Breast Implants Are Making Women Sick—Here's What's Happening | Dr. Jonathan Kanevsky

20:19I mean, you're removing this thing that's full of silicone that's causing this chronic inflammatory reaction. So I think just from the etiology, it just makes sense. You just take out the thing that's causing the problem and you have less of a reaction. There's a plastic surgeon, her name is Patricia McGuire. She's done probably the most research on explant capsules, things like that. And what she found was that removing the implant helps, but removing the capsule doesn't always create improvement symptoms. So I still think the source of the problem is what needs to be removed. The implant is primed.

20:55Dr. Mark Hyman:Yeah, I mean, that's sort of classic functional medicine. Someone's sick, you take out all the bad stuff until you see what happens. Because you don't know. And the truth is that many people have autoimmune diseases or issues for many reasons. And so the way I think about toxins is it's sort of like a cup that overflows. Your body can handle it to a certain moment, and then your toxic load gets so high that it tips over into a disease. And so, you know, there may be other factors and other toxins that are affecting you. There may be other things in your microbiome, there may be dietary factors, there may be late infections.

21:29Dr. Mark Hyman:There's a lot of reasons for all those symptoms that relate to immune activation and inflammation and autoimmunity and microbiome issues. Even there's heavy metals, right, in the silicone. In the things that are used to process the implants, they have all sorts of heavy metals. You know, the dose or amount is probably what is the most important question, but they are present. Yeah, it's small. But it's a cumulative effect of all this. And so I think that, you know, we're now in an era where we're beginning to understand that, you know, toxins play a role in human health. Doctors have been really notoriously bad at thinking about that or assessing it.

22:02Dr. Mark Hyman:And unless you have an acute poisoning, they don't think toxins are a problem because your body can handle it. You know, they just think you're fine. And so what's really unfortunate is that doctors, because women wanted this, developed a way to help women with their body image or get breast implants. But the dark side of it is it's problematic. And it's created a whole string of issues that are concerning and that have a lot of metabolic effects and cellular effects and cognitive effects. I mean, it's not just autoimmunity. You can get neuroinflammation and brain fog. You've said some of the, you know, neuropathies, headaches, POTS, things like that.

22:42Dr. Mark Hyman:So it's a concern. So I think that what I really kind of want to dive into now is kind of the work you're doing and what you've discovered. Because, you know, after listening to this, I'm sure many women who are listening, either who want breast implants are disappointed or have implants or are freaked out. Like going, what do I do now? I don't want to get sick. Or if I am sick, do I have to take these things out? And what am I going to do? Because, you know, it's going to affect how I look and how I feel about myself. and you know it's a big deal it's not just like oh geez you've got a wart take it off and big deal like you know because i'm dealing i deal with this regularly because i treat a lot of patients who have autoimmune disease who are sick who have breast implants and it's always like it's always the hardest thing for me to say listen i think we tried everything and i think it's time you really explore this because this could be a factor and there's no way to prove it although there was a lab in germany that was actually testing for immune reactivity silicone and other things so So, you know, there are ways of potentially actually doing immunological testing to see.

23:41Dr. Mark Hyman:There's ways to check how your white blood cells react to the telicone or your antibodies. There's two different kinds of immune reactions. One is your white cells fight it, the other is your antibodies fight it. But you can actually start to test that. So I think, you know, until we get better at that, it's going to be hard to know. And the question is, for the women who are listening to this and in despair right now, or husbands who are worried about their wives or partners, What actually is available now? Because you're pioneering a whole new field of surgical interventions around safe and effective breast augmentation surgery that doesn't involve foreign toxic material.

24:18Dr. Mark Hyman:So walk us through what you do, what you've been doing, and what's coming. So there's two ways that I think about this. The first is, for anybody listening, if you do have breast implants and you're concerned, there is an ample amount of ways that you can explore what is safe to be done. The first thing that I noticed among my patients is it takes an average of about three years from the time of thinking or being concerned about your implants to going through the whole journey of explant, removing the breast implants. So wherever you're at on that journey, whether you're just curious about it or you think you might actually follow through with it, there's an abundance of support groups and information and ways to think about it.

24:51And surgeons are getting better and better at the technique of removing the implant and all the surgery around it. It is a big undertaking though, because psychologically it's, it's a lot to have undergone a surgery to change a part of your image to, um, you know, that might impact your identity to then probably anywhere from five, 10, 15 years later, think about now removing the implants and reclaiming that identity. So it's a lot of the body, but it's also, you know, how do I accept this new part of myself without implants? What does that look like? So the second category is wanting to change a part of your body, wanting to, whether it's after, you know, cancer, breast reconstruction, or as a primary augmentation to increase or change the shape and size of the breast.

25:35Fat grafting is a safe option. It may not achieve this. So what is that? Yeah, so fat grafting is taking fat from one part of your body, processing it, and then using it as a sculpting medium. So literally changing the shape and volume somewhere else.

25:46Dr. Mark Hyman:All these women are saying, how do I get rid of my belly fat? This is really a twofer, a twofer, right? Yeah, twofer, a twofer wanting strain. So you can shape and sculpt one part of the body and also use it as a medium. And I think it's the most natural way to do something because the breast tissue itself is a combination of fat and gland. And so we're just putting fat where it's supposed to be. Fat grafting has, there's a lot of myth around it over the past, you know, it's been around for a long time, over a hundred years. Yeah, yeah, fat grafting has been around for a long time. Amazing. What was it used for?

26:14The very first case was a case of liposuction that was done in like the 1800s. It did not go well. This is an experimental procedure at the time, but using, transplanting a piece of fat actually for a breast implant as a breast implant. Wow, wait, wait.

26:27Dr. Mark Hyman:In the 1800s, they didn't have anesthesia. No, this was like late 1800s. The story is it was, I believe it was a ballerina. I can't remember, but it was exactly, don't quote me on this, but they actually took like a lipoma and transplanted this lipoma as a breast implant. Uh-huh. Yeah, so like a ball of fat put somewhere else. Of course it didn't survive. We know a lot more about how tissue grows and regenerates now. You can't just take a blob of fat and put it somewhere else in the body. Expect to survive. Oh, what do you do? Well, the technology has gotten a lot better. The myth used to be, well, you transplant fat, it doesn't survive.

26:54That's kind of true, but not entirely true. So 50 to 80 % of the fat that gets transferred will survive. It's literally like planting stem cells. And you know all about this. You take these little adipose-derived stem cells, you plant them like seeds, and then all these new blood vessels grow in, and then that tissue grafts and it lives in this new place. There's many things that have been done to improve the fat graft survival and some things I do in my own practice. And everything from red light therapy to treating the fat with something called surfactant. It's like a little soap molecule that will help preserve the fat cells after they've been removed.

27:25And it has a lot to do with technique, the way that it's injected. You inject these little micro droplets, so not these big globs of fat, these tiny little fats with special tools. That is like planting little seeds in a garden versus just throwing a big handful of them. So fat grafting became popular around the time that breast cancer surgery was really also being developed. So women would have breast cancer, have a mastectomy, have an implant placed, and then have radiotherapy. And radiotherapy would completely damage the tissue. It would become really thick and tough and leathery because of the radiation therapy.

28:00So fat grafting was used as a way to regenerate the tissue. So fat would be injected. the stem cells in the fat would soften the skin and also have the benefit of creating more of a contour. Ironically, fat grafting became popular because of breast cancer to the breast. And that's what most breast cancer surgeons would do? They'll do a combination of an implant because still, if a lot of breast volume is removed, still, in many cases, the best option is a breast implant or a bigger surgery called a free flap. So taking like a big block of tissue from one part of the body to sculpt and make the breast.

28:34But fat grafting is used throughout as a modality, and it's getting better and better. So that's what you do, right?

28:39Dr. Mark Hyman:So kind of walk us through how it works and what women can expect and what kind of different options are in terms of sizes and stuff. Because I think, you know, you kind of think, well, how, depends if you have fat or don't have fat. Right, so the process is really three steps. The first is we have to get the fat from somewhere. So harvesting the fat involves a process known as liposuction. So the areas are numbed, and we remove the fat with a combination of vibration and suction under low pressure, which minimizes the damage to the fat. Once the fat's collected, it's processed and treated, and then it's re-injected back into the body and sculpted.

29:12So you just like a needle-needle? Yeah, it's tiny. So everything's done through little keyhole entry points, so about two to three millimeter incisions, no big cuts, and the entry points are hidden throughout the body, so it's really meant to be as aesthetically neutral. Yeah, so you're not seeing big scars anywhere. and I do all of the fat injection through one tiny entry point in the base of the breast. It's about the size of a tip of a pen. So it just kind of like fills up like a balloon. It's it's I'm literally sculpting. I'm literally sculpting. So when the tools go inside and it's like I'm painting with a brush like 3D painting.

29:45Wow. And so it's about surgery as art. Surgery is art. Exactly. So I'm able I'm able to sculpt the area to make sure that it's it's not just like a one and one and done thing. Everybody's different. So certain parts of the breast need more fat here or there. And it's about sculpting. And the results you get are just like an implant or better? No. So I would say, well, it depends what the aesthetic is you're going for. So I never try to push in a certain aesthetic on a patient. Most patients that come to see me want the more natural look. They don't want really large over like breasts with that.

30:18What is a giveaway that somebody usually has an implant is there's a lot of fullness in the upper pole. So the top part of the breast is really full. The natural breast doesn't have that shape. It's more of a natural slope and then fullness on the bottom. And that's what fat grafting can achieve. Sometimes it does take more than one round of fat grafting. The reason for that is because unlike an implant, you know, you can put almost any sized implant into somebody. It's pretty traumatic. You're just shoving this large thing in there. Whereas fat, you're limited. It's like a sponge. So if you imagine a sponge filling with water, it can only fill with so much water before it just flows out.

30:50And the fat in the breast is the same way. You can only put so much fat in before the fat cells don't survive. So the first round of fat grafting, it's like a one-to-one ratio. You can double the volume of the breast. Not all of it will survive. Once that fat heals, the stem cells cause all these new blood vessels to grow in. And then with the second round, you can accommodate even more fat. And so you can get to the same size as an implant, but it may take more than one round of fat grafting. But the aesthetic will be different. It's going to look more like a natural-shaped breast. Are there any complications or risks or challenges other than just normal surgery, infection, and bleeding?

31:21Those are the main ones that we look out for. So infection, bleeding, it's still surgery. So just like any surgical procedure, those are common things. The things that are more important to look at with fat grafting, there's a risk of something called fat necrosis. So if the fat's not properly injected, they get these big globs, some of it will die. It can create an oil cyst and cause problems. The thing that I see more commonly is the entry points can get, you can have a bit of scarring around them. And that's hard to predict. Not everybody scars the same way, but usually the scars heal really well.

31:51And the question I get asked a lot, and it's super important, is fat grafting doesn't increase the baseline risk of breast cancer. So patients with fat grafting want to know, is this going to change my future risk of breast cancer? The answer is no. And the second thing is it doesn't obscure mammograms. In the first six months, it can. It's just important to be aware of if you have any family history of breast cancer. But onwards, most radiologists are well-trained enough to know what calcifications from fat grafting can look like compared to breast cancer. And there's breast ultrasound and breast MRI.

32:21So there's other technologies which help. So compared to breast implants, I think the risk profile is much lower, but it's still surgery.

32:28Dr. Mark Hyman:So you got to be careful. But it's not the autoimmune issues and the breast implant illness and the cancer risk and all that stuff. It's your own tissue. So you're not dealing with any of these autoimmune issues and it's going to heal. So let's say ideally you'd want to be having a little extra body fat and you can use it and then you want to stay at the same weight. But what if you're like, you know, want an implant and then you're a little overweight and then you want to lose 20 pounds. What happens? So the fat that gets transferred is a great question. Fat that gets transferred is just like the fat anywhere else in your body.

32:56So if you lose weight, gain weight, it'll go in the same direction. The fat cells that survive will stay there. It's just their capacity to grow and shrink is what changes as the body weight changes. Usually I recommend patients, it's not around the time of surgery is not the time to lose weight. So you want to achieve a weight that you're comfortable with within like, let's say five to 10 pounds and then do the surgery. And then you want to just try and maintain your weight. If you lose a significant amount of weight afterwards, the breast size will decrease. And the same for the opposite, which is if you gain a lot of weight, the breast size will increase.

33:27And patients will use that to their benefit all the time.

33:29Dr. Mark Hyman:Yeah. But if you're really overweight and you want to take Ozempic and you have a fat transfer. Yes. So Ozempic and fat transfers do not go well together. So when I, if patients are on any kind of GLP-1, I say, we've got to stop the GLP-1. Forever? Not forever. Just reach a plateau that you're comfortable being at. Stop the Ozempic or the other GLP one around for four weeks. Let the fat fully heal, and then you can restart. But the idea is about maintenance. It's not about going up or down significantly. And then there's new technologies. This is what's been around. This is what works. This is what you're doing right now.

33:59Dr. Mark Hyman:Yeah. But we were chatting a little earlier, and you said there's some newer technologies that are available, which are pretty interesting, which is using other people's fat. There's an endless supply of that in America, right? it's like you think people give give uh medical students to make money by giving blood donations it's wild or sperm donations yeah i don't even do fat donations do you do you see i mean the ozempic thing is really taking off apparently the ozempic thing has taken off so much so that airlines are now saving money on fuel fuel of course yeah yeah so we're maybe not for long yeah ozempic's good for climate change yeah that's who knew the side effects yeah everybody on Ozepic right now.

34:39Dr. Mark Hyman:Save the planet. Take Ozepic. In terms of the way it's important, I think, for people to understand it, if this is fat tissue and it fluctuates. But these new technologies sort of use an endless supply of fat from other donors. So tell us about what that is, what it's called, how it works, what the risks are. So the big vision is that nobody puts an implant in ever again. I'm putting my stake in the ground at maybe five to 10 years later, hopefully sooner, that we'll just say, you know what? implants are really not it. You want the FDA to go, this is done? Yeah, and they've done it twice. In the 80s, they said, 80s or early 90s, there's a moratorium placed on breast implants because of these rheumatologists that were saying, I think implants are making people sick.

35:21We need to do more investigation. Bunch of research was done. Questionable about how the studies were funded and what the outcomes were. But they said, okay, they're safe. They can come back. And then again, the resurgence, I think in 2018, black box warning on implants, but they're still out there. And now there's these newer generation implants who are, you know, the whole - Like trans fats are now ruled they're not safe to eat by the FDA, but there's still a cool whip in the grocery store. Exactly. Or it's like, hey, don't smoke the regular cigarettes, smoke the skinny ones, which is exactly what's happening now with implants.

35:48The implants are getting smaller and there's a whole new design of an implant by certain Motiva is the latest one. And they've redesigned this implant for it to be more safe. But it literally, to me, I look at it, it's like, oh, it's a safer cigarette. I'm like, what are we doing? This is not -

36:00Dr. Mark Hyman:Why do they say it's safe and why do you think it's not safe? I don't think it's safe. Because I've heard about this one. We have not changed the fundamental laws of biology, which is you put in a foreign object, it is going to have a reaction. If it's less of a reaction, great. But there's still some percentage of people that are going to have that reaction. They've done a lot of science. They changed the way that the rough surface of the implant is created. It's no longer abrasive chemicals. It's now a 3D printed surface. And it's done even more minimally invasively. But the root cause is still the root cause.

36:26People are still smoking. Silicone. Silicone. There's still silicone in the body. And now I saw recently a surgeon's putting in a hundred CC implant. That's a third of the size of this. That's small. It's not only is it small, you could easily do that with fat. So it just makes, it makes even less sense to me. So to answer your question, I don't think, so hopefully implants stop altogether, but that won't happen until there's better technologies out there that fully replace them. And the three technologies that I think are, have, are making waves and breakthroughs in the world of fat, fat transfer, fat grafting.

36:57The first is using your own fat, but doing everything possible on the surgery side and recovery side to improve fat graft retention. Yeah. I want to talk about

37:04Dr. Mark Hyman:surgery as a ceremony after what you do this, because you're not just a regular surgeon. We're going to get into all that. So I'm going to save that. But, but there are ways to use various kinds of therapies and treatments to enhance healing. And I recently, I had a bike accident and I smashed it on my face and I recently had to use it. And I was sort of amazed at how fast things heal. You look great, Mark. Thank you. So what's the name of this, this fat transfer that you get from other people? Like, what is it called? Aloe clay. Basically, it has... Aloe clay. Aloe clay is the name of the brand right now, but...

37:37Clay like molding. Yeah, aloe clay. And aloe means foreign. Correct. So aloe from somebody else, clay, it's spelled, it's not spelled the same way. It's A-L-L-O-C-L-A-E. But the concept or the medical term for it is cadaveric acellular lipid or fat. It's basically fat from somebody else that's been processed that you can safely inject. And before that was Renuva, another brand, but the technology has gotten better that you now have this like pre-processed fat that can be injected from somebody else. I don't use a ton of it just because I still think the best source is your own natural fat. But if there's no other option, if you truly are too thin, BMI is too low, there's not enough fat to harvest to get the results you want.

38:14If you're ballet dancer. Yeah. It's a good alternative, which is you're not using an implant and you're using this other thing. It can be a little bit pricier at times. And the immune reaction is? It's minimal. Yeah. Sometimes patients can have, like the body can react and have a bit of redness around it, but it's rare.

38:31Dr. Mark Hyman:Now, we also talked about a newer technology that is kind of interesting to me that you say it's only a year or two off because it involves taking some of your own fat and then growing it in a lab. So can you talk about that? Sure. And what the promise of that is? So I think this will be big in the future, which is you can, so it's really, I'll go over the four. This is the third one that we talked about. the third technology is banking your own taking your own fat getting the stem cells from there and growing ex vivo so outside the body growing fat cells and i think we'll see that in a few years as a safe alternative so you could go to your doctor to get like a quick five minute procedure because you don't need a lot of fat for that you just take a little bit of fat out send it to a lab the lab will grow that fat tissue outside of your body and then whenever you're ready you get a notification on your phone and come back into the office and you get the fat transfer and how How long does it take to grow?

39:20I mean, fat, like most, and this has been done, this isn't, you know, this is new, but it's been done in many other examples. It's been done for bone, it's been done for skin, it's been done for other tissues. Six to eight weeks.

39:33Dr. Mark Hyman:Basically, you get a little fat sample taken out and it doesn't have to be a lot. And then you can, you put it in a lab and you cook it. Basically, it goes in like an incubator and you grow your own fat cells. You can grow as much as you want. Yeah, it'll be, I would say right now, it's probably cost prohibitive. It's more experimental, but like with any technology, as it becomes more abundant and scales, the cost goes down. What's available today and can be done today is you can bank your own fat. So four technology, four things we talked about for fat trainers. The first is improving everything possible in the operating room with your own fat.

40:04The second is aloe clay or using somebody else's fat. The third is banking or growing your own, growing your own fat cells outside your body. And the fourth one, which is available today is you take your own fat and save it and freeze it and process it for later. And so if somebody's undergoing a procedure and wants to do fat grafting, but doesn't want to have to have liposuction every time, they can store their own fat outside their body. And that's good for two things. It's good for as a source of stem cells for any number of things in the future. And two, as a volume filler. But ultimately you wouldn't need to do the banking if you could just...

40:34Yeah, if you can just grow it, great. But right now that's not commercially available and it would be extremely expensive. It's kind of like, you know, with impossible meat and all the lab-grown meat. like lab grown meets a thing today but it's do you it's 800 burger it's it's or i don't know how much it costs now but it's expensive it's less not 800 how far off is this growing your own fat technology for women i don't want to put an exact number up i'd say at least two to five years it's it's it's it's like not right around the corner five years in terms of the the interesting the

41:03Dr. Mark Hyman:volume because we're talking about you know fat transfer if you're thin it's hard but if you have a lot of fat would you be able to have bigger breasts yeah and when i do fat transfers i like to have at least three to 400 cc's of fat per side. And just for reference, this is a 250 cc implant. So like double that almost. Yeah. And a can of soda is about 330 cc's or something like that. So it's a good amount knowing that not all of it's going to survive. And that's per side. So usually like in the best case scenario, you'd harvest about a liter of fat, which is doable if you treat multiple areas in the body.

41:31Dr. Mark Hyman:People are listening to this and wondering, you know, okay, this all sounds like promising. There's actually this aloe clay now, which you can do. you can do if you're if you're underweight if you're if you have plenty of body fat you can use your own fat how do you kind of coach women and explain to women when they're talking about their breast implants and worried about them and taking them out because that's a big deal like i think it's i just want to sort of spend a minute on the psychology of that how you handle that because i deal with this and i feel uncomfortable to be honest uncomfortable like i'm like god you know this is this is a very personal thing you know i think as a doctor this is affecting your health adversely.

42:05Dr. Mark Hyman:If you want to not have this autoimmune disease, you know, I have this woman who's got breast implants and her platelets are like 10. And I'm like, everything is just not moving the needle. And I'm just like, listen, this is the thing I think is causing it. But, you know, what's the threshold that you kind of say, okay, you've got to do this. The first place is like you're doing, it just comes from a place of compassion saying like, you know, this is a procedure that you have that may be impacting your health. And also medically, it is a diagnosis of exclusion. So let's check, let's do every other possible work up to make sure that it's not something like Lyme disease or your thyroid or this or that.

42:39It's like once everything else is ruled out, we've arrived at the final destination, which is, I think it's, it could be the implants and it's important to do everything else medically.

42:47Dr. Mark Hyman:Well, that's what I do. I deep dive on every possible other cause from a functional medicine perspective of what could be causing it. And I get rid of that. And if they're still not better. And the latest research shows that it's actually more of a neuroimmunology, probably something closer to fibromyalgia, the way that it's approached and handled. And so, I mean, imagine all the patients that suffer from fibromyalgia, if you could say, I think it's this physical thing that's causing it. You've ruled out everything else. Let's remove it and see what happens. So the coaching or the counseling comes from first, compassion.

43:15The second, where are you on the implant journey? Because if a patient says like, I heard about this yesterday and I think I have breast implant on this, I don't think it's a good time to have surgery within a week. there's a lot of understanding that needs to happen about the risks and benefits of explant, also the identity of who you're going to be on the other side because you've become this avatar of yourself over the past however long the implants are there and it's a lot to dramatically change your appearance if you're not fully sure that the symptoms are caused by the implant or where you're at psychologically to prepare for it so that process takes time usually I recommend patients wait at least 6 months to a year Many patients that come see me have been thinking about this for years.

43:58They've been on message boards. They've talked to other patients. They've really done a lot of their own research to understand what it's gonna be like on the other side, and they're ready for it. A big mistake is to do a surgery too soon just because a patient feels like they're ready, and then they're unhappy. And there have been situations where it's rare, but once or twice patients, one patient stands out in mind. She had her explant. Even though I felt like she was ready for it, she felt like she was ready for it. And then months, about eight months later, she's like, you know what? I feel better, but I can't handle the way that I look.

44:31And I really want that look back. And that's, and that's part of the journey. So for me, it's more about doing everything I can from what I know and hearing what the patient's saying to say, like, you're really ready for this journey and it takes time. Also preparing before and after there are protocols, things that help healing. Um, and you know, that's, that's everything from preparing psychologically for it to physically. The amount of modalities out there is amazing to detoxify afterwards.

44:56Dr. Mark Hyman:So how long after women get an explant surgery, do they have to wait before they do some kind of other procedure like a fat transfer? I usually recommend waiting three months. And I always stage it. I don't do the explant and the fat crafting at the same time. It's like demolishing and building a house at the same time. It just doesn't make sense. So let everything heal, adapt, get comfortable in your body, and then we can talk about the next step. And that can be done, And that next surgery could be done either awake or asleep. And I think awake is important because less general anesthesia, less risks of all those heavy medications.

45:28Dr. Mark Hyman:I think for everybody listening, you know, I can say as a practicing physician that this is a real phenomenon. The FDA thinks this is a real phenomenon that it can cause a range of symptoms from sort of mild, you know, fatigue and cognitive dysfunction all the way to full-blown autoimmune disease and cancer. And it's not to be taken lightly, and it's a serious subject because a lot of women have this. About 5 % of women in the country have breast implants, which is a big number. Many people are thinking of having implants. So I hope you get to listen to this and understand the risks and kind of wait a minute and pause and maybe wait for these new technologies or use one of these other possible transfer techniques.

46:04Dr. Mark Hyman:You're also thinking about how to really take care of women in a way that's safe and effective. But your thinking goes far beyond that. And you're one of the few surgeons that I've ever met that's thinking holistically about surgery, its impact on. And I've had surgery many times, and it's a very scary thing. There's not a lot of psychological support, and there's not a lot of ritual around it. There's not a lot of understanding of how it affects you. I mean, I had massive surgeries like about a year ago, and it was a lot. I have a pretty good constitution and a pretty stable mind. And so, but I remember like, I mean, for mine, it was, you know, it was, it was a very severe thing and I could have died.

46:45Dr. Mark Hyman:And, and, and I remember going into the operating room and, you know, it's just, you know, you're kind of in the hospital, you're in a sterile environment, you're getting wheeled into the operating room. They kind of stick the needle in you. They go, okay, you're going to sleep out, you know? And I remember this could be my last breath. This is my last moment of consciousness, you know? And, uh, it was kind of scary. And you, you, you've been in the operating room for thousands of hours probably. And you understand what the normal approach is. And you've created this whole other framework. You call it surgery as ceremony.

47:16Dr. Mark Hyman:And I love that. So I'd love you to unpack that. What is that? And what do you do that's different? And why do you do it like that? So I know this might sound woo-woo and a bit out there, but I believe that we've removed a lot of the ceremony from many parts of our lives. The intention behind why we do things, the protocol behind it, the process, the ritual. And I heard once this, it was a U.S. general was giving a talk. He said, what is a protocol but a process, a process but a ritual, and a ritual but a ceremony? And it stuck out to me as how many things do we do regularly in our life that are ceremonial nature, but we treat them as a protocol?

47:58Think about flying. There's the FAA checklist, which turns into flight school, which turns into the ritual of boarding an airplane. But the ceremony is like travel. Travel is an amazing experience. But we've removed a lot of that. And surgery is no different. We've taken what used to be, you know, it started, you were there in Egypt. We were in Egypt and I was looking at these, the walls of, I think it was like, I can't remember, Ra or Ka. Yeah, the gods. Yeah. But they had all these hieroglyphs of surgery and pharmacy and things like that. And I was like, wow. And psychedelic mushrooms. Yeah, of course.

48:35Very strange. It's got to put part of the experience. So 5 ,000 years ago, there were these elements of medicine and surgery that were very ritualistic, very ceremonial. You know, they didn't have a sterile, clean operating room. They had these altars and things like that. And then if you really break down the nuts and bolts of surgery through a different lens, and I'm not the very first person to think about and talk about it like this, maybe to operationalize it in a way that it's used in my practice, that might be new.

48:58Dr. Mark Hyman:When I was in residency, one of the surgeries used to play the Grateful Dead in the operating rooms. That was kind of like a ceremony. music music and i'll talk about this music is a huge part of it

49:11Dr. Mark Hyman:did you know that circadian disruption affects all of us and that most modern lighting misaligns our internal clocks and quietly doses us with junk light signaling the brain to stay alert long after our biology is preparing to rest i felt this myself for years that vague sense of being off even when everything else in my routine was dialed in chorus the makers of oyo created a smarter solution. Their circadian lighting shifts gradually throughout the day to support your natural rhythm. And in the evening, it removes blue wavelengths so your body can do what it was designed to do, rest and recover.

49:40Dr. Mark Hyman:They didn't just build a new bulb. They spent years decoding how to bring the sun indoors. And I've seen how the right light can transform how you feel. When people fix their light, everything shifts. Mood, focus, sleep, and resilience. You can make the switch to lighting that works with your biology today. And learn more about their newest product, Oiosphere, at chorus.com slash S-P-H-E-R-E and enjoy 15 % off with code hymensphere15. That's K-O-R-R-U-S.com slash sphere. I've always believed that one of the most powerful things you can do for your health is cook your own food. Recently, I had some friends over and made some delicious slow braised short ribs, steamed bok choy, and some red potatoes.

50:17Dr. Mark Hyman:The meal was deeply flavorful with simple ingredients. And afterwards, someone said, you're such a great cook. I laughed because I always tell people what my mother told me. If you can read, you can cook. Cooking isn't about being a chef. It's about following simple steps, using real food, and having the right tools. That's why I love cooking with Maiden. Their cookware heats evenly, is beautifully designed, and is trusted by professional chefs as well as millions of home cooks. When I'm braising short ribs or searing wild salmon, I know I'm going to get consistent results. And when cooking feels easier, you actually want to do it.

50:47Dr. Mark Hyman:That's how healthy habits stick. If you've been wanting to cook more at home or upgrade the pans you're using every day. This is a great place to start. Visit madeincookware.com and use code hyman10 for 10 % off your order. That's M-A-D-E-I-N cookware.com. I know you will love these products as much as I do.

51:07If you think about a ceremony, what is a ceremony? Ceremony, it could be meditation, could be a week-long retreat. It could be sometimes plant medicine experience, but you have this desire to undergo a change, whether it's psychological or physical. You're looking for an altered state. Again, it could be meditation, quieting the mind. It could be, some people do it with plant medicine. And then the third thing is you have to go through the journey. You have a guide sometimes that brings you. And then if you look at surgery through that lens, well, you're wanting to undergo this major transformation, whether it's elective or not.

51:42You could have a broken knee or something. You want to be fixed. There is an altered state of consciousness, which is the medication that's using in surgery. It's without a doubt, 100 million surgeries a year, people are having their consciousness altered for that time period. Your consciousness is being unplugged. All these medications flood your system. And then you have to go through the journey, meet yourself on the other side. And very rarely is there psychological support after the surgery to say, even before to say like, oh, your body's changed, but your mind has to catch up with what's happened.

52:07And the consensual part of surgery, which is I know I'm going to receive this damage from my surgeon, which, you know, it's very carefully done, but it's still damaged. It's the cautery, things are being burned, Things are being cut. You're asleep.

52:20Dr. Mark Hyman:The shaman once told me that, you know, your body can't tell the difference between a samurai sword and a surgeon's knife. Exactly. It's exactly the thought that led to this, which is surgery is a traumatic experience for the body. And if we're unplugging consciousness just before it happens, even though you knew what you went in for it, when your body wakes up, it's still having to, you know, body keeps a score. It's trying to make sense of what's going on inside. So why not have a system that allows more support for the journey, for the experience of surgery? And that can happen before, that can happen during surgery, and immediately after.

52:56So surgery ceremony is a protocol that has three parts. The first part is having psychological support immediately. It's like, I call it like surgical psychology. So basically, in preparation for your procedure, you meet with a therapist to go over the intentions, desire, fear, and anxiety that you might have around the surgery. The protocol that I use, it uses ketamine as part of the process. So it's ketamine-assisted psychotherapy. Not a big dose, it's a very light dose, but it helps kind of drop the ego defenses so you can get into the discussion with the therapist. The therapist then will elicit certain key words, mantras, and you know Dr.

53:31Kat, we've worked together. She helped craft this protocol, amazing therapist to work with. We'll help basically pull out little key phrases, mantras, and things to understand that are unique to that patient that I can then use during surgery because patients are generally awake during their procedures to coach and talk them through it. So, and they're also listening to music during that first part. And this is where the Grateful Dead thing is actually pretty important. The music, that sort of like neuroacoustic recall that you hear during this transformative experience where you're dropping into your, why you're going to surgery.

54:01If that playlist starts playing again during surgery, it's like a warm hug. You've like, oh, I heard this before. I felt pretty good last time. Let me listen to that music again. And then I also have key phrases and words and intentions that I can say back to the patient of why they're doing this as a reminder. For example, one patient, her mantra was like, I want to come home to my body. And I could tell during the surgery as the medication was coming in, I also used ketamine as an anesthetic during the surgery. I was able to, I said those phrases back to her. I said, you're coming home to your body and you just smile and it's just like, yeah, yeah, I'm ready.

54:31So the ceremony of the surgery itself is also very important. So you talked about having surgery. It's this clean, sterile environment. It's loud, it's noisy, it smells weird. It's like - Nobody wants to go to a party like that. You want the light to be good. You want the music to be good. You want the vibes to be good. Why can't an OR be the same? So the energy of the staff that are in there, you know, they're here holding a patient's hand, tactile sensation, the release of oxytocin may be the best pain medication we know. So all those things add up. Right music, right lighting, right vibe. Even the bed has to be warm.

55:05I use these vibrating pads to help distract patients from the experience, drop them more into a parasympathetic state. The ceremony of the surgeries has a lot of steps to it. But the most important thing is it's about removing the things that are uncomfortable at the typical OR environment. The last thing is actually afterwards. So it's body work. It's coming home to your body. I work with a great team of lymphatic therapists that will help you land back in your body as you're integrating everything. And that's just really important. So three parts. Before surgery, psychotherapy, the actual journey of the surgery itself, and then afterwards with body work.

55:37and all of those things come together to be what I call surgery ceremony. Yeah, it's true.

55:43Dr. Mark Hyman:You know, I had this massive surgery in my back and without the people I brought in to help me after, which was not recommended by the surgeon, I don't think I would be where I am. You know, I had lots of body work to get back in my body. I had dry needling and acupuncture. I had physical therapy. I had all these things that helped to move the energy and get my body back. And it's amazing. I mean, my neurosurgeon was like, what are you doing? Like, we've never seen anybody recover like you. Like, you're an anomaly. And I'm like, well, this isn't rocket science. It's just, you know, understanding how the body works.

56:18Dr. Mark Hyman:And surgeons are great at, like, cutting and leaving them. It's like, boom, boom, you're done. Not anymore. And what's really interesting is that, you know, you can ask a surgeon, what do I do after surgery? They almost don't even have an answer for you most of the time. And don't lift heavy things. that don't do this. It was like all the don'ts, not what the do's are, not the do's, but the don'ts. And I was like, wow. You also do other things to advise patients. You'd mentioned red light therapy and there's other modalities. What else do you use in terms of helping recovery? So it's, it's things you can do to your body and things you shouldn't do.

56:53And the things you can do, it starts with foods that you eat, actual physical things that you can do to your body and some, some other parts of the protocols. So I generally recommend a whole food, mostly plant-based diet, but having a lot of protein. Because after you have surgery, it's like your body's running a marathon every day. You need a lot of supplementation. The next thing is I'm a big believer in red light therapy. The specifically near-infrared and infrared light, 650 nanometers is about the wavelength that really stimulates mitochondria and improves wound healing. Hyperbaric oxygen is amazing.

57:22I know you're a big fan of that. Acupuncture and lymphatic therapy is essential. I recommend it for all of my patients. It's closing that loop between what's happening in my body and what's happening in my mind. So if you're anxious, you're gonna feel more pain. And if you're feeling more pain, you're probably gonna feel more anxious. And it's just this loop. And those kinds of modalities like lymphatic massage, acupuncture, they cut the loop. You're addressing the mind, relax, feel less pain. It also feels nice to be held and touched. There's other modalities that I think are great now. More and more, I'm recommending peptides to my patients.

57:56So TB500, BPC157, Thymus and Alpha. We have a little peptide protocol that I think is more and more important. Up tissue repair, regeneration, yeah. And to touch on what you said is, I think the old paradigm of surgeons just cutting and leaving, I think it's done. I think the most cutting-edge surgeon or the new way is, what do we do before and after surgery? How do we curate the whole experience for your wellness, not just cut and done?

58:22Dr. Mark Hyman:Yeah, and I think this kind of holistic view of surgery ceremony, of preparing patients before, of how the environment is and how you do it and the post-op care, which is quite different, and it's important. But I just want to touch on something I know you know about and I want to dive in because people don't think about this when it comes to surgery. And it's going to sound very crass and you probably heard this in medical school, but you remember those patients you'd operate on and their tissues would just fall apart. Like you try to like sew them and you're in the wound or in the surgical field.

58:50Dr. Mark Hyman:Yeah, it's like tissue paper. And it's like, yeah, you can't grab onto it with a needle and it'll rip. And we had a terrible saying for it. Do you remember what that is? Tell me. Piss poor protoplasm. Oh yeah. Do you remember that? Piss-poor protoplasm. It's terrible. It's kind of what doctors do to sort of deal with the gruesomeness of all the things they have to do is make jokes. But it's a real thing. And I think it has to do with how your body heals and wounds. And the cause of that, in my belief, is that it's people's overall health and diet and nutritional status. because, you know, if your tissues are bad and you're malnourished and you're eating tons of sugar and you're inflamed and you have insulin resistance, which is to some degree over 90 % of the population is on the spectrum, not of autism, but on the spectrum of insulin dysregulation and blood sugar issues, you know, you're not going to heal as well.

59:47Dr. Mark Hyman:Like if your vitamin A is low or your zinc is low or your protein is low, as you said, or you have lower levels of omega-3s. Even copper, like all these micronutrients are super important, yeah. And so, so I'm curious, you know, what I really found interesting was as I began to do functional medicine, I started to like, you know, use supplements and things 30 years ago. And one of the only other doctors and two groups of doctors using supplements were plastic surgeons and dermatologists. And I was like, this is fascinating. And they're recommending stuff for wound healing and repair and recovery.

1:00:18Dr. Mark Hyman:And I actually, there were supplement companies that had like a pre and post-op supplements, which I thought were amazing that I use a lot of my patients. Yeah, I recommend them all the time. What should people do to prepare and what should people do after in terms of their diet and the right supplementation regimen to help them get through surgery? Great question. So before, it's kind of like the do's and don'ts. There's things you should do, things you should definitely not do. So you want to avoid anything that might thin the blood. So avoiding omega-3s, ginkgo, ginseng, garlic, usually anything with a G kind of thins the blood.

1:00:48And that's not forever, just usually - Vitamin E. Vitamin E, yeah. So like in the omegas and that category, things that we know thin the blood. Avoid those for at least a week before surgery. Of course, consult your doctor to know for sure. Plus aspirin and Advil and everything. Yes, yes. Anything that thins the blood. And it's interesting. NSAIDs, less so now, the evidence for them that they -

1:01:07Dr. Mark Hyman:But is there really evidence about the omega-3s? Like, is it just a - We just know that it thins the blood. I'm a huge proponent of omega-3s, but we know, like, the risk - We don't really have any good data during surgery. It's a problem. We just hypothesize that it - I recommend them afterwards all the time. I just said beforehand, just stop. Also, with the surgeries I do, the risk of bleeding is so low because there's not really big incisions. So it's less of a risk. But with other surgeries, yeah, for sure. But the things you should do is, so I think protein intake is incredibly important. Creatine, more and more evidence that it's actually important in the wound healing.

1:01:36Zinc, copper, vitamin D. And so there are supplements out there that incorporate all those things. And I share a few with my patients. I think they're really helpful before and after surgery. I think the things that get slept on the most are arnica and bromelain. So arnica is a plant-derived thing that helps with bruising. And bromelain is a compound from pineapple that helps with swelling. Before surgery, you just want to make sure you're in the best shape possible to undergo the stress of surgery. Afterwards, you want to be doing things that are going to nourish the body. And the diet. Yeah.

1:02:06Oh, diet's the most important part. So having, in general, I think a whole food, mostly plant-based, but obviously with a good amount of protein can be animal. And the base is good too.

1:02:18Dr. Mark Hyman:Yeah, we were about to do a study with the head of orthopedics at one of the key orthopedic surgeons at Cleveland Clinic, I think. And he wanted to do a study of knee transplants, like knee replacements. And he was like, listen, a lot of our patients bounce back because they're, I mean, bounce back, they come back to the hospital with complications, infections, problems. And, you know, these patients who get knee surgery usually overweight and they have, that's why they have, you know, bad knees because you're putting massive forces of pressure of weight on your knees, which you're not supposed to.

1:02:48Dr. Mark Hyman:I forget the math on that, but It's like an exponential amount of force for every pound. And they come back with complications. And so we were about to do a study where we put people on a 30-day program to reduce inflammation, to help them lose weight, to improve their metabolic health, and nutritional health as a pre-op strategy to reduce post-op complications. And then even post-op, the same thing. So I think that's really important. And I knew, in my recovery, I just loaded up on protein and inflammatory foods. And you want just the right of own inflammation and all the nutritional support you can get.

1:03:17I think in the future, there will be diets that will be specific for certain surgeries. I mean, it already sort of exists, but there's these things called early recovery after surgery protocols, ERAS protocols. A lot of hospitals have them. But I think with the more information we get about specific blood work and the type of surgery people are having and what's really good for them and their wound healing. Like if you're having bone surgery, it's probably better to be supplementing things that are going to support joints and collagen and things like that. More push that kind of healing more. If you're having more skin surgery, things that are going to, you know, favor more skin healing, brain surgery.

1:03:49Like, I do think there is a world in which we have more organ-specific or surgery-specific diets afterwards that are tailored toward your recovery.

1:03:57Dr. Mark Hyman:Absolutely. Yeah. Yeah. I mean, it definitely wasn't a diet that I got served after my back surgery. So I think, you know, we don't really have this consciousness in medicine, but we will. And I think your work around understanding surgery ceremony, around using all these nutritional and lifestyle modalities and psychological supports and post-op healing technologies, whether it's peptides or red light or hyperbarics, lymphatic drainage, acupuncture, these are all things that should be used as part of standard of care. Hopefully they will be because they ultimately reduce costs because they reduce complications, they pre-approved recovery, they basically save money.

1:04:34Dr. Mark Hyman:So, John, thanks for enlightening us about the dangers of breast implants, which I think most people need to know about. And also the hope of new technologies that are around, because it's not just all bad news. There's good news. Because that was the problem before. I was like, you know, okay, you need things out, but like, I'm sorry. Like, there's nothing to do, you know, and now there is, which is really refreshing. And where can people find out about your practice, learn more about you, understand what you're doing, go see you? Best place is going to be online. My Instagram, it's at drjohn.k.

1:05:06So D-R-J-O-N.K. And I answer most of the message I get and always happy to chat. And what's your website? It's auraesthetica.com. So that's A-U-R-A, Aura, Aesthetica, A-E-S-T-H-I-C-A.com.

1:05:21Dr. Mark Hyman:Okay, great. Aura Aesthetica. We'll put a link in the show notes. I can't wait until your book comes out. I don't know when you're writing it, but you better write it. I'm going to need your help. Give me some pointers. I definitely need to write a book on this. I'm thinking busted. Busted? Yeah. That's a good one. Yeah. Something about breast implants not being a thing anymore. Anyway, we'll workshop the title out. Okay. Okay. Thanks, John, for coming over and doing what you do and being a pioneer in all this and thinking about things differently. So glad to see how well you're doing with it all.

1:05:51Yeah. I appreciate your friendship, mentorship, and always good vibes. All right. Thanks.

1:05:56Dr. 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 This podcast represents my opinions and my guests' opinions.

1:06:30Dr. Mark Hyman: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.

1:06:59Dr. 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.