Analyzing Your Blood Test – CBC Blood Test Evaluation – Podcast #142

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Complete Blood Count (CBC) Markers

Dr. Justin Marchegiani and Evan Brand talk about blood testing. Listen to them as they discuss about the assessment of significant imbalances in B vitamins or Iron in one's blood. Know the importance of Vitamin B12 to having healthy red blood cells and determine why it is needed by people on a plant-based diet.

Learn about the tests and white blood cell markers which are significant in determining infections. Discover more about an H.pylori infection and understand how it can be addressed by using a functional medicine approach.


In this episode, we will cover:

02:36   Big Components of CBC

09:00   B12 and the Intrinsic Factor Binding It

11:31   Infection Components of CBC

17:22   White Blood Cell Markers

26:55   Stool Test and CBC Testing







Dr. Justin Marchegiani: And we are live on YouTube and Facebook. Evan, how are you doing, man? Happy Father’s Day Weekend!

Evan Brand: Yes, sir. Same to you.

Dr. Justin Marchegiani: I know. Steaming off; the countdown’s ten weeks and uh– and counting. [croostalk] Your excited?

Evan Brand: That’s it? Ten weeks?

Dr. Justin Marchegiani: That’s it.

Evan Brand: Holy smokes. It goes quick, don’t it?

Dr. Justin Marchegiani: I know. I’m trying to think about all the things I want to cram in before I’m uh – adapt. But I’m just hitting, kind of keeping a pretty simple low key life, so, nothing that’s on my to-do-list that hasn’t already been checked off.

Evan Brand: Great, man.

Dr. Justin Marchegiani: Awesome, and how’s your weekend though. Ain’t it fun?

Evan Brand: What did we do? Honestly, my days flow together so much. I mean, my work– my work and my life, in a great– so much, that I honestly can’t discern the difference between weekends, typically. But I know I went for a hike, and– Oh, actually, so yesterday, I took my brother out for a mountain biking adventure.

Dr. Justin Marchegiani: Yeah.

Evan Brand: I thought I – you know, I thought I – oh, man I’m really not that in shape but then I got my little brother out there, who– he’s not in shape, at all. And I wasn’t out of breath and he was dying. I felt kind of bad. I thought he was gonna pass out at one point. So, we were like two (2) miles into the woods and you know, he’s hyperventilating. I’m like, “Okay, buddy.” Luckily, I brought some uh– professional grade electrolytes along, and so I gave him some of those and he was able to rebound and feel good enough to get back out to the car. So, that was yesterday. That was a blast.

Dr. Justin Marchegiani: Yeah, I mean, it’s amazing. The more, uhm – the more you have inflammation under control in your body, just your resiliency for everything, because the more inflamed you are, the more your body is kind of allocating all of its resources to putting out that fire, right? You don’t have carpenters go into a house while it’s on fire. The firefighters go into the house first. Same kind of thing with your body in– when it comes to performance. Getting the inflammation down helps on everything.

Evan Brand: I was just in better shape than I thought I was. I mean it was a pretty intense trail, and assuming that the adaptogens were probably still in my blood at the time when she was helping with performance, too.

Dr. Justin Marchegiani: Absolutely, we also got a new audio setup today so you can see we’re microphone free. Got a little tip from my friend Abel James on how to set some things up, and I think it may be working out pretty good. And hopefully, people on Facebook Live can hear you as well. So, hopefully. If not, coach up in the YouTube link, as well, to that Facebook live post so they can access it.

Evan Brand: Yeah. Thank you, Abel.

Dr. Justin Marchegiani: Yeah, very cool. And we’ll take questions here on YouTube chat as we go. But, today, we want to talk about Blood Testing. Starting out, looking at your CBC and your CMP. CBC is your Complete Blood Count, and your CMP is your Comprehensive Metabolic Profile. So, your CBC is gonna look of things, such as your Red Blood Cells sizes, like uhm– red blood cells, Hemoglobin, Hematocrit. It will look at thing– and then you also have something called NDC, which is like, MCV, MCA, MCHC. That’s just how big the red blood cell and the Hemoglobin is, right. MCH is Mean Corpuscular uh– Hemoglobin Mean Corpuscular Hemoglobin Concentration, and uhm– MCV is like uh – the width of the blood cells. So, it’s looking at, basically, how big the blood cells are and how many of them there are, and then, it’s looking at also the Hemoglobin content and Hematocrit content. And this is helpful because if you’re Iron or B12 goes low, you’re gonna see your Red Blood Cells, your Hemoglobin and your Hematocrit actually dropped, and actually same thing with your B12; you’ll start to see those drop. You’ll start to RBC, Hematocrit and Hemoglobin start to drop, so that can give you some indications if there’s a potential Iron or B12, and B12 in a Folate and B6 tend to come together. So, it can give you a pretty good indication of what’s going on under the surface. And again, we’re looking at these things from a functional perspective, so the ranges that we look at them at are gonna be a lot more sensitive than, let’s say, a pathological range for let’s say, Iron-based Anemia, right. Your Red Blood Cell marker may have to be below 3.8 for your MD to say anything, we may say below 4.1 on the RBC. Yeah. Same thing with the Hemoglobin, maybe under 11– 11 or so. They may look at it. We may say, “Ooh! Upper 11’s low 12’s for Hemoglobin.” Hematocrit, same thing, like 36, 38-ish, we may start to look at it. They may say 35 or below. So, we kind of have a little more of a narrower range, so for heading in that direction of being more Anemic. So, we know if there’s a B12 or Iron issue from just those markers. And then, we can dig in to look a little bit deeper by looking at the NDC’s, the MCH, MCHC, MCV– These markers get higher, bigger, or larger numbers if it’s a B12 or B Vitamin issue. And they may just stay low if it’s an Iron issue. But again, it may not have to go low but, typically, we differentiate the Iron in the B12, because the MCH, MCV, MCHC will start to go up when their B Vitamins start to get lower. And why is that? It’s because the maturation of Red Blood Cells. They start off really big and they actually get smaller as they get mature. Where, humans, right; we start off smaller and we get bigger, so, the exact opposite of human beings. So, if we don’t have enough B Vitamins, they get stuck in this bigger phase, and they can’t get nice and small like they should. Where, if there’s too much Iron, they actually get too small, right? If you look up– you know, that we’re Anemic, right? It’s kind of mean smaller, weaker, right? So, if we don’t have enough Iron, we can actually get too small if we don’t have enough B Vitamins. We can actually stay too big. So, that kind of just differentiates that. That’s kind of one of the big when I call deal-breakers. What we look at someone’s blood is being able to assess significant imbalances, either in B Vitamins, B12, Folate B6, and then the Iron.

Evan Brand: So, let’s get a bit of context about reference ranges, when you go to your conventional Doc, you’ve got Lab Corp or Quest, or some other Lab running your blood, and the doctor or the nurse calls you and says, “Doctor Justin, everything’s fine. You checked out okay. Go home.” Uh– really– you want to make sure you get a copy of all of your blood tests for many practitioner, because someone’s analysis, may not be the correct analysis. And like we’ll discuss a little bit today, we’re not gonna go too much into the numbers but we will give some about functional numbers. Anyone who’s almost dead, and anyone who’s alive, their getting factored in to the average. So, when you see that the reference range issue’s so huge if you’re anywhere within dead and alive, you’re okay. And for us, that’s just not the case because, if you’re listening to us, we want you to be the top one percent of health, top one percent human performance on the planet, and so the reference range is gonna be much tighter. So, I hear this time and time again, and Justin does too. Every single week, we hear our clients tell us, “Hey, my nurse said my thyroid was fine. Go home.” And then we looked at the thyroid and their TSH is just absolutely in the tank. You know we’re in, like, the single decimal point, through in like a point two (0.2) or point three (0.3), or the TSH is so high – they’re like a six or a seven, and they get told that they’re fine. So, don’t take fine as a correct analysis of your blood work. Get the piece of paper, and you can work with someone like us, and we can help to identify, “Are you actually in the functional range or are there adjustments that need to be made?”

Dr. Justin Marchegiani: Absolutely, and just the people that are seeing on Facebook, give me a thumbs-up or a comment. Let me know if you guys can hear me, or hear Evan’s side of the combo here. We got a new speaker setup, so we’d appreciate that feedback. So, I think we hit some good things, and again, typically, how laboratories are assessed is you got two standard deviations to the left and to the right, right? This is kind of what makes up our Bell Curve. And– so, you have your middle and then you have two – two standard deviations to the left and two to the right. And that those two standard deviations made what’s called the Bell Curve, and 95 percent of the population fits in that Bell Curve. Two and a half on the pathological low; two and a half on the pathological high, so what happens is, there’s always two standard deviations no matter what. So, what Evan said is true. So, as the population gets sicker, those standard deviations get wider and wider and wider. So, that range gets wider and wider and wider. So that’s – it’s really important, because optimal never changes. If here’s optimal, just because you get more sick, people stuck in that reference range, it’s gonna be polluted. Optimal will look more like it’s – it’ll look narrower and narrower as the range gets wider and wider. So keep that in mind. So, we hit the B Vitamins off. We hit some of the Iron stuff. That’s important. Iron’s gonna be more important with female’s that are menstruating, because hormone imbalances like Estrogen Dominance and low Progesterone and Cortisol issues can throw off their menstruation in their cycle. And that can cause excessive blood loss. So, if I see patients, you know, bleeding more than three days and greater than four tampons a day, we’re really going to the super supers[8:39], that can mean excessive blood loss. So, that’s one component. The next is Vegan Vegetarians. Again, really hard, you need to get – plant-based B12 sources aren’t gonna be the best. Even Vegans that are really healthy, they need to be supplementing B12.If you’re not, that can create a lot of problems. And then also, gut issues, right? If we have severe gut inflammation, if we have intrinsic factor antibodies in our stomach, if we have a lot of gastric inflammation in the stomach, it may be really hard to bind up that B12, ‘cause B12 is really interesting. We bind this compound to what called intrinsic factor, and then we– so here’s the B12 that comes into the body via the food, maybe some liver, some really good grass-fed. The intrinsic factor binds it. So, intrinsic factor is made by the Parietal cells using the same cells that produce Hydrochloric acid. So, if we have more gastric stress going on, it’s possible we may not– we’ll have less of these intrinsic factors. So when these factors hits the B12, it goes to the stomach, it goes into the small intestine, the Duodendum, the Jejunum, the Ileum. So, at the very end of the small intestine before it goes into the Cecum, the first part of the large intestine, that’s where it gets reabsorbed into the bloodstream. So, if we have any of those issues in the gut, that’s really gonna affect how we absorb B12. And if we have pathological low levels of B12, we can just have maybe immature, big, goofy Red Blood Cells, like we mentioned, or we can even go more pathological. We start to have nerve issues, Posterolateral sclerosis, Subacute Combined System disease. These are issues, where your Nervous Systems actually gets destroyed because you don’t have enough of that B12 in there to make enough healthy Red Blood Cells.

Evan Brand: Let’s go down that Avenue. Let’s talk about this that will impair stomach acid production. There’s a lot of things out there that people are doing. Things they’re putting into their body. Infections that are going on that could sacrifice this. And so, if we see Blood Tests that are gonna show low Iron, it could be just a Malabsorption issue, right? I mean, you– we see people all the time. They say their eating grass-fed meats but, they could still show up with low Iron because, they’re just not digesting it well or they had a prescription, uh – acid blocker that they’ve been using. Oh, by the way, just feedback for you. Stay close to the mic when you do your visuals, just because, when you go away, you sound so distant. And I know, probably 95 percent of our listeners are audio so, stay close.

Dr. Justin Marchegiani: Evan, I don’t ever want to be away from you man.

Evan Brand: [laughs]

Dr. Justin Marchegiani: No distance now. I’ll get extra close.

Evan Brand: Good.

Dr. Justin Marchegiani: Good feedback. So, we hit the uh– the B Vitamin stuff, right? So, also, platelets, too. Platelets, if they go low, that could be– also an Iron issue, too. Like the big components of CBC. Let’s shift gears if you’re ready to the infection components.

Evan Brand: Yeah, let’s do it. So, H. pylori is the first thing that comes to mind when you’re talking about Parietal cells. I mean, we see that – what would you say the average is? About one in three that you’re saying is infected in H. pylori? Maybe one in four?

Dr. Justin Marchegiani: Absolutely. I mean, here’s the deal. There are a lot of people out there that probably have H. pylori, and they’re symptom-free. So, h. pylori is a helical-shaped, kind of like a little screw kind of shape, uhm– bacterial creature that can burrow itself into the gastric lining. That’s the stomach lining. And it’s gonna be opportunistic. So, the more stressed you are, the more meal-compromised you are, the more your diet sucks, the more your lifestyle sucks, the more that thing will create problems. So most patients that are coming to see us, they’re either– most of them are coming ‘cause they have some kind of symptom that’s driving them in, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: You have some that come in because they want to be at their highest level, and they’re already good but they want to be better. So, if you have an infection, it’s– think it’s everyone’s goal to be infection-free. So, if there are infections there, we want to get rid of the infection. That’s like having a guest come in your house, leave the water on in the guest bathroom you never go in, and then you see the water bill’s like three times higher the next month. It’s the same thing. It’s just sucking resources, may not be financial resources, just maybe energy resources. Uh– mental, emotional resources, that are getting pulled out. Number two, they’re gonna affect, potentially, digestion. And, number three, it’s a ticking time bomb, ‘cause when you do get more stressed, and your immune system got weakened, that can really come in there and create problems.

Evan Brand: Yeah. So, what do you say to the practitioners who tell on their clients, “Hey, look. You’ve got H.pylori. You’re not symptomatic. Let’s just leave it alone – what’s not treated.” What do you say to that?

Dr. Justin Marchegiani: Well, I think we should always get rid of it, because it could potentially be a bottleneck on the digestive system. And then, number two, it will be sucking up some kind of resource on the body, so we wanna do our best to to knock it out. I think, the more resources you can have going towards performing to your optimal level, the brain function, to rebuilding muscle and healing tissue, and going to your healthy anabolic hormones. That’s better. We want to allocate our resources to things that are gonna help us grow versus frivolous things, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: So, it’s kind of like, investing, right? You want more money going to assets and things that really make your life uhm– you know, better: food, shelter – those kind of things, versus all the things that may not be as much of your priority.

Evan Brand: yeah. I think I told you this already but, I’ll say it again just to make sure it’s on the air. Is– I had a client who came to me a few weeks ago, uh– who went through   medical doctor. He did test, positive for H. pylori, and I said, “Did you get treated for it with the MD?” He said, “Yeah.” And I said, “Oh. Was it triple therapy?” And he goes, “No. They’re doing quadruple therapy now.” That’s for antibiotics instead of three because, H.pylori’s getting so resistant. We probably have to do a whole podcast on antibiotic resistant bugs and how big of an issue it is. But, long story short, the guy did four antibiotics at the same time, and tons of digestive complaints. Still showed up positive for H. pylori.

Dr. Justin Marchegiani: Wow.

Evan Brand: So, it didn’t work.

Dr. Justin Marchegiani: Right. It didn’t work, yeah. Triple therapy is typically Erythromycin, Amoxicillin, and, typically, Prilosec or Bismuth, uh– they used in there. I wonder what the fourth antibiotic they’re adding. Or the third, really ‘cause Prilosec isn’t antibiotic.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Erythromycin and Amoxicillin are– so that…

Evan Brand: I– I think, I’m pretty sure he said it was uh – it was Prilosec so, the acid-blocker and I think three antibiotics. I’m not sure what they were though, in terms of the strains or anything.

Dr. Justin Marchegiani: Yeah. I see so many patients that have uh– zero acid reflex or heartburn and they still put them on Prilosec. Which is just retarded because, it’s like if they’re not having issues with stomach acid and irritation on the gut, why are you putting them on a blocker that may decrease their stomach acid and more nutritional issues down the road. It’s so silly. I get it if they have a lot of the Acid Reflux but, if not, why are you adding another drug in there?

Evan Brand: Yes, there’s a couple markers I wanted to– I wanted to see if I could find them he, in our clinical handbooks on Blood Testing. There’s so many markers that show up as Hypochlorhydria. Do you know any writeup on the top of your head. I guess, you talked about Iron already, so if you have Iron issues, we know that, yeah, that could be yeah, excess of bleeding. But if you’re male, you could still show up low just due to Hypochlorhydria, right? Just low stomach acid?

Dr. Justin Marchegiani: Yeah, you can. Absolutely. That may not be pathological, right? Maybe more of a subtle kind of thing. And here’s the thing. When it comes to functional medicine, we’re moving so many needles, you don’t really know what needle per se is really making the difference ‘cause we may give you Hydrochloric acid, right, and some enzymes, but we may also try to get you to have more time chewing your food, and then drinking water away from food and eating in a more stress-free environment. So, you’re moving six or seven needles right there. I may say, go out get a little more sunlight and Vitamin D, right. So, there’s eight needles we just moved. So, in a double-blind Placebo-controlled trial, typically, they’re moving one needle at a time. Well, man, have you the slow boat to China if you’re moving one needle at a time as a functional medicine practitioner. It’d be so hard to figure out what is the absolute variable, and it will take forever to get patients to get better. That’s why I always say if you can glean from clinical research, do it. Like, you know, the research is the PODMED per se. But a lot of times, the clinical research that were doing, removing so many needles, it’s hard to know what one, but it’s okay because every needle we’re doing on the lifestyle side, we know is helpful. Like, it’s not ever gonna hurt anyone to be in a more relaxed environment to eat, or to drink water away from food, or to chew your food more, right? Those things are gonna help anyone for the most part. So, we combine all of those things with the other stuff and we may see improvements in the B12, or the Iron, or other Digestive things. So, sliding back to the H. pylori, we may look at it indirectly if we’re looking at a CBC, right? We may look at what’s called our white blood cell markers, right. And this is a general kind of indication of our Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Basophils, right? Nutri School we learned it: never let monkeys eat bananas, right? That’s kind of the general jest. And then Neutrophil’s have the highest content, about 60 percent of your White Blood Cells. And Neutrophils all the way down to the uhm– the Basophils, which is like one or two percent. So, kind of keep that in mind. Neutrophils can go up or down for bacteria, Lymphocytes for bacteria and viruses, Monocytes for gut inflammation, bacteria and, potentially, parasites. Eosinophils can go up for, uh– typically, parasites and allergies, and Basophils for Histamine and allergies too.

Evan Brand: Now, is your typical blood test gonna have this broken down like that though…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …or you’re just gonna get a generic White Blood Cell Count?

Dr. Justin Marchegiani: Yeah, typically, you’re gonna have on your CBC your White Blood Cell Number, which will be all of those: Neutrophils, Lymphocytes, Eosinophils, Basophils, Monophils combined– Monocytes combined.

Evan Brand: Yeah.

Dr. Justin Marchegiani: That’s your White Blood Cell Number. And then you can get uh– a breakdown of all of them. [inaudible]

Evan Brand: So [inaudible] get [crosstalk] a percentage.

Dr. Justin Marchegiani: You get a percentage breakdown, as well as the absolutes. So, the absolutes, the how much Eosinophil’s are in there, and then you get the number as a percentage too.

Evan Brand: All right, so let’s say, I just got my blood work done. I didn’t get the breakdown though. I’ve just got White Blood Cell Count, can we get general inferences about whether White Blood Cell Count– let’s say, their currently up. You can say, possibly active infection, as compared to if White Blood Cells were down, could you have said that that’s a Chronic Infection…

Dr. Justin Marchegiani: Hundred percent.

Evan Brand: …but the body’s not been able to fight it any longer?

Dr. Justin Marchegiani: A hundred percent. So, when you look at White Blood Cells, high or low, but high’s gonna be an active infection. That’s non-specific though. And if White Blood Cells are low, that’s definitely gonna be more of a Chronic Immune depleted kind of situation. And then, from there, we can run the actual individual White Blood Cells. We can infer uh– what may be happening there. So the typical pattern is like Neutrophil’s high, Lymphocyte’s low – that’s a common H. pylori pattern. High Neutrophils, low Lymphocytes, typically, one should get into the mid-60’s– middle-o-60’s. That’s maybe a problem.

Evan Brand: Now, let me clarify here. Is this high Neutrophil’s got a functional range or even like your conventional Lab Corp would flag you, “Hey, look. Your Neutrophils are high.”

Dr. Justin Marchegiani: Yeah. You probably would not– I mean, the functional range is gonna be in the low 60’s. The lab pathological range, typically, is above 70’s, some goes high as 75.

Evan Brand: So, maybe. Maybe your conventional lab will pick it up but,  maybe you got to use a functional reference range instead?

Dr. Justin Marchegiani: Exactly, a hundred percent.

Evan Brand: Okay. So, basically what we’re kind of getting at is we can detect stuff like this H. pylori. We can guess parasites possible based on some of these other components of a White Blood Cell Count but, if any of these stuff is off, whether you’re a White Blood Cell Count, just as a whole, regardless of the breakdown, if the whole WBC is up or down, we could say that warrants further investigation with something like stool, or urine organic acid testing tech sheet, look and prove on a piece of paper, H. pylori’s there.

Dr. Justin Marchegiani: A hundred percent.

Evan Brand: Okay.

Dr. Justin Marchegiani: You got it?

Evan Brand: All right.

Dr. Justin Marchegiani: Absolutely.

Evan Brand: We got a couple questions. Let’s see Samuel asked about lots of Ketosis lately. He said, “Can you give us examples of a day of eating Ketosis?” It’s pretty much meat and fats. I mean, like, I’m probably on Ketosis right now. ‘Did some pastured sausage for breakfast, half of an Avocado, I would say I’m producing ketones right now. Samuel, same thing probably meat, meat and some veggies later for lunch, and meat and veggies for dinner. Like probably do a grass-fed steak tonight. Actually, you know what, I made Fajitas last night. I made some grass-fed beef Fajitas. So I’ll fry the– those again. That’s just bell peppers onions, and maybe a piece of dark chocolate. So, I’ll probably be Ketotic during that meal. Uh – Kendra loves blood tests analysis. Ocasious said, “how do you work” – how does she work with us? Uh – you can just Google Dr. Justin Marchegiani or go to his website Just in Health and then you can check out my website Samuel: How do you know if herbal treatment for H. pylori’s working? To eradicate it, are there any symptom during the two-month protocol? What would you say Justin? I mean, sometimes it’s not symptoms during the two-month protocol. It’s just the matter of the removal of bad symptoms. So, it’s like, stomach pain, like you told me. I said, “Man, I had this weird, sharp pain in my stomach.”

Dr. Justin Marchegiani: Right.

Evan Brand: You said, “All right, and you better look for H. pylori.” It might not be that symptoms, like more energy, but it might be the removal of things. Like instead of more energy, I phrased it as “the removal of fatigue,” or “the removal of gut pain,” or “the removal of diarrhea or constipation.” So, I’m kind of worried. It’s like the removal of the bad thing, like pulling off the layer as opposed to saying, “Here’s your positive symptom” if that makes sense.

Dr. Justin Marchegiani: Yeah, yeah. So you make your list of the conventional H.pylori symptoms, which will be, you know, gut irritation, acid reflux, gastritis, indigestion, constipation, diarrhea, like a lot of your big GI symptoms, right? But then, you kind of have your eight typical symptoms, which could be joint pain, mood issues, fatigue, depression, anxiety, uhm– brain fog, so, energy, right, so, a lot of those things, depression. A lot of those things are gonna be a typical meaning they’re not– they’re outside of the digestive sequela of symptom. So, we got to keep that in the back of your minds. So, typically, you’re either gonna see an improvement in some of those symptoms, right? So, if you have mood stuff, you may see improvements in the eight typical stuff, like fatigue, energy, joint pain, start to go down, you may have some typical gastric symptoms, like the bloating, the constipation, the diarrhea. So, you kind of make a list, and see what improves on the typical and see what improves on the eight typical. And again, most people are gonna see some level of improvement there but in general, the goal is to reduce, kind of pull those stressors out of our stress bucket. The more stressors out of that bucket, you may get better. Some people, if you could kill it too fast, they may feel worse during that killing phase. I can’t tell you how many patients I have, where we create, you know, a die-off reaction handout, if you have this issues, make sure you curtail the dose or adjust the tape right up. So many patients ignore that. They just go into the mindset,

“the faster, the better,” “the more I kill, the better,” so they feel like crap, and then, they don’t even do anything or follow the instructions to modify the dose. So, I always say if you’re really feeling like crap, that means you’re just stressing your immune system, your lymphatics, your detox. You’re killing things off too fast and your body’s having to deal with that dead debris. Slow it down. Add in some things to help with uhm– with the lymphatic flow. Change your tea. Maybe add in some binders, some bentonite clay, some charcoal, some citrus packed in. And then maybe, even add in some extra things for your detox phase 1 or phase 2 nutrients, to help push those pathways. But that’s a good start right there.

Evan Brand: I got a couple more questions here. Avie: are there any books you guys have read about functional medicine that you recommend? I don’t know if I would consider a functional medicine book. But Dr. Jonathan Wrights book, “Why Stomach Acid’s Good for You” I think is pertinent to today’s discussion. And it’s like nine bucks on Amazon. What about you?

Dr. Justin Marchegiani: Tsss. I got a book coming out, man, “The Thyroid Reset.” That’s gonna be a great book; all the practical things. I don’t give myself a plug but, it’s gonna be great because it’s gonna be all real practical things. So, look for that soon. And we’ll gonna get that out. I’m just – I’m too busy with patients, so I need to get someone on board to help uh– get it done, because I don’t want to take away from my helping patients.

Evan Brand: Totally, alright. Outside of your books– Your books gonna be a good one, I know. I’m excited. What about other recommendations?

Dr. Justin Marchegiani: Uh– from a functional medicine standpoint, I mean, I have– we have some books here that are more clinician-oriented, right here, on Blood Testing and such, that I use [crosstalk] for myself.

Evan Brand: Uh– Dr– Dr. Weatherby; he’s got – he’s got a good one. It’s titled, “Blood Chemistry and CBC Analysis.” That one’s a cool one. There’s a couple other once out there. What’s [crosstalk] it– what’s it…

Dr. Justin Marchegiani: I– I wouldn’t give – Izabella once had plugged the Hashimoto’s Protocol. It’s a really good book.

Evan Brand: Yeah. Izabella’s book was really good. What else did I read, so far, this year?

Dr. Justin Marchegiani: I got another book over here. Dr. Horowitz’ book, “Why Can’t I Get Better.”

Evan Brand: That’s a great book. He’s got a new one now, too, Horowitz. I can’t remember what it’s called. I think it’s… [inaudible]

Dr. Justin Marchegiani: Play off some word.

Evan Brand: Yeah, it’s like, “I Can Get Better.”

Dr. Justin Marchegiani: I Can Get – something like that. It’s like a play of that same theme. So yeah. Those are some really good things there too, for sure.

Evan Brand: You want to answer Kendra’s question? I’m gonna go back to the blood here.

Dr. Justin Marchegiani: Uhuhmn – so let me hit one thing. So, I talked about kind of the way blood cells stuff, and then, the breakdown of the blood cells. Now, there’s specific tests that you can do for us, specific H. pylori antibodies, right? IGA, IGG, IGN, and then also, you can do Breath Testing, and then also, Stool Antigen Testing so there’s more specific testing. But you can look at the CBC and you can infer and draw things from that, which is nice.

Evan Brand: Okay.

Dr. Justin Marchegiani: And then, what’s Kendra’s question?

Evan Brand: Yes, she says, “Do you consider elevated Eosinophils a good sign – a good enough indicator of infections or do you think Stool Test are always necessary?” I’ll give my two cents first. We run the Stool Test on every single new client, I mean, if we just depend it on blood test, I feel like our– us having all the puzzle pieces on the table would not be complete.

Dr. Justin Marchegiani: Exactly, and sometimes they can take a lot long time for those markers to drop. So, if you’re treating an infection, it may take like months like after the infections treated for those numbers to kind of slowly go down so, it’s nice to have more immediate infection markers that tell the story. But it’s good, because we– number one, it tells me, the clinician, that something’s wrong. And that we got to look deeper in that stool testing area. And then it gives me more ammo to get the patients to run the test that I think are best. So, that way, the patient’s more motivated because, they know, here’s the clinical direction that we’re going down. Here’s the clinical path that we’re going down. Here’s why we’re going down it.

Evan Brand: Yes. She had a follow-up question. She said, “Or rather should you not do a Stool Test if the CBC doesn’t indicate parasites?” No way, always do Stool Testing. I’d say, once or two times a year. Just a preventative, everybody should be doing Stool Testing because, here’s the deal. We can try to make the guesses and checks based on the CBC like all we think it could be this, we think it could be that, but let’s say, you’ve got, like, Klebsiella or Citrobac, or some type of bacterial overgrowth that can trigger autoimmunity. Well, let’s say you’ve also got H. pylori on top of that, or let’s say, you’ve got Candida, or let’s say, you’ve got Blasto with it. you know, the protocol’s gonna be different. If it’s just…

Dr. Justin Marchegiani: Yes.

Evan Brand: …yeast. We’re gonna do one thing, if it’s just bacteria, we gonna do one thing. If it’s bacteria plus parasites plus yeast, that’s gonna  be a totally different protocol so, if you just say, “Oh I think, this number’s off of my blood, therefore, I’m gonna take this gut supplement.” Waste of time.

Dr. Justin Marchegiani: A hundred percent. So, I think that’s essential because you’re gonna treat different infections differently. And then also, you want to know if the infection’s knocked out because, if you don’t see the CBC go down, you’re like, “Well, it’s just in the latency period. It’s gonna drop over the next few months. Where if you get the infection, you retest and the infection’s still there, you’ve a lot more clinical confidence to keep on moving and trying in different things versus the hate that you get. You’re not, kind of in, an uncertain state.

Evan Brand: Now, the question here, uhm– do you agree that low Melatonin on a BioHealth HPA Axis Spit Test– low Melatonin, do you believe that indicates gut dysfunction?

Dr. Justin Marchegiani: It definitely can. It can increase, or can be uhm– you know, something that I would add to the list of potential, differential diagnosis is, or what the root cause could be. ‘Cause if we don’t have the ability to break down, let’s say, Tryptophan, which then gets converted in the 5-HTP, which then gets converted into Serotonin, which then gets inverted into Melatonin, right? That that could be a potential issue. I also look at B6. I also look at the stress because, your body will burn through Serotonin. The more stressed you are, you’ll see that an organic acid test, you’ll see 5-hydroxyl to last, take a high or low. So that can be indication you’re burning up a lot of those uh– precursors there. Uhm– so, I look at the stress components, you know, adrenals and such. And I, also, would look at the gut component, for sure. And then make sure all the diet and lifestyle things are uhm– you know, the T’s are crossed and the I’s are dotted, right? HCL, enzymes, no infections, making sure sleep is getting all those things, but definitely that’s one thing I would add to the list to rule out.

Evan Brand: Yeah, it could be something simple as you look at your phone too close to bedtime. Low Melatonin showed up before [stuttering] your last Saliva Test.

Dr. Justin Marchegiani: Yeah, I mean, I would say, if you’re like running the test right before that, for sure. But if you’re kind of getting more of an average, so to speak, of the night and in snow, that’s probably not enough to not knock it down from an average standpoint. But, punctuated yes, I think that makes sense.

Evan Brand: Yeah. Let’s see what else we have. Questions here. Diana said, “Do you recommend Nystatin for Yeast Overgrowth to keep it in check while taking herbals? I can’t prescribe, and I would not prescribe it even if I have the ability to prescribe it, ‘cause I typically use like Saccharomyces boulardii, and I’ve just never had issues with– with Yeast Overgrowth, as long as people are doing the diet. And, a lot of the herbs that we use and, Justin, you want to add some stuff too. A lot of the herbs we use, like if we’re working on yeast Overgrowth, the parasites, or bacteria– they’re gonna be multifactorial. So, we may be using an herb that’s gonna also– let’s say we use Olive leaf for Oregano. That could kill bacteria but it could also kill Yeast as well.

Dr. Justin Marchegiani: Yeah, absolutely. So, I think uhm – nice that some of the antifungals uhm – may be needed for more severe issues but for the most part, you should always try the herbals first. And, you should always look at other infections because there could be other infections like Blasto or H. pylori, that could predispose that fungal overgrowth. And if that’s – that’s what’s predisposing it, a Nystatin, a Fluconazole, or an Amphotericin B. That’s not gonna fix the H. pylori, or the Blasto, right? So then, the root underlying issue is still there. While you uhm– you know, basically, you went outside, you pulled the weeds, at the ground level, versus pulling the roots up. So that’s the equivalent. Just – just puling the weed out of the surface and not pulling the root out.

Evan Brand: Yep, well said. Samuel said, “How accurate is the Breath Test for H. pylori?” I’ve personally, never actually recommend this one for a client, because the Stool Testing is just so awesome that I prefer to use that. But, Justin, what’s your – what’s your take on that?

Dr. Justin Marchegiani: Yeah, I mean, if someone has insurance, and they’ve met their deductible, you know, I’ll throw it on there an order from Lab Corp, but uhm – I find that patients may still have an H. pylori infection in their stool, and not have a comeback for a breath. The Breath is good for like acute stuff, but uhm – it’s not something I would just run b5y itself, and say, “Yeah, you’re good.” I’ll always wanna go to the Gold standard which is the H. pylori Testing. And again, we’ve been doing a lot of the DNA Testing for the H. pylori about BioHealth. You know, their #418 or their – the #401H. The H part of the #401 does the H. pylori. And they do great parasitology on their H. pylori. They beat a lot of Labs on that, which is awesome.

Evan Brand: Yeah, it is. Avie have a question, “ Should I wear a Blublockers all day on the computer or only  when it gets dark out?” I’m so glad you answered this. It drives me nuts when I see people promoting these BluBlocking glasses in them, like, out of it, hence, like a health conference and they’re just walking around the daytime, wearing your BluBlocker, it’s absolutely retarded, because you’re destroying – I’ve seen people on the Lab results, who said they’ve been wearing BluBlockers all day. They’ve destroyed their Cortisol rhythm because, their body never knows when it’s daytime. So – and this is not against you asking the question but, I see so many photos of people promoting them because they’re like trending and cool now. But it’s absolutely stupid to wear them during the day because, you can just use a screen software, like Justin and I talked about, called Iris, you can keep your screen at a 23 or 1,900 Kelvin. So, it’s pretty much Amber-colored, which is what I do all day. Because you still need those beneficial spectrums, you know. Those like 1,500 different spectrums you’re getting from sunlight. So, if you’re exposed to, like, an LED light, or a screen light from your computer, you can modify those lights to make it a better situation. But you absolutely still has to have those natural spectrums that come from the Sun. Otherwise, you’re really screwing yourself up.

Dr. Justin Marchegiani: Yeah, I mean, during the day, for me, I’m okay being a little bit overstimulated by light during the day, ‘cause that’s just gonna increase my Cortisol. So, if– as long as everything else is going well, I don’t have a significant Cortisol imbalance, I think it’s fine. I just use it at night; just when the Sun sets. That’s where I pull them out. And I have this one, like, brand now, that I put over my glasses. I’ll put them on, typically, between 8:00 to 9:00 – the last two hours before I go to bed, I put them on.

Evan Brand: Yeah. And I put it too early with the baby so, I mean, at that time during the summer, we’re going to bed before it’s even completely dark outside so, I just kindled down. You know, we’ve got like a little salt lamp to use as a night light, and turned that off. And, we’re good. So–

Dr. Justin Marchegiani: Love it.

Evan Brand: I got a little–

Dr. Justin Marchegiani: Love it.

Evan Brand: I got a little ranty there. I see these pictures of these BluBlockers. These people wearing them, promoting them on Health Conferences. There’s people doing like Facebook ads wearing the glasses during the day. It’s just makes me want to sock them.

Dr. Justin Marchegiani: Yeah, I think I had uhm – I had a Neurosurgeon on the jet cruise recently, and he had them on during the day. But his situation was different. He was up all night doing a Neurosurgery. So he had it on during the next day, because he was tryig to, I think, probably get to bed when he got home. So, I think he was trying to dampen it, and kind of tell his brain that it was night time, so he could get some rest. I think that was a different situation people watch that show. You’re probably thinking about him. I know, I could think of a couple of people that do it at conferences like a freak. I  won’t say their name but, I don’t– I just don’t understand during the day why that’s gonna be the best. I get it at night, right, because you don’t want to lower the Melatonin by upping the Cortisol from the light. So, that makes a lot of sense.

Evan Brand: Well, the Sun, I mean, right now, there’s blue light from the Sun. You’re getting blue spectrum’s during the day.

Dr. Justin Marchegiani: Right.

Evan Brand: And so…

Dr. Justin Marchegiani: Naturally.

Evan Brand: Yeah, naturally. So, it’s not – it’s not like you’re, you’re hacking sunlight. Sunlight is good. You’re never gonna be able to beat that in terms of the spectrum – the color– the color ranges.

Dr. Justin Marchegiani: Totally. Well, we just hit the CBC today, I think saved uhm– the comprehensive metabolic profile for next time. Because I– we’ve already done a good amount. We hit the key CBC markers, RBC, Hemoglobin, Hematocrit, right? We talked about the differentiating, the Iron versus the uhmm– the B12. We talked about the White Blood Cell panel, right? The White Blood Cell, we talked about the uhm – Neutrophils, Lymphocytes, Eosinophils, Basophils. And then one of their marker here, I’ll hit is– we’ll hit in the CBC and the CMP part next time. But you can do markers for Red Blood Cell and Magnesium, which is great but, Magesium kind of comes under the Comprehensive Metabolic Profile. So, we’ll talk about that. Intracellular versus extra cellular so, we always like to do if we can do, a specialty test for, like, the Magnesium Serum versus– I’m sorry. Red Blood Cell Magnesium – that’s better, ‘cause that gives us the window intercellular, inside the blood cell versus outside of that. Kind of what the blood cell swims in if you will.

Evan Brand: Yep. That would be fun.

Dr. Justin Marchegiani: Home. Awesome. Home. Any other questions, comments, concerns?

Evan Brand: We had one from Gupta here. Okay. Gupta: “ What’s the best hormone test?” Kind of a general question but, since we talked about Cortisol and Melatonin today, a lot of times, we’re looking at a salivary uh- Cortisol test, which is gonna tell us a lot about Gut Health. If you got high Cortisol, we know that’s gonna damage somebody’s gut. Uh– so that– that’s what I typically write in. Justin, what are you doing hormone-wise.

Dr. Justin Marchegiani: Yeah. Hormones I’ve been doing and going combination between the Dutch and then also doing more of the BioHealth, the Cortisol Awakening Response. So, we’ll run the #201 and the #205, nd then we’ll add the Cortisol Awakening Response, so we can look at zero, 30, and 60 minutes waking and see if we have that ice bump of Cortisol here, a bump at 30 and then a halfway drop down here. A lot of patients, they’re not even getting that, that Cortisol up. In your awakening response, we get a bump, 50 percent bump, a drop of about a third here, like that. And most people they aren’t getting enough, high enough, and they’re dropping down actually lower. So that give us a pretty much good window of what’s happening with our HPA Axis.

Evan Brand: And yeah, it’s so much more fun to have the Awakening response versus impervious times that’s just having that one morning reading?

Dr. Justin Marchegiani: It’s nice. It gives you a pretty good window what’s happening with the brain, and the hypothalamus-pituitary-adrenal axis, for sure. I love it.

Evan Brand: Stacey, thank you for the feedback. We appreciate it. Uh– Kendra said, She gives a podcast idea. “A Recommended Test: Serum, Urine, etc., For Each Essential Micronutrient: Magnesium, Zinc, B6, Fatty Acids, etc.” I’m gonna guess. You’re gonna tell her just to do a SpectruCell but maybe we’ll save that for future reference.

Dr. Justin Marchegiani: Yeah. I mean, SpectruCell will be great, ‘cause you get more intracellular nutrients there, but yeah, we’ll talk about that next time. There’s other markers that we can look at for Zinc, like Alcohol and Phosphatase, and Magnesium, like the Red Blood Cell Magnesium. So, we’ll say that for next time. We’ll dig in more.

Evan Brand: Cool. People can go check out They can check out Justin Store, custom formulations there, lab tests, scheduling consults with him– Then myself, just Evan Brand. E-V-A-N Brand dot com (, and check us out. We’ve got, what? Probably a combined total of five or 600 pieces of contents. So if there’s something there that we didn’t cover today I’m sure he have – in some form or fashion.

Dr. Justin Marchegiani: Yeah, just use the search bar on our site. A lot of people, they come in on some of the questions and they asked questions. Uhm– like about stress and things like that. Uh – we may not be able to answer more very generic questions but that’s why we go back to the site and just put that into our Search browser, and you’ll get uh– lots of Podcasts and other articles on that. So, we don’t mean to ignore you but, go back and use that Search Bar first.

Evan Brand: Yep, totally.

Dr. Justin Marchegiani: Cool. And you no longer the Not Just Paleo guy. You’re uh– you changed your brand. I mean…

Evan Brand: It’s on.

Dr. Justin Marchegiani: Evan Brand changes his brand. Is that a coincidence or what?

Evan Brand: It’s gone. The website, like, went down, and I said, you know what, this is it. I finally got it. I was able to purchase my– my name dot com. So, that’s what I did. Stacey: “Is it okay to take D3 on a regular?” Yeah, probably is. If you’re taking Vitamin K, or you’re doing grass-fed butter. Then, you’ve got the K that’s gonna help act as a traffic cop for the Calcium, so that you’re not upping D3 and then Calcium on your arteries but, just get your levels retested. I had a lady who has taken a bunch of Vitamin D. She got her levels tested. She was above a hundred and twenty (120) and that’s toxic, so you can’t have too much of the good things. So just get your blood checked. If you can get it through your doctor, cool. If you need to get it through somebody like Justin or myself, we can do it on uh– an out of pocket basis, as well, for blood. And, it’s always good to check. Make sure you’re about 60 units.

Dr. Justin Marchegiani: Love it, man. Love it. Well, anything else you want to mention here before we go?

Evan Brand: I don’t think so. People listen on YouTube. They can’t give us a review obviously. But, if you’re listening to the audio portion on iTunes. Give us a five-star review, ‘cause it helps sustain the top of the hills chart, and that way, this functional medicine approach can get to more people and then we beat out people like a Jillian Michaels, who are promoting, like, Calorie Counting and Weighing Yourself, and Weighing and Measuring Your Food, and all that other crap that we just don’t agree with. Is not necessary for you to be optimally healthy. If you give us a five-star review on iTunes, we beat out her, and then this info gets to people like you instead.

Dr. Justin Marchegiani: Hundred percent, man. Awesome. Well, great chat today, Evan.

Evan Brand: Likewise.

Dr. Justin Marchegiani: We gotta do it again, real soon.

Evan Brand: Yes, Sir.

Dr. Justin Marchegiani: Alright, take care.

Evan Brand: Bye.

Dr. Justin Marchegiani: Bye.



“Why Stomach Acid’s Good for You” by Dr. Jonathan Wrights

“Blood Chemistry and CBC Analysis” by Dr. Weatherby

“Hashimoto’s Protocol” by Izabella Wentz

“Why Can’t I Get Better” and “I Can Get Better” by Dr. Richard Horowitz

“The Thyroid Reset” by Justin Marchegiani



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