Ben Greenfield [00:00:00]: My name is Ben Greenfield, and on this episode of the Ben Greenfield Life Podcast.

Dr. Marty Makary [00:00:03]: The gut of a baby in utero is sterile. There's no bacteria in there. The microbiome that is the garden of these millions of different bacteria is seeded from the bacteria that the baby acquires from passing through the birth canal and augmented by breast milk bacteria and skin and kisses from grandparents. But when a baby is born by C-section, a sterile baby is extracted from a sterile operative field. And what may seed their microbiome and gut are bacteria that normally live in the hospital at Mount Sinai. They have a protocol now where if you're born by C-section, they take some vaginal fluid and swab it on the baby's skin with the idea that they're going to promote healthy seating in the microbiome. If we stop and look around, there's some pretty compelling data that's giving us some hints.

Ben Greenfield [00:00:53]: Fitness, nutrition, biohacking, longevity, life observation, optimization, spirituality, and a whole lot more. Welcome to the Ben Greenfield Life Show. Are you ready to hack your life? Let's do this.

Ben Greenfield [00:01:17]: Well, I read a lot of books, and this last book that I read, honestly, it made me a little bit upset. I'm not a very angry and emotional guy, but there were some sections in it that pissed me off a little bit, almost feeling like the wool had been pulled over my eyes. Which kind of might make sense because the book is called Blind Spots. Blind Spots. Dr. Marty Makary wrote this book. The subtitle is when medicine gets it wrong and what it means for our health. If you want to check out the book, you can go to bengreenfieldlife.com/blindspots. That's bengreenfieldlife.com/blindspots.

Ben Greenfield [00:01:55]: If you haven't heard of Marty, he's a surgeon, he's a professor at Johns Hopkins, he's a public health expert. He's a leading advocate for healthcare transparency. He's the New York Times bestseller, and two Times New York Times bestseller, actually. And this book is fantastic. We're going to delve into some of the nitty gritty details of what happens when medicine gets it wrong and why Marty wrote this book in the first place. So, Marty, welcome to the show, man.

Dr. Marty Makary [00:02:23]: Great to be with you, Ben. Thanks for having me.

Ben Greenfield [00:02:26]: Yeah, yeah, absolutely. It's my pleasure. I've actually really been looking forward to this interview. Your book has come up in a few different dinner parties and conversations in the past month, so I've been looking forward to actually chatting with you about it. And although I got to tell you, I want to get into some of the deepest philosophies and underlying reasons why he wrote the book. But I think just to kick things off here, I found this intriguing, by the way. I would love to hear this idea of a blind spot of peanut allergies that you describe in the book. Cause it's such a great example of the rest of the book.

Dr. Marty Makary [00:03:03]: Yeah, I thought it was a good example to open the book off with. It's a example where the medical establishment, Ben, didn't know what was causing peanut allergies. So when parents were asking the medical establishment, they just made something up. They said, if a kid avoids peanut butter for the first three years of life, then you will prevent peanut allergies later in life. And it turns out they got it perfectly backwards. Peanut abstinence results in an immune sensitization, and that's why peanut allergies have skyrocketed over the last 20 years or so. This was in the year 2000 when they put out this dogma, this medical dogma.

Ben Greenfield [00:03:46]: And this was in the US, by the way.

Dr. Marty Makary [00:03:48]: It was in the US and the UK, and the rest of the world never adopted this medical dogma. And that's why Africa and most places in Europe have no peanut allergies. I've got two health professionals studying with me, one from Zimbabwe and one from Cameroon. When they came to the US, they're blown away by all this. You know, food is labeled, has tree nuts, has no tree nuts. You know, they're making announcements on planes. Their waiters are asking. One of the students invited one of these guys over for dinner and said, this was like on his first day in the United States.

Dr. Marty Makary [00:04:26]: They asked him, do you want to come over for dinner? And do you have a peanut or other allergies? And so he came up to me, he's like, what is it with America and these peanut allergies? And I explained that it is mostly a manufactured, manmade epidemic. That is, it was ignited by this medical dogma in the year 2000, which loomed for 15 years before anyone actually took the time to do the basic simple study showing that peanut abstinence in the first couple years doesn't prevent peanut allergies. It increases them by eightfold. We also saw a new type of allergy. That is the super severe sensitivity, that is a kid can stop breathing just from being near a peanut. These are uniquely American problems.

Ben Greenfield [00:05:17]: Yeah, I don't remember hearing about it on airplanes for much of my life growing up. As a matter of fact, it was a real travesty. Because one of my favorite things that I used to do on airplanes was sit there and make peanut butter in my mouth. You know, I'd grab five or six of those peanut packets and chew them up. And, I mean, you can make. Make your own crunchy peanut butter. And when my sons were born, it was really interesting. And maybe this is why I found this part of the book interesting, Marty.

Ben Greenfield [00:05:42]: I was holding one of them. He was probably about, I don't know, maybe nine months old. And when I put him down, red marks from my hands were in the two locations where I'd been holding my body. You could literally see my hand marks against his skin, like a red inflammatory response. And I realized right before I picked him up, I had been holding a jar of peanut butter. I was making myself a meal that had peanut butter in it. And I thought, well, gosh, that's interesting.

Ben Greenfield [00:06:15]: I wonder if my son has a peanut allergy. And way back then, I was kind of soared into some of these alternative health concepts, and I came across a recommendation to, if your child is displaying some sensitivity to peanuts, to begin giving them trace amounts of peanuts. And so I actually started giving both my sons little bits of peanut every day. They never manifested a peanut allergy. I retested that, hands on peanut butter touching my son's skin about three months later. No red marks, nothing like that. And so it kind of makes sense to me what you describe in the book. But I guess the bigger question for me is, what motivated the origin of that dogma in the first place? Where'd the idea come from?

Dr. Marty Makary [00:07:03]: So, in the book, I do a little investigative journalism, and I interviewed people who made that initial recommendation in the year 2000. And I heard a number of different reasons why this small group of people made this recommendation. One was they said, well, we had a handbook put out by the American Academy of Pediatrics a couple years prior, which suggested people should avoid peanut butter. And so we wanted to stay consistent. That was important. Another guy said, look, we had no idea, and I'm not even an expert in this, and I'm not really even sure how I ended up on the committee. And the committee leadership kind of made up its mind, and I just kind of fell in place. But the most striking thing was one of them told me, the public was asking, why are there peanut allergies out there? There were some big media stories sort of magnifying what was happening.

Dr. Marty Makary [00:07:56]: And the public asked medical authorities, what can we do? And they said, this one person said to me, we had to tell them something. And I said, no, you didn't. You don't have to say. If you don't know, you don't have to tell them what to do. Cause you don't know.

Ben Greenfield [00:08:15]: Oh, my gosh. Wow. That's so interesting about the committee. I mean, it almost reminds me of like a Trumpism, you know? I don't know why he's on the committee. I don't think he even knows why he's on the committee. You know, it's interesting because I've actually come across, it was actually a little while ago, maybe three or four years ago, the same idea regarding gluten, that children who are raised on a strict gluten-free diet tend to manifest with gluten sensitivities later in life, I would imagine. I mean, you know, you're the doctor, not me. I just occasionally wear the t-shirt.

Ben Greenfield [00:08:49]: But does that make sense? Like, the more that you would restrict certain food compounds early in life, the more you might risk, beyond just nuts sensitivity to those things later on in life?

Dr. Marty Makary [00:09:00]: Yeah. Look, I talked to the world expert on children allergies and food allergies, peanut allergies, and they said that the basic principle that folks have known about for centuries, that is the dirt theory, when you're around germs, your immune system learns to tolerate them. That's true of not just peanut butter early in life, but milk, eggs, dogs, cats. The guy who ended up doing the big New England Journal Study that reversed the peanut avoidance recommendation and had noticed that ear piercing allergies were less in people who had metallic dental work. And so it fit. It fit what we call immune tolerance.

Ben Greenfield [00:09:49]: Yeah. Wow. So immune tolerance would be the term for that. Now, related to that, I think that this whole idea of the hygiene hypothesis, not raising your child and say, like a hyper clean environment so they get appropriate immune system development, is linked to something else that you talk about in the book, The Blind Spot, I suppose you would call to get into medicine, that there are little to no downsides to antibiotics. What's your take on that?

Dr. Marty Makary [00:10:20]: Look, this has been one of the most damaging dogmas in all of medicine and has harmed millions and millions of people with irritable bowel, unexplained chronic pain. We have these terms that are just wastebasket umbrella terms, bacterial overgrowth syndrome, irritable bowel. But many of these conditions didn't exist before the advent of antibiotics or were super rare. Ulcerative colitis, inflammatory bowel disease. Antibiotics, it turns out, are not totally safe, and no medication is totally safe, despite what you hear they carpet bomb the microbiome that is the garden of millions of different bacteria that line the GI tract, that train the immune system, that digest food, that maintain an equilibrium, and even produce serotonin, involved in mood and GLP-1 naturally the active ingredient in ozempic. So when we drop an antibiotic in there, we're undoing that balance. And we may. There may be overgrowth of bad bacteria, like C. diff.

Dr. Marty Makary [00:11:27]: Like pro inflammatory bacteria, increasing general body inflammation, but the microbiome has been this unrecognized area of the human body, as if it has nothing to do with anything. Antibiotics save lives, and it's important to take them many times. But 60% that are prescribed are unnecessary, according to several studies. I think the most significant study of the modern era, in my opinion, was a study I found just a couple years ago that came out from the Mayo Clinic, comparing kids who got an antibiotic in the first couple years of life versus kids who did not. In this study of 14,000 kids, kids who got an antibiotic in the first couple years of life, when that microbiome is still forming, had higher rates of obesity, 20% higher rates of obesity. By the way, farmers have been noticing that in animals for a long time. That's why they give them to animals. Learning disabilities were higher.

Dr. Marty Makary [00:12:25]: Attention deficit disorder and other learning disabilities went up. These are all chronic diseases, new diagnoses that have been skyrocketing in the modern era of antibiotic and microbiome, sort of imbalance. And asthma was 90% higher. Celiac was nearly 300% higher. So when patients come in to see us as doctors and they have celiac or one of these other conditions, and parents say, what caused this? We've been basically telling them, we don't know, or we make something up. Here, we have a strong signal in the data that changing the microbiome may cause or hasten some of these chronic diseases on the rise. And it's not just antibiotics, it's unnecessary C-sections and other things.

Ben Greenfield [00:13:18]: Yeah, I was going to ask you, and then you brought it up, this idea about antibiotics and obesity, because you briefly mentioned GLP-1, which is, of course, on the tips of everyone's tongue these days. You know, it seems like half of Hollywood and all the Silicon Valley tech entrepreneurs and billionaires are all using ozempic or something like it. Do you think you could draw some kind of a correlation between antibiotic use and either a surge in obesity or a diminished ability to resist the hyper palatable foods that are around us?

Dr. Marty Makary [00:13:55]: Well, it's hard to make a direct causal association, although in animal studies, the world expert on the microbiome, who I interviewed for the book has made those direct associations. But it's hard to know which alteration of the microbiome is the one that's really causing this, or is it all of the alterations. If you think about it, we're doing a ton of stuff in the modern era, in our lifetime. We're the first generation, Ben, that's had a massively altered biome from antibiotics, carpet bombing, some bacteria from C-sections, ultra processed food, tons of refined carbohydrates, foreign substances that do not appear in nature. Be it microplastics, pesticides, or byproducts of seed oils. These are substances that do not appear in nature. And when they go down the GI tract, not only are they altering the bacterial balance, but the immune system lines the GI tract. And so the immune system may be responding and sort of fighting off some of these foreign particles that don't naturally appear the environment. And you get a sort of, not a major inflammation, but a mild and chronic inflammation.

Dr. Marty Makary [00:15:06]: And that just makes people feel blah. Makes people feel sick. And that's why, you know, many people are taking a hard look now at the food additives and the diets in foods.

Ben Greenfield [00:15:23]: Right. You're describing a piece of the so called evolutionary or ancestral mismatch, you know, the human body and brain being maladapted to this modern environment of not just the hyper palatable foods, but a large variety of synthetic compounds. And honestly, it makes me think that if I were. I'm not saying this is the case, but if I were a pharmaceutical company, it would actually be a very good move to encourage use of antibiotics. This is related to that other question I asked you a few minutes ago, and simultaneously produce something like a GLP-1 agonists. Those would seem like a match made in heaven, based on what you're describing, not saying that's the case. I don't know if it is, honestly, but it is very interesting. It's also interesting what you say about C-sections. And I think a lot of people still aren't aware of this.

Ben Greenfield [00:16:14]: I saw a figure. I don't know how accurate this was, but it's several years that it takes for the biome of a child born via C-section to become as diverse as that of a child born vaginally, a process during which you, of course, collect a lot of your mom's flora. And as gross as this is to think about, you know, pick up some poop particles as you're coming, you know, through that canal and, you know, and basically having a little bit more of a natural delivery. So I would imagine C-sections are also a pretty big part of this problem also.

Dr. Marty Makary [00:16:47]: I think you're onto something there, Ben, and I think that's a very important point. And just to sort of restate it a little differently, the microbiome, the gut of a baby in utero is sterile. There's no bacteria in there. The microbiome that is the garden of these millions of different bacteria is seeded from the bacteria that the baby acquires from passing through the birth canal and augmented by breast milk bacteria, and skin and kisses from grandparents. But when a baby is born by C-section, a sterile baby is extracted from a sterile operative field. And what may seed their microbiome and gut are bacteria that normally live in the hospital.

Ben Greenfield [00:17:28]: Oh, wow. Wait, wait. I need to repeat that. So my audience, I want to make sure they pick that up. Your biome would be seeded by the bacteria in the hospital rather than the natural floral environment of your mother.

Dr. Marty Makary [00:17:41]: That is a distinct possibility. And that was a primary concern with all these C-sections that the head of the microbiome research center at the NIH had explained in that very eloquent way. And so what are we doing. Now C-sections save lives and antibiotics save lives.

Ben Greenfield [00:18:01]: Yeah, I mean, my wife had a C-section. She, twin boys. Tiny, petite woman. She would have been the type of gal who probably would have died in the wild, wild west 150 years ago trying to push a couple of boys out. And the C-section probably did save her life. Or their lives.

Dr. Marty Makary [00:18:17]: Absolutely. Good point. C-section save lives, but they're overused. You know, there's a dogma that it doesn't matter. You get to choose. You can pick a date if you want to pick your grandmother's birthday to deliver your daughter or son. There are extremes at every level, but the idea that there's no difference or that it's perfectly the same. At Mount Sinai, they have a protocol now where if you're born by C-section, they take some vaginal fluid and swab it on the baby's skin with the idea that they're going to promote the healthy seating in the microbiome. You're familiar with the rise of colon cancer in young people?

Ben Greenfield [00:19:00]: Yeah, I've been hearing a lot about that in the past year.

Dr. Marty Makary [00:19:02]: And everyone's scratching their heads. Even I'm a cancer surgeon myself, trained in surgical oncology and gastrointestinal surgery, and everyone's scratching their heads. Not many people are asking what's going on, but if we stop and look around, there's some pretty compelling data that's giving us some hints. A study just came out in JAMA surgery. Remember, JAMA's the largest circulating journal in all of medicine. The JAMA surgery subjournal just had a study that kids who were born by C-section were more likely to have colon cancer before age 50, suggesting there's some role of the microbiome.

Ben Greenfield [00:19:43]: That's super interesting. I did just interview Azra Raza wrote the book the first cell about the origins of cancer, and she does talk about the link in that book between the biome and potential cancer onset. I had no clue about that recent study, though. When was that released?

Dr. Marty Makary [00:20:03]: Just came out in the spring. Just came out several months ago.

Ben Greenfield [00:20:06]: And surely there are things we can do about this, though. You mentioned populating with mom's vaginal flora, with children being born via C-sections. Had you dug into any other kind of solutions for the C-section? Or maybe a child given antibiotics early in life in order to do a good job repopulating or rebuilding the carpet bombed scenario?

Dr. Marty Makary [00:20:27]: You know, some of the interventions that people can do to try to reduce that risk are better known than others are just a hypothesis. For example, all of the food additives, ultra processed foods, it's probably lowering your risk if you eat organic food and start a kid on organic food early. It's probably a lower risk if a baby breastfeeds early. We're kind of told a dogma that it doesn't matter whatsoever. Just remember the formula companies that make formula milk are one of the biggest sponsors of the American Academy of Pediatrics. Now, some women cannot breastfeed. They should not be shamed. They have to have formula or augment what they can provide with formula.

Dr. Marty Makary [00:21:10]: But avoiding unnecessary antibiotics. Avoiding unnecessary C-sections. There are studies looking at not just vaginal swabs at birth, but maybe probiotics in young people. The problem is there's millions of probiotics out there. We don't have the research funding to evaluate all of them. So the ones that are popular tend to be the ones with the best marketing. But there are some studies now that show probiotics can work for treating bipolar and other mental health conditions. Because remember, some of those bacteria make serotonin.

Ben Greenfield [00:21:43]: Right, right. The whole gut brain connection. Yeah, that's interesting. You can take your standard over the counter formula and go outside in the backyard and sprinkle some dirt in there. There is one cup I'll give them a shout out. Serenity Baby Foods. I know they do a good formula that's well comprised, and they have things like colostrum and immunoglobulins and growth factors and a lot of the things you'd find in mom's breast milk in their formula. They actually sent me some some time ago, and I used it in my smoothies.

Ben Greenfield [00:22:10]: Delicious. So the idea that we're talking about in terms of just newborn care in general, you actually have a whole list in the books of things or in the book of things that we could be doing to improve newborn care in the US. Obviously, considering how and when we use C-sections and not using them when unnecessary is one that you've already brought up. But what are some others?

Dr. Marty Makary [00:22:37]: Well, I remember as a medical student, my job was to cut that umbilical cord the second the baby comes out, and it's always kind of a blur. There's a lot going on, and I'm holding the scissors, and then the baby comes out and they clamped the cord and say, cut it. And I cut it.

Ben Greenfield [00:22:52]: Yeah, yeah. I was there in the room when my sons were born. It was a very similar scenario.

Dr. Marty Makary [00:22:58]: Well, it's really nuts, because we take the baby to the back table, the baby's immediately whisked away, even if the mom has this sort of natural reflex to reach for the baby. And we engage in almost the medicalization of ordinary life. We take the baby, we poke and produce. And when I asked, why are we doing all this stuff to the baby in the back table of the delivery room, I was told, well, we have to rewarm the baby under some French fried light or something. And the irony is the baby was already getting a blood transfusion of warm blood directly into their circulation through the umbilical cord before we cut it. And we also cut off pulsating fetal oxygen, what we call fetal hemoglobin, which has a very good binding. Stem cells, antibodies. Everything else that was flowing, it normally can pulsate for a minute or two or more. Studies are now showing that the longer that cord is pulsating, that you let it pulsate naturally, the greater the benefits to the baby, including the myelination of the brain being different on MRI years later. That was an incredible study.

Dr. Marty Makary [00:24:17]: And so the best practices now are to do a delayed clamping of the cord at, say, two minutes, a minute and a half, two minutes when it stops pulsating.

Ben Greenfield [00:24:26]: Right. So that's not. That's not that long. We're talking about a couple of minutes here.

Dr. Marty Makary [00:24:29]: Yeah, it's amazing. I mean, a minute or two can have a dramatic benefit. They've found that the babies are less likely to require a NICU, neonatal ICU bed, and vasopressors and meds, and their heart rate is more normal. And when the mom holds the baby immediately upon birth, which is the best practice for the vast majority of babies, the mom should be holding the baby skin-to-skin. That's the best rewarming and incubator, by the way.

Ben Greenfield [00:24:55]: That's also like. That causes similar to when you make love or hug someone, there's an oxytocin release. I know, but I think there's a flood of other hormones that occur with that skin-to-skin contact.

Dr. Marty Makary [00:25:06]: Well, it's funny you say that, because the expert in this area, who I spent time with and interviewed for the book Blind Spots, she told me that not only are all their hemodynamic parameters improved when the mom holds the baby skin-to-skin, but their blood glucose is more normal, the baby's blood sugar is more normal. And that one I couldn't really figure out. And then she pointed it out to me. The mechanism is the baby is not having spikes in their stress hormones, which alter the blood sugar level.

Ben Greenfield [00:25:38]: So there's endocrine regulation occurring from skin-to-skin contact.

Dr. Marty Makary [00:25:41]: That's right, that's right. Through a reduced glucose steroid and glucocorticoid surge in the baby, the baby's not stressed as much. And there's something magical about the bonding. A baby is more likely to latch and breastfeed when they're held. And there's no need to be washing baby. Why? You know, I remember one of my jobs. Wash the baby the second baby's born. Why? The baby has bacteria that are going to colonize the microbiome.

Dr. Marty Makary [00:26:10]: This sort of protein coat can be a bit of a thermal protection layer.

Ben Greenfield [00:26:14]: Yeah, that's interesting. So even the washing component, I mean, it kind of makes sense. I mean, you know, probably mom shouldn't take much of a shower. So the, you know, so the breast milk is nice and non-hygienic and you don't wash the baby either.

Dr. Marty Makary [00:26:26]: These are the best practices now identified for childbirth, but sadly, they're not all universally applied. We come from an era of what we call the white coat era in the history of medicine, that is, doctors tried to do a ton of interventions back when maternal and child mortality rates were very high. I mean, crazy high.

Ben Greenfield [00:26:54]: Back when they didn't even wash their hands.

Dr. Marty Makary [00:26:56]: Well, yeah, that's. That was part of the problem identified by Sam, by Ignaz Semmelweis.

Ben Greenfield [00:27:02]: Yeah. Who was ridiculed, if I recall.

Dr. Marty Makary [00:27:04]: Yeah. He noticed doctors were giving infections to women. It's called childbed fever. And he said, hey, wash your hands. And they, like, ran him out of town. He ended up getting admitted to a mental asylum.

Ben Greenfield [00:27:15]: So sad.

Dr. Marty Makary [00:27:16]: But so before World War II, doctors were respected through most of history, but not held on a pedestal. I mean, they might have been respected like a barber, you know? And matter of fact, I'm a surgeon. Surgeons and barber. It was the same profession in the UK. They called them surgeon barbers.

Ben Greenfield [00:27:37]: Right? Leeches, a cleaver, dirty hands.

Dr. Marty Makary [00:27:40]: Leeches, dirty hands and a saw to do amputations at a lancet. That's why our journal, our big journal is called Lancet. That was it. That was it. And then when Alexander Fleming discovered penicillin in 1922, and right around World War II, a few decades later, the mass production of antibiotics enabled doctors to now control and prescribe. Only they could prescribe a magical pill that could cure you. And it was magical. All of a sudden, doctors began to wear white coats.

Dr. Marty Makary [00:28:16]: We had technology in hospitals kind of dazzle the public. No longer were they field tents or places just to recover. And so that ushered in the white coat of medicine. And we separated babies from their mother immediately upon birth, for ten days. Normal babies. And by the 1970s, it drifted down to, like three days. My little sister was born in the 1980s. I still remember mom came home after delivering her and we would ask mom and dad, when is our little sister going to come home from the hospital? She was totally normal, right? There's nothing wrong. And they said, well, the doctors haven't released her yet, but we can go and look in through the glass and see her.

Ben Greenfield [00:28:59]: They hold the keys to the kingdom initiated by having the power of antibiotics. And then that seems to have almost kind of like gaslit that power into so many other categories of medicine.

Dr. Marty Makary [00:29:09]: Well, that unquestioned authority of the white coat era of medicine, which really was, is a new phenomena. After the 1940s, it really led to some strong medical paternalism. When home pregnancy tests were developed, doctors tried to block it. Women cannot handle this information on their own, they argued. And then when HIV testing became available, they said, people can't get this information on their own. They can't get their test results. They have to come in and we have to give them the results. Beginning of COVID, same thing.

Dr. Marty Makary [00:29:45]: Once Covid was already at large and broad community transmission, a doctor and I wrote in the Washington Post, we should have home COVID testing. Medical establishment said, no, no, no, we have to do this and monitor and control. So you see this threat of medical paternalism that really has carried into so many areas of medicine. It's something we have to be mindful of.

Ben Greenfield [00:30:06]: Yeah, probably a larger political discussion best saved for another day. But it's a classic case of trading someone caring for you, dependency, and care and support for loss of power. And, you know, we see that in education, we see it in politics. You know, you, you certainly have a trade off when you give away the keys to someone else. Now, obviously. And by the way, I really appreciate having this discussion with a Johns Hopkins professor, a surgeon, you know, someone who is a member of the National Academy of Medicine. It's not like you're some hippie cook who's saying this about medicine. Know, you're, you're one of, you're one of them in terms of being like, showing some of these Blind Spots in the profession in which you're in. Surely when you bring up all these issues with newborn care, Marty, not everybody's going to get like a tiny turtle swimming pool with a slide and move into having a water birth at home.

Ben Greenfield [00:31:11]: But how close are we? Or is there initiative now to adopt some of these things that you've just described into standard practice in modern medicine?

Dr. Marty Makary [00:31:20]: So the Baylor, Scott and White hospital where I interviewed, one of the neonatologists that I really respect on this topic, a woman who's done a lot of research, Dr. Shiravulu, she's made it standard at their hospitals. It's funny because when they started and did the skin-to-skin time, one of her colleagues said, you know, what are we doing going, are we now, you know, doing African care here? Because that's how they do things in Africa.

Dr. Marty Makary [00:31:49]: So she in her feisty way said, if we can learn something from Africa, then, yes, we will do it the African way.

Ben Greenfield [00:31:54]: Exactly. Yeah.

Dr. Marty Makary [00:31:55]: So some places are adopting this protocol, and if you're going to deliver a baby now, a lot of OBs will customize the birth plan with you. And I encourage people not to sort of retaliate against the medical establishment because of their past or current mistakes. You don't want to have a totally anti-medical birth. Kids die when they don't have medical attention, when they're completely separated from the ability for doctors to rescue kids in certain emergencies. So the pendulum does swing and there's a balance. But ask your midwife or nurse practitioner, PA, OB doctor, about delayed cord clamping skin-to-skin time for hours, as long as you can safely hold a baby. Oftentimes with help. You want help to do that first hour golden hour colostrum or breastfeeding and not washing the baby immediately upon birth, avoiding unnecessary C-sections, avoiding unnecessary antibiotics.

Dr. Marty Makary [00:32:57]: I personally don't think you need your eyes smeared with erythromycin antibiotic cream immediately upon birth if the mom tests negative for bacteria. And I personally don't think, and I'm sure others may disagree, you don't need a hepatitis B shot on within the first hour of birth. You can have it a little bit later on as a sexually transmitted infection.

Ben Greenfield [00:33:20]: Yeah, yeah, I'm chuckling. When you said the first hour colostrum, that's, believe it or not, an actual ingredient in the face mask that I use once a week. It says first 2-hour colostrum goat milk. So don't get fancier than that, folks. So anyways, not that I want to myopically focus on newborn care, but these are great illustrative examples, I think. And there's another one that you bring up in the book related to tongue ties, and I'm a bit confused about this myself, because I recently interviewed someone on the podcast who specializes in deep tissue mouth jaw work, tongue mobility, etcetera, and reported during that podcast that many people who have had, were born with tongue ties have a lot of biomechanical issues related to fascial development later in life. It seems that you indicate in your book, though, that we need to use some kind of a different approach to tongue ties. Can you explain your stance on this?

Dr. Marty Makary [00:34:17]: So there's very little solid research on what to do about tongue tie or a foreshortened tongue. Some argue that, including many ENT doctors I respect, and I don't have an answer on this issue. But here's the different views. One view is that it should never be done. Many ENT doctors I respect say in selective cases, when the child does have a foreshortened tongue and may not be breastfeeding well, cutting the frenulum under the tongue can improve breastfeeding rates and have benefits.

Ben Greenfield [00:34:51]: Right. I've heard the same, yeah.

Dr. Marty Makary [00:34:52]: And I think that makes sense to me. But there's also a view that you need to do it liberally. And interpreting what's a tongue tie can be sort of subjective. And what we're seeing is this mass explosion of some dentists, physicians, others cutting the frenulum under the tongue on almost every baby, arguing that it helps with all kinds. There's claims out there that it helps reduce sleep apnea, helps with speech, breastfeeding, all kinds of stuff. There's no data to support a lot of this. And the routine use of this procedure seems out of control, especially when they're cutting the frenulum under the upper lip and even the sides of the tongue. Now, the ENT society says that's crazy.

Dr. Marty Makary [00:35:38]: It should never be done. So here's a good example of an issue that desperately needs a randomized controlled trial. That's how we learn in science. But who's gonna fund it, right?

Ben Greenfield [00:35:49]: Right. There's really not. There's not a huge amount of monetizable motivation behind something like that. And it is interesting because you're right. A lot of what I've heard about tongue ties has been anecdotal. And perhaps I'll ask you this question. I posed this question to the guy interviewed, this is only like a week and a half ago, who is helping out all these people who were born with tongue ties? And I said, well, surely there must be some sort of evolutionary or ancestral mechanism or underlying reason why that tongue tie would occur in the first place. I mean, is it that there's some mass human mutation that has caused babies to be born with the wrong kind of tongues? Or would there be a reason not to cut the, it's called the frenum, right?

Dr. Marty Makary [00:36:39]: The frenulum.

Ben Greenfield [00:36:40]: Yeah, yeah, the frenulum. Is there a good reason why tongue ties would exist in the first place, do you think? I realize this is speculative, but.

Dr. Marty Makary [00:36:47]: Well, many people say it's maybe just be a variation of normal. Maybe we're engaging in the medicalization of ordinary life. If your white blood cell count is below four, why is that the normal range? Right. So we've sometimes create these constructs. Attention deficit disorder. Is that a problem with the kid's activity level or is that a problem? Or is it more a function of fact? We've asked the kid to be sedentary for 8 hours during the day, every day. So I don't know what the solution is on the tongue tie, but it's emblematic of a much larger problem in medicine, and that is, if it's not aligned with the interests of big pharma, who's going to do this study? And so we have these Bermuda triangle gray zones wherever practices become rampant and dogma rules. I mean, what about who's going to do the studies on pesticides and food additives and all this other stuff? Same thing, same problem.

Dr. Marty Makary [00:37:42]: So we've got to call for the NIH to fund some randomized trials we desperately need, because the H in NIH is supposed to stand for health and the F and FDA is supposed to stand for food, not just drug trials.

Ben Greenfield [00:37:57]: Yeah, it sounds to me like with the tongue tie situation, it might be very similar to the C-section, possibly a time and a place for it, but now that it's become a practice, it's nearly become a standard practice. And when you say call for the NIH, what does that even mean? What does that look like?

Dr. Marty Makary [00:38:17]: Well, we desperately need NIH reform because we're not talking about the big topics in healthcare that we need to be talking about. I wrote this book because we're ignoring giant issues. We're ignoring big issues around the microbiome, pesticides, chemicals, processed food, heavy metals. We have an epidemic of chronic disease. And as long as we only fund medications and the hammers that doctors have on the very end of medical illness to play whack a mole, we're missing a giant problem, and that is that 1 in 22 kids in California now is born with autism. Who's working on preventing that or figuring out what's going on.

Ben Greenfield [00:39:00]: And this is not a case deal manning this of increased awareness of and recognition of the issue of autism. This is not an over diagnosis issue. This is an actual increased prevalence of.

Dr. Marty Makary [00:39:14]: Autism with the severe autism, for sure. With you take other psych diagnoses, and it may be a combination we made, for example, oppositional defiant disorder. What is that?

Ben Greenfield [00:39:29]: AKA being a kid who is a human being designed for eventual independence?

Dr. Marty Makary [00:39:35]: Right?

Ben Greenfield [00:39:36]: Yeah.

Dr. Marty Makary [00:39:37]: So we've got to change what we're doing. In my field of pancreas cancer, for example, we do a lot of pancreatic cancer at Johns Hopkins, more than any hospital in the country, we've got the best experts. I love my partners, but at any point, has anyone stopped to ask, why has pancreatic cancer doubled in the last two decades? And when I posed that question to our group, my friends, it's as if nobody had ever thought of it. And certainly we haven't given doctors the time and resources to investigate that. But that is the big question, not how you cut out pancreatic cancer or what chemo to use. That is the big question. And it's going on with every disease in medicine, autoimmune diseases, obesity in children. Half of kids are overweight or obese.

Dr. Marty Makary [00:40:29]: Now, what's causing that? And at some point, we as doctors, have to look around, see what's happening, and be empowered. The NIH has to fund these important studies. Doctors need to be encouraged to look into these things. Instead. We do a terrible thing to doctors. We tell them to put their head down and bill in code and maximize throughput. And we measure them by these crazy work units called RVUs.

Ben Greenfield [00:40:56]: Well, doctors or physicians, practicing physicians are obviously able to play a role in collecting patient data that could be used in research. But aside from perhaps the somewhat rare case of, say, like the MD, PhD, or should it be the physician's role to be engaged in this research, or should that be set up as a separate scientific arm?

Dr. Marty Makary [00:41:22]: All of the above. I grew up in rural Pennsylvania, Ben, in the coal mine region, and there's a type of coal there called anthracite, which burns a lot more well than the typical B type cold. And so, going to the mall, my mom driving us to the mall, I noticed that there was smoke coming out of the ground. And I asked her mom, what's that smoke coming out of the ground? She said, that's the Centralia mine fire. It's been burning for a long time, and it's going to burn for hundreds of years. They can't put it out.

Ben Greenfield [00:41:57]: See, me as a dad. I would have said something like, the devil is mad at you. I like to bring my kids down very non-scientific roots. Okay, so your mom gave you a thorough explanation.

Dr. Marty Makary [00:42:08]: So this is like 15 minutes from our house, right? So my dad, who's a doctor in town, sees all of these crazy cases of rare leukemia and a type of leukemia that he believes must be associated with this coal mine toxin that's floating up. I figure somebody's going to put the pieces together, somebody's going to figure out a solution. When I get to med school, it's still an open question. I realize nobody is interested in these big questions. And to this day, like, nobody looks, nobody puts the pieces together and asks the questions that need to be asked. My first day of med school, we're dissecting the lung in a cadaver, and some of the lungs have this fleshy appearance, and others are black. And it's so startling. I remember the professor saying, oh, don't worry, that's just from living in a city.

Dr. Marty Makary [00:43:05]: The lung turns black among city dwellers, but it's not bad for you. And I thought, how dismissive. Like, do we really know? And you realize people are not asking the big questions that we need to be asking.

Ben Greenfield [00:43:20]: Yeah. Is there a way to arrange this in such a way that there is a mechanism or a better mechanism for independent donors or even something like the modern crowdfunding approach to allow for this research to take place?

Dr. Marty Makary [00:43:36]: Yes. So that is a bright spot right now. My research team at Johns Hopkins, which is dedicated to addressing the blind spots, the big areas of medicine that we're not talking about that we need to talk about. We're funded entirely by philanthropy, and so we're able to do really creative work. And we were able to pivot rapidly to the opioid epidemic, to the COVID epidemic. The old system of the NIH grants and you apply over the course of a year, and you do the grants in the right font and margins, and then you find out a year later, and then these are small, incremental studies. That's not working. We need big ideas.

Ben Greenfield [00:44:16]: Yeah. Deja vu. The discussion I just had two weeks ago with Azra Raza, the author of first sell, she's terrific. Yeah, she's terrific. Fantastic. Real quick, while we're talking about this idea of your institute, is there a website for it that we can name or link to in the podcast?

Dr. Marty Makary [00:44:31]: Yeah. Restoring Medicine, the redesign of healthcare. I will give you the website, but we call it the Redesign of Healthcare.

Ben Greenfield [00:44:40]: I'll put it at bengreenfieldlife.com/blindspots. We've still got a little bit of time. Out of the forest, back into the trees. Just a few other questions for you. This idea behind breast implant illness, I'm bringing this up because I did release an interview again just several weeks ago with Dr. Robert Whitfield, who specializes in breast explants based out of Austin. He reported on all these fuzzy, mold covered silicone implants that he pulled from women, pleiotropic effects of all of these, across everything from brain fog to gut issues to endocrine disturbances, etc. And then you seem to indicate in the book that perhaps this idea of breast implant illness is overblown.

Ben Greenfield [00:45:28]: So I'm trying to navigate this now. And kind of similar to the tongue tie question, what's going on with breast implant illness, and why do you write about it in the book?

Dr. Marty Makary [00:45:37]: Well, I wrote about it because the FDA banned breast implants, silicone breast implants, in the 1990s, arguing there was no long-term data, that it was safe, and the silicone implant had already been given to over a million women. Surgeon said, we have long term experience. We are not seeing these, a rash of these side effects that people claim. Well, at that same time, the FDA approved OxyContin based on a 14-day follow up study and approved it for chronic pain. And it just shows how erratic our regulatory process has become. Now, after silicone breast implants were banned, there were a bunch of large studies that were done to try to understand whether or not these claims of increased autoimmune diseases and chronic fatigue syndrome was actually just the normal prevalence in the population of these things or truly associated with the implant. And it found they were not associated with the implant. The class action lawsuit was thrown out.

Dr. Marty Makary [00:46:44]: You know, like 440,000 women out of the million who had a silicone implant had signed on to the class action lawsuit. Turns out lawyers were trying to get rich.

Ben Greenfield [00:46:55]: Okay, got it. Interesting. So this doesn't necessarily mean. And then there are other forms. This might be kind of a stupid question. I'm trying to recall. There are other forms now of breast implants besides silicone, right?

Dr. Marty Makary [00:47:06]: There are. But silicone is the implant of choice because of the softness and the contours of it sort of replicate, you know, duplicating the natural contours of the breast tissue. So, to this day in America, almost 3% of women, of adult women have a silicone breast implant.

Ben Greenfield [00:47:27]: And it's not banned anymore, is it?

Dr. Marty Makary [00:47:29]: It's not banned anymore. Finally got back on the market when people realized, when the studies came out showing no association with autoimmune diseases or these other illnesses.

Ben Greenfield [00:47:39]: Do you think additional research is necessary on that, or if research should be done on something beyond just autoimmune illnesses?

Dr. Marty Makary [00:47:46]: Look, I always think we need to study what we're doing instead of just taking the industry's word for it. I have heard from some plastic surgeons that if a woman has silicone implants, their spine may not be built for that added weight and a different center of gravity in their musculoskeletal frame, so they might have more back pain. Those are things that I think deserve better study.

Ben Greenfield [00:48:09]: Yeah, yeah, obviously, that's solvable with some. Some core training to go along with your new D cup. Uh, but, you know, I get more concerned about some of the stuff Whitfield talked about. That obviously is anecdotal. You know, he's pulling this stuff out in his surgical clinic. But, yeah, it's.

Ben Greenfield [00:48:24]: It sounds like breast implants just need more research. I mean, if my wife were to ask me today, I'd say, well, proceed with caution, you know, because I've got on one hand this big study that says there's no breast implant illness, at least for autoimmune disease. And then I've got this other doctor who's telling me about dozens of cases a week where he's, you know, fixing women and doing these explants that have what he reported as some kind of a mold or something like that on them. So it sounds to me like it's kind of, kind of yet another area that needs more research.

Dr. Marty Makary [00:48:53]: You know, we get this pile on effect. There were claims that women were developing autoimmune diseases and rheumatoid arthritis, and there was a suggestion it was from the breast implant. So there was a pile on effect. And then finally the studies caught up. At the same time, we sort of lose sight of some giant areas of where there's health benefits that we don't talk about at all. For example, hormone replacement therapy.

Ben Greenfield [00:49:18]: Oh, yeah, that was a fiasco, wasn't it?

Dr. Marty Makary [00:49:21]: Giant fiasco. There's probably no medication that has improved the health of a population more, the exception of antibiotics, than replacing a woman's estrogen or estrogen plus progesterone. In menopause, women live longer, they feel better, they have stronger bones. The rate of heart attacks goes down, cognitive decline goes down by 50% to 60%, the rate of Alzheimer's goes down by 35% in one study, and they feel better. It alleviates the symptoms of menopause. But tragically, the one doctor said it caused breast cancer, even though his own study that he pointed to did not have a statistically higher incidence of breast cancer.

Ben Greenfield [00:50:01]: Remind me the details of the flaw in that study, and I believe it was even the form of hormones being used might have been different as well. Something like the pregnant horse urine extract or something along those lines.

Dr. Marty Makary [00:50:13]: Well, they, in my opinion, they used the wrong type of estrogen. They used horse estrogen, not the type that mimics the body's natural estradiol. They started it way too late. At an average age of 63. You need to start hormone replacement therapy within several years of menopause. Within ten years of the onset of menopause. And so they said, oh, we saw all these other problems with taking estrogen. Well, you started it too late.

Ben Greenfield [00:50:35]: Within ten years of the onset, you don't need to predict menopause ten years in advance, but when you start to display symptoms, you would want to be on top of it within the next ten years, is what you're saying.

Dr. Marty Makary [00:50:48]: That's right. Within ten years, replacing your own estrogen or estrogen plus progesterone, depending on other factors, results in women feeling better, living longer, being healthier, having stronger bones, and reducing cardiovascular disease, which is the number one cause of death in women. And yet, it's amazing 80% of doctors don't prescribe it because of this one doctor who held a press conference 22 years ago claiming that it increased the risk of breast cancer when his own study never showed that, he misrepresented the data in his own study. And I interviewed him for the book, and people can learn more about it.

Ben Greenfield [00:51:30]: How did it gain such mass adoption, though, that flawed study?

Dr. Marty Makary [00:51:34]: Well, breast cancer is so scary that if you dangle that out there, as he did now, he believed it caused breast cancer before he did the study. I showed how he had written about it. You know, we have to stop the hormone therapy bandwagon. He had written years before the study was done, before it was final.

Ben Greenfield [00:51:53]: He'd already argued himself into the results of the study.

Dr. Marty Makary [00:51:56]: Cognitive dissonance. Yes.

Ben Greenfield [00:51:58]: He did that. Yeah. Yeah. Interesting. Okay. Yeah. And then breast cancer became the scary part. So, a few minutes left here.

Ben Greenfield [00:52:07]: I got to ask you your take on this. I know there's an entire history and story behind this, but after having written the book, would you have an egg yolk omelette for breakfast?

Dr. Marty Makary [00:52:20]: Yes. Yeah. I love that.

Ben Greenfield [00:52:22]: Tell me why you're not going to die of a heart attack.

Dr. Marty Makary [00:52:24]: So, eggs, because they are a source of natural fats, especially the yolk, got demonized in this medical dogma that natural fat is the biggest driver of heart disease and that the cholesterol in food is bad for your health. Turns out they tried to do three large studies to prove that, correct. None of those three studies found an association, and yet they were sort of in too deep. They just kept saying it. And only recently did we recognize this is totally backwards. They got it perfectly backwards. It's the refined carbohydrates, which things like added sugar, the flour, which functions like added sugar because it's stripped of fiber and its nutrients, and that's why it's addictive.

Dr. Marty Makary [00:53:15]: And you don't feel full when you're done eating it. That's probably what drives body inflammation. Along with all the other things that go down our gut, which are not natural, the body may be responding with that reaction, increasing general body inflammation. And guess what, heart disease is inflammation of the wall of the coronary artery that enables certain lipoproteins to deposit.

Ben Greenfield [00:53:42]: Yeah, I believe it's Ben Bikman, who has a pretty good book about the link between inflammation and insulin resistance, which is, of course, a big issue as well. But there was a study, was the Minnesota Heart study that you brought up in the book that I believe proved the opposite of what folks like Ancel Keys, leading up to that point, had been suggesting that high fat intake was linked to heart disease.

Dr. Marty Makary [00:54:03]: Yeah. Ancel Keys was the champion of this low fat diet. And so at his institution, the group there, University of Minnesota, led this Minnesota heart study, randomizing people to a low fat diet or a standard diet. And this was supposed to be the end-all study. That final, you know, ended all debate and proved that natural fat caused heart disease. Well, there was more heart disease, heart attacks, fatal heart attacks in the low fat group. It was opposite of what they expected. But the study was not published for 16 more years after the data came in.

Dr. Marty Makary [00:54:41]: And when my friend Gary Taubes asked the senior author, Dr. Franz, why did you wait 16 years to publish it, he said it was just because we were disappointed in how the data turned out.

Ben Greenfield [00:54:54]: I'm getting a deja vu from the I don't know why I'm on this committee question. Right. Okay. So once again, he said. He said they didn't know how to interpret the findings.

Dr. Marty Makary [00:55:03]: No, he just said they were disappointed. They were disappointed that they were, yeah, that they were opposite. Yeah. Of course it didn't support the hypothesis, but that's science. That's the scientific process. You have to evolve your position as the data come in.

Ben Greenfield [00:55:17]: Yeah. And obviously, based on statistics, much of this is. It goes beyond the so-called baby talk, all or nothing, black or white, you know, you're no doubt aware of this, Marty. Like, certain people have a genetic predisposition, such as familial hypercholesterolemia or an APOE4, you know, homozygous gene mutation or something like that, that would predispose some type of inflammation or, you know, high ApoB or something like that in response to high intake of fats. So we can't paint with a. With a broad brush either. Right?

Dr. Marty Makary [00:55:47]: That's right. And at the same time, there's a couple blood tests everyone should get if they haven't. Or next time you get your blood work done, add a lipoprotein A and ApoB. Those are two powerful predictors of early heart disease. Your insulin level is probably one of the most important things we should be tracking. What is your insulin level? High insulin levels are bad. I.

Dr. Marty Makary [00:56:09]: And there are tests to look at certain toxins, like the GGTP and liver function. Looking at liver function testing is important. So it's not the old HDL, LDL.

Ben Greenfield [00:56:23]: None of this is difficult. I mean, literally, 5ft from me, I've got two boxes on my shelf, because I do, every six weeks, I send them these tests. They're called Siphox. And I do a few blood spots for my finger. It's kind of funny. I literally go in my sauna and turn the sauna on so my fingers bleed more quickly, and just cover the blood spots, let them dry, stick them in an envelope, ship it off, and within two weeks I've got most of the same parameters, including all of those you've just listed that I would have had to have made an appointment and driven to the lab to get five years ago. So the book is fantastic.

Ben Greenfield [00:56:59]: Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health. Obviously, if you're listening, the call to action I would encourage for you, is not only to read or listen to the book, but Marty will send me a link to his website. And if you'd like to go and learn about how you can participate in helping to remove some of these Blind Spots and change the future of healthcare, I would love for you to visit his site as well and get to know more about what he is doing, because I do think it's a noble quest. And I think that if a lot of podcast listeners, and I'm sure you'll be on other podcasts, Marty as well, start to band together and read or start to band together, we can make it down. We're not completely powerless, right, Marty?

Dr. Marty Makary [00:57:43]: Yes. Look, people like yourself are disrupting healthcare in a very positive way, asking big questions. And we need to ask big questions. Can we treat more diabetes with talking about cooking classes instead of just throwing insulin at people? Can we finally start talking about school lunch programs instead of putting every kid on ozempic? So these are the big topics now. Can we talk about environmental exposures that cause cancer, not just the chemo to treat it? These are the big questions now we're starting to ask. Thanks to a more decentralized, open, civil dialogue about health and food and the stuff we don't get taught about in med school. The big blind spots of medicine. So thank you, Ben, also for what you're doing.

Ben Greenfield [00:58:29]: Yeah, for sure, man. Well, keep up the great work. It was a pleasure talking to you. I could tell from reading your book that we get along. And the website, for those of you listening is bengreenfieldlife.com/blindspots. I'll link to the book. I'll link to Marty's website. Anything else that we brought up during the show, some of my other podcasts, like the one on tongue ties and breast explants that I mentioned. All the juicy show notes are bengreenfieldlife.com/blindspots.

Ben Greenfield [00:58:54]: And until next time, I'm Ben Greenfield, along with doctor Marty Makary, wishing you an incredible week.

Ben Greenfield [00:59:01]: Do you want free access to comprehensive show notes, my weekly Roundup newsletter, cutting edge research and articles, top recommendations from me for everything that you need to hack your life and a whole lot more, check out bengreenfieldlife.com. It's all there. Bengreenfieldlife.com. See you over there. Most of you who listen don't subscribe, like, or rate this show. If you're one of those people who do, then huge thank you. But here's why it's important to subscribe, like, and or rate this show. If you do that, that means we get more eyeballs, we get higher rankings, and the bigger the Ben Greenfield Life Show gets, the bigger and better the guesthouse get and the better the content I'm able to deliver to you. So hit subscribe, leave a ranking, leave a review. If you got a little extra time, it means way more than you might think. Thank you so much.

Ben Greenfield [00:59:47]: In compliance with the FTC guidelines, please assume the following about links and posts on this site. Most of the links going to products are often affiliate links, of which I receive a small commission from sales of certain items. But the price is the same for you, and sometimes I even get to share a unique and somewhat significant discount with you. In some cases, I might also be an investor in a company I mention. I'm the founder, for example, of Keon LLC, the makers of Keon branded supplements and products, which I talk about quite a bit.

Ben Greenfield [01:00:30]: Regardless of the relationship, if I post or talk about an affiliate link to a product, it is indeed something I personally use, support and with full authenticity and transparency, recommend. In good conscience, I personally vet each and every product that I talk about. My first priority is providing valuable information and resources to you that help you positively optimize your mind, body and spirit. And I'll only ever link to products or resources, affiliate or otherwise, that fit within this purpose. So there's your fancy legal disclaimer.