Brain-gut connection, is your brain causing you GI problems? – Podcast #65

Brain-gut Connection – Anxiety and depression have been thought to contribute to gastro conditions like irritable bowel syndrome (IBS). Experts explain that what’s going on in your gut could be affecting your brain.

Dr. Justin Marchegiani and Evan Brand discuss the brain-gut connection via the HPA, HPT, and HPTHE axis. Find out how important it is to have a good feedback loop of communication. Discover how vital the enteric nervous system is as much as our central nervous system. Listen to this podcast and learn how you can get optimal HCl production and get some info on what chiropractic care can do for you when it comes to excellent brain communication.

brain-gut-connectionEvan shares his experience from previous gut issues that were eventually fixed. Dr. Justin further explains how some brain issues could potentially cause gut issues especially in the realm of trauma, but emphasizes that we need to focus on the gut to get things working again. In this interview, we also find out how we can get relief from constipation to avoid all the toxic reabsorption that’s bad for the body.

In this episode, topics include:

3:15   Gut-brain axis

7:29   Causes of system dysfunction

12:05   Intestinal motility speed tweaks

13:08   Laxative herbs

16:15   Chiropractic care







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Dr. Justin Marchegiani:  It’s Dr. J here.  Evan, how’s your magical Friday doing?

Evan Brand:  Oh, it’s very magical.  I just had some bone broth mixed in with some of this specific organic chicken and wild rice soup.  So that’s my breakfast before you ask me.

Dr. Justin Marchegiani:  Nice.  That sounds really good.  I actually just got a VitaMix–super, super stoked about it.  Actually made some awesome ginger tea this morning.  I’ve been doing that a lot.  Ginger is phenomenal especially if you’re having die-off reactions, you know, when you’re doing gut killing programs for infections or even if you’re sick.  Ginger has some amazing properties that it can help basically viruses that fuse to maybe your throat or a particular tissue in the body.  It can help those viruses off.   It’s also anti-inflammatory.  It’s anti-coagulative, meaning it keeps the lymph fluid moving.  It keeps the liver moving and it’s anti-inflammatory.  So it’s just a phenomenal herb and I just blended it up with some lime and added a little bit of honey in there and it’s–it’s pretty phenomenal.

Evan Brand:  So you just took a little chunk of lemon.  You threw that in with water and you squeeze lime juice in there or you threw a lime without the skin or how do you–how do you add each?

Dr. Justin Marchegiani:  Well, the VitaMix is like a blender on steroids, so I just threw in like maybe a chunk of raw organic ginger from Whole Foods.  So maybe about the size of my fingers, threw them in there, added just a little bit of water and I threw–actually threw a whole lime in there, probably wasn’t the best bet, throwing a whole lime–I think you’re–I think you’re better off just squeezing the lime juice in there, because once you get the rind going, it’s a little bit tart.  But just squeezing the juice in there, blending that up and then I mix it in with some hot water on the stove, just enough to fill up a coffee mug and then pour it in, stir it up, add a little bit of honey, and I was good to go.

Evan Brand:  I think you just wanted to test the power of your new VitaMix.

Dr. Justin Marchegiani:  Oh, yeah.

Evan Brand:  So you threw–so you threw the whole lime in there.  Total–total lime domination.

Dr. Justin Marchegiani:  I know, I know, absolutely.  So it was good.  I enjoyed it and really good thing to use if you’re having a sore throat or you’re starting to come down with a cold or you’re on a gut killing program.  I recommend that to all my patients.

Evan Brand:  Yeah, it’s definitely a lot better than going and getting–I can’t even think of any over-the-counter remedy that’s–that’s crap right now.  Can you name one?

Dr. Justin Marchegiani:  For your throat?

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  I think they just have like some Robitussin kinda stuff.

Evan Brand:  Yeah, yeah, yeah.  Yup.

Dr. Justin Marchegiani:  That’s the only think I can think of.  That ginger is a natural tussin.  All tussin means is–it’s a anti-cough so to speak, so it helps kind of decrease that cough reflex.  But ginger’s great.

Evan Brand:  Yeah, if I were to boost that thing up, I would add like a half teaspoon of schisandra extract and like sneak an adaptogen in to that drink.  I bet it would be even–even better.

Dr. Justin Marchegiani:  That’s great.  You know, I’m a huge fan anytime you’re sick, the medicinal mushrooms are powerful.  Just like the adaptogenic herbs, they have an effect on the immune system and the adrenals where the mushrooms really have a strong effect on the immune system especially Reishi or Shiitake, a very powerful medicinal mushroom.  And that’s it’s been used for thousands of years.

Evan Brand:  Yup.  I know we got a limited time today so I guess we should dig in.

Dr. Justin Marchegiani:  Let’s dig in.  So we’re gonna talk about the gut-brain axis.  I had a patient the other day ask if we could dig into this and I said, “Let’s do it.”

Evan Brand:  Sure, so where should we start?

Dr. Justin Marchegiani:  So anytime we talk about like an axis, like the HPA axis or the HPT axis, the HPTHE axis, all these abbreviations are just for different parts of your body and the various feedback loops that go downstream to upstream to communicate.  So like for instance, the big ones like the HPA axis.  What does that mean?  H and P stand for hypothalamic and pituitary–hypothalamus and pituitary, those are parts of your brain.  And then the A stands for adrenal, so it’s just that feedback loop of communication.  And we need this feedback loop so our body can adapt to stress and stress disrupts a lot of these feedback loops.  Now on that note we have what’s known as the brain-gut axis which is the brain talking to the gut and the gut then talking back to the brain.  Now everyone knows or everyone’s probably familiar with the central nervous system–that’s the brain and the spinal cord–the CNS, central nervous system.  Well, we also have a nervous system that has just as many neurons in the central nervous system in the gut.  It’s called the enteric nervous system and this is its own nervous system in the gut.  So we have this kind of cross-off between the brain to the gut, the gut back to the brain.  And it’s–it’s pretty profound.  Now I find a lot of people, they have a lot of dysfunction like let’s say you’re having memory issues, brain fog issues, mood issues–I find a lot of issues today area emanating from the gut and feeding back into the brain via inflammation, via dysbiotic bacteria, via infections, via the infection-like by-product such as lipo–lipopolysaccharide, LPS, or endotoxin, via food allergens getting into your bloodstream, via pesticides and junk in the environment, getting into your gut and into your bloodstream and affecting your brain.  So anytime we see fire in the gut, we see fire in the brain.

Evan Brand:  I absolutely had that when my gut was messed up, which got me into all this health stuff.  Depression was probably my biggest symptom.  It started out as brain fog, just feeling like I was looking at life through an opaque piece of glass and then eventually depression wrecked me and obviously I was working 3rd shifts at that time, too.  People go back and listen to my old episodes and–and complaints there.  But eventually after the gut got fixed, those symptoms went away.  So the connection is huge and I felt it first-hand.

Dr. Justin Marchegiani:  Got it, yeah.  I mean, I see a lot people with gut issues and they don’t really equate their gut issues causing their brain problems.  Now there’s a doctor, Dr. Kharrazian, he’s a–he’s a good guy.  I learned a lot from him, took all of his classes and courses.  Now he’s a big fan because he’s a chiropractic neurologist that a lot of gut issues really emanate from the brain.  Now I’m not quite sure how I feel about that.  Now I do agree that some gut is–or some brain issues could potentially cause gut issues especially in the realm of trauma, you know, car accidents, head trauma, you know, bumping your head and such.  I do believe that type of trauma can affect the gut because the vagus nerve which is–it’s a parasympathetic nerve fiber that kinda makes its way from the brain, it’s the 10th cranial nerve in the back of your brain stem but also makes its way and has an effect on every single part of your body.  And that vagus nerve, again controls the–the rest and relaxation.  Now Dr. Kharrazian is a big fan of like the gargling and the singing to really activate that vagus nerve, but frankly, I think it’s okay.  I think it’s good.  It’s a palliative way to support parasympathetics, but let’s face it, if you have a gut issue and it’s underlying issue is primarily gut-based, you’re not gonna be able to sing your way back to a healthy gut and you’re not gonna even be able to gargle your way back to a healthy gut.  I really think depending on your history, as long as you don’t have this type of trauma that we’re talking about, you’re gonna typically have to be focusing on the gut primarily to get things working again.

Evan Brand:  Yeah, so let’s talk about some of the things that can lead up to this–the dysfunction on this system.  For me, I always go to low HCl levels first.

Dr. Justin Marchegiani:  Low stomach acid, is that what you’re trying to say?

Evan Brand:  Yeah, yeah.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Because you’re just not gonna be breaking things down if you’re coming across some organisms in your food that shouldn’t be there, some bacteria or pesky things, if you don’t have enough HCl to kill those guys off and properly digest those foods, then that could create other issues downstream.

Dr. Justin Marchegiani:  Yeah, I’ll even go one step higher up.  I think low stomach acid but people don’t typically just have low stomach acid out of the blue.  There’s some type of stress that’s activating their sympathetic nervous system response, right?  Parasympathetic being that vagus nerve stimulation.  The sympathetic essentially is gonna be the branch of your nervous system that’s the fight or flight.  It’s the part of your nervous system that activates the adrenal glands.  That’s the, you know, when your adrenal glands get stimulated by adrenal rush, that little spidey tingly sense you get, that’s your sympathetic nervous system and if that response is activated prolonged, it really shuts down digestion, enzyme production, and hydrochloric acid secretion.

Evan Brand:  Great point, great point.  Yeah, so all those people out there listening to this podcast, driving, texting and eating a burrito at the same time, you are not giving yourself optimal HCl production right now.

Dr. Justin Marchegiani:  Absolutely.  Now some people with gut issues though, this is where it gets a little hairy because once you have a gut issue, so many other things start breaking down because we need minerals for all of our various metabolic processes in the body.  We need protein, right?  Protein becomes a building block for neurotransmitters.  Fatty acids and cholesterol become building block for all of our hormones.  So once we have gut issues, a frog–a frog came back and it’s actually–hold on one second.  I got my ginger tea so that will at least help.  So once we have absorption affecting all of these various nutrients, so many things can happen.  So one of the things we’ll see is we’ll see neurotransmitter dysfunction because neurotransmitters come from protein and once protein is affected, we can start to see neurotransmitter issues.  Now when we start supporting neurotransmitters, a couple of things can happen that can help motility, right?  Peristalsis which is big, because if we fix the neurotransmitters, mood gets better, sweet cravings get better, we can create better willpower so we’re eating better foods, but also we can affect motility and that motility can keep the stool particulate moving throughout the intestinal tract and help it evacuate in a timely manner so we’re not reabsorbing a lot of our toxins from the stool which can then affect our guts and they can affect our brains, right?  Because everything–our brains are basically bathing in this pool of blood and if we make toxic blood from reabsorption of the stool particulate, you can image your brain’s not gonna function too well.

Evan Brand:  It makes sense.  So are you alluding to the fact that constipation could contribute to some of these issues, too?

Dr. Justin Marchegiani:  Absolutely and constipation is gonna be primarily driven by malabsorption, low stomach acid, low enzymes, followed by this dysbiotic/pathogenic infection overgrowth that disrupts peristalsis, or that’s–that’s the scientific terms–the layman term is you got like the toothpaste, right?  And you’re at the very end of the toothpaste, well, you start rolling it up to get that toothpaste out.  Well, that’s kinda what your intestine does with these various wave-like contractions to move that stool out and if we don’t get it out in, you know, a 20- to 24-hour time period, we’re gonna be potentially reabsorbing a lot of those toxic materials.

Evan Brand:  It’s amazing how many people have constipation.  I never realize the scope of the issue until I actually start talking to people about their poop and a lot of people, I mean, they’ll think it’s normal to go poop once every 2 days.  That’s not normal.

Dr. Justin Marchegiani:  Oh, totally not normal.  I had a patient just the other day–I think she was going like, she’s using magnesium just to be able to go, and if she wasn’t–she wasn’t magnesium, it’d be like once every 5 days to a week.

Evan Brand:  Oh.

Dr. Justin Marchegiani:  Man, that’s just like, “Oh, my gosh, like your brain is bathing in that toxic sludge that’s gonna be floating around your bloodstream.”

Evan Brand:  To me that’s–that almost sounds scary, once a week.

Dr. Justin Marchegiani:  It does.  Super scary.

Evan Brand:  So at that point, definitely magnesium citrate, the Natural Calm, that was my recommendation to the girl I was talking to yesterday, too.  She said, “I’m–I’m pooping, you know, once every 2 or 3 days.”  I’m like, “Whoa!”  Definitely up the magnesium.  And in terms of neurotransmitters stuff, I mean, what would we do to–to tweak that there.  Would you tweak serotonin or what else gonna work on that intestinal motility speed?

Dr. Justin Marchegiani:  Yeah, serotonin is a big one for peristalsis.  So 5-HTP is gonna be very, very helpful for helping things move.  More importantly though because like 5-HTP and/or magnesium, a lot of these things are palliative–I mean, they’re better than the drugs.  They’re better than the enemas.  They’re better than, you know, even like the natural herbs like senna or cascara sagrada, right?  We gotta get to the issue and a lot of times it’s just getting enzymes and getting acid levels up makes a huge different because that kinda helps us process things better but many times we actually have to get rid of the dysbiotic bacteria, fungal, or pathogenic imbalances in the gut for that to help but off the bat, yes, magnesium’s a good one, adding an extra soluble fiber can be a big help, and potentially even using some of these laxative herbs if we need to, just so we’re not creating this toxic environment.

Evan Brand:  What are some laxative herbs?

Dr. Justin Marchegiani:  I mentioned senna, cascara sagrada, those are a couple of ones that I use in naturopathic medicine.  Big fan of magnesium, and again, you can use it to tolerance because your body will start evacuating the stool at higher levels when you hit tolerance, that could be different for each person.  Higher dose vitamin C is a good one.

Evan Brand:  Yeah, as I was gonna say next, is vitamin C.  I’ve–I found out the hard way of–about vitamin C tolerance.

Dr. Justin Marchegiani:  Yeah, even ginger.  Ginger tea is phenomenal at helping things move because it’s an anti-coagulant and it keeps things moving and it’s anti-inflammatory and it’s also a biofilm buster, so it helps knock out the biofilms which are like the protective shields that a lot of these critters kinda carry so they can live longer if you will.

Evan Brand:  I wonder if the GT, that ginger–the ginger one.  I wonder if that would have enough actual ginger inside of it to be considered at a therapeutic level.

Dr. Justin Marchegiani:  That’s a great question.  There’s also some saccharomyces boulardii.  There’s also some other acidifying compounds that may be beneficial, definitely worth trying.

Evan Brand:  Because I know it’s easy to be lazy when it comes to this stuff and a lot of people may be freaked out by going and grabbing like a piece of ginger and throwing it into the blender.  Don’t be scared.  But a lot of people are kinda skeptical I think of doing some of that raw hands on stuff and they’d rather just grab something pre-packaged and pre-handled, so that may be the introductory way to expose yourself to ginger.

Dr. Justin Marchegiani:  Yeah, also you can get the ginger in tincture form. That can be really helpful, too.  It’s already in like a tincture, like an Herb Pharm tincture.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  And then you’d to take a couple of squirts of that and mix it with some water and just down it that way.  That’s–that’s really good, too.

Evan Brand:  That sounds good.  Okay, what’s next?

Dr. Justin Marchegiani:  Well, if we’re having slow transit time, right?  Because I’m kinda just equating it back to the gut-brain.  So I have my bias that a lot of these issues primarily are gonna emanate from the gut first.  Now if we’re dealing with people that have had TIAs, you know, transient ischemic attacks, strokes, brain trauma, car accident issues, football, sports-related injuries–yeah, it’s very possible that the underlying issue is emanating from the brain and you may have to see a skilled chiropractic neurologist and have specific neurological stimulation on the brain, lasers on the brain that are parts of the brain that are inflamed or maybe there’s a lesion in the brain because of inflammation.  So you wanna kinda look at your history and if you kinda line up with any of these traumas, then you may need to really work on the brain.  But let’s say you have a brain issue, you’re never gonna hurt yourself by working on the gut, too.  In my clinical opinion, 99% of people I’m seeing, they have primary brain issues–I’m sorry, back up–they have primary gut issues that are affecting their brain.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So what we do is we’re fixing the gut, but we also look at the neurotransmitters just to make sure that if there is a brain issue on the neurotransmitter side, we’re at least supporting it.  So if there is something, we’re making sure that’s being addressed, so the brain from a neurotransmitter perspective is working well.

Evan Brand:  Right, man, I wanted to talk about chiropractic for a minute just because everything that you’ve learned and built upon on top of that stuff is awesome, and we don’t talk about that very much.  So I mean, when you adjusted me, there were tons of symptoms that go away.  So maybe you can talk a little bit about how chiropractic care would be a good ancillary thing to get done on top of all this other internal work.

Dr. Justin Marchegiani:  Well, on the chiropractic side, you can look for things known as hemisphericities and all this means is that one side of the brain, whether it’s the cortex, that’s like the–the big part of the–of the your–the brain like right above the ears so to speak–you have a right and the left.  And then you also have the cerebellum which is the brain stem, that bump right in the back of your head as you roll your hands down from your crown, down the back of your head, those little bumps there.  You have the right and left cerebellum.  And if you see one side more overactive or underactive than the other, well, you can do specific adjusting to help bring one side up.  You can do specific exercises, counting, singing, gargling, laser stimulation, adjusting, exercises, movement, so depending on those imbalances, you can have a specific protocol, eye movements, eye exercises to help address that.  And a skilled chiropractic neurologist will be able to put you through a couple of different examinations to figure that out.  Now also doing applied kinesiology is big.  I also check out the whole body on a chiropractic side when I’m seeing patients chiropractically and we’ll address where certain joints aren’t moving properly, because the brain communicates primarily to the rest of the body via movement and the rest of the body communicates through the brain via movement.  So if there’s not movement–there’s not movement, then the brain’s not gonna have that excellent communication, right?

Evan Brand:  That’s a great point.

Dr. Justin Marchegiani:  So one of the big areas that has a lot of stimulation is the atlas, so if that top part of the cervical spine is out of balance or isn’t moving properly then that provides a lot of input to the brain and it’s kinda like having bad software, right?  If we have a bad software with a bug in it, bad info in creates bad info out.  So if we can reset or reformat that software by providing the right adjustment or the right stimulation to the brain, that can make a huge difference.  But on that–on that standpoint a lot of chiropractors will provide the right adjustment and then their patient will go home and eat a whole bunch of inflammatory food, eat some gluten and still have a gut issue and they’ll think they made a difference, but there’s still a lot of inflammation coming in from other parts of the nervous system because they forget there’s just as many neurons in your gut as there are in your central nervous system.  So they forget the fact that there’s a whole other nervous system underneath the surface that is being–I should say rotting out because it’s being ignored.  So a good functional neurologist is gonna look at the structure, but they’re also gonna look at underneath and look at the gut and look at digestion, and even look at hormones and neurotransmitters, too.

Evan Brand:  Absolutely.  My wife, she was having a lot of headaches, just constant everyday headaches until she got her atlas adjusted and it fixed it for a while.  She still had some other symptoms going on and then as soon as we got her diet cleaned up, which now it’s pristine, all the symptoms are permanently gone.  So you know, if you’re getting these adjustments and you’re going back every week and still getting these adjustments but your ending right back where you started, then it’s time for you dig a little bit deeper into these other things that we’ve talked about.

Dr. Justin Marchegiani:  Yeah, I totally agree.  So you gotta have a holistic approach.  So getting back to the gut-brain axis.  The gut has a major effect on the brain.  Always look at the gut being the primary indicator. Why?  Because we have too much sugar consumption.  We have antibiotics in our food, even just the conventional meat and such.  We have lots of pesticides and chemicals in our environment and we have lots of stress.  All of these things really screw up our gut and then it’s kind of sad but as we get more stressed, other things get worse and worse in our gut.  Low stomach acid, low enzyme production, imbalance in gut bacteria, so the problem gets compounded and worse over time.  So if you ignore the problem, chances are it’s gonna get worse each and every year, and I see it in my patient’s history.  The patients that act sooner get better faster.  The patients that wait, they accumulate more infections, more imbalances.  They stress their adrenals out and they have to eventually get that fixed for them to really get better.

Evan Brand:  Yeah.  Well, on top of that, if they’ve waited so long or maybe they’ve gone the conventional route, by this time, some of the people we helped have been suffering 10, 20, 30, even longer years and now there’s 5 drugs that have been added to the picture because these, you know, they’re not gonna get addressed.  These type of things we’re talking about are not gonna get addressed by nutrition and lifestyle and stress management and things like that.  They’re gonna get addressed by drugs typically.  So that’s just gonna throw a whole another spin into the equation that’s gonna most of the time make people worse or cover up symptoms.

Dr. Justin Marchegiani:  Absolutely.  They’ll be on prokinetics or laxative or enemas and such, and that’s not a good way to do it because it doesn’t fix any of the issues and actually creates lots of side effects, too.

Evan Brand:  Yeah, so no Pepto-Bismol.  That’s not gonna help you.

Dr. Justin Marchegiani:  Uh-hmm.  And there’s one deeper thing, too.  People forget about this a lot–is low thyroid function.  One of the common side effects of low thyroid, of hypothyroidism, is gonna be peristalsis and constipation, and I see that a lot in my patients.  We test their thyroid and we see low thyroid and we start supporting their thyroid and magically their constipation’s gone.

Evan Brand:  That makes perfect sense because if the adrenals and thyroid are gonna be tied together and they’re under all this adrenal stress, that thyroid is gonna slow down, too.   So it’s gonna slow everything down, not just your metabolism but your–your poop speed, too.  So–

Dr. Justin Marchegiani:  Oh, absolutely.

Evan Brand:  That’s interesting.

Dr. Justin Marchegiani:  Absolutely.

Evan Brand:  It’s all connected.

Dr. Justin Marchegiani:  You gotta get the thyroid looked at.  Yeah, absolutely.  And then if you get the thyroid looked at, you always have to get the adrenals looked at because every now and then I see patients get much sicker when they support their thyroid without their adrenals because their adrenals may already be low.  That extra bit of thyroid support they get can actually lower their cortisol even more and create more adrenal faci–fatigue symptoms.  So we always wanna get the adrenals and the thyroid looked at together.  So if we’re supporting the thyroid, you always wanna be supporting the adrenals.  I find more people get into trouble by supporting the thyroid by itself versus supporting the adrenals by itself.  People that support the adrenals by themselves, if they have a borderline thyroid issue, a lot of times that thyroid issue gets better.  If you support the thyroid issue by itself and there’s a low adrenal issue, that adrenal issue can actually be made worse by supporting the thyroid without the adrenals.

Evan Brand:  I had a lady the other day that was just rubbing herself with iodine every day for no reason.  Has never been tested for thyroid issues or anything.  She just takes iodine and just rubs it on her skin every day because she read in some book that it was good for her.  What would say to that person?

Dr. Justin Marchegiani:  Well, I think it depends how or you know, what the motivation is.  If you’re just trying to get iodine in your body just for the sake of getting iodine in your body, you’re better off taking it orally, swallowing it.  But again you wanna find out and make sure you’re not autoimmune.  First, you wanna make sure you actually need it.  Again, a lot of my female patients that have fibrocystic breast disease, where they have, you know, cyst in their breast, will actually rub iodine topically on the breast tissue so we can get the iodine into the breast because iodine has an amazing effect at helping to break up cyst.  Iodine is big at helping to metabolize estradiol into estriol which can really help affect fibrocystic breast and even fibroids in the urinary, too.  So topically it’s really good on the breast tissue if you have fibrocystic breast, maybe not the best thing if you’re trying to get iodine in your body systemically.  So you’d wanna do something to–you wanna support iodine ideally with a really good liquid solution with iodine and iodide.  Iodide primarily goes to the thyroid.  Iodine will go to the breast tissue and the prostate if you’re a guy and such.  So you wanna make sure you’re supporting it right and then you also wanna make sure that if you are giving iodine, make sure you’re not autoimmune and make sure you’re supporting the selenium and the vitamin C and the other minerals, too, because iodine in the body can create a whole bunch of hydrogen peroxide as a metabolite which is inflammatory.  Selenium comes in there, pulls off one of the oxygen molecules, mix it with water so it decreases the inflammation from iodine metabolism.

Evan Brand:  Uh-hmm.  Yeah, that was what I was worried about.  I was thinking, “Man, everything she’s saying sounds like autoimmune and yet she’s been doing all this iodine.”  So it’s a little bit–little scary what people put themselves into, what situations they get themselves into because they–they read and read and read and self-diagnose and self-treat.

Dr. Justin Marchegiani:  Yeah, just wanna make sure you get the thyroid full tested before you do anything like that, get the antibodies looked at, and then get everything else dialed in first before you go into the iodine because you can easily have a–a Wolff–Chaikoff effect or a Jod-Basedow effect where too much iodine can actually cause a hyper or hypo-like symptoms especially if you go too much, so you’re always better off starting low with a couple hundred mics and working up to, you know, the lower milligram level.  But you gotta make sure you’re working with a skilled practitioner and you gotta have some labs ahead of time so you’re not exacerbating a thyroid autoimmunity.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So anything you wanna summarize with Evan regarding the gut-brain axis?

Evan Brand:  Yeah, well, definitely my–I’m biased.  So I’m always gonna say that stress is gonna be key.  So any way that you can reduce stress whether it’s your nutritional stress in terms of getting in inflammatory foods, you’re still eating gluten or you’re still sneaking that bagel or pasta, things like that.  Getting the nutritional stress out of–out of the picture.  Emotional stress, you and I were talking earlier about EFT, Emotional Freedom Technique, and how helpful that is.  I love it.  You use it as well.  So definitely work on the emotional stuff and then just making sure that you actually have a solid connection between the brain and the gut.  So I’ve actually taken some hypothalamus before in supplement form just to turn that system back on because I was getting some testing done like some different reflex point testing like the Bennett’s and–and such, and I was not–I was not pulling any numbers.  Like I was just numb to these sensations and so I added some hypothalamus-pituitary extract in in a supplement form, just put a little bit on my tongue and then all of a sudden all these receptor sites were woken up.  So I don’t know what the–the take-away action there is, that may be for another podcast, but definitely a lot of people have some level of dysfunction going on with this system so it’s definitely important to try to get it straightened out.

Dr. Justin Marchegiani:  Absolutely.  Absolutely.  So the common sequelae is really simple.  Stress–emotional, physical, chemical stress that creates a lower stomach acid and enzyme environment, increase in food allergens, increase in dysbiosis because food’s not being broken down, lower immune function, compromised immune function, infections, leaky gut continues to get worse along the way, more immune stress, potential autoimmunity, and then more brain inflammation due to the all the stresses in the gut making their way into the bloodstream.

Evan Brand:  Yeah, I would say how household toxins would be my other like side note to add to all this stuff.  Getting a good HEPA air filter and making sure you’re filtering out as many toxins that you’re gonna be taking in that way.  That’s kind of another hidden source of inflammation that people don’t talk about much as their home health so if you  have good weather, open up the windows, get that fresh in there, get the crap out, whether you just have new paint or new carpet, new upholstery, new furniture–Dr. J got a new couch.  He can fumigate this office now, things like that. So–

Dr. Justin Marchegiani:  You got it.  Absolutely.  Awesome, Evan.  Appreciate the call.  Hope everyone got some good take homes from it and we’ll talk next week.

Evan Brand:  Alright, take care.

Dr. Justin Marchegiani:  Bye.

Evan Brand:  Bye.




HCL and enzymes to improve digestion – Podcast #64

HCL (Hydrochloric acid) activates pepsinogen into the enzyme pepsin, which then helps digestion by breaking the bonds linking amino acids, a process known as proteolysis. Enzymes break down proteins, cellulose, starches and other foodstuffs. This makes it possible for the intestines to absorb nutrients. Enzymes begin thedigestive process in the mouth, as they’re secreted by salivary glands. They work to break down starch into sugars.

Dr. Justin Marchegiani and Evan Brand address some topics around digestion in today’s podcast and also talk about various digestive supports. Learn more about the importance of hydrochloric acid and enzymes needed for digestion. Find out why and how the conventional model does not succeed in getting to the root cause of digestive issues.

stomach-acid-HCLThis interview really is all about the bases and the foundations of digestion but also touches upon the subject of gallbladder issues and other gut inflammation that can be avoided with proper digestive support. Discover how you can optimize your HCl levels and learn about the various enzymes that help in the digestion process as well as find out what the role of bile salts are.

In this episode, topics include:

00:56   digestive issues and digestive support

8:09   gallbladder stones, flushes and surgery

10:51   hydrochloric acid doses

13:35   enzyme support

16:25   gut infections







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Dr. Justin Marchegiani:  Evan, how are we doing today, man?

Evan Brand:  I’m doing great.  What about you?

Dr. Justin Marchegiani:  Doing pretty good.  Actually just got back from San Francisco.  Nice little week up in the Bay Area and back to a nice hot weather here in Austin, Texas.  Nice hot summer.

Evan Brand:  Yeah, it’s–you can tell that it’s slowly sliding into fall here in Kentucky and I’m not ready for it yet.

Dr. Justin Marchegiani:  Imagine the foliage.  It’s probably awesome up there.

Evan Brand:  It is when it turns.  It hasn’t turned yet.  In another month or so it’s gonna be crazy beautiful.

Dr. Justin Marchegiani:  That’s great.  So we talked before the show about addressing some topics around digestion.  Especially how to use various digestive supports.  I got a email question this week where a patient wanted to–want–wanted me to elaborate more on this topic.  I think this would be a great topic to discuss today.

Evan Brand:  Yeah, absolutely.  Everybody–not everybody, but a lot of people have digestive issues and that’s kinda where I like to start with people most of the time.  If you fix that, you fix a lot of other stuff.

Dr. Justin Marchegiani:  Yeah, so regarding digestive issues, there are various digestive supports you can use to help.  So HCl or betaine HCl, various enzyme support products whether it’s like protease or lipase or trypsin, like protein or fat digesting enzymes.  And then there are things like bile salts which can also be helpful for emulsifying and breaking down fat.  So those are kinda like our 3 that we’re gonna contrast with today.  So the first foundational one is HCl.  And again HCl can vary depending on how much you need, anywhere between 1 to 3 or 4 grams per meal, and HCl is really important because that HCl really helps lower the pH in your stomach and that nice low pH activates a compound, a proteolytic enzyme called pepsin.  It takes it from pepsinogen which is inactive to pepsin which is active.  And when it’s active, it really starts to hold protein digesting process.  So we need this nice low pH in our stomach and that nice low pH activates these protein digesting enzymes and that starts the digestive process and that nice low pH mixes in with all the food and that’s–this is called chyme and that chyme then gets released into our small intestine and without that nice low pH, we don’t get that trigger from our pancreas and gallbladder to release bile salts from the gallbladder, and then various enzymes like trypsin and proteolytic enzymes–that means protein digesting, and then also lipase, fat digesting enzymes.  So again, this whole domino rally here of kind of, you know, what has to happen first, second, third, really happens with hydrochloric acid.

Evan Brand:  Yup.  And hydrochloric acid, if people don’t know, is a good thing.  This is a time where acid is more is better most of the time.  People may have this idea from the mainstream media––I just a commercial the other day that still makes me gag about Zantac and all these other Nexium and all these companies competing on who has the best acid blocker and 99.9–and correct me if I’m wrong–99.9% of the time, the issue is too low stomach acid and not too much and people that have like a faulty lower esophageal sphincter from stress or whatever,  that could actually cause some of that acid to sneak back up into the esophagus where you don’t want it to, but if we have the HCl levels optimized, that could prevent some of that stuff from happening.

Dr. Justin Marchegiani:  Yeah, one of the big feedbacks for it, that esophageal sphincter, that’s where the part of your stomach and your esophagus meet.  One of the main mechanisms for that esophageal sphincter tightening is nice high levels of hydrochloric acid, but also keeping dysbiosis down in the stomach.  So it’s one of these things where if we have inadequate levels of HCl in the stomach, well, we start to have bacterial overgrowth because food sits and rots and ferments and putrefies in the stomach and then part of that whole putrefaction process and rancidification fermenting process, we have various organic acids that rise off of that and then because everything is disrupted, that esophageal sphincter is left open and those acids will rise up and actually burn that lower part of the esophagus and the upper part of the stomach creating inflammation.  And then you go to your conventional doctor and they say, “Oh, you have esophagitis or gastritis,” right?  All you have to do is just break down the medical speak.  Cut the word in half.  Esophagitis or gastritis, stomach or esophagus, -itis meaning inflammation.  It’s like, well, wait a minute.  I already know those inflammation there, right?  If you have pain in your throat, it’s probably esophagitis.  If you have pain a little bit lower, it’s probably gastritis.  The question becomes now, what’s the cause?  Now your conventional doc will just throw a–an acid-blocking medication like Nexium or Prilosec or omniprazole, etc.  But again, what’s the underlying cause?  We already talked about the fact that lack of acid will create this environment where this food rots and then the esophageal sphincter stays open and organic acids rise up.  So if you know that mechanism, giving a medication that’s blocking the acid, actually makes the problem worse.  So when–once you have this biochemical physiological understanding, you can see how the problem is actually being made worse in the long run.  You may get symptomatic relief in the short run but you have a massive amount of other problems because now you can’t ionize minerals.  You can’t break down protein optimally.  There’s gonna be more dysbiosis, more gut infections because we don’t have the ability to sterilize the environment so now we’re set up for a whole host of long-term issues.

Evan Brand:  Yeah, and I’m trying to think of a good analogy.  I know you–you’re always killing it with those, but it’s almost like blaming the firemen for the fire.

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  Does that count as an accurate analogy for that situation?

Dr. Justin Marchegiani:  Yeah, that makes sense.  I mean, most medications are designed to manage symptoms and there’s nothing wrong with that like in the short run.  You know, a day or two, right?  But the problem is when symptoms are managed and you have the false expectation that the underlying cause was fixed, that’s where problems become long-term because then now you’re stuck using this long-term and then because the–your whole gut physiology is screwed up, you can’t come off it.  And the conventional medical model is really about managing symptoms and then essentially you get hooked on these drugs because the symptoms now once you come off are now really bad and you just–you can’t–you can’t deal.  Any comments on that, Evan?

Evan Brand:  No, I think that’s a great overview of how the conventional model once gain does not succeed in getting to the root cause of digestive issues.

Dr. Justin Marchegiani:  Yeah, and these medications, I mean, they’re like in the top 5 every year.  These proton pump inhibitors.

Evan Brand:  Billions.

Dr. Justin Marchegiani:  Yeah, billions, top 5.  I mean, right next Synthroid and–and Lipitor.  I mean, they’re–and your anti-depressants.  They’re right up there in the top 5 every year and like I–the analogy I kinda tell my patients–you know, when you’re stressed and you’re taking these medications, they’re really lessening or they’re really taking off or–or turning off your force field.  So imagine like the Star Trek ship, it’s got that nice force field around it so when the Klingons come in there and attack, it’s got the force field up and it can –it can defend itself but when we lower our hydrochloric acid levels and things come into our environment, we’re not gonna be able to mount an attack against it.

Evan Brand:  Great.  Yeah, I was hoping you would navigate into that territory.  What happens then once that acid level is low over a period of time?  It’s not just the crappy digestion, it’s not just the burping and the heartburn, indigestion.  It’s not all that.  It goes way deeper and that’s kinda what you’re alluding to now is that other stuff downstream, these next dominos in line, those get messed up, too, and you run into all sorts of things like biliary stasis, gallbladder issues, and all that.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  So I don’t know if you wanted to move down south, down the system, and talk about that now.

Dr. Justin Marchegiani:  Yeah, if we don’t have enough hydrochloric acid, that nice low pH and all that chyme, which is just mixed up food, right?  If you don’t have that nice low pH, our gallbladder isn’t triggered to contract.  And if we’re not contracting that gallbladder, bile salts sit too long in that gallbladder and aren’t being emptied periodically, kinda like changing the oil in your car, things can get really grimy and get sludgy and that can potentially create a stone over time.  And these stones then at some point when you eat a fatty meal, that gallbladder contracts, it’s like wrapping your hand around a porcupine and squeezing.  It’s not gonna be a–a good situation.

Evan Brand:  That’s a good one.  Let’s–if you have–if we have a minute here, I wanna talk about gallbladder flushes real quick, because I know a lot of people do those and they read about them like drinking like a cup of olive oil at the end of a fast and I just, I get asked about that and I just think it sounds crazy.  So I don’t ever have a complete answer on it.

Dr. Justin Marchegiani:  Yeah, I’m not a huge fan of doing that off the bat.  There may be a desire and a need for that down the road.  But if your digestion isn’t working and you’re not breaking down food and then you go do this big flush and there potentially is a stone in there, and that gallbladder is contracting because of all the olive oil and/or apple juice you’re taking in, and that gallbladder contracts down around that stone, right?  Visualize yourself grabbing a porcupine and squeezing, that there could be some inflammation and you may end up going to the ER, and then you’re gonna be pushed to have that gallbladder taken out always.

Evan Brand:  Mmm.

Dr. Justin Marchegiani:  I mean, I’ve saved hundreds of gallbladders just because gallbladder issues are almost always due to food allergens and a combination of low level stomach acid which, you know, may be driven by even a deeper infection, but definitely the food and the stomach acid off the bat is the first perfect storm element that really sets you up for gallbladder issues.

Evan Brand:  Wow.  Yeah, gallbladder surgery.  It’s ridiculous how common it is, act like it’s just as simple as getting some stitches on a cut.  “Oh, yeah, let me just pull your gallbladder out real quick.”

Dr. Justin Marchegiani:  Oh, I know, I mean, I wonder–I wonder if most of these medical doctors had the same kind of mindset like if we dealt with our car, like if we just say, “Hey, you know, you’re having a little bit of a issue in your car today with this issue.  Let me pull open the hood.  “Yeah, oh yeah, what’s this thing right here?  Let’s pull it out.”  You know, I–I guarantee you they’d be a little bit more selective over their car but when it comes to their patients, they’re just like, “Yeah, let’s pull it out.  It’s not working.”  I say, “But why?  And is there anything we can do conservatively to prevent that?”  Like–

Evan Brand:  Incredible.

Dr. Justin Marchegiani:  Some of the things we talked about that are virtually free.

Evan Brand:  Yeah, we can’t make billions.  We could talk about all these supplements and we’ll never make billions off of these things.  I mean, a bottle of hydrochloric acid is gonna be less than 30 bucks, you know, so it’s just insane.

Dr. Justin Marchegiani:  I know and on that note, hydrochloric acid is a powerful supplement to start off it with anyone that has chronic health issues.  Typically, how we dose it is we start off with 1 capsule per meal and I like to take it in the middle of the meal.  Why in the middle of the meal is because, well, if you have gastritis which is that gut inflammation, right?  Gastro meaning stomach, -itis meaning inflammation.  So if our gut lining is thin and we’re inflamed and we put a nice hydrochloric acid capsule right against that mucosa and it starts to dissolve, well, it’s like touching a scab on your hand or on your arm.  It’s gonna be more sensitive.  So we take it in the middle of our meal, kinda like an Oreo cookie.  It’s like the cream filling, not–not at the beginning, not at the end.  And we start off with one and we take it at breakfast, lunch, and dinner.  We see how we do and then each day we work up to 2, to 3, to 4.  Again, there’s this whole idea, we can go up to warmness or HCl tolerance.  That can be good.  I’m–I’m also very careful of going above 4 or 5 capsules just because I don’t wanna cause a–a ulcer in the small intestine.  So it–this called duodenum, that’s where the stomach connects in with the small intestine.  When all that acid goes into the duodenum, our pancreas has to make a whole bunch of bicarbonate to start to neutralize that acidity.  So if we’re jacking it up really high where we’re doing 8, 9, 10, 11, 12 capsules per meal and you’re not still feeling warmness, I get a little concerned because I don’t wanna cause a duodenal ulcer.  So 4 or 5 tend to be a pretty good place that I stay at for patients, especially if they’re seeing a benefit of foods feeling lighter.  They’re feeling like it’s digesting.  They’re having, you know, better bowl movements.  They’re having less burping or gas.  We’ll stay at that 4 or 5 mark.  I don’t like to go too much above that unless we’re closely monitoring them.

Evan Brand:  Yeah, I got nothing to add there.  That’s great advice and I typically take 1.  I’m great with 1 but I’m still one so I’m still producing a–a decent amount for now.

Dr. Justin Marchegiani:  Uh-hmm.  Yeah, yeah.

Evan Brand:  Until I get older.

Dr. Justin Marchegiani:  Yeah, exactly.

Evan Brand:  Like an old man.

Dr. Justin Marchegiani:  Uh-hmm.  And it–hydrochloric acid levels do go down with age, so we gotta keep in mind that because a lot of, you know, elderly patients, they’re having all these bone issues and osteoporosis issues and it’s like, “Man, like, you know, Boniva and all these other medications are not gonna fix the issue,” because a lot of times it really starts in the digestive system.  We’re just not breaking down and ionizing these minerals and we need good levels of hydrochloric acid to ionize minerals, so we can absorb them into our bloodstream and utilize them.

Evan Brand:  I don’t know if you agree with this, but to me, optimizing HCl levels to me is probably one of my top 3 to 5 foundational things I could ever do for somebody.

Dr. Justin Marchegiani:  I couldn’t agree more, 100%.

Evan Brand:  So–

Dr. Justin Marchegiani:  Now the next thing on top of that is we’ll also add in enzymes and depending on how–how chronic or how long someone has had gut issues, I either use a combination product with enzymes and hydrochloric acid together with bile salts for my patients that aren’t doing too bad.  Like patients that have more chronic issues, we’ll separate them out because a lot of times their gut lining is thinner.  They have this gastritis issue where that gut lining has been worn down and they will only be able to handle maybe 1 or 2 hydrochloric acid capsules.  But they’ll need a lot more enzymes.  So if we package the enzymes together, we kinda hit the wall sooner, because we only can do 2.  Where if we have the enzymes separately, we can go up to 3, 4, 5 enzymes per meal and it’s just the enzymes, and because the enzymes aren’t as abrasive we can hit a more therapeutic level with them and have better protein and fat digesting or digestion capacity even when the HCl has hit the wall at a 1 o 2 state.

Evan Brand:  Interesting.  So sometimes, people can get away with just enzymes and they won’t need the hydrochloric acid and combination with.

Dr. Justin Marchegiani:  Yeah, I mean, I typically recommend enzymes separately but we’re still giving HCl by itself.

Evan Brand:  Right, okay.

Dr. Justin Marchegiani:  So like, we may hit the wall at 1 for instance.  Some of my chronic gut issues, they’ll hit the wall at 1, but great, I mean, that doesn’t meant though you’re getting enough enzymes, well, we’ll work on upping the enzymes separately to 3 or 4 or 5 and seeing how we do.  And some patients even after that, if I see a lot of fecal fat in their stool test, we’ll even add a separate product by itself that just has high amounts of lipase which is a fat-digesting enzyme and high amounts of bile salts.  And with my chronic gut issues, we can–my chronic gut patients–by this combination here of combining HCl and enzymes or HCl enzymes and fat digestive support, we can get their body’s ability to break down some of these nutrients better which buys us time to start getting the gut and the adrenals fixed because if we absorb better nutrients, if we absorb the nutrients from our good diet better, we’re gonna be able to use those nutrients to help heal our body and then if we get to the underlying adrenal stuff, infections, dysbiosis, SIBO, etc., we’re gonna be able to fix this problem long-term so maybe in 6 months or so, we can pull them off from of these digestive support products as long as they’re managing their stress and–and eating well.

Evan Brand:  Great point, yeah, and I see that people wanna self-diagnose themselves or they’ll zoom in on this tiny, tiny problem.  But sometimes we can’t get to those tiny problems if we don’t zoom out and hit on the foundation that’s going to help improve that tiny problem downstream where we may not even need a specific protocol for X, Y, Z tiny problem because we fixed–we zoomed out and fixed the big thing that’s at the top of the chain.

Dr. Justin Marchegiani:  Absolutely, and a lot of my patients have H. pylori infections and H. pylori is this gram-negative bacteria that actually produces toxins called lipopolysaccharide or endotoxins, but it also produces an enzyme called urease which takes the urea which is a by-product of protein metabolism, right?  Protein’s di–protein digestion primarily happens where?  In your stomach.  So it takes that urea and metabolizes it into CO2 and ammonia.  Ammonia has a pH of 11, so it will actually lower your stomach acid levels, meaning it will raise the pH, right?  Remember low pH, 2 or so, is where you’re–where you’re nice and acidic, where your stomach should be so it will actually raise the pH, okay?  And that will make your stomach acid levels go lower, alright?  Don’t get that confused, so when pH goes up, stomach acid levels go lower, so it’s kind of an inverse opposite thing and that will affect your body’s digestion.  So we can’t just give HCl or enzymes and just say, “Hey, the problem’s fixed, even though I’m feeling better.”  Because if there’s an infection, especially H. pylori, we gotta get to the root cause.

Evan Brand:  Yeah, what’s your favorite for that?  Do you like the breath test?

Dr. Justin Marchegiani:  Breath test can be helpful and what’s the breath test looking at?  It’s looking at an excessive amount of CO2 essentially.  Well, why CO2?  Well, we just mentioned, right?  What’s the mechanism?  Urease from H. pylori takes the urea and pumps it out to ammonia and CO2.  So it’s the–the by-product of what the H. pylori is doing.  It’s what’s making the CO2 go up.  So breath test can be helpful.  We’ll look at stool antigen and stool PCR, which is stool DNA.  And then we’ll also look at blood which is IgG, IgM, and IgA and that’s kinda looking at an immune response to the H. pylori.  But I like the–the stool the best.  That’s gotta be my favorite, PCR and stool antigen which are great.  So we’re looking at a piece of the DNA and we’re looking at a piece of the actual infection in the stool.

Evan Brand:  Nice.

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

Evan Brand:  No, I’m loving it.  Keep going.

Dr. Justin Marchegiani:  So I find a lot of conventional docs, they miss the digestive support element and even the functional medicine docs, they miss the digestive support element or they don’t hit it at a therapeutic level, that’s step 1.  And then step 2 is they miss that deeper underlying infection.  And a lot of times, it may not just be an H. pylori.  It may be an H. pylori, a parasite, and a fungal issue.  So I see a lot patients because you know, candida programs are really pop–you know, popular these days, or they’re just doing a candida program but they have candida, but they also have an H. pylori infection and a parasite, and again, H. pylori and parasites, they’re more on top of that pyramid in our infection hierarchy where it’s kinda like if you just knock out the candida, it’s like pulling grass out at the surface–I should say, it’s like pulling a weed out at the surface.  If we don’t get to the root, that weed’s gonna grow back so a lot of people are treating gut issues even SIBO for instance, but there’s a deeper issue underneath at the root that may be an H. pylori or a parasite, and all the SIBO programs and all of the candida programs may not be enough to get to the root issue.

Evan Brand:  Great, yeah.  Great point, and once again, cookie cutter doesn’t work, that’s why you need a practitioner to do this stuff.  It gets–it gets complex sometimes real quick.

Dr. Justin Marchegiani:  Yeah, I know you have a lot of experience, too, so as well as if anyone’s like thinking about this and like, “Alright, you know, I’m gonna try some of this HCl.  I’m gonna try this.”  If you wanna dig in deeper and see if there’s any other root causal issues, that will be your next step to–to dig in at least ensure there’s nothing else lingering under the surface.

Evan Brand:  Yup.

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

Evan Brand:  No, I think this is a great overview.  I think we can make it a lot longer, but there’s no need to because we have covered the bases and the foundations of digestion pretty well, so good job.

Dr. Justin Marchegiani:  Yeah, you, too. And I think, you know, what we’re specializing is really foundational information because you can get minute and you can do this study or that study, or this isolated nutrient or whatever, but again, if the foundation isn’t there, people aren’t gonna benefit.  They aren’t gonna get better so I hope people just walk away with a good foundational take home and also, remember one thing.  Hydrochloric acid, taking HCl is not gonna lower your own production, okay?  So that’s a good thing.  It’s not like taking testosterone where your–your, you know, the organs act–that make testosterone actually shrink, right?  You’re not gonna have that issue so with taking HCl, it’s not gonna affect our body’s production of it.  It actually takes the stress off our gut so we can actually heal.  So kinda keep that in mind, too.  If we take some of these things, even long term, it’s not gonna hurt our own internal production.  It’ll actually only help it.

Evan Brand:  Great point.  Yeah, I’m sure a lot of people are questioning that.  Is it safe long term?  And the answer is yes.

Dr. Justin Marchegiani:  Yeah, because the–the main signal for HCl production is gastrin and they’ve done studies looking at gastrin levels while on HCl over periods of months and time, and the gastrin levels did not drop while on HCl which is good.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Alright, Evan, man, hey, great talking to you, bud.

Evan Brand:  Yeah, sounds good.  You, too.

Dr. Justin Marchegiani:  Bye.

Evan Brand:  Okay, bye.








Thyroid nutrition for optimal thyroid health – the adrenal, gut, brain and thyroid connection

By Dr. Justin Marchegiani

There are certain nutrients essential for thyroid health, yet often times doctors are not checking to see if they are a root cause of a person’s thyroid issues. Today’s talk is going to be on nutrition for your thyroid, how important nutrients and nutrition are for healthy thyroid function. We’ll do a brief overview of how the thyroid works in case you haven’t seen any of my past videos on the thyroid. Just so you’ll have some foundational info so you can see how healthy thyroid works. And then know what you need or what maybe you’re missing that’s preventing your thyroid from functioning optimally on the nutritional side.

Overview of Thyroid Hormone Production

So let’s outline how the thyroid hormonal cascade or domino rally works.  The first step we have is really the brain signalling down to the thyroid.  This pathway is known as our TSH or our thyroid stimulating hormone.  Our TSH is coming from the brain particularly the pituitary and it’s telling the thyroid to make thyroid hormone.

Now from there, our thyroid then spits out some T4. About 20% of that T4 actually gets converted to T3 at the thyroid and about 20% and we’ll review some of the nutrients that we need to help that conversion.  So 20% actually happens in the thyroid gland. The other 80% actually happens peripherally.  So we look down at that 80%, 60% of that 80 actually happens at the liver.

What do we need for optimal thyroid function?

Liver Health

Healthy liver function is very important.  So if we’re getting toxins in our food, chemicals, various plastics, we’re not getting enough sulfur-based amino acids or antioxidants in our diet to run those pathways. Our liver maybe burdened and that may affect our body’s ability to convert and activate thyroid hormone.

One of the enzymes that’s responsible for thyroid conversion, the 5-deiodinase enzyme–you break it down 5-deiodinase. De-i is taking an iodine off.  So the T and the number 4 stands for how many iodines there are.  The 4 stands for the number of iodines.  So where de-iodinate something, we’re pulling an iodine off and that’s why it goes from T4 to T3. It’s because we’re pulling 1 iodine molecule off it.  We’re doing it with that liver-based enzyme known as the 5-deiodinase enzyme, which is selenium-based.

So things like egg yolk, seafood, nuts, seeds–things like that are going to be very rich in selenium. We’re going to need these for that liver enzyme to work.  And selenium is also a strong precursor to glutathione.  So selenium also helps with our detoxification. It also supports the liver.  Liver is very important for thyroid hormone conversion.

Gut Health

We need good, healthy gut bacteria because about 20% of conversion is responsible in and around the gut with acetic acid or the various sulfatase enzymes. And these enzymes are important at taking inactivated T3 and activating it.

So if you have dysbiosis or imbalances in gut bacteria from various infections, pathogens, or even small intestinal bacterial overgrowth, that can throw off the balance of your gut bacteria. In addition, it decreases your gut’s ability to activate thyroid hormone.

Adrenal Health

The adrenals are profound. It’s very, very important for activation of thyroid hormone. Mainly because of the fact that if we’re under adrenal stress, that can increase our reverse T3 levels.

So really simple, I count the adrenals as being a 20% contributor of activating thyroid hormone.  It does it a couple of ways.  If the body is under too much stress, cortisol is too high and if we have high cortisol. We’ll have more reverse T3s. And reverse T3 is inactive T3. If we have our receptor site for the thyroid hormone and reverse T3 molecule gets in it, that does not have the same metabolic effect of the T3.  The T3 can’t make its way into the receptor site because the receptor site is blocked.

So that’s kind of how reverse T3 works.  It’s like taking a gun and putting bullets in the magazine to that gun that are blanks.  So you got to fire that gun and the effect that you’re looking for is that bullet to come out. But then all you hear is the noise. You don’t get the actual end result. Metabolically, we see a hormone in that receptor site.  But it’s a hormone that doesn’t have the same type of stimulation that thyroid hormone does at the nuclear receptor site level.

Are you worried about your thyroid condition? Click here to get help.

Thyroid nutrition


We need healthy levels of cortisol for thyroid conversion to happen. So the adrenals are also affected because of high levels of cortisol, stress, etc. This can actually affect TSH. TSH levels can go off with extreme amount of stress via cortisol. And if we’re depleted, if our adrenals are so dysfunctional where cortisol levels are now low, like at a stage 3 adrenal fatigue person, then we’re not going to have enough cortisol to make that conversion happen. And we need cortisol to really activate that thyroid hormone.

Thyroid Temperature Assessment

When we do thyroid temperature testing, we’ll see the following:

  • chronically low temperatures: low thyroid function
  • aberrations in temperature greater than .3 degrees Fahrenheit: adrenal stress
  • straight low temperature: thyroid dysfunction
  • low and aberrant: thyroid and adrenals dysfunction
  • normal and aberrant: adrenal dysfunction

So that’s a great way that you can use temperature to assess whether you have a thyroid, adrenal issue, or both.

Nutrients for Thyroid Hormone Activation

Now that everyone has a good background of how the thyroid gland is converting a lot of these T4 and T3 into active hormone, let’s talk about some of the nutrients that are involved for activating thyroid hormone.

Vitamin A, Zinc, Amino Acids

The brain needs vitamin A.  It needs zinc, it needs B vitamins, it needs protein, asparagine, the various amino acids to make our TSH.  That’s the signaller.  So TSH is an inverse hormone.  It goes high when thyroid hormone is low and it goes low when thyroid hormone is high.

If I’m yelling at someone and I’m not getting their attention, I’ll have to raise my voice louder until I get their attention.  Think of that as what TSH is doing.  The brain is yelling down to the thyroid to make hormone. If it’s not high enough, it will increase the amount of TSH. This is a very bad indicator to use for thyroid dysfunction because it’s so late stage.  It comes on so late in the game, 5 to 10 years down the road, we really want to be looking at the actual active hormone downstream, the T3 that’s activated down here.

This is much more important and much more indicative of an early stage thyroid issue. And a lot of times people may have fine levels of TSH because T4 feeds back into the brain better than T3.  We could have normal levels of T4 but have low levels of T3. And it may not even be reflected in the TSH.  I see that all the time in my patients.  That’s why we got to be very careful.  We actually have to look at TSH, T4 free and total, T3 free and total. Maybe even look at reverse T3 as well, and the thyroid antibodies.

Gut issue

We talked about the nutrition, vitamin A, zinc, various B vitamins, and protein for healthy thyroid hormone function knocking that first domino over which is TSH.  If we have a gut issue, you can see nutrition isn’t just given.  If we take in nutrient-rich foods, but we have a gut issue and a malabsorption and low stomach acid and dysbiosis and infection, you can see how that may impede the absorption of these nutrients, thus causing deficiency even though we’re having a really good diet intact.  So keep that in mind, we always got to look deeper at the gut, deeper at the liver, and deeper at the adrenals.  We can’t ignore these three body systems.


Iodine is an important nutrient for thyroid hormone creation.  So the process known as iodination involves iodine and tyrosine being cleaved together.  The T actually stands for in T4 or T3, it stands for tyrosine. That’s an amino acid.  The 4 and the 3 stand for the number of iodines.  So we don’t need too much iodine to have this healthy conversion and this activation.  There’s a lot of debate out there that we need more high milligram range.  Some say we only need the RDA, a couple hundred micrograms, 250 or so to be exact to make our thyroid hormone.

Iodine and Hashimoto’s

Again, we got to be careful because iodine can be a strong stimulator of autoimmunity.  There’s a great deal of research showing that excess iodine can actually stimulate Hashimoto’s.  It activates TPO or thyroglobulin antibody that can increase thyroid destruction.

Iodine and Selenium

A lot of people say that the reason why iodine’s a contributing issue with autoimmune condition is because people also are very, very low in selenium. And when iodine is being fused to thyroid hormone via this process known as iodination, what happens as a result is hydrogen peroxide gets kicked out.  This hydrogen peroxide can be very inflammatory and can cause our B cells to come up and infiltrate and start attacking the thyroid tissue.  So that’s why if you’re giving any amount of iodine, you want to make sure there are adequate levels of selenium there. Because selenium comes in and it actually neutralizes the hydrogen peroxide, pulls an oxygen off it and makes it H20 which is water, which is very benign.

You can see giving iodine and not having selenium there by its side can definitely be a recipe for destruction.  So with iodine, be very careful of it.  Make sure you’re working with a functional medicine doctor.  Also, make sure you’re not autoimmune or have any autoimmune symptoms before you give iodine at higher levels.  A couple hundred mics will probably be okay, but double check with your functional medicine doctor.

Again, you can see iron is really important.  If you have a microcytic, hypochromic anemia, that’s going to be a major issue.  We need iron to make thyroid hormone but we’d also need iron to help carry oxygen throughout our body.

B Vitamins

B vitamins–B6 is super important because B6 helps with dopamine activation. And if we go up one stream here and we look at the hypothalamus, which is the top part of the brain, we actually need dopamine from the hypo–dopamine production to actually stimulate the hypothalamus to make TRH.  And TRH is important at stimulating TSH. So dopamine is essential and a lot of people may have neurotransmitter issues that need to be fretted out doing an in-depth organic acid test.


Summary of Nutrients

Iodine, Tyrosine, Iron

B Vitamins

Your B vitamins are really important for energy, for making the Krebs cycle go around.  I did a video on the mitochondria recently.  Take a look at that video to get more info on B vitamins.

Vitamin C

This is a really important antioxidant and helps the adrenals as well.

Vitamin D

This is really important for immune function.  A lot of people with Hashimoto’s and hypothyroid autoimmune issues tend to have a vitamin D polymorphism at the receptor site of the vitamin D receptor and they need higher levels of vitamin D, 70 to a hundred.  Be very mindful if you have an autoimmune thyroid.  Make sure your vitamin D levels are up at 70-100, just to make sure you have that therapeutic immune balancing effect.


We already talked about the nutrients needed for our T4 to T3, that selenium is essential, also for the autoimmune effects of helping to neutralize the hydrogen peroxide into water.


Zinc is important for thyroid conversion. It is also essential for sex hormone production, esentially for making testosterone. And then also it’s an important building block for making hydrochloric acid.  If we don’t have hydrochloric acid levels adequate enough, we won’t keep a nice low pH in the stomach.  So if we don’t have that nice low pH, we won’t be able to break down protein and fat adequately. We’ll have a harder time ionizing minerals.  And we need to ionize minerals and hit them with hydrochloric acid, so then we can then take them in our blood and they’re not like rocks floating in our bloodstream.  We actually want to ionize them so they’re absorbable.  So that’s really important.  If we have issues with these nutrients, we may see other problems in the thyroid hormone chain that could be happening as well.

Have your thyroid checked and get it tested now! Click here to get a free functional medicine doctor consult.

Thyroid Testing

Like I mentioned, a thyroid autoimmunity is a big issue–40% of people that test for thyroid autoimmunity actually test–they are a false negative.  They may come back negative but they may still have a positive thyroid.

So make sure you get your thyroid looked at either palpation-wise and/or if you need, get an ultrasound run just to make sure there are no nodules or inflammation in the thyroid that could be caused by Hashimoto’s.

Outside of that, if you have a thyroid issue or nutritional issue or neurotransmitter issue that could be affecting your thyroid, and you’re not quite sure the next step to take, click on screen.  Again schedule a consult with me, subscribe to the videos, and get my Thyroid Hormone Balancing Series for more information how you can get your thyroid back into balance.

Estrogen dominance, female hormones and your health.

By Dr. Justin Marchegiani

Estrogen, one of the two main sex hormones that women have, is responsible for female physical features and reproduction. Today’s talk is going to be on estrogen dominance.  Again, anyone that has female hormone symptoms for the most part, it is going to be a contributing factor to why you’re having those symptoms.

So I’m fresh off an interview I did today where we talked about estrogen dominance in one of the local summits that went here and I want to dig in a little bit deeper and give you some of the tidbits and the factoids of what causes estrogen dominance. Also, how it actually looks on the lab work, and what are some simple things that you can do to help to start improving it in the right direction.

What is Estrogen Dominance?

We have this ratio of estrogen that’s a little bit higher in relation to what the normal ratio of progesterone should be.  So let’s establish what those norms are.  So Dr. John Lee talks about the fact that progesterone to estrogen, that amount of progesterone to estrogen can be anywhere between 200 to 300 times.  So progesterone can be 200 to 300 times more than 1 molecule of estrogen.

Now typically, we see this 200 to 300 per ratio right around day 20 of our female cycle.  Day 20, so right here is where we typically see this ratio intact.  Now right around day 20, we could be making about 200 micrograms of estrogen. While we’re making 20 to 25 milligrams of estrogen, that 200 or 300 time ratio can be seen.

Now if you add all the plots of progesterone up in blue and all the plots of estrogen in red typically on average, this will be day 18 to 22 roughly.  But if we’re looking at an average, typically you’re looking at about the 23 to 25 times ratio for progesterone in relationship to 1 estrogen.

To delineate, typically around Day 20, we’re looking at a 200-300 progesterone:1 estrogen. While over here, a 23-25x progesterone:1 estrogen, in general.

So, this is from a research of what Dr. John Lee.  He’s written a couple of books on this topic.  So when we do a month-long cycle, we can really delve in and see some of these imbalances.

Got female cycle problems? Click here to get more in-depth information on how female hormones work in your body.


Female Hormone Cycle Overview

Let’s walk through normal female hormone physiology briefly.

  1. Drop in hormones: This triggers menstruation or bleeding. That’s important because it’s causing the endometrial lining to slough off.
  2. Menstruation / Bleeding / Period
  3. Increase in FSH. This increase in FSH grows that follicle into an egg. That follicle then starts to produce an increase in estrogen.
  4. Increase in estrogen: Increase in this hormone causes LH or luteneizing hormone to trigger increase in progesterone. It peaks typically around day 12 or 13.
  5. Increase in Progesterone: It spikes typically around day 18 to 22. That’s where the ratio 200-300 progesterone:one molecule of estrogen can be seen.
  6. Drop in Progesterone

That’s our normal female hormone cycle and typically we start to see the ratios skewed. Our average Progesterone:Estrogen (P:E) is 23-25x. And at day 18-22, it is about 200-300x.

That is estrogen dominance affecting the female cycle. We start to see these ratios skewed.  So estrogen dominance would be occurring when we start dropping below 20. Most women I see are in that 20- 50 to 20-80 around their peak, where they have significant less progesterone, but they also have a lot less estrogen, too.

Female Hormone Level Imbalance

I see a lot of women whose hormones are very depleted where the ratio may not be great, but it’s the hormone level by itself that is may be even worse.  So estrogen dominance is really just looking at a ratio.  You can still have low estrogen and low depleted hormone levels and still be estrogen-dominant.  That’s kind of a big myth and depleted hormones make it really hard for you to heal and regenerate.

So looking at estrogen dominance symptoms, we have bloating, cramping, fibroids, tissue growth, moodiness, and endometriosis. It is a hormone signal that causes cells to grow.

Progesterone is a hormone signal that causes cells to grow up, ideally mature. So growing is like me lifting weights and just getting big. So that’s the estrogen analogy. The progesterone analogy is like a child growing into an adult. One is maturation.  One is just bulk.

Now estrogen is important because we need that when it comes to certain tissue like in the endometrial lining, but progesterone is important to help that egg bond to the endometrial lining and then essentially maturize into a grown baby.  That’s the goal and that’s why these hormones, they’re on a teeter totter and they’re incredibly important.  But if we have this imbalance in progesterone and estrogen, all of those estrogen dominance symptoms can happen.

Kinds of Estrogen

So we have a couple of different kinds of estrogen.  We have DHEA which is a part of the adrenal hormones, but it’s also part of the ovaries, too.  That converts to our main estrogen, estradiol.  Estradiol, otherwise known as E2–look at that prefix here with the di, E2 can get converted into E1.  You can see the estrone–look at the O-N-E.  And this can go either one of two ways.  It can go to our 2, which is our more healthy estrogen or it can go to our 16, which is our more anti-healthy, unhealthy, disease-promoting estrogen.

And again, our ratio is we like to have greater than 2 over here to 1.  So we like a 2:1 ratio or greater for healthy estrogen balance.  Estrogen dominance is kind of the macro view, the telescope view.  Now we’re looking at estrogen metabolism.  That’s more of the microscope and the microcosm view.  These are just how estrogen is being metabolized.  But this is important, too, because you can have more bad estrogens on this side of the fence, and then you may experience more estrogen dominance symptoms because of the fact you have this imbalance ratio.


The Metabolic Process in relation to Estrogen

Estrogen dominance is estrogen in relationship to progesterone. But we also know that how estrogen is metabolized can also create estrogen dominance symptoms.  So a lot of people that we see–we’ll run organic acid testing and we’ll look at these various organic acids like sulfate or pyroglutamate, hippurate, glucarate,. Also, we’ll see backed up metabolic processes or pathways to metabolize these hormones.  Another is we see something known as beta-glucuronidase, where we have an inability to metabolize some of these estrogen hormones.

So think of beta-glucuronidase as an enzyme and it’s there to take the straitjacket off of our metabolized estrogen.  So when our body goes and metabolizes hormones, it conjugates it.  It binds a protein to it. In other words, puts a straitjacket around it so it can escort it out to the kidneys and the liver and the stool.

Now beta-glucuronidase, this enzyme occurs when we have dysbiosis, a high amount of bad bacteria in the gut, in relationship to good bacteria. That beta-glucuronidase comes in, it unhooks the straitjacket and now the estrogen can go back and become reabsorbed and create lots of hormonal issues.

Again, estrogen also makes bile sludgy and this is why people that have estrogen dominance can also have digestive issues because bile is so important for fat breakdown. And you actually need good fats to make your hormones. So you can see how estrogen and digestion actually compound each other and make your hormone issues worse in the future. If you can’t make bile, you can’t break down fat. And if you can’t break down fat because bile is needed to break down fat, then you can’t make the fat into your hormones.  So you can see how one problem actually makes the other problem worse and worse as you go on.

Estrogen in the Body and in the Environment

Bad amount of beta-glucuronidase from this imbalance in bad bacteria and infections then takes the straitjacket off all these metabolized estrogens.  They get reabsorbed into the system and that can create more hormonal havoc.  So you can see, estrogen dominance in our cycle.  We can see it through our metabolites and then now we can break it down via the environmental causes.


The gut, through the beta-glucuronidase, through the dysbiosis, through the SIBO, through parasitic and fungal and bacterial issues.  All of these things cause low stomach acid and low enzymes, inability to break down food.  We can’t break down our food.  Our food sits in our tummy.  It rancidifies.  It putrefies and it makes the problem worse.  So one problem kind of begots the next.


So the pesticides, the chemicals, the GMOs.  Again, these pesticides are estrogenic-based.  So they go into our body and they have an estrogenic load to our body.  So pesticides add more estrogens.  The plastics contain estrogens as well.  And again, estrogen cause cells to grow.  The scientists back in the late 1990s, Dr. Sotomayor, over at Tufts found that when she put her cells into the plastic test tubes, that the cells would grow more vigorously in these test tubes, kind of like cancer does. She found that it was the plastic test tubes especially the BPA was causing those cells to grow.


So now flash forward, people are putting their food and their water in plastics all over the place and we’re reabsorbing those chemicals which cause our cells to grow. This is because they have an estrogenic like effect.  So environmental estrogens from food and from plastics and then also from phytoestrogens contribute to estrogen dominance.


Soy can be devastating because there’s a lot of gut and enzyme inhibitors in it such phytic acid and oxalic acid and chymotrypsin in various trypsin inhibitors, which affect protein breakdown but they’re also estrogenic.  They can add to your hormone levels of estrogen and for many, can be incredibly devastating because estrogen is the opposite of testosterone.  And men need testosterone to be healthy and virile.


So again, we have the gut and we have food.  We have phytoestrogens and we have plastics, and again all of these are so important. Also, if we don’t have the gut working, we don’t have the building blocks to make the hormones, which then makes the problem even worse.  For so many people, it’s hard for them to wrap their head around the fact that their gut could be a potential hormonal causing factor that could be driving a lot of their hormone issues.  People think the gut and the hormones are like two separate things.  “Hey, if I don’t have digestive issues, well, there’s no way that’s part of my hormonal issues,” but it can be.


If you have a hormonal issue or long-term issue, we may want to run a month-long test, if not, a test that looks at hormones especially in the sensitive time of your cycle around day 18 to 22.  We may also want to do an adrenal test to get a window into how your adrenals are functioning because your adrenals produces a significant amount of DHEA, which is depleted in people that are chronically ill.

We also want to dig into the environmental and lifestyle causes over here that could be driving the issue.  And there’s a lot of natural cyclical augmentation programs and adrenal programs and gut-healing programs that we do on the functional medicine side to address the underlying cause of what’s driving these issues.

So click on screen, subscribe to my female hormone balancing video series. And if you’re struggling with this issue, and you want to take it to the next level and get to the root cause, reach out on screen or below and I’m always here to help.

Discover the root causes of your female cycle issues by contacting a functional medicine doctor.

Michele Rosenthal – Getting to the root cause of PTSD and healing emotional stress – #Podcast 63

Dr. Justin Marchegiani and today’s guest, Michele Rosenthal, talk about everything PTSD. From identifying who gets posttraumatic stress disorders to discussing strategies to help with PTSD recovery. Michele speaks about the importance of being ready to go through the recovery process in order to succeed.

michele-rosenthal-heal-your-ptsdMichele also shares with us her wounded healer journey and how she was able to recover from PTSD with her non-pharmaceutical approaches in this podcast interview. Learn about hypnosis and neuro-linguistic programming and how these can significantly aid in PTSD recovery.

In this episode, topics include:

7:53   approach and techniques to support healing

11:48   hypnosis and neuro-linguistic programming

18:45   tension and trauma-releasing exercises and power postures

22:48   breath work and breathing exercises

25:38   meditation and coaching








Podcast: Play in New Window|Download

Dr. Justin Marchegiani:  Hey, it’s Dr. Justin.  Welcome back to Beyond Wellness Radio.  Today I have Michele Rosenthal on and Michele has just come out with her book, Heal Your PTSD.  She is a PTSD or post stress disorder expert and again, Michele is an award-winning blogger at PTSD Blogger.  She’s a best-selling award-nominated author.  She’s the host of the program, Changing Directions, and the founder of  She’s a former faculty member of the Clinical Developmental Institute for Timberline Knolls Residential Treatment Center.  Michele is also a trauma survivor who struggled with PTSD stress order for over 25 years.  Then she’s launched her successful healing rampage program.  Now Michele’s been 100% free of PTSD symptoms for almost a decade and we’re talking about her book, Heal Your PTSD.  Well, Michele, welcome to the show.

Michele Rosenthal:  Thank you so much, Dr. Justin, for having me and I appreciate your focus in this area because it’s so important especially today, September 11.

Dr. Justin Marchegiani:  Totally. I–I agree.  Well, tell a little bit more about yourself and how you got into this niche.

Michele Rosenthal:   I–I lived the niche.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   In 1981, I was just a 13-year-old kid living a very normal, very fine life, and I ended with a run-of-the-mill infection.  The doctor gave a run-of-the-mill antibiotic–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:    And what happened after that was anything but run-of-the-mill.  It was–

Dr. Justin Marchegiani:  Got it.

Michele Rosenthal:   Undisclosed. Unknown to us.  I had an allergy to the medication–

Dr. Justin Marchegiani:  Mmm.

Michele Rosenthal:   And so I ended with toxic epidermal necrolysis syndrome, which is a fancy way of saying that the medications worked its way out of my body through the skin and turned me essentially into a full body burn victim.

Dr. Justin Marchegiani:  Wow.

Michele Rosenthal:   So over the period of a few weeks in a quarantine burn unit hospital room, I lost 100% of the first two layers of skin, and that could traumatize just about anybody.

Dr. Justin Marchegiani:  Oh, my gosh!  Alright, so we typically we think of like these posttraumatic stress disorders–we kind of associated them with war and battle but it sounds like you came about this from–from a different angle.

Michele Rosenthal:  You know–excuse me, that’s just a great point because we do–the media makes it seem like the only people who have PTSD are our veterans.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And I highly respect them.  I’ve worked with them.  I work hard to help them.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  They are so important in our PTSD community and yet they are a portion of the PTSD community.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Actually speaking, 1 in 3 cancer survivors end up with posttraumatic stress disorders, 1 in 4 heart attack and stroke victims, domestic violence, child abuse, sexual assault, car accidents, natural disasters.  Posttraumatic stress disorder can come from anything.

Dr. Justin Marchegiani:  Uh-hmm.  So looking at that, like where’s that line cross from just encountering a really crappy situation for it being actual a–a PTSD situation.  How–how does that line get drawn?

Michele Rosenthal:  I think that’s a very personal line.  Up to 70% of all US adults will have some kind of major trauma in their lifetime.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  But only 20% will end up with posttraumatic stress disorder and for those of us that do get stuck there, it’s a combination of personality, history, childhood programming, the biology of trauma, how trauma affects your brain, the neurophysiological response that you have to trauma.  So a lot of different factors come in to play to–to create your post-trauma response, and for some people that means PTSD and for another–really the majority of people that means moving through a post-trauma transition and then being free and moving on.  Or for those of us who get stuck, it’s a variety of factors that hold us there.

Dr. Justin Marchegiani:  Got it.  And it’s really interesting because you’ve kinda gone through that wounded healer type of journey where you were 13 you had this allergic reaction, you had this post–this posttraumatic event.  So you’re 13, you lost your first 2 layers of skin via this allergic reaction.  What happened next with you and how did you–how did you deal with it?

Michele Rosenthal:   It was incredibly hard.  You know, this is such a rare illness.  Only 1 in 2 million people end up with it.  None of my doctors–

Dr. Justin Marchegiani:  Wow.

Michele Rosenthal:   Had ever seen it.  And–

Dr. Justin Marchegiani:  Well, I’m looking at your pictures today, I mean, you seem like you–you must have made a 100% full recovery.

Michele Rosenthal:   You’re so right and I’m so lucky because not everybody looks that way.  I–I was very fortunate.  I had great care.  My parents were amazing.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And what happened to me really that destroyed me was more what happened afterward, I–you know, you survive a trauma any way you can.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And I had a near-death out-of-body experience and an enormous amount of pain and when I came out of the hospital, the doctors told me you won’t survive this again.  So you are living in a body that you have to be very careful with–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And I thought, “Oh, my God.”  And Dr. J, think about it.  When you were 13, what kind of coping mechanisms did you have for major trauma?

Dr. Justin Marchegiani:  Wow. I mean, not much.  I remember being 13, you didn’t have the confidence, the self-awareness, you relied a lot on your parents. Yeah, that’s a tough situation to be in.

Michele Rosenthal:   You’re so right and so I came out of the hospital not really knowing how to cope–

Dr. Justin Marchegiani:  Mmm.

Michele Rosenthal:  And very unable to process and all I wanted was to get as far away from that experience as possible and so when I started exhibiting posttraumatic stress disorder symptoms which happen very, very soon after I–I was released from the hospital, nobody recognized them.  It was the early 1980s.

Dr. Justin Marchegiani:  Mmm.

Michele Rosenthal:   PTSD only became a–a diagnostic criteria that was recognized in 1980–this was 1981 and it was only being applied to the military at that time.

Dr. Justin Marchegiani:  Right.

Michele Rosenthal:   So there’s a psychiatrist that my parents took me to said, “Oh, she’s resilient.  She’s a kid.  She’ll bounce back.”  But I didn’t.  I descended into place of anxiety and depression and mood swings and frequent rage and nightmares–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And insomnia.  And for the next 24 years, thought that that was who I was.

Dr. Justin Marchegiani:  Right.

Michele Rosenthal:   I thought I–you know, some people are supposed to be crazy and I’m one of them.

Dr. Justin Marchegiani:  Right.  So basically, you knew you were going to this PTSD event because of the linger depress–the lingering depression and anxiety and mood stuff that didn’t just quite go away after the experience.  Is that kinda how you knew something else was deeper?

Michele Rosenthal:  No, actually. I mean, I wasn’t conscious enough to know that or–or mature enough.  I really–I really just thought this is who I am.  I didn’t understand that it was PTSD until I was so dysfunctional.  I had lost my job.  I was floundering in life.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   And–and I started looking at, “Okay, I need help.” And–and when I started getting into the “I need help” process–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   And researching the symptoms that I had, little by little the literature led me to PTSD and it was at that time that I actually took a self-test we have on the website, a self-test for PTSD–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  It’s actually the one I took when I was in recovery and then I took that to a trauma-trained professional and said, “What is this?”

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:   And–and from there I got my diagnosis and–and started recovery.

Dr. Justin Marchegiani:  Got it.  Well, we see with our troops today, a lot of the–the mainline therapy is for PTSD out there–a lot of them stem around pharmaceuticals and SSRIs and such.  So how did your approach to get better differ from a lot of the mainline therapeutic techniques?

Michele Rosenthal:  It–it didn’t, because there–there–there’s no one way to heal–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  PTSD and it doesn’t necessarily change depending on what your original–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Trauma was. Because my original trauma was medical and related to a medication, I know you’ll understand when I tell you–

Dr. Justin Marchegiani:  Yup.

Michele Rosenthal:   I didn’t wanna have anything to do with pharmaceuticals.

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:   Because I was terrified.  So–so I did it, you know, hardcore which was not easy.  But–but I–I really think we overprescribe medication–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  For PTSD recovery.  And I’ve worked with clients who, you know, I–I actually my very first client came to me.  She’d been in 3 medications for 10 years and her psychiatrist and psychoth–psychologist had told her, “You can’t heal PTSD. You just have to learn to live with it and we’ll keep upping your medication,” and that made her unable to do anything.  So I–I think there’s a place for pharmaceuticals–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  But that’s at the extreme and they’re only to be used to allow you to be functional enough to do the work of recovery.  And if you can avoid them, I and many other professionals really promote that you do.  Because getting off of those medications is–is a thing all by itself.  It’s not easy.

Dr. Justin Marchegiani:  Right, right.  Well, I know there are a lot of good techniques out there to help deal with stress.  I know EMDR or the eye movement desensitization techniques, EFT or these various tapping techniques, also talk therapy.  I also see a lot of patients that come in with PTSD and we run adrenal testing and they’re adrenals are shot.

Michele Rosenthal:   Mmm.

Dr. Justin Marchegiani:  They’re at total stage 3 adrenal fatigue and they have a hard time managing and dealing with and adapting to stress.  So what techniques did you use–also talk therapy, too–what techniques did you use that found to be, you know, the biggest support for you in healing?

Michele Rosenthal:  I started as many of us do in talk therapy–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And got into behavior therapy–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  Which–which I think is so important.  It gives you a good foundation for learning how to consciously be aware of what’s your feeling and why and to put words to the chaos–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  That’s in your head and–and share those words so it gets out of you and into the world.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Which allows you to–to reclaim a certain amount of control.  So I started there and then we use many of the things that–that you’ve referenced, EMDR, EFT, thought-feel therapy–

Dr. Justin Marchegiani:  Yup.

Michele Rosenthal:  Tapas acupressure technique.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  Chiropractics.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   I–I would try anything.  What I found in my recovery was all of those that worked with the conscious mind and the energy processing were great and they have their place and I got functional.  I could go back to work and that was fantastic.  The problem was I still had all my symptoms.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   They were just modulated and I was better able to manage them.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   And–and so I discovered later, just by trial and error, what I believe now is so important to understanding recovery, which is this, that your mind is divided into your conscious and your subconscious.

Dr. Justin Marchegiani:  Mmm.

Michele Rosenthal:  Let’s just say those predominant ways, and you’re conscious mind is 12% of your brain.  It’s–

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:  Your short-term memory, your logic, your analysis, your reasoning.  And your subconscious mind is 88% of your brain.  It’s all of your long-term memory.  It remembers everything that’s ever happened to you.

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:  It drives 100% of your behaviors based on the beliefs that you hold.  So any recovery to be successful and truly freeing, I believe, has to use 100% of your brain.  Not just the traditional, but also the alternative processes that access the subconscious mind.  Things like hypnosis, neuro-linguistic programming–

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:  Those kind of processes that incorporate both sides of the mind.

Dr. Justin Marchegiani:  So which techniques for you made the biggest difference in re-wiring that subconscious?

Michele Rosenthal:   Actually hypnosis and NLP, neuro-linguistic programming.  And so much did they impress me that I went on and got trained in them and now I use them with a lot of my clients and I see the benefits over and over.  Partly I think they’re useful because you remain totally in control. I know that’s not, you know, what everybody thinks about hypnosis.  But hypnosis is really just a way of altering your focus so that you can engage the subconscious mind, and we actually go in and out of hypnosis all the time when we’re watching a movie, when we’re going an activity and we don’t realize how much time has gone by.  That’s an altered state of focus.  That’s hypnosis.  So your brain is already doing that all the time.  With hypnosis and hypnotherapy, we actually use the process to help engage the subconscious mind to talk to it in its language, which is a language of symbol and metaphor and story and suggestion.  So you remain completely in control.  You can accept or reject anything that a hypnotherapy says but it’s a–a gentle way to help the subconscious mind, where we start reframing perspectives, beliefs and events in a way that brings relief.  So I–

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:  I love that and I love neuro-linguistic programming because you–you don’t have to be an altered state.  It just–it uses language to literally change the structure of the neuro pathways of the brain.  So you put those two things together and–and there are two very gentle ways of working no matter what your comfort level is.  I–most people can find one or the other that is useful to them.

Dr. Justin Marchegiani:  Yeah, I use–I use NLP, neuro-linguistic programming and various hypnosis programs daily.

Michele Rosenthal:   Mmm.

Dr. Justin Marchegiani:  I use a technology called Zen Frames where I have these various NLP programs that involve hypnosis and I wear these–these glasses that produce various wavelengths to the eyes and I find that’s very helpful and I’ve lots of different programs that I do for, you know, motivation or for self-improvement, and I think NLP is profound, very phenomenal.  How do you apply it?  Like let’s say, can you just kinda just give the average person at home just a visualization of what NLP is?

Michele Rosenthal:   Sure, ab–absolutely.  That’s a great question.  Neuro-linguistic programming speaks to the fact that your brain represents your world in 3 dominant ways.  Sight, sound and feeling.  And it–neuro-linguistic programming puts together neuro, how your brain represents the world with language, the linguistic, and programming and then it helps re-program the brain.  So for example, I have–I’ll give you an example from somebody I worked with last week.  I have a client who child–child sexual abuse survivor–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And has a huge fear of bathtubs.  So you can talk and talk and talk about your fear of bathtubs and why, I mean, she knows why–

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:   She has a fear of bathtubs.  She was abused in a bathtub.  But that makes it incredibly hard for her to take a bath.  So–and–and she likes bathing rather than showering so she wants to be able to take a bath and be unafraid.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   And so what we do in NLP is instead of talking and talking and talking about it, we take the–the feeling and the image that that creates in the brain and we literally start changing the image.  So for example, when we have a–a fearful feeling, that creates an image of the brain that can be totally realistic or abstract, it doesn’t matter, but it creates an image in the brain and then we can change–that image is usually in Technicolor.  It’s usually very big–

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:  It’s usually very close.  We can start changing those kind of elements which are called submodalities.

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:   So we can shrink that picture, change it to black and white, move it from in front of you to behind you.  We change all the different ways that that feeling is being represented in that picture–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   And by the time we’re done with that process, you’d be amazed how the feeling shrinks and is eliminated and how it doesn’t come back because we’ve literally re-wired the way that scenario is existing in the brain.

Dr. Justin Marchegiani:  Yeah, I totally agree.  I mean, I do that exercise in my patients sometimes. We’ll take a really bad memory and then we’ll–we’ll shrink it down. We’ll–

Michele Rosenthal:  Mmm.

Dr. Justin Marchegiani:  We’ll blink it black and white.  We’ll put some circus music in the background.  We’ll–we’ll zip if forward and backwards really fast, and it’s like you’re flattening these neurons so when these neuro connections go to–go to essentially fire again, they’re quite not firing the same way, right?

Michele Rosenthal:   Exactly.  And you know, the whole use it or lose it neurons that fire together, wire together–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Idea of neurology and how neurogenesis works and how neuro pathways are strengthened or weakened.  So when we put all of the science together with this really simple seeming process–

Dr. Justin Marchegiani: Uh-hmm.

Michele Rosenthal:   It’s amazing what can happen.  It sounds like you’re doing great work with that.  I wish I’d known you during my PTSD recovery.

Dr. Justin Marchegiani:  Yeah, I know.  I hear you, I mean, I’ve–I’ve seen a lot of practitioners myself, more just for human performance.  I work with a couple of people that combine NLP with hypnosis and–and tapping and EFT.

Michele Rosenthal:   Mmm.

Dr. Justin Marchegiani:  So we’ll go into various NLP states and where those emotions come up, we’ll kinda tap on some of those points as we go through the NLP, you know, visualization and such.  So I’ve tried combining them and I think it works great.  Have you tried combining them at all?

Michele Rosenthal:  I do.  I use hypnosis and NLP together all the time.

Dr. Justin Marchegiani:  Do you combine the tapping at all, too?

Michele Rosenthal:  I don’t.  I’m not trained in the tapping.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   So I haven’t.  But I can see that it absolutely would work.

Dr. Justin Marchegiani:  Yeah, I’ve seen it work phenomenal and I find that, you know, a lot of your conventional psychologist, psychiatrist or a way author, typically more just in the drug interventions but most of the psychologists, they’re just only working on the conscious mind, just the talking, and I feel like these type of therapies really get below the surface like you said.

Michele Rosenthal:   I think that’s so true and we should also add into this, the somatic therapy.  It’s like somatic experiencing, tension and trauma-releasing exercises, the things that really speak to how the body is holding the trauma–

Dr. Justin Marchegiani:  yeah.

Michele Rosenthal:  And seeking to release it to.  I–I–there’s so many ways to approach the recovery process that are stronger and more to the point than talking about it.

Dr. Justin Marchegiani:  Can you talk about some of those exercises?  Like is there something that our listeners could do right now if they’re not driving or if they’re in a good spot?  Could they do an exercise?

Michele Rosenthal:   Like a–like a NLP exercise?

Dr. Justin Marchegiani:  Oh, you just mentioned an exercise a minute ago just–

Michele Rosenthal:   Oh, tension and trauma releasing–

Dr. Justin Marchegiani: Yeah.

Michele Rosenthal:   Exercises–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Developed by David Berceli.

Dr. Justin Marchegiani:  Okay.

Michele Rosenthal:   He–I–I’m–I can tell you what he’s told me because I’ve interviewed him.

Dr. Justin Marchegiani:  Oh, great.

Michele Rosenthal:   But to really do this, you would need to follow up and–and connect with–with him.  I think it is–it’s, I think it’s his website.  But he–he has an interesting story.  He was administering aid in–in a–in I think a Middle Eastern country and was very traumatized by the war that was going on and he noticed that when we curled himself into a ball, and then allowed his body to release, he was able to relieve some of the stress and the tension.  And then he developed that into an entire modality that he teaches people, so that they can help their body learn to tense and release in ways that relieve the trauma.

Dr. Justin Marchegiani:  Uh-hmm.  Yeah, that makes sense.  Are you familiar with any of Amy Cuddy’s work.

Michele Rosenthal:   Yes, power postures.

Dr. Justin Marchegiani:  Yeah, that’s what–

Michele Rosenthal:   I love them.

Dr. Justin Marchegiani: Yeah, can you talk about some of her work and how–how posture and how you hold your body is important to recovery and your–your emotion and your subconscious?

Michele Rosenthal:   Absolutely, definitely.  And this is one of the main points that we make in–or that I make in Heal Your PTSD.  The book is all about chunking down recovery to find the little things that work for you and power posture is a great example of that.  Because power posture, literally we know that testosterone reduces cortisol.  When we’re in a high stress state like PTSD, your cortisol is usually elevated.  So any time that we want to make that shift from powerless to powerful, which is at the base of PTSD recovery, we learn to do that on a daily basis.  Repetition is how the brain learns.  So the more often you can repeat a process to teach the brain how you want it to be, the more often you will be successful, and power posture is a great way for–to do that.  Because what Amy Cuddy discovered is that there are just certain postures when you put your body into that posture, it immediately increases your testosterone so you drop your cortisol and can put your body into a frame of feeling so grounded and secure that it’s, you know, we have that mind-body loop.  When your body feels that kind of grounding and security, it sends that message to your brain that then sends that message back to your body and you can immediately shift out of a feeling of fear and into a sense of security.  So Amy Cuddy particularly promotes putting your feet up on a desk with your hands behind your head.  And it–it’s a very relaxed looking pose.  That’s her favorite.  I really love sitting in a chair, feet flat on the floor, hands palm down on your thighs and then really rolling your shoulders back, strengthening and aligning your spine, and allowing your hips to pop forward so you’ve got that alignment, and then sitting like that because you can’t always on a bus, when you start to have a panic attack say to everybody, “Move over please, excuse me, I gotta put my feet up and my hands behind my head.”  But this other power position helps you feel grounded and allows you to feel completely connected.

Dr. Justin Marchegiani:  Yeah, I love that.  I know she did the study where she did the power pose where it’s kinda like a–it’s–it’s like if you’re in the Rocky movie and Rocky gets to the top of steps–

Michele Rosenthal:   Mmm.

Dr. Justin Marchegiani:  And he puts his arms above his head and he just kinda puts his arms out and really extends that spine.  I think she saw a significant, like a 20% reduction in cortisol and while a 20% increase in testosterone.  So we can shift our hormones by just out posture and I deal a lot with hormones and gut stuff in functional medicine and it’s–and I do a lot of these salivary tests that measure hormones.  I was just fascinated to see she was doing these same tests and seeing hormones change with just posture.

Michele Rosenthal:   It’s amazing, isn’t it?

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:   You know, there’s so many ways we can change our body chemistry in under 2 minutes.  For example, breath work does the same thing.  Not the same cortisol. I’m not saying that.  But in under 2 minutes, you can change your whole chemical makeup, just by doing breath work.  So I–I think the power of the body as you know so much from you work–

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:   Is amazing.

Dr. Justin Marchegiani:  Uh-hmm.  Can you talk some of the–

Michele Rosenthal:   And we just have to learn how to do that.

Dr. Justin Marchegiani:  Yeah.  Can you talk about some of the breath work that you do with your patients or that you recommend in the book?

Michele Rosenthal:   Yeah, absolutely.  I love, more than anything, square breathing.  It was–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   And I think I love it, because personally it helped me so much, but I love it, too, because I speak a lot nationally about posttraumatic stress disorder and trauma and recovery, and I always–I love to do this exercise in the room where I ask everyone to rate their stress on a scale of 1 to 10 and then we do a group breathing exercise of square breathing.  And just 2 minutes and afterward you can feel the entire energy of the room just come down, and when everyone rates their feeling of stress afterward, they’re so amazed.  It’s just been 2 minutes and it’s breath work.  So my favorite breathing exercise is square breathing which is literally a 4-4-4 count.  4-4-4-4, so it’s 4 sides of a square.

Dr. Justin Marchegiani:  Got it.

Michele Rosenthal:   So you breathe in for 4 counts, hold for 4 counts, out for 4 counts, hold for 4 counts.  Now that’s what I learned, that was back in the late 90s.  What we know since then is that it–it seems–seems to work even better if you have a longer exhale than you have an inhale. And I interviewed a PTSD breath work expert who suggested that the optimal number of breaths per minute is 5 and that the optimal–optimal number for breathing count is 4-4-6-2.  That was from all the research that she had done and so that’s breathing in for a count of 4, holding for a count of 4, releasing for a count of 6, holding for a count of 2 and then starting over.  And I always like to remind people that the first time that you do this exercise and maybe the second time and the third time, the first 3 to 5 rounds of the breathing, you might wanna jump out of your skin and that’s okay.  Because it’s very hard as a survivor to sit still, to trust, to be okay just with your breath.  That’s okay.  If you will allow yourself to embrace the resistance, acknowledge, accept it, validate it and stick with the process of breathing.  After about the fifth round, you will start to notice everything changes.  If you can get to 10 rounds, it will be so much easier.

Dr. Justin Marchegiani:  Got it.  4 in, 4 holds, 6 out, 2 hold.

Michele Rosenthal:  Yes.

Dr. Justin Marchegiani:  Great.  Now how do you incorporate or do you incorporate meditation?

Michele Rosenthal:   Oh, I do.  One of the first things that I did in my own recovery, my therapist taught me transcendental meditation.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And that 1998 and I still do it today because the benefits, I mean, I’m symptom-free.  I have been for almost a decade but I love transcendental meditation.  It feels good.  It’s energizing.  It improves your cognitive abilities.  It focuses your brain.  It reduces stress, so I–I developed a practice right away, after a little bit of initial resistance because again, no survivor wants to sit still and be quiet, so I had a little bit of a–a resistance that I had to work through, but when I did, within a month, I was already seeing the benefits.  I was better able to handle change, better able to handle stress and starting to feel a little more calm throughout the day.  So I teach for all of my clients that feel comfortable, I teach that to them so that they can incorporate that in their own recovery process and I–I think that all the things that we’re talking about are so beneficial, Dr. J.  I think the most important thing–

Dr. Justin Marchegiani: Uh-hmm.

Michele Rosenthal:   To remember is that everybody is so unique an individual that again and again, we have to come back to–you have to try something.  If it resonates with you, do it again.  If it doesn’t, find something else because so many times, I see people forced into recovery processes that are making them worse.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  When it’s just it was the wrong recovery process for them.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And–and so it’s important to sort of recognize your own feedback and say, okay, I’ve tried this 3 x and I feel significant worse each time, I need something else.

Dr. Justin Marchegiani:  Do you think like a NLP or the hypnosis and such, would that every not be the right path for someone to heal?

Michele Rosenthal:   Well, I–you and I have a deep understanding of hypnosis and NLP–

Dr. Justin Marchegiani: Uh-hmm.

Michele Rosenthal:   And we see the results.  But from a–an ideological standpoint I would always say that there’s going to be someone that doesn’t like it.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   And someone from whom it doesn’t work.  Because just statistically speaking, I think that would be the case.  I have not met that person yet–

Dr. Justin Marchegiani: Okay.

Michele Rosenthal:   But–but that just really has a lot to do with there you are in your recovery and–and how you’re managing it.  Sometimes we can try something at one point in our recovery and hate it.  It doesn’t work and 6 months or 2 years later, it’s exactly the thing we needed.

Dr. Justin Marchegiani:  Mmm.

Michele Rosenthal:   But we just had a little more work to do to get to that place where it was beneficial.

Dr. Justin Marchegiani:  So if you encounter that patient, how would you shift gears away from, you know, your–your bread and butter NLP and hypnosis?  How would you shift gears?

Michele Rosenthal:   Well, I–I’m also trained as a coach, so there’s a lot we can do–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   With coaching and–and in fact, Heal Your PTSD is a book all about coaching.  You know, it’s all about figuring out how do we chunk down the process of recovery to create–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  Daily healing actions and develop a process that feels comfortable for each individual person.  One of the things that–that I worked really hard in Heal Your PTSD to do is to customized it so that everyone can create their own personal process.  So right away I would switch to coaching and a lot of times, other processes, hyp–like hypnosis and NLP will work when you’re farther along in the cognitive conscious realm.  So when you get to a place where you trust yourself more or you believe in what you’re doing or you feel less afraid, then you can try hypnosis or NLP again and see how it goes.  I particularly in those instances stick with NLP because there’s less fear related to it.  You don’t have to close your eyes.  You don’t have to be in altered state.  There’s so much we can do that is less “fear-producing” than hypnosis where you have to close your eyes.  Some of my clients don’t want to close their eyes.  That’s frightening for them.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   So–so we steer away from those.  If in the end someone really doesn’t wanna use hypnosis or NLP and we’ve gone as far as we can go with coaching, they really need another modality, then I bring in a colleague and say, “Okay, well, my colleague is trained in this, so if that resonates with you, let’s try that.”

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   And I–I’ll bring in a colleague because I mean, you never wanna stand in the way of someone’s recovery if they can’t do it the way you’re trained, find somebody who’s trained a different way.

Dr. Justin Marchegiani:  Uh-hmm.  Yeah, that totally makes sense.  Now going back to your transcendental meditation, how does that look like how’s that compa–how’s that different compared to your conventional, you know, run-of-the-mill meditation?  Like how does that–if someone wants to do right now, how does that apply?

Michele Rosenthal:   Right.  Well, there is so many different ways to meditate.  So I’ll explain the answer to that by–by sharing the other ways.  You know, meditation is really just a way to focus your brain so we can do that by literally just sitting still and focusing on our breathing, how the breath moves in and out, we can focus on the flame of a candle or–

Dr. Justin Marchegiani:  Mmm.

Michele Rosenthal:   Another image, a spot on the wall, you know, for anyone–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Who’s into yoga, you know you have a drishti when you’re doing balancing processes, you–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   You focus on one spot on the wall and we can even do that with sound, just by listening to a sound. And I think it’s important to approach the idea of meditation by understanding there are many ways to do this.  Again, for survivors who don’t wanna close their eyes, transcendental meditation purely speaking might not feel comfortable.

Dr. Justin Marchegiani: Uh-hmm.

Michele Rosenthal:   Because you don’t wanna close your eyes to meditate and you don’t have to.  So what I love about TM is I–I was happy to close my eyes and I needed a focus for my brain.  My brain would jump all over the place with all kinds of anxiety when I try to meditate.  I couldn’t just focus on my breath.  It didn’t work.  My brain was all over the place with the reasons we shouldn’t be doing that.  So for me, TM was really useful because it–you know, you choose a–a word.  And you just focus on the word and for me, I chose the word peace.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  I just–and it–I don’t even remember why I chose that, but in looking back, it was what I most wanted.  And so I held that word in my consciousness–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  In my closed eyes I could see the word and I just would stay focused on the word repeating it over and over to myself, so that my brain was able to just chill out, calm down.  It had a focus.  It had a little job to do.  It was supposed to focus on this word and that allowed me to slip into a very deep state of meditation for an hour.  So–

Dr. Justin Marchegiani:  Wow.

Michele Rosenthal:  So it was very useful for me especially for someone who has insomnia which I did.  You, I’m sure, know this, Dr. J but one hour of meditation is like 2 hours of REM sleep.

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:   So the benefits of TM or any meditation are enormous and very vast.

Dr. Justin Marchegiani:  So when you’re doing this meditation, you’re putting your visualization on the word peace and are you doing that same breath pattern you talked about, the–the 4-4-6-2?

Michele Rosenthal:  No, actually.  I don’t.  I do a lot of big cleansing breaths and allow myself to sort of hum, you know, the–

Dr. Justin Marchegiani:  Yup.

Michele Rosenthal:   The–the–your body resonates.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   So I do like 5 really–I breathe in as far as I can and then–

Dr. Justin Marchegiani: Yup.

Michele Rosenthal:   Release as far as I can allowing–

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:  The breath to hum out and–and then I just let myself go into regular breathing because I think it would be hard to focus on a word and count the breath at the same time.  So I just focus on the word and let the breathing take care of itself so that my mind can just shut down.

Dr. Justin Marchegiani:  Got it.  So 5 big really deep breaths to start.  You’re focused on that word or that image and then you’re just breathing regularly as you keep that focus.

Michele Rosenthal:   Right.  And those big deep breaths really slow, like really slowly in and really slowly out because–

Dr. Justin Marchegiani: Uh-hmm.

Michele Rosenthal:   What you’re doing is sending a message to your body, slow down, and what we said before comes into play here.  The message that your body picks up, it relays to your mind.  So when you get your body into this slow, rhythmic breathing it sends a message to your mind, slow down.  And that is the beginning of creating a meditative state.

Dr. Justin Marchegiani:  And these breaths are coming from the diaphragm, right?  The belly–

Michele Rosenthal:   Uh-huh.

Dr. Justin Marchegiani: Is distending.  You’re not breathing from the chest. These are all big belly breathes–breaths, right?

Michele Rosenthal:   Yes, definitely.

Dr. Justin Marchegiani:  Great, awesome.  I know Jon Kabat-Zinn does a lot on the transcendental meditation.  Is he a good resource?

Michele Rosenthal:   Absolutely.  He’s a great–great resource for so many things.

Dr. Justin Marchegiani:  Right.

Michele Rosenthal:  I love his work.

Dr. Justin Marchegiani: Awesome. Well, going back in time for you, was 1983, 84, where this all happened, when did feel like you hit a full recovery?

Michele Rosenthal:   My original trauma was 1981, so you’re right.

Dr. Justin Marchegiani:  81.  Uh-hmm.

Michele Rosenthal:   By 83 or 84, I was a mess.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And then my full recovery was around 2007.

Dr. Justin Marchegiani: Uh-hmm.

Michele Rosenthal:  So it was a long time coming, you know, almost–almost 30 years, 26 years of–of struggling and then attempting to heal and failing at it.  I hate that word.

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:  But that’s the word that we always like mostly comes to mind, but that’s the way recovery goes.  You make some successes.  You have some gains and then something happens and you think you’ve been set back but one of the points that I make in Heal Your PTSD.  We have a whole section on what to do, to bust through blocks, and–and the point really is that just because you feel like you’ve gone back, the operative word there is feeling.  It’s a feeling that you’ve gone back, but you can’t go back.  That’s one of the–the biggest problems with traumas.  You can’t go back to who you were before.

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:  You can only go forward.  So it’s not like then you get into recovery and oh, suddenly you can go back to who you were 3 years ago.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Where you were much worse.  You can’t.  Because you’ve come so far since then and I–

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:  I’m working with a client now and he–he–every time he hits that–that wall and there are many.  He says, “I’m right back to where I was last year.”  And I said, “No. you’re not.  Tell me the differences between how you were able to function today and how you were a year ago.”  And he is full of the differences.  So it’s just a matter of being able to access a thought process that helps you re-claim your permanency in the present moment, and figure out where you go from there.

Dr. Justin Marchegiani:  Got it. I know you used that word failing to start.  I have a really great mnemonic device for failing.  It’s Find An Important Lesson Invite Needed Growth.

Michele Rosenthal:  I love that.

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:  That’s awesome.

Dr. Justin Marchegiani:  Yeah, that’s a really good one.  I like it, too. And you know, I noticed in your timeframe, 81 to 2007, that’s a–that’s a long time and I imagine you just didn’t quite, you didn’t encounter the tools you needed until later on in your healing journey.  Is that what the delay was?

Michele Rosenthal:   I think part of the delay was a lack of knowledge and awareness about posttraumatic stress disorder.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   1981, nobody was looking at a civilian kid with medical trauma–

Dr. Justin Marchegiani: Exactly.

Michele Rosenthal:   And diagnosing those symptoms.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   I think another problem was there was no Google, you know.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   So–so it wasn’t like my parents who were very active in trying to help me, there was no Google like, “Let’s get online and put in her symptoms and see what comes up.”  I–I think another is that while I love the psychologist that taught me TM, he had no clue about PTSD.  So I spent–

Dr. Justin Marchegiani:  Right.

Michele Rosenthal:   8 years in and out of therapy with him, getting a little bit better and then really, really taking a nose dive off the face of the planet and he had no clue what was really wrong.  So I–I think part of it is you have to be working with the right person.  I–I didn’t know there was such a thing as a trauma-trained therapist until I was really, really sick mentally and physically, and I started doing my own research and all of a sudden, I started realizing I–I’m working with the wrong person.  He was awesome. I loved him but he was not equipped to help me.  So there’s that and then there’s also just the timeframe of figuring out what’s going to work with you and trying things and–and having the successes that you do and–and the unexpected outcomes that make you say, “Okay, I need to do this a different way.”

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  So my–my journey is by no means unique.  There are other people who go 30 years without the proper diagnosis but there are other people who heal in 6 months, you know.  So it’s important to recognize both sides of the spectrum so that nobody thinks, “Gosh, if it took her that long, it’s gonna take me that long, because that’s–that’s–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Not the case.”

Dr. Justin Marchegiani:  So if you encountered yourself–if you encountered yourself now as a practitioner back in 1981, how long do you think it would take you to get over this?

Michele Rosenthal:   Well, 2 factors I think come into play.  Number one, the–the strengths of the practitioner and–and so I would say, if I was working with me, I’d be really, really well on my way.

Dr. Justin Marchegiani: Uh-hmm.

Michele Rosenthal:   The other–on the other hand though, we as survivors have to be ready–

Dr. Justin Marchegiani: Uh-hmm.

Michele Rosenthal:   And willing to heal.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And there is a lot that goes into the recovery process that is frightening and painful and challenging and if we’re not ready to do that, then nobody can help us, because we’re not ready to be helped. And so there is that aspect of it, too.  A recovery from PTSD changes everything.  PTSD becomes a lifestyle and recovery and healing become a lifestyle, but they’re two totally polar opposite lifestyles.  PTSD is all about your safety and your control–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And trying to maintain those two things.  Healing and recovery is a lifestyle of understanding.  You don’t have the ability to constantly be safe in control.  Your job is to learn to live in a world with as much strength and certainty and power as you can despite those things and–and recovery asks you to give up all of the coping mechanisms you’ve put in place to ensure your survival.

Dr. Justin Marchegiani: Uh-hmm.

Michele Rosenthal:   The insomnia, the hypervigilance, the mood swings, all of those things we do to maintain the status quo to keep us safe.  Now recovery is asking you to drop all of that because those are actually the things making you worse.  And so you have to be prepared for that place of uncertainty and not knowing what you’re doing, and not knowing who you’re going to become.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And figuring that out and having an attitude.  In Heal Your PTSD, I write about it as an attitude of being an adventurer and an explorer, because you are in uncharted territory.  What are you going to do there?  And that’s really the point of having these strategies so that on any day depending on how you feel in any day, you can open Heal Your PTSD and find a strategy that will work for you for that day.  Because every day is different and that’s really the challenge, is to figure out how to work through each day, adding incrementally to your healing process along the way.

Dr. Justin Marchegiani:  Yeah, and you have a lot of these strategies in the book as well, too.  That’s great.  And when you say ready, being ready, do you mean like you’re just admitting there’s a problem and something–something need to be addressed?  Is that what you mean by ready?

Michele Rosenthal:   I mean, it starts there.  For the longest time, Dr. J, every time my parents or particularly my mother would say, “You need help.  This is not right the way you are.”  And she didn’t mean that unkind.  She meant you’re in so much pain, this isn’t right, we can–

Dr. Justin Marchegiani:  right.

Michele Rosenthal:   Fix this.  And I kept screaming and yelling her, “There is nothing wrong with me.  You’re the problem.  If you would–

Dr. Justin Marchegiani: Right.

Michele Rosenthal:   Leave me alone, I’d be just fine.  So first you have to admit, yes, it–the problem is me.

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:   A–and then you have to be willing to do the work. The work is painful and it is frightening and it–it is one of my–there are a lot of fears that go along with PTSD recovery.

Dr. Justin Marchegiani:  What was the hardest thing for you?

Michele Rosenthal:   Yeah, my biggest one was I was afraid that the recovery process itself would make me clinically insane.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   I was so afraid that my mind would not be able to handle what I was being asked to do and the influx of memory and the flood of intense emotion, I thought I would literally have to be straightjacketed and put into–

Dr. Justin Marchegiani:  Mmm.

Michele Rosenthal:  A padded cell.

Dr. Justin Marchegiani: Uh-hmm.

Michele Rosenthal:   So I–I resisted for–for at least 17 years.  I resisted the idea that I needed help because I was frightened–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   To get help and–and then once I got into recovery, there were a lot of times that I quit because I just couldn’t handle how awful it felt. I–I think really living with PTSD and going through the recovery process is–is worse than the original trauma itself.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  Because you’re so much more conscious during the living and recovery process.  During a trauma, you know, your survival mechanisms take over and you just do what you have to do, but so–so it–it’s for me and I–I see this for a lot of people, and I hear this from a lot of the survivors who connect with me that fear of recovery is one of the biggest blocks to recovery.  So you really, I–I recommend for everyone deal with the fear first.  You will not make any recovery gains until you face the fear of recovery and put that out of the way because otherwise it’s just gonna keep popping up and distracting you.

Dr. Justin Marchegiani:  And what will be the big piece of advice that you would give to someone that may subconsciously be afraid of recovering?  What’s the–that piece that you would give them to overstep that?

Michele Rosenthal:  If they are subconsciously afraid?

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Meaning they are not aware of their fear?

Dr. Justin Marchegiani:  Yeah, like let’s say there’s–there’s some type of hidden block that’s preventing them from saying, “Hey, I have a problem and I need to fix this.”  What’s–what’s that first step that you could encourage them to take to help overcome that?

Michele Rosenthal:   Oh, excellent.  I would use one of the favorite NLP techniques which I’m sure you’re familiar with, which is future-pacing.  Like let’s look out–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Into the future.  What’s your future going to look like if things stay as they are now?

Dr. Justin Marchegiani:  Yeah.

Michele Rosenthal:   And once you start doing that, people can start to see the difference between how life can be and how it is now and they are usually able to pop up and say, “But if I do that–” and the minute you have the but, you’ve got the problem.  Because the “but if I do that” is usually what the underlying fear is; usually it’s losing something, you know, in terms of their current relationships.  I have–I have a one client now who literally the thing that is stalling his recovery is that his girlfriend doesn’t like that he feels better.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  So for a long time he wasn’t aware of that and then once you become aware of what that underlying thing is, whether it’s somebody else that’s going to change, how you will change, how your life will be different.  A lot of times we fear feeling better.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  And–and that’s a very relevant fear but it’s usually subconscious, it’s not something we recognize until we say, “Well, if I’m–if I’m that okay,” this is a great example, because it–this exact process worked with one of my clients. This was maybe 4 or 5 years ago and we were working through this exact process and she said, “Well, if I’m that okay, then my family,” her extended family who had abused her, “they’re gonna come after me.”  And all of a sudden, the subconscious fear of recovery was there in the spotlight.  She was really afraid that if she felt better, her family would descend upon her, whereas right now if she stayed in bed, didn’t bathe, didn’t eat, and watched TV all day, nobody was bothering her.  So from that little exercise, we could pop out, here’s the underlying fear and we started–we suspended all work on recovery and started working on how are we going to make her safe, so that recovery–

Dr. Justin Marchegiani:  Right.

Michele Rosenthal:   Was possible.

Dr. Justin Marchegiani:  Right. And it–I could see it also being scary, you get a lot of attention when you’re sick.  You know, you get more doctors coming around you.  You get more nurses, you get more sympathy from friends and family and then you also get excuses if you aren’t successful in your life or if you aren’t doing the things that maybe you wanted to be doing when you were younger and set your goals out.  Well, you have an excuse.  So it could be scary to now lose that excuse, right?

Michele Rosenthal:   Mmm.  Absolutely, that’s a great point.

Dr. Justin Marchegiani:  So after everyone’s listened to this last 45 minutes or so, what would say are like the big 3 take homes?  Like a, hey, if you just missed everything but you’re tuning into these 3–3 little take homes, what are the 3 take homes you’d give to our listeners?

Michele Rosenthal:   I would say number one, don’t listen to the naysayers.  PTSD can be healed.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:  It absolutely can.  Every single one of us has enormous healing potential.  The goal is learning to access it and that’s your job.  So I’m not saying everyone will heal because not everyone wants to go through the process of recovery.

Dr. Justin Marchegiani:  Right.

Michele Rosenthal:   But we all start from that level playing ground of the possibility is out there for you.  So stop listening to anyone who thinks it’s impossible and turn yourself in a different direction and move toward the people who know it is and are doing it.  So number one, recovery is possible.

Dr. Justin Marchegiani: Right.

Michele Rosenthal:   Number two, recovery happens through 2 things, making choices and taking actions.

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Those are the two fundamental elements for every recovery.  It doesn’t matter what your trauma is.  It doesn’t matter what modality you’re using.  If you implement choices and actions on a daily basis that are designed to move you forward, you will start seeing gains.  And–and the last thing I would say is to always stay in touch with your hope, because there are going to be dark moments that challenge it and I think the best way to stay in touch with a sense of hope is number one, to start with an openness to it.  When I started my recovery, I didn’t know that I was going to get to where I am today, which is 100% free of symptoms for almost a decade despite enormous–an enormous triggering event 2 years ago.  So I didn’t know this is where I was going to be, I just hoped that I would get there. And–and number two, we have to feed hope.  It has–it’s–it–it’s like a little plant.  It needs to be tended to.  It needs to grow and–and for that, I really recommend and I do this with all of my clients, we need those life affirming experiences that make us feel it’s–it’s good to be alive.  I feel okay.  I even feel happy about being alive.  For me, that came in the–in the scenario of joy.  I decided I needed to feel joy every day.  Even if it was at just 30 minutes.  I decided I needed that sense of joy, 30 seconds even would be great.  So I literally developed a program for myself.  I knew when I dance, I feel good.  I feel joyful.  I feel free and I literally signed up for a dance class every single day of the week for months on end just to help the brain have that repetitive process of this feels good.  And for me, that allowed me to feel hope.  “Oh, I can feel good for this amount of time, maybe I could feel good for twice that amount of time one day.”  And by repetitively training the brain, “This feels good.  We can do this,” you start to develop a sense of belief that deepens and ultimately more courage.  So for all of my clients, I ask them to find that thing that it feels good to do.  So the client that I just told you was worried about her family if she healed, she loved to ride her Harley on the back roads of this–

Dr. Justin Marchegiani:  Uh-hmm.

Michele Rosenthal:   Very rural town that she lived in.  I’ve another client who his thing is, jet-skiing.  And he’ll just go out for a couple of hours, just to have that connection with a part of ourselves that feels good to be alive.  So I’d say those 3 things are–are super important as they create a base for recovery and then from there, you build on it in whatever way is personal to you.

Dr. Justin Marchegiani:  Mmm.  That’s great. Are you still seeing clients?  Are you seeing clients virtually as well?

Michele Rosenthal:   I do.  I do.  I work with people from around the world via Skype and phone and their recovery process to me is ongoing all the time.  Even when you’re done, your job then is to continue living your life the way you’ve designed and created your recovery process that is with intention and consciousness and a desire to feel good.  And–and so from there, we–we can go anywhere and creating a life and who we wanna be that feels good and is meaningful and–and substantial and successful.

Dr. Justin Marchegiani:  Great.  And what’s the best way for the listeners to get a hold of you?

Michele Rosenthal:  You can have access there, not only to me, but to our Heal My PTSD forum. We have over a hundred podcasts of interviews with healing professionals and survivors, all of who talk about how to heal and–and the results that they’re seeing.  And also Heal Your PTSD: Dynamic Strategies that Work and my other books are available there, plus our free webinar training series on The Science Behind Your Symptoms.  So it’s like a virtual PTSD party on site.

Dr. Justin Marchegiani:  Great!  Are there any other social media avenues that listeners can find you at?

Michele Rosenthal:   Absolutely.  Twitter and Facebook.  The links are on the site as well.

Dr. Justin Marchegiani:  That’s awesome.  Well, I really appreciate your story, Michele. The fact that you’ve gone through it.  You’ve healed.  You tried lots of different strategies.  I mean, I–I definitely am a big fan of some of these strategies before we even chatted today.  I’m a bit–I knew about these strategies before and it’s great that we were so in sync.  I really appreciate that and it’s, you know, you walking the journey of the–the wounded healer and you bring so much more to your patients because you walked that journey.

Michele Rosenthal:   Thank you so much, Dr. J.  I appreciate that and thank you for your interest in all of this today.

Dr. Justin Marchegiani: Thanks, Michele, for coming on the show.





Sleep and hormone connection, is your sleep destroying your hormones? – Podcast #62


Dr. Justin Marchegiani and Evan Brand discuss the connection between sleep and hormones in this podcast. They shed some light on how many hours of sleep is essential and what time people should go to bed. They also talk about winding down before sleeping and the different techniques they do in order to get a good night’s sleep. Learn why it is important to address and control sleep in relation to supporting blood sugar and hormones especially for females.

sleep-and-hormonesGet more information on the conversion process to sleep hormones. Find out how important it is to have a balance of having the perfect amount of fitness, movement and activity and using your brain to get a deeper quality sleep, as well as know the right balance of foods to eat to help achieve that restful night sleep. Discover the benefits of sleeping with white noise. All these and more when you listen to this podcast.

In this episode, topics include:

2:14   Sleep and hormones

8:30   How to avoid progesterone steal

12:55   Sleep and exercise

16:48   White noise

22:44   Sleep remedies and supplements







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Dr. Justin Marchegiani:  Hello, ladies and gentlemen.  It’s Dr. J here.  Evan, what’s going on, man?

Evan Brand:  What is up?  I just had some elk for lunch before we jumped on this call.  So I’m feeling elkified.

Dr. Justin Marchegiani:  Elkified.  There we go.  Making up words again.  I like it.  It’s how we get your creativity going.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  I’m actually sipping on a nice little LaCroix here.  I love these LaCroix.  These are great.  You know, over 10 years ago I used to be a little Diet Coke soda addict because, you know, we wanna keep the sugar down so taking a whole bunch of aspartame or Splenda, right?  A lot of these artificial sweeteners, thought I was doing myself a whole world of good but definitely wasn’t.  Love these LaCroix, got the Natural Mango going.  It’s quite thirst quenching.

Evan Brand:  How do you feel about sparkling waters?  Do you think there’s a teeth enamel issue that occurs with excessive consumption of those?

Dr. Justin Marchegiani:  I don’t know.  I mean, again a lot of water, a lot of sparkling water just added CO2 in it or depends if it’s mineral water like Pellegrino or like a Topo Chico where it’s infused minerals in there as well.  So I’m not really too worried about that.  I take a lot of–when I get up in the morning, I have a really good filtered water with a whole bunch of sea salt covering the bottom level of my–my mug and I down 2 or 3 really big glasses.

Evan Brand:  So that’ll get plenty of good stuff in regardless of what you drink afterwards you’re saying?

Dr. Justin Marchegiani:  Yeah, a lot of good minerals in there.  I mean, my concern is like I had someone on my shoulder talking about filtered water recently and the person was just really concerned about, well, you know, the demineralization and all these different things and you know, I kinda have a different perspective.  Yeah, that’s a concern, but I think the bigger issue is people consuming water that’s not clean, that still has chlorine and fluoride and probably some pharmaceutical drugs and other potential pathogens in there that’s far worse.  Now, of course, you know, if you get your water filtered and cleaned up, or whether it’s reverse osmosis or a carbon-based filter or like a Berkey or one of those guys.  Yeah, I mean, just pinch a little bit of sea salt in there, high quality sea salt, that will really help add the–the mineralization it needs.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  So today we talked pre-show that we wanted to chat a little bit about sleep and kinda connect the dots with the hormones, right?

Evan Brand:  Yes, sleep is essential but for some reason it’s still not prioritized among health enthusiasts and health seekers.  It’s thought of as a luxury or people are called lazy if they take a nap or if they sleep more than 8 hours and hopefully we can shed some light on why that’s not the case today.

Dr. Justin Marchegiani:  Yeah, I just saw a–well, it wasn’t a study but it was basically a survey of people that use these technology that go around your wrist like the–the Jawbone or the Misfit, these different things that track sleep and such.  Well, they had people sleep a certain amount of timer and they have them rate by, you know, how they felt the next day and such.  And they found on the Jawbone, that’s one of these different devices here, that 8 to 9 and 1/2 hours allowed people to feel the best during the next day.  So that’s pretty interesting.  So 8 to 9 and 1/2 hours is a really good place I believe and it’s not only just the time, it’s also when you fall asleep because that allows you to tap in to some of these different hormones that we’ll talk about in a bit.

Evan Brand:  Yeah, I don’t have any particular study or any documentation, but I always tell people that the hours before midnight almost count as double.  You know, if you’re going to bed midnight, 1 AM, you’ve already basically passed the hormonal regulation optimal starting point if you will and now you’re gonna have limited results and limited recovery which is why if I go to bed at midnight for some reason which is rare these days, I don’t feel the same in the morning as I do when I go to bed at say 9:30 PM.

Dr. Justin Marchegiani:  Yeah, that makes sense and there’s a handful of studies out there.  We’re not gonna say them all.  You can just go in to–to the Google machine and just punch in sleep and hormones or sleep and blood sugar or college student studies sleep and blood sugar.  They did a study a couple years back looking at college students and they cut down their sleep, I think to 4 hours or so, and they saw significant perturbations, fluctuations in blood sugar to the point where they were nearly pre-diabetic.  So we know sleep and blood sugar play a huge role and also anytime we’re messing with blood sugar we’re more than likely messing with cortisol.  So cortisol is gonna be out of balance as well and we know cortisol should have this nice rhythm of high in the morning and lower at night and the more stress we get with–with sleep, right?  We’re gonna start lowering cortisol in the morning and raising it at night relatively speaking to where it should be within that range.

Evan Brand:  Yeah, and cortisol and melatonin are gonna get thrown off out of their balance so now you’re gonna have low melatonin, your hunger hormones are gonna get thrown off so you’re gonna have tons more ghrelin than you normally would.  So you’re gonna have an insatiable appetite so that could contribute to binge-eating of gluten-free cookies and brownies when you wake up–

Dr. Justin Marchegiani:  Ah!

Evan Brand:  Because you’re exhausted.

Dr. Justin Marchegiani:  Yup, absolutely.  Again, I look at sleep–if you can address and control sleep, you’re really addressing and controlling blood sugar and if you’re supporting blood sugar, you’re also gonna be supporting your hormones.  That’s a big one because when we throw cortisol off, especially if you’re a female listening, cortisol can be taken from progesterone.  So if we’re robbing from our progesterone, well, guess what we’re doing?  We’re setting ourselves up for a–for a really wonky luteal phase.  A luteal phase is that second half of our female cycle and it’s primarily predominated by progesterone and if progesterone drops out a little too soon in that cycle, we can really start suffering from PMS symptoms which is like breast tenderness, back pain, moodiness, irritability, excessive bleeding, menstrual cramps, etc. and this can happen before bleeding, before menstruation, and during menstruation.  So a lot of these are really not so good and it throws us into a state known as estrogen-dominance and this can allow things like fibroids to grow and endometriosis and even cause excessive bleeding that can even cause things like anemia which cause more fatigue and cause more thyroid and adrenal issues because now your body’s ability to carry oxygen because you’re low in iron is now impeded, so now you’re set up for a world of hurt when it comes to energy and mood and how you feel.

Evan Brand:  So what if you’re sleeping good but you’re still having all of those symptoms?  Is that–is there something else going on that’s causing that progesterone to be too low?

Dr. Justin Marchegiani:  Yeah, we always kinda look at stress and we kinda have this metaphorical stress bucket so everyone just kinda close their eyes unless you’re driving.  So you get this bucket here, right?  And we got the 3 major stressors that contribute to that bucket and that’s gonna be your physical stress, so kinda take a nod at here if you get any back pain or neck pain or chronic headaches, or you sit all day, you do too much CrossFit that’s causing you to be worn out, and maybe some old injuries, you know?  Throw a couple of balls into that bucket.  Look at the emotional stressors, you know, how’s marriage, kids, family, job?  All those things.  If you got some emotional stress, put a couple of balls in that bucket.  And then look at the chemical stressors and these stressors are the ones that are–that fly under the radar.  People have no idea they’re even an issue because you gotta actually talk to a functional medicine doctor or specialist or get some lab testing done to even know about it and that could be like low stomach acid.  So just take a look at your fingernails–nod if you’re driving–do you have any vertical ridging or white spots?  Do you have any fungal toes, right?  Do you have any white tongue stuff?  Do you get dizzy standing up fast?  I mean, these are just all signs of protein issues and adrenal issues.  Is your temperature low, right?  You don’t even need lab tests to get these things done but a good functional medicine doctor will extract this info and it’s very telling about the underlying hormonal system, gut infections, etc.  So–

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Go ahead, yeah.  I’ll breathe for a second.

Evan Brand:  Well, I was just gonna–yeah, breathe.  So yeah, so that’s what I was getting at is that it’s not just a one thing that’s gonna go wrong like we’re talking about sleep today but there’s many people that may feel like they’re sleeping good but they still have all of those symptoms, so at point they need to zoom out a little bit and look at all these other things to make sure everything’s in place, and at a certain point, if your adrenals are taxed regardless of the nutritional aspect, if you don’t have some type of support system in place, it sounds like you’re never gonna get better with that progesterone deficiency if you will.

Dr. Justin Marchegiani:  You know that progesterone steal or cortisol escape or pregnenolone steal.  There’s a whole bunch of names to describe it but yeah, everyone listening that has a sleep issue, the first thing they should do before even seeing or contacting someone like us is just try to get the diet dialed in, right?  Just try to get the blood sugar going, you know, eating with the first 30 to 45 minutes of getting up.  Again, forget–throw out the window the rule of “Hey, you shouldn’t eat, you know, before bed.”  A lot of people will do better eating before bed especially some protein, fat, and maybe a little bit of carbs because their adrenals may be so messed up, their cortisol may be dropping, their blood sugar may be dropping and it may be causing their adrenals to produce more adrenalin and more cortisol to bring that blood sugar back up which could wake them up in the middle of the night.  So if you’re having a hard time going to bed, that’s probably high cortisol.  If you’re having a hard time waking–if you’re waking up in the middle of the night, we always look to lower cortisol and low blood sugar causing a stress response in the middle of the night.

Evan Brand:  I had this snack the other day.  I never eat any sort of processed food like this but this brand Pamel–Pamela’s, they have like–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  A gluten-free cinnamon gram cracker and I saw it and I was like, “Oh, my God!” I’ve dreamed of having some cinnamon–

Dr. Justin Marchegiani:  Wow.

Evan Brand:  Gram crackers since I was a kid that are actually not gonna hurt–

Dr. Justin Marchegiani:  The memories.

Evan Brand:  Hurt my stomach and so I bought a pack of those and I just loaded it with–loaded it heavy with some almond butter and I had that before bed, and it could have been the nostalgia kicking in but I don’t know what it was, it could have just been the good fats from the almond butter, I slept amazing that night when I had those.

Dr. Justin Marchegiani:  Well, sometimes a little bit of carbs and a little bit of good fat before bed can be really good fuel on the fire.

Evan Brand:  Oh, and I had the cinnamon, too.  So I didn’t even think about the blood sugar–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Stabilization there.

Dr. Justin Marchegiani:  Yeah, and it maybe have been enough.  You know, you probably had a good dinner as well, right?  So you probably had a good, some good protein and fat at dinner so you threw maybe a little bit of extra carbs than what you normally would, you add some cinnamon, some fat, too.  So that probably helped.  Again to convert your melatonin, right?  That all comes from serotonin and then serotonin comes from 5-HTP and that comes from L-tryptophan which is an amino acid, right?  Amino acids are nothing more than pearls on the pearl necklace, right?  The necklace is the protein and the pearls are the amino acids.  So imagine breaking that necklace up and all those pearls, those are the amino acids, well, 5-HTP is a protein, right?  Essentially a protein and we need insulin to help that amino acid cross that blood brain barrier.  So sometimes a little bit of carbs, you know, some safer carbs–we’re not–not talking inflammatory carbs, can really help those aminos cross that blood brain barrier and start converting into some of these sleep hormones.

Evan Brand:  Another thing that we should talk about since we’re on the subject of the conversion process to sleep hormones is a lot of people that are dealing with adrenal issues or just a lot of stress in general, they’re gonna be burning through their B vitamins, so if they’re deficient in say B6, that’s necessary for that conversion from the 5-HTP over to serotonin, melatonin, that whole little cascade–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  If they don’t have that B6, they’re not gonna be able to do it.  So in terms of having a big list of B6 foods in front of me, I don’t have that, but I know just adding in a little bit of supplementary B6 could be helpful.  Do you recommend a certain like handful of nuts or something like that in terms of B6 or–

Dr. Justin Marchegiani:  Yeah, I mean, typically you’re gonna get your best bang for your buck with B vitamins with good clean meats, right?  Meats are gonna be loaded especially grass-fed red meats, those are gonna have some good B vitamins, glandular, some nuts as well.  So I mean, I typically do a little bit of almond butter before bed with like a Granny Smith apple and some cinnamon on top of it.  That’s really good.

Evan Brand:  You got me.

Dr. Justin Marchegiani:  Again, I’ll–you know, that’ll be like an hour after dinner so I’m already having good grass-fed meat, kind of non-starchy vegetable, good fats kinda thing.  If I do CrossFit that night, I’ll maybe have a sweet potato in there or something.  So it really depends on my activity level how I dose my carbs, but something like that before bed can be super helpful and you can even try, you know, if you have a good meal maybe just a little bit of honey, maybe a teaspoon of honey can be helpful just to get that insulin up to help some of those aminos cross the blood brain barrier.  A little bit of a protein shake, maybe some beef protein or good clean whey protein and some collagen can be helpful, too.  Get those extra aminos going.

Evan Brand:  You mentioned exercise.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Can we–can we transition into the sleep-exercise picture?  Because just like I’ve definitely felt this working behind the microphone in the computer.  If my brain’s exhausted but my body has not been active or used enough, I’m gonna sleep like crap, vice-versa.  If I’ve just been physical all day and I haven’t used my brain juice, so I’m gonna have a lot of brains left at night to think and not be able to sleep.  So it’s like a balance of having the perfect amount of fitness and movement and activity and the perfect balance of using your brain, so you mentioned CrossFit and I forgot to ask you.  You always keep some pretty good muscle and I’ve never actually talked with you about what you do at home.  Do you go to the gym?  What–what are you doing?

Dr. Justin Marchegiani:  Yeah, just functional movements.  I mean, I lift weights typically 2-3 times a week and I try to do some burst stuff so like after our interview here, I’ll probably go to the gym, do a CrossFit class or I’ll just do some functional movements whether it’s squatting, lunging, bending, pushing, pulling kinda gig.  And yeah, it’s really important a couple times a week but really getting, keeping the diet in check is really gonna be what’s good so keeping the insulin levels down at least when you’re, you know, not working out as much; that’s gonna be important so you’re more of a fat burner versus sugar burner.  But when we tie in the exercise to sleep, exercise is a sympathetic nervous system stimulator, right?  That’s kinda cortisol, sympathetic nervous system, adrenalin, that’s gonna be pushing that part of the nervous system.  Not a bad thing because, right?  Parasympathetics predominate when you sleep and you’re eating and then the sympathethics predominate while you’re working, when you’re stressed, when you’re focused and you’re moving.  So the more we trigger those sympathetics, right?  The more we’re utilizing the adrenals, so we gotta be careful if we are stressed and our adrenals are a little bit beaten down because our rhythm’s off, we gotta be careful of how much exercise we do, how intense it is and also when.  We don’t wanna be firing up the sympathetic nervous system if we’re transitioning into a parasympathetic sleep time, right?  If it’s 8-9 o’clock, 10 o’clock we wanna be in bed and winding down, asleep by 10:30-11.  We’ll come back from the gym around 8 or 9 maybe a little too much stimulation and not give you enough time to turn off the switch and kind of downregulate into that parasympathetic mode.

Evan Brand:  Yeah, definitely.  I mean, the artificial light, too.  That’s the whole other piece of the equation.  In terms of the gym, I mean, typically those places have tons of bright florescent lights that contain a lot of blue light.  So any melatonin that would naturally be getting produced around sunset time, that’s not gonna happen for, you know, it’s about 45 minutes what I found. I haven’t found an exact number.  I guess it depends on the person, but it seems like about 45 minutes after that bright light exposure, melatonin will try again to start secreting some more or so.  If you’re flipping on your Netflix or you’re checking your email or your Instagram one last time just to see what you missed out on, the fear of missing out, see what you missed out on right before you go to sleep, maybe don’t do that and see if your sleep improves.

Dr. Justin Marchegiani:  Yeah, one thing I’ve kind of created here.  I’ve kinda made a deal with my wife is that once 8 o’clock gets, you know, we plug in our phones upstairs.  We put them in airplane mode, we set the alarms, we put out, you know, white noise kind of thing already on low so that when we come upstairs, light are already off, curtains are closed, lights are super, super dim just so we can see where the heck we’re going, right?  So not tripping over stuff, we just turn up the–the white noise, don’t have to touch the phones at all, they’re all ready to go.  I don’t have to wait and see this next text then get my little dopamine from the little texting coming up or my little Facebook thing, I could just be like, alright, go right to sleep.  I don’t gotta deal with any technology.  That’s a game changer right there.  Have your phone in airplane mode ready to go.  You know, I use white noise because I don’t want anything to wake me up.  You know, my cat’s jumping in and out my bed and stuff.  I don’t wanna be able to hear him and know what they’re doing.  So the white noise significantly helps anything, you know, waking me up and then having everything dialed in and ready to go and airplane mode prevents me from wanting to check that last text.

Evan Brand:  What’s your white noise?  I use a HEPA filter myself.

Dr. Justin Marchegiani:  Oh, the white noise.  Well, yeah, if you’re using like a fan or if you’re using a HEPA filter, that totally works, too.

Evan Brand:  Or using digital sound?

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  White noise?

Dr. Justin Marchegiani:  Yeah, I like the app.  It’s called White Noise.

Evan Brand:  Oh, okay.

Dr. Justin Marchegiani:  And it’s–it’s just a white noise.  It’s a little purply pink one with little bars.  It’s the–the most popular one in the iStore, so that’s the one I’ve used.  I’ve used it about 3-4 years. And there’s–it’s–

Evan Brand:  Oh, okay.  There’s another one called Relax Melodies.  And it’s kinda fun.

Dr. Justin Marchegiani:  I used to use that one.

Evan Brand: Where you add in a little–

Dr. Justin Marchegiani:  You could change it from a–yeah.

Evan Brand:  Yeah, yeah.

Dr. Justin Marchegiani:  I used to use that.

Evan Brand:  That was–

Dr. Justin Marchegiani:  I used to use that.  It’s just a little too complicated because–

Evan Brand:  It is.

Dr. Justin Marchegiani:  Yeah.  I just like this because it’s just, boom!  And it work great, but my wife and I have the same one on both of our phones, so we have them kind of in sync and we do that so in case she gets up early, she can like get on her phone and start doing whatever she’s gotta do and it doesn’t just kill the, you know, the volume in the room.  Because we have a little stereo effect going that works.

Evan Brand:  That’s cool.  Yeah, I’ve just used the HEPA filter.  I don’t know we’ve gotten the habit of it.  I–I think because we–

Dr. Justin Marchegiani:  That works good.

Evan Brand:  May–maybe we just moved in somewhere.  We wanted to clean the air and it–it just happened to be the perfect amount when we have the HEPA–air on medium.  It was the perfect amount, not too loud where you wake up with exhausted eardrums, but–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Enough to keep you asleep.

Dr. Justin Marchegiani:  I mean, when we have guests stay at our house.  People freak out like, “What the hell is that?”  It’s like the Martians landing or something.  What the heck is that?  Because it just sounds kinda weird, right?

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  But yeah, just some white noise.  But I find that a lot of my patients for instance, they don’t sleep with white noise or something like that and they get woken up really easy.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  By–by an animal–

Evan Brand:  And especially–

Dr. Justin Marchegiani:  Or by something. Who knows?

Evan Brand:  Or a train or traffic–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  If they live in a super urban area.  You gotta block that stuff out.  You have to have a cool, dark, quite, blood sugar stable.  Little bit of exercise earlier in the day.  Little bit of brain usage, reading, writing, researching, talking.  What else?  There’s some other pieces we can add in to this thing.

Dr. Justin Marchegiani:  Yeah, so I really try to give myself 2 hours.  So like wind down time happens 2 hours.  If I wanna be asleep at 10:30, I’m gonna be winding down like on the couch just chillaxing at 8:30.  And that could be like me just all showered, ready to go, maybe take a little bit of lavender oil, put it behind my ears, behind my elbow creases or kneecaps.  It could be put in on my blue blocking sunglasses.  I like a little Netflix before bed.  I mean, I got a couple of shows right now.  I’m looking forward to the Walking Dead coming back on.  So I gotta give myself an extra half hour to 45 minutes before bed to stop that show so the adrenalin kinda winds down.  But I like turning my brain–I think that’s really important, just kinda–if you’re dealing with stuff all day like I start at, you know, 7:30 with patient stuff and videos and our podcasting and all kinds of stuff and I don’t stop ‘til 7:30-8 o’clock, 12 hours.  So I need to really add that–that–that relaxation, just mind numbing stuff to kinda chill out.

Evan Brand:  Yeah, I found myself even after that, doing 12 or 14 hours which I know is too much sometimes for both of us.  We just rely on our handy adaptogens to–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Make that sustainable.

Dr. Justin Marchegiani:  Yeah, exactly.

Evan Brand:  Trying to just read something that’s not geeky, like I literally maybe only have like one fiction book on my book shelf and it’s just straight non-fiction.  Nutrition stuff, brain stuff, neurotransmitter stuff, and so I’m taking recommendations for good fiction.  Although I just can’t get into fiction.  I feel like there’s so much non-fiction stuff, so many great things in the world that I wanna learn about that why should I delve into the world of things that are not real.  But–

Dr. Justin Marchegiani: Yeah, well, it’s like the old expression, right?  Truth is stranger than fiction so that kinda–that kinda sums it all right there.  But I agree, like something at nighttime can be really good that’s spiritual.  A lot of times I just get on my Audible and I’ll just have something going that’s pretty chill and I just keep my eyes closed and I just sit in the corner and just, you know, just listen to it while I’m–maybe 10 minutes before bed.  And then I use–

Evan Brand:  That’s a good idea.

Dr. Justin Marchegiani:  My Zen Frames before bed.  Those are phenomenal.

Evan Brand:  What is that?

Dr. Justin Marchegiani:  Zen Frames.  It’s called MindFit Technology and it’s got specific wavelengths for the light so you wear these glasses and it has specific wavelengths that sync up on–on the light side to the sound side.  And it’s got almost like a-a meditative type of hypnosis program and I use various programs for recovery or you know, mindset and goals and, you know, gratitude.  Just lots of different programs for performance, everything.  Any kind of thing you could–you’d want.  I mean, they have like for natural birthing to stress to performance for athletes.  So I’ve used a lot of these different programs.  Obviously, not the birthing one because that–that wouldn’t make too much sense.  But use them all and they’re phenomenal.

Evan Brand:  I had something like that.  I had a–iDevice where it kind of does flashes to your closed eyes.  It was–I don’t think it was binaural beats but some type of sound thing and I felt so crazy when I got off of it that I returned it.  I was like, “Whoa! I can’t do this.”  It freaked me out.

Dr. Justin Marchegiani:  Yeah, I love the one I have.  I use the one MindFit Technology Zen Frames by Porter Vision.  We could put a–

Evan Brand:  Okay.

Dr. Justin Marchegiani:  We could put a link in it for Porter Vision on the podcast and if people want some more info, they can reach out below the podcast or YouTube video.  But I like that.  I use it every night before bed.  I’ve been using it for years.  When I’m physically seeing patients that’s a great way.  You know, we have it in the office hooked up to pull them out of the para–pull them out of the sympathetics and really kinda activate parasympathetic more–more frequently.

Evan Brand:  Yeah, so kinda like brain training.  A little bit like–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Neuro feedback in a way.

Dr. Justin Marchegiani:  Yeah, very much.  I mean, you don’t have the actual feedback part of it where–whether it’s–however they’re doing it.  But it’s–

Evan Brand:  Right.

Dr. Justin Marchegiani:  Profound and I think visualization is super important because too many people are just sitting there, visualizing negative things all day and you gotta actually go in there and put the positive stuff because, you know, just like negativity, weeds grow automatically.  So you gotta actually go in there and put those positive plants if you will.

Evan Brand:  Yup, that’s great.  Shall we talk about some remedies?  Some–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Consumables.

Dr. Justin Marchegiani:  Yeah, I like that.  So off the bat, blood sugar and diet’s gonna be number one, right?  So that 4- to 5-hour gig with blood sugar and not skipping breakfast and obviously avoiding the alcohol before bed that can be devastating because alcohol shuts down the liver because the liver’s gotta just focus on detoxifying and not stabilizing blood sugar.  Not doing all the other things it’s gotta do.  So that can be a big one.  Alcohol can easily cause low blood sugar at night because of the reactive hypoglycemic spike.  So the blood sugar gig is gonna be important.  Timing of exercise, right?  Not too late, especially if you’re adrenally stressed, you won’t be able to flip the switch between the sympathetics and the parasympathetics, so getting the exercise a little bit earlier.  I’d say be finished before 8 o’clock at the latest, maybe even sooner, or switch to morning or afternoon if possible.  And then I would say really have maybe a little bit of carbs and protein and fat right before bed, an hour or two, if your meal is 5 hours.  Let’s say dinner’s at 6.  You’re going to bed at 11.  That’s 5 hours, maybe another little small mini-meal an hour or two before.

Evan Brand:  And watch out for caffeine, too.  Because sometimes people metabolize caffeine slowly.  I just got my genetic data back and it finally confirmed what I had already figured out that I’m a slow metabolizer of caffeine, so that could be an issue, too.  People think that morning or mid-day coffee doesn’t affect you.  It could.

Dr. Justin Marchegiani:  Yeah, absolutely.  Now on the supplement side, we can use adaptogens.  So when we see things like the excessive cortisol at night and sleeping, well, the first thing I go to is ashwagandha.  And you gotta be careful–ashwagandha if it’s not from organic sources can be loaded with lead and other crappy stuff, so you wanna make sure you’re buying organic, you know, independently tested ashwagandha.  That’s important.  But that’s a really good herb.  I like holy basil before bed.  I use it a lot in Tulci tea by Organic India.  They’re great.  Little holy basil before bed.  Some soluble–water soluble magnesium, either magnesium citrate or a Natural Calm or magnesium maleate.  We have some on the site we like and that works phenomenal to kinda get the–the parasymapthetics going and magnesium’s really just very relaxing, very sedating.

Evan Brand:  It’s amazing. You wouldn’t–you wouldn’t think magnesium could be so profound but like you’ve told me a few times, you just take a gram or so and you feel incredible.  I mean, it’s mildly–mildly sedating–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Almost.  Not–not incapacitating but it feels great.

Dr. Justin Marchegiani:  Yeah, some lavender, you know, behind the–the ears or in the elbow creases, etc.  That can be phenomenal.  Phosphat–phosphorylated serine can be great if we have elevated levels of cortisol at night.  That can be awesome.  Again, some of these remedies would be based off of lab tests, too.  So I’m giving generalities, but again, we specifically recommend things a lot of times based on clinical presentation but also labs, too.  So just throwing out some ones for the average person to check out.  Also 5-HTP can be phenomenal and we always combine it long-term with L-tyrosine.  So you wanna combine them together but again at night we typically favor the 5-HTP tend to be less stimulating and more sedating.  Although 15% pf the population have a paradoxical response and actually feel more relaxed with L-tyrosine before bed.  So you kinda have to fret that one out.  That could be a–throw you for a loop.  But 5-HTP a couple hundred milligrams before bed especially with B6 can be awesome.  Just make sure you combine the L-tyrosine in the first half of the day so you balance it out and you don’t create neurotransmitter deficiencies.  That’s a big one.

Evan Brand:  Yeah, I like passion flower.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  I like matcha tea.  Now passion flower, it’s a–

Dr. Justin Marchegiani:  Matcha.

Evan Brand:  GABA antagonist so passion flower over a long period of time in a higher dosage could downregulate GABA production so kinda like steroids, you don’t want to depend on them and tell your body to stop making GABA because you can make your problem worse, but I really like passion flower.  I like matcha.  It does have caffeine.  It does have possibly depending on the–the purity and the strength, maybe 40-80 milligrams of caffeine per cup.  So it’s that it’s kinda–it’s kinda lot for–for evening time.  But if you’re doing matcha as opposed to just regular green tea, you could add up to 40 milligrams of L-theanine which still is kinda below the therapeutic threshold.  You would probably say, too.  Like I like 100 milligrams of L-theanine but still I really like the calming yet mildly energizing effect of matcha and I can sleep perfectly fine on and I’ll throw a little bit of raw honey in that like a half teaspoon of raw honey and it’s just a great way to soothe myself to sleep.  I’ll also use a tea–trying to think of who it is–it might be the Yogi brand, if that’s even a brand.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  I’m picturing a yellow box.  Oh, is it Yogi?

Dr. Justin Marchegiani:  That’s Yogi.

Evan Brand:  And it’s the honey lavender.

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

Evan Brand: And it’s all organic but–or maybe it’s–yeah, is it honey lavender?  And I think that one maybe even have some chamomile in it, too.

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  Which also helps GABA–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  And chamomile.  If you just take straight chamomile tea that will knock you out cold.  So I do use that for severe sleep issues.  If I’m just like super excited, somebody’s coming into town or a conference the next day or something like that. Chamomile tea is kinda the go-to one but I don’t use that every night.

Dr. Justin Marchegiani:  Yeah, I’ll use a lavender or a sleepy tea with some Tulci in there, that’s–that’s phenomenal.  That’s the holy basil.  And those are all some really good things.  With some people, if we get testing back, that they’re low in melatonin, I mean, we’ll obviously work on the underlying issues, right?  Why is the melatonin low?  But in the meantime, while we’re working on getting to the root, some sublingual melatonin can be excellent.  For some people that are waking up midnight, they may even benefit from some time-release melatonin and I try to start with a very small dose, probably 500 micrograms or 0.5 of a gram–milligram, sorry–0.5 milligrams.  I think a lot of people OD on the melatonin just too much.

Evan Brand:  Oh, totally!  Yeah, 3, 5, 10 sometimes.  That’s crazy.  No wonder you feel hung over the next day after taking that.

Dr. Justin Marchegiani:  Yeah, so I really try to work on the amino acid stuff more for a long-term approach.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  And then you gotta figure out, you know, why is it–why are the amino acids burnt out?  Is there malabsorption stuff?  Some–some gut stuff?  Some stress stuff that’s causing it?  So you always wanna get to the root issue and we aren’t gonna go into that per se, but just don’t forget that.  That’s always in the background and always a–a given so to speak.  But the amino acids and the melatonin can be very powerful if used together with a comprehensive program.

Evan Brand:  Definitely.  Yeah, melatonin’s more crisis management, not something that you just heard and now you’re gonna go do it because you can throw yourself off and feel like crap if you depend on melatonin and get stuck on that.  It’s not fun to wean yourself off of melatonin if that–if that’s the term, the best term I can come up with right now.

Dr. Justin Marchegiani:  Absolutely.  And also gut infections.  I see a lot of patients that are waking up middle of the night and gut infections are really behind the root of the issue because infections have opposite sleep and wake cycles than we have.  So the infections are really active up in the middle of the night, they’re hanging out, they’re–they’re doing their thing and they’re creating inflammation.  That inflammation creates a corresponding rising cortisol and that cortisol affects your blood sugar and your alertness and you start waking up.

Evan Brand:  Wow.

Dr. Justin Marchegiani:  And we see that a lot.

Evan Brand:  So that would be the time to run the stool test then.  If you’re trying some of these things or you’ve contacted us and you have a program going, you’re still not getting the results, that may be the next underlying root cause is–is some gut bugs.

Dr. Justin Marchegiani:  Yeah, running a comprehensive stool test can make a huge difference.  We’ll see it on the stool.  We’ll even see like mildly elevated eosinophils on your blood test, right?  Eosinophils are a white blood cell that can go up with severe anaphylactic allergies but can also go up with parasites, too.  And we’ll see for instance on an adrenal cortisol rhythm, we’ll see people’s cortisol really high in the morning like, you know, either very, very high in the range or even above the range high and then we’ll see them bottom out throughout the day and a lot of times that’s a–a parasite pattern because the cortisol’s been jacked up throughout the night and then it spills in to the morning and now that these guys are kinda, you know, in their chillaxing mode if you will, hibernation, then the cortisol would drop then later in the day.

Evan Brand:  We’re gonna have to do a whole podcast on that because that is so fascinating.

Dr. Justin Marchegiani:  Yeah, isn’t that crazy?  But I’ve seen a lot of people their sleep get better once we start treating them for bugs.

Evan Brand:  Yup, that’s amazing.  And just because you live in the United States, it doesn’t mean you’re free.  I mean, it’s more common than you think.  You don’t have to go to a tropical place to get something like that.

Dr. Justin Marchegiani:  Yeah, I think the biggest separator between most functional medicine docs is a lot of functional medicine docs have a really good approach where they’re addressing diet and lifestyle and–and hormones and everything, but they’re missing the gut connection and it’s so easy because so many of the symptoms are extra-intestinal which means outside of your typical bloating, gas, diarrhea, constipation, etc.  There are things you would never ever connect to with a gut issue or gut infection.  And I’ve–

Evan Brand:  Yup, that’s coming up really soon.  That podcast–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  We have to do that.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  It’s gonna be a blast.

Dr. Justin Marchegiani:  Yeah, we’ll do some research on that one, but just, you know, think about it, right?  These gut infections, they affect nutrient levels because they’re, you know, they’re eaten up and they’re stealing your nutrients.  They’re creating malabsorption issues. They’re putting stress on your liver and they’re creating stress on your hormones causing hormones to go out of their natural rhythm.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Makes sense though.

Evan Brand:  It does.

Dr. Justin Marchegiani:  So do you wanna kinda recap everything for the listeners?  I mean, I said it–I think if they hear it again, it’ll–it’ll sink even deeper.

Evan Brand:  Yeah, we definitely jumped a lot of different places today but it was awesome and worthy.  Number one, get the blood sugar picture going.  You gotta have the diet picture first. You can’t just jump straight to 5-HTP supplements and think everything’s gonna work, especially if you’re intermittent fasting and you’re doing CrossFit at 8 PM and trying to go to bed at 9 PM while you’re scrolling on your phone.  It’s not gonna work, so getting the diet picture, getting the blood sugar picture, getting a good dose of exercise.  I think that’s–no exercise at all–you know, walking is a great way to get exercise in.  You don’t have to do high intensity stuff.  Next I would say is the stress picture.  Get your stress under control.  Get your emotional stress figured out, whether you have a conflict going on with somebody.  Try to work on that.  If you need to go out in nature for a walk with somebody and try to hash out something, that’s a good idea.  Reducing your negative inputs if you’re taking the fast lane to work and you’re doing 30 miles an hour over the speed limit. You know, reducing that stress is gonna be helpful.  Next, dig a little bit deeper.  Contact us.  Get some testing run.  Get some gut testing run.  See if your energy is getting sapped and your sleep is getting disrupted because of some underlying gut bugs and infection.  See how your neurotransmitters are.  See if they’re balanced.  See if they’re imbalanced.  See which ones need help before you start tweaking all of the amino acid picture because you can definitely–it’s not going to destroy you or anything.  It’s not damaging necessarily to your health, but it’s just gonna delay your result if you start throwing things into the fire without actually identifying what’s going on first.  Lastly, just, you know, take a baby step.  Take one thing.  Take an Epsom salt bath tonight.  Maybe that’s your one thing that you apply and then you work on the other stuff tomorrow.  But do something tonight that’s gonna give you that deeper quality sleep so that you can perform better and be a better person in your waking life during the daylight hours.

Dr. Justin Marchegiani:  Absolutely and I would just say make a deal with your spouse or partner or even just yourself.  Put your phone on airplane mode at 9 PM.  Put it on and get the–get the airplane mode going.  Have your alarm already set.  Have it already plugged in and ready to go so you’re no longer getting that stimulation.  Get the light turned down low if you’re gonna be watching a little Walking Dead or some Netflix like I do.  Maybe get some blue blocking sunglasses and you can sing that Corey Hart song from the 80s sunglasses at night. You guys know what I’m talking about. But that’s some great strategies right there off the bat.  Evan, anything else you wanna add in there?

Evan Brand:  I think that’s it, man. I think that was a–an earful for–for everybody today.

Dr. Justin Marchegiani:  That’s it.  Well, I’m gonna go put my sunglasses on a little bit early, I’m just–I’m inspired.

Evan Brand:  Sounds good.

Dr. Justin Marchegiani:  Evan, have a good one.

Evan Brand:  You, too, man.  Bye.

Dr. Justin Marchegiani:  Bye.



Macronutrients and micronutrients – Nutrition basics

By Dr. Justin Marchegiani

Today’s talk is going be on Nutrition 101.  We’re going to go over what macronutrients and micronutrients are. We’re going to show how to customize a diet according to you what your needs, goals, and desires are. So first things first, when we’re dialing our diet, there’s got to be a couple of things that are in common across any way of eating.  We want our diet to be macronutrient agnostic.  In the paleosphere,  you can go high-carb, low-carb, high-fat, low-fat, high-protein, low-protein.  We just want to make sure we fulfill these 3 criteria: nutrient-dense, low toxin, and anti-inflammatory.  That’s really important. If we’re nutrient-dense, anti-inflammatory, low toxin, we’re good to go.  We can dial up carbs high or low based upon our metabolism.

In-Depth Look at Macronutrients

We have protein, we have fat, and we have carbohydrate.  You can see we have four calories in protein, 4 calories in carbs, 9 calories in fat.  And what’s happened is in the 50’s and 60’s, fat was one of these macronutrients that was demonized because the higher amount of calories in there and one of the first thing we could measure in the blood was cholesterol.  So it just made sense. Let’s demonize fat because we can actually see some of it in the blood and we know it has more calories.  But what we come to find is that the hormonal effects of each one of these macronutrients is far different.

We have protein and we have more of a hormonal effect of glucagon.  We have fats and we have a more hormonal effect of peptide YY and ketones, which are appetite suppressant.  And then carbohydrate, we have more insulin.  So it would tend to be the carbohydrates based on endocrinology that are driving fat gain. Because it’s the insulin  opening the cell up.  It’s taking a lot of the extra sugar that can’t be stored in the cell.  And it’s shuttling it to the liver and pumping it out as palmitic acid, which is a saturated fat. And again, we can literally get fat by having too much carbohydrate. And that tend to be what’s driving most of the obesity epidemic.

Click here to know more about macronutrients and micronutrients through a functional medicine doctor consult.


The Protein Analysis

When we have proteins, it primarily comes from two sources.  We have animal and we have plant. It’s really important to break it down this way.  The reason why is animal proteins tend to be very high in protein, also some fat in there.  If we’re doing lean chicken breast, lower.  But there’s going to be some fat in there and it’s also going to be very low in carbohydrate.

Now when we go to plant proteins, unless we’re doing like a plant, like a pea protein powder or a rice protein powder or a hemp protein powder, outside of that example, you’re going to have a lot more carbohydrate. Typically two-thirds to seventy-five percent of the bulk of that item will be carbohydrate.  For example, we have rice and beans.  About 15‑18 grams of protein to about 60-70 grams of carbohydrate.  So you can see if we’re eating whole foods, not powders, if we’re eating real foods, you get a whole bunch of carbohydrates. That is when you do it plant-wise or vegetarian-wise versus the small amount of protein. Some of the benefit that we get with animal protein are good essential fatty acids, vitamin A, D, E, K, EPA, DHEA fat and cholesterol, which is the hormone building blocks.

In my opinition, animal protein is going to be the best. It’s going to be the most complete and it’s going to be higher in sulfur-based amino acids. Amino acids are going to help run glutathione pathways, which is a natural antioxidant.  So animal proteins are always going to be superior.

The Categories of Fats

Now we deal with fats.  Fats come in a couple different varieties.  To keep it simple, we’re going to have:

Mono-unsaturated fats. That’s going to be like your avocado.  Pretty good fat.

Poly and saturated fats.  These are going to be like our fish oil.  So fish oil, salmon, tuna–good fats.  And also our omega 3’s, too.

Saturated fats. They’re going to be primarily animal sources with the exception of coconut oil.  Coconut’s a saturated fat.  We’re going to have butter in there.  We’re going to have a lot of the fat in beef, chicken, fish.  There’s going to be some saturated fat in there as well, stearic acid as well.

The Carbohydrate Classifications

Non- starchy

Non-starchy are our vegetable carbs. Non-starchy carbs, low in sugar, high nutrition.  These are your broccoli, kale, spinach, asparagus, and carrots.


Starchy can be high nutrition.  But it can also be higher in carbohydrates.  Sweet potato, yam, jicama, starchy tuber, squash, etc.  Some break down the sugar faster or slower but again, relatively speaking, much higher in carbohydrate but still relatively high in nutrition as well.

Low sugar fruit

We have low sugar which are going to berry, strawberries, raspberries passion fruit, lemon, lime, grapefruit.

High sugar fruits

These are going to be our tropical fruits.  They are going to be your papayas, mangoes, watermelon, bananas and pineapple.

Glycmic Index

The reason why I classified as high sugar is because a lot of times we use the glycemic index. Because fruit is primarily fructose. Fructose does not have a very high glycemic index, but it can still create insulin resistance.  So I want to make sure that we’re taking into account the sugar part of it because fructose is a sugar.  It may not have a higher glycemic index, so I want to classify as low sugar and high sugar.


Adjust Macronutrients According to Your Needs

Depending on where we’re at here, we can dial these up or down.  We can be macronutrient agnostic, essentially. So we can dial the carbs up higher for our CrossFitter or if we’re doing triathlons.  We can up the starchy and we can up maybe the non-starchy or if we have insulin resistance. Also, we can go on low on everything here, except the non-starchy. Maybe we just go up on the vegetables.  So we can dial things up or down depending on where our metabolism is at.

What should you eat?

There’s also one filter that we have to apply to it.  We have to answer yes to these three questions.  These are my essential questions that all patients have to answer yes to.


The food needs to be anti-inflammatory.  So if we’re eating foods that are driving inflammation, excessive inflammation, it’s going to: cause our body to break down excessively fast, create pain and put stress on our adrenal glands. Those are not good since it’s going to break our body down faster.


Next it has to be nutrient-dense.  This is very important. Outside of macronutrients, we have micronutrients–vitamins, minerals, water.  So we have to make sure the foods we’re eating are nutrient-dense.  Again, you can see here, one of the things I did not talk about are grains because grains are very nutrient-poor. And then when you actually factor in gut irritation, the lectins, the phytate, the oxalic acids which actually can chelate but it can hug and pull more nutrients out, it’s actually even more nutrient-poor and its very inflammatory. That’s why grains don’t fit in. It’s got gliadin in it, gluten essentially, and wheat germ agglutinin, other lectins.

Low in Toxins

Now the low in toxins is important because let’s say we’re having good old fashioned broccoli but it’s got a whole bunch of pesticides in it, that’s not good.  So that doesn’t fit the low toxins.   Having a template that looks at quality is so important because you can have the same exact macronutrients. But if you throw in a whole bunch of carcinogenic pesticides, it can put stress on the body, stress on the liver, and disrupt your health.

Get a Customized Diet Template

We want to make sure we look at things from a perspective of is it anti-inflammatory, nutrient-dense, and low in toxins.  But we can also adjust the macronutrients according to what your body’s needs are.

So for instance, if you’re a CrossFitter, we may jack up the carbohydrates high.  We may keep the proteins and the fats relatively high as well.  We may keep the carbs over 200.  If you have insulin resistance or diabetes, well, guess what?  We’re only going to be getting non-starchy carbohydrates in for our carb sources and we’re going to be very high in fats and then moderate to low in proteins.

So I can dial that up and down according to what my patient’s needs are.  We just have to make sure the following template is in place.  We don’t really want to look at calories.  The only time I look at calories is when people are actually not eating enough and that can happen sometimes.  When you’re in a stressed-out state, it’s very common to not really have much of an appetite because the blood’s going to the extremities and are going away from the core.


So again, we have our calories, not that big a deal. But again the hormones are important and also making sure we have the right categories down. Then we can adjust the macronutrients according to what your body’s needs are.

So again, this is a foundation if you have other chronic health challenges or issues, this is the starting point and if you want to reach out to me and get a hold of me for more in depth issues, feel free and click on screen or click below. Subscribe so you can get more of my great free information.

Get a customized diet template for a healthier body by clicking this link!

Infections, Digestive Issues, Brain Fog and What To Do Next – Podcast #61

Dr. Justin Marchegiani and Evan Brand talk about gut bugs and multiple gut infections in this interview. While you’ll see some symptoms when a person’s experiencing a gut infection, remember it’s not always the case as there are times when people don’t get any symptoms at all. Find out what types of specialty labs to order to test for gut infection by calling your functional medicine practitioner.

gut infectionsGet in-depth information on what the usual suspects are for gut infections and watch out for where you could possibly get them. Learn more about allergy medications and discover the effective treatment protocols to knock out these gut bugs by listening to this podcast.

In this episode, topics include:

3:03   Where do gut infections come from

11:15   Compromised gut health immune system

13:32   Allergies and allergy medications

16:30   Treatment protocols, enzymes and HCl

18:56   Infections and recovery







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Dr. Justin Marchegiani:  Hey, Evan!  What’s going on, man?

Evan Brand:  Hey, not much.  I’m excited I got to talk with you this week.  I was curious if we were gonna get together and do this thing.  I was like, “Oh, man! I need my–my weekly dose of inspiration.” So glad we’re getting to do this.

Dr. Justin Marchegiani:  Vice-versa.  I always enjoy talking to you as well.  What did you have for breakfast?

Evan Brand:  I woke up and my wife said, “Hey, I made some sausage for you.”  So it was just some of the Applegate, no hormones, no antibiotics, sausage links.  Had about 5 of those puppies and just some lemon water and that’s it so far and I’m still feeling good and that was a couple hours ago.

Dr. Justin Marchegiani:  Nice.  Yeah, myself, I did a great little green drink.  So I took some celery and some parsley.  Took a whole lemon, one carrot, some kale, cucumber and about 3 or 4 ginger cloves and I had them all juiced up, but you know, nice coffee-mug size.  I drink that.  Had some coffee, butter, and MCT oil all blended up and then I’m also sipping on a whey protein shake.  So I got a lot of micronutrients in my green drink.  I got some good fats in my butter and MCT coffee, and then I got some extra protein and amino acids in my grass-fed whey protein.

Evan Brand:  That shake sounds pretty potent.

Dr. Justin Marchegiani:  Oh, it was very spicy with the ginger.  I love ginger.  I mean, ginger is phenomenal.  I have it part of my programs with any gut killing program because ginger is very anti-inflammatory.  It’s a prokinetic so people that have delayed gastric emptying or digestive issues, and also keeps the lymphatic system moving.  It’s an anticoagulant so people get inflamed–either things move in the body much slower from a lymphatic and detox perspective so keeping the ginger in there really keeps things moving.

Evan Brand:  Ah, that makes sense.  Yeah, I’ve had some ginger kombuchas–

Dr. Justin Marchegiani:  Love those.

Evan Brand:  Like some home-made.  I’ve had some of the ones that are in the bottles but I’ve had a couple like home-made ones at some health fairs and it’s enough to make you squint your eyes after you drink it.

Dr. Justin Marchegiani:  Yeah, I was quite hot after I drink it.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  So that’s what I had.  I’m actually heading to Kansas City this weekend.  What are you up to?

Evan Brand:  I don’t know yet.  I know I’m gonna be here in town.  My buddy, Matt, was in town last weekend from Charlotte, so I think I’m just gonna do a rest and relaxation, engage my parasympathetic mode all weekend.

Dr. Justin Marchegiani:  Very cool, very cool.  We talked again pre-show–we wanna talk about gut bugs a little bit.  I’ve done a lot of shows and posts on parasites and gut bugs.  Again, we’ll try to look at it from a different perspective, so anyone that’s listened to our old stuff it won’t be repetitive.  And again we wanna walk–we wanna have people walk away with some, you know, take home application, but I see a lot of people with gut bugs and gut infections and they don’t even have any digestive symptoms at all.  They have no diarrhea, no bloating, no gas, no constipation, no reflux, none of that stuff.  But on the test we find gut infection.  Sometimes even multiple gut infections.

Evan Brand:  So where do these things come from?  I mean, when I–I first hear that I think of people traveling to a tropical place but I know that’s not necessary to get a gut bug.

Dr. Justin Marchegiani:  Yeah, so I’ll give you for instance.  I had a patient–we can go back in time to let’s say the mid-2000s when this person was in Brazil and they noticed they got sick and things were–weren’t quite the same.  Had gone to multiple different GI docs, after the fact and nothing came back.  Now this person’s main symptom and they some digestive symptoms but their number one symptom was fatigue.  Fatigue.  So we ran some tests.  We did some of our functional, more specialty labs, and this is kinda where it gets hairy because I have a lot of people that come in that have digestive issues and they say, hey I’ve gotten my conventional blood work done or my conventional stool test at my local hospital done and I did not come back with an infection.  Let’s not go this route.  And I say, “Huh.” I’ve done this thousands of times. I’ve had this conversation like it’s Groundhog’s Day, right?  And I’ve seen people come back with infections where they’ve already been tested by their conventional labs and hospitals and they–they come back negative there but they come back positive on mine.  So moral of the story, this guy that had the chronic fatigue came back with a couple different infections and we were able to catch it on the test.  We just started to treat the infection, his fatigue started getting better.  Now if we just relied on the conventional setting, we’d never would have even got the info to know that his person had a major infection and conventional medicine doesn’t look at these infections of even existing in a chronic state.  Infections are acute.  You have diarrhea.  You have, you know, all of the traveler’s diarrhea, you know, things like that, maybe even throwing up and once that’s gone, you’re–that’s it.  You’re over the infection.  That’s kind of the mindset.

Evan Brand:  Yeah and the problem is, even if the conventional model were able to identify it, they’re not gonna be able to properly address it with some of the things we–that we may talk about today as the treatment options for lack of a better term.

Dr. Justin Marchegiani:  Yeah, so there’s an antibiotic out there called metronidazole or Flagyl and we run a specific genetic stool test and we find a lot of people that come back with infections are also resistant to that antibiotic.  I see it all the time.  So you’re typical doctor is just gonna prescribe Flagyl and say “Here you go. Infection be gone.”  But I see a lot of my stool tests that this comes back resistant.  Now before I even was doing genetic testing for antibiotic sensitivity, I already intuitively noticed that a lot of people were being treated with Flagyl and–and metronidazole and tinidazole and other antibiotics like this and they weren’t working.  Like meaning that person would feel a little bit better for a bit of time and then the symptoms would come back so I knew intuitively something wasn’t right and then now with some of this newer technology we can see that there’s actually antibiotic resistance.  So that kinda makes sense, my intuition was kinda proven right and that’s why a combination of herbs specific to what the infection may be is gonna be the optimal way to–to knock out the gut bug.

Evan Brand:  Yup, so let’s dig a little deeper.  Where do these things come from?  You mentioned the Brazil case.  That’s definitely interesting, but say somebody that’s not traveling internationally?  Where are they gonna pick these things up or how are they gonna get into the system and allow to become problematic?

Dr. Justin Marchegiani:  Great question.  So a lot of these infections are just opportunistic, right?  There needs to be some level of immune stress, adrenal stress, stress in that person’s life for these infections to kind of take foothold.  That’s kind of one scenario.  Scenario number two is you just get exposed to a lot of that parasite or a lot of that infection and–and the–the bolus, the amount on that infection that’s there is just overwhelming to the system to begin with.  So it’s typically either a small amount where the body is just not able to handle it because of chronic stress.  A large amount that really overwhelms the body and typically one or two tend to be kind of, you know, in effect.  And then most of the time people go to their conventional doctor and doesn’t come up for the–all the–the many reasons that we talked about.  So reason number one, chronic stress.  Their immune system is somewhat compromised to begin with and then number two, there just a very large amount of the infection there and then what tends to happen is the infection starts to compromise the body’s ability to breakdown food.  So then we have stress in the gut.  The first thing that happens when our sympathetic nervous system starts activating is the inability to secrete hydrochloric acid.  Hydrochloric acid is needed for protein digestion.  HCl for short is what activates our proteolytic, right?  Remember medicine uses big words to make you confused.  Proteo, protein.  Lytic, cutting or break down.  So activates your proteolytic or protein breaking down enzymes called pepsin in the stomach.  The nice low pH of all of that acidic chyme.  Chyme is just mixed up food.  Take the food, put it in the blender, that’s chyme.  When that food comes out that stomach into the small intestine, that nice low pH does two things.  It causes a stimulation of secretion of cholecystokinin which causes the gallbladder to contract and produce bile salts or stimulate the release of bile salts and that CCK also causes the pancreas to produce a whole bunch of lipase which breaks down fat, right?  That LIP, right?  Lipid, that’s the–the fat abbreviation and then it also stimulates the pancreas to produce some proteolytic enzymes–trypsin, chymotrypsin, etc.  So we have this whole digestive domino rally effect here and when the gut becomes inflamed, when there’s stress in the gut, one of the first thing that gets compromised is hydrochloric acid secretion and once HCl secretion gets compromised, enzyme secretion gets compromised, bile salt secretion gets compromised and then foods tend to sit and rot and ferment and putrefy and rancidify creating more stress.  So this–it’s this downwards spiral cycle and then over time the gut lining becomes thinner and thinner, leaky gut starts occurring, more and more food allergy start occurring, and then the patient symptoms get worse and worse and worse overtime.

Evan Brand:  Mmkay.  So you–so you kinda answered that in a long winded way which is good.  So basically–

Dr. Justin Marchegiani:  Sorry about t

Adrenal Fatigue, Adrenal Failure and the Cortisol Rollercoaster – Podcast #60

Dr. Justin and Evan clarify the issue of high cortisol levels versus low cortisol levels as well as how you can get tested for them. Find out which labs are recommended, what to look out for on your adrenal cortisol tests, and how to get a customized specific protocol in today’s interview. 

adrenal rollercoasterGet in-depth information about the importance of healthy cortisol levels in our body and the various roles it play for body function. As far as methods of treatment are concerned, discover why functional model is superior than the conventional model.  Also learn helpful exercises you can do to aid in your healing process. Get tips on how to start your morning to reduce stress and negativity in your life.

In this episode, topics include:

1:50   What is cortisol

11:03   Symptoms of adrenal issues

14:03   Methods of healing, functional vs conventional model

18:42   Treatment or the healing process

24:45   Supplementation and diet







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Dr. Justin Marchegiani:  Evan, it’s Dr. J.  Evan, what’s going on, man?

Evan Brand:  Hey, not too much.  I had my own protein today.  I was just telling you about it and it–it’s still delicious.  I–I feel like when I was pitching my protein this week on my own show–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  I felt kinda like, man, I have to say it’s delicious.  But it really is.  I’ve had a lot of people send me stuff and you probably get stuff sent to you, too, to test things out and organic vanilla bean is a real deal.  It’s not that fake–fake vanilla bean, that natural flavor vanilla–vanilla bean that comes from beavers anal glands.

Dr. Justin Marchegiani:  Oh, my gosh!  I can’t believe that.  So your whey protein, it–it’s grass-fed, right?

Evan Brand:  Yeah.  And–

Dr. Justin Marchegiani:  High-quality stuff like that?

Evan Brand:  Yeah and there’s collagen in there, too.  I think I was–

Dr. Justin Marchegiani:  Ooh.

Evan Brand:  Getting fairydusted at first, so I told him I wanted 14 grams of–it’s a 20-gram scoop so I told him, you know, 14 grams I wanted to come from the grass-fed whey and then 6 grams I wanted to come from collagen, and I can feel it.  I don’t know if that makes sense.  I can feel when it goes into my body.

Dr. Justin Marchegiani:  Dude, that’s awesome!  Anyone listening to the show, feel free to check out Evan’s site at  Get some good quality whey protein with some collagen in there.  That’s good stuff.

Evan Brand:  Yup.  I–I’ll send you some, as soon as we–as soon as we run this batch, I’ll send you a–a few bottles of each.

Dr. Justin Marchegiani:  Yeah, I’m a huge fan of collagen honestly.  I mean, there’s all kinds of good benefits for it just for like healthy gut function and stuff, but let’s just say you’re vain and you want the aesthetic stuff.  Great hair, great skin, great nails.  I just actually saw Dave Asprey out a few months back and you know, Dave’s got his new hairstyle, right?  Dave’s the–the Bulletproof exec and I said, “Dave, what the heck’s going on with your hair?  It looks really different.”  He was like, “Dude, I’m just upping my collagen levels.”  So I’m just like, “Hey, collagen’s good for him.  It’s good for hair, good for skin, good for nails, and there’s a lot of health benefits outside of the aesthetics.”  So in my opinion, it’s a win-win.

Evan Brand:  Yup, definitely.

Dr. Justin Marchegiani:  So in our pre-game talk here, we chatted about cortisol.  We felt like that this would be a really good topic to kind of bring to our listeners.  So why don’t you get the ball rolling, Evan?

Evan Brand:  Yeah, so I wanted to talk about this because cortisol is a buzzword first of all, so people aren’t gonna be like, “Oh, great! Cortisol.”

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  But I think a lot of people have been convinced that high cortisol is always the case and people think, I have high cortisol and it’s causing me all my problems but not one adrenal cortisol rhythm test that I’ve reviewed has had high cortisol.  Every single one is low.  Everyone’s lower than they should be and that’s causing more problems.  I mean, high cortisol is a big deal but I think more people have been burnt out or burning the candles at both ends longer than they–than they realize.  And so that high cortisol stage, you–you’ve already passed that, now you’re in the low cortisol stage because you’re running on fumes anymore.  You’re not just being chased by the tiger.   You’ve been chased by the tiger for 40 years and there’s nothing left to help you run from that thing.

Dr. Justin Marchegiani:  Absolutely and cortisol is actually good for you.  Like you said, most of the patients that we see, we run this salivary cortisol rhythm test and again, a salivary cortisol rhythm is looking at the free fraction of your cortisol so I know a lot of people may get confused because they may have had their conventional doctor run a cortisol and that’s typically via blood and blood primarily, actually it’s only testing for cortisol, the serum, the protein-bound cortisol.  So imagine this, imagine you got–here’s my analogy for the day.  Now each day I kinda pull one of these out from you know where and help it resonate to people.  So 2% of hormones are–are typically free fraction.  So imagine a baseball going into a catcher’s mitt, right?  That’s your 2% and the other 98 out of 100 are beach balls, right?  A beach ball is too big to fit into that catcher’s mitt but those baseballs can fit into the catcher’s mitt.  So a lot of the–the beach balls for instance are the 98% that are protein-bound, right?  They are made by the gland.  It’s a good measure of glandular function which is great in conventional medicine because when they were testing for disease, right?  Pathology of the gland, it’s great to measure the beach balls because the beach balls represent 98%.  So it gives us a good window at actual gland output.  But because the beach balls are so big, they can’t get into the catcher’s mitt.  So we look for the baseballs and the baseballs are the free fraction.  They don’t have a–a protein carrier attached to it so they can actually go into that catcher’s mitt or in actual physiology and biochemistry, they can bind into that receptor site and have a metabolic effect.

Evan Brand:  I like that.  That’s a good analogy.  So you know, the thing with cortisol like I’ve mentioned, in the morning, you want it to be high.  That’s normal.

Dr. Justin Marchegiani:  Yes.

Evan Brand:  That’s the time where high cortisol is a good thing and a lot of people wake really early for work.  Sometimes 5AM and they go to the coffee to get them up but in reality, if you don’t need as much time in the morning, say you can push your schedule back a little bit and try to wake up closer to 7AM or closer to the actual sun up time, if you’re getting up before the sun and you can change that to–to getting up at sunrise, you’re basically–I’m gonna use my analogy that I mentioned to you–if you’re getting up at 4AM to get ready for work, you’re only going halfway up the hill on your favorite rollercoaster before you start going back down the hill.  So you’re gonna get to the bottom of that hill a lot of quicker and it’s not gonna be as fun of a ride for you as if you were to get up closer to sunrise time or 7AM and now you’re at the top of that rollercoaster hill, that’s gonna be a really fun ride and you’re gonna have a lot longer distance to cover before you get to the bottom of that hill and that’s why people that are waking up too early or people that are not pumping out enough cortisol in the morning, by noon, they’re bottomed out and the fun’s over for the day.  You might as well close shop and give up.

Dr. Justin Marchegiani:  Exactly.  Exactly.  And again, cortisol typically goes low with chronic stress.  So if you see low cortisol, at one point you were probably in this high cortisol space.  And we kinda go back in the history, when we–we kinda do an exam and intake, you know, going back in time, was there a place where you were under a lot of stress but you felt good?  Like you had energy, you may have been stressed, you may have been anxious but you had the energy, you know, behind you to do all the things that you needed to do, and then at some point, it started to teeter out where, you know, you’re having less energy, you’re feeling more fatigue, you need more naps, you need more time sleeping, you spend more time resting on the weekend, and most people when we do a detail history, we see that pattern kind of unfolding and we progress, that’s called stage 1–again, depending on what lab you use, there’s a lab called Diagnos-Techs out of Washington, they have like a 7 phases of adrenal fatigue–I like keeping things really simple.  Again, if you’re not able to break concepts down into simple easy to explain analogies, it just tells me you don’t really understand that that well yourself or you’re just a bad teacher, one of the two.  Hans Selye called the alarm phase if you will, and then state–phase 2 or stage 2 is when that cortisol is dropping.  Typically what categorizes or what’s characteristic of a stage 2 is we start to see some rhythm perturbations, some rhythm abnormalities, maybe a high morning or a low afternoon or a–a high late afternoon or a low night.  We’ll start to see some rhythm imbalances and some drops in DHEA, in your sex hormones.  And then stage 3, we’ll start to see it drop beneath 23, I think it’s picomoles per liter is the amount that’s typically used on your conventional salivary labs.  Don’t quote me though, but you know, if you’re running like your Biohealth or your Diagnos-Techs, labs like that, that’s your conventional range, and you’ll start to see that go beneath 23 units, you typically see 2 or more rhythm disturbances and you’ll see lower or low DHEA on that as well.

Evan Brand:  How often is it for you to see all 4?  Almost every single person I run that on it all 4, they’re low all day.  They’re below morning, below mid-day, below evening, and below night.  I mean, I’ve never had anybody that’s been in range on all 4 actually.

Dr. Justin Marchegiani:  I totally agree and frankly with–I’d say with majority of patients, I really don’t need adrenal cortisol tests because I just tell by symptoms and by talking with them, but at the same standpoint though, my patients need to see it.  They need to see it’s real and then it’s really important that be able to see it, make a change, go back and re-test, and see it get better.  That’s like a really important thing.  And again, there’s a couple things every now and then we run these tests, I can’t predict rhythm disturbances.  So for instance, I’ll be like your stage 3, but then they’re low in the morning, high at night, they’re DHEA is low, and you get surprises.  So one, you gotta run the adrenal test just to see where you’re at because the weaker your adrenals are, the longer it’s gonna take you to heal and also to heal your gut because we need cortisol to heal our–our guts and to put out the fire in our guts.  So typically, if you’re doing a good questionnaire and most people are gonna be stage 3, but we need to see it.  People need to see it’s real.  They need to see what kind of rhythm disturbance is there.  They need to see where their DHEA is at and then it’s great to create a program, come back, re-test it, and see rhythm come back into effect.  See cortisol levels go up.  See DHEA levels improve.  It makes a huge difference for people being on track.  It also gives them a sense of how long it’s gonna take to get better and then it also really keeps them motivated and allow the functional medicine doctor to create a–a customized specific protocol, not a general one which would–would be what I would be stuck doing if we just did it based on symptoms, it’d be a very general protocol.  But with the labs, we can create a specific protocol so instead–instead of pulling out the RPG or the bazooka, I can pull out the sniper rifle and really target the exact rhythm, because it’s not just giving support, we also wanna really target the rhythm so if we’re low in certain areas, we wanna use certain nutrients to bring it up.  If we were high on certain area, we wanna use certain compounds to bring it down and we wanna time it throughout the day so we’re mimicking normal hormonal physiology.

Evan Brand:  Perfect.  That’s great.  That has actually improved some of the stuff that I was doing, because before when just like you said I can assume that a lot of people are gonna have adrenal issues but I didn’t know exactly what time so if I was gonna add in say an adaptogen or if I was gonna add in something like some phosphatidylserine, it’s like, “When do they need it?”  And I can use generalities but now that I’m actually running more of those, I see like, “Man, it really is a good idea to run this even though I probably already knew what it was gonna tell me.  It’s just a little bit more accuracy.”  Let’s talk about some of the symptoms of some of these issues people may be hearing this and they’re thinking, “Huh.”  So I had just a couple written down here.  One being fatigue.  Another being aches and pains or you wake up and you don’t feel refreshed, maybe you feel tired even, even after you have–

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  A full night of sleep.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  You wake up and you’re just like, “Gosh!”  Lightheadedness is something that I see a lot.  Poor balance, just like you stand up and you’re like, “Whoa!”  Crashing after meals, cravings, mood imbalances, headaches, digestive stuff.  Another one that I don’t have written down but I experienced personally was a loss of muscle at first.  I guess in that first phase, that high cortisol, basically catabolized my muscle.

Dr. Justin Marchegiani:  You are a weakling.

Evan Brand:  I know.  I’m building back up now.  I’m feeling good now that I’m–got my–my protocol under control.  But what other symptoms?  I mean, have I covered kind of the main things that–that you see as well?

 Dr. Justin Marchegiani:  Yeah, I know and actually, you are–you are putting on a lot more muscle, Evan.  I–I can totally notice that.  We gotta bring the show to video format so you can flex for listeners next time.

Evan Brand:  Sure.

Dr. Justin Marchegiani:  But yeah, you are 100% right.  I’d also say allergies are a big one.  Joint pain, right?  People that are chronically in pain.  Like think about it.  When you go to the joint doctor, you know, you’re a–I think it’s a rheumatologist or orthopedist, I mean, they’re gonna give you a cortisone injection and cortisone is the cousin or sister of cortisol, right?  We have our natural anti-inflammatory being produced by our adrenals called cortisol, which we already talked about, and if we break the word cortisol down, it’s really a glucocorticosteroid.  And again, like we talked about, right?  Medicine loves to use big words that keep people in the dark and feel confused.  So we just break it down.  Gluco pertaining to blood glucose/energy, okay?  Corticosteroid pertaining to stress and inflammation, right?  Corticosteroid injection, right?  Corticosteroid for inhalers.  Corticosteroid for creams.  Corticosteroid pills for pain, right?  So pain, inflammation, stress, energy.  So this is kind of the big things that cortisol are incredibly responsible for but we also need healthy levels of cortisol for thyroid hormone activation, right?  Goldilocks effect–too high, we shut down and block the thyroid; too low, we can’t convert and activate thyroid hormone.  We need cortisol for healing or address inflammation in our gut and–and being resistant to common allergens.  We need healthy cortisol levels to maintain energy and blood sugar throughout the day so we’re not having to eat every two hours like, you know, like you’re grazing, like you’re an animal.  And then also, just we need it to be able to help detoxify it.  Cortisol has a role in detoxification.  Alright, so we need healthy levels of cortisol just to be resistant to stress in the environment.

Evan Brand:  Yeah, so let’s about–I wanna get into some–some methods of healing, if you will.  But maybe you could spend a minute or two explaining kind of why the functional model of looking at this is superior to the conventional model, because you’ll hear–hear people even they don’t even have in their consciousness an issue of adrenal dysregulation, they may just think that they need this cortisone shot.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And that’s not going to actually fix what’s going on.

Dr. Justin Marchegiani:  Absolutely.  So first off, I’m gonna get to that in a roundabout way.  I feel like a politician answering your question here.  So when we look at your cortisol rhythm, there’s 3 things we always wanna prioritize.  Most people just look at the–the number, how much cortisol you’re outputting throughout the day, right?  And that’s kinda what conventional medicine does, right?  Addison’s disease, super low cortisol.  Cushing’s disease, right?  Cush–push, that means high cortisol, alright?  So we’re looking at amounts with the conventional medicine.  In functional medicine, we’re really looking at rhythm.  We’re looking at what’s your cortisol rhythm like?  And a lot of these has to do with the HPA axis, the hypothalamic-pituitary.  These are glands that sit a couple inches right between your eyeballs, right between your eyes and they–they’re master controllers.  They talk down to the thyroid, to the adrenals, to the gonads, etc.  And again, they talk to the adrenals and they help regulate cortisol.  So when we’re stressed, those glands, that tissue loses communication and we start seeing the aberrations and the perturbations in the cortisol rhythm.  And that’s one of the most important things we like to look at first.  The second is cortisol amount.  The third is then DHEA levels.  So when we talk about the word adrenal fatigue, we’re not–we’re not talking about it from the perspective like a pancreas that’s fatigued and can’t make insulin.  There may be some fatigue in the gland but a lot of what we’re talking about is HPA–hypothalamus, pituitary, adrenal–just think brain talking to adrenal, that type of communication, that thermostat that talks to your adrenals or the thermostat that talks to your heater or your A/C in your house is broken, so to speak.  And just because the A/C or the heater isn’t running properly, it may not be the actual heater or A/C.  It may just be the thermostat.  So a lot of what we’re doing yet, we’re supporting the actual gland, that–that’s cool.  But we’re also supporting the brain.  So I think when we’re doing a lot of these programs, we’re still working on the brain just as much as we are working on the adrenals.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  Okay?  Go ahead.

Evan Brand:  No, keep going, that’s great.

Dr. Justin Marchegiani:  Now, getting back to the original question you asked me to begin with.  When we look at conventional medicine, conventional medicine really what they’re looking at, they’re looking at adrenal failure.  There are probably a hundred patients over the years that we–you know, after our consult, we review what’s going on, they go to their MD, they–they show them the tests, they talk about and they say, “You know, your doctor’s crazy.  You don’t have adrenal fatigue or adrenal failure.”  Because they–they equate adrenal fatigue to Addison’s disease or adrenal failure where cortisol gets super, super, super low where you can’t regulate inflammation and the body starts shutting down, right?  So they equate it to that in their mind, because that’s what adrenals to them means, because they’re on a pathology-based state, not in a functional state.  So they come back and they’re like, “Well, I don’t have adrenal fatigue” or “I don’t have this adrenal imbalance,” and then we just have to differentiate, right?  The conventional doctors looking at disease, that’s Addison’s disease.  That’s super, super, super, super low, low cortisol levels typically caused by an autoimmune condition that starts to destroy the adrenals.  So we wanna realize that.  Let’s say on a spectrum of 1 to 10, 10 being optimal adrenal health and 1 being Addison’s disease, you gotta be at a 1 to have Addison’s, right?  That’s kind of our subjective criteria but most people that are going into the doctor maybe are sitting at 3 or 4 or 5.  And again, they are far away from 10, right?  But they’re not near 1 yet and they may not–they may never even get to 1.  So they’re going to their doctor and they’re just saying, “Hey, what’s up?”  And then their doctor says their fine but they’re really not in a good place.  So we’re looking at things more from a functional perspective not a pathology perspective, and that’s the–the main thing and again, most people are at 3 to 5 on that subjective range, so they’ll never ever be helped.  They’re never ever fall into that adrenal failure criteria, but they’ll have dysfunctional adrenal fatigue primarily driven by HPA–brain, poor brain adrenal communication by chronic stress and it’s our job as the functional medicine doctor to figure out where that stress is coming from, nutritionally, diet-wise, obviously all the emotional and lifestyle stressors, and then even bigger, the internal infection, toxicity stressors.

Evan Brand:  Yeah, so let’s get into the–if we can use the word treatment or the healing process.  Something that I like to start with is the exercise looking at that a little bit closer because–

Dr. Justin Marchegiani:  Oh yeah.

Evan Brand:  A lot, a lot, a lot, a lot of women think they have to do 6 days a week of their spinning class or 6 days a week of their CrossFit class, and then they combine that with 2-3 mornings of yoga and then they combine that with another 2-3 afternoon workouts of weightlifting and that’s like, “Holy crap!”  It’s like no wonder you’re so low.  So that’s kinda almost the first starting place for people because at a certain point, too much or too intense exercise is gonna tax the system and if we’re trying to rebuild it with some of these methods that we’ll get into it, you’re just spinning your wheels.  So I like to just tell people to go for a walk.  If you live on the beach, go for a walk and get the wet sand in between your toes and try to reduce some stress that way.  If you like to go swimming, that’s a good way to do it if you’re not in chlorine pools, if you can get access to some saltwater pools or something like that or a walk in the woods, just walking.  I think that’s like one of the most restorative but helpful exercises I could prescribe if you will.

Dr. Justin Marchegiani:  Absolutely and I have a 3-step criteria that I use to help kind of evaluate whether exercise is positive stress or negative stress and you gotta answer positively to all these questions.  So number one, do you feel energized after your exercise?  Alright, do you feel good after your exercise?  Number two, 10-15 minutes after you complete the exercise and you kinda caught your breath and such, how do you feel?  Do you feel like you could emotionally repeat the exercise again or you’re just like, “Holy crap!  Like get me the heck out of this CrossFit box,” like “I’m done,” you know?  And then number three would be, how do you feel that night or that next morning?  You know, barring, you know, you didn’t do any new exercises and you’re not gonna be sore because the movements are different and you had a good night’s sleep.  Barring all that stuff, how do you feel?  Do you feel hit by a bus?  So those are kind of my 3 questions that we need to answer positively for.  If we don’t, then one of the first things we have to do is cut down the duration.  So if we had an hour-long workout 5 days a week, well, we’ll just cut it down to half hour or 45 minutes then we can also cut down the intensity.  I find most people do good with intense movement patterns depending on how fatigued they are but just keeping them really short and that could be a Tabata and if you’re really adrenal fatigued, that intensity could be a–a fast walk to a slow walk kind of interval, to someone swimming, to a– you know, let’s say they’re–have a lot of joint issues, we can even do movements that are in water that don’t have the impact or using an elliptical or rower so we’re not slamming our joints down.  That could be another way we could involve that interval-type training.  And then if we’re still really in–in a bad place there, then just things like walking in general, even incorporating tai chi or qigong if we’re really extremely fatigued hormonally.

Evan Brand:  I like qigong.  I tried to get–get Hannah, my wife, to do it and she just laughs every time I start doing it in the living room.

Dr. Justin Marchegiani:  Absolutely, you got it.  And I just wanted to add one more thing, too.  When you’re conventional doctor is testing for your cortisol, we already talked about that they’re looking at your protein levels, just your typical cortisol sum, cortisol serum, so if you see serum that means it’s protein-bound.  Again, the only way you’re gonna know it’s not protein-bound is if it says free, free next to it.  So typically if you’re running like your thyroid, they’ll run thyroxin T4 free and you’ll see that word free, so that’s important.  But number two on that, it’s pretty stressful to get–for most people to get a blood drawn.  It’s like you get that needle, you get the white coat syndrome, they–they wrap the rubber band around your arm, you’re–you know, you have those memories maybe when you were younger getting stuck.  So that can be stressful in and of itself and stress increases cortisol, right?  So you can get a lot of people that they’re blood cortisol actually looks a lot better than what it would be normally because there’s actually a stress response when you’re getting the cortisol drawn.  And that’s why we love the cortisol labs because there’s no, you know, stress spitting the tube.  If you’re sitting there and you just spit in the tube.  That’s it.  So it’s–it’s great that we can elicit a measurement without causing a stress response.

Evan Brand:  Yeah, instead of adding in other things, I’d like to talk about subtracting things from people’s lives and one that’s really helpful is negativity.  Now whether that’s watching too much news or that’s just spending time around people that are negative and aren’t thinking like you and they’re not inspiring you.  People like that, energy vampires–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  If it’s really hateful music or really loud music and you’re constantly having to–there’s always that guy in the gym that has his headphones so loud you can hear him across the gym.  That guy is depending on that music to get him through that workout, that’s a crutch.  So I try to look at removing the negative inputs, too, before I even get to adding in the other beneficial supplements and things like that.

Dr. Justin Marchegiani:  Yeah, I think one of the most important things is how you start your morning.  There’s a book called the 6-minute Miracle Morning where the author talks about gratitude and visualization and affirmations.  I’m always a huge fan of–I do a lot of Anthony Robbins 15 Minutes to Fulfillment where you get up and I’m gonna do it this afternoon today but you have 5 minutes of affirmation and–and tapping on certain meridian points that kind of prime the system.  Number two, you go into a kind of a–a gratitude state.  You really kind of gracious for all the things that you have and then the last 5 minutes you go into a visualization.  So it’s–it’s affirmations, gratitude, and visualizations and that’s a great way to prime your system and really get all the beneficial hormones going in the right direction.  So I–I think that’s a great way to start your morning off the bat for sure and reduce that negativity.

Evan Brand:  Great.  So supplement-wise and if this is not the direction you intend, interrupt me and shift me, but I think mentioning a couple helpful supplements for just general support would be a good idea.  I really like a good vitamin C complex.  Not just ascorbic acid, but getting multiple different forms of vitamin C and if you can do the whole food form, there’s a couple good brands out there that have some like derived from organic oranges vitamin C.  That’s kinda cool.  I just haven’t noticed that much supplementing it personally.  But I think that’s kind of my first vitamin that–that I’d be safe giving a blanket recommendation for.

Dr. Justin Marchegiani:  Yeah, I–we’re on the same exact page, so I’m gonna kind of go right into the diet stuff and dub tail that with the supplements.  But off the bat, blood sugar or stress.  Blood sugar instability is one of the biggest adrenal stressors on the body, right?  We talk about what’s cortisol?  It’s a glucocorticosteroid, right?  The first part of glucocorticosteroid is gluco meaning blood sugar, so eating 4-5 hours is gonna be super important.  If you have adrenal issues, if you’re stressed, don’t intermittent fast.  Don’t–that’s putting a lot of stress on your system.  Make sure you’re having a good protein and fat-based breakfast.  Try to get, you know, your carbs from non-starchy sources or at least low-sugar fruit initially.  That’s gonna be huge because that’s gonna take away your adrenals from having to pump out cortisol to bring that blood sugar up.  Because again, if you eat too much sugar, what happens?  You have this reactive hypoglycemic response.  Blood sugar goes up like you do on the rollercoaster and then crashes down because your insulin sucks that blood sugar right down.  And when that blood sugar is down and low, your adrenals are sitting there having to muster up adrenaline, norepinephrine, epinephrine, catecholamine, this is just the same–the same word for adrenalin 3 different times over, and then the cortisol as well to bring that blood sugar back up.  So blood sugar is really important.  Now on the blood sugar vein, we can use different supplements like chromium and alpha lipoic acid and vanadium and magnesium and cinnamon and gymnema and bitter melon and banaba.  So these are different herbs and nutrients that we can use to help stabilize blood sugar.  Again in the hierarchy, the diet part is gonna be the most important, the second will be the timing, and the third will be the supplements.  So that’s a really good start off the bat.  Next is, we’ll use a lot of precursors.  We’ll use different building block precursors called pregnenolone or DHEA and we customize these according to the level of adrenal fatigue.  So I recommend getting lab–if you’re gonna ever use a hormonal precursor, you wanna have your labs actually checked.  You don’t wanna be supplementing any precursor stuff without labs.  Number three, vitamin C is awesome.  Again vitamin C, the reason why the–a lot of the Eskimos and the Inuit avoided scurvy, right?  Scurvy is a disease of basically hemorrhaging of the various capillaries in the body because of lack of vitamin C and the–I think it was the British or the people over in the UK area, they were called limeys because they figured out when they would travel over from the UK to the US hundreds of years ago that people would die if they didn’t have vitamin C.  So they found that if they just brought whole bunch of limes and ate these limes that they would avoid scurvy.  So they got the–they got the term or the nickname limeys.  So vitamin C is really important for that kind of health but again, the Inuit avoided scurvy because they would eat a lot of glandular tissue.  So they would eat the adrenal glands of the mammals that they would kill and they got a lot of vitamin C from the adrenal glandular tissue because the adrenals love vitamin C.  That’s why we add the vitamin C in our proto–programs or protocols so we support the adrenals.  Also glandular tissue will have a little bit of vitamin C and also a lot of minerals and vitamins that are specific to the gland and then after that, our adaptogenic herbs which can help bring cortisol up or bring it down.  It’s kind of a multitasker.  It can downshift or upshift depending on where our stress is.  And I know you’re a big adaptogen guy so I’ll toss the mic over to you and you can kinda give your 2 cents on that.

Evan Brand:  Yeah, so there’s tons of different ones, but I recently just switched over per your recommendation and just to see what’s up.  I was taking ashwagandha for a while which is a–a great adaptogen.  You can take it in the morning for energy and endurance or you could take it in the evening to help sleep.  It’s very unique like you just mentioned.  But I just switched over to holy basil recently.  I think it’s the Himalaya brand.  They have a–an organic holy basil extract that’s pretty potent and I’ve been taking that and honestly I feel a little bit like Superman, like I feel invincible on holy basil compared to ashwagandha.  Ashwagandha I just felt more calm energy.  Holy basil, I feel like I just wanna pick a kettlebell up and just throw it like a shotput.

Dr. Justin Marchegiani:  So does that mean we get to do the interview now with you wearing a cape?

Evan Brand:  Maybe.

Dr. Justin Marchegiani:  That’d be awesome.  I would–I would like the big S on your shirt, maybe we’ll do a E for Evan with a cape.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Love it.

Evan Brand:  So maybe–maybe that wasn’t the most clinical explanation of–of adaptogens but my experience with them is that they’re very helpful.  I think it’s kind of a 21st century necessity for people that have some type of adaptogenic support because we need to adapt–

Dr. Justin Marchegiani:  100%.

Evan Brand:  To the environment.  The environment’s changing.  The climate is changing.  Economics are changing.  Job stress is changing.  Gender roles are changing.  I mean, I–I vacuum the floor.  You know what I mean?  I sweep the kitchen.  You know, I have new roles that–that may not have previously been my roles like my Grandpa.  He didn’t necessarily take care of in the home task, you know what I’m saying?

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  It’s a tangent but I’m saying there’s so many new things that–that–

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  Men and women both are–are dealing with that they need some adaptogenic support.  So I really think it’s been one of the most helpful things to keep me from derailing during building a business and all the stresses that come with being a, you know, a growing entrepreneur.

Dr. Justin Marchegiani:  Right, and if you look at kind of Darwin’s theory of the survival of the fittest, really what he’s saying there in that theory is whoever can adapt the quickest and the fastest will be the most successful.  So if we have stress coming in our lives, I think adaptogenic herb of some kind rotated in and out is a foundation in anyone’s life because we got stuff coming at us from the home with our kids and our family.  We have work stuff.  We have all–all of our play stuff we do on the weekends or on our free time and our exercise and our businesses and all these different things.  We need to be able to adapt or even pivot, right?  So a good adaptogenic herb helps one, modulate the immune system.  Two, it helps support our hormones, right?  Sex hormones like eleuthero helps with DHEA levels.  Again, it can also help with libido and such, and two, it’s gonna help modulate our cortisol up and down.  So if we’re in this place we’re anxious, we can knock it down; if we’re low and depressed, we can bring it back up.  And certain herbs may be better for certain things.  Like ashwagandha, maybe sleep and anxiety.  Eleuthero for vitality, stamina, and exercise.  Rhodiola for depression.  Maca for libido and sexual performance.  Tribulus for–for muscle mass.  And the list goes on.

Evan Brand:  What did you take today?  Have you taken any adaptogens yet?

Dr. Justin Marchegiani:  Evan, of course.  So I had my little adaptogenic herb cabinet and I have all my herbs just kinda laid out and I just sit down.  I go, “Hmm.  How do I feel today?”  And I just kind of, you know, use a little bit of intuition on what herb that I’m gonna use.  But today was an ashwagandha day.  Yesterday was an eleuthero and rhodiola day.  And before that, it was a ginseng day.  So I tend to pick things out depending on kind of my mood and whether I’m seeing patients or not, and I really need to be super, super hardcore focused and do a lot of listening, or if I’m with you and I’m gonna be kind of, you know, talkative and you know, connecting with you.  So depends on what kind of stresses are I’m–I’m dealing with.

Evan Brand:  So yesterday, you said yesterday was a rhodiola and what day?  Did you have–

Dr. Justin Marchegiani:  I think it was a rhodiola and eleuthero day.

Evan Brand:  Okay, so I haven’t combined those two.  I’ve used rhodiola and ashwagandha together and I love it.  But I’ve never used a–eleuthero and rhodiola.  What’s the–what’s the–the bonus effect there as opposed to taking rhodiola by itself.  Well, I mean a lot of people like you said, they get a–fairydusted when they do a lot of these combos.  They don’t get enough.  So a lot of my patients, I’ll just recommend a really good combo product so they get the best of both worlds.  They’re not taking a whole bunch of supplements.  I mean, I’m a little crazy so I can have my 6 or 7 adaptogenic herbs.  I mean, I couldn’t ask my patients to do that.  If they want, they can always ask me and we can get them set up.  But I like to have one or two that we rotate with patients or a good kind of a good broad spectrum one.  So with myself, we kind of just–just have a whole bunch lined up and I kinda use my intuition based on what I know and based on my stress levels and how I slept the night before and what I’m gonna do and what I need.  I think I side-stepped your question.  Can you say it again?

Evan Brand:  Yeah, the question was what do you feel when combining eleuthero with rhodiola as opposed to just rhodiola by itself?

Dr. Justin Marchegiani:  You know what?  That’s a really good question.  I don’t know per se.  I just know the various effects and profiles that these herbs have and there’s a lot of research that they work together synergistically.  So for me, it’s more based on intuition.  I wouldn’t be able to crystalize that for you.

Evan Brand:  Right, and that–that’s totally what I expected.  It is hard to feel.  I just thought you may have noticed, “Ooh!  When I add this to the cocktail, I feel an extra color enhancement or something like that.”  I’ve had some crazy effects combining things.  It’s kinda nice.

Dr. Justin Marchegiani:  Yeah, I agree and I think everyone should be on some level of an adaptogenic herb depending on their stress.  I think it’s super important.  Everyone should be on a multi.  A good quality fish oil if you’re not eating good–at least 4 servings or 4 ounces of fish a week.  A good adaptogenic herb and then whatever other nutrients you’re missing based on your lab work people should be on as a–as a minimum kind of foundation in my opinion, and adrenal support is gonna be important because most people are stressed.  They’re working more.  They’re under more stress.  They’re doing more and that’s kinda what’s happening in our society.  Everyone is go, go, go, go, go, go.  I mean our work week’s going up 10 hours, we’re sleeping less, so anything we can do to help us modulate and adapt to stress, we’re definitely better off.

Evan Brand:  Yup.  Well, that’s all I had in terms of today’s topic.  I feel like we could go on tangents for another hour but I think that’s a great concise overview of this whole picture, the modern 21st century epidemic.

Dr. Justin Marchegiani:  Yeah, and let me just kinda hit one thing home.  The Russians in the 40s and 50s and 60s, they actually were doing a lot of research on adaptogenic herbs.  They’re sitting there and they’re like, “Alright, like we want to have our athletes do better.  We want out military to be better.  We got this whole thing and the space race going on, what can we do?”  And they spent tens of millions of dollars which back then probably, you know, equals hundreds of millions of dollars today on testing these herbs.  I mean and they found that their military performed better, their athletes were better, they were using herbs to help recover.  I mean, they’re probably using some steroids, too.  But they were using some herbs that really helped recover from their workouts to modulate sex hormones, to improve immune function so after severe exercise or you know, mil–military mission so to speak, their immune systems wouldn’t be suppressed.  So they did a lot of research and experimenting with these herbs and it’s like, “Man, if people really knew how powerful these things are, I think they would be part of everyone’s rotation if you will.”

Evan Brand:  It’s life-changing.

Dr. Justin Marchegiani:  Yeah, absolutely.  Any take homes from you, Evan, here?

Evan Brand:  No, just take a baby step from listening.  I know there’s a lot of information thrown at you.  So if there’s one lifestyle thing you can tweak, if there’s one supplementary thing you can tweak, if you can not skip that meal that you were thinking about skipping, go ahead and get you some good fat and protein, if there’s one little piece you can pull out of this podcast today and apply that, that’s gonna be helping to keep you in a normal rhythm and not become another burnout victim or maybe it’s the first step to try to help pull you out of that burnout that you’re in.

Dr. Justin Marchegiani:   Totally agree.  Again, my take home is make sure you’re getting to bed before 11 o’clock.  Don’t skip breakfast.  Eat every 4-5 hours, high quality anti-inflammatory protein, good quality fats, relat–you know, healthy carbohydrates for your metabolic type, right?  If you’re doing a lot of exercise, you may need a little more carbs and again, find a good functional medicine practitioner if that’s helping a bit but it’s not getting you over the hump 100%, reach out to someone like myself or Evan so we can get some testing done and we can pull out the sniper rifle so to speak and get really specific versus, you know, just general run-of-the-mill adrenal protocols.

Evan Brand:  Yup, definitely.  Well, cool.  Thanks!  It’s been a blast.

Dr. Justin Marchegiani:  Thanks, Evan.

Evan Brand:  Alright, bye.

Dr. Justin Marchegiani:  Bye.



Hashimoto’s Disease and The Infection Connection

hashimoto's disease

By Dr. Justin Marchegiani

Hashimoto’s Disease, is an autoimmune disease, a disorder in which the immune system turns against the body’s own tissues. In people with Hashimoto’s, the immune system attacks the thyroid. This can lead to hypothyroidism, a condition in which the thyroid does not make enough hormones for the body’s needs.

While a healthy immune system resists infection, a weakened immune system welcomes it in with open arms. Infections thrive in unhealthy environments. And once a bug (parasite, bacteria, fungus, or virus) moves in, it can be difficult to exterminate.

Infections can worsen autoimmune conditions of the thyroid (such as Hashimoto’s thyroiditis and Grave’s disease) and other parts of the body. It can also create inflammation, disrupt detoxification, and wreak havoc on the digestive system. So the bug has moved in—here’s what you need to know to minimize infection and protect your thyroid.

Bacteria in the Gut: The Good vs. the Bad

Our gut needs good bacteria to function and thrive. A ratio of 80% good bacteria and 20% bad is a healthy level of gut bacteria.

An imbalance in this bacteria (e.g., 80% bad and 20% good) is called dysbiosis. Overgrowths of yeast (such as Candida) or infections (such as H. pylori) can cause this imbalance.




Good bacteria consume toxins and send nutrients to the body. Bad bacteria consume nutrients and send toxins to the body. Those bad bacteria can lead to a leaky gut.

Small intestinal bacterial overgrowth (SIBO) is a condition that’s driven by bacteria that’s migrated from the large intestine into the small intestine. They’re in the wrong place. This can produce toxins in the gut and disrupt peristalsis (the wavelike contractions that move stool through our intestines).

If we have a delay in peristalsis, we can reabsorb a lot of the toxicity. This is called autointoxication.

Infections in the gut can be particularly challenging and difficult when they accompany an autoimmune condition.

If you are concerned that you might have a gut infection, please feel free to reach out here for help!

Infection with an Autoimmune Condition (Hashimoto’s)

When we have an autoimmune condition, this simply means the body is making antibodies that can’t tell the difference between the invader and the body itself. Antibodies are proteins that fight invaders such as bacteria and viruses. So while the antibody may fight the invader, it will also attack a specific part of the body.

In the autoimmune condition Hashimoto’s thyroiditis, the body makes antibodies to thyroid peroxidase (TPO) causing thyroid breakdown. In Grave’s disease, the body makes antibodies to thyroxine-binding globulin (TBG) causing thyroid breakdown.

Infection Leads to Leaky Gut Leads to Thyroid Breakdown (Hashimoto’s)

The bad bacteria (overgrowths of infection) in the gut pave the way to a leaky gut.

When our gut becomes leaky, undigested food particles pass through “leaks” in the gut and enter the bloodstream. The surface proteins on gluten, for example, can look very similar to the thyroid and cases of “mistaken identity”. This is known as molecular mimicry. This is true for other body tissues as well. Dairy can look like the pancreas, for example.

So the immune system starts making antibodies for the thyroid because it can’t tell the difference. And then know, the thyroid is under attack.

Infection and a leaky gut are two of the prime mechanisms that exacerbate the breakdown of the thyroid.


immune system


Infections That Impact the Gut and Thyroid

A few common infections that are found when dealing with leaky gut and thyroid issues follow:

  • Helicobacter pylori (H.pylori)—This bacteria is common in greater than 50% of the population. It can drive autoimmunity in Hashimoto’s. Also, it is linked to other autoimmune conditions. It is transmitted through saliva or fecal contamination.
  • Borrelia burgdorferi (Lyme disease)—This bacteria looks similar to the thyroid, so it can exacerbate autoimmunity. It can be acute or chronic and is transmitted by the deer tick.
  • Yersinia enterocolitica—This parasitic infection can trigger thyroid conditions and autoimmunity. It is transmitted through contaminated food and water.
  • Candida—This fungal infection disrupts digestion, throws off good-bad gut bacteria balance, and creates constipation. It is transmitted through direct contact and can be spread by contact with contaminated objects.
  • Epstein-Barr virus (mono, the kissing disease)—This virus causes an imbalance in the immune system and is present in 80–90% of the population. It’s connected to many autoimmune conditions, including Hashimoto’s. It is transmitted through saliva.

Removing the Infection Isn’t the First Step

Addressing infections can be stressful on the body. Being unhealthy means having an imbalance in gut bacteria, poor gut function, adrenal issues, energy issues, a bad diet, poor sleep habits, etc. When we are unhealthy and we knock out an infection, our body has to deal with the dead debris.

The infections are like soldiers fighting on a battlefield. We introduce our natural or herbal antibiotics to destroy the infections. Massive numbers of soldiers (the infections) are falling all over the battlefield.

Our immune and detoxification systems have to send out the medics to help pull the soldiers off the battlefield, but there are just too many soldiers (too much infection debris). The medics (our immune and detox systems) get backed up. And there’s a huge line of soldiers that still need help.

Once our immune and detox systems are backed up, this creates a Herxheimer reaction. In this reaction, the harmful biotoxins from the infectious debris accumulate. Then, they start creating stress on our immune, detoxification, and lymphatic systems. The medics are stressed—they can’t keep up.

To eliminate the stress of infection debris on the body, removing infection should be the fourth step in a five-step (the 5Rs) strategy that can be found in detail at this link, and briefly below:

  1. Remove hyperallergenic foods.
  2. Replace enzymes, acids, and bile salts.
  3. Repair with healing nutrients and adrenal support.
  4. Remove infections
  5. Reinoculate with probiotics.

Removing infections can leave the gut empty. It will even knock out some good stuff, too. And weeds (bad bacteria) tend to grow automatically in this world. Gardeners don’t go to Home Depot to pick out weeds to plant. Weeds just happen. So it’s important to reseed the gut with the good bacteria after removing infections.


Studies have shown that when certain infections are removed, we see a significant decrease in the amount of thyroid antibodies. This means that these infections are driving the immune system to destroy the thyroid faster. So if we can knock out the infections, ideally naturally, herbally, and safely, we can reduce the self-destruction of our thyroid tissue. That’s the goal.

Determining if you have a thyroid and infection connection can be difficult. Please don’t self-diagnose, but feel free to click here for help.


Featured image from

Benvenga S, Guarneri F, Vaccaro M, et al. Homologies between proteins of Borrelia burgdorferi and thyroid autoantigens. Thyroid, 2004 Nov; 14 (11): 964–66.

Corapçioğlu D, Tonyukuk V, Kiyan M, et al. Relationship between thyroid autoimmunity and Yersinia enterocolitica antibodies. Thyroid, 2002 Jul; 12 (7): 613–17.

Molina V, Shoenfeld Y. Infection, vaccines and other environmental triggers of autoimmunity. Autoimmunity 2005 May; 38 (3): 235–45.

Tomer Y, Davies TF. Infection, thyroid disease, and autoimmunity. Endocr Rev, 1993 Feb; 14 (1):107–20.

Wentz, Izabella. Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause. Wentz, 2013: 238–241.

The entire contents of this website are based upon the opinions of Dr. Justin Marchegiani unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Justin and his community. Dr. Justin encourages you to make your own health care decisions based upon your research and in partnership with a qualified healthcare professional. These statements have not been evaluated by the Food and Drug Administration. Dr. Marchegiani’s products are not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using any products.