The Gut Connection With Urinary Tract infections (UTI) and Yeast Infections | Podcast #367

Urinary tract infections (UTIs) are a common medical problem affecting millions of people worldwide. The primary source for UTIs is presumed to be the gut. That’s why in this video, Dr. J and Evan talk about how gut bacteria can contaminate the urethral opening, eventually propagate themselves in the bladder, and cause symptoms of a UTI and possible yeast infection.

They also added that women are significantly more likely to get UTIs than men. It is due to anatomical differences that make it easier for disease-causing bacteria to travel to the urinary bladder after accidental transfer from the bowels. They also discuss the other clinical and evidence-based factors with helpful tests to find the root cause of these issues.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:00  – Introduction
1:53   – Urinary System
10:54 – Antimicrobials and probiotics
18:55 – UTI and Yeast Infection

Dr. Justin Marchegiani: Excited to be here with Evan Brand. Today, we are gonna be chatting all about the gut connection with urinary tract issues, UTIs and yeast infections. Really excited to dive into this topic. This is the common female topic that we deal with. I mean, men deal with UTIs as well but men have a longer urethra area so it’s harder for men to have UTIs with them. Women have a much shorter urethra so bacteria can make its way up to the urinary tract and blood much faster and easier and so probably more of a female issue but we’re gonna dive in. The physiology is similar between the two so men listening will still get something of it as well. Evan, how are we doing today?

Evan Brand: Hey, doing really well. And so, looks like about 90% of infection in the bladder, 90% of these cases of these infections of bladder, urethra and kidneys, it’s all related to E. coli, which of course E. coli are in your poop and can generally just take route up that way and they can migrate and populate within the urinary tract and so women obviously know these symptoms if they’ve had it but it’s you have to urinate more frequently, it’s painful urination. It could be pressure in the pubic area. It could be fatigue. It could go more severe into kidney injury but most women are usually so miserable before they get to that point that they end up doing some sort of conventional treatment. So, why don’t we just talk about the conventional approach because I think it’s great to highlight what people are doing and then what we’re doing differently that we may argue is a far more sustainable solution without the side effects. Antibiotics are gonna be huge and we’ve got some statistics on this. Antibiotics are prescribed for 33% of women to combat a UTI before the age of 24 but of course these synthetic antimicrobials are not without short- and long-term consequences.    

Dr. Justin Marchegiani: I’m gonna just share one thing here on screen just so everyone can see. So, you can see the female anatomy, right here is the urethra, here’s the bladder so you can see a very short distance from the urethra to the bladder. You can see here in the male anatomy, right at a much longer distance to get up here. Obviously in the urinary tract, you’re just typically with the UTI, it’s the bacteria that’s making its way up here, okay, into the urinary tract that’s causing the infection like Evan already mentioned that’s mostly gonna be bacteria, right?  Usually on the UTI side, it’s gonna be E. coli there, can be some Pseudomonas, it’s mostly E. coli. And so, it’s really easy for women to get bladder infection because you can see it goes up faster. Again, things like birth control pills we’ll talk about and antibiotics really shift the urinary pH and the intestinal pH which has a major effect on the bladder and the urinary tract and it makes it easier for bacteria to grow that tends to be why women are a little bit more susceptible than that for bladder infection obviously but in general you’re gonna see that with birth control pills because how estrogen affects the pH and then also women when they menstruate, right, just that whole vaginal area right there, sloughing off that endometrial lining. All that blood flow does shift that whole entire are to be way more alkaline because bloods around 7.3 pH so it does shift that whole vaginal tract to be more pH higher on the pH side which can increase other bacterial infections more on the vaginal side but hopefully that helps. Any comments on that, Evan?  

Evan Brand: Yeah. It’s totally interesting and this is stuff that maybe you didn’t pay attention to in school and biology class but now in adulthood it’s a lot more important and I think people just don’t even understand the anatomy of it and this is something that according to the research here, 25% of people treated for UTI, they will experience a recurrence 6 – 12 months later. So, I mean, that’s a quarter of these people that now have another UTI and they just go on this merry-go-round. And of course, every time you go on these antibiotics, you’re damaging the mitochondria, you’re damaging your gut microbiome in total, so it’s not just this one thing that you’re doing, it’s the sum to your system and it can really add up.   

Dr. Justin Marchegiani: Yeah, when we deal with urinary tract issues, I kind of look at, okay, you have yeast issues over here. They’re kind of, they intermingle right and how the different things happen. You have bacterial issues over here, right? So, your UTI issues are primarily bacterial, right, affecting the urinary tract. You can have BV, bacterial vaginosis, that’s another bacterial issue. Usually, Gardnerella bacteria is one that’s affecting the vaginal canal. So, a little bit different, right? Different, you know, same general area, different anatomy per se. You’re gonna have similar sequelae of tissues affecting it, right?  The big difference with the BV issue is you’re gonna get the potassium hydroxide odor which is, that’s kind of the fish smell. That’s what the bacteria in the vaginal canal does, it creates that potassium hydroxide that’s the fish odor. You’re not gonna quite get the odor with the UTI but you will have the burning during peeing. So, that’s gonna be the big differentiating factor. Sometimes, more odor on the BV but sometimes you can have none and then of course more pain during urination on the urinary tract issue and then if that continues to be left up that bacteria will eventually continue to go north and eventually hit the bladder as you can see that anatomy pretty short on video here. But, one of the big common issues is I would say like the big three, anytime I look at this problem, they tend to be the same. It’s gonna be a combination of antibiotic use so we’re wiping out a lot of the good flora in our intestinal tract which also affects the vaginal or urinary microbiome and then that affects the beneficial probiotics that actually make hydrogen peroxide like probiotics usually make hydrogen peroxide which is antibacterial. They’ll make different acids, glucuronic acid, they’ll make acidic acid. Different acid acids that actually help keep the microbes in check. They make hydrogen peroxide H202 and it keeps a lot of the bad bugs down. So, the first thing is we have a wiping out of the beneficial flora that also drive yeast overgrowth too so the same thing where it wipes out the good stuff, the beneficial probioflora, the probiotics the Bifidobacter, the Lactobacillus. The different species within the Bifidobacter and Lactobacillus, right? There’s Rudaea, casei, plantarum, lactis, these are all beneficial species, okay, that keeps the bacteria in check but also when you knock down a lot of the good stuff that can also causes this rebound overgrowth and yeast and that’s a lot of doctors today even on the conventional side tend to give an antifungal after an antibiotic in a lot of these female patients because they see a lot of these symptoms happen frequently. 

Evan Brand: Wow. And, you’re mentioning the antibiotic that starts this whole cascade and that’s not necessarily the antibiotic to treat an existing UTI and then we’re talking about these recurring UTIs. We’re talking antibiotics for something simple like, I’ve heard of some women going in for a dental cleaning or something just that seems benign and then boom the antibiotic just really had forced them to take another fork in the road with their gut health and of course the vaginal health is affected. 

Dr. Justin Marchegiani: Exactly. Now, with urinary tract issues, I mean they’re simple things, right? Sometimes, just after intercourse, after sex, just not peeing. Sometimes that sperm and the semen being up there can kind of create some issues with bacteria so urinating after sex can be very helpful. You’ll see it with younger kids just wiping the wrong direction, right, essentially wiping back to front bringing some of the bacteria in the stool into that urinary vaginal area can be a problem. Sometimes different contraceptive methods like that involve, like a spermicidal intravaginally can sometimes mess up the milieu of flora in the vaginal tract. Having bladder stones or kidney issues can sometimes have problems, going in for a surgical procedure where they put in some of a catheter, you know, those are, you know, gonna be way unlikely but you know just kind of given the gamut of those across the board. And then of course, you know, the antibiotic exposure and I would even say just too much sugar, too much carbohydrate, a lot of bacteria like acellular easy to digest refined processed carbs. So, more carbohydrates, more sugar, more grains, more flours are definitely gonna work, you know, increase those microbes’ kind of having a feeding frenzy if you will.   

Evan Brand: And, how can you find this out? Well, there’s an easy to do at home test that you can buy for less than 10 bucks. You can do these test strips at home. These urinary test strips and if generally, you see a dark purple, you’ve got a big issue and so it’s something that people should have on hand if you’ve suffered for a while. I know a lot of women; they just hate having to go to the doctor’s office and get tested and then they leave with another antibiotic and then they’re on this merry-go-round. So, we talked about the conventional approach, they really as far as it goes antibiotics 

Dr. Justin Marchegiani: So, with the test strips, I think most of them are primarily looking at either immune cell in the urinary tract. I think, a lot of times with yeast or bacteria. They’re looking for, like leukocytes or leukocyte esterase, they’re looking for bacteria or I’m sorry immune cells in there. I know, some of the yeast ones are looking at pH so they’re looking at a more alkaline type of pH. The more alkaline the pH moves from six to seven to neutral, right, neutral is around 7. Into the 7-ish range, that tends to say that okay we have more yeast issues or we’re starting to move back in the direction of bacteria if we’re starting to see some of these leukocytes moving into the urinary tract. 

Evan Brand: Yes. It’s kind of an indirect marker, right? You’re looking at those leukocytes and that’s what you would be seeing in terms of like, the light purple, dark purple, extreme purple on the test strips.  

Dr. Justin Marchegiani: Yeah. So, they’re looking at the immune system starting to come in there and obviously with a BV issue, bacterial vaginosis. They probably need a swab to see what’s going on there, see if it’s like a Gardnerella or a Pseudomonas or Klebsiella, you know, what the bacterial species is. Now, typically with yeast issues in the urinary tract, I’m sorry with, uh, yeast infections primarily gonna be Candida or Candida subspecies. With BV, it’s primarily Gardnerella and with UTI’s it’s gonna be E. coli, typically.    

Evan Brand: Now here is the cool part. Are you ready to talk about some of the transitions you hit on the diet piece of a bit of sugar process things? Maybe we should hit this first and then we’ll talk about, like, the functional strategies that kind of thing. You and I were talking about this before we hit the record that so many people, they want the solution to an issue like this but they haven’t even got the foundation styled in, in regards to their sleep, in regards to stress, proper hydration, nutrient density, lack of antibiotics if possible. Just those foundational pieces, a lot of times, are gonna keep women in a place where they’re not gonna end up with this problem so if you’re just tuning in, somehow you found us and you’ve not been listening for a while and you’re just now hearing us and you’re looking for this magic remedy, you got to make sure you get the foundations in order first because in theory, this should not happen if you’ve got the foundation style then.  

Dr. Justin Marchegiani: Correct and so first thing out of the gates is just foundational things like hydrating enough because if you have a UTI issue just having constant good water flow and also you know with some electrolytes in the water that can be very helpful kind of having an antibacterial effect. And just keeping that good water flowing, the solution to pollution is dilution so that can really kind of keeping things flushed down. Obviously, being very careful if you’re having antibiotics. Why did you have the antibiotics? Was it for routine preventative things? Was your diet off and your immune system’s weak and you got sick and you needed it? Why, right? So, you want to look at that and if you had chronic antibiotic use, you know, what does the bacteria in your gut look like because odds are, if your bacteria or yeast imbalances are present in the vaginal tract or the urinary tract, you probably, also have issues in the digestive tract. You may have SIBO, you may have bloating, you may have gas, you may have poor digestion, low enzymes, low acids, H. pylori, parasite infection, you may have to look deeper in the intestinal tract and actually work on knocking down some of those microbes fixing the gut and then really work on repopulating some of the good bacteria after the fact to really work on fixing the gut because you start to fix the gut pH and the gut bacterial milieu that does help improve IgA levels and that does help with the immune system in the vaginal area as well. 

Evan Brand: Yeah. Well said. So, if you’re coming in with the UTI, most of the time, there’s gonna be more than just a UTI present. There could be as you mentioned a number of, we have someone coming in and UTI or recurrent UTI is one of their complaints, I can tell you, you and I are gonna wanna run the stool panel and we’re gonna run organic acids because we’re gonna want to look at the whole microbiome and certain things may get missed on the stool and the urine should feel in the gaps like we might find Candida in the urine and it got missed in the stool. So, stool and urine, there are things that your typical doctor and your lab locally is not gonna run. They might run a urine panel but this is not the same urine panel as an organic acid, we’re talking something far more advanced, far more comprehensive whereas the urine panel, locally, is primarily just gonna look for bacteria or maybe leukocytes as you mentioned you might get a positive or a trace or something like that but it’s not a detailed description of what’s going on you mentioned several bacteria too, like Klebsiella and Prevotella, we can identify this on a stool panel. So, that’s why it’s so important to get the data and could we just throw a woman on an herbal UT formula, we could but you know, we want to do our due diligence, we want to do a good work-up on these people too to make sure that we’re not just cut straight to the chase and we skip something huge that we would find on these tests.  

Dr. Justin Marchegiani: Right. I mean a lot of the antibiotics they’re gonna be using are gonna be like Bactrim or any of these kinds of, um, Mors, Augmentin’s a big one. Bactrim and Augmentin, those are a couple definitely be very wary of any of the fluoroquinolone families because they have significant side effects regarding tensing tendons and ligaments and mitochondria so be really careful of using fluoroquinolones. Of course, when we work these patients up, we’re doing a really good history so we understand how everything came to fruition regarding the UTI, yeast infection or bacterial vaginosis. We’re trying to understand it, right? Obviously, with certain things like yeast infections, BV, like making sure things are dry in that area. If you’re in a very moist environment keeping things dry helps because yeast and mold love a very moist environment. So, keeping things dry tends to be very helpful. Soaping up some of those areas you’d be very helpful too that you can use a really nice, um, as long as the mucosa is not like really, um, irritable, you can really use a really nice sulfur soap especially in the outside air if there’s anything yeasty on the outside are, anything internally. There are definitely internal things that we can do. So, on the internal side, just getting water in there, maybe helpful using raw cranberry juice, not anything with added sugar but raw organic cranberries, you know, 4 ounces at a time diluted some water is pretty good. You can drink that. That’s gonna have a nice low pH in it, which helps prevent the bacteria from growing. It also helps with some D-mannose in the cranberries. Can also internally do things like different berberines, can be very helpful, that’s excellent boric acids, another excellent compound. You gotta be careful with these by, enlarged by itself because they can be a little bit irritating so you want some nice things that provide some moisture whether it’s aloe or shea butter. There’s different, like moisture compounds that can provide the moisture so you don’t dry out that tissue as well. 

Evan Brand: You know, how about some of the suppositories. Have you used those before? I’ve seen some of these like pH suppositories, those have been helpful, also I think it’s integrative, I know Aviva Romm did a talk or an article on it one time. There was a specific probiotic that we had used, I think, it was called pro-flora that we had used, uh, that was supposed to be inserted vaginally and that was like a game changer for BV and some other related issues. So, not only taking oral probiotics but vaginal probiotics as well. That has been a game changer for many women. It’s not something we have to go to a lot but it is a good tool if someone just in bad shape and the conventional strategies failed them or made them worse then something like these vaginal probiotics are helpful. So just to be clear, there’s some strains specifically for vaginal health that are taken orally but then there’s also other blends that you can insert vaginally and the women have reported great success with those. 

Dr. Justin Marchegiani: Yeah. You want to make sure the hydration is there, whether it’s aloe or beeswax or shea butter or coconut oil, some of those can be helpful. Again, the antimicrobials that we may use would be the boric acid, some of the neem, some of the different berberines. And again, we may want to also add probiotics in and around there that can be very helpful. In regards to, like yeast issues or, um, UTI issues, you got to be very careful because when you women menstruate, well more with yeast and more bacterial vaginosis because that’s affecting the vaginal canal more. When women menstruate, that blood is like 7.3, right? So, that’s very neutral to alkaline. So, when you’re menstruating, you’re taking that acidic pH in the vaginal tract and you’re moving it backup to a more neutral pH when you menstruate so that’s gonna actually make it easier for bacteria and potential yeast to grow and you could have a BV issue or yeast issue that can happen due to your menstruation. So, when you’re already more susceptible in that vaginal area, you know, you gotta, you may actually wanna do a suppository in and around your period too, because that pH is gonna move up and that can start to cause microbes to grow. Some women have to be more careful with that, you know, if they have a chronic yeast or bacterial issue just to make sure it doesn’t come back. 

Evan Brand: I want to hit a few more herbs and then I want you to riff on the birth control conversation because I think that’s huge. So, you mentioned berberine and some of the other related herbs. Also, we’ll use the antifungals at the same time. So, you and I have our own custom blends that we use and so we may use something like Pau D’arco, French tarragon, horse tail, olive leaf, things that have antifungal and antimicrobial properties. So, that’s the cool thing about what we do is as you mentioned Backstrom or some of these other conventional strategies. It’s just a big sledgehammer, right? It’s not a targeted tool. It’s one sledgehammer. We don’t know exactly what we’re gonna kill but it’s an antibiotic, were just gonna drop the nuclear bomb into your gut and we’re gonna disturb not only your gut microbiome, we’re gonna negatively affect the production of your nutrients in your gut. We’re gonna negatively affect your mitochondria. We may knock out the UTI but as you saw in the papers, 25% of those UTIs are gonna come back within 6 months to a year and so when we’re coming in with these antimicrobial herbs, also, throwing in antifungal herbs, that’s where the magic really happens because there could be a combination as we talked about. It’s rare to see just UTI, it could be a combination issue meaning there’s some Candida, there’s some bacterial problems, maybe there’s parasites in the gut too. Maybe there’s H. pylori like you mentioned. And so, that’s the fun part is when you take a blend and you’re working people through this protocol. You’re now knocking 4,5,6 issues out all at once in one fell swoop when they originally just came in with the complaint of UTI. When you do the labs, you wanna uncover so much more and that’s where the beauty is. 

Dr. Justin Marchegiani: 100%. Here’s one study here looking at the perceptions using contraception birth control pills. So, usually this is like a synthetic estrogen mostly, right, an ethanol, estradiol. I’m looking at the influence on the vaginal microbiota and so really the take home here inside of the gate, the vaginal state was significantly modified hormone administration apparently corrected the alterations uh, but has the potential of being an accurate tool. Where is it? Right here, um, there it is, I’m sorry. Statistically significant association between, this is, um, this is contraception and normal microbiota was observed after three months when the vaginal microbiome was modified at 6 months inflammatory reaction was detected in almost half of the women. So, only seven women but you can, it created an inflammatory state in the vaginal microbiota and then also yeast colonization was increased and it created an inflammatory reaction in three out of seven women and it altered some of the beneficial bacteria in the vaginal area. Now, small study but you can see, you know, three out of seven, it affected this and this is what we see clinically with a lot of our female patients is some of these things can be affected because it’s affecting: one, it’s creation; two, it’s causing yeast to grow impacting some of the good bacteria and how does it do this, it does it mostly via LDH. If you alter someone’s digestive pH, right, let’s say you give them a proton pump inhibitor, you’re gonna have all kinds of digestive issues and maybe even nutrient deficiencies that can affect things long term. Obviously, with birth control pills, there’s other things they do, they can create issues with nutrient absorption or they can cause nutrient deficiencies in areas of B vitamins, folate and also calcium and magnesium. So, we see a lot of women that do birth control pills have a lot of those nutrient problems. So, if you’re on a birth control pill, ideally, it’s better to use something that’s more barrier based or if you want to set it and forget it method, you know, potentially looking at the ParaGard which is a copper IUD, you just have to make sure you can handle the copper. I find if you want to set it or forget that the copper tends to be better than the hormones but ideally, you know, a barrier method it’s not internal all the time. It’s probably better so that just kind of gives you a couple options there. 

Evan Brand: Yeah. I’ve heard some stories, some horror stories about the copper ones too. So, like you said it cold be a problem but

Dr. Justin Marchegiani: Not everyone has problems with it. I mean, women that like tend to cramp a lot, they could have, because that cramping, IUD being in that uterus sometimes that can cause pain but it just depends kind of where women are, you know. Some parents may be pushing kids to have a method because they don’t want their kid getting pregnant and maybe they feel like they aren’t responsible enough at maybe 18 or 19 and they set it and forget it method. If you want that, I would recommend doing the ParaGard before you go to a hormonal method. 

Evan Brand: Yeah, for sure. And, not to mention too we’re already in a society of so much estrogen dominance and you and I have done podcasts about the impact of gut imbalances in issues with the glucuronidation pathway which is then causing further issues. So, we could see this estrogen problem in a woman who’s not on birth control. You could still see that manifest in this way and so that’s why you’re getting off of the xenoestrogen, you’re cleaning up your makeup. You’re getting rid of plastics. You’re fixing your gut. You’re improving detoxification. All these other functional medicine strategies are directly impacting your ability to beat this situation. So, we know, we always want people to look at the big picture. Don’t just look for the magic, uh, like, berberine, Pau D’ Arco remedy. And there’s a question here in the chat, ‘how many Pau d’ Arco capsules is needed for someone who has Candida in their gut?’. I have no clue because we rarely use it in isolation. We’re always gonna use it in a blend. And I doubt you have just Candida. You’ve probably got other issues too. 

Dr. Justin Marchegiani: Yeah. Somewhere when they come in, they could have a combination of a little bit of a bacterial, a yeast issue, UTI thing. That could be a kind of combination of 2 or 3 different things happening. This one may be more predominant. So, we never wanna just go all in on one thing. Again, if someone’s having vaginal issues specifically, there’s gonna be things that we insert intravaginally like some of the boric acid, like some of the neem or the berberines and we’ll probably interchange in some probiotics because part of the big problem is you have to get the bacteria flora in the vaginal area, back up to where it should be because it’s the good bacteria that will help keep the other bad bugs in check through their natural acid and hydrogen peroxide production. 

Evan Brand: Well said. 

And so, the point I was making is that I don’t want people listening and going okay just give me the freaking remedy. What’s the natural urinary tract remedy? That’s what I’m here for. And we’ve talked about some of those, you know, the mannose, the cranberry, the berberines, the Pau d’ Arcos, the French Tarragon, this whole blend, you know, that may be the solution but what got you here is important. Have you fixed the other issues that have gotten you here. And so, I hope people see the big picture. Sometimes, you and I are happy to just go boom, hit the oregano oil and were happy to just throw out just this natural solution but like you said before we hit the record, you don’t want people skipping out on the low hanging fruit. 

Dr. Justin Marchegiani: Exactly. And so, it’s always good to do history. I find the big issue is antibiotics can be a big factor. I also find just some of the low-hanging fruit like the intercourse and hydration can also be a big factor as well. You’ll be surprised. And so, my wife comes to me, she’s like, ‘my friend has this issue, what should I recommend?’. Well, it’s hard, I can’t really recommend a lot of things because I don’t know much about them if eating like crap and they’re not hydrating and they’re drinking lots of soda and they’ve been on lots of antibiotics, you know, I may say, hey, all right, do this [24:34] but that’s gonna be palliative and not fix the whole lead up and how everything went down. And so, the lead up and I call it the timeline history of how we get to this point matters so much because, you know, if not, you were just becoming naturopathic doctors that are using nutrients and herbs like MDs use drugs. Now, again, I think that’s better because a lot of these things are natural, have less side effects but still we want to be holistic and still root cause. 

Evan Brand: Yeah. Well said.  That’s the problem. There’s a difference between naturopathic approach to this issue and functional medicine approach to this issue. So, I think you made that clear, which is, you go to the naturopath, it’s hey, here’s the oversee, functional medicine is gonna come in and say, ‘okay, well, how did you get to the UTI?’. Oh, you took antibiotics, you’re on birth control for 20 years, you had a sexual partner who had extremely poor microbiome health, maybe there was some issue there, maybe you had multiple partners, maybe one of them had H. pylori. You have low stomach acid. You ended up with dysbiosis, then you got Candida overgrowth, then you drank too much alcohol, you loved to do wine in the evenings. You ate a little too much chocolate, you know, it’s like, that’s the more investigative route and that’s where people need to be thinking.  We’ve got friends that are naturopaths, good people, but you just got to go deeper most of the time.  

Dr. Justin Marchegiani: Yeah, and a lot of times too, if I’m, if someone has chronic issues, I wanna know more about their gut because the microbiome has such an impact especially with IgA and with the overall immune system. So, if there’s chronic issues in the vaginal area, you have to look up to the intestinal tract. Very important. 

Evan Brand: Yeah, and you would say there’s gotta be some link between the low secretory IgA that you and I are seeing on the stool test and what’s going on with the vaginal microbiome too, right? You would assume that’s a system-wide defense shield that’s gonna be affected.  

Dr. Justin Marchegiani: Yeah. It’s part of the mucous membrane barrier. So, mucous membranes in the eyes, the mouth, the intestinal tract, the urinary tract, the vaginal canal. So, if we see low IgA issues in the intestinal tract, that barrier is a little bit weaker. Think of the force field, you know, you see star trek, they put, like their force field up, right, so they, so when the Klingons go to shoot them, it kind of bounces off, right? Think of the force field we have in our intestinal tract and our vaginal canal and our urinary canal that kind of protects and so probiotics can help, obviously getting rid of the dysbiotic microbes can help, avoiding a lot of things that create the imbalances to begin with, which would be a lot of the antibiotics or maybe pesticides or GMO foods that produce a lot of antimicrobial compounds too. All those help avoiding those things too. 

Evan Brand: You know, what’s happening even in the functional medicine world, is that everything’s becoming isolated. Are you noticing that? Like people are focusing on just the gut. So, it’s like this leaky gut formula, this leaky gut protocol and they’re ignoring the fact that you just mentioned this IgA, this mucosal barrier is kind of a system-wide problem. So, there could be oral, vaginal, gut all at the same time, all related to the same dysfunction of these force fields being down. I think it’s just marketing, right? People just want to market that they’re the gut guy, they’re the parasite guy, they’re the Candida guy. I think that’s just a marketing probe but hopefully people are seeing this and of course if they’ve been listening to us for months or years, they’re seeing that this is a system-wide problem, it’s just manifesting in this way. 

Dr. Justin Marchegiani: Yeah. In the functional medicine world, a lot of people market to niche areas and symptoms which is fine because a lot of people when they get focused on something, they think they have these issues, they’re going into google or they’re typing that issue. So, for you to be relevant and for that person that has health issues to find you, you do kind of have to market to a symptom but then when you find that person and you talk to them, you wanna make sure that their approach is globally where they look at things holistically and you’re not seeing the gut person that only deals with the gut and they’re not looking at your thyroid or your anemia or your low glutathione. They’re not connecting the dots. So, you got to make sure they’re still able to connect the dots but multiple systems and they’re not just focused on one issue. So, it’s okay for doctors to market to that, you just have to make sure that their philosophy is a holistic philosophy that encompasses everything in there. 

Evan Brand: Yeah and holistic spelled w-h-o-l-e a wholistic, the whole thing, the whole body, the whole person, not just holistic as in natural, it’s gonna be the whole piece and I think that’s where I suffered for a long time because I focused on my gut for so long but I was ignoring toxicity issues, I was ignoring dental issues, I was ignoring tick bite infections. So now, oh crap, I see the whole picture and I would miss that if I just dialed in the gut so and that’s what you and I do. We’ve done this over with clients worldwide, we look at the whole picture. If you’re suffering, if you’ve been through the conventional rabbit hole or maybe you’ve been fortunate to avoid the conventional rabbit hole, you don’t want to go down it but you need help, feel free to reach out. Dr. J and I work with people around the world. We can send these labs that we’re talking about stool and urine. These are at home, these are non-invasive. It’s rare that we need to do invasive testing but most of the time it’s at home functional medicine tests can be sent to your door, you do them, you send them back to the lab. We get the results. We jump on a call. We run you through them. We interpret those. We make a protocol for you and get you better and get you off the merry-go-round. So, if you need help, feel free to reach out, Dr. J is at and me, and you can reach out, book a call with us, we’d love to talk with you, help you, find and fix the root causes if you just have UTIs and you think that’s all it is, maybe you’re right but maybe not, either way, we’re gonna help you get to the bottom of it. 

Dr. Justin Marchegiani: Very good. Excellent. So, for women that are listening and kind of want to recap here, first thing, make sure your diet is right, keep in the process refined sugar, grains, flours out, makes a huge difference. Omega-6, seed oils, in general, should be reduced as well. Hydration, make sure hydration is good, clean and filtered water, um, you know, good mineral water, especially if you have more health issues, more minerals in there is gonna be better. Next thing out of the gate, you know, urinate after intercourse, those kinds of foundational things. If you have chronic gut issues, definitely, get your gut looked at. If you’re on hormone, if you’re on birth control pills, definitely get your hormones looked at and figure out why you’re on them. Most women aren’t even on hormone or birth control pills for birth prevention. They’re on it for off-label issues like acne or headaches or lots of PMS and so most women could totally get off it because they’re not even using birth control pills for the original intention. They’re for off-label use and so that would require looking deeper at the hormones. Next, you can get tested, you can do either a, um, a MONISTAT test to look for yeast, you can get those at the drugstore, you can do one of the strip tests to look for leukocyte esterase or I think it’s nitrites in the urine for more of the UTI issues and of  course, if you have a lot more of the odor-like, uh, issues, you can get a vaginal swab from your OB or your primary to rule out any of the BV issues as well, again, similar solutions, you know, some maybe more internal in regards to what we recommend, some maybe more internal like with swallowing pills so maybe internally, intravaginally and of course the more chronic the issue is, the more we have to really support the vaginal microbiome with the right beneficial bacteria getting in there internally as well. And then, of course, just keeping up with a lot of the menstruation because that can really affect a lot of the, um, the bacterial issues and yeast issues in the vaginal canal because it’s gonna shift that pH from very acidic to more neutral to alkaline at that time of the month when you menstruate. So, hopefully, that’s a good kind of crash course, out of the gates and kind of you guys understand kind of our spitball kind of philosophy and how we look at the whole history and really connect the dots and we have our little toolbox of all these things but we just got to make sure it’s catered to the history.  

Evan Brand: And alcohol too, I think, we briefly mentioned it but alcohols got to go. It’s just, it’s not gonna help you. It’s going to promote all sorts of issues. It’s gonna aggravate the immune system. It’s gonna affect your IgA levels. It may promote dysbiosis and it may promote more yeast problems and so I’ve heard many stories where a woman’s like, oh yeah we went to Napa Valley and we drank wine and ate chocolate and salami and cheese all weekend and now I had a flare up. It’s like, well, yeah, duh, I mean, that’s incredibly damaging. Everything that you’ve done, you binged on wine all weekend so I think wine kind of gets like this people think that they’re not drinking alcohol. Somehow, they think they’re getting off the hook. Oh, it’s just wine, like, it’s so socially cool, it’s like coffee. It’s like coffee and wine, like wine is so accepted into the culture but it can be a big problem, I tell you. Some of those California women, the ones in San Francisco, like, it’s part of the culture here. I had one woman argue with me that she didn’t want to get off alcohol. I said, well, what if it’s gonna help your gut. She’s like, well maybe I’ll consider it. So, sometimes as practitioners, we’re having to bargain with people and try to make trades and make healthy swaps, we’ll swap it for this and try this and what if you do a binder afterwards. So, sometimes, you gotta work with people, they’re not just in a vacuum. We got to work with them and help educate them so that they’re more dedicated to the lifestyle changes but I just want to mention alcohol because I think a lot of people, don’t even consider the impact it has on the gut but then on this flora.    

Dr. Justin Marchegiani: Yeah. A couple things with alcohol, number one it’s diuretic so it will increase the frequent urination and kind of make you more dehydrated so good hydration helps prevent a lot of that bacteria from growing. Number two, out of the gates, you know, it may be necessary out of the gates for the first month so as you get things under wrap. There’re also healthier versions of alcohol. I mean, you can always get, like a Cosmo martini that has the fresh lime juice in there and cranberry juice. Just make sure it’s, like not the cranberry with sugar or the lime with sugar. Make sure, it’s fresh lime or actual juice cranberries with, like a nice Tito’s vodka, I mean, Tito’s vodka is, um, it is charcoal filter, right? So, it’s gonna be really clean and you can get some nice cranberry and lime in there that should be almost be beneficial in a way, obviously, you know, keep it, you know, a drink or two maybe once or twice a week max but once you better that maybe a good option to add things back in and just stay away from a lot of the sugary stuff and of course the glutinous drinks and you’ll be in a lot better position.   

Evan Brand: Yeah. It’s a funny thing you have to mention. There’s got to be real cranberries because most of the time you go to a bar, it’s like that. It’s garbage. The heart or it’s the high fructose corn syrup concentrate. 

Dr. Justin Marchegiani: Yeah. So, worst case, you can always just do a fresh lime squeezed in there and see if they have anything that’s just a pure, you know, extract and that’s a much way to do it. Of course, dry or white wines and you know just a good Tito’s vodka is always great with just the lime in and of itself. That’s an easy way to do it and keep the sugar and junk down but also keep a nice acidic pH there which is helpful for the vaginal area. 

Evan Brand: Yeah. We’ll hope, as you mentioned, no I think we covered It so if you need help, we mentioned the links here Dr. J, that’s Justin at You can reach out for consult worldwide. Me at, either way, we’re here to help you guys. We love what we do. We have a blast and it’s fun to educate people. It’s fun to empower people and take back your health and it’s possible. Whatever you’re dealing with it’s possible to make progress so just keep your head up. Stay motivated. Don’t always run straight to that antibiotic if there’s another way. You may try another solution. If you’ve been doing this for a decade now and you’re still battling it, you’re not out of the woods yet, it’s time to look deeper.    

Dr. Justin Marchegiani: Excellent. Great chat, Evan. Everyone, have an awesome week. We’ll talk soon. Take care of you all. 

Evan Brand: Take care, now. 

Dr. Justin Marchegiani: Bye now. Peace. 

Evan Brand: Bye-bye 

The Top 5 Nutrients to Improve Brain Function | Podcast #333

For your brain to work efficiently, it needs specific nutrients, making the food we eat vital to brain function. What types of nutrients do we need to help our brains work? 

Some foods, such as fruits, vegetables, coffee, and tea, have antioxidants that help safeguard your brain from harm. Others, such as eggs and nuts, have nutrients that support memory and brain development. You can help keep your brain healthy and boost your alertness, memory, and mood by strategically including these foods in your diet. 

Nutrition is essential for healthy brain function! To learn more about refining your brain process in memory, attention, focus, and sleep while also eliminating symptoms of anxiety and depression, don’t skip the full podcast, check out other videos, and don’t forget to hit like, subscribe button, and the notification bell!


Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

1:43  Inflammation in the Brain

3:50  Improving Brain Function

7:41  How Food Affects Brain Function

11:24 Insulin Resistance on the Brain

24:11 Improving Blood Flow in the Brain

27:16 Glutamate Issues

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Dr. Justin Marchegiani: Hey guys, it’s Dr. Justin Marchegiani here with Evan Brand in the house. Today, we’re going to be talking about the top five nutrients to improve your brain function. Really excited to dive into this topic today, it should be a good one, Evan, what’s happening, man?

Evan Brand: Oh, not too much been reading about some of these herbs. And these are something that we do personally. And clinically, I just want to point that out from the beginning. The difference between you and I and conventional practitioners is they’re not taking the drugs, they’re not experimenting with the stuff they’re prescribing. They’re not putting people on the depression drugs and the beta blockers and all of that, and the Adderall and vyvanse. And all the cognitive enhancing drugs, they’re not doing that themselves. So the cool thing about us is that we believe in what we do, and we want to try these things and see how they perform on us. And what if we mix it with that nutrient? How does that combine with this diet approach? And how does that combine with good sleep and good sunshine. So I think it’s fun, because you and I have personal insight into these things. And not just the clinical insight. And that really, I think makes you a better practitioner, but it makes you make a better protocol, because you know, how you feel. And then you can then tweak the nutrients based on that.

Dr. Justin Marchegiani: 110%. So I mean, I think, based on our clinical performance, I mean, just kind of, we always start with the low hanging fruit. So like if people are coming into the show when they you know, want a lot of the nuance, more granular stuff, right stuff. And that was we’ll talk about that too. But we also have to make sure people that are coming in, that don’t have a good foundation, we have to assume that foundation is not there. So of course, getting inflammation in the body down in the gut makes a huge difference, because inflammation in the gut will create inflammation in the brain. And inflammation in the brain will activate certain immune cells in the brain, right. So you have these astrocytes, which are like that make up the blood brain barrier, which prevent things on the inside going into the brain right outside going in. So if you can have good blood brain barrier, that’s important. And then once you get things going into the blood brain barrier into the brain that’s going to activate these cells, these immune cells called micro glial cells, and these are basically part of the brains immune system that go in there and clean up inflammation and gunk. And the when those brain cells or immune cells are activated, those microglial cells are activated, that’s actually going to create cognitive issues, brain fog, and things like that mood issues. A lot of the new wave of antidepressants and mood medications that are coming out are actually working on brain inflammation. So we know inflammation plays a massive role. And the hallmark of inflammation is going to be cytokines interleukins, c reactive protein, maybe other inflammatory metabolites, nuclear factor Kappa beta, of course, um, you know, part of the inflammation is going to be in activation of the immune system on one side, and usually their cells that are going to be broken down to the faster rate than they’re building up, whether it’s inflammation from bad foods, excess omega six junky fats, trans fats, hydrogenated oils, pesticides, mold, toxins could be bacterial toxins, mycotoxins from fungus and yeast, acid aldehyde, from alcohol and yeast by products. So all of our gut, bacteria, yeast, parasites, all of these things are going to create endotoxins, or internal toxins, endogenous toxins in the body. And then of course, we have exogenous toxins in the environment, like our mold, heavy metals, pesticides, chemicals like that plastics, xeno, estrogens, all of these things are going to be in the environment, of course, all the foods we put into our body. And then of course, the more nutrient poor our food are, right? The more nutrient poor our food is, the more crap in the more junk, the less nutrients you have to run those metabolic pathways to run optimally.

Evan Brand: Yeah, great job laying the groundwork, as people coming in are gonna say, Well, why why do we need a whole podcast dedicated to improving brain function? And the answer is because we’re up against so much. So you did a great job kind of highlighting that it’s the food, it’s the air, it’s the water, it’s the heavy metals, it could be the silver amalgam fillings in your mouth. I mean, there’s a lot of things that are in our environment now that are neurotoxic. They’re not just highly estrogenic and endocrine disrupting, but they’re also neurotoxins. And we’re breathing them in every day. And you and I’ve measured hundreds, if not 1000s, at this point of clients around the world. And I’ve seen children as young as two and three years old with massive toxicity from gasoline additives to thau, late to xylene, to nail polish chemicals and hairspray chemicals, and to 4D and glyphosate. I mean, it’s amazing just how toxic people are. I would tell you just based on looking at this clinically, the most toxic people on the planet right now according to me running all these labs would be children less than age 10. And I think it’s due to just the toxicity of the planet that’s increased, but also this maternal transfer through breast milk and through the placenta. All the women that grew up in the 70s and 80s and 90s and now 2000s that are having children, that multi generational toxicity really built up, whereas someone like my grandparents, and you know, growing up in the 1940s, glyphosate wasn’t even around for the First 30 plus years of their life. So yeah, there was a lag, basically. And yeah, the lag has caught up.

Dr. Justin Marchegiani: Exactly. And there’s a lot of environmentalists out there that are, you know, talking about co2 and things like that. Well, co2 is plant food. I mean, I really wish the conversation about the environment really switched to pesticides, and xeno estrogenic compounds, I think these one they’re affecting us, they’re getting into our groundwater, they’re getting into our food, they’re affecting our kids, you know, much more than like, let’s say co2, wood, right? Because I mean, you can just grow more plants and more plants around you to, to take in and basically, you know, use that co2 for photosynthesis to make glucose and, and for plant fuel, essentially, but things like toxins, right? I mean, you need to actually there’s nothing in nature, that’s going to be buffering that, like, I know, plants buffer co2, right, I’m not aware of it. And so we have to use special filtration, whether it’s air filtration, like for instance, and Evans situation, Evans, very sensitive to fumes, incense, so he has a really good high quality Austin air filter with activated charcoal with zeolite and impregnated potassium iodide to filter a lot of those volatile organic compounds out or if we’re using something on the waterside, we’re using a really high quality carbon or reverse osmosis filter to filter out pesticides and chemicals and pharmaceutical drugs that are actually in our water. So we actually have to go through extra modalities and methods to filter these things out, I’m just far more concerned about these things, then, you know, more natural forming things. So I hope that conversation can shift because it plays a big role on our mood, and our energy and our brain performance. And so kind of switching things back to our brain function, getting inflammation dialed in. And of course, I talked about nutrient density. Why is nutrient density important? Well, B vitamins are the low hanging fruit for brain function. Okay, and B vitamins are going to be the highest and high quality animal products, especially animal meat. And then of course, our high quality vegetables. So that’s to be in my opinion, the foundation of our diet is kind of this really good paleo template that focuses on lots of good healthy plants, and lots of good healthy fats and animal products. And ideally getting more of our fats from healthy animals, saturated fats and plant fats because animal fats are much more stable due to their saturated nature, right? plant fats tend to be a lot more unsaturated monounsaturated, and they can be more heat unstable, right? So the best plant fats that are out there are going to be your extra virgin olive oil, your avocado, your palm oils. And of course, the the hallmark of plant fats are going to be your coconut oil because it’s saturated, which makes it a lot more heat stable. And then of course, our if we can tolerate high quality grass fed butter, high quality, ghee, or duck tallow or beef tallow, good, high quality saturated fats on the animal side are going to be great too.

Evan Brand: Yeah, I mean, hate to call them out specifically, but we’ve seen it clinically, the vegetarian vegan people, they have a harder time with brain function, not only brain function, but mood issues, you and I’ve done podcasts on depression, we’ve done podcast on anxiety, due to the lack of the good fats in general, unless they’re trying really hard, we’re going to see this issue with poor cognitive function much, much worse and vegetarian vegan clients. And we’ve actually had some clients that have went back on meats and good quality fish and eggs, because their brain function was so poor, they were literally failing at work. And I had a couple people who were at potential job loss because their cognitive function was so bad after getting off of good meats and fats, and just going with just plant foods, they literally had to for their brain function, I was of course, very happy to see them perform better will make out those good fats back in.

Dr. Justin Marchegiani: 100%. And of course, they just kind of a little crash course and organic chemistry, saturated fats, they there’s the bond in between the carbons, so you have a carbon, and then the other carbon that’s connected to this a single bond, right, so it goes carbon, carbon, carbon, carbon. And so for instance, like medium chain triglycerides are fats that are between six and 12 carbons, right. And like butyric acid butter, I think, is around four carbons. So imagine, you know, six or 12 carbons, they’re all going to be connected with single bonds in between, which means the outer edges are going to have three hydrogens or the inner part of the bonds are going to have two hydrogens attached to it. Again, all you have to know is the difference in the bonds. So saturated fats have single bonds, which make it more flexible and ability to withstand higher heats. poly unsaturated fats, right, omega threes or omega sixes, right? The omega refers to how many double bonds there are in in the fatty acid chain. So omega threes have three double bonds, omega sixes have six double bonds, and when you have double bonds, they’re they makes the fat more inflexible, and makes it more a lower smoke point, meaning it can oxidize and it can go bad. And so just no saturated fats don’t have the double bonds, and it’s going to make it a lot more stable. And why is that important? Because our brains like 70%, fat and cholesterol. So if you’re not eating the right ratio, and the end the good raw material building blocks for your brain, you’re gonna have a problem. And every cell in our body has a what’s called a lipid by layer. So you have this little fatty lipid layer on the outer part of the cell. And if you start making or Start using junky fats to build that layer of backup is going to stress out your antioxidant reserves. And you’re going to build really inflexible, non healthy non-communicative cells with very inflexible cell membranes.

Evan Brand: Yeah. And how does that manifest? Well, that’s where some of the memory issues pop up, you freak and your best friend’s name, you go into the pantry, you don’t know why you’re there, you figure you forget which way you’re supposed to turn. When you get off the highway off the exit, do I go left? Do I go right? Even though you’ve been that way before, maybe you slip up on someone’s name, maybe at work, you’re slipping up in a presentation, you completely get sidetracked and you just can’t get yourself back on track. Maybe you’re unable to read, maybe you’re unable to retain the information you read, you have to read things multiple times. Maybe you hear someone like Hi, nice to meet you, john, and you immediately forget his name, that kind of stuff. Those are things that we see. It doesn’t necessarily have to be Alzheimers or dementia level to be considered a cognitive problems. So when we say cognitive problem, like everything else, there’s there’s a spectrum, you have the far end, which is going to be your clinical diagnosis of dementia and Alzheimer’s and whatever else Parkinson’s, and then maybe you have like your brain fog, forgetfulness, memory issues. And I’m not saying that those people with those mild brain issues are all going to end up demented. But it’s important to recognize those things now. So that we can do what we can, like you said to reduce inflammation to try to preserve the neurotransmitters in the brain. So let’s go into the nutrients if you’re ready.

Dr. Justin Marchegiani: Yeah, let me just hit one more things. We’re talking about diet, right. And one of the big things when people have chronic health issues, what tends to happen is we have insulin resistance, okay, where the cells become numb to insulin, insulin basically helps glucose get into the cell, it also helps protein get into the cell. And when insulin becomes resistant, it’s going to start taking a lot of the glucose and converting it and storing it as fat. Now that’s kind of in the body. Now what’s happening in the brain, insulin resistance will manifest in the brain through our brain not being able to use glucose for fuel. So it’s like you can have a lot of glucose in the bloodstream, but the brain is not going to be able to use it. So it’s like the brain starving nutritionally, to be able to use glucose for fuel. And so you start to form inflammation in the brain and a lot of plaquing in the brain. Now, the same enzyme that helps break down insulin is called insulin degrading enzyme. That enzyme when there’s lots of insulin around gets wasted away dealing with insulin. The problem is that insulin degrading enzyme has dual purposes, it can go in and clean up plaque in the brain. So it cleans up the brain, it’s the vacuum cleaner for your brain keeps the brain free of plaque. We know plaque has a negative impact on cognitive function and performance. And also when you become more insulin resistant in the brain, it’s hard to use glucose. So starting to decrease insulin allows the brain to also switch hit and start using ketones for fuel. And ketones are very people that have brain issues. That’s part of the reason why they’re reversing Alzheimer’s with ketones. So the first thing we do is we we don’t add ketones in our body, we switch our body’s insulin levels by restricting excess carbohydrates or our body can make ketones and start utilizing ketones for fuel. That’s just kind of first step out of the gates though, because if we have this physiology there, where we’re insulin resistant, and I’m recommending extra B vitamins, or extra gingko, or extra bacopa, man, I mean, you’re not fixing any issues, right? You’re not you know, you’re not fixing anything, you’re not getting to the root underlying problem.

Evan Brand: Yeah, well said and then I guess that would also give people a false sense of hope. And then they would come back to you and they’d be disappointed because they’re insulin resistant, but yet you’re giving them all these good brain nutrients and maybe they only had 5% improvement.

Dr. Justin Marchegiani: Exactly. So you have to make sure the brain is able to utilize the fuel in the body already. And we have to switch out you know, the insulin resistance so the the parts of the brain that are utilizing insulin and breaking down insulin can actually go in and clean up the brain instead. That’s very important.

Evan Brand: Yeah, well said I mean, that’s the important fat you know, foundation framework, whatever you want to call it, because it’s impossible to circumnavigate that issue by just supplementing like you said bacopa. 

Dr. Justin Marchegiani: Exactly, exactly. So a couple of my favorite things out of the gates like I mentioned, are going to be high quality methylated B vitamins you know B one, B two B three which are going to be thiamine riboflavin, niacin, pyridoxal, five phosphate, right which is B six pens authentic acid, which is B five, I think B7 is bioten. Right and then B nine is going to be folate and then your B 12. Make sure it’s either methylated hydroxylated or, or Adenosyl B12, which are excellent sources of B vitamins. So those are going to be great out of the gates. Outside of that things that support acetylcholine are going to be excellent. So either taking acetylcholine or using an herb called huperzine huperzine. A is is excellent at supporting that thing here. A couple of the things that um, acetylcholine really is very it’s, it really improves the colon ergic neurotransmission, which it basically helps with cognition, decreases the decline of cognition. Anything else you want to say on acetylcholine or huperzine out of the gates?

Evan Brand: Yeah, I’ve played with acetylcholine a lot. It’s kind of the Forgotten neurotransmitter, I think you and I’ve done a great job of kind of highlighting this. You know, we’ve hit on dopamine, we’ve hit on serotonin, we’ve hit on GABA, but man, you rarely have people talking about acetylcholine. So it’s, it’s probably easier to work in this mechanism, which is the huperzine is inhibiting the brain time from breaking down-

Dr. Justin Marchegiani: So the acetylcholinase, acetylcholine, acetylcholine esterase, which is going to be you know, it’s an enzyme because the ASC that what breaks down acetylcholine, so it’s slowing down the breakdown. And again, [inaudible] something we find in liver, egg yolk, so it’s really important in like high quality animal products, and we’re basically slowing the breakdown.

Evan Brand: Yeah, so you can do both right, you can come in with the good foods and good fats, and then you can try to slow the breakdown of that gland. It’s pretty cool. So there are a couple papers on this huperzine. Specifically, they talk about it, modifying the beta amyloid peptide processing, reducing oxidative stress. Also, they talk about helping with the secretion of NGF, which is nerve growth factor. So that’s really cool. And then it says here, finally, this is the research paper. Finally, huperzine a can significantly improve cognitive function in patients with mild to moderate vascular dementia. So that’s pretty impressive. And I personally just take this on going, I’m not necessarily fearful, but I just want my brain to function the best. So I do supplement on and off with some of these brain nutrients we’re talking about.

Dr. Justin Marchegiani: Right. And it also helps improve mitochondrial function in the brain. So we have mitochondria in every cell, I think except red blood cells, right. And basically, the mitochondria is the powerhouse where it generates ATP. And that’s really important fuel source. And so, one, it’s neuroprotective. So if you have chemicals or not so good compounds floating around the brain, mycotoxins whatever, it’s kind of protected from being damaged. And it’s also going to help the mitochondria the brain to generate ATP. So that’s important, too.

Evan Brand: Let’s talk about the next one on our list here, the EGCG, which is going to be the poly phenol coming from green tea, because this is really cool. The study here talks about the enhanced transport of huperzine is possible with the egcg. So they found that when they were able to stack these two nutrients together, you get even more bang for your buck, which is what we find a lot with nutrients. When you and I are working on gut infections, right, we’ll find that the individual parts are not as valuable as the sum when you combine this herb with that herb and that with that, you get a much more synergistic, I would guess you would call it an exponential beneficial effect. Right?

Dr. Justin Marchegiani: Exactly.

Evan Brand: We got wild blueberry next on the list. Let’s talk about wild blueberries. So there are some cool antioxidant benefits here. But there are some papers-

Dr. Justin Marchegiani: I wanted to highlight one thing on the egcg, right, it also helps reduce the beta beta amyloid plaque accumulation. So we talked about that, right? Because insulin resistance plays a big role because that insulin degrading enzyme, which is depleted when you have insulin resistance, that’s there to help decrease beta amyloid plaque. And we know that the beta amyloid plaque is going to be reduced when we’re taking egcg is due to its anti inflammatory and antioxidant effects.

Evan Brand: That’s awesome. All right, let’s go back to the wild blueberry. This one’s cool, too, some cool papers on this in regards to being a potent antioxidant. They have done some animal studies on this to help increase the capacity of neurons to maintain proper functioning through the aging process as also reduces some of the beta amyloid plaque aggregation. It also talks about how of course the mitochondrial function is disrupted, and the wild blueberry extract helps to protect against that. And then also, guess what, this is cool. It also leads to higher production of glutathione. So that’s a pretty interesting little mechanism.

Dr. Justin Marchegiani: Yeah, very interesting. I mean, a lot of those compound gluta phones are really powerful antioxidant. So again, they’re gonna still have like a good anti inflammatory kind of benefit. And again, you can get some of these benefits by just eating a handful or two of organic blueberries a day, which is going to be really helpful by drinking a little bit of green tea. So you don’t have to supplement these things all the time. You can also try to get them in Whole Foods sources. And again, it helps with mitochondrial function, it’s going to help in decreasing a pop ptosis and cells kind of dying on their own. And like you mentioned, natural acetylcholine esterase inhibitor. So it helps acetylcholine increase and like you mentioned on codifier on so I like that a lot. I wanted to bring one other thing in here is Lion’s Mane. Lion’s Mane is a medicinal mushroom. But it’s well it’s well established to be super helpful. It was so as Reishi as well Ganoderma lucidum. That’s Reishi. Lion’s Mane as well as very helpful on cognitive funk function. So it’s going to help with a lot of different things. It helps with antioxidant, it’s what’s known to be helpful in improving cognitive performance. It’s known to be helpful at repairing brain cells. And again, just 20 or 30 years ago in medical school, they would have taught their medical students that the brain can not repair When you damage a cell, that’s it, it’s done. And we know today that cells can actually recover and improve. So one of these mushrooms is going to be a great thing out of the gate. So big, big fan of lion’s mane, it’s shown to be protective against dementia as well, which is awesome. It stimulates brain cell growth, which is awesome. It’s also has some really improved and excellent benefits regarding depression and anxiety and mood. It helps with injury recovery. So it has some anti inflammatory kind of benefits as well. Couple of studies where they did damage to, I think it was rats or mice, spinal cords. And then they looked at the growth and the recovery on it. And they saw that when they gave these little rats Lion’s Mane mushroom that reduced recovery time 20 to 40%. And they saw that Lion’s Mane extract may also help reduce the severity of brain damage after a stroke. And in one study, the lion’s mane extract was given to rats immediately after a stroke helped decrease inflammation and reduce the size of the stroke related brain injury by 44%. So big, big fan of lion’s mane and medicinal mushrooms, for sure.

Evan Brand: And can you believe that’s not happening in standard practice right now in the medical facilities? I mean, if you have a stroke today, you’re going to go into the hospital, and then they’re going to give you peanut butter crackers for lunch right after.

Dr. Justin Marchegiani: It’s unbelievable. Yeah, I mean, they should be doing hyperbaric oxygen, they should be doing Lion’s Mane they should be doing maybe progesterone therapy, which is helpful. They should be doing like a lot of the antioxidants and glutathione and nutrients that we just talked about, right? They’re not and it’s just, it’s frustrating, because all these things are in the scientific literature, but you know, conventional medicine unless they can patent it or make a drug out of it. You know, they’re not really interested. Yet everyone thinks that, hey, they’re giving you the most cutting edge care possible? Probably not. We know this is all in the literature. And so it’s out there, it’s just you know, we all have our biases, and we’re all about utilizing all the options that are there. And there’s so many natural options that have been around for so long, like medicinal mushrooms are used in oriental communities for for very long periods of time. Rishi courtice apps, my talkie, very good immune boosting immune enhancing benefits. So I like that.

Evan Brand: Yeah, I’ve been taking Lion’s Mane for several months, it’s been a big help. I actually had a female client who she had a chronic tongue burning issue. This was one of those guests in Czech type things, and it actually works. So she had some sort of a dental procedure. I don’t remember exactly what but we believe that was some nerve damage. And so she had literally chronic burning of her tongue 24 seven, she was just absolutely miserable. We got her on lion’s mane. And within two months, she had 75% reduction in the burning tone. So that was one of those random guesses and checks and it happened to work. So we’re luckily we’re keeping her on it. And she’s maintaining her benefits.

Dr. Justin Marchegiani: Yeah, can modulate the immune system, it can also help decrease inflammation. Also, there’s studies on Lion’s Mane helping with diabetes, and we know diabetes. And that insulin degrading enzyme helps to remove plaque in the brain. So we know that the blood sugar component of lion’s mane, maybe part of the reason why it’s helping cognitive function.

Evan Brand: Yeah, and there’s a lot of anti cancer benefits to a lot of these medicinal mushrooms you’re talking about too. So we’re both huge fans, we love them, we take them. And you probably should, too, if you’re listening. And these are supplements that are not super expensive. I mean, you’re talking maybe 50 bucks for a really, really high quality version.

Dr. Justin Marchegiani: Yeah. And then also a lot of these met the the big mechanism you’re going to see across the board is you’re going to see an acetylcholine mechanism, you’re going to see an antioxidant mechanism, right. And so usually when you see the ability to reduce oxidative stress, you also see that the ability to reduce inflammation because when you reduce inflammation, inflammation drives oxidation. So oxidation is when you lose electrons. And so a lot of these compounds like lion’s mane, they have antioxidants in them. Usually they have a clue to fire and supporting effect. And then that helps buffer the oxidative stress because antioxidants come in they freely donate their electrons. So when electron pair is removed, that can create oxidation. And these guys come in there and they donate electrons freely and stabilize those cells. And that reduces oxidation. And that reduces inflammation. So that’s pretty powerful, and so very helpful with inflammation and oxidative stress in the brain.

Evan Brand: Let’s hit on another mechanism. It’s about improving the blood flow in the brain. We know that gaesco which is amazing. Gingko has some what they call like microcirculation in the brain improvements. I love gingko I’ve played with a lot of gingko and used it and they’re amazing, beautiful trees. If you’ve seen the Leafs of them, they’re very, very cool actually found my old property actually found a rock that was like a fossil with well preserved gingko leaves in the rock. It was super cool. So gingko is like one of the oldest trees it’s been around hundreds of millions of years. But on that same vein of cerebral blood flow, you’ve got the vinpocetine which comes from Periwinkle flower. And that’s really cool because it’ll actually cross the blood brain barrier. You know, there’s, there’s a lot we talked about, and but the truth is you got to get the nutrients across that barrier if you really want the benefit. So there’s a lot have different studies on dementia related issues and vinpocetine, quote, producing a significantly more improvement with memory problems than placebo on global cognitive test regarding attention, concentration and memory, it talks about increasing the cell membrane flexibility and stroke pay since it talks about decreasing platelet and red blood cell aggregation. It talks about protecting neurons from toxicity of glutamate. So this is a very cool nutrient.

Dr. Justin Marchegiani: Exactly. And you mentioned the bacopa. And they’ve been post a teen, they all have blood flow enhancing effects. And we know inflammation causes increase aggravation of red blood cells and platelets. And that can decrease blood flow and blood flow is going to carry oxygen and it’s going to carry nutrients, right. And so the more we can decrease inflammation and get nutrients up to the brain, you’re going to feel better, and you’re going to do better, right. And then you mentioned a lot of the big benefits are going to come from antioxidants, effects, they’re also going to come from the protection of neurons. So if we have any type of inflammatory or toxin around it, is going to help those neurons and prevent them from dying, right, which is really important. And then also just to highlight, there’s a lot of studies on gluten actually decreasing blood flow to the brain. And we know blood flow is a really important component. And there was, I think, one study on migraines and they found that you know, the garden hose is the carotid arteries that go up the side of the neck here brings blood up to the brain. And in patients that were consuming gluten, they found that there was a decrease in blood flow. And then this one group, I think they restricted gluten and they saw 90% of them nine out of 10 and your migraines went to zero, and they saw an improved blood flow up to the brain. So we cannot you know, underestimate the the effects of kodagu ability meaning reducing coagul ability clotting and increasing blood flow, better blood flow, better nutrition and that can have major effects on the brain. And we know things like gluten and anything more on the inflammatory side will impact that on a negative side on the on the negative fashion.

Evan Brand: That’s amazing. It’s like you should go to the restaurant and they’re going to give you the gonna give you the bread or give you the bun. Yeah, here we’re going to reduce your cerebral blood flow. Are you ready for this? Oh, sure. I would love to reduce my examination to my brain.

Dr. Justin Marchegiani: Exactly. And you mentioned like a lot of the glutamate issues and how that’s going to be part of that inflammatory cascade. And we know glutamate is shown to be an excitotoxin so it really overstimulate cells to the point they die. And so of course, decreasing that gluten exposure and decreasing that glutamate and that and MDA, which is going to be stimulated by that glutamate, which is going to overstimulate ourselves and cause them to die. That’s a problem. And so we know a lot of these compounds, right? [inaudible] bacopa, are a neuroprotective and they’re also going to help with blood flow. So that’s a good component out of the gates. And I would say next would be one of my favorites, serotonin and dopamine support. So I have a product called brain deplete that has dopamine or tyrosine. And it’s also gonna have five HTP and some of those key B vitamins out of the gates. I think those are kind of low hanging fruit because those amino acids serotonin and dopamine, which are going to be building blocks of tryptophan and five HTP, and Tyrosine and phenylalanine, they’re really important for serotonin and dopamine, which have a lot to do with sleep and recovery. And serotonin is a powerful precursor to melatonin, which is a powerful antioxidant. And then of course, dopamine is a powerful focus and brain enhancing kind of effects. Right? Don’t means focus and feel good. I love you that good feeling of satisfaction and helps with really focusing and studying and learning. So dopamine and serotonin and have major important benefits on brain health.

Evan Brand: Yeah, and we’re in a very chronically low neurotransmitter population. And I mean, Doug, look at the way society performs. Look at our everyone’s addicted to everything addictions come from low dopamine. So you’re constantly refreshing your Instagram, you’re going to this social media, then that one, I mean, that’s kind of a low dopamine state. And you and I have the data to prove this is not just theory, you and I’ve looked at 1000s at this point of organic acids test, and I will say probably seven out of 10 people I’m looking at, they have sub clinical, I guess you would call it it’s not like a pathological level. It’s not like a, you know, Parkinson’s type level, but they’re going to be on the low dopamine side, and we can boost this back up. So the fun part is helping people to reverse this stuff. So I want to just, you know, wrap this thing up and tell people that you can reverse a lot of your cognitive problems, and most people don’t even know how brain fog they are until they truly get better. So clearing out the garden infections, cleaning up the diet, reducing inflammation in the gut getting rid of Candida that’s producing the aldehyde you talked about getting rid of the lightbulb polysaccharide production, getting rid of any kind of toxin that’s internally pooping in you essentially getting rid of those toxins, plus dialing in the diet plus the nutrients while you can improve brain function 300%. 

Dr. Justin Marchegiani: I mean, it’s totally possible 100% and the only other X Factor should be if we have to work on detoxification of mold or heavy metals. There are special compounds that we would use, whether it’s glutathione or various binders, beet root extract activated charcoal zeolite fulvic minerals. Maybe if we’re doing heavy metal, we may use things like dmps or HLA or cloudify on so it depends when it comes to a lot of these more intense detoxification programs you want to make sure you’re healthy enough you want to work with the practitioner to make sure that you’re in a stable place to be able to handle that it wouldn’t be something that would say hey, you want to improve your brain function just knock these things down right away because you may actually feel worse. You want to work on the foundational things the low hanging fruit and the maybe some of the more I don’t know more general support that would be helpful like B vitamins or Lion’s Mane or some of those herbs that aren’t going to have a over a detoxifying effect if you will.

Evan Brand: Yeah, good call. I mean there is a point where you need a practitioner the line brain the mold, brain bartonella brain I mean some of these bigger complex 

Dr. Justin Marchegiani: Chronic infections, infections for sure. 

Evan Brand: They get intense so if you do need help, please reach out you can reach Dr. J at and you can reach me at and we would love to talk with you about this figure out what’s going on with you and see if we can help.

Dr. Justin Marchegiani: Absolutely, if you guys enjoyed it, give us a thumbs up click down below our links where you can give us a review., for that review, put your comment down below. I’d love to know your experience and kind of you know, applying some of the things we’re talking about and to give us some feedback on things that you’re already applying in what you’re seeing improvements in your health. We really appreciate it. It gets us excited.


Audio Podcast:

Recommended products:

Brain replete

Serotonin replete

Dopa replete

Antioxidant Supreme

TruKeto Collagen


Organic Grass Fed Meat

What are the Natural Anti-Inflammatory Agents for Pain Relief

In general, we have our COX pathways. Now, Arachidonic acid can feed those pathways. A lot of excess, junky, refined Omega-6 from animal products can definitely feed those pathways. That sets the table like gas in the kitchen where a little spark can take it off.

Click here to consult with a functional medicine doctor for recommendations on natural pain relievers.

Where to find anti-inflammatory agents:

  1. Natural herbs like ginger can help with COX-1.

  2. Fish oil is excellent for COX-2 at high doses. If you do high doses of fish oil, you can increase what’s called lipid peroxidation because fish oil is a polyunsaturated fatty acid. It’s more unstable. It’s got more double bonds in it. Omega-3 means three double bonds. The more double bonds that are they are, the more unstable the fatty acid is to heat things like that and the more, let’s say it can be oxidized. So, having extra vitamin C or extra vitamin D on board when you’re taking extra fish oil just to make sure you don’t have oxidation is great, and we already talked about things like systemic enzymes.

  3. There is also curcumin but liposomal curcumin is better due to the absorption or something with black pepper in it helps with absorption, too.

  4. Frankincense or Boswellia.

  5. White willow bark which is kind of how aspirin is naturally made though aspirin works more on COX-1. So, aspirin can be your other natural source and you can do white willow bark which is the natural form of aspirin.

  6. There are things like Tylenol but Tylenol works more on the central nervous system perception. So, it decreases the nervous systems’ perception of pain. Note: We have to be careful of Tylenol as it can actually chronically reduce glutathione. So, if you’re taking Tylenol longer-term, you definitely want to take it with NAC and/or some glutathione, just to be on the safe side.

  7. At the extreme example, we have opiates which block pain receptors in the brain, the opiate perception of the brain. It’s not the best thing because you’re just decreasing perception of pain. Obviously, the opiates are way more addictive.

  8. We can block some of these natural pain perceptions with CBD oil. So, CBD is another great way to reduce the perception of pain.

In general, we want you to try to do more of the herbals and more of the natural stuff out of the gates because that really, really, really can help reduce inflammation.

If you have osteoarthritis, rheumatoid arthritis, sports injury, or you’re just trying to heal maybe postoperation, these things may be something to implement and then obviously work in all the other root causes, too. You are not just what you eat. You are what you digest from what you eat.

So, if you’re doing all these good nutrients, but you’ve got some type of malabsorption issue in the gut, you’ve got ridges on your fingernails, you’ve got thinning hair or falling out here, you may need to look deeper at the gut and try to find some of these more root cause issues that led you to that amount of inflammation or slow recovery in the first place.

If you need to reach out to talk about your pain and inflammation issues, click this link to schedule a chat with me!

Top 5 Warning Signs of Hormonal Imbalance

Let’s talk about hormones. I’m going to dive into a couple of clinical pearls that I see in my practice from working with hundreds of female patients and male patients which have a major effect on modulating and supporting hormonal balance.

Click here for a consultation with a functional medicine doctor if you want to learn more about hormonal imbalance.


These are my top 5 hormonal balancing strategies:


  1. One of the first things in regards to hormones that’s very important, and this may be common sense but I try to give a lot of knowledge guided by experience, is nutritional building blocks for your hormones. Healthy cholesterol from animal products are very essential. Fat soluble vitamins like A, D, K are very important. Lots of good protein are also very important. We have steroid-based hormones that are going to be more cholesterol-based and we have peptide-based hormones that will also be protein-based. So, a lot of these protein, fat-soluble vitamins, and cholesterol especially healthy animal cholesterol are very helpful for hormonal building blocks. If you have a vegan-vegetarian diet or if it’s very nutritionally poor or there’s a lot of processed food, that may set you up with a deficit out of the gates for just hormonal issues. Remember: Make sure the food is nutritionally dense, anti-inflammatory, and low in toxins. That’s vital.

  1. Now, if you’re having a lot of good nutrition in there, the next thing is we have to make sure we’re able to digest it and break it down. So, if we have a lot of chronic acid reflux, poor digestion, constipation, or bloating, we know we’re not quite breaking down our food and our nutritional building blocks. That could tell us that we may have hormonal issues because we’re not breaking that down. Therefore, those nutrients can’t get into our body or get in our bloodstream and be taken throughout the body to be used as building blocks. So, if we have a bottleneck in the nutritional side, that could be a big factor.

  1. Stress, whether it’s emotional or chemical stress. If we’re eating foods that are inflammatory or we’re nutritionally deficient and we have a lot of emotional stress, what tends to happen is our hormones kind of go on two sides. We have an anabolic side which are the growth hormones — testosterone, estrogen, and progesterone — that kind of help deal with growing. Then we have anti-inflammatory hormones which would be cortisol and are catabolic. I always put progesterone in that category because progesterone can be used to make more cortisol. So, we have our anti-inflammatory and then our anabolic. In some, they kind of cross over. Insulin, growth hormones, and testosterone are anabolic. The more inflamed we get, we could have high amounts of testosterone because of PCOS and because of inflammation. So, some of these hormones kind of interact and cross over. With men for instance, the more inflamed men get and the more stressed they get, that can actually cause an upregulation of aromatase and could increase their estrogen. So, see how these things kind of cross react. Your hormones are going to be either pro-building or anti-inflammatory to reduce stress. So, for chronically and stressed out state, cortisol is going to rip up your protein and kind of decrease your muscle mass. As a woman, you’ll see your progesterone level start to drop and that will start putting you into an estrogen-dominant state because if we normally got 20 to 25 times estrogen than progesterone, that ratio starts to drop. Even if you still have more progesterone than estrogen, that ratios is going to throw you off and that can create breast tenderness, cramping, mood issues, excessive bleeding/menorrhagia, infertility, a lot of mood issues, back pain, and fluid retention. All those are possible situations.

  1. Xenoestrogens from the environment and foreign estrogens. They can come from plastic components, pesticides, herbicides or rodenticides, mold toxins, and heavy metals. They are going to disrupt our hormones. The easiest thing is eat organic, avoid plastics, and avoid a lot of the chemicals in the water because a lot of times you can get pesticide runoff or hormone runoff in the water. So, clean water and clean food, and then make sure it’s organic avoid the plastics as well. That’s a big, big thing. Plastics are probably okay if they are in a refrigerator or in a cold environment but ideally if you’re heating stuff up or it’s going to get exposed to light, you want some kind of a Pyrex or a glass container. It’s much better and really important.

  1. Last but not the least would be just making sure our detoxification pathways are running well. So, if we have good hormonal balance but we can’t detoxify it, then a lot of times we can reabsorb it. So, if we don’t have good sulfur, good glutathione precursors, good B vitamins, good methylation, N-acetylation and glucuronidation, we may have a hard time eliminating. Hence, we are re-absorbing a lot of our hormones. So, being able to break down your proteins, break down your amino acid and your B vitamins is going to help with your body’s ability to eliminate a lot of these toxins.


Blood sugar, digestion, stress, xenoestrogens, and toxicity are really big. Those are the big 5 across the board. Try to apply at least one of these things.

If you’re struggling with hormonal issues and you want to dive in deeper, feel free to schedule a consult with myself.

The Gut Skin Connection – How Your Gut Health Can Impact Your Skin | Podcast #330

The gut and skin enjoy a constant dialogue via what has become known as gut-skin axis. In this video, Dr. J and Evan are discussing that while symptoms of gut health issues can be incredibly varied, the skin is often a great barometer for what’s going on inside the gut.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

1:51    Different Skin Aspects

5:37    Getting Good Skin

13:12   How Gut affects Skin Health

20:28  Collagen Benefits

28:52  Tips to Remember

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Dr. Justin Marchegiani: Hey guys, it’s Dr. Justin Marchegiani here today we’re going to be talking about the gut skin connection, how your gut health can impact your skin. This is a, you know, quite a big topic of discussion. A lot of my patients have gut health hormone health. And part of that whole sequelae of symptoms is going to be skin issues. And it’s important right skin kind of is your first representation to the world of who you are and your health. And if you’re healthy, you want good skin as a byproduct. So we’re going to dive into that and talk about, you know, things you can do to improve your skin and your gut health. If it’s not at an optimal level, Evan, how are we doing today, my friend? 

Evan Brand: Doing really well. And you’re right, when you see someone your initial gut reaction, you know, they say, Don’t judge a book by its cover. 

Dr. Justin Marchegiani: Pun intended.

Evan Brand: Exactly. When you look at somebody, you go, oh, wow, they don’t look healthy, or they look pale, or they look frail. Or they look weak. I mean, we make a lot of quick judgments on people. So you know, for the people listening that are like, well, I don’t really care about my vanity, you know, that’s so vain or whatever. It’s like, Well, do you want a good paying job? Do you want a good spouse? You know, you might not even get to the second date. If the person looks at you and goes, Oh, wow, you know, this person looks unhealthy. They look sickly. So I think it’s, it’s important to try to go beyond feeling vain about it and know that as you mentioned, your skin is it’s it’s a picture of your health picture. And my skin was a really good barometer. For me going through some of my detox protocols, my wife would look at me and say, Honey, you look pale, and I would go take a binder and then all of a sudden my skin tone would get better. It was almost like I was recirculating toxins. And then when I took my liver detox or binder support, my skin looked better. So for me, I kind of personally use it as a barometer. Or if I eat dairy as a treat, I may see acne pop up and I’m like, Oh, look at that. Look what I did. Here’s the effect of that dairy.

Dr. Justin Marchegiani: Yeah, totally. Yeah. And the pre show, we were trying to figure out effect versus a fact. Right? And so effect is the end result. A fact is, is the verb so we’re trying to wrap our heads around that the English language is quite the the crazy thing. So yeah, absolutely. So skin is very important. So there’s a lot of different aspects of skin right? Its first aspect is, you know, just keeping acne and skin rashes under control, whether it’s psoriasis, or eczema, or just general acne, there’s different food allergens that can have effect on that. There’s different enzyme and acid and just indigestion with foods, not breaking them down, that can have a big effect on that. And there can also be things like hormones. So whether it’s elevations in testosterone with women, whether it’s, you know, testosterone, androgens, that can have a major impact on women’s skin. Also just inflammation in general food allergens, in general, high levels of insulin can create more oil from that sebaceous gland. And that sebaceous gland, that oil can feed a lot of the bacteria on the skin, which can create, obviously the acne vulgaris bacteria feeding and creating acne. So there’s a lot of different mechanisms, right. So when you look at skin health or anything, is a lot of different components. And so food allergies are one component in digestion, not enough acid and enzymes, a component and of course, things like H. pylori, and bacterial overgrowth and fungal overgrowth, and parasitic infections can all impact that. And then of course, female hormones can play a big role. estrogen dominance is a big thing. Insulin resistance is a big thing. Insulin resistance can feed excess androgens and women, that’s a big thing. And then of course, increase aromatization. And estrogen in men can also feed skin issues as well. So there’s a lot of different connections here that play a big role. And of course, certain nutrients, if you’re deficient in zinc or vitamin A, can also play a big role in skin health as well. And then, of course, poor detoxification, because your skin is the integumentary system. And it plays a major role in detoxifying. So the biggest organ of detoxification in the body. So there’s a lot of different mechanisms here. And we’ll kind of dive through them one by one.

Evan Brand: Imagine how much profit we could reduce from the makeup industry. If Well, I guess it would be a multifactorial process, right. And number one, you’d have to convince women that natural skin is beautiful, and that you don’t need the six inch long eyelashes and all that. But imagine how much of a hit we could put into the makeup industry if we were to improve people’s skin because you have so many women that they’ll say oh, well, I wake up with bags under my eyes. It’s like, well, it’s not the bags that are the problem that needs to be covered up by makeup. Those bags under the eyes are the clue that maybe there’s some lymphatic issues or there’s some detoxification issues. And so many women, yeah, food allergies. You’re right. I mean, I have so many women that report that just by working through some of the protocols that you and I use that they need less makeup, and of course their husbands are always wanting women to look more natural anyway, at least my wife, I look at her and I’m like wow, she’s naturally pretty, I don’t think you need or should be putting stuff on. So and of course, there’s the mental brainwashing of society and the psychology behind makeup and all that that we don’t have to get into. But I think from a biochemical perspective, women should embrace the way they look and use that as a motivating factor. to work on these underlying issues that we’re talking about, meaning don’t just go for the foundation or whatever, it’s called to cover up the bags, let’s fix the bags.

Dr. Justin Marchegiani: Yeah, and ideally you get healthier so if you want like a natural healthy makeup option, there’s some decent ones out there, you need less of it to kind of get the job done. You know, because some women it’s, it’s, it’s part of who they are is they’ve been doing it for so long. So let’s just try to reduce it and try to use healthier ones that are going to be less toxic, right?

Evan Brand: Yeah, and the Environmental Working Group will just get that out of the way now the Environmental Working Group has done a great job of their skin deep database you and I’ve covered that I know you’ve mentioned some of the micelle products and some of these others that that are that are helpful.

Dr. Justin Marchegiani: Yeah, I like the Marie Veronique has a couple other good companies from a skincare standpoint. So the first rule of thumb when you’re supporting your skin is do with food. Right? Don’t put toxins and food allergies, fix your gut. Use good nutrient dense foods right your skin needs high quality fats. It needs high quality amino acids. It needs collagen in each vitamin A it needs zinc. It needs a lot of good nutrient dense foods to support it. We also want to decrease inflammation right? A lot of the junky omega six fatty acids, trans fats, foods that are refined processed grains lots of sugar that drives insulin. Insulin feeds the sebaceous glands to make oil oil can feed bacteria on the skin and create acne. And then of course, food allergens can also drive eczema can also drive psoriasis, sub harangued dermatitis right, a lot of these things that are fungal or bacterial or autoimmune base can be driven by a lot of these things. So foods really important. And again, there’s a big disconnect in the dermatology community, like you go to a lot of conventional dermatology offices, they’ll say in some of the pamphlets like food does not influence your skin. And that’s an absolute crock of crap. Right. And part of the reason why that’s the case is because dermatologists aren’t educated in nutrition. They’re not doctors in medical school, conventional allopathic doctors have very little education and nutrition. And when they do, it’s primarily from the aspect of disease, vitamin connection, right? scurvy, but low vitamin C very, very low B one, right? A lot of these diseases that are connected to low nutrient levels. But we know health is not about diseases, it’s about a health is on a continuum. And so the extreme end is a disease but there’s a lot of stuff in between, that we’re looking at. And part of that could be skin issues. And so certain nutrients play a big role. And I can tell you having seen 1000s of patients and hundreds who have skin issues, and I’ve been able to have you know 95 99% resolution with these issues, partly because of the fact that diet plays a major influence. So foods, keeping carbohydrates in check reducing insulin, insulin and women drives lots of androgens, androgens will create more cystic acne, inflammation, even dairy like even sometimes butter in really healthy people could be a problem. So I always say anytime you have any acne issues, we’re cutting out 100% dairy, even carry gold grass fed butter out of the gates. And that’ll be one of the first things we try to add back in as the skin gets clear to see if it’s kryptonite or not. But that plays a very important role. I’m trying to get more zinc in your diet, whether it’s like pumpkin seeds or oysters or just high quality grass fed beef zincs very important can always throw in some extra zinc in your molti or in a zinc lozenges things are very important for the skin vitamin A very important some studies back in the 1920s on to dermatologists called Pillsbury and Stokes and they found that probiotics and called Never Oil were very important for skin health. This is 100 years ago. So the fact that dermatologists aren’t up on this literature is just ridiculous. It’s because they aren’t interested in a nutritional intervention. When you have retinae and clindamycin and Accutane and tetracycline and, and different, and you chrissa and you know, all these different medications that are used for skin, right, that’s what their go to is and that’s what they’re educated on. And it doesn’t fix any of the problems anyway, it’s it covers it up. And so a lot of other things that can be done and have been done for a very long time.

Evan Brand: It’s funny that you and I are not dermatologists, but that we have, in most cases, better results than dermatology offices. And at least if it were a comparable success rate, like with their drugs, that’s palliative care. And what we’re doing is root cause care. So maybe if you took Joe Blow and Jane Doe over here, and let’s say they work through you and I and our protocols and testing, and then they go to the dermatology office and just get the Accutane or whatever, maybe in terms of look, maybe you’d make the person look similar because those drugs do work. But then you get off of them and things go backward. But man, all I’m saying is I think we’re better at skin now. I don’t know how to recognize melanoma. My grandfather’s had it and he’s got it cut out. So in those skin cases, yeah, go to your dermatology office. But if it’s more of these chronic issues, these more functional scan issues. I tell you, we’re gonna have much, much better results and somebody listening may hear what you said and go oh my god, he said 95 to 99% success rate. You’re not you’re not inflating those numbers. at all, I can tell you with confidence those numbers are legit that you’re saying because I’ve seen the same thing, even within just six weeks of Gut protocol, sometimes we’ve had 80 to 90% improvement in skin symptoms.

Dr. Justin Marchegiani: Yeah, I think dermatologists do a really good job at handling skin cancers. You know, I think that can be very helpful picking up melanomas. There’s also a lot of the autoimmune stuff that they recognize, it’s typically you know, they’re just going to recommend corticosteroids or some kind of, you know, immunosuppressant like Ella dal or you chrissa. They’ve done a lot of options, or they’re just throwing a lot of antibiotics on the skin, which can screw up your skin microbiome as well, your skin has its own microbiome. So some of these things acutely may be fine. If you have a teenage kid that has an acne flare, and you want to decrease the chance of scarring, right? That makes sense. But you know, what’s the long term solution, right, you need a long term solution outside of that, and they may not have those options for you. So it’s good to have someone in your back pocket know where they’re good know whether or not there’s getting to be more holistic ones out there that understand diet plays a big, big role. And that’s good to know. I mean, I think, you know, if, if your kid eats like crap, and your dermatologist says it doesn’t matter, and then that keeps your kids acne flaring. Well, that’s not going to fix any problems. And plus, we know skin requires nutrition, amino acids, fat soluble vitamins. So just kind of from like a foundational level, you need to consume good building blocks. So your body can repair and turn over and use those good building blocks to help your body becomes stronger, right. Food and calories that you consume and nutrients you consume. They’re not just for energy, they’re actual building blocks so your skin can turn over. So very important there. I think also with sunlight and things like that getting some sunlight don’t burn, right, minimal urothelial dose, if you’re going to go outside, make sure you’re using you know, for a long periods of time where you would burn make sure you’re doing a full spectrum sunscreen that’s in a block out UVA and UVB for a long time, we’ve only blocked out UVB light, and we let a lot of UVA come in and people will damage their skin because the collagen will get destroyed. If you’re chronically allowing a lot of UVA exposure, the UVB that gives you the burn is kind of the it tells you whether or not you’re out there too long. But if you block the B and allow the A in, you’re basically allowing yourself to potentially destroy collagen. So if you’re going to be out in the sun, use a full spectrum, UVA UVB maybe even a UVC to make sure you have coverage if you would get burned, and then try to get yourself some sunlight. And then for me topically, I’m going to be using some natural retinol not a lot of the retina the retina has a lot of side effects can create redness and irritation, don’t love it. But I’ll use some of the retinol with some vitamin C and glue to fire and in some of the skincare products that I use, I use a really excellent prebiotic probiotic miss that have good bacteria for my skin. Because I want to really support my skin microbiome. Those are really important things for me on the skincare side. And then of course, like keeping the food allergies down. Now, for some people coming out that have a lot of acne, we’re going to come out of the gates with some autoimmune stuff out of the gates because I’ve seen eggs and nuts and seeds, dairy and butter be problem. So we’re going to be a little bit more strict out of the gates. We’re going to make sure we’re digesting our foods really well indigestion is a problem. We’re going to look at the gut, the gut can play a major, major role. And I’ll pause there and you can you can kind of dive a little bit. 

Evan Brand: Sure. Yeah, I’ll take it further. So the gut, to me, the big mechanism is h pylori. Now parasites are big. I mean, you saw my skin was six, maybe I can’t keep up with yours, maybe six or seven years ago, my skin was messed up. And it was because I had various gut infections. I do believe parasites are a big contributor. But really, it’s hard to pick a smoking gun for the gut, because Candida bacterial overgrowth, parasites, they all contribute to the same thing, which is an issue with nutrient absorption, they create this malabsorption problem. But I think h polarize is one of the big ones for people because of what it’s doing with the parietal cells and reducing your stomach acid because then what’s really happening is you have this domino effect of the H pylori, then allowing the purification of your food which then creates the overgrowth of even more pathogenic bacteria, which then may allow parasites to thrive because now there’s not enough stomach acid to kill them off. So I really do think that h pylori was one of my big variables for my skin. And I can tell you with confidence that I’ve seen it in countless countless teenagers and people in their 20s that are still dealing with acne. If we get rid of H. pylori alone, we may have 60 to 75% improvement in the skin just based on that. And then the question is, well, can you bring in enzymes to help reduce some of the malabsorption and 99% of the cases? Yes, rarely is there too much inflammation or gutter rotation where we don’t do enzymes and acids out of the gate. But really, if I were a dermatologist running a brick and mortar practice, you know what I’d have on my shelf, I’d have digestive enzymes, and every client that comes in with skin problems, here’s your enzymes, and that would fix it. 

Enzymes and HCl as long as there’s not so much gastritis or gut irritation, definitely a combination of the two for sure. I 100%. Agree and then a good elimination diet plays a big role. These you know, if you have bags under your eyes, that’s called allergic shiners and allergic shiners. They’re basically a pool of the lymph under the iron because there’s a lot of lymph in this area. And so lymphatic increase lymphatic fluid increase is going to happen with inflammation. Think about if you bump your head or get in a fight and get a black guy, what happens there’s inflammation and pulling, while you’re doing that at a at a micro level when you have inflammation from food, and you’re going to see it in the eye area, because that’s where there’s a lot of lymph. So if you’re having allergic shiners, right, don’t carve it up with makeup, try to cut out the foods out of the gates, that’s gonna be a big one out of the gates. Make sure you’re consuming enough water, people that have chronically dry skin, it’s not a hydration issue. Remember, fats provide a lot of the moisture to your skin to be moist and not overly dry. So if you’re having a lot of chronic dry skin, you know, eat consume good water, right, but also really make sure your fats are up and make sure you’re digesting those fats that’s really important. And if you want to topically add some shea butter or some coconut oil to your skin, if it’s the winter and you’re in a really, really low humidity environment, you know, you may need to topically add a little bit of that to during the winter months if it when it’s drier out. So you may want to topically hit it. But you don’t want to get into the habit of only doing the topicals because you got to support your skin inside and out.

You know what’s amazing now that you mentioned it like that. When my wife and I first got together, it will be 11 years ago, our diet was not like it is today. And every winner her and I both we would get really itchy our skin would get red, we get really dry skin. I’m telling you, man, I did not put lotion on but maybe once this entire winter. And I used to have to do that all the time. How funny is that? We could put the lotion industry out of business with this advice too.

Dr. Justin Marchegiani: Yeah, I mean, you may topically need to add a little bit but you’ll be able to reduce the 80 to 90%. I remember when I was first trying to get healthy 15 20 years ago, 15 years ago, I was trying to low fat thing. I’m the gates and I remember one winner, my skin was so itchy and dry. And I remember I came across an article and I started adding in coconut oil and an olive oil. And I was just doing a tablespoon of a day and I remember being like Wow, my skin the dryness just it reduced at 90% with just internally adding fats, because I’m thinking like oh dryness, that just means more water, right, you need more water, but you need to be able to carry that water to the skin. And the fats provide that kind of support, the fats help bring that hydration to the skin. And so fats for me played a huge role. And I’ve seen that as well. And of course with all this fat phobia, the more dry your skin gets. That means the more inflamed is going to get the more inflamed the more redness and and and potential for other issues are going to happen. So if you don’t have enough fats on your skin that can create this cascade of a lot of other skin issues.

Evan Brand: Well, you know what else is I’ve noticed too, you know, Irish descent, at least some Irish some German. And years ago, I would never be able to get tan, I would just straight burn. And I rarely wear sunscreen, maybe you advise me different. But I typically just wear like a big sun hat in the summer. If it’s like 95 degrees and it’s frickin hot. I might do some zinc oxide if I’m out all day, but if I’m just out like half an hour plane in the garden, and then I’m gonna head back in and cook lunch or something I’m not putting sunscreen on I’m just out there with no shirt. And I used to just burn so bad even from that dose. Now, I don’t burn. The fats are helping me not burn now. Maybe it’s the meats to the collagen. I mean, there’s something changing where I just, I can I can bronze now, which is pretty interesting, especially for an Irish guy.

Dr. Justin Marchegiani: Yeah, the fats definitely play a big role and helping to bring calcium to the skin that can be I’ve seen that be something also having a lot more of the bioflavonoids whether it’s Grapeseed, or a lot of the antioxidants, those can go to the skin and also have an SPF kind of factor. I know Grapeseed extract plays a big role. A lot of these oligomeric proanthocyanidins, which are like these antioxidants, and in fruits and vegetables can play a big role. The fats, like I mentioned, the omega threes play a big role.

Evan Brand: Oh, you make a good point. Yeah, sorry, I forgot to I forgot to mention that. Yeah, I mean, I do a ton of blueberries like come spring, early summer, I’m doing a ton of blueberries, I think you’re right, there’s probably some antioxidant factor too.

Dr. Justin Marchegiani: Antioxidant factor, there’s a good fat factor, the fast to play a big role with bringing calcium up to the skin, which I know helps. And then obviously having enough zinc plays a big role because we typically, the more natural skincare is going to use like zinc oxide or titanium dioxide for kind of natural sun scare sun skincare. And so of course that that has a deflective aspect to it. And I imagine that the zinc that you consume orally is also going to play a big role. So like in summer months, you know, I’ll bang down six to eight oysters in a week. And you’re getting you know, eight milligrams of zinc per oyster. So if you bang down eight or nine oysters, I mean you’re getting 70 or 80 milligrams of zinc and you know the daily requirements only like 10 so you can get like a week’s worth of your zinc in one oyster session.

Evan Brand: Wow, that’s impressive.

Dr. Justin Marchegiani: Yeah, so it’s really good and you can also get some extra from pumpkin seeds too as long as you tolerate the seeds.

Evan Brand: Yeah, I actually had some pumpkin seeds yesterday they were good just some I got some sprouted ones supposedly those are easier to digest so if someone reacts, maybe tried to sprout it I personally don’t have an issue either way. So some one thing to consider Alright, so we hit the gut infection piece. You did great hitting on some of the nutrients Stephen some of the good nutrients that would be in a multi which you and I make some really professional multis.

Dr. Justin Marchegiani: Alright guys, you’re gonna have 20 or 30 milligrams of zinc in there. So that kind of gives you a good whack and then if you’re adding in, you know, mushrooms or grass fed beef, right or any some of the healthier nuts and seeds that are out there, that and obviously, that’s gonna play a big role and then collagen, collagen really helps because we’re just not getting a lot of collagen based amino acids, right, we’re getting a lot of muscle meat, we’re not getting a lot of skin or joint. So having the skin on your chicken or chicken thighs very helpful, right having soups or bone broth helps. And you can also really take an excellent collagen amino acid support. I know mine, we use collagen from grass fed cows and we also use proteolytic enzymes to help break down those amino acids to make it easy and you can mix them in your water you can mix them in your tea or your soup or your coffee. So it’s just a great way to get extra building blocks for your skin. And it also helps your hair and your nails and your joints.

Evan Brand: I was speaking to college and let me do a little rant here and an anti plug. So the bulletproof collagen bars I used to eat those. Dave Asprey is bulletproof company, who he was the CEO of and then he stepped down couple years ago and now the ex or current CEO of hostess who makes like ding dongs now he’s the CEO in charge of bulletproof product. Anyway, I was at Whole Foods a couple weeks ago, I used to love eating those collagen, like the collagen bars, you know, it’s like a hydrolyzed collagen with like a little bit of stevia or monk fruit in there with some organic cashews. And I go in there, and there’s a new box, and it’s like new and improved recipe and I’m like, Yes, this is gonna be delicious. And I didn’t even read it because I just thought, okay, it’s gonna be awesome, right, you know, and I get home and I start to eat it. And it’s like real slimy. And it used to be kind of crumbly. I’m like, What’s weird wise, it’s slimy. Maybe I got a bad batch or something. And I flip it around, I look at the label. And it’s no longer organic cashews. Now it’s just regular cashews. And then now there’s safflower oil, which Dave was extremely anti bad oils. So now there’s safflower oil in there. And there was one other thing that tripped me out. But yeah, so safflower oil from organic to non organic nuts. And then there was one other thing. So luckily, I was able to return them and get a refund. But that used to be my go to thing that I’d recommend for people to get a good easy source of collagen as a snack, and I can no longer recommend that product.

Dr. Justin Marchegiani: Interesting. Yeah, I had an experience to where I bought a mainstream collagen brand at Whole Foods, I have my own called Tru collagen, but I ran out. And I needed something right away, because I typically put it in my coffee or tea in the morning. And I grabbed the you know, good one, or named a brand that everyone will recommend put it in my coffee and my coffee tasted sour as heck. And I’m like, this is unflavored what’s going on. And basically, there’s two ways you can manufacture collegen. Of course, like you buy the best raw material you can, but then you got to break that cut, you know that collagen into peptides, right. And so there’s two ways you can do it. You can do it with sulfuric acid, or you can do it with enzymes. And so mine we do it with enzymes, which gives it a very, very neutral taste. So when you mix it and stuff, there’s not an extra taste. But this brand, I guess had used sulfuric acid because that’s the major side effect is you get that little bit of sourness or a little bit of a bitter aftertaste when you mix it and things. Now it’s like, oh, okay, got it, even though it’s unflavored. And you don’t see anything in the ingredients. You know, how you extract those, how you extract those amino acids matters, and it can really affect the taste.

Evan Brand: Wow. So I’d love to put them on blast. But if you don’t want to, that’s fine. And we’ll just tell people that storebought is not the best. And there’s a reason that Justin and I have professional healthcare manufacturers. And there’s a reason that what we have is considered a practitioner grade, you know, I get kind of annoyed when, when people will market supplements as like pharmaceutical grade because pharmaceuticals are crap. They’re filled with corn and fillers and all kinds of garbage. So when I see like, you know, pharmaceutical grade, like vitamin C, it’s like, ah, get out of here with that crap. So I would just prefer that we use the term professional, professional quality. And that’s not bs marketing. That truly is a difference.

Dr. Justin Marchegiani: Yeah, when people say pharmaceutical grade, because there can still be a lot of crap and pharmaceuticals, it’s more like the cleanliness of the factory or the manufacturing facility is very clean. But you could still add a whole bunch of crap into the supplement that’s not clean. But because the the manufacturing process is clean. It’s it’s pharmaceutical grade, right? And so yeah, so it’s professional grade, because we’re also cutting out all of the extra crap that we know isn’t going to be as good fillers, dyes, corn, you know, potential glutens all those different things that aren’t not going to be as good so for sure we keep all that in consideration and then We also do testing, right? I mean, we, I tested bunches of ashwagandha from major, you know, manufacturing people that we get it in and we test it and it’s got lead in it, we’re like nope, see later, you know, because we need to have the highest quality of product because we’re working with patients and we need to, we need to have a clinical outcome. It’s not just selling something and making some money, I need a clinical outcome, I need the highest quality because that matters, the outcome really matters. So you’re 100% right on that professional grade, so where to go. So we talked about collagen, I think low hanging fruit anyone, you could always do tablespoon of cod liver oil a day, tablespoon or two across the world, the vitamin A, and there’s excellent central fatty acids really good at eating high quality animal products is obviously going to be great. If you’re not doing high quality animal products, we’ll fix your digestion. But you could always do some seafood. If you can do that, you could always do some egg yolks, you could do that. You could also do some nuts and seeds, as long as you can tolerate them, especially the pumpkin seeds can be really good or chia seeds can be really good, or at least some algae on that side of the fence can be great. And then I would say make sure you’re pooping every day, make sure your bowels are regular. If you’re not going every day, you can be reabsorbing a lot of toxins in your gut. And if you have a lot of bacterial overgrowth, what happens? The bad bacteria Creek creates an enzyme called beta glucuronidation, this enzyme de conjugates metabolize estrogen. So what happens is you bind these proteins to estrogen. And these proteins are that you’re basically conjugating you’re binding this protein, and that allows you to excrete these hormones. And this enzyme comes in their ad conjugates. It breaks the handcuffs and allows those hormones to go back into general circulation. And so it’s possible that bad bacteria can really create hormonal imbalances. And if you’re a female, and you have potential estrogen dominance, that can be part of what’s going on. And so estrogen dominance can drive hyperpigmentation and skin issues as well. So you got to be on top of that. And of course, if you’re taking the birth control pill, you can almost guarantee that you’re going to be in that estrogen dominant state as well, because you have all this synthetic typically ethanol estradiol in your bloodstream as well.

Evan Brand: Yeah, well said. So we technically could have called this something like the SIBO hormone skin connection or something, but it is all connected. And we do find that when you get gut infections resolve skin’s better. And also, when like you mentioned, you’re knocking out the gut infections, you’re able to lower the beta glucuronidation. And now that pathway, the glucuronidation pathway works more efficiently. And then you get other toxins out to like mold toxin. So you can have skin issues with mold toxin, I certainly did. And that’s because we know that mold toxin can affect the gut barrier, mold can create leaky gut. So if you are treating the infections, you don’t get that toxin out to you’re not fully out of the woods. And in regards to testing, let’s mention that real quick. And then we can wrap up. So if you’re working with somebody like Dr. Justin and I what we’re going to be doing is a GI map stool test or similar, we’re going to be using organic acids testing, maybe some hormone profiles, and maybe some other toxin profiles. So with urine and stool, we can get so much information into this. And your dermatologist is never going to run a stool test. They’re never going to run an organic acids test and find that you have clusters and Candida and strep and klebsiella, Giardia and H pylori and give you herbals to kill it herbal antibiotics antifungals. That’s never the protocol. So I’m not saying don’t go to them. I’m just saying if you want root cause solutions. These are the types of tests and solutions you need to implement. Not a topical steroids, which is exactly what my wife got prescribed when she had a lot of issues. They did a good job with testing, but it was a patch test. And they found that she was reacting to some parabens and all the garbage that was in her conventional skincare products at the time. So they at least did a good job of testing that. But they never tested the actual body. They just tested the chemicals. They didn’t go and say hey, what are the deeper underlying issues? Oh, you’ve got poor methylation poor detox function. You’re not pooping. You’re pooping once every three days. They don’t go into that.

Dr. Justin Marchegiani: Yeah, 100% you know, so we got to try to get to the root underlying issue. The problem is when you do steroids, you also weaken your connective tissue, you weaken the skin, and then it sets you up for more dependency. And then it also weakens the immune system and it could also create more blood sugar imbalances, especially if you’re having to use a lot of steroids. And that blood sugar, guess what, that can increase insulin and increase insulin increases what more sebum oil production, potentially more acne. So a lot of times these medicine medications can create a vicious cycle. So you got to be very, very careful with that. So out of the gates, kind of what’s the Reader’s Digest version, work on the diet, work on your carbohydrates, work on certain nutrients, fat soluble vitamins work on digesting your protein, adding college and adding vitamin A and zinc. Get your gut looked at work with a good functional practitioner. If the low hanging fruit things aren’t working? Right, it’s okay to you know, stop guessing and assess what is going on. Also, put your comments down below. Let us know things that have already helped you in the past. I’m curious to know, let us know your successes. Also feel free and share this information with friends or family that are suffering or dealing with issues and want to dive into the next step or want to do deeper testing into it. Give us a thumbs up, I really appreciate it. And we’ll put our links down below you want to reach out to Evan, great place to go. You can schedule with Evan worldwide, as well as myself, Dr. J As well, we’ll put links underneath as well where you guys can review our podcast, we appreciate your feedback. This helps us to help more people. So if you’re enjoying this information right now, give us a quick review just a sentence or two, let us know if we’re doing good. And if we’re not give us some feedback, we always want to do better, Evan, anything else you want to highlight?

Evan Brand: Yeah, if people are just sitting there like maybe they’re like halfway awake, or they’re daydreaming, snap back into reality, review us, we will love you forever. We really do need the reviews, it helps us beat out other people. You know, we don’t do ads on this show. Maybe one day I’ll go back to doing some if I have a good partner that we work with again, but for now, this is a non ad show. And so many other shows are just filled with it. You just have to put up with the spam, we try to give you guys all killer, no filler. So I hope you recognize that. Take the two seconds go on your your app. for iPhone users, it’s probably the easiest. That’s the best place to review us on your Apple podcast app, see the show, click write a review. Boom, give us the stars you think we deserve? Give us a few comments. It really helps motivate us, you know this kind of a thankless job, you’ll get hundreds of thousands of downloads and then maybe two people are like, yeah, that was a good episode. So we really want to hear it. And we really appreciate it. It’s what keeps us fueled up and just mentioned the links, don’t hesitate to reach out. We’re going to save you more time and more money. Yes, you got to pay to play, so to speak to get labs and console’s done, but I tell you if I knew what I know now, man, I could have saved myself years of suffering with my skin issues throughout high school. I mean, I just had, it wasn’t the worst that wasn’t the pizza face, kid. But I certainly have my my issues with acne. And man, if I would have been able to get it dialed in now like we do for some of our kids and teenagers that you and I work with. Wow. And we’re literally changing the trajectory of their entire life. It doesn’t go this is like I said the beginning. This is beyond the vanity. I mean, I had a kid in California who’s 17 and now that his skin is so much better he’s so much more confident he got a promotion at work so he’s making more money. He’s feeling better he’s got a new partner so he’s you know, he’s he’s with a female now and he was previously too like embarrassed to to want to date anyone. So I mean this this could affect everything. Career finances, this is not just how you look in the mirror. So I want people to go beyond that and think about how much more could you achieve if your skin was better? And I think the sky’s the limit.

Dr. Justin Marchegiani: Yep, also scanning god are intimately connected. If you have skin issues, you may not be breaking things down. You may be gassy. You may be bloated. So look within right above below inside out. Alright guys, hope you enjoyed today’s podcast. Really appreciate it. Share, care, thumbs up review links below.


Audio Podcast:

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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

Dr. Justin Marchegiani

In this episode, we cover:

0:20     Labs At Home

5:07     Low Cortisols

9:37     Hormones

11:09   Dutch Tests

28:19   Useful Herbs

34:47   Healthy Estrogens

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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 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 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 and reach out to Evan. Evan’s available worldwide and myself, Dr. J at 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.


Audio Podcast:

Recommended products:

DUTCH Adrenal Test

DUTCH Complete Hormone Test

DUTCH Sex Hormone Metabolites


Detox with the Correct Binders | Podcast #324

Dealing with toxic substances can be an overwhelming experience. With that in mind, it helps when things are simplified and made into relatable terms. Intestinal binders are a crucial part of any detox protocol. When the liver processes toxins, they get excreted through bile and into the small intestine. If the toxins are not bound to anything, most of them will get reabsorbed in the gut.

It is important to note that certain health conditions may make binder types more or less desirable. Having a good practitioner help determine those choices for you is always advisable. Also, there are some circumstances, such as in autoimmune disease and infectious conditions, that require the use of precaution and targeted choices with binders. Proper sourcing is critical as with all supplements, as each of them can come with unnecessary risks if they are not high-grade/quality. 

Binders are like free hall passes! In using a binder, your body is spared the work required to process a toxin through the liver and gallbladder and is, instead, excrete from the body. Check out this podcast to know more about what suits you!

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:18      How Binders Work

8:38      Binders’ Mechanism

15:11     Detoxifying

21:20    Different Kinds of Binders

29:44    Detox as a Side Effect

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Dr. Justin Marchegiani: We are live. It’s Dr. J here in the house with Evan brand. Today we’re gonna be talking about using binders to help detoxify, exciting podcast because we are utilizing all the things that we are chatting about with our patients every week. And we’re excited to share with everyone else, some of our natural strategies, Evan, how you doing, man? 

Evan Brand: I’m doing really well excited to dive into this. This is something that you and I got into several years ago. And it’s been really helpful for our practice, because we’ve been able to take people that were not tolerating protocols, and then we were able to get them to tolerate the protocol. And so when you’re coming in and working on something like gut infections, whether it’s h pylori parasites, bacterial overgrowth, Candida, sometimes, if people have been sick for a really long time, they may not tolerate the protocol we’re giving them. And that doesn’t mean the protocol that we’re giving them is incorrect, or there’s something wrong with it, or there’s an herb reaction or I don’t know, like a, you know, a supplement, it’s not working well for them. That’s not usually the case. In fact, that’s extremely rare. But what rather is happening is that the process of killing off these toxins, I kind of use the analogy of like a bad breakup. And when you’re kicking out the girlfriend, she’s taking off the pictures off the wall, and she’s breaking them and there’s a bunch of glass shards in the hallway as you kick her out. It’s not a clean breakup. And so when you’re killing off these bugs, they don’t want to die, they don’t want to leave. And so they may release toxins that make you feel bad in an effort to get you to stop killing them. Hence, that’s where binders will come in, and they’re acting as the janitor, and they’re going to come sweep up the glass shards that the bugs left behind. interesting way of looking at it. 

Dr. Justin Marchegiani: I like it, like the analogy that I typically give is imagine you got a trash barrel right in your home, well, it may not be a big deal until you go buy a whole bunch of groceries. Now imagine you got a smaller trash barrel. Well, once you throw it away the egg carton and all the other trash from everything else it’s going to overflow. And that overflowing is where you start dealing with die off. And a lot of people, people that are more sick tend to have smaller trash baskets to begin with. And so essentially giving yourself a bigger trash basket or increasing the frequency that we take it out, right, empty it out, is going to help. So I think either analogy works. So in general, I think the first thing I want to highlight off the bat is well, I like to prepare patients to get there you know, to get killing done in the right way. So I’m always working on hormones and adrenals and diet and blood sugar indigestion first, I find that is the most important component to all this. So an ounce of prevention is worth a pound of cure. So before you go in and start having to do all this killing and and use binders, first, get yourself ready for it. And most people do not like that they want to go in there and Kill Kill, kill, kill, kill, but preparations and be really important. 

Evan Brand: Yeah, and it sounds really attractive. And people, they get really excited when they find pathogens on a test. So we’re going to run a comprehensive stool panel, we’re going to run an organic acids test. And we’re going to be jumping on a call with someone to discuss the lab results. And then they’re going to say, Oh my god, I have to get this stuff out of me. I knew I had parasites. I knew I had this. I knew I had that. And then they’re ready. But we kind of have to pace people, you know, when we’ve done this thousand plus times between the both of us. So we know that, hey, based on their constitution, how do you pick up on that as a practitioner? Well, it all goes into stress management? What’s in their bucket of stress? Are they going through a divorce? Are they moving cross country? Are they a teacher? Are they working overtime? Are they a CEO? Are they not sleeping? Well? Are they doing too much alcohol? Those things are going to make us say, Hmm, well, you know what, we probably can’t go full strength with this person. Or if we do, we’re going to need to come in and bring in the binders. And the binders are these tools that they can be used in isolation. And we often use those in isolation. However, the majority of time we’re going to be using them as just part of a protocol, meaning maybe during the day, we’re going to be killing bugs. And then maybe at night, we’re going to be using binders or maybe first thing in the morning when they’re fasted and we know fasting increases the excretion of toxins, including mold and mycotoxins. Maybe we have someone do a binder first thing in the morning at six or 7am when they wake up, and they don’t eat until eight or nine when they take their killing or something like that. So there’s a lot of ways to work these into the protocol. And that kind of depends on the person. It depends on the Constitution. It depends on whether it’s a kid or an adult. But these are amazing tools. And we’ll break it down here in a minute.

Dr. Justin Marchegiani: Yep, I like that. I think it makes a lot of sense. So one of the first things we can do to help it die off as decrease inflammation. We know agglutination happens or cells become really sticky when there’s a strong inflammatory environment. So like imagine walking in your kitchen and like the floor is really sticky. It’s like you’re like creeping around that icky feeling on your feet. That’s kind of what happens when you’re inflamed and you start doing detoxification, your body is just all inflamed, things aren’t moving, things are sticky. And we want to keep things loose and flowing and slippery. So the first thing kind of in preparation For all this is getting the inflammation down. So one of the things that I love doing for die off support, we talked about it before. One we’ve already worked on the diet, right inflammations down food allergens, our digestion is better. We’re working on sleep, we’re working on hydration. Getting your hydration up is super important, right? Every time you consume water, you’re diluting the amount of toxins in your body, alright significantly. And so solution to pollution is dilution, high quality, filtered water, reverse osmosis or some kind of really good filter spring water, maybe add some extra minerals in so that you’re getting some minerals to add in some ginger tea. Ginger is natural anti inflammatory, and it’s also a natural anticoagulant. So prevents things from sticking, you could do ginger tea, burdock teas also really good, that’s a good starting place. And then things are moving, your cells aren’t clumping up and sticking together. And then from there, that’s where it’s a good place to maybe add in some binders. So a good first binder would be a really good activated charcoal, especially ones that are kind of more coconut shell based at bedtime, two hours after food and supplements. So it’s kind of in your bloodstream, it’s kind of filtering things out. It’s not getting binding up to all your food and all the nutrients in your food, unless you want to because you’re eating some bad food. That’s a good first starting point to kind of get you moving. 

Evan Brand: Yeah, let’s break down charcoal just a little bit. So people understand what it is they hear it but they’re picturing maybe the charcoal, you know, petroleum based block that your dad used to put lighter fluid on and burn them down and put them in the grill. And then you cook some hot dogs as a kid or something.

Dr. Justin Marchegiani: Yeah, totally. 

Evan Brand: That’s not the charcoal we’re talking about. So basically, what they’re going to do is they’re going to heat these coconut shells, that’s going to be the best. And that basically, they’re decomposed coconut shells. So they’re at a very, very, very high temperature. And then they’re going to combine it with oxygen to, quote, activate the charcoal. And then what happens is, if you were to look at it under a microscope, you’ve got millions and millions and millions of what they would call micro pores on the surface of the charcoal. And it’s when people say bind, it sounds like a magnet, but it’s really not, you know, it’s called an adsorbent agent. And so you’ve got just make sure you had it right. 

Dr. Justin Marchegiani: So it’s not like a sponge. It’s more like a magnet. 

Evan Brand: Yeah, right. So it’s like you’ve got but it’s a weak magnet is my point about the magnet is, is it’s weak, meaning that you actually can create a hurts if you do too much charcoal, for example. So I did it personally, when I went really high dose like 810 capsules, several times a day of charcoal, I actually, I started to get just a little off like I was detoxing too much. And so I found Yes, it is kind of a magnet, but it’s a weak one. Meaning that if you picture like the lava rock, that’s probably the best example in in a big form that people can visualize as those lava rocks. Maybe you had though, that was like old school landscaping. I know as a kid, we had lava rocks in the front of our house. Yep. And so the lava rock, you saw these tiny little holes in it. And that’s kind of the charcoal but but at a bigger level. And so let’s say it’s mycotoxins or heavy metals or pesticide, whatever else is kind of in those little holes. But remember, you still have to move this microscopic lava rock with the, with the toxins on through the intestinal tract. And if you have a leaky gut, some of those things can kind of fall off the law of rock and then go back into the bloodstream, which is why you can hurt even from binders alone. And so this is a really important point I want people to know because more is not always better when it comes to binders. So sometimes you can only handle one cap of charcoal three times a day, some people can handle more than that. 

Dr. Justin Marchegiani: 100% so you kind of highlight a couple things. What’s the mechanism? Well, there’s gonna be an adsorbent mechanism thing absorbed more magnet absorbed more like a sponge, right? absorbent sponge adsorbent more magnet. Again, we want to take it after food and supplements. We don’t bind up nutrition. I like starting in a bedtime. So it’s working overnight because a lot of how we detoxify happens around one to 3am. So I like having it in the intestinal tract when the liver and gallbladder dump. That way, it’s there binding stuff up and we can excrete it better. Now, one of the big side effects of activated charcoal on binders is constipation. So I always tell my patients Make sure your bowel movements are regular before you go into killing and use any binders because if we’re adding things that could slow down the motility more well that’s that’s a problem. Now, it’ll at least help pull toxins in but it’s still going to be slowing down your body’s ability to get toxins out of your intestinal tract. So that’s not good. So if that’s the case, we’re going to be adding in things to help move our intestinal tract and make sure we’re passing all of our bowel movement out in 24 hours or less 18 to 24 hours. So we have that effective mechanism of elimination working. So first thing is first check is like hydration. Second check is making sure your bowel movements are working and then if they’re not, we’re going to be adding things in to make sure our intestinal intestinal tract is moving appropriately before we add in binders. And if we have Side effects of constipation with the binders, we’re going to be adding more support to keep the bowels moving. 

Evan Brand: And it’s honestly pretty easy. I mean, it’s a very common kind of gut reaction, oh my god, charcoal, constipation. But I’ll be honest with you, it’s rare that it’s something that requires special attention. Because a lot of times we’re doing extra vitamin C, because most people are low in that most people are deficient in magnesium. So we’re doing extra of that already. A lot of times the herb formulas that you are using for gut infections, those may have some extra bow moving support in those and just by clearing out infections you and I’ve talked about, in the past how bacterial overgrowth can create certain gases that will slow the transit time down, just by eradicating those infections, the bowels can return to normal. So yes, constipation can happen. But it’s usually not a huge wrench in the gears. And we can overcome it pretty easily with minor tweaks if needed.

Dr. Justin Marchegiani: Yeah, exactly. So it can go either way. Some people when they get inflamed, they’re pulling a whole bunch of water in to flush things out. If you’re more prone to be constipated, you just have to be mindful of it. That’s why when we’re adding in binders, we’re doing it like one capsule at a time. So there’s no big jump, where people get into trouble is they just kind of come in there with a higher dose or they jump too fast. And that’s where the problem comes in. And again, like Evan mentioned us some of the herbs that we give may have a really, you know, good laxative effects are really healthy intestinal migrating motor complex work well, if not, I’ll be using special special things like magnesium and things like that to keep the intestinal tract moving. Ginger is a really good pro kinetics. So we’ll be adding that in and really just helping to support the natural migrating motor complex of the intestinal tract while adding some binders now, once we start adding some binders at nighttime, we may do it sometime midday as well that way we kind of have coverage within a 12 hour timeframe. So we have some coverage at night, some coverage during the day. But I always start at night first, partly because that’s when we were dumping a lot of toxins at night. 

Evan Brand: Yeah, let me just address this concern real quick. And then we’ll move on to my next favorite binder, which is chlorella. So just like oh, charcoal, constipation, people go Oh, charcoal mineral depletion. I’ve talked with a guy named Neil Nathan, who wrote a great book called toxic. I often recommend people buy that to look into binders. He has worked alongside a guy named Dr. Michael gray, who’s a toxicologist, I believe he’s out of Arizona, he’s a guy who’s been working on treating mold. For decades, this guy has been using, I’ve heard insane numbers like 50 to 100 grams of charcoal per day, we’re talking literally 8090 100 capsules of charcoal a day for years. And there’s never been an issue of mineral depletion, ever, ever, ever, ever, ever. So his kind of argument after I probed him on that question was, well, what about mineral depletion? He goes well, so what if you lose one or 2% of minerals? If you’re getting 98% of your nutrition and minerals, still, the the pros outweigh the cons in the sense that you’re removing toxins that are affecting hormones, the brain, the liver, the kidney, so he’s like, yeah, maybe you lose a couple percent. But it’s never been something that’s called like a heart attack. Because you’ve lost so much potassium or anything crazy like that. 

Dr. Justin Marchegiani: Yeah, you’re just going to be taking it away, you’re going to be just taking it away from it. So that’s going to mitigate most of it. If you’re taking activated charcoal with your food all the time. Yeah, maybe you have a problem. But you’re going to be one you’re going to be kept getting a lot of minerals in your water and food throughout the day. And then you’re going to start by taking it at night when you’re not, like overly hydrating anyway, and to at least two hours after you eat and so it’s not that big of a deal. And so yeah, as long as you time it up, right. I just think that’s a moot point for sure. 

Evan Brand: Yeah. All right. So let’s let’s go into chlorella, because I really love chlorella, and I didn’t know too much about it. Besides that you’d see like little chlorella tablets, it always comes in these little green looks like a little Pez or something and they’re kind of hard to chew, but they’re a little awkward to swallow. And then Luckily, I found a couple companies that make micronized liquid chlorella, and that’s what I often use. chlorella is an algae. But it works amazing as a broad spectrum. So a lot of people kind of market it as a heavy metal detox because it has a really unique ability to bind on to heavy metals like mercury and lead and cadmium and arsenic and aluminum things that every modern human has, whether it’s from breathing and car exhaust, to having amalgam fillings in their mouth, but it’s awesome. And I’ve seen I could show you several case studies on pesticides, herbicides, and mold toxins, and chlorella being used to pull those out. We’ve got in fact before and after results of seeing even little kids, 234 year olds that I’ve worked with where they had major, major major pesticides. These were kids that were diagnosed autistic, are on the spectrum. We give them as high doses we can go with chlorella, we retest after three to six months and guess what the pesticides herbicides are gone. And oh my god. I mean, sometimes it just almost makes you cry because it’s like, wow, how is something like this so beneficial, but you’re not hearing about this on the nightly news?

Dr. Justin Marchegiani: Yeah, absolutely. So the first thing we can do to detoxify I always tell patients is stop adding toxins in. So first stop adding toxins in so look at your pesticides right? Look at the food that you’re eating, make sure it’s organic, no GMOs, you know, make note, no added hormones, don’t consume foods and plastics. If you use plastic, you know, try to keep it in the fridge out of the sunlight out of heat out of the microwave. Excellent clean water, filtered water, clean water, if it’s aro, no big deal, add some minerals back in there, I see a lot of people complaining about our water, hey, I rather have my water cleaner, and then add minerals back in and have water that’s more toxic, because you can’t, you can’t add things into the water that make it more or less toxic. It’s either got to be filtered from toxins, and then you can add minerals back in on the flip side. And that’s totally okay. And then from there. And then from there, that’s going to kind of give you that the first foundation because your food’s good, your water is good. And then all your hygiene products make sure deodorants and skincare and soaps were free of toxins there. And that way when we add in binders, there’s going to be just less things that have to be binded. So our body can work on binding up more things that are released from our tissues that are more stored toxins versus toxins that are coming in every day from our environment. 

Evan Brand: That’s a great point. I even forgot to mention that which is duh. Why did people have to get into the situation where they need binders in the first place? Well, it’s they’ve been exposed to toxins. Now, some people they weren’t exposed to toxins on purpose, it was just they ate organic, but then they, you know, stayed a month in a moldy Airbnb or something and they got exposed that way. So it’s not always your fault. But you’re right, you got to empower people and say, hey, look, you can make a choice, you can either eat organic, and not get exposed, or you can eat conventional. But now you’ve got to do the cleanup work. And it’s much better to stop it before it gets in than having to remove it once it’s already in.

Dr. Justin Marchegiani: 100%. Now, outside of that we can do things that help our livers function better, we can work on phase one detoxification support, which will take a lot of these fat soluble toxins and convert them into water soluble. Now these toxins are mobile. So the activated charcoal really works great when toxins are now mobilized, if they’re not mobilized, these binders aren’t going to really work well because everything’s kind of be in the tissue kind of stored up so to speak. So it’s gonna be hard to really grab it. So getting phase one detoxification support dialed in B vitamins, antioxidants, these are going to be key nutrients, maybe liver tona fine herbs like milk thistle, or dandelion or artichoke root. I have a supplement called liver supreme or antioxidant supreme are both my phase one detoxification support that gets things mobilized. Now if they’re mobilized now we can come in there with binders and we can soak it up a little bit. 

Evan Brand: Yeah, phase two is important to now a little involved, I would suppose with the with the binder conversation, because if phase two is not working, you know, phase one can be up regulated. But if phase two is not working, it’s like you’ve got a fire hose going into a garden hose and the backup can happen there. And I’ll tell you personally, and clinically, when I start to use nutrients to fuel phase to like some of the amino acids. I’ve taken it too far like with everything, you know, because I’m a guinea pig. But I’ve noticed massive, massive improvements just by helping out phase two. And then if I ramp up phase two too much, I’ll throw in binders and then the binders will kind of help mitigate the hurdles from up regulating phase two. So it’s a it can be a little bit of a seesaw sometimes. 

Dr. Justin Marchegiani: Exactly. 

Evan Brand: All right, what else what else should we hit on? We should hit on the the Clay’s a little bit as well. You and I love clays that are awesome. You’ve got zeolite you’ve got bentonite clays, those are kind of your top big ones you’ve got like green clays and such clays are awesome. I find that they are really good at heavy metals and molds and will often use it in a blend. So we’ll use a little bit of clay a little bit of charcoal a little bit of chlorella all at once. And they’re well tolerated. I haven’t seen that many people who works from clay so I don’t have any, you know, evidence beyond clinical with this, but I would say that you seem to have less hurting with clays than you do like chlorella or charcoal. I find you can go too much with the others.

Dr. Justin Marchegiani: Exactly, yeah. So just to highlight a couple of things here regarding the sulfur. NAC. glutathione glutathione is a tri peptide anyway. So that’s made from glutamine, glycine, cysteine, right, taurine, MSM, alpha lipoic acid, just getting a lot of our sulfur nutrients on board is going to be huge. That’s going to help provide a lot of the building blocks for phase two. And that way we’re going to be able to, you know, and acetylation, glutathione, conjugation, methylation, right, these are going to involve a lot of our phase two nutrients and so Phase One, like methylation will evolve, like b 12. And full eight, right? So we want to make sure all those things are working if we need Now, some people, we’re not going to be pushing the toxification directly, we’re going to just be, it’s gonna be there more to help pick up the dead debris from things that are being killed in the gut. But if the activated charcoal still not enough, we may have to push more of those phase one and phase two, just to make sure those toxins are releasing, and then the binders will be there to catch things a little bit as well. So a little bit of a push catch, if necessary. If not, we’ll just be doing more of a catch and the push will be more from the killing side. So everyone’s a little bit different. And I tend to a lot of times this isn’t a problem when you have the foundation built in first. 

Evan Brand: Yeah, the funny thing is going into this podcast, I thought, oh, wow, this will be you know, pretty easy to explain. But the more we dive into it, the more this thing gets a little tricky. And so case specific because some people, they don’t tolerate up regulating phase two that much, and other people they have trouble with the binders. So we try to make this stuff as simple as we can. But keep in mind people this is not This podcast is not designed to replace one on one functional medicine care. So if you really want to get to the bottom of these issues, you need help you need us to help guide you through this because I don’t want you to go in and just pop in a bunch of charcoal and you feel bad. You don’t know why. And then you’re confused about what you’re going to do next. 

Dr. Justin Marchegiani: 100% So let’s talk about some binders. So activated charcoal, you mentioned the heating like that the you know the which is going to really have a big binding effect. It’s also going to help with mold as well. We have things like bamboo, bamboo binders are excellent as well. We have things like citrus pectin, which are shown to be very helpful for lead. We have zeolite binders which are very helpful for mold. I think activated charcoal is also very helpful for mold. We have things like beetroot powder, which has some natural binding effects for mold as well. Obviously, we have the medication coolest I mean, which is a really good mole binder. There’s some side effects, though, which can lower your sex hormones fulvic minerals, which have some mold and some binding effects to any comments on the different kinds of binders having chlorella, more on the metal side more for Mercury, though more in the intestinal tract. Anything else?

Evan Brand: Yeah, the colas. darmian is strong stuff. I used it. And, man, I tell you it works. But I do believe that it affected my gut negatively. I do believe that. Now I don’t know if I don’t know if that’s a direct influence, or is it a byproduct of dragging mycotoxins out of the system? I’m not too sure. But I would try to tell people don’t use the prescription binder unless you absolutely have to. And you’re just so miserable. You can’t get yourself out of the rabbit hole with it. Because for me necessary for most. Yeah, for me, I just I really struggled. And I was doing the natural binders for months. And I needed a little extra help. So I did it short term. But I would try to stray most people away the natural binders can be really good if you have enough patience and time to resolve the issues.

Dr. Justin Marchegiani: And you’ve like for you it’s more of a mold thing. So we’re kind of talking for binders for most people is more in the killing side. Right. So for that you had no problems with it. Right? It was more on the mold side, correct? 

Evan Brand: Yeah, yeah, that’s right. 

Dr. Justin Marchegiani: And then you find you fit on the mold binding side, you found that which is better for you when you had what more glutathione and more so for support in along with the binders? Was that true? 

Evan Brand: Yeah, yeah, the glutathione definitely helped as long as I didn’t do too much. And then also helping the glucuronidation pathway that’s also part of this whole conversation. And so calcium D glucose rate did great things for me. 

Dr. Justin Marchegiani: Yes, calcium to glucose. It’s good. And that’s a estrogen binder as well as a mole binder. 

Evan Brand: Yeah, yeah, it really helps with z, what’s called [inaudible], which is something we test for on the urine. So, you know, like we’ve talked about today, you can have a kind of a broad spectrum approach, but we really try to dial it in if we can, if we see specific mycotoxins, we’ll try to give a little more specific. 

Dr. Justin Marchegiani: 100%. So I think that’s really important. Anything else you wanted to highlight on that?

Evan Brand: I think that’s it. I would just say the first step is really trying to get the data, right, because, you know, people hear the word detox and like, yep, I need some of that. And it’s kind of trendy, which is, I guess, good, but also bad because people just jump into detox not knowing why or what they’re doing or what they’re after. So my recommendation as always our philosophies test, don’t guess and figure out what do you have that you’re detoxing? Do you have a heavy metal burden? Let’s find out. Do you have a mycotoxin burden? Do you have pesticides and chemicals? Do you have all that? Okay, great. Now, let’s make a plan to go after these things. So, like I said, Don’t just run to Whole Foods, buy coconut charcoal and take it if you don’t know why you need it. I prefer people have a reason. 

Dr. Justin Marchegiani: 110% I totally agree. So a couple things, right. So number one, people say toxification. Right? Well, number one, you’re always detoxifying. The question is, are you detoxifying at 100%? Are there enough toxins and stressors in the environment that are impairing your detoxification? where certain toxins are accumulating in your body more than are being eliminated. So number one, you’re always detoxify. Number two, it’s more optimizing your detox vacation systems. Also number three people that talk about cellular detox. That’s marketing garbage. Okay. detoxification is happening at a cellular level. It’s called their cytochrome p 450 oxidase pathways that’s happening biochemically at a cellular level. amino acids, vitamins, minerals, nutrients, these pathways are being upregulated all the time that’s happening at a cellular level. So when people talk about cellular detox, that’s just marketing hooey. Anything you do to help detoxification just drinking more water, guess what you’re enhancing, so detoxification just by you, decreasing inflammation. You having really good nutrition in your food, you’re enhancing the certification. Okay, so don’t get don’t get caught up with a lot of these marketing buzzwords. 

Evan Brand: Yeah, unfortunately, detox is probably the most what would you say? Maybe sleazy snake oily type part of functional medicine? 

Dr. Justin Marchegiani: Yeah, it is for sure. I think a lot of the time it is because people come at it from that’s the first step. So they’re taking people and they’re just trying to upregulate these pathways right out of the gates. And people have gut issues, and they’re being nutritionally deficient for a while. And there have a lot of toxins that they’re consuming food wise, or in their life. Yeah, they can really feel crappy and sick. So it’s probably the last thing I do out of the gates again, specifically, right, we’re always detoxifying. So if I see a patient and I don’t hit the toxification, specifically with those nutrients, but I get them drinking better, cleaner water, and get them going organic, and get them pooping every day. I am enhancing their detoxification, like, tenfold just doing that alone. Yeah, yeah. I mean, it’s just funny, I guess, it gets a little-

Evan Brand: Cheesy, because that’s one of the few things that your average person who knows nothing about functional medicine knows about is the word detox. They probably heard it before their friend drinking detox tea or something silly like that. 

Dr. Justin Marchegiani: Right? And then you have like the master cleanse detox, right, which is, hey, that’s cool. You’re giving your digestive system a break, and you’re not necessarily detoxifying. When you when you do that, I mean, you’re not enhancing nutrition, you’re enhancing fasting and autophagy. And, and that can help with stem cells. And that can help detoxify a little bit, because you’re, you’re fasting. So detoxification is a little bit higher there, but you’re not specifically pushing those pathways. Most of those benefits happen because you’re not consuming a whole bunch of food allergens. People feel better doing a Master Cleanse, it’s typically because their diet usually isn’t that great. So when they go on a Master Cleanse, they’re avoiding a lot of those foods that are inflaming them all the time. The more healthy Your food is, when you go to a cleanse, you’re kind of like, Oh, well, it isn’t that big of a deal, because your food’s already really high quality. 

Evan Brand: Yeah, yeah. silica is on the list, too. There are small nutrients. I mean, there’s there’s boron, there’s trace minerals. Or you may be helpful. Yeah, molybdenum can be helpful. So I think we hit on a lot of the big ones, though, a lot of the big tools that you mentioned the pack, then I’ve done packed and I’ll be honest, I haven’t noticed much from it. I do use it in combination with some other binders. But I’ve never done just like a pectin trial by itself and notice any significant difference, meaning I haven’t taken it. And my head’s clear, like with charcoal, if I’m kind of fuzzy, I’ll take a little charcoal and then boom, you know, I’ll notice the clarity. I don’t know if it’s pectins different maybe it’s not binding on to the type of toxin that’s causing the head drunkenness in the first place. 

Dr. Justin Marchegiani: It’s better for lead I think and Merc, okay, yeah, we’re for the heavy metals, but it’s still helpful, you know, ya know, if you’re gonna be detoxifying, it’s not gonna hurt having that in there. It just wouldn’t be the only thing you’d have in there.

Evan Brand: Right, right. Yeah. And so, and maybe heavy metals, they don’t have as much of a quick turnaround time on your symptoms, whereas mold does, like, I know, if I’ve taken a mold hit, it’s like, Whoa, it’s a pretty quick symptom reaction. Whereas, hey, I breathe in a little car exhaust, I’m probably not going to feel anything right away from that.

Dr. Justin Marchegiani: Right. Exactly. Yeah, totally. So anything else you want to add? And I think we really went to town on all this stuff. I mean, I think the key thing I want to highlight for everyone listening, if you’re having a lot of issues or hormone issues of detoxification issues, you know, do the foundation’s out of the gates. But if you’re still struggling, you want to reach out to someone like myself, and Evan, so we can help you all out. We’re available worldwide, and Evan’s at EvanBrand com. I’m at, you can click on our schedule buttons, and we can support you and help you during the process. If you need that extra help. We’ve helped thousands of patients together. So we have a lot of experience. And a lot of people have other issues going on, like gut infections, like hormone imbalances, like inflammation issues like other thyroid or autoimmune issues that are part of the issue. And just supporting detoxification by itself won’t be the fix for that. It’s part of a bigger broader plan. Yeah, on the fence. Feel free to reach out guys. 

Evan Brand: Yeah, good point. And some of our mentors that said you really have to kind of market to people for what they think they need, but give them what they truly need. So a woman may say, Oh, I need detox. Okay, so I’m like, Okay, yeah, we can help with that. But hey, guess what, detox is not your number one priority based on these labs, we really need to do this. And as a side effect of working through this, yep, we’ll detox you as well. So, don’t always assume in your head, you’ve got it all figured out. Because there may be a different set or of priorities or a different order of operations. 

Dr. Justin Marchegiani: Yeah, it’s always interesting when patients come in, and they kind of have an idea what they want. But then the question is, I’m gonna try to give you what you need. And I’ll try to connect the dots. Because if your goal is to get better and address these issues, then we’re totally in alignment, you just may be, you may think this is what you have to do to get there. But as long as you’re open to guidance, then hey, we can adjust that for sure. 

Evan Brand: Yeah, it’s always a fun process. So Justin mention the links I mentioned a moment of time, Dr. J at available online. And me, And that’s it. So we’ll be back next week. take great care. If you have questions, concerns, comments, you know, write us a review and tell us what kind of topics do you do you want us to cover we’re happy to dive into all of it. We live we eat, we breathe this stuff every day, all day. I mean, this is our life. So we’re very passionate and we would love to hear what you want to hear about. 

Dr. Justin Marchegiani: Absolutely. And we’ll put a link down below under references for products that we specifically use and formulate to help support some of the pathways and the objectives that we chatted about in today’s podcast. So if you want to support the show, you can also purchase those products that which we believe in personally use for ourselves, patients and family. Awesome, everyone. You guys have a phenomenal day. It was great chatting with y’all. Take care now. Take care.

Evan Brand: Bye bye.


Audio Podcast:

Methods To Encourage Good Bowel Movement

You see women on Instagram. They’re all done up with their hair and makeup, and they’re marketing #ad #detox #tea. They have these ridiculous products that they’re remarketing and they’re not talking about poop. The best way to detox is getting poop out. I’m not going to buy detox tea. I’ll get a bit of dandelion or some milk thistle blended in and that’s part of it but unfortunately, detox is co-opted by the marketing industry. Most people don’t even focus on that. They’ll poop once a week but then they take a detox tea and they think they’re doing it correctly.

Click here for a consultation with a functional medicine doctor if you want to learn how to detox properly!

My whole take on detoxification out of the gates is very simple.

    1. Get enough good clean water in your system.
    2. Make sure you’re digesting your amino acids and all your nutrients well.
      Remember: Sulfur-based amino acids run the majority of your detoxification pathways, along with B vitamins. We need good B vitamins, good antioxidants, and good sulfur amino acids. For breaking down those nutrients well, there’s not a bottleneck with ACL levels or enzyme levels. We’re getting enough to clean water.
    3. Not overly stressing our sympathetic nervous system.
      Remember: The more we overly stress the adrenals, the sympathetic nervous system decreases that migrating motor complex which are the wavelike contractions that move stool through your intestinal tract, just like you roll up the toothpaste roll at night to get that toothpaste moving through to get your toothpaste out to brush your teeth. Your intestines are the same things.

    If you can do those top three things right, you’re on the right track. There may be extra things where we need extra sulfur or extra antioxidants or compounds or binders to help with mold or heavy metal. That’s true and that would be addressed down the road but a lot of detoxification happens hepatobiliary, liver, gallbladder, back into the intestines, and then out the intestinal tract. So, we need to have really good motility and really good absorption of nutrients, and a lot of good clean water to help fuel.

    Supplement Suggestion:

    Use one for liver support that has some gallbladder nutrients built into it. That can be really helpful because with sluggish bowels because a lot of times there’s also sluggish bile production. So, just helping thin the bile whether it’s using supplemental ox bile or methionine, taurine, B powder, whatever else we can do to increase bile flow. That’s going to be helping.

    Detox and Diet

    This is a low-hanging fruit that your average American is still really, really blowing it on which is just the fact that they’re not doing enough good meats, good fats, and good veggies. Your average American might wake up and do a piece of toast and maybe in 2020 or 2021, it’s an avocado toast but still that’s not the optimal thing for good poop.

    Inflammation in the diet can easily mess up the intestinal tract and can easily create inflammation in the gut. That could either move the body more to diarrhea or more to constipation. If we start moving more to constipation, that’s not good. Of course, these foods can stress out the intestinal tract and then when we start creating inflammation in the intestinal tract, then we already have indigestion meaning we don’t have adequate enzymes and acids. So, we’re burping a lot after our meals, food sits longer in our tummy, and a lot of gases are produced because the foods are not being broken down properly. That’s a problem.

    We’ve got to really make sure we’re masticating and chewing our food very, very, very well. We’ve got to make sure to increase the surface area for enzymes and acids to work. We also have to make sure not overly hydrating with our meals. So, hydrate 10 minutes or more before meal, and then if you’re consuming a little bit of liquid with a meal, just do it to help with swallowing pills. Don’t do it for hydration purposes. Because water has a pH of 7 and your intestinal tract has a pH of 1.5 to 2. So, if you start adding a whole bunch of pH 7 to up to a pH of 2, you’re going to move that pH more in the alkaline direction away from the acid direction. We need good acidity to help activate her enzymes in our acid levels. That’s very important.

    If you have any issues with detoxification, please reach out to a functional medicine doctor.


        1. Chew your food up well.
        2. Make sure you’re not overly hydrating with the food. Do all your hydration 2 minutes before.


Winter Skin Care Tips: Get Rid of Dry Skin | Podcast #320

Winter can wreak havoc on your skin — making it dry, itchy, and irritated. And it can feel like there’s no escape: Cold, blustery conditions outside can leave your skin feeling raw, while indoor heat zaps moisture from the air and from your skin.

In this podcast, Dr. J and Dr. Evan are talking about skin problems that you might encounter during this season. There are many simple ways to combat the causes of dry winter skin and help keep your skin feeling moist and supple all season long, including some easy changes to your everyday routine. Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:23    Skin Issues

4:43    Detox Pathways

13:24  Infections

22:00  Humidity Issues

24:07  Proper Digestion

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Dr. Justin Marchegiani: We are live. It’s Dr. J here in the house with Evan Brand. Evan, hope you had a great new year great holiday season so far. Today we’re going to be diving into skin issues dealing with skin issues coming the wintertime, all the different things that may happen due to dryness, cold. Lots of sweets from the holidays in the New Year’s all that stuff. Let’s dive in man. How you doing? 

Evan Brand: Doing well. Happy New Year to you. Happy New Year to everybody. This is the first podcast of 2021 Hooray, we need to like clap for a minute. Yeah, exciting. 2021 All right. So skin issues. While I was telling you about my daughter, Jenna, my little 1- 19 month old, she was having some really dry skin on the back of her arms and legs. And so we’ve done a couple of things to help her which is pretty cool. So I’ll share that right off the bat and then we’ll dive into some more root cause stuff. So we really upped up her fish oil we were giving her about it was two squirts of a liquid and it was a professional version so I don’t remember the milligrams but we just doubled their dose so we just kind of doubled her doubled the normal dose of omegas and that seems to help especially if we think what’s happening is like a keratosis Polaris, which is a common situation. And then secondly, we did a babo botanicals brand and it was called a colloidal oatmeal lotion and it was fragrance free. And it’s mainly just like shea butter. We tried coconut oil topically that’s always kind of my first go to for skin issues, but it didn’t touch it. It didn’t help it at all. But when we got this Colloidal Oatmeal Babo Botanical product, it was a game changer. And no This podcast is not sponsored by them. But hey, if you want to sponsor us reach out to great product above to share it with more people.

Dr. Justin Marchegiani: Very cool. Very cool. So we have the keratosis Polaris, which is where the [inaudible] and kind of just accumulates in the pores and, and you can get this bumpy chicken skin feeling usually like on the back of the arms on the button stuff, right? Is that what you’re referring to? 

Evan Brand: Yeah, that’s right. 

Dr. Justin Marchegiani: Yeah, you’re saying that the omega threes really helped that omega threes really make a difference and help improve the extra keratin deposits in the pores?

Evan Brand: Yeah, my wife had it too real bad when we first started dating and we’ve got around like, two to four grams a day of omegas and her back her arms feel perfectly smooth now. I mean, of course we got her gut better, we got her diet better, but I honestly think the biggest factor the biggest variable was the omegas.

Dr. Justin Marchegiani: Yeah, the extra omega threes can make a big difference. Also good zinc, extra zinc too can also help. That’s really good to know. So we also talk about skin diet plays a big role. So we have to kind of rule out things like gluten extra refined sugar can feed yeast and bacteria and these things can produce, you know various mycotoxins or endotoxins that can put stress on the liver in the body and you may see the skin reacting as a means to that you may see skin issues and breakouts as a means of that. Also, large amounts of sugar can cause insulin which can cause insulin surges, which can cause extra sebum and sebum, can cause can feed bacteria on the skin which can create more acne and more skin inflammation. Also, things like gluten can potentially drive autoimmune reactions like eczema, psoriasis, potentially even rosacea issues. So you got to look at dairy you got to look at gluten, you got to look at refined sugar that could be driving a lot of that insulin that could be feeding a lot of the microbe was the fungal the yeast, the bacterial overgrowth, which can obviously affect the skin too.

Evan Brand: Yeah, yeah. So what about eggs? I think that’s important to mention, too. I personally feel that pulling out eggs is a good strategy for people if they’re unsure of what’s happening with their diet and reactions, that eggs may be a culprit. And then also, conventional dairy. I know that was a big culprit for me. I would like to cheat on it a little bit and do like some grass fed cheese every once in a while but then even that sometimes I’ll notice a skin reaction to it.

Dr. Justin Marchegiani: Yeah, so eggs could definitely be a role. So for unknown I’d probably want to go autoimmune out of the gates, no grains, legumes, dairy, nuts, seeds, nightshades or eggs and keep the sugar down just so we’re not overfeeding bacteria and yeast which could be causing skin issues like I mentioned earlier. So that kind of be a first step. I always want to look at omega threes, right? Because that can help to KP the keratosis Polaris that can also just help inflammation. Your skin needs really good healthy fats. So if you’re a female and a lot of your skin issues tend to be more based around your cycle. I tend to like fats like borage or black currant seed oil, which are GLA omega six fats, a good omega six, but it can these kind of omega six like GLA fats can really help decrease a lot of the sebum and a lot of the stuff that may clog the pores of the skin. So I do like a lot of the black currant seed oil can be very, very helpful for women’s skin issues. That’s excellent out of the gates. Usually women tend to help it more but if you’re a guy and you’d have more of the KP or the bumps, that’s where really up in the omega threes can make a big, big difference.

Evan Brand: Yeah, awesome. How about detox pathways? Maybe we should mention that I think just supporting the liver I’ve seen personally, especially with kids, when we see skin issues will come in with some liver support. If it’s a kid who can’t take pills, we’ll give them some kind of a liquid liver support tincture and I’ve noticed a big difference especially under the eyes, you know, if we’re talking scan, we’re not just talking like bumps on the arms. We’re not just talking acne, we’re talking possibly like dark circles under the eyes. That’s often at least in Chinese medicine, they say dark circles under the eyes, his liver, and I’ve actually noticed that correlate quite well. When we bring up liver support dark circles under the eyes go away. So if you’re a woman, every morning, you’re doing your makeup. And here you are doing your powder foundation or whatever the heck you’re putting on under your eyes. You might not have to do that if you just support your liver. It’s funny how women, they can just cover stuff up with makeup, but man, we’re not going to cover up it. So we’re going to see the dark circles, we need to treat it root cause we’re not just going to, you know, put some powder on it.

Dr. Justin Marchegiani: Oh, yeah. And so with the we call allergic shiners, so what you see is a lot of lymphatic pooling, so you have a lot of lymph in the face area. And a lot of times what you see is the pooling of the lymph right under the eyes. And a lot of times that’s going to be food allergies, just go on Google type in allergic shiners, okay. And that’s a lot of times because of it’s not like an aging thing. It’s a lot of lymphatic stress because of certain foods. So like I mentioned, cut a lot of those big foods out, see how much that helps decrease the lymphatic pool. And you can also do things to support the lip, right? You can do rebounding, you can do whole body vibration, you can drink ginger, or burdock tea or essiac tea, things that naturally bright clover tea, red roots, etc. Things are naturally support the limp that can be helpful. But if you’re doing that, and you’re still eating foods that are inflammatory, that may still kind of counteract it. So ideally, you know, support the limp and cut out some of those commonly offending foods that may really help decrease that pooling underneath the eyes.

Evan Brand: That’s smart. I didn’t know the the food connection there with the allergies. So what about the darkness? Do you think that’s tied into any kind of toxicity? Or do you think just with the lymph in general, it’s just going to appear dark just because it’s stagnant no matter what.

Dr. Justin Marchegiani: Yeah, I mean, a lot of that just has to do with the length. I mean, we’ll pull up a couple pictures here in a minute. But anytime you really increase an immune response, you’re going to just get more lymphatic pooling, and you’re going to see it underneath kids eyes, or Yeah, it’s interesting on kids, and you also see it in, in adults too. But you know, it’s people put they go to the spa, you put a cucumber over it. Why? Because the cucumber telling tends to help disperse a lot of that lymphatic fluid. That’s the reason why. And let me pull up a Google image here so you guys can see.

Evan Brand: And sometimes it’s dark. And then sometimes it’s bags too. Oh, yeah. Yes. You look at the one to the left, though with the little girl. That one. No, go to the second one there. That’s what I’m used to seeing with people. Yeah, just that kind of darkness.

Dr. Justin Marchegiani: Yeah, I mean, it just has to do with the increased blood flow and lymphatic pooling. It’s really what it is. Wow. And just cutting that out can make a big, big, big, big difference.

Evan Brand: Yep. I wonder if there’s, there’s got to be a histamine connection to this too. 

Dr. Justin Marchegiani: Yeah, I mean, anytime you have a food allergy response, part of a allergenic response is going to be histamine at so-

Evan Brand: Oh go back up, go back up on the top there on that screen. The very top of there, it said, Oh, this is interesting. So it was talking about indoor allergens. So mold could be a trigger of the allergic shiners, too. I never even thought about that.

Dr. Justin Marchegiani: Yeah, I mean, anytime you breathe stuff into that sinus cavity, right? Whether it’s outdoor allergens, like dander or cedar or things like that, grass pollens, right of course, those can be a big role. But you know, you can see right here what causes it, right. So what happens is the the tissues and the blood vessels in the nose become swollen and a lot of excess fluid happens. People don’t understand when you have a histamine reaction. And a lot of times that causes things to vasal dilate. So these blood vessels get swollen, so you get a lot more blood, you get a lot more lymphatic flow, you get a lot more immune reaction. And that’s why all that stuff sends a pool right there because all that the sinus cavity kind of coming together right in this T zone here.

Evan Brand: There you go. Look at that pollution and perfume and other irritants. So women if there’s any left listening to the podcast, it’s still wear perfume. Stop doing that. That’s so bad. Do essential oils if you want to smell.

Dr. Justin Marchegiani: Exactly. If you want a nice scent do a good really good essential oil, do a lavender do a.. see trying to think of a bunch of other feminine herbs or feminine essential oils if you’re a guy do rosewood or do cedar keep it really simple. You know there’s a couple of really good blends that are out there that I like Frankincense is a pretty good neutral one. You know, I just tend to rely on my nice essential oil based deodorant tends to be really clean and, and works well. But yeah, so you want to not put in, rub toxins on your skin, toxins on the fragrances, all of that can affect bags under the eyes. All of that can affect your skin too, because it’s going to just create more toxicity, more stress on your liver in your body. Now getting back to the hormone stress, if we have more, let’s say detoxification problems that could create issues because if we have estrogen dominance, right, well we have high levels of androgens as a female, right high levels of estrogen estrogen dominance, and it can be low estrogen, but it’s just higher relatively speaking than progesterone, right? That ratio is off that 20 to 25 to one progesterone, estrogen often maybe it’s 10 to one or 15 to one That ratio starts to skew that could put more stress on the liver. And if you have estrogen issues that can be a problem. A lot of women when they consume too much refined carbohydrates and inflammatory foods, they tend to convert more of their estrogens to androgens, testosterone, right stauss rounds and androgen, it’s in the androgen umbrella, right. And those can cause like I mentioned a lot more sebum and more skin issues and more acne that way, and then having prostaglandin imbalances prostaglandin two, which is more inflammatory. Having them one in three supported with a lot of those good fats, like I mentioned, are going to be helpful. So you’re going to really help a lot of the inflammatory pathways with good fish oils, you’re also going to help prostaglandin one and three, which are going to help with the skin with the black currant seed and the borage oil. So those can be very helpful too.

Evan Brand: Good Good call. Also, when we’re coming in with detox support, you mentioned estrogen we’re going to come in with like some phase two detoxification support anyway, so we may come in with something to help with glucuronidation, maybe some calcium D glucose rates, so you wouldn’t think of it like your average person, maybe even a naturopath or a functional Doc’s probably not even going to think calcium D glue, great for skin issues. But if you think that the mechanism of helping with estrogen dominance, it may be a game changer. And then let’s go into the infections a bit. I–

Dr. Justin Marchegiani: Also calcium lucre could help with some mold too, because it was any mold exposure that could also help by enough to mold too.

Evan Brand: Totally, yeah, binders plus a little calcium D glue. Great. I think you’re on your way. Let’s Let’s hit on infections. I’m surprised you and I haven’t brought this up here we are this far. And we haven’t thought about infections. I mean, that was a big one for me. I think my face was already better. But I was still suffering quite a bit when you and I first became friends my skin was still not very good because of all my gut infection history.

Dr. Justin Marchegiani: I think you were also still consuming some higher quality dairy that may have been a problem. So some people that are doing a lot of cheese or like milk even if it’s raw. Right and good quality, you may still have a problem with that even if it’s really good clean dairy. Usually butter or ghee tends to be okay because there’s less casein less lactose in there almost none. But if you’re doing other stuff, it could be a problem. Was that an issue? Evan? Do you remember the dairy being a problem? 

Evan Brand: Man, you remember Central Market and all their amazing cheeses I would do some of those grass fed organic cheeses. It wasn’t often though I’ll be honest, it would maybe be like a chunk of cheese every few days or so. But I think even that was too much for me. 

Dr. Justin Marchegiani: Yeah, and you know, I tell you I can do well with butter or ghee, but I do not do well with milk or cheese as well. What happened is gassy, tend to get loose stools and then skin issues will tend to manifest shortly after for sure. So even high quality dairy not that good. Now the fat based dairy, right? Butter and ghee tends to be different because it’s primarily 99% fat. There’s very little casein, very little lactose, which is the sugar in dairy. And so of course, gese even cleaner than butter because there’s virtually zero casein versus virtually zero. lactose in there. So I tend to be a lot better.

Evan Brand: I mean, it’s curious. How do you do with whey protein? Are you okay with it?

Dr. Justin Marchegiani: Yeah, I do. Okay, with wakers weighs 99% casein and lactose free? Mm hmm. Yeah. tends to be a lot better. Yeah, I do okay with it. My favorite is gonna be collagen, you know, high quality grass fed collagen peptides. So I do my true collagen blend, which works great. Because there’s really it’s it’s in a peptide form. So there’s no other larger proteins in there. It’s really clean and well broken down. So that tends to do my powder standpoint does really well.

Evan Brand: Awesome. All right. Well, let’s just talk a couple minutes about infections. I think this is an important part to consider if you have skin issues, I’ve worked with countless small children and teenagers and we always are going to look at the potential for infections. There’s nothing in particular, I’m not going to say hey, it’s got to be blasto. Or it’s got to be this or that. I would just say in general, any type of dysbiosis bacterial overgrowth SIBO Candida H. pylori, the whole party that usually happens together is going to be a potential. And I think the one of the big mechanisms here is just to reduce stomach acid by the H. pylori. So I think enzymes to fix the skin are also another important strategy we’re going to implement.

Dr. Justin Marchegiani: Anytime we have indigestion and our protein and our fat and carbohydrate molecules of the food that we’re eating are larger and are broken down. You’re going to have intolerances, foods not going to be broken down all the way. And those large globules, proteins, fats, etc, can get into the bloodstream create more immune reaction, also, there’s going to be a fermentation that happens when those food molecules are not broken down all the way and that can create bacterial overgrowth. And we know hydrochloric acid does have a way of being disinfected in a way it really decreases. bacteria and yeast flow to the intestines. And if we have low levels of acid, it’s kind of like missing the natural disinfectant on your table. Right? That you know that can help clean things up in your body so that that’s definitely a real thing there. And the other component i would say is being because we were kind of talking about the holidays and Christmas is it can get very dry in the wintertime and a lot of places in this country. And so having a really clean moisturizer can be helpful. Now it depends So we’re just talking about, you know, person with dry skin, we may just choose a really, really good clean shea butter, or coconut oil or just a really clean, moisturizing product from a high quality company. And you can use skin deep cosmetic database Environmental Working Group database to look at healthy skin products that have really good ingredients in there. I like to use the Marie Veronique products. I like their lipid barrier complex and their barrier restore serum. They work amazing. I use that on my skin. And I had one child that had eczema, he’s kind of gotten over it, he’s done really well. We’ve kind of cleaned out the his diet and his mom’s diet too. So things like salicylates could be a potential problem outside of just your autoimmune foods. And then we use a really clean, hypoallergenic moisturizer called Vannapply. Again, it’s not anything like nutritious for the skin. But sometimes when the skin’s inflamed, immunologically, from an autoimmune skin issue, sometimes the skin just needs moisture and not things that could potentially stimulate the immune system. So sometimes a clean thing like that can be very helpful. So that applies very good. There’s another product called La Roche-Posay, I’ll pull it up, it’s a French brand of a moisturizer. And that works very good, as well as providing just really good moisture. And then sometimes we may have to change the environment, sometimes it gets very, very dry, you know, 20, to 20%. And humidity, we may have to add a humidifier into the kid’s room or into the adults room to get a little bit more humidity in the room. The big X Factor is don’t just leave it on non stop, because you can actually create mold it with a humidifier if it’s unchecked, unchecked Uncharted. So you have to make sure that if you’re adding humidity to the room, it’s for a season, it’s for a reason it’s for a short period of time. And you may want to have a humidity detector in the room just to make sure you don’t get above you know, 50% where mold could grow.

Evan Brand: Yeah, you know what I was thinking I’ve never seen it, maybe it exists, it’d be cool to have a humidifier that actually has an hygro hygrometer built in. So like you could set your for you know, 40% and then you’re pumping humidity in and then it hits 40 and shuts off. That’d be super cool.

Dr. Justin Marchegiani: I 100% agree. Yep.

Evan Brand: So I think the x layer would be good too for just to implement this as a tangent, not related to skin. But the xylitol spray for the sinuses are is awesome too, because that can help moisturize it. And the next layer is kind of a good, natural antimicrobial, if you will, it can help a little bit with the sinus cavity. But yeah, back to the skin. So how we’re going to investigate this was peoples, we’re going to start with diet, we’re going to come in and say, probably remove the eggs, definitely get off the dairy, get off the gluten. And then we’re going to come in and do stool testing, we’re going to do urine organic acids. So we can look at all the different bacteria that may not show up. You see, sometimes what happens I had to happen last week, we had a guy who, on the organic acids, he looked pretty good. There wasn’t any kind of bacterial overgrowth evidence, but when we got to his stool test, he had Prevotella and klebsiella, and all sorts of bacteria off the chart. And so if someone’s on an extreme budget, maybe one test would be sufficient. But in most cases, we’re going to try to get the full picture because it’s hard to make a puzzle complete if you don’t have all the pieces. And so that’s really why we’re gonna want to look at multiple things. And then as you mentioned environment, we’re going to factor that into, and then potentially improving the indoor air quality. So what if you are having some sort of an allergic reaction to your environment, whether it’s mold or dander, pollen, or whatever, something like a really good charcoal filled air filter, it’s going to be a game changer, possibly putting charcoal in your body, you know, supplementing with binders, and then addressing any infections we see supporting the liver bumping up omegas. I think stress has a factor. We talked about hormones, we talked about the estrogen we talked about glucuronidation. I think those are really the main variables. Do you think we’re missing anything else?

Dr. Justin Marchegiani: No, I think we hit it pretty well. My only other component is if you have eczema or psoriasis, and your skin’s overly dry and you’re trying to get the dryness down while you’re fixing the root issue. I mentioned the vanapply vanicream product being good. And the other one was the La Roche-Posay, and it’s the lipikar balm is a nice one. It’s just a lot of moisture, which can decrease a lot of the dryness and then when the dryness is decreased, that decreases the itching and when the aging is decreased, that can help decrease a lot of the inflammation. But you have to make sure a lot of people when the eczema psoriasis kind of Facebook groups because I follow a lot of them just to read what they’re doing. They want a magic solution. They want something to rub on their skin and have it all go away. But that’s never how it is. So you typically have to get to the underlying issue with foods and guts stuff too. So make sure if you do something that’s a lotion that’s topical, make sure you’re not ignoring the internal stuff.

Evan Brand: Well that one sounds so fancy. It’s got to be good just based on the way you pronounce the name of it.

Dr. Justin Marchegiani: I know like a nice little long French name there with the Amazon links in the description so you guys can access it. And then you mentioned the other one that had the oatmeal in there. That was really clean. What was the product?

Evan Brand: Yeah, I’ll give it the link to it it’s like a there’s like a kid’s, like fragrance free version. It’s like a colloidal oatmeal product.

Dr. Justin Marchegiani: It began with a B right?

Evan Brand: Yeah Babo. Yeah let me look I’ve got it here. I was like colloidal oatmeal lotion and this stuff is awesome I tell him my wife’s like honey this look at look at her skin and I was feeling these areas on our little girl’s skin like man it’s it’s crazy and yeah here it is nine bucks can’t beat it. So it’s called Babo Sensitive Hydra lotion, Chamomile Calendula. And then like I said, it’s got the colloidal oatmeal, I’ll put you the link in the I’ll put it in your chat here if you want to look at it.

Dr. Justin Marchegiani: And is there any worries at all with that due to gluten sensitivity in the oats?

Evan Brand: I don’t think so. We haven’t seen any type of issue. I know there’s a possibility. You’ve got that Avena Sativa Kernel Flour. So it does have the oat flour in there. I mean, if I thought that was some autoimmune possibility, we may stay away with it. But it’s a pretty rare situation. I’ve only seen a few people where we thought that they were going to be sensitive enough to it, you know that we should pull it out or find something without oats I’m not doing like oatmeal bass or anything like that, you know, this is just like the the spot of maybe a quarter at most on the areas and that’s like maybe once a day, if that issues- 

Dr. Justin Marchegiani: -any kind of here and there to kind of knock it down. It’s not like a staple. 

Evan Brand: No, no, no, we’re not lathering her in it or anything. It’s just like a spa treat is is all we’re using it for. I know some people get crazy with lotions or lathering the whole thing. Now I think I’d probably stay away in that case, but for spa treats, probably. Okay,

Dr. Justin Marchegiani: That’s smart. Excellent. I think we hit a lot of good skin stuff. Today we talked about some of the hormone stuff with female hormones. We talked about some of the androgen component and how that can tie into insulin. Don’t forget guys, high levels of insulin can drive excess estrogens in guys. And that can cause other issues too, and put stress on the liver. We talked about some mold stuff. We talked about allergen issues, food allergies and stuff and some of the eye stuff. We talked about the humidity issues in the winter, where it gets drier, maybe get a humidifier really monitor the percent humidity if you can get one that has engaged that test the environment and let’s say it doesn’t go above 40% or 35%. That’s better, because that way you kind of have a limiter on there. It doesn’t go over the top. We at one point had the humidifier on too much. This was years ago, and we noticed a little bit of mold in the in the carpet nearby. And we never made that mistake again. So if you use a humidifier, like put a timer on it, like an hour or two, boom, have it go off. Don’t leave it on all the time. Be smart about it.

Evan Brand: Yeah, that’s interesting. When you think about a humidifier, right tip tip, typically, people are going to just sit it on like a wood, night nightstand or something and then that wood is probably just absorbing all that moisture. It sounds like a recipe for disaster if you overuse it for sure.

Dr. Justin Marchegiani: Exactly. So you may be like if you can, if your kid has some humidity issues, skin issues, maybe put it on for an hour or two at night, put a timer on it done. Yeah, and that way, it’s not going to go the whole night. But we’ll provide a little bit of relief and and help the mucous membranes that may be a little bit overly dry.

Evan Brand: And then also, you know, don’t overbake don’t over with your soaps or shampoos or conditioners make sure everything’s clean there. Don’t over soap yourself. I mean, you’re not you don’t need to lather your whole body and soap. I think that’s an easy one. Regarding hand soaps, I mean, I know a lot of the conventional ones are gonna dry out hands and skin. So we got to mention that also water filters are key. That’s why you and I both have whole house water filters, because the chlorine and the trihalomethanes and all the irritants in the tap water can irritate your skin in the shower.

Dr. Justin Marchegiani: That’s a big one. Yeah. So if you have a lot of chlorine and a lot of chemicals in the water that can be very irritating on your skin. So we really want to make sure that that is addressed with a high quality filter. And that will take stress off your skin a ton really well.

Evan Brand: I don’t travel with it. I even bring like the Berkey or a comparable shower filter. Like when we went to Florida last winter, I brought a portable shower filter with us man, it was a game changer because, you know, we wanted to fill up the bathtub for the kids because the chlorine was so strong. So luckily, we just filled the tub with the showerhead filter. And it was awesome. So we didn’t take the kids and they weren’t just breathing in chlorine.

Dr. Justin Marchegiani: That’s good. That’s really good. And the only other thing I would just say beyond that is just making sure you’re digesting your fats and proteins well. So people think oh, I’m gonna just drink a whole bunch of water that’ll get moisture to my skin, it’s like well, you need a good fat carrier to bring that hydration to the skin. A lot of times the skin and the you know, these are that layer there’s a hydrophobic layer in the skin so it does not like water. So you need fat to kind of bring that moisture to that skin. So if you don’t have enough fat you will get very dry skin and dry skin can get more irritated, you tend to scratch that dry skin more and then that scratching creates inflammation and that inflammation just it’s a kind of a self defeating cycle. So you really want to make sure you have good healthy fats in there and at least half those fats should be saturated fats coconut oil, it should be high quality grass fed animal products. It should be pork, pork fat lard and if you want to do any plant fats Keep it to high quality olive oil, avocado oil, maybe some palm, obviously coconut is going to be a great fact that it’s saturated and it’s plant. So those are a couple of good things to do just to make sure you have good fats. And of course, if you don’t have good digestion, you know, at least get into enzymes and some HCl In the meantime, while you work on fixing your stress or fixing your gut In the meantime, for better absorption and digestion.

Evan Brand: You know, the way I look at it, it’s rarely going to be just a skin issue, there’s going to be possibly bloating, gas, burping, some type of food sensitivities, food reactions, right skin issues are rarely going to occur in isolation. So I think of it as a clue, right? You and I talk about clues in functional medicine, the skin is really just a clue. And then we think Oh, interesting what’s going on under the hood. So that’s where we come in, and do the testing. And if you need help clinically, please reach out. We would love to help we work with people worldwide, via phone, FaceTime, Skype, etc. We’re very blessed to be able to provide lab testing to people across the globe, and to provide solutions to healthcare that other practitioners and doctors have failed before. So if you need to reach out clinically, you can reach Dr. J at You can reach me Evan Brand at and we look forward to 2021 together so let’s have some fun. Give us some comments and questions if you’re on watching listening on Dr. J’s YouTube channel. Put some potential topic ideas in there. We’re always open to new topics. We talk about stuff we think’s important, but if you have some issues or concerns, you know, we’re happy to do kind of like some q&a stuff too. So please give us some feedback.

Dr. Justin Marchegiani: Absolutely. If you guys want to reach out and dive in deeper it could be a good issue could be a hormone issue. for Evan, for myself, we are here to help worldwide. Thank you guys, and I hope you guys are having a great start to 2021 and we’ll be here you guys take care. Bye now.

Evan Brand: Take care.


Audio Podcast:

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Essential Blood Tests to Analyze Your Health | Podcast #305

Regular blood testing is one of the most important ways to keep track of your overall physical well-being. Getting tested at routine intervals can allow you to see how your body changes over time and empower you to make informed decisions about your health. Here’s Dr. J and Evan talking about the areas to check aside from the usual blood tests we know. 

A conventional medical doctor will typically recommend that you get routine blood work, but this is the bare minimum. There are several significant reasons you may want to get blood tests more often than that. Either you want to optimize your health or to reduce the risk of disease and health complications. 

What are some routine tests and others that you should ask or know? Aside from CBCs (Complete Blood Count), Dr. J and Dr. Even pointed out enzyme markers, cholesterol tests, blood sugar tests, liver markers, thyroid panel, and so on. It will help your doctors make a differential diagnosis and dive into the root cause of your present health status. To know more, check out this podcast.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

3:12       Conventional Side of Blood Works

12:14     Thyroid Panels

17:56     Blood Glucose

23:50     Adrenal Issues

29:33     Lipid Panels

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Dr. Justin Marchegiani: We are live. It’s Dr. J here in the house with Evan brand. Today, we’re gonna be chatting about blood tests that we use to help assess our health and help us get better. So we’re gonna be chatting a little bit about kind of intro blood tests, what the best tests are kind of what our perspective on that is, Evan, how are we doing today, man? 

Evan Brand: Doing really well excited to dive into this topic, I went, got my blood work. And I got my wife’s blood work done on Friday. And I just want to give a brief little note on how you and I run blood work as clinicians because it’s very easy. And it’s so convenient, because we don’t have to go and beg a GP or an MD and say, Hey, please, please, doctor. I mean, you and I’ve heard countless stories. Yeah, I asked my doctor to run this, they wouldn’t run it, I asked my endocrinologist to run this, they wouldn’t run it. With us, the accounts that we have with our credentials, were able to order and create customized lab panels. So you and I both have created customized blood panels that with a click of a button, we can go boom, order it for anyone, whether it’s ourselves, or our clients or patients, and then we get an instant requisition form. We go straight into labcorp request, you check in, you sit down, they call your name, you hand them the paper, you get the blood draw, you go home, it is so amazing. Every time I get my bloodwork done, I’m like, wow. And I didn’t have to get anyone’s permission to do that. But my own. 

Dr. Justin Marchegiani: Isn’t that nice? Yeah, it totally is nice. Also, there’s the big insurance scam, right. So because we have accounts directly with the lab companies, we can order tests, and typically we get, you know, an 80 to 90%. You know, discount in price compared to what the insurance would bill. So like my typical thyroid panel, full thyroid panel that I charge my patients probably around $120. And the insurance would typically charge a patient for that well over $1,000. So then patients, most patients don’t get 100% coverage, right, especially if you’re not in network, and then the doctors can’t ever retest, but once every six months, so then you’re you’re stuck not being able to ever retest. But they think, Oh, I’m gonna get coverage for this. And then they get 90% coverage, and they end up paying more money. For the for the 90% coverage, even though they paid 100% cash, it had been cheaper. So that’s kind of the insurance scam. And then the problem with that is they can’t retest but once every six months, so they’re kind of stuck. So yeah, it’s really nice to be able to order what the patient needs and to be able to reorder and reassess. Based on a time that is good for us. Not good for the insurance companies. That’s kind of nice, right? 

Yeah. And you’re kind of we’re kind of circumnavigating that conventional system where you’re waiting two, three months, and then you get a bill in the mail and you’re like, oh, medical bill, What’s this about? And then it’s like, oh, you owe 700. with us. It’s all transparent. It’s up front, you pay, boom, boom, boom, you’re done. I’ve already paid for it. I know that I’m not spending another penny. And the turnaround time is insanely quick to like one or two days, typically on some of these panels are running. So let’s go into some of the details. Now, let’s quickly compare and contrast. I think you and I have a lot of fun. Like where we did our conventional functional medicine vers conventional medicine, gut workup. Let’s talk about the same with bloodwork. So if you go to your doctor, and you have them say, hey, Johnny, we’re going to run your blood. What is that going to look like?

So conventional medical doctor, they’re typically going to do a CBC, they’re going to do a metabolic panel, they’ll probably do a lipid panel that’s usually going to be at maybe a year analysis, that’s kind of it. So like on the CMP they’re kind of looking at liver enzymes. They will look at some electrolytes on the liver on the CMP as well. Those liver enzymes electrolytes, maybe some protein markers there, they’ll probably look at glomerular filtration kind of some baseline kidney function with creatine and and bond. The kit the liver markers are going to be a lt and as to the liver enzyme markers, the gallbladder is ggt but probably look at some bilirubin your electrolytes are going to be sodium chloride, potassium magnesium, all serum not not intercellular which is a difference Okay. And then on the red blood cells are going to look at red blood cells RBC some adequate hemoglobin that’s part of the CBC right complete blood count which is going to help be helpful for anemic patterns right low iron right, although also run indices which are MC VMC, HMCHC right me corpuscular volume me corpuscular hemoglobin me corpuscular hemoglobin concentration. When those markers go high, that tends to mean that we’re dealing with B vitamin issues like b 12, full eight issues, and we call that megaloblastic anemia. So we have two kinds of anemia. As we look at big cell anemia is right we tend to be more B vitamins stuff. And then small anemias. We tend to be more on the red blood cell hemoglobin hematocrit, low iron side, and then we have immune markers, whether it’s neutrophils, lymphocytes, eosinophils, monocytes, and basophils, which could be from bacterial issues, parasite issues, gut inflammation issues, viral issues. And then I would say on top of the CBC, that’s pretty much it and then your limits. So total cholesterol, triglycerides and then of course, your LD vldl pattern, and then there’s some add ons that we may talk about whether it’s c reactive protein for inflammation, fibrinogen, for inflammation, homocysteine for inflammation, methylation, vitamin D. and we can kind of go into each one of those in regards to what we think is important on the functional side. But you know, the whole lipid thing is, it’s kind of overplayed, right people think that lipids are a really important issue now once you start going over 200 or so on the total cholesterol, and that may not be. And we’ll talk about the ratios and the perspective that we add to when we look at it.

Evan Brand: Yeah, so the way you talk, it sounds pretty good. It’s like, oh, wow, that’s a lot of stuff. But truthfully, there are rarely issues that show up on just standard bloodwork. Now, if you have more of the functional training that you and I’ve had regarding blood chemistry, you can kind of, I guess you would just say pick through the CBC with a fine tooth comb, and you can really look and maybe find some functional issues, like for me, I know that I you know, for a very long time, my hematic crit, you know, I’ve always had the hematocrit be a little bit high, which, based on some of the training you and I’ve had, it would indicate that there’s probably a dehydration issue. And that’s tough. You know, it’s, it’s, it’s tough to stay hydrated. And so even if I mean, I’m sipping on water all day, but you know, I’ve heard there’s a big influence on anti diuretic hormone, and all of that when you’re exposed to mold toxin, that’s a conversation for another day. But anyway, unless you’re really looking with a with a fine tooth comb, conventional bloodwork doesn’t reveal much. And you may see a little bit of this a little bit of that, but it’s not, I’m not making too many protocol decisions based on a CBC I would say. 

Dr. Justin Marchegiani: So when I look at blood, it can give me a good area of where to where to look next, or where to dive in deeper, which is helpful. And then if we look at it, using the optimal reference range, or a functional reference range, we can definitely glean better information. So the problem with most conventional medical doctors, they’re looking at blood through a pathological range, they’re trying to pick up like major disease patterns or pathological patterns. And so how it works is you have to show you have all people kind of fit in what’s called the bell curve. And the typical range is going to be two standard deviations to the left and right, this is represents about 95% of the population fit into the so called normal. So you have two and a half on the high two and a half on the low that are on the high or low side, pathologically, right. And so the problem with that range is it as people get more unhealthy and sicker. And as those sick people tend to test more, what happens to the lab reference range over time, it gets wider. And so it becomes more encompassing, it’s like having a bad field goal kicker and you make the field goal every year wider and wider and wider and closer and closer to compensate for the lack of, you know, good kickers out there. So it’s kind of like that. And so what we do is we kind of narrow up that range a little bit, and that narrower range helps us pick things out before it becomes a problem. So let’s kind of go over a couple of things. So with women or people that are vegan vegetarians, women, because they bleed more when they’re when they’re at menstrual age, right, typically 50 or below 48 or below, they can be more anemic. So we may look at things like lower red blood cells, right, red blood cells, you know, below 4.2 or so we may look at hemoglobin below 12, we may look at him at a crit, you know, in the mid to low 30s as a sign that there could be some low iron issues brewing, we may also run an iron panel, it’s not typically run, but we may run things like ferritin, or iron binding capacity. Or we may look at things like iron saturation to get a window of low iron, for instance. And that’s commonly missed, because what most conventional Doc’s do is, their threshold for low iron is really low. And there’s a lot of women I see in vegetarians in general that could be on that lower side could be a little bit anemic, and then they’re not going to be able to carry oxygen throughout their body adequately, which makes a huge difference in energy and stress and and mitochondrial function and thyroid function because you need to be able to carry oxygen to have good energy. 

Evan Brand: Yeah, let’s go into some of the more let’s let’s, let’s break some of the stuff down. But before we break it down more, let’s hit on what are the things that that we’re going to run and so I’ve got my panel pulled up that I ran. And so I’ll kind of run through some of these things. But as you mentioned, ferritin that’s typically not going to get run I’ve rarely rarely seen fair to run by anyone. The iron saturation as you mentioned the iron binding capacity. That’s really wrong. That’s right to be ti BC. Often on your bloodwork, the vitamin D. I mean, my God, it’s so important, but yet vitamin D to this day is still not commonly run. Nope. And if they run it, they may run the wrong one. I’ve seen people where they don’t run the 25 o hydroxy. tryptophan, they’re going to run like the even the beat the D two. They’re going to run the What is it? Ergo? 

Dr. Justin Marchegiani: Yeah, the vitamin D too. Yep, Ergocalciferol.

Evan Brand: Yep, yeah. Ergocalciferol? Yeah. So you have a vitamin D, they may run the D two and you’re like crap I needed to d3.

Dr. Justin Marchegiani: Yeah, the [inaudible]. The animal base kind of the d3 is the more active form. The D two is the more plant synthetic form, typically made from lanolin. A lot of times, that’s the D two, that’s the ergocalciferol. Ah, so vitamin D is really important. And then the range on that is pathological as well. They want above 20. Why? Because they’re looking for rickets, right, the bone bending disease, right, because d3 helps absorb calcium and helps a calcium get into the bone. So we want 50 to 70 or maybe 70 to 100 if we’re autoimmune or cancer risk. So vitamin D is a big one, I would say also on the CBC, we may be looking at immune cells, if I see low white blood cells, you know, below four and a half. There could be some you know, deficiency issues if there’s high white blood cells, you know, greater than seven and a half there could be some immune stress. Now we look at the, the immune cells, how do we look at those never let monkeys eat bananas, that’s the mnemonic device and doctor at school we learned so neutrophils we want to see, you know, below 60 lymphocytes, we want to see mid reference range when we see high neutrophils or low neutrophils and elevated lymphocytes. That’s a common h pylori or bacterial infection pattern. If we see elevations in eosinophils, greater than four, we’re thinking potential parasites or chronic environmental allergies by sea monocytes, greater than 10. I’m thinking some kind of intestinal inflammation. So we there’s different, you know, patterns you may look at, when we look at some of these immune cells. That’s very important. But unless it’s very high, they’re typically not going to say much. And if it’s very low, they typically don’t say much either there. 

Evan Brand: Yep, so also more advanced thyroid markers. It’s very, very sad how many people go to even an endocrinologist and they may only end up with a free T for possibly a free t three, but even that’s not guaranteed. Maybe a total T for you may get Of course, TSH is going to be on there. But you and I are definitely going to be running like thyroid globulin, I mean obat antibodies, we’re going to be running t TPO, thyroid paradoxus antibodies, maybe TSI, sometimes if we think there could be something else going on next. And then you’ve got the uptake of T three, what else you got? You got reverse t three that we’re going to be looking at. That’s an awesome marker. And that’s never run. 

Dr. Justin Marchegiani: Yeah. So when it comes to a thyroid panel, you already mentioned it, most conventional endocrinologist and primary care are going to run TSH because that’s the major screening brain hormone, not a thyroid hormone majrooh. It’s not a thyroid hormone, but it’s a major brain hormone that talks to the thyroid and you’d be lucky to get a T for total after that. But we know downstream is a lot of conversion issues and even patients that have normal TSH, guess what, especially if they’re on Synthroid, which is a synthetic thyroid medication that’s just T for many of them can’t make that conversion. And that’s a problem too. And so you can have adequate T for good TSH and low t three. And you may have a lot of thyroid symptoms. So it’s really important that we look at things complete. And don’t even get me started on thyroid antibodies, because that’s almost never run and thyroid antibodies are the major mechanism why most people sideway glands aren’t functioning properly because their immune systems have beaten the crap out of their thyroid for a very long time. 

Evan Brand: And we’re talking what I mean, you’d say probably over half of cases of hypothyroid are probably autoimmune based on what I’ve seen, what would your guess be? 

Dr. Justin Marchegiani: Yeah, I would say that and some may not even come back on the lab test, but it’s very helpful to be able to look at those we run TPO antibodies and thyroid globulin antibodies. And so my full thyroid panel nevitt, some kind of a TSH, T for free and total t three free and total TPO antibody, federal globulin antibody, and we may run a reverse d3 or an uptake. Those are all okay markers to add to. So that’s kind of your complete thyroid panel. Let me just piggyback to the CVC. Is there anything else on the CDC? I think we hit it all there. We can go to the metabolic profile now if you want. 

Evan Brand: Yeah, well, you mentioned like earlier, like CBR active protein c reactive protein, I guess it kinda depends. I mean, sometimes that standard, but a lot of times that’s not an hscrp is, you know, going to be the same same section of the inflammation panel on your blood. So hopefully you get those two run together. 

Dr. Justin Marchegiani: Yeah, usually CRP and cardio CRP is basically the same thing CRP, they’re just, they’re breaking the number down typically below two, I think the cardio CRP, they typically don’t do it less than two or so. So when they you do a highly sensitive CRP, they’re just breaking it down into a smaller number. Let’s go we want to see that below one that’s great as a good marker of systemic inflammation. And fibrinogen is great. We have for highly inflamed, we may see a lot of clotting happen. And fibrinogen looks at clotting factors, which is helpful. So if we don’t have good fatty acids, good omega three omega six ratio or a lot of inflammation, a lot of trans fat, high blood sugar cells tend to agglutinate they get very sticky. And so it’s nice to see where that stickiness that stickiness level is. And homocysteine is also another measure of blood inflammation because it’s homocysteine is an inflammatory metabolite. That typically happens when there’s not enough B vitamins B six and four And B 12. In their active form, that can be a big inflammatory issue there too.

Evan Brand: Yeah, that was a problem for me. Actually, I did have elevated homocysteine couple years ago and started hitting some more Foley and it fixed it. So it was fun to see how the blood correlated to that. 

Dr. Justin Marchegiani: Yeah, you know, we’re going to try to get as much of that which we can do leafy greens and high quality, you know, essential fats and meats, right, but that’s good. And so metabolic profile, we may look at liver enzymes that could be helpful patients that have a lot of insulin resistance and inflammation, you may see an elevation in liver enzymes. What does that mean? That could be a non alcoholic, fatty liver, non alcoholic steatohepatitis, that’s Nash or non alcoholic fatty liver, meaning your liver has stressed not from alcohol, but from typically too much fructose and junky carbs. So the liver is a people think the liver is just a big filter for toxins. No, it also has a major effect at regulating blood sugar, and is also a storage site for sugar, especially fructose. So when you over consume fructose from high fructose corn syrup, or, you know, just too much carbohydrate, in general, the liver really gets stored up. And then when that liver fully gets saturated, overly saturated with fructose, for instance, you start having all these up regulations of inflammatory enzymes called the the junk enzymes, the J, the J and K one enzymes, and you see a lot of inflammation and a fatty liver there, and you see it an ultrasound. And so that’s a common marker seen those elevated liver enzymes, and it’s good to be able to look at that. 

Evan Brand: Yeah, I don’t know if you’ve tested bloodwork much with people like in the middle of a protocol. But I’ve had a couple interesting cases where, while using binders, we’ve seen liver enzymes go up. And it could have been also parasite protocols and things like that, that were kind of interwoven with detox protocols. But I’ve seen liver enzymes temporarily go up during that. So I don’t know if you pay much attention to that. But I’ve seen it and they always go down as soon as it protocols over so.

Dr. Justin Marchegiani: Even with some killing herbs, like worm woods, a common one that we may see a little bit of elevation and liver enzymes, people that are sensitive, some of the killing herbs, it could be a little bit of stress, is it just the herbs? Or is it the dead debris that is now mobilized from the killing of those microbes, it could be both. That’s where adding things like binders can be very helpful just to kind of put handcuffs on those critters and escorted out of the body versus kind of having it go back into general circulation. also adding an extra glutathione support can be helpful too. Just to really support and tone if I deliver those are very important too. 

Evan Brand: Yeah, well. And it’s common for you and I to use some sort of a liver gallbladder support too. So we may be throwing in like some extra taurine or Mathionine or beet powder artichoke. And there’s many, many things that I say milk thistle already NAC. So there’s a lot of stuff we can do. But yeah, I just figured I mentioned it. Because if someone’s listening and you happen to do blood work in the middle of a protocol, it’s possible that the levels may you may look at him and go, Oh, my God, my liver enzymes, but it will go back to normal relatively quick after killing protocols over. 

Dr. Justin Marchegiani: Exactly. Also, we may look at glucose, blood glucose is going to be on a metabolic profile as well. CMP panel, I don’t love it as much, because most people that are going to get a blood test and they’re getting pricked in the arm of the big needle, or they kind of stressed. Yeah, and so that the cortisol from that can really increase their blood glucose. So I like getting a really good blood sugar kit like this. And then you can measure your blood glucose during the day. So here’s my little kit here. And so I have I use the keto Mojo now because it measures ketones, so I’m a little meter, I have my little pricker here from my finger, and then I have the blood glucose and the ketones. So this one right here is the blood sugar. And this one here in the lighter blue, this is my ketones. So it’s kind of nice to have those. So I can test my blood sugar before I eat. And then I can do a one two hour three hour and play around with my blood sugar. The whole goal is the more you keep your blood sugar down after a meal and bring it back to baseline within two or three hours, the less insulin you’re making, the higher it goes up and the longer it takes to come back down, the more insulin you’re making. So it gives you kind of a good window how you’re responding to food. 

Evan Brand: Yeah, what I wanted to point out is that you’re doing more functional analysis of glucose versus if you just go into your doctor once every six months, you get a morning fasted glucose, that’s just not enough information.

Dr. Justin Marchegiani: It’s not because the whole goal while you’re just checking morning glucose is because you’re thinking your food, so out of whack, that your glucose is now elevated as a result. Now the problem is most people haven’t eaten in 12 hours. So for your glucose is still be out of whack. 12 hours later, the problem has to be pretty severe number one, and then number two, a lot of times it can be elevated not because of food, but because of stress hormones in the morning. And so the stress hormones, people say oh, I’m at 105. Yeah, but it just could be a good cortisol response in the morning called the dawn phenomenon that’s raising that glucose. That’s why you want to check it against your foods during the day. If you have a blood glucose issue. You’re going to see one and two hours later, it’s chronically elevated, and it’s taken a bit of time to come down. So that’s a better marker. Make sure you’re handling glucose okay.

Evan Brand: Yep. How about hemoglobin A1C, this is something that for diabetics, obviously, this is hopefully going to be regularly checked. But for your average person that maybe has some issues, A1C is probably not going to be on your standard blood panel. 

Dr. Justin Marchegiani: I don’t love A1C, I used to like it. I don’t love it as much, I find that when people’s blood cells live longer, because they’re more healthier, they have more time to accumulate blood glucose. So the A1C it’s a part of the hemoglobin and they’re looking at the coding, the coding of glucose on the outside of the hemoglobin, right? So imagine, like, you know, when you, you know, you go up into your car during allergy season, you can see like a big fixed swath of like pollen on the car, they’re kind of looking at the swath of glucose on the outer part of the human lobe. And now the problem is, the longer your red blood cells are hanging around, the more time they have to accumulate that blood sugar. So it can be helpful to look at something. But if you’re, if you’re a little bit on the higher side, or like, let’s say 5.5 or so, let’s say under six, but 5.5. And up, it may just because your red blood cells are a little bit more healthier. So like, for instance, with my anemic women who may have a ton of blood sugar, right, a lot of carbs, because maybe they’re vegetarian or vegan. Guess what? When you’re anemic, your red blood cells die faster. So all my anemic women have A1C super low, like in the forest. And so it’s not going to be a great marker when your red blood cells don’t live that long, and we see it with our anemic patients.

Evan Brand: That’s a good point. Good point.

Dr. Justin Marchegiani: If I see someone six or higher, yeah, it’s helpful, you know, but when you’re kind of in that subclinical zone, you’re going to typically have to go back to one, a meter like this, to really look at it. And then also look at your fasting insulin, which is a better marker, because that’s going to give you a better window, how much insulin you’re making frequently. 

Evan Brand: Yep, good point, that analogy is perfect. The pollen on the car. So good job there.

Dr. Justin Marchegiani: Right. And if you leave your car out there a lot longer, you’re gonna get a lot more pollen. It’s kind of like that, right? 

Evan Brand: I’m always under five though, no matter what with a one C, I’m always right. 4.9. Somewhere in there. 

Dr. Justin Marchegiani: Yeah, I’m pretty low, too. I’m always like, right in the low fives. 5’1 5’2. But I’ve seen a lot of patients in my career that have that have really good diets that have tested their blood sugar, have good insulin, and they’ll still have a little bit higher on the a one C and I’m just like, yeah, it’s just it’s missing some people. That’s all. It makes sense. The question is, what’s the mechanism? And that’s what it is. 

Evan Brand: Yep. Makes sense. You hit the you hit the dawn phenomenon. So you know, cortisol that may be run via blood, although we don’t really like blood cortisol too much. We really like more functional analysis of cortisol, like with urine or possibly saliva? 

Dr. Justin Marchegiani: Oh, yeah. And part of the reason why we don’t we don’t like it, is it because when you’re measuring a stress hormone, while creating a stress response, ie putting a needle in my arm, you may influence that a little bit, right? And so that’s kind of the reason why we don’t love that. And even if you’re like, Well, you know, do the adrenals make cortisol fast enough after the needle happens to show in the blood? Well, it’s not just that it’s the fact that you’re anticipating it happening. Therefore, you’re replaying that stress in your mind all the way up to the doctor’s office to go and then the elevator getting into the you’re already making that stress hormone while you’re anticipating what’s going to happen. 

Evan Brand: Yeah, you go in the friggin lab with the scientific fluorescent lights above your head. It’s all awkward the quiet they got some like drug commercials on in the waiting room, Justin, and they call your name come on back. Yeah. So and, you know, also Not to mention, too, that that’s just a snapshot, right? I mean, that doesn’t tell us anything about what’s happening at two or 3pm when you’re complaining of that midday crash. So I really am not too interested about what happened at 8am. I’m really want to know what what’s going on at 2pm when you’re saying you need that third cup of coffee. 

Dr. Justin Marchegiani: Exactly, yep. 100%. So it’s, it’s really important that you’re kind of on top of that. So I think we hit some good blood glucose stuff, we hit some liver enzymes we hit. I’m thinking here, we hit some of the electrolytes. electrolytes are good, too. So sodium and chloride are really good ones. Now when I see patients that have adrenal issues, you could easily have low sodium and high potassium, or you can just kind of have lower minerals all together. Now the serum is not going to be the best marker for testing minerals. So when you see your minerals out of balance, you know, it’s a big issue, but you could still have mineral issues. And the serum be okay, because it really matters what’s in the cell. Not necessarily what’s floating around in the blood. So think of interesting Imagine you’re in a pool, okay? The pool is serum. Okay, you’re in the little floaty. You’re in the little inner tube, right? So it’s you in the inner tube, right? You and the inner tube and the water in the inner tube that’s intercellular. The water outside of the inner tube is extracellular serum. So that’s kind of how you think of it. So when we test some of these nutrients, it’s better to get a sample of the water in the inner tube with you that’s intercellular versus the water outside of the inner tube. That’s serum.

Evan Brand: Yeah, and how do people get that? What is look like?

Dr. Justin Marchegiani: Well, you can like we can add like a red blood cell serum or a potassium serum on some of these panels, we may run like a spectracell, or a Nutri eval or an ion panel that looks at more intercellular nutrients, we may look at different tests that allow us to do that. But there’s not too many add ons for conventional testing like quest or labcorp. Outside of I seen a blood cell magnesium is good. You can do a potassium if you wanted. So there are a couple that you can do to get a window into that. 

Evan Brand: Yeah, I was gonna say I looked through all the options for the conventional labs, RBC magnesium, I think that was about it. I think that’s all I could find. 

Dr. Justin Marchegiani: So yeah, not too much. But it’s something you know, because magnesium is a big one, right? And with magnesium RBC, we want to see a greater than five on that one, red blood cell magnesium greater than five. So that’s helpful. And then, of course, we mentioned magnesium surround, we want that greater than two. And then your minerals, you want them somewhat mid reference range, once we start going under 100 or so I think like sodium, it’s like 104 is kind of mid range. If you’re under 104, it could be a problem, potassium, I forget the exact ranges in it, but I want them all about mid range. In regards to the reference range. 

Evan Brand: What do you feel about using conventional bloodwork to do like omega three omega six fatty acid panels, I know, there’s some Doc’s that are just so obsessed with all these ratios. But, you know, truthfully, if you’re doing the things that we’re discussing with our clients and patients for nutrition, you’re going to pretty much be optimized anyway. I don’t know what that would tell you. Besides, hey, maybe you need to do a little more this or that? 

Dr. Justin Marchegiani: Yeah, it’s a great question, I think, look at the person’s food. Like someone could have really good diet, but let’s say the meat and the eggs aren’t pasture fed. Well, that could easily be the reason why your omega six to three is off a little bit. Or it could be that you know, you’re just doing too much plant fats, and those plants or from coming from, you know, omega six bass plants soy or canola or safflower. So if you’re doing good fats, like coconut oil, and olive oil and avocado stuff, which are monosaccharides are Yeah, so those are, yeah, those are MonEl fatty acids versus like, vs. poly, which is like a fish oil, right. And then so the fish oils, you have omega threes, right, which are going to be like, the ones that are we talking about that are going to be more on the anti inflammatory side, right? These are the Polly’s. And then of course, the Omega sixes are going to be more on the vegetable side. These are going to be also Polly’s but they’re going to have six bonds, these are going to be your safflower canola, these are going to be your soybean oil, all of your plant based fats, most in the most of your plant bait fast, to extract the fats from them with the olive oil or maybe an avocado, you tend to have to damage the fats, they tend to be more damaged, they tend to be more on the Omega six side. And when you get when you eat plants by themselves, you’re not getting that concentration of fats. And so you tend to not have that high omega six to omega three, when you’re doing just vegetables by themselves. Okay. And so we can just look at how much fish you haven’t per week, how much pasture fed eggs you have in a week, how much steak or meat that is grass fed, you haven’t per week, and then you can kind of look at it relative to what’s high on the Omega sixes like the knots and the seas and the refined vegetable oils. And you can kind of get a pretty good assessment of where you’re at, which is like kind of for one or less. So four times omega six to one is pretty, it’s pretty. Okay. And you can always run that omega three to six tests on the blood too. Does that make sense? 

Evan Brand: It does. Yeah, I just find that it’s not a huge needle mover. So I don’t run it too often. I mean, I think it’s cool to check in you could call it kind of a lie detector test as somebody says they’re doing everything that’s dialed in, but then you find out that Oh, they’ve been coconut grass fed steak, but it’s been in this healthy heart oil blend that they found on the shelf and it was a safflower canola combo. You’re like, Oh crap, then we missed it. And you got to get off of that stuff. So yeah, I mean, I was just gonna say so it’s not really a standard thing. For me at least you know, I’m not running into often with people but- 

Dr. Justin Marchegiani: But it’s there it’s an option and then it’s something if someone wants to run we’ll run it and so we have the polyunsaturated which is the fish oil or on the omega three side, right. And then we also have things like flaxseed oil, but it has to get converted to the to the higher up fatty acid so you know, omega three fish, and then you get to get some mega three from cows that are grass fed as well. 

Evan Brand: What about particle size on a lipid panel? So we talked about that briefly. It’s just a good add on that most people don’t do and our friend jack Wolfson, he discusses particle size and I think it’s something that more people are asking questions to their doctor about but it’s still very uncommon to run. 

Dr. Justin Marchegiani: People that have a cardiovascular history. Just want to run it to begin with. I think it’s okay. I can almost always tell you what your particle sizes if you’re eating good health saturated fatty acids like coconut oil and grass fed butter. And you’re getting meats that are like good quality fish, good quality grass fed beef, egg yolks, you’re keeping a lot of your junky fats down a lot of the refined sugar down and a lot of the trans fats down, you’re going to have a large, you’re going to have a particle size A, which means large and buoyant and fluffy, right? Think of a like you want an ad on your test. And then you have the small dense atherosclerotic particle size B, think B for bad, and the B for bad, more trans fats, more inflammatory, processed vegetable oils, more refined sugar. And so with patients, I almost always can look at their diet. And guess what that will be to begin with. So if I do a dietary check and do a diet recall, what’s what’s the average day look like? And I look at that and I get a window, it’s pretty easy to predict that. And so we’ll run it for patients that have a cardiovascular history, and they just want to know, but for the most part, it’s not hard to predict it. 

Evan Brand: Yeah. And when you see it, are you just tweaking dial? Like, if you see a bunch of small dense particles, or are you coming in? Are you using any kind of like plant sterols or anything like that, to help with it are you just tweaking diet, and then it fixes itself? 

Dr. Justin Marchegiani: It depends how acute the patient is. But if it’s if it’s not acute, meaning the patient’s not dealing with a heart issue right away, then we’re going to just tweak the diet, and that’s going to take care of it, we’re going to add an extra omega three fatty acids from fish oil, we’re tweaking the diet, we’re getting the carbs down, we may be adding extra nutrients to manage blood sugar and manage inflammation. And then usually within a month or so you’re gonna see a big change. After we retest. Awesome, yeah, usually once you get about 100 good meals, then you’re going to see a big shift. A good average person is doing about 21 meals a week, right? So three a day times 721. So four to five weeks, once you get 100 meals in, if you can get them close to in a row. Your body has a huge shift in physiology. 

Evan Brand: It’s amazing how quick you can change stuff I knew. I mean, sometimes we get impatient because like what the detox piece like that takes longer. I mean, I’m here I am a couple years in detox and mycotoxins. I’ve still got some going on. So, you know, with that, it’s like, oh, man, you get impatient. But luckily, with the blood, it’s a quicker turnaround time sounds like. 

Dr. Justin Marchegiani: Oh, totally, man. It’s really important. So I think we hit some of the big markers today. I would say one other one for lipids. You know, I don’t really care if cholesterol is a little bit on the higher side, just I try to make sure the cholesterol to HDL ratio is ideally you know, four. So if the if your Triggs are sorry if your total cholesterol is 200, and your HDL is 60, or what’s that ratio to the math, put my calculator 200 divided by 60, that’s 3.3. That’s pretty darn good. Usually, when you’re under three and a half, that’s half the average risk factor. Okay? When you let’s say you’re at 242 40 divided by 60. On the HDL, now you’re at four. And so I like to look at the total cholesterol to HDL because HDL is what recycles cholesterol. Okay? So if you have good recycling lipoproteins, ie HDL, that’s a good sign. And then I’m also going to look at my trigger to HDL ratio, we want that under two. But if we can have a closer to one, that’s wonderful, what does that mean? Take your trig number, let’s say your trig numbers at 60. Let’s say your HDL is at 50. Well, what’s that? What’s that number? Well, we do 60 divided by 50. We’re at like, 1.2. That’s good. So we want to under two but closer to one’s ideal. That’s a really good marker. That’s my insulin resistance inflammation marker for my limits. So I’ll look at trade over HDL. That’s a really good marker. 

Evan Brand: Yeah, you know, I talked to jack one time about the, the blood and I said, When do you start getting freaked out regarding total cholesterol, because if you talk to a conventional cardiologist, they’re they’re brainwashed on that 200 number. And he says that he’s got people up in the 450s, that he’s not worried about 1%, like total cholesterol being 450. And it’s not an issue. So he just talks about, like he said, ratios, inflammation associated with it, you know, then you get into more trouble. But I mean, the total number, I mean, he acts like it’s just minimally important.

Dr. Justin Marchegiani: Yeah, on its own, I would be a little bit concerned once you start getting in the mid 300. Just because that’s that could be more hypercholesterolemia. And that’s not necessarily a diet thing, that’s more of a genetic thing where you’re making a lot more cholesterol. So I personally would get a little bit more concerned with that and I’d be monitoring that. But it’s hard to really jack up your cholesterol when you’re keeping inflammation down. Like I just did a blood test for my lipids last month, and my cholesterol my total cholesterol and you know what I eat man? I good fats, good proteins, good eggs, good fatty acids. And my total cholesterol was at 165.

Evan Brand: Whoa, yeah, I was like a 202.

Dr. Justin Marchegiani: Yeah, 165 my my trades were at 60. And my HDL is we’re at 50. So I had like a 1.1 1.2 ratio for trigger over HDL, which is great. And so most of the cholesterol, you’re gonna Ahead is gonna be made by your body. So when it starts getting too jacked up and your diets good, you know, we want to look at thyroid hormone, maybe that could be a big thing. And there could be a hypercholesterolemia genetic issue, and we can always run a genetic test for that to see what’s going on. And if that’s the case, what are natural things you can do to get your cholesterol down, you can do higher dose berberine to make sure your thyroids check, you can also do some potential plant sterols as well. But get that check. So my philosophy if it goes a little too high, I’m curious, I’m worried about the hypercholesterolemia piece. 

Evan Brand: Yeah, and I don’t mention that 400 number just to get people off the hook. I just thought it was interesting that that’s what he was saying. And he’s probably talking like, you’re in big trouble if you get to that point. But But anyway, so that’s rare, though. 

Dr. Justin Marchegiani: That’s super like these are very, very rare situations, you know, sub 1% of the population are going to be there. My never seen it ever. I have two patients with that. But most people already know about it, because someone in their family already had been picked up previously. Yes. So most people already know what especially today, you know, maybe 3040 years ago, not as much, but people that have had those issues have already been picked up. They already know genetically, if it’s in their family, and then once you know genetically, if it’s in their family attend to get tested for it. 

Evan Brand: Yep. Right? Well, let’s wrap this thing up. So as we mentioned, bloodwork is a piece of the puzzle. If you go to a practitioner, and they’re like I’m going to analyze your blood and tell you everything you need, they’re wrong, because you mentioned some of the clues into the immune section about parasite infections and all that. However, I will speak for you and say that you’re not going to depend on that bloodwork solely to identify parasites, you’re still going to be running comprehensive genetic DNA based school panels, you’re going to be running organic acid panels to look and deeper. So yes, you may look at those things. And I think it’s awesome that you gave us some insight into that, however, I’m not going to go to a guy who’s going to look at the blood and say, Yep, you’ve got parasites, let’s put this protocol together, I’m going to want more data. So blood is just part of that data. And it can be helpful, especially when you’re working with autoimmune people, because you and I like to look at these antibodies, and it’s very fun and satisfying. And it makes you look better when you could have a a woman come in with a TPO of 1000. And all you do is fix her gut and our TPO antibodies go down to sub 200. That’s exciting. 

Dr. Justin Marchegiani: Totally, that’s huge. So I think today is very great, great podcast, because we’re talking about actual things. We want people to kind of like say, Hey, you know, what’s it like to be inside Dr. J, and Evans head, and this is kind of it. And everything that we look at, we’re kind of like a detective, we’re putting like checkmarks in the column over here that support us going in this direction, or going in that direction. So we add up all of our checkmarks, right, and we’re kind of create what that differential diagnosis is, and what tests we’re going to do to dive in deeper in in whatever those avenues where those check marks are adding up. So that’s kind of inside of our head, we’re walking through you through our thinking. And if you want to dive in and reach deeper, you know, into work with a practitioner, like Evan or myself, you can head over to, you can schedule a consult with Evan or myself at And you can schedule we are available worldwide to help y’all with your functional medicine and natural health care needs. And if you want to get to the root cause we’re going to be the best person to to look at anything else you want to highlight here today. 

Evan Brand: Maybe just one frequently asked question, Well, I’m not where you live. Does that matter? Well, in the US, it doesn’t matter at all. We can run like a blood comprehensive blood panel, we can run that anywhere now. We’ll try to help people internationally in regards to providing maybe some codes or things like that to help people. But at least for the us know, you location does not matter. We haven’t had any issue with that. I think New Jersey for a while was getting a little more strict. But beyond that, no. I mean, nationwide, it’s a piece of cake. So as we talked about the beginning, create a panel, send a requisition form to your email, print it go get your labs drawn, you’re done. It’s awesome. percent was in New York, or was in New York or New Jersey was one of them. 

Dr. Justin Marchegiani: Yeah, both. 

Evan Brand: They’re both difficult. But was it for blood? Or was it for some of the functional or was it- 

Dr. Justin Marchegiani: For blood, but there are some still some Malin fingerprick tests that we have accessible to deal with patients like that. So we still have options for them. Maybe not quite as much. And then if they’re near the Connecticut border or the Pennsylvania border, we have also options there too, but we still have some mail and stuff. That’s helpful. 

Evan Brand: Cool, cool. All right. Well check out the sites We’ll be back next week. Take care.

Dr. Justin Marchegiani: Excellent. Have a good one, y’all. Take care. Bye.


Audio Podcast:

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