Why Food Is More Powerful Medicine Than Drugs with Maggie Ward

Coming up on this episode of the Doctor's Pharmacy.

Honestly, I don't focus so much on the scale because we know the scale doesn't tell you your body composition. So with everyone, I'm really saying, you know, watch how your clothes fit, especially.

Around that midsection, right? Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman, and that's Farmacy with F-A-R-M-A-C-Y, a place for conversations that matter. And if you care about nutrition and food, you're gonna love this conversation because it's about how food is medicine and how we can use food to help solve so many of our chronic health issues. And our guest today is none other than my nutrition director at the Ultra Wellness Center, Maggie Ward, who's been working with me for 12 years, which is hard to believe, 12 years, Maggie. Wow. She's got a master's degree in nutrition from Bastyr University and she focuses on using whole foods in medical nutrition therapy, which is actually what we should all be doing, treating people with food because it works far better and far faster than most drugs. She is a registered dietitian as well, and she has worked in Brooklyn and many other places at, and she's really focused on the very difficult cases that we have at the Ultra Wellness Center, people suffering from digestive issues, food sensitivities, inflammatory problems. She focuses also on Pediatrics, nutrition and sports nutrition because she's an athlete herself and you don't want to get caught running with her because she'll leave you in the dust.

Not anymore.

She's really been the mainstay of our nutrition practice at the Ultra Wellness Center and I'm just so glad to have her on this special episode of the Doctor's Pharmacy called House Call. And in this series, I sit down with my colleagues at the Ultra Wellness Center to discuss how we as functional medicine physicians and nutritionists tackle specific conditions that are tough to treat but that we do extremely well with. So welcome, Maggie.

Thank you. Thank you for having me. I'm really excited to do this, especially, you know, in these days of social distancing, at least we're connecting a little bit here with our loved ones outside of like our homes. So thank you for having me.

Yeah, it's true. We probably get to see each other.

More on-- I know. I feel like that. We are connecting more.

So this is great. So we're going to dive right in because what we do at the UltraWellness Center in Lenox, Massachusetts, is we focus on how to use food as the core therapy. Now, I probably can't guarantee this is true, but I do believe that I am the first practice that Ulterawanda Center was the first practice in the country, maybe in the world, where you could not see the doctor unless you agreed to see the nutritionist. You cannot get a doctor's appointment without also having a nutrition appointment because food is medicine. And if food is medicine, how can I treat patients without a nutritionist. So that is why it's such a central part of our practice. And we do everything from general nutrition to really focused nutrition for medical therapy for all sorts of different conditions. And we're gonna talk about how we personalize our food intake, our personalize our diets, we use genetic testing, we use laboratory testing, we look at nutritional profiles, and we're gonna talk about various kinds of approaches that we use in functional medicine to get granular about how to treat troubled problems. So Maggie, tell us a little bit about this first patient that you've had that you wanted to share a little bit about what their struggle with around grief, which is a big issue.

Yeah, right, right. And you know, this case I picked it because it's fairly common to what we see. I mean, we see a little bit of everything, especially at the Ultra Wellness Center, but I think it's a kind of common theme, especially for people that come to see me just for a nutritionist, one of our nutritionists. So this woman, she's a 64 year old woman who I've been working with for a while, dealing with some weight gain. That was one of her main concerns. I mean, mild, about 20 pounds overweight, kind of came on around menopause for her. But she also had a very long history of reflux, had been on different medications.

Heartburn, right?

Right, heartburn.

We used to call it heartburn. Now we call it reflux. And the whole industry of drugs and it's like the third, most commonly prescribed class of drugs out there were the acid-blocking drugs, little purple pill, right?

And many you can get right now over the counter, too. So people are taking it, you know, even without a doctor's prescription and, you know, sometimes needed for short term, but unfortunately a lot of people have been on these medications a long time. And I think, you know, we see the negative impact of that so much at our center. So she, you know, she had a long history of the reflux and also dealing with lower energy. She's been on many diets, which we hear so often. People come to us trying many, many different things. And the common theme I hear so much is that way of eating just wasn't sustainable. And obviously we use the word diet just to kind of have that language, but I really don't like that word because I think we tend to think of food as black and white. We're either on a diet or off a diet. And initially we might be asking people to walk a kind of a finer line with their food choices to get them feeling better quicker, but ultimately, eating whole foods, kind of balancing those macronutrients, eating every maybe four hours once you're eating during the day. I mean, those are things that you kind of want to make your lifestyle. And that's, you know, ultimately what we really talk about is how do you make this sustainable for you?

So this is reflux case is so common. You know, the number one reason that people go to the doctor in America is for digestive problems. And reflux is right up there among them. So what are the causes that you see, Maggie, for heartburn and reflux, which is so common in our patient population and in the country?

Right, I think it's multiple things. I mean, from a dietary standpoint, we know a lot of the foods that can cause indigestion and reflux. Dairy is a big one, gluten's a big one. So we do a lot focusing on taking out those foods that might be more irritant to the gut. Those aren't like allergies, true allergies, necessarily.

They might be sensitivities.

More like sensitivities, exactly. I mean, people do definitely have true allergies, What we see is just different ways your immune system can react or even intolerances where you just don't digest the food well. Dairy is a good example of that where lactose eventually gives everyone issue and can cause things like reflux and bloating and gas. So that's definitely a big one. I mean, obviously working with providers doing more testing around breath testing and stool testing to get a sense of dysbiosis, that's a very common thing that we see.

So what's dysbiosis, Maggie?

So dysbiosis is when your bacteria is out of balance in your body and also can often be in the wrong place.

In your gut, usually.

Right, right, in your gut. Many people, what we see, they have that small intestinal bowel overgrowth, what we call the SIBO, and bacteria and even yeast can move further up into the upper GI and definitely cause a lot of distress there.

So normally there's a lot of bacteria in your lower intestine, in your large intestine, but not so much in your small intestine. You've got 22 feet of small intestine. starts at the end of your stomach. And when the bacteria migrate up for different reasons, motility issues, low magnesium, stress, whatever, you end up with this overgrowth of bugs in the small intestine. And so when the food hits there, it should be sterile. But when there's bacteria in there, they go to town, right? They go to town and they ferment the starchy foods that you're eating. And you get this thing called a food baby. Everybody knows what that is. You eat and you get this bloating and discomfort. And that's called SIBO, which is a very horrible condition that so many people suffer from. Right, right.

And that's why I tell people, I mean, all bacteria produce gas. It's one thing if it's down your colon and you can release it when it's up in your upper GI, I mean, it can cause a lot of discomfort. So we see that a lot. And I think that is, again, a big issue with the reflux. Also motility issues. I work with a lot of people talking about how how you eat, slowing down, chewing your food well, doing some deep belly breathing before you eat to kind of relax that vagal nerve that runs along the whole digestive tract. I think that goes a long way. I've had multiple people tell me just by slowing down and chewing better, the reflex has gotten a lot better.

Yeah, well, when you're stressed, your sympathetic nervous system is your fight or flight nervous system. And one of the things it does is shut down your digestive system. Because when you're running from a saber to tiger, you don't want to be digesting your food. You want all the blood to go to your muscles and be able to run as fast as you can. So that's what happens when you eat under stress. And this is, this is why these practices you're talking about, deep breathing, taking a pause, they call it take five. Just take, take five breaths before every meal and see what happens. It's a very powerful reset. In fact, what was interesting when I was writing my book, ultra metabolism, I found that there was this paper that showed that the sympathetic nervous system connects to the fat cells. So this is the stress response. And when you're stressed, it inhibits the fat cells metabolism. So it literally slows your metabolism. So being stressed literally can slow your metabolism and make you gain weight. Right, right.

And, you know, from an evolutionary standpoint, right, that makes sense. I think we're all designed to hold on to our fat, our calories for, you know, to kind of get through those famines, get through those times of stress. But unfortunately, in this day and age, it's usually working against us. So, you know, what I did with this woman, you know, to start was, 'cause she really wasn't aware of if certain foods really bothered her around the reflux. You know, she said alcohol for sure, more stress, she would notice it. So we started with an elimination diet, and that is taking out of a lot of the common food sensitivities, you know, just so what we've seen epidemiologically, what we see clinically. So we took out, now I'll go a little bit more into that. We took out gluten grains, but I actually encourage her to take out all grains. Just because she was dealing with that extra weight, we know blood sugar and higher insulin levels from too many carbohydrates definitely can get in the way of losing that weight. So I just had her take out all grains and many people feel better for multiple reasons doing that. No added sugars, obviously flour. We took out dairy, second in line, usually what people are reacting to. Eggs, corn, and also alcohol. She liked her glass of wine at night. and I just said, let's take a break from that, see how you feel from it, and then we can look at that again, maybe adding that back in. She also had a fair amount of caffeine in her diet. She was drinking about three cups of black tea. So some people can handle that, some people can, but it definitely can be an irritant. So we took all that out, talked about how do we balance our blood sugars, eat lower carb, make sure you get enough protein. What I really focus on, especially for women, is really not losing weight. It's really shifting your body composition because you don't want to lose your lean muscle mass. muscle mass. We really want to preserve and if anything build that. So I really was focusing on getting sufficient protein, the expression on your exercise. We know when you eat sufficient protein after you exercise, that's that window in which you're really going to support muscle growth. Because your protein is going to everything, all your organ needs, your detox system, your immune system. So building protein, and I feel like it's kind of the lowest on the priority list for the body, but if you get sufficient protein after workout, it really helps support that lean muscle mass. And this woman was also diagnosed with osteopenia. so I really want to make sure that we're doing things to support her bones and good healthy muscle is probably the most important thing around supporting bone health. So we worked on that and I did do some testing with her. I wanted to get a little better sense of what nutrients might be impacting her given that she's got this fatigue. I had started her on just a.

Little bit of vitamin D. Before you get into the testing, so she basically started with an elimination diet, getting rid of common food sensitivities and triggers. And we know traditionally in medicine that for reflux, we tell people to avoid alcohol, caffeine, spicy foods, tomato-based foods, citrus foods, and so forth. But it often goes further than that. There may be other triggers like dairy and gluten are very common and often they're not on that list that typical doctors use. And then she was also on this drug Nexium, which is one of those powerful acid-blocking drugs. and when I was in medical school, these drugs just came out about 30 plus years ago. And we were told by the drug reps, never keep people on this more than six weeks. These are super powerful drugs that can disrupt gut function. They're good for healing ulcers, but do not keep people more than six weeks on these drugs. And now people are on them for years and years, and we know that they cause all sorts of problems. So they might stop your heartburn. But one of the most common, quote, side effects is irritable bowel.

Because we need that stomach acid.

We need to change the pH. And so you get different bugs growing. You might get yeast overgrowth in your gut. You might get small intestinal bacterial overgrowth, like we're talking about, or SIBO. You might also develop nutritional deficiencies, which is why I think it's so important. The testing you talk about is so important because when you are taking an acid blocker, you are inhibiting the ability of your body to absorb things like B12 and magnesium and zinc and calcium. So you end up with osteoporosis as a result of taking acid blockers. You end up with SIBO, you end up with even increased risk of pneumonia and all sorts of other health issues. And I think most people don't understand the danger of these medications and how now they're just over the counter. So people think they're fine and safe to take for a long time, but they really aren't. And most of the time, like most of the time when we see patients with reflux, it's just a slam dunk, easy fix by changing their diet. And then of course, there's other issues, we might have to dig deeper. Maybe there's SIBO that needs to be treated. Maybe they have H. pylori, which is a bacteria that can cause ulcers, but it can also cause heartburn and reflux. So we have to be a little bit of detectives, but the basics work so well. And that's why these nutrition focused appointments that we do at the UlTrawellness Center are so helpful for people that often don't actually need, you know, to see.

A physician at the end because they're better just from shifting their diet. Absolutely. And she's a great example of that. I mean, I did start her on some supplemental support from the beginning, we used a product called DGL Plus, which is deglycyrrhizated licorice. It's in the family of these mucilaginous herbs. And what they do is they're nice because they help with those symptoms of reflux, but they're helping to build up that mucosal layer, which is the very top layer on the digestive tract. So they are working to start healing the gut, which is, you know, we're always in functional medicine looking for what is at the root cause. So, started on that. And especially for someone, as you know, like being on these medications for so long, it's hard to get off of them.

Yeah, they're designed like that. They're designed literally. If you take these medications and you try to stop, you will immediately get worse because you get what we call rebound acid production. And that causes worse thing this people, oh, I need it. I need it. There's a way to taper slowly off it using these additional things like you're talking about, Maggie, like DGL plus and others. that are helping to coat the stomach. We use glutamine. In Japan, they use glutamine, for example, aloe, licorice, as ways of helping the gut get soothed while you're tapering down on these medications.

Right, right. And I think we find so much good success using those and then people can start weaning off of them. So we did that. We actually did a high-dose fish oil, too, just because for overall kind of inflammation and a B complex again around her energy because those B vitamins and going back to these medications that lower stomach acid, something like B12 is often impacted because it needs a certain acidic environment and other factors to have good absorption. So we started with that, again the testing, she did an organic acid test, which is a urine test that we can do, and it's really my favorite nutritional test that's out there because it's looking at this Krebs cycle, which is the energy cycle that happens inside your cells, inside your mitochondria. So it's basically where your food gets converted into energy and you can measure the different steps in the cycle, and we know the nutrients that run these steps. By looking at these markers, they're these functional, basically looking at the function of these nutrients to get a sense of certain nutrients are low. I think that's some of the limitations sometimes, which is straightforward conventional testing for something like B12. It often isn't going to pick up a deficiency.

Yeah, unless it's pretty bad, right?

Right, exactly. Unless it's pretty exasperated. with this testing, it's really saying, okay, is that B12 that you have in your system? Is it doing what it's supposed to be doing? So she did that test. The other thing I wanted to point out, and this is more of a medical piece, but in the packet that we ask clients to fill out and patients fill out, there's many, many questions there that we ask. And she had said that she snores at night. So I didn't get into that much in that first appointment, but I did When I sent her her plan, I said, you know, talk to your doctor about maybe doing a sleep study because she also had high blood pressure. You know, that weight was there. We know that, you know, sleep apnea and things can cause weight gain along with the blood pressure and her fatigue. You know, she said she was sleeping a fair amount, but when you're tired.

You start thinking, okay, how good is that sleep?

Right.

So, you know, I think that I want to stop you there for a second because I think what people should understand is that is that sleep apnea is very common. It's underdiagnosed. It causes high blood pressure. It causes prediabetes. And the treatment with CPAP or breathing machine that helps you stop the snoring and opens your airways at night literally will help people lose weight, lower blood pressure, and feel better without even changing their diet. I remember this guy who was a lawyer and he told me that he was struggling to lose weight. And I said, Tell me about your life. What are you doing? Well, I'm a lawyer. I work. I have to work at a stand-up desk. I'm like, why? He said, well, if I sit down, I fall asleep. I'm like, snoring. I said, my wife says I snore. I'm like, okay, let's get a sleep study. We got him a sleep study. He had severe sleep apnea. We got him CPAP treated.

He lost 50 pounds without doing anything else, just simply fixing his sleep. Dr. Right, right. And that's the thing. I think food is always going to be part of the solution for people, but many times there's multiple variables and you have to kind of be a detective. And I think that's what we do in functional medicine is look at these other pieces. I mean, there might be things I can't really address from a nutritional standpoint, but I can guide people, talk to your physician, look at this, look at that. And it's amazing what gets missed when.

You meet with your physician. Yeah, this organic acid test you mentioned is so important. I think in traditional medicine, we use this test, but it's usually looking for genetic inborn areas of metabolism in children who have weird problems with metabolic pathways. but we use this test in a different way, looking at functional status, looking at more small deviations that indicate problems with nutrient deficiencies or different pathways that aren't working or inflammation that we can pick up or troubles with detoxification. Or even we can look at this test to determine whether you have bacterial overgrowth or yeast overgrowth in your gut because you're, you're seeing molecules that are produced by these bad bugs in your gut that then show up in your urine. So this is one of my favorite functional medicine tests. And again, it's something we don't use in traditional medicine. It's what's really unique about functional medicine and our work at the Ultra Wellness Center. And the nutritionists can do this on their own because they understand how to interpret these metabolic pathways. Hey, everyone, it's Dr. Hyman here. Now, I know we're all focused on being as healthy as possible during this unprecedented time, and that means drinking clean water, eating loads of anti-inflammatory foods, and it also means keeping our homes clean. Now, I've been doing my best to keep my family safe while indoors. And for me, this means using an air filter. Now, we know that toxic air particles can contribute to cardiovascular disease, lung disease and even neurodegenerative diseases like Alzheimer's. These toxic particles come from cleaning products and stoves and pet dander and air fresheners and house paint and furniture and so much more. That's why it's super important to filter our indoor air with the highest quality filter around. And a few years ago, I found Air Doctor, which is an air filter that's made my ideal living. And I loved it so much that I bought it and brought it into my home and my clinic. The Air Doctor is the first affordable air purifier that not only removes 100% of the particles, but also the vast majority of volatile organic compounds and gases. It features an ultra HEPA filter, which is 100 times more effective than ordinary HEPA filters. The Air Doctor is a 100% sealed system to ensure that all the air you breathe is pure and filtered. Now, I've teamed up with the makers of Air Doctor to give the Doctor's Pharmacy listeners the best deal yet on this amazing filtration system. Right now, if you go to drhyman.com/filter to access the Air Doctor filter for $329, and that's $300 off the normal price of this filter. And this is their biggest deal yet. You definitely want to take advantage. So head over to drhyman.com/filter to access the deal. Thanks for tuning in. So what happened to this patient after the first time you saw her and put her on the elimination diet? and did these treatments. Right.

So, five weeks later, we followed up and her reflux was gone. So, that's in five weeks. And she had weaned off of the, she was on, I think, Pepcid actually at the time when I spoke with her. And she was taking the DGL. She was taking it pretty regularly, but between the diet and just starting that DGL, I think, made a huge shift for her. So, that, I was surprised to see it because it can take a little while again for to really start feeling better and get off those medications. But she did it quite quickly. She was down seven pounds, which is a lot in five weeks. You don't want to lose weight too quickly. So that's a really good amount of weight to lose.

Wait, is that true? Is that true? You don't want to lose weight too quickly because... Well, I think there's controversy about that.

Yeah, I think it depends on that person. I think initially you can get a pretty rapid weight loss just by dropping your carbohydrates. because we know inflammation, you hold onto water and fluid and can gain weight from that. So I think when you take out these more inflammatory foods, you'll see this kind of rapid weight loss, and that's a good thing. Initially you can easily see a quick drop, but I think in the long run, it's different for everyone, but generally I like to see a slow decline in weight because, again, especially with women, I want to make sure they're maintaining their lean muscle mass. So are they getting enough calories? Are they getting enough protein? And honestly, I don't focus so much on the scale because we know the scale doesn't tell you your body composition. So with everyone, I'm really saying, watch how your clothes fit, especially around that midsection, right? That's that weight builds up right around the belly, that tire that we always call it. And that's-- when you lose that, that's not muscle. You're losing the right type of weight. And I mean, I can't tell you how many times over the years, People say, you know, Maggie, I haven't lost any weight. I'm like, well, how are your clothes fitting? Oh, I went down two pant sizes.

I'm like, you are losing weight. You're losing the right type of weight. And so it's such a better barometer and it's less stressful.

And it can go the other way too. You know, my wife has been working out and she does her clothes still fit her great, but she's gained almost.

15 pounds of muscle. Right. I mean, when I'm in my best shape, I weigh my most because I've got more lean muscle mass on me. So yeah, that's again, where the scale can be deceiving. So we see in these patients, these reflux clear pretty quickly. usually with diet. And then, you know, if sometimes we need to dig deeper, but we really help people taper off these medications. We help them transition to supplements that can help mitigate it. We look for other factors, whether it's nutritional deficiencies or, or bacterial overgrowth or yeast overgrowth. It can be a problem. We treat those things. And it's just such a rewarding practice at the Ultra Wellness Center because we see these people who struggle for years, who think they have something wrong with them that they have to live with forever. They just don't. I mean, reflux is not a normal state for a human being, right?

It's not.

And then you found some other stuff and you replaced nutrients and then what happened?

Yeah, so what came back in the urine acid test is that she was low in B12. I kind of suspected it as well as B6 and B6 is really important in that energy cycle. It also helps us make our neurotransmitters, those chemicals in our brain. So if you don't have enough B6.

You can affect mood and serotonin, right? You're happy, right?

People take serotonin, your dopamine.

Right.

Right. So, and I'd already started her on a B complex, so I just reinforced, you know, really important for you to be on that because we're repleting these, these nutrients. She also came back low in coenzyme Q10, which is a really important molecule in producing that cellular energy. And we do produce it. But I suspect maybe from she had been on statins years ago for higher cholesterol. She came off because she didn't feel well on them and had more fatigue. And we know that low what happens with a lot of these statin medications is they're blocking the production of this molecule. So I added in some coenzyme Q10. It's hopefully something she won't need to be on long term, but I wanted to do it to kind of bump up that energy for her. So that was really helpful to see that in that testing.

Yeah. And so, so then she just needed the, the DGL occasionally, so to symptomatically, but she noticed that she feels better. off the gluten, which was driving the reflux, and her joints felt better. The arthritis felt better, right?

Right, right. So that's, you know, in that second phase after we met, we talked about how do you reintroduce? So that's really, I find, there's a lot of great tests out there for food sensitivities, and we do use them, but I still think the gold standard is take a lot of these things out that we know are problematic, see how you feel, and then slowly reintroduce. And that's where I think you get that aha moment of like, oh, I didn't think I felt better off dairy, but I added back in cheese or whatever it might be, and those symptoms came back. And so I find it really helpful. It's just working with people to slowly reintroduce it. So there's a really more systematic way of doing that. So what she found, we walked through that, and when we talked again after she had done the reintroductions, that's where gluten, she said, I definitely don't feel well. My joints, and I see that quite a bit with gluten, her joints were hurting her again. She had osteoarthritis in her knee. And her reflux, she said she definitely Yeah. and that might be the flour and stuff that, you know, where we get our gluten. She did reintroduce some dairy and she found goat cheese. If she had it maybe two, three times a week, she was okay, but, you know, on a daily basis, she.

Wasn'T digesting it as well. So. Well, so it's interesting you mentioned goat cheese because, you know, we have changed our cows so much over the last 100 years. We used to have all these strange varieties and then traveled around the world and you see these funny looking cows all over the place. Here, they're the same old white and black. Holstein cows, and they're bred in a way that has produced a milk that contains high levels of a form of casein, which is the protein in milk called A1 casein. And this tends to be more inflammatory. It also tends to cause more digestive problems. And when you look at sheep or goat cheese or milk, they are A2 casein, which is far better tolerated, less inflammatory. And I notice the same thing. If I if I have goat or sheep cheese, I'm good. If I have cheese that's not goat cheese or sheep cheese, or I have milk or any kind of dairy products, it's a problem. So I get congested, I get digestive issues, and I think most people will notice a difference. So you're right, it's not all or nothing, dairy or not.

And there's often a tolerance level, right? I think even if she had goat cheese every day, you know, she maybe start feeling symptoms, but she found, you know, what her tolerance level is and, you know, being able to have goat cheese twice a week. It definitely adds some nice pleasure to your eating.

So I think that's important. And this speaks to the whole idea of personalized nutrition and precision nutrition, personalized medicine. I think this is what we do at the UltraWellness Center. So I think this is great, Maggie. I want to get to the next case because we really do so much around digestive health at the UltraWellness Center. And if people are suffering from any kind of digestive issues, whether it's reflux or irritable bowel or something more serious colitis, they just had a patient texted me yesterday saying I gave her this cocktail of a shake that essentially was gut healing shake and she's no more blood. They were going to take out her colon. I mean, they're going to take out her colon and now she's completely fine and it's great because we know how to actually use the principles of functional medicine to restore health and balance. And that's what you did in the next patient. You did a very personalized approach to figure out what this particular woman who is very overweight needed to deal with her risk factors for obesity and diabetes. So can you tell us about the second patient? Sure.

So this is a 48-year-old woman. She had a very long history of being overweight, you know, started pretty young. When I met with her, she was at least about 80 pounds overweight and a strong family history for obesity as well as diabetes. She had a fair amount of joint pain. She said her ankles and her knees, she often would get joint pain and her doctor had said she had some osteoarthritis. She had a very high stress job, I want to say she was a lawyer, I think, so just working a lot and pretty intense. And she would drink alcohol, even smoke a little bit occasionally, kind of just as a social smoker for her stress outlet. And she also did a lot of exercise, which is typically, you know, we think of as a good thing, but she liked those really high intense, you know, like spin classes and things like that. And I think, you know, maybe that was setting her up to have a little bit more inflammation and joint pain. And she had followed very, restricted diets over the years, very low calorie, even taking things for her metabolism. And, you know, we know so often that can have negative impacts on, on people and helping them lose weight in the, in the long run and keep it off. Yeah.

So it's so interesting to see how we deal so differently. And, and the nutritionists that deals on this are deals so differently with weight because historically, it's all been about calories. Calories in, calories out, eat less, exercise more. and if you don't succeed, it's because you don't have willpower. And we, we take a very different approach at the ultra wellness Center with our nutrition approach to weight and metabolism, which is to try to figure out what is right for that person. And, and this was a very unique case because you did some testing that allowed you to zero in on what her particular metabolism required in order to actually optimize her health. And, and we, and we don't really put people on diets. We teach them how to create health. and the conditions that they're suffering from, the way their symptoms get better as a side effect of using the principles of functional medicine to create health for people. Right, right.

So, I mean, we did some basic, you know, low carbohydrate. Obviously, that tends to work really well for a lot of people. You know, I got her on, like, a good fish oil and things for her inflammation. She hadn't been eating Seafood, you know, some basic things like curcumin, you know, which is from turmeric, which is a really good anti-inflammatory but then I wanted her to do some DNA testing because of her family history and and really get a better sense of what might be working against her somewhat in losing weight. So, and the area of neutral genomics, it's rapidly evolving. I think we try to be cautious and aware of, there are a lot of things we don't know yet, but the beauty is just over in the last 10 years, there's been so much research done in this area. And we've been working with laboratories that I think are really weighing the research. These are genetic variations, which we call SNPs, that seem to really have a significant impact on outcome and have some good research indicating that. So, we've really kind of done our diligence in trying to find good lab tests to go look at this nutritional genomic component.

Yeah, I mean, I think there's a lot of companies out there offering genetic testing or nutrition that say, take this test and here's what you should take, here's what you should be eating. And it's often not in the context of the bigger picture of what's going on with that person's health and life. So the functional medicine approach at the Ultra Wellness Center, we really look at the whole picture and the DNA testing is one part of that. It can help guide us into specific recommendations. So it's not just here, take this test and do these things. It's really through the filter of functional medicine.

Right, right. And even with DNA testing, right, you always want to take that into account with the clinical picture, right? So if someone has some of these symptoms that would connect with some of these genetic variations, that's when you really, you know, focus on it. so, you know, you don't want to ever look at one thing in, like, a silo. You really look at the whole person. So I followed up with her six weeks later, and she had been doing better at the lower carbohydrate diet, something she had tried before. We, you know, were really careful, obviously, with those higher food sensitivities that often can cause inflammation, too.

So when you say low carbohydrate diet, I just want you to focus on that for a minute, because I think there's a lot of controversy about it. There's a lot of confusion what that means. I broccoli is a carbohydrate. You're not eating broccoli?

Right, it's a carbohydrate, but it's got a lot less carbohydrates per serving than a higher, more starch, what we call starchy food would have. And a lot of these are good foods, but-- Dr.

It's starch and sugar that are the real problem, right?

Right, they will break down quicker. They will raise blood sugar quicker. So those are the carbohydrates we're more careful with. Things like broccoli, our leafy greens, yes, they do have carbohydrates, but very small amounts. And, you know, they have a lot of vitamins and minerals and things that.

Help us metabolize those carbohydrates that are in there. So, I mean, yeah, I mean, I always joke that, you know, carbohydrates are the single most important thing for long-term health and longevity. And, and sort of jokingly say that because people say, no, I'm like anti-sugar and starch, but. Right. The, the plant foods are made from carbon. That's why they're called carbohydrates. I mean, that's what they do. They take the carbon from the atmosphere, the carbon dioxide. they breathe it in because we breathe it out, it goes into the plant. And that's what the structure of most plants is, is carbohydrates made from carbon, but it's not the quickly, rapidly digested carbs that David Kessler calls fast carbs. These are slow carbs and they have a very different effect. So we're not telling people to have a truly low carb diet in the sense of the volume of foods, but most of the volume of food they're eating is going to be carbohydrates in terms of a plant rich diet. but it's getting rid of the starch.

And sugar, is that right? Right, right. And I do kind of break it down to percentage of the amount of calories I think they would need. So I think for her, I did about 30% of her calories from carbs, which is pretty low, but given her history and the diabetes in her family, I thought that was most appropriate. We did a little bit higher fat and again, good quality, more anti-inflammatory fats because there's a big difference there, too, compared to the processed fats and some of the saturated fats. So that's what we initially did. And she did see some benefit. Not a whole lot of weight loss, but again, like around her middle, she had lost about two inches. And she felt like her joints were getting a little bit better. And I'm sure that's because inflammation was coming down and the right type of weight was coming off. But her genetic testing was really, really interesting. There are a few things really stood out. She needed a lot of support. with detoxification. And, you know, in this day and age, I'm really focusing on detox support with everyone, but some of the people we see are, from a genetic standpoint, have a lot more of an impact from those toxins in the environment. And it's an area you really want to focus on because it can cause weight gain. And, you know, as women and our hormones and our estrogens and we do carry more fat in general, you know, we have, I think, more of that impact from these toxins. So I really shifted my focus over to her, really thinking about foods and other things we could do to to support detox, moving those bowels well, I mean, sweating, you know, why our exercise is good, but, you know, we can do saunas and things like that.

So Maggie, two things. One, you know, there's a whole class of, of these compounds that we're identifying that are obesogens. They're environmental chemicals that come from our water, from air, from Plastics, from Cosmetics, from pesticides. These, these are, are compounds that seem to interrupt metabolism. So toxins cause weight gain. I did write about this because I was this in my patients. And then the literature is just increasingly abundant about how these environmental toxins are driving obesity and diabetes. So the fact that you found this on this patient allowed you to really customize her diet. So what were the specific foods that you recommended that helped the detoxification pathways for this patient?

Right. Plants, you know, but mostly cruciferous vegetables. We know, you know, a lot of the compounds in there like sulfur, sulforaphane, push these pathways known as sulfation through the liver. It's a really important pathway to support. And that was a genetic marker that came up is that she had issues with sulfation.

So what are these cruciferous vegetables you're talking about?

So your broccoli and your cauliflower, cabbage, kale, there's quite a bit. And I always- Russell sprouts, kohlrabi. Russell sprouts, broccoli, actually broccoli sprouts too is some of the richest sources. You can get these sprouts too. And I think, yes, you can take this in a pill. And I did actually recommend it for a form of sulforaphane. But I'm sure there are compounds in our food that we have not discovered and work synergistically. So, I never want to say take a pill over food. It's food, and then if you can add in a pill. So we really ramped that up. We did more allium foods, which are your garlic, onions, leeks, scallions. There's quite a bit in that family. A lot of reasons why they're good for you, but they're high in sulfur, so they support the sulfation pathways. And again, also getting enough protein. I think many people that we see because they're needing more support with detox or their immune system is compromised, everything's built from these amino acids. We talk so much about glutathione being this really powerful detox molecule that we make in our body, and it's a tripeptide, it's three amino acids. So when you have more of those building blocks, you can support those detoxes.

And can you get those from plant proteins or is it More analog.

You can. I mean, I do a combination and it really depends, I think, on each person, you know, and what diet they feel comfortable with what they, you know, so we fine tune it. But, you know, whether, whatever amount of protein I'm recommending, I find a way to get them up to that based.

Off, you know, what they feel they do best with. Yeah, it's interesting. You know, whey protein has been traditionally recommended to help boost glutathione and these detoxification pathways, but people often don't tolerate it. but I found there's a goat whey protein, which some patients do a lot better with. So you can, you know, kind of pack the system a little bit.

Right, right. And yeah, I mean, whey, as you know, has so much research on it behind not just detox support, but athletic performance, Cachexia that you see a lot in, you know, when you get that wasting of the muscle and things like cancer. So I do recommend it. And often, you know, around those workouts, too, again, getting enough protein after you exercise to support repair and muscle growth. so yes, whey can be an excellent source of these proteins. So we really dialed in there and focused on the detox support. The thing that I found most interesting and really helped me fine tune her diet was that she had at least two genetic markers that indicated she had a harder time metabolizing fat. So breaking down her fat stores, expending energy from that, and just not doing as well with that.

Eating fat or her own fat tissue?

Both. Both. She had more fat receptors on that when she eats fat, she's going to be more likely to store it. And that I found really helpful because typically we're really watching those carbs and I think still for her it was important, but that's where I kind of tweaked her diet and I brought that fat down a little bit and brought the protein up a little bit more. So we just adjusted those macronutrients and I really wouldn't have had that insight without this genetic test.

And what happened when you customized that for her? Did you see a better result?

She started doing better. She started doing better. And I think, too, it was also she was nourishing herself. She was getting enough calories. We were focusing on detox, and we were also focusing on stress reduction. You know, she had that alcohol and the smoking as her outlet, which now she knew from a genetic standpoint, she really doesn't do well with that. So, it gave her that extra motivation to let those things go and find other outlets around her stress. And that's what I find too. There are certain genetic markers that come back so often for people that indicate they're not doing well with their stress. They have a bigger impact from their stress hormones like cortisol and adrenaline. And like you were just saying, that stress also brings up your blood sugar and impacts those fat cells. So we really focused in on, okay, you have this job, But what are some more healthy outlets to help minimize that impact of stress on your body that's more helpful for you? And I think she just seeing that and explaining that, it gives so much more information about themselves and motivation to make it.

Yeah, and the genetic testing is interesting because this is not genetic testing that say, well, you have Down syndrome or you have some hard fixed genetic disorder. These are traits that can get expressed and can be changed by your lifestyle or by various supplements or other interventions. So these help us as functional medicine practitioners to personalize our approach. For example, I have a gene that makes it difficult for me to methylate, which means I can't convert the folate that I might get from food into the active form. So I need an extra special kind of folate. Or I also have the gene that prevents me from detoxifying. So I'm always eating every day at least a cup or two of cruciferous vegetables. And I also take N-Acetyl Cysteine because I know my genetics and I can personalize this approach. And I think this is what we do at the Ultra Wellness Center. And these are simple tests. They just use a little cotton cheek swab and put the thing in the test tube and send it in. It's really simple. And it's so effective in helping people understand where they're, I call them potholes, where are the things where you might have a predisposition to a problem. And then how do you customize it both in terms of, you know, dietary a customization, but also what supplements you may need, what things you really want to be aware of in terms of diet and on, and other lifestyle factors. So I think it's, it's such a powerful tool for us in functional medicine. We don't test every Gene. We test the most common things that we can do something about that have an impact that can be modified through lifestyle, whether it's the diet of exercise you do, the type of diet you're eating, whether the supplements you're taking, whether maybe you, you should be more aware that you want to avoid for example, certain types of chemicals or pesticides, you're not good at detoxifying or charcoal broil stuff. If you have a certain lack of an enzyme or a weak enzyme, then you shouldn't probably be charcoal grilling your vegetables even, forget the meat. And I think this is something we can determine from these tests and it really helps us personalize the treatments.

Right, right. And that's what we say, you know, your genetics is in your destiny. You can alter how that gets expressed and you always use that expression. and food as information. It can support certain pathways. It will turn on and off genes that either can be helpful or be detrimental. And obviously we're supporting turning them on in a way that's going to be helpful for us.

The genes load the gun and the environment pulls the trigger. That's something we can modify.

And I think it's empowering. A lot of people get worried about, I don't want to know my genetics, but they're thinking about some of these are high penetrance genes, like you were saying, that you can't always alter that much. But these you can. You can do things to lower your stress. You can do things to support detoxification. You can take supplements around methylation, which we do so much. And actually, that's one of the things I added in for her was more methylation support given some of her genetics. And so it just, I think, was very empowering to make some of these changes. And I think it validated a lot of what she's dealt over the years. Not that it's just that she's not exercising enough or she's eating wrong. She had these things that she wouldn't have known about otherwise and needed to eat in a way and actually exercise in a way than she had been doing. So we actually, I tweaked her exercise and kept some of that high intensity in there, but doing more yoga and stretching and recovery and hiking, things that were less stressful on her body in general, but also it helped with recovery and and stuff too, because there was such great variation saying she was a little high risk for some injuries too.

So, Maggie, you're the nutritionist at the Ultra Wellness Center. Yeah, I mean, Maggie, you and the nutritionist at the Ultra Wellness Center do such a great job at the Ultra Wellness Center. And I, you know, maybe you could just spend a minute sharing the kinds of services that we offer that can help people customize their nutrition and deal with many chronic health issues, not just weight, but all kinds of issues that actually is the first step. even before you may need an actual medical consult.

Absolutely, and that's a lot of people, when they contact us initially, the people upfront will help try to determine, have you worked with a nutritionist? What are you dealing with? Maybe that's the best place to start. And we've always been able to do more phone remote consults. So that's also helpful for people, especially in this day and age of COVID-19. So we offer just initial consults just with nutrition and doing a lot of the stuff we just talked about. You don't have to do testing, but again, if you're able to, and want to really get a little more information, we offer different nutritional testing, genetic testing, food sensitivity testing. So really, depending on the person and what they want.

There's a lot of things you can do without even having to actually see the doctor that allows you to personalize and customize your nutrition.

Right, absolutely. And then if we get to a certain place and there's still things going on, that's when I'll say, it's probably good to connect with an integrative or functional doctor and give them some direction around that. And I also guide them, again, we were talking about doing the sleep study to look at that possible sleep apnea and also say, you know, talk to your doctor about getting some of these other tests. And many doctors are willing to work with their patients, you know, if they request these things. So, you know, we try to partner too with their physicians. So we do that. We're actually, you know, with everything going on and having to work more remotely, we're putting together different packages now for people to do nutrition that incorporates more than one consult and also some testing. so it kind of is a bundled deal and trying to make it as affordable as we can for people with everything going on right now.

So should people go to the Ultra Wellness Center website, ultrawellnesscenter.com, there's a get started tab and they can learn about all these different approaches.

We are in the midst of doing that, so that should be up and running very soon. I just, with Lisa, one of our other nutritionists, we just wrote a blog about nutritional genomics, so check that out. That should be up very soon.

Shortly. We'll post that in the show notes. We'll post the links of how to actually access the Ultra Wellness Center and all the various nutrition consults and services we have in the show notes that.

Are accompanying the podcast. Dr. Great. Yeah. So, I know we're adjusting that website with everything that we've been dealing with COVID-19. So, there are a lot of updates. So, definitely check that out. And you can always call the office. You know, they will walk you through the different things that we have available and try to connect you with the service that they think will be best for you.

Well, thank you. And thank you, Maggie, for being so great and sticking with me for 12 years. And we're going to keep working together a long time, I think. You're just the best. And the nutritionists we have are just a world class and they have a unique perspective because they work with among the leading functional medicine doctors in the world and learn so much from them. And there's a collaboration. We learned so much from you. and we work together with our patients in a very unique way. So, I'm so really thrilled that you joined us on the Doctor's Pharmacy in this special episode of House Call. If you love this podcast, please share with your friends and family on social media. Leave a comment. We'd love to hear from you. Subscribe wherever you get your podcasts and we'll see you next time on the Doctor's Pharmacy.

Thanks, Mark. Stay safe.

Hi, everyone. It's Dr. Mark Hyman. So, two quick things. Number one, thanks so much for listening to this week's podcast. It really means a lot to me. If you love the podcast, I'd really appreciate you sharing with your friends and family. Second, I want to tell you about a brand new newsletter I started called Mark's picks. Every week, I'm going to send out a list of a few things that I've been using to take my own health to the next level. This could be books, podcasts, research that I found, supplement recommendations, recipes, or even gadgets. I use a few of those. And if you'd like to get access to this free weekly list, all you have to do is visit drhyman.com/pics. That's drhyman.com/pics. I'll only email you once a week, I promise, and I'll never send you anything else besides my own recommendations. So just go to DrHyman.com/picks. That's P-I-C-K-S to sign up free today. Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. this podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Don't forget, there's a way to listen completely ad free with Hyman Plus on Apple podcasts. You can enjoy every episode without any breaks, just open open Apple Podcasts and tap Try Free to start your seven-day free trial.