Tired But Wired? The Hidden Loop Destroying Your Energy | Dr. Scott Sherr, MD

20:55And what the CDR does when the cell danger response is active, we get into more of a catabolic state. We start breaking down parts of our body to try to protect it. Where in the anabolic state is really when we're building up and getting stronger. That's when you're in a safe space, right? When you're in safe spaces, you're parasympathetic. I call it the parasympathetic edge, really. And we can talk about that. But the idea is when you're in the parasympathetic mode, you're resting, digesting, you can turn off the cell danger response. But you can't turn it off if you're always in stress mode.

21:25And the cell danger response is basically protecting you from stress. It's protecting you so that you can survive. It's a survival mode. It's also activated in the short term when you have acute stress, when you have acute infection, you have acute additional stress outside, external stress. But it's supposed to turn itself off. but it can't turn itself off if it doesn't have that anabolic parasympathetic activation. And that's the challenge. And in addition to that, what happens over time is that you deplete a lot of the intermediates, a lot of the vitamins, minerals, nutrients, and cofactors that are responsible for shifting you out of the cell danger response.

22:01Dr. Mark Hyman:So just the very fact of trying to manage the danger, you're using a lot of nutrients. Tons of it, yeah. And you deplete your nutrients. Yes. And then you end up in this vicious cycle where you need the nutrients to fix the problem, but you don't have the nutrients and it deploys them. And you're still in the stress mode and you're still right. So the major question is, well, how do you approach it? How do you work on optimizing somebody's capacity and increasing their reserve, getting them out of the sympathetic, but also supporting their capacity to flip out of that cell danger response and support mitochondrial function?

22:29Dr. Mark Hyman:Well, that's an important question. I want to get into the practical aspects of how do people end the sympathetic spinal treatment, how do they stop the cell danger response? Before we get to that, I want to kind of unpack a little bit about your top-down, bottom-up idea here. Because it's important because, you know, you can enter into this sympathetic spiral of doom from your psychological state, from trauma, or from your biological state, from things you're exposed to in the environment that you may have control over or your diet, which you do have control over. So can you kind of walk us through the top-down, bottom-up explanation and where are the contributors to this sympathetic spiral of doom and cell danger response?

23:07Dr. Mark Hyman:So I think if we understand what those are, we can start to think about how we might approach them. The top down part, let's talk about that first. The top down part is how are we stressed? What is causing our sympathetic activation? And the amount of things that can be doing this is unlimited in this part. We can talk about it from social media to politics to what's going around in the world right now with wars and things like that. Two things that are going - How about the stress in the world right now? I mean, a little, I mean, a little, I mean, it's not going away. And we are wired as humans to do two things, survive and reproduce.

23:43That's it. That's what we are wired to do because that's what the species requires. And so as a result of that, what do our news media, what does our social media do? It wires you, it's wired, or it's created to fit into those two patterns, survival and reproduction, mostly survival. So fear, right? Fear is the biggest one. And so there's tons of things that are coming outside of us all the time that are trying to instill fear in us. It could be everything from the things I mentioned. It could be within your own home, right? If it's a relationship, that isn't great. If it's a job, that's too hard.

24:18If you're not getting enough sleep, that's a huge one because if you're not getting enough sleep, you're not going to be able to regulate your nervous system either. And so that's what I call the top-down aspects. And I could fill in maybe...

24:29Dr. Mark Hyman:That's all the psychological stuff. All the psychological stuff. It can be your childhood trauma, whatever, you know. Yes, and I mean, you've had patients like this too that, you know, they were abused as a child and they never feel safe in their own body. There's no way they can ever heal. There's no way they can ever really fully, truly be their best self because they're always in this locked-in sympathetic state. But there's ways for people to come out of this. A hundred percent. Yeah, we'll talk about that. And then that's exactly what this is all about. It's about understanding the pattern and then seeing how to break it.

24:54So that's the top-down. That's the top down. The bottom up is... The bottom up is really... You did a great job earlier when we were talking about direct mitochondrial stress. You know, things like infections and...

25:04Dr. Mark Hyman:They're very sensitive. Mitochondria are very sensitive. They are. Everything affects them. They do. They do. I mean, they're a sensitive organelle. There's a lot of them. There's quadrillions of them in our bodies. Huge amounts of them. That's a big number. It's huge. I can't count that high. I can't either, but it's a quad. I know that. I think after that, I can't remember. It's like, I don't know, it's quint after that, I think. But it's after trillions is quadrillions, it's a lot of mitochondria. And so we need a huge amount of energy. In fact, we need to make about 150 pounds of it every single day of ATP to maintain our energy capacity.

25:35And as I mentioned, 94 % of us can't do this on a regular basis. And that's because of the things you mentioned. You talked about insulin resistance and toxins in our environment, medications that we take on a regular basis that actually have a dysfunctional impetus or actually make our mitochondria do worse. Things like metformin, even things like birth control pills even, because they deplete nutrients that help with mitochondrial function. Not to say people should get off their medications, but even proton pump inhibitors, which are a big one.

26:03Dr. Mark Hyman:That's acid blockers, or a big one. That's third leading cause of use of drugs, which is acid blockers from people eating a crappy diet. Yeah, but statins too. Statins also have significant impact. And that's the number one class of drugs. So the number one and three class of drugs is causing mitochondrial damage. So statins, and they have effect on both complex one and complex two, which are the two first proteins in the mitochondria that help you make energy. And pesticides do it. Infections do it. We talked about it. And then, of course, this sympathetic activation, which can be overarching to everything, but on its own can cause mitochondrial stress.

26:35And I think that the way I kind of picture this and I talk about it with my patients is that you and I were talking, it's not just one thing. You know, it's often a combination. And you're going, you're riding along.

26:46Dr. Mark Hyman:Combo package. Yeah, of course. You know, it's the bundle. and like you're riding along, you're doing okay until you hit around for most people, though it's getting worse now, like around like your mid thirties, late thirties, like early forties. And then things start going a little, you know, pear shaped as they say in Ireland, one of my favorite expressions. And they're like, yeah, a little pear shaped and things kind of go like, why am I not recovering as well? Why do I need more sleep? Or why don't I feel as rested when I wake up in the morning? Or why does when my son comes in, when he gets home at school at four o 'clock and he says like, hi dad, I go, What do you want?

27:18You know, I start like, what's going on there, you know? And so you start noticing these things. But as you said, Mark, it's happening at earlier, in earlier ages because of just the amount of toxic exposure that people have on a regular basis, which is crazy.

27:32Dr. Mark Hyman:Yeah, it's a lot. It's a lot. And you know, the truth is we have a lot of mitochondria, but they're fragile. Yeah. And they're very sensitive to any insult, even like disturbances in your microbiome. For sure. And the bacteria in your gut can cause harm. Yeah. You know, the microbiome mitochondrial connection people don't even think about. Yeah, the interkingdom crosstalk stuff is so cool. It's very impressive. Yeah. And, you know, you mentioned quickly metformin. I think I want to just quickly double click on that. This is a drug that's widely being used for diabetes. I've used it for years in my practice.

28:03Dr. Mark Hyman:Yeah. And it can be a good drug for diabetes. But it does have a weird side effect, which is it inhibits mitochondrial complex one. And this is like one of the first steps in producing energy from food and oxygen. and in one of the studies that most concerned me was they did a randomized control trial where they did progressive resistance training meaning must strength training and in two groups one taking metformin and one not taking metformin yeah and the one taking metformin didn't have any muscle gains and it inhibited muscle growth yep and that concerns me so it's being used a lot for longevity and aging i i feel strongly that it's not something people should use for that.

28:42Dr. Mark Hyman:I think in certain cases, in certain patients, it can be an adjunctive therapy and is a transition to get off of drugs because you can reverse all of it with lifestyle. But like, yeah, I just, I think it's important. So, so you've got, you've got all this top down, bottom up stuff. It even gets more interesting than that because a lot of new research and we've had Chris Pomeran and others talking about the mitochondrial role in mental health. Oh yeah. So it's not just that you lose energy and you're tired from the stress, your mitochondria play a big role in dysregulating your mood and your brain function.

29:15Dr. Mark Hyman:So talk about that. Yeah, that's a big piece of it. I'm glad that you had Chris on. I think his work is so great looking at metabolic dysfunction and the reversal using the ketogenic diet, for example. And that's a big symptom of what we just described here. By the way, when we talk about metabolic dysfunction, it's kind of a confusing term. Metabolic dysfunction in this context means means how we turn food and oxygen into energy in the mitochondria. That's our metabolism. Yes. And then I would just add to that that how we are able to address the stress of making energy as well, in the sense that when we make energy, we make ATP, we're also making waste products, as I mentioned.

29:49And that's the other part of metabolic health is that you're able to make energy effectively and you're able to neutralize the stress of making energy. But I love your definition because people get so confused by it. So I appreciate you mentioning it. So when it comes down to brain health and mental health disorders, depression, bipolar, even schizophrenia and some of the major ones, like you see amazing capacity to work on mitochondrial function and see these things get so much better. I mean, people throw around and don't like the word cure, but in some cases, people coming off of medications like entirely.

30:19And I've seen this. Like curing schizophrenia with diet. Yeah. It's amazing. And I, you know, I have a colleague that's on this with bipolar disorder. Right. And so I feel like where it comes down to is that this is a mitochondrial dysfunction, at least a significant component of it. There might be neurochemical things for sure, but you and I both know, I learned in medical school that depression was a serotonin deficiency.

30:41Dr. Mark Hyman:How did that work out? Not so well. Wait, wait, depression isn't a Prozac deficiency? It's a Prozac deficiency, right? And so everybody, we need to put Prozac in the water. That was like, not LSD anymore, but the Prozac. And we know now that - LSD would be better. 100%, yeah. That would have been an interesting experiment in New York City back in the day. We know that depression is not a serotonin deficiency. And we know that people that have depression have no lower levels of serotonin than people that don't have depression, right? So I think that, you know, that's an interesting thing that we all learned that's completely wrong, right?

31:09And that's what I learned in medical school. And so we now know that mitochondrial dysfunction is so much more of the actual game here. Now, understanding why people have the mitochondrial dysfunction is absolutely essential. We talked about the top down, the bottom up, and how you have to address the causes for sure. But in the essence of this conversation, what I would say to those that are listening is that we can help people right now by working on mitochondrial function and sympathetic activation while long-term trying to figure out what those inputs are that are causing it too. But seeing mitochondrial function improve and then all of a sudden depression, anxiety, insomnia get better, it's been transformative to people that I work with.

31:49Dr. Mark Hyman:No, it's huge. And I think people should stay tuned at the end of this podcast We're going to get to fix this, but I have a few more. No, I keep, I keep foreshadowing. No, no, it's good. It's good. It's good. We're going to get there. One of the ways, you know, as people are listening, I imagine they're thinking as well, you know, okay, I know how to activate my parasympathetic system. I can meditate. I can do breath work. I can do yoga. I can maybe exercise to improve my mitochondria, but, you know, co-plunges, saunas, whatever. But you said something, which is interesting. you said you can't parasympathetic your way out of cell danger.

32:22Dr. Mark Hyman:What does that mean? So this is the thing, right? Because - You can't meditate your way out of this physiological stress to your cells and mitochondria is what you're saying, right? Yeah, you can't. I mean, because you're in this sympathetic locked in kind of mode. And the challenge is anytime you try to downregulate your nervous system, it actually might make you feel like you're crashing. Because when you try to get yourself out of sympathetic and get into parasympathetic, but you've been in sympathetic for a long period of time, so you're in that fight or flight, your mitochondria, as we've been talking about, have been under a lot of stress for a while.

32:54And we've depleted vitamins, minerals, nutrients. We're in that cell danger response location of your cell spectrum of capacity to make energy. And then you're trying to bring down the nervous system. But what can happen when you do that is that you've only been able to function because you've been at that high of a state. And when you bring down the nervous system without enough support, on the mitochondrial side especially, immune system would really be helpful too, you'll see that you have this crash. People feel like they crash. When they go down and try to do their breath work, try to do their meditation, oftentimes they feel terrible when they try to do it, if they can even do it in the first place.

33:31Because the other challenge of this too, Mark, is that people don't even know what it feels like to be back in parasympathetic mode. They don't even remember what it felt like to calm down their nervous system. And so it can be very difficult to do breath work or tell somebody to meditate or the last thing you want to do is to tell them to calm down, of course, right? That doesn't work. If anybody's married or has a partner, they know rule number one of being married is that you don't tell your partner to calm down, right? It doesn't work. I was talking to my son who's eight. He's like, dad, he has three sisters, three older sisters and my wife.

33:59He's like, dad, what are the things you never tell a girl? I'm like, number one, do not tell them to calm down. Good advice. Yeah, yeah. So that's the thing, right? If you're in this locked in state where you're in this metabolic dysfunction related to being in this cell danger response, not being able to make enough energy. You can't just breathe your way out of it.

34:17Dr. Mark Hyman:And so you've got to really deal with those root causes. Like, you know, we say if you're mercury poisoned or you're betrothed a fish in your thighs not working, it's hard to get enlightened. You know, you got to like, you got to deal with those biological things. And then the, often the psychological things or the physiological stress gets better. But it takes time. And, and, you know, it's interesting. I, I, I really sort of fascinated when you came up with this, cause I, I've noticed this for years in my practice. I was like, gosh when people have a physical stress meaning a toxin an allergen infection it's poor diet whatever it actually causes a a like a trouble with the whole system like it's not just yeah it's not just causing like a mental stress causing stress it's physiological stress it creates the same fight or flight the same sympathetic activation the same even if you even if you're kind of cool and everything's fine you can still feel stressed because of having mercury in your system.

35:10Dr. Mark Hyman:A hundred percent. For example. Yeah. And I think that's something people don't realize. So it's not just psychological. It can be biological causes of psychological stress. A hundred percent. And that's what I tell my patients all the time. It doesn't have to start with that sympathetic activation, but it begins somewhere. And then at some point they both often, they both have to be addressed, right? Which is you can't just address the mercury exposure if you don't address also the sympathetic activation that was caused by the mercury exposure. Even if it wasn't a top-down issue before, maybe you had some mild things that were stressful, but not too bad.

35:43But all of a sudden, you're mercury toxic. That's a different story. So when you work on mercury toxicity, you also have to work on the sympathetic activation too. Because if you don't do them both, you're still going to be left in a place where you're still sympathetically activated. And you know how it is. You've worked with patients like this. You know that if somebody is so fight-or-flight dominant, there's no healing that you can do with these patients. No, it's true. It's impossible. And it's really difficult. It's like the one time I agree with our conventional colleagues that if you're giving them supplements, it's like giving them expensive urine.

36:12You know, if you're not addressing the sympathetic activation along with the root cause, if it was mitochondrial first. Right. And so that's why it's so nuanced here. And, but it's so important to kind of piece this out as you are and discuss it.

36:26Dr. Mark Hyman:But then even like if the mitochondria are stressed from toxins or whatever, it actually makes the body stay in fight or flight. Yeah. So how to explain that connection between the mitochondrial stress from things that are just insults that you didn't have to do, do it like that are not mental insults. Right. So causing this to be in this mental state of fight or flight. Right. So the idea is that when you have a lot of mitochondrial stress, you're not making enough energy. OK. And when you're not making enough energy, the system goes, oh, no, I need more energy. And what it does is tries to compensate by increasing your sympathetic nervous system, increasing your capacity to find out psychologically how you can help the situation.

37:05So it's almost like it's a bottom up where you have these sensations and activation of inflammatory pathways and et cetera in the body related to mitochondrial dysfunction that overtly, psychologically, this manifests in you trying to figure out why this is happening or trying to give you more energy to maintain the capacity that you need to make any energy at all. And so you get in this loop where it doesn't have to be any of that over-sympathetic activation from outside sources. All of a sudden, it's just the mitochondria itself that are not making enough energy and then causing the system to compensate for that.

37:39Dr. Mark Hyman:Okay. So let me see if I get this straight. We've got this thing that you've described, which is something that I think most of us who practice this way for years have already seen. We never called it this, but the sympathetic spiral of doom, which can come from the top down, bottom up. Right. It's a lot of mitochondrial dysfunction and stress, a lot of inability to produce energy in our cells, which runs everything. Right. And we end up in this cell danger response. So we've got like sympathetic spiral doom, cell danger response. So people listening go, yeah, that's me. Right. I'm listening go, yeah, that's kind of me.

38:08Dr. Mark Hyman:So like, what do we do? Like if someone's stuck, how do, what's the first step to getting out of this loop? The first step. The spiral of doom. The spiral is to escape the spiral. That's what you want to do over the long term. But initially, you want to figure out ways to help somebody now to help break the spiral and get them additional support so they actually can maintain and benefit from long-term support. So the idea is that you're a functional medicine expert. You founded the field basically with Jeff and others. You know that working with people and optimizing their health, vitamins, minerals, nutrients, optimizing their gut, their neurotransmitters, that can take a long time to do, right?

38:48And if you're in this spiral, it's very difficult to do as well because, again, you're clamped down, you're sympathetically activated. So the goal of breaking the spiral is to support the mitochondria now as much as possible and at the same time, slowly start down-regulating the sympathetic activation, slowly down-regulating the nervous system so it can calm down. But you have to do it in that order. You have to start off with supporting mitochondrial first, mitochondrial function first.

39:13Dr. Mark Hyman:So it's not meditate first and then - No, no. It's fix your mitochondria first, then meditate. Because what can happen is if you go too soon on the parasympathetic side, trying to calm down the nervous system without having mitochondrial support, that's when you get into trouble too, because you physically and mentally can't compensate because you don't have enough energy capacity. And so your energy capacity is still low. You've down-regulated your nervous system. And now the sympathetic activation, the fight or flight is down. You're trying to calm down the nervous system, but you don't have energy that you can make.

39:44You don't have enough energy. And so as a result of that, you crash. And I've seen this in my practice all the time, where if you start working on the nervous system too soon, people crash. And so the key is to work on mitochondrial function now and give immediate support so that when you start down-regulating and calming down, that this nervous system has enough capacity, the whole system has enough capacity, because the mitochondria is supported.

40:08Dr. Mark Hyman:Okay. So let's talk about that. How do we fix mitochondria? Because it certainly wasn't something that we all learned in medical school. It's something that's one of the central features of functional medicine, which is understanding how to diagnose and treat mitochondrial dysfunction. It's a little bit tricky because the best way to look at mitochondria is do a muscle biopsy, but that's not fun. But there are other tests. How do you think about approaching mitochondrial dysfunction? Because yes, it's got to be focusing on the causes, like if you're eating something that's bad or if you've got exposure to toxins, but let's assume you're working on those because you have to.

40:45Dr. Mark Hyman:What else can you do to revive these little poor baby little mitochondria that don't feel so good? Well, I think you're kind of alluding to the idea of testing to see how mitochondria are working. And there are new tests out there that are working on giving you a direct sense of what's happening in the mitochondria. And there are a number of them that are on the market already. Some of them might be more ready for prime time than others. What do you think is the... Well, I mean, there's a couple out there. I mean, the ones that I use are more the indirect measures. like you do like organic acid testing, for example, looking at the intermediates that are associated with making energy and also oxidative stress markers, inflammatory markers.

41:19Those are really good indicators really of mitochondrial function. There's things like Miescreen and MitoSwab and others that are out there that I think are interesting. I think they're new. In the end, what I see here is it's really nice to have the data for sure, because then you can get a sense of how people do over time. But so much of this, as you know, Mark, is subjective, that people really do know how they feel. If you, even guys who are not as good as women, as we know about telling you how they feel, like, well, how did you feel last, you know, five years ago? Tell me about your energy now versus five years ago.

41:49Like, oh yeah, I had a lot of energy. I had no issues. And now I get brain fog. I get that dip during the day and I feel terrible. Like people can typically give you a sense. So subjectively such a big part of this, and when that's hard, but it's so important because it's how you feel on some level. But what it comes down to is that when you're looking at optimizing mitochondrial function, It is giving the mitochondria what it needs to make energy effectively and to address the stress of making energy. Vitamins, minerals, nutrients, antioxidants, getting rid of heavy metals. This is your work.

42:19This is my work. The challenge with all of that, though, is that it takes time. It doesn't happen overnight. And so I've kind of fallen in love with a compound called methylene blue that you know of. That is a very novel compound in some respects, but it's been around for a long time. But it's one of the most effective ways at supporting mitochondrial function right now. And the reason is that it works on the energy production cycle of things. It helps with energy production. And it also works directly like an antioxidant. So our cells are like gasoline-powered cars. Methylene blue at low doses, as long as it's a clean source, 4 milligrams to 25 milligrams or so, works both as an energy enhancer and as a detoxifier.

43:03So more like an electric power vehicle rather than a gasoline-powered one. And so it's become one of these big levers that I can pull with patients to be a bridge, to be that bridge. I like a picture. I often will put up a picture of the Brooklyn Bridge. I love the Brooklyn Bridge. I grew up in New York. And it's this bridge where you can help people right now while they're on that path. So if you're starting at like letter A through H or something in the alphabet on your path to optimizing your health, that first beginning can be really hard, really hard because you don't have energy to go take a walk around the block.

43:36You don't have enough energy to make your own food. You don't have enough energy to maybe get out of a relationship that's toxic, right? But once you start giving people enough energy, supporting that capacity without causing stress on the system, that's when they can make huge gains across the alphabet in my analogy here, getting them to LMO or whatever. And then they're able to start really making changes that they really want to make. And so I see methylene blue as a fantastic bridge for so many people on this path to their own health optimization journey.

44:06Dr. Mark Hyman:You know, and the mechanism of action is really interesting, right? It kind of acts as an electron carrier, which is, electrons are really what goes through this little mitochondrial, you know, assembly line to make energy, to make ATP. And it kind of bypasses some of the complexes, like two and three, that are kind of in the way.

44:28Dr. Mark Hyman:So bit, right? Yep. It bypasses it. Then you get more ATP and you get less oxidative stress. In my practice, you know, one of the doctors was sharing with me how they were doing intravenous methylene blue and how they had a Parkinson's patient and they immediately improved their symptoms. And I don't know if it was a long lasting effect, but it was an incredible thing because we know that Parkinson's is fundamentally a mitochondrial disease in the part of the brain that has to do with motor function. Right. And so can you kind of explain how that might all be possible? Yeah. So in the end, neurocognitive disease, metabolic, as we've been talking about, everything has these parts of the cell called the mitochondria that help make energy, your immune system, everything.

45:06And so if your mitochondria aren't working well, you have significant incapacity in the areas that have the most mitochondria that are affected. And so in Parkinson's, you know, it's in the substantia nigra in the brain, for example. So one cool thing about methylene blue I should mention is that it is highly bioavailable, which means that orally absorption, oral absorption of methylene blue is almost as good as IV. The only difference with IV is at how fast it gets in the body, but most people don't need IV. Most people can use oral and get the same mitochondrial benefits. And so what you were describing on what's called the electron transport chain in the mitochondria.

45:39So the mitochondria has these proteins that are all kind of aligned up and electrons that we get from our food, mostly carbohydrates and fat, they get donated to this chain using something called NAD and FAD, which people know NAD these days, right? That's a hot topic I know. So you get these carriers, electron carriers, NAD and FAD that bring electrons into the mitochondria. So what happens is if you have those first couple proteins not working very well, complex one or complex two, the whole rest of the system breaks down. You don't have the capacity to make energy. And most of the mitochondrial toxins out there are affecting complex one and complex two.

46:14We talked about statins. We talked about metformin, infections, pesticides, more are affecting those first four complexes, those first two complexes, excuse me. And so if those first couple of complexes aren't working, the rest of the system breaks down. So what methylene blue can do is it can come in, it can bypass the complexes that aren't working very well and donate electrons directly up the chain. So all of a sudden you're able to start making energy in these cells. So it's almost like a bypass road. If there's a broken road, it just kind of goes around it. Yes, and it also can recycle things like NAD and FAD, so those can maintain their capacity to take electrons from your food, even if those particular complexes aren't working as well as they needed to.

46:52So it's this amazing capacity to bypass and compensate for almost any capacity or incapacity of the electron transport chain to work. And that, even to the much as so as it's actually the antidote for cyanide poisoning. So cyanide is actually a -

47:08Dr. Mark Hyman:kills you by stopping your mitochondria from working. Complex four. So the fourth complex in the mitochondria, complex four, is destroyed by cyanide. And what methylene blue can do is it does these ninja moves of going across membranes and being an electron acceptor so you can maintain electron flow through those protein complexes, even if you're poisoned by cyanide. And so that's just demonstrating the power of this particular molecule. And it's actually how I learned about it was in the emergency room. As an emergency room doctor, if someone comes with cyanide poisoning, this is the drug that you give to cure people.

47:39Right, so it's not common, but it's there. There's another one called methemoglobinemia, which is more common, and that's also why it's used in emergency rooms all over the country.

47:48Dr. Mark Hyman:That's from carbon monoxide poisoning. Carbon monoxide poisoning, and also if you've, like the huffing glue or like the stuff, if you have too much of that, that gives you the incapacity to carry oxygen on your real blood cells. And methylene blue changes the iron state to make sure that you can. I recommend magnesium to most of my patients, and for good reason. It's involved in hundreds of biochemical reactions in the body, including regulating the nervous system, supporting muscle recovery, and helping your body transition to a restful sleep. Now, what's interesting is that newer research is starting to look at how certain forms of magnesium may support brain health and sleep quality.

48:24Dr. Mark Hyman:Now, one randomized clinical study, adults who took a brain-available form of magnesium reported improvements in sleep quality and daytime functioning compared to placebo. Now, magnesium is one of the most common nutrient deficiencies I see, and low levels can contribute to stress, poor sleep, muscle tension, and low energy. And the challenge is that most magnesium supplements only contain one or two forms, and they're not always well-absorbed. And that's why I recommend Magnesium Breakthrough by Bioptimizers. It's a full-spectrum formula that includes seven different forms of magnesium designed to support your brain, your muscles, your stress response, and your sleep.

49:00Dr. Mark Hyman:I take it as part of my evening routine. Try it today and go to bioptimizers.com slash hymen and use the code hymen at checkout to save 15 % off your order. That's B-I-O-P-T-I-M-I-Z-E-R-S.com slash hymen and use the code hymen. As a doctor, one of the questions I get all the time is, how bad is alcohol for me really? Now, many people reach for a drink at the end of the day to unwind or to feel social, and it works in the moment. But even moderate alcohol, as little as one drink, can disrupt sleep, it can leave you groggy the next morning, and it puts stress on your body in ways most people don't realize.

49:36Dr. Mark Hyman:Plus, alcohol is classified by the World Health Organization as a group one carcinogen, meaning there's strong evidence linking it to certain cancers, including breast and colon cancer. So while an occasional drink isn't catastrophic, alcohol isn't actually a health-promoting substance. And if what you're really looking for is relaxation, connection, or that subtle eating lift, Is there a smarter, gentler way to get it? Well, yes, that's where Vesper comes in from peak. Vesper is a non-alcoholic adaptogenic aperitif designed to give you a mindful alternative to your usual drink without the next day sleep disruption or the next day brain fog.

50:11Dr. Mark Hyman:Ingredients like L-theanine and lemon balm help your body relax while the gentian root adds a subtle uplifting effect. You feel calm, bright, and present, not sedated. I've been paying close attention to this category and Vesper is the most thoughtfully formulated option I've come across. If you're ready to rethink your evening ritual, Vesper is a thoughtful, healthier option. And get up to 20 % off for life at peak.com slash hymen. That's P-I-Q-U-E life.com slash hymen. And it also acts as an MAO inhibitor, which is, MAO is like a monoamine oxidase. It regulates neurotransmitter function, but you get higher serotonin, dopamine, norepinephrine.

50:49Dr. Mark Hyman:It can have improved mood, neurocognitive effects, right? So it's dose dependent. So lower doses of methylene blue will increase norepinephrine and serotonin. Higher doses will also increase dopamine once you get to about 100 milligrams or so. The key, as I mentioned, is that it's dose dependent, meaning that a little bit will do a little bit of that and more of it will do more. So there are people that have talked about how methylene blue just helps people feel better because it increases serotonin. But that's not the case at all. We're talking about small amounts compared to the huge effect on mitochondrial function.

51:20Dr. Mark Hyman:People listening want to know how to take it. Like, you know, what are the doses like? How do you do it? You know, I see a lot of people like sucking on these lozenges. It makes their tongue all blue. They can just swallow it. It's okay. You can swallow it. You can swallow it, yeah. Yeah, because as I mentioned, it's almost 100 % bioavailable, which means if you ingest it, whether you dissolve in the mouth as a trochee or if you swallow it, you can get the same mitochondrial benefits. The key here, Mark, and I think this is important for your audience to know, is that methylene blue is not a natural compound.

51:48It doesn't come from the earth. It's a synthetic ingredient. And as a result of that, it can be sometimes contaminated with heavy metals, things like lead, mercury, cadmium, and arsenic. In the manufacturing? In the manufacturing process. And so to take the synthetic thing just for a minute, because I know some people don't like the idea of taking anything synthetic. The way I like to talk about this is that not everything natural is good for us. Okay, you can forage -

52:11Dr. Mark Hyman:Arsenic is, yeah. Arsenic, mushrooms. Like I was in medical school and I saw two people die of liver failure because of foraging for the wrong mushrooms, for example. So, and of course, the dose makes the poison, right? So you can have low doses of natural products that can be okay, but high doses of nicotine, for example, can kill somebody, right? And so on the other side of things, synthetic argument, not everything synthetic is bad for us is what it comes down to. We live in synthetic worlds. We have lots of synthetic things all around us, right? My son, when he was four, he had a tracking cellulitis or a skin infection up his leg, and I was looking at it, go up his leg in front of me.

52:44And so I took him to the hospital and I got him antibiotics, which are synthetic, okay? And if you're taking insulin right now as a diabetic, if you have type 1 diabetes or type 2, it's a synthetic ingredient. It's not from a pig anymore. And so there are reasons why we need synthetic things. And I think methylene boot falls into this category where it's a synthetic compound that can help so much, especially in the short term. And I think over the long term, as you get more optimized, you don't need it as much.

53:09Dr. Mark Hyman:And do you use it in conjunction with other mitochondrial supports? So in functional medicine, we talked about CoQ10 and creatine and carnitine and epoic acid and NCO-cysteine and riboflavin and, you know, magnesium, potassium, aspartate, and all these wonderful ribose that can be supportive. And I've used them in my practice to great benefit, often, you know, together with, you know, thinking of things like heart failure. Of course. But do you have to use them in conjunction with methylene blue or not as much? It works better when it's being used in more of a synergistic, mutual way, as you just described it.

53:43Because not only... So, methylene blue, what it's going to do is increase metabolic rate, because it's going to increase the amount of energy you're making. So, low doses are very supportive. They don't cause a huge amount of stress. But it is much better to have it as a full ecosystem that you're creating in the mitochondria. So, you're creating all the substrate, meaning you have the capacity from vitamins, minerals, nutrients, like all the things that you just mentioned, to support mitochondrial function. and use the methylene blue, it's like a supercharge. Because the things you mentioned do a great job with mitochondrial function, but it takes time for all of those to work.

54:16Whereas you give some methylene blue in the system, within about three days, once you find the right dose, you will feel a difference. It's not something that happens 30 days or a month later, which can happen with many of the things that you mentioned, which I love and I use in my clinical practice too. And they're so supportive and necessary. But what methylene blue can do is in that short term, give you the boost that you need. and so that you start feeling the difference much sooner.

54:38Dr. Mark Hyman:So this is the most important tool for getting out of this sympathetic spiral of doom? I found it's the fastest tool to be able to do it from a mitochondrial perspective, right? Because you want to be able to support the mitochondria to help it relax. And a good example of this - And it's okay to take it every day? In the beginning, yeah. As long as you're keeping the dose low, my sense of this is that - What does a dose low mean? Right, so usually - Is it a milligram amount? So typically milligram dose that I find that's really great for the mitochondria is somewhere between eight to about 25 milligrams a day.

55:05If you're keeping the dose less than 30 milligrams per day, you don't even have to take a day off and you can take it every day. If you're taking above 70 or 80 or 100 milligrams of methylene blue, then you do need to take more days off. So the thing about it, methylene blue kind of has this sort of bimodal capacity. What I mean by that is like low doses of it around what I just described as a range, fantastic mitochondrial function. Sometimes a little bit higher than that, but when you get to about a milligram per kilogram, which is around 50 to 70 milligrams of methylene blue and above, what happens then is it becomes more of an anti-infective, actually.

55:35It's a fantastic antimicrobial at higher doses. And it does that because it produces something in the body called hydrogen peroxide. And hydrogen peroxide, you know, you can buy at this door. It's actually what your white blood cells produce to kill infections. Exactly. And so what methylene blue does is it creates more of a hydrogen peroxide capacity and you kill bugs easier. And you also enhance your antioxidant systems if you have the capacity. And that's the key. And that's why if you have an acute infection, I use it all the time at high doses. But if you have a chronic infection, chronic Lyme, chronic mold, I use it at the higher doses, but I ramp them up.

56:07I don't start up. Yes, because if you give somebody a high dose of methylene blue right off the gate and they have chronic Lyme, they're not going to feel good if you give them 50 or 100 milligrams right away. So slowly increasing their dose, mitochondrial support, and then higher doses can be fantastically effective for chronic Lyme, for chronic mold, for even people with spike protein. I've seen interesting things as well. And also, you know, it's just as a result of that, even viral infections as well, I've seen some really interesting things. But the majority of people are going to be using lower doses for mitochondrial function.

56:38That being said, some people have these chronic infections that are causing significant, you know, infection, significant mitochondrial dysfunction. But I was going to say, I was going to tell a patient, a story about a friend of mine, he's a colleague, he's like, doc, I've had anxiety for, you know, my whole life. I started taking methylene blue and it's gone. You ask, well, why is that the case? Is that because we changed his neurochemical stuff? No, it's because we gave him significant mitochondrial support immediately. And then he's like, I've never felt this good. And as a result of having enough mitochondrial support, his system started being able to unclench itself.

57:12And because now you're making enough energy, and now the system can start healing. And I found methylene blue at these low doses to be fantastically effective, Mark. And I haven't, and initially I was very skeptical, you know, because I was like, this is a compound that doesn't come from the ground. And my dad's a chiropractor for 45 years. Like in the beginning, he was militantly against Western medicine. But over the years, he now knows that it's important to use too. But so I was blown away the first couple of years when we started using it. People, I had this, we had this one lady with mild cognitive impairment.

57:43She started telling stories about her childhood that nobody in her family had ever heard of before. Her brain came back online. I had another lady that had chronic mold, done all the remediation in her house, in her body, still felt terrible, started giving her some methylene blue. She was back to work in two weeks. It was crazy. And then I had another lady with chronic ankylosing spondylitis, like severe pain disorder in the back, inflammatory issues, nothing had ever worked. She started taking methylene blue and her pain just went away. And I was like, this is back in 2020. So, you know, we were the first people to really pioneer this back then in 2020 at the company, at our company.

58:19And so we've seen gigantic amounts of anecdotal data. And then there's researchers that have been doing this and showing that these models of Alzheimer's, models of Parkinson's, you know, others looking at it in traumatic brain injury, looking at it in stroke. And so it's just, it's a fantastic compound that, you know, has gotten more popular over the last couple of years, which is great. But understanding what you're doing, like dosing wise and making sure you're getting good quality stuff is absolutely essential. Like the stuff on Amazon is garbage. Mostly most liquids out there are not as potent.

58:47Even if it says it on the label, it's, you know, it's a huge deal. And so I'm a very much a proponent of using it, but using the right company stuff, the right products and the right dosing is absolutely essential.

58:57Dr. Mark Hyman:And just to be transparent, you have created a company called Dose Criptions. which I use, but, but it, it, you provide a methylene blue and, and you have different forms of it, but you run through all third-party testing and make sure it's the right dose and that there's no contaminants. And so is, is there, is there like a, is there a method that you've kind of developed that you're able to do that? So at Tris Christians, which is our company, um, we decided to make this company, by the way, Mark, we did, we actually evolved it out of a nonprofit organization. So we have a nonprofit called Health Optimization Medicine and Practice.

59:32You've met Dr. Ted in the past, who's our founder, Dr. Ted Ococoso. And the idea with a nonprofit was to create an ecosystem for practitioners for training and for learning how to optimize health rather than focus on disease and very much aligned with functional medicine. And out of that, we birthed the Trescription company because we wanted to help people right now along that path. And Trescriptions was the first company to come out with a commercial product of methylene blue using it in 2020. I thought Ted was crazy at the time. I'm like, what are people going to, they're going to want their urine to be blue because your urine will turn blue.

1:00:02Well, by the way, yeah, you make sure your urine green or blue.

1:00:05Dr. Mark Hyman:Exactly. It concentrates in the urine. So you got to, you got to watch out for that. And you have to, so you don't surprise. You can stain your clothes if you get them. Yes. You got to be very careful. And so we came out with the first commercial product in 2020. And I was a little bit hesitant to be honest, because I was like, I saw the research. It was very compelling. But then the other issue that I was very hesitant about is that it took us about a year and a half longer to launch the company to find a good source of methylene blue. Even when it said pharmaceutical grade, USP grade, it was contaminated with heavy metals, or it was not as potent as it said on the label.

1:00:36The challenge is, and you know this, you get a compound from another country. We get ours from Japan and Korea, even China. I mean, it doesn't matter where you're getting it from. You're going to get what's called a certificate of analysis with your product, with the ingredient itself. That certificate analysis is technically supposed to be a third party assessment of that particular ingredient. But can you trust that that's coming from another country? No, right. Is China policing itself? Right. I'm not even throwing China under the bus. Any other country, right? And so what we do, which most companies don't do, unfortunately, you know this in the supplement world, even across the board, is that we test it again once it comes into the United States with another independent lab to make sure that it's safe, to make sure that it meets our specifications.

1:01:17And only then do we put in our products. And then we test it again, final product to make sure it's the exact amount of milligram dosage. And we've tested a lot of things on the market. But in the end, I didn't get into this to sell methylene blue. I get into this because I saw this pattern. I didn't know, I didn't name it until recently.

1:01:34Dr. Mark Hyman:And you can use it in conjunction with your other areas of expertise, like hyperbaric oxygen, red light therapy, which can also help modify mitochondrial function, right? 100%. Yeah. This is not just a zero sum game. It's not like one thing. What I find with methylene blue is just a fantastic supercharger accelerator bridge for our patients that are just stuck. And then all of a sudden we unstick them. They can become unstuck, I guess. And then we can actually let them finally heal, finally maximize their potential because you can't heal when your mitochondria is stuck and you can't heal. I agree.

1:02:05Dr. Mark Hyman:It's one of the sticky issues in functional medicine is how do you unburden someone's mitochondria? How do you get them out of this cell danger response in this, what you call the sympathetic spiral of doom. So, so let's kind of talk a little bit about what you call the parasympathetic edge. What is that? Why is it important? And it's, you know, people talk about, you know, pushing hard and just going through and, you know, going through the barriers that you feel and kind of overcoming resistance, but you're saying maybe that's not the best way. So what is the parasympathetic edge? So this is the opposite of the sympathetic spiral.

1:02:38This is the parasympathetic edge. But the deal, I have a friend of mine, he's the only Olympic skier and former wide receiver on the Philadelphia Eagles. His name's Jeremy. And he told me when he first started doing his competitions, he would listen to like Metallica and like hard metal. But by the time he was Olympic level, he was listening to Mozart and Beethoven. Why? He didn't need his nervous system to be functioning at a sympathetic level. He needed to drop down. just a little bit to find that edge so that he was right in there. And you talk about people that are high performers, they are not in sympathetic overload.

1:03:15They are just below that in a place where they can maintain their capacity. Navy SEALs are famous for this, right? They can find ways when they're actually in operations, they're not sympathetically dominant. They've done training so much. Like Michael Phelps is a great example of this too, right? You have trained so much for every eventuality. that nothing is going to make your nervous system go too high. Because if it goes too high, we can't function that high. We don't do well. And this is where the classic example is like, you have that dream where you're supposed to give a speech and you can't remember your lines.

1:03:48Because when your sympathetic nervous system is so high on such high alert, you actually lose blood flow to the front of your brain, which is where you have what's called your executive function, your capacity to maintain things, bring things from your long-term memory. You go blank. you go blank. That's sympathetic activation. And so we want to have people learn is that when we down-regulate the nervous system, you're going to function better than you're even thinking that you're functioning at a higher capacity when you're at sympathetic dominance. Because when you teach people that you can bring people down and have them function at a better level, it is like night and day.

1:04:22I mean, the main good example of this, another one, just to give another example, is recovery. Like we're now in 2026, people care about recovery, right? We were kind of like, oh, but you know, five or 10 years ago, if you were an athlete in the professional sports, nobody gave a crap about recovery, right? And people were burning out, they were getting injured and things like that. But now if you focus on knowing you can strength train three times a week at most, and it's better than strength training five times a week. Why? It's the same deal. Because are you going to exercise optimally? That is sympathetic.

1:04:55But as soon as you finish exercise, you need to drop yourself down into parasympathetic to actually gain muscle and actually build. Because you build most of your muscle when you're out of the gym.

1:05:04Dr. Mark Hyman:Right. Because cortisol actually causes you to lose muscle, right? Yes. It's catabolic. But the GABA system, and that's the system that is involved in calming down the brain. GABA is your primary inhibitory neurotransmitter. That is your neurotransmitter that puts the brakes on your firing, calms down your nervous system, and it's enhanced when you have increased insulin, for example. So when, after you eat, your GABA levels go up, for example. But GABA is deficient in so many people because of the lives that we live with stress all over the place. So GABA deficiency is actually more associated with depression, anxiety, insomnia, than any serotonergic issues that you could ever imagine.

1:05:46Dr. Mark Hyman:But you say that you're taking GABA because you can buy GABA supplements over the counter. Right. So GABA as a supplement is not a good idea. Yeah. Yeah. But you're saying there's another compound that comes from the toxic mushroom, the aminium muscaria mushroom, which is agarin. Yeah. Agrin, yeah. Agrin, yeah. Agrin, yeah. And so what it comes down to, to break it down just briefly, so GABA, again, your breaks of your brain, right? Most of us are running around GABA deficient because of the sympathetic activation, the spiral that we've been talking about. The challenge is that if you go to your regular doctor and you say, I have anxiety, I have stress, I have depression, they're probably going to give you an SSRI.

1:06:24Maybe they'll give you a benzo, which they don't want to give you, but they might give you a short amount of it. Now, when it comes to benzos and alcohol - Benzo like Valium or - Like Valium, Ativan, Xanax, right. Right. So those medications and alcohol, they all bind to the GABA receptor, but they vastly deplete GABA in the process, giving you more GABA issues over time and more anxiety, more stress, and then you have more tolerance to those drugs and you take more of them, et cetera. And so GABA supplements sounds like a good idea, right? But the problem with the GABA supplement is that GABA is too big of a molecule to get into the brain.

1:06:54If you take GABA and it works for you, you have a leaky brain, meaning that your blood brain barrier is not doing what it's supposed to keeping things out. And so, well, what do you really have there? Oftentimes you have a leaky gut as you know. So if you optimize the gut, I've had patients like this where GABA works for them beautifully. They feel nice and calm and relaxed. We optimize their gut, seal it up, GABA supplements stop working. And when I first started talking about this a number of years ago, I had a number of clinicians that came up to me and said, GABA supplements, if they work for my patients, it's diagnostic they have a leaky brain.

1:07:28And I was like, this is interesting. And I started learning more about it and seeing it in my own clinical practice. When you optimize the gut, which you and I do in practice all the time, the brain gets better. So GABA supplements don't work. If they do work, go see a practitioner.

1:07:42Dr. Mark Hyman:But there's something else you can take, which is from the mushroom. Yeah. But the mushroom has, so the amanita mushroom has a very cool compound called agarin or agarin. And it's a long acting molecule that works in the GABA receptor binding to where GABA would bind. The cool thing about the GABA receptor is that there's a, there's, it's five subunit receptor, not getting too technical, but you have a place where GABA binds itself. And then you have separate sites called separate sites or allosteric sites where other things can bind. Where agrin binds is directly where GABA would bind. So when you take it, you're not depleting GABA in the process.

1:08:13The thing is, if you're binding something on a separate site to the GABA receptor, say it's CAVA, for example, or CBD or CBG or magnolia bark or valerian, these are all binding to separate sites, increasing the amount of GABA to bind. But if you don't have enough GABA around, what's going to happen is over time, those aren't going to work very well for you. they're going to stop working.

1:08:34Dr. Mark Hyman:So Scott, so this is really fascinating stuff. And I think that, you know, getting a parasympathetic edge is key. Getting the sympathetic spiral of doom is key. How do you kind of support people to kind of maintain, they've sort of broken the cycle a little bit. And we're going to refer you to resources. I know you've written a lot about this and I want to ask you sort of where people can find out more information, but how do you maintain a more stable state rather than keep falling into the sympathetic spiral of doom? Yeah, I think the first place is to know what it feels like to not be in that state, right?

1:09:06Because when you know that the system is now calmed down, you're going to feel better. You may not feel 100 % better right away because you still need a lot of long-term support. You need support with your vitamins, your minerals, your nutrients, your diet. These things can take time, as you know, and be difficult, and then you fall off the wagon and come back up and things like that. But I think what it comes down to for me is that you need to have short-term ways to intervene, right? Short-term way for me is methylene blue is just a great capacity enhancer in the mitochondria. Optimizing the GABA system can be great.

1:09:38And Trescriptions does have some products there. We have something called Trocom and Trozi that can be helpful. You don't have to go product. You can also learn how to meditate and do breath work and start taking more walks in nature, get better sunlight. These are all going to be helpful too. It doesn't matter where people are on their level of capacity to start doing something. Sometimes it's helpful, I've found, is to give them something, like something that downregulates the nervous system, something that's GABA-urgic, that works on the GABA system, to give them the experience of what it feels like to not be in that sympathetic state.

1:10:11And doing it in a very supportive way. So they're mitochondria-supported, typically, is what I try to do first, as I mentioned. And then I'll give them the experience. You can still get some reactive anxiety. when that happens, because you're used to being at a certain level. So that's short term. So short term, giving people the experience of where there is. We talk about in meditation, there's no there there, but in parasympathetic edge, there absolutely is a there there. So knowing what that feels like, and then you can try to modulate that in various things that you're doing in your day-to-day life.

1:10:40Powerful. But that's the thing, like your day-to-day life becomes your meditation, becomes your life, right? You have to find ways during your day to break down, not break down, but calm down the system, right? Taking more breaks, getting outside in the sunlight. And then that's more medium term. Long term is like, okay, why are you so sympathetically activated? We talked about this. Is it external stuff? Is it top down? Do you need to get out of a bad marriage? Do you need to sleep in a different room to just get a sleep divorce from your partner? I think about 50 % of US couples sleep in different beds, different rooms.

1:11:13This is not, it's not a small thing. They have a more PC word of it, like sleep union or something like that now instead of sleep divorce, it'd make it doesn't sound as bad. But if you need to sleep in a different room so you get better sleep, you should, but that can be hard, right? So trauma, you mentioned this as well. And this is where things become harder, right? This is where your experiences with psychedelics specifically are very interesting, right? Because like looking at psychedelics like ketamine and MDMA and it's legal. And Ibogaine, like you did, right? These are huge. And I know you've spoken openly about this, which I really commend you on, because I'm very often sending my patients to go get ketamine with our friend Dave Rabin and others that are out there that are really good at creating a huge neuroplastic response to these medicines.

1:12:02And that's where the real healing is going to occur long term. We can give the people the experience of downregulating their nervous system now. We can give them modes of operation at a day-to-day basis. But if there's elephants that are hanging around in the room, those are still there, you know? And we have to address those. And from the mitochondrial side, it's the same thing. We have to address the mercury toxicity. We have to address the toxic exposures or the - Practice functional medicine, basically. Exactly, yeah. Yes, exactly. Like that's - Work the system, yeah. You have to be, the system is, And your system is fantastic for that, right?

1:12:37That's what you do. And that's what's beautiful.

1:12:39Dr. Mark Hyman:But that takes longer. Yeah. Takes longer. So can people stay on methylene blue long-term or is it like a maintenance thing? What I have people typically do is that find your right dose. My main way of doing that is start off at a low dose, somewhere about four or eight milligrams, which is a quarter or half one of our trochies. And then increase your dose every three to five days. See how you feel at one dose. Take it in the morning. So one whole trochee is 16. Yeah, one whole trochee is 16. Then one quarter is four milligrams. So take four milligrams in the morning. See how you feel. Take it on an empty stomach.

1:13:13You don't have to dissolve in the mouth, okay? You can if you like, but your mouth is going to be blue. That's okay too. It works faster up here, but the same amount of methylene blue is going to get in the body. See how you feel for about three days. Take it in the morning. Don't feel much? Go to eight milligrams. See how you feel. Take it on an empty stomach in the morning. If you don't feel much, go to 12. Then go to 16. But somewhere between 8 and 16 for most people is when they're going to start feeling, wow, I do have more energy. Wow, my brain's functioning a little bit better. I don't have as much brain fog.

1:13:40I'm not getting that energy dip in the middle of the day. My inflammation is better. Even my pain might be better. My mood seems to be more regulated. You will know. And that's what I find is that. And then when you start increasing the dose more from there, you don't typically see as much return on your investment. Usually there's like a sweet spot for people. And once you find that right dose, how long or how often should you take it? It depends on what you're taking it for. If you're taking it as a bridge, you're kind of early on in your process, you might need to take it every day. And I have patients that are on it every day for a while.

1:14:09But over time, the goal is always to come on it less or use it less, only using it when you need it. So for example, when you get more optimized, you're still going to have mitochondrial stress, you know? And the question is when do you use it? So a good example is when you're traveling on an airplane. On an airplane, you're going from about 21 % oxygen in the air that you're breathing at sea level to about 18 % relatively on a plane. That's a huge hypoxic stress, low oxygen stress on an airplane because you're pressurized to about 8 ,000 feet above sea level. The best jet lag hack that I've ever found, Mark, is to move to Colorado because I live at 5 ,500 feet.

1:14:44And so when I go on an airplane, it's 8 ,000 feet pressurization. Then I come to Austin to visit you. I'm at sea level. I feel great because I've been at altitude for a while. And I was just at 8 ,500 feet in Montana. And I felt it. You need methylene blue for that, man. And because then actually what I have is anybody that's coming to visit me, I always give them methylene blue before they get on the plane. And then I was actually with our nonprofit, Dr. Ted and Boomer, who's our CEO of Transcriptions and Home Hope. We were in Tibet and we were at Mount Everest Base Camp at 17 ,800 feet. 17 ,000.

1:15:18It was very, very high. We didn't have, we had intermittent oxygen. We had oxygen canisters, but we're using methylene blue. It was game changing up there. That wasn't the only thing we used. We used Diamox and we used.

1:15:27Dr. Mark Hyman:I got, I got, I got a pretty significant altitude sickness. when I was in Bolivia, we drove right up to 16 ,000 feet. There was no acclimatization. That's, yeah. And there was a hotel there and my oxygen saturations were down in the 70s. I'm sure, yeah. And Ted's were low too and we had them on oxygen. Yeah. But we were using Diamox, which is a drug for altitude. We're using Viagra as well. Yeah, right. Because it helps with nitric oxide and blood flow. And then we're using methylene blue. So as you get more optimized, Mark, you don't need it as much. Yeah. And you don't need it as often. And that's, but I have everybody, all of my patients have a higher strength methylene blue in their medicine cabinet just in case.

1:15:59Which is? Which is 50 milligrams in strength. So we have something called Troplus Blue, which is available to practitioners. So if you're a practitioner listening, we have a practitioner. And why would you use a 50? So the 50s are great for acute infection, acute stress overall. And so I use it for acute infection, acute stress. So if somebody has like a concussion or has a acute injury, I give them higher doses.

1:16:21Dr. Mark Hyman:For a short period of time. Yeah, for a short period of time. And sometimes I combine it with antibiotics. So my mom, for example, was bitten by a Lyme tick in New York. She's around 70. And so, sorry, mom, I gave away your age. But I gave her, I gave her methylene blue, about two milligrams per kilogram, about 150 milligrams for five days. And she also took Doxy at the same time. We wanted to give her Doxy because she's in New York. Lyme ticks are everywhere, right? But we checked her Lyme titers four weeks later, they were negative, right? And so it's not like it's the only thing sometimes, but it's also being used as monotherapy for urinary tract infections as well at these higher doses.

1:16:57So I give higher doses. That's amazing. Intermittently, but it's the lower doses that I use and maintain. So for me, I'll use it about three times a week, four milligrams every day, four milligrams at a time, sometimes twice daily. You can dose it in the morning. Sometimes I'll dose it again early in the afternoon as well because it doesn't typically keep you up. It's not like caffeine or a stimulant. It should just give you more energy. I feel like you can just kind of go. You know, that's the idea. And then when you find that right dose, often you'll know it. If you're pretty well optimized, you can also use it for endurance.

1:17:26I have guys that use it because it increases aerobic capacity.

1:17:29Dr. Mark Hyman:Oh, good. Okay. So I have cyclists that use it. I have a bike trip this summer. Yeah, exactly. And I have ultra marathons that use it. I know you've used it as well and had some experience as well. This has been such a great conversation. Where can people learn more about your work, about the sympathetic spiral of doom, or self-danger, all that stuff? A couple different places. And thank you for having me, Mark. Um, so my personal website is my name. It's my name, Dr. Scott Scherr, D-R-S-C-O-T-T-S-H-E-R-R.com. Um, the company that makes some of the products we've been talking about today is called Troscriptions.

1:18:01It's the word troche and prescriptions mashed up into Troscriptions. We are pharmaceutical grade. We're physicians that run the company and we have precision dosing with all of our products. I really care about all of that. So does Dr. Ted. and you can check it out at troscriptions.com. We have Just Blue, which is our pure methylene blue. We have something called blue canatine, which is a combination with methylene blue, nicotine, caffeine, and CBD, which is fantastic for focus. It's more for stimulation, but great as a stimulant. Then we have Trocom and TroZ, which are more on that GABA side, turning that brain off, that GABAergic side.

1:18:34So Trocom and TroZ, and then we have a whole practitioner.

1:18:37Dr. Mark Hyman:And the TroZ is for sleep. TroZ is about the most comprehensive sleep formula that I've seen on the planet. It's got eight different ingredients, including the GABA system. So Trozy is fantastic. And we also have a practitioner ecosystem. So if you're a practitioner, you can sign up for our practitioner account. You can either buy for your office or we have direct shipping. We have a huge portal and ecosystem that I've developed over the years with my team. So that's at troscriptions.com. And then the nonprofit is called Health Optimization Medicine and Practice, or Home Hope for short. It's homehope.org.

1:19:05And there you can find, if you're interested in training, we have CME certified courses. We have a whole ecosystem there that's very much aligned with functional medicine. as well. And then where else? I think, you know, on our website, on Transcriptions website, there's a lot of information on the sympathetic spiral of doom. I've been talking a lot more about this, and I will continue to be doing it as well. And again, this is not a diagnosis. It's a pattern that you and I have seen in clinical practice for years, Mark. But the key, I think, is the sequence here is mitochondrial support first, then sympathetic downregulation.

1:19:36And in that order is the key. And then we break the spiral. We escape from it long-term using the work that you do and that I do in clinical practice.

1:19:44Dr. Mark Hyman:Well, thank you. Thanks for doing it, Scott. Thanks for always helping me when I reach out to you on the hyperprojection stuff. Oh, yeah. And then finally, I have one other company called One Base Health, and that's a company that's involved in the hyperbaric space. I know you have a chamber now and had some good experiences too. Yeah, well, thanks, Scott. Thanks for what you do and just bringing the science to everybody and being dedicated to helping people live a healthier, better life. Right back at you, Mark. Thanks for having me. If you love this podcast, please share it with someone else you think would also enjoy it.

1:20:10Dr. Mark Hyman: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.

1:20:40Dr. 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.

1:21:10Dr. 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.