Investigating Your Adrenal and Hormones With a DUTCH Test | Podcast #327

In this video, Dr. J and Evan talk about the adrenal glands in our body – to produce certain hormones directly into the bloodstream. These hormones will respond to stress and other necessities to our existence. Also, they are discussing the detailed test needed to identify the root cause of problems and what other materials and hormones are essential to keep our adrenals and body healthy.

To support the body naturally, Dr. J recommends using herbs such as maca and ashwagandha. Progesterone, estrogen, and estriol may be fit for a patient. However, it is essential to know that protocols may be different for every patient since presentations and lab results may differ.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

0:20     Labs At Home

5:07     Low Cortisols

9:37     Hormones

11:09   Dutch Tests

28:19   Useful Herbs

34:47   Healthy Estrogens

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Dr. Justin Marchegiani: And we are live. It’s Dr. Justin Marchegiani in the house with Evan Brand. Today we’re going to be talking about hormone and adrenal lab testing what we’re actually using in our virtual clinic to assess our hormone imbalances in our patients and different things that we’re doing to address those imbalances. Evan, how are we doing, man? 

Evan Brand: Good, excited to get back in the saddle here and talk about something that we can test at home, which is amazing. I think that’s the first benefit to point out about some of the testing you and I are utilizing is that many people now they care more about their health than ever obviously, the state of the world has convinced people that health does matter. You need to prioritize this stuff. And so we can send these labs to your door. And so the test that you’re going to be showing people today will be something that you can do if you’re listening via audio, you might miss the visual, you can go to Justin health YouTube channel and see the video, but we’ll be sure to make sure we talk about it in a way that you can still understand even if you’re just audio only today.

Dr. Justin Marchegiani: Yeah, if you’re listening to the audio, we’ll put a link down below for the video so you can see it. And also if you’re listening, you can go to Justin slash YouTube and hit subscribe. Alright, so let’s dive in. And so we deal with patients from all over the world virtually that have all kinds of different hormonal imbalances. It can range from a menopausal woman with lots of hot flashes, mood issues, vaginal dryness, depression, skin elasticity, hair loss issues, it could be a cycling woman that has a lot of PMS. pmdd breast tenderness, cramping, back pain, mood issues, irritability, also infertility as well. And then it was a lot of different imbalances in between excess androgen issues like we see in pcls, polycystic ovarian syndrome, we may even see estrogen dominant issues just like which could be PMS as well. Could be infertility, could be fibroids could be endometriosis could be fibrocystic breast issues, all of these things are on the table and of course, even manage a male issues to could have men could have excess estrogen and or low androgen and or low or high cortisol and or low or high Da, da all these imbalances are potential, I always tell my patients, you have the right to have more than one issue at the same time. And you can also have a hormone imbalance and also have multiple gut infections too. Of course, it’s all possible, right?

Evan Brand: Yeah, people hearing that too. They’re like, what the heck kind of mumbo jumbo? Did he just say, and how does that manifest? Well, you know, low libido, too. I mean, that’s one that I’d say at least 90% of the people I’m working with, that’s a question we always ask is, you know how you drive. And sex drive is always terrible for people. I was actually a study that came out. And the vast majority of people surveyed said that they would rather scroll on their smartphone on social media than have sex with their partner. And I thought, Oh, God, is that where we are in the technology world that the phone is more desirable than our partners? That’s no good.

Dr. Justin Marchegiani: Yeah, definitely not good. 100%. So I just kind of laid out a couple of potential patterns there, we’ll kind of dive into them one by one will actually show you a real live patient lab here for y’all to kind of look at obviously, it’ll be centered regarding who the patient is. But we’ll put all that information out there for y’all. So you can kind of see how a lab looks out of the gate. So one of the first things that we do when we look at a patient, male or female, we’re going to look at adrenal function. And adrenal function is very important because your adrenals make cortisol. Cortisol is an anti inflammatory hormone. Most people in today’s day and age, they’re not under inflamed, they’re over inflamed. So having your body’s natural anti inflammatory system on board is vital, very, very important. Second is cortisol rhythm. Cortisol rhythm plays a major role in your circadian rhythm, which is waking up energy in the morning. Having good rhythm helps a lot with mood, and also lower cortisol at night. And that nice gentle taper of cortisol. So cortisol starts, it starts mid range, when you wake up, and in that first 30 minutes to an hour, it almost doubles. And then from there, it tapers down throughout the whole day. And we want a nice lower cortisol rhythm, lower cortisol level at nighttime, so we can wind down and relax not too low, when we start having maybe blood sugar issues, which could wake us up at night and not too high, where we could have problems going to bed because we’re too wired right, or not a reverse pattern, we’re lower in the morning, which means low energy and higher at night, relatively speaking, which could cause us to have too much energy at night and then we don’t get good sleep. So the adrenals play a really big role because of cortisol and its effects on anti inflammatory mood, rhythm, sleep, and then also especially for women listening men too, but da da da da sulfate is a precursor to a lot of our sex hormones, that helps with our female hormones. And that plays a big role in healthy, healthy reproduction. people. People think when they talk about female hormones or just thinking about having babies no your hormones there to reproduce you Yeah, reproduce the baby but also reproduce you which means healthy aging, healing recovery as a man to healing recovery. Healthy libido, good muscle building. In good building the ability to turn over your tendons and ligaments and bones, all these things require good healthy anabolic metabolism.

Evan Brand: Yeah, great point. You know, one thing you pointed out, which I think a lot of people miss with cortisol is you mentioned cortisol being too low at night and that impairing your sleep. See most people just a buzzword, or if they’ve ever heard of cortisol, they’ve heard of adrenal testing and things like that. They think, okay, high cortisol at night equals poor sleep. But you mentioned low cortisol at night or too low cortisol at night could also be an issue because of that blood sugar. And then what can happen is you and I’ve covered this before, but there’s some sort of a spike, right? Maybe an adrenaline cortisol spike in the middle of the night, is that what you think is happening?

Dr. Justin Marchegiani: Yeah, so with sleep issues, you could definitely see a low cortisol kind of going into nighttime or low cortisol during the night. And that can cause a drop in blood sugar, and that drop in blood sugar can then signal a increase in adrenaline. So adrenaline tends to come to the scene first, cortisol tends to come to the scene 1020 minutes later, or so. So you get this spike of adrenaline that’s very stimulatory, that increases cortisol. And then now you’re alert and you’re waking up, right? So we want to make sure higher cortisol, lower cortisol at night that’s causing a increase in cortisol is not happening due to blood sugar regulation. So we want good blood sugar, good healthy protein, and fats, maybe work on amino acids and melatonin production at around bedtime, and maybe have something by your nightstand to help stabilize blood sugar before in your end. Or if you get up like a nice simple college and smoothie, or a really good protein and fat base, simple bar by your nightstand to stabilize blood sugar, those are all really really good options to help you on the sleep side.

Evan Brand: So like if you had a good quality protein, fat, maybe some carb starts with dinner, but let’s say I don’t know, 9:10pm, you go to have a snack and you just do. I don’t know popcorn or I don’t know, handful of strawberry, some kind of a simple sugar, you think it’s possible that your glucose could spike and then it will crash in the middle of the night if you’re doing something too simple or too high on the glycemic index?

Dr. Justin Marchegiani: Well, it depends on how blood sugar sensitive you are. I mean, the two examples you gave are two different things, right? Because grains and popcorn are going to be a little bit more higher glycemic, higher sugar stuff, strawberries, pretty low glycemic and a lot of fiber there, so probably not as much with the strawberries. But could you have some strawberries and maybe a spoonful of almond butter, right or some kind of a good fat or protein probably better, right? It just depends upon what time you’re going to bed and what time you’re eating. Usually you see people that are eating around five or six o’clock dinner, and they’re going to bed like around 11. And there’s like a five hour gap between their last meal and sleep potentially. And again, it has to do with how dysregulated their blood sugar is and how weak their adrenals are. So it really depends. But if sleeps an issue, that’s one pattern we want to look at. We talked about da da playing a big role. If you’re a female going into menopause, that means your egg follicles are being used up essentially. And you’re not going to get that hormone production from that follicle that’s now no longer there. So we require a lot of the DA DA from our adrenals to now be made. And if our adrenal reserves on da, da are low, guess what? We’re not going to have that that backup battery that we had already to go right we’re in middle of, we’re just coming out of a bunch of storms in Austin here. And if you didn’t have a generator ready to go, guess what you you went without power for a while, well, that’s kind of like going into a spa, menopause is going into a storm with a generator that’s maybe three quarters empty. And so the adrenal is play a really important role as the backup generator for sex hormones. And so the better that generator is charged up, the easier you’re going to sail into menopause and not have all the hot flashes and mood issues and sleep issues and skin issues and hormone issues and vaginal dryness issues that you may have with lower sex hormone reserves.

Evan Brand: Yep, well said you’re ready to show us this thing. I’m sure people that are on video want to see what the heck we’re talking about. We can see some of the rhythms and also da da is measure two, which is cool. So when we talk about a cortisol test, we’re getting a lot more than cortisol to right we’re getting melatonin also.

Dr. Justin Marchegiani: Exactly. And then one last thing to look at is PCOS, which is also common. You see it more in younger women, you know, 20s and 30s. But blood sugar issues high level of insulin, this can really jack up testosterone and this can do a whole bunch of issues in regards to abnormal hair growth, you may see an increase in libido, some still go down. And then of course, weight gain is going to be another another big side effect there. Let me share my screen with you so you guys can see an actual lab test for y’all. Okay. All right. So while I get that going here, in the meantime, anything else you want to say about that, Evan?

Evan Brand: Well, you and I were talking about this before we hit record and that was the idea of retesting hormone. And so you thought well, based on a lot of people with progress, you don’t necessarily need to incur the cost again. So a lot of times you and I may run this as an initial snapshot, but depending on symptoms, you may not need to do this over and over and over again because a lot of the support We’re using a pretty broad spectrum. And they’re going to help regulate your rhythm regardless of where it’s at. Right? So initially, we may want to tweak one thing a certain direction or the other, but long term care wise, you and are using things that are pretty, would you just stay state stabilizing, not necessarily a big sledgehammer to the hormones.

Dr. Justin Marchegiani: It depends for me. So if someone has very, very low cortisol levels, or very, very high cortisol levels, and or significant estrogen dominance and low progesterone, the more significant the hormonal pattern, the more significant the imbalance, the more I want to retest less significant if we see corresponding symptomatic improvement, usually it becomes less necessary because the patient knows they’re getting better we can feel it, we can see it in their their physiological activation and how they’re sleeping, their mood, their energy, their libido, we can you know, their cycle, there’s just so many things that are improving that the patient is confident that we’re good. And if the imbalance isn’t major, right, they’re not a fertility case. They don’t have a major hormonal imbalance right there that may not be necessary, but I always kind of I’m on the fence always give the patient the ability to to make a decision on that. So this is my screen here, Evan, are you able to see it?

Evan Brand: Yep, we see it just fine.

Dr. Justin Marchegiani: So here’s a Dutch test that’s done with a patient whose kind of perimenopausal menopausal, meaning their cycles kind of been on and off hasn’t really had it for six to eight months or so kind of in that area of transitioning into full menopause, which is usually not having a cycle for a full year 12 months in a row. So they’re kind of in this Peri menopausal phase, and usually perimenopause and start to hit in your, in your early to mid 40s. When you start skipping months, maybe you start having some hot flashes like symptoms, whether it’s mood or libido or a hot flash stuff. And again, it’s always tough to say because perimenopause can easily feel like PMS too, right? I think that the biggest differentiating factor is not having all the hot flashes and not having the skip cycles. When it comes to more of the PMS like stuff, that’s usually a distinguishing factor. But we look at the Dutch test a couple things here. This is our cortisol pattern, our daily free cortisol pattern. And you can see you wake up here at a and your cortisol should taper up in the morning, this isn’t within the first hour and then go down throughout the day. So this patient actually started with a here, right, this is cortisol with a pretty good rhythm out of the gates. But instead of picking up 100% or so they actually went down. So they started here that having that nice rise, they went down This is big, this is a big problem, right not going to have the energy you’re not going to have that good rhythm that good up and Adam kind of energy in the morning and they trace low the entire day, relatively low and flat the entire day. So we call this a flat cortisol rhythm relatively speaking, it’s flat, they should be starting here a peaking up at B and then gently tapering down throughout the day. And they basically start at a at their highest point. And they go down throughout the day. So very low and flat cortisol rhythm. Now when we look at their cortisol levels, they’re free cortisol, which is a+b+c+d, this is what’s represented on the graph here. And again, if you’re listening on the podcast, click down below to watch the video link if you want, if not, we’ll just try to describe it. They’re free cortisol when you add a plus b plus c plus d is 73. That’s very low. So if you see this little gauge here, imagine this is like the volume knob on your stereo, this is all the way up high this star and this on the left all the way up low. So they’re almost all the way till the to the left. It’s like their volume knob is like 5% on it’s like having a whisper out of their stereo. So 73 is very, very low. Now this is the cool part, right? So normally with a salivary test, right, the Dutch test is the dried urine for testing comprehensive hormones. The benefit of this test is we get a window into free cortisol, but also total cortisol could its urine with a salivary test, we’d only be able to see this 73 number, which is the which is the free cortisol, that’s two to 5% of all cortisol is free, and biologically available. The other total, which looks at the free, which is the two to 5% Plus, everything else that’s protein bound, is give us a window into all of our cortisol, we’re making them this is the cool thing. We never would have this number on a free cortisol test from saliva. But you can see their total cortisol, which is everything is very high. It’s 93 04. Right? It’s way off the charts. Hi. So they have very, very, very low free cortisol, very, very, very high total cortisol. So there’s not like an adrenal fatigue issue or like a low adrenal pattern. Even though the cortisol is low, their adrenals are making a lot of it right. And this is a common pattern we see when there’s HPA access dysfunction. So if you go down to this page over here, you’re gonna see what the HPA axis is. I’ll go back and I’ll just explain this in a minute. But if we go down to this page here, the HPA axis we have this feedback loop from the hypothalamus and the pituitary. This is the HP portion of the HPA axis. And this communication feedback loop talks to the adrenals where we make cortisol with We make DAGA. And we have our free cortisol, we have our total cortisol, we have our DAGA, this feedback loop from our corticotropin releasing hormone to the adrenal corticotropin releasing hormone. This feedback loop is our HPA access. And when this starts to break down, and that feedback loop that miscommunication happens, this is where we start seeing a very high amount of total cortisol and a very, very low amount of free cortisol. Does that make sense out of the gates questions they’re having?

Evan Brand: Makes perfect sense. So what do you do?

Dr. Justin Marchegiani: Yeah, so let me continue to roll with that. Let me go back up here a little bit more.

Evan Brand: DAGA production look good there, though. That was nice to see.

Dr. Justin Marchegiani: Let’s kind of break it down. So I always hit things like this. I might order of doing things that way. I don’t miss anything. So the first thing I look at is cortisol rhythm. How’s the cortisol rhythm? Good in the morning. A and then B, C, and D morning after night are low, low, low. So normal, low, low, low. So definitely poor cortisol rhythm. How’s the cortisol amount? Well, free cortisol is low. Okay, total cortisol is high. Now, so I tend to treat someone more in the middle in regards to their adrenal support, I won’t over support their cortisol too much, because we know they’re making a lot. So we’re really going to focus on an in between amount of cortisol and more HPA access support in regards to adaptogenic herbs, we really have to support good adaptogens. This being a menopausal woman, or Peri menopausal, we’re going to support the adrenals. We’re going to support HPA access. And we’re also going to use herbs to support the estrogen and progesterone receptor sites, we’re going to do both Okay, so you can see her now the next part is sex hormones. So we talked about the total cortisol right free cortisol, low total cortisol high strong HPA access pattern, and then the sex hormone wise, estrogen Astra diawl is low. This is primarily the hormone that’s going to be used in cycling women, progesterone is low, they’re both equally low, you see how they fall in the same place in the dial. So if you’re looking at the volume knob, they’re both in the same place, they’re both low on the volume knob. Usually with estrogen dominance, we’ll start to see the estrogen knob higher up relative to progesterone. So that tends to give us a good ratio if we’re intact. So estrogen to progesterone ratio is good. But the hormones are just low altogether. And then testosterone for a perimenopausal woman it’s in the bottom 25% of the range. Not bad. For a perimenopausal woman, you know, top 25 or top third to half is ideal. Not bad at all.

Evan Brand: And this woman was not doing anything correct. She wasn’t doing any dapa or testosterone support-

Dr. Justin Marchegiani: Correct. And then I ignore total da da, I look at these numbers individually here, I look at da da sulfate, eat a clan alone and I look at them all separately. Her total da da number it looks okay. But that can give you a false interpretation. And again, I’ve been doing labs like this lab for six years, I’ve been looking at hormone labs for over a decade. So I mean, I’ve done 1000s of these things. So I always try to boil it down to the to the patterns and the data that matters and ignore the fluff.

Evan Brand: So how would this woman feel I think important to mention, you know, all these numbers, people may look at this and think okay, this looks like Greek so can you just explain how would a woman with that pattern be feeling we’re seeing that cortisol was okay?

Dr. Justin Marchegiani: Peri menopausal symptoms, a lot of Peri menopausal symptoms, libido, mood, hot flush stuff, skipping cycles, of course, low energy, mood stuff, all of those things are present for sure. And then look at her DAGA sulfate here, right? This is the backup generator of the sex hormones to the bottom 25% of the range. So this is the dial here, right? 170 she’s definitely on the lower part here that bottom 25% I like to group things based off a percentage, then the actual numbers don’t matter as much like I just say, hey, you’re in the bottom 25% of the reference range. I like my patience in the top half the top 25% or so. So I always look at things as a percentage. That way you don’t get overly infatuated on the numbers, the numbers can kind of confuse things testosterones in the bottom 25% not as bad there. But I mean, if we get the DAGA to the mid range, that testosterone should take care of itself because that’s gonna trickle downstream from DAGA to Android to testosterone. All of her androgens are okay, they’re all mid to upper 25% no problem. They’re her hormones are pretty balanced in regards to five alpha reductase. This is kind of the enzyme is very important to things going down a less androgenic pathway versus like DHT, which can be more associated with hair loss and prostate issues. And then if we go look at her estrogen levels over here, so this is progesterone, progesterone is calculated by pregnant a dial press plus alpha prineta dial so alpha and beta combined and we already saw her levels here. This is 1.9. I don’t know why the lab doesn’t show that number here. It should it’s like an error, but it’s 1.9 should be the progesterone number Now go look at the estrogen and that’s low. I mean from a cycling female we want at least 10 ideally 15 on the progesterone and then if we go look on the estrogens right, she’s low across the board. So estrogen is he one you know how you know it’s you want it has plenty in it, right? And that’s how we know it’s a one. And then Astra dial, this is your primary cycling estrogen. And it’s easy to because it’s got the prefix di and their di meanings two right, like two sets of dice die. And then we have estria, which is e three and the TRI prefix is how we know it’s e three. So for short e one e two, e three, or estrone estradiol estriol. And again, Esther dial will predominate when you’re cycling more, and estriol we should shift when you’re more menopausal, okay. And we tend to support more estria when they’re men appointment, women are menopausal. So her estrogens are pretty low across the board, you can see that you know, it’s gonna, these are all the metabolites downstream. But you can see, and again, if we want healthy estrogen metabolism, right, we have e to e4 and e 16, which are a different estrogen metabolites. And then you can see here, it goes down this protective pathway from a one to two hydroxy astone. And then that goes down into it and gets methylated into two methoxy. estrogen. And you can see here, right to keep it really simple. This 2.5 number on the estrogen metabolite should go down this pathway, at least half of that should be metabolized. It’s not so you can look at this at this methylation gauge. Don’t look at the numbers, just look at the gauge. So her methylation activity for metabolizing. Estrogen is actually low. So this is not getting fully metabolized. Now, why is that a problem? Well, one, she’s not metabolizing estrogen to her estrogen levels are low to begin with. So it just tells me that there’s some methylation detoxification issues that are a problem. Why could that be a bigger problem? Well, if we start supporting more da, da, maybe start supporting hormones better, this could cause a backup in regards to her hormones being metabolized, we may want to really work on supporting extra sulfur groups extra methylating nutrients, so there’s not a clog in these hormones getting metabolized. So, in general, we want to see at least half of this getting metabolized downstream. So if we look at two hydroxy, one, we want at least 1.25 there. And again, forget the numbers, it’s all represented in the gauge. So I want this gauge at least mid range. If the gauge is not mid range, and it’s on the lower side, it tells me we’re not metabolizing or methylating, our hormones actively, you know, as optimally as possible, and we may want to provide supporting nutrients to help that.

Evan Brand: So let me ask you this, if a woman, maybe she had run this and got the analysis from you, but then she just went to her conventional hormone doctor down the street, and he goes and puts her on some estrogen and maybe some progesterone, maybe some testosterone, how would that differ in terms of outcome based on this versus what you’re going to do?

Dr. Justin Marchegiani: Well, number one is they’re going to look at your extra dial just via the blood. And that’s okay. But it may not be able to look at free SSL dial as well. And most of the time, they’re not going to time it up at the right time of the cycle, you really want to time some of these things up around day 20 of the cycle to get a window of where progesterone is at. And then of course, you have to compare it to where in the cycle it is. And the next thing is no one’s going to look at how it’s being metabolized downstream. So we get a window into our total estrogen. All of our estrogens e one, e two e three, not just extra dial, we’re getting a window of progesterone as well. We’re getting a window into our androgens, we’re getting a window into d h, EA and our testosterone. And then we’re also looking at how it metabolizes downstream from 16 hydroxy from four hydroxy and to two hydroxy to four and 16.

Evan Brand: And then what’s the protocol? What’s the protocol for this woman?

Dr. Justin Marchegiani: So it depends. So off the bat, we may want to support estrogen metabolism a little bit better. That could be giving something like NAC it could be giving something like glutathione, it could be doing something like indole, three carbinol DIMM, or calcium to glucose, they could all be really good options. Even just giving some extra fiber could also be really helpful. Just to help out of the gates just to make sure there’s no bottlenecks there. Number two, we would support the adrenals accordingly, okay, we would support sex hormones as well. So depending on if she’s cycling or not, because remember, this woman kind of was skipping cycles. We would definitely do herbs like different kinds of phenotypes of Makkah that we use I use a product called feminine essence menopause as a special phenotype of Makkah. You can get that adjusted slash shop and the female hormone section that’s wonderful because it works on upstream HPA axis. We may work on the in different herbs to help the HPA access to like ashwagandha which is wonderful at modulating that hi level of cortisol. And then depending on hormones, we may want to throw in some progesterone, especially if she’s cycling in the last half of the month. And we may want to throw in a little bit of estriol. It depending on if she’s cycling or not, if she’s transitioning into menopause at her age, right 52, I think is the age of this patient. Well, the average age of menopause is 4852. So she’s definitely on the later side. So she may be transitioning into menopause. And if she has no cycles for a period of time, we may want to throw a little bit of estriol in, but if she’s not, if she’s still cycling, we don’t want to do any sgl. Right now, we want to focus on good healthy herbal support for astron production, we want to focus on good da ta support, we want to focus on progesterone, the last half of the month, we want to also focus on good estrogen metabolism. We want to focus on really, really, really good HPA access, support, all of those things are going to be really, really important. I’m not going to give like an exact protocol on dosing, just because it’s you know, this is a very general kind of thing right now, I don’t have the patient in front of me, but it just kind of gives you a good idea. What what I’m looking at there.

Evan Brand: Totally. So someone may think, oh, they saw that high metabolized cortisol and they may need, they may think they need to come in and do something like relora, which a lot of people talk about to lower cortisol, that is not the right choice to do because her total, or the free cortisol is already on the low end. Correct. So like at nighttime, like if this woman says, Hey, I’m not sleeping good at night, you’re not going to come in and use relora are you because that would take the low situation and make it lower? Is that right?

Dr. Justin Marchegiani: I wouldn’t give something that would lower the free cortisol more like something like a phosphatidylcholine or serine. Right. But I would do some things to calm down the HPA axis for sure. So things that really can help calm it down. Because that total cortisol being really high is what’s telling me that there’s definitely HPA access issues. But I mean, you know, it’s possible some of these symptoms could could kind of conflict because our free cortisol so low and our total cortisol so high, but I wouldn’t overly lower the free cortisol, I would just focus more on adaptogens to help modulate over cortisol. Just the the overactivity, the overstimulation of the adrenals the whole, and that would still come in there and support with some pregnenolone and dapa as well. I wouldn’t overdo it either, though, because her cortisol is total on the higher side. So this is where it’s really important. Like, it’d be really easy to want to give this woman a lot of licorice and a lot of pregnenolone. Some of that may be necessary, but you may want to just take the fact take into consideration that she has a total cortisol level that’s very high. And we may want to have some kind of in between those. So we got to really look at that total cortisol production in relationship to the free not overdo it.

Evan Brand: Yeah, what you’re saying is because she’s desperate to feel better, right? And you want to give her more energy and you’re going to look at that rhythm and say, Okay, yeah, it’d be great to give her a boost here some licorice at breakfast time and maybe some lunchtime dose to perk her up. But you’re saying you can overdo it because of how high the total is in this case.

Dr. Justin Marchegiani: Yeah, very easy to do that.

Evan Brand: Yeah. And so then that would manifest how maybe anxiety heart palpitations, insomnia.

Dr. Justin Marchegiani: If we overdo it, yes, harpy, potentially heart pals, potentially insomnia, potentially, anxiety, all of those things are potential issues that you may see a problem with.

Evan Brand: Yeah, and this is why we love to to mix herbs to right you’re rarely going to be using an urban isolation, right? You’re going to be coming in possibly with ashwagandha. But you may come in possibly morning. Maybe she could benefit from something like some eleuthero. Some holy basil, maybe some other more stimulating things. If you don’t want to go too high on the licorice. Is that what you would do?

Dr. Justin Marchegiani: Correct. Yep. 100%. Cool. Any other questions there so far? It’s great to see it.

Evan Brand: I think this should should help a lot of people.

Dr. Justin Marchegiani: Yeah, in general, you really want to make sure you kind of clearly delineate where the patient is in their in their hormonal pattern. I think it’s really tough. The hardest part is when you have a woman who’s perimenopausal who’s still cycling, but is starting to not cycle and starting to switch into menopause. Because you’re kind of you kind of have two ways to handle a woman if they’re still cycling versus they’re not because hormones have a rhythm, rhythmic fashion, and you want to add them in, pull them out. And if a woman is more menopausal, you can keep hormones really in throughout the month, you’ll have to cycle them as much. And so I always err on the side of treating a woman like they’re cycling until they clearly delineate that they aren’t cycling, because if I start getting hormones monthly, daily, and that could throw off their their cycling pattern. I don’t want to do that right first, do no harm. Let the body clearly delineate where it’s at in regards to its natural hormonal patterns. So the hardest part in dealing with women, is if they’re perimenopausal transitioning to menopause, I really want their bodies to clearly show me that they’re ready to stop cycling and that’s why I always treat them like they’re cycling until it’s crystal clear they aren’t.

Evan Brand: Yeah, and then that The most common time for symptoms, right? So that’s probably the majority of what what people are going to feel in that stage of their life, they’re going to feel the most symptomatic in that transition time, or at least in what you and I’ve seen, this is probably the most common time a woman’s going to reach out for help.

Dr. Justin Marchegiani: 110% Yep. So it’s really, really important to kind of take a look at that and make sure that we keep that in mind. Absolutely. And then also, you know, we have different estrogen metabolism risks, right, we have different estrogen metabolites. So if we look over here, we have e one, e two, and E three. And when you look at these different metabolites, you know, he one tends to be a little bit more, you know, safer, right? He one tends to be a little bit more safer in regards to his to his detoxification, okay. And then when you look at e4, or sorry, two hydroxy, estrogen, right, or Astra dial here, this can go down pathways as well, are four that could be a little bit more damaging to DNA. So our four hydroxy, could be a little bit more damaging, as you can see.

Evan Brand: Let me ask you this real quick. So if you scroll down a little, it’s showing how on that pathway, you can get DNA damage, it’s showing reactive there. So we have to factor in what we learned from the stool test into this also, right, because if we see like a high beta glucuronidation problem due to bacterial overgrowth, isn’t that going to mess up this same pathway or my..?

Dr. Justin Marchegiani: Yep, it definitely can. And you can see here with the different, you know, metabolites, right, your four is going to be a problem area, right? So you’re for your your two hydroxy. Your two hydroxy going into the this four hydroxy right here could be a problem. Two hydroxy tends to be a little bit less damaging right here, especially if you have good CMT and methylation, when you go when you because all these things can can conglomerate. So you can see how e one e two and E three can all go side by side, they can all transition. But then you can see they can go down to 16 pathway, which tends to be a little bit more gentler. It can go down the four pathway, which can go into reactive oxygen species, it can also get methylated, right? What’s methylation, full eight, B six, right? b 12 really helps support methylation, Coleen, and then also gluta phi m can help decrease a lot of this too. So healthy gluten diet and healthy sulfur, healthy cruciferous vegetables, healthy digestion of our animal products. And that can help a lot of this, this methylation issue, and detoxification. And then of course, we have our E, two hydroxy. Over here, which again, methylation is very important, full A B 12. b six, Coleen, right, healthy cruciferous vegetables are going to be really important if you’re here. And we can even if it’s really high, we can even do things like dim, we can do things like calcium to glucose, we can do extra fiber, things like that to help bind it up.

Evan Brand: And the reason you’re saying this is so important is because we need to get out these excess hormones, right, we don’t want them just sitting in the tank, so to speak, after they’ve gone through this process. So you’re saying the gluco rate, the Bluetooth ion, the methylation, these are all the processes in the body to get rid of these, once they’re done is I don’t know what the right word is. But once they’ve been used by the body-

Dr. Justin Marchegiani: -agreed, though, your body will conjugate them bind that proteins to them and excrete them. And so we’re gonna really focus on a lot more gluta phone support more sulfur amino acids. If we see this guy over here, the four hydroxy ones higher. And then of course, you know, you can always give sulfur support methylation as well, which is going to be the B six, b 12, full eight, Coleen all of that as well. And this will support both of these two methoxy, two hydroxy, as well as four hydroxy. One, all of these are going to be very helpful, you can’t hurt to support any of those. And if we have anyone that has, you know, estrogen cancer, you know, risk? Well, we tend to if we need estrogen in someone’s more menopausal, we’re going to try to support more estria, which is going to be more cancer protective. But if someone has a previous cancer history, we probably will not do any hormones at all on the estrogen side. And just focus on progesterone as long as their their cancer is not progesterone sensitive, and good, healthy herbal support to help modulate some of the receptor sites.

Evan Brand: Yeah, awesome, awesome question there. This ties into a lot of stuff we do with the gut to which is really cool, because we’re often going to be in detox to we’re often going to be using Bluetooth ion for mold or chemical toxins, we’re going to be using calcium D glue, great to help with zero unknown or other mycotoxin removal, we’re going to be using possibly a methylated multi based on what we see with poor mitochondrial function on the organic acids test. So the cool thing that I’m seeing here, the trend is that the whole picture works together. So by working on the other body systems, we’re already really fixing the majority of stuff we’re seeing here plus the addition of some of the extra hormonal support.

Dr. Justin Marchegiani: Yeah, exactly. And then kind of the general ratio of healthy estrogens, is we like to see a kind of, you know, we have the, what’s called the estrogen ratio, where we look at Astra dial thrown relative to 16 hydroxy. Right? So it’s like we’re looking at basically each one. I’m sorry, e to e4 and 16. We like to see a higher level of 16 in relationship to four and two, right? 16 tends to be more cancer protective. Why? Because most of its coming from estriol. And then you can see two and four tend to be a little bit more from stronger estrogens, e two and E one are stronger estrogens, e three is a weaker estrogen. So we kind of have our two, four and 16 metabolite ratios, right. So you could say to four and 16, we want to have higher levels of 16 in relationship to lower levels of two and four. And again, it just depends upon how the metabolism is to right. If we’re metabolizing these things well, not as big of a deal, right? Because why these hormones come up higher typically is where they’re getting the hormones in our body from, from hygiene products, from plastics, from chemicals in our environment, or we’re just not metabolizing them. So we make sure the lifestyle components are dialed in, where we’re not getting them in our body and to we make sure that we’re metabolizing them as well. Does that make sense?

Evan Brand: It does it does and why we’re not metabolizing metabolizing them, I just wanted to make that clear to people that could be due to gut issues, right, there is a gut hormone component here.

Dr. Justin Marchegiani: Yeah, so the beta glucuronidaze enzyme really helps metabolize a lot of estrogens. And when beta glucuronidaze goes high, it takes the SD estrogens that would have handcuffs on them or a straitjacket on them that would be escorted out of the body. And it breaks those handcuffs and allows them to go back into general population. And so having good healthy gut levels is very important. Now, if you come down here a little bit more, this is kind of cool. We look at melatonin levels, patients mid range, not that big of a deal. These are the same markers over here. So we’re not worried. This is cortisone pattern, I don’t really care about it, it almost always is congruent. What we see on the cortisol side, you can see this kind of with more emotional stress issues. This is more like inflammatory stress. But almost always, they always tend to have a similar pattern as the other side. So I don’t really care as much, because you can see the cortisone pattern is almost the same as the cortisol pattern, right? And that’s not going to change protocol. It’s not going to change protocol. And the cortisol is the more physiological active compound, right? cortisol gets gets broken down downstream to cortisone, which is a weaker kind of metabolite, it’s the weaker sibling. So it’s not quite as it’s not going to be the stronger one we’re worried about. And these are all the same numbers on here. This test is very confusing if you don’t know what you’re looking at, because there’s a lot of repetitive data. That’s just more I think, so people don’t have to scroll around as they’re going over the labs. It’s kind of repetitive for the doctor so they can explain it to the patient. But if the patient’s looking at it, they think, wait, this is new, this is new, this is new. It’s just like this is like the third time they’re saying it not a big deal. All right, and then this is where we’re looking at some of the the markers here in regards to organic acids.

Evan Brand: How you can correlate to the Oh, I mean, have you-

Dr. Justin Marchegiani: It’s pretty good. It’s it’s on point, most of the time, sometimes it can be off, I always tell patients, if we have an organic acid test, like the gray plant lab or the Genova, we’re going to always listen to that one as the most important because that test is specific for organic acids. And there’s a greater sample there too, so it’s going to be more accurate. But if we have this test in by itself, we’ll still utilize it. So out of the gates, you can see here, b 12, this is for methylation looks pretty good 1.5, Santhi RNA can be six marker, kind of urinate look pretty good. glutathione is on the lower side, right? So with this patient, we may want to support either some kind of a sulfur amino acid or some kind of fluid found to help with estrogen metabolism. And again, it just depends out of the gates if we’re not providing a ton of hormone support. Her hormones are so low as well, it may not be a top priority out of the gate. If the person’s hormones were higher, definitely a top priority out of the gates. Okay. And then this is interesting. This looks at the catecholamines it looks at basically adrenaline, or catecholamine. do the exact same thing. By the way, norepinephrine, epinephrine, exact same thing. Three words that mean the same thing. I know it’s really confusing. So we have dopamine, which is the home of anolyte metabolite, and then we have vandalia Mandalay, which is a which is a metabolite of adrenaline or epinephrine. And so dopamine is a precursor to norepinephrine or epinephrine. So the more chronically stressed you you are you will pull dopamine, and so they have high levels of dopamine metabolism and high levels of adrenaline metabolism. What does that mean? It means this pathway, this pathway here is is redlined. So we’re really breaking down and metabolizing lots of dopamine, a lots of adrenaline, and that could be part of the reason why the adrenals are more depleted here, right. And so we may want to add in some amino acids to support some of the catecholamines catecholamines. Definitely stressed. Now, we just have to make sure as we add some of those support in that we’re fixing underlying issues. So we’re fixing diet, we’re fixing blood sugar, we’re trying to get sleep better. We’re not over exercising, we’re making sure all those things are, are pretty good. And then again, Melatonin is on the lower end of the range, but it’s at 24. The range is 10 to 85. So it’s not that bad. I mean, it’s in the bottom third. I only work on this if there’s sleep issues. And typically, I’m always going to be supporting melatonin with amino acid precursors. First, I’m never going to target melatonin by itself unless we absolutely have to. I rather give building blocks and let the body do with it what it’s going to do first, then force melatonin, but if we have to, we can at the lowest possible dose, like-

Evan Brand: What are you doing? What are you going to do for aminos on the homo vanolate vandal mandalay you’re mentioning there, you may come in and support aminos.

Dr. Justin Marchegiani: Yeah so if you look at the range, they’re not super high. It’s six remember, this goes six point four um high end of the range four to thirteen. So i’d probably come in there with some tyrosine. Definitely i throw in some extra b vitamins, extra b6, even though b6 looks good. Just because these pathways are going to be stressed, so i really want to make sure some of the b vitamins are there. Some of the extra amino acids are there. I’m going to work on some of the adaptogens for the adrenals, i’m going to work on some of the adaptogens for the female hormones, uh we’ll throw in a little bit of DAGA, we’ll throw in a little bit of pregnanalone building blocks as well, if we go look here –

Evan Brand: So would you come in and never do dlpa over tyrosine in that situation, would you go based on symptoms like if somebody was like super weepy and crying at the drop of the hat, would you say okay we’re going to go dlpa instead or you’re just going to have tyrosine?

Dr. Justin Marchegiani: I would just do tyrosine out of the gates. I’d only do more dlpa stuff if there’s like a lot more chronic pain because dlpa will tend to go down more of that beta endorphin pathway which could be helpful for chronic pain stuff. If not i would just hit more of the the tyrosine and the b6 and then really calm down the hpa axis. Does that make sense?

Evan Brand: Yeah it does.

Dr. Justin Marchegiani: And then again you could see here pregnanalone is an important building block that we like to use because it’s it’s the mother of all hormones. Now i like it but you don’t want to just take it willy-nilly. I like to always use the lowest possible dose and i like to use it sublingually to bypass the gut and you can see chronic. So you can see here pregnenolone can go downstream to progesterone, right and then you can see pregnenolone, um can also go downstream to DAGA which can then go downstream to our sex hormones right, potentially some of the androgens. Potentially some of the female hormones right go right from here to andro to e1, that goes to e2 and then that can go to e3, all right and then it can also go downstream to testosterone too. Okay and then it can also go downstream to your mineral corticoids which are right here DAGA to where’s um.. Aldosterone here? Help me find aldosterone, where is it there.. Uh andro e1 let me know if you can see it but there should be a pathway where it goes downstream to aldosterone which helps hold on to our minerals.

Evan Brand: Is it at the bottom scroll down i’m seeing it.

Dr. Justin Marchegiani: Maybe they left it out on this graph but there should be a pathway that goes down to aldosterone which is a mineral corticoid, which helps you hold on to your minerals as well. Now also too if you have progesterone right, but then you’re having a lot of like um inflammation right, you can go progesterone down to 17 hydroxy progesterone and then that can go down to cortisol right, so if you’re chronically inflamed you can create low levels of progesterone. Because progesterone is going from here right downstream to cortisol. So that’s why chronic stress and chronic inflammation could throw off your female hormone balance. Does that make sense?

Evan Brand: Yeah it does. Yeah it shows there too uh mother’s diet during pregnancy. Insulin, resistance, obesity, inflammation, hypothyroidism, licorice phthalates, I like how they put the information about what’s going to contribute to the problem that’s really cool.

Dr. Justin Marchegiani: Yep exactly. And then also you can see here you can go your cortisol right and then your cortisol this is your free cortisol here. Right, this is your your active cortisol. Um so this is your this is your free cortisol here, and that the free cortisol is going to be what we measure on the cortisol rhythm graph and then it can go down the um the cortisol. That’s more inactive right we have our the cortisol as well, which is part of our cortisone.

Evan Brand: We need to do a show. Let’s do let’s do another one on this and review our own. I’m going to get a new one. And let’s do it.

Dr. Justin Marchegiani: Yeah, absolutely. So our metabolized cortisol is thf plus th e right, this is our total cortisol and then our free cortisol which is the th the thf so f for free right, so when we look at this here when we look at this here the cortisol, right this is the free cortisol right and then the total cortisol is the free plus the e just an fyi so we’re looking at the cortisone plus the cortisol is what the total cortisol is on that on that graph above. Just so you guys kind of wrap your head around that. And they they left out the uh the aldosterone here. Let me just see if it’s there albosterone. No not there. So yeah. They left that out but that should be in there somewhere as well. I’ll put a i’ll put a graph on that all right. Anything else you want to highlight there evan?

Evan Brand: No. I would just tell people that this is a really good starting place. But i just want to make sure that if you go to just the hormone person that they don’t just treat this because i think it’s really important to understand that there is a massive issue with bacterial overgrowth messing up some of these pathways. So if you come in and you’re doing all these hormones but you’ve got the build up because of those glucuronidation pathway issues. I’m seeing that with mold too that these glucuronidation issues people are on hormones and sometimes they feel worse and i think it’s because they’re not addressing some of these other pathways. I don’t think it shows glucoronidation on this does it this this panel.

Dr. Justin Marchegiani: No no. That’s gonna be more on the detoxification side okay. Any question there?

Evan Brand: No. I’m i’m good.

Dr. Justin Marchegiani: Cool and then just so you guys can see i’ll pull this over here real fast so if we look at this one right here just so you guys can see it so normally progesterone. Um it can go from progesterone down here into aldosterone and so in general if we look here it should go progesterone to aldosterone. So this pathway here you’d see aldosterone kind of coming down here if it really extends it all the way. Just an fyi on that all right. Anything else?

Evan Brand: I think we hit everything pretty good here. So are you saying progesterone could help aldosterone problems?

Dr. Justin Marchegiani: Yeah exactly so if we support pregnenolone that could also help aldosterone issues also supporting licorice can help aldosterone there’s a basically a drug called fluorine f right there’s cortef that’s supports cortisol levels that are very low okay and there’s fluorina which supports aldosterone and licorice has a an effect of mimicking um aldosterone so that can be helpful because when your adrenals are really weak you may have a hard time holding on to your minerals and so that’s important because we need healthy blood pressure to perfuse blood to the brain oxygen to the brain and we also need good minerals to help our sodium potassium pump to work properly we need electrolytes for our nerves to work so. All these are really really important.

Evan Brand: So one last question then we should wrap it up. So if someone is taking adaptogenic herbs or doing adrenal supports they’re doing hormones they’re doing licorice. What’s the approach or protocol to doing this test if we get the test kit in their hands and they’re on let’s say an adaptogen blend. They’re Doing the ashwagandha, the licorice, and everything do you suggest taking a break or does it not matter we gonna we’re gonna see how the body’s functioning while on those herbs?

Dr. Justin Marchegiani: You’re talking about down the road?

Evan Brand: No i’m saying like right now they’re already on them.

Dr. Justin Marchegiani: If they’re yeah if they’re already on them it may not be bad to take a look at kind of where they’re at with them already on them yeah for sure that i don’t see that  being a bad a bad situation if they’re taking hormone support it just depends where they’re at i usually don’t like it the day of just because you can get an artificially high reading.

Evan Brand: Yeah.

Dr. Justin Marchegiani: If it’s if it’s in your system that day so usually maybe take 24 hours off that way it’s not overly high in the system.

Evan Brand: but you still see the trend. Yeah i’m always on the fence about it because you’ve got so many people taking blends which is great. I think you and I have really helped educate people about adaptogens but you’ve got people taking so much and it’s like well are we seeing an artificially good cortisol pattern or is this really how your cortisol pattern looks so i think maybe a day or two off sounds smart.

Dr. Justin Marchegiani: Yeah if it’s herbs i’m not worried about those as much because that’s they’re going to be more modulating and it’s just where they’re at you know and if they tell me that hey i’ve been on them for the last couple of months and i’m feeling better good we’ll just have you stay on and we’ll just take that into consideration  on the test.

Evan Brand: Okay.

Dr. Justin Marchegiani: When we’re interpreting it because if they have some adrenal issues and they’re doing well with that well guess what we probably still want to make that part of their plan anyway we’re not going to change it too much right.

Evan Brand: Yeah well said.

Dr. Justin Marchegiani: Any questions there so far?

Evan Brand: No that no that’s it i think we should do a part two and review our own that’ll be fun i’m gonna get another one and run one on myself and you should do one too yeah i think that’s a great idea i like it a lot so.

Dr. Justin Marchegiani: I think we hit a lot of good stuff here hope um you know anyone listening you can see that you know Evan and i are kind of the real deal when it comes to this like we actually do this we’re in the trenches a lot of people that you may see online are kind of they’re like thought leaders from a um let’s say esoteric standpoint meaning they’re not actually doing this to not actually practicing so we try to differentiate ourselves by bringing actual information so just kind of know this isn’t theoretical stuff this is Kind of the real deal and and hopefully that gives you confidence to take action and to try some of the things maybe you want to dig in. Maybe you want to get testing maybe you want to reach out to Evan or myself. We’re here to help you out, if you need more help. Of course start with all the foundations, we have thousands of hours of free content because we know 99.9 of patients that that we work with or help, they’re doing it with our free content. We’re not even seeing them now if you’re ready for that next step and you want to dive in. We’ll put links down below so you guys can reach out and reach out to Evan. Evan’s available worldwide and myself, Dr. J at to schedule with myself as well. We appreciate you guys um connecting with us all anything else you want to say Evan?

Evan Brand: No people really appreciate it and yeah we’ll make sure  to have the link if you listen on audio your mind’s probably blown right now you thought what the heck just happened we will make sure to give you the link that way you can see this thing because the screen share is great and you just want to give you kudos you’re a great teacher and you’ve taught me a lot about the dutch too so i really appreciate it and your eye to detail on this thing is awesome and most people don’t have that eye so we we really look up to it and really appreciate it.

Dr. Justin Marchegiani: Hey thanks Evan really appreciate it. And if anyone has any hormone issues that are way out of balance and you want to double check it with some blood work too. I don’t have a problem with that either especially some of the androgens I always like to double check with blood if we’re seeing some chronically high stuff um feel free to do that as well. And i hope you guys enjoyed it. Feel free give us a share as well thumbs up and if you want to write us a review that gets us motivated. Um we’ll put a review link right down below if you want to write us a review on itunes. Appreciate it you guys have a phenomenal day. Take care now.

Evan Brand: Bye-bye. Take care y’all.


Audio Podcast:

Recommended products:

DUTCH Adrenal Test

DUTCH Complete Hormone Test

DUTCH Sex Hormone Metabolites


Low Body Temperature! – Dr. J Podcast # 156

Dr. Justin Marchegiani and Evan Brand engage in a very informative discussion about low body temperature. Learn how different potential stressors like thyroid issues, adrenal issues, gut health, autoimmune conditions, nutrition and low calories cause low body temperature. Find out about the role of micronutrients in thyroid hormone conversion and be aware of the medications that have a negative impact on mitochondrial function.

Gain information about the different foods, including modifications in macronutrients, and various supplements, which will improve your health and prevent different stressors that are possibly causing low body temperature.

In this episode, we cover: low body temperature

03:27   Thyroid issues

07:05   Beneficial Nutrients

14:14   Toxins and Medications

22:51   Food and Supplements

33:46   Calorie Intake






Dr. Justin Marchegiani: And we are live here on YouTube. It’s Dr. J in the house. Evan, my man, how are you doing brother?

Evan Brand: Hey man, happy Monday! We’re talking all fair about that shooting this morning so my mom, she worked right next door last night at the Hotel Luxor which was uh— right next door to that shooting event in Vegas. So I called her this morning and she’s safe and sound and she got released, so she’s home, hopefully sleeping. I’m sure she’s extremely adrenally stressed at this point, but hopefully she’s resting and settling down from all that.

Dr. Justin Marchegiani: Yeah. Lots of empathy for all the people out there going through that. It must be just incredibly stressful.

Evan Brand: It’s insane.

Dr. Justin Marchegiani: It’s just so difficult. So wishing everyone, you know, speedy recovery from that. That is just so difficult and man, everyone’s adrenals are revved up from that, right?

Evan Brand: I know.

Dr. Justin Marchegiani: So let’s go into some stuff here where people, we would get— put some information out there about improving everyone’s health.

Evan Brand: Yes.

Dr. Justin Marchegiani: Uh—and just continue to empower more people. So let’s dig in, brother.

Evan Brand: Yes. Yes, so you and I want to chat about low body temperature, which is something that so many people have. I’ve had it in the winter for a long time. I’m hoping that since I work so much, my gut and my adrenals that I don’t have it this winter but cold hands, cold feet you know that had been something that I mentioned going on with me for—for several years. I know there’s a lot of different causes that you and I wanted to go through. So how should we open this thing? Should we talk about hormones, thyroid, how do you want to lay the groundwork?

Dr. Justin Marchegiani: Oh, we look at body temperature. Temperature is probably one of the best indicators of your metabolism, right? Because the more energy you have, typically the— the better your temperature is. And so typically, you’re gonna have symptoms of cold temperature which are gonna be cold hands, cold feet those kind of things. Also, fatigue, but now there’s also objective ways that we can test your temperature. You know, with the thermometer, obviously. We can do axillary temperature, which is armpit. 97.8 to 98.2 is—is Fahrenheit is a pretty good range to be in. Or 98.2 to 98.6 orally. And so you can kind of assess your temperature. You can do it in the morning and then you can also do it in the afternoon as well. Kinda do it just for before eating. That gives you a pretty good indication but if your metabolism is low and your temperature is low, it could be caused by an interplay of different things. We’ll go into it. It could be thyroid issues. It could be adrenal issues. It could be gut issues. It could be nutrient issues. It could be mitochondrial issues. So all of these things are potential stressors that could be driving that problem.

Evan Brand: I’d say number one is probably thyroid issues. Wouldn’t you suspect because so many people we talk with they have adrenal issues with them on top of that there is a thyroid problem. Like maybe elevated reverse T3, whether you’ve got that blank bullet going on or they just got a low free T3 or like you and I’ve chatted about with adrenals, you’ve got the conversion process that happens where you take the inactive T4 hormone, you convert that to active T3.That conversion process gets messed up if you’ve got chronic stress. And chronic stress as you mentioned, could be gut infections, it could be emotional stress, could be chemical, heavy metals. It could be circadian rhythm stress if you’re working third shift, for example. That could be enough to change this whole cascade. Wouldn’t you say?

Dr. Justin Marchegiani: Oh, yeah. Hundred percent. I mean, again, all of those things can be intimately connected. The first we look at is thyroid because thyroid hormone has a major effect on our metabolism. And our metabolism is the sum of all chemical reactions in the body. And our metabolism is pH driven, right? So if our pH becomes too alkaline or too acidic, like you know blood pH, which exists in a very fine-tune range, right around 7.35+ or -1/10 of point there. And if that pH shifts up or down, that can affect how all of our enzymes in our bodywork. So that can affect temperature and there’s things like—uh like a diabetic coma, right? Where blood sugar can go to he— or too low typically. If someone’s type I dependent and they don’t have insulin, they don’t get sugar into their cell, which can create ketoacidosis. And that can really, really drop that pH and that put you into a coma. So our pH is very driven and has a major effect on our metabolism, so, totally.

Evan Brand: So let’s hit on—let’s hit on the thyroid peace. Now autoimmunity is something we talk about so much. Would you say a common symptom of someone with Hashimoto’s, for example, could be low body temperature or possibly even a fluctuating. Maybe their low body temperature if they’re a bit underperforming but then couldn’t they just bounce right back and get actually hot if they bump into hyperthyroid. If they’re in the Hashimoto’s state, and things are still fluctuating.

Dr. Justin Marchegiani:  Yeah. So, if you’re having Hashimoto’s and your immune systems constantly attacking your thyroid, your thyroid hormone can spill.

Evan Brand: Right.

Dr. Justin Marchegiani: Coz every time it’s attacked, hormone spills out. Eventually those follicles run dry and you’re not gonna quite have that hyper kind of symptoms. So in an acute attack, hyper symptoms may be increased temperature are common, right? You can have like PVC’s periventricular contractions. Uh—you can have, you know, kinda this—kinda heart palpitations. Your heart’s kinda beating erratic and hard, uh—anxiety, night sweats, irritability. These are all hyper thyroid symptoms. You feel warming, right? You feel excessive warmth or temperature. But then, in a chronic state, that will eventually lead to a hypothyroid kind of environment, where your body temperature just gets very low.

Evan Brand: So someone has had Hashimoto’s for quite some time, let’s say there’s been a pretty significant tissue destruction, you would say someone will not end up being hyper long-term with Hashimoto’s. It’d probably be hypo long-term.

Dr. Justin Marchegiani: Yeah. I mean you can—hyper feels very similar. Hyperthyroid Grave’s feels very similar to a hypothyroid autoimmune attack. The difference is with hyper, typically, there’s a specific antibodies or immunoglobulin compounds that come back. So with Grave’s, you’re seeing TSI immunoglobulins or you’re seeing thyroid TSH receptor site antibodies. So that’s what’s typically common in Grave’s. And when those things are high, it’s accelerating the thyroid hormone to produce excessive amounts of thyroid hormone. So there’s like a production stimulation where with the autoimmune attack, from like thyroglobulin antibodies or TPO antibodies is it’s more the spilling of a thyroid hormone out of the thyroid. It’s spilling out where the antibody attack from Grave’s, it’s stimulating the thyroid to produce more.

Evan Brand: Exactly.

Dr. Justin Marchegiani: With Hashimoto’s, you’re not getting the stimulation. You’re more or less getting that spilling effect, which eventually, you know, will run dry.

Evan Brand: Got it. Got it.  Okay. So we hit the autoimmune piece. What else would go on thyroid-wise that will be an issue with temperature regulation?

Dr. Justin Marchegiani:  Well, again, there’s also certain nutrients that have a major effect on thyroid uh—conversions. So we know things like selenium are super important for thyroid conversion. So someone may have decent thyroid levels from a T4 perspective, uh— but they may not have that activation, right? They may not have that conversion uhm— that’s so important.

Evan Brand: So could it just be the lack of trace nutrients, trace mineral selenium, zinc— things like that activators.

Dr. Justin Marchegiani:  So here, we are live on Facebook now, too with the low body temperature podcast. So getting back onto our common thread. Yeah, micronutrients like selenium are gonna be important for thyroid conversion. It’s a five—the enzyme that converts T4 to T3 inactive thyroid hormone to active thyroid hormone is a 5 deiodinase enzyme. It’s also important with glutathione and detoxification. So, yeah, that’s totally uh— important micronutrient that will affect thyroid activations. So when we look at thyroid function, we’re looking at are there blood sugar fluctuations? Are you eating grains or foods that are gonna cause that thyroid antibody attack that could cause the hormones to spill out and eventually deplete the hormones? Your thyroid follicles carry about four months of thyroid hormone. So again, if you have a chronic Hashimoto attack, where the thyroid hormone’s spilling out faster than you can synthesize and make more, then you’re going to definitely get to that depletion state where you’re gonna go hypo from a temperature standpoint. You’re gonna go almost hypothermic. That temperature will drop below that 97.8 – 98.2 armpit temperature wise or 98.2 to 98.6 and I’ll put a handout down below to my uh— metabolic temperature handout. So people can actually track their temperatures and it’s basically a graph of three different lines. And then the top brackets where you want your temperature to be through which ranges 97.8 – 98.6 We want to be checking off daily that your temps are in this bracket not the bottom or the very bottom.

Evan Brand: Got it. Okay. So what else? Should we talk about the nutrients next?

Dr. Justin Marchegiani: Should we talk about the nutrients, right? Vitamin A, we talked about uh— zinc, copper, selenium, magnesium very important nutrients for thyroid conversion. Now if you’re eating a whole food diet, you’re gonna be typically pretty good. If you’re having enough HCl and enzymes, you’re gonna be good as well because we need those type of compounds to be able to ionize the minerals. So it’s the diet component. It’s making sure we have the ability to break down the foods in our diet that are nutrient dense. Uhm— number three is making sure our stress response is okay because stress hormones will affect thyroid conversion. Cortisol being hyper— very high— will affect thyroid T4 to T3 conversion that inactive to active thyroid hormone. Also, if cortisol is too lo from chronic stress. So there’s this, kinda Goldilocks effect that we see here with thyroid hormone kinda need it to be not too high, but not too low to have optimal conversion. Does that makes sense?

Evan Brand: Yeah. It does. Well said. Let me mention about the gut, too, coz you just hit on the fact that you’ve got to have absorption. So even if the diet’s good, which many people listening to us, they probably already dialed in like a Paleo template but they could still have this symptom. You may want to check for infections. Coz like Justin and I talk about almost every week at some level, there could be an H. pylori, bacteria, yeast, fungus, something going on in the gut that’s stealing your nutrients or preventing you from optimally digesting. And then that issue is compounded, if you’ve been taking any type of anti-acid where acid blocking medication something simple as Tom’s or something more strong like a prior was it Prilosec or Zantac.

Dr. Justin Marchegiani: Yeah. So, yeah. Totally.

Evan Brand: Keep that in mind. If you’re looking at your medication list and that includes acid blockers and you have cold body temperatures, it’s probably cause you’re not digesting your foods therefore the thyroid is not getting fed the nutrients it needs.

Dr. Justin Marchegiani:  Totally. And also a lot of medications could affect your mitochondria. Just Google antibiotics and mitochondrial function, you’ll find that antibiotics can negatively impact mitochondrial function. And you’ll also find that other medications can impact the mitochondria. And the mitochondria is like the little powerhouse of your cell where it generates a lot of ATP, which is that currency of energy in which your body runs. So that’s really important and also an important nutrient call carnitine really helps that mitochondria utilize fat for energy, generate ATP out of that good fat, you know, it’s called uh—beta oxidation where you’re generating energy from fat. And carnitine is an important nutrient primarily made from methionine and lysine. Now, I did a video call why vegan and vegetarian diets can make you fat? Now—no—don’t make you fat. But you know, why they the can—meaning it’s not a hundred percent. But if you’re insulin resistant and you’re doing it the wrong way, where you’re emphasizing maybe too much carbohydrates, not enough protein and more gut irritating foods, yeah, it can definitely predispose people that have an inflamed guts and work more on the insulin resistance side to gain weight. And one of the big things is that when you eat certain animal rich amino acids, there are some plant ones as well, you activate the cells in the brain that are called—hold on, one __my notes—uh—tenocytes. And these tenocytes are receptor sites in the brain in the third ventricle area of the brain. And there’s a direct blood flow between them and the hypothalamus. These tenocytes, one, they sense satiety but the big thing that senses satiety for them is arginine and lysine which are really high in animal-based foods. So these amino acids really get that sense of satiation so that means you’re one, gonna have appetite regulation. Coz when you actually start feeling full, you tend to not eat all the crap, right?

Evan Brand: Yup.

Dr. Justin Marchegiani: So the more you can keep your cravings in check, the more you eat healthier foods because you got control over your biochemistry. You’re not reacting. You’re acting based on what you know you need to be healthy. But those amino acids are primarily gonna be higher in animal-based foods especially lysine as well.

Evan Brand: Yeah. Well said.  So in a roundabout way, if you are a vegetarian or a vegan and you’ve got low body temperature, it could just be something as simple as a carnitine deficiency. I mean you could probably get a little bit in beans maybe—

Dr. Justin Marchegiani:  A little bit in beans, a little bit in almonds, a little bit in plums and avocados, for sure.

Evan Brand: But even then, once we talked like—we talked all the time, digestion of those foods is probably not very good and the concentration of those is gonna be much less as opposed to a grass-fed beef.

Dr. Justin Marchegiani: Yeah. In my video, I talked about, you know, if you are a smart vegan where you’re not emphasizing a lot of the grains, you’re doing safer starches, you’re getting lots of fats from avocado, olive oil, coconut oil, you’re supplementing DHEA in the form of algae, right? And if you’re getting B12 uh—supplementation and you’re getting a good multi- in there and you’re getting lots of— you’re getting some protein supplementation in there, maybe from pea or hemp, right? You may be okay on a vegan-vegetarian diet, but it’s just— it’s still less than optimal just because of the fact that you gotta go through such extreme lengths to get high-quality protein sources without all the carbohydrate. Coz vegetarian-vegan diet’s typically are packed with 60 to 80% carbohydrates for that 20 to 25% of protein you get.

Evan Brand: Yup.  Well said. You hit on the mitochondria, too. We should take  that a bit further and talk about more toxins. You hit on antibiotics, some mitochondrial issues there. Makes perfect sense. We work with people all the time where they say, “Oh Justin or Evan, as soon as I took a round of antibiotics, all of a sudden things went bad.” And it could be temperature –temperature issues, it could be sleep problems, it could be gut issues, digestive problems. And so also with mitochondrial issues, we’ve got toxins. So if you’re not using 100% organic, that’s an issue because glyphosate and these other pesticides and herbicides, fungicides and insecticides— they all compound with each other. So it’s not that one chemical by itself will kill you, but if you get a little bit of glyphosate from your non-organic berries, you combine that with a little bit of conventional vegetables coz you did a salad at a restaurant, you combine that with in antibiotics that you’re getting from meat. If it’s not labeled “no antibiotics” you stock all those upon each other, you’ve got some bad mitochondrial problems here that you need to fix. And we can measure the—

Dr. Justin Marchegiani: Yeah. The enzymes that are needed to help move those gears that  kinda crank around that mitochondrial Krebs cycle and then flow in so the beta oxidation process. Uhm— you need certain nutrients. You need B vitamins, you need magnesium, you need zinc, the healthy levels of amino acids. You also don’t need all the toxins— the aluminum, the pesticides, the glyphosate. So those things can kinda gunk up the gears of that metabolic machinery. So it’s not only what those gears need to keep it lubricated, but what it is we don’t need to put in that will prevent those gears moving. So it’s a combination of avoiding certain things, right? And again, the medications are a double-edged sword. I’m not saying don’t use them. I’m saying just really make sure they’re— they are prescribed specifically for what you need. And it’s the last case kind of thing with antibiotics. We really want to go to herbs and botanical nutrients over antibiotics. They may have a time or place, but we want to use it only when we’ve exhausted other options.

Evan Brand: Yeah. Well said. And you and I were talking off air, we can quantify a lot of this stuff, too. So you’re talking about measuring your temperature. We can quantify what’s going on in the gut, right? We can test the gut, we can test the thyroid with—with blood using functional reference ranges and using functional numbers that conventional doctors don’t use. They’re only going to detect disease. We’re going to detect the issues before disease occurs. We’re gonna look into the gut so we could test you for infections. We could test the adrenals, look at your free cortisol rhythm so the uh— HPA axis, the hypothalamus, pituitary adrenal axis, you hear us talk about, you know, that is a factor in all of this. If your brain is not connecting the signal to the adrenals and adrenal to the thyroid, that whole system gets often chronic stress. And it’s up to us to figure out when we talk about stress what’s in that bucket. Is it just your job, your bad boss, your relationship, the divorce you’re going through? Is it that stuff only or is that stuff plus chemicals in the diet, plus nutrient deficiencies, plus infections, plus not having enough quality meat in the diet.  You see how these things can all add up.

Dr. Justin Marchegiani: Totally. And just to kinda look at the thyroid component again, there’s dysregulation up top where the TSH is either high extreme, higher extreme, low. Now it can be extremely low because you’re on thyroid hormone and the body needs more thyroid hormone. The body is sense— sensing more thyroid hormone in the brain, but there’s less than the actual tissues. So that you’re keeping the thyroid hormone higher, but that’s keeping the TSH low. That’s step one. The TSH may be low because of HPAT access dysregulation. That hypothalamus pituitary and that adrenal thyroid axis. There’s some kinda short-circuits happening in there because of the stress— the emotional stress, because of the physical stress, because of the chemical stressors. And we have to address those while we support the nutrients to get this hardwire back on track. We can also have low T4 levels. Coz if T4 is low, we’re gonna have low T3 over here. So we got to make sure the nutrients for T4 in there like I mentioned before the vitamin A, the zinc , the copper, magnesium, selenium, uhm— amino acids, tyrosine and potentially iodine. As long as we know that there’s not uh— autoimmune attack that’s the lease active going on. And then number three, after that, we let see how the T4 to T3 conversion is. If T4 is good, how does T3 conversion look? Is it this big drop off? Or also is there a very high amount of reverse T3 because of that stress? All those can make a big difference. And then one person ask here—James asks, “Well, is hypothyroid and hyperthyroid hypo and hyper kind of the same for treatment?” Yes and no. With hyperthyroid from a TSI thyroid stimulating immunoglobulin or TSH receptor antibody attack, we’re more concerned about coz it tends to be more chronically high which can increase the chance of a thyroid storm and then potentially a stroke. So we take that very seriously. We refer that patient out to their medical doctor uh—for monitoring. We don’t want—we wanna make sure there’s not a stroke going on. But typically, the treatment will be, you know, PTU. Uhm—basically  uh—propylthiouracil or methimazole. Things to basically block iodine uptake to make thyroid hormone. Or though— you know, typically, go to a thyroid radioactive thyroid kind of ablation or even a thyroidectomy. I’ve had patients where we’ve been able to avoid those because we give nutrients to help modulate the thyroid response and modulate the autoimmune response like carnitine, like blue flag, like lemon balm, melissa uhm—into certain adaptogens. They could also help kinda dampen that response. There are some protocols that even show higher amounts of iodine can block that sodium uhm— iodine’s import that transfers iodine into the thyroid. So there’s a couple of different protocols you can use to help. And of course, all of the diet and lifestyle things are the same. But we take the Grave’s autoimmune attack a little bit more seriously just because of the repercussions of it not being treated appropriately, what will happen, we really want to sidestep those.

Evan Brand: Yup. Well said. So get the TPO antibodies checked. Get your eTG antibodies checked, you talk about the TSI. Now, have you seen where TPO TG would be high at the same time as TSI? Where it’s gonna look like Hashimoto’s and Grave’s at the same time?

Dr. Justin Marchegiani: It could. I’ve seen it before.  Yeah. It definitely can. So get—we’re  gonna really get patients on an autoimmune protocol to help lower any autoimmune attack from the food, from the gluten, from the leaky gut. And we’ll also work on blood sugar stability coz high and low blood sugar fluctuations have a major effect on the immune system.

Evan Brand: Yup.

Dr. Justin Marchegiani:  Now another person asked here, the reason why you know I’m such a huge fan of how we do our podcast is coz it’s literally on the go and we’re infusing questions from people on YouTube here right into the conversations. So it’s like—remember those books you read when you’re like a kid and you read it and it’s like, “Oh, if you want the character to do this, turn to this page. If you want the character to do this, turn to this page.”  You can totally change how the book goes.

Evan Brand: Yup.

Dr. Justin Marchegiani: Well, it’s kind how our podcast are. So interjecting here uhm—, Gerald asked, “What about T3? How does T3 work?”  Well number one, T3 can just help support low T3 levels. And if there’s some kind of conversion issue, that can kinda biased time to fix the conversion aspect, number one. Number two, giving that T3 in the Wilson protocol uhm— that can have some effect on clearing out the receptor sites. So that now the T3 works better and binds better uhm— in the future. You can do that by starting low and then tapering up, holding it and then tapering it back down. In the Wilson protocol, Dr. Dennis Wilson does that with time-released T3. But we do a glandular’s in it. That can still be helpful as well. We’re using that as a way of clearing out the receptor site but were also not, you know, thinking that that’s gonna be the only issue. We’re also banking that there’s other things that we’re gonna be fixing that will allow it to be a long-term solution, right?

Evan Brand: Got it. So you’re saying the thyroid glandular’s can be used for low—a low  T3 situation.  That’s the fix that’s going to get you better enough to keep moving the needle in other departments.

Dr. Justin Marchegiani: Correct. Like in my line, we have Thyro Balance which is a—a really glandular uhm—nutrient thyroid support from a glandular perspective. And then we have that we have Thyro Replete which is nutrients for the conversion. So there’s some herbs that help with conversion like coleus forskohlii and ginseng and then we have the nutrients for conversion that I mentioned—the vitamin A, magnesium, copper, zincs, selenium—all of those—and tyrosine’s. We wanna make sure all those are in there. Uhm so we hit it from all angles. I mean if we knew exactly what that missing like nutrient component was, we could hit it more practically. But it’s too difficult to do that.

Evan Brand: Right.

Dr. Justin Marchegiani: You’re better off using multiple methods to hit it. That way the patient can get better faster.

Evan Brand: Agreed. And you mention the adaptogens. I’m so glad you did. We use those all the time. I take them every day in some shape or form, whether it’s ashwaganda, holy basil, shoshandra. There are so many options and people ask, “Well, can I just take a bunch of adaptogens and fix myself?” Uhm— it doesn’t work like that. You just want to use them as one piece of your toolbox. You still want to be getting to the root cause. So adaptogens are life-changing but if there’s root causes, you can take all the adaptogens in the world and it won’t fix you.

Dr. Justin Marchegiani: I’m gonna take my ashwaganda right now—

Evan Brand: Perfect.

Dr. Justin Marchegiani: A little bit of immune support. But I mean, like yeah, if you’re doing okay and you’re like, “Hey, Dr. J and Evan talked about some ashwaganda and some of these nutrients. I want to try it out.” Fine, go ahead.  But if you’re actively having issues that are you know, the symptoms that we mention here whether it’s on the hyper or hypo side, you really want to get someone on board to help guide you because it’s never just one magic bullet. It is—it’s a whole bunch of things that we’re doing together. And the more chronic it is, the more you have a you know, that momentum working against you. You got overcome that inertia to stop that— that snowball effect and start pushing it back uphill. So, yeah, if you’re in pretty good shape, fine you know just try some of these things. But if you’re in not so good shape, you want to reach out, for sure.

Evan Brand: Yep. Cool. Oh, we got time for one more question. Uh James said, “It’s not a thyroid question.” He’s taking an antibiotic for root canal this week. “Will this affect the result of organic acids test and stool test if he collects the samples while antibiotics are still in the system?”

Dr. Justin Marchegiani: I mean if we’re doing some of the genetic base testing, it shouldn’t have an effect on it. If we’re doing a stool base to antigen-based testing, then it would.

Evan Brand: Right.

Dr. Justin Marchegiani: So you should be okay but we’re doing the G.I. map which is you know, what my go-to is. It should be okay according to the lab. I try to avoid it— doing it. So I would say in a perfect world, if it’s not gonna delay your treatment, I would say get to the antibiotics give it like a day or two to let it wash out and then do it. But if uhm— timing doesn’t work out, just do it, get done.

Evan Brand: I would also look at Mercola root canals and read about those. I mean maybe you’re too far down the rabbit hole and you can’t avoid the root canal. But you know there are some other options you may have available if you’ve got a good biological Dennis maybe will sit down with you and say, “Okay, root canal’s option A but maybe there’s a option B C you could look at too because we’ve had a lot of people to come to us with infected root canals and maybe Jessica can speak on this a bit. But I’ve seen it as a big needle mover for people.

Dr. Justin Marchegiani: Yeah. There’s a book by Ramiel Nagel that talks all about root canals. It is highly recommended. You take a look at it. Uh— fat-soluble nutrients, vitamin A, vitamin K are very helpful. Uh—oil pulling that kinda help extract any toxins that may be in there and you don’t want a root canal you want to get the tooth pulled out. Uhm— you want to get an implant put in using biologically appropriate material. You don’t want the gangrenous tissue still in the system without the blood flow. And the immune response to be able to get it is just a harboring place for a whole bunch of bacteria and viruses to hang out.

Evan Brand: Right. Yeah. Well said. So James, look into that. Maybe it’s not too late. Uh—hopefully, you’ve got some other options you can pursue it’d be much— much safer and much healthier in the long term. That way, you don’t have a hidden dental infection. There’s a guy named, Simon Yu that you and I should reach out and interview. He’s over in St. Louis he talks a lot about hidden dental infections. I think that’d be a good show.

Dr. Justin Marchegiani: Okay. Absolutely. Hundred percent. So couple of things we wanna talk about. Oh, also carbohydrate, I think is important. Again, my bias is towards a lower carbohydrate template—Paleo template. And again, I hate the word “diet” because it assumes something is temporary and it assumes that it is fixed; where a template gives us flexibility and modification and may change day to day. It may change uh—meal to meal. I tend to be very lower carbohydrate my first two meals of the day and then after that, I may increase in carbohydrate at nights uhm—you know a bit of the starchy based. So I’m very strict during the day. It’s high-quality. It’s— set—it’s 60 to 70% fats, the only carbohydrates are vegetables and then good proteins and then I go higher at night. On the carbohydrates side, maybe a little bit of sweet potatoes and some butter and cinnamon or maybe I have a—some dark chocolate or have couple more berries than I normally would. So there’s that component. So I always go lower carbohydrate to start because so many people are insulin resistant just because of the fact that we eat too much carbohydrate and were inflamed. So I always go lower carbohydrate to start and then typically, patient will do be better and will feel better because insulin resistance can affect T4 to T3 thyroid conversion, which can cause lower temperature. Now, in the double edge side of the fence, if people go too low insulin, they may also get poor thyroid conversion as well. So just like I mentioned cortisol has a major effect on thyroid conversion. Well, guess what? Insulin has a major effect on thyroid conversion. Type I diabetics— guess what? With low insulin levels coz of the autoimmune attack to the beta cells of the pancreas, they have low body temperature. So if you go too low carbohydrate, and this is for certain individuals not everyone, I know people are gonna be like, “But I’m low carbohydrate and I felt great and it reverse my low temperature.” I get it. Again, there are exceptions to every rule. There are tall Chinese people that play basketball even though they are more shorter in the population. There are exceptions to everything, okay? We got to get that in. So yes, there are some people that a low carbohydrate diet, the majority I would say would help partly because our consumption of refined carbohydrate and sugar is higher, but there are some people when they’re chronically load, they may increase that carbohydrate just a bit. And that ups the insulin a little bit which then helps that thyroid conversion. They’re like, “ Dude, my hair started to grow back better, my temperature’s better, my energy is better.” Boom! You at least now figure it out for you. So exceptions to every rule, figure it out. And uhm—if you feel great going low-carb, great, keep it there, hang out. But if you start getting some of those hypo temperature symptoms, then we’ll just ratcheted up a little bit.  And I primarily ratcheted up starting at night.

Evan Brand: Yup.

Dr. Justin Marchegiani: They’ll still get the benefit of keeping it lower carb during the day.

Evan Brand: Well said. I mean that’s me in a nutshell. I went very, very, very low-carb ketogenic, I guarantee. I was probably ketogenic most of the time and then I started to get cold and so I added in some starch with dinner and all of a sudden my body temperature’s perfect now. I feel good. So uh—if I go too low-carb again, it may come back or if there’s a huge piece of stress on my plate, the low body temperature may come back. But for now, I’ve been able to reverse this and been able to clear out all the infections with your help in terms of protocol a couple of years ago getting rid of all my gut bugs, plus supporting adrenals, getting the diet dialed in, getting my sleep improved, blacking out my room. All of those things are still important. So I hope this has been helpful. I gotta run. You’ve gotta run, too. Uhm—or are there any last questions that we could answer? I closed out the chat window. Uh there’s just one thing I want to say is it’s not about being higher carb or lower carb, have a –have a foundational template which you— which you go back to and then you can customize it. And then if you increase carbs, you can still get some of the benefits by having that first 20 hours of your meals relatively lower carb, higher fat, moderate protein and those last four hours you pop up a little bit and so you can still get some of those benefits. If you’re like, “Oh, I feel better with higher carbs.” You can still get the benefits of the first 20 hours of your day kinda in that ketogenic state and then pop up the carbohydrates later. So it’s not an either or thing. We can kinda straddle the fence but we want to customize it. I don’t give a crap if—if low-carb is your missing link and being low-carb all the time helps you, that’s what we’re gonna do. If being low-carb and a little more high carbohydrate helps you out, I don’t care. I’m all about the results and not about what tool I have to use to get the job done.

Evan Brand: Yup. Well said. For me that looks like the breakfast like a pastured sausage, maybe a handful of macadamias, maybe a handful of organic blueberries. Lunch—I  probably do some leftover steak and veggies like a big thing of broccoli with some butter. Dinner— that’s when I may do some type of pastured meat, a little bit of some veggies and then starch, so it could be a medium-size baked sweet potato, butter, cinnamon. That’s all it takes and I feel good. So just to kind of give people an idea what is that look like. That’s what it looks like.

Dr. Justin Marchegiani: Totally. That’s great. And a couple of questions here. Uh— Stephanie talks about menopausal women with lower estrogen and a low estradiol vaginal tablets. Well, this is interesting because typically low estrogen can cause hot flashes. And why does that cause hot flashes? Because typically the FSH and the LH starts to rise in the pituitary which is that signaling hormone trying to yell to the ovaries to make more progesterone and estrogen. So when LH and FSH primarily FSH goes high, that can create some vasodilation effects and create the hot flashes. So by giving a little bit of thyroid—giving a little bit of uhm— female hormone support, we can drop down that FSH then we can also modulate the receptor sites with some herbs as well to help with how flashes. Whether we use maca, or  we use dong quia, or black cohosh or raspberry root, or shepherds purse. There’s different nutrients or herbs we can do to help modulate that. So again, you could still have hypo, low thyroid issues, but have menopausal issues because of the low estrogens, which could drive the hot flashes up. So it’s kind of a conundrum. The hot flashes may—may overshadow this low thyroid thing over here. So as we get the female hormones fixed, you may notice the low thyroid comes back later on because it’s just not a secondary issue and the primary issue is the menopause. Once that’s ruled out, now this one comes to the surface.

Evan Brand: Got it. Well said.  We should probably do a whole show just on low estrogen if we haven’t.

Dr. Justin Marchegiani: I think that’d be great. I mean, I see estrogen dominance is a big problem.

Evan Brand: Right.

Dr. Justin Marchegiani: Where estrogen –the ratio of estrogen is higher than progesterone, right? So progesterone should be like this 25 to 125 times more than estrogen. But if that ratio starts to creep up where estrogen gets higher, that’s estrogen dominance. The problem is a lot of people, though, where that ratio—they’re estrogen dominant, progesterone’s slow but estrogen is also low. So they get this estrogen dominant, but also low estrogen sums at the same time. So it’s kinda like this conundrum. It’s like this little tug of war that’s happening there.

Evan Brand: Wow. Put it on this to do list. It sounds like it’s gonna be a fun one for us to dive into more. And I’ve probably got some stuff to learn from you on that topic as well.

Dr. Justin Marchegiani: I think it’s great. Well any last questions, comments, or concerns, Evan?

Evan Brand: No. I think this has been good. People, you got to get the testing run because if you don’t test, you’ve guessed. So if you’re trying to figure this out on your own, even if you’re not working with Justin or myself, then get the test run. Find a functional medicine practitioner they can take care of you. We are accepting new clients, so if you do need help, feel free to reach out justin We run these labs on all of our clients because it’s the foundation. We’ve got to have the data. We’ve gotta have the puzzle pieces on the table; otherwise, you can’t move the needle. We could throw a bunch of random stuff at you might help, can’t hurt, but we want to get you better. There’s a systemic process that we do step by step by step to take you through this. So happy to help. Reach out if you got questions and thanks for tuning.

Dr. Justin Marchegiani: Oh! One last thing, man. I forgot to add.  This is so important. Low calories.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Just not eating enough calories will cause low body temperature. It’s shown to cause a low level T3. Now this is important because if your diet is 25% crap Ola and let’s say you’re eating 2000 calories a day and then we switch you over— we switch you over to a uh— autoimmune kinda Paleo template, but you’re only able to—to—to switch over 75% of your diet because you don’t—you don’t have enough you—you can’t replace all the crap that you’re eating with the good stuff, right?

Evan Brand: Right.

Dr. Justin Marchegiani: Because if you’re eating a whole bunch of crappy carbohydrates and stuff and then you replace it with a whole bunch of really good vegetables or lower sugar foods, well guess what? You’re probably didn’t replace the calorie amount either. So now you got this 25% calorie deficiency. So now instead of having 2000 calories, right? Now you’re having 1500 calories and maybe metabolically you need 2000 calories. Now you’re 500 calories in the hole which means your 500 calories deficient of various nutrients. So now your metabolism goes low coz there’s less fuel. That’s important. I see a lot. So you gotta  work with someone that really can make sure you’re exchanging the foods and you’re getting enough calories as well. Coz calories equal nutrition. if you’re eating real foods.

Evan Brand: I’m glad you mentioned that. That’s such a simple but common issue. If you’re going AIP, you are going Paleo, you’re eating real foods, you could have an entire plate full of broccoli and it may only be 50 calories.

Dr. Justin Marchegiani: Exactly.

Evan Brand: Yeah. Dude, great job. Way to kill it.

Dr. Justin Marchegiani: And of course, the infections like you mentioned can really suck down the energy. Of course, acute infection, you know, you’re causing a fever, right? Because the immune system’s trying to up regulate itself because a lot of the bacteria and crap there uhm—they’re like—they’re mesophilic. They—they thrive in a medium temperature. So when you go a little bit higher, you can actually kill them off with a higher temperature. But these chronic bugs can really deplete the energy the body and create this kinda lower temperatures as well. For sure.

Evan Brand: Yeah. And I went—I went to low-calorie for a period of time, not intentionally, not on purpose. It just happened. I was eating meats, I was eating veggies and  I track my calories for a few days and I was eating m—and my activity level  and all that. I was probably 4 to 600 calories deficient. So just added in an extra tablespoon of butter here and there, half of an avocado here and there, handful of nuts and seeds. And I was right back up to where I needed to be.

Dr. Justin Marchegiani: Like here’s a seesaw right?

Evan Brand: Yup.

Dr. Justin Marchegiani: So if like carbohydrate is here, if carbs go lower— this is fat over here. The fats have to go up.

Evan Brand: Yup.

Dr. Justin Marchegiani: If you keep the fats here, you keep the fats on—on this side low, and drop the carbohydrates, that’s where the problem happens. The fats also have to go up. That’s the biggest issue. Proteins typically stay in the middle. Typically, proteins only go up if you’re doing a whole bunch of protein powders because proteins and fats are intimately connected. Uh so if you’re eating real whole foods, you know, it’s hard to get just proteins in whole foods, unless you’re doing maybe like venison or rabbit or like boneless chicken breast. But if you’re eating full fat foods, you’re gonna get fat. And then if you’re adding fats to your vegetables, you’re gonna get extra fat without the protein there as well.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So keep that at the back of your head.

Evan Brand: Perfect.

Dr. Justin Marchegiani: Anyone listening here, give us comments below. Give us some shares. Give us some likes. We want to hear thoughts in the comment section. If you’re listening to us on iTunes, that’s great. Click below and subscribe to our YouTube channel. You can see Evan and I’s mugs going back and forth in our little combos here. And then you can give us some comments below here on YouTube. We love the see the feedback. And Evan, hey man, you have a great day. We’ll talk soon.

Evan Brand: Take care.

Dr. Justin Marchegiani: Take care. Bye.

Evan Brand: Bye.




The other reasons why you may be tired – Podcast #91

Dr. Justin Marchegiani and Evan Brand are connecting the dots as to why some people who have normal adrenals come back still a little bit tired throughout the day. This podcast touches upon the mitochondria and the thyroid, which are the major driving factors of why someone may be fatigued and tired even though their adrenals look good.

stressListen to learn more about dealing with fatigue and inability to cope with stress. Get a better understanding of the thyroid hormones and how they affect the body. Discover facts about fluoride and the effects of drinking fluoridated water. Also find out the benefits of adding mitochondrial support in this interview.

In this episode, topics include:

04:24   Fatigue and inability to cope with stress

11:23   Adrenal, thyroid, and gut issues

14:41   Fluoride

25:32   Mitochondrial support

27:43   Summary









Dr. Justin Marchegiani:  Hey there, it’s Dr. J. Evan, what’s going on this great Tuesday?

Evan Brand:  Hey, good morning, man! I’m drinking some vitamin C and I’m feeling quite—quite yummy.

Dr. Justin Marchegiani:  Nice. Yeah, I got my butter and MCT coffee here, rocking it out, getting my ketones up so in a fat-burning mode today, feeling really good.

Evan Brand:  Great.

Dr. Justin Marchegiani:  How was your weekend?

Evan Brand:  It was great. My wife and I went to Cumberland Falls State Park. It’s the biggest waterfall in the south and I’m gonna be making like a little vlog on my YouTube channel of our adventure. We ended up coming home at like 4 a.m. on Sunday morning because the bed—we rented a little cabin—the mattress in this cabin was so freaking uncomfortable and because of her pregnant belly, she was unable to get in a comfortable position as it is, and it had the worse, like 19.000 springs in it. That–

Dr. Justin Marchegiani:  Oh, my gosh.

Evan Brand:  It—it killed our back. So we tossed and turned until 4 o’clock, and then I said, “Babe, we need to just get up and go home because it’s a 3-hour drive, but we’ll still get more sleep there than trying to lay and toss and turn here.” So—but it was still fun. It did not hinder our ability to enjoy the—the rest of the time we had there.

Dr. Justin Marchegiani:  That’s good. So you survived it. Very nice.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  So I’m getting back in the gym again, just more frequently and lifting heavy again, doing a lot more—a lot more compound lifts like front squats and you know, deep dead lifts. So I’m feeling really just a good total body soreness. It’s a really good healthy soreness. So I like that feeling. I’m looking forward to bring in that back more frequently, kinda combining that in with some of the high intensity interval training and then some of the—the heavy lifting as well.

Evan Brand:  That is a great feeling, yeah. I’m gonna be back into the gym today. I took probably a week or so off just to—I pushed it a little too hard and that belly button pain where I thought I had a hernia–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  But it ended up being an abdominal wall tear. I felt something—something give. So I was like, “Oh, I’m gonna take a week off and up the collagen.” So now I’m—revisit it.

Dr. Justin Marchegiani:  And I think, too, once you get your infections fully eradicated, what’s gonna happen is you’re not gonna have that viscerosomatic reflex—viscero meaning organ, somato meaning muscle. So when you have inflammation in the surroundings organs, they’re on the same 2-lane sensory nerve highway as the muscles around there. So I think what’s happened is the inflammation in those organs are refluxing to the sensory nerves that go to the surrounding muscles probably at L1 through maybe S2, regarding the spinal nerves, and they’re probably shutting off some of those muscles for support.

Evan Brand:  Ah, okay. So I should be increasing my ability to lift and not feel pain.

Dr. Justin Marchegiani:  Absolutely. Yup, that’s one of–

Evan Brand:  Good.

Dr. Justin Marchegiani:  The big ones. We can do a whole podcast on that piece alone.

Evan Brand:  Yeah, that’ll be fun.

Dr. Justin Marchegiani:  I see a big connection between these organs and inflammation in the organs and the muscles being affected, and we all know this intuitively, right? Anyone that knows about like heart attack symptoms, you know, it’s that left arm pain, left jaw pain kinda thing, right? We see it with appendicitis in that lower right hip quadrant, we see it with gallbladders in the shoulder, we see it with every woman who has had PMS for the most part, they can empathize with some lower back pain right in and around menstruation.

Evan Brand:  Definitely.

Dr. Justin Marchegiani:  So it makes sense, right?

Evan Brand:  Yeah, it does.

Dr. Justin Marchegiani:  Well, we talked before the show and we’re really trying to connect the dots for our patients listening and people that are having health issues, so it’s a practical show, and one of the things that we talked about the last few weeks, we’re seeing people that have normal adrenals but are coming back still a little bit tired throughout the day, and why is that? So we’re gonna help connect the dots with that and we’ve done some other shows on this where we talked about the mitochondria and the thyroid which are some of the—the major driving factors of why someone may be fatigued and tried even though their adrenals look good. So refer back to those shows for anyone that’s listening for more in-depth info, but we’re gonna kinda connect the dots here, just so it—we’re putting everything in once place, because this is a common symptom that we’ve been seeing recently.

Evan Brand:  Yup, definitely. Yeah, so we’ll start the story I suppose with a patient story of mine, maybe you have one as well, and fatigue and inability to cope with stress were some of the main symptoms that we were working on. So we started out with just the adrenal test. Now in a perfect world, you and I would have all of the testing done at the same time so we can get the full complete picture, but sometimes it just works out to where someone needs to proceed with just one test and we have to prioritize that. That’s what we did here is we ran the adrenal test and it showed up pretty normal. I would not consider it adrenal fatigue, maybe some dysfunction because his afternoon level was really low, but otherwise, he was in range throughout the rest of the day and his DHEA level was really good, and so it’s like, “Huh, well.” I know what’s going in terms of the adrenal picture? Why are you only low out of rhythm one part of the day? But your DHEA looks good but you can’t handle stress and you’re exhausted. So I don’t have the results yet, but what I was sort of playing out in my mind is there’s gotta be something going on with the gut because I asked him, kinda went through some of the symptoms that I—I see, and you and I have talked about for GI stuff. I said, “Huh, maybe there’s some type of infection going on that’s, you know, stealing your amino acids and impairing digestion.”

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Because he did talk about some heartburn. So I thought, “Oh, okay, good. We have at least one—one clue here.” And he’s got the vertical ridging on the nails like I’ve had.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  And so we’re running the stool test now. I don’t have the results but let’s just hash it out and say, “Maybe there is an infection or a parasite going on and that’s stealing his amino acids, and he’s unable to make energy from his food.”

Dr. Justin Marchegiani:  It’s very possible. People forget like when we see low amino acids on someone’s organic acid test. And you know, some of those organic acid markers for low amino acids could be—off the top of my head—could be a lactate. That’s a marker that goes low. We see low amino acids. It could be cis-aconitase, that’s another one, or it could be pyroglutamate. These are sulfur amino acid markers. So when we see these low markers, we automatically go back to malabsorption, right? It’s the gut stuff. We automatically go back to stress, because the more we are stressed, our body prioritizes lean tissue.  It—it says, alright, so here’s the mindset of the body, of the epigenome, it’s saying, “Alright, we wanna get rid of the most metabolically active tissue because it takes the most amount of nutrients and rest and hormonal output to—to keep it there.” So we wanna get rid of the most metabolically active tissue in times of stress. It’s kinda like you’re going—you’re going for a hike, you know, at Mt. Washington, right? And your pack’s really heavy. Well, what do you do? You go into your pack and you pull out all the stuff that may not be a necessity. Well, that’s kinda what your body does when it comes to stress and muscle and tissue like that tends to be one of these things that becomes less of a priority, the more stress you get. And also people just say, well, if I have low amino acids, why can’t I just eat more protein? That’s a really good idea. That’s one of the things we work on, as we’re making sure we have a palm to a first to a full hand of protein at each meal. That’s important, maybe even adding a protein shake in, but a lot of times it’s not enough because of the fact that 50% of the energy of the protein that we take in actually goes to breaking down the protein. Protein is very energy depleting regarding just the digestive processes and a lot of people already have broken digestion, so we’re working on the 5Rs and supporting the digestion with hydrochloric acid and enzymes by adding in free-form amino acids, adding in the collagen like you were talking about is a great way to help fill in those gaps.

Evan Brand:  Yeah. Yeah, that’s common that a lot of people, I mean even if they came from like vegetarian or vegan diet, they have trouble adding this stuff back in. Their body is like, “Whoa! We have no resources available to actually start breaking down these meat.” So that’s kind of a slow moving process, too, that I’ve been dealing with over the past week as just trying to work some amino acids in to people that have not eaten meat for a while, and it takes a lot of energy. I mean, that is like throwing the big log on the fire and it’s definitely a little bit troublesome for some people if they’ve done it for 5 or 10 or 15 years, which is just crazy.

Dr. Justin Marchegiani:  Yeah, and I personally believe this is the major reason why a lot of people go vegan and vegetarian because their guts really aren’t working and it’s just easier for them to process more vegetable-based things and they do the shake in the morning, very low amount of protein, maybe they add a tiny bit of MCT in there if they’re lucky, but most of them they aren’t doing it, and they’re avoiding it because their gut isn’t working to begin with. That tends to be the reason why.

Evan Brand:  You know what would be amazing if we could do and get him on board with allowing him—allowing us to run some testing on him would be Rich Roll. He’s got a top ranked podcast as well and he’s got a book about being a vegan and he promotes a vegan lifestyle. He’s got a huge, huge following with this ideology but he’s a skinny guy. So I guarantee if you and I reached out, and we said, “Hey, Rich! Let us run some GI testing on you, I wouldn’t be surprised at all if something showed up in terms of some adrenals issues, maybe some gut issues, maybe infections.” What do you think?

Dr. Justin Marchegiani:  Yeah, it’s very possible. Now a lot of vegans and vegetarians, they could still get away with it if they’re using a ton of pea protein or they’re using a ton of free-form amino acids. Or if they’re–

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Using a ton of—it depends—if they’re allowed to do collagen or not. Sometimes in a powder form they can—they can kinda rationalize to themselves, hemp protein, even rice protein, so if they’re doing a lot of extra amino acid—let’s say they’re supplementing an extra 100g a day, well, that’s a huge step in the right direction. So it’s possible if they’re using supplements to get that, the difference is as a meat eater, as someone who is omnivore who eats both, we can get the extra amino acids from meat, without all the extra carbohydrates. When you’re vegetarian, if you’re—forget using supplementation, if you’re just relying off of whole food, it’s really hard to get the protein in there unless you’re doing soy, pure soy, which we know the detriments of that—we’ll have to do a whole podcast on that and the phytoestrogen effect—but for the most part, you’re gonna be getting a whole bunch of carbohydrates with a little bit of protein so the people that tend to do–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Good on vegetarian diets are the ectomorphs because they can handle a lot more carbohydrate and it doesn’t affect them, but the mesomorphs or even the endomorphs, right? So go back to our body typing podcast and videos for that info—they tend to be more insulin-resistant and those extra carbohydrates and even some of the—the lectins in the gut, the anti-nutrients and some of those beans and other proteins that vegetarians eat tend to create a lot of gut inflammation.

Evan Brand:  Yup, definitely. So I guess let’s zoom back in to this issue here of why someone may have like a good adrenal results or decent, you know, maybe it’s not stage 3 adrenal fatigue like most people are. What would you first clue into maybe beyond the gut that could be going on?

Dr. Justin Marchegiani:  Well, the first thing is we—we draw like the first layer I kinda draw a triangle, right? And in that triangle when there’s energy issues, we always look at the adrenals from the top. So kinda draw a triangle in your mind, put A on the top. That’s adrenals. Now, at the foundation let’s say we have adrenal symptoms but our adrenals look decent. So adrenal function is this nice cortisol rhythm, high to low cortisol rhythm, right? It’s where cortisol’s higher in the morning which give us energy and it slopes down throughout the day. So if we have adequate cortisol levels, you know, upper 20s to—to lower 30s and we have a good rhythm, well, then the next piece is we look at at the bottom 2 points, which are gonna be thyroid and the mitochondria. And we kinda already touched upon the amino acids because the amino acids are really important for the mitochondria. That’s a really important piece and when we see amino acid issues, we almost always see B vitamin issues because B vitamins tend to get depleted when there’s malabsorption in the gut. And then we also see other nutrients like CoQ10 and L-carnitine and a lot of the Kreb cycle intermediaries like succinate, fumarate and maleate. We’ll see those off on an organic acid test, and then if we go to the other side, that’s the T side, that’s the thyroid, we can see low thyroid function whether it’s primary hypothyroidism with elevations in TSH from the pituitary or whether it’s low T4, right? Your thyroid is not making enough active thyroid—or inactive thyroid hormone or it’s a conversion issue where we’re not converting T4 to T3, and that could happen from gut inflammation, autoimmunity. It could happen from liver issues and/or just low nutrients like selenium, zinc, and vitamin A and copper, etc.

Evan Brand:  Hey, I was gonna stop you there and ask what the conversion issues, you know, I know if you have some adrenal issues, maybe it’s not severe enough adrenal issues to have like a real diagnosis attached to it, but doesn’t that process cortisol and there some interaction there where you reduce the conversion of the T4 to the active T3?

Dr. Justin Marchegiani:  Exactly. So there’s a couple things, right? If cortisol is too high, that can actually increase TSH and that can block the thyroid conversion T4 to T3. If cortisol’s too low, we need some of it to actually get into the cells and to actually help activate T4 to T3 as well. So it’s kinda like the Goldilock’s effect. We—we don’t want so much where it’s—it’s a sign of a stress response, right? Because when cortisol’s high, too high, it’s typically because your Fight or Flight mechanism, right? Your HPA axis—hypothalamus, pituitary, brain, adrenals are active because your body’s sensing stress, so we have that sign and we have it on the low side where we’re now in a chronic stressed out state and now cortisol’s low. So it’s the Goldilock’s effect. We don’t want acute stress happening and we don’t want chronic stress happening, so just enough to help convert that T4 to T3 as essential.

Evan Brand:  Right, and one other thing I wanted to mention, too, is you mentioned things causing issues with the thyroid and the lack of selenium and things like that. What comes to mind for me, too, is you know, a lack of iodine potentially, maybe a lack of some of the amino acids like we talked about like tyrosine specifically and then what about like fluoride and bromide that people are getting if they’re still eating some processed foods or drinking fluoridated tap water for example. Is that a big factor? I mean, is that something—it’s something on my radar but I just don’t know how big of a needle mover it really is compared to some of these other ones.

Dr. Justin Marchegiani:  Yeah, I got a video lined up at my queue on my Trello board that I’m gonna do a video on fluoride for the thyroid because they’ve had an epidemiological study over in Europe come out last year where they looked at people who consumed fluoride water, based on the water systems, like they looked at various towns in England. And they found like the towns that had the—the more fluoride in the water had the higher incidence of hypothyroidism.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  So more low thyroid function was present in people that were having higher amounts and more fluoride consumption in their water supply. So there’s definitely an effect there because fluoride is a—it’s a halide. I think it’s the 6–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Or 7 periodic table element. I’d have to—to look it up again. My—my biochemistry is a little but fleeting right now, but that—that group, that 7 periodic table, I think it is—is the halide family. Iodine sits there as well and basically, fluoride can get in there and kind of pinch hit and knock fluoride—I’m sorry, knock iodine out of its proper function and role of the iodenation process which is making thyroid hormone, right? When we see T, for T4, that stands for tyrosine. We see the 4 or the 3, that stands for the amount of iodine molecules that are there. So we know iodine is important building block for the production of thyroid hormone.

Evan Brand:  Yeah, the—I’ve been sounding the alarm on fluoride for a while, but I still feel like there’s not enough light on it, and so I guess I’ll do a video as well, and you know, the other piece of it that I looked at, which is maybe a little off-topic, but there’s a study out of China that was looking at children. Some that were exposed maybe different towns like you said, a fluoridated town versus non-fluoridated, and there was a difference of 7 IQ points. When the kids were fluoridated, 7 IQ points lower than a non-fluoridated town. So there is a huge impact on our intelligence as well and it’s no surprise that most of the United States is fluoridated except for 2 cities, I think it’s Portland and I wanna say it’s Houston, which sounds bizarre.

Dr. Justin Marchegiani:  I think—I’m pretty sure it’s Half Moon Bay as well. I know Half Moon Bay up in the Bay Area is an—is a one water supply that was not fluoridated. We had a—when I was in doctoral school, we, a whole class, a whole Public Health class based on us going through the literature on fluoride and it’s pretty crazy the stuff that fluoride is linked up to in the hard core science that people don’t wanna talk about.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  I mean, like the study that you mentioned, I’ve read Mexico studies. These studies that happened in Mexico where it was like 10 to 15 IQ points. Like just scary stuff and in that—that halide group there is also chlorine, too, and bromine. And bromine, you’re gonna find that in a lot of your conventional bakery foods, a lot of your conventional grains, right? That’s why more reasons not to consume grains. And then your chlorine you’re gonna get that in your conventional water supply as well, so it’s like a double whammy. You don’t just get the fluoride, you get the chlorine as well which are—are problems. And then also people that—that studied fluoride, I’ll have to have like Dr. David Kennedy come on board here or Dr. _____, they’re some great experts on fluoride. But when you get fluoride, it’s not just like sodium fluoride. It’s fluorosalicylic acid which actually has a lot more dangerous compounds in it than just fluoride. So again, those molecules can come in and pinch-hit in the thyroid and really downregulate the thyroid function and the 1940s in Germany, they were using fluoride to treat hyperthyroidism and that was—it was literally a prescription medication that was given to people that had Grave’s or hyper symptoms and because it would go in there and—and pinch-hit and knock down that thyroid function, kinda like reverse T3, you’ve kind of alluded to it. Reverse T3 is when we’re in a stressed out state. Your body will convert T4 to reverse T3 which is like putting blanks, metabolic blank bullets in your metabolic guns so when you pull the trigger, yeah, you get the sound of a bullet, but there’s no bullet that actually comes out, right? You get the hormone going into the thyroid receptor but you don’t have that same kind of metabolic effect, which means you’re gonna have lower thyroid symptoms, the more metabolic reverse T3 or are T3 blanks that that are produced because of stress.

Evan Brand:  Yup, so yeah, and I think I may have mentioned it before but in the concentration camps, in the same time zone around, you know, 30s, 40s, sodium fluoride was used in the water, probably high, high, high doses for the concentration camp victims to keep them very docile.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  And very numb almost like operating like a sheep, so not to get conspiratorial here, but hmmm they’re—you know, a lot of our founding fathers said there should be a revolution in the United States every 10 years and it has been quite some time since we’ve had any type of major uprising, and our whole country generally is fluoridated and a lot of people are unhappy with what’s going on in the country, but we’re all fluoridated so it’s almost like we’re too numb to actually respond or actually get energetic enough to do anything about it, so that’s crazy.

Dr. Justin Marchegiani:  Well, it’s do—it’s doing something. We know it, just like, you know, let’s just stick to the facts here, right? We know it’s affecting the thyroid. We know it’s affecting—we know thyroid has a big effect on IQ, right? You look at many women that are—that have low thyroid hormone levels, they’re hypothyroidism through pregnancy, right? We know that that can create lower IQ in the baby, especially if the thyroid problems are caused by very low iodine levels. We know that can cause a form of retardation called cretinism, right? That’s a—that’s basically a totally preventable form of mental retardation because of very low iodine levels. We know it’s affecting the IQ as well just in people that have—were born healthy but are just consuming a lot of it. And if you look at the drug, Prozac. Just look at the organic chemistry of it. Just go to and pull up the organic chemistry of Prozac, you’re gonna see the major molecule of the drug is centered around is a fluoride molecule. So we know that there’s a lot of things that that drug can do, not a lot of good things per se. Now there may be some things like calcium fluoride that are more mineral-based in the water, that are more natural. We’re—we’re talking more of the sodium fluoride and the fluorosalicylic acids that are synthetic, man-made, typically as a result of the—the fertilizer/bomb-making industry. These are a lot of the by-product of those industries and a lot of this actually came about after World War 2 from all the excess bomb-making material that was basically from all the industry, right? A lot of our industry went to making weapons for World War 2, and then this—all these residual things were leftover afterwards, and this is what we’re getting exposed to today. And some great books on this is like Christopher Bryson has a great book on fluoride. See I think that’s Paul Connett. He’s an organic chemist over at St. Lawrence University. We have Dr. David Kennedy, DDS, phenomenal guy, great stuff on fluoride as well. So lots of good information out there and also lots of studies, too. Just Google Harvard Study and fluoride. You’ll see fluoride will actually increase your risk of osteosarcoma especially in boys. These are like a bone and muscle tumors. So we know there’s an increased risk for these compounds and they can affect your thyroid and they can create some of these energy issues that we’re talking about outside of just adrenals.

Evan Brand:  Yup, definitely. So long—long diversion but that still ties in to exactly what we were talking because we’re not gonna be able to see specifically, “Oh, are you getting fluoride exposure?” So we’re just gonna have to kind of ask and pry you for this question and so if you do have fatigue, if you do have hypothyroid symptoms, this is something to really look at and make sure that you are being more diligent about filtering your water. I know Justin you have a whole house system and your water tastes really good. I got to taste your water, and you know, I’m typically going to be doing some type of spring water which does have some natural fluoride but like you mentioned, it’s not the same.

Dr. Justin Marchegiani:  Not the same, yeah.

Evan Brand:  So, yeah, so really, you know, getting a good grip on your water. If that’s the only take away you get from this podcast today, then that’s—that’s fine because this is a factor that is still overlooked, and I can’t tell you the amount of people that I still see drinking tap water. One of my wife’s friends when we were down in Austin, I got on this whole subject with her and was talking about the science and all of that, and she goes, “Evan, I’m not scared.” And she goes over to the sink and pours a big glass of tap water and just starts drinking in, and I’m just like, “You’re not hurting my feeling by doing that, I’m just trying to help you,” you know? And so a lot of people are still—they think this is like a tin foil hat subject for some reason.

Dr. Justin Marchegiani:  I mean, this isn’t that controversial. Just go to the CDC’s website and just look at—just google fluoride and cavity. The CDC’s admitted that the children between 13—or 10 and 14 or 10 and 16, the major cause –the major cause of cavities in that age group is actually—it’s called a dental fluorosis, meaning excess fluoride in the drinking water. That’s like the major cause of cavities in these younger aged children.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  It’s like, my gosh, I mean I have con—I have conversations with dentists and they aren’t even aware of this stuff, but it’s like the CDC—it’s like it’s admitted that it’s out there. I mean you can just google these things, just type in CDC dental fluorosis, major cause of cavities, and you get a whole bunch of studies coming up and you get the CDC even saying it. So we know it’s out there. It’s real, just you know, things don’t get talked about because there are financial interest out there that, you know, benefit by having that there. So we just wanna empower people, be aware of it. Do your own research, right? That old, Reagan quote, “Trust but verify.” So do some Google work. Pull up some of these studies on Google Scholar or PubMed and do your homework on it, but forget fluoride, right? We know that there’s a lot of other crud and crap in the drinking water. Pharmaceutical drugs are getting in the water, because we don’t have means of filtering these things out, that people throw the—the drugs in there, down the toilet or you know, emptying them out or we have pesticide and chemical residue that goes into the drinking water supply as well. So everyone in their home should have a water filtration system. I have two. I have a whole house water filter, as well as a countertop filter that’s reverse osmosis based that filters out everything and then infuses some minerals back in as well.

Evan Brand:  Yup, that’s great.

Dr. Justin Marchegiani:  So any additional comments on the mitochondria part or the thyroid part, Evan?

Evan Brand:  It’s—it’s something to factor in for sure, you know, if you’re struggling with your program and it hasn’t been addressed. It’s something that you definitely wanna take in to consideration. The mitochondrial support, you know, we talked about the adaptogens a lot. That’s something that I like. I like some of the ribose and some of the PQQ and the other super mitochondrial boosters. It may not be necessary for you, you know, if you look and you get the organics run if you haven’t had it run, you know, by one of us, that’s something that you can have done. A lot of times we’ll see some mitochondrial issues on there and then we’ll know, “Okay, you do need some good mitochondrial support,” and then we bring it in and then the lights come back on and people feel amazing. So it’s always fun to really help people feel better. I think that’s the funnest part about my job is when you jump on the phone with somebody and we’re like checking in, you know, “How are you feeling?” And the energy has tripled. It’s like that is so priceless and it cost maybe $30 for a bottle of supplements that we just needed to prove that they needed and they feel better, so this—I’m just a huge proponent of what we do.

Dr. Justin Marchegiani:  Yeah, and then again, right? The reason why we need these things are either because one, we’re burning the candle at both ends and we’re burning through these nutrients faster, and/or we’ve had a poor diet in the past so we have to make up for that, and/or because we’ve had malabsorption because of infection. So you know, we’re—we’re changing the diet. We’re getting to the root cause. We’re fixing the underlying lifestyle and dietary stressors and then also making sure our body is detoxifying, right? Toxins rev up our need for antioxidants and B vitamins and all these minerals that you’re talking about, too. So toxicity from the water. Toxicity from the air, poor food, all of these things are gonna deplete you as well.

Evan Brand:  Yup, definitely.

Dr. Justin Marchegiani:  Well, any additional take homes here, Evan?

Evan Brand:  Not for today. I think probably have to break this up into more podcasts. I know you and I both gotta go to a call, but also there’s a lot of info just in here and we can kind of navigate the river and go down some more smaller diversion topics that we can break down further, but there’s always—there’s always next time.

Dr. Justin Marchegiani:  So I think that the bullet—the bullet point take homes from today’s call is get your adrenals tested, number one. Get on an adrenal program that includes diet and lifestyle and supplement changes. Number three, if you’re not getting the results you’re looking for—5 to 10% improvement each month, then we gotta look at the thyroid. We gotta look at the mitochondria, be it the organic acids, and then once we have that dialed in, then the next piece would be the gut afterwards. Is that a good take home, Evan?

Evan Brand:  That sounds great.

Dr. Justin Marchegiani:  Awesome, man. Well, best of luck with your patients today. You’re gonna knock them dead and we will talk really soon, my man.

Evan Brand:  Same to you. Well, hopefully, I’ll knock ‘em alive.

Dr. Justin Marchegiani:  Knock–yeah, I’m sorry. When I say knock ‘em dead in a good way. We’re—we’re getting to the underlying causes of why they’re feeling the way they’re feeling, but yeah, I get it, man. Cool.

Evan Brand:  Totally. Same to you, my man.

Dr. Justin Marchegiani:  Alright, you take care.

Evan Brand:  See ya.

Dr. Justin Marchegiani:  Bye.

Evan Brand:  Bye.

Adrenal Fatigue, Adrenal Failure and the Cortisol Rollercoaster – Podcast #60

Dr. Justin and Evan clarify the issue of high cortisol levels versus low cortisol levels as well as how you can get tested for them. Find out which labs are recommended, what to look out for on your adrenal cortisol tests, and how to get a customized specific protocol in today’s interview. 

adrenal rollercoasterGet in-depth information about the importance of healthy cortisol levels in our body and the various roles it play for body function. As far as methods of treatment are concerned, discover why functional model is superior than the conventional model.  Also learn helpful exercises you can do to aid in your healing process. Get tips on how to start your morning to reduce stress and negativity in your life.

In this episode, topics include:

1:50   What is cortisol

11:03   Symptoms of adrenal issues

14:03   Methods of healing, functional vs conventional model

18:42   Treatment or the healing process

24:45   Supplementation and diet







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Dr. Justin Marchegiani:  Evan, it’s Dr. J.  Evan, what’s going on, man?

Evan Brand:  Hey, not too much.  I had my own protein today.  I was just telling you about it and it–it’s still delicious.  I–I feel like when I was pitching my protein this week on my own show–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  I felt kinda like, man, I have to say it’s delicious.  But it really is.  I’ve had a lot of people send me stuff and you probably get stuff sent to you, too, to test things out and organic vanilla bean is a real deal.  It’s not that fake–fake vanilla bean, that natural flavor vanilla–vanilla bean that comes from beavers anal glands.

Dr. Justin Marchegiani:  Oh, my gosh!  I can’t believe that.  So your whey protein, it–it’s grass-fed, right?

Evan Brand:  Yeah.  And–

Dr. Justin Marchegiani:  High-quality stuff like that?

Evan Brand:  Yeah and there’s collagen in there, too.  I think I was–

Dr. Justin Marchegiani:  Ooh.

Evan Brand:  Getting fairydusted at first, so I told him I wanted 14 grams of–it’s a 20-gram scoop so I told him, you know, 14 grams I wanted to come from the grass-fed whey and then 6 grams I wanted to come from collagen, and I can feel it.  I don’t know if that makes sense.  I can feel when it goes into my body.

Dr. Justin Marchegiani:  Dude, that’s awesome!  Anyone listening to the show, feel free to check out Evan’s site at  Get some good quality whey protein with some collagen in there.  That’s good stuff.

Evan Brand:  Yup.  I–I’ll send you some, as soon as we–as soon as we run this batch, I’ll send you a–a few bottles of each.

Dr. Justin Marchegiani:  Yeah, I’m a huge fan of collagen honestly.  I mean, there’s all kinds of good benefits for it just for like healthy gut function and stuff, but let’s just say you’re vain and you want the aesthetic stuff.  Great hair, great skin, great nails.  I just actually saw Dave Asprey out a few months back and you know, Dave’s got his new hairstyle, right?  Dave’s the–the Bulletproof exec and I said, “Dave, what the heck’s going on with your hair?  It looks really different.”  He was like, “Dude, I’m just upping my collagen levels.”  So I’m just like, “Hey, collagen’s good for him.  It’s good for hair, good for skin, good for nails, and there’s a lot of health benefits outside of the aesthetics.”  So in my opinion, it’s a win-win.

Evan Brand:  Yup, definitely.

Dr. Justin Marchegiani:  So in our pre-game talk here, we chatted about cortisol.  We felt like that this would be a really good topic to kind of bring to our listeners.  So why don’t you get the ball rolling, Evan?

Evan Brand:  Yeah, so I wanted to talk about this because cortisol is a buzzword first of all, so people aren’t gonna be like, “Oh, great! Cortisol.”

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  But I think a lot of people have been convinced that high cortisol is always the case and people think, I have high cortisol and it’s causing me all my problems but not one adrenal cortisol rhythm test that I’ve reviewed has had high cortisol.  Every single one is low.  Everyone’s lower than they should be and that’s causing more problems.  I mean, high cortisol is a big deal but I think more people have been burnt out or burning the candles at both ends longer than they–than they realize.  And so that high cortisol stage, you–you’ve already passed that, now you’re in the low cortisol stage because you’re running on fumes anymore.  You’re not just being chased by the tiger.   You’ve been chased by the tiger for 40 years and there’s nothing left to help you run from that thing.

Dr. Justin Marchegiani:  Absolutely and cortisol is actually good for you.  Like you said, most of the patients that we see, we run this salivary cortisol rhythm test and again, a salivary cortisol rhythm is looking at the free fraction of your cortisol so I know a lot of people may get confused because they may have had their conventional doctor run a cortisol and that’s typically via blood and blood primarily, actually it’s only testing for cortisol, the serum, the protein-bound cortisol.  So imagine this, imagine you got–here’s my analogy for the day.  Now each day I kinda pull one of these out from you know where and help it resonate to people.  So 2% of hormones are–are typically free fraction.  So imagine a baseball going into a catcher’s mitt, right?  That’s your 2% and the other 98 out of 100 are beach balls, right?  A beach ball is too big to fit into that catcher’s mitt but those baseballs can fit into the catcher’s mitt.  So a lot of the–the beach balls for instance are the 98% that are protein-bound, right?  They are made by the gland.  It’s a good measure of glandular function which is great in conventional medicine because when they were testing for disease, right?  Pathology of the gland, it’s great to measure the beach balls because the beach balls represent 98%.  So it gives us a good window at actual gland output.  But because the beach balls are so big, they can’t get into the catcher’s mitt.  So we look for the baseballs and the baseballs are the free fraction.  They don’t have a–a protein carrier attached to it so they can actually go into that catcher’s mitt or in actual physiology and biochemistry, they can bind into that receptor site and have a metabolic effect.

Evan Brand:  I like that.  That’s a good analogy.  So you know, the thing with cortisol like I’ve mentioned, in the morning, you want it to be high.  That’s normal.

Dr. Justin Marchegiani:  Yes.

Evan Brand:  That’s the time where high cortisol is a good thing and a lot of people wake really early for work.  Sometimes 5AM and they go to the coffee to get them up but in reality, if you don’t need as much time in the morning, say you can push your schedule back a little bit and try to wake up closer to 7AM or closer to the actual sun up time, if you’re getting up before the sun and you can change that to–to getting up at sunrise, you’re basically–I’m gonna use my analogy that I mentioned to you–if you’re getting up at 4AM to get ready for work, you’re only going halfway up the hill on your favorite rollercoaster before you start going back down the hill.  So you’re gonna get to the bottom of that hill a lot of quicker and it’s not gonna be as fun of a ride for you as if you were to get up closer to sunrise time or 7AM and now you’re at the top of that rollercoaster hill, that’s gonna be a really fun ride and you’re gonna have a lot longer distance to cover before you get to the bottom of that hill and that’s why people that are waking up too early or people that are not pumping out enough cortisol in the morning, by noon, they’re bottomed out and the fun’s over for the day.  You might as well close shop and give up.

Dr. Justin Marchegiani:  Exactly.  Exactly.  And again, cortisol typically goes low with chronic stress.  So if you see low cortisol, at one point you were probably in this high cortisol space.  And we kinda go back in the history, when we–we kinda do an exam and intake, you know, going back in time, was there a place where you were under a lot of stress but you felt good?  Like you had energy, you may have been stressed, you may have been anxious but you had the energy, you know, behind you to do all the things that you needed to do, and then at some point, it started to teeter out where, you know, you’re having less energy, you’re feeling more fatigue, you need more naps, you need more time sleeping, you spend more time resting on the weekend, and most people when we do a detail history, we see that pattern kind of unfolding and we progress, that’s called stage 1–again, depending on what lab you use, there’s a lab called Diagnos-Techs out of Washington, they have like a 7 phases of adrenal fatigue–I like keeping things really simple.  Again, if you’re not able to break concepts down into simple easy to explain analogies, it just tells me you don’t really understand that that well yourself or you’re just a bad teacher, one of the two.  Hans Selye called the alarm phase if you will, and then state–phase 2 or stage 2 is when that cortisol is dropping.  Typically what categorizes or what’s characteristic of a stage 2 is we start to see some rhythm perturbations, some rhythm abnormalities, maybe a high morning or a low afternoon or a–a high late afternoon or a low night.  We’ll start to see some rhythm imbalances and some drops in DHEA, in your sex hormones.  And then stage 3, we’ll start to see it drop beneath 23, I think it’s picomoles per liter is the amount that’s typically used on your conventional salivary labs.  Don’t quote me though, but you know, if you’re running like your Biohealth or your Diagnos-Techs, labs like that, that’s your conventional range, and you’ll start to see that go beneath 23 units, you typically see 2 or more rhythm disturbances and you’ll see lower or low DHEA on that as well.

Evan Brand:  How often is it for you to see all 4?  Almost every single person I run that on it all 4, they’re low all day.  They’re below morning, below mid-day, below evening, and below night.  I mean, I’ve never had anybody that’s been in range on all 4 actually.

Dr. Justin Marchegiani:  I totally agree and frankly with–I’d say with majority of patients, I really don’t need adrenal cortisol tests because I just tell by symptoms and by talking with them, but at the same standpoint though, my patients need to see it.  They need to see it’s real and then it’s really important that be able to see it, make a change, go back and re-test, and see it get better.  That’s like a really important thing.  And again, there’s a couple things every now and then we run these tests, I can’t predict rhythm disturbances.  So for instance, I’ll be like your stage 3, but then they’re low in the morning, high at night, they’re DHEA is low, and you get surprises.  So one, you gotta run the adrenal test just to see where you’re at because the weaker your adrenals are, the longer it’s gonna take you to heal and also to heal your gut because we need cortisol to heal our–our guts and to put out the fire in our guts.  So typically, if you’re doing a good questionnaire and most people are gonna be stage 3, but we need to see it.  People need to see it’s real.  They need to see what kind of rhythm disturbance is there.  They need to see where their DHEA is at and then it’s great to create a program, come back, re-test it, and see rhythm come back into effect.  See cortisol levels go up.  See DHEA levels improve.  It makes a huge difference for people being on track.  It also gives them a sense of how long it’s gonna take to get better and then it also really keeps them motivated and allow the functional medicine doctor to create a–a customized specific protocol, not a general one which would–would be what I would be stuck doing if we just did it based on symptoms, it’d be a very general protocol.  But with the labs, we can create a specific protocol so instead–instead of pulling out the RPG or the bazooka, I can pull out the sniper rifle and really target the exact rhythm, because it’s not just giving support, we also wanna really target the rhythm so if we’re low in certain areas, we wanna use certain nutrients to bring it up.  If we were high on certain area, we wanna use certain compounds to bring it down and we wanna time it throughout the day so we’re mimicking normal hormonal physiology.

Evan Brand:  Perfect.  That’s great.  That has actually improved some of the stuff that I was doing, because before when just like you said I can assume that a lot of people are gonna have adrenal issues but I didn’t know exactly what time so if I was gonna add in say an adaptogen or if I was gonna add in something like some phosphatidylserine, it’s like, “When do they need it?”  And I can use generalities but now that I’m actually running more of those, I see like, “Man, it really is a good idea to run this even though I probably already knew what it was gonna tell me.  It’s just a little bit more accuracy.”  Let’s talk about some of the symptoms of some of these issues people may be hearing this and they’re thinking, “Huh.”  So I had just a couple written down here.  One being fatigue.  Another being aches and pains or you wake up and you don’t feel refreshed, maybe you feel tired even, even after you have–

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  A full night of sleep.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  You wake up and you’re just like, “Gosh!”  Lightheadedness is something that I see a lot.  Poor balance, just like you stand up and you’re like, “Whoa!”  Crashing after meals, cravings, mood imbalances, headaches, digestive stuff.  Another one that I don’t have written down but I experienced personally was a loss of muscle at first.  I guess in that first phase, that high cortisol, basically catabolized my muscle.

Dr. Justin Marchegiani:  You are a weakling.

Evan Brand:  I know.  I’m building back up now.  I’m feeling good now that I’m–got my–my protocol under control.  But what other symptoms?  I mean, have I covered kind of the main things that–that you see as well?

 Dr. Justin Marchegiani:  Yeah, I know and actually, you are–you are putting on a lot more muscle, Evan.  I–I can totally notice that.  We gotta bring the show to video format so you can flex for listeners next time.

Evan Brand:  Sure.

Dr. Justin Marchegiani:  But yeah, you are 100% right.  I’d also say allergies are a big one.  Joint pain, right?  People that are chronically in pain.  Like think about it.  When you go to the joint doctor, you know, you’re a–I think it’s a rheumatologist or orthopedist, I mean, they’re gonna give you a cortisone injection and cortisone is the cousin or sister of cortisol, right?  We have our natural anti-inflammatory being produced by our adrenals called cortisol, which we already talked about, and if we break the word cortisol down, it’s really a glucocorticosteroid.  And again, like we talked about, right?  Medicine loves to use big words that keep people in the dark and feel confused.  So we just break it down.  Gluco pertaining to blood glucose/energy, okay?  Corticosteroid pertaining to stress and inflammation, right?  Corticosteroid injection, right?  Corticosteroid for inhalers.  Corticosteroid for creams.  Corticosteroid pills for pain, right?  So pain, inflammation, stress, energy.  So this is kind of the big things that cortisol are incredibly responsible for but we also need healthy levels of cortisol for thyroid hormone activation, right?  Goldilocks effect–too high, we shut down and block the thyroid; too low, we can’t convert and activate thyroid hormone.  We need cortisol for healing or address inflammation in our gut and–and being resistant to common allergens.  We need healthy cortisol levels to maintain energy and blood sugar throughout the day so we’re not having to eat every two hours like, you know, like you’re grazing, like you’re an animal.  And then also, just we need it to be able to help detoxify it.  Cortisol has a role in detoxification.  Alright, so we need healthy levels of cortisol just to be resistant to stress in the environment.

Evan Brand:  Yeah, so let’s about–I wanna get into some–some methods of healing, if you will.  But maybe you could spend a minute or two explaining kind of why the functional model of looking at this is superior to the conventional model, because you’ll hear–hear people even they don’t even have in their consciousness an issue of adrenal dysregulation, they may just think that they need this cortisone shot.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  And that’s not going to actually fix what’s going on.

Dr. Justin Marchegiani:  Absolutely.  So first off, I’m gonna get to that in a roundabout way.  I feel like a politician answering your question here.  So when we look at your cortisol rhythm, there’s 3 things we always wanna prioritize.  Most people just look at the–the number, how much cortisol you’re outputting throughout the day, right?  And that’s kinda what conventional medicine does, right?  Addison’s disease, super low cortisol.  Cushing’s disease, right?  Cush–push, that means high cortisol, alright?  So we’re looking at amounts with the conventional medicine.  In functional medicine, we’re really looking at rhythm.  We’re looking at what’s your cortisol rhythm like?  And a lot of these has to do with the HPA axis, the hypothalamic-pituitary.  These are glands that sit a couple inches right between your eyeballs, right between your eyes and they–they’re master controllers.  They talk down to the thyroid, to the adrenals, to the gonads, etc.  And again, they talk to the adrenals and they help regulate cortisol.  So when we’re stressed, those glands, that tissue loses communication and we start seeing the aberrations and the perturbations in the cortisol rhythm.  And that’s one of the most important things we like to look at first.  The second is cortisol amount.  The third is then DHEA levels.  So when we talk about the word adrenal fatigue, we’re not–we’re not talking about it from the perspective like a pancreas that’s fatigued and can’t make insulin.  There may be some fatigue in the gland but a lot of what we’re talking about is HPA–hypothalamus, pituitary, adrenal–just think brain talking to adrenal, that type of communication, that thermostat that talks to your adrenals or the thermostat that talks to your heater or your A/C in your house is broken, so to speak.  And just because the A/C or the heater isn’t running properly, it may not be the actual heater or A/C.  It may just be the thermostat.  So a lot of what we’re doing yet, we’re supporting the actual gland, that–that’s cool.  But we’re also supporting the brain.  So I think when we’re doing a lot of these programs, we’re still working on the brain just as much as we are working on the adrenals.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  Okay?  Go ahead.

Evan Brand:  No, keep going, that’s great.

Dr. Justin Marchegiani:  Now, getting back to the original question you asked me to begin with.  When we look at conventional medicine, conventional medicine really what they’re looking at, they’re looking at adrenal failure.  There are probably a hundred patients over the years that we–you know, after our consult, we review what’s going on, they go to their MD, they–they show them the tests, they talk about and they say, “You know, your doctor’s crazy.  You don’t have adrenal fatigue or adrenal failure.”  Because they–they equate adrenal fatigue to Addison’s disease or adrenal failure where cortisol gets super, super, super low where you can’t regulate inflammation and the body starts shutting down, right?  So they equate it to that in their mind, because that’s what adrenals to them means, because they’re on a pathology-based state, not in a functional state.  So they come back and they’re like, “Well, I don’t have adrenal fatigue” or “I don’t have this adrenal imbalance,” and then we just have to differentiate, right?  The conventional doctors looking at disease, that’s Addison’s disease.  That’s super, super, super, super low, low cortisol levels typically caused by an autoimmune condition that starts to destroy the adrenals.  So we wanna realize that.  Let’s say on a spectrum of 1 to 10, 10 being optimal adrenal health and 1 being Addison’s disease, you gotta be at a 1 to have Addison’s, right?  That’s kind of our subjective criteria but most people that are going into the doctor maybe are sitting at 3 or 4 or 5.  And again, they are far away from 10, right?  But they’re not near 1 yet and they may not–they may never even get to 1.  So they’re going to their doctor and they’re just saying, “Hey, what’s up?”  And then their doctor says their fine but they’re really not in a good place.  So we’re looking at things more from a functional perspective not a pathology perspective, and that’s the–the main thing and again, most people are at 3 to 5 on that subjective range, so they’ll never ever be helped.  They’re never ever fall into that adrenal failure criteria, but they’ll have dysfunctional adrenal fatigue primarily driven by HPA–brain, poor brain adrenal communication by chronic stress and it’s our job as the functional medicine doctor to figure out where that stress is coming from, nutritionally, diet-wise, obviously all the emotional and lifestyle stressors, and then even bigger, the internal infection, toxicity stressors.

Evan Brand:  Yeah, so let’s get into the–if we can use the word treatment or the healing process.  Something that I like to start with is the exercise looking at that a little bit closer because–

Dr. Justin Marchegiani:  Oh yeah.

Evan Brand:  A lot, a lot, a lot, a lot of women think they have to do 6 days a week of their spinning class or 6 days a week of their CrossFit class, and then they combine that with 2-3 mornings of yoga and then they combine that with another 2-3 afternoon workouts of weightlifting and that’s like, “Holy crap!”  It’s like no wonder you’re so low.  So that’s kinda almost the first starting place for people because at a certain point, too much or too intense exercise is gonna tax the system and if we’re trying to rebuild it with some of these methods that we’ll get into it, you’re just spinning your wheels.  So I like to just tell people to go for a walk.  If you live on the beach, go for a walk and get the wet sand in between your toes and try to reduce some stress that way.  If you like to go swimming, that’s a good way to do it if you’re not in chlorine pools, if you can get access to some saltwater pools or something like that or a walk in the woods, just walking.  I think that’s like one of the most restorative but helpful exercises I could prescribe if you will.

Dr. Justin Marchegiani:  Absolutely and I have a 3-step criteria that I use to help kind of evaluate whether exercise is positive stress or negative stress and you gotta answer positively to all these questions.  So number one, do you feel energized after your exercise?  Alright, do you feel good after your exercise?  Number two, 10-15 minutes after you complete the exercise and you kinda caught your breath and such, how do you feel?  Do you feel like you could emotionally repeat the exercise again or you’re just like, “Holy crap!  Like get me the heck out of this CrossFit box,” like “I’m done,” you know?  And then number three would be, how do you feel that night or that next morning?  You know, barring, you know, you didn’t do any new exercises and you’re not gonna be sore because the movements are different and you had a good night’s sleep.  Barring all that stuff, how do you feel?  Do you feel hit by a bus?  So those are kind of my 3 questions that we need to answer positively for.  If we don’t, then one of the first things we have to do is cut down the duration.  So if we had an hour-long workout 5 days a week, well, we’ll just cut it down to half hour or 45 minutes then we can also cut down the intensity.  I find most people do good with intense movement patterns depending on how fatigued they are but just keeping them really short and that could be a Tabata and if you’re really adrenal fatigued, that intensity could be a–a fast walk to a slow walk kind of interval, to someone swimming, to a– you know, let’s say they’re–have a lot of joint issues, we can even do movements that are in water that don’t have the impact or using an elliptical or rower so we’re not slamming our joints down.  That could be another way we could involve that interval-type training.  And then if we’re still really in–in a bad place there, then just things like walking in general, even incorporating tai chi or qigong if we’re really extremely fatigued hormonally.

Evan Brand:  I like qigong.  I tried to get–get Hannah, my wife, to do it and she just laughs every time I start doing it in the living room.

Dr. Justin Marchegiani:  Absolutely, you got it.  And I just wanted to add one more thing, too.  When you’re conventional doctor is testing for your cortisol, we already talked about that they’re looking at your protein levels, just your typical cortisol sum, cortisol serum, so if you see serum that means it’s protein-bound.  Again, the only way you’re gonna know it’s not protein-bound is if it says free, free next to it.  So typically if you’re running like your thyroid, they’ll run thyroxin T4 free and you’ll see that word free, so that’s important.  But number two on that, it’s pretty stressful to get–for most people to get a blood drawn.  It’s like you get that needle, you get the white coat syndrome, they–they wrap the rubber band around your arm, you’re–you know, you have those memories maybe when you were younger getting stuck.  So that can be stressful in and of itself and stress increases cortisol, right?  So you can get a lot of people that they’re blood cortisol actually looks a lot better than what it would be normally because there’s actually a stress response when you’re getting the cortisol drawn.  And that’s why we love the cortisol labs because there’s no, you know, stress spitting the tube.  If you’re sitting there and you just spit in the tube.  That’s it.  So it’s–it’s great that we can elicit a measurement without causing a stress response.

Evan Brand:  Yeah, instead of adding in other things, I’d like to talk about subtracting things from people’s lives and one that’s really helpful is negativity.  Now whether that’s watching too much news or that’s just spending time around people that are negative and aren’t thinking like you and they’re not inspiring you.  People like that, energy vampires–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  If it’s really hateful music or really loud music and you’re constantly having to–there’s always that guy in the gym that has his headphones so loud you can hear him across the gym.  That guy is depending on that music to get him through that workout, that’s a crutch.  So I try to look at removing the negative inputs, too, before I even get to adding in the other beneficial supplements and things like that.

Dr. Justin Marchegiani:  Yeah, I think one of the most important things is how you start your morning.  There’s a book called the 6-minute Miracle Morning where the author talks about gratitude and visualization and affirmations.  I’m always a huge fan of–I do a lot of Anthony Robbins 15 Minutes to Fulfillment where you get up and I’m gonna do it this afternoon today but you have 5 minutes of affirmation and–and tapping on certain meridian points that kind of prime the system.  Number two, you go into a kind of a–a gratitude state.  You really kind of gracious for all the things that you have and then the last 5 minutes you go into a visualization.  So it’s–it’s affirmations, gratitude, and visualizations and that’s a great way to prime your system and really get all the beneficial hormones going in the right direction.  So I–I think that’s a great way to start your morning off the bat for sure and reduce that negativity.

Evan Brand:  Great.  So supplement-wise and if this is not the direction you intend, interrupt me and shift me, but I think mentioning a couple helpful supplements for just general support would be a good idea.  I really like a good vitamin C complex.  Not just ascorbic acid, but getting multiple different forms of vitamin C and if you can do the whole food form, there’s a couple good brands out there that have some like derived from organic oranges vitamin C.  That’s kinda cool.  I just haven’t noticed that much supplementing it personally.  But I think that’s kind of my first vitamin that–that I’d be safe giving a blanket recommendation for.

Dr. Justin Marchegiani:  Yeah, I–we’re on the same exact page, so I’m gonna kind of go right into the diet stuff and dub tail that with the supplements.  But off the bat, blood sugar or stress.  Blood sugar instability is one of the biggest adrenal stressors on the body, right?  We talk about what’s cortisol?  It’s a glucocorticosteroid, right?  The first part of glucocorticosteroid is gluco meaning blood sugar, so eating 4-5 hours is gonna be super important.  If you have adrenal issues, if you’re stressed, don’t intermittent fast.  Don’t–that’s putting a lot of stress on your system.  Make sure you’re having a good protein and fat-based breakfast.  Try to get, you know, your carbs from non-starchy sources or at least low-sugar fruit initially.  That’s gonna be huge because that’s gonna take away your adrenals from having to pump out cortisol to bring that blood sugar up.  Because again, if you eat too much sugar, what happens?  You have this reactive hypoglycemic response.  Blood sugar goes up like you do on the rollercoaster and then crashes down because your insulin sucks that blood sugar right down.  And when that blood sugar is down and low, your adrenals are sitting there having to muster up adrenaline, norepinephrine, epinephrine, catecholamine, this is just the same–the same word for adrenalin 3 different times over, and then the cortisol as well to bring that blood sugar back up.  So blood sugar is really important.  Now on the blood sugar vein, we can use different supplements like chromium and alpha lipoic acid and vanadium and magnesium and cinnamon and gymnema and bitter melon and banaba.  So these are different herbs and nutrients that we can use to help stabilize blood sugar.  Again in the hierarchy, the diet part is gonna be the most important, the second will be the timing, and the third will be the supplements.  So that’s a really good start off the bat.  Next is, we’ll use a lot of precursors.  We’ll use different building block precursors called pregnenolone or DHEA and we customize these according to the level of adrenal fatigue.  So I recommend getting lab–if you’re gonna ever use a hormonal precursor, you wanna have your labs actually checked.  You don’t wanna be supplementing any precursor stuff without labs.  Number three, vitamin C is awesome.  Again vitamin C, the reason why the–a lot of the Eskimos and the Inuit avoided scurvy, right?  Scurvy is a disease of basically hemorrhaging of the various capillaries in the body because of lack of vitamin C and the–I think it was the British or the people over in the UK area, they were called limeys because they figured out when they would travel over from the UK to the US hundreds of years ago that people would die if they didn’t have vitamin C.  So they found that if they just brought whole bunch of limes and ate these limes that they would avoid scurvy.  So they got the–they got the term or the nickname limeys.  So vitamin C is really important for that kind of health but again, the Inuit avoided scurvy because they would eat a lot of glandular tissue.  So they would eat the adrenal glands of the mammals that they would kill and they got a lot of vitamin C from the adrenal glandular tissue because the adrenals love vitamin C.  That’s why we add the vitamin C in our proto–programs or protocols so we support the adrenals.  Also glandular tissue will have a little bit of vitamin C and also a lot of minerals and vitamins that are specific to the gland and then after that, our adaptogenic herbs which can help bring cortisol up or bring it down.  It’s kind of a multitasker.  It can downshift or upshift depending on where our stress is.  And I know you’re a big adaptogen guy so I’ll toss the mic over to you and you can kinda give your 2 cents on that.

Evan Brand:  Yeah, so there’s tons of different ones, but I recently just switched over per your recommendation and just to see what’s up.  I was taking ashwagandha for a while which is a–a great adaptogen.  You can take it in the morning for energy and endurance or you could take it in the evening to help sleep.  It’s very unique like you just mentioned.  But I just switched over to holy basil recently.  I think it’s the Himalaya brand.  They have a–an organic holy basil extract that’s pretty potent and I’ve been taking that and honestly I feel a little bit like Superman, like I feel invincible on holy basil compared to ashwagandha.  Ashwagandha I just felt more calm energy.  Holy basil, I feel like I just wanna pick a kettlebell up and just throw it like a shotput.

Dr. Justin Marchegiani:  So does that mean we get to do the interview now with you wearing a cape?

Evan Brand:  Maybe.

Dr. Justin Marchegiani:  That’d be awesome.  I would–I would like the big S on your shirt, maybe we’ll do a E for Evan with a cape.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Love it.

Evan Brand:  So maybe–maybe that wasn’t the most clinical explanation of–of adaptogens but my experience with them is that they’re very helpful.  I think it’s kind of a 21st century necessity for people that have some type of adaptogenic support because we need to adapt–

Dr. Justin Marchegiani:  100%.

Evan Brand:  To the environment.  The environment’s changing.  The climate is changing.  Economics are changing.  Job stress is changing.  Gender roles are changing.  I mean, I–I vacuum the floor.  You know what I mean?  I sweep the kitchen.  You know, I have new roles that–that may not have previously been my roles like my Grandpa.  He didn’t necessarily take care of in the home task, you know what I’m saying?

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  It’s a tangent but I’m saying there’s so many new things that–that–

Dr. Justin Marchegiani:  Uh-hmm.

Evan Brand:  Men and women both are–are dealing with that they need some adaptogenic support.  So I really think it’s been one of the most helpful things to keep me from derailing during building a business and all the stresses that come with being a, you know, a growing entrepreneur.

Dr. Justin Marchegiani:  Right, and if you look at kind of Darwin’s theory of the survival of the fittest, really what he’s saying there in that theory is whoever can adapt the quickest and the fastest will be the most successful.  So if we have stress coming in our lives, I think adaptogenic herb of some kind rotated in and out is a foundation in anyone’s life because we got stuff coming at us from the home with our kids and our family.  We have work stuff.  We have all–all of our play stuff we do on the weekends or on our free time and our exercise and our businesses and all these different things.  We need to be able to adapt or even pivot, right?  So a good adaptogenic herb helps one, modulate the immune system.  Two, it helps support our hormones, right?  Sex hormones like eleuthero helps with DHEA levels.  Again, it can also help with libido and such, and two, it’s gonna help modulate our cortisol up and down.  So if we’re in this place we’re anxious, we can knock it down; if we’re low and depressed, we can bring it back up.  And certain herbs may be better for certain things.  Like ashwagandha, maybe sleep and anxiety.  Eleuthero for vitality, stamina, and exercise.  Rhodiola for depression.  Maca for libido and sexual performance.  Tribulus for–for muscle mass.  And the list goes on.

Evan Brand:  What did you take today?  Have you taken any adaptogens yet?

Dr. Justin Marchegiani:  Evan, of course.  So I had my little adaptogenic herb cabinet and I have all my herbs just kinda laid out and I just sit down.  I go, “Hmm.  How do I feel today?”  And I just kind of, you know, use a little bit of intuition on what herb that I’m gonna use.  But today was an ashwagandha day.  Yesterday was an eleuthero and rhodiola day.  And before that, it was a ginseng day.  So I tend to pick things out depending on kind of my mood and whether I’m seeing patients or not, and I really need to be super, super hardcore focused and do a lot of listening, or if I’m with you and I’m gonna be kind of, you know, talkative and you know, connecting with you.  So depends on what kind of stresses are I’m–I’m dealing with.

Evan Brand:  So yesterday, you said yesterday was a rhodiola and what day?  Did you have–

Dr. Justin Marchegiani:  I think it was a rhodiola and eleuthero day.

Evan Brand:  Okay, so I haven’t combined those two.  I’ve used rhodiola and ashwagandha together and I love it.  But I’ve never used a–eleuthero and rhodiola.  What’s the–what’s the–the bonus effect there as opposed to taking rhodiola by itself.  Well, I mean a lot of people like you said, they get a–fairydusted when they do a lot of these combos.  They don’t get enough.  So a lot of my patients, I’ll just recommend a really good combo product so they get the best of both worlds.  They’re not taking a whole bunch of supplements.  I mean, I’m a little crazy so I can have my 6 or 7 adaptogenic herbs.  I mean, I couldn’t ask my patients to do that.  If they want, they can always ask me and we can get them set up.  But I like to have one or two that we rotate with patients or a good kind of a good broad spectrum one.  So with myself, we kind of just–just have a whole bunch lined up and I kinda use my intuition based on what I know and based on my stress levels and how I slept the night before and what I’m gonna do and what I need.  I think I side-stepped your question.  Can you say it again?

Evan Brand:  Yeah, the question was what do you feel when combining eleuthero with rhodiola as opposed to just rhodiola by itself?

Dr. Justin Marchegiani:  You know what?  That’s a really good question.  I don’t know per se.  I just know the various effects and profiles that these herbs have and there’s a lot of research that they work together synergistically.  So for me, it’s more based on intuition.  I wouldn’t be able to crystalize that for you.

Evan Brand:  Right, and that–that’s totally what I expected.  It is hard to feel.  I just thought you may have noticed, “Ooh!  When I add this to the cocktail, I feel an extra color enhancement or something like that.”  I’ve had some crazy effects combining things.  It’s kinda nice.

Dr. Justin Marchegiani:  Yeah, I agree and I think everyone should be on some level of an adaptogenic herb depending on their stress.  I think it’s super important.  Everyone should be on a multi.  A good quality fish oil if you’re not eating good–at least 4 servings or 4 ounces of fish a week.  A good adaptogenic herb and then whatever other nutrients you’re missing based on your lab work people should be on as a–as a minimum kind of foundation in my opinion, and adrenal support is gonna be important because most people are stressed.  They’re working more.  They’re under more stress.  They’re doing more and that’s kinda what’s happening in our society.  Everyone is go, go, go, go, go, go.  I mean our work week’s going up 10 hours, we’re sleeping less, so anything we can do to help us modulate and adapt to stress, we’re definitely better off.

Evan Brand:  Yup.  Well, that’s all I had in terms of today’s topic.  I feel like we could go on tangents for another hour but I think that’s a great concise overview of this whole picture, the modern 21st century epidemic.

Dr. Justin Marchegiani:  Yeah, and let me just kinda hit one thing home.  The Russians in the 40s and 50s and 60s, they actually were doing a lot of research on adaptogenic herbs.  They’re sitting there and they’re like, “Alright, like we want to have our athletes do better.  We want out military to be better.  We got this whole thing and the space race going on, what can we do?”  And they spent tens of millions of dollars which back then probably, you know, equals hundreds of millions of dollars today on testing these herbs.  I mean and they found that their military performed better, their athletes were better, they were using herbs to help recover.  I mean, they’re probably using some steroids, too.  But they were using some herbs that really helped recover from their workouts to modulate sex hormones, to improve immune function so after severe exercise or you know, mil–military mission so to speak, their immune systems wouldn’t be suppressed.  So they did a lot of research and experimenting with these herbs and it’s like, “Man, if people really knew how powerful these things are, I think they would be part of everyone’s rotation if you will.”

Evan Brand:  It’s life-changing.

Dr. Justin Marchegiani:  Yeah, absolutely.  Any take homes from you, Evan, here?

Evan Brand:  No, just take a baby step from listening.  I know there’s a lot of information thrown at you.  So if there’s one lifestyle thing you can tweak, if there’s one supplementary thing you can tweak, if you can not skip that meal that you were thinking about skipping, go ahead and get you some good fat and protein, if there’s one little piece you can pull out of this podcast today and apply that, that’s gonna be helping to keep you in a normal rhythm and not become another burnout victim or maybe it’s the first step to try to help pull you out of that burnout that you’re in.

Dr. Justin Marchegiani:   Totally agree.  Again, my take home is make sure you’re getting to bed before 11 o’clock.  Don’t skip breakfast.  Eat every 4-5 hours, high quality anti-inflammatory protein, good quality fats, relat–you know, healthy carbohydrates for your metabolic type, right?  If you’re doing a lot of exercise, you may need a little more carbs and again, find a good functional medicine practitioner if that’s helping a bit but it’s not getting you over the hump 100%, reach out to someone like myself or Evan so we can get some testing done and we can pull out the sniper rifle so to speak and get really specific versus, you know, just general run-of-the-mill adrenal protocols.

Evan Brand:  Yup, definitely.  Well, cool.  Thanks!  It’s been a blast.

Dr. Justin Marchegiani:  Thanks, Evan.

Evan Brand:  Alright, bye.

Dr. Justin Marchegiani:  Bye.



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