As the food as medicine movement gains popularity, more people are trying rigid diets and restrictive food protocols to ease their symptoms and achieve optimal health. But what diet is best? Paleo? Vegan? Vegetarian? And have some patients taken regimented eating and food restriction too far? Can a rigidly healthy diet be too much of a good thing? In this episode of New Frontiers, Dr. Fitzgerald talks with Mark Hyman, MD, whose new book Food: What the Heck Should I Eat? cuts through the media-promoted contradictions about food (“Eat butter!” one week. “Wait! Don’t eat butter!” the next week) and offers readers clear guidance on what to put on their dinner plate. In this podcast, you’ll hear:
- About the limits of observational nutrition studies
- Why clinicians must pay close attention to studies and whether they show correlation or causation
- How genetic polymorphisms affect the ability to process dietary fats
- The importance of considering bio-individuality when recommending food protocols for patients
- About the emerging field of regenerative agriculture and how it benefits the body and the environment
- Resources for buying high-quality food at a reasonable price
Dr. Hyman is a practicing family physician, a 11-time New York Times bestselling author, and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the Pritzker Foundation Chair in Functional Medicine at the Cleveland Clinic Lerner College of Medicine and Director of the Cleveland Clinic Center for Functional Medicine. He is Founder and Director of The UltraWellness Center, chairman of the Institute for Functional Medicine, medical editor of The Huffington Post, and a regular medical contributor in the media for CBS This Morning, Good Morning America, CNN, The Dr. Oz Show, and more.
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Dr. Kara Fitzgerald: Hi, Everybody, welcome to New Frontiers in Functional Medicine where I’m interviewing the best minds in Functional Medicine, and today is no exception. I’m really excited to have Dr. Mark Hyman returning to our podcast. He’s going to be talking about his new book, and loads of insights, and I’m going to ping him on questions for the clinician, so Food: What the Heck Should I Eat?
Let me give you his background, although I know you already know it. He is a practicing family physician. He’s an 11-time New York Times bestselling author. Mark, I was amazed when I looked at the list of books you’ve written, just as a sidebar. I mean, seriously. It’s extremely…….
Dr. Mark Hyman: You and me both.
Dr. Kara Fitzgerald: Massive, massively prolific. Anyway, he’s an internationally recognized leader, speaker, educator, an advocate in the field of Functional Medicine. You are an amazing advocate for us. He’s the Pritzker Foundation Chair in Functional Medicine at the Cleveland Clinic Lerner College of Medicine, and he’s the Director of Cleveland Clinic’s Center for Functional Medicine. Congrats on the massive expansion over there. He’s the founder and director of The UltraWellness Center, Chairman of the Institute for Functional Medicine, medical editor at Huffington Post, and a regular medical contributor to all sorts of media outlets over the years. Mark, welcome back to New Frontiers.
Dr. Mark Hyman: I’m so glad to be back. Thank you.
Dr. Kara Fitzgerald: Yay. You know, I enjoyed our last podcast, Tussling with All Things Fat. I mean, I guess I appreciate you’ve been in our world for a long time, and you’ve been thinking … You’ve always been very nutrition-centric and, of course, our world, and the greater world, moves through all sorts of fads, and it’s grounding to write a book called Food: What the Heck Should I Eat? You know, it is.
Dr. Mark Hyman: Yeah.
Dr. Kara Fitzgerald: I mean, I’m asked that question every day in my practice.
Dr. Mark Hyman: Yeah, that’s great.
Dr. Kara Fitzgerald: So, I really appreciate you tussling with this, so, what the heck should we eat? When I lecture at the Immune Module with Bob Roundtree, he points out the data on vegan diet, NRA, and, of course, now we’re looking at Paleo, or ketogenic leaning, or to the other extreme, Esselstyn, who’s pulled all fat out in heart disease.
Dr. Mark Hyman: No avocados, no nuts, no seeds.
Dr. Kara Fitzgerald: Yeah. So, no wonder we’re so confused, and just comment on this ping-pong.
Dr. Mark Hyman: Well, there’s a bunch of reasons that I sort of uncovered about nutritional confusion. One is that the science itself is challenging to do, because it’s not like you can take a drug and randomize people with two different medications, follow them and track what happens.
Dr. Kara Fitzgerald: Right.
Dr. Mark Hyman: Unless you stick people in a lab, in a hospital, and there are a few studies that have done this. Remember the study, it was in the 20s, I think, where they put people in a lab for a year, and they fed them only meat to see what would happen.
Dr. Kara Fitzgerald: How extraordinary.
Dr. Mark Hyman: Yeah. They’ve done some of these experiments which originally were studies in mental hospitals where you have 9000 people randomized to saturated fat, or vegetable polyunsaturated fats, Omega-6s like corn oil, and then you get really amazing results from that. Most of the data we have in nutrition is observational data. It’s essentially data that can’t prove cause and effect, it’s correlation only. What I think most providers, practitioners, and scientists don’t necessarily understand, unless you’re a statistician, is that unless you have a hazard ratio over two, the results are meaningless. In other words, for smoking when we looked at correlation data with smoking and lung cancer, there was a 20 to 30-fold increase in the risk.
Dr. Kara Fitzgerald: Right.
Dr. Mark Hyman: When you look at nutritional studies, let says look at the recent cancer and processed meat study, it wasn’t a 20 or 30-fold increase, it was a 0.2 increase, so unless the hazard ratio is over two, this is 10 times less than that, the results could be chance. A lot of the data that, for example, like the Nurses’ Health Study and the Women’s Health Initiative were really great examples where we had 50 million women taking hormones because the Nurses’ Health Study showed that it prevented heart disease, it was the best thing since sliced bread. Patients say to me, “My doctor told me it was malpractice if you didn’t prescribe hormones to women after menopause.” I’m like, “Whoa.”
This is back in the 90s, and then we had the Women’s Health Initiative published in ’98, which was like, “Whoa, wait a minute.” When we actually did a randomized control trial of 130,000 woman, which was a billion dollar study, guess what, the people who took the hormones did worse. They had heart attacks, strokes, cancer, and the reason they didn’t in the Nurses’ Health Study was because it was an observational study, and the women who took the hormones were the ones who went to their doctor, they cared about their health. They were motivated to do healthy behavior, so they ate better, they exercised. They didn’t smoke, they didn’t drink. They took their hormones like dutiful patients, because they’re supposed to be good for them. That’s why they had less heart disease. It wasn’t because of the hormones. In fact, it was the opposite.
So, we see this confusion in science, and around meat it’s the same thing. In the era where we thought meat was bad, people were doing these food frequency questionnaires every year, and they found that people correlated meat with heart disease, but the truth is the people who were eating meat in those days weighed more, ate more, smoked more, drank more, ate less fruits and vegetables, didn’t take their vitamins, and ate more processed food. It wasn’t the meat. When you look at meat eaters and vegetarians and both shopped at health food stores, they both had their risk reduced in half. You really have to understand these observational data and how it’s correlation, not causation, and that there’s a lot of confounding factors. Nutritional studies are extremely hard to do. So, that’s just sort of a basic level. Then, you see the other data … I’m sorry, I’m just going to-
Dr. Kara Fitzgerald: Yeah, yeah, go, go, go.
Dr. Mark Hyman: There’s other data like looking at, for example, I saw today that a high-fat diet caused trouble with the gut flora that led to more complications with health and disease and diabetes. Well, the truth is that it depends on what you’re eating and the contexts, and the high-fat diet, these weren’t avocados, and nuts, and good fats. They were like McDonald’s and ice cream and things you just don’t want to eat, because if you’re eating high-sugar… ice cream has sugar and fat and milk shake. It’s the worst thing you can eat, right? Even if it’s healthy fats, you combine it with sugar, it’s a disaster. That’s the kind of challenge we have to look through and understand how to interpret the data, so that’s the first big thing is the science itself is challenging. What were you going to say? I have a bunch more reasons.
Dr. Kara Fitzgerald: Oh, my god, I know. All right, well let me just throw out a couple of things. We’ve been looking at the ketogenic, we use the ketogenic diet in practice with certain patients. We support Seyfried’s work and work with cancer patients here and use that diet. If you look at the animal studies, you know there’s liver disease with keto, but it’s the same thing … I’m just backing up what you said. If you look at actually what they’re eating when they put them on this “high-fat” diet, its complemented with a bunch of bad carbs, and there’s just much more going on. Even the animal data aren’t reliable.
Dr. Mark Hyman: There’s another study, for example, where they looked at fatty liver, and different effects of differential fats calorie-for-calorie on fatty liver, and they found that the fats from PUFAs, from Omega-6 PUFAs, they caused acceleration of liver damage and inflammation. Whereas, when they gave them MCT oil their livers healed even though they were still feeding them alcohol, so they were literally giving them a poison, and while they gave them the right fat they actually resolved the problem, so that’s pretty interesting.
The other reasons we’re confused are the media, right? Eggs are bad, eggs are good. Coconut oil’s good, coconut oil’s bad. Meat’s bad, it’s good. It’s like one cover of Time magazine is cholesterol is going to kill you, and another one says eat butter, so consumers are confused. A third reason is that our policies don’t drive proper dietary guidelines, and they are corrupted by industry. The National Academy of Sciences just convened a group to review the dietary guidelines process and found that they were unduly industry-influenced and they ignored huge slots of data that they didn’t even review, like on saturated fats or low-carbohydrate diets, and so they really don’t reflect the science, and they are often unduly industry-influenced. Of course, all of government policies keep people confused, and then the media, the government policies, corruption of the science, and then a lot of fads and competing information out there.
I tried to break through all that, look at the data. I’ve been studying nutrition for 40 years, since I was in college, and I really have been practicing nutritional Functional Medicine for 30 years, and so I see what happens to people in real life. It’s not just an abstract thing where I read a bunch of papers, or a book, and I’m trying to make sense of it. I’m literally doing these things in real time with people, and you actually get to see what happens. It’s very humbling.
I used to be a vegetarian. I used to recommend low-fat, high-carb diets, because that was the recommendations, and people weren’t getting better. Like, I would help people get a little better by getting them off junk food and on whole foods, but now I’m getting people off insulin in a week who have been on insulin for decades, you know. This didn’t happen before.
Dr. Kara Fitzgerald: That’s extraordinary. Good, okay, so that was a lot. That was-
Dr. Mark Hyman: That’s why we’re confused.
Dr. Kara Fitzgerald: Yeah. Well in not just our patients but in our community of Functional Medicine providers, we’re inundated. “When do I prescribe this diet?” or “When do I use that? Do I prescribe veganism to this patient?” Talk to me, though, about … We did mention … So, folks, I did podcasts with Mark, I think it was last year, and so circle back to that, because we drilled down on fat in a remarkable way, and it will be very satisfying to you. Let’s just look at meat. We talked about meat in that podcast, but we can touch on it again here, just a little bit beyond what you’ve already said. Are we eating it these days? I mean, what’s going on?
Dr. Mark Hyman: You know, if you look at, interestingly, the guidelines, dietary guidelines told us to eat less meat, eat more chicken, eat less eggs, eat less dairy, eat less saturated fat, eat more grains, and we did all that. We literally did all that. If you look at the dietary patterns that our consumer Americans…we were compliant, and we got sicker, and fatter than ever, right? We got sicker and fatter than ever, and that drove so much from the wrong guidelines. In fact, factory farm meat, I agree, is not something any of us should consume. It’s bad for us, it’s bad for the planet, it’s bad for the environment, bad for the animals. It causes environmental degradation from the nitrogen runoff, climate change from the methane and the way we grow the food. I mean, it depletes our water supply. It destroys our soils, it’s just not a good thing.
But, that’s a different question than whether meat is healthy or not. A lot of the data, again, was this observational data and it didn’t really prove cause and effect. There’s much other data that doesn’t show that. For example, the 42 country study recently published looked at not just 7 countries like Ancel Keys, but with the 42 food consumption patterns. They found no correlation between animal protein or fat and heart disease, but actually a correlation with cereal, grains, and potatoes. The peer study, 135,000 people, ten countries, five continents, I think again found, over 10 years, found no link between animal products and animal fat and heart disease but, again, a correlation with cereal grains.
Now, here’s the thing. If it’s a negative correlation, in other words, if there’s no signal, the likelihood that it’s an issue is extremely low, right? If it shows that there’s no harm then it’s unlikely that there’s really an issue there. I think we also have to look at… what is the meat consumed with, and what’s the consumption patterns, and what’s the overall diet? When they looked at vegans who were force-fed meat, they found that they didn’t have any inflammatory markers in their blood. It’s because it depends on the gut flora. In this study with animals they found that if they gave them a junk food diet and gave them oligosaccharides for prebiotics to feed bacteria they didn’t have any adverse effects.
Dr. Kara Fitzgerald: That’s really interesting, so they fed them a crap diet and then gave them a prebiotic and they were all good?
Dr. Mark Hyman: Pretty much.
Dr. Kara Fitzgerald: Oh my gosh, note to self.
Dr. Mark Hyman: Note to self, yeah, yeah, note to self, go out Mickey Ds with a prebiotic.
Dr. Kara Fitzgerald: Right. Right.
Dr. Mark Hyman: So, we really have, I think, got it a little bit wrong, and I think the people…Eat meat, don’t eat meat because it’s going to cause climate change, bad for the planet, use 70% of our water resources, 70% of our land is used to grow food for animals for human consumption, not a good idea.
Dr. Kara Fitzgerald: I got it, yeah.
Dr. Mark Hyman: But, what’s really fascinating is this emerging field of regenerative agriculture, which suggests the research that you can actually reverse climate change by consuming the right meat. If you consume grass-fed meat you restore grasslands, and you build soils, you actually sequester carbon, and you then … Soil is basically a carbon sink, like the rain forest, and you will … Actually the water can be held in the soils. Right now it just runs off and causes floods, and then you get droughts, and it’s like this horrible situation where we’re in this water shortage and it’s really not, but when you’re using regenerative agriculture you restore the soils, you hold the water, you prevent droughts and water shortage. You don’t need to irrigate. You don’t need cleaner aquifers, you actually sequester carbon. In fact, the studies show that regenerative agriculture can actually bring our carbon levels on a scale back to pre-industrial levels. We have the capacity to really change.
Dr. Kara Fitzgerald: It’s amazing.
Dr. Mark Hyman: Yes, it’s extraordinary. So, it turns out we need to be soil farmers and grass farmers. You know, 40% of the world’s surface is grasslands but we don’t really think of how to use those in the right way to support human health. The quality of the meat matters, too. If you eat grass-fed finished meat you’re going to have a better fatty acid profiles, more nutrients, and even a little bit better taste.
Dr. Kara Fitzgerald: God, that’s absolutely great. There are more and more resources. In fact, I was just looking at a local resource here in Connecticut with my mom last night, so it is more available. Do you have any off the top of your head you would recommend, you’d direct people to?
Dr. Mark Hyman: For?
Dr. Kara Fitzgerald: Grass-fed sources?
Dr. Mark Hyman: Yeah, I mean. It’s interesting. There’s grass-fed and then there’s …
Dr. Kara Fitzgerald: Or grass-finished, grass-fed, grass-finished.
Dr. Mark Hyman: … and then there’s regenerative, and they’re different …
Dr. Kara Fitzgerald: Ah, got it.
Dr. Mark Hyman: … lingos, right? Thrive Market now has been … It’s the first commercial company … You can go to thrivemarket.com, … to source and sell regeneratively grown meat and also fish. It’s fascinating. There’s a whole new standard that’s coming that’s beyond organic, beyond sustainable, because you can have, for example, organic food that they use tilling methods in the soil that create soil erosion and lead to more climate change issues, even if you are eating organic. You can eat grass-fed that may actually use high-potency grass pellets, or they may be corn finished, or it’s just terminology out there that people can get away with a lot of bullshit. Basically, my rule sometimes is…a health claim on the label and then you probably shouldn’t eat it.
Dr. Kara Fitzgerald: So, we want to look for regenerative agriculture.
Dr. Mark Hyman: Yes.
Dr. Kara Fitzgerald: And Thrive Market is a good place to start.
Dr. Mark Hyman: Yes, yes, and in the book, Food: What the Heck Should I Eat? There are all sorts of resources of where to find these products and what companies are doing this and how to do it.
Dr. Kara Fitzgerald: Incidentally, if you’ve got at your fingertips any of those 623 citations you just buzzed off the top of your head, shoot them to me. Folks, I’ll attempt to get as many of those references as I can.
Dr. Mark Hyman: I can just send you a document which has all the references.
Dr. Kara Fitzgerald: Okay, perfect. Handy, easy, okay. Good, good, good.
Dr. Mark Hyman: There’s all 500, yeah.
Dr. Kara Fitzgerald: All right, so any comments on cholesterol? We talked about it before. I know the government dietary guidelines, basically, overturned the whole idea of don’t eat cholesterol. Actually, let me ask you this. So, a lot of us are getting that cholesterol is not a huge deal, and I want you to comment on some of that background that we’ve discussed before, but I also want to talk to you about it in the context of our ApoE4 allele patients, as well, and if you might nuance these guidelines in that population.
Dr. Mark Hyman: Yeah, yeah, right. For sure Functional Medicine is all about personalized medicine and you know there are genetic heterogeneities in terms of numbers, and I’ve seen this. I’ve seen you put them on a ketogenic diet, butter and coconut oil, and their cholesterol drops 100 points, their triglycerides drop 200 points, the HDL goes up 30 points. Other people, I see their LDL go way up, their particle number go way up. I see a lot of heterogeneity in how people respond to different fats, it could be a genetically a cholesterol synthesizer, or a cholesterol high absorber. There’s a lot of variability in how we handle our dietary fats, and I think there’s a lot of genetics we’re just sort of discovering. I think the same way with statins, there’s very statin-intolerant patients, but there’s others may do better with statins, and I think we just have to kind of be open to that.
Dr. Kara Fitzgerald: Now, would you start an ApoE4 person on a lower fat, lower cholesterol, or cleaner fats, unsaturated fat sources, or would you actually just monitor their labs and see how they respond. What’s your approach?
Dr. Mark Hyman: For ApoE4 patients?
Dr. Kara Fitzgerald: Yeah, just-
Dr. Mark Hyman: Yeah, I think I would just … You know, everybody’s their own n of one, right, so you try different things. Say, “Okay, try this type, try this type,” doing the check back in six weeks, and then we’ll redo the labs and we’ll see what happens. You can’t always predict, because these are not just a single allele that is the problem, right, a single. These are multiple connections of SNPs, or they call them genome-wide associations. I think everybody’s different. Some have great detox in one way. Some are terrible in another way. Some are great methylaters in this pathway, but terrible in this pathway. Some have great lipid pathways here but shitty ones over here. Really, it depends on the whole collection.
Dr. Kara Fitzgerald: Absolutely.
Dr. Mark Hyman: I think you have to sort of see how people respond, and then you look at them as individuals. There’s no one recommendation for everybody. There is some sense that ApoE4 patients, they don’t want to be having a ton of saturated fat.
Dr. Kara Fitzgerald: We’ve got loads of tools, and we can look at them in the full picture. I agree with you. Have you completely moved away from considering calories? Is it gone from your world?
Dr. Mark Hyman: Yeah. I think I don’t have people focus on calories. I think that’s the other big myth around food is that food is energy and it’s all about energy balance. In the whole nutritional, medical world, the government’s recommendations, the food industry guidelines, are all about how it’s all about energy balance, calories in, calories out, eat less, exercise more. That’s been really totally disproven, and the fact is that the quality of the calories matter more than the quantity, and that you can’t presume, and you’re not going to eat more stuff. In other words, you can eat a whole sheet cake, but people aren’t going to eat 10 avocados, right? If you eat the right foods you don’t have to worry about how much, you just have to worry about what, and that makes a huge difference. We know that the quality matters and, for example, fat calories stimulate metabolism, cut hunger, increase lipolysis, that they actually are much more beneficial, speed up metabolism.
Whereas sugar or starch calories do the opposite, right? They cause permanent lipolysis. They store fat in belly fat. They increase your hunger. They slow your metabolism calorie for calorie, so we have to sort of get away from that. We know, for example, there’s a large study recently published, we’re looking at a randomized trial for a year comparing a low-fat, restricted calorie diet, compared to an unrestricted high-fat, low-carb diet. After a year, the ones who had the unrestricted, they give you as much as they want, high-fat diet had much better weight loss, as well as better lipids and blood sugar, insulin, and everything else.
Dr. Kara Fitzgerald: They were probably able to adhere to it.
Dr. Mark Hyman: Yeah, it’s a lot harder to stick on a low-fat diet.
Dr. Kara Fitzgerald: Right, right. All right, so let’s talk about the Paleo thing. That’s pretty massive in our world, and in the greater community. Moving away from grains, beans, and dairy. What is your take on why we need to move away from those things?
Dr. Mark Hyman: Well, I think … I kind of jokingly created something called the Pegan diet after sitting on a panel with a vegan cardiologist, Joel Khan and my friend, Frank Lipman, is kind of a Paleo guy. They were fighting. I’m like, “You guys, you’re paleo, you’re vegan, I must be Pegan,” and I was sort of laughing.
Dr. Kara Fitzgerald: Yes, I remember that.
Dr. Mark Hyman: Were you there?
Dr. Kara Fitzgerald: Yeah, yeah, I was there. That was really funny. Yeah, yeah, but go ahead.
Dr. Mark Hyman: It was like, it just was meant as a joke. I was like, “Wait a minute, there’s actually something here. This is actually interesting, because there’s a lot of things in common. Dairy’s in common, whole foods is in common, low-starch or sugar is common, lots of veggies is common, nuts and seeds is common, good fats are common, but the things that aren’t are beans, grains, and meat, and eggs, basically.
I think that when you sort of look at the data, you only had to say, “Compared to what?” So, if you take a person who is eating total crappy American diet and you put them on a vegan diet, they’re going to do better, but if you take someone and you compare them to let’s say a high-fat paleo diet versus a low-fat vegan diet, they’re going to do worse, and we see this over and over. We need more large studies for this, but even the new study that came out, the Gardner Study, out of Stanford where they looked at basically whole foods diets that were low fat or high fat. The differences between them were not really significant. I mean, the low-carb diet was like 40% carbs, which is not low carb.
Dr. Kara Fitzgerald: Right.
Dr. Mark Hyman: But, the point was that if people ate whole foods they both did fine, but you can, I think, accelerate the process of… prepare and heal metabolism by eating more … I wouldn’t say like people who did paleo Atkins, I’m like, “No,” because Atkins was like lots of protein and lots of meat, and I think it doesn’t have to be that much. It’s really more of plant-rich diet with high-quality animal protein intermittently, and lots of good fats, and eliminating grains and beans and dairy for a reason, which is that dairy is a very inflammatory food, so how do you move to an anti-inflammatory diet, and we can go into dairy in a minute. Two, it eliminates grains and beans, which for some people it can be fine and well tolerated. It’s really the situation of that patient. If they are overweight, pre-diabetic, which is one in two Americans, 70% of us are overweight, 40% obese now, and if they have gut issues, or autoimmune issues, it may be worth a trial of an elimination of those foods.
I just had a patient that had ulcerative colitis and she was struggling and struggling, and she was vegan and I said, “Listen, just switch over your diet to this.” She started eating meat and I said, “Get off grains, and beans, and dairy, and see what happens, and sugar,” and she’s like, “I’m better.” We hear this all the time so, again, it’s personalized. It’s not like grains and beans are always bad. It just depends on the person and what grains and what beans, right, so that’s what I do in the book. I go through each area. If you’re going to eat meat, eat this meat. If you’re going to eat eggs, eat these eggs. If you’re going to eat vegetables, here’s the ones you should focus on. If you’re going to have grains, here’s the ones to eat and here’s the ones to not eat. For example, gluten grains are probably not great for most people, especially wheat, because of how it’s grown and processed, which is essentially hybridized to give a high level of amylopectin-A, which is a super starch.
The way the plant breeding goes, they add genes, they don’t like getting a pair from each parent, so you get like extra genes, and the ones in the dwarf wheat are full of very inflammatory gliadin proteins. We also spray all the wheat at harvest with glyphosate, which has issues around affecting the microbiome, glutathione status, as well as potential cancer risk. Then, they preserve the flour with calcium propionate, which is a preservative, but it’s a short-chain fatty acid propionate that’s been shown to cause autism in animal models and is not the greatest short-chain fat. You’re basically screwing yourself by eating that food, but you can eat, for example, buckwheat, or quinoa, or amaranth, or black rice, or wild rice. Those are fine to eat. Again, the dose is problem, right? If you eat two cups a day, that’s a lot of starch. If you eat three cups of beans a day, which is 6 oz of protein in a meat, or fish, or chicken, that’s 100 grams of carbs versus zero when you eat the animal protein.
Dr. Kara Fitzgerald: Right, right. So, my mom-
Dr. Mark Hyman: Some of it’s fiber but, of course, there’s still a lot.
Dr. Kara Fitzgerald: Yeah, there are. There are still quite a few carbs. A couple of questions around that. Dairy is inflammatory, but there are schools of thought who use raw dairy. They ferment, et cetera. Any comments on that?
Dr. Mark Hyman: Yeah. I mean, I think that everybody’s different. Historically we really never ate that much dairy, and I think our guts are such a mess, and there’s so much inflammation in our diet. Even raw dairy, I think, is an issue. The issue for me isn’t whether it’s raw or not, it’s what type of casein is in it? If you’re getting raw dairy from a cow that’s been hybridized, and it’s all an A1 casein cow, it’s still going to be a problem. For example, if you eat goat or sheep it could be raw or not. That is A2 casein, which is less inflammatory, less likely to cause eczema, asthma, also less likely to cause gut issues and inflammation, so you might want to focus on more A2 casein sources of dairy if you’re going to eat that.
Dr. Kara Fitzgerald: Okay. Yeah, that makes sense. So, in certain patients they may be able to tolerate goat source without a problem?
Dr. Mark Hyman: Yeah, I noticed that. I once had goat milk. I hate milk, but I found that when I used goat milk I didn’t have any of the normal symptoms. I usually get congested, I usually get terrible gas, I get pimples. I didn’t get any of that having goat milk.
Dr. Kara Fitzgerald: Nice.
Dr. Mark Hyman: Tried it out, yeah.
Dr. Kara Fitzgerald: So, you can imbibe in the periodic piece of goat milk cheese, or something like that without-
Dr. Mark Hyman: Yeah, no problem.
Dr. Kara Fitzgerald: Good, good, good. My mom this week threw caution to the wind and made heirloom wheat bread. She used what is it called Eikorn?
Dr. Mark Hyman: Einkorn.
Dr. Kara Fitzgerald: Einkorn. She brought a piece over to me, a little bit, because I don’t do a heck of a lot of grains myself, and it was actually really nice. It was delicious. What do you see your position on the heirloom gluten-containing grains?
Dr. Mark Hyman: Of course. I think if you’re not celiac, if you don’t have gluten sensitivity, which is probably 20% of the population, you want to enjoy it, it’s much lower glycemic. It has more phytochemicals and lignans in it, it’s actually got different gliadin proteins in it, so, yeah, I think something like that is okay if someone wants to try it. I find I like dark German rye bread, because rye isn’t so messed with. That can be also really good, a whole kernel rye for people who like it. It can improve insulin sensitivity. It has a lot of intra-genomic effects.
Dr. Kara Fitzgerald: This is so radical of you, Dr. Hyman.
Dr. Mark Hyman: What?
Dr. Kara Fitzgerald: A little bit of grain. No, I love it. I’m teasing you.
Dr. Mark Hyman: That’s the whole point of the book, it’s like, “Okay, everybody like just chill out for a minute.”
Dr. Kara Fitzgerald: Take a breath.
Dr. Mark Hyman: Take a breath. Let’s go with what’s going on, and let’s see how to personalize it. Yeah, if someone comes in with autoimmune disease, I’m like, and they’re celiac, I’m not like, “No, you can’t have Einkorn wheat.”
Dr. Kara Fitzgerald: Look at the Blue Zone data. I just love that research. It’s just so heartening, because it’s way more balanced, and if you look at what they’re eating, they’re eating beans, and they’re eating some grains, but they also have fabulous community, and exercise, and they’re got all of these lifestyle components and, of course, their sources are probably cleaner. Any comments there?
Dr. Mark Hyman: Yeah, they are. I think they can be for sure.
Dr. Kara Fitzgerald: All right, so why don’t you give me some of the … Talk to me about what you’re eating these days, this Pegan diet.
Dr. Mark Hyman: Well, what am I eating for a Pegan diet? So, let’s see. What did I eat this morning? The other day I went to Bulletproof coffee in Santa Monica. I was traveling around and I had a Bulletproof coffee, which I don’t have every day but I love it. It really makes my brain go, “Whee!” Then, I had eggs, like pasture-raised eggs, some sort of organic bacon, avocado, with olive oil, salt and pepper. That was my breakfast. Lunch I had zucchini noodle Pad Thai with organic chicken and a Gazpacho soup. For dinner I went out to a Vietnamese restaurant and, oh my god, it was so good. It was like a special one in California, but they had like all these veggies, yams, and chinese broccoli, and fish, and shrimp, and it was great. I tend to eat very low levels of grains and beans. What I always try to do is order, if I go out, order three or four vegetables. At home I always fill up my plate with three-quarters plant foods, mushrooms, vegetables, salad, whatever I can get.
Dr. Kara Fitzgerald: Then, you’re animal protein, I think you say in your book, is sort of like a condiment.
Dr. Mark Hyman: Yeah, yeah, so I’ll have 4 to 6 ounces of protein for dinner, organic chicken or grass-finished meat, or lamb, or fish, small fish. I’ll often have a can of sardines or wild salmon at lunch, stuff like that. Pretty simple. I eat pretty simply and deliciously. In the morning we make an alkalizer shake, which is essentially like a ton of veggies, and avocados, and lemon, and ginger, and we throw it in a blender like a Vitamix, and it’s like a smoothie.
Dr. Kara Fitzgerald: It sounds really yummy. All right, I’m sold. It sounds really good. I know I was like rooting around your kitchen one day when we were working on the case studies book, you had some good eats there. All right, so organic. Obviously, it’s extremely important and buying these regenerative agricultural sourced meats and looking into that, which I think is a great idea, and I will explore that on Thrive, is important. Some of us can do it, and some of us can’t. So, organic … This world it’s expensive, so how do you talk to the general population?
Dr. Mark Hyman: Well, there’s been studies done on this, so to eat healthy is about $1 or more a day, and that’s only because the real price of the food we’re eating isn’t embedded in the price. For example, what’s the real price of a can of soda, or junk food? It’s not accounted for in the price at the checkout counter. Why? Because when you grow food and deplete the soil to grow corn syrup, for example, you use nitrogen fertilizers that runoff in the sea, rivers, and lakes. It causes dead zones and environmental degredation, increased pesticide exposure which creates disease. You actually deplete the soils which contributes to climate change, and then, of course, you have people eat this, it costs huge amounts in chronic disease, disability, lowered quality of life, and then, of course, Medicare/Medicaid, and then we’re paying it for it-
Dr. Kara Fitzgerald: The cost of a coke.
Dr. Mark Hyman: Yeah, and we’re paying for it with tax payers dollars, with food stamps. Like, what does it cost Coke? It could be 100 bucks, right? Vegetables and fruits have gone up 40%, while soda has gone down 40% in cost over the last 40 years, so this is like … This is the problem, to even know this is true it’s still only about a $1 a day more, and even can be done for less. I always think it’s a hierarchy of priorities. If you’re eating a total junk food diet and you switch to a whole foods diet, you actually can make profound changes in your diet and don’t have to break the bank.
I work for a group called The Environmental Working Group, and they have a guide called, Eat Good Food on a Tight Budget, which is good for you, good for your wallet, and good for the planet. Essentially, I gave this to a poor family living in a trailer in South Carolina, one of the worst food deserts in America, and they lost hundreds of pounds just by switching over. You don’t have to buy a $70 grass-fed Rib eye steak, you know. You can just eat regular feed-lot meat. It’s not the best, but it’s better than anything else, right, if you get off of all the junk. You just make choices, and then there’s all these great resources online like thrivemarket.com where they have everything at 25-50% off, even the meats and stuff. You can get, really, access to high-quality food through different distribution channels now online. I think that’s doable for people.
Dr. Kara Fitzgerald: There’s a real sort of shift in how you approach your food supply, I think, when you’re moving into eating cleanly, and you want to do so affordably, so it’s not just running out to the Kroger and grabbing what’s in front of you, which oftentimes is a lot of crap. It’s actually ordering it, maybe planning a little bit ahead, and it’s true it can become much more reasonably priced. Did you happen to see that Forbes article by Stephen Savage on his take down on The Environmental Working Group? Dirty Dozen/Clean 15?
Dr. Mark Hyman: No.
Dr. Kara Fitzgerald: It’s okay. He was just batting it around a little bit recently here. He was just challenging the utility of it and quoted some farmers, both conventional and organic, although I suspect that the organic farmers were part of the Agrobusiness Group, arguing that we should be eating conventional, that it’s as safe. It’s a pretty interesting read. We’re generating our rebuttal now. So, his argument was, and he quoted some organic farmers that, basically, don’t worry about conventional. Comments?
Dr. Mark Hyman: Yeah, well, what I’m interested in is who these people are, because I can tell you that I’ve had articles written about me in Forbes magazine, and when you dig down into who these people are, they work, for example, this guy worked at DuPont, you know.
Dr. Kara Fitzgerald: Yes, well and he actually … This guy, actually, disclosed at the end of the article … I was amazed that it was so easy to find that he is, indeed, a consultant to Agrobusiness.
Dr. Mark Hyman: Right. So, he’s a consultant to Agrobusiness. He’s probably paid for by Monsanto. They’re often part of the things called like the American Counsel on Health and Science, which is basically Monsanto front group, so you dig down these people. This woman wrote this article about me, and it was a real take down. I looked who she was and she was part of the Genetic Literacy Group, which is a front group for Monsanto. So, it’s like, you know.
Dr. Kara Fitzgerald: Yeah, do a little digging, and sometimes not much digging to find out.
Dr. Mark Hyman: No, it doesn’t take much. Yeah, the guys who, for example, came after Dr. Oz, one of them was in jail for eight years for Medicare fraud. The other one took 30 million dollars from Monsanto.
Dr. Kara Fitzgerald: Oh is that right?
Dr. Mark Hyman: Oh, yeah, like. You just got to do a little digging with who these people are. Of course, they’re-
Dr. Kara Fitzgerald: Fascinating. Of course, that was missed by the media, but that’s really wild. All right, so I have one last question for you. Again, circling back to the fact that most of the folks listening to our podcast are clinicians. I want to talk about the “orthorexic” patient that we’re seeing in our practice more and more.
Dr. Mark Hyman: Yeah, that’s bad.
Dr. Kara Fitzgerald: Yeah, so the person coming who’s on a micro diet, really restricted, thinks that they’re reactive to everything. They’ve pulled out oxalates and salicylates, and they’re sensitive to all the beans and, of course, grains, maybe minimal meat, et cetera, but it can be a challenging … We’re seeing this more and more.
Dr. Mark Hyman: For sure. For sure.
Dr. Kara Fitzgerald: Back in the day we were the ones who took them off of gluten, and now we have people coming and we actually have to expand their diet. All right, so talk about that, what you’re doing, what you think about it.
Dr. Mark Hyman: Yes, for sure. I think that there is a real challenge here with patient’s who tend to sort of get stuck on extreme beliefs, behaviors, and I think orthorexia is a real problem. From the perspective of Functional Medicine it’s that resilience is the goal, not restriction, and that the goal of Functional Medicine is to help restore balance, integrity and resilience, and metabolically there’s a freedom in your health and not to be more and more and more restricted.
There are people who do over-interpret this. There are doctors who over-interpret food sensitivity testing. These are not definitive. They show leaky gut. That needs to be fixed. They can go down. I think it’s really important to sort of put in context. I think people who are really restricted … There are some who really literally generally are reactive, but for most of them it’s more of a sort of a psycho-emotional thing that they get stuck on the fear around food, and I think that’s really a problem.
Dr. Kara Fitzgerald: Yeah. I agree. You know, there’s an interesting … We’re thinking about with regard to our allergic patients, I’m sure you’re familiar with introducing peanut at a younger age, in infancy, to stave off peanut allergy, and there’s massive success with that lead study that came out. A lot of us we’ve been using elimination diets for years, and one of the things I’ve been circling on, sort of spring boarding off this peanut study and some other research, was doing micro-exposures to things that people could become sensitive to, to limit the possibility of reactivity. In fact, there’s this company out. I think it’s called Spoon One, that has these just micro-exposures of the top antigenic foods that you can introduce early in childhood to develop tolerance to those foods they might encounter later in life. Even though you may not want them to eat dairy, or wheat, etc., but you can at least develop tolerance early on. I think it’s fascinating and I think it’s important, and I think us, we’re going to circle back to this balanced position that you’re articulating, because if we’re too restricted for too long we can actually induce hypersensitivities.
Dr. Mark Hyman: No, it’s true. It’s so true. Yeah. I want to come back to this guy that you mentioned, Steve Savage, because I literally just looked for two seconds on the internet while we’re talking.
Dr. Kara Fitzgerald: Okay, what did you find?
Dr. Mark Hyman: He works for the Crop Life Foundation, which has as its mission “advanced sustainable agriculture and public health through science education.” The funders include Monsanto, BASF, which is a chemical company, Dow Chemical, DuPont Chemical, Bayer CropScience, which is all GMO, Syngenta.
Dr. Kara Fitzgerald: There you go.
Dr. Mark Hyman: I mean, this is why these people write this stuff. It’s not because it’s true, it’s just a form of propaganda, and I think it’s really unfortunate that Forbes magazine lets these people write this crap without any filter, and no counterpoint, and no overall sort of investigative reporting, that they basically allow propaganda from the food industry to be presented as some independent scientist sharing his views. I think that’s a problem.
Dr. Kara Fitzgerald: Within the article Savage attacks Environmental Working Group because they’re funded by organic farmers, and that’s a conflict of interest that he pointed out in his actual article, even though you just found that he’s sponsored by the ugliest of Agrobusiness.
Dr. Mark Hyman: Right.
Dr. Kara Fitzgerald: Well, Dr. Hyman, it has been lovely to talk to you, and I look forward to our paths crossing in person. Tell me, actually, before we go, what are you up to. Cleveland Clinic has just epically expanded. Things are growing. What do you see the … Not only what are you up to in Cleveland Clinic, but just the global Functional Medicine movement, any kind of insight into what’s happening? It’s a big open-ended question. Speak to all of that.
Dr. Mark Hyman: A lot. A couple things. One, Cleveland Clinic we’re just continuing to grow and expand and really prove the model of Functional Medicine for value-based care, and community-based medicine. I’m super excited about that. We’re super excited. We’re just working with the chair of the digestive diseases, too. We’re launching programs on gut, and irritable bowel, and IBD, and it’s kind of fun.
Second, I’m starting a new podcast called The Doctors Farmacy, and really to talk about issues around food, and medicine, and really get deep conversations going about how we really rethink our approach to what’s happening in the world of food and medicine, and I’m writing another book on Food Injustice.
Dr. Kara Fitzgerald: Really?
Dr. Mark Hyman: Yeah, it’s exactly this thing, so like people don’t understand that there’s this machine that’s driving narratives around what’s true and not true that’s highly corrupt and industry funded, and this was a perfect example just during this podcast, this guy Steve Savage, who’s basically a shill for Big Ag, and for Monsanto and all the companies that are producing chemicals and pesticides. I mean, they say we’re a sustainable agriculture, crop life, it’s nonsense. So, I think that … I’m excited about exposing that story, helping people connect the dots and tell the story about how food is connected to everything from the environment, our health, to the economy, and so forth.
Dr. Kara Fitzgerald: It’s a really, really important story, and I’m glad you’re getting in there and exposing it. It’s really important. All right, Mark-
Dr. Mark Hyman: It’s nice to talk to you.
Dr. Kara Fitzgerald: Yeah, it’s been lovely to talk to you, too. We’ll connect soon.
Dr. Mark Hyman: Okay.
Dr. Kara Fitzgerald: Thank you.
Dr. Mark Hyman: Thank you. Bye.
Dr. Kara Fitzgerald: Okay, bye.