Top 5 Reasons You Are Losing Muscle Mass | Podcast #369

Muscles are essential to everyday movements, and if you noticeably lose muscle mass — especially without knowing why — it can be alarming. Losing some muscle mass is normal as you age. However, losing muscle mass quickly or atrophy, especially in the context of other symptoms, can indicate an underlying illness.

In this video, Dr. J and Evan discuss the top reasons you lose muscle mass aside from aging. Preventing a loss of muscle mass can also be achieved by exercising regularly (such as functional strength training) in conjunction with a balanced food template of lean meats and proteins, fruits and vegetables, healthy fats, and whole grains.

However, if the loss is due to an underlying illness, it must also be addressed and mindfully managed with a trusted healthcare professional or your functional medicine doctor.

Dr. Justin Marchegiani

In this episode, we cover:

0:00 – Introduction
2:33 – Functional movements
3:37 – Infections
7:21 – Vegan-vegetarian
9:35 – Autoimmune digestive disorders
12:21 – Hormones
15:06 – Types of muscle building

Dr. Justin Marchegiani: And we are live. It’s Dr. J here in the house with Evan Brand. Today, we’re gonna be chatting about the top five reasons you are losing muscle mass. This is really important. All right. If you’re losing muscle mass, it’s gonna be essentially an all-cause predictor of mortality, increased mortality. So, we gotta make sure that we’re keeping our muscle mass and or improving our muscle, especially as we get older, we need good muscle to support and stabilize our body so we don’t get hurt, we don’t slip, we don’t fall, we don’t get injured. We don’t slip a disc so to speak. So, we have to make sure that we are keeping our muscles strong and functional. Evan, how are we doing today man?  

Evan Brand: Doing really good. I talked with a guy actually this morning where his mother, due to age and related muscle loss, fell, broke her hip, got in the hospital, had to get surgery, got an infection, died. So, I’m not saying everyone is gonna end up like that. But my God, look at how quickly something just like a fall due to lack of muscle strength and mobility could turn into something scary where you’re hospitalized, you’re getting surgeries, you end up with a hospital acquired infection then you’re on antibiotics then you go septic, I mean, this is crazy and so I hope we can help people prevent. This is such a common story. I mean, how many times have you heard, like, old granny falls, breaks her hip and that’s the end of her. She never recovers. It’s like, that’s not good. And so, fortunately, in the past, up until the past couple years, both of my grandparents right around 80 years old, they were playing tennis and they were still active in mobile so I just encourage you guys, just because you’re getting grow older that doesn’t mean that you need to become a couch potato. Even some of her friends that she’d played tennis with are in their mid-80s, still playing tennis, still moving well on the court. So, I just encourage you to find something that you love first and foremost. Use exercise as a side effect of having fun, meaning, if it’s pickleball, if it’s tennis, if it’s ping pong for all I care, I mean, basketball, volleyball, I mean, whatever you can do it. It doesn’t have to necessarily be intense. That’s all fun stuff, maybe competitive, fine. But exercise is a side effect of it. But if you’re just trying to depend on willpower to go run a mile, I think that's a terrible long-term strategy and I don’t think you’re gonna like to continue with it, like my row machine, you and I both, we have the same row machine, we love it. You can go on there, and you can do little games, you could do just row, you could pick like, oh, I’m gonna, I wanna burn 10 calories or I wanna grow 500 meters and you have this like goal that motivates you to do something, but at the end of the day, all this physical performance is gonna pay dividends. 

Dr. Justin Marchegiani: No. Exactly. 100 percent. So, when I kind of, when I lift weights, I’m always trying to do functional movements, I think as you get older, especially as you know, you move into adulthood, you want muscles, right, you want to look fit or lean or trim right? You wanna feel solid but you wanna have functional muscles. One that allows you to do housework or click pick-up your kids easier and feel more confident or do well at your sport or just be able to enjoy life and feel good like if you think about, like, getting into a car, right? You get into a car, it’s like a one-legged kind of squat, right? So, I’m a bigger fan. As you get older, trying to do more unilateral body movements, meaning like a one-legged squat, a one-legged lunge or a lunge obviously with that, you know, you can look at discrepancies in your body. If you’re doing a squat, you know, you have other sides that you can compensate for but when you’re doing one-legged movements either a dead lift or a squat or a lunge or a step-up, it magnifies imbalances in the body. I like that because most of the time, when you’re moving, you’re actually on one foot in a sense and so it’s good to do movements like that so you start to develop a lot of the stabilizer muscles that support you when you’re moving so you don’t get hurt. 

Evan Brand: Let’s get into the functional stuff, like the functional medicine stuff, not functional movement but like functional reasons, I’m gonna go ahead and say, number one as a category of infections and you and I can break this down as much as you want. Yeah. I’m gonna say infections because you know my story, you saw me, I lost like, 25 pounds without trying and some of it was related to H. pylori. I think the parasite also wrecked me so I would just say infections as a whole. 

Dr. Justin Marchegiani: Yeah so when you have inflammation in the gut, right, it can be cause by infections like a parasite like Cryptosporidium, Giardia, Blasto, H. pylori, bacteria in that category, SIBO, general dysbiosis, bacteria imbalances, right? It creates inflammation in the intestinal tract, right? Whether it’s small intestine, large intestine, if you look at where these nerves sit on the spinal column, they sit in the lower thoracic to lower lumbar spine, and you know, let’s say t10 to L5 or so. Maybe even, maybe even S1 and when you have inflammation in the intestines, it’s on a two-lane nerve root highway from your intestines to your spine back to the muscles, right, so we have what’s called a visceral somatic reflex. So this Visceral means organ, somatic means muscles. So inflammation in the organ can actually take that signal of inflammation put on that two-lane highway to the muscle and it can actually create that muscle to shut down or not be fully facilitated or active and so with inflammation in the intestines can cause that. Now, women know this just think about the average women that has PMS and has PMS symptoms of back pain. It’s their ovaries having inflammation or hormonal imbalance that’s then refluxing to the muscle, right, visceral organ, somatic muscle. So, women know that if they have PMS or if you ever had a gallbladder issue, you feel it in your shoulder, if you have appendicitis, you feel it in that lower right hip quadrant, right? If you have a heart attack, you feel in the jaw down the left side down the left arm so we know there’s this organ muscle connection so a lot of people can have muscle issues because their core and their back gets very weak due to inflammation in their intestinal tract and the more inflammation there is the less likely you’re wanna, you’re gonna, wanna lift and want to do one of them, you know put resistance on your body because you’re just more inflamed and you’re more likely to get hurt and injured. 

Evan Brand: Yeah. So, if you, now, not all people lose weight and I’ve seen many women who gain weight magically 20, 30, 40, 50 pounds, sorry ladies, sometimes it happens that way. It’s where you gain weight due to infection but for me and I’ve seen other men the same, you lose weight, so I don’t know, I would just say this, any fluctuation whether it’s weight gain, including muscle loss so you could gain weight and still lose muscle right. You could gain body fat and lose muscle so whether it’s a significant, let’s say 10, 20 pounds or more weight loss or weight gain with no explanation, I would definitely look into the gut, start looking for infections  and as you mentioned, the strength is important and people don’t want to get strong if they feel like crap and so for me, luckily, my gut’s much better and now I feel good with resistance training whereas before I was just so depleted. So, let’s go into reason number two, I’m gonna say nutrient deficiencies, now, this ties directly into infections right because in the case of H. pylori, if it’s reducing stomach acid. Now, if you’re eating this good grass-fed steak, you’re not really getting as much nutrition from that and so these nutrient deficiencies compound over time because if you don’t have the amino acids being cleaved off the meats to produce muscle mass that also creates a big problem so nutrient deficiency and we could go any direction you want with this even vegetarian vegans, we could talked about the deficiencies there and how they’re gonna have trouvle with muscle mass. 

Dr. Justin Marchegiani: Yep. 100%. So, of course, if we have vegan vegetarian, we’re not gonna get enough carbohydrate, we’re not gonna get enough protein, typically or if we get enough protein, right, let’s look at the combination of rice and bean which is a pretty common one. Well, you end up getting 70 grams of protein to 15 grams or so of carbohydrates so you get a lot of carbohydrates. Now, if you’re not that active or you’re more insulin resistant, you know some, most people are gonna need probably a minimum of half their body weight and in ounces of protein so if you’re like 200 pounds that’s 100 grams of protein. Well, do the math if you’re getting 15 to 20 grams of protein per 70, 75 grams of carbs that’s you know, 75 times five, you’re looking at like 340 to 400 grams of carbohydrates. Obviously, you can fix some of that by doing, like, a protein shake, like protein or hemp protein, you know, you can fix some of that. But again, you’re still relying on artificial sources, not whole food sources. Now, the benefit of the animal product is you’re gonna get all the protein, none of the carbs and you’re typically, if they’re grass-fed and pasture-fed, you’re gonna be getting excellent good fatty acids along with it and you won’t be getting a lot of the excess omega-6 fatty acids like you’re not gonna get on the vegetarian vegan side. So, you have this nutritional density that you get on the animal side which is wonderful and as long as we’re choosing you know, avoiding the factory farm, you know, we’re doing grass-fed pasture-fed, you’re gonna be in great shape and the next thing after vegan vegetarian is low stomach acid so if we have achlorhydria, low stomach acid, and that typically connects with low enzymes too, we may have a hard time breaking down a lot of that proteins. So, I know when you had some of your gut infections years ago, I think you had what Cryptosporidium, Gardia, H. pylori, that’s it Three Amigos, right? And so, when you had this gut infection, you also had lower stomach acid, lower enzyme levels. So, supplementing the enzyme and the acid so we can break down those amino acids and then also adding in or cutting out the bugs is helpful and then sometimes adding in some amino acids in a free form can be helpful because 40% of the Energy that you get from the protein actually goes into digesting the protein. It’s like having a credit card with a 40% transaction fee, right? Very expensive. So, there is some benefit by doing amino acids, if it's already broken down but we still wanna make sure the whole food is dialed in and that we’re getting enough, uh, we’re getting access to the whole food nutrients via hydrochloric acid and enzymes too. 

Evan Brand: All right. Moving on to another cause here, and this is inspired by a comment here from Teresa, she said that she has muscle wasting from my colitis. So, we could just say, any gut issues and that one include autoimmune gut issues, right? So, colitis or what’s called pancolitis would be the whole colon, even celiac, Crohn’s, I mean, any of these autoimmune gut issues oftentimes that’s gonna create a lot of muscle wasting that ties directly into what we just said though which is nutrient deficiencies and infections. A lot of these people with major gut issues, like this, there’s usually a trigger. Now, in the case of like, celiac, obviously, that may or may not have a parasite infection involved but this is still part of the equation and we can use gut healing nutrients to work on this, you can put some of this stuff into remission but you know what, I don’t want people to do, you know, what I don’t want people to do is like eat clean all week and then they go eat garbage on the weekend. 

Dr. Justin Marchegiani: Correct. Yep. 100%. And so, of course, if you have colitis, right? Whether it’s microscopic or ulcerative colitis, you know, it’s an extreme irritable bowel disease, you gotta look at the foods and then sometimes the foods could even be in vegetables it could be in the oxalates, the phenols, the salicylates, the FODMAP, so sometimes even healthy foods on paper could be problematic and then of course, you know, the grains and the dairy and he refined carbohydrate and the omega-6 fats of course those right. So, getting the inflammation via food is super important, we talked about dysbiosis, we talked about SIBO, H. pylori, of course is super common because H. pylori is notorious for lowering stomach acid and so of course, if we’re just taking stomach acid and enzymes and we’re not fixing the H. pylori, you know, that may not get to the root cause. So, if we’re taking supplements like hydrochloric acid or enzymes or bile support, we also got to make sure we’re getting to the root cause of any additional bugs that could be present and if we’re chronically stressed like the adrenals if we’re in sympathetic fight or flight the sympathetic fight or flight nervous system tends to be more catabolic than anabolic. So, anabolic is building back up, healing, recovering, getting stronger. Catabolic is breaking down. So, from this fight-or-flight state, our bodies always tend to be it. You know, running versus, building and growing and so if you’re catabolic from the adrenals being over active with cortisol, that’s gonna make it hard to build muscle, you’re gonna be breaking down the muscle instead, making glucose out of it and it’s also gonna be harder to digest because your body’s hard wired to take blood and bring it to the extremity so you can fight, flight or kind of run versus to the organs so you absorb and break down. So, that fight or flight is really important in fir digestion, for where the blood goes and also and how it allocates nutrients. It’s more likely to break down muscle than build muscle back when that fight or flight is really active.

Evan Brand: That’s a good call. That’s exactly where I was gonna go next is hormones, I was gonna talk about maybe low testosterone. We’re seeing that in men in their 20s, 30s, 40s, I mean just low hormone levels and women need some level of testosterone too. So, if you do hormone issues whether that is adrenal related cortisol, thyroid hormone, maybe you can riff on that for a minute because I think people are focusing on gut gut gut, which is great but there’s also this other connection of the hormone piece and I will tell you my cortisol was completely depleted when I did a salivary panel  years ago. My cortisol was flat all day and it was really tough no matter how much I tried in the gym, I was weak. Like, just my God, I could not make progress, fortunately better now, but man I’ve been through it. 

Dr. Justin Marchegiani: Yeah. Some people, they may be high with their cortisol and we have to use adaptogens to calm it down of course, like good diet and lifestyle things, some may be low and typically you don’t just go low all of a sudden. You ten to be on the higher over stimulated side for a while and then you ten to crash and that’s where that low cortisol kind of comes together and with that chronic cortisol, a lot of times we see low DHEA, and DHEA is important because that’s gonna be a precursor to a lot of men and women’s sex hormones and so women will go more down the estrogen side. Men, it will trickle more down testosterone. These are both anabolic hormones and so if we have lower DHEA, that tells us the adrenal issues that are going on are more chronic and DHEA will go downstream to more of these anabolic building up type of hormones so very important to take a look at your DHEA because that could tell you if you’re more catabolic inflamed place. And also too, if you do exercise, I get it if it’s like your first couple of movements, It’s like a new exercise kind of thing, you may be a little bit torqued. It’s new but you shouldn’t be overly sore after your workouts. If it’s a new thing, fine, or it was really you know, an acute hard workout but in general you shouldn’t be overly sore, you know, more than two days or so later. You really shouldn’t, you should still be able to function like maybe you feel it like it feels like you did something but it’s not overly sore if you are um and it was a reasonable amount of exercise, it wasn’t like you did too much you’re probably in a more catabolic state, and it’s also you could be over exercising too. So, you gotta make sure you’re not over exercising.  

Evan Brand: Yeah or I’m thinking like what about lactic acid build-up too due to gut bacteria or a mitochondrial issue due to some sort of toxin where they’re just depleted, they’re not recovering well, they’re not performing well. So, maybe not directly related to muscle mass but I think mitochondrial issues could be something to look into. You and I measure this and look at this on an organic acid test and we often find a lot of issues, I mean we’re in a toxic world with a lot of chemicals, metals, pesticides and so these things damage the mitochondria which to me would directly impair your ability to perform. Is it directly reducing muscle mass? If your mitochondria are damaged, I’m not sure on that. I’m sure we could look into it but it makes sense. 

Dr. Justin Marchegiani: Yep. Absolutely. So, a couple different types of um ways you can build muscle, right, we talked about resistance training is obviously gonna be my favorite, right? So, we can do resistance training that kind of acts like cardio so if we do let’s say three or four movements back-to-back to back-to-back that kind of acts like cardio like or instance if I do like bicep curls, right, this is resistance training, you’re probably not gonna see a big bump in your heart rate which is bicep curls, right? So, there’s resistance training where you’re not getting a cardio effect and it’s resistant training where you’re actually getting a cardio effect. So, just like, people think cardio, like, oh, I’m gonna try them all that’s cardio. It’s well no, you can do exercise that’s resistance and still have a cardio effect. So, if I just did like bicep curls or tried extensions probably not a big cardio effect. Now, if I did like bicep curls and then I paired that with the next exercise, let’s say kettlebell swings, right and then the next exercise being some type of full body row or a lunge, you can see how you start getting more muscle groups involved. Your heart rate starts to go up significantly. So, that’s nice because there’s some benefit if you look at some of the zone two exercise theories that are out. With zone two exercises, essentially, when you’re working at about 60 to 70 percent of your max heart rate so if you’re at typically like you know, typically around if you’re like max heart rate for most people in their 40s or so will be like maybe around usually, it’s 225 minus your age and so if you’re like 40 that’s like what 225 minus 40 would be like what 185 and so you do 185 times 60 or so that should give you then you’re around like typically around 120 or so for your heart rate so they want you to stay around 120 for about 30 minutes. Now, you may find that you kind of have that zone 2 type of benefit while you're actually doing lifting, if you kind of do it in a circuit fashion, then you choose movements that are more compound, you may find your heart rate stays that high. Now, the benefit of zone two is you get this really nice drop in your resting heart rate. There’s a lot of people that are reporting a lot of their data from like their fitbits or their or rings where they just have a significant drop in the resting heart rate that they wouldn’t necessarily see for like interval training or I’m sorry like a type of a tabata training where you’re like high intensity low, right? So, this kind of steady state thing for 30 minutes, you know, could have some cardiovascular muscle benefits and you may also be able to get some of that like if you do circuit movement so you can, you know, get one of these fitbits and measure your heart rate while you’re doing it and see if you can stay around 120 for that 30 minute phase that kind of put you in that zone two category around 120 or so. 

Evan Brand: Very cool. There was a comment in here from Selena, what about muscle wasting with chronic Lyme? Yeah. 100%. Unfortunately, I’ve dealt with Lyme with co-infections from many tick bites over the years and that’s a big big factor because Lyme loves collagen. It really likes to eat up your collagen reserves and then the inflammation it creates, that invites other things like the Bartonella to move in and create more inflammation in your joints. I’m sure that is a big big factor for you. I think you can get better from it. I’ve certainly gained muscle mass even with the infections, I would still throw it in the infection category though. I think the gut infections are a big one too so don’t go all in online and forget the gut bugs because if you’ve got H. pylori, I think that’s a bigger smoking gun for your digestion. Lyme could still wreck you and cause you to lose muscle, I know one of the girls that I used to work with, I saw her recently at a park and she was so skinny, skeleton skinny and she’s had Lyme for like a decade so I know it really affected her in that way but I do think some of that is reversible if you work on the bugs and get your gut better. 

Dr. Justin Marchegiani: Yeah. And also, people that have Lyme, it’s very rarely it’s just Lyme. It’s like Lyme but then they have, like a ton of dysbiosis, really poor digestion, so it’s usually people are already in this kind of not so great state and then Lyme comes in there and it’s the straw that breaks camel’s back and because it was the thing. They pushed them over the finish line. They just look at Lyme as being the culprit for all of it and therefore, I think it’s all then all they do is focus on that one thing because they think, oh well this is the root cause because this is what happened when everything went sideways and they get myopically focused on just that and then they’re on these crazy herbal antibiotic protocols for years and they don’t fix the other thing so still get back to the basics with your digestion with your, you know addressing the guts, um, really addressing all the stressors, the adrenals, make sure all of that’s kind of dialed in. Also, how did you do with collagen, I mean I found collagen it’s just great for building up that connective tissue because even like in today’s day and age, we’re getting a lot of muscle meat from our protein source, we’re very, we’re not getting enough of our connective tissue or skin or hide or those type of things like the soups and bone broths probably our ancestors used to do. We’re not getting a lot of those amino acids which are really important for connective tissue. 

Evan Brand: I do good with it. I do it every day. I do collagen protein every day so it helps man. I don’t have any elbow problems anymore, my knees are better so like my joints are like so much better, my skin is probably better, hopefully that’s helping with the muscle too. She commented that she did have Bartonella and Babesia. So, yeah, that’s a triple whammy, I mean, you gotta keep working on it, I’m not a fan of the antibiotics, this is a topic for another podcast but you had mentioned that you were doing antibiotics and you know that typically causes the Lyme to go into like a cyst form where it hides from the immune system and a lot of people rebound and relapse on that so I prefer herbs.

Dr. Justin Marchegiani: Yeah. And also, if you go look at all the antibiotic side effects, they all match Lyme as well and so it’s like joint pain, fever, malaise, and so there’s like you see a lot of these conventional or should I say more natural minded medical doctors like oh that’s just 

Herxheimer, that’s like but it’s like you literally are giving something that has the same side effects of the disease you’re trying to treat and so that’s why we tend to like herbal treatments that are more gentle and we’re trying not to hurt and we’re trying to kind of choose a low dose of herbs that are gonna allow us to support the immune system, still have an antimicrobial benefit, we’re still providing a lot of antioxidants and nutrients in the herbs which is the benefit of the herbs and they don’t cause as much mitochondrial damage while we work on everything else. So, we’re still not gonna ignore everything else and we’re gonna find a treatment that makes sense and doesn’t make you feel sicker and have this self-fulfilling prophecy that the side effects actually match the disease that you’re taking.  

Evan Brand: No joke. I mean, we do a whole podcast. Let’s do one sometime on this but she said that she was tired of antibiotics, it’s been three years. Yeah. I mean, that’s affecting your gut which is affecting digestion. We know antibiotics damage the mitochondria so if someone had muscle mass and they had done antibiotics, obviously, you got to look at the gut so I would recommend that you do a stool panel. Do organic acids, try to uncover it, somebody said I look like Arnold Schwarzenegger with the beard, I hope that’s a compliment. Thank you.     

Dr. Justin Marchegiani: Yeah. There you go. I like it. Very good. So, I hope this helps everyone out of the gate here. I mean, just kind of like start from the basics like all right, so to keep your muscles strong you have to have one not be stressed, right? So, do not put yourself in a catabolic state. Think of like, your adrenals being an overdrive, think of like good sleep, good hydration, good food, allowing yourself to be in a parasympathetic nervous system state. Deep nasal breathing, right, appreciation, gratitude, right, make sure we have good digestive support enzymes, HCl, we’re eating a really healthy anti-inflammatory, nutrient dense, low-toxin template, again, I have some patients that have autoimmune conditions where they have to be even more carnivore because they’re really sensitive to the plant nutrients then after that, looking at all the bottlenecks that could be absorbing things or causing absorption problems in the gut, right, like Evan mentioned, Evan had three Amigos, right, Giardia, Crypto, and H. pylori. And then looking at any of the other bugs there and then of course what types of movements are you gonna do, right? You can start out with just walking if that’s kind of a foundational level then you could start off with some type of a you know circuit training, picking three or four movements and going back-to-back-to-back. You could do some kind of a zone two cardio thing where you do about 30 minutes or so at 120 beats per minute and you can do something non-impact. I like rowing because rowing devices you’re using upper and lower body and you’re putting your body into extension or most of the times on like cardio, you’re kind of like hunched over and like doing your elliptical or you’re running like this or you’re kind of in this flexion state where a rower you’re kind of opening up so that’s kind of cool so those are a couple of tools you know to stimulate the muscles and to um make your heart work as well as make your muscles work. 

Evan Brand: I love the rower. Hiking too. I mean, hiking is so easy. 

Dr. Justin Marchegiani: Yep. Hiking is great.

Evan Brand: I really love it because there’s a lot more variability in your movement as compared to walking on a flat surface so I’m having to like bring my leg up more to go over that rock to go over that tree root like it’s a lot of more leg involved than a flat surface so I love it as long as I’m not getting a tick bite, I’m happy in the woods. 

Dr. Justin Marchegiani: Yeah. And my favorite functional movements would be like a one-legged squat, uh, it’s excellent and you could just have a chair underneath you where you sit, touch and come back up and you could put up like a phone book on it or something so you don’t have to go all the way down to parallel, uh, a single leg deadlift is excellent and step up. I know, right. I know you can just grab whatever book right. I’m thinking up like the thickest book I could think of right. You know something like that. And then, you could do that and then you could do a step up which is great like on a plyo box and step up. That’s what this is.  

Evan Brand: How about, I mean the jumps? Obviously, that’s more intense but man those jump boxes, my God, that’ll, you talk about workout, that’s intense. 

Dr. Justin Marchegiani: Yeah. Yeah. I mean those plyo boxes are wonderful, I mean, I like is that 

Evan Brand: What it’s called the plyo like p yeah how you spell that? 

Dr. Justin Marchegiani: Yeah. Like P-L-Y-O like a plyometric box

Evan Brand: That’s where you’re jumping up and down up and down? 

Dr. Justin Marchegiani: Yeah. I actually like going on top of those and then just jumping off and then get into a squat because then you’re teaching your body like I’m generating all this force and I’m trying to absorb it so you’re teaching your body to be a shock absorber like just soak up energy which is great.  

Evan Brand: To think about that, that hurts my knee. Thinking about jumping off, I used to, I screwed up my knee years ago though you know, I was jumping off loading docks like behind warehouses when I was a kid with a skateboard and when you bail off the skateboard I would land flat on the concrete, my God. That hurt. That was done.  

Dr. Justin Marchegiani: No. Totally. But yeah, if you’re putting your joints in that kind of intensity, make sure your form is good. Some people say don’t go knees over toes, there’s a whole knees over toe guy on I think Instagram that talks about knees over toes but if you do that just make sure your form is good and you’re not causing any inflammation. Make sure you have enough protein and collagen, amino acids on board as well so you’re dialed in. 

Evan Brand: Yeah. And if you need help please reach out, we work with these issues all the time. We’ll help you investigate what’s going on. You may have this root cause, you may have that root cause, you may have multiple root causes but we’re happy to help find the puzzle pieces because you can’t fix what you can’t find so that’s where we come in, we’re happy to help you with this issue. If you want to reach out clinically, we work around the world with people we’d love to help. You can reach out to Dr. J directly at justinhealth.com and there’s consults available everywhere, lab testing, we can get it to your door. It’s no problem. If you’d like to work out with me, not physically but work out with the labs, let’s do it at evanbrand.com. So, justinhealth.com, evanbrand.com, we’re happy to help. 

Dr. Justin Marchegiani: Yeah. We’re here to help and we’ll put some of the products that we talked about like collagen and some of the nutrient support, we’ll put them in the description below so if you wanna access some of the things that we recommend for our family and patients and take ourselves, feel free and access that. All right guys, hope you have a phenomenal day. Take care of you all. Peace. 

Evan Brand:  See you. Bye-bye. 

Dr. Justin Marchegiani: Bye.

Evan Brand: Bye.