Treating & Preventing Shingles From A Functional Medicine Perspective

Bacteria and viruses have their own circadian rhythm. And the immune system can then establish a circadian rhythm that will allow it to fight and suppress infection. Fascinating.

Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman, and that is Pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you've ever suffered from shingles or know anybody who has, you better listen up to this podcast because we're having a special episode of our House Call podcast with none other than our Dr. George Papam: from the Ultra Wellness Center on the West, Massachusetts, one of our incredible team there. And we are going to talk about what to do if you have shingles from a functional medicine perspective. So welcome, George.

Mark, thank you for having me. It's always a pleasure to talk to you about anything.

Anything? Okay, here we go. We've had some good talks. So let's just jump in here. You know, what is shingles? shingles. Why should we care? And how big of a problem is it anyway?

Shingles is a, it's a pretty big problem, and it's something that I think everybody is more aware of than they think of. It's, it's really chicken pox. Everybody, you know, most everybody that had chicken pox, now we have fewer cases. We have vaccines for it. But chicken pox is caused by varicella-zoster. And once you have chicken pox, that Varicella-Zoster is going to actually stay in your body, as many viruses do, and it's going to hide in a nerve root in your spine, and it's going to stay there for a very long time. Unfortunately, as we get older, it's possible that our immune systems may wane, and this virus can then move back out of its hiding place along a nerve root where it creates enormous amount of inflammation and destruction. finally escapes onto the skin and you get this blistering rash. If you've ever seen it, it gets pretty nasty looking. It happens usually on one side of your body. It's usually arms or torso most commonly. It can be very uncomfortable. Big problem, about 30% of Americans will develop psoriasis in their lifetime. That's about 1 million people per year. It has enormous amount of morbidity and cost associated with it.

Yeah, it's pretty bad. Basically what happens is you get chicken pox when you're a kid. Now, when I was a kid, we used to go to chicken pox parties. Where your mom would take you to a party with the other kids with chicken pox, so you'd get the chicken pox and get it over with. And I still have the chicken pox scar on my head.

And.

What happens is that viruses tend to live in you forever. They're hard to get rid of. And basically the chicken pox goes to sleep. for 60 years. And then things happen that trigger the re-emergence of the chickenpox, which is actually sleeping in your nerves, which is why it's so painful when you get this rash on your skin. It's really the virus traveling through the nerves that causes this horrible pain and burning and inflammation, and the blisters are just the end result of that. So what is the driver of the emergence of chicken pox into shingles as we get older. Because not everybody who has chicken pox when they're younger gets shingles.

Right. So, I know when we talk about getting older and the issue is your immune system. So, your immune system begins to be suppressed. It doesn't work as well as we know during this time of COVID we've talked about the immune system a great deal. I think people are more understanding of epidemiology and immunology than any other time in the history of mankind. And I can't go to a party. I can't talk to a party. There aren't any parties. But I can't talk to people having a conversation. So it's really, you know, we say as we age, there are things that happen that are, that will cause our mucus to wane. But what does aging mean? Well, you know, we're getting older, but as we're getting older, I think what's happening is things that we've been doing for years. begin to catch up. And I think a podcast of yours I listened to recently, you were actually asking answering questions on your one podcast. You brought up the concept of long latency deficiency disease. And I think over time, when we're not eating foods that have nutritious value, we're not eating foods that have those nutrients and minerals that that support our immune systems, then our immune systems begin to suffer. And that happens as we age. But it's an aging problem. It's a food problem. It's a stress problem. It's those things that we understand in functional medicine.

I think you were talking about it's so important. It's this whole idea of immuno aging, that our immune systems age. And we should talk about how to rejuvenate our immune system, particularly now in the face of COVID We'll get into it, but keep going about shingles.

Yeah, and so when you brought it, you asked me to put the connection between aging and shingles. It's hard for me just to say it's aging. I think it's the processes. I think it's our lifestyle or nutrition that accumulates over years that results in disease, and particularly in the suppression of our immune system. What really drives conventional medicine to address shingles as aggressively. And I say aggressively because we have vaccines for it. So, you know, millions and millions of dollars go into the research and development of vaccines because you think a disease is creating such a epidemiologic social and health problem that you need to stamp it out. And so then you have this mass immunity. Why? Well, because although it sounds like a simple problem that goes away as a skin rash in about 14 days, and it's mild for most people, it can have some severe adverse outcomes. It can actually travel to your eye, it can travel to your ear, you can actually get meningitis, encephalitis, as a complication of shingles. Now, very rare, but it can happen. And the cost of treating shingles is enormous. So there's a lot of emphasis put on it in terms of a vaccine to prevent it. And that's how conventional medicine works. Prevent it with a vaccine or treat the symptom once it happens or the disease once it happens. focusing on what I just mentioned earlier and preventing through lifestyle, nutrition, and other factors that we can alter is what we need to be thinking about.

Yeah, and I think we are suffering not just from shingles as we get older, but we're suffering from all of the age-related diseases. They're all related to the decline of our immune system. We call it immunosenescence. But we can be old at 35 too, right? If we're eating a crappy diet, I mean, biologically, I've seen people who were 20, who were 20, but their biological age was 45. And I'm 61, my biological age is 39. So I think, you know, we have-.

I knew you.

Were gonna bring that up. I got some new tests. I gotta see what they show. I got some immune- There's new tests for immune aging too, which has to do with DNA methylation.

When I see it on paper, I'll believe it.

I'll send it to you.

But going back to the shingles, I don't want to underestimate the effect it can have because when we treat people with shingles, it's extraordinarily uncomfortable and painful. And when you are older and you have a declining immune system, you are much higher risk for those adverse reactions I talked about. And one of the ones I didn't mention, the most important thing is something called postherpetic neuralgia. As I said, as I was talking about it, the virus comes out and as it's coming along that nerve route, it's creating a lot of damage on that nerve. You may or may not recover. If you don't recover, that nerve can then emanate pain in a chronic fashion for months to years, and I've treated patients, unfortunately, that have had it for years. It's extraordinarily uncomfortable. It disrupts sleep. It creates a lot of stress, and it just leads to a lot of, you know, disability. Right.

So, so basically, even after the rash goes away, the nerve endings continue to be inflamed and cause pain. 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 favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/pix to sign up. That's drhyman.com/pix, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode. Well, conventional medicine, isn't that great with shingles, right? What do we got to offer from conventional medicine? And then we're gonna get into what's different about functional medicine and how we treat it with functional medicine.

Yeah. So the two things that in conventional medicine is the first thing is that they're really treating the symptoms. But what I wanted to mention is that there is a vaccine. There is a vaccine, I think it was called Zostavax, and it came out in early 2000s. and it actually only had a 50% efficacy rate. And by the time he was, after eight years, it had declined to about 35%. It was actually taken off the market in 2020. But it did limit potentially your chance of getting it. And if you did get it, it decreased the severity of the illness. And then a new vaccine came out in 2017. called Shingrix and it has a 97% efficacy rate in keeping you from getting shingles. So it's much, much better vaccine. The issue with the vaccine, vaccines and this particular vaccine, it does have some adverse reactions and if you need to get that second shot. And the concern is that not enough people are going to get it and that not enough people are going to get the second shot. So, it's not a panacea to solve that problem. But it's what conventional medicine does. It doesn't look at how can we make your immune system better. So, you have overall improved health so that your immune system can fight off all types of infections, not just one single infection called parasitic zoster. that's all that vaccine is good for. So that's what they offer. They offer a vaccine. And then if you do get it, they offer antivirals. You have 72 hours to get your antiviral. And then it's going to decrease the length of your illness and the severity, but the length by just about two to three days. That's it.

Not. Yeah, that's not so impressive, right? So basically, you've got steroids, you've got Advil, you've got topical creams and antistatic creams, but none of that stuff really solves the problem that much. So let's talk about our approach with functional medicine. How do we think differently about it? What can we do with these people who are suffering? And how do we actually get these people better over the long term using an approach that looks at root causes and also looks at the other side of the equation? Because traditional medicine is basically shutting down something, right? Steroids shut down inflammation. NSAIDs or Advil, shut down inflammation, narcotics shut down the pain. But it doesn't do anything to deal with the virus itself. It doesn't do anything to do with the virus itself or actually fixing your immune system or rejuvenating your immune system. We're working on only one side of the scale here. And functional medicine is the science of creating health, which means how do you create a healthy immune system? One, so you don't get shingles activated. And two, if you do get it, how do you build a more resilient immune system so you can minimize the effects of it, recover faster, and actually get over the problem without being too miserable?

Where would you like to start?

Just go in, like, go in all and just dive in, man.

Yeah, because then we could go. But, you know, I, I, I'm going to start where you start, you know, and it's food is medicine. I really think that it really begins with what we're eating over the long term. We have our food system, and you've talked about this, you write about it. It's your baby, but I'm going to jump in on it. We have a food system that's supplying food that is calorie-rich, nutrient-poor. Minerals are gone. Why do I bring that up? It's in those key nutrients and minerals that we get what we need to support a healthy immune system. We need zinc. We need vitamin A. We need vitamin C. We need vitamin D. We need selenium. We're finding that a lot of our foods are just missing these, and a lot of those foods that we aren't readily available in our supermarkets. And if they are, they are grown in such a way that they don't have the concentration of those minerals and nutrients that we need. So in functional medicine, we see supporting your overall health starts by choosing really good healthy foods from a wide range of vegetables, fruits, and fish, and healthy grass-fed grass finished beef, and getting nuts and seeds and berries because they're all going to carry the nutrients that we need to support the healthy immune system. So it starts with really your nutrition.

So really upgrading the quality of your food you're eating and using both anti-inflammatory foods, basically spices, herbs, all the colorful phytochemicals in food, ginger, and all these wonderful things that we can use to upgrade our immune system. And at the same time, getting rid of the foods that drive a disturbed immune system. For example, sugar and starch suppress your immune system. So if you're eating tons of processed food and sugar and starch, which is the bulk of our calories, about 60% of our calories, that's going to drive a suppressed immune system and make you more likely to get into trouble. And then you also mentioned the nutrients, which are critically important because they're not just making expensive urine. These are regulating all the functions of your body, particularly your immune system. So you mentioned zinc, you mentioned vitamin A, you mentioned vitamin D, you mentioned vitamin C. These are really important. Even amino acids like lysine can be very helpful in regulating viral infections. So I think these are the things we use in functional medicine and often we can get really tremendous benefit with people helping to reduce the course of the illness, to shorten it, and also to reduce any long-term side effects. So tell us about, tell us about this 42 year old patient you had with shingles who kept going, come, coming back and back. She's got hives, yeast problems and like was a vegetarian. So what was the story with her and what did you do to fix her? How did you identify the issues? Because typically in traditional medicine, we just use conventional tests. We don't really look under the hood. And someone said that, you know, using traditional medicine is like trying to diagnose what's wrong with your car by listening to the noises it makes instead of looking under the hood.

And functional medicine is really about looking under the hood. So how do we do that? Right. So, so this was a, you know, this is a, a case of a woman. As you said, she was a 42 year old female. So, you know, you're, you're immediately starting to, as they're giving you your, your, their symptoms, you're starting to think about this, the systems that are involved. And so when I'm hearing that she's a vegetarian, I'm immediately starting to think about, you know, some of possible deficiency she may have. So I'm thinking about that. I'm thinking about that, how that will impact her overall health. I'm thinking about how it will impact the health of her gut. So I'm starting to think about her gut. And what makes me think more about her gut is the hives and the yeast infections. They start to make me think that, you know, that's an unhealthy gut. There's a good chance that she has a bacterial imbalance that we call dysbiosis and that it might be being driven by Candida or the dysbiosis was there and the Candida then grew and Candida can cause highs and eases. So I'm thinking now there are guts involved that she has some nutritional deficiencies, maybe not enough A, maybe not enough zinc, maybe not enough C. So I do a stool analysis, a complete diagnostic stool analysis and indeed I found that she had significant dysbiosis and candida overgrowth. Additional testing I did included what we call an organics acid test, and I looked at her overall amino acids. And what I found was that she was low in zinc and she was low in amino acids, which, again, you know, I was, I wasn't totally surprised because vegetarians, if they're not really careful, may not be getting enough proteins. And indeed, you know, she wasn't when we looked at her diet and amino acids are low. So what does that all add up to? It adds up to this. She wasn't getting some of the key nutrients she needed to support her immune system. She wasn't getting enough protein to give the amino acid that she needs to make those proteins that are important for the immune system to function. And her shingle, she had the Candida in her gut, and that all caused her immune system to tank, and she developed shingles. And this is happening repeatedly. she had recurrent episodes. By the time she came to see me, she had four episodes. She'd been treated four times, and she was being put on a suppressant. She was taking an antiviral every day, and she was breaking through on the antiviral. That's why she came. She said, I don't know what else to do. Having put all that together, I started her on lysine and vitamin C, and I put her on a mushroom compound called Turkey Tail because of its benefits for boosting the immune system. And then I treated her gut. We treated her Candida with caprylic acid, and I used another compound called Biocidin to help with overall general dysbiosis. And we cleared up her gut, and I talked to her about her diet. She leaky gut, by the way, which means that that permeable membrane that's responsible for filtering out the bad guys and letting in the good guys through these gates. We treated that with curcumin and some l-glutamine. As these things improved, one thing she just felt generally overall better. We, she, you know, her shingles, that case of shingles improved. And the other thing that we needed to address was she was under an enormous amount of stress. And so I had her start meditating. And what's really interesting is that there's, you know, there was a recent study that showed that meditation actually will alter the function of genes that will improve immune function, particularly those genes involved in viral fighting viruses. So, you know, meditation, we started meditating, and six months later, she hadn't had another outbreak. And she had been on, like, you know, pretty much up to that point in every, you know, three to five, six month cycle. so that's how we treated her and she did really well. That's really amazing, George, because we really.

Often don't think of how do we strengthen our immune systems, not just in terms of shingles, but in terms of everything and in terms of COVID And if you go to your doctor, what do I do to boost my immune system? They're like, I don't know. Come to me when you got a problem and there's inflammation. I can give you drugs to shut it off. But if you say, well, where is the inflammation coming from and why is my immune system not working? well and how do I upregulate it? How do I rejuvenate my immune system? Well, it's all the things we're talking about. It's eating the right foods with immuno rejuvenating properties. It's taking the right nutrients. It's fixing your gut, which is a big part of your immune system. It's using various herbs and nutrients to actually that can be antiviral or immune regulating like the adaptogenic mushrooms, reishi, shagga, cordyceps, lion's mane, you know, shiitake, all these maitake mushrooms. These are powerful mushrooms that help with the polysaccharides and using food as medicine to upregulate immunity. So we have this incredible arsenal of tools at our disposal that are completely ignored by traditional medicine. And that's really what we do with the Ultra Wellness Centers. We help people dig down into one, finding what the root causes are, and two, actually helping people to rejuvenate their health in a very specific way. It's very personalized. And that's really what's so gratifying for the work we do because we literally get to see people's lives change and transformed by doing some very simple things. You mentioned protein and I think people don't understand a lot of people may be trying to eat less meat or not eat protein. And if you want to be a vegetarian or vegan, it's okay, but you have to be on top of the protein. Oh, we don't need as much protein we can get. We can get it all from greens. It's just nonsense. Your immune system is driven by protein. You need protein to build the immunoglobulins, the antibodies. and so I've seen many patients and we test them. We don't just guess, we test, right? And so we see at the Ultra Wellness Center really dramatically low levels of amino acids, protein insufficiencies, and it's not like they're having protein calorie malnutrition like in third world or developing world. They're having dysregulated immunity and overall health. I mean, one woman, she's like her hair was falling out, she was tired all the time, she had all these health issues, and she had like zero, she just was a vegan who only ate sugar and vegetables. So, you know, it wasn't really healthy diet.

Yeah.

And, and so we need, we need to do those things. That's great. So what happened when, when you started to do these things with this patient?

Yeah, she got better. I mean, I, you know, her, you know, her, I mean, her shingles went away, obviously. But what was most important was that her hive stopped. She didn't have another yeast infection. She was getting yeast infections monthly. you know, and at the six months.

Like vaginal yeast infections.

Yes, vaginal yeast infections. And so once we cleared up her Candida, that resolved her high yeast zole. And at six, at six months out, she had, you know, she was off of her, her viral suppressant medication, and she hadn't had an episode. And so what was interesting, I want to mention this, I did get her to eat more protein. and it wasn't because I convinced a vegetarian not to, I mean, to start eating meat. I just went over with her all the foods and made sure that she was really focusing on getting her tofu, her tempeh, her lentils, her chickpeas, her beans. I had her start using some nutritional yeast. So, I just reminded her, if you're going to be vegetarian, because she really wanted to be, these are the foods you need to eat. I re-established your protein needs and had to really be careful about making sure I think I calculated her out to needing about 50 grams, 48 to 50 grams. I said, you really need to get that every day. And so helped her be a better vegetarian. And she was really grateful, and it really worked out well. What was really helpful to her, too, and she told me this, was that she really, like, when I told her about the meditation piece, she was like, What's meditation gonna do for my shingles? And I explained to her that, you know, it impacts the immune system. So she bought it, she did it, and she said, George, of all the things I've done, meditation's had the biggest impact on my life. She said, I just am more relaxed every day. I function better at work. I communicate better with my children. My sex life with my husband is actually better. Sleep actually, as I was just reading about the immune system and prep for this, sleep, we talk about how the sleep is so important for overall health. But sleep in the bigger context of establishing a healthy circadian rhythm. There have been recent studies that show that it's just circadian rhythm, establishing a good circadian rhythm actually sets the immune system up because bacteria and viruses have their own circadian rhythm. And the immune system can then establish a circadian rhythm that will allow it to fight and suppress infection. Fascinating. So working on making sure that we're Getting our circadian rhythm in place, sleep is a big part of that. From the moment you wake up in the morning to the time you go back to bed, you're actually preparing yourself for sleep. One of the best things you can do in the morning is wake up, open a window, open a door, go outside, get some fresh air, and look into the sky because that light hits your your brain, there's a certain nucleus that sets your circadian rhythm for the day. And it's going to now start preparing for 12 to 14 hours later when you go to sleep to have you completely ready to sleep in a comfortable and restorative way.

That's great. So really, what you're saying, George, is that with functional medicine, whether it's shingles or any other viral issue or preventing infections, you had yeast infections, all those things that we have a a lot we can offer from the perspective of functional medicine to one, identify the imbalances that are driving immune dysregulation, immune aging, and immunosenescence, as well as identify very specific interventions from lifestyle, supplements, herbs, and other therapies that can actually help. And one of the things we didn't talk about, which is interesting, is ozone therapy, which we do at the Ultra Wellness Center, and has been studied, is published in the online National Library Medicine database looking at, for example, the use of ozone therapy with postherpetic neuralgia and found that it was more effective than any other treatment. It can also be used topically for shingles. So there's a lot of options that we use in traditional medicine and functional medicine that are not typically available with functional medicine.

Absolutely.

So George, thank you for joining us on this podcast on this special episode of House Call and the Doctor's Pharmacy, where we dive deep into healthcare issues and medical problems that many people suffer from that aren't getting good answers. And here at the UltraWellness Center in Lenox, Massachusetts, we're now doing virtual consults and we can see people from anywhere. It's pretty wonderful. It's one of the silver linings of COVID for us. We've been able to really increase our reach and help so many more people. So if you've been listening to this podcast and you loved what you heard, please share with your friends and family. Subscribe wherever you get podcasts. Leave a comment. Maybe you've had shingles.

How have you found a way to get through it?

We'D love to learn from you and hopefully we'll see you next week for another episode of the Doctor's Pharmacy.