9 Ways to Fix Your Gut Flora

9 Ways To Fix Gut Flora

By Dr. Justin Marchegiani

What is Your ‘Gut Flora’?

There is a whole community–a whole universeliving within our intestinal tract. Roughly two pounds of microbes live in and on our bodies; the vast majority of these are located in our gut. With this many guests setting up camp inside of us, we must take precautions, just as we would if we were hosting guests in our homes, to ensure we are only inviting good company.

How Your Gut Flora Affects Your Health

How Your Gut Flora Affects Your Health

Our gut flora is responsible for more than you might realize. It can cause cravings, impact our mood, and affect allergies and food intolerances. By keeping our gut bacteria balanced, we can control how fast our metabolism works, boost our energy, prevent disease, and extract more nutrients from our food. If you don’t have a healthy gut balance, your immune system will be severely compromised. Poor gut health is tied to many health issues and diseases, including:

  • Asthma and allergies
  • Autoimmune diseases (arthritis, IBS)
  • Cognitive decline (Alzheimer’s, dementia)
  • Fatigue and brain fog
  • Fungal overgrowth
  • Gluten sensitivity and other food allergies and intolerances
  • Infertility
  • Learning disabilities (ADHD)
  • Mood disorders (anxiety, depression): The human body has a “second brain” that we are just starting to learn about, located in the gut. Breakthroughs in science are being made on how the trillions of bacteria in our gut— the microbiome— communicate with the neurons in our gut lining. This effectively means the bacteria living inside of our intestines have an effect on our mood! Science is showing depression, anxiety, and other mood disorders are linked to the microbiome.
  • Parasitic infections
  • Small intestinal bacterial overgrowth (SIBO)
  • Type 1 diabetes

Click here if you are suffering from digestive issues to consult with a functional medicine doctor and start feeling better today!

Just as bad bacteria negatively affect your health, good bacteria have a positive influence on your health! Good gut flora assists in the following ways:

  • Gut flora is responsible for helping your body absorb and store nutrients, like vitamin B.
  • It produces vital nutrients. For example, your body doesn’t store or produce vitamin K, and the food you eat can only provide you with a little of what you need. Luckily, your gut flora produces the majority of the vitamin K you require, and since your body isn’t good at storing vitamin K, it’s crucial that your gut flora is always producing more for you!
  • Good bacteria keep the walls of your intestines strong and prevent you from developing leaky gut.
  • Balanced gut flora trains your immune cells to fight inflammation.
  • Good gut flora is energy-efficient.  Having an imbalanced (“bad”) gut flora means your body has to hold on to more food to get the same amount of energy, which causes more food to be stored as fat. On the flip side, if your gut flora is in good shape, you get maximal energy out of the food you eat and excrete what’s left over!

Nine Ways to Fix Your Gut


We’ve seen how gut flora is responsible for keeping us healthy or making us sick. How can we make our gut stronger? Here are 9 ways to fix your gut flora!

  1. Reduce or cut your sugar intake: Sugar is one of the bad bacteria’s favorite foods!
  2. Avoid inflammatory foods: Some studies have shown that fats and oils ruin your health, but this research studied diets comprised largely of refined vegetable oils, such as soybean oil. On the other hand, grass-fed butter, organic coconut oil, and extra-virgin olive oil have been shown to promote a healthy gut flora and aid in weight loss!
  3. Eat a variety of healthy foods: Eating a wide range of healthy foods ensures we have a diverse microbe population, which is very important!
  4. Eat vegetables with every meal: If you can fill half your plate with vegetables and plant-based foods, your good bacteria will have plenty of fiber and nutrition to feast on and use to boost your health!
  5. Choose organic: Not only are GMOs and toxic pesticides are bad for our microbiome, they also affect the soil they’re grown in, and our gut bacteria and the bacteria in the soil are related.
  6. Eat prebiotic rich food: Sweet potatoes, asparagus, and other prebiotic foods feed the good guys!
  7. Incorporate fermented foods into your diet: Sauerkraut, kombucha, kefir, and pickles are all delicious fermented foods.
  8. Take prebiotics and probiotics: The use of pre- and probiotics feed the good bacteria that keep your gut healthy.
  9. Take steps to lower your stress: Try meditation, yoga, a walk or a jog, or partaking in your favorite hobby to reduce your stress. Studies have shown that stress can actually negatively affect the composition of your gut flora!


The state of your gut is responsible for both your physical and mental health. Luckily, even if your gut is in bad shape, it is easily remedied by following the nine steps listed above. The good bacteria are always ready to move back in, all you have to do is provide them with the right environment.

Click here to consult with a functional medicine doctor for a personal plan to improve your gut flora!










Lowering Histamine Naturally – Getting to the root cause of high histamine – Live Podcast #154

Dr. Justin Marchegiani and Evan Brand engage in a discussion about histamine. Listen as they talk about finding the root cause and driving factor of the issues related to histamine. Learn all about the symptoms associated with histamine issues and find out how problems with the adrenals, hormones, gut, diet and lifestyle contribute to these issues.

Know how some of the medications like anti-depressants, immune modulators and beta-blockers are related to nutrient deficiency. Gain information regarding higher histamine foods and natural supplements. Apply some of the natural solutions and recommendations regarding diet and lifestyle that would address histamine issues.


In this episode, we cover:

04:12   DAO& HNMT: role in our bodies

08:13   Medications and nutrient deficiencies

10:38   Higher Histamine Foods

18:39   Natural Supplements to lower histamine

21:57   Toxic mold

28:42   Diet and Healthy enzymes







Dr. Justin Marchegiani: And we are live on YouTube. Evan, to it’s Dr. J here. How are we doing today, man?

Evan Brand: Hey, man, Happy Wednesday! You and I have been pulling out the research books today. We’re like, “Hey, let’s make sure we know everything as— as much as possible about histamine.” A few have been asking you, asking myself, you’ve done interviews with histamine experts and what was it, the histamine chef is that who you chatted with?

Dr. Justin Marchegiani: Yeah. Yup. Yasmina Ykelenstam. She’s the histamine chef and we did a podcast last year on this topic. And uhm lot of good stuff, we’re kinda rehash some of the key take homes, we’ll talk about getting to the root cause and we’ll also talk about ways that we can supplement and just support histamine issues in general, more specifically.

Evan Brand: Yeah. So what you and I were talking about affairs. We— we don’t really market ourselves necessarily, it’s like, “Hey, histamine practitioner” There’s a lot of people the kind of attached the word “histamine” to their name or to their marketing efforts, but, you and I, as we start to dig deeper and find root causes of the histamine intolerance which we’ll talk about exactly what this means, we’re fixing histamine intolerance just as a side effect of doing all the other good work we’re doing to support the adrenals and support the immune system and ensuring that people are free of infections and fixing neurotransmitters like all the stuff, Oopp, it just happens to fix histamine intolerance.

Dr. Justin Marchegiani: Exactly. Like in the functional medicine world, you know, there is ways that you can market to so you can kinda row people in specifically coz you talk to their issues, but again, if you really are a good functional medicine practitioner, clinician, you’re hitting all of the body system. So in general, you’re not gonna really miss anything but there are ways that we can dive in deeper to issues such as histamine. And we’re gonna try to do that today. We’ll kinda zone out a bit. So we have like the big picture perspective, so people don’t forget what the root causal things that can’t be ignored are, and then we’ll also talk about you know, palliative things we can do on top of just the—the functional medicine principal stuff to get even better results.

Evan Brand: Sure. So should we start with some symptoms? What exactly people are noticing when they’re coming to us and they’re saying, “Hey, I think I have a histamine issue and I believe it could be coming from my diet.” We’ve got symptoms like headaches, could be anxiety, it could be your face flushing, it could be an itchy tongue or runny nose. What— what else am I missing symptom wise?

Dr. Justin Marchegiani: Yeah. Headaches. All those different things. It could be flushing, it could be even hives or the eukaryotes, those wheels that come up on the skin uhm— those can be all, you know, things that are happening. And again, what’s histamine doing? Histamine is a neurotransmitter. And there are various receptor sites for histamine in the body. There’s you know, H1 or histamine 1. Histamine 2, 3 and 4. And again, these things can control for instance, smooth muscle and endothelial tissue that affects blood vessels. This is what like Benadryl and like Claritin would—would utilize. So if you have like an allergic reaction and like your skin get super blown up, right? That’s why you do like Benadryl, right? Or histamine two controls acid secretion and abdominal pain. So histamine can also increase acid as well. It can also increase the heart rate. Histamine three has an effect on controlling the nerves, sleep behavior, appetite. Histamine four has an effect on the intestines, the spleen the colon, white blood cells and the inflammatory response. So it’s kind like this, right? You take your hammer; you whack your thumb, and all of these different reactions that happen, right? So you can look at all of the clotting factors and the cytokines and all of the inflammation and the white blood cell mobilization. And if you just kinda zone back, zone back, zone back, what caused it all? The hammer. So we’ll kinda zoom in, alright, what’s happening and the nitty-gritty, but then we’ll kinda zoom out and say, “Okay, what’s the hammer in this analogy?”  Coz if we can focus on the hammer, it’s way easy to wrap your head around, “Don’t whack your hand—don’t whack your thumb with a hammer than it is to look at all of the nitty-gritty. But we’ll kinda do both. So people that are looking to nerd out a little bit, kinda get satisfied and the people that just want the action items get satisfied, too.

Evan Brand: Sure. So let me just pronounce what we’re actually talking about. Diamine Oxidase also known as DAO, so basically, this is an enzyme that we’re making on our own in our body which is basically just like when we’re talking about proteases and lipases and lactases and just different digestive enzymes. DAO is an enzyme that’s basically going to find, it’s gonna seek out like the CIA, it’s gonna find the bad guy which is gonna be excess histamine in your foods and it’s can help break those down it could be foods or beverages so we’ll talk about the alcohol component in DAO when it works properly, it can break down up to 99% of the histamine. And then there’s 1% of histamine that actually enter circulation but we’ll talk about some of the root causes here. There could be going on with the gut. When you’re deficient in DAO, which is why you can supplement, which Justin told me off air, “Man, this stuff is sold out everywhere.” But when you’re supplementing with it or you’re fixing the root causes, and your getting your DAO in time to be back in adequate amounts, you’re able to break down the histamine and you no longer have histamine intolerance, which is why people can take DAO supplements and they can feel better but you’ve always got to work back to the root cause of other issues why is it not working in the first place.

Dr. Justin Marchegiani: Yeah. It’s also this DAO which is Diamine Oxidase and there is also another one called HNMT Histamine N-Methyl Transferase and these both have an effect of breaking down histamine. So if we take off our functional medicine root cause hat and we put on our palliative natural medicine hat, we wanted to just control symptoms, well, we can give enzymes like DAO which has been backordered for years. They are typically extracted from kidney or thymus tissue and big back order for a while, but we can give those to help lower histamine, alright? Coz that enzyme helps break histamine down so, you know, it’s like someone that has a lactose intolerance issue, they may take Lactaid which is milk enrich with lactase, the enzyme, right, to break down the milk, the milk sugar and they have less diarrhea. So kinda into that perspective where we’re adding in the enzyme to be able to break things down uh— which can be helpful from a palliative perspective. Uh— number two, we can avoid— we can make sure we have all the nutrients required to make a lot of these enzymes. So like the HNMT enzyme, we need SAMI, right? We need SAMI, S- Adenosyl Methionine which is really important for MTHFR. Uhm the Diene Oxidase we also need B6, we need copper, some of these other enzymes to for histamine processing, right? We need B2; we need iron; we need B5, right? And a lot of these nutrients we’re also gonna deplete with adrenal dysfunction, too. So you can see how adrenal issues and low histamine can be affected. Anytime you see B vitamins we know how important healthy gut bacteria is for producing B vitamins. So you can see, if we have a dysbiosis or SIBO, we have food allergens driving inflammation, driving leaky gut and/or gastrointestinal permeability, that can all affect our ability to make enzymes to lower and process histamine.

Evan Brand: Well said. So any gut infection, I mean, Justin and I that’s one of the things that we work on so much because it’s so common you probably heard our stories but, you know, I had H. pylori, I had parasites, I had bacterial overgrowth, I had yeast and all that’s driving leaky gut. So if you got something like H. pylori, for example, which we see every single week on lab results when we’re looking at people, the H. pylori is going to suppress the stomach acid and so if you’ve got undigested food, even that alone, could be causing leaky gut, therefore causing low DAO, therefore causing you to have “cortical histamine intolerance”. So if you work with a practitioner on histamine, we’ll talk about the diet piece in a second, but you’ve got to get the gut in healthy spot. You’ve got to fix the—the diet. Make sure that the gluten is out of the diet, or anything that could be causing a leak ego situation; otherwise, you’re just setting yourself up for failure. And then, surprisingly enough, which maybe you know more about this than I do, but it’s interesting that a lot of these medi—medications, I don’t know the mechanism but like antidepressants like Cymbalta, Prozac, Zoloft, you’ve got the immune modulators like Humira and Enbrel. You’ve got the Metaprololol, the beta-blockers; you’ve got Zyrtec and Benadryl. All of these things are causing the DAO enzyme to become deficient. I mean I guess the mechanism isn’t too important but it is interesting.

Dr. Justin Marchegiani: Well I think some of the mechanism pretty straightforward. Uhm— a lot of this is via nutrient deficiencies. A lot of these medications create nutrient deficiencies and a lot of these nutrition these nutrient deficiencies and a lot of these nutrition deficiencies revolve primarily around B vitamins and minerals. So it makes sense. If we create deficiency with B vitamins and minerals, of course, that’s gonna create more issues. I mean it’s like blood pressure. If you look at the acid block—the beta-blockers or the uhm—water pills like hydrochlorothiazide or the Lasix.

Evan Brand: Yup.

Dr. Justin Marchegiani: They are either diuretics but they create deficiencies with potassium and magnesium, which are really important for blood pressure. So you can see a lot of these drugs actually can make the problem worse. It’s an amazing business model if you’re only looking at you know the money factor, but if you’re looking at fixing the root cause, like we are, it’s definitely not good. You wanna really back up.

Evan Brand: Agree. Well said. You wanna talk about diet?

Dr. Justin Marchegiani: Just to kinda—just to kinda back out just a little bit. Uhm—we talk about the nutrient deficiencies, right? We talked about medications and antibiotics, antacids, antihistamines, right? Uhm—We talked about uhm—well, I’m gonna add it, nutrient stressors. So if we have more stress, more adrenal stress, more fatigue, poor sleep, inflammatory diet, that’s gonna drive more in a higher increase in histamine. If we have hormonal imbalances whether we’re estrogen dominant or that we have adrenal dysfunction, right? Imbalance in our stress hormones, cortisol, rhythm issues, a lot of that’s gonna be driven by a lot of these lifestyle stressors. That’s gonna really create more histamine issues. Now, I always backup. How do we know someone has a histamine issue? Well, do they have any of those histamine symptoms we mentioned in the beginning? Coz we know histamine does a few things. It helps increase heartbeat; it helps with gastric acid secretion; it opens the blood vessels, hence why when, you get allergies or allergic reaction, you swell. It helps increase bronchial dilation; it helps with gut permeability; it increases adrenaline. But if people get headaches or flushed or rashes or headaches with higher histamine foods, we definitely take notice. And those higher histamine foods, the big one, is going to be fermented foods. Do you get worse with fermented foods? Do things like teas create, you know, problems? If you have bone broth, does that create problems? Does citrus fruits create problems? Do meats over, you know, they’re too old, create problems? Uhm—does chocolate and coffee create problems? So if we start seeing issues with some of those symptoms, I really look a little bit closer to see what could be the driving factor.

Evan Brand: Yeah. I’ll list down a couple of more, too. Kombucha—that’s gonna be popular for our crowd, our community.

Dr. Justin Marchegiani: Yup.

Evan Brand: Yogurts, even if it’s like a grass-fed yogurt, your sauerkraut, if you’re having flare-ups, I’ve had some women that said have flare-ups on their skin after doing sauerkraut, that’s a sign right there and then alcohol, too. So wine, beers, champagnes even if it’s organic wine, it’s not gonna matter. Cured meats— so salami, could be pepperoni, the beloved bacon—bacon an issue, unfortunately for the time being. You mention the citrus fruit, aged cheese and then nuts— walnuts, cashews, peanuts, avocados. I believe— I don’t know if it was histamine, but I had something going on where I had to pull out avocados for like six weeks. I was having headaches from them. It was no other foods. It wasn’t any other nuts and seeds but I believe I had—I’m gonna guess a histamine issue because why else would avocados give me a headache?

Dr. Justin Marchegiani: Oh, exactly. Yeah, totally. So—

Evan Brand: I was doing like everyday they’re so good and so easy to add to a meal, so.

Dr. Justin Marchegiani: Totally. And then we also have things like mast cell activation disorder, right? Histamines produced by mast cells, so you got these like basophils, which are like in our white blood cells, right? They’re like one of the smallest amount of white blood cells are basophils. And these basophils go into our blood straight to our tissue. They become uhm—mast cells. And these mast cells will produce histamine, alright? So then you have this thing like called mast cell activation disorder. So like the more inflamed you become, right, the more your body tends to dysfunction. And—and you get more names for that kind of inflammation whether it’s IVD or IBS or mast cell activation disorder or some type of you know, allergic issue or some type of autoimmune issue. You can just go through all the different names. The more inflamed someone gets, the more symptoms. And basically diseases are nothing more than grouping a constellation of symptoms together. That’s why it’s funny when people tell me, “I just need a diagnosis.” Well, a diagnosis is nothing more than someone in the medical field taking a set of symptoms that have been, you know, trace for you know, many, many years into a disease name and someone studied and published. But it doesn’t do anything, it just basically groups these symptoms together and maybe there’s a drug for it, which is typically how a disease, you know, gets name because of the drug or treatment for the most part. But in the end, does it really help you fix the issue? A lot of times, “No”. But it gives people relief to know that it’s something, but again, if you’re depressed and you’re stuck on antidepressant your whole life, well, do you really feel good about that if you’re not fixing the issue? Maybe not.

Evan Brand: Right and I had a—I had a diagnosis of IBS, right?

Dr. Justin Marchegiani: Yes.

Evan Brand: We have no idea what’s going on but here’s some acid blockers I was never talked to about the root cause ever. So, for me, if you’re seeking a diagnosis, I would just let that attachment go because you really don’t need a term for the symptoms. We just need to figure out what’s going on. So, you mention the diet piece, we hit the gut piece, we hit the—

Dr. Justin Marchegiani: Adrenal and hormone deficiency, too, I think.

Evan Brand: Say that again.

Dr. Justin Marchegiani: We hit the adrenal and hormone piece, too.

Evan Brand: Yeah. Adrenals. That’s very important. So, how should we go about this? I mean, we’ve— we put all the pieces on the table, now how should we arrange this kinda step 1-2-3-4-5? Diet first?

Dr. Justin Marchegiani: So, off the bat, I would say, look at like kind of like your histamine bucket or your stress bucket. Everything goes in that bucket. Some people—it just sucks, they are brought into this world with the poor genetic constitution and their bucket’s smaller. What that means is they just can’t tolerate as much stuff. That means, hey, if they got a little bit of gluten and a little bit of stress, their bucket is full. Some people can have a lot more things. They could have some medications in there, some stress and sleep, some poor food, some nutrient deficiency, and then maybe their symptoms start to increase. Now, again, over time, we naturally have a smaller bucket overtime because our hormones become less restorative the older we get. So we just want to make sure that we know that theirs is bucket mindset and the more we take stressors out of the bucket, we can make a small bucket uhm— we can add more space to it. So someone that’s got a big bucket but is three quarters full, well, if we have a smaller bucket that’s a hundred percent empty, we may create more resiliency for us, even though our bucket, genetically, is smaller. So we have control. We’re not victims. We just got to be honest with ourselves. If we got a small bucket, we just gotta be on point more frequently. So, we do that by working on blood sugar stability, we do that with the baseline Paleo template, that you can work on customizing with your functional medicine doc regarding what that looks like macro wise and whether or not uhm—you have to add an extra digestive support to be able to breakdown the proteins and fats that’s important. Now we can look at the hormones, if there are significant hormone or adrenal issues, we gotta work on it because that helps improve our ability to regulate blood sugar inflammation and stress. And then, we also got to look at our hormones, too. We have significant hormonal imbalances, we have to work on supporting that so we can develop our healthier cycle or healthier anabolic hormones. We could put on muscle and recover. And then, of course, this goes without saying, gut issues. Coz if we have dysbiosis, leaky gut, we have chronic infections like H. pylori or Blasto or Crypto or Entamoeba histolytica or Giardia. Any of these parasites are gonna create leaky gut. They’re gonna create more nutrient deficiencies. And a lot of these nutrient deficiencies are needed to make healthy DAO or HNMT enzymes to break down histamine. And these enzymes, all these nutrients also help make healthy uh— nutrients for a detoxification system as well.

Evan Brand: Well said. So you got to get tested. That’s our philosophy—Test, don’t guess. I mean, you could probably fix maybe 50% of the issue just by working with a good nutritionist, their practitioners are gonna help you dial in the diet, right? Just getting that piece started even if you’re closer to an AIP approach, you are already gonna be eliminating a lot of the problematic foods including alcohol. So if you’re working with a nutritionist, you make it 50% there, but to get fully better, adrenals— test them, we’re gonna run the stool panel, we’re gonna look for infections that way. We’re gonna look for a lot of problems on the organic acids, too. Fungus, yeast Clostridium bacteria, uh— detox problems. I mean, all of that is a factor, so there’s never gonna be just one silver bullet. If somebody tries to sell you my online histamine course and there’s like one silver bullet they’re promoting, I would be skeptical because like any topic we discussed, there’s 20-30 maybe 50 factors that all need to be factored into that pie chart which is the pie chart being your problem. How is that problem broken down? Maybe it’s 50% adrenals for one person, but it could be 5% adrenals for another person. If they’ve got a super positive attitude about it, that could change things, too.

Dr. Justin Marchegiani: Exactly. So we fix the nervous system stimulation, the stress— that’s the diet and lifestyle,  that’s also the adrenals. We fix the gut bacterial imbalance, which could be infections, it could be just low beneficial bacteria. We cut out the high histamine foods. We cut out the histamine blocking, the DAO blocking foods: coffee tea etc. And we try to add lower histamine, paleo foods, in the meantime, which typically are gonna be uhm— low sugar fruits, the citrus-free, typically vegetables are gonna be okay, uh—typically fresh meats are gonna be okay. Healthy fats, maybe minus avocado, are gonna be okay. Uh— avoid the—you know, the aged meats and fermented foods for a period of time. But as we get the gut healed and we fix these issues, we should be able to get better and better and better. And then there also additional supplements we can add in as well. They can make a difference. So in my line, we use one called, Aller Clear, that I formulated that has things like, stinging nettles, it’s got promalin, potassium bicarb uh—these are things that have been used for a long time to help lower histamine naturally. Uhm— big big fan of that. Uhm—let’s see. What else can we do on top of that? I got my list here. Quercetin, like I mentioned, vitamin C, these are in Aller Clear as well to help lower histamine levels naturally. Well I also did a research on that. Grapefruit, seed extract and pycnogenol, which are in these kinda category of league Proantothocyanidin which are these kinda antioxidant bioflavonoid and some of these really good uhm—fruits that can be helpful. We have green tea. Again, it can be a natural antihistamine but can also be a DAO blocker so you got take that with a grain of salt. Uh—magnesium can also be very helpful, stinging nettle can helpful, omega-3 fatty acids uh—can be helpful, uh— some essential oils— peppermint, lavender, lemon can also be helpful. Again, but be careful because some of them are citrus there. You just got to test it out. And of course, a lot of the herbs to help knock down dysbiosis can help in the long run so like the berberines and the goldenseal can also be very helpful as well. So a lot of different alternatives there. Any other comments or concerns, Evan?

Evan Brand: Yeah. I’m guessing some of the medicinal mushrooms can help, too. I’m  not too familiar on the exact mechanism, but I’m assuming things like reishi, cordyceps mushrooms. I’m guessing those may help too depending on how they were grown, of course, uh—would probably make a difference modulating the immune system can be helpful.

Dr. Justin Marchegiani: Absolutely. Is there any other questions or comments you wanna add before we start hitting up some of our listeners questions. I don’t think so. Let’s hit the questions. I’m gonna pull them up, so I can see here, too.

Dr. Justin Marchegiani: Cool. And if you guys uhm—putting comments in the live chat  if you can kinda keep the questions kinda pertinent to the topic, it always helps and again, right now, for answering your question and you like it, give us a thumbs up right now, give us a share, give us a like. We appreciate it. We get really pumped and motivated coz of that.

Evan Brand: Should you—should you interview—uh, not interview—Should you introduce us, I mean I don’t know, maybe we’ve got new people that don’t even know who are these two guys talking about histamine all of a sudden. Should we briefly do that?

Dr. Justin Marchegiani: Yeah. Absolutely.

Evan Brand: Alright. Tell us who you are.

Dr. Justin Marchegiani: Well, I’m Dr. Justin Marchegiani, a functional medicine specialist, a functional medicine Doc and yeah, I see patients all over the world and we work on chronic health issues, from hormone to gut, to detox autoimmune issues and you know, we’re trying to always get to the root cause so that’s me.

Evan Brand: Absolutely.  I’m Evan Brand, functional medicine practitioner and Justin and I been doing this— doing this hustle on the podcast for— for several years. We’ve got hundreds of episodes together and I also work virtually with people via Skype and phone. And we do the live thing because we get comments like this, so let’ dive in.

Dr. Justin Marchegiani: And we’re the real deal. We don’t get a script here. We’re, we’re on-the-fly taking our clinical knowledge and plugging it into you guys, so you guys, the listeners can get healthier which—which is our purpose here.

Evan Brand: Yup.

Dr. Justin Marchegiani: So off the bat, couple things, uhm— I just saw here, Dale made a comment here about toxic mold. So yeah, I’ll connect Dale’s comment to toxic mold. But yeah, mold can definitely be a stressor that can fill up that histamine bucket.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So of course, things that we use to help with mold is number one: good quality or filtration. If the house is really bad with mold, we got to get that remediated maybe even move depending on how bad it is. I never have someone move unless they can—they leave the house for a week or two and they’re like, “Oh my God, all of my issues got so much better!” And again, we gotta be careful because if you’re leaving for a week or two, it may be a vacation where you’re not –

Evan Brand: Yeah.

Dr. Justin Marchegiani: We gotta kinda like control those variables. Maybe you get a hotel room or you go somewhere else and you work outside of the house for a week. But if you notice significant improvement, there could be a mold issue. So air filtration can be good uh—do that little one to two-week test that I mentioned and binders such as modified citrus pectin, zeolite activated charcoal, liposomal glutathione these are all great things to use. A lot of the nutrients to help improve phase I and phase II detoxification. So, in my line, we use Liver Supreme or  antioxidant uhm— Antioxidant Supreme or  we’ll do Detox Aminos. which have a lot of those phase I and phase 2 nutrients. That’s very helpful there.

Evan Brand: Good. I just wanna double comment on that with the recent hurricanes that have hit people in Florida, Georgia, Texas, all the other states affected this mold issue is probably gonna be a lot bigger. A lot of people will probably try to remediate their old mold. Uh—one of my wife’s friend down in Texas posted a picture of her car, they got flooded in Houston. Her entire car, I believe it was leather, may be a fake leather, her entire car was covered in mold that look like a lab experiment, so—

Dr. Justin Marchegiani: Oh my gosh! Sounds terrible.

Evan Brand: So if there’s mold there, please please please don’t try to mitigate that stuff unless you’ve got like proper mask and all that coz you can make yourself sick.

Dr. Justin Marchegiani:  Totally. Couple of questions here. “What are the best herbs for parasites?” Again, I would go look at some of our parasite podcast, we dive into it. Again, in my line, we have GI Clear 1-6 that we use for herbs uhm—to help knock down these infections. Evan has some similar ones in his line as well. So you can check out either Evan site, evanbrand.com or mine at justinhealth.com for more information on that by clicking on the store button.

Evan Brand: Yeah. I’ll hit the second part of the question there. “Are herbs usually enough to beat up parasites?” The answer is, “Yes” We do not prescribe drugs herbs is what we use for bugs and yes bacteria fungus, yeast, parasites. With the right protocol, the right approach, all the other factors, yes, you can successfully get rid of it. I’m a success story. Justin is a success story.

Dr. Justin Marchegiani: Yeah.

Evan Brand: And you know, thousands of people in our belts that we’ve been able to successfully eradicate parasites with herbs.

Dr. Justin Marchegiani: And just to highlight one thing, I think you put in there, but just to make sure any new listeners don’t assume it, we’re also factoring in diet and lifestyle changes into that because that is a massive effect on changing and making the immune system more resilient which has a huge effect on decreasing the chance of reinfection, too.

Evan Brand: Yup, well said, well said. Yeah, you can just take one magic pills, you got to do the hard work, too, which is putting a fork to your plate with good food on it, is organic as much as possible.

Dr. Justin Marchegiani: Totally. 100%. And then, again, some people here talking about H. pylori and SIBO and eradicating H. pylori, uh—they still have stomach issues. So I’ll connect this persons question to the issue. But if you have SIBO and H. Pylori, does that go into your histamine bucket? Yes. So these type of critters and infections can increase that histamine bucket which can create more histamine reactions like Evan and I talked earlier and the breathing issues and the burping constantly, yep. Those are all symptoms of that and that can drive histamine problem. So we got to get to the cause of those infections and again, I refer you back to our H. pylori or SIBO podcast where we spent a full hour talking about that one topic.

Evan Brand: Yup. Well said. Get that test to get that treated. Rosalin, she has itchy skin, scalp. “Is that a symptom of too much histamine in the body always itchy?” What would you say? Sounds like probably.

Dr. Justin Marchegiani:  It could be a histamine issue, it could also be just a fungal issue, too. Seborrheic dermatitis is what affects scalp like that or a.k.a. dandruff and that can be fungal in nature. So I would just look at just the whole gut biome imbalance and/or histamine as a byproduct of that, right? Remember I gave you the a hammer and the thumb analogy, right? The— the histamine is just the collateral damage caused by the— the hammer, right? That’s kinda the whole idea. But, yes, it could definitely be— be part of it but more than likely, not the whole thing.

Evan Brand: Yeah. Kelly had a question, “Thoughts on the Biome test worth the money?” So Biome is a pretty new company who’s running stool testing. I met the guy who created the test. I’ve had a few clients who’ve had that run and they sent it to me. And the readout is— is terrible. I hope they improve on it, but currently, I’ve had a few clients send me their readouts, it’s crap. There’s a bunch of information but there’s no real action.

Dr. Justin Marchegiani:  Not  actionable, right?

Evan Brand: Yeah. It’s not actionable at all. It’s just too much data. So, Kelly, I do not use and Justin. Neither of us use the Biome test. We use more functional test that are available through practitioners. Which I like the idea Biome give people the power to get their own testing, but we still are gonna use other companies like the G.I. MAP on our clients.

Dr. Justin Marchegiani:  Exactly. But the biggest issue is like you get companies that are trying to give you like more information, they’re trying to like dazzle you with all this information, but then you sit back and you’re like, “What the hell can I actually do with it?”

Evan Brand: Yup.

Dr. Justin Marchegiani: What lifestyle change? What diet change? What supplement? What can I eradicate? What can I support or balance based on this information that will help the patient get better? That’s always the question. And the second question is, well does this test allow me to leverage my patient to make an action to allow them to get healthier? And if I don’t get one or two—if I don’t get an answer for one, primarily maybe two, then it just—it becomes not worth it. Kind of you know, glittery, you know, it’s very like, it’s kinda like glittery and flashy and like, “Ooh, look at this!” but it doesn’t really do much to me.

Evan: Yup. Should we get James’ question.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Yeah. So James put friends nine-year-old sons on a new drug, which I looked it up here, Spinraza for spinal muscular atrophy. And it’s a brand-new drug looks like December 2016, it was the first drug approved for this disorder. Now  he’s having swollen lips and hives. Any suggestions will DAO help enzymes? That’s a hard one. Coz who knows if that’s a side effect of the drug or is that some type histamine issue.

Dr. Justin Marchegiani: Yeah. Number one, the kids—Again I don’t know enough about this patient. So this is, take it with a grain of salt, this is a medical—medical uh—you know, uhm—advice. This is just me kinda talking here. So off the bat, kids notoriously have the worst, freaking diets in the world, okay? Especially if they go to school and they’re eating the school lunch and they trade in with their kids. They eat like crap. So number one, clean up the diet. And again, it’s hard because if you’re a parent who’s not eating healthy then it’s your house is full of crap. So first thing is the parent, get all the crap out of your house, create a really good environment, have really healthy snacks, get all of the crap out. So  get on the Paleo template to start. Do that for at least a few weeks to a month. That may fix so many of the issues, but in the meantime, yeah, can you had add  in enzymes like DAO can maybe hard to get them, but can you add in regular digestive enzymes and HCl, yes. Can you add in things like stinging nettle and bromolein and an acetylcysteine and all of the nutrients that I mentioned, yes, you can. So I would definitely add in all those histamine nutrients. Uhm— I would try maybe be going lower histamine, kind of a Paleo template and really get the diet a hundred percent and make sure they’re able to digest their food. HCl enzymes, all of those really good things and that’s a great starting point and then from there, if that still not helping, our only getting part of the way there, you want to really get a functional medicine doc to look deeper at what’s happening with the gut and things.

Evan Brand: Yeah. Well said. That was what—my next thing I was gonna say I’ve seen uh— little girls as young as three and little boys four, five years old with massive gut infections, parasites, and H. pylori and the rest of it. So it’s very possible that that’s going on in the gut depending on the history and use of antibiotics in the kid and things like that.

Dr. Justin Marchegiani: Exactly. Patient here— my w— My mom has been diagnosed with lichen sclerosis, that’s an autoimmune condition that affects the skin. I’ve seen a handful of patients after that cream after cream the probably referring to hydrocortisone, a corticosteroid cream. It gets worse, any tips regarding the root cause of this? Yes. Autoimmune. Get the autoimmune stuff dialed in. I’ll use some stem cell types of creams like J Bio Serum, it’s one of the nice sell that I sell it works great. It’s got some stem cells in it, but you gotta make the diet and lifestyle change. Autoimmune template to start with and then dig in with all the functional medicine principles, next. One of the symptoms of histamine tolerance all the things that we mentioned earlier, from swelling to flushing to headaches to rashes. Anything you wanna add there, Evan?

Evan Brand: Yeah. Fast pulse or a rapid heartbeat. I’ve had women say they eat the food and then their heart starts racing. So could be mood issues, could be physical changes as well.

Dr. Justin Marchegiani: Yeah. And the best way to test for histamine issues, in my opinion, is I just look at people symptoms and I connect them to higher histamine foods and we just pull those foods down a little bit and if their symptoms get better, then we know. I think for me the telltale sign for histamine issues, fermented foods and citrus fruits.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Those are the big telltale for me. Coz they’re relatively healthy foods. No one’s gonna say like, “Oh, eating a grapefruit is bad.” You know having some low sugar Kombucha or you know some sauerkraut is bad. It’s relatively good but if you’re –if we’re doing that history and we see symptoms of those food, then we’re like, “Ooh, there probably is a histamine issue.”

Evan Brand: Yeah. Well said. See, what else we got here. I’ll read a couple off here for you. “Does everyone have some degree of histamine tolerance, don’t think I have histamine problems but not sure.” Well, if you say everyone— the average person is very unhealthy. Autoimmune diseases ramp it, the standard American diet which is the same in Australia, the same in Europe, the same and most developed countries are following kind of a standard American diet— processed grains, sugars, conventional pasteurized dairy, meats that are not organic, they contain hormones and antibiotics. So, yes, most of people are taking Ibuprofen and over-the-counter drugs, they’re taking steroids and doing in antibiotics. They’re getting them in the diet. They’re doing acid blocking drugs, they’re not sleeping well, they’re addicted to their smart phones. So, yes, so many people have things in their bucket. Then, yes, I would say everyone has a degree. Now, kind of our tribe that Justin and I are building of you know, healthy people that are doing as many right things as possible, they’re probably gonna have a less risk of—of histamine intolerance.

Dr. Justin Marchegiani:  Totally. Hundred percent. Makes sense. And how about the bone broth stuff? I mean, I see, you know, I see uhm— lots of people with issue with bone broth and it kinda falls in and around the fermented food issue, right? If you’re having issues fermented foods or things that are slowly cooked, like bone broth, that can increase histamine and that can create a problems. So, again, we may hold off on the bone broth or cook it in a way where it’s cooked shorter. What kind of preparations for bone broth do you do to help lessen it? I know there are some out there.

Evan Brand: Well, I’m spoiled. I haven’t been making it because I’ve been using Kettle & Fire Bone broth that they sent me, so I literally does have to throw it in a in a pot and heat it up. I’ve been fine. I know they slow simmer or slow cook theirs for like 48 something hours like it’s an extremely long simmer time. So I don’t know how that would affect somebody that they were sensitive. But for me, I feel quite well with that. I don’t have any symptoms.

Dr. Justin Marchegiani: Yeah.

Evan Brand: I don’t know. I haven’t had to modified it at all.

Dr. Justin Marchegiani: Yeah. So a couple, you can skim off the scum of the top of the bone broth. You can skim that out. Uh—it may be helpful, you can also do just the shorter brew maybe an 8-12 hour one. Uhm—that can be good. You can also just try buying some maybe your higher-quality or they may have a way of you know, producing it that produces low histamine like the Kettle & Fire. So that could be some good options. But again, if you have a food that we consider to be healthy like bone broth or Kombucha or fermented foods and you can’t respond to it, you can always put that food aside. That’s kind of like that’s like you’re free-histamine test, right?

Evan Brand: Yup.

Dr. Justin Marchegiani: So you can work on the gut. You can work on a lot of these hormone and diet things. And then you can add that thing as your free test add back in the future and that’s a good objective marker to see how you’re doing with your gut. And if it’s starting to heal, you may be able to handle more of that yet.

Evan Brand: Yup. Well said.

Dr. Justin Marchegiani: I believe my link should still be active Kettle & Fire sponsored my show for a while. They’re not anymore but they should still be giving people 20% discount so you can try it. If you do, evanbrand.com/chicken you should be able to get 20% off— so try it out. I think they pay me like a buck if you buy some, but that’s good bone broth and definitely—

Dr. Justin Marchegiani: We’ll support the cause. I know the products—only products that we ever mentioned on our shows are things you believe in. So again, you guys gotta know that we’re coming from a place of authenticity. So if you want to support us and we reference something, just know that it’s got to go to the filter of actually being a high-quality product and we actually have to use it on ourselves and our friends and family for us to recommend it.

Evan Brand: Yup.

Dr. Justin Marchegiani: We appreciate that support.

Evan Brand: Another question here. “What herbs do you suggest for fungal issues?” Once again, I’m gonna say it depends. And I know Justin would say the same thing because we’re gonna make our protocols based on what you’re up against. So if it’s bacteria plus fungus plus yeast plus parasite, that’s gonna be far far more heavy hitting protocol. If it’s just fungus by itself, which is not too common, because most people have a lot of issues together, you may be able to get away with some garlic or some oregano or like Justin mentioned earlier, Berberi or the barberry or the—

 Dr. Justin Marchegiani: Yup. Berberines.

Evan Brand: Berberines. That whole can be great and we’ve got several formulas if you just stalk our stores a bit look on justinhealth and look into his categories and you can check out mine, too. We’ve got many, many different combinations of herbs. Could you go and technically just buy a couple herbs and just you know, shoot a shotgun approach and maybe get success, yes. But I would of course, advise you to get tested because if you have fungal issues, you probably have other issues, too.

Dr. Justin Marchegiani: Yeah. And here’s one like clinical pearl that I’ve kinda find over the years. I’ll throw it out there for everyone listening. How I know fungal issues are more of an issue for— for some people than others, is number one, we’ll see the fungus on a stool test, which will be helpful. We can see either multiple kinds of yeast or fungus where it’s Geotrichum, Microsporidia, Candida, etc. We’ll see different kinds of species. But also on a organic acid test, we’ll see the uhm— D-arabinose, which is a metabolite of Candida but that also kinda means it’s gone systemic. It’s gone more more systemic coming up the urine. So if we see something like the D-arabinose is more of a systemic marker in the urine and we see in the gut, then we know that fungal issue is—is a lot deeper. Now a lot of fungal issues tend to be driven by other issues like H. pylori, other parasites are bigger but some people just gonna have a rip-roaring fungal infection. We’ll see it systemically via the organics as well as on the gut, too.

Evan Brand: Let me ask you this. I mean let’s say you see somebody with a really, really gross fungus fingernail like it look like their fingernails about to falloff because it’s so infected. Would you assume that person has got a massive amount of fungus in the gut and it’s manifesting on the nail on the—on the fingernail?

Dr. Justin Marchegiani: To a certain degree, I would say that’s a good, you know, you can’t hurt yourself faulting that, coming to that conclusion. But again, if you knock out some gut stuff, it can be hard for those herbs and for your immune system to get all the weight at that peripheral tip of that nail to knock out the infection. So sometimes we got topically hit things coz they just got to travel a long way so we’ll either topically hit our herbs there or we’ll uhm—have to do some kind of a soak to hit it as well. Even if we were to address the gut, it may not be enough to make its way down there.

Evan Brand: Coz I’ve seen that. I remember it was a cashier or somewhere, I saw a guy with his finger like his index finger, the nail was literally about the come off and it was completely—

Dr. Justin Marchegiani: There are different degrees, right? There’s like, “Oh, I had a slight fungal nail and I knocked it out with some oregano and a soak and just a few—in a few weeks.” There’s somewhere it’s like nail is incredibly like sclerotic and—

Evan Brand: It was extreme, yeah.

Dr. Justin Marchegiani: Almost falling off and then like totally dis_ that’s like the highest degree. I mean it’s just like, “Oh, it’s a little bit rough and then it’s got a slight yellowish hue.”

Evan Brand: No. I’m talking when it was like—it look like if you flicked it, it would fly off.

Dr. Justin Marchegiani: That’s one of the extreme.  And then the other extreme is maybe– is a light, it’s kinda like a little bit sclerotic like it’s rough.

Evan Brand: Yeah.

Dr. Justin Marchegiani: And if you were to file it, it would get smooth but it would grow out of the bottom again rough. That’s how you know it’s fungal. And typically it’s slightly yellowed. And again, it can go really dark and brown, like dark yellow brown the longer it’s there.

Evan Brand: So what is that? When is that extreme? I mean how in the world would that happen? What sets the stage for that since we talked about—

Dr. Justin Marchegiani: Just chronicity. It’s just deeper and deeper and deeper and deeper into that nail bed.

Evan Brand: Yeah. Wow! Last question here: “What does it mean if a rash shows up only on the legs and not other parts of the body?”

Dr. Justin Marchegiani:  I have no idea. Uhm—again typically the body’s just gonna push stuff out. And again, if things are in the body systemically, where or why the body pushes it out there, beats me. Maybe that’s a stronger area for the body to push it out, hard to say. Again, as things get worse and worse, problems tend to be more systemic, so I wouldn’t worry about why it’s there. Uh the fact that it’s in a local spot is better. I would just want to make sure there’s nothing constant— contact dermatitis issue where things are in contact in that spot. And when nothing is contacting, I wouldn’t worry about it. We’re treating the body systemically as a whole. We’re really work on lymphatics and the detox so everything will get better.

Evan Brand: Yeah. Well said. And I mean—in a rash in the leg, that could be so generic. I mean, that could be something from your skincare products. That could literally be allergy to parabens or something. My wife—

Dr. Justin Marchegiani: A contact dermatitis issue where something is actually touching it.

Evan Brand: Right. Yeah. My wife she had a reaction on her legs and it had nothing to do with diet or histamine or anything. It was just uh—uh she had a sample of the skincare product and it must had some ingredient in it that we didn’t know about and she had a rash on her leg. So don’t—maybe don’t freak out, don’t think too deeply. It could be something that simple.

Dr. Justin Marchegiani: Yeah. And my baby just had some baby acne. My wife is freaking about it a little bit. But it’s just you know, he’s just metabolizing her hormones. So he’s getting over it pretty fast uh— which is good. But again, things happen and if it’s a contact issue like control all the vectors of what’s going on your skin. And then second is like, what’s in your body and just try to decrease inflammation.

Evan Brand: Yup. We got uh—you got time for one or two more?

Dr. Justin Marchegiani: Sure. Let’s do it.

Evan Brand: Alright. James he said, he’s not allergic to nuts and seeds but every time he eats peanut butter, he always gets a fungal rash around his glute region.

Dr. Justin Marchegiani: Don’t touch peanut butter, man. I mean it’s known to be higher in aflatoxin, it’s a legume as well. So that could be some gut-irritating stuff in it. Stay away from that. Switch over to high-quality almond butter instead and let us know how that works.

Evan Brand: Yeah. There’s a brand I use—what is it? Cadia. C-A-D-I-A. It’s like the only organic almond butter I found that’s less than 20 bucks a jar.

Dr. Justin Marchegiani: I actually created my own brand called Justin’s. You’ve seen that brand at Whole Foods?

Evan Brand: I did. Good job!

Dr. Justin Marchegiani: Nah, I’m just kidding. It’s convenient to say it, but, no. Not my brand.

 I won’t take credit for it. But I do like Justin’s. Uh—I will do that a little bit sometimes. And I do like just the whole food 365. I’ll get the organic. It’s also a cool one. Its’ really expensive! It’s called, NuttZo, in an upside down container so like the lid is on the  bottom and it’s upside down kinda thing. That’s kinda cool. Really expensive, but it’s really a nice treat.

Evan Brand: Here’s another question. Uh—little bit off-subject. How is holy basil an adaptogen for stress?” Uh—we’ve done—I could go so long on this.

Dr. Justin Marchegiani: Yeah.

Evan Brand: That I’ll have to shut myself up right now. You just have to check out our other episodes on adaptogens  because I love them and Holy basil, __rhodiola, ashwagandha, all the ones you mentioned.

Dr. Justin Marchegiani: Good.

Evan Brand: We do use all those. They’re great.

Dr. Justin Marchegiani: Yup. I think it’s good. It’s good to kinda rotate through some or use a combination to use them individually and have a rotation to it. I think that’s great. Evan Brand: Yeah. “Is water sounding in ears related to histamine?”

Dr. Justin Marchegiani: The first thing I would look at are just food allergens in general. Uh– especially mucus-producing food, so like dairy and things coz anytime you get more mucus that could go in the ear and that can create issues. Just gluten and inflammatory foods to begin with. So, yeah. Definitely kinda hit that overall  Paleo template, you’ll hit a lot of those things out.

Evan Brand: I think that’s it. We should probably wrap it up. We’re gonna turn into a pumpkin here.

Dr. Justin Marchegiani: I know.

Evan Brand: If there’s any last questions please ask us.

Dr. Justin Marchegiani: How much salt did you ingest for every liter of water you drink replenish lost—I mean, I would just do half a teaspoon to a teaspoon twice a day of high quality mineral base salt. So like my favorites, Real Salt, or you can do Celtic, or Himalayan, just really good minerals that you’re gonna put back into your body. I like that.

Evan Brand: Yeah. I saw a new study about sea salt. I posted it up—I think I put it up on my twitter account where all the sea salt from US and Europe was contaminated with micro particles of plastic and so I’d support your idea of using the real salt which is gonna be an inland sea as opposed to the ocean sea salt that’s contaminated. Dr. J, do you think Tom Brady is on a low histamine diet?

Dr. Justin Marchegiani: Well, let’s breakdown Tom Brady’s diet. He’s eats 20% meat. There’s a lot of means out there. If Tom Brady goes vegan, no—you’re not vegan if 20% of what you eat is meat—not even close. But, as a qualifier there his meats are organic and grass-fed, so there’s really good quality meats. He avoids nightshades, tomatoes, potatoes, eggplants, peppers. He eats lots of vegetables. He eats very little starch. He eats a little bit of fruit. So I would say relatively speaking, yeah. I mean, his kinda thing is, “Oh, I’m eating acid alkaline kinda thing”, right? That may be the result of—that may be what he thinks he’s doing, but my thing is he’s really just doing an anti-inflammatory diet.

Evan Brand: Yup.

Dr. Justin Marchegiani: I’m not worried about acid alkaline. If he is worrying about so being alkaline a hundred percent, he’d avoid the meat, right? But we know that meat has a lot of important nutrients and it’s balance the meat with a lot of the veggies that are very alkaline. I don’t worry about that so much. Most of the acid your body’s gonna get is from inflammation. Inflammation is like 1000 times more acidic than actually eating an acid-base food. So I’m more worried about the food’s inflammatory qualities that I am about whether it’s acid or alkaline. But, again, grains are 10 times more acidic than meat. So if I can leverage that conversation or that idea with the patient, I’ll say, “Hey, if you really wanna be more alkaline, at least meat’s 10 times less acidic than grains.

Evan Brand: Well said.

Dr. Justin Marchegiani: I would think he would be indirectly not his goal but again, anyone that’s on anti-inflammatory diet indirectly, would be lower histamine outside it may be citrus and fermented foods and such.

Evan Brand: Yup. Well said. Well, we’ll wrap this thing up. We hope you enjoy it. If you have more questions, more ideas, more things that you want to hear us cover in terms of topics, reach out. We both got contact forms on our website. Send as an email.

Dr. Justin Marchegiani: Subscribe. We appreciate it. Give us a share, give us a thumbs up.

Evan Brand: Yeah. Justin— Justin’s over 30,000 on the YouTube, man. So great job! Keep it up. Hit the subscribe button so that we can keep pushing up this content in helping you guys achieve the most optimal health on the planet to help us get more people healthy we really appreciate health on the planet.

Dr. Justin Marchegiani: Help us get more people healthy. We really appreciate it. Healthy people make healthy decisions. They’re better parents, they’re better employees they’re better bosses, they’re better everything, so—

Evan Brand: Yeah. I saw Mark Hyman he was talking about autoimmunity and how it’s twice or even up to 10 times more expensive to take care of a sick patient with autoimmune disease and so we guys want you to be healthy because to save our population from collapsing. We’re kind of in the midst of healthcare collapse. Basically, the health of society falling apart. We’re trying to make a healthy dent in the universe by helping you guys. So thanks for the feedback. It means a lot to us.

Dr. Justin Marchegiani: Love it, Evan. Alright, man. Great chat today. I appreciate it.

Evan Brand: Take care. Bye.

Dr. Justin Marchegiani: You too, take care.


















Sinus and ear infection solutions – Podcast #133

Dr. Justin Marchegiani and Evan Brand plunge into a discussion about ear and sinus infections and how nutrition either boosts our immune system or makes our bodies susceptible to infections. Be well informed about the products and natural solutions they have used in successful treatment of infections they have encountered with young ones and adult patients, too.

If you have kids, pregnant, breast feeding or planning to breast feed, listen very well and get loads of beneficial information regarding the importance of breast milk, high-quality and nutritious diet, as well as supplements for the mom that may affect the babies in relation to infections. Also, learn more about recent research in antibiotic use and its possible negative effects in our ability to fight off infections.


In this episode, we cover:

02:47      Ear Infections

06:23      Antibiotics and its side-effects

10:26      Nutrition and the importance of breast milk

13:22      Allergies

18:26      Natural Solutions & Product Recommendations








Dr. Justin Marchegiani: And we’re back. We’re live on YouTube and Facebook. Evan, how we doing today, man?

Evan Brand: Hey, what is going on? Good old technology.

Dr. Justin Marchegiani: I know. Excellent. I guess you got the memo. It’s the uh—blue polo day.

Evan Brand: Yes, sir. Happy Friday.

Dr. Justin Marchegiani: I love it.   A little—I got my Lulu lemon on. We gotta get them as the show sponsor of our clothes.

Evan Brand: I agree. That will be a great sponsor.

Dr. Justin Marchegiani: You gave me that idea the other day. So I like that. I’m gonna jump on board with it.

Evan Brand: Yes. So this idea we’re—we’re gonna discuss today, we’re gonna discuss some allergy issues, sinuses, ear infections, which a lot of this could apply to children, but adults, too. I mean this is something we deal with all the time, we hear about all the time.

Dr. Justin Marchegiani: Totally.

Evan Brand: A lot of fear mongering all the time about ear infections and that’s one of the most common reasons that children are getting put on antibiotics. That’s like their first exposure to antibiotics as they get an ear infection. So we should dive in. This is gonna be fun.

Dr. Justin Marchegiani: 100%. So if you’re listening on Facebook, I’m gonna pin down a link so you can access the video on YouTube live. Coz YouTube live is where we’re gonna have the back and forth until we get the Facebook setup. So Evan, how’s your day going, man? It’s Friday morning. I’m really excited.

Evan Brand: It’s great. I’ve got the window open. It’s gonna be 80° today, the birds are chirping, the grass is green and growing. I can’t complain.

Dr. Justin Marchegiani: I love it. Oh by the way, I have an awesome announcement for uh—just for me, and you, an the listeners. My wife and I will be expecting our first baby this fall. So we are super excited. It’s a boy, too, so—

Evan Brand: That is awesome.

Dr. Justin Marchegiani: Hence why I’m wearing the blue today. The baby blues.

Evan Brand: Love it, man. Congrats.

Dr. Justin Marchegiani: Thank you. Excellent. Well, what did you have for breakfast, Evan ?

Evan Brand: Did I eat today? Yeah. I ate. I had bison jerky and some matcha tea.

Dr. Justin Marchegiani: Matcha. Love it.

Evan Brand: That was it. Actually, I just finished out the Matcha and now I’ve got some vitamin C here. I’m drinking about 3 g of vitamin C with some good clean water and that’s it. I was gonna do some berries this morning. My wife got some blackberries yesterday but I decided against it. Just went with the bison jerky, so I’m probably in a slightly ketotic state right now, which I feel pretty good and my brain is working.

Dr. Justin Marchegiani: That’s excellent, man. Very, very good.

Evan Brand: How about you?

Dr. Justin Marchegiani: Today I had some high-quality coffee with some butter and some MCT. I put about 10 or 20 g of collagen in it. And after the podcast today, I’m gonna make a nice little uh— green drink. Add a little MCT to that. You know, some fresh organic, green vegetables, maybe a little carrot to sweeten it up. And add some more collagen onto that just so I have some good fats and good protein and some good uh—micronutrients. So really, really excited there.

Evan Brand: Sound good, man. Sounds good.

Dr. Justin Marchegiani: Well, let’s dig in. We talked about yesterday, kinda in our—pre set up for the podcast about talking about sinus and ear infections. The natural solutions we can do to help address sinus and ear infections. So what do you think about that?

Evan Brand: Totally. Yeah. Let’s hit it. Like I mentioned in the beginning. Ear infections are gonna be the common reason that kids and children are gonna be put on antibiotics. A lot of times, ear infections are preventable which we can talk about because food allergies are gonna be one of the most common causes that you can modify. And so, we can talk about the influence of dairy, your sugar, your fruit juices, your grains, your gluten, your sodas. I mean all these things are impacting your immune system that can set you up for potential ear infections. And honestly, a lot of children that you and I work with, likely have tubes put in because the doctor fear mongers them and there’s actually no evidence that ear tubes actually even work that much. Mercola has got a great of studies about this showing that, in the short term, the ear tubes, they get put in, can reduce the time with the middle ear infection. But it in the long term, there is no longer benefit of tubes. And so, you know, when I quote one of the studies here, “The said tubes and watchful waiting does not differ in terms of language, cognitive, or academic outcomes.” Basically they don’t do much. And a lot of times—what about the adenoids, too. I mean a lot of people get their adenoid removed for these things. That seems a bit extreme.

Dr. Justin Marchegiani: Yeah. And I can speak from personal experience because I tubes many, many times. I had chronic ear infection that the child. Now here’s kinda the vicious cycle, right? Because we talked about—And we’ll put here, we have some really good studies that we’re gonna put down below. Looking at the microbiome connection. That’s kinda the gut microbiota and its connection with healthy ears, right? Healthy ear, flora health, right? So if we have ear infections, because of other reason which we’ll go into, and then we start taking antibiotics for those ear infections, that then disrupts the microflora. And that creates further imbalance that will perpetuate more and more frequent ear infections down the road. So you see the vicious cycle that conventional medicine really throws down is they’re not addressing the root cause of why these things happen in the first place. And then they give medication that actually works to treat the symptoms in the short run. But then actually perpetuate a need for more of that intervention and more of these problems. And then I can’t tell you how many patients— patients that I see that have been on more antibiotics throughout their life tend to be sicker and have—they’re the hardest to work with because of chronic gut infections, chronic gut inflammation and extreme food sensitivity because their gut microflora is so screwed up. So we really want to mitigate the use of antibiotics only to like absolutely must-haves. Now, if I go back in time and look at the things that drove me to have all the ear infections, gluten and dairy was huge. And part of the being reason why is I think that it affects the microflora, it creates more of an inflammatory environment but it also is gonna affect lympha—lymphatics. Coz I remember my ears always feeling like there was crap in it. Like I would like go swab it when I was younger and there’s gonna be so much junk in it. And my ears always felt full. So I do believe the research show some lymphatic increases when these inflammatory foods are there. So to live with all this fluid that interplay between the tissue and the blood, and the more sluggish that is, right? The more viscous that gets, that can create the ability for these—for that stuff to hang out longer and potentially perpetuate uh— infections. So making sure those foods are out. Go ahead, Evan.

Evan Brand: Yeah. So before we get into the functional approach to all of this, you know, we should talk about some of the side effects. So you mention what happens with antibiotics and now there is research that shows that antibiotics cause permanent damage to the DNA. So this is not something benign where you’re on the antibiotic for 4 or 6 or 8 weeks or even like a 7-day pack. This is lifetime impact. And I think we should probably add the question to our intake form when we’re working with our new clients. How many rounds of antibiotics have you—

Dr. Justin Marchegiani: Already on my intake form.

Evan Brand: Over—over your lifetime, though. I mean, yeah, a lot of times I’ve had people people would not even have a count because it could be in the dozens of times. I uh— typically like every 2 to 3 years, like what’s the last two to three year history of antibiotics? But I feel like we should almost say over the life, how many have you had?

Dr. Justin Marchegiani: I have that exact question on mind. I have one patient like a month or two ago, they said between 0 and 5 years of age, they had 120 antibiotic prescriptions.

Evan Brand: Oh my god.

Dr. Justin Marchegiani: Like you gotta be kidding me.

Evan Brand: That’s—that’s. I mean they are passed out like they are

Skittles, which is unfortunate now. Now, let’s talk about side effects. I mean if you are getting tubes, for example, then you could potentially have hearing loss from that.

Dr. Justin Marchegiani: Totally.

Evan Brand: I’ve read about some cases of hearing loss, you’ve got calcification of the tissue in the middle ear, and then also getting the, adenoids removed which I don’t know why, but the they—they always tell, “let’s go ahead, remove your adenoids, too as we put in these tubes.” And then—I mean, you’ve got risk of hemorrhage, you’ve got bleeding issues, you’ve got potential infection sites that could pop out where you got the surgery removed. I mean, it’s just crazy. My wife when she was a nanny down in Austin, the kids that she was a nanny for, everyday, literally if the kids were fussy, the mom would say, “Hey, if ever they get fuzzy, just give them Ibuprofen or Tylenol and Motrin—

Dr. Justin Marchegiani: Terrible.

Evan Brand: Or give them– And just because they’re fussy. And a lot of times, she said, “I would try to not give them the dose. I would act like I’m dozing them the medication.” But my wife knew what it was doing to their guts. And, of course, these kids get sick, they get up on antibiotics then both kids had tubes, then both kids had their adenoid surgery. It’s just crazy. So, yeah. Let’s talk about diet. I mean you hit on gluten and dairy, food intolerance is gonna be huge, and also, for me a big one is gonna be—which if you’re an adult now, it’s too late. But whether you were breastfed, or whether you are formula-fed because breast milk is like the most ultimate super food ever.

Dr. Justin Marchegiani: Absolutely. So you hit a couple of things that I wanna backtrack on for the listeners. You mentioned the adenoids. And the adenoids and the tonsils are the first vessel for the lymphatic system to come in contact with—with our environment. So the adenoids are kinda like in the upper sinus back area, where the tonsils are in the back of the throat. So it’s like tonsils – adenoids. And they’re that first— first vessel for the lymphatic system. And that lymph is designed—think of it as like the fit—the air filter in your house, or the filter in your pool. It’s really designed to pull out a lot of that crud. Now the thing is, if we’re constantly driving a ton of inflammation, and a ton of crud’s going in there, it’s like getting a smoker in your house. What’s your air filter gonna look like in a couple of weeks? couple of month? It’s gonna be black. Now what’s gonna happen when that air filter gets so clogged that the pressure is increasing and now the HVAC and the heater has to work so hard now the heater is heating up, i.e. were having infections, right? Well, guess what conventional medicine would do? They would say, “Let’s just pull out the air filter and put a new one.” Right? But in—in the real world, example, right? When you pull the tonsils out and the adenoids out it’s gone. You don’t put a new one in, right? So it’s like, “Let’s just pull out the air filter and leave nothing there.” Because now nothing get’s clogged, right? But holistically and functional medicine-wise we say, “Hey! You’re smoking at my house, get the hell out, right? You’re clogging out my filter! Get out of here! Right? That’s kind of the solution. Now the smoke is coming from the smoker in your house but in a real world example, it’s coming from a lot of the foods—uh— especially refined sugar, it’s coming from refined dairy, it’s coming from gluten, of course, and obviously getting, you know, lack of breast milk is going to be huge. I did not get a chance to have breast milk that long as a child, alright? Did not. Only a couple of weeks. It’s kind of like that thing I really wish I could go back in time, and like, “Mom you need to breast-feed me longer.” She said, “Look I didn’t want it, whatever.” I’m a baby. I didn’t know any better. C’mon. But in general, that’s what I would’ve wanted to have happen. But the breast milk is a big thing, right? Having that breast milk, for at least that for six months minimum a year, World Health Organization says, 18 months. I try to at least get all my patients to do a year. That’s super, super important for starting the cascade of good microbiome health and thus, affecting the ear, too.

Evan Brand: Yeah. Now if you’re an adult and like myself, too, I was formula fed for most of my baby years. I mean there’s nothing we can do now but to work forwards. So this is involved – this is getting the testing run now. So if you’re an adult, and you’ve had ear infections, or you had your tubes in, or you had the adenoids removed, well, you—you gotta get yourself tested because 9 out of every 10 clients that we test, we’re gonna find some type of issue in the gut. And this is bacterial in nature, which could be for previous antibiotic use. This is yeast so we’re talking, Candida mainly, we’re looking for albicans and SPT—

Dr. Justin Marchegiani: Yup.

Evan Brand: Although there is about 20 different species of Candida. And then we’re looking for parasites, too, because anything that’s gonna damage the gut barrier, can also leave you susceptible to ear infections, sinus problems, any type of allergies. Because your gut is basically the foundation. So, you don’t necessarily have to go straight to the ear which we’re gonna talk about some ear treatments that you can do to fix your infections and these problems. But a lot of times, do you agree this has to start in the gut. We’ve gotta make sure that you’ve got a healthy gut, and a healthy blood brain barrier, and a healthy—uh – basically a sealed-up gut, for lack of a better term.

Dr. Justin Marchegiani: 100%. It all starts in the gut, it all starts with the food. Now, I see people, I seen parents online and I—I jump on there, and they’re like complaining about their kid’s ear infection and I’m just like, “Alright, I’ll be a good Samaritan doctor.” I’ll be like, “Hey! Do this, do that, and it’s always ignored.” Like, I look at all the likes and the comments, people are like “Oh! Poor thing! Get this done! Get antibiotics!” And then my comment that actually addresses a solution goes like, unanswered, kind of ignored because it actually involves making some changes. So, people— I think people are getting the idea that the conventional solutions for these things aren’t working and are creating more problems. But uhm—you know, it’s definitely some extra effort that you have to do, but in the end, I remember of having tubes and chronic ear infections for so long up into my— even early teens. It was terrible, I was miserable! Now I didn’t get a lot of the sinus stuff, my brother got a lot of the sinuses. But in my opinion, whether its ears or sinuses, it’s just the weak link in the chain. The same mechanism that’s affecting the sinus issues is the same thing that’s affecting the ear issues.

Evan Brand: Yup. Well said.

Dr. Justin Marchegiani: What about allergies too? I mean you and I talk a lot about the stress bucket, and so what you and I were talking about before we went live is, how many people have allergies? And it’s almost per trade, is it’s a “normal thing”, but I always tell people just because something is common, like saying ear infection or sinus issues or allergies that doesn’t mean that it’s normal. And you’ve got these Claritin commercials and you’ve got these other pharmaceutical drugs to get on TV, and they make it seem like everybody needs—everybody needs that, everybody has allergies. The outdoors, it—it’s just a crazy environment, there’s grass, and trees, and flowers and oh my god, you’re not meant to live outdoors. You’re meant to live in your little bubble, and anytime you go outdoor, well, you need our pharmaceutical protection. And that’s just crazy. If you do have environmental allergies, there’s likely some deeper stuff going on. That could be adrenal related, it could be gut related, the yeast, the bacteria, the parasites. It could be detox problems, if you got sluggish liver, if you’re not digesting your foods well, if you’ve got food sensitivities, so you’ve not remove the gluten and the dairy from the diet, that stress bucket’s full. Then you go outside and then you do get allergies which gives you the sinus problems and maybe that gets worse and worse and turns into some type of ear problem. We have a question, from—let’s see—Genesis, on here, he said, “Why do my ears ache when it’s windy?” What’s your take on that? To me, I would just say go you get your gut check. But I’m not sure why that would happen.

Dr. Justin Marchegiani: Yeah, that’s kind of—that’s kind of vague—uhm—typically, the more inflamed certain parts of the body are, the more sensitive to certain things it will be. Like if I have from chronically inflamed to shifting my manual car may create some elbow inflammation. Now, is the shifting of the car really the problem? No. It’s the roomful of gasoline or the roomful of gas fumes and it’s that small little match that— that burns down the house. Even though the match went off, it’s with the inflammatory environment of all the gas fumes that are hanging out. That’s the issue. So I was always look at the underlying inflammatory environment that’s setting up the milieu to then when that spark goes off to create that issue. And that spark essentially being the wind there.

Evan Brand: Yup. Well said. I wanna go back to not just making it an anti-antibiotic podcast but I do want to mention the fact that—that even the US Center for Disease Control and Prevention they write that ear infections will often get better on their own without antibiotic treatment. Taking antibiotics when they’re not needed is harmful. Un— unwanted side effects like diarrhea, rashes, nausea stomach pain, more serious side effects can occur.

Dr. Justin Marchegiani: Right.

Evan Brand: Which can include life-threatening allergic reactions, kidney toxicity, severe skin reactions. And each time your child takes antibiotic, the bacteria that live in the body ,skin, mouth, intestine. And now we know that there’s a microbiome of the ear. Isn’t that crazy?

Dr. Justin Marchegiani: It’s crazy. The microbiome of the ear. Everywhere. I mean vaginal canal, gut, everything. It’s all—It’s interconnected, for sure. So also, couple of side effects with the antibiotics that we really need to talk about is the mitochondria.

Mitochondria are like these little power houses of the cell that generate ATP which is the currency of energy in which our body functions. And that’s so important for optimal energy. I mean, Dave Asprey has got a book coming out or it’s coming up very soon. He’ll be here in Austin next week. And its called, Head Strong and it’s all about basically improving your mitochondria. And your mitochondria is so important. Just google “mitochondria and antibiotics” you’ll see a strong connection. We put some of these links in previous podcasts. I’ll let the viewers do your homework. I will post a reference section on the bottom. Antibiotics and mitochondria, you’ll find significant disruption of the mitochondria with antibiotics. And obviously, it’s dose-dependent, right? The more you do it, the more you use it, the potential that increase has to happen. So that’s another mechanism. Now, we can talk about some solutions. Any thing else you want to address, Evan, before we actually dig in with some solutions?

Evan Brand: Sure. I’d like to just pile on top of the mitochondrial thing you mentioned. You know, a lot of clients come to us with brain fog and chronic fatigue as well as a starting place and maybe they’ve had these type of infections but they’ve also got chronic fatigue. And you’ve just brought the word “mitochondria” so it sounds like to me, we could infer based on someone’s use and history of antibiotics that we can infer. Well, here’s a root cause of chronic fatigue is the mitochondria that’s been damaged from antibiotics. So that’s really gonna make us have to do a lot more work on supporting mitochondrial health, but then getting the gut back in check, too.

Dr. Justin Marchegiani: Absolutely. And also, cortisol. I mean if—if we’re bringing babies into this world that are adrenally-depleted, again, this is kind of weird but if a woman is stressed, especially that during pregnancy, you can put on certain you can activate certain epigenetics that will start exacerbating or stimulating that babies adrenal in the third trimester. And the more stressed that mom is throughout pregnancy, you’re activating certain epigenetics, but also in the third trimester, gonna be stimulating the babies adrenal glands. So if you bring a baby into this world with a lot of adrenal dysfunction, off the bat, they may have an inability to regulate inflammation in general coz they’re not spitting out enough cortisol. Now we don’t ever want to treat a baby directly, you know, supplement-wise. We would do it by getting the mom really healthy. Uhm—the only thing I recommend to a child, probably off the bat, if they’re having issues, is probiotics. And then we could talk about maybe some homeopathic drops, or some natural solution to be put in the ear topically uh—to hit the area very focused versus do a systemic kind of atom bomb dropped.

Evan Brand: Yeah. Well said. I thought that was crazy 3-4 years ago when I heard the fact that you can basically steal your—your baby your fetus’ adrenal glands. This is why some women report feeling so good during pregnancy and some of it could be that they’re deriving some of their boost from the adrenals of the baby and then you give birth. Now instead of having four adrenals that your thriving energy from, you got two adrenals just—you’re driving energy from. And some women have kind of that postpartum either Hashimoto’s or some type of postpartum depression. So yeah, that’s a trip. There was a question here, “Can your sinuses get clogged for years?” I mean I would say, “Absolutely!” What do you think? If you’ve got these uhm— food allergies in your diet for years and yeah, you could stay clogged up all the time.

Dr. Justin Marchegiani: Yeah. Absolutely. So that congestion can happen. Now we also have to look at physical structure issues, especially in the nasal area. So being a chiropractic doc, you really want to make sure that you are well-adjusted like make sure you at least see a good chiropractor once a month and make sure your cervical spine and everything is doing well, number one. Number two, you may have some turbinate issues with these bones up here in the spine. You may need a technique called “nasal specific” where they put these balloons up and they can help declog any of these turbinate issues whether from trauma or malformation. And again, Weston A. Price talks about poor nutrition. One of the things that happens is narrowing of the middle third with this area— here is broken into a third – a third – and a third. And the more nutritionally-deficient the parent was that brought you into this world, this middle third starts to narrow. So one of the biggest signs of gluten sensitivity and poor nutrition is a narrowing middle third and a very large upper thirds. So when you see people walking down the street with that big forehead and you see that smaller middle third, with that smaller lower third, gluten deficiency, poor nutrition of the parents, big time, off the bat. So again, some of this we can’t really change, right? Like the parent stuff, that’s all epigenetic stuff. But we can at least be aware that we’re bringing kids and babies into the world, right? We got to get the nutrition dialed in. That’s number one. Number two, uhm—chiropractic’s helpful on the spine as well as the nasal canal and nasal specific. And also, acutely, chiropractic can be great for the—uhm— for the canal of the child. The person with the ear issue. Now when you’re younger, the ear canal tends to be more parallel, right? So it won’t drain as well. You have that—that draining angles. So one of the things that some chiropractors will do is, pull my ear front out, they’ll do a specific adjustment where they rotate the ear, they pull it, they rotate it in clockwise and they tug. And that tug kinda opens up the uhm—the nasal canal and will allow some of that junk to drain. Now, is that root cause? No. Is it palliative without any— without very little side effects and no— not affecting the microbiome and inflammation? Yes. So it’s a really good from a palliative perspective. Again, spine, really good. Nasal really good and then the ear adjustment, that’s the next really good step.

Evan Brand: That’s great. Now what happened with my wife, I believe, I don’t know if we were swimming in the ocean, or where we were, but she came home and her ear which is clogged. And we thought, “Man, this is gonna turn into an ear infection.” Coz she had this water that was just in her ear for like a week. And I said, “Justin, what do I do?” And you said, “Evan, you’ve gotta go get these—these eardrops. Do you remember that?

Dr. Justin Marchegiani: Yeah. Yup.

Evan Brand: And—

Dr. Justin Marchegiani: That was the Citricidal Eardrops. Those are great. Little bit of grapefruit seed extract in there. Those eardrops are phenomenal. Also, men, Hydrogen Peroxide, 3% it’s like two dollars at your uhm— drugstore. Just a little cap for that, it will bubble like crazy. Leave it in there till the bubbling stops and then you can dump it out. That was my go-to ear infection. I was waterskiing on Lake Traverse two years ago and I took a header. And I perforated this eardrum and uh—whole bunch of you know, bacteria and crap from the lake got in there. And one of the things I did was hydrogen peroxide and I diluted with a little bit of silver. So hydrogen peroxide – silver. That way, I could just clear that crap right out.

Evan Brand: That’s amazing. Now when-when you did that to your eardrum, was there any other bad side effects? What happened?

Dr. Justin Marchegiani: Just the side effects of a perforated eardrum. It’s irritated, it’s inflamed. Uhm— when you have an ear issue, man, it screws everything up because just sounds that come in are just like balance, just you’re over hyped up. So everything is irritating and kinda bother you. That my wife just leave me alone for a few days but then we just gonna do all the good things that help with the inflammation and all the good healing nutrients. I use the uh—the Similasan’s. Similasan’s, they have a really good homeopathic eardrop that we used. I use the Citricidal eardrops. I use some silver and I used some hydrogen peroxide and I kinda just rotated those. And growing up, hydrogen peroxide was absolutely phenomenal for the ear coz it’s just so cheap and it’s great. And actually that’s a natural—uhm— flu or cold kind of cure because they say a lot of ways that viruses kinda vector into your body is through the ear. So just doing like a little capful of that 3% hydrogen peroxide, it can really knock out potentially any viruses or bacteria making their way into the body.

Evan Brand: I think I told you when I met with one of the—the higher-ups at designs for health, which is a professional healthcare company if people are listening. I met with one of the higher-ups and he said he travels like 250 days a year. He’s always concerned about picking up sinus infections or ear infections from being on airplanes all the time. And one of his preventative measures was he was taking the silver in a spray bottle and he would spray his ear canals.

Dr. Justin Marchegiani: Yup.

Evan Brand: Then he would spray his nose, right? You know, kind of like a barrier protection around his holes of his— his nostrils in his ears. And the guy never got sick, so—

Dr. Justin Marchegiani: I love it. Totally make sense. So, off the bat, we kinda have the preventative stuff with the mom to baby, and stress in the adrenals. Obviously, try to have a vaginal birth. It’s gonna be essential because the activation of the bacteria in the vaginal canal and how that affects the child’s immune system. Number two, if you can’t get, for some reason, emergency happens where the cord gets wrapped around the child, the child’s oxygen levels drop and you have to have a C-section or the baby’s breach, number one, see a chiropractor beforehand. Get Webster technique to get that baby to go headfirst. But let’s say you can prevent that. Number two, go in there, and again, the doctor and the midwife probably won’t do this. So you have to get in there, get in there with a good swab. Swab your wife’s vagina area and then afterwards, when that baby comes out, you swab the baby with it because the baby would be getting exposed to that, anyway and now it’s not. So do a good swab, put it in like a little baggie and then after the C-section, then you— when you’re doing skin-to-skin, have that baby all swabbed on. Now don’t tell the— the doctor or nurse what you’re doing coz they’re probably look at you like 10 heads. And this is—you know, I told my OB about this ahead of time, she’s like, “Oh, well, you know, you can do that, but just keep it to yourself. We don’t have a problem with it, but you just keep it to yourself.” So that’s what we’re doing if that does happen. So have a back up plan, ideally.

Evan Brand: Totally. And why? Why—why would they— why is it have to be so hush-hush, I don’t understand what the deal is?

Dr. Justin Marchegiani: Well, it’s – in conventional medicine, there’s a conveyor belt man. Like here is what you do, here’s the cookbook, great. 1-2-3-4-5. And anytime you put a kink in that step, or something that disrupts that flow, you know, everyone perks up and it’s like, “What—What’s happening?” You know. So the more you can just lull them to keep that procedure going uh—it’s ideal.

Evan Brand: Makes sense. Yeah. Yeah. I had a client who—I’m trying to—who it was—it was either yesterday or the day before and she actually went to her conventional doctors to show the lab test, the organic acids test and he’s like, “This isn’t even a valid test. I’ve never heard of this before.” It’s like just coz you never heard of organic acids testing, doesn’t mean it’s not valid. You try to say that uh—instead of the herbs that were gonna use for Candida that she should just be using a Diflucan and— which is a prescription which is just unnecessary, so—

Dr. Justin Marchegiani: There can be a lot of side effects with Diflucan. I tried it before the—with the uh— with the fungal infection in the past. Coz I just was trying all these different things and one of the side effects I found was lightheadedness. That drug cause a ton of lightheadedness, insane.

Evan Brand: That’s scary.

Dr. Justin Marchegiani: Yeah. And there’s some research that it can cause neurological problems, too. So I mean, some people it may not be a bad thing, uhm— if you’re combining it with herbs and everything else and it’s just a part of the program, but just as like a, “Hey, you know, don’t change your diet, don’t do anything else, just take this.” —probably not gonna be the best long-term solution.

Evan Brand: Yup. So I think—I think we —we’ve we kinda jumped around. We jumped into some—some solutions and side effects and all that’s— I mean really diets can be first step, getting a nutrition plan in place it’s gonna be more like a Paleo or autoimmune paleo diet, potentially getting rid of your grains, your sugars, of course your sodas, your juices gotta go, pasteurized dairy—it’s gotta go. I remember for me, with my skin, you were like, “Evan, even though it’s organic grass-fed cheese, you still gotta cut it out.

Dr. Justin Marchegiani: Yeah. Your skin look so much better compared to last year.

Evan Brand: I know. So I had to get rid of it, even though I miss it and it was delicious. I rather feel good and, you know, have— have better skin. So you’ve got a get out the— the dairy except for butter. Sometimes you can do okay with butter and the wheat. I mean we talked about that but any type of gluten issues you’re gonna be creating the intestinal permeability. Even if you don’t have celiac, doesn’t matter. The gluten is still gonna affect the gut which is therefore going to make you more susceptible to ear infections and allergies and sinus problems. Uhm— secondhand smoke, we talked— you talked about that a little bit, that analogy. But yes, uhm— there is research that secondhand smoke also increases the risk of ear infections for children. So if you’re going over to a family’s house or someone in the family smokes—

Dr. Justin Marchegiani: Yeah.

Evan Brand: And then when you hold the baby, uhm— don’t let them do that. Also, if you are gonna bottle feed for some reason, apparently, bottle-feeding while lying down increases your risk of ear infections. That’s something that I just learned this morning with some research, but it makes sense.

Dr. Justin Marchegiani: Yeah. Yeah. Absolutely. Also, the quality of the food that the mom eats has a huge effect on the baby, okay. I’ll give you an example, alright? My neighbor —her child had a really difficult time sleeping continuously, up every half-hour. The big thing that they did is they pulled out eggs, and it was one nightshade family made up of eggs and tomatoes. And that one tweak, change the composition of the breast milk and the baby slept like just magic. So quality of breast milk is incredibly important and is dependent upon what the mom eats. So if you’re having issues with your child off the bat, even if it’s just sleep or ears, get your diet super, super clean. Super, super clean. Just because you’re feeding a baby or growing the baby, it’s not a license to eat whatever the heck you want. Nutrient density is incredibly important. With my wife being pregnant, we— we’re doing lots of things to increase nutrient density. She gets exposure to a little bit of liver everyday. Uhm— she does a green smoothie with organic vegetables in the morning, we mix in some MCT oil there. We do some collagen. She gets some Pasteur-fed eggs and Pasteur-fed bacon from time to time. And she’s eating 3 solid meals a day. And then get one good, healthy, organic shake in there. And really mitigating stress, and some probiotics and some magnesium to keep the bowel moving. So when you get pregnant with the hCg and all that stress down, it can create some issues with regularity. So that’s — I don’t wanna go too much on that, that’s a separate podcast. But, you know, we could just— we could do a podcast marathon and be here for 8 hours—I think, it allows us to do 8-hour straight, so we should uh—we should push that one time.

Evan Brand: We could. We could to a marathon.

Dr. Justin Marchegiani: Yup.

Evan Brand: So we—we hit on the—the eardrops, there’s garlic eardrops, too that I’ve read about. I’ve personally not use those. I’ve only used the uh— grape seed extract. Also, breast milk for eardrops. If you have a small little dropper, you can use breast milk for your drops, And it’s gonna be safer, less expensive, far better than antibiotics. Also, I don’t know if read about this, but coconut oil eardrops apparently exist, where basically I mean, all I would—I wouldn’t buy a specific drop, I would just take a load of the coconut, heat it up a bit, and then put into a container.

Dr. Justin Marchegiani: Exactly.

Evan Brand: You’re gonna get the caprylic acid in there. Which is probably gonna be the best thing. What else you—you got capric acid in there, or two that maybe gonna acts as a natural antimicrobial.

Dr. Justin Marchegiani: Absolutely. So let’s kinda go through some of the sinus stuff. So, off the bat, with the sinus, you can do Xlear, too, which is great. Xylitol which is an anti-biofilm kinda type of sugar alcohol and it also has an effect of being antibacterial. So that’s excellent.

Evan Brand: What is it called?

Dr. Justin Marchegiani: Xlear or X-Y-L-E-A-R. We’ll put links below the video and in the transcription, we’ll put some amazon product links, too. So if you guys wanna support us, you can get some of the things that we’re talking about through our affiliate links.

Evan Brand: Perfect.

Dr. Justin Marchegiani: And these are things that I usually that I bought and used, too. Anything we talk about and recommend are things that I have personally done myself or have seen my patients do it with great success. So what you’ll read, though—we’re all about clincial results first. So Xlear is great, or Xylear, however you pronounce that. Next is gonna be—Dave Asprey’s got a good bulletproof sinus rinse which is really good. You got a big salad bowl. We’ll put the link for this, too. You put a whole bunch of—just gently warm water in there. You do about a quarter of a teaspoon of some high-quality salt—sea salt in there. And a couple of drops iodine for the most part. And then you’re gonna dip your head upside down, and then you’re gonna breathe or you’re gonna suck that in to the nose. Keep your mouth out of the water, of course. Suck it in to the nose. So it will kinda feel like you’re drowning, not the nicest feeling, uhm—but that will be really, really helpful. So half a teaspoon of high quality sea salt for every cup of water. That will prevent bacterial overgrowth. You can add a little bit of iodine in or a little bit of Xylitol. So basically, you’re gonna do the whole little dippy bird, a little—tip—tip your head back. Don’t tilt your head back or you’ll gag. So keep your spine parallel to the floor and then you’re gonna breathe in to the nose. And I will put the protocol down below. So blink your eyes a few times. The iodine will sterilize the lining of your eyes if you get it in your eye. So be careful with the iodine in your eyes and that will significantly help clear out. And I will put protocol down below as well. Next, you can do a Nasaline, as well. And I’ll do the Nasaline with the Neti Xlear or the NetiXlear, which is potassium biocarbs, some salt and uh—Xylitol, and a little bit of uh—I think that’s pretty much it. And it goes into the solution, and then you can pump it through with a Nasaline which is basically a plunger for your nose. So a Neti Pot’s one thing but you just pour it and it’s gravity that goes through. The Nasaline, it goes through in one nostril and it’s a plunger where you push it. So you get full contact of the sinus canal and then will go through and rinse that everything with full contact.

Evan Brand: That seems way better than the Neti Pot. I’m glad you brought that up because—because my wife she did the Neti Pot and something happened. I think she—she had some weird drainage and I think that that actually lead to her getting like kinda an ear pain from the Neti Pot. So what you’re talking about sounds way better.

Dr. Justin Marchegiani: Well, think about it, right? If this is like your sinus canal, right? And we’re putting water in there. The water is just gonna hit the bottom part, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: For the most part. But if you get plunger in there, and you’re plunging it with actual pressure, it’s gonna have full contact of that sinus canal. So better chance of getting all the debris out.

Evan Brand: And that’s called what?

Dr. Justin Marchegiani: That’s called a Nasaline. We’ll put the link below. We’ll put the uhm—with the references. That’s gonna be great. That’s a really good product that I had a lot of patients used with great success. So you have the Bullet Proof Sinus Rinse, you have the Nasaline. If you already have the Neti, you can feel free and use the Neti. And the key things is just using the minerals using the Xylitol and/or adding some iodine. And/or just adding some silver. Like a simple thing you can do, too, is just lie back, ten drops in each nostril, three to the four times a day of high-quality silver. You know, in my line, it’s GI Clear-3 that we use and that has the 15 to 20 ppm of nano silver, not colloidal, but it’s nano. And again, don’t worry about argyria or turning blue with that. That’s gonna primarily happen from your homemade silver products.

Evan Brand: Why is nano silver better than colloidal? You got a lot of people promoting and selling colloidal out there but can you tell us why nano is superior?

Dr. Justin Marchegiani: Just the structure of it. It’s a different structures of a colloidal structure. It’s nanostructure so you’re gonna get better absorption for the most part.

Evan Brand: Sounds like it’s gonna be tinier the way that it’s gonna be structured.

Dr. Justin Marchegiani: Yeah. And you can go look at—I think it’s Dr. Gordon Peterson. He’s an immunologist that’s talked a lot about this kind of silver and he’s helped formulate that kind of silver. So the nano silver, in my line, GI Clear-3, is the one we like uh—to help with that.

Evan Brand: Love it. Should we answer any couple of questions. We had a question about goat cheese. For me, dairy is dairy, regardless of the animal. I’d say pull it out especially if you’re—you are struggling. You’re better to just go completely dairy free for 30 to 60 days.

Dr. Justin Marchegiani: People asking the questions, try to keep pertinent to the uh— podcast so we can connect it here. And then regarding ghee—ghee is definitely a good first dairy to add-in. So if you’re dairy-sensitive, you pull the dairy out for a few weeks to a month, and the first thing you add back in should be the ghee. Ghee is clarified butter so they suck out the lactose part. They suck out the casein part. All you got is the butter fat. So you have, basically, you know, very little casein, maybe microscopic levels and very little lactose. So you— it’s gonna be even better than butter, per se. An then if you do go with ghee, then you can try a little bit of grass-fed butter which will have very tiny amount of lactose and very tiny amounts of casein which may be acceptable level for you.

Evan Brand: For me, I could to the good quality grass-fed butter without a problem.

Dr. Justin Marchegiani: Cheese, though—ee—cheese and even raw milk, man. I don’t do good with those. I just—I really don’t. Skin breakouts, gas, bloating—not good. But I can do great with ghee and great with grass-fed butter.

Evan Brand: Isn’t it amazing, though. I mean just that one simple swab you got on me, you’re like, “Evan , man, you’ve gotta get rid of the cheese. Coz I would talk you through, you know, we’re kinda—you and I will talk off-air about what you eat, what do you do in diet-wise and what’s working and I told you, “Man, I’m doing this organic cheese.” And I don’t know if would say I was having sinus issues, but I definitely had some—I guess I would call it head pressure. Basically, kind of like a mild headache in the front of my—in the front of my head. I did not know that that was caused from dairy. And it was.

Dr. Justin Marchegiani: Your skin looks a thousand times better since you cut a lot of that cheese out.

Evan Brand: Yeah. I feel good. And I cut out corn, too. Now, I will do a little bit of some organic—blue—uh—blue corn chips maybe once a month or something now. They just taste so good.

Dr. Justin Marchegiani: Alright. That’s one paleo demerit down there.

Evan Brand: Hey, I know you’ve done some corn in 2017, right?

Dr. Justin Marchegiani: A little bit. Well, I mean—obviously, it’s a Mexican restaurant, called Maddy’s. And we’ll do a little bit of their gluten-free organic corn chips that are like in a plastic bag. So it’s totally a waste, there’s no cross contamination. So, I will, from time to time, as a little reward. It’s Friday, you know, a little—little NorCal margarita, a little bit of Dr. J’s Moscow Mule. Yeah. Absolutely. Love it. Add it to the list.

Evan Brand: And now is that—are—or now is that blue? Or is that—is that yellow corn? I may be one up on you in the blue here.

Dr. Justin Marchegiani: Uh—Yeah. I think it’s probably just the yellow. But it’s least organic and GMO free which is essential.

Evan Brand: Totally—totally.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Maddy’s is good and what was it—Tacodeli down there in Austin. They’ve got organic, pasture-raised pork shoulder tacos.

Dr. Justin Marchegiani: Unbelievable.

Evan Brand: Have you had those?

Dr. Justin Marchegiani: I’ve not. Tacodeli?

Evan Brand: Oh my, god. You’ve gotta go, man. It’s off uh—I wanna say it’s off of 360. Shouldn’t be too far from you. And they do organic uhm—they do organic tortillas as well and pasture-raised pork, so.

Dr. Justin Marchegiani: Love it. Love it. Very cool. So let’s kinda summarize, alright? So you’re coming into this here and you missed the whole 45 minutes chat. So what are the key take homes? Diet, of course, refined sugar, dairy, gluten, grains—cut that out. If that’s not enough, you can go do an autoimmune template where we cut out, nuts, seeds, nightshades and eggs. You’ve left meat, vegetables, maybe a little bit of low, sugar fruit, maybe a little bit of starch and healthy fats minus dairy and uhm—nut and seeds. So that’s our good first step that we need. Now, after that, there are some preparation and things we can do ahead of time but may not help you in the moment. That’s the healthy pregnancy, that’s the stress, that’s getting the vaginal canal in contact with the baby on the way out to activate the immune system, that is the good quality breast milk, that is all that good stuff there. And keep them mom’s nutritional density high when she is breastfeeding because that becomes the building blocks to a lot of the uhm—raw material in the breast milk. You know my expression is you can’t make chicken salad out of a chicken shit, right?

Evan Brand: Yup.

Dr. Justin Marchegiani: If you got crappy quality ingredients going in that mom, guess what, you can’t make this awesome breast milk with bad ingredients. So let’s really keep the quality high. Next, we have for the sinuses, you have structural issues, you can do the nasal specific chiropractic technique, you can do adjusting of the spine, and the whole—the neck as well, especially the upper cervical area and then adjusting Eustachian tube to help increase the angle to allow the ear to drain, right? Now we have the rinses for the sinuses. We have the bulletproof rinse, we have colloidal silver uhm—for the sinuses. And we also can do hydrogen peroxide in water, 50-50 split and do drops in the nose, 4x a day, 10 drops. And then we also have the ear. We can do Similasan Homoeopathic, we can do the Citricidal; we can do the Hydrogen Peroxide; we can also do the silver. And then you can also do a little bit of garlic oil in there, as well. What do you think, Evan? I think we just like hit it all at once.

Evan Brand: Yeah. That was good. And treat the gut, too.

Dr. Justin Marchegiani: Of course. And the best things—the supplement you can use on your baby if they’re newborn, Infantis Probiotic. Infantis is a specific type of probiotic. One that we like is Ther-biotic Complete for Kids. That’s a great one uh—for kiddos. And—and that can be powder so you can just put in on your finger and then you can just put it in the gums or if you’re breastfeeding, you can put in the nipple area and have the child, get it from that. And also, give it to the mom and it will help with any potential translocation via the breast milk as well.

Evan Brand: I will say one last thing about breast milk and this is probably gonna only apply to maybe just a few listeners, but there are breast milk donation services out there, where for some reason if the mother is just too busy, she is working too much, I’ve seen women going and getting breast milk from other moms. I would never do that from my baby because who knows what that moms diet is like. Who knows how much glyphosate is in that. If the mother is not eating organic. We know, I just chatted with Dr. William Shaw in my podcast, you know, we’re talking about parts per billion of glyphosate which is what’s used a non-organic produce. Parts per billion being enough to disrupt uh— gut bacteria and kill beneficial bacteria in the gut which can lead to these ear infections. And so for me, I would never ever, ever, ever unless there’s was just something so wrong with the mother that she could not feed the baby—her breast milk. And she had to get another mom’s breast milk, I would literally have to do an interview process of that— of that mother. Is your diet organic? Are you eating gluten? Are you eating dairy? Because that’s gonna—breast milk is not all created equal, like you mentioned.

Dr. Justin Marchegiani: Yeah. I mean, it’s really simple. You just pay a little bit more money. You—you provide that food for that mother who’s donating the milk if that’s your only option.

Evan Brand: Yeah.

Dr. Justin Marchegiani: I mean, for the first 6 months. What you’re doing there, for 6 months to your kid is a better investment than paying for college or any of that. That’s like the best investment. So if you’re in that position and you have to do that, then definitely find someone. You know, the Lalecheleague’s a really good reference for that. But really find high-quality breast milk, if you need. There’s some Weston A Price recipes where you can do some home-made breast milk with liver extract and cod liver oil and raw milk or raw goat’s milk. But then also, like if the mom can’t breastfeed, it’s typically something wrong from a stress perspective and from a diet perspective, so really look at getting the diet fixed. I see a lot of women who go low fats have problems with producing breast milk. So—

Evan Brand: Yup.

Dr. Justin Marchegiani: That’s really, really important. And then don’t quit. Like, don’t quit. Like can you imagine, like evolutionary times where like food’s like, you can’t feed. You don’t have like formula, you didn’t have all these things. So you couldn’t breastfeed your kid, like what would you do? That was it.

Evan Brand: You’re done for.

Dr. Justin Marchegiani: This is it. They can’t eat solid food, right? Too young, what do you do, right? So maybe there will be another woman in the tribe that you give the baby off to and they would lactate for you. But ideally, you gotta get the diet right, you gotta get the stress right and then also, make sure that the inflammatory foods are out of there so the highest quality nutrients are coming through.

Evan Brand: Yeah. It sounds like we have to do a whole breastfeeding.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Or optimal baby podcast.

Dr. Justin Marchegiani: Yeah.

Evan Brand: But I’ve heard many women, who they’ve completely just given up on breastfeeding because they said they were too stressed or too busy or something like that. But you really gotta try to modify that to make it possible because—

Dr. Justin Marchegiani: We’ll do a whole podcast on this. We’ll do a whole podcast on it. There’s a lot of nutrients and stuff you can do like fenugreek, you know, uh—mother’s milk tea. Just all kinds of things. And also, get a doula. If you’re having a hard time, get a doula. There are so many things. Like most women, it’s like, “Oh, I tried and it’s done.” No, get a doula. Like try for days, use—get someone who’s done it. So many times, they know all the tips and tricks to make it happen.

Evan Brand: Yup. Totally.

Dr. Justin Marchegiani: And that’s coming from someone who wasn’t breastfed ideally long enough. So I’m really passionate about getting that information out there.

Evan Brand: Me too. Me too. Well, we’ll send people back to your website. They can type in, Justinhealth.com to check out Justin and schedule consult with him. We deal with this stuff all the time, every single week, in the clinic. And my website notjustpaleo.com or just google our names: Justin Marchegiani Marchegiani Evan Brand. You’ll find us and make sure you subscribe here on the YouTube channel. Justin have over 25,000 subscribers on YouTube. Congrats. Whoo—

That’s uh—make sure we push that closer to a hundred grand because this is important information that is not readily available. Even in 2017, somebody’s gonna go down the street to the clinic, and maybe regret the mode of action that was taken. So we want to save you from that.

Dr. Justin Marchegiani: Absolutely. Any other questions you wanna answer in the queue there, Evan? I don’t think so. Was there any for you?

Dr. Justin Marchegiani: Uhm—again, someone said- Sam asked about Probiotics for a 7 year-old. Well, I’d probably still go with the Infantis. But you know, you’re gonna go, you’re gonna have a blend of Lactobacillus, Bifidobacterium Infantis in there . So you’re probably good with that one. I recommended it.

Evan Brand: Yeah. And I would say for a 7-year old, too. Believe it or not, I had a three-year-old girl but I just had her stool test back and she had 2 parasites and Candida and bacterial overgrowth. So, I mean, if the seven-year-old has got symptoms go ahead and get a—get a GI Map stool test on her I wouldn’t be surprised if she’s had antibiotics her seven years of life. She might have some type of overgrowth already. And you just don’t wanna come in and just try to fix it with a probiotic. A lot of times, that won’t be enough. You can’t just out probiotic your way out of an infection, unfortunately.

Dr. Justin Marchegiani: Absolutely. And the easiest way to get kids to eat healthy. And again, this may, you know, sound kind of patronizing, right? But it—it’s a 100% true. Number one, don’t have crap in the house. Clean out all the crap in the house. Number two, you have family meals together and you will role model what good eating looks like. Mom and dad, they sit down to have their meal and they role model what it looks like. And the whole idea, you know, once the kid’s eating solid food, and they actually have teeth and they can chew and stuff, the whole idea behind baby food versus kids food, once they—once the mastication’s dialed in is ridiculous, right? They should be eating adult food and just, you know, cut it up small and make it really easy to digest. But those foods need to be done as well and you just role model it to the kids. You just parrot it back and the kids want to be like the mom and the dad. And they’re gonna wanna just do what the parents are doing. So you role model it and you create a really good environment and family meals.

Evan Brand: So we’re in those something funny uh—and we’re getting off topic but it’s Friday so we’re having fun. Uhm—

Dr. Justin Marchegiani: It all connects back to that because if you don’ get to diet, right? Then you’re gonna have sinus infections and ear infections all day long.

Evan Brand: A 100%. So it is on topic. Yeah, for sure. So my wife and I, we were discussing last night, “When do you make the transition from baby foods over to solid food?” You know, from pureed foods to real foods. And well, she said, “They tell you.” And our daughter, she’s starting to fuss about the pureed foods. And she’s trying to grab of mom’s plates. So like last night, for example, we some steam broccoli, we had some peas and carrots that we did for lunch, with our veggies and we did some meats. And we gave her her own little plate of peas with some butter on there and some carrots, and some broccoli. And she ate it up—insane. And she’s 10 month old, I thought, “Oh, my lord, look at her appetite. She’s probably starving to death waiting for real food.” She’s like, “I’m sick of this pureed crap. Give me some real food.”

Dr. Justin Marchegiani: Exactly. Plus the teeth are coming in. So it’s a natural progression, right?

Evan Brand: At six months, you may start to add in some smooshed peas, some smooshed avocados, 95% of it doesn’t get in the mouth. It’s more of that tactile play experience. But eventually it gets in there and the teeth come out. And then you can start introduce it. And you’re doing a great job with how you’re doing it. Keeping it mashed, keep it simple, staying away from the hyper-allergenic food. That’s great.

Evan Brand: Yup, yup. So we have uh—we gave her a little bit of chicken yesterday, too, which she did fine with. It was very plain, not much seasoning on it.

Dr. Justin Marchegiani: Yup.

Evan Brand: Just some—some baked—pieces of some baked uh chicken thighs and she loved it. She ate it up. So it’s a lot of fun—a lot of fun—

Dr. Justin Marchegiani: I love it.

Evan Brand: to eat healthy.

Dr. Justin Marchegiani: Awesome, man. And well, it’s great little Friday, here in Austin. I’ll be uh—doing a little waterskiing this weekend.

Evan Brand: Nice.

Dr. Justin Marchegiani: Really excited about that. Any plans for you? Well, uh—we’re gonna go scope out—scope out some eco-friendly uh—paint and flooring options. And figure out what we can do about—about this house, so—

Dr. Justin Marchegiani: I love it, man. Excited about it. Keep me posted.

Evan Brand: Sure.

Dr. Justin Marchegiani: And everyone listening, we appreciate your attendance. If you like these live ones, these live podcast, give us feedback. Let us know; like it; share it; give us a five-star review on iTunes as well. We’ll put—we’ll repost them on iTunes. If you listening on iTunes right now and you wanna see Evan and I go back and forth, duking it out in the flesh, click the link below so you can watch the uh—YouTube link. And uh—we’re excited to continue to do more of these and share more information.

Evan Brand: Take care. Have a great weekend.

Dr. Justin Marchegiani: Evan, my man, take care, buddy. Bye.

Evan Brand: Bye.










Products mentioned:

JustinHealth GI Clear-3


Dave Asprey’s Bullet Proof Sinus Rinse


Citricidal Ear Drops

Similasan Homeopathic

Infantis Probiotic

Ther-biotic Complete for Kids

Hydrogen Peroxide, 3%

Immune System, Tapping Technique and GI infections – Podcast Live with Dr. J and Evan | Podcast #131

Dr. Justin Marchegiani and Evan Brand engage in a lively and informative discussion about their recent clinical successes with their patients using the functional medicine approach. Listen to them as they dig into the root cause of their patients’ issues and turn chronic and seemingly complicated problems into success stories.

Know about the tapping technique which involves turning something negative into a better, positive thought. Learn more about GI infections, the bacteria or parasite that may be involved, as well as the tests and treatment options that are proven successful in the functional medicine world. 

 In this episode, we cover:

 03:50   Immune System, bacteria, and infection relationship

 15:50   Tapping Technique

 19:17   Treating Hypochloridia

 24:10   GI infections

 28:34   Enzyme Tests






Dr. Justin Marchegiani: We are live on YouTube here. Podcast live on demand. Also, live here on Facebook. Evan, how are you doing, man?

And again, Facebook people you gotta click on the link here uhm—I’ll put in the comments to see Evan’s pretty face and go back and forth on this. How we doing, man?

Evan Brand: What’s going on? I’m feeling really good today. We’ve got a blue skies, the trees are blooming which they probably—

Dr. Justin Marchegiani: Awesome.

Evan Brand: a year ago in Austin. So I’m enjoying myself.

Dr. Justin Marchegiani: Very good. So we got podcast on demand. So anyone wants to write in some suggestions as we chit chat here, we’ll figure out what exactly we want to talk about moving forward.

Evan Brand: Yeah. And I might as well post a link over here to my Twitter page and see if uh—people are paying attention over there. That way, if they’ve got questions, they can get them answered here.

Dr. Justin Marchegiani: Love it. Totally makes sense. Same thing, anyone on Facebook, too, every  chimes in first we can get this thing moving. But let’s uh—just talk about some clinical successes in the last week with patients. Any updates from you, man?

Evan Brand: Yes. So interesting update is uh—there’s a female client that comes to mind and she had seven, I believe, I have to go back at here stool test and count. But I believe it was seven infections and this is a combination of two parasites which—let me just pull it up, that way, I’m not just shooting into the dark here, but—Uhm— with these infections, we started a gut protocol and symptom improvement was seen. She was having a lot of irritable bowel symptoms uhm— running to the bathroom. So she showed up with H. pylori, Blastocystis Hominis, Entamoeba and Fragilis and Proteas  and Citrobacter. Somehow, cal protectin level was still low  which is intestinal inflammation where—

Dr. Justin Marchegiani: Yeah.

Evan Brand: –I look at but I was surprised. And so anyhow, we put her on this protocol. And this is like 8 weeks.  And the H. pylori while it’s still positive, instead of two viral factors, now she’s got one viral factor. The level of H.Pylori has dropped. The Citrobacter is completely gone. The Proteus completely gone. The Blasto is completely gone. But we still got Entamoeba. So there’s still the parasite and there is still the H. pylori there. So we’ve got work to do but yet, we’ve seen 3 or 4 things disappearing. So I think what the takeaway message is from me is that the bodies gonna heal in an interesting way. It may not heal everything at the same time. Some things may be easier to kill. Some things may disappear first, but you gotta heal yourself especially your gut, your microbiome. You gotta heal these things in layers. And that’s what we’re seeing here.

Dr. Justin Marchegiani: Yeah. So typically with a lot of patients that have chronic issues is there are some underlying stress, right? Emotional, physical, chemical stress but even deeper above and beyond that, there is some level – there’s some level of  infection that’s deeper that creating inflammation even though it didn’t show via calprotectin or it’s just creating leaky gut. And the whole leaky gut mechanism is getting the immune system fired up. The more the immune system is fired up, it’s just an energy suck for  your body. It’s like uhm—let’s say guests in you guest bathroom that you never go into your house. And they just leave the water on. Just a little bit—little drip, drip, drip. And then you get your water bill at the end of the month, and you’re like, “Where the heck did that bill come from?” And you’re like, “Oh, yeah. The faucet’s on.” But it’s like that with your energy resources. When got these bugs, it really—when the immune system is overactive. And even just a leaky gut, right? The more your immune system is overactive, the more it’s gonna suck your energy dry. That’s why when you get sick, the first symptom you get when you get sick is what? You get a lot of fatigue and malaise coz the immune system is sucking resources. Go ahead—

Evan Brand: I wanna hear uh—a recent case from you, but first I wanna ask you the question that I get asked all the time. And the answer really doesn’t matter because we need to fix the root cause no matter what. But people often ask well– chicken or egg? Was it that ma—my immune system got taxed first? And then I picked up these bacterial pathogens or these parasites? Or did I pick up the parasite and the bacterial pathogens and then that that set my immune system? What’s your take? Can it go either way?

Dr. Justin Marchegiani: Yeah. So typically it’s one of two scenarios, right? Typically someone gets exposed to a very high amount of infectious debris, right? Parasitic—parasites. So you drink some really bad water, you to go Mexico, you have really bad meal or at a foreign country, you get the Bali belly, so to speak. And then you’re overwhelmed with all of that infectious debris and then there’s so much of it that it compromises your immune system, you get diarrhea, you have a lot of gut inflammation that creates malabsorption. That malabsorption puts stress on all of your glandular systems and then you spiral downhill. That’s scenario number one. So just the infectious—the infection was so overwhelming, it just threw everything else downhill. Scenario number two is there some type of immune compromisation  that’s happening. Meaning adrenal stress, poor diet, poor sleep, or poor diet and lifestyle habits, low nutrient density. The immune system’s kinda a little bit weaker underneath the surface then you get exposed to some of these infectious debris at smaller micro levels that are in the food. And eventually makes its way to the system and creates inflammation.

Evan Brand: So yeah—so let me—let me clarify there. If we’ve—If we’ve got diet, lifestyle mostly dialed in, but let’s say people are cheating with gluten, for example. They still got intestinal permeability going on. You can still have good class, good sleep, blah, blah, blah. But if you’ve got just a simple thing like leaky gut, for example, you could potentially be more susceptible to pick up these infections regardless of whatever else is dialed in.

Dr. Justin Marchegiani: Yeah. I mean—here’s the deal with leaky gut, too. If you’re creating leaky gut, and then there’s some research, you know, on the non-celiac, gluten sensitivity side of the fence, that looks at these foods. Even if you’re not like reacting to a it, like symptomatically, and even if you’re not like having like IBS -like symptoms,  bloating, you know, gas constipation, diarrhea, that gluten can still create leaky gut. Where the undigested food particles in the gut can make their way into the bloodstream and create stress. And then the LPS that comes in there along with that, that’s the— the bacterial debris can get into bloodstream and create a lot of mood issues as well. So you can still have leaky gut and not risk from gluten— and still not respond to gluten in general.

Evan Brand: Yup. Yup. I just posted a post on uh—Facebook which I think might be a slightly controversial which was I wrote this little bit of a letter and I put kind of like these five things that have happened over the last year or so where people have said, “Evan, I’ve ditched psychiatrist or I’ve ditched my psychologist or my marriage counselor, or my conventional doctor because of functional medicine.” I kinda wrote the reasons why of how if you lower inflammation, you may need less adjustments at the chiropractor, for example. If you heal the gut, you start producing your neurotransmitters optimally, you might not you’re your antidepressants anymore, so you might not need your psychiatrist. Or if you heal your adrenals, you’re not gonna snap at your children anymore, so therefore you’re not gonna need the marriage counselor that is telling you need to stop yelling at your kids. And how basically how functional medicine can literally, not intentionally, but it’s just a side effect is that we can replace these other industries. I’m not saying these other industries are bad for mental health care or anything like that. But a lot of times, this is not root cause medicine. And my wife and I went out you with a friend of ours yesterday and she said she had a lot of stress, she had to put her dog down and she called up her psychiatrist and said, “Hey I need help, I’m freaking out.” What does he do? He prescribed her 60 Xanax and says, “Here’s your Xanax bars and take these.” And I told her, I said, “Listen, your anxiety and your stress from this issue is not a Xanax deficiency.

Dr. Justin Marchegiani: Totally.

Evan Brand: How about we do some emotional freedom technique. We start tapping. How about we cleanup the diet? And then before we left, out the parking lot, I had her do the quick coherence technique, the Heartmath, like the heart focus breathing.

Dr. Justin Marchegiani: Yeah.

Evan Brand: And focusing on someone that she loved and we got done with it, and she said, “That was weird.”  I said, “What happened?” And she said, “I got tingly and warm.” I said, “Oh, it worked.” And she said, “What happened?” I said, “Well, you just took yourself out of fight or flight that you’re probably stocked in which is causing you to be dependent on Xanax and now we’ve pushed you into that parasympathetic rest and digest mode.” And she feels better. And this is what this is all about. Uh—a little bit of uh—off-subject uh—, but I just wanted to mention to people, check on my Facebook post and you’ll read about what I’m saying. I’m not saying these other uh— practitioners out there are garbage. What I am saying is that if you’re not getting a practitioner to focus on root cause, even if they are psychiatrist, if they’re not a root cause psychiatrist, then what the hell are they doing?

Dr. Justin Marchegiani: It’s all about resources, right? And in functional medicine world, we’re trying to help enhance your resources. So just like someone with more money in their bank account can buy more things, well if we enhance our mental, emotional bank account via healthy and diet and lifestyle functional medicine principles, we have more resources to deal with stress in our life. Whether it’s family, friends, being a parent, being present for our partner, just being able to do the hobbies of a hobbit—hobbits—uh—

Evan Brand: Haha

Dr. Justin Marchegiani: The hobbies and the habits that we have going on in our life.  I got uh—I guess I’m missing my uh – Lord of the Rings movies there. Yeah. So—It ‘s all about resources, right? So we have to make sure that we have enough resources in our system so we can allocate them toward these stressors. And I always tell my patients, “Have you ever tried dealing with stress on 0 night sleep? or “Try doing your taxes the next day when you’re getting like three hours of sleep?”  You’re just  not gonna be able to handle it. You don’t have the resources. So everything we’re trying to do is let’s test the resources of our body systems, let’s look where the hormone’s at, let’s look at where the gut resources are at, let’s look at detox and nutrient resources are at, let’s support them and let’s work on fixing them.

Evan Brand: Well, the analogy I like to use is we’re just using a big spotlight. Because a lot of different industries and health care, what they do is they use like a little laser pointer or like one of those tiny little keychain flashlight. And they shine something real dimly into one corner. And you’re like, “Oh, Justin looks like we found something. We found some anxiety issues, here’s the Xanax.” But instead, we come in with a giant spotlight and we’re like, “Whoa, look at the left corner of this microbiome. We got parasitic and bacterial infections, which can steal your nutrients, can mess up your blood sugar and cause anxiety. Look over here,  we’ve got some adrenal issues. You got spiking of cortisol that’s gonna need to be addressed.” And then we shine the spotlight over here, “Oh, take a look at our detox pathways on the organic acids, you’ve got trouble over here.” And “Oopp, we shine the spotlight behind us, here’s mitochondrial issues. This is why you’re so fatigued.” And that’s the—I think that’s the greatest analogy. It’s a little laser pointer or a little small keychain flashlight, which is just pinpointing one industry of psychiatry or psychology or whatever versus exploring everything. Which is why for you and I, it’s tough for us to become the blank guy. You know people out there, “the thyroid guy” “ the detox chick” “ the bone broth chick” You know what I mean? It’s really gonna be tough for you and I to just say we’re the blank person because I don’t want to limit myself. I wanna let everyone know it is all encompassing.

Dr. Justin Marchegiani: Yeah.

Evan Brand: And if rest and niche yourself down, I think it’s a bad thing.

Dr. Justin Marchegiani: Yeah. Like from a marketing standpoint, right? Marketing is just telling the truth attractively. You know it’s good to have the niche because you wanna reach the people that have special conditions. Because if like, my specialty is thyroid. Number one, I have—I have or had a thyroid issue. It’s under control. Autoimmune thyroid issue. So I’m more passionate about that issue. But again, to treat  a thyroid issue, you have to be able to treat all of the systems. So it’s kind of a mythology, like you don’t just ever treat thyroid, you treat the whole thing. But you may mark and put information out there that’s gonna resonate and speak to someone with a thyroid issue more. But again, the underlying issue is from education and clinical standpoint. We’re addressing the key underlying surface issues and the deep root issues as well. So we’re never ignoring it. We may speak to someone uhm—more specifically and get into the more nuances of that condition, but it all comes back down to the foundational stuff that we always talk about.

Evan Brand: Right. I would say my specialties would be— it’s become parasites really. I mean, I’m seeing so many each week and it’s just so fun. I guess because I had parasites.

Dr. Justin Marchegiani: You had a parasite, you.

Evan Brand: Uh—Yeah. And also depression, I mean because depression is what got me into this whole thing. IBS and depression in college, I mean, like I told you before, I had to figure out when I went  into a college class, where’s the bathroom. Coz I have to get out in the middle of the class to run to the bathroom.

Dr. Justin Marchegiani: Yeah.

Evan Brand: And so for me, depression, IBS, parasites, you know, those are all linked together—the whole gut-brain connection. And I really am empathetic for people that have struggled with that because it’s so common and if you diagnosed with IBS, that’s a pretty generic diagnosis. And unless you’re with functional medicine practitioners, you’re gonna get an acid blocker, an antispasmodic—

 Dr. Justin Marchegiani: Yeah. Absolutely.  

Evan Brand: — or some other drug and—

Dr. Justin Marchegiani: Well actually, you were diagnosed with IBS, right?

Evan Brand: I was.

Dr. Justin Marchegiani: And you use the antispasmodic, you used the medications that helps with the gastroparesis. You know—

Evan Brand: Well, they never –

Dr. Justin Marchegiani: They even do that—

Evan Brand: Well they never got to use it. They try. They wrote me the prescription pad but I denied all three of the drugs.

Dr. Justin Marchegiani: And the thing is, too, we can also use natural medicines for a lot of those things. That may not fix the root cause, right? There’s root cause medicine and there is using natural medicine in a way that’s gonna help alleviate the symptoms that’s gonna up regulate physiology so things work better. But we have to still be investigating and digging to the root cause, right? So we’re dealing with someone with gastroparesis or low motility, we may add in things like ginger. We may add in things like carnitine. We may add, you know, higher amounts of mag citrate to keep that uhm—migrating motor complex moving. But we are still digging in deep. We’re still making the diet, the lifestyle. We’re still enhancing digestive nutrients, uh—hydrochloric acid enzymes. And then we’re digging deep for the infections. And we’re trying to lock in those diet and lifestyle habits, right? The supplements are great because they can give us that symptomatic relief while we continue to dig over here to the root cause. So as long as you have, you know, that  four pace envision that addresses some of the symptoms without the side effects, you know of some of the drugs, which may have more side effects than what you’re treating, and then working on the functional medicine plan, I think we’re in a really good place. 

Evan Brand: I agree. Yeah. I actually got a good—good success with that IB Synergy product from designs which get Bonigut in there. It’s got the 5-HTP. I had a guy with just super bad IBS and I said, “Man” I mean he was critically, critically stricken with both diarrhea and constipation just alternating every other day.

Dr. Justin Marchegiani: Yeah.

Evan Brand: So I have him going with that 5-HTP Bonigut blend. And he got better. Now we start to wait for lab results but yeah—I mean  sometimes we will do some of the quick fix of band-aid situations to fix things, but we still got to work backwards. I guess to answer these questions uh—should we answer the question about the cancer question here or shall we just make a whole show on the future?

Dr. Justin Marchegiani: Yeah. We’ll do a whole show on that. I’ll get some experts on. I got Dr. David Jocker is coming next month as well. He was in the truth about cancer series. And we’ll go on ketogenic diets and we’ll talk more about therapeutic ways to address cancer outside of just the natural chemotherapy. So we’ll hold that one that—we need more time for that.

Evan Brand: Yeah. Agreed. Uh—Samuel asked, “What is the tapping technique? Can you show us? Well since most of our audiences are gonna be audio listeners we’re not gonna take up the air time to show you the technique, but the best resources—EFT (Evan-Frank-Tom) EFT.mercola.com and you can just view the different acupressure meridians that you’re gonna tap. But then also, you’re gonna learn about the affirmations that you can use for emotional freedom technique and that’s something Justin and I use all the time.

Dr. Justin Marchegiani: I think it’s helpful. I’m—I’m gonna just give it 15 seconds of airtime here, so—just—I do two hands coz it’s adding it’s more efficient. But you just tap the  inners part of the eyebrow, the outer parts of the eyebrow, under the eyes, I do under the nose, and the bottom part of the chin the same time. And then I do both collarbones. So I do this, and you can go top of the head and tap midline. So I do two hands coz I just feel like you get more stimulation. So I go here, and I’m just thinking about whatever is pissing me off, my wife, I just think about it.

Evan Brand: Haha

Dr. Justin Marchegiani: I kinda give it a number. So if I’m a t like 6/10 regarding irritation, I just think about it. Whatever that issue is, whether it’s like, you know, the person driving  in front of me is so slow  or whatever. And I try to knock that 6 out of 10 so that 10 is the worst.  6 is like 60% to being at the worst. I try to knock it down to a4 to a 3. And so every round—every 2 rounds or so, you kinda just check back in and see if you knock it down. And you go as you kinda knock everything down to a 3.

Evan Brand: Yeah. And we have—I—I start at the top of the crown which I usually like—many ways—

Dr. Justin Marchegiani: You can do that. You can start there, you can end there.

Evan Brand: Now do you do the sides? I know Mercola, he’s big on the side of rib cage under the armpit.

Dr. Justin Marchegiani: Yeah. I do that, too, sometimes. It’s just wasn’t good for a video.

Evan Brand: Yeah. So you criss cross?

Dr. Justin Marchegiani: Yeah. I do two at the same time just coz it’s stimulation.

Evan Brand: No. I mean you criss cross your arms so the underarm’s like this. I do like a monkey.

Dr. Justin Marchegiani: Haha

Evan Brand: And then—and then finish with the wrist. I typically finished by tapping the insides of the wrist together then doing the affirmations. So even though I’m angry, or even though I’m anxious, I deeply love and accept myself. But you gotta say the affirmation verbally. I tell people if you can, if you’re just embarrassed, then don’t do it. But why be embarrassed? Nobody—nobody is paying that much attention to you.

Dr. Justin Marchegiani: Yeah. That depends, too. Like you can do this stuff, and you can kinda say like if you’re at—let’s say, if you’re lying in bed and you’re just really stewing on something and your wife’s next to you and you don’t wanna wake her up, then you can just kinda think it in your head. And then you can just, you know, do the affirmations, tap like this.  And then you can tap here, and think about the issues.

I like them to end, though, with a positive thing. So you can end with something positive. So then I just go into like, “What is it that I want to manifest?” So I’m going into right there. I’m thinking about whatever I’m gonna try to create or produce in my life, I just tap it while I’m thinking about it. And the whole idea of tapping is you’re just stimulating various meridian systems that have been mapped out via acupuncture system for thousands of years. And really what it’s doing is it’s neutralizing the negative response that’s stored in the limbic system or in that subconscious of your—more in the psychological side of it. And you’re trying to kinda rewire it so you can get a good pattern there instead. So then, naturally that reflux is to go back to the better thing and not to the negative thing.

Evan Brand: So if you do affirmation about the bad part, would you do like an affirmation about the bad part and an affirmation for a positive?

Dr. Justin Marchegiani: Yes. So I start off with the negative and just try to lessen—lessen it first.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Coz if you’re—feeling negative, it’s really hard to be positive when you’re negative so I try to decrease the negative to about a three. And then I go into the positive because then, you are in a better place to deal with the positive, right? It’s kinda like when someone tells you to relax and you’re pissed off, like relax, calm down. You just wanna punch him, right? Like, “No, I’m too wound up, come on.”

So I wanna get that dialed in and then now I’m relaxed, now I can rewire it and create some positive things.

Evan Brand: I like it. I like it.

Dr. Justin Marchegiani: So calm down first, and then work on manifestation.

Evan Brand: Should we answer a couple of more questions here?

Dr. Justin Marchegiani: Yeah. Let’s hit it, man. Let’s hit it.

Evan Brand: Solam asked, “How long does it take to heal hypochloridia?”

Dr. Justin Marchegiani: It totally depends, right? If you have emotional stressors that are unresolved ore you’re eating foods that are incredibly inflammatory, maybe never. But if you’re making the root causal changes and your managing your stress, and you’re fixing the underlying gut stuff, I would say within 3 to 6 months, you have a really good chance of not needing hydrochloric acid to digest your food. But again, everyone is different. A longer—the longer the issues been going on, the more severe the infections, and the more infections that are layered in there, I’d say longer, up to a year, at least.

Evan Brand: Yeah. I’ll just have my two cents to that, too. If you had a previous history of a prescription, as a blocker’s proton pump inher—inhibitors are now it’s open to counter like the Xanax or the Toms, or anything like that, or—

Dr. Justin Marchegiani: Yup.

Evan Brand: Or if you’ve had H. pylori which we’ve chatted about many times, then I would say it may lengthen that time, too, to fix that stomach acid issue.

Dr. Justin Marchegiani: The longer that gut’s has been worn down, the more the immune system is revved up like you get patients are just supersensitive to every little thing. Like I can’t even put in an enzyme, I can’t even put in our apple cider vinegar or lemon juice or the smallest fermented food sets them off. It’s really hard and you’re looking at a couple of years to really dive into it because the immune system is so revved up and it’s so ready to attack the smallest invader that it’s so hard to put things into help and heal it because it’s looking at everything as a foe not a friend.

Evan Brand: Right. We really, really have the baby step in those cases so that’s why—

Dr. Justin Marchegiani: Totally. Yeah. I mean, just like you heal, with you know, food is medicine there, you go really slow and you do lots of things in broth form, in soup form so it’s – so it is so palatable. There is very little digestion that has to happen. And typically one supplement at a time and one nutrient at a time, titrate up from low to high. Even if it’s something that they can handle, if they go high dose, off the bat,   their immune system just freaks out.

Evan Brand: Well I wanna hit on something you just mentioned which is if we’re talking 1 to 2 years, it takes extreme patient—extreme patience for patients and clinicians because for us, that is a very intensive case for us to take on.

Dr. Justin Marchegiani: Totally.

Evan Brand: And you know, maybe this is to toot our own horns, maybe it’s just calling out the obvious that we do take the time, you know, with people we’re working  with. Sometimes it maybe 30-45 even an hour-long call for a follow-up just to take these baby steps. Whereas, let’s jus say some of the clinicians that we’ve seen out there, it’s too cookie-cutter approach and they don’t have the mental bandwidth or capacity for empathy to baby step this people.

Dr. Justin Marchegiani: Yeah.

Evan Brand: So it’s here’s your cookie-cutter protocol, good luck.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Where with us, we’ve really, really, really gonna get super details.

Dr. Justin Marchegiani: Yeah.

Evan Brand: And so this is why if you go and you buy like a leaky gut online program or some other type of program, and you get limited results and you get to us, we’re not gonna be surprised if you suffered through that, and you didn’t get a good result. Because at the end of the day, that’s why  Justin and I haven’t created  online courses at this point because it’s—it’s hard for us to sleep at night thinking that we’ve created a program that’s too cookie-cutter. We’ve really got to figure out a way that we’re gonna be able to work in all the minutiae and the small details and the variations—variation A, B and C, D for different people.

Dr. Justin Marchegiani: Yeah.

Evan Brand: So if someone uh—packages something up all beautiful and says, “Oh, it’s $297 and all your problems are gonna be healed.” Uh—please be a little bit skeptical  of that.

Dr. Justin Marchegiani: I agree. And I’ve talked to you about a patient that I had today that email in that was dropping out of care. And we try to always set realistic expectations. This person just had her labs reviewed a month or two ago, and had multiple parasitic infections, severe adrenal dysfunction, HPA axis dysfunction, and then a lot of issues on her organic tests. Uh— detoxification issues, mitochondrial issues, and we just started with simple adrenal support, made diet and lifestyle changes and she had some— some side-effects so we try to cut things down, go slower. And we’re gonna kinda reconvene and work on supporting detoxification, but person had dropped out. Now, the problem is, to have expectations that things will work off the bat when so many things are wrong like that, expectations are incorrect. So  a lot of people they have preconceived notions even if you spell it out to them and you let them know, “Here’s where we’re at now, here’s where we’re going.” They forget because they—they want it done now. And they think because things didn’t work in that initial uhm—in that initial experience, that there is no way to fix it. So continuing to harp on patients in managing their expectations, even though they have a lot of stuff they’re projecting from past failures, we kinda have to get through it. Make sure expectations are real and that make sure they know, “Hey, here’s where we’re going now. Here’s where we’re going next.” These things ahead that may have to be dealt with for us to really see great changes.

Evan Brand: Yup. Well said. We got another question here.

Dr. Justin Marchegiani: Let’s hit ‘em.

Evan Brand: Let’s hit Steve’s question. After all GI infections are eradicated, how long does it take the gut to fully heal? All my infections are gone, but I’m still dealing with IBS, leaky gut and issues after H. pylori.” I’m gonna hit on this first Dr. Justin Marchegiani, if you don’t mind.

Dr. Justin Marchegiani: Yup. I know you’re gonna say it, by the way.

Evan Brand: Okay. So – haha if—

Dr. Justin Marchegiani: If you say it—If you say it, I’ll—I’ll tell you that.

Evan Brand: Okay. Alright. Please. Alright. So here’s what I’m gonna say. You say all your infections are gone, but you’re still dealing with IBS, leaky gut, and issues, I would like to know what test was this that says all your infections are gone because I bet all of your infections are not gone.

Dr. Justin Marchegiani: Yes! Whoo! I knew it. Yeah. You’re totally right.

Evan Brand: Haha

Dr. Justin Marchegiani: Yeah. You’re totally right. And then also, just making sure that you have the digestive nutrients on board to help heal the gut lining and the digestive support to break down the food and then I would make the food more—more palatable right now. I’d be looking more at the GAPS or an SCD or more of a soup or broth approach that makes the food really easy to take in. No raw veggies, uhm—try to keep it really palatable so the body can access it without much stress.

Evan Brand: Alright. So the beauty of the Internet, Stevie says—Stevie replied and he says, “DRG” Well, uhm— Justin–

Dr. Justin Marchegiani: It’s missing a lot of them. It’s missing a lot. You gotta do the DRG with the GI map. I a—I never do the DRG by itself for the most part—always both. You gotta do both.

Evan Brand: Yup.

Dr. Justin Marchegiani: And if there’s still an issue with the DRG and the GI MAP, I want them go for the  41 side-by-side.

Evan Brand: Yup. Agreed. So, Stevie, not that—you know, we’re not diagnosing you. That’s not what these calls are for. But, hey, Justin and I have seen a lot of false negatives with DRG and some other test out there. So potentially some stuff going on. And I would like to add a couple of points about like the—the issues, the leaky gut type stuff. You know, make sure you are doing some of the easy supports, too. You know, chamomile is great. You can do chamomile in a supplemental form. You’ve got chamomile teas, uhm—you’ve got L- glutamine. So there are some leaky gut supplements that why your til—still trying to figure stuff out, you can still be taking support of nutrients in the meantime while waiting for retest.

Dr. Justin Marchegiani: Absolutely. Totally. Let’s hit  the uh—last question there by—E Center Riley. See here, just diagnosed with Hashimoto’s, TPO and TGB bodies, 465 is that high? Eliminated the foods, gluten, dairy, soy, balance in blood sugar, hard with 5 kids. What should I focus on next? So 465 is definitely high. The LabCorp reference range for TPO is 34. Anything 34 above is considered positive—I think it’s above 34. 34 below is considered positive. And anything about 20, for me, I considered to be subclinical. So that is high. Anything above or around 500 is definitely high. I’ve seen patients at 2000, though. I’ve seen patients that go from 2000 to below a 100. Now, my goal is to get people—If I were you, I’d like to see a 70 to 80% reduction in that. Again, maybe you were higher before you made those changes. So I’m not sure if it was  gluten, dairy, soy. That stuff was cut out and then you saw the drop. But either way, uhm—getting enough selenium in there, 400 micrograms of selenium, addressing the underlying infections, things like H. pylori, Blasto and Yersinia can be coming to increase the antibodies. And then making sure the adrenals are looked at. There’s a strong adrenal-thyroid connection and a lot of people who have thyroid issues also have adrenal issues. And remember, TPO is a microsomal or essentially it’s uh—intracellular microsomal antibody that helps bind the thyroid hormone together. So if you’re making antibodies to that, it’s gonna prevent that thyroid hormone that I—Iodination process from occurring. So making sure we have the adrenal support there because the adrenals help produce cortisol. Cortisol is an anti-inflammatory that’s gonna help with the inflammation. And with the TPO there uhm—you could potentially have increase in hydrogen peroxide, especially if there’s small amounts of iodine getting in there. So get them the selenium will help neutralize that hydrogen peroxide into H20. High quality H20 which is uh—not gonna be as inflammatory.

Evan Brand: Well said. Yeah. And so uhm—Isabella Wentz, I just did podcast with her a couple of weeks ago. Actually that was my last uploaded episode. And uhm—we’re talking about bacterial infections, too. So you mentioned some of the parasites and she’s seen the same thing the parasite but also the bacteria. The Klebsiella, the Citrobacter, and all these autoimmune triggers has been bad guys for uh—these Hashimoto’s situations and these antibodies, so—

Dr. Justin Marchegiani: Yeah.

Dr. Justin Marchegiani: So, look for the bacteria, too, and you can definitely fix this stuff and you can make significant progress.

Dr. Justin Marchegiani: Absolutely. I mean one person here, wildlab access, “How do you test for various enzymes?”Number one, if you have gut stress, you probably have low hydrochloric acid. And if you have low hydrochloric acid, you probably have low enzymes. Why? Because hydrochloric acid is important for acts of—for converting pepsinogen to pepsin which is the proteolytic enzyme. Hydrochloric acid lowers the acidity of the chyme, which is the mixed up food in the intestine. That inten—that food that chyme that goes into the small intestine which the acidity then triggers the pancreas to make bicarbonate, it also triggers CCK that then caused that the gallbladder to produce bile that also stimulates the pancreas to make light based trypsin and chymotrypsin and all the enzymes that come down. So if you have enzyme issues, you also have hydrochloric acid issues, but we can also assess it by looking at enzyme markers, like elastase, too, which will uhm—look at that in the DRG or the GI MAP test.

Evan Brand: You better get that frog out.

Dr. Justin Marchegiani: Frog out. It just attacked me, man. I’m like, Ugh—

Evan Brand: Alright.

Dr. Justin Marchegiani: My water—so uh—yeah. Elastase, I think it’s elastase 1 is the enzyme marker we typically look at for uhm— low enzymes. But typically, just assuming that we have digestive stress, let’s assume it for sure.

Evan Brand: Yeah. I mean that’s the same—the same answer that I would say for the leaky gut. I had people say, “Oh, can you test me for leaky gut?”  It’s like, “Yeah. We can go to Cyrex and spend 500 bucks if you want to, but based on your symptoms, I guarantee there’s intestinal permeability. You’ve got XYZ. And we can—we don’t need to spend the 500 bucks on that test. Save your money for the organic acids, your comprehensive stool panels, the GPL-TOX, maybe heavy metal testing. Save your money for that stuff that you can’t really guess on.

Dr. Justin Marchegiani: Yeah. Absolutely. I agree, man. Well, anything else you wanna hit off the bat here? I mean I think—I had some really good successes last week, too, with some patients that had chronic pain, chronic mood, chronic energy, hair loss. And I mean—just really simple things. We—we fix their hormones, this person has autoimmune thyroid, uhm—hypothyroid as well. T3 was super low, it was uh– T4 to T3 conversion issue, dysregulated cortisol. They had a lot of malabsorption and they had a couple of infections and we just—we just took them down the map. An then just everything first time around, uhm—just knocked in place. I mean it’s like you swing the bat once and it’s connected. It’s gone. Those were the patients where its like, “It’s just so rewarding coz it’s just—it’s easy” And then you have  some patients where it’s a lot more trial and error and digging in. So it’s nice to have those home runs every now and then.

Evan Brand: Oh, man. I—so I had a home run earlier with this guy that I got off the phone with name Dion. And he was on an inhaler. An asthma inhaler.

Dr. Justin Marchegiani: Yeah.

Evan Brand: And also I believe he was taking uh—allergy medication, like a prescription allergy medication.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Maybe it was one or the other. He alternated or he was on the inhaler something. But he was on prescriptions for allergies. And all we did is we cleaned up the diet, we’ve addressed some gut infections. He had candida and I believe a couple bacterial infections. I don’t believe he had parasites. I have to look back. But I remember a couple of infections, fix the gut, uh—supported adrenal’s basic adrenal support, some adaptogens. And I talked with him today and he said, “Evan, I’ve not used my medication in the last six weeks. And everything is blooming here right now. All the trees and plants and everything are blooming and normally, I’m debilitated. He said, “I’m completely fine.”

Dr. Justin Marchegiani: Isn’t that awesome?

Evan Brand: How in the world just by working on the gut and adrenals am I not allergic to the environment anymore? It’s just like, “Oh, it makes me feel so good.”

Dr. Justin Marchegiani: I see that all the time, too. And hydrochloric acid is one of those things that’s really great with allergies, too. You notice that?

Evan Brand: Ain’t that weird? I mean since digestive enzymes, I told him, I said, “Man, we’ve gotta keep up digestive enzymes.” And then actually I am gonna send him a bottle of some of the like natural herbal anti-histamines, just in case. Because he started sneezing on the phone. I’m like, “Whoa, maybe you’re not all the way out of the water yet. Have this on hand, in case you need it.” So the coresatin in, the rutin, some of those–

Dr. Justin Marchegiani: Hesperetin

Evan Brand: Yeah.

Dr. Justin Marchegiani: The things I love for allergies: number one, just really get a good air filter. I used one by Advanced Air. You can see that at justinhealth.com/shop Look at the approved products. I like it. It’s good. Uhm—and then your natural anti-histamine degranulating compounds. In my product, Aller Clear. Stinging Nettle, coresatin, and then you’re gonna have like some vitamin C in that, some potassium bicarb as well. So those are really good. And you can go up to eat. The nice thing about it, just not gonna be drowsy. So you can get that allergy support without getting the drowsiness and then really make sure the diet is anti-inflammatory. Up the hydrochloric acid because HDL is really important with low—with allergy. It’s gonna make a big difference.

Evan Brand: Yup, Yup.

Dr. Justin Marchegiani: Ginger. Ginger is phenomenal, too, for allergies. Really good.

Evan Brand: I love ginger. So it’s a great nutrient. I’d do teas, ginger kombucha, there’s so much you can do with ginger.

Dr. Justin Marchegiani: Oh, yeah. By the way, right after this, I’ve got a new grill. So I’m gonna go out, I’m gonna grill some grass-fed hotdogs, right? And then I’ve got some sauerkraut with mustard. And I’ve got a nice ginger kombucha, I’m gonna open up. So I’m really excited for my lunch break today.

Evan Brand: Nice. What kind of grill? Is that one of those  pellet jobs?

Dr. Justin Marchegiani: I actually—I got a new Webber just because it’s—it’s—my other one was 10 years old. And then the knobs are starting to go. So I got a nice, little Webber Spirit. So it’s great. It’s got three burners. Love it. And uhm—I got a smoker that I use sometimes for ribs on the weekend just like a 4-hour job. So it’s good to have a day or an afternoon to kinda be at home to enjoy that one but—Yeah. So love my grilling. Try not to get things charred. Try to keep the heterocyclic amines and the polyaromatic hydrocarbons to a minimum.

Evan Brand: Agreed. Agreed, man. Cool. Well I don’t have one on my end.

Dr. Justin Marchegiani: You wanna have a share?

Evan Brand: No.

Dr. Justin Marchegiani: Hope you guys are liking these calls here. We wanna do more. We wanna connect with the listeners. Our purpose really is to serve and help people get their health back. If people want more feedback, or want more kinda like rolling up the sleeves and specifically diving into your case, go to notjustpaleo.com or justinhealth.com, click on the schedule buttons. And we are here to help you out. Evan, anything else, man?

Evan Brand: That’s it. Have a great day people, drink clean water, get rest, reduce stress, be grateful. It’s gonna go a long way.

Dr. Justin Marchegiani: And people on Facebook, I’m hoping we can get Evan on here soon. We gotta just  figure that out. So hopefully, soon we’ll do that. So Evan, great chatting with you, man. We’ll talk soon.

Evan Brand: Take Care. Bye.

Dr. Justin Marchegiani: Bye.









Putting together the optimal functional medicine program – Podcast #116

Dr. Justin Marchegiani and Evan Brand discuss about effective functional medicine programs and how they create and follow protocols. This interview goes in-depth about the world of functional medicine practice.

functional medicine programsFind out why you shouldn’t wait for something to happen before doing anything about it health-wise. Discover the differences between Body System One and Two and how optimal health can be attained. Learn about the various tests you can take and the right tools that are available to further achieve better and more effective results with functional medicine.

In this episode, topics include:

01:26   Get help as early as possible

07:00   Body System One

10:19   Diet and lifestyle

17:16   Body System Two

38:22   Tests







Dr. Justin Marchegiani:  Hey, Evan, it’s Dr. J in the flesh. How we doin’ this Monday?

Evan Brand:  Hey, man! I’m doing great. How are you?

Dr. Justin Marchegiani:  I’m doing great. Can’t complain. It’s a little rainy Monday here in Austin. The grass is getting plenty of water which is great. I got the fireplace on behind me, so it’s got that wintery Christmas feel a little bit.

Evan Brand:  Nice. Excellent.

Dr. Justin Marchegiani:  Can’t complain. How about you?

Evan Brand:  Doing well, man. Hey, we were trying to record this thing, and then we had choppy audio so I wanna repeat what my little rant was because I thought that was important. I’m always curious about what is the catalyst for someone to work with yourself or myself, and I had a lady this morning who had been listening to us for six months and she knew that she had problems. She had a lot of gut issues going on but she continued to just listen to try to fix herself, and then she got the diagnosis of alopecia and now she’s lost over half the hair on her head, and now she’s figured out that that’s the time to come and get help. And I just want that to be a fire under people’s butts listening that you shouldn’t wait until things are so bad that you’re at rock bottom before you get help and unfortunately, that’s the conventional system that we’ve all been brainwashed to do which is we wait until we’re really bad, we absolutely need a doctor or practitioner and then we go get help. And my advice, get help now. If you have symptoms and things are off, and this is something you’ve—you’ve trained me on so much. It’s like, “Evan, look, these issues are not gonna resolve themselves. You have to resolve issues now. They’re not just gonna magically disappear.” Did you wanna speak on that a little bit about people just waiting too long or people just not having enough reason so they think to get help?

Dr. Justin Marchegiani:  Yeah, well, there was an interesting scenario just the recently. There was a plumber in my house a few months back and he was doing some work, and there was just like a leak on the faucet, and for some reason the leak went away the next day. So there were two plumbers there and he goes down and looks, and he couldn’t find the leak. And he goes, “Well, maybe it just went away,” and then his partner, the plumber next to him spoke up and said, “You know what? Leaks never go away on their own. If there’s a leak, it’s gonna get worse.” So he went down there and he looked, and he said, “Okay, well, we just need more flow and if you had more flow coming, it would start to leak.” And he looked a little deeper back and he found the leak and just the environment wasn’t quite right enough for the leak to be expressing itself but the whole idea was that these problems don’t ever tend to go away by themselves. So that was kind of the moral of the story and connecting it to your patient, let’s say if you have these symptoms, they’re gonna get worse and the question is, how long do you wanna wait until those symptoms, right? Pain, pay attention inside now—that’s what symptoms are—whether it’s aesthetic, whether it’s inflammatory, whether it’s mood or energy. How bad do they have to get before you start getting a—a fire under your butt so to speak.

Evan Brand:  Right. Well, and my grandparents, their old house, you know, they had issues with their plumbing and they had to wait until their entire basement was flooded and thousands and thousands of dollars’ worth of carpet and furniture was ruined due to the flood before they came in and got the issue. So maybe they saved, you know, a couple hundred bucks in the beginning, but then it cost them likely $10,000 or more in the long run because they waited until things just hit an absolute worst-case scenario. So you know, I know there’s a lot of people out there listening that are trying to fix themselves and you and I certainly applaud that. I mean that’s what this is all about, right? Taking your health into your own hands and us teaching you how to fish, but at a certain level, you really just have to reach out and—and don’t be afraid to get better and—and don’t be afraid. You know, we’re real people. We don’t bite and we’re here for you. That’s what this is for. The show is to inspire you and to help you, but there’s nothing that’s gonna replace a one-on-one, you know, with one of us because there’s so many courses and online things, and things that you can look into, but it’s not specialized and I’m against specialization if you only look at one person. But you know, something we’re gonna talk about today is functional medicine is a specialty but we’re breaking that down. We’re—we’re looking at someone. We’re casting a net wide enough to look at every body system, so that we’re gonna figure out what in the world going on with somebody.

Dr. Justin Marchegiani:  100%. And so the template for how we treat patients is pretty unique for—for us as functional medicine clinicians, right? There a lot of nutritionists out there that will primarily just focus on the diet piece. There are a lot of medical doctors out there that I find that will a lot of time skip the diet, maybe focus on more of the hormones and ignore the gut. You have other people that will only work on infections, whether it’s Lyme or a gut doctor. They’re only focused on the infections. So the question is, how do we become the general or the ultimate general practitioner, where we can pull the key issues from the infections, from the hormones, from the diet, from the lifestyle, from the digestive system, and combine them together and mesh it? So we put it all together in a way that is holistic, that represents the underlying cause from each person, because that underlying cause percentage-wise may be different for each, meaning one person that may be 60% diet, 30% infections, and 10% hormones, and others it may be 30% diet, 50% hormones, 20% gut. So you gotta look at it from the perspective of what piece may be the bigger player, and it may not be the same for each person. So we may not know, but if we hit them all in the order that we consider to be the order of priority, that’s gonna give us the highest chance of hitting all of those key issues and not missing them.

Evan Brand:  Right, and during the free calls, you and I block out just a few hours each month for free calls, which we’re always booked up for those and it’s a true honor to be able to offer that to people.

Dr. Justin Marchegiani:  Absolutely.

Evan Brand:  A lot of people ask us, “Hey, Justin or hey, Evan, you know, can you just tell me right now what tests we’re gonna need to run.” And we can’t because that involves a case review, that involves looking at your history, looking at the fork in the road when did things get bad, how long have things gotten bad, what else was going on at that time in your life in terms of stress and travel and relationships and moving. You know, so there really is no one-size-fits-all program. Now there are similar tests that we run on nearly everyone, but at the end of the day, it’s so case-by-case and I know people wanna just get put into a box because it makes them feel comfortable. I mean, think of like Weight Watchers, right? You know, it’s a point system and you can buy their little hundred-calorie snack packs of pretzels. But that’s a horrible box to be in and you don’t wanna be confined there. So it—it’s a box of functional medicine but it’s a box without boundaries, too, because we never know what toolbox or toolkit we’re gonna need to reach into to pull something out specifically based on—on your symptoms.

Dr. Justin Marchegiani:  100%. So we wanted kinda get things dialed in, and we have like the pallet of our tests that we may choose from for body system one. That’s like the hormonal system and we break that up into ATF and ATM, adrenals, thyroid and female hormones for our female patients and then our ATM, adrenals, thyroid and male hormones. And depending on how deep we go is depending upon what kind of symptoms present themselves and how long the patient’s been sick. Typically, the longer someone’s been sick, it may be better to get more data so we can fine tune the plan better, more specific to what’s going on. If someone’s been maybe not feeling good for just a little bit of time, maybe only a few years or a few months, we may run less off the bat because we don’t need as much data. Typically, the low hanging fruit tend to work on people that aren’t as chronic. So that’s kind of a good rule of thumb. So our body system one test are gonna typically include high-quality adrenal tests. Well, and that depends. I know we’re going back and forth and testing, you know, the new Biohealth saliva test that’ll be out soon. We’ve been using the Dutch for a bit of time. We have been using the old Biohealth 201. I have lots of patients that come in with other subpar salivary hormone testing that—that come in. We also look at the DHEA sulfate, which is an adrenal marker of sex hormone precursors from the adrenals, DHEA sulfate. And then we’ll also add on female and male hormones to those tests, whether it’s female hormones, progesterone, estrogen, estrogen metabolites, the different kinds of estrogens, estradiol, estrone, estriol, whether we are looking at the DHEA metabolites like androstenedione or etiocholanolone. Those also get factored in, maybe even melatonin as well. So we’ll look at all these different metabolites on the hormone side and then depending on if they’re showing with thyroid symptoms, we may even run a thyroid blood test or we’re looking at all of the thyroid markers, TSH, T4 Free and Total, T3 Free and Total, reverse T3, T3 uptake, and thyroid antibodies. So those are kind of all of the hormonal tests that we may run. And we even have some different. We may even time it up on day 20 of a female cycle if they’re—if they’re menstruating to get a window into where their hormones are tapping out. We may even look at a full month long panel, testing hormones every other day for a full month, so we can get a window of ovulation and the ebb and flow of the hormones throughout the month, just to make sure it’s optimal for fertility.

Evan Brand:  Yup, well said. So body system one. I mean, this is the foundation, you know. You talk about these people that just focus on the gut and we’ve dealt with that. I mean a lot of times and I know you hear this just as much as me if not more, “Oh, I’ve already been to 10 specialists or 20 specialists or 20 doctors. They all think I’m crazy or they said it was just the gut. They gave me antibiotics.” If you don’t get the hormones aligned and checked out, you’re kinda wasting your time really because if you have cortisol issues, you’re likely gonna have leaky gut issues which is gonna leave you susceptible to infections. So it’s like if we come in and just hit the gut, which we’ll talk about in a minute, body system two, it’s not really worth it, right? Because if you get the infection gone, but the leaky gut’s still there due to the cortisol issues, I mean, that’s kind of a bigger top of the food chain issue, right?

Dr. Justin Marchegiani:  100% and just backing up one bit, everything sits on a foundation. So the introductory foundation for everything is diet and lifestyle.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And we’ve talked about this before, but just to make sure we don’t miss it, the foundation is gonna be what you eat, when you eat, the quality of food that you eat, how you sleep, how you move, how you deal with stress, and hydration. So that’s gonna be a really important piece of the puzzle. Making sure we’re eating nutrient-dense, anti-inflammatory, low toxin foods. Making sure the diet is dialed in for you. Now what does that mean for you? Well, if you’re just a little bit sick, maybe you’re kinda in the middle, it’s not too bad, a Paleo template may be good to start with. Alright, no grains, no legumes, no dairy. If we’ve been sick for longer, maybe we have a history of autoimmunity in the family, or there may be known autoimmunity in yourself or known autoimmune symptoms, well, the next step may be an Autoimmune Paleo template where we go to the next step which is cutting out nuts, nightshades, and eggs. And then from there if there’s excessive gut issues, we may look at specific carbohydrate diet where we cut out salicylates and phenols and peel our vegetables and—and make sure everything’s well cooked and mash our foods. We may even look at a GAPS approach where we focus more on bone broth and soups and—and the same type SCD stuff, more in a liquid, palatable—a liquid, more palatable type of form. And we may even go to a low FODMAP diet where we cut out the fermentable carbohydrates–fermentable oligo-di-po—let’s see, fermentable oligo-di-mono and polysaccharides. So it’s your—your fermentable carbohydrates, your fermentable sugars. So we may add that piece onto it just to make sure that we’re taking as much stress off the body. We’re stabilizing blood sugar. We’re not adding toxins from the pesticides and chemicals and GMO and Roundup and—and the glyphosate and we’re stabilizing blood sugar. We’re not skipping meals and we’re making sure that we’re sleeping good at night and we’re hydrating appropriately in between meals or 10 minutes before, so we’re not diluting digestive enzymes and hydrochloric acid.

Evan Brand:  Well said and there’s a ton of overlap in all of those, too. I mean–

Dr. Justin Marchegiani:  A ton.

Evan Brand:  You’re going to be omitting gluten. You’re gonna be omitting–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Many of the dairy components, the inflammatory component, then you’re going to stay away from pesticides and chemicals. I had a guy the other day. He asked me. He said, “Well, I’m not sensitive to gluten. So do I still have to avoid it?” I said, “Absolutely.” There’s no deficiency of gluten ever and just because you don’t think you’re sensitive to it, some of your skin rashes and all that is probably caused from some type of food intolerance. You know, you don’t have to be doubled over in pain from eating a bagel to—to necess—you know, to necessarily have to stay away from it, right? You don’t have to be falling over, needing a morphine shot due to the pain from gluten if you—if you have anything, any symptom, headaches. I mean I had a lady who had migraines for 20 years and it was amazing how simple it was just to get the diet and the gut cleaned up and the migraines went way. So I think people expect massive, massive symptom sometimes to be caused from gluten and otherwise, they don’t wanna get rid of it but you should just get rid of it.

Dr. Justin Marchegiani:  Yeah, my thing with grains and gluten is if you’re gonna cheat and you’re gonna do grains, number one, the safest grain for most people tend to be white rice. So that’s tends to be an okay alternative if you’re gonna do a grain, if you’re gonna cheat. White rice tends to be okay. Even better, try doing the safer starch. You know, yucca, plantains, sweet potatoes, let’s see—I said plantains, yucca, sweet potatoes,  squash—those type of safer starches tend to be a better alternative for most. Go ahead.

Evan Brand:  Yeah, I was gonna say taro, too. Some people talk about that.

Dr. Justin Marchegiani:  Taro, arrowroot, yeah, and then also if you’re gonna—like let’s say you’re like, “I’m gonna do bread.” Well, sourdough bread has actually shown to have less gluten because of the fermentation process that gliadin protein tend to be more dissolved in the fermentation process. So if you’re gonna go get all glutened out, take a look at the good, better, best side of it, right? Good or best would be abstaining and doing zero grains. Good may be doing like white rice or better—sorry, better maybe doing like white rice or something that’s fully gluten-free. And then third would be, alright, fine. You’re gonna do a gluten bread, well, it’s gonna at least be fermented, i.e. sourdough bread. It’s fermented, so the gluten and the compounds in there that may be more allergenic are decreased. But the other things–

Evan Brand:  Right.

Dr. Justin Marchegiani:  That Evan and I still wanna touch upon are the lectins, are the phytates and the oxalates, the mineral disruptors, the protein disruptors, and the high amount of pesticide and Roundup that are on some of these products. So you can at least reduce it by going organic and by going the sourdough method so it’s at least fermented and soaked, so the grains are gonna be more palatable and not have the mineral and enzyme disruptors. But again, better, right? Good, better, best. Best is gonna be at least keeping the grains out. Good or better part is gonna be in between, going like a rice protein and then like, you know, good would be doing the fermented sourdough bread option like I just mentioned.

Evan Brand:  Yeah, and put it this way, it helps me sometimes to understand kind of the ancestral or the planetary perspective on this. These plants and these grains, they don’t want to get eaten–

Dr. Justin Marchegiani:  Oh, yeah.

Evan Brand:  And digested, right? I mean, they want to pass seed on through an animal and then it come out fully digest—or un—you know, undigested, fully undigested, so that that seed can go back into the ground and grow more grass or grain. I mean, that’s the goal with birds and humans, too, if it goes through and it’s not getting digested, the goal is for that seed to be intact enough to grow more plants, and they don’t wanna get eaten.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  So that—that’s enough reason there that—that makes sense and really help me. But like, “Oh, man. Wow. Okay.”

Dr. Justin Marchegiani:  And it’s pretty simple, right? You know, from evolution standpoints our role, I mean, it sounds crude is just to be able to pass on our—our seed to our offspring, right? That’s pretty much it. You know, be able to survive enough so you can procreate and pass on your DNA to your offspring. That’s pretty much it. Now there’s two ways of doing it. There’s having claws and weapons and tools and teeth, so you can prevent getting attacked on or preyed on, right? That’s like the wolf or the fox, or maybe us with our weapons as humans. And then there’s the, “Okay, I’m gonna get eaten, right?” Berries, grains, but there’s gonna be seeds and things that are gonna keep the seed and the DNA intact, so eventually maybe it will go back and be able to grow again and pass on its offspring so it can live again, right? So there’s two methods. It’s either you’re gonna fight now or you’re gonna basically submit but live the fight another day by passing itself back into the soil again so it can grow.

Evan Brand:  Yup, yup. Should we move on to body system two?

Dr. Justin Marchegiani:  Yeah, and then last piece that is the foundation with the diet, I’d say is also the emotions. So if there’s a lot of emotional stress, like there’s an active serious relationship issue. You know, not just like hey, you know, you had a fight here or there but you have active relationship problems. Maybe there’s an active divorce issue. Maybe you’re real problem with the child or a family member or maybe a death of a loved one or serious work stress, or stress at your church or where you go to—to have a spiritual connection, or you excessively exercise a ton, right? Those kind of things need to be looked at because they can provide a lot of stress underlying. So we wanna make sure there’s not an active emotional issue because it affects the timeline in which we expect healing to occur. If you’re actively going through a divorce or you’re having serious work issues, we may say hey, our goal is gonna be just to dig out feet in and prevent us from sliding downhill, and we may not be able to gain a whole bunch of ground going uphill.

Evan Brand:  Well said, yeah, and I’ll also mention the electromagnetic fields which I’ve done–

Dr. Justin Marchegiani:  Oh, yes.

Evan Brand:  Countless podcasts on. I had a lady the other day. She heard a podcast about EMF that—that was on the show and she bought a meter online and anything above 1 milligauss, a measure of magnetic field is bad, right? And this lady had 50 milligauss in her bedroom. And so she lives in San Francisco. She didn’t believe it. She called the power company as I told her to do and they came out and they measured, and sure enough, it was about 25 or 30 milligauss. So her meter was pretty inaccurate, but it was accurate enough to detect a problem that warranted further investigation. And even the power company was like, “Well, this is insanely high.” I mean, you’ll see some people that say anything above 3 milligauss of magnetic fields which comes from power lines is—is bad, but either way, 20, 50, that’s insane and so she’s moving immediately and she said she hadn’t slept well for months and kinda like my story that you and I chatted about when I had to move. I was measuring 7 milligauss in my office and I feel like I didn’t sleep. So I mean, that’s another cause of adrenal hormone issues that you and I are discussing and talking about with people because it’s—it’s an invisible smoke, right? If you had glasses that you could wear and see this stuff, everybody would freak out. But it’s invisible. And like my friend Eric Windheim says, “It’s like fighting a ghost.” So you have to measure this stuff and—and mitigate it, and there’s more. We won’t go into more detail today, but just check out EMF in the search bar on the website, and you’ll be able to find, you know, more episodes.

Dr. Justin Marchegiani:  Absolutely. So we addressed the foundational pieces, diet, lifestyle, emotional stress, meal timing, nutrient density–

Evan Brand:  Environmental.

Dr. Justin Marchegiani:  Toxins from the chemical. Toxins are essentially—the electromagnetic toxins, right? That’s kinda in that toxin realm.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  We hit that. We talked about the hormones, ATM, ATF. And then next step is gut function/gut infections. Now typically when we start out with the diet piece, depending on what’s happening symptomatically, if we see a lot of reflux, a lot of bloating, let’s say we have a history of vertical ridging in the nails or we see a lot of undigested food particulate or the stool looks grayer or the stool floats or we have poor hair quality or very dry skin, these are all symptoms that we’re not digesting our food optimally. So to support the diet piece, we may bring some of the digestive support up forward, and bring it into intro phase. What I mean is we may bring in some of the hydrochloric acid, some of the enzymes, some of the bitters, some of the digestive support to help stimulate digestion because we see that as supporting the intro phase. We’re working on digesting foods and making sure that piece is dialed in. So that may have to be brought up forward because it’s—it supports the foundation. That’s number one. Number two is we have to knock out the infections. So as we look at body system two, we really break it down into 5 steps. So number one is remove the bad foods. Number two is replace the enzymes and acids like I mentioned. So that’s the digestive support to make the intro diet piece work better. Number three is repair and repair means repairing the adrenals because we have to make sure that piece is there. because we don’t wanna work on really healing the gut, until we have the hormonal environment dialed in to help reduce inflammation and help heal the gut lining and help improve IgA levels, which is the localized immune system in the digestive tract. We also wanna make sure healing nutrients are present for people that have extra gut inflammation or extra gut irritation. Things like L-glutamine and the healing nutrients, the licorice root, deglycerized licorice root, maybe slippery elm, maybe cat’s claw, maybe some gentle amino acids like L-glutamine, and Jerusalem artichoke, etc. These are healing nutrients that help that gut lining. Number four is the removing of the infections and we’re able to remove the infections most adequately because of the 3 phases before it. Because of the removing the foods, the replacing the enzymes and acids, the repair in the gut lining and the adrenals, now we can come in and we can start working on removing the infections, and the infections are gonna be specific to the stool test we recommend to pick up the infection. So the H. pylori comes back or fungus comes back or various multiple parasites come back, those all need to be specifically addressed with unique protocols for each. And then number five is going to be the re-inoculation with robotics, really receding all of the good seeds after the weeding’s been done. And then number six is gonna be the retesting to make sure one, infections are cleared and two, there are no new infections as last podcast talked about, making sure there are no resistant infections that were burrowed in deeper that are showing their ugly head, and the only exception will be adding probiotics in the repair phase. Because sometimes probiotics can have an anti-inflammatory effect, and depending on how bad the gut is, we may add some probiotics in the ref—the repair phase as well as the reinoculation phase to help support gut healing and inflammation.

Evan Brand:  Well said. I wanna speak just for a minute and see if you wanna add anything to it about the topic of antibiotic use and infections. There’s a lot of hate on the Internet about herbal remedies for infections, you know, whether it’s an M.D. or a naturopath or someone. You know, getting in an argument about saying, “Oh, herbs don’t work. You have to use triple therapy or this antibiotic or this antifungal prescription.” And there’s very, very, very, very few cases where it takes us more than one or two rounds to get rid of an infection using just herbs, no prescription. So could you add something to that conversation, too? I would 95% of patients can address their gut function and their got infections with herbs alone. 5% of the time we may have resistant bugs that we’ve treated, re-test, still there. Treated, retest, still there. Treated, retest, still there. And it’s 2-3 times and we’re not able to knock it out. But I’ve had people go and on the third time, we knock it out. So the antibiotics may be an option for some people. The conventional antibiotics that are typically run like the metronidazole, the Flagyl, which are the most commonly prescribed ones for these infections tend to miss the infection about two-thirds of the time. And then a lot of times the antibiotics prescribed for your typical triple therapy for H. pylori like clarithromycin, amoxicillin, and/or omeprazole like Prilosec, acid-blocking medications, tend to do the same kind of thing. They’ll miss the infections a third half the time.

Evan Brand:  Well, what about this, too? What about creating more resistant strains due to the antibiotics that have been so overused? Which then makes our job a little bit tougher because people have gone through rounds and rounds of this crap and it’s done nothing.

Dr. Justin Marchegiani:  Exactly. That’s the problem is you run the risk of having these antibiotics not work in the time where maybe you really need them, like you get in a car accident or you step on a—a rusty nail or some, some kind of infection that’s more acute and more severe based on the exposure of the microbes. So I’m always about conservative to invasive, right? What’s the most conservative type of care off the bat? It’s always gonna be diet. It’s always gonna be lifestyle. It’s always gonna be using antimicrobial herbal medicines that have been around for literally thousands of years to have a strong safety profile, to have the ability to use them long-term without resistance–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And also aren’t gonna wipe out a—as many other microbes, any other beneficial microbes the may be present that are helpful for your gut. We won’t wipe those out and create more problems. I can’t tell you how many patients I’ve seen that have been on antibiotics and had devastating side effects, and now we’re treating them from the damage caused by the antibiotics in the beginning. I’ve seen it so many times. Don’t see it with herbs though.

Evan Brand:  I know.

Dr. Justin Marchegiani:  But I see all the time with antibiotics so I’m always very conservative and we go up in—in gradations on what step one is. Herbs. Step two. Herbs. Step three. Maybe herbs. And then if we’re still having issues, then we go and we lean towards the antibiotics, typically on step three most of the time.

Evan Brand:  Yup, yup. Well said. And just the fact that this has been used, the herbs that we’re talking about. They’re been used for thousands of years before antibiotics were invented. To me that says something about the success rate and the safety. So when people read concerns about herbs. A lot of times the concerns are unwarranted unless you’re talking about mixing herbs with pharmaceuticals, like you know, 5HTP and SSRIs and stuff like that. Yeah, you can get into trouble. But generally, there’s really nothing to be concerned about compared to the tens and if not hundreds of thousands of people dying due to medical error. That’s now the third leading cause of death. Did you know that? Medical error.

Dr. Justin Marchegiani:  Wow.

Evan Brand:  So—so this—this is real. This isn’t something were just saying on our—on our high horse. You know, this is for real. Look at CDC death or medical top causes of death. You’ll see medical error and this is from the proper, you know, or this is the prescribed rather is what I meant to say, the prescribed dose of a medication is still causing third leading cause of death, is medical error.

Dr. Justin Marchegiani:  Yeah, I know. I know Barbara Starfield has her prized article in the Journal of the American Medical Association 2000, all on how much medications and surgical procedures done correctly, right? Hey, the surgery was a success but the patient died. Hey, the prescription was—was perfect according to what the patient’s symptomatology was, but the patient had an ulcer and died, right? Just like that happens with ibuprofen 19,000 times a year according to the New England Journal of Medicine. So we know there’s a risk with conventional treatments. So we wanna be as conservative as possible, so we don’t have to go to those type of higher risk procedures.

Evan Brand:  Agreed, agreed. Well said. So yeah, the infections are huge. I mean, Justin and I, we have more podcasts on that talking about our own history with infections. So not only are we in the trenches helping others remove them, but we’re doing it on ourselves, too. So this is—this is a huge piece and has been instrumental for me to get my—my weight back when I’ve lost, you know, 20 pounds of muscle from infections. So this is a real big deal in something that has to be addressed.

Dr. Justin Marchegiani:  Correct, and I think the key thing, too, is we’re not anti-medication.

Evan Brand:  Right.

Dr. Justin Marchegiani:  We’re all about using the correct tool at the right time, but also weighing the pros and cons. Like if we’re, you know, we got our tool bag on or our toolbelt on, right? And we have all these different tools in our tool bag, alright? And we look at this screw and it’s the flathead groove in it, so we know I gotta pull my Phillips head out, right? I’m not gonna look at that screw and be like, “Screw this, my dog must not gonna allow me to use this flathead, throw it away and then try to pull it—the Phillips in there and try to work it.” So let’s say it’s a—a flathead groove, I’m not gonna look at flathead screwdriver and throw it away, and say, “I’m gonna try using a Phillips, right?” I’m gonna go and say, “Well, this is the right tool for it. So I’m gonna put it in and I’m gonna use the correct tool based on what’s presenting itself.” That’s like if you get in a car accident, we’re not gonna look at the patient and say, “Great! Let’s just throw you on some turmeric right now and call it a day.”

Evan Brand:  Right.

Dr. Justin Marchegiani:  No. We’re gonna say, “Go to the ER. Get the correct test to make sure there are no fractures, no bleeds, no hemorrhaging.” You may even want to be on some higher dose pain meds. You may want to avoid the opiate ones, right? Because of the addiction, but maybe some higher those pain meds acutely just because you’re in severe trauma and pain. And then we’ll get you stabilized and then we’ll get you on a really good routine after. So we look at the right routine. If we see that flathead groove, we’re reaching for the flathead screwdriver. We’re not reaching for the Phillips.

Evan Brand:  Yeah, absolutely. And if you break your arm, yeah, you don’t go take a dose of turmeric and fish oil. I mean, you need to get that checked out and make sure there’s no internal bleeding, etc., etc. So there’s no trophy for—for trying to be a hero and dismissing the acute, incredible trauma medicine that—that is offered. You know, it’s just the things we’re dealing with, their 1, 5, 10, 20, 30-year chronic issues and that’s where functional medicine tends to have far superior success rates. You know, 90+ percent success rates that you and I both have.

Dr. Justin Marchegiani:  Exactly, and some of the things that are talked about regarding antibiotics, and I’ll put some of the research in the show notes, but antibiotics can create oxidative stress and mitochondrial dysfunction. That’s a big issue, so the mitochondria is gonna be the powerhouse of the cell which is gonna help generate ATP which is like the fuel currency for energy, and also creates oxidative stress which is just a way of breaking down your body, right? Oxidation, you leave a rusty nail in the rain, it gets all rust or you leave a nail out in the rain, it gets rusty because of that oxidation process. We have internal rusting. Doesn’t quite show itself like that, a brownish rust, but it happens—it happens internally and that creates a depletion of a lot of your antioxidant reserves. So your body has to use up more vitamin C, use up more vitamin E, use up more nutrients that would typically be used for other healthy functions. So oxidative stress and mitochondrial dysfunction are a side effect of some of these antibiotics use. So we really want to make sure if we’re using them—excuse my frog on my throat—we wanna make sure they are used appropriately for the right situation.

Evan Brand:  Well said. Yeah, and I’ll briefly mention, typically for body system two, we’re gonna be looking at comprehensive stool testing. We’ve discussed that. So whether PCR-based testing or otherwise, and then also the organic acids testing. So you hear us talking, maybe it sounds fancy, mitochondrial issues, amino acid metabolite problems, etc. but we can see and I see it all the time. Vitamin C levels, very, very, very low across the board most time on organic acids which is a urine test that you do at home and then you send that back to the lab and then we go over the results and then stool testing, you’re gonna be able to find infections. You’re gonna go through the protocol and then you’re gonna retest and the infections are gonna be gone. So that’s—that’s it for body system two. Let’s go on to body system three, Justin. So detox, methylation, making sure that people are able to actually do things at the end of the line. Once everything has happened, once a good digestion has happened, you’ve absorbed your minerals, your colon’s helping to produce vitamins for energy, your probiotics are doing the things they should be doing, now it’s time to get the stuff out of the body. We’re hoping the liver is gonna be able to do what it can do. We’re hoping you’re pooping, right? I mean, people buy all these fancy detox powders and teas, but it’s like if you’re not pooping but once a week, that’s a huge issue. That’s a great way to detox, poop and pee. How simple and revolutionary is that?

Dr. Justin Marchegiani:  100%. Poop, pee, breathing, and sweating. It’s like un—unreal. So looking at a lot of the detox things, certain nutrients are required to detox. So you can see why number three, why detox is put number three. Let’s just break that down so everyone can get the—understand the concept. Again in this show, we’re really committed to being able to teach concepts because if you get the concept, there’s zero memorization involved in it. Once you get the concept, it’s like riding a bike. You get back on—Boom! You never have to go to that learning curve of falling. So what’s the concept? So number one, if we’re poor foods and eating toxic foods, and foods that are nutritionally poor, what happens to detox? Automatically impaired.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Right? So why are we gonna work on detox off the bat? Because if we just get that first phase done, we’re starting to work on detox even though we’re not working on it directly, because it’s body system three, we already worked on it in the intro phase. Number one. Number two, we actually start breaking down the foods. That means we start breaking down the proteins into their smaller amino acid constituents and we know how important the sulfur based amino acids for operating phase 2 detoxification. Phase 2 is like the n-acetylation, hydroxylation, the glutathione production, the methylation, and we need methionine and we need cysteine and glutamine and glycine and taurine, and all these really important sulfur aminos, and if we can’t break down our protein constituents into those smaller products, you know? Ripping off the pearl necklace and pulling off the individual pearls, that’s what it’s akin to. If we can’t do that, we’re not gonna be able to run phase 2 and then frankly we need lots of antioxidants and B vitamins to run phase 1. So if we have SIBO or dysbiosis, well, our probiotic production internally from our gut bacteria is automatically forwarded or downregulated because we know good bacteria in our gut produces a lot of those nutrients for us, right? Good bacteria eats poop and poops nutrition, B vitamins, antioxidants, nutrients. Bad bacteria eats nutrition and poops poop. Bad bacteria makes you more toxic. So what is the more toxicity from the bad bacteria due to body system three? It decreases its function. So you can see how we lead up to diet and lifestyle. We lead up to digesting food. We lead up to healthy gut bacteria, knocking out infection, addressing the flora, because all of that sets the stage for body system three, so we can come in there and really support the nutrients that are missing, the pathways that aren’t working properly, and we can potentially even knockout specific heavy metals if we see heavy metals are in there with other types of chelators and compounds that pull the metals out. And some of the test we do—well, I’ll take a breath there, Evan. Any comments?

Evan Brand:  Yeah, I mean, well said. I wanted to mention this comes at the end because we want to make sure that everything else has been addressed upstream. I mean we’re not going to go straight to detox if we know that you have infections and we know that you’re still getting, let’s say artificial sweeteners in your diet which can be placing a burden on the liver, right? So we want to see the liver and your detoxification abilities, methylation, this includes anybody with like MTHFR genetic defects. This includes you, too. All that other stuff’s gotta be taken care of first because we want to see what the actual baseline is. Not the baseline when you are doing so much sugar and alcohol and bad fats and artificial sweeteners and all of that that’s got the burden on the liver. So once we get all that stuff out of the way, then we take a look at body system three. It’s the, “Oh, okay, so this is the true baseline,” and then yeah we can look for heavy metals, from dental fillings, amalgams, you know, bad food, bad water, too much tuna fish, other environmental exposures, and then we can start helping to get the detox system working better because if you’re not pooping well and you have an overburdened liver, you’re just gonna be recirculating all these toxins. So then you’re gonna get the joint pain and the allergies and the asthma, and the skin problems, the headaches, the brain fog, alcohol intolerance, I mean, we could go on and on but you gotta get all that other stuff taken care first, so if you go straight to detox or somebody tries to sell you on some detox protocol first when you don’t even know if you have leaky gut or not, I would be cautious and maybe you have more to say about that, but I don’t like the idea of pushing stuff out of people’s body if they don’t even have enough trash men to come gather all of the trash at the end of the road.

Dr. Justin Marchegiani:  Yeah, 100%. So we have everything lead up to it and I think you emphasized the whole leaky gut part right because the leaky gut as you mentioned is really the consequence of all of the inflammation, the inability to break down food, the compromised immune system, and then the infections. All of that will lead to leaky gut. So leaky gut isn’t necessarily a result. It’s more of an effect of all of the inflammation and the damage.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Right? The gluten, the bad foods, all of the inflammation. So that’s kind of the end product that you get there is leaky gut. So looking at everything that you mentioned. How do we quantify it? Because you put some really good points out there. How do we actually know what’s going on from the detoxification side? Well, we’ll look at an organic acid test. Typically as a good starting point because we’ll get a window into various detoxification pathways, whether it’s pyroglutamate or other types of organic acids, sulfate—these are organic acids that will give us a window into how those sulfur aminos are doing. If the demand for them is higher or if they’re depleted. And we’ll also get a window into B vitamin status. We’ll get a window into methylation and we’ll also get a window into oxidative stress by looking at the 8-hydroxy 2-deoxyguanosine for instance. Again, these are all like jeopardy words but these are organic acids that give us a window into all these systems, whether it’s simply xanthorrhoea for B6, whether it’s the amino acids for the brain with vanilmandelate or homovanilate or 5-hydroxyindoleacetate or whether it’s markers for gut bacteria like hippurate or benzoate. So these—these markers give us a big window into what’s happening and the organics can really help tell us what’s happening there from some of those detox nutrients, and we may even look at like a SpectraCell or a NutrEval as well. Again, I lean more towards the organics because that’s my baby.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  The NutrEval combines the organics with another blood test for nutrients, too. So that’s a—another side option which at least does contain the organics and that gives us a good window into what’s happening but we always go back to intro, body system one, hormones, ATF, ATM; body system two, the ability to digest, removing food allergens, healing the leaky gut, repairing the gut lining, removing infections, adding in probiotics, and retesting because we gotta make sure new infections aren’t there and the old ones are gone. Number—body system three is gonna be detox nutrients and that’s typically where we follow suit, and we reserve the right to kinda move some things in. Like if I know someone has a ton of oxidative stress, I may throw some extra vitamin C that we may discover on an organics test, I may throw it in with the adrenal protocol. So we do things and we mix-and-match outside of that box a bit, so if any patients are listening, they may think, “Well, Dr. J gave me some detox support in body system one,” and that’s gonna be dependent upon how that person’s presenting, how sensitive they are, and how bad their detox is. We may add some small things in with body system one, because maybe the adrenal support is too much for their liver, and we need to give their liver just a little bit of support so they don’t have a lot of those hormone side effects.

Evan Brand:  Totally, well said. I’m gonna mention two things and then we can wrap it up.

Dr. Justin Marchegiani:  Cool.

Evan Brand:  One for me on the organics, which I just love is the quinolinic 5-HIAA ratio–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Looking at inflammation because you could go on and on and sound fancy, but when someone sees inflammation and you’re like, “Look, here it is.” It’s like, “Oh, crap.” Because inflammation, you know, even a conventional physician is gonna talk about inflammation as a cause of disease, right? And so when we can actually prove that to a client or a patient, it’s incredible and it’s very profound to be able to do that and then whether it’s 3, 4, 6 months later when the retest comes, and you can see that that number’s gone down, it’s very, very rewarding for both of us, and lastly, the toxin piece, too, something that Justin and I have been talking about a lot and—and I’m running on—I’m running this test on nearly everyone I possibly can–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Including myself is the GPL-TOX so I can look at the toxic load because I bought a sauna based on my toxic load of insecticides, and this is not a challenge or a push test so even the sickest people, we don’t have to worry about doing any type of chelation which may push some stuff out. You just urinate in—in the morning in a cup and you send it off. And the cool thing is you can run it side-by-side with the organics, so it’s literally the same urine sample. All you have to do is spend a little bit extra investment to get both test run organics and GPL-TOX at the same time, and I had insecticide levels in my body that are known carcinogens that were higher than they should be. And so for me, this is a huge, huge, huge new realm of opening up this. Look, we know there’s detox problems. Let’s fix it, but what are we actually fixing. You know, that had always been the question, right? Ooh, there’s detox problems. Man, you got headaches. You got chemical sensitivity. You can’t handle perfumes, gas fumes. Look, here’s why. And oh, man, is there anything more fun in the world than this? I mean, I—I don’t think so.

Dr. Justin Marchegiani:  Yeah, I agree. I mean, it’s like we’re CSI detectives without all the—the murder and blood, right?

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  We’re trying to put together the—the puzzle piece that’s really getting people’s quality of life back. So just summarizing those tests. We run the organics test. We run maybe the OAT, which is the—the Great Plains Lab organics. We run the GPL-TOX. We may run the NutrEval, the SpectraCell and then we have the heavy metal challenge test where we challenge, with a chelation compound, like DMPS or DMSA or EDTA to get a window into the toxic burden of metals because metals don’t want to stay in systemic circulation. They don’t wanna stay in the blood. They only go on the blood acutely in that first 24 to 48 hours, then they go into the tissue.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Whether it’s the brain or the individual tissues or even bones when it comes to lead. So we gotta get a window into it so we have to do a challenge, a provocation agent that can go in into the tissues and really kinda pull things out. It’s like, “Hey, you go outside. You look for bees. There may not bees swarming around, but if there’s a beehive there, well provocation agent’s throw rock into the beehive, right?” You know those bees are in that beehive when those—when that rock hits it and those bees come out, that’s the provocation agents. So we use that same kind of methodology with the heavy metal test. The rock is like the chelation compound that we use to see what’s coming out in the urine and a lot of times we see aluminum, we see arsenic, we see cadmium, and we see a whole bunch of mercury and lead, and it’s different for each person.

Evan Brand:  Yup, absolutely, and then you got blood metals, too. Quicksilver’s Blood Metals is cool.

Dr. Justin Marchegiani:  Yup.

Evan Brand: There’s the Mercury Tri Test, too, for hair, blood, urine. There’s so many different things out there. A lot of them are good. A couple of them are bad, but you know, we’ll help you to make the distinction what is right for you and this is case-by-case. Some people they may not need to investigate metals. Other people they’ll come to us and they’ll say, “Evan or Justin, man, I got metal problems.” And they just have a gut feeling and in those cases, I say, “Okay, cool. Let’s get you checked out.“ It’s not gonna hurt. It can only help you to investigate. So if you have a gut feeling and that gut feeling can be disrupted obviously if you have got problems, right? Because the inflammation in the gut, you might be getting mixed signals, but if you have a gut feeling, ask us, and let us help you to investigative. If it’s something we didn’t bring up yet or maybe it’s early in the game and we wanted to do it later, just bring it up because you never know. You could be onto something that we just haven’t got to yet and that may save us, you know, a month or two of—of time.

Dr. Justin Marchegiani:  Absolutely. And again, we’ll the show notes for everything, the full transcription, again in my new Thyroid Book that will be coming out very soon, just putting the finishing touches on it, we’re gonna have a chapter in the book all on this type of discussion, putting it all together because I feel like this is probably one of the key pieces that most functional medicine practitioners and doctors really, it—it’s very esoteric. It’s kind of in the ether. Like how does it all look?

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Like what does the whole plan look like? And it just kinda like, you feel like almost like they’re making it up as they go and I think is really important if you’re gonna hou—you know, you’re gonna hike Mt. Everest so to speak, I wanna see that map. I want to know how we’re gonna go up there. I wanna know how we’re navigate that crevice and—and get across that—that ledge or that cliff. I wanna kinda feel like it makes sense when we get directions. So I think that’s a really important piece that we’re adding, is that clarity and that, you know, what’s our fu—future pacing vision? How are we getting to the top?

Evan Brand:  Yup, amen.

Dr. Justin Marchegiani:  Anything you wanna add there, Evan?

Evan Brand:  I don’t think so. I think this was great and fun as always, real honor. If people want to schedule, go to justinhealth, J-U-S-T-I-N, Justinhealth.com to schedule with Justin. If you want to schedule with myself, go to notjustpaleo.com and like I said, we both block out a few hours, so you know, if there’s a spot available, you wanna grab it for the 15-minute free call. See if we’re a good fit, you know, discuss your options together. Justin and I are happy to do that and we look forward to helping you all out. You know, listening to this is one thing. Getting in the trenches with us is another, and I mean without functional medicine, I would likely still be dealing with depression and irritable bowel syndrome and skin issues and fatigue and insomnia and adrenal problems. I mean, every aspect, everything that could’ve gone wrong was wrong in my body systems and just one by one, plucking these things off the list, and there’s never a finish line, right? I mean it’s always a continual journey. So you’re just always pushing to the next step ahead and this is your time. You know, you don’t have to suffer.

Dr. Justin Marchegiani:  Love it. I appreciate the hope and the inspiration, Evan.

Evan Brand:  Yes, sir.

Dr. Justin Marchegiani:  Great chat. Great chat. Look forward to chatting with you very soon.

Evan Brand:  You, too. Take care.

Dr. Justin Marchegiani:  Have an awesome day!

Evan Brand:  You, too. Bye.

Dr. Justin Marchegiani:  Bye.

Yasmina Ykelenstam – Are histamines wreaking havoc on your health – Podcast #106

Dr. Justin Marchegiani interviews health journalist, Yasmina Ykelenstam, in this podcast episode where they go into an in depth discussion about histamine, diet and foods that you may want to keep an eye out for. There are a lot of knowledge bombs dropped in this conversation about inflammation and other gut issues so be sure to tune in and listen closely. 

Learn about the different types of histamine and the symptoms associated with histamine intolerance. Find out how Yasmina got around to getting her life and her health back on track after being diagnosed with histamine intolerance (HIT). Discover how good nutrition helped her cope with her health challenges and get a load of all the brain candy which may be the answers you’re looking for when you listen to this interview.


In this episode, topics include:Yasmina Ykelenstam low histamine chef yasmina

11:15   Testing histamine

19:00   Histamine symptoms

32:03   Histamine categories

36:33   Histamine offenders

43:20   Summary and recommendations








Dr. Justin Marchegiani:  Hey, there! It’s Dr. Justin Marchegiani with Beyond Wellness Radio. We have an awesome guest today. I’ve had a couple of my patients who are dealing with histamine issues, so back by popular demand, we have one of the biggest histamines experts out there, Yasmina Ykelenstam is here on the show.  Yasmina is a former CNN producer. She had her own health challenges where she was able to come up with dietary changes; part of that was cutting out gluten and also reducing histamine from her diet and she has a great site over at thelowhistaminechef.com—thelowhistaminechef.com. Great references. Great blog articles there. So everyone, head over there and check it out. But Yasmina, welcome to the show. How you doin’ today?

Yasmina Ykelenstam:  I am doing wonderful. Thank you so much for having me. I’m really excited to be here. I’m a big fan of your work.

Dr. Justin Marchegiani:  Thanks a lot and me as well. I mean, you got a great site up here. I mean, one of the things I see in my functional medicine practice is that I see a lot of patients with histamine issues and we’ll talk about what that is in a bit. But one of the triggers that I see is parasites. People come in, they have a lot of gut bugs which typically equals a lot of inflammation. The more inflamed your gut is, it’s like a ticking time bomb for histamine and I know one of your most recent blog kinda touched upon that, so that really hit close to home for me. So I wanna to just kind of get everyone to get a sense of where you are in this journey. Because you were a producer, you were in media, how did you get over into this natural health side of the world?

Yasmina Ykelenstam:  Ah, well, my body broke down basically and I thought I was dying. And I—I really didn’t have a choice. I mean, I’ve never liked cooking. I—I mean I was always kind of interested in health but I’ve, you know, to me health meant buying an organic pizza from Whole Foods, you know?

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  And—and having an organic – with it?

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  You know, that kind of thing. And so it was really kinda fooling with myself thinking that I was doing the right thing for my body but so it was really all born out of necessity. I mean, for me, stress is my biggest trigger in addition to other issues. But really stress, so working as a journalist in war zones was really not the smartest thing I could for myself and a huge part of the, you know, recovery process was learning how to manage this stress, but you know, the kinda of emotional aspect of it but also the physical aspect and you know, it was born of necessity as it is for so many of us, you know, the kind of wounded healer archetype that is so apt for–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  So many of us.

Dr. Justin Marchegiani:  Absolutely.

Yasmina Ykelenstam:  And—and so you know, I started my journey in a very kind of methodical journalistic way, just trying to apply everything I had used as a journalist, you know, I interned at 60 minutes. I worked for the BBC. I started out as a researcher, you know, and then worked my way up to a producer so I was very familiar with kind of intensive like research sessions that go on for you know, 12 hours at a time, when—when–

Dr. Justin Marchegiani:  Mmm.

Yasmina Ykelenstam:  Pursuing a story and I wanted to do something different with my blog which was—I mean maybe not different, but there aren’t many bloggers who kind of approached things from the scientific standpoint–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Which is, you know, we’re not doctors, but we’re you know, looking at the medical studies that come out–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  And sharing that information with readers so that they can make better informed decisions with their physicians rather than trying to go at it alone. For example, with this parasite thing that I just recently blogged about, showing that parasites are a major trigger of histamine-related inflammation–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  In the body. So you have all of these inflammation symptoms. You know, doctors can’t really pin down. You may be misdiagnosed with other issues and you know, maybe then you find out it’s a parasite issue but your doctor maybe doesn’t wanna test you for parasites which is where somewhere like—someone like you would come along in functional medicine who is more open to kind of thinking out of the box and accepting that, you know, sometimes we need to look beyond the tip of our nose for an explanation and but you know, so the—the information that I share in my post on parasites for example, you know, touches upon different ways of treating them. You know, what tests to ask your doctor for, but also I say, you know, I’m not a doctor, so I’m not sharing exact dosages of herbs that—that you might go out and try and treat yourself with because that’s not the aim of this blog. It’s just to share the information with you so you can share it with other people who are better informed to make those medical decisions with you.

Dr. Justin Marchegiani:  That’s great. So you started having these health challenges back I think in the mid-2000s, you mentioned I think you were oven in Iraq, and how did you come across the histamine approach? Because histamine’s—it’s—it’s getting more popular but 10 years ago, it had to have been more nuance. I mean, Paleo was just kinda coming out. You had the gluten-free thing kinda happening, too. So how did you grab the—the low histamine piece and make that your niche?

Yasmina Ykelenstam:  Ooh, wow! That was a—that was sheer luck. That was–

Dr. Justin Marchegiani:   Hmm.

Yasmina Ykelenstam:  Unbelievable. I literally just—I lost my mind after tracking my symptoms and which foods were bothering me–

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  For about 6 months, and then I finally just put everything into Google and it just came up with a forum where I met this wonderful woman who was also a blogger and she was in contact with a practitioner in London who tested for histamine issues. So I flew from Bangkok to London, I think it was a few days later to—to get tested and—and that happened. I—I received a diagnosis of histamine intolerance which was too much histamine in my blood, too little of the histamine degrading enzyme in the body–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Diamine oxidase–

Dr. Justin Marchegiani:  Yup, DAO. Yup. Uh-hmm.

Yasmina Ykelenstam:  DAO and you know, some people may not know this but histamine is necessary for healing. It’s used as a neurotransmitter. It’s necessary for digestion. You know, histamine is a good thing. You know? Too much histamine is a bad thing. You know, without histamine we wouldn’t be able to fend of viruses or you know, fight bacterial infections or parasites for example. But at the time that I was diagnosed, there was absolutely no information out there and I mean, it was—it was actually quite distressing. There was literally nothing. I was researching and researching and researching. There was one paper at the time and that was pretty much it. But slowly, slowly I started looking deeper into the medical journals and you know, I found out histamine was related to mast cells which were part of the white blood system and that, you know, the origin of histamine release is actually from mast cells–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  As well as foods.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  So and that’s where I came up with this idea that turned out to be transformative. I mean, it completely changed my life that avoiding histamine containing foods wasn’t going to heal me. It was an overall anti-inflammatory diet with the focus on excellent nutrition that was going to.

Dr. Justin Marchegiani:  Great points. Yeah, one of the things I always tell my patients is kinda this metaphor of the histamine bucket, and basically in that bucket environmental toxins kind of fill up in that bucket. Dietary stress fills up in that bucket. Various drugs or hormonal imbalance or nutritional deficiencies or infections, they fill up that bucket and so essentially some of the histamine foods or the higher histamine foods can just be enough to overflow that bucket and a lot of those symptoms start to occur, whether it’s the urticaria or hives, or whether it’s just fatigue or skin issues, or brain fog, etc. and it’s interesting because it’s never just one thing, like the parasite article or some of the higher histamine foods, it tends to be a couple of different things. And—and what are those couple of things that you—that were specific to you and most of the people that write to you?

Yasmina Ykelenstam:  Well, I look at it—the histamine bucket is an excellent analogy—analogy, metaphor, I always get those mixed up—it’s—for me, it’s the inflammation bucket in the end–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Which is that things like–

Dr. Justin Marchegiani:  Yes, I like that.

Yasmina Ykelenstam:  Gluten–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Become a problem, because you know, the latest research shows that weak—that certain people cannot—are not celiac–

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  But still have an immediate, acute inflammatory reaction that it—a systemic reaction. So for me, you know, things like gluten, even pets, hay fever, I mean just being exposed to pollen, you know, but for me, stress—stress was really, really the biggest–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  Trigger and you know, I eventually figured out that I could provoke an inflammatory reaction that was very severe just by experiencing some kind of major stress and then I realize that being stressed while eating was a huge issue and that’s–

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  Where the whole amygdala thing comes in.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  You know? And you know, I realized that if I was able to stay calm while enjoying my food or actually just enjoying my food, not eating a desk, not eating on the run, not worrying about what food was going to do to me, instead focusing on the positives of the food–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  As long as I was able to do that, that made a huge difference.

Dr. Justin Marchegiani:  Yeah, that whole Fight of Flight nervous system response really messes up your body’s ability to—to digest and break down foods. So every time you can be on that parasympathetic state, you get more enzymes, you get more hydrochloric acid. There’s a better chance of you breaking down that food fully and being able to utilize it nutritionally.

Yasmina Ykelenstam:  Exactly. There was a very interesting study. It was a few year’s old but it was about rat brains and they—

Dr. Justin Marchegiani:  Cool.

Yasmina Ykelenstam:  They put rats in front of—and they had to open cages to get to their food and they measured the release of brain histamine. When the rats had to figure out how to get to their food or experience any kind of stress, there was a significant release of histamine in the brain.

Dr. Justin Marchegiani:  Mmm.

Yasmina Ykelenstam:  When they were given free access to food and didn’t have to work anything out have any kind of stress, there was no release of histamine in the brain. Now they were only measuring histamine in the brain in this particular study but it’s not unreasonable to—to think that, you know, it might be systemic rather than just in the brain.

Dr. Justin Marchegiani:  That’s excellent. I love the brain candy, so good. You really—you really referenced a lot of these scientific studies which is great. It makes it a really good reference not only for patients but also for physicians. I mean, you have this really good blog up here now. I’m looking at it and it’s talking about testing for histamine. And this is really interesting because I typically don’t do a lot of testing for histamine unless I have a lot of overt symptoms. Typically we do a lot of food elimination and if we pull out certain foods, or we see probiotic intolerance or we cut out fermented vegetables or the higher histamine foods, or teas or—or DAO-blocking foods and see improvements. That’s kind of how I clinically diagnose, but you talked about of couple of different tests on your site. You talked about testing histamine plasma, looking at DAO or diamine oxidase.

Yasmina Ykelenstam:  Right, well, I–

Dr. Justin Marchegiani:  Go ahead. Uh-hmm.

Yasmina Ykelenstam:  The goals and­—sorry.

Dr. Justin Marchegiani:  You’re good.

Yasmina Ykelenstam:  The—indeed, the golden standard for diagnosis is still considered to be responsiveness–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  On the elimination diet and when I run workshops, I tell people that, you know, working with a doctor obviously but to keep very detailed food diaries and to figure out what’s bothering you and that’s—that’s kind of your approach, rather than just saying, “Well, I think I have a histamine issues. I’m not just gonna eat any histamine foods because–

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  The—the food lists tell me this.”

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  It’s kind of like figure out your own sensitivity and, you know, I—I tell people to—to put them in a spreadsheet, you know, from the foods you are least reactive to, to most reactive to, and then work towards trying to incorporate foods from the further list on a very long rotation and the ones that you are least reactive to more regularly, obviously.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  But the—the testing that exists at the moment for histamine intolerance is only the—the plasma levels of histamine.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Which are unreliable because histamine fluctuates wildly throughout–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  The day and throughout the week and obviously if you haven’t been eating high histamine foods, the amount of histamine in your plasma is gonna be different and then we have also the diamine oxidase test which is also fairly unreliable because, I mean, when I look at the research about DAO, there’s still not entirely sure as to how it’s actually working with the histamine whether it’s indicative of high histamine levels or that’s just enough DAO for some people and also it fluctuates depending on what you’ve eaten and whether you have enough nutrients to manufacture the DAO of that particular day. So the—the 2 tests that we have that most people may be familiar with, the practitioners that—that are going them–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Are unreliable, which is why the elimination diet is the standard.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  When we’re talking about mast cell activation which is a related disorder that doctor Afrin one of the leading specialists in the field has—he wrote a book recently and he says that it’s believed that maybe 1 in 6 Americans suffers from some kind of mast cell activation. Now mast cells as part of the white blood cell system as you know, but just for–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Just for anybody out there listening, mast cells are part of the white blood cell system and within them are contained histamine, interleukins, heparin, prostaglandins which are all inflammatory molecules. They’re needed for healing but when mast cells become activated such as provoked. Let’s say you’re—you have an allergy.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  And—and so the mast cells break open, process called degranulation–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  And they splurged these inflammatory molecules all through the body and they cause inflammation. Now if you need that, if it’s not provoked by allergy, by stress or by trigger foods or by medications that are inappropriate or whatever it is, then we have too much inflammation in other kinds of, you know, inflammation in the body which is another reason that I don’t focus on just a low histamine diet, because we have other types of inflammation in the body. There are foods that correspond to prostaglandins and interleukins also. So we can either drive ourselves insane following you know, a hundred different lists or do what you do—if I have switches to work out our individual triggers and go from there.

Dr. Justin Marchegiani:  That’s great.

Yasmina Ykelenstam:  Oh, so sorry. For testing for mast cell activation is fairly difficult because you need to find an immunologist who’s willing to test you for it. I’ve had situations where people have gone to doctors and attempted to pay out of pocket and been told that they would not give them some tests which is frankly something I’ve really just don’t understand. At least they could give them a referral to somebody else who would be willing—because I accept that people need to work with a—with a physician.

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  But you know, refer them to somebody who’s open to working with them on it, just don’t tell them mast cell activation is so rare which it absolutely isn’t, that you know, it’s not worth testing, you know. So for mast cell activation, we have as you know, basic inflammatory panels, you know, for the—for the molecules that I just mentioned a moment ago and—and yeah, I’m hoping that more doctors will—will start getting into these tests but they are very expensive and most are not available on insurance which is why many people don’t offer it even if they’re open to it.

Dr. Justin Marchegiani:  And is that the mastocytosis you’re referring to when you had that just accelerated histamine in the body? Is that where you’re looking to get diagnosed by your conventional doctor with?

Yasmina Ykelenstam:  No, actually, well, there—mastocytosis is one of them. We have—we have histamine intolerance. We have mast cell activation which is just the unstable mast cells, then we have mastocytosis which is a more serious incarnation of mast—well, people with mast cell activation would be happy to hear me say that because they can be just as severe.

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  But the mastocytosis is linked to a type of leukemia called systemic mastocytosis, technically, a myeloperative—I can never pronounce this.

Dr. Justin Marchegiani:  Yup, yup.

Yasmina Ykelenstam:  And incarnation, but so we have different—they’re all linked. They differ—they can differ in intensity, severity, and progress but they are linked by the mast cells and by the histamine. Mastocytosis is believed to be rare.

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  As is the systemic obviously highly rare, but mast cell activation on the other hand—the—can be triggered by so many different things, as we said the parasites, the stress–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  The—you know, exposure to chemicals which is why it’s becoming more and more common because we just live in a more toxic world generally.

Dr. Justin Marchegiani:  Uh-hmm, right. So like mastocytosis is kinda like the pathological expression vs the histamine intolerance is kinda more of the—the functional kind of impression where you go to a conventional doctor, they may not even recognize it because it’s more in that functional realm where the mastocytosis is more of that in the pathological realm. Is that correct?

Yasmina Ykelenstam:  Absolutely. I—I would love to see more functional doctors getting into the mast cell activation because that seems to be exceedingly common and I have so many people who—who have turned out to—who have gotten their diagnosis and it’s really quite astonishing.

Dr. Justin Marchegiani:  I agree and I like how you hit the inflammation piece. You talked about some of the prostaglandins and we know like prostaglandin E2 is one of the ones that’s more of the inflammatory. We get that with a lot of refined vegetable oils, excess sugar. You also talked about a lot of the immune system upregulation that happens. Well, we have 5 kinds of immune cells typically. In—in doctorate school, we—we learn them by the acronym. At least I did, Never Let Monkeys Eat Bananas. Neutrophils, Lymphocytes, Eosinophils, Monocytes, and Basophils—and a lot of them live in the—in the gut, in the MALT and the GALT. They’re inside the—the gut lining. And the big ones are the basophils and these guys in your blood cell, they’re basophils but when they go into your tissue, they become mast cells and mast cells just they—they are the ones that erupt the histamine like you mentioned and histamine’s job is to vasodilate so blood can get in there to help heal, but what’s happening as you mentioned before, Yasmina, is the chronic inflammation that histamine’s just coming out all the time and then you’re getting all of the symptoms of—well, let’s touch upon that. Let’s talk about what are the common histamine symptoms that you’re seeing with people and yourself?

Yasmina Ykelenstam:  The common symptoms are—okay, let’s see, there’s just—there’s absolutely dozens but here are the most common ones.

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  Migraines, dizziness, brain fog, acid reflux, severe gastric distress, severe bloating of the stomach, inability to pass stools or the opposite, diarrhea, some—some people present with bladder problems. It’s linked to interstitial cystitis by Dr. Theoharides at Tufts.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Who is the director of immunopharmacology there and he actually makes a supplement for mast cell disorders called NeuroProtek and there’s another called CystoProtek–

Dr. Justin Marchegiani:  Mmm.

Yasmina Ykelenstam:  Which is specifically for people with—with bladder issues. I take NeuroProtek myself.

Dr. Justin Marchegiani:  Got it.

Yasmina Ykelenstam:  Let’s see, what else—there is—those are the biggies. Rashes, you know, urticaria–

Dr. Justin Marchegiani:  Yeah, the hives. Uh-hmm.

Yasmina Ykelenstam:  What else? Hives, severe exhaustion–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Like a chronic fatigue type—type of exhaustion and in fact, many people are diagnosed with chronic fatigue and there is a mast cell link to there as there is to many different things and those are the biggies.

Dr. Justin Marchegiani:  Got it.

Yasmina Ykelenstam:  I would say—and, oh and obviously, intolerance just to foods, food allergy like symptoms, hay fever–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  That kind of thing and the thing is, testing for allergies will often come back negative.

Dr. Justin Marchegiani:  Uh-hmm. Yup, like even–

Yasmina Ykelenstam:  Which confuses people understandably.

Dr. Justin Marchegiani:  Yeah, even like an IgG or an IgA test will still—those delayed one will still kinda come back negative, right?

Yasmina Ykelenstam:  Exactly. You know, my entire life, my test results have unfailingly come back absolutely normal which is why I have been pegged as a hypochondriac and you know, told that it’s psychosomatic, it’s all stress–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  And while they were kind of right, stress is involved–

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  There were very definite issues that people were missing because they were convinced that it was on my head because I was in perfect health.

Dr. Justin Marchegiani:  Right, and I find, too, with a lot of the food allergy stuff, typically all the inflammation like you mentioned earlier we get this phenomenon known as leaky gut or in the medical litera—literature, gastrointestinal permeability where those tight junctions open up and you get all these undigested food particles and even histamine getting into the bloodstream and so you come back with this test of all these food allergens, you switch your diet around, but guess what? If the—the gut’s still permeable, then you just develop more food allergies, so it’s kinda like playing Whack A Mole.

Yasmina Ykelenstam:  Exactly. Exactly, that’s it. I try to explain that to so many people and yes, there is some research I came across recently that—that kinda blew my mind which is at that how you cook your food affects allergenicity–

Dr. Justin Marchegiani:  Mmm.

Yasmina Ykelenstam:  First of all–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  But also can cause mast cell activation even if you don’t actually have a genetic mast cell activation disorder, so for—and it was advance—AGEs—advanced glycation end products.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  That really lovely, crust that you get–

Dr. Justin Marchegiani:  Crème Brulee.

Yasmina Ykelenstam:  When you cook something in the oven and you broil it.  Ex–oh, crème brulee.

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  Wow. Yes, exactly. Crème brulee, you know, potatoes, you know.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Anything, it’s—it’s the process of sugar combining with—with fat and browning.

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  And so these AGEs contribute to intestinal permeability, aka leaky gut, through the process of mast cell activation and there was more research on how quercetin, which the—the thing that I take, quercetin helps heal the tight junction permeability of the gut and also, ah, the other one, emulsifiers.

Dr. Justin Marchegiani:  Mmm.

Yasmina Ykelenstam:  Emulsifiers causing mast cell activation of the gut but something that really, really blew my mind was that, for example, strongly roasting peanuts–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  According to this one study, typically increases their allergenicity by 30%.

Dr. Justin Marchegiani:  Wow, so we–

Yasmina Ykelenstam:  Oh, sorry. No, I have that wrong. Sorry. Sorry. When compared with raw food antigens–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  IgE antibodies were elevated four-fold against processed food antigens in 30% of humans. So 30% of humans experience a four-fold increase in allergenicity when food is cooked. When ro—when peanuts are roasted. Sorry.

Dr. Justin Marchegiani:  So if you’re gonna have your nuts–

Yasmina Ykelenstam:  But peanuts are already highly allergenic.

Dr. Justin Marchegiani:  Got it. So if you’re gonna have your nuts, you wanna soak your nuts essentially.

Yasmina Ykelenstam:  Exactly.

Dr. Justin Marchegiani:  Alright.

Yasmina Ykelenstam:  Which, you know, everyone’s been telling us for a while. But you know, some of us don’t listen.

Dr. Justin Marchegiani:  Yeah and it makes sense because things like a lot of those foods are very high in phytates or oxylates and a lot of these mineral blockers and enzyme disruptors so that kinda make sense, that that—those soaking methods and I know, I think it’s Sally Fallon’s book, what is it? Something traditions. She talks about a lot of the–

Yasmina Ykelenstam:  Oh, I don’t–

Dr. Justin Marchegiani:  I think it’s Nourishing Tradition. That’s the book and she talks about soaking the nuts and thinks like that and helping to deactivate a lot of those things, so these old type of cooking things kinda make sense when the science kinda looks at the nitty-gritty so to speak.

Yasmina Ykelenstam:  Oh, absolutely and you mentioned something super topical which is the ox—oxylates–

Dr. Justin Marchegiani:  Mmm.

Yasmina Ykelenstam:  And for me oxalic acid turned out to be a huge piece of the puzzle. I focused on histamine for so long I wasn’t seeing the wood for the trees.

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  And, you know, oxalic acid, you know, found in kale. You know, all the world’s healthiest–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  Foods, chards, all the histamine foods but oxalic acid, you know, and I explained it to people like this. So oxalic acid is a plant-irritant protection mechanism as you know.

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  And, you know, along with salicylates, fructose–

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  And—and you know, other things, so the way I explained it, the inflammation bucket as I look at it is we—we are the giant bucket–

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  Obviously, as with the histamine bucket, and within us we have lots of tiny little buckets. So we have the fructose bucket, the oxalate bucket, the salicylates, you know, all these different little buckets of things, tyramine bucket, all these different things that are found in foods that have the potential to cause inflammation. Well, it just takes one of those little buckets to spill over, for the entire bucket to spill over and cause inflammatory—an inflammatory response. The gluten bucket, the whatever bucket. So you might think that, “Oh well, I’m on a low histamine diet, but I’m still spilling over. I’m still spilling over.” It might be because your salicyclate bucket is full.

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  But your histamine bucket is empty. So as I tell people, it’s really important to eat a wide variety of foods, and to kind of keep track in your head. Initially, I tell people, you know, use a spreadsheet, write out a weekly meal planner, you know, be aware of the different lists that foods fall into and combine them. I call it the balance plate. So you’ll have a little bit of high salicylate foods, a little bit of low salicylate foods, high histamine, you know, a little bit of low histamine, and just combine it all into one day.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  So that you make sure that you are not making any one of those little buckets overflow.

Dr. Justin Marchegiani:  Really good points. Really good points. I’m gonna put you on the spot. What’s your diet like right now? Because of the things I start off with my patients is typically a Paleo template and then we’ll add on different layers to it, whether it’s like a low salicylate or oxalate kinda thing, with like a specific carbohydrate diet or kind of a GAPS approach or a low FODMAP or even autoimmune approach. I’m just curious to kinda figure out what diet you kinda created for yourself now.

Yasmina Ykelenstam:  My diet is in transition at the moment because I’m traveling for the next few months–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  And that always make things a little bit difficult. I find myself relying more of proteins when I travel–

Dr. Justin Marchegiani:  yup.

Yasmina Ykelenstam:  Because that’s what I can get easily in restaurants or you know, I can pop in to Whole Foods–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  And buy a—a piece of chicken, you know, some parsnips—not parsnips, sorry, beets.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  I’m thinking of England here. Beet roots and fat, but I consider myself normally to be—I—I don’t really use labels but it would—the closest thing it would be is a plant-based Paleo but not entirely plant-based. So I would say that I’s maybe 70% plant-based with 30% proteins and fats and what’s not. I’m—I’m not including fats there basically. But, you know, for me–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  A typical day is I would wake up. I will have a—a green smoothie–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  With very little fruits–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Or a juice with very little fruit.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  And you know, maybe some nuts because I’m not a big eater during the day.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  For lunch, it’ll be a—a salad with lots of different greens like all of these different very green greens like 5 or 6 different kinds, cucumber, you know, carrots, lots of anti-histamine and anti-inflammatory herbs like thyme, cilantro, basil, parsley, you know, all chopped up. You know, make a nice dressing with maybe a tablespoon—a teaspoon of mustard which will probably be too high histamine for people–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Starting out but it’s fine for me. I’ll add maybe a little bit of protein to that, usually a piece of fish or something like that.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  And then dinner, you know, maybe some noodles made from zucchini.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  With a white bean sauce or I go more protein and you know, more salad, lots of vegetables, just you know, whole foods. My diet changes–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  You know depending on where I’m traveling to.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  What I’m currently doing. Lentil pasta, I love lentil pasta.

Dr. Justin Marchegiani:  Mmm.

Yasmina Ykelenstam:  Pasta made out of lentils, it’s just amazing. But I find myself always wanting to—I find myself drawn to the higher protein idea. But the problem is that when I look at the longevity studies, for example the ones coming out of the University of Southern California–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Under Dr. Valter Longo–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  All of the life extension studies and disease prevention studies seem to indicate that a lower protein diet is what we want to be focusing on.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  But of course, that doesn’t take into account different age groups and you know, different—different protein needs over the years.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  You know, but that—that is something that’s always in the back of my mind when I go higher protein and all of the studies showing that, you know, the lower rates of disease in vegans and vegetarians. Obviously, there’s problems with all of these studies. There’s a problem with every study if you look hard enough.

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  But so maybe my—my—I’m skewed towards the ones that lean towards more plant-based diet because that’s usually my personal preference. I just—I don’t like eating too many animals, it’s I feel bad for the animals.

Dr. Justin Marchegiani:  I—I totally get it. But one of the things that I wish those studies really took into account is number one, typically a lot of people that are—are more plant-based tend to be more healthy to begin with. They’re—they’re more conscious of being active.

Yasmina Ykelenstam:  True.

Dr. Justin Marchegiani:  Or avoiding sugar and avoiding alcohol, so you kinda have that biased, too. And the next one is that we really don’t classify what kind of meat. Like are we talking grass-fed, organic meat or we’re talking grain-fed which means a whole bunch of histamine, too, right? And then a whole bunch of–

Yasmina Ykelenstam:  Oh yeah.

Dr. Justin Marchegiani:  Antibiotics and pesticides, and I think that really matters, too. What’s your opinion on the quality of the meat?

Yasmina Ykelenstam:  Oh, absolutely essential. I mean, I—I actually had quite an amusing moment. I mean grass-fed always top preference.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  You know, budget-permitting obviously.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  And I—I tend avoid chicken unless I’m traveling because of what they’re fed.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  Because of you know, corn being allergenic–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  And the Omega 6 and you know, all of that. And I tend to focus on grass-fed meats, and you know, lamb and things like that and but it was amusing to me, because when I was in France—I lived there for a year recently, and I went into this supermarket. I went to the butcher and I said, you know, in French, “Could you tell me which of your meats are grass-fed?” And he looked and he burst out laughing and he said–

Dr. Justin Marchegiani:  Hmm.

Yasmina Ykelenstam:  “But madam, what else would we feed them?”

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  And I thought that was just an amazing answer. Of course, they eat grass.

Dr. Justin Marchegiani:  Right. Exactly. I know, over here in the US, it’s amazing. It’s totally flipped, right?

Yasmina Ykelenstam:  Oh, absolutely. Yes.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  I’m—I’m terrified when I see some of the things that they’re feeding cattle.

Dr. Justin Marchegiani:  I know. Well, it’s getting better because people are putting their dollars, you know, where their mouth is so to speak and they’re demanding it which is great and we’re getting more access in a lot of these stores. That’s at least a good shift that’s happening.

Yasmina Ykelenstam:  Absolutely, if only it didn’t cost so much then we could include more people on this quest for health. That would be amazing. But you know, slowly.

Dr. Justin Marchegiani:  Slowly. Exactly. You know, when I–

Yasmina Ykelenstam:  Hopefully, one day.

Dr. Justin Marchegiani:  Yeah, absolutely. Now when I educate my patients on histamines, I kinda break them into like 3 categories. Now I don’t wanna be too nary, if I go over the top, you know, I’ll back up a little bit. But we kinda have like histamines that are just foods that are high in histamines. Like the foods, histamines actually in the food. Then we have like histamine-releasing foods where there may not be a lot of histamine in it but it stimulates a release. And then we have like the histamine enzyme blocking food, the—the DAO or the DAO—the diamine oxidase blocking foods. So I just kinda wanted you to touch upon them briefly and just—I have a list in front of me. I don’t expect you to remember it, but it’s quite a list but the foods that are higher in histamines are gonna be like your nuts and your vinegars and your fermented foods and your aged meats and citrus. The foods that are gonna be histamine-releasing are gonna be like more of milk, chocolate–

Yasmina Ykelenstam:  Citrus choc–

Dr. Justin Marchegiani:  Citrus fruits, bingo. Yeah, you got it. And then the blocking foods are gonna be like your teas and—and such. But what’s your take on that? Just in general.

Yasmina Ykelenstam:  I mean, you know, it’s difficult because unless you’ve done genetic testing–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  For example, I mean you know, you can—you know, you can figure out if your DAO is impaired or if your HNMT, the histamine-methyl transferase–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Which is the other histamine degrading enzyme which is only possible to figure out via genetic testing.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  And also you need to look at the MAO genes and you know–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  All of this because for example, you can have a food like I—I was very upset for a number of years because one of the most popular high histamine food list had turmeric marked as high histamine.

Dr. Justin Marchegiani:  Wow.

Yasmina Ykelenstam:  And I just kept saying over and over again, turmeric is not high histamine. It is an antihistamine. It is a mast cell stabilizer. But what it can do is block the DAO. But if you have a person who does not have a DAO problem, then turmeric would be very healing to them. You know?

Dr. Justin Marchegiani:  Mmm.

Yasmina Ykelenstam:  So what I say is, you know, we have—and this is a concept that I struggle to communicate to people some—you know, that I’ve worked with in the past is that foods can have opposing properties. You know, you can have like the turmeric that blocks something and there’s also antihistamine, you know, as you explained there’s many different types of inflame—inflammatory cells in our body and you know–

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  What’s good one might not be good for the other.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  You know? So it’s—it’s all a balancing act and unless you want to live your entire life in fear–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  And so focused on your health that you forget to live–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  Then my advice to people is just you know, for a couple of months, track what works for you.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  You know? And—and try and—and figure out what your tolerances are. You know, try to see how far you can get without filling your bucket and see what it is that helps you empty the bucket. Here are the general guidelines that seem to work for many people based on the research bearing in the mind that a lot of the research is conducted on animals, not humans.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  You know, and at quantities that—at dosages that are much higher than what we would normally get from foods, you know, extracts and what not. So and just—and try and make something for yourself that—that doesn’t completely kill your enjoyment of life and that allows you to have a social life because–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  You know, the unhappiness that is created by keeping your—by separating yourself from society by not eating out with friends–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  Not eating with your family, you know, serving different foods at home, being you know, terrified of the outside world really because you are so focused on your health is counterproductive because that stress actually causes more histamine release.

Dr. Justin Marchegiani:  Mmm.

Yasmina Ykelenstam:  So you know, it’s—it’s kind of a never-ending cycle of—of pain and misery and so yes, we have all these different foods with the different properties and with different properties and you know, for example, the—the stem of a—of a plant might have a different property to the fruits or the left or whatever, so you know, the—the studies need to be taken with a pinch of salt and all of that.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  But you know, I think it’s good to be aware of all of this stuff and then kind of step a step back and say, “How can I protect my—my sanity?”

Dr. Justin Marchegiani:  Yeah. Yeah.

Yasmina Ykelenstam:  And have a good quality of life and still have fun.

Dr. Justin Marchegiani:  Got it.

Yasmina Ykelenstam:  You know?

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  So that’s—that’s my approach.

Dr. Justin Marchegiani:  Got it. That’s great. And then the people that have written to you and that you’ve worked with, and also yourself, what have been the major histamine offenders? Like what have really been their kryptonite? Is it more of the histamine-releasing, the—the DAO-blocking or more of the—the high histamine foods based on your experience?

Yasmina Ykelenstam:  It’s—it’s really the fermented foods, number one.

Dr. Justin Marchegiani:  Fermented, yeah.

Yasmina Ykelenstam:  So, yeah, the fermented foods, and the—especially the vinegars, the alcohols, and—and you know, the kombuchas, and you know, most people who come to the histamine diet, the low histamine diet, or the antihistamine diet arrived there via GAPS.

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  Because of the—yeah, I see it time and time again and in fact, that’s how I worked out what was wrong with me in the end. Somebody served me Rejuvelac. I don’t know if you’re familiar with that beauty. But it’s a fermented drink made from barley I think it is.

Dr. Justin Marchegiani:  Okay, yup, yup.

Yasmina Ykelenstam:  But she had fermented it for a few weeks and I think she had combined it with kombucha and she swore up and down that it would heal me. This was a raw foodist.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  And—and I drank it all and I—I had—I basically had a seizure.

Dr. Justin Marchegiani:  Wow.

Yasmina Ykelenstam:  And—but it didn’t happen immediately and that’s the confusing thing as you know with histamine foods–

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  Because inflammation takes time to build up so especially if your bucket is already empty-

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  You can think that something’s not affecting you and also there’s, you know, the power of wishful thinking such as well, you know, a Snickers bar doesn’t trigger me but a tomato does.

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  Wow. Now, let’s really think about that.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  Let’s be honest with ourselves.

Dr. Justin Marchegiani:  Right, tomatoes obviously better for you than a Snickers bar, right?

Yasmina Ykelenstam:  Exactly and what are the odds really that the Snickers isn’t doing anything?

Dr. Justin Marchegiani:  Anything, exactly.

Yasmina Ykelenstam:  Or are you maybe just you know, kinda lying to yourself. But—but yeah, I know, absolutely it is. So it’s mostly the fermented foods and it’s a–

Dr. Justin Marchegiani:  So are you telling me I can’t have bone broth though?

Yasmina Ykelenstam:  There’s a lot of back and forth on that one.

Dr. Justin Marchegiani:  Yup, I see that.

Yasmina Ykelenstam:  I think it was the Paleo Mom, Sarah, who said that–

Dr. Justin Marchegiani:  Yeah, Sarah Ballantyne.

Yasmina Ykelenstam:  Yeah, Sarah Ballantyne and she—I—I think it was her who said that you know, technically because it’s—it’s boiling—as long as you keep it at a temperature where bacteria does not start to accumulate then it shouldn’t be an issue.

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  Now that kind of makes sense to me. But at the same time, you know, there’s—I mean there’s just a lot in bones. There’s—there’s a lot of different ‑amines that can cause–

Dr. Justin Marchegiani:   Yup.

Yasmina Ykelenstam:  Problems in people. Glutamine for example and I know this is—this is a struggle for a lot of people because they want to heal the gut so they want the glutamine and a lot of people take glutamine supplements and then–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  You know, they—they have some sort of major episode and you know, glutamine is an –amine.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  If you’re sensitive to histamine–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  You are likely to be sensitive to other –amines–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  And glutamine, you know, and so to these people, well there’s another interesting study conducted on animals–

Dr. Justin Marchegiani:  Let’s hear it.

Yasmina Ykelenstam:  Which was found that rat mast cells–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  If you expose them to an antigen for a—for a long period of time at very small doses that increase incrementally, the mast cells eventually stop reacting. So this is what I tell people. A couple of years ago, I couldn’t eat anything.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  I didn’t go out and heal my gut. I ate a sensible diet. I didn’t do any complicated protocols with bone broth or glutamine or whatever. I was—I wasn’t even taking quercetin at the time actually. I just started eating a very healthy diet and I started a process of incremental exposure to things that bothered me.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Now I would not advise anybody at home to do this on their own. I literally couldn’t find anybody to work with me and I took a lot chances that could have ended very badly because I had had very serious reactions in the past. So in combination with stress relief and meditation because there’s no point in exposing yourself to something if you are so stressed out about it that you’re causing a reaction to begin with because then the brain begun—begins associating that food even more strongly with a negative—with a negative impact because you know, if you experience something negative, your body doesn’t want it to happen again so you start thinking about this thing and the body might start giving you the feeling of that reaction that you had that bothered you. So I—I’m not sure I explained that very well but that goes back to the amygdala as you know.

Dr. Justin Marchegiani:  Uh-hmm. Uh-hmm.

Yasmina Ykelenstam:  And so the—the process of desensitization took many forms, you know. One was, you know, I called it a—what did I call it? Homebased immunotherapy–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Or something—

Dr. Justin Marchegiani:  Yup. Uh-hmm.

Yasmina Ykelenstam:  Low-dose immunotherapy. And so you know, it was first I would be in a room for one second with flowers, with a big vase of flowers. I’d walk into the room and walk straight out of the room–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Because I had really bad hay fever.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  You know, then I would spend a minute in the room and—my best friend walks in and I have 2 flowers shoved up each nostril.

Dr. Justin Marchegiani:  Huh.

Yasmina Ykelenstam:  She’s like, “What are you doing?” And I’m like, “Immunotherapy!”

Dr. Justin Marchegiani:  Love it. I love it.

Yasmina Ykelenstam:  But you know, and then I went out and walked through the park then I sat and meditated in the park, you know, and then it just kinda—kinda went from there.

Dr. Justin Marchegiani:  Yeah, it-it’s–

Yasmina Ykelenstam:  And the same with foods, you know.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  If—if something bothered me, I would—I would take the food and I would cook it for just a second in a bit of olive oil because–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  Olive oil boosted DAO in the—in the gut.

Dr. Justin Marchegiani:  Oh, great.

Yasmina Ykelenstam:  So that’s a great thing. And you know, I found that with many people, oil-based foods and supplements worked better for them when beginning to reintroduce and I don’t know if it’s just literally just shielding something from the gut lining where it’s inflamed and it’s—it’s kind of achy or if it’s, you know, the DAO boosting of—of the oils. But in any case, you know, just—I would just cook something for one second in the olive oil. I would take the food out and then I would cook the rest of my food in that olive oil. And the next time I’d cook it longer and longer and longer, and then I’d leave the food in there.

Dr. Justin Marchegiani:  Interesting. Very cool. Yeah, it’s like cooking a frog, right? You put a frog in the water, boiling water, it jumps out. You put it in low, you know, temperature water and you gradually heat it up and kinda get it desensitized to that change, you can eventually cook that frog.

Yasmina Ykelenstam:  That is absolutely what I tell people. I’m very amused to hear you say that.

Dr. Justin Marchegiani:  Nice. It’s a great analogy but I still don’t know anyone that cooks frogs though.

Yasmina Ykelenstam:  Well, I lived in France for a year, it’s–

Dr. Justin Marchegiani:  Oh, yeah. There you go. Yup, that’s good. But yeah, that’s the analogy I like it. So just kinda getting all the people that are listening here summarized all the—the brain candy that you’ve dropped here. So we have number one is kind of getting the inflammation down in general. Like figure out where those inflammation triggers are, whether it’s stress in your life emotionally, meditation, sleep, the gluten sensitivity—forget just being celiac but the non-celiac gluten sensitivity. We also talked about the desensitization you—you also touched upon. And I also want to go into a couple of other things. I know you have some really good videos online that have been viewed hundreds and thousands of times on supplements and histamines. I know just—you already touched about quercetin is one of them and you even mentioned the DAO enzymes. What else do you recommend supplementation-wise?

Yasmina Ykelenstam:  Mangosteen. Well, I’m not a doctor so I can’t recommend anything, but should people wish to discuss with their doctors–

Dr. Justin Marchegiani:  Yes. I would—I would just say–

Yasmina Ykelenstam:  The following–

Dr. Justin Marchegiani:  Let’s frame it like this, things that have worked for you and have worked for patients–

Yasmina Ykelenstam:  Yeah.

Dr. Justin Marchegiani:  Or people that have written to you–

Yasmina Ykelenstam:  Yeah.

Dr. Justin Marchegiani:  And shared them with you.

Yasmina Ykelenstam:  Right, okay. So mangosteen–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Supplements which are made from the—the skin of the mangosteen, not the actual fruit itself. So drinking the juice is not the same thing.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Mangosteen supplements work as a mast cell stabilizers, preventing it—preventing them from releasing inflammation along with–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Along with histamine into the body, unnecessary inflammation. It might also be beneficial for hair loss that is associated with histamine issues and mast cell activation which is driven by prostaglandin D2. There is also—hang on, let me look over a little bit—holy basil.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  You can buy this–

Dr. Justin Marchegiani:  Adaptogen.

Yasmina Ykelenstam:  Also known as tulsi. Exactly.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  It’s absolutely wonderful and if you have low cortisol, it might not be great for you. It acts as a mast stabilizer and antihistamine, highly inflammatory. It’s been one of the most healing things I’ve discovered. You can get it as a tea or as a supplement.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  There is also—it’s important to have—to make sure that you are not lacking in nutrients.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  I’m finding more and more people and you know, I’ve—I’ve been saying this for years, but people restrict themselves so much that they lack vital nutrients that will help fight the inflammation. So on the one hand, you’re restricting foods because the symptoms go away, but that’s the short-term achievement, because long-term as you deplete your nutrients, you become incapable of fighting inflammation in—in the future. There—probiotics are a really difficult one because on the one hand obviously it’s—it’s a problem with the fermentation and you know, some people if they’re lactose-based but Seeking Health make a–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Histamine-safe probiotic, which is basically they are strains that raise histamine and trigger inflammation but this—and here’s again where it gets confusing but in many cases, this might not be a bad thing in the long-term because they have other positive effects on other types, on other aspects of inflammation. But for our particular needs, they may not be appropriate because in the short-term they trigger this histamine release. So the Seeking Health ProBiota—ProBiota Bifido is what it’s called–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Has the histamine neutral and histamine lowering strains in it; otherwise for people who are unable to tolerate probiotics, a prebiotic foods are a good options. Things like chicory, dandelion, you know, those—those high fiber–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Food—plant. Things like that. And magnesium—a lot of people find beneficial simply because it calms the nerves and it’s necessary for proper manufacture of the DAO enzyme. We have DAO pills—diamine oxidase pills made from—from pork extract.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  And those you know, mixed reports on that. They really work for some people. They don’t work for other people. They initially worked for me then did not, and then I just didn’t like the fillers in them but you know, people were talking about a plant-based one, you know, different companies issued patents for them. I also trolled the patents to see what’s—what’s new and what’s coming out.

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  But something interesting that I’m waiting to see more on but haven’t heard anything about it for a while was a handheld device that could measure histamine tent of foods for the consumer. And–

Dr. Justin Marchegiani:  Oh, wow.

Yasmina Ykelenstam:  Because a concern to me, although I am not concerned when I eat foods anymore, and you know, although I’m careful about what I eat, I will eat what I want, you know, I will have a baguette. You know, a nice piece of crusty French bread when I’m—when I’m–

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  In France, you know, I will have—well, no, ice cream. I just don’t like dairy, that’s the thing. But you know, I will eat what I want within reason because I just don’t deal with any of this on a regular basis anymore. But—oh, no, and I forgot where I was going with this—that’s terrible.

Dr. Justin Marchegiani:  So, you were saying that you were able to do it. You are eating the bread and such because you are able to tolerate it more frequently?

Yasmina Ykelenstam:  Yes, and I was making a point with that, I’m sorry, and I don’t know where I was going. Never mind. But–

Dr. Justin Marchegiani:  It’s okay. It’ll come back to you. It’ll come back.

Yasmina Ykelenstam:  It will come back, but so you know–don’t know where I was though

Dr. Justin Marchegiani:  We were still talking about the supplements. We were hitting—hit the mangosteen.

Yasmina Ykelenstam:  Yup.

Dr. Justin Marchegiani:  We talked about the diamine oxidase. Is there any other supplements you wanna add to that list?

Yasmina Ykelenstam:  Some people—those are the primary ones that work for most people. Vitamin C.

Dr. Justin Marchegiani:  Oh, yes, yes. Oh, perfect.

Yasmina Ykelenstam:  Vitamin C is—yeah. Vitamin C is a mast cell stabilizer–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  And also an antihistamine. It’s actually really, really, really powerful and it is even prescribed by the world’s leading mast cell activation experts.

Dr. Justin Marchegiani:  Mmm.

Yasmina Ykelenstam:  In the field and the one caveat to make sure it’s not–

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  Corn-based and you know, for obvious reasons, but it’s also it gets worse than that. It’s not just corn but it’s fermented corn.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Which is not great.

Dr. Justin Marchegiani:  You–

Yasmina Ykelenstam:  And something to watch out for is–

Dr. Justin Marchegiani:  Go ahead.

Yasmina Ykelenstam:  Citric acid–

Dr. Justin Marchegiani:  Mmm.

Yasmina Ykelenstam:  Just so people know. They’re often derived from mold.

Dr. Justin Marchegiani:  Ahh.

Yasmina Ykelenstam:  And that’s something we obviously need to avoid.

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  You know, people make the assumption that it’s derived from—from lemons. But no.

Dr. Justin Marchegiani:  Right. And also you mentioned before that you like a lot of Vitamin C that comes from palm, is that true?

Yasmina Ykelenstam:  Yeah, that’s the one I’ve been using.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  Simply because it came packaged with quercetin, but that one is now not—no longer being manufactured.

Dr. Justin Marchegiani:  Was that the one by–

Yasmina Ykelenstam:  Which is very upsetting.

Dr. Justin Marchegiani:  Was that the one by Between Balance?

Yasmina Ykelenstam:  My—Twin Lab, exactly.

Dr. Justin Marchegiani:  Twin Labs, yes.

Yasmina Ykelenstam:  Yeah and it—it’s just out of stock, and people write to me every day about it. But sadly, it’s out of stock.

Dr. Justin Marchegiani:  Got it.

Yasmina Ykelenstam:  My usual preference is for a Whole Food supplement. So something like camu-camu.

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  But a lot of people are reactive because it’s a berry–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  And some of the berries are problematic for us. Acerola cherry Vitamin C.

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Some people do well with and you know, I generally get a lot of vitamin C from my diet already but you know, if—if you’re traveling, if you eat something that, you know, didn’t agree with you, vitamin C can sometimes help.

Dr. Justin Marchegiani:  Got it. And then you mentioned I think in your story. I’m not sure if you said it today or if I saw it in one of your videos or blog post, you mentioned you lost over a third of your hair on your head. Is that—is that true?

Yasmina Ykelenstam:  Oh, that was—that was awful. That was so awful.

Dr. Justin Marchegiani:  I know, it does sound terrible. I see lots of patients that have that though and I’m just curious, just on a personal note, do you see a connection between hypothyroid? Because hair loss is a common hypothyroid symptom. Do you see the connection with thyroid issues and histamine issues, too?

Yasmina Ykelenstam:  For a lot of people that is the case.

Dr. Justin Marchegiani:  Yeah.

Yasmina Ykelenstam:  And I, you know, I would encourage people to make sure they have enough iodine in their diet–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Or iodine-containing foods–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Which is a huge problem nowadays.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  But that in my case, my thyroid was although I was at one point told I might be hypothyroid.

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  I mean, I was still well within range and I was prescribed the—the thyroxine which–

Dr. Justin Marchegiani:  Yup.

Yasmina Ykelenstam:  Made me feel awful.

Dr. Justin Marchegiani:  Synthroid.

Yasmina Ykelenstam:  For a month. Yeah, exactly. And I came off it. For most people-not for most people. For people dealing with mast cell activation or histamine issues, it is very likely that it is either a thyroid issue because we’re already dealing with an—with an immune system breakdown.

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  Or just general, you know, body breakdown. But also it’s important to bear in mind that one of the most common side effects of inflammation is hair loss, and generally and you can pin it down to interleukins and prostaglandins. And if there is an excess of either of those, then it’s likely that they are contributing to hair loss. So it’s something that should be looked at also. I don’t feel that people who are within the normal range for their thyroid technically what’s considered technically than normal range–

Dr. Justin Marchegiani:  Right.

Yasmina Ykelenstam:  That the first approach should be to prescribe thyroid, you know, the—the Armour or whatever.

Dr. Justin Marchegiani:  Yeah, Synthroid, right.

Yasmina Ykelenstam:  To people just on the basis of hair loss, I think that further testing for inflammatory molecules should be done and that’s as I said, the interleukins and the prostaglandins, and this is something for people out there who do decide to pursue testing of—of their mast cells for example, it’s important to have a physician who will run a full panel–

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  Rather than just one or two.

Dr. Justin Marchegiani:  Yes.

Yasmina Ykelenstam:  And you know, as you know, there’s many different tests. There’s the 24-hour and methyl-histamine test which is urine test which is a test for metabolite of histamine which is much more accurate than the histamine plasma test, but there are others and most doctors will only do one. But the thing is you can test negative for excess histamine in your urine. But if you have a high prostaglandin level, or interleukins, heparin–

Dr. Justin Marchegiani:  Uh-hmm.

Yasmina Ykelenstam:  Or whatever, than can intensity the effects of histamine in the body by up to according to one medical study, up to a thousand times.

Dr. Justin Marchegiani:  Ah, okay. So that’s big.

Yasmina Ykelenstam:  So if one of–

Dr. Justin Marchegiani:  Because prostaglandins, go ahead, yup.

Yasmina Ykelenstam:  Yeah, so—so exactly. So one of your—if one of your levels is off or two of your levels are slightly off, this all compounds and can indicate that you have massive inflammation because they build on each other and they cause the bucket to spill over. Sorry, go ahead.

Dr. Justin Marchegiani:  No, that was perfect because the prostaglandin E2, the one you mentioned and eicosanoid 2, that’s really—goes high in inflammation. So kinda everything I think you’re really driving the point home on is it all comes back to inflammation. The more inflamed you are, the more that histamine’s gonna have a, you know, a more virulent effect in your body. Is that correct?

Yasmina Ykelenstam:  Absolutely.

Dr. Justin Marchegiani:  Great, awesome. Yasmina Ykelenstam:  It’s so nice to be interviewed by a doctor.

Dr. Justin Marchegiani:  Well, thanks. You’ve really brought some awesome knowledge bombs today. I mean, seriously you got all the research going. You got a lot of experience with different people that are writing to you. I mean, I have a lot of my patients that are very familiar with your work and I use a lot of your blogs as references clinically. So I appreciate all the great work that you’re doing, too, and getting the word out there.

Yasmina Ykelenstam:  Thank you for having me. It’s been an absolute pleasure being interviewed by somebody who knows the subject so well and has helped so many people. You asked all wonderful questions and I’m really excited to get the information out there.

Dr. Justin Marchegiani:  Thank you so much. Her name is Yasmina Ykelenstam. You can find her at thelowhistaminechef.com. Subscribe to the Facebook there and also she’s got some really good cookbooks, as she mentioned there are 25-page eBook all on histamine on her site, so go over there, check it out, lots of good recipes. Last question, Yasmina, you’re stuck on a desert island. You only can bring one supplement. What do you bring?

Yasmina Ykelenstam:  That would be quercetin. That would be the Dr Theoharides NeuroProtek, which is quercetin and luteolin.

Dr. Justin Marchegiani:  Love it. Alright, everyone go out there and get that. Well, thank you so much, Yasmina. We will post this up and feel free and share it with your peeps at your site, too, to help get this information out there. Thanks so much.

Yasmina Ykelenstam:  Wonderful, thank you.


Non celiac gluten sensitivity and what you can do about it – Podcast #105

Dr. Justin Marchegiani and Evan Brand talk about addressing some gluten issues in this podcast episode. Get some great info regarding gluten sensitivity testing and whether you really need to take it or not. Find out the truth about gluten when you listen to this discussion.

gluten sensitivityDiscover the different reactions that people get when they consume gluten. Learn why grains in the modern world is quite different from the ancient grains. Get great advice on options and what you can eat when you’re out at restaurants as well as how you can avoid exposure to gluten.

In this episode, topics include:

00:57   The effects of gluten

08:21   Gluten reactions

13:30   Alternatives to eating gluten

20:40   Gluten sensitivity testing

22:22   FODMAPs





Dr. Justin Marchegiani:  Evan Brand, it’s Dr. J! What’s going on, man?

Evan Brand:  How you doin’?

Dr. Justin Marchegiani:  Doing great! Doing great! It’s been a little while since we chatted. I was out of town in the Boston area. I’m back in Austin here. It’s Labor Day weekend right now so it’s probably won’t come out for another month but that’s where we’re at on the schedule and excited for our fall to be here soon enough.

Evan Brand:  Back in action.

Dr. Justin Marchegiani:  That’s it man. How about you?

Evan Brand:  I’m doing great. We’ve had perfect weather for like the past week. I’ve been outside as much as possible soaking up the sun rays because in the next 4-6 weeks, we’ll probably see some trees starting to turn colors here, so then we’ll be freezing and complaining before you know it.

Dr. Justin Marchegiani:  I know right? Well, we talked about in the pre-show a little bit that we wanted to address some gluten issues. When we talked about gluten we got a whole bunch of content on gluten, but we’re gonna try to look at it from a nuance position here today.

Evan Brand:  Sure.

Dr. Justin Marchegiani:  Well, off the bat, people know gluten is the main protein primarily found in wheat, barley, and rye. Anyone who wants a little more intel, they can go look at my interview with Dr. Peter Osborne on that topic, but gluten, primary protein, wheat, barley, rye and why does it matter? Because of the fact that there can be some inflammatory reactions that can occur in the body via the immune system and then also one of the big catastrophic side effects is leaky gut and when you have leaky gut, that can really exacerbate the immune system to start tagging and attacking proteins that were in the gut that now got into the bloodstream and then immune system can basically have a case of mistaken identity, right? The APB goes out for the guy driving the black—the black Honda Civic so to speak, and then you’re driving that Civic because it’s a similar car, right? And you get pulled over. In other words, what’s happening in your body is it’s tagging this certain protein marker, whatever that tag is—X, Y, Z, A, B, C and then it looks similar to the proteins—surface proteins on your thyroid and then your thyroid gets attacked or your brain or your nervous tissue, your myelin, your—your ganglioside tissue, your intrinsic factor. So then what happens is your body can start to mistakenly attack various things. So the key issue is we wanna cut some of these things out. One because they’re inflammatory. One, they’re nutrient-poor and the second done would be they are toxic, meaning there’s a high amount of pesticides and chemicals, GMOs and Roundup that are used on it so people that are using it especially if not from organic sources, they’re gonna have a high amount of toxicity.

Evan Brand:  Yup, yup. Now people in the health space, sometimes they’ll have a little bit of a relaxed approach with gluten. I think what Dr. Rodney Ford, I think he said it best when he came on my show. He likes to call it instead of a gluten-free diet that he recommends for his patients, he calls it a gluten-zero diet, which honestly, I think sounds better because gluten-free just kinda sounds like, “Ehh.” Gluten-zero is like, it’s very blunt and—and concise. Zero gluten is the amount that’s best for you even if you’re not someone that is a celiac. You don’t have to be a celiac. I’m not celiac. I feel like I would know if I was celiac by now. I’m not, but I still do no consume it as much as possible, close to 100% zero.

Dr. Justin Marchegiani:  Yeah, in my clinic, I refer to it as a grain-free diet, because it’s not just popcorn or this or that. It’s gonna be grain-free, 100%, no grains at all. Now if I cheat—in my life, I cheat a little bit—it’s gonna be with high quality organic corn or it’s gonna be with high quality, you know, organic rice. Things like that. But it’s gon—it’s gonna be few and far between and the better I feel though, the more I wanna keep my diet dialed in because I’m just addicted to performing at a certain level.

Evan Brand:  I agree.

Dr. Justin Marchegiani:  So that’s kinda—that’s kinda my goal regarding that. Now the cross-reactivity is also there where other sister or cousin grains, whether it’s oats or whether it’s rye or whether it’s other type of gluten-free types of grains even rice, can potentially cross-react so you’re immune system can see those other proteins, and think, “Well, hey, you know, your cousin kinda looks like you or your brother kinda looks like you,” and it may mistake it as being gluten. So that can be an immune stressor on the body. So keeping all the grains out can be a really good starting point. Now here’s the problem. There are a lot of clinicians and people out there that say, “Well, you know what? If you don’t feel bad when you have gluten, then you may be okay.” That’s kind of the adage or the thinking out there with a lot of people that may not react to it. And the problem with that is, it’s like telling a diabetic, “Well, if you don’t get diabetes after having a little bit of sugar one time, it’s probably okay.” Now we know those kind of an effect where having maybe a small amount of sugar once may not be a big a deal but over time, your blood sugar would start to spiral out of control and go higher and higher and higher as insulin resistance sets in. Now looking at gluten issues, so when we have celiac, that’s like the pathological form of gluten sensitivity, and then we have the NC, the non-celiac gluten sensitivity, and CGS, that’s the “Hey, you’re not quite celiac, it’s not quite pathological, but we know you’re sensitive to it.” That’s where to person may have it and they may not have an instantaneous response. It may not happen right away and it may take a while and it may not even be connected to the gut, meaning you may not have the bloating, the diarrhea, the gas, the cramping. You may just have a little bit of brain fog or maybe a little bit of joint pain and never even connect the dots.

Evan Brand:  Exactly. Now a lot of people they have spent money and a lot of practitioners out there are recommending people to get tested, food sensitivity testing to look for wheat or gluten sensitivity, a waste of money. You and I have covered this on several, several podcasts. Don’t go and pay $400, $500, $600 to get told that you shouldn’t eat gluten. Just cut it out for 60 days. Cut out all of your grains for 60 days and see what changes. See what happens and then if you’re willing to add some back in, like you mentioned Justin, the organic rice or the organic corn and see if things change, like for you, you got on me about corn. You’re like, “Look, man. You need to get rid of all grains. Don’t just go gluten-free,” and my skin got better, as soon as pulled the corn, as soon as I pulled out–

Dr. Justin Marchegiani:  Yes.

Evan Brand:  The rice. So for me, I have to be a little bit more strict. I’m trying to make sure that we give people take-aways and we’re not just saying a bunch of stuff. The point is clear here. Don’t waste money on food sensitivity testing. The best test is yourself, using patients, and journal and if you react to blueberries, well, there you go. If you react to avocados, there you go. If you react to rice or potato, there you go. But wouldn’t you agree that there could be some false positives where someone may test reactive to something but they’re not? They’re immune system is just hyperstimulated from their previous historical diet. Is that possible?

Dr. Justin Marchegiani:  Yeah, I mean, my issue is more with the false negatives. Meaning they test for something, gluten whether it’s like a—a gliadin test.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  And they test negative and they think, “Oh, now I got this false sense of security that I can go–

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Eat gluten.” That’s really the issue. The false positive’s gonna be harder because your immune system’s gonna be hyperresponsive, so if those antibodies are higher, it’s gonna be easier to see. My issue is maybe the immune system isn’t at that responding level and it really is but it’s just not at that time, and then you—you basically take snapshot when it’s negative, but it’s really an issue because then typically people that are positive, they’re gonna go and do what? Cut the foods out.

Evan Brand:  Right, yeah.

Dr. Justin Marchegiani:  So I’m not worried about someone cutting it out that may be able to handle it. I’m worried about someone adding it in because they think they can handle it based on a lab test.

Evan Brand:  Because they got the green light, for sure.

Dr. Justin Marchegiani:  They get—they get the green light. Exactly.

Evan Brand:  Right.

Dr. Justin Marchegiani:  I’d rather have someone stop at that stop sign even though they may not have to.

Evan Brand:  Right.

Dr. Justin Marchegiani:  Than think it’s a green light and go through it and get T-boned, right?

Evan Brand:  Ex—yeah, that’s well said.

Dr. Justin Marchegiani:  Yeah, so that’s kinda my mindset on that. Now the big picture on top of that is there can be delayed reaction. So when we add foods back in in our patient’s diet, we do it every 3-4 days. So it’s kind of a very slow type of add in and we do a small amount in the beginning and then we max out to about 3 or 4 days and we look for any type of reaction, any kind of small reaction whether it could be brain fog, joint pain; it could even be just skin issues. So it could be poor sleep. So we really wanna look at the nuance symptoms that may not even be a gut-based symptom, and also, I got patients—one patient said, “Screw it! I’m adding gluten back in.” It took 2 weeks and they just felt absolutely terrible, like it just came reeling in where he was literally incapacitated for days.

Evan Brand:  Oh, I’ve seen months in some cases.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Nobody that have experienced month, I’ve—I’ve had people say about a month that their wrist pain came back but I’ve read sometimes 3, 4, 5, 6 months for somebody that’s just like, “Ah, I’m gonna go off the rail, screw it, I’m sick of this. I’m not really getting any better with keeping gluten—gluten out. I’ve maximized my potential.” But then they don’t realize, they really haven’t maximized their potential. They were at a good baseline and then they backtracked.

Dr. Justin Marchegiani:  Exactly.

Evan Brand:  So don’t suffer. Don’t suffer. Now people think, well, where does this nutrition advice come from anyway? I mean a lot of the stuff that you and I talk about is inspired by some of the work from Weston A. Price and what he’s done. And he traveled the world looking at tribal societies and maybe some of these ancient tribal were doing grains, but if they were it was gonna be either a fermented or a soaked or a sprouted or a properly prepared grain and yes, they could. So if you see people arguing on the internet about, “Oh, grains are good for you. Here’s why ancestors did eat them.” Well, the grains are still relatively new. Now they probably are some ancient wild rices. There’s the einkorn, the original ancient grain.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Stuff like that.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  But at the same time, the world is a different place, meaning that there’s more toxins and there’s more things that people have to react to. So yeah, maybe a thousand years ago you could have tolerated something like some wheat and some grains. But now, if your toxic load is already so high, if you’ve had a history of a low fat diet and your gallbladder is likely stagnant or not optimally functioning or you have a lot of chronic stress, so your hydrochloric acid levels and your enzyme production is lower, you’re not in the same world that those people were in that were eating those type of grains. So your response is gonna be different. Just because somebody else did something before doesn’t necessarily mean that it’s good for you. We have to really look at the new variables, and so that’s kinda what I think you and I do is we’d look at, “Okay, what is the modern world presenting with this person.” You know, what are your biggest areas of stress? Oh, you’re an executive in a high rise in LA. Okay, well, that level of stress is significantly more than what a hunter or gatherer would have—would have had. So really need to make sure that it’s a low toxin, nutrient dense, anti-inflammatory diet that is based around your goods fats, your good proteins, your veggies. Maybe they can do rice but maybe it’s once a week and it’s a treat and then they’re done and they’re done and they’re okay with it, and they don’t flare up.

Dr. Justin Marchegiani:  Exactly and now looking at it from my perspective, number one we have to realize that negative effects may not happen overnight.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  It’s nice to have that. It’s nice to have like, you know, the so-called canary and the coal mine. Anyone that doesn’t understand that analogy, it’s basically old miners used to not be sensitive to carbon monoxide as fast until they were asleep which means they were dead. But the canaries would literally be sensitive to it. So they would literally bring a canary in the coal mine and the canary would literally drop dead, meaning we’d better get the heck out of this mine because–

Evan Brand:  Ugh.

Dr. Justin Marchegiani:  The carbon monoxide’s really high. So that’s the canary and the coal mine, is you get the instant feedback before it’s too late. Now some people it’s delayed and it comes in ways they don’t ever connect the dots to and that where it’s were—that’s where it gets really hairy. Now I hear a lot of doctors out there, “Well, pull gluten out for a bit,” which I think is great, almost—almost all of my patients go on an autoimmune diet to start with, because I can’t tell you how many times something like nuts or eggs can cause a problem, and because they’re such a common staple in a Paleo diet, anyone that has gut issues or severe neurological stuff or mood stuff or hormone stuff, an autoimmune diet with the potential of something like a—an SCD or GAPS or a low FODMAP may even be added on, kinda like a filter. You kinda add an additional filter on that camera or a different lens on that camera to make it more superior, more intense based on what the patient needs, but I can’t tell you how many times we found things that we would never even have thought to begin with. So we start there and then we add things back in slowly. Now it’s my belief that things like grains should not be a staple just because of their nutrient density, alright? And I shouldn’t even say it’s belief, it’s actually a fact. Grains are pretty nutrient-poor if you look at their nutrient levels and then when you take into account that they have mineral blockers and protein disruptors like chymotrypsin, trypsin inhibitors, oxalates, phytates. Remember these plants don’t wanna be eaten. They want to pass on their DNA just like human beings do.

Evan Brand:  Well–

Dr. Justin Marchegiani:  So they secrete to make it so if the person that eats it may not want to do so long-term. So because of that we wanna be choosing foods that we can digest and eat and still have the nutrient density. So my say on the patients is pretty simple. Sub your grains for greens. Sub your grains for greens. Meaning anytime you would eaten a whole bunch of grains in your diet, eat greens instead and if we want to have a little bit more carbs because you need more carbs because it fits you better metabolically, then we can add some yucca or we can add some sweet potato or we could add some plantains or we can add some pumpkin or some squash. That’s a good starting point and if you want something that gives you the pasta feel, you can do like a miracle noodle or a zucchini noodle or a sweet potato noodle, so you still have that mouth feel and you don’t feel like you’re missing out.

Evan Brand:  Yup, yup. That’s well said. Yeah, I did some white rice the other day. I didn’t feel good with it. So I’m back on plantain cake and I’m feeling amazing with it.

Dr. Justin Marchegiani:  Yeah, I actually went and had sushi last night. I love sushi. I primarily do sashimi and I actually show up there with my own MCT oil and coconut aminos and I just—I mix that up. That’s kinda my, you know, my so-called soy sauce. You know, they have tamari there which is a gluten-free soy sauce, but tamari still got a whole bunch of soy and which is a phytoestrogen, so I’m not a big fan of that, so we chose—my wife and I did the MCT and the coconut aminos—now I did do a nice roll. I did like 2 nice rolls and again, imitation crab or imitation lobster is commonly loaded with gluten. Be mindful of that. And a lot of times they coat gluten and stuff on there. So anytime you go to restaurant—this is advice I’ve used over the last decade—you tell them you have celiac disease. You say, “I’m celiac. I have a severe allergy to gluten.” You let them know and they come back and they—they really kinda comb over everything for you. If you just tell them, “Hey, please avoid gluten” or “Hey, I’m gluten sensitive,” people don’t quite know what that means. So “Hey, I have celiac disease. I have a severe gluten allergy.” Because what does that mean to the waitress or the restaurant owner? It means if I feed this person this food, they’re gonna start choking and that’s bad for business. They’re gonna start, you know, grabbing their throat. They’re gonna need an Epi-Pen. They’re gonna get shipped off to the ER. We’re gonna have an ambulance pull up to the restaurant. So you wanna insinuate that by letting them know severe allergy. Now they go back and they’re very careful at what they give you.

Evan Brand:  Yup. I’ve heard–

Dr. Justin Marchegiani:  Like last–

Evan Brand:  I’ve heard–

Dr. Justin Marchegiani:  Go ahead, yeah.

Evan Brand:  Multiple people say that. So what do you do logistically? You just—you bring the bottles in your wife’s purse, of your aminos?’

Dr. Justin Marchegiani:  Yeah, I just literally brought them. I just—I had a nice little baggy and I just brought it in there, in my wife’s pur—purse, It’s actually just like that.

Evan Brand:  It—it’s really not that hard. We bring—I bring Himalayan salt packets in, too,

Dr. Justin Marchegiani:  Yeah. It was easy. I just brought it in and it was great and I feel good afterwards. I get really good fats in my body which is excellent, and I just feel a lot better.

Evan Brand:  Now how do you know—how do you know if you’re getting imitation meat at those places? Do you ask them? How does that work?

Dr. Justin Marchegiani:  Yeah, you ask. You ask and this place I went to–

Evan Brand:  Is this imitation crab?

Dr. Justin Marchegiani:  Yeah, I asked and say, “Is this imitation crab or imitation lobster?” Now on the menu, it said imitation crab, imitation lobster, so I knew off the bat–

Evan Brand:  What is that?

Dr. Justin Marchegiani:  It’s typically like gluten. It’s gluten combined with some other types of things. Because think about it–

Evan Brand:  Eww.

Dr. Justin Marchegiani:  Gluten is glue, so they can like stick gluten to other types of proteins.

Evan Brand:  Is it fish? I mean, what in the world do they use?

Dr. Justin Marchegiani:  It may be fish. It may be like a pea or a legume kind of thing, and they combined it in it to make it feel like crab or feel like lobster.

Evan Brand:  That’s so gross.

Dr. Justin Marchegiani:  Yeah, I’ll pull it up here and I’ll—I’ll let you know exactly what they bind it to. But again, what does it mean? It just means there’s gluten in it.

Evan Brand:  Yeah, a lot of people ask me that. I think it’s a common question. I know we’re kind of just freestyling this episode here. People ask about, “Well, if I’m trying to do AIP, can I ever go out to restaurants again?” And I would say, the answer is yes. But it’s just–

Dr. Justin Marchegiani:  Of course.

Evan Brand:  You just have to choose carefully where you go.

Dr. Justin Marchegiani:  So basically what it is it’s the—the fake crab or the fake lobster—they just take other kinds of fish and they kind of mush it together they use gluten to hold it together. It’s kinda like a–

Evan Brand:  Ahh.

Dr. Justin Marchegiani:  A binder of you will.

Evan Brand:  Ahh.

Dr. Justin Marchegiani:  No, you totally can. People tell me this all the time and I’m like, “It’s nonsense. I’m sorry. It’s absolutely nonsense.” I went out to eat last night. All I would have had to have done which was not have the rolls and the rolls just had a little bit of white rice in it. But everything else was super clean. It had like eel or I had tuna or I had salmon and I had like avocado and like some carrot and some lettuce. The only thing was a little bit of white rice, but worse off, I would just go and get the sashimi.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  I would just do sashimi. I would just do a seaweed salad or regular salad and make sure the dressing is clean. I’ll just typically use the coconut aminos and the MCT for the dressing. So I’ll just say, “Please no dressing.” And I’ll do–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  MCT, coconut aminos, a little bit of sea salt on there and then you’re good to go. If you go on to a streak restaurant, really simple.  Order a nice clean steak and just say, “Hey, I have severe gluten allergy. I wanna make sure the spices that are on the steak are just sea salt or just you know, spices that contain no filler, no MSG, and any nice restaurant’s gonna have that.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Even The Outback had that, too. They have like really good like spices that are certified gluten-free. So worse off, you just say, “Hey, just sea salt.” That’s it and you’re good.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And then you can always do your vegetables and if they don’t—if you don’t like butter, you can’t do butter, you can always bring a little thing with you or if you don’t wanna do that because it’s too high maintenance, just do olive oil. Have them put some high quality olive oil. Have them just steam it and have them just bring the olive oil to the table and you dress it. Same thing–

Evan Brand:  Or you could bring that, too, if you want it.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  You could bring some olive oil.

Dr. Justin Marchegiani:  Yeah, and most restaurants will have it though so you don’t have to.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  And then worst off, for like dressing, you can always just ask for a lime or a lemon and then some olive oil and then just squeeze that lemon on there and then just pour some olive oil, add a little sea salt and you’re good to go.

Evan Brand:  I’m on an avocado oil cake lately.

Dr. Justin Marchegiani:  It’s great. It’s a little expensive but it’s great.

Evan Brand:  It is expensive.

Dr. Justin Marchegiani:  Yeah, I’m a huge fan, like I do all my dressings either with avocado or olive oil and I’ll just do a little olive oil. I try to stay away from balsamic because it’s a little higher in sugar and mycotoxins–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Which is like the fungus and I’ll mix that with some olive oil and I’ll do a tablespoon of high quality, organic German mustard and I blend it up in my Vitamix and it’s good to go.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  That’s my salad dressing.

Evan Brand:  So you don’t—it—it doesn’t have to feel so sacrificing. I think it’s a mindset thing.

Dr. Justin Marchegiani:  Totally is.

Evan Brand:  You just have to hack it a little bit.

Dr. Justin Marchegiani:  Totally is.

Evan Brand:  You gotta be a food hacker.

Dr. Justin Marchegiani:  Meat, right? Steak, great, awesome. You can go to a place that has salad. Get a really good Cobb salad. There’s a restaurant across me called Maudie’s where I live in Austin and then we’ll just go and I’ll get the fajita and green salad in which I’ll ask for extra meat. I’ll say no fajitas chips on it, and I’ll say 100% certified gluten-free so they know not use different tongs or use the same grill that may have had something that had gluten on it before, and they keep it really clean and then it just got vegetables and it’s got a whole bunch of meat and some salad in it and that’s it. It’s good to go.

Evan Brand:  That’s excellent.

Dr. Justin Marchegiani:  Yeah, so there’s a lot of good options that you can do. Just speak up and remember like, you’re the customer. You know what you want. You wanna feel good afterwards. That’s the goal. It’s not that you wanna be a pain in the butt, you wanna feel good.

Evan Brand:  Right.

Dr. Justin Marchegiani:  And you just gotta know what makes you feel good. That’s it. If you know what your kryptonite is, Superman is not gonna choose to be around kryptonite just because it makes you feel better. You wanna choose to be around and say screw it. I’m gonna—I’m gonna do what makes me feel the best.

Evan Brand:  Yup. Yup.

Dr. Justin Marchegiani:  So outside of that, we talked about some the testing stuff. Now like Cyrex Labs has some testing that you can do as well.

Evan Brand:  It’s pricey.

Dr. Justin Marchegiani:  Yeah, it’s a little pricey, and I only do that kinda testing—I think it’s Array Panel 3.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  I’ll do that testing with some patient only if they’re just absolutely, for the most part, not willing to make any diet changes. Now most people that are finding us have already read and already are—heard our content so they’re already very motivated to make these diet changes and most of them have already done it. So we kinda help people already because our content is so ubiquitous. The next, some our stool testing that we do with the DRG and GI Map comes with gliadin antibodies and I see a lot of patients that come back with gliadin antibodies in the stool and they may not even be symptomatic from a digestive perspective. I had one patient on Friday with a whole bunch of mood issues and joint pain, and they have the gliadin in their stool.

Evan Brand:  So what is that telling you? That they are getting exposed to gluten?

Dr. Justin Marchegiani:  They’re getting exposed or they’ve been clean for a few months, but their immune system is so jacked up from that previous exposure that it’s taking that long for it to drop. That’s kinda scary, right?

Evan Brand:  That is.

Dr. Justin Marchegiani:  That can be very–

Evan Brand:  Well, that’s why I’ve heard that I—I think, I can’t remember if that was Dr. Ford or who it was, that told me about that—the 6th month number is stuck in my head. I believe that’s what he said, that was how long his—he’s a pediatric gastro—that’s how long his pediatric patients took, was 6 months away from gluten to get that immune system reset.

Dr. Justin Marchegiani:  There’s a famous study out there that looks at thyroid patient’s thyroid antibodies being elevated up to 6 months after gluten exposure. So that—I think that’s where some of that came from.

Evan Brand:  Oh, okay.

Dr. Justin Marchegiani:  It just came from that piece. And again, there’s claims out there like that gluten sensitivity isn’t’ real and that any reactions that people may be from FODMAPs and FODMAPs are like these fermentable carbohydrates. Fermentable, oligo, fructo-oligo, disaccharide, monosaccaride, and polyols. And these are certain sugars that can be in foods. I mean onions are really high, garlic’s really high, avocado is moderate, sweet potato is moderate. So sometimes people can be reacting to these higher FODMAP foods.

Evan Brand:  And not actually a gluten exposure.

Dr. Justin Marchegiani:  Yeah, and that’s tough, right? It’s really hard to figure that out, so we start with an autoimmune diet and I tell patients to be FODMAP conscious because FODMAP symptoms tend to be more immediate, because it’s the gas that arises from the bacteria in your gut eating the fermentable carbohydrate. So you eat, let’s say some onions, the bacteria in your gut after a certain amount of hours it‘s gonna start producing methane or hydrogen-based gases that will create either bloating or—or flatulence or gas or indigestion and you’ll tend to know more frequently, again the problem is I’ve seen patients cut out gluten, still have other higher FODMAP foods like cruciferous vegetables or broccoli or onion, and their symptoms are gone. Even though they’re still consuming high FODMAP food. So that’s kinda where I call BS on it, is I’ve just seen too many patients that cut it out but still have FODMAPs feel better. And that’s where the clinical experience is really important because we’ve dealt with so many thousands of patients. We just go back to our database, you know, of what makes sense based on our clinical experience and—and that may be the case, or it may not be the case, but we have examples of it on both sides.

Evan Brand:  Yup. Also I’ve seen on the GI Map some of the elevated—what was it—it’s the one near the bottom.

Dr. Justin Marchegiani:  Probably lactoferrin or elastase.

Evan Brand:  Yeah, the elastase, I’ve seen that one.

Dr. Justin Marchegiani:  Yeah, typically we’ll see it low. We’ll see it like, you know, we’ll see it low which means the enzyme level is low, meaning the amount of enzymes the person is putting out is lower, so if you’re not putting out enough enzymes that means the foods you eat, you don’t break them down fully. The better chance of them not being broken down meaning there’s more fermentation and the more gas and bloating and symptoms can arise because of it.

Evan Brand:  Oh, never mind. I was thinking of the secretory IgA, that one being high and then the anti-gliadin secretory IgA, too. Those—those two top ones that are on the bottom. That’s what the one I was thinking about.

Dr. Justin Marchegiani:  Yes, yes.

Evan Brand:  Okay.

Dr. Justin Marchegiani:  100%. So IgA will get elevated as an immune response because that’s the first line of defense for our immune system. So when we see IgA elevated it’s like the army sending out the infantry to kinda start the attack so to speak. Now most people that when they’re chronically stressed adrenally because of all kinds of diet and lifestyle issues, they’ll—they’re IgA will be lower. So it’s analogous to leaving your front door open and unlocked at night.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Anyone can just walk in. So IgA, having good IgA levels are important. Stress, adrenal issues, and chronic food allergen exposure can really weaken your immune system for sure.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Via the leaky gut.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Just like leaving the light on. If you’re immune system is chronically hyperresponsive. That’s extra energy being allocated towards something that shouldn’t be there. If, you know, you leave some water running in your bathroom, your guest bathroom that you’re never in and then you leave a light on in that bedroom, too, and you’re magically, the next month your electric bill and your water bill are much higher even though you didn’t notice that because you were, you know, that was—that room was all closed off, right?

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  That’s kinda what’s happens with gluten sensitivity, your following the food pyramid, you’re eating your 10-12 servings of grains a day, and you’re thinking you’re doing yourself a good deed, but you’re really turning on the lights and running the water and you don’t even know it.

Evan Brand:  Absolutely. Good analogy.

Dr. Justin Marchegiani:  Yeah. So regarding that piece, don’t fall prey with a lot of people saying that, “Hey, you know, just because you didn’t react to gluten, it may not be an issue.” There are tests out there that you can do. But you can also reintroduce it very carefully and see how you respond, then obviously gluten-free grains first, and those may be okay from time to time. It should never be a staple and I would try to never do gluten unless it’s really a special occasion and you know you can handle it, and, you know, have no un—you have no diagnosed autoimmune conditions.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  That’s kinda my rule of thumbs and just, the big take-home is this. You can ignore reality but you cannot ignore the consequences of reality. Know your body. Know you what you can handle. Make sure you’re really healthy before you—you even get to that level of exposure. I much rather see someone cheat with gluten-free food, like a white rice-based dessert or something versus a whole bunch of wheat.

Evan Brand:  Yup. Definitely.

Dr. Justin Marchegiani:  So any other comments–

Evan Brand:  Less risk.

Dr. Justin Marchegiani:  So far?

Evan Brand:  I don’t think so. I think we’ve—we’ve kinda gone to a couple different places and gotten the point across, I believe, which is be careful. Don’t be paranoid. But be careful, be wise, be questionable, but you don’t have to create a scene. You can still get what you need at restaurants and not be problematic. Like today we went to a local place where I got a bison burger with some greens and it was excellent and I feel so good from it. Avocado on it, oh, man! I’m still feeling good.

Dr. Justin Marchegiani:  Yeah, excellent.

Evan Brand:  So—so it’s possible. You don’t have to—you—it’s not as big as a sacrifice as it may seem I guess. So that would be my last—my last message.

Dr. Justin Marchegiani:  I’m gonna just read one last research study. This came from a Chris Kresser blog. It was really good on gluten sensitivity, but I’ll just kinda reference it here. New study took place over at the Columbia University and what they did was they enrolled 80 subjects who had self-reported non-celiac wheat sensitivity. So they reported that were sensitive to what they ate, that they didn’t feel good. Forty was celiac and then 40 healthy subjects. So 40 were celiac, 40 were just sensitive, and then what they did was they—they excluded certain diagnostic markers. So like they had IgA, they had transglutaminase 2, histology—they took blood samples on all of the patients and even intestinal biopsies. The blood samples were used to look at signaling molecule proteins in the blood which is really interesting. Now what they found was that the non-celiac wheat-sensitive individuals had leaky gut. So they had this gastrointestinal permeability. Now they compared it to the health—the healthy subjects and they did not since—this is not really surprisingly but they found out that the gliadin component of gluten can affect the tight junctions even in the healthy patients as well. So what does that mean? It means the main mechanism of action is the leaky gut. So it’s like just because you leave your front door open for one night and no one comes in your house, doesn’t necessarily mean that you’re compromising your house, your gut, your immune system in this analogy in the long-term. So if you do it every day and you leave that door open every day, your chance of getting robbed goes higher and higher and higher.

Evan Brand:  Yes, so you could feel well eating gluten but you’re still gonna be causing intestinal permeability–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Therefore, allowing toxins and parasites and other things to get into the system that shouldn’t be allowed in free.

Dr. Justin Marchegiani:  Yes, so the whole moral of the study was just because you didn’t have celiac, and you had this non-celiac, meaning you didn’t have all the diagnostic markers, the villous atrophy, all of the transglutaminase antibodies but you still were sensitive, the reason why was the leaky gut. The more you keep that—that gut open, the bigger chance of inflammation and that’s the thing. It really comes down to immune activation. The more your immune system is activated, the worse and what they also found was that these people in the non-gluten sensitivity group had higher levels of LPS or lipopolysaccharide binding protein. This was elevated and that in itself can increase leaky gut as well and these are sensitive markers for gut bacteria moving in the gut. So basically, you have gut bacteria from the gut moving into the bloodstream. That’s like the vagabonds on the street, the criminals on the street moving into your house. And when they’re in your house, they’re setting up shop, right? They’re not respecting your stuff, they’re creating a whole mess and that’s what these bacteria and these LPS and these bacterial junk are doing in your bloodstream and they’re causing the immune system to activate. So it’s like having someone in your house that’s like the Sheriff and then just start shooting at the people that come in. The problem is there’s gonna be a whole lot of collateral damage and the walls are gonna be shot out and a whole bunch of other things are gonna be shot out, too, and that’s like your immune system attacking the thyroid or attacking other kinds of tissue in the body.

Evan Brand:  Yes, there you go. That was good analogy.

Dr. Justin Marchegiani:  Yeah, anything else you wanna add to that, Evan?

Evan Brand:  I don’t think so. I think we’ve got the point across today.

Dr. Justin Marchegiani:  Cool. And then what would you say the best action points are? I’d say steak restaurants, sashimi, grass-fed burger places just sub the bun and just put the burger on a salad.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Really good things like Epic bars are great. Jerky is great. If you can handle like the nuts and spiced kind bar, if you can handle the nuts, those are great. They’re high protein, lower in carbs. Jerky. I would say smoked salmon at Whole Foods are really good like snacks on the go and really good collagen protein shake is great as well.

Evan Brand:  Yup, I agree. The only thing I would add—I don’t know if I would add anything. No, I thought I had something in mind. I don’t.

Dr. Justin Marchegiani:  So again–

Evan Brand:  I like–

Dr. Justin Marchegiani:  Go ahead.

Evan Brand:  I like butter. I like butter.

Dr. Justin Marchegiani:  I like butter, too, man. I got—that’s why I named my dog, Butter. But moral of the story is this, alright, there are gonna be some people that have already tried this and they’re not getting better. There are gonna be some people that tried it and are feeling a lot better. So my kind of plug is for people that are trying it and aren’t quite getting all the way better, there’s something deeper and there could be some serious digestive distress. You’re not breaking down food. There could be some infections. There could be some serious dysbiosis or SIBO and we may have to have the clinician’s eye really look over it and see what else is going on. There are also may be a lot of malabsorption from this happening for a long period of time, too, that needs to be assessed and looked at.

Evan Brand:  Totally, but here’s the free step. So take the free step first and then reach out, go to Justin’s site, justinhealth.com. I believe you’re booked out like 2 months now. I’m booked out like a month now. So we’re still available. We still block out a few hours each month for free consults. So if you’re kind of out there thinking, “Well, can I get help? Can I possibly get better?” Generally the answer is yes, as long as you’re motivated to try to–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Make the changes that are necessary.

Dr. Justin Marchegiani:  Yeah and we keep a few after hour consults available. People that need to get in on an emergency basis. So if people need that, you know, they can get to the front of the line. They don’t have to wait the—the one to two months because we know some people really need to get in and people that are, you know, less emergent they can always just get in in 1-2 months.

Evan Brand:  Totally, totally, yeah. So it’s good to have options there because the last thing we want you to do is think that you are going—not necessarily, it’s not that you’re not gonna get help, but we don’t want you to go to the emergency room and say, “Look, my gut’s hurting,” and then you go and you get the endoscopy and then you pick up an antibiotic resistant bacteria but the endoscopy shows nothing because it’s something else. It’s not something that’s pathological enough that’s gonna get detected or diagnosed by them, so–

Dr. Justin Marchegiani:  Yeah, and the worse thing in conventional medicine is once they see you have gluten, they’ll have you come off it and then re-test it and the only problem is if you’re really sensitive, you may feel like crap for weeks or months afterwards. That’s the problem because if you know already, do you really wanna, you know, play around with fire like that?

Evan Brand:  No, it’s scary.

Dr. Justin Marchegiani:  May not be the best. Yeah, it is.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  I mean I see patients that are really sensitive where they—if they get exposed to it, they literally can be disabled.

Evan Brand:  Yup, I know.

Dr. Justin Marchegiani:  Not good. So–s

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Well, everyone listening, feel free and click below. Give us a review. We love your feedback. We love the word being spread and if you want, just check out Evan’s site and my site. Get more educated, inform yourself, get wicked smart so you can take your health back and your control.

Evan Brand:  Well said. Take care.

Dr. Justin Marchegiani:  Evan, have an awesome Labor Day weekend, man!

Evan Brand:  You, too. See ya!

Dr. Justin Marchegiani:  Thanks! Bye!

Evan Brand:  Bye!



Dr. Peter Osborne – No grain, no pain! – Podcast #88

Dr. Justin Marchegiani interviews Dr. Peter Osborne in today podcast episode where they talk about being true gluten-free and what the gluten-free diet is all about. If you aren’t having the results you are looking for after trying the gluten-free diet, here’s everything you need to know. 

Dr. Peter Osborne Dr. Osborne has a book out right now called No Grain, No Pain. Listen to this podcast and learn how diet becomes a potential cause for autoimmune disease. Discover two common nightshades that most people tend to forget or don’t know about and the need to stay away from these if they are having chronic pain. Find out what highly specialized testings are available that you can take to check if your body tolerates gluten or not.

In this episode, topics include:

01:45   The history of gluten

9:47   Gluten-free diet vs true gluten-free

13:54   Pain and nightshades

16:20   Mechanism of gluten causing pain

25:00   Prescription pain trap

31:44   Summary








Gluten Free Society: https://justinhealth.com/gluten-free-society
No Pain No Grain Book: https://justinhealth.com/no-grain-no-pain
Gluten Free DNA Testing: https://justinhealth.com/gluten-testing



Dr. Justin Marchegiani:  Hey, there! It’s Dr. Justin Marchegiani. Welcome back to the show. Today I have an awesome guest, a friend and mentor, Dr. Peter Osborne. Peter’s got a book out right now called No Grain, No Pain, all about reducing chronic pain by making simple dietary changes. And I first heard of Peter about 5 or 6 years ago because I was one of these conventional gluten-free diets and I wasn’t quite having the results I was looking for. I still had some skin issues, some rosacea, some inflammation and he was the first person that put the concept out there that really resonated with me called being true gluten-free and the phenomenon of gluten-free whiplash. So it stuck with me 5 or 6 years ago and Peter’s out there helping thousands of people. He’s reaching out to hundreds of thousands of people via his weekly emails and this new great book that we wanna talk about and get some more information out to all the listeners today. So Peter, welcome to the podcast.

Dr. Peter Osborne:  Hey, Justin! Thanks for having me, it’s great to be here.

Dr. Justin Marchegiani:  It’s great for you to be here. Before we start, what did you have for breakfast this morning?

Dr. Peter Osborne:  Right out of the gate, well, I had a couple of scrambled eggs and coconut oil with a cabbage salad. I had some purple and green cabbage with some shredded carrots on top, some pecans and some sliced red bell peppers. That was—that was breakfast for—for me this morning.

Dr. Justin Marchegiani:  That’s great. I was hoping you weren’t say a gluten-free bagel.

Dr. Peter Osborne:  No, I stay away from anything gluten-free. At least labeled gluten-free, right?

Dr. Justin Marchegiani:  Yeah, absolutely.  Now one of the podcasts I first heard of you on a few years back, you kinda talked about the history of gluten. I think it was Dr. Willem Dicke, he was physician over in Holland and how he came about connecting the dots, I think with World War II rationings that grains, especially wheat, barley and rye, and as you put out there in your research, it’s much deeper than that. But can you just go over, just a brief overview of the history of gluten, and how we know it to be, you know, what it is today from a clinic perspective, cutting it out actually helps with a lot of these issues?

Dr. Peter Osborne:  Yeah, this is a really unique story. So, you know the physician was—was treating kids in—in a pediatric ward during World War II and what happened was grain was rationed and so no grain was available as food source for the hospitals, so the kids all went into spontaneous remission.  Now this was at a time in our history where we—we knew of celiac dis—disease, we just didn’t know what caused it.  So here—here all of a sudden, grain’s no longer available, all these kids are healing because celiac disease is—basically it’s a disease, you know, pediatric disease where you vomit and—and diarrhea and until you dehydrate and die. So—so he wrote a paper. It was published in 1952 and the same year, a group of researchers at the University of Alabama Burming—Burmingham did a study on 10 patients with celiac disease. Now here’s the sad part. This study was done on 10 patients. This is the study that isolated the protein that we—we commonly refer to as gluten. This protein is named alpha gliadin.

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Peter Osborne:  And they said, “Look, no further, we’ve discovered the cause of celiac disease. It’s alpha gliadin, therefore, all these other things are fine. All we really need to worry about is anything that contains alpha gliadin, and this is where wheat, barley and rye comes from.” Because when we’re referring to gluten in the FDA and the—and the definition in the grocery stores referring only to alpha gliadin, it’s not referring to this family of proteins which gluten is technically, it’s—it’s a family of proteins found within all grains—all grains, meaning corn, meaning rice, and sorghum, and millets. So not just wheat, barley and rye. But again, this study isolated alpha gliadin and it was again, only on 10 patients, but this was kind of a platform moving forward.  And another group of—of physicians did a study and wrote a book on it. It’s called If You’ve—If You’ve Heard Or Read, it’s one of these books—I’m actually pulling it off my library shelf right now, by Sidney Valentine Haas.

Dr. Justin Marchegiani:  Mmm.

Dr. Peter Osborne:  It’s called the Management of Celiac Disease and they did this—this study on 600 patients. So again, a comparative, 10 patients versus 600 patients. And what they found is they found that really grain-free was—was actually what led to a remission, and they had a remission in 600 patients.  So 100%—100% remission rate versus today, if you look at the standard gluten-free diet, what is the remission rate if we measure—if we measure the components of celiac disease, which are antibodies, persistent inflammation as well as villous atrophy on biopsy. If we look at how many of the patients with celiac disease actually are cured with a wheat, barley, rye-free diet? It’s in essence, it’s less than 9%.  So it’s about 8%–

Dr. Justin Marchegiani:  Yeah.

Dr. Peter Osborne:  Could actually experience a curative rate.  So—so this was my first kind of techy endeavor into or scientific endeavor into this because for me it was—I was eating all these gluten products just like you—gluten-free products. I was drinking the gluten-free beers. I was eating the gluten-free breads and for me, what—what was happening was I felt worse. I—I could go eat a loaf of wheat bread and feel better than if I ate this gluten—this—this gluten-free rice bread or corn bread, etc. So it—it really started to get me asking different questions and so I started reading about the history of—of grain in and of itself, and TJ Osborne who discovered prolamins. He’s actually the—the—who we call the father of plant biochemistry. He discovered prolamins and classified prolamins, which—prolamins are a form of gluten, and—and so we have gluten being this family of proteins found within grains. Grains are the seeds of grass. Within the seeds of these grass, we have proteins that are storage proteins that are designed to feed the—the embryo of the grains so that it can grow and sprout and to form a new grass, right? So, but also designed to protect the embryo so that predators don’t eat all the seeds, and basically eradicate the species of grass. So these glutens are not only storage proteins but they’re defense mechanism proteins found within grains and the—and—and interesting that the guy who discovered this and classified it shares the same last name with me.

Dr. Justin Marchegiani:  Small world, right?

Dr. Peter Osborne:  Right, right.  I was blown away by it, I mean it certainly I don’t take credit for it, but I—I love that he did that work and—and has that available for us to read and—and to think and ponder on, but so we’ve got these—we’ve got these gluten proteins and there are over—in 2010, there was a study done in Australia by Bob Anderson and his group. They discovered 400 new forms of gluten, and they found that 10% of these forms of gluten were worse than alpha gliadin in terms of celiac patient cells. So they found that 10% of these new discovered gluten proteins actually interacted and caused an inflammatory response in celiac cell lines greater than—than alpha gliadin.  So we know there’s more to this story and I think—I think it’s important to say, Justin, that, you know, I wrote No Grain, No Pain to shed light on this information so that people could think clearly and people could get real scientific information and—and make good smart decisions, and—and right now, with, you know, if people go to the celiac sites and to the—the general GI doctors, what they’re gonna get is they’re gonna get, “Hey, if you have celiac disease, go wheat, barley, rye-free. Don’t worry about oats. Don’t worry about corn. Don’t worry about rice.” And the vast majority of them are not gonna heal, the vast majority of them are gonna go on to develop multiple autoimmune disease as in have a life span that’s 26 years shorter. So I felt like getting that information out there to the world was an extremely important part of my mission.

Dr. Justin Marchegiani:  Love that. And I had a patient just maybe a month or two ago came in with severe RA, had multiple surgeries on her spine and hands because of the actual disfigurement and she had been on gluten-free diets, but then we kind of upped it one notch with a true gluten-free diet or an autoimmune diet following a lot of the same tenets in your book and her pain, 30-year pain, literally vanished in little less than a month. I couldn’t believe it, so this stuff is real. So a lot of the things that you’re talking about should be a first line defense with anyone with chronic pain or joint issues and it’s too bad the rheumatologists out there aren’t holding this book up and giving it to all their patients.

Dr. Peter Osborne:  Yeah, I would love to see it become a primer in—in rheumatology internships and rotations in hospitals across the country, and—and maybe one day we’ll get that to happen. I—I actually, you know, what’s ironic is? I—I started this whole thing started for me in Rheumatology. I—I was fortunate enough to do a rotation in the VA Hospital here in Houston, Texas in the Rheumatology Department.  So what I got to see first-hand was patient after patient on methotrexate, on steroids, on immune-suppressing drugs.  None of them really ever got better.

Dr. Justin Marchegiani:  It’s terrible.

Dr. Peter Osborne:  It—it was a horrible environment for these people, and then the surgeons would come in on—on one day a week and they would do these surgical consults and it was kind of like a mill. So, you know, the patients would get drugged with immune-suppressants. They really didn’t get better. Their joints continued to deteriorate and then they got surgical consults and got surgical joint replacements and then they were back 10 years later with a—with—with a need for a secondary joint replacement because there other one wore out. And so I got to see kind of all these kinds of patients going through that rotation through the VA Hospital. It was very eye-opening and enlightening for me and it’s actually what led me down the path or even investigating diet as a potential cause for autoimmune disease.

Dr. Justin Marchegiani:  Yeah and a lot of people talk about gluten-free being kind of like a fad, and I think people need to kind of realize if you study the Paleo diet, gluten-free from a true gluten-free perspective that you echo really cutting out the grains in general is not a fad, it’s actually has history of 10-plus thousand years, it being in our, you know, in part of our diet and lifestyle, but really what it is the fad is the gluten-free substitutes that are being added in. I mean, you don’t ever have to put a label on broccoli being gluten-free, but you have to put a label on maybe rice flour or potato flour being gluten-free. So can you just talk briefly about the—the misnomer of gluten-free being a fad and then compare it to the true gluten-free aspects?

Dr. Peter Osborne:  Yeah, so I mean, in—in any diet trend and we’ve seen this with Atkins and—and South Beach and we’ve seen this with—even with Paleo and ketogenic diets and probably the—the most famous of all is the gluten-free diet, right? Because what happens is big business, big companies take advantage of ignorance and—and that’s—they take advantage of ignorance through marketing. So gluten-free is a perfect example of this. We’ve got, you know, tons of companies that are out there. I think—I think some of them really started with good intention, Justin. I think, you know—you know, not really understanding what gluten truly was, they were just trying to create options for people with celiac disease, you know, rice breads, corn breads, and pastas, etc. But I mean, the reality is we have the science and we have the knowledge and—and now that they’re continuing to do that, to me now there’s an ethical and moral obligation for them to reevaluate their business models and to come back and say hey, we need to look at this in a different way. But if you look at what they’re doing, you know, first of all, we’re taking people who are very sick—autoimmune disease, right? Years, decades of damage, and we’re saying, “Hey, cut out gluten but eat crap.” I mean, that’s literally what these marketers are saying is cut out gluten, but here it’s still okay. Coke is gluten-free. Snickers candy bars are gluten-free, and hey, by the way, there’s genetically modified corn that we just shaped into the form of pasta spirals so that you can still eat macaroni and cheese. We want you to go ahead and buy a ton of that for 10 times what you pay for regular macaroni and cheese, it’s not healthy for you but we’re gonna—we’re gonna label it gluten-free and we’re gonna—we’re gonna kind of put the trend out there that gluten-free is healthier, and that’s what marketers have done.  That’s what companies have done, is they’ve created this kind of trend in the market that says, “Hey, gluten-free is better for you.” But the—the problem is that the vast majority of—of people out there are ignorant to the fact of what gluten actually is. So they’re just going out buying gluten-free products, right? They’re eating them and they’re still feeling like crap, and then they’re saying, “Hey, why do I still feel like crap on this gluten-free diet?” It’s because they’re—one, they’re not really on a gluten-free diet. Two, they’re eating food that isn’t good for them, right? And the cardinal rule in nutrition, you can’t get healthy or stay healthy eating food that isn’t healthy regardless of gluten-free status. There are, you know, sugars gluten-free but it isn’t good for you, and so if you’re diet is 60% sugar, you’re still gonna feel bad and you’re still not gonna heal and recover from years of chronic autoimmune damage. So it’s important to understand perspective and perspective for the person who needs this diet is that, “Look, you’ve been sick and you’ve been accumulating damage, inflammatory damage in an—in an overactive immune system for decades.” That requires a degree of stoicism in the diet. That requires a degree of—of discipline. It requires a degree of willpower and change and desire to change if your desire to get healthy is greater than your pain, then you will make these right decisions. If your desire to get healthy is not your priority, then you’ll continue to buy these processed foods, and you’ll continue to—to buy into these marketing hype and you’ll be one of those statistics where—or you’ll be one of those people out there that say, “Yeah, I tried that gluten-free diet thing, it didn’t work for me.”  And it’s not that it doesn’t work, it’s that it didn’t work for you because you didn’t apply it correctly.

Dr. Justin Marchegiani:  Exactly. That makes so much sense. And I have so many patients that we even go grain-free but there’s one element because you talk about the pain in your—in your book, all about pain. I find some patients have to really cut out some of the nightshades, the tomatoes, the potatoes, the eggplants, peppers, and we know there’s a high amount of alpha-solanine and glycoalkaloids that can be very irritating to the joints and cause pain. Can you touch more upon the nightshade piece and pain?

Dr. Peter Osborne:  Yeah, so—I mean, nightshades, in and of themselves, especially for rheumatic-arthritic conditions, we see these more. So like a person with a thyroid condition, we might not see nightshades be as much of a problem, but if somebody is really suffering with joint pain, these compounds in nightshades really have a great tendency. If there’s an intestinal leakage or a leaky gut or a permeability, they have a tendency to travel to the joints and really create a lot of the irritation and breakdown. So this is one food group that really needs to be looked at with aggression at removing and—and I see it in—very chronically and a lot of patients have to remove it indefinitely meaning that it’s not like a, you know, remove it for the next six months and then bring it back in. It’s a remove it because for you, as a unique person, as a unique genetic biochemical individual, this group and this compound of foods it—it irritates your joints. It’s actually we could—we could actually look at nightshades with rheumatic pain and say they’re probably just as much of a problem as grains are and that we really wanna get them out of the diet. Potatoes, peppers, one of the nightshades that people tend to forget about is a goji berry.

Dr. Justin Marchegiani:  Ahh.

Dr. Peter Osborne:  I mean, we—you buy the goji berries in these, you know, you can buy, you go to Whole Foods or like Trader Joe’s and buy the bags and berries frozen to make smoothies and stuff like that, and a lot of times, goji berries are in these mixes. You gotta remember goji berry is a nightshade. Now one of the other nightshades that—that people tend to forget about because you don’t eat it is tobacco because you smoke it.

Dr. Justin Marchegiani:  Oh.

Dr. Peter Osborne:  And so let’s say that you live—and I just had a patient. She’s living in a home, her father smokes, she’s getting exposure to second-hand smoke, she’s got chronic rheumatic pain and what ends up having to happen is we gotta get this girl out of this place and into her own place, so that—and she was an adult, so we—we were able to make that recommendation.  She was able to get out of there and basically was able to recover a little bit better. Now you will see a higher tendency of people who are smokers developing rheumatic-arthritic and that’s one of the reasons why. It’s that tobacco is a nightshade.

Dr. Justin Marchegiani:  Well, I just learned two new things. Goji berries and tobacco. That’s great. Good clinical call on that one. And what’s the mechanism of gluten actually driving the joint pain. We know we have the underlying leaky gut which can cause all these proteins, undigested proteins to kind of get into the bloodstream. We know the immune system and then maybe the potential molecular mimicry that’s happening where the immune response is calling out an APB for this type of protein and then other tissues kinda get in the way because they look similar. What else is happening just beyond that molecular mimicry mechanism?

Dr. Peter Osborne:  So, okay, you’ve got—you’ve got leaky gut, which like you just said, it allows all these things into the bloodstream that, you know, can travel to the joint, can travel to the muscles and that’s where the inflammation process is occurring. The immune response is occurring and so we’re getting secondary or collateral damage, right? Collateral damage to the tissue as a result of the immune system mounting a response. But one of the other things is just the direct inflammation, so gluten has been shown to cause a number of different pathways in the immune system. It’s been shown to activate a number of different ones. We generally tend when we’re measuring, clinically when we’re measuring to analyze to see where the person’s making antibodies, we measure antibodies to something called an antiendomysial antibodies. We will measure antigliadin antibodies. We’ll measure anti-tissue transglutaminase antibodies. But when we’re doing these measurements, we’re typically only measuring IgG which is one type of antibody or IgA. Now we make also IgM, okay? Which is an antibody that very rarely gets measured. So you’ve got also IgE which is an acute allergic response, and then you’ve T-cell responses and immune complex responses that are also potential pathways where people are reacting to gluten but then you have this whole other pathway that isn’t measurable at this point in time. We don’t have a commercial lab that measures this and this is the innate immune response. So antibody responses are called humoral immunity, it’s—it’s ada—what we call adaptive immunity where people get exposure and they create antibodies to what they’re getting exposure to to protect themselves, so that, you know, the example would be like a virus. You get—get exposed to a virus, your body responds by making these antibodies to protect you. But in the case of a virus, the virus comes, your body attacks it, and the virus goes away. It’s not like gluten where you—gluten comes, your body creates antibodies against it and gluten goes away, because if you keep eating the gluten, you continue to make the antibodies, you continue to battle it. You continue to create inflammation and collateral damage. But, so that’s humoral immunity. Then we have innate immunity. And innate immunity is the immune system you’re born with. Humoral immunity is the immune system you adapt with. So your body gets smart and basically takes the feedback from the environment and makes decisions. Whereas innate immunity is what you’re born with. And so there are specialized immune cells that look—they look at things and they just don’t like them and they’re gonna attack them. And so there’s not a way that we can clinically measure innate immune response specific to gluten or specific to grain. It doesn’t exist. There’s no technology out there at this point in time. Maybe they’ll happen in the next 10 years but as of right now, it doesn’t exist. And so that’s one of the other mechanisms of inflammation damage is an innate immune response. And so what we’ll see is we’ll see people with high levels of interferon gamma or tumor necrosis factor alpha, you know, these are other markers in the blood. You can measure that they’re high. They’re markers of inflammation but again, you—you can’t measure that they’re high because of gluten but—but you can—you can measure them and you can see that their high and then you can take gluten out of the diet and then you can measure them again and see that they come down. So—so does that make sense? So you have these generalized markers of inflammation that you can measure. You can get a baseline and then you can do a follow-up and you can say, “Okay, yeah, we changed your diet and these markers have come down.”  But there’s not a test that says your—your markers are high because of gluten. Because those markers can be high for other reasons, too, Justin. They can be high because you have a bacterial infection or a viral infection. They can be high over trauma, over an ankle sprain, or over liver damage. So there are other reasons why these—these inflammatory markers can be high. So it’s up to the clinician to kind of piece that together when he’s working with a patient. So–

Dr. Justin Marchegiani:  Yeah, totally agree with that.

Dr. Peter Osborne:  The other mechanism of damage that we see in—in rheumatic athritity, so in autoimmune arthritis is infection. So when that gut is leaky, we get bacteria that now get access and so some of the bacteria that are notorious for contributing to arthritic pains, Klebsiella and pseudomonas are two different species of bacteria. Another one is Lyme. Lyme is a very, very common cause and mimicker or rheumatoid arthritic symptoms. So you’ve got multiple forms of bacteria, so the other thing that’s important to rule out is infection. So you’ve got food that can cause leaky gut, then the bacteria leaks in, and it can get in—it can get in to the joints and start creating damage, so now you’ve got, you know, food started the problem but bacteria is finishing the problem, so if you just treat the bacteria but you don’t treat the leaky gut, then you still don’t win the war. So all of these things have to be looked at, because it—it’s the old scenario, which came first, the chicken or the egg?

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Peter Osborne:  It doesn’t matter. We can’t answer the question but we have to address the chicken and the egg if we’re gonna get the patient better.

Dr. Justin Marchegiani:  Also I think mycoplasma pneumonia is a—a big infection, too, for some of the joint stuff, do you see that, too?

Dr. Peter Osborne:  Yup, yup. It’s another one, Absolutely.

Dr. Justin Marchegiani:  And I also notice where there’s smoke, there’s fire. Could we have this systemic inflammation thing happening and pain may be the first indicator for people that have that genetic predisposition, but we also see autoimmune issues, maybe even type I diabetes or MS, so how many other—they call it PGAS or polyglandular autoimmune syndrome and they say, I think 78% of people that have one autoimmune condition, maybe it’s RA or some type of fibromyalgia pain, probably have another one, how much of the people—patients that you’re seeing individually in your office are having more than just the pain? There’s something else right next to it or beside it that’s happening.

Dr. Peter Osborne:  Well, pretty much all of them.

Dr. Justin Marchegiani:  Yeah.

Dr. Peter Osborne:  It’s very rare to see a—a singular autoimmune disease that just presents in solo fashion if you look. Now you know a lot of times, the patient’s symptoms, whatever predominating symptoms they have, those are the ones they bring to the doctor and then the doctor gives them a singular diagnosis. But I find if you’re thorough and ask enough questions, you find that these patients don’t have singular autoimmune conditions, and these can actually be measured, too. You can—there are a number of autoimmune tests that can be run if a person has—if a person doesn’t have a severe immune compromi—compromization, you can run tests that measure different autoimmune responses to different tissues, and you can actually find in many of these patients, 4, 5, 6 different autoimmune reactions going on in multiple tissues. It explains a lot of their other mysterious symptoms. It’s just a lot of times, doctors don’t dive in any deeper than just kind of, patient’s got joint pain, they go to the rheumatologist. They run rheumatoid factor and any nuclear antibodies as tests, and if those come back positive, they give them a diagnosis of lupus or RA or reactive arthritis, and that’s where it ends. You know? And then patient, you know, then they stay putting them on drugs and then you know, maybe that patient’s tired, too. Maybe that patient has other symptoms like chronic brain fog and fatigue, but they never get that piece put together, they never get—they never get tested for brain antibodies or neurological antibodies, so they never even know that that piece is part of their—is part of their underlying autoimmune complex problem. It just ends with the rheumatologist.

Dr. Justin Marchegiani:  Exactly. And then you just kinda talked about the—the dangerous medications that they’re putting a lot of the patients on. What really bothers me a ton is that the first line of therapy that they’re using actually perpetuates the problem even more because you have the NSAIDs which then are gonna create more of a leaky gut. It’s gonna lower glutathione levels, make it harder to detoxify the inflammation to begin with. Typically there’s gonna be gastrointestinal symptoms so they’re gonna be put on a proton pump inhibitor which will then decrease stomach acid which will make it harder to ionize minerals like selenium, calcium, magnesium, iron. They’ll get anemic. They’ll have low B12. That’s gonna create more fatigue, more leaky gut, more brain and mood issues because of the LPS that you mentioned, that lipopolysaccharide. So then now a couple years in, they’re on an antidepressant. They probably have low libido. They’re on a—a proton pump inhibitor. And then they’re on all these dangerous pain medications creating more, more issues decreasing detox. So it’s like conventional medicine is setting these people up for a world of hurt. Can you talk about the conventional approach that I outlined briefly and then your approach to get into the root?

Dr. Peter Osborne:  Yeah, so I actually I call this the protru—the prescription pain trap, because what ultimately happens with chronic pain is you get patients that are put on—they’re—they’re put initially some form of pain reduction medication, typically a nonsteroidal anti-inflammatory like an ibuprofen or a—or a Celebrex or a Mobic. You know, one of these—one of these classes of—of nonsteroidal anti-inflammatories that will—will erode the mucosal lining of the GI tract and induce a permeability within the gut itself and also induce ulceration within the GI tract. So it starts to affect their nutrition. Now once you start affecting nutrition and you start reducing their ability to absorb and digest, now it’s—it’s even harder for them to heal. So you’ve—you’ve kinda established this—this is why it’s called a trap, because you start with the medication and the medication does reduce the pain. It is effective at that, but it’s effective at keeping the person trapped in a state of always needing the medication and never being able to truly fully heal because of the damage to the GI tract. You’ll also induce vitamin and mineral deficiencies in this way—vitamin C and folate, and as you mentioned, glutathione. These are nutrients that get depleted and that’s just nonsteroidal anti-inflammatory drugs. But then we look at some of the other drugs that are used in these patients. The—the steroids, so the steroids themselves which inhibit calcium and magnesium and vitamin D. Vitamin D deficiency all by itself can cause an autoimmune condition. So for being put on a drug that causes a deficiency of vitamin D long-term and we’re being treated with an autoimmune condition. We’re just allowing again—we’re allowing vitamin D deficiency to never kind of recoup, and so one of vitamin D’s function is—is it regulates immune response. It regulates how strong immune cells respond to a threat. That’s why vitamin D deficiency can cause a hyperreactive immune system, and so again these steroid medications cause these nutrient deficiencies. They also cause bone loss and water retention and bloating and weight gain. So now you take this person who’s got pain and you’ve just given them a drug that causes them to gain weight and increase their chance of diabetes, and now they’ve got joint pain already, so you’ve increased the physical pressure on their joints because now they weigh more. So now that joint gets eroded and damaged, just having to carry more weight and so that extra weight now causes more erosion.  You see where it’s kind of a bleak scenario, isn’t it?

Dr. Justin Marchegiani:  Yeah.

Dr. Peter Osborne:  And the now we look at other drugs that sometimes get brought in and these drugs are basically severe immune-suppressants like Humira or Enbrel, and these things shut down immune system so now you—you start these medications and you’re on them 5-10 years, now you’re looking at a huge risk, increased risk for cancer and other kinds of infection. Well, we said earlier that infections play a big role, and the by-products of infection is lipopolysaccharides, play a big role in perpetual joint pain.  So it’s—it’s a futile effort in modern rheumatology. It is a futile effort to go that route and expect to get resolution. All you will do is—is fall into that trap. Now how do you get out of that trap? Because a lot of people will say “Well, I can’t get off my methotrexate, or I can’t get off my–”

Dr. Justin Marchegiani:  Mmm.

Dr. Peter Osborne:  “My steroid because it hurts so much.” Yes, you can. But it has to be done. It has to be done with scrutiny. It has to be done with intelligence and purpose. The first step is you gotta change your diet. Diet change, first and foremost, has to be implemented because a lot of the inflammation is stemming from the poor diet in the first place. The second step is part of changing the diet is increasing your Omega 3:Omega 6 ratio. You want—for somebody with chronic pain, you want a 2:1 at least Omega 3:Omega 6 ratio of fat–

Dr. Justin Marchegiani:  Mmm.

Dr. Peter Osborne:  In your diet. Now that’s really hard to achieve in modern diets today. Most people don’t live on the coast where they have access to fresh coldwater fish–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Peter Osborne:  Where they can get that quantity of Omega 3. So we’re gonna use concentrated EPA and DHA, you know, fish oils, so that we can drive that factor up. And I see working really, really well anywhere from 4 to 8 grams. So a lot of people stop shy of about 2 grams and they never really achieve a therapeutic dose of Omega 3 to switch that—that balance. So we’re looking at 4-6 grams potentially there. Other things that can be done naturally is the use of turmeric. It’s very, very–

Dr. Justin Marchegiani:  Uh-hmm.

Dr. Peter Osborne:  Effective at pain control and—and it can be—you can use turmeric to cook with, and so if you—if, you know, a lot of Indian recipes, this is where turmeric hails, a lot of our knowledge from turmeric actually comes from that culture but it’s being—been studied more and more and more. We know it has extremely powerful and potent anti-inflammatory and pain reductive properties so the use of turmeric and I recommend 3-4 grams of turmeric, concentrated turmeric, meaning it should be at least 90% or more concentrated curcurminoid. So it needs to be standardized to contain that, otherwise, you gotta use so much turmeric in your cooking, it’s really, really hard to achieve that level for pain reduction. So if we’re trying to get pharmacological pain reduction, we really gotta go high doses, we can’t go small doses.

Dr. Justin Marchegiani:  And only 15% of that’s absorb, too. I’ve—I’ve seen.

Dr. Peter Osborne:  Right, so you can use things like pepper, black pepper, or BioPerine to enhance absorption then there are also lipophilic forms of curcuminoids, meaning they’re—they’re fat-soluble forms, it get absorbed better than your traditional powder. So those are all things that if you’ve got a good functional medicine doctor to guide you, that—that ultimately is a—is a really smart thing to have. You know one other thing that works extremely well for kind of pain reduction in—in these people, who there’s a couple—I’ll talk about a couple more. One is a proteolytic enzyme. Proteolytic enzymes work extremely well at modulating pain and there are a number of good clinical brands that are out there. I actually have my own formulation called Matrizyme, but they—they work really, really well at pain reduction and inflammation control. You’ve got to get the dose high enough and then the other thing that I find that is very, very helpful is something called an SPM. It’s—SPM stands for specialized pro-resolving mediators and these are by-products of fish oil. So what these are is ultra-concentrated resolvents that are derived from EPA and DHA that have a tendency to shut off the inflammatory cascade when it’s overreactive and so this is—again this is one of those things it can be used, it’s—it’s clinical so you can use it clinically in high doses for several months as you’re trying to get a patient to wean off some of their pain medications and get them moving back in the right direction. So again, if we summarize: the diet’s gotta change, inflammatory foods have to go away, grains gotta come out, nightshades gotta come out, I recommend that dairy comes out, I recommend high levels of—of Omega 3 fatty foods as well as high levels 4-8 grams a day of Omega 3 fatty acids concentrated EPA and DHA, I recommend high levels of turmeric anywhere form 4—3 to 4 grams a day, concentrated curcuminoids at least 90%, I recommend proteolytic enzymes, and I recommend SPMs, specialized pro-resolving mediators, to help with all of these different things to wean that person out of that prescription pain trap.

Dr. Justin Marchegiani:  And you also use Gluten Shield as well, I think, you formulated that. It’s very high in dipeptidyl peptidase-4 to help with any cross-reactive gluten and you also use a lot of anti-inflammatory herbal blends. I think you use like your GI Soothe or your GI Restore, is that true, too?

Dr. Peter Osborne:  I do, yeah. We try to seal the gut, and—and so the difference is, Justin, as you know, when we’re doing a podcast together, we’re trying to give a general—general quantity of information to people. Ultimately what I recommend if somebody has an autoimmune arthritis or an autoimmune condition, really to work with a doctor like yourself or myself or another functional medicine expert who has these things at their disposal and discretion but also the ability to run highly specialized types of tests, because the testing and you know the—we’re do—we’re giving general advice and it’s good advice but highly specialized testing allows us to take the guesswork out, because for some patients—for some patients, it’s not a bacteria at all. It’s a yeast overgrowth and for some it’s not bacteria or yeast. For some patients, it’s that their reac—I had one young child terminal allergic to blueberries, right? And every morning, blueberry smoothie was breakfast, so—so this is the kind of specialization, you can do all these right general things and still be struggling to find an answer, and that’s why taking the guesswork out, you know, sometimes it’s the best thing that you could possibly do.

Dr. Justin Marchegiani:  That’s great. So in summary, get the food dialed in. Go get a good functional medicine doctor in your corner to get the—the right supplements, whether it’s getting rid of the infections, adding in digestive support whether it’s specific enzymes and hydrochloric acid, anti-inflammatory herbs to help reduce inflammation, anti-inflammatory fats and then healing-repairing nutrients. Is that a good summary to start?

Dr. Peter Osborne:  Yeah, it’s great. Perfect summary.

Dr. Justin Marchegiani:  Good, and then you touched upon the lab testing. You already talked about we have some of the immune testing, IgA, IgG, which is indirect—it’s not looking at things directly, and we know based on whether your weakened immune system, that may even come back a false-negative. You also talked about the conventional testing, looking at endomysial antibodies, transglutaminase, and then also your typical villous atrophy where we need like an 80% reduction in those microvilli in the small intestine to be even be able to pick up celiac which is one out of hundreds of manifestation of gluten-sensitivity, but your big thing is you’ve really gotten into the genetic testing and you’ve laid out the—the conventional HLA-DQ2 and HLA-DQ8 as being the—the celiac. But then you go deeper into the different subtypes, A1, B1, and then all the different subtypes there. Can you just kinda give us an overview with the HLA-DQ genetic typing? I know you do it on your site over at GlutenFreeSociety. We’ll put some links below the video so if anyone’s on the fence and doesn’t know if they have a sensitivity to gluten, they can get the—the tell-tale sign which is the genetic test. Can you go into that, Peter?

Dr. Peter Osborne:  Yeah, so as you—as you mentioned, a lot of these tests they detect late-stage disease. So you’ve gotta have 80% of your villi destroyed before biopsy comes back.

Dr. Justin Marchegiani:  Yup.

Dr. Peter Osborne:  I actually had a patient, you know, it—it was a 19-year trek for her. She literally had 19 biopsies. The 20th biopsy was positive. The first 19 were negative. And—and so I say it because a lot of people go to the GI doctor, they’re dependent upon this test to give them a definitive answer. And it’s not that you shouldn’t get a biopsy per se, it’s that, look if you get a biopsy and it’s negative and you suspect gluten, you shouldn’t rule gluten out just because the biopsy is negative. You get false-negatives with biopsies very frequently. One of the reason why is the damage has to be severe enough to identify, too.  The intestinal tract is 22-foot long and has a surface area of a tennis court. So when you do a biopsy, you take one little tiny cross-section, one little microscopic—it’s like taking a little tiny pebble off the tennis court and saying this pebble represents the entire tennis court and it doesn’t. And so you can’t rely on that information as definitive. You can rely on it if it’s positive. You can’t rely on it if it’s negative.

Dr. Justin Marchegiani:  Right.

Dr. Peter Osborne:  What genetic testing does, HLA-DQ2—there are two genes, there’s HLA-DQ2, alpha 1 and HLA-DQ beta 1—these are immune genes and they’re job is—and they’re on Chromosome 6, their job is to produce an antenna that sits on the surface of the white blood cell, and the—the job of this antenna is to identify what is good versus what is bad. So if the body says, “Hey, we don’t like this.” That antenna says bad guy and then it—it captures it, presents it to the immune system and create some kind of inflammatory reaction. Okay? They’re a variety of different types of inflammatory reactions that can occur as a result of that. So there are certain pattern s on the HLA-DQ2 alpha 1 and beta 1 gene that are gluten-sensitive patterns, meaning if a person has these patterns, their body, their genetic receptor is gonna look at gluten as an enemy not as a friend. And so it doesn’t—so gene—what genetic testing tells us is that they’re going to look at gluten as a friend or an enemy. It doesn’t tell us whether they’re currently reacting to gluten, it tells us whether or not they would react to gluten and to me that is far more variable because you can take somebody who’s chronically, chronically sick, and run a genetic test and not worry about a false-negative, because a lot of these chronically sick people have immune suppression over time.  Their—their IgA levels plummet and—and they’re malnourished, so they don’t have enough protein to generate enough IgG to generate an IgG-positive response. So if we’re using these traditional labs, we have this high tendency towards false-neg—excuse me—false-negative.  Genetic testing doesn’t ever change. You either have the gene pattern for gluten-sensitivity or you don’t. And so again, what it tells us—it doesn’t tell us that it tells that you are reacting to gluten. It tells us that you will or you will not react to gluten. And these genes are activated by gluten exposure, so you know, a lot of people say, “Well, how do you turn these genes on?” Well, you eat gluten and these genes get mad and they activate the immune system and create an inflammatory response. So it allows us to actu—it actually and accurately identify people who should be taking gluten out of their diet and it’s a genetic issue. So gluten—we’ve defined gluten sensitivity as it’s not disease. It’s a state of genetics. If you have the gluten-sensitive gene pattern and you eat gluten, your body’s normal and natural response is gonna be to create inflammation. The more gluten exposure you get over time, the more inflammation you make. The more inflammation you make, the more you perpetuate disease processes and the more sick you become with time. So it’s—it allows us to say, “Look, you could be a little kid who doesn’t have any symptoms, but have gluten-sensitive genes, we can now say, ‘Look, get it out of your diet now, so that in 20 years, you’re not back at my clinic for me to treat your 3 or 4 different autoimmune and disease and 20 or 30 years’ worth of damage.’” We can—we can actually isolate and identify the people who need to get it out of their diet right now regardless of their illness and—and that to me is a much valuable, clinical tool than any other form of blood test because genetics don’t change. Blood tests can vary dramatically.

Dr. Justin Marchegiani:  And I know that the conventional celiac genes are 2 and 8, HLA-DQ2 and HLA-DQ8, which supposedly about 35-40% of the population has those, but when you look at the other HLA-DQ1, 2, and 3, and then 1 breaks down into 5 and 6, and the alpha 1 and beta 1, and 3 breaks down to the 7, 8, 9. According to, I think, Kenneth Fine, he says 90-95% of celiacs have a copy—have at least 1 copy of those genes. So we know it went from 35-40 to 90-95 and then we originally thought well, it was at 1 in 133 people were celiacs, so now we’re starting to see it’s getting the infinites is getting greater and greater and greater.

Dr. Peter Osborne:  Well, and part of that it has to do with—you know, I—I honestly believe that most people are gonna benefit from a gluten-free diet because most people have a degree of genetic gluten intolerance or gluten sensitivity. Nobody has done enough of broad scale genetic study to confirm that one way or the other, but you know, we’ve got data in our clinic that tends to—tends to go to that direction. But the other factor that you—you have to consider, it’s a—it’s a dose response issue, so the more gluten you eat, the more damage you create. So with some people who don’t eat as much, maybe don’t create as much damage and don’t get quite as sick, but so you’ve got that as an issue, but then you also have certain medications that enhance–

Dr. Justin Marchegiani:  Mmm.

Dr. Peter Osborne:  The way we would react to gluten, and so these are what would—and Dr. Fasano refers to these as—as the trick. He says what happens is there’s a trick. There’s basically an event that occurs and then your body starts reacting to the gluten more aggressively to the point where you could identify it almost immediately. Those tricks per se are things like chronic non-steroidal anti-inflammatory use, chronic Nexium or Prilosec or Zantac or you know, antacid–

Dr. Justin Marchegiani:  Right.

Dr. Peter Osborne:  Medication use. Chronic antibiotic use, right? Chronic intake of chlorine because you’re drinking chlorinated water which disrupts gut bacteria.

Dr. Justin Marchegiani:  Right.

Dr. Peter Osborne:  You know, these are the tricks per se that we now we have an environment—a modern environment that has—we have all these elements that damage our gut and make it more susceptible. So we may already have genetic susceptibility but now you add all these other factors and it accelerates the damage that’s being done to the GI tract so that we’re getting more leaky gut. We’re getting more of these chemicals and bacteria and other things that are leaking through. So we have a modern environment that accelerates the damage that gluten can cause, because that’s one of the big questions I get, what—you know, go—go back in time 50 years ago, why weren’t people quite as reactive? Well, 50 years ago, you didn’t have antibiotics in the major cities’ drinking water on accident, right? Fifty years ago, doctors weren’t just hammering everybody with the antibiotic. You know, you didn’t have ear infections in kids and every other week, the kid’s getting put on a new antibiotics. You didn’t have mother delivering vaginal—or cesarean babies where kids don’t get normal bacterial flora from the vaginal canal when they’re being born. They get nosocomial disease-causing bacteria as the first bacteria that colonize our GI tract. So we have all these other factors that are going on today that enhance gluten sensitivity and make it happen earlier in life, and I think that’s the trend that we’re seeing. But then you also add, Justin, you add to the compo—all that component, you add to the fact that grain is processed with heavy quantities of glyphosate.

Dr. Justin Marchegiani:  Right.

Dr. Peter Osborne:  Atrazine is another pesticide that’s used. So these grains are soaked in pesticide. These grains are stored in large bins where they have this tendency to grow heavy quantities of mold which produce mycotoxins.

Dr. Justin Marchegiani:  Exactly.

Dr. Peter Osborne:  Okay, and then you also have the fact that grain in and of itself, some of the—some of the grains have been hybridized so that genetically they’re more complex and harder to digest. Some of them have been genetically manipulated and so they actually produce their own chemical toxins and so when we eat them, we’re eating a lot of that. So you’ve got all these different factors that play a role in why we’re seeing people respond so well to going grain-free. That’s why that—that’s why the gluten-free diet trend is there. And if you look at historically at how this is all played out, it really started with Dr. Atkins. You know, he—he challenged the original conventional wisdom and said, “Look, quit eating carbohydrate and he—what he was onto is he was on—I think he was on to two very important things. One, he was onto the burden of—of too much excessive sugar in the diet creates a problem, causes sticky blood and—and damaged blood and it—it causes brain damage and brain fog, and it disrupts mitochondrial function and a number of other things, but I think the other piece that he really stumbled on and—and maybe he was aware of it, maybe not—I never—I never had the chance to talk to him, so I can’t say one way or the other. But I couldn’t detect that he—that he was onto this by reading any of his—his books, is that gluten in and of itself was in all these carbohydrates that people were eating as staple foods, and so just eliminating those two factors, eliminating excessive carbohydrates but also eliminating grain and—and glutens, people were dramatically improving their health and so today we have evolutions of that. We’ve got the gluten-free diet. We’ve got ketogenic diets. We’ve got Paleo diets. All kind of evolutionary diets that have moved in—into a—and they all have the same thing in common, right? And that’s grain-free for the most part.  Let’s get the grain out of the diet and I think that’s why we see that as all those different reasons that we just talked about again. That’s why I wrote No Grain, No Pain. It’s not another gluten-free diet book. So those of you who are out there listening, it’s like you’re tired of hearing about gluten. It’s not another gluten-free diet book. If you really wanna understand this topic and you really wanna be able to apply it to your life intelligently so that you can restore your health, you gotta understand that this book is so much deeper than just a gluten-free diet.

Dr. Justin Marchegiani:  That’s great. So if anyone’s on the fence about whether or not getting grains or out, you know, are a good thing for you? Definitely get it out, but if you need more, the genetic testing’s gonna be great especially the one that Peter’s talking about because it looks at that alpha 1, beta 1 subtype and we’ll put a link in the podcast and the video description below so people can access it. Now in your testing, you also talk about HLA-DQ4 being the only genotype that technically isn’t a gluten sensitivity genotype but even if you have that, you may still have problems with gluten. Can you talk about that for a second?

Dr. Peter Osborne:  Well, it would—it wouldn’t necessarily be that you had problems with gluten per se as much as it might—is it might be that you have problems with—with grain because of all the unhealthy other factors.

Dr. Justin Marchegiani:  All the things you mentioned.

Dr. Peter Osborne:  Right. Well, here’s the—here’s another thing. This has been around for a number of years, but it’s really starting to come to head. There are several new classes of proteins found in grain.

Dr. Justin Marchegiani:  Mmm.

Dr. Peter Osborne:  That are non-glutens, and one of them is—is called ATI, amylase trypsin inhibitors. These are proteins that shut off your pancreas. So here we’re—we’re saying, we’re shutting off your pancreas, then—then we’re shutting off the digestive function of your pancreas so that when you eat these grains, they’re not being digested because the grain’s goal—it’s a seed, right? It wasn’t to come out. It—it doesn’t wanna be your food. It wants to come out of your butt with poop around it because that’s fertilizer so it can grow.

Dr. Justin Marchegiani:  Right.

Dr. Peter Osborne:  So it has developed mechanisms to protect itself from predators and one is to prevent digestion. So this—this family of proteins called ATIs have been shown to shut down pancreatic function. But they’ve also been shown to acti—activate something in the GI tract called the toll-like receptor.  And one of the things that happen when you activate this toll-like receptors is you get an anti-inflammatory pathway or an inflammatory cascade going, and so this ATI has not only created a gastrointestinal inflammation but they also created pancreatic shutdown and these have nothing to do with gluten. So if we’re talking just specifically HLA-DQ testing is—is gonna identify gluten sensitivity where-as grain may be unhealthy for other reasons and I just want—I want the—I want the audience to understand that, and ATI is one of those reasons. I actually—I wrote there’s 5 different—part of the book is I wrote, there’s 5 different classes of new proteins that have been discovered in grains. They’re inherent to protect the grain, and—and so part of their job in protecting the grain is to defend it from us and our ability to digest it and our ability to process it. So you wanna understand that those are part of the problem of grains beyond gluten. Pesticides are part of the problem. Molds and mycotoxins are part of the problem. None of these things have anything to do with gluten.

Dr. Justin Marchegiani:  Right.

Dr. Peter Osborne:  And that heavy metals like cadmium and arsenic are part of this problem because especially rice, rice contains high quantities of these. And then you have what Atkins and so many others have discovered is that grains are super high sugar producers.

Dr. Justin Marchegiani:  Right.

Dr. Peter Osborne:  You know? So we’re gonna get, you know, the amylopectin which is one of the—one of the elements to grain that causes elevations in blood sugar worse than sugar does. So you’re gonna get carbohydrate load that’s going to induce a diabetic state. So you’ve got all these different reasons. We could—we could say, “Look, regardless of your gluten status, maybe you are HLA-DQ4, but do you really want to eat this grain as a primary staple food in your diet because all of these other things are gonna wreck your health, too.”

Dr. Justin Marchegiani:  Totally agree. I got a study here form the Journal of Experimental Medicine that says more over ATIs, that’s the trypsin inhibitors you just mentioned, may fuel inflammation and immune reactions in—in other intestinal and non-intestinal immune disorders. So this is right out there in the literature, everyone. So what we’re talking about really is—is deep and hardcore science.  It’s just most conventional doctors haven’t really got into it yet.

Dr. Peter Osborne:  And that’s the sad part, Justin, is like—look, you know, one of biggest criticisms I take on, you know, and I’m—I’m definitely a leader, a thought leader in this field, I—I know that to be the—the truth, and I don’t say that, I’m not tooting my own horn, but I take on this criticism because I’m a chiropractor, you know, and I’ve got other degrees and diplomas, but my heart is in chiropractic as well, and that because I’m not a medical doctor, so many people say, “Oh, he’s a quack. He doesn’t know what he’s talking about.” But the reality is, I didn’t create any of this information like out of a whim or even out of clinical experience. This information comes directly from the medical literature. The problem is most doctors don’t read their own literature.

Dr. Justin Marchegiani:  Nope.

Dr. Peter Osborne:  I happen to read an extra 15 to 20 hours a week in my spare time so that I can keep up with this type of information because I feel like it’s my job. If I’m gonna help patients get better, I gotta understand the latest and the greatest and the newest and even the oldest and—and if more doctors took time to take that on and take their jobs more seriously, I think a lot of doctors just get into this, you know, this regular routine of just cranking patients through a mill and not really seeing patients, not really hearing patients, just kinda of—just kind of going through the motions with patients. I think that’s a travesty. That’s—that’s one of the hugest problems we face in the United States is that we’ve got doctors who have lost bedside manner, who’ve lost compassion, who are in it for the wrong reasons and I’m—and I’m not categorizing all doctors here. I know there’s a lot of great doctors, too. But look, I wouldn’t have a clinic with 5-month waiting list if those doctors they were out there, for most of the GI doctors that were out there, most of the specialists that were out there, if they actually look the moments and the time to read the literature and to—to apply the literature with their existing patients, I would be out of job. But the fact of the matter is, I’m not out of a job. I’m busier than I’ve ever been in my life because the experts who are supposed to be being the experts, who are supposed to be being the leaders and leading the field, are dropping the ball. So the chiropractor has to pick up the literature and he’s gotta read it and he’s gotta be able to apply it with his patients and he’s gotta be able to apply functional medicine, you know, and I—and I just say that because that—that is one of the things that makes me the maddest, it—it, you know, it’s frustrating to deal with every patient coming through the door who’s so frustrated because they’ve been to 8 to 9 or 10 different doctors who are supposed to be the leading experts. It’s so—so it’s an uphill battle, Justin, as you know, not only do we have to educate our patients, but we’ve got to overcome all the misinformation. And look, a lot of these doctors—I had a patient come in to see me last week, her child had hives—had had hives for years. They didn’t know why. So they were seeing a pediatrician. They were seeing an allergist. The kid had been taking allergy shots for 2 years and the doctor said, “Well, it’s gonna take about 5 years of allergy shots to really get it to clear up.” Now that’s ridiculous, to take 5 years of allergy shots–

Dr. Justin Marchegiani:  Oh, man.

Dr. Peter Osborne:  To clear up hives. We cleared them up in less than months. Now when this woman took her son back to the allergist, she took all the paper work and all lab testing that we did to this allergist and she said—she said, “Here, I just want you to know what we’re doing because he’s better and, you know, we—it’s not like I—I didn’t give you to get him better. We’ve been doing this for 2 years but I wanted to share this with you because I think that if you understand this, you might be able to help other patients.” And this doctor rolled his eyes at her.

Dr. Justin Marchegiani:  Unreal.

Dr. Peter Osborne:  It basically laughed at her and said, “Well, you know, if it’s working, keep doing it, but it isn’t really important,” and it’s like, “Shame on that doctor!” I could tell you something right now from patient who brought in information to me. If I had been treating a patient for 2 years and not been able to get them better, and they—and they came back and said, “Look, I visited another doctor and this is what we did.” And it got me better, you can bet your bottom dollar, I’m gonna be on a the phone with that doctor, as soon as that appointment is over, trying to figure out where he’s doing something that I’m not doing, how could I better improve my own skill set so that I could help more people, you know? But—but the attitude with a lot of these doctors is, look, if it’s not mainstream, it’s quackery, which is—which is BS. And—and if—if he’s a chiropractor, he doesn’t know very much and he’s not qualified which is also, as you know, BS. We have our background and education is—is so advanced compared to what people think that it is and anyway that’s—that’s a horse site, we don’t have time to get on but–

Dr. Justin Marchegiani:  Yeah.

Dr. Peter Osborne:  I just—I just had to say that because, you know, a lot of people that’s—that’s, you know, I would say, “Look, if you—if you doubt the information in this book just because I’m a chiropractor, shame on you.” It’s documented.

Dr. Justin Marchegiani:  Right.

Dr. Peter Osborne:  There are 33 pages of medical references. I didn’t create this science. I just interpreted, put it out there for the rest of the world in a manner that’s consistently easy to read so they can be applied. So get out there. If you’re struggling with autoimmunity and you’ve gone through convention and it hasn’t worked for you, you know, get your—get off your high horse and read the book and apply it, and watch miracles happen.

Dr. Justin Marchegiani:  That’s great. That’s great. And I think a lot of doctors—it—it’s not like this great grand conspiracy but I think a lot of people, a lot of doctors for instance, they are under the impression and most people are, too, that if I didn’t learn it in medical school, it’s not important, and everything in medical school is gonna be all I need to help my patients get better. And that’s I think the grand assumption that most doctors and most people that go the conventional route are under. And you’re really dispelling a lot of that in your book. And—and my last question before we give you a send off, as I heard someone on the podcast just recently talking about, well, you know, get—go gluten-free, cut it out, and then add a little bit back in, and if you don’t have a reaction or a symptom when you add a little bit back in, then you may be able to handle a little bit. So what’s your perspective on just relying off of symptoms and adding a little bit of gluten back in? Is that the best way to do it or should we look deeper?

Dr. Peter Osborne:  Symptomatic response, it’s like saying, don’t exercise tomorrow and if you don’t feel diabetic symptoms tomorrow–

Dr. Justin Marchegiani:  Beautiful.

Dr. Peter Osborne:  That—that, you know what I’m saying? It’s—it’s–

Dr. Justin Marchegiani:  Yeah.

Dr. Peter Osborne:  It’s a ridiculous statement.

Dr. Justin Marchegiani:  It is.

Dr. Justin Marchegiani:  I don’t know who said that, but shame on them.  Shame on that person. Gluten sensitivity is a very, very serious issue, and if you’re truly gluten-sensitive, you shouldn’t be introducing it back in. So I—I would say, you know, there’s no safe amount of gluten. There’s, you know, not if you’re gluten-sensitive, in fact and as a matter fact, research shows it’s 20 parts per million, which is equivalent to a drop of water to a gallon of water, that—that amount of gluten exposure can create an inflammatory response for up to 2 months.

Dr. Justin Marchegiani:  Wow.

Dr. Peter Osborne:  So you know, absolutely don’t reintroduce it and try and see if you tolerate it, because what’ll happen is you go gluten-free for 6-8 months, you’re gonna feel dramatically better. Most people do, and when you feel better and your body is now healing, it’s gonna be more adaptive, it’s gonna be more resilient, it’s going to have a greater reserve to combat, you know–

Dr. Justin Marchegiani:  Perfect.

Dr. Peter Osborne:  Environmental problems. It’s part of what we’re after with wellness, is to have good adaptability to the environment without becoming sick, you know? So—so to say, okay, take the gluten out and then start reintroducing it, it’s like saying, okay, take the sugar out and when the diabetes clears up and the blood sugar normalizes, start eating sugar in again, what’ll happen is eventually you’ll start developing diabetes again, so it’s—it’s a ludicrous statement.

Dr. Justin Marchegiani:  Totally agree. And I wanna push everyone to head over to GlutenFreeSociety.org. This is where I got my foundational information about gluten and even being a physician, there’s tons of great info and if even if you’re a layperson just getting into a it, there’s still a ton of great info to kinda get your feet wet and even go beyond that with some of the clinical stuff. So I wanna push everyone to go to GlutenFreeSociety.org. We’ll have some links for the specific lab testing as well. Also head over to DrPeterOsborne.com. Peter’s got his awesome 7 Highly Effective Habits for a Gluten-Free Warrior. Lots of great information there. Anything else Peter that you wanted to kind of leave the listeners with? And then also I’m gonna go purchase my—my copy of your book here, No Grain, No Pain right now and I wanna urge everyone to get their copy as well. Let’s push it on to the New York Times’ List. I know you’re almost right at the 10,000 mark for sales and we’re gonna push it way above it and get you on there so we can get more exposure to people that need access to this information.

Dr. Peter Osborne:  I—I would say I’d leave with your audience, you know, if—if you’re suffering and—and you don’t know why and you’ve gone through convention and it hasn’t worked for you, you don’t’ have anything to lose. Try phase 1 and phase 2, it’s a 30-day plan.  Try it out. Take it for a test spin. You have nothing to lose. You have everything to gain. I would say to any of your listening audience, if you’re a healthcare practitioners or clinicians, and you really wanna get this dialed in and get this information, because part of my goal is to help people get better and part of that is helping physicians, I’ve created a 10-hour post-Graduate course for physicians. If you go to GlutenFreeSociety, there’s a tab that says GF Doctors, click on that and you can learn more about that. Take the course because the information you’ll learn from it, that knowledge you’ll get from it will allow you to help more people get better.

Dr. Justin Marchegiani:  Love it, awesome! Great information and last simple question I ask it to everyone—I almost missed it with you—if you were stuck on a desert island, what supplement or herb would you bring with you or one supplement?

Dr. Peter Osborne:  I—you know, what? I think if I were stuck on a desert island, I would probably take my high-quality multivitamin.

Dr. Justin Marchegiani:  Mmm.

Dr. Peter Osborne:  Simply because I want a diverse amount of vitamins and minerals in me and if I’m gonna be foodless or missing certain foods that are gonna be devoid or certain nutrients, I want as much of a variety to prevent major malnourishment diseases like beriberi, pellagra, or scurvy.

Dr. Justin Marchegiani:  Very common sense answer. I appreciate it, Peter. We’re gonna do a video basically summarizing all of the key points with all of the links on the video. Thank you so much, Peter. We really appreciate your time.

Dr. Peter Osborne:  Hey, Justin. Thanks for having me and have a great afternoon.

Dr. Justin Marchegiani:  You, too. Bye.



Is your brain and immune stress making you tired? – Podcast #84

Dr. Justin Marchegiani and Evan Brand in today’s podcast talk about HPA axis for fatigue and its connection to the immune system, given how cortisol helps with energy and its importance with immune response.  They also talk about healthy gut bacteria and B vitamfatigue, brain, hpa axisins. 

Learn about malabsorption and the effects of surgeries like a gastric band or bypass. Discover how you can transition to a Paleo template and how you can go low calorie naturally. They also emphasize how important it is to get enough absorption to avoid dysbiosis, infections and low stomach acid.

In this episode, topics include:

00:45   Apple cider vinegar

9:40   Supporting the immune system

15:46   Fatigue and immune health issues

16:46   HPA axis

22:46   Poor digestion/poor bacterial balance









Dr. Justin Marchegiani:   Evan Brand, it’s Dr. J. What’s going on today?

Evan Brand:  Hey, not too much. It’s Friday, feeling good, ready to rock this house.

Dr. Justin Marchegiani:   That’s excellent. Today I’m actually drinking my—drinking apple cider vinegar right now.  Bragg’s has this new little apple cider vinegar drinks.  It’s—this one’s called Ginger Spice.  Because I love ginger.  Lots of great anti-inflammatory and lymphatic and anticoagulant benefits.  This has 0 calories and it’s sweetened with a little bit of Stevia, and it’s a little bit of organic ginger and then it’s just basically distilled water with organic apple cider vinegar. So—

Evan Brand:  I’ve had that one.  It’s good.

Dr. Justin Marchegiani:  Yeah, I love it, because apple cider vinegar’s basically acetic acid and most people are like, “Wait a minute! Wait a minute! You’re—you’re drinking acid.  Isn’t that gonna make you more acidic?”  Well, the whole acid-alkaline thing I’ve kinda debunked it in many different talks, but most people with stress actually get more alkaline, alright?  And the problem is most people whose intestinal tracts are alkaline, or guts are alkaline especially the stomach, they’re gonna have protein issues, they’re gonna have maldigestion; if a urinary tract is too alkaline, you’re gonna get a yeast infection, or a UT—a UTI or E. coli, you know, BB infection.  So apple cider vinegar has so many great benefits and it just shows you taking in some apple cider vinegar helps with digestion and also helps mobilize calcium and minerals as well.  So lots of good benefits.  Most of your acidity issues are gonna come from inflammation typically from extra refined sugar and infections and stress.

Evan Brand:  Yeah, I’ll never forget when I worked third shift in college, I had a—the building or general manager—

Dr. Justin Marchegiani:   So you were saying third shift when you were in college or when you were working?

Evan Brand:  Yeah, when I was working third shift in college, this guy, he was a general manager, some type of big wig.  He always looked so good where other third shift people looked like vampires and I asked him like, “What is your secret? How do you look so good?” And he says I take a shot of apple cider vinegar every day, and he was doing the Bragg’s.  And so that’s what kind of turned me on to it.  I was like, “Man, this guy looks so much better than everyone, all the other vampires working the shift, and so that was my—my entry into apple cider vinegar.  And if you go on earthclinic.com, they have a lot of like natural remedies and stuff there.  Apple cider vinegar is literally at the top of the chart for everything.  I’m talking digestive issues, food poisoning, skin issues, like it’s incredible.  I mean that—that is a—a true super nutrient.

Dr. Justin Marchegiani:   Yeah, it’s phenomenal just for the fact it’ll help your digestion when you get stressed, digestion goes south, which means, well, you’re not gonna be able to break down protein as optimal.  If you’re not making enough acid, well, you’re also gonna have inability to kind of like sterilize your gut so infections that come in are definitely gonna be a problem.  Apple cider vinegar has been shown to help with blood sugar and blood sugar stability which is awesome.  They did a study where it reduced blood sugar by 34% when eating white bread, right?  Not that I’d ever recommend that but it has a beneficial effect on that.  Great disinfectant, can help with weight loss, and I think a lot of it has to do with the pH and with digestion and potentially helping with minerals.  Like if you get a little eye twitching, a lot of times that’s from calcium, and if you take that you can help mobilize that calcium so it can get to where it needs to get, because a lot of time if you are under stress, your body will pee out alkaline minerals when you have excessive cortisol and taking in the apple cider vinegar will help mobilize those minerals so you can hold on to them better. 

Evan Brand:  That’s very cool, so you’re saying you’re gonna be dumping magnesium from the stress and therefore, the kidney-magnesium balance is offset.

Dr. Justin Marchegiani:   And potassium as well, and that—that’s Guyton’s Physiology, that’s in the textbook.

Evan Brand:  Yup.

Dr. Justin Marchegiani:   High secretions of cortisol and stress hormone will cause you to dump alkaline minerals.

Evan Brand:  It’s like dead fuel.

Dr. Justin Marchegiani:   Yes, so on that standpoint, how would your pH look on a urine strip if you’re dumping a whole bunch of alkaline minerals?

Evan Brand:  Not well.

Dr. Justin Marchegiani:   It may not look that bad, right?

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:   May not look that bad and also go out and do some sprints and then check your pH.  Do you think it’ll be more alkaline or more acidic?

Evan Brand:  I’d say more alkaline if you’re stressing the body with that high intensity.

Dr. Justin Marchegiani:   Actually if you do exercise like that, you’re gonna be creating lactic acid, right?  And that—that will shift your pH more acidic.  So now, would we say that go out and doing some HIT training, high-intensity interval training, would that be good or bad for the body based on what we know?

Evan Brand:   I don’t recommend it.

Dr. Justin Marchegiani:   Well, if we–

Evan Brand:  Not often. 

Dr. Justin Marchegiani:   Well, if you’re doing it right, there’s lots of great benefits for interval training, lots of great benefits.  You know, if you’re keeping it within 10-20 minutes, it’s—there’s phenomenal benefits with growth hormone and everything.  So that would be a beneficial thing.  So just because you’re creating some acidity from that exercise in the form of lactic acid, that’s not a problem.  But if we just base everything off the pH alone and that’s our only filter for saying something is good or bad, you’d have to say exercise in that form is bad.  But it’s not.  We know it’s not bad, right?  Maybe if you’re doing too much of the CrossFits and doing too many AMRAPs, right?  As in many reps as possible for 20 or 30 minutes and not resting and not having that interval downtime, that may be a problem especially if you’re adrenally stressed.

Evan Brand:  That’s what I was gonna say.  I’m just biased because 9 out of 10 people I’m working with, they’re so adrenally fatigued anyway that they can hardly get to the gym and let alone do 15 minutes on a treadmill walking, you know?

Dr. Justin Marchegiani:   Right, so it’d have something that energizes you.  So kinda keep that in mind, we went on a little tangent with the apple cider vinegar that I think it’s a—a worthwhile topic.

Evan Brand:  Yeah, definitely.

Dr. Justin Marchegiani:   So we wanted to talk about just fatigue a little bit, just in the context where fatigue comes from and simple things we can do to help fix it.  You wanna start us off, Evan?

Evan Brand:  So the first thing for me is gonna be light exposure, bright light exposure.

Dr. Justin Marchegiani:   Mmm.

Evan Brand:  Because a lot people that we’re working with, they’re working inside of an office environment, so typically they’re going from their house which is a box to their car, which is another box to their parking where their parking garage which is a box and then the office box.  They’ve never got exposed to that bright light and we know cortisol is driven by light.  Even these people are throwing on sunglasses all the time, maybe because they have adrenal issues so they’re always wearing sunglasses to—to try to cope with the bright light because they can’t handle it, but if you’re never getting exposed to that bright lux, that measurement of brightness like 100,000 lux that you get on a sunny day versus 500 lux that you’ll get in an office, you’re—you’re gonna be tired.  Just like that, no matter if you’re having a good diet or not.  So that’s why people will go to the caffeine because they never got that cortisol bump from the bright light so now they’re seeking a stimulus to try to artificially boost the cortisol up.

Dr. Justin Marchegiani:   Yeah, exactly.  So I’m a big fan of like getting up and I’ll have my—my butter, coffee, and MCT out in the sunlight.  Like this morning, I do wear a little bit of sunglasses though in the morning, not because of—we got a lot of bright light here in Austin but because I do have some kind of like little bit of specks on the side of my sclera in the eye, and I just wanna mitigate sun damage that I wear—I do wear sunglasses out in the sun especially at the lower latitude here in Texas.  But I do get out in the sun.  I expose my skin and my face first thing in the morning because it really gets that HPA axis kinda dialed in, right?  So I do cold showers in the morning, at least in my 5-minute shower with the last minute being cold and then I do have a little bit of coffee with butter and MCT and then I get that sunlight, that bright light exposure to get my HPA axis woken up saying, “Hey, this is time to get things moving and be productive.”

Evan Brand:  Yeah, that is one thing I miss about Austin, the abundant sunshine there. 

Dr. Justin Marchegiani:   Exactly.  And today just on the fatigue perspective, I don’t think we need to go too much into detail on the adrenals and thyroid component because we’ve already done many, many podcast on this.  So off the bat, the adrenals and thyroid and mitochondria are all gonna have be ruled as a potential driving factor of the fatigue.  So we’re kinda looking at strata just outside, just looking at the adrenals, the thyroid, and the mitochondria.  The—the Three Amigos as I call it for energy.  Those are the Three Amigos.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  So outside of that, sunlight is really important.  I’m a big fan of blood sugar stability and that kind of falls in the camp of the adrenals and thyroid because it’s gonna help that, right?  Everything’s gonna help all of these three body systems, but getting good blood sugar stability, meaning eating that breakfast in that first 30 minutes to an hour of getting up is gonna be a really important one to stabilize the blood sugar.  The more you’re under stress, the more your body is gonna need minerals like magnesium and zinc, and B vitamins for energy.  So it doesn’t make too much sense to skip breakfast and skip meals especially when you’re stressed, because well, where’s your body gonna mobilize those things from?  It’s gonna have to mobilize them from tissue or it’s gonna have to mobilize them from, you know, your mineral—your mineral stores in your body and it’s gonna put stress on your body and it’ll cause more cortisol because your body is gonna have to mobilize it somewhere and cortisol is that catabolic hormone that’s gonna break things down in your body in particular amino acids to help give you energy and convert it over to glucose and sugar.

Evan Brand:  Yeah, I figured we could talk about the immune system, too, just because a lot of people that are under stress they have some baseline level of stress—we all do.

Dr. Justin Marchegiani:   Uh-hmm.

Evan Brand:  The immune system can get taxed and I know you and I, I think we’ve probably done a whole episode on medicinal mushrooms, but supporting the immune system is something that’s really helped me so I’ve been doing a lot of astragulus lately just a daily dose of it and I’ve significantly improved my energy levels and I was reading a book the other day about herbs, just herbs and herbal medicine.  It was talking about how astragulus can help to boost your cold tolerance as well and so I really haven’t been that cold even though I’ve been out in the snow and hiking in ice and freezing temperatures.  The astragulus has boosted me up.  So some good baseline immune support may be helpful for the fatigue picture, too.  And we’ve talked about cordyceps before but I’m sure there’s other—there’s other herbs and stuff like that and mushrooms that are helpful.

Dr. Justin Marchegiani:  Yeah, I totally agree.  I mean astragulus is great for helping the spleen.  It’s a good blood filter and it also increases your body’s Th1 immune response, so we–

Evan Brand:   Will you talk about that for a minute?  Like the Th1, Th2, that’s something that I’m not an expert in.

Dr. Justin Marchegiani:   Yeah, so your Th1 is gonna be kind of your—it’s called the cytotoxic immune response.  It’s like the—the Special Forces of your immune system.  So it’s like the Navy Seals or the—the Delta Force or the Army Rangers so to speak.  The people that are in—in the—I should say where all the action is upfront, right?  So that’s like your CD8, it’s like your natural killer cells.  That’s the Th1 branch.  They’re in there upfront, getting in off the bat.  And then we have kind of the infantry that may lag behind and keeping the analogy of our immune system.  That’ll be the Th2 immune system, so these could be like our helper cells or CD4 helper cells.  These could be the various antibodies that are made like IgA, IgM, IgG is a little bit more delayed.  These are im—immune antibodies that then come later after the fact like the infantry.  So we want a good strong immune system, the Th1 immune system and then it takes about a week for the Th2 guys to come out.  Now people talk about vaccines for immunity but vaccines really only touch the Th2 and even that’s debatable with some people because you can have an antibody and that antibody may not be a good antibody to actually fight and then kill an invader.  It could be weak antibody.  So vaccines only touch the Th2 or the humoral immune system. They don’t do anything to work on the Th1, the cytotoxic natural killer base CD8 immune system. 

Evan Brand:  So you’ll–

Dr. Justin Marchegiani:  And that’s important.

Evan Brand:  So you’ll hear about people with an imbalance of Th1 and Th2 which I guess this is another tangent but are people more dominant with that Th2 typically because they’re lacking that Th1?  They’re lacking that good immune response out of the gate, the frontline NK killer cells and stuff like that?  Or is it are you able to—to say–

Dr. Justin Marchegiani:   Yeah.

Evan Brand:  The majority of people are X or Y?

Dr. Justin Marchegiani:   Yeah, there are some theories out there that some people are more Th1 dominant over Th2 dominant.  People that are more sensitive to—to coffee and caffeine, that’s a Th2 type of stimulant.  So if you are Th2 dominant already, imagine a see-saw right?  AS Th2 goes up, Th1 goes down.  Let’s say you have caffeine and that stimulates your Th2 more and you feel worse, well, that may be a sign that you’re Th2.  Again there are certain interleukins that you can measure on a blood test, interleukin 1, 2, 6, 12, TNF-alpha.  And they kind of—they correspond with each side of the immune system—I don’t know the exact breakdown off the bat, at which ones go to which side, but on the markers you can look at it and you can do a CD8 to CD4 test and you can see kind of what’s—what’s higher or lower.  Now ideally we want a CD8, it’s about twice as high as a CD4, right?  We want more twice as much natural killers—twice as much natural killers as we do helper cells.  Because we want a good, strong Th1 defense.  Some people are—are more imbalanced on one side or the other.  Now when we look at that, it’s gonna be like your medicinal mushrooms.  It’s gonna be like your astragulus, your Echinacea, a lot of your immune-boosting herbs, elderberry, golden seal, all your medicinal mushrooms—Shiitake, Chaga, Cordyceps, Reishi.  These are gonna be like your Th1 stimulants and then all of your antioxidants and things like caffeine, green tea, EGCG—Epigallocatechins, resveratrol, pycnogenol, grapeseed, your OPCs, your oligo proanthocyanidins—say that ten times fast.  These are all gonna be your antioxidants that drive Th2 stimulation.

Evan Brand:  So you need both?

Dr. Justin Marchegiani:   You need both, yeah, but again I’m a big fan if you get sick though, stimulate the Th1s. 

Evan Brand:  Yup.

Dr. Justin Marchegiani:   Again, but be—be wary if you notice, if you push one side or the other and you really don’t feel good, it could be that you’re dominant on one side or the other.  For me, I don’t really get caught up in that because I call that like window dressing.  Because if you have an infection or you have blood sugar issues or you have a lot of gut problems, that’s gonna screw up your immune system already.  Now does it matter, you know, what—what direction it’s screwed up in?  Well, let’s just fix why it’s screwed up.  Let’s fix the stressors.  Let’s fix the infection and then we can have a better immune system that’s balanced. 

Evan Brand:  That makes sense.

Dr. Justin Marchegiani:   Simple things like vitamin D and glutathione will balance out the immune system in either direction, whether your Th2 or Th1.  Vitamin D and glutathione with help with your T-regulatory cells and help balance it out either way.  So those are things you can’t go wrong with is the vitamin D and the glutathione.

Evan Brand:  Cool, we’ll have to rename this to the Immunity Show. 

Dr. Justin Marchegiani:   I know, we’ll have to kind of have like your fatigue and immune system connection show.  I mean, this—we’re off the cuff here.  We’re going pretty spontaneous and we extrapolate all the information based off what we’ve seen and what we’ve experienced with our patients in the clinic.

Evan Brand:  Yeah, immune health issue is a big one because you hear so many people and they will talk about the fatigue as maybe like a main symptom, right?  Or their depression or sometimes, you know, we’ll have people come in with anxiety issues that happen with the gut and then they talk about well, I have the year-round sniffles.  And so that kind of why I wanted to bring up the immunity piece is because it’s like people don’t really understand what to do about it.  So they’ll go in and take the Dayquil or the—what else can we talk about, the conventional antihistamines, the Claritin and all of that, but they’re never really getting to the root cause, but immunity is still on the forefront.  And I went to the gym the other day and I saw 3 different TVs with 3 different drug commercials all for immune-based issues, like it was like Claritin and Nasonex or something and something else.  And you’re never gonna hear, “Hey, why don’t you just fix your—your gut or thyroid or your adrenals?”  Right?  It’s like let’s just—let’s just shove something up your nose and fix this immune response, which is just crazy.

Dr. Justin Marchegiani:   Yeah, and then also people don’t really talk about the HPA axis, but that’s the—the hypothalamus and the pituitary of the brain, or I call it the thermostat of the brain or the body, which talks to the adrenals is really, really important in your immune system.  There’s one article right here from the Journal of Medical Hypotheses and I’m just gonna read the last couple of sentences.  It says, further studies of the nature of the beneficial effects of cortisol, and possibly other adrenocortical hormones, upon humans are needed.  And it says there’s recent evidence of the feedback relationship between the immune system and the HPA axis, and with the increasing awareness not only that the immune process provides protection against infection, but also that, you know, it—it may get impaired with excessive cortisol stimulation or a drop in cortisol, super low cortisol.  So one of the major reasons or one of the major signs of good cortisol-HPA axis function is a nice cortisol rhythm on a 20, or you know, a 6am to 10pm to 12pm, 12am test, that good—I should say maybe a 17 to 18-hour test, we have a nice cortisol rhythm and that’s gonna be really, really important for HPA axis feedback.  And starting your day off with a cold shower and that light stimulation can be very helpful at setting the bar for that HPA axis and then stabilizing blood sugar in the morning, that’s gonna help as well.  So if we have good energy and good adrenal function, we’re also gonna have good immune function and good HPA axis function, too.

Evan Brand:  Right, when you see the people on the commercials, it’s not normal.  They show the lady walking her dog through the park and she’s just sneezing and it has like this orange glow to the commercial and then she takes this drug and it’s like, “Oh, everything’s green. I’m not allergic to the environment.”  It’s like allergies are not a normal thing to me.  Maybe you have a different opinion, but to me I don’t think people should be as hypersensitive to the environment and react to everything, like a lot of people do.  People just talk about it like it’s no big deal.  “Oh, I’m allergic to this.  I’m allergic to that.  I’m allergic to grass.  I’m allergic to cats, to dogs.”  It’s like, “Mmm, maybe.”  But I’ve seen improvements and I’m sure you have, too, with—when you support these other systems, the immune response kind of turns off a little bit.

Dr. Justin Marchegiani:   Absolutely and if you have chronic allergy issues, it typically means a Th2 immune system type of response.  It’s your Th2 system is just so hyperresponsive where you’re developing antibodies and allergies to just dander in the environment, cedar or various things in the environment and that’s not healthy either.  Now I most find that allergies can be a really big sign of low stomach acid, right?  It can also be a big sign of adrenal dysfunction.  Because if you look at a lot of the common allergy medications, like what is it?  Well, a lot of them are gonna be corticosteroid-based, right?  Or they’ll be like histamine-based.  They’ll be like histamine degranulators like Benadryl or whatever other histamine drugs that are out there or they’re gonna be corticosteroid-based, Zyrtec or like an inhaler or albuterol.  I mean, there are like 100 different names, it’s impossible to know—know them all but they’re all corticosteroid-based.  And if you continue to take a whole bunch of synthetic cortisol, well, that can actually weaken your immune system, too. 

Evan Brand:  That makes sense.  Do you get cedar fever or are you tough enough to beat it?

Dr. Justin Marchegiani:   I’ve no—I’ve zero seasonal allergies.  Absolutely zero.

Evan Brand:  I mean, it—it’s amazing when—when I was down there in Austin how many people are like, “Oh, God, here it comes, the cedar fever.”  And—and I was fine.  And I just thought that was crazy how many people talked about it like it was an epidemic virus that was gonna spread throughout the city.

Dr. Justin Marchegiani:   Yeah, I never had any issue.  I—I still don’t.  I mean I have no problem with it and you can see it.  It really lays out in the cars pretty well, pretty thick bit of pollen there, but if you have good adrenal function, if you have good stomach acid levels, and let’s say, you know, and also good detoxification system, too, because good detox means good gluthathione.  Glutathione like I said affects your immune system, right?  It’s a good balancer of your immune system.  Outside of that, let’s say you did have allergies.  Well, what would you do?  I mean, if you look at a lot of the really good allergy products, N-acetyl cysteine is a big compound in a lot of these products.  What does that affect?  Well, that’s gonna affect glutathione.  What else is in there?  Well, bromelain.  Bromin—bromelain is a really good enzyme that will help with the immune response.  Also you’ll see things like stinging nettle, which is a natural antihistamine.  You’ll see things like vitamin C, which is a really good anti-allergy one.  And you’ll even things like quercetin, right?  Quercetin also is a big converter over to glutathione as well.  So when you look at a lot of these things on the herb side, you have things that are gonna help with histamine.  They’re gonna help with your immune system and they’re gonna help with glutathione, which are all super, super great for helping to actually support your immune system versus just, I don’t know, like if you had a house that was on fire and someone kept on lighting the fire and you just came over there and put the fire out.  But then as soon you turn around, they’d lit it again.  Would that be good?  No.  You wanna get that person out of there and stop lighting the thing on fire.  And that’s kinda how I see cortisol, as like the synthetic cortisol, it may be helpful in the moment and be palliative.  But long term, it’s just totally ignoring the underlying cause of why you’re immune system’s there.  And not to mention all of these things are gonna affect fatigue, because the reason why you’re having these issues is because your body is not able to deal with inflammation to begin with.  And what’s the main system of dealing with inflammation of the body?  It’s gonna be your adrenals. 

Evan Brand:  Yup, great way to tie that back in to—to that fatigue picture.

Dr. Justin Marchegiani:   Yeah, so kind of—we’re gonna just keep this podcast on the immune-fatigue connection here, just so we keep a good linear thread.  So also when it comes to the fatigue and energy system, if we have poor digestion, we’re gonna have poor bacterial balance.  And one of the big things that bacteria produces is B vitamins, right?  B vitamins are gonna be really, really important with energy.  So we want good B vitamins.  Like one of the things I’ll start seeing when I give specific probiotics back in to patients, we’ll start to see their urine get a touch more yellow sometimes.  And that’s a lot of times they’re starting to make some extra B vitamins, and they’re starting to pee some out, which are fine.  Because if they’re peeing some out, that means they’re also utilizing some, too, right?  You don’t just pee them all out.  Your body’s gonna pull some of those in and maybe push some out.  So that’s okay, because it means that the other parts are getting some.  So we’ll see some yellow tinge to the urine happening, which is a really good sign because we’re getting the gut bacteria to make some more B vitamins and maybe even vitamin K, too, as well.

Evan Brand:  That’s so cool.  Yeah, I—I completely forgot about that whole aspect is so the probiotics are going to start producing—they produce B12, that’s all in the colon, right?

Dr. Justin Marchegiani:   Well, we’re gonna absorb B12 in the stomach.  We’re gonna bind it to intrinsic factor in the stomach and then we’ll absorb it at the very end of the small intestine called the ileum.  So if we have poor stomach health, the same cells that produce intrinsic factor are the parietal cells in the stomach, the same cells that make HCl.  So if we have gut, stomach issues, we’re probably gonna have issues absorbing B12 in the stomach, binding it to intrinsic factor and then finally absorbing it in the ileum at the end of the small intestine.

Evan Brand:  So what happens in the case of like my dad for example, he’s had like 18 inches of his colon, his large intestine removed, from super bad diverticulitis—are you—can you ever get back to a normal energy and—and health?  Or I mean, are you—without that section, are you unable to manufacture things?  Like how does that change the whole process?

Dr. Justin Marchegiani:   Well, your colon’s gonna be like reabsorbing a lot of like electrolytes and minerals.  The big place of absorbing nutrients is gonna be the small intestine.  So that’s gonna be the big place of absorbing nutrition, but you definitely wanna run some nutrient-based test like an organic acid test and a SpectraCell test just to make sure nutrient levels are dialed in and supplementing them.  I mean, the people that really have the biggest, you know, hurt are the people that get the gastric bypass, because they’re stomach is just may be the size of a thumb or a thimble and it’s just not a good situation, it’s—I call it, surgical-induced anorexia.

Evan Brand:  Oh, my God.

Dr. Justin Marchegiani:   They—they basically now have to go on like a 500 to 800-calorie diet just because they don’t have the structural anatomy to absorb it.  So basically, they’re inducing anorexia.

Evan Brand:  Oh, my God.  And so typically they do gastric bypass for what, just major obesity? 

Dr. Justin Marchegiani:   Yeah, they’re just doing it because they—well, one, they don’t have the right strategy on the diet perspective so they’re eating the wrong foods and they’re keeping this whole craving thing going and they’re just oversecreting insulin and eating the wrong foods, and the medical establishment isn’t skilled in the nutritional changes that have to be made so they just throw the only solution they have, which is a surgical intervention.  So it’s like, alright, here’s the food pyramid which says 60-70% carbohydrates, mostly gluten and inflammatory grains.  No emphasis on quality or pesticides or chemicals.  So once that doesn’t work which most people it doesn’t work, then the only other option they have left is a surgical-based option, which is, you know, isn’t the best especially when you’re just inducing—when I say anorexia, I mean starvation.  I consider eating a 600 or 800 or 1000 calorie a day diet if you’re supposed to be eating 2, I consider that starvation.  Okay, the concentration camp victims in Auschwitz ate 1200 calories.  So if you’re inducing starvation beyond that point, right?  Well, no one would say, “Oh, well, yeah, these people at Auschwitz are well-fed.”  No one would say that.  Okay, so you having a gastric bypass procedure and having under 1000 calories now or let’s say, 50% below what you’d need, that’s starvation.  That’s not good.  And that’s why the rates of these people after these procedures, they risk of depression and all these other conditions just sky high because when you decrease surface area of getting nutrients in your body, now everything you eat has to be incredibly nutrient-dense because you just don’t have room to avoid bad stuff when there could be good stuff that needs to come in.

Evan Brand:  Wow.  So you’ve taken a cruise ship-sized fishing net and now you have just a little handheld fishing net to catch like a goldfish and that’s pretty much it.

Dr. Justin Marchegiani:  That’s it and it’s not fixing the underlying issue.  And I get it, these people are reaching and a lot of it comes from the fact that they’re just thinking that their medical doctor just knows it all, and that, hey, that dietician they referred me to, they showed me the food pyramid.  If there were something else that was better or different, they would have told me it.  So they have this kinda false sense of hope that all their options have been explored because their medical doctor and dietician would have told them otherwise.  So there’s this false sense of superiority and that’s where the Internet comes in because you reach 4,000,000 people.  I reach hundreds of thousands a month, and people without even seeing us just try it and then write us back, “Wow, I’m doing so much better.”  Like we’re not even working with them directly and we’re helping people.  But the medical establishment has this false sense of superiority that people are just indoctrinated on from the drug commercials and growing up and the whole idea of doctor’s orders and watching all these shows on TV that glorify doctors, thinking that they know everything and so once, you know, the diet doesn’t work, the next option is gonna be this gastric bypass and at least the newer surgeries, like the lapband or the glove around the stomach, it’s better because at least they can be reversed.  Just having the old fashioned gastric bypass is ugh, it’s really—it’s more permanent because they’re really cutting that stomach off versus the glove or the—the band can be—can be loosened up later. 

Evan Brand:  Talk about fatigue.  I guess that’s a good way to probably wrap this thing up, is just to talk about calorie deficit in general because—

Dr. Justin Marchegiani:   Oh yeah, huge.

Evan Brand:   You mentioned that, I mean, you’d be—you’d be crazy to think you could have enough energy after that surgery and I’ll find, too, that if you look at like someone’s food journal, it’s kinda hard to get enough calories for certain people depending on their activity level.  If they have a Paleo style diet because if you are eating a lot of vegetables and say meat’s a little bit more of a—an accessory as a main—as opposed to a main thing, and if they’re not getting enough fat, maybe they’re still a little bit fearful of getting in enough butter and coconut oil, there calories can be pretty low on a Paleo diet.  And I think sometimes people are too low and that’s why they’re tried as well.

Dr. Justin Marchegiani:   A 100%, because let’s say your diet is 60-70% crap and then you switch over to a Paleo style of eating or a Paleo template as I like to call it, where now you’re eating nutrient-dense, anti-inflammatory, low toxin food.  But let’s say 50% of those calories you haven’t replaced.  Let’s say you just—let’s say that some of the meat and the fat in your diet you keep over and maybe some of the veggies, but now you’re a 1000-calorie short, well, you’re gonna feel fatigued because you’re telling your body and telling your epigenome—alright, this is the part of your genome that flips switches, genetic switches on or off, that, “Hey, we gotta conserve energy because we are in a famine,” right?  We’re in a desert for 40 days and 40 nights so to speak.  We don’t have access to nutrition, so let’s start shorting some body systems, right?  It’s like you’re in your house and you get a big electric bill, and you and your wife say, “Well, let’s just, you know, put the A/C on in the summer instead of 70, let’s put it on 78.  Let’s make sure the lights are turned off.”  You’re conserving energy in the house to have a—a lower electric bill.  Well, the same thing happens in your body.  Instead of turning lights on and adjusting temperatures, it adjusts energy, it adjusts brain power, it adjusts sleep and focus, it adjusts respiration and hormones, all of these systems start to become dampen.  And then the question you have to say to yourself, “Well, if you’re trying to start conserving on these things, which body systems do you want to start shorting?” Do you wanna have less detox capacity?  Do you wanna have less hormonal strength?  Do you wanna have less brain power or neurochemicals?  And most people would say, I don’t wanna short anything.  I need it all.  So the question is, “Well, how can we just—instead of, you know, work on decreasing the amount of energy, how can we just increase the amount of nutrition coming in?  So our energy can be as optimal as possible and part of that is if we switch from that Paleo template, we have to make sure we’re also getting enough calories.  So the things that I’ll do is, is I’ll do a food log with patients or we’ll use a MyFitnessPal app, and I’ll have them plug in all their foods and we’ll figure out how many calories they need to just to maintain.  And if they don’t get that amount of calories, we know off the bat there’s gonna be fatigue and body system shortage just because calories are always gonna have nutrition in them if we’re eating nutrient-dense foods.  If we’re eating poor foods, yes, we can get calories with no nutrition.  But for just keeping this conversation consistent, all of our calories are gonna have nutrition because we have a Paleo template.

Evan Brand:   Right, yeah, and I just came across some research the other day that I was showing to my wife that was looking at women who during pregnancy had calorie deficits.  Obviously, the fatigue’s gonna be greater but that the baby or when it grows up to be a child was actually at a greater risk of obesity because if there was a “famine” during the pregnancy, that child’s gonna have to be a little bit more efficient at storing calories and so there you go.  This stuff starts even pre-natally which is kinda crazy.

Dr. Justin Marchegiani:   It does and then the other piece is—okay, let’s say you’re having enough calories coming in.  Well, are you breaking them down?  Are you absorbing them, digesting them, and assimilating them?  That’s the next question.  Because if you have let’s say an infection going on, whether it’s a SIBO or H. pylori or parasitic infection, that could impair absorption because you got critters competing inside your tummy.  The next piece is, well, are you super stressed where your hydrochloric acid levels are low because you’re in that fight or flight state.  And if you’re hydrochloric acid levels are low so are your enzyme levels.  So you may not be extracting nutrition from your calorie—from your food because—because of that stress response.  I see people that, you know, aren’t able to go 4-5 hours between meals and they’re eating a lot of food and they’re telling me, “I’m just—I’m eating a lot.  I’m eating a lot.  I can’t eat anymore.”  The next piece would be, well, there could be a malabsorption thing, and we try to fix it by replacing enzymes and acids and bile salts.  But the next thing is really getting the infection cleaned out, too. 

Evan Brand:  Well, see if I have one.  My test is done.  It’ll be shipped next week, so stay tuned for my test results.  Do you have one on hand that you can run?  I wanna see what yours says, too.

Dr. Justin Marchegiani:   Yeah, I got two tests I’ll be running side by side any day now so I will—I will keep—I will keep you plugged in on what’s happening.

Evan Brand:  Okay, cool.

Dr. Justin Marchegiani:   And I know you’ll be waiting on—on bated breath.

Evan Brand:  Yup.

Dr. Justin Marchegiani:   So just to kind of recap here.  We talked about HPA axis for fatigue.  We kinda connected fatigue to the immune system because cortisol helps with energy and also is important in the immune response.  Too high, that can suppress the immune system.  Too low, it can sup—it can decrease energy as well.  And if we go too high on the allergy meds, that can suppress our immune system because cortisol or synthetic cortisol derivatives can have an effect on our immune system.  Next we talked about healthy gut bacteria and B vitamins.  How crucial they are to energy especially B6 is so important for the brain function, it helps really kind of escort and bring in a lot of the amino acids for the brain.  So we need a lot of B6 and then obviously our B1, our thiamine, our B2 riboflavin and B3 niacin.  These are all really important for energy, healthy gut bacteria.  We talked about how malabsorption and some of these surgeries and such.  The—the gastric band or bypass can decrease surface area.  We talked about transitioning to Paleo and how people go low calorie naturally, which can affect nutrition and energy.  And then we also talked about—we also talked about last but not the least was making sure we get enough absorption avoiding dysbiosis and infections and low stomach acid, making sure we have the absorption piece to the gut dialed in because we could be eating enough but not absorbing enough.

Evan Brand:  Yup.  Absolutely.

Dr. Justin Marchegiani:   Anything else you wanna touch upon?

Evan Brand:   That’s it.  I would tell people if you like this show, share it with people, review the show on iTunes, share with one friend even if you are applying everything, there’s what—350 other million people in the United States and another 7+ billion in the world that we need to help get this information before the American medical establishment takes over the rest of the world and—and indoctrinates them with that mainstream attitude.  There is another way.  There is another solution.  So that’s what we hope to provide here and hope you enjoyed it.

Dr. Justin Marchegiani:   Oh, yeah, and I wanna just touch one thing.  Be afe—all great points, Evan, really, really good points.  Last piece though is be a fat burner.  Most people are sugar burners, okay?  Meaning they have excessive carbohydrate in their diet and they are relying more on sugar for fuel.  Okay, relying on sugar for fuel is like going to a campsite, needing to have a fire to cook and provide warmth, and having to put twigs and paper in that fire.  Well, if you do that, you’re gonna have to be putting twigs and paper in that fire all night long every few minutes to keep the fire going.  That’s what people that do too much carbohydrate and eating too much carbs are like.  They have to constantly feed it.  If you put a log in that fire, that fire will sit for hours on end.  And the logs are akin to healthy proteins and fats and vegetables where the refined sugar or the higher carbohydrate is equal to the twigs and the paper, and the hot—really refined sugar and the alcohol is akin to the gasoline.  So if you try to have a fire going with gasoline and twigs and paper, it will be a very long night for you.

Evan Brand:   Yes.

Dr. Justin Marchegiani:   If you’re using the logs and the proteins and fats, it’ll be an easier night.  And depending on how much logs and how much protein and fat and how much paper or kindling and carbs can be adjusted for each person.  So don’t freak out, there’s—there’s ways to customize and make it specific to each person, but we wanna push people into being more fat burners versus sugar burners.  Now whatever level that may be, are you it should be more where you gotta be at 20 grams of carbohydrate a day?  Or can you be somewhere 50, 70, 80, 120?  That’s gonna be up for you the individual with your doctor or nutritionist to find what works best for you. 

Evan Brand:   Yup.

Dr. Justin Marchegiani:   And it may change based on your stress levels.  And based on what’s happening in your life and how much exercise you’re doing, so again this isn’t a one-size fits all.  We’re really customizing it and we’re providing you that clinical functional medicine eye that we use it every day with our patients.

Evan Brand:  Yup, I know we’re way over time here, so lastly go to our websites.  Check our stuff out.  Check out Justin’s YouTube channel.  He’s killing it.  I tell him he’s gonna be the functional medicine king of YouTube and I’m trying to become close to—a close second behind him.  I’ve watched a—a body building video or some type of fitness channel on YouTube where they have hundreds of thousands of subscribers and they—this guy, kind of a real cut guy, he took everybody through his day of eating and his lunch was—or no, his breakfast smoothie was straight mangoes and it was, I don’t know, some protein with like sucralose in it and then he said, “Oh, because I like to have a little crunch in my protein shake, I recommend adding a half cup of Reesy Puffs.”

Dr. Justin Marchegiani:   Oh, my gosh.

Evan Brand:  And then he—so then he goes to his lunch and then he’s showing a—you know, he’s got egg whites and turkey bacon for kind of a brunch and then a Diet Coke.  And it’s like—and this—this is recent.  This is not outdated material.  This is something that’s come out like over the last like month.  This is a huge fitness channel.  There’s tons of them like that and you know, these—these videos are getting hundreds of thousands of views and people are doing this and it really scares me.  And really think we have to break in to the YouTube model a little bit more.  You and I have a lot of work to do there to really bring some more clarity there because that YouTube space of health and fitness and nutrition is still stuck in 1980. 

Dr. Justin Marchegiani:   Yeah, it’s getting polluted and everyone listening to this, either on iTunes or YouTube, click right below.  We’re gonna have links for our YouTube and podcast subscribe, so just click right below.  Do it right now, I’ll take a second out and wait for you. Alright, click it, hit subscribe and then you can keep up with Evan and I and what we’re doing on YouTube and the podcast.

Evan Brand:   Yup.

Dr. Justin Marchegiani:   Evan, great talk today, man.  It’s Friday.  You have an awesome weekend!

Evan Brand:  You, too.  Take care.

Dr. Justin Marchegiani:   Take care.  Bye.

Evan Brand:  Bye.

Gluten Sensitivity

By Dr. Justin Marchegiani

Gluten sensitivity is a state of genetics, just like your genes cannot be changed. Therefore, what we have control over is the expression of our genes. Gluten is one of those food products which our genetics have not adapted to well. I suggest that if you are a person who have genetics that predispose you to gluten sensitivity, avoid gluten. Since this is the way in which you can control  how your genes are being expressed.

Terminologies related to gluten or grain

Gluten Sensitivity

Many people with gluten sensitivity can be gluten intolerant or have a gluten allergy as well. The terms allergy and intolerant have come to mean different things in conventional medicine. “Sensitivity” is the more excepted terminology in gluten circles. Sensitivity is referring to the fact that your immune system is hyper responsive to the gluten proteins. The byproduct of these hyper-immune responses is inflammation. And if prolonged, autoimmune conditions are a strong possibility.

Gluten Allergy

The term “gluten allergy” typical refers to your immune system creating an IgE immune response (anaphylactic in nature) to the gluten protein. These allergies are inborn and are usually known at birth.  We know allergies can also be delayed in nature via an IgG or IgA response with new cutting testing. And this is closer to what we see in gluten sensitivity.

Gluten Intolerance

Gluten Intolerance typically refers to the inability to break down the gluten proteins in the digestive tract. Just like with lactose intolerance, some individuals have a difficult time breaking down lactose. Lactose is milke sugar. But with specific enzymes (like lactaid), this is possible. Most people who are gluten sensitive have a difficult time breaking gluten down, too. But taking enzymes alone will not be enough to avoid the inflammation and autoimmune destruction from consuming it.

Celiac Disease

In science today, gluten sensitivity has been primarily connected  with celiac disease. Thus, the misconception is if you don’t have celiac disease, you don’t have gluten sensitivity. This couldn’t be further from the truth! The testing used to diagnose and assess celiac disease can miss many people. Essentially, you can have all of the telltale signs and symptoms of gluten sensitivity or celiac disease, yet still be misdiagnosed. The typical mainstream diagnosis for celiac disease is a sample of your micro-villi from your small intestine. This can be seen via endoscopy. The micro-villi have to be worn down 80% for you to be considered celiac.

There are a couple problems with this diagnosis criteria:

1. What if we do not collect a sample that was affected by gluten?

2. What if the  micro-villi have not been worn down 80%?

This method is analogous to pulling a bucket of water out of the ocean. It is like examining that there is no fish in the bucket. And then concluding the ocean must have no fish. This may not be a perfect analogy, but I think you know what I’m getting at.

Blood Test

There are other blood tests that can be used to confirm celiac disease. These blood test includes transglutaminase antibodies, endomyseal antibodies. Other blood tests are deamidated gliadin and gliadin antibodies. If you come back positive with one of these test markers, you can be confident that you have celiac disease. But the problem is many individuals come back negative with these markers may still have gluten sensitivity.

So this is where genetic testing comes into play. If you have a gene that predisposes you to gluten sensitivity, it’s just a matter of time till those gene expresses itself. The more physical, chemical and emotional stress you  are under, the more increased chance that your gluten sensitive genes will react. Then it will start creating symptoms. The symptoms for gluten sensitivity are all over the map!

Genetic Test

I think genetic testing is a good tool to assess if you have the genes for gluten sensitivity.  The problem with other testing is it’s very easy to have false negative result. This means the test comes back negative. But in reality, you may still have gluten sensitivity. If you come back with a gluten sensitive gene, you can be confident that it’s just a matter of time before that gene expresses itself. This will be the case if you keep eating gluten.

The primary genes that are involved in celiac disease are HLA-DQ2 and HLA-DQ8.  There are other HLA-DQ genes involved as well. HLA-DQ 1, HLA-DQ 3 and HLA-DQ 7 are also genes that predispose you to gluten sensitivity. When you’re looking at genetics such as HLA-DQ testing, you get one HLA-DQ gene from each parent.   If you receive two HLA-DQ 2’s or two HLA-DQ 8’s, this increases the risk of celiac disease. The same goes for gluten sensitivity.

According to the genetics, the only people that are immune to gluten sensitivity are people with the genetic sub-types HLA-DQ 4. This is actually less than 1% of the population. There needs to be more research done validating gluten sensitivity and its connection with the genetics (1).

Population Affected

The percentage estimates surrounding gluten sensitivity regarding the population are a point of contention among experts. Dr. Alessio Fasano at the University of Maryland medical school is a pioneer in gluten research. He feels that only 6 to 7% of the population are gluten sensitive. On the other hand, Dr. Ford a pediatrician in New Zealand and the author of the book “The Gluten Syndrome,” believes  30% to 50% of the population are gluten sensitive.  And according to Dr. Kenneth Fine, over 50% of the population is gluten sensitive. Either way you look at it, the new estimates that are coming out surrounding gluten sensitivity are showing a significant increase than the original 1% estimates of celiac disease.

The information that we have now shows the majority of the population are gluten sensitive. Majority of symptoms that come from gluten are not necessarily correlated with digestive issues.  And this is the problem with gluten sensitivity. Gluten sensitivity includes symptoms that are gastrointestinal in nature like bloating, gas, diarrhea and IBS. With gluten sensitivity, you are actually 8x more likely to have extra intestinal symptoms. And these are symptoms not related to the gastrointestinal tract, like headaches, depression, lupus and thyroid disease.  This is the main reason why gluten sensitivity is so easily glossed over today.

Most patients with gluten sensitivity complained of 2 or more symptoms (2).

gluten symptoms

The symptoms of gluten sensitivity

Celiac disease is a form of gluten sensitivity. So essentially, if you have celiac disease, you are gluten sensitive. And if you are gluten sensitive, you don’t have to necessarily have celiac disease.

There are many common manifestations of gluten sensitivity, I call this the web of gluten sensitivity:

This includes:

  • Various anemia’s
  • Type I diabetes
  • Hashimotos and other thyroid diseases
  • Fibromyalgia
  • Chronic fatigue syndrome
  • Lupus
  • Gut infections
  • Skin issues (psoriasis, eczema, dermatitis herpetiformis)
  • Psychological and mood disorders (schizophrenia, depression).

the web of gluten sensitivity

I challenge you to Google scholar or Pubmed. Search for gluten or celiac disease with any disease of your choice. You will see many results come up in your search, proving the connection cannot be ignored.

My favorite method to assess for gluten sensitivity!

The problem with many of the tests that are out there, is that similar information can be received through a simple elimination provocation diet. And this is where inflammatory foods are cut out for a period of time and then added back in. The only time I conduct testing on patients, is if patients are resistant to changing their diet. Then the lab test can be very useful. It’s because they can quantify to the patient in an objective manner that these issues are real. Some people  need to see that type of evidence before they cut out some of their most favorite and addicting foods!

I find almost all individuals who are suffering from some type of chronic illness benefit when they cut gluten out of their diet. The foods that contain gluten, which are all grains, tend to be very low in nutrition. In addition, they have a high glycemic index and create inflammation. Hence, it is always better to eat foods that are nutrient dense, anti-inflammatory and low in toxins.

My recommendations are for all of my patients to start off with some type of anti-inflammatory, autoimmune paleo or bulletproof style of eating. The focus with this type  of eating is to be consuming foods that are anti-inflammatory, low in toxins and nutrient dense. This allows us to put our body into a state of healing.  We can start recovering from all of the damage created by the gluten exposure by following this guideline. Macro-nutrient will be important. This includes ratios involving carbohydrate, protein and fat. It can always be adjusted to meet the needs of the patient. I deal with these macro-nutrient ratios on individual basis per patient.

What Do You Do If you Aren’t Feeling Better After Going Gluten Free?

When dealing with patients that are chronically ill,  making the above dietary recommendations may not be enough. The inflammation created from years of stress and gluten consumption may have caused damage to your bodies. This includes your adrenals, thyroid and gastrointestinal system. You may have weakened your immune system because of all these. Also, chronic infections like parasite, bacterial, fungal and viral infections have already gained a foothold. So, I find removing these infection can be the missing barriers that are preventing people from getting better.

If you’re not getting better  from going gluten-free,  feel free and schedule a complimentary consultation. Click here to review what your options are.


1.A. Fasano et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: Celiac disease and Gluten sensitivity. BMC Medicine 2011, 9:23. doi:10.1186/1741-7015-9-23.

2. New understanding of gluten sensitivity. Umberto Volta & Roberto De Giorgio: Nature Reviews Gastroenterology & Hepatology 9, 295-299 (May 2012).

The entire contents of this website are based upon the opinions of Dr. Justin Marchegiani unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Justin and his community. Dr. Justin encourages you to make your own health care decisions based upon your research and in partnership with a qualified healthcare professional. These statements have not been evaluated by the Food and Drug Administration. Dr. Marchegiani’s products are not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using any products.