Reverse Triiodothyronine (T3) Metabolites | Podcast #192

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Welcome to today's live podcast with Dr. J and Evan Brand! In this podcast, they discuss about Reverse T3, which is the body’s metabolic blanks or brakes. Watch as they tackle about the reasons why Reverse T3 elevate, what affects it, and what are its relationship to Cortisol levels and other metabolites found in the body.

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Dr. Justin Marchegiani

In this episode, we cover:

01:30  What is Reverse T3?

05:50  Ways and Why Reverse T3 Elevate

09:30  Myth About Parasites in America

11:10  Reverse T3 Optimization

15:10  Inactive T3 in the Gut




 Dr. Justin Marchegiani: Hey, guys! It’s Dr. Justin Marchegiani here. Welcome to today’s podcast. Evan, how are we doing, brother?

Evan Brand: Happy Monday to you, man! I’m doing well. We were chatting about my blood work off air a little bit. I have made significant improvements since we did our podcast on Iron. My Ferritin was way too high, which was not good.

Dr. Justin Marchegiani: Uhmhm—

Evan Brand: My Iron saturation was way too high, which is not good, and I’m coming out of it. So no more heart palpitations, which is good, and blood pressure has been relatively normal, maybe slightly high. Maybe that’s stress due to finishing the summit, you know. I don't know. I don’t know why else. I have no other reason why my blood pressure would be like 130 over like 85. Just slightly high. I’ve got no answers for it. 

Dr. Justin Marchegiani: Yeah. That is not big of a deal. Is that like across the whole course of the day when you’re relaxing, watching TV, reading a book?

Evan Brand: That, yeah. That’s just like in the middle of the day. If I take a random reading, it’s just a few points high.

Dr. Justin Marchegiani: It’s not too bad. And then, what about like if you’re doing some house work or you’re getting some chores done in the morning?

Evan Brand: It’s all the same.

Dr. Justin Marchegiani: Yeah.

Evan Brand: I tracked it throughout the day, it’s all the same. Now, if I take like an Epsom Salt bath and really chill out with like some Lavender essential oils, it’s like 118/78.

Dr. Justin Marchegiani: Oh, good. [crosstalk] That’s probably where it is most of the day…

Evan Brand: [crosstalk] That really show…

Dr. Justin Marchegiani: …once you’re sleeping and stuff.

Evan Brand: Yeah. If–If I really chill out, it’s good.

Dr. Justin Marchegiani: That’s good. Awesome. So it’s not too bad.

Evan Brand: Yeah.

Dr. Justin Marchegiani: I know— you know, we were gonna chat today about Reverse T3 ‘cause that was an interesting phenomenon we noticed with you. Your Reverse T3 was in the 30’s, right? What, 33?

Evan Brand: Way too high.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Was like 33 ½, almost 34.

Dr. Justin Marchegiani: Exactly. When Reverse T3— It’s basically metabolic blanks in the magazine cartridge of your thyroid hormones. So imagine you have thyroid hormone, and it binds to a receptor site. So here’s your hormone, the key. Here’s the lock, which is the receptor site. It has to kind of go in and you have to be able to turn it, basically for that hormone to work. So imagine, essentially like, the key in your pocket is like Reverse T3. It— It can’t get into the receptor site. Or, in other words, imagine someone puts in the hole in your— in the hole for your house key. Right? So then, when you go to put that Reverse T3 in there, that gum is like Reverse T3. It gums up, literally, the— the receptor site so that when that key goes to bump in there to actually create a metabolic effect or unlock your door, so to speak. Now, it can’t work. So Reverse T3 is basically the body’s metabolic brakes uh— being able to block thyroid hormone from getting into the receptor site and creating that metabolic effect.

Evan Brand: And this is a protective mechanism. I mean, in ancient times, if we were under significant amount of stress, like running away from a bear, it would be a good idea, theoretically, for Reverse T3 to go high. Because if you’re hiding behind a tree for a week from a bear, you don’t want your metabolism firing on all cylinders. We would hope Reverse T3 would kick in and sort of slow things down a bit.

Dr. Justin Marchegiani: Exactly. Exactly. One hundred percent. So Reverse T3 is that natural way of kind of slowing things down. Now there’s lots of ways that reverse T3 can go— lots of reasons why Reverse T3 can go high. Can go high from low Cortisol or high Cortisol. And again, high Cortisol can easily be from acute stressors— emotional stress. Prolonged emotional stress, right? Most people, their hor— their— their— basically, their adrenal system responds to stress, and then, that stress seizes and then you come back down to baseline. But if you’re under chronic emotional stress— work, family, relationships, finances, and it stays high all the time, that can definitely create Cortisol resistance. Kind of like Insulin resistance. And then, of course, chronic adrenal stress will eventually create HPA Axis Dysfunction. That’s your brain talking to your adrenals. That feedback loops start to get disrupted, and then Cortisol can start to go low longer term. And we also need Cortisol for that thyroid hormone conversion. And low Cortisol tends to be a sign of chronic stress, and that Reverse T3 mechanism can still be active, where the— you get the gum into the— the door lock, which is gumming up that T3 from having a metabolic effect.

Evan Brand: Yeah, and we measure adrenals all the time. We do a test called the Cortisol Awakening Response Panel, so we have six (6) saliva samples that we collect throughout a 24-hour period. This is something that our clients do at home, and we can measure the total Cortisol sum. And I’ve seen some crazy low levels. I’m sure you have too, like 10, 12, 14 total Cortisol sum for the full day. Twelve (12) units, which is so low— I mean, really. You should be at about 30 units of a Cortisol sum. So we’re seeing tons of people. I mean, this is people that are doing all the right things too. They’re exercising. They’re eating a good diet. I mean, these are not your average American sitting or watching TV for eight hours and eating McDonalds. Like, these are people that are doing all the low hanging fruit and their Cortisol still comes back so low, which is a— a big factor why their thyroid is not working too. So, uh— You got to get this stuff looked at. The interesting too about Cortisol in this whole conversation, if you’re trying to guess what Cortisol? Like you’re just like, “Oh. Dr. J, I don’t want a test.” Here’s the thing. High Cortisol and low Cortisol can feel the same. So like, if you have high Cortisol, which I’ve had several women with high Cortisol, they’re exhausted. And they’re like, “Okay. My Cortisol’s got to be low. I’m so tired.” But we measured them, and the Cortisol’s through the roof, and then vice versa. We’ve had people where the Cortisol’s flatlined, and they are tired. So like, you can’t guess with this stuff.

Dr. Justin Marchegiani: One hundred percent. And most people are only getting a snapshot of their thyroid , so their conventional doctor may only be looking at TSH. Or if you’re lucky, maybe TSH and T4. Uh— and again, The Journal of Clinical Endocrinology and Metabolism has said that TSH and T4 are poor level— are poor indicator of one— one’s thyroid function. So we really want to look at, one, T4, but also T3, free. And again, if we can run T3 free in total, at least initially it’s better, same with T4 free in total. ‘Cause then, we can get a window into the— the free fraction hormone. What’s available to bind to the receptor site and the— the total fraction hormone. Right? Total is like what the gland is producing, about 98% of that hormone is bound to a— a protein, right? So— Right? The key in your hand, that’s the free hormone, right? The key in your pocket, that’s the protein-bound hormone, right? The key that you can’t get out ‘cause it’s in your pocket or purse, that’s the total fraction. The key that’s in your hand, that’s the free. That’s the one that can bind to the receptor site. So, imagine, for every— you know, nine keys floating around your— your bloodstream— hormone keys, nine of them are in your pocket, one’s in your hand. So only one can actually— I— I should say, even less than that, would be— you know, 98%. Solve. Do the math, right? Let’s just say, 98— 98 keys floating around or in someone’s pocket, two are in your hands. So, only a small amount can bind to that receptor site. [crosstalk] Then if we—

Evan Brand: But we also want to get the antibodies too. Let’s— Let’s tell people what they should be asking their doctor, maybe their endocrinologist for. And you’re— you’re probably gonna get pushed back, which is why we do what we do and provide blood testing for people.

Dr. Justin Marchegiani: Correct. So, let me just highlight a couple more things before I shift to the autoimmunities.

Evan Brand: Okay, yeah.

Dr. Justin Marchegiani: So, that fits in because chronic inflammation can easily affect Reverse T3. So, one of the biggest things about— of chronic inflammation would be autoimmunity, and we know a large percent of people that have thyroid issues, it’s partly ‘cause there’s an autoimmune mechanism that’s active, thyroid tissues getting attacked and destroyed. The antibodies can have also an aspect where they can kind of clog and congest receptor sites a little bit, kind of like Reverse T3 can. That inflammation can prevent that binding from happening. Reverse T3 also doesn’t. Remember, Reverse T3 is the gum in— in the— in the keyhole, right? Or for on Hollywood set, we have like one— you know, a gum, right? It’s the blank, the metabolic blank, in the gum. It fills up the spot in the magazine cartridge where the real, you know, hollow point bullet would be, so to speak. So, again, the chronic inflammation that plugs into the autoimmune piece. We talked about Lyme. we talked about other stress. We talked about Gluten. So, there’s anything that’s a physical, chemical, or emotional stressor could be increasing that Reverse T3.

Evan Brand: We could say dairy as well. Anything that’s gonna affect the gut. I mean, we have to assume if you’ve got to elevate a Reverse T3, there could be something going on in the gut. Now, just for my specific case, I did get my GI Map Stool Test. What was it? Maybe two to three months ago. I didn’t have any parasites or worms or H. pylori anymore. All that stuff’s cleared out. I did have a few bacterial overgrowth. Nothing that was insanely high, but a few bacterial overgrowth species. So, I do have a little bit of gut work to continuously improve upon. And then also, uh— liver function as well. You and I we’re kind of talking pre-show about liver and how that’s influenced in terms of reverse T3 levels. So, if you do have Lyme, or you have infections that are creating stress or creating garbage, essentially, you’ve got to do some liver support, and we do this almost every time with gut protocols.

Dr. Justin Marchegiani: Yeah. One hundred percent. So the chronic gut infections easily get missed just because they’re underneath the surface. And a good percent of people, I’d say close to half, may not have the typical symptoms. Bloating, gas, diarrhea, malnourishment, weight loss— like those kind of things. hey may have other issues, like brain fog and energy issues, may— may never connect the dots. [crosstalk] That’s so important.

Evan Brand: I’ll share you an interesting story.

Dr. Justin Marchegiani: Uhmhm— Yeah.

Evan Brand: So, uh— a client I had this morning, a guy who was working with like a Lyme-literate medical doctor. The guy asked his doctor to run the GI Map Stool test on him to look for parasites, and the Lyme-literate doctor told the guy no. He would not run that test because we live in America, and there’s no parasites in America.

Dr. Justin Marchegiani: Right. Right, and that’s kind of the big misconception. Again, you know, indoor plumbing, sanitation— you know, dishwashers, soap— all those things have helped, but there are still certain infectious debris we may get exposed to. And with our chronic immune stress and lower, you know, IGA or gut immune barrier function, we can very easily come up with infection. Not to mention, when we’re chronically activating the sympathetic nervous system, that’s gonna decrease our Hydrochloric acid and enzyme levels. And HCl, you know, keeps a nice low acidic pH, and that low acidic pH can act like disinfectant to infections in your gut tract.

Evan Brand: Yeah, but I— but— but everybody is— They’re rushing through their meals, or they’re eating all distracted, or they’re on Proton Pump Inhibitors…

Dr. Justin Marchegiani: Uhmhm—

Evan Brand: …whether prescription or over-the-counter acid blockers, reducing stomach acid making the gut more alkaline. And then you eat your Sushi, and you pick up bugs. And then the food supply’s international. So if you get your organic blueberries at Whole Foods, a lot of times, they’re from Chile or some other country, and so your food supply is international. I don’t care if you’re not an interna— international traveller ‘cause your food travelled internationally for you. Look at your pineapple from Costa Rica, but you live in New York City, you know.

Dr. Justin Marchegiani: That makes a really good point, man. You’re just being so darn practical today. I appreciate it.

Evan Brand: Yep. So, let’s look at a couple questions if you want to or did…

Dr. Justin Marchegiani: That’s good.

Evan Brand: …you have some other points you wanted to make first?

Dr. Justin Marchegiani: Yeah, a couple of other points. I think we hit the Reverse T3 part, so when we look at a complete thyroid panel, TSH and T4, most people only run TSH, so that’s a— a brain hormone, right? It’s a part of the pituitary gland. It what talks to the thyroid to make T4. T4 is free in total. Free is what binds the receptor sites. Total represents, you know, 98%— you know, outside of the free. And that gives you a total, you know, picture of how much hormone the gland is actually producing. Then you have T3, which is converted. And then, T3 free is the actual, you know, metabolically active thyroid hormone, about four to five hundred percent more than T4. And then, you have the free fraction, which is the same thing as the T4 free. It’s what’s actually biologically available. And then, depending on stress levels, you can take that T4, that is alternate— alternate pathway, where it goes into Reverse T3. So normally, T4, right— metabolically inactive, you know, by four to five hundred percent, converts to T3. And then we have this— this suboptimal pathway where it goes to Reverse T3. And all of those various stressors that we mentioned, uhm— it could be adrenal stress. It could be Cortisol issues, inflammation issues, any physical, chemical or emotional stressor will cause this Reverse T3 pathway to be optimized.

Evan Brand: Yeah. We were talking about my labs, so my Reverse T3 back in April was in the mid-30’s. It was about 34. And then now, we retested it. Just last week, it was like 22, so I dropped like over 12 points with Reverse T3. Still— Still high. I think the reference range is like 0-25 so I’m still a little elevated on the high end there at 22, but I’m hoping no longer travelling, no longer having surgeries. The cavitations are cut out of my gums now. I’m taking my liver and adrenal supports. I’m getting good sleep lately. I’m taking some Lemon Balm at night to help the sleep. I feel like that Reverse T3’s gonna continue to drop. My hands and feet, remember? I told you my hands and feet…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …were rev freezing. It’s not happening as much anymore, so maybe that Reverse T3 was bl— blocking that active T3 that’s why my hands were cold.

Dr. Justin Marchegiani: It’s very possible. And your numbers went down from what? Thirty-three (33) to 24? Twenty-one (21)?

Evan Brand: Uh— I think I’m at 22. I’m way from about 34 to 22. It’s about 12 points in about six (6) weeks.

Dr. Justin Marchegiani: So 34 to 22?

Evan Brand: Yeah.

Dr. Justin Marchegiani: That’s like— That’ like a 35% drop. That’s great. That’s a huge drop. And ideally, we want to be below 20, but you’re right on the cusp now.

Evan Brand: I’m headed that direction.

Dr. Justin Marchegiani: Yeah.

Evan Brand: I hope over the next few weeks, I should be below 20, and I’ll probably retest in a few months. I’m not gonna retest right away like I did this time.

Dr. Justin Marchegiani: Yeah.

Evan Brand: I was just really concerned about my Ferritin being above 500. Now, Ferritin, I believe I’d have to look back in my lab here. I believe Ferritin now is— Actually, man, you’re not gonna believe this.

Dr. Justin Marchegiani: What’s that?

Evan Brand: Let me tell you what it was before. Okay, just for— just for us to be accurate here in our— in our speaking.

Dr. Justin Marchegiani: Uhmhm—

Evan Brand: Okay. So Ferritin in mid-April was 548. This is on April 25th. I was up at 5:48. I just retested last week, and Ferritin is 187.

Dr. Justin Marchegiani: Wow!

Evan Brand: So let me just— I— I already did the Math before. Let me just do it again. Five forty-eight [crosstalk]

Dr. Justin Marchegiani: Did I hear 548 to one— what?

Evan Brand: To 187. A 361 points?

[long pause]

Dr. Justin Marchegiani: So we do the Math on that, but the uh— 65% drop. That’s great.

Evan Brand: Yeah. [crosstalk] I feel better too, and I don’t have any heart palpitations anymore ‘cause I— That was like almost every night. I’d be sitting on the couch and my heart would just, “Oh my God! I’d have these crazy heartbeats.” It’s not happening anymore. 

Dr. Justin Marchegiani: Wow.

Evan Brand: Now, without the infections and the gum causing that, releasing toxins into the bloodstream, without some thyroid stuff, I don’t know.

Dr. Justin Marchegiani: Interesting. Well, I mean, I think there’s definitely a big stressor with the gums, so I think getting that inf— that chronic inflammatory stressor eradicated could had made a big difference. It really sounds like it did.

Evan Brand: yeah, and— and by the way, uh— if you guys saw our live podcast we did together a few weeks ago, uhm— Justin made me a grass-fed steak for dinner. It was the best steak ever. So, if Justin ever host a retreat, if he’s the cook, which I vote him…

Dr. Justin Marchegiani: [laugh]

Evan Brand: …to be, the steak goes. Uh— You guys are gonna be super impressed.

Dr. Justin Marchegiani: Excellent. I appreciate the— the feedback on that. Awesome. And then, one last thing I wanted to talk about…

Evan Brand: Yeah.

Dr. Justin Marchegiani: …regarding T3, is there’s also some inactive T3 in your gut. Uh— T3 Acetic acid and T3 sulfate. And, that’s important. These different T3’s in your gut are actually relatively inactive. At about 20% of T3’s in your gut, it’s acetic acid— T3 Acetic acid, T3 sulfate. And, there’s an enzyme called Sulfatase, that’s made by your healthy gut bacteria. So healthy gut bacteria can activate that T3 Acetic acid, T3 sulfate. And that can activate and bring your T3 levels up. So that’s why having a healthy gut can really help improve that— not necessarily your Reverse T3, but more your inactive T3 in the gut.

Evan Brand: Yeah.

Dr. Justin Marchegiani: That’s another component people don’t talk about.

Evan Brand: No, they don’t. And here’s the cool thing too. It’s like, knowing that mechanism is cool, but even if you and I didn’t know that mechanism, we would still get good results because our goal is always to eradicate the bad guys and restore health to the good guys. Knowing that mechanism makes us want to do our job even more and do our job harder and more efficiently and effectively. But even if we didn’t know that mechanism, it’s kind of like one of those things you and I are fixing by accident. Like, even if we didn’t know that mechanism, “Oh! Great!” Restoring your gut bacteria happen to improve thyroid conversion and then taking off the load of the adrenals by removing infections, that improves conversion too. So like, when people ask what’s the silver bullet, there’s not one because we’re moving so many levers at the same time.

Dr. Justin Marchegiani: And that’s part of what our job is. We— We— You— That’s why anyone listening, you want to work with a functional medicine doctor o practitioner that has a system that they’re working with, because when you have a system where you’re kind of crossing all your T’s and dotting all your R’s, regarding— regarding all your I’s, regarding nutrition, supplementation, diet, lifestyle, hydration, addressing each hormonal system— adrenals, thyroid, female or male hormones, gut, infections, immune, digestion— working to the six R’s, right— removing the bad foods, replacing enzymes, repairing gut lining and hormones, removing infections, repopulating gut bacteria, retesting. We’re having a systematic program. For the most part, it— it’s very difficult for patients, for us to miss certain things. And there may be lots of mechanisms that are happening like that, one I just mentioned with the T3…

Evan Brand: Yeah.

Dr. Justin Marchegiani: …that we don’t even know about. But when you have a comprehensive approach, you address it. Lots of people, eben in the natural world, they’re seeing the natural doctor that only addresses the thyroid, that only addresses the gut. And there’s a good chance they could miss other mechanisms by— by not treating the whole person there.

Evan Brand: You know—

Dr. Justin Marchegiani: Does that make sense?

Evan Brand: Yeah, it does. Well, let me just say it in a different way to make it super clear for people. If you go to a specialist like, “I’m a functional blah— blah— blah— but all I do is thyroid,” in my opinion, and Justin would agree, those people are gonna be limited in their— in their effect, that they can provide for you. If you go to someone and it’s the “Adrenal Guy,” and that’s all he does— adrenals. He’s limited! If you go to a gal, and all she is is female hormones, she’s limited. So like, we’re special specialties in the sense of like functional medicine is its own specialty, but you don’t want to just use a microscope. You’ve got to use a macroscope at the same time.

Dr. Justin Marchegiani: One hundred percent. And you have to distinguish marketing from treatment. Like I market a lot to thyroid. Now, that does not mean I only do thyroid. I market to thyroid but we address the gut to actually fix the thyroid, or the detox to fix the thyroid. So I think if you’re gonna reach out to someone that’s a functional medicine specialist, that only like, let’s say, does the thyroid or female hormones, you’d want to interview them or ask them a questions and say, “Hey! Do you also address the gut to help the female hormones or thyroid? Do you also address the adrenals to affect the female hormones and thyroid?” So you just want to ask those questions to make sure ‘cause some people market that way but how they treat encompasses everything. So if you do find someone that you do like, you just want to make sure you ask those questions.

Evan Brand: Or just see if they have regular content. We’re such big fans of—

Dr. Justin Marchegiani: That’s the key thing. Look at the content ‘cause then you can already know.

Evan Brand: And if they have somebody else writing their articles and you— you seem— they seemed like they’re disconnected from their practice, does that mean they suck? Maybe not, but, you know, Justin and I are big like— We practice what we preach, and we’re in the trenches constantly. And then, I’m sharing my health stories. I mean, how many practitioners are telling you they had heart palpitations and blood pressure issues and blah— blah— blah—? No. They— They want to act like they’ve got it all figured out and their health is perfect, an now you can be just like them and be perfect. You just have to pay on easy payment at 1.99 per month. You know, it’s like— I’m gonna tell you guys the truth, and I think people resonate with that and we get feedback every week. “Oh, Justin, you an— you and Evan and blah— blah— blah—” So, I know that— [pause] I know we’re on the right track with— with the way we’re educating people. 

Dr. Justin Marchegiani: Oh, I appreciate it. I appreciate your candor, Evan, sharing all these great information. Is there anything else you want to leave today’s listeners with?

Evan Brand: Yes. If they want to check out or schedule a consult with you, learn more about your clinic, etc., check out That’s the site. And Justin’s got another functional medicine doc that he has fully trained behind the scene, so that is awesome. And I’ve also heard great things. So, check out And then if you like to reach out to me, same thing, my site, And Candida Summit’s coming up, so if you guys haven’t registered, Justin has his own special link which he can give uh— which is

Dr. Justin Marchegiani: That’s it!

Evan Brand: Okay. So type in Go register for the summit. It’s literally imagine missing 35 of our best talks ever. That’s what it’s like if you miss out on this event. So go register, and uh— we look forward to talk with you guys again soon, and we’ll look forward to consulting with you in the meantime.

Dr. Justin Marchegiani: One hundred percent. Head over to as well for the same great content and info. Give us a thumbs up. Give us a share. Subscribe. Hit the bell. The bell will allow you to get notifications when we do these future live uhm— podcasts and my live Q&A’s as well. Smash that bell. That way, you get the notifications. Hey, Evan, thanks so much for being here today. And everyone listening, I appreciate you staying in touch and look forward to talking soon.

Evan Brand & Dr. Justin Marchegiani: Take care.



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