Staying Fit with Adrenal Dysfunction and Chronic Fatigue – Is it Possible? | Podcast #308

If you have adrenal dysfunction and chronic fatigue, exercise is probably the last thing you feel like doing. Your adrenal glands are responsible for keeping the well-being of your body in balance through hormones. These glands also produce the hormone cortisol, which is released during your fight-or-flight response. As you can imagine, cortisol is beneficial when you need to be alert and escape danger.  For more on exercise with adrenal dysfunction and chronic fatigue, listen to the entire podcast!

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

1:38        Exercise Movements, Use of Bands, Etc

9:06       Rowers

15:37      Hacks to Increase Exercise Performance

18:53      Post Recovery Stuff

29:39      Why Exercise is Important

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Dr. Justin Marchegiani: And we are live. It’s Dr. J here in the house with Evan brand, Evan, how are we doing my friend? 

Evan Brand: Doing really good, excited to dive into this topic, I’ve suffered tremendously with exercise intolerance for a while, and luckily have pulled myself out of it. And I can empathize with people that want to exercise, but they literally physically can’t. Or if they do, they crash out, which is what was happening to me. So let me just share a story just for a minute, and then we’ll dive in some to the details of it. But there are different things that can make people exercise intolerant. For me, I think it was a combination of factors like everything, but I was to the point where, if I did try to push myself, it would take an extremely long time to recover, you know, two, three, sometimes four days, I would still be recovering from the the workout and I thought, Okay, well, as you and I talked about, we got to adjust the levers, I got to lower the intensity, I got to lower the duration and the frequency. So I did, but it wasn’t enough, I still felt like no matter if it’s a 10 minute or 30 minute, I was still drained. So for me, I think it was detox, I think it was getting my mitochondria working better, definitely getting adrenals working better. I think neurotransmitters played a role too, because, you know, you could have low motivation and low drive if dopamine is effective. So we’ll go into that. But that’s, that was my story. 

Dr. Justin Marchegiani: Very important. I think anyone that’s health conscious, right, like you’re moving a couple of levers when you’re health conscious, right, you’re really working on drinking clean water, you’re working on improving your food quality, maybe adjusting your macros, maybe you’re taking some supplements. And of course, the The other thing you will be putting a lot of focus on will be movement, right. And I just call exercise movement. So like the first met, the three levers that we can move we already kind of highlighted is frequency, how many times per week we’re exercising intensity, could be how intense the movement is a compound movement that uses multiple joints, like a front squat, or a single leg deadlift with a row kind of component, or something like a bicep curl, that’s like, you know, just your elbow joint, that kind of a single joint movement, that’s more bodybuilding based, and, and less kind of metabolism based, right full body bass. So we have frequency intensity, the type of movements and that also can include the rest time between sets, too, right. So you can also increase, you can do more intense stuff, and then just have more rest time to kind of be back to baseline in between. And the last is duration, how long your workout is, that’s helpful, too. So some data by Charles poliquin, who talked about cortisol really starts to increase, you know, 45 to 50 minutes in. And again, that’s gonna be for someone that’s more on the healthy side. So I always tell people, like keep your workout, if you’re more stressed, keep it under 20 minutes, that’s a pretty good rule of thumb, you know, and just try to do more circuit movements, where you do movements back to back to back, that can be helpful. But then we kind of have to gauge and how your body is adapting to the exercise. It’s all about adaptation. And so exercise is a stress, and we want our body to be able to adapt to that stress, so we grow stronger. Now, if that stress is too much, where our body is not able to adapt to it, meaning we’re getting weaker, we’re getting more tired, that defeats the purpose of exercise, we want our body to positively adapt to that stress. If it can’t, then we have to move those three levers frequency, intensity, duration, and we may even have to switch out of certain movements, we may have to switch into more yoga or more walking or more, you know, Tai Chi types of movements in the beginning and just kind of go from there. So there’s a couple different levers. And so there’s three questions I always ask my patients, my patients that are listening, they know this, do you feel better after the workout than when you started, you want to always feel like your exercise is energizing you. That’s a good place to know that you’re adapting to your exercise you’re able to adapt to it. Number two is you can emotionally repeat the exercise afterwards. Once your heart rates kind of brought back down to the baseline after you stopped your movement. Can you emotionally do it again? Are you like, wow, I’m done. Right? And then number three is going to be last question is how do you feel later on that day, if it’s a morning workout, or that next morning, if it’s an afternoon or nighttime workout? Do you feel overly tired hit by a bus overly sore? Now if you’re adding in a front squat or a deadlift for the first time, you may feel a little sore. But in general, how do you feel? Do you feel overly tired overly sore hit by a bus? If so we want to adjust some of those movements for sure.

Evan Brand: Yep, good, good points. For me. I don’t have to count or measure or anything like that or time to workouts. I just get to a certain point with lifting weights. I primarily lift weights. I mean, I do like to go on bike rides, I’ll take the kids that’s pretty hard work with the legs. I do like my roll machine. So I’ll do that. But I don’t really measure count or anything I get to the point in the workout where my pump goes into more of like you can just feel that you’re becoming catabolic, you feel like your muscle tissue is now being used as an energy supply. Now, people that are new to it or if they haven’t been exercising for a long time. They may not be that in tune with their body. But for me, it starts out with the heavy lifts, I’m getting the pump, I feel good, I feel the blood flow. And then it gets to the point where I feel like I don’t want to say I’m hurting myself. But the dumbbell that used to feel pretty good and challenging now just feels like a frickin rock. And I’m like, oh, okay, I think that means I’m done now, and then I end the workout. If I go past that point, then it’s too much. 

Dr. Justin Marchegiani: Yeah, exactly. So that that’s a really good place, you can also incorporate bands, what’s nice about bands is the loading is the highest at your concentric phase, right? Imagine I’m doing a dumbbell curl, right? At the highest point, the The band has the most force in it, right the most intensity or force. And then as I lower right, this is the East centric face. I’m Ilan gating my muscle, so in a bicep curl, I’m moving the bar down to the dumbbell downward, the load is actually decreasing as I’m lowering it. So you have a decrease in force on that essentra curve, where like, if a dumbbell or barbell was there, it’s the same the whole way, like, so the benefit of the decrease in load is most of your muscle, shredding, or depletion happens in the E centric. So what does that mean? That means you can focus on really light, really nice, slow lowering phases that those two things, it burns more muscle, right. And then number two, most injuries happen, because people are bouncing the weight, or in that lowering phase, they kind of have a jerky move where they kind of relaxed the weight, and they catch it at the bottom of that movement. And like what sofa benchpress, that’s on your chest or military press that’s on your shoulder. Or if it’s a bicep curl, it’s at the bottom right, and you’re kind of bouncing that way, or a deadlift that’s at the bottom right where you bounce. So when you do a nice lowering phase, you prevent that bounce from happening. And that’s where almost always all the injuries happen. So if you do a nice lowering a nice slow lowering phase, maybe a three to four second, he centric think he centric he long gait. So have a nice, slowly centric, you’re not going to hurt yourself as much. And then number two, you’re still burning a bit of a bit of muscle. And number three, if you’re still really sore excessively, one, you can switch to more bands, and the bands will give you that decreased load. As you as you kind of move, which is nice, it really helps the muscles give it a little more recovery, but still gives you that increased load at the top, so you have more concentric load, right? So when your muscles the shortest, right that benchpress at the top position, the loads the highest, and it’s going to be even more than a weight would be right. And then it drops off on the lowering. So it’s a little bit safer. And you’re not going to overly kill your muscles in that lowering II centric phase. 

Evan Brand: Yeah, that’s safer, too, if you don’t have a spotter, right? If you’re trying to do all this stuff at home, I mean, I’ve been guilty before of wearing myself out getting past a point of fatigue, where I’m like, Oh, I could really use a spotter right now. But I don’t have one. So the bands would be safer in that aspect too. 

Dr. Justin Marchegiani: Yeah, bands are safer and are of course, just using like a dumbbell is going to be helpful too. Because dumbbell obviously there’s no bar across there. So you’re not gonna expect to fixate yourself, your lower too much. And then you’re going to get a lot of fatigue on the lowering. And that’s what helps. But the bands do help for sure. And it gives you that really good ability to generate a lot of force. And also it’s safer. So I do like that as a good option. 

Evan Brand: Yeah, and someone’s listening and they’re gonna say, well, bands where the heck do I get them? What strength? Do I get them? They usually come in variety packs, don’t they? Like there’s going to be like a black one, a green one. And they’re going to be different like intensities, right? 

Dr. Justin Marchegiani: Yeah, I mean, I like the X3 bar for some of the some of the the bigger bodybuilding movements because the band’s really thick and it can generate hundreds and hundreds of pounds of force. So I like the x3 bar for that. So like for deadlift, that bar that that strap or that a cable is going to create a band. I’m sorry, that band will generate hundreds of pounds of force. Same thing on the bench, same thing on a tricep extension. And so it’s very helpful. So I do like that. 

Evan Brand: Cool. Any updates on your rower? 

Dr. Justin Marchegiani: Oh, yeah, it’s coming. I got the concept D rower. So I try to do a little bit more of the rolling for my aerobic stuff just because I like things that bring me into extension so much cardio is like your inflection, whether you’re on elliptical or riding a bike or whatever. I like kind of bringing more extension into my body so… easy! Sorry. That’s my dog. That’s my dog. We’re live here. 

Evan Brand: I love it. I love the rower. I mean, to me, it’s, it’s, I feel so good on it. And I never really thought about what you’re saying. But yeah, most exercises are you’re kind of like going into monkey mode, you’re not really pulling back and stretching. That is like one of the only things that and the seated row, like on an actual machine with weights. Those are probably two of the only things that really kind of pull you pull you out and stretch you out like that. 

Dr. Justin Marchegiani: Oh, totally. Oh, by the way, I have my my natural pesticide guy here, which is kind of cool. So he’s actually spraying essential oils around my perimeter. So he’s spraying cedar, some citronella, some orange peel some olive leaf, just to keep some of the bugs down. So and then we found a bee’s nest in the back on the ground. So we’re putting a little bit of boric acid in diatomaceous earth in there to kind of to knock that out. So we try to, you know, just a little education here, we’re trying to do some natural kind of insecticide solutions, because a lot of those toxins can be very harmful to kids and, and women and children, especially guys, too, because they’re very estrogenic. So we try to use natural solutions here. So you guys see that live in the flesh here. 

Evan Brand: Yep. And if you are exposed to all that crap, whether it’s from you spraying it or hiring somebody else to spray and you’re getting exposed to it, that’s going to affect mitochondria. And that’s going to affect energy. So when you get into this whole thing of chronic fatigue, adrenals exercise and tolerance, a lot of it has to do with toxicity, I will tell you 100% with confidence, when I’m doing binders, I’m stronger when I’m on detox support chlorella, whether it’s charcoal, Clay zeolites. I’m always stronger with some binders in my system. So for me, the toxins and for everyone really, the toxins are kryptonite. And that’s just a fact of the modern world. So wherever you can reduce those, reduce them, I mean, think about your kids, right? You go to a playground, my wife took my kids to a couple playgrounds over the summer, and the guy shows up with a huge tank of glyphosate on his back and just bombs the whole playground, because there were weeds growing up in the mulch and it goes up, well can’t go to that playground anymore. So it’s annoying that we have to be this observant, but it’s kind of what it takes in the modern world. I mean, unfortunately, in the 21st century, everywhere you look in turn, whether it’s the the air, or the water supply, or the ground, or the dirt or the soil you’re eating food out of there are chemicals that are disrupting your mitochondria, they’re disrupting cell membranes that are affecting your gut bacteria. And so I get annoyed with just the diet and exercise conversations that you see in the mainstream because they make it just like it’s that like, you’re not motivated enough. You just need to be strong pain is weakness, leaving the body push through, push through, it’s you literally from a biochemical, mechanical, mitochondrial perspective, neurotransmitter perspective, you can’t push through, you can’t so you know, you got poor Jane Doe, at the at the fitness class. And you know, she’s 50, or 100 pounds overweight, and she just thinks that she’s just fat and lazy. And that’s why that’s her problem. But it’s like, no, you’re toxic. Let me show you on paper. And I’m going to explain why your personal trainer doesn’t have a clue why you can’t tolerate the exercise and why you’re sore for a week. He just thinks you need to just quit being a sissy and drink another protein shake. No, that’s not the answer. So I love that we can intertwine the functional medicine piece into the exercise piece. Because the mainstream fitness community, it’s sad, it’s all this boot camp, you know, military CrossFit mentality. But when someone doesn’t perform like everyone else, those people get ostracized, and they don’t have a clue what’s underneath the hood. 

Dr. Justin Marchegiani: Yeah, I mean, everyone, you got to treat everyone like an individual. And everyone’s coming at this a little bit differently. So you want to meet people where they’re at exercise, you know, and a lot of these things is going to be a stressor, so you want to apply the appropriate amount of stress. So you give your body the chance to adapt, it’s never the the exercise, it’s the ability for your body to adapt, and you have to kind of meet your body where it is. So if you’re someone that’s obese, it may just be walking a couple thousand, maybe 1000 steps or just squeezing your muscles doing an eccentric movement, you know, that may be enough based on where you’re at. So you got to figure out where you’re at and try to go maybe 10%, above where you’re at, on a day in day out basis.

Evan Brand: Yeah, and I’m not trying to poopoo personal trainers, I used to do some personal training, I had some certifications in different movements, kettlebells and things and I helped a lot of people but so so you can tweak the exercises, meaning you can tone things down for those people. But there’s at a certain point, you at a certain point, a personal trainer has a limit to what they can do for you. Meaning if you literally have so much toxicity that’s affecting mitochondria, you literally can’t build up your your weight, you can’t go 10 minutes longer. You can’t, you know, do three more planes, you just can’t. So then that’s where you got to come in. And we look at the labs to try to figure out what’s under the hood with these people. Why can’t they Why are they such a poor recovery. So like, well measure lactic acid on organic acids testing. And we know that when you have bacterial overgrowth, for example, that it produces lactic acid certain species do. And so if this person is sore without even working out, they’re going to be really sore when they work out. So we’ll focus on the gut, we’ll get that the production of lactic acid down from the gut bugs, and then boom, now they can handle that lactic acid bucket is drained now they can handle the exercise and the production there. 

Dr. Justin Marchegiani: Oh, exactly. You know, I’ve taken personal training sessions as a personal trainer for a long time and I’ve been trained by people where I feel too sore for a couple days afterwards. And usually if you feel too sore, it’s you put too much intensity in it. The dose wasn’t dialed in for you because you’re Giving your body the chance to heal and recover because you get stronger on the rest time. And if you created so much damage for 234 days later, you’re really excessively so you did too much you’re creating scar tissue in the muscle. And that’s not good. So you really want to individualize this. And I, you know, I see patients from all different walks of life from chronic fatigue autoimmune patients that are bedridden to people that are professional athletes trying to perform at the highest level, and you want to meet the demand where that person is at because it’s all about getting their body to function just a little bit better every day, and everyone is at a different place on their journey. So I think the individualization is so important. 

Evan Brand: Do you want to get into some of the hacks at all like some of the things we do to kind of increase exercise performance? Because I’ve got several ideas at the top of my tongue here. 

Dr. Justin Marchegiani: Yeah, sure. I did a video on this last week where I talked about some of the ideas in regards to movement stuff like exercise stuffs, I think the easiest first thing for is really good lowering or good eccentric movements, I think are a great way to burn a whole bunch of muscle and, and allow you to use more weight and not get hurt. Because I mentioned earlier, it’s the lowering phase, the centric phase where people get hurt. And when you do a nice low, slow movement on the centric, you’re less likely to get hurt. And number two, you’re going to create more burning of that muscle, more depletion of that muscle. And as long as you don’t overdo it, it’s a good first step. 

Evan Brand: I was into bodybuilding in high school. So I was doing a lot of those pre workout drinks. And they were just so bad for you. I mean, it was all just hundreds and hundreds of milligrams of caffeine, artificial colors. I’m sure there were sucralose and aspartame and potentially other garbage in there. And it just wasn’t good. I tried to pick clean choices. But you know, at the time, there weren’t that many good clean products on the market. So now there are there are some professional companies that you and I use that have some pre trained type nutrients, things that have some creatine, some tyrosine, some acetyl, l carnitine, can be very helpful. A little bit of like green coffee bean extract for caffeine can be good. There’s actually a nutrient called peak ATP, it’s a company and they’ve make so much like literally just straight ATP, and you can actually take it in powder form so that for me really, really helps. And then I like all the nitric oxide stuff. So I’ll do like a teaspoon of beet powder. I’ll do before the sauna, but also do before exercise, the beet powder is awesome. And then I like a lot of the adaptogen. So rhodiola makes me feel really good. As a as an endurance support. We use it for athletes, as you mentioned. And Holy basil’s is good. B vitamins a course that’s always low hanging fruit, there’s some good really good forms of creatine that we use, those can be helpful. And I think that’s about it. Are there any other like pre train nutrients that you like or that you use? 

Dr. Justin Marchegiani: So you kind of hit a bunch of them. So off the bat, you know, creatine and branched chain amino acids are wonderful, and it gets great, a little bit of caffeine can be very helpful to kind of mobilize free fatty acids. So whether you’re doing like a cold brew, coffee in your smoothie with the amino acids can be great. I do my Mito synergy support because it’s got some extra carnitine, extra ribose, a little extra creatine in there, some HLA some B vitamins, just those low hanging fruits are wonderful before workout. But I’d say creatine, branched chain amino acids, maybe a little bit of caffeine, especially if it’s a morning or afternoon workout, don’t do that, if it’s a nighttime workout. That’s a good first step, I think, to really hit it out of the park. And then we talked about movement patterns, I like really focusing on the centric, I also like focusing on circuit. So doing two to three movements back to back to back can be very helpful, because you can get a lot of volume done meaning a lot of reps and sets in, you know, smaller amount of time. So that’s great, because you can have a 15 to 20 minute workout that may have may have taken you 30 or 45 minutes if you did it one exercise at a time. So it gives you the ability to to make it more practical, which is great. 

Evan Brand: Yeah, I think the next thing we should hit on is kind of the post recovery stuff. So what about the person who is getting into the exercise? Maybe they’re not tolerating it? Well, maybe their recovery time is a bit too long the wanting to shorten that I think the bcaas could be great before and or after. And then I’m a huge fan of like a Grass Fed Whey Protein Shake, but make a smoothie out of it. So there’s a couple grass fed ways that you and I use it are super good quality, and we’ll throw in like a scoop of coconut butter. If you can tolerate nuts, maybe a scoop of almond butter may be good. And then I’m a big fan of some of the Oregon meats too. Whether it’s actual Oregon meat or like some organ meat capsules, those can be really helpful for recovery and just making sure your body has the role nutrition it needs. And then good sleep. I mean, you can’t forget about good sleep. I mean, I see so many people who are moms that are trying to hit the gym or do whatever, five times a week, but they’re up too late. And they’re up too early. You know, they’re up at 430 in the morning to go hit the treadmill. It’s like ah, I’d prefer you sleep in until 630 or seven. Do that workout later and not miss your cortisol peak because the problem is if you’re up too early to exercise, you’re really missing that cortisol peak. It’s kind of like you took your iPhone off the charger when it was only at 50%. We’ve seen based on thousands of reviewing labs that the cortisol doesn’t really peak until around sunrise or so. And if you’re up at 430, the battery is not fully charged. So now that cortisol is going to just halfway peak, and then it’s going to crash much sooner, so you’re just not going to get the best bang for your buck, if you’re doing those super, super early workouts now isn’t better than nothing, probably. But I’m just giving you a couple details that we’ve, we’ve seen. 

Dr. Justin Marchegiani: Yeah, when your nervous system is a little bit more fragile. When you have more adrenal issues, doing a later workout in the day is probably not the best, because that’s going to get more of that sympathetic nervous system kind of stimulated. And it made the the more unhealthy or the more out of balance your adrenals are the harder it, it takes your adrenals to wind down and kind of downshift from that sympathetic adrenal stimulating workout. So there’s going to be some adrenal stimulation, of course, right, which isn’t bad thing. But the question is, Do you have enough time to adapt and come down from that workout before bed, and that’s where it may affect your ability to repair before bed. So that’s why doing a workout, let’s say before two o’clock is ideal, you know, and again, the healthier you are on, the more you can downshift, the better, right, I typically recommend try to give yourself at least two to three hours to come down. So if you want to be in bed by 11, you want that workout to be done by eight for sure. That way you have at least three hours to come down from it, and try to do it more in the morning because you have that natural cortisol peak. And if that cortisol peak is going while you’re stimulating cortisol, you’re just more in harmony with your natural rhythm of cortisol going up. And adrenal stimulation going up, it’s kind of like, hey, more light at night. And when when melatonin goes up, are they’re not going to work because cortisol is going down at night. And light goes up at night, which can stimulate cortisol. So you kind of have the inverse thing happening with lights. And with cortisol at night, it’s the same thing with exercise and cortisol. So you rather do it when you have more harmony going on. But I understand some people that may not be an option. And if that is just try to give yourself more time. And really try to make sure that it’s not throwing off your sleep rhythm. And if it is adjust the frequency, the intensity and the duration, so you can recover from it and not mess up your sleep.

Evan Brand: And this is tough to do a podcast on because there’s so many different people with different work schedules. And well, my, my kids are with me on these days. So I can’t work out in the morning on these days. And I take my kids to school on this day, you know, so obviously, what we’re saying these are generalities, I know you have to work it into your schedule. But yeah, if you could do like a morning workout, I think that’s smart. But not an early morning workout. I don’t think people should be setting an alarm to get up at 4am to go jump on the treadmill at 4:30am. I just don’t think that’s smart. But if you were up with the sun at seven, and you could do it, that would be good. 

Dr. Justin Marchegiani: Yeah, ideally, for sure. Now, if someone visits us their work schedule, and they can get to bed by between eight and nine o’clock, so they they’re still getting at least seven hours of sleep. Sure, that’s at least better than nothing. So you just got to make sure the sleep is is compensating for the time getting up early for sure. But I agree, you know, the more you’re in harmony with the sun, the more your body likes that. 

Evan Brand: Yeah, ashwagandha can be used in the evening, I remember I would do that if I had some late workouts that would kind of stimulate me. If I did like some ashwagandha at night, it would help help kind of calm it down you and I’ve talked about many times how it helps to regulate cortisol. So that’s what adaptogens do. If you’re too low, it kind of brings you back to balance if you’re too high and can bring you back to balance. So let’s say you did a eight o’clock workout tried to go to bed at 930 You’re still kind of ramped up maybe capsule or two, I like to use some liquid gel caps of ashwagandha tincture, and that really settles you down pretty quick. 

Dr. Justin Marchegiani: 100% agree. Yeah. 100%. Great. That makes a lot of sense. So I think we hit some of the exercise kind of options, right? We talked about amino acids and nutrients pre post during we talked about different styles of exercises. I would say one thing in there, if you don’t have a lot of time to BOD or some kind of an interval on the cardio cardio side, whether it’s like an elliptical or treadmill or or bike, we’re a bigger fan of the rowers because you’re getting more extension in your body and there’s tends to be less extension with cardios and we tend to be more inflection throughout the day right at a keyboard right typing, all that stuff brings our body more into flexion. So using more extensions stuff can be really helpful. So I like more extension movements like we already chatted about. And I like a rower for that and you can do a 32nd 20-20 or 32nd high intensity movement followed by a Tabata which may be a 10 second rest period all the way up to a peak eight which may be a 92nd rest period. And you can just adjust the rest period and the exercise period to kind of suit your body so anywhere between a 10 to 32nd. High Intensity full out, you know as fast as you can go followed by a 10 second to 92nd rest period. That’s very helpful for increasing your metabolism and putting on muscle too. 

Evan Brand: I tell you on that rower, what I’ll typically do is I’ll do 500 meter sets, you know so typically with like weightlifting in regards to building muscle people, you’re going to want to be looking for around three, maybe four sets of 10 to 15 Just depending on how you know what how you’re feeling what your goal is, but with the rower, I’ll do 500 meters as a set. And it’s give or take around two minutes to do that, man, I’ll tell you, you want a full body blood flow, that rower does it because you know your legs, you’re pushing to kind of slide yourself back, and then you’re pulling, and then hopefully, you’re, you’re fully pulling back, I think a lot of people stopped too soon. But if you’re pulling that bar all the way back to the chest, and then you go back in, and man, I feel great on it. So it’s-

Dr. Justin Marchegiani: Yeah, it’s using your hamstrings to kind of bring yourself back closer to the machine to so you’re getting a little bit of extension on the quads, a little bit of flexion on the hamstrings, and then you’re getting some bicep and some and some rhomboids and some upper back, which is really nice. So I agree, I think it’s really good movement pattern. 

Evan Brand: I put it on Max, I mean, you know, it’s, it’s kind of hard. Like if I was on a desert island, would it be the only piece of equipment No, I’d probably bring like a kettlebell maybe, or a dumbbell on the desert island. But it, rowers pretty dang close to the all in one solution, if you’re somebody who’s just looking to get your heart rate up, but also you could build some muscle, I put it on the max setting. So it is it’s the most resistance. And then if you pull on that thing really hard or really quick, you increase the resistance more. So yeah, I mean, you can get a pump, you can build some, some good back muscles and arms and deltoids using that and some traps. I mean, you’re gonna hit your traps a little bit on the road. So I’m a huge fan. 

Dr. Justin Marchegiani: Yeah, I like kettlebell swings as well. I mean, the only issue with the kettlebell swing is when you go into the East centric on the kettlebell swing, there is no low, slowly centric, it’s gonna be fast. So you’ve got to make sure you’re in a little bit better condition on the kettlebell. So you can go you know, have a really good explosive, ie sedgewick. And concentric because that eccentric when that kettlebell is coming down, you’re not you can’t lower that speed, it’s coming down at full speed, which is great, because you have to absorb it and use those hips to kind of soak in and grab that momentum, which is great. People that are beginners, they tend to use their back more and they can get hurt. So kettlebells I think there’s a really simple movement where you can kind of walk by it a couple times a day, and do you know some sets to failure on it, just make sure you know how to do it right. You have some good forum, find a trainer that can kind of walk you through the movement pattern, so you feel comfortable and confidence you don’t get hurt.

Evan Brand: Yeah, I was gonna say I probably in a kettlebell situation, I’d probably pay for a couple hours of training on it, because I definitely hurt my back. When I first started. I didn’t know what the heck I was doing. I just looked at some videos, I thought, Oh, yeah, this seems about right. Now, there’s some minor tweaks that can really affect how that load bearing hits your back. So for people, you know, that are not, you’re not an athlete, I would not go straight to a kettlebell. 

Dr. Justin Marchegiani: Correct. Yeah. 100%. And then I’d like a lot of body weight stuff. So I have like the push up bars I like just because I can get a really good deep push up most people, man, they do have push ups, right? They do have push ups. I like the bar. So I can just get really in deep, get a good full range of motion. And I keep my wrist kind of in a neutral format holding the bar versus like this, which I don’t I don’t think it’s the best thing. You know, it hurts the wrist. Yeah, it hurts. So you can kind of keep it nice and neutral. You can go nice and deep. And that can have a nice, good eccentric on there, which is wonderful. 

Evan Brand: Yeah, so you’re using the like, the handles, yeah, like here, we have each handle for the, for the push ups. Okay. 

Dr. Justin Marchegiani: Yeah, like that. And it goes really good. They have some that do a rotation thing, which is okay, too. I mean, you can hit the packs pretty good there too. But just to be able to go deep in there and be able to keep your wrist neutral, I think is wonderful. 

Evan Brand: I love pull ups. I mean, I tell you, I got extremely strong doing pull ups. But for people that are beginners pull ups, you might not even be able to do one and that’s okay, what you could even do is use like a little step stool, and just jump up there and just hold yourself up and the pull up position. That’s how I started out was just holding at the peak of the pull up. And then eventually I just let myself down slowly, and then pull up again. And then I was to the point where I could do three sets of 10 on pull up, I swear to you, man, that’s exhausting. 

Dr. Justin Marchegiani: If you go search online, like pull up assist, you can get bands, they kind of hook around and there’s like three or four bands. And then you can add a band for the for the intensity on the assist. And so what I’ll do is I’ll go in, I’ll do as many pull ups, which is you know, palms facing you or chin ups, palms facing away, right chin ups, more lat pull up more biceps, and I’ll do as many as I can the failure. And then I’ll go in and then put the bands on right after my knee and then I’ll go do it again to failure. So that’s a pretty good kind of a nice drop set where you go as much as you can bodyweight. And then you jump in with a little bit of help. And that can be super, super helpful. Just just people don’t people aren’t used to controlling their body weight like that. And it’s really functional to be able to move your body in a way where you are, you know, in control of your body from a weight standpoint, like you’re able to, to move and functionally manage your body in space and time without any extra stuff on there think it’s really functional. 

Evan Brand: Yeah, I mean, that’s the thing that people listening if you’re like, I just don’t like exercise. I hate exercise. I’m not into it. I’d rather go hiking Look, I hear you. But the benefits are not just in and out of the workout. The benefits apply to picking up your kids the benefits apply to playing with your grandchildren, the benefits apply to doing yard work. Bringing in heavy bags of groceries and you don’t want to make multiple trips, you can grab all the groceries in one trip. And so it’s just awesome to be able to to build muscle. If you’re climbing ladders, if you’re in construction, I mean just that, as you’re mentioning, it’s functional, this stuff applies. This is not just for vanity, this stuff really applies to everything if I weren’t in decent shape. my four year old, she’s heavy. When I go to pick up that kid, it’s awesome to be able to have the muscles to just make her a dumbbell. I just pick her up like a dumbbell. You know, it’s it’s fun. If I were in bad shape, you know, I maybe hurt my back, just bending over to pick her up. So this stuff is the stuff is great. And especially as you get into 60s and 70s. I mean, we know that with bone density being a big issue, we have so many clients with osteopenia, osteoporosis issues, yeah, we can give you supplements for that. But the best free thing you can do is to do weight bearing exercises to really preserve your bone health as you age. 

Dr. Justin Marchegiani: Yeah, I always look for movements that translate to me living my life better. So anytime you can move your body, you know, in a way where you’re managing the weight of your body, that translates to you managing the weight of your body when you’re, for instance, roughhousing with your kids in the pool or something like or like I’m throwing my kids up in the air, like one handed like, you know, one handed, like, Where did that get shot, put kind of thing. It’s like, I need really good shoulder stabilization and really good lat strength, and core stabilization to be able to make that happen. So it’s nice to do movements that can translate to you being able to play with your family or friends or do your sport or do your hobby. So that’s really important to think of like, what movements do I want to do in my workout that will translate to me living my life better. So always kind of think a little bit deeper. Most people just think like, hey, what movements to make myself look better naked. That’s cool. I have to run with that. But now we got to think a little bit deeper now.

Evan Brand: Yeah, I think if someone’s listening, and they’re like, well, I’m pretty much disabled. In terms of my physical performance. I’m just super weak. I would try a plank. I mean, a plank is a game changer, where you’re just getting on, you’re kind of resting on your elbows and forearms. And you’re just holding yourself even if you can only do a plank for 10 seconds. My Lord, I can’t tell you core strength, you hear about this term core strength, it really does apply, I just got back into doing some planks pretty regularly. And even just sitting in a chair, I sit better in a chair now having more core strength. Yeah, I think it’s great. You just don’t fold in, you know, if you have no core strength, you just like you said you fold in, you get into the turtle the turtle position on the computer, and it’s just not good. The next forward and get the core strength, you’re more just confident with the way you sit. 

Dr. Justin Marchegiani: Yeah, also just just get a stand desk that allows you to stand throughout the day, like I’m standing right now, I’m using core strength just being able to stand right, that’s super helpful. Or let’s say you sit a lot and you don’t have the money to invest in a state that’s well, let’s just try to invest maybe in a Swiss ball, a physio ball or Swiss ball that will allow you to sit but now you have to engage your core a little bit so you don’t fall right. That’s a good first step. And then you can move to a stand desk where you’re upright, and you can kind of move and like look at my body posture throughout the day, I’m pretty upright, I have to pull my backpack, pull my arms back. So I’m in a much better position to be more athletic. And to get my my cold body activated versus in this like sitting down position, which is totally unhealthy. 

Evan Brand: Yeah, I kind of bend my legs a little too, I’m standing down too. And so you know, I mean, my hamstrings are pretty flexed right now just standing here talking. So that’s pretty cool. 

Dr. Justin Marchegiani: And you can buy an anti fatigue mat, which is fine, you can do that too. I’m kind of moving a lot. When I’m standing I’m on a treadmill, so it’s not necessary. For me I like to move a little bit. So that’s helpful. And then it kind of have a slight bend my knees, take the stress off my my lower back so that I think those are really good first steps. And I also have some QB pedals when I sit down, I can also pedal a little bit. So it’s good to have a lot of unstructured exercise that you’re doing throughout the day where you’re getting some movement and it’s not yourself being in the gym doing this workout, you’re kind of adding some movement here adding some movement there. And it’s it’s nice to be able to get that 10,000 steps or so a day, just to make sure your body’s moving. You’re not overly sedentary. Because if you’re getting 2000 steps a day, but you’re in the gym for 30 minutes. Is that really healthy. I mean, you definitely want some steps, you definitely want some movements as well. 

Evan Brand: Yeah. Now, if you just want to opt out of the whole thing and just become a farmer, then that’s an option too. But if you’re like a farmer that’s just sitting on a tractor, you’re not getting much exercise, but think of our ancestors, right? I mean, they didn’t have to think about exercise the way we do. It just happened. It was a byproduct of surviving. And now it’s optional. So it’s funny, we have to have this conversation versus even just a couple hundred years ago, my grandparents, grandparents, you know, they’re out in the field. They didn’t even have mechanical equipment. They had horses and plows. Oh, my God, I bet you those people were getting 10,000 steps at least per day and sunshine and fresh air. They didn’t have to think about it. 

Dr. Justin Marchegiani: Yeah, I 100% agree, you know, but we got to adapt and we got to create artificial stress through our workouts to keep our muscles and our body strong. So I think that’s great. Is there anything else you want to add today and I think we hit all the really good stuff. Maybe people that are really having a hard time adapting and figuring out the next step they can they can reach out to us here below to reach out to for you worldwide. for Dr. J myself. And also we may have to dive in deeper and test your adrenals test your hormones, get your gut, maybe give you more nutritional support, hormone support adaptogenic stress support to get you all to the next level. And that’s going to be a thing for most people, depending on how good or bad they you know where they’re at, and how much they want to improve. That could be something that we consider to be an accelerator to get you to the next level. So that’s always an option for y’all as well. Anything else you want to add, Evan? 

Evan Brand: No, that’s it. You mentioned the links we’re happy to help people. We love this stuff. I mean, it’s, it’s such a great thing to be able to take a woman who’s exhausted trying to keep up with the kids, we get her mitochondria working better, we get her gut working better, she’s able to exercise and perform and then boom, it in turn makes her a better parent. She’s able to keep up with the kids now or the grandparents are able to run around with the grandkids. So you know, remember what this is all for. At the end of the day, it’s for you to be able to function through you know, on planet earth through your body in a better way without being injured. So it’s awesome. 

Dr. Justin Marchegiani: I love it Evan, excellent point today. It was a great podcast. Hope you guys enjoyed. Thumbs up really appreciate it. Comment down below. We really appreciate it. There’ll be a link below if you guys enjoyed it. Shoot us over a review. We’d love to hear your thoughts and feedback. Evan, you have an awesome day, man. You take care. 

Evan Brand: Take care now. Thanks bye bye.


Audio Podcast:

Low Potassium, Adrenal Dysfunction Your Immune System | Podcast #288

For today’s live podcast, Dr. Justin and Evan Brand talk about Potassium and our immune system. Among other minerals, Potassium also acts great especially in our body, energy, mood, blood pressure and a lot more. Let’s dive into why potassium is important for our immune health. Check this podcast’s transcript. Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

2:18 All about Potassium

9:11 Oral Supplementation

18:32 Glucose

20:57 Foods with Potassium

27:11 Vertigo and Dizziness

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Dr. Justin Marchegiani: Hey there, it’s Dr. Justin Marchegiani, we are doing a live podcast here on potassium and your immune system. Potassium is an essential mineral. And it has major effects on the sodium potassium pump, how your cells function, energy, mood, blood pressure has a huge effect on the adrenal glands. I’m excited to dive in here with Evan Brand, Evan, how you doing today man? doing really well.

Evan Brand: So we were looking at some papers on this thing. And turns out a national survey found that approximately 98% not nine not 8, 98% of Americans are not meeting the recommended potassium intake. A Western diet is to blame as it favors processed foods over a whole plant foods such as fruits, vegetables, beans, and nuts. Everybody knows that the American diet is crap. And it’s not just the American diet. Right? This is the standard European diet. This is the standard Australian diet you know, kind of most developed first world Countries they’re doing too much. Too much potassium devoid food. And let’s tie that directly into what we were also looking at which is this paper this based on the names of these doctors. And yeah, actually it shows it right here. When Zhu Zi Yong ha, Province, China, so yeah, so this is a Chinese hospital and Chinese medical universities to study that came out of hyperkalemia and clinical implications and patients with Coronavirus and long story short people that had potassium deficiencies. They had severe hypokalemia, which is the technical term for potassium deficiency. And it said here that the patients responded well to potassium supplements. And they were inclined to recovery so they don’t say directly Hey, low potassium means you’re going to get the virus or low potassium means you’re going to be really sick, but they just talk about how, because of this whole Ace to enzyme thing that you and I’ve covered many times, and the whole relationship to the virus that one of the side effects of the issue can be low potassium, and if you’re already low potassium to begin with, then you can end up in potentially fatal shape, which is not good.

Dr. Justin Marchegiani: 100% in potassium is very important because our sodium potassium pump is requires potassium. So what happens is, you have your cell, and then you have sodium inside the cell and you have potassium outside of the cell. And they do a little switcheroo ski, right. This is called the sodium potassium pump. The enzyme that’s involved in making that happen is ATP. And then you know, it’s an enzyme because of the word Ace next to an ATP ace. So ATP is important because ATP is generated from your mitochondria, right? We have glycolysis outside of the cell in the cytoplasm, and then we have our Krebs cycle, right? And we have our electron transport chain within the cell we generate 36 to 38 or so ATP from that that eight TP part of that ATP runs their sodium potassium pumps that ATP takes that sodium that’s in the cell and that potassium outside of the cell, they do a dance, they switch. So it’s three coming out to come in, right? Boom, just like that. And the cell needs that healthy fluid fluidity to work and to communicate. And if we don’t have that healthy fluidity, we’re going to have side effects. So one of the big side effects is we’re going to have muscle or nerve issues because potassium and sodium are very important for the muscles slash nerves to work, right nerves help control muscles, so very, very important there. You’re also going to see it with you’re going to see it with potential mood issues as well because sodium and potassium play an intricate role with the adrenal glands and part of the reason why people’s potassium gets low outside of a poor diet is going to be because of adrenal function. Now, typically with adrenals. Your dosterone starts to go low, which is a mineral corticoid that exists in The cortex to the adrenals. And what happens is as your dosterone starts going low, your sodium can start to drop. And as your sodium drops, sometimes your potassium can look like it’s not too bad, it can look actually a little bit high, but you could still actually have potassium issues because of the fact that you are your adrenals are weak and you’re pulling out a lot of your minerals. So muscle and cramps are going to be a big deal, weakness and fatigue because your nerves need that. Also, if you don’t have good sodium potassium pump issues, you probably have energy issues because the mitochondria healthy mitochondrial function for ATP is needed for that sodium potassium pump to work so potassium works better when there’s the ATP so that whole sodium potassium pump works. We talked about cramping as well because of the the muscles needing the wiring the fluid wiring sodium and potassium and minerals. So cramping is gonna be a big deal. We’re also going to have potentially digestive issues right? your bowel movements and your motility starts to Coming slower when your potassium drops, so we need healthy levels of potassium. So we have good bowel movements. Also heart palpitations, we need potassium and magnesium. So our heart could pump right our hearts a muscle as well. So if your heart skipping beats or beating harder or faster, that’s a sign of palpitations, which could be from that. And also just achy muscles, muscle breakdown, feeling tired and stiff, right? the breakdown of muscle was known as rhabdo. My license or my analysis, right? And that breakdown is going to be very much helped with good potassium levels, right, you’re gonna have less muscle breakdown, with potassium levels being adequate, of course, tingling and numbness issues are going to be a big one difficulty, you know, using your lung muscles mood stuff because of the adrenals as well. I’ll pause and give you a chance to comment.

Evan Brand: I’m glad you mentioned magnesium too, because, uh huh. You and I were kind of looking with a microscope today, right? We’re kind of spot picking right? One thing to talk about, but all these people that are deficient in potassium, I’m sure they’re going to be deficient in magnesium as well. I mean, we know how hard it is to get it from the food, even if it’s organic, because the soil is so depleted. So it’s a really common problem. And then on that whole mood changes, I just wanted to talk about that real quick. There was one study, and this wasn’t a necessarily a causation, but just a correlation study that we were looking at here. 20% of patients with mental disorders that came into this psychiatric ward 20% of them had potassium deficiency. So it’s not saying directly, the potassium deficiency caused the mood issue, there could very well be other things going on you and I’ve covered hundreds of times about gut infections, which could lead to mineral and electrolyte imbalances you hit on the adrenals. So, of course, as we know, when we hear something like that, we say, Okay, well, if you just give these people potassium, are they not going to have mood issues anymore? And the answer is, they could still have mood issues, even if they supplement Potassium, but it’s interesting and it’s something that often gets skipped. This is really low hanging fruit. Somebody could go to something very nuanced as this particular herb for this retrovirus or this bug, but the person’s just simply dehydrated and they’re not getting enough electrolytes, it could be something very, very simple like that.

Dr. Justin Marchegiani: 100% and low potassium is so common, just like low magnesium is common. I think you said what 98% are going to have some kind of an issue.

Evan Brand: Yeah, and I think this idea that yeah, I think this study I was referencing was probably just a survey where they looked at diet and figured out whether people were even getting the the the recommended daily amount, and 98% of people are not getting the recommended daily amount are already on the recommended daily intake. So I guarantee magnesium is in the same boat, probably 90 plus percent.

Dr. Justin Marchegiani: Yeah, 100%. I agree. And then also there are medications that are going to affect potassium, right. We know a lot of the blood pressure medications as well as things that like water pills or diuretics. So if you’re on a BP medication, right, there’s a good chance some of that’s going to be actually driving further potassium deficiency. So low potassium levels are super common because of that. Also, we’re going to have problems with potassium if we consume too much alcohol, right, alcohols gonna cause us to pee a lot more potassium out because things like diuretics are going to cause you to lose more minerals, right? diuretics basically activate a hormone that causes you to kind of continue to pee. And the more you pee with a diuretic in your system, whether it’s, you know, excess coffee, or even access alcohol, you’re going to pee out a lot of those minerals. So that’s kind of like vitally important, right?

Evan Brand: And even Yeah, and even tea, I mean, even tea could be to blame. I think herbal teas can be great, but there is somewhat of a diuretic effect of certainties as well. So if you’re just like sipping on tea all day and not drinking enough just straight water or our preference water with a pinch of salt or water with some electrolytes, actually to it, you know, this can happen easily. And this is not just a problem in athletes, people hear the word electrolyte and they think you only need that if you’re in the NFL No, you need electrolytes just to function.

Dr. Justin Marchegiani: Exactly, the problem with a lot of people with their potassium is, it’s hard to get too much if you’re taking it orally, right? Obviously, you go back to like the lethal injection people are actually you know, in the lethal injection in the prison system, people are actually being killed by potassium IV right or injection. Now, it’s hard to get too much potassium orally because some of the vomiting and from some of the vomiting and diarrhea side effects and the nausea side effects that you get from have actually having too low potassium. Well guess what, you actually have similar side effects when you go too high. So usually you get so nauseous, and you’ll either throw off or you’ll get diarrhea. So it’s very difficult. The only way to really do it orally is going to be with an oral supplementation. And you’d have to do a lot of it and all those symptoms would come into place. It’d be really high. The only way you You can get your potassium levels to the point where you’re going to be too high is going to be on an IV. And what they do actually on an IV to reverse potassium overdose is they do a bicarbonate infusion, bicarbonate actually neutralizes that high level of potassium. But some of the major causes are going to be diarrhea, right? So if you have a parasite infection or a gut infection that’s causing chronic loose stools, guess what? You may be having low potassium because of your gut. I have some patients that need five or six or seven grams a day of potassium supplementation, whether it’s because of a stress or a malabsorption issue, but all of their low potassium symptoms go away when they hit that level, meaning like the cramping, the twitching, the heart, the mood stuff all go away when they hit that higher level. So I mean, the goal is let’s fix the stress. So you’re not dumping the minerals as much let’s fix the gut. So we’re absorbing but, you know, I don’t typically don’t recommend doing more than one to two grams of potassium supplementally and we’ll do a good high quality keylight whether it’s a discoloration A or A potassium bicarb or we’ll do a potassium citrate like a new salt, which is a cheap source, and then we’ll try to plug in the recipe of the diet but if we have to go above, you know, we’ll do it incrementally and we’ll start looking for those low potassium symptoms to go away but alcohol is gonna be a big one, chronic kidney issues. uncontrolled Type One Diabetes will do it diarrhea, like we mentioned. So gut issues, diuretics is a big one. So if you’re on a diuretic on a blood pressure meds side, that could be a problem. sweating a lot. So if you’re sweating a lot, yeah, you’re gonna need a lot more minerals. Again how Gatorade was figured out I think it was the 1968 late 60s I want to say was the Orange Bowl one of these big bowl games the Florida Gators were actually playing halftime I think one of the exercise physiologist or PT people, trainers said hey, let’s get these electrolytes in and they had a kick butt second half and they just they killed it and won the game. And part of it was the electrolytes they put it and now we have all these things. Gatorade substitutes, but the real they were called Gator lights, right? Gator lights, not Gatorade. They tasted like absolute crap. So what you have now are a whole bunch of minerals with a whole bunch of sugar and dyes. Back then they just had the minerals and it tasted awful. But from a performance standpoint, they did really well because the other team didn’t have it. So they their muscles were functioning better. So sweating, not having enough full later B vitamins, having high amounts of aldosterone, whether it’s a tumor, or just our adrenals being overstimulated. Some antibiotics can actually have problems as well. And then vomiting vomiting too much can create low potassium too. And then obviously, just that junk food diet, we’ll talk about what it takes to have enough potassium in a minute.

Evan Brand: Yeah, and one thing too, that people miss out on a lot of these new companies, they’re doing a good job because they’re getting away from the corn syrup and the fake sugar and all that stuff, but you still do need based on some of the stuff we’ve looked at. I believe you need a little bit of glucose to help get potassium And your other minerals and electrolytes into the cell. So you’ll see if you look at they call it o RS oral rehydrating solution. This is like the military grade electrolytes. There has to be a little bit of sugar there has to be a little bit of a blood sugar spike, I believe it somehow opens the channel to let the electrolytes in. I’m not sure the exact you know, molecular level stuff that’s going on. But I’ve read into formulas that are just stevia or just monk fruit, some of these natural sweeteners that if they don’t affect blood sugar, you don’t actually get the benefit. So when you look at legit like military grade, electrolytes, they have a little bit of glucose spike associated with it.

Dr. Justin Marchegiani: Yeah, and the glucose is better, right? The problem is a lot of these places they have fructose, the fructose doesn’t target the muscles the same way as glucose does. So if you’re looking for an electrolyte formula, you you really want you can get the electrolytes by itself but then if you want if you’re doing a lot of sweating or a lot of glycogen depleting activity, whether it’s football or some kind of a sport that requires a lot of sprinting or running, then you’d want a formula that’s going to have more glucose in it for the sugar source, not fructose. fructose is a problem because it hits the liver more than the muscles. Glucose hits the muscles more than the liver. And like you mentioned, that helps open up that cell with the insulin and helps deplete the glycogen levels and helps that sodium potassium pump work better if you’re using a lot of glucose or if you’re sweating a lot, but if you’re not, and you’re just the average everyday person, probably getting the minerals in without the extra glucose is probably okay.

Evan Brand: Yeah, we talked about mold and detox and sauna and all of that, but I’m really shocked at how many people are doing sauna 234 or five times a week and they’re just drinking water. I’m like, Are you nuts? You gotta be doing electrolytes that is a critical component of detox in my opinion, is you have to make sure you’re replenishing and rehydrating because you’re losing a lot of minerals. You’re not just magically sweating out heavy metals and mold toxin, you’re sweating out minerals and electrolytes. You have to replenish those and you You were drinking a green juice earlier, I think you said your green juice had like 1200 milligrams per bottle or something crazy. 

Dr. Justin Marchegiani: Yeah, this is a great brand right here. It’s called evolution. They sell them in Austin and Selma, even in target now, which is kind of cool. Like, I like the fact that a lot of these healthier things are coming into kind of more mainstream box stores. But organic greens, I’ll typically drink the celery juice, but I’ve been doing the essential greens, they have the celery is the first ingredient so it’s still great. I love celery because of the minerals in there the electrolytes and then potassium is really high in celery, but it’s got cucumber, spinach, romaine kale, lime and parsley. And then they have a green devotion instead of lime. It’s got lemon, so they go back and forth, but there’s no actual fruit outside of the lemon or lime which is pretty low sugar. And this has got just alone It’s got I’m almost about 1200 milligrams of potassium. So I got about 25 to 30% all my potassium right here. So that’s pretty cool. So I just kill that after I have my really nice good breakfast with collagen and then I’m already a you know, a quarter of the Through my potassium needs for the day, which is great.

Evan Brand: Don’t you feel more like your thirst is quenched to like when I drink regular water compared to something like that. It’s just not as quenching to me as the good stuff, the green juices, they’re more thirst quenching. I’ll do like a little bit of electrolyte through a pinch in, like with some beet powder and stuff like that. And I feel great if I’m just doing filtered water and I’m not using aro I’m using like a carbon system even then though I water just doesn’t cut it for me. I like a little extra bang.

Dr. Justin Marchegiani: Well, I think a lot of people what they’re really craving is they’re craving some water, but they’re also craving minerals, right? And so because they’re craving minerals, if there’s no minerals in there, yeah, you’re going to feel like you’re missing out on something, right? So that’s definitely a big part of what’s happening is your body’s craving the minerals, and if they’re not there, that’s a problem. Also, I’m pretty sure Cushing’s is going to be another potassium issue, right? Cushing’s and potassium is going to be a big problem as well. So now what does that mean? So the kidneys excrete large amounts of potassium when you make a lot of cortisol. So what does that mean? So If you have Cushing’s that’s kind of more tumor induced where the cortisol is so high probably because of some kind of a tumor. But what if you’re in between? Right? What if your your adrenals are just overstimulated, you’re not on the adrenal, you’re not on the Cushing’s disease side but you’re just making a lot of cortisol because of chronic stress. So it’s possible your chronic adrenal stress could be causing you to dump a whole bunch of potassium out. So that’s where when you’re getting stress, under stress, physical chemical emotional, maybe that gluten is causing the stress, right? You’re gonna probably need more potassium, more minerals. potassium and magnesium are the most common ones. It’s so hard to get them most people get enough sodium and chloride because of just it’s in their natural junk food. I don’t get they don’t get the good quality from like a good high quality sea salt or Redmond Real Salt, but they’re getting some it’s really the magnesium and potassium I’m seeing as the big big missing pieces and today we’re really focusing on potassium.

Evan Brand: Yeah, makes sense. I mean, think about what happens when you’re dealing with somebody that’s really stressed right? They may have issues with constipation, they may have issues with Sleep, they may have issues with their blood pressure, they may have issues with anxiety as you hit on earlier, potentially Heart, heart pumps. So all of that, to me sounds like stress induced mineral depletion, which then causes other symptoms and you’re stressed about your blood pressure being elevated. So then that cortisol dump and adrenaline dumps more minerals, and then it become more mineral deficient. So you see how this thing can get out of control. And it sounds really cliche and corny to say, well, stress did it but it really does. And it’s not just the emotional, it’s the gut stress. It’s all of it that we always hit on.

Dr. Justin Marchegiani: 100%. Also people are talking about in the messaging. Well, what about if I’m in ketosis and I don’t have glucose to open the cell? Well, I mean, we’re just talking about with x with extra exercise, right extra exercise, extra sweating. If you’re doing a lot of glycogen depleting kind of movement or exercise, you’re probably going to want to do some type of a glucose kind of refeed the night before the movement. And a lot of athletes who do keto still have a punctuated kind of glide And reefy the night before just other tapping their muscles out, because your muscles can hold anywhere between 250 to three to 400 milligrams or grams of glucose or glycogen, right? glucose in the muscles is glycogen, it’s stored, right? That’s the storage form of glucose in the muscles. So a lot of people, they’ll be in ketosis most of the time, they’ll do a refeed the night before, that way they have access to that glucose The next day, and again, depending on how depleting or how long you’re exercising, you probably want a nice little bit of a glucose, electrolyte drink. And again, that’s not most of the time, that’s going to be just more timed up according to exercise and kind of what your metabolic needs are. But for most people, you know, a good natural Gatorade source, guess what coconut water, got a little bit of glucose, a little bit of sugar in there, and it has a lot of potassium, so that can kind of be mother’s nature’s natural kind of Gatorade. It just depends on what you’re doing. If your kids playing football and sweating a ton, they may need a little bit more than that. You’re going to have to just feel it out. See what works. Test it on your own when your practice To sing and playing and see how you feel with that you may not need pure coconut water, maybe just diluted half and a half with a really good clean mineral water. And then you have a little bit of glucose, a little bit of extra potassium plus the other minerals working for you.

Evan Brand: Yep, you want to hit a little bit of the diet piece. Yes, you and I were kind of looking at some of this before you pointed out. Interestingly, and we’ve probably talked about this in previous but if you look at 100 grams of food as a measurement, the potassium per 100 gram of avocado is higher significantly than bananas. If you look at a full avocado, versus a full cup of banana, which maybe is a full banana, you’ve got almost double in the avocado. So you know as a kid, I remember thinking potassium banana, and that’s just kind of this thing you grow up with. But in reality, there’s things that are much much higher like beet greens takes the cake with number one here. 1300 milligram per cup of potassium that is insanity. 

Dr. Justin Marchegiani:  Exactly. So most people don’t get it. So if you’re sitting Get in there. And you’re on keto, right? Well, what are the biggest easiest things you can do? Well, beet greens is number one. Okay? What’s number two salmon, high quality fish that’s per hundred grams. So what’s 100 grams? 100 grams is about 3.3 ounces ish. Let me just double check that hundred grams and ounces. I’m pretty sure that’s what it

Evan Brand:  sounds about, right? Because it says here, potassium per six ounce filet of salmon.

Dr. Justin Marchegiani: So 3.5. So what does that mean? So Alright, so if you’re keto, right, and you want to really be on top of this, or you’re keeping your carbs down, what does that mean? That means Okay, if I eat seven ounces of meat, seven ounces of fish, I’m at 1300 milligrams of potassium, boom, you’re right there. And then you throw in some beet greens with it right? That’s three ounces worth right hundred grams. You’re at another one gram almost. And then guess what? You cut up an avocado with that. Right big avocados. Another 500 I’m sorry, another per avocado. You’re about one gram per full avocado you’re set. Right?

Evan Brand: I want to look up cassava because I love cassava. And what if you like did some guacamole with like cassava chips? I wonder if we’re getting any?

Dr. Justin Marchegiani:  Oh yeah, so we could do like Yuka in potassium because Yuka in protect you guys same thing as cassava. Yeah. So one cup of cassava is 558 milligrams, boom. 

Evan Brand:  So because our chips and I mean now, some would argue, well, you know, the, the baking process and whatever of the chips, okay, whatever, but it’s still better than zero.

Dr. Justin Marchegiani:  Yeah, but a lot of times if you don’t bake it or cook it, you’re not going to be able to get the nutrients anyway. Like, if you look at broccoli, raw versus broccoli steamed, you’re going to see the nutritional value in the content goes up once you cook it, because then the fiber is broken down so you can actually access some of those nutrients.

Evan Brand:  Yep.

Dr. Justin Marchegiani:  So cooking a lot of times can make certain nutrients more bioavailable, too. It’s not Oh, cooking bad all the time. 

Evan Brand:  No, I’m just thinking. I’m just thinking of the one devil’s advocate out there saying oh well you’re eating. you’re advocating Eating, you know, chips fried and avocado oil. It’s like Yeah, I am. I think it’d be great. 

Dr. Justin Marchegiani:  I think it’s okay. I think it’s fine. I mean, don’t make it a staple. But I mean, I think it’s if you’re gonna have something like that it’s all about not going to the place in your head about like, Hey, what do you have to cut out versus Hey, what can I substitute? When you have a substitution mindset versus the cutting out mindset? One, you feel a lot more free and you feel like you’re not missing out on stuff because there’s always a good healthy stuff the tuition option that works. So let’s let’s kind of just create a simple day like what does a day of potassium look like? So off the bat, you know, on the vegetable side, one cup of you know, your typical vegetable greens will be anywhere between 500 milligrams to about 800 milligrams depending on the vegetables, right? Like one avocados gonna be about a gram, right? One cup of Swiss chard is gonna be about a gram. So you’re really at the top with those. One cup of spinach is about 840 milligrams, and then you have on the lower side, which would be like broccoli and brussel sprouts are closest 500 milligrams. So just to kind of give you a sample day here, let’s say we start out with a full avocado, boom, you got one gram of potassium so that now you’re like you’re like really on the way there. If you do a serving of fish like a good six ounce serving of fish, now what? Well now another gram is added, right? No problem. All right, and then now you’re at about now you’re at about two grams. And then if you throw in a green juice like this, you’re over three. And then if you have a serving of squash, or even white potato, or sweet potato, well now you’re at another 500 to 800 milligrams. Okay, now you’re at 35 to 3800 milligrams. And then you just need about four more servings of vegetables. And most people when they have veggies, they’re probably going to have two servings at a time, right? They’ll probably have close to a gram anyway. So you need about, I would say about four to six servings of a good quality green vegetable, you’re probably going to need one full avocado, and then one full serving of a good quality fish. And then you’ll get right about there and then you can always add in an extra avocado, you could always add in a little bit more fish, you could always add in a little bit more beet greens or green vegetables to get you the rest of the way there which is about 4500 to 4700. And then if you’re doing a lot more sweating, you could always throw in some coconut water. So I would say about six servings of green vegetables one full avocado, a good serving of fish and then you can always plug and play coconut water or banana according to what your metabolic needs are. What do you think?

Evan Brand: Yeah, and yeah, very good. And you didn’t mention any nuts which is another easy low hanging fruit so if you can get away with doing like pumpkin seeds, you can get a ton there if you do almonds or almond butter or you put a scoop of almond butter in a smoothie, you can get some there pistachios are super high and then I was looking on this other foods like-

Dr. Justin Marchegiani:  potatoes potatoes are huge so it means depending white potatoes if you’re trying to keep low carb or autoimmune find Nick’s that go to a squash or a potato but potatoes are very, very high in potassium. He will forget that.

Evan Brand:  Yep, yep. I was looking on this nutrient density chart. Whey Protein is number four 100 grams away, you’re getting over two grams 2200 milligram potassium 400 grams away. So if you can tolerate a good high quality Grass Fed Whey protein, that’d be easy. Think about if you made a smoothie with some greens, some whey protein in there, he threw some pumpkin seeds and a scoop on the butter, man, you’re set.

Dr. Justin Marchegiani:  How many milligrams in the way?

Evan Brand: 2200 for 100 grams of, you know substance 2200 potassium.

Dr. Justin Marchegiani: okay, I put 400 grams in the whey protein. Okay, so your typical servings probably like 25. So how many again, per 120 200? Okay, so if you’re doing maybe 25 or 30 grams of protein, which is what most people do in a scoop, I mean, you’re probably about what 500 milligrams.

Evan Brand: I’m going to look up I’m going to see what the serving size is because you and I use a couple professional grass fed powders. Let me see what the what it looks like. Yeah, so so one scoop Typically is 30 grams. So exactly, exactly, yeah, so you could almost call it you could almost call it one third then so you know 2200 divided by 600

Dr. Justin Marchegiani: ish 656 50 ish. Okay, that’s cool. Someone else also asked about the vertigo and dizziness Yeah, low potassium can cause that vertigo and dizziness kind of feeling. So we kind of gave the general recommendation of 45 to 4700 milligrams of what you need per day on the potassium side. Most people aren’t hitting it, you’re getting six to eight servings of green vegetables, a high quality serving a good fish and some potassium and maybe I’m sorry, potassium from a full avocado or a green drink or some extra say starch, squash or sweet potato or white potato, you’re gonna be there at about 45 to 4700 milligrams. Most people may need more if they’re sweating, or if they’re under a lot of adrenal stress. So you may want to think about supplementing, if you’re still doing a great job on your food and you’re not there. You may want to fill in the gap, or you may want to just try it out. Add in a couple more of these nutrient dense foods that Evan and I just hit, and see if that fixes the issue. So, a lot of times people have these low potassium symptoms and they see it go away the BR and all I see is you’re going to see a lot of heart stuff, and a lot of muscle cramping stuff, those are going to be big things. So if you see the heart start to get better or the cramping get better. That’s an easy sign that you’re on the right track.

Evan Brand: What do you think, Kevin? Well, I think this is fun, and it’s something that can’t be ignored. So please address this, work on this, tweak it and see how you feel, I definitely feel better. I feel in a better mood. I feel more energetic when I’m staying regular with getting enough electrolytes as a whole. So I think he could be a game changer. And we can run some of these analyses on your body. You and I kind of talked before we hit record about how the blood really doesn’t change much. So looking at serum potassium may not be the best. So there are some other panels that we can look at, but as a whole, when we’re looking at organic acids testing and stool testing and we’re looking at gut infections a lot of times We can infer just based on observation symptoms, and what else is going on that you probably got a new issue. So the good news is, you can fix this, it’s relatively cheap to free to fix it outside of just tweaking the diet a bit at the grocery or farmers markets, but you can make it happen and make a big difference.

Dr. Justin Marchegiani: Exactly. Now, someone else chimed in about the evolution drinks and the plastic. I’m not too worried about the plastic with these, these are all cold pressed. Alright, so they’re cold pressed so that the juice that’s put in here is cold and these are refrigerated right away. So you’re gonna have leaching of plastics more when it hits UV light and or higher heat. So not now not that concerned about plastic plus, these things have a short shelf life. So it’s not like the the juice is sitting in there for like a year. It’s just sitting in there a very short amount of time it’s not being exposed to UV light or high temperatures going to being refrigerated, right. So you got to keep all that in mind. So I think if someone’s worried about the plastic, I think the extra extra nutrients that’s in there, it overlays any risk from the planet. Plus you’re not getting the heat you’re not getting warm substances and you’re not getting the UV light so I think the plastic is isn’t as big of a deal versus like a dishonor water that sits in there for a year or two and who knows if it’s going to be exposed to light when it sits out back the the the convenience store or the supermarket thought- 

Evan Brand: That’s what I’m thinking when you go to the gas station. You see the guy taking a smoke break you got the palette of dishonor water sitting there getting blasted by the sun on 100 degree day and then he goes and puts the water in the shelf at the gas station. So yeah, I think you got to choose your battles, right so I mean, the other argument would be well, if you were too busy this morning, you’re working with the kids you got to jump on here with me you got to go into clinic after this. You might not have got that green juice and you would have had zero minerals and zero potassium and zero greens because you didn’t know plastic because you would have tried to go for a blender instead. So you know.

Dr. Justin Marchegiani:  Exactly plus the higher quality grocery stores like Whole Foods for instance, they got a big dock the truck just goes right up to its full containment and some of the stores refrigerating it. If you’re going to a gas station and you’re kind of limited, some gas stations have the Pellegrino so you could always go by glass at the gas station. That’s probably a safer way but I’m not necessarily worried about the plastic with that but in general, a lot of sulfur in here anyway which will help you to toxify any lingering estrogen. So if you have the option I think it’s worth it.

Evan Brand: All right, well, let’s wrap this thing up. I think we covered a lot if you want to reach out clinically, Dr. Jay and I we work around the world with people we’re very grateful we’re very blessed for the opportunity to help you guys so thank you so much for not only commenting on these live videos, but of course just being there clinically because you help us learn we learned so much from working with people one on one way more than you learn in any book or any study is seeing how do people feel Hey, when you recommended this or that my energy went up 20% we love stuff like that it’s addicting for us. So we’re very very grateful and if you do want to reach out clinically, please check out Dr. Justin at Justin Health. and me, Evan brand at and we’ll be back next week to talk more. 

Dr. Justin Marchegiani: Excellent chatting with you guys. And if you enjoyed the content put your comments down below really want to know what you guys think. And if you have any future podcast recommendation topics we’d love to see it as well and sharing is caring. Get this to your families and friends and people that can use this information to help take control of their health. Alright guys, enjoy the fabulous holiday weekend. Take care y’all. See you later. Bye

Evan Brand: Bye.


Audio Podcast:

The many faces of adrenal dysfunction – Podcast #107

Dr. Justin Marchegiani and Evan Brand explain all about the adrenals and the functional medicine approach to fixing adrenal and gut issues. This podcast is part of the Adrenal Summit.

adrenal dysfunctionFind out how functional medicine is more convenient for the patient and how it contrasts with conventional medicine. Discover the specific lab tests and how they significantly differ in providing results from ones ordered by your conventional doctor. Learn the role of adrenals in the body and how important it is to have it functioning optimally at 100%.

In this episode, topics include:

03:28   Conventional medicine and the functional medicine approach

05:51   Adrenals

12:39   Adrenal dysfunction or adrenal fatigue

24:07   Labs

40:00   X-factors for infection







Evan Brand:  Dr. Justin Marchegiani, welcome to the summit. How are you?

Dr. Justin Marchegiani:  Evan, it’s great, man. It’s like déjà vu all over again, right?

Evan Brand:  Isn’t it? Isn’t it? Well, cool. Well, tell people about what you do. You run a wellness clinic out of Austin, a worldwide functional medicine clinic. So tell people a little bit about yourself. How you got into this whole space? What led you to venture away from chiropractic and focus more on the science part of—of health and looking at hormones and adrenal lab tests and gut tests and all the things that you do.

Dr. Justin Marchegiani:  Well, off the bat. This is for the Adrenal Summit. The summit you are hosting. So any of my listeners that’s listening to this on my podcast, Beyond Wellness Radio, feel free and head over to Evan’s site, and sign up for his adrenal summit that he’s doing with Dr. Alan Christianson.  And then answering your question, so really functional medicine has evolved to the point now where virtual medicine is kinda taking over and it’s really convenient number one, for the patient, because the patients doesn’t have to drive back and forth to the doctor’s office and inconvenience their day and then sitting around this bland office, waiting to get, you know, serviced and treated by the doctor with these quick visits that are typically happening in conventional medicine. We can have this kinda of tele-medicine kinda situation whether—whether it—it’s phone or Skype and we can order all the lab work locally pretty much anywhere in the world. I mean, obviously domestic’s better in the US but we can still do it anywhere and that’s kinda changing medicine because we have the ability to check in with people on the diet and lifestyle side, create functional medicine programs, evaluate lab tests and there’s a level of convenience that’s really nice but also the ability to connect with someone so fast, face-to-face, to record calls that have a lot of digital aspects to it with the website and a lot of the podcasts and videos supporting the healing, I think really makes it more convenient and easier to get better.

Evan Brand:  Makes sense, so you would argue, you’re almost not missing out on much. Maybe the physical touch element that you would have in clinic but beyond that there’s really not anything that—that’s—that you’re losing by working virtually.

Dr. Justin Marchegiani:  Yeah, I mean I would say a good physical exam is always great but I mean, we can fret out a lot of that information in a good metabolic assessment or handout where we ask more in-detail questions about skin and rashes and—and fingernail, you know, ridging and such, and maybe hair quality or you know, different energy things that we can fret just with good metabolic questionnaires, but it’s nice to be able to have a—a physical interaction but all my patients typically, they’ve already seen doctors anyway, so they’ve already been at least evaluated from a physical perspective. I mean, if someone’s got a—a tumor in the back of their neck, right? You know, when we’re on Skype you may not be able to see that. So it’s nice to get that kinda crossed off our list before we begin.

Evan Brand:  Right, right, and then that’s something I noticed, too. Most people have already been through a handful of doctors or specialists so they’ve already had all of the baseline, the conventional stuff done that would pick up anything that would be alarming. So now we’re looking deeper.

Dr. Justin Marchegiani:  Yeah, and it’s nice for us to dig in knowing that those conventional pathologies have been crossed off because it really allows us to kinda really zone in super focused on what could be there on the functional side and not have to be as observant of the—the pathological situations which typically they’re more in your face anyway, right?

Evan Brand:  Exactly.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Tell people a little bit about the compare and contrast between conventional medicine and the functional medicine approach. And if you wanna use the context of adrenals or something else, then you can. I think that would be a good starting—good starting point.

Dr. Justin Marchegiani:  Great. So overall in functional medicine, I give this comparison to my patients. Functional medicine and conventional medicine, it’s like a light switch. Functional medicine is the light switch that’s the really cool dimmer switch. It can go off and on, and there’s a spectrum. You can have it just a little bit on. You can have it in the middle. You can have it almost off. You can have it all the way on, right? So you have the ability to have various intervals of how high or how low that light is. Now with conventional medicine, the light’s either off or on. In other words, if the light’s on, you’re healthy. If it’s off, you’re deceased, right? That’s conventional medicine. Now let’s say the light’s just a little bit flickering in the functional model, right? We got the dimmer switch, right? It’s on just a little bit. Well, if you go to the conventional doctor, they’re gonna say, I see light; therefore, you’re fine. But on the functional spectrum, we say, “Yeah, we see light but it’s—the light’s kinda like 90% off, right?” So let’s work on ratcheting that dimmer switch up to 100%, 100% being 100% function. So conventional medicine, any bit of light, you’re fine. You’re normal. Hey, keep coming back. I’m gonna write you a prescription for depression. If you’re a female, maybe we’ll—we’ll recommend some birth control pills or both. Right? That’s typically the conventional medical solution. In functional medicine, we have the philosophical approach of the dimmer switch, so we can pretty much no matter where you are in that light spectrum work on ratcheting you up into the right direction.

Evan Brand:  Excellent analogy. Now most people what they do for you and I both something we’ve noticed is many people wait until they’re ridden with health symptoms before they come to reach out and get help with functional medicine but the analogy you used just proved something that I’ve been hoping for all along which is that someone who is relatively healthy overall may be just has a couple of little kinks in their armor somewhere. They can still come and get help and feel new energy or feel an increased sex drive. Something that they’ve wanted or feel less bloating, even though they are “okay” by any other practitioner standard.

Dr. Justin Marchegiani:  Correct. So can you reiterate that question one more time? I didn’t quite get the full question.

Evan Brand:  Yeah, that was just a statement, that wasn’t a question.

Dr. Justin Marchegiani:  Okay, got it.

Evan Brand:  Yeah, so let’s talk about–

Dr. Justin Marchegiani:  I agree.

Evan Brand:  Let’s talk about adrenals. This is the—one of the first steps that you do when you’re working with patients is looking into the adrenals which you and I both kinda break it down, adrenals, gut, detox, hormones, which is just so beautiful–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And I thank you for all the mentorship that you provided to me, even over this past year every single week, we’re—we’re digging in together.

Dr. Justin Marchegiani:  Love it.

Evan Brand:  So I appreciate that.

Dr. Justin Marchegiani:  No problem.

Evan Brand:  Now let’s talk about why adrenals have to be first in a functional medicine program. Eventually we’re gonna talk about why most people are not getting results from that. But why can’t you just go straight to the gut if someone has issues there? Why—why do you have at adrenals?

Dr. Justin Marchegiani:  Great question. So let’s—I’m gonna use my last patient that I had just before our call here as an example and that’s the nice things about us in—in the podcast that we do and the summits that you’re doing and then the interviews that I do, is we have a functional medicine clinical perspective that we bring to and that perspective and that allows people to not just a theoretical kinda look into it, but actually, hey, what’s working in the trenches? Because in the end, you know, it’s better to be coached by someone that’s doing it than who’s just doing it theoretically. So on that note, I just had a patient and we got some of her labs back in. We had a DUTCH adrenal test with female hormones. We had a thyroid test and we also had a gut test—two gut tests—an organic test that looked at bacterial function as well as a GI Map test and a DRG test. Now on those tests, on the female hormone and the adrenal side, her adrenal hormone levels were okay. Like if we looked at how much amount of hormones she was pumping out, she’s pretty good. The issues were very aberrant timing. Very low in the morning, high in the afternoon, and very low at night. So there was this timing issue throughout the day and that created mood swings and energy dips. Number two, she had thyroid issue. So she had elevated TSH. She had very poor T4 levels and even poor T4 to T3 conversion. So there were thyroid issues. We need thyroid hormone to metabolize the building blocks to make hormones. i.e. cholesterol comes down the hormonal cascade. It gets acted upon by thyroid hormone to break it down into building blocks so it can actually be used to—to make some of these hormonal constituents. And last but not the least, this woman’s female hormones were very low. She’s already post menopausal but she had very low estrogens—almost non-existent—very low progesterone, and very low DHEA. And so as a woman into menopause, the backup generator so to speak are the adrenals. And this is—being in the Adrenal Summit, this is important because the adrenals become this backup generator for sex hormone function once menopause hits and is through.

Evan Brand:  Say that one more important, I think that’s profound.

Dr. Justin Marchegiani:  Yeah, so DHEA, one of the major building blocks—DHEA sulfate from the adrenals becomes this major building block for your sex hormones once the ovaries are in the menopause. So it becomes the backup menopause. So I always tell patients, imagine you got this generator. You spend a—a bunch money on it. It’s sitting on your garage or whatever, so when that storm comes, you can still have power, right? Now most people want that generator 100% charged. That’s the goal. So then when you plug it in, it works and everything is at 100% capacity. Like there’s no lapse in function between the storm and—and being in the storm so to speak. But now you got this generator, it’s in the garage. It’s 90% empty. So you got 10% of fuel capacity in there and you’re trying to get 100% function out of our house, right? You want the heat, you want the AC, you want everything to work. But that’s not gonna happen or at least not for long when the charge is that low, and that’s like your adrenals being on low. So now instead of the storm or instead of the heat wave coming, now we got stress. We have family issues, financial issues, kid issues, job issues, up and down s stressors that normally happen in life. They’re like the thunderstorm or the heat wave that comes in, stressing your house’s electrical system. So supporting the adrenals really helps buffer out the hormones and hormones aren’t just to have babies. Hormones, they’re there to reproduce, right? Have a child but also reproduce you, meaning every cell in the body—hair, skin, nails, muscle, tissue, bones—all of these important things as you get older become more important because who doesn’t want to have healthy skin, healthy nails, you know, have decreased chance of being osteoporotic, having weak bones, weak muscles? Everyone as they age wants to age as gracefully as possible and having strong adrenals is paramount to that goal.

Evan Brand:  Excellent. So talk about this female—people wanna know well, what does this feel like? You mentioned some—some geeky lab results here. What does that actually translate to? What would this person be—how would they be going through their day?

Dr. Justin Marchegiani:  Oh, great question. So especially women with the sex hormones, because women have that drop, right? They’re cycling. Now they’re not cycling. It typically takes a year or so to make that transition. So now they’re not cycling. One of the big first issues we’re gonna see are hot flashes, right? Typically FSH starts to rise, that’s the brain hormone that says to the ovaries, “Wake up! Wake up!” So FSH is trying to, you know, wake them up and that can start to create some hot flashes with the vasodilation. We can start feeling more moody, right? Mood issues, irritability, even can see things like depression, okay? I already mentioned depression, mood stuff, sleep issue is a big one. We can start to see hair quality, skin quality issues, and also lower libido. So all those are all common symptoms, and also fatigue and brain fog because–

Evan Brand:  Yeah, and–

Dr. Justin Marchegiani:  These hormones are antioxidants, right? So they help with stress and inflammation so the more your hormones are off, the more inflammation can kinda be like a—a wildfire without a firefighter to put it in check so to speak.

Evan Brand:  Yeah, and so you mentioned low cortisol, so she’s probably waking up, not feeling ready to start the day, maybe needing some caffeine, coffee to get going.

Dr. Justin Marchegiani:  Exactly and then also the swings in cortisol, too, right? Remember when we look at adrenal function, I think we’ll get to this later when we dig into more lab assessment and lab testing, we not only look at adrenal levels because this woman’s levels they weren’t bad. They were actually in the middle of the range but the rhythm piece wasn’t good and the sex hormone piece wasn’t good. So when we look at adrenals, we have a 3-pronged approach on how we assess it. Number one’s gonna be cortisol rhythm, because we have to recognize when we look at adrenal issues, it’s not just, “Oh, do you have adrenal fatigue or not?” Right? It’s how’s the rhythm? How’s the HPA axis, the brain, the HP? The hypothalamus, pituitary talking to the adrenals, that’s number one. Number two is how’s the actual amount? What’s the adrenals actually making? Is that enough to support function? And then number three, how’s the sex hormone piece? So in this lady, rhythm wasn’t good, amount was okay, but sex hormones were low. So she was missing two out of the three, so she’s going up to the plate with 2 strikes on her.

Evan Brand:  Wow. So let me ask you this. If you see normal adrenal output, so you see normal hormone levels–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Well, let’s just say everything was normal, but it was dysfunctional. Do you call that adrenal dysfunction or do you classify that adrenal fatigue?

Dr. Justin Marchegiani:  Well, I don’t like the word adrenal fatigue. I think adrenal fatigue can be a good way to describe people that have low sex hormones and very low cortisol, because that kinda be called adrenal fatigue because everything’s starting to become more depressed which is good. The problem is a lot of people confuse adrenal fatigue and adrenal failure maybe because there’s 2 F’s that start the words—I don’t know. But adrenal failure is kinda like Addison’s disease, right? That’s more of where there’s an autoimmune attach on the adrenals and the adrenals literally are barely functioning and there’s almost not enough cortisol to even get through daily requirements.

Evan Brand:  And how often have you actually seen that compared to what we’d typically work with which is more adrenal dysfunction?

Dr. Justin Marchegiani:  I have only seen one case of Addison’s disease in my practice which is adrenal failure.

Evan Brand:  And this among— yeah, and this among thousands–

Dr. Justin Marchegiani:  Thousands of patients.

Evan Brand:  Of patients, so–

Dr. Justin Marchegiani:  Most people know when they have Addison’s because they literally cannot get out of bed. I mean, if you go look back in the history books, cortisol was created I think synthetically or bioidentically in the 50s and one of the things, one of the major reasons why John F Kennedy, JFK, won the presidential race in the 60s is the won the Senate in the mid-50s up in Massachusetts where I’m from and they had just found out a way to create cortisol. So he started taking it for his Addison’s disease and you can literally see his face and his muscles all start to fill out because he did not have enough cortisol. So if you look at pictures of him in the mid-50s or early 50s, he’s absolutely gaunt. But then you look at him in the 60s during the presidential debates he looks amazing, and part of that was that cortisol shift and that’s what happens when you have cortisol failure. You literally just—you look terrible.

Evan Brand:  Wow.

Dr. Justin Marchegiani:  And you feel terrible.

Evan Brand:  Wow. Okay, so that’s pretty rare overall for Addison’s. So typically somebody’s gonna be in that 99% range where–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  You’re having good cortisol or just completely horrible. Most people are existing somewhere bet—between Cushing’s which is super high all the time or Addison’s where you can’t make enough.

Dr. Justin Marchegiani:  Yeah, it’s the dimmer switch, right?

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So let’s say off, that’s Addison’s. On, that’s Cushing’s, right? Alright, think Cush-push. Alright, that’s how we learned it in school. Cush-push, it’s high. Addison’s is failure, okay? And most people, right? On as Cushing’s, off as Addison’s—most people are on that dimmer switch somewhere in between.

Evan Brand:  So probably 99% of the people and you and I have both had patients who have diagnosed themselves with Addison’s but then we’ve looked and it wouldn’t be an Addison’s scenario. They’ve just been–

Dr. Justin Marchegiani:  yeah.

Evan Brand:  Almost fear mongered because when you look into the conventional research about adrenal fatigue or adrenal dysfunction, you’re typically not gonna find much. You’re gonna find WebMD’s approach which is Addison’s or Cushing’s. That’s all you’re gonna read about. So this just goes to show the importance of the work that you’re doing and the work that you and I do together, recording podcasts–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Weekly because we’re seeing this stuff. It is real.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And it’s not in your head.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And you’re not crazy if you’re dealing with these symptoms that—that you’ve discussed.

Dr. Justin Marchegiani:  I 100% agree. Now I like the word adrenal dysfunction because they kinda gives you a lot of latitude to—to address HPA axis stuff. Maybe the cortisol is not low. Maybe it’s a rhythm issue. Maybe it’s a sex hormone issue. I think adrenal fatigue can be more aptly described to be put on a label of like very low cortisol, very low sex hormones, alright? But people still conflate it with failure. So remember, adrenal fatigue is not adrenal failure, and a better word maybe be just adrenal dysfunction to look at it and that really–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Puts in the key issue that a lot of people are looking at. It becomes more of a brain issue than an adrenal issue, right? The HP—the brain’s not talking to the adrenals. And then also when we add in the gut issues, we know there’s certain nutrients that are required to make the adrenals run optimally—vitamin C, pantothenic acid, B5, zinc. And if we have digestive issues which will eventually go there soon, that could be a driving factor of why the adrenals aren’t running as well and most people in Adrenal Land totally miss the gut piece of it.

Evan Brand:  Absolutely. Well, let’s transition there now. That’s basically phase 2 which is the gut and many people which you and I have kinda come up with an average of about 1 in 3 people have infections.

Dr. Justin Marchegiani:  I’d say 1 in 2 to some degree. I mean, obviously when we look at infections, there’s a difference in severity. Let’s say a bacterial overgrowth vs dysbiosis or a full-on parasitic infection or a combo of all three, right?

Evan Brand:  Right, which maybe we a have a little bit of bias–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Population since we’re with people that have all these symptoms so maybe the average person out there but even if you look at like World Health Organization, they’re saying that, you know, 20% or greater of the US population has Blastocystis hominis.

Dr. Justin Marchegiani:  Yes, I know.

Evan Brand:  A common parasite and this is–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Something we see weekly at this point, so it’s like, wow, a lot of people are going undiagnosed and I’m sure that’s kinda the lens that you wanted to start this—this topic on is people are going to “adrenal fatigue specialists or adrenal fatigue experts”. We’ve seen some adrenal programs online and typically the gut piece is ignored. Is that why people are—are suffering and not getting results?

Dr. Justin Marchegiani:  That’s a big part of it. So when we look at the symptom of fatigue, right? You have fatigue. Now a lot of people because of education in functional medicine, people are linking up fatigue as adrenals. Right? I kinda have my fatigue triangle, right? On the top part of the fatigue triangle, we have the adrenals because the adrenals help regulate glucocorticosteroid aka cortisol which helps regulate energy and inflammation. Most people are low energy and also inflamed, so it makes sense why the adrenals are in poor shape. So top part of the triangle is the adrenals. The bottom parts are gonna be the thyroid and the mitochondria. Okay, the thyroid is there to help regulate metabolism. With low thyroid, we’re not gonna be able to have the building blocks to break down the healthy levels of corti—cholesterol and to building blocks to make hormones, number one. And thyroid controls temperature and resting metabolism. If you have a low resting temperature and metabolism, you’re not gonna be able to generate energy as well. That’s important.

Evan Brand:  So let me ask you this, too. How does Hashimoto’s play into this, too? Because this is something also that typically goes undiagnosed. Autoimmune thyroid issues where they’ve never been tested. They’ve never even had that looked at.

Dr. Justin Marchegiani:  Yeah, great question. So Hashimoto’s gonna hit the thyroid part of that triangle, but it really is a combination of all three because when you have Hashimoto’s, typically there’s immune system upregulation where the immune system’s attacking the thyroid gland so that creates inflammation. So if we have inflammation, then guess what’s in overdrive? The adrenal is in overdrive to help with the inflammation. The thyroids are being attacked by the immune system. So that means, these various little follicles are being attacked by the immune cells so they’re bursting open and thyroid hormone goes up and it goes down, so early on you can feel like you’re on a rollercoaster ride. You may even be diagnosed hyper to begin with. You may have anxiety and depression during the—during the swings of thyroid hormone being released. So it can be this up and down rollercoaster, and let’s not forget autoimmune conditions, typically there has to be some level of leaky gut happening. So we have leaky gut whether it’s some gluten exposure, various infections like Lyme or Blasto or Yersinia enterocolitica or H. pylori so you see how the gut starts to interplay with the adrenals and how the adrenals interplay with the thyroid and how the thyroid actually interplays back with the adrenals because we need healthy levels of cortisol to help activate and convert thyroid hormone. So you can see if we have adrenal dysfunction, that can start to create thyroid issues, too. And this patient I just saw, she—it was on Synthroid for 30 years, 150mcg dose which is equal to about a gram and a half of Armour or NatureThroid which is a pretty hefty dose for someone that still has her thyroid, right? But she still had low levels of T4, very poor T4 to T3 conversion, and their TSH was still high. She being medicated by endocrinologist for 30 years.

Evan Brand:  Wow.

Dr. Justin Marchegiani:  So we had to go in there and change that thyroid support a bit. Support it a little bit more but also fix the adrenals and the big thing was fixing the gut because she had a significant amount of small intestinal bacterial overgrowth and we know the gut bacteria is really important with the enzyme sulfatase which is produced by healthy gut bacteria to activate the T3 acetic acid and sulfate and activate thyroid hormone in the gut.

Evan Brand:  Wow, that’s amazing. And so people that don’t know, if—if you don’t listen to my podcast or you don’t listen to Justin’s podcast already, I showed up with 2 parasite infections about a year ago and Justin was the guy that told me. I went over to his house and I think we were just hanging out or you were gonna give me an adjustment or something–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And I said, “Justin”. I said, “Help me. What’s going on?”  I said, “I’ve lost 25 lbs without trying.” He took one glance at me and he goes, “Evan, you got a parasite.” And it hit me and I was kinda like, “Yeah, I mean. Maybe.” And I—I put off testing. You were like, “You need to go get your gut checked out. Go get a test.” And I was like, “Okay, okay.” And so I finally got hold of the lab. I said, “I’ll get a test kit.” I ran it. I showed up with Cryptosporidium and Giardia—two parasites that are pretty—pretty bad. They’re not the funnest parasites to have and since working on those, I’ve been able to build more muscle. I’ve been able to gain more weight. When I ran my adrenals, I showed up with what I would consider adrenal dysfunction, if not adrenal fatigue; my cortisol was low all day. So that just goes to show that even a younger guy who is pretty active—I spend a lot of time outdoors. My diet is—is much—is close to 100% organic as possible, I still had adrenal issues and I’m gonna go ahead and say it was due to the—the stuff going on in the gut. What about you?

Dr. Justin Marchegiani:  100%! I agree with 100%. A lot of people that have adrenal issues, they miss the gut piece and it’s so hard because people are programmed to think of gut issues as diarrhea, bloating, like these are symptoms that are associated with a gut issue. So when you start to tell someone that they’re fatigued; it could be from a gut issue or their brain fog or their mood issues, could be from a gut problem, they’re like it’s so hard to get your head wrapped around that.

Evan Brand:  So basically what happens is and not to put words in your month, you can elaborate as much as possible–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  But in these situations you’re basically, you’re getting robbed because you are feeding these bacterial overgrowths. You’re feeding these yeast. You’re feeding these parasites and you’re not feeding yourself and myself even today looking at my fingernails, I do still have the vertical ridging, which that’s not always 100% indicator, but it told us there was some type of malabsorption going on. It was just a matter of getting the right testing done to figure out what was going on. So maybe we could—if you wanna comment on that and then we can talk about what tests need to be run for people to get an accurate diagnosis of what’s going on.

Dr. Justin Marchegiani:  So speaking clinically to your situation, there may still be another infection or two still lingering. So I know we’re waiting to hear back on some of those re-tests so it’ll be interesting to see what happens with you and it’ll be interesting to see how your fingernails change over time. Not to mention, this could be a long-time coming to, right? So it may not just shift overnight. So we just gotta keep an eye on it.

Evan Brand:  Yup. Do you–

Dr. Justin Marchegiani:  Go ahead.

Evan Brand:  Do you—yeah, I was gonna say, do you wanna talk about the labs and then do you want to reveal what you found on your labs?

Dr. Justin Marchegiani:  Yeah, that would be cool. I would just say one more thing here because when we deal with fatigue and adrenals issues, I created this analogy because for me it really just rings true and analogies are great because you don’t have to memorize. You just have to understand it and it sticks, right? So that’s why I like it. So my analogy is the adrenals, it’s like let’s pretend you’re in a car. It’s a stick shift. It’s a standard transmission, okay? So the adrenals are like your ability to shift gears, alright? Going from 1st gear to 2nd gear, 2nd gear to 3rd—3rd gear. That’s like your body’s ability to handle more stress, right? The higher up in the gears you go, the faster your car’s going, the more stress on the engine. Your ability to downshift is your body’s ability to adapt to stress. To kinda get back to homeostasis or that parasympathetic rest and relax state. So the being it—being able to shift gears up and down is being able to upregulate and downregulate to stress. That’s number one. Number two, your resting metabolism, so if you put a car in neutral, yeah, you put it right in neutral, you could pull your foot out of the clutch now, it won’t stall it out. And typically you’ll be at about 700 to 1,000 RPMs on average, okay? Now that’s like a good resting metabolism or resting RPM for the car. If you go too low, anyone that drives a stick knows their car will stall out, right? If you go too high, well, now you’re putting extra stress on the car and it may burn out. It may red line. So think of neutral as the resting metabolism of the engine and then think of the mitochondria or the nutrients needed for the car to run as like the gasoline and the lubricants that are in the engine and in the gas tank that provide the fuel for the car to run so on one hand, we have the ability to shift up and shift down as being able to deal with stress. The resting metabolism is kinda the thyroid piece. The nutrients required for the car to run, right? The substrate, the oil, the gas, etc. is the mitochondria and then all that stuff feeds into the gut and feeds the detox pathways and feeds the brain so when we have an issue with those 3 things, other things tend to be at root as well.

Evan Brand:  So it’s all connected and you can’t just focus on–

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  One piece of the puzzle because what’s gonna happen, you’re gonna come and maybe re-test your hormones if you ever got them tested in the first place and they’re gonna look probably the same and your symptoms are still gonna be there, is that right?

Dr. Justin Marchegiani:  Correct. 100%!

Evan Brand:  Wow.

Dr. Justin Marchegiani:  And regarding my test, I just came back with an E. histo parasite so I’m treating that as well. My actually came back with H. pylori and Blasto. And this is her second time with Blasto.

Evan Brand:  Wow. So–

Dr. Justin Marchegiani:  So it’s hard to say you know, where these things are coming from? And we—we waterski every week and you know, you take a mouthful of water every now and then, so who knows, right? We also have some pets. We have our dog, Butter, who is hanging out with me right now and then a couple of cats, Mischa and Dexter, and you know, they like to be friendly and stuff, so who knows maybe we got some from them, but you know, you fix what you find.

Evan Brand:  Exactly.

Dr. Justin Marchegiani:  You get the testing done. You clear it out because I think it’s everyone’s right to be infection-free and we wanna make sure that we have that opportunity.

Evan Brand:  Agreed, agreed. And I would consider you definitely one of the best, not just online but in general one of the best functional medicine practitioners out there that are actually looking at this stuff and not only helping people to be healthy but doing in a way that’s fun. Now this is isn’t a video—this isn’t a video interview for the summit side of things but I’m looking at you here and you smile the entire time. You love this stuff.

Dr. Justin Marchegiani:  Love it, man. It’s great.

Evan Brand:  Isn’t it?

Dr. Justin Marchegiani:  Well, it’s—the thing is it’s incredibly rewarding. I mean, I say that we have the best jobs in the world because when you have patients come in to your office that have really bounced around the conventional medical establishment for a while, they have maximized their options, and when you can help them get to the root cause of why they’re feeling the way they’re feeling, it’s great. It’s really exciting. It’s like you’re a—a CSI detective on TV. You know, it’s great.

Evan Brand:  I know. Does it ever—does it ever hit you and kind of trip you out a little bit when—because it—this happened to me last week when you are working with someone and they’ve been to 10 or 12 specialist, but yet they’ve never had some of these basic foundational functional medicine tests run?

Dr. Justin Marchegiani:  Yeah, I mean, I think a lot of people in functional medicine, a lot of them may have a really big conventional medicine background so they look incredibly myopically at certain things under a functional medicine light, like maybe they look at the adrenals and they’re so myopic on the adrenals but then they forget the gut or they’re looking at the gut but they forget the thyroid or they forget malabsorption pieces so I think people they—they don’t have a good clinical hierarchy model of where to treat and they’re lens is so focused on one thing they, you know, they’re looking at the trees but they’re missing the forest so to speak.

Evan Brand:  Right, and when I talk with Alan about this summit, I said, “I basically want this to be the anti-summit summit because a lot of these people that are in summits, the interviewees are not clinicians.“

Dr. Justin Marchegiani:  They aren’t.

Evan Brand:  They may have some of these credentials but they’re typically not working with people. They’re not in the trenches and so I commend you for your work in the trenches on a daily, weekly, monthly, yearly basis, not only that working with people but also putting out the content because I think that really shows that you’re putting in the effort and you’re not just reading a book and then regurgitating something because something I found is it doesn’t matter how educated you are or how many letters you have after your name if you’ve not been in the trenches, you cannot successfully get people better because you don’t understand the psychology that foes into this about people having to make the changes and being there as sort of a therapist as well to support them if there are any effects. You know? Let’s just say you’re killing off an infection, you may feel a little bit worse before you feel a little bit better for the first couple of days and being able to have the expertise to know that and forewarn them of it, it’s priceless. So you know, people definitely check out Justin’s site. It’s and you can go look into the podcasts. There’s probably 100 episodes released by the time you listen to this and I’m honored to be the co-host of that show for many of the episodes and we—we have fun just like we’re doing here. So you can check him out there. Obviously we could go on and on for hours, but I think you get the gist of it here is that, you just—one, you have to go check out his content but two, you really have to look at this whole adrenal piece as a puzzle, but it’s a puzzle that’s solvable, right?

Dr. Justin Marchegiani:  100%, 100%. And I appreciate your kind words there and I think the big thing that we do on the podcast is we really bring that clinical experience because you know, I have a lot of clinical friends and colleagues that are—they have their head in—in the literature, the scientific literature which I think it’s great and maybe you can draw a lot of inferences from what to do next, but I think the best thing is one, work on yourself, and then number two, observing how patients respond to and from different interventions and treatments is the absolute best learning experience for any doctor. I think having the clinical context before you go in is gonna be important because then you know where to put the different puzzle pieces to start, right?

Evan Brand:  Right.

Dr. Justin Marchegiani:  So that gives us the ability to kinda put it in the right order and we’re fortunate to have mentors like Dr. Kalish and Dr. Timmons when he was alive regarding how and the best ways to treat people for success. So we all know that we try to avoid heavy metal stuff first, right? We try to avoid doing gut-killing stuff at first. We may even try to do—avoid detox stuff at first. Now again, there are exceptions to all these rules but that’s the general trend in which we’ve worked on things and the adrenals and the thyroid and the adrenals and the hormones tend to always be the first thing that we do and it makes a big difference when you line it up in the right order. You could find the right things but you put the puzzle pieces in the wrong order, the picture may not look as clear.

Evan Brand:  Absolutely, so if you’re something out there and I’m sure you are if you found this summit, who you’ve googled your symptoms or you’ve looked on some Paleo health blogs and you’ve read about some detox formula or you’ve read about some cleanse or a gallbladder flush with olive oil and there’s just all sorts of crazy stuff out there and a lot of people don’t have a clear direction. Here’s the clear direction if you’ve been looking for it because I get goosebumps saying this because it’s been able to help my health. It’s been able to help thousands of patients–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  On your side of things, nearly a thousand on my side of things, this is approach—an approach that actually makes sense. You see that there’s no dogma attached to it. Justin’s telling how it is and telling it to you straight. There’s no fluff.  There’s no fancy words if there are they’re broken down into analogies. This stuff can be very complicated. It is all tied together but at the end of the day, it comes down to some simple takeaways. So maybe as we wrap this thing up together you could sort of boil all this down for people and give them a clear direction of what they can do next or what steps they’ve ignored for 40 years that need to be taken now.

Dr. Justin Marchegiani:  Awesome. So number one, a couple of the interventions that you’ve mentioned, right? You mentioned like gallbladder flushes or maybe coffee enemas or this thing or that thing may not be necessarily be bad, but it’s like you have this 500-piece puzzle and I give you 1 piece and it’s like solve it.  Well, I—I need a little bit more clarity on—on what the heck’s going on for where to put that piece down, right? And I think that’s where having the clinician approach to get the diet and lifestyle dialed in; that’s always foundational, right? That’s the foundational piece. You wanna build a big skyscraper or you wanna build a small 2-story house, you always start with the foundation first. And again, the higher up you wanna go, the deeper that foundation is. That’s number one and we always start with the diet and the lifestyle. So anti-inflammatory, nutrient-dense, low toxin type of Paleo template where the macronutrients can be adjusted and certain foods can be pulled in or out like salicylates, phenols, FODMAPs, again we adjust that according to how messed up someone’s gut or digestion is. Blood sugar, eating every 4 or 5 hours if possible. If we can’t even handle that because eating too much food causes problems we may have to adjust what we eat. And then the next piece I think is I mentioned before getting clarity where that puzzle piece goes. That’s where the lab tests really are helpful because they can tell us what’s going on deeper but also it can give the patient a lot of confidence that what they’re dealing with is real. Because a lot of people that I’ve seen, they bump their head up against the wall so many times with doctors that have told them it’s not real or its’ all in their head and they don’t even know what’s fact from fiction so we can get clarity on what’s real and what’s not and then we could measure it and check back in. That one, it keeps the patient excited. It’s like, you know, you’re sitting there in your term class, right? In your—in your class throughout the semester and you know, why are you gonna study and do your homework if there’s no test at the end, right? So the test at the end is the re-test or it’s the reassessment or it’s the follow-up. So people sit in class and pay attention when there’s a test. So I like the ability to get a starting point, create the anticipation of hey, we’re gonna follow-up and then know there’s gonna be accountability along the way, so I think working with a practitioner that has those types of foundation pieces in between are really important.

Evan Brand:  Agreed. I can’t tell you any greater feeling than looking at a re-test and you find someone that’s suffered for 20, 30 years and then you see the infection’s gone.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  It’s like, ahh, you could take a breath when you see stuff like that.

Dr. Justin Marchegiani:  And you see the adrenals start to heal or you see thyroid levels start to get back into balance.

Evan Brand:  So–

Dr. Justin Marchegiani:  So I think those are really important.

Evan Brand:  What would you say, just in a—in a general sense if someone just feels like I’ve done everything. I’ve tried the herbs. I’ve tried the adaptogens. I’ve had the natural thyroid support. And I still spun my wheels. How am I supposed to—can I truly get better?

Dr. Justin Marchegiani:  Well, I would say, number one, there may be something missing on the digestive side. So I would say, off the bat, look at your nails. Look at your regularity. Look at your bowel movements. Are you a Bristol stool chart #4? Or do your nails look decent? Do you have good digestion without gas and bloating and reflux and irritation? Is that 100% good as well? And let’s say it is. We should still get it looked at because if you’ve done all the—the body system one test which is what you kind of alluded to which is like the thyroid, the adrenals, all the supplements to support that but there are other pieces that really haven’t been looked at or maybe their symptoms alluding that we should look there, that has to be looked at next, and we really have to do a thorough analysis. Maybe even multiple tests side by side to make sure nothing’s being missed.

Evan Brand:  Well-said.

Dr. Justin Marchegiani:  Because I can’t tell you how many tests I see from other patients coming in where I already know, you know, pardon my French, this lab sucks, right? I’m not gonna say the name of it. This lab over here—and we talked about this before—they run one lab from this crappy lab and we’re like, “Oh, man. That lab stinks. It definitely missed it.” And then we don’t even run that lab. We run other labs that we consider to be better based on our thousands of data points on it, and we see even the good lab misses one, but the other lab pulls something up. And it’s like, wow, if we didn’t use this really good labs to begin with and if we didn’t use one or two side by side, we wouldn’t even have picked it up. So most patients are already coming in. They’re having lab tests that may be subpar on the gut and they’re saying, “No, I’m fine. Look, I’m fine. No problem.” And it’s like, just maybe be a little bit more skeptical if you haven’t done the right test and you haven’t done multiple tests that I consider to be the—the good test, right? And—and we would say like maybe the 401H and the DRG and the GI Map would be some good tests that we put out stamp of approval on. Maybe even the one by Doctor’s Data, too, is a pretty good one. But I like to say at least 2 of those and definitely having the DNA one in there to be—to look at it and really round out our assessment.

Evan Brand:  Yeah, so I’ll—I’ll add a note to that, too. I had a female patient who struggled forever and ever. She went to conventional doctor who then made the referral to the gastroenterologist, a very common step that they’ll make.

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  She got the stool test at the hospital. She showed up with no infection. So she thought I’m fine. “Evan, it’s just a yeast problem. Can you help support me for yeast? Getting rid of yeast.” I was skeptical. I thought, “Okay, this doesn’t make sense.” So we ran—when Justin said 401H, that’s by a company called BioHealth. We both use it–

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  And love them.

Dr. Justin Marchegiani:  Yup, they’re great.

Evan Brand:  We ran—we ran the 401H and she still showed up negative. So even I was almost convinced at this point. So I said, “Well, okay, well let’s try to knock out the candida.” Let’s go for another 4-6 weeks, see what happens. Bloating, excessive distention was still there so then we ran the other tests that you mentioned, the GI Map which is by a company—in case people are trying to find them—it’s Diagnostic Solutions Lab.

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  And she showed up with Dientamoeba.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  A parasite infection. We finally found it.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  So even some of the best of the best test that you just alluded to, sometimes there will be false negatives and you’re gonna need to go and do 2 or 3 or maybe even 4 test panels looking at different things, whether it was stool or urine, etc. to actually find something because if you have a feeling in your gut that something’s not right in your gut–

Dr. Justin Marchegiani:  Pun intended.

Evan Brand:  Your gut feeling is probably right.

Dr. Justin Marchegiani:  Yeah. Absolutely. And I’d say here’s the kicker right now. And this is like I think this bothers a lot of people but I just put it out there so they’d know it in advance. The more you can predict what—what’s gonna happen good or bad, patients have faith in you. So I think it’s really important to make sure patients have faith because they’re taken, you know, a lot of what you say to heart. So the big thing is, sometimes when we re-test some of these gut infections we have a new infection. Okay, now there’s a couple of variables, a couple of reasons why. Number one, it could be the fact that as the gut heals, proximal to distal meaning into the middle part of the gut where the food resides versus into the gut wall, right? Where everything kind of emanates or it goes into, there can be deeper infections that are burrowed on deeper and it may come to the surface as the gut heals. And this is kind of theoretical in functional medicine, that’s called a crypt hyperplasia phenomenon that could potentially be happening. I’ve seen people with 4 or 5 infections burrowed in deeper and 1 or 2 comes out at a time. So–

Evan Brand:  Wow. So let me—let me kind of restate that so people are like, “What? What does that mean?” So basically, what happens is, you know, you’ll come in and you’ll find an infection. You’ll treat that in someone, that original infection’s gone, you get the re-test but now a new infection’s there. And you’re like, “What the?” So then you come in, you re-treat again.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  That infection’s gone. Another one shows up. So you are really doing a great job of—of zooming in and zooming out here because if people–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Have been struggling with adrenal issues and you’re 4 or 5 infections deep. It’s gonna take a while before you get those adrenal hormones back online. It’s that safe to say.

Dr. Justin Marchegiani:  100%! Now I’m gonna give you guys a good visual analogy so anyone that’s listening to the show, go check out Beyond Wellness Radio and watch the YouTube of this. So imagine—I’m gonna pull out my spirit fingers, okay, here they are, they’re going—these are like the microvilli in the small intestine, okay? So imagine where my head is, right? This where the food is, in the more of the central part of the intestinal tract. Here are the microvilli and then here’s the deeper intestinal wall. So maybe you run a stool test and it’s pulling samples more from this area and then as the gut starts healing, now the stool’s starting to grab particles or particulate from this area so deeper in. So the infections could be burrowed deeper in. So I’m proximal and then distal is kind of deeper into the gut linings. Does that make sense?

Evan Brand:  Makes sense.

Dr. Justin Marchegiani:  Okay, I’m gonna put my spirit fingers away now.

Evan Brand:  Good.

Dr. Justin Marchegiani:  So getting back to that, number one is the crypt hyperplasia. Number 2 is maybe a spouse of partner that has an infection and is passing it back and forth. Then you guys are playing hot potato. It’s like, you know, get rid of my infection; I’ll throw it back to you the next week. So that’s the potential thing and things like H. pylori can be spread via saliva, so it’s very possible, and that’s number two. And then the next thing could be pets. So like I got Butter over there. Butter loves giving me kisses and I’m just like, “No!” You know, you can kiss my hands and I’ll wash it later or I’ll give her a kiss on top her head, you know, where there’s not like saliva and a tongue there. So that piece is the pet piece and then also you have X-factors like food, traveling abroad, like me you know, waterskiing over in Lake Austin, you know, getting a mouthful of water like that. I mean, I imagine some of the people down at the—the Rio Olympics right now that are going on. I’ve seen some of that nasty water. I mean, I saw something like a teaspoon of that water can make you sick with this nasty bacteria. So—so water and those types of things, you know, drinking when you’re on a hike from a stream. You know, all those things could be potential X-factors I call it. So number one is the crypt hyperplasia phenomenon. Two is partner and spouses. Three can be the X-factor, the water and food and such.

Evan Brand:  So who knows if the Olympic athletes are getting access to functional medicine practitioners because it sounds like a lot of them are gonna be going home with parasites?

Dr. Justin Marchegiani:  Yeah. Yup, I agree. And it’s very possible that that is the case and again, you get some people that you know, we do a round of treatment and they’re not better, and then they get discouraged and they don’t have the fortitude to go through it again at a re-test. And that’s the hard part in functional medicine is knowing that, you know, we’d like to have a home run the first time but sometimes it doesn’t happen and we have to do 2 or 3 rounds and that may be the case or sometimes we may even have a to have a breath test, too, as well because maybe they’re just not a major infection there but they’re just a major gut bacteria issue that’s driving gases, hydrogen and methane, to you know, higher levels that are disrupting peristalsis and—and gut motility and such.

Evan Brand:  Yeah, so this is—this can go deep. As you see, Justin and I could go for hours and hours about this but I think you’ve done a great job for summarizing this people. So the takeaway here: Get your adrenals checked if you haven’t and make sure you’re doing that with a lab that makes like BioHealth, we like; you talked about the DUTCH earlier–

Dr. Justin Marchegiani:  Oh, let me hit one more thing, too.

Evan Brand:  Yeah, please do.

Dr. Justin Marchegiani:  So I’ve noticed I’ve been doing, you know, hundreds of the new DUTCH test. DUTCH test is one of the big hot ones out—the dried urine testing hormones. The difference with the DUTCH is you can look at the free fraction along with the metabolized hormones as well. So you get kind of the, you know, what’s bio-available and what’s totally coming from the adrenals. So you get kind of the—the big and the small picture. It’s like T3 Free and T3 Total on the blood test. You see what’s bio-available. You see what’s actually coming out from the gland. So DUTCH is great. I find it projects a little bit high on the cortisol cascade or chart.

Evan Brand:  Yeah, same.

Dr. Justin Marchegiani:  And I find BioHealth test a little bit low. So you—when you look at those tests, you have to kind of factor in the BioHealth, maybe on the lower side if you’re doing it. And the DUTCH may be on the higher and you gotta factor those couple of things in even though it may say you’re low on the BioHealth, you may be okay. Or if it says you’re normal on the DUTCH, you may actually be high or even—yeah, typically you’d be higher on the DUTCH.

Evan Brand:  Yeah, so this—I guess that would add in the—the variable here. The practitioner that you’re working with—make sure that they’re actually listening to you because if you’re telling them, “Look, I’m exhausted. I’m exhausted.” But the adrenals show up and they don’t wanna do anything about it. Then that practitioner is not listening to you because we—we can’t treat people in a—as a robot. We can’t treat in a vacuum and we can’t just go on labs. There’s gotta be a combination and we can’t just treat on symptoms either. I’ve had people who’ve said that they’re completely exhausted. The adrenals show up okay but then we see that it’s a major mitochondrial issue. But if we just tested adrenals, you would have given them a clean bill of health and moved on. So–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  You know, really look at the full picture is this—the takeaway.

Dr. Justin Marchegiani:  Oh, and also I have one little pet peeve, I’m gonna hit it up, but there’s a—a couple of people out there that I know that aren’t using adrenal testing, and I have colleagues out there. So yeah, I think the adrenal testing isn’t available. I mean, it’s—it’s not valuable. It’s—it’s not worth it, right? I can just base—adrenal program based off of some people’s symptoms.

Evan Brand:  Right.

Dr. Justin Marchegiani:  Now I totally disagree with that. Now here’s the reason why. Number one, I’ve run adrenal tests on people where you’re like, “Oh my God!” Like they have all these adrenal symptoms and the adrenals come back looking great and then we run the thyroid and then the organic acid testing and their mitochondria’s shot and the their thyroid’s low. Now I would have went into it thinking, well, this person has to have adrenal issue, they didn’t. So you see how important it is. Well, you can be chasing your tail if you don’t know that. And also maybe their adrenals are good but their DHEA—sorry, maybe their adrenals are in the middle but their DHEA is super low. So now we know, oh, maybe their adrenals are worse than they are because the DHEA output which becomes the precursor to the sex hormones is really fatigued, is really depressed. So that may tell us there may be a deeper adrenal issue even though the cortisol stuff, the cortisol rhythm may be fine. And again, the rhythm is gonna be where you’re getting the answers regarding energy. Are you higher in the morning, lower energy at night? So may see that more with the rhythm. The DHEA you may not be able to extrapolate that from those symptoms. So that’s my issue with people not running these tests and just basing it off of symptoms. I think it’s a—a big mistake.

Evan Brand:  Well said. And it’s not that you’re gonna necessarily get sick. You know, we’re not talking about playing with chemo drugs or anything here, but if you’re investing your money and you want to get healthy and you’re not getting healthy because you just got guessed, now you’re playing guess and check, well, your supplement graveyard is gonna get pretty big if you do that method.

Dr. Justin Marchegiani:  Plus it’s really nice to have a pre- and post-test to look at.

Evan Brand:  Agreed.

Dr. Justin Marchegiani:  Yup, so I like that.

Evan Brand:  Agreed. Well, cool. Well, any last words of wisdom for people? And then we’ll send them back to your website,, where they learn more about you. They can sign up for consultations if they wanna work with you and you got videos, you got podcasts, all sorts of free content, thyroid videos, hormone videos, etc.

Dr. Justin Marchegiani:  Well, I’d say off the bat, number one. Do all the foundational stuff. I mean, myself and Evan, we have great podcasts and great information out there. It’s totally free that people can listen to it and basically get access to our brains and our info, you know, the things that we’ve spent hundreds and thousands of dollars to learn over the last decade. It’s right at your fingertips for free. So most of that you can already access. So start with that information off the bat. Number two, if you’ve already tried some stuff and you bang your head against the wall. Remember if you’re trying to get better and you’ve already done the foundational stuff and you’re not getting better. If you don’t make a decisions to start seeing a good functional medicine practitioner out, you end up paying twice. Because you pay number one, with the quality of your health which starts to get worse over time. And the number two, as it gets worst, it becomes a more expensive and more timely and costly to fix it. So if you’ve already done the foundational piece, which you can access a lot of the information free from justinhealth on YouTube and podcasts at Beyond Wellness Radio and then notjustpaleo. If you’re doing all that, then the next step is you wanna reach out to a really good trained functional medicine physician or nutritionist or diagnostician to get the next steps lined up.

Evan Brand:  Well said and I’ll lastly add on the part of wasting your money. If you have a gut infection, it doesn’t matter if you’re buying organic grass-fed beef. If you’re not digesting it, you’re not getting those amino acids that are fueling your hormones, your brain, what’s the use?

Dr. Justin Marchegiani:  100%! And again, who goes cl—who goes and climbs Mt. Everest and doesn’t hire the Sherpa that’s gone to the top 50 or 100 times, right? You want that Sherpa that’s been to the top 100 times to lead your way, right?

Evan Brand:  Yeah

Dr. Justin Marchegiani:  Right, in the Mt. Everest analogy. So most people, they’re saying, “Yeah, I can climb Everest on my own, even though I haven’t done it yet and it’s kind of treacherous, meaning it can be expensive and timely and costly if you ma—make the wrong move, right?” You don’t die probably, right? It’s not like Mt. Everest. But you know, you’ll suffer. If—it may not just be on the health side. It might just be financially with taking, choosing the wrong supplements and getting that supplement graveyard like you said, right?

Evan Brand:  Yeah, and it’s—if you read books and hear podcasts on climbing Everest, I don’t think it’s gonna—it’s gonna mount up to the same thing as having that Sherpa there.

Dr. Justin Marchegiani:  I 100% agree. You got it.

Evan Brand:  Well, cool. Well, take care. Thanks for your time. I appreciate it as always.

Dr. Justin Marchegiani:  Evan, it’s been real as always, my friend. Thanks so much for having me on.

Evan Brand:  Of course. Take care.

Dr. Justin Marchegiani:  Thanks, bye!

Evan Brand:  Bye!

Low DHEA Levels & Adrenal Fatigue – Podcast #85

Dr. Justin Marchegiani and Evan Brand share with us today some pertinent clinical information regarding low DHEA levels and symptoms of adrenal fatigue. Find out DHEA-effectsmore about the relationship between DHEA and cortisol and get more insights on cortisol rhythms when you listen to today’s podcast. 

Learn about the symptoms that people get if they have adrenal dysfunction or if they have adrenal imbalance. Dr. Justin also discusses how DHEA affects women who are experiencing menopause. Discover what strategies you can do to help with stress hormones. Also find out about what salivary tests you can take to measure your DHEA-sulfate levels and learn how you can supplement DHEA.

In this episode, topics include:

00:58   About cortisol

2:33   What is DHEA?

5:03   Symptoms of adrenal imbalance

12:10   Strategies to help with stress hormones

15:00   Supplementing with DHEA









Dr. Justin Marchegiani:  Evan, it’s Dr. J.  It’s a beautiful Monday down here in Austin, Texas.  What’s going on over in Louisville?

Evan Brand:  It’s pretty.  I had the window open but I had to shut it because there’s a bunch of big trucks that drive by and I wanted a super clean audio today.

Dr. Justin Marchegiani:   Nice, awesome.  Well, we got more pertinent clinical information coming out from our patients and from our practice, so more applicable information for everyone at home and we talked in our pre-show that we wanted to talk about DHEA, dehydroepiandrosterone.  Do not confuse that with DHA, the 22-carbon fatty acid in fish oil, known as docosahexaenoic acid.  We got all these multi-syllable words here that belong on Jeopardy.  So we’re gonna be talking about the DHEA, the sex hormone precursor, not the fish oil DHA.

Evan Brand:  Yes, sir.

Dr. Justin Marchegiani:   Alright.

Evan Brand:  So when we’re looking at adrenal cortisol or adrenal stress profile test, this is something that you and I run on every single patient, we’re gonna see that 24-hour rhythm where we want cortisol to be highest in the morning and we want it to gradually drop to the lowest point of the evening, where melatonin can come up and the person can actually go to sleep and feel good.  But something that we see every single day is people are gonna have a few different things wrong with their adrenal rhythm.  So one is gonna be that they have high cortisol that’s out of the charts which means that their body’s in a super catabolic state and they’re in one of the earlier stages of adrenal fatigue where they’re trying to start thriving and adapting to this stress.  The body is producing excess hormones to deal with bear that they’re running away from even if that bear is taxes that they haven’t paid that they need to pay.  And so secondly–

Dr. Justin Marchegiani:   Yup.

Evan Brand:   What we’ll see is that the cortisol is gonna be depressed all day and they’re gonna be in the later stage of adrenal fatigue where they’ve waited so long, they’ve burned the candle at both ends before they’ve come to work with one of us that now they have the depressed cortisol all day and that’s a whole another issue.  And then the third piece of the puzzle, what we’re gonna discuss today, is the DHEA which I kind of using analogy of a bodyguard that’s gonna be anabolic in nature, that’s going to protect you from the potentially catabolic effects of cortisol and a lot of people will have either really high DHEA and their boat is still floating and they can cope–

Dr. Justin Marchegiani:   Uh-hmm.

Evan Brand:  With this cortisol or the DHEA is super tanked out and the cortisol’s tanked out as well and those are some of the worse cases that we’ll see.

Dr. Justin Marchegiani:   Absolutely.  Now DHEA, if we kinda break hormones into a couple of different categories to keep it simple, hormones typically help your body grow and heal and recover, fight inflammation and/or improve energy.  We kinda put our all hormones in that category.  Alright, if we look at like progesterone and estrogen, they’re helping with growth, right?  So growth, tissue growth, ideally pregnancy at some point for women.  We have sex hormones like testosterone and DHEA which can be very helpful for men and healing and recovery and again, we have hormones that are more stress-based hormones, catecholamines, norepinephrine, epinephrine, adrenalin, again those are all the same hormones, 3 different names, right?  Medicine likes to be confusing like that and those are helping more with stress responses and to mobilize fuel during a stress response. So if we look at it in 3 categories, it’s inflammation, it’s cell growth and repair, and it is energy.  So when we look at DHEA, that’s helping more of the anabolic, the growth side and as we become more and more stressed, our body prioritizes resources to deal with the stress of right now and hold off the healing of tomorrow.  The problem is if you’re constantly stressed, well, tomorrow always keeps on getting put off by one day and we never quite reach that optimal repair window that we’re looking to be in for optimal health.  So when we’re stressed, we’re breaking down faster, right?  That’s catabolism or being in a cata—a catabolic state, right?  It’s catastrophic to be in a catabolic state.  That’s how I—I remember that.  It’s not a good thing, so you’re breaking down too much and we wanna shift it over and DHEA is really an important anabolic hormone and it’s a pre-cursor, right?  Because it can turn into 7 or 8 different things.  They can turn into all 3 estrogens, estrone, estradiol, estriol.  It can turn into your progesterone and it can even turn to—into andro or androstenedione and it can even turn into potentially DHT and testosterone.  So a lot of different hormones it can go into and the goal is to help rebuild your body.

Evan Brand:  Yeah and DHEA drops with age, too.  So–

Dr. Justin Marchegiani:   Big time.

Evan Brand:  You and I aren’t too old yet where the point we’re still probably making a lot of DHEA but I’m seeing people with 22, 23 years old that have depressed DHEA levels worse than some of the 60-year-olds that we’ll look at.  So just because you are young, it doesn’t mean that you are gonna have that maximum output if your adrenal stress is going to overwhelm that level.  Maybe we should talk about some of the symptoms that people may be feeling if they do have some type of adrenal imbalance which would include DHEA.

Dr. Justin Marchegiani:   Great.  So a lot of the adrenal symptoms are gonna be connected in and around energy, in and around pain or inflammation whether it’s in the joints or it could be inflammation in the brain like brain fog, mood, memory, because DHEA is primarily gonna be produced by the adrenal glands, a female is gonna significantly notice it as they transition to menopause because now they’re—they’re not getting a lot of their anabolic hormones from their ovaries anymore because they’re no longer cycling.  So as soon as they start going into this perimenopausal range where they start shifting or missing periods or they go 3 years without a period, that’s considered to be menopause.  Once they start transitioning between 48 and age 51, they’re gonna be relying more on their adrenal glands for that sex hormone output.  So my analogy is we get this backup generator, right?  Let’s see you live in the northeast.  I great up in the Boston area so this was common for me.  But you’d have a—you purchase generator because if you ever had the power go out because of a big snowstorm for 2 or 3 days, you wanna make sure you don’t freeze.  So you buy this big generator and typically the generators will run off of either electricity or gasoline.  Now the gas has to be in the tank for that generator to work.  So imagine if you got this big snowstorm, it hits and you don’t fill that generator up fully with gasoline, well, now when it comes time to need it and rely on that generator to power your house and to keep the heat going and electricity on, well, it’s not gonna be there for your needs, so you’re gonna start having symptoms have like maybe lower heat in the house.  You may have less electricity.  Maybe the TV will flicker.  Now that’s kind of akin to your adrenal glands because that’s the backup generator for women as they go into menopause for their sex hormones, so just like we had a—a generator that was not fully charged when the snowstorm hit, the snowstorm now is gonna be menopause so when menopause starts happening that generator, your adrenal glands, are more depleted with DHEA so now when we start to rely on more on those adrenals, they aren’t gonna be there to help us in this stressful transitionary period.  And then the symptoms of menopause come on harder which can be the mood, the hair loss, the—the skin issues.  Obviously the hot flashes, fatigue, depression, a whole milieu of symptoms.  It could be 20 or 30 going down a line, vaginal dryness, low libido, all of the—you know the top 10 or 20 things that we see, weight gain that all of our patients complain of.

Evan Brand:  Yeah, I would say the sex drive one’s huge, too.

Dr. Justin Marchegiani:   Yes.

Evan Brand:  Every woman is—I—I’ve heard several women say they haven’t had sex in 10 or 15 years with their spouse.  That is a long time and not to say that that’s what the whole relationship is built around, but a lot of people prioritize that as making love is a—is a good piece of their marriage and if that’s not in place due to hormones, it’s not you that will often get blamed or you’ll feel guilty or something or not.  It’s time to take a deeper look at the hormones, it’s not just your brains.

Dr. Justin Marchegiani:   Yeah, I totally agree.  And then a lot of times that’s a symptom of something deeper hormonally, right?  Because fertility is an important sign of health.  So if for some reason those fertility signals aren’t there, i.e., libido being an important fertility signal, right?  If we don’t have the libido, then you don’t have the—the strong motivation to—to have intercourse or to make love.  So that’s a really important sign that something is not there on the hormonal side and again, when we have adrenal issues, we kinda have our 3 stages of adrenal fatigue or a better terminology is adrenal dysfunction, which just means as we go from stage normal to 1, that’s a sign that cortisol’s increasing and as we have that hyper-stress response, cortisol and DHEA will typically increase together.  And as that response stays, right?  If we have like someone sneak up behind us—boom—we go into that stage 1.  It’s a quick—we call it the alarm phase by Hans Selye.  It’s the alarm phase.  So—boom—cortisol goes up, eventually we adapt and we go back into normal cortisol rhythm.  But if we continue to stay stressed, our cortisol will start to drop with the rhythm.  We’ll start to become more aberrant, meaning instead of having that nice high to low to lower to lowest rhythm, it starts going off.  Maybe a little bit lower in the morning or higher in the afternoon or lower at night, right?  And we start to feel that in our moods and our energy, and then we start to see DHEA drop in the stage 2 as well.  DHEA will drop.  And as we go into stage 3, we’ll start seeing cortisol and DHEA drop as well. And that’s like our ideal like scenario.  We can go into some other scenarios that happen outside of our conventional 1, 2, and 3 for adrenal dysfunction.  But as we go deeper from 2 into 3, what’s happening is HPA axis dysfunction.  That thermostat in our brain is not able to talk to the AC and the heater, i.e., our adrenals and maybe thyroid and other gonadal glands.  So we start having this type of dysfunctional pattern.

Evan Brand:  So the way that I’ve understood, too, and correct me if I’m wrong is it’s not that the adrenal glands run out.  They’re never gonna run out of hormones because they’re being told what to do by the brain and this whole HPA axis, so I’ve used this analogy for a while where the body is basically saying, “Hey, Justin, every time we give you stress hormones, you’re taking it and you’re running with it, and burning the candle at both ends or whatever, and so now I’m gonna downregulate and stop producing these hormones for you.”  So basically what we’re doing is we’re trying to turn on this process again and basically tell the nervous system in the brain, “Hey, everything’s okay, let’s turn the system back on.” Is that the best way to bring that across or do you have any other ways you could explain or visualize that?

Dr. Justin Marchegiani:   That’s exactly what we’re trying to do.  We’re trying to get that HPA axis rhythm back on track.  We’re trying to help support our body’s ability to regulate inflammation, generate energy, but also repair because the allocation is always hard wired to deal with the stress of now and the healing of tomorrow and we wanna make sure tomorrow actually happens. so our body can do what it has to do to repair.

Evan Brand:  I mean, we definitely are in the—I think there’s a key chess piece going about it.  It’s like a here today, gone tomorrow world, or something to that effect where people really are—they’re so stressed out and they’re so focused on today. 

Dr. Justin Marchegiani:   So Evan, we were just talking about strategies to help with stress hormones and to help push some of the anabolic hormones like DHEA back into balance. If you wanna go over a little more specifics on that?

Evan Brand:  Yeah, so the treatment is something that we’ll get to but the testing is the first step so people listening they may resonate with some of the symptoms but you really have to do get that—you need that 24-hour cortisol rhythm to be able to identify it and that’s something you and I rely on very heavily because without it, we’re just guessing and checking and that’s where—this is nothing against naturopaths or anything, other type of medicine practitioner—but if you go to someone and you complain of the symptom and you just get thrown a supplement and even if it is a natural herbal supplement or minerals for example, if you don’t have a lab that you’re basing that protocol on, you’re sort of short-changing your potential results because you might start spending money on various supplements and bottles and I know everyone has a supplement graveyard where they’ve tried things and they don’t work, you and I want to minimize how many supplements end up in the graveyard or completely eliminate the graveyard because we’re gonna be basing things on your results rather than, “Well, I think you might benefit from this.”

Dr. Justin Marchegiani:   Exactly. And again a lot of people is they get older that DHEA drops like we talk about and with some people, obviously, say with all people the diet and lifestyle strategies are gonna be really, really important, right?  The blood sugar stability, obviously making sure diet’s like a Paleo template to start and then making sure we’re getting sleep and doing some movement.  That’s kind of foundation.  So everything we talk about after that is gonna be that already assumed.  Just so we’re clear on that.

Evan Brand:  Right.

Dr. Justin Marchegiani:   But supplementing using DHEA, we like to do it sublingually because we bypass the liver and if we have patients, which we do quite frequently, that have digestive issues, we can bypass the gut, we can bypass the liver which can deactivate about 4 times—you have to get 4 times more orally via pill than you do with the sublingual drops.  So we can bypass that, we can get the same effect of an injection without the needle by absorbing it to our sublingual and buccal tissue in the mouth.

Evan Brand:  Uh-hmm.  That’s great.

Dr. Justin Marchegiani:   So again dosage-wise, we like to use smaller doses or lower doses, typically 5 to 10 mg is a pretty good starting dose and it’s kind of a little bit contradictory in thinking about we would actually use the more adrenally fatigued or the more adrenal dysfunction there is, we typically want to use less DHEA because of the fact that DHEA can also have an effect of lowering cortisol.  So you can th—you can think of DHEA and cortisol as like a seesaw and the more DHEA we put in the system, the more it can decrease our cortisol level, so if we’re already having issues with energy and adrenal insufficiency and low cortisol and inability to regular inflammation, going too high on the DHEA can definitely cause some problems.

Evan Brand:  Yes, sir.

Dr. Justin Marchegiani:  So regarding that, typically we do DHEA between 5 and 10 mg sublingually, and then as a couple—so that’s spread out over 2 or 3 times—3 times over the course of the day because we’re trying to mimic normal physiology and not just give one whack at once, right?  Your adrenals aren’t gonna just spit out a whole bunch of DHEA all at once.  It’s gonna do it naturally so mimicking natural rhythms is gonna be the best possible way to handle it.

Evan Brand:  Yeah, so if you’re at the health food store and you see 50 mg of DHEA, don’t buy and start taking that supplement just because you think you have low DHEA.

Dr. Justin Marchegiani:   Definitely not worth it.  And then also with DHEA, we—you alluded to like the DHEA cortisol ratio, typically we’re at this 6:1 type of ratio.  We should be able to make at least 6 times the amount of cortisol in relation to one unit of DHEA.  And as we start going above that, like you had a patient I think morning, Evan, that was at 30 you said, so there are—if we do the Math, they’re 5 times more catabolic than anabolic.  In other words, in layman terms that means they’re breaking down 5 times faster than their body should be rebuilding and healing.

Evan Brand:  Yeah, and this is actually a guy who’s doing CrossFit 3 to 4 times a week, and he’s wondering why he can’t build muscle.

Dr. Justin Marchegiani:   Right, exactly.  And again, there’s a lot of stuff out there on DHEA like not working, like not being good, or not being the best thing.  There’s a lot of factors that go into it, right?  Are we using DHEA in conjunction with the right amount of pregnenolone?  Are we fixing underlying issues, right?  If we just use DHEA like someone uses ibuprofen for a headache, right?  Well, that may not be the underlying issue.  If you’re banging your head every day and you’re taking ibuprofen for a headache, well, the underlying cause is banging your head.  Now that’s kind of a drastic analogy but people have underlying analogies like infections or low stomach acid or dysbiosis or SIBO, or toxicity issues or food allergens and that—even though the banging the head is pretty obvious—it’s more subtle with the underneath things but that may still be in motion and happening every day, so we gotta make sure if we’re using DHEA and potentially pregnenolone with it, we gotta make sure it’s being used in conjunction with the comprehensive functional medicine program.

Evan Brand:  Yeah, exactly, and based on labs.

Dr. Justin Marchegiani:   Based on labs, yeah.  And then typically for labs, we’re using that 2:10 I think—I think it’s the pg/mL ratio.  It’s the typically salivary ratio that most labs use like BioHealth uses it, Diagnos-Techs uses it, CRT uses it, that’s your—your broad spectrum lab ratio and we like it—I’d say 6:10 is a pretty good place for me.  What do you like?

Evan Brand:  What are you—what are you saying?

Dr. Justin Marchegiani:   For the lab rate—so like at the—the lab levels on the salivary lab, a DHEA-sulfate, what level do you like patients to be at regarding their DHEA?

Evan Brand:  Most people they feel the best somewhere on the mid to upper end there, closer towards 6, 7, sometimes 8, definitely not what I saw this morning which was I think a 0.8 DHEA.  That was just awfully low and he can feel it.

Dr. Justin Marchegiani:   Wow, you saw someone at a 0.8!  Yeah, that’s really low.

Evan Brand:  Yeah, and this is the same guy.  This is the guy whose cortisol sum was decent and he was like a 28, when we would consider something like 30 or more decent.  So he was—he was decent on cortisol but the DHEA was less than 1 unit.  So that’s the lowest I’ve seen, and most people say they feel best, it seems like 5, 6, 7, 8 somewhere in there.  And then I’ve seen some other crazy ones—I’m sure you have, too—where DHEA was 20 or 30, just out of the roof and sometimes I found that these people were just popping DHEA supplements like Skittles.

Dr. Justin Marchegiani:  Exactly and the—the range that I like for the lab of the DHEA-sulfate, that’s the salivary DHEA—DHEA-sulfate, it’s looking more at the storage form of DHEA, like 6:10 and that’s an ng/mL, nanograms per milliliter.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:   Okay, and then in the lab range like some of the blood labs, they’re a little bit different for the blood lab.  We typically like in the—in the 200s for the blood lab.  I’ll pull up my template that I typically use with most patients here in a sec.  Any other comments on the salivary labs that—the salivary lab ranges?

Evan Brand:   No.

Dr. Justin Marchegiani:   Got it.  Yeah, so looking at the blood labs are a little bit different.  When we look at the blood, so the reference range maybe a tiny bit different here.  Our blood labs, we’re typically gonna be looking at DHEA-sulfate.  I like upwards of 250 to 300, and that’s micrograms per deciliters.  So different reference range, different standard deviation, so upwards of 250 or so is a pretty good place to be and if you’re on DHEA drops, you gotta be mindful that you come off them for a day or at least 36 hours to 48 hours at least 2 days to get an accurate reading of what you’re DHEA levels are actually pumping out from the adrenals.  Anything else you wanna add, Evan?

Evan Brand:  No, that’s it.

Dr. Justin Marchegiani:   Alright, great.  Well, I know you got a patient here.  I do as well.  So wrapping it up, get your blood lab, a DHEA-sulfate done and/or get a comprehensive cortisol rhythm like Evan mentioned using the salivary DHEA.  Well, great talk today, Evan.  We will be in touch very soon.

Evan Brand:   Take care.

Dr. Justin Marchegiani:   Take care.

Evan Brand:  Bye.

Dr. Justin Marchegiani:   Bye.



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