not just yeast in the gut that do this, but also Klebsiella bacteria. So both bacteria and yeast can actually produce these compounds which are toxins. Alcohol is a toxin. That's why when you get drunk, you're intoxicated. And you'll actually produce alcohol and other toxins which affect your brain.

It's interesting. I never really had that insight before you said that word intoxicated.

You're toxic.

Toxic.

Yeah, toxic. Exactly. That's what you're saying.

Intoxicated. Okay.

That's how I explain it to people.

It took six years to figure that out.

Exactly.

But I think that what you're saying is very true. I've had two times in my life when I've had severe brain fog. One was when I had mercury poisoning 25 years ago. And my gut was a mess then because the mercury poisoned my gut. I had terrible bloating, distension, diarrhea. And the second time was more recently when I had mold toxicity. and I had C. Diff and I also had colitis and gastritis and my whole gut was a mess and I had severe brain fog and it was pretty debilitating. You could barely focus, answer an email, talk to somebody. You can't concentrate at all and people think, oh, that's just sort of in your head. It's not in your head, maybe in your stomach.

Well, it's manifesting in the head. That's the whole thing. And we have these artificial boundaries between the brain and the body. and the mind and they're all interconnected and brain fog is a real phenomenon and then you have to sort of figure out what's doing it. The other thing that is interesting that I see with some people with brain fog is just gluten and dairy. And I tell patients that one of the most addictive foods is pizza. And the reason for that is that pizza has gluten in it.

It's true. You can eat a whole pie, right?

I tell you, it's one of the foods that I'll occasionally indulge in, but I don't have it that often because it's not the best food for you.

You have my cauliflower pizza with goat cheese.

You make a healthy pizza, exactly. But the two foods which are interesting is that gluten and dairy both get broken down. The proteins in those get broken down into caseinomorphins and gliadinorphins. And caseinomorphins are the ones from dairy and gliadinorphins are from gluten. And those have morphine-like effects. So you literally become a little high. You get a little high, you get a little foggy in the brain, and it also can cause cravings and it can sort of make you sleepy, you know, you eat it and then you get a little sleepy from it also. That's, you know, when children drink breast milk, they go to sleep after, they conk out. I mean, that's because of the morphine-like action in milk.

Yeah, so that's true. I think, you know, it can be our diet, diet. It can be food sensitivities like gluten and dairy, which are really common. And often people going on an elimination diet will have an immediate relief of brain fog, which is something that you don't know you have until you don't have it anymore sometimes. People just think this sort of slow decline of their cognitive function. They're not realizing that it's actually something that can be reversed and it can be reversed very quickly. So the second thing is, you know, the factors that are in the gut, right? Bacterial overgrowth, yeast overgrowth, we call dysbiosis. That can also lead to a lot of cognitive issues because your gut's connected to your brain and that causes this effect when the bugs are out of balance and it drives inflammation and then you get inflammation in the brain essentially.

Is what causes brain fog. Absolutely. Well, the other important thing, I think I talked about this last time, is that the blood flow from the gut to go through the liver. And the reason for that is to filter all of the toxins that are there. So, there's a lot of immune cells, the Kupffer cells in the liver and a lot of filtering processes and detoxification takes place in the liver prior to the blood from the gut then going into the systemic circulation. So, sometimes you'll have, in addition to leaky gut, you'll have problems with detoxification in the liver.

Itself.

And that's, you know, an example of that is the condition, hepatic encephalopathy, which is brain fog. That's essentially, talk about that.

What is that for people who don't.

Know what that sounds like a big word. I learned, and I think I mentioned this before, and it was one of the things that really stuck with me is when I worked at the VA hospital, there was a lot of alcoholics. And when you're an alcoholic, you basically turn your liver into a pickled liver. You trash your liver. You trash your liver. And then you're not they were not able to detoxify. And I would typically see this over and over where patients had cirrhosis of the liver and their liver was not able to detoxify. And then when they would eat foods, especially high protein type meals, they would get hepatic encephalopathy and literally go into a coma.

So they would literally get delirium, confusion.

Absolutely. Brain fog. Brain fog.

That's like the brain fog on steroids. And the reason is it was coming from their gut. And what I found so striking when I started learning about functional medicine was that here was a condition in medicine that we knew how to treat by fixing the gut. We gave people antibiotics to sterilize their gut to kill the bacteria that caused all these byproducts that made people have basically delirium or encephalopathy and brain fog. So, it was like wow, the gut is connected to the brain.

Totally connected to the brain, absolutely. And in some cases, there have been cases of people actually having psychosis from gut dysfunction.

You mentioned Auto-Brewery Syndrome. I remember reading a case of a woman who was arrested for driving under the influence and it turned out she wasn't drinking, but she had a high blood alcohol level that was coming from her gut.

It is. It's a very real phenomenon. You have to think about it. The way that you actually test for that is you can, it's actually quite simple. You just have somebody do what I call a pancake challenge. You basically some pancakes full of carbs, but throw some maple syrup on it, eat it, and get a blood draw at point zero. Eat the meal and then half an.

Hour later check your alcohol level. That sounds like a fun medical test. I thought the pancake challenge is that's the same thing. so we've talked about the gut, we've talked about gluten, dairy, food sensitivities. There are other reasons too.

Infections, infections can do that. Another one that is- Tick infections. Oh absolutely, tick infections. Yeah, those are, I would say that that's in addition to brain fog, you get a lot of cognitive dysfunction too.

Yeah, it's more severe.

It's much more severe. The one thing that I see a lot is allergies. I call it the allergic brain. And you can have food allergies that can potentially do that or even environmental allergies or mold. And the high levels of histamine, because histamine actually acts as a neurotransmitter. And I've seen this in a number of patients. I've had some patients with another condition which we're seeing more and more of is mast cell activation syndrome. It's sort of a diagnosis now, but it's a very real phenomenon and is related to the mast cells, which are the types of immune cells in the body, in the interstitial, the sort of the spaces between the cells where they reside, and they release lots of histamine. And if anybody has ever had hay fever, you see that the typical picture of a person with hay fever, they're like this, like half asleep and like they're walking through a fog. Hay fever is an example of brain fog. And antihistamines can actually have a benefit with that. Naturally, things like quercetin and nettles can also be very helpful. And you probably have used it. This is something that I've been using more is the drug, chromal and sodium, which is, I've had some amazing success with that in more difficult cases. I wouldn't necessarily go to that for my first choice.

What Todd's talking about is this is this drug that's used for asthma and allergies that is usually inhaled.

Yeah, usually inhaled.

But there's a version you can take orally that before you eat inhibits your white blood cells from releasing histamine and creating an allergic response. And, I often found it extremely effective for some patients. So, Todd, talk about this patient that you had that had really bad brain fog. This is a guy who come to see you who worked a lot. It was a little less stress, and that could be easily dismissed as though you're just stressed and tired, but you went deeper. What did you find?

Well, he actually came into me and he had already seen a variety of different doctors. The background is that the gentleman as a child had lots of allergies and asthma. So he had ear infections, bronchitis, also developed some sinusitis type symptoms. So he had multiple rounds of antibiotics. and I always emphasize to patients that when you have an immune dysfunction, look for the gut because 60 to 70% of your immune system is in the gut. And just like with what's going on with the COVID virus or the COVID-19 syndrome that we're seeing by coronavirus, it's not the virus or the bacteria itself that causes the problem. It's our immune system's response to it. In general, we want to have a, I call it a balanced immune system. So, we want our immune system to be idling. Yeah. So, basically just sitting there and okay, we're enjoying planet Earth. We're going out for a walk. We're not reacting to this. Not underreacting or overreacting. Exactly. Underreacting or overreacting. And when you overreact, we call that an autoimmune disease.

When you underreact, we call that AIDS.

So, AIDS are cancer?

AIDS are cancer. reactions, allergies or immune.

Right. And then I think we talk about a weak immune system or a strong immune system. It's really, I think, an intelligent and a balanced immune system. That's how I like to think about it. And that's related to immunotolerance, which is what the gut does. So when we have a healthy gut, we have an immune system that is tolerant to lots of things. And you can eat certain things, you can go out in the environment, you're not going to react to dog to and all these other things. There are some genetic, some people have genetic predispositions towards being more atopic or allergic, but having a healthy gut, especially early on, the priming of the gut is so critical. Having a vaginal birth, being breastfed, not introducing certain foods like gluten early on in the- Living on a farm. Living on a farm, exactly. Being exposed- Expose a lot of antibiotics. around in the dirt and literally putting dirt and, you know, I call it, you know, your body's immune system samples planet Earth. Planet Earth is a very dirty place. There's lots of bugs and all kinds of things and your body learns to be immunotolerant. And one of the things that is really, I also focus on, is part of this immune system is called the T-reg cells. The T-reg cells are like the conductor in the Boston Symphony Orchestra. so you've got, you know, the wind section over here and the horns over here, and they keep everything in balance.

Yeah.

And the T regs are really, really critical. And what we're finding regulatory. They regulate. They regulate the whole, you know, the whole balance of the immune system. And the T regs that we find out, the two things that are really simple that people can use to upregulate your T regs to keep things in Balance are fibers, fibers in the fibers are the key things that help with regulation of that. And then also, which I use quite a bit in the patients that I see, is vitamin A. Vitamin A helps to down regulate the immune system and helps to keep the T-reg cells in place.

So this guy came in with brain fog and he had a lot of stress, but he also had other things. He had mold exposure.

Yeah, he was working in a building and they found out that he was in a water damage building unknown to him and he had mold exposure which you've been experienced yourself. Yeah, exactly. And we live in, you know, a lot of people are in older buildings. You don't know, you might buy the building and there's water damage, you don't even know it's there.

I mean, 50% of buildings have water damage in America. That's a lot.

Really? Yeah. Wow, that's a lot. Yeah, so he was actually, he came to me and he was he had the diagnosis of mold toxins. In fact, he actually learned about this through one of your podcasts. I think it was you were talking with David Asprey. Exactly. It was a moldy podcast. So, that's how he sort of went down that road. And he got treated with a variety of different therapies. He got some IV glutathione, he got some ozone therapies and other interventions. And he got about 50% back. and then within several months he sort of went back to where he was. He was also again not sleeping much because he was, you know, he was doing a lot of litigation. It was a lot of stress. He wasn't sleeping well. The big thing that I see with patients with conditions like immune dysregulation is stress and lack of sleep is a stressor. Probably the number one stressor so if people aren't getting a deep restorative sleep. That is a stress to the immune system. And I was trying to emphasize that you can do that for one or two days, but you can't do that on an ongoing basis. So really, really important. I always emphasize getting good deep restorative sleep with patients. So I emphasized that with him. So when he came in, he also had a lot of digestive symptoms. He was actually on a whole a whole bunch of inhalers. He was on like Brio, Spiro, Ventolin, on Zolair injections, Flonase for his sinuses. He also had Zolair is a very.

Expensive like $20,000 a year intense immune suppressing medication. Yeah. And, he still wasn't better.

He still wasn't better. No, exactly. And, that actually worked by stabilizing mast cells which you can actually naturally do quercetin actually can help high dose quercetin can be very helpful for a mass.

It's also good for COVID.

Exactly, exactly. Yeah. So, when he came in here, I did a thorough workup on him and I did retest him for mold and he did have some mold, but I compared it to his previous labs and it wasn't that bad. So, I empirically treated him with some binders to sort of help, but he had already moved out of the moldy building that he was using.

You get out of the moldy environment and then use these binders to help get the mold toxins out of your system.

Right, because the mycotoxins, they do tend to recirculate in the body, the enterohepatic recirculation, so they'll get reabsorbed by the body. And, what are the kind of binders you use? In him, I actually use very natural things. I used clay, Medi-Clay, and I also used activated charcoal.

That was pretty much it. These are Things that don't get absorbed.

That suck all the bad stuff out. Oh, yeah, exactly. And, well, you worked in Merck, right? Somebody would overdose on drugs, we would give them charcoal.

Yeah, that's right.

We make them drink black charcoal. It was terrible. And every now and then they might.

Vomit up on you and get black. We've been there, done that. Yes, we. Right. Yeah, so this guy had also other stuff, right? He had gluten issues. Oh, yeah.

A lot of gut issues.

Yeah, yeah.

And unfortunately when he went to the previous doctors who did help him out, they didn't go deep enough. They didn't sort of get all the pieces of the puzzle. So they did not check him for gluten sensitivity, which he markedly was gluten sensitive, and also did the Cyrex testing on him for gluten and Cyrex for leaky gut, and both of those were markedly positive.

So those are tests that we use at the Ultra Wellness Center that are a little bit different than traditional food testing. that looks at antibodies that aren't true allergy, but there are reactions that our immune system is having against foods and we can tell what you should and shouldn't eat based on this what's causing an immune response.

Exactly, exactly. And then I also did stool testing on them. I did the, what I think is sort of the state of the art, the GI MAP test, which does quantitative PCR for the DNA of bacteria, yeast, viruses, parasites. and he had probably one of the worst cases of dysbiosis I've ever seen. That's imbalance. Yeah, imbalance. Yeah, a lot of imbalances. You know, I tell patients that everybody has, you know, hundreds of different kinds of bugs in their gut and they're a little bit like weeds in the garden. No garden does not have weeds. You just don't want too many weeds. And the interesting thing about the digestive tract and bacteria is that there is a phenomenon which is known as quorum sensing. quorum sensing. And quorum sensing means that when certain bacterias reach a critical level, they start acting as bad actors. An example of that is like a cluster of diphthearia. So, when patients get antibiotics and they wipe out the good guys, the bacteria, the C. diphthearia, somehow or another sense that there's not enough cops around and they take over the place and they start producing toxins. Same thing happens in this particular case, he had one one of the highest levels of pseudomonas bacteria that I've ever seen. And we typically see that in patients with cystic fibrosis. So he had bacterial dysbiosis, that organism plus other organisms. And he had a lot of gut symptoms, right? Yes, yes, exactly. Yeah, a lot of mucus. And that's, in my opinion, that mucus, that sticky mucus is a biofilm. That's where the bacteria they live in that biofilm layer. And antibiotics and such are very difficult to penetrate that.

You're not having a smooth log that just comes out clean. There may be some problems in there.

Exactly, yeah. And he also had yeast overgrowth, which was not unexpected. Because of all the antibiotics he had. Oh yeah, absolutely. And the acid blocker he was taking. He was on a proton pump inhibitor.

That's one of my, you know, I hate them. They are good and bad. They can be helpful, I remember when I was in medical school, we talked about this on the podcast. We were told they just came out and they were like, these are very powerful drugs. You don't want to give them to any patient more than six weeks. It shuts down acid production.

It's risky long term.

And now everybody's on it. They're over the counter. They're over the counter. Over the counter and for life. And it causes all sorts of disruption in the gut. It causes you to not absorb your nutrients. It causes overgrowth of yeast.

It changes the pH.

Leaky gut.

Leaky gut.

I mean, it causes irritable bowel. So you have osteoporosis. osteoarthritis, pneumonia, B12 deficiency. Yeah, there we go.

We can keep going. It's not.

It's a great way to keep the business going. Yeah. Yeah. I wrote a textbook chapter on reflux.

And it was like, looking at all the data, it was like, holy cow.

This is not good. Exactly. Yeah. And.

And unfortunately, they're handed out like Pez candy.

Yeah.

Number one, I better make sure my guts in the water because I just had inflammatory process in my brain that's going lymph drainage, it's going to affect the blood-brain barrier which protects my brain. If I have leaky gut, I've got leaky brain, and after trauma, you will have an autoimmune response. And that autoimmune response, if your gut isn't healthy, could be quite dramatic. And now, on top of your brain injury, you're having autoimmunity which is going to prevent you from healing well. So, I started doing some some different things. You know, one of the things that you really want to try and do is you want to make sure that you, again, you go to the gut, make sure your gut's healthy, and you're eliminating any inflammation that you can have. So I really cleaned up my diet. And when you're sick, you begin to realize, eh, maybe my diet wasn't as good as I thought it was. And I made some significant changes. I went gluten free, and all of a sudden, that bloating I'd get occasionally, that, you know, some of those GI things I'd been moring went away. So I went gluten free. Really a big deal. I started using really high dose fish oil because there are studies that show higher doses of fish oil can really help in the brain injury. Brain injury. Improving neuronal regenesis, membrane. Omega-3s are very important for membrane integrity. So I went up to 10 grams per day.

That's like 10 pills almost.

Yeah, I was taking a lot of fish oil. the real first inflection point though was my sleep. Brain injuries definitely impact your ability to sleep. So I needed to really find ways to work on my sleep. I tried melatonin, which will trigger your body into the right rhythmic pattern, but it just triggers you to get into sleep and won't necessarily maintain it. I was really having a hard time maintaining sleep. So I started working with a advanced medical provider who grows organic hemp. And he was able to create a combination of CBD, THC with botanicals specifically to help me sleep. When I started using that, I started to sleep. That was the first time I started to feel like I might get better. Because up to that point, I was depressed, flat, really had to work hard for memory recall, off. Everything I did took me so much longer to get done.

Yeah.

I mean, I, I was working 24/7 just to keep up with stuff that should have been done in, you know, six hours. So that was the, that was the big first inflection point. And I also started taking lithium orotate, which is known to increase bdnf, which is Miracle Grow for the brain. So bdnf helps with neuroregenesis. It also helps. your neurons speak to each other, makes those transactions occur faster, and allows more neurons to combine at a junction to talk to each other. So I started using that. But the next big major inflection point was when I started meditating. I had never meditated. And I came across a book just serendipitously. I use Amazon books as a library, and I was just just flipping through different things. Then I look up some things on Amazon and I found a book and I started using this technique and I started, as can I mention the book? Sure. Yeah, so it was Stress Less, Accomplish More by Emily Fletcher. And I think, did you write the forward for that? She's been on my podcast.

Did you write the forward for that? I did.

Right.

So that's what I thought. So I opened the forward and I'm like, oh my heavens, Mark wrote the forward for this.

It must be a good book.

So I started reading it. My meditation teacher so I started listening to it and she narrates her own book, it was just amazing. And she went through the science of meditation and what it actually physically does to the brain. You know, it increases the thickness of the connection between the right and the left brain called the corpus callosum. It increases the size of your hippocampus. Decreases inflammation. Decreases inflammation, it decreases the size of your amygdala, giving you more control over your anger and frustration. When I started meditating, that was a huge inflection point. My focus became clear, my worries, my negative self-talk resolved. I was able to take a huge step forward. And then it's not just for people with brain injury.

No, it's for everybody.

We all sort of have chronic brain.

Injury from chronic stress. So that as a way to actually.

So there were things that I could actively do, but the critical pieces were get the sleep, get the nutrition in order, get the sleep in order, and then, you know, I did things that were known to enhance healing. And I will say, and I will have to emphasize what you just said, meditation isn't just for injury. Meditation should be taught as part of basic life hygiene for your entire physiology. Yeah, it's huge.

And.

Then I was able to have enough energy to start exercising. And so I started running. running. Running is probably, of all the exercises, increases BDNF, miracle grove for the brain, more than any other exercise. So, running is not something I've done for a long time, but my wife encouraged me to do it and I've been running and that is just really gives me a lot of mental clarity.

So great.

The truth is you can heal from brain injury. Absolutely. And I think, you know, our traditional.

Approaches are lacking and I think that's one of the things we do. And if I had known now, if I had known then what I know now, I would have forced myself to exercise earlier because some new research has come out that says with brain injury, particularly concussion, don't wait to start exercising. Actually, when you start exercising sooner in modulated ways, you'll enhance recovery.

Going back to light, you know, I mean, there are certain instances where light, it's been proposed, and this is a, you know, a rapidly evolving science, we're just at the tip of the iceberg, but can actually act as a Light.

Yeah, what kind of light?

Well, artificial bright light at night that suppresses the hormone melatonin. Melatonin is a key gatekeeper to the process known as autophagy, which is when our cells clean house. And, you know, it's sort of like the KonMari method for biology that it uses to clean up old, worn out dysfunctional proteins and organelles. It's also involved in DNA repair.

Repair.

So DNA damage is at the root of cancer, aging.

How we get rid of waste and how we repair our systems is regulated by melatonin and light.

Yeah, so I think that's kind of a bold statement and it's a hypothesis that certainly warrants further testing to know for sure, but there is a well-documented increased risk of certain cancers seen in night shift workers, which make up 20% of the global workforce. so getting bright light in through your eyes in the morning is crucially important for anchoring your body's circadian rhythm, which guides everything from how coordinated we feel, how much focus we're able to have, how much energy we're able to have, how well we digest and metabolize food. But in the latter half of the evening, avoiding exposure to extremely bright light, especially if it's on an ongoing chronic.

Basis, I think is we were all being with those goofy glasses with the, with the, like Dave Asprey with the, the orange lenses. Amber glasses. Yeah.

Like amber colored blue, blue light blocking glasses. I think that among all the wellness biohacking gimmicks that are out there, I.

Think that those are among the most useful. Yeah.

Yeah.

And it's powerful because I remember reading a number of years ago about studies in animals where they would give them melatonin and it would suppress cancer. Yeah. And part of that has to do with the light, which ash actually inhibits melatonin. So if you're, you know, living as a hunter-gatherer, the sun goes down, you maybe got a few candles. Maybe they didn't have candles back then. Maybe they didn't have fire when we start out. Yeah. And our bodies are designed that way. And now we have this incredible light. That's such an issue. I remember reading a book a number.

Of years ago called Lights Out. You ever come across that book?

By T.S. Wiley. Yeah. Yeah. And it was, it was like an eye-opening literally. And it was about how the invention of the light bulb correlated with all these chronic diseases we're seeing now. Yeah, I don't, I mean... Heart disease, diabetes, cancer. And it talked about the biology of light and how it impacted us. And we don't even think about it. We just are on our phones all night or have computers in our beds. We have bright lights and there are ways to fix it. So what are the ways people can fix the light problem.

Yeah, well, I think there's two things. First of all, you want to make sure that you're getting good quality light early in the day, so preferably before noon. So, not only is that going to help anchor your body circadian rhythm, but it's going to help protect you against blue light induced melatonin suppression later in the day. So, that bright light, the suppression. Go outside, don't wear sunglasses. Go outside, don't wear sunglasses or don't wear sunglasses when you're driving to work if you have a half an hour to commute to work.

And get through your windshield?

Yeah, yeah. It's all about the light intensity. What you need is about a thousand Lux of light. And there's an app that I have no affiliation with, but it's called Lux. And you can, there's some questions as to how reliable it is, but I think it could give you a good relative sense to the light intensity in your ambient environment. So if you download the app, you can kind of just, you know, make sure that you're spending time in an environment that's at least 1,000 thousand Lux in the morning because that seems to be the light intensity that the melanopsin proteins in our eyes are sensitive to. That basically kicks off this 24-hour timer.

Yeah.

So that I think is crucially important.

And so in other words, to actually have good sleep, you need to get outside and get sunlight in the morning.

Yeah, 100% good sleep begins actually the morning of and 1000 Lux light. These melanopsin proteins in your eyes that are sensitive, they act like a light switch. They're not super sensitive because as you mentioned, then a hunter-gatherer exposed to campfire or the stars in the sky would have their circadian rhythms all messed up. So it's not that sensitive. It requires again a thousand lux and you can easily achieve that by standing by a window for about a half an hour and even on an overcast day you're gonna get at least a thousand lux. Now the problem is maintaining that circadian has become one of the central challenges of modern life because that light intensity, which 150-200 years ago nothing would be a thousand lux, there would be no artificial light source that would reach a thousand lux, right? But today we have TV screens, we have smartphone devices, you can easily walk into a drugstore or a supermarket and the lighting inside, those bright fluorescent lights are easily a thousand lux. Yeah, that's true. So it sends your circadian rhythm deep into the abyss. And that's one of the reasons why I think and why it's been proposed.

That.

We see ill health associated with people's.

It's true. One of the founding father doctors of functional medicine, one of my mentors, Sidney Baker, wrote a book called Their Circadian Prescription, which was all about exactly this circadian medicine. And, there's even things like chronobiology where there are different different chemotherapy drugs that work better at different times. Different organs are active at different times and they work better. And I think he even described in the book how in sports, if you look at the statistics, that teams that have to cross time zones typically lose more than the ones who don't and who are playing at home.

Interesting.

Yeah, so it's a huge factor. Besides light, what else have you found that was sort of unusual in your target optimization of the brain and the body or the brain body or the body mind or the mind body. It's the same thing. There is no separation, is the point.

No separation. I talk about the relationship that we have with temperature and how important that is.

Cryotherapy.

Cryotherapy, yeah. Saunas. Yeah, and I always try to make things like my recommendations achievable by average people. So you might not have access to a sauna on a sauna, you might not have access to a cryotherapy chamber. But just getting into colder water, taking a cold shower or exposing your wearing your skivvies on your terrace during the cooler months can all be a great way of activating these ancient thermoregulatory mechanisms that we all have in us that we've allowed to gather dust because we all live in a state of chronic climate control. And I think that by staying in that climate comfort zone all the time, it undermines some really powerful, you know, reparative and restorative pathways that we have in our body. So, what's the science of that?

Well, I mean, cold, being exposed to.

Cold air boosts the proliferation of brown fat. So, I mean, we're all afraid of gaining more, even more fat on our waistlines and on our hips, but brown fat is actually something that we want to have more of. It's metabolically active. It's brown because it actually has a lot more mitochondria than normal white adipose tissue.

And it-- which are the energy factories in your cells.

Energy factories in your cells, yeah. They give you more energy, but they also, this brown fat actually burns fat and it burns sugar. And we can actually increase the amount of brown fat that we have on us. It's not actually visible. You can't see brown fat. It only accumulates in a few parts of the body. In our armpits, around our collarbone, down our spines, shoulder blades, that's where you're going to see the brown fat. You can't actually see it because it's really relative to the amount white fat that we carry. It's like a very small in concentration, but it's really good for our metabolic health. So, whether that means turning down the thermostat.

You get more brown fat if you expose yourself to cold. Yeah.

Because brown fat, it burns calories to generate heat. So, when you're in a cooler environment, this brown fat is burning calories to generate heat. Brown fat was actually originally identified identified in babies. Babies, when they get cold, they can't shiver. Babies can't shiver. So they have this brown fat that basically acts like an internal heating pad. And for that reason, it wasn't known whether or not we carried this type of fat with us through adulthood. But now not only do we in fact carry this brown fat with us, which acts like an internal heating pad that burns calories, as I mentioned, but.

We can encourage its proliferation.

Yeah.

Well, the Tibetan monks knew this for years. They have a practice called tumo. Do you know about this?

No.

Tumo is amazing. It is a technique called drying of the sheets. And so, they train the monks to activate their brown fat through meditation. And they have them up in the Himalayas and the monasteries way up in the freezing mountains. And they practice by dipping cold sheets in ice water and they wrap stop the monks in the sheets and the monks have to dry the sheets with their internal body heat. And when they can do that, they send them up overnight into the snow with basically a loincloth and they have to stay alive. Wow. And they do and it's quite an amazing practice. And, you know, we've had such a surge of things like saunas and cryotherapy. And, you know, we haven't talked about on the show but there's something called zombie cells.

Zombie cells?

Exogenous cells. Yeah, the things that tend to kill us where these sort of senescent or aging cells and they just create a lot of nasty immune effects and inflammation in the body and it's hard to get rid of them. Cryotherapy or cold exposure is one of the key mechanisms for getting rid of these zombie cells to help extend longevity. And personally, you know, I found that when I was really sick and even now it's a standard part of my practice, I go into a hot sauna or a steam get really hot and then I turn the bath, big bathtub, only cold water and I jump in. Wow. And, it's pretty invigorating but you feel afterwards like your whole nervous system is awake and you're alive and you're energetic and it clears your head. It's pretty striking.

Yeah, it is striking.

And, when I had chronic fatigue syndrome, it was one of the few things that gave me like a half an hour, an hour of feeling some respite.

Wow.

Yeah.

I use that therapy regularly for, I have low back issues. I think a lot of people do. I feel it's like a powerful analgesic. Like, I get instant pain relief. What it does for my mental acuity and my mood is, I mean, I don't think that there's a drug as powerful as what that does.

Jump in a cold lake, it'll wake you up.

It'll wake you up, yeah. But I also want to mention before moving on from cold, there have also been a number of studies where they've taken people with type 2 diabetes, which is very common. Many people have blood sugar issues.

Pretty much every other human in America. Yeah.

And they found that when taking subjects with type 2 diabetes and exposing them to just mildly cool temperatures, I believe anywhere between, I think it was somewhere between 60 and 66 degrees Fahrenheit, which is not super cold, by making no other changes to their diets or lifestyles, they were able to achieve a a 40% improvement in insulin sensitivity, which is an effect size that you would expect by putting these patients on a new exercise regimen. Just exposing them to cooler temperatures.

Wow, so you don't have to get out of your chair, you just have to freeze?

Just activate that brown fat. Yeah, leave your thermal comfort zone. Life begins at the end of your comfort zone, your best biology.

Well, that brings the next subject, which is nature is medicine, because we're so isolated from nature. Both the light experience we have isn't based on natural light cycles. The temperature experiences we have aren't based on being exposed to the environment like we always have been. And it has really detrimental health effects. So you talked about, you know, nature and how that is really the disconnection from nature is really a source of problems for us.

Major. Today we spend 93% of our time indoors, you know, in big cities, and there's a lot of this research now coming out of Japan on forest bathing. There's actually a Japanese word, I believe it's keroshi or keroshi or I could be butchering it, but essentially there's a very significant portion of the population that gets worked to death in Japan. And there, I mean, 90%, 93% of Japanese people live in cities. So they are far removed from nature. And so this nature bathing line of research has really become a major focus.

Wow. Yeah.

And it's now being studied, you know, increasingly around the world, the relationship that we have with nature, especially as our cities become more and more dense and more and more polluted. But in the Genius Life, I talk all about the how air pollution can affect cognitive function and put us at increased risk for Alzheimer's disease. 20% of Alzheimer's Alzheimer's cases might be owed actually to heavily polluted air. And today, 52% of Americans live in environments with heavily polluted air.

Isn't there some UV app on your phone where you can tell the air quality?

The air quality index.

Yeah.

I believe you can actually, I think the weather app on an iPhone tells you the air quality.

But yeah, my niece lives in Houston. She says every day they get warnings not to go outside. side.

I mean, it's scary. And our indoor home air can be just as polluted, if not more polluted, than outdoor air. But in regard to outdoor air, what I think is really the most pressing of concerns where brain health is concerned is what's called fine particulate matter. So, airborne particles that are two and a half micrometers or smaller that are actually able to enter, we breathe it, we breathe these particles. in, they enter circulation and they can pierce the blood-brain barrier and enter brains. And they're doing studies now in very polluted parts of the world, like in Mexico City, where they'll take children and they'll actually see these particles like magnetite, which is made of iron in the brains of children. And what's very interesting, Mark, you know Rudy Tanzi up at Harvard doing all this research on viruses in the brain and how it can like micro the microbiome of the brain. Yeah, the microbiome of the brain and how amyloid might be a response to.

An inflammatory insult in the brain. Amyloid is like the gunk that clogs up your brain if you have Alzheimer's.

And it's sort of a response to inflammation, sort of like a Band-Aid in a way.

Yeah.

What they're seeing now is amyloid presence in brains of people who have inhabited very highly air-polluted areas with very high level concentrations of pollution. Yeah, so whether it's like magnetite or other fine particles or the herpes virus, amyloid is like this protein which may be actually coming to the rescue. But the point is that being in a place where there's a high concentration of air pollution might actually be creating this inflammatory insult to the brain which is causing this very early presence of the pathologies that we associate with Alzheimer's disease.

So connect back to nature because you're saying we should all move out of cities and become farmers.

More connected to nature. Yeah, that would be good. Yeah, I mean there are some things that you can do. So spending more time in nature, I think is super important, especially if you are at heightened genetic risk for Alzheimer's disease. So if you're an APOE4 allele carrier, making an effort to spend more time in nature.

And that's a gene that increases your risk. If you have two of those genes, like I'm getting Alzheimer's.

14-Fold. So doing that, also getting out in nature is crucially important because of the exposure to the sun. So exposure to the sun, I think, is very important. We were talking all about circadian biology, exposure to bright light, crucially important. Vitamin D deficiency is thought to be a risk factor for developing Alzheimer's disease. There's a review of environmental risk factors that I talk about in the book. Vitamin D was one of the top.

Yeah, well, I mean, it's a big deal because, you know, depending on the data you look at, up to 80% of us are insufficient or deficient. And the way the reference range works is it's based on a population measure. So, you take a group of people, you measure, you know, the spectrum of the levels in the population, and then you look at sort of what's the average, right? And you have like two standard deviations from that and you can kind of determine what's, what's, quote, normal. But normal is an optimal. If you were a Martian and you landed in America today, 75% of Americans are overweight. It would be normal to be overweight. It does not mean it's optimal. So the levels we often see in the laboratory ranges are not really where we should be hitting. The levels can be 20 or 30, but you should really probably have 45, 50, 60 at least. And I think I think probably 80% of us are deficient or insufficient and that leads to depression, it leads to increase for Parkinson's, Alzheimer's, cancer, so many different things. And I think there's been mixed data about replacing it, fixing it or not. I think it's complicated because when you're like, people are eating garbage and they throw vitamin D in there, it's not going to help. Yes, correct. If they're not exercising, they're smoking, they're drinking a lot, they're eating crap, take a vitamin D. It's not going to do anything. But if in all things being equal, people who are low in vitamin D have higher risk of this. And if you clean up your lifestyle.

And you're still low vitamin D, it'll make a big difference. Yeah, I'm glad you brought up context because one thing that very few people know, you could be spending as much time in the sun as you want, frolicking all day in the beautiful warming rays of the sun or even supplementing with vitamin D. But if you're not getting adequate magnesium in your diet, which 50% of the population does not get adequate magnesium, the enzymes that convert the vitamin D that your skin creates into its active hormone form in the body, all are magnesium dependent. And magnesium, half of us don't consume adequate magnesium.

It's found in dark leafy greens, pumpkin seeds, dark chocolate almonds. And a lot of things cause us to lose magnesium, stress, coffee, alcohol, sugar, all those things we love. Exactly.

Magnesium is like an anti-aging. It's a macro mineral. We don't consume enough of it and it's involved in all of the DNA repair enzymes. We're talking a little bit about DNA damage. They all require magnesium as a co-factor. It's involved in ATP synthesis, so energy production.

So, true. I see so much of my practice and these patients come in with all these magnesium deficient symptoms and they think I'm a genius when I give them magnesium, they go away. Things like migraines or headaches, constipation, muscle cramps, twitching, palpitations, anxiety, insomnia, anything that's irritable, twitches or spasms in any way or cramps is usually magnesium deficiency. And it's so easy when people take it, they go, my God, I didn't know I was so low. And I think you're right, it's so prevalent. I think as you age also your skin doesn't really convert magnesium, I mean vitamin D as well either, right?

Yeah, I make specific recommendations in the book for people no matter where they are in their life, no matter what age they are, it's important, context is everything really, but you're right, people who are overweight, people who have darker skin complexions, people who are older, they probably are going to need to spend more time in the sun to create the same amount of vitamin D. D. Yeah.

So, I once learned from Michael Holick, who's a vitamin D expert. He said, if you really want to get adequate vitamin D without taking vitamin D, you have to basically be practically naked between 10 and 2 in the daytime for 20 minutes south of Atlanta.

Wow.

That probably isn't happening for 99% of people.

Yeah, it's tough. tough. I try to get into the Sun as much as I can. Cuz the other thing about the Sun, we as humans, you know, we, I think that reductionist approach that we were talking about, it's, I think we're hardwired to try to break everything down. And I believe, I forget who, maybe it was Michael Pollan, but in, in nutrition, they call it nutritionism.

Yeah.

Where they like to break down foods into just the bare Essentials to see if we can replicate it in a pill form.

And that hasn't, you know, really, or, or identified. or we even do worse. We sort of identify the bad ingredients like saturated fat or sugar or whatever. And so, we focus on regulating those in food and then the food companies just kind of dial up or down different ingredients to sort of make it healthier, but it's not really. It's still junk food.

Yeah, exactly. And so, I think we can apply the same thing to the benefits of getting sun exposure on our skin and in through our eyes. So, I mean, vitamin D is created when the UVB rays from the sun reach our skin, but UVA rays might actually be useful in terms of creating nitric oxide and actually helping us lower our blood pressure. Yeah, that's pretty cool. Yeah, so blood pressure is another topic that I talk about in the book because it's so related to brain health. If you want your brain to be performing well, if you want it to age well, you really have to make.

Sure that your blood pressure is in a healthy range.

And getting the right amount of sunlight can help. There's very strong compelling evidence at this.

Point that bacteria are the cause of neurodegenerative diseases.

Not my- yeah, we talked about Rudy Tanzi, who's a Harvard scientist, one of the discoverers of some of the presenilin genes, which are the genes that show that people are at risk for early Alzheimer's. He actually said they were.