How to Address Sinus Infections Naturally | Podcast #368
A sinus infection, also called sinusitis, is a common problem that causes your sinuses to swell up. The sinuses become inflamed and cause symptoms similar to the common cold. Many people can contract a sinus infection after having a cold or the flu. A bacterial infection usually causes sinus infections, but viruses or fungi can also cause them. These infections can either be acute or chronic.
Dr. J and Evan discuss nasal flushing, which can help clear the mucus out of your sinuses. It is one of the most effective home treatments for a sinus infection. They also emphasized the importance of rest, filtered air system, and other nutrients to boost the immune system.
Dr. Justin Marchegiani
In this episode, we cover:
0:00 – Introduction
2:17 – Nasal flushing products
10:03 – Mucus and nebulizer
16:54 – Sinus anatomy
Dr. Justin Marchegiani: For today’s podcast, we’re gonna be talking about how to address sinus infections naturally with Evan today. Really excited. Good topic here. It’s a common topic that people are experiencing especially in the winter season so we’re gonna go through it. What we gotta do to heal fast from sinus infections naturally. Evan, how are we doing today?
Evan Brand: Hey, doing really well. Why don’t we start with the conventional approach? What is that? If you go to your ENT with a sinus infection, what are they doing?
Dr. Justin Marchegiani: Well, it depends, I mean, some are gonna be more antibiotic hesitant and say well you know it could be a viral infection, right? You know, almost a quarter of all antibiotics are actually prescribed for sinus infections. You know that? It’s crazy. So, most of the time, they’ll wait and see how bad it is. See if you have a fever, uh, usually like you have that punch in the face kind of feeling where your teeth are really starting to hurt, chronic headache and then you’re having a fever usually they’re waiting seven to ten days or if it’s gotten better and then gotten worse again and it’s usually seven to ten days out with a fever then they’ll start to, you know, typically prescribe antibiotics. Again, most sinus infections are viral so you know, you have to get to the root cause of that so a lot of times antibiotics won’t work. The problem with antibiotics is you’re swallowing it, it’s going 2 or 3 feet away from the actual issue so you’re basically dropping a systemic bomb to instead of hitting a localized area. Now, there are some more, I would say functional based medical doctors that may do some kind of an antibiotic in a compounded powder like an amoxicillin, something like that in a suspended solution or powder and they put it in a sinus rinse bottle like this and then you can flush your nose with that. Better, right? At least it’s more localized. We’ll talk about some strategies using saline flushes and different things that I recommend to help get that under control, naturally and not have to destroy your microflora in the gut. So, that’s a big thing out of the gates which can be very helpful. I got a sinus infection last week from a viral infection that my kids brought home. I never have been exposed to so many bugs since I have two young kids, 2- and 4-year-old boys that go to an outdoor wilderness school and they bring stuff back home from all their classmates and so I’m getting inoculated every single day and so we’ll talk about some of the strategies that I take so I can recover fast.
Evan Brand: Yeah. I still hear a little bit of you. So, what are you doing? You mentioned you got some kind of tools on your desk there.
Dr. Justin Marchegiani: Yeah. So, couple of things out of the gate, you know, to irrigate or flush that area out can be very very helpful. One, to flushing the viral particulate out. Two, we may add in some components to actually help kill what’s up in the nose as well. So, we have our saline, so you can either do NeilMed saline, which is really good. We’ll put links down below. The Neti Xlear is really great. I’ll kind of go back and forth between those. I have both. And so, we’ll take this and you’ll add eight ounces of water in one of these types of bottles. This is actually the best bottles. It’s made by Xlear. It’s Xlear’s bottle. It’s the best because of the plastic isn’t cheap so when you press it, it recoils really fast so when you’re doing good flushes, sometimes you’re pressing and then you’re having to let it reload so to speak and it’s just a really good plastic. Some of the plastics are weak so then, it kind of just stays sunken in so I also have a NeoMed bottle, definitely a cheaper plastic. And there’s another bottle by Walgreens. It’s even cheaper. So, this one is okay, you know, they give it away with like 60, 70 packets of saline so it’s pretty cheap. It’s a nice bottle. I have like three or four of them lined up in my office sink so when I’m in between patients, I’ll just give it a good flush. And so, we’ll take the saline packet. We’ll mix 8 ounces of water; we’ll add it to it and then I’ll take either food grade hydrogen peroxide. You could do regular hydrogen peroxide from the drug store. It’s not as big of a deal if you’re nebulizing it. Again, it you’re flushing it, if you’re nebulizing it, you probably wanna go more food grade just to make sure any stabilizers are out. And then, I typically just fill it up just enough to cover the bottom part of the cap. That’s it. Just about that.
Evan Brand: That’s like a dash. I mean just a tiny amount.
Dr. Justin Marchegiani: Yeah. And you know, you went too much if you put it into the water and then I would just pour it into the saline, my finger over and just shake it up and then you know you did too much if you feel any kind of irritation or burn. You can so you can always start less and kind of work your way up and then if you do too much you can just add a little bit more water to it and back off so that’s a good option right there. Another option I have is I’ll do like my GI clear 3 silver and I’ll add a cap full of that to it. You can do that. You can add just straight up betadine iodide. I’ve stopped doing that because of the orange color. It just stains. It’s really annoying so I’ll go to, like, a clear simple potassium iodine which is good. Those are a couple good options out of the gates and so we’ll basically irrigate 2 to 3 seconds of flow, clear everything out and blow your nose in between. 2 to 3 seconds of flow below your nose. That’s a good way to do it out of the gate. Now, there’s a couple of other strategies that you can do, so some of my sinus sprays that I’ll use and so I have 3 big sprays so here’s extra rescue which is really a good one because it has six different herbs in there. It has, like pau d’arco, parsley, eucalyptus, oil of oregano, tea tree, right, so it’s really good. Six different herbs and so what I’ll typically do out of the gates if you’re new to using the product. I’ll do it, about 2 sprays in each nose, about ten minutes before a sinus flush. What I find is, it starts to, like, agitate and release all the mucus. That’s kind of stuck to the inside of the sinus cavity and so like five to ten minutes before spray it, wait, and then do a sinus flush. I find that it releases things a lot better. So, that’s really good there. And once you’re better with it and you feel more comfortable, you can do it after as well. Just see how you feel. If you’re really, really inflamed too, there’s another product called Xlear max, which is a good one.
Evan Brand: I’ve never tried that one. I’m scared of that one.
Dr. Justin Marchegiani: Yeah. Well, the rescue one, I think, is like the strongest form, like a killing perspective. The Xlear max is more, like anti-inflammatory. So, the big difference is, this, the last one was grapefruit by the way and the Rescue.
Evan Brand: Okay.
Dr. Justin Marchegiani: And so in the max, the difference is it still has the same saline, still has the same xylitol. So, this has xylitol plus six herbs, okay, saline. This says xylitol saline, the difference is it has aloe so it’s a little bit more soothing, all right, for the sinus. It has the grapefruit as well, which, so it still has some killing effects in it and it has some capsicum which is like a homeopathic anti-inflammatory. So, this is like, if you’re like the tissue is really inflamed, really raw, this is a better one. This one’s really good for killing because of the different herbs that are in there. And then, there’s a regular one out there. I have it upstairs, as well, which is the regular Xlear and that’s more like people that have chronic sinus issues, you can use that more every day and it’s a little bit more gentle where it’s just the xylitol and the grapefruit extract and it has the saline and again the benefit of that, the xylitol, it really kind of knocks down some of the bacteria that could be there. It prevents biofilms from adhesions so biofilms are like the protective shields that a lot of the bacteria used to protect against the bugs. So, that’s very helpful. And so, the nice thing is if you do the saline, right? Oh, by the way, the water reverse osmosis or distilled, make sure it’s high quality filtered water. Do not use your general tap water, very bad, so make sure it’s really good. Don’t even use, like, river water, it’s gotta be really good clean filtered water. Like even now and then, I’ll use the water out of my faucet because I have a whole house activated charcoal system so it’s still good but I also have a RO system where my countertop is, so that’s where we cook in and drink out of that water so I use that 99% of the time. So, I’ll use that, I’ll add the packet, fill it up to 8 ounces, pack it and then I’ll add either hydrogen peroxide or silver. It’s good to have a couple that you rotate through just in case there’s some resistance which is, you know, meaning like there’s some bacteria or viral resistance. It’s going to have a couple of things there and then I also have just a straight grapefruit and saline solution as well. This one is okay. It’s gentle and so those are good ways to do it. I recommend, start to do it before you flush like 5-10 minutes before because a lot of times it just releases a lot of mucus and then it allows the flush to do really well and then depending on how you feel afterwards, you can also try it after a flush and then give it a sprayer. So, once everything’s really clean and see how you do afterwards. So that’s a good start out of the gates. Of course things like N-acetylcysteine are wonderful. NAC is great. That helps with the inflammation. Really helps drying up the sinuses. I’ll do glutathione, as well. I’ll do high-dose vitamin C. We’ll add in some different nutrients, zinc, those kinds of things as well. All the good immune nutrients, vitamin D decrease all the sugar consumption. A lot of that is very very helpful. I also have a red light in the office and so I’ll kind of go up against it and let the red light get in there because that’s very anti-inflammatory as well.
Evan Brand: Man, I should have paid better attention to the label on that Max. I was afraid of that one because I thought that one was more intense than the rescue. I’ve done the Rescue forever. I kind of like the berm. You will get a little burn with that Rescue one but the way you talk that Max is actually more soothing than the Rescue. The Rescue is more hardcore so I need to try the Max, I’ve never experimented with it.
Dr. Justin Marchegiani: Yeah. I think the big thing in the Max is just people are already, like more inflamed because there’s less killers in there, it’s grapefruit. It’s got the same sodium chloride, it’s got the aloe which is soothing and that has the Capsicum. I’ll do that right now actually.
Evan Brand: That’s very cool and the question came in about colloidal silver so in some of the rinses you could do a little bit of silver. We, also, have talked about it.
Dr. Justin Marchegiani: I already talked about that so I said you can do the hydrogen peroxide, add it or like I’ll do my nano silver like my GI Clear 3 or some kind of a silver so you’d add like a dropper or 2 worth of silver in there which is what I have for there. So, you can do silver, you can do hydrogen peroxide and you can also do some iodine. Those are your three good ones that you could do. You could also throw in like someone in the chat wrote about like oil of oregano or tea tree or something of that. Maybe overkill if you’re already using the Rescue afterwards or before because you’re already adding that to it.
Evan Brand: Yeah. And so, we could do that in a nebulizer protocol too, so if we’re doing a hydrogen peroxide or a glutathione or a silver nebulizer that could be another sinus support.
Dr. Justin Marchegiani: Yeah. The problem with the nebulizer, I find it’s just, it’s deeper, it’s better for, like lower respiratory stuff. The problem with, like the mucus that comes out of the nose, it’s very tarry. It’s very sticky, right? And so, what is the mucus? Well, you have one just mucus which is clear which is like your body trying to flush bacteria or virus out and then you have the immune system interacting with the infection and then the dead soldiers, right, of that fight, that battle are essentially all the green and yellow and so the more dead soldiers, right, the more battle we go from like light yellow to yellow to darker yellow to green, right? So, the darker, right, and the, the more chunky the mucus is, the more there’s an immune fight happening up there and so what happens is, you have, you know not that, this is the best analogy I can think of is you have all these dead soldiers from the immune reaction just like sitting up there and sticking all to the sinus cavity preventing breathing oxygen exchange and also some of that can eventually go down the eustachian tubes which connects to the back which can go to your ears then you can start to get an ear infection and all that dead debris can also become like fertilizer for like a bacterial infection down the road. So, you got to get it out. So the problem with nebulizer, it’s in a vapor form so it doesn’t have the ability to push the junk out and so with a nice bottle like this pressurized, you can come in there and you can really pull all that stuff out and push it out where you’re not gonna get that with a nebulizer so your nebulizer is gonna be, you can still do it, I still did it daily but it’s gonna be better for lower respiratory issues and this have all the same stuff in it a nebulizer will, the difference you’ll have the pressurized force behind it to really get it out. Push it out. That’s the difference. And there’s some like I mean there’s sometimes, I mean I won’t get graphic but like I’ll blow my nose I’m good right? I’m good, go flush it out and then there’s twice the amount of junk left behind after the flush that was that what I couldn’t get out through blowing and so you get a much deeper cleanse of the sinus cavity with this because a lot of times you’re getting stuff out literally in this upper forehead area in here and so you’re just getting a lot better release.
Evan Brand: Yeah, you mentioned NAC already, which NAC got banned from amazon so if you need access to it, Justin seems on your store, I believe I’ve got a glutathione NAC combo. I do not have an NAC by itself. What do you do, do you have something to offer there?
Dr. Justin Marchegiani: Yeah. We have different products like in my line have a detox amino product that has more other stuff in it. I just have a straight NAC here. I’ll go, there’s a couple of brands that I’ll go back to before, in between 90% are out so a lot of times I just have to get brands right now. That I typically wouldn’t get if we had a better supply chain with NAC right now but yeah we’ll put a link down below anyone needs NAC, they can reach out to the office but to highlight back on what you’re saying there, NAC is super helpful and then also there’s a Nasaline you can get which is like a pressurized syringe which is great. So, you suck up the saline from the bottle, it’s like a syringe, you put it up against your nose and you press it, that’s helpful. Also, I find too if things are really stuck, sometimes you need to go like pulsations so you need to like squeeze hard, relax, squeeze hard, relax, squeeze hard, relax because I find that the pulsation sometimes will free up some of these mucus that’s really tarry and sticky so that can be very very helpful.
Evan Brand: Knock on wood, I never ever get sinus infections.
Dr. Justin Marchegiani: I don’t either. It’s my first time.
Evan Brand: I don’t know what to, what to attribute them to like you said is it an exposure, is it a weak immune system, is there a gut connection to it?
Dr. Justin Marchegiani: It’s just part of the viral infection so viruses tend to go in two major areas. They go upper respiratory or lower respiratory, right? So, a viral infection that goes too deep can eventually become pneumonia. A viral infection here can become a major sinus infection and so by being on top of this, you have your tools, your sinus flush is your best for your upper respiratory, your nebulizer is best for your lower respiratory and so you can prevent those things once you have viral infection, it’s replicating it creating inflammation. You could prevent these things from going too far with those tools.
Evan Brand: Well, that’s a great point you just made which is the possibility of it turning into pneumonia so people listening are like well why should I care, why should I try to do this and speed the process up, why should I try to intervene? Well, because you don’t want to create more systemic inflammation or lead to something more serious especially in a person who’s 80 years old or above, you know, that could create much more problems if they didn’t treat it while it was just up here and it went further south.
Dr. Justin Marchegiani: Yeah and if someone’s sick and they’re trying to prevent it, I think two to three flushes a day is good for, like, prevention especially while you’re sick. I think it can’t hurt just doing straight saline rinse once a day in general. I wouldn’t add any killers or anything to it. Just a straight saline. I think it is fine, just to kind of keep your nose clean at the end of the day. You wanna do that, I think it’s fine. If you’re sick, I’m going like every hour or two, I’m flushing my nose out just because at one it feels really good. It’s really clean and just as long as you’re not irritating the mucus, you know, its isotonic solution, so you have like the sodium, the chloride, it has the bicarbonate in here. Those are the two major compounds, right? Like sodium chloride is basically your sea salt, right? And then, you have your bicarbonate in there. So those are the two major ingredients and then of course this is like USP grade so it’s just really really clean.
Evan Brand: And what do you mean by that? For people listening, what you’re saying is that pH balance so it’s not gonna irritate your sinus cavity.
Dr. Justin Marchegiani: Yeah. You can’t just take regular, like, clean water and put it in your nose. If you will absolutely burn it and irritate it. It would feel like someone punched you in the face because the mucous membranes need a certain pH and a certain level of sensitivity so it’s kind of like using eye drops, right? Same thing. You need to have, like, saline-based eye drops. This is, you’re using sodium chloride. Pharmaceutical grade plus the bicarbonate which is baking soda. That’s everything nice and balanced for the tissues. So, when you flush it, it shouldn’t irritate the sinuses and it should have allow it too feel nice and smooth and gentle afterwards and then if you have some kind of infection brewing even preventative for a bug just add a little bit of silver or hydrogen peroxide in there or a couple of drops, you know, some iodine that’ll give you enough killing capacity to knock down any bugs that could be multiplying but I’m going every hour or two, for me it just feels really good very soothing. It feels like plus if you blow your nose too much, you just keep your nose all raw around the side so it’s nice to have a nice clean flush. I kind of call it like, it’s like a bidet for your nose. It’s kind of how I look at it.
Evan Brand: That’s hilarious. You know, this would be a good strategy for travel too. So, if you need something portable like the excellent Rescue. If you’re on a plane or after you get off a plane it’d be a good idea to boom boom do a couple of sprays that’ll be great.
Dr. Justin Marchegiani: Oh, also, amazing for kids. Kids cannot honk their nose, blow their nose or the damn right. They just cannot get a good blow in there and you get these things on the market like a nose Frida which you know we have one you get like that deep in the cavity. We’ll do the whole nose Frida for you to think about the nose and then we’ll do this with my kids, flush it out and you’ll see so much junk come out. This is how kids get ear infections right? If you look at sinus anatomy, once you go up this far, there’s this canal, right here that goes straight to the ears and it’s called the eustachian tube and with kids it’s a little bit flatter a delta kind of angles up a little bit so it’s harder to get things uphill with kids because it’s a little bit flatter so it’s easy for the mucus and the junk to go into the ear and then you have an ear infection and of course like if your kids are getting ear issues to the food, sugar and of course high dairy products are gonna create more mucus, more mucus in the sinus cavity can make their way and so if your kids are more mucusy, one make the diet changes but two get their nose cleaned out as well so it doesn’t travel to the ear and this is why you want the mucus cleared up because if you let all the mucus and all this coagulation of all the immune soldiers so to speak, stay up there, it can make its way to the nose and now you have an ear infection.
Evan Brand: Yeah. Good point about the diet. I know we got to run here in a minute or two but that’s a good point about the diet if you are looking for like preventative maintenance strategies, I mean obviously you can’t just live in a bubble and not get exposed to things but you wanna have the good foundation of your diet to reduce inflammation, I mean so many people come in and say they have quote sinus problems, really it appears that they’re food allergies because once they clean up their diet, they get rid of gluten, they get rid of dairy all of a sudden their sinus is clear.
Dr. Justin Marchegiani: Yeah. And people have, like, allergies to the environment. One, have a really good high quality air filter. We recommend the Austin air because it has the activated charcoal, the Zeolite plus the Hepa. Hepa is, like, usually standard in most if you’re on a budget. You know, go with the Hepa to start but definitely get one that has an activated charcoal, Zeolite, the Austin air, the filter lasts five years per replacement so you don’t have to spend as much money replacing it every six months and the activated charcoal and the zeolite filters out more toxins but I’ll tell patients like you know, do a flush you know in the morning when you get up, do one after you’re outside working and then do one before bed. Just the saline’s fine. You could do a little bit of spray, you know, before or after. Try before that’s helpful but just try to get the allergen out especially before bed because if you have all these allergens way up here and they’re creating inflammation that could be a stress response during sleep that’s preventing you from deeper restorative sleep and so the sinus can be flush really helpful along with some of the uh some of the remedies that we have here.
Evan Brand: It’s a good call. Well, if people need help, they can reach out. You can book a consultation with Dr. J at justinhealth.com. So, if you have sinus issues or other health symptoms, you wanna talk, see what’s going on, see if we can help that would be justinhealth.com for Dr. J, or if you need help from me, that’s Evan, evanbrand.com. We’re available worldwide. So, most of these products we can get and we can ship to you. I know a lot of people internationally have trouble getting some of this stuff, silver and NAC. Some countries are just weird and it’s hard to import stuff but usually we have. Our team is great with logistics. So, I think it’s good to just have a stash of this stuff if you don’t already, don’t wait till you get the sinus infection then try to order, get it. Get it now. Get it, get prepped.
Dr. Justin Marchegiani: They have a bottle of it there. Someone said, can you do too much of it. I would say it depends, right. I would say, if you have an active infection, I think you’re gonna be fine just make sure the water is clean, RO high quality water. Make sure you’re using a good quality sodium bicarb, I think if the killers are making you more sensitive, right? You could always do your spray or killers before and then do the just the saline without anything in it after so then everything’s clean and flushed out so then you don’t have anything overly abrasive in your sinus after the fact, that’s a good way to do it and if that’s still a problem you could even, you could even just do a saline flush and not anything else after that. It’s still better than nothing just to get everything out of the sinus cavity but worst case do your spray before and then afterwards just the flush. And they have spray that are just silver too, so you have, I have a silver spray too. You can just do that, I’ll do that for my kids sometimes because they’ll complain about it like just the feeling it’s a tiny tinge of a burn for like 10 seconds and so I’ll do the silver sometimes with them. Oh by the way, my kid had a pink eye issue, used to silver spray, opened his eye up, I just like this, I went, gone in two days. So, silver is excellent for some of the pink eye stuff, I would never do it with this. That would burn but the silver is good. I hope that makes sense. Any other questions about that so far?
Evan Brand: I think we got most of the questions answered here, there was one question about getting mucus after food and these were things like yogurts, ice cream, soy sauce, wheat products, well yeah, I mean it sounds like food allergy so obviously I would clean up your diet. I don’t recommend any of those foods, maybe if it’s like a coconut cream ice cream with low sugar maybe but beyond that all of those foods to me sound like potential irritants.
Dr. Justin Marchegiani: Sugar and inflammatory foods, especially excess sugar and inflammatory foods will cause mucus, that’s part of the inflammatory response, that’s just part of it. Yep. That’s part of the reason why people have sinus infections outside of just getting upper respiratory tract viral issues.
Evan Brand: Yeah. Absolutely. How many people are going to the ENT and getting a paleo diet prescription, probably not many.
Dr. Justin Marchegiani: No, and there just gonna recommend steroids, Flonase, steroids, antihistamine, they’re not really ever get to the root cause that’s the problem and so It’s really good that people are bringing these things to the light, you know, this guy Dr. Mehta, I think it’s Dr. the NeilMed guy, he’s really been on top of it, which is great. I mean this is an MD that’s talking about using really good options to clean out your nose and then you know having more of these sprays together is really good and having things that can add to them, I mean, just amazing and a lot of these viruses live in your nose so preventatively we can be on top of it, you’re out with a bunch of people, you know, instead of being overly worried about washing your hands which you know, that’s fine, wash your hands but flush your nose, easiest thing, flush your nose.
Evan Brand: Totally more valuable in my opinion for sure.
Dr. Justin Marchegiani: Yeah. So guys, to reach out to Evan, evanbrand.com. Evan is available worldwide for health consultation support. I am as well, Dr. J, justinhealth.com, we are here to help you out. We’ll put some links here. Give us a little bit of time. I’ll put the links down below very soon so you can see some of the products that we use. Also, we’ll put some of the products that we recommend from our own store so you guys can get an idea of what we like. All right, any questions feel free to put them in the chat. We appreciate it. Share with family and friends, they could benefit and have a phenomenal day. Take care.
Evan Brand: Take care. See you next week.
How to Get Your Energy Back Post-Infection | Podcast #365
When people start to feel better after an infection, it is often tempting to return to previous levels of work, leisure, and social activities. However, too soon, trying to do too much can often be counter-productive. It is easy to get caught up in a ‘boom and bust cycle of activity that can prolong your recovery.
Dr. J and Evan discuss that if fatigue and other symptoms persist, it’s important to remember to allow yourself time to recuperate by finding the right balance of rest, relaxation, and activity for your circumstances. It is essential to listen to your body and gradually build a physical and emotional recovery plan that can help you get back to your life and stay on track without experiencing too many setbacks.
Dr. Justin Marchegiani
In this episode, we cover:
0:00 – Introduction
5:11 – The essential vitamins to boost your immune system
10:12 – What is the goal of the Krebs Cycle?
14:06 – Mitochondria and microbiota dysfunction in viral pathogens;
17:12 – The role of mitochondria, oxidative stress, and the response to antioxidants in chronic fatigue
20:08 – The neurotransmitters from amino acids and tryptophan pathways in B6 deficiency
Dr. Justin Marchegiani: With Evan Brand, really excited today. We’re gonna have a nice conversation on how to get your energy back post-infection. This is the topic that we’ve been getting a lot from our patients and again a lot of our inspired podcasts and videos come from real life clinical work with patients. So, we’re excited to bring you the real-life actionable information here to improve your health. Evan, how you doing today man? What’s cooking?
Evan Brand: Hey. Doing pretty well, uh, cooked some bacon this morning and that was about it with some organic blueberries and so I’m feeling good. my brain is clear and I look forward to helping people on this energy conversation, you know, so many people have chronic fatigue post-infection and they’re not fully bouncing back and so, I think that there are some easy low hanging fruit strategies that we can talk about but I’m just gonna jump straight to the big smoking gun which is looking at your mitochondria. We’re seeing a lot of issues with mitochondrial dysfunction or mitochondrial damage. I’m also seeing issues with neurotransmitters. So, I think, if you are to pick one and only one functional medicine test to look at to investigate yourself after this infection and fatigue, it would be the organic acids because you can get a great window into not only your gut health. We know that with infections, it does damage the gut, we know that there are ACE2 receptors in the gut so people that are ending up with irritable bowel or diarrhea or other problems during and post infection, we can look at that. A stool might be smart too but if you had to start with only one thing maybe the window into your gut via urine organic acids would be good enough. But more importantly, I want to see what the heck is going on with mitochondria and what kind of damage do we have because once you have the data then you can put together a protocol to fix it.
Dr. Justin Marchegiani: 100% agree. So, we know with chronic inflammation, especially like, post-viral inflammation. We know one of the biggest drivers is gonna be oxidative stress, right? So, oxidation is nothing more than your body losing electrons, right? And one of the big things that helps oxidation within any type of infection pre, ideally, we’re doing these things pre to mitigate al of the oxidative stress that’s happening at the mitochondrial level but simple low hanging fruit, out of the gates, is gonna be glutathione, vitamin C, these are really powerful antioxidants. Vitamin D even kind of fits in that category, right? Your big antioxidants are ADEK, um, I’m sorry, no, those are your fat-soluble vitamins but E is gonna be an antioxidant A is gonna be an antioxidant, right? I would even say E and K would for sure but your B and C are gonna be your water-soluble kind of more antioxidants for sure but the big are gonna plug in, you know, post-viral oxidative stress and/or pre is glutathione and vitamin C, out of the gates. And we can also look at low-hanging fruit on the mitochondrial side, which plugs into the Krebs cycle and the electron transport chain is gonna be B1, which is thiamine. I would say B vitamins as a whole was great but B1 has a major, major role and I’d even say B5, as well, pantothenic acid. So, you have thiamine, B1, right? You have Riboflavin, B2. You have niacin, B3; Pantothenic acid, B5; Pyridoxine, B6; biotin, B7; folate, B9; B12 is your methylcobalamin or hydroxyl or adenosine. And so, we’re talking B1 and B5 are gonna be big when it comes to post-viral fatigue. Those are really, really important nutrients that we can add in out of the gates and, why it’s all of this oxidative stress that’s happening when this infection is present. And so, the more you can do things like hydrate, keep inflammatory foods down like the excess Omega-6 fatty acids, um, keep the carbohydrate and the sugar in check, right? That’s gonna play a major, major role in not adding fuel to the fire if you will as well.
Evan Brand: Yeah, and you can do oral glutathione. So, we have a combination product, which is an acetylated glutathione along with an acetylcysteine. So, you can give your body the nutrients to make more. You can give the precursors but then you can also take just straight glutathione. There are some liposomal versions. There’s reduced glutathione. There’s a nebulizer version that you can take so you can inhale glutathione if you feel that there was some lung involvement. You may consider doing both. I personally did both. I did oral and I continued to do oral glutathione daily and then, also, during the acute situation, nebulized glutathione with silver. And then, you mentioned B vitamins and you can measure all this, right? So that’s the important thing is, you know, you’re shouting out all these different names but people can look at this, right? We can look at this on organic acids. We can look at the various B6, B12. You can’t look at every single nutrient in the body but you can look at a ton of nutrients from one urine sample. So, it’s pretty awesome. And then, vitamin C, believe it or not, we’re seeing a lot of issues with viral infection and acute scurvy, which is pretty interesting. If you just put it some of this data and scurvy into the research, I guess, it’s due to the oxidative stress. It’s happening quickly and every single person I’m seeing post-infection is showing low vitamin C. So, we’re just keeping people on 2 to 3 grams every day. We’re doing a powdered version with a mixed ascorbate. So, you probably don’t want to do just straight ascorbic acid and you probably wanna do like a sodium ascorbate, magnesium ascorbate, if you can get some citrus bioflavonoids in there too and just take it ongoing. Don’t wait until you’re sick. We, as a family, we just take vitamin C ongoing because we know it’s important for the health of your capillaries and all that. Can you speak on that for a minute? Like vitamin C and skin and collagen, I mean there’s a role in other things. People think vitamin C, immune, but there’s other benefits to see, right?
Dr. Justin Marchegiani: Yeah. Vitamin C plugs into making collagen, which is all of the connective tissue for your skin, uh, hair, you know, cartilage, vitamin C is really important for that. Vitamin C is a very similar molecular structure as glucose, right? Don’t quote me but it’s similar to I think C6H12O6 or O8, it’s right in that molecular area, looks very similar. So, what does that mean? That means, vitamin C has a docking site on the macrophage that actually goes and gobbles up bacteria and potential viruses and it’s gonna use that vitamin C that docks onto that macrophage to deal with the oxidation. So, I kind of think of it as like a firefighter going into a house and the vitamin C is like that fire fighter bringing that hose to squelch that fire, to squelch it, right? That’s kind of what I see vitamin C as, right? And, it’s almost like with the macrophage, it has a docking site and that glucose can actually come in there because it looks very molecularly similar to vitamin C and it can almost dock on that receptor site on that macrophage and take that vitamin C where to be used. It’s almost like giving the fire fighter a water hose, taking the water hose out and giving him a gas hose and he doesn’t even know. It’s almost like that and that’s why glucose and high levels of glucose and when it comes to a lot of these post-viral illnesses, you’re gonna see people that have very high levels of blood sugar, insulin resistance and even the extreme on the diabetes side are gonna have most of the side effects of most of the issues partly because of the oxidative stress, partly because of poor levels, you know, when you have insulin resistance that’s gonna affect oxygenation, right? Because, you’re not gonna have good blood flow and when you have poor blood flow and poor oxygenation, we need oxygen to plug into that mitochondria as well. It’s part of, you know, the key nutrients, right? We talked about B vitamins, B1, B5, very important to plug into the Krebs cycle. Well, guess what, when you have a high level of blood glucose and you’re on that pre-diabetic to diabetic side, right, 110 to 126mg/dl on the blood glucose side, your body has to process that and if you just go pull up, you know mitochondria, Krebs cycle and nutrients, right, you’re gonna see all the nutrients that are involved in that Krebs cycle to process that glucose because how it works in the Krebs cycle, everything gets funneled down to acetyl CoA, right? So, you have glucose comes to acetyl CoA, fatty acids come to acetyl CoA, they can also go this way into ketones and then you have protein coming down to acetyl CoA. Acetyl CoA pumps around the Krebs cycle twice and if you look, there’s gonna be nutrients that have to come in there to help that acetyl CoA to come around and a lot of those nutrients are gonna be B vitamins, magnesium, amino acids and so, if you’re coming in with lots of glucose and you’re not bringing in a lot of nutrients to funnel down to the acetyl CoA side, you’re gonna run that Krebs cycle twice and you’re gonna be using more B vitamins than you’re coming in. So, you can actually create a lot of nutrient deficiencies and oxidative stress when you consume a lot more glucose because it’s a transaction fee for your body to process energetically.
Evan Brand: Nice. Nice. That’s a great way to put it. And, the truth is people are coming into this infection with nutrient deficiencies already due to bacterial overgrowth problems, Candida problems, maybe post-antibiotic therapy, you know, they have issues with the gut now and they’re not making enough of their nutrients in their gut. And so, a lot of people will just depend on diet and they’ll simply, well, can I just get enough on diet, can I just eat liver and grass-fed steak and all that and get enough nutrients from that and I’ll say, look I’ve tested and I know, you have too. Over a thousand people and many of those people were already dialed in with their diet for years before they got to us. Paleo, carnivore, autoimmune, paleo, we’ve had people that have been doing an incredibly job with nutrient density and they still show up with nutrient deficiencies and so I would love if everyone could just eat their way out of this situation but I just think with the modern stress that we’re under we’re dumping a lot of those Bs. You’re mentioning all these that are fueling this cycle. We’re so depleted and burned out emotionally, physically, chemically, we’re exposed to toxins. We’re just not living in Paleo time, so Paleo, you can’t just like paleo your way out of this and you know, that’s why I used to call my podcast years ago ‘Not just Paleo’ and then I got rid of it, just call it Evan Brand now but, um, that was my whole thought at the beginning. It was like, man, if everybody could just eat their way out this and get enough Bs in the diet then you and I wouldn’t be needed.
Dr. Justin Marchegiani: 100%. Let me just kind of break this down for people just so they can get a better understanding of what’s happening here. So, when we have oxidative stress, oxidative stresses, we’re losing electrons. What’s the whole goal of the Krebs Cycle? The whole goal of the Krebs cycle is essentially gathering up electrons. Okay, so, you have fats like I mentioned before, they’re all funneling down to Acetyl-CoA. Proteins all funneling down to acetyl-CoA, right? Then you can see on the carbohydrate side like I mentioned, look at a lot of the nutrients that are involved in funneling the carbohydrates down to acetyl-CoA, different B vitamins, okay?
Evan Brand: Zoom in so,
Dr. Justin Marchegiani: B1, B2, B3, magnesium, all play really important roles and then look at the carbohydrates, look at the amino acids that are involved. Cysteine, that’s a major precursor of glutathione, serine, really important for stress. Glycine, that’s your major amino acid in collagen, right? This is why, when you’re stressed and you’re sick, it’s why your grandma tells you to have chicken soup, right, especially with the whole bone in there because you’re getting a lot of these amino acids in a liquid form. So, if your tummy doesn’t feel good and you’re nauseous, right, because the infections tend to really cause nausea because your energy is going to fight an infection versus digestion. So, it’s trying to shut that down. That’s why your grandma said chicken soup, right? Ideally, we keep the noodles out now. Now, look at the fats, right, look at where the fats can go so the fats go down to acetyl-CoA but it can also go and create these ketones, right. This is beta-hydroxybutyrate. This is a ketone, okay? Now, really important here. So, we have this acetyl-CoA, right, this is kind of our energy currency that everything gets converted from our three major macronutrients, fats, carbs and proteins. And again, if you’re listening at home, there’s a video version of this of me going through it. I know, it’s a little confusing but I’m going to try to make, break it down. Acetyl-CoA comes around this citric acid cycle or Krebs cycle. It’s the same thing. It goes around twice, okay? And you can see GSH that stands for glutathione. Fe stands for Iron. So, if you’re a female and you’re very low iron or you’re anemic or vegetarian vegan, that could be a problem.
Evan Brand: So, let me pause there, really quick, because I want to point out something. You’re showing here on this cycle that you’ve got to have not only glutathione but you’ve got to have iron so you gave a shout out to the anemic women and what I want to point out is that the women that came into this infection, anemic, which is extremely common. Women have hormonal imbalances. It’s an epidemic problem so many women have heavy periods or maybe post childbirth, their period was screwed up and they’re having heavy menstruation. So, they’re coming into this anemic or they’re coming into this with low ferritin and then that’s compounded by maybe a mold exposure where now they have low glutathione levels. The way you’re showing this cycle here, if you come in with low iron and low glutathione, you’re in big trouble.
Dr. Justin Marchegiani: You’re in big trouble. And, women are more predisposed because if they have hormonal imbalances, guess what happens to their period, they get heavier. Heavier period, they’re just gonna lose that iron. Now, men on the other side, men have it, you know, they can have increased iron. They can cause oxidative stress because iron is like, you know can be like gasoline on the fire if it does get too high, right? But you can see glutathione, iron, you can see B vitamins, you can see magnesium, you can even see manganese here and you can see different B vitamins. And, what they do is you’re creating NAD and FADH and they’re grabbing hydrogen, they’re grabbing electrons, okay? So, typically comes around here twice and you get usually two NADHs and one FADH2 per cycle and then essentially all of these things will jump into the electron transport chain next. If I could find that section here, but the electron transport chain is the next big step for that kind of gathers nutrients but for really, for today’s talk, this is the really most important thing and then just kind of highlight, you can see some of these toxins over here that come in, right? You can see fluoride, Hg is Mercury, As is gonna be, uh, arsenic, Al is gonna be aluminum. So, you can see some of these toxins, how they can kind of come in there and sabotage some of these things. And, to kind of highlight one thing, this is an article we saw here. Mitochondria and Microbiota dysfunction with post-viral issues, you can see how the gut microbiome also plays a certain role and why is that? Well, I think, because 80% of the immune is in the gut so if you have a pathogenic or dysbiotic microbiome, it’s gonna affect toxins being produced, right? It’s gonna put you right here in a hyperinflammatory state, right? We already have a lot more cytokines being produced if we have an illness and so we have to be able to calm down our immune system’s inflammation to what’s happening from an immune stress standpoint. And so, the microbiome plays a big role, iron dysregulation, reactive oxygen species, right? Vitamin C plays a major role here. Vitamin, uh, glutathione plays a major role there as well.
Evan Brand: Yeah, right there, look at that one, the mitochondrial, the heightened inflammatory oxidative state may lead to mitochondrial dysfunction and so this is what we’re seeing on paper. We’re seeing this in the stool test. We’re seeing this in the organic acid test, this issue with the gut with the mitochondria.
Dr. Justin Marchegiani: Yeah. It talks about platelet damage too which is important because what do platelets do, those are your clotting factors. And so, if we can have increased coagulation cascades, that means more clotting, right? And, you can see more clotting events, more thrombosis is that’s a blood clot, right? And so, you can see furthermore, mitochondrial oxidative just make, may contribute to microbiota dysbiosis altering coagulation and fueling inflammatory oxidative response leading to vicious cycles of events. So, this is really important and so things that we can do to be on top of the fatigue is gonna be the same things that we can do to help mitigate a lot of the inflammation. That’s gonna be keeping blood sugar in check, adding in some of these additional B vitamins, um, adding in anti-inflammatory anticoagulants. What do those look like? That could be ginger. That could be curcumin, which has anti-inflammatory and anticoagulation effects. That could be adding some extra Cod liver oil that has more vitamin A in it, which is a really powerful antioxidant but it also has natural blood thinning aspects because of the extra omega-3s in there. So, there’s different things we can do to really help reduce a lot of that inflammation. Any comments on that, Evan?
Evan Brand: Yeah. On the more intense side of supporting hypercoagulability, lumbrokinase is gonna be your most powerful. That’s your earthworm-based enzyme, which is just a cool, cool thing. Natto, there’s also serratiopeptidase, so there are other enzymes that you can use and I personally take those. I take lumbrokinase, one per day just ongoing and it’s been very helpful. I also did a podcast with Dr. Thomas Levy, all about vitamin C IV and he’s got some dark field microscopy photos of people that we’re having blood clotting issues and the vitamin C along with ozone and IV was like a game changer and vitamin C can help energy too, so I don’t want to get too deep in the rabbit hole of blood clots but we’ll just say that the vitamin C is helpful for energy also.
Dr. Justin Marchegiani: 100%. I want to show you guys one other journal article here, role of mitochondrial oxidative stress and antioxidants when it comes to chronic fatigue and so one kind of thing here, it talks about the known role of oxidative stress and how it can relate to essentially fatigue, as well as, potential, uh, specific therapeutic treatments for the mitochondria so that’s really powerful. And, you know, here are some of the big things, they’re gonna talk about vitamin C, talk about B vitamins, talk about glutathione and then also some of the more natural anti-inflammatory things but you know, each study is going to find out focus on a couple of their major things but, people in the literature are looking at these things. It is real and, um, we’re seeing it in our patients and we’re trying to apply some of these things to get people’s health back.
Evan Brand: Yeah. So, the way you look at this is what you can do to protect against oxidative stress, we covered that glutathione. What can we do to help support the Krebs cycle? We talked about B vitamins. You’ve also got just things that are gonna help the mitochondria in general, like CoQ10 and then also you can do things like PQQ and there’s other nutrients that actually create what’s called mitochondrial biogenesis where you can literally make new mitochondria. And so, I don’t think it’s in that paper, it does mention CoQ10 there but
Dr. Justin Marchegiani: Right here in the mitochondria, there are enzymes and coenzymes such as vitamin E, CoQ10 to remove ROS, that’s reactive oxygen species to prevent DNA damage. So, these are really powerful things that we can add in. For example, low CoQ10, they’ll see an increase in damage, so Coq10, PQQ, you know pyro quinolone, right? Vitamin E, and then, you know, we try to give Coq10 with vitamin E together for that same reason to prevent a lot of the oxidative stress while fueling the mitochondria. Any comments on that?
Evan Brand: Yeah. Look at the next part there too, talking about exercise. People that come in with chronic fatigue and how they’re having an increased oxidative stress after exercise and that’s a problem that we’re seeing a lot too is people that now are having, uh, post-exertional fatigue, people that are crashing. Even athletes that were really high performing people that now their performance is just in the tank and a lot of that is just this ongoing oxidative stress and mitochondrial damage that’s not, that’s not been supported and you can’t just exercise your way out of this and I get kind of annoyed when I see like those motivational videos of people that are really sweaty like you just nee to suck it up, you know, pain is weakness leaving the body. It’s like, no, you’re wrong, you got to fix the mitochondrial damage. I hate those like raw-raw videos because it’s ignoring all the nutrients. That video really needs to be talking about, hey get your glutathione up, get your ribose up, get your CoQ10 up, come on people, like that’s what he used to say.
Dr. Justin Marchegiani: And this is a similar marker that we use on the organic acid test, the one that we use 8-hydroxy-2-deoxyguanosine, this is very, very similar to that. But this is a marker for oxidative stress so we’ll actually use the same marker on a, um, on a mitochondrial test on the organic acid. So, we’ll look at some of these things to get a window of how stress these pathways are so that’s very powerful.
Evan Brand: Yeah. Ribose is amazing. Carnitine is amazing. Acetyl-L-carnitine is amazing. Also, you know, let’s hit the, let’s go up a little bit like that picture there was a like a neurotransmitter picture there that you had. Maybe, we should talk about that a little bit because it’s not directly gonna be a mitochondrial support, yeah, right there, but I think, that’s cool to point out too, which is that, if we’re coming in with nutrients like phenylalanine or tyrosine, eventually some of that may convert over to your neurotransmitters but then also your adrenal hormones like epinephrine and I think a lot of people and I know you see this too, a lot of people are showing up with just low brain chemistry across the board. And so, I’m thinking out loud with you that like, the real magic remedy is the mitochondrial support plus throwing in some of these neurotransmitter supports as well.
Dr. Justin Marchegiani: Well, that’s why we talked about B vitamins and I kind of went to the gamut, look how important B6 is in regarding the synthesis of tryptophan to serotonin, really important so you can see how B6 deficiency is really important in this process to convert this inflammatory product here, quinolinic acid, uh, back to tryptophan, it needs B6 or to avoid that whole thing it needs B6 so that’s really important. So, B6 is really important in the synthesis of amino acid tryptophan to serotonin, very important.
Evan Brand: And so, vegetarians, vegans, obviously, you’re gonna be at increased risk of issues and your recovery is not gonna be as good as someone who’s getting these good animal proteins because you’re gonna be getting adequate tryptophan and other nutrients from your animal-based products. So, even if we could get these people on eggs, if we could get these people on organ capsules, if we could get these people on even like a protein like, I’ve got one we call carnivore collagen, which is a like a beef peptide, I mean something you gotta supplement at some level if you’re not eating those foods. So, please, if you’re a vegetarian vegan and you’re exhausted then look at some of this and hopefully we can convince you to change and improve your diet a bit.
Dr. Justin Marchegiani: Yeah. No, I totally agree. I think that’s really important. I want to see if there’s anything else here, I want to highlight now because that’s enough, that’s powerful enough. Anything else, you wanted to highlight there?
Evan Brand: Well, we hit the urine, we hit the stool. Looking at the gut, you showed the study about the gut changing, we’ve seen that, I mean, you and I were talking about that march of 2020, I mean that was 2 years ago. We were talking about being affected. And so, obviously, our message is the same that it’s always been is get your stool looked at so we can see what kind of dysbiosis do you have going on because if you’re taking all these supplements, you’re doing all these foods but you’ve got malabsorption or you’ve got gut inflammation. You’re not gonna, you know, people say you are what you eat but you really what you digest from what you eat. So, if you have all these other issues in your gut, the grass-fed steak is not gonna be as valuable to you. Now, I’m not saying stop eating it, I’m saying still eat it but we’ve got to improve the digestion and assimilation of that.
Dr. Justin Marchegiani: 110%. And one thing here, I just want to highlight here, just to kind of this article, it’s talking about mitochondrial function in infections in the gut because we’re trying to talk about mitochondrial and energy post-illness, that could be a viral illness, it could also be a gut illness, right? Because, it’s talking right here, even virus dedicated virulence factors and talks about downstream of an infection. It’s fascinating that a plethora of immune responses but, uh, be it against viruses, bacteria or LPS. LPS is lipopolysaccharides or endotoxin, this can come from H. pylori, this can come from SIBO, or dysbiotic bacteria and they strongly impact tht mitochondria which is really, really important because they’re toxic, they kind of throw a monkey wrench in how the FADH and the NAD is kind of moving around the Krebs cycle, collecting hydrogens and then bringing into electron transport chain. It talks about, um, governed by the mitochondria can be translated into active therapeutics to boost immunity against pathogens to over immune responses under control in the case of inflammatory disorders. So, essentially, the more you have these infections there, the more inflammation your immune system creates that can actually impact your mitochondria. Again, when you have a lot of these illnesses, it’s not just the stress from the illness, it’s the immune response from your own immune system that creates inflammation that can actually disrupt your energy pathway. So, sometimes, you’re just fighting against yourself. And so, using nutrients to help modulate the immune response i.e., glutathione, Vitamin D, vitamin C, right, really important nutrients there. I’d also say, you can do things like curcumin, or resveratrol as well. You can have immune modulating effects. These are powerful. So, it’s good to kind of get your immune system in check. Most people that are having longer term, we call it kind of long haulers type issue. It’s typically their immune system has over responded and it’s just creating so much inflammation. So here, this illness, they’re no longer testing positive for whatever this illness is and they’re prolonged 2 to 3 months out and they’re feeling like crap still, it’s because they really didn’t get their immune system’s inflammatory cascade in check afterwards.
Evan Brand: Yeah. Well said. So, a couple comments. Number one, you can improve your energy by simply fixing your gut and that’s exactly what that data is showing and that’s exactly what you and I have seen and done clinically, hundreds and hundreds of times. People that were exhausted coming in, we give them a gut protocol, sometimes, not even giving them energy supplements because on paper they look good and all of a sudden, their energy level doubles and all we did is fix their gut so that’s the number one comment. And then number two comment is that, people need to stop waiting for some illness like this to take them down before they take this stuff serious. I mean, you and I are all about preventative approaches meaning getting your mitochondria, you gut, your brain chemistry getting all that stuff optimized now so that you’re a warrior on a daily basis so that when you do come across something like this and there probably will be more things like this that you do to get exposed to, you’re ready and you’re able to handle it and you’re not coming in so sick and looking for this emergency therapy at the end stage, it’s, in some cases, it’s too late. I think, a lot of times you can turn it around but you should have been working on your health years ago before you got this stage.
Dr. Justin Marchegiani: Yeah. And a lot of it is, you know, anytime you have some type of illness coming up, the more you can be on top of a lot of these key immune modulating anti-inflammatory nutrients ahead of time and or during versus coming in at the end when the inflammation is super high. It’s like coming in when the fire is a little baby fire and knocking it out versus having a full five alarm and trying to stop it, right? That’s kind of the analogy. So, I always recommend telling people have a couple of nutrients. You may not be taking it everyday but they may in your medicine cabinet is kind of like a, um, you know, last ditch kind of effort to kind of come in there if you start to feel a little bit ill so on my line, we have Immune Supreme, which is nice because you have some green tea in there, you have some echinacea, you have some medicinal mushrooms, you have some antioxidants and some immune modulators, that’s kind of cool. Have that in your medicine cabinet. You start to feel the tiniest thing, start taking that to get that immune system, obviously, you can ratchet up, vitamin D, vitamin C. These are easy first line things, if you have any NAC or glutathione, we can ratchet that up. These are easy things that we can do to kind of take charge of our health and prevent our immune system from throwing us off.
Evan Brand: Yeah. Well said. And, if you need help clinically, we do offer one-on-one consults around the world with people so we’re very blessed to be able to help so many people by getting the proper testing done, making the proper protocol to get you better. So, if you don’t test, you guess, you got to see what you’re up against first, look at your Bs, look at your gut, you know, once we get the data, we can help you more accurately and you’re gonna save a lot more money, a lot more time and a lot more suffering and you’re gonna get out of the dumps out of the trenches, out of the depths of hell, depression, whatever you’re dealing with. You’re gonna get out of that faster if you’re using clinical data and you have a tour guide to your body. So, if you need help clinically, you can reach out to Dr. J at justinhealth.com for consults worldwide or me, Evan Brand at evanbrand.com and we’re here for you guys. So, we look forward to helping you out.
Dr. Justin Marchegiani: 100%. I appreciate it. Yeah. Anyone that wants to reach out, Evan already gave you the links, really appreciate it. Comments down below, I really appreciate your feedback on that and also, we’ll put links down below with some products that we chatted about. We have different ones that we recommend in our line. Just wherever you go, make sure you get them from a professional grade company because raw material does matter in the supplement world. You can buy, you know, the equivalent of the grass-fed steak from the local farmer or you can get it from McDonald’s, right? And so, we want to get the high-quality raw material that’s tested to make sure there’s no impurities and just building blocks are excellent. Evan, excellent chatting with you man, really appreciate it. Guys, um, have an awesome week and we’ll talk soon. Take care you all.
Evan Brand: Take care, now. Bye-Bye.
Dr. Justin Marchegiani: Bye.
Signs and Solution for Gut Inflammation and Leaky Gut | Podcast #351
In this video, Dr. J and Evan stress the importance of what you eat and how it impacts the rest of your body. However, what you might not realize is how your food is digested in your body, and when it gets inflamed and leaky, how do you fix it?
A lack of digestive enzymes can cause leaky gut syndrome—another unfortunate result of chronic inflammation in the digestive system. Many culprits cause leaky gut, including stress, medications, poor food choices or quality, alcohol, cigarettes, and even hormone changes.
Dr. Justin Marchegiani
In this episode, we cover:
0:00 – Introduction
1:08 – Poor Gut Health Connection to Virus.
4:31 – What is the role of bile movement and production?
11:16 – The influence of gut michrobiota on Inflammation and Insulin Resistance
19:29 – General recommendations on carbohydrates and for a healthier gut
Dr. Justin Marchegiani: Hi! Dr. J here in the house with Evan Brand. Today, we’re gonna be talking about the signs and solutions of gut inflammation and gut permeability or leaky gut for short. Really exciting topic. We see it a lot in our patients every single day. Evan, how are we doing today man?
Evan Brand: Hey. I’m doing really well. I can’t remember if we covered this on the podcast or not, this specific study but there was a paper that came out all about leaky gut and worsen outcomes with the virus and so people could put in the, you know, what virus in PubMed and leaky gut and we’re finding that a lot of people with leaky gut that’s actually one of the precursors and that’s what’s leading to worse outcomes so this is more important, It’s always important but this is more important now because we know that there’s a massive link and I’ll actually pull this up here and I’ll show you this, American Society for Microbiology, they did this. Did we talk about this yet or not?
Dr. Justin Marchegiani: Let’s talk about it. Let’s go ahead.
Evan Brand: This particular paper. Let’s bring it up there.
Dr. Justin Marchegiani: Let me check here. Oh yeah. Let me add it on. Go ahead.
Evan Brand: Yeah. So, there we go. So, poor gut health is connected to severe blank, new research shows and long story short, you can go into this microbiology article but long story short they actually show a picture too. Let me see if I can get to that picture. Here we go. That was the picture. I think, we already showed this picture but forgive me and people listening on audio. Basically, we’re just showing that viral particles with a leaky gut are gonna be able to get into the circulation and that’s gonna increase your inflammatory response so the real goal of today is making sure that your gut is in good shape because therefore you’re not gonna have leakage into your circulation. You’re gonna be far far better if you have that healthy gut barrier. So, that was really kind of the spark notes of that but that’s like a 19 pages paper that you can dive into and many people I think have thought of leaky gut as kind of trendy topic that only people like you and I talk about but this is finally, actually getting into the mainstream. So, I hope gastroenterologists are gonna realize the importance of addressing the gut and I hope they actually start taking it more seriously. Right now, it’s just antibiotics that’s really the only thing that gastroenterologists do for gut, right? I mean steroids maybe and immune modulating drugs in the case of like, ulcerative colitis and Crohn’s but beyond that there’s not really much leaky gut conversation going on.
Dr. Justin Marchegiani: No. There’s not and again, really, a leaky gut has an effect, right? Or we’ll call it gut permeability, right? If you go on PubMed, a leaky gut is like a slung. If you want to really find it, you want to look at, you know, gastrointestinal permeability, right? These are gonna be the big things, it’s the tight junctions, the epithelial cells and the small intestine, they start to come apart like my fingers here interlocked like I’m saying a prayer, they come apart and then you can see lipopolysaccharides undigested food particulate can slip out. So, this is, um, this is part of the major, major mechanism. Now, with gut permeability, it’s an effect not a cause so I always tell patients, we don’t go in and treat leaky gut, we treat the corresponding vectors of inflammation that drive gut permeability so that could be food allergens, that could be immune stressors like virus, parasites, small intestinal bacterial overgrowth, general dysbiosis, poor digestion, antibiotic exposure, creating rebound overgrowth, fungal overgrowth, you know, just poor digestion, lots of stress, increased sympathetic tone and adrenal stress, that’s shutting down the digestive system and making gut permeability more probable. So, these are the big vectors so we always wanna draw a line. What’s the root cause and what’s the effect and gut permeability is in the effect not necessarily a cause.
Evan Brand: Yeah. I’ve seen a lot of, even advertisements now on social media for all these leaky gut healing formulas and that kind of stuff and it always has the word heal involved but you could take as much glutamine and whatever else you want. You could go into an elemental diet and all of that. It’s not gonna get rid of these big root causes and certainly for me, I tried some gut support but ultimately it was resolving my parasite infections. That was the most important thing for me and so, you can test for this. This is not an uncommon situation; you and I personally and clinically see parasites every single week. So, when you hear this idea of like, oh, it’s a third world country problem, you haven’t traveled to Mexico or anything like that. That’s just crap, I see it all the time and I had them and I was not out of the country and I had multiple parasite infections and then that affects your bowel flow, right? Can we talk about the bowel for a minute, what’s the role there, because you and I talked about how you have to have adequate bile to act as sort of a natural antimicrobial but how is this happening. What do you think are the big driving factors for why bile production is just not good?
Dr. Justin Marchegiani: Well, first off, we look at the domino rally of digestion. The first thing that has to happen is good, nice aesthetic pH in the stomach. So, we need adequate HCl in the stomach, hydrochloric acid that lowers the pH and again, lower pH tends to have an antimicrobial effect, right? So, if we have to bring the pH down a little bit, that makes it harder for bugs to grow and that pH is also responsible for activating a lot of proteolytic enzymes in our stomach so if we have a good pH, we activate our enzymes, that starts the digestive cascade, we make it harder for bugs to grow and then once all that kind that mixed up food and enzymes and acids and all the stuff in our stomach is all mixed up. That’s called chyme, C-H-Y-M-E, that gets released into our small intestine, our pancreas then produces a bunch of bicarbonate to bring that pH back up to around neutral but that pH being nice and acidic, it triggers bicarbonate and then it also triggers cholecystokinin production, CCK, which then causes the gallbladder to contract so then you get a whole bunch of bile that comes out, you get a bunch of bicarbonate that comes out of the pancreas but then you’re also gonna get a bunch of lipase and proteolytic enzymes, trypsin, chymotrypsin lipase, lipolytic enzymes is coming out of the pancreas as well. So then, you bring the pH back up, you add the fat digestive enzymes, the proteolytic enzymes and then you also stimulate that bile production which then emulsifies that fat. Think of emulsification as you have a nice greasy pan where you cook some bacon on, right? Throw under water, you feel the fat on the pan, throw some dawn soap on there, it emulsifies it. It breaks that up so then you can get it all out the intestinal tract and be able to absorb it, carry on, mycells and be able to use it for lipid bilayer, hair, skin, nail, energy all that stuff. Prostaglandins.
Evan Brand: Yeah. Well said. And though bile is produced by your liver but it’s stored in your gallbladder so people that have had their gallbladders removed which is a very common surgery, a lot of surgeons are very happy to remove gallbladders, I think in many cases, they may have been saved with fixing these other upstream issues but, well, once it’s gone, it’s gone. So, people listening that have no gallbladder, you have to take that into consideration. There was a study here in 2018, it was in the annals of gastroenterology, it found that poor bile flow can contribute to the development of inflammatory bowel disease. So, you’re really setting yourself up and find all the time with people clinically when they come in, they’ve had gallbladder removal, we see a lot of issues, we see massive bacterial overgrowth problems in these people and I think that’s partly due to not having enough bile being stored anymore like you and I have talked about it before, I think you said it was a 10x concentration in the gallbladder, is that right?
Dr. Justin Marchegiani: 10 to 15x. Yeah.
Evan Brand: So, you’re missing out on that when you have just liver production, you don’t have that storage facility. I mean you have some but just nowhere near what you would have had if you had your gallbladder. So, please. Try to save your gallbladder. You got to fix these upstream infections because that’s gonna be and get off proton pump inhibitors with the help of your doctor if you can because we know that, that suppression of stomach acid is gonna lead to the overgrowth which then fuels these downstream issues to not happen the domino effect, it literally gets stopped or prevented by the PPIs.
Dr. Justin Marchegiani: 100%. And so, we need good, think of bile, it’s an emulsifier, it breaks down fat, it’s also an antimicrobial and so we create antimicrobial environments by having good, nice, low pH by having good enzyme and acid levels that also helps and then also by having good bile output and plus the longer that food sits there and rots and putrefies because we are not breaking it down into its constituent parts, right? Then it’s gonna create future petrification, fermentation, and rancidification. Essentially proteins and fats and carbs are rotting, right? Then you can get gas and bloating and that just creates this incredible breeding ground for bugs to grow. It’s like you can have this beautiful home that you take care of but if you leave the garbage in there like, a week too long it’s gonna get like, stinky and then you’re gonna get a whole bunch of bugs attracted to it, right? Same kind of thing in our microbiome so it’s really important that we stay on top of, you know, those good health practices.
Evan Brand: Let’s hit the symptoms and signs and symptoms because people know most of the gut ones but there are some that you and I find clinically that maybe people wouldn’t think are a gut symptom, right? It might not manifest outside of that so we can cover the stuff like unusual color texture, smell, messy poops, you have floating stool. You have maybe alternating diarrhea, constipation, bloating, gut pain. But, what about like, skin issues and what about anxiety and depression and hormonal imbalances and brain fog. I mean, you and I have seen, we lost count how many times we’ve seen cases where we simply just fix the gut and all the sudden, this depression is lifted. I had one client named Miranda, who she had been depressed for, she said quote 20 plus years, all we did is do a gut protocol. I gave her no antidepressant herbs. We simply just did a gut protocol and when we did a six-week follow-up, she said her depression was 90% better and when she said 90% better, she didn’t even sound too excited and I said, are you realizing what you just said to me. You’ve been depressed for over 20 years and you’re 90% less depressed in six weeks of doing a gut protocol like do you realize how profound that is and she goes oh yeah, I guess that is amazing. Thank you. And, I think people, they get so used to feeling a certain way that when the clouds lift. They’re almost not even ready for it but depression, anxiety, I would put at the top of the list for mental health issues connected to these gut inflammation problems, I will tell you. And, you and I discussed this I remember calling you one-night years ago is probably like coming up on be six, seven years ago was like 2014, 2015 and I was like man, I’m having like a panic episode or something and this was when I was living down in Austin and it was H. pylori. It was driving that because as soon as I cleared the H. pylori, all those weird episodes of panic completely disappeared and I’ve seen that more than just the n equals one, me, I’ve seen it many, many times. So, if you have anxiety problems, you go to the psychiatrist. They’re not going to suggest you have gut infections but that’s something you need to be thinking about.
Dr. Justin Marchegiani: 100%. Yep. 110% for sure. Anything else you want to add in that topic?
Evan Brand: If you’ve got mental health issues, look in the gut maybe even look in the gut before you look in the brain. Now, obviously, we’re gonna be doing organic acid testing and other things to look at neurotransmitters so we’re gonna check out dopamine, serotonin. We’re gonna look at what’s called quinolinic acid so we can look for actual brain inflammation or brain toxicity related to gut infections like sometimes Clostridia, we’ll see will drive up the quinolinic acid markers but we still have to fix the gut. So, if you have a family member, they’re anxious, they’re depressed, they’re fatigued. We’ve seen a massive link between chronic fatigue and gut infection. So, there’s another big one that people may not recognize, the gastro doc may not suggest your chronic fatigue is from a gut infection but it certainly can be skin issues as well. My skin was a wreck years ago. I had major acne even though my diet was clean. It was my gut.
Dr. Justin Marchegiani: Totally. I also wanna highlight one other kind of variable here. I think it’s really important. I’m gonna pull this on screen here. I think this is really interesting. So, an interesting abstract here and it’s looking at the influences on the gut microbiome on inflammation and insulin resistance so this is interesting because we talk about insulin resistance, right? Consuming too much carbohydrate and refined sugar. All carbohydrates get broken down typically into glucose, fructose or a combination of the two, right? And so, the more sugar that gets released into our bloodstream that gets broken down whether from refined sugar, sucrose which is fructose in glucose, high fructose corn syrup is fructose in glucose 55, 45 concentration and then of course we have starches which get primarily broken down into glucose and then we have fruit which is more on the fructose side. These things all have an impact on our blood sugar and the more insulin resistant we become, we, it drives inflammation. It’s hard to utilize these fuel resources and these fuel sources to get deposited in our fat because our muscles don’t have the ability to store it. our liver loses the ability to store it. We don’t have the activity level. We don’t have the mitochondria stimulation to burn it so we store it as fat. Now, this article is interesting. It talks about obesity as the main condition that’s correlated with the appearance of insulin resistance. Think of this as when your cells get numb to insulin. Now, this is on screen here. People that are looking if you’ve got mental health issues on the audio version, we’ll put the link below for the whole video. Whole bacteria, their byproducts and metabolites undergo increased translocation through the gut epithelium. Translocate, let me give you the translation on that. Here’s your gut. Leaky gut happens, right? Where it talks about gut permeability and things start to translocate meaning move from the inside of the gut back into the bloodstream, right? So, it translocates through the gut epithelium into circulation due to the degradation of tight junctions. This is a leaky gut, right? Here. And it increases intestinal permeability that culminates in inflammation and insulin resistance. So, what this says is the inflammation caused by gut permeability caused by gut permeability caused by lack of enzymes, bile, food allergens, all the gut microbiome issues can actually drive inflammation and insulin resistance. Now, it makes it harder for your mitochondria to generate fuel because you’re not able to get that fuel into your cell and you start to become more of a sugar burner. It’s very difficult to burn fat when you have high levels of insulin, Very, very difficult. So, several strategies focusing on modulation of the gut microbiome using antibiotics, again, we would use antimicrobial herbs, probiotics and probiotic fibers are being experimentally used to um, in order to reduce intestinal permeability, increase the production of short chain fatty acids. Guess what, things like butyric acid, medium chain triglycerides. Those are all very helpful. And again, this helps promote insulin sensitivity and counteracts the inflammation. So, really, really important here. This study, influence of gut microbiome on subclinical inflammation here and this is the 2000, see what’s the study, 2013 study so we’ve known this stuff out for a long time here that the gut microbiome plays a major role on your blood sugar, blood sugar handling and if you’re a diabetic or someone with insulin problems, you need to be looking at the gut. Yeah. look at the diet, look at, you know, getting your diet and your macros in order, make sure your food quality is good and then look at really getting the microbiome dialed in to really help. That could be a missing piece of the puzzle for people that have really changed their diet but not quite gotten the metabolic benefits of losing weight yet.
Evan Brand: Wow. That’s a good point. You know, when I think back, when I had gut infections, my blood sugar was definitely not as good. I mean, 2 to 3 hours is as far as I could go without having to eat a meal. Now, I could fast all morning and not eat till 1 pm and I’m perfectly fine. I think there is an adrenal component too. I think I’m in a lot better place with that but I can tell you that certainly after mixing my gut, my blood sugar and blood stability is much better. So, I think you’re onto something with that paper and how people that even have gone paleo or animal based or keto. That still has issues with blood sugar regulation. That could be a sign of gut issues and I think even If diet dialed in in some cases what like you’re showing here, there could still be issues with the blood sugar. So, sometimes, it’s portrayed as like just fix your diet and everything else falls into place but you have to consider these other factors and also, I’ll throw in at the, you know, 11th hour here, mycotoxins, we know that mold toxins significantly affect the gut barrier and create a leaky gut. They damage the mitochondria, and we know that certain mycotoxins promote the overgrowth of bacteria like Clostridia and Candida. In fact, the lab will tell you that on paper, for example mycophenolic acid, it’s a very common mycotoxin that we see that comes from water damaged buildings. You breathe that in, that’ll then affect the gut and allow the overgrowth. So, if you’re just treating the antimicrobial herbs or fungal herbs and you’ve missed this giant mold exposure that can still affect the gut, still affect the brain and people won’t get fully better. So, that’s really the beauty of what we do is we try to work through all these puzzle pieces and help you because you could have this guy who says everything is gut and you go all the way down this gut rabbit hole and not get fully better or you go all the way down this insulin resistance rabbit hole and you still miss the smoking gun. You got the leaking dishwasher and your whole kitchen cabinetry. We had a woman in Texas last week, her dishwasher apparently leaking for years. Her entire kitchen has to be replaced now. She’s looking at 25k, just to replace her whole kitchen and she’s been to 10 doctors, 10 practitioners and nobody’s figured it out and I’m not trying to toot my own but I’ll just say I kept suspecting something because she said that she would always feel weird while she was washing dishes at her sink. She would get a little bit of a headache, feel a little bit sick to her stomach, said, ‘huh, is it possible that something’s leaking?’ and then boom brought in the remediator and they found it. There was a leaking dishwasher black mold everywhere.
Dr. Justin Marchegiani: Yeah. Mold plays a major role in stressing out the immune system. It can create gut permeability within itself and then obviously drives the insulin problems. And also, people that eat this type of diet, I mean, it’s natural when you have microbiome issues to create a bunch of sugar because these foods are from an evolutionary standpoint, things that had a lot of sugar in it ended up having a lot of nutrients in it, right? Oh, a bunch of berries, some honey, right? And they were very rare in society. It was hard to find a lot of these things. Even fruit, you know, back then, tended to be a lot more sour and bitter and we’ve kind of hybridized and you know selectively grown fruits that tend to be sweeter and more, uh, and more plump and luscious now they taste. And so, we have sweeter fruits today and so it’s natural for people to want to crave all the crap that feeds the bad bugs because the bugs are producing chemicals to make you crave these foods. So, you have to be educated and understand that these foods, even though you’re craving them, you need to like not listen to those cravings sometimes and really shift your gut in it. If it shifts your macronutrients in a way to starve out some of these bugs, it can make a big difference.
Evan Brand: Yeah. Well said. I mean, a lot of fruits hybridize now too as you mentioned to be sweeter, so like a strawberry. I’ve seen strawberries as big as my hand sometimes, like, ‘God’, you know wild strawberries, they’re tiny. I mean they’re like the size of a fingernail, if you’ve ever seen wild strawberries out in the yard, very tiny and definitely not anywhere as sweet as the other ones. So, when you hear people talk about fruit, like our modern fruit, like you said it’s not really, it’s more like candy with some, it’s like natural candy as opposed to the more ancient fruits so If I can find like some heirloom apples and that kind of stuff, I’m totally into it.
Dr. Justin Marchegiani: Exactly. And you know, my general recommendation with carbohydrates, just make sure you earn it, make sure you’re not in a place where you’re inactive and try to get some activity because sugar goes three directions: gets stored in the liver and muscle, okay, so, if you’re working out, you’re always draining that muscle every day, you have a storage reservoir for it a little bit in the liver; It goes to fat or it stays in the bloodstream and gets burned up by the mitochondria essentially. It gets burnt up mitochondria-wise by the muscles etc. So, it’s gonna go either stored, burnt, you know, it’ll stay in the bloodstream but burnt up by the muscles of mitochondria or it gets converted to fat. So, if you’re doing things that allow you to utilize the glucose in that bloodstream, not as big of a deal, but that’s what you really have to look at what activity level is and you have to work with your functional medicine doctor about dialing in those macros and some people they need to starve out certain macros especially the fermentable carbohydrates and a lot of the inflammatory foods especially grains, legumes, dairy. Those things are really, can be, drive a lot of inflammation and that can keep your sympathetic nervous system and your immune system on high alert which just drains a lot of energy from you. Food allergens can make you fat and they can drain energy from you. Yeah. Seeds too. You know, I cut out almond seeds, nut seeds. Yep, even some eggs too for sure.
Evan Brand: I cut out eggs for her while greens, I mean, some people are way overdoing it on the leafy greens. I can’t tell you the last time I ate a salad. I don’t really care. I don’t do leafy greens. I used to but, you know, I see way too many people doing these like kale smoothies. I had a lady doing like a pound of kale a day. Oxalates were off the chart. We know those affect the gut barrier too so there are downsides to plants.
Dr. Justin Marchegiani: Yeah. I mean, it’s all about, you know, how you tolerate it, can you eat and feel good afterwards, how does your stool look? Do you see a bunch of undigested particulates? If so, you may want to work on just chewing your food up more. Taking some enzymes. See if that helps or sauteed it a little bit and see if that moves a needle. Again, there’s almost always a way, we can adjust things so it works but everyone’s a little different.
Evan Brand: If you need further help, you can reach out to Dr. Justin at his website, justinhealth.com. Now, we do worldwide consultations, phone, facetime, skype, whatever it can connect to, we do it. Lab tests are sent around the world. It’s awesome we have distributors to work with. We can get these things to your door. We sign off on it and get you rolling so we can investigate and look deeper. So, justinhealth and then for me Evan Brand, it’s evanbrand.com. You can reach out and we’re both happy to help you. We love what we do. We’re very blessed for the opportunity to be in the trenches. We’re always improving our own health. We work on our families, our children. We work on everybody around us. We’re always trying to improve them and to be able to do it clinically too is just great. We learn so much from you all and we like to be the shining light in a world of darkness where people have been to countless practitioners and the stuff that to you and I is just common everyday conversation, functional medicine stuff. This stuff to some people is like wow why has nobody ever mentioned that to me before. And for us, it’s like, oh yeah uh-uh, we do it with everyone. So, we look forward to helping you uncover your root causes if you have gut inflammation, what’s going on. There’s something under it so don’t give up, keep pushing forward and please reach out if you need help. We’d love to help you.
Dr. Justin Marchegiani: Yeah. Evanbrand.com, work at Evan. Dr. J, justinhealth.com, works with me. We are here with you guys. And, put your comments down below. Let us know the different things that you guys are applying, what’s working, what’s not and if you get overwhelmed listening to this. Try to take at least one action item out of it. I would say action items from a supplement standpoint. We’ll put our recommended supplements down below. We have different hydrochloric acid and enzyme support products that we’ll put down below for links. That’s always low hanging fruit. Again, diet wise, you know, a good autoimmune, lower fodmap diet can really be a good starting point and I would say for liver gallbladder, you know, we have our different formulas. I have one called liver supreme and again some of the hallmark nutrients in these products are gonna be bile, phosphatidylcholine, taurine, some products will have things like Tudca, which can be very helpful for biliary flow. Beetroot can be really helpful. if I didn’t mention Ox Biles. These are all maybe some milk thistle, very supportive for liver, gallbladder function, liver-gallbladder flow. So, very beneficial, we’ll put the links down below so if you guys enjoy the information and you wanna take action feel free to take a look at some of those links and support the show by grabbing some of those products and Evan will have his links down below as well. Anything else, Evan, you wanna add?
Evan Brand: I think, I said, we give people the links. Make sure you subscribe to the podcast if you’re listening on apple that’s probably where most people find us if you’re looking up. Justin’s show, make sure you subscribe there or my show, Evan Brand. We don’t care how you’re listening, you know, obviously we cross pollinate. We put these on each other so make sure you’re subscribed to both of them so you don’t miss it and we appreciate it. give us a review too. I think we should probably do a giveaway. I know some people giveaways so we can give away a book or you know free supplement or something but, in the meantime, give us a five star review on apple, we would love it. That’s how we stay up in the rankings so that we can actually share true functional medicine education to the masses because right now there’s still a lot of people that are in the top charts just theory. They’re not clinicians. They’re not in the trenches every day, all day, I mean we look at an exhaustive amount of lab testing that helps us to really dial the stuff we’re saying in. We then sprinkle in some studies and we stay up on the research but you could keep your head in the research all day and totally miss what actually works and it’s all about what actually gets people the results. So, keep that in mind and make sure you subscribe. Give us a review on Apple, we’ll love you forever. Thank you.
Dr. Justin Marchegiani: 110% All the links will be below for you guys. Alright, thanks a lot. Evan, great chat with you man. Have a good one. Bye everyone.
Evan Brand: You too, take it easy. Bye-bye.
The Nuts and Bolts of Your Mitochondria – How to Enhance Mitochondrial Function | Podcast #349
Have you ever thought about what powers are inside your body? In this video, Dr. J and Evan talk about mitochondria and how to boost them.
When we talk about your body’s powers, the easy answer is nutrients, of course! Our body transforms those nutrients into energy, and it’s that energy that boosts the cells in our body. All types of cells have small generators called mitochondria that, in many ways, are their sources for life. Mitochondria are the only part of the cell where our basic life requirements — food and air — are combined to make energy in a process known as the Krebs cycle.
Dr. Justin Marchegiani
In this episode, we cover:
1:30: The role of creatine in mitochondria
6:34: Energy pathways
14:47: Cell Danger Response
16:07: Citric Acid Cycle
Dr. Justin Marchegiani: Mitochondrial function, your mitochondria, little the powerhouses in your cell and they help generate ATP which is the cellular currency of energy so to speak. And we’re going to talk about natural ways to improve mitochondrial function, Evan, and how we doing today, man.
Evan Brand: Doing really well. I think first, let’s dive into some of the big assaults that we have as a modern society on mitochondria. And that could be anything from viruses, bacteria, parasites, gut infections, pesticides, herbicides, heavy metals, plastics, phthalate’s, the BPA, the BPS, flame retardants, nonstick chemicals, car exhaust, air pollution. That I miss any I mean.
Dr. Justin Marchegiani: Like you hit a lot of I would say being sedentary. There’s a lot of mitochondria in your muscles. And if you don’t do enough, you’ll put enough force to those muscles, they will atrophy. And so just not doing enough about creating enough stimulus on your body. That could definitely we can and decrease your mitochondria in your muscles. So, I would say, sedentary and in active resistance through your muscles.
Evan Brand: OK, OK that’s a good point. That’s a good point. So, you’re saying that, like, just in general, you have to have some level of physical stimulation physical activity to keep the mitochondria working. I guess it’s kind of like an old car that you’ve sat there…
Dr. Justin Marchegiani: All your muscles at least. Yeah, ’cause if you decrease, you know your muscle levels via just atrophy due to lack of use. Yeah, your muscles will shrink absolutely and that’s your mitochondria will shrink for.
Evan Brand: Sure, what about creatine? Do you know anything about the role of creatine in mitochondria? ’cause I know when I’m taking creatine, I just I feel stronger? Obviously, there’s creatine’s used a lot in like bodybuilding world, but there’s gotta be a mitochondrial mechanism there because I’ll tell you I feel like. I can lift, you know, at least a good 1020 pounds heavier on particular exercises with creatine in my system.
Dr. Justin Marchegiani: Yeah, me crazy definitely has an effect on growth hormone and improving growth hormone stuff that will help with muscle. Creatine is like instant energy for the muscle. So, it’s it’s there. It’s ready to be used right away in that first 10 seconds or five, five to 10 seconds of muscle use or like explosion movement through that muscle. So, that definitely plays a role in muscle. I’m not sure how it plugs in 100%. I see ’cause really you know with ATP right in the mitochondrial function? If you look inside the mitochondria you have glycolysis and then you have the electron transport chain. Or I’m sorry, you have the Krebs cycle citric acid cycle and that plugs into the electron transport chain. So, glycolysis that’s going to be utilizing the carbohydrate in the muscle right glycogen in the muscle. Fast immediate source. I think creating plugs into that top part. And then you have the Krebs cycle citric acid cycle, where B vitamins, magnesium. All these different things kind of plug into that and with that. With the citric acid or Kreb cycle, that didn’t mean the same thing. Essentially, they’re grabbing hydrogens, right? So, there it’s it’s a reducing agent, so it’s just grabbing reproduce. Reduction is a gain in electrons and so you have NAD goes around. Then it grabs NADH so you get 3 NADH and I think 1FADH2 so you have FADH. And it grabs another hydrogen and that becomes FADH2, and so it’s grabbing all these hydrogens. And then it’s essentially bringing those hydrogens downstream into the electron transport. Jane and Beta fatty acid oxidation there and so yeah, I think you generate was at 36 to 39 ATP through the Krebs cycle and the electron transport chain.
Evan Brand: Unless you’re in like chronic fatigue stayed, this cell danger response, and I think you’re spitting out something low like 2 maybe 3 ATP. I’ve read about this cell danger response. They just call it HDR in the literature, but it talks about how. The cell danger response, could be initiated by trauma or a car wreck or even mold exposure or tick-borne illnesses, or viruses. There’s a lot of you know, Epstein Barr. You’ll see the link between like mono and chronic fatigue. It said that these people are in this state of just a low power output, or even if you have the nutrients, you’re just not generating the ATP with some I don’t know if it was Caitlyn or somebody that you and I had looked into where there was a talk on this about. How the w the the ATP was literally in the single digits. The low single-digit output in some of these states. So, the message here is that for people that have chronic fatigue, you got to realize there is a mitochondrial component to this. Why don’t we talk about testing a little bit? The main thing that you and I are going to look at is going to be the organic acids. I know there are some other tests out there. I’ll admit I’ve had clients send them to me such as the mito swab. I’ve not run the model swab. Personally, I don’t know enough about it to speak on it much, but I’ll just say that it does exist. I believe it is a a mouth swab and it’s probably looking at just a couple generic markers in the saliva. But we like to use the organic acids test because, as you mentioned, there’s the Krebs cycle metabolites on there. We can look into the supinate or what some people call succinic acid. You’ve got the malic acid. You’ve got fumarate. There are other markers on there, and we we see when people have talks and exposure. Like I said in the beginning, the heavy metals, the mold, the pesticides will see those. Mitochondrial markers go up. And the higher the numbers go, generally, the more tired someone is because that indicates more damage to that Krebs cycle. So, the oh is huge, and then obviously we’ll look at stool too. Now the stool test you don’t measure like the stool tests we’re running. You’re not measuring mitochondrial function, but I look at it in a roundabout way. Meaning if you have all these gut infections producing toxins that could be damaging mitochondria as well, so we know that when we clear the gut out, we see the mitochondrial function improve.
Dr. Justin Marchegiani: 100%. Yep 110%. I want to just put something on screens. People can see it here I guess is really helpful.
Evan Brand: Have you seen or heard about that my to swab before? Have you seen anybody send you those?
Dr. Justin Marchegiani: I have, I’ve ran up. Fulham, it’s kind of a binary test. It gives you a result my the issue I have it’s not a lot of actionable information. It’s like OK, you know there’s some issues there, but then now what’s, what’s the remedy that you’re going to plug in from a diet lifestyle supplement? Toxin reduction execution right? What’s the next step on it? So that’s the problem with some. Of those tests, I always. Look and I always ask well what’s the corrective action based on the test showing uses a concern.
Evan Brand: Yeah, yeah
Dr. Justin Marchegiani: That makes sense.
Evan Brand: That’s the problem with a lot of them like I’ve seen a lot of these stool testing companies. Same thing there’s like so much data. Well, this percent of this bacteria and this percent of that. It’s like, what do I do with that? Is that an infection? Is that not an infection? So you and I’ve seen the same problem in other categories of health tests do.
Dr. Justin Marchegiani: 100%. I want to show a couple things on screen here? Just so it’s crystal. Where the mitochondria is and how all these different energy pathways plug in, I think it’s important I’m going to pull it up here on screen in just a second so people can see it.
Evan Brand: Yeah, people listening on audio, they’re going to be lost. So just look up Doctor Justin YouTube page and you’ll be able to view some of this stuff. Some stuff, like mitochondria, gets a bit geeky. The the main thing here is toxins are a big factor in damaging this cycle and you gotta get toxins out. Reduce exposure where you can and we can run actually chemical test on your current too so we could talk about that in a minute.
Dr. Justin Marchegiani: Absolutely, and so if you look here right. Do you have the mitochondria right here. Some middle part, the mitochondri. The outer part is the cytosol. So, from what I understand, like creatine is going to plug more into the cytosol and glycolysis, OK, but then you’re going to see you get about two ATP which is adenosine triphosphate. And this gets broken down into ADP and you get energy right? And so, you have glycolysis which generates a little bit of ATP 2. And creatine to plug more on the outside then that goes into your mitochondria. Now you have the Krebs cycle and the electron transport chain electron transport chains part of also the beta fatty acid oxidation. That’s how you burn fat for fuel. OK, so Krebs cycle that churns around twice, and essentially what you’re doing is you’re gathering NAD and FADH2. NAD&FADH are grabbing hydrogen so and a design to grab a hydrogen making NAD. HFADH is going to grab a hydrogen, making FADH2, so I think you’re going to grab it’s like two or three. NADH is, and then one FADH2. And all those hydrogens then go into the electron transport chain here and this is where you generate most of your ATP. And again, what comes out, oxygen comes and this is why, if you’re like anemic right? And you’re not carrying oxygen. Well, that’s why you’re going to get tired and this is going to have an effect on your thyroid and your adrenals because the mitochondria is important for energy at all levels. And so if we have anemic issues or were inflamed because inflammation is going to make it harder to carry oxygen all. And also nutrition, because this electron transport chain, when we run the organic acid test, we can look at citrate, malate, fumarate, succinate. These are important metabolic essentially inputs into the Krebs cycle that correlate with certain nutrients like amino acids, alpha-lipoic acid, magnesium B vitamins, and so we can get a window on how this. Krebs Cycle was functioning based on the organic acid testing at some of those compounds and then all sister connotate citrate, right? These are really important, and then electron transport chain we can get a window into things like carnitine and Co Q10 ’cause they also play a major role in the electron transport chain. So we get a good window with how the mitochondrial function functioning by looking at the B vitamins and looking at a lot of these nutrients and so essentially things that can impair this. As you mentioned, pesticides. Heavy metals, mold toxins, antibiotics, and all these things have a negative impact. But that’s kind of how things look, so we have. Glycolysis is the first part that then goes into the mitochondria, and then we have Krebs cycle and electron transport chains. These are the big three. If you can kind of zoom out and see how it looks and how it makes sense. That should hopefully make more sense, so on that front. Any question that, Evan?
Evan Brand: Well people listening to that. They’re going to be like wow, this sounds like a really crazy rare problem, right? This must be just rare. This must be like a one in million case and I would say. Not going to say 99. I would say 90% of the people we work with. I see some level of mitochondrial dysfunction or damage either on the chemical profile test, so that’s something I alluded to earlier. We can run chemicals so we can look at gasoline. We can look at xylene. We can look at phthalates, all sorts of organophosphates. 24D is a major herbicide. I still see people at Lowe’s and Home Depot in the Garden Isle buying grass seed. That’s called weed and feed, weed and feed is a grass seed mixed with three different types of herbicides. It’s 24D, I believe it’s dicamba and glyphosate. Wait, I could have mixed one of those up, but either way, it’s three different chemicals, very toxic substances mixed with grass seed, and that’s like people just buy it and they don’t think anything of the term weed and feed. That means you’re going to be killing all the good stuff in your soil and poisoning yourself at the same time. It’s just not smart. So this mitochondrial thing. My point was, this is not rare, like when you show that image and people see that like. Oh no, that’s not happening to me. It’s like it happens every day, all day. I had mitochondrial damage, my latest test shows our mitochondria are much, much better, but I had significant mitochondrial damage from my mold exposure.
Dr. Justin Marchegiani: Very interesting, I want to highlight one thing here so you can see creatine does primarily exist here in the cytosol, right? So if we zoom out, right cytosol is outside of the mitochondria, right? Right glucose, pyruvate here, so just so you guys can highlight here, creatine does go from the cytosol and it can go into the mitochondria. So, we did talk about creatine. It does primarily happen more in the cytosol outside the mitochondria, and it can go in via this. Mi-CRT kind of transport. Compound, so yeah, so creatine is a compound that we talked about that goes outside but can also go inside the mitochondria. To yeah Doctor Neil Nathan.
Evan Brand: That’s awesome! Doctor Neil Nathan did a huge thing for 155-page slide show that people can look up just called the Cell Danger Response. It’s very complex stuff. There’s going to be maybe a few geeky on that. People want to dive into that, but for your average person there’s not much takeaways built into that. But if you want to look into more of like the biochemistry side of it, then then you could look at it. But I think the big summary is it’s all. It’s all the Chemicals, and this is a relatively new problem I mean we face now over 80,000 chemicals are in the environment. Depending on what number you read, there’s only a small amount of those that are even tested. You’ll see stuff in Europe like oh Europe has banned these chemicals and makeup and personal care products, but the US was very far behind. And if you look at the environmental working group, they have a water testing report. You can look at and you can plug in your zip code. I mean just the amount of trihalomethanes’s pesticide herbicide residue pharmaceutical drugs that are in the municipal tap supply in your city are massive and you’re getting hit with this all the time. If you go to a restaurant and you eat rice, what do you think they make that rice with? They make it with tap water so you’re getting exposed to it that way too, which is why if I go out to eat, I don’t really do rice that often anyway. But if I do it, It’s going to be at home with good, clean filtered water.
Dr. Justin Marchegiani: I like it. Anything else you want to say on that, so obviously get the toxin exposure. Super important hydration obviously really important to anything else you want to say on that?
Evan Brand: Yeah, you hit you hit the the Co Q10. You mentioned some of the markers we’re going to look at on the oak test, so we will use those. We have a formula. I believe you’ve got 1/2 mines called my to boost. It’s essentially like a multi for the mitochondria with all the Co Q10, ribose, carnitine B vitamins. So, when we see mitochondrial dysfunction, we can supplement that and we tell people this is a band-aid for your mitochondria. This is not some of it is the root cause, right? If you just are simply low and depleted in Co Q10, one could argue supplementing Co Q 10 is the root cause, but in reality it was usually. Oh here we go. Let me see if I can share this slide with you. Mainly it was the the toxins that led to this so let. Me share my screen really quick.
Dr. Justin Marchegiani: And there is going to be because we do make Co Q10 on our own via the mevalonic acid pathway. And of course, as you get older, just like stomach acid, you’re gonna make less of it and so there there could just be a depletion based on age as well.
Evan Brand: Does that show up at all on your side? The video is that screen share show.
Dr. Justin Marchegiani: Try again.
There’s like a little bell there. Let me let me pop it up again. How about that, yes? Oh yeah, let me let.
Dr. Justin Marchegiani: Me highlight it, go ahead.
Evan Brand: Yeah, there we go. So, this is this is kind of what I was alluding to, and many many other people may have different ways to look at this, but this is from Neil Nathan. He had a great paper on this cell danger response and it just shows at the top here. Basically, everything I already mentioned like a flame. Heavy metals, pesticides, infection, so that would include viral issues as well. Mass cells, NK killer cells, cytokines, the microbiome. All these issues here are what really breaks this role. You know, the one of these is the final straw that breaks the camel’s back and then you end up in this what’s called the cell danger response phase. And then that’s where you get the issues with the mitochondria down regular. So there’s more in that. Like I said, it’s 155 pages. It’s like you got to be, you got to be, you know, have your bulletproof coffee before you look through that.
Dr. Justin Marchegiani: No, that makes a lot of sense, so your kind of really focusing on the toxicity and how that negatively impacts it. I want to just kind of tie in the dietary component. Why is food so important to enhancing the mitochondria? Let me let me break that down for a second here. This is important. OK, so this is really important. We talked about like Kreb cycle right? And so like this is our zoom out right? What’s happening here? We have glycolysis, Krebs cycle, electron transport chain outside of the mitochondria with the cytosol inside. Now check this out. This is a good one. This is from textbook of functional medicine, so. We have fats, carbs and proteins. These are our primary nutrients where everything comes from right. Fast could be coconut oil, grass fed butter could be fats from. Uhm, grass fed meat right? Our carbs can be vegetables, fruit, starch and our proteins could be protein powder or it could be animal protein, right? All of these essentially shuttled downstream. Fats get carried into the mitochondria via carnitine, so if you go into any biochemistry textbook, it’s called the carnitine. Shuttle right. Every medical doctor, doctorate level person would studied this at a graduate level. I studied as well now in the textbook of I think that guidance Physiology, but there’s another textbook of biochemistry that’s common at the graduate level. You know what the rate limiting amino acids to make carnitine are. It’s methionine and lysine and so really important.
Dr. Justin Marchegiani: Guess what some of the rate limiting amino acids are in a vegetarian diet.
Evan Brand: Oh yeah, well.
Dr. Justin Marchegiani: Medallion Leisinger actually very deficient in vegetarian diets, and so this whole process of a carnitine shuttle here that helps bring carnitine converts it into acetyl Co A. So then the actual it can get inside the mitochondria. And run through the citric acid cycle again. That’s the same thing as Krebs Cycle. They have multiple names. In medicine for the same thing, it’s just meant to confuse people. So citric acid cycle or the Krebs cycle. This is how we get fat inside the mitochondria is via carnitine. So very important, right so if we zoom out. Here, we have energy out here, fat. We get it inside via the carnitine shuttle. Super important there and then you see carbs. Right glucose, other sugars. We go pyruvate to lactate and we need guess what B vitamin? So if we’re putting in lots and lots of refined processed sugar and we’re insulin resistant, we can actually deplete B vitamins. And we can actually deplete a lot of magnesium and other nutrients downstream. So, this is really important. Too much carbs, too much sugar, especially if you’re insulin resistance and you’re putting on weight due to too much carbs. That’s going to be a problem, and you’re going to deplete nutrients now. Then we have proteins, amino acids. These all get converted downstream. We also need B itamin to support that now the difference is if you’re eating high quality protein. Guess what? You’re getting good quality B vitamins in that. Protein if you’re doing a lot of refined processed sugar, guess what? You’re not getting vitamins and nutrients with it. So carbohydrates, it’s possible to eat a lot of empty carbs that are actually going to deplete your nutrient levels. Protein not as much if it’s grass fed and organic right now, really, you’re taking all these nutrients, fats, carbs and proteins. You’re converting them into acetyl Co A. OK, you’re converting it to acetyl Co A and again we spit off beta-hydroxybutyrate what’s that? That’s a ketone now this is important. If we keep our carbs in check we can use ketones for fuel, so this is a really important fuel source or people that are going to be lower carb because we’re going to be more keto adapted. We’re going to be able to use that and then you can see here that acetyl Co A. Runs around the Krebs cycle. Twice we go 2 turns. Guess what, we need cysteine amino acid iron really important. So if you’re a female you have heavy bleeding your estrogen dominant you heavy bleeding that’s in effect energy magnesium manganese B vitamins lipoic acid magnesium B vitamins B vitamins tyrosine phenylalanine aspartate, glycine, histidine, arginine, proline. Glycine, valine methionine, right? These are all amino acids over here. So, we need amino acids to run these systems. We need B vitamins. We need magnesium and then of course, once we pump these things around, here’s our NADH and then our FADH should be there somewhere as well. So here NADH, it may not. They may just be oversimplifying it not showing it. But we have NADH here. We should have an FADH2 coming in. This all goes right into. Guess what? This is the electron transport chain and base. Yeah, fatty acid oxidation right there, right? This is now now hydroxymethyl Glutarate. This is Co Q10. This is where Co Q10 comes in and this is where it runs through the electron transport chain and burning fat for fuel and we generate our 36 to 38 ATP from all these three sources 1-2 and three and so that’s what’s happening in your mitochondria. So just to kind of highlight macro nutrients, fats, protein, carbs, very important two, don’t junk it up with all the toxins that you mentioned. And then of course, making sure we. Can breakdown protein. Make sure we’re getting enough iron making. Sure, we’re not. Anemic right? All of those things kind of flow into allowing all these pathways to to work optimally.
Evan Brand: That’s amazing, I love the breakdown to that. The visual super helpful. So just to clarify a little bit. So for women out there, you’re saying that if having heavy ministration, they have low iron. It’s not just the the low iron that we assume is creating like a low oxygenation, you’re you’re showing here. The low iron is literally creating a mitochondrial deficit.
Dr. Justin Marchegiani: Correct. You’re not getting the oxygen in right? If we go back to here, right? Mitochondria, what do we need to get into the mitochondria? Oxygen, what’s one of the big carrying capacities for oxygen in the body? Hemoglobin and then iron affects hemoglobin in red blood cells, right? Hemoglobin is part of the red blood cell carrying capacity and we need the iron to really keep the hemoglobin levels up so we can carry enough oxygen.
Evan Brand: Wow, so there’s why you’re tired.
Dr. Justin Marchegiani: Could be. Yet, one and then of course all of the other nutrients play a role. Not enough of the amino acids. The only issue with this graph, any biochemists that are looking on? I think the only thing that’s missing is really the FADH2, so it should. So, all these things, they’re just reducing compounds. Really, the whole goal of this Kreb cycle to run is just grabbing hydrogens. And then once we grab these hydrogens, Uhm, these things get cleaved off, and then it generates ATP. What’s happening there? And all these things like hydroxymethyl iterate. These are right. These are all driven through Co, Q10, right? We need Co Q10 to make that happen.
Evan Brand: Now for people like supplementing ketones, if you go back up to the top there, you can basically kind of inject your own spark plug into the cycle, I guess right? If you’re taking exogenous ketones, what is that doing in relationship to this whole cycle?
Dr. Justin Marchegiani: It’s giving you more beta hydroxybutyrate. The problem is your body is going to primarily want to use that when insulin levels are lower, so you have to keep your insulin levels and check. If not, you’re not setting your Physiology up to want to burn that. If you’re probably, gonna pee it out more like more than likely versus burn it. Cause typically, your body has an enzyme called hormone sensitive light pace where it wants to break down fat and convert more of these ketones. Hormone-sensitive light base is inverse with insulin. So hire your hormone-sensitive light pace is you need lower insulin to make that happen.
Evan Brand: So the lady who eats the donut and then goes to the store and buys her exogenous ketones, she’s wasting her.
Dr. Justin Marchegiani: Probably not as good. There may be some mild benefits that you get cognitively just ’cause your brain has some additional fuel to run on. If people brains are insulin resistant, they may have a lot of sugar from that doughnut, but the cells in their brain maybe so numb. To it that they may not be able to access it so some ketones could be helpful, but in the end, you want to fix the insulin resistance if you’re going to do it. Try doing both. Don’t just do the ketones. Try to do both that you can.
Evan Brand: And you can make your own ketones too. For free.
Dr. Justin Marchegiani: Yeah, yeah, that’s how you’re doing that you keep in your insulin in check. And you’re going to start. Making your own. 100%.
Evan Brand: Yeah, cool.
Dr. Justin Marchegiani: Cool, that was awesome. Very cool guys. I hope you guys enjoyed today’s podcast. We’re trying to be a little bit more visual; you know. Go into some hard hard science Y stuff, but you know just kind of zoom out. Like what’s the take home right? The take home is don’t put junkie toxins and that screw up your mitochondria right? Antibiotics, I mean antibiotics? You know if if you have an acute infection that’s not resolving, you know you gotta do what you gotta do, right? You have an acute pneumonia. You gotta do what you gotta do. Talk to your doctor about it. Just don’t go to antibiotics all the time as your first line defense. Try to do some. More natural things to fix it #2 you know, try to be aware of mold in your environment. Make sure you’re not. Getting exposed to pesticides. Chemicals heavy metals. Make sure you’re doing your best to hydrate right. We need water to make this whole thing work too. I would say after that make sure you have your macronutrient style, then good quality protein fats and carbohydrates. Organic sources dial in your carbs so you’re not insulin resistant and make sure your inflammation is good. Inflammation helps with oxygenation and blood flow. Then after that we can look at using supplemental nutrients in my line and Evans line we have mito supports products mine is mito synergy. Evans is my toe. Boots will put links down below. Those products have a lot of these nutrients. It’s going to have the ribose to creatine the carnitine, the B vitamin. Since it’s going to have the Co Q10, it’s going to have actually Kreb cycle intermediary compounds like fumarate malate, succinate. All those different nutrients or run those pathways better. Of course, that all sits on top of a solid diet. Don’t take supplements if you’re going to eat crap, eat really great and then say OK now I’m going to work on enhancing it. And again, we can run testing on organic. Message to look at some of these intermediary nutrients, like citrate to connotate succinate bloomer, a mallet we can actually test them, which is pretty cool.
Evan Brand: Yeah, the testing is the best part because you you know if you actually need it. I can tell you the average person has mitochondrial problem, so in general, could you just take this? I kind of call it a multi for the mitochondria. Could you just take that test? You know like a guess and check you could, but we like to see the data and obviously my biggest thing is looking for mold colonization. Candida overgrowth clostridia. Some of these gut infections and how that affects your brain chemistry too. So when you do the oh, you really are getting the best bang for your buck in terms of testing. Like if you could only do one test out there, I think the oh it would. Probably be the number one most.
Dr. Justin Marchegiani: Important 110%. Anything else you want to say?
Evan Brand: If people need help, they can reach out to you worldwide or me worldwide. Doctor J at justinhealthcom me Evan at evanbrand.com and we would love to chat with you about your symptoms, your goals and we’ll tell you for your good fit for care, so please feel free to reach out. Look forward to helping you.
Dr. Justin Marchegiani: Foot and get adjusted. Help calm here and then you guys have any questions, comments or concerns. Put him down below. Let us know. Kind of what you’re doing. What’s working that really helps us out as well. Very cool. Alright guys, well you guys have a phenomenal day here and we’ll. Be in touch. Take care of y’all.
Evan Brand: Sounds good.
Dr. Justin Marchegiani: Alright Bye bye.
Genova NutrEval FMV
Vitamin D Benefits You Should Know
Vitamin D has a couple of different benefits. Let’s go over some of the benefits. We’ve talked about the natural antibiotic that’s being produced by vitamin D, which is called cathelicidin, a kind of antibacterial enzyme. It is super helpful at being able to knock down bacteria. It also has antiviral mechanisms, as well as antimicrobial peptides and antiviral mechanisms.
Part of that is it stimulates and it can modulate the Th1 immune response in the Th1 immune system where you’re making a lot of your natural killer cells and your helper cells. Good helper cells can also help your antigen-presenting cell and it can help make antibodies more efficiently. So, you’re also going to have a better Th2 immune response. You’re going to make antibodies to whatever that infection is. Those tend to come a little bit later in the game, but good signaling to make your antibodies is super helpful as well.
There is a couple of other studies here that are talking about different things. We have a reduction in our MMP-9 concentrations. We have a reduction in bradykinin storms and reduction in our cytokine storm. So, basically we have a lot of inflammatory molecules that get produced such as bradykinin, cytokines, interleukins MMP-9. These are inflammatory types of chemical messengers. Vitamin D can help modulate that and prevent that from being overproduced. The more we overproduce those, the more our immune system responds. So, we can create more cytokine storm issues because our immune system will be on this positive feedback loop, responding and creating more issues with the cytokines. When there are less cytokines, there’s less chance of a cytokine storm, which is basically our immune system responding.
Imagine a fight between two people where one person yells out first and the other person yells back. Then they’re pushing, shoving, and hitting and the violence escalates. That’s what happens with the cytokine storm with your immune system and all the different cytokines and immune chemical signal. So, we can keep that modulated a bit which is very helpful. Vitamin D plays a really important role in that.
Get vitamin D supplementation from Thanksgiving to spring. At least, make that investment. If you want to come off the rest of the year, as long as you’re getting some sunlight, it’s fine. At least do that vitamin D supplementation to give you a good bump and the fat-soluble nutrients you’ll get over those four or five months will hang around months afterward because it takes a while for that vitamin D level to build up.
Effective Ways to Increase Your Vitamin D Levels
Back in the 1980s, a guy named Edgar Hope-Simpson proposed that a seasonal stimulus was intimately associated with seasonal epidemic influenza. Long story short, winter comes and then all of the sudden viruses become more of a prevalent issue. There was this whole interventional study that showed vitamin D is reducing the incidence of respiratory infections in children. So, this was specifically talking about kids but there are countless of these for adults.
What’s happening when the vitamin D levels are sufficient are a multitude of things but in particular, it’s helping to reduce Interleukin 6 (IL-6), which is one of those inflammatory cytokines that get people in trouble. So, if you can reduce your cytokines, that’s going to be beneficial. Also, another cool benefit is not only a sort of an antiviral but there’s some antimicrobial benefit. It can actually activate your immune cells to produce some antimicrobial like a natural antibiotic if you will by upping vitamin D concentration.
How do you take Vitamin D?
Is it just an ongoing thing? If you think you’re getting into trouble with illness, do you go high dose of it? It depends on what your levels are.
So, get a baseline first. I would say the lighter or more fair your skin is, probably the more efficient you are gonna be in converting vitamin D from the sun. The darker your skin is, the more melanin you have. You’ve got different spectrums and for example, a full-on African-American has the highest amount of melanin.
What is Melanin?
Melanin is like your natural UV block and it helps block your skin from the sun’s rays. So, due to evolution and where we evolved, there are people who live closer to the equator and there’s more UV light based on the angle of the sun hitting it. These people naturally evolve with more melanin in the skin. People that evolve further away from the equator get less direct UV light, so there’s less melanin in the skin because it’s all about making vitamin D.
So, the more efficient you are at making vitamin D, you probably will be able to get away with not supplementing as much or as frequently. The more melanin in your skin, the more you have to be on top of your vitamin D because unless you’re going to be outside 6 to 8 hours a day and you’re at a mid to low 30 latitude, you’re probably just not going to be able to ever make enough vitamin D. Therefore, you really have to be on top of everything in your testing.
Vitamin D Dosage, Testing, and Recommendation
For lighter skin, in general, a good rule of thumb is 1000 IUs per 25 pounds of body weight, especially in the fall and winter months. If you want to take a break in the summer, that’s fine. Just make sure you get a test here there to confirm it. The darker your skin is, you may even want to double that in the winter months. Then you may want to follow-up and retest in the early spring to see and to monitor where you’re at. If you’re someone who works outside, you have to make that adjustment. If you’re an office person and you’re inside all day, you also have to make that adjustment, too. So, in general, 1000 IUs per 25 pounds of body weight.
If you have darker skin, you may want to double that for the winter months, and then it’s always good to confirm some time in the winter and some time coming off the winter or early spring-summer to see where you’re at. We can always adjust accordingly and if there is any risk of autoimmunity or cancer, we probably want to be testing just a little bit more frequently. Once you know where you’re at, you can guess based on how well you’re doing.
How To Enhance and Support Fertility with Functional Medicine | Podcast #332
There are two main methods for getting pregnant and if you’ve struggled with conceiving then you’ve likely looked into and/or pursued traditional medicine. This doesn’t necessarily make you healthier, but your doctors will try to change your hormones to encourage pregnancy. On the functional side, Dr. J would focus on enhancing health, enhancing physiology, regulating hormones, etc. Even then, sometimes measures like IVF are still necessary for the end. But before we get to that, we want to look at all the natural ways we can encourage your body to prepare for baby-making in both men and women.
Dr. Justin Marchegiani
In this episode, we cover:
0:24 Two Approaches in Fertility
7:29 Root Causes
17:20 Right Diet
30:40 Prenatal Supplements
Dr. Justin Marchegiani: And we are live. It’s Dr. J here in the house. Evan, how are we doing today man?
Evan Brand: I’m doing better. I had COVID Believe it or not. And that was like a five day journey. I think I’m over the hump. So if I sound a little weird, that’s why, but family’s healthy. And I’m a survivor. Now I’m going to be in the, quote, recovered category.
Dr. Justin Marchegiani: Love it. That’s good. Excellent. Well, today we chatted kind of pregame that we wanted to talk about fertility, talk about natural ways to enhance fertility. We see lots of patients that as a side effect of getting healthier through natural medicine, functional medicine, good nutrition, diet and lifestyle. They get pregnant, even if fertility wasn’t a goal, and we have some patients that come in with a goal of fertility and the nice thing is, fertility is a byproduct of getting healthy. So I mean, there’s kind of two approaches to it. There’s the conventional medicine side where they’re not really making you healthier, they may just be changing some of the hormones in your body. So you can get pregnant, right? IE via IVF therapy, those kind of things, right. And then there’s kind of natural ways that we are utilizing the enhancing of healthy and enhancing physiology to get pregnant. And sometimes IVF may be necessary. If you’ve done everything you can do on the health side, and you’re still not getting pregnant, that may be an option, right? But we want to do everything we can do on the natural medicine side, because if you do that, you know, 80 to 90% of people I think are going to get the results they want, which is getting pregnant. So I’m excited to dive into this topic with you today.
Evan Brand: Yeah, I would say that it’s pretty rare to need IVF based on some of the people that you and I’ve seen clinically, I’ve had several men and women and it’s good as a couple right. So that’s the important thing to mention. It’s important for the couple to get healthy the a lot of the blame is placed on the woman but in many cases, you know, male sperm motility or sperm concentration is a big issue. So the men kind of, you know, I don’t know why, but in general, the men get ignored in this conversation, but it’s really important for them to get optimized as well. And we’ve had couples where they looked at the cost of IVF, you know, typically 10, upwards of $15,000, depending on where 20,000 Really? Yeah, okay, so 15 to 20. And people come to us first and say, Well, you know, we didn’t want to go to IVF yet, because of the cost cost was kind of their main motivator, and maybe they, you know, hopefully had some sort of a natural minded bias. And so they said, well, let’s see what we can do first. And then 100 out of 100 times, so far, we’ve been able to avoid IVF for those people. And we’ve had, you know, between you and I alone, we’ve had four healthy children on our own. And then, you know, countless women that have had healthy pregnancies with our support
Dr. Justin Marchegiani: 100% it’s all about getting to the root cause, right? And yeah, there is that whole idea of the pottenger cats experiment where pottenger was in a medical doctor, I think, in the 50s, and he had different cats and he would feed some raw food, some processed food and and then there was, I think, within three generations of eating processed food. The cat group that ate the processed food lost the ability to reproduce. So there is this idea that we’re on like the third generation or so of this pottenger cat experiment. And there is some people that are just at that and end level where they may have reduced fertility just because they’re living out the pottenger cat experiment in real life. It’s possible some of that is the case. So we want to do our best to really emphasize a whole food nutrient dense anti inflammatory diet. We know that pregnancy involves healthy hormones. And as a starting off point, we don’t want to eat foods or toxins or hormones in our animal products that could throw off our fertility. So the first step in any fertility program, nutrient dense anti inflammatory, low toxin, that’s going to mean an organic whole food diet. that’s going to mean cutting out hormones and antibiotics and pesticides, and GMOs. A lot of these pesticides are xeno estrogens, they mimic hormones as well because they affect the insects from reproducing. That’s how they kill them. Right. And so it can also have an effect a cumulative effect on women and men on the sperm count women on the fertility side. So diet is going to be one of the first things and the second thing is going to be blood sugar stability. I think this low fat low cholesterol era, skipping meals fad dieting has prompted lots of insulin resistance, lots of reactive hypoglycemia, meaning too much sugar, too much carbs, blood sugar goes up and then spikes down, which then creates this insulin surge and high levels of insulin is really what’s behind the leading cause of infertility in women which is pcls. That’s polycystic ovarian syndrome. And that the mechanism there is high levels of insulin, insulin resistance insulin surges, thus increase androgens, and then the androgens also can throw off prolactin and then that can dis regulate a woman’s cycle. So you can see There’s a lot of different hormonal rhythms that can that can go off together and create many issues. So the major mechanism is in the beetus, insulin resistance, followed by increased level of androgens, free testosterone, testosterone, and then also prolactin issues to boost. Those are kind of the big initial sequelae that we see. And of course, usually if they’re eating a lot of crap or hydrating junky foods, people that are missing that level of awareness, tend to also be consuming the pesticides, maybe going to low fat, low cholesterol, maybe not getting high quality animal products and getting all the hormones in there too. So that’s like kind of my first two things out of the gates.
Evan Brand: Yep, well said and just want to quickly go over the conventional treatments for infertility, especially resulting from pcls. That’s what we did on our gut health podcast, kind of the conventional versus functional gut health. People loved it. I got a lot of good feedback on that. So thanks for the feedback. But it’s not pretty you mentioned it’s not root cause and it’s not so you’ve got this clomiphene which is the American College of obstetrician gynecologist recommendation that’s their primary medical medication for pcls patients with infertility, it indirectly causes eggs to mature and be released. Then you’ve got Metformin, which we just talked about the insulin resistance problems. So Metformin would come in and help. They talk about it helping just in terms of population, but that would probably be just due to helping to lower insulin. That’s what it is.
Dr. Justin Marchegiani: Yeah, Metformin, it liquefies. That’s a big one.
Evan Brand: And then you’ve got the letrozole. This is a drug that slows estrogen production causes the body to make more follicle stimulating hormone FSH, which is what you need for ovulation. And what else here they’ve got just other hormones in shot form, which are going to cause ovulation and then the craziest one, let me just read this one here and then we’ll we’ll move on into the functional you’ve got ovarian drilling. And so the surgeon makes a small cut in your abdomen inserts a long thin tool. And they use a needle with an electric current to puncture and destroy a small part of the ovary. This surgery leads to lower androgen levels, which may improve ovulation. So Wow. And if you do all those and you don’t get pregnant, then you could go to the IVF, which is where the sperm in the egg are put in a dish outside the body fertilization, fertilization happens, and then they put the fertilized egg into the uterus, and then boom, there you go.
Dr. Justin Marchegiani: Exactly. Now, I kind of want to tie back to the root cause I want everyone thinking about fertility from a root cause perspective, because when you think about it from a root cause then you can say, hey, are we getting to the root cause doing this procedure or doing this thing? So first off, like I already mentioned, pcls is a big one. Now with infertility, there’s usually going to be some level of insulin resistance or blood sugar dysglycemia meaning your blood sugar is up and down. And your body has to make a lot of hormones to regulate that flow blood sugar So when your blood sugar goes really high, right, because of excess carbohydrates in balanced meals, not enough protein and fat, you’re going to surge a whole bunch of insulin to bring the blood sugar back down. Now, women that tend to be more on the heavier side, usually that blood sugar eventually start staying higher, because that’s that’s what diabetes is right chronically high levels of blood sugar, but usually before that, there’s some level of reactive hypoglycemia where blood sugar goes up and then crashes down because the body over secretes insulin. And when the cells are still sensitive to insulin, that blood sugar will drop down really, really fast. And then your body has to make a lot of adrenaline and cortisol to bring it back up. Okay. So if we tie in prolactin, prolactin is going to go high when there’s high levels of estrogen. So when we start having more estrogen dominance, Okay, first mechanism, how does estrogen dominance happen? Well, it’s going to happen one through exposure of estrogens and the environment to with gonna happen through metabolism of progesterone. So progesterone is a really important progestational Pro fertility hormone very important. When we get stressed we’ll actually convert progesterone downstream into cortisol. So when we get chronically stressed, we’re going to decrease progesterone. And then number three high levels of estrogen, estrogen dominance, that is going to start driving prolactin issues. And when we start burning up dopamine, right, dopamine is a very important neurotransmitter. Dopamine gets used to make adrenaline so when we start making a lot of adrenaline, a lot of stress neurotransmitter, dopamine gets used, and dope means a tonic inhibitor or prolactin. So imagine you have prolactin and you have dopamine level is like the foot on the brake, right. And as you start depleting your dopamine and you start getting more stress, you’re taking your foot off the brake and what happens to prolactin, it goes up and prolactin starts to go up one of the side effects Next is loss of ovulation. Right You can go, [inaudible]. So you have a couple of mechanisms, right? You have this prolactin mechanism from dopamine, you have estrogen dominance, which can affect prolactin as well. You have this infertility through pcls. And insulin resistance and elevation and androgens, right. And then also all of the food components, all of the hormones and the toxins and the pesticides also contribute to that.
Evan Brand: Yeah, those are, I would say the biggest and most important things affecting your average american. There’s a couple other small subgroups, I want to mention what I’ve seen with infertility, one being people that are overtraining with exercise, you mentioned also the period. So I had a woman who she was, she was in the small percentage, but we have to talk about the small percentage because you know, people who are healthy and want to be healthy, listen to our podcast, and so there’s people that may be overachievers will call them and so we had a lady that was doing CrossFit like four or five times a week 45 minute sessions, and just beating the pavement. Now, typically when someone’s doing that we don’t really need to run a hormone profile. But just because I knew that it would increase her compliance. If I told her to stop exercising, she may not listen to me. So we use the testing to prove on paper what we already knew intuitively, which is that she was causing her cycle to be disrupted due to the chronic stress of the overtraining. So when we ran the hormone profile, and we showed her what her cortisol look like, it was basically flatlined, except for the time of the day when she did the exercise, she had a mild spike, which is why she felt better. You know, she said, Oh, my day is not complete until I exercise that’s because her cortisol was so low, and when she whipped the tired horse, all of a sudden she got this temporary boost of cortisol and adrenaline. She felt normal and that was it. But the prescription for her to get pregnant was simply just go down in the exercise. I just told her do three days a week Max, but do yoga, restorative, do biking, do hiking, do gentle things that are fun for you, and fun. For your family, and that’s all she did. I mean, her diet was already dialed in. We did look at her gut. We didn’t see any infections there. You know, we knew that there was no insulin problem, the carbs were not an issue. And she got pregnant just by simply reducing the training. And then another small group of people are people, women, specifically that were just going to low carb. So I had several women that were on a ketogenic diet. And some would argue well, our ancestors they could have been ketogenic, right, they were out in the prairies eating the bison, and they may not have had access to potatoes and whatever else but I do believe that some carbs are beneficial and necessary for fertility and for healthy pregnancy. So I had some women that were on keto for a long time, all we did is just add in some starch, organic white rice, we did some potatoes every once in a while and boom, they got pregnant and we didn’t change anything else. This is of course after we do the whole functional medicine workup, which you and I will talk about in a minute. That was after we did all that then we tweak the diet and then boom, she got pregnant.
Dr. Justin Marchegiani: Yeah, and I would say because information ability is primarily driven through PC OS and PC OS, the major mechanism behind it is going to be insulin resistance. I think a default template should be a lower carb paleo ketogenic template. But just because that’s our default doesn’t mean we’re not clinicians and adjusting things for the patient. So of course, with this girl, she may have done really well with that. And then she may have tapped out her benefits with it. And she may have already been at a really good place with her insulin. Because if you get insulin too low, and you’re already are relatively healthy body comp, that could also be a problem too. So this is why we have to individualize it for patients. So we’re talking about pcls and insulin resistance. And for most people, that kind of a dietary strategy is going to be a really important starting point. But for some people, you may hit the wall, and you have to adjust like you haven’t talked about others, you may have to hang out there a lot longer. So it’s kind of keep that in the back of your mind because we’re kind of having two conflicting recommendations. And that’s because everyone’s at Individual, and we have a starting point for most and then we adjust according to the patient’s needs after.
Evan Brand: Yeah, and that’s just an extreme case, but I at least wanted to mention it right? Because you always have the people that say, well, I’ve already done paleo and I still you know, had issues of course, there could be other underlying causes, you know, infections or whatever else we’ll get into, but in her case, this lady who was literally just doing like meat, and maybe a salad, you know, she literally had almost like virtually no carbs at all. So, so that’s just an extreme manifestation. But if you’re doing your, like you said, just kind of standard paleo template, you’re probably going to do maybe it’s plantains or some berries or you’re probably eventually over the day would accumulate enough starch or carbs to to fuel the fertility, but in her case, no, she was too low.
Dr. Justin Marchegiani: And again, if you’re insulin resistant, the starch or carbs may be keeping you infertile, right? Yeah, we can always do testing. We can always run fasting insulin and we can see where your fasting insulins are at. If there’s pcus. We may also want to look at prolactin, we may also want to look at free and total to stop Throw a see where that’s fitting to make sure it’s not, you know, in the top half top top 25% of the reference range. That’s pretty good to look at. So what’s the underlying mechanism? So if this person’s over exercising, it’s probably one over exercising, it can create estrogen dominance, right? So it can decrease progesterone. It can also decrease your dopamine and adrenaline which can be that driver that increases prolactin, right. And it can also just deplete hormones in general, I see a lot of women that are low estrogen, low progesterone, and they still may be a little bit in estrogen dominance because the ratio is still skewed, but their hormones are just low across the board. I see that a lot as well. So you have to this is why it’s super important to to test right because if you’re not testing you’re guessing. So with fertility cases, we may run a month long test to see where you’re at from day one when you bleed, all the way to oscillation all the way to the end of the month looking through the luteal phase to see how high that progesterone gets. We may just come in there and run a snapshot on the luteal phase two If patients have some infertility issues, but it’s not a primary thing, then we may just come in there with the luteal thing. If they’re really struggling on the fertility side, then we may do that full month. So I’ll typically do one or the other. And of course, looking at the adrenals are so important. Why? Because the adrenals interplay with dopamine and adrenaline and cortisol and estrogen dominance, ie via progesterone going to cortisol, we have to look at the adrenals because they play a major role as a backup generator with the female hormones.
Evan Brand: Yeah, absolutely. I mean, adaptogenic herbs are part of my life. They’re part of your life, you know, on a daily basis for us clinically And personally, and it’s a game changer. I would say it’s one of the biggest, one of my most favorite and biggest tools that I will use with a woman who is struggling with infertility, especially because there’s so much emotional stress. And there’s trauma associated with this, especially if a woman’s had a miscarriage or if a woman you know, has worked on this for months and months and years and been to several doctors in practice. And she feels like she’s at the end of the rope and she’s aging and she’s kind of running out of her her fertile window anyway. I mean, there’s so much stress associated with the emotional component of this as well and maybe family pressure when you’re going to have kids and that whole thing so, to me, that’s where adaptogenic herbs come in and not only help with the hormonal side, but the mental emotional stress as well.
Dr. Justin Marchegiani: Exactly. So in general, like with women and men, similar things with the diet, right men, there’s less of a hormonal fluctuation that’s going to be throwing fertility off. So keeping the pesticides, the hormones, the artificial hormones, these you know, estrogens, the growth hormones, really emphasizing good proteins, good fats, high quality cholesterol from animal products, lots of good antioxidants from leafy greens, keeping insulin in check. That’s a good first step. Of course, we can add in resistance training, we can add in mitochondrial nutrients like carnitine and co q 10, and arginine and zinc and selenium. Again, it was certain male patients will come in. We’ll run a nutrient profile and see what nutrients Their low end as well and of course, we’re going to be fixing the gut fix to the adrenals. And using a lot of those first line things, it’s also herbs we can use as well. ashwagandha is a big one tyrosine and dopa means a big one right? You see macoun as well as a big one. Why? Because dopamine helps with fertility. You mentioned earlier tongkat Ali really helps with that upstream signaling from the banana tropic releasing hormone, which then helps with FSH and LH. Lh is really important for spermatogenesis and making healthy sperm. So these are really good first line steps for enhancing male fertility. Anything else you want to add about that?
Evan Brand: Yeah, we weren’t. We didn’t press the record button yet. When we when you were now we’re talking about that. So let me just give just a quick little story on Tongkat Ali. There’s a Latin name for it as well. It’s something that’s beneficial for for men. We give it a lot to athletes, it does help with testosterone levels. And there are a couple of really, really cool papers on it. Where it’s increasing supermoto Genesis by influencing that HP ga axis the hypothalamus pituitary go Natl access. And long story short, not only did it increase the sperm count, but it increased the sperm motility. So you’ve got better swimmers. So when we talk about men, you know, having an important role in this fertility, you know, piece, that’s also a game changer. And then tribulus is another, you know, tribulus is once again kind of used in the bodybuilding community quite a bit to help with muscle mass and androgen increasing effects and all that, but it does help with the testosterone in the DHT DHT levels, which are all sex hormones that are important. And then also, what about the What about the influence of the gut? Do you want to talk about that now because I’m just thinking out loud with you here. We should probably talk about the mechanism of beta glucuronicdase issues with men and women where they would be re circulating estrogen and having issues with estrogen due to the beta glucuronicdase. enzyme being hired. Due to like a bacterial overgrowth problem, for example.
Dr. Justin Marchegiani: Yeah, so in functional medicine, right, we may look at things a little bit closer when it comes to fertility, but we’re still going to be doing the same things with the gut because if we don’t go to the six R’s of healthy gut function, we don’t go to the six R’s, removing the bad foods, replacing enzymes and acids repairing the gut lining in the in the hormones, removing the infection, repopulating rynok elating, good bacteria retesting. The gut is where everything happens 80% of the immune systems there, that’s where all the nutrients are absorbed and digested and assimilated and utilized. So if we just were to skip that and go to a hormone protocol, or a typical augmentation program with progesterone, we may miss a lot of those nutrients getting assimilated, broken down and absorbed and utilized. So we have to always assume the gut could be a major interplay. And again, most people, they’re not connecting the gut with their hormones. They just never right. But like you mentioned beta glucuronidation plays a role in hormone detox and We could be increasing estrogen dominance to the bad bacteria causing us to reabsorb estrogens. Right. We could also just have bad liver and gallbladder function because we’re not digesting fat, partly because of low stomach acid partly because of an H. pylori infection or grd infection. And that can make us hard to break down and assimilate cholesterol and essential fatty acids, which are important building blocks for fertility, right. So these things always kind of connect whether they’re one two or three degrees away from the root.
Evan Brand: Now if you’re a little brain fog, and you’re listening to Justin talk, you’re like, Oh my God, he’s talking fast. What is he saying? Giardia? What the heck pet parents Oh my god. So yes, literally, gut infections can literally make you infertile. We had several women who were infertile, and we ran their stool panel, they showed up with parasites, whether it was Giardia or krypto. As you mentioned, H. pylori being a big influence on stomach acids. So now, if we think about we always talk about good diet for mom, which is going to be a good diet to feed and grow a baby. But what if she does have these infections, and she is doing a paleo template and she’s doing her Grass Fed Whey or whatever to get her amino acid profile complete. And now all of a sudden she’s got these gut infections. So literally, just by running a gut panel and walking someone through using herbs to eradicate these infections, boom, I’ve had I lost count many women who, during a parasite protocol, they’ll email the office, I’m pregnant. What do I do? I’m like, holy crap. Yeah, by the way, this protocol by eliminating parasites, it actually increases fertility. Boom, there you go. Congratulations. And so it’s, it’s pretty nuts.
Dr. Justin Marchegiani: In general, anything else you want to say about that? So we talked about gut being really important. So HCl, enzymes, those kind of things are really important. We talked about the six hour if you’ve done podcast on that topic, so just make sure if you’re thinking about fertility, make sure we don’t ignore that right. has to be on the women has to know On the men, usually male men are easier to deal with because they don’t have a very unique symphony of a cycle. They kind of have a foghorn of hormones. And usually that’s going to be depleted by stress and poor nutrition and gut stuff. So it’s a little bit easier on the hormone side. But with women, it’s a little bit more complicated because of the cycle. So we talked about IVF. We talked about medication like clomiphene citrate or Clomid, which is a stimulates gnrh, which then stimulates FSH and LH and follicle stimulating hormone luteinizing hormone from the pituitary, which then stimulates egg maturation and oscillation. So there’s that right. But that’s kind of like a stimulator. Like Think of it as you got a tired horse. Do you really want the horse to perform by whipping it harder? Right? Is that the mindset? So for some people, that’s like an easy, you know, quick, simple, okay, I’m pregnant now. And most people who are aren’t as natural minded, that’s usually the first line of therapy that they’re going to do on the fertility side right. Then usually after that, they may go I UI which is the inter uterus insemination and then they may go into IVF or they shut down the whole HPA access using Lupron, they come in there with certain like follistim and different hormones at certain times so they can grow the eggs, harvest them, put them back in, get the whole hormone cascade going with all the injections, and then while you’re pregnant and then maintain the pregnancy with progesterone, that’s kind of what happens on the IVF side. But that may not be necessary for a lot of women. We already talked about the major mechanisms. Now, what are some deal breakers that may hold you back from getting pregnant even with doing all this? So there are certain things you have to look out for fibroids are a big one. If you have some big fibroids that are just hanging out, they could be there could be enough there where it’s disrupting blood flow, because the fibroids are a blood flow hog, and that could be preventing the egg from implanting into the uterus lining. Also, the fibroid can create a little bit of inflammation now everything we’re talking about is designed to To help prevent those fibroids from growing, the question is How long have they been growing they’re they’ve been hanging out for like years and years and years and decades. Some of the natural things just make take may take too long. And so you have to be very, very aware of that. Or it may be so big where it has so much momentum, it may need to be removed surgically. So you have to be mindful of things like fibroids. Also, endometriosis is a big one. That’s endometrial tissue, can it which is basically the endometrial lining tissue starts growing in areas it shouldn’t be, it could grow on the ovaries, it could grow on the bladder. Sometimes endometriosis, endometriosis can cause inflammation in that area. And then a lot of times with a simple procedure where you come and take a laser and kind of laser it off can be very helpful. conventional medicine won’t fix the root cause of why the fibroids there or why the endometriosis is there, but sometimes it’s gotten so bad where that may be necessary. There’s also something called a chocolate cyst, which is basically an Dimitrios in the ovary and that can Definitely be a problem as well. So that may need to be drained. So that you have to look at some of these things, some of these tissues that have grown for a long period of time, they may need a conventional intervention. Now, as long as you’re relatively young, and you have some time, try the natural stuff first and see if your body can handle it. If not, that may be the next thing to look at. And then of course, we already talked about pcls, which is polycystic ovarian syndrome. And that’s where there’s system the ovaries from all the things I mentioned, elevations and insulin and androgens, and I seen those reabsorb time and time again. So I’ve seen the body be able to handle that. I don’t see most patients that will have to go in and get those things drain per se, I find the body can handle that. The other things may need to be addressed at some point over time, but I always say wait and see work with a good functional medicine Doc, have a good ob gyn or a reproductive ob gyn kind of in your back pocket. So you’re monitoring things as you move forward. And if you have to go a surgical route, don’t throw away the functional medicine doctor keep both of them working together.
Evan Brand: Yep. Yeah, good point. And you know, it’s possible that you could find like a holistic or more natural minded ob as well, that would be good to have on hand that way they would help support you with some of the dietary stuff. But yeah, with endometriosis, you know, there’s a hormone component to that as well. So we already talked about diet and things like that, but of course, in the beta glucuronidation, so like calcium D glucose rate, for example, you know, that’s something that we may use to help with getting out these excess xeno estrogens. And that could be a game changer too. And of course, in the diet, you’re getting some like, you know, calcium D glucose, right? You’ll get some of that naturally in the diet. So whether you’re doing like broccoli, or blueberries or whatever, I mean, different. You know, cruciferous veggies, you’re going to get some beneficial stuff like that. Anyway, that will help. Regarding the hormones. It sounds crazy that broccoli could help pregnancy but yeah, but it definitely could. And then also, I mean, there’s no there’s various exercises to that can be helpful. Exercise in general is helpful. So I mean, if you have a sedentary woman, and you get her moving, but not to the CrossFit, five, you know, five times a week level, you know, that could be a game changer.
Dr. Justin Marchegiani: Exactly. So you got to look at everything holistically, like, I’ll tell you my personal story. We have two Healthy Kids, two healthy boys. And my wife and I had a hard time getting pregnant in that first year. And we found she just had a really, really, really, really, really big fibroid, very big-
Evan Brand: Was that ultrasound or how gel, figure that out?
Dr. Justin Marchegiani: Transvaginal ultrasound, and my wife before she met me, she was on birth control pills for over a decade. So I think there was that she wasn’t he she was eating a lot of conventional foods in the beginning before she met me before we tweaked her diet. So I think there was a lot of hormonal growth that was going on for decades that caused some of that growth. And you can’t just pull it away and expect it to just reabsorb all of a sudden, right? You can’t take 10 years and just expect it to go away. And so we actually tried reducing it. Now there are things you can do, they can work there. You can do things like egcg epigallocatechin is in the green Green tea you can do things like resveratrol and lipids or curcumin, and you could do systemic enzymes like Sarah peptidase and lembrar kinase, which are helped to metabolize some of that tissue and can work. The question is, can it work fast enough? And so we went the surgical road that the fibroids removed and literally within two months of it being gone pregnant, no problems. And so sometimes that can be an issue. So you have to look at, okay, what’s the root? Cause? You know, do we have some limitations of matter, right? Were those tissues just been hanging out too long? Just the body needs a little bit of a head start getting that tissue removed. And if you got time, you know, do the natural things and just watch and wait, right watch and wait. So if you’re a female listening, and you’re not in a relationship, or you’re not looking to get pregnant anytime soon, but you want to at some point, I just recommend getting good, good workup with your ob gyn to make sure there are no endometriosis or fibroids, endometriosis. This is hard. Typically the only way to figure that out is laparoscopically, little incision for the scoping. So it’s kind of tough to know that one. But you know, usually a lot of the telltale symptoms like the painful periods, like those kind of things, if you’re having those symptoms work with a good functional medicine doc to help it, but keep an eye out on bigger issues, like fibroids and those things so you can act on it early.
Evan Brand: Yeah. Thanks for sharing the story. And now you got two little boys and they’re keeping you busy. So everything worked out.
Dr. Justin Marchegiani: You got it? Absolutely. So keep that in the back of your mind. Anything else you want to add? On the supplements? I know you were kind of riffing on a couple of adaptogens earlier. Anything else you want to add? You mentioned while you listen tongkat Ali?
Evan Brand: Yeah, so that could be for the men. I would just say during during the you and I’ve talked about this idea before we kind of call pregnancy more like a four trimester thing which women like cringe at like, Oh my God isn’t pregnancy long enough, but not just meaning that there’s a kind of a pre, a preNatal phase that happens before you even get there. Right now kind of a pre, you know, fertility supporting area. So we’ll bring in multis and omegas. And like you said, maybe systemic enzymes will bring in trace minerals, micronutrients, maybe Grass Fed Whey protein, maybe some Oregon supplements. I mean, there’s a lot of things that we can do right away to kind of prep the body before you even get pregnant. It’s not I disagree with this idea of you got, you’ve got a pot of positive pregnancy test start the prenatal, it’s like, No, you could be six weeks in already, like you should have been on the prenatal six months before you got pregnant in my opinion.
Dr. Justin Marchegiani: Yeah, and most prenatals I mean, prenatal is a more of a marketing thing, like in some of the prenatals that we recommend, what makes it a prenatal Well, there may just be a little bit more calcium, there may be some extra full weight in there. And of course, everything’s active, full light, no folic acid, everything’s mthfr. Of course, everything’s methylated. There may be some extra iron in there, right? So there may be a couple little nutrients that are a little bit extra. But if you look at a really good high quality multi versus a prenatal they’re going to be about 90 95% At the same Yeah, if you’re getting a high quality couple little tweaks here and there, of course, you may want to add in some extra essential fatty acids cod liver oil, those kind of things I think are are very, very helpful.
Evan Brand: I get so mad I get so mad when you go like if you go to like Whole Foods or I mean even even places like that where you’ll go and you’ll see these little cute gummies in like a clear container. And it’s like six gummies a day and the first ingredients like fructose or fructose tapioca syrup. And it’s like, okay, here you are taking the woman who, you know may not know exactly what’s going on may not understand the root causes, and he or she has eaten these little gummies every day as a prenatal it’s like no, it’s like candy.
Dr. Justin Marchegiani: Totally 100% agree. One other thing if you have to go a surgical intervention I recommend personally, if you’re a fertility age and you want to get pregnant that you see someone that has a specialty in reproduction as well as being a gynecologist. I find that certain gynecologist have a A perspective on what’s happening surgically with the goal of removing the tissue, while others have a perspective of that while maintaining fertility. So I find someone that’s a ob ob gyn as well as a reproductive specialist, they looking at the procedure with a lens of keeping fertility intact. So I always recommend if you have to go the surgical route, try to find an OB GYN that also has that reproductive specialty as well. Yep. Good advice. Yeah, I think that’s important. I’ve just seen, I’ve heard too many stories from ob gyns, who don’t have the repro specialty, and they’re just and again, some of these are older stories. They’re too easy. They’re too They jump the gun on just doing a complete hysterectomy or doing a partial hysterectomy just removing the uterus or just removing too much tissue and and that scaffolding of that uterus can collapse and other issues can happen. So I always like to make sure you have someone with an eye Keeping fertility intact.
Evan Brand: Yep. No, I mean that if that’s their job to just remove uterus and ovaries all day Yeah, they may not care about the fertility aspect at all.
Dr. Justin Marchegiani: Yeah, it’s really, really important. And then yeah, and that’s, that’s incredibly important and of course, the most non invasive to invasive is is the best way to go. Anything else having you want to add on the topic? I mean, Today’s been really great. I think we really hit a lot of things from the nutrition aspect to some of the herbs and nutrients just to dovetail that progesterone is a big one we may be adding in progesterone we may be adding in things like chase tree and damiana and different herbs that help modulate maka that modulate estrogen receptor sites and or modulate progesterone and even support progesterone and of course, we’re also supporting the adrenal so all of those key tenants there need to be fully looked at and supported that you want to add anything else that Evan?
Evan Brand: I don’t think so. There’s a Yeah, there’s a good handful of like female supporting herbs, things that we would typically use anyway. To help with like PMS, for example, things that are going to help regulate hormone levels, those things alone can contribute to fertility. So yeah, it’s sometimes where a woman comes to us with a different problem with hormones, they may say, Oh, I eventually want to get pregnant. But right now I need to focus on this major PMS. I’m out of work every week, you know, I’m laying in bed in pain, and we just help regulate hormones using some of those herbs you mentioned there and then fix the gut and then boom, hey, we got pregnant sooner than anticipated. Cool. Let’s go ahead and kind of transition now let’s, you know, let’s get you into this, you know, maternal support phase now and it’s really fun I tell you, there’s there’s nothing better than you know, whether it’s getting a picture in my inbox of a new baby or just a mom telling her birth story. It’s It’s fun, and it’s a very, very rewarding thing. And, and, and I always, I don’t know I like to pop my collar a little bit more after I hear a good story like that, especially when a woman was dealing with the conventional medical world and she was so frustrated. And so hopeless, and then she was able to actually do it naturally. It’s like, Yes, I told you so I told you you could do it because the conventional doctors are obese will be like, nope, you can’t do it. You’re not going to get fertile. You’re too old. Your hormones are too messed up. It’s not gonna happen. And then boom, a baby comes. It’s always just like I told you, so.
Dr. Justin Marchegiani: I like it. Well, after you talked about popping the collar, I’m gonna I’m gonna join you on that one. There we go. Excellent. Very good. So yeah, I love those stories. I think that’s excellent. We always want to focus on the root cause so just anyone listening we want to make sure our goal is that you’re looking at your fertility from a root cause perspective. If you have to bring a functional medicine doctor in great if you have to bring a conventional fertility MD and great just always make sure you’re looking at the root cause. If you have to go you know more invasive on the IVF or surgery side, that’s fine. Just make sure you exhaust all of the foundational options first, nutritionally and functional medicine wise. And then also make sure your husband’s a part of what’s going on. So Make sure he’s getting tested, his nutrients are assessed. He’s doing all the right things on the fertility side, we can also get a sperm count on him as well make sure sperm numbers are good, you know, at least 50 million, make sure shape and morphology and all that good stuff is dialed in as well to assess that being okay. And of course if, if it’s not, then we have to work on all the nutrients and work on removing a lot of the toxins that we already talked about.
Evan Brand: Yep. So get off the mountain dew. Oh God, we had a friend that was an old friend who was having issue with fellow body and her and her husband both just pounded the Mountain Dew. I’m like, who even drinks Mountain Dew anymore? I mean, it’s like, it’s like 80 grams of sugar per bottle. I was like, oh, get off the mountain dew. So of course, you know, typically people would think everybody around you and I like we’re just the circle of health, our family, our friends and everybody would just listen to us and reach out to us for help. But that’s typically not how it we’re not how it is. So of course they don’t ask me anything. What do they do? They go do IVF they spent, I think it was 15 or $20,000. They did like a fundraiser raise money. It’s like how about just like, let us give you the workup, it’s going to be a fraction of the cost. And you’re going to have, you know, minimal to no risk. I mean, like with other procedures, you know, you could have risk of twins and triplets. I mean, they’re not, you know, death necessarily risk, but there are risk associated with some of these other things. So, it’s just sad. It’s sad that people just don’t know. And, you know, you always say, oh, let’s talk about the root cause of this. It’s like, why is that so revolutionary? That should be the first way people think but it’s not.
Dr. Justin Marchegiani: 100% you’re never a prophet in your own town. And also, if women have to go the IVF road, the goal remember the end goal is not just to get pregnant, right? What’s the angle? Let’s huddle up and focus on what’s the end goal the end goal was to have a healthy baby, right that’s that’s the angle and pregnancies one step in that journey. So don’t confuse the first step as success number one, and then number two, If you’re going to engage in more conventional approaches that don’t address the root cause, I strongly urge you to make sure you’re addressing the root cause. So the angle should be having a healthy baby at the end. So just keep that in mind, make sure you are really focused on what the root cause and goals are.
Evan Brand: Let me say one last thing, and then I want to get your take on this real quick. And I love the way you said that, you know, the pregnancy is not just the end all Gold’s it’s the healthy baby and all that. So, you know, what about if a woman does get pregnant, and in an unnatural method, like IVF, for example, but she still has an insulin problem. I’ve seen cases where you could argue with something else, but I would argue that the elevated insulin and the sugar and the carbs and all the crap in the diet could potentially make the baby get too big. And then the doctors are saying, Hey, you know, now you’ve got a nine pounder, we’re gonna have to do a mandatory c section, for example. You know, there’s other complications there.
Dr. Justin Marchegiani: Yeah, I mean, just having that high amount of insulin, gestational diabetes. kind of thing going on, which a lot of times the Hopis don’t even acknowledge, really being a diet thing. I mean, I remember going in and my wife was getting testing on the blood sugar, and we were monitoring her blood sugar at home. And the nurse practitioner said, you know, hey, you know, the gestational diabetes is a genetic thing. And I’m like, I literally pulled up a study of like, literally says more grains, and trans fatty acids can actually increase it. And it was like a, it was just, it was like a paradigm thing. It’s like, even though like, if people are conventionally trained, and have to pass all these, you know, mainstream boards for their licensing, they’re not really up to date with the conventional literature in the conventional literature isn’t really injected in the first line therapies for what these doctors and nurses need to know. So it’s kind of sad. So we just want to bring that information everyone on the forefront now so they’re aware of it, and also test the blood sugar and if you’re at high risk for a miscarriage, then you’d want to keep an eye on your progesterone levels. As soon as you get pregnant. One of the easiest first things is using progesterone, an inter-vaginal progesterone probably 200 milligrams or so a day throughout that first trimester can be a godsend for a lot of women. So if you’re at high risk for miscarriage, make sure you keep an eye on testing those progesterone levels, you know, 15 to 20 or so in that first week, couple weeks of getting pregnant and to be important, so keep an eye on that with your ob. So you’re monitoring if you’re high risk.
Evan Brand: Yup. Well said. Well I’m sure I could break off a few of the things but let’s wrap it up and keep on reaching out clinically. We’d love to help you. Justin is available around the world at JustinHealth.com. Me, EvanBrand.com and we’ll be back soon to talk more.
Dr. Justin Marchegiani: Phenomenal chatting with you all. Have a good day.
Evan Brand: Take Care.
Dr. Justin Marchegiani: Bye.
How to Address Your Fatigue and Gut Symptoms via Organic Acid Testing | Podcast #328
Hey, guys! In this video, Dr. J and Evan talk about addressing gut symptoms via organic acid testing. To start with, Organic acid testing (OAT) became very popular amongst functional medicine doctors and dietitians. It is a urine-based test that gives essential information about the functioning of various bodily systems and to identify possible nutrient deficiencies, gut dysbiosis, and more.
Organic acid testing may be beneficial for people whose symptoms have not yet describe through other stool tests, blood work, or urinary hormone tests. It helps give an immense understanding of nutrient deficiencies, mitochondrial function, neurotransmitter metabolism, detoxification abilities, antioxidant status, and gut health, which trained and experienced clinicians can utilize to dive deeper.
Dr. Justin Marchegiani
In this episode, we cover:
1:07 Organic Acid Testing, Gut Issues
5:17 Candida, Oxolates
10:27 How Lab Results are Interpreted
17:14 Metabolism, Energy Production
Dr. Justin Marchegiani: And we are alive. It’s Dr. Justin Marchegiani in the house with Evan Brand. Today we are going to be talking about organic acid testing organic acids are wonderful technology that we use with almost all patients to really look under the metabolic hood to see what is going on whether it’s functional metabolic issues, deficiencies, certain nutrient deficiencies, gut imbalances, detoxification problems, methylation issues, we weren’t able to kind of peel back the onion, so to speak and look deeper under the hood. Evan, how are we doing today man?
Evan Brand: Doing really good excited to dive in! You know, I can say this with confidence, because I’ve actually spoke to the lab about this that you and I, personally, between us clinically, we are in the top five of practitioners worldwide running the most organic acids testing.
Dr. Justin Marchegiani: Wow, isn’t that cool? I didn’t even know that. I knew I knew we were up there. But that’s really cool to hear.
Evan Brand: Yeah. So So what does that mean? Well, that just means that we’ve looked at so many of these that we can really get good at what we’re doing. And most importantly, we can help you the listener figure out exactly how your symptoms are linked in to a particular body system dysfunction. So we’re going to talk today about how the gut, you can find information about the gut via urine. And we talked about stool testing a lot. But in some cases, the urine is actually a little bit better for investigating the gut, which is pretty interesting. So we’ll dive into that we’re going to talk about energy markers and how your energy and fatigue levels can be tied in also. And the mood category, we’re going to get into possibly depression, anxiety, and how that could be tied in or even OCD behavior, depression, winter depression, and then we’re going to get into nutritional markers. And I mean, there’s just so much information from one cup of tea, it’s like magic.
Dr. Justin Marchegiani: Yeah, we can get a lot. And again, when we’re looking at gut issues, I always tell patients, we’re always going to look at a gut test, like a good high quality gut tasks. You know, there’s a couple of tests that we use, but once the genetic test that looks at the gut microbiome infections, h pylori, bacterial overgrowth, inflammation, markers, digestion, markers, immune markers, so we’ll always want to look at a comprehensive gut test to see what’s going on. But it’s nice to look at the organic acids, because sometimes, most of the time, I would say they kind of correlate where we see some kind of bacterial overgrowth, or a fungal overgrowth, it will a lot of times say it on there, I do find the organic acids do pick up fungal overgrowth far more often than stool test to a lot of times, if you’re looking at under the threshold level of fungal stuff, we do see a lot of fungal stuff. It’s not at the positive level. But if we see it there at all, you know, we typically consider it a problem. And then third, you know, we may not see total congruence, like there may say gut issues on an organic acid test, but not on a gut test. And guess what, if we just see it anywhere once, then that’s enough for us to kind of move forward on it. We don’t need total agreement. It’s just an extra check. It’s an extra net to catch anything that could be missing. And of course, we get deeper look in what’s happening nutritionally methylation, B vitamins, sulfur metabolism, detoxification, mitochondrial functions, we really get a good window at what’s happening underneath the hood.
Evan Brand: Yeah, I want to show you this three year old, if you’ll let me share my screen, I tried to click on it, it says you got to enable it for me. But I’ve got a three year old little girl as a client who has been to conventional doctors, and she can’t get help. And the pediatrician, of course, is just saying, Hey, you know, possibly do some vitamin D. And that’s really it. Okay, now I can share. So let me pull this up here. Can you see that?
Dr. Justin Marchegiani: Yes, I can.
Evan Brand: Okay, good. So the people watching too, if you’re listening via audio, I encourage you check out Dr. Justin’s Justin Health YouTube channel. If you’re listening and you want to see the visual here, we’re going to try to make sure that those doing audio only still get the gist of it. But really, what we’re trying to find here are high markers. That’s when you really see problems. And you can see for this little girl, this is keep in mind this a three year old little girl. And the parents said that the girl is literally addicted to sugar, and she refuses to eat anything else. And she has a ton of symptoms, skin, mood, gut behavior, just all kinds of stuff and look at this tartaric acid, which is an indication of Aspergillus, growing in our gut, we want less than 3.9. She’s 147. I think this is the highest I’ve ever seen. And sadly, it’s an a child. And then of course, arabba knows you and I’ve talked about that being the gas that Candida produces, we want less than 56. She’s off the charts at 226. So right there really high, that’s really high. This is the amazing thing in five seconds of us looking at this page, we know this person’s already colonized for mold, and they were in a moldy house in Texas had major mold exposure. And when now we know that she’s got a major Candida problem. So even if we just had that data and just pursued those two points, we would get a hell of a hell of a lot more results than what you would get if you went to the pediatrician and said, Hey, I think she’s got a problem. They’re not going to know anything about these tests or these markers.
Dr. Justin Marchegiani: Plus in the conventional medical world, I mean, frankly, you know, candida that doesn’t really exist to people like that right. Conventional medical doctors at They’re very rarely saying, hey Candida is a problem. Usually it’s one of those things. They just say, Oh, yeah, that’s just kind of what natural medicine thinks everything is. The problem is candida, but not necessarily. But if we have objective markers that show it, it’s good to really know that and conventional medicine isn’t typically doing testing that sensitive enough to really pick it up.
Evan Brand: Yeah, and I know you run a lot of the Genova panels. And the reason that I use the Great Plains is just because I like to run the combo a lot when I, you know, I’ve kind of attracted a lot of moldy people. And so we like to run the mycotoxin combo test. So one cup of tea, and we get two labs. So that’s why I do the the Great Plains, but the rest of page one was okay, she didn’t show any major bacterial overgrowth, he was starting to creep up there on one of these markers. But overall, it was decent. Let’s move on. Let’s look at this is where all the fatigue is coming from. They said that this kid is just exhausted. And then they described it as poor tone, where she literally just lays on the floor all the time. Justin, I don’t know if you’ve ever even seen anything this high. I mean, look at these oxalates 677 off the charts. We know Candida is a piece of it, but man, and then look at the I call it succinic. But I think it’s actually pronounced succinic.
Dr. Justin Marchegiani: So succinic, yeah, and just so you know, oxalates a lot of times, especially in a kid, it’s probably not like, I would never tell a mom like oh my gosh, like most green vegetables have oxalates in it. So I wouldn’t be telling any mom like oh my gosh, you need to avoid green vegetables. Unless there was some kind of oxalate crystal issue in regards to kidney or significant muscle or join issues. I would just think that, hey, those oxalates are probably high because of the candida, candida that can really increase oxalate production and decrease oxalate synthesis. So I would lean more on the Candida being the oxalate problem.
Evan Brand: And I think this is huge, because you have some unnamed people writing books and fearmongering people about oxalates. And now you have people paranoid vegetables, like you just mentioned, you’ve got people that are like cutting vegetables out because they’re worried about the oxalates. But you and I’ve seen personally and clinically hundreds and hundreds of point reductions in the oxalic acid just by treating the Candida so Yeah, I would agree that when we know she’s not eating vegetables, so we know that that’s not where it’s coming from.
Dr. Justin Marchegiani: Yeah. And so we know if they have a Candida issue and they have a whole bunch of sweet cravings, you know, exactly. They’re not eating a whole bunch of vegetables. That’s not the issue. They’re, you know, a whole bunch of crap. And we don’t want to give them any more ammo to let their that their kiddo eat crap, right. So we want to definitely get some good nutrition in there, more than likely most of the oxalate issues are going to be from the Candida. Now again, some of the exceptions may be if we have vulvodynia, excessive joint pain from oxalate crystals, crystals, maybe kidney stones, or really kidney pain issues, that could be something really clinically significant. If not, we’re not going to worry about the oxalates, we’re going to think of that more as an effect than a cause the cause really being Candida and the effect being more of the oxalates as the cause. So I always when I’m looking at these labs of patients, I always have them in their head, draw a line one sides, cause one size effect affects we watch and monitor causes we treat and work on supporting. And so it’s easy for people to look at an effect think that is the cause and treat the effect. And then a lot of times the result won’t be as good or you do things that aren’t necessary, like cut out foods that may be really healthy for your kid.
Evan Brand: Totally Yes, same thing for the citric acid here on 29. For those listening, we’re looking at these little triangles, basically, the higher the number goes down in general, the more of a problem or dysfunction we have. And we want citric acid, maybe somewhere around 200 would be moderate. This poor little girl is off the charts almost at 1300. And we know citric acid will go high with Candida and fungal overgrowth in general. But all this succinic acid and malic acid oxic glutaric, these things are off the chart. So this just indicates an insane amount of mitochondrial dysfunction. And that’s, that’s why this girl is literally so exhausted. She can’t go to school, the parents can hardly get her out of bed. And she’s three years old. I mean, you know, my daughter, she’s four now, but when she was three, I mean, she bounces out of bed and she’s just running, running, running, going and putting her bird feeders up. I mean, this kid wakes up with energy. So you can just see, these symptoms that kids face in the parents is think gold. They’re just, like bored, or they’re just tired, but they don’t think Wow, she could have a ton of mitochondrial damage.
Dr. Justin Marchegiani: 100% Yep. 100%. So looking at a bunch of these things here. I think we hit a lot of good things out of the gates. Let me just keep on rolling here. So actually, do you want to hit a little a couple more things? I’m going to show some of my organic acid testing to the second.
Evan Brand: Let me do to show this one page here. So some of the nutritional markers are gonna get, we’re gonna see here that she was very deficient in riboflavin. The higher it goes actually the more deficient and then of course vitamin C is in Charlie is just completely toast. And then we’ve got some other markers ammonia excess and some gi bacteria markers, but overall, the main things I wanted to hit were just massive mitochondrial damage, massive colonization of mold and Candida. So don’t think that just because your kid is young That means they can’t, they don’t have permission to be sick. I mean, I started treating my daughter when she was two because she had parasites. And so I just, I feel bad because you know, these kids, when they’re really young like this, they may not be able to express all of their pains and their symptoms. But hopefully there’s enough whether it’s skin or mood or behavior or, or sleeping issues, that there’s enough justification for the parents to reach out, run the labs, and then we can really show them on paper, what their kids just can’t verbalize.
Dr. Justin Marchegiani: 100% I think it’s really good points. Now, just to kind of give people a little understanding how we interpret how we look at some of the labs pretty simple. So we want some of the markers here on the labs to be in the middle distribution. So if you look at my screen here, can you see my screen?
Evan Brand: Perfect.
Dr. Justin Marchegiani: Okay, good. Excellent. And I just make sure that you can see me as well along with that. Okay. So in general, we want these markers to be somewhat in the second to fourth quintile distribution, when they go on the extreme high or low, we always get a little bit concerned. And we get more concerned if it’s near a red area. So there are some of these markers are two tailed meaning, let’s say number seven citrate, where there’s a red on the left and the right, and some are one tail there say most are one tailed, like adipate subarray, [inaudible] where there’s only a red to the right, does that make sense to tail means read on both sides, one tail means read on one side. And of course, if markers are low, and we’re closer to a read that matters more, so we want them to be somewhat distribution in the middle extreme highs or lows are more concerning, especially if they’re grouped together now. So in this section here, fatty acid metabolism, we see them on the lower side, not as big of a deal, because this is only one tail. But we do keep that in mind. We look in the carbohydrate metabolism, you see you’re in the middle here without lactate, which is one of the more important markers, beta hydroxy butyrate, being higher isn’t that big of a deal. That’s a ketone. That’s a ketone. It’s not that big of a deal. lactate is a marker for co q 10. Typically, and pyruvate is a marker typically for B vitamins and B complex as well. So this being a little bit low, less than detectable limit isn’t that big of a deal, as long as you don’t have a whole bunch of them there. But we do keep an eye on it. And I always tell patients chronically high organic acids, that’s like a demand issue. So it’s like you’re making a million bucks a year, but spending $2 million a year you have a lot of income coming in, but your demand for that money for those resources is high. So functionally, we’re still in debt, right? And when we’re chronically low, especially in areas where there where it’s two tailed and red, that’s a sign that there’s a depletion issue depletion, it’s like you’re making 10,000 bucks a year. But spending 100, right, you’re making a lot less, right. There’s not a lot coming in, but but you’re still spending more than you’re making, right? So both in the end, you’re in debt. Okay, that’s kind of the analogy I give. And I always tell patients, well, what’s the root cause? Like? No, we always want to be focused on the root cause we may be doing palliative support. People can feel better in the moment, but we always want to get to the root cause support now, with organic acids pretty simple. First is going to be diet, and it could be a macro issue, and or micro issue, meaning if someone’s eating that looks like a healthy diet, but it’s not organic. Well, it may be significantly deficient in certain nutrients, right. If you look at Joel Salatin runs polyface farm, he found he sent his organic eggs to the lab, and they looked at the amount of full weight that was in his organic eggs, it was 20 times more fully in his organic eggs than the typical conventional storebought eggs. So organic matters. It’s not just pesticides, pesticides is important. It’s a big part, but it’s also nutrition. So of course, eating organic makes a bigger difference, food quality makes a big difference. And then number two is going to be absorption absorption can be affected by gut microbiome issues, parasites, fungal overgrowth, bacterial overgrowth, it could be affected by low stomach acid and enzymes and bile salt levels. It can also be affected by food allergies, chronic food allergens, or chronic inflammation in the intestines, can can drive it to number three, just general stress. Stress can be categorized as physical stress, right? you’re exercising too hard. Maybe you’re too sedentary, maybe you’re not getting enough sleep, maybe your emotional stress is off the charts. And that’s throwing off your cortisol and your adrenals and your hormones. Stress plays a big role. Number four is toxicity, toxicity primarily from pesticides, heavy metals, mold, toxins, pesticides, heavy metal mold, toxins are biggies. And then number five is genetic. Genetic can mean hey, you just need more magnesium, you need more amino acids, you need more B vitamins than the average person just for who you are. Could be an mthfr issue. You need good high quality full eight, that cheap folic acid stuff is not cutting it. You need more methylated B vitamins. So genetically, there could be just some imbalances in regards to what your biochemical needs. I think Roger Williams wrote a book called biochemical individuality talking about people’s need for certain nutrients can be exponentially higher than someone else’s. And so those are kind of the big five things out of the gate. Any comments on that, Evan?
Evan Brand: Yeah. So one thing I think it’s important to point out is people get really caught up in the DNA and the genetic testing and I’m cool with So I’m cool with it. But I just want to highlight something you said here, which is that we’re really going to be looking more at the downstream effect of any of those genetic predispositions here correct meaning, let’s say that there is a genetic predisposition to needing some more foliage or some B vitamins upstream, but then that manifests downstream, we’re gonna see it here, we’re going to see the citric acid cycle, we may see some things off of this carbohydrate metabolism section. So what I’m saying is not that the genetic stuff is useless, but that you and I are going to see the result of those genetic issues here. Is that correct? And the you might not need that genetic data, because you’re going to be looking here at what the actual body has. Is that true?
Dr. Justin Marchegiani: 100% Yep. 110%.
Evan Brand: Because you send us the snips, right, well, I’ve got this snip or this genetic This or this genetic that, but I really would prefer to look at the organic acids, maybe in addition to but if I’m without the genetic information, I still feel confident in what we’re going to do and the results we can achieve with just the test alone.
Dr. Justin Marchegiani: Yeah, here’s one image. I’ll put it on screen. These are two twins here called Otto and Iwa, can you see it? Yep. These are exact twins. Okay, so one engaged in you know, lifting weights eating better the other one? Not? I mean, you can see, look at the difference. Fuller hair for muscles, right? It’s same DNA. Remember, twins have the exact same DNA. Right? So this is important. So we know our genetics can change. The reason why I don’t like the genetic tests as much as because you could have you could have someone being an alcoholic eating terribly. Someone totally changing their life and and eating incredibly healthily. And guess what? The DNA looks exactly the same. So it kind of it’s a snapshot in time. It’s not functional does not change based on your your lifestyle decisions. And so you can see here we know, right, this is the same DNA here. This is the these are two German twins, like 1969. Same DNA. Look at the difference.
Evan Brand: Okay, yeah, people on audio people on audio listening, he’s showing a picture of these guys, they’re twins, you can see same height, same looks everything. But then the guy, one guy is, who knows, maybe 130 pounds, the other guy’s like 170, and just ripped shredded muscles.
Dr. Justin Marchegiani: Yep. And so basically, it’s the epi genetics. It’s it’s the functional progress that we’re looking at. So just kind of put that there. And again, anyone listening, we’re trying to do enough of a good job describing what’s happening. So if you’re in your car drive and just kind of listen to us, if not, we’ll put a link right below to the YouTube video. So if you guys want to engage in the video, feel free. Let me go back to the organic acids, though. So we talked about fatty acid metabolism, carb metabolism, energy production. So we’d like this to be somewhat in the middle seven through 14 is a bunch of these organic acids here. The names don’t necessarily matter. citrate, Sr connotates, ISO citrate alpha ketoglutarate, succinate, Fumarate analyte, hydroxy, [inaudible] doesn’t matter, right, that’s just just focus on what it means these typically correlate with nutrients like B vitamins and CO, q, 10, and chromium, chromium and arginine and cysteine, and B complex and manganese and magnesium and lipoic acid. So when we see deviations high or low, especially a whole section, higher low, that tells us those nutrients are going to be burnt up depleted. And it just gives us a window, what’s happening. And we got to look at it in correlation to someone’s lifestyle, how good their diet is, how crappy their absorption is all that matters. I always try to look at the top the patient’s top two or three symptoms, I try to correlate it to the, to the systems that may not be functioning optimally based on the organic acids. And then I support based on that, because there’s a lot of things you could support at all times. At the back page, they’ll typically give you a whole bunch of things that were to recommend here. I ignore that. Because because there’s a clinical art to this. And we’re doing a lot of different things. At the same time. We’re not just like running this test. I’m just saying here, take the supplements, we’re really trying to look at the whole big picture.
Evan Brand: Okay, I kind of skipped over some of the importance of the neurotransmitters in the beginning. I mentioned we’re gonna hit some brain chemistry stuff, depression, and some mood issues. Cool.
Dr. Justin Marchegiani: Depending on how bad your gut health is. Ideally, if we’re doing some kind of a really good high quality methylated B 12. Or [inaudible] or hydroxyl and or some kind of something sublingual, usually we can not necessarily need it if we’re doing the high enough of a dose and or sublingual. But if someone maybe has really bad Crohn’s or ulcerative colitis and bloods coming out of their stool, and we see markers on their differentials, you know, hi MC, ah, Hi mctv Hi, MC, hc, and or high methylmalonic acid, we may want to just do a one off injection to bias time, but most of the time, it’s not necessary. Because when patients come in to see us, we’re doing all kinds of diet changes and lifestyle changes a month before these tests even come in. So then the time they get these tests in usually we’ve calmed down most of any acute issues to begin with. Does that make sense?
Evan Brand: It does. Yeah, I just see a lot of these pop up IV clinics going around and people they’re paying a really pretty penny for some of these injectable B vitamins versus some of the pricing that you and I offer on some of the our professional methylated sublingual nutrients, it’s maybe a quarter of the cost, if not half the cost. And you don’t have to get an injection. You don’t have to travel to a clinic and sit in the chair. You can do it at home and you can fix it. So yeah, I would agree with you.
Dr. Justin Marchegiani: Yeah, I would say depending on how acute The issue is, maybe that may dictate. And also if you’re acutely sick, that may help kind of as a palliative thing, but in general, it’s not practical from a day in day out standpoint. And then we have our neurotransmitter. So vanel, Mandalay and Homo vandelay. They’re kind of they’re two, they’re two sides of the same sword so vandal Mandalay, it’s a marker for adrenaline, home of analytes, a marker for dopamine. Now in the in the neurotransmitter synthesis pathway, it goes phenyl alanine tyrosine tyrosine l dopa l dopa epinephrine norepinephrine. So what does that mean? It means home of anolyte will eventually home of anolyte looks at dopamine, right? So dopamine will eventually go downstream to adrenaline. It’s the next step in the cascade if there is stress going on. So when you support adrenaline, you’re also support a dopamine, when you support dopamine, you’re also supporting adrenaline. And you may not have both of these out of balance. So in this case, this person is having more of an adrenaline issue. Now, by supporting the adrenaline we will be supporting dopamine. But if you have a chronic adrenaline issue, you will eventually be depleting dopamine, because it just comes from it. It’s the precursor, your fan, Amanda lates, the post cursor, dopamine or Homo ventilates, the precursor? Does that make sense?
Evan Brand: So let me say it in another way, you’re going to see a depletion of your endorphins before you see a depletion of dopamine.
Dr. Justin Marchegiani: Oh, no, you could see both, you could see a dopamine issue before endorphin. That’s gonna be all based on genetics. But if you only see one issue going on, it’s just a matter of time before that second issue kicks in.
Evan Brand: I’d say 75 80% of the time, you are seeing both at the same time lower.
Dr. Justin Marchegiani: So think of it as like this, you have two credit cards, right? You’re only in debt on one credit card. Well, if you keep up your spending habits, it’s just a matter of time before you’re in debt on both credit cards. Does that make sense? Okay, just like that, and then five hydroxy. And these are all metabolites. So these organic acids, they’re metabolites of amino acids. And these metabolites give us a window into certain nutrients. And so as long as you have an understanding on what the nutrients are and what the area is, the actual organic acid doesn’t necessarily matter that much, FYI.
Evan Brand: I think I think of it and kind of refer to it as like the fingerprint of what’s going on or maybe the ash in the bonfire, you can see the evidence of what’s happened. You’re just kind of analyzing the ash and looking at the fingerprints.
Dr. Justin Marchegiani: Yeah, patients usually think of it as like gas in the gas tank. Is it higher? Is it low? I’m like, Nope, it’s RPMs and the engine RPMs is overly overly high or really low or really high demand overly low on the on the stimulation.
Evan Brand: Scroll down to that detox marker. I want to see what you can tell us about that one there that-
Dr. Justin Marchegiani: Let me just finished the neurotransmitters real fast. So five hydroxy acid that’s a serotonin marker. So serotonin plays roles in motility, mood, sleep, happiness. Another big one kind of urinate plays a really important role would be six right B six helps with the synthesis of all these nutrients. All these neurotransmitters and of course, kind of urinates brother or sister is anther urinate so this person has high xanthine Made in high kind of urinate. So we know there’s definitely a B six problem. And B six plays a really important role in neurotransmitters. So if you’re just thinking, Oh, I’m going to just take some tyrosine or phenyl. alanine, yeah, probably not the best, okay? Because you need the other nutrients there. And then also picolinate chronically low is a big sign of low amino acids and if we have low amino acids, it could be a catabolic stress issue. You’re just burning up a lot because you’re you’re a lot of Khattab catabolic stress, cortisol imbalances, hyper adrenal stuff, it could also be, you’re not getting enough protein, you’re not eating enough vegetarian V and not eating enough or you’re not digesting enough, it could be all of the above. And then we have our oxidative stress. Oxidation is losing electrons when you lose electrons. And you don’t have enough antioxidants like vitamin C, or a or E or good antioxidants like curcumin or resveratrol. Those help donate electrons. And if we are donating electrons, when we lose them, we can create free radical damage and that can chip away at our DNA and cause our DNA to age rapidly. Any questions on that last part?
Evan Brand: No, we’re good. Let’s run into the detoxes part.
Dr. Justin Marchegiani: Yeah, so this person right here is very depleted detoxification. So the most important markers here are these two, or these two tailed markers at the bottom, pirate, glutamate and sulfate. Very important, they all correlate with Bluetooth ion. So when I see low sulfate and low pirate glutamate that almost always means a glue to phi on depletion. So the big neurotransmitters here are n acetylcysteine, cysteine, taurine, glutamine refining, right? glycine, they all play a very important role in making our tripeptide most powerful antioxidant glutathione.
Evan Brand: Let me pose a question to you that some people will have at this section is they’re going to say okay, you mentioned gluta found depletion. So are you saying that there was a toxin issue, maybe a mold toxin that depleted the glutathione and or you’re saying that you may not even have the raw materials necessary to synthesize Bluetooth ion, right. So it could be a two pronged issue, it could be a depletion of glutathione due to toxins, plus the inability to make it is that what you’re saying? This could show?
Dr. Justin Marchegiani: Yes, so it could be one more variable so one, it could be a combination of exposure to toxins that are stressing out that pathway to you’re not getting enough good exposure to sulfur amino acids. Three, it could be not, you’re not digesting your protein well, right. And for when you get stressed part of the whole catecholamine adrenaline noradrenaline pathway require sulfur requires sulfur to help with that conversion and metabolism of healthy, healthy neurotransmitters. So you actually need sulfur on the neurotransmitter. So if you’re chronically stressed, you could also deplete sulfur that way,
Evan Brand: So each each your broccoli, folks as long as you can tolerate it.
Dr. Justin Marchegiani: Well, more importantly, yes, there’s a lot of sulfur there. But more importantly, like your animal protein, like you’re gonna get a lot of sulfur in there. But from an amino acid from a bulk amino acid standpoint, you’re going to get way more sulfur in protein from a caloric standpoint, as a percentage as a percentage of the food, you’re going to get a lot of sulfur and broccoli, but this is just low calorie, right. So you get more from a caloric standpoint with high quality animal products, or honestly, whey protein or college and proteins. Excellent, too, for that, too.
Evan Brand: Yeah, that’s what I was gonna say if somebody is listening, and they either maybe were previously vegetarian or couldn’t get back into the meats, maybe they were having issues digesting meats, we’ve got some really good like grass fed ways or some collagen hydrolyzed beef proteins. Those work amazing.
Dr. Justin Marchegiani: Yeah, or even just free form amino acids that are kind of been fermented that still are pretty balanced, they can, they can help get the needle moving on that. And then this to methyl hippuric can also be elevated due to xylene. And xylene can be in drinking water could be smoking, inhalation, vehicle exhaust, now, a different different nail polish those xylenes one of those things that could be an issue up there as well. It’s possible it’d be put on the list. I mean, most people we’re trying to educate them on healthy products, how you know, good water filtration, good, hygienic products. And then if we look down here below, this is gut bacteria. Now this person only has one elevated gut bacterial metabolite. And I tell patients like what we’re looking at here like this is typically bad bugs, usually more on the gram negative side. It’s not telling us what the bugs are. Could it be h pylori, could it be klebsiella? citrobacter? Could it be prepatellar morganella. It can be all those things. Right? Pseudomonas, it could be it’s just looking at the exhaust. So it’s like, okay, a car was was had their engine on they were in the garage, they left you show up to the house, you open the garage, I feel like there’s some exhaust in here. Like you may not be able to know Oh, that’s a four. That’s a Chevy. that’s a that’s a Toyota, you may not be able to know what car it is, but you can know Okay, something was in here. Does that make sense? And so it just tells us Okay, we got some exhaust of some bad bugs here. And we probably got to work on it. And now if we have the stool test, we can no okay. Yeah, well, you also test the positive for Pseudomonas and klebsiella and H. pylori. So that’s probably what that’s correlating with. I had a patient last week had a lot of bugs and he Laurie, and there wasn’t much elevated at all, I think this is the test. This is the person that had a lot of other big bigger bugs. And that can happen. I tell him, you, we don’t need both tests to confirm most of the time they do. And then I’d say most of the time, the organic acids, picks up the de arabba, Anatol, this picks up the the fungal overgrowth before the GI map or the stool test. So it’s good to have both, that’s a really good marker. And then a lot of times the if we see a lot of bacterial overgrowth here, that a lot of times would correlate maybe with a SIBO breath test where we do a lactulose. And we and we blow into it for three hours afterwards. A lot of times, we’ll see a correlation on that as well.
Evan Brand: Yeah, yeah, well said. And I think you made a great point here, which is that sometimes you’re not going to get the smoking gun on this test, the stool may come in and provide better data and vice versa. Rarely, the Candida shows up on the stool, though the the oat test is always going to be better for Candida at least 98% of the time.
Dr. Justin Marchegiani: Well, 100%. Now also, with induction, this may also give us a window into bio output, as well as poor protein digestion. So induction issues, you know, usually more purified protein work on HCl, of course, I’m always working on HCl Anyway, I’m just giving you a little bit more of an insight. Usually, with the lactate being on the higher side, that almost always means there’s a lot of extra probiotics in the system. So they may be taking a lot of lactobacillus or bifidobacterium. And usually these patients may get more bloated to those kinds of probiotics. And usually that’s common with SIBO. So we see a lot of the lactate, that can mean there’s other already taking a lot of probiotics, and then that may be a problem. And they may want to switch to a spore based probiotic or even just no probiotics, and maybe even a a low fodmap diet out of the gates. You know, those are different things just clinically, I noticed over the years. And again, when we look at this, we’re taking into account the patient’s adrenal tests, what’s happening with their thyroid? What’s happening with their their gut functioning, what’s happening with their lifestyle? Have they had their had they had mercury fillings removed? Has there been any mold exposure? What’s their diet? Like? What’s their digestion? Like? Are they pooping everyday, we’re looking at the whole picture. So some people may look at this test totally in isolation, not good. You really want to connect it to everything else that’s going on?
Evan Brand: Yep.
Dr. Justin Marchegiani: Anything else you want to highlight there Evan?
Evan Brand: If you haven’t had your organic acids test, reach out, let’s get it done. Let’s see what’s going on. This is an amazing test. If I only had like desert island situation, I only had one test to run, I’d honestly probably pick this one, wouldn’t you? Or what would you pick?
Dr. Justin Marchegiani: I would because you do get a window, what’s happening with the adrenals a little bit you do get a window, what’s happening with the mitochondria. And then you also get a little bit of a window in regards to what’s happening in the gut and detoxification. So you get a window of a lot of different things. And I love it with kids. Because, you know, kids don’t want to get their needle, get a needle in their arm, right. And so it’s really nice. This is a urine based test if you want to avoid getting a blood draw. It’s a really easy test to do out of the gate. So I do like that.
Evan Brand: Also. And it’s at home too, right? So if you got people that are elderly, or just you know, paranoid to go out, for example, in the public and go into a lab, hey, you do it at home, you get it back. I mean, how convenient does it get?
Dr. Justin Marchegiani: Yeah, and then also with this test, you got to be careful if you’re chronically low protein. This is running it off of creatine. So if creatine is too low, which is a protein metabolite, you could get some, some false readings on the on the lower side. So you got to make sure there’s a protein in the system. And so if you’re dealing with someone who doesn’t eat much protein at all, you know, we’ll typically throw in some freeform amino acids for a couple of weeks ahead of time. That way, those systems at least have the substrate to move metabolically, if you will.
Evan Brand: Yeah. Great pointing out.
Dr. Justin Marchegiani: Anything else you want to say, Evan?
Evan Brand: I don’t think so we’ll give the links to people. If you enjoyed this, please let us know. I know this was kind of fast, and maybe a little overwhelming, because we’re breaking down. But for us, this is something we do all day every day. And of course, for your unique situation. We’re going to talk you through what’s going on what you need to do, how to fix it. But give us some feedback. So like I said, if you’re on Justin’s YouTube channel, right in the comments, do you like these video versions, because a lot of times you and I are just riffing on stuff. But if people like the videos, we’ve got so much stuff that we can uncover. We’ve got literally 1000s of case studies, we can start reviewing, if you want to see before and after, like, Hey, here’s a protocol we implemented. And you know, we’re not going to give exact dosing and say, Tell it tell you to do it, but we could run you through what we do, if you like it. So let us know because we really need the feedback to help guide the show.
Dr. Justin Marchegiani: Yeah, and also, we’re trying to be different than other people that are talking about these topics, because they’re not in the trenches. So we’re in the trenches. So, you know, our kind of unique proposition for y’all is that we do this every day, and we want to provide valuable information that’s actually actionable. And is it’s real, it’s something that we’re in that this is the patient from last week that I’m talking about here, right? And so we’re trying to provide actionable information and if you see this and you kind of get a little bit overwhelmed, it’s okay, it’s normal to feel overwhelmed. We review 1000s of these tests, it takes a couple you know dozen to kind of get your get your, your feet wet, so to speak. So just an FYI, if you get overwhelmed, not a big deal. If you work with us as patients, you know, we typically go over these things a couple of times and then usually patients have questions a month or two later after the test. We always go back. Part of being a great clinician is you have to be a great teacher. So if anyone feels overwhelmed with it, don’t worry, we tend to take these things, boil them down, make sure you have the key action components. As long as you have the action items, that’s the most important thing. And if you want to reach out to someone like myself or EvanBrand.com you can reach out to Evan. Evan has the same philosophy you got to have a heart of a teacher. And then Justin Health myself, Dr. J at JustInHealth.com. There’s links there for you guys to click. If you enjoyed it, let us know. If you want to dive in deeper. Let us know if you want to support us in any way you can always purchase any of the labs or supplementation from our website. It goes to help fund this show and make it all possible. Evan, anything else you want to say?
Evan Brand: I don’t think so. You covered it. And please subscribe if you’re not already, you know, I looked at our statistics and a lot of people that listen, they’re not subscribed, so make sure you hit subscribe. I think with no ads and all killer, no filler content. This is a much more listenable podcast, I tried to listen to a couple health podcasts the other day. And there was like an ad in the beginning that was like five minutes. And then there’s like right in the middle of the conversation. There’s like another ad and then like an ad at the end. I mean, I think people take us for granted with our adlis shows I might have to start doing ads just to you know, tell us Hey, didn’t you miss the ad free days?
Dr. Justin Marchegiani: I know man to do that with the switch. So if you enjoy it, let us know and support us down below. Alright Devin phenomenal chatting with you today. We’ll be back next week everyone share, thumbs up comment-
Investigating Your Adrenal and Hormones With a DUTCH Test | Podcast #327
In this video, Dr. J and Evan talk about the adrenal glands in our body – to produce certain hormones directly into the bloodstream. These hormones will respond to stress and other necessities to our existence. Also, they are discussing the detailed test needed to identify the root cause of problems and what other materials and hormones are essential to keep our adrenals and body healthy.
To support the body naturally, Dr. J recommends using herbs such as maca and ashwagandha. Progesterone, estrogen, and estriol may be fit for a patient. However, it is essential to know that protocols may be different for every patient since presentations and lab results may differ.
Dr. Justin Marchegiani
In this episode, we cover:
0:20 Labs At Home
5:07 Low Cortisols
11:09 Dutch Tests
28:19 Useful Herbs
34:47 Healthy Estrogens
Dr. Justin Marchegiani: And we are live. It’s Dr. Justin Marchegiani in the house with Evan Brand. Today we’re going to be talking about hormone and adrenal lab testing what we’re actually using in our virtual clinic to assess our hormone imbalances in our patients and different things that we’re doing to address those imbalances. Evan, how are we doing, man?
Evan Brand: Good, excited to get back in the saddle here and talk about something that we can test at home, which is amazing. I think that’s the first benefit to point out about some of the testing you and I are utilizing is that many people now they care more about their health than ever obviously, the state of the world has convinced people that health does matter. You need to prioritize this stuff. And so we can send these labs to your door. And so the test that you’re going to be showing people today will be something that you can do if you’re listening via audio, you might miss the visual, you can go to Justin health YouTube channel and see the video, but we’ll be sure to make sure we talk about it in a way that you can still understand even if you’re just audio only today.
Dr. Justin Marchegiani: Yeah, if you’re listening to the audio, we’ll put a link down below for the video so you can see it. And also if you’re listening, you can go to Justin health.com slash YouTube and hit subscribe. Alright, so let’s dive in. And so we deal with patients from all over the world virtually that have all kinds of different hormonal imbalances. It can range from a menopausal woman with lots of hot flashes, mood issues, vaginal dryness, depression, skin elasticity, hair loss issues, it could be a cycling woman that has a lot of PMS. pmdd breast tenderness, cramping, back pain, mood issues, irritability, also infertility as well. And then it was a lot of different imbalances in between excess androgen issues like we see in pcls, polycystic ovarian syndrome, we may even see estrogen dominant issues just like which could be PMS as well. Could be infertility, could be fibroids could be endometriosis could be fibrocystic breast issues, all of these things are on the table and of course, even manage a male issues to could have men could have excess estrogen and or low androgen and or low or high cortisol and or low or high Da, da all these imbalances are potential, I always tell my patients, you have the right to have more than one issue at the same time. And you can also have a hormone imbalance and also have multiple gut infections too. Of course, it’s all possible, right?
Evan Brand: Yeah, people hearing that too. They’re like, what the heck kind of mumbo jumbo? Did he just say, and how does that manifest? Well, you know, low libido, too. I mean, that’s one that I’d say at least 90% of the people I’m working with, that’s a question we always ask is, you know how you drive. And sex drive is always terrible for people. I was actually a study that came out. And the vast majority of people surveyed said that they would rather scroll on their smartphone on social media than have sex with their partner. And I thought, Oh, God, is that where we are in the technology world that the phone is more desirable than our partners? That’s no good.
Dr. Justin Marchegiani: Yeah, definitely not good. 100%. So I just kind of laid out a couple of potential patterns there, we’ll kind of dive into them one by one will actually show you a real live patient lab here for y’all to kind of look at obviously, it’ll be centered regarding who the patient is. But we’ll put all that information out there for y’all. So you can kind of see how a lab looks out of the gate. So one of the first things that we do when we look at a patient, male or female, we’re going to look at adrenal function. And adrenal function is very important because your adrenals make cortisol. Cortisol is an anti inflammatory hormone. Most people in today’s day and age, they’re not under inflamed, they’re over inflamed. So having your body’s natural anti inflammatory system on board is vital, very, very important. Second is cortisol rhythm. Cortisol rhythm plays a major role in your circadian rhythm, which is waking up energy in the morning. Having good rhythm helps a lot with mood, and also lower cortisol at night. And that nice gentle taper of cortisol. So cortisol starts, it starts mid range, when you wake up, and in that first 30 minutes to an hour, it almost doubles. And then from there, it tapers down throughout the whole day. And we want a nice lower cortisol rhythm, lower cortisol level at nighttime, so we can wind down and relax not too low, when we start having maybe blood sugar issues, which could wake us up at night and not too high, where we could have problems going to bed because we’re too wired right, or not a reverse pattern, we’re lower in the morning, which means low energy and higher at night, relatively speaking, which could cause us to have too much energy at night and then we don’t get good sleep. So the adrenals play a really big role because of cortisol and its effects on anti inflammatory mood, rhythm, sleep, and then also especially for women listening men too, but da da da da sulfate is a precursor to a lot of our sex hormones, that helps with our female hormones. And that plays a big role in healthy, healthy reproduction. people. People think when they talk about female hormones or just thinking about having babies no your hormones there to reproduce you Yeah, reproduce the baby but also reproduce you which means healthy aging, healing recovery as a man to healing recovery. Healthy libido, good muscle building. In good building the ability to turn over your tendons and ligaments and bones, all these things require good healthy anabolic metabolism.
Evan Brand: Yeah, great point. You know, one thing you pointed out, which I think a lot of people miss with cortisol is you mentioned cortisol being too low at night and that impairing your sleep. See most people just a buzzword, or if they’ve ever heard of cortisol, they’ve heard of adrenal testing and things like that. They think, okay, high cortisol at night equals poor sleep. But you mentioned low cortisol at night or too low cortisol at night could also be an issue because of that blood sugar. And then what can happen is you and I’ve covered this before, but there’s some sort of a spike, right? Maybe an adrenaline cortisol spike in the middle of the night, is that what you think is happening?
Dr. Justin Marchegiani: Yeah, so with sleep issues, you could definitely see a low cortisol kind of going into nighttime or low cortisol during the night. And that can cause a drop in blood sugar, and that drop in blood sugar can then signal a increase in adrenaline. So adrenaline tends to come to the scene first, cortisol tends to come to the scene 1020 minutes later, or so. So you get this spike of adrenaline that’s very stimulatory, that increases cortisol. And then now you’re alert and you’re waking up, right? So we want to make sure higher cortisol, lower cortisol at night that’s causing a increase in cortisol is not happening due to blood sugar regulation. So we want good blood sugar, good healthy protein, and fats, maybe work on amino acids and melatonin production at around bedtime, and maybe have something by your nightstand to help stabilize blood sugar before in your end. Or if you get up like a nice simple college and smoothie, or a really good protein and fat base, simple bar by your nightstand to stabilize blood sugar, those are all really really good options to help you on the sleep side.
Evan Brand: So like if you had a good quality protein, fat, maybe some carb starts with dinner, but let’s say I don’t know, 9:10pm, you go to have a snack and you just do. I don’t know popcorn or I don’t know, handful of strawberry, some kind of a simple sugar, you think it’s possible that your glucose could spike and then it will crash in the middle of the night if you’re doing something too simple or too high on the glycemic index?
Dr. Justin Marchegiani: Well, it depends on how blood sugar sensitive you are. I mean, the two examples you gave are two different things, right? Because grains and popcorn are going to be a little bit more higher glycemic, higher sugar stuff, strawberries, pretty low glycemic and a lot of fiber there, so probably not as much with the strawberries. But could you have some strawberries and maybe a spoonful of almond butter, right or some kind of a good fat or protein probably better, right? It just depends upon what time you’re going to bed and what time you’re eating. Usually you see people that are eating around five or six o’clock dinner, and they’re going to bed like around 11. And there’s like a five hour gap between their last meal and sleep potentially. And again, it has to do with how dysregulated their blood sugar is and how weak their adrenals are. So it really depends. But if sleeps an issue, that’s one pattern we want to look at. We talked about da da playing a big role. If you’re a female going into menopause, that means your egg follicles are being used up essentially. And you’re not going to get that hormone production from that follicle that’s now no longer there. So we require a lot of the DA DA from our adrenals to now be made. And if our adrenal reserves on da, da are low, guess what? We’re not going to have that that backup battery that we had already to go right we’re in middle of, we’re just coming out of a bunch of storms in Austin here. And if you didn’t have a generator ready to go, guess what you you went without power for a while, well, that’s kind of like going into a spa, menopause is going into a storm with a generator that’s maybe three quarters empty. And so the adrenal is play a really important role as the backup generator for sex hormones. And so the better that generator is charged up, the easier you’re going to sail into menopause and not have all the hot flashes and mood issues and sleep issues and skin issues and hormone issues and vaginal dryness issues that you may have with lower sex hormone reserves.
Evan Brand: Yep, well said you’re ready to show us this thing. I’m sure people that are on video want to see what the heck we’re talking about. We can see some of the rhythms and also da da is measure two, which is cool. So when we talk about a cortisol test, we’re getting a lot more than cortisol to right we’re getting melatonin also.
Dr. Justin Marchegiani: Exactly. And then one last thing to look at is PCOS, which is also common. You see it more in younger women, you know, 20s and 30s. But blood sugar issues high level of insulin, this can really jack up testosterone and this can do a whole bunch of issues in regards to abnormal hair growth, you may see an increase in libido, some still go down. And then of course, weight gain is going to be another another big side effect there. Let me share my screen with you so you guys can see an actual lab test for y’all. Okay. All right. So while I get that going here, in the meantime, anything else you want to say about that, Evan?
Evan Brand: Well, you and I were talking about this before we hit record and that was the idea of retesting hormone. And so you thought well, based on a lot of people with progress, you don’t necessarily need to incur the cost again. So a lot of times you and I may run this as an initial snapshot, but depending on symptoms, you may not need to do this over and over and over again because a lot of the support We’re using a pretty broad spectrum. And they’re going to help regulate your rhythm regardless of where it’s at. Right? So initially, we may want to tweak one thing a certain direction or the other, but long term care wise, you and are using things that are pretty, would you just stay state stabilizing, not necessarily a big sledgehammer to the hormones.
Dr. Justin Marchegiani: It depends for me. So if someone has very, very low cortisol levels, or very, very high cortisol levels, and or significant estrogen dominance and low progesterone, the more significant the hormonal pattern, the more significant the imbalance, the more I want to retest less significant if we see corresponding symptomatic improvement, usually it becomes less necessary because the patient knows they’re getting better we can feel it, we can see it in their their physiological activation and how they’re sleeping, their mood, their energy, their libido, we can you know, their cycle, there’s just so many things that are improving that the patient is confident that we’re good. And if the imbalance isn’t major, right, they’re not a fertility case. They don’t have a major hormonal imbalance right there that may not be necessary, but I always kind of I’m on the fence always give the patient the ability to to make a decision on that. So this is my screen here, Evan, are you able to see it?
Evan Brand: Yep, we see it just fine.
Dr. Justin Marchegiani: So here’s a Dutch test that’s done with a patient whose kind of perimenopausal menopausal, meaning their cycles kind of been on and off hasn’t really had it for six to eight months or so kind of in that area of transitioning into full menopause, which is usually not having a cycle for a full year 12 months in a row. So they’re kind of in this Peri menopausal phase, and usually perimenopause and start to hit in your, in your early to mid 40s. When you start skipping months, maybe you start having some hot flashes like symptoms, whether it’s mood or libido or a hot flash stuff. And again, it’s always tough to say because perimenopause can easily feel like PMS too, right? I think that the biggest differentiating factor is not having all the hot flashes and not having the skip cycles. When it comes to more of the PMS like stuff, that’s usually a distinguishing factor. But we look at the Dutch test a couple things here. This is our cortisol pattern, our daily free cortisol pattern. And you can see you wake up here at a and your cortisol should taper up in the morning, this isn’t within the first hour and then go down throughout the day. So this patient actually started with a here, right, this is cortisol with a pretty good rhythm out of the gates. But instead of picking up 100% or so they actually went down. So they started here that having that nice rise, they went down This is big, this is a big problem, right not going to have the energy you’re not going to have that good rhythm that good up and Adam kind of energy in the morning and they trace low the entire day, relatively low and flat the entire day. So we call this a flat cortisol rhythm relatively speaking, it’s flat, they should be starting here a peaking up at B and then gently tapering down throughout the day. And they basically start at a at their highest point. And they go down throughout the day. So very low and flat cortisol rhythm. Now when we look at their cortisol levels, they’re free cortisol, which is a+b+c+d, this is what’s represented on the graph here. And again, if you’re listening on the podcast, click down below to watch the video link if you want, if not, we’ll just try to describe it. They’re free cortisol when you add a plus b plus c plus d is 73. That’s very low. So if you see this little gauge here, imagine this is like the volume knob on your stereo, this is all the way up high this star and this on the left all the way up low. So they’re almost all the way till the to the left. It’s like their volume knob is like 5% on it’s like having a whisper out of their stereo. So 73 is very, very low. Now this is the cool part, right? So normally with a salivary test, right, the Dutch test is the dried urine for testing comprehensive hormones. The benefit of this test is we get a window into free cortisol, but also total cortisol could its urine with a salivary test, we’d only be able to see this 73 number, which is the which is the free cortisol, that’s two to 5% of all cortisol is free, and biologically available. The other total, which looks at the free, which is the two to 5% Plus, everything else that’s protein bound, is give us a window into all of our cortisol, we’re making them this is the cool thing. We never would have this number on a free cortisol test from saliva. But you can see their total cortisol, which is everything is very high. It’s 93 04. Right? It’s way off the charts. Hi. So they have very, very, very low free cortisol, very, very, very high total cortisol. So there’s not like an adrenal fatigue issue or like a low adrenal pattern. Even though the cortisol is low, their adrenals are making a lot of it right. And this is a common pattern we see when there’s HPA access dysfunction. So if you go down to this page over here, you’re gonna see what the HPA axis is. I’ll go back and I’ll just explain this in a minute. But if we go down to this page here, the HPA axis we have this feedback loop from the hypothalamus and the pituitary. This is the HP portion of the HPA axis. And this communication feedback loop talks to the adrenals where we make cortisol with We make DAGA. And we have our free cortisol, we have our total cortisol, we have our DAGA, this feedback loop from our corticotropin releasing hormone to the adrenal corticotropin releasing hormone. This feedback loop is our HPA access. And when this starts to break down, and that feedback loop that miscommunication happens, this is where we start seeing a very high amount of total cortisol and a very, very low amount of free cortisol. Does that make sense out of the gates questions they’re having?
Evan Brand: Makes perfect sense. So what do you do?
Dr. Justin Marchegiani: Yeah, so let me continue to roll with that. Let me go back up here a little bit more.
Evan Brand: DAGA production look good there, though. That was nice to see.
Dr. Justin Marchegiani: Let’s kind of break it down. So I always hit things like this. I might order of doing things that way. I don’t miss anything. So the first thing I look at is cortisol rhythm. How’s the cortisol rhythm? Good in the morning. A and then B, C, and D morning after night are low, low, low. So normal, low, low, low. So definitely poor cortisol rhythm. How’s the cortisol amount? Well, free cortisol is low. Okay, total cortisol is high. Now, so I tend to treat someone more in the middle in regards to their adrenal support, I won’t over support their cortisol too much, because we know they’re making a lot. So we’re really going to focus on an in between amount of cortisol and more HPA access support in regards to adaptogenic herbs, we really have to support good adaptogens. This being a menopausal woman, or Peri menopausal, we’re going to support the adrenals. We’re going to support HPA access. And we’re also going to use herbs to support the estrogen and progesterone receptor sites, we’re going to do both Okay, so you can see her now the next part is sex hormones. So we talked about the total cortisol right free cortisol, low total cortisol high strong HPA access pattern, and then the sex hormone wise, estrogen Astra diawl is low. This is primarily the hormone that’s going to be used in cycling women, progesterone is low, they’re both equally low, you see how they fall in the same place in the dial. So if you’re looking at the volume knob, they’re both in the same place, they’re both low on the volume knob. Usually with estrogen dominance, we’ll start to see the estrogen knob higher up relative to progesterone. So that tends to give us a good ratio if we’re intact. So estrogen to progesterone ratio is good. But the hormones are just low altogether. And then testosterone for a perimenopausal woman it’s in the bottom 25% of the range. Not bad. For a perimenopausal woman, you know, top 25 or top third to half is ideal. Not bad at all.
Evan Brand: And this woman was not doing anything correct. She wasn’t doing any dapa or testosterone support-
Dr. Justin Marchegiani: Correct. And then I ignore total da da, I look at these numbers individually here, I look at da da sulfate, eat a clan alone and I look at them all separately. Her total da da number it looks okay. But that can give you a false interpretation. And again, I’ve been doing labs like this lab for six years, I’ve been looking at hormone labs for over a decade. So I mean, I’ve done 1000s of these things. So I always try to boil it down to the to the patterns and the data that matters and ignore the fluff.
Evan Brand: So how would this woman feel I think important to mention, you know, all these numbers, people may look at this and think okay, this looks like Greek so can you just explain how would a woman with that pattern be feeling we’re seeing that cortisol was okay?
Dr. Justin Marchegiani: Peri menopausal symptoms, a lot of Peri menopausal symptoms, libido, mood, hot flush stuff, skipping cycles, of course, low energy, mood stuff, all of those things are present for sure. And then look at her DAGA sulfate here, right? This is the backup generator of the sex hormones to the bottom 25% of the range. So this is the dial here, right? 170 she’s definitely on the lower part here that bottom 25% I like to group things based off a percentage, then the actual numbers don’t matter as much like I just say, hey, you’re in the bottom 25% of the reference range. I like my patience in the top half the top 25% or so. So I always look at things as a percentage. That way you don’t get overly infatuated on the numbers, the numbers can kind of confuse things testosterones in the bottom 25% not as bad there. But I mean, if we get the DAGA to the mid range, that testosterone should take care of itself because that’s gonna trickle downstream from DAGA to Android to testosterone. All of her androgens are okay, they’re all mid to upper 25% no problem. They’re her hormones are pretty balanced in regards to five alpha reductase. This is kind of the enzyme is very important to things going down a less androgenic pathway versus like DHT, which can be more associated with hair loss and prostate issues. And then if we go look at her estrogen levels over here, so this is progesterone, progesterone is calculated by pregnant a dial press plus alpha prineta dial so alpha and beta combined and we already saw her levels here. This is 1.9. I don’t know why the lab doesn’t show that number here. It should it’s like an error, but it’s 1.9 should be the progesterone number Now go look at the estrogen and that’s low. I mean from a cycling female we want at least 10 ideally 15 on the progesterone and then if we go look on the estrogens right, she’s low across the board. So estrogen is he one you know how you know it’s you want it has plenty in it, right? And that’s how we know it’s a one. And then Astra dial, this is your primary cycling estrogen. And it’s easy to because it’s got the prefix di and their di meanings two right, like two sets of dice die. And then we have estria, which is e three and the TRI prefix is how we know it’s e three. So for short e one e two, e three, or estrone estradiol estriol. And again, Esther dial will predominate when you’re cycling more, and estriol we should shift when you’re more menopausal, okay. And we tend to support more estria when they’re men appointment, women are menopausal. So her estrogens are pretty low across the board, you can see that you know, it’s gonna, these are all the metabolites downstream. But you can see, and again, if we want healthy estrogen metabolism, right, we have e to e4 and e 16, which are a different estrogen metabolites. And then you can see here, it goes down this protective pathway from a one to two hydroxy astone. And then that goes down into it and gets methylated into two methoxy. estrogen. And you can see here, right to keep it really simple. This 2.5 number on the estrogen metabolite should go down this pathway, at least half of that should be metabolized. It’s not so you can look at this at this methylation gauge. Don’t look at the numbers, just look at the gauge. So her methylation activity for metabolizing. Estrogen is actually low. So this is not getting fully metabolized. Now, why is that a problem? Well, one, she’s not metabolizing estrogen to her estrogen levels are low to begin with. So it just tells me that there’s some methylation detoxification issues that are a problem. Why could that be a bigger problem? Well, if we start supporting more da, da, maybe start supporting hormones better, this could cause a backup in regards to her hormones being metabolized, we may want to really work on supporting extra sulfur groups extra methylating nutrients, so there’s not a clog in these hormones getting metabolized. So, in general, we want to see at least half of this getting metabolized downstream. So if we look at two hydroxy, one, we want at least 1.25 there. And again, forget the numbers, it’s all represented in the gauge. So I want this gauge at least mid range. If the gauge is not mid range, and it’s on the lower side, it tells me we’re not metabolizing or methylating, our hormones actively, you know, as optimally as possible, and we may want to provide supporting nutrients to help that.
Evan Brand: So let me ask you this, if a woman, maybe she had run this and got the analysis from you, but then she just went to her conventional hormone doctor down the street, and he goes and puts her on some estrogen and maybe some progesterone, maybe some testosterone, how would that differ in terms of outcome based on this versus what you’re going to do?
Dr. Justin Marchegiani: Well, number one is they’re going to look at your extra dial just via the blood. And that’s okay. But it may not be able to look at free SSL dial as well. And most of the time, they’re not going to time it up at the right time of the cycle, you really want to time some of these things up around day 20 of the cycle to get a window of where progesterone is at. And then of course, you have to compare it to where in the cycle it is. And the next thing is no one’s going to look at how it’s being metabolized downstream. So we get a window into our total estrogen. All of our estrogens e one, e two e three, not just extra dial, we’re getting a window of progesterone as well. We’re getting a window into our androgens, we’re getting a window into d h, EA and our testosterone. And then we’re also looking at how it metabolizes downstream from 16 hydroxy from four hydroxy and to two hydroxy to four and 16.
Evan Brand: And then what’s the protocol? What’s the protocol for this woman?
Dr. Justin Marchegiani: So it depends. So off the bat, we may want to support estrogen metabolism a little bit better. That could be giving something like NAC it could be giving something like glutathione, it could be doing something like indole, three carbinol DIMM, or calcium to glucose, they could all be really good options. Even just giving some extra fiber could also be really helpful. Just to help out of the gates just to make sure there’s no bottlenecks there. Number two, we would support the adrenals accordingly, okay, we would support sex hormones as well. So depending on if she’s cycling or not, because remember, this woman kind of was skipping cycles. We would definitely do herbs like different kinds of phenotypes of Makkah that we use I use a product called feminine essence menopause as a special phenotype of Makkah. You can get that adjusted health.com slash shop and the female hormone section that’s wonderful because it works on upstream HPA axis. We may work on the in different herbs to help the HPA access to like ashwagandha which is wonderful at modulating that hi level of cortisol. And then depending on hormones, we may want to throw in some progesterone, especially if she’s cycling in the last half of the month. And we may want to throw in a little bit of estriol. It depending on if she’s cycling or not, if she’s transitioning into menopause at her age, right 52, I think is the age of this patient. Well, the average age of menopause is 4852. So she’s definitely on the later side. So she may be transitioning into menopause. And if she has no cycles for a period of time, we may want to throw a little bit of estriol in, but if she’s not, if she’s still cycling, we don’t want to do any sgl. Right now, we want to focus on good healthy herbal support for astron production, we want to focus on good da ta support, we want to focus on progesterone, the last half of the month, we want to also focus on good estrogen metabolism. We want to focus on really, really, really good HPA access, support, all of those things are going to be really, really important. I’m not going to give like an exact protocol on dosing, just because it’s you know, this is a very general kind of thing right now, I don’t have the patient in front of me, but it just kind of gives you a good idea. What what I’m looking at there.
Evan Brand: Totally. So someone may think, oh, they saw that high metabolized cortisol and they may need, they may think they need to come in and do something like relora, which a lot of people talk about to lower cortisol, that is not the right choice to do because her total, or the free cortisol is already on the low end. Correct. So like at nighttime, like if this woman says, Hey, I’m not sleeping good at night, you’re not going to come in and use relora are you because that would take the low situation and make it lower? Is that right?
Dr. Justin Marchegiani: I wouldn’t give something that would lower the free cortisol more like something like a phosphatidylcholine or serine. Right. But I would do some things to calm down the HPA axis for sure. So things that really can help calm it down. Because that total cortisol being really high is what’s telling me that there’s definitely HPA access issues. But I mean, you know, it’s possible some of these symptoms could could kind of conflict because our free cortisol so low and our total cortisol so high, but I wouldn’t overly lower the free cortisol, I would just focus more on adaptogens to help modulate over cortisol. Just the the overactivity, the overstimulation of the adrenals the whole, and that would still come in there and support with some pregnenolone and dapa as well. I wouldn’t overdo it either, though, because her cortisol is total on the higher side. So this is where it’s really important. Like, it’d be really easy to want to give this woman a lot of licorice and a lot of pregnenolone. Some of that may be necessary, but you may want to just take the fact take into consideration that she has a total cortisol level that’s very high. And we may want to have some kind of in between those. So we got to really look at that total cortisol production in relationship to the free not overdo it.
Evan Brand: Yeah, what you’re saying is because she’s desperate to feel better, right? And you want to give her more energy and you’re going to look at that rhythm and say, Okay, yeah, it’d be great to give her a boost here some licorice at breakfast time and maybe some lunchtime dose to perk her up. But you’re saying you can overdo it because of how high the total is in this case.
Dr. Justin Marchegiani: Yeah, very easy to do that.
Evan Brand: Yeah. And so then that would manifest how maybe anxiety heart palpitations, insomnia.
Dr. Justin Marchegiani: If we overdo it, yes, harpy, potentially heart pals, potentially insomnia, potentially, anxiety, all of those things are potential issues that you may see a problem with.
Evan Brand: Yeah, and this is why we love to to mix herbs to right you’re rarely going to be using an urban isolation, right? You’re going to be coming in possibly with ashwagandha. But you may come in possibly morning. Maybe she could benefit from something like some eleuthero. Some holy basil, maybe some other more stimulating things. If you don’t want to go too high on the licorice. Is that what you would do?
Dr. Justin Marchegiani: Correct. Yep. 100%. Cool. Any other questions there so far? It’s great to see it.
Evan Brand: I think this should should help a lot of people.
Dr. Justin Marchegiani: Yeah, in general, you really want to make sure you kind of clearly delineate where the patient is in their in their hormonal pattern. I think it’s really tough. The hardest part is when you have a woman who’s perimenopausal who’s still cycling, but is starting to not cycle and starting to switch into menopause. Because you’re kind of you kind of have two ways to handle a woman if they’re still cycling versus they’re not because hormones have a rhythm, rhythmic fashion, and you want to add them in, pull them out. And if a woman is more menopausal, you can keep hormones really in throughout the month, you’ll have to cycle them as much. And so I always err on the side of treating a woman like they’re cycling until they clearly delineate that they aren’t cycling, because if I start getting hormones monthly, daily, and that could throw off their their cycling pattern. I don’t want to do that right first, do no harm. Let the body clearly delineate where it’s at in regards to its natural hormonal patterns. So the hardest part in dealing with women, is if they’re perimenopausal transitioning to menopause, I really want their bodies to clearly show me that they’re ready to stop cycling and that’s why I always treat them like they’re cycling until it’s crystal clear they aren’t.
Evan Brand: Yeah, and then that The most common time for symptoms, right? So that’s probably the majority of what what people are going to feel in that stage of their life, they’re going to feel the most symptomatic in that transition time, or at least in what you and I’ve seen, this is probably the most common time a woman’s going to reach out for help.
Dr. Justin Marchegiani: 110% Yep. So it’s really, really important to kind of take a look at that and make sure that we keep that in mind. Absolutely. And then also, you know, we have different estrogen metabolism risks, right, we have different estrogen metabolites. So if we look over here, we have e one, e two, and E three. And when you look at these different metabolites, you know, he one tends to be a little bit more, you know, safer, right? He one tends to be a little bit more safer in regards to his to his detoxification, okay. And then when you look at e4, or sorry, two hydroxy, estrogen, right, or Astra dial here, this can go down pathways as well, are four that could be a little bit more damaging to DNA. So our four hydroxy, could be a little bit more damaging, as you can see.
Evan Brand: Let me ask you this real quick. So if you scroll down a little, it’s showing how on that pathway, you can get DNA damage, it’s showing reactive there. So we have to factor in what we learned from the stool test into this also, right, because if we see like a high beta glucuronidation problem due to bacterial overgrowth, isn’t that going to mess up this same pathway or my..?
Dr. Justin Marchegiani: Yep, it definitely can. And you can see here with the different, you know, metabolites, right, your four is going to be a problem area, right? So you’re for your your two hydroxy. Your two hydroxy going into the this four hydroxy right here could be a problem. Two hydroxy tends to be a little bit less damaging right here, especially if you have good CMT and methylation, when you go when you because all these things can can conglomerate. So you can see how e one e two and E three can all go side by side, they can all transition. But then you can see they can go down to 16 pathway, which tends to be a little bit more gentler. It can go down the four pathway, which can go into reactive oxygen species, it can also get methylated, right? What’s methylation, full eight, B six, right? b 12 really helps support methylation, Coleen, and then also gluta phi m can help decrease a lot of this too. So healthy gluten diet and healthy sulfur, healthy cruciferous vegetables, healthy digestion of our animal products. And that can help a lot of this, this methylation issue, and detoxification. And then of course, we have our E, two hydroxy. Over here, which again, methylation is very important, full A B 12. b six, Coleen, right, healthy cruciferous vegetables are going to be really important if you’re here. And we can even if it’s really high, we can even do things like dim, we can do things like calcium to glucose, we can do extra fiber, things like that to help bind it up.
Evan Brand: And the reason you’re saying this is so important is because we need to get out these excess hormones, right, we don’t want them just sitting in the tank, so to speak, after they’ve gone through this process. So you’re saying the gluco rate, the Bluetooth ion, the methylation, these are all the processes in the body to get rid of these, once they’re done is I don’t know what the right word is. But once they’ve been used by the body-
Dr. Justin Marchegiani: -agreed, though, your body will conjugate them bind that proteins to them and excrete them. And so we’re gonna really focus on a lot more gluta phone support more sulfur amino acids. If we see this guy over here, the four hydroxy ones higher. And then of course, you know, you can always give sulfur support methylation as well, which is going to be the B six, b 12, full eight, Coleen all of that as well. And this will support both of these two methoxy, two hydroxy, as well as four hydroxy. One, all of these are going to be very helpful, you can’t hurt to support any of those. And if we have anyone that has, you know, estrogen cancer, you know, risk? Well, we tend to if we need estrogen in someone’s more menopausal, we’re going to try to support more estria, which is going to be more cancer protective. But if someone has a previous cancer history, we probably will not do any hormones at all on the estrogen side. And just focus on progesterone as long as their their cancer is not progesterone sensitive, and good, healthy herbal support to help modulate some of the receptor sites.
Evan Brand: Yeah, awesome, awesome question there. This ties into a lot of stuff we do with the gut to which is really cool, because we’re often going to be in detox to we’re often going to be using Bluetooth ion for mold or chemical toxins, we’re going to be using calcium D glue, great to help with zero unknown or other mycotoxin removal, we’re going to be using possibly a methylated multi based on what we see with poor mitochondrial function on the organic acids test. So the cool thing that I’m seeing here, the trend is that the whole picture works together. So by working on the other body systems, we’re already really fixing the majority of stuff we’re seeing here plus the addition of some of the extra hormonal support.
Dr. Justin Marchegiani: Yeah, exactly. And then kind of the general ratio of healthy estrogens, is we like to see a kind of, you know, we have the, what’s called the estrogen ratio, where we look at Astra dial thrown relative to 16 hydroxy. Right? So it’s like we’re looking at basically each one. I’m sorry, e to e4 and 16. We like to see a higher level of 16 in relationship to four and two, right? 16 tends to be more cancer protective. Why? Because most of its coming from estriol. And then you can see two and four tend to be a little bit more from stronger estrogens, e two and E one are stronger estrogens, e three is a weaker estrogen. So we kind of have our two, four and 16 metabolite ratios, right. So you could say to four and 16, we want to have higher levels of 16 in relationship to lower levels of two and four. And again, it just depends upon how the metabolism is to right. If we’re metabolizing these things well, not as big of a deal, right? Because why these hormones come up higher typically is where they’re getting the hormones in our body from, from hygiene products, from plastics, from chemicals in our environment, or we’re just not metabolizing them. So we make sure the lifestyle components are dialed in, where we’re not getting them in our body and to we make sure that we’re metabolizing them as well. Does that make sense?
Evan Brand: It does it does and why we’re not metabolizing metabolizing them, I just wanted to make that clear to people that could be due to gut issues, right, there is a gut hormone component here.
Dr. Justin Marchegiani: Yeah, so the beta glucuronidaze enzyme really helps metabolize a lot of estrogens. And when beta glucuronidaze goes high, it takes the SD estrogens that would have handcuffs on them or a straitjacket on them that would be escorted out of the body. And it breaks those handcuffs and allows them to go back into general population. And so having good healthy gut levels is very important. Now, if you come down here a little bit more, this is kind of cool. We look at melatonin levels, patients mid range, not that big of a deal. These are the same markers over here. So we’re not worried. This is cortisone pattern, I don’t really care about it, it almost always is congruent. What we see on the cortisol side, you can see this kind of with more emotional stress issues. This is more like inflammatory stress. But almost always, they always tend to have a similar pattern as the other side. So I don’t really care as much, because you can see the cortisone pattern is almost the same as the cortisol pattern, right? And that’s not going to change protocol. It’s not going to change protocol. And the cortisol is the more physiological active compound, right? cortisol gets gets broken down downstream to cortisone, which is a weaker kind of metabolite, it’s the weaker sibling. So it’s not quite as it’s not going to be the stronger one we’re worried about. And these are all the same numbers on here. This test is very confusing if you don’t know what you’re looking at, because there’s a lot of repetitive data. That’s just more I think, so people don’t have to scroll around as they’re going over the labs. It’s kind of repetitive for the doctor so they can explain it to the patient. But if the patient’s looking at it, they think, wait, this is new, this is new, this is new. It’s just like this is like the third time they’re saying it not a big deal. All right, and then this is where we’re looking at some of the the markers here in regards to organic acids.
Evan Brand: How you can correlate to the Oh, I mean, have you-
Dr. Justin Marchegiani: It’s pretty good. It’s it’s on point, most of the time, sometimes it can be off, I always tell patients, if we have an organic acid test, like the gray plant lab or the Genova, we’re going to always listen to that one as the most important because that test is specific for organic acids. And there’s a greater sample there too, so it’s going to be more accurate. But if we have this test in by itself, we’ll still utilize it. So out of the gates, you can see here, b 12, this is for methylation looks pretty good 1.5, Santhi RNA can be six marker, kind of urinate look pretty good. glutathione is on the lower side, right? So with this patient, we may want to support either some kind of a sulfur amino acid or some kind of fluid found to help with estrogen metabolism. And again, it just depends out of the gates if we’re not providing a ton of hormone support. Her hormones are so low as well, it may not be a top priority out of the gate. If the person’s hormones were higher, definitely a top priority out of the gates. Okay. And then this is interesting. This looks at the catecholamines it looks at basically adrenaline, or catecholamine. do the exact same thing. By the way, norepinephrine, epinephrine, exact same thing. Three words that mean the same thing. I know it’s really confusing. So we have dopamine, which is the home of anolyte metabolite, and then we have vandalia Mandalay, which is a which is a metabolite of adrenaline or epinephrine. And so dopamine is a precursor to norepinephrine or epinephrine. So the more chronically stressed you you are you will pull dopamine, and so they have high levels of dopamine metabolism and high levels of adrenaline metabolism. What does that mean? It means this pathway, this pathway here is is redlined. So we’re really breaking down and metabolizing lots of dopamine, a lots of adrenaline, and that could be part of the reason why the adrenals are more depleted here, right. And so we may want to add in some amino acids to support some of the catecholamines catecholamines. Definitely stressed. Now, we just have to make sure as we add some of those support in that we’re fixing underlying issues. So we’re fixing diet, we’re fixing blood sugar, we’re trying to get sleep better. We’re not over exercising, we’re making sure all those things are, are pretty good. And then again, Melatonin is on the lower end of the range, but it’s at 24. The range is 10 to 85. So it’s not that bad. I mean, it’s in the bottom third. I only work on this if there’s sleep issues. And typically, I’m always going to be supporting melatonin with amino acid precursors. First, I’m never going to target melatonin by itself unless we absolutely have to. I rather give building blocks and let the body do with it what it’s going to do first, then force melatonin, but if we have to, we can at the lowest possible dose, like-
Evan Brand: What are you doing? What are you going to do for aminos on the homo vanolate vandal mandalay you’re mentioning there, you may come in and support aminos.
Dr. Justin Marchegiani: Yeah so if you look at the range, they’re not super high. It’s six remember, this goes six point four um high end of the range four to thirteen. So i’d probably come in there with some tyrosine. Definitely i throw in some extra b vitamins, extra b6, even though b6 looks good. Just because these pathways are going to be stressed, so i really want to make sure some of the b vitamins are there. Some of the extra amino acids are there. I’m going to work on some of the adaptogens for the adrenals, i’m going to work on some of the adaptogens for the female hormones, uh we’ll throw in a little bit of DAGA, we’ll throw in a little bit of pregnanalone building blocks as well, if we go look here –
Evan Brand: So would you come in and never do dlpa over tyrosine in that situation, would you go based on symptoms like if somebody was like super weepy and crying at the drop of the hat, would you say okay we’re going to go dlpa instead or you’re just going to have tyrosine?
Dr. Justin Marchegiani: I would just do tyrosine out of the gates. I’d only do more dlpa stuff if there’s like a lot more chronic pain because dlpa will tend to go down more of that beta endorphin pathway which could be helpful for chronic pain stuff. If not i would just hit more of the the tyrosine and the b6 and then really calm down the hpa axis. Does that make sense?
Evan Brand: Yeah it does.
Dr. Justin Marchegiani: And then again you could see here pregnanalone is an important building block that we like to use because it’s it’s the mother of all hormones. Now i like it but you don’t want to just take it willy-nilly. I like to always use the lowest possible dose and i like to use it sublingually to bypass the gut and you can see chronic. So you can see here pregnenolone can go downstream to progesterone, right and then you can see pregnenolone, um can also go downstream to DAGA which can then go downstream to our sex hormones right, potentially some of the androgens. Potentially some of the female hormones right go right from here to andro to e1, that goes to e2 and then that can go to e3, all right and then it can also go downstream to testosterone too. Okay and then it can also go downstream to your mineral corticoids which are right here DAGA to where’s um.. Aldosterone here? Help me find aldosterone, where is it there.. Uh andro e1 let me know if you can see it but there should be a pathway where it goes downstream to aldosterone which helps hold on to our minerals.
Evan Brand: Is it at the bottom scroll down i’m seeing it.
Dr. Justin Marchegiani: Maybe they left it out on this graph but there should be a pathway that goes down to aldosterone which is a mineral corticoid, which helps you hold on to your minerals as well. Now also too if you have progesterone right, but then you’re having a lot of like um inflammation right, you can go progesterone down to 17 hydroxy progesterone and then that can go down to cortisol right, so if you’re chronically inflamed you can create low levels of progesterone. Because progesterone is going from here right downstream to cortisol. So that’s why chronic stress and chronic inflammation could throw off your female hormone balance. Does that make sense?
Evan Brand: Yeah it does. Yeah it shows there too uh mother’s diet during pregnancy. Insulin, resistance, obesity, inflammation, hypothyroidism, licorice phthalates, I like how they put the information about what’s going to contribute to the problem that’s really cool.
Dr. Justin Marchegiani: Yep exactly. And then also you can see here you can go your cortisol right and then your cortisol this is your free cortisol here. Right, this is your your active cortisol. Um so this is your this is your free cortisol here, and that the free cortisol is going to be what we measure on the cortisol rhythm graph and then it can go down the um the cortisol. That’s more inactive right we have our the cortisol as well, which is part of our cortisone.
Evan Brand: We need to do a show. Let’s do let’s do another one on this and review our own. I’m going to get a new one. And let’s do it.
Dr. Justin Marchegiani: Yeah, absolutely. So our metabolized cortisol is thf plus th e right, this is our total cortisol and then our free cortisol which is the th the thf so f for free right, so when we look at this here when we look at this here the cortisol, right this is the free cortisol right and then the total cortisol is the free plus the e just an fyi so we’re looking at the cortisone plus the cortisol is what the total cortisol is on that on that graph above. Just so you guys kind of wrap your head around that. And they they left out the uh the aldosterone here. Let me just see if it’s there albosterone. No not there. So yeah. They left that out but that should be in there somewhere as well. I’ll put a i’ll put a graph on that all right. Anything else you want to highlight there evan?
Evan Brand: No. I would just tell people that this is a really good starting place. But i just want to make sure that if you go to just the hormone person that they don’t just treat this because i think it’s really important to understand that there is a massive issue with bacterial overgrowth messing up some of these pathways. So if you come in and you’re doing all these hormones but you’ve got the build up because of those glucuronidation pathway issues. I’m seeing that with mold too that these glucuronidation issues people are on hormones and sometimes they feel worse and i think it’s because they’re not addressing some of these other pathways. I don’t think it shows glucoronidation on this does it this this panel.
Dr. Justin Marchegiani: No no. That’s gonna be more on the detoxification side okay. Any question there?
Evan Brand: No. I’m i’m good.
Dr. Justin Marchegiani: Cool and then just so you guys can see i’ll pull this over here real fast so if we look at this one right here just so you guys can see it so normally progesterone. Um it can go from progesterone down here into aldosterone and so in general if we look here it should go progesterone to aldosterone. So this pathway here you’d see aldosterone kind of coming down here if it really extends it all the way. Just an fyi on that all right. Anything else?
Evan Brand: I think we hit everything pretty good here. So are you saying progesterone could help aldosterone problems?
Dr. Justin Marchegiani: Yeah exactly so if we support pregnenolone that could also help aldosterone issues also supporting licorice can help aldosterone there’s a basically a drug called fluorine f right there’s cortef that’s supports cortisol levels that are very low okay and there’s fluorina which supports aldosterone and licorice has a an effect of mimicking um aldosterone so that can be helpful because when your adrenals are really weak you may have a hard time holding on to your minerals and so that’s important because we need healthy blood pressure to perfuse blood to the brain oxygen to the brain and we also need good minerals to help our sodium potassium pump to work properly we need electrolytes for our nerves to work so. All these are really really important.
Evan Brand: So one last question then we should wrap it up. So if someone is taking adaptogenic herbs or doing adrenal supports they’re doing hormones they’re doing licorice. What’s the approach or protocol to doing this test if we get the test kit in their hands and they’re on let’s say an adaptogen blend. They’re Doing the ashwagandha, the licorice, and everything do you suggest taking a break or does it not matter we gonna we’re gonna see how the body’s functioning while on those herbs?
Dr. Justin Marchegiani: You’re talking about down the road?
Evan Brand: No i’m saying like right now they’re already on them.
Dr. Justin Marchegiani: If they’re yeah if they’re already on them it may not be bad to take a look at kind of where they’re at with them already on them yeah for sure that i don’t see that being a bad a bad situation if they’re taking hormone support it just depends where they’re at i usually don’t like it the day of just because you can get an artificially high reading.
Evan Brand: Yeah.
Dr. Justin Marchegiani: If it’s if it’s in your system that day so usually maybe take 24 hours off that way it’s not overly high in the system.
Evan Brand: but you still see the trend. Yeah i’m always on the fence about it because you’ve got so many people taking blends which is great. I think you and I have really helped educate people about adaptogens but you’ve got people taking so much and it’s like well are we seeing an artificially good cortisol pattern or is this really how your cortisol pattern looks so i think maybe a day or two off sounds smart.
Dr. Justin Marchegiani: Yeah if it’s herbs i’m not worried about those as much because that’s they’re going to be more modulating and it’s just where they’re at you know and if they tell me that hey i’ve been on them for the last couple of months and i’m feeling better good we’ll just have you stay on and we’ll just take that into consideration on the test.
Evan Brand: Okay.
Dr. Justin Marchegiani: When we’re interpreting it because if they have some adrenal issues and they’re doing well with that well guess what we probably still want to make that part of their plan anyway we’re not going to change it too much right.
Evan Brand: Yeah well said.
Dr. Justin Marchegiani: Any questions there so far?
Evan Brand: No that no that’s it i think we should do a part two and review our own that’ll be fun i’m gonna get another one and run one on myself and you should do one too yeah i think that’s a great idea i like it a lot so.
Dr. Justin Marchegiani: I think we hit a lot of good stuff here hope um you know anyone listening you can see that you know Evan and i are kind of the real deal when it comes to this like we actually do this we’re in the trenches a lot of people that you may see online are kind of they’re like thought leaders from a um let’s say esoteric standpoint meaning they’re not actually doing this to not actually practicing so we try to differentiate ourselves by bringing actual information so just kind of know this isn’t theoretical stuff this is Kind of the real deal and and hopefully that gives you confidence to take action and to try some of the things maybe you want to dig in. Maybe you want to get testing maybe you want to reach out to Evan or myself. We’re here to help you out, if you need more help. Of course start with all the foundations, we have thousands of hours of free content because we know 99.9 of patients that that we work with or help, they’re doing it with our free content. We’re not even seeing them now if you’re ready for that next step and you want to dive in. We’ll put links down below so you guys can reach out evanbrand.com and reach out to Evan. Evan’s available worldwide and myself, Dr. J at justinhealth.com to schedule with myself as well. We appreciate you guys um connecting with us all anything else you want to say Evan?
Evan Brand: No people really appreciate it and yeah we’ll make sure to have the link if you listen on audio your mind’s probably blown right now you thought what the heck just happened we will make sure to give you the link that way you can see this thing because the screen share is great and you just want to give you kudos you’re a great teacher and you’ve taught me a lot about the dutch too so i really appreciate it and your eye to detail on this thing is awesome and most people don’t have that eye so we we really look up to it and really appreciate it.
Dr. Justin Marchegiani: Hey thanks Evan really appreciate it. And if anyone has any hormone issues that are way out of balance and you want to double check it with some blood work too. I don’t have a problem with that either especially some of the androgens I always like to double check with blood if we’re seeing some chronically high stuff um feel free to do that as well. And i hope you guys enjoyed it. Feel free give us a share as well thumbs up and if you want to write us a review that gets us motivated. Um we’ll put a review link right down below if you want to write us a review on itunes. Appreciate it you guys have a phenomenal day. Take care now.
Evan Brand: Bye-bye. Take care y’all.
Low Serotonin Signs, Symptoms and Natural Solutions | Podcast #325
Serotonin deficiency has common symptoms, including low mood and poor sleep quality. Most of the time, taking antidepressant medications called selective serotonin re-uptake inhibitors (SSRIs) can improve serotonin deficiency symptoms. So in this podcast, Dr. J and Evan talk about the root causes and presentation of this condition.
Our serotonin helps regulate a wide range of bodily functions, including sleep, bladder and bowel functions, orgasm, and emotions. It plays such an essential role in the body, it can be hard to determine whether low serotonin is causing a problem.
Dr. Justin Marchegiani
In this episode, we cover:
1:22 Serotonin Neurotransmitter
5:17 PMS for Females
9:00 High Serotonin Symptoms
15:13 Neurotransmitter Nutrients
25:47 Products for A Better Serotonins
Dr. Justin Marchegiani: We are live! It’s Dr. J here in the house with Evan brand. Today we’re going to be chatting about low serotonin signs, symptoms, and natural functional medicine root cause solutions to get to the root of why everything’s happening, why these mood issues, energy issues, cognitive issues could be a play, Evan, how you doing today, man?
Evan Brand: Doing really well. I’m excited to dive in with you here. This is an issue that I suffered with when I had gut issues. And, you know, once I figured out the connection between gut and mood, it was a game changer because I was focused so much on mood supplements, right? I would take like rhodiola is a natural antidepressant helped to boost energy. I would take ashwagandha to help with hormones and adrenal support. But I didn’t realize that I was missing the smoking gun, which was all the gut infections I had. So I was playing with adaptogenic herbs, long before I had the knowledge I have now about gut infections and serotonin. And so what I first want to tell people is that you can come in and you can spot treat things like you can use different nutrients and amino acids to help serotonin. But in reality, we really need to be focusing on the gut you and I’ve discussed this many times, but a large percentage of serotonin is going to be made in the intestines. And if you’ve got bacterial overgrowth are parasites or other infections, that pathway is not going to be working as optimally and no, this is not a deficiency of antidepressant drugs.
Dr. Justin Marchegiani: Exactly right. So serotonin neurotransmitter helps a lot with motility helps a lot in the digestive tract, right. Also, a lot of serotonin supposedly does not cross the blood brain barrier. There’s a lot of people that talk about this, a lot of the precursor amino acids like five HTP, or even dopamine or tyrosine, the precursor amino acids can actually cross the blood brain barrier and then also convert. So of course, there’s some people that say like, like Kevin just said about the serotonin being made in the gut really important, helps motility probably does have some mood influences just because the guts so important for absorption of all these nutrients, and we need serotonin for reasonably healthy gut function. But we also need to be able to break down all of our protein and amino acids because all these amino acids are the building blocks for all of our neurotransmitters, whether it’s serotonin, dopamine, glutamate, GABA, whether it’s our beta endorphin, all these are really, really important and we have to be able to break them down. So of course, things like low stomach acid, low enzymes, gut inflammation from food allergies, gut bugs, infections, being overly stressed over a sympathetic nervous system output, adrenal dysfunction, high chronic, higher, low cortisol, all of these things are going to shift our nervous system, it’s going to act our activate our fight or flight, nervous system response. And those things can play a major role, and being able to digest, absorb and assimilate. So that’s like kind of a foundational thing, I want to just kind of start with off the bat because we need that to be in place. And then once that’s in place, that gives us a good neurological foundation to not overly activate our sympathetic nervous system response, have the enzymes and the acids. And then of course, we’re making an assumption that we’re eating really good foods that are anti inflammatory, nutrient dense and low toxin to kind of provide those building blocks out of the gates.
Evan Brand: Yeah, well, you just highlighted something important here, which is this serotonin issue. And other neurotransmitters too, can be a vicious cycle, in the sense that if you have gut infections, reducing stomach acid levels, now you’ve got this malabsorption issue, so you’re not going to get the amino is any way to manufacture the neurotransmitters. So you could come in, and you could use amino supplementally to try to spot treat. But in reality, if you don’t fix the infection, creating the malabsorption in the first place, it doesn’t matter how well you do on the diet. It’s not about what you eat. It’s about what you digest from what you eat. And I think that’s the important piece of the conversation that’s missing with people is they focus on do this food do that food, but it doesn’t take into account Are you actually absorbing and assimilating that and we know based on Dr. Wright’s work in his amazing book, why stomach acid is good for you that by age 30 40 50 60 and beyond you make less stomach acid just with age alone. And that doesn’t even account for the fact of modern life stress, circadian rhythm issues adrenal issues not chewing your food, that kind of stuff. So your regardless of the lifestyle factors just age alone is enough to create a bigger problem. So let’s just run down the list real quick together here of too low of a level of serotonin. Now you may see various lists across the internet, Justin and I found one that we like from a respected source. So I’m just going to kind of run down the list here of two low serotonin. Course depression. Everyone thinks about that, but also anxiety, insomnia or sleep problems, nervous or worried, poor response to stress, negativity or pessimism, irritable or impatient, self destructive, potentially even suicidal thoughts, low self esteem or self confidence you feel worse in the winter. So you could call it a winter depression if you’d like younger, rage, explosive behavior inflammation. Here’s one that’s interesting. We need to, I think, talk about this further PMS. And then OCD or eating disorders as well have a link to serotonin. So the PMS is interesting. What do you think the meccan mechanism is there?
Dr. Justin Marchegiani: Well, a lot of female hormones like progesterone, for instance. And or just healthy progesterone, estrogen balance, have major effects. Basically, they’re like mono amine oxidase inhibitors. So essentially, they almost are like mini antidepressants, they help kind of keep a lot of the neurotransmitters in between the post and presynaptic synapse. So you kind of have this presynaptic synapse, we have a postsynaptic synapse. And this is what’s called the synaptic cleft, right? This is these are where the neurotransmitters accumulate between the two. Okay? And things like progesterone, for instance, they have a mild serotonin reuptake inhibition effect. Now, when you do medications, the problem with medications, the longer you keep those neurotransmitters between the synapses here, the faster those neurotransmitters are recycled and broken down. That’s why over time, people that are on antidepressants, or SSRIs, their dose has to go up, not down, especially if you don’t fix like underlying root issues. So I think a lot of these hormones like progesterone, we know is a GABA chloride channel inhibitor. So GABA is big, because it promotes relaxation, the more relaxed and calm your nervous system is, the less chance you’re going to be burning through serotonin because you’re less stressed. And there’s a mono amine oxidase inhibition effect, right, MAO, inhibitor, so it’s almost like a mild antidepressant in a way for sure.
Evan Brand: Oh, cool. Totally interesting. Yeah. So I mean, it sounds like, you know, part of the protocol could be both, it could be using potentially some hormones, like maybe some progesterone, but also coming in with the amino acids. And then once you figure out what’s going on, after you test, then you could come in and start fixing the infection. So let me just tell just a brief story. I think people relate to the stories here. So I just remember, you know, when I was down in Texas, and I had gut infections, I had just a baseline anxiety level that was so high. Now granted, I was away from home, I had some homesickness, I missed my family, that kind of thing. But this was different. This was related to my gut, because as soon as I was doing no microbial herbs, the anxiety was 25, maybe 50, maybe even 75% better. So I can just tell you, personally, you know, you and I’ve seen it clinically as well. But just personally for me, you know, I was doing supplemental gabbeh, I was doing motherwort passionflower, all the calming herbs. But it didn’t matter how many calming herbs I did, it was just a band aid. It wasn’t root cause. So I just want to make sure people understand that there’s a difference between natural and functional. So natural medicine is like, hey, you’re anxious take passionflower functional medicine is like okay, fine, take passionflower. But why are you anxious? And that’s the secret. The secret sauce?
Dr. Justin Marchegiani: Correct. I think with you mean, part of the underlying reason was you had multiple gut infections that were not being addressed. Yeah, there was there was that kind of thing in the background, I think that was really important. And so fixing that played a big role, you had some potential mold stuff that was hiding as well. I think there was also some blood sugar stuff that was happening with you as well, that we were looking at, I think you also had like really low blood pressure, too, didn’t you?
Evan Brand: Yeah, my blood pressure was like, maybe 100 over 70.
Dr. Justin Marchegiani: So on the lower side, so there was definitely very weak adrenals where your mineral corticoids were paying a price and you weren’t able to hold up a lot of the holding a lot of the minerals that your blood pressure was dropping, and so you weren’t able to really perfuse blood flow adequately. Right. So yeah, all these things play a big, big, big, big role.
Evan Brand: I was peeing a lot too. So I was up in the middle of the night, three, four or five times to pee. I now know that that was related to mold, because since using appropriate binders, I no longer wake up in the middle of the night to go pee. So just folks listening, you know, could be an adrenal component as well. But, you know, for me, the excess urination was definitely a mold thing, and it’s luckily resolved.
Dr. Justin Marchegiani: Exactly. So you already kind of talked about a lot of the symptoms. Let’s just kind of go over those real quick. So we have our high serotonin symptoms just briefly here. Let’s hit them again. So too high depression, anxiety, nervous being a worrier.
Evan Brand: And these are low stress. These are low. You said to-
Dr. Justin Marchegiani: I’m sorry. Yeah, I’m sorry. These were too low depression, anxiety, nervous worry. Anger, PMS, right. And then on the high side, let’s go over the high ones again, briefly. There’s no high Okay, there’s no high for those. Okay, so those are the big ones with the seratonin. Right. Now, we already talked about the foundational things. So when we talk about nutrients, just kind of make sure everyone that’s listening understands Foundation has to be in place, good foods, good digestion, good hydration management of stress, and we can talk about different techniques that help decrease stress. I won’t go into specifics but I’m a big fan of EFT, EMDR, NLP a lot of times techniques or eye movement techniques that can help rewire the nervous system that can help dampen sympathetic nervous system responses. There’s another one that you like Evan, that you did that does a lot of rewiring as well. Which ones that?
Evan Brand: You talk in the brain retraining?
Dr. Justin Marchegiani: Yeah, brain retraining, a lot of that requires NLP?
Evan Brand: Yeah, I’m playing with a couple of them. Yeah, some of it is kind of NLP strategy. There’s one called gupta. There’s another one called dnrs. They’re just doing our online one. Yeah, they’re online brain retraining, I’m gonna work through the Gupta, the one and I’ll have feedback for people, but I have done the dnrs. It’s basically just trying to rewire your brain, right, you’re trying to tell your brain that your issues are fine, and all of that. So I like it. But I personally, I think EFT is better. I like the tapping aspect of EFT tapping is nice-
Dr. Justin Marchegiani: You can feel a nice reduction of that nervous system response. It’s like when your brains are used to firing a certain way. It’s like, if you have a big backyard and you go on a hike or you go for a hike, where your local park, there’s a path kind of carved out when you go into the woods and that paths there. Where do you go, you naturally walk on the path, you don’t just go randomly go in the woods with all the sticks and trees and ticks, right? You kind of go on that carved out path, your brain kind of works the same way. So when it’s used to thinking about something a certain way, it carves out a path. And when you jump on that when you jump in the woods and you see that path, you naturally go down that way. And so essentially, the tapping is kind of like it’s a way of like pulling out the machete and kind of carving out a new path in the brain to fire a little bit differently.
Evan Brand: That’s that’s a great analogy. Yeah, that’s a great analogy. You’re saying how basically with this low serotonin that you can get stuck in these pathways of like, pessimism and negative thinking and all of that. So it’s harder to break out.
Dr. Justin Marchegiani: Yeah, I’ve listened to Julia Ross lecture one time, because she does. He’s an MFT marriage family therapist. And she has done counseling on lots of people. And she has had clients and patients for decades, where they just couldn’t get over certain issues. And she just started utilizing nutrients and amino acids and these problems that were problems, just naturally, were non issues, they they just became they just people were able to get over them so much easier. And a lot of that is is you need the mental neurological equipment to be able to process and handle them. You know, my my analogy, I get patients, it’s like staying up all night and then trying to do your taxes the next morning, like you just may not be able to have that mental capacity to handle it. And so I look at neurotransmitters, it’s giving you the equipment, you need to deal with these issues, it’s like giving a child adult level problems like they just going to be overwhelmed, they’re not going to be able to handle it and process it. And so if you have the right neurological equipment on board, that gives you the ability to handle it. And then also having these extra strategies in our back pocket. Like I mentioned with the EMDR. EFT Now the easiest thing is you just talk about the problems and you just kind of tap all the different EFT spots, side of the eyebrows, middle of the eyebrows underneath the eyes, underneath nose and chin, collarbone, underneath the nipple area, under the armpit, right. And those are just those are the really good spots you can do you can do right in the parietal line in the center of the brain here. Those are all good spots. And you can just kind of talk about the problem, whatever the problem is, let’s say you’re at a seven out of 10 and 10. Being you know the most sensation or irritability or emote, you know, palette of emotion that you could feel, ideally you want to get below five. So I always just say talk about the problem, talk about the fear, talk about the emotion you’re feeling and try to get it below a five. And ideally, if you can get below a three even better. And so you just keep on doing that it’s a good way out of the gates. And then also NLP kind of comes in where you you really are focused on the pictures that you have in your brain, right? That the pictures that you have in your brain are very important. So you really want to put pictures of yourself succeeding doing the thing, right? And then an easy kind of NLP technique is you can do the stop sign. Have that stuff sign flash in front of your, your, your mind’s eye when you start thinking things that are negative or you can do no stop. Right you there’s a DNR s one that you can tell about to.
Evan Brand: Yeah, yeah. And then that’s what they do. You basically just kept pace. tell yourself that your brains sending your body false messages. So it’s like this negativity, it’s this fear. It’s this hyperstimulation it’s the overreaction, you’re trying to just shut that down. And the mind is powerful. And I think it’s I think it’s an underappreciated thing. Now, you made a great point, which is that you got to have the fuel in the fuel tank, right. So you could do all the the physical tapping and all that stuff. But if you simply just don’t have any neurotransmitters in the tank, it’s going to be tough to focus on this, it’s going to be tough to have drive to get this done. So that’s where you and I are going to come in. And you know, let’s talk about some of the testing now. So we’re going to be looking at like an organic acids testing. And we’re going to look and measure some of the various aspects. We did a podcast recently on low dopamine, so check that out if you’re interested. But in that same category, we’re going to be able to measure the serotonin marker. And once we look at that we can see where people are at. And then of course, we’re going to factor in what’s going on with the gut to because rarely is the serotonin good To become a dysfunctional problem, unless there’s a gut issue as well. So we may see Candida bacterial overgrowth parasites, H. Pylori, gut inflammation and low serotonin. It’s rarely just low serotonin by itself.
Dr. Justin Marchegiani: 100% and so it’s good to have the foundation it’s good to have some tapping techniques. Now let’s go talk about some of the other nutrients. So we know things like five HTP, or triptophan is a precursor to serotonin and serotonin. You know, obviously, that neurotransmitter that helps with focus and feeling good. It’s a very, you know, happy neurotransmitter. A lot of times dopamine can overlap because dopamine helps with focus, it’s an I love you neurotransmitter. So a lot of times there can be an overlap in those symptoms. And a lot of times people that have low serotonin could have low dopamine as well. And also the enzyme that metabolizes serotonin that metabolizes five HTP, and converts it downstream to serotonin is the aromatic decarboxylase enzyme. And that enzyme also metabolizes dopamine. So if you constantly take five HTP support chronically, you probably want to have a little bit of dopamine tyrosine support as well, because you can create some functional deficiencies long term. So just kind of keep that in mind. Like in my line, we have a product called brain deplete that has a 10 to one balance of tyrosine to serotonin. And if you’re taking a lot of serotonin, it’s probably okay especially if you’re testing it on the organic acid, but just long term, you probably want to throw a little bit of dopamine, whether it’s tyrosine in there to provide some building blocks, that’s excellent out of the gates. And then there’s a couple of really important methyl support that needs to be there, B six and B 12 are very, very important. B six is incredibly necessary for the synthesis of neurotransmitters, we need B six is an important cofactor and so is b 12. b 12 is methylated B 12. Really important for the methylation of these neurotransmitters. Well, we attach a carbon and three hydrogen to it. That’s methylation. Very important. Also, vitamin C is very important because vitamin C tends to be burnt up and overly utilized when there’s a lot of adrenal stress as well. We talked about five HTP, we talked about some potential tyrosine. And then it’s also nice to throw in a little bit of an adaptogen. Because adaptogens help with the stress response, they help with perceived stress. So even if you’re stressed right now, just giving you some support on the adaptogenic herbal side, will change your perception to it. And so things like rhodiola or ashwagandha, or ginseng, or eleuthero are amazing to help kind of or even macca, especially women do very well, macca are very good for stress perception and stress modulation.
Evan Brand: Yeah, great, great calls. So just to back up what you said, there was a trial done. We’re not fans of drugs, we prefer to try to come at it the natural functional way whenever possible. However, there was a study done that compared antidepressant use, and just in a depressant by itself, compared to antidepressant plus b 12. And 100% of the subjects that got the B 12. And the antidepressant showed at least a 20% improvement with their symptoms compared to the antidepressant alone. So just to tell you one more time, and a depressant plus b 12 20% improvement in the outcome, as opposed to just the antidepressant by itself. And then also Foley, same thing. There’s a paper on Foley, and how that also boost things up. And then I don’t know if you’ve, you’ve played with this one much, but have you seen some of the Selenium extracts? You’ve got some of these saffron and selenium blends like this? Yeah, so it’s pretty cool. I’ll put it in the chat for you. So you can look at this tech sheet, you might have to log in, but I’m gonna send it to you.
Dr. Justin Marchegiani: Yep, I’ve put those links to the studies. And we’ll put it in the description notes after the show. So you guys can take a peek at it.
Evan Brand: Yeah, but so just, I just put it for you in the chat. If you want to see, like I said, you may have to log in to see this tech sheet. But this is a cool product. And I’ve used it with some people that were previously on antidepressants, and they got off of it. And many of them reported they felt just as good. And so the Sceletium plant, it’s kind of an indigenous South African plant. Indigenous people used it says for relaxation, stress reduction, calming thirst and hunger prior prior to long hunting hunting trips, which is pretty cool. And it acts like an SSRI. So the Sceletium binds to the serotonin transporters inhibiting the uptake of serotonin from the synapse, resulting in increased serotonin concentration in the synaptic cleft. That’s the same mechanism of prescription SSRIs. So this is a game changer, potentially. And like I said, I’ve had clients that were previously on the pharmaceuticals, and then they did this one, and they like this one much, much better.
Dr. Justin Marchegiani: That’s good. Yeah, there’s a lot of good options. It’s nice to have some herbals, whether it’s adaptogens or the sceletium, whether it’s the saffron and I think in that the important cofactors need to be there B six b 12. You can maybe even throw in some full weight in there because full weight tends to interact. So I tend to have you know, products that will Be six, we’ll have the seratonin have the dopamine support. And then we always like, I think you’re in the same place always having a really good molti there in the background just to make sure all those cofactors are there. And then of course, having a really good solid diet as a foundation that kind of gives you that insurance policy that the building blocks are there, the cofactors are there, and then you can really hit things more therapeutically after.
Evan Brand: Yep, absolutely. Now, have you played with any of the other testing? You know, we already hit on the test. But there are some companies that do just neurotransmitters Have you ever played with those at all?
Dr. Justin Marchegiani: Well, the whole idea with some of those is that you may not get a good window, what’s happening in the brain, right. So supposedly, you have the idea one is going to be some kind of like a spinal tap, right, where you really get a window into what’s in the cerebral spinal fluid, which is kind of flowing to the brain, that’s kind of like your ideal, obviously, that’s invasive. And then the urinary metabolites, I think, are pretty good. Because you kind of get a window like, if someone’s buying a whole bunch of food, you kind of get a window by going into their trash what they bought last week, right? It’s kind of like that. So you get a pretty good window of how you’re doing. So if we don’t see a lot of stuff in the trash, or we see too much stuff in the trash, that gives you a window what your body’s utilizing. And so that’s organic acids, we’ll look at with serotonin and we’ll look at five hydroxy and dolo. Last day five HIIA. So that’s helpful to give it give a window into it to know what’s happening. And then we’ll apply some of those nutrients, maybe 100 milligrams of five HTP at a time. And we’ll kind of go out from there. And I like doing it more, you know, at the last half of the day, especially if it’s more calming and relaxing, because some people they may get too tired because of it during the day. So you got to individualize it. And if you’re on a medication, it’s really important if I’m having people that are on meds like SSRI medications, amino acids will help the drugs work better because these drugs work by blocking re uptake ports. And if you’re blocking a rehab, take a port and you’re providing more substrate. Well guess what happens that substrate now is going to increase the symptoms or the potential effects of the drug which can also increase the potential side effects. So I always tell patients, look at the medication that you’re on, make sure you know what the side effects are. And so if we add things in, we look for those side effects to occur. If they do, we go back to the prescriber, and we gently nudge down the dose of the medication under the prescribers controls, we got to look at what those side effects are. That way, if it happens, great, we adjust or we just go slower to so my goal is if we’re going to adjust medication, we’re always doing it from a point of stability, not instability, and we’re always utilizing the prescriber that prescribed it. And if you’re on some of these meds long term, whether it’s an SSRI, or maybe even benzos are the worst, we may need a very, very long term taper, it just really depends. Could be six months up to a year, depending on what the medication benzos tend to be worse, SSRIs tend to be less. And it depends on how long you’ve been on them for Okay, so But either way, we don’t touch medication dosages, unless we have everything in order, we’re stable, and then we have a prescriber that’s involved in the prescription of the medication, monitoring and tapering the dose.
Evan Brand: Well said and there’s a link between antidepressants and gut bacteria to if you just look up and depressants, microbiome, you can find some studies on this. But we now know that these antidepressants are negatively affecting the gut. And we’re seeing changes with bacteria. And in particular, we’re seeing clostridia and other pathogenic organisms that we test for via stool and urine. We’re seeing these pathogenic bacteria overgrowth. So there is a link now between antidepressants and bacterial overgrowth in the gut. So just keep that in mind. If you’re somebody who’s been on these prescriptions for a period of time you’re having gut issues, maybe you’ve worked through some protocols, whether it’s with us or other practitioners, maybe you’re not to the finish line yet, you know, consider the drug could be a contributing factor, I’m not telling you stop the drug, I’m telling you that it needs to be factored in, and we got to try to counteract what that drug is doing. And we’ve seen cases like that, where clostridia just keeps coming back. And the drug, if the doctor was able to remove it from the protocol, then boom, they were able to get well and stay well.
Dr. Justin Marchegiani: Yeah, totally. I mean, my personal opinion on medications like SSRIs, or drugs like that. The only, you know, real good application, in my opinion, is some kind of a short term where someone may commit suicide or harm themselves. That’s the only I think, you know, valid reason to be on it at all, is for just pure stabilization. And then working with someone with various therapies, whether it’s talk therapy, whether it’s then I think, combining EFT or EMDR, with that to kind of calm everything down and then utilize the diet and nutrients and then get off the medication. The problem with most medications is once you’re on it, you kind of get stuck, and the prescriber doesn’t want to take you off and they’re also not fixing the underlying root issue. So, you know, my general application is if something’s incredibly acute, that may make sense. But outside of that, you want to always try to work on coming off that way responsibly with all the foundational support underneath, and with the prescriber involved. So if anyone’s listening and they’re on a medication like that, and they just want to come off, don’t do that work with the functional medicine doc, and then we’ll also work with your prescriber to get you off because there’s always going to be some kind of a relapse that happens. And we don’t want anyone to be in a position where their neurotransmitters just really go wonky with a major, something they regret.
Evan Brand: Yep, absolutely. Well, I think that’s all I have to say on it. So if you have any more than let me know, otherwise, we’ll give people some info here where they could reach out if they need help, I know you’ve got some products to mention, I’ve got some too as well. So in your show link in your show notes on the podcast app, you should be able to click there and then boom, check out some of these products. You know, if you’re on drugs, you know, consult with us or consult with your practitioner, how you may work some of these in.
Dr. Justin Marchegiani: Yeah, the big ones that I use in my line, of course, a good multi multi support pack excellent brain repletes to have that 10 to one ratio of tyrosine to serotonin with some of the cofactors there I’ll also use serotonin with B six. So in my line, serotonin replete or dopa repletes, are going to be the big ones and the dope replate Plus is my bigger l dopa, which is a it’s let’s say, a little bit more down the line in regards to dopamine synthesis, so it can have a better effect on improving dopamine levels. So those are my big ones. We’ll put the links down below. Evan, what are some of the ones that you have in your store that you use with patients?
Evan Brand: Well, a lot of them I’m ordering through third party, so I don’t have any on my store right now. And we’re moving warehouse. So I don’t have any right this second. But you know, if you’re working clinically with me, I will definitely educate you on those. And then some of the Zimbra and some of those, there’s different professional manufacturers that will use so there’s a couple different brands. But either way you could reach out and we’ll we’ll let you know what we’re going to use.
Dr. Justin Marchegiani: Yeah, maybe a good idea. You have a category on your website, like say, like maybe neurotransmitters so people are listening to this down the road, maybe look for a category on brain nutrients, or neurotransmitters. And some of those will be there too. I have a category on brain nutrients too. So we’ll try to make it easy for you all to navigate. If you need support, we’ll put links down below.
Evan Brand: Awesome. If you need help clinically, you can reach out Dr. J works with people worldwide via phone, FaceTime, Skype, however you need to chat. So please reach out to him at JustinHealth.com. And if you need me, Evan Brand, EvanBrand.com is the website. And we love working with this stuff. I mean, we’ve been able to transform our own lives with these products, we’ve been able to transform 1000s of other lives. And so this is really just a sigh of relief, when you can fix these issues. And you can help people take back not only their mood, but take back their life. I mean, when you optimize these things with brain chemistry, you can allow people to become more focused, you can allow them to become more calm, they can sleep better, they become better parents, they become better husband, better wife, better workers, better CEOs, better entrepreneurs. So it’s just incredible what you can do when you optimize this stuff. And so we want to test not guess, figure out what’s going on, look under the hood. And you can help modulate these things. So please reach out if you need help.
Dr. Justin Marchegiani: Yeah, and if someone’s coming into this, they don’t know where to go. They’re not quite sure where to start, keep it really simple. Start with the food. Start with a good healthy paleo template out of the gates, maximize your ability to break down protein with HCl, good digestive acid enzymes just start there out of the gates because that’s the building block for everything. And then from there, definitely get a practitioner in your corner to really work on all the building blocks, all the supplements support all the other precursor support so you have that good foundation, and then maybe also dive deeper into a lot of the gut, which could be a lot of bottlenecks. If you have chronic digestive issues. That’s gonna be an important part of the equation as well.
Evan Brand: Totally, totally Well said, well, always fun. I love these brain neurotransmitter episodes. They’re always a blast. I think they’re very helpful, very empowering for people. So please give us a review. We would love it. If you can review Justin’s show on iTunes or my show on iTunes. We really appreciate it. Give us some stars. Let us know what you think. Share it with your friends and family people who are dealing with issues we know that depression anxiety issues are massively increased over the last year. So the thing that we can hope here is that this is a beacon of light to help people know that there is solution to this problem.
Dr. Justin Marchegiani: 100% we’ll put some review links below so you guys don’t have to hunt it down too far to do that. We really appreciate it guys have a phenomenal day. Take care y’all.
Evan Brand: Take care. Bye bye.