Sleep Podcast #10

In this podcast, Dr. Justin Marchegiani and Baris Harvey emphasize the importance of getting enough sleep and how it affects a person’s brain function, performance and overall health.  Listen as Dr. Justin explains in detail the phases of sleep, and the adverse effects of sleep deprivation on one’s metabolism and blood sugar regulation.

Learn the different strategies and tips for better sleep and for staying asleep, the different adaptogenic herbs to support our sleep as well as the importance of magnesium supplementation.

In this episode we cover:

04:06   How sleep works

08:35   Effects of sleep in metabolism

12:32   Sleep hygiene

17:20   Magnesium supplements for sleep

24:58   Tips and strategies for better sleep

27:11   Adaptogenic herbs

47:26   Valerian Root, Hops and L-theanine

Baris Harvey:  Thank you guys for tuning in to another episode of Beyond Wellness Radio.  To continue to have a lot of these audio straight to you make sure that you go to beyondwellnessradio.com and subscribe.  So that way you guys do not miss an episode.  So first of all, how is it going today, Dr. Justin?

Dr. Justin Marchegiani:  Baris, it is going great man.  I probably had about seen a full day of patients so I am ready to do the show.

Baris Harvey:  Yes, sounds awesome.  When it comes to sleep, this is going to be the topic today.  It is super-duper important.  And I actually just recorded an episode on sleep on my other podcast about sleep because it is so important. And I have had a lot of questions from different clients and different listeners about sleep and I am pretty sure you know throughout a full day of clients you probably talked about the topic at least several times today.

Dr. Justin Marchegiani:  Absolutely.  Absolutely.  Yes. It actually makes me sleepy taking about sleep, you know can you believe it?

Baris Harvey:  It actually really does.  I usually do podcast early in the morning and last night I didn’t sleep so I am messing up already.  And did a podcast about sleep and man it might have been a little bit of the train wreck but I started getting sleepy throughout and started you know a bit forgetful.  But it was all good.

Dr. Justin Marchegiani:  Nice.

Baris Harvey:  So yes, today we are going to go into sleep.  But before we do that you know we usually do this super early.  Today right now it is about 2 o’clock my time and Dr. Justin is probably what, 4 over there for you?

Dr. Justin Marchegiani:  Just about 4.  How about we talk about lunch today?

Baris Harvey:  So lunch now rather than breakfast.  For me I had some, I actually had a little bit of leftover ribs.  I did a football workout in the morning and so I had some scrambled eggs with some ham and bacon and some green onions and then also some potatoes as well.

Dr. Justin Marchegiani:   Nice.  You have a little bit of carb back loading there after the workout.  I like it.

Baris Harvey:  Yes, definitely.

Dr. Justin Marchegiani:  Very good.  So myself I did some kielbasa which was really awesome.  I heated it up.  I had some great German mustard which had like a little bit of apple cider vinegar in it.  I had maybe 6 or 7 strawberries for dessert but I also had a carrot along with it and it was just scrumptious.

Baris Harvey:  Yes.  You mentioned the mustard.  I do not see it in my line of view right now.  I can look into the kitchen but I cannot see.  I had this specific kind of mustard but it is so delicious.  It is like a smoked maple mustard.  Man!  It is off the hook, it is amazing.  Yes, it makes everything taste better.  And I am actually right now as we speak I have a crock-pot on and I have some pork ribs in the crock-pot slow cooking with some of that as well as some other all-natural barbeque sauce as well.

Dr. Justin Marchegiani:  Man after my own heart, Baris.  I love it.

Baris Harvey:  Right, exactly.

Dr. Justin Marchegiani:  Awesome.

Baris Harvey:  So let us get the podcast rolling.  We have questions about sleep all the time so I know this will be extremely valuable for our listeners and our clients as well.  So just to start off, sleep is super important and I think one of the most important thing is understanding how important it is.  Sometimes we do not really prioritize it and that is why it shuts down.  So to start off, could you just tell us why it is so important and what are some of the mechanisms that are happening during sleep?

Dr. Justin Marchegiani:  So sleep is really important because one, it is how we recharge our body.  So there are a couple of different phases of sleep and we will break it down.  So sleep basically, our hormones run on a circadian rhythm or a sleep and wake cycle.  So essentially, when the sun comes up that stimulates cortisol.  Cortisol is a stress hormone but it is important that we activate our sympathetic nervous system.  We get up or out of that, right?  Cortisol gets it up.  It is a glucocorticosteroids.  So it helps mobilize blood glucose and allow us to have energy.  Again it also helps with inflammation and stress.  So we get up.  We are ready to go and that cortisol drops throughout the day kind of like you were on a roller coaster ride.  You are at the top of the day, the top of the roller coaster where you are crashing down in the morning and that cortisol drops throughout the whole entire day and goes down at night.  And that is important because we also have this phenomenon known as the melatonin-cortisol rhythm.  So melatonin goes up as cortisol drops.  So kind of makes an X.  So as cortisol drops at night melatonin comes up.  That is important because melatonin is a powerful sleep hormone, produced from the pineal gland which is kind of right between your eyes back a few inches.  And again it is very powerful because it is an antioxidant and it helps you get to sleep.  It helps you get the deep phases of sleep.

Baris Harvey:  Uh-hmm.  Definitely.  It is funny that you mentioned like the deep phases of sleep because I know you probably have some clients that have some issues with sleep and have been put on different medications and one common medication is Ambien, I hear.

Dr. Justin Marchegiani:  So Baris when we talked about our cortisol rhythm we also have a sleep rhythm, too.  As we kind of were alluding to earlier.  And what happens in the sleep rhythm is through at around the hours of 10 pm to 2 am that is where the growth hormone is at its highest.  So it is really important that we are in bed at or around that time so we can access or tap into that growth hormone stimulation.  And if we are not asleep at that time we won’t be able to plug into it.  So we really want to make sure we do our best to plug into the growth hormone because that really helps repair muscles, repair our body, definitely on the structural side it is very, very powerful.  And as we get deeper into the night, typically around 2 am to 6 am, that is where we start getting into our psychological repair and turnover of our neurotransmitters.  That is why if we get to sleep typically around you know 1 or 2 at night, you may not feel great physically the next day but typically you can still think.  So we want to make sure we tap into both of those.  And that is why most people say the hours before midnight count as double because we are tapping into the growth hormone and all of the extra hormones that are helping our body stay strong and getting the sleep as well.  We combine that with our neurogenic repair so we repair a lot of the neurotransmitters like dopamine and serotonin and GABA and such to help us stay relaxed and focused and happy and in a good mood.

Baris Harvey:  Yes.  And it is super obvious one of those common sense thing that sometimes we do not pay attention to but I mean, you can go a couple of days without food but go one night without sleep and you are a zombie, right?  And we noticed that we really need that to have, I mean one of the biggest things when somebody kind of approaches you and say, “Hey, I want help and I have poor energy.”  And you noticed that they are only sleeping you know maybe 5 to 6 hours at night sometimes that is even by choice.  Like they choose to watch TV and they stay up and it is like, “Well, how can you have energy if you are not getting sleep?”  But sometimes it is not always by choice.  So for the people that are actually having difficulties falling asleep, let us kind of help them out.  Then also staying asleep as well because those can be some issues and we probably do not have to rehash why sleep is so important.  We know that there are just so many reasons and we can talk about metabolism, we can talk about leptin and ghrelin and some of these hormones that basically are influenced by sleep.  So I actually I am going to switch over.  Right before we get to kind of what are some of the things that we can do to improve, getting the sleep and staying asleep.  Actually go over that real quick about basically how our metabolism is influenced by sleep and probably why that happens as well.

Dr. Justin Marchegiani:  So again our metabolism is affected by sleep because not getting enough sleep literally can create an insulin resistant state.  So you can go out there and Google.  There are many studies on this where you look at sleep, just go on to Google right now.  I will do it in a chat, type in sleep deprivation and insulin resistance.  I am doing it right now.  What you are going to find is a handful of studies out there.  There is one study for instance where they took college students that were healthy, no problems.  They sleep deprived them I think three or four hours at night or four hours at night sleep for, I want to say, two weeks.  And then in that two-week time period, what they found was they were literally pre-diabetic, they were nearly insulin resistant.   

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  This is called the finals, right?  (Laughs)

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  They are in finals time so that is probably when they gain their freshmen at 15 and also all the others are just probably from staying up.

Dr. Justin Marchegiani:  Yes.  So I have the study right here.  Actually, I pulled it up.  I cannot believe I did it that fast.   Typically when you go to PubMed it takes a little bit of time finding the studies.  But this study was published in the Journal of Clinical Endocrinology and Metabolism 2010.  The study was called, it is actually a single night, I have seen one of two weeks though, this is a single night of partial sleep deprivation and how it induces insulin resistance.  So what they did was they took, I want to say, some colleges students in this study.  Nine healthy subjects five were men and four women.  And what they did was they allowed them to sleep from 2:30 in the morning to 7:30; 2:30 to 7:30 and what they found was they were measuring insulin sensitivity.  And the results of the study they found that partial sleep deprivation of four hours of night sleep on a single night induced insulin resistance in multiple metabolic pathways.    

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And basically they are correlating this study and just saying that the physiological observations maybe relevant when you are dealing with glucose in patients who are Type 1 and Type 2 diabetics.  So this is really important.  If you are dealing with someone who is a clinician and who is dealing with Type 1 or Type 2 diabetic patients that have glucose problems already, well before we look at metformin and all the other drugs out there or even nutrients like you know, herbs like bitter melon or alpha-lipoic acid and cinnamon which I think are great, work on the foundational stuff, too.  Like sleep.  And that is where I think it is important because we know when insulin resistance gets kind of messed up that is the first domino that falls.  Then we will start seeing leptin resistance and leptin controls satiety.  And then we will see issues with other satiating hormones like peptide yy and adipopectin and ghrelin and the whole nine yards.  And this can set us up for just the inability to really feel satiated after meals and it just creates a cascade of becoming more of a fat storer than a fat burner, right?  We are relying more on sugar for fuel which really sets us up for a whole bunch of impaired performance regarding how we think, feel and look.

Baris Harvey:  Wow!  Yes that is wow! And that is only after one night, too.  So I mean just the next day your body is going to have more issue handling sugar than the day before just by staying out late and maybe it could just be because of work sometimes or maybe you are studying but you have to understand how important that sleep is.  So for people having trouble with sleep, of course, one of the easiest thing to do is kind of regulate sleep hygiene.  And it do not necessarily mean just like you know being clean but just the environment because we are creatures of our environment.  So could you kind of give us some kind of tips or strategies on how we can improve and the foundational stuff before we start kind of tinkering with other things?

Dr. Justin Marchegiani:  Okay, so again we know that light stimulates cortisol, right?

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And cortisol and melatonin have inverse relationships.  So by just getting exposed to light I mean seriously you are shutting down your melatonin.  So I one of the first things you can do is just get your house ready.  So like at night time come 8 or 9 o’clock get those lights turned down.  If you want, you can be super cool like myself and my fiancée rocking our blue blocking sunglasses at night.  Sitting there with our sunglasses on and rocking that.  That can be helpful, too.  I actually just purchased one of Dave Asprey’s blue night lights.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  It is one of the light bulbs from his website that does not have the blue light in it.  So it is like the blue blocking night light.  And I have that in my bathroom.  So I keep that on only if I have to go in there at night.  And I use the sunglasses and I keep my lights down low and that is kind of like getting my hygiene really ready for bed.  So 1 to 2 hours of just keeping the light down; keeping the stimulation on my pineal gland off so the melatonin can be really, really strong.

Baris Harvey:  Yes, that is super important just keeping the blue light.  And I also have one of those lights in my bathroom.  It is kind of like an amber glow.

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  The same kind of light as if you had a candle lit.  And I am pretty sure our ancestors might have lit fires but it is not going to interfere and have that blue light that kind of stimulate us to wake up.  You are not around the campfire like, “Oh, I have a bunch of energy now.”  And like you are still kind of wind down.   And it is funny how if you go camping or there is a power outage naturally you are going to be going to sleep a little bit earlier.  But now when you are in your house and you have the lights on you are going to stay up as long as I guess as you please.

Dr. Justin Marchegiani:  Absolutely.  So that is one of the first things that I do.  Also, there are a lot of different things in functional medicine land that we can do to help with sleep.  One of the first things is we just want to make sure people’s diets are dialed in.  So good quality protein and fat and making sure your blood sugar is not going too high up or too low before bed.  Typically in functional medicine it is kind of good training type of idea if we are seeing patients that are having a hard time going to sleep, we are always thinking high cortisol at night.  And high cortisol is going to happen for a couple of different reasons, right?  Stress, you know eating too much refined sugar before bed.  So making sure diet is dialed in where there’s appropriate amount of healthy fat, healthy protein and maybe just enough carbohydrate for your metabolic needs.  That can be helpful.  Also when we see high cortisol we may bring in things that are adaptogenic, these herbs, these herbal medicines that are called adaptogens can be really helpful in getting that cortisol down or at a moderate level.  Typically 1.5 units around bed time so we can get to sleep.  So one of my favorite things that I do is I use Tulsi Tea which is a brand from the organic Indian company that uses holy basil.  And again holy basil is an adaptogenic herb.  And they called it holy basil because typically when it was discovered years ago, I think in Egypt, the Egyptians would say that they felt like they were one with the gods when they would take this herbs.  That is kind of how it got that name which is pretty interesting.  You will never forget it once you hear it in that context.  So I take holy basil before bed and I have different flavors.  They have sweet rose, they have lemon ginger, they have honey chamomile.  I kind of have four or five of them and I rotate between each of them every night.  And that just kind of helps get my brain and the cortisol and my HPA axis kind of more dampened so it is ready for a good night’s sleep.  That is a really simple thing hygiene wise, the good night’s relaxing tea, the blue blocking sunglasses, turning the lights out and just really getting your atmosphere kind of in a more relaxed fashion.

Baris Harvey:  Yes.  I also have Tulsi Tea and it is really, really good for that and it just tastes good, too.  And it is a really good routine as well.  It kind of gets your body into a state where the same way people kind of might even start to feel awake whenever they walk to a coffee shop because they know, “Hey, I am about to get my coffee.” And their brain kind of remembers this routine and starts to energize.  You might do the same thing with the tea where you get it and you know that, “Hey this is my time to wind down and to relax.”

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  Yes, definitely.  Another really good way to do it is to take a magnesium bath, so using Epsom salts or magnesium flakes and taking a bath and to feel relaxed.  And this might not be something you do every night but can be beneficial.  I will let Dr. Justin kind of go into the reasons why using magnesium transdermally could be beneficial to you before you go to sleep.

Dr. Justin Marchegiani:  So magnesium is probably one of the most efficient nutrients in our food supply.  And there are many, many studies on that.  Go to PubMed and just type in magnesium deficiency in food, it is ridiculous and it is one of the cheapest products out there, too.  Now I am a big fan of using a good quality chelative magnesium.  I like the magnesium dimalate or glycinate.  These are really good.  They are highly absorbable.  Typically, if you are doing citrate or oxide, they can be used better for constipation.  But again the chelative ones tend to be best.  Now again, magnesium helps kind of get the parasympathetic nervous system going, it helps relax the body.  So there are a handful of studies, I just have a few in front of me.  One is called the Effects of a Magnesium Deficient Diet on Sleep Organization in Rats.  And what they found as they did these brain scans, kind of these EEGs of the brains to look at the electrical patterns in the brain.  And what they found were the more aberrant the electric patterns were, were basically a sign of the more deficient magnesium was in the diet.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And they found that when they repaired or when they got the magnesium levels back up these patterns, they call them ECoG patterns, basically repair themselves.  And they also mentioned that magnesium is neuroprotective and they found the most deficiency in neurological disorders like epilepsy.   So really important to think of magnesium as protection for the brain but it also helps get the parasympathetic nervous system on.  And we need the parasympathetic so we can rest and digest.  So typically, we are either sympathetic where we are going, going, going and or parasympathetic.   So magnesium is one of those nutrients, it has got 300 different roles in the body.   Now I think personally, this is why sleep issues can cause magnesium problems.  Magnesium is highly important for blood sugar stability and blood sugar regulation.  So if we are not getting the sleep and sleep is making us insulin resistant and insulin resistance is causing problems with blood sugar metabolism, well it is further inducing more magnesium deficiency.  So we need to run through our magnesium more to help process and metabolize our blood sugar imbalances thus having more sleep.  So when we see this it is like, whoa! It is like if we have these problems, it literally compounds and makes our sleep problems worse and worse and worse overtime.  And then we will try to grab Lunesta or Wellbutrin or Ambien or some type of medication that is not getting to the root of the problem and making you feel like you are walking around like you are knocked out like you mentioned earlier, Baris.

Baris Harvey:  Uh-hmm.  Definitely.  And for people that just want to test it, you can go to a natural food store and get yourself like a small packet of something called Natural Calm which is just a magnesium citrate that is really simple.  You can grab like a packet or I know they have like a 5-packet samples sizes for like a buck, maybe $2, $3.  And you can try it for yourself and just take one of those packets with some water and drink it before you go to bed and you will notice an improvement in your sleep.  And that improvement might signal you that you might have a deficiency in magnesium.  And it is one of the easiest and simplest things you can do.  And then like we mentioned Epsom salts or magnesium chloride which is magnesium flakes can even be more beneficial because you are going to get it transdermally.  And you can also make an oil or buy an oil form of it as well.

Dr. Justin Marchegiani:  Yes, I love it.  I love it.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  There is another excellent study out there I will share with the listeners.  It is called the effects of chronic sleep basically on HRV or heart rate variability on catecholamines.  This is adrenalin and then also intracellular magnesium levels.  We will put a copy of it in the show notes.  But again HRV is really cool because that is basically looking at the unevenness between heartbeats.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:   So if you have the emWave or emWave2; that is kind of like looking at the heart rate variability.  And it said that the higher heart rate variability you have it is just a sign of a really good health, right?  And what they studied there they looked at the students during final exams. They looked at 30 healthy males of college age.  They took this study four weeks.  So they took it during and after the exams.  And what they found was, their HRV went down, HRV function went down as they had more sleep debt, their magnesium deficiency decreased, that is a red blood cell magnesium and their epinephrine went up as they had more and more sleep issues.  So it is not really causative but clinically we see that we improve magnesium, we improve sleep quality.  And that magnesium could also be a support for adrenal fatigue and we are seeing more and more adrenalin come up the more we have sleep issues.  So if you think you are adrenally fatigued getting some good magnesium on board they will be helpful because it will help reduce your adrenals from whipping out all that adrenalin which is norepinephrine and epinephrine and that will help your body heal.  Because the more we are in fight or flight and breaking down the less we are going to be producing good quality sex hormones on the flipside.   

Baris Harvey:  Uh-hmm.  And isn’t it funny that magnesium is also required for proper glucose utilization and signaling insulin.  Like we know that if we do not go to sleep on time it is going to interfere with our insulin and will be more insulin resistant the next day from the study that Dr. Justin just mentioned.  But also if our intracellular magnesium is low, it is going to make it even harder and it is going to throw up our blood sugar regulation which Dr. Justin mentioned is going to require more cortisol.  So basically, I will break it down for the listeners and make it a little bit more understandable.  But basically if you are going to sleep late you are going to throw off your blood sugar.  You are going to throw off your insulin and you will probably throw off your magnesium.  You will need more of this stuff to operate better.  And when your magnesium is lower it also makes it harder to utilize your blood sugar, so thus making it even harder.  So you get into this vicious cycle.  So making sure that you are going to sleep on time and maybe using and including some extra magnesium will help get you back rolling on the right track versus this vicious cycle of getting worse and worse.  And like we mentioned, sleep is so important and so making sure that we actually value that as going to be priority number one.  Because we talked about nutrition and exercise all the time but making sure that bringing our sleep in there is also extremely important.   So for the people that are doing all the things or at least they believe they are doing all the right things, they are trying to go to sleep on time but they are still having issues, what are some of the things that they can do?  What are some strategies that they can use in order to fall asleep?  I know some patients and some of our clients have a real difficulty falling asleep.  They say they lay in bed and they toss and turn or they need to watch TV you know with air quotes and to fall asleep.  But they are watching like an hour show they do not fall asleep until the end anyway.  What are some of the things that they can do to help influence them to go to sleep quicker?

Dr. Justin Marchegiani:  Well, one make sure if you are going to watch some TV before bed you kind of give yourself that last half hour or so to go up to your room meditate, read a book, relax, chat with your partner, try to keep the conversation light.  Do not bring up taxes, and bills and stuff.

Baris Harvey:  Laughs

Dr. Justin Marchegiani:  Keep it like gentle conversation.  Keep it really light, that is important.  Make sure the last show that you are watching, you know, or at least you are not watching it up until you sleep.  Make sure you are not watching the Walking Dead or like True Blood or something and get you all riled up that is just going to increase your cortisol by itself.  So your question was things that we can do.  So one, if you are having a hard time going to sleep make sure your blood sugar is dialed in.  Take an audit of what you are eating, protein, fat and carbs.  Make sure you are not going four or five hours before bed without eating.  I mean there is an old kind of an analogy that is out there, “Oh, your last meal should be you know about 5 or 6 o’clock.”  I do not know where these things come from?

Baris Harvey:  Laughs.

Dr. Justin Marchegiani:  But it is not good.  Because if it is at 6 and then you are sleeping until 7 or 8 the next day and you got 13 or 14 hours and you already have adrenal fatigue, well that is not good because your blood sugar is going to drop and that is going to cause your adrenals to wake you up throughout the night.  So we want to make sure we eat within that 1 to 2 hours.  Keep the meal a little bit lighter but a little bit of protein, little fat, maybe a little bit of carbs and keep that dialed in.  And a typically cause if we are waking up in the middle of the night, it tends to be that low blood sugar at night.  So our blood sugar will drop at night and we would get woken up because our adrenalin has to keep the blood sugar up because blood sugar is really important.  It is the biggest stressor on the hormonal systems.  But if blood sugar drops our adrenals will bring up that adrenalin to bring it back up.  So we want to make sure adequate levels of cortisol there.  Cortisol is too low our blood sugar goes low then our adrenalin gets called for the action, right?  Our adrenalin or our adrenals producing adrenalin gets called.  And if it goes too high you may never get relaxed and be able to go to bed.  So we kind of want the happy medium.  Do your best with diet to help facilitate that.  That is step one.  Do you want to comment on that, Baris?

Baris Harvey:  That is perfect.  I think that makes total sense.  So let us go right on step two.

Dr. Justin Marchegiani:  So next, we can use adaptogenic herbs.  So the holy basil and Tulsi Tea can be helpful an hour or two ahead of time.  Some people that have higher levels of cortisol they will do better with phosphorylated serine which helps get the hypothalamus sensitized to or helps get the cortisol kind of more sensitized to the hypothalamus.  So essentially, what that means is your brain is basically kind of regulating cortisol by just kind of like a thermostat with temperature.  So imagine the thermostat set at 70; temperature goes to 73, right?  Typically, the AC should kick on but it is not.  It is not sensitive.  So the phosphorylated serine can basically make the HPA axis get a little more sensitive so then it says, “Oh, that cortisol is a little bit too high, let us bring it down a little bit.”  It is like it sees it now and it fixed it and just dials it back in then we can start bringing that cortisol down.  And that typically gets dysregulated.  We call it HPA axis dysfunction, hypothalamus, pituitary our brain, adrenal HPA, adrenal axis dysfunction, so that thermostat in our brain gets broken.  And using some of these adaptogenic herbs like phosphorylated serine that is more of an adaptogenic nutrient but that can help lower the cortisol.  We can also use various herbs throughout the day to help with our cortisol.  Ashwagandha is very powerful to use throughout the day that could help restore sleep as well.  I do not recommend taking ashwagandha after 4 pm but taking it throughout the day can be very helpful at normalizing that cortisol rhythm so we can ensure that our cortisol is not coming up at night like it should be.  It should be coming down at night and that way we can make sure it keeps that rhythm back on track.  And if you are a little bit curious to see, you know is your cortisol rhythm off or on, we can always do a salivary cortisol test. Where we spit in a vial four times throughout the day: in the morning, afternoon, late afternoon and night and then we can see and we can actually map that out.  And if it is off we can use various nutrients and herbs and dietary and lifestyle strategies to get it back on track.

Baris Harvey:  Uh-hmm.  Yes, definitely.  So it is funny that you mentioned the ashwagandha, too because I actually took some before we did this recording.

Dr. Justin Marchegiani:  It is one of my favorite adaptogens.  I love it.

Baris Harvey:  Yes it is really awesome.  So you mentioned we want to make sure that you know we can do some testing with salivary testing in order to measure our cortisol and how the curve is and not just doing a one-time test but also to see how is it in the morning, in the noon, the afternoon and at night.  Are you noticing in your practice patients having a hard time?  Let us look at the people that are having a hard time waking up and maybe they also have problems with sleep.  And you know that it seems that maybe bringing that cortisol up in the morning might be beneficial because I see a lot of people that have low cortisol in the morning and we kind of cured this.  If you go on a holistic, all-natural blog, you might hear sometimes like cortisol is like evil stress hormone you need to get rid of it and get is as low as possible.  But just like any hormone it is there for a reason and we need it.  We just want it to be in balance, correct?

Dr. Justin Marchegiani:  Yes.  Cortisol is really important.  Again it is a stress hormone but it also helps with inflammation.  So if you are chronically in pain, you can pretty much assume that there is probably an adrenal fatigue going on.  And it is important because cortisol, it sounds like cortisone that is its sister.  And cortisone can be injected into various areas.   I do not recommend that because after two or three injections the doctor will say, “Yes, we have to stop because this is going to break down your ligaments and tendons.”  So it does not fix the problem.  But if you are adrenally fatigued and your body cannot regulate inflammation on its own a typical cause is because your adrenals are not doing the job at keeping that fire down.  So it starts smoldering.  And where you see smoke there is probably fire.

Baris Harvey:  Uh-hmm.  So is there a way without having to let me see, I guess you do not want to have too much cortisol just overall running.  But what if your cortisol is low in the morning?  Is there a way you can keep that higher in the morning so that way when we get to bed it can possibly be lower?  Because I have seen people with not necessarily high but relatively high at night and have some people that are really low like they did not have any, like the stress hormones is the same as you know even like you said it happens when there is more inflammation as well and so our natural pain killer as well as kind of like our energy supply.  So if we do not have much in the morning we could be sluggish.  Are there ways that we can kind of bring that up in the morning while keeping it lower at night?

Dr. Justin Marchegiani:  Yes, so I would recommend hitting up specific herbs like ashwagandha first thing in the morning that is very powerful.  We could even use some licorice roots first thing in the morning to kind of well, the ashwagandha is going to get the HPA axis kind of in sync.   And the licorice basically helps extend the half-life of cortisol.  Licorice does not have that same type of HPA axis type of effect but it extends the half-life of cortisol and inhibits the enzyme that breaks down or metabolizes cortisol.  So having licorice there could help allow our body to kind of allow our cortisol that is naturally there to just stay around or linger longer which has a good effect because our body can utilize that cortisol more.  That can be another good effect.  Even taking in a glandular depending on how fatigued someone is.  They may need a little bit of glandular with some bioidentical cortisol in there because they are so fatigued.  And that could be helpful to kind of jumpstart the HPA axis for a period of time.  And again a lot of the strategies that I am talking about are really dependent upon lab results.  So we take a look at their history, their labs, their blood work and that gives us a really good indicator of what is going on.  And so for instance, when we run blood panels, we will run a red blood cell magnesium and we will see if it is below 5 and a half that is kind of on the low side.  Typically, I like the top third of the reference range which 6 or above that we know that they will definitely benefit with a therapeutic dose of magnesium and they would use some really good adrenal adaptogenic herbs.  Another one of my favorite is Eleuthero.  Eleuthero can be pretty stimulatory as well and it also supports the sex hormones, too.  So as we get more sleep deprived our body is making more stress hormones.  And as we have that HPA axis dysfunction those stress hormones can actually start going down and then we start getting fatigued.  And taking these herbs can help bring some of those stress hormones back up but also modulate the stresses itself by getting the brain and that thermostat back on track.  And again, we want to make sure we are never giving these things in isolation.  Meaning we are never giving these supports without fixing these physical, chemical and emotional stress that cause the problem in the first place.  We always want to make sure that the root cause has been addressed and assessed and we want to make sure the person’s diet is on track.

Baris Harvey:  Uh-hmm.  Definitely.  So one common thing that I have noticed is people waking up around the hours of 2 and like 4.  Like they wake up at 2 or 3 and for some reason it is always between these hours.  Could you kind of chime in and kind of maybe talk about what can be causing that and how to improve that?

Dr. Justin Marchegiani:  Yes.  So there are certain times throughout the day, you know, we have what is called the Traditional Chinese Medicine, a 24-hour Organ or Chi cycle.  You can easily go online and do a Google image search of it.  But typically between 1 and 3 am is where we have the liver hour.  And the liver is most active at dumping out toxins at that time.  And the gallbladder between 11 and 1.  So that 11 to 3 is typically that liver-gallbladder hour.  So for having problems in that time frame it could easily be from our body detoxifying, very possible.  So again, make sure your diet is low in toxins, anti-inflammatory and nutrient dense, some type of Paleo version with the macronutrients customized to you.  Making sure that your food is organic.  Making sure the pesticides and chemicals are out and the artificial sweeteners and crap are out of there, too.  That is going to be important.  Now some people also have a lot of internal toxins like parasites and SIBO and bacterial overgrowth and fungus.  These toxins actually produce lots of endotoxins or internal toxins.  They are produced inside of your body.  So we have like the environmental toxins like BPA and phthalates and pesticides and chemicals on the outside, those are environmental.  And then we have our endo or internal toxins and bacteria that produce various toxins such as lipopolysaccharide.  We have different toxins that are produced by our small intestinal bacterial overgrowth.  We have various microbes that can stimulate the immune system and wake us up.  So a lot of these things can be a problem.  And again, these infections or these microbes that are there they have opposite sleep and wake cycles that we have.  So what that means is when they are more active, we can basically see an increase surge of cortisol because of all the inflammation and damage that is being done.  So one of the main things that we will see on adrenal-cortisol rhythm is we will see high levels of cortisol in the morning coming off of a party night of these various microbes kind of partying up inside your intestinal tract.   Concomitantly, we will see higher levels of cortisol in the morning after your little gut friends have had a night out in the town, if you will.

Baris Harvey:  Uh-hmm.  And do you notice this more on certain days?  I have heard of and I do not know if there is any truth to this.  But on certain times of the month maybe on a lunar cycle just because of the effects of, the same way our body kind of regulates itself in a sleep cycle depending on circadian rhythm and the sun, I have also heard of parasites possibly and other gut issues kind of relating to the lunar cycle.  Is there any truth to that or is that kind of like hippie mumbo jumbo?

Dr. Justin Marchegiani:  I think there is some truth to it.  I see some people correlate you know looking at the lunar calendar and looking at the full moon time and such and seeing more symptoms or more die-off issues at that time.  I mean again, it is individualized.  Unless there is evidence to the contrary, I think there is a lot of empirical evidence that people had just noticed and observed.  And you know, frankly no one is going to do a multi-million dollar study to figure this out.

Baris Harvey:  Laughs

Dr. Justin Marchegiani:  So there is no drug to be made of it.  So we are just very empirical and try to be as subjective as possible.  I think I have encountered a fair amount of people that notice that.

Baris Harvey:  Yes. Definitely, I have heard that many times but it is just hard to quantify it.  So it is easy for somebody kind of on the outside who is not really into, more into like the left-brain stuff not really into like the “feeling” kind of way.  The same way you know we have to be able to feel what foods are good for us.  People that are more left-brained sometimes do not really kind of understand that portion.

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  They will kind of throw that out of the window.

Dr. Justin Marchegiani:  Yes. 

Baris Harvey:  Yes so what are… Oh, yes go ahead.

Dr. Justin Marchegiani:  So it is great to have research.  Well, we have research on magnesium and other nutrients.  It is great to have research.  When we have research we use it.  The problem with researches today is we have lots of nutrients and things that are not really marketable.  We cannot make the billion or millions of dollars like the drug companies can.  So you are not going to get all these funding.  You are going to see some independent universities doing things and doctors like myself will look at that and use that evidence to support it.  But again, we do not have the billion dollar payroll so we are not going to be able to do a study on every single thing.  So in my opinion, clinical evidence, doing things, trying it, looking how, you observe, you know, N=1. Myself, I have, you know, hundreds if not thousands of patients I am working with that I can kind of draw influence from and do various things and have them report back to me.  And we can always you know see if we are seeing a beneficial effect.  So again, just because we do not have a study for everything it is not the way to go.   And again, we have most studies out there all industry funded. And when the industry like the drug company or like we can look at aspartame or artificial sweeteners, when they fund studies they are 99.9% in favor.  So you also have to look at who is funding the studies.

Baris Harvey:  Yes.

Dr. Justin Marchegiani:  So ideally, independent studies are the best but frankly you are just not going to get a ton of them because there is not a whole bunch off money to make off of a $10 jug of you know Natural Calm, frankly. (Laughs)

Baris Harvey:   (Laughs)  Yes, right.  Exactly.  Yes, it is so true.  So what are some of the things that we can do in case you have any of these party animals down in your gut?  What are some of the things that we can do to kind of hush that down, get them out?  So that way they are not causing stress and they are not causing the cortisol splurge in the middle of the night.

Dr. Justin Marchegiani:  So again, if someone is having these issues, I am working with a handful of patients right now with these exact problems.  We want to identify the infections.  Some people have more than one infection and it takes multiple treatments to get to them all.  We could see small intestinal bacterial overgrowth, various SIBO type of bacteria that is overgrown.  We can see various parasites: giardia, E. histo, Enterobacter bacteria, cryptosporidium, you know various amoebas.  These can cause stress at night as well.  So we want to identify what the infection is ideally and use some type of broad spectrum antimicrobial on it.  And again, the dosage is so important.  Like I mentioned a lot of the herbs, you can have a really good herb.  But if the quality is not there of the herb, like if it is just a cheap you know crappy supply of it or if you are not using it in the right therapeutic dosage, you may not have the same effect.

Baris Harvey:  Yes, and that is what is important about either going to you know high quality like natural food store that might have high quality supplements.  We are getting like practitioner grade supplements to kind of avoid some of those problems I have noticed.  And again some of these companies because there is not too much regulation by the FDA like there are a lot of rules set but it does not mean it is super.  Just because there is a speed limit it does not mean everybody follows the rule, right?

Dr. Justin Marchegiani:  Yes. 

Baris Harvey:  So there are companies that might claim to have x amount in their supply and they don’t.  And another thing is some companies just add stuff in there and they might say like a proprietary blend if you look at kind of like the energy drinks.  I mean they are probably just dumping a bunch of caffeine but they will say like, “Oh, B vitamin.” Or maybe some taurine or some other amino acids but the dose is probably like super small.  They just put a tiny bit amount just to claim that that substance is in there but that does not necessary mean it is in there and doing anything.

Dr. Justin Marchegiani:  Right, is it actually functional?  Yes, I totally agree.  I am a big fan of using a practitioner line because a lot of the practitioner lines they hold themselves up to a higher standard than what the FDA would.  And again, I am not a big fan of the FDA just because ah, that is a whole other podcast.    

Baris Harvey:  Yes.

Dr. Justin Marchegiani:   But essentially, there is massive connection between the drug companies and the FDA.  There are a lot of documentaries on that.  But essentially, I like it when supplement companies hold themselves up to a higher standard and say we are going to do this.  We are going to have independent studies, independent, you know, companies come in and test our sourcing and make sure what is in there is in there.  Make sure the contaminants and the junk is not in there.  And there are all kind of scandals, too where companies over in Japan and China are slapping labels of good quality products on crappy supplies.  We want to make sure what we are getting is direct from the source as possible so we can ensure potency and ensure quality.  Because the most expensive supplement or product is the one that is just not working or is just not what it is supposed to be.

Baris Harvey:   Exactly.  Exactly.   So we went over a lot of stuff, a lot of different tactics.  But let us kind of go full circle and kind of bring it back.  And we talked a little bit about food.  Let us make it a little bit more tactical for people.  Maybe it is around after dinner time they already have eaten but now they are getting a little bit of craving again.  What is like a go-to snack that can not only help or should I say not destroy their sleep but also might be beneficial to their sleep.  What would be one of your snacks?

Dr. Justin Marchegiani:  Well, depending on how sensitive they are, some decent good quality dark chocolate can be helpful because dark chocolate is high in magnesium.  You just have to be careful there can be a little bit of caffeine in there.  So you have to figure out how caffeine sensitive you are.  So also on that note, on that thread right there, making sure no caffeine is consumed after noontime can be really helpful because caffeine does breakdown over like an 8-hour period.  So the caffeine is really important.  And a little bit of dark chocolate can be helpful after a meal.  I am talking upwards of upper 70s, low 80s.  I even go up to 90% dark chocolate can be helpful because of its magnesium content.  It gives you that good mouth feel like you have a nice little cheat.  So I like that.   

Baris Harvey:  Yes.

Dr. Justin Marchegiani:  I would do like after a meal, I will do a little bit of carbs.  Like if I have a good solid grass-fed meat and some vegetables, I will go steam a nice sweet potato and put some grass-fed butter on there and some cinnamon to get a little bit of carbs in.  And again, we need a little bit of insulin to get that tryptophan across that blood-brain barrier.  So that is where it comes down to having a really good digestion and making sure we are eating enough protein.  Because our amino acids especially if the amino acid L‑tryptophan gets broken down into 5-HTP which crosses the blood-brain barrier and then gets converted to serotonin in the brain via 5-HTP.  So we want to make sure that we are eating good proteins and that we are crossing that blood-brain barrier and converting over.  So that 5-HTP gets converted to serotonin.  That serotonin then gets converted to melatonin.  And that is really important for sleep.  So making sure protein is there and digestion is there.  And if you are having reflux or GERD or bloating or gas issues there is probably a good chance that you are not digesting and breaking down your proteins which could cause a deficit in the supply chain.        

Baris Harvey:  Wow!  That is really good.  Really a lot of good information.

Dr. Justin Marchegiani:  So looking back, if someone is…

Baris Harvey:  Yes.

Dr. Justin Marchegiani:  So looking back, getting in some good turkey in there with some skin on it can be really helpful.  Maybe having a little bit of carbs with that to help bring up that insulin and help shuttle that serotonin or 5-HTP across the blood-brain barrier can be very helpful from a dietary perspective.  

Baris Harvey:  Yes.  Let us do one more because I do not want, because I love the snack thing and I think that is awesome.  And we talked about some of the herbs, talked about magnesium.  What is one other maybe amino acid supplement or maybe we have talked about tea maybe some kind of herb that is specifically meant for sleep?  Is there one thing that you might go to like a little hack that you might have?

Dr. Justin Marchegiani:  So there are people out there that may have experimented with a benzodiazepine type of drug or something like a Xanax if you will.  This family of medications upregulate the GABA receptors and GABA kind of helps your brain relax.  So a couple of things that are really good at upregulating GABA are valerian root.  Valerian root is very powerful.  Hops, hops are very powerful.  L-theanine, this is an amino acid found in green tea.  That is why green tea can be very beneficial because you have a little bit of caffeine but again you have the L-theanine that can also have that relaxing effect.   So people that maybe need that stimulant effect but they have adrenal fatigue maybe do better with some Tulsi green tea with the adaptogens because they get the GABA and they get the anti-cortisol effects there.  But adding in the L-theanine, adding in the valerian, the hops, passion flower, lemon balm, these are great herbs that help kind of upregulate those GABA receptors potentially even adding in some GABA itself.  There is a little controversy in that, people say well if you do not have a leaky brain GABA is too big to cross it.  So, there is a little controversy there but when in doubt some of the herbs like valerian and passion flower and hops and lemon balm and L-theanine all will definitely do the job.  

Baris Harvey:  Yes, well great information.  And for the folks at home I want you guys to be able to listen to this and make sure that you send this out to people that might be having difficulties with sleep.  For more information make sure you go to beyondwellnessradio.com.

Dr. Justin Marchegiani:  Baris, can I add one more thing in?  I am sorry to cut you off.

Baris Harvey:  Yes, yes.

Dr. Justin Marchegiani:  This is important.

Baris Harvey:  Oh no, no.  Yes, I just want to make sure to put the website in there one more time just in case people are listening to their phones you can always go to beyondwellnessradio.com for much more and then you can ask us questions if you have any questions about sleep.  Yes, we are going to probably make a couple more about sleep because I still have a lot of questions and I have a lot of questions from different clients.  But yes go add one more thing for this episode.

Dr. Justin Marchegiani:  Sure.  So really important there are people out there that has probably used melatonin.  Now I am very careful at using hormones unless we have testing.  Now some people we actually get testing back and their melatonin is low and that is where it may be beneficial to add that in.  But again, if you are seeing melatonin low we have to look where does melatonin come from?  Well, it comes from L-tryptophan that is an amino acid.  So is your digestion working?  So if you are noticing low melatonin on your blood work or saliva test, think digestion, right?  Next, if you are finding yourself having to use melatonin every night try using some of the more natural things and are more nutrient-based or herbal-based to help you fall asleep.  So we do not want to be dependent upon a hormone.  And thirdly, I do use melatonin from time to time.  I use it to reset my cycle after the weekend.  I find on the weekend time, when you are up later and maybe you sleep in a little bit that can throw off your rhythm just a little bit.  Taking melatonin on Sunday night can help reset my cycle, doing it an hour or two before sleep can help get my cycle reset.  So I recommend if you are going to use it, use it reset, to hack yourself when you are flying or when you are switching time zones or you are jet lagged or you are staying up a little bit later on the weekend to start your week.  But then make sure you go back to using more of the lifestyle and nutritional and herbal options to get you back on track so you are not leaning on melatonin as a crutch every night.   

Baris Harvey:  Yes, I am glad you brought up that point.  It is really important and I bet we would have a lot of questions about melatonin if you did not address it.  But I know one other question might pop up from that so what are the doses you might recommend?

Dr. Justin Marchegiani:  Awesome.  I always recommend starting at the lowest dose possible.  I am a big fan of starting off with a sublingual melatonin between a half of milligram to one milligram to start.  Let it dissolve under your tongue so you can absorb it that way.  Some people may go up to 3 but you do not know.  If you just start at 3 you maybe be able to get away with a lot less.  And some people if they are constantly waking up throughout the night they may benefit from a time release melatonin that breaks down in a cellulose capsule over a 4-to 6-to 8-hour period so they get that slow release throughout the whole night.  So it would depend on what the issues are.  If it is going to sleep the sublingual would be best.  If it is staying asleep the prolonged release, sustained release would be best.  

Baris Harvey:  Yes, sounds awesome.

Dr. Justin Marchegiani:  One half of milligram to one milligram to start would be a good starting dose and then working up, titrating up slowly from there.

Baris Harvey:  Yes, that is what I have.  I have a 1 mg sublingual for times that maybe after the weekend, and I was up super late or even when I travel on a different time zone that is something awesome to use definitely.  So any last little notes maybe?

Dr. Justin Marchegiani:  Meditation before bed can also be helpful, too.  I listen to various delta or theta wavelengths, these various CDs before bed to get my brain into those deeper, deeper type of electrical pattern so I can relax and wind down that can be helpful.  Dr. Jeffrey Thompson has some really good CDs to help put your brain into that type of state.  So that can be helpful if you just do not even want to take anything and maybe you are more of in the right‑brain and you want to listen to some music, those CDs can be helpful if you do not want to take a supplement.

Baris Harvey:  Yes, awesome.  So we are definitely not done on the topic of sleep.  And we will record more strategies, more tips for you.  And to stay in contact with us to make sure that you are getting these updates make sure you go to beyondwellnessradio.com.  You can enter in your email there so that way you can stay and be ready for the latest episode.  Make sure you also go to ITunes and give us a 5-star review.  We really appreciate it and cannot wait to hear from you guys and your feedback and we love addressing your questions.  So if you guys have any questions as well you guys can go to our contact box as well.   So thank you, Dr. Justin for coming on to the show today and again we will continue to put out more and more and more especially on sleep because sleep is super important.

Dr. Justin Marchegiani:  Yes, Baris.  Thanks.  The show is great, man.  Let us keep it up.

Baris Harvey:  Yes, sounds good.  Yes.  And I will hear from you, Dr. Justin next week and we will go ahead and put another one out for you guys next week.

Dr. Justin Marchegiani:  Great.  Everyone you take care.