How to Reduce Inflammation and Improve Joint Mobility | Podcast #359

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When you think of joint mobility issues, you're probably thinking of inflammation. Inflammation is a process in which your body's white blood cells and immune proteins help protect you from infection and things like bacteria and viruses.

In this video, Dr. J and Evan Brand discuss that your immune system triggers an inflammatory response when there isn't anything to fight off in some diseases. With these diseases, called autoimmune diseases, your body's immune system damages its tissues. Your body responds as if normal tissues need to be fought off. These are all linked to diet modification and testing that needs to be done to make you health better.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:00 –  The benefits of movements to joint mobility
5:23 –  The benefits of ergonomic chairs and tables for your back
18:56 – The vital role of proper diet for better joint mobility of reduction of inflammation
30:04 – The anti-inflammatory benefits of ginger for joint health

Dr. Justin Marchegiani: With Evan Brand, we’re gonna be going into reducing inflammation in the joints and how to improve joint mobility. We’re gonna be talking about it more from a biochemical kind of metabolic inflammation standpoint. So excited to dive in on that topic. Evan, how are we doing today man? What’s cooking? 

Evan Brand: I’m doing pretty good. I was telling you about my shoulder. I was lifting some heavy things over the weekend and my shoulder got a little tight on me. I thought, oh oh. So, uh, that spurred the idea of this conversation and I hit some arnica homeopathic 30c which worked very well. It’s not necessarily the root cause but it has been helpful and you know I wasn’t trained on homeopathy so this is something you and I have kind of dove into in our personal lives with our kids and such and it’s been a game changer. So, I mean, out of the gate, I think that’s something to have on hand even if you don’t know biochemically your root cause, what’s going on, at least you could remedy your situation, feel a little bit better well and buy some time while you’re investigating. 

Dr. Justin Marchegiani: 100% So, when I look at joint issues right, you have physical inflammation that’s being caused by physical things, right? The most common things are going to be either over exercising too much, probably less common on that and the other one is just very poor posture, right? So, the easiest thing out of the gates is you’re either sitting in a really poor chair that has very poor lumbar support, right, lower back curve support or cervical curve support. So, the easiest thing is just getting a really high good quality rated ergonomic chair especially if you’re sitting a lot, right, that has cervical support and lumbar support, that’s super helpful. In that way that part of the spine is supported. Ideally, being able to stand a portion of your day. I mean, right now, I’m standing. I don’t think you are. So, I stand at least half of my day. I have a treadmill that I’ll slide it under there. I have a Cubbi stepper. So, I’m always trying to keep some movement in there. I get about 15,000 steps a day so it’s very helpful to be able to move, get some steps. That’s helpful for the joints. The disc in the joint get hydration through inhibition. So, the joint has to pump and move to get hydration into the joints. So, movement through the joint is super helpful. So, being able to stand for a portion of the day, sit a little bit with good support, getting some movement, super helpful. And then depending on the kind of where you’re at, if you have inflammation, if you have pain, I mean, you can do some simple core kind of postural functional movements to strengthen that area. I mean, one of the things I like, uh, is a book by Eric Goodman called Foundation Training, where he just does some simple posterior chain work like a standing prone cobra with the chin pull back, right, that activates the deep cervical flexors here. I mean, you can bend down to a 45-degree angle like this for 30 seconds. You can also bring it up like this and get the whole posterior chain activated and then you can also reach down and then create traction with the spine so go look at Eric Goodman’s work. He is a, just that these three or four movements called the founder that, those are really good movements to get the posterior chain like this, like this. Simple stuff out of the gates. And so, I like that to get the posterior chain, good stability with your chain, investing good money on your desk chair. Get sine ability like a stand desk to be able to stand up throughout the day even if you’re just kind of moving going back and forth. These are super easy ways to kind of get simple movement through your spine during this, you’re not sitting all day. And if you’re sitting all day, at least invest in a really good chair and try to get some of the stand desk where you can go up and down.

Evan Brand: I do this little bar stool too and that way I could just lean my butt on it. So, I’ll just put my butt on that but I’m still standing. I’m just kind of leaning back on it. I know there was some really expensive thing, I can’t remember the name of it, a few years, I think Marxism was promoting it but it had like rocks. It has this thing that he learned. It was almost like a pogo stick with a seat and so it was like this imbalanced chair. You’re sitting but you’re standing but there’s some like rocks on the floor and so he’d put his bare foot on the rocks. I don’t remember what it was but this is kind of my homemade version of it, this little bar stool that It’ll just kind of leave off kilter. In that way my butt’s just taking a little bit of load off because if I just try to stand all day, my back hurts. So, standing all day just doesn’t work for me but with a little bit of lean, it helps.  

Dr. Justin Marchegiani: Yeah. They have these, um, these little, they’re called like wobble board chairs. There’s one called the Luna standing desk tool. It’s kind of like that, it's kind like a pogo stick, right, but it’s got a flat surface, that’s kind of oblong so then you're kind of sitting on that. You kind of have balance so then it activates the core but then you can kind of move around, kind of get some movement in your hips which is good for your spine. You can also just get like a Swiss ball, right? Just sit on one of those in that way, you can get some movement. And you won’t have so much support in the back so you really have to activate your core, activate your back so you can sit up there straight. That’s good, nothing wrong with that so that’s helpful. You probably wouldn’t want to do it all day because you’d be really keeping these muscles active all day but it’s nice if you’re at a desk, you can at least bring that in and bring the wobble board stool type of chair in there. These are a couple options, you know, minimal cost to bring in some good core activation. And when I say core, core is everything. It’s like the whole core thing is your back, it’s multifidus, it’s your iliocostalis muscles, right? It’s your longissimus muscles, it’s obviously your TVA, it’s your rectus abdominis, it’s your oblique, transverse, external, internal oblique, right? It’s everything around your back and front abdominal area. 

Evan Brand: People may be listening and go ‘God, why does that be so complex, I gotta get to this fancy chair or this or that’. Because, we didn’t really evolve if we were sitting like this all day staring at a screen. I mean, we’re just not really built for this, so it’s no surprise that we see so many people with mobility problems. I mean, I’ve been to several different physical therapy people over the years, just for random injuries and aches and pains and they all tell me that in their careers, these are people that have worked 20, 30, 40 years. They’ve seen just the rise of younger and younger people having worse mobility because they’re just sitting at a desk all day and how it’s shortening the muscles. I think it’s the hamstrings, right? It’s shortening the hamstrings when you sit all day?   

Dr. Justin Marchegiani: Well, I would say it’s probably shortening the hip flexor muscles, right? Because the hip flexors, right, when you flex the hip, you’re shortening that muscle so you’re creating that muscle shortens and that muscle, its insertion is on the lesser trochanter in the hip flexor in the femur muscle, in the femur, uh, bone so the lesser greater trochanter muscle, the top part of the femur but then it inserts, no, that’s where it inserts. Its origin is I think from L1 to L5 on the spine. And so, when you have tighter hip flexors, it pulls super tight on the origin which is going to be L1 to L5, I think, transverse process, and even the ribs.  So, it’ll pull really really hard on that back and so a lot of times, your chronic lower back pain is gonna be from the shearing force from really tight hip flexors, that’s part of how lower crossed syndrome happens, right? Lower crossed syndrome is nothing more than super tight hip flexors on one side and on the other side weaker glutes and weaker lower abdominal muscles. Weaker abdominal muscles, weaker glutes because you’re not using glutes to step up or squat or lodge and then you’re getting these shorter, tighter hip flexor muscles and that’s the lower crossed syndrome, right? One cross is weak and loose or weak and tight, that’s your hip flexors, the other one is, um, weaker, that’s the glutes and that is the lower abdominals. And so, this is common and so people talk about investing a lot of money in beds, right? I have a nice Tempur-Pedic bed, that’s pretty expensive. I know you have a nice bed as well but we spend just as much time in bed as we do sitting in our chairs all day, so I think, you should, people should have, you know, enough money invested in a really good chair that has good postural support. You can go to like different ergonomic stores. There’s one in Austin called Human Solution on Anderson Lane. They have a lot of great options. I got my stand desk from them. They have some really good ergonomically certified chairs that are excellent, that have the cervical support as well as the lumbar support. These are really good options to kind of start out of the gates. So, kind of my thing is start with like, you know, the easiest buy-in, right? The easiest buy-in out of the gates is upgrade your chair, maybe get some swiss ball that you can sit on, maybe get your desk, get your stand desk so you can go up and down throughout. These are just some simple, easy investments. And if you already have these things and you wanna get more kind of biohackerish-like we are, I have a Cubbi, little pedals here so I can pedal. I have my little, um, I actually got a new treadmill desk that’s under my desk that’s lighter and it goes four and a half miles per hour and I have a remote, I can just hit it. 

Evan Brand: Spell Cubbi. 

Dr. Justin Marchegiani: C-u-b-b-i. And then my other treadmill, hold on, let me go look at real fast. And my new treadmill desk is Rhythm Fun. I’ll put the links down for Amazon below. Take a peek at. But the cool thing is the remote because you can just kill it, turn it off, turn it on. Without having to go touch it. 

Evan Brand: Now, if you don’t sit at a desk all day, congratulations. Hopefully, you’re out working in the field or something like that, you know, years ago, I was working in the woods and building hiking trails and restoring different natural, you know, natural areas, nature parks and stuff but man, it killed my back. I mean, it was a lot of work, a lot of labor and not much pay at all, could raise a family on that wage. So, if you are out and you’re physically great, that’s awesome or if maybe you’re just doing that in your free time, maybe that’s counteracting your desk work. I mean, that’s what I try to do, it’s even in the middle of the day for lunch, I’ll just try to go out and walk around even if I just like hiking up and down my driveway. Just something simple, just to break it up. And I forgot what her name was, it was, uh, Joan Vernikos. I had her on my podcast probably almost like 10 years ago. I think she worked with NASA or for NASA, but anyway, she talked about the importance of just standing up and sitting down and just the change in posture was more important than anything. She said, it wasn’t necessarily the actual exercise, it was just breaking up you’re sitting. So, if you’re sitting for 20 minutes and then you can stand for 10 seconds, that was enough she said to, you know, positively impact your mobility.  

Dr. Justin Marchegiani: Yeah. I mean, adding another 90 degrees of extension onto my hip flexors, right? If your hip flexors right at your leg to your hip you’re at 90 if you’re sitting. Well, if you’re standing you go to about 180, 160 – 180 right? So, I create more length to my hip flexor which means it’s less likely to get tighter and shorter and create lower back pain. And so, that’s the easiest thing, so there’s a lot of different buy-ins, right, so like we’re not trying to give a one-size-fits-all, we’re trying to say okay if you already have a good desk or already have a really good ergonomically supported chair, maybe upgrade into a stand desk or just get a simple physio ball. Ideally going from sitting to standing is ideal. So, I would say good chair, then go to a good desk and then if you wanna add a physio ball or a wobble chair, that’s great. And then, if you wanna go to the next level and get a treadmill that slides underneath, I think mine was 500 bucks which is great though. My other one was a Rebel Desk treadmill that I used for five years, I just got rid of it because of the belt, just like almost I wore though and I’m like doing the math. I'm like all right it’s about the same cost to repair it as to get a new one. That goes a little bit faster and I get the remote. So, that’s kind of where I’m at. So, there’s a lot of different buy-ins. Now, that’s kind of like the lifestyle exercise movement standpoint and remember, I’m not saying crazy exercise. I think the more you can get movement throughout the day that’s non structured is better. Meaning, if you can get 10, 15 thousand steps throughout the day where it’s non-structured throughout a 10-hour, 12-hour a day that’s good because if you just exercise for 30 minutes and you sit on your butt for 10 hours, is that really that good? You’re still sitting down not moving for 10 hours, that’s still not great. So, if you can get a little bit of movement in and you can also have a lot of unstructured movement, that’s even better, I think overall. 

Evan Brand: I would say so, I mean, I certainly can tell you the days that I exercise and then sit for too long, I’m just as stiff as if I did an exercise compared to times where I’m moving around throughout the day. So, yeah, I think throughout the day is better. Let’s get into some of the chemical stuff too, some of the infection stuff, I mean, I’ll tell you personally with some of the stuff I’ve had from tick bites. whether it’s Lyme, Bartonella, Babesia different things that create inflammation and affect blood flow, I would tell you that there are some waxing and waning periods like where hands, feet, knees, hips, that kind of thing can get tight and so I think, ultimately, you gotta test not test. So, you and I have talked about this before. Not all testing is a hundred percent accurate but we do feel that the DNA connections report does give us a pretty good read for different types of Borrelia that we can look into Lyme then some of the co-infections which the name co-infection kind of sounds like it always comes with Lyme, I do believe some people just have Bartonella or Babesia. And those things can really affect people in terms of mobility so for me, things like Japanese knotweed are very helpful and I take a tincture of Japanese Knotweed and of course we’ll mix that into some of the other stuff we’re gonna dive into but you have to investigate this. So, if you’ve got mobility stuff or if you sit for a while and you get stiff or if you’re having issues just making a full fist, you can’t fully get those fingers in, make a full fist, there’s probably something there, infection-wise.    

Dr. Justin Marchegiani: Well, anytime you create chemical, so I kind of look at like, all right, we have structural inflammation and we kind of just talked about postural things like things that you’re gonna be doing sitting, standing kind of lifestyle habits, so not like going to the gym like, right? That’s kid of like our physical but you know more lifestyle. Now, we have our chemical and the more inflammation we put in our body, the more it decreases blood flow to tissues, the more it exacerbates prostaglandin 2 and arachidonic acid which are more pro-inflammatory. It’s gonna decrease inflammation, decrease blood flow and then we, when we, sorry, increase inflammation and decrease blood flow, decrease oxygen, so when we do that, the tissue starts to become less pliable, right? So, think of like beef jerky, very like not pliable, like you have to rip and tear it. The more inflamed you become, the lack of blood flow that you have, right, the lack of nutrition to the muscles, the more your muscles become less pliable, less like a nice raw beef tenderloin and more like beef jerky. That’s not good. So, when you do movements, you’re more likely to tear and injure tissue. And obviously, if you tear muscle, that’s more vascular tissue, it has good blood flow so it can heal better. But as soon as you start affecting cartilage and tendons and ligaments, that tissue is very avascular, very poor blood flow so it’s gonna be very difficult for that to heal. So, big things that we can do is, you know, more vegetables less fruit and carbs so keep your carbs in check. Again, if you’re more active, you can do more carbs, be very careful of your Omega-6 vegetable oils, ideally, you know, two to one on your high-quality saturated fats, really important and then you can do on your vegetable side, you’re better off doing your mannose, right? Avocado, olive oil, be very careful of your nut and seed-based oil and your omega-6 like sunflower, corn, soy, canola, very inflammatory and of course things like gluten, processed dairy, processed grains, sugar, these things are gonna drive more inflammation, they’re gonna decrease blood flow and just when the more inflamed you are, it just, it can create a lot of inflammatory molecules going through the body and they just make your body more stiff, more inflamed. The more stiff you are, you can’t get full range of motion, your tissues start becoming less pliable and easy to tear and injure and you feel just more stiff throughout your movements. 

Evan Brand: Yeah, well said. And then on the conversation of Lyme, for example, I mean, we know that Borrelia, in general, likes to eat up your collagen, I mean, it’ll really try to hid out in joints and such, so I think, collagen supplementation may be helpful too, just trying to replenish some of what’s eating up. But then, you just got to clear some of the infections, I mean, I’ll tell you, if I’m doing some of the anti-Borrelia formulations whether personally or clinically, people can move better. So, if you’ve had tick bites if you grew up anywhere, almost anywhere in the U.S. except for maybe Nevada or New Mexico, supposedly there’s not many ticks there. But beyond that, if you have tick bites from childhood, I mean that could be a factor to look into. This could be a dormant infection that’s left you alone for 30 years and then all of a sudden, you got exposed to mold or you had a death or a divorce or a move or a major job stress or even just the pandemic that’s been going on. And some of that stress people out of the sudden, boom, they have these major joint problems so who knows, there could be a trigger but like you said, it could just be, over time lack of blood, inflammation together. So, what about, like..

Dr. Justin Marchegiani: All these things modulate the immune system, right? And so, like, what you’re gonna see is you’re gonna see an increase in arachidonic acid, which a lot of these things are come from meat, so it’s not bad to have too much arachidonic acid but if we increase prostaglandin 2, that’s a more proinflammatory pathway. So, vegetable seed oils, omega-6, too much arachidonic acid but if you balance it with omega-3, high quality grass-fed meat which is very high in GLA. It’s not necessarily the fact that you’re getting it, it’s more of the ratio of where you at with the others and so that’s why, really what’s gonna tip you over is the processed sugar, the hydrogenated oils, the trans fats, the soy, the canola, the sunflower, too much nuts, too much seeds, that’s gonna tip you over and put you into a more proinflammatory state. And then the more sugar you eat, the more grains you eat, the more your tissue starts to become less pliable. Now, I have a history, like, doing applied kinesiology work and using percussion work, and um, chiropractic work. I remember working on a patient and they literally, their tissues literally felt like a bag of cement and this person, like, couldn’t like, so we would use a percussor, we’d do some soft tissue but we, I noticed that when we got gluten out of that person’s diet and grains out of that person’s diet and sugar out, the tissue quality totally changed and it’s like if you’re inflamed and you have such poor movement, you’re not gonna want to move but then if you don’t move the tissue gets tighter and if it gets tighter then now you restrict your range of motion and you’re, it’s a vicious cycle, right? So, you kind of have to get some movement in there, you have to loosen up the tissue, you have to make the diet changes so you get better blood flow but you got to work into it because if someone’s coming in, really inflamed and they go too over the top, they may create so much inflammation that they have a paradoxical reaction to feel worse, so you really wanna ease into it. And so, if you’re not used to walking, just walk a little but try to exercise just enough where you repeat it. That next day, you may feel a little bit sore but you can still function, you can still do all the things you do. If you feel too sore the next day, where you can’t do what you have to do, you probably did too much. So, just enough to feel it and know you did something but not enough where it affects your you being able to function.   

Evan Brand: Yeah. I got a few physical therapists clients and they tell me straight up that they know they’re never fully gonna get their patients better because of their diets and these people are coming in, you know, they’re eating like a subway sandwiches as they walk into the physical therapy office, so the physical therapist doing the best they can but they know just listening to us that they’re never fully gonna get them better without the diet changes and then they’re like well that’s out of my scope of practice. I can’t, you know, educate them much on diet so I’ll try to hint at it but yeah. It’s sad because you see billions and billions of dollars being spent per year on physical therapy, occupational therapy, physical rehab, that kind of stuff, people maybe had car injuries, for example, where there was a traumatic event that led to this mobility problem but then they never fully recover because they go right back eating the RB sandwich, you know, the roast beef and the bread and the ketchup and they never fully get better. So, I think, there’s a place, hopefully, people pick up on this, you pass this information onto maybe a physical therapist, get people off of grains, get people off of dairy, at least temporarily of dairy. I think butter, there’s maybe a place for that in most people’s diets. But I will tell you personally, I’ve seen the changes in my own family members if we can get them off gluten or off grains even for a month, we see improvement and so it’s just this doesn’t make money for people, I mean, there’s so many pharmaceuticals that people are taking instead, right? What’s the conventional approach for these issues like Aspirin, Tylenol, maybe Aleve and maybe some anti-inflammatory steroid drugs, right, I would say in severe cases, those are being useful. 

Dr. Justin Marchegiani: Yeah. I mean, you have your, like NSAIDs, which are gonna be like your Ibuprofen, your Advil, your Aleve, right, I think your Aleve’s kind of your time-release Ibuprofen, right. These are gonna help with the prostaglandin 2. And then acutely, you know, for a couple of days, if something happened that may not be a bad idea. The problem is if you’re chronically needing these medications that’s the problem. And then you have your acetylsalicylic acid, that’s your aspirin and then you have your acetaminophen, which is Tylenol, again Tylenol blocks the pain receptors so it's not an anti-inflammatory. Aspirin is a mild anti-inflammatory. Ibuprofen is an anti-inflammatory. And then you keep on going up into the steroids where you actually get an injection, the problem with that is after one or two injections, your anesthesiologist or your pain doctor will tell you, yeah, we’re gonna start to break down tissues and cartilage and tendons, that’s not good either. And so, I tell patients, you know, one, you don’t wanna jump on injections right away because you want there to be some pain signal to tell you you’re doing too much when you’re rehabbing. So, it’s good to have some pain signals that will tell you, ‘hey I’m doing too much because the problem with this medication is it covers up the pain and then you may be doing things in your life movement wise, it’s actually creating more pain but you can’t feel it right. So, then of course, you go up the ladder and you’ll eventually be on opiates and that’s the problem and that opiates are very addicting, it’s just basically telling it’s blocking the brain’s ability to perceive pain and then essentially the longer your on an opiate, um, you know Suboxone, of course, you have the incredible, your morphine post-surgery, you have Fentanyl which is like incredibly higher version above your oxytocin which is like time-released opiate, it rewires the brain and you start to need more of it to then block that pain signal and then that creates more addiction right. So, you really wanna not be on these pain medications. Now, my problem with physical therapy and chiropractors is that a lot of times they can apply therapy that does not fix the underlying issue. So, chiropractors are very notorious for just, you know, adjusting a segment of the spine and creating some movement on that spine and calling it a day, right? But, if the person’s inflamed from their diet and lifestyle, that’s not helping it and also the soft tissue component should be addressed. So, when I was a chiropractor doing these kind of work, we would do like, percussion, I’d have a percussion instrument, just a couple of minutes to get the tissue warmed up and that way when I would adjust, I wasn’t having to adjust through all this soft tissue that was so hard, the soft tissue was more loose and I could move that segment and I’d always talk about how we get some better movement in the spine with exercise too because you wanna, you don’t want only movement in that spine to be through adjustment right? And so, getting these soft tissues under control using some active release techniques to help lengthen the muscle, help break up fascial adhesions, super, super helpful and so physical therapy, they’re notorious, oh I have knee pain, let’s just focus on that knee, maybe they do like an anti-inflammatory you know, uh, Russian stim or microcurrent or ultrasound, that’s good from an anti-inflammatory standpoint but physical therapy is common, we just only exercise that joint, we only stretch that joint, that’s it. They don’t look at the instability above and below the joints. Joints are very rarely just become unstable at that joint unless it’s an acute injury, someone took out your knee, it’s usually there’s instability either above and below so a good chiropractor, PT person will make sure the joint above and below is doing well. If I see knee issues, I’m gonna make sure there’s good glute activation, I’m gonna make sure that the hip flexors are facilitated, they’re not overly tight, I’m gonna make sure glute mi, glute max, all the adductor muscles in the middle are doing good. I’m gonna make sure the tip fib joint at the ankle has good stability. I’m gonna look at everything above because if there’s instability above and below that knee can compensate and have to work harder. So, I’m gonna make sure all the muscles around the knee, the glutes that stabilize the hips, the hamstrings that go to the glute that go up to the hips and also help stabilize the knee, the sartorius, the gracilis, semitendinosus, and semimembranosus, make sure everything is stabilized. 

Evan Brand: Yeah. You and I have coached many different, uh practitioners, a lot of them chiropractors and so many of them tell me, I’m just straight up sick of cracking backs for a  living because they know they’re gonna have to come back every week, they’re gonna crack the back again and then they’re gonna send the patient on their patient on their way and they’re never gonna get better and when I was working out of that brick and mortar practice and I started doing functional medicine consults, doing lab testing, getting all of the existing patients in the clinic, simply to make diet changes, it was funny but I guess not so funny for his bottom line, the chiropractor I was working for because, now instead of Betty needing to come in every week, she’s like no I’m fine doctor, I’m gonna come in in two weeks or three weeks or four weeks and it’s because the underlying inflammation was improving based on me fixing the gut, getting the diet improved. So, it’s kind of funny because people got in this routine of like, I’ll see you next Friday. It’s like, she shouldn’t need to be cracked again next Friday, you’re cracking her today, like what the heck.    

Dr. Justin Marchegiani: Yeah. It just depends how acute. If it’s an acute episode, you know, you’re gonna need to do it more frequently the first couple of weeks but if it’s more of a chronic thing, yeah you gotta get the soft tissue under control, or you gotta get the systemic inflammation in the body to the diet under control. And if you’re a chiropractor, you definitely wanna look at upper cervical, right, C1, C2, malalignments can create a lot of problems so that you definitely want to make sure that’s kind of crossed off your list because that can really cause a lot of issues and that could be a root cause as well but most people, it’s like poor posture, poor sitting, not enough movement, crappy diet, lots of inflammation and then of course, you know, muscles can also pull joints out of alignment too and cause them to feel sticky too. So like, I find the best chiropractor are like the applied kinesiology chiropractors because they would like use a percussion instrument even just for a minute or two is huge or they would do like origin insertion work, they would do like SOT technique, which uses blocks to get the hip alignment better I found those techniques were really helpful for chronic back issues and then when you have disc issues too, like you need to pump that back whether it’s a flexion distraction technique to help open up that disc, whether it’s an inversion table or whether it’s an inversion table or an inversion device for the neck that goes over the door or cuff to kind of create that negative pressure to pull that disc in off the nerve roots can be super helpful but then you got to get the muscles train down the road so a good PT or a good postural program like you can start with Eric Goodman’s foundation training. There are a couple of really good PTs online that are excellent, Bob and Brad, they go, they do a lot of nice postural videos at home stuff that are very helpful to people that are in pain. So, those are good guys, I’ll give them a, you know, a hot tip. Anything else you wanna highlight on the structural stuff we can go talk about the supplements next. I think that’s a good kind of ending point. Anything else, Evan? 

Evan Brand: Now, let’s move into the supplements, I had already mentioned like some of the enzymes, so I mean, we’ll use some of those and we often use these in combination, I mean sometimes people are taking so serratiopeptidase or I’m even personally doing lumbrokinase, I do a lot of lumbrokinase too because that’s like way more potent than serratiopeptidase and so we use that for blood flow problems with some sort of coagulation issue so whether it is an infection or mold toxin, Lumbrokinase, it’s a game changer.

Dr. Justin Marchegiani: But I want to hit that one. I wanna just hammer that one spot for a second. If you have poor blood flow which diet and infection can drive poor blood flow, if we can’t get the blood flow improve, we’re not gonna get the inflammation out and nutrition and oxygen in so ginger, the enzymes getting your diet under control, one of the biggest things that helps coagulation, if we decrease coagulation, we improve blood flow, we improve blood flow, we improve oxygen, we improve nutrition, we work on pulling inflammation out, that’s like a foundational mechanism to getting pain under control.

Evan Brand: Yeah. Well said. And there’s a lot of issues we’re seeing with post-viral coagulation issues or even acute coagulation issues, so make sure if you get some viral stuff going on, you gotta be knocking some if that too and we’ve seen people that are having chronic issues months and months later. So, to be honest in the time that we’re under I am personally staying on and recommending a lot of clients stay on some sort of enzyme just as an ongoing coagulation support, I think it’s a very, very smart insurance policy.  

Dr. Justin Marchegiani: Correct. And when we talked about these enzymes, for people that are listening at home, these are enzymes you take with food, we’re talking about enzymes we take an hour away from food on an empty stomach, you know, some of the best ones are gonna be the Lumbrokinase the nattokinase, the serratiopeptidase. Some are really good at taking them, um, enterically coated so they break down in the small intestine away from food so they get into the bloodstream. These enzymes can one break up scar tissue, they improve blood flow and they also can decrease a lot of interleukins and cytokines that are flowing in the bloodstream. So, if you’re chronically inflamed and you have a lot of these cytokines and interleukins in the bloodstream, these chemical messengers from inflammation, it can actually start to break them down a little bit, which is good. So, that starts to relieve pain. Now, if you get to the root cause, where you’re getting some movement, you’re working on your posture, you’re working on sleep and diet. This is powerful because now that starts to accelerate healing even better faster.   

Evan Brand: Yeah. And these are proteolytics so when you’re like researching these proteolytic enzymes as opposed you said the ones you're taking with food are digestive, so they’re still called enzymes. 

Dr. Justin Marchegiani: Two different things and they cost a lot more too than digestive enzymes. They’re not the same price. 

Evan Brand: Right. Yeah. Like Lumbrokinase, I mean a bottle of it, retail on the one we use which is the Bolouke from Canada RNA. It’s like the best one, as far as I know right now. It’s like 98 bucks a bottle retail. So, it is pricey but man it’s incredible stuff, I mean in terms of hands and feet, my blood flow is incredible. That plus beet powder, which is maybe another thing I’ll go ahead and mention now increasing blood flow, I do like beet powder and I will use some of that supplementally. Yeah. Arginine, citrulline, I’ll take some those in liquid form and I’ll mix those together and drink it all down. Those can be very, very helpful. You mentioned ginger too, let’s talk about ginger because you’ve talked a lot about ginger for like nausea and digestive benefits but you and I were looking at some of the papers on it and it does have a lot of really anti-inflammatory benefits too. So, that’s kind of cool, we’re saying that it’s a digestive aid but also a systemic inflammatory aid, correct?   

Dr. Justin Marchegiani: Yeah. I try to add things into protocols that just have a wide net so I love ginger because (1) it’s a natural bitter, so it will stimulate digestive juices, (2) it’s an anti-inflammatory so it’s very calming, (3) it’s a prokinetic so it helps the digestive tract empty because if your have like some kind of chronic inflammation or gastroparesis, food and acis can sit in there too long and create burning, (4) it helps with coagulability so it helps with coagulation so it decreases it, so there’s less clotting so you improve the blood flow, it also helps with blood pressure as well. So, a lot of and then also it’s an antibiofilm, so if we’re using ginger, um, to help with like, you know, killing it, it can actually help strip the biofilm, which are the protective shields that bacteria use to prevent themselves from being killed so it helps with the biofilms which allows the herbs we use to be even better and again the enzymes we use also help with biofilms too. 

Evan Brand: Yeah. A cool study here was just saying that in rat models of liver cancer, ginger extract counteracted oxidative stress and inflammatory damage and it restored levels of superoxide dismutase catalase glutathione and prevented an increase in COX2, which is one of those pathways you and I were talking about that like some of the natural NSAIDs work on, ginger is basically a natural COX inhibitor. 

Dr. Justin Marchegiani: Yeah. It modulates, right? The problem with a lot of the COX inhibitor drugs of the early 2000s like Vioxx COX is called cyclooxygenase enzyme 2. That enzyme is also very important for repairing the gut lining and repairing the heart. So, if you block that all together like Vioxx did, you can destroy the heart and the gut lining, so with herbs it tends to more modulate not overdo it but bring it down in a modulatory kind of gentle way, kind of like an adaptogen works for adrenals and cortisol and stress. Shut it down but it pushes it in the right direction. 

Evan Brand: That’s an awesome way to think about it. So, ginger is an anti-inflammatory adaptogen? 

Dr. Justin Marchegiani: Yeah. Yep. 

Evan Brand: Pretty cool. Okay. Let’s hit the others too because there’s others we use in blends, how about some of the polyphenols like the quercetin, the rutin, the resveratrol, the rosemary. I talked about Japanese Knotweed earlier, the main benefit of the knotweed is because of the resveratrol in it.   

Dr. Justin Marchegiani: That’s Japanese knotweed. That’s very helpful. Yep. 

Evan Brand: It’s amazing for like rheumatoid arthritis, like I said Lyme type of arthritis, which a lot of RA probably is Lyme but it’s been not properly diagnosed. So, I love those. I personally take some sort of that all the time. You know, quercetin, I love too, it’s in the vitamin C family. I love it because it’s a great mast cell stabilizer. So, if you are dealing with mast cell activation in the case of mold toxin or Lyme or Bartonella, Babesia, Borrelia, Mycoplasma, any of these things, even viruses that are triggering mast cell problems and you have all this histamine out in your system, the quercetin is really gonna calm that down so that’s why I love it. And you can do too much of the good thing but in general something like 250 to 500 milligrams 3 times a day of course for me is a game changer. 

Dr. Justin Marchegiani: 100% I would say next, we could do curcumin much better off to take it liposomally that’s very important. So, liposomal curcumin also, you know, make sure you cut out nitrates, nitrates and of course grains and refined sugar can create joint issues, so you’d be surprised how many people that have many chronic issues just making those changes help. So, liposomal curcumin for better absorption. 

Evan Brand: Why the nitrates? Will you riff on that for a minute because nitrates..

Dr. Justin Marchegiani: The alpha-Solanines, their compounds, their anti-nutrients in the nitrate family, tomatoes, potatoes, eggplants, peppers, these alpha-Solanine can get into the joints and they can kind of create a lot of inflammation similarly with people that have oxalate problems. Oxalates can get into the joints. These oxalate crystals and create a lot of pain issues in the joint tissues, in the muscle belly too. Now, again, I don’t go into oxalate restriction out of the gates because there’s a lot of healthy foods that have oxalates in them. Spinach and green vegetables. So, if someone’s coming off of a processed food diet, the last thing I want them to do is not to be worried about oxalate because that restricts a lot of vegetables. So, I don’t worry about oxalates out of the gates if someone’s diet’s crappy. So, I would just, I would work on their diet very clean and then potentially in some organic acid test that we do, we could see if oxalates are really high. If do they have a history of kidney stone problems, those kinds of things are helpful.  

Evan Brand: Well, yeah, don’t forget to mention too, Candida, I mean we’ll see oxalate. 

Dr. Justin Marchegiani: A ton from a kid's problem. 

Evan Brand: Yeah. So, I’ve seen people on like a low oxalate diet for years, they still show up off the charts and they’re having these joint pain issues, we simply just fix the yeast overgrowth or the fungal problems and then the oxalate markers go down and their joints are better. So, make sure that when you’re doing a work-up on these type of issues whether it’s mobility or pain or otherwise, make sure you’re looking for these fungal colonization markers, you’re looking at the Candida, you’re looking at some of the bacterial overgrowth because all of these things are gonna act as we’ll just say toxin in the bucket and if you get this infection plus that infection plus yeast then you really have much, much higher chance of having these problems and you go take the ibuprofen, you’re not knocking any of that stuff out. The yeast is still there.   

Dr. Justin Marchegiani: 110%. So, the oxalates, maybe more of a yeast issue, not necessarily an oxalate problem. So, something we add to our list, we can use, uh, things like Boswellia or Frankincense, very, very helpful, very good. Again, these things, how they’re working is they’re primarily modulating interleukins, they’re primarily working on cytokines, reducing some of these inflammatory compounds they may be working on the COX enzyme C-O-X-2, they may be working on nuclear factor beta, right? These are different inflammatory signals or chemical messengers, uh, may be working on prostaglandin E2, so they may be helping a lot of these things. So, we have to make sure if we use supplements though we’re not just covering it up like a band-aid, we’re actually trying to get to the root cause. So again, herbs tend to be better than like an ibuprofen long term because these things kill tens of thousands of people a year, not in the right way. Go look at Wolf et. al., 1998. New England Journal of Medicine Ibuprofen kills 19,000 people a year taken incorrectly. So, using these medications like Ibuprofen or NSAIDs in the short term may be fine, it’s the long-term use because you’re not getting to the root underlying issue. The nice thing is if you use the herbs and the natural things, long-term, there’s virtually no negative impact using those but again we’re not still getting to the root so use the herbs and the natural stuff long term to get to the root, get to diet things, that’s your best kind of foundational things. We can also add in some CBD oil, which is very anti-inflammatory. Anything else you wanted to highlight supplement-wise?  

Evan Brand: I would say magnesium would probably be one other one that’s located.. 

Dr. Justin Marchegiani: Great muscle relaxer

Evan Brand: How about, also, some of the herbal muscle relaxers too, I mean like Valerian and Passion flower, there’s some benefit from these. There is kind of a dual purpose, right? You could use it for sleep. Yeah, poppy would be good too. You could blend all those as kind of a sleep but also like a pain remedy and then I like topical magnesium also I love the Epsom salt bath. I like it more in a float tank though. I mean, Epsom salt bath, you’re like what a couple of pounds at most whereas a float tank, you’re getting 800 pounds, so just not eating.. 

Dr. Justin Marchegiani: I still absorb a ton though; I just do my fit. Just like a scoop or two but I still feel a huge difference but I agree if you can do the float tank, great, but if not that’s still a good in-between at home. Try it out for sure. 

Evan Brand: If I was like super stiff and I’m like my God, I can’t move, I’m going in a float tank because, I tell you I’m so flexible in there like when I first get in that so folks listening, this is basically like a large bathtub with 800 pounds of salt give or take. Super filtered water, it’s warm, it’s your body’s temperature, you take a shower, it’s usually at a spa setting, you get in there, you float on the surface of the water, you have your own little private float tank or float room usually and you’re just floating there and you’re there for an hour and your nervous system relaxes, they’ve used it for trauma and PTSD, so in terms of mental benefits, there’s incredible anti-anxiety benefits from it, but for physical too also, I tell you man, when I’m in there I fell, I mean, I feel like I’m made of jelly like, I mean I can just move so much better. One of my things. 

Dr. Justin Marchegiani: I would say, that, you know, from a nutrient standpoint amazing, a good myofascial release massage person, a good active release chiropractor, some kind of soft tissue technique, even if you’re doing, um, you know, foam rolling or get one of the hypervibe percussive tools at home. Just something to improve pliability, add in some of these nutrients that we mentioned CBD, curcumin, resveratrol, anti-inflammatory, I think also incredibly underrated collagen, I mean I do my true collagen 20-40 grams a day, um, collagen is a building block of your connective tissue that we don’t get a lot of because we’re not getting the knuckles and the bones unless you’re doing lots of soups with the whole carcass in there, we’re not getting these nutrients. So, adding extra collagen is essential for good building blocks or your joints and connective tissue.  

Evan Brand: I would agree. I mean, a forgotten nutrient that we just don’t eat in our diet, you can’t get that at a steakhouse, I mean, you’re just getting lean muscle. 

Dr. Justin Marchegiani: Unless, you’re getting bone marrow, unless they cut the long bone and they have all the marrow for you and eat that, that’s the only way you get it. Work in soup but most people aren’t getting it and so we’re getting more muscle meat, so that’s a good step out of the gates. I mean, I had my little coffee here, I had 30 grams of collagen this morning. People aren’t getting it. 

Evan Brand: Sweet. So, regarding 

Dr. Justin Marchegiani: A lot of anecdotes of patients, a lot of anticipations of just getting more collagen and changing their diet, huge chronic joint pain just shifting. 

Evan Brand: Oh, yeah. And yeah the diets used. So, yeah, I mean, labs, I mean we’re gonna look at stool, we could look at urine, we could look at blood too but you know but this is part of a work-up that we do, so if you need help please reach out. I’m sure we could get to something that hasn’t been found, I mean, even the Prevotella infection we look for in the stool like 75% of cases of Rheumatoid Arthritis are linked to in certain studies this Prevotella infection, which is the bacterial we test for. So, you’ve gotta look for the microbiome type issue, you gotta look for the deeper stealth infection issues, intracellular parasite type issues. There’s a lot of stuff too but we just have an approach to it, you know, we kind of peel back the layers here and we get to the root of it so if you need help, you can reach out. We both work worldwide with people via video and phone calls so you can reach out to Dr. J, it’s Justin at or me, Evan Brand, and like I said we work online so we’re very blessed to be able to help people in every nook and cranny of the globe and it’s a wonderful thing to be able to help people find things that they never found in 20 years of suffering and we just love to provide that, I don’t know, the pot of gold at the end of the rainbow, I suppose. 

Dr. Justin Marchegiani: 100% and you just mentioned some bacteria issues and different joint issues we know ankylosing spondylitis, which is an autoimmune issue that affects the lower back, your Klebsiella is a common bacterial imbalance, we’ll see affecting the lower back and causing AS that’s another issue, we kind of add to the list so very powerful. So, yeah, again, justinhealth,com for me, we’ll put the list of recommended products and different herbs that we use in our practice clinically if you wanna support, uh, the podcast and support us, feel free click down below, look under the references and you can get all these things that we recommend for our patients and ourselves right down there. Anything else, put your comments below, we really appreciate you interacting, sharing with family and friends and most people that we interact with, we don’t even get a chance to see and they get benefit so we love to hear your stories and your success. Evan, anything else man? 

Evan Brand: Yeah. If you’re on apple either on Justin’s podcast or mine since we will publish these episodes on each other, make sure you give us a review, we would really love it on the apple podcast, it helps to keep us up in the top of the charts of health and fitness so we can provide real root cause functional medicine strategies, there’s millions of people out there suffering and maybe a fraction are gonna get to hear this so please sharing is caring. Leave us a review, tell us what you think the show deserves and we’ll love you forever. 

 Dr. Justin Marchegiani: Thanks guys. Have an awesome one. Take care. Bye. 

Evan Brand: Take care. 


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