Evan Brand:  Dr. Justin Marchegiani, welcome to the summit. How are you?

Dr. Justin Marchegiani:  Evan, it’s great, man. It’s like déjà vu all over again, right?

Evan Brand:  Isn’t it? Isn’t it? Well, cool. Well, tell people about what you do. You run a wellness clinic out of Austin, a worldwide functional medicine clinic. So tell people a little bit about yourself. How you got into this whole space? What led you to venture away from chiropractic and focus more on the science part of—of health and looking at hormones and adrenal lab tests and gut tests and all the things that you do.

Dr. Justin Marchegiani:  Well, off the bat. This is for the Adrenal Summit. The summit you are hosting. So any of my listeners that’s listening to this on my podcast, Beyond Wellness Radio, feel free and head over to Evan’s site, notjustpaleo.com and sign up for his adrenal summit that he’s doing with Dr. Alan Christianson.  And then answering your question, so really functional medicine has evolved to the point now where virtual medicine is kinda taking over and it’s really convenient number one, for the patient, because the patients doesn’t have to drive back and forth to the doctor’s office and inconvenience their day and then sitting around this bland office, waiting to get, you know, serviced and treated by the doctor with these quick visits that are typically happening in conventional medicine. We can have this kinda of tele-medicine kinda situation whether—whether it—it’s phone or Skype and we can order all the lab work locally pretty much anywhere in the world. I mean, obviously domestic’s better in the US but we can still do it anywhere and that’s kinda changing medicine because we have the ability to check in with people on the diet and lifestyle side, create functional medicine programs, evaluate lab tests and there’s a level of convenience that’s really nice but also the ability to connect with someone so fast, face-to-face, to record calls that have a lot of digital aspects to it with the website and a lot of the podcasts and videos supporting the healing, I think really makes it more convenient and easier to get better.

Evan Brand:  Makes sense, so you would argue, you’re almost not missing out on much. Maybe the physical touch element that you would have in clinic but beyond that there’s really not anything that—that’s—that you’re losing by working virtually.

Dr. Justin Marchegiani:  Yeah, I mean I would say a good physical exam is always great but I mean, we can fret out a lot of that information in a good metabolic assessment or handout where we ask more in-detail questions about skin and rashes and—and fingernail, you know, ridging and such, and maybe hair quality or you know, different energy things that we can fret just with good metabolic questionnaires, but it’s nice to be able to have a—a physical interaction but all my patients typically, they’ve already seen doctors anyway, so they’ve already been at least evaluated from a physical perspective. I mean, if someone’s got a—a tumor in the back of their neck, right? You know, when we’re on Skype you may not be able to see that. So it’s nice to get that kinda crossed off our list before we begin.

Evan Brand:  Right, right, and then that’s something I noticed, too. Most people have already been through a handful of doctors or specialists so they’ve already had all of the baseline, the conventional stuff done that would pick up anything that would be alarming. So now we’re looking deeper.

Dr. Justin Marchegiani:  Yeah, and it’s nice for us to dig in knowing that those conventional pathologies have been crossed off because it really allows us to kinda really zone in super focused on what could be there on the functional side and not have to be as observant of the—the pathological situations which typically they’re more in your face anyway, right?

Evan Brand:  Exactly.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Tell people a little bit about the compare and contrast between conventional medicine and the functional medicine approach. And if you wanna use the context of adrenals or something else, then you can. I think that would be a good starting—good starting point.

Dr. Justin Marchegiani:  Great. So overall in functional medicine, I give this comparison to my patients. Functional medicine and conventional medicine, it’s like a light switch. Functional medicine is the light switch that’s the really cool dimmer switch. It can go off and on, and there’s a spectrum. You can have it just a little bit on. You can have it in the middle. You can have it almost off. You can have it all the way on, right? So you have the ability to have various intervals of how high or how low that light is. Now with conventional medicine, the light’s either off or on. In other words, if the light’s on, you’re healthy. If it’s off, you’re deceased, right? That’s conventional medicine. Now let’s say the light’s just a little bit flickering in the functional model, right? We got the dimmer switch, right? It’s on just a little bit. Well, if you go to the conventional doctor, they’re gonna say, I see light; therefore, you’re fine. But on the functional spectrum, we say, “Yeah, we see light but it’s—the light’s kinda like 90% off, right?” So let’s work on ratcheting that dimmer switch up to 100%, 100% being 100% function. So conventional medicine, any bit of light, you’re fine. You’re normal. Hey, keep coming back. I’m gonna write you a prescription for depression. If you’re a female, maybe we’ll—we’ll recommend some birth control pills or both. Right? That’s typically the conventional medical solution. In functional medicine, we have the philosophical approach of the dimmer switch, so we can pretty much no matter where you are in that light spectrum work on ratcheting you up into the right direction.

Evan Brand:  Excellent analogy. Now most people what they do for you and I both something we’ve noticed is many people wait until they’re ridden with health symptoms before they come to reach out and get help with functional medicine but the analogy you used just proved something that I’ve been hoping for all along which is that someone who is relatively healthy overall may be just has a couple of little kinks in their armor somewhere. They can still come and get help and feel new energy or feel an increased sex drive. Something that they’ve wanted or feel less bloating, even though they are “okay” by any other practitioner standard.

Dr. Justin Marchegiani:  Correct. So can you reiterate that question one more time? I didn’t quite get the full question.

Evan Brand:  Yeah, that was just a statement, that wasn’t a question.

Dr. Justin Marchegiani:  Okay, got it.

Evan Brand:  Yeah, so let’s talk about–

Dr. Justin Marchegiani:  I agree.

Evan Brand:  Let’s talk about adrenals. This is the—one of the first steps that you do when you’re working with patients is looking into the adrenals which you and I both kinda break it down, adrenals, gut, detox, hormones, which is just so beautiful–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And I thank you for all the mentorship that you provided to me, even over this past year every single week, we’re—we’re digging in together.

Dr. Justin Marchegiani:  Love it.

Evan Brand:  So I appreciate that.

Dr. Justin Marchegiani:  No problem.

Evan Brand:  Now let’s talk about why adrenals have to be first in a functional medicine program. Eventually we’re gonna talk about why most people are not getting results from that. But why can’t you just go straight to the gut if someone has issues there? Why—why do you have at adrenals?

Dr. Justin Marchegiani:  Great question. So let’s—I’m gonna use my last patient that I had just before our call here as an example and that’s the nice things about us in—in the podcast that we do and the summits that you’re doing and then the interviews that I do, is we have a functional medicine clinical perspective that we bring to and that perspective and that allows people to not just a theoretical kinda look into it, but actually, hey, what’s working in the trenches? Because in the end, you know, it’s better to be coached by someone that’s doing it than who’s just doing it theoretically. So on that note, I just had a patient and we got some of her labs back in. We had a DUTCH adrenal test with female hormones. We had a thyroid test and we also had a gut test—two gut tests—an organic test that looked at bacterial function as well as a GI Map test and a DRG test. Now on those tests, on the female hormone and the adrenal side, her adrenal hormone levels were okay. Like if we looked at how much amount of hormones she was pumping out, she’s pretty good. The issues were very aberrant timing. Very low in the morning, high in the afternoon, and very low at night. So there was this timing issue throughout the day and that created mood swings and energy dips. Number two, she had thyroid issue. So she had elevated TSH. She had very poor T4 levels and even poor T4 to T3 conversion. So there were thyroid issues. We need thyroid hormone to metabolize the building blocks to make hormones. i.e. cholesterol comes down the hormonal cascade. It gets acted upon by thyroid hormone to break it down into building blocks so it can actually be used to—to make some of these hormonal constituents. And last but not the least, this woman’s female hormones were very low. She’s already post menopausal but she had very low estrogens—almost non-existent—very low progesterone, and very low DHEA. And so as a woman into menopause, the backup generator so to speak are the adrenals. And this is—being in the Adrenal Summit, this is important because the adrenals become this backup generator for sex hormone function once menopause hits and is through.

Evan Brand:  Say that one more important, I think that’s profound.

Dr. Justin Marchegiani:  Yeah, so DHEA, one of the major building blocks—DHEA sulfate from the adrenals becomes this major building block for your sex hormones once the ovaries are in the menopause. So it becomes the backup menopause. So I always tell patients, imagine you got this generator. You spend a—a bunch money on it. It’s sitting on your garage or whatever, so when that storm comes, you can still have power, right? Now most people want that generator 100% charged. That’s the goal. So then when you plug it in, it works and everything is at 100% capacity. Like there’s no lapse in function between the storm and—and being in the storm so to speak. But now you got this generator, it’s in the garage. It’s 90% empty. So you got 10% of fuel capacity in there and you’re trying to get 100% function out of our house, right? You want the heat, you want the AC, you want everything to work. But that’s not gonna happen or at least not for long when the charge is that low, and that’s like your adrenals being on low. So now instead of the storm or instead of the heat wave coming, now we got stress. We have family issues, financial issues, kid issues, job issues, up and down s stressors that normally happen in life. They’re like the thunderstorm or the heat wave that comes in, stressing your house’s electrical system. So supporting the adrenals really helps buffer out the hormones and hormones aren’t just to have babies. Hormones, they’re there to reproduce, right? Have a child but also reproduce you, meaning every cell in the body—hair, skin, nails, muscle, tissue, bones—all of these important things as you get older become more important because who doesn’t want to have healthy skin, healthy nails, you know, have decreased chance of being osteoporotic, having weak bones, weak muscles? Everyone as they age wants to age as gracefully as possible and having strong adrenals is paramount to that goal.

Evan Brand:  Excellent. So talk about this female—people wanna know well, what does this feel like? You mentioned some—some geeky lab results here. What does that actually translate to? What would this person be—how would they be going through their day?

Dr. Justin Marchegiani:  Oh, great question. So especially women with the sex hormones, because women have that drop, right? They’re cycling. Now they’re not cycling. It typically takes a year or so to make that transition. So now they’re not cycling. One of the big first issues we’re gonna see are hot flashes, right? Typically FSH starts to rise, that’s the brain hormone that says to the ovaries, “Wake up! Wake up!” So FSH is trying to, you know, wake them up and that can start to create some hot flashes with the vasodilation. We can start feeling more moody, right? Mood issues, irritability, even can see things like depression, okay? I already mentioned depression, mood stuff, sleep issue is a big one. We can start to see hair quality, skin quality issues, and also lower libido. So all those are all common symptoms, and also fatigue and brain fog because–

Evan Brand:  Yeah, and–

Dr. Justin Marchegiani:  These hormones are antioxidants, right? So they help with stress and inflammation so the more your hormones are off, the more inflammation can kinda be like a—a wildfire without a firefighter to put it in check so to speak.

Evan Brand:  Yeah, and so you mentioned low cortisol, so she’s probably waking up, not feeling ready to start the day, maybe needing some caffeine, coffee to get going.

Dr. Justin Marchegiani:  Exactly and then also the swings in cortisol, too, right? Remember when we look at adrenal function, I think we’ll get to this later when we dig into more lab assessment and lab testing, we not only look at adrenal levels because this woman’s levels they weren’t bad. They were actually in the middle of the range but the rhythm piece wasn’t good and the sex hormone piece wasn’t good. So when we look at adrenals, we have a 3-pronged approach on how we assess it. Number one’s gonna be cortisol rhythm, because we have to recognize when we look at adrenal issues, it’s not just, “Oh, do you have adrenal fatigue or not?” Right? It’s how’s the rhythm? How’s the HPA axis, the brain, the HP? The hypothalamus, pituitary talking to the adrenals, that’s number one. Number two is how’s the actual amount? What’s the adrenals actually making? Is that enough to support function? And then number three, how’s the sex hormone piece? So in this lady, rhythm wasn’t good, amount was okay, but sex hormones were low. So she was missing two out of the three, so she’s going up to the plate with 2 strikes on her.

Evan Brand:  Wow. So let me ask you this. If you see normal adrenal output, so you see normal hormone levels–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Well, let’s just say everything was normal, but it was dysfunctional. Do you call that adrenal dysfunction or do you classify that adrenal fatigue?

Dr. Justin Marchegiani:  Well, I don’t like the word adrenal fatigue. I think adrenal fatigue can be a good way to describe people that have low sex hormones and very low cortisol, because that kinda be called adrenal fatigue because everything’s starting to become more depressed which is good. The problem is a lot of people confuse adrenal fatigue and adrenal failure maybe because there’s 2 F’s that start the words—I don’t know. But adrenal failure is kinda like Addison’s disease, right? That’s more of where there’s an autoimmune attach on the adrenals and the adrenals literally are barely functioning and there’s almost not enough cortisol to even get through daily requirements.

Evan Brand:  And how often have you actually seen that compared to what we’d typically work with which is more adrenal dysfunction?

Dr. Justin Marchegiani:  I have only seen one case of Addison’s disease in my practice which is adrenal failure.

Evan Brand:  And this among— yeah, and this among thousands–

Dr. Justin Marchegiani:  Thousands of patients.

Evan Brand:  Of patients, so–

Dr. Justin Marchegiani:  Most people know when they have Addison’s because they literally cannot get out of bed. I mean, if you go look back in the history books, cortisol was created I think synthetically or bioidentically in the 50s and one of the things, one of the major reasons why John F Kennedy, JFK, won the presidential race in the 60s is the won the Senate in the mid-50s up in Massachusetts where I’m from and they had just found out a way to create cortisol. So he started taking it for his Addison’s disease and you can literally see his face and his muscles all start to fill out because he did not have enough cortisol. So if you look at pictures of him in the mid-50s or early 50s, he’s absolutely gaunt. But then you look at him in the 60s during the presidential debates he looks amazing, and part of that was that cortisol shift and that’s what happens when you have cortisol failure. You literally just—you look terrible.

Evan Brand:  Wow.

Dr. Justin Marchegiani:  And you feel terrible.

Evan Brand:  Wow. Okay, so that’s pretty rare overall for Addison’s. So typically somebody’s gonna be in that 99% range where–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  You’re having good cortisol or just completely horrible. Most people are existing somewhere bet—between Cushing’s which is super high all the time or Addison’s where you can’t make enough.

Dr. Justin Marchegiani:  Yeah, it’s the dimmer switch, right?

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So let’s say off, that’s Addison’s. On, that’s Cushing’s, right? Alright, think Cush-push. Alright, that’s how we learned it in school. Cush-push, it’s high. Addison’s is failure, okay? And most people, right? On as Cushing’s, off as Addison’s—most people are on that dimmer switch somewhere in between.

Evan Brand:  So probably 99% of the people and you and I have both had patients who have diagnosed themselves with Addison’s but then we’ve looked and it wouldn’t be an Addison’s scenario. They’ve just been–

Dr. Justin Marchegiani:  yeah.

Evan Brand:  Almost fear mongered because when you look into the conventional research about adrenal fatigue or adrenal dysfunction, you’re typically not gonna find much. You’re gonna find WebMD’s approach which is Addison’s or Cushing’s. That’s all you’re gonna read about. So this just goes to show the importance of the work that you’re doing and the work that you and I do together, recording podcasts–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Weekly because we’re seeing this stuff. It is real.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And it’s not in your head.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And you’re not crazy if you’re dealing with these symptoms that—that you’ve discussed.

Dr. Justin Marchegiani:  I 100% agree. Now I like the word adrenal dysfunction because they kinda gives you a lot of latitude to—to address HPA axis stuff. Maybe the cortisol is not low. Maybe it’s a rhythm issue. Maybe it’s a sex hormone issue. I think adrenal fatigue can be more aptly described to be put on a label of like very low cortisol, very low sex hormones, alright? But people still conflate it with failure. So remember, adrenal fatigue is not adrenal failure, and a better word maybe be just adrenal dysfunction to look at it and that really–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Puts in the key issue that a lot of people are looking at. It becomes more of a brain issue than an adrenal issue, right? The HP—the brain’s not talking to the adrenals. And then also when we add in the gut issues, we know there’s certain nutrients that are required to make the adrenals run optimally—vitamin C, pantothenic acid, B5, zinc. And if we have digestive issues which will eventually go there soon, that could be a driving factor of why the adrenals aren’t running as well and most people in Adrenal Land totally miss the gut piece of it.

Evan Brand:  Absolutely. Well, let’s transition there now. That’s basically phase 2 which is the gut and many people which you and I have kinda come up with an average of about 1 in 3 people have infections.

Dr. Justin Marchegiani:  I’d say 1 in 2 to some degree. I mean, obviously when we look at infections, there’s a difference in severity. Let’s say a bacterial overgrowth vs dysbiosis or a full-on parasitic infection or a combo of all three, right?

Evan Brand:  Right, which maybe we a have a little bit of bias–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Population since we’re with people that have all these symptoms so maybe the average person out there but even if you look at like World Health Organization, they’re saying that, you know, 20% or greater of the US population has Blastocystis hominis.

Dr. Justin Marchegiani:  Yes, I know.

Evan Brand:  A common parasite and this is–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Something we see weekly at this point, so it’s like, wow, a lot of people are going undiagnosed and I’m sure that’s kinda the lens that you wanted to start this—this topic on is people are going to “adrenal fatigue specialists or adrenal fatigue experts”. We’ve seen some adrenal programs online and typically the gut piece is ignored. Is that why people are—are suffering and not getting results?

Dr. Justin Marchegiani:  That’s a big part of it. So when we look at the symptom of fatigue, right? You have fatigue. Now a lot of people because of education in functional medicine, people are linking up fatigue as adrenals. Right? I kinda have my fatigue triangle, right? On the top part of the fatigue triangle, we have the adrenals because the adrenals help regulate glucocorticosteroid aka cortisol which helps regulate energy and inflammation. Most people are low energy and also inflamed, so it makes sense why the adrenals are in poor shape. So top part of the triangle is the adrenals. The bottom parts are gonna be the thyroid and the mitochondria. Okay, the thyroid is there to help regulate metabolism. With low thyroid, we’re not gonna be able to have the building blocks to break down the healthy levels of corti—cholesterol and to building blocks to make hormones, number one. And thyroid controls temperature and resting metabolism. If you have a low resting temperature and metabolism, you’re not gonna be able to generate energy as well. That’s important.

Evan Brand:  So let me ask you this, too. How does Hashimoto’s play into this, too? Because this is something also that typically goes undiagnosed. Autoimmune thyroid issues where they’ve never been tested. They’ve never even had that looked at.

Dr. Justin Marchegiani:  Yeah, great question. So Hashimoto’s gonna hit the thyroid part of that triangle, but it really is a combination of all three because when you have Hashimoto’s, typically there’s immune system upregulation where the immune system’s attacking the thyroid gland so that creates inflammation. So if we have inflammation, then guess what’s in overdrive? The adrenal is in overdrive to help with the inflammation. The thyroids are being attacked by the immune system. So that means, these various little follicles are being attacked by the immune cells so they’re bursting open and thyroid hormone goes up and it goes down, so early on you can feel like you’re on a rollercoaster ride. You may even be diagnosed hyper to begin with. You may have anxiety and depression during the—during the swings of thyroid hormone being released. So it can be this up and down rollercoaster, and let’s not forget autoimmune conditions, typically there has to be some level of leaky gut happening. So we have leaky gut whether it’s some gluten exposure, various infections like Lyme or Blasto or Yersinia enterocolitica or H. pylori so you see how the gut starts to interplay with the adrenals and how the adrenals interplay with the thyroid and how the thyroid actually interplays back with the adrenals because we need healthy levels of cortisol to help activate and convert thyroid hormone. So you can see if we have adrenal dysfunction, that can start to create thyroid issues, too. And this patient I just saw, she—it was on Synthroid for 30 years, 150mcg dose which is equal to about a gram and a half of Armour or NatureThroid which is a pretty hefty dose for someone that still has her thyroid, right? But she still had low levels of T4, very poor T4 to T3 conversion, and their TSH was still high. She being medicated by endocrinologist for 30 years.

Evan Brand:  Wow.

Dr. Justin Marchegiani:  So we had to go in there and change that thyroid support a bit. Support it a little bit more but also fix the adrenals and the big thing was fixing the gut because she had a significant amount of small intestinal bacterial overgrowth and we know the gut bacteria is really important with the enzyme sulfatase which is produced by healthy gut bacteria to activate the T3 acetic acid and sulfate and activate thyroid hormone in the gut.

Evan Brand:  Wow, that’s amazing. And so people that don’t know, if—if you don’t listen to my podcast or you don’t listen to Justin’s podcast already, I showed up with 2 parasite infections about a year ago and Justin was the guy that told me. I went over to his house and I think we were just hanging out or you were gonna give me an adjustment or something–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And I said, “Justin”. I said, “Help me. What’s going on?”  I said, “I’ve lost 25 lbs without trying.” He took one glance at me and he goes, “Evan, you got a parasite.” And it hit me and I was kinda like, “Yeah, I mean. Maybe.” And I—I put off testing. You were like, “You need to go get your gut checked out. Go get a test.” And I was like, “Okay, okay.” And so I finally got hold of the lab. I said, “I’ll get a test kit.” I ran it. I showed up with Cryptosporidium and Giardia—two parasites that are pretty—pretty bad. They’re not the funnest parasites to have and since working on those, I’ve been able to build more muscle. I’ve been able to gain more weight. When I ran my adrenals, I showed up with what I would consider adrenal dysfunction, if not adrenal fatigue; my cortisol was low all day. So that just goes to show that even a younger guy who is pretty active—I spend a lot of time outdoors. My diet is—is much—is close to 100% organic as possible, I still had adrenal issues and I’m gonna go ahead and say it was due to the—the stuff going on in the gut. What about you?

Dr. Justin Marchegiani:  100%! I agree with 100%. A lot of people that have adrenal issues, they miss the gut piece and it’s so hard because people are programmed to think of gut issues as diarrhea, bloating, like these are symptoms that are associated with a gut issue. So when you start to tell someone that they’re fatigued; it could be from a gut issue or their brain fog or their mood issues, could be from a gut problem, they’re like it’s so hard to get your head wrapped around that.

Evan Brand:  So basically what happens is and not to put words in your month, you can elaborate as much as possible–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  But in these situations you’re basically, you’re getting robbed because you are feeding these bacterial overgrowths. You’re feeding these yeast. You’re feeding these parasites and you’re not feeding yourself and myself even today looking at my fingernails, I do still have the vertical ridging, which that’s not always 100% indicator, but it told us there was some type of malabsorption going on. It was just a matter of getting the right testing done to figure out what was going on. So maybe we could—if you wanna comment on that and then we can talk about what tests need to be run for people to get an accurate diagnosis of what’s going on.

Dr. Justin Marchegiani:  So speaking clinically to your situation, there may still be another infection or two still lingering. So I know we’re waiting to hear back on some of those re-tests so it’ll be interesting to see what happens with you and it’ll be interesting to see how your fingernails change over time. Not to mention, this could be a long-time coming to, right? So it may not just shift overnight. So we just gotta keep an eye on it.

Evan Brand:  Yup. Do you–

Dr. Justin Marchegiani:  Go ahead.

Evan Brand:  Do you—yeah, I was gonna say, do you wanna talk about the labs and then do you want to reveal what you found on your labs?

Dr. Justin Marchegiani:  Yeah, that would be cool. I would just say one more thing here because when we deal with fatigue and adrenals issues, I created this analogy because for me it really just rings true and analogies are great because you don’t have to memorize. You just have to understand it and it sticks, right? So that’s why I like it. So my analogy is the adrenals, it’s like let’s pretend you’re in a car. It’s a stick shift. It’s a standard transmission, okay? So the adrenals are like your ability to shift gears, alright? Going from 1^st gear to 2^nd gear, 2^nd gear to 3^rd—3^rd gear. That’s like your body’s ability to handle more stress, right? The higher up in the gears you go, the faster your car’s going, the more stress on the engine. Your ability to downshift is your body’s ability to adapt to stress. To kinda get back to homeostasis or that parasympathetic rest and relax state. So the being it—being able to shift gears up and down is being able to upregulate and downregulate to stress. That’s number one. Number two, your resting metabolism, so if you put a car in neutral, yeah, you put it right in neutral, you could pull your foot out of the clutch now, it won’t stall it out. And typically you’ll be at about 700 to 1,000 RPMs on average, okay? Now that’s like a good resting metabolism or resting RPM for the car. If you go too low, anyone that drives a stick knows their car will stall out, right? If you go too high, well, now you’re putting extra stress on the car and it may burn out. It may red line. So think of neutral as the resting metabolism of the engine and then think of the mitochondria or the nutrients needed for the car to run as like the gasoline and the lubricants that are in the engine and in the gas tank that provide the fuel for the car to run so on one hand, we have the ability to shift up and shift down as being able to deal with stress. The resting metabolism is kinda the thyroid piece. The nutrients required for the car to run, right? The substrate, the oil, the gas, etc. is the mitochondria and then all that stuff feeds into the gut and feeds the detox pathways and feeds the brain so when we have an issue with those 3 things, other things tend to be at root as well.

Evan Brand:  So it’s all connected and you can’t just focus on–

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  One piece of the puzzle because what’s gonna happen, you’re gonna come and maybe re-test your hormones if you ever got them tested in the first place and they’re gonna look probably the same and your symptoms are still gonna be there, is that right?

Dr. Justin Marchegiani:  Correct. 100%!

Evan Brand:  Wow.

Dr. Justin Marchegiani:  And regarding my test, I just came back with an E. histo parasite so I’m treating that as well. My actually came back with H. pylori and Blasto. And this is her second time with Blasto.

Evan Brand:  Wow. So–

Dr. Justin Marchegiani:  So it’s hard to say you know, where these things are coming from? And we—we waterski every week and you know, you take a mouthful of water every now and then, so who knows, right? We also have some pets. We have our dog, Butter, who is hanging out with me right now and then a couple of cats, Mischa and Dexter, and you know, they like to be friendly and stuff, so who knows maybe we got some from them, but you know, you fix what you find.

Evan Brand:  Exactly.

Dr. Justin Marchegiani:  You get the testing done. You clear it out because I think it’s everyone’s right to be infection-free and we wanna make sure that we have that opportunity.

Evan Brand:  Agreed, agreed. And I would consider you definitely one of the best, not just online but in general one of the best functional medicine practitioners out there that are actually looking at this stuff and not only helping people to be healthy but doing in a way that’s fun. Now this is isn’t a video—this isn’t a video interview for the summit side of things but I’m looking at you here and you smile the entire time. You love this stuff.

Dr. Justin Marchegiani:  Love it, man. It’s great.

Evan Brand:  Isn’t it?

Dr. Justin Marchegiani:  Well, it’s—the thing is it’s incredibly rewarding. I mean, I say that we have the best jobs in the world because when you have patients come in to your office that have really bounced around the conventional medical establishment for a while, they have maximized their options, and when you can help them get to the root cause of why they’re feeling the way they’re feeling, it’s great. It’s really exciting. It’s like you’re a—a CSI detective on TV. You know, it’s great.

Evan Brand:  I know. Does it ever—does it ever hit you and kind of trip you out a little bit when—because it—this happened to me last week when you are working with someone and they’ve been to 10 or 12 specialist, but yet they’ve never had some of these basic foundational functional medicine tests run?

Dr. Justin Marchegiani:  Yeah, I mean, I think a lot of people in functional medicine, a lot of them may have a really big conventional medicine background so they look incredibly myopically at certain things under a functional medicine light, like maybe they look at the adrenals and they’re so myopic on the adrenals but then they forget the gut or they’re looking at the gut but they forget the thyroid or they forget malabsorption pieces so I think people they—they don’t have a good clinical hierarchy model of where to treat and they’re lens is so focused on one thing they, you know, they’re looking at the trees but they’re missing the forest so to speak.

Evan Brand:  Right, and when I talk with Alan about this summit, I said, “I basically want this to be the anti-summit summit because a lot of these people that are in summits, the interviewees are not clinicians.“

Dr. Justin Marchegiani:  They aren’t.

Evan Brand:  They may have some of these credentials but they’re typically not working with people. They’re not in the trenches and so I commend you for your work in the trenches on a daily, weekly, monthly, yearly basis, not only that working with people but also putting out the content because I think that really shows that you’re putting in the effort and you’re not just reading a book and then regurgitating something because something I found is it doesn’t matter how educated you are or how many letters you have after your name if you’ve not been in the trenches, you cannot successfully get people better because you don’t understand the psychology that foes into this about people having to make the changes and being there as sort of a therapist as well to support them if there are any effects. You know? Let’s just say you’re killing off an infection, you may feel a little bit worse before you feel a little bit better for the first couple of days and being able to have the expertise to know that and forewarn them of it, it’s priceless. So you know, people definitely check out Justin’s site. It’s justinhealth.com and you can go look into the podcasts. There’s probably 100 episodes released by the time you listen to this and I’m honored to be the co-host of that show for many of the episodes and we—we have fun just like we’re doing here. So you can check him out there. Obviously we could go on and on for hours, but I think you get the gist of it here is that, you just—one, you have to go check out his content but two, you really have to look at this whole adrenal piece as a puzzle, but it’s a puzzle that’s solvable, right?

Dr. Justin Marchegiani:  100%, 100%. And I appreciate your kind words there and I think the big thing that we do on the podcast is we really bring that clinical experience because you know, I have a lot of clinical friends and colleagues that are—they have their head in—in the literature, the scientific literature which I think it’s great and maybe you can draw a lot of inferences from what to do next, but I think the best thing is one, work on yourself, and then number two, observing how patients respond to and from different interventions and treatments is the absolute best learning experience for any doctor. I think having the clinical context before you go in is gonna be important because then you know where to put the different puzzle pieces to start, right?

Evan Brand:  Right.

Dr. Justin Marchegiani:  So that gives us the ability to kinda put it in the right order and we’re fortunate to have mentors like Dr. Kalish and Dr. Timmons when he was alive regarding how and the best ways to treat people for success. So we all know that we try to avoid heavy metal stuff first, right? We try to avoid doing gut-killing stuff at first. We may even try to do—avoid detox stuff at first. Now again, there are exceptions to all these rules but that’s the general trend in which we’ve worked on things and the adrenals and the thyroid and the adrenals and the hormones tend to always be the first thing that we do and it makes a big difference when you line it up in the right order. You could find the right things but you put the puzzle pieces in the wrong order, the picture may not look as clear.

Evan Brand:  Absolutely, so if you’re something out there and I’m sure you are if you found this summit, who you’ve googled your symptoms or you’ve looked on some Paleo health blogs and you’ve read about some detox formula or you’ve read about some cleanse or a gallbladder flush with olive oil and there’s just all sorts of crazy stuff out there and a lot of people don’t have a clear direction. Here’s the clear direction if you’ve been looking for it because I get goosebumps saying this because it’s been able to help my health. It’s been able to help thousands of patients–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  On your side of things, nearly a thousand on my side of things, this is approach—an approach that actually makes sense. You see that there’s no dogma attached to it. Justin’s telling how it is and telling it to you straight. There’s no fluff.  There’s no fancy words if there are they’re broken down into analogies. This stuff can be very complicated. It is all tied together but at the end of the day, it comes down to some simple takeaways. So maybe as we wrap this thing up together you could sort of boil all this down for people and give them a clear direction of what they can do next or what steps they’ve ignored for 40 years that need to be taken now.

Dr. Justin Marchegiani:  Awesome. So number one, a couple of the interventions that you’ve mentioned, right? You mentioned like gallbladder flushes or maybe coffee enemas or this thing or that thing may not be necessarily be bad, but it’s like you have this 500-piece puzzle and I give you 1 piece and it’s like solve it.  Well, I—I need a little bit more clarity on—on what the heck’s going on for where to put that piece down, right? And I think that’s where having the clinician approach to get the diet and lifestyle dialed in; that’s always foundational, right? That’s the foundational piece. You wanna build a big skyscraper or you wanna build a small 2-story house, you always start with the foundation first. And again, the higher up you wanna go, the deeper that foundation is. That’s number one and we always start with the diet and the lifestyle. So anti-inflammatory, nutrient-dense, low toxin type of Paleo template where the macronutrients can be adjusted and certain foods can be pulled in or out like salicylates, phenols, FODMAPs, again we adjust that according to how messed up someone’s gut or digestion is. Blood sugar, eating every 4 or 5 hours if possible. If we can’t even handle that because eating too much food causes problems we may have to adjust what we eat. And then the next piece I think is I mentioned before getting clarity where that puzzle piece goes. That’s where the lab tests really are helpful because they can tell us what’s going on deeper but also it can give the patient a lot of confidence that what they’re dealing with is real. Because a lot of people that I’ve seen, they bump their head up against the wall so many times with doctors that have told them it’s not real or its’ all in their head and they don’t even know what’s fact from fiction so we can get clarity on what’s real and what’s not and then we could measure it and check back in. That one, it keeps the patient excited. It’s like, you know, you’re sitting there in your term class, right? In your—in your class throughout the semester and you know, why are you gonna study and do your homework if there’s no test at the end, right? So the test at the end is the re-test or it’s the reassessment or it’s the follow-up. So people sit in class and pay attention when there’s a test. So I like the ability to get a starting point, create the anticipation of hey, we’re gonna follow-up and then know there’s gonna be accountability along the way, so I think working with a practitioner that has those types of foundation pieces in between are really important.

Evan Brand:  Agreed. I can’t tell you any greater feeling than looking at a re-test and you find someone that’s suffered for 20, 30 years and then you see the infection’s gone.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  It’s like, ahh, you could take a breath when you see stuff like that.

Dr. Justin Marchegiani:  And you see the adrenals start to heal or you see thyroid levels start to get back into balance.

Evan Brand:  So–

Dr. Justin Marchegiani:  So I think those are really important.

Evan Brand:  What would you say, just in a—in a general sense if someone just feels like I’ve done everything. I’ve tried the herbs. I’ve tried the adaptogens. I’ve had the natural thyroid support. And I still spun my wheels. How am I supposed to—can I truly get better?

Dr. Justin Marchegiani:  Well, I would say, number one, there may be something missing on the digestive side. So I would say, off the bat, look at your nails. Look at your regularity. Look at your bowel movements. Are you a Bristol stool chart #4? Or do your nails look decent? Do you have good digestion without gas and bloating and reflux and irritation? Is that 100% good as well? And let’s say it is. We should still get it looked at because if you’ve done all the—the body system one test which is what you kind of alluded to which is like the thyroid, the adrenals, all the supplements to support that but there are other pieces that really haven’t been looked at or maybe their symptoms alluding that we should look there, that has to be looked at next, and we really have to do a thorough analysis. Maybe even multiple tests side by side to make sure nothing’s being missed.

Evan Brand:  Well-said.

Dr. Justin Marchegiani:  Because I can’t tell you how many tests I see from other patients coming in where I already know, you know, pardon my French, this lab sucks, right? I’m not gonna say the name of it. This lab over here—and we talked about this before—they run one lab from this crappy lab and we’re like, “Oh, man. That lab stinks. It definitely missed it.” And then we don’t even run that lab. We run other labs that we consider to be better based on our thousands of data points on it, and we see even the good lab misses one, but the other lab pulls something up. And it’s like, wow, if we didn’t use this really good labs to begin with and if we didn’t use one or two side by side, we wouldn’t even have picked it up. So most patients are already coming in. They’re having lab tests that may be subpar on the gut and they’re saying, “No, I’m fine. Look, I’m fine. No problem.” And it’s like, just maybe be a little bit more skeptical if you haven’t done the right test and you haven’t done multiple tests that I consider to be the—the good test, right? And—and we would say like maybe the 401H and the DRG and the GI Map would be some good tests that we put out stamp of approval on. Maybe even the one by Doctor’s Data, too, is a pretty good one. But I like to say at least 2 of those and definitely having the DNA one in there to be—to look at it and really round out our assessment.

Evan Brand:  Yeah, so I’ll—I’ll add a note to that, too. I had a female patient who struggled forever and ever. She went to conventional doctor who then made the referral to the gastroenterologist, a very common step that they’ll make.

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  She got the stool test at the hospital. She showed up with no infection. So she thought I’m fine. “Evan, it’s just a yeast problem. Can you help support me for yeast? Getting rid of yeast.” I was skeptical. I thought, “Okay, this doesn’t make sense.” So we ran—when Justin said 401H, that’s by a company called BioHealth. We both use it–

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  And love them.

Dr. Justin Marchegiani:  Yup, they’re great.

Evan Brand:  We ran—we ran the 401H and she still showed up negative. So even I was almost convinced at this point. So I said, “Well, okay, well let’s try to knock out the candida.” Let’s go for another 4-6 weeks, see what happens. Bloating, excessive distention was still there so then we ran the other tests that you mentioned, the GI Map which is by a company—in case people are trying to find them—it’s Diagnostic Solutions Lab.

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  And she showed up with Dientamoeba.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  A parasite infection. We finally found it.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  So even some of the best of the best test that you just alluded to, sometimes there will be false negatives and you’re gonna need to go and do 2 or 3 or maybe even 4 test panels looking at different things, whether it was stool or urine, etc. to actually find something because if you have a feeling in your gut that something’s not right in your gut–

Dr. Justin Marchegiani:  Pun intended.

Evan Brand:  Your gut feeling is probably right.

Dr. Justin Marchegiani:  Yeah. Absolutely. And I’d say here’s the kicker right now. And this is like I think this bothers a lot of people but I just put it out there so they’d know it in advance. The more you can predict what—what’s gonna happen good or bad, patients have faith in you. So I think it’s really important to make sure patients have faith because they’re taken, you know, a lot of what you say to heart. So the big thing is, sometimes when we re-test some of these gut infections we have a new infection. Okay, now there’s a couple of variables, a couple of reasons why. Number one, it could be the fact that as the gut heals, proximal to distal meaning into the middle part of the gut where the food resides versus into the gut wall, right? Where everything kind of emanates or it goes into, there can be deeper infections that are burrowed on deeper and it may come to the surface as the gut heals. And this is kind of theoretical in functional medicine, that’s called a crypt hyperplasia phenomenon that could potentially be happening. I’ve seen people with 4 or 5 infections burrowed in deeper and 1 or 2 comes out at a time. So–

Evan Brand:  Wow. So let me—let me kind of restate that so people are like, “What? What does that mean?” So basically, what happens is, you know, you’ll come in and you’ll find an infection. You’ll treat that in someone, that original infection’s gone, you get the re-test but now a new infection’s there. And you’re like, “What the?” So then you come in, you re-treat again.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  That infection’s gone. Another one shows up. So you are really doing a great job of—of zooming in and zooming out here because if people–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Have been struggling with adrenal issues and you’re 4 or 5 infections deep. It’s gonna take a while before you get those adrenal hormones back online. It’s that safe to say.

Dr. Justin Marchegiani:  100%! Now I’m gonna give you guys a good visual analogy so anyone that’s listening to the show, go check out Beyond Wellness Radio and watch the YouTube of this. So imagine—I’m gonna pull out my spirit fingers, okay, here they are, they’re going—these are like the microvilli in the small intestine, okay? So imagine where my head is, right? This where the food is, in the more of the central part of the intestinal tract. Here are the microvilli and then here’s the deeper intestinal wall. So maybe you run a stool test and it’s pulling samples more from this area and then as the gut starts healing, now the stool’s starting to grab particles or particulate from this area so deeper in. So the infections could be burrowed deeper in. So I’m proximal and then distal is kind of deeper into the gut linings. Does that make sense?

Evan Brand:  Makes sense.

Dr. Justin Marchegiani:  Okay, I’m gonna put my spirit fingers away now.

Evan Brand:  Good.

Dr. Justin Marchegiani:  So getting back to that, number one is the crypt hyperplasia. Number 2 is maybe a spouse of partner that has an infection and is passing it back and forth. Then you guys are playing hot potato. It’s like, you know, get rid of my infection; I’ll throw it back to you the next week. So that’s the potential thing and things like H. pylori can be spread via saliva, so it’s very possible, and that’s number two. And then the next thing could be pets. So like I got Butter over there. Butter loves giving me kisses and I’m just like, “No!” You know, you can kiss my hands and I’ll wash it later or I’ll give her a kiss on top her head, you know, where there’s not like saliva and a tongue there. So that piece is the pet piece and then also you have X-factors like food, traveling abroad, like me you know, waterskiing over in Lake Austin, you know, getting a mouthful of water like that. I mean, I imagine some of the people down at the—the Rio Olympics right now that are going on. I’ve seen some of that nasty water. I mean, I saw something like a teaspoon of that water can make you sick with this nasty bacteria. So—so water and those types of things, you know, drinking when you’re on a hike from a stream. You know, all those things could be potential X-factors I call it. So number one is the crypt hyperplasia phenomenon. Two is partner and spouses. Three can be the X-factor, the water and food and such.

Evan Brand:  So who knows if the Olympic athletes are getting access to functional medicine practitioners because it sounds like a lot of them are gonna be going home with parasites?

Dr. Justin Marchegiani:  Yeah. Yup, I agree. And it’s very possible that that is the case and again, you get some people that you know, we do a round of treatment and they’re not better, and then they get discouraged and they don’t have the fortitude to go through it again at a re-test. And that’s the hard part in functional medicine is knowing that, you know, we’d like to have a home run the first time but sometimes it doesn’t happen and we have to do 2 or 3 rounds and that may be the case or sometimes we may even have a to have a breath test, too, as well because maybe they’re just not a major infection there but they’re just a major gut bacteria issue that’s driving gases, hydrogen and methane, to you know, higher levels that are disrupting peristalsis and—and gut motility and such.

Evan Brand:  Yeah, so this is—this can go deep. As you see, Justin and I could go for hours and hours about this but I think you’ve done a great job for summarizing this people. So the takeaway here: Get your adrenals checked if you haven’t and make sure you’re doing that with a lab that makes like BioHealth, we like; you talked about the DUTCH earlier–

Dr. Justin Marchegiani:  Oh, let me hit one more thing, too.

Evan Brand:  Yeah, please do.

Dr. Justin Marchegiani:  So I’ve noticed I’ve been doing, you know, hundreds of the new DUTCH test. DUTCH test is one of the big hot ones out—the dried urine testing hormones. The difference with the DUTCH is you can look at the free fraction along with the metabolized hormones as well. So you get kind of the, you know, what’s bio-available and what’s totally coming from the adrenals. So you get kind of the—the big and the small picture. It’s like T3 Free and T3 Total on the blood test. You see what’s bio-available. You see what’s actually coming out from the gland. So DUTCH is great. I find it projects a little bit high on the cortisol cascade or chart.

Evan Brand:  Yeah, same.

Dr. Justin Marchegiani:  And I find BioHealth test a little bit low. So you—when you look at those tests, you have to kind of factor in the BioHealth, maybe on the lower side if you’re doing it. And the DUTCH may be on the higher and you gotta factor those couple of things in even though it may say you’re low on the BioHealth, you may be okay. Or if it says you’re normal on the DUTCH, you may actually be high or even—yeah, typically you’d be higher on the DUTCH.

Evan Brand:  Yeah, so this—I guess that would add in the—the variable here. The practitioner that you’re working with—make sure that they’re actually listening to you because if you’re telling them, “Look, I’m exhausted. I’m exhausted.” But the adrenals show up and they don’t wanna do anything about it. Then that practitioner is not listening to you because we—we can’t treat people in a—as a robot. We can’t treat in a vacuum and we can’t just go on labs. There’s gotta be a combination and we can’t just treat on symptoms either. I’ve had people who’ve said that they’re completely exhausted. The adrenals show up okay but then we see that it’s a major mitochondrial issue. But if we just tested adrenals, you would have given them a clean bill of health and moved on. So–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  You know, really look at the full picture is this—the takeaway.

Dr. Justin Marchegiani:  Oh, and also I have one little pet peeve, I’m gonna hit it up, but there’s a—a couple of people out there that I know that aren’t using adrenal testing, and I have colleagues out there. So yeah, I think the adrenal testing isn’t available. I mean, it’s—it’s not valuable. It’s—it’s not worth it, right? I can just base—adrenal program based off of some people’s symptoms.

Evan Brand:  Right.

Dr. Justin Marchegiani:  Now I totally disagree with that. Now here’s the reason why. Number one, I’ve run adrenal tests on people where you’re like, “Oh my God!” Like they have all these adrenal symptoms and the adrenals come back looking great and then we run the thyroid and then the organic acid testing and their mitochondria’s shot and the their thyroid’s low. Now I would have went into it thinking, well, this person has to have adrenal issue, they didn’t. So you see how important it is. Well, you can be chasing your tail if you don’t know that. And also maybe their adrenals are good but their DHEA—sorry, maybe their adrenals are in the middle but their DHEA is super low. So now we know, oh, maybe their adrenals are worse than they are because the DHEA output which becomes the precursor to the sex hormones is really fatigued, is really depressed. So that may tell us there may be a deeper adrenal issue even though the cortisol stuff, the cortisol rhythm may be fine. And again, the rhythm is gonna be where you’re getting the answers regarding energy. Are you higher in the morning, lower energy at night? So may see that more with the rhythm. The DHEA you may not be able to extrapolate that from those symptoms. So that’s my issue with people not running these tests and just basing it off of symptoms. I think it’s a—a big mistake.

Evan Brand:  Well said. And it’s not that you’re gonna necessarily get sick. You know, we’re not talking about playing with chemo drugs or anything here, but if you’re investing your money and you want to get healthy and you’re not getting healthy because you just got guessed, now you’re playing guess and check, well, your supplement graveyard is gonna get pretty big if you do that method.

Dr. Justin Marchegiani:  Plus it’s really nice to have a pre- and post-test to look at.

Evan Brand:  Agreed.

Dr. Justin Marchegiani:  Yup, so I like that.

Evan Brand:  Agreed. Well, cool. Well, any last words of wisdom for people? And then we’ll send them back to your website, justinhealth.com, where they learn more about you. They can sign up for consultations if they wanna work with you and you got videos, you got podcasts, all sorts of free content, thyroid videos, hormone videos, etc.

Dr. Justin Marchegiani:  Well, I’d say off the bat, number one. Do all the foundational stuff. I mean, myself and Evan, we have great podcasts and great information out there. It’s totally free that people can listen to it and basically get access to our brains and our info, you know, the things that we’ve spent hundreds and thousands of dollars to learn over the last decade. It’s right at your fingertips for free. So most of that you can already access. So start with that information off the bat. Number two, if you’ve already tried some stuff and you bang your head against the wall. Remember if you’re trying to get better and you’ve already done the foundational stuff and you’re not getting better. If you don’t make a decisions to start seeing a good functional medicine practitioner out, you end up paying twice. Because you pay number one, with the quality of your health which starts to get worse over time. And the number two, as it gets worst, it becomes a more expensive and more timely and costly to fix it. So if you’ve already done the foundational piece, which you can access a lot of the information free from justinhealth on YouTube and podcasts at Beyond Wellness Radio and then notjustpaleo. If you’re doing all that, then the next step is you wanna reach out to a really good trained functional medicine physician or nutritionist or diagnostician to get the next steps lined up.

Evan Brand:  Well said and I’ll lastly add on the part of wasting your money. If you have a gut infection, it doesn’t matter if you’re buying organic grass-fed beef. If you’re not digesting it, you’re not getting those amino acids that are fueling your hormones, your brain, what’s the use?

Dr. Justin Marchegiani:  100%! And again, who goes cl—who goes and climbs Mt. Everest and doesn’t hire the Sherpa that’s gone to the top 50 or 100 times, right? You want that Sherpa that’s been to the top 100 times to lead your way, right?

Evan Brand:  Yeah

Dr. Justin Marchegiani:  Right, in the Mt. Everest analogy. So most people, they’re saying, “Yeah, I can climb Everest on my own, even though I haven’t done it yet and it’s kind of treacherous, meaning it can be expensive and timely and costly if you ma—make the wrong move, right?” You don’t die probably, right? It’s not like Mt. Everest. But you know, you’ll suffer. If—it may not just be on the health side. It might just be financially with taking, choosing the wrong supplements and getting that supplement graveyard like you said, right?

Evan Brand:  Yeah, and it’s—if you read books and hear podcasts on climbing Everest, I don’t think it’s gonna—it’s gonna mount up to the same thing as having that Sherpa there.

Dr. Justin Marchegiani:  I 100% agree. You got it.

Evan Brand:  Well, cool. Well, take care. Thanks for your time. I appreciate it as always.

Dr. Justin Marchegiani:  Evan, it’s been real as always, my friend. Thanks so much for having me on.

Evan Brand:  Of course. Take care.

Dr. Justin Marchegiani:  Thanks, bye!

Evan Brand:  Bye!