The UltraMind Solution | Dr. Mark Hyman | Talks At Google

[applause] >>Liv Wu: Hi, everyone. [applause] >>Liv Wu: Hi, everyone. I’m Liv Wu, Executive Chef, and I’m excited and delighted that Mark Hyman accepted our invitation to speak to us as part of our Optimize Your Life, Health Speaker Series. I first met Mark at a health conference and was struck by-by this man’s extraordinary level of enthusiasm and energy. He talks fast. And-and how just passionate he is about health and well being. He tells a compelling story about finding and living in ways that optimizes all our systems and-and-and drive us to perform well and feel well and thrive.

I don’t think I’ll ever encounter the word “ultra” again without thinking of-of Mark. He’s kind of the ultra guy. [laughter] The gains, the greatest gains in 90% of medicine and longevity have been about cleaning up; cleaning up the inner and outer environment. And in the early 20th century it was about clean water, basic sanitation, getting rid of infections. And so now at the dawn of the 21st century we need to look at cleaning up again. From processed, highly refined, chemicalized foods we consume to the air we breathe, and-and all the other toxicities that are, that are part of our world.

Mark combines his training in conventional medicine with cutting edge genetics and nutrition, and tells us why and how we should clean up within and without so that we can really perform as ultra human beings. Mark is a four-time New York Times best-selling author and Chairman of the Institute for Functional Medicine which is a very exciting new field; a real paradigm shift in-in medicine. He has dedicated his career to identifying and addressing the root causes of chronic illness through a groundbreaking whole systems approach that he calls “functional medicine.” He is also Founder and Medical Director of the UltraWellness Center. He advises Dr. Oz-Oz’s HealthCorps group and he is nominee to President Obama’s advisory group on prevention, health promotion, and integrative and public health. Welcome, Mark.

[applause] >>Mark Hyman, M.D.: Thank you. Thank you. So as I was, I do talk fast so they-they told me you were smart enough you could handle it so I think it’s, I should be okay. Now as I was getting my talk ready I realized that Googlers know more about the future of medicine than most doctors do. And they know that because Google is very much like the future of medicine. In medicine we have a new model that’s emerging we call P4 Medicine which is personalized, it’s predictive, it’s preventive, and it’s participatory. In the same way of Google, it’s very personalized. You-you get to find out exactly what you’re looking for at the moment you’re looking for it.

It’s also predictive ’cause it predicts, what Google is [inaudbile] exactly what you’re looking for and it allows you to identify exactly what you wanna find at any moment. And it’s also preventive ’cause it prevents you from going down all sorts of roads looking for data and information that isn’t relevant to you. And it’s also participatory ’cause you have to take action based on what you find and what you do. So Googlers actually have created a system that models the future of medicine ’cause the future of medicine is going to be personalized. It’s gonna look at your genetics, at your environment and how those variations affect your health in this moment.

The future of medicine is taking the data in your story which is called narrativomics this, the data in your narrative, in your story and making sense out of that and seeing the patterns in that. The future of medicine is about genomics and all the omics: the proteomics, metabolomics, the phenomics, which is really looking for the patterns in the data which is exactly what you do here. And it’s also preventive because we’re going to be able to understand how to best look at a health map on a predictive model by looking at all the data points in your story and in your file markers, and tracking that forward to see what your health risks are and how to create a personalized plan to help you get healthy and stay healthy. And it’s also participatory ’cause it means you need to be engaged. It’s not just taking a pill that your doctor gives you because you’re gonna treat some symptom of some disease and not-not to do anything else except pop that pill. So it’s very participatory and you have to be an engaged user of health care.

So this is, so what struck me this morning at about 6 o’clock in the morning and-and made me realize that the talk today you guys are gonna get it because it really reflects what you guys already do and already know, but it-it’s the medicine of the 21st century. And the unfortunate fact is that it takes about 20 to 50 years before a medical discovery gets implemented in practice. It took 50 years for the stethoscope to begin to be used. And-and the future of medicine is-is not going to be creating a hypothesis, as we do now, and then doing a study and collecting data and analyzing the data. It’s gonna to be looking for patterns in the data that already exists and the patterns in your story and the patterns in the biomarkers and using the computational power we have now to create a model of thinking about disease, disease patterns, and connections and relationships and linkages in ways that we don’t now. Because medicine is completely is completely solid as I’ll share with you in a minute. Now this is happening all across the world. You may not have heard of it. You may not be familiar with it in the words that I’m speaking to you about it, like functional medicine or P4 Medicine, but you’ve heard about the concept of systems and of a systems biology.

And schools like Johns Hopkins have created an entire new medicine school curriculum to map to this new concept called Genes to Society. And we don’t realize this but medical education was established in 1910 and the-the model of education we have now is pretty much the same as it was then. If you wanna know how a doctor practices you just look at the early graduate of medical school and things are very difficult and slow to change. So they’re tryin’ to shift that and tryin’ to understand how the environment interacts with our genes in any moment to create our phenotype.

This is really the-the concept of the future of medicine which is the moment of health that you have now, the person you are right now, is created by your lifestyle and your environment, toxins and everything in your environment, washing over your DNA to create the person you are in this moment. And that it’s really a continuum of illness not simply on or off, you have this disease or you don’t. One day you have, don’t have diabetes, the next day you don’t. One day you-you’re free of cancer and the next day you have cancer. That’s not how disease works. It’s a continuum of shift from optimal function all the way to full blown disease. It’s the medicine of-of why not what. We’re trained as doctors to say, “What disease do you have? What drug to I give you?” Instead of, “Why is this happening? Why does this particular person have this particular symptom at this moment. What are the underlying causes? What are the mechanisms and pathways and connections that we can use to link together this information to understand what’s really at the root of disease? And this is happening all over the world. Over 40 countries have participated in educational programs at the Institute for Functional Medicine. There’s 31 medical ed-educational institutions that have been involved. There’s over 13 residency programs that are exploring this. So this is out there.

And today I wanna take you through the lens of the brain and show you how this model applies. And it applies not just to the brain, but to all chronic diseases; all the things that are our pain points as a nation, as a, as a world which we’ll share globally. I don’t know if you know this but by 2020 there will be less than 20 million who will die from infectious disease. But over 50 million will die from preventable, chronic illnesses, and reversible chronic illnesses like heart disease, diabetes, and cancer. So it’s not just in America, it’s globally. So how do you power up your brain? It’s important to focus on prevention because often as I’m gonna show you with this patient it’s difficult and it can be too late if you wait too long you can end up with re-irreversible problems with your brain.

And-and hopefully you haven’t gotten to this stage yet about where we can do a lot. Now this is a, no joking, this is a big epidemic. There’s 1.1 billion people in the world who have brains that aren’t working; they have depression, they have ADD, they have dementia and there’s all sorts of other spectrum of brain disorders along the continuum of brain dysfunction. And the question is how is your brain working? I mean it’s probably a good brain to start with or you wouldn’t be here, but is it working as well as it can and if not, why not? And how can you make your brain work better? Maybe you have mood issues, maybe you have a little trouble focusing, maybe you have trouble sleeping, maybe you have trouble with energy, maybe you have trouble with even cognitive focusing and-and memory. Now we have a lot of insults to our brain and there’s a lot of damage that happens as a result of things that we do. And there’s a way we can understand how to change that. When our brain aches we don’t really feel pain, but it shows up as mood problems or focus problems or attention problems, right? If you’re, if you have a sore throat your throat hurts. If you have a toothache, you’re tooth hurts, right? But if you’re, if you’re brain hurts what happens? You have ADD, you have autism, you have depression, you have dementia, you have cognitive loss. These are things that happens to your brain as your system becomes imbalanced.

And so what we’re gonna learn about is how if you change your body it’ll change your brain. The inputs you put into your system create the outputs. And if you change the inputs you’ll get different outputs in terms of cognitive function, mood, attention, memory, behavior, and so forth. So I’m gonna talk to you a little bit today about a pretty radical idea. But I think you guys are up for it; which is that the way we think about disease really is passé. In fact and recently at a conference a CEO of a major drug company said that in the future there’ll be no more drugs for block buster diseases only drugs for block buster mechanisms. And the reason for that is that diseases don’t exist. Not really in the way we think they do because just the way the world looks flat and it’s not and just the way it-it appears that the earth seems to be the center of the universe, it’s really not. Diseases also appear real but their simply the downstream effects from upstream mechanisms and causes. So we’re gonna talk about how your brain works and how we do things that harm it and what we can do to help it and how we can optimize your brain function, your focus, your mood, and your performance.

So the way we do this, and-and I’ve written about this in the books. Many of you got lucky to sit in a seat with the UltraMind book which this is what this is and the other ones have the weight book. I don’t know if it’s applicable to you, but you can swap the books around and this is a personalized prescription for creating a powerful brain. It’s-it’s not a generic program; it’s something that can be personalized and-and individualized to match your specific issues. And we’ll talk about why that’s important. And it’s based on this notion that P4 Medicine, which its clinical model is functional medicine. Most of what I’m gonna tell you is in the book. There’s over 400 references in the book; there-there’s really based on seeing thousands of patients over 15 years using this model. Here’s the practice that I have in Lennox, Massachusetts which is having an ice storm now so I’m thankful I’m not there.

So the basic notion here is that if you change your body, you’ll change your brain. We all know that the mind influences the body but we don’t think so much about how the body influences the mind. And someone mentioned to me earlier that they were having depression and that they were gonna go see a psychiatrist and they were probably gonna get a drug and said, “Gee if I knew that I could change what I’m doing to change my mood, I might do that.” So people don’t really make the connection between what the inputs are and how they feel. We sort of don’t think about it. Somehow we wait until we get sick to really think about our health, but we don’t notice that all these subtle problems and symptoms and conditions that we suffer from are really fixable by addressing the underlying cause. If you guys want a copy of the slides you can go to drhyman.com/google to-to get a download so you don’t have to write everything down.

So this is a pretty shocking idea, but diseases don’t really matter anymore. As we understand the body as a system our notion of disease is-is taking flight and it’s, and it’s shifting from understanding disease as a discreet set of different conditions to understanding the underlying pathways and systems underneath it. So my hypothesis today is that there really is no such thing as depression. There’s no such thing as bipolar disorder. There’s no such thing as ADD or autism or dementia; that these are really systemic illnesses that happen to affect the brain. And that you have to treat the system in order to fix the problem. So we get stuck in this whole concept of the name it, blame it, and tame it. We name the disease and then we blame the name for the problem, and then we try to tame it with a drug. And-and we don’t think in a complex way in medicine. We get really focused on one disease, one drug model which is really 19th century diseases.

The bacillus that was discovered by Louis Pasteur and was treated with antibiotic that seemed to work, so we try to apply that to all the rest of medicine. But that’s actually not how the body works. And-and we really good at labeling things and naming things. There’s this category of psychiatric diseases called DSM-IV and I was sitting at dinner with the-the head of the National Institutes for Mental Health in Washington a few years ago and I said, “Dr. Insel what do you think of this book the DSM-IV which is the Bible for psychiatrists? He said, “I think it has a 100% accuracy but 0% validity.” Meaning it’s very good at describing the symptoms people have and putting them into groups according to their symptoms, but it tells me nothing about the cause for those problems or even really how to think about them in a way that works. And this is an article from my favorite alternative medical journal, the Journal of the American Medical Association, which has all sorts of amazing things that people just don’t pay attention to. And-and they-they-they talk about dementia in this article and-and our shifts in thinking about it and how when we study dementia and we look at ginkgo or fish oil or this or that it doesn’t seem to work. Or we use this drug or that drug. It’s because dementia doesn’t really exist the way we think it does. It’s simply an end result of a whole series of insults and many different kinds of insults that can lead to the same common symptoms.

So in this article they talk about how that-that we classify things incorrectly and we’re not very good at talking about the cause. This is categorical misclassification and etiologic imprecision. Meaning we classify by symptoms instead of by cause which is really what we’re going to be doing in the future. So let’s just take an example. You go to the doctor and you feel sad and helpless and hopeless and you’re not interested in life and sex and food anymore; you can’t sleep well; and you even have thoughts maybe of killing yourself from time to time. And your doctor goes, “I know what’s wrong with you. You have depression.” But that’s not what’s wrong with you, that’s just a name of those collection of symptoms. It doesn’t tell you anything about the cause. It tells you what, it doesn’t tell you why. So for example, someone who comes in with depression might have many, many causes. You might be, for example, eating gluten and you might have a genetic susceptibility to create problems from this which creates an autoimmune disease that attacks your thyroid that causes you to have low thyroid function that can lead to depression. And the treatment is getting off gluten and treating your thyroid.

Or you might be having reflux for years and taking an acid blocking pill which inhibits B-12 absorption which leads to depression. Or you may live in Seattle or work inside all the time, although you guys are out playin’ volleyball so maybe you get outside and get some Vitamin D, but you might have a Vitamin D deficiency and have depression and need Vitamin D. Or you might be taking antibiotics for acne or have frequent colds or sinus infections and take antibiotics that destroy your gut flora. And that changes the microbiome in your gut and changes the regulation of the immune system in your body that leads to inflammation. And an inflamed brain is also a depressed blane, brain.

Or you might love sushi ’cause I see you had lunch today and may be full of mercury. And mercury can cause depression. Or you may hate fish and have Omega-3 fat deficiency because you don’t like fish. And Omega-3 fats are critical for brain development and mood. Or you might love sugar and eat lots of sugar and soda which actually leads to something called pre-diabetes or metabolic syndrome which has been cause of depression. So the treatment and the diagnosis of each of these things is very different and you have to ask the question why, not what. So in-in medicine we come up with a lot of solutions and often we find out they may be the wrong thing later on.

This is an ad from 50 years ago that more doctors smoke Camels than any other cigarettes and 113,000 doctors are coast to coast. So you can substitute more doctors recommend Prozac or Lipitor or any other drug for this or that and in 50 years how are we gonna be looking at this? In fact think about it, is depression a Prozac deficiency? Right? Is it, is this a drug deficiency or is it some other imbalance in your system that’s driving this? Now in the future we’re gonna be shifting away from just saying, “You have depression. Take this antidepressant,” to “Oh this is a-a symptom of some other factors. Let’s find out what those factors are. Let’s look at your whole biology as a system.” This is called systems biology. And redefine disease based on causes and mechanisms and not on labels. And we’re gonna be shifting from the silos we have which are all the ologies, the specialties, that we have in medicine and we go to a doctor for every different part of our body. We take a pill for every ill. We’re gonna shift into thinking more about complex networks and systems. We’re gonna be moving away from the 12,000 labels of diseases we have in our code book to an understanding of biology as a, as a network or a system.

And it happens at a, at a very fundamental level. We’re-we’re discovering this in biology that your-your physiology is a web; that it’s a network and that it happens at a genomic level, at a metabolic level, at a disease level, and there’s patterns that connects all of these different pathways and things together and link them together. And there’s also a network at a social level. In fact if your friends are overweight you’re more likely to be overweight than if your relatives are overweight, or your mother or father’s overweight. So there’s a huge component of-of-of understanding the networks and connections between things that are important. So just as, for example, depression can be caused by many different factors. One causative agent can trigger many different diseases. For example, gluten can cause depression.

It can also lead to autism. It can also cause rheumatoid arthritis. It can lead to osteoporosis. It can lead to irritable bowel syndrome or even inflammatory bowel syndrome. Sorry some of you guys are eating lunch. And even heart attacks, and cancer, and dementia. In a recent study of 30,000 people they found that people who had low level reactions to gluten, not even a full blown celiac disease, had between a 35 and 72% increase in their risk of death from heart disease and cancer. So we have to reframe how we’re thinking about these things.

You can go to the doctor and have all these different conditions, you’re gonna get a certain specific treatment based on suppressing the symptoms. You’re not gonna get a treatment based on the cause. And so for all these conditions you might have a result of relieving the symptoms by treating the-the gluten problem. And this is not just applicable to mood issues. It’s across the whole spectrum of what we call the B-O-I which is the Burden of Illness, including the big cost drivers and-and-and things that drive suffering and disease like obesity, heart disease, diabetes, depression, and mood disorders which are rampant; I mean the second leading category of pharmaceuticals are psychiatric drugs. And then of course these arise in allergies and asthma and respiratory illnesses, digestive disorders. I was shocked to find that one of the biggest cost drivers for a major insurer was reflux and heart burn which is a treatable condition not using PPI’s or acid blocking drugs but-but using the approach that I’m talking about.

Cancer, back pain, migraines, and all autoimmune disease which affects 24 million people collectively like rheumatoid arthritis, lupus, and MS, and so forth. These are all things that-that have really very poor treatments in conventional medicine, but in this new model of systems thinking that we addresses the underlying causes; a very powerful approach. So the question is: do you suffer from brain damage, and if you do, what can you do about it? Now this is what our brain should like, look like, and this is what it may look like if you’ve taken too many drugs or maybe drink too much alcohol or don’t get enough sleep or drink too much sugar or on and on and on. And-and the good news is though, that if you’ve injured your brain you can repair your brain.

This concept of neurogenesis is very critical in-in the research. And even in people who are dying they’re making new brain cells. People who have cancer they, they’re-they’re dividing neurons through a special tag, biochemical tag, and they find that in rapidly dying people there are actually new dividing cells in their brains. And there’s also the concept of neurotrophic factors: things that enhance and optimize our brain function. We were talking about that at lunch. There’s a molecule for example in coffee and-and in actually the coffee bean and in-in curcumin and in fish oil that actually help regulate pathways that improve your brain development and improve connections. So you have both new brain cells, which is neurogenesis, and-and new connections, which is neuroplasticity at any age. And the cause of our problem with brains is-is really not a chemical imbalance in the way we think it is. There’s not a Prozac deficiency. But it’s a, it’s a series of insults that happen over time. It’s our nutrient depleted diet. It’s our toxic environment, heavy metals and pesticides; it’s our unremitting stress. It’s various triggers that upset our immune system such as allergens or-or infections. And in many of the things we eat: high fructose corn syrup, sugar, trans fats, food additives, pesticides, hormones, all influence our brain function.

Also things we do everyday affect it: our sleep cycles, our circadian rhythms, levels of stress, not-not exercising. Exercising is one of the best things you can do to actually prevent Alzheimer’s. And a brain trauma, I saw somebody fall off a swing today out there. I was a little worried, but brain trauma is not good for your brain and I know they’re your most important assets. You wanna be very careful. And in certain drugs we use: nicotine, caffeine, alcohol, in some ways are all injuring to the brain. Caffeine has a, is a double edged sword. It may help regulate certain pathways that control inflammation, but it also may damage you by decreasing dopamine and that leads to needing more coffee and then having this sort of crash and burn cycle where you basically get a little boost and then you-you fatigue and then you need more coffee and it eventually doesn’t work. So you have to be careful. There’s certain medications that can have impact: the statins, and acid blockers, and various things. So, also heavy metals and toxins.

So we really have to understand that depression, ADD, and autism and dementia are not really diseases they’re really just symptoms of some underlying imbalances. And they can be nutritional imbalances and this is really the crux of-of the story here. And this is what I-I talk a lot about in-in my books and which is the foundation of functional medicine is reorganizing biology into a series of-of nodes within the network of-of our physiology and the webs of our physiology. And these nodes are really the places we wanna look for problems in nutritional status.

We wanna look for problems with B vitamins and Vitamin D and zinc and magnesium and Omega-3 fats. We wanna look for triggers of inflammation in the brain like gluten and food sensitivities and infections and toxins and sugar and molds. We wanna look for hormonal imbalances like thyroid, adrenal, and sex hormones and problems with sugar. Even our gut and I’ll talk some a little bit about how the gut plays a role in-in our brain. And then of course toxic injury: heavy metals, pesticides, molds, loss of energy in our cells, very important. And loss of energy in our cells and our capacity to produce energy creates a decreased brain function and performance and then any sort of chronic or acute stress.

So these are the areas that we pay attention to and we-we navigate to and filter our information through a new set of lenses. And the problem with medicine is that the treatments we use don’t match the cause. So if you’re eating gluten and you have depression, taking Prozac’s not gonna help. Or if you have a folic acid deficiency, for example you get a 6% benefit from an antidepressant. If you actually correct the folic deficiency the benefit of the drug goes up 44%. But I say, “Why not just try the folic acid first or the folate first and then if it doesn’t get better use a medication?” So let me make this a little more granular for you and show how this works in a particular story of-of a boy who came to me with Attention Deficit Disorder. This is a rampant problem. There’s 12 million kids who have problems and this arises in all the whole spectrum of disease like autism over the last 20 years in extraordinarily high rates. We’ve gone from 1 in 10,000 to 1 in 100 kids who have autism.

And the-the-the hypothesis here is that the cure for brain disorders is really outside the brain. It’s by treating your system and your body. So we have to ask, “What’s going on? Why are these kids having this problem?” And this is Clayton; this is every kid in America. He came to me he had 11 diagnoses, he’d seen five specialists, was on eight medications. He had asthma, allergies, anxiety, ADD, and anal spasms, and that’s just the A’s. Now he had lots of other issues: digestive problems, and he had anxiety and fearfulness, and he was very disruptive, he had bad handwriting. And-and these are his list of problems. You can see it’s a very long list and he was a long, a long list of medications at 12 years old. And nobody asked how is everything connected in this boy. Nobody wanted to look at how things are out of balance. How is he sort of off kilter? And-and nobody wanted to understand how we can look at the underlying factors that are driving his symptoms. So we began to do things that put his system back together and it required a sort of set of complex changes that-that looked at the underlying factors.

Now we knew he was on antibiotics, he had frequent infections, he had a horrible diet, he ate junk food, and we knew that-that he’d seen a bunch of people, but no one asked how is everything connected. So we were asking the wrong questions. Now this is the map I used to help figure out what was wrong with him. Which is rather than seeing a specific disease and treating it separately like his ADD and treating that with Ritalin, and his asthma-asthma with a certain inhaler, and his allergies with an antihistamine, and so on. I said let’s take a map and look at how all these things are connected. So it just looks like probably one of your white boards as you’re doing your-your-your programming, but this is a model of-of this little boy, Clayton, who had some predisposing factors of poor diet which led to, and antibiotics for lots of infections when he was younger, which led to disruptive, disruption in his digestive system.

And that led to various disruptions in his immune system. And that led to also to antibody development related to foods and also gluten. So that disrupted his whole system and that affected his-his brain. He also had lead in his system and he had also nutritional deficiencies. And this was obvious just from talking to him ’cause he had, for example, muscle cramps and anxiety and insomnia and-and-and headaches which were all signs of magnesium deficiency. He never ate fish so I knew he had Omega-3 fat deficiency. He was always inside playing video games so I knew he had Vitamin D deficiency. He also had very poor diet, he didn’t eat vegetables, so I’m assuming he had low levels of antioxidants like beta carotene. And he had a high processed diet and it was high in sugar.

So these were all clues to me and patterns that I see and I-I see this disruption in his basic physiology and I wasn’t sort of treating each disease separately I was saying, “How do we create balance back in his physiology?” “I’m afraid that your irritable bowel syndrome has progressed. Your now have furious and vindictive bowel syndrome.” [laughs] And I think what people don’t realize is that an irritable bowel often causes an irritable brain; that the disturbances in the gut flora, in the levels of inflammation in the gut trigger inflammation in the brain. And that leads to mood and cognitive disorders. So we really spent our time looking at all these nodes and this network and this system that are all dynamically interactive. These really aren’t separate things; they’re really just, we’re just using this as a model for thinking about disease, but it’s-it’s a model that-that can explain most chronic illness. So instead of thinking about diseases, I think, “Well what’s goin’ on with his immune system? How’s his digestion? What is his nutritional status? How-how’s he detoxifying? What’s going on with his-his gut?” So these are the things that I really look at. And we found when we looked under the hood, and people say that modern medicine is like trying to figure out what’s wrong with your car while listening to the noises it makes, right? We need to look under the hood a little bit. So not everybody needs all these tests and I just use this for you as an illustration, but I-I’ve been able to actually predict what most of these-these results would be just by talking to him; just by his narrativomics, by his story.

So we found out he had low levels of certain amino acids and low levels of fish oil, low levels of minerals like zinc and magnesium which we predicted; low levels of Vitamin D and E ’cause he didn’t like grains and he had B12 and B6 deficiencies which affect mood. He also had immune disturbance with allergies as we talked about and elevated antibodies to gluten. And he also developed yeast problems in his gut because had lots of antibiotics. And when we checked for mercury and lead we found he had a high level of lead which can really disturb his-his system. Now this might look like one of your white boards too and, or computer program, but essentially this the-the sort of dynamic interactions that happen at a molecular level that drive downstream symptoms.

So let me just sort of walk you through this. This is an enzyme and enzymes are simply catalysts or helpers in biochemical reaction; they turn one molecule into another. If there are things that stop this enzyme from functioning like heavy metals, mercury, lead, it jams that biology and that creates a whole series of things so this wheel can’t turn and you end up, for example, not being able to methylate or turn on dopamine receptors. So you can’t focus or pay attention or concentrate. It prevents the energy production to preventing adenosine which needs to be methylated and so you lose energy in your body in your cells.

It prevents methylation of neurotransmitters so you can’t produce serotonin and-and-and epinephrine and adrenalin which help you focus. And you also can’t produce antioxidants like glutathione which protect you against inflammation and help you detoxify from heavy metal; so this will all jam if something is-is-is poisoning this enzyme. The good news is there are ways to help this. For example, you can unblock it using methylcobalamin which is a special form of B12 that actually can open up the system. And I’ve seen kids for example with attention deficit or autism or behavior issues, you give them the right form in the right way of this methylcobalamin and they literally focus and pay attention. You know these kids don’t look at you, they don’t look at you in the eye, they don’t pay attention; they’ll literally wake up and they’ll focus and they’ll pay attention, be alert.

Very interesting to see how you can play with this web of physiology by dealing with the root issue as opposed to dealing with the downstream symptoms. And here are just some of the tests we did: looking at his food sensitivities, genetic predispositions, looking at heavy metal levels, looking at his gut function, looking at his-his levels of-of mitochondrial function, and all sorts of things that are novel biomarkers that don’t specifically look for a disease but look for patterns in the data; look for associations and connections and linkages to help us understand what the drivers are of disease. And actually we can work and play in this, in this data field and change the outcomes by simply taking out the bad stuff and putting in the good stuff. And it helps create balance in the body. So how did I treat him? I gave him a healthier diet, I took away the junk food, I took away the things that his body is reacting to in his immune system, I cleaned up his gut with some drugs that clear out the bad bugs like antifungals, I got rid of his heavy metals, and then I-I gave him a real food diet and some nutrients that were based on his story and some of the testing that helped to regulate his biochemistry and change his gene expression and changed how he was actually functioning.

And I gave him things to help his gut and the bacteria and normalize his gut function. And you know what was striking to me was no not that his symptoms got better and his stomach aches and headaches and his allergies and his asthma and his ADD went away and that he had good school performance and he was doing better in every way, but what struck me was what happened to his handwriting. This was his handwriting before he came to see me and I was downstairs taking a tour and I saw some white boards that sort of looked like this actually. [laughter] And maybe [laughs] some of you have some of these issues, I don’t know but.

The-the result of two months later looking at his handwriting was this. So I had to ask myself when I saw this what was going on? How did his brain go from dysfunctional to functional; from incoherent to coherent? How did the asynchrony and coherence happen in his system? I didn’t treat his brain, I treated his body. I treated all the imbalances that I found. And-and really as we think about this were looking at these sort of biological origins of-of dysfunction, this complexity science and how genes interact with our, with our environment and our diet and out food and how various insults like toxins or nutritional deficiencies or immunological factors, stress all play a role and change the brain conditions or the conditions in any area of our body, right? And they, and that leads to abnormal cell function and cell structure and organization or chemistry and that leads to altered processing and signaling and gene transcription and the whole proteomics, metabolomics phenomics which is the end result of phenome is the expression of your genes at any moment. And-and that’s when we see the downstream observable symptoms which we call ADD or depression or dementia. But those become less relevant as we understand the underlying causes in disease.

Now this was me 15 years ago and as you see this is me today. And I-I began by, this journey by being sick myself and understanding this-this problem in a way that forced me to look at things differently. In-in medical school I didn’t learn what I needed to know to solve my own problem. So I had to go and begin to look at the data and look at the research and see what was going on out there in medicine to find out how things really work. How does the body work? What are the, what are the basic organizational principles that on which our biology is founded? How, it’s really very sort of existential question and it’s a paradigm shift so profound it’s as great as when Columbus said, “The earth is not flat,” or Galileo said, “The earth is not the center of the universe,” or when Darwin said, “Species don’t just arise fixed in their current form but they evolve.” In the same way diseases don’t just show up fixed in one moment to the next, they evolve in a continuum. And this is a really new-new radical idea in medicine that has not been adopted yet. But at the Institute for Functional Medicine we have a textbook if any of you are really interested in this you can learn more about it. And it’s really based on this-this notion of dealing with the roots of the problem. Most of the ologies are out here in the branches and the leaves of the tree and we focus on this-this diagnosis by organ, right? And then we-we don’t really look down here at what are the underlying drivers of disease and what are genetic predispositions in our thoughts and our feelings and how those affect us. We-we know that our thoughts and our feelings actually talk to our DNA; that our food talks to our DNA and changes its expression moment to moment. And that leads to physiologic changes that lead to imbalances as in these sys, in these systems that I mentioned.

So these are the systems that we looked at with this little boy and that’s what really I focused on in practice and that’s what we teach at the Institute for Functional Medicine. Now many of you think you sort of got genetics from your family. I had lunch with somebody today who said they have a family history of diabetes and heart disease and dementia and Parkinson’s and these are things which we sort of somehow believe we’re destined to experience because they are in our genetics. But DNA is not your destiny. In fact, your genes are fixed but the expression of those genes is not fixed. And let me show you some pretty radical information.

This is talking about, for example, Parkinson’s where we know that-that there be certain pre-predispositions to Parkinson’s and there’s, but there’s a dynamic interaction between the genes and the environment to-to lead to certain problems in our biology like inflammation and free radicals and energy production which then leads to cell death. And we know, for example, I was talking about earlier the NR2 pathway which works in modulating this-this expression of your genes and regulates things like inflammation. This is a really profound study looking at the Agouti mouse which looked at these predisposed mice who were predisposed to diabetes, heart disease, obesity, and cancer; sounds like most of us; and had a lower life span. And what they did was they took pregnant rats and they gave them certain supplements that were methylating supplements that are-are nutritional supplements that regulate gene expression.

But these are nutrients that our bodies have used since we’ve evolved and are used across all life species to actually regulate turning on and off of genes. It’s called methylation. So things like B12 and folate, zinc, and so forth, B6, they regulate this-this-this modulation of your genes. So they found that without actually evolving you can create what we call epigenetic changes that tag genes and turn on and off genes and regulate genes to create a different outcome. And the outcome in this little mouse was a brown mouse instead of a white mouse; a thin mouse instead of a fat mouse; a mouse that doesn’t have diabetes or cancer or heart disease and lives a long time.

And the only thing that changed was they changed the inputs in terms of the nutrients that regulate gene expression. Same genes, no different in genes; change in expression. So this is the kind of impact we can have and it’s enormously important we’ve seen this go in reverse. This is the Pima Indians who a hundred years ago were thin and fit and had no diabetes, obesity, or heart disease. And now 80% have diabetes and their life expectancy is 46. And in one generation they went from being really relatively thin to being enormously obese and now they’re the second most obese population in the world.

Their genes didn’t change, but the environment changed and the expression of those genes changed. So what we have to realize is that food isn’t just calories. It’s actually information; it talks to our DNA. It talked to our epigenome and it transforms our biology in a moment to moment way. So the most powerful decision you have every day is what you put on your fork or what you put in your mouth. Literally with every bite are talking to your genes. And it’s-it’s as well worked out scientifically it’s not just a theory. We understand how this works. And we see changes in our phenome that leads to for example increases in obesity. Now we’ve seen obesity rates triple, double triple, quadruple across the world in a very short time.

We’ve seen China; 30 years ago I was in China and I never saw an overweight person. Now there’s-there’s tremendous amounts of obesity and they went from having no-no diabetes to having 93 million diabetics in-in less than a generation in China. And the reason is that they’re eating different food and it’s quickly changing their biology. The bad news is is that as your belly size goes up your brain size goes down. So if you have a fat stomach you have small brain. You shrink the hippocampus which is the memory center in your brain. So this correlation is not just there for cognitive function and memory, it’s also there for depression. More likely you are to be depressed if you have metabolic syndrome.

The more likely you are to get cancer and heart disease and all these factors that have impact on your brain. And-and we’re-we’re sort of inundated with-with sugar. We went from less than 10 pounds per year per person a hundred years ago to 185 pounds per person per year now. And I know I don’t have that much so that means some of you are having a lot more; that’s average. So we have a tremendous problem and-and we-we drink a lot of our calories. So if-if you look at the caloric intake. For example, if you just drink one soda or drink a day and that has about 225 calories that’s about 90,000 calories a year, that’s about in terms of 3500 calories per pound, that’s about 20, 25 pounds of weight gain a year just from one drink a day if you don’t equalize your calories. And the thing about liquid calories is that you don’t compensate by decreasing your solid food intake. So you actually will-will gain weight. If-if you have one way to lose weight and gain health in this, in this country that’s easy to do it’s don’t drink your calories.

Now you might think, that this was in the New England Journal of Medicine that you can, you can just do things like liposuction and get rid of all this fat and-and have some benefit. And in fact they found there was really no benefit by removing all this outer fat because the inner fat wasn’t removed by the liposuction. So all their metabolic parameters: their blood pressure, their blood sugar, their cholesterol, their inflammation levels, were not changed at all; and so there was no impact and then we see the opposite happen. If you take someone who does a gastric bypass they can’t eat. All their metabolic markers change even though they don’t lose weight that much because their inputs are different and it happens very quickly. Now there may have been some psychological benefits in this patient that was reported in New England Journal because before liposuction she was wearing a panty and after she was wearing a thong — [laughter] so there may be some benefits, I don’t know.

[laughter] Now how do you fix your brain? I’m gonna give you some take homes and then were gonna open it up for question and answer. The-the concept here is that if you heal your body you can power up your brain. And that you can customize the prescriptions for powering up your brain other than just a generalized lifestyle program. So this is a sort of a generalized wellness program or what I call Lifestyle 1.0. This is Lifestyle 2.0. This is personalized wellness lifestyle recommendations that-that are based on this model of systems biology or P4 medicine. So there’s some basic concepts that work for everybody, right? Which is eat right for your brain. Tune up your brain chemistry with supplements and I’ll talk to you about those in a minute.

The UltraMind Lifestyle which is essentially common sense: exercise which increases what we call B-D-N-F or miracle grow for your brain; fertilizes the increases in connections and neuroplasticity. Sleeping is critical; if you used to sleep seven, nine hours a night a hundred years ago now we sleep seven hours and that two hour decrease not only affects our cognitive function in focus and depression, it causes depression, but also causes obesity ’cause it drives appetite. I know when I worked in the ER I used to be hungrier because I wouldn’t sleep so I would crave more sugar. So we found that if you reduce sleep by a couple hours a night in young healthy men they’ll increase their levels of ghrelin which is the hunger hormone and decrease the hormone called PYY which leads to increases in sugar cravings. So it’s a big problem.

Learning how to find the pause button is ke-key. We all know how to work hard and we all know how to produce, but most of us don’t know where our pause button is. We don’t know where the off switch is. Very poor at, you have massage here which is fantastic, you have fitness and play, so I think you have tools here at your, at your service to do something that can help you switch on the pause button. And it’s critical because you have to have active relaxation. You can’t just do nothing and expect your body to relax. And we were talking at lunch about this concept of heart rate variability which is a big predictor of health. And that’s really how complex your heart rate is. So the-the least complex heart rate is a flat line; you don’t want that, right? [laughter] More complex, the healthier you are. So marathon runners and people who are very fit have very complex heart rates, beat to beat. It’s not 72 every minute, it’s 72, it’s 71, it’s 69 1/2, it’s 73 1/4, and it just varies from beat to beat. That indicates health and that’s something you can measure; you could even measure it on a device like an Android and just have your-your-your pulse taken and it measures the complexity of your heart rate. And that’s an incredible predictor of health and of-of disease and mood and cognitive function. And it’s something that is directly related to your ability to reduce stress and to modulate the stress response in your body.

And of course there’s things that you do everyday thought lifting, you don’t have to worry about that that’s using your brain; you do that and you’re good at it. And also living clean and green which is removing insults from your brain. So and I’m, I was really pleased to talk to Olivia here who told me that they-they don’t serve foods that are on the dirty dozen list in terms of pesticides, for example. They have water filters which is great. So how do you eat right for your brain? What do you do? And-and these are really common sense things, but one of the things that I think has-has been overlooked in a lot of care is that there is certain foods in our diet for various reasons that have to do with hybridization, have to do with genetic changes in the foods, have to do with changes in our gut flora, that drive inflammation in our body. And a lot of people have brain allergies and brain fog and brain dysfunction and they don’t know it until they stop eating these certain foods.

And the two biggest triggers are gluten and diary which is the wheat, barley, rye, oats, spelt, kamut, these grains that-that you should be alright to eat but actually drive inflammation in a lot of people. Getting rid of the toxins, the food additives. I mean I don’t know how many people have Diet Coke but aspartame is-is a neurotoxin. It actually increases what we call excitotoxicity that increases something called glutamate which overexcites your brain cells and causes cell death. And it, and a lot of people have extraordinary symptoms and that we know are connected to what they’re drinking and they may have headaches or migraines or other things. Eating real food. You’ve heard Michael Pollan speak. He talks about eat real food; not too much, mostly plants, that’s a good thing. And-and I think that’s really sort of common sense eating lots of fruits and vegetables.

I mean I think less than 5% of Americans or 3% get their recommended five a day fruits and vegetables. Lots of fiber; good quality protein; and Omega-3 fats which are incredibly important for your brain; a multi-vitamin is also very important and-and this is a whole concept that I think hasn’t really been talked about enough in relationship to the brain, but your brain runs on nutrients. What do nutrients do? They-they actually are the helpers or the co-factors for all the chemicals and reactions in your brain. And if you don’t have adequate levels of nutrients you can’t actually regulate your brain function properly. So having adequate levels of nutrients particularly the methylating nutrients: B6, folate, B12, Vitamin D, Omega-3 fats, these are critical for brain function. And then we personalize the care based on optimizing your nutrition, balancing your hormones, cooling off inflammations, fixing your gut, all these nodes in the network.

We help to tune them up. It’s like a metabolic tune up. We help you detoxify and boost energy in yourself and we help you learn how to calm your mind. And-and-and what I do is I have a bunch of stories here and cases that teach you how to treat the fire and not the smoke that-that sort of go through this a little bit. And I-I thought maybe I would just stop here rather than go through all these stories ’cause I’ve given you the broad view and-and invite you to ask questions and to explore and to sort of think with me about how you can power up your brain a little better. So thank you and I look forward to some questions.

[applause] >>Liv Wu: Are there any questions? [pause] >>male in audience #1: I was wondering what your thoughts are on how if all of this, if your program is very personalized how does that stack up in a world where all of our results are judged by clinical trials and everything that can’t be personalized? You know you look at a single drug and they say, “Well in a population, here’s the results.” Your technique doesn’t work with that. >>Mark Hyman, M.D.: Yeah. Well you’re-you’re exactly right. And I was at a NIH think tank recently on complexity in-in-in systems research. It’s not something, and I have funds and research is driven by drug development which is a single drug for a single disease looking at a single end point. But we don’t live like that. That’s not human beings. In fact if you look at clinical trials they don’t really reflect real people in the real world. And-and they’re helpful in certain ways to identify the benefits of certain treatments. And-and-and you have to look at the collective data not this-this sort of evidence based they call it the randomized clinical trial or control trial.

These-these actually distort the-the larger body of research which is that the basic science, the-the epidemiologic research, the observational research, and the whole body of-of data points together. And-and if you look at actually the practice of medicine today very little of it is actually evidence based. Probably 70% of it doesn’t have clinical trials to support it. And-and this model has to be looked at differently. I-I think that the instructive kind of work that Sergey’s doing looking at-at patterns in the data and collecting large amounts of data and then looking at-at-at results based on that as opposed to the-the sort of traditional way we do science which is at a glacial pace, is really the future of health care. And-and this model lends itself perfectly to that. Yeah.

>>male in audience #2: I’ve got two questions so I’ll take turns with another person. So consumers are confused, right? Like what’s the common thread running through all this? They’ve got [inaudible], [inaudible], about reversing heart disease [inaudible] reversing diabetes, and then your supplements [inaudible]. So keeping things simple what’s common thread that’s running through all these different speakers and experts that we should do? Like something actionable that we should do? >>Mark Hyman, M.D.: Right, well I think the common thread, some of the simple things are-are really important and I sort of talked about just-just briefly which is realizing that food is information and that the quality of the food and the type of food you put in your body changes your gene expression. So you have to have a healthy respect for that and-and also-also understand that a lot of the symptoms that you have currently are the, are the result of some input that’s going in and you can change that input and have a different outcome in terms of how you feel.

‘Cause most people don’t connect how they feel to what they’re eating or doing. So simple things like changing your diet, getting enough sleep, exercising, taking a few nutrients are simple things that you can easily implement. And in fact the food service here’s so fabulous at Google it’s not even that hard, and see the outcomes. And I’ve talked to a number of people in the audience today who actually came to me and said, “Well we tried this, we did this, and we saw these changes. And we can do this ourselves.” So there-there-there’s some very simple common sense threads that run through all of it and I think if you listen to all the speakers that have come and all that are gonna come, we’re all saying similar things. The unique thing that I’m really saying here is that, is that this is really not just about general wellness program this is about beginning to understand the roots of illness and-and creating a model that’s based on this-this concept of P4 Medicine or personalization.

And that-that-that actually requires some algorithms to help you figure it out. And I-I think that’s what’s so exciting for me to be here at Google is ’cause you guys understand how to turn words into math. And you-you can take the words in a person’s story and you can take the biomarkers and data points and we begin to create algorithms that help to customize and personalize care and treatment. And using feedback mechanisms through various tools that we can develop that-that help us create the quantified self in a sense and-and get that immediate feedback. So we can customize and personalize it. So while there is some general concepts that are common to everybody it is also important to realize that not one size fits all.

Yeah. >>male in audience #3: You mentioned some of the tools we have here at Google to manage stress. Can you quickly walk — >>Mark Hyman, M.D.: [laughs] >>male in audience: us through. >>Mark Hyman, M.D.: Well you’re an expert in that. He’s head of, well what’s the department? Massage services? [laughs] So I-I think the things that-that you have that I, that I’ve just noticed is you have outside. So there’s lot of play out there. There was all kinds of devices and courts and sand and volleyball and all sorts of things to-to play and have fun. And that’s a way to reduce stress. >>male in audience: Right. Can you walk us through what happens in the body if we do or don’t manage stress well? >>Mark Hyman, M.D.: Absolutely.

So in terms of stress one thing we talked about is heart rate variability. Stress leads to increased weight gain around the middle. It leads to high cholesterol. It leads to high sugar. It leads to inflammation in the body. It shrinks your brain in the hippocampus. It causes depression, it causes cancer, it can cause heart disease. I mean these are well described phenomena that happen and also can make you feel badly and disrupt your-your normal cognitive functioning. So-so looking at stress and its impact on biology is-is-s very [inaudible]. I talk a lot about it in my book. But in terms utilizing tools there’s a lot of stuff you have here: the massage, you have exercise, even food. You can stress your body by eating the wrong foods. Having too much caffeine, too much sugar, these actually raise epinephrine, adrenalin, cortisol, all of which damage your-your biology and your brain.

Hi. >>male in audience #4: Hi. Dr. a bit of a plug for you for about a year and a half ago I read your book and followed the UltraMetabolism Diet and literally within a week or two sleep, stress level, certainly skin rashes, stomach problems all of that just kind of went away and-and continued to kind of stay away as I, as I, as I continued to stay on the eating the-the right foods. I’m-I’m so fascinated by the gluten thing. There is something, so I try to get rid of it completely from my diet, but is there something good about it? You-you-you see a– >>Liz Wu: It tastes good. >>Male in audience: and start hearing a lot more about it, but you can eat gluten free foods that are just, almost just as good – >>Mark Hyman, M.D.: Yeah.

>>male in audience: and are getting better. What-what is it about the food that it-it is good or why do we keep using – >>Mark Hyman, M.D.: Why is gluten here and to it’s — >>male in audience: Yeah. >>Mark Hyman, M.D.: Well we choose grains when we start agriculture and gluten was one of the grains that was in wheat that we ate a lot of and it became part of our diet as we became an agricultural society. But our genes change .2% every 20,000 years and we only became agricultural about 10,000 years ago. So from an evolutionary point of view we’re not in complete harmony with eating a lot of grains. Wheat is a particular unique grain in that it has a very unique protein called gliadin and this-this plus other findings that we’re seeing now, for example, like wheat germ agglutinin and-and gliadin affect our-our gut function and change our immune system and lead to things like rashes.

Like you said you had rashes all over your body that can be from inflammation that’s triggered from gut. And when you stop eating it the rashes went away. And you had side effects like your-your brain woke up, you had more energy, you could focus, and you lost weight as a side affect ’cause if you’re inflamed you actually gain weight. So they may cause inflammation like we will gain weight. So I mean I like bread like the next person and like-like flour and it’s just sort of delicious products, but the reality is that about 30% of us have a problem with it. And as I was talking at lunch we-we know that-that increasing portions of our population are sensitive. They had 10,000 pooled samples of blood from 50 years ago and they compared it with 10,000 pool samples today, and they found that there was a real increase of 400% in celiac disease.

And that’s not even latent celiac or latent gluten problems which probably affect many more. And we know that if you have latent celiac you can increase your risk death from heart disease and cancer by 35 to 75%, and that 99% of people who have this problem are not diagnosed. At-at Cigna they did a study there 11 mil – >>voice in audience: [inaudible] [pause] >>Mark Hyman, M.D.: At-at Cigna they did a study there of 11,000 subscribers and they found that there was a 30% reduction in cost in those people who actually identified gluten sensitivity and eliminated the gluten. So not only will it make people feel better, but it-it had a direct impact on health care costs. And 99% of the people who have this problem don’t know it.

[pause] >>male in audience: So I was – >>Mark Hyman, M.D.: I want to say one other thing about that. People say, “Why all of a sudden do we see this increase in gluten sensitivity?” There’s a couple of reasons. One is that I think we’ve changed the-the actual protein structure of the gliadin in the wheat and that we know that as a fact and-and that may have different immunological affect on the body. But also we’ve changed our digestive system and our, what we’ll call our microbiomes. I don’t know if you know this but there’s more foreign DNA in your body than your native DNA from the microbes that live within you and on you.

That there’s more foreign cells in your body than your own cells from all the microbiome. And they have enormous impact on our health and our immune system. For example, in Africa they did a study recently of hunter-gatherers they found that they had a whole different profile looking at DNA analysis of the bugs in their gut than we do today. And that are in the comparable group of-of people from Europe.

And those-those changes have led to more allergies, more asthma, more autoimmunity, and-and I believe also more heart disease, and many other things we see in obesity. So I-I think this is, this is just the tip of the iceberg that we’re seeing here. Yeah. >>male in audience #5: So I’m interested in helping people like you make a long and lasting impact. So my question is – >>Mark Hyman, M.D.: That’s good news. [laughs] >>male in audience: Who will continue your work after you? How do you spread what you’re doing, how do you spread behavioral change in the consumer world like wildfire? >>Mark Hyman, M.D.: That’s a great question and I’ve spent a lot of time thinking about that. And I don’t have a ton of time to answer it, but I’ll give you the short answer which is I believe we need to create a disruptive model for health and-and to-to create what-what a friend of mine recently called a “disintermediate strategy.” Where we empower people to gather their own data about themselves, both through questionnaires and through bio-biochemical and various blood specimens and body fluid data; to input it into a computational model that recognizes patterns that is predictive of what the imbalances are in their systems; that then can be prescriptive for what to do in a personalized way to identify the problem.

So, for example, you [inaudible] could have put in that you had rashes and that you’re tired and you’re a bit of gaining weight and you have x, y, and z symptoms. Then you might have been suggested to maybe do certain types of tests and ask your doctor, or you might be able to actually do home testing to actually look at some of these things. And then there may be other devices you can look at to measure it through very sort of quantified self techniques that we’re learning about. What-what’s going on the other biometrics. And then you put all that into the system and then it gives you certain outputs that tell you what the likely probability is that you have gluten sensitivity or that you have magnesium deficiency or that you have trouble with your gut flora ’cause you’ve taken years of antibiotics for acne or all sorts of patterns and correlations and relationships that we know exist that are out there in the data. And this is what was so extraordinary to me is that the scientific data has not been looked at as a collective whole. It’s like, it’s like we have the answers already. It’s like Dorothy and her-her ruby red slippers we-we, she can go away any time she wants.

We have all the data points we need in the current scientific research that are laid out like puzzle pieces strewn across the floor and nobody’s put the puzzle pieces together. And I-I think in terms of what-what you guys do here at Google that’s-that’s so extraordinary for me to think about is how do you take that computational understanding and that ability to-to sort of use math to solve problems and apply that to biomedicine and systems biology. That’s what’s exciting. I-I know you guys actually have the answer to the world’s health problems right here.

>>Liz Wu: Thank you – >>Mark Hyman, M.D.: You don’t need me. >>Liz Wu: very much. Thank you. It’s two o’clock. Mark will be over here signing books. >>Mark HymaNature’s Way Sambucus Black Elderberry Gummies with Vitamin C and Zinc, 60 Gummies

Source: Talks at Google