Erectile Dysfunction: The Warning Signs You Shouldn’t Ignore

Erectile dysfunction is more than just a bedroom issue—it’s often an early indicator of more serious health problems. In this episode of “The Doctor’s Farmacy,” I look back on conversations with Dr. George Papanicolaou and Dr. George Shapiro to explore the surprising connections between sexual health and overall wellness and why ED is often an early indicator of metabolic issues, insulin resistance, and heart health. I’ll cover conventional treatments, as well as emerging therapies, and share how lifestyle changes in diet, exercise, and sleep can boost testosterone and improve sexual performance. View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Full-length episodes of these interviews can be found here: The Science of Erectile Dysfunction and Unexpected Ways to Treat It How To Treat Erectile Dysfunction Without The Little Blue Pill The State of Science for Sex, Aging, and Regenerative Medicine This episode is brought to you by Pique, LMNT, and Eight Sleep. Head over to PiqueLife.com/Hyman20 and get up to 20% off + a complimentary beaker and rechargeable frother. LMNT is giving listeners a FREE eight-count sample pack of their vital electrolyte drink mix with any purchase. Just visit DrinkLMNT.com/Hyman today. Save three-hundred dollars off the POD 4 Ultra and two-hundred dollars off the Pod 4. Head to EightSleep.com/Mark.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Mark Hyman?

  Coming up on this episode of The Doctor's Farmacy.

• 0:02Speaker 01

  People's sex lives are not over at age, you know, 50, 60, or 70. There are men that come to me wanting to have prescriptions for Viagra at age 70. And I always tell them, I'm not giving it to you unless I get a, I get a written note from your wife.

• 0:19Dr. Mark Hyman?

  That's not going to go well.

• 0:23Dr. Mark Hyman?

  Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for a summary of my favorite and tested products.

• 0:59Dr. Mark Hyman?

  Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Farmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just jump right in. An estimated 30 million American men are affected by ED. Now, people don't like to talk about this, and it's uncomfortable to talk about sex. It's kind of a taboo, but you have to talk about it because it's a significant issue that impacts so many aspects of people's life. Now, your physical health and sexual health are, are totally connected.

• 1:42Dr. Mark Hyman?

  Obesity, for example, is independently linked to erectile dysfunction. People have what we call a dad bod, you know, it's becoming normalized among young men, where you kind of, kind of become a little pudgy around the middle. It's not normal. People with a high body mass index or who are overweight tend to have lower testosterone. I'm going to explain why that is and how you can reverse that. Also, your emotional health and well-being are tied to your sexual function. People are stressed, you know, have more trouble with sex. Quality of relationships and intimacy also plays a big role. And it's so common, we're going to talk about how common this problem is. In the Massachusetts male aging study, ED was the most common sexual health problem.

• 2:24Dr. Mark Hyman?

  In 1995, it affected about 150 million men worldwide. And that's projected to reach 300 million next year. The prevalence, in other words, the number of people in the population, men particularly, obviously, who have this, is about 52% of men between ages of 40 to 70. That's a lot of guys. And what does it mean? Well, erectile dysfunction or ED means the inability to have or maintain an erection. Now, as you get older, it's more common. 40% of men are affected at age 40. 70% of men are affected at age 70. A recent study published in the Journal of Sexual Medicine found that one out of every

• 3:07Dr. Mark Hyman?

  four men under the age of 40 is affected by ED. Now, that's shocking. You're talking about guys under 40, and that's about 25% of men under 40. There's also a strong relationship between testosterone, and particularly testosterone deficiency, and erectile dysfunction. And what's shocking, and I see this in my practice, and it kind of blows me away, honestly. Young guys have very low testosterone. I mean, what you see sometimes, I see in a 90-year-old, I see in a 20 or 30-year-old. And about 30% of men aged 40 to 79, according to the American Journal of Medicine article, experience low testosterone. Now, researchers show an increased prevalence that's associated with aging, that's common.

• 3:52Dr. Mark Hyman?

  But it's also associated with other diseases that are causing erectile dysfunction. It's not just the penis that's the problem, it's the rest of your biology and your body that's not operating properly. So obesity, diabetes, high blood pressure are all clues that some things are rye with your hormones, your metabolic health, and likely soon with your sexual health. In fact, there's a phenomenon that's called andropause, or male menopause, which is sort of a gradual decline in testosterone after the age of 30, about 1 to 1.5%. Drop in testosterone a year. Now that doesn't mean it's a norm or it has to be. I mean, I have a guy who's like 62 who's got a testosterone of like 900, which is what you see in a, you know,

• 4:34Dr. Mark Hyman?

  healthy young 20 year old or 18 year old rearing to go all the time. And I promise you, he's rearing to go all the time. It doesn't mean it's normal, right? It means it's common. It doesn't mean it's normal. Normal is just means the average in a population. So it's quote, "normal," but it's not optimal. And so you have to understand how you want to get to optimal ranges by addressing the root causes of the problem. And, and there are a lot of ways you can naturally increase testosterone. Now, there's a strong relationship between low testosterone and erectile dysfunction. And, and the reason is that, you know, low testosterone is a clue for other problems. It's a clue that you have poor metabolic health. And it's so common. And

• 5:17Dr. Mark Hyman?

  I've talked about this so many times on podcasts, but 93% of Americans have poor metabolic health. And that is what leads to erectile dysfunction. I'm explaining exactly how we're getting into the science. And by the way, all the references, everything I'm saying is in the show notes. You can go dive deep them. You can click through, read the articles yourself. But it's a, it's a sort of scary picture in America now with increasing obesity, diabetes, and, and poor metabolic health. But this leads to what we call endothelial dysfunction. Now, what the heck is that? Your endothelium is a lining of your blood vessels. And the health of your blood vessels determines your sexual health and your cardiovascular health and your cognitive health and pretty much

• 5:59Dr. Mark Hyman?

  everything. In fact, that's one of the problems with COVID and with long COVID, which we've talked about, is this massive damage to the lining of our blood vessels. And that is what happens with COVID that drives so many of the pathologies. Now, men who have low testosterone are 38% more likely to die of a cardiovascular attack. That's like a heart attack or stroke. Now, the question is, why? Why do we see low testosterone? Well, it has to do with what we call insulin resistance. Now, I've talked about this for almost, God, scary now, say, 30 years. It is something I've paid a lot of attention to. I've written many books on this. Insulin resistance is the scourge of the modern world. Like TB was everywhere before, and it wasn't even as prevalent as insulin resistance.

• 6:42Dr. Mark Hyman?

  We're talking about 93% of Americans having some poor metabolic function, and that's some degree of insulin resistance, somewhere in the spectrum from optimal metabolic health, blood sugar regulation, insulin sensitivity, to a slow decline in insulin sensitivity, more insulin resistance, prediabetes, type 2 diabetes. It's all a spectrum. And this leads to low libido or low sexual desire, low desire for sex, for masturbation. It's influenced by low testosterone. And basically, I'll give you the punchline here. But as your belly grows bigger, your testosterone gets lower. Big belly, low testosterone. Why do you have a big belly? Because you deposit fat, or VAT, visceral adipose tissue.

• 7:27Dr. Mark Hyman?

  And this visceral adipose tissue is a, excuse me, my French here, a [bleep] storm of hormonal and inflammatory chaos. Essentially, it causes an increase in what we call adipocytic kinds. And we'll talk about why inflammation plays a big role in messing up hormones, particularly testosterone. And it also causes an increase in estrogen for men, lower testosterone. And that leads to sexual dysfunction. So it's a big issue. And so this low sexual desire, low sexual function is influenced by this low testosterone, but can be influenced by other things like stress, anxiety, and many other chronic diseases. Now, 2019 study of more than 12,000 45-year-old men

• 8:10Dr. Mark Hyman?

  found that about 1 in 20 reported low sexual desire, which is a lot. When you think about 45-year-old guys, they should be still wearing a go. Now, some desire for sex drops naturally with age, but it doesn't go away, even in your 60s, 70s, or 80s. I mean, Mick Jagger had a kid at 75. Picasso had a kid, this was in the pre-Viagra era, at 80 years old. So it's not impossible to keep going for a long time. Now, what's the problem with our conventional approach to dealing with erectile dysfunction? It's not just as simple as giving people Viagra or Cialis. It's really about taking a deep dive into the why, what's the cause? Now, often your hormones are not tested. It's amazing how many people go to the doctor and never get their hormones tested.

• 8:54Dr. Mark Hyman?

  Don't get testosterone, free testosterone, estrogen, FSH, LH, all the important biomarkers that are critical to understand what's going on with your hormonal health. Also, doctors don't test for insulin resistance. I was recently on a conference call with some of the top scientists and doctors at Quest Laboratories Diagnostics, which is, you know, one of the biggest testing laboratories in the country, probably the biggest. And I said, how many, how many doctors are testing for insulin, fasting insulin? And they're like, well, it's pretty low, maybe 1% of our lab tests are for fasting insulin that are ordered by doctors. Now, this should be a standard test that everybody gets as part of their annual checkup. It is the most important test to determine your longevity, your risk of heart attacks,

• 9:39Dr. Mark Hyman?

  cancer, stroke, dementia. It's so critical. The other test that they almost never look at is what we call lipoprotein fractionation. I've talked about this on other podcasts, we'll link to those in terms of how to look at your lipids. But the cholesterol test that doctors do now is really so outdated. It's like, you know, looking at things, you know, with a, with a, you know, like, I mean, listen to your heart with a stethoscope instead of looking at it with an echocardiogram or an MRI. You know, it's just, it's kind of old fashioned and it doesn't, it gives you some indication of what's happening, but it's really not the gold standard. And I asked, again, I asked these experts in cardiovascular diagnostics at Quest, I said, well, what percent of tests out there are for the lipoprotein fractionation, which

• 10:24Dr. Mark Hyman?

  means the quality of the cholesterol, the particle number, the particle size, which gives you a much better indication of your insulin resistance and your risk factors? And I said, what percent of your tests are for this? You know, 21st century cholesterol panel and they're like 1% or less than 1%. And so that means 99% of people are not getting the right cholesterol tests, which prevents them from really understand what's going on with their metabolic health. Now these tests, hormone tests, insulin, lipoprotein fractionation, A1C, many, many other things. We do test at Function Health. Now I'm a co-founder of Function Health. I'm the chief medical officer and I believe that people should have access to their data and it's very empowering to know what's going on.

• 11:05Dr. Mark Hyman?

  We found all sorts of things. We've, we've had over 25,000 members to date at the recording of this podcast. We've had over 3 million biomarkers tested and you can get over 110 biomarkers for less than $500 and you get testing twice a year and you can track what's going on. You can see changes based on your interventions, lifestyle, diet, supplements, and then actually be empowered with the right information and knowledge and education about what to do about these numbers. Anyway, back to the topic at hand.

• 11:34Dr. Mark Hyman?

  The other thing is most doctors don't really deal with lifestyle, you know, weight, diet, exercise, sleep. It's considered soft medicine, but the truth is it is the most important thing in determining your risk factor in your health. And what do they do if you come in complaining of erectile dysfunction? Well, they give you the little blue pill. You know, that was a blockbuster. And that was an accident. That, that pill was actually designed to treat high blood pressure, but it had a side effect that a lot of the people in the study noticed and they liked the side effect. And so the drug company got very smart and they're like, well, this is a lousy blood pressure pill, but it's a great pill for erectile dysfunction. And you know, before that, it was, it was tough for guys, you know, they were vacuum pumps

• 12:17Dr. Mark Hyman?

  or, you know, you can have a penile implant. There was sometimes revascularization. You can do a transurethral kind of thing called MUSE we used to recommend. It's like pretty scary. You put a little pellet in the end of your penis. It's painful. There's injections which you can use that work, but they're painful. But when Viagra hit the scene in 1998, within six months of approval, there were over 5.3 million prescriptions written and then the prescriptions have just tripled in the last decade. So. There are a lot of other drugs, Cialis, Levitra, Tendra. They work for different reasons and different people, different ways, but they're not bad to use. In fact, they can be helpful. They may be protective against Alzheimer's, I read recently. So they increase blood flow, they increase circulation, they increase nitric oxide.

• 13:02Dr. Mark Hyman?

  We're going to talk about all that, and those are not bad things. But more and more people are actually using this, even younger people are getting it for off-label use. They secretly take it, they're embarrassed, they have performance anxiety. Maybe they have erectile dysfunction when they're younger. But let's talk about how these drugs work and what is the physiology of actually having an erection. When you have sexual arousal, it causes the release of nitric oxide, which is a good thing, in those cells that we call the line your blood vessels called the endothelial cells. And they're in your penis. And so basically you get increased blood flow because it helps to activate something called guanulate cyclase, an enzyme. You don't remember it, promise no test on this.

• 13:46Dr. Mark Hyman?

  And that leads to an increase in something called CGMP. Now, that particular thing causes the relaxation of smooth muscle cells, or it causes your muscles to relax, and that leads to the dilation of the blood vessels in your penis. And that increases blood flow, and that leads to an erection. And then it gets trapped inside the penis, in the corpus cavernosum, which then you maintain the erection and have fun. Now, after you ejaculate, there's an enzyme called PDE5 or phosphodiesterase type 5. And that degrades the CGMP, so the thing that keeps your erection going.

• 14:26Dr. Mark Hyman?

  Now, that causes the smooth muscles to contract again, and that reduces blood flow to the penis, and that ends the erection. Now, how Viagra works, sildenafil and Cialis, daphenol, how they work is they inhibit this PDE5. They inhibit five phosphodiesterase, which is this enzyme that degrades CGMP. Now, in that, that prolongs the effect of this particular compound. CGMP keeps the blood vessels constricted in your penis, and it helps maintain the erection. For longer, which is fun and great and it's no problem. But you know, side effects are common about over one in a hundred people.

• 15:06Dr. Mark Hyman?

  You get mild headaches, sizziness, flushing, congestion, sinus, you know, I mean, basically having sex, you're congested, runny nose and have a headache. Well, it's not so much fun always. It can cause back aches, muscle pain. Sometimes it can cause low blood pressure because it was designed for a blood pressure pill. It can rarely cause a painful erection to last a long time, like over four hours. And that's called priapism. And that can damage your penis and it can cause all the heart issues. Rarely, it can cause vision or hearing loss, but that's very rare. Now, if you're taking drugs like nitrate drugs, if you have angina, you have heart disease, if you have liver issues, you don't want to take them. So they're not bad, but let's talk about maybe getting to the root cause, which is exactly what functional medicine is about. It's not about treating the symptoms, it's about the cause.

• 15:51Dr. Mark Hyman?

  So how do we get to the root cause? We have to really understand the full picture. And so we have to look at diagnostics. And I think it's really important to do a proper testing. So you understand what's happening with your biology. And that's really why we've created Function Health. Why I'm the co-founder and chief medical officer. Because all the tests that I'm going to mention right now are all available at functionhealth.com. And you can sign up. You can just get in there and get your test done and right, there's a waitlist, but we can get you off the waitlist if you use the code DRHYMAN. Now, the first thing you want to know is something called sex hormone binding globulin, or SHBG. Now, this is important because it regulates the amount of free hormone, free testosterone. It's a protein made by the liver.

• 16:35Dr. Mark Hyman?

  It binds to testosterone and estrogen and it basically makes them inactive. So it's sort of like a reservoir of extra hormones when you need them. Also, albumin can bind to estrogen and testosterone, but not as well. And that's something that's normally in your blood. Now, when you have insulin resistance, high insulin, the liver suppresses the sex hormone binding globulin, and that leads to potentially more free testosterone, and that can kind of screw up normal hormone balance. And we often see an increase in prostate cancer in the large prostates in guys who have insulin resistance and big bellies, and that's a concern. Inflammation, on the other hand, can also increase sex hormone binding globulin. So why does that matter if there's inflammation, you get higher binding globulin, that means

• 17:19Dr. Mark Hyman?

  you get less free testosterone, and that's what matters. That's what does the job. And so when you have less free testosterone from any source of inflammation, you can end up in trouble. So sometimes guys, even with insulin resistance, tend to have the high sex hormone binding globulin because of the belly fat, which is basically a factory of inflammatory molecules. Now, what does testosterone do? Well, it increases your sex drive or libido. It is involved in the production of red blood cells, which can sometimes be an issue if you're taking testosterone. It is involved in sperm production, mood, so makes you happy, or if you take too much, it can make you angry, motivation. So it's very important for motivation in men and women. And by the way, women have a lot of

• 18:04Dr. Mark Hyman?

  testosterone, too. It's really critical to build lean muscle mass, which we'll talk about, and why that's important for sexual function. It helps energy or cognition, recovery from, you know, exercise or injury, and it improves insulin sensitivity. So it's good. Now, free testosterone is the active kind. It's not bound to the sex hormone binding globulin. It's the active form of testosterone, and it's not less than 2% of the total amount. Now, the optimal range, and these are all going to be in the show notes, you have to memorize them now, but you can check it out in the show notes, the optimal range is over 30 picograms per deciliter. Now, you want to look also at the total and the free. So you want to get both.

• 18:50Dr. Mark Hyman?

  Now, if you look at the total testosterone, the ranges are kind of screwy because you know, how we develop reference ranges in America is based on the average or quote normal in a population. So if you're a Martian, you land in America, it's quote normal to be overweight because 75% are overweight. It doesn't mean it's optimal. So the ranges that we see are not the really optimal levels, but you see ranges of 200 or 300 nanograms per deciliter. But the range should really be over 500 and you have to look at the combination free and total, but it can be up to 1,000 or more. And I think it's important to sort of look at what the symptoms are, what the person's overall health is, and look at the free and

• 19:29Dr. Mark Hyman?

  total, and you get a sense of how much is going on there. Now, even if your total can be normal, you can still have issues of low testosterone because your sex hormone binding globulin is high. In other words, there's not enough free testosterone. So I see that very often in my patients. Also, the other hormone that guys have, which probably may not know, is estrogen or particularly estradiol. Now, men and women have estrogen, and it has a lot of important functions. It does affect the libido, it affects erectile dysfunction, sperm production. It's also important for bone health, for brain function, and also for nitric oxide production. You don't want it too high or too low. And often, guys who

• 20:11Dr. Mark Hyman?

  have big bellies have basically something called aromatase in their fat, which turns testosterone into estrogen. You don't want that. You don't want testosterone turning into estrogen. It's not nice. The other hormone you want to look at is the pituitary hormones and the hypothalamic hormones. Your pituitary hormones are really important. We call LH and FSH. Luteinizing hormone and follicle stimulating hormone. Now, it's kind of a weird thing because follicle stimulating hormone, uh, sounds like it's for women's follicles that produce eggs, but it's also active in men. So in men, um, the way this works is your hypothalamus, which is kind of way in the

• 20:52Dr. Mark Hyman?

  top of your brain, it's kind of the master control center, creates a hormone called gonadotropin releasing hormone. So gonadotropin essentially are, uh, the hormones that make, uh, gonadal hormones. So it's like stimulates the pituitary to produce the gonadal, uh, gonadotropic hormones, which are hormones that stimulate the testicles or the ovaries, and that, uh, which may be the case of women, to produce more hormones. So LH, our luteinizing hormone, which again, it's kind of a weird name because it basically lute- luteal phase of the menstrual cycle, it's, it's named after women's hormones, but it's really affects men too. So, uh, LH, uh, affects a cells in the, in the testicles called the Leydig cells.

• 21:34Dr. Mark Hyman?

  Now these cells produce testosterone, so higher LH will increase testosterone. FSH affects different cells in, in, in the, um, testicles called the Sertoli cells, and they lead to sperm production. So LH testosterone, FSH sperm, really important. And as important as that's fertility, what's going on with somebody, it's really important. You may not know what's going on and you might have low testosterone, but you could have a pituitary tumor for some reason. So you gotta check all these things. Also, we look at prolactin, uh, another hormone we check with function health, again, not usually checked. Prolactin is another pituitary hormone that is involved in many things, uh, including lactation, that's why I call it proli- prolactin.

• 22:16Dr. Mark Hyman?

  Uh, but it, it can be high in certain, uh, benign tumors that grow in the pituitary, which are not that uncommon, and the treatment usually is surgery, sometimes there's drugs that can treat it. We also need to look at inflammation and we look at something called HSCRp or high sensitivity C reactive protein. Inflammation is such an important factor in our overall health and aging and longevity. High inflammation is a root cause of sexual dysfunction, whatever is causing it. Now, many things can cause it, including our diet. That's the number one cause really, sugar, starch, processed foods, all that's driving inflammation, our gut microbiome, environmental chemicals, heavy metals, toxins. You know, there's also endocrine disrupting hormones, which are really concerning to me.

• 22:59Dr. Mark Hyman?

  And I see a change in the population in the birth rates of men and women. We see changes fertility. We're going to talk about that on another podcast. And, and I think a lot of it has to do with, with these forever chemicals that are petrochemicals that are in the environment that don't go away. We used to have dioxin and PCBs and DDT, they're still around. And then we have other plastics and other pesticides and herbicides. These are highly dangerous and, and they're toxic at very small levels. So, oh, you're like, ah, so what? I'm not getting that much this or that. But, but you are, cumulatively, you are of your lifetime. And then they've done fat biopsies of people and they found pretty much every human is a toxic waste tub and we probably wouldn't be safe to eat if we were food. Other hormones are important as well.

• 23:44Dr. Mark Hyman?

  Leptin, again, something we check on function health that mostly doctors don't check, but leptin is the appetite suppressing hormone. But it is sometimes when you have insulin resistance, you also get leptin resistance. So you see high levels of leptin and that leads to low testosterone and suppressed LH. So that's concerning. In one study in the Journal of Clinical Endocrinology, they looked at three groups of men and they found that those with higher leptin levels, mostly due to leptin resistance, had a higher body mass index, so they were heavier and they had lower levels of testosterone. So it's an important thing to check. Adiponectin, another important hormone, it's an anti diabetic hormone, it's an anti inflammatory hormone, it prevents

• 24:26Dr. Mark Hyman?

  Heart disease and it's often low in insulin resistance and inflammation obesity. So you want to check adipenectin again, and we check that as part of our panel with function health. Again, it's not usually checked, but it's important because if it's high, it's good. And if it's low, it's bad. We also check your fasting insulin and hemoglobin A1C because you know, insulin resistance is really, I would say, the majority of the causes of erectile dysfunction as we get older and it leads to, like I said, low testosterone, higher belly fat, more estrogen, abnormal cholesterol, more inflammation, low sex drive. It's just not a good thing. And your insulin, you really want between two and five. Now, most reference ranges are 15, again, because the average American is unhealthy and overweight.

• 25:09Dr. Mark Hyman?

  So the reference range is wrong, basically is what I'm saying. So in function health, we talk about what are the current reference ranges and what are the optimal ranges. Also, you want to look at stress hormones like cortisol and DHA. And you also look at cardiovascular testing and not just a regular cholesterol panel, as I mentioned, but looking at what we call lipoprotein fractionation. And this really looks at cardiovascular risk, insulin resistance, really important. And I think if you don't look at the right cholesterol panel, you're basically just living in the 20th century and not the 21st century in terms of cardiovascular health. Thyroid also really important, and we have to look at thyroid properly, not just the way doctors do it on their traditional panel, a lot of the TSH. You have to look at the TSH, the free T3, free T4, even thyroid antibodies, which we

• 25:53Dr. Mark Hyman?

  all check on function health. And they're really important because thyroid function, if it's low, will cause a low libido, a low sex drive, a low mood. And it may be as simple as taking thyroid and also will influence sex hormone binding a lot more. Now, none of these tests are hard to get or expensive, but unfortunately, your doctor is probably not doing most of them or doing them properly. So that's why, again, I co-founded Function Health and I encourage you to check out your own tests so you can see what's going on and be empowered with your own health data and be the CEO of your own health.

• 26:31Speaker 01

  People's sex lives are not over at age, you know, 50, 60, or 70. There are men that come to me wanting to have prescriptions for Viagra at age 70. And I always tell them, I'm not giving it to you unless I get a written note from your wife.

• 26:47Dr. Mark Hyman?

  That's not gonna go well. Actually, yesterday, I was doing a consult with a patient who was 87 years old.

• 26:54Speaker 01

  Yeah.

• 26:54Dr. Mark Hyman?

  Who's still having sex with his wife.

• 26:57Speaker 01

  I plan on it.

• 26:58Dr. Mark Hyman?

  Yeah, I'm going at least to 100.

• 27:00Speaker 01

  It's only getting better as time goes on, so why stop?

• 27:03Dr. Mark Hyman?

  That's exactly right. So, this is a very common problem. From a traditional medicine point of view, there really wasn't much of an approach to this beforehand. We had some really coarse and crude treatments. Talk about what the traditional approach to erectile dysfunction has been, other than the Viagra, Cialis, and Levitra category of drugs, which now are pretty widely prescribed and do work and help people.

• 27:25Speaker 01

  Yeah. So, you know, prior to Viagra, there were some fairly primitive approaches to it, like vacuum pumps and revascularization, because vascular issues, endothelial dysfunction is a key part of what causes erectile dysfunction.

• 27:45Dr. Mark Hyman?

  So, in English, you're basically saying that you get hardening of the arteries in your penis, which makes it not so hard.

• 27:50Speaker 01

  Right. And so, but that hardening of the arteries not only reduces blood flow, but there's this endothelial dysfunction, and it's in the endothelial cells that nitric oxide has its effect.

• 28:01Dr. Mark Hyman?

  So, what are endothelial cells?

• 28:03Speaker 01

  The endothelial cells are the cells that are lining the blood vessels of the, that are inside the penis.

• 28:09Dr. Mark Hyman?

  So, throughout your entire body, you've got these lining of all your blood vessels, and it's a very active lining. It does all kinds of things, including regulate the dilation and the blood flow and lots of other things, inflammation, and nitric oxide is a key regulator of that.

• 28:26Speaker 01

  Very key.

• 28:26Dr. Mark Hyman?

  And that's, and that's what goes wrong. And one of the reasons why that men tend to get this decreased blood flow in the penis that leads to these erectile dysfunction.

• 28:36Speaker 01

  There's, there's multiple reasons, but before we go on to that, I think probably is a good idea, just, and let me just review quickly, because we're going to talk about nitrous oxide. We're going to talk about why Viagra works and other drugs like it. Essentially, what happens is that you have the release of nitrous oxide.

• 28:53Dr. Mark Hyman?

  Nitric oxide.

• 28:54Speaker 01

  Nitrous oxide.

• 28:55Dr. Mark Hyman?

  Nitrous oxide is laughing gas.

• 28:57Speaker 01

  I'm just going to call it NO, okay, NO. So you, you release the NO, and then NO has its act, its action on the endothelial cells inside the blood vessels of the penis. It also acts on the corpus cavernosa muscles. And so you get this simultaneous relaxation of those muscles so blood can flow in. Those are the big muscles of the penis so that when they're full of blood, they main, they, they, they actually start the erection and maintain the erection. And then you have the small blood vessels, nitrous oxide acts on those at the same time and causes those to constrict. So the blood that flows into the cavernous muscles then stays there as these small veins constrict.

• 29:40Speaker 01

  And that basically starts the erection and maintains the erection.

• 29:45Dr. Mark Hyman?

  Hmm.

• 29:45Speaker 01

  And what happens is you have, and that's called tuminescence. Then you have detuminescence when the, the, after the ejaculation, the penis relaxes. And that's when five phosphodiesterase breaks down the compound that was responsible for causing that relaxation and constriction. And when that compound breaks down, the small blood vessels relax and the penis relaxes and becomes flaccid. It's five, it's the five phosphodiesterase that gets inhibited by Viagra.

• 30:17Dr. Mark Hyman?

  Yes.

• 30:18Speaker 01

  Right? So this is just a little lesson to everybody listening. That's how it works. Viagra blocks the five, um, five phosphodiesterase, allows this.

• 30:28Dr. Mark Hyman?

  So basically it increases blood flow and makes the erection stay.

• 30:31Speaker 01

  Longer, because you don't get the breakdown of this thing called cyclic GMP. So that doesn't break down, that maintains the, the constriction of the small blood vessels. You can maintain, actually obtain an erection and sustain an erection for a longer period of time.

• 30:46Dr. Mark Hyman?

  It's a good thing you have to remember all those chemical names when you're having sex, because that would not go very far.

• 30:50Speaker 01

  No, it would. So, but, but that's what's going on. And so, so then what can affect, what are the things that affect that? So metabolic syndrome. So when you're, when you're thinking about people with ED.

• 31:03Speaker 01

  See, all the blue pill does is fix that end problem. Right? It fixes that. Let's just make sure we get the erection and we maintain it. But there's reasons why we get there. We get there because of stress and its impact on that neuro that very, very sensitive neurovascular problem, that neurovascular, and it's not a problem, that neurovascular symphony that has to occur for you to have, you know, your erection and ejaculation. So metabolic syndrome.

• 31:32Dr. Mark Hyman?

  That's prediabetes.

• 31:33Speaker 01

  Which is predi prediabetes, which includes, you know, to make that diagnosis, you have to have obesity, dyslipidemia, which is just abnormal.

• 31:41Dr. Mark Hyman?

  Cholesterol.

• 31:42Speaker 01

  Cholesterol, triglycerides, HDLs. You have to have hypertension. And one of the things is insulin resistance. And so insulin resistance is connected to endothelial dysfunction. When those endothelial cells aren't working, then the the NO, the nitrous oxide, is not going to have an impact and you're not going to be able to start that erection. So what do you treat? You can give the person Viagra, but since metabolic syndrome has so many of the impacts on their overall health and their their health span and lifespan, it'd be better to fix that.

• 32:16Dr. Mark Hyman?

  Right. Okay. So let me let me translate that because that was that was really good. I think I think here's what's going on. Basically, people eating lots of sugar and starch and crapping their diet get prediabetes, which goes along with, you know, high triglycerides, low HDL, high blood pressure, belly fat, the whole, the whole thing.

• 32:34Speaker 01

  Exactly.

• 32:35Dr. Mark Hyman?

  And when you have this problem, which by the way affects every other American, and if you take out the kids, it's probably more than half the adults, right? So we've got 75% overweight, 88% metabolicly unhealthy in this country. Most of those people have some degree of insulin resistance. And what you're saying is when you have this phenomenon going on in your body, it damages the ability of the lining of your arteries to function properly. So you can't get blood flow in your organs, not just in your penis, but in your heart and in your brain, which is why insulin resistance causes heart attacks and strokes.

• 33:16Dr. Mark Hyman?

  And also dementia. So this is all connected. And in fact, the first sign of heart disease is probably having trouble getting an erection.

• 33:24Speaker 01

  I was about to say, you're worried about your erection, but you know what? You better be worried about your heart and your brain, because they're the ones that are really the target of what's going on.

• 33:31Dr. Mark Hyman?

  Absolutely. And I think people don't realize that. It's not just a local problem. It's just a systemic problem.

• 33:35Speaker 01

  Absolutely.

• 33:36Dr. Mark Hyman?

  And so

• 33:36Speaker 01

  That's one of the points I really hoped we'd make today, because you know, as important as erections are, it's getting those root causes that impact your overall health. And then the cherry on top of the pie is great erections.

• 33:47Dr. Mark Hyman?

  Yeah. And I think, I think most people don't realize that, that our, our whole system is connected. And that's what's so different about functional medicine is that it's looking at the whole system. So, you know, most people don't think of your diet when you think about having sexual dysfunction, but that's the first thing we think about, right? We do think about stress, for sure. That plays a role, but

• 34:07Speaker 01

  There's alcohol, there's alcohol, you know, and it was, one of the roles that alcohol plays is that when you're, when you're drinking alcohol, that itself is going to impact that endothelial function during the time of your use. And you're going to maybe that night not have an erection. Here's, here's what happens. You can stop drinking and say, okay, that will fix it. But there's something that happened. You had, you have, you're gonna have a psychogenic response. It's called performance anxiety. And once you, once, for some men, once they have a failure, it multiplies itself. They get performance anxiety and it becomes a psychogenic problem.

• 34:46Speaker 01

  And there's a vast majority of men who have erectile dysfunction actually have a performance anxiety or psychogenic cause.

• 34:56Dr. Mark Hyman?

  So basically, just if it doesn't work once, you're going to be afraid it doesn't work every time. And that's going to make the whole thing worse.

• 35:01Speaker 01

  Yeah.

• 35:02Dr. Mark Hyman?

  Yeah. So that's, that's a hard mental thing to fix. But the, um, the fascinating thing to me is that the, the phenomena around

• 35:12Dr. Mark Hyman?

  Seeing this as a systemic metabolic vascular issue is so, is so important. And there's a lot of ways to address that, that, you know, we're going to get into. And of course, there's a lot of ways to also address erectile dysfunction that are up and coming, that are quite new, just far beyond Viagra, which we, we're going to talk about. I'm excited to talk about those things. But, but even in traditional medicine, you've got the vacuum pump, which is pre Viagra, where you put a little ring around the base of your penis and you basically put a tube around your penis and you're basically vacuuming all the blood in, which is, doesn't sound like fun to me. And there's penile implants, which can work. There's, there is alprostadil, which is an injection or something that goes inside, inside the urethra and the penis that can help. That's a prostaglandin.

• 35:57Dr. Mark Hyman?

  And there's revascularization, which is a, a, something I would love you to talk a little bit about.

• 36:03Speaker 01

  So revascularization is essentially you're having, as we talked about, hardening of the arteries. And it's, there's two ways that can be done. Just like you have angioplasty, your stents placed in the heart, the same thing can be done for the penis. And that's, that's one possibility. It's, I.

• 36:21Dr. Mark Hyman?

  So it's basically like angioplasty for your penis?

• 36:23Speaker 01

  Yeah.

• 36:24Dr. Mark Hyman?

  Wow, that's incredible. And, and.

• 36:27Speaker 01

  Again, these are, these are very interesting, very interesting responses to the problem. But I would, and, and we're going to go through other possibilities. As you said, we're going to talk about stem cells and platelet-rich plasma. I always like to go back to the idea that, yeah, you can be revascularized, but why get there in the first place?

• 36:49Dr. Mark Hyman?

  Exactly right. It's like you get a stent, but you gotta fix your.

• 36:53Speaker 01

  All of these things actually work. I mean, I, I've had patients of mine use the vacuum pump. I don't know how they do it. It works, doc, I love it. I've had people get penile implants. It works, doc, I love it. And they're pressing their testicle and they're getting their erection. And you know, that's how, that's how the pump works. You know, they have, the pump is inside one, one testicle and you start pressing on it and it gives you your erection and it works. I've had men use the injections, they feel like 18 years old again. But they all have diabetes, hypertension, metabolic syndrome, and I can't get them to get to that underlying cause. So almost sometimes when I not let them get their erections.

• 37:29Dr. Mark Hyman?

  Right. Well, let's talk about, let's talk about testosterone because there's this whole. Conversation about their, about male menopause or andropause and this whole syndrome of low T or low testosterone. And I think part of it's gone to the extreme and there's a lot of bodybuilders use testosterone and I think can be used in appropriately. But, but what I want you to talk about is why do we see the drop in testosterone as men age? Because I think this is really important. There are natural ways to raise testosterone. There are ways that we are living that lower testosterone. So let's get into talking about that because if you fix testosterone, a lot of things get better.

• 38:08Speaker 01

  A lot of things do get better. Erections may or may not get better. Testosterone can definitely have an impact on erectile dysfunction. It impacts the five phosphodiesterase we talked about earlier, and it also can have an impact on nitric oxide. And that can result in improved erections. And you asked me, why do we see this drop off in testosterone? Well, there's this natural drop off of testosterone as men age. So after the age of 30, you're losing about 1% per year. And over time, that's going to drop you pretty low. But that's not going to do it all by itself.

• 38:43Dr. Mark Hyman?

  Now, I've seen many older guys with raging high testosterone levels.

• 38:46Speaker 01

  Here's the older guys that don't have raging testosterone. Those are the guys that have sleep apnea, alcohol over, they drink too much alcohol, they have diabetes, they haven't learned how to manage their stress. Did I mention sleep apnea?

• 39:02Dr. Mark Hyman?

  You did.

• 39:02Speaker 01

  Yeah, I did. But that's a very important one. And so those are things that as you age, begin to impact your body's ability to make testosterone.

• 39:11Dr. Mark Hyman?

  Yeah. So I just want to emphasize something you said there is so important. You said diabetes, but this whole prediabetes insulin resistance thing is the biggest reason. So here's the deal. The bigger your belly, the lower your testosterone.

• 39:26Speaker 01

  And the smaller your...

• 39:31Dr. Mark Hyman?

  The, the more belly fat you have.

• 39:35Dr. Mark Hyman?

  The lower your testosterone is. And, and people don't understand that. And then you mentioned alcohol. And the reason alcohol is such a problem is that it increases a hormone, a hormone converter called aromatase, which is an enzyme that converts testosterone into estrogen, which is why you see guys who are drinking lots of beer and alcohol, have man boobs and have big bellies and lose the hair on their chest and lose the hair on their legs. So they become more like women and they have very high estrogen levels. So you, you, people are shocked to find that out. So you're basically become like a woman, the more alcohol you drink.

• 40:14Speaker 01

  Absolutely.

• 40:15Dr. Mark Hyman?

  And I, I think those two things are really important for guys to understand because if you are struggling with erectile dysfunction, it's a big deal for people. And they don't understand that it's directly related to what they're eating. Now, in addition to the fact that eating starch and sugar will lower your testosterone, what are the things that actually might increase it from a dietary point of view?

• 40:35Speaker 01

  Mark, it goes back to one of the books you wrote. It's called Eat Fat, Get Thin. So now I'm going to tell you this, the name of the book can now be, the one that I'll write will be Eat Fat, Get Hard.

• 40:47Dr. Mark Hyman?

  Oh gosh, it's getting to be a racy podcast. We've got to put explicit warnings on this one.

• 40:52Speaker 01

  You know what, they should have known getting this together, this was going to happen. So yes, fat, because fat actually, you know, we've talked about this before, has cholesterol on it. Cholesterol is not a bad guy. Cholesterol is really important foundational molecule for building hormones and one of them is testosterone.

• 41:09Dr. Mark Hyman?

  That's right.

• 41:09Speaker 01

  So eating good, healthy fat is going to allow you to have that precursor molecule to maintain high levels of testosterone as long as you're doing everything else right. Sleeping well, managing stress and limiting your alcohol use.

• 41:26Dr. Mark Hyman?

  The next topic I want to get into is people's often challenging subject for people to talk about, which is sexual dysfunction. And it's a pretty big problem across the board for men and women. And it's something people really don't talk about that much. We had a little blue pill Viagra, everybody was happy. But there's more to it than that. And I want to talk about some of the approaches you have. But first, can you share some of the scope of this problem, and who it affects, and what kinds of things you are doing to help people solve this issue? Because I have this patient who's like 75. And I mean, all she does is talk about sex and all her partners. So people can stay sexually active for a

• 42:09Dr. Mark Hyman?

  long time. I have 80 year old patients who are like, I want to keep being engaged. And I think we often say, I'm 50, I'm over it. You know, I had met another guy who was like 58, and he's like, I'm done. You know, like, I'm like, wait a minute, you're done. It's like, you don't have to be done. And so I think, what are you finding in terms of the scope of the problem? And what are the kinds of things that are really working?

• 42:29Speaker 02

  Scope of the problem is significant. And it just is not in the older population. We're seeing problems age 30, age 30, 40, 50, men and women. 80% of erections in men is vasculogenic, it's due to blood flow. 20% is hormones. So a lot of the, a lot of the younger patients come in and say, listen, my testosterone must be low because I can't get an erection. But that's not the case. It's, it's other things that are involved. Vessels, blood vessel flow, blood flow is a big problem. Now, why do people have lack of blood flow?

• 43:04Dr. Mark Hyman?

  Yeah.

• 43:05Speaker 02

  It turns out that, you know, atherosclerosis starts at age five. You can start having plaque in blood vessels.

• 43:11Dr. Mark Hyman?

  Hardening of your arteries.

• 43:12Speaker 02

  Yeah. And the first sign of erectile dysfunction is endothelial dysfunction. The endothelium is the inside lining of blood vessels. We have 60,000 miles of blood vessels in our body.

• 43:23Dr. Mark Hyman?

  How many miles in your penis?

• 43:27Speaker 02

  Well, so it turns out that it's one organ, not multiple organs, the endothelial system. So people often ask, you know, as a cardiologist, why are you dealing with erectile dysfunction? Because the first sign of endothelial dysfunction is erectile dysfunction. The first presentation that someone has a blockage in an artery is lack of early morning erections or erectile dysfunction.

• 43:48Dr. Mark Hyman?

  Yeah.

• 43:49Speaker 02

  So when we see that-

• 43:50Dr. Mark Hyman?

  Can be a sign of heart disease, diabetes, right?

• 43:51Speaker 02

  Absolutely. Diabetes is a big thing. Hypertension is a big problem. Alcohol is a huge problem. When you have alcohol, you have an acute inflammatory reaction in the blood vessel wall. But the most, the most that we see is sugar.

• 44:06Dr. Mark Hyman?

  Sugar.

• 44:07Speaker 02

  Sugar is extremely inflammatory. If you have a Coca-Cola within-

• 44:11Dr. Mark Hyman?

  So basically the donut or a Coke or an erection, you gotta choose, right?

• 44:14Speaker 02

  Within two hours, right, within two hours of having sugar. We can actually measure in the urine, an inflammatory mediator. We can actually measure your blood vessel by looking at endothelial function testing to see that it's vasoconstricted after sugar. Sugar can precipitate a heart attack. There was a, it was a good video-

• 44:34Dr. Mark Hyman?

  So basically don't have dessert if you want to have sex, is that the idea?

• 44:36Speaker 02

  You gotta pick your, you gotta pick what you want. So sugar's, sugar's a big problem. But what we're finding out is blood flow is huge. And, and like you said, to see the diseases or, or, you know, what we're eating, and that, that can affect us a lot.

• 44:49Dr. Mark Hyman?

  I want people to really get that. What Dr. Shapiro just said is that sugar is one of the biggest causes of sexual dysfunction.

• 44:57Speaker 02

  It, well, sugar's the biggest cause of inflammation inside the blood vessel lining, which is a big, which is a reducer of blood flow. It's all about blood flow. So what are some of the things that we can do to increase blood flow? A technology that I recently started using about a year ago is called GainsWave. GainsWave uses low intensity, extra corporeal, shock wave therapy, and it basically can optimize men's health, it can optimize performance. What it does, it creates a small injury. Injury then- Says a message to the brain. The brain releases mediators, mesenchymal stem cells, to go to that site and increase blood flow by causing what was called angiogenesis.

• 45:38Speaker 02

  So, actually, the Gainswave treatment, which has been very popular lately, and it's available all over the US. Uh, we do it in New York City and my Westchester location, but uh, it's involved everywhere, but it's for two things. It basically helps increase blood flow. And it does that by uh, angiogenesis.

• 45:56Dr. Mark Hyman?

  And angiogenesis means growing new blood vessels.

• 45:59Speaker 02

  Correct. So, anytime you have an injury, your body is trying to repair that injury. And our natural repair mechanism is stem cells. So, you have a cut on your finger, or shave, you're shaving and you have a cut. What happens in two days? It's healed. Why does it heal so fast? We have a self-repairing mechanism. So, this, this low-intensity shockwave therapy, Gainswave, basically gives you this small injury, uh, and we're all familiar with, with shockwave therapy for lithotripsy, right? Lithotripsy is higher intensity for kidney stones. So, this is low intensity. So, the Gainswave therapy basically works by angiogenesis, new blood vessel growth, and growth factors, bringing new growth factors to the area. Usually, we do a treatment once a week, or twice a week.

• 46:43Speaker 02

  It's about six sessions. Uh, it doesn't hurt, it's not painful, it's non-surgical, it's not invasive, uh, patients see results, uh, you know, significant, we're getting great responses. And usually, we do six treatments or 12. Some people have Peyronie's disease, which is a plaque, a fibrous plaque, an injury to the penis. This has been curing it in patients.

• 47:05Dr. Mark Hyman?

  Incredible, that's incredible.

• 47:06Speaker 02

  And, and, I mean, and these are young patients that we're seeing, uh, you know, 30s and 40s, some 50s and 60s, but, you know, we're seeing, we're seeing some great results with, with Gainswave therapy. Um, it's, uh, you know.

• 47:19Dr. Mark Hyman?

  So, does it, when you get like six or 12 treatments, is it a temporary result, or does it affect for a longer lasting?

• 47:24Speaker 02

  We're seeing results lasting up to two years.

• 47:26Dr. Mark Hyman?

  It's sort of like having a cardiac bypass, in a sense, right? You get new vessels.

• 47:30Speaker 02

  Well, yeah, not exactly. I mean, that's the mechanism of it. Let's say you exercised your whole life, compared to someone who was sedentary their whole life, and you both had a heart attack. From the books, remember some of these studies, the person who exercised is gonna have a smaller heart attack, the person who doesn't exercise will have a larger heart attack. What does exercise do? Grows new blood vessels. So, you know, if someone who exercises a lot, who has some blood vessel growth, but, you know, sort of like is having a lot of ED issues because they changed their diet, they have some inflammation and their blood vessels are kind of like constricted, this will, this will help knock off some of the calcium inside the vessel wall, it'll increase dilation of blood flow, bring in more growth factors, uh, and, and basically-

• 48:14Dr. Mark Hyman?

  It's like regenerative medicine for the penis, basically.

• 48:17Speaker 02

  Correct.

• 48:19Dr. Mark Hyman?

  And it, and it may allow you to throw away your Viagra or Cialis, right?

• 48:23Speaker 02

  So, so, you know, Cialis and Viagra work locally on the penis by phosphodiesterase, uh, PDE5, you know, uh, receptor inhibitors. And what this is doing is you're inhibiting constriction, so you're dilating. But there's other side effects with, with some of these medications. It reduces blood flow to the eye. Sometimes you can have increased, yeah, you have visual changes, you're gonna have increased reflux by reducing lower softgill sphincter pressure in the esophagus. Um, I mean, you know, sometimes they're great, like Cialis, five milligrams daily is great for people with BPH because it reduces the pressure on the prostate and, and able, you know, allows you to urinate better. That's been a help with a lot of patients, but sometimes combination therapies help.

• 49:05Dr. Mark Hyman?

  Yeah.

• 49:06Speaker 02

  Um, like we mentioned exosomes before, so now we're taking exosomes and we're, and we're doing what's called, uh, uh, an XX shot, uh, or an XY shot.

• 49:15Dr. Mark Hyman?

  Hmm.

• 49:16Speaker 02

  And, and basically what that does-

• 49:17Dr. Mark Hyman?

  They call it a P shot, is that it?

• 49:19Speaker 02

  So, so I actually trained with Dr. Renells and learned PRP and did a lot of PRP, the P shot, the O shot, which helps a lot of women and men. Uh, but that's with their own blood. We spin it down and we re-inject it back into them. So we're getting some growth factors.

• 49:33Dr. Mark Hyman?

  Yeah.

• 49:34Speaker 02

  But if you compare PRP with some of the new therapy, exosomes, you know, exome, you're talking about, you know, a tremendous increase in, in growth factors that basically make the result so much more powerful. So, you know, I'm, I'm doing some PRP now, not as much. I'm doing a lot more exosomes. I think exosomes will be the future. I know a lot of the-

• 49:53Dr. Mark Hyman?

  Those are injected directly into the penis or-

• 49:55Speaker 02

  Yeah, so, you know-

• 49:56Dr. Mark Hyman?

  Sexual organs.

• 49:58Speaker 02

  You go right into, you go right into the penis, you numb up the area. Sometimes you can do a nerve block. It's no pain at all. Uh, and it takes about 15 minutes and the response is significant. Patients with prostate cancer who have decreased sensitivity, who got radiation, who now can't get an erection, now suddenly can get an erection after an exosome injection.

• 50:17Dr. Mark Hyman?

  That's amazing.

• 50:18Speaker 02

  Yeah.

• 50:19Dr. Mark Hyman?

  So how's, how's GainsWave different from other treatments for erectile dysfunction or performance enhancing drugs?

• 50:26Speaker 02

  Well, because GainsWave is the only therapy that's, that's basically using low intensity shockwave therapy.

• 50:32Dr. Mark Hyman?

  It's not pharmacologic, it's not invasive.

• 50:35Speaker 02

  It's drug-free, not invasive, surgery-free, we improves blood flow, gives a better erection quality, you have harder erections, more full erections, sexual performance is improved. And, and actually, a lot of patients will come who are younger, who want to increase performance. They, they have good erections, but they want performance, they want to be able to last longer. So they, they, you know, so they come in for performance issues, not ED issues. And then we have maintenance, once a patient goes through their six or 12 sessions, they'll come back once a season and get a maintenance treatment. But the combination thing of, of exosomes, PRP, or, you know,

• 51:10Dr. Mark Hyman?

  Diet, exercise, all of it.

• 51:11Speaker 02

  And GainsWave, exercise, so important, diet, eating less sugar, keeping those vessels dilated, very important. And, and we're seeing, you know, it's a safe procedure, too. Everyone's concerned about, you know, surgery. I mean, we used to, I used to send a lot of patients for, for bypass, coronary artery bypass graft surgery. It's a, you know, if, if you need it, you get it. But I mean, right now, we're trying to do multi-vessel stenting. And I, I, I can speak for hours on just cardiology and traditional, you know, disease management. But I mean, here we're talking about, you know, more natural ways to, to stay younger and healthier and live longer.

• 51:47Dr. Mark Hyman?

  Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at Dr. Mark Hyman, and we'll see you next time on The Doctor's Pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. Now you can have access to all of this information by signing up for my free Mark's Picks newsletter at drhyman.com/marks picks. I promise I'll only email you once a week on Fridays, and I'll never share your email address or send you anything else besides my recommendations. These are things that have helped me on my health journey, and I hope they'll help you, too. Again, that's drhyman.com/marks picks. Thank you again, and we'll see you next time on The Doctor's Pharmacy.

• 52:35Dr. Mark Hyman?

  This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the Chief Medical Officer. This podcast represents my opinions and my guests' opinions, and neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for your help in your journey, seek out a qualified medical practitioner. You can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com. If you're looking for a functional medicine practitioner near you, you can visit ifm.org and search "find a practitioner database."

• 53:19Dr. Mark Hyman?

  It's important that you have someone in your corner who is trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public. In keeping with that theme, I'd like to express gratitude to the sponsors that made today's podcast possible. When it comes to supplements, you only want the best for your body, the kind with the highest quality, cleanest, and most potent ingredients you can get. That's exactly what you'll find at my supplement store, where I've hand-selected each and every product to meet the most rigorous standards for safety, purity, and effectiveness. These are the only supplements I recommend to my patients, and they're also what I use myself. Whether you want to optimize longevity or reduce your disease risk, or you're looking

• 54:03Dr. Mark Hyman?

  to improve your sleep, blood sugar, metabolism, gut health, you name it, drhyman.com has the world's best selection of top-quality, premium supplements, all backed by science and expertly vetted by me, Dr. Mark Hyman. So check out drhyman.com, because when it comes to your health, nothing less than the very best will do. That's drhyman.com, D-R-H-Y-M-A-N dot com.