The Silent Fire Behind Chronic Disease—and How to Put It Out

0:00Coming up on this episode of the Dr. Hyman Show. And what we know about that is that 95 % of chronic disease is caused by the exposome, not the genome. Meaning your genes are affected by the exposures that then change the genes function, which then lead to all these diseases. But it's not the genes that are the problem. It's the exposome that's the major problem. Before we jump into today's episode, I want to share a few ways you can go deeper on your health journey. While I wish I could work with everyone one-on-one, there just isn't enough time in the day, so I've built several tools to help you take control of your health.

0:32If you're looking for guidance, education, and community, check out my private membership, The Hyman Hive, for live Q &As, exclusive content, and direct connection. For real-time lab testing and personalized insights into your biology, visit Function Health. You can also explore my curated doctor-trusted supplements and health products at drhyman.com. And if you prefer to listen without any breaks, don't forget you can enjoy every episode of this podcast ad-free with Hymen Plus. Just open Apple Podcasts and tap try free to start your seven-day free trial. Inflammation is a natural part of your body's function.

1:06It's essential. Yes, you cut yourself. What happens? The white blood cells gather. They come to the site to rescue. They create swelling. They bring all kinds of healing factors. and what you see is redness and swelling and pain and heat, that is the classic sign of inflammation in the body. We used to call that in medical school rubor, dolor, color, and tumor. Tumor just means swelling, not tumor. You know, that's anyway, Latin, whatever. But the key is that it's this normal process that happens as a result of dealing with problems that go wrong. But here's the rub. In the past, most of what we had to deal with was acute things that caused inflammation, like a cut or an infection.

1:51But today, our modern lifestyle is driving so much hidden inflammation, systemic chronic inflammation, silent inflammation. It's a silent killer. And it turns out that it's not the kind of inflammation that we are familiar with, like a sprained ankle or a sore throat or something that's an obvious kind of inflammation, the kind that's good. The kind that we're talking about is the kind that's bad and that leads to almost every known disease of aging, heart disease, cancer, diabetes, Alzheimer's, not to mention things like ADD, depression, obviously autoimmune disease, obviously allergies, asthma, all sorts of gut issues.

2:36All these problems are caused by inflammation. Of course, then the question is, what causes inflammation? We're going to get to that. From a functional medicine perspective, I don't care that you're inflamed. I care about why you're inflamed. I don't want to give you an immune suppressant, an anti-inflammatory drug, a pile of aspirin. I want to find out what the cause is and get rid of it. In functional medicine, there's a simple rule, and it's this. It's called the tack rule. If you're standing on a tack, it takes a lot of hours to make it feel better. Take out the tack. And if you're standing on two tacks, taking one out doesn't make you 50 % better.

3:09So get rid of both of them, okay? And all of them, maybe there's five or 10 tacks. And that's the secret of functional medicine. It's a method of investigating the body as a system, looking for root causes and getting the body back in balance. All right, so what is the deal with this inflammation? I mean, I think, you know, when I was in medical school, heart disease was a plumbing problem. You know, it was clogged arteries. We now know that it's an inflammation problem, that the reason your cholesterol becomes an issue is because it gets inflamed and white blood cells sop up the cholesterol and stick it in the arteries, causing plaque.

3:44Same thing happens in the brain. Alzheimer's is inflammation in the brain. All those plaques in the brain come from inflammation. So cancer also is a disease of inflammation. And when you, for example, look at various studies, even with cholesterol, if your inflammation level is high, but your cholesterol is also high, you're at high risk. But if your cholesterol is normal and your inflammation is normal, you're at no risk. But if your cholesterol is high and your inflammation is not high, you're really not at great risk. And the worst is if you have, obviously, both. So inflammation is a real big issue.

4:17They did a study of an enderly population. They found that if their CRP was high, which is a blood test for inflammation, and interleukin six, another cytokine test for inflammation, they had a 260 % more likely chance of dying in the next four years. So this is no joke. So you might feel fine. The patient with me is like, I don't know what's wrong. I feel fine. I saw my blood test test. I don't really care. I feel fine. Why should I change what I'm doing? I'm like, well, if you don't change what you're doing, it might not go well for you. Now, there's no guarantees that's true, but it's likely true.

4:49So the real concern isn't our response to an injury or an acute infection or something like that, but this chronic smoldering inflammation that slowly destroys our organs and our ability to function and leads to rapid aging. In fact, I just finished my book on aging called Young Forever, and they talk about the hallmarks of aging. One of the key hallmarks is inflammation, or they call it aging itself, inflammaging. And what happens with aging is there's this runaway inflammation that just degrades your whole body. So understanding what inflammation is, how to diagnose it, and how to deal with it and get rid of it is so essential if you want to be healthy.

5:24Now, what's the problem with the treatments we use? Why not just take Advil or aspirin or take a steroid like prednisone? Well, they're fine for acute problems, but when things are in this slow smoldering state, they really don't work. In fact, the new data on aspirin was pretty scary about heart disease. Oh, it's going to help you and stabilize your blood and blah, blah, blah, and prevent clotting. But it turns out that the recommendations for aspirin were overenthusiastic and that there are certain patients who should be on aspirin, but very few compared to the, you know, universal statement that everybody should take an aspirin to prevent heart disease.

6:02No, because it causes strokes and it causes bleeding, which is not good, like GI bleeding. So, you know, if you look at those drugs like aspirin or Advil or Aleve, they're not benign. I mean, they're really helpful when you need them, but they can cause terrible gut issues. I had gastritis, for example, after taking them for a broken arm. And many, many people die. In fact, as many people die from taking those drugs as from asthma or leukemia. So imagine if we literally eliminated those drugs, we'd basically be essential. it'd be the equivalent of curing leukemia or asthma. So it's not a joke.

6:41So, you know, statins, for example, even cholesterol drugs, like statins like Lipitor, they may not have their main effect by lowering cholesterol. In fact, it may be because they actually lower inflammation. That's what they do. It's a side, quote, a side effect of the statin, but actually may be their main effect. So how do you know if you have inflammation? Is there a way to test for it? Is there a blood test? Well, there are, and there are more and more coming. So the most common one that people do is called C-reactive protein. It's high sensitivity C-reactive protein. It's something your doctor can order.

7:15It's on any lab panel you can get. And you can also see that as a sign of hidden inflammation. Now, if it's super high, it could be infection. But if it's in the sort of 1 to 10 range, that's usually the hidden inflammation. Ideally, it should be less than 1. Any higher than that means you're on your way. Now, there are other blood tests you can check, cytokines, sedrate, and so forth. May not be as helpful, but there's a new test developed by a professor at Stanford called I-AGE, I-A-G-E, meaning immune age. And it really looks at your immunome, which are 50 different cytokines, many of which you've never heard of, there are molecules that are regulating immunity and inflammation, that he was able to correlate by using artificial intelligence with disease.

8:00So he found there really there were about four that highly correlated with your risk of heart attack, cancer, diabetes, Alzheimer's, and so forth. What's so amazing is this test is really not that expensive. It's easy to get and you can track it over time. And then the good news is you can change things and change your inflammation. Anyway, enough with that. So, you know, the reason we really don't track this is because doctors just kind of are not thinking about the root causes of disease. They're like, okay, what's your symptom? What are you suffering from? Okay, let me find the drug that best matches that.

8:35You know, if you have a strep throat and I can give you penicillin, great, I'll get a cure. But most of the time I'm just managing symptoms and, or I'm giving you an immune suppressant. And that's not the answer, unfortunately. So, okay. So let's say you've identified the causes, you figured out you have inflammation, you know, how do you live an anti-inflammatory lifestyle? It's the same old stuff. I hate to say it, but it's eat real food, lots of phytochemicals. All those colorful plant compounds are anti-inflammatory. All the phytochemicals in food are so powerful for reducing inflammation.

9:05Also, you know, just real, whole, unrefined, unprocessed foods, not lots of sugar and starch, no trans fats, no refined oils, and get lots of those phytonutrients. Good fats are really important too. Avocados, olive oil, extra virgin olive oil, ideally. Omega-3 fats, things like sardines, herring, sable, wild salmon. They're all really rich in omega-3 fats and they're very healthy for you. Exercise. Lots of research on exercise can reduce inflammation. It supports your immune system. It strengthens your heart. It corrects insulin resistance and improves your mood. It helps reduce stress. I mean, it's one of those miracle therapies that can really do so much for you at so many levels.

9:45Um, practice active relaxation, which sounds like a contradiction or an oxymoron, but no, you have to actively relax. It's not, I don't mean sitting, watching TV, drinking a beer. I mean, meditating, doing yoga, deep breathing, getting a massage, doing something where your body just kind of hits down into the parasympathetic state and calms your nervous system. Hot bath. I love that. Last night I was a little, had a very busy day, uh, lots going on. And I just took a hot bath with Epsom salt and I just kind of floated away. It was great. Also, food sensitivities are another big factor. You might not know this, but a lot of hidden inflammation can come from not allergies, but food sensitivities, things like gluten, dairy, and certain things that people react to that they may not know they react to.

10:32So I often recommend an elimination diet, like the 10-day detox diet that I've created to help people reduce their overall level of inflammation. And then you can add back foods and see what's really the problem. So maybe it'll need a lot of things and then you just add back one at a time. And for example, dairy, I know it causes inflammation. If I have dairy, I get pimples, my skin's weird, I get congestion, so I don't need dairy. Although I do manage to tolerate goat and sheep okay. Many people would benefit from actually a focused gut repair program because a lot of their imbalanced bacteria are causing inflammation.

11:05And lastly, take the right supplements. A multivitamin, fish oil, vitamin D all help drop inflammation. We know today that exercise actually can dampen inflammation in the body. We have dozens of clinical trials to back this up. And even in the absence of weight loss, the exercise can decrease the amount of immune cells that are infiltrating your fat tissue. And to me, that's an amazing fact because we're not just looking at the end result, weight loss. We're actually changing our bodies on a biological level, even if we are not able to see it on the outside. And so just getting out and moving every day, even if you do it in small bursts, that tends to add up.

11:44For example, if you take your bike instead of the train or if you try to go up the stairs instead of taking the elevator, All of these different things can actually add some exercise in your day, some movement in your day. And when you think about the Blue Zones books, this is how they incorporated some movement into their days. And I think it's a very seamless way to do it. Nothing wrong with going to the gym and exercising or anything like that. But for most people, it's a difficult thing to begin exercising when they have not done any of it, especially some of my patients who come to me saying, you know, doc, I don't have time to incorporate exercise into my day.

12:24And this is something I think that anyone can do just by making some simple lifestyle changes, and it can actually dampen the inflammation in the body. And another thing, too, I think, is to just be mindful of the times at which you're eating because fasting has been shown to dampen inflammation in the body, to fortify your body against a variety of diseases. And just something as simple as trying to consume your calories in a 10-hour window. It doesn't have to be anything complicated. And of course, if you have comorbidities, then you should speak to your physician and a nutritionist before attempting a fasting program.

13:01But we do know that stressors like exercise and fasting are good stress in our life because we have to have the good stress and also maintain the bad stress that we don't want. And those things, I think, are very important for inflammation.

13:22Yeah, I think that's really important to think about. I think exercise is so key. And I think we don't realize how powerful it is as a trigger for all the beneficial things we want to have happen with aging. And it works for depression. It works for heart disease, for cancer, for diabetes, for Alzheimer's, for every kind of inflammatory disease. It's pretty amazing. and yet, you know, less than 8 % of Americans get the recommended amount of exercise, maybe 20-something if you take a broader view of what's minimal, but I think most people don't even get close to that. I think, you know, what about the role of supplements or phytochemicals or other things that we can be taking to help regulate our immune system?

14:03Do you have any perspective on that? I mean, I do love to tell patients to get their phytochemicals from the foods first. So I basically, you know, I have my patients eat lots and lots of colorful vegetables. And we know that polyphenols are incredibly important phytochemicals for inflammation. They're antioxidants. They help to tone inflammation down in the body. They are also metabolized by the gut microbiome in part, and more beneficial compounds were created. So I certainly think that polyphenols have a major role. And when I think about supplements, I think it's more the exception than the rule.

14:39So when you look at supplements like curcumin supplements, some of which have been shown to be efficacious in diseases like inflammatory bowel disease, that's a great thing. You can also use curcumin in your cooking, for example. But with supplements, as long as you have the data behind them, then that could be something that is potentially beneficial depending on your disease process as well. The things that I tend to sort of recommend people to eat are certain foods which have anti-inflammatory compounds. So what are your top anti-inflammatory foods? that people should be focused on? Well, I really love grains.

15:12I think kale is one of my favorite grains. It has the immune-modulating potential of our ancestors, our ancestral plants. And it's very versatile, very easy to cook. So we want to try to get to foods that are more like those ancestral plants, like scallions instead of onions, for example, because the ancestral iterations are actually much more powerful from an inflammation-damping standpoint. Berries, again, are a wonderful food. You can have frozen berries, for example, just in your freezer and eat them whenever you want. And they're filled with a variety of phytochemicals, including polyphenols.

15:53And when you think about inflammation, you really want to think about the very, very colorful foods, not just the iceberg lettuce and the bananas. And in my pantry, I have a variety of whole grains. And by whole grains, I mean actually whole. So I love quinoa. It's one of my favorite grains. And I think it's something that is very easy to use. And whole intact grains are actually much better for your gut microbiome than processed grains. So that's just something that's a nuance that can be helpful when it comes to talking about inflammation and also fermentation. Yeah. Fermentation. Yeah. Fermentation of those grains.

16:30So I think that when we were talking about grains in general or certain foods, we really do need to be looking at the nuances. So that you have a hearty bread that's fermented and baked in the ancient tradition without any flour, say. That's a very different response in terms of your immune response than a bread that you buy at the supermarket. it. And so that's something to be very mindful of. And I love beans as well and lentils. There are dozens of randomized controlled trials showing that beans can help to dampen inflammation and beans have a good amount of soluble fiber. And you probably know all of this already.

17:08So I'm just regurgitating what you already know here. Oh, great. That's great. People need to hear it. People need to hear it. This podcast is for me. It's for everybody listening. yeah yeah so the soluble fiber is very important for the gut germs and that's uh you know they metabolize that fiber and you salvage calories that way you make beneficial compounds that go throughout the body and calm the immune system down and one thing i think that i don't want you to skip over that feeding your microbiome is so important right it's incredibly important yes and also those polyphenols which is your discovery yeah so they they're not just even fiber but They're eating all the colorful plant compounds that can improve their bacterial content in there.

17:51And they're also eating some fat, like healthy fats from nuts and seeds. That's another food that I prescribe for patients. All those healthy monounsaturated fats and just a handful of nuts a day is a great thing to add into the diet. And then something I think that people tend to forget about are just spices and herbs. I mean, there are so many different spices you can use. And in my family's tradition, you know, the cuisines that my parents and grandparents cook, they're just an array of spices that I can't even, I still have to learn all the names of everything. So, but spices and herbs are just filled with polyphenols and just very, very beneficial nutrients.

18:31You know, if you look at something like cumin, which has salicylic acid in it, you're actually getting kind of some anti-inflammatory potential from that, which also helps to resolve inflammation. because aspirin is one of the few medications that actually not only dampens but also results inflammation and um you know just like uh thinking of things like a lot of you were talking during covid about using black cumin seed oil like as a black cumin seeds are really different kind of cumin and it's a very powerful immune modulator and antiviral yeah so these these spices that are we sort of neglect you know we use a lot of salt a lot of sugar a lot of processed refined oils to kind of make food taste good and we don't actually use the spices and then you don't really need that much of those other things when you actually have a yummy spicy yummy diet i mean i i love to cook indian food at home i actually make it scratch stuff so like i actually get the actual spices i grind them i get the oh that's wonderful yeah and it's like oh it's so good it's like and and it's a lot of hard work it's a lot of hard work well i have i have a little I have a little like a brawn like thing.

19:39I just push the button and go, but it's so more to start to include these in your diet on a regular basis. Absolutely. And the one thing I want to mention, the last thing is also seaweed because I love seaweed and it's kind of like a superfood in some ways. And you can find fibers in seaweed that you don't find in terrestrial plants. And the goal is to have a diverse array of some of these plants. And we know that simply by increasing the diversity of plant foods in the diet, that can actually predict lower inflammation. It's not just about the quantity, but also the diversity. So just kind of thinking about all these different types of foods that you can get, I think, can be pretty useful.

20:19I've been studying social and exposome determinants of inflammation for about 15 years now, right? And the type of data that is out there point very clearly to things that most of us know. However, there are certain aspects of the exposome that we do not know. What's the exposome? like what's what's the ozone yeah yeah yeah so um it's the totality of um uh biological chemical and uh social exposures that a person suffers throughout the life course and what we know about that is that 95 of chronic disease is caused by the exposome not the genome meaning your genes are are affected by the exposures that then change the genes function which then lead to all these diseases but it's not the genes that that are the problem it's the exposome that's the major problem for most of us that's exactly right i i would like to get at that in a moment um we have the genome everybody you and i and everybody in this world to be able to live 120 130 years um um uh at least right uh that is that something we know now the problem is in some countries people are dying at the age of 70, 75.

21:43That's the average lifespan expectancy. Some countries it's 89 or 90 like Monaco or Japan because we figure out ways to extend that period of healthy living, right? So in essence, what we're trying to achieve is to push that 80 to 90 average life expectancy to 120. Now, tweaking genes is a completely different thing. We're not going to talk about that at this podcast. But I'd like to go to the idea of the exposome. Yeah. Back to the root cause of inflammation. So we do know already today that pollutants in the air, that pollutants in water. Pollution. Pollution, exactly. pollution, are drivers of inflammation.

22:35Imbalances in nutrition, such as both macro and micronutrients, right? These cause inflammation by large. Food additives go back to the microbiome. Things like carboxymethylcellulose or polysorbid 80 that will wipe out your microbiome and will cause inflammation because the musing layer in your linen of your gut will get very thin and then you're going to have translocation of different antigens to your periphery and you're going to develop an inflammatory reaction. Gluten you know, gliadin What you said was very important. You just said that basically when you eat this food out of it, things that are in our food that we don't even pay attention to like polysorbid 80, it damages your gut lining and then all the poop and bad like in food particles that are partially digested leak across that and your immune system is right under the lining of your gut and then your immune system goes hey what's this bad foreign stuff and it starts creating this inflammation so that's why it's bad so food adams are just not bad because they're you know if you're a hippie and you want to eat granola and like this you shouldn't eat food adams they're really damaging to our bodies Right?

23:47Your microbiome. Yeah, exactly. They're causing this concept of dysbiosis, right? Yeah. And then you were going, gluten was the next thing you were going into. Exactly. So, or plasticizers, plastics, things that are stored in plastics, plasticizers, or plasticizers and plus the resin make a plastic and there's leaching, right? And there's a leaching of plasticizers that go into our foods. And those are hormone disruptors that also cause inflammation long term. I was going to go to gluten. Gluten, as you know, is highly inflammatory. Glyadin can bind to certain cells in your gut and cause inflammation, increasing leaky gut, etc.

24:29The other word is sedentarism. As you very well are aware, if we're sitting in a chair, we're developing an inflammatory reaction. And that it's a perfect combination between the types of... The time sitting in a chair and mortality, there's almost a perfect correlation between those two. Sleep quality, there's disruption in our circadian rhythm. Social stress. There's a very, very compelling evidence that individuals that are exposed chronically to social stress, social isolation, they develop inflammation, they have more cardiovascular disease, these elevated rates and death. And obviously other chemicals that we're exposed to that are surrounding us, just even an example, formaldehyde, right?

25:23Paraformaldehyde that serves as a glue for plywood that is often used in furniture and cabinetry. So those are important things. So basically it's environmental toxins, it's social stresses, it's inflammatory foods like sugar, it's food additives, and even other environmental toxins you didn't even mention, like heavy metals, not just plastics. We're exposed to all this stuff. And our gut microbiome becomes disturbed because of a lot of these things, and that even creates worse inflammation. So we're in this inflammatory environment, which historically we really didn't have throughout evolution.

26:02And the truth is we did a lot of things that naturally combated inflammation. So just as there's an inflammatory lifestyle, there's an anti-inflammatory lifestyle, right? And so the beauty of your work, and I want to get into this in a minute, is that you've been able to map out the changes in the immunome. And for those that don't know what that is, it's basically the sort of immune... Well, why don't you define the immunome? You're the expert. I don't know, I don't probably screw it up. I doubt you will. But so similar to the concept of exposome, the end in the word somme accounts for the totality of it.

26:40So when we talk about the immunom, we talk about all the cells, the proteins, and the genes that are in your immune system that are able to communicate between them. And so orchestrate an immune response. So, we're talking about hundreds of thousands of different parameters that can be measured from blood, and that's what we did in 1000 Immunomes Project, which is a project that, as you mentioned, lasted for about now 15 years. We just got another source of funding from NIH,$15 million to continue to study for the next five years. And we've been monitoring these individuals, their immunome. And basically, we focus it in blood.