Use These ANTI-AGING SECRETS To Stay Young, Smart & Fit FOREVER | Mark Hyman

One of the biggest drivers of aging is muscle loss. Muscle gets replaced by fat. And if you actually have muscle, it's like a ribeye steak instead of a filet mignon.

I'm going to keep the first one on high homocysteine levels from Danielle in the community.

Hi, Dr. Hyman. I have a quick question.

My homocysteine level is consistently high. Right now it's at a 4.7.

I am gluten free and I am a vegan. Please help me. Any suggestions would be wonderful. So, hyaluronic acid, what the heck is that? You've probably never heard of it. Your body has thousands and thousands of molecules, millions literally, of compounds that are running around your body. One of the most important ones is called hyaluronic acid. Now, for those who don't know what that is, essentially it's a measure of how your body is handling the B vitamins. So if you are deficient in certain B vitamins like B6, folate, and B12, it can actually be high. And that's a problem because high homocysteine is in itself, you know, maybe causing more oxidative stress, more inflammation, or more other problems like heart disease, dementia, cancer, depression. But it actually is caused by a number of different things that we can actually address clinically. So, so when I see someone high homocysteine, I'm concerned because it means that they might be at risk for heart disease, cancer, dementia, depression, and many other things. Birth defects, for example. And I don't know, just how do we sort of learn all about this and how do we sort of start to figure out about this? Well, there's a guy named Kilmer McCully who's written numerous scientific papers on this, a number of books about this, and was the first person to really introduce the idea that this could be a problem. And there's a severe genetic disorder called hyperhomocystinemia, which is an extreme version of it. and in this extreme version, kids who are 10 years old will get heart attacks and strokes because their body can't.

Process.

The homocysteine properly and they end up in a lot of trouble. So most people don't have that, but about 20 to 35% of people have some variations in their genes that make them need extra folate or a special kind of folate or extra B12 or B6 and special forms of those nutrients. And so I really very consistently look at this. And the data is a bit confusing because I think if you look at the science, it's not clear not everybody agrees about how big of an issue for heart disease or this or that. But pretty much everybody agrees that should be in the optimal range. Or if your level, for example, is over 14, your risk of dementia is 50% higher. Now that's a pretty big risk. And the question is, what is it? How does it work? It really is important because it regulates one of the most important biochemical processes in your body we call it methylation. Now, it's a big mouthful, but essentially what it means is there's a chemical compound called methyl groups, carbon and three hydrogens called CH3. Think about this like the currency of your body, like dollars. We use dollars to spend and buy things in exchange currency in the economy. And in the body, these methyl groups are constantly being exchanged for all these biochemical process, including our DNA regulation. And we've heard about epigenetics, and we've heard about the idea that we can actually regulate our epigenome through doing lifestyle changes, through diet, and all of the epigenomes function in large part is determined by these methylation patterns. And we call it DNA methylation. And in the longevity test that we can look at and tell us, for example, I'm 62, but I did my DNA methylation patterns, I'm 43 according to my DNA epigenome, which is kind of cool. It plays a huge role in a lot of different diseases. If it's high, you need to figure out why. You have the genetic problems. I pretty much test most of my people who have hyaluronic acid looking at a number of different genes. There's many methylation genes. One of the main ones is called MTHFR. There's also ones called CBS or MTR, and they all regulate different enzymes. So basically what happens in your body is that you have to convert one chemical to another chemical, and those processes happen through an enzyme or a catalyst that converts one molecule to another. And these catalysts depend on the right nutrients. All the cofactors, all the helpers for the enzymes are vitamins and minerals. And so the B vitamins, B6, folate, and B12, are critical for regulating all these methylation pathways. And if they're insufficient for you, and I mean for you because some people might need 400 micrograms of folate, some people might need four milligrams or 10 times that amount of folate to regulate the same enzyme because they have a functional difference. I'm not going to call it a defect. It's just a difference. We all have these variations in our genes. that require us to have different amounts of different nutrients. In fact, one third of our entire DNA codes for enzymes. And all those enzymes need helpers and vitamins and minerals, and there's variability in the function of those enzymes that requires you to have higher amounts of certain of these nutrients. So let's get back to the homocysteine question. So if you have a high homocysteine, it means you might have one of these genetic problems, you might need more B6, folate, B12, and I look at a whole complex of genes when I test people, not just one or two. And you can go to 23andMe and do that, and they'll actually give you all your methylation genes. You can actually upload it to this thing called Genetic Genie and see what your methylation patterns are and whether you have these problems. So there's a lot of kind of cool ways you can kind of figure it out yourself. And I'll just tell you a quick story about a patient of mine. I know some very cool patients had issues with this. One of them was a woman who helped with the movie Fed Up. and she was struggling for years to try to get pregnant and have a baby. She was the director of the movie and she ended up having miscarriage after miscarriage after miscarriage. And then she finally got pregnant and delivered a baby with no brain. We call it anencephaly. It's pretty awful. And in fact, a lot of the work around this was discovered in China. And I actually heard a lecture when I lived in China because in Harbin, which is the northern part of China, it's cold in the winter. It's like north of Beijing. It's kind of near Siberia, basically. And they don't grow a lot of vegetables in the winter there. They don't have hot houses back then. They don't have like, I mean, greenhouses. And so basically in the winter, they don't have vegetables. Now in China, everybody gets married when? Chinese New Year. When is that? February. When is that in the middle of winter when there's no green vegetables? And where does folate come from? Foliage. The word folate comes from the word foliage or greens essentially. So they don't eat greens all winter. And what they found was a really high rate of birth defects we call spina bifida, which is a defect in the spinal column. It's so important in so many regulating and regulating so many things including the development of the spinal cord in a baby. That's why all prenatal vitamins have extra folate, but they have to have the right kind of folate. They basically discovered that there was this link between the B vitamins and these birth defects. Now, she had this problem of having these miscarriages, which was caused by this gene she had, we call MTHFR. I'm not going to give you the chemical name, but it's kind of a big thing, but it's MTHFR. It's a gene that regulates an enzyme that you need to actually convert the folate that you eat from food into the right form of the folate that your body can use. Well, it turns out she had this gene and she read one of my articles and she then ended up taking it to her doctor and said, hey, can you please test me for this? And she definitely had this gene. He said, well, just take folate. And she's like, no, no, Dr. Hyman said in this article, I have to take this special form of folate called methylfolate. Well, he's, I don't know about that, but she did it anyway. And then when I met her, she literally had this, we were going around New York City doing PR for the movie, and she had a perfectly formed, beautiful little 10-month-old baby that occurred only because she actually found out about this and took the right vitamin that was based on this methylation pattern, and she had this high homocysteine. It's that powerful. I had another person who had dementia. Same thing. They weren't able to actually do the proper methylation, end up with dementia, and I gave them the right B vitamins, and their dementia went away. Another guy I met who was 50 years old who had everybody in his family died of heart attacks in their 50s, and he was terrified. And I checked, and he had a super high homocysteine, and he ended up having this gene as well. And so we treated him with the right kind of folate. Now, what are the things that affect this methylation process? Genetics we talked about, and there's tests like 23andMe youe Can Do. I use in my practice something called DNA Health from Nordic laboratories, which is a thing that doctors can order. A diet plays a huge role, right? If you're not eating enough greens, you're not getting enough folate. If you're not eating the fruits and vegetables, greens and beans and fruit, you're not getting B6, B12 and folate. But also it comes from, I mean, by the way, the best source of all these nutrients is liver. And I was a kid, we were very poor. We lived in Queens in New York and we used to eat chicken livers and onions and rice for dinner. I thought it was a gourmet meal. It was because we were poor, but actually it really is one of the most nutritionally dense foods on the planet. So egg yolks, meat, liver, oily fish, lots of sources of B12, foliage, folate. So you want to make sure you have plenty of these foods in your diet. There's also things that can cause too high homocysteine, like sugar, too much processed fats, coffee, alcohol is a big one, kidney failure also. And a lot of our food is irradiated. That can deplete the nutrients in the food. So that may be lower in B vitamins. Smoking, if you're a smoker, really messes up your methylation, high homocysteine. If you have gut issues, you might not absorb these nutrients. Like if you have Crohn's disease or if you have a leaky gut or damaged gut, you might not absorb these nutrients like B12 in particular. If you're older, you might have low stomach acid and you can't absorb B12. If you are like I don't know, the bazillion Americans taking acid blocking drugs like Pepcid and Prilosec and these drugs, they block stomach acid which you need to absorb B12. That can be an issue. Also, certain medications in addition to these acid blockers like methotrexate, which they use for cancer, autoimmune diseases, the birth control pill, B6 deficiency, high blood pressure pills like diuretics, like hydrochlorothiazide, Dilantin, which is used for seizures, all affect these B vitamins. Then if you have kidney failure, like I said, thyroid issues, cancer, pregnancy, all these things, and toxins also. Really, there's a lot of reasons it can get screwed up. How do you check if you're doing okay? Well, check your blood count. You can check your blood count and see if you have a high level of something called MCV. That means your red blood cells are too big. If they're too big, it may mean you have a folate or B12 deficiency. That's an easy, cheap test. Homocysteine, you can check. Obviously, the level should be six to eight. Most labs say 14 or less is normal. No, that is not normal. That's not optimal. That's the range of the population, but that doesn't mean that we have a healthy population. If you were a Martian and you landed in America in 2022, you'd go, 75% of us are overweight. It's normal to be overweight. It's definitely not normal to be overweight. You can look at urinary levels of methionine acid or blood levels, certain amino acids, but it's really important to optimize your methylation process. Dark leafy greens, now things like bok choy, Swiss chard, kale, watercress, spinach, dandelion, mustard, collard greens, beet greens, also really great. Get the B vitamins, we talked about seeds like sunflower seeds, fish and eggs, beans and walnuts, dark greens, almonds, and so forth. Avoid processed food, canned food, which is a pleating B vitamins. Avoid caffeine, alcohol, Don't smoke, obviously. If you're taking medications, be careful with those medications and make sure you're getting enough of the vitamins. For example, if you're taking acid blocking medications and you take B12, it's not going to work. You need a B12 shot. Your gut plays a big role. Fix your gut. We talk a lot about that in a lot of our podcasts. So those are the ways you can optimize your methylation. And this is such an important part of your biology. It's one of the central hubs of all your biology.

So I talk about this a lot. I work with my patients a lot about it. But if you have a hyaluronidase deficiency, it's for sure concerning and you got to deal with it. All right, Mark, a bunch of follow-up questions off of that. Let's go into the first one. You mentioned you took this test that helps you look at your biological age. I believe it's from a company called True Diagnostic. We have a link to it inside of the show notes. No affiliation with them, just a test that you've been doing. And also, one of your colleagues and one of my friends, Dr. Kara Fitzgerald, used this test in her study that she published in the Journal of Aging on how actually through following a very similar program that you talk about, she was able to reverse people's biological age over the course of eight weeks. weeks through lifestyle and dietary interventions. So the question is, if somebody came back and they were shocked by their score, maybe they're 40 and their true biological age showed back as being 50, what are some of the things that they could do to start bringing that biological age down? And how does some of those recommendations play into your answer of the last question?

Well, funny you should ask you, because I just finished writing a book on it called Young Forever, where I basically answered that question about how do we reverse our biological age? Just a little background on the whole concept. There's a guy named Stephen Horvath, who's a scientist who looked at the epigenome. Now, the genome is your genes. You can't control your genes. You got them from your mother and father, and they're fixed. Maybe soon we'll be able to edit out our genes and use CRISPR and gene editing tools, which is coming down the pike. But for now, it's not really available. But what is available is the epigenome manipulation. Now, the epigenome is like the piano player. Now, on a piano, you got 88 keys, that's it. But think about what you can do in a piano. You can have Mozart, you can have the Grateful Dead, you can have jazz, you can have ragtime, right? You can have folk music. It's like that. Epigenome is a piano player. And the epigenome is controlled by everything that you do. We call the exposome, everything that you're exposed to in your life. Your thoughts, your feelings, your diet, exercise, stress, sleep, environmental toxins, your relationships, everything affects your epigenome. So, you have massive control over that by the quality of your life and your lifestyle and by doing the things that actually help to improve it. And, you mentioned Cara Fitzgerald, she didn't use really anything except a very aggressive, and I call it aggressive, it's not really aggressive, it's what I eat all the time, but it's an aggressive dietary intervention, which isn't just the Mediterranean diet, which is great, but it's like an up-regulated version of that. based on functional medicine. It's a very powerful anti-inflammatory diet, but also specifically included foods, a lot of foods, which are designed to improve methylation, improve this process we've been talking about for a while, and this podcast. So basically in the study, what they did was they focused mostly on diet. They had a few other lifestyle interventions they did, which helped like stress reduction and exercise and so forth, but it was mostly diet. And what they found was that in eight weeks, they were able to reverse their biological age by three years, which is mind-blowing when you think about that. And imagine we did that for a year. I mean, I don't know, would you get, what is A 52 divided by 8? I'm terrible at math, but anyway, you get the idea. It's a lot of age reversal now. There's a limit to it, but it's really impressive to see what you can do when you actually upregulate this process of proper DNA methylation. So that's what's kind of exciting. And in the book that I wrote, young forever, it's really about how do you work on your biological age, not just through diet, but through exercise, through meditation, through eating phytochemical-rich diet, through various supplements and compounds that we can now take like NMN or NAD. There's really a lot of strategies, even hormesis, which is this whole idea that what little stresses that we can take on our system that don't kill us make us stronger, whether it's exercise or hot and cold therapy or hypoxia or hyperthermia, whatever we kind of are coming up with that can stress the system a little bit. I mean, hyperbaric oxygen therapy is another kind of stress where you put yourself under pressure with a lot of oxygen in a tank. And, they actually dramatically increase telomere length, which is a measure of your biological age. They actually killed a lot of the zombie cells, or we call senescent cells, which increase inflammation in the body. So, they able to kill zombie cells and increase telomeres almost more than any other intervention. and that's just by applying oxygen under a high pressure, like two atmospheres of pressure. So, there's a lot of really cool technologies out there that we now are learning about that can help us reverse our biological age.

That's fantastic. You also mentioned looking at your DNA and getting an understanding of it. There are friends of yours at Nordic Labs that basically took your DNA analysis and we are friends with them and we've done some fun projects. They're not a sponsor of this podcast, you just mentioned it. So, I thought we'd link it up in the show notes below, they go through your genetic test and talk about the insights that you took away from it. So they made a whole little video and put it on a website. So we'll link to it below. If anybody's curious about that test and what some of the insights you got, you can check that out in the show notes. We'll make sure to link to it. Mark, something that I wanna get your insights on that's also, again, surprise, surprise on the topic of longevity. is this idea of grip strength, right? Why is it that grip strength do you think has been so associated with, you know, being as far as I understand, one of the top, if not the number one marker of somebody's lifespan here on Earth? So what is it about grip strength?

Well, I think grip strength is just an indirect marker of your overall muscle mass and strength. Right? So if your grip strength is weak, it's a sign that you have sarcopenia, which is muscle loss, and that you can't do the things that you might do, whether it's open a jar or just the basic activities of daily life. So one of the biggest drivers of aging is muscle loss. And it's not really talked about it. We don't really learn much about it in medical school. We don't learn what to do about it. We don't exercise and eat well. but it's such a profound science when you look at what happens as you start to lose muscle. So grip strength is sort of an indicator of your overall level of strength and sarcopenia. And if you have sarcopenia, you're kind of screwed because it's not just that you get weak muscles, but muscle is the currency of aging. If you don't have muscle, you're going to age fast. Why? Because muscle gets replaced by fat. And if you actually have muscle, it's like a ribeye steak. instead of filet mignon. You don't want that. You might want to eat a ribeye steak, but you certainly don't want it for your muscle. Why? Because when you are marbleized muscle, you are actually producing lots of damaging compounds. You actually create lots of inflammatory compounds and increase inflammation. We know that aging is an inflammatory process. We call it inflammaging. It also makes you insulin resistant, which we know is one of the key features of aging where you become more resistant to the effects of insulin and diabetic and pre-diabetic. It also increases cortisol and stress hormone levels, which ages us and shrinks your brain and makes you demented. It lowers growth hormone, which is necessary for repair and healing. It lowers testosterone, which is necessary for keeping your muscle and for sexual function. So it really creates a whole cascade of problems when you have low muscle mass. And that's sort of, we've had another podcast where we talked about protein. and the importance of approaching as we get older because we have to maintain our muscle mass. If we're going to stay healthy as we age, we need muscle mass. And, Drew, I don't know if you know this, but the major reason people go into nursing homes is not because they're sick, it's because they can't do their daily activities. They can't tie their shoes, they can't get out of bed, they can't get out of a chair. That's because they've lost muscle. And if you are listening to this, I encourage you to sit in a chair, like a kitchen chair, and don't touch the chair. and keep your back straight and just try to sit up out of your chair without actually bending forward. And if you can't do that, it means you probably have weak muscles and you better get on it.

Yeah, it's so true. And unfortunately in this world that we live in today, it's not like a long, slow decline in this thing where one day you wake up and say, you know what? I'm having a hard time getting up. I'm having a hard time tying my shoes. I think I need to now being in a nursing home. It's usually you're in the kitchen, you've lost so much muscle mass you don't really know. And this activity used to do, which is getting on top of the stool to put the dishes away at the top of the shelf, you end up slipping and falling and you can't catch yourself because your grip strength isn't good. You don't have enough muscle mass. You fall and you break your hip. And that's how most people end up in these situations. It's very tragic. It's happened to family members of mine before, and it's very unfortunate. And it's a very tough thing. You know, I heard a statistic from one of your colleagues that you introduced me to, Dr. Gabrielle Lyon, who was on my podcast recently, and you've done some podcasts with her too. We'll link to those in the show note. She said, For a woman 65 plus who falls from, you know, who falls and has like a hip fracture, less than 50% of them will ever end up walking again. That's terrifying.

And that should be terrifying for people who are listening. Well, it's even worse than that, Drew. It's like getting a terminal diagnosis of metastatic cancer. in terms of your longevity. If you get a hip fracture, your risk of death is as high as that of getting a terminal cancer diagnosis with stage four metastatic cancer.

Wow, that's nuts. And, I know that there are a lot more companies and solutions and people that are talking about how do you make working out strength training, of course, diet. Our whole last podcast that we did together was about dietary interventions and protein. And I'm just excited to see that to really make this a national focus for individuals. You know, it's never too late to start making movement a regular part of your lifestyle. All right, Mark, I want to continue on this topic of longevity, but bringing up and tying back into something that you had mentioned, which is this idea of sexual health. A lot of people notice that as they get older, that their libido starts to go down. That could show up in the form of erectile dysfunction or just actually not craving, you know, wanting, you know, physical intimacy. Of course, intimacy is a spectrum and there's all sorts of different types, but specifically when it comes to our sexual drive. What have you known as a practicing functional medicine doctor about how things like inflammaging and our modern lifestyle take a toll and are some of the root causes behind a low sex drive as people age?

Well, I mean, this is a complicated subject because it is many aspects to this. It's relational aspects, there's the intimacy aspects, you know, for women, often the biggest sex organ is between their ears. So it's, it's really a complicated subject, and it's, it's all about the relationships as well as their biology. So I'm going to focus a little bit on the biology for a minute. And, and, you know, I know, I know you, all this, you might think this is just because I'm focused on sugar and my whole life, so I'm focused on talking about sugar and insulin resistance as a big factor and everything. But the truth is that sugar is one of the biggest problems with our sexual health. What are you talking about, Dr. Hyman? Well, especially for men and women, it's a little bit different. But for men, what happens is that as you increase your sugar and starch intake, you develop what we call belly fat, visceral fat. that organ fat, or you get the little poachy stomach, or maybe you got a big stomach. And that causes the production of huge amounts of inflammation, as we talked about, but it also increases something called aromatase, which actually converts estrogen, testosterone into estrogen. So you end up actually having high levels of estrogen. and so you become more like a woman, your testosterone levels go down, your estrogen levels go up, and you basically lose desire and lose function. The only thing that happens within some resistance is it's the biggest driver of hardening of the arteries. And the small blood vessels are the ones affected often first, and guess where they are? In your penis. So, those you get literally hardening the arteries in the penis and the lack of blood flow affects circulation. That's why Viagra and those drugs work is because they increase blood flow and circulation by increasing nitric oxide, which dilates the blood vessels, which is not a bad thing. A lot of people continue to have healthy sex lives. But the key is figuring out the cause, not just taking Viagra, because it eventually won't work. So, you've got to focus on the cause. A lot of the time, as we age, as we talked about, when you lose muscle, you lower testosterone, when you increase fat in your body, you lower testosterone. In fact, There are a lot of great ways to increase testosterone. Weightlifting is a powerful way to increase testosterone, eating more fat. And by the way, your sex hormones are made from fat. And in fact, cholesterol is the building block of testosterone and all the sex hormones. So if you're taking a statin, for example, it can really lower testosterone and sex function. So you've got to look at the whole picture of what's going on with that person. And of course, there are other complications that might affect your health, like thyroid function, certainly affects libido and sex drive. and your testosterone, as we mentioned. You've got to look at the whole picture of what's happening with somebody. I think for most of the people I see, it has to do with this problem of insulin resistance, which affects almost nine out of 10 Americans. For women, it's a little bit different. They go through menopause and their hormones change. They may have vaginal dryness, which may affect their desire and function and cause pain. Many women post-menopausal continue to have really healthy sex lives, and sometimes they need a little help. they might need a little bit of estrogen, they might need a little testosterone to help them with libido. But by working with people's lifestyle and diet and lowering the starch and sugar, increasing the good fats, doing strength training, kind of tweaking some of the hormonal things, often people can really regain sex function once it's lost or actually just continue to have healthy sex life well into their 60s, 70s, 80s, and even 90s. And I've seen people older than I mean, surprising. I had a woman come to me who was 88 years old. She's like, I'm in a new relationship. Can you help me out here? And I'm like, sure. We got her going again. So, I think we just have these weird ideas in our culture about sexuality and aging, but you can continue to have a healthy sex life well into your late life. Well, there's something important that you said.

That a lot of functional medicine doctors talk about is that actually for men, erectile dysfunction is one of the first indicators of cardiovascular issues that are going on in the body. It's like a leading indicator, the canary in the coal mine.

Absolutely. Exactly. So, if you're having trouble there, It's good to look at your heart for sure.

All right, Mark, we're going to go into our next question here from Jules in our community, and she's asking about PCOS.

I'm just curious if you have any recommendations for someone who's been diagnosed with polycystic ovarian syndrome. I am interested in learning about what diet you recommend as well as exercises you feel would be beneficial. Drew, PCOS stands for polycystic ovarian syndrome. When I was in medical school, we learned about an obstetrics and gynecology. The truth is it's not a gynecological problem, it's a nutritional problem. What happens is that women who have high levels of starch and sugar in their diet and have some genetic predisposition to insulin resistance, prediabetes, which is pretty much almost everybody except for a few lucky people. I mean, if you're basically someone who tends to gain belly fat when you eat starch and sugar, and by the way, all of us can force ourselves to be like that. When I went to Italy a few years ago, I kind of went on a binge. I'm like, I'm going to hell with it. I'm just going to eat bread and pasta and pizza and drink wine. I got a little tummy. So even I can get that if I'm not careful. But it's pretty common. And it basically happens when you eat you eat a lot of sugar, you get high levels of insulin, and that affects your hormones in a really adverse way. So women tend to get high levels of estrogen. They get anovulatory cycles, meaning they don't ovulate and make progesterone. So their estrogen/progesterone ratio gets way off. They have heavy periods. They get acne, which is for more testosterone. And they get hair loss on their head. So you'll see women with like kind of balding in the head on the top. you'll see them, they'll have a beard, literally, the bearded woman syndrome, they'll get facial hair. That's all we call polycystic ovarian syndrome, at least infertility and all kinds of problems for women. So, it is really primarily a nutritional problem and unfortunately it's treated by the birth control pill, by giving women all kinds of weird hormonal shots. And most of the time it can be treated usually in nutritional therapies. And that means a diet that's lower in starch, sugar, higher in fat. good fats like olive avocados, nuts and seeds and so forth. And by really eliminating all that kind of processed junk that we eat that's causing this epidemic of insulin resistance. There's also some really interesting data on certain like kind of forms of B vitamins. One of them is inositol, which people might have heard about, but it is in a B complex usually. And a particular form of it called D-chiro-inositol, which has been used in research and published in the New England Journal of Medicine. So it's not like some alternative medical journal. This is the top medical journal in the world. If you're American, if you're British, it's the Lancet, and they have a fight about that. But basically it's a top medical journal showing that giving this nutritional compound can help regulate insulin. And when I work with patients in my practice, I use the same approach I do with someone who's got diabetes, for example. A ketogenic diet can be helpful. Fixing people's gut can be helpful. A lot of the hormones are regulated through the gut. We know, for example, that if you have a bad microbiome, you can produce more, for example, clostridia, which is a bacteria that can increase estrogen levels and cause some of this estrogen-progesterone imbalance. It's a horrible problem for women to have. It's really common. It's not always women who are obese or overweight. Sometimes women who are not can have this. It's not entirely because people are eating junk food and sugar, but most of the time it is, and it can be really well addressed. Many women, for example, have been resistant to getting pregnant and have infertility. Dr. Walter Willett, who's one of the most revered nutrition scientists in the world at Harvard School of Public Health, wrote a book called the Fertility Diet, which was all about this issue of insulin resistance and infertility and polycystic ovarian syndrome, which is super common. I think it's really honestly poorly treated by obstetricians and gynecologists. I was talking to somebody recently and they were like, My internist was saying, really how shocked they were to realize how much food played a role in chronic disease. I'm like, oh my God, finally people are getting it. I see more and more conventional doctors getting the idea that nutrition should play a role in our medical school curriculums and should be part of our therapeutic practice. It's kind of coming. I've been pushing the rock uphill for the last 30 years. I think finally we might be on the downhill side. and then getting more common. But it is a really treatable condition. It creates a lot of misery for a lot of women, but I would encourage people to think about really looking at ways they can handle it through diet and lifestyle. And then certain supplements and nutrients play a big role.

All right, Mark, our next question comes from the High HO app, and this is Tammy who has a question about osteoporosis.

Looking for your suggestions. for osteoporosis in a woman who is in her 60s.

I was told hormones is too late.

For hormones and I don't want to take the drugs. So, would love to hear what you have to say.

Thanks.

Osteoporosis is really a common problem. And as we chatted about earlier, one of the challenges is if your bones get thin and weak and you fall and break a bone, particularly a hip as you get older, It's like getting a terminal cancer diagnosis in terms of your risk of death. It's really quite shocking. I think 50% of people who get a hip fracture die within a year. That's not great. You really don't want to get osteoporosis. Historically, we really didn't have a lot of it because most of us were out there working hard, using our bodies, and eating a very nutrient-dense diet. Unfortunately, the dogma has been that if you want to prevent osteoporosis, you have to drink a lot of milk and take a lot of calcium. Unfortunately, that's not true. The Got Milk ads were taken off the air and out of magazines because the FCC, the Federal Trade Commission, which regulates truth in advertising, said there's no data. You have to stop advertising. By the way, these ads were part of a campaign It's a government sponsored program called the Checkoff Program, which partners with industry to help do research on various nutritional and agricultural products. But unfortunately, it's used to actually promote products. It was a kind of a government sponsored program with the Dairy Council that put these ads out without a lot of data. Now, you don't take my word for it. You simply need to Google milk and health. And Walter Willett and David Ludwig are the authors, Harvard researchers, who reviewed all the science and published it in the New England Journal of Medicine, again, the top medical journal in the world, showing that not only was milk not good for your health, not only was milk not good for fractures, but your risk of fracture went up by 9% for every glass of milk you had. So it's actually the opposite. Also, calcium supplements, not so great either. and it's not about the calcium you're eating, it's the calcium you're losing. If you look at what really makes the most difference for bones, it's vitamin D. If there's one thing I would say to you is make sure your vitamin D levels are 50 to 75. That is so important. I say what your vitamin D levels are, not what vitamin D amount you should take because it's different for everybody. Some people might get there with 1,000 units of vitamin D. Some people might get there with 5,000 or maybe 10,000 based on their genetics or their absorption or various issues. don't think that milk's going to help you, number one. Take vitamin D, number two. And number three, understand that you need to have not only the right nutrients in your diet, but you need to exercise. And before I get into the exercise piece, I just want to come back to this calcium issue. If you look at calcium intakes, for example, in Africa, they might have 300-400 milligrams of net calcium intake a day, but they actually have very, very strong bones. Now, if you look at American intake, they're saying take 1500 milligrams of calcium a day. Well, it doesn't matter how much you're taking in, it matters how much you're losing. And we have a calcium-losing environment. What do I mean by that? Well, if you have sugar, if you have caffeine, if you have alcohol, if you have soda, it's the worst. like the colas particularly have phosphoric acid in them. That causes you to lose tremendous amount of calcium. If we eat an acidic diet, which is processed food and sugar and so forth, that acidity causes you to lose calcium. So basically peeing out your bones, literally peeing out your bones in your urine. And we actually can do a test to measure this. I do this with women who come to see me with osteoporosis. I measure their urine levels of certain markers. that tell me that their bones are dissolving and are coming out in their urine. So it's really, really important to not look at the total calcium intake, but the net calcium retention. So you could be, for example, taking in 300 milligrams of calcium and losing 200. That means you're up 100. If you're taking in 1,500 and you're losing 1,700, you're down 200. So it really matters what your net calcium absorption versus your net calcium loss is. And then all those things I mentioned are the things that cause calcium loss. There's lots more. Really important to look at your diet as a key factor and making sure you're getting a nutrient-dense diet, making sure you're not doing the things that cause you to lose calcium, and make sure you're taking adequate vitamin D. Now, you say, why do I need vitamin D? Because hunter-gatherers never had vitamin D and they didn't have bad bones. Why do I take vitamin D? Sure, if you want to go around in a loincloth naked outdoors most of the time hunting and gathering, and getting sun exposure on your whole body, go ahead. Or if you're going to be living in a coastal area, if you're eating only wild, wild fatty fish all the time with lots of vitamin D, okay. If you're hunting and gathering and eating like tons of wild mushrooms, you're probably okay. But most of us don't do that. So most of us live and work inside and we need plenty of vitamin D and we can get it through vitamin D supplements. I, unfortunately, we have, I think we have to take them. It's one of the most important things we need to do. We also have so many other things like immune function and, and COVID prevention and many other things. I mean, in fact, one study, I from Israel. They found out their vitamin D levels were over 50. There was zero death from COVID It's a really critically important nutrient. You kind of have to make sure you're not actually losing calcium, that you're actually getting vitamin D, and that you're then exercising. You can do all the right things, but if you actually are not exercising, it's like putting all the ingredients for soup in a pot on the stove, but not turning on the heat. You're not going to make soup. It's just going to bunch of ingredients in the soup with no, I mean, in the pot with no soup. So, you have to turn the heat, and that's exercise. I've seen women, even at 70 years old, take seriously exercise. One started like a Vinyasa yoga practice, like a power yoga practice. She increased her bone density by 10%, which is more than any of the drugs you'll see. Now, you mentioned you don't want to be on hormones, it's too late for the hormones. Well, that's not true. You can sometimes use hormone therapy like estrogen, progesterone, testosterone. By the way, testosterone is a great bone builder and a lot of women have low testosterone and women can actually take testosterone. Women had testosterone, men have estrogen. It's not like it's sort of a binary thing. It's just that women tend to have more estrogen, obviously, and men have more testosterone, but you have to have the right balance for your sex. So you can, through a number of lifestyle factors, really, really improve your bone density at any age. There are certain things that really tend to cause osteoporosis that are concerning that may be not thought of, like for example leaky gut and gluten. Gluten is a huge factor because it causes all kinds of problems in the gut, absorption, and a lot of osteoporosis risk comes from gluten issues, which by the way may affect up to 20% of the population in some level of gluten sensitivity, or we call it non-celiac gluten sensitivity. Like 1% has true celiac and that they're really at risk, but even the non-celiac gluten sensitivity people have an issue. So, you know, you want to make sure you're really taking your bone health seriously. And that's why, you know, I really doubled down on my exercise and strength training, and I really focused on it, and I really, I made sure that I really take adequate vitamin D and exercise, and my bone density, it keeps increasing, which is amazing. So even as I get older, I get better.

Osteoporosis is a condition. that you don't want to have. You want to preempt it. You want to, you want to, the horse out of the barn. By the time you lose your job.

I mean, it's really the thing that often ends up killing people because if you're old and frail, you fall, you break your hip, and you end up with a blood clot, and you get pneumonia, and it's really a killer. And life expectancy a year after a hip fracture is dismal. It's like worse than cancer. It's like 50% life expectancy. So, it's no joke. you know, there's about 10 million Americans that have osteoporosis, and about 43 that have osteopenia or low bone mass. That's like 53 million Americans who are headed for disaster. And it's one of those things that most doctors don't check. They don't really think about until the horse is out of the barn and you've already broken a hip or you've already got osteopenia or osteoporosis. And often it can start early.

Yeah.

So why are we seeing this incredible rate of osteoporosis? Because you know, we as a society drink so much milk and have so much calcium, and we should, we're told to take calcium, but what is going on? Why are we seeing these incredible rates of osteoporosis?

Yeah, well, you bring up a really good point, which is that most patients and most doctors think, oh, I just need more calcium for osteoporosis. I need to drink more milk for my osteoporosis. And I'll never forget it when I was in my primary care practice, I had a patient who was an older woman who had severe kyphosis. So she was, you know, had the hunchback.

Yeah.

And guess what her guess what she did for a living? She was a farmer and her family had a dairy farm. And she guess what? She drank milk every day of her life and she had the most severe case of osteoporosis that I've ever seen.

It didn't work out so good for her.

Exactly.

Right.

And I think as I mentioned earlier, as we were talking, is that for every 200 grams of milk that you drink, you have a 9% increased risk for osteoporosis.

Okay, so every glass of milk that you have, you increase your risk of osteoporosis by 9% of a fracture or osteoporosis? A fracture though. I mean, this is incredible. I encourage people to check out this brilliant article in the New England Journal of Medicine. You can just go online and Google, it's called Milk and Health by Dr. David Ludwig and Walter Willett. and it really is one of the most well researched, profound analyses of all the data on milk and whether or not there's any data to support its health benefits. And I do believe it's nature's perfect food, but only if you're a calf, because for humans and adults, it seems to cause a lot of issues, including osteoporosis, so it doesn't decrease fractious. So, but that's not the cause of osteoporosis. osteoporosis. What are the, what are the real causes in our society of osteoporosis? Why are we seeing these high rates? Because it seems like a design flaw. And why, why are we seeing such.

High rates of osteoporosis in this population? Well, I mean, there's, there's the, the risk factors for osteoporosis, obviously, as you get older, you will, you know, you will lose some bone mass.

I mean, that's part of the Aging process. And I always want to look at the risk factors. So women are more prone towards.

Is it aging or is it, is it what we do while we're aging? Inflammaging. Inflammaging. Is it, is it what we do while we're aging that makes us faster. Yeah, actually it's inflammation. Chronic inflammation is one of the big things that's tied in with osteoporosis. And there's a term called inflammaging. So as you age, your body can develop more inflammation. So chronic low-grade inflammation, patients who have colitis, patients have rheumatoid arthritis, are at higher risk for osteoporosis.

Patients have heart disease. That's right. Yeah, absolutely.

That's right.

Absolutely. So there's this phenomena where where we're seeing high rates of osteoporosis. And as I dug into it, one of the things we had to do at Canyon Ranch is we had to give lectures three or four times a week. And one of the lectures I gave was on osteoporosis. I got really smart about it. And we also at Canyon Ranch, it's a lot of preventive screening. And we used to do a lot of DEXA scans. Now, DEXA scan is a special machine that is a low dose X-ray. It's like flying across from New York to LA, that amount of radiation you get when you fly in a plane, very low dose. and it looks at the bone density. So you can see on this very low dose x-ray whether or not you have thin bones or strong bones and where they're weak or where they're thin. And so we treat a lot of patients, but I gave these lectures and started looking, why are we seeing such high rates in this society? And we came up with so many different factors. Our diet, we know that sugar, alcohol, caffeine, salt, and even what is consumed in massive quantities is about 10% of our calories is soda, phosphoric acid in sodas and the colas is incredibly dissolving of your bones. Stress makes your bones soft. And of course lack of activity, we're all sedentary, we don't use our bodies. And you mentioned aging, but if you keep up your muscle mass and if you keep up your activity level, you can maintain your bone mass. We often talk of osteopenia or osteoporosis, we don't talk of sarcopenia, which is a loss of muscle. And that's what goes along with bone loss. So you have all these factors and we're literally peeing out calcium in our urine because in some countries like in Africa, they have intakes of calcium of 200-300 milligrams a day, but they don't really have osteoporosis. Here we have intakes of 1000 or 1500 milligrams a day and we see high rates of osteoporosis. What's the difference? It's not the total calcium, it's the calcium balance.

Exactly.

It's what you're peeing out compared to what you're taking in. So in Africa, they're not doing all these bad things and they're not losing their bones and their urine. And we actually have tests where we can measure if you're peeing out your bones. Yeah, exactly.

We do that at the UltraWellness Center.

Bone resorption test. We measure markers of increased bone turnover because there's this constant dance between bone build up and bone breakdown. breakdown. Exactly. And so we've got to kind of make sure we're constantly pushing the bone.

Build up and not so much the bone breakdown. Exactly. Yeah, the osteoclast, the analogy of is like somebody building a wall and osteoclast, which are the cells that break down bone, and then there's the osteoblasts, which the cells that build up bone. And normally our bodies are constantly doing it in a balanced way. So, there's just as much bone breakdown, turnover, and then you rebuild the bone. When you have too much osteoclastic activity, which happens in chronic inflammatory conditions, then what you're doing is you're breaking down more bone than you're building up. And the other important thing, which is also it's not actually determined by DEXA.

Scanning, is the quality of the bones. Yeah, so tell us about the quality of the bone because you can look at a scan and see it's good.

Or not good, but what if it's more fragile or brittle? Exactly, so you want flexible bones.

You want bones that bend.

And you want bones that are a little more rubbery, if you will.

Yeah.

Because. And I remember this very well because when. When I was in my training, one of the things that they used to give for patients with osteoporosis was fluoride. Do you remember using fluoride? And what they found is that, guess what? You did get denser bones with taking fluoride. But guess what? The bones were more brittle. Yeah.

So they broke.

Yeah.

So you want actually healthy quality bones, not just the density, but the quality.

The bones. And what determines the quality?

The connective tissue that's in the center of the bones. It's not just the calcium, it's the connective cartilage tissue that's in the center of the bones that makes it healthy. And that's also, this is a very simple thing to remember is one of the big things that increases a person's risk for osteoporosis is smoking. And I always tell my patients, you know, you ever see somebody who's a chronic smoker, what do they have? wrinkles. Okay.

They get more wrinkles.

Right.

Smoking upregulates matrix metalloprotease enzymes, which are breakdown collagen. And that's why patients who are smokers have higher risk for cardiovascular disease, higher risk for osteoporosis, because they're actually breaking.

Down their connective tissue. Wow.

Yeah.

That's another reason to stop smoking. Exactly.

Right.

Well, actually, one. It's all. It's funny because if you have a woman who's a smoker, they oftentimes, one of the things I'll tell them is, well, you don't want to have wrinkles and they'll stop smoking because, you know.

The vanity, I name is woman. That's right. That's right. Well, you know, you mentioned something I want to come back to, which is this whole idea of inflammation. And we've talked about all kinds of conditions on this podcast in the house call. And the truth is most chronic illnesses are related to inflammation, heart disease, cancer, diabetes, dementia, depression, autoimmune disease, obviously. But osteoporosis just seems a little bizarre.

To be related to inflammation.

How does that work and how do we identify what the factors are that are causing the inflammation that leads to osteoporosis?

There are measures that you can do to check for sort of low-grade inflammation, things like HS or high sensitivity C-reactive protein, looking at their diet, so an anti-inflammatory diet helps to decrease inflammation. Looking at essential fatty acids are also important. Looking at whether or not there's any silent gut inflammation. When you do stool analysis, you can check for markers which I call CRPs of the gut, which is Calprotectin. So, if you have chronic low-grade gut inflammation, that's going to potentially increase your risk for osteoporosis. If you have sort of low-grade osteoarthritis, rheumatoid arthritis, which is more severe than osteoarthritis, it's more of a significant joint destructive inflammatory arthritis. Those are things which break down bone very, very slowly. It's like a slow leak.

And our American diet is, our standard American diet is a very inflammatory diet of processed foods, sugars, refined oils, and lack of protective anti-inflammatory foods, which are the phytonutrients and plant foods. And so we get this incredibly upregulated immune system, which is why we're all suffering from COVID in America. We've over 11 million cases, over a quarter million deaths to date, as this recording. And I think we're uniquely susceptible because we're so inflamed. And osteoporosis is one of the the victims of inflammation. Our bones are one of the victims. And it's from leaky gut, it's from our processed diet, it's from lack of protective foods. So we really have an opportunity to really change that dynamic and shift the balance from bone breakdown to bone build up. Right?

Exactly. Healthy bones.

Yeah.

And you know, how do we normally treat this with traditional medicine? What is the general approach in terms of diagnosis and treatment?

Well, diagnosis, as we mentioned, is really with DEXA scan. And I always I always like to emphasize, especially is women tend to have osteoporosis more than men, but men can get osteoporosis, you know, and there's certain medications that can do that. But I actually think that one of the ideal things to do is to actually get your bone density checked when you have no symptoms whatsoever. When you're at Peak bone mass, which is around 30 to 35 years of age, you want to know what your bones are then. What your Baseline is. Right, exactly. Because I, I can't tell you the number of times that I've seen a patient and they're a woman, especially a woman, they're entering into menopause. I have you had your bone density test checked? No. Well, I said, well, you need to actually have that checked. And if you have one when you're at peak bone mass, which is around maybe 20, 25 to 30 years old, and then you get one as you're entering menopause or the perimenopausal area, then you can see, okay, where are your bones going? Where are they going? You have two points. One data point doesn't show you much. Two data points show you a trend of is going up, going down, staying the same.

Very, very important information.

So make sure you get your bone.

Density early and at intervals that are depending on what your bone density shows. If you're great at 30, you can probably wait till you're 50. But if you're menopause, you want to check more.

And men, men, men get osteoporosis, too. Absolutely. Men get osteoporosis. It's not exactly. Anybody can get it. And, you know, again, you know, high levels of alcohol, high levels of caffeine.

The PPIs, which acid blockers. Acid blockers, big ones. Okay, that's the third leading most prescribed drug in the world and it's an acid blocker. And if you take this for hypertension or reflux, you're gonna get osteoporosis because you're inhibiting mineral absorption. That's like Protonix, Prilosec, Aciphex, Nexium, all those drugs.

Chronic steroid use is a big risk factor for osteoporosis, a huge one. And then as I mentioned earlier, smoking and then just sedentary lifestyle. If you're not stretching your bones, you're not putting stress on your bones. There's a, I remember when I was in my training, use it or lose it, basically. Use it or lose it. And there's, there's actually a interesting thing. It's called wolf's law, which is that bone responds to stress. And I remember reading this, this, this article looked at astronauts. They were in their, you know, young, you know, 30 years old, and they went up into outer space. And guess what? In outer space, you float around. There's no stress on your bones. And when they came down on planet Earth, they actually lost a significant amount of their bone loss, bone mass because they were having sort of the body and it says, oh, you know, we don't need our bones. We're just going to jettison. It's like a balloon where you jettison the ballast and you get rid of the bones that you don't need. So, our bodies naturally will make stronger, better bones when we respond and use stress, weight resistance exercise, bands, you know, resistance machines, et cetera, is very, very important for maintaining good bone mass.

Hey, everybody, it's Dr. Hyman. Thanks for tuning in to the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses. to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode. Let's get back to the diagnosis part because you know you do a DEXA scan, let's say you have low bone density. What do you look for next? Because a lot of things that doctors don't often check that we look at here, what do you think about? What are the most common things that.

Maybe a traditional doctor might look at and what are the tests that we might do that are quite different? Oh yeah, so some of the tests that we'll do is the, as I mentioned, the DEXA scan. We will then do urinary bone resorption so we can actually measure the collagen breakdown products like N-Telopeptides in the urine. Basically, you're peeing out your bones. Exactly. When you lose your bones, you pee them out. That's exactly right. You can do that. Measuring the vitamin D level is very, very important. That's another vitamin D helps to regulate calcium and calcium metabolism. Far more important than calcium. Yeah, way more important than calcium. And then the other thing that's also important is to realize is that you do not want to take too much calcium. And I actually tell my patients, I don't want you actually taking a calcium supplement most of the time. I never want you getting it through your diet.

Yes, exactly.

And if you do take it in a supplement form, you probably don't need and you don't want to go over probably about 600, 500 to 600 milligrams. And there's studies showing that women who are taking higher doses over a thousand, like 1200, 1500 milligrams, they actually get more calcification in their arteries, too.

Yeah, well, that's the calcium is the nature's Band-Aid. So wherever there's inflammation, calcium goes. And so when you talk about hardening of the arteries, it's so many calcium buildup in the arteries.

Exactly.

Exactly. So that's not good. So we look at vitamin D, we look at the bone density, we look at the bone resorption, we look at.

Vitamin K. Vitamin K. Vitamin K is.

A vitamin made in your gut and if you don't have a good microbiome.

That can be a problem. Exactly, yeah. So there's actually two forms of vitamin K. There's the vitamin K that you find in plants and the vitamin K that you make from gut bacteria. And vitamin K is traditionally thought of as a vitamin which helps with clotting. but vitamin K actually has an effect on bone density. And, it's very, very important to get adequate amounts of vitamin K. So, you can actually take low levels of vitamin K and that can help with clotting issues, but you need much higher levels of vitamin K to have a bone effect. And, we do the test here, which is a mouthful, but it's called undercarboxylated osteocalcin. And, it is a biomarker for a functional vitamin K deficiency. And this is a test I love to do in patients because people don't know about it.

Doctors don't usually.

Yeah, yeah. Right now, there's only one lab that actually does it, but measuring that can tell you whether or not you have a functional vitamin K deficiency. And I oftentimes, and actually most of the time, if I'm giving vitamin D, I will give vitamin K at the same time. Otherwise, you'll start getting calcium deposition in.

Tissues that you don't want to. That's right. And then there are other conventional things that often get looked at. like parathyroid hormone. If you have a tumor on your parathyroid gland, it causes more bone turnover. If you have certain cancers like blood cancers, but you can look at protein levels in the bread that look like protein can be affecting bone health. And also, people can get weird things like Cushing's or adrenal tumors or brain tumors that cause high steroid levels in the body. So, there's a lot of things that we look at. Most of those don't turn out to be it's mostly the age-related just general sedentary life, bad lifestyle habit, osteoporosis. But we also look here at the UltraWellness Center at a lot of other things that give us clues about why you might have a problem. For example, we look at the gut because if you have leaky gut, you could drive inflammation that causes problems. If you have digestive issues and not absorbing minerals, if you're taking an acid blocker, we care about that. And also gluten is a huge cause of osteoporosis. People don't realize that if you have celiac for sure, but even if you have low grade non-celiac gluten sensitivity, definitely it causes leaky gut, impairs absorption. So there's a lot of things we look at that may be different than what you see in normal practice.

Yeah, it's interesting you say you mentioned that because one of the biggest risk factors is having celiac disease because gluten issues can affect mineralization. and one of my take home things when I do with patients is I often ask them, because I come from a family of dentists, is I often ask, you know, how many fillings do you have? Do you have any cavities? Do you have weak teeth? It's a very common thing. People say, well, my dentist said I have weak enamel. Well, why do you have weak enamel? Well, guess what? Celiac disease is associated with enamel defects. So not only do you have weak enamel, you've got weak bones.

Yeah.

Yeah.

So.

So we do this workup and someone has osteoporosis. And a traditional doctor, what do they give them?

Usually the bisphosphonates. Those are the, you know, things like Fosamax, Boniva, Actonel, those kinds of things. And the interesting thing about them is they have a not, not so good risk benefit ratio.

Yeah.

You can get significant side effects. You can osteonecrosis of the jaw. They're not to be used.

They're not risk free.

They're not risk free.

And there's injectable drugs.

Injectable now.

And also there's Forteo, which is like a parathyroid hormone like drug. And sometimes doctors even use drugs like Avista, which blocks estrogen receptors. They're selective estrogen blockers. And of course, doctors use hormones like estrogen therapy, although that comes with certain risks. And even in men, testosterone therapy. So these are all therapeutic options out there. But we take a different approach in functional medicine. So what would be an approach that we would focus on with osteoporosis, is it different? Where do you start with patients and how do you build up the treatment model for them?

Well, the first thing I get people to do is to start using their bones, start using their muscles. So getting people to the gym, you know, doing some resistance exercise at least three days a week where you're really stressing the bones is going to be the biggest thing. Optimizing their vitamin strength training, weight lifting.

Bands and also body weight exercise like that. You just really need to push your bones.

And at the same time, you're building the muscles and then you're also helping with balance. So, it's not so much that when you fall, because you know everybody falls, okay, but you want to have the muscles and the reflex time to be able to catch yourself so that you don't necessarily break something. That's right.

So, really important to have the muscle mass and the, the, the. It's true.

Yeah.

Yeah.

Core strengthening exercises are so important. People have just so low stability as.

They get older and they lose their balance and that's an important point. And then also optimizing vitamin D levels. And we actually will do some genetics related to that. And interestingly, there are some gene variations related to the vitamin D receptors. So people who have genetic variations of the vitamin D receptors need higher levels than quote unquote normal. So if you look at the range of normal vitamin D, the standard laboratory is about 30 to 100. And if you're at 32, your doctor will say, oh, you're fine. You have enough vitamin D. Well, guess what? If you have problem with the polymorphisms related to the vitamin D receptor, you need to have that on the higher end. You may need to be up to about 80 to 100 in order to have that, the beneficial effect.

That's right. So we really focus on exercise and strength training, focus on vitamin D levels. We also do a lot with diet, right? Because you want to eliminate the bone dissolving things in your life, in your lifestyle and your diet, and you want to add the bone building things. So what are the bone dissolving things we want to help people get rid of. And we talked about them a little bit, but.

Yeah, well, excess amounts of protein and also if you have acidic urine, you can actually be more susceptible to more or less peeing out your bones.

So.

Decreasing those things.

Which is our processed diet will cause you to be more acidic.

Exactly. And then the green leafy vegetables are very good. And then, you know, things like sardines, which are great because they have natural sardines are one of my favorite foods because guess what? They got great protein, they have great Omega-3s, and they have great calcium, and it's highly absorbable calcium. So if you want to actually help.

Your bones eat sardines.

Yeah.

Herring, sardines, mackerel. That's what I remember for lunch. I'm having canned mackerel with the ones with the bones in them is even better. Exactly. That's how a lot of the populations who lived on islands would get their calcium. They'd eat the fish bones.

Yeah. Yeah. So.

So getting rid of things like alcohol, caffeine, excess salt, excess protein. too much sugar, obviously all the sodas, the junk food, the food additives, that's so important. And then adding in all the foods that are going to build your bone, like the sardines or herring or mackerel, but also the greens. I mean, where, where do cows get their calcium from? Grass. Grass, right? So you can actually get more calcium, more absorbable calcium from things like tahini, which is sesame seeds. Sesame seeds are probably the highest source. Chia seeds have more. calcium per serving than milk and it's better absorbed plus Omega-3 than fiber. All the dark green leafy vegetables that you mentioned. The vitamin K is also in these green leafy vegetables. So, Omega-3 fats are really important which you can get those from the sardines.

And the fatty fish.

So, a lot of foods that are bone building foods. If you love that last video, you're gonna love the next one. Check it out here.

Alzheimer's may have very different causes.

Dale Bredesen, we've had on the podcast, has talked a lot about the various causes, whether it's inflammatory triggers, mold, toxins, lime, blood sugar issues, insulin, nutritional deficiencies, hormonal dysregulation.