The Dr. Hyman Show

Episode: The Silent Fire Behind Chronic Disease—and How to Put It Out
Host: Dr. Mark Hyman
Date: September 8, 2025

Overview

This episode of The Dr. Hyman Show dives deep into the pervasive role that chronic, “silent” inflammation plays in nearly every modern chronic disease—and how lifestyle, diet, environmental factors, and innovative science can help us tamp down this hidden fire. With contributions from leading experts in immunology and exposome science, Dr. Hyman explores the root causes of inflammation, the limitations of conventional medicine, revolutionary new diagnostics, and actionable ways to reclaim health through an anti-inflammatory lifestyle.

Key Discussion Points & Insights

1. What Is Inflammation? (04:47–07:00)

• Acute vs. Chronic Inflammation:

  • Acute inflammation is a normal repair process (e.g., a cut or an infection), showing redness, swelling, pain, and heat.
  • Chronic ("silent") inflammation is persistent, systemic, and underlies most chronic diseases—heart disease, diabetes, cancer, Alzheimer's, autoimmune diseases, gut issues, addiction, depression, and rapid aging.

  Dr. Hyman (05:32):
  "It's not the kind of inflammation that we are familiar with, like a sprained ankle or a sore throat... The kind we're talking about is bad and leads to almost every known disease of aging."

2. Root Cause Approach in Functional Medicine (08:13–09:19)

• The "Tack Rule":
  Conventional medicine treats symptoms; functional medicine seeks causes.

  • Remove all "tacks" (sources of inflammation) for real healing rather than just suppressing symptoms.

  Dr. Hyman (08:42):
  "If you're standing on a tack, it takes a lot of aspirin to make it feel better. Take out the tack."

3. Inflammation and the Diseases of Aging (09:20–10:52)

• Rethinking Disease Etiology:

  • Heart disease, Alzheimer's, and cancer now understood as fundamentally driven by inflammation—not merely by cholesterol, plaques, or mutated cells.
  • High markers of inflammation strongly predict early death.

  Dr. Hyman (10:27):
  "If [CRP and cytokines] were high, they had a 260% more likely chance of dying in the next four years. So this is no joke."

4. The Limits and Risks of Conventional Anti-Inflammatory Treatments (11:01–12:03)

• Shortcomings of Drugs:

  • Chronic use of NSAIDs or aspirin is risky (GI bleeding, strokes) and often ineffective against chronic, low-level inflammation.
  • Statins may work more by reducing inflammation than by lowering cholesterol.

  Dr. Hyman (11:37):
  "As many people die from taking those drugs as from asthma or leukemia."

5. How to Diagnose Hidden Inflammation (12:03–13:45)

• Blood Testing:

  • Common tests: high-sensitivity C-reactive protein (hs-CRP), interleukin-6, other cytokine panels.
  • "iAge" and "immunome" testing: Advanced panels (developed at Stanford) now track up to 50+ cytokines for a more precise picture of immune aging and inflammation risk.

  Dr. Hyman (12:41):
  "What's so amazing is this test is really not that expensive, it's easy to get... and the good news is you can change things and change your inflammation."

6. Lifestyle as the Antidote to Inflammation (13:45–21:36)

Nutrition

• Whole Foods & Phytochemicals:

  • Plant-based diets loaded with colorful, polyphenol-rich foods are powerfully anti-inflammatory.
  • Eliminate refined foods, sugars, trans fats, and additives.
  • Good fats (olive oil, avocados, omega-3s from fish) and high-fiber beans, lentils, and whole (especially fermented) grains are key.
  • Spices (e.g., cumin, turmeric) and herbs provide potent anti-inflammatory compounds.

  Dr. Hyman (15:22):
  "All the phytochemicals in food are so powerful for reducing inflammation."

  Dr. Hyman, on spices (20:10):
  "These spices and herbs we sort of neglect... we use a lot of salt, a lot of sugar, a lot of processed refined oils to kind of make food taste good. And we don't actually use the spices, and then you don't really need that much of those other things when you actually have a yummy, spicy diet."

• Focus on Plant Diversity:

  • More types of plants mean a more diverse, resilient microbiome and lower inflammation.
  • Seaweed provides unique fibers beneficial for gut health.

• Avoiding Harmful Additives:

  • Food additives (e.g., polysorbate 80, carboxymethyl cellulose) can destroy gut lining, disrupt the microbiome, and promote systemic inflammation.

  Dr. Hyman (24:29):
  "When you eat these food additives... it damages your gut lining... your immune system goes, 'Hey, what's this bad foreign stuff?' and it starts creating this inflammation."

Exercise (12:04–14:11; 14:14–15:10)

• Exercise as Anti-Inflammatory:

  • Regular movement (even without weight loss) lowers immune activation, particularly in fat tissue.
  • Everyday movement (stairs, walking, biking) as important as gym workouts.

  Guest B (12:25):
  "Just getting out and moving every day, even if you do it in small bursts, that tends to add up... it can actually dampen the inflammation in the body."

Stress, Sleep, and “Active Relaxation”

• Restorative Practices:

  • Activities like yoga, meditation, deep breathing, and even a hot bath can drop stress hormones and lower inflammation.
  • Poor sleep and social isolation are potent, under-appreciated drivers of inflammation.

  Guest C (25:14):
  "Disruption in our circadian rhythm, social stress... they develop inflammation, they have more cardiovascular disease, elevated rates and death..."

Fasting & Meal Timing

• Intermittent Fasting:

  • Compressing eating into a 10-hour window can help dampen inflammation and improve metabolic health.

  Guest B (12:59):
  "Fasting has been shown to dampen inflammation in the body, to fortify your body against a variety of diseases..."

Gut Health

• Feed Your Microbiome:
  • Fiber and polyphenols from diverse whole plants nourish good gut bacteria, resulting in beneficial compounds that calm immune activity.
  • Focused gut-repair programs may be needed for those with issues.

Supplements

• Selective Use:
  • Multivitamins, fish oil, vitamin D helpful for many; some disease-specific supplements (e.g., curcumin for IBD) if supported by good evidence.
  • Priority still on food first.

7. The Exposome: Why Genes Aren't Destiny (21:36–23:32)

• 95% of Chronic Disease Linked to Exposome, Not Genes:

  • Exposome = cumulative lifetime exposure to chemicals, nutrients, pollutants, and social factors.
  • Environmental toxins (pollution, plastics), processed foods, additives, sedentary lifestyle, and chronic social stress all drive inflammation.
  • Genes provide potential; environment determines expression.

  Guest C (22:03):
  "It's the totality of biological, chemical and social exposures that a person suffers throughout the life course."

  Dr. Hyman (22:16):
  "It's not the genes that are the problem, it's the exposome that's the major problem for most of us."

8. The Immunome, "iAge," and Next-Gen Biomarkers (27:36–42:50)

• Revolutionizing Inflammation Measurement:

  • The "1000 Immunomes" project uses high-tech panels to track thousands of immune/biochemical parameters.
  • "iAge" is an inflammatory biological age metric tied to risk for multimorbidity (multiple chronic illnesses), frailty, cardiovascular aging, and mortality—far more predictive than traditional blood tests.

  Dr. Hyman (32:08):
  "This is something that's never been possible before because you have this convergence of the framework of systems biology..."

• Key Discovery:

  • Five main blood biomarkers (including the chemokine CXCL9) are most closely tied to inflammatory aging and chronic disease risk.
  • CXCL9, in particular, comes from blood vessel lining cells and drives dysfunction in the heart and vasculature; blocking it in cell models can reverse this dysfunction.

  Guest C (39:37):
  "We identify five—it's a core, five biomarkers, including this one CXCL9, that is largely produced by your endothelium... those cells can become senescent and they start producing CXCL9. And then you have all these downstream effects..."

• Limitations of Older Tests:

  • Traditional markers like CRP or sedimentation rate are only modestly predictive; advanced panels bring new accuracy and granularity.

Memorable Quotes & Moments

• Dr. Hyman (10:27):
  "If [inflammatory markers] were high, they had a 260% more likely chance of dying in the next four years. So this is no joke."
• Guest B (12:25):
  "Just getting out and moving every day... can actually dampen... the inflammation in the body."
• Dr. Hyman (22:16):
  "It's not the genes that are the problem, it's the exposome that's the major problem for most of us."
• Guest C (34:32):
  "In essence, are you generating a clock, a biological clock, a new clock of aging. And this is an inflammatory clock..."
• Guest C (37:24):
  "We're able to predict with the inflammatory age seven years before it happens who's going to become frail."
• Guest C (41:17):
  "When we take CXCL9 and incubate... we put in a petri dish and we start growing cells in the presence of CXCL9. These endothelial cells are completely dysfunctional."

Timestamps for Important Segments

• 04:47: Defining inflammation; acute vs. chronic
• 08:13: Tack rule—removing causes, not just symptoms
• 09:20: Inflammation as the root of major aging diseases
• 12:03: How to test for hidden inflammation
• 13:45: Lifestyle as medicine—diet, exercise, stress, sleep
• 15:22: Anti-inflammatory foods and spices
• 21:36: The exposome’s dominance over genes
• 27:36: New science—immunome, iAge, biomarkers, and aging clocks
• 39:37: CXCL9 as the emerging key biomarker
• 41:17: Mechanistic evidence for how CXCL9 accelerates aging and disease

Conclusion

Dr. Hyman and guests reveal chronic inflammation as a silent but curable epidemic powering nearly every modern disease. The path to health lies in understanding the exposome, feeding the immune system right, leveraging exercise and restorative habits, repairing the gut, and adopting a functional medicine mindset focused on root causes. Science is now catching up, providing powerful measurement tools and shifting the paradigm—putting the power to reverse disease and aging squarely in our hands.

For those seeking the actionable short version:

• Eat a diverse, plant-rich, minimally processed diet.
• Move daily—walk, exercise, minimize sitting.
• Manage stress actively and prioritize sleep/social connection.
• Remove environmental toxins and food additives.
• Invest in measuring and lowering your inflammation, not just your cholesterol.
• Remember: the root is almost always lifestyle, not unlucky genes.