Struggling with Magnesium Deficiency? Here’s How to Fix It

Coming up on this episode of the Doctor's Pharmacy. Yeah, American Academy of Neurology gives magnesium a level B rating as probably effective for the prevention of treatment of migraine. So often when someone comes in with a migraine to the emergency room, I would give them intravenous magnesium because it.

Relaxes all that spasming blood vessels in.

Their head and helps them relax.

Before we jump into today's episode, I'd like to note that while I wish.

I could help everyone via my personal.

Practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplement store for.

A summary of my favorite and tested products. Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to the Doctor's Every week I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just jump right in. Why is it a problem? Well, about 20% of the population is living with overt magnesium deficiency. This is full-blown magnesium deficiency, and that's like one in five people. That's a lot of people. Subclinical or insufficiency, not true deficiency, which you see on a lab test, but insufficiency. can affect up to 80% of the population. Now, why is this important? Well, unlike drugs, which work with one pathway and one particular reaction in the body, magnesium and most vitamins and minerals, by the way, work on hundreds and hundreds of different pathways. And, and magnesium is involved in over 600 enzymatic reactions in your body. Now, enzymes help convert one molecule to another critical for everything, and it basically influences every single one of our biological systems, which is why it can cause symptoms all over the place, from your brain to your heart, to your, to your gut and constipation to menopause. and cramps and muscles. I mean, it's literally everything. And in low levels or suboptimal levels impact every area of our health, increase our risk for chronic disease. So it's not just kind of this annoying symptoms like muscle cramps. It puts you at big risk for serious illnesses. Now, it really probably should be considered a public health crisis, but most physicians don't test for it. It's not on your regular blood panel you get every year. If they do agree to test for it, they're likely run at what we call a serum magnesium test. That's what I learned in medical school. But it's not really the indicator of what's happening in your body. It's like this joke I have. I often tell when I'm giving a lecture. I say, you know, this guy dropped his keys on the street and his friend comes over and sees him looking under this lamppost. He goes, well, why, what are you looking for? What are you doing? He says, well, I'm looking for my keys. He said, where'd you drop them? He said, why are you dropping them down the street? But he said, why are you looking over here? He says, well, the lights better here under the lamppost. So that's how medicine is. It's easy to test your magnesium, but it's not the right way to find out if you're low or not. I mean, if it's low and it's your magnesium, you're really, really low. By the time it gets low, you're in trouble. Now, in a perfect world, I'd have the chance to see millions of patients, but the truth is, I'm just one doctor. Over 30 years of seeing millions of biomarkers and tens of thousands of patients, I've come to understand that much is being missed by conventional healthcare. We often wait until we have symptoms or diseases, then we get tested, but the transition from wellness to illness can often be detected decades before any symptom or diagnosis. I want people to have access to their own health data and the ability to engage in self-care and lifestyle practices that I believe can optimize their health and reverse the trajectory of chronic diseases that now affect six in 10 Americans and accounts for over $4 trillion in healthcare costs. And that is why I recently co-founded Function Health, where I'm the Chief Medical Officer. Function is a revolutionary way to understand and manage your health through lab testing that you are often not getting through your healthcare system. All the results are delivered in an easy to use dashboard that tracks your numbers over time and gives you actionable insights for every biomarker. the best test, which is really not practical, is something called a magnesium loading test, which is a 24 hour urine test. And you basically give people magnesium IV, and then you collect their urine for 24 hours and you see what spills out. And if they don't spill out anything, it means they're alone magnesium. If they spill out a lot, it means their body's good and they can get rid of what they don't need. The next best test, and what we do with a function Health, is called the red blood cell magnesium level. Now, this is not as good as the magnesium loading test, but it's pretty good. And it gives you a sense if you're, if you're insufficient or low, and people should be over five. And, and now often we see levels much lower than that. Okay, so what does magnesium do? Why should you care? As I mentioned, I call it the relaxation mineral. I think about epsom salt, right? That's magnesium sulfate. You soak in a hot bath, your muscles get relaxed, you don't have soreness. It just basically relaxes everything. And again, it controls over 600 different enzyme reactions. It helps in the production of ATP, which is the thing that makes you move and grow and do everything you do. It's basically the energy of life. and it's, it's really the key to making energy in the body. And, and often when you see low magnesium, and I've had this before, it, it can be something that's found in chronic fatigue syndrome, fibromyalgia, often if, if you have insulin sensitivity issues, in other words, you're insulin resistant and your blood sugar is not good. It could be low magnesium and magnesium is very much involved in blood sugar regulation. Also, it's involved in regulation of vitamin D in the body, the activation and transport of vitamin D. It's important you're not, not just for muscle health and contraction and relaxation of muscles, but also bone strength and bone density. It's also critical in making hormones such as testosterone, progesterone, estrogen. It's important in the sense that this of neurotransmitters in your brain. It's involved in calming and relaxation and, and inhibits the release of what we call excitatory neurotransmitters. It's also involved in DNA repair. It's involved in fluid and electrolyte balance, right, with calcium, sodium, potassium and hydration, which is why it's often in electrolytes. So, it's really important for electrolyte replacement. It's critical for heart, right? I mean, having a healthy heartbeat, blood pressure, high blood pressure is basically tightness of the arteries and the blood vessels. And so, magnesium is used in relaxation. We actually, when we have patients with really severe diseases, this was so interesting. When I trained as a doctor, it was kind of a last resort. drug, right? It's a mineral, but it was a drug that we used when things didn't work or nothing else worked, for example.

So.

In every ICU, in every cardiac unit, in every emergency room, it's on the crash cart, which is basically what we use when we resuscitate a person who basically has their heart stop and stop breathing. And when none of the drugs work, the last thing we give to stop a cardiac arrhythmia, which is the rapid beating of the heart that can kill you, we use intravenous magnesium. We use it to treat pre-term labor. If someone comes in in early labor, we give them IV magnesium. If someone has high blood pressure in pregnancy called preeclampsia, and that causes seizures, we give them intravenous magnesium, and we only use it when everything else has failed. But it shouldn't really be like that. We also use it for bowel prep. If you're constipated, it's basically one of the best treatments, milk of magnesium. You heard of that. And it also it's used to prep for colonoscopy such as magnesium citrate which makes you really go. So, it's used in everything in the body. We use it in medicine a lot. It's just kind of one of those things that doctors don't really think about as a problem for people when they come in with all these symptoms. So, the question is, why are we deficient? Well, 75% of Americans aren't eating enough magnesium in their diet. Where does it come from? Dark greens, beans, nuts, seeds, seaweed, people don't eat that. you know, it's declining soil quality. It's resulted in almost a 50 decline in magnesium in fruits and vegetables over the last 50 years. There's been a dramatic decline. So I think it's really concerning. Also, you know, about 25 of kids are magnesium deficient, which is very concerning to me, too, because it's critical for their bodies and to grow. Another thing is Ultra processed foods deplete magnesium. So 60 of our diet is Ultra processed food. 67% of kids diets, food processing reduces magnesium in the food by up to 80%. Also, if we eat a lot of high starch and sugar foods, which is our standard American diet or SAD diet, those foods deplete magnesium. So the more sugar you eat, the more starch you eat, the more you lose magnesium and increases the rate of excretion of magnesium and that's not good. So you eat sugar and starch, pee out magnesium. Also, the recommended levels are to prevent deficiency diseases. The RDA, we call the RDA, is about 300 to 420 milligrams. It's just too low. It's said to prevent deficiencies, but it's not really about optimal health. And about half the population doesn't even get the minimum amount you need to prevent deficiency. And globally, it's a huge problem as well. And a study of healthy university students in Brazil, they consumed an average of about 215 milligrams of magnesium and 42% have low levels in healthy, quote, healthy college students. Also, there's a number of groups that are at higher risk for magnesium deficiency. So if you're in one of these groups, you gotta pay attention. If you're pre-diabetic or diabetic, if you're low in magnesium, it increases the risk of various things like eye damage or retinopathy, neuropathy, nerve damage, kidney disease, and blood vessel disease. It's really critical in regulating our blood sugar. For women, it's involved in estrogen regulation and metabolism, detoxification, and deficiency is present about 80% of pregnant women and 55% of women with hormone-related issues. Think about that. I mean, if you're pregnant and 80 of women are deficient, it's one of the biggest causes of pre-term labor is low magnesium levels. So if you have low pre-term labor or you have high blood pressure in pregnancy, like I said before, we treat you with intravenous magnesium. So why not take magnesium? Also, you can get constipated when you're pregnant, too, so it helps with all that. 84 of post-menopausal women with osteoporosis had low magnesium. So this is just a rampant problem. As you get older, you're not so good at absorbing things. It's another group that has risk. So you don't absorb it, you excrete more magnesium. If you have certain age related diseases that cause low magnesium, certain medications we'll talk about in a minute can lower magnesium levels and make you pee out magnesium. Often things that'll use to treat high blood pressure, like diuretics. If you look at hospitalized patients, 65% of people who are critically ill who were admitted to the ICU or intensive care unit were magnesium deficient. And with COVID-19, we saw also those who had the highest magnesium intake had the lowest levels of inflammation and had 70% lower odds of developing severe symptoms. So just taking magnesium can reduce the inflammation if you get COVID and reduce your risk of having severe COVID by 70%. That's amazing.

And this is completely safe.

Unless you have kidney failure, it's an incredibly safe a mineral to take. Now, the other thing you should know is, most doctors don't think about it unless you're in an extreme situation, like we talked about, whether you have preterm labor and arrhythmia or having seizures from pregnancy or high blood pressure in pregnancy, we just don't think about it. But we should. And again, as I mentioned, if it's tested, it usually is a serum magnesium, which doesn't reflect whole body. It's only about 1% of the magnesium in your body. 99% is in your tissues, your bone, muscle, the body has really tight regulation methods for magnesium and it pulls from the reservoirs in your bone or muscle if you want if you're needing to keep levels stable. So if your whole body is depleted, it's going to be hard to replenish and normal, normal serum magnesium levels are about 1.8 to 2.3. But I think anything under two is linked to increased health risks and optimal levels should be over two. So you're getting a serum magnesium, it should be over two. But I, I don't like that. I like the red blood cell magnesium. So functional medicine looks at this a little bit differently. We look at, you know, comprehensive testing. look at what's going on with all their biomarkers. And we look at red blood cell magnesium. It's way more accurate reflection of whole body magnesium. It measures intracellular magnesium, which is where often it needs to be to do the job. It reflects the magnesium content of muscles and bones. It has a longer half-life. It's less prone to fluctuations from your diet, and it correlates with clinical symptoms. So it's a really good biomarker that is part of the function panel that you're not getting when you go to your regular doctor. We're sure it's not on your annual panel, and it's probably not on any panel that they do. at all if you're going to measure magnesium. The other things you can kind of look at in relation to magnesium that are part of the functional panel include kidney tests like creatinine, BUN, vitamin D levels, because low levels are often associated with low levels of magnesium absorption, just like calcium absorption. Calcium levels are also interacting with potassium levels, low levels of potassium or calcium can be an indicator of low magnesium. If you're high in sodium and other clue that you might have a low magnesium. If your blood sugar is high, your insulin is higher, A1C, your average blood sugar is high, blood sugar control. that that's a sign of low magnesium. So a lot of, a lot of things you can look at to kind of get a clue that you might be magnesium deficient. Another hormone that's important they should look at is parathyroid hormone. And we, we, we also think it's important to look at that. And magnesium can be involved in, in the release of parathyroid hormone from the par, from the parathyroid gland in the neck. And if your parathyroid levels are low, you're gonna have low magnesium. So it's important to look at all this stuff. Look at your EKG, look at your heart function. So there's a lot of ways to look at magnesium, but the key is a red blood cell magnesium to start. What are the root causes of having an abnormal magnesium or low magnesium? Well, our diet, right? Our SAD diet, our standard American diet, as I mentioned, salt and sugar make you pee out magnesium and starch. Phosphorus also, that's in soda, right? Cola is particularly food additives. And, all these things are used in ultra-processed foods and that causes us to basically pee out magnesium, coffee and alcohol. also make us lose magnesium and too much calcium from supplements, not a good idea either. Stress, another one, chronic stress is a big factor because obviously when you have a magnesium, your nervous system is relaxed, your body's calm, when you are stressed, you actually pee out magnesium. Those living in Kosovo during the war in one study had higher cortisol levels, which is a stress hormone, and lower magnesium levels. Also, if women have heavy periods, it's another factor that can cause low magnesium malabsorption issues. If you have celiac, inflammatory bowel disease, colitis, Crohn's, if you have diarrhea, you lose magnesium. If you're and have diabetes and you're peeing too much, you lose magnesium or kidney damage, you'll have magnesium issues. Also, if you sweat a lot, like you do saunas, exercise, go on a hot climate, you're gonna, without electrolyte replacement, get into low magnesium States. Again, over supplementation with calcium, you don't want to do that. And then a few other things can cause you have magnesium issues. One is having aluminum from antacids and cookware, food additives, drinking water, deodorant, all that will potentially affect your magnesium. Drugs, a lot of drugs as I mentioned affect magnesium levels. So, these are common drugs like diuretics which are used in high blood pressure which is often a low magnesium issue. Certain antibiotics, steroids, I mentioned the cortisol will make you lose magnesium, used for inflammatory disorders, acid blocking drugs we use for reflux, are horrible because they block acid which you need to absorb minerals such as magnesium and other deficiencies of nutrients like vitamin B6 or vitamin D or selenium often will cause us to have low magnesium. All right, so what are the things we talked about? Let's just kind of go over those. What are the things we should be worried about that can be related to magnesium deficiency? Well, cardiometabolic disease, type 2 diabetes, as I mentioned, in one small study they looked at the intracellular magnesium status of patients diabetes and it was depleting over 30% of patients. And now this problem affects 93% of the population to some degree or another. Heart disease, another big category. If you have coronary artery disease, and this is the Rotterdam study, looked at 10,000 people, reported a 36% greater risk of death from heart attacks and a 54% greater risk of sudden cardiac death in those with low serum magnesium levels. So that's really concerning. So if you have low magnesium, you're 54% greater to die from a sudden death, 30% greater risk of having a heart attack. That's bad. If you have high blood pressure, often a clue that you might be low in magnesium because magnesium relaxes blood vessels and improves flexibility. If you have palpitations or rapid heartbeat, again, magnesium could be the cure. Heart attack, strokes, and a blockage in your arteries. Again, studies show that this was a cross-sectional study published in Nutrition, Metabolism and Cardiovascular Disease, showed that otherwise healthy Koreans with the lowest serum magnesium had two times the risk of having calcium build up in their heart, which is a huge clue that there's atherosclerosis or plaque development. And also, it could involve calcium metabolism. There's too much calcium, not enough magnesium. It's a problem. You've had a stroke, you know, those with highest versus lowest magnesium intake had a 40% reduction in all-cause mortality versus the lowest intake. So basically, if you have high intake of magnesium and end up with a stroke, you're going to have a 40% reduction in your risk of death after. That's pretty good. It's low magnesium, linked to cataracts, it's linked to headaches, obviously. In fact, American Academy of Neurology gives magnesium a level B rating as probably effective for the prevention of treatment of migraines. So often when someone comes in with a migraine to the emergency room, I would give them intravenous magnesium, because it relaxes all that spasming blood vessels in their head and helps them relax.

Okay, let's talk about some of the nutrients because there are some key nutrients that are often low in people who have migraines.

Absolutely.

What's the number one nutrient that you would be thinking of?

I would say magnesium.

Yeah, magnesium.

Now, the interesting thing, now 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, it's actually a calcium channel blocker.

And guess what doctors use to prevent migraines?

Calcium channel blockers.

It's a natural muscle relaxant. Yeah. It's actually, I remember, you know, when I was an ER doctor, it was one of the things we used.

None of the drugs worked. We would use IV or intravenous magnesium for migraine patients. Remember that? Absolutely. And, well, not only that, but we use in the ER, we use IV magnesium for heart arrhythmias, you know, life-threatening ones like torsades de pointes and VTAC. 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 as 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 magnesia. 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. 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. And 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, severely constipated. Muscle cramps, headaches, insomnia, irritability, anxiety, palpitations, sensitive and loud noises. These are all symptoms of low magnesium.

And so it turned out she needed.

Like, normal dose is 200, 400 milligrams. She needed like 2,000, 3,000 milligrams a day of magnesium. And literally her migraines went away. and that's sort of our constipation and all those other symptoms. So it's often really often very simple if you know what to do. People who are nutritionally deficient in certain things can cause high blood pressure, like magnesium. Right.

And magnesium, studies show that there's a very large percentage of people in our country have low magnesium.

45%. People have low magnesium, which is- and.

You know, Magnesium, it's not magic but when we replace magnesium in patients, we see amazing things happen. We see blood pressure come down. We see them being able to sleep better. We see muscle twitching and cramping go away. We see mood improve. Magnesium has a very important role in the body and certainly plays a big.

Role in lowering blood pressure.

Yeah, but I call it the relaxation mineral. And, you know, it's funny how in medicine we have these blind spots but when I I was training in obstetrics and gynecology. I was a family doctor. I deliver lots of babies. There's this common condition that women get called preeclampsia, which is high blood pressure in pregnancy. And when they come in and their blood pressure is high, which can cause seizures, the treatment isn't high blood pressure pills because they don't tend to work. We give them intravenous magnesium to relax their blood vessels and save their life.

So we sort of, it's just a.

Strange thing to me.

We don't think about it that way.

The other thing that is important is omega-3 fats and fish oil because it helps relax your blood vessels, make them more pliable. But there's other causes that we also see. For example, environmental toxins, heavy metals in particular, lead and mercury are really common. They're under diagnosed. And when you go in your high blood pressure visit, your doctor's not checking your mercury and lead levels, not even your blood, and probably not on the most important test, which which we do at the Ultra Wellness Center, which is a challenge test where we give people a drug to pull out the metals, the chelator, and then we check their urine and see how much dumps in there. And if they have high levels, that's.

Often a big factor as well. And I think you're, you know, you're, you're really hitting on all the things that I think about. And I, I tell people when they come to me and hypertension is part of what they want me to work with, I said, we're gonna get your hypertension better by not treating your hypertension. We're not going to treat your hypertension. We're going to treat everything else that's causing your hypertension. We're going to find the sleep apnea. We're going to find the nutritional deficiencies. We're going to work on your stress levels. We're going to help you lose weight. You know, when you lose weight, I mean, you actually are going to drop your blood pressure. I think. I think the number is per pound. I think for every two pounds you lose, you drop your blood pressure by a millimeter mercury.

So if you lose 20 pounds, you can drop blood pressure by close to 10 points. So, a diet is so key. We created a program called the 10-day reset, which you can find in getpharmacy.com, we put a thousand people through it, tracked their blood pressures. It was incredible. Their blood pressures dropped an average of 20 points. Yeah, in 10 days.

Well, if you think about it, if you think about that most Americans are at least 25 pounds overweight or, you.

Know, so let's say it's better than medication. results.

Exactly. If you get them to drop that 25 pounds, they're going to drop their blood pressure by near 15 millimeters of mercury.

So we have insulin resistance, sleep apnea, low magnesium, low omega-3 fats, which about.

90% of Americans have.

You have heavy metals, environmental toxins, and we now are learning that the gut microbiota, the microbiome in the gut, if it's altered through our bad processed diet and all the nasty drugs we take, it actually causes inflammation throughout the body that drives high blood pressure. Anything that causes inflammation or oxidative stress will cause high blood pressure. And the thing that struck me as I, and this is stuff that's in the traditional medical literature, is that high blood pressure is an inflammatory disease.

And we treat it like a plumbing problem.

We do.

And going back to the nutritional piece, Lithium, a little potassium can be another reason why you can have high blood pressure. And that speaks to where do you get potassium, get it from green leafy vegetables. So having a vegetable-based diet is very, very important.

I love my green smoothie in the morning.

Absolutely. Yeah, more kale. More kale.

Yeah. So this is very important. I think people also think about salt. So people think high blood pressure is salt. What's the deal with salt and high blood pressure? Is it something we should worry about?

Is it as big a deal as we thought? It's not something everybody needs to worry about. There's certain populations that are going to be more salt sensitive than others. And so we can actually do genetic tests and we do them here at the Ultra Wellness Center that lets us know if you have those genes that make you more sensitive to salt, more likely to have high blood pressure. So we do need to be concerned about it in certain populations and limit it. Salt actually, it's the salt we add to our food that is the problem because it's processed, all the natural nutrients are taken out of it. It can be iodized and iodine can cause problems. So it's not the salt that we.

Personally add in our kitchen, it's the salt that's added in factories to process food.

Yeah, exactly.

That allows huge amounts of intake of salt because how do they make junk ingredients taste edible? Salt, fat, sugar.

Yeah, and sugar.

Processed fats, right?

Yeah, so we know that. But if you get really good salt, sea salt that you've purchased that actually has nutrients in it that can be valuable to you. Minerals and so forth. Yeah, exactly.

So these are some of the common.

Causes we see and they're often things.

That aren't looked at. When you go to your doctor with high blood pressure, they're not checking your heavy metals, they're not checking your insulin resistance, they're not checking necessarily sleep apnea, although some might be. thinking of that. That's just medicine.

It's interesting.

We're not checking your magnesium.

When I started learning about all this.

I learned about nutrition in medical school. It was like, okay, vitamin C prevents scurvy, and vitamin D prevents rickets, and vitamin A prevents blindness and B vitamins prevent this and that. And I never really understood why they were important other than preventing deficiency diseases, which is sort of why we first what we learned about them was from these diseases. And then I began to understand this and began to think about, you know, what do vitamins and minerals actually do in the body?

Right.

And there's 37 billion billion chemical reactions that happen in the body every second. 37 billion. That's crazy, right?

I don't even know what that is.

It's like a kazillion, you know, I don't know. A lot.

It's a lot.

And every A single one of those chemical reactions requires helpers. And the helpers are- Co-factors. Our vitamins and minerals.

Vitamins and minerals, yeah. Right, and one of the other shocking.

Things I learned was that our DNA, one-third of our DNA, codes for enzymes. So enzymes are catalysts that convert one molecule to another. So all these chemical reactions I talked about all need catalysts or enzymes. One-third of our entire genetic material is coding for these enzymes, and there's variations in how they work that make one person require more or less of a different nutrient. So some, for example, is you need more B vitamins if you have certain variation. You might need more folate or B12 or B6. And if you take the normal amount, quote the RDI, which is not the optimal amount to create health, it's the minimum amount necessary to prevent a deficiency disease. Yes. So how much vitamin C do you need to not get scurvy? Probably 60 milligrams. How much vitamin C do you need to optimize your immune system to not get COVID?

Probably 4,000 milligrams, right? And it's different for each person, like you're saying, based on our genetic makeup, right? And everything else going on in our body, not just our genetics, but what other diseases we're dealing with, how we.

Digest and absorb our nutrients. I mean, so many things impact our nutritional needs. Yeah, it's so true. Your gut microbiome determines what's going on with your nutritional levels. You may not be producing the vitamins in your gut like vitamin K or B12 because you have a bad gut.

Exactly.

It's so fascinating to me and really in functional medicine, our focus is on nutrition as the first line of therapy and it's both using food as medicine but also understanding the role of key nutrients and playing a role in how they function. so you and I have been in this field for a long time and it's easy to be sort of a little bit arrogant and think that the traditional doctor, well, people need food, they don't need vitamins, waste of time, waste of money. But we get kind of humbled by seeing actually what happens when we test people. And I think despite doctors saying this.

When you look at the data, I.

Think 72% of doctors recommend supplements to their patients and 79% them themselves. So whatever they're telling you, it's interesting that, you know, and we see studies that show, oh, vitamin D doesn't affect heart disease or cancer and omega-3 fats don't really benefit heart disease or cancer prevention. So we see these studies that are conflicting all the time.

You know, I think that happens for so many reasons, right? Why those studies are conflicting. One is because we're putting everybody in that same group, so we're not personalizing the approach. And so it depends on people's health status, how they're digesting, absorbing, how their nutritional status in general, are they deficient to begin with? What are their genetic needs? So that really impacts how somebody shifts or improves from when we give them those nutrients. So I think that one of the biggest issues with research which is we're not looking at individual variations and SNPs in somebody's makeup, their genetic variations that impact what they need. And so it just sort of lumps everybody into one category.

Yes, so someone, for example, had a vitamin D receptor gene that made them require a high dose of vitamin D, and you took 100,000 people and you saw them taking vitamin D, well you think they're taking enough, but it might not be enough for that person. And if you actually took that subset and you studied them and you gave them the right amount to get their.

Blood levels optimally, it might be different. It will absolutely be different. So, we know with fish oil, for example, if people are eating a couple servings of good fatty fish a week, then fish oil supplements might not be as helpful for them. But when people aren't eating that, then fish oil supplements make a huge difference and help lower triglycerides and decrease risk of heart disease. So we know that it really is.

Dependent so much on your individual diet as well all those other things we've spoken about. That's true. I always say, if you don't have a headache, an aspirin doesn't do anything, right? If your Omega-3 levels are already good and you take Omega-3, it doesn't do anything, right? So I think the studies are challenging and they're often, like you said, it's hard to distinguish what the overall health of the patient is. And so if these patients are eating crappy diets, they're smoking, they're drinking, they're not exercising, taking a vitamin is not going to help them. They're not that powerful.

Right.

In that sense, right? If you clean up everything and then you add them in, they can be extremely effective and powerful. So that's not to say that if you're overweight and unhealthy, you shouldn't take supplements because I think they will help, but they work much better if you clean up house first.

Comprehensive program, right?

So let's talk about how we learn in our practice, the UltraWellness Center, about what people's nutritional status is.

How do we figure that out?

Well, so we do, we look at it from multiple different angles, right? First, it starts with the physical exam. What is their waist-to-hip ratio? How are they holding on to weight in their body? Then we look to look for signs of nutritional deficiencies. Maybe their hair is dry or their skin is dry or they have different spots on their nails, which could indicate zinc deficiency. We look at their diet intake.

Wait, wait, wait. The nutritional physical exam, I just want to pause because you teach that. that course at the Institute for Functional Medicine. And it's fascinating when you learn as a doctor what the clinical signs are of vitamin deficiencies. So we know the obvious ones. For example, if you have scurvy, you get no gum issues. If you have B vitamin deficiencies, you get little cracks in your mouth called keloids. If you have white spots on your.

Nails, it might be zinc deficiency. For example, bumps on the back of your arms or dry skin, we think about vitamin A. A lot, we think about zinc.

And my favorite test is a vitamin D test. You know what that one is?

Yes.

Tell us about that.

So if you bang on somebody's leg and they have pain, then that could be a sign that they're low in vitamin D. Yes, if you take your.

Thumb and you press right now, ready to go press right now on their shin bone, and if it's tender, then it means you're probably vitamin D deficient because it makes your bone soft. Now I take vitamin D so my.

Bone doesn't hurt at all when I press on it. depressing right now.

Yeah, mine doesn't hurt either.

There you go.

I'm taking my vitamin D. So, you can just do a simple test. So, there's a lot of things clinically.

You can figure out that are signs of nutritional deficiency. So, that's the first step. And I think that's really important to look and examine because biomarkers are not perfect, which are lab tests, but they can be very helpful, but they're not perfect at determining everybody's nutritional deficiencies. For example, magnesium. We know that magnesium, as we talked about, it's a very common deficiency. But sometimes serum magnesium and red blood cell magnesium can be normal and somebody can still be deficient in magnesium and would benefit from more magnesium, whether it's dietary or supplement-wise.

Well, that's the other thing. We take a detailed history. So, by actually questionnaires, you can determine what your nutritional deficiencies are. So, I wrote my book, UltraMind. I literally had questionnaires in how do you know if you're zinc deficient, vitamin D deficient, magnesium deficient, folate deficient, you know, so forth?

And you can actually do these questionnaires.

And you're going to get a pretty sense if you're deficient or not. And then you look at their diet too. You look to see what they're eating and what they're not eating. When somebody's a vegan, you're thinking more about, okay, I've got to really look for B12, I've got to really look for issues with iron, I've got to really think about zinc and the omega-3 fats. because they're more common deficiencies, you know, if you're not eating any iodine.

Iodine, because you don't eat fish, right?

So there's things we have to think about depending on what their diet is like and their digestive system. So we do a comprehensive approach and the biomarkers can be really helpful too. They're not perfect, but- Like blood tests.

Or what other tests?

Yeah, so we can look at blood, we look at urine. We do this panel called the ion panel. and it's this all over nutrition panel. It gives us so much good information. It tells us about amino acid levels. Those are the components of protein in the blood. Building blocks of protein, yeah. Yep. And it tells us about omega levels, omega-3 levels, omega-6 levels. It tells us about mineral levels. It tells us about all those steps of the mitochondria, you know, steps of the Krebs cycle, which need nutrients to work properly, like you were talking about, those cofactors, the vitamins and minerals that help those reactions work so we can take our food and turn it into ATP or energy. So when we have deficiencies in certain nutrients, we'll see shifts in this panel called the Organic Acid Testing, which, you know, that's really helpful.

It's a urine test.

It's a urine test.

So that's really important. So what you're saying essentially is that we use a lot of different kinds of tests Yes. Because your typical doctor will check your blood levels, but if you check your blood levels of folate or magnesium, they go, oh, it's fine. You're not necessarily fine. So each nutrient requires a very different approach depending on the nutrient. So vitamin D, yeah, you can check your blood level of vitamin D. You gotta check the right one, but it's pretty good.

Yes. Right?

You can check your blood levels of omega-3s pretty good, right? But you wanna check in the right way. Some like folate or B12 or magnesium, not so much. Not so good, right? And I think you mentioned magnesium, it's a really good point. So a lot of doctors will check magnesium. Now, if it's low on a regular blood test, it means you are in big trouble. You're really low. You're really low. And then you can check red cell magnesium, which is a little bit better. But the true test is something called a magnesium loading test.

Which is what? So you give magnesium and then you collect urine for a period of time. period of time. So that magnesium, depending on the level of sufficiency that somebody has in their body, that will impact how much magnesium that spills over into their urine.

It's not a test we do very often, but it's something you really want to know. You got to give someone a load of magnesium. If they pee it out, they're good. If they hold on to it and.

Nothing comes out in the urine, they're pretty low. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts and follow me on all social media channels@drmarkhyman and we'll see you next time on the Doctor's Pharmacy.

I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free Mark's Picks newsletter@drhyman.com/markspicks. I promise I'll I only email you once a week on Fridays and I'll never share your email address or send you anything else besides my recommendations.

These are the things that have helped.

Me on my health journey and I hope they'll help you too. Again, that's drhyman.com/markspicks.

Thank you again and we'll see you.

Next time on the Doctor's Pharmacy. This podcast is separate from my clinical practice at the UltraWellness Center and my work at Cleveland Clinic and Functional Health where I'm the Chief Medical officer. This podcast represents my opinions and my guests' opinions, and neither myself nor the podcast endorse the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. You can see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com if you're looking for a functional medicine practitioner near you, you can visit ifm.org and search find a practitioner database.

It's important that you have someone in your corner who is trained, who's a.

Licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of.

Improving health to the general public. In keeping with that theme, I'd like.

To express gratitude to the sponsors that made today's podcast possible.

Don't forget, there's a way to listen completely ad free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts and tap Try Free to start your seven-day free trial.