The 5R Protocol That’s Helping People Reverse Disease Naturally

Mark Hyman, MD

Full Transcript

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Dr. Elizabeth Boham
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.

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 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 Hyman Hive. And if you're looking for curated and trusted supplements and health products for your health journey, visit my website at DrHyman.com for my website store for a summary of my favorite and thoroughly tested products.

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 And we use tests that traditional doctors just don't do. We have a different set of lenses, a different set 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 first case is just so rich with a story that is so common that I I just love you to share this because I think I think everybody's gonna resonate with this story. Right. And by the way, I have never seen this patient as your patient, but I have I've literally seen the same story a hundred times or maybe 500 times

Dr. Mark Hyman
or a

Dr. Mark Hyman
thousand times in my bracket.

Dr. Elizabeth Boham
It's so common.

Dr. Mark Hyman
It's same freaking story.

Dr. Elizabeth Boham
So tell us about this person. So 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?

Because he was having so much stomach pain, he had lost some weight. So 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, well, for everyone, the timeline is so important, right? That's what we learn in functional medicine is gathering that information, learning about that individual patient's story,

Dr. Mark Hyman
seeing their we start with a history with the mother and her pregnancy and the birth and were 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 irritable bowel, the average GI guy is not asking all these questions. So why do we ask all those questions?

Dr. Elizabeth Boham
Because for this gentleman, for example, he really didn't have stomach pain before a year ago, but what we found out is that when he was a kid, he had ear infections. And

Dr. Mark Hyman
he had Probably because he was eating dairy.

Dr. Elizabeth Boham
Probably, right? So it's such a common connection.

Dr. Mark Hyman
Oh my god, I remember months being in the ER, Liz, and this patient came in and this little boy keeps coming back and like a 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 was even before I knew about functional medicine.

Dr. Elizabeth Boham
I

Dr. Mark Hyman
know. And I was like, well, maybe you shouldn't eat dairy. Like it was fine, you know?

Dr. Elizabeth Boham
Right. That's such a common connection. Mean, even my son when he started dairy,

Dr. Mark Hyman
he

Dr. Elizabeth Boham
got asthma and 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, you know, 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, When

Dr. Mark Hyman
you screw up the gut with antibiotics or a C section or lack of breastfeeding, then you get often more acne.

Dr. Mark Hyman
Yes. And we

Dr. Mark Hyman
treat acne from the top in as opposed to the inside out, which is actually where it works much And

Dr. Elizabeth Boham
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 of these digestive issues and was losing weight. And so

Dr. Mark Hyman
Which is a common story. People are gonna have like this of smoldering a bunch of insults over the course of their life. Know, maybe they're a C section, they had antibiotics as a kid, they took acne antibiotics, they got, you know, they were eating a crappy diet, whatever. And all of a sudden something happens and then boom, the body can't take it anymore and it creates some kind of disease. But if you look at the story, can often map out exactly how this happened.

Dr. Elizabeth Boham
That connection with his acne, with his asthma, with his digestive issues, with those antibiotics. That's that story we often see.

Dr. Mark Hyman
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.

Dr. Elizabeth Boham
Right. So with him, as we do with most of our patients, we do food first, right? So we said, okay, we've focus on this person's diet and help him start feeling better right away 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.

You know, sometimes we will do some tests that look at, of course, we'll test for celiac disease

Dr. Mark Hyman
or Which is a big cause of leaky gut.

Dr. Elizabeth Boham
Yep, that's for sure.

Dr. Mark Hyman
Probably the number one.

Dr. Elizabeth Boham
And he didn't have that.

Dr. Mark Hyman
By the way, you don't have to have celiac disease to actually

Dr. Mark Hyman
have a problem, Right? You can have,

Dr. Mark Hyman
they call it non celiac gluten sensitivity. I would estimate it probably affects twenty percent 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 them. Yep. You know, I read a study that autistic kids and schizophrenic patients often have twenty percent of them have antibodies to gluten. Yes.

And it may not be full blown celiac.

Dr. Elizabeth Boham
Absolutely. And and even, you know, irregardless of even if if people are negative totally for celiac, if they have increased intestinal permeability, they start reacting to a lot of different foods.

Dr. Mark Hyman
Yeah.

Dr. Elizabeth Boham
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.

Dr. Mark Hyman
So they're not true allergies, they're more like sensitivities.

Dr. Elizabeth Boham
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. Mean, still always want them to be on a healthy diet, but we wanna relax those restrictions over time.

Dr. Raja Dhir
Most of

Dr. Elizabeth Boham
the time we can.

Dr. Mark Hyman
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.

Dr. Elizabeth Boham
Then you just Remove, right? That's the remove

Dr. Mark Hyman
in five Right, the five Rs, remove, replace, reinoculate Repair.

Dr. Elizabeth Boham
Rebalance. Yep.

Dr. Mark Hyman
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?

Dr. Elizabeth Boham
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, you know, probably because of years of antibiotics, he developed this dysbiosis, this imbalance in the bacteria and yeast. So there was an overgrowth of the unhealthy things.

Dr. Mark Hyman
It's like weed, having a lot of weeds in your garden. Yeah. Right?

Dr. Elizabeth Boham
Right. It's not always like one of those, do 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 know, you can get a lot of bloating after you eat, you can get, a lot 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.

Dr. Mark Hyman
Yeah, it's so powerful. Know, when I see these patients, I'm like, okay, you don't have to do all the tests, but sometimes you get stuck. You look at various tests that look at antibodies against things that are in the gut that determine a leaky gut. Right. And we call it Cyrex two testing, which is a test you can get

Dr. Elizabeth Boham
through functional You can look right, you can test to see if there's leaky gut. I love that test too because it's a great way for us to follow-up and see how much we're seeing improvement. Right. Are we doing enough? Right.

Are we seeing improvement in their leaky gut or increased intestinal permeability?

Dr. Mark Hyman
And then

Dr. Elizabeth Boham
we look at

Dr. Mark Hyman
poop testing. You know, we do thousands and thousands of these tests and it's so helpful. It doesn't just look at the microbiome, it actually looks at the function of the gut. Like whether there's malabsorption, you have no digestive enzymes, whether there's inflammation, whether there's overactive antibodies in there, whether you have imbalances in 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. If they're low it means there's an imbalance.

We look at the microbiome, 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. And 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 five r.

It wasn't working. But I forgot the first part of the r which was removed and I I thought well maybe you know heavy metals cause autoimmunity, maybe it's a problem. And so I tested him and he was like wasted away and it was terrible. He actually had high levels of mercury, we treated mercury and his colitis went away.

Dr. Elizabeth Boham
Which is phenomenal. Yeah.

Dr. Mark Hyman
So I think it's so powerful. And this case is so important because it really describes how a patient goes to a traditional doctor, is diagnosed with the disease irritable bowel syndrome. By the way, any time you hear syndrome, it means doctors know what the heck is going on. It's just a collection of symptoms that we agree we're gonna put in this bucket and if you have those symptoms you have this disease. But it's not really a disease.

And so that's what functional medicine is. It sort of looks upstream to figure out what the root causes are and personalize treatment for everybody. And there's common things that we do like the five R, but it may be different Rs for each patient, right?

Dr. Elizabeth Boham
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 Weed killer. Yeah, weed killer.

So that was the remove, right? And then the replace, because he was underweight and because of inflammation in his digestive system, I gave him some digestive enzymes for a short period of time just to help him, to help it so the food wasn't as inflammatory for him and to help him absorb more nutrients. And then we worked on reinoculating, inoculating, right? So after we gave him some good probiotics.

Dr. Mark Hyman
Put in the healthy bacteria.

Dr. Elizabeth Boham
Put in the healthy bacteria, some good prebiotics, So we know that there's What

Dr. Mark Hyman
are prebiotics?

Dr. Elizabeth Boham
Prebiotics are the things that help feed bacteria. So they're the food for the Which

Dr. Mark Hyman
is usually what?

Dr. Elizabeth Boham
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. What are phytonutrients?

Right. 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 achromanacea that we know can lower inflammation.

We know that

Dr. Mark Hyman
Just just to back up on that achromanacea thing. So when we look at the poop, we can tell if there's like good levels of different bugs. Yep. And one of them we look at is achromanacea. 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 and response to cancer therapy and metabolic issues and weight. And it's such an overlooked thing. You can't take a probiotic of it, at least not yet. Right.

But you can feed it, the good guys.

Dr. Elizabeth Boham
Right, 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.

Dr. Mark Hyman
So broccoli, collards, kale, but not juicing it.

Dr. Elizabeth Boham
Right, 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. 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. All those good healthy plant foods like our vegetables, our fruits, our spices, our teas, our coffees, really actually are impacting our microbiome, which is fascinating.

Dr. Mark Hyman
It's so great. And just a great anecdote from a colleague of mine, Doctor. Lee, who was on our podcast talking about Eat to Beet 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 achromancy, 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. So basically you die unless you have good bacteria in your gut. 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 achromancy levels up, and she was cured of her stage four cancer within a month.

Dr. Elizabeth Boham
That's a phenomenal story.

Dr. Mark Hyman
Yeah. It's an incredible story and I think that just shows the power

Dr. Elizabeth Boham
Of these plant foods.

Dr. Mark Hyman
Of the plant foods and of getting focused on the gut.

Dr. Elizabeth Boham
Yes.

Dr. Mark Hyman
Yes. You know, we call it the five R. 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 that stuff. So it's really, it's so powerful.

Can't tell you, as a functional medicine doctor for the last thirty years and you've been doing this almost as long, 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 and eczema, whether it's your mood, whether it's weight, metabolism, whether it's migraines, whether it's Alzheimer's, mean, autism, ADD, it's just amazing when you start to focus in on this. So let's break down the the five r program for everybody. So we got the remove. So what are we looking at? We're removing

Dr. Elizabeth Boham
Removing unhealthy foods or or inflammatory foods for that person.

Dr. Mark Hyman
So they can be food sensitivities, things like gluten and dairy, big ones.

Dr. Elizabeth Boham
Sensitivities. Yep. And then we're removing

Dr. Mark Hyman
Processed food and junk food.

Dr. Elizabeth Boham
Oh, yeah. That's for sure. Correct. 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 or Human fear

Dr. Mark Hyman
overgrowth, yeast overgrowth, a parasite. You know I was on the Red Table Talk and Jada

Dr. Elizabeth Boham
and her

Dr. Mark Hyman
son both had parasites and they both had gut issues for a long, long time.

Dr. Elizabeth Boham
Right.

Dr. Mark Hyman
And they thought it was just how they were. Yeah. But with short little course of treatment, they were both, I've never felt better, right? And all the other symptoms got better.

Dr. Elizabeth Boham
Because now you're actually absorbing the nutrients you're eating, just helps the body heal.

Dr. Mark Hyman
Yeah, so then, so you remove

Dr. Elizabeth Boham
And we replace

Dr. Mark Hyman
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.

Dr. Mark Hyman
Right, right, right.

Dr. Elizabeth Boham
Replace means just to replace some of those digestive enzymes if needed,

Dr. Mark Hyman
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 people who aren't digesting their food as they get older.

Dr. Elizabeth Boham
Yeah, to help get them off of the acid blockers, which we know are creating a lot of problems because we need that acid in our stomach to digest our food.

Dr. Mark Hyman
Okay, take a little detour. So you just mentioned acid blockers. Uh-huh. Okay, these are among the most prevalent drugs prescribed today in America. Other than statins I think.

Mhmm. When I was in medical school in the eighties and we 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 cause they block stomach acid and they'll cause significant problems if you do that long term. You can cure an ulcer with it, you can fix an acute problem but never use this. Now people are on this for decades.

And the side effect which is listed in the manuals that we get as doctors is that it causes irritable bowel syndrome. So you end up fixing the heartburn but you get irritable bowel and bloating and bacterial overgrowth and all these problems.

Dr. Elizabeth Boham
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 slow problems.

Dr. Mark Hyman
Also Change the pH, you get more yeast issues and all this stuff.

Dr. Elizabeth Boham
And then you're not absorbing your minerals, so you can get osteoporosis and you're not absorbing your b 12, so you can get fatigue and dementia. Right? It just goes on and

Dr. Mark Hyman
on and It'll absorb zinc and magnesium, minerals, calcium, it causes osteoporosis, pneumonia, it causes, you know, irritable

Dr. Elizabeth Boham
bowel. Goes on and on. Right? 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 because their body has gotten pretty used to it.

Start to get their bodies their body wants to make acid, so it's it's working against the medicine. So when you wean them down, sometimes they get more acid production. Rebound.

Dr. Mark Hyman
So you actually it's like and it's sort of a trick. Like, get off it, but it makes you worse. So you feel like you have to get

Dr. Mark Hyman
back on.

Dr. Elizabeth Boham
Gotta get back on it.

Dr. Mark Hyman
But it's actually not true.

Dr. Mark Hyman
And you

Dr. Mark Hyman
can actually get off it.

Dr. Elizabeth Boham
Absolutely.

Dr. Mark Hyman
So we do that all the time.

Dr. Elizabeth Boham
We do it all the time. So reinoculate, 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 repairing.

Dr. Mark Hyman
How do know what probiotics to take?

Dr. Elizabeth Boham
Oh, that's a great question.

Dr. Mark Hyman
I wanna know, what are you prescribed?

Dr. Elizabeth Boham
Oh my goodness, that's such a, that goes on and on. We could talk about that for the next

Dr. Mark Hyman
Yes, it's true.

Dr. Mark Hyman
Right?

Dr. Mark Hyman
There's more and more probiotics in the market every day and all have different roles and different functions. We're just sort of, honestly, I think we've doing this forever, but it feels to me like we're at the infancy of this understanding of how to use these in medicine. Yep. What

Dr. Elizabeth Boham
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, go to a reputable place, 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.

Dr. Mark Hyman
They have bacterial overgrowth. Exactly. If you have bad bugs growing in there and you put the good bugs in there, they have a fight and they cause

Dr. Elizabeth Boham
lots so that means we just have to do more work before we can start it.

Dr. Mark Hyman
So

Dr. Mark Hyman
So they got to reinoculate and then you got the And then

Dr. Elizabeth Boham
repair. And that's the fourth R. So that's things like giving good protein, good amino acids, which are the building blocks of protein Repair. 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 in 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 at rest.

Dr. Mark Hyman
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 hardwiring of nervous system in our the gut even has this independent nervous system that actually is like a second brain.

Dr. Elizabeth Boham
And

Dr. Mark Hyman
so we often say people are irritable bowel or emotional or anxious or have maladaptive emotional coping mechanisms but it turns out that the irritable bowel actually can cause an irritable brain and lead to anxiety and all these emotional issues. So it's bidirectional and I think that's a great lever for helping people reset their gut. Gut.

Dr. Elizabeth Boham
Absolutely.

Dr. Mark Hyman
You know I just wanna share a story because I've been doing this for a long time and of course my, I don't know what it is, curse or blessing depending on how you look at it actually getting really sick and having to figure out what to do to fix

Dr. Mark Hyman
myself. Yeah.

Dr. Mark Hyman
And I've had a lot of gut issues over the years which is why I really focused on this. The first was when I had mercury poisoning. Yeah. And I tried everything. I did every functional medicine trick in the book back then and it wasn't working.

Right. 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 disrupts up the bacteria in your gut. Until I got rid of the mercury from my system, I couldn't get my gut straight.

Dr. Elizabeth Boham
Yeah. Because it's impacting your immune system too,

Dr. Mark Hyman
Yeah, right. Then many years later, kinda got an issue which was triggered by an antibiotic for a root canal that I had to take called clindamycin which is known to cause C diff which is a terrible bacterial infection that kills like thirty thousand people a year. And I got that. And I was so sick. I remember.

Liz would come over to my house and I was like, it was pretty bad. We're all struggling to figure out. 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 us seen like 20,000 stool tests. We're like this is the worst one we've ever seen.

And everything was screwed out. And I had no good bacteria, I had low butyrate, I was not digesting, I had tons of inflammation, it was terrible. 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 five r 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

Dr. Mark Hyman
Yeah.

Dr. Mark Hyman
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. There's so many probiotics out there. You go to the grocery store, you go to health food store, there's ones in the fridge, there's ones that not in the fridge, there's this strain, there was that strain.

Nobody knows what's going on. Even most doctors have no clue what's going on. Can you define what's a probiotic and whether we should actually be taking probiotic supplements? Because we've been taught, for example, that when you take probiotics, they don't really take up residence here. They just kind of pass through and do little things and they go on.

Do they colonize? Do they not? Does it matter? Should we be thinking about probiotics from a basic health maintenance perspective? Should we all be taking them?

How do we pick the road probiotic? Should we just be eating sauerkraut and kimchi and forget about probiotics? Can you help us unpack some of that?

Dr. Raja Dhir
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. I can't explain it, but people love them, people use them, but the science and the understanding and the development of them is very confusing and varied. 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. Gregory Reid chaired the panel at the UN that wrote it in 02/2001.

At its core, probiotics are not a new discovery or not a new hypothesis. Typically, were in the early 1900s, organisms that were isolated that were found to be beneficial, and benefit has changed over the years dramatically. Back then, was just keeping your food sterile or safe from pathogens that 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. What is it intended to do?

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, so there's a whole spectrum of even that live part. 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, so that actually was just defined in a Nature review this year for the first time. They're both good, they both can be good, or they both could do nothing. It really depends on what you're looking at.

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. Lactobacillus actually was broken into about 200 subclasses and was completely renamed.

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, the third are the three class of probiotics that have been used in food in Japan, in Europe and predominantly in North America. Almost every probiotic product that is a microbial product that's standardised will contain or derive some version of these, or it's going to come from soil. 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 people that I call your super healthy individuals that exercise well, but not too much. They're not elite athletes because that 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 you can even find that in ways that you wouldn't expect, which you can talk about later. So if you're living in the wild, if you're growing all of your own food, if you're regulating contaminants in your water supply the soil of the food that you're eating, and you're eating a very diverse plant and animal based diet, I think that you're in more or less peak performance.

Lastly, you didn't have heavy antibiotic usage, either early in life or at any period throughout your life, periods of disruption and recolonisation 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 wilded environment. People that meet those conditions, I would say, you probably are doing just fine. You don't need to do too much. 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 more of the modern world.

You're bathing using modern and eating modern foods or packaged 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. I don't know if when you were in medical school, you heard this theory that actually they were giving people with IBS or IBD helmets, were giving them known worms, basically. They found that it was very effective. 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, that an active immune system has to be active or inactive, and that's very context dependent. I've actually even heard many in the field on this podcast talk about the indigenous microbiome, or the hunter gatherer microbiome, and define it as this optimal state, but optimal for who?

If you took this microbiome and transplanted it to an 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 Bellows, Marty Blazer, a lot of the missing microbes people that were involved in characterising the northern Amazonian microbiome. Actually, they went for six weeks to go live like them and see how their microbiomes shifted. This was an experiment from the mid to late 2000s. I remember Gloria telling me that she could do everything, 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 that's what it means to live like that. Means that you're taking it all.

Dr. Mark Hyman
With probiotics, there's a lot out there. What's important to think about if people are trying to choose a probiotic, how do they evaluate it? Now, for example, 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 five methylfolate as opposed to just folic acid.

Or if you need magnesium, maybe you need magnesium glycinate 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 think, you know, it has to be bioavailable in terms of the form.

It also has to be absorbable. So if it's in a crushed tablet, it's under tons of pressure, it might be the right everything, but it may not digest it. So tell us about how do we think about probiotics? Should we be taking hundreds of different strains? Should we just take one?

How do we know what's good? If you buy something in the store, it says 50,000,000,000 on the bottle, is it actually that? How do we know? What should we be thinking about?

Dr. Raja Dhir
It's a very simple rule of thumb for people. 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. There are 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. I think that this is bucket one. Bucket two is your

Dr. Mark Hyman
general I just want stop there for a sec. 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. 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. It's quite interesting, the differential ability to determine which probiotic is good for which thing. That is something that's pretty new.

It's almost like personalized probiotics.

Dr. Raja Dhir
You're not going to get that from one or two bacteria, so you have to either only take one benefit you're looking for, or you have to take a more complex consortia. It's not that you need 100 strains, but if you want to maximize the outputs, you generally want to see more microbes adding up together to create broader spectrum effects. So there is a kind of network effect, if you will, going on, on which probiotics you take and for what purpose you are taking them. That second category of probiotics is, well, what is basis? You hear all the time somebody say, Oh, well, I get my probiotics from kimchi or I get my probiotics from a nutritional shake or, well, you 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 the gut barrier, or a strain that regulates cholesterol uptake, or a strain that works on evacuation disorders to relieve constipation.

All of these are different mechanisms, and they're coming from different strains. That's why, again, I want to emphasize consortia are so important. Bacteria?

Dr. Mark Hyman
When you say consortia, mean a lot of different strains that have

Dr. Raja Dhir
different A lot of strains together.

Dr. Mark Hyman
Keep going on how we know to pick the right one or the right strains then.

Dr. Raja Dhir
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 what you're picking 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 bacteria which are you list. And none others. It's very simple, and that's done by very good quality control. You're sequencing at the level of individual genes all the bacteria in your product.

You know them. 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. This is the most important question to ask from a 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 1,000,000,000,000 organisms or a yogurt starter culture from Australia that says we have 1,000,000,000,000 bacteria.

There's kind of your VSL3 kind,

Dr. Mark Hyman
gastrointestinal

Dr. Raja Dhir
gastroenterologist recommended probiotics that are 300, four hundred billion, where you see these big, big numbers on them. But you have very 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 label, it's predominantly one. The number one gastroenterologist recommended probiotic has nine strains listed on its label, I believe, or eight, but it's 96% yogurt starter culture and the rest are small, tiny byproducts. 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. A model there's a sequence

Dr. Mark Hyman
of In other words, can take a probiotic that looks good in the bottle, everything's in there, you eat it, take it as a pill, it gets digested in your stomach and kills everything, right?

Dr. Raja Dhir
Yeah, or what's listed as never even alive by the time it makes it. Maybe you see 100,000,000,000 written on the label, but there's ninety nine percent die off by what reaches the colon. You're not going to get much organic acid production with 99% die off before it even gets where it needs to go.

Dr. Mark Hyman
Here, you have to make sure you know you're taking a multiple consortium of, what you call them, 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 we can use that data to start to design probiotics that actually make sense.

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, to help your detox system, to help your immune system, to help reset your nervous system, and it's powerful. So if you wanna really see how your body can feel and get rid of what we call FLC syndrome, I would do this. Most people are like a frog that's in cold water where you turn the heat up slowly and it starts to boil to death. We just kinda get used to it and think it's normal.

These symptoms are not normal. But then I wanna 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. 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 just maybe opposite. But anyway, yes, it's very safe. Anybody could do this. And some people, by the way, need more of certain things or other things, but basically, this is a very universal approach to resetting your system. A second pillar aside from what you're eating, food is really important.

And then by the needy protein in the morning, you need to make sure you get rid of sugar and starch in the morning. Super important. We'll make people start their diet, their day with carbs, which is the worst thing you can do with sugar sweetened coffee, Steves, cereals, muffins, bagel, breads, diamonds. Second pillar are your daily habits. Essentially, mom's 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 tending to time. One is when you eat and also when you sleep. 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 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 twelve to fourteen hours between dinner and dinner at six, breakfast at eight, that's a fourteen hour fat. Okay.

If you eat at six 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 rep and getting the body to reset. And I wrote a lot about this in my book, The Young Forever, but basically there's a whole process at night that happens called autophagy, clean up, or repair. You wanna eat your body, the ability to do that.

The next is food. Now you can do a breakfast if you're eating, for example, dinner at six and breakfast at eight or so. That's important to our sauce. Really important to have protein in the morning, not carbs and sugar. Also, not eating three hours before bed is really important.

So most people eat and snack after dinner. Don't do that. Have at least three hours of time you eat and you go to sleep. That way you will lose weight. Your body can repair and deal 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 gonna eat sugar and arms, you're gonna eat more. So you wanna focus on sleep and restorative rest. We know that getting in a routine of waking and sleeping can help with a deeper, more restful sleep.

So try to pick the same bedtime every night, try to get off your screens for an hour or two before bed, keep your room or use blue block glasses, keep your room dark and cold, probably five to 68. Very 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 at six to 07:10 days, turn your phone off and get it 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 kinda wind down. Oh, and the third pillar is extra support we need on the journey.

Right? Now we all need nutrients. They they're called vitamins because they were vital amines, vital to life. Right? And and so we've seen a dramatic reduction in the nutrient density of our food.

Our organic matter's 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 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 do you need to not get? Rickets, not very much, like thirty 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, know, kind of food that we never ate and nutrient depleted.

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 forty five percent are low or deficient in magnesium involving over 300 different enzymatic reactions. Super important, helps relax your nerves system at night, help you calm down.

Also, people get constipated. Sometimes they change their diet. So taking magnesium citrate can help. And lastly, D. I mean, it's all sick fish well, but vitamin D is really important.

Vitamin B over eighty percent is lower, deficient in vitamin D. It's involved in so many different things in the body. So really important and it helps your mood, muscle function, helps your brain, your energy, inflammation, autoimmunity, it's just super important and most of us show love. Fish oil is also important and I often recommend fish oil to people who are omega-three fats. So what are the program steps in the ten day detox?

What should be the tips? And then we're gonna go through this. The first step is to eat from the ten day detox approved lives for ten days. So eat one of value eats. Right?

Whole foods, you know, whole food based shake in the morning. You could add, you know, protein powder, protein. If you wanna have a 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 twelve to fourteen overnight fast, which means eating within a ten or twelve 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 you to have a multivitamin, magnesium, vitamin D, and fish oil, and we're gonna list which products you should take in the show notes so you have it all listed there. Also what you should eat and what you should avoid during your ten eighty calories, let's go through that. So here's a full food list. We're gonna have it in the show notes.

You can take it with you in store. It's in the book, the ten eighty Talk. It's in the ten eighty Steps 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 the right protein. Right? So grass fed or regionally raised meats is great. You can have a path to raise lamb, beef, bison, venison, elk, grass fed beef, industry is chicken, turkey, duck, all that's fine. What you should avoid is conventionally raised chicken and poultry and and eggs and so forth.

And by the way, you can also have eggs, they're pastry as 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 raised fish are pretty bad for you. What you should be consuming are things like the I call this match fish as small wild salmon, sardines, anchovies, herring, or mackerel. You can have black cod, shrimp, scallop, trout.

Eggs, as I said, pastries, eggs are fine. Nonorganic regular eggs are what about nuts and seeds? Very important. Almond, Brazil nuts, cashew nuts, hazelnuts, macadamia, pecan, pine nuts, pistachios, walnuts, all that's great. You even have cacao nibs, chocolate, and I actually talked about where chocaine comes from.

Seeds are great. Chia seeds, flax seeds, hemp seeds, pumpkin seeds, sesame seeds, sunflower seeds, pumpkin seeds, all great. Nut butter's also great. So unsweetened nut butter, so almond, cashew, pecan, macadamia, macadamia, All that's great. You also eat beans if you're a vegan and you wanna do this, you can use GMO free or non GMO tofu or tempeh as your protein.

What you should avoid are nuts there with sugar. They are cooked in oils that are case of candied stuff. A lot of nut butters have sugar, hydrogenated fats. Peanut butter, peanuts can be okay, but I wouldn't say mostly avoid peanuts because they have aflatoxin often are rinsed so you wanna be careful with that. About oils and fats.

Well, the ones you wanna use are organic avocado oil. You can use organic coconut oil for cooking grass fed dhee. If you wanna use tallow, lard, duck fat, chicken fat, that's okay as long as they're they're path to raise or regenerate. For salads, you can use some kinds of oils like almond oil, flax oil, hemp oil, and Canadian oil, and convert to olive oil. And you can cook with olive oil, but only like tomato sauces and things like that.

Think they're not high heat. Sesame oil, tahini is great as well, great fat. Sesame seed kind of taste. Walnut oil, all the flavorful oil, they're not main oils, but you wanna avoid the traditional oils, all the seed oils like canola oil, partially hydrogenated oils, margarine, peanut oil, soybean oils, sunflower oil, safflower oil, trans sats, vegetable oil, vegetable shortening, all that stuff's bad. What about veggies?

What should you eat? Well, you wanna stick with lots of non starchy veggies or or anchokes, organic if you can. I use the dirty dozen guide from the environmental working group, e w g dot org, tell you which are the clean 15, meaning you can eat thing when not organic or the dirty dozen, which you definitely not eat if they're not organic. But I love asparagus, artichoke, avocado, bean sprouts, broccoli, brussels sprouts, cabbage, cauliflower, celery, cucumber, eggplant, garlic, ginger, hearts of palm, kohlrabi, leafy greens, mushrooms of 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, half a cup a day. What you should be avoiding is corn, corn, potatoes, mostly. A little you know, some of the little fingerling potatoes or the premium potatoes. Pourable potatoes is a 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 you to just get all other dairy. If you're having we encourage you to have it, make sure it's best fed or we're generally raised. What about bees? Well, you can have green beans. You can have green beans.

You can have a non GMO organic soy, just tofu or tempeh. You can have sap beans, you can have snow peas, but otherwise, definitely no beans. What about grains? No grains at all. So even healthy grains, quinoa, buckwheat, things like that, I agree really have opt opt all of that.

Why? Because it just shuts down the insulin response,

Dr. Mark Hyman
helps

Dr. Mark Hyman
you lose weight, reduce inflammation. Not that these are necessarily all bad, but eventually you can add them back, but basically get rid of all other grains, wheat, barley, rye, rye, amaranth, oats, everything, get rid of it. Fruit, fruit can be okay, but small amounts of non hypoglycemic traits. So organic blackberries, blueberries, cranberries, kiwi, lemons, limes, raspberries, all that's fine. Not too much.

Right? You know what mean? Like, you know, two pounds of blueberries, but you can have a help have a company that wanna 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, maybe good for you are actually good for you, right, whether it's, you know, peaches, pears, nectarines, cherries, for example, but you don't wanna eat them while you're on the ten day detox. You wanna really shut down the blood sugar and response.

What about sugar sweeteners? Sorry. The Chip. You can sometimes add a little bunk fruit or stevia. You have them in the shake.

We have but generally, you 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 the answers, basically. Right? Then what should you be drinking?

Well, lots of water, herbal tea, green tea, all this caffeine. That's okay. A little green tea is fine. You know, if you get a little coffee, Sparkling water, mineral water, the way to avoid alcohol, coffee, bottled water, potpicks, soda, obviously sugary beverages. Basically, that's the program.

So if you eat that way for ten days, you use simple habits, your body is gonna totally transform, and you're gonna 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 that you do it for ten days or twenty one days or ten weeks or ten months, you have to be smart about getting off it where you can get a big trouble Because when you go off of things that are inflammatory foods that you're allergic to, and then you reintroduce them, you can get a worse symptoms. So let's say you had migraines before and they're gone. Wow.

You're gonna get a doozy of a migraine. Let's say you had gut issues before, you had a real problem. Unless you had sinus congestion from eating dairy and then eat it again, you might get a sinus infection. So you really have to be smart. So if you're feeling great and you wanna continue and you, let's say you have a lot of weight to lose, let's

Dr. Mark Hyman
say you

Dr. Mark Hyman
have immune disease, you just wanna you're feeling great. You wanna continue. No problem. You continue it. Continue to do it.

You can do it for another ten days. You can do it for another ten months.

Dr. Mark Hyman
It's

Dr. Mark Hyman
totally safe to eat. It is pretty much how I eat most of the time with the Cajun grains and meats.

Dr. Mark Hyman
If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Doctor Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the doctor Hyman show wherever you get your podcasts.

And don't forget to check out my YouTube channel at Doctor Mark 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 doctor 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 my opinions and my guests' opinions.

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