Functional Medicine Lab Testing – Podcast #22

In this podcast we will review how tell if you are anemic via blood testing. Do you have adrenal fatigue and how use a cortisol rhythm test to help evaluate this? Do you have a chronic infection that is throwing off your hormones? How do you evaluate blood sugar via lab testing?

Dr. Justin Marchegiani talks about the key labs so we can get a clear understanding of how our body is functioning including some tests that we can use to take a deeper look into our cholesterol numbers and what the readings essentially mean in a basic sex hormones panel. He will also give us an insight on the importance of blood sugar management and how we get these tested for fasted glucose, insulin, and hemoglobin A1c.

 

 

 

 

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Baris Harvey:  Thank you guys for tuning to another episode of Beyond Wellness Radio.  In today’s podcast we are gonna be talking about Lab Testing 101 and diving in so that way you guys kinda have an overview.  But first we wanna make sure that you guys go to beyondwellnessradio.com/newsletter.  This way, you would have–you’ll be the first to get the updates.  We usually have our shows sent out to our–our subscribers before you’ll even hear it on iTunes about 3 episodes early.  So definitely go to beyondwellnessradio.com/newsletter.  We also have a lot of things in the bag coming at you, so a lot of freebies, a lot of good things.  So make sure you get on the newsletter.  Second thing, make sure when you go to beyondwellnessradio.com, you click and take a look at both Just In Health and Really Healthy Now.  Those are both mine and Dr. Justin’s site.  Dr. Justin is a functional medicine practitioner.  So if any of you guys are having some real health complications, like I mentioned before, he is my go-to guy.  So I would definitely hop on there.  Get yourself a complimentary call and–and try to see if maybe you need–you need to get pretty deeper.  We’re about to talk about lab testing today, so you know, he would be the perfect person to go to.  Also if you needed help with getting your nutrition right, your mindset right, and trying to improve your health overall, you can also send me–me a message at reallyhealthynow.com.  You can go on there and go ahead and work with me as well.  So definitely go there.  And one last thing, make sure that you guys go to iTunes and leave us a review.  This really helps us spread the message and yeah, for extra incentive, you know, maybe we’ll start reading these iTunes reviews and giving something away.  So definitely go to iTunes and search Beyond Wellness Radio and give us 5 stars preferably, right?  And yeah, so with that being said, how’s it going today, Dr. Justin?

Dr. Justin Marchegiani:  Oh, it’s great!  Oh, by the way, if everyone wants to review us, Beyond Wellness Radio, and this little button that says Write A Review and that will bring you right to the iTunes page to make it easier.

Baris Harvey:  Oh, very convenient.

Dr. Justin Marchegiani:  Absolutely!  I’m doing great.  I’m actually–we just talked behind a scenes here that I’m getting a whole house water filtration set up and I’m also getting a under the counter unit setup that’s reverse osmosis-based as well, kinda being extra protective as more than likely next year I’ll be, you know, having a baby, keeping my fingers crossed, you know, and–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And we got the reverse osmosis and I also have the system where it infuses some magnesium and calcium minerals back into the system as well, so we’re not totally stripping out the water.

Baris Harvey:  Yeah, I just go to the beach and just drink them; I’m just kidding.  Yeah, but no, definitely.  It’s important to get those minerals in the water, because I know sometimes like we filter everything out, but when we filter everything out, it filters everything out and then you get this–this water has like no minerals, no electric charge, so then it kinda just like flows right through you.

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  So the question that we always wanna know is what did you eat today?  What was your breakfast?

Dr. Justin Marchegiani:  So today was a different day, got up and I worked out in my home gym.  Did some kettlebell swings, did a tabata on the row machine, did some functional lifting on my TRX, and some–just some functional movement exercises.  And then I had a nice little 35 or 45 grams of whey protein with some collagen and some bulletproof coffee and right now, I’m just sipping on a ginger kombucha before lunch.

Baris Harvey:  Yeah, sounds good. I had a–I had an interview this morning so when I woke up I had about, I wanna say like, it wasn’t that much, like 15 or 20 grams of just some–some whey protein with some almond/coconut and I threw an egg in there just for some extra protein.

Dr. Justin Marchegiani:  Nice.

Baris Harvey:  And did I _____, maybe, oh I think I put some–usually when I make like these–these smoothie, I put like a teaspoon of like mocha powder or something like that, and it just, you know, just for some extra kick.

Dr. Justin Marchegiani:  Nice.

Baris Harvey:   And after that, after I was done with that show, I went ahead and cooked actual breakfast that had some chicken sausage and some–2 more eggs.

Dr. Justin Marchegiani:  Awesome.

Baris Harvey:  Just cooked this time.  Yeah, definitely.

Dr. Justin Marchegiani:  Very cool.

Baris Harvey:   So let’s get on with the show.  Today, we want to make sure that we give you guys the 101 to Functional Lab Testing.

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  If you go to your doctor’s, you’re gonna get some basic panels like your a–like get the basic blood work and that can be very useful.  But there’s also some other key labs that you might need to get–to get a deeper understanding of how your body’s functioning.  So with that being said, let’s get it started, Dr. Justin.  What are some of the–or actually before we even talk about some of the functional labs, let’s just talk about some of the basic labs that you might get at, you know, just your normal doctor.

Dr. Justin Marchegiani:  Great.  So we get our basin blood chemistry, our CBC, a complete blood count, or we get like a CMP, a comprehensive metabolic profile, or we get a lipid panel.  These are all basic tests but they really give us some great information.  So a couple of key things we see off the bat when we run like a CBC with differentials.  This is looking at the size of our red blood cells and this can give us some great information.  One, we can figure out if we have an anemia potentially and there’s a couple different kinds of anemia.  If it’s like a microcytic anemia, alright.  Hence the micro part, that means our blood cells are really small.  And then we have like a macrocytic anemia where our blood cells are really big.  So one is more of an iron-based anemia when our cells are small and one’s a–a B12 of folate or B6, typically a B12/B vitamin anemia when the cells are really big.  And both are really important because if our cells are too small we can’t carry oxygen properly and if we don’t have oxygen, well, think back to middle school science class when you have the experiment with the candle, when you put the glass jar over the candle and the candle typically goes out, so we need oxygen for metabolism, electron transport chain, glycolysis, all that good stuff.  And if our red blood cells are too big, well, typically our red blood cells actually get smaller as they get more mature.  So our red blood cells start out big and they actually get smaller when they’re exposed to certain B vitamins, and when they don’t have enough of those B12 folate and/or B6, they get stuck in this bigger size.  So imagine there’s big, goofy red blood cell walking around, it’s like really clumsy, it’s like tripping over things, it’s like a bull in a china shop, that’s what happens when we have a B vitamin deficiency.  These red blood cells aren’t really mature, they aren’t really coordinated, and they don’t carry oxygen and nutrition properly throughout the body.  So we can get fatigue, we can get coldness, numbness, and these things can also lead to thyroid problems, too, which is really one of my big specialties, thyroid and adrenal issues, too.

Baris Harvey:  What are some of the things that we can see?  Because I know, know usually when you go into your–your doctor’s when you get this–this blood chemistry done, usually one of the things we look at is our–is our cholesterol.

Dr. Justin Marchegiani:  Yeah.

Baris Harvey:  So that’s kinda one of the first things that the doctor might pay attention to.  Sometimes it might not be perfect.  What are some of the things we might see on–on their tests and order some other tests that we can do to take a deeper look into our cholesterol numbers?

Dr. Justin Marchegiani:  Well, cholesterol numbers–we can actually get some god information even from conventional tests.  My biggest thing is looking at any number or looking at any cholesterol number or fat number in isolation, typically doesn’t do us much good.  We wanna look at in relation to other numbers.  So for instance, I like HDL.  HDL is a really good number but HDL in conjunction with triglycerides is even better.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  So looking at your triglyceride to HDL ratio, making sure it’s a minimum of 2:1 or less. I like closer to 1:1.  So 1:1 would be like someone having 50 on the HDL and 50 on the triglycerides.  We have a 1:1 ratio.  Where 2:1 would be like 100 on the triglycerides, 50 on the HDL, and then when you over that ratio that’s like getting into over 100 on the trigs, which are triglycerides.  So again, try to get that 1:1 ratio where 1.5 to 1 typically a really, really good place that tells us that we’re recycling cholesterol well and it also tells us that we’re not consuming too much carbohydrates and we’re not getting into a place of insulin resistance.

Baris Harvey:   Yeah, definitely.  I know oftentimes and this probably is an important–when working with a functional medicine practitioner, when we look at the scale like the range, usually the ranges are pretty large and as the diversity and as the population continues to get sicker, sometimes the ranges actually shift, what do you feel about when you have someone who comes to you and like, “Oh, well, my–it says that I’m normal but I don’t really feel right.”?

Dr. Justin Marchegiani:  Yeah.  So we have to look at what a lab test is designed to do.  So typically conventional medicine uses lab tests to pick up pathology or disease.  Nothing wrong with that.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  That’s great.  The only problem is there’s an assumption and the assumption is if you’re not diseased, you’re healthy.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  That is the assumption or said another way, the absence of disease equals health.  And that could not be farther from the truth.  So–

Baris Harvey:  That’s like saying, your car that’s basically, “Oh, you have 4 wheels on your car, oh well, well then it runs, it’s fine.”

Dr. Justin Marchegiani:  Yeah, exactly, exactly.  It’s like saying, “Oh, well, if your car like isn’t like, you know, in a car accident and like bented up it must be perfect, right?”

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  And that’s just, that’s not the case.  So we have to look at what is a lab test.  So typically, anyone that’s, you know, has done like a statistics type of class at a graduate level, they’ll probably hear something known as standard deviations or a bell curve.

Baris Harvey:  Uh-huh.

Dr. Justin Marchegiani:  And a bell curve in a lab testing, we have the normal reference ranges made out of 2 standard deviations either way.  What that means is 95% of the population fits within 2 standard deviations, and outside of that, 2-1/2 on the high and 2-1/2 on the low would equal out of range.  So essentially when we’re looking at lab ranges, 95% of the population are considered normal–

Baris Harvey:   Yeah.

Dr. Justin Marchegiani:  And 2-1/2 on the high and low aren’t.  So 5% aren’t normal, 95% are.  So we know like just go walk around an airport or public event and just walk around and just look at people.  There is no way in heck that 95% of the population are healthy.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  There’s no way.  So when we look at these lab tests, it means–

Baris Harvey:   No, no offense to everybody but–

Dr. Justin Marchegiani:  Yeah.

Baris Harvey:   95%, yeah.

Dr. Justin Marchegiani:  Yeah, I mean, just go walk–just go walk around.  Just go to an airport and just look, right?  I would say like it’s probably 50-50, if less than that, you know.  Probably maybe even 25% of people are really, really healthy.  Like 20% are probably really healthy.

Baris Harvey:   Uh-hmm.

Dr. Justin Marchegiani:  And then the 80% probably have some type of symptom they’re working on and as they progress it gets worse and worse.  But when we look at, the conventional lab tests, obviously we wanna look at the standard lab ranges, because if something’s off there, that’s more of a problem.  It just means the chronicity has been there.  It’s a long–it’s been there longer.  But also we wanna look at things on a spectrum.  So we kind have like our optimal reference range, which is, would be like the middle 30%.  That’s kinda like our reference range and then we look at things as–as they would veer away 10% either direction.  And the farther they go away from that would be potentially the more there’s an issue.  And it just helps us because we can pick things up before they go out of range.  It may take years to go out of range, right?  So if you’re running towards a cliff at full speed, well, it’s just a matter of time before you fall off the cliff.  Conventional medicine says we, you know, we really can’t do much until we literally see you in mid-air off the cliff.  But it’s already too late, you’re gonna hit ground, hit rock bottom.  So if we like we see you heading in that directions, meaning we run a lab test and we see you moving, you know, towards that second standard deviation, we can start making diet and lifestyle and stress interventions.  We can look at things from a functional perspective.  We can do more functional test such as maybe obscure thyroid markers.  We can look at adrenals.  We can look at infections.  We can look at stool testing for SIBO–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And parasites.  We can do things that are a little bit more comprehensive.

Baris Harvey:  Yeah, definitely.  So one of the things I know that is–that is common when it comes to testing is at least when it comes to the functional perspective is a adrenal complex and making sure that you get the–not just a one-time reading but a basically a 4-time markers, kinda of seeing the curve of a cortisol reading.  Why is it important to get an adrenal panel?

Dr. Justin Marchegiani:  Great question.  I’m gonna actually side step that question and then come back to it.

Baris Harvey:   Yeah, sounds good.

Dr. Justin Marchegiani:  Because we talked about anemia right in the beginning.  I know there’s a lot of bio-hackers that really want some solid info.  So real quick with the anemia.  When we start to see our red blood cells, hematocrit, and hemoglobin start dropping, that’s a sign that we have an anemia.  Now when we wanna figure out what kind of anemia it is, well, we would look at iron and transfer factor, and we look at TIBC and transferrin saturation and such, and this would give us some information regarding if it’s an iron-based anemia.  And if we start looking at the B vitamins, we’d look at MCH which is mean corpuscular hemoglobin, MC–excuse me–MCHC or mean corpuscular hemoglobin concentration, or MCV which is mean corpuscular volume.  These are looking at the size of the red blood cells so when these go higher, that’s more of a sign of a B vitamin or B12 anemia.  So we would look at those markers to differentiate, and we may not let–we may not look at them and say, “Well, they have to be way out of range.”  But we may look and say, “Are they in that bottom 10% on the iron or in they in the top 10% on the B vitamin,” and that way we can pick these things up before they’re a problem.  And again, there are specialty tests that we would look at like the urinary methylmalonic acid or we run ferritin or things like that to rule out iron or rule out B12 anemia.  Any questions on the–on the anemia side, Baris?  That’s a big one I find.

Baris Harvey:  Yeah, and I know sometimes people have–it’s–it’s hard because it’s kind of trying to differentiate that B12 anemia and that iron anemia and it–it is also a little bit more common when it comes to the female, especially the female athletes.

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  That we–that we work with, so making sure you’re paying attention–what are some–let’s get into some of the symptoms that we might–we might find if someone’s ane–because that’s–that’s kind of a hard one if we–if we haven’t tested that yet to make sure that maybe we should–maybe we should take that test.  So what are symptoms that if we were having, we should probably take a deeper look into that and get those tested?

Dr. Justin Marchegiani:  Well, one, if we’re vegetarian or vegan, we definitely need the test.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Absolutely essential, especially B12, you know, can affect your nervous system, can affect, you know, you know, peripheral neuropathies, tingling, you know, the generation of the nerves can happen with B12 deficiency.  So if you’re vegan or vegetarian it is absolutely essential, probably one of the most important tests you can do.  That’s step 1.  Two, if you’re having thyroid issues, if you’re losing your hair, if you feel tired, if you just like are looking a little bit more pale, if you’re trying things and you’re not feeling better, and you’re fatigued, it has to be ruled out.  Anemia has to be ruled out.  One, if you’re bleeding excessively around menstruation cycle, you know.  Frankly, I could be a little bit more kind of a TMI here, but if you’re a female and going through more than 3 or 4 tampons per day and bleeding more than 3-4 days a month in your cycle, that may cause an anemia because you’re losing that iron.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  That’s another great indicator right there.

Baris Harvey:  Yeah, so if you have excess of really essential–if you’re woman, if you’re having a heavy flow, if you’re having some-some fatigue issues as well that can definitely be a–be a sign.

Dr. Justin Marchegiani:  Yes, and then now, I think, let’s just kinda back up a little bit, because you talked about the adrenals.  So let’s touch upon that.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  So adrenal testing is really helpful because you’re sympathetic nervous system or the fight or flight mechanism, that this kinda gets activated when we are stressed, this is controlled by our adrenals.  Our adrenals produce cortisol and also adrenalin.  So it’s really great to see how we are functioning because typically cortisol gets pulsed out in a circadian rhythm.  So it’s based upon light and dark.  So in the morning time, we’re getting more sunlight so we have higher amounts of cortisol and as cortisol drops throughout the day along with the sun and darkness sets in, melatonin comes up which pushes cortisol down even more, cortisol drops.  So it’s great to look at that cortisol rhythm, one that tells us how strong our adrenals are, and it also tells us about HPA axis dysfunction which is basically stress affecting the communication of our brain.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Pituitary and hypothalamus talking to our glands, our adrenals.  And if we typically have that HPA axis dysfunction, we can see cortisol kind of basically going up or down and not quite being in the rhythm that it should be and when we see that, it also means there could be some HPT axis dysfunction, meaning hypothalamus, pituitary, thyroid because they’re both really connected.

Baris Harvey:  Yeah, definitely.  I went ahead and went to your site and wanted to look at the lab core, the comprehensive post–it’s almost seeming unbelievable the price right now.  We talked about real quick about the comprehensive bio screen blood test that you have right now currently on your site.

Dr. Justin Marchegiani:  Yeah.  So in details about that, that’s a great test because it’s typically–I work with patients that have insurance.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And when I bill insurance for tests like that, insurance will charge up to $3000 or $4000 sometimes.

Baris Harvey:  Wow.

Dr. Justin Marchegiani:  And the patient may still have to pay like $1300 or $1500 even with coverage.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  So I’m able to get that test for my patients for $299 cash–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  Which is an awesome price because, I mean, and this is the reason why healthcare is so expensive, because no one should be spending $2000 or $3000 for a test like that.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  Especially when the cash discounts are so much more affordable and frankly, we can order almost every thyroid marker known to man, even–even a lot of our autoimmune markers.  We can order–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  All of the markers for CBC, all of the anemia markers.  We can order the urinary analysis as well.  We can order all of the fat markers and inflammation markers like C-reactive protein and fibrinogen and sed rate, and also vitamin D.  So we get just a window into what’s happening inside someone’s body and I recommend, even if you’re healthy, a test like that once a year.  I do a test like that every 6 months.  It’s coming up time for me to do another one, but I do that about twice a year.

Baris Harvey:  Yeah and that’s really good price.  Like that’s an unbelievable price.  Most–most of the labs that–that you’re looking forward to get anything close to that is gonna be, like you mentioned, at least what you have at price here, at least $1200 so you’d be lucky to find it under a thousand.

Dr. Justin Marchegiani:  Yeah, even though–it’s actually even more affordable than WellnessFX.  It’s about $100 to $150 cheaper than WellnessFX, so if anyone want–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  To check that out, justinhealth.com/shop and then click on lab test on the category side on the right and you’ll find it.

Baris Harvey:  Yeah, definitely. So what’s really fun in what we always want the test to find out is the sex hormones.  So what are–what are some of the basic, when usually we get a panel, what are some of the things that we’re gonna find on–on the readings of a basic sex hormones panel?

Dr. Justin Marchegiani:  Well, when we’re looking at sex hormones, there’s a couple things we can look at.  We can look at DHEA or–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  DHEA-sulfate.  This is like an adrenal hormone but it’s precursor for women to estrogen and progesterone and for men, it’s more of a precursor to testosterone.  Again, it’s a great indicator of how our adrenal reserves are because our adrenals are our backup generator for our sex hormones.

Baris Harvey:  Yup.

Dr. Justin Marchegiani:  So so many women that when they transition into menopause or when they have PMS, really their adrenals aren’t helping out.  They aren’t coming to table with some extra sex hormone reserves.  So they’re just sitting there totally dependent upon their ovaries so in menstruation time or in, you know, when the woman is actually cycling, what typically happens is just PMS and maybe excessive bleeding, maybe bloating or cramping or mood issues or headaches.  Things like that happen.  But when the women transitions into menopause, that’s where it gets really bad because then those ovaries, they aren’t working like they used to, and more of up to half of all the hormones are now being totally relied upon from the adrenals.  And then what happens then is we have depression.  We have our skin and hair just going to hell, just looking really–

Baris Harvey:  Uh-huh.

Dr. Justin Marchegiani:  Really bad, mood issues, libido issues, and frankly, my number one clientele typically are women because when this transition happens, it’s really bad.  And conventional medicine typically only offers, if they’re no longer menstruating, they’ll typically offer an anti-depressant or they’ll offer some HRT and maybe they’ll offer it in creams or maybe they’ll offer the horse hormones, Premarin, Proair, and you get some good doctors out there that are doing it more bio-identical now which is great, but even that sometimes they’re still being overdosed, sometimes they’re not using the right estrogens.  I find estriol tends to work better than estradiol.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And also using estrogen in conjunction with progesterone.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  And sometimes these creams aren’t the best because they super saturate.  When I use creams with a woman, it’s typically vaginally because the creams don’t sit around, because the mucosa is so thin vaginally, it’s goes right into the vaginal tract, right into the bloodstream.  I don’t typically do any creams, topically on the skin, and most of the hormones on the hormones that I would use would be one, adrenal-based and/or female hormones, but they’d be liquid.  Sublingual, so we can put it right into our bloodstream, kinda like an injection but without a needle.  We can do it right to our submuscosal, sublingual tissue.

Baris Harvey:  Uh-hmm.  Definitely.  And it’s not just the older women, too, where they are given these treatments that are messing with their sex hormones.  I mean, you can–I’ve seen women get birth control just because they have a painful period and they don’t wanna experience the pain.  But rather than figuring out why it’s painful, it’s like, “Oh, we’ll just take this birth control.”

Dr. Justin Marchegiani:  Yeah.

Baris Harvey:  Or even having depression and having birth control.

Dr. Justin Marchegiani:  Ex–exactly and you know, the way I look at a lot of women that have bad cycles and get put on birth control pill, it’s like going to see a symphony and the conductor is off a little bit.  The conductor isn’t quite, you know, getting the flutes timed up with the horns or the strings, right?  So then we’re not quite in sync, so it’s easy for a symphony that plays beautiful music to sound like noise.  And that’s what happens when you’re–when you’re a female and your cycle is off, right?  The timing of TSH and LH, and our luteal phase and our follicular phase, and our estrogen spike followed by a progesterone rise, all those things are off.  So conventional medicine’s perspective is, “Alright, like, we’re off the symphony, let’s just like–let’s just like pull out our sniper rifle and just shoot the conductor, so then the–the orchestra stops.”  I hope that–I know that imbalance is little bit violent there, but–

Baris Harvey: Oh.

Dr. Justin Marchegiani:  We’re just like we’re mugging–

Baris Harvey:  Exactly.

Dr. Justin Marchegiani:  The conductor.  We’re like knocking the conductor off the stand and what I mean by that is, what we’re doing in females now is we’re just giving a super high amount of synthetic estrogen or progesterone if we’re using the–the Mirena IUD, and we’re just super saturating our hormones synthetically and it starts shutting down our FSH and LH.  These are our pituitary, our brain homones.  These are the conductors, right?

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  So it shuts those down.  Those hormones start to rise a little bit and the reason why is because we’re–actually they would–sorry, those hormones would actually drop a little bit because our hormones are super, super high.  So it just drops down all of our upstream brain hormones because we’re super saturating our estrogen and/or progesterone, and it’s synthetic, too.

Baris Harvey:  Uh-hmm.  Definitely.  Yeah, it’s crazy what’s going on.

Dr. Justin Marchegiani:  I just wanna add one thing there, Baris.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  So like the functional medicine philosophy is, “Hey, we like.” We just take the conductor.  We pull him off to the side, we say, “Hey, man, you know, see the timing over there with the strings and the flutes?  We gotta work on this.”  So we get specific instead of just knocking the conductor and taking away his job.  We actually get in there and try to fix where the timing is off and we can do that with blood sugar support.  We can do that with–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Diet and lifestyle changes.  We can do it cyclical augmentation program where we-synchronized the progesterone.  We can use herbs to help with upstream signaling.  We can support the adrenal glands.  We can address anemias or nutrient deficiencies.  We can also address the infections that are potentially throwing things off.  So it’s kinda like pulling the conductor off to the side, giving him a pep talk, and saying, “Hey, this is what we gotta do,” versus just saying, “Hey, get outta here.  Go home.”

Baris Harvey:  Yeah, exactly, because guess what, you only have one, right?

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  Can’t just replace it.

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  So when you talked a little bit about of the–the nutrients and the diet, oops, something that I feel–it’s weird we don’t really get this tested as much in our–in our normal practitioners, usually you have to go somewhere else to get a total nutrient deficiency panel.

Dr. Justin Marchegiani:  Yeah.

Baris Harvey:  This seems like something that should be like, kinda–kinda basic but I guess why–why isn’t it and–and why–why do we need it?

Dr. Justin Marchegiani:  Well, there’s definitely a couple of nutrients that are really important.  So I already kinda mentioned the B12.  We can infer that by some of the markers I already talked about.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  Also, iron is really important.  We can look at that via ferritin, on our nutrient like on a conventional blood test, we can look at alkaline phosphatase.

Baris Harvey:   Yeah.

Dr. Justin Marchegiani:  If we see it below 50 or 60, that’s typically a sign of zinc deficiency.  Also on blood test, we can look at red blood cells or magnesium red blood cell levels.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  Not magnesium serum but magnesium RBC.  And we can look at–

Baris Harvey:  Yeah, RBC magnesium.

Dr. Justin Marchegiani:  Exactly.  We can look at the intracellular amounts of magnesium which is really, really important.  So those are some that we can get on simple blood tests and then we also run more specialty ones like a SpectraCell test.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Which looks at intracellular nutrients of all kinds.  And then we can also run an organic acid test which is another great indirect way of getting our nutrient levels.  I like the organic acid testing because it’s just easier because you don’t have to go to a lab and get a blood draw.  But both are really good options.

Baris Harvey:  Yeah, definitely.  Another thing, a topic that I know you really like.  Blood sugar management.  Getting our fasted glucose and our insulin and our hemoglobin A1c, like–like what–why are these important and how do we get these tested?

Dr. Justin Marchegiani:  Well, blood sugar’s really important because it’s one of the biggest hormonal stressors on our body.  I just did a video recently about this at youtube.com/justinhealth on blood sugar.  But one of the big things is, we have more hormones that help bring our blood sugar up than bring it down.  So for instance, we have glucagon, cortisol.  We have adrenalin.  We have somatostatin and we have IGF1.  We have probably one more hormone I’m missing, but about 5 or 6 hormones that help bring blood sugar up.  Now, that’s great because evolutionarily speaking, we would have famines and we’d have fasting periods because food wasn’t that abundant so our body adapted to really keep our blood sugar up because typically we were just going without food.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  And now that we have this super abundance, well, we’re having insulin resistance and metabolic syndrome which is basically caused by blood sugar being too high because our body only has one hormone to bring blood sugar down which is insulin and we commonly have insulin resistance now with most of our polycystic ovarian patients, our patients that have PMS, our patients that have adrenal fatigue, patients that have metabolic syndrome, diabetes, Alzheimer’s, they typically have these blood sugar imbalances and one of the biggest stress on the hormonal system is blood sugar stability.  So if we can use markers like fasting glucose can be decent.  It’s a very late stage marker, so it’s not that sensitive.  But if you are above a hundred that could be a problem.  We have hemoglobin A1c.  If you’re above 5.5-5.6, that could be a problem.  We have fructosamine.  That’s a great marker.  We have–let’s see–an oral glucose tolerance test.  We can do that at the lab or we can do a homemade one with a blood sugar meter.  We also have fasting insulin, anything above, you know, 6 or 7 is definitely a sign of moving into insulin resistance.  So we have these great markers we can use because we know blood sugar is definitely an issue that really we have not evolved to a place to deal with high blood sugar.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  We’ve spent way more years with low blood sugar or lower blood sugar because of lack of food abundance and now we have the exact opposite situation, but it’s even worse because we have this lack of–we have this overabundance of food but we have this underabundance of nutrition, meaning we have so many calories available but so little of these calories are–contain nutrients because 90% of food that’s purchased is processed food, meaning it’s packaged.  It’s not found in Mother Nature.

Baris Harvey:  Yeah, definitely.  And I know we’re–we’re coming close to the end of this quick 101, but what–one more would be–alright, I know we–we talked about quickly, like the–the total in what you would get in, you know, cholesterol panel, but if we–you didn’t want and you did like cardiovascular risk, I know some of the things that you might wanna look for is some, you mentioned before, the C-reactive protein but also maybe the lipid particle size.

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  And the number, maybe even like homocysteine.  What–what are-what are some markers that you might be looking for?

Dr. Justin Marchegiani:  So if we’re looking for cardiovascular risk factors, obviously inflammation is gonna be important.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  C-reactive protein, erythrocyte, sedimentary rate, fibrinogen, these are all inflammatory markers, homocysteine as well.  And we can also look at particle size so we can a VAP test, a vertical auto profile, which looks at HDL, pattern A, pattern B; LDL, pattern A, pattern B.  And again, LDL, we want more A; A is good, right?  You want an A on your tset.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  And then LDL B, B for bad so we don’t want much B.  We want more A.  These are the large, fluffy buoyant LDL.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  That’s important and we can also look at lipoprotein (a).  We can also look at genetic test like ApoE proteins, like we–4/4–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  ApoE, E is not a good one.

Baris Harvey:  ApoE protein B, uh-hmm.

Dr. Justin Marchegiani:  ApoE protein B is a little bit different, that’s more particle size–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  But we have a generic ApoE protein testing where 4/4 tends to be the worst.  That means we really can’t be cheating much.  We have 3/4.  We have 2/2, 2/3.  I don’t do too much of those testings because, you know, typically it doesn’t really tell you much other than the fact if you’re 4/4, you should be really on point.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  So if you’re–you’re someone with a 4/4 or a 3/4, it just means you can’t get away with that much, so you gotta manage your stress, you gotta keep the refined sugar to a minimum, keep the healthy fats and healthy proteins and nutrient dense foods up, and the gluten and all the food allergens down for sure.

Baris Harvey:  Yeah, definitely.  Well, sounds good.  I–we got a lotta great information and it seems like some of the important things to focus on is like we make sure we test our sex hormones, our thyroid, our–excuse me–our nutrient deficiencies, blood sugar, and also any of our cardiovascular risk.

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  Pretty good starting places and then of course, there’s so much more, you know, maybe different–

Dr. Justin Marchegiani:  You know what, Baris, I don’t mean–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  To cut you off, I just know if I don’t touch upon this, everyone is gonna be emailing me afterwards–

Baris Harvey:  Oh.

Dr. Justin Marchegiani:  We didn’t talk about thyroid much.

Baris Harvey:  Yeah, yeah, so we, let’s go into it.

Dr. Justin Marchegiani:  Sure.

Baris Harvey:  Because I know, there’s a couple.  You know, there’s a–I mean, basic, you’ll probably go into the thing and just get your–your TSH but we know that we need our free T3, our reverse T3, our T4, and there’s also some other, like you mentioned, the antibodies, go over the thyroid stuff.

Dr. Justin Marchegiani:  Sure, and we’re gonna do a whole podcast on thyroid testing because it’s way too nuisance and it’s not–there’s not enough information out there on it but just a bird’s eye view, most people or most conventional doctors and/or endocrinologist are just doing TSH testing–

Baris Harvey:  Unm.

Dr. Justin Marchegiani:  And maybe T4 testing.  This is helpful for people that have elevated TSH or low T4, because you’ll get picked up–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  As having a thyroid problem.  The assumption is made though if your T4 isn’t low or if you’re TSH isn’t above 4-1/2 on the West Coast or 5-1/2 on the East Coast–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Then you’re fine.  The big running joke in functional medicine community–the easiest way to cure someone in California of hypothyroidism is to fly them out to the East Coast because the reference ranges from 4.5 to 5.5.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  That’s the easiest cure, the plane ticket.  But outside of that, people who really are suffering from thyroid issues and TSH and T4 aren’t enough to figure out if there’s a problem.  So we have to do deeper testing and that would include T4, but T4 looks at thyroid hormone in general.  It’s not looking at the functional aspect, the free portion.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And the free portion is only about 2% of the thyroid hormone.  Alright?  So I got this analogy from you one time, Baris, because you referred to like the free fractions of thyroid hormone is like driving around a parking spot with a hundred spaces–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  But 98 spaces have cones in them.

Baris Harvey: Yeah.

Dr. Justin Marchegiani:  So that means only 2.  So imagine we have a hundred cars driving around.  So 98 of those cars are our T4 hormone and maybe the only 2 of the cars are really are T4 free.  So only 2 cars out of the hundred get to park in the parking spots.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  And that same analogy then happens with T3. So we imagine having a hundred parking spots open for T3, only 2 are actually able to park in because there are cones in all the other parking spots, right?  So we only have 2 hormones or 2% of the hormones that can go in there.  And most people don’t have the ability to convert T4 to T3, and if we don’t have the ability to convert T4 to T3 we may even have higher amounts of reverse T3.  Reverse T3 is like putting another cone in the parking spots.  So instead of having 2 cones available, now we only have 1–excuse me–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  If we have only 2 spots available, now we only have 1 spot available.  So it just decreases the ability for our thyroid to even have a metabolic effect, because for the thyroid to work, in our analogy the car has to be able to park in the parking spot.  The free hormone has to be able to park or go into the receptor site.  So again, looking at T4, looking at free and total, and looking at T3, free and total, and then even the antibodies, too.

Baris Harvey:  Yeah, definitely.  Yeah, so we’re gonna go into an entire podcast on thyroid testing because there’s–there’s so many different markers that need to be looked at and so often we’re just–just looking at the TSH which is–is not good enough.

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  Definitely not good enough and we’re seeing so many people with thyroid issues and all the different metabolic problems and metabolism that’s broken and a lot of it, it, you know, starts from the thyroid, so making sure that we’re actually understanding what’s happening in the body and giving the correct measurements are gonna help us make those changes, so definitely sounds awesome.

Dr. Justin Marchegiani:  Alright, great, my man!

Baris Harvey:  So we wanna remind you again to make sure you go to beyondwellnessradio.com/newsletter.  Make sure that you hop on the list.  You’ll be the first one to be able to access all these podcasts.  Also you’ll be first whenever we have anything ready set to go, any freebies, any kind of launches, you’ll be the first one to know and then also to get further understanding so make sure you go to justinhealth.com and he also has all these labs and the comprehensive lab that we talked about today available that you can just purchase straight from there and to get these labs looked at.  And again, please, please, please give us a review on iTunes.  It helps us so much to spread this message and to–to help anybody.  If you know anybody that needs help with lab testing or have any questions, make sure you send this to them.  Send to an email or tweet it.  It–it really helps get this message sent out.  So thank you, guys, again for listening.  Thank you, Dr. Justin, for your time.

Dr. Justin Marchegiani:  Excellent talk, Baris.  Have a good one!

Baris Harvey:  Yeah.  You, too!

 

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