Joint Pain and Functional Medicine | Podcast #247

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Joint pains are one of the common problems especially in active, or people of old age. It is often caused by injury affecting ligaments or tendons surrounding the joint. While our daily movements can be a cause to this, the food we eat can also be one of the factors.

Enjoy this podcast as Dr. Justin and Evan Brand laid out infos on joint pains, supplements for healthy joints, lab tests, infections and a lot more.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

00:48 An overview on joint pains

06:29 Mycoplasma

14:29 Food then vs. now and how it affects our joints

21:44 Supplements for healthy joints

34:16 Hip pain, glutamate issue, etc.


Dr. Justin Marchegiani: And we are alive. It's Dr. Jay here in the house with Evan Brand. Today we are chatting about joint pain and functional medicine and how we can get people who are doing pain better. Evan how we doin' today man?

Evan Brand: Oh I'm doing wonderful. Excellent. And through some stuff here about back pain knee pain. I mean there's I would say if you did a survey of one hundred people and you said, Hey do you have joint pain I would say 90 percent of those people would say yes occasionally, my elbow, my knee, my wrist, my ankle, I mean the joints are to me one of the first things that really deteriorates and shows that you're becoming unhealthy. It's not like your biceps one day just falls off and hurts you know joints I think go first before you start to get weak and decrepit and lose all your muscle mass.

Dr. Justin Marchegiani: 100 percent. So we look at joint pain right. There's a couple elements. So we also have we have the cartilage which is kind of like the softer connective tissue. You know typically at the ends of the bones. So for instance you know on your femur and tibia right where your knee is you're going to have cartilage right in between here and the cartilage with the knees and the shoulders and the labrum on the shoulder. So you have this cartilage tissue which is really important that the softer kind of connective tissue and we need certain nutritional building blocks to help with that. Collagen is really important because we are typically consuming connective tissue building blocks like collagen right. We're typically a muscle meat type of culture but we need to be consuming organ meats and also connective tissue and we can get connective tissue by using a crock pot or an insta pot and throwing the full bone or knuckle of that joint in there. We can also get it through bone broth and we can also get it through collagen amino acids which are higher in protein hydroxide and glycine. These are really important nutrients that we're just not getting. So we have Cartilage connective tissue and then of course we have the bone connect tissue that's actually the structure the all the in-between connective tissue structure. That's the solid portion of the joint so we have cartilage on the ends and then we're going to have the bone in the middle and the bone people just think Hey the bones, calcium. They say hey a bone looks white, it's calcium but there's about 12 minerals that make up a bone. Calcium is predominant but there's other minerals too. And then people forget your bone is half protein so we're not eating out of the protein or we are not able to digest adequate protein from food allergens or poor stomach acid or infections or automatically going to have deficits on the bone side and potentially the cartilage side typically cartilage is easier because we aren't really getting that much cartilage tissue in our diets but we tend to get more protein but if we had other stressors going on- food, poor digestive support, infections or just a poor diet nutritionally we're going to have significant deficits.

Evan Brand: Check your zoom preferences it sounds like you may be on your headset audio and not your big ole microphone and I'm going to talk about some of the testing that we'll do with people when they come to us with joint pain because there are functional causes that we can find. So could this be like you said just a deficiency if you look at Dr. West in a Price's book one of the interesting things was that he said that when he was looking at these tribal cultures they would feed the muscle meat to the dogs. I mean muscle meat. Your microphone sounds much better now. Yes. Thank you for that. He I mean he literally said this was not just him you know talking to be funny. This was literally him documenting he said the organs were the first thing that people would go for and then boom muscle meat just. Here you go doggy. And now we pride ourselves and our grass fed steak which is good but I think yeah we are super deficient as a whole. And I'm taking several different supplements now I'm playing around with some bone marrow supplements and other things so I haven't been doing it long enough to give full feedback. I've been doing bone broth for you know a few years but I'm actually trying real bone marrow now and to see what happens because I've had many people report good things.

Dr. Justin Marchegiani: You know I'm doing the same thing as well. Thanks for the mic thing. Anyone listening in the wants higher quality audio click below. We're going to actually have the podcast link as well where we even have just the E higher audio version. So if you guys want to hear us in crystal clear quality feel free and click below. But yeah you're 100 percent right. So there's some supplements out there that will give you some of these building blocks like you mentioned some of the bone marrow some of the organ meat, some of the glandular meat which I think is really important. Bone broth collagen peptides are going to be great. Like in my life we have a product called true collagen and so collagen amino acids are wonderful. And if you have gut issues I love the amino acids because they're already in broken down form so 50 percent of the energy from protein actually goes into the digestive process. So there's an expensive transaction fee when you're digesting protein. So if you use an amino acid product it's a peptide form you're going to be able to absorb more of it and there's less stress on your gut. So of course we love collagen amino acid products. Whole Foods first but in the meantime that there's digestive issues or deficits in being able to break down those amino acids good collagen amino acid products are great bone broth is gonna be great. And like Evan said. There's some ancestral health products we use on the bone marrow side in organ meat side. We'll put some links down below. So you guys want to access some of those we'll put those links down below so you guys can see that. Anything else I want to highlight there.

Evan Brand: Yeah. So that was it for the food section. Most people I won't drop names but most people that's that's where their knowledge stops. They just say real food real food real food it'll fix everything and then they stop. Now let's take it to the functional medicine side and talk about testing when joint pain comes up we're gonna be looking at different ways to measure some of this nutrient malabsorption that you just spoke about so we could start talking about the stool test. We may be looking at pancreatic elastase, we may be looking at Secretary IGA to look at gut barrier function we may look at steatocrit which is a marker of fecal fat to see if someone's digesting their fats or not. So we don't have to guess and just say oh sounds like this person isn't absorbing they need collagen supplements. No we can prove it on a piece of paper with a combination of stool and urine testing and if someone comes to us with joint pain 90 percent of the time there's going to be some sort of infection. So why don't we talk about those whether you want to dive into like bacteria viruses parasites how that may affect joints.

Dr. Justin Marchegiani: Absolutely. So we can see joint pain with certain infections like cytomegalovirus or Epstein Barr virus. That's very possible. You may see it with Mycoplasma. Mycoplasma is one of these bacterial infections that can drive rheumatoid arthritis. So when we look at joint issues we kind of draw a line. Right. We have kind of the wear and tear of joint issues where you're just pounding that joint whether it's exercise or just poor posture or stress. And essentially the build up starts to drop and the breakdown tends to increase. So normally we have this build up and break down and as long as the buildup is at least even or a little bit above with the breakdown. Right. Anabolic to catabolic. We're OK. All right. Now over time though if the if the build up starts to drop and the breakdown increases that's where we start to get osteoarthritis and that tends to be that tends to be bilateral right now with rheumatoid arthritis or the autoimmune side of the fence so one side's wear and tear the other side's auto immune then. Now we're breaking down our tissue cartilage our joints and it's our immune system that's doing it. So it's not necessarily wear and tear it may be but now our immune system is coming to the party and it's certain to beat up the joint tissue. And of course there's different markers that we can look at to assess that. But infections play a big role like Mycoplasma, like H pylori, EBV, cytomegalovirus. These are really important things to look at from an infection standpoint. Most people ignore the infection connection with a lot of these issues because they think of these infections as hey if I'm not tired or if I don't have digestive issues I'm OK so we may look at things like antinuclear antibody like RNA. You may look at rheumatoid factor. We may look at anti citrullinated peptide or ACCP is also ESR which is erythrocyte sedimentation right. That's a marker of inflammation and we can also look at CRP, C reactive protein. These are really good markers of inflammation that's more associated with the joints and CRP and EST is more a systemic inflammation markers. And then of course the optimal gut markers are gonna be cow protected for inflammation in the gut cow protect and tie. That's like CRP for the gut. And if we have inflammation in the gut is a really good chance that we're going to have gut permeability and that gut permeability can drive autoimmune stuff and that auto immune stuff could potentially go after the joints if you after the cartilage the bone etc. So we really have to remember there's an autoimmune component and there's also a wear and tear component.

Evan Brand: Yeah. Well said that's what I wanted to to mention is many people that come to us they're not exercising you know that's something we'll ask you know what type of exercise are you doing how much how often etc.. And a lot of people with joint pain they're not doing anything. They're more sedentary. But yet they still have miserable joints. And so we ought to tell the story about my wife about almost five years ago to the day I remember because it was around it was around the first of the year of 2015 almost five years ago my wife woke up one day and she had joint pain everywhere her ankles hurt her knees hurt her elbows hurt and her wrist her and she had trouble putting on her jewelry and I thought What the heck is this. It was very freaky. And so I said hey what do you think this is. And you say well I don't know it could be X Y Z. So that's when we ran the bloodwork and confirmed that it was Mycoplasma and per your recommendation we had started on cat's claw and a strike list to really really good herbs that you and I love and enjoy for many reasons. But there is a sort of an antimicrobial antiviral component to those herbs. And then I mean it maybe took like a week or two and then the joint pain was perfectly gone and it hasn't bothered her ever since. So it could have been a move or let's see she would have been pregnant at the time with our first born she wasn't born yet so she would've still been pregnant. Maybe it was something a pregnancy change you know there was some type of stress all of a sudden that allowed this Mycoplasma to thrive and then and then take her down.

Dr. Justin Marchegiani: Yeah. What uses immune support and those significantly help bring down the inflammation from knocking down the infection. So that's an important one the infections I think are just very very easily missed and we want to make sure that we are on top of that.

Evan Brand: Let me mention prevotella it too because we can't skip. You have a tell us so prevotella. This is something that Justin and I both tests on the stool panel and we've seen time and time and time again the link and just look in pub med for yourself type in prevotella RA and you'll find that about 75 percent of patients with rheumatoid arthritis have a prevotella infection. And if you get rid of that prevotella the joint pain magically goes away. Now we're still going to be doing diet and all that actually did a podcast with a client of mine on psoriatic arthritis. She had terrible pain she would cry every morning when she would put her pants on because of the pain and with the help of an autoimmune protocol and addressing got infections her pain went from an eight or nine out of ten to one so wrecked. The good news is you can reverse this stuff but the problem is your doctor is not going to tell you about stuff we're speaking about today. So these people just end up crippled and it's really sad because you'll see a woman that's not that old but yes she could be using a cane or some sort of other apparatus she's limping and she's you know the lady is hurting but she's never going to get this type of information which is just sad.

Dr. Justin Marchegiani: Exactly. So in general with the joint issues and infections prevotella for instance also club CL is associated with Ankylosing Spondylitis or AS which is an autoimmune issue that affects the spine and will create arthritic like symptoms in the lower spine and the secret iliac joint so enclosing spine the lightest is a big one.

Evan Brand: Proteus doesn't doesn't Proteus do something as well I feel like we have we've had some education on Protease being linked to something or another autoimmune wise but I can't.

Dr. Justin Marchegiani: Yeah there's definitely some autoimmune implications again when you have various infections the major mechanism is going to be gut permeability and the gut permeability is going to increase your immune system and then of course those genetic predisposition to some of these conditions manifesting. So we always look at gut permeability and of course the big things are going to be gluten is going to be one of the bigger ones casein more casein is the major protein in dairy you're going to have less of it and butter and ghee you'll have more of it and cheese in and milk inside. So casein can be a big one of course roundup or glyphosate could increase gut permeability. Any foods that you're going to be very allergenic to the increase gut permeability will increase your chance of an autoimmune attack. And again typically with the wear and tear you're going to see those things happen unilaterally. Sorry you're going to see those things happen. More unilaterally typically the wear and tear stuff. And then you'll see the autoimmune stuff happen more bilaterally because the autoimmune is more systemic. Right. The immune cells aren't going to just attack one knee over the other. They typically attack both where the wear and tear stuff the osteoarthritis tend to be more unilateral one side versus both. Typically unless there's a unique wear and tear thing that you're doing. That's half that's affecting it equally. Most people tend to have one knee done before the hip or you know typically they're not getting both knees are in the same terrible position. So usually unilateral is going to be the osteoarthritis bilateral is going to be more autoimmune of your bilateral issues swelling in the joints you're seeing a lot of nodes and bumps in the joints. Typically that's going to be an autoimmune thing and we can always do some of the conventional markers to test it. And it's nice because when we treat patients and we support them we're not treating the disease we're just treating the gut permeability and the inflammation and getting to the root underlying factors. A lot of these markers can go negative again. I've seen ANA and CRP and all these markers come down because we're getting to the root cause of the inflammation.

Evan Brand: Yes. Well said also stomach acid. I think we should give a brief mention to stomach acid. We talked about some of the infections. Let's just say you have a bacterial overgrowth that's causing reduced digestive fire. So now you don't have enough stomach acid or maybe you were doing a proton pump inhibitor you and I could easily paint the picture of the link between using acid blocking medications either over-the-counter or prescription acid blockers and how that would lead to downstream joint pain or other issues. Because now the foods that are rotting in future fighting in the gut feeding the bacterial overgrowth would then create more permeability create more inflammation. So you could [INAUDIBLE] What's the other one there's another one? Prilosec you could take those and you could cause joint pain very easily by taking those and people don't have a clue and also I need to just restate what you already said so people make sure this is clear. You mentioned glyphosate. Here's the problem. There's still tons of people. Vast majority of Americans and other people in the world in the developed world eating conventional food. Conventional foods should be titled chemical when you go to the grocery and you see apples and it's conventional and then you see organic apples it's not just some special fancy food, people think like I've had this debate with people that oh organics no better it's like OK look all food was organic 100 years ago.

Dr. Justin Marchegiani: So it's not even that just in the 50s.

Evan Brand: Yeah. Before glyphosate I mean my grandparents they were eating organic food and they were eating grass fed beef and it wasn't a special label. So you got to know what you're eating. It's destroying your joints if you're eating a regular Apple. That's it's almost doing more harm than good to eat non organic fruit.

Dr. Justin Marchegiani: Yeah I had a lady in her 70s tell me that organics a fad and this and that. OK. So walk me through your thinking so was it a fad up until the early 1950s or even late 50s when you were eating organic. She's like I wasn't an organic in the 50s and like you realize that that's all there was because we didn't have all of the pesticides and the various chemicals till post-World War Two were a lot of the various pesticides were kind of byproducts of of the technology from the war and then we would we use these into the farming and we started applying them into the farming industry. So yeah everything was generally speaking was organic up until late 40s early 50s. So yeah that's all you had access to. And it's like Oh people don't be able didn't wrap their heads around that because they'd ever label the food back then but it really hit a lot of that criteria. People are kind of a little bit you know they don't have that level of awareness to know how that came about what the timeline was like.

Evan Brand: It's a massive change that has happened in our food supply that many people just turn a blind eye to. I read an article the other day which is pretty scary about the world of pollinators and the fact that all these insecticide chemicals in the last 20 to 30 years the world has become like 50 times more toxic. There was some crazy number two to pollinators and I saw this other article this scientific american put out that you stay on is.

Dr. Justin Marchegiani: Are you referring to bees.

Evan Brand: Yes bees and butterflies that for pollinators in general that the planet or at least America has become like 50 times more toxic in the last twenty five years. I think that was the number. And then just over the weekend I saw an article from scientific american talking about the amount of birds that have been lost. They said it was. They call it the silent extinction of birds. And since 1970 we've lost over 30 percent of all birds in America. Now some are doing better like Raptors. You know we've put in protection for raptors so you know your hawks and bald eagles and all that are making a quite good recovery since we're not using DDT and other things that destroyed them. But in terms of your small birds your songbirds they're dying out and disappearing because of our use of agricultural chemicals which are killing the insects and messing up the food chain. So basically the birds are just starving and disappearing and the populations aren't sustainable because of all the bugs are dead because of all the chemicals. So we're extinct thing ourselves but we're extinct and everything else too. So just think about when you're paying the extra one dollar to get organic strawberries versus conventional strawberries which have an average of 22 different chemicals in them. You're helping yourself but you're helping everything else too. So if you care about the planet that you're going to leave for your kids do organic. Even if you don't care about yourself hopefully care about your kids and you can do organic to protect their future.

Dr. Justin Marchegiani: Yeah I mean there's a lot of environmental causes out there and you know some are like you know are they true are they not. But you have a direct control over buying food that we know has chemicals used to grow them and those chemicals affect animals and can get into the groundwater. We know that directly. So you just don't buy those foods then you're having a positive impact on a lot of those chemicals getting into the water supply and affecting animals and people that drink that water. So that's the easiest first thing you can do is just buy healthier quality food that's your best impact on the environment. And then you know grass fed organic meat because you're going to have less less junk produced by the animals when they're eating corn and ingrates. So that's gonna be huge impact now.

Evan Brand: Good. I just want to say one thing about the meats too. So we you know I love getting on this rant about food quality and getting away from chemicals but remember how this can tie back into joint pain is the fact that if you're eating quote conventional meats those meats are going to have antibiotics in them. Those antibiotics in the food supply to kill the good bacteria and then you get bacterial overgrowth like the Klebsiella and then you end up with Hashimoto's or some other autoimmune condition because of the meat. So make sure you know hey my joint pain could be due to me eating a Hardee's or other fast food burger. It could be directly correlated.

Dr. Justin Marchegiani: 100 percent and also the fact that we know any joint issue there's and has to be in the environment. Excess inflammation in your body. Right. Because inflammation is what accelerates the breakdown. And then healthy anti inflammatory hormones or nutrients is what accelerates the build up. So when you start to break down faster than you're building up inflammation has to be part of that. So that omega 3 to omega 6 ratio is gonna be a big component. So animals that aren't fed grass fed nutrients they're going to have more mega six lots of refined vegetable oils are going to have more mega six not having good quality fish or a mega three supplementation or consuming good egg yolks from pasture fed chickens like he's got a look at that omega 3, omega 6 ratio you want at least a one to one or even a four to one. OK. Meaning four times the omega 3 to 1. I'm sorry four times the omega 6 to 1 Omega 3 is acceptable. Ideally a one to one or a four to one and you can do that by just consuming good quality efficient seafood or good quality Omega 3 supplement as well. And then just make sure the animals that you're consuming are going to have Pastor fed kind of sources so grass fed cows chickens that are kind of free range and pasture fed where they can eat bugs and stocks they'll be able to produce a much higher quality yolk. So that's got to be a big component with that.

Evan Brand: Let's go back to lab testing just for a minute because I only talked about the stool. Let's spend a few minutes on labs and then let's talk about some herbs or other nutrients that can be used to help joint issues.

Dr. Justin Marchegiani: Absolutely. So with certain nutrients there of course collagen's gonna be number one. Typically how you're [inaudible] is going to be part of the collagen byproduct. OK you can also do things like magnesium and calcium will still be helpful. Vitamin K is really important because that's going to help get that calcium into the bone. So we need to make sure that we have good vitamin K ideally K2 which is in a come from quality animal product. So if we can consume things like egg yolks and grass fed butter and ghee that's going to be essential if we have problems with butter or ghee then we probably want to look at making sure we supplement that or get it from a good quality fermented called liver oils we got to keep an eye on if we can get good quality butter again there you're probably going to be OK with your K2. If not we'll have to supplement that. I would also say just making sure you have a good multi to get the all those extra other minerals that we need like selenium and zinc and calcium magnesium are going to be typically separate. And then of course you're going to have copper and of course your fat soluble vitamins are going to be very important. We've got to make sure those are all present your vitamin K2 etc. As a female, especially as you get older lower levels of progesterone and estrogen before menopause age are going to be a detriment because progesterone helped stimulate osteoblast which helped build up the bone. Estrogen help stimulate osteo class so if we start getting more estrogen dominant we're more likely to be breaking down the bones. And then as you go menopausal you want some level of hormone support to help support bone health because going to super low that's to prevent your body from building healthy bones. So making sure hormones are dialed in and making sure we're testing the hormones is gonna be ideal. And then of course resistance training isn't to be helpful right. We we grow our body adapts by demand. This was called the piezoelectric effect where you can stimulate bone building through stimulation whether it's resistance training or whole body vibration or using bands or doing some kind of an interval on an elliptical or a rowing device something like that can be very helpful to stimulate healthy bone growth. So we need that as well. And then I would say last component is making sure your joints are pliable making sure your muscles are pliable your muscles are shock absorbers for your cartilage and for your bone. So if we have excess of wear and tear because your muscles are your natural shock absorbers aren't working. That's really important so you know you can get your muscles turned back on with you apply. Can you see logical techniques various soft tissue techniques like my old fashioned released or air tea or grassed in or like muscle spindle techniques or we can even use bio electric devices like like the newby for instance which really helped stimulate the muscles so they can work again they help reduce inflammation all these things are helpful. Are you seeing a good chiropractor that can test your muscles to see which ones are on or off can be helpful. It's a lot of people that have a joint issue at the knee may have issues at the ankle or the hip above. So a lot of times were joint issues manifest. The problem is usually above and below the joint and that gets ignored and you see a physical therapist and they only want to work on the knee. They don't go upstream or downstream. So kind of like in functional medicine we are always looking upstream. If you're working with a good PT or a Chiro you want to make sure you're looking upstream from just the knee hip and ankle you got to look at both of those places if you have an issue at the hip you want to look downstream at knee and ankle and upstream at the back. So you've got to look at this holistically.

Evan Brand: Yep. Well said a lot of great points. Other supplements too. We'd like to use curcumin, turmeric extracts limited human.

Dr. Justin Marchegiani: CBD oils excellent for extreme pain some people do better with a little bit of THC in there but I try to do mostly CBD initially and then we can topically rub CBD on the joints as well which can be helpful. Systemic enzymes with [inaudible] in between meals away from food. Help with inflammation. Go ahead I got.

Evan Brand: Yeah. No you're fine. You're excited. I love it. Digestive enzymes too. You know we always like to throw in enzymes. We talked about the connection of low HCL bacterial overgrowth joint pain so extra enzymes could be helpful. And then testing. So I want to talk about testing so stool that's gonna be our first thing. Organic acids we can look at amino acid metabolism and then some of this viral and co infection testing so Mycoplasma Epstein Barr the cytomegalovirus that would be something you would find on a blood panel. So you may need to get blood urine and stool to really get to the bottom of your joint pain.

Dr. Justin Marchegiani: 100 percent. So also there's biologic devices like I mentioned called the newbie put some links below for some of these things. All the nutrition is really helpful. Autoimmune gut stuff's really helpful. And then I would say if you're in the stage you definitely want to be working at all these things together and you may even want to be adding in some stem cells if you're trying to avoid surgery you probably want to be incorporating some stem cell therapy along with it. I've seen that work miracles and significantly and help improve patients ability to heal. You can also do prolotherapy which is like an injection of like amenos or a dextrose sugar which kind of creates an inflammatory response which then stimulates the immune system to help kind of heal that area. That those worked too, I tend to favor the stem cells over that just because of what I've seen on the recovery side. So let's kind of give you a couple of really good options. But the soft tissue component I find is what most people chiropractors and physical therapists they ignore. They ignore the pliability component and they don't get the soft tissue working or pliable again. So think of your muscles as like shock absorbers. It can either be a soft tenderloin kind of spongy spring or it can be beef jerky beef jerky. It's not going to provide any level of cushioning it's just tear. We want the soft springy kind of tenderloin for your muscles so kind of think about that. You want to train and get therapies that help provide make your muscles into that softer sponge.

Evan Brand: Yeah I've seen insane results with stem cells I haven't used them but I've had clients that have used them and we've seen countless stories of athletes you know professional athletes where they were going to end up getting like rotator cuff surgery they do stem cells instead and they're fine. Yeah.

Dr. Justin Marchegiani: At some point I will do some level of preventative therapy where I just go out of the country and just get stem cells injected everywhere in my body just to promote healthy living and healthy tissue recovery. Not yet. I'm too I'm still in great shape healthwise and an age wise I'll probably but some somewhere down the road maybe the next decade I'm thinking about I just for preventative.

Evan Brand: What you have to go out of the US?

Dr. Justin Marchegiani: There are some places in the US that some doctors in Vegas or some up in the north west as well I note Tony Robbins talked about going down to Argentina. I think it's Peru. Or Panama. Panama's that is the spot. A lot of them are going.

Evan Brand: OK I wonder why.

Dr. Justin Marchegiani: Is it cheaper or they're better at it. I think a lot of it has to do with the regulations. So a lot of times they'll do cord stem cells. So which is good. You know it's not you know you're not taking any any babies that are aborted or any things they're using cord stem cells and that's where they're extracting it from. So that's you know a greater supply of that because everyone every baby that comes out has that cord. I think we even donated our cords for for stem cell purposes for burn victims and such. So there is that right. So you can extract those stem cells from that and then they inject it making do an I.V. where they can do localize. So I know people made you both those those are helpful places I know in the U.S. some some people are starting to do it. There's a couple places I saw in Dallas in the northwest. Vegas is a good podcast with Mel Gibson on the Joe Rogan podcast and he talks about stem cells and his dad's shoulder injury got significantly better and Joe talks about stem cells on that one. That's a good little podcast if you want to look at the stem cells.

Evan Brand: Yeah I don't know enough about it to do a whole podcast on it but I am fascinated by and I have heard good things about it.

Dr. Justin Marchegiani: Exactly. So I think we hit the stem cells we hit nutritional component we hit collagen we hit the autoimmune we hit the gut component. A lot of these things you're going to need a good functional medicine doctor to do a workup on to get these things better or to kind of line everything up and create a priority list. I've had some patients though honest to god people that have had destructive. Arthritis for decades and we just cut like grains out and it was like magic. I know sometimes sometimes one issue could be everything and sometimes it's a combination of everything combined and you don't know. So we kind of have our algorithm and how we work through things. We do a really good history. We kind of prioritize what's going to be the best bang for our buck. We have the foundational things we start with diet and lifestyle and we kind of work off with testing and assessment and we kind of start from there and sometimes things we hit a homerun like you know we're at the plate we're calling our shot and we hit a homerun right away and sometimes we have to get a lot of singles and there is that scoring.

Evan Brand: Yeah well said It's crazy just pulling grains out how effective that could be it can be good to be true yeah and it's not always like you said sometimes you've got enough.

Dr. Justin Marchegiani: Some patients are not so impatient that it's a long steady road of doing a lot of different things like we're getting a lot of singles to get some runs. Sometimes we hit a home run and we feel like a million bucks doing it. So you know you kind of have it. It's tough because if you're an individual and you had one experience of this being it you tend to associate that that's going to be the same thing for everyone. And because we work with so many patients we know it's not the case. We're a little bit more humble because we failed so many times they had to get more creative to get these things working.

Evan Brand: Yeah well said,like you said you may get 5 percent with the diet and 5 percent by fixing the guy and then all of a sudden you knock out some of these Michael plasma load and boom you've got 65 percent better in a month and then.

Dr. Justin Marchegiani: And then the person sleeping better and they're getting an extra hour or two of sleep and then they're cutting out the alcohol and then maybe they're like they're digesting their proteins better and they're having regular BMI and it's like oh wait a minute. Like five percent here two percent they're 10 percent there and then a year later they're 60 70 80 90 percent better.

Evan Brand: Yeah. So it's a miracle I mean the body does have a wonderful capability to heal itself if you give it the right nutrients the right tools and you remove the roadblocks. That's a lot of what we do is find the roadblocks because you can't fix what you can't find. So the hardest part is finding it getting the workup done to where you find what are you up against because you could go take every joint supplement known to man at the grocery store not get any better because you didn't find what you're up against so now you're building up that supplement graveyard.

Dr. Justin Marchegiani: One hundred percent now in general there are conventional drugs that are typically in heavy use like bone IVA or a lot of these supplements that are going to stimulate bone growth. The problem is a lot of the bone growth is kind of haphazard. It's not as good quality bone. So I typically don't recommend a lot of the medications to Bill back the bone because it's not going to really be creating good healthy strong bone number one and then there's a lot of medications that are like anti inflammatory as or even steroids which may not actually fix the problem and have their own whole whole host of side effects with gut issues or liver issues or even actually breaking down the bone and creating more inflammation especially with steroids and may set out your bones even faster and even drive blood sugar issues too so you've got to have to weigh out the options from a medical standpoint is also methotrexate which you're like which is used for immune issues but it's actually a chemotherapy. So there's other medications that can have a lot of side effects with it. I think it's plaque on X, plaque well that's going to be used a lot of times for inflammation in the joints as well as blood issues too. So I've seen that help to buy again their side effects in a lot of it's not getting to the root underlying issue. We want to get to the root issues. We want to have a good functional medicine kind of work up and how we get to the bottom of it and of course as other stressors like heavy metals that could be an issue and then you know Even with mold and mycotoxins that can create a stress on your body too. So it's not the first thing I look at when we have joint issues but it's kind of in our algorithm and it's there and we eventually get to it. But we try to prioritize based on symptoms based on history and based on the timeline of how we got here.

Evan Brand: Yeah. And also you may find that you have a relapse after a big stress. So that would want to that would clue you in to maybe a viral component. So like if you just had a baby and then you got joint pain or you had a death in the family and you have joint pain or you had a horse and you had joint pain for sure. Yeah. So you've got to kind of peel back the layers of it. Were there any questions that you wanted to hit.

Dr. Justin Marchegiani: Oh yeah. Let's take a look at questions here and try to engage. All right cool. So if you guys are listening at home and you are enjoying the podcast give us a thumbs up right now. Give us a share we appreciate it. We also love getting reviews, for review we appreciate it. Let's dive three questions here one by one is a repetitive question or it's not as relevant for the crowd. We'll probably just skip it. I have hip pain every three years what are my options. All the things we just mentioned. How to handle glutamate. So a lot of collagen's very high end gluten mean which can convert to glutamate. So I work on just getting the inflammation under control first before you do that. If you can do collagen that's great. May want to try a Marine base collagen or a fish based collagen see if you can deal with that over the bovine source if you are having issues.

Evan Brand: Yeah. Good recommendation.

Dr. Justin Marchegiani: There if you want to chime in. Evan just just chime in. I'll try to get to that the more the more meaty questions you're doing.

Evan Brand: No no you're doing good. I think the advice on the glutamate issue is good and you know look at the gut because my gosh most people shouldn't react to glutamate glutamate type conversion issues like that. So there's something else underlying that's causing that.

Dr. Justin Marchegiani: Yeah. And if you're having issues that would just say focus on reducing inflammation more first with digestion, gut, anti inflammatory herbs all the diet and lifestyle things and then come back to it in a month or two if we're having issues and work into it. Start with an eighth of a teaspoon and then just kind of nudge your way up.

Evan Brand: Yeah. Here's a question from Riley how beneficial is physical therapy for joint pain arthritis. My mom has chronic arthritis in her lower back and hips. I mean I've been to physiotherapy before I got minimally better with it because it wasn't a root cause I would say if your mom is eating grain step one get her off grains. Step two Look at her gut. Is she moving? Is she sedentary. Yeah get her you know some good ol maggots may help some tumor extract may help some Boswell yeah those type things.

Dr. Justin Marchegiani: Not all chiropractors or physio hours are root cause based. So like the average chiropractor hey there's back issues. I'm going to just gesture back where the average physio there's knee issues I'm going to just exercise the knee. That's the wrong way to do it. You may still do that but you may be looking above and below. So what I was doing more chiropractic therapies I would test the joints I would see how the muscle integrity at each joint was above and below before I provided any therapy because I want to make sure all the muscles in the kinetic chain are working. And then if you're going to move the joints well that's fine. But you also want to make sure the soft tissue in the muscles are activated and if you're going to exercise a joint as a physio, well you want to make sure the muscles are more pliable because imagine having a knot in a string if exercising that muscle is the equivalent of pulling that string tighter will guess what happens when it's not there the knot gets tighter. So you really want to undo the knots in my opinion professionally before you do a lot of exercise. So that's where the soft tissue therapies are really important and that's where making sure the joints are moving. So there's good Chiros and bad Chiros is good physio and there's bad physio. My biggest thing is make sure whoever you're seeing is addressing the soft tissue and make sure they're looking at the joints above and below. And if they can do some muscle testing that's great. That way you can objectively see and feel the muscles in and around that area getting stronger which is great.

Evan Brand: Here's a question here. I like this one going off of Evan. What would come first hypochondria or dysbiosis slash bacterial infection question. I think it could go either way right.

Dr. Justin Marchegiani: So it can. But I typically find and this is just generally speaking there's exceptions to every rule. Is there some level of stress that happens that stress compounds and activates the sympathetic nervous system then you have less stomach acid and enzymes and then it's more it's greater risk now for bacteria and critters to kind of come in there. It could also be something like you took an antibiotic and that drove rebound bacterial overgrowth and then that started driving all of hydrochloric acid or enzymes so it could go both ways. And it's all going to be about the history.

Evan Brand: Exactly yeah. So I was going to say in the case of bacterial overgrowth happening before stomach acid there's gonna be an intervention of some sort like antibiotics.

Dr. Justin Marchegiani: Exactly. Yep. Exactly. Wonderful girl and swelling of legs and feet sign of inflammation. It comes from joint problems after operation for artificial hip recovery period five months. What do you think. OK. So in general yeah you've got to just do all the things that I mentioned. When people have these kind of they already have their joint replaced you still want to do all the same things because just because you had your joint replaced the kinetic chain, the kinetic chain of imbalance like let's say your hips replaced right. Well are the muscles working good in your glutes are they muscles working good in your knees in your back. So you just because you fixed the joint that those muscles are actually still not fixed and they actually may be worse because now you cut open to the body. And now there could be subclinical inflammation from just the surgery and the muscles could be more inflamed now because of all the surgery so you need even more work on the soft tissue component and the kinetic chain. All right let's dive in a little bit deeper the more questions not really related here as to heavy metal detox supplements not related to this podcast sorry. Where to get stem cells. Panama is a good place or some places in Dallas and the north west. Heavy metal supports not going to go there. See here. Yep. We did a podcast on that. A friend is allergic glutamate and protein and lactate and fresh fruit and vegetables don't remember which one. OK so this is really important. So I've seen people who are very allergic. I'll just give you one person to look up. Mackenzie Petersen. Mackenzie Petersen has a significant autoimmune issue I think in her early 20s. She had both knees and hips replaced in her early 20s and she had significant autoimmunity and what she needed to actually help decrease her autoimmunity was full carnivore because she was actually very sensitive to even the lecterns in fruits and vegetables so she needed to be grain free and autoimmune. Right. But she also needed full carnivore on top of that meaning only high quality meats and fats. And that really made a huge difference in her life.

Evan Brand: Yep. Her name's McKayla.

Dr. Justin Marchegiani: I'm sorry. Yeah. MCKAYLA Peterson Yeah that's Jordan Peterson's daughter correct.

Evan Brand: Question what do you think about the highly erotic acid joint supplements. I mean it could be a part of the puzzle but I wouldn't put too much faith in it just that by itself.

Dr. Justin Marchegiani: You'll get some of that I'm pretty sure in collagen for sure you'll get some holographic assets from the collagen for sure yeah. And then also Vitamin C is really important for building up the collagen do Vitamin C is important cool factor so you can get vitamin C separate and then also you can get it from the collagen as well or you can combine it with the collagen as well that way your body can make collagen as well as have the collagen building blocks. So you got to combine the two.

Evan Brand: Yeah. Perfect. Well that was all the relevant question so let's wrap this thing up if you're ready. If you're suffering there's probably a reason. So if you want to reach out to Justin we do testing around the world. So no matter where you are we can help you with this issue if you want to reach out Justin's Web sites. and my website is And either way, whether it's one of us or somebody you're already working with we just hope that they're getting to the root cause and helping you because there are solutions and there's so many people that you know we're talking about an issue that affects your quality of life. You know people that want to go hiking and biking and go to national parks and be mobile. You know I think we get focused on the health issue but it's important to look back at what are we trying to help people achieve. We're trying to help people achieve playing with the kids you know the grandparents that have grandkids and they want to be mobile and active with the grandkids and keep up with them you can't do that if your joints hurt. So this is an important topic that affects how you navigate through your life.

Dr. Justin Marchegiani: Yeah exactly. I'll give a shout out to my friend and colleague Garrett saw Peter over at Neu fit in Austin. So NEU.FIT is the website NEU.FIT put the link below. He does a lot of this work as well he has his own bioelectric device that I have different versions of that really work well with stimulating healing helping activate the muscle helping to improve blood flow and getting the muscles to work really well in that kinetic chain. Muscles work like dominoes if you're missing one of those dominos in the middle that chain doesn't work appropriately so Gareth's a great person to reach out to will put his links down below and make sure you let him know that we shot you over here for this podcast. Appreciate that. Anything else you want to mention having I think people are liking this. Sharing is caring we appreciate it. Thumbs up that give us a little boost on the YouTube algorithm. And if anyone wants to reach out to us more on the metabolic or functional Madison medicine site click down below and you can schedule online.

Evan Brand: I think we covered it all. I'm sure we could write about something else but I think we did a great job of looking at the nutrition the gut infections viruses testing herbs and nutrients to briefly hit the medication. So now I think there's plenty plenty good to wrap up.

Dr. Justin Marchegiani: I'll do a little summary video on my side here. People wanting to get the condensed version. But if you guys appreciate it put your comments below let us know what you guys have done to help improve your joy and your overall inflammation in your skeletal system. We appreciate it.

Evan Brand: Well, take good care we'll chat next week.

Dr. Justin Marchegiani: Evan you have a good day man. You take care.

Evan Brand: Bye now. See you later. Bye bye.


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