The 7 DAILY HACKS To Reduce Inflammation & INCREASE LIFESPAN! | Dave Asprey & Mark Hyman

You don't have to do anything crazy. Just move for 20 minutes a day.

That's it?

That's step one. By fasting from crappy foods, you actually have more control of who you are.

One of the things people are doing every day that mess them up, that decrease their energy, that affect their ability to function, think and be.

The first one is why is it that people are willing to spend an hour a day in a spin class, which is probably creating overtraining anyway, but they're not willing to skip breakfast sometimes? I think skipping breakfast is easier. and it's okay to do both. It's just from a return on investment thing that it's the most important thing that I could think of. Even if you're not committed to changing your diet, even if you're going to eat all the things that you and I know are not real food, fasting can still help. It's just a lot easier and it helps more if you eat the right way. And one of the things that's really behind fasting, Mark, is the idea that fasting is just going without. And in the book, I talk about, okay, let's think through what happens emotionally when you say you're going to go without something. We have other kinds of fasting that you probably haven't thought of. The keto diet is fasting from carbs. The vegan diet is fasting from animals. I don't know why you'd want to do that if you want to live healthy for a long time, but maybe for a couple of weeks to turn on- that's another podcast.

Exactly.

And, hey, go Pegan, there you go.

The.

The, the thing that's also happening, you fast from substances that's called, you know, addiction or sobriety, you know, addiction treatment or sobriety. And we have fasting from people is called Solitude. And we have fasting from the, the, at the end of the book, I actually tell people, try fasting from hate, right? I also talk about fasting from sex or at least porn for a brief period of time because your body feels like you're gonna die if you don't have sex frequently. You're not going to die if you don't have sex for a couple weeks. You're not going to die if to have food for a month, but you feel like you're going to die if you don't have food for a brief period. We're talking about skipping breakfast, but the.

Body is like, no.

So that's the thing. How do you create a sense of safety when you're going without something that you think you need, that you feel like you need, but you know you don't need? And just by doing that for brief periods of time, it's just like lifting weights. It's just like exercise, but it's exercise for your emotional body. It's exercise for your spiritual body. It's exercise for your physical body, including those subcellular things that you just talked about. and when we change our mindset to fasting is just exercise, we can do exercise, right?

And you might feel like you're gonna.

Die on the treadmill, but you know you won't and you do it anyway, every day. So we're just gonna normalize fasting and also acknowledge, Mark, there are a lot.

Less painful than my workouts, my trainer. I don't know, that's my, like, no more reps, please. Yeah. He makes me do push-ups with bands. You know, you put like a, oh, that's so cool. I love bands. I'm like, Holy cow.

Well, I mean, you are looking a little bit bigger in the shoulders there. So all that Tom Brady stuff seems like it's working.

Yes, it is.

There was something else. I know I'm not exactly answering your question, but you mentioned Tom Brady. The other part of his longevity, he figured out, like I did, that nightshades, the lectin problem with nightshades, for me, but not for everyone, for about a third of people. Man, those things cause cravings like no one's business. If you give me nightshades like potatoes or bell peppers or eggplants, man, I want to eat sugar like no one no one's business.

Right?

So you got to find the foods that don't trigger that.

How can you give up tomatoes? I just can't give up tomatoes.

Yeah, I'll still eat some fresh tomatoes. I take out the seeds and you peel them. And this is a core part of.

Tomato off the vine in the garden in a hot August summer day. Well, you have a garden, Mark. Life experience.

I live in an organic farm and that's something that I also would encourage people to fast from junk food and industrial meat and things like that.

Now there's a fast I can get behind. Fast from industrial food. I love that.

It's a real type of fast. You say, look, I'm going to go without because there are people, in fact, a great many people listening right now, they're going, you, mean, I can't have Skittles, I can't have Reese's peanut butter cups, I can't have Cheetos or whatever thing is. Well, you can have them. I'm telling you that fast from them because your body feels like you're going to die if you don't have those. And the side effect of a fast like that, Mark, is, as you all know, it builds soil. and we have pigs, sheep, turkeys, chickens, and a great number of vegetables growing on my organic farm. I feed my local community and I am building soil like no one's business. We recovered a five acre gravel pit using animal manure and turned it back into fertile soil and we're restoring the.

Forest on a part of the property.

When you choose to do that kind of a fast, you can still eat, but you're giving back to the planet and the work you've been doing lately on food policy and all that stuff, that is also a part of the fasting world. You are choosing to go without the things that make you weak. Even though there's a part of your body that wants you to eat those and you are becoming master of that part of your body. And when you're master of that part of the body, the side effect is you're nicer to everyone around you because you're eating better food. Like everybody wins when you do this.

It's so important. Wait, wait, wait, I don't want to just pass by that. You just send something that's highly profound because in the middle of this incredibly divisive world, I mean, I was born 60 years ago and yeah, they were Democrats and Republicans and there were certainly divisions in society and there was segregationists and there was to hate. And, but the level of divisiveness, the level of reactivity, the level of hatred. I mean, I post a picture of me with now President-elect Biden talking about how we can start to build bridges and have conversations. And we don't have to agree. We can, you know, have deep conversations, even if we don't have the same worldview without hating each other. And, I mean, and there was just the most incredible blowback that I just could not believe. and all this projection of hatred on me and saying I was for vaccine mandates and mask, I mean, mask mandates, stuff I never even, I was just talking about love and let's, let's all be friends and let's, let's disagree, but let's disagree nicely. Let's not vilify and hate. And I was like, whoa. And, and, and what really is clear and David Perlmutter's work and his son, Austin, and then their latest book, Brainwash, really talked about this, that our diet, our modern industrial diet has literally hijacked our brain and activated the amygdala, which is the fight or flight attack, defend, victim part of our brain. And so we are operating in a highly activated way in which our frontal lobe becomes disconnected from our amygdala. Our frontal lobe is the adult in the room. It's our executive functioning. It's the one who doesn't do the stupid thing even though he thinks about doing it. Right. Well, instead it's like Dennis the Menace. And when I think about what I'm not doing what I'm gonna do, I've already done it. You know, like and I think, yeah, I think this is such an important thing you said that it changes the quality of our behavior, our emotions, our relationships, our fear, our anger, our hostility. These are things that are killing us society now. And I just, it just breaks my heart.

Me too. I interviewed Dr. Vivek Murthy, former US Surgeon General. He wrote a book saying, In his time as Surgeon General, the number one epidemic that he came across that was causing the most problem wasn't viral at all. It was connectedness. He said, We have a profound state of loneliness and disconnection in people, and that's what's making us sick, and we have to fix it. Then a week after he comes out on the podcast, he gets named by Biden to co-chair his coronavirus task force. This is a guy who values connection and connectivity and will value those things so that our policies might say, it's kind of important we don't turn on that epidemic when we're trying to turn off another one.

That's right.

Okay, that's it. And I said, hey, congratulations. We got a guy who cares about what we care about on a panel. Man, the amount of people saying exactly what you heard, just projecting all this hate. Here's what's going on, Mark, which is take it back to fasting. okay, if you don't have a healthy metabolism, your blood sugar can crash. And if you do something like eat MSG, which as you well know, as you've written about, is hidden in so many foods under fake names. And when you eat MSG, it causes hypoglycemia. When your blood sugar gets really low, your body says, oh, this is kind of an emergency. I need some blood sugar. Good thing I have built-in systems to turn on blood sugar instantly. It's called cortisol and adrenaline. So your body says, I'm crashing. Let me get you some stress hormones right here. And then you get your energy back, but it's fighting energy, it's stress energy. And then you see someone post about, Hey, could we have more connection and empathy and kindness? And they're like, you,'re a bad man.

Well, there's a connection directly to food.

There really is. Yes, there really is. By fasting, you train your body to do that. And by fasting from crappy foods, you actually have more control of who you are. And you can show up as the person that you want to be instead of the person you are when you're hungry. Because I don't know about you, but.

Hypoglycemia is a very real word for me, at least it used to be.

Yeah.

What is that? ICD-9-Goni-Cd-10-code-103-4.2, is that it? It's a clear medical diagnosis, hypoglycemia. I've never heard that. That's very funny. No, you sort of, we're sort of kind of skirting around the edges of this, but in your book, you talk about how fasting can be a powerful entry point into honesty and control of ourselves. What do you mean by that?

Well, there's two kinds of fasts. There's fasting for health and you can do this intermittent fast with the hacks. You can do it during the week. And there's another kind of fast, which I call a spiritual fast. And these tend to be for at least 24 hours, a little bit longer, where you actually sit with what's going on in your feelings. You journal. So what I'm doing for people who order Fast this Way and send me the receipt at fastthisway.com, I'm taking them through a two-week, I'm calling it a fasting challenge, but it's really a fasting course where as an author, I feel like I haven't done my full job because I'm also a teacher. I taught at the University of California for five years. So I'm actually teaching people what's in the book for two weeks and we're going to all together, thousands of people at the same time, practice intermittent fasting with the hacks, without the hacks. But for the last two days of this two-week challenge, we're going to do a spiritual fast. I'm actually going to get you a fasting journal and you're going to be able to sit there and say, all right, I'm actually going to go for 24, 36, even 48 hours without food, but I'm going to do it mindfully. I'm going to reduce distractions in my life and I'm going to be hungry. and I'm going to say, wow, how many times am I actually thinking about food? Do I really want to snap at my kids or am I getting even more angry at the news that I shouldn't be watching during a spiritual fast anyway? All of those things so we can gain awareness of ourselves. And the cool thing is because you're fasting, you have extra ketones present and you have more energy to think about it. And this is why all the great spiritual traditions include fasting, because that little boost to the neurons is a boost that you can use for self-awareness. Mm-. And that's why fasting is so powerful. It puts you back in charge of you instead of letting these automated life systems are like, is that scary? Take my attention. Is that food? Take my attention. Is that a nice pair of legs? Take my attention.

Right?

You're supposed to own all of that and you can own all of that and it doesn't have to be painful to get there. And the reason most of us haven't taken on fasting and the reason it terrified me, in fact, I was offended when someone told me I should fast when I weigh 300 pounds because I'm like, I would die. It would be terrible. All of that fear, it's not real. The fear is real, but the reality is very different. And the more we can help ourselves live in reality, the more control we have of our energy. That energy goes to the prefrontal cortex, which allows us to catch those negative thoughts before they turn into negative behavior. And the challenge in the book at the end is, look, just spend two hours fasting from hate. Maybe spend a whole day where you don't say one hateful thing, you don't think one hateful thing. And that is really challenging. I had hooked electrodes up to my head and spent time meditating, a lot of time meditating to get to that point where I can do that. And even then, you'll see these things sneak in. But just a regular short practice of that allows you to remember the kind of person that you're capable of being instead of the kind of person you are when you're constantly triggered by industrial foods, by industrial news sources, and basically by a world that really isn't set up to let you be who you're supposed to be.

This last book, Headstrong, was about the mitochondria, which seems like an esoteric thing. It seems like a complicated word, but you sort of explained that there are these little bacteria-like organelles inside our cells, and there's hundreds to thousands and tens of thousands in some cells, and they basically take food that you eat and they take oxygen that you breathe and they turn it into energy that runs every system in your body. And there's byproducts, there's water and you pee out and carbon dioxide that you breathe out and then there's waste products that your body has to deal with. And that whole process is at the center of everything that matters in terms of cancer, heart disease, diabetes, dementia, Alzheimer's. Yeah, all these things are related, even autism are related to mitochondrial dysfunction. And there's a woman, Suzanne Goh, who's an extraordinary scientist from Harvard, Oxford, pediatric neurologist, discovered on the autistic brains that the mitochondria aren't working well. There's no energy in these kids' brains, and so they gave them mitochondrial stuff.

Support, and these kids get better. You may not know this, but I met the clinical definition of Asperger's syndrome until my early 20s. Yeah, it's brain mitochondria. You don't make enough energy. You don't have enough energy to filter out all the noise from the world around you. And of course, you're not going to make social skills. That's less important than just being able to know what's going on. And what I'm finding in the research in Headstrong shows 48% of people under age 40 have early onset mitochondrial dysfunction. It means you take a unit of food and a unit of air and you get less than a unit of energy. And everyone over age 40 has mitochondrial dysfunction. They call it aging. I think it's still early onset. Our mitochondria don't have to decline with time, and it comes from poor management. And if you think about it, if they really are ancient bacteria, which we're sure they are, then what you have is you have a gut biome, all these bacteria in your gut, and you have another network of bacteria that's trying to run your system. That's an integral part of your system. And if you treat that as carefully as you treat the gut in your bacteria, or frankly, you treat your compost pile so that it makes good soil, it's all the same activity. And bacteria actually do think they have not real brains, but they have a process. They have an algorithm for staying alive. if you make them happy and you tell them only the strong survive and you do the things that you would do to maintain any biome like that, you can actually have way more energy than really Mother Nature intended. I think we can do that.

And that's what I want to dig in. And I just want to sort of share this story that I heard the other day about the role of mitochondrial therapy in treating ALS. Now, you might not have heard this study, but the mitochondria require certain nutrients and certain factors. One of them is called NAD and we're going to talk about that. And this is taken as a supplement. It also has some resveratrol, which is from red wine, also is a mitochondrial regulator. It controls these master genes that affect inflammation, that affect oxidative stress, that help produce more energy. And there was a preliminary study done. Now, there's been many, many drugs studied for ALS. None of them work. Even the best, best, best one that got approved reduces the decline by about 15%, but you still decline. They did an interventional trial using NAD and resveratrol, which actually stopped and actually improved patients with ALS. And they regained function, which is something that's completely out of the medical paradigm. That just doesn't happen.

And it's one of 10 different mitochondrial stimulation strategies, all of which will help ALS.

So, what are the things that like nuke your mitochondria? What are the things people are doing every day that mess them up, that decrease their energy, that affect their ability to function, think, and be?

The first one is eating damaged fats or bad fats. And we hear about this thing called a cellular membrane, but it's not really a membrane. It's a collection of tiny droplets of fat. And your mitochondria have their own little.

Bag of fat that they're held in.

It's like a baggie that holds all the contents of your cell. It's made up of fat. Correct. And then there's another one that holds the cell itself. So if you eat the wrong fats, particularly fried foods, even if you fry them in coconut oil or butter, it's still not good to fry because the heat damages oils. Then your body gets these oils and it goes, what do I do with these? I'm going to try and build mitochondria that are supposed to take energy and.

Or take food and air and make energy, but they can't do it because.

Their membrane isn't flexible enough. It gets damaged. So I call them FLFs. FLFs.

Funny looking fats.

There you go.

And just don't eat that stuff. you don't need the fried calamari. It's just not good. Eat the guacamole.

I like it.

So that's one thing. Another thing is there are toxins, a variety of toxins, some of which come from Mother Nature and some of which come from man. And if you eat these, even in relatively low amounts, they will affect your mitochondrial function. And the most confusing part that's made this hard for medicine, and particularly nutrition, is that different DNA, different backgrounds can affect which toxins really mess with you. In my case, in my family history, it turns out somewhere on my mother's side, because this is a mitochondrial thing, mitochondria only come from your mom, not your dad. My people don't handle something called nightshade vegetables very well. And this is potatoes, tomatoes, eggplant.

Good thing you're not Italian.

Yeah, no kidding. Italian and Greek food are full of it. I grew up dearly loving green chile in New Mexico. And if I eat even one bite of foods from that family, this is the deadly nightshade family, but some people metabolize it, for me, I get joint pain, brain fog, muffin top, it's bad.

And what if you take the seeds out and peel it?

Even if I do that, it just doesn't matter. I'm highly sensitized to it. And my daughter's not that way, but I am. and it's irritating, but that doesn't mean for someone listening that it's bad for them. So a third of cases of rheumatoid arthritis are caused by this family. It's a mitochondrial problem, but it's only a problem for people with that genetics. So what I recommend people do on the Bulletproof Diet, I put a set of suspect foods. These are foods that may cause problems for you, but they may be good for you. So it's not that simple to say, oh, here's the standard MRE, military ready to eat ration that everyone can eat. it's not like that, but you have to know what are your kryptonite foods that lower your mitochondrial function. And the first sign of mitochondrial function, even without lab tests and all the expensive cool stuff, if you eat it and you get a massive sugar craving afterwards or you get massively tired and you can't remember things, your brain is stuffed with mitochondria. It has the most mitochondria of any part in the body, so you're going to feel it in your brain first. If you can't focus after lunch, and you're just dying for dessert, you ate something that whacked your mitochondria. It may have hit them directly or it may have just crashed your blood sugar like MSG will do. Either way, you crash your blood sugar, your mitochondria freak out and they get.

Stressed and it's not a good stress. Exercise is a good stress but that kind of stress is not. So you got the fried foods which is going to kill your mitochondria. You've got food toxins but they're different for different people. But you've also got other things you eat? And what is the main thing? And I've written many books about this. It's a clue. It's a hint.

Yes.

The answer is?

The answer is grain.

Sugar.

Oh, sugar. There we go. You know, I would have... I don't know, Mark. I don't like sugar. Sugar is bad for you. I don't know if sugar is worse than grains, which are essentially made out of sugar, but covered with other toxins from Mother Nature. But, I'm 100% with you. If you eat sugar, especially drink sugar, what ends up happening is the mitochondria get a burst of sugar saying, Yay, but then they're dead. They don't actually die, but they're out of energy and it's that sudden spike and sudden crash.

It causes metabolic damage far beyond just mitochondria. I mean, we eat 152 pounds of sugar and 133 ounces of flour, which is worse than sugar. That's almost three-quarters of a pound a day of flour and sugar. That is poison for a moment of country. And that accelerates aging and causes this pre-diabetes and insulin resistance. That is a huge driver. And then there's also other things, toxins, other toxins. And I had mercury poisoning. I was about to say mercury. Good. I had mercury poisoning and I had chronic fatigue syndrome and my muscles were damaged. I had a muscle enzyme called CPK really high, which is really a sign of your muscle cells exploding because there's no energy. And it was, I had severe pain.

And aching all the time.

And it was because of these environmental toxins and there's a lot of them and some people are more susceptible than others.

Mercury is a big issue because we've been burning coal for so long that when you burn coal, it releases mercury into the air and then it comes down in rain and gets in our fish and some types of fish are much better than others and you and I have both written about the type of fish that you want to eat like salmon, not farm salmon, but wild salmon, sardines, herring, anchovies, you know, all the stuff that people don't like, I like them. All the stinky fish, right? but those are the ones that are safest. But I also had mercury poisoning and lead poisoning when I was younger. And I remember the first time I got treated for it, my wife was like, Dave, your skin is pink. You've always been gray. And what happens when these toxins are present, just look a little lead-like. Yeah, you look lead-like. And you're actually creating a condition called pseudo-hypoxia, which is when your mitochondria just can't use air and food because they've been poisoned. and so you get this sort of backed up system metabolically and you feel gray and your skin looks gray, your circulation isn't good and you get that horrible muscle pain that was just a part of my life until I was about 30.

So what do you do to rebuild and revitalize your mitochondria? Stay away from sugar, fried foods, environmental toxins, your kryptonite foods, but what are the things that we can actually do to rejuvenate them and to live to be 180?

The good thing is there's way more mitochondrial organelles, these little bacteria in your body, than there are cells in your body. And they are replaceable. So the first thing you want to do is you want to tell them only the strong survive. And there's a few ways to do that. That's why you call your book Head Strong. Yeah, exactly. And so you sort of need to manage them like a system instead of like little individual things. So you want to take the weakest 20% of your mitochondria and you want to tell them die. And that sounds a little bit brutal, but here's what happens when they die. Fresh new young ones sprout in their place. How do you kill them? All right, here's one of my favorite techniques from Headstrong. Tomorrow morning when you take a shower, take a nice warm shower at the end of the shower with the water hitting you right in the forehead and chest, turn it to full cold.

And now after about- It sounds like great advice. That's not so much fun.

I can't wait to do it in the morning.

After eight seconds, you're gonna be like.

Dave Asprey's a jerk. But if you stick with me for four days, the next day you'll do it, you'll last like 20 seconds. And what's gonna happen? happen is the voice in your head, which is your mitochondria, is going to say, you,'re going to die.

You must get out.

It's unbearable to be in here. But you rationally know, if I'm in here for one minute, I'm not going to die, but it feels like it and you believe that feeling. But what you're doing is you're telling the mitochondria, if you can't make enough energy to keep yourself warm for just.

A minute of cold water, then you're.

Weak and you should die. And that's them saying, please don't kill me. Please don't kill me. And you're a strong survivor. You're going to die. And when you do that, after the fourth day, you're like, you know what? This isn't that cold. In fact, I feel invigorated. My skin is tighter. I'm losing weight. I feel good. I sleep better. Like, it's really powerful. We're talking one minute of cold water. Wow. But four days. Four days of pain first, and then all of a sudden, just. Just believe me.

Just try it for a week.

You're like, you know what? I like my life when I do this.

You're like the Iceman. Yeah. This is like the. The weak version of that. You don't have to go swimming. I find, you know, when I sick with chronic fatigue, the only thing that would give me like a few hours of relief would be to take a steam or a really hot bath and then I would jump in an ice bath. Correct. And that would kind of flush everything out and I'd feel like a minute.

Of clarity and energy. And the thing is, this doesn't require liquid nitrogen like we have at Bulletproof Labs who do cryotherapy. It's low tech, it's free, everyone can do it. And if we all just did that.

The measurable incidence of all chronic disease.

Would go down across the country. Okay, that's a great tip. So what else can we do for a medicine? There's two kinds of exercise that matter and I looked up all the research on this stuff and your job with exercise is to make yourself grow healthy young mitochondria but also to grow more mitochondria because who wouldn't want a bigger battery on their iPhone, right? So one kind of exercise is in.

That low battery mode, right? Right. That shuts off all the operating apps.

Our body will do that. The last thing is your brain but the rest So it's like you don't have to repair and regenerate. Why would you do that? You don't have enough energy. Just keep it for the brain. Keep it for the lungs. You're totally right. And what I end up doing for this exercise stuff is one body of research says if you move for 20 minutes a day, it has a set of behavior on maintaining youthful mitochondria. So this means not like running. You don't have to go get all dressed up in your Lululemon outfit, although you might want to. But all you have to do is just go for a walk. You don't have to run, you don't have to do anything crazy. Just move for 20 minutes a day. That's it? Well, that's step one.

Okay.

All right, that's not too easy. And if you want to really grow more mitochondria and get all the benefits for anti-aging, there's another body of research that says at least once and maybe twice a week, you need to do.

Something really hard for 10 to 15 minutes. Meaning, basically exercise hard enough so you're.

Going to throw up. Pretty much. What I recommend in the book is that once a week you want to sprint and you want to run about 400 yards like a tiger is chasing you and then lay down on your back. It's actually important to lay down on your back instead of stand there. There's a whole different thing that happens in the brain when you do that around recovering faster. You do that three times and then you can just say, all right, I'm done. That's not very much pain and it's not very much work and it actually is going to replace being on a spinning thing every day for the week. The idea here is that-- you- can.

Exercise far less time and get far more benefit.

In fact, we created Bulletproof Labs in Santa Monica, which is a facility that has equipment to help people do this with technology. Because the idea is if you're commuting home every day and you're commuting to work and you have kids and a family and responsibilities, you just don't have time to do 90 minutes a day.

That's the good news. Yeah, I mean, I read a study years ago where they looked at giving people 30 minutes of interval training, which is what you're talking about, three times a week versus 60 minutes, six days a week of just like a run, light jog, like a regular aerobic exercise. And at the end of 12 weeks, the group that only exercised 30 minutes, three times a week, far less exercise, had 9% less body fat and were far more fit doing far less exercise.

If you get more fit and less time, it's awesome. And here's what's really going on, Mark, and this ties into your functional medicine background. It's relatively easy to whack yourself over the head in the gym. And I see so many CEOs who, well, you know, I'm running my company, I just flew to Japan and back, and I'm going to do an Ironman triathlon.

And I'm like, let me guess.

Your adrenals are shot. Yeah, you can't sleep, you have no sex drive, your joints hurt all the time, and like, how did you know? well, here's what happens when you don't recover enough. Well, what happens is exactly that. Hormones crash, adrenals crash, testosterone goes down, women oftentimes get monthly hormone problems.

So, you over-exercise your sex life goes to pot.

It really does. And also, if you're constantly stimulating instead of recovering, it just doesn't work. So, our job is to actually be masters of recovery, which means small amounts of targeted stimulation. Great news, that takes less time. and then recovery. And recovery means you sleep. It also means that if you're in a toxic relationship that you fix it. It means that if you have a lot of emotional stress, old trauma, PTSD, substance abuse problems, eating disorders, you deal with that stuff because if you have chronic stress from just being unhappy, that's enough stress even without exercise. And if you have lots of travel stress, you're jet lagged. Maybe you don't want to hit the gym really hard. Maybe you just want to take it easy and get some extra sleep and get a massage. And to recognize that the massage makes.

You just as good of a person.

As going to and lifting heavy things. It's recovery that matters.

That's good to know. I'm going to write that down. Yeah, you said something there very hopeful, is we can actually change our mitochondria by changing our thoughts. That our thoughts actually are being eavesdropped on by our mitochondria. And that if you have a set of beliefs or attitudes that are keeping you stressed, because you and I live very crazy lives, but both of us aren't really stressed. We just seem to kind of go through every day and have a good time and enjoy life, right?

You can do big things and still be happy. In fact, my next book comes out in December. One of the big themes in it is that you can only do big things if you work on happiness first. And whether your goal is to do big things or just do the things that make you happy, you will not have healthy functioning cells if you have a belief system that says everything's a threat. because the mitochondria, they want to keep your petri dish alive no matter what. And if they believe that you believe there's a tiger present, even if the tiger is just the next email, the next Facebook post, or the next time that you're getting in a fight with your boss or whatever it is, if that looks like a tiger to a dumb little bacteria, they're going to constantly change your metabolism and be ready to fight. And you'll be in that fight or flight mode. And there's a complex thing that happens with neuropeptides, these little tiny chains of amino acids, little protein fragments that are signals throughout the body. And another thing that most people don't know about, when your heartbeat changes to get ready to run away from a tiger, there's a magnetic field around your heart, shaped like a donut, and it's tipped eight degrees to the left, and you can measure this. This isn't the woo-woo side of things. This is hard physics. And if there's the electrical current, it makes a magnetic field. We also have proven that mitochondria are sensitive to magnetic fields. That means that they're listening to your heart. And when you're ready to run, your heartbeat changes predictably. And if they're getting that signal and they're getting neuropeptides of stress, they're going to be like, screw recovery, screw repair. Who cares about cancer?

There's a tiger here. It's going to eat me. Cancer doesn't matter. It doesn't know.

It's just your imagination that you think your spouse is having an affair, which may not be true. You still get the same response. Exactly. And if that's running the show, your body will naturally make sure that you stay alive right now and not worry about preventing death 20 years from now because, hey, if you miss this one, the one down the road doesn't matter. and if you realize they're dumb, they're little bacteria, they care about three things, Mark. This is mitochondria. Number one, run away from, kill or hide from scary things, because if you miss that one, it's game over. The Petri dish is dead. Number two, eat everything. Because otherwise, if you don't eat within a month, you're gonna starve to death. And maybe that's not true for us, but that's what they think they're dumb little bacteria. So the algorithm is eat everything. This is why if someone puts a plate of cookies in front of you, it's really hard not to think about the cookies. They just keep calling to you. to you. They're actually not calling to you. It's your mitochondria going, Hey, is that food?

Hey, is that food? Eat it, eat it. Although, I believe if you change your brain chemistry and your hormones, that it won't really look like food anymore. I walk by the Starbucks corée of pastries, those cakes and scones and donuts and muffins, and I'm like, it doesn't look like food. Even if I'm hungry, I'm like, oh.

That doesn't look like food. It's a rock.

Why would I eat a rock? You are absolutely right.

Absolutely correct.

I used to want to eat it. I used to go to the airport when I was traveling around and you can sneak around and buy a Cinnabon when no one was looking and I'd.

Get them with nuts because I thought that was healthier. We've had such a similar path. I used to have these cravings like, I've got willpower. I forget willpower comes from mitochondria. It's energy. I've got willpower, but every time you say no to these, you're using a.

Little bit of willpower till you run.

Out and then you're like, I'll just have half the cookie, right? And then you feel like a bad person. Well, you're using science, not willpower, to fix the problem. What happens with me now, the same thing. You look at that and I'm like, those don't make me feel good. Those aren't food. And I would never eat one.

I would rather eat nothing. I would eat it if I wanted to. I'm not gonna go, I'm not gonna eat if I want to. But it doesn't attract me. The desire is gone. And it's sort of striking. And sometimes if I get eating a little too much chocolate and sugar, then.

It starts, oh, that might be interesting to eat. And then I stop and it goes away. So it's all hormones and biology. It really is. I can tell you in the last 10 years, there's one time I've had grains. It was actually when we were hanging out, Mark, in Greece at Vishen Lakhiani's event. We're on some little Greek island and there's a guy at a little guest house and he said, Here's some baklava. It was made by my grandmother from local wheat and honey. I'm like, you know, I'm eating that.

I took some charcoal with it.

I felt better the next day. It's fine. In Europe, it's better, right? It is. But that sort of thing to be.

Willing and acceptance but just to not see it that way, that's myochondrial. It's part of the approach of functional medicine. We start them on the elimination diet. So eliminating all the inflammatory foods, gluten, dairy, processed foods, all that stuff.

And then you- Remove, right?

That's the remove in the 5-Rs. Right, 5-Rs. We remove, replace, reinoculate, repair, rebalance. Yep. And we'll go into each of those because they're really important. But the next step is also there's other things we may need to remove, there's tests we need to do. So what kind of tests would you look at as a functional medicine doctor that you wouldn't see at a traditional doctor? that give us a roadmap of how to treat these patients.

Right, so we did a stool test that looked at his microbiome. And what we noticed is that there was an overgrowth of unhealthy bacteria and unhealthy yeast. So he had this, you know, probably because of years of antibiotics, he developed this dysbiosis, this imbalance in the bacteria and yeast. And so there was an overgrowth of the unhealthy things.

It's like weeds, having a lot of weeds in your garden.

Yeah, right? Right, it's not always like one of those you think of a stomach infection and you're getting really, really sick, you're throwing up or having diarrhea. This is this, it's an imbalance and it's called dysbiosis, but that imbalance causes a lot of symptoms in people. When you have the wrong bacteria and the wrong yeast levels, you can get a lot of bloating after you eat, you can get a lot of fatigue after you eat, you can get those symptoms of constipation, constipation and diarrhea and that causes this inflammation in the digestive system. So all of your digestive enzymes don't work well. So you're not breaking down your food well, you're not absorbing your nutrients well and it becomes this vicious cycle that people are dealing with and we see all the time.

Yeah, it's so powerful. So when I see this patient, I'm like, okay, you don't have to do all the tests but sometimes if you get stuck, you look various tests that look at antibodies against things that are in the gut that determine a leaky gut. We call it Cyrex 2 testing, which is a test you can get through functional medicine.

You can test to see if there's leaky gut. I love that test too, because it's a great way for us to follow up and see how much we're seeing improvement. Are we doing enough? Are we seeing improvement in their leaky gut or increased intestinal permeability?

Then we look at poop tests. testing. We do thousands and thousands of these tests and it's so helpful. It doesn't just look at the microbiome, it actually looks at the function of the gut. Whether there's malabsorption, whether you had no digestive enzymes, whether there's inflammation, whether there's overactive antibodies in there, whether you have imbalances in what we call the short-chain fats, which are the food for the colon that are produced by bacteria eating the right kinds of fiber. And if they're low, it means there's an imbalance. Then we look at the microbiome, we look at what grows, we look at parasites, and then we target and micro-target the things that are out of balance for that person. And it's different for everybody. And we might look at food sensitivity testing. We might look at, and even things like heavy metals or other things which can also cause it. I had a patient with ulcerative colitis once, and I did everything right. I did the whole 5R. It wasn't working, but I forgot the for a first part of the R, which is removed. And I thought, well, maybe, you know, heavy metals can cause autoimmunity. Maybe it's a problem. And so I tested him, and he was, like, wasted away. And he was like, it was terrible. He actually had high levels of mercury. We treat his mercury, and his colitis went away. So it's phenomenal. Yeah. So I think it's, it's so powerful. This case is so important because it really describes how a patient, you know, goes to a traditional doctor, is diagnosed with a disease, irritable bowel syndrome, by the way, anytime he hears syndrome. It means doctors know what the heck is going on. It's just a collection of symptoms that we agree we're going to put in this bucket and if you have those symptoms, you have this disease. But it's not really a disease. And so that's what functional medicine is. It sort of looks upstream to figure out what the root causes are and personalize the treatment for everybody. And there's common things that we do.

Like the 5R, but it may be different R's for each patient, right?

Right.

So for him, we removed the inflammatory foods. and we removed the bacteria and yeast. I actually treated him with an antibiotic, a non-absorbed antibiotic, and an antifungal. So I treated him with a prescription medication. Yeah, a weed killer. So that was the remove, right? And then the replace, because he was underweight and because of that inflammation in his digestive system, I gave him some digestive enzymes for a short period of time just to help it so the food wasn't as inflammatory. for him and to help him absorb more nutrients. And then we worked on re-inoculating, right? So, after we gave him some good probiotics...

Put in the healthy bacteria.

Put in the healthy bacteria. Some good prebiotics. Right, so we know that... What are prebiotics? Prebiotics are the things that help feed the good bacteria. So, they're the food for the probiotics.

Which is usually what?

Like... Like fibers, Fibers are amazing prebiotics. We know a lot of phytonutrients are prebiotics. So this, I think, is really exciting research when we're looking at our phytonutrients. We know- what are phytonutrients?

Right. I know.

It's amazing. So our food has minerals in it, it has vitamins, but it also has these things called phytonutrients, which are these components in our plant foods that have this amazing health benefit for us. So that can include things like ellagic acid that we see in pomegranate that can feed some of the good bacteria, that Akkermansia that we know can lower inflammation. We know that... Just to back up.

On that Akkermansia thing. So when we look at the poop, we can tell if there's like good levels of different bugs. One of them we look at is Akkermansia. And it turns out that that is so important for protecting your gut. It helps you keep your biofilm or that little coating over the gut so you don't have a leaky gut. And it's involved in so many autoimmune diseases and response to cancer therapy and metabolic issues and weight. And it's such an overlooked thing. You can't take a probiotic of it.

At least not yet. But you can feed it, the good guys. Right, we can feed it. We can feed it with all these amazing phytonutrients like what's in pomegranate, the ellagic acid. and also we know that sulforaphane from our cruciferous vegetables feeds the good bacteria.

So broccoli, collards, kale, but not juicing it.

Right, Brussels sprouts, all those good ones. We know that green tea, that has good phytonutrients in it that's good for the digestive system. So we always say to people, get something from every color of the rainbow every day. Get some plant foods. from every color of the rainbow every day. Get some good red foods like the pomegranate or cranberry. Get something orange and yellow and green, blue, purple, white, tan. All those good healthy plant foods that we, you know, like our vegetables, our fruits, our spices, our teas, our coffees really actually are impacting our microbiome, which is fascinating.

It's so great. And you know, just a great anecdote from a colleague of mine, Dr. Lee, who was on our podcast talking about EAT2B disease. His mother had stage four uterine cancer. And being the smart doc he is, he understood from the research that if you have low akkermansia, patients don't respond to the immunotherapy, what they call the checkpoint inhibitors, which is this new form of cancer therapy that helps activate your immune system. So if your gut isn't healthy, you can't actually get the cancer cells to die with immunotherapy. So basically you die unless you have good bacteria in your gut. So his mother had stage four uterine cancer and was gonna die and wasn't responding and he gave her pomegranate, cranberry, green tea, all these phytochemicals, got her acrymancy levels up and she was cured of her stage four cancer within a month.

That's a phenomenal story.

It's an incredible story and I think that just shows the power of these plant foods. Of the plant foods and of getting focused on the gut.

So sleep is when we're repairing the powers of both the mind and the body. Sleep is when we reduce inflammation, repair tissues. The discovery of the glymphatic system in 2012-2013 is this passive channel that runs alongside our arteries and veins in the brain that fills with fluid when we're in deep sleep and allows a washing out of debris we may have accumulated during the day.

Things. So all those bad thoughts get washed out.

Well, not the bad thoughts. No, but the amyloid plaque, that sticky plaque that we secrete in response to inflammation or injury, if it accumulates, of course, it can damage surrounding neurons and.

Is associated with neurodegenerative disease and Alzheimer's disease.

So in English, that means if you don't sleep, you're likely to get demented. It's definitely playing a role. And this concept of bidirectionality, we know that sleep disruption, circadian rhythm disruption, sleep apnea is present in two-thirds of people with insulin resistance, pre-diabetes diabetes. And it is a chicken and the egg thing. It is driving the bus. We used to think, well, you get the sleep apnea because you have insulin resistance and gain weight. But if you have disrupted sleep, your insulins are higher, your cortisols are higher, your glucose is higher, you're looking for highly processed, quick energy dense foods and.

Less able to resist them. Wow, so not sleeping is a risk factor for obesity. Absolutely. And heart disease.

Yes.

And cancer. And dementia. And flares of autoimmune conditions.

Yeah.

And chronic pain. And fibromyalgia. So, and anxiety and depression.

I mean, it really affects- oh my.

God, if I don't sleep, I'm depressed and anxious.

But the more you worry about it, the harder it gets to sleep. Yeah, it's true. So, okay, so we have that chronic stress. What else is driving this insomnia pandemic.

Which is huge, right? How many 70, 90 million people are- struggling with insomnia.

Right.

So I do think that there's a need to address underlying contributors to anxiety and depression independent of their impact on sleep. So talking about what's going on, bringing in some kind of breath-based practice, whether that's yoga or tai chi or meditation, just to ratchet everything down. That's another important component of it. And thirdly, you've already touched on a little bit about the dopamine with the foam, but it's also the dysregulation in our circadian rhythms. You know, we think about how I, there's been a lot of research about how important it is to avoid light exposure at night, for example. But everything we do during the day and when we do it is ultimately going to influence our ability to go to sleep when we want to and get the rest that we want to. So in other words, when we're eating all day long and snacking late at night and watching TV at night, that's signaling our computers. Yes, and on our computers, that's telling our bodies and brain that it's day, it's day, it's day. So we want to actually reestablish a consistent circadian rhythm, meal timing, so we're having eating earlier in the day and then building in a fasting interval before we go to bed.

So don't eat three hours before bed? No.

Interestingly enough, as you know, there's a connection as well with digestive function that eating late at night not only disrupts your sleep, but it's contributing to higher reflux, which can also interrupt sleep. everything's interconnected.

That happened to me last night actually, because I went hiking and it's summer and it's so beautiful and it stays late light. So we were like, didn't get down from the mountain till eight o'clock at night. And I'm like, oh, let's go eat. I'm hungry. But then by the time we ate, it was like nine o'clock. And I like last night, I tossed and turned for a couple hours before I went to bed, which I usually don't do. It was some pretty crazy stuff. I was like, oh, it was the, you know, it was the fleeing late at night. So there's eating late at night. There's circadian rhythm disruption. This morning I went out and sat on my deck and the sunshine was out. So you're getting light the morning is so important. Absolutely. So we don't do that. We're all like on our phones or computers right away. We need the natural light to reset our brain. Makes a big difference. Light is medicine, right? It is. Light is medicine. It is. And also it could be bad medicine if it's the wrong light at the wrong time, right? Exactly. So we have all this like, there's this great book called Lights Out that I read years ago, Cindy, that was.

Really talking about the advent of the light bulb driving chronic disease because of the disruption in our rhythms and so on. It's interesting, they even looked at LED street lights disrupting the circadian rhythm of animals and insects too.

So it's not just humans that are being impacted by this. And there's some other weird stuff that.

Affects sleep that we don't think about, like what else? Well, one of the conditions is restless leg syndrome. And that's, it's hard to diagnose, it's more of what we call a clinical diagnosis. People describe this creepy crawly sensation in their legs or this irresistible urge to rub their feet together. And typically it's treated with dopamine medications. connected to relatively low dopamine levels in the brain. You know, dopamine, yes, revs you up, but dopamine also seems to play a role with movement. So it's treated with some of the same medications they use to treat Parkinson's disease. But it turns out that that can be more prevalent in people who have autoimmune conditions, in which case we wanna address the underlying autoimmune conditions. There are some nutrient deficiencies that are gonna make this symptom of restless legs more significant. low iron, low vitamin D, low folic acid, low magnesium. So we really want to look at somebody's nutritional status.

Yeah. And by the way, 80% of the population is deficient in vitamin D, 50% in magnesium, you know, like 20% iron. I mean, it's like a lot of people are deficient in B vitamins and they don't even know it. Right. You know, and you go to your doctor, you have insomnia, they're not checking those things. Exactly. and there's even weirder things in nutritional stuff, right?

So if we identify a nutrient deficiency, for example, the next step is why? What's the why that somebody's nutrients might be low? And there we come back like so many other things to the function of the gut. And interestingly enough, there is a higher correlation in people who have small intestinal bacterial overgrowth also having restless leg syndrome. Maybe because it's contributing to ongoing inflammation, maybe because it's also contributing to difficulty absorbing those nutrients from your food.

Food.

So we're even going to go a step further and say, is there an underlying issue with digestive function, absorption and assimilation of nutrients that are- so if.

Your gut's a mess, it can also cause insomnia.

Absolutely.

And then heavy metals are another big one that we don't really hear about. Right.

Lead, mercury, things that are under the radar for many, many people and unfortunately can be a problem.

Yeah, and I had that. we talked about on the show, but I've had mercury poisoning 30 years ago almost, and it really totally screwed up my sleep.

What happened with your sleep?

I just couldn't sleep. Like, I just, I was just really couldn't fall asleep, couldn't stay asleep, never felt rested, had chronic fatigue syndrome. Until I got the mercury out, got my fillings out, chelation, everything, I couldn't sleep. And it really took a long time to reset that. Okay, so we've got all these different things that traditional medicine ignoring, the hormonal fluctuations, the gut issues, heavy metals, nutrient deficiencies. I mean, doctors know about sleep apnea, but they often miss it in thin women because that's not the archetype of someone who actually, like the Pickwickian figure with, you know, a huge belly and a thick throat and size 17 neck. I mean, you know, so there's all these issues. And, and yet, you know, this continues to be such a struggle for so many people. and the traditional treatments really are just stop gap. They don't really address the cause. So in functional medicine, the way we think about things is to look at some of these other factors. So in your practice, Eddie, how do you start to dig down? What are the kinds of diagnostic things you look at differently? We talked about all these different factors, but how do you identify what's the problem in this or that particular person?

Well, I think it's the time to take a history and really understand all of the other interconnectedness that could be going on. For example, somebody with sleep concerns might also have digestive concerns and then we might be thinking about assessing their digestive function. Looking at a nutritional assessment. But I think there's a time and a place and there's tremendous value in screening somebody with a portable sleep study because that gives you a tremendous amount of information. And we're using it, yes, to diagnose sleep apnea but also to say, how often do you wake up during the night? How much percentage of time are you spending in REM sleep and deep sleep? are you tossing and turning all night long? So it can give us a tremendous overview in terms of somebody's sleep throughout the night. And from that, we can also decide, okay, what else do we need to explore?

And then we do some testing, right? You can look at nutritional levels. You can look at these vitamin D and magnesium and folate and iron studies. You can look at, obviously, the sleep apnea test and there's home tests now you can do really great. right? We look at heavy metals, right? And the hormones, we can really get a sense of what's going on with hormones for people. If their estrogens and progesterone is all out of balance, it just happens in menopause. You see a lot of sleep issues, heavy metals, like I said, we can test. So there's a lot of ways we can diagnose using functional medicine testing that you don't really get with traditional doctors that can help get underneath things. So tell me about this. this patient you had because it sort of speaks to a lot of the issues that we're talking about. And it gives you a little unusual approach to insomnia, something you wouldn't really get from a traditional doctor.

Right, so this is somebody that, and one of the things I want to plant the seed for is sometimes we start with what we think is the most likely issue and we gradually uncover more potential contributing issues and peel the layers of the onion. And this was a woman that I had known for years. She was pretty healthy in terms of her lifestyle. She exercised, she wasn't overweight, she ate a healthy diet. She didn't drink any alcohol. She was treated with antidepressants. She was on a serotonin reuptake inhibitor and Wellbutrin for her depression. And she started, she was also on hormone replacement therapy. She was postmenopausal in her 60s. And she started complaining of fatigue and difficulty concentrating and just felt scattered. And by Sundays, she would have the need to take a three-hour nap. So, well, that's unusual. So we did some of the usual testing for causes of fatigue. We tested her thyroid. It was okay. We looked at her iron levels or sugar levels, they were okay. So I decided to do screen her with a sleep study. And it turned out you would not have looked at her and said, oh yes, she is the poster child for sleep apnea. She turned out to have one of the most striking positional components to sleep apnea I've ever seen. When she was on her side, her sleep was normal. But when she was on her back, she had respiratory events that count as either a slowing of airflow or a stopping of airflow more than 60 times an hour.

Wow.

Stop breathing 60 times an hour. Yes. Yes.

Like once a minute. That's a lot. No wonder she was exhausted.

Right.

So in, when you see a positional component like that, you know, I have people who don't want to do a sleep study because they don't want to. I don't, I'm, I'd never wear that stupid mask. But for her, we said, okay, well, let's start with retraining you to learn to sleep on your side. And she tried that. There's some commercially available positional devices.

There are all kinds of strategies you can use. It's a very, very sophisticated. it's called the tennis ball strategy, where you sew a tennis ball into a t-shirt on the back. So if you roll over on your back, it makes you flip over to your side.

Or the fanny pack with the pillow stuffed in it, yes. There's all kinds of strategies you could do. And of course, it's big business, right?

You can buy a slumber bump or a bumper belt.

Oh, I didn't know they had those. I was on the tennis ball track. Even more sophisticated, there's now a biofeedback device that's a strap around that vibrates when you roll on your back. So it's sort of autogenic nighttime training to get you. So that's what she used, interestingly enough, and it helped a little, but she was still tired. So as we're peeling the layers of the onion, she had some digestive symptoms, a lot of bloating, a lot of discomfort, and she had, we had done a full sleep study. She had restless legs and periodic limb movements. She turned out to have a very abnormal breath test. for small intestinal bacterial overgrowth.

That means bugs growing in your small.

Intestine where they really shouldn't be.

Where they don't belong. Right.

Right. Which can cause inflammation. Absolutely. And low iron. Her iron wasn't terribly low, but one of the sidebars here, I think the other thing we do in functional and integrative medicine is understand the difference between a normal blood test, I should put quote, normal blood test, and an optimal blood test.

Yeah. Ferritin is a classic example of that.

Ferretin looks at your total tissue iron.

And I think- How much iron is.

In your iron bank in your body? In your iron bank, your iron stores, right? And normal can be anywhere from 15 to 250.

Yeah. So- It's a big range.

It's a big range. And what we know the threshold is for somebody who's got restless leg symptoms is you actually don't want to be normal. You want to be over 100 because there's some evidence even comparing it head to head with those dopamine drugs we mentioned earlier, getting somebody's ferritin over 100 was as effective as the dopamine medications. That's amazing. That's amazing, right? As simple as correcting a nutrient deficiency not to the normal range but the.

Optimal range for that condition. Yeah, it was interesting is, you know, if heme iron is the best absorbed kind of iron, but that usually comes from meat. And people who are vegan, the plant forms of iron aren't as well absorbed. And you often see very significant iron deficiency in these patients, especially women who are menstruating. and I think that, you know, I learned actually in traditional medicine that ferritin was connected to sleep actually. Interesting. I learned that in a lecture on insomnia that I went to by some drug company. That's great.

I was like, well, that's interesting.

But yeah, I think it's something that's often overlooked and it's an easy blood test to check your ferritin, which most doctors won't look at.

And Mark, I think from the internal medicine standpoint too, it's equally important to say, don't just correct the iron, figure out the why. You don't want to miss colon cancer.

Yeah, she got colon cancer. Absolutely. A stomach ulcer, she just menstruating heavily, that she have a bladder cancer, something, right? So I think that's really important. You're right. Just don't look at the symptom, look at the cause. Because low iron is a symptom. It's not a cause. It caught me, low iron may cause insomnia, but what causes low iron? So that's what functional medicine does, it keeps going upstream. And you said something a couple of times that I just want to come back to, which is peeling the onion. so one of the principles of functional medicine from our Mentor, Sid Baker, who is this cool old guy, Yale Professor, erudite, super smart, one of the most thoughtful men in medicine, people in medicine, period. And he said, you know, we, we have the tack rules that help us sort of determine how to figure things out. One is if you're standing on attack, it takes a lot of aspirin to make you feel better. Right. Take out the tack. So so if the bacterial overgrowth is causing the restless leg syndrome, you can take a lot of these traditional medications, but it's gonna take a lot of medication to make it away. Or if you fix the bacterial overgrowth, that'll help. But then also, if you're standing on two tacks, taking one of them out doesn't make you 50% better. So she had bacterial overgrowth and she had iron and she had the positional thing. So it's like usually three or four or five things and the problem with medicine is we are so focused on the one thing, you know?

You know, there was one other piece related to her story that I think is also important to call out. Addressing all of those things, her sleep quality was still not what she wanted to be. So we had a conversation and she relayed the fact that when she was growing up, things were pretty unsettled in her home of origin. There were a lot of late night parties, a lot of noise and bedtime became a time where she didn't really feel safe and quiet and comfortable. So we also talked about referring her to a life management behavioral therapist to really talk about what it meant to be safe and regaining that sense of being okay being in bed. And I think that's that goes hidden as well that a previous history of trauma or not feeling safe can also show up with insomnia and difficulty sleeping.

Yeah. And I think that's a big thing for a lot of people. You know, there's a questionnaire you can do online called the Ace questionnaire. It's adverse childhood events, and you get a score. And if you have a high score, it means you've had a crappy childhood and you probably have some level of trauma. And different people respond differently to the trauma, of course. But, you know, PTSD is so prevalent and, and our nervous systems are so jacked up in general, so it's sort acute on chronic.

Absolutely.

We've got our acute stresses on this chronic level of PTSD, and it leads to so many physical, psychological, emotional stresses for people. And there's a lot of ways to sort of access that. You shared about how you use cognitive behavioral therapy or yoga or meditation or breath work or emotional freedom techniques. There's all kinds of techniques out there, but now people are exploring psychedelic assisted therapy, MDMA, psilocybin therapy, it's legal in Oregon now. And there's some interesting research going on, Johns Hopkins and NYU and others are really looking at how do we help people with these chronic long-term traumatic events and experiences. And I think listening to it's interesting to hear that you're dealing with something as simple as insomnia can be quite complicated. You have to look at inflammation in the body. Where's it coming from? Is it the gut? is it heavy metals? Is it hormonal changes? Is it nutrient deficiencies? Is it, maybe it's food sensitivities or allergies? Maybe it's low thyroid. There's things that we, you know, we just don't often think about. And so, what's so satisfying with functional medicine is we're able to actually dig into these things and look and see the why. You know, we say functional medicine is the medicine of why, not what, not what disease you have, which is helpful, but it's not the end of the story. we go, why do you have that disease? And that's the challenge of traditional medicine. It's like you make the diagnosis and you stop thinking, okay, you've got depression. Here's antidepressant. You've got insomnia, take the C pill. Oh, you've got rheumatoid arthritis, take the rheumatoid pill. Not why do you have insomnia or depression or rheumatoid arthritis or migraines, but why? And that's what's so powerful. So then you sort of, there's some basic sleep practices that are really good. We've covered some of this, but I think it'd be good to go over it. and I think, you know, and I think it's important to emphasize that everything matters, sleep, exercise, stress, you know, obviously your diet plays a huge role, nutrient status, and that's what we do in functional medicine, so we dig down into it. So talk about some of the other factors around sleep hygiene that we sort of haven't touched on in terms of diet and lifestyle and food and and exercise.

Sure.

I think first and foremost we have to recognize that sleep, you and I trained in an era where sleep deprivation or how little sleep you could get by on was a badge of honor.

Yeah.

We need to shift that internal dialogue that we all have that, oh, if I'm sleeping, I'm wasting my time and I'm not getting my stuff done. So first honor the importance of sleep for your overall health and well-being and even your ability to stick to your intentions around choosing healthy foods and sticking to your exercise plan. Then create a sanctuary that's really conducive for rest and relaxation. Dark, quiet, cool, ideally electronics out of the bedroom or turned off if you can. Getting rid of all of the light exposures, even your chargers, you know, that.

Had that- yeah, like those like lights, like this red green lights on different devices. I'm like, that drives me crazy.

I used to, I had a patient who told me she traveled around with black electrical tape whenever she went to a hotel and she would put it over all the little light sources.

That's a great idea. I travel with eye shades because you never know where you're going to be.

So those two, quiet, calming. And I think this idea that you go, go, go, go, go, hop in bed and turn it off like a switch, that doesn't work either. So building in a transition to rest and relaxation. If you can do an hour, that's great. And getting off the devices, not watching TV, maybe reading a book or journaling or doing something, taking a bath, stretching in the tub. I mean, there's all kinds of wonderful ways to ease into rest.

I like the hot Epsom salt bath and lavender drops because the lavender lowers cortisol. The magnesium relaxes you and the sulfur.

And the Epsom salt helps you detox. That's my favorite as well. And then you go to your cool bedroom and you do your legs up the wall yoga, restorative yoga position and.

Bingo, you've got your transition to rest and relaxation.

So powerful.

And alcohol obviously is a big factor for people.

Oh yeah, that's a tough one. That's a tough one. So the rough analogy is this. It's funny when they asked partners of people with insomnia how many of them were suggesting that they have a drink to go to sleep, it was about a third of them. So people think alcohol is going to help you sleep and it might make you fall asleep, but then as it clears out of your system, there's an arousal that can exacerbate hypoglycemia, it makes you wake up, it's going to Sleep apnea worse. If you're a woman in midlife, oh boy, it's a bladder irritant, it's a hot flash trigger. So it's really affecting sleep in a lot of ways. The rough equivalent is there's about an hour of sedation followed by an hour of arousal.

Yeah.

So if you had a glass of wine at six and you go to bed at 10, it's probably not going to impact your sleep as much as.

If you have two glasses at eight.

Or like your late dinner last night.

If you had a glass or two of wine. Yeah, yeah.

That has another impact on your sleep.

I just noticed it, actually. I had an aura ring for a while, and I was tracking my sleep, and I noticed whenever I drank, my sleep's pattern was so disrupted. Yeah. Quality of sleep, the depth of sleep, the amount of REM sleep, deep sleep, snoring, you know, all that.

It's really interesting. And then caffeine also is another big one, right? Yeah, absolutely. And we're all, we're all different in terms of our caffeine metabolism. ability. Some people are really fast metabolizers. Sorry, fast metabolizers. I happen to be one of those. But if you're a slow metabolizer, half of your cup of coffee from noon could still be in your system at nine o'clock at night. And most of the time we're not thinking back to that new cup of coffee. With food, it's really about quality, quantity and timing of food.

It's all three.

Yet another area that's impacted with with the health of the gut microbiome is sleep. And data is suggesting that people who eat a wide variety of colorful fruits and vegetables tend to have better sleep quality, whereas a highly processed standard American diet is associated with more sleep disruptions and less deep sleep. So quality matters. We already touched a little bit on the timing of eating. So eating your calories earlier in the day, also helps re-regulate those circadian rhythms. So this, the clocks in the brain and the clocks in the body that are ideally going to be working in sync with each other, they're influenced by light, by movement, and by food. So when we line all those things up during the day, it's going to help us get the rest that we need at night.

So important. This is such good information. Let's talk about what are the challenges that you see in your clinical practice around women and sleep. and what are the main reasons that you're finding and some of them aren't expected. And then let's go into how, you know, there would be traditionally approached by conventional medicine. And then we'll dive into functional medicine. Sure.

So I think the first thing is that some common sleep conditions like insomnia and restless legs, they disproportionately affect women and they can have a connection to lifestyle. Sleep apnea, interestingly enough, gets underdiagnosed for women. And there's a lot of reasons which you can dive into it, but some of it has to do with steering stereotypes on the part of clinicians of thinking about sleep apnea being a man's condition, especially if they're overweight. Right, especially putting weight on around the middle. But lean women can get sleep apnea too, and it may show up very differently.

Yeah.

There's also the idea that when we look at times of hormonal fluctuation for women, whether that's before their periods or during pregnancy or the postpartum or the menopause transition, that can also cause an uptick in disrupted sleep. So hormone balance and regulating hormones can play huge role in improving sleep quality. And finally, you know, disproportionately in the past, caregiving demands have fallen on the shoulders of women. And I think that really became manifest or evident during the COVID-19 pandemic when you saw a bigger proportion of women than men experiencing an uptick in insomnia, anxiety and depression. So they're all interconnected.

Yeah. So women take on the burden of the families. They often, especially during the perimenopausal years, become the sandwich generation between raising their and taking care of their elder parents. And you're kind of in the middle of that, a little bit towards the tail end of it, but you kind of went through that. And it puts a lot of stress on women. Also, I think there's some unusual causes of sleep that get missed by traditional medicine. And so, if you were a woman and you went to the doctor, they're like, I'm having insomnia.

What are they going to tell you?

They'll probably tell you to take a sleeping pill. Little Ambien. Little Ambien. Little Valium. Right? Or maybe they'll give you an antidepressant. right?

Right, right.

And of course, those come with side effects. They're absolutely, they impair cognition. They have all kinds of long-term effects. I mean, the benzos or things like Valium, lorazepam or Ativan, they may lead to increased cognitive problems like dementia when you get older. Ambien, you know, we heard all the stories about people wandering around doing stuff they shouldn't do in the middle of the night. It's unfortunate that there are other things too that traditional medicine misses that affect sleep. You talked about the big ones, which are the stress and the sleep apnea and the hormonal issues, but there's really more that we know about sleep disruption. And the difference with functional medicine is that we tend to take a detective approach. We don't just stop at the diagnosis. Insomnia is a symptom. It's not a disease. Right. And so we go, oh, I know it's why you can't sleep. You have insomnia. that's just the name of it, silly. That's not the cause. And so we kind of have a different approach. And over the years, you know, there are things we've really uncovered in functional medicine that play a role in sleep that are mostly ignored. So you shared a little bit about it earlier when we were chatting, but what are the kinds of other things.

That we see underlying the root causes of insomnia? So if we think about insomnia, about 80% of people who develop chronic insomnia, there's an initial inciting event, but it leads to a stressful event, for example, and there's sleep. Like a death or divorce.

Right.

Or a transition with the job. and I think the pandemic has contributed to it as well. But then what happens is there's this upregulation of the HPA axis and this chronic overproduction of cortisol is hypothalamic pituitary adrenal axis.

So it's the brain's command center that tells the body what to do.

Absolutely. So it's that connection between what our brain is registering as a threat and how that impacts our need to respond to that threat by pumping out these hormones that then in turn keep us ready to deal with a threat that may not be there anymore.

So basically, if you're in fight or flight, your job isn't to go take a nap.

It is not. Stay on alert and wait for the next thing that's gonna threaten you.

So that activated sympathetic nervous system is huge. And our culture just does that. The phone is like a dopamine, you know, pump. It's like a dopamine pump that keeps your blood pressure up. I mean, you know, when people are dying in the intensive care unit, the drug we give them to keep their heart going is dopamine.

Right?

And that's what, you know, and so, like, it's like at the very end of life, like, if you can't, if everything else, epinephrine fail, everything, you give dopamine because it's so powerful at keeping you awake and alive. And so what everything in our life is the sugar, the phones, all the new, I guess just we're constantly in a dopamine barrage.

You know, it's funny you said that because I've had people tell me, I wake up at 1:30 every night. I said, well, how do you know it's 1:30? Because I look at my phone and it says 1:30. And that, again, perpetuates the cycle because then you're thinking, oh, it's 1:30. Oh, crap. I'm awake. I should be asleep.

And then it just becomes. Yeah. You know, the best thing I ever did for my sleep issues, because I struggle with them as well, is putting my phone and my watch off, like just taking everything out and not knowing what time it is. And just letting my body do its thing.

I think that's brilliant, Mark.

When you eat more processed foods, which means simple sugars, trans fats, and a lot of simple carbs in all those ways that, you know, it's not just sugar folks, it's like, you know, fructose syrup and, I love corn syrup solids.

Right, now they changed the name of high fructose corn syrup.

Right, it sounds like a corn kind of, like corn syrup. Corn syrup, maple syrup. And so those are the things that certainly we want folks to avoid. And what does the data say? If you eat highly processed foods, you have 50 to 100% increased risk of clinical depression. If you eat high glycemic index foods, there's a great study that came out, a colleague at Columbia, looking at high glycemic index foods. So those are foods that just spike your blood sugar more. those have a significant increased risk, individuals have an increased risk of depression, the Women's Health Initiative, so big, big study of women ages 45 plus. And so there's that correlational data and it's just consistent when you look at the meta analyses of it, it's consistent that the food that we've created in the last 100 years leads to an increased risk or increased risk in that population of depression, same data for ADHD, not as much data for anxiety disorders, which is interesting, but certainly certainly feels true to me clinically. Then we move on to randomized controlled trials. And the reason this is of interest is on the molecular side, like in the mouse models, you know this. I mean, yeah, not having enough nutrients and putting lots and lots of fuel.

In any sort of mouse look like.

What does mouse look like? I mean, it's very clear what depressed mice look like because you stick them in little cages and they don't try and, and you put them into swim. It's a forced swim test. and when mice are depressed, they don't fight to get out. They just stop swimming.

They drown?

We don't let them drown, but they would drown if you didn't fish them out. Whereas non-depressed mice, they're fighting to get out. That's what a depressed mouse looks like. So, the randomized controlled trials that came out recently are exciting because we can say it makes common sense. We can say on a molecular level it makes lots and lots of sense. We can say it makes sense in the correlational data, but you and I know Mark medicine is not going to change until we have randomized clinical trials. And that's where folks like Felice Jacka and Michael Berk and the Food and Mood Centre in Australia, they're really, I would say, the leaders in this, where they've completed a number of trials. Natalie Parletta is also not part of that group, but they're part of the leaders in this. And now they're putting down numerous randomized trials and creating resources for patients with mental health concerns like depression to make sure food's part of the and their data looks quite strong. And what I love about this is when the data comes out, it's funny, one of the big leaders in psychiatry, won't mention it by name, but it's been very critical. It gets really crit, it's funny, there's a big post about how in some, you know, one of these health medicine review websites about, you know, how bad the trial was or how small it was.

It's like fighting, and everybody's always criticizing.

Each other about the study. And I was like, so when we don't have data, you say there's no data. and then when people do a really good trial, you want to pick it apart. And there's some feeling that it's almost.

Like folks have really- People don't like paradigm shifts.

Well, I mean, is this how bad it's gotten, Mark, that we're at a paradigm shift? We're suggesting that our patients, our neighbors, our families eat well for things like when they're thinking about their brain and their mood and their dementia risk and their depression. We've gotten so far down the rabbit hole of that that's a paradigm shift.

Yeah.

Like, that's crazy.

It is absolutely nuts. And you're right, there's so much data. Like, you might be aware of Hiblen's.

Work, which was from the show, the Captain Joe. Captain Joe Hiblen is like, he's the leader of the, what he calls himself the, he is the servant, he's the.

Surgeon General's, he's a soldier in the Surgeon General's Army. There you go. And he did these amazing studies looking at the rise of omega-3, I mean, the rise of omega-6 fats refined oil. and the decrease in Omega-3 fats lead to violence, homicide, suicide, and that changed behavior. And I remember once coming back from, you know, somewhere and I had a letter on my desk in my office, and it was from a prisoner who wrote me a letter, read my book Ultra Metabolism way back when and said, you know, I was a violent criminal in my life, and I realized, you know, that when I changed my diet after reading this book in prison, I don't know how he did that, that, that he realized he was a very different person. And they've done prison studies where they feed prisoners healthy diets and they reduce violent crime by 56% if you give them a multivitamin. It reduces crime by 80%. In prisons.

Yeah, you can just see the notion that we don't approach that. What is criminal activity violence? Some of it's stuff we don't understand. Some of it's certainly horrible character pathology. But some of it, when we think that this is a population that in general does not have good nourishment, In general, does not learn a lot of mental health skills. There's a way that some of what's going on there is certainly just a result of a broken system of mental health care and I would say a broken system of our culture. I've been inspired this month by the Benjamin Rush biography. And the reason is that I didn't know anything about Benjamin Rush. And Benjamin Rush is one of our youngest founding fathers. He is the second youngest signatory of the Declaration of Independence and the only I think the only physician signer. And he is our original American physician. They called him the American Hippocrates back in the day. And he's also our original psychiatrist. And he founded the first mental hospital and he helped us found this country on a very, very simple principle, which is that when we think about mental illness, we can't put people in asylums and say that they don't have spirituality or they're sinners or they're bad people. that we as physicians are going to treat them as patients and we are going to care for them. And that has just inspired me to really think about what's happening in our country and how bad our mental health has gotten and how we all know about it and we're just finally starting to talk about it. But we were founded as a place where we should have freedom to talk about this. I'll get you a copy of the Benjamin Rush book.

Yeah, it's fantastic.

Every doctor should read it.

Drew, you wrote this paper. It was published September 2018 in the Psychiatric Journal. It was really quite detailed in terms of its analysis of the types of foods and nutrients. So help us take this home. What are the things that you learned from there that are the most important nutrients we need and what are the most important foods to help us get those nutrients and just in general to help us for mental illness?

For sure. And so the simple, the paper is called Antidepressant Foods and folks can check it out. this open source article. And I did this with my colleague, Dr. Laura Lachance, and quite simply, it's arithmetic. It's bean counting. And we went through all of the literature, looking at all of the essential nutrients, vitamins and minerals, and did a literature search to say, well, which of these have significant evidence that they can help prevent depression and that they can be used to treat depression? And there are 12 that we found. And I bet you could name all 12, Mark. They're the 12 we would expect. Omega-3 fats and zinc and B12, vitamin E, magnesium, and then iron. And so then we looked at just as simple what a nutrient profiling system is, is it just tries, it's just a system for looking at what foods have the most of those nutrients per calorie. And then what a good nutrient profiling system does, and Dr. LaChance and I really wanted to create a good one because oddly there are, I think, 27 nutrient profiling systems in the world that have been treated. Some people have seen ones like the Andy or Nuval. You know how many have been about mental health? None.

None.

And so what we, a good nutrient trophic line system does looks at food categories. So we're not saying kale, kale, kale, kale. And people say, well, I don't like kale. Can't eat too much of it. You're going to hypothyroid. Exactly. Oh, no, it's toxic now. Now it's toxic work. But what we say is leafy greens. And so what we did is we scored, we looked at all of the, all of the, the top foods for these nutrients, scored them, and then created list of the top plant and animal foods. And so, first of all, they're the foods that top the list, which I just think are interesting. Oysters, clams, and mussels are in the top five on the animal side. And, the reason we did animal foods is that no nutrient-fulfilling system usually has any meat or any animals in it because it's all based on calories usually and plants always have fewer calories. But, most people eat meat or seafood, so we wanted to give folks a.

List of which had the most nutrients. And, why so what were the shellfish, the top ones?

Top ones, because think about oysters, why do they top the list? You got 10 to 15 calories per oyster. So, let's just say six oysters, 60 calories. And, for those 60 calories, you're getting 768 milligrams of long-chain omega-3 fats, you're getting 340% of your vitamin B12, you're getting, gosh, at least a third of your iron, you're getting 500% of your daily need of sink. I mean, on and on and on. You're getting in some vitamin C in oysters. Okay, let's go get some oysters. Yeah, exactly. All that for 60 calories. And that's just. And on the other side, looking at plants, like things like watercress top the list. And why just watercress? Lots of nutrients, no calories or very few calories. And so that's a great example of nutrient density, those foods. And so the food categories that people should be looking for are things like leafy greens, the rainbow vegetables. more seafood, and if you're eating meat and red meat to look more towards.

Wild red meats or grass-fed red meats. So, this is fascinating. So, the diet that prevents cancer, heart disease, dementia, depression, and fixes most chronic.

Illness is the same diet. It's really, well, it's where we got off in medicine. We kind of separated out mental health and brain health from the rest. Like you're saying, kind of like somehow the blood brain barrier was like, thou shall not pass. We didn't think that sure, all those same activities that we think about in terms of our general health and the foods we want people to eat and the things we want people to do, move their bodies, connect, be part of their community, yeah, that's key to your brain health and your mental health.

And the trouble with our food supply is that it's often depleted, even if you're eating the best foods, foods, you know, you have an organic Farm. The soil matters. It really is in the food. Yeah. And if you're growing in depleted soils, which most of our soils are, it's more like dust and dirt.

Well, they're just like chemicals in chemicals out. I mean, it's really, you know, if you, if you, if you grow, live, you know, if you, if you live by the foods you grow, you don't, you know, you don't do it the way that a lot of food is grown. And even, you know, even organic food, it's funny, as you drive through the produce spell. And, I encourage people to do this and you look out, you'll see organic stuff out there.

But.

It doesn't look like a healthy farm somehow. It's got a lot of food on it but it doesn't smell right. The people working it, they don't seem happy in a certain way.

It's because of their big monocrop organic farm.

Yeah, it's a big monoculture.

You look at a big... Until the soil is produced great soil.

There's a ton of tillage, there's a ton of diesel spent, there's a ton of compaction. And it's a real, I think it's a challenge right now. Industrial organic is what Michael Pollan calls it. It is. And in a lot of ways, you know, that's been a huge victory because we have a conversation about organic, right?

It's better than. And organic was just found to reduce cancer by 25% in people who had it.

This French study, right? I mean, so there's, you know, there's something there. so it's a step in the right direction. But when you think about where I'm from and you drive around, our soil is pretty rough in Crawford County. But boy, I would say that a lot of places, Mark, where we live, if you'd take a lot of Americans, they wouldn't know they were in America. Because it's just that whole central notion, that Central America or middle American notion of a small farm and what that looks like and how that functions. Some cows, couple pigs, not a monoculture, a nice garden for all your food and for sharing with your neighbors. That has died in a way.

And I think- Wendell Berry calls it the unsettling of America.

Yeah, and I think that maybe dead is not, that's on life support and maybe we're seeing a shift now.

It seems like it's coming back. There's more smallholder farms.

I hope so. I mean, it's definitely coming back. You see you see it on the coasts, you see it around urban centers, but there's still a lot of places that don't, you know, where it's not happening and that kind of combo of, you know, I would say agri-tourism and interest in food, but also just interest in farms. But I'm hopeful.

So, my question was going down the path of, okay, if our, even organic isn't the best that it could be if the foods have been bred in a way to create more starch, a lot of the phytochemicals have been bred out of it, the nutrients aren't there because the soil, even if it's the best organic farm. And by the way, Dan Barber and Walter Robb, a former CEO of Whole Foods, have created a seed company to actually reinvent new seeds to breed them so they have flavor and they have nutrient density and they are phytochemical rich. It's a very different idea than breeding them for yield or for pest resistance or water or drought. But, they're doing all that too, but they're doing both. So, the question is if that's true then do we need supplements and do you use nutritional supplements in your practice to treat mood disorders?

So, I think even with the food we have today, you can still get all the nutrients you need. It's actually challenging if you look at all the recommended daily allowance and I think what you would need to eat to meet that.

Yeah.

It's a little challenging. It requires some thinking about it. I always tell people, no, just eat nutrient-dense food. You'll be fine. But if you start scratching your head and adding up, it can be tough.

Yeah. This is tough. I had a patient once who was like, I don't want to take supplements. So I literally looked every food up, and I'm like, okay, selenium, it's in Brazil. So I have two Brazil nuts a day. I have 17 pumpkin seeds. I have, you know, two three cups of, you know, broccoli or whatever it is. And it was like, okay, fine. If you want to do that, go ahead.

Let's check your nutrient levels. Well, I have that problem where I, I don't like the idea of turning a meal into a math equation. And so, yeah, I myself, I mean, I'm, I'm 44 and I, I stopped taking all supplements probably about maybe 10 or 15 years ago. I guess that's not entirely true. I'll take, I'll take a little Omega-3 sometimes. And certainly in my practice for non-seafood eaters or for individuals who are kind of eating seafood every now and then, especially for individuals who don't want to try a medicine and they've never, even for individuals who do, I'll put them on a 1 to 2 gram milligram grams of fish oil. I mean, in the trials that fish oil is very in the science in the studies of depression is one of these things that has statistical significance but it's not able to show clinical significance in the meta-analyses that you get about a point reduction on on a Hamilton D depression rating scale. That said, well, you can't take fish.

Oil and be eating processed oils. Exactly. Which displaces it. You can't be eating piles of sugar.

Yeah. You know, it, you know, and you wonder a lot of the studies are designed. Well, you wonder, one do they control for that? And two, you know, we have all these SNPs now in the elongase genes in terms of how we process omega-3 fats.

So genetic variations. Yeah.

I mean, there's that. There's also if you have somebody who's a seafood eater versus not.

But.

The bottom line is I think that there are certain supplements that should be tried, especially when people are struggling with traditional antidepressant response. A lot of people I'll see, they'll have been on a medicine, it works some, like with cheerfulness or with sleep, but they're not eating well and for whatever reason, they're not gonna start eating well. So that's a really good example of somebody who a multivitamin or something with zinc or magnesium I am certainly anybody who's low. I mean, I always have that feeling like if you're low, I definitely like-- Do you test your patients? Yeah, yeah. I don't do as extreme or not even extreme, maybe as thorough, but I certainly test everybody. I mean, I think what you were saying earlier, I think any mental health clinician who misses, I mean, it is malpractice if you miss a thyroid problem, a B12 deficiency, syphilis, I mean, there's a bunch of biological causes of depression.

Yeah.

And, I think you and I see that get missed sometimes where it's like this is not even functional medicine. This is just basic medicine. It's all good medicine.

Yeah, it's good medicine. I mean, in my practice, I see the common deficiencies you're testing are vitamin D, magnesium, omega-3 fats, sometimes iron, and the B vitamins, particularly around homocysteine and methylation issues, which is this cycle of folate B12, and B6. And so, I find that giving people a multi and fish oil and vitamin D and maybe a little magnesium usually has enormous impact. Well, you think it's that even if.

You'Re going to get them to change their food right away, there's some, you know, that takes a little bit in... But even with changing the food, I.

Feel like we're so depleted, it's just... Yeah, well, it's hard.

And, it's also it's really hard when you're depressed.

Yeah.

You know, so I think what... It also gives people something to do. you do. Yeah, because you do. I mean, depression causes a lot of carbohydrate craving and a lot of, you know, we eat, we call it comfort food for a reason because we eat it when we want to be comforted. I mean, I know when I'm in.

That bad spot, man, I'm, I'm a.

Mac and cheese guy.

Yeah.

Gives you a little serotonin.

Yeah.

Don't give me, don't give me any talk about carbs. I need, like, my comfort food.

But it's, I think it's something else.

The other one that's, I think, exciting is the L-methylfolate. It's just exciting in the idea that, which is actually a prescription drug for depression. Well, it's called Deplin, but it's a B vitamin that got you served by, am I allowed to say it's a B vitamin that got you served by Big Pharma is the way I think about it, which is you have L-methylfolate, which is folate that has a methyl group added onto it. And instead of that being five bucks, it's 200 bucks.

Yeah.

But, you can get it for five bucks. You can get it. But, the idea that we're just now, because this is going to be the next frontier mark, as you know, which is we're going to start really getting into precision psychiatry. I mean, that's my most, my favorite new center at Columbia is the Center for Precision Psychiatry. There is that. There's a center for precision psychiatry. There's a center for practice innovation. There's a center for women's mental health. I mean, we, there's, there's going to be, there's a new center for media and mental health that's going online. And precision psychiatry is just that, which is, there's no, I mean, one of the things I think is interesting is there's nobody that's more critical of psychiatry than our, like, than ourselves. Yeah. Because nobody sits with the, and sees the failure. Well, nobody sits with it like, you know, until you sit with with getting an antidepressant prescription wrong and then getting it right and knowing that somebody suffered because you didn't make the right choice. When you sit with that, you want to get it right more than anybody else because that's your job. And so it's an exciting time between the new knowledge of the microbiome, the psychiatric genetics, which it's not there yet, but man, it's getting close. We're, I hope, going to see the tide turn on our mental health health epidemic. We are going to see the tight turn on our mental health epidemic mark. Yeah. We won't rest until it does deal.

No, no, we can. No, it's, it's, it's, I mean, it's the food stupid, as, you know, to paraphrase a former president.

But it's like, it's, it's, people don't get how powerful it is and how impact on how quick it works. How do you get people to see it? Because I feel like when we tell.

People, hey, eat right, feel right, they get that when we say, you know, you know what I do? I, I I think often incrementalism doesn't work because people don't see a change. So people are eating a crappy diet, I said just stop the soda, but they're eating garbage. They're not gonna feel better. So I put people usually for 10 days, you can do anything. So I put them on a basically elimination diet. I call it the 10-day detox diet for 10 days. And they can experience without me telling them the changes that happen in their body, in their brain, in their mood, their energy, their and it's quick. So you usually can get people to do anything for 10 days and then they go, oh, okay.

Well, they have to, I mean, I think any good behavioral change, it's like we can't tell you, you can't read about it, the study is not going to help, the sound bite, the science. Like you have to experience it working and as soon as you experience that, that extra energy, that better, what I find, the better sleep quality, where, you know, I'm expecting to hear like more mood, more energy, people like, you know, doc, but I'm really sleeping better.

Yeah.

And all those ways that, you know, that then makes nothing affects mood, I would say, like sleep.

I always say the smartest doctor in the room is your own body. Like, you have to see what affects you, which foods make you feel good, make you feel bad, which foods actually make you gain weight or lose weight. And, and pay attention, because smarter than any lab test or doctor is your own body's response to the food you're eating. And I think if it's not working, then you have to say, well, why is it not working and what do I do? And I think your book really outlines a different way of thinking that is really at the key to not just solving weight and obesity, Gary, it's at the key to solving most of our global issues because food and the food we're eating is 60% ultra processed food, mostly refined starchy carbohydrates. It's driving this pandemic of obesity. It's also driving the pandemic of chronic disease, heart disease, cancer, diabetes, dementia, and more. It's literally killing 11 million people around the world. And we think COVID is bad, but there's far more people that die every day from eating the wrong food than from COVID or any other disease combined. And it's all related to this underlying mechanism of high levels of insulin sustained over a lifetime that drives aging. It's really the fundamental mechanism of aging and reversing it is the fundamental strategy to longevity, well-being, weight loss to all the solving of all of our chronic problems and all their downstream consequences of the economic impact, of climate change, of social injustice, so many things are connected to this. And I think, you know, if you hit on this key idea that we need to get rid of these starchy, refined calories that are causing high insulin, we literally pull the thread that's connecting everything that will literally unravel our current metabolic, economic, and environmental mental catastrophe. Yeah.

And that's, I mean, again, it's, it's, I mean, there are huge issues to doing this because, again, what does the food industry produce, which are exactly the foods that we're going after and saying people can't, I had to go to the, I dropped my son off school bus, thank God, this morning at seven in the morning, and I stopped off at Safeway to, to pick up some butter. And I'm walking down this aisle and I want to call it the diabetes aisle. Right. It starts with this, it's not the sports drink, it starts with the the high caffeine, high sugar drinks on the left, and it's got the chips going on the right and the chips on the left. And then I move down to the sodas, and then I go to the sports drinks, and the chips go to.

The, you know, from potato chips to the. I love it. I mean, you could have a cancer aisle, a heart disease aisle, a dementia aisle, a diabetes aisle.

That would be great.

Seriously, it was like, I love that. And that's the thing. The world doesn't have to go keto. One of the things that runs in that the keto the low-carb movement has run into lately is the idea that livestock is bad for the environment. Livestock, the significant producer of greenhouse gases, and I don't know enough about this science to comment. So I'm willing to assume that it's, for sake of argument, that this is true and it's a problem and it's got to be dealt with. But the underlying assumption is that if we all go plant-based, we'll all be healthier. the phrase used by this E. Lance at commission that was headed by Walter Willett at Harvard and has made such inroads into pushing this plant-based movement for everyone is it's a win-win situation. We know that if we eat plant-based diet, we will be healthier. We know if we eat a plant-based diet, the climate, the world will be healthier. And again, the point is we don't know.

That.

You know, the lean people, the world, they can eat a plant-based diet. They're fine. All of us can improve our diet and be healthier by getting rid of, you know, the refined sugar and the stuff in the diabetes aisle, the supermarket. All of us will be healthier, but some of us have to go further. We just have to, we have to cut out carbs and then plant-based foods come with carbs attached. That's the name with the exception of olives and avocados.

That'S, you know, and if anybody wants to dig into the whole meat, no meat, you know, climate change, health, so for issues, I, we've done a lot of podcasts on this, but the short answer is it's not the cow, it's the how. And if you grow factory farmed animals, yes, they're an abomination. They should be outlawed and they're devastating human health, environmental health, animal welfare, and destroying our soils and polluting our waters. and poisoning us with chemicals. So that there's no doubt about that or disagreement. However, there's a movement of regenerative agriculture which has the hypothesis that you can actually raise animals in an integrated ecosystem of a farm that builds soil, that conserves water, that eliminates the need for chemicals, that produces healthier food, more food, more profitable for the farmers, and actually maybe healthy. In fact, some guys like Fred Provenza, I don't know if you've heard this research, Gary, but Fred Provenza is a rangeland scientist from University of Utah or Utah State who's now working with folks at Duke and finding that animals that are allowed to forage on a wide variety of plant foods actually uptake all these phytochemicals and have much different nutrient profiles, much different metabolic profiles when you eat them. The one favorite study I always quote is the kangaroo study in Australia because you can get kangaroo meat there and they fed them gram per gram protein, the same amount of feedlot beef or kangaroo meat. And the feedlot group had increased inflammatory biomarkers and the kangaroo eaters actually got better. They were healthier. They had lower inflammation as a result. And this is taking a chunk of meat exactly the same amount and feeding them based on what they ate. So I think this is a different topic. And I don't think a ketogenic diet is a high meat diet either. It's not necessarily early a high meat diet.

It doesn't have to be.

Yeah.

Yeah. And I think some people can tolerate some level of whole grains or beans. Some people can't. And often the argument is, well, when I switched to vegan, I lost weight, I got healthy. And I think if you're eating the standard American diet, the absolute answer is yes. You will be much better off if you switch to a lot of plants and whole foods and get off all the crap. And it may not be the vegan diet, it may be just getting getting off the crap. And then the question is long term what happens to these people? And if you start looking at a lot of these situations, you see this increasing creeping insulin. Even if you're eating whole grains and beans, some people are just that carbohydrate intolerant. So I think there's a continuum we have to understand. And I think that's what you're saying with your book. It's not just one size fits all. Everybody in the world should be keto because I don't think that's true. You're talking about this spectrum of eating styles depending on your and your response to the food you're eating.

Right, and that's it. So we're cutting carbs and we're adding fat at some level. And if you prefer animal protein and animal fat, you can make it work. My favorite part of the book, so the end of the book, I have lessons that I've learned from the physicians I've interviewed. And I think, you know, I sort of encapsulated the key lessons in how to think about progressing. to a low-carb, high-fat ketogenic diet. And so Carrie Dooling, I'm sure you know Carrie, she's Cleveland and formerly Cleveland Clinic. So Carrie's a spine surgeon, formerly at the Cleveland Clinic, now private practice in Ohio. And she comes from a family history of obesity. She had a weight problem.

She said she was 300 pounds. She was 300 pounds.

Yeah. has type 1 diabetes, and she can't tolerate animal products. She just can't do it. Her body can't do it. So she has moved to eating a vegan ketogenic diet. And she said to me, and this is the quote that I lead off the section with, it's not a religion. It's just about how I feel.

Right.

And that's a thing we're all doing. It's about how we feel. And that's, again, it's part of learning, the learning process and learning how to do these experiments. I mean, you and I probably do Naturally, it's like some issue comes up in your life. My wife always gets, she's been living with this for far too long, but I'll make some comment about how I feel and I go, I can't understand it. And she says, he always said that. I go, well, what I can't understand is why I feel like this today.

Yeah.

So I'm trying to understand it in terms of what I ate yesterday or the day before that, because I think it's related. And can I change my diet in such a way that I don't feel like I do today? in the future. And what do I have to do, you know, and over the course of among the vices we talked about before we got started, all the vices we've given up, part of the reason we've given up these vices is because they don't make us feel good. You know, I no longer drink alcohol, not because I have any moral ethical issues with alcohol, but quite the contrary, it's just the next day I tend to feel like crying all day long.

Oh, I'll give you a hug. Don't worry. bury.

Yeah, there we go. So, you know, a hangover you could fix with aspirin. Depression, you can't.

Yeah.

So eventually, as slowly over the years, it's become. No, but because I'm paying attention to how I feel the next day. And in my case, it's so it's, it doesn't need a lot of attention to be paid to notice it. But these are the kind of things you can do with all issues of your diet.

Well, you're right.

If I start adding beans back to my diet and I gain 10 pounds. And I find that I'm craving beans. Black beans doesn't matter. Healthy beans, just like they might eat in the blue zone. But when I add it back to my diet, I gain weight and I don't like the weight and I don't like the fact that I'm now craving the beans. Maybe it's better that I don't eat them.

Yeah.

They're bad for me. They might be fine for David Katz or Mark Bittman. That's right.

But they're not fine for me. That's right. right.

That's right.

We're all trying. Yeah.

Yeah. And I think we have this amazing opportunity now to start to teach people about personalized nutrition and food is medicine. I think one of the things that people don't understand, and you sort of highlighted this with what you said, I think it's important for people to really get this. Most people don't connect what they eat with how they feel. And food is the single the single biggest modifier of your biology every day. There is nothing that influences your biology in terms of hormones, the microbiome, your immune system, your detoxification system, your brain chemistry, your metabolism. I mean, there's nothing besides food that has that impact. And when you, when you, the underlying subtext of what you're saying, and then we talked about in functional medicine, is that food isn't just calories, it's information, it's instructions that regulate your biology with every bite and can turn on or off hormones, genes, and immune function literally in minutes. And, I think most people, if they started to pay attention like you did, when I drink alcohol, I cry the next day, or when I eat a bagel, I don't feel good, or I take a nap. I mean, I went to some friends over on Valley. And I went to visit some friends on the island who were pretty much vegetarian vegan, and they had lunch and I'll eat anything. I'm not religious, and I normally don't eat a lot of beans or grains. I don't have a thing against them. I just feel better without them. And she had a big bowl of grains and beans for lunch. And then I literally that afternoon we went down to the ocean. There was this place where the river comes to the ocean. There's really rocky beach. and I literally was in a food coma. I laid down on my stomach. It was like on a bed of nails, like on this really uncomfortable, like rocky thing with like rocks sticking everywhere in my body. And I literally fell asleep with these rocks sticking in me because I was in this coma from what I had for lunch. Now, that's not true for everybody, but for me, that was true.

And I think it just, I just, well, this is part of my, part of my conversion experience, right? As I used to say, back, you know, prior to 2000, I didn't take naps. Naps took me. So I'm a science journalist. I would be interviewing some Nobel Prize winner over the phone at two in the afternoon at lunch, and I would have to get off the phone before I fell asleep. I would have to think up some excuse. I have. I used to have notebooks back in the days when we would take notes on the notebooks, and then, like, I'd go back to look at them and my, my. my pen would just fall off the page because I'd have fallen asleep while I was taking notes. Yeah, I gave up carbs that stopped. Actually, one of the things that triggered this is I was doing the first piece I ever did on dietary fat for science. I was interviewing a guy at Yale who's an authority on carbohydrate metabolism. And I said to him, why is it I fall asleep every afternoon after lunch, you know, religiously?

And. And.

He said, but we don't know. It's like, how could you not know that? I mean, it's such a profound phenomena. His whole cultures that have siestas in the afternoons because they have carb-rich lunches and then they go to sleep. Anyway, and then you give up the carbs, it just stops happening. I often wondered, you know, we get a message nowadays, we should all sleep eight hours a night. It's vitally important. we'll control our weight better if we do it, we'll control our blood sugar better if we do it. But one of the things that happened when I cut out sugar, starches, and grains, I stopped needing to sleep as much. I can get by on five, six hours of sleep and I constantly have this struggle that I should be sleeping more. And then if I sleep more, I'm actually less alert. So it's sort of, again, individual variation and being aware of your body, is we don't need a clinical trial. And this is the point I make in the book. We're taught, well, you don't know if these, and again, people, we don't have enough clinical trials to know if this is good for you. Well, you don't have, we do have the 100 plus completed clinical trials of ketogenic diets, and it's undeniably beneficial over the course of at least a couple years. And then it's hard to imagine that somehow it all goes bad the longer you do. but people who don't like this message can imagine anything. So I'm not gonna. But you don't need a clinical trial to tell you if this will change your ability to control your weight and blood sugar.

Yeah, particularly the weight.

It's just. Just do it.

Yeah.

But do it right.

Well, that's the thing. I mean, I think how. I'd love you to sort of share some of the clinical trials that have been recently done around diabetes, because I think. the data is so striking that it's really worth talking about because we are now facing a pandemic of obesity and diabetes. In fact, one out of two Americans is pre-diabetic or type 2 diabetic. It's the number one driver of our economic costs within Medicare, which is, you know, if Medicare was a company, it would be the biggest corporation in the world with a budget of over $1.3 trillion a year. And it's a good third of that and probably more if you include pre-diabetes. So talk about what we've learned from these rigorous clinical trials using ketogenic diets on type 2 diabetics who are actually on insulin, on medications, severely overweight, and how it compares to sort of other trials and treatments for diabetes.

Well, the story with diabetes has always been the same. Is it the carbs or is it the calories? Okay, this is the recurring theme going back to 1920s. 2013. So today you do a clinical trial. So the conventional wisdom, the ADA tells their doctors just tell the patients to keep eating however many carbohydrates they're eating. We don't want to disturb them. We don't want to give them any advice they can't follow and then we can cover that with insulin. And the insulins we have are so fancy and so exotic these days, so high tech that this won't be a problem, except then when they look at population-wide insulin control, you find out that it's actually worse than it's ever been. So both type 1 and type 2 diabetics are doing bad jobs at controlling their insulin, controlling their blood sugar. So now you put them on a ketogenic diet, and the best study we have is Virta, and it's criticized because it's not a randomized controlled trial, but you don't actually need a randomized controlled trial for chronic degenerative condition that never gets better because people serve as their own controls. So they have smartphones and telemedicine and they prescribe well-formulated nutritional ketosis ketogenic diets. And over the course of five years, they have, I think their five-year data is now available and I've extract form. They have tremendous maintenance of the diet, and virtually all of the people are on insulin, get off insulin, and most of the people get off their oral medications and they lose weight even when they're not trying to lose weight. This isn't prescribed as a weight loss diet, and they get healthier and they sustain it because they're sustaining their health. On the flip side, you've got a trial in England that got a lot of attention where you put people on, I think it was 600 calorie a day, semi-starvation diets. They're all, it's even more than semi-starvation. That also will lower insulin levels and will put the diabetes into remission. But now you have a problem with what do you do when the people go back to eating the way they used to?

Yeah, because you can't eat 600 calories your whole life.

You can't stay on 600 calories. You're all, so, and one of my with the nutrition, diabetes, and obesity research community to begin with is they just keep reiterating the same thing. Like a sign that a science is pathological is they keep saying the same thing over and over again, doing the same experiments over and over again, and they never make progress. And so what we know from these trials is you advocate abstinence from sugars, grains, and starches and, you know, beans, and people get healthy, they'll get off the, the type 2 diabetes are going to remission. And they knew that pre-insulin as you said, it did pre-insulin and was known as the animal diet and type 2 diabetics, we didn't use that terminology back then, but the Physicians in the 19th century knew that, that older people got their diabetes older and heavier had a.

More.

Less acute chronic form of the disease and they could put it into remission and basically live perfectly healthy lives so long as they didn't eat carbohydrates. Don't eat the foods that you can't tolerate. How difficult is that?

I mean, what struck me was the Virta Trials, which essentially is an online digital disruptive healthcare delivery system using coaches and high touch points with pretty advanced diabetics and our friend Sarah Halberg and others, and this is some of the data you're talking about, were able to see within a year or two years a 60% reversal, not just improvement, but reversal of diabetes with normalization of glucose, lipids, A1C without medication, a 90 plus percent reduction in insulin, 100% elimination of some of the key diabetes medications and a 12% weight loss, which may not sound like a lot to people, but if we see a 5% weight loss in a weight loss trial, that's dramatic. The results seem to be sustained at two and even longer now years. And they did a follow-up study looking at all the biomarkers around heart disease, which was fascinating. So the concern that people have is, oh my God, if I eat fat, what about my cholesterol? Cholesterol is causing heart disease, it's going to get bad. Can you talk about how you would address these concerns about eating a high fat diet and lipids and heart disease and what this trial showed that was the impact on lipid profiles.

Well, and this is, you know, the issue with LDL cholesterol has always been the problem with these low carb high fat diets. Even when I was doing my first piece for science, one of the researchers I interviewed was a guy named Pete Ahrens at the Rockefeller Institute in New York and Ahrens was the probably the best scientist in the field in the 1950s, the 1960s. And he told me the story of a, a young woman, a Broadway actress who came to see him. She had gone on Atkins to keep her weight under control. And, you know, her cholesterol went up to 600.

Ah, right.

You have to get her off the.

Diet because the diet's going to kill her. That's the idea. So you got a lot of people, we eat this high fat, high saturated fat diet. They're, the phrase now thrown around the communities that they're hyper responders and their LDL cholesterol goes up or their LDL particle number goes Yeah. The good news is it used to be that would happen. The doctor would, you know, say you're going to kill yourself. You can't eat this way anymore. Now an improvement, they'll say, well, look, since you've dropped 50 pounds and your A1C is coming down from like 10 to six and we've gotten you off your medications, maybe you should continue to eat this way. But let's monitor the cholesterol or let's put you on some, you know, low dose statin to try and control the cholesterol and everyone feels differently about statins. bad. And so I'm not gonna. I don't know what to think because I have friends I respect on all sides of this. For the most part, the virtus study showed us. And these are in people who really are metabolically disturbed and that they have type 2 diabetes. They looked at 26 risk factors for heart disease. 26 of them, 22 of them improved on the nutritional process. 22 got three stayed the same, and LDL cholesterol occasionally got worse. And of course, you know, sometimes it.

Can get better, too.

Sometimes it can get better. And the cosmic joke, right, is that LDL is the only thing that conventional medical establishment, cardiology community has paid attention to. But then when they look at overall risk factor, you could do an overall risk factor assessment from these numbers, and it clearly got better. And that's with these people getting off drugs. so the comparison are diabetics who are getting standard of care diabetic therapy at Indiana. And so, you know, I talk about in the book, I just talk about my own experience. My LDL was fine for about a decade on this diet. And then the last time it was measured, it, well, it got higher the one time it got measured, not just LDL cholesterol, but LDL particle number, which is a much better predictor of still not as good as HDL over triglycerides, which always improves on this diet or total cholesterol over HDL, which always improves when you eat this way. Yeah, but they're almost always nothing's Universal. Well, it's powerful.

It's powerful.

When you.

And again, it's really like I. I just recall a patient who I had who was a woman struggling with weight loss for years. her total cholesterol was over 300, her triglycerides were well over 300, her HDL was terrible, like 30 something, her blood sugar was higher, insulin was high, she had small particle, I mean she had the worst metabolic profile. And I said, listen, eat coconut oil and butter and get off of all the starch and let's see what happens. Just, I don't know, let's try it six weeks, two months, there's no harm in a short-term trial. And then I, you know, then I met measure, right? Trust but verify, right? As Reagan said. And then I checked her lab tests. Her cholesterol dropped 100 points. Her LDL dropped like almost that. Her HDL went up 25 points. Her triglycerides dropped 200 points. I was like, and she lost 20 pounds. Another guy was a skinny little biker who wanted to try keto for performance and athleticism. And, you know, he was in his 50s, and he just, you know, was biking four hours a day and just doing all this. And his numbers just went through the roof.

So it just, that's the LDL though, I assume.

No, not the whole, his particle number, his small particles. I mean, everything went haywire. And I noticed the same thing for me. I'm one of those lean mass hyper responders. I probably shouldn't announce that because people will send me all kinds of hate mail or hate messages on social media. But, you know, if I, if I, you know, don't eat a little bit of carbohydrate like a sweet potato or winter squash. I will tend to lose too much weight, but also my lipids will go crazy if I'm eating just too much saturated fat. So, I can modify it. I can eat more avocados and more olive oil and more nuts and seeds and other different fats.

You know, even then the assumption is always that what you're doing is going to make a significant difference in your long-term health. and this is the issue that, you know, again, I discuss in the book, we've been taught to, whenever you're doing preventive medicine, right, you're, you're, you're, it's hypothesis based medicine. If I get you to do this or I add the, this little bit of sweet potato winter squash back and I get my LDL down, I'm going to minimize my risk of heart disease and I'm going to live longer. And this is a probabilistic assessment. Doesn't mean you're not going to have a heart attack, you're just going to lower the chance of having a heart attack. And the flip side is, if I get you to eat the coconut oil and the butter and get rid of the carbs, I can watch you get healthier. So not only will your lipid profiles get better, but I could literally watch you get healthier. I could watch your weight come down and your sleep disturbances improve and your mood will improve and your energy will improve. And, you know, you'll walk in the office three months from now, and this is why people like us can sound a little quackish and you'll be a different person.

Yeah, absolutely. Your book is such a brilliant analysis of the science, but it's also got a lot of practical aspects called the Plan, where you go through a number of principles of how to think about doing this, how to work with a doctor and how to get started. So, it's not just an abstract theoretical historical analysis. It's actually very practical. And, I really encourage people to get a copy of the Case for Keto: Rethinking Weight and the science and practice of low carb, high fat eating. Because if you are one of those people who are metabolically unhealthy, the 88% of us, it's now more important than ever to really get this right and get your insulin down because COVID-19 disproportionately affects those who have poor metabolic health, including obesity, overweight, pre-diabetes, diabetes, and chronic disease, which is all connected to insulin. And Gary, what's exciting is your book focuses on weight, but keto is being researched for cancer, for improving, for example, responses to chemo and radiation, for obviously reversing diabetes, for heart disease, for dementia. It's now becoming a standard recommendation. I know this was at Stanford and they were like, yeah, I've got Alzheimer's and they told me to be on.

A keto diet or epilepsy or other conditions. This is what's so amazing because the conflict we're up against, we've got US News and World Report every year they give their diet diet ratings. And every year they tell us the Mediterranean diet's the healthiest, and then the dash diet, which is supposed to lower your blood pressure. And they'll look at 35-40 diets, and the worst are always low-carb, high-fat ketogenic diets. Always the least healthy around. And yet, if you go to clinicaltrials.gov, which is the website that the government has to register clinical trials, and just stick in ketogenic as the keyword.

Yeah.

You'll pull up, as of last week, about 250 different trials. A hundred of them have been completed. The others are still in the works. And it's basically, you name a medical condition, somebody is testing a ketogenic diet somewhere in the world to see if that will make it better.

Yeah. I use it for heart failure patients. And the results are amazing because it improves mitochondrial function. And, and we didn't really talk about it, but, you know, your body has two, it's like ACDC, it's like an electric hybrid Prius, right? It can run on carbs or run on fat or run on both. But if you actually switch to just running on fat, it seems to burn cleaner, it seems to have all these downstream metabolic effects. And something that we really didn't talk about was aging and insulin aging. And when you look at the, whether it's a ketogenic diet or a high fat low carb diet or whether it's a diet that's intermittent fasting, or time-restricted eating or any of these kind of approaches, they all do the same thing. They all reduce inflammation, they reduce belly fat, they increase muscle mass, they increase bone density, they improve cognitive function, they improve stem cell production. I mean, they have all these downstream effects that are promoting aging and healthy aging. So this is really the key to everything.

Yeah, or another way to put it is they're removing the thing that increase, that accelerates aging. Because remember, even diabetes is a kind of accelerated aging. All these symptoms of aging are basically driven by glucose oxidation. The cells you raise blood sugar, your body kicks in into overdrive, the attempt to like burn it off. And you do that, you generate reactive oxygen species, you generate, I mean, it's just all the major manifestations of health of aging are accelerated by the same foods we're telling people not to eat on these diets.

Nitric oxide prevents inflammation of the arterial wall. That will prevent certain blood cells from coming in to deposit cholesterol plaques, develop atherosclerosis. So, and that is why our arteries make nitric oxide. We make nitric oxide in order to protect us against hypertension. and protect our arteries against inflammation and prevent unwanted blood clotting, nitric oxide, very potent that way. So if you prevent unwanted blood clotting, you can prevent a stroke. If you prevent inflammation of the arteries, that certainly will go a long way to preventing the development of coronary artery disease, right, which causes myocardial infection or heart attack. Yeah, absolutely.

And I think what's striking is, you know, statins have, we call pleiotropic effects. They have multiple effects. They lower cholesterol, they increase nitric oxide, they decrease inflammation through other mechanisms, and lower C-reactive protein. That may be the real way they work. But what's really fascinating to me is, is this link between nitric oxide and inflammation. Because anybody who's listened to my podcast or understands my work around the, the role of food as medicine is is that inflammation is the driver of almost all the major chronic diseases we see today. Heart disease, cancer, diabetes, Alzheimer's, autoimmune diseases, all these diseases are driven by inflammation. So, it seems like nitric oxide could play a big role in modulating these.

Diseases or influencing diseases. That's exactly correct. Nitric oxide has pretty powerful anti-inflammatory effects. And, the reason is that nitric oxide nitric oxide is a free radical, believe it or not. It is a free radical, but it's a fairly safe free radical. And what free radicals like to do is to interact and find other free radicals so that they can react covalently and take them out. And that's what nitric oxide does. It is an anti-inflammatory because it goes after other radicals, whether it's oxygen radicals like superoxide, or fatty acid radicals, for example, that hang around in membranes.

And by rancid fat in your arteries, right?

Exactly. And by neutralizing those free radicals, then by definition, nitric oxide is anti-inflammatory. Actually, we can say that NO is antioxidant. And many cases, believe me, after all the years of research I've been involved with, antioxidant and anti-inflammatory story are very similar phrases. It's almost the same thing.

Absolutely. It's incredible. So, let's talk about some of the mechanisms because, you know, what was going on with Viagra was fascinating because it was designed to be a blood pressure drug and it didn't really work that great, but it had this side effect that people complained about, or maybe they were celebrating, I don't know. And that's what happened. And then this Blockbuster category of drugs, which are these drugs that actually increase nitric oxide. And tell us about this sort of relationship between blood vessel health, blood pressure, blood organ flow, because really where blood goes is where health goes, right?

Of course. Of course. Well, I can tell you a little bit more about Viagra and the development if you like. I mean, as you said, so When Viagra was first being developed, it was actually tested to see if it could lower the blood pressure in humans. And they found that if they raised the concentration high enough, it was still very safe and could lower the blood pressure. But unfortunately, or fortunately, depending upon how you look at it, a side effect was produced. And that is all the male volunteers who were in this developed an erection whether they wanted to or not. And appropriately, this was noticed by the nurses who were running the study.

I don't want to hear about that.

I was on the scientific advisory board for Pfizer for a long time before, a while back.

Back.

And so what happened was that Pfizer did not want to deal with this. They had no concept then that this could be a useful drug to treat erectile dysfunction. But because of the side effect, they said, listen, we're not going to mess with this. So they stopped developing the drug. They put the drug on the shelf. Then I published my work in 1992 in the New England Journal of Medicine that nitric oxide, because we had shown for the first time at that time, the neurotransmitter released from the nerves that causes penile erection was not known. That's why no drugs could be developed to treat ED. You didn't know what the neurotransmitter was. How can you develop a drug? So we discovered that the neurotransmitter was our good friend nitric oxide, which makes good sense, right? It's vasodilator. And so they read my work, and they realized, oh my goodness, our drug works by increasing nitric oxide. So they filed a new drug application, they took the drug off the shelf, they developed it, the FDA fast tracked it, and in six years it was marketed as sildenafil, or the trade name Viagra. And what's interesting is that Pfizer invited me six months later, because it was just after the Nobel Prize, invited me to their pharmaceutical company in England where the work was done and showed me the laboratory where this was done. And you could see all my reprints pasted on a wall and in the laboratory notebooks, it was really great to see this. And from that point on, I'm not sure if you're aware of this, but from that point on, I was given the acronym of the father of Viagra.

Yeah.

Which is an acronym I don't mind at all, but my mother was alive at the time and she used to get very upset whenever- Very embarrassed. And she would tell me, why don't you tell them to stop that already?

Well, I imagine they probably didn't have trouble getting volunteers for that study. So that's incredible. So you call it a neurotransmitter as well as an antioxidant, anti-inflammatory. So it has all these different effects. right?

It's really amazing. When it's released from the nerves, it functions as a neurotransmitter in the erectile tissue of men and women, by the way, but it's also a neurotransmitter in the brain, where it's released in certain areas of the brain that promote memory, learning and information recall. Many scientists believe that dementia, especially Alzheimer's disease, may be attributed to a deficiency of nitric oxide neurotransmitter in the brain. And what I tell all my young scientists when I was teaching, I would tell my graduate students that, remember this, the brain has 10 times more nitric oxide than does any other organ in the body, and we don't know why. So go after that problem. I mean, that's a good problem to go after.

That's amazing. So let's just kind of review, and then I want to get into the question everybody everybody's thinking about, which is how do I get more of this stuff in my system?

So.

So let's see. It dilates your blood vessels and lowers your blood pressure and improves blood flow in your organs. It prevents clotting, you mentioned, and prevents blockage in the arteries. It's an anti-inflammatory so it helps keep the healthy arteries. It promotes learning memory and information recall. It helps regulate erectile function in men and rousing women and other things, including affecting protecting your skin from the Sun. and skin cancer. And you also mentioned in your work that it promotes digestion by helping the movement of digestive foods and regulating digestive enzymes and hormones. So it's an incredible molecule that is doing all these things that no one even knew about until you came on the planet.

Isn't that something? I mean, it took somebody to discover that nitric oxide, which had long been known to be a pollutant in the Earth's atmosphere, atmosphere. It took someone to show that our bodies could actually produce it. And once that was identified, everyone jumped on the bandwagon, and so many different people discovered so many different effects of NAD. But what's miraculous is that one single molecule can exist ubiquitously throughout the body and produce all of these effects. And, you know, we've mentioned only half of them. So, yeah, to me, as a scientist, I find that remarkable. But if you have a chemistry background, which I do, and you look at NO, it's perfectly suited for its job. Why? Why have 25 different chemical molecules in the body each doing something when you can have one nitric oxide? But it has to be regulated because, you know, you don't want to increase blood flow to your legs at the same time that you're creating a penile erection. You know, I mean, in one place it works, in other places it doesn't. So it's highly regulated so that it's not working everywhere at the same time.

It's incredible. So how do you know if you're low in nitric oxide as a person walking around the street?

Well, let me tell you something, sir. If I did not retire and I still had my laboratory, I would invite you to my laboratory to try to work out that problem because no, it's such a difficult problem. It's impossible to measure nitric oxide real time because it's an unstable gas. It has a half-life of about two or three seconds.

That's it.

As soon as it's made in the body, it works within a second or two and then it's gone. And that's what you want from a signaling molecule. You don't want the molecule to hang around forever. whatever, you just want it to hang around just for a little bit. But luckily we're continuously making nitric oxide. If we have healthy arteries, they are continuously making nitric oxide. Unfortunately, we can't measure it. We can measure byproducts. In other words, we can measure nitrite NO2 minus and nitrate NO3 minus because thio is oxidized, that's how it's broken up, it's oxidized to nitrite and nitrate. So you can measure that. It's good in laboratory animals, but not in humans.

Not great for going to your doctor and having it checked out.

Well, because nitrites and nitrates are present in all the foods we eat. If you like beets and spinach and brussels sprouts and you like to eat bacon and so on, all those foods are loaded with nitrite nitrate. So you'll have a very, very high background level. And although it's been attempted, you cannot measure changes in nitric oxide production that way.

But symptomatically, there's ways people can know, right? I mean, sure.

Oh, absolutely.

Well, so what would be the kind of symptoms people might have?

What we have tied, we meaning the scientific community, not I. But anyone with hypertension that's been examined clinically using invasive methods to measure NO, it's been shown that NO production by the arterial endothelial cells is diminished. Okay? People who are obese have absolutely low levels of nitric oxide produced by endothelial cells. people who lead a sedentary lifestyle the same. People have been subjected to physical activity, just even minor physical activity, walking fast, riding a stationary bike, and there's ways to measure indirectly nitric oxide production. I can tell you about that in a second. And that NO goes up. And the way you measure NO indirectly is you put something like a blood pressure cuff on your and it's made tight. And then the blood flow in your arm is stopped just for a few seconds. And then the tourniquet is released. That will cause blood flow to go through the finger. And there's something called blood flow dependent vasodilation. In other words, when you release that cuff and you allow the blood to flow through, the hand, the blood flow, because it creates a force against the arteries. That's called shear stress. That stimulates the arteries to make enormous amounts of nitric oxide. That's good, because you want to dilate all the blood vessels there that have just been constricted. So NO is released to dilate the blood vessels and allow blood flow. That's what happens during exercise in all of your skeletal muscle. By the the way. But you can measure that flow dependent vasodilation, and that's a pretty darn good measure of your capacity to make nitric oxide. So if you run that test, which is expensive, you usually have to go to a clinic, whatever, for now, anyway, you can determine how much NO you can make. And what we know is that people who lead an unhealthy lifestyle, if I just leave it at that, make substantially less nitric oxide that's been borne out every time. That's amazing.

Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter, and in it I share my from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S. and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode. So everybody's listening and probably wondering how do I boost my nitric oxide levels? And you talk in your work about a lot of things, nutraceuticals, diet, protein, exercise, breathing, the microbiome, all these things. I want to get into all this. So let's start with the conversation about diet and nutraceuticals or supplements and how they can affect your nitric oxide production.

Okay, so I'll make this as brief as I can. It's clear from the work so many people have done that a healthy balanced diet is the best way to maintain your adequate production and action of nitric oxide. And what do I mean by healthy diet?

Yeah.

But, you know, and you know all about that. My goodness, that's been your career and your pharmacy and everything else. I mean, we have to eat healthy. What does healthy mean? Stay away from saturated fats. Look, I like a hamburger once in a while, once every two months. I have a juicy, fatty hamburger. It's not going to kill me. It tastes good. I get it out of my system. But then I eat fish. Fish is my healthy protein. There are plant proteins, of course, that are healthy, but I stay away from meats most of the time, even chicken. I mean, chicken's okay, but as soon as you start eating the skin of the chicken, forget it. That's loaded with saturated fat. So I like eating fish for my healthy protein, and you do have to have you know, healthy protein. But like many diets out there, which I don't want to talk about unless you do, I do not lower my carbs. I'm a firm believer that you really, that 30% of your diet, you know, should be carbs, but healthy carbs, not potato chips, not packaged food.

What do you mean by healthy carbs?

Oh, I mean the most colorful fruits and vegetables you can eat.

Yes.

The most powerful antioxidants. remember, antioxidants can increase nitric oxide. Why? Because the antioxidants destroy the free radicals that go after nitric oxide to destroy the nitric oxide. So antioxidants will boost nitric oxide simply by stabilizing the molecule. We've done a lot of work on that, but most of it's been done by everybody else. But the darker the fruit, for example, the better the pomegranate juice. Everybody knows pomegranate. If you ever get it on a white shirt, you can never get the stain off. That is a dark fruit. Same thing with blueberries, strawberries, any kind of berry. Let's go to the plant family. Spinach. Popeye knew all about nitric oxide before anybody else did. I mean, spinach is very healthy. Kale, my goodness, kale, brussels sprouts, the dark green green, you know, leafy vegetables. My wife and I have that every single day. I, you know, I just think that those carbs are so important because they're loaded with antioxidants.

Yeah.

Fats are also important. You need fats for energy, but unsaturated fat. I'm lucky I'm Italian because my parents never used anything but olive oil.

Olive oil. What I use.

Olive oil. I use olive oil for. I put it in everything except. coffee, okay? And we use olive oil. And if you want to eat, you know, unsaturated fats from food, avocado is one of many good examples. You just have to watch the calories. You know, whenever you're consuming any kind of fat, whether it's saturated or unsaturated, if your goal is to watch your weight, then, you know, just practice a little caloric restriction and you'll be fine.

Well, I think it's right there. I think you're eating lots of good fish and fruits and vegetables, and that's definitely a healthy diet. And you're cutting out the starch and sugars and the junk.

100 agree.

I, I think, you know, there is, there is some question about, you know, the variations in the population, how some people can tolerate saturated fat better than others. And, you know, Dr. Ronald Krause actually should have him on the podcast is one of the leading lipidologists. You might have heard of him or know him.

Yeah.

And, you know, he's, he's challenged some of the Orthodoxy about saturated fat. So I think there's, there's still a debate about this, but I, I think you're right. I think there aren't, like, for example, for for me, I'm someone who genetically, I don't think I can tolerate a lot of saturated fat, whereas I've seen other patients do really well. So it's really the N of one or personalized medicine on that. 100% agree. So let's talk about the supplements you develop. I'm really curious about what can we do because the other thing you talk about is protein and we haven't really discussed it but the precursor or the building block of nitric oxide is an amino acid called arginine. arginine, which is found in a lot of foods, including almonds, is very high in arginine. So. So tell me about what we can do in terms of the protein we should be eating, like the, the nitric oxide that, that this needed, the arginine that's needed to get nitric oxide produced. What are the best sources of that? And then what are the supplements that you've been using to actually help boost nitric oxide levels?

Sure. I, I think that after we discovered that our arteries can produce nitric oxide, another group actually discovered the enzyme, a group from Johns Hopkins discovered the enzyme that makes nitric oxide, and that you referred to as nitric oxide synthase or nOS synthase. And what they showed was that, like any other enzyme, a substrate is required, right, to be converted to product. So the substrate for nOS synthase is arginine, one of the 20 or so basic amino acids that found in all protein. And so arginine is converted to nitric oxide by this enzyme. And, you know, if you have an arginine deficiency, you're going to make less NO. If you have excess arginine, you'll be safe and you'll be able to make, you know, the normal amount of nitric oxide. Unless, of course, there are other underlying problems. You can make a lot of NO, but if you're not taking in sufficient antioxidant if you are obese, especially morbidly obese, then you know you can take in all the arginine you want and you just, your NO levels are not going to be very high. So anyway, arginine is a great amino acid. And you know, this has come under some criticism. Some people, some scientists say that we have so much arginine in our body it saturates all the sites. So adding more is not going to increase NO. And I can tell you from our experiments and the experiments of hundreds of others that nothing could be further from the truth. You know, sometimes we don't understand something in science. That doesn't mean it's wrong. It just means we don't understand it.

Right.

So we will make more nitric oxide if you take in more arginine that's been shown. in mice and rabbits with atherosclerosis. It's been shown in humans. A lot of great studies conducted in Germany. So it's good to consume arginine. Various ways you can do it. The richest source of arginine on a weight basis is, as you said, almonds. Actually walnuts are good too. Almonds have arginine. Almonds the most. most, there's a problem there. Because if you eat a cup of almonds, you're making huge amounts of NO and you'll wind up with a 50 inch waistline in no time. I mean, it's extremely caloric. But if you eat fish, all protein has arginine. There's a lot of protein. So you I can, that's why I always say, Mark, healthy, balanced diet, you know, don't, don't overdo this and overdo that and, and eliminate this, you know, we're not, human beings were not designed for that, you know?

No, but the diet eating is very different than your grandparents ate in Italy 100 years ago. Right?

For sure.

For sure.

Well, what they ate was good because, you know, my father, my father smoked camel cigarettes unfiltered for 70 years. He died at 96 years old.

Without a cough.

Without a cough.

Wow.

Well, you know, that's good genetics right there.

My mom, same thing. My mom was overweight. She didn't smoke, but she was overweight. She loved her cooking. You know, she died at 91. So I'm blessed. I probably don't even have to take care of myself and I'll live well. I'll be 80 years old in a few months.

So, and I, and I, that's good. That's good. Now, you remember UB Blake said, you know, I wish I'd known I was going to live so long. He lived to be over a hundred.

He says, I would have taken better care of myself.

I love that.

I think you have to have the APOE double two gene to get that. They might have the APOE double two and a bunch of other longevity genes, which is pretty awesome. So good for you. Okay, so what about just taking arginine? What if I just go to the store, take arginine? Is that a good idea?

You can do that. When the work was published by us and other oh, I guess in the early 90s, or late 90s, I should.

Say.

It was clear that arginine was important. So many of the companies developed arginine supplements, and at the time they were very expensive. They put arginine, for example, in capsules and so on. And you have to be careful that way because arginine has a terrible, terrible taste. So either you're taking it in a capsule, or many companies have made formulations of arginine mixed with flavors and other substances to make it more palatable so that you could take a couple of teaspoonfuls and make a solution and drink it. And those products have been extremely popular. I think there was a fellow, his name was Dr. John Cook, he was at Stanford in 1998, and he developed something called the heart bar, which was a chocolate bar loaded with 6,000 milligrams of arginine.

Wow.

And I was a good customer. The only problem was that the chocolate bars tasted god awful. I mean, you literally had to close your nose when you ate them. and eventually nobody would buy them. And so, you know, that was the end of that.

That's very funny.

And then we came up with, I worked with the company we came up with, or they did, with a formulation that was really great. And it's very good tasting. And I've been taking that since July of 2003. My wife and I.

Now, is it a powder? Is it a powder?

It's a powder. It's a powder that consists of a, of five grams. That's 5, 000 milligrams. grams of arginine. It also has some citrulline, which I'll tell you about in a moment. And then it has, of course, vitamin C in it. And newer formulations will probably contain pomegranate instead because it's much more powerful antioxidant. And, and that's the way that works. When we marketed that product, it's really funny.

About a year later, what's it called?

It's called Nightworks. N-I-T-E-W-O-R-K-S. It's called Nightworks because at the time, we thought, scientists thought that most heart attacks and strokes occurred in the evening hours. And so even though we can't put claims on the bottle that it cures any disease or treats it or whatever, you can't say anything like that, of course, because of the FDA. and the Shaya rules. We just thought that, you know, we said, good for your heart health, that you're allowed to say, and it is. And we just thought, why not take it at night before you go to bed? But now we know that it doesn't make any difference when you take it. As long as you take it, it doesn't make any difference. The levels of NO go up, they stay up. You could take it in the morning. I take it in the morning every single morning.

Even once a day is enough to keep it all day long?

Yes, more or less. Yes. I mean, clinical studies have not been done. Those are very, very expensive to do. And, you know, I mean, it didn't feel that way.

But you've done animal studies looking if you give arginine to these animals, there are levels of nitric oxide increase.

Yes, and it's interesting. We still don't understand it completely. If you give the arginine every day, the nOS base enzyme for some reason gets upregulated. So there's actually more enzyme. Maybe it's because the enzyme sees more substrate. It thinks we got to have more enzyme. I don't know. But anyway, that means you get more NO production and it stays up. Now, if you stop giving the arginine to the animals, takes three to five days and it gradually goes down. So it's very interesting.

Amazing. Does it help lower blood pressure or would it help sexual function for people who take it?

Okay. Well, number one, I know you can't.

Say anything for the FDA, but you.

Know, I have to be careful what I say.

But just the theory.

You're very famous. Everybody listens to you, including the FDA. So we got to be careful what we say. And I'm still working for this particular company, and I have to be very very careful what I say. And also, you know, unless it's tested clinically in a double control, placebo control trial, which it's not, most supplements have not, you know, what supplement company has 50 million dollars to do a correct study, for God's sakes? You know, nobody does. But yes, I can tell you because I gave this, I let people, you know, I gave this product to my mother or to many people, my neighbors in the gym and so on. If you have hypertension, in many cases, this seemed to, you know, lower the blood pressure. But I can't say that it was due to the product. Could be a placebo effect. You know, we have no evidence that this product in humans, you know, will lower the blood pressure. But the way I look at it is this. I look at the science. I'm a scientist, okay? I look at the science. This is a perfectly safe product. It makes all the sense. in the world that if you give arginine, you're going to make more nitric oxide. Everyone knows that nitric oxide lowers the blood pressure. But I don't want to say that because that means everybody who buys the product is going to be telling everybody else to buy the product because it lowers the blood pressure. And we can't say that.

I understand.

It's very heart healthy. That I can say.

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You have to do this if you are alive in the modern world and you want to live to a highly functional old age. And the reason I say this is that the safe EPA limits for lead used to be 20 parts per million in.