Bonus Episode: Treating High Blood Pressure at the UltraWellness Center

20:04But there's something that's really fascinating about seeing the data in front of you. This helps explain the why that people take it in in a whole different way. You can't argue with some of the things that show up. So I think it can be incredibly helpful at personalizing the recommendations for people. And for her, that was really, really true. So what were some of the things that showed up? She did have some gene variants in that she had an ACE gene that is not associated with salt sensitivity, but potential dysregulation of the angiotensin system. She also had a gene variant called ENOS, endothelial nitric oxide synthase.

20:43So she had a predisposition to potentially have difficulty with making nitric oxide in her blood vessels. We know a lot from a lifestyle standpoint that can really support that, particularly foods. Some of the ones you've mentioned, Mark, the magnesium-rich foods, the polyphenolic-rich foods, these deeply pigmented dark leafy greens and blueberries and black raspberries. We know that nuts and seeds provide arginine, a precursor for endothelial cells to make their own nitric oxide. We know that extra virgin olive oil and omega-3s, there's a lot of great things we can do.

21:19Dr. Mark Hyman:Yeah, so why is that important? Because nitric oxide, didn't they, does something really important to the blood vessels, right? What does it do? It dilates them, makes them more elastic. So basically it helps your healthy blood vessels function better. And it increases your blood vessel dilation, lowers blood pressure. So it's really, really important. It's really important. And it is probably the very first thing that changes when there's anything in the lifestyle or diet or stressors that is starting to impact the vascular system. It's loss of that elasticity in the arteries, the endothelial dysfunction.

21:49Just a little side note about that too, there are other clinical clues. Her Raynaud's was a big clue that she was predisposed to that or potentially had some endothelial dysfunction. For men, it could be erectile dysfunction. That's a huge red flag to think about endothelial dysfunction.

22:06Dr. Mark Hyman:And Raynaud's is kind of an autoimmune disease, right? So it's an inflammatory problem. It can be. That's when you get like your hands turned white when you go out in the cold weather and stuff like that, you lose all the circulation. and it's often, it's just an inflammatory problem in the blood vessels. Often in response to cold, but it can occur in response to stress as well. And it can coexist with autoimmune diseases. So that's another important piece to make sure you're not missing a secondary autoimmune condition, which again, then leads us back to some of the root causes. When somebody does show signs of an autoimmune condition, we go back upstream and think, how healthy is your microbiome?

22:40What's going on with the health of the gut lining? Do they have food sensitivities that are driving inflammation? Always going upstream. to figure out what's going on. Another thing that was eye opener for her is she saw on paper that she was a relatively slow metabolizer of stress hormones. So for years, she'd been saying, oh, okay, I just need to do better with my stress. I need to do better with my stress. And she kept having the reactive blood pressure. This hit home. It's like, yeah, I really do. And there's something different about seeing it on paper and then testing her salivary cortisol throughout the day, seeing that she was high a good portion of the time that made it much more real and tangible for her.

23:18Dr. Mark Hyman:And she also had a gene that helped and made her have trouble kind of metabolizing some of those stress hormones, right? Exactly. So the genes and the high cortisol allowed her to really shift and take it more seriously to do the breath-based practices that she needed to do to try to reduce the impact of stress on her artery elasticity and vasculature. But you're saying individuals have different responses to stress based on their genetics. So So when you have this particular gene that she had, it makes it harder for you to respond to stress. You have to be more proactive about modifying your stress response, not just sort of live in this stew of stress that we all do.

23:53Dr. Mark Hyman:And that stress will increase the blood pressure tone. That's what you're supposed to do when you're running from a tiger. You want your blood pressure to go up, and you want your blood pumping as fast as you can. But that's a good short-term adaptation. But long term, it leads to these problems of hypertension and all the consequences, which is stroke and dementia and heart attacks and kidney failure and like all kinds of problems in the rascular system, lower extremity, lack of blood flow, which leads to ulcers, amputations. So basically, you can have all sorts of issues from high blood pressure that are really caused by some of these other factors that we can modify.

24:35That gene that you mentioned, it's called COMT. We actually talked about this recently in a webinar that we did about hormone metabolism, because it's the main enzyme that inactivates reactive estrogen, but it also inactivates the fight or flight hormones. And people can have two genes that code for a fast copy, two genes that slow for a slow copy, or have one of each. and double slow metabolizers, it might take them 10 times longer to clear those fight or flight hormones out of their system whenever they have a stress response. You can't change those genes, but I think it can help you, number one, have compassion for yourself if you start to feel your body tensing up, tune into those clues that you need to shift gears and then engage in whatever breath-based practice you can so you can mitigate the negative impact on your vascular health.

25:24And, you know, I like to think of it this way, breath-based practices, meditation, yoga, they are great fundamental practices for all of us, but it is doubly important for people who are slow metabolizers and not just your baseline practice that you might start your day with, but finding little mini moments during the day to figuratively empty your stress bucket, whether that's one or two quick breaths or giving somebody a hug or walking outside or doing whatever you need to shift gears.

25:51Dr. Mark Hyman:yeah so important and most people don't know how to do that we don't learn how to actively relax it takes work to relax although i i like the cheaty way i put on headphones and there's like different like mind spa using an app or newcom and it basically takes you through like a guided visualization meditation i'm like boo i feel like i go into never never land and it's really interesting it activates your sympathetic parasympathetic system it can use different technologies like binaural beats but i mean there's even like devices like a shift wave chair, which you can use. It's a little expensive, but you can use it to kind of put yourself in this altered state.

26:23Dr. Mark Hyman:There's a lot of ways to do it, but for someone who's got high blood pressure, it's especially important. It's especially important. You also found this woman had some other issues, right? She had like her blood sugar A1C was high and a normal. And let's talk about that connection between like blood sugar, insulin, prediabetes, and high blood pressure, because it's such an important thing. It's a really important one. So interestingly enough, high blood pressure is one of the criteria for metabolic syndrome. Metabolic syndrome is that combination of a higher than optimal fasting blood sugar, high triglycerides, low HDL, high blood pressure, and truncal weight distribution.

26:59Dr. Mark Hyman:And big waist size. Big waist size. Her waist hip ratio was low risk. Her weight was normal. She had a healthy BMI, but yet she had an A1C of 5.7. So that's in the prediabetes range. What does that tell us? That she's either eating foods that are playing a role with post-meal spikes and or her stress has also contributed to high blood sugar or her sleep disruption is playing a role with her blood sugar. So it's another clue that her vascular health and her cardiometabolic health is not optimal. So she had some room to move the needle and we needed to do a little more digging to see what was driving that and what she could control.

27:37Dr. Mark Hyman:We kind of don't really look carefully at this problem. 90 % of people with prediabetes are not diagnosed by their doctor. Right. And they don't measure insulin. They probably don't measure A1C on their regular blood tests. They look at blood sugar, but if that's normal, they go, you're normal. But blood sugar is the last thing to go up in this whole spectrum of this condition. Like insulin goes up after a meal, then it goes up fasting, and then your blood sugar goes up after a meal, then it goes up fasting. So it's like the fourth step down the chain of disease, and you're kind of picking it up late.

28:08Dr. Mark Hyman:So A1C is a good way to check things. Your fasting insulin is a good way. And these are not things that are typically done when you go to your traditional doctor, but we do this almost routinely at the Ultra Wellness Center because we know this is a problem affecting so many people. And what happens when you have high insulin and when you have high insulin levels? What does it do that causes high blood pressure? Insulin itself drives oxidative stress and it drives inflammation. Insulin is also a player in terms of contributing to more weight gain around the middle. dysregulated metabolism in terms of more difficulty getting glucose into the cells to get processed for energy.

28:42But it's multifactorial.

28:44Dr. Mark Hyman:Yeah. And the other reason is that when you have high insulin, the secondary effect is you retain sodium. So you retain salt. So we kind of touched on before, when people are eating ultra processed food, it's got a lot of sugar and a lot of salt, or a lot of starch and a lot of salt, which is essentially the same as sugar. and so that's what's causing you to hold on to the salt but if you're metabolically healthy which by the way it's not that many people anymore in america you know it's maybe seven percent of americans are technically metabolically healthy you know you you you can have salt without causing high blood pressure i eat a lot of salt and i don't have high blood pressure and it's because my metabolic health is really good i exercise regularly i eat a low sugar starch diet when you when you have high insulin you get like not just a salt retention but you get activation of your stress response, adrenaline, you get activation of, of, of, of like, you know, various things like called the growth factor properties that activate smooth muscle to be growing more where that leads to high blood pressure.

29:43Dr. Mark Hyman:You get endothelial dysfunction, which you talked about with like with nitric oxide issues, you get no basic dilation. So all this can be a factor of, of why high sugar diets cause high blood pressure. You know, most people need to know what their metabolic health is and their statuses and where they are on that spectrum. Because you get risk all the way, not from just 5.7, but even lower, you get risk. So it's something to really look at. That's important because here she is at 56. Nobody had ever measured an A1 stay on her because she wasn't overweight. And I think that's really important to understand that you don't have to be overweight to be on the spectrum of insulin resistance, number one.

30:18When you talk about that metabolically healthy, two-thirds of people with a healthy weight are actually metabolically unhealthy.

30:25Dr. Mark Hyman:Wait, that's a bomb you just dropped, Cindy. Say that again. I believe the statistic is two thirds of people with a so-called normal weight are not metabolically healthy. Doesn't mean you're skinny fat. You're skinny fat. Like you look thin on the outside, but you're fat on the inside and you're metabolically unhealthy. So you don't have to be overweight to have prediabetes or to even have all the dangers from insulin resistance. And that's only going to get worse, unfortunately, unless something changes with our food system and how we eat. So she never had that done. And also the point that A1c, just like everything else, it's a linear spectrum.

31:00So 5.7 is the cutoff to say you're in the increased risk for diabetes category. But if you start at 5.0, every tenth of a point you go up, there's a linear incremental increased association with dysregulated insulin and glucose metabolism and vascular health.

31:18Dr. Mark Hyman:If you're five, you're probably good. But every point you go up from that, even within the quote normal range, you're still increasing your risk gradually. And then we come up as an arbitrary cutoff. It used to be 6.0 or 6.5, and now it's 5.7. What should it be? It should probably be 5.2 or something like that. And the great part of tracking over time is you can pick things up before somebody gets to that point. If somebody's 5.2 one year, the next year they're 5.4, The next year, they're 5.5. What's that telling us? They're on a trajectory that's going the wrong direction. And what's really interesting with high blood pressure is that insulin resistance is a big thing you can actually track and measure, as we just talked about.

32:00Dr. Mark Hyman:You know, one of the ways and the mechanisms by which it causes high blood pressure is inflammation. And there are many causes of inflammation besides that. So let's talk about some of those other factors like nutrient deficiencies or things like gut inflammation that comes from poor diet or lack of healthy gut microbiome. Let's kind of dive into some of those, or even toxins and environmental factors that cause it. So I think people don't really look for those things. When you go to your doctor and cardiologist, they don't look at a poop test. They don't look for heavy metals. They're not looking at your nutritional status.

32:30Dr. Mark Hyman:Like they're just kind of like, oh, you have high blood pressure here, take the pill. So what are the patterns in the gut microbiome that are associated with insulin resistance and vascular dysregulation? Loss of overall microbial diversity. Changes in the composition of the different microbes that exist. So overgrowth of less beneficial species like yeast or some other microbes changes in the metabolic health of the colon. So when we think about what your gut microbes do, they ferment dietary fiber. They create these signaling molecules like butyrate that play a key role in maintaining a healthy gut lining.

33:06And again, it is both chicken and the egg with diet, but loss of microbial diversity, loss of the butyrate species, lower butyrate production. reduction and increased intestinal permeability is one of the drivers of insular resistance, chronic endotoxemia, chronic systemic inflammation.

33:25Dr. Mark Hyman:So basically in English, what you're saying, you're saying in English is that you got a lot of bad bugs in your gut that come from eating a crappy diet, and then you get damaged through gut lining that causes you, your body to be exposed to all the crap literally in your gut and also foods that you shouldn't be interacting with in less when they're already digested and broken down. And so you create this inflammatory response in the body that you can change by healing your gut. So maybe part of dealing with high blood pressure, it's not only dealing with the sugar and starch in your diet and pre-diabetes, not only dealing with things like sleep apnea, actually repairing your gut and optimizing your gut microbiome.

33:59We can do that through foods like good prebiotic foods, things like Jerusalem artichoke or greenish bananas and garlic and onions in the leek family provide food to allow the re-bloom of those beneficial gut microbes, those polyphenols, again, those same foods that help with artery elasticity, they support growth of a particular keystone species that you've talked a lot about, Mark, acromantia, which seems to play a role with a healthy, tends to mirror a healthy mucus layer in the gut. So we know that nutrition can go a long way. Sometimes we'll use supplemental support, especially if somebody has really got a lot of intestinal permeability supplements that contain things like glutamine and zinc carnosine just to help provide extra support for healing that gut lining or adding butyrate or taking an acromantia probiotic.

34:49Dr. Mark Hyman:So in functional medicine and the ultra-harmônia center, this is what we do. We look at the poop, we look at all your toxins, we look at your nutritional status, we see what's going on with you. And it's different for different people, like you said at the beginning, and not everybody has the same issue. And so we optimize gut function. What about common nutritional deficiencies that can lead to high blood pressure? because those are usually not looked at. We call it essential hypertension, means essentially we don't know what it is, but we actually do. So what are the nutritional factors that are common and that are linked to high blood pressure?

35:16I think you hit on two of the biggest, most important one. It's the potassium and the magnesium. Most of us by far don't get our magnesium needs met. And foods today don't have the same levels of those micronutrients that they did. Magnesium, one of the things to understand about magnesium is the blood level of magnesium doesn't tell you anything about your body levels of magnesium because the body is always trying to maintain a blood level at a very critical level, but you can be cellularly deficient in magnesium. And what are the side effects besides high blood pressure? What symptoms of low magnesium?

35:52Irritability, muscle twitches, constipation, premenstrual tension, migraines. Magnesium has a calming effect on nerves and muscles. So if we're not meeting our needs, all of those things can show up. And I think omega-3 fatty acids are another one that's overlooked. Most of us are not getting our needs met. So omega-3s, you're going to get shorter omega-3s from nuts and seeds. The longer omega-3s can come from algae, seaweed, and fish.

36:21Dr. Mark Hyman:And some people also talk about CoQ10 and potassium as supplements to help. Can you talk a little bit about that? Yeah. So CoQ10 is a critical nutrient. I think the highest food sources, correct me if I'm wrong, Mark, but it's actually in meat and animal foods. CoQ10 is a critical nutrient for the mitochondria and any organ that is metabolically active relies on mitochondria to convert calories to energy. So mitochondrial dysfunction, which we didn't really touch on before, also plays a role with vascular health and insulin signaling. You can measure CoQ10 levels, although I will tell you that in my experience, they don't really necessarily mirror, again cellular deficiencies so supplementing coq10 can not only lower blood pressure potentially but also lower cholesterol in some studies like you said the sources are often organ meats those are the richest source uh and people don't really like to eat kidneys or liver or beef heart but they're quite high in them go q10 the next they may be per kilo beef heart has about 115 milligrams but some people need more than like two, three, 400 milligrams.

37:28Dr. Mark Hyman:So you can't, unless you're eating like, you know, four pounds of beef heart a day, you're not getting enough, right? Especially when you have higher needs. I mean, you have mitochondrial issues and our mitochondria are constantly stressed by our modern lifestyle, by our diet, by toxins, by our gut microbiome being off. And so we can actually help our mitochondria by giving supplements. And I'm glad you said that because mitochondria are both negatively impacted by oxidative stress, these overproduction of free radicals, but when the mitochondria don't work well, they create more of those free radicals.

38:01So you actually can become a vicious cycle. And we've got some whole new tests now that we can do to actually look at the pathways of energy conversion in the mitochondria and help people understand, all right, what patterns of dysfunction do they have if they have them and how can we best supplement or target them while we're also looking upstream to see what's driving the mitochondrial dysfunction.

38:20Dr. Mark Hyman:There's other supplements that can help like arginine, which you can take, or garlic has been used to help with blood pressure. Citrulline, garlic, beetroot powder. I mean, there's lots of different things. There's some pretty good combination products out there that we'll often use in people who have endothelial dysfunction. I've seen really good benefits both in blood pressure and, interestingly, in men who've had erectile dysfunction. They've done really, really well with some of the supplemental support. Yeah, because it increases arginine, which is what increases nitric oxide, which is what Viagra or those drugs do.

38:53Dr. Mark Hyman:They increase nitric oxide, which is great. And actually, what's interesting about these drugs, I don't know if you've been keeping up with the literature, but we're seeing mortality benefits from people who take these drugs regularly, from guys who are using daily Cialis or whatever, or Viagra every day. They're actually seeing increases in their health and not just erectile function, but also just mortality goes down. Well, you know, it makes perfect sense, Mark. Go back to what we were talking about with the blood-brain barrier and how that also depends on nitric oxide to have healthy blood vessels and how endothelial dysfunction is a big upstream, one of the first things that changes that leads to a leaky blood-brain barrier.

39:30Dr. Mark Hyman:Tell us more about what happened with this patient of yours, and then I want to sort of summarize and go through how we think about this differently in functional medicine. You know, one more piece about her genetics that I think was interesting is she had some genes that could affect collagen recovery and collagen repair. And I think this is also an emerging story. So certainly played a role with her repetitive motion injuries, helped her learn that she needed to exercise smarter, not harder. That, you know, if you're prone to oxidative stress and inflammation, very intense exercise without adequate recovery can actually become counterproductive.

40:04And if you keep getting injured because you don't realize that you've got these connective tissue issues, it's not going to ultimately help you meet your goals. So it actually helped her shift the way she was exercising, pay attention to her recovery needs. And I think another emerging story we're going to start seeing a lot more about is this connection between fascia, healthy fascia, the connective tissue that joins everything in our bodies, muscle and joint stiffness and artery stiffness, because they're all made up of connective tissue. So using things like foam rolling or something called melt or stretching, they may actually have benefits on the vascular system as well.

40:44So that's an emergency story we're going to hear more about. So a couple other things we did for her. She's now postmenopause. She's still snoring. So we redid her sleep study. And guess what? Now she met criteria for mild sleep apnea. Also had a lot of those other non-apneic respiratory events. So Center for a Mandibular Advancement Device. So she got an oral appliance and we followed up to make sure that that was controlling her sleep apnea. It was. And after a few months of this, one of the best things that she noticed is she was no longer tired during the day. Quality of life got better even before the vascular changes got better.

41:19That's important. We did. We also did. We did test her for heavy metals. She's not had a provoked urine for burden of heavy metals, but we did blood levels to see if she had a lot of mercury or lead. She did not. But one of the things to keep in mind, especially for postmenopausal women, is you can actually have increases in blood lead levels, not because of a new exposure, but all of us who grew up exposed to lead paint, lead gasoline, the big reservoir of that lead was our bones. So after menopause, as women start to mobilize and turn over bone at a more rapid rate, you can actually release lead that's been there for years.

42:00And as those lead levels go up in the blood, it impacts oxidative stress, inflammation, and vascular reactivity. So we have to be mindful of that potential risk as well.

42:09Dr. Mark Hyman:And you mentioned a challenge test we do. We look at blood levels, but often if there's a risk factors or we have a reason to suspect there's an issue, and I always do this with high blood pressure patients, we do a challenge test where we give a chelating agent to bind to the metals, pull it out, collect it in the urine, and see what your body stores are rather than just what happens to be in your blood. And so, you know, that may be another avenue for treatment for people who are resistant to the normal lifestyle changes because it may not be their fault. It may be some environmental factor that's driving some pathology that's leading to inflammation or oxidative stress that then causes high blood pressure.

42:43And there's been some research showing that when you remove those metals, blood pressure gets better and has a protective effect on kidneys as well. They've seen that people have kidney dysfunction, but kidney function improves. So it's really important not to miss that.

42:54Dr. Mark Hyman:And this is such an important topic. And we think about it like all the kidney failure, all the dialysis that people have, all the heart failure that people have. A lot of this is driven by kind of poorly managed high blood pressure. And it's such a common issue. So I think doctors really need to think about how we get a more focused approach on root causes and better diagnostics that we do at the ultraviolet officer that should be everywhere, but are not, unfortunately. And you found many of these problems in this particular woman who had high blood pressure. She had a little bit of prediabetes.

43:25She had high stress.

43:27Dr. Mark Hyman:She had some vascular issues genetically. She had some genetic predisposition, side blood pressure. She had probably some toxic load a little bit. Maybe she's going through menopause and lead. So we kind of start to see patterns and things we can actually treat. So I think it's kind of, you know, it's sort of a shame that we haven't taken this approach with traditional medicine because the science is there. It just takes decades to get into practice. Like you're quoting all kinds of scientific papers. So am I. And yet somehow, for some reason, it doesn't get into the actual doctor's office with the individual patient who's being treated for X, Y, or Z disease.

44:04Dr. Mark Hyman:And that's really what we try to do with functional medicine. We keep our ear to the ground. We pay attention to emerging science. We try to look at what makes sense, what's not going to harm someone, but it's going to help someone. and doing the things of optimizing nutrition, taking certain nutritional supplements, increasing potassium in your diet, having your gut health optimized a little bit, dealing with food sensitivities, dealing with things like sleep apnea, dealing with heavy metals. All these things are modifiable risk factors for high blood pressure that are just generally not treated.

44:34One other thing for her is she turned out to have a dairy sensitivity. Interestingly, not gluten sensitivity. She had a dairy sensitivity. And there was a study last year showing that food sensitivities are also contributors to high blood pressure, probably mediated through inflammatory changes in the gut microbiome. So it all comes back full circle. And interesting thing, when she cut out her dairy, what did she notice? Her arthritis symptoms were better. She had less stiffness in her hands. I think it's nice when you actually have a tangible, palpable result to some of the changes that you make.

45:04That's a big motivator to stay the course and keep doing it.

45:07Dr. Mark Hyman:Amazing, Cindy. So this is such a great example of how we think differently about how to treat common problems by looking at root causes, by optimizing different systems in the body, by removing things that are causing problems like environmental toxins or certain foods that might be triggering inflammation in the body. So it's sort of like the thing with high blood pressure, it's the result of a whole series of insults that are different in different people that you have to find what those insults are for that particular patient in front of you. And that inflammation and free radical oxidative stress is what drives the pathology of high blood pressure.

45:40Dr. Mark Hyman:and there's a million reasons why you can have that. It's the final common pathway. And so whether it's the gut or there's nutritional deficiencies like omega-3s or whether it's heavy metals or whether it's increasing insulin resistance and prediabetes that makes you retain salt, all those things need to be looked at. And unfortunately, they're just not. And that's really why I love our practice at the Ultra Wellness Center because we do this every day. We've been doing it for decades and it's such a gratifying way to practice medicine. My daughter, Cindy, I don't know she's in medical school.

46:10She just graduated.

46:12Dr. Mark Hyman:I mean, and she's now in orthopedic residency starting soon. And I mean, I think she didn't go into traditional medicine from a medical specialty because she saw what a shit show is, but she feels like she can actually help people doing orthopedic surgery, which is great because it's like, you've got a broken bone. You got to see the broken bone doctor, right? But you know what's funny, Mark? Think about what we were touching on all these things that affect vascular health. They also nourish joints. So people who develop hypertension and insulin resistance, they're more likely to develop osteoarthritis and knee joint replacements.

46:43And it still is going to be connected even in her field.

46:47Dr. Mark Hyman:Sydney, thanks for joining us. This is an incredible story. I think for people listening, if you want to learn more about what we're doing at the Ultra Wellness Center, go to ultrawellnesscenter.com. Realize that whatever problem you have, whatever diagnosis you have, there's another way of looking at it and getting under the hood and helping deal with root causes and optimizing the body systems. And that's what we do every day at the Ultra Wellness Center. It's a dedicated team. We've been working together for decades and I hope you come visit us. And Cindy, thank you for joining us today on how we deal with common chronic disease problems using functional medicine at the Elder Wellness Center.

47:18Thank you, Mark.

47:19Dr. 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 Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. 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 Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health, where I am Chief Medical Officer.

47:50Dr. Mark Hyman:This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at ultrawellnesscenter.com and request to become a patient.

48:23Dr. Mark Hyman:It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.