Low Serotonin Signs, Symptoms and Natural Solutions | Podcast #325
Serotonin deficiency has common symptoms, including low mood and poor sleep quality. Most of the time, taking antidepressant medications called selective serotonin re-uptake inhibitors (SSRIs) can improve serotonin deficiency symptoms. So in this podcast, Dr. J and Evan talk about the root causes and presentation of this condition.
Our serotonin helps regulate a wide range of bodily functions, including sleep, bladder and bowel functions, orgasm, and emotions. It plays such an essential role in the body, it can be hard to determine whether low serotonin is causing a problem.
Dr. Justin Marchegiani
In this episode, we cover:
1:22 Serotonin Neurotransmitter
5:17 PMS for Females
9:00 High Serotonin Symptoms
15:13 Neurotransmitter Nutrients
19:42 Herbals
25:47 Products for A Better Serotonins
Dr. Justin Marchegiani: We are live! It’s Dr. J here in the house with Evan brand. Today we’re going to be chatting about low serotonin signs, symptoms, and natural functional medicine root cause solutions to get to the root of why everything’s happening, why these mood issues, energy issues, cognitive issues could be a play, Evan, how you doing today, man?
Evan Brand: Doing really well. I’m excited to dive in with you here. This is an issue that I suffered with when I had gut issues. And, you know, once I figured out the connection between gut and mood, it was a game changer because I was focused so much on mood supplements, right? I would take like rhodiola is a natural antidepressant helped to boost energy. I would take ashwagandha to help with hormones and adrenal support. But I didn’t realize that I was missing the smoking gun, which was all the gut infections I had. So I was playing with adaptogenic herbs, long before I had the knowledge I have now about gut infections and serotonin. And so what I first want to tell people is that you can come in and you can spot treat things like you can use different nutrients and amino acids to help serotonin. But in reality, we really need to be focusing on the gut you and I’ve discussed this many times, but a large percentage of serotonin is going to be made in the intestines. And if you’ve got bacterial overgrowth are parasites or other infections, that pathway is not going to be working as optimally and no, this is not a deficiency of antidepressant drugs.
Dr. Justin Marchegiani: Exactly right. So serotonin neurotransmitter helps a lot with motility helps a lot in the digestive tract, right. Also, a lot of serotonin supposedly does not cross the blood brain barrier. There’s a lot of people that talk about this, a lot of the precursor amino acids like five HTP, or even dopamine or tyrosine, the precursor amino acids can actually cross the blood brain barrier and then also convert. So of course, there’s some people that say like, like Kevin just said about the serotonin being made in the gut really important, helps motility probably does have some mood influences just because the guts so important for absorption of all these nutrients, and we need serotonin for reasonably healthy gut function. But we also need to be able to break down all of our protein and amino acids because all these amino acids are the building blocks for all of our neurotransmitters, whether it’s serotonin, dopamine, glutamate, GABA, whether it’s our beta endorphin, all these are really, really important and we have to be able to break them down. So of course, things like low stomach acid, low enzymes, gut inflammation from food allergies, gut bugs, infections, being overly stressed over a sympathetic nervous system output, adrenal dysfunction, high chronic, higher, low cortisol, all of these things are going to shift our nervous system, it’s going to act our activate our fight or flight, nervous system response. And those things can play a major role, and being able to digest, absorb and assimilate. So that’s like kind of a foundational thing, I want to just kind of start with off the bat because we need that to be in place. And then once that’s in place, that gives us a good neurological foundation to not overly activate our sympathetic nervous system response, have the enzymes and the acids. And then of course, we’re making an assumption that we’re eating really good foods that are anti inflammatory, nutrient dense and low toxin to kind of provide those building blocks out of the gates.
Evan Brand: Yeah, well, you just highlighted something important here, which is this serotonin issue. And other neurotransmitters too, can be a vicious cycle, in the sense that if you have gut infections, reducing stomach acid levels, now you’ve got this malabsorption issue, so you’re not going to get the amino is any way to manufacture the neurotransmitters. So you could come in, and you could use amino supplementally to try to spot treat. But in reality, if you don’t fix the infection, creating the malabsorption in the first place, it doesn’t matter how well you do on the diet. It’s not about what you eat. It’s about what you digest from what you eat. And I think that’s the important piece of the conversation that’s missing with people is they focus on do this food do that food, but it doesn’t take into account Are you actually absorbing and assimilating that and we know based on Dr. Wright’s work in his amazing book, why stomach acid is good for you that by age 30 40 50 60 and beyond you make less stomach acid just with age alone. And that doesn’t even account for the fact of modern life stress, circadian rhythm issues adrenal issues not chewing your food, that kind of stuff. So your regardless of the lifestyle factors just age alone is enough to create a bigger problem. So let’s just run down the list real quick together here of too low of a level of serotonin. Now you may see various lists across the internet, Justin and I found one that we like from a respected source. So I’m just going to kind of run down the list here of two low serotonin. Course depression. Everyone thinks about that, but also anxiety, insomnia or sleep problems, nervous or worried, poor response to stress, negativity or pessimism, irritable or impatient, self destructive, potentially even suicidal thoughts, low self esteem or self confidence you feel worse in the winter. So you could call it a winter depression if you’d like younger, rage, explosive behavior inflammation. Here’s one that’s interesting. We need to, I think, talk about this further PMS. And then OCD or eating disorders as well have a link to serotonin. So the PMS is interesting. What do you think the meccan mechanism is there?
Dr. Justin Marchegiani: Well, a lot of female hormones like progesterone, for instance. And or just healthy progesterone, estrogen balance, have major effects. Basically, they’re like mono amine oxidase inhibitors. So essentially, they almost are like mini antidepressants, they help kind of keep a lot of the neurotransmitters in between the post and presynaptic synapse. So you kind of have this presynaptic synapse, we have a postsynaptic synapse. And this is what’s called the synaptic cleft, right? This is these are where the neurotransmitters accumulate between the two. Okay? And things like progesterone, for instance, they have a mild serotonin reuptake inhibition effect. Now, when you do medications, the problem with medications, the longer you keep those neurotransmitters between the synapses here, the faster those neurotransmitters are recycled and broken down. That’s why over time, people that are on antidepressants, or SSRIs, their dose has to go up, not down, especially if you don’t fix like underlying root issues. So I think a lot of these hormones like progesterone, we know is a GABA chloride channel inhibitor. So GABA is big, because it promotes relaxation, the more relaxed and calm your nervous system is, the less chance you’re going to be burning through serotonin because you’re less stressed. And there’s a mono amine oxidase inhibition effect, right, MAO, inhibitor, so it’s almost like a mild antidepressant in a way for sure.
Evan Brand: Oh, cool. Totally interesting. Yeah. So I mean, it sounds like, you know, part of the protocol could be both, it could be using potentially some hormones, like maybe some progesterone, but also coming in with the amino acids. And then once you figure out what’s going on, after you test, then you could come in and start fixing the infection. So let me just tell just a brief story. I think people relate to the stories here. So I just remember, you know, when I was down in Texas, and I had gut infections, I had just a baseline anxiety level that was so high. Now granted, I was away from home, I had some homesickness, I missed my family, that kind of thing. But this was different. This was related to my gut, because as soon as I was doing no microbial herbs, the anxiety was 25, maybe 50, maybe even 75% better. So I can just tell you, personally, you know, you and I’ve seen it clinically as well. But just personally for me, you know, I was doing supplemental gabbeh, I was doing motherwort passionflower, all the calming herbs. But it didn’t matter how many calming herbs I did, it was just a band aid. It wasn’t root cause. So I just want to make sure people understand that there’s a difference between natural and functional. So natural medicine is like, hey, you’re anxious take passionflower functional medicine is like okay, fine, take passionflower. But why are you anxious? And that’s the secret. The secret sauce?
Dr. Justin Marchegiani: Correct. I think with you mean, part of the underlying reason was you had multiple gut infections that were not being addressed. Yeah, there was there was that kind of thing in the background, I think that was really important. And so fixing that played a big role, you had some potential mold stuff that was hiding as well. I think there was also some blood sugar stuff that was happening with you as well, that we were looking at, I think you also had like really low blood pressure, too, didn’t you?
Evan Brand: Yeah, my blood pressure was like, maybe 100 over 70.
Dr. Justin Marchegiani: So on the lower side, so there was definitely very weak adrenals where your mineral corticoids were paying a price and you weren’t able to hold up a lot of the holding a lot of the minerals that your blood pressure was dropping, and so you weren’t able to really perfuse blood flow adequately. Right. So yeah, all these things play a big, big, big, big role.
Evan Brand: I was peeing a lot too. So I was up in the middle of the night, three, four or five times to pee. I now know that that was related to mold, because since using appropriate binders, I no longer wake up in the middle of the night to go pee. So just folks listening, you know, could be an adrenal component as well. But, you know, for me, the excess urination was definitely a mold thing, and it’s luckily resolved.
Dr. Justin Marchegiani: Exactly. So you already kind of talked about a lot of the symptoms. Let’s just kind of go over those real quick. So we have our high serotonin symptoms just briefly here. Let’s hit them again. So too high depression, anxiety, nervous being a worrier.
Evan Brand: And these are low stress. These are low. You said to-
Dr. Justin Marchegiani: I’m sorry. Yeah, I’m sorry. These were too low depression, anxiety, nervous worry. Anger, PMS, right. And then on the high side, let’s go over the high ones again, briefly. There’s no high Okay, there’s no high for those. Okay, so those are the big ones with the seratonin. Right. Now, we already talked about the foundational things. So when we talk about nutrients, just kind of make sure everyone that’s listening understands Foundation has to be in place, good foods, good digestion, good hydration management of stress, and we can talk about different techniques that help decrease stress. I won’t go into specifics but I’m a big fan of EFT, EMDR, NLP a lot of times techniques or eye movement techniques that can help rewire the nervous system that can help dampen sympathetic nervous system responses. There’s another one that you like Evan, that you did that does a lot of rewiring as well. Which ones that?
Evan Brand: You talk in the brain retraining?
Dr. Justin Marchegiani: Yeah, brain retraining, a lot of that requires NLP?
Evan Brand: Yeah, I’m playing with a couple of them. Yeah, some of it is kind of NLP strategy. There’s one called gupta. There’s another one called dnrs. They’re just doing our online one. Yeah, they’re online brain retraining, I’m gonna work through the Gupta, the one and I’ll have feedback for people, but I have done the dnrs. It’s basically just trying to rewire your brain, right, you’re trying to tell your brain that your issues are fine, and all of that. So I like it. But I personally, I think EFT is better. I like the tapping aspect of EFT tapping is nice-
Dr. Justin Marchegiani: You can feel a nice reduction of that nervous system response. It’s like when your brains are used to firing a certain way. It’s like, if you have a big backyard and you go on a hike or you go for a hike, where your local park, there’s a path kind of carved out when you go into the woods and that paths there. Where do you go, you naturally walk on the path, you don’t just go randomly go in the woods with all the sticks and trees and ticks, right? You kind of go on that carved out path, your brain kind of works the same way. So when it’s used to thinking about something a certain way, it carves out a path. And when you jump on that when you jump in the woods and you see that path, you naturally go down that way. And so essentially, the tapping is kind of like it’s a way of like pulling out the machete and kind of carving out a new path in the brain to fire a little bit differently.
Evan Brand: That’s that’s a great analogy. Yeah, that’s a great analogy. You’re saying how basically with this low serotonin that you can get stuck in these pathways of like, pessimism and negative thinking and all of that. So it’s harder to break out.
Dr. Justin Marchegiani: Yeah, I’ve listened to Julia Ross lecture one time, because she does. He’s an MFT marriage family therapist. And she has done counseling on lots of people. And she has had clients and patients for decades, where they just couldn’t get over certain issues. And she just started utilizing nutrients and amino acids and these problems that were problems, just naturally, were non issues, they they just became they just people were able to get over them so much easier. And a lot of that is is you need the mental neurological equipment to be able to process and handle them. You know, my my analogy, I get patients, it’s like staying up all night and then trying to do your taxes the next morning, like you just may not be able to have that mental capacity to handle it. And so I look at neurotransmitters, it’s giving you the equipment, you need to deal with these issues, it’s like giving a child adult level problems like they just going to be overwhelmed, they’re not going to be able to handle it and process it. And so if you have the right neurological equipment on board, that gives you the ability to handle it. And then also having these extra strategies in our back pocket. Like I mentioned with the EMDR. EFT Now the easiest thing is you just talk about the problems and you just kind of tap all the different EFT spots, side of the eyebrows, middle of the eyebrows underneath the eyes, underneath nose and chin, collarbone, underneath the nipple area, under the armpit, right. And those are just those are the really good spots you can do you can do right in the parietal line in the center of the brain here. Those are all good spots. And you can just kind of talk about the problem, whatever the problem is, let’s say you’re at a seven out of 10 and 10. Being you know the most sensation or irritability or emote, you know, palette of emotion that you could feel, ideally you want to get below five. So I always just say talk about the problem, talk about the fear, talk about the emotion you’re feeling and try to get it below a five. And ideally, if you can get below a three even better. And so you just keep on doing that it’s a good way out of the gates. And then also NLP kind of comes in where you you really are focused on the pictures that you have in your brain, right? That the pictures that you have in your brain are very important. So you really want to put pictures of yourself succeeding doing the thing, right? And then an easy kind of NLP technique is you can do the stop sign. Have that stuff sign flash in front of your, your, your mind’s eye when you start thinking things that are negative or you can do no stop. Right you there’s a DNR s one that you can tell about to.
Evan Brand: Yeah, yeah. And then that’s what they do. You basically just kept pace. tell yourself that your brains sending your body false messages. So it’s like this negativity, it’s this fear. It’s this hyperstimulation it’s the overreaction, you’re trying to just shut that down. And the mind is powerful. And I think it’s I think it’s an underappreciated thing. Now, you made a great point, which is that you got to have the fuel in the fuel tank, right. So you could do all the the physical tapping and all that stuff. But if you simply just don’t have any neurotransmitters in the tank, it’s going to be tough to focus on this, it’s going to be tough to have drive to get this done. So that’s where you and I are going to come in. And you know, let’s talk about some of the testing now. So we’re going to be looking at like an organic acids testing. And we’re going to look and measure some of the various aspects. We did a podcast recently on low dopamine, so check that out if you’re interested. But in that same category, we’re going to be able to measure the serotonin marker. And once we look at that we can see where people are at. And then of course, we’re going to factor in what’s going on with the gut to because rarely is the serotonin good To become a dysfunctional problem, unless there’s a gut issue as well. So we may see Candida bacterial overgrowth parasites, H. Pylori, gut inflammation and low serotonin. It’s rarely just low serotonin by itself.
Dr. Justin Marchegiani: 100% and so it’s good to have the foundation it’s good to have some tapping techniques. Now let’s go talk about some of the other nutrients. So we know things like five HTP, or triptophan is a precursor to serotonin and serotonin. You know, obviously, that neurotransmitter that helps with focus and feeling good. It’s a very, you know, happy neurotransmitter. A lot of times dopamine can overlap because dopamine helps with focus, it’s an I love you neurotransmitter. So a lot of times there can be an overlap in those symptoms. And a lot of times people that have low serotonin could have low dopamine as well. And also the enzyme that metabolizes serotonin that metabolizes five HTP, and converts it downstream to serotonin is the aromatic decarboxylase enzyme. And that enzyme also metabolizes dopamine. So if you constantly take five HTP support chronically, you probably want to have a little bit of dopamine tyrosine support as well, because you can create some functional deficiencies long term. So just kind of keep that in mind. Like in my line, we have a product called brain deplete that has a 10 to one balance of tyrosine to serotonin. And if you’re taking a lot of serotonin, it’s probably okay especially if you’re testing it on the organic acid, but just long term, you probably want to throw a little bit of dopamine, whether it’s tyrosine in there to provide some building blocks, that’s excellent out of the gates. And then there’s a couple of really important methyl support that needs to be there, B six and B 12 are very, very important. B six is incredibly necessary for the synthesis of neurotransmitters, we need B six is an important cofactor and so is b 12. b 12 is methylated B 12. Really important for the methylation of these neurotransmitters. Well, we attach a carbon and three hydrogen to it. That’s methylation. Very important. Also, vitamin C is very important because vitamin C tends to be burnt up and overly utilized when there’s a lot of adrenal stress as well. We talked about five HTP, we talked about some potential tyrosine. And then it’s also nice to throw in a little bit of an adaptogen. Because adaptogens help with the stress response, they help with perceived stress. So even if you’re stressed right now, just giving you some support on the adaptogenic herbal side, will change your perception to it. And so things like rhodiola or ashwagandha, or ginseng, or eleuthero are amazing to help kind of or even macca, especially women do very well, macca are very good for stress perception and stress modulation.
Evan Brand: Yeah, great, great calls. So just to back up what you said, there was a trial done. We’re not fans of drugs, we prefer to try to come at it the natural functional way whenever possible. However, there was a study done that compared antidepressant use, and just in a depressant by itself, compared to antidepressant plus b 12. And 100% of the subjects that got the B 12. And the antidepressant showed at least a 20% improvement with their symptoms compared to the antidepressant alone. So just to tell you one more time, and a depressant plus b 12 20% improvement in the outcome, as opposed to just the antidepressant by itself. And then also Foley, same thing. There’s a paper on Foley, and how that also boost things up. And then I don’t know if you’ve, you’ve played with this one much, but have you seen some of the Selenium extracts? You’ve got some of these saffron and selenium blends like this? Yeah, so it’s pretty cool. I’ll put it in the chat for you. So you can look at this tech sheet, you might have to log in, but I’m gonna send it to you.
Dr. Justin Marchegiani: Yep, I’ve put those links to the studies. And we’ll put it in the description notes after the show. So you guys can take a peek at it.
Evan Brand: Yeah, but so just, I just put it for you in the chat. If you want to see, like I said, you may have to log in to see this tech sheet. But this is a cool product. And I’ve used it with some people that were previously on antidepressants, and they got off of it. And many of them reported they felt just as good. And so the Sceletium plant, it’s kind of an indigenous South African plant. Indigenous people used it says for relaxation, stress reduction, calming thirst and hunger prior prior to long hunting hunting trips, which is pretty cool. And it acts like an SSRI. So the Sceletium binds to the serotonin transporters inhibiting the uptake of serotonin from the synapse, resulting in increased serotonin concentration in the synaptic cleft. That’s the same mechanism of prescription SSRIs. So this is a game changer, potentially. And like I said, I’ve had clients that were previously on the pharmaceuticals, and then they did this one, and they like this one much, much better.
Dr. Justin Marchegiani: That’s good. Yeah, there’s a lot of good options. It’s nice to have some herbals, whether it’s adaptogens or the sceletium, whether it’s the saffron and I think in that the important cofactors need to be there B six b 12. You can maybe even throw in some full weight in there because full weight tends to interact. So I tend to have you know, products that will Be six, we’ll have the seratonin have the dopamine support. And then we always like, I think you’re in the same place always having a really good molti there in the background just to make sure all those cofactors are there. And then of course, having a really good solid diet as a foundation that kind of gives you that insurance policy that the building blocks are there, the cofactors are there, and then you can really hit things more therapeutically after.
Evan Brand: Yep, absolutely. Now, have you played with any of the other testing? You know, we already hit on the test. But there are some companies that do just neurotransmitters Have you ever played with those at all?
Dr. Justin Marchegiani: Well, the whole idea with some of those is that you may not get a good window, what’s happening in the brain, right. So supposedly, you have the idea one is going to be some kind of like a spinal tap, right, where you really get a window into what’s in the cerebral spinal fluid, which is kind of flowing to the brain, that’s kind of like your ideal, obviously, that’s invasive. And then the urinary metabolites, I think, are pretty good. Because you kind of get a window like, if someone’s buying a whole bunch of food, you kind of get a window by going into their trash what they bought last week, right? It’s kind of like that. So you get a pretty good window of how you’re doing. So if we don’t see a lot of stuff in the trash, or we see too much stuff in the trash, that gives you a window what your body’s utilizing. And so that’s organic acids, we’ll look at with serotonin and we’ll look at five hydroxy and dolo. Last day five HIIA. So that’s helpful to give it give a window into it to know what’s happening. And then we’ll apply some of those nutrients, maybe 100 milligrams of five HTP at a time. And we’ll kind of go out from there. And I like doing it more, you know, at the last half of the day, especially if it’s more calming and relaxing, because some people they may get too tired because of it during the day. So you got to individualize it. And if you’re on a medication, it’s really important if I’m having people that are on meds like SSRI medications, amino acids will help the drugs work better because these drugs work by blocking re uptake ports. And if you’re blocking a rehab, take a port and you’re providing more substrate. Well guess what happens that substrate now is going to increase the symptoms or the potential effects of the drug which can also increase the potential side effects. So I always tell patients, look at the medication that you’re on, make sure you know what the side effects are. And so if we add things in, we look for those side effects to occur. If they do, we go back to the prescriber, and we gently nudge down the dose of the medication under the prescribers controls, we got to look at what those side effects are. That way, if it happens, great, we adjust or we just go slower to so my goal is if we’re going to adjust medication, we’re always doing it from a point of stability, not instability, and we’re always utilizing the prescriber that prescribed it. And if you’re on some of these meds long term, whether it’s an SSRI, or maybe even benzos are the worst, we may need a very, very long term taper, it just really depends. Could be six months up to a year, depending on what the medication benzos tend to be worse, SSRIs tend to be less. And it depends on how long you’ve been on them for Okay, so But either way, we don’t touch medication dosages, unless we have everything in order, we’re stable, and then we have a prescriber that’s involved in the prescription of the medication, monitoring and tapering the dose.
Evan Brand: Well said and there’s a link between antidepressants and gut bacteria to if you just look up and depressants, microbiome, you can find some studies on this. But we now know that these antidepressants are negatively affecting the gut. And we’re seeing changes with bacteria. And in particular, we’re seeing clostridia and other pathogenic organisms that we test for via stool and urine. We’re seeing these pathogenic bacteria overgrowth. So there is a link now between antidepressants and bacterial overgrowth in the gut. So just keep that in mind. If you’re somebody who’s been on these prescriptions for a period of time you’re having gut issues, maybe you’ve worked through some protocols, whether it’s with us or other practitioners, maybe you’re not to the finish line yet, you know, consider the drug could be a contributing factor, I’m not telling you stop the drug, I’m telling you that it needs to be factored in, and we got to try to counteract what that drug is doing. And we’ve seen cases like that, where clostridia just keeps coming back. And the drug, if the doctor was able to remove it from the protocol, then boom, they were able to get well and stay well.
Dr. Justin Marchegiani: Yeah, totally. I mean, my personal opinion on medications like SSRIs, or drugs like that. The only, you know, real good application, in my opinion, is some kind of a short term where someone may commit suicide or harm themselves. That’s the only I think, you know, valid reason to be on it at all, is for just pure stabilization. And then working with someone with various therapies, whether it’s talk therapy, whether it’s then I think, combining EFT or EMDR, with that to kind of calm everything down and then utilize the diet and nutrients and then get off the medication. The problem with most medications is once you’re on it, you kind of get stuck, and the prescriber doesn’t want to take you off and they’re also not fixing the underlying root issue. So, you know, my general application is if something’s incredibly acute, that may make sense. But outside of that, you want to always try to work on coming off that way responsibly with all the foundational support underneath, and with the prescriber involved. So if anyone’s listening and they’re on a medication like that, and they just want to come off, don’t do that work with the functional medicine doc, and then we’ll also work with your prescriber to get you off because there’s always going to be some kind of a relapse that happens. And we don’t want anyone to be in a position where their neurotransmitters just really go wonky with a major, something they regret.
Evan Brand: Yep, absolutely. Well, I think that’s all I have to say on it. So if you have any more than let me know, otherwise, we’ll give people some info here where they could reach out if they need help, I know you’ve got some products to mention, I’ve got some too as well. So in your show link in your show notes on the podcast app, you should be able to click there and then boom, check out some of these products. You know, if you’re on drugs, you know, consult with us or consult with your practitioner, how you may work some of these in.
Dr. Justin Marchegiani: Yeah, the big ones that I use in my line, of course, a good multi multi support pack excellent brain repletes to have that 10 to one ratio of tyrosine to serotonin with some of the cofactors there I’ll also use serotonin with B six. So in my line, serotonin replete or dopa repletes, are going to be the big ones and the dope replate Plus is my bigger l dopa, which is a it’s let’s say, a little bit more down the line in regards to dopamine synthesis, so it can have a better effect on improving dopamine levels. So those are my big ones. We’ll put the links down below. Evan, what are some of the ones that you have in your store that you use with patients?
Evan Brand: Well, a lot of them I’m ordering through third party, so I don’t have any on my store right now. And we’re moving warehouse. So I don’t have any right this second. But you know, if you’re working clinically with me, I will definitely educate you on those. And then some of the Zimbra and some of those, there’s different professional manufacturers that will use so there’s a couple different brands. But either way you could reach out and we’ll we’ll let you know what we’re going to use.
Dr. Justin Marchegiani: Yeah, maybe a good idea. You have a category on your website, like say, like maybe neurotransmitters so people are listening to this down the road, maybe look for a category on brain nutrients, or neurotransmitters. And some of those will be there too. I have a category on brain nutrients too. So we’ll try to make it easy for you all to navigate. If you need support, we’ll put links down below.
Evan Brand: Awesome. If you need help clinically, you can reach out Dr. J works with people worldwide via phone, FaceTime, Skype, however you need to chat. So please reach out to him at JustinHealth.com. And if you need me, Evan Brand, EvanBrand.com is the website. And we love working with this stuff. I mean, we’ve been able to transform our own lives with these products, we’ve been able to transform 1000s of other lives. And so this is really just a sigh of relief, when you can fix these issues. And you can help people take back not only their mood, but take back their life. I mean, when you optimize these things with brain chemistry, you can allow people to become more focused, you can allow them to become more calm, they can sleep better, they become better parents, they become better husband, better wife, better workers, better CEOs, better entrepreneurs. So it’s just incredible what you can do when you optimize this stuff. And so we want to test not guess, figure out what’s going on, look under the hood. And you can help modulate these things. So please reach out if you need help.
Dr. Justin Marchegiani: Yeah, and if someone’s coming into this, they don’t know where to go. They’re not quite sure where to start, keep it really simple. Start with the food. Start with a good healthy paleo template out of the gates, maximize your ability to break down protein with HCl, good digestive acid enzymes just start there out of the gates because that’s the building block for everything. And then from there, definitely get a practitioner in your corner to really work on all the building blocks, all the supplements support all the other precursor support so you have that good foundation, and then maybe also dive deeper into a lot of the gut, which could be a lot of bottlenecks. If you have chronic digestive issues. That’s gonna be an important part of the equation as well.
Evan Brand: Totally, totally Well said, well, always fun. I love these brain neurotransmitter episodes. They’re always a blast. I think they’re very helpful, very empowering for people. So please give us a review. We would love it. If you can review Justin’s show on iTunes or my show on iTunes. We really appreciate it. Give us some stars. Let us know what you think. Share it with your friends and family people who are dealing with issues we know that depression anxiety issues are massively increased over the last year. So the thing that we can hope here is that this is a beacon of light to help people know that there is solution to this problem.
Dr. Justin Marchegiani: 100% we’ll put some review links below so you guys don’t have to hunt it down too far to do that. We really appreciate it guys have a phenomenal day. Take care y’all.
Evan Brand: Take care. Bye bye.
References:
Recommended products:
Audio Podcast:
https://justinhealth.libsyn.com/low-serotonin-signs-symptoms-and-natural-solutions-podcast-325
B12 Deficiency | Podcast #223
In today’s talk, Dr. J and Evan Brand discuss some important points regarding B12, a topic that is so common yet so overlooked by conventional medicine but could change one’s life.
B12 deficiency was a problem of Evan Brand that stemmed from gut infections. He believes because he had H-Pylori, it reduced his stomach acid even though he was eating grass-fed beef. Having low B12, it resulted in nausea, digestive issues, and fatigue. B12 is huge even for someone like him who thought they were doing it right. Watch the video and answer your own questions too! Don’t forget to share!
Dr. Justin Marchegiani
In this episode, we cover:
04:48 How Does B12 Deficiency Happen?
08:33 B12 Shots
10:10 Food Sources of B12
11:03 Why do We Need B12?
16:12 More Food Sources of B12
17:14 Neural Tube Defects
Dr. Justin Marchegiani: Hey there it’s Dr. Justin Marchegiani, welcome back to the podcast. Evan Brand and I are in the house, we will be discussing on all topics: B12. Let’s dive in. Evan, how we doing today man?
Evan Brand: Hey man, I’m doing pretty well. I’m excited to talk with you about something that is so common, yet so overlooked by conventional medicine, but it could change your freakin’ life, and it’s B12 deficiency, which is a problem that I have, and I had previously, and I think it was all stemming from my gut infections. I believe it was because I had H-Pylori, which reduced my stomach acid, therefore even though I was eating grass fed beef I still wasn’t getting the B12 from my meat, and therefore I was low. And I had definitely some nausea, I definitely had some uh, digestive issues, fatigue, uh it showed up on my testing too. So, B12 is huge even for somebody like me who thought they were doing it right.
Dr. Justin Marchegiani: Yeah, B12 is really important. A couple of things off the bat, just to kinda highlight, B12 is really important for methylation. So, methyl groups are- are carbon and essentially free hydrogens and we methylating neurotransmitters, detoxification pathways, uh we activate various uh genes through methylation. So B12 and- I would say B12 tends to work really well with its sibling, uh folate. Folic acid is kind of uh- uh let’s just say uhm, one of the more slang not so good qualities or not so good uhm, types of uhm folic acid or folate. Folic acid has to get converted to folate and a good chunk of the population, 70% or has at least heterozygous, meaning, they’re missing one gene to help uhm basically convert that folic acid to folate be it as enzyme called MTHFR, methylenetetrahydrofolate reductase. So, essentially, B12 is really important and it uses folate, activated folate along with it for methylation and gene activation.
Evan Brand: Yeah, and a lot of people talk about MTHFR, then I’m really sure what’s going on. You’re just had a reduced- you’re had a reduced capacity than other people to- to work this conversion process. So, that can result in fatigue and the- the question maybe, well, does that mean I go straight on a methylfolate supplement? The answer is not always, ’cause some people don’t feel well with those, so there’s- there’s a- a goldilocks that Justin and I figured out with people. Sometimes you can go too high, sometimes you go too low. So, there’s always a tweak with this, so on this podcast we’re gonna say, “Hey, your magic dose of B12 and folate is gonna be X milligrams or X micrograms per day”, ’cause you gotta figure it out. Uh there’s just not a- a- a number.
Dr. Justin Marchegiani: And then there’s a couple different types of B12 that’s out there. You have your conventional cyanocobalamin, right. Cobalamin is the B12 and it’s bound to a- a- basically almost like a- a cyanide type of molecule, right? And then you have the more bile available types, you have the methyl B12 which is it’s methylated, it’s bound to a methyl group. Then you have the hydroxyl group. Hydroxyl group is bound to a hydroxyl, and then have the adenosyl group. Hydroxyl is gonna be uh- I think it’s gonna be a lot more mitochondrial based, and then B12 can help uh on the methyl side, will help more with detoxification and- and will help more with the methyl donor side. So detox on one side, and then on the uh hydroxyl side will help more with the mitochondria and help with uh nitric oxide which is really important for mitochondrial function.
Evan Brand: I’ve had a lot of people actually react pretty poorly to doing supplemental methylcobalamin B12, er- myself included, I don’t feel well on methyl. So I end up doing- using a combination of hydroxocobalamin and/or the adeno-cobalamin-
Dr. Justin Marchegiani: I think [crosstalk] is from a detoxification like we were loading to I think some of that could have a detoxification effect, and then going more with adenosyl or hydroxyl or combination of those two can help with the mitochondria, a little bit more help with energy, help with nitric oxide. Know you have- with some of the stress issues, you had more blood pressure issues, so of course, nitric oxide is vasodilator, it opens things up.
Evan Brand: Yup. So we’ve got some symptoms of- now, we can test this, we’ll talk about testing towards the end, if you have too little vitamin B12 in your system, what may happen? Uh, could be poor vision, weakness, tingling in your hands and feet, clumsiness, fatigue, nausea, mental confusion, anemia, digestive issues, skin infections, nerve problems. And so, uh Linus Pauling Institute, they’ve got their own opinion of major problems that could be linked to B12 deficiency like breast cancer, depression, osteoporosis, thyroid issues, gastric cancers neural tube defects, chronic stomach inflammation. So this is pretty nuts, and they’ve got quite a lot of literature on this too. So, uh, it makes sense.
Dr. Justin Marchegiani: Yeah, it’s a use. So let’s kinda dive in first. How does B12 deficiency happen? So, number 1, it can happen if you’re a vegan or vegetarian and you’re not getting- let’s just say any animal products, uhm even- even plant-based products, a good vegan or vegetarian is gonna have to supplement B12. You just not gonna get enough in plant-based products, you’re gonna get it in egg yolks, you’re gonna get it in meat and animal products. So, being vegan or vegetarian is one risk factor. Risk factor number 2 is you have poor malabsorption, you have gut issues, absorption issue, whether it’s an- irritable bile disease, or crohn’s, also of colitis type of thing, or even just poor digestion, ’cause, remember, the intrinsic factor is produced in the stomach, and it’s produced by the parietal cells, the same cells that make hydrochloric acid. And we- this intrinsic factor basically- basically tags B12, it grabs on to it, and then from the stomach, you go to into the small intestine, the duodenum is the first part, the jejunum, and then the ileum, it is then released and then reabsorbed back up in the ileum. So it’s like you have this carrier, this tag, or this relay race, where intrinsic factor binds to that B12 in the stomach, and then releases it back down to the very end of the small intestine in the ileum. So it’s really important because if we have gut inflammation, and let’s say we have poor parietal cell function, which tends to mean we also may have low stomach acid. That poor digestion is gonna create more leaky gut, more gut inflammation, and continue to decrease intrinsic factors. So, if we have low intrinsic factor or if we have intrinsic factor antibodies, uh or parietal cell antibodies, this is called pernicious anemia, where we have an autoimmune attack, it’s attacking either the cell or the compound that’s produced to help basically run that relay race for the B12. So the more you have leaky gut, the more you have gut inflammation, there’s a greater chance of autoimmunity, which could affect B12 absorption. And for those kinds of people, which tends to go more on the sublingual side, with intrinsic factor we may even do the adenosyl-hydroxy versions, go sublingual, bypass the guts, and we may also uhm even opt for an injection.
Evan Brand: Great point. Yeah, people were gonna ask, “Well, why can’t I just take a supplements, swallow a pill for this”, well, you just alluded to the gut infections or other problems, inflammation, autoimmune gut conditions, that may reduce the absorption. So just because it says on the label, you’re gonna get “X” amount, that- uh- you know, we always say, “Oh, you are what you eat” but not necessarily, you really are what you digest. So if your digestion is compromised, then you’re not gonna get what’s on the bottle, and therefore you might not get the clinical improvement you’re looking for. No I just sent you a link to a- a PubMed study here, they call it “Impact of Helicobacter Pylori on the Development of B12 Deficiency”. And long story short, the findings prove, strong evidence, H-Pylori infection is associated with cobalamin deficiency. So that probably started it all for me, you know, diet wasn’t great as a kid, but me having that H-Pylori infection, that was probably a huge trigger for my B12 to be so low.
Dr. Justin Marchegiani: Exactly. Yup, totally makes sense. So, this is why it’s so important that if you have B12 issues, you have to make sure the diet is right. And the diet is gonna be super important. Uh, vegan, vegetarians are maybe gonna have a problem, uh, the next is, if there’s a leaky gut or any inflammation in the gut, that has to be rectified and addressed. Now in my line, we use like methylated B12, and- and uhm methylated B-Vitamins, ’cause typically you wanna take you a B6 and folate, and B12, uhm but some people they may need to go sublingual. So we may wanna go in adenosyl-hydroxy form which gets absorbed more in the mitochondria, versus the plasma for the methyl B12. So, very important, you gotta get to the root cause. So, what are some great food sources, or anything else you wanna highlight before we go into the food component Evan?
Evan Brand: Well, I wanted to get your opinion on the whole B12 shot thing. I mean, you and I work with so many people, and we hear every single week someone going into a naturopathic clinic, or some other clinic to go get a B12 shot, yet, we run their testing, and they still look low in B12. So, what are your thoughts on B12 shots?
Dr. Justin Marchegiani: I think for some people it may make sense to do it especially with severe malabsorption and severe gut issues, I think for most people, uh, just a sublingual or just a capsulated B12, with uhm other methylated B’s like the MTHF folate and- and pyridoxal phy- phosphate or good quality pure- uh, you know pyridoxine HCL, uh B1 to 3, that’s gonna be enough for most, some may have to go 1 step up and go to a sublingual, and- and adenosyl or hydroxyl form, for most, that’s gonna be enough. If there’s severe issues, maybe an injection in the beginning, like if we have a- and also of col- colitis or crohn’s issue, we have blood in the stool, maybe-
Evan Brand: Yeah.
Dr. Justin Marchegiani: -to that degree that makes more sense in the beginning, but uh, in general, I work with dozens of IBD patients in, we typically are able to get their choline and their digestion stable and the de-inflammation downward or that stops, and then we’re able to get their uhm- their levels up, which is uh sublingual.
Evan Brand: Yup. The uh- that’s uh- I mean, that’s- that’s my whole point too, I- I’ve really don’t wanna go get a shot. The sublingual works so good. Uh, so, I mean, here’s the thing with the- with the B12, you know, even if you do take more than you need, it’s more fo- a people having problem with deficiency, ’cause if you take excess, your excess B12 gets stored in your liver. So even if you do take more than you need, that’s fine, we’re more concern about you having too little, you know, rather than too much.
And then you mentioned the foods. So yeah, let’s get into that. I mean, organ meats are gonna be number 1. So, I’ve seen a lot of companies out there now where people don’t wanna eat organ meat. So these companies will take like a grass fed liver or a grass fed kidney of a- of a cow, and- or a lamb, and then they’ll put that into capsules. So you can take like liver pills, you can take kidney pills if you want, I personally don’t do that, uh, maybe when I get more into hunting, I will eat, you know- you know, eat- eat the deer or eat the other animals’ liver, but- but currently me personally, I do not do uh liver.
Dr. Justin Marchegiani: Yeah, exactly. So, I mean, I think it- it’s a great source to do it. A lot of my women that are cycling and uhm me- menstruate heavily, I’ll ’em do liver during that time frame just to get some extra B12 and store it up in their liver, even just an ounce or two, per day during that time is enough, uhm, there’s a lot of B12 and- or Iron in the liver.
So, couple of things I wanna highlight, so, we need B12, 1, to help develop our nervous system. So, early on, we can have neural tube defects, which is basically our- our s- our nervous system doesn’t close all the way up, and essentially, we can have it on the back side where we have spina bifida or we can have it on the front side, or we may- we may even have a cleft palate, right? Those are all B12 or neural tube defect issues. Uhm, next we may see macrocytic anemias, right? Megaloblastic macrocytic anemia is where our blood cells are really big. So, red blood cells, unlike us, we start off small and get bigger right? Red blood cells actually are bigger and then get more smaller as they mature and get older. And we need healthy levels of B12 and folate and methylate and B-Vitamins to help this conversion happen. If not, we’ll run an RBC or uh- uh- a CBC I should say – complete blood count – within the C’s. So we’ll run like MCH, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular volume MCH, MCHC, MCV, these are markers to look at how big the red blood cell is. And of we see a really big red blood cell, that can give us a big sign that uhm, where we don’t have enough of those B-Vitamins onboard, especially if we start to see lower RBC, low hematocrit, low hemoglobin that tells us we got some B-Vitamin issues.
Evan Brand: You know what I found this true in- is women, or I mean, men too, uh do too much alcohol, you know, I’ve looked at some of the literature on how alcohol can damage your liver and as well as your red blood cells, so when you look at some of these like not “let’s freak out level”, but when you look at some of these low red blood cell levels, it could be linked to, you know, a woman doing 2, 3 glasses a wine every night. And all we do, we don’t even have to supplement, in that case, we’ll just say, “Hey, pull out the alcohol for a month”, then if we look blood looked at again, now all of a sudden, the red blood cell count looks normal. Uhm, you and I talked about this book before but I loved it, uh, Dr. Dicken Weatherby’s book, “CBC and Blood Chemistry Analysis”, he’s got some really good functional markers in there for like your red blood cells and white blood cells and all that, so that has a good resource for people if they wanna look at their blood work and see, you know, “How do I stack up compared to a functional range”, which is tighter than conventional range, that’s a good book for that.
Dr. Justin Marchegiani: A hundred percent. Yup, a hundred percent. So, a couple of ways to test like I mentioned, right? You can do the MCV, MCH, MCHC which is, you know, it’s gonna be good to your- give you a good medication, we could also run B12, and if you’re vegan, vegetarian, that could be really good, that could be a good marker. You may have, let’s just say enough B12 in your blood but not enough in your cell. So this is where we like to look at methylmalonic acid or trans holo cobalamin. So if we had adequate levels of B12, we convert methylmalonic acid into suc- succinic acid. So there’s this conversion, right? And then if methylmalonic acid goes high, it’s- could- it’s not able to convert it and- to a succinic acid and then we can make that inference that there’s not enough B12 to make that conversion happen. That make sense?
Evan Brand: Yeah it does. So, you’re saying, with blood- blood might not always show the true picture, correct?
Dr. Justin Marchegiani: It not always show it, I mean, we serum B12, you may have- you- you know, you may show an- an okay amount but we may still have issues, we have to run that organic acid that we always talk about, and then on that test, we’ll look at- for amino glutamate, which will give us a folate marker, we’ll look at methylmalonic acid which will give us a B12 marker, and we may also look at ___[14:29] and ___[14:30] which will give us markers in the B6, we like to look at those key methylating nutrients: B6, B12 and folate together.
Evan Brand: And this is on- I think you said it already but just to be clear what this test is. This is a urine test, it’s a first one in urine-
Dr. Justin Marchegiani: Right.
Evan Brand: -sample. We run it on everyone, it’s an organic acids test, and often what I’m doing now is I’m having that organic acid test combined with a chemical profile or even a mold test. Uh, which- which is a mycotox panel. So we can take one urine sample, run it through multiple machinery at the lab and then we get multiple read out which is pretty cool, that way you- or not just guessing on why this is happening.
Dr. Justin Marchegiani: Yes, and I had a podcast with Tim Jackson just on last Friday and he talked about the idea that lithium helps with B12 transport, and Dr. Amy Yasko talks about this too. So, lithium orotate, not lithium carbonate, the drug, lithium orotate can really help with B12 transport. So that can be something if we’re having issue with B12, you may wanna look at adding, you know, 5 or 10 milligrams of lithium orotate with that as well.
Evan Brand: Yeah, I was gonna say it probably be a low dose, right?
Dr. Justin Marchegiani: Mm-hmm.
Evan Brand: Just a- just to get that effect going in, and then lithium too, that’s also used for a lot of brain issues, right? Lot of like-
Dr. Justin Marchegiani: Yeah.
Evan Brand: -depression and- and-
Dr. Justin Marchegiani: Yeah you can see that help with dep- depression, mood, anxiety issues, and we’re not talking lithium carbonate which is commonly used for bipolar, right? We’re talking lithium orotate, the- the nutrient.
Evan Brand: Wow, I’ve heard of lithium orotate being really calming for people-
Dr. Justin Marchegiani: Yup.
Evan Brand: -I wonder if that’s because it’s helping to transport the B12 as you’re mentioning. Maybe that’s why it does- it has the effect that it does, it has multiple mechanisms.
Dr. Justin Marchegiani: Hundred percent, yup. And [crosstalk] on it? Studies showing that it’s connected with lithium- with uh B12 transport, so I think it’s- you know, it’s another tool that we’ll put in our “tool belt” so to speak.
Evan Brand: Well, let’s get back to food just for a couple of minutes-
Dr. Justin Marchegiani: Yeah.
Evan Brand: -and then we gotta wrap up. So you- you know, we talked about the liver. So beef is gonna be good especially your pastured animals, your grassfed beef, uh, you could do your elk, your bison, whatever type of meats you like, eggs are gonna be great if you can tolerate ’em, you know, good pastured eggs, happy chickens that roam the grass and ate bugs like they’re supposed to, uh, clams, I personally don’t eat clams but that was on a huge list of “Hey, here’s all this B12 foods”, clams was up there, uh, there was another one, dairy, but I personally don’t do much dairy except for butter. Would you say there’s some B12 in some good grass fed butter, probably yes.
Dr. Justin Marchegiani: I think so. I think you’re gonna get some of it just for the fermentation of lot of the grass i- in the gut-
Evan Brand: Yeah.
Dr. Justin Marchegiani: -right? You know, the cows gonna basically ruminate a lot of that good healthy butyric acid though, and I think you were gonna- you will get some B12 out of that as well.
Evan Brand: Okay, okay. And then, so we talked about blood, talked about urine, talked about supplementation, talked about foods, what are the mechanisms, what is B12 cause if its low, I think we hit on every point unless you wanna bring a- a couple others.
Dr. Justin Marchegiani: Yeah, so, kind of going back, we talked about neural tube defects if you have low B12, that’s kinda more in the pathological side, and of course that starts early on. So, of course, if you’re a woman, you’re looking to get pregnant, you should be on a really good- your multi should automatically have f- folate in there, not folic acid and it should have at least good methylated B12 if you’re not having any problems. And then we should be eating our leafy green vegetables, we should be getting egg yolks, we should be getting grass fed, high quality meat, maybe even a little bit of liver, especially if- is a woman if you’re having your period, you’re gonna be losing blood, so getting that liver will help with extra Iron as well, and then some good B12 which you’ll store up in your liver. So, that’s a really good starting point to prevent a lot of this. And then number 2, uh, on the back end, we can have let’s call it- uhm, subacute combined systems disease, or posture lateral sclerosis could we need healthy levels of B12 to build our myelin, to build our ner- to build our nervous system up. So it’s really important that we have enough B12 uh for those issues. I already talked about uhm, B12 in the gut, and how that can be a sign of pernicious anemia or other IBD or irritable bowel issues, or just a lot of gut inflammation and extreme malabsorption in the gut. So I think these are all really important things. And then uhm, I would say, I mean, of course you’re gonna see thyroid issues, right? If we uhm, had un- inadequate levels of B12 because we don’t have enough mature red blood cells. Mature red blood cells carry nutrition, carry oxygen, and we need that for healthy metabolism. So we could have lower thyroid function as well, we need B12 to be able to methylate, so we do drugs like the- the methotrexate, chemotherapy drugs for let’s say massive gut issues. A lot of these- a tricky irritable bile disease is with typically corticosteroids and chemotherapy on the gut, methotrexate, that inhibits a lot of B12 and folate, and that can create more DNA damage. So we need adequate levels of B12 to really have good healthy DNA, uhm repair. And that’s really important in activation.
Evan Brand: Yeah, well, just to mention too on the drug front, think of all the people on acid blocking medications, whether prescribed by their GI doctor, their regular doctor, or, even just the over-the-counter zantac, prilosec, any of these proton pump inhibitors, those are all gonna be reducing your ability to digest and absorb B12. So even if you eat a paleo diet, but you’re on acid blocking medications, or you have infections like we test for, parasites, bacterial overgrowth, candida, H-Pylori infections, anything that’s disturbing that gut balance, and they’re stealing the nutrients from you, you could have low B12 there. So always make sure you’re working towards that root cause, don’t just take the pill- a B12, get a good quality as we mentioned but make sure you figured out why. Why did this happen in the first place? Always ask why. Make sure you get there with the practitioner. So I know Ju- Justine and I gotta wrap up, so if you wanna say a couple comments-
Dr. Justin Marchegiani: Yeah. And also, if you have let’s say an elderly parent or grandparent, some dementia and Alzheimer’s like symptoms can come from low B12. So, if you know anyone on your family whose older and has these issues, this is where I think it’s really great to de- bring in, “Hey let’s get ’em a good quality injection, let’s get some nutrients”, ’cause sometimes that can be turned around with simple high quality injectable uh methylated or you know, adenosyl-hydroxy B12 can be super helpful. There’s been some studies on Alzheimer’s dementia patients where, you know, I think it was 10%, so on massive improvement in their memory with the B12 injection. And then also say look for the canker sores. Canker sores are a big uh- big sign that you could have B12 issue, also it’s a big sign of a gluten-sensitivity, right? These are aphthous ulcer, so, that’s another big thing I would say to look at. And I think the B12 injections are really big one, you already mentioned the foods, the eggs, the venison, the beef, the liver, some of the sea food, I think we hit all the major things Evan. So I’ll just say if you guys enjoyed this great info, give us a thumbs up, we’re clinically applying this information with patients every day, so it’s not theoretical for us, or in the trenches applying it. So hoping that listeners here can use it to make them- make their health better. If you like it give us a thumbs up, give us the share. Let us know your comments below, we appreciate it, and uhm we appreciate you guys supporting the podcast. You guys have phenomenal day. Evan, great chatting man.
Evan Brand: Yeah. Take care. If people wanna reach out to you, justinhealth.com, you could schedule consults around the world. If you wanna reach out to me, evenbrand.com we look forward to helping you. Take care in the meantime.
Dr. Justin Marchegiani: Awesome. Evan, you just take care man. Thanks so much. Bye everyone.
Evan Brand: See you, bye.
References:
A study on Impact of Helicobacter Pylori on the Development of B12 Deficiency by PubMed
CBC and Blood Chemistry Analysis by Dr. Dicken Weatherby