Dr. Justin Marchegiani interviews Dave Korsunsky back on the show and introduces Heads Up Health, a new technology that allows people to input their lab data and other health information so they can better keep track of everything and all in one place. Discover how empowering yourself with your own medical records work and why it's effective for tracking success.
With Heads Up Health, you can track things like weight, blood pressure and blood sugar, and really see what’s happening biochemically. Learn how you can collect data or at-home markers without lab tests as well as understand what clinical markers you need to keep an eye out when you listen to this podcast.
In this episode, topics include:
4:06 Tools for betterthealth and lifestyle
9:05 At-home markers
22:51 Clinical markers
24:50 Dr. J's spreadsheet on functional medicine ranges
33:37 Case study and Heads Up Health software
47:00 Complete lab panel
Dr. Justin Marchegiani: Hey, there! It’s Dr. Justin Marchegiani and welcome to Beyond Wellness Radio. Feel free and head over to BeyondWellnessRadio.com where you can access our full podcast transcriptions. While you’re there you can also sign up for our thyroid and female hormone video series. This series goes into the root cause of why your hormones are out of balance. While you’re there you can also schedule a functional medicine with Dr. Justin, myself, where we’ll dig deeper into the root cause of your health challenges. Feel free and think of sharing this podcast with at least one person. This podcast grows by people sharing it. Sharing is caring. If you can think of one person that can benefit from this information, please feel free and share it. If you’re enjoying the podcast, make sure you subscribe on iTunes. You can also click below the video or podcast where you’ll see the iTunes Review button and leave us a review. You can also sign up for the newsletter at BeyondWellnessRadio.com where you’ll get updates before anyone else. Thank you so much and enjoy the show.
Hey there, it’s Dr. Justin Marchegiani. Welcome back to Beyond Wellness Radio. Again, we have Dave Korsunsky. Dave Korsunsky was on the show back this last summer. Again, Dave’s created this awesome technology called Heads Up Health, which is basically this way of charting and being able to keep track of all of your functional medicine or even your conventional medicine lab data. Dave’s actually a patient of mine as well and Dave came to me one day and he had all this lab data. We had it in a big Excel spreadsheet. And Dave came to me and said, “Hey, you know what, is there a market–is there a need out there for people to be able to keep their lab data in a–in a way that’s organized so we can chart it, look after it, and be able to see how things in your health changes, just a way to kind of frame things out better?” And I–I agree with Dave and Dave’s been on this journey creating this basic better mousetrap which is–which is phenomenal and I’m starting to use with my patients as well. So I wanted to welcome Dave to the podcast.
Dave: Yup, thanks for having me back, Doc. Last time we spoke was earlier this summer and we were still building. Pleased to say that our–our software is now available. People are using it. They’re loving it. And you and I were talking and said, “Well, why don’t we put together a demonstration on how people can use this, specifically for tracking results on Paleo?” So we thought it would be good to do a case study with my own data so people can see exactly how this works and exactly how it can solve the–the challenge that I was facing, which is that my medical records were everywhere. I’ve mostly been seeing conventional doctors and yet you were the person I want to share my records with, and so largely out of my own frustration I started to build Heads Up Health. So very happy to be back.
Dr. Justin Marchegiani: Awesome. And just for everyone listening at home here, this podcast is actually gonna be on video as well. So if you’re listening to it on the iTunes stream, feel free and click below. We’ll have a link to the YouTube podcast page where you can actually watch our ugly mugs in process and also be able to see the screens. We’re gonna be sharing our screens here via Skype, where we’re gonna have some lab data things that’ll be more visual. So click on screen below and join with us on the video feed.
Dave Korsunsky: And you’ve got a collar shirt on Doc, so you’ve already one upped me, just on the attire.
Dr. Justin Marchegiani: You got it. If you could just tilt your screen down just where it’s a little bit–there we go, oh–
Dave Korsunsky: Perfect.
Dr. Justin Marchegiani: With the pipes. I love it.
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: Alright, great.
Dave Korsunsky: So here’s our agenda, Doc. You wanna take us through this?
Dr. Justin Marchegiani: Yeah, let’s go through it. So overall, we wanna work on providing the–the tools for people that are switching over from a healthier diet and a healthier lifestyle. So we like to use the framework a Paleo template. Because Paleo is nothing more than an approach that’s using anti-inflammatory, nutrient-dense and low toxin foods to help modulate inflammation, improve health and performance. So it’s great because we have people that make these dietary and lifestyle shifts and they’d feel better, they look better, their clothes fit better, but what’s really happening under the hood biochemically? And we know there’s a lot of things that do happen, and Heads Up Health software will help kind of be able to quantify that so we can see it, and we’re gonna talk about some of the lab markers in-depth today and what those look like and what they mean. We’re also gonna talk about some at-home markers, too, such as waist-hip ratio, blood tests, we’ll go over that in a bit. But things you can do at home outside of the lab and outside of needing a lot of needles for the most part. And then we’re gonna do some case studies. We’re gonna go over Dave’s old labs and some of his new labs. We’re gonna look at them. We’re gonna break it down. We’re gonna–we’re gonna show you some changes that were made from a functional medicine and Paleo type dietary changes and then how do we get started? What are the things that we need to do or people listening at home need to do if they’re really getting motivated, they’re getting pumped up, where do we go, what’s the next step? We’re gonna talk about labs and how we can get started.
Dave Korsunsky: Sounds great, Doc. So yeah, on this slide, I think really what we’re gonna–what we’re getting at is that, you know, especially in my case and I’m sure with your other patients, you–you can make a dietary change and quantify your success and in my case, it was actually when I started really digging into the data with you, which is when I started getting results, so we wanna show people how you can easily track this information and not be intimida–intimidated by the data. We’ll show technology that can help you track it all and empowering yourself with your own medical records is inc–incredibly effective and it worked for me, and so that’s essentially what we’re going after here is how you can track your success as you make these diet and lifestyle changes. And Doc, what do you see with your patients who actually are doing the tracking and have the data, do you see better results or–or not? What do you see in terms of how your patients are tracking today?
Dr. Justin Marchegiani: Well, anytime we can tangibly chart something from pre-imposed, it gives people motivation. So number one, when we see the blood sugar go down, when we can chart sleep, when we can see an improvement with sleep, when we have ways to organize data like food logs and such, or tap into our MyFitnessPal or be able to look at blood pressure and things over time, it’s really nice. It really provides a lot of motivation and it keeps things really organized. So I think it’s definitely a win-win for the doctor, myself, because it keeps things at my fingertips, but it also makes it easy for the patient. And then there’s also some cool features we’ll talk about in a bit that we can plug in variables like sleep and blood sugar, and being able to extrapolate and say, hey, does your sleep, does your party night affect your blood sugar the next day, too, which is kinda cool.
Dave Korsunsky: Yeah, and I remember when I was coming to your office in Cupertino when you were based in the Bay Area and I just started working with you at that time, and I’d come in and sit down with you and we’d look at all of my results in a spreadsheet. And you’d look at my thyroid data and my lipid panels and you’d make recommendations, you’d give me a protocol, you’d give me some supplements to take, and then we’d re-test 6 months later. And using that approach, first of all, it was incredibly educational for me, and second, it was just probably the best care I’d ever received. And that’s when I actually started to see results, it’s when you and I were collaborating and using this information, you were showing me the changes in my own numbers and it was incredibly effective. And so hopefully today we can communicate how other people can do the same.
Dr. Justin Marchegiani: Awesome and I think it’s also really great, too, when you’ve had–you’ve tangibly had this successfully shift or change in your lifestyle and then you wanna go express that change to your family and friends, and you know, people say, “Well, you’re just full of it.” But if you can say, “Hey, look at this data.” Look at this, look at that. It really can help make a case to any people in your family or in your life that you wanna help sway over to a healthier lifestyle, too.
Dave Korsunsky: Yeah, particularly skeptics and I–
Dr. Justin Marchegiani: Uh-hmm.
Dave Korsunsky: Listen to a lot of podcasts on health and there’s a lot of, I guess what would the word be? Debate about which nutritional template is the best and–
Dr. Justin Marchegiani: Uh-hmm.
Dave Korsunsky: If you have the data to say, “Listen, I’ve measured my blood chemistry. I’ve measured the data at home. These numbers don’t lie.” Then you have definitive proof and so I think it’s one thing we wanted to do with Heads Up Health was not only help people track the–the things like weight and blood pressure and blood sugar, but also be able to say biochemically what’s happening. Are my lipid markers getting better? Are my inflammation markers getting better? And I think when you have both sides of the story, you really have a defensible position at that time to say, “Yes, this works for me. Here’s my data to prove it.” So that’s–
Dr. Justin Marchegiani: Totally agree.
Dave Korsunsky: I think that’s what we’re after here. So maybe, Doc, take us through this slide which just talks about some of the things as people are making a–a nutritional change towards Paleo. What are the data, the things, that you typically ask your patients to collect at home? And what types of trends should they be seeing with these things we’ve got on the slide here?
Dr. Justin Marchegiani: Alright, let’s roll up our sleeves and dig in. So this is what I call the low hanging fruit. These are things we don’t a needle, we don’t need expensive lab work for. So number one, body composition. This can say so much. A lot of people get their head wrapped around, we’ll need them to jump on a scale and seeing how much the scale says in pounds, but we know that body fat may not show true when it comes to weight because as we get less inflammatory and we’re eating more nutrient-dense foods, we put on more muscle, muscle weighs twice as much as–as fat. So if we put on 2 pounds of muscle and we lose a pound of fat or 2 pounds of fat, the scale may look exactly the same yet we feel smaller in our clothes. So we wanna have a good scale. We’ve talked about this. The Tanita scale is a phenomenal scale to look at, water, hydration levels, and even body fat. So we like body fat. For men, that could be 12-15%, 12-17% depending on what time of the season it–it is for you. And for women, it may be a little higher, maybe 16-22%. It really depends. Some women when they get too low fat, it can really affect menstruation and their cycle, so we’re a little more generous on the body fat percentage for the females, and I keep that in mind. Next would be blood sugar. Blood sugar is important because as you start to lose weight, one of the big things that starts to happen is we have better blood sugar control because we’re becoming more insulin-sensitive. So looking at blood sugar fasting can be helpful via a blood test monitor like a-a Bayer Contour or a OneTouch. We can also use these OneTouch monitors for a–a functional glucose tolerance test which is testing your meal and how your blood sugar responds to the food you eat, whether it’s having your breakfast, looking at fasting before you eat, and then looking at a 1, 2, 3-hour test after the meal so we can see how our body responds to glucose, ideally below 140 within 1 hour, 120 within 2 hours, and below 100 within 3. Ideally if you are extra ambitious, try to shoot for it below 120 within that first hour. And that’s helpful because the better we are with insulin, the more sensitive we are, that reduces all kinds of inflammatory risk and even cancer, too.
Dave Korsunsky: And just to jump in on–on that–
Dr. Justin Marchegiani: Yeah.
Dave Korsunsky: From the patient’s perspective, Doc. I don’t have any blood sugar issues or diabetes or pre-diabetes or anything, and yet still learning how to track my blood sugar was probably one of the most insightful pieces of information I could ever learn to collect at home. And so I think even if you don’t have a metabolic issue, you’re really just interested in optimizing your weight, your energy levels, your body composition, learning how to track your blood sugar is essential in my opinion.
Dr. Justin Marchegiani: I’m actually gonna an at-home blood sugar test right now on the air, and I keep my blood sugar monitor on my desk right now for these exact times if you will.
Dave Korsunsky: Beautiful.
Dr. Justin Marchegiani: So it’s nice to keep it around. You can chart your meals, see how you’re doing, see how you respond to various things, which is–it’s great. I’m at 92 right now, which is great. Go me! I could get a couple of Paleo points there.
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: So just nice little cheap thing you can use to help chart how you’re doing with food and insulin resistance. Next, macronutrients. So the nice thing about a Paleo template is that it’s really macronutrient agnostic. It doesn’t really matter. You can be high carb. You can be low carb. You can be high fat. You can low fat. So typically, the standard American diet is kinda like a–a 60% carb, 15% protein, 25% fat. You may have to add those up for me, but I think it’s a 100. That’s the standard American diet percentage. And now a lot of times we can just take that standard American diet percentage and just shift it over to Paleo. Well, instead of getting your carbs from grains, we can do some more sweet potato and some low sugar fruit and some veggies, and we can get our fats from better quality sources and get proteins from grass-fed meat and eggs, and such. So we can automatically just take the standard American diet macro percentage and just swift–switch over to Paleo and that’s gonna make a huge difference off the bat. Now from there, we could maybe go and do a Jimmy Moore type of keto where we’re down to 10% carbs, 60-70% fat, 10-15% protein, or we can go somewhere in the middle like a zone, a 40-30-30, 40% carbs, 30% protein, 30% fat. So we can switch and dial up the protein and fats and carbs just like a dial on your car radio to adjust it to according to what we need. Now my–go ahead, yup.
Dave Korsunsky: Yeah, just to jump in on that, Doc. I think that’s one of the hardest things from the patient’s point of view is really just okay, knowing what I’ve been eating throughout the day and understanding, okay, what is the breakdown between protein, fat, and carbs, and reading all the labels and figuring out how much is in this or that, and so one of the things we do with Heads Up Health is we integrate with MyFitnessPal. And if you’re trying to make these changes and you’re trying to say, “Okay, well, I know I wanna make this change to a Paleo template, they’re telling me to get 60% of my calories from fat, what does that even mean?” And so My–MyFitnessPal is an incredibly effective tool especially for the beginner because you can essentially just enter in everything you’re eating and it’s gonna give you a readout of where your distribution is across the protein, fat, and carbs and using that tool, it becomes very easy to educate yourself and allows you just to fine tune instead of a lot of guess work. It’s just a really–it’s a really helpful way to start to get your ratios right, and we’ll get into the specifics on that. But for people who wanna do this, there are some tools out there that make it a lot easier.
Dr. Justin Marchegiani: That’s great and you can get the MyFitnessPal app on your smartphone and I have–
Dave Korsunsky: It’s free, yup.
Dr. Justin Marchegiani: And I have a lot of patients–totally free–and I have my patients share it with me. I’m JustinHealth on MyFitnessPal and it’s a great way to kind of chart things in. And once you kind of have your 3 or 4 meals in, you can kinda adjust it and then you can kinda tweak things up. “Oh, I get my fat there or if I cut this out, I get my carbs there.” So it’s a great way to visually see where you’re at.
Dave Korsunsky: Yeah, it takes a bit of work but once you do it for a week or two, you’ve pretty much got it figured out and you can stop being so diligent about it. So it’s just a really good way to–to learn how to re-balance your–your macronutrients as you’re making this nutritional change.
Dr. Justin Marchegiani: Love it. Cool. Next step is sleep. Sleep is so important. It really is a nutrient. If we could bottle up what our body makes physiologically, neurochemically from sleep. I mean, it’d be a trillion dollar drug. So sleep’s important because certain times throughout the sleep, the 10PM, the 2AM time is really where we tap in to a lot of our growth hormone. And if we’re not asleep during that time, we miss that output. So sleep’s important from that perspective. Also if we don’t get enough of it, they’ve done studies on college students, they deprived their sleep down to 4 hours a night and after 2 weeks, they were pre-diabetic. So we know sleep has a major influence on blood sugar and we know blood sugar has a major influence on insulin and we know insulin and cortisol are on this kinda seesaw if you will, and insulin also will influence body fat. So you can see some of the at-home markers already factored that in, right? We got blood sugar already down, body comp, and that sleep. So really important, wanna make sure sleep’s there and we can integrate with the Misfit which is great. I have mine on now and that–
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: Will help kind of monitor your sleep time and that does the API feed to Heads Up Health and you can track your sleep as well.
Dave Korsunsky: Beautiful. So I know last time we talked about this you were explaining linkages to me as you start to go Paleo, as your blood sugar starts to normalize, how that starts to affect some of the insulin markers and the circadian rhythms and the cortisol rhythms and so, I guess what you’re saying is as these changes start to sink in, you should start to feel yourself sleeping better, sleeping deeper, and maybe getting on to norm–more of a normal circadian cycle, is that right?
Dr. Justin Marchegiani: Yeah, so could see right here. I had 8 hours and 3 minutes last night.
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: On my Misfit.
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: So I guess some more Brownie points there but regarding that, you’re 100% right because like you mentioned, the cortisol circadian rhythm, cortisol higher in the morning, lower at night, and then melatonin flip flop–or it basically flips the switch. So as cortisol drops, melatonin comes back up, and we need good melatonin levels to have sound sleep, and it’s also a powerful antioxidant.
Dave Korsunsky: Cool.
Dr. Justin Marchegiani: Alright, next, fingernails. These are like a gateway into protein and fat digestion, even minerals, too. So we have these nails here that go up and down and you could see–if you put your finger across the nail, you can feel east to west or right to left, we can feel what are known as vertical ridgings–vertical ridging or ridges, and some people even have it horizontal. So if it’s horizontal, you gotta basically go in the direction of the finger to feel it. If it’s vertical you can go across it and that’s gonna be indicative of protein, protein maldigestion and it could even be fat because fat and protein typically function and dysfunction together.
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: Because hydrochloric acid’s there to help break down protein and activate the proteolytic enzymes, but it’s also there to trigger the gallbladder and the pancreas to produce enzymes and bile for fat. So protein to fat are typically connected. Also white spots on the nails will be indicative of zinc, which is an important mineral for sex hormones and making hydrochloric acid. So if you have a digestive issue, it tends to compound itself and make itself worse and worse. So fingernails can be a really good perspective. Also pitting in the nail can be important, maldigestion issues, flakingness, brittleness, peeling of the nails, and just nails growing slow as well and a fungal nail, that yellow discoloration especially on the toes that can be a marker of a–a chronic deeper infection.
Dave Korsunsky: Great and then the last one–
Dr. Justin Marchegiani: Next–
Dave Korsunsky: For the at-home markers.
Dr. Justin Marchegiani: Yeah, blood pressure is a really important one. Blood pressure can be–it can go two ways. Now if you’re really inflamed, it tends to be high and high blood pressure’s important because it means that your heart has to be harder, has to pump harder to get blood into systemic circulation. So we get concerned about congestive heart failure and such, but again if we reduce inflammation that typically decreases a lot of the things that drive blood–blood pressure to go high. Inflammation and blood pressure basically are a–a parallel correlation, okay? Direct correlation. Now most people that are adrenally fatigued, if their blood pressure isn’t high because of chronic inflammation, a lot of time it’s actually low because their adrenals are dysfunctional. They’re hypo-adrenic. Not–not Addison’s disease where it’s adrenal failure, but it’s more of a-a dysfunctional HPA axis cortisol rhythm and that low blood pressure is important because we’ll see a lot of symptoms of if you bend over and stand up fast, we may see that dizziness because we don’t have adequate blood pressure to perfuse oxygen and nutrition of the brain. Also we’ll see in a blood pressure test called a Ragland’s Test. If we sit down or lay down and do a blood pressure and stand up, and then do it right away after, we should see about a 10mm of mercury boost. And a lot people we see a drop in it meaning their adrenals can’t respond because those mineral corticoid portion of the adrenal glands, actually I got a textbook on the adrenal glands right here, maybe I can even pull up the exact page here as we’re chatting, but that part of the adrenal glands is not functioning enough and it can’t control the minerals which are super important for getting everything–getting the blood pressure regulated. So one of the big things we do with that is get enough sea salt on board and fix the adrenals and we’ll see the blood pressure improve. So that’s a nice thing that you can look at is that Ragland’s or that orthostatic hypotension test to assess that.
Dave Korsunsky: And that’s just using a standard blood pressure monitor at home which you can pick up pretty much anywhere at Walgreen’s or anything like that, just pretty much standard blood–blood pressure test.
Dr. Justin Marchegiani: Exactly and just people at home here, this is the adrenal cortex and this is where the outer part, the outer layer of the adrenal gland right here, that’s where aldosterone’s made. So that’s kinda how the blood pressure can really give us a window into what’s happening in the adrenals.
Dave Korsunsky: Yeah, so these at-home markers, I mean, this pretty much mirrors my exact experience since I’ve been your patient which has been since about 2012. My body composition has completely changed. Body fat percentage has gone down. Weight in my case has pretty much stayed the same, it’s just the fat that’s come off. I started tracking sugar and that’s one of the most important things for me. I–I really keep an eye on that. I see how my body responds after different meals. I will check my sugar 1-hour and 2-hour after. That’s gotten better. I’ve learned how to dial in my macronutrients. Before I used to think that I was–I was supposed to eat low fat and it wasn’t until I started increasing my fat consumption to 60–50-60%, but that took a long time. It’s just you have to re-learn how to eat in a sense and so that’s something I’ve been working on. My sleep’s gotten better. I did have ridges in the fingernails, white spots. Those are gone for me personally. And my blood pressure has always been pretty good. It’s been high at times of–of heavy stress but it’s interesting how all of these things are connected through the same system. It’s essentially I guess the nutrition underlies all of it and then everything else, and it has since starts to fall in line. So this mirrors my experience as well and I guess these are some of the things that people can start tracking at home on their own. In fact, many of your listeners are probably doing it already, to start to measure some of their progress.
Dr. Justin Marchegiani: Yeah, just to kinda hit a vein there, you mentioned your blood pressure being on the higher side and if I remember, you had some lower magnesium levels, too, on some of your blood work.
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: So we can touch that again in a few minutes.
Dave Korsunsky: And that helped actually when–
Dr. Justin Marchegiani: Uh-hmm.
Dave Korsunsky: I went on the magnesium supplement.
Dr. Justin Marchegiani: Yeah.
Dave Korsunsky: Okay, so next, we–we’ve talked about things people can track at home, really easy stuff, a cheap glucometer, a cheap scale, a cheap blood pressure monitor. What about the clinical markers? That’s the other side of the equation and so equally important and–and you and I talked about this and I said, “Hey, Doc, if someone was wanting to go Paleo, what would you wanna look at in their blood chemistry?” And–and this is the list we came up with. So take us through it.
Dr. Justin Marchegiani: Yeah, awesome. So lipid panel, it’s very important. That can give us a window into various cholesterols, whether it’s our total cholesterol, HDL, LDL, BLDL, and triglycerides. So some good things to gleam from that, is just the fact that total cholesterol doesn’t matter that much. The ratios are much more important and we’ll go over that in a bit. That’s helpful. If lipids are abnormally high, it could mean too much carbohydrate or potentially inflammation or a low thyroid. Next would be blood sugar. We already kind of alluded to blood sugar to being over 100 in the morning, could be a sign of maybe insulin resistance. In some people there’s something known as Dawn phenomenon which is more stress hormone-induced. Also we talked about the functional glucose tolerance to–to know if we are responding to our meals well enough, again trying to make sure we’re not having too much carbs or too much inflammation in our food. Inflammation, another important marker. Alright, we have things like highly sensitive or HSCRP, C-reactive protein. We have fibrinogen, looking at clotting factors, homocysteine and ESR or erythrocyte sedimentation rate. We also have thyroid hormones looking at the brain, the T4, the T3, and various antibodies to look at thyroid production. We have some liver and kidney ma–kidney markers to look at protein and look at like kidney stress. We have our general CBC to help us gleam in–at what these other–any anemias at all or iron or B12 anemia, or B vitamin anemia, even infections, even have iron panels to further elucidate microcytic iron anemia, and then we have vitamin D and red blood cell magnesium which is important because there are important nutrients that we can be very deficient in especially in the winter and magnesium is just deficient in a lot of people who are stressed.
Dave Korsunsky: Yeah and from my point of view, just for the patient’s point of view, it seemed like a lot. One of first things I did was go back to some of the doctors I’d seen in the past and requested copies of my old labs and so those were things that I put into my Heads Up Health profile and we’ll show people how to do that so if you already got markers, you can request them and get copies of them, and then we’ll also show later on, Justin’s put together a spreadsheet that has all of these markers brown down into functional ranges, just to make it people–make it easier for people to see how their results stack up to where you should be on a–on a functional template. So we’ve got some resources that will make this a little bit more digestible for people just so they can get started tracking the–the lab markers and then Doc, I know you also put together a panel for people so they can just order it themselves. So there’s a few resources we have got at the end for people who wanted to gather the lab data.
Dr. Justin Marchegiani: Sounds great.
Dave Korsunsky: So with that, Doc, I thought we could jump into a case study here. Actually, did you wanna go through the spreadsheet first?
Dr. Justin Marchegiani: Yeah, let’s go through that, just briefly here.
Dave Korsunsky: Okay.
Dr. Justin Marchegiani: Everyone’s probably dying at to see it because–
Dave Korsunsky: Yeah, I see.
Dr. Justin Marchegiani: We’re gonna offer that as a–a copy for people at home as well.
Dave Korsunsky: Yeah, so Justin and I said, “Hey, how could we give people a–a spreadsheet to see how their own labs stack up?” If you’ve already got labs, then you wanna plug them in here and see who you’re doing. So this spreadsheet is available and we’ll provide the link to it after the show. But what are we looking at here?
Dr. Justin Marchegiani: So off the bat, I’m gonna go here briefly, anyone that needs more further elucidation on the thyroid, check out Justin Health, I got a really good thyroid series that goes more into depth than some of these markers, but we have thyroid off the bat. And we have our functional versus standard ranges, and just a brief overview. Functional ranges are more looking at optimal health where the standard lab range is what 95% of the population fits into. And we know that 95% of the population is not optimal healthy, so we kinda have a higher standard in our functional medicine ranges. So off the bat, we have our thyroid markers. We have looking at our brain. Looking at how our brain talks to our thyroid, how our thyroid produces T4 which is our inactive hormone, and how our thyroid activates hormone into T3. We’re looking at how our body absorbs and uptakes T3. We’re also looking at how stress and our adrenal function affects reverse T3. I think on your test, Dave, we saw this one high and we’ll talk about that more in-depth. And even our thyroid antibodies, especially autoimmunity being so rampant, most doctors don’t look at it and don’t diagnose it, but it’s really important because it means your immune system is attacking your thyroid and doing things like it getting rid of infections and getting rid of gluten is essential to healing that or helping to help reduce the inflammation there. That’s our thyroid. Next, our lipids. You can see we have cholesterol here, which can be an important marker. It’s really overrated in conventional medicine because it’s typically a marker used to sell and prescribe more statins, and we know statins can cause issues like diabetes and even potential Alzheimer’s and such. We gotta be careful using that. Cholesterol doesn’t matter too much. If I punch in, let’s say cholesterol here of 240, which was the acceptable rate back in 2006, and they moved it to 200. So it’s always moving. It was 330 back in the 1970s, so it’s a moving bull’s eye. And let’s say our triglycerides here are 70 and let’s say our HDL is 60 hypothetically, and our LDL maybe is 1–even let’s say it’s 140, off the bat, and you can see our ratios for our triglyceride to HDL are actually perfect, which is a–
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: Really good marker for ex–for glucose and carbohydrate.
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: We look at our trigs, divided by HCL, that gives us our–a really good carbohydrate sweet spot about how much carbs we’re going. Again, cholesterol by itself doesn’t have a lot of value, but we look at the ratio, total cholesterol to HDL, well, that’s a decent ratio of 4. So we may have a 240, which is considered high, but our ratio looks pretty good. So–
Dave Korsunsky: Yeah, and we’ll look at that. That’s exactly what happened in my case when we–we’ll look at my specific data in a minute–but that’s exactly what happened. Total cholesterol went up to what might be considered “high” but all of the ratios actually stayed the same or got better. So we’ll take a–look at my results but what you just described is exactly what happened to my when I went on the Paleo template.
Dr. Justin Marchegiani: Exactly and a lot of people, let’s say went ever higher into the mid-300s where you’re in the hypercholesterolemia range, well, you may wanna get a–a VAP or a–an MR–
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: Profile done and look at particle size just to make sure you’re have–the good A particle size versus the B, bad particle size. But the next thing we wanna look at is the inflammatory markers, homocysteine, ESR, HSCRP, C-reactive protein, fibrinogen, because if you don’t have a lot of elevation in inflam–inflammation, if you’re inflammation is under control, well, that’s a good sign because cholesterol can go up with inflammation. So cholesterol may not be that important but if it’s going up because of inflammation then the cholesterol may not be the cause, and also cholesterol can possibly go up with thyroid being lower. So if we look at our T3 over here, free and total, that can be helpful to elucidate what’s happening with the thyroid and if that’s driving up our lipids. Any question–
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: Question on that, Dave?
Dave Korsunsky: No, I saw my inflammation markers go down as well and we can take a look at that but that mirrors my experience, too.
Dr. Justin Marchegiani: Great. Also B vitamins. A lot of people that are switching over to a Paleo template may have been vegan, may have had a really standard American diet with poor nutrients and we may see issues in red blood cells. Okay, red blood cells start to go low when there’s–let’s say a drop a here, when there’s certain nutrient deficiencies like B vitamins and/or iron, and these markers down here, the–these are basically how big the red blood cells and how big the hemoglobin is. These markers tend to go up when we have B vitamin issues. And these markers over here tend to go down, the hemoglobin, hematocrit, and RBCs, all go down when there’s anemias and we see iron problems, these actually start to drop. The ferritin starts to drop, the iron saturation starts to drop, and these markers, the TIBC and the UIBC actually go up, they’re inverse. Alright, they go up as iron goes down. So a good CBC panel can give us good information on B vitamins and iron and anemia and if you’re vegetarian-vegan coming from a Paleo diet, that can be really important.
Dave Korsunsky: Yeah, I know from my specific data, it–it turns out that I had a MTFHR problem, a methylation and so it wasn’t until you got me on a specific combination of vitamin B supplements–
Dr. Justin Marchegiani: Yes.
Dave Korsunsky: That my labs started to move in the right direction. And so we’ll take a look at that in a second, but mine was mostly showing up in elevated homocysteine and it wasn’t until we got the supplements dialed in that my numbers came down and we’ve got the–the hard numbers coming up here in a second, but B vitamins was a big one for me.
Dr. Justin Marchegiani: Absolutely. Now if we look here on the infection component, that can be really important, too, because a lot of people come over from a Paleo template and they may have infections. We can see neutrophils being above 60%. That can mean an H. pylori infection. Lymphocytes being below 20 or so. That can be a chronic viral infection. Eosinophils being above 3, in the 4+ range, could be a parasitic infection. So it’s important to kinda look at all these and–and draw inference whether or not there’s an infection, we may do deeper tests, but it can be a really good general screening for anyone coming in the gate. And then we got some these markers down here below. We’re not gonna go too much into these outside of just some of the liver protein, and–and that’d be it. So we already went over the glucose, right? Glucose was an important one. We have BUN and creatinine which are important markers for protein and kidney function. If we have low creatinine here, that could be a potential sign of low protein.
Dave Korsunsky: Uh-hmm.
Dr. Justin Marchegiani: If we have low BUN here, that could be a sign of low protein as well. Also albumin, globulin, and protein. If these are out of balance, these could mean protein issues or digestive issues, too. So we gotta keep those all in mind. We have our liver enzymes here, too, where if these are high and I’d say above 30, there can be some liver stress whether it’s toxicity or maybe you had a–a rough night–the night before at the bar, so that could be a possibility.
Dave Korsunsky: We’ve all–
Dr. Justin Marchegiani: And also magnesium.
Dave Korsunsky: We’ve all been there, Doc, once or twice.
Dr. Justin Marchegiani: All been there, absolutely.
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: And then red blood cell magnesium, which we’ll talk about on your labs coming up, which could be important because magnesium’s essential for over 300 enzymatic reactions in the body. Also keeping the–the arteries nice and relaxed and being a nice sedative and helping you to relax as well. Any questions there?
Dave Korsunsky: So this–no, this looks great. This spreadsheet is available. We’ve got the link coming up at the end of the show. So why don’t we dug–dig into specific case study. I-I offered, I know you said you’ve had a lot of people come to you and say, “Hey, Doc, we’d–we’d love to see a real patient’s data as part of a case study, of someone who’s made this change.” And so I track everything in Heads Up Health, a software that I built, to help me manage my own health and we wanted to make this available to anybody and I thought it would be interesting and fun to look at my own real data and you can just take us through it. The data I’m collecting at home, which we talked about, and my lab markers as I’ve gone Paleo, and you can just take us through some of the work you did with me and what kind of outcome we were able to achieve.
Dr. Justin Marchegiani: Let’s do it.
Dave Korsunsky: So, just quickly, this is–this is my dashboard in Heads Up. So all the things Justin talked about that you can be tracking at home to measure your Paleo progress are set up here. So I’ve got–
Dr. Justin Marchegiani: Dave, if you could share your screen, that’d be great.
Dave Korsunsky: Oh, that must have gotten turned off here. Let me try that again, share screen.
Dr. Justin Marchegiani: And then just while you’re doing that, everyone that is watching this at home, that blood test review, that blood test roadmap sheet, we’re gonna give you a link at the end so you can get access to it yourself and be able to chart you’re–be able to track your own lab markers at it as well.
Dave Korsunsky: Okay, is it–is it up now, Doc?
Dr. Justin Marchegiani: You’re up.
Dave Korsunsky: Okay, cool. Yeah, so when you wanna track all this, it’s a lot of information, so we built Heads Up as a way to just centralize it and so these are my body composition readings. Justin talked about measuring weight and body fat. I use a–a scale called the Tanita, both Justin and I use the same one, but we also plug in to the Fitbit scale and the Withings scale so you can bring it in wirelessly. Here’s how I chart my blood glucose, so every morning when I do decide to check my blood sugar, I just come here and take the glucose reading. I’ll make some notes about what I may have eaten the night before or exercise I’ve done so that I have context. And then here’s the macronutrients, the MyFitnessPal data and this is just showing me as depending on what I eat, how much is–how much of my calories is coming from protein, fat and carbs. And I’ve gotten pretty good at this so I don’t need to use this anymore but it’s really effective when you’re just starting out. And then Justin talked about sleep. My sleep is being tracked by a device called the Misfit Shine, but there’s a number of free apps out there that can help you track sleep as well and then my blood pressure is here. I’m also tracking ketones, some of the things of that nature. But it’s just a really easy way to enter all the data that you’re collecting at home and then there’s tools to share it with people who you wanna share it with. So my profile is shared with Dr. Justin so that he has access to this data and then we just can review it together.
Dr. Justin Marchegiani: Hey, Dave, would you mind going back to the sleep section, for a sec?
Dave Korsunsky: Yeah, sure. So these are my sleep numbers. You got me deep, Doc. I think you said you had 8 last night.
Dr. Justin Marchegiani: yeah.
Dave Korsunsky: I’m at 7.8, so you know, again, you’re one upping me.
Dr. Justin Marchegiani: Yeah.
Dave Korsunsky: I’m just trying to hang with you but this is my sleep data over the last 7 days.
Dr. Justin Marchegiani: Would you mind clicking on it, too, to make it big?
Dave Korsunsky: This one?
Dr. Justin Marchegiani: Yeah.
Dave Korsunsky: Sure, let me see if I can just expand things a little bit. How’s that?
Dr. Justin Marchegiani: Great. How do you go into where you can look at the data by itself? Can you do that?
Dave Korsunsky: Just the sleep data?
Dr. Justin Marchegiani: Yeah, just the sleep.
Dave Korsunsky: Oh yeah, so in that case, all you would do is click on this graph right here and that will take you to a place where you can just start to look at trends. So this is a–
Dr. Justin Marchegiani: And can you compare another trend? I–I know this is one of the cool features. You can add the glucose in there and overlap it. Can you show that?
Dave Korsunsky: Yeah, anything that you’re tracking in here, you can–you can put on the graph. So let’s say, you know, one of things I’ve been tracking–so let’s say I wanna track sleep, it–there may or may not be correlation with my fasting blood sugar but I can put it on the same graph and look at it at the same time. So this is over the last 30 days and I can change it to any date range I want. But you can see over the past 30 days, my blood sugar–my fasting blood sugar has been as high as 99 and it’s been as low as 78, as I’ve been on the ketogenic diet. My sleep, I’ve been a–a pretty good sleeper regardless, so there hasn’t been a lot of change, but you could start to compare those types of things, more interestingly is I’ve been on Paleo for years. So my sleep’s been pretty good for quite some time. But if you’re just coming on to it, and you wanted to say, “Okay, I’d like to get a–a device that can help me track my sleep like the Misfit and then measure that over 6 months as I go on Paleo,” you could start to graph all of that data. I think, you know, equally interesting is one thing I’ve been tracking over the last month–
Dr. Justin Marchegiani: Oh, I wanted to add one thing, Dave, before you go on.
Dave Korsunsky: Yeah, sorry. Go ahead.
Dr. Justin Marchegiani: I think if we had a–if we had a marker for partying in there, I think we may see an inverse correlation between sleep and partying. What do you think?
Dave Korsunsky: You know, Doc, in my case, I think that’s gonna be the–the subject of a separate podcast. And yeah, I’m not sure I wanna get into that yet. The Dave of old would have probably had some–some numbers that didn’t look so good on a graph.
Dr. Justin Marchegiani: Love it.
Dave Korsunsky: But anyhow, yeah, we–we don’t have a marker for partying in the software yet, Doc. But for you, we’ll build it.
Dr. Justin Marchegiani: Perfect.
Dave Korsunsky: So, the–these are the labs and so this is what you and I have been working on for years.
Dr. Justin Marchegiani: Uh-hmm.
Dave Korsunsky: It’s just getting these things dialed in.
Dr. Justin Marchegiani: Uh-hmm.
Dave Korsunsky: My vitamin B levels, my RBC magnesium levels that were down, my thyroid panel. I–I’ve been seeing a conventional doctor for years, he only ran TSH. It wasn’t until I saw a functional doc where you ran the full thyroid panel. It turns out my–my reverse T3 was too high, my T3 was too low, and my T4 was too high. So it was a conversion prob. I didn’t even know what the heck that meant until I met you. All of this lingo, you know what I mean? But–but that’s where you helped me get to and understand the things that could start to affect those ratios. So take–this is my data. You can see before I went before Paleo, my cholesterol was about 177 total and then it went up predictably as I made the dietary change, but so did my HDL.
Dr. Justin Marchegiani: Yup.
Dave Korsunsky: And my cholesterol ratios actually stayed the same. They got a little higher but they’re actually now better than they’ve ever been. So looking at this lipid panel, Doc, what do you see?
Dr. Justin Marchegiani: Yeah, so off the bat, you can see your cholesterol numbers actually did drop. Now one of the biggest things that’s interesting is cholesterol, dietary cholesterol does not influence cholesterol that much. A lot of times it’s sugar and carbohydrate and inflammation.
Dave Korsunsky: Sure, interesting.
Dr. Justin Marchegiani: So cholesterol drop and you can also see your ratio’s improved.
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: With your trig to HDL and I even think your total chole–or HDL to total as well also improved, too. So a lot of these markers are moving in the right direction. Now you weren’t really off to be begin with because you were already pretty healthy but if you’re coming into this game with some inflammation and health issues to begin with, you’re gonna see dramatic improvements on this stuff.
Dave Korsunsky: Yeah, and I think if you were just to look at the total absolute number and say, “Hey, I–I made a dietary change and my cholesterol went from 177 to 228,” there are a lot of people who might jump to an assumption that that’s bad. But that’s actually the–not entirely the whole story, you could see my HDL went from 68 up to 81, and actually my ratios stayed stable and in–in fact, most recently they got better. So that was important learning for me that I just didn’t jump to an assumption because one number went up. You really need to look at the ratios as a whole before you come to any conclusion, is that right?
Dr. Justin Marchegiani: Yeah, and also your inflame–inflammation markers dropped as well which is huge, meaning the cholesterol–
Dave Korsunsky: Yup, so here they are here–
Dr. Justin Marchegiani: Yeah, we’ll jump on that.
Dave Korsunsky: Yup, so this is my–this is my CRP. It was–it was good to begin with, 0.48 but then it’s come down to 0.1 and then the homocysteine actually which is another inflammation marker, you can see here, back when I was first working with you, it was high. And we’ve cut that by, you know, almost 40% here down to 8.7–
Dr. Justin Marchegiani: It’s great. Awesome.
Dave Korsunsky: So this is–these were my results and they were really effective and these were the inflammation markers, so anything to comment on there?
Dr. Justin Marchegiani: Yeah, inflammation’s going down. We helped you with some specific B vitamins, maybe some MTHFR stuff.
Dave Korsunsky: Yup.
Dr. Justin Marchegiani: And you’re just, you know, living a really good inflammatory–anti-inflammatory lifestyle which is great.
Dave Korsunsky: How much of a role does physical exercise play in reducing inflammation? Because I’ve always been really physically active, and I–I’ve, some of my own personal research, I’ve done some reading that exercise has a way of reducing inflammation and so do you see differences in your highly physically active patients versus the non-physically active patients with respect to inflammation levels?
Dr. Justin Marchegiani: Well, inflammation, basically exercise can be a really big stimulator of growth hormone which can be, you know, a really good signal to put on muscle and muscle can help many, many different things, right? And also the more muscle you have, the less fat. The less fat, the lep–the better leptin sensitivity, better insulin sensitivity, so a lot of things happen with exercise in and around muscle. But we wanna make sure we’re choosing exercise that’s gonna be interval-based, resistance-based. If we do too much, long, slow, you know, chronic cardio type of stuff, that can actually be inflammatory and drive more cortisol so the right kinds of exercise, the things you’re doing are gonna anti-inflammatory because of their effects on muscle and hormones.
Dave Korsunsky: Yeah, that wasn’t always the case for me personally. I was actually overtraining at one point when I was also under a tremendous amount of work stress, and I didn’t realize it at that time but I thought the physical activity was good. It was really intense, like the P90X and the Insanity workouts, when I was already really taxed stress-wise and looking back on it, I realize I was just pounding my body back into the ground, and so I’ve actually backed off quite a bit. I don’t do training that’s ex–that’s that extreme anymore and it’s made a big difference.
Dr. Justin Marchegiani: Uh-hmm, and also when you’re under a lot of stress emotionally, that cortisol and adrenaline can mobilize extra glucose and a little bit of the right exercise especially interval, circuit, resistance stuff can clean out that glucose from your body and burn it up which can be helpful and reduce stress, too.
Dave Korsunsky: So there are some of the liver and–and kidney markers.
Dr. Justin Marchegiani: Uh-hmm.
Dave Korsunsky: I think the last ones that were interesting for me with respect to working with you was–here’s the glucose markers, they’ve–they’ve stayed pretty much the same, but in my case it was the thyroid panel and again it was–it was working with you where we found the T4 to T3 conversion ratios, the unusually high reverse T3, and that’s I think the importance of doing a full thyroid panel, correct?
Dr. Justin Marchegiani: Yeah, most people, most doctors barely would ever run a T4. It’s typically just the TSH. Now we ran the T4, we ran the whole kitten caboodle that we showed you on the blood test roadmap, but we even ran reverse T3 which never gets looked at which can be a sign of adrenal stress and a sign potentially of liver issues because our liver’s gotta clear that out. So that’s really gives us a good idea that the thyroid issue is probably connected to an adrenal stress or two.
Dave Korsunsky: Yeah, I–I’ll just call one of those thing out is, you know, when I was seeing my conventional doctor that the TSH number was the only one they–they–
Dr. Justin Marchegiani: Ever.
Dave Korsunsky: They love that.
Dr. Justin Marchegiani: Yup.
Dave Korsunsky: It was normal and then when I started working with you, you can the full thyroid panel. You started to see some things that were indicative of stress within the thyroid panel, then you ran the adrenal panel which no one has done before. The–the cor–saliva cortisol test.
Dr. Justin Marchegiani: Yeah, uh-hmm.
Dave Korsunsky: And that’s where you started to figure out, wow, the adrenals are really in bad shape. It’s something I’ve never even thought about before and then you got into the digestive health, and so that’s how you’ve been slowly putting all the pieces together and–and quite honestly it’s stuff that had never even been looked at before. And so I think that’s just a testament to functional medicine based on my own experience.
Dr. Justin Marchegiani: That’s great feedback and it’s important that we have a systems based approach. We’re not just looking at symptoms and how your body is functioning symptomatically. We’re looking at the body system and how they’re functioning and we’re looking at the stressors and how your body’s physical, chemical, and emotional stressors are, because stressors cause body systems to dysfunction and the wake of that dysfunction is symptom. So conventional medicine’s in the symptomatic relief program which can be helpful especially in trauma. We’re in the stressor and body system focus to get to the root cause of those issues.
Dave Korsunsky: Cool, so that’s all we had. Heads Up is available for anyone who wants to use it. We–we integrate with all of the major medical facilities, all the consumer health data. So everything Justin and I have talked about here, you can collect it yourself. And if you’re like me, you’ve moved around a lot, you’ve seen different doctors, your records are everywhere, and you wanna just have one single source of truth that you maintain, this is a tool that you use to manage it all. And again, I share my profile with Dr. Justin and so it’s–hopefully this is helpful for people but it’s worked for me and that’s why Justin and I wanted to get together and–and put this program together for you. So, Doc, what else should we cover off on–oh, there’s a couple of these things here.
Dr. Justin Marchegiani: Uh-hmm.
Dave Korsunsky: There’s the–let me just jump back to the slides here because for the people who wanted to get started, the easiest way to do it is–is one, can you still see my screen, Doc?
Dr. Justin Marchegiani: I got it, yeah.
Dave Korsunsky: Yeah, so you can use–
Dr. Justin Marchegiani: If you could make it a little bigger, can you Apple F5 it?
Dave Korsunsky: Yeah, so you can register at Heads Up Health if you wanna use the software. There’s a link here where Justin’s created a spreadsheet with the functional medicine ranges for all of these lab tests. So if you’ve got lab tests already and you wanna see how they stack up functionally, the spreadsheet is here. I’ve put together a list of all the devices that I use to track, the glucometer, the scale, Justin and I both use the same one, the sleep tracker, etc. So if you want some recommendations, they’re here. And Doc, you put together a complete lab panel at this link and it’s $299, but what exactly is included in that and how could people take advantage of it?
Dr. Justin Marchegiani: Yeah, this is a great lab. It’s gonna involve all the labs that we talked about today and then some. So we’re gonna have our typical CBC, CMP, right? A complete blood count and our comprehensive metabolic profile. We’re gonna have a full thyroid lab panel, every single thyroid lab on there. All the inflammatory markers, fibrinogen, homocysteine, CRP, ESR, it’s gonna have a full urinalysis as well, and it will even look at vitamin D. So this test typically, if someone goes to pay cash it’s about $1200. Some patients they have me bill their insurance and the insurance charges them $2500. We got it here for $299. So it’s the comprehensive panel that I run on myself, twice a year, and it’s pretty much everything you need to get started out the–out the gates here.
Dave Korsunsky: Yeah, I have health insurance, so in my case, I can get these tests covered. But if you don’t or you don’t wanna deal with your insurance or you want to use Justin’s test and then just–the–the codes are in there to apply for reimbursement. Sometimes it’s easier just to pay out of pocket than it is to fight with insurance. So those resources are available and then if you have questions for myself or Justin about any of this stuff, how do we get started tracking all of this stuff, or questions on anything we’ve talked about, our contact details are here. So what else, Doc? Anything we missed here?
Dr. Justin Marchegiani: Not too much. If people order that lab work, I think the–we’ll send them a receipt with some Superbill codes on there so they can always submit it. I mean, I have United Health. I have good insurance and I still do the cash-based labs because it’s cheaper for me than go into my insurance.
Dave Korsunsky: Cool.
Dr. Justin Marchegiani: Yeah.
Dave Korsunsky: Okay, well, that sounds great. Hopefully, we–we threw a lot of information at people but hopefully it’s–it’s helpful. So there’s–there’s the video on the slides and–and you can contact myself and Justin, so with that, Doc, I’ll leave you to close us off here.
Dr. Justin Marchegiani: Great. So if you guys have missed everything up to now, what’s the action item? What’s the take home? Really simple. Make the transition to a healthy Paleo template. Figure out your macronutrients. Pick 2 or 3 markers that you can check out, whether it’s the Tanita scale, whether it’s your functional glucose tolerance, whether it’s just looking at your fingernails, right? That’s a good start. Next is take some of your old data. Look at it, compare it to the reference range that we have here for the blood test roadmap, compare that, see where you’re at. Do you wanna get a little bit spicy there? We can dig deeper and get some new lab work and see what’s going on. See where your thyroid’s at. See what your inflammation’s at, and then from there, you can chart it and monitor it, and see how you do over time and the goal is to keep you performing, looking, and feeling better. And this is a great way to object it, objectify it, quantify it, and then be able to share with your friends and help them get better and healthier, too.
Dave Korsunsky: Yup. That’s–
Dr. Justin Marchegiani: So, Dave, I appreciate you being on the podcast. We’ll put it up soon and again, there’s a video for this, so make sure you’re watching it so you can see it and get the transcripts as well over at JustinHealth.com/podcast or BeyondWellnessRadio.com. Thanks, Dave, for being an awesome guest.
Dave Korsunsky: Thanks, Doc.
Dr. Justin Marchegiani: Take care.
Dave Korsunsky: Bye.
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