← The Dr. Hyman Show
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- [00:00]
Dr. Mark Hyman
Coming up on this episode of the Dr. Hyman Show.
- [00:03]
Dr. Liz Lipski
When you have the wrong bacteria and the wrong yeast levels, you can get a lot of bloating after you eat. You can get a lot of fatigue after you eat. You can get those symptoms of constipation and diarrhea and that causes this inflammation in the digestive system. So all of your digestive enzymes don't work well.
- [00:22]
Dr. Peter Attia
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- [01:14]
Dr. Mark Hyman
Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects to help you better understand. Well, you if, if you're looking for data about your biology, check out Function Health for real time lab insights. And if you're in need of deepening your knowledge around your health journey, check out my membership community, the Hymen Hive. And if you're looking for curated and trusted supplements and health products for your health journey, visit my website@drhyman.com for my website store for a summary of my favorite and thoroughly tested products.
- [01:49]
Dr. Liz Lipski
Now, people don't understand how so many of our issues come from the gut and how easy it is to diagnose it and treat it. And, and we use tests that traditional doctors just don't do. Like we have a different set of lenses, a different set of of filters that we can sort through information and data and ask Questions that traditional doctors can't. Like, how do you measure leaky gut? How do you look at the microbiome in the gut? How do you look at the digestive function in the gut? How do you actually start to treat it in a different way? And I think your, your, your first case is just so rich with a story that is so common that I just love you to share this because I think everybody's going to resonate with this story. And by the way, I've never seen this patient as your patient, but I've literally seen the same story a hundred times or maybe 500 times or a thousand times in my practice. Same freaking story, right? So tell us about this person.
- [02:43]
So it was a 24 year old gentleman who came in to see me and was really struggling over the last year with his digestive system. He was having a lot of bloating and gas pain in his stomach. Every time he ate, he was having diarrhea and sometimes he was getting constipated. And he went to his traditional GI doctor and they told him, you have irritable bowel. But he wasn't getting any better. Right. And he was just really, because he was having so much stomach pain, he had lost some weight, so he wasn't, you know, he was on the thin side to begin with, but because he was having stomach pain when he ate, he wasn't able to eat as much and he was even losing more weight. He was feeling really weak and tired and sad, depressed. Right. And so for him, the time. Well, for everyone, the timeline is so important. Right. That's what we learn in functional medicine is the gathering that information, learning about that individual patient's story, seeing.
- [03:45]
So we start with a history with the mother and her pregnancy and the birth and where they breastfed and when they took antibiotics, whether they were sick as a kid, what happened when they were introduced to food, when they got gluten, when they got dairy. We ask all these questions. So when someone comes in with an irritable bowel, the average GI guy is not asking all these questions. So why do we ask all those questions?
- [04:04]
So, you know, because for this gentleman, for example, you know, he really didn't have stomach pain before a year ago. But, but what we found out is that when he was a kid, he had ear infections. So probably because he was eating dairy. Probably. Right. So it's such a common connection.
- [04:20]
Oh my God. I remember once being in the er, Liz, and this patient came in and this little boy keeps coming back and like the toddler was coming Back over and over to the ER with ear infections and just so inflamed. And I said, how was he? Like, did you breastfeed? Yeah. So when did he start getting the ear infections? When we started formula and dairy and milk. And I'm like, oh, okay. And this is even before I knew about functional medicine.
- [04:43]
I know.
- [04:44]
And I was like, well, maybe you shouldn't eat dairy.
- [04:46]
Dr. Will Cole
Yeah, yeah.
- [04:47]
Dr. Liz Lipski
The kid was fine, you know.
- [04:48]
Right. It's. That's such a, such a common connection. I mean, even my son with. When he started dairy, he got asthma and eczema. It was, it's, it's unfortunately such a common connection. So for this child, he had a lot of ear infections and eczema. And so he was on antibiotics about once or twice a year in his childhood. And he really didn't think that was very much. He's like, that's not, you know, that wasn't too much. But it makes a huge impact on the microbiome as we're learning. And then he started to have acne as a teenager, maybe because of dairy more. Right. Or some of the imbalances in the microbiome. Right.
- [05:28]
When you screw up the gut with antibiotics or a C section or lack of breastfeeding, then you get often more acne. And we treat acne from the top in as opposed to the inside out, which is actually where it works much better.
- [05:42]
And this gentleman was given low dose antibiotics for two years, so then he took even more antibiotics. And so this history of antibiotics sort of set him up. And about a year ago, he had some sort of stomach bug, so some probably viral stomach infection. And then since that time, he started to have all these digestive issues and was losing weight.
- [06:04]
And so this is a common story. People are this sort of smoldering a bunch of insults over the course of their life. You know, maybe they're a C section, they had antibiotics as a kid, they took acne antibiotics, they had, you know, they were eating a crappy diet, whatever, and then all of a sudden something happens and then boom, the body can't take it anymore and it creates some kind of disease.
- [06:24]
Yeah.
- [06:25]
But if you look at the story, you can often map out exactly how this happened.
- [06:28]
That connection with his acne, with, with his asthma, with his digestive issues with those antibiotics. That's that story we often see.
- [06:37]
And we're not making this up. There's so much science that shows that your gut microbiome plays a role in acne and eczema and asthma, that it plays, I mean, we're actually doing this at clinical clinic now. We're studying asthma and looking at how the microbiome plays a role and how it affects inflammation. All these various factors that most doctors just don't pay attention to.
- [06:54]
Right. So with him, as we do with most of our patients, we do food first. Right. So we said, okay, we've got to really focus on this person's diet and help him start feeling better right away.
- [07:06]
Dr. Will Cole
So.
- [07:06]
Dr. Liz Lipski
So he can start to eat more and regain some of his strength. So we pulled away inflammatory foods. We took them off of gluten and dairy while we were waiting for tests to come back. Sometimes we will do some tests that look at. Of course, we'll test for celiac disease.
- [07:22]
Which is a big cause of leaky gut.
- [07:23]
Yep. That's for sure.
- [07:24]
Probably the number one.
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And he didn't have that, by the way.
- [07:27]
You don't have to have celiac disease to actually have a problem. Right. You can have. They call it non celiac gluten sensitivity. I would estimate it probably affects 20% of the population. And I think if you look at the antibody levels, you can get a clue, which most doctors don't look at. And I read a study that autistic kids and schizophrenic patients often have 20% of them have antibodies to gluten. And it may not be full blown celiac.
- [07:52]
Absolutely. And even, regardless of, even if people are negative totally for celiac, if they have increased intestinal permeability, they. They start reacting to a lot of different foods. So then you start to see with that leaky gut, as we talked about before, right. The coffee filter and things are coming through, then the body's reacting to lots of foods that it maybe never reacted to before.
- [08:17]
So they're not true allergies. They're more like sensitivities.
- [08:19]
Sensitivities. And because of. And the real thing is it's because of this increased intestinal permeability. So our job is we have to heal that increased intestinal permeability so that they don't have to be so restrictive with their foods. I mean, we still always want them to be on a healthy diet, but we want to relax those restrictions over time. Most of the time we can.
- [08:40]
Yeah. And so it's part of the approach of functional medicine. We start them on the elimination diet. So eliminating all the inflammatory foods, gluten, dairy, processed foods, all that stuff. And then you remove.
- [08:52]
Right, that's the.
- [08:53]
Remove the five Rs. We remove, Replacement, replace, reinoculate, repair, repair, rebalance, and we'll go into each of those because they're really important. But the next step is also there's other things we may need to remove. There's tests we need to do. So what kind of tests would you look at as a functional medicine doctor that you wouldn't see at a traditional doctor's office that give us a roadmap of how to treat these patients?
- [09:16]
Right. So we did a stool test that looked at his microbiome, and what we noticed is that there was an overgrowth of unhealthy bacteria and unhealthy yeast. So he had this, probably because of years of antibiotics, he developed this dysbiosis, this imbalance in the bacteria and yeast. And so there was an overgrowth of the unhealthy things.
- [09:39]
It's like weeds. Having a lot of weeds in your garden, right?
- [09:42]
Yeah, Right. It's not always like one of those. You think of a stomach infection, and you're getting really, really sick. You're throwing up or having diarrhea. This is this. It's an imbalance, and it's called dysbiosis. But that imbalance causes a lot of symptoms in people. When you have the wrong bacteria and the wrong yeast levels, you can get a lot of bloating after you eat. You can get a lot of fatigue after you eat. You can get those symptoms of constipation and diarrhea. And that causes this inflammation in the digestive system. So all of your digestive enzymes don't work well. So you're not breaking down your food well. You're not absorbing your nutrients well. And it becomes this vicious cycle that people are dealing with and we see all the time.
- [10:26]
Yeah, it's so. It's so powerful. So. So, you know. You know, when I see this patient, I'm like, okay, you don't have to do all the tests, but sometimes you get stuck. You look at, you know, various tests that look at antibodies against things that are in the gut that determine a leaky gut.
- [10:41]
Right.
- [10:41]
We call it Cyrex 2 testing, which is a test you can get through functional medicine.
- [10:45]
Right. Is there. You can test to see if there's leaky gut. I love that test because it's a great way for us to follow up and see how much we're seeing improvement. Are we doing enough? Are we seeing improvement in their leaky gut or increased intestinal.
- [11:00]
Then we look at poop testing. We do thousands and thousands of these tests, and it's so helpful. And it doesn't just look at the microbiome it actually looks at the function of the gut, like whether there's malabsorption, whether you had no digestive enzymes, whether there's inflammation, whether there's overactive antibodies in there, whether you have imbalances and what we call the short chain fats, which are the food for the colon, that are produced by bacteria eating the right kinds of fiber. And if they're low, it means there's an imbalance. Then we look at the microbiome and we look at what grows, we look at parasites and then we target and micro target the things that are out of balance for that person. And it's different for everybody. Then we might look at food sensitivity testing. We might look at and even things like heavy metals or other things which can also cause it. I had a patient with ulcerative colitis once and I did everything right. I did the whole 5R. It wasn't working. But I forgot the first part of the R, which is remove. And I thought, well, maybe, you know, heavy metals can cause autoimmunity. Maybe it's a problem. And so I tested him and he was like wasted away. And he was like, it was terrible. He actually had high levels of mercury. We treated mercury and his colitis went.
- [12:07]
Dr. Mark Hyman
Away, which is phenomenal.
- [12:08]
Dr. Liz Lipski
Yeah.
- [12:09]
So I think it's so powerful. This case is so important because it really describes how a patient, you know, goes to traditional doctor, is diagnosed with a disease. Irritable bowel syndrome. By the way, anytime you hear syndrome, it means doctors know what the heck's going on. It's just a collection of symptoms that we agree we're going to put in this bucket. And if you have those symptoms, you have this disease, but it's not really a disease.
- [12:29]
Right.
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And so that's what functional medicine is. It sort of looks upstream to figure out what the root causes are and personalize the treatment for everybody. And there's common things that we do like the 5R, but it's maybe different Rs for each patient.
- [12:41]
Right, right, right. So for him we removed the inflammatory foods and we removed the bacteria and yeast. I actually treated him with an antibiotic, a non absorbed antibiotic and an antifungal. So I treated him with prescription medication. Yeah, weed killer. So that was the remove. Right. And then the replace. Because he was underweight and because of that inflammation in his digestive system, I gave him some digestive enzymes for, for a short period of time just to help him help it. So the food wasn't as inflammatory for him and to help him absorb More nutrients, and then we worked on reinoculating, right? So after we gave him some good.
- [13:23]
Probiotics, put in the healthy bacteria.
- [13:25]
Put in the healthy bacteria, some good prebiotics, right? So we know that.
- [13:29]
What are prebiotics?
- [13:30]
Prebiotics are the things that help feed the good bacteria. So. So they're the food for the probiotics, which is usually what, like fibers? Fibers are amazing prebiotics. We know a lot of phytonutrients are prebiotics. So this, I think, is really exciting research. When we're looking at our phytonutrients, we.
- [13:49]
Know that what are phytonutrients, right?
- [13:50]
So I know it's amazing, right? So our food has minerals in it, it has vitamins, but it also has these things called phytonutrients, which are these components in our plant foods that have this amazing health benefits for us. So that can include things like ellagic acid that we see in pomegranate, that can feed some of the good bacteria, that Akkermansia that we know can lower inflammation. We know that just to back up.
- [14:19]
On that Akkermansia thing. So when we look at the poop, we can tell if there's good levels of different bugs. One of them we look at is Akkermansia. And it turns out that that is so important for protecting your gut. It helps you keep your biofilm or that little coating over the gut so you don't have a leaky gut. And it's involved in so many autoimmune diseases in response to cancer therapy and metabolic issues and weight, and it's such an overlooked thing. And you can't take a probiotic of it, at least not yet. But you can feed it the good guys, right?
- [14:48]
We can feed it. We can feed it with all these amazing phytonutrients, like what's in pomegranate, the ellagic acid. And also we know that sulforaphane from our cruciferous vegetables feeds the good bacteria.
- [15:03]
So broccoli, collards, kale, but not juicing it, right?
- [15:07]
Brussels sprouts, all those good ones. We know that green tea that has good phytonutrients in it. That's good for the digestive system. So we always say to people, get something from every color of the rainbow every day. You know, you get some plant foods from every color of the rainbow every day. Get some good red foods like the pomegranate or cranberry. Get something orange and yellow and green, blue, purple, white, tan. You know those. All those Good, healthy plant foods that we, you know, like our vegetables, our fruits, our spices, our teas, our coffees, really actually are impacting our microbiome, which is fascinating.
- [15:44]
So great. And, you know, just a great anecdote from a colleague of mine, Dr. Lee, who was on our podcast talking about Eat to Beat disease. His mother had stage four uterine cancer. And being the smart doc he is, he understood from the research that if you have low akkermansia, patients don't respond to the immunotherapy, what they call the checkpoint inhibitors, which is this new form of cancer therapy that helps activate your immune system. So if your gut isn't healthy, you can't actually get the cancer cells to die with immunotherapy.
- [16:15]
Right.
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So basically, you die unless you have good bacteria in your gut. And so his mother had stage four uterine cancer and was gonna die and wasn't responding. And he gave her pomegranate, cranberry, green tea. All these phytochemicals got her akkermansia levels up, and she was cured of her stage four cancer within a month.
- [16:35]
That's a phenomenal story.
- [16:37]
It's an incredible story, and I think that just shows the power of these plant foods, of the plant foods, and of cancer getting focused on the gut.
- [16:44]
Yes, yes.
- [16:45]
I, I, you know, we call it the 5R. I call it the weeding, seeding, and feeding program. So, like, you weed out the bad things, you seed it with the good things, and you feed it with good nutrients and all this stuff. So it's really, it's, it's so, it's so powerful. I, I can't tell you, you know, as a functional medicine doctor for the last 30 years, and you've, you know, been doing this almost as long, the, the results you get from focusing on the gut with so many conditions, whether it's autoimmune or whether it's allergic, whether it's digestive, whether it's your skin issues like acne, eczema, whether it's your mood, whether it's weight, metabolism, whether it's migraines, whether it's Alzheimer's, I mean, autism, add. It's just amazing when you start to focus on this. So let's break down the 5R program for everybody. So we got the remove. So what are we looking at?
- [17:32]
We're removing, removing unhealthy foods or inflammatory foods for that person so they can be food sensitivities, things like gluten and dairy allergies, sensitivities. And then we're Removing processed food and junk food. Oh, yeah, that's for sure. And sugars and, you know, excess sugar, which is feeding the wrong bacteria. And then we're removing the unhealthy bugs or yeasts or viruses.
- [17:57]
Overgrowth. Yeast overgrowth. A parasite. You know, I was on the red table talk. And Jada and her son both had parasites, and they both had gut issues for a long, long time.
- [18:09]
Right.
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And they thought it was just how they were, but with, you know, short little course of treatment, they were both. I've never felt better. Right.
- [18:16]
Dr. Mark Hyman
And all these other symptoms, because now.
- [18:18]
Dr. Liz Lipski
You'Re actually absorbing the nutrients you're eating, which just helps the body heal.
- [18:21]
Yeah. So.
- [18:22]
Dr. Peter Attia
So then.
- [18:22]
Dr. Liz Lipski
So you remove, then we replace. But you might also remove things like heavy metals or stress or toxic people in your life or whatever's giving you a stomach problem.
- [18:35]
Replace means just replace some of those digestive enzymes, if needed, reinoculate.
- [18:41]
So the replace also could be like prebiotics. Right. So putting in the fibers to feed the gut and to actually maybe use hydrochloric acid sometimes for people who aren't digesting their food as they get older.
- [18:53]
Yeah. And to help get them off of the acid blockers, which, you know, we know are creating a lot of problems because we need that acid in our stomach to digest our food.
- [19:03]
Okay, let's take a little detour. So you just mentioned acid blockers. Okay. These are among the most prevalent drugs prescribed today in America, other than statins, I think when I was in medical school in the 80s, we just had those drugs come on the market. The drug reps used to come to us and say, these are very powerful drugs. Never use them for more than six weeks because they block stomach acid, and they'll cause significant problems if you do that long term.
- [19:27]
Right.
- [19:27]
You can cure an ulcer with it. You can fix an acute problem. But never use this. Now, people are on this for decades.
- [19:34]
Yes.
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And it. And the. The side effect which is listed in the manuals that we get as doctors is that it causes irritable bowel syndrome.
- [19:43]
Right.
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So you end up fixing the heartburn, but you get irritable bowel and bloating and bacterial overgrowth and all these problems.
- [19:50]
Right. Because you need the acid in your stomach, and when you block that acid, then there can be an overgrowth of bacteria where there's not supposed to be, and that can cause all those slew of problems.
- [20:00]
You change the ph, you get more yeast issues and all this stuff.
- [20:03]
And then you're not absorbing your minerals, so you can get osteoporosis and you're not absorbing your B12, so you can get fatigue and dementia. Right. It just goes on and on and on.
- [20:12]
It absorbs zinc and magnesium, minerals, calcium. It causes osteoporosis, pneumonia. It causes irritable bowel on and on.
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Right. It's so. And it takes some work. Sometimes when people have been on an acid blocker for a long time, it takes some work for us to help wean them off because their body has gotten pretty used to it. They start to get. Their bodies. Their body wants to make acid, so it's working against the medicine. So when you wean them down, sometimes they get more acid production.
- [20:40]
It's called rebound. So you actually.
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It's like.
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And it's sort of a trick. Like you get off it, but it makes you worse. So you feel like you have to get back on it.
- [20:46]
I gotta get back on it.
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But it's actually not true. And you can actually get off it.
- [20:50]
Absolutely.
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We do that all the time.
- [20:51]
We do it all the time. So re. Inoculate, giving all the good prebiotics and probiotics, the good bacteria and all the things that feed the good bacteria. And then the fourth R is repair.
- [21:01]
How do you know what probiotics to take?
- [21:03]
Oh, that's a great question.
- [21:06]
I want to know what do you prescribe?
- [21:08]
My goodness, that's such a. That. That goes on and on. We could talk about that for the next hour. It's true, right?
- [21:13]
There's more and more probiotics on the market every day, and all have different roles and different functions.
- [21:17]
Dr. Mark Hyman
And we're just sort of.
- [21:18]
Dr. Liz Lipski
Honestly, I think, you know, we've been doing this fore, but feels to me like we're at the infancy of this understanding of how to use these in medicine.
- [21:25]
Yeah.
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So what.
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I mean, there's some great brands that I trust and I use all the time, but when somebody is, you know, doesn't maybe know what to do, I'll say, you know, get one. Get. Go to a reputable place, a reputable pharmacy or a good wellness store pharmacy, and get a probiotic. You know, try it. If it makes you feel worse, then stop it, you know, because there's some good bacteria that make people feel worse.
- [21:54]
They have bacterial overgrowth.
- [21:55]
Exactly.
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If you have bad bugs growing in there and you put the good bugs in there, they have a fight and.
- [21:59]
They cause all of them. And so that means we just have to do more work before we can start it.
- [22:05]
So they got to reinoculate and then.
- [22:06]
You got the and then repair. And that's the fourth R. So that's things like, that's like giving good protein, good amino acids, which are the building blocks of protein to help repair. Yeah, to help repair that barrier, that coffee filter, we have to repair it with good protein. And sometimes we'll use amino acids like glutamine that help repair it. We'll give more zinc. Whether it's from food sources or as a supplement, maybe we'll give some vitamin A, which also helps with healing that barrier. It helps with healing the endothelium and the gut. So those are things we will do to repair and then rebalance. Right. That's the fifth R, which is really focused on managing our stress and how we're reacting to the world because we know that when our parasympathetic nervous system is engaged, when that calming nervous system is engaged through meditation and yoga and breath work, that our body has the ability to heal. And it heals better when our body is, is, is at, at rest.
- [23:09]
I mean. Yeah, you know, you just touched on something very powerful, which is that our, our gut and our brain are connected. There's a whole hard wiring of nervous system in our. And the gut even has this independent nervous system that actually is like a second brain.
- [23:25]
Yeah.
- [23:26]
And, and so, you know, it's, you know, we often say people are irritable bowel, are emotional or anxious or have, you know, just maladaptive emotional coping mechanisms. But it turns out that, that the irritable bowel actually can cause an irritable brain and lead to anxiety and all these emotional issues. So it's a bi directional and I think that's a great lever for helping people reset their gut.
- [23:49]
Absolutely.
- [23:49]
You know, I just want to share a story because I, you know, I've been doing this for a long time and of course my, my, I don't know what it is, curse or blessing, depending how you look at it, is actually getting really sick and having to figure out what to do to fix myself. And I've had a lot of gut issues over the years, which is why I really focused on this. The first is when I had mercury poisoning and I tried everything. I did every functional medicine trick in the book back then, and it wasn't working. And until I got the mercury out, which disrupts all your enzymes, it disrupts your gut, it causes leaky gut, it causes yeast overgrowth, it screws up the bacteria in your gut. Until I got rid of the mercury from my system, I couldn't get my gut straight.
- [24:28]
Yeah. And then it's impacting your immune system, too. Right, right.
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And then. And then I fears, many years later, I, you know, kind of got an issue which was triggered by an antibiotic for a root canal that I had to take clindamycin, which is known to cause C. Diff, which is a terrible bacterial infection that kills like 30,000 people a year. And I got that.
- [24:48]
Dr. Will Cole
Yeah.
- [24:48]
Dr. Liz Lipski
And I was so sick, and I. And, you know, Liz would come over to my house and I was like, it was pretty bad. I'm like, we were all struggling to figure it out, and I. Yeah, and I had mold in my house and all these other things, but I ended up having colitis and I had tremendous leaky gut. And I did my own stool test. And my friend Patrick Hanaway, who worked for the stool test company for many years, my colleague at Cleveland Clinic, he and I looked at my stool test and we probably between the two of the seen, like, 20,000 stool tests, we're like, this is the worst one we've ever seen. And everything was screwed up. And I had no good bacteria. I had low butyrate. I was not digesting. I had tons of inflammation. It was terrible.
- [25:30]
Dr. David Perlmutter
And.
- [25:31]
Dr. Liz Lipski
And I couldn't really fix it using a lot of the traditional things. And then I started to sort of work on a gut shake, which included a lot of the sort of 5R concepts. Right. So I cleaned up my diet. Obviously, I got rid of the bad bugs, but I used a combination of these polyphenols from the plants, a pomegranate, cranberry, green tea, also added, you know, glutamine. I added prebiotics, probiotics. I even added colostrum.
- [25:57]
Yeah.
- [25:57]
You know, which is to help regulate the immune system. And it was like a miracle. I had went from full blown colitis to, like, normal in three weeks.
- [26:13]
Dr. David Perlmutter
There's so many probiotics out there.
- [26:15]
Dr. Mark Hyman
You know, you go to the grocery.
- [26:16]
Dr. David Perlmutter
Store, you go to the health food store, there's ones in the fridge, there's ones not in the fridge. Is with this strain. It was that strain. Like, nobody knows what's going on. Even most doctors have no clue what's going on. So can you. Can you define, like, what's a probiotic? And. And, you know, whether we should actually be taking probiotic supplements because, you know, we've been taught, for example, that, you know, when you take probiotics, they don't really take up residence there. They just kind of pass through and do little things and they cook on. Is. Do they colonize? Do they not. Does it matter? And should we be thinking about probiotics from a basic health maintenance perspective? Should we all be taking them?
- [26:53]
Dr. Liz Lipski
How do we pick the rote probiotic?
- [26:55]
Dr. David Perlmutter
And should we just be eating sauerkraut and kimchi and forget about probiotics? Can you help us unpack some of that?
- [27:02]
Dr. Will Cole
I think probiotics are fascinating in the sense that anytime a piece of news or press comes out that says probiotics don't work or they don't do this, it seems that probiotic usage goes up. And so I can't explain it, but it's. People love them, people use them, but the science and the understanding and the development of them is, is, is, is very confusing and varied. And so just to start with some definitions, Probiotics are defined as live organisms that confer a health benefit to their host. It's a very simple definition. Gregor Reed chaired the panel at the UN that, that wrote it in 2001. At its, @ its core, probiotics are, are, you know, and not a new discovery or not a new hypothesis. You know, typically they were in the early 1900s, organisms that were isolated, that were found to be beneficial. And benefit has changed over the years dramatically. I mean, back then it was just keeping your food sterile or safe from pathogens could be considered a benefit, and preventing you from getting sick from what you eat could be considered a benefit. Today, people look for a lot more complex things. So what is it? What is it intended to do, and what is the health benefit? That's the question that you have to ask anytime you hear the word probiotic. That's what you have to say right back. Say, okay, so it's a live organism, yes or no? You'd be surprised many times they're not live or they're not guaranteed to be live, or they don't make it to your colon alive. And so there's a whole spectrum of even that live part and part two is, okay, so beneficial. What are they beneficial for? What are they going to do? What is the basis for if they are beneficial or not? I think people confuse probiotics sometimes with fermented foods, which have a very different definition. Fermented foods are microbially metabolized food matter that carry a microbial load. And so that actually was just defined by. In a Nature review this year for the first time. And they're both good. They both can be good, or they both could do nothing. It really depends on what you're looking at. So fermented foods are different from probiotics, but sometimes fermented foods can be probiotic and sometimes probiotics can be fermented foods, but it depends on what they are and what you're trying to accomplish. Classically, probiotics have been Lactobacillus and Bifidobacterium. Two years ago the scientific community convened and said, okay, this is way too generic. And so Lactobacillus actually was broken into about 200 subclasses and was completely renamed. And so we don't really use Lactobacillus anymore. But there's way more genus and species variation now from what was originally called Lactobacillus, Bifidobacterium, at least Lactobacillus and Bifidobacterium and Streptococcus, I would add is the third are the three class of probiotics that have been used in food in Japan, in Europe and predominantly in North America. And so almost every probiotic product that is a microbial product, that's standardized will contain or derive some version of these or it's going to come from soil. So that's kind of the landscape right when you hear probiotics. And we'll get to the cases at the edge a little bit after. I do not think that most people, in the absence of any gastrointestinal or gut microbiome related, you know, people that I call like your super healthy individuals, that, that exercise well but not too much, they're not elite athletes because that creates, carries its own risk or not over endurance athletes. People that eat virtually no processed foods and that have no environmental toxins in their environment, you've talked before where, where you can even find that in ways that you wouldn't expect, which you can talk about later. So if you're kind of living in the wild, if you're growing all of your own food, if you're regulating contaminants in, in your water supply and in the soil of the food that you're eating. And you're eating a very diverse plant and animal based diet. I think that that's, that, that that you're in more or less peak performance. And lastly is you didn't have heavy antibiotic usage either early in life or at any period throughout your life or periods of disruption and, and recolonization from the built environment, which means you didn't move to a big city or an urban dwelling place and change your microbiome away from what you would get in the countryside or in a more agrarian or a more kind of wilded environment. So these people that meet those conditions I would say you probably are doing just fine. You don't need to do too much. And a simple microbiome test will tell you what you need, what you don't need. The converse of all of those are people that live in kind of more of the modern world. And so you're getting, you know, yeah, you know, you're bathing, using modern and eating modern foods or packaged or foods or foods bought from a grocery store, you're drinking beverages which are contained in some container. You're generally using urban infrastructure and you may or may not have gastrointestinal or related to gut microbiome maladies. This is kind of that area that I want to focus on where I say probiotic usage is the most impactful, it could be the strongest, and it could be the most helpful. My hypothesis why is that people that are in this environment actually have a very low microbial inoculation. So I don't know if when you're in medical school you heard this theory that actually they were giving people with IBS or IBD helmints, they were giving them known worms basically, and they found that actually it was very effective. And I don't know if it was an urban tale or not, but the idea is that, remember what I said about being born inflamed, right? That an active immune system has to be active or has to be inactive. And that's very context dependent. So I've actually even heard many in the field and on this podcast talk about the indigenous microbiome or the hunter gatherer microbiome and kind of define it as this optimal state. But optimal for who? If you took this microbiome and you transplanted it to an urban urbanite living in New York City, that person would probably get very sick. I remember when the Amerindian project was happening, it was Maria Gloria Dominguez Bella, it was Marty Blazer, a lot of the missing microbes, people that were involved in characterizing the Northern Amazonian microbiome. And actually they went for six weeks to go live, live like them and see how their microbiome shifted. This is an experiment from from the mid to late 2000s. And I remember Gloria telling me that she could do everything. She could follow all of their practices except for she snuck a little toothbrush with her and snuck away to brush her teeth every night because that's the one thing she couldn't give up. But you know, that's what it means. That's what it means to live like that. It means that you're taking it all.
- [34:48]
Dr. David Perlmutter
So with probiotics, I mean, there, there's a lot out there. And you know, what, what, what's important to think about. If people are trying to choose a probiotic, how do they evaluate it? You know, for example, for when people are choosing a vitamin, I'm very clear with them, they need to make sure that the product is in the right form. So in other words, the right version of that nutrient. For example, if you're taking folic acid, maybe you need 5 methyl folate as opposed to just folic acid. Or if you need magnesium, maybe you need magnesium glycine or magnesium threonate instead of magnesium oxide, which isn't well absorbed. Second, you need to make sure that what it says on the label is actually what's in the bottle, that things are third party tested to be there for both purity and potency. In other words, there's no contaminants or toxins. And it actually is what it says on the bottle, that there's no weird stuff in it, like allergens, fillers, excipients, colors, dyes, sugar, lactose, gluten, all that stuff can be in vitamins and I. And I think, you know, it has to be bioavailable in terms of the form. It also has to be absorbable. So it's in a crushed tablet that's under tons of pressure. It might be the right everything, but you may not digest it. So tell us about, um, how do we think about probiotics? Because, you know, should be taking hundreds of different strains. Do we take one? How do we know if what's good? How do we know? I mean, I could buy something in the store. It says 50 billion units on the bottle. Is it actually that, like, how do we know?
- [36:24]
Dr. Mark Hyman
What should we be thinking about?
- [36:26]
Dr. Will Cole
It's a very simple rule of thumb for people is there's two major classes of probiotics. One is targeted for a specific indication. I want to lose weight, I want to improve my mood, I want to signal, to improve my skin. You know, they're very different microbes that work on these different axes and they're usually very specific. So it's not necessarily a bunch of bugs that will do that, but you could find ones that are very targeted, that have that targeted effect. And so I think that this is. Bucket one, bucket two. Are you, is your.
- [37:03]
Dr. David Perlmutter
Well, that's what I just want to.
- [37:04]
Dr. Liz Lipski
Stop there for a sec.
- [37:05]
Dr. David Perlmutter
That's an incredible statement you just said, was that there are different strains of probiotics that have different effects for different diseases and conditions. And Some may be good for your skin, some may be good for your brain, some may be good for your immune system, some might be good for your heart, some might be good for your metabolism, regulating your blood sugar. I mean, it's quite interesting, you know, the differential ability to determine which probiotic is good for which thing. And that is something that's pretty new. I mean, it's almost like, you know, personalized probiotics.
- [37:36]
Dr. Will Cole
Well, you're not going to get that from one or two bacteria. And so you have to either only take one benefit you're looking for or you have to take a more complex consortia. And so it's not that you need 100 strains, but if you want to maximize the outputs, you generally want see more microbes adding up together to create broader spectrum effects. So there, there's a kind of network effect, if you will, going on, on which, what, what, which probiotics you take and, and, and for what purpose you are taking them. That second category of probiotics is, well, what is your, what is your basis? Right? What is your, you know, you hear all the time somebody say, oh, well, I take, I get my probiotics from kimchi or I get my probiotics from a nutritional shake, or well, you get one or two strains of bacteria or you get kimchi organisms. But you can't say that that is going to therefore be equal to a strain which is proven to signal to you to the gut barrier, or a strain that regulates cholesterol uptake or a strain that works on evacuation disorders to relieve constipation. I mean, all of these are different mechanisms and they're coming from different strains. It's why again, I think I want to emphasize consortias are so important. Which bacteria.
- [39:11]
Dr. David Perlmutter
I mean, when you say consortium, mean a lot of different strains that have.
- [39:14]
Dr. Will Cole
A lot of strains. Yeah, together, together.
- [39:18]
Dr. David Perlmutter
So, so keep going on how we know to pick the right one or the right strains then.
- [39:22]
Dr. Will Cole
So, so now you've kind of asked your first sequence of questions. Do I want a broad spectrum consortia for many different things or do I want something more targeted? From there, you need to assess if, if what you're picking is, is good and there's three layers to it. There's purity, there's potency and there's efficacy. Purity means that there's the, the bacteria which are you list and none others. It's very simple and that's done by very good quality control. So you're sequencing at the level of individual genes all the bacteria in your product. You know them you get a fingerprint every time you do a fermentation, every time you do a production, you get a fingerprint. And you know that those organisms are there and nothing else is there. And so this is the, the most important question, question to ask from sake of purity. Potency is not just what's written onto the label because that can be very misleading. So there's products in Japan that say that we have 1 trillion organisms or a yogurt starter culture from Australia that says we have 1 trillion bacteria. There's kind of your VSL3 kind, your gastrointestinal gastronomy, enterologists recommended probiotics that are 300, 400 billion where you see these big, big numbers on them. But you know, you have very kind of high die off, either very high die off when it comes into your stomach right away, or it's typically only one strain or one species. Even if there's listed eight or nine different strains on the, on the label, it's predominantly one. Like, you know, the, the number one gastroenterologist recommended probiotic has, has nine strains listed on its label, I believe, or eight. But it's 96% yogurt starter culture and the rest are small like tiny byproducts. So you know, so, so potency is very important. Potency is very, very important. But at the level of, throughout the entire gastrointestinal tract is something that I take very seriously. There's model, there's, there's sequence.
- [41:34]
Dr. Liz Lipski
So in other words, in other words.
- [41:35]
Dr. David Perlmutter
You could take a probiotic looks good.
- [41:37]
Dr. Liz Lipski
In the bottle, everything's in there, but.
- [41:38]
Dr. David Perlmutter
You eat it, take it as a pill and it gets digested in your st. Kills everything. Right?
- [41:43]
Dr. Will Cole
Yeah. Or, or it's never even, what's listed is never even alive by the time it makes it. And you know, so maybe, maybe you see 100 billion written on the label, but there's, there's 99 die off and by what reaches the colon. So you're not going to get much organic acid production with, with 99 die off before it even gets where it needs to go.
- [42:07]
Dr. David Perlmutter
So the bacteria, you have to make sure, you know, you're taking a multi multiple consortium of what you call a consortium of bacteria that all have different scientific evidence behind them because there's a lot of stuff out there that doesn't. But there's a lot of evidence around a number of bacteria that have very specific effects on the GI tract, on the immune system, on heart health, on metabolic health, on immune health. So, so there we can use that data to Start to design probiotics that actually make sense.
- [42:36]
Dr. Mark Hyman
I want to walk you through how to do this. I'm going to teach you how to hit the reset button, reboot your system and to optimize your biology to help your gut, help your detox system, to help your immune system, help reset your nervous system. And it's powerful. So if you want to really see how your body can feel and get rid of what we call FLC syndrome, I would do this. Most people are like, the frog is in cold water where you turn the heat up slowly and it starts to boil to death. We just kind of get used to it and think it's normal. These symptoms are not normal. I want to do this with a junior high school once. And the teachers are like, well, we might have to get permission from the parents to see if it's safe. You know, maybe they don't want their children doing this. I'm like, what is it safe to eat? Fruits and vegetables and nuts and seeds and protein and cut out sugar and starch and processed food. I mean, they should get a note that it's permission to eat the junk food that they have to the opposite. So anyway, yes, very safe. Anybody can do this. And some people, by the way, you know, need more certain things or other things. But basically this is a very universal approach to resetting your system. The second pillar, aside from what you eat, the food is really important. And by the approach in the morning, you need to make sure you get rid of sugar and starch in the morning. Super important. Let people start their diet, their day with carbs, which is the worst thing you can do. Sugar sweetened coffees, teas, cereals, muffins, bagels, breads, bad news. Second pillar are your daily habits. Essentially involves a pattern of eating and living that puts your body back in rhythm. It helps you reset your nervous system. And there's two really important habits as part of the tendency. One is when you eat and also when you sleep. So let's talk about when you eat. Now, when you eat might be as important as what you eat. So many of us don't eat in the right pattern. We tend to, you know, eat all day long. We snack, we tend to eat before bed, we snack late at night. It's kind of bad. So basically, when you eat is very important. Research shows that doing that can really be bad for your health if you eat at night. So the first is, make sure you give yourself at least 12 to 14 hours between dinner and breakfast. So dinner at 6, breakfast at 8. That's a 14 hour fat. Okay. If you eat at 6 and then you keep snacking all night, that doesn't count. Right. And it's the most simple form of what we call time restricted eating. And it's basically giving your body a rest and getting the body to reset. And I wrote a lot about this in my book the Young Forever. But, but basically there's a whole process at night that happens called autophagy and cleanup and repair. You want to eat your body, the ability to do that. The next is food. Now you can do a breakfast if you're eating, you know, for example, dinner at 6 and breakfast at 8 or so. That's a 14 hour fast. Really important to have protein in the morning on, not carbs and sugar. Also not eating three hours before bed is really important. So most people eat Zach after dinner. Don't do that. Have at least three hours time. You eat and you go to sleep. That way you will lose weight, your body can repair and heal. Instead of trying to digest and store the food. What about sleep? Sleep is one of the most underrated pillars of health. It's probably even before exercise, meditation, maybe even before nutrition. Because when you don't sleep well, you're going to eat sugar, carbs, you're going to crave more. So you want to focus on sleep and restorative rest. We know that getting in a routine of waking and sleeping can help them deeper, more restful sleep. So try to pick the same med every night. Try to get off your screens for an hour or two before bed. Keep your room or use blue blocker glasses. Keep your room dark and cold. Probably 5 to 68. Really important because your body does much better with sleep at night. Try to relax at night with meditation. Do a gut imagery, do breath work, stretching, journaling, gratitude, practice whatever you like, but do something very important. So your evening routine should be like set a bedtime and stick to over 10 days. Turn your phone off and get out of your bedroom. Turn the TV off for at least an hour or two before you go to bed. And then use the time at night to read, to journal, to meditate, to connect with people you love and just kind of wind out. The third is extra support we need on the journey. Right now we all need nutrients. They're called vitamins because they were vital amines, vital to life, right? And so we've seen a dramatic reduction in the nutrient density of our food. Our organic matter has gone out of our soil. Nutrients can't be extracted. Foods travel long distances. We have commodity crops which Are bred to actually breed out the nutrients and in the starch and, and yield. And so foods aren't as nutritious as they once were. And probably 90% of Americans according to the government owned surveys are deficient in one or more nutrients at the minimum level to prevent deficiencies. How much vitamin D or you need to not get rickets? Not very much, like 30 units. How much you need for optimal health? Probably three to 5,000. So we need to really probably focus on nutrients. And even with a perfect diet, you know, because none of us are hunter gatherers anymore, all kinds of food that we never ate and nutrients bleeding, we need, we need the basics. So we need a basic set. It's a multivitamin, mineral, foundational, magnesium. A lot of us are deficient. Probably 45% are low or deficient in magnesium. Involving over 300 different enzymatic reactions. Super important. Helps relax your nervous system at night, help you calm down. Also people get constipated sometimes when they change their diet. So taking magnesium citrate can help. And lastly vitamin D. It's all sick fish oil, but vitamin D is really important. Vitamin D over 80% is lower deficient in vitamin D. That's it's involved in so many different things in the body. So really important and helps your mood, muscle function, helps your brain, your energy, helps inflammation, autoimmunity. It's just super important. And most of us are low. Fish oil is also important and I often recommend fish oil to people or omega 3 fats. So one of the program steps in the 10 day detox, what should be the tips? And then we're going through this. The first step is to eat from the 10 day detox approved list for 10 days. So eat one of all you eats, right? Whole foods, you know, whole food based shake. In the morning you could add, you know, protein powder, grass fed protein if you want. I have a grass of protein called super simple protein. But you really need to make sure you have good breakfast. Second is commit to daily habits, right? Pick your designated eating window, right? You want a 12 to 14 hour night fast, which means eating within a 10 or 12 hour window. Don't snack before bed. Try to have the same bedtime. Get off your technology an hour or two before. Practice some active relaxation. Huge impact on your health. Step three is adding the supplements. Now you don't have to do this, but I really encourage people to have a multivitamin, magnesium, vitamin D and three fish oil. And we're gonna list which products you should take in the show notes you have it all listed there. Also, what you should eat and what you should avoid during your 1080 talk. Let's go through that. So here's the full food list. You can, you know, we're gonna have it in the show notes, you can take it with you to store. It's in the book the Ten Day Detox. It's in the 1080 Cookbook. But essentially, here's what you should eat and what you should actually get rid of. What you should eat is protein. You need, right? Protein, right? So grass fed or reginaldly raised meats is great. You can have pasture raised lamb, beef, bison, venison, elk, grass fed beef, pasteurized chicken, turkey, duck, all that's fine. What you should avoid is conventionally raised chicken and poultry and eggs and so forth. And by the way, you can also have eggs, they're pastraised eggs. Meat. Get rid of all processed meats, deli meats, all conventionally raised feedlot meats. Get rid of all that stuff. But by fish and seafood, lots of small fish are good, big fish are bad. Right? Big fish like swordfish, tuna, sea bass, halibut, most farm based fish are pretty bad for you. What you should be consuming are things like the. I call this mad fish, a small wild salmon, sardines, anchovies, herring, a mackerel. You can have black cod, shrimp, scallop trout, eggs. As I said, pastures eggs are fine. Non organic, regular eggs are. What about nuts and seeds? Very important. Almonds, Brazil nuts, cashew nuts, hazelnuts, macadamia, pecans, pine nuts, pistachios, walnuts, all that's great. You can even have cacao nibs, chocolate, not actually chocolate, but where chocolate comes from, seeds are great. Chia seeds, flax seeds, mccallum, sunflower seeds, pumpkin seeds, all great. Nut butters also great. So unsweetened nut butter. So almond, cashew, pecan, macadamia, I love macadamia walnut. Oh, that's great. You also eat beans. If you're a vegan and you want to do this, you can use GMO free or non GMO tofu or tempeh as your protein. What you should avoid are nuts. They're with sugar, they're cooked in oils that are basically candied stuff. A lot of nut butters have sugar, hydrogen, fats, peanut butter, peanuts can be okay, but I would say mostly avoid peanuts because they have aflatoxin, often are rancid and so you want to be careful with that. What about oils and fats? Well, the ones you want to use are organic avocado oil, you can use organic coconut oil for cooking grass fed ghee. If you want to use tallow, lard, duck fat, chicken fat, that's okay as long as they're. They're cast purees or regenerative graze for salads. And you can use different kinds of oils like almond oil, flax oil, hemp oil, macadamia oil and convert to olive oil. And you can cook with olive oil, but only like tomato sauces and things like that. I think they're not high heat. Sesame oil tahini is great as well. Great fat sesame seed kind of tastes walnut oil. Those are flavorful oils, they're not main oils. But you want to avoid the traditional oils. All the seed oils like canola oil, partially hydrogenated oils, margarine, can oil, soybean oils, sunflower oil, saffloral, trans fats, vegetable oil, vegetable shortening, all that stuff. Bad. What about veggies? What should you eat? Well, you want to stick with lots of non starchy veggies or artichokes, organic if you can. I use the Dirty Dozen guide from Environmental Working Group EWG.org tell you which are the clean 15, meaning you can eat them, not organic or the Dirty Dozen, which you definitely not eat if they're not organic. But I love asparagus, artichokes, avocado, bean sprouts, broccoli, brussels sprouts, cabbage, cauliflower, celery, cucumber, eggplant, garlic, ginger, hearts of palm, kohlrabi, leafy greens, mushrooms, all kinds. Onion peppers, radicchio, radish, rutabagas, all that kind of stuff. Seaweed is great, lots of minerals, shallots, summer squash, tomatoes, turnips, zucchini. List goes on. We have all in there. You can have some things like sweet potatoes. I like the Japanese purple sweet potatoes, winter squash, carrots, pumpkin, all that's fine. I mean carrots are fine because unless you're doing carrot juice or that problem. But basically try to limit to like one serving which is like half a cup a day. We should be avoiding is corn potatoes mostly a little, you know, some of the little fingerling potatoes or the Peruvian potatoes, purple potatoes. What about dairy? You can eat pasture, raised butter or ghee, but I encourage you to get all dairy including sheep and goat which are mostly fine for people. But I encourage people to skin up all other dairy. And if you're having, we encourage you to have make sure it's best fed or regionally raised. What about bees? Well, you can have green beans, you can have green peas, you can have A non GMO organic soy such as tofu or tempeh, you can have SAP beans, you can have snow peas, but otherwise definitely no. No beans. What about grains? No grains at all. So even healthy grains, quinoa, buckwheat, things like that. I agree. Really off all of that. Why? Because it just shuts down the insulin response, helps you lose weight, reduce inflammation. Not that these are necessarily all bad, but eventually you add them back. But basically get rid of all, all the other. All grains, wheat, barley, rye, rice, amaranth, millet, oats, everything. Get rid of it. Fruit. Fruit can be okay, but small amounts of non high glycemic. So organic blackberries, blueberries, cranberries, kiwi, lemon slime, raspberries, all that's fine. Not too much, right? You know what I mean? Like you know, two pounds of blueberries, but you can have a half a cup of it. Want to get rid of all the other fruit, all the high glycemic fruit like bananas, pineapple, melons, cherries. Grapes is the worst. Even foods that foods that you think you know may be good for you are actually good for you, right? Whether it's, you know, peaches, pears, nectarines, cherries, for example, but you don't want to eat them while you're on the 1080. Want to really shut down the blood sugar response. What about sugar sweeteners? Sorry, the tip. You can sometimes have a little bunk fruit or stevia you have in the shake we have, but generally tend to avoid all that stuff. Also just get rid of all the other artificial sweeteners, sugar, all that stuff. If you have to ask answers, basically, then what should you be drinking? Well, lots of water, herbal tea, green tea, caffeine. That's okay, a little green tea is fine. It'll help you get a coffee, sparkling water, mineral water, alcohol, coffee, bottled water, pot sticks, soda, obviously sugary beverages. Basically that's the program. So if you eat that way for 10 days, you use those simple habits, your body's going to totally transform and you're going to see just how food is impacting your health, which I think most people don't have a clue about. And that's why I love this so much. Now after the program, it's really important. If you do it for 10 days or 21 days or 10 weeks or 10 months, you have to be smart about getting off it or you can get big trouble. Because when you go off of foods that are inflammatory, foods you're allergic to, and you reintroduce them, you can get a lot of worse symptoms. Let's say you had migraines before and they're gone. Wow. You're going to get a doozy of a migraine. Unless you had gut issues before you get a real problem. Unless you had sinus congestion from eating the area and then he eat it again, you might get a sinus infection. So you really have to be smart. So if you're feeling great, you want to continue and you let's say you have a lot of weight to lose, so you have immune disease, you just want, you're feeling great, you want to continue, no problem, you continue it. Continue to do it. You can do it for another 10 days, you can do it for another 10 months.
- [57:41]
It's fine.
- [57:41]
Totally safe to eat. It's pretty much how I eat most of the time with Cajun grains and meats.
- [57:46]
Dr. Peter Attia
Have you ever wished there was a trusted space where you could get real support on your health journey? Where your questions get answered and you don't feel like you're doing it all alone? That's exactly what's happening inside my brand new membership community, the Hymenhive and I couldn't be more excited about it. Thousands of members are already inside, sharing wins, asking meaningful questions and supporting one another like never before. The conversations are powerful, the camaraderie is real, and the community is growing every day. Day inside the Hive, you'll get monthly live sessions with me, office hours with our resident functional nutritionist, science backed protocols, monthly challenges, behind the scenes content, and so much more.
- [58:21]
Dr. Mark Hyman
All designed to help you create healthier.
- [58:23]
Dr. Peter Attia
Habits that actually stick. Whether you're just getting started or fine tuning your routine, the Hive meets you where you are and gives you the tools and support to keep going. If you're ready to take control of your health with a community that truly gets it, join us at Dr.hyman.com hive that's Dr. Hyman.com hive H I V E if you love this podcast, please.
- [58:42]
Dr. Liz Lipski
Share it with someone else you think.
- [58:44]
Dr. Mark Hyman
Would also enjoy it. You can find me on all social media channels at rmark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Drmark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness center my work at Cleveland Clinic and Function Health where I am Chief Medical Officer. This podcast represents presents my opinions and my guests opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public, so I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.