Looking Deeper at Your Blood Tests – Podcast # 168

Dr. Justin Marchegiani welcomes Dave Korsunsky, founder and Chief Executive Officer of headsuphealth.com, which is a website about tracking health data. Join them as they discuss about blood sugar levels, ketone levels, blood test and other health-related data that can be integrated with smart devices and the website as a means of analyzing your health.

Know about preprandial and postprandial blood sugar readings and glucose functional ranges. Also, find out more about the Carb Tolerance Test and learn how it can provide value and insight to how your body responds to sugar from different food sources.

Dr. Justin Marchegiani

In this episode, we talk about: 

05:08   Functional Glucose Tolerance

13:45   Body Composition and Postprandial response

18:16   Quick walk through on Headsuphealth

31:51   Heart Rate Variability

35:54   Stress and its associated markers


Dr. Justin Marchegiani: Hey there! It’s Dr. Justin Marchegiani. Welcome back to Beyond Wellness Radio! My good friend Dave Korsunsky is in the house. Dave Korsunsky, how we doing today?

Dave Korsunsky: Fantastic, Doc. It’s been far too long since we’ve connected, so happy to be back.

Dr. Justin Marchegiani: Excellent. Love it. So happy we’re connected here, too. Let’s talk about I mean you run the website headsuphealth.com— Heads Up House, phenomenal site where you can track your data. Again, you’re putting lots of new features in there where people can—can plug-in or integrate some of their smart devices, Fitbit, some other ketone or blood sugar reader scales, blood pressure cuffs integrate with lab companies. Lab Corps, coming out soon, you mention Qwest. So great way if you’re kind of like a bio hacker or a health hacker and you want to put everything in one place. Awesome place to look at there. So we have uhm—we have a new feature, where we talked about the new features that are coming up. So we’ll have an affiliate link here below, so if you’re listening to this information and it resonates with you or you want to try plugging it in, we’ll have an affiliate link down below that you can click to get access to some of this information to get your account moving. And again, start integrating some of the features that we’re gonna chat about today.

Dave Korsunsky: Great.

Dr. Justin Marchegiani: Okay. So off the bat, let’s dig in. So, one of the more important things that it’s coming here is we have some newer ketone readers in the market. Uh—one of those readers is called the “Keto Mojo” Cool thing about it is Keto strips are cheaper, which is great. It’s gonna measure ketones along with blood sugar and and it’s also gonna measure hemoglobin and hematocrit. Love it. I’m waiting for just that extra feature of insulin then we got like just freaking lab in the little reader right front of us. Wouldn’t that be amazing?

Dave Korsunsky: Every time I see Dorian the founder, I beat him up to say, “Hey, Dorian, can we get an insulin strip?” Because as you know, that’s— that would be a game changing piece of information that currently there’s no way to do that in a consumer test. But if you can start testing things like postprandial insulin just at home after different meals, it’d be awesome but nonetheless, they’ve put a great product out there and it’s really made ketone testing affordable and accessible to people who perhaps couldn’t have access to this before. So that’s a great one. We’re gonna to talk more about it as we go here.

Dr. Justin Marchegiani: And the reason why insulin is so important is because you have a lot of people that are insulin resistant with their blood sugar looks decent, let’s say 90 or 95 right? But it’s only decent because insulin is compensating and going so, so high. So insulin is shoveling out that blood sugar into the cell, so then the blood sugar looks lower because the insulin is basically the shovel. You got a lot more shovels shoveling that out. So it’s different coz if your blood sugar is here with high insulin, then you’re developing insulin resistance, right? Coz you have more shovels—cons—you know, compensating for that. If we decrease—and your blood sugar’s good, that means you are insulin sensitive.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: And we need low insulin to increase ketones, right? Ketones and insular on the scale. So people are like, “Hey, I’m like trying to lower carb or my blood sugar’s low but my ketones are low.” Well, that’s the missing variable is the insulin could be high. So to keep that in mind, we have this little seesaw fat with insulin and ketones. Anything you wanna say about that?

Dave Korsunsky: Yeah. We wrote a blog post exactly on that topic. And we talked about why fasting insulin is one of the most important test your doctor probably isn’t running because you’ll—you’ll get a typical fasting glucose test with no indication of whether or not insulin is artificially inflated, keeping that number down. That’s why it’s important to test both at the same time. So, yeah, I would agree. I think it’s incredibly important. I’d love to see the day we can start testing that at home. But right now, the only way to get an insulin test, whether it’s fasting or postprandial or whatever, is at the lab. And we’re gonna talk about that a little later in this metabolic panel that you have cooked up here.

Dr. Justin Marchegiani: Yeah. Absolutely! And we’re gonna do a screen sharing just a few minutes. The key—we’re gonna kinda just dial a couple of key components here. So let’s say you kinda already transitioned from a Paleo template approach or maybe you’re doing a Keto Paleo where you’re focusing on nutrient dense, anti-inflammatory, anti-toxin foods, right? But you’re keeping the grains, the dairy, the legumes out and such and you’re doing higher-quality fat, but you’re trying a very lower carb version 20 or 30 net grams. Big thing that we can work on integrating today is some of the heads up features looking at that fasting one hour, two hour and three hour glucose tolerance where we called it a functional glucose tolerance. Meaning, we’re not going to drink that 75 gram of glucose artificial sugar crap at the doctor’s office. We’re choosing a real meal not a fake exaggerated meal, but a real meal that we can see how our blood sugar fluctuates over that three-hour period. And you’ve integrated that in there. And why don’t we go to the screen shot on your side and you can kinda just walk us through how that looks. And just for everyone below here, if you listen to this on podcast, the YouTube channel click the affiliate code below we’re gonna have so you can get access to this information.

Dave Korsunsky: Yeah. I remember when you and I first started working together, doc. And I was your patient and you educated me on what the functional glucose tolerance test actually was versus the oral glucose tolerance. And the functional glucose tolerance being something you could do at home after any meal. And for those who were unclear, the oral glucose tolerance is the formal test we go to the doctor, drink the sugar and you hang around and get the— the postprandial blood glucose test done. Not really that practical in reality. But the functional glucose reference you can test with anything. So I’ve got my screen shared, can you see it here, Doc?

Dr. Justin Marchegiani: I can see it. You’re up.

Dave Korsunsky: Yes. So, this is something we ended up calling initially we called it the functional glucose tolerance test, but it was just a little too wordy to fit in. So it’s really just a carb tolerance test and actually Rob Wolf talks about this in his book as well, where based on some research out of Israel, there was a study done following 800 different people and they found that you could give two people the exact same carbohydrate source whether it’s sweet potato or bread or lentils and they would have very different postprandial glucose responses. So the key take away was that it’s different for everybody. And back to the functional glucose tolerance, where you’re actually having people test their favorite breakfast, test their favorite restaurant meals or meals they’re eating at home. So here’s how this works and you can see on my screen here I’ve got the future called the Carb Tolerance test and you can just click the plus button here. You can test anything you want. So let’s say you test your—your favorite breakfast of Denny’s bacon and eggs. And all you do is just put a name in here, but this could be anything. It could be a muffin, it could be 50 g of Sweet potato, it could be anything that you’re curious about. You say I eat this food regularly, I want to understand how my body— my body’s postprandial glucose responses are going to be. So I’ve called this anything I want. And what I do is I test my blood sugar before I eat that food. So let’s say that my—my pre-prandial for example was 85, and if this was a fasting reading, I could also take it as such. And then what you do is you just test one hour, two hour and three hours after the meal and update this intro info accordingly. You can also record any subjective symptoms and this could help you identify—even though you may have a nice, healthy postprandial glucose response, there’s also the ability to record subjective symptoms. “Did I have an energy crash?” “Did I get brain fog?” Did I feel hungry 30 minutes later?” or “Did I have digestive issues?” And you can save that and then share it with a practitioner like yourself. So I’m gonna answer my pre-prandial glucose reading here and then hit save. And you’ll see this will create a new entry here. And then all I have to do is just update the one hour and a two hour and a three hour after I go. And just to give you an example of what that looks like when it’s completed is here’s what I did at In-N-Out Burger because when I’m traveling, often you don’t have access to all of the healthy, low-carb food to do a home. So I go to In-N-Out, I’ll get two lettuce wrap burgers with—they call it the protein style. And I wanted to see, does—does just a protein burger with no bun have an effect on my glucose?

Dr. Justin Marchegiani: Uhm.

Dave Korsunsky: And here with the results: 90- 106 at one hour; 89 at two hour; and then back to about 95 at the three hour mark. So, maybe I’ll kick it back—back to you, Doc. And you can share more about what you’re looking for in the postprandial glucose curve as you have your patients test different meals and different foods.

Dr. Justin Marchegiani: Absolutely. So, in general, you know, we have this kind of fasting ideally below hundred and 95. Again, we got to be careful in the morning because in the morning and that from when you wake up to 30 minutes later, your cortisol is increasing nearly 50 to 60% in that 30-minute period. And because of that healthy cortisol response, you can actually increase blood sugar and that big spike that’s like, you know, you’re making them over three quarters of your cortisol just in that zero- 30 minutes. So that spike can increase blood sugar and you may think, “Hey, you know, this is partly because of my diet.” And it may or may not be. So just kinda keep it like a little, you know, asterisk next to that and really look at your lunch and dinner ones, especially if you’re seeing an anomaly in the morning. So we like that zero below hundred and 95. We like hour number one, below 140 for extra credit. For extra credit, we like it below 120.

Dave Korsunsky: Right.

Dr. Justin Marchegiani: Below 120 and then at two hours, below 120 or close to a hundred and below— at three, definitely, below 100. So, kinda keep that as your— as your kind of your baseline. Remember we went out to eat out like a few months back. We went to a steak restaurant. I think I tested mine one hour after a meal and my blood sugar was 70 or 75, right?

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: So you can eat really well and you can choose foods that keep your blood sugar from spiking. And the whole benefit that is when your blood sugar’s not spiking like that, you’re not over secreting insulin; when you’re not over secreting insulin, you’re not gonna develop insulin resistance and all of the effects of that may have with ovarian cyst or cancer cells or inflammation and our blood pressure. So all those things kinda benefit. So, just kinda highlighting on your side, we can plug those in and we can map them and we can put the notes in there regarding what meals. Then you can say, “Hey, protein style In-n-Out.” “The steakhouse where I did” or “The cheat day where I ate this dessert or this crappy food.” Right? And then you can kinda map it out. And that can provide a lot of value and insight of how your body responds and also there’s the immunological qualities that Rob Wolf has talked about where it may not be a carbohydrate thing. It may be a cortisol response to a food allergen that’s getting your immune system wound up that could— that cortisol can increase the blood sugar as a—as a side side effect.

Dave Korsunsky: Yeah. And we—we’ve had several users on Heads Up Health test different foods that they thought were metabolically safe for their body and the results were absolutely shocking for someone will test certain foods that they’ve been eating. And I’ll share some results with me anecdotally and I’ll say, “Wow, I thought this food was safe.” And then they tested and it’s—the blood sugar still skyrocketing at the three-hour mark. It hasn’t started to come down at all. It’s a runaway train. And—and people actually had no idea. So this can be incredibly helpful just to make sure that there’s nothing really sabotaging your efforts. And unfortunately, you do need to test these foods yourself. You can’t just rely on things like the uhm— the guidance from the Diabetes Association or from the uh—glycemic load tables. There’s so much individual variance that this is why postprandial blood sugar testing— even if you’re not diagnosed as having a metabolic disease, even just for your own personal health, it is helpful to test different foods and—and just make sure that you are having a healthy postprandial response. So, that’s the new feature we’ve built into Heads Up Health. You can test anything you want and just make sure it’s metabolically safe. All of these readings will be stored. And actually, you can probably add more here, Doc. But after you’ve been on a clean Paleo eating template for several months, you may actually be able to tolerate foods that you couldn’t tolerate before as your body composition improves, your gut microbiome improved. So, maybe, you can comment on how something that might not be metabolically safe now could potentially be reintroduced at some future point after you’ve made some progress on your health journey.

Dr. Justin Marchegiani: Absolutely. So, of course, if you’re not breaking that food down, not digesting it well, that can create a stressor. It could just be a food allergen kinda like gluten. That could be a stress or dairy or casein, right? People on the Keto community, Keto Paleo community, they are notorious for maybe doing excess casein because you know, “Hey, you can do dairy or cheese or all these things.”
Dave Korsunsky: Yup.

Dr. Justin Marchegiani: And you got to be careful with the case in uh—from a Ketogenic perspective because that could be__. And uhm—of course, if you have an infection or SIBO or parasite or H. pylori something that’s driving gastrointestinal permeability or the word “leaky gut” That can get your immune system wound up, too. And of course, if you have you know, low levels of probiotics in your gut that can create issues. Coz probiotics help with the immune function to help reduce B vitamins and vitamin K. And of course, you know, good bacteria eats poop and poops nutrition, right? Bad bacteria eats nutrition and poops poop. Essentially, good bacteria provides more nourishment; bad bacteria provides more toxins and stress in your gut.

Dave Korsunsky: Yup. Exactly. So and—and what about body composition as well? Have you seen for example as you increase your lean muscle mass, for example, that may— does that also have an impact on postprandial response? Because we—we talked to a lot of guys who are bodybuilders and they can go out and need a huge quantity of food and—and postprandial responses are very low. So, I know you mentioned gut microbiome, but what about body composition muscle mass in response to uhm— postprandial glucose?

Dr. Justin Marchegiani: So, number one, if you have more muscle mass, you’re gonna have more glut 4 receptors to soak in that glucose. So, think about it as your kid makes a mess on the table, you go with a tiny little sponge to clean it up. That’s like tiny bit of muscle is a tiny of sponge.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: Whereas like a huge—like one of those big sponges you used to kinda wash your car you have more muscles equivalent to a big sponge like that. Lots of glut 4 receptors. You can soak about that glucose just like you can go to your table with your kids mess and you can soak it all up and you didn’t even— didn’t even bat an eye, right?

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: So muscle does that. Also, muscle, if you have more muscle, that means you automatically have less fat, right? So fats and exocrine gland within itself so it will produce estrogen as well.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: And what pretty much drives the fat is gonna be insulin. So excess insulin drives more fat; more fat drives more estrogen. So it’s kinda like this vicious cycle. More estrogen can make you more insulin resistant, especially if you’re a guy and then more insulin increases aromatase, which will take your testosterone and bring it downstream to estrogen. So you become more of a female hormonally and with women, it’s actually the opposite. They get more insulin – more insulin will drive the 17,20 lyase enzyme, which then increases androgens and then they get ovarian cyst and then they get more, you know, hair growth, acne. So it’s this vicious cycle our mother nature kinda swaps the roles there.

Dave Korsunsky: Yeah. I talked to a lot of people who are doing everything right in terms of the macronutrient profiles. They are eating low-carb, they’ve got things dialed in there, but— but little to no exercise. And yes, you will— you will lose that to a certain extent body composition will improve, but there’s—it’s also critically important to be building muscle mass, lifting heavy things and sweating. Those are two of the most important ingredients in my own regimen. Making sure I’m building up lots of muscle mass in in the quads, in the back, in the large muscle groups. And I think that’s something that at least in my experience, people I don’t think appreciate as much as they start down this path. They think that diet alone is going to handle it, but lifting heavy even if you’re just starting out starting to learn some of the functional movements that are— that build a lot of core body strength and really hit the big muscle groups. I think that’s perhaps the next level to get to once you have a solid foundation with the diet. Would you agree?

Dr. Justin Marchegiani: Hundred percent. And also, say make sure you get your 10+ thousand steps. Yesterday I got a 14,000 steps. That’s helpful because that— the steps really allow you to start basically cleaning out some of that extra—there’s little bit of extra carbohydrate in there. You can clean some of it out coz you’re constantly moving and the extra steps really help. And of course if your— you know, “ I don’t have a ton of time, so I’ll just jump in and do a couple cattle bells swings to failure, some push-ups to failure.” And that could help because the—the push-ups, right? You know, I have a push a bar so I can go really deeply, so I get a full range of motion push-up all the way down all the way up. I can get the upper body going. I’ll do my TRX Rose to get the posterior side nice and some kettle bell swings as well. And if you have a lot of time, throw a Tabata in there coz that high-intensity gets the growth hormone. And growth hormone is really gonna be stimulating a lot of that—that muscle tissue.

Dave Korsunsky: Yeah. I definitely have a home gym envy, Doc. I’ve been over to your place and I’ve seen your set up. It’s pretty nice, so I definitely would love to have something similar someday in the home.

Dr. Justin Marchegiani: And if you’re on a budget, really simple, TRX that hangs over door.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: You have the adjustable kettle bells on Amazon and get a push-up bar. Push-up bar is optional but I just like it coz you can get really deep coz I would go so deep I bang my head against you know, the floor. So I can go really deep full range of motion and not have to you know make out the floor, so to speak. So that’s a great option for you.

Dave Korsunsky: Those are great. I’d love to maybe see if we can find some of the recommended products on Amazon— the adjustable kettle bells, the TRX stuff and just actually may be included that here in the notes so people know which ones you’ve tested and they can just go out and get that and try it. So I think that would be uhm—yeah, that’d be cool.

Dr. Justin Marchegiani: We’ll get that in the show notes, for sure. Also, let’s just give—we kinda show some of the functional glucose tolerance stuff but you know—you just give us a cursory. Just just give us a quick walk through through Heads Up so someone that they’re gonna click on the link below, they’re gonna get to the site, but then what do they do? How does it work? Give us that like little round up there.

Dave Korsunsky: Yeah this is—this is my—my personal data. So let me just refresh the screen here because uh— some of the information didn’t actually come in on the last load. And as you share screen that’s what I wanted. So the first thing we’ll ask you as a new user is, “Which devices and apps you’re using to measure your health?” And so at least everyone who signs up has at least one of these devices. A withing scale an eye health wireless blood pressure monitor or glucometer, a fit bit, uh— my fitness pal for tracking the macros, Apple Health. These are gonna be able to pull in things like heart rate and blood sugars, sleep, macronutrient profiles. So all of that will flow in so you can connect as many of these sources as you want and then you’ll see were also starting to build some of the more specialized sources as well. The ones I showed first were more of the commercial grade stuff, but you can also see we’re starting to integrate devices like the Oura ring and the level breath acetone analyzer and things like Elite HRV and the other HRV monitors are coming in. So uh—we’re also working on the decks com, CGM device so we want to make it easy for people to build their own custom dashboard because everyone’s tracking different metrics. So this is all completely customizable. So that’s step one. And then you’re allowed to build your own custom dashboard. So I’ve got the carb tolerance test data here, but if that’s not something I’m working on, I can just actually hide it. And you can see my top three metrics are glucose, ketones and the glucose ketone index, which is just a ratio of these two numbers. A lot of our cancer patients and people with serious metabolic dysfunction are tracking the—the index of the two numbers. And then you can see I’ve got my weight and body fat readings those can come from a withing scale. They can be entered manually. This year is my heart rate variability, which actually comes in from the Oura ring and so that’s on here as well. Same as sleep. So that ring gives me a good sleep and HRV reports. So this is all completely customizable, breath ketones, resting heart rate. And then really what people try and figure out is how is this affecting my clinical markers? Are my lifestyle changes lowering my inflammation or not? And the only way to see that is to put the clinical markers in the same system as the light markers. And typically, the doctor has this clinical data. So it’s very difficult to compare lifestyle changes to clinical markers and that’s what we wanted to solve here and make it available for everybody. So I could just jump down and look at things like my inflammation markers and say, “Okay, is CRP coming down as I go on a clean Paleo template?” And we can actually link directly to your medical facility and pull this data out. So all you do is click the connect data button and let’s say that you’re sending patients to Quest Diagnostics. They would be able to just link their quest account to Heads Up and all of that information would flow in or if they’re using a more traditional health system and billing their insurance, you can connect Stanford, you can connect UCLA, you can connect the Cleveland clinic. There’s over 10,000 medical facilities in here and what we’ll do is we’ll take all of that data, clean it up and organize it from oldest to newest so people can actually have the full picture of their health and what we’re seeing is patients can look back into their history five 10-15 years into the past. Maybe even decades before they’ve even started working with their current doctor and see these patterns emerging years before the disease was diagnosed. And the reason you—you can’t do that today is because every time you change doctors, your health record get fragmented but when we put it all together for people, then you can start to see, “Wow, actually that trend was visible 10 years before I even got the diagnosis.”

Dr. Justin Marchegiani: Right.

Dave Korsunsky: But nobody noticed because I moved and my records got fragmented and my doctor can only see back three years, but I can see back 15 years. And that’s where this has the potential to I think really help people uhm— have actually more power and more information on their health. So, there’s a whole bunch of other stuff that goes into the system, Doc, but it’s really meant for patients and then most importantly all I have to do here is go to care team access.

Dr. Justin Marchegiani: Uh-hmm.

Dave Korsunsky: Give you access and you can come in and review all this data whenever you want. And then if I don’t want you have access anymore, I would just disable that access.

Dr. Justin Marchegiani: And if you’re listening to this on iTunes or a kind of an audio version, we’ll put a link down below for the YouTube video version as well. So if you’re trying to figure out like kinda find us, we’ll put the link but Justin health.com/YouTube Y-O-U-T-U-B-E and subscribe there. That way, you can see the videos well and then you can also listen to the audio.

Dave Korsunsky: Yeah. So I just killed the screen share, but that’s a quick walk-through. I wanted to show people the functional glucose tolerance test because it just allows everybody to test their favorite foods, make sure that they are metabolically safe even things you thought might be safe, may not be. So it’s easy to just test and be hundred percent sure and obviously, you can integrate all the other information. So, that’s a little bit about one of the most recent features we just finished up.

Dr. Justin Marchegiani: Love it.

Dave Korsunsky: And actually we uh— we have a debt of gratitude to Dr. J on that one because he was the one who told me about the functional glucose tolerance test. So we took your vision, Doc, and implemented it into our software program.

Dr. Justin Marchegiani: Love it. That’s phenomenal, man. Very cool. I’m also gonna be doing a live right now—a blood sugar test to myself kinda see where I’m at and put it out live on air.

Dave Korsunsky: Well, I can’t get you go solo there, Doc. I’m gonna have my Keto mojo here.

Dr. Justin Marchegiani: 87.

Dave Korsunsky: 87—that’s respectable.

Dr. Justin Marchegiani: And just so you know, that’s an hour and a half to two hours after having three eggs cooked in ghee with sea salt and then some butter coffee with MCT.

Dave Korsunsky: Alright. Let’s see what I got here. So uh—you mention the mojo here it is—uh 99 ketone strip. I’m not gonna do the ketone test right now. I’m just gonna do a is to glucose strip. This is about I don’t know, half an hour after I had breakfast which is really just a chicken breast today. I’m traveling so I don’t have access to all my food and uh—clocked in at 82. Respectable 82. That’s where I wanna be, so, yeah, I’m dialed in.

Dr. Justin Marchegiani: That’s good. Yup. I mean, my ketones are probably around .6 mmol typically is where they are out of, what, like an 80, 80+ percent fat breakfast. I typically get my protein in the morning from collagen. I did some good quality pasteur-fed eggs, but that’s important. And let’s just kinda hit a couple of the other blood sugar markers that we can do. So, I like the functional glucose tolerance. One: because it’s specific to the meals.

Dave Korsunsky: Right.

Dr. Justin Marchegiani: Where if you do kind of a blood test, so you go to Labcorp, it may be helpful, but it’s kinda like a fixed thing—

Dave Korsunsky: Yeah.

Dr. Justin Marchegiani: And it’s not something that someone can do all the time. So we can do fasting insulin, which is really nice. And if you’re more insulin resistant, that’s great because your blood sugar may look okay, but it’s nice to see the insulin coming down. And that’s even better coz that tells us that we’re reversing insulin resistance. We can do fructosamine. So, fasting insulin, ideally, below five—the sweet spot.

Dave Korsunsky: So let me—let me jump in on fasting insulin.

Dr. Justin Marchegiani: Yeah, sure.

Dave Korsunsky: A lot of people, probably their doctor might not run it for them because there’s not a diagnostic code. My doctor wouldn’t run it for me and it’s extremely important. As you said, to see glucose and insulin to make sure that one is not overcompensating for the other. And so that’s— sometimes to test that, a patient will have to order on their own and whether they get it from you or whether they go or it themselves online, maybe you can just comment on that. My doctor won’t run that specific test for me and—and how could somebody do that themselves if their doctor won’t run it?

Dave Korsunsky: Yes. So, of course, you want to reach out to a functional medicine Doc like myself. There are others out there because in the realm of functional medicine, we’re not actually treat disease, we’re supporting underlying systems that may not be working optimally. We’re fixing diet and lifestyle and we’re trying to bio hack and kinda maximize optimal performance. So it’s a different mindset and if you’re in the insurance model, things tend to be all disease-based, CD 10 code, CPT attached to it and uhm—it’s just you know, if you’re trying to utilize your insurance for this type of healthcare, it’s typically not gonna work.

Dave Korsunsky: Yup. And so what I did just for myself and my family is we just— we just went on to one of the websites where you can order your own tests. There’s a bunch out there and just ordered our own fasting glucose, our own fasting insulin 70 bucks and just got it done and make sure all numbers were in range. So, at least in the United States, this is not available internationally. But within the United States, we do have direct to consumer lab testing. If you’re concerned and you want to know the numbers and your doc won’t run it, do it yourself and track it in Heads up Health.

Dr. Justin Marchegiani: One hundred percent. And again, a lot of people, they maybe listening concerned about you know, cholesterol, eating this much fat and this much good quality protein, again, I just got approved for the highest life insurance policy you can get from uh—you know, grade wise health and my lipids came back 180-185 for total cholesterol HDL is in the mid-60s Trigs were in the 50-60 range. So again, you know, nearly perfect on everything is wide at the highest rating that you can get for life insurance. But just to show you, you know, you’re concerned about thinking about eating these foods and it jacking up your cholesterol, typically not. The biggest thing that will jack it up will be insulin. Insulin will up regulate the enzyme that makes more cholesterol the uh—Hemo Methyl Glutarate COA Reductase enzyme.

Dave Korsunsky: Yup. So, yeah, we–-and that’s great. And you were just actually also, we were talking about a panel we’re gonna put together which is going to be a fasting glucose fasting insulin A1C and fructosamine. So uh— some people may not be familiar with fructosamine and A1C so maybe comment on those and then we’ll will put the panel together on the website people can just go do it themselves, Quest or Lab Corp and we’ll put the functional ranges in the show notes because the conventional ranges are misleading sometimes. So what do you think about those numbers in general?

Dr. Justin Marchegiani: Yes. So fructosamine, typically is a 10-14 day window. So in the lower, 200 is gonna be great.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: A1C in the lower fives—

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: Lower 5’s is gonna be great. Of course, glucose, it depends upon the timing. But fasting you know, below hundred, below 95 is great, you know, we got shot it in the 80’s which is excellent. Insulin below five below six is really good from a fasting insulin closer to two or three is—is—is great, too, as well. And again, if we go really low in the insulin, we have a lot of fatigue issues. We do need insulin to help convert thyroid hormones. So we could be driving insulin too low, which could be creating some other metabolic issues. So keep that in the back of your head if you’re Keto, Paleo and you’re still having some symptoms you may need to actually raise the insulin a bit especially if your body comps are already pretty good. So keep that in the back of head. That could be a little something we have to tweak down the road.

Dave Korsunsky: And that is actually something you help me with last time I was in Austin where I had extremely low carb for a really long time. Potentially, it was even keeping insulin too low and I was seeing some elevated cortisol responses and just having some uh— post exercise uhm— insomnia type issues. And I was able to just dial it back a little bit and over time, quickly correct those. So that was one of the things I learned just from my own personal experience was to cycle out every once in a while and—and dial back up the—the carbs maybe from below 25 to 50 or something around there. I know you’d target 100, you’ve mentioned before. So, I think variance is good, basically. And uhm—I I know I personally may have stayed low carb too long I didn’t need to be I was actually— my body composition was good, but that’s a good point. It’s actually being too low can also have some downstream effects on the insulin side as well. Correct?

Dr. Justin Marchegiani: Hundred percent. And again, for me, I always default to go in low coz it’s easier to start low.

Dave Korsunsky: Absolutely.

Dr. Justin Marchegiani: Kind of stabilized and then move up.

Dave Korsunsky: Yeah.

Dr. Justin Marchegiani: Coz if you’re kinda in the middle, then which way that you gotta go. There’s more variables that you have to move through; but if you start lower, then you start to move one direction.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: And you know, then you’re okay. Then if you hit a point, you know, you got, you got—so to speak, some uh—you have a direction that you just got to go the opposite to get back to where in case you just start having a negative reaction.

Dave Korsunsky: Yup, cool. Okay, perfect.

Dr. Justin Marchegiani: So we talked about those couple of markers there. That’s perfect. We hit those things. Also, let’s chat about the HRV a bit. So I see HRV, your heart rate variability, which is the unevenness between the hearts uh—you know, the heartbeat in each second. It’s not a consistent beat, there’s some level of unevenness, which basically is a parasympathetic response. So the more the parasympathetic nervous system is activated, that’s a great sign of being able to heal anabolic hormones, being able to recover, build, back up, recycle neurotransmitters, build muscle. That’s really good. So we have some devices that we can utilize I mean you can do the Amway device by HeartMath. Uhm—I like the just the Fit bit, making sure sleep looks pretty good. Uhm you can check in with the Oura ring. So let’s dial in with some of the things that you use to help improve heart rate variability.

Dave Korsunsky: Yeah. That sounds good, Doc. Give me one second here. Can you hear me, okay?

Dr. Justin Marchegiani: Yeah. You sound great.

Dave Korsunsky: Alright. So, starting to see a lot of individuals who are starting to look at heart rate variability. I think there’s still a lot of people who aren’t quite sure what is. They’re starting to hear that term, HRV. You might not know exactly what it is. I’ve only recently started introducing it into my regimen. Initially I started by very simple—just purchasing a heart rate monitor— a polar heart rate monitor that you can get on Amazon for 30 bucks and it’s a chest strap. So in the morning you would—you’d put it on and you would fire up an HRV app. And in my case, I was starting with the lead HRV. There’s a number of them out there you can pick one that you like and it will just ask you to sit—sit still for two or three minutes in the morning and it will start doing what’s called a readiness score and it will start measuring that variability. The—the time between each heartbeat and looking at the variance and then it will be able to give you a—a measurement of your level of recovery. How well recovered your body is on a given day and it just can help you inform how hard you should push yourself on your training. So some of the popular apps out there that I’ve come across are lead HRV, bio force and the one I’m using now is actually the Oura ring, which is here and this one actually will measure a number of different metrics. It will measure HRV, body temperature, sleep cycle analysis and give you a readiness score based on all that information. But for those who are not familiar with it, HRV is an excellent measurement to start assessing your level of personal stress, sympathetic versus parasympathetic, your level of recovery from physical training on a given day. And it can be a very helpful metric to understand just—just the level of stress in the body that can have implications for inflammation, can have implications for your blood sugar levels. So for those who aren’t familiar with it, starting to look into doing some basic HRV measurement I think is increasingly becoming a very popular metric that we’re seeing requests for from our users.

Dr. Justin Marchegiani: Love it. Excellent.

Dave Korsunsky: Are you testing? Have you tested HRV? Have you use any products there? do you have your patients measured at all?

Dr. Justin Marchegiani: I don’t do a lot of testing with it. I just—I haven’t found something that I’ve been streamlined with because there’s many things out there. So like the bigger things for me are like functional glucose testing. I like the Fit bit. If people aren’t gonna be going to the gym, making sure they’re getting enough steps.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: There’s a cool one that’s out there I’m liking. Coz I see a lot of people poor posture. It goes on your spine.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: And then there is an app and that it tells you how straight your spine is.

Dave Korsunsky: Yeah.
Dr. Justin Marchegiani: So you put it on for optimal posture and then if you start moving, there’s a screen alert and it shows you where your posture is. So it’s instantaneous biofeedback for your posture.

Dave Korsunsky: Yeah.

Dr. Justin Marchegiani: That’s—

Dave Korsunsky: Yeah. It’s called—I forgot the name of it. It’s Lumo Back or something like that.

Dr. Justin Marchegiani: Yes. I’m liking that to a certain degree coz if people sit all day, I think it provides a lot of awareness that, “Hey, your posture is pretty bad maybe get a stand desk.” I stand 5-6 hours a day and have a walking treadmill that I slide into my desk and I walk about you know 5 to 10 miles a day while I’m seeing patients. That’s I think helpful. So I don’t go crazy on that, but I think it’s something that I will look more into. I— I wish that Fitbit would integrate and have a heart rate variability aspect, too. I think some of the more expensive ones do, but I like the Flex for the Fitbit. It’s just a little more durable.

Dave Korsunsky: So this is something that I think would be uh— helpful—helpful to a lot of users on our system who are managing autoimmune disorders. They are managing metabolic diseases. They are managing cancer, for example. And if HRV is a proxy measurement for stress and perhaps underlying cortisol and elevated sympathetic nervous system response, maybe it’s not specifically to HRV, but can you share how things like stress can affect autoimmune, specifically, gut disorders and other autoimmune diseases and how measuring and lowering stress can improve symptoms and associated markers.

Dr. Justin Marchegiani: So, of course, we have stresses –is in a couple different areas, right? We have like when people think of stress, it’s typically emotional stress, right? It’s work, families, relationship, finance. Like that’s one element to you know, emotional stress.

Dave Korsunsky: Uh-hmm.

Dr. Justin Marchegiani: Also things are like blood sugar. Having your blood sugar swing up and down because you’re eating too much carbohydrate or you’re skipping meals and you’re not getting enough nutrition and B vitamins and minerals at the meals coz you’re burning that stuff up, the more stressed you are, right?
Dave Korsunsky: Got it.

Dr. Justin Marchegiani: Think of you driving a car. You gas it on the highway. You’re going faster, you’re making fast turns. Well, you go through gasoline at higher rate.

Dave Korsunsky: Uh-hmm.

Dr. Justin Marchegiani: Well, the same thing happens with people when they are skipping meals, right? And they’re under a lot of stress. They don’t have the gasoline and the take. The difference is our body just starts shifting in the catabolic physiology where it starts breaking down other tissue. The difference in a car is once you’re on empty, right? That Seinfeld episode, how low can you go? Well, eventually, you just—the car just stops. The difference is if the car was equal to our physiology, we’ll start metabolizing the bumper or we’ll start metabolizing the internal uh—gas, you know, the internal oil and fluids and such, right? The car is not quite like us. Once it’s on, once it’s out of fuel, it stops.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: We don’t stop. We break down other tissues and hormones and neurotransmitters and that creates disease because we’re breaking down, we’re getting chronically inflamed. So cortisol is gonna break down of course more neurotransmitters. It’s gonna create— it’s gonna a breakdown gut tissue, which is gonna create more leaky gut and create more immune stress. The more immune stress there is, the immune system sucks up a lot of resources, a lot of energy and of course, when the gut is impaired, when the gut is inflamed, we’re not gonna be able to absorb a lot of those nutrients. So, let’s say you start shifting your diet back to up to a Paleo template or an autoimmune template and you’re not getting better, that’s probably why. Is your sympathetic nervous system is so turned on we have to work on that. We need to support the gut integrity. And there’s probably some infections that have come because your immune system has been shut off. So basically, you left your door in uh— unlocked and now you get five homeless people sleeping your house when you get home, right? That’s the equivalent of you know these parasites. You got to come clean them up, right. You gotta go do all the stuff you need to do in the functional medicine program to get them all dial back in.

Dave Korsunsky: Yes. So my take away from that is heart rate variability is actually a way that people construct to quantify stress because—

Dr. Justin Marchegiani: Another way to monitor it, right? Like heart rate variability is not “tell me what to do” but it tells me that what I’m doing is actually working.

Dave Korsunsky: That’s exactly right. So if someone is suspecting that they’re doing everything right and they’ve got an autoimmune condition, they’ve got some other condition going on, they know that they have some stress in their life that’s probably exacerbating things. Starting to get some HRV measurement can actually give you some hard data because otherwise stress is just as nebulous thing. “Yeah I’m stressed out. It may be affecting my markers, my symptoms. I don’t really know how to quantify it.” And I think that’s where learning HRV can become extremely helpful especially getting that morning HRV readiness score, where it just says, “you got a great sleep” “your HRV numbers look good” “you can push yourself today” or you can say “Your HRV numbers are terrible. Take today focus on rest and recovery.” And it actually gives you a number of quantifiable, accurate number that can be used to start to calibrate lifestyle, actually understand how stressed your—your system is. And then make adjustments and have some data to work with instead of this nebulous “I’m stressed” term. The HRV can give you real numbers to work with. And there’s some great tools out there. The Oura ring is one. The elite HRV readiness score is another. Not difficult to measure and that can help you start to move the needle in terms of stress response. So, I guess that’s my take away from why I recommend HRV, why I test it personally.

Dr. Justin Marchegiani: And what’s your favorite device again?

Dave Korsunsky: Well, right now I’m using the Oura ring. It’s a pricey device that’s the thing, but it incorporates a lot of different things into the uhm— stress response score. It includes a lot of data from your previous night’s sleep. Deep, light, REM, uh— bedtime, wake time, resting heart rate. Things of that nature. So that’s the device I’m using. I also have a Polar heart rate chest strap which I bought on Amazon. I think it was $29 and the elite HRV app is free. So that’s another one. And I know that there’s other HRV apps out there. Pick one you like. Maybe test a couple. Start getting some basic HRV measurements and then it can be just another helpful data point to help you try to assess and measure and improve metrics associated with stress, elevated sympathetic nervous system, poor sleep quality could also contribute to poor HRV numbers. So those are the products I currently am familiar with.

Dr. Justin Marchegiani: Love it. Excellent. Well, I have to get them to sponsor the show here, Oura Ring, phenomenal. Alright, Dave, hey, phenomenal show. We’re gonna put links here kinda link to get access all this material here for you guys.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani: Get people over there. We’ll put some of the material and things we talked about in the show notes section underneath. So if you’re listening to iTunes or YouTube, we’ll be able to give you access some of those information there and some of those tools. Anything else you want to share that you think is really important before we wrap it up.

Dave Korsunsky: No. I think it’s always good to—to be on here and just –my whole thing is data-driven health and using having access to your numbers and learning how to figure out what works for you and it’s also great to speak with you and get the clinical perspective on how to interpret these numbers as well. So it was just great to be back. We’ve always got a lot of stuff we can talk about. We could probably go on forever but I think we recovered some good information here so uh— it was it was fun as always, Doc. I’ll be seeing you at Paleo f(x) Not to— not too far from now. Always a fun time so I’m sure we’ll have an opportunity to have some fun and uh yeah, otherwise, it’s just great to be on the show.

Dr. Justin Marchegiani: Love it. Great to be here, too. And also you’re listening to this, sharing is caring. Give us a share. Give us the thumbs up. We appreciate it. Spread the word. Uh again, it really fires me up when I see more people getting healthier so make sure you give that a share. Dave, thanks a lot. Great having you here today.

Dave Korsunsky: Okay, great.



Adjustable Kettlebells

TRX suspension trainer

Push up bar

Keto Mojo

Lumo Back App


Oura Ring

Elite HRV readiness

Analyzing Your Blood Test Part 2 – Comprehensive Metabolic Profile – Podcast #151

Dr. Justin Marchegiani and Evan Brand dive into the topic of blood test analysis—specifically the Complete Metabolic Profile (CMP). Learn about the different markers that they look into like the glucose, calcium, BUN, creatinine, Alanine Aminotransferase (ALT), Aspartame Aminotransferase (AST), potassium and sodium. Know about the different symptoms and health conditions associated with the different blood markers.

Gain some valuable information about functional ranges in blood work and understand how it can provide more information regarding health issues and nutritional deficiencies compared to the general reference range. And lastly, discover some healthy recommendations to address nutritional deficiencies.

In this episode, we cover:Analyzing blood cell

2:56   Glucose Marker

6:10   Calcium Marker

8:20   Protein Marker

10:30   BUN:Creatinine

14:12   Liver Markers






Dr. Justin Marchegiani: Hey there! It’s Dr. Justin Marchegiani.  I’m with Evan. We’re live on Facebook and YouTube. We’re ready for an awesome podcast. My baby’s doing one week exactly from now we’re really, really stoked. Uh—maybe do a live podcast uh— from the operating room, probably not but maybe something that week, give people some live updates. Evan, how we doin’, brother?

Evan Brand: Life is good. It’s back to school season, so all the school buses are around the city and when people go back to school all of our female clients especially the teachers they start having flare ups of their symptoms. So we got to keep you under control ladies and teachers and men teachers as well. Make sure you’re taking your adaptogens, if you’re going back to school and you’re starting up your teaching again. This is a good time to whip out your—your adaptogen formulas and double the dose of those.

Dr. Justin Marchegiani: Love it. Totally makes sense. Also, congratulations on the new car. You got a great deal on a— on a pre-owned Tesla which is really exciting.

Evan Brand: Yeah. It’s like dropping a spaceship. I’m gonna be putting up a YouTube video. Jack Cruise, who is a mutual friend of ours, he said, “Oh my God Teslas are the worst cars for EMF but that’s actually not true. I’ve actually measured using several devices the EMF from a Tesla. It’s actually not bad. It’s actually less, believe it or not, than Honda Accord that I was driving beforehand. I didn’t take a video so people just have to take my word for it, but the Honda Accord in the backseat where the baby was, I was actually measuring 4 mill gauss, which is a pretty high magnetic field. The Tesla’s actually less than that. So videos and content to come.

Dr. Justin Marchegiani: Unreal. Very cool, man. Well, everything is going here in this front. I’m excited chat with you about today’s topic. Uh—let’s dive in. So, we talked about blood tests in the past.

Evan Brand: Yeah.

Dr. Justin Marchegiani: We talked about the comprehensive—I’m sorry, the uh— complete blood count, the CBC, alright, which is some really cool marker. We chatted about some of the anemia and the B vitamin markers and such. Really cool stuff. Today we want to chat about the comprehensive metabolic profile, the CMP, for short. So really excited to chat about that. Now, let’s go over what the CMP is. So, off the bat, I’ll just kinda give you the list here and we’ll hit the most important ones. Number one: glucose, calcium, we have protein markers, albumin, and total protein. We have electrolytes, including sodium, potassium CO2, and chloride. We have some kidney markers/protein markers including BUN and creatinine. And we have some liver markers including a ALP or alkaline phosphatase, ALT which is alanine aminotransferase or SG PTZ 01. And we have AST or aspartame aminotransferase AST or SGOT, for short. We have bilirubin as well. So let’s start off first with some of the simple ones. So, we have glucose. That’s a really good set kinda general marker. That marker’s gonna be used to look at diabetes, right? 126 or higher is gonna be your diabetes marker. And again, 110 or higher for pre-diabetes and typically, our functional range is gonna be greater than the hundred in the morning is gonna be uh— good a general indicator. Again, glucose fasting is kind of a late stage indicator. It’s not something we want to use as our way to pick up blood sugar abnormalities, in general. I like looking at a functional glucose tolerance. Kind of you can look at fasting in the morning sometimes that can be higher from a cortisol or stress response, otherwise known as the Dawn phenomenon or the somogyi effect. Typically, I like to look at fasting glucose during the day from a functional perspective. So we do a functional glucose tolerance. We tested fasting, let’s say, breakfast, lunch, or dinner and then we look at a 1, 2, 3 hour post meal and just see how that blood sugar is responding. We like below 140 within an hour. Below 120 in two hours and below a hundred in 3. That’s a good general rule of thumb. Ideally, below 120 in one hour and then back around 110 to 100 within two hours and definitely, below 103. That’s—that’s kinda my range. The goal is less blood sugar means less insulin spiking, which is a good thing.

Evan Brand: Yeah, which means less fat storage, too. So when we’re talking about people with uh— a fat loss goal. You’ve gotta have relatively low insulin to be able to do that. If you’ve got high insulin all the time coz you’re eating refined carbs and sugars, blood sugar goes up, insulin goes up, you can’t burn fat. So that’s a really good foundational mark to hit on.

Dr. Justin Marchegiani: Absolutely. I think we need to get a Topo Chico as a—as a sponsor for the show. I love the Topo Chico. It’s like uh—kinda like the sparkling Pellegrino we use here in Texas kinda like a Mexican sparkling water. Uh— absolutely love it.

Evan Brand: Why don’t you email them?

Dr. Justin Marchegiani:  I will. I’ll email them. I’ll make them our show sponsor. I mean, this stuff is awesome, man. It’s like, you know, I used to be a soda addict when I was younger. And I kinda have those, you know, nostalgic memories of drinking out of the glass coke bottle, so it kinda brings it back here.

Evan Brand: [laughs] We need to email them. Just tell them. I mean it doesn’t hurt to ask. So put that on your to do list for today.

Dr. Justin Marchegiani: We’ll get Lululemon as a show sponsor and then we’ll get Topo Chico as the show sponsor.

Evan Brand: That sounds great.

Dr. Justin Marchegiani: Hey, you know, while you’re at it, we might as well reach out to Elon Musk and see if we can get Tesla on board, man. That’d be nice for some complimentary free cars.

Evan Brand: That would be great. I don’t know if that will happen with the—the demand right now.

Dr. Justin Marchegiani: I know. I don’t think that will happen. We’re not the Joe Rogan podcast yet. Alright, so any comments on the blood sugar piece we just uh— brought up?

Evan Brand: Yeah. The blood sugar—you’re always gonna get that run. So this podcast people may say why are you doing this on blood? Your— you guys focus on functional medicine. Well because a lot of people anybody— anybody down the street, your neighbor, your friend, or family likely has some of the metabolic panel stuff that we’re outlining today, plus the CBC from our other blood test podcast, and so, this is designed where if you don’t have functional labs, how can we help you to identify these basic labs at everyone under the sun has access to, regardless of what country you’re in. So yeah, glucose, I think you—I think you killed it with that one in terms of the range. Let’s move on what—what else is on your plate here?

Dr. Justin Marchegiani: Well, we can chat about calcium, too. So calcium is a pretty good marker just for overall blood calcium. Again, blood calcium has to drop down pretty low for them to be a nutritional deficiency.

Evan Brand: Yeah.

Dr. Justin Marchegiani:  And calcium, one of the things I look at when I see calcium go too low, is potential hypochlohydria. Well number one, are we consuming enough leafy greens, right? That’s gonna be a major source of calcium, uh— salmon with the bones major source of calcium. Of course, some dairy products are gonna be great but it just depends, right? Well just use grass-fed butter and ghee over any of the milk and cheese stuff. And if you’re gonna do milk and cheese, you want to make sure that we can—we’re not reacting to. We’re not autoimmune and we’re also, you know, trying to choose raw, organic sources to prevent hormones, the antibodies and also have the enzymes intact to be able to process it. But when I see calcium go too high or too low, I think, potentially nutrient deficiency is number one, right? Not getting the right foods. And I also think low stomach acid and enzymes, number two. And if see calcium go high, a lot of times calcium can be utilized as an inflammatory mediator. So I also look at inflammatory markers when I see high calcium on a flipside.

Evan Brand: Yup. Interesting. Yes. So uh—hypochlorydia, these are the people been popping tums because they’ve got heartburn but in reality they could have something like H. pylori infection or they’ve been on prescription acid blockers which are very, very, very, very common. So if you’re looking at your calcium even if it’s out, sometimes it may be out of the general reference range, let alone our functional range then that’s an issue. Do you have a functional range for us since a lot of people are in the US we may be able to give the measure of units for calcium. Do you have that in front of you?

Dr. Justin Marchegiani: Typically, the calcium range, if I remember correctly will be in the mid 9’s. I think it’s like low 8’s to upper 10. Low 8, upper 8 to low 10’s. So I like in the mid 9’s, it’s a pretty good place. Typically, in the middle of the range, tend to be okay.

Evan Brand: Okay.

Dr. Justin Marchegiani: Any comments on the calcium component?

Evan Brand: No. I think you’re doing good. I’m just kinda uh—walk your hand through this. What’s— what’s next on our list?

Dr. Justin Marchegiani: Yes. So again, I like kinda the middle of the reference range. But next would be uh—protein markers, alright. So we have a couple of protein markers. We have albumin and total protein. And then we also have bun and creatinine, alright. Those are some pretty good markers that we utilize off the bat when it comes to proteins. So number one, I like creatinine above .79. It’s a pretty good place to go right above .79. So for below .79 or maybe some low-protein. And creatinine is a breakdown product of protein as well, alright. It’s a breakdown product, so above .79 if creatinine’s too high, it could potentially be some inflammation going on. It’s very possible there could be some inflammation happening. Uhm— there could be a high workout happening where you know we had a lot of exercise the day before and then we’re breaking down a lot of amino acids from the muscle, right? That’s one component. And then next is inflammation, too, right? There could be some breakdown from inflammation like your kinda—your body’s more in a catabolic state and you’re breaking down. But it can be a good window into protein levels uh—high or low. And then if we look at total protein, I like in the 7. 7 or above is a pretty good place for pro— total protein. If I see it lower, of course, I’m gonna make sure are we eating enough protein? Are we getting about, you know, half a gram per pound of bodyweight? That’s a pretty good rule of thumb, right? They say that 1.2 g per kilogram, right? What does that mean? People don’t think in kilograms in the US, so, I think about a half a gram of protein per pound of body weight. So if I weigh 200 pounds that’s 100 pounds approaching. If I weigh a 150 pounds,

Evan Brand: 100 pounds [laughs]

Dr. Justin Marchegiani: I’m sorry—If I weigh uh— 200 pounds, that’s a 100 grams of protein. If I weigh a 150 pounds, that’s 75 g of protein. And then a good rule of thumb—

Evan Brand: I like your diet, man. A 100 pounds—

Dr. Justin Marchegiani: Yeah. I know, man. That’s it. Exactly.

Evan Brand: Let’s do the BUN: creatinine ratio. So this is something that we see often where this is off. So optimal range, I’ve got a couple pieces of literature here optimal range of BUN: creatinine ratio is gonna be 10:16. A lot of times, we’ll see this altered, where the BUN: creatinine ratio is high. Whether above 16, a couple notes could be antibiotics, could be dehydration, and then in bad cases, some type of G.I. bleeding. So that’s not good. And then you’ve got low issues, where your BUN: creatinine ratio is below 10. This would be issues like we see pretty often. So this would be liver dysfunction, once again, antibiotics, also a diet that’s low in protein. So a lot of older people, I mean, you and I work with a lot of people above age 50, so 50, 60,70-year-olds, they eat less and less protein. It seems they just forget that it’s important they start eating snack foods or their appetite just goes down because they’ve got low stomach acid so they do start to get a distaste for meat. So you’ve really got to use enzymes and HCl with them, ox bile, get their gallbladder working better because if they don’t have a taste for protein, it’s gonna be tough for us to say, you know, “Hey Jack, Hey Jill, we’ve got to get you to eat more protein.” So if you are having a BUN level that is low, or the BUN: creatinine ratio, the BUN: creatinine ratio is low, you might have just a simple issue like not enough protein in the diet.

Dr. Justin Marchegiani: Oh, exactly. Yup. A hundred percent. Now, we talked about creatinine. Now, I’m just gonna crystallize BUN a little bit more. So we talked about creatinine going high, right? Uhm—the potential dehydration as well, potential kind of catabolic physiology rights. That can be a big one. It could be a lot of uhm— creatine supplementation, right? That can be one aspect of—of going high. I just gotta keep that in mind. And on the lower side, of course, will be the protein, right? The low-protein not getting enough of that in there, is really, really important. And then on the BUN side. BUN’s a Blood Urea Nitrogen. That’s another breakdown product. On the high side, we look at hypochlorydia, we can also look at adrenal and dysbiosis, right? And then on the low side, it can be malabsorption, low-protein and low enzymes and liver issues. So there’s a handful of different things that can be implicated either way. I love those as a good rule of thumb of what’s happening. And then we could also look at albumin and globulin. And if we see imbalances in the albumin and globulin, that can also mean issues with protein as well. So if we see like albumin to globulin, I think is on the higher side for globulin and the lower side for albumin, we’re also gonna think of potentially more protein issues.

Evan Brand: Yes. So let’s talk about the biomarkers here. You know, Justin and I are talking about functional ranges. You can make it your blood work if you have it in front of you. You may look at that. It may look okay and actually be in range. According to all the sick people that have been in that clinic. So we’re trying functional ranges. So even if something’s not flagged low or high, or using specific markers, Justin and I have taken some extra training in terms of functional blood chemistry analysis. So we’ve got a tighter reference range. So if you don’t see anything out of range on your paper, it might not be, but the functional range is much, much, much tighter and that’s where we find the issues.

Dr. Justin Marchegiani: Exactly. Typically, it’s gonna be the bottom fifth or the bottom and top 15 to 20% we look at more frequently, like with some of the protein things, some of the albumin high or low. If it’s on the high side, we may think dehydration; if it’s on the low side, we may think low stomach acid or enzymes. And some of these markers kinda contradict themselves, so you wanna kinda look at the complete picture so you can get a window of what’s happening. So I mentioned some of the albumin uhm—there. If you wanna comment on that at all, Evan?

Evan Brand: I was gonna move onto the AST. I had AST notes in front of me. Did you want to hit ALT and AST, the liver markers?

Dr. Justin Marchegiani: Uhm—yeah. Let’s hit that next. It’s one of the common— one more thing on the globulin—So globulin is also one of those things for oxidative stress. So we see globulin go on the high side, that can also mean oxidative stress. Oxidative stress are like, you know, free radical things, right? Oxidation is a loss of electrons. The more you’re losing electrons, the more you want extra antioxidants to help support you out, whether it’s antioxidant, herbs like curcumin, or resveratrol, or green tea, or things like vitamin C, vitamin A, vitamin E. Those kind of things are really helpful. So we have albumin and globulin; We have creatinine; We have total protein; We have uh—those are big protein markers there.

Evan Brand: Good.

Dr. Justin Marchegiani: Next, let’s hit the liver enzymes.

Evan Brand: Yeah. The AST to ALT. I wanted to hit on these because, you know, for my— whether it’s my grandparents, or some of the in-laws, always see markers off with AST and ALT even outside of the conventional range these are some of the markers and I’m gonna see off. So let me give people a bit of background on the— what they call the SGOT, also known as the AST. So this is an enzyme that’s very, very, very prevalent in skeletal muscle, liver, heart, kidneys and lungs. The enzyme can be liberated into the bloodstream following cell damage or destruction. So optimal range here is gonna be 10 to 30 units of A— of AST. If you’re out of the rain, so if you’re too high, this could just be liver dysfunction. So some of the reasons Justin and I may look at your AST and its high, it could be anything that’s affecting the liver. So this could be parasites, this could be bacterial overgrowth, this could be yeast, this could be chemical toxins, like glyphosate. If your diet is not very rich in organic foods, this could be gasoline additives, which is why I got rid of a gas-powered car because my gasoline additives were off the charts on my GPL toxic chemical profile test. Uhm— you’ve got a potential for developing congestive heart failure. So if AST is above 30, so AST—if it’s above 30, and then you’ve got these other symptoms like you have a hunger, your yawning frequently, you’ve got some edema, some of that swelling in the ankles at the end of the day, you’ve got a little bit of shortness of breath with moderate exertion, that may point a picture to some congestive heart failure. That’s possible. Now, the good thing is a lot of that stuff is reversible, but these are just signs that things could go bad. Uhm—and then on AST, you’ve got liver cell damage. That’s possible. So alcohol, that’s huge. We see that a lot with previous alcoholics. People who are trying to get off alcoholics. If it’s tied into the liver, you’re thinking, “If my AST’s high, what’s going on with my— with my liver? Is that the problem?” It could be. Symptoms would be pain between shoulder blades, you’ve got a headache sometimes over the eye, you’ve got those phase 2 liver detox problems, like you’re sensitive to perfumes, or you’re sensitive to fragrances, or you’re sensitive to car exhaust fumes, that’s a big one. Hemorrhoids, varicose veins—that’s also tied into the liver, and excessive muscle breakdown. So if you’re doing a bunch of CrossFit exercise and then you got your bloodwork done, it’s possible the AST could show up high there and that’s not a bad thing. Uhm—

Dr. Justin Marchegiani: Absolutely.

Evan Brand: We got the low side of AST which I won’t take too long to go over but B6 deficiencies, alcoholism. So B6 as we know, Justin and I have talked about it a million times, alcohol burns through some of your vitamin and mineral reserves, so B6 is one of them. And then once again, protein deficiency or malabsorption. So AST, either way, if it’s high or low, your out of that 10 to 30 functional range, we can find a lot of good information out about you.

Dr. Justin Marchegiani:  Absolutely. So let’s go see what once—what we have reviewed so far. so we hit the uhm—the liver enzymes. And again, liver ALT, the alanine, the “L”part, that tends to be more liver, where the AS can be—tend to be more in the heart side, tend to be more on the heart and the skeletal muscle side. So kinda keep that in the back of your head there. We’re looking at these things. So a heart attack, we may see more of the AST elevated and uhm— liver stress more of the uh—  more the AST for the heart and skeletal muscle, more liver for the ALT. But again, things like gluten can easily raise ALT. I’ve seen that. Also, just excessive exercise before, within 48 hours of the blood test could easily raise them of some of those enzymes as well. So kinda keep that in the back your mind.

Evan Brand: Okay. Yeah. I mean, same thing, I want—it sounds like I’d be repeating myself before going over ALT, but functional range for ALT, 10 to 30.

Dr. Justin Marchegiani: Yup.

Evan Brand: Once again is the units. And if people had been doing a lot of uhm— aspirin that could also cause the ALT to go up. So if you’re just somebody who popped—uh chronically pops aspirin, your ALT may go up there. Once again,

alcohols gonna throw off your— your ALT. So pretty common sense really.

Dr. Justin Marchegiani: Yeah. Exactly. And we may also see—if we look at bilirubin, which is a breakdown of a lot of the red blood cells, and if we have excessive breakdown, we may look at potential gallbladder issues or liver, gallbladder stuff going on. So we like, you know, typically, you know, below 1.2 or so, is pretty good for the bilirubin in the gallbladder. If not, we may think there’s some kind of gallbladder issue. We may look at food allergen. We mat really up the bile salts and HCl’s and and lipolitic enzymes— enzymes that really help the fat digestion.

Evan Brand: Yep. Yep. We’ve got— we’ve got a little bit of time left. Should we answer some of these questions here?

Dr. Justin Marchegiani: Yeah. I think so. And the only thing would say is uhm—some of the sodium and potassium and chloride, if we see some of the sodium low, we may think adrenal dysfunctions. If we see some of the potassium excessively high, right, we might think that’s an adrenal pattern of low sodium, high potassium. If we see lower potassium in general, we may think you’re not getting enough potassium, right? We need 4700 mg of potassium a day, so we have to make sure that is kinda dialed in. Same thing with the chloride, I mean, the real easy thing is with the minerals, is number one, we’re getting sea salt in our water, right? High-quality sea salt in our water, half a teaspoon twice a day, we’re eating lots of green vegetables, either cooked, or juiced, or made in away so you can process and digest it down. And then fix the adrenals. These are all things that are gonna commonly be thrown off by adrenal and mineral imbalances. And sugar and insulin can also throw that off, too. Well, adrenal dysfunction.

Evan Brand: Well said. Uh—we got question from—I believe it’s Nalema. Do you have to worry about potassium intake if your bloodwork does not show a deficiency? If you’re eating a pretty good paleo template, I mean, for example you and I have chatted about our love for avocados, you’re gonna get much more potassium in avocados and bananas. So I think if you’re eating an avocado a day or every couple of days, potassium is probably not an issue. What’s your take?

Dr. Justin Marchegiani: Yeah. We’re gonna get one avocado, you get about 1 g a day. You need 4700 mg or 4.7 g. So I would say, if you’re doing six servings of green vegetables a day and you’re doing one avocado, you’re probably  gonna be okay. But I will just throw it into chronometer. Put your height and weight and just ensure that you are getting that 4700 mg, which again is really easy to not get. I think that’s the DRI. That’s the Daily Recommended Intake, not the RDA which is the Recommended Daily Allowance. So 4700 mg, probably good with two servings, probably six servings of veggies and an avocado a day, you’ll probably be okay, but just run it through chronometer to double check.

Evan Brand: Okay. Cool Samuel—uhm a bit off topic. We’ll do a whole show on this. “How do you feel about making your home a smart home?” “Does it create negative effects from EMF like adding nest products and Phillips hue lights?” Not a fan of uh— LED lighting. I’ve chatted with Mercola about that on my podcast and yes, the nest and all the wireless technology, I do avoid that. I’m hardwired everything. No Wi-Fi, hardwired Ethernet. And uh—funny enough I’d been wanting to turn off the breaker to our bedroom so we could sleep better. And all the sudden the power to the bedroom has been off, but all the breakers look fine. So I don’t know if someone from the universe magically cut off the power to our bedroom, but even though the breakers look normal, there is no power in the bedroom and I’ve been surprisingly sleeping way deeper. Uhm— but we could do a whole show on that, but ideally you stay away from the wireless stuff or you just turn down the intensity of your— your products if you can.

Dr. Justin Marchegiani:  Yeah. I’m on the opposite side of that. You have the nest. I do have the nest. I do love it. I think it’s absolutely awesome. Uhm— and again, for me, I have my Wi-Fi on a wireless timer so once 11-11:30 hits, all my Wi-Fi goes off for the night. And that includes nest and everything. So I set it up so during those hours of sleeping, they are not on, number one. And number two, I have— I used a very, very high-end EMF meter and I’ve tested the nest and such and really, the EMF comes out in those first 10 feet or so, away from it.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So I’ve been across the room or sitting in my couch and I aim it at that or it get caught and it’s few—and it take—you got to be pretty close to get that EMF out.

Evan Brand: Yeah.

Dr. Justin Marchegiani: You really do.

Evan Brand: Yeah. Distance. I think your distance should probably much safer. I started doing the Wi-Fi on a timer, then I thought, “What the hell, if I’m sleeping better without it, what am I sacrificing during the day being at home with it. So that’s why I’ve just went hardwired. Maybe I’ll go back, but for now, I’m hardwired and I feel pretty good.

Dr. Justin Marchegiani:  Yeah. I mean—its just, like for me, like I’m at the airport, I’m coming in and it’s like my house is like a hundred degrees. I’m like, “Oh, let’s get it cool, or like, you know, we go away and if like uhm—we’re out of the house, right? It’ll take the temperature up a little bit.

Evan Brand: Right.

Dr. Justin Marchegiani:  You save a little bit of money on—on that side of the fence. So there’s pros and cons. I think uhm—if you can like—I’m hardwired right now. But I think if you can put your thing on a Christmas tree timer at night, I think you really, you know, you can at least have it off when you’re sleeping, which I think is really important. I also sleep on a ground and I have EMF blockers in my room as well.

Evan Brand: Yep. For sure. Let’s keep going. Uh—let’s see what else we’ve got here.“What are some blood test markers for thyroid issues?” I believe we did a whole podcast on this.

Dr. Justin Marchegiani:  Yeah. I would see the whole podcast on that. TSH, T4, T3. Real quick, TSH, you know, below 2.5; 1’s ideal; T4 free: 1 to 1.5; T4 total: 6 to 10; T3 total: 100 to like 150-160. Again, go see the podcast on that. We’ve riffed on it for over an hour at a time, so check that out.

Evan Brand: Yeah. Another question is “Redmond’s real salt worth it if you’re having pink Himalayan salt?” I think so. I switch out. I have a lot of salt Celtic sea salt, I’ve got all sorts of different types and flavors and sources. I think they’re all helpful and they’re not gonna hurt you. It’s in that category of my help— not hurt you.

Dr. Justin Marchegiani: Yeah. And I think, Redmond’s in my opinion just taste better. It dissolves really well in the water. So you throw it in there, dissolves really nice. I mean I’ve used Himalayan and Celtic— doesn’t quite dissolve as good. Maybe there’s a more, uhm—you know, a version that’s ground-up better so it absorb as more soluble in water. But I like the Redmond’s. I love the taste. Love it.

Evan Brand: Yeah. It does taste good.

Dr. Justin Marchegiani: Yeah. It’s very good. And it’s lower in —

Evan Brand:—We do the same. Turn off the Wi-Fi after 10 so that’s cool like I said, I used to, but then I’m like, “Yeah, I’m gonna just get rid of Wi Fi completely especially after I was in a Dr. Klinghardt talk about “How you can detox heavy metals if you’re exposed to Wi-Fi” which is pretty interesting on his latest talk. I was like, “Whoa! That’s pretty nuts, so—“

Dr. Justin Marchegiani:  Yeah. I mean, I think what happens is you get some people who are the exception to the rule.

Evan Brand: Yeah.

Dr. Justin Marchegiani:  Regarding their high level of sensitivity and then you get a lot of practitioners that had had success with that one person.

Evan Brand: Right.

Dr. Justin Marchegiani:  And they they start— this is the rule for everyone. I think that’s really excessive, but if you are chronically ill, should you try it? Heck, yeah. You should try it.

Evan Brand: Yeah.

Dr. Justin Marchegiani:  But it may not be the end-all or be-all. I mean, I love the convenience of having Wi-Fi. I don’t know this as much, Evan, but I do know that, you know, I’m sleeping at night. Maybe I’ll get into a little bit deeper REM sleep. So I’m not using it at night. I get no benefit by keeping it on at night. So why not just turn it off, right?

Evan Brand: Right. For sure. Uh—we got a question from Vevec. He said uh—“How to differentiate between type I and type II diabetes? Any diagnostic test?”

Dr. Justin Marchegiani:  Yeah. I mean, type I is gonna be an autoimmune condition. So what’s gonna happen is uhm—typically it’s gonna happen in the first 12 to 13 years of life. That’s when it mostly happens for kiddos. And their reality tend to be behind it, but one of the big things that you’re gonna see, is you’re gonna see just blood sugar just going up super, super high, right? The reason why it’s going up super, super high is because the insulin isn’t there by the beta cell so it cant’ let the—the sugar get into the cell. So you see blood sugar come up super, super high. These people tend not to be big and be more small. You know, more uh—I should say smaller because they don’t have the insulin bringing the sugar into their cell to get the fat up.

Evan Brand: Yup.

Dr. Justin Marchegiani: But you can also run what’s called the C-peptide test, which will look at the uhm— the beta cell function of the pancreas. And if you see C-peptide on the lower side, uhm— then you’ll know. And you can also run uhm—type I diabetes. I think the beta cell antibodies. You can run to also confirm that too, or pancreatic isolate cell antibodies to confirm that. So there are different things you can do to assess. But you’re gonna know because you just— you’re getting emaciated uhm—and your blood sugar’s off the charts high, for sure.

Evan Brand: Yup. Uh—last question we can take care. Shayna, “What is over a 115 vitamin D level? I mean I don’t take a vitamin D supplement.” First, we gotta make sure that’s actually the vitamin D not the 1,25. That’s a kidney marker but the 25OHhydroxy vitamin D marker. You gotta make sure it’s that one. If it’s that one and you don’t supplement, I’m not too sure. I’ll see if I can find something. Justin, what’s your take?

Dr. Justin Marchegiani:  Yes. Same thing. I would just—I would look at what your—what the marker is. And then number two, maybe you’re getting out in the sun a lot or maybe your—one of your supplement has some vitamin D in there, you’re not aware of it coz that’s pretty high to get to naturally. So  maybe you’re sunbathing a lot, maybe that’s totally natural. I would just double check that and make sure that’s the case. But double check if it’s 25 versus the 125. That’s the big thing I’d say.

Evan Brand: Yeah. I mean my wife’s prenatal, for example, there’s a lot of vitamin D in there. Those other formulas that we’ve taken that have vitamin D, so you could really add up to six or eight or 10,000 IU pretty pretty quick. So, yeah, I second that. Look at your protocol. Make sure there’s nothing in there.

Dr. Justin Marchegiani:  Absolutely. Let me just knock up just one more question here. So regarding alkaline phosphatase—Yeah, less than 50 is low zinc. Again alkaline phosphatase is an enzyme that correlates with zinc. So it’s— it’s a metalloenzyme so when the enzyme’s lower, we tend to have lower zinc. You can also test it Zinc Tally test get some zinc—I think it’s zinc chloride or zinc sulfate.

Evan Brand: Yup.

Dr. Justin Marchegiani: It’s the liquid zinc. And then basically the better it tastes, the cleaner and the more like water it tastes, the less you need it. I’m sorry—the more you need it—the more you need it. The more metallically it tastes, and you know, the more metal it tastes, the less you need it. So that’s a good kinda rule over time to kinda look at. And then A1C—again is a marker for blood sugar. If A1Cis really low, right? We want to look at other markers to correlate anemia. So if we see MCV, MCH, MCHC on the higher side, that could be in some kind of B vitamin anemia or if we see RBC hematocrit hemoglobin below, that could be another indicator for an anemia.

Evan Brand: Oh, we got one more question and then we’ll have to wrap it up. It just gets addicting answering questions.

Dr. Justin Marchegiani: Yeah.

Evan Brand: Abner—he has buddies telling him it’s ideal to spike insulin before weight training. Is there any benefits to it? I mean, I’ve always thought the exact opposite that you want to have a little bit of a spike after—

Dr. Justin Marchegiani: Post work out training.

Evan Brand: –weight training.

Dr. Justin Marchegiani:  Post work out. The reason why is people are incredibly anabolic. Most people that have high levels of insulin, it’s anabolic in the terms of uh—generating fat cells, right? Coz anabolic means to grow in fat cells. But if you can use insulin post work out, you can basically have the key to drive protein into the cell. You’re also driving which is gonna help with, you know, protein synthesis, ideally building more muscle. It’s gonna help spike mTOR and then you’re also gonna have effects of driving sugar into the muscle, which it’s just wrung out all that glycogen during the workout. So you’re repleting the glycogen which will have some anabolic effects and it will uhm—it will help lower cortisol, too. It will drive down some of the cortisol because the cortisol has made all the blood sugar so it’s gonna pull all that sugar from the cortisol into the muscle so it can be used to help generate hypertrophy.

Evan Brand: Yup. I just did a little bit of research on vitamin D. If it’s super high, it could be a buildup of calcium in the blood. So other symptoms that could go along with this could be poor appetite, nausea, vomiting, weakness, frequent urination, kidney problem. So maybe look at your other markers on your blood test. See if you got anything off with your calcium, you got anything off with some of the kidney markers and then if you’ve got those other symptoms— frequent urination, things like that, definitely take a look.

Dr. Justin Marchegiani:  Yeah. It’s almost always from a supplement so just stop—stop taking the supplement if __ vitamin your body will eventually clear it out in a few days to a few weeks.

Evan Brand: Yup. It should be pretty quick. Well, cool. Any last things you wanted to say before we wrap it up. I think we did a great job on this one.

Dr. Justin Marchegiani: Yeah. This is probably my first—my last podcast uh— without a kiddo. So I’ll be officially a dad uh— next time that we are on the air. So pretty excited about that.

Evan Brand: Me too. I’m pumped for you.

Dr. Justin Marchegiani: Can you give me like one fatherly tip or advice here before we go.

Evan Brand: My fatherly advice is just you—you take it day by day and when something happens where you could see yourself stressing out, just remember you have the ability to control how you respond to something. So I like— when the baby is super fussy, and you’re trying to figure out is he tired, is he uh— hungry what is it? I just like take an extra second it’s like, “Okay, let’s run through the day. Okay, the last feeding was this. Okay, maybe it’s too warm in here. Maybe a little too cold.” Before I let my sympathetic nervous system kick in to overdrive, I try to walk through the situation step-by-step and then, “okay” and then that way, I don’t make myself sick by the extra stress.

Dr. Justin Marchegiani:  Right. So instead of getting mad at the situation, you kinda like take a step back like kinda problem solve or think what could be the issue before you have an emotional response.

Evan Brand: Exactly, dude. Try—try to not have the emotional response.

Dr. Justin Marchegiani:  Right. Try to be more—more logical than emotional about it.

Evan Brand: Which can be hard when you’re tired, and your sleep is interrupted and stuff like that, but you just get better and better every day at it.

Dr. Justin Marchegiani:  Appreciate it, man. Excellent.

Evan Brand: Yup.

Dr. Justin Marchegiani: Hey, today was a great chat. Let’s do more, probably in the next two weeks here, but maybe I’ll jump on here while my little paternity leave here for the week.

Evan Brand: No rush, man. You deserve it. You earned it. Take that paternity leave. Will be here waiting for you when you get back and uh—if people want to schedule, in the meantime with Justin, may be a little bit till he gets back. Til his back in the trench but uh—justinhealth.com He will be ready and willing and for me, evanbrand.com you can schedule with either of us. In the meantime, make sure you subscribe if you’re watching on YouTube and we’ll chat with you again soon.

Dr. Justin Marchegiani: It will be a lot of sleep in down time so maybe I can sink one up in there, so we can have a chat in between.

Evan Brand: Sounds good.

Dr. Justin Marchegiani:  Alright, Evan. Great chat. You have a great day.

Evan Brand: Take care.

Dr. Justin Marchegiani:  Take care. Bye.




Redmond Real Salt


Topo Chico




Analyzing Your Blood Test – CBC Blood Test Evaluation – Podcast #142

Complete Blood Count (CBC) Markers

Dr. Justin Marchegiani and Evan Brand talk about blood testing. Listen to them as they discuss about the assessment of significant imbalances in B vitamins or Iron in one’s blood. Know the importance of Vitamin B12 to having healthy red blood cells and determine why it is needed by people on a plant-based diet.

Learn about the tests and white blood cell markers which are significant in determining infections. Discover more about an H.pylori infection and understand how it can be addressed by using a functional medicine approach.


In this episode, we will cover:

02:36   Big Components of CBC

09:00   B12 and the Intrinsic Factor Binding It

11:31   Infection Components of CBC

17:22   White Blood Cell Markers

26:55   Stool Test and CBC Testing







Dr. Justin Marchegiani: And we are live on YouTube and Facebook. Evan, how are you doing, man? Happy Father’s Day Weekend!

Evan Brand: Yes, sir. Same to you.

Dr. Justin Marchegiani: I know. Steaming off; the countdown’s ten weeks and uh– and counting. [croostalk] Your excited?

Evan Brand: That’s it? Ten weeks?

Dr. Justin Marchegiani: That’s it.

Evan Brand: Holy smokes. It goes quick, don’t it?

Dr. Justin Marchegiani: I know. I’m trying to think about all the things I want to cram in before I’m uh – adapt. But I’m just hitting, kind of keeping a pretty simple low key life, so, nothing that’s on my to-do-list that hasn’t already been checked off.

Evan Brand: Great, man.

Dr. Justin Marchegiani: Awesome, and how’s your weekend though. Ain’t it fun?

Evan Brand: What did we do? Honestly, my days flow together so much. I mean, my work– my work and my life, in a great– so much, that I honestly can’t discern the difference between weekends, typically. But I know I went for a hike, and– Oh, actually, so yesterday, I took my brother out for a mountain biking adventure.

Dr. Justin Marchegiani: Yeah.

Evan Brand: I thought I – you know, I thought I – oh, man I’m really not that in shape but then I got my little brother out there, who– he’s not in shape, at all. And I wasn’t out of breath and he was dying. I felt kind of bad. I thought he was gonna pass out at one point. So, we were like two (2) miles into the woods and you know, he’s hyperventilating. I’m like, “Okay, buddy.” Luckily, I brought some uh– professional grade electrolytes along, and so I gave him some of those and he was able to rebound and feel good enough to get back out to the car. So, that was yesterday. That was a blast.

Dr. Justin Marchegiani: Yeah, I mean, it’s amazing. The more, uhm – the more you have inflammation under control in your body, just your resiliency for everything, because the more inflamed you are, the more your body is kind of allocating all of its resources to putting out that fire, right? You don’t have carpenters go into a house while it’s on fire. The firefighters go into the house first. Same kind of thing with your body in– when it comes to performance. Getting the inflammation down helps on everything.

Evan Brand: I was just in better shape than I thought I was. I mean it was a pretty intense trail, and assuming that the adaptogens were probably still in my blood at the time when she was helping with performance, too.

Dr. Justin Marchegiani: Absolutely, we also got a new audio setup today so you can see we’re microphone free. Got a little tip from my friend Abel James on how to set some things up, and I think it may be working out pretty good. And hopefully, people on Facebook Live can hear you as well. So, hopefully. If not, coach up in the YouTube link, as well, to that Facebook live post so they can access it.

Evan Brand: Yeah. Thank you, Abel.

Dr. Justin Marchegiani: Yeah, very cool. And we’ll take questions here on YouTube chat as we go. But, today, we want to talk about Blood Testing. Starting out, looking at your CBC and your CMP. CBC is your Complete Blood Count, and your CMP is your Comprehensive Metabolic Profile. So, your CBC is gonna look of things, such as your Red Blood Cells sizes, like uhm– red blood cells, Hemoglobin, Hematocrit. It will look at thing– and then you also have something called NDC, which is like, MCV, MCA, MCHC. That’s just how big the red blood cell and the Hemoglobin is, right. MCH is Mean Corpuscular uh– Hemoglobin Mean Corpuscular Hemoglobin Concentration, and uhm– MCV is like uh – the width of the blood cells. So, it’s looking at, basically, how big the blood cells are and how many of them there are, and then, it’s looking at also the Hemoglobin content and Hematocrit content. And this is helpful because if you’re Iron or B12 goes low, you’re gonna see your Red Blood Cells, your Hemoglobin and your Hematocrit actually dropped, and actually same thing with your B12; you’ll start to see those drop. You’ll start to RBC, Hematocrit and Hemoglobin start to drop, so that can give you some indications if there’s a potential Iron or B12, and B12 in a Folate and B6 tend to come together. So, it can give you a pretty good indication of what’s going on under the surface. And again, we’re looking at these things from a functional perspective, so the ranges that we look at them at are gonna be a lot more sensitive than, let’s say, a pathological range for let’s say, Iron-based Anemia, right. Your Red Blood Cell marker may have to be below 3.8 for your MD to say anything, we may say below 4.1 on the RBC. Yeah. Same thing with the Hemoglobin, maybe under 11– 11 or so. They may look at it. We may say, “Ooh! Upper 11’s low 12’s for Hemoglobin.” Hematocrit, same thing, like 36, 38-ish, we may start to look at it. They may say 35 or below. So, we kind of have a little more of a narrower range, so for heading in that direction of being more Anemic. So, we know if there’s a B12 or Iron issue from just those markers. And then, we can dig in to look a little bit deeper by looking at the NDC’s, the MCH, MCHC, MCV– These markers get higher, bigger, or larger numbers if it’s a B12 or B Vitamin issue. And they may just stay low if it’s an Iron issue. But again, it may not have to go low but, typically, we differentiate the Iron in the B12, because the MCH, MCV, MCHC will start to go up when their B Vitamins start to get lower. And why is that? It’s because the maturation of Red Blood Cells. They start off really big and they actually get smaller as they get mature. Where, humans, right; we start off smaller and we get bigger, so, the exact opposite of human beings. So, if we don’t have enough B Vitamins, they get stuck in this bigger phase, and they can’t get nice and small like they should. Where, if there’s too much Iron, they actually get too small, right? If you look up– you know, that we’re Anemic, right? It’s kind of mean smaller, weaker, right? So, if we don’t have enough Iron, we can actually get too small if we don’t have enough B Vitamins. We can actually stay too big. So, that kind of just differentiates that. That’s kind of one of the big when I call deal-breakers. What we look at someone’s blood is being able to assess significant imbalances, either in B Vitamins, B12, Folate B6, and then the Iron.

Evan Brand: So, let’s get a bit of context about reference ranges, when you go to your conventional Doc, you’ve got Lab Corp or Quest, or some other Lab running your blood, and the doctor or the nurse calls you and says, “Doctor Justin, everything’s fine. You checked out okay. Go home.” Uh– really– you want to make sure you get a copy of all of your blood tests for many practitioner, because someone’s analysis, may not be the correct analysis. And like we’ll discuss a little bit today, we’re not gonna go too much into the numbers but we will give some about functional numbers. Anyone who’s almost dead, and anyone who’s alive, their getting factored in to the average. So, when you see that the reference range issue’s so huge if you’re anywhere within dead and alive, you’re okay. And for us, that’s just not the case because, if you’re listening to us, we want you to be the top one percent of health, top one percent human performance on the planet, and so the reference range is gonna be much tighter. So, I hear this time and time again, and Justin does too. Every single week, we hear our clients tell us, “Hey, my nurse said my thyroid was fine. Go home.” And then we looked at the thyroid and their TSH is just absolutely in the tank. You know we’re in, like, the single decimal point, through in like a point two (0.2) or point three (0.3), or the TSH is so high – they’re like a six or a seven, and they get told that they’re fine. So, don’t take fine as a correct analysis of your blood work. Get the piece of paper, and you can work with someone like us, and we can help to identify, “Are you actually in the functional range or are there adjustments that need to be made?”

Dr. Justin Marchegiani: Absolutely, and just the people that are seeing on Facebook, give me a thumbs-up or a comment. Let me know if you guys can hear me, or hear Evan’s side of the combo here. We got a new speaker setup, so we’d appreciate that feedback. So, I think we hit some good things, and again, typically, how laboratories are assessed is you got two standard deviations to the left and to the right, right? This is kind of what makes up our Bell Curve. And– so, you have your middle and then you have two – two standard deviations to the left and two to the right. And that those two standard deviations made what’s called the Bell Curve, and 95 percent of the population fits in that Bell Curve. Two and a half on the pathological low; two and a half on the pathological high, so what happens is, there’s always two standard deviations no matter what. So, what Evan said is true. So, as the population gets sicker, those standard deviations get wider and wider and wider. So, that range gets wider and wider and wider. So that’s – it’s really important, because optimal never changes. If here’s optimal, just because you get more sick, people stuck in that reference range, it’s gonna be polluted. Optimal will look more like it’s – it’ll look narrower and narrower as the range gets wider and wider. So keep that in mind. So, we hit the B Vitamins off. We hit some of the Iron stuff. That’s important. Iron’s gonna be more important with female’s that are menstruating, because hormone imbalances like Estrogen Dominance and low Progesterone and Cortisol issues can throw off their menstruation in their cycle. And that can cause excessive blood loss. So, if I see patients, you know, bleeding more than three days and greater than four tampons a day, we’re really going to the super supers[8:39], that can mean excessive blood loss. So, that’s one component. The next is Vegan Vegetarians. Again, really hard, you need to get – plant-based B12 sources aren’t gonna be the best. Even Vegans that are really healthy, they need to be supplementing B12.If you’re not, that can create a lot of problems. And then also, gut issues, right? If we have severe gut inflammation, if we have intrinsic factor antibodies in our stomach, if we have a lot of gastric inflammation in the stomach, it may be really hard to bind up that B12, ‘cause B12 is really interesting. We bind this compound to what called intrinsic factor, and then we– so here’s the B12 that comes into the body via the food, maybe some liver, some really good grass-fed. The intrinsic factor binds it. So, intrinsic factor is made by the Parietal cells using the same cells that produce Hydrochloric acid. So, if we have more gastric stress going on, it’s possible we may not– we’ll have less of these intrinsic factors. So when these factors hits the B12, it goes to the stomach, it goes into the small intestine, the Duodendum, the Jejunum, the Ileum. So, at the very end of the small intestine before it goes into the Cecum, the first part of the large intestine, that’s where it gets reabsorbed into the bloodstream. So, if we have any of those issues in the gut, that’s really gonna affect how we absorb B12. And if we have pathological low levels of B12, we can just have maybe immature, big, goofy Red Blood Cells, like we mentioned, or we can even go more pathological. We start to have nerve issues, Posterolateral sclerosis, Subacute Combined System disease. These are issues, where your Nervous Systems actually gets destroyed because you don’t have enough of that B12 in there to make enough healthy Red Blood Cells.

Evan Brand: Let’s go down that Avenue. Let’s talk about this that will impair stomach acid production. There’s a lot of things out there that people are doing. Things they’re putting into their body. Infections that are going on that could sacrifice this. And so, if we see Blood Tests that are gonna show low Iron, it could be just a Malabsorption issue, right? I mean, you– we see people all the time. They say their eating grass-fed meats but, they could still show up with low Iron because, they’re just not digesting it well or they had a prescription, uh – acid blocker that they’ve been using. Oh, by the way, just feedback for you. Stay close to the mic when you do your visuals, just because, when you go away, you sound so distant. And I know, probably 95 percent of our listeners are audio so, stay close.

Dr. Justin Marchegiani: Evan, I don’t ever want to be away from you man.

Evan Brand: [laughs]

Dr. Justin Marchegiani: No distance now. I’ll get extra close.

Evan Brand: Good.

Dr. Justin Marchegiani: Good feedback. So, we hit the uh– the B Vitamin stuff, right? So, also, platelets, too. Platelets, if they go low, that could be– also an Iron issue, too. Like the big components of CBC. Let’s shift gears if you’re ready to the infection components.

Evan Brand: Yeah, let’s do it. So, H. pylori is the first thing that comes to mind when you’re talking about Parietal cells. I mean, we see that – what would you say the average is? About one in three that you’re saying is infected in H. pylori? Maybe one in four?

Dr. Justin Marchegiani: Absolutely. I mean, here’s the deal. There are a lot of people out there that probably have H. pylori, and they’re symptom-free. So, h. pylori is a helical-shaped, kind of like a little screw kind of shape, uhm– bacterial creature that can burrow itself into the gastric lining. That’s the stomach lining. And it’s gonna be opportunistic. So, the more stressed you are, the more meal-compromised you are, the more your diet sucks, the more your lifestyle sucks, the more that thing will create problems. So most patients that are coming to see us, they’re either– most of them are coming ‘cause they have some kind of symptom that’s driving them in, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: You have some that come in because they want to be at their highest level, and they’re already good but they want to be better. So, if you have an infection, it’s– think it’s everyone’s goal to be infection-free. So, if there are infections there, we want to get rid of the infection. That’s like having a guest come in your house, leave the water on in the guest bathroom you never go in, and then you see the water bill’s like three times higher the next month. It’s the same thing. It’s just sucking resources, may not be financial resources, just maybe energy resources. Uh– mental, emotional resources, that are getting pulled out. Number two, they’re gonna affect, potentially, digestion. And, number three, it’s a ticking time bomb, ‘cause when you do get more stressed, and your immune system got weakened, that can really come in there and create problems.

Evan Brand: Yeah. So, what do you say to the practitioners who tell on their clients, “Hey, look. You’ve got H.pylori. You’re not symptomatic. Let’s just leave it alone – what’s not treated.” What do you say to that?

Dr. Justin Marchegiani: Well, I think we should always get rid of it, because it could potentially be a bottleneck on the digestive system. And then, number two, it will be sucking up some kind of resource on the body, so we wanna do our best to to knock it out. I think, the more resources you can have going towards performing to your optimal level, the brain function, to rebuilding muscle and healing tissue, and going to your healthy anabolic hormones. That’s better. We want to allocate our resources to things that are gonna help us grow versus frivolous things, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: So, it’s kind of like, investing, right? You want more money going to assets and things that really make your life uhm– you know, better: food, shelter – those kind of things, versus all the things that may not be as much of your priority.

Evan Brand: yeah. I think I told you this already but, I’ll say it again just to make sure it’s on the air. Is– I had a client who came to me a few weeks ago, uh– who went through   medical doctor. He did test, positive for H. pylori, and I said, “Did you get treated for it with the MD?” He said, “Yeah.” And I said, “Oh. Was it triple therapy?” And he goes, “No. They’re doing quadruple therapy now.” That’s for antibiotics instead of three because, H.pylori’s getting so resistant. We probably have to do a whole podcast on antibiotic resistant bugs and how big of an issue it is. But, long story short, the guy did four antibiotics at the same time, and tons of digestive complaints. Still showed up positive for H. pylori.

Dr. Justin Marchegiani: Wow.

Evan Brand: So, it didn’t work.

Dr. Justin Marchegiani: Right. It didn’t work, yeah. Triple therapy is typically Erythromycin, Amoxicillin, and, typically, Prilosec or Bismuth, uh– they used in there. I wonder what the fourth antibiotic they’re adding. Or the third, really ‘cause Prilosec isn’t antibiotic.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Erythromycin and Amoxicillin are– so that…

Evan Brand: I– I think, I’m pretty sure he said it was uh – it was Prilosec so, the acid-blocker and I think three antibiotics. I’m not sure what they were though, in terms of the strains or anything.

Dr. Justin Marchegiani: Yeah. I see so many patients that have uh– zero acid reflex or heartburn and they still put them on Prilosec. Which is just retarded because, it’s like if they’re not having issues with stomach acid and irritation on the gut, why are you putting them on a blocker that may decrease their stomach acid and more nutritional issues down the road. It’s so silly. I get it if they have a lot of the Acid Reflux but, if not, why are you adding another drug in there?

Evan Brand: Yes, there’s a couple markers I wanted to– I wanted to see if I could find them he, in our clinical handbooks on Blood Testing. There’s so many markers that show up as Hypochlorhydria. Do you know any writeup on the top of your head. I guess, you talked about Iron already, so if you have Iron issues, we know that, yeah, that could be yeah, excess of bleeding. But if you’re male, you could still show up low just due to Hypochlorhydria, right? Just low stomach acid?

Dr. Justin Marchegiani: Yeah, you can. Absolutely. That may not be pathological, right? Maybe more of a subtle kind of thing. And here’s the thing. When it comes to functional medicine, we’re moving so many needles, you don’t really know what needle per se is really making the difference ‘cause we may give you Hydrochloric acid, right, and some enzymes, but we may also try to get you to have more time chewing your food, and then drinking water away from food and eating in a more stress-free environment. So, you’re moving six or seven needles right there. I may say, go out get a little more sunlight and Vitamin D, right. So, there’s eight needles we just moved. So, in a double-blind Placebo-controlled trial, typically, they’re moving one needle at a time. Well, man, have you the slow boat to China if you’re moving one needle at a time as a functional medicine practitioner. It’d be so hard to figure out what is the absolute variable, and it will take forever to get patients to get better. That’s why I always say if you can glean from clinical research, do it. Like, you know, the research is the PODMED per se. But a lot of times, the clinical research that were doing, removing so many needles, it’s hard to know what one, but it’s okay because every needle we’re doing on the lifestyle side, we know is helpful. Like, it’s not ever gonna hurt anyone to be in a more relaxed environment to eat, or to drink water away from food, or to chew your food more, right? Those things are gonna help anyone for the most part. So, we combine all of those things with the other stuff and we may see improvements in the B12, or the Iron, or other Digestive things. So, sliding back to the H. pylori, we may look at it indirectly if we’re looking at a CBC, right? We may look at what’s called our white blood cell markers, right. And this is a general kind of indication of our Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Basophils, right? Nutri School we learned it: never let monkeys eat bananas, right? That’s kind of the general jest. And then Neutrophil’s have the highest content, about 60 percent of your White Blood Cells. And Neutrophils all the way down to the uhm– the Basophils, which is like one or two percent. So, kind of keep that in mind. Neutrophils can go up or down for bacteria, Lymphocytes for bacteria and viruses, Monocytes for gut inflammation, bacteria and, potentially, parasites. Eosinophils can go up for, uh– typically, parasites and allergies, and Basophils for Histamine and allergies too.

Evan Brand: Now, is your typical blood test gonna have this broken down like that though…

Dr. Justin Marchegiani: Yeah.

Evan Brand: …or you’re just gonna get a generic White Blood Cell Count?

Dr. Justin Marchegiani: Yeah, typically, you’re gonna have on your CBC your White Blood Cell Number, which will be all of those: Neutrophils, Lymphocytes, Eosinophils, Basophils, Monophils combined– Monocytes combined.

Evan Brand: Yeah.

Dr. Justin Marchegiani: That’s your White Blood Cell Number. And then you can get uh– a breakdown of all of them. [inaudible]

Evan Brand: So [inaudible] get [crosstalk] a percentage.

Dr. Justin Marchegiani: You get a percentage breakdown, as well as the absolutes. So, the absolutes, the how much Eosinophil’s are in there, and then you get the number as a percentage too.

Evan Brand: All right, so let’s say, I just got my blood work done. I didn’t get the breakdown though. I’ve just got White Blood Cell Count, can we get general inferences about whether White Blood Cell Count– let’s say, their currently up. You can say, possibly active infection, as compared to if White Blood Cells were down, could you have said that that’s a Chronic Infection…

Dr. Justin Marchegiani: Hundred percent.

Evan Brand: …but the body’s not been able to fight it any longer?

Dr. Justin Marchegiani: A hundred percent. So, when you look at White Blood Cells, high or low, but high’s gonna be an active infection. That’s non-specific though. And if White Blood Cells are low, that’s definitely gonna be more of a Chronic Immune depleted kind of situation. And then, from there, we can run the actual individual White Blood Cells. We can infer uh– what may be happening there. So the typical pattern is like Neutrophil’s high, Lymphocyte’s low – that’s a common H. pylori pattern. High Neutrophils, low Lymphocytes, typically, one should get into the mid-60’s– middle-o-60’s. That’s maybe a problem.

Evan Brand: Now, let me clarify here. Is this high Neutrophil’s got a functional range or even like your conventional Lab Corp would flag you, “Hey, look. Your Neutrophils are high.”

Dr. Justin Marchegiani: Yeah. You probably would not– I mean, the functional range is gonna be in the low 60’s. The lab pathological range, typically, is above 70’s, some goes high as 75.

Evan Brand: So, maybe. Maybe your conventional lab will pick it up but,  maybe you got to use a functional reference range instead?

Dr. Justin Marchegiani: Exactly, a hundred percent.

Evan Brand: Okay. So, basically what we’re kind of getting at is we can detect stuff like this H. pylori. We can guess parasites possible based on some of these other components of a White Blood Cell Count but, if any of these stuff is off, whether you’re a White Blood Cell Count, just as a whole, regardless of the breakdown, if the whole WBC is up or down, we could say that warrants further investigation with something like stool, or urine organic acid testing tech sheet, look and prove on a piece of paper, H. pylori’s there.

Dr. Justin Marchegiani: A hundred percent.

Evan Brand: Okay.

Dr. Justin Marchegiani: You got it?

Evan Brand: All right.

Dr. Justin Marchegiani: Absolutely.

Evan Brand: We got a couple questions. Let’s see Samuel asked about lots of Ketosis lately. He said, “Can you give us examples of a day of eating Ketosis?” It’s pretty much meat and fats. I mean, like, I’m probably on Ketosis right now. ‘Did some pastured sausage for breakfast, half of an Avocado, I would say I’m producing ketones right now. Samuel, same thing probably meat, meat and some veggies later for lunch, and meat and veggies for dinner. Like probably do a grass-fed steak tonight. Actually, you know what, I made Fajitas last night. I made some grass-fed beef Fajitas. So I’ll fry the– those again. That’s just bell peppers onions, and maybe a piece of dark chocolate. So, I’ll probably be Ketotic during that meal. Uh – Kendra loves blood tests analysis. Ocasious said, “how do you work” – how does she work with us? Uh – you can just Google Dr. Justin Marchegiani or go to his website Just in Health and then you can check out my website evanbrand.com. Samuel: How do you know if herbal treatment for H. pylori’s working? To eradicate it, are there any symptom during the two-month protocol? What would you say Justin? I mean, sometimes it’s not symptoms during the two-month protocol. It’s just the matter of the removal of bad symptoms. So, it’s like, stomach pain, like you told me. I said, “Man, I had this weird, sharp pain in my stomach.”

Dr. Justin Marchegiani: Right.

Evan Brand: You said, “All right, and you better look for H. pylori.” It might not be that symptoms, like more energy, but it might be the removal of things. Like instead of more energy, I phrased it as “the removal of fatigue,” or “the removal of gut pain,” or “the removal of diarrhea or constipation.” So, I’m kind of worried. It’s like the removal of the bad thing, like pulling off the layer as opposed to saying, “Here’s your positive symptom” if that makes sense.

Dr. Justin Marchegiani: Yeah, yeah. So you make your list of the conventional H.pylori symptoms, which will be, you know, gut irritation, acid reflux, gastritis, indigestion, constipation, diarrhea, like a lot of your big GI symptoms, right? But then, you kind of have your eight typical symptoms, which could be joint pain, mood issues, fatigue, depression, anxiety, uhm– brain fog, so, energy, right, so, a lot of those things, depression. A lot of those things are gonna be a typical meaning they’re not– they’re outside of the digestive sequela of symptom. So, we got to keep that in the back of your minds. So, typically, you’re either gonna see an improvement in some of those symptoms, right? So, if you have mood stuff, you may see improvements in the eight typical stuff, like fatigue, energy, joint pain, start to go down, you may have some typical gastric symptoms, like the bloating, the constipation, the diarrhea. So, you kind of make a list, and see what improves on the typical and see what improves on the eight typical. And again, most people are gonna see some level of improvement there but in general, the goal is to reduce, kind of pull those stressors out of our stress bucket. The more stressors out of that bucket, you may get better. Some people, if you could kill it too fast, they may feel worse during that killing phase. I can’t tell you how many patients I have, where we create, you know, a die-off reaction handout, if you have this issues, make sure you curtail the dose or adjust the tape right up. So many patients ignore that. They just go into the mindset,

“the faster, the better,” “the more I kill, the better,” so they feel like crap, and then, they don’t even do anything or follow the instructions to modify the dose. So, I always say if you’re really feeling like crap, that means you’re just stressing your immune system, your lymphatics, your detox. You’re killing things off too fast and your body’s having to deal with that dead debris. Slow it down. Add in some things to help with uhm– with the lymphatic flow. Change your tea. Maybe add in some binders, some bentonite clay, some charcoal, some citrus packed in. And then maybe, even add in some extra things for your detox phase 1 or phase 2 nutrients, to help push those pathways. But that’s a good start right there.

Evan Brand: I got a couple more questions here. Avie: are there any books you guys have read about functional medicine that you recommend? I don’t know if I would consider a functional medicine book. But Dr. Jonathan Wrights book, “Why Stomach Acid’s Good for You” I think is pertinent to today’s discussion. And it’s like nine bucks on Amazon. What about you?

Dr. Justin Marchegiani: Tsss. I got a book coming out, man, “The Thyroid Reset.” That’s gonna be a great book; all the practical things. I don’t give myself a plug but, it’s gonna be great because it’s gonna be all real practical things. So, look for that soon. And we’ll gonna get that out. I’m just – I’m too busy with patients, so I need to get someone on board to help uh– get it done, because I don’t want to take away from my helping patients.

Evan Brand: Totally, alright. Outside of your books– Your books gonna be a good one, I know. I’m excited. What about other recommendations?

Dr. Justin Marchegiani: Uh– from a functional medicine standpoint, I mean, I have– we have some books here that are more clinician-oriented, right here, on Blood Testing and such, that I use [crosstalk] for myself.

Evan Brand: Uh– Dr– Dr. Weatherby; he’s got – he’s got a good one. It’s titled, “Blood Chemistry and CBC Analysis.” That one’s a cool one. There’s a couple other once out there. What’s [crosstalk] it– what’s it…

Dr. Justin Marchegiani: I– I wouldn’t give – Izabella once had plugged the Hashimoto’s Protocol. It’s a really good book.

Evan Brand: Yeah. Izabella’s book was really good. What else did I read, so far, this year?

Dr. Justin Marchegiani: I got another book over here. Dr. Horowitz’ book, “Why Can’t I Get Better.”

Evan Brand: That’s a great book. He’s got a new one now, too, Horowitz. I can’t remember what it’s called. I think it’s… [inaudible]

Dr. Justin Marchegiani: Play off some word.

Evan Brand: Yeah, it’s like, “I Can Get Better.”

Dr. Justin Marchegiani: I Can Get – something like that. It’s like a play of that same theme. So yeah. Those are some really good things there too, for sure.

Evan Brand: You want to answer Kendra’s question? I’m gonna go back to the blood here.

Dr. Justin Marchegiani: Uhuhmn – so let me hit one thing. So, I talked about kind of the way blood cells stuff, and then, the breakdown of the blood cells. Now, there’s specific tests that you can do for us, specific H. pylori antibodies, right? IGA, IGG, IGN, and then also, you can do Breath Testing, and then also, Stool Antigen Testing so there’s more specific testing. But you can look at the CBC and you can infer and draw things from that, which is nice.

Evan Brand: Okay.

Dr. Justin Marchegiani: And then, what’s Kendra’s question?

Evan Brand: Yes, she says, “Do you consider elevated Eosinophils a good sign – a good enough indicator of infections or do you think Stool Test are always necessary?” I’ll give my two cents first. We run the Stool Test on every single new client, I mean, if we just depend it on blood test, I feel like our– us having all the puzzle pieces on the table would not be complete.

Dr. Justin Marchegiani: Exactly, and sometimes they can take a lot long time for those markers to drop. So, if you’re treating an infection, it may take like months like after the infections treated for those numbers to kind of slowly go down so, it’s nice to have more immediate infection markers that tell the story. But it’s good, because we– number one, it tells me, the clinician, that something’s wrong. And that we got to look deeper in that stool testing area. And then it gives me more ammo to get the patients to run the test that I think are best. So, that way, the patient’s more motivated because, they know, here’s the clinical direction that we’re going down. Here’s the clinical path that we’re going down. Here’s why we’re going down it.

Evan Brand: Yes. She had a follow-up question. She said, “Or rather should you not do a Stool Test if the CBC doesn’t indicate parasites?” No way, always do Stool Testing. I’d say, once or two times a year. Just a preventative, everybody should be doing Stool Testing because, here’s the deal. We can try to make the guesses and checks based on the CBC like all we think it could be this, we think it could be that, but let’s say, you’ve got, like, Klebsiella or Citrobac, or some type of bacterial overgrowth that can trigger autoimmunity. Well, let’s say you’ve also got H. pylori on top of that, or let’s say, you’ve got Candida, or let’s say, you’ve got Blasto with it. you know, the protocol’s gonna be different. If it’s just…

Dr. Justin Marchegiani: Yes.

Evan Brand: …yeast. We’re gonna do one thing, if it’s just bacteria, we gonna do one thing. If it’s bacteria plus parasites plus yeast, that’s gonna  be a totally different protocol so, if you just say, “Oh I think, this number’s off of my blood, therefore, I’m gonna take this gut supplement.” Waste of time.

Dr. Justin Marchegiani: A hundred percent. So, I think that’s essential because you’re gonna treat different infections differently. And then also, you want to know if the infection’s knocked out because, if you don’t see the CBC go down, you’re like, “Well, it’s just in the latency period. It’s gonna drop over the next few months. Where if you get the infection, you retest and the infection’s still there, you’ve a lot more clinical confidence to keep on moving and trying in different things versus the hate that you get. You’re not, kind of in, an uncertain state.

Evan Brand: Now, the question here, uhm– do you agree that low Melatonin on a BioHealth HPA Axis Spit Test– low Melatonin, do you believe that indicates gut dysfunction?

Dr. Justin Marchegiani: It definitely can. It can increase, or can be uhm– you know, something that I would add to the list of potential, differential diagnosis is, or what the root cause could be. ‘Cause if we don’t have the ability to break down, let’s say, Tryptophan, which then gets converted in the 5-HTP, which then gets converted into Serotonin, which then gets inverted into Melatonin, right? That that could be a potential issue. I also look at B6. I also look at the stress because, your body will burn through Serotonin. The more stressed you are, you’ll see that an organic acid test, you’ll see 5-hydroxyl to last, take a high or low. So that can be indication you’re burning up a lot of those uh– precursors there. Uhm– so, I look at the stress components, you know, adrenals and such. And I, also, would look at the gut component, for sure. And then make sure all the diet and lifestyle things are uhm– you know, the T’s are crossed and the I’s are dotted, right? HCL, enzymes, no infections, making sure sleep is getting all those things, but definitely that’s one thing I would add to the list to rule out.

Evan Brand: Yeah, it could be something simple as you look at your phone too close to bedtime. Low Melatonin showed up before [stuttering] your last Saliva Test.

Dr. Justin Marchegiani: Yeah, I mean, I would say, if you’re like running the test right before that, for sure. But if you’re kind of getting more of an average, so to speak, of the night and in snow, that’s probably not enough to not knock it down from an average standpoint. But, punctuated yes, I think that makes sense.

Evan Brand: Yeah. Let’s see what else we have. Questions here. Diana said, “Do you recommend Nystatin for Yeast Overgrowth to keep it in check while taking herbals? I can’t prescribe, and I would not prescribe it even if I have the ability to prescribe it, ‘cause I typically use like Saccharomyces boulardii, and I’ve just never had issues with– with Yeast Overgrowth, as long as people are doing the diet. And, a lot of the herbs that we use and, Justin, you want to add some stuff too. A lot of the herbs we use, like if we’re working on yeast Overgrowth, the parasites, or bacteria– they’re gonna be multifactorial. So, we may be using an herb that’s gonna also– let’s say we use Olive leaf for Oregano. That could kill bacteria but it could also kill Yeast as well.

Dr. Justin Marchegiani: Yeah, absolutely. So, I think uhm – nice that some of the antifungals uhm – may be needed for more severe issues but for the most part, you should always try the herbals first. And, you should always look at other infections because there could be other infections like Blasto or H. pylori, that could predispose that fungal overgrowth. And if that’s – that’s what’s predisposing it, a Nystatin, a Fluconazole, or an Amphotericin B. That’s not gonna fix the H. pylori, or the Blasto, right? So then, the root underlying issue is still there. While you uhm– you know, basically, you went outside, you pulled the weeds, at the ground level, versus pulling the roots up. So that’s the equivalent. Just – just puling the weed out of the surface and not pulling the root out.

Evan Brand: Yep, well said. Samuel said, “How accurate is the Breath Test for H. pylori?” I’ve personally, never actually recommend this one for a client, because the Stool Testing is just so awesome that I prefer to use that. But, Justin, what’s your – what’s your take on that?

Dr. Justin Marchegiani: Yeah, I mean, if someone has insurance, and they’ve met their deductible, you know, I’ll throw it on there an order from Lab Corp, but uhm – I find that patients may still have an H. pylori infection in their stool, and not have a comeback for a breath. The Breath is good for like acute stuff, but uhm – it’s not something I would just run b5y itself, and say, “Yeah, you’re good.” I’ll always wanna go to the Gold standard which is the H. pylori Testing. And again, we’ve been doing a lot of the DNA Testing for the H. pylori about BioHealth. You know, their #418 or their – the #401H. The H part of the #401 does the H. pylori. And they do great parasitology on their H. pylori. They beat a lot of Labs on that, which is awesome.

Evan Brand: Yeah, it is. Avie have a question, “ Should I wear a Blublockers all day on the computer or only  when it gets dark out?” I’m so glad you answered this. It drives me nuts when I see people promoting these BluBlocking glasses in them, like, out of it, hence, like a health conference and they’re just walking around the daytime, wearing your BluBlocker, it’s absolutely retarded, because you’re destroying – I’ve seen people on the Lab results, who said they’ve been wearing BluBlockers all day. They’ve destroyed their Cortisol rhythm because, their body never knows when it’s daytime. So – and this is not against you asking the question but, I see so many photos of people promoting them because they’re like trending and cool now. But it’s absolutely stupid to wear them during the day because, you can just use a screen software, like Justin and I talked about, called Iris, you can keep your screen at a 23 or 1,900 Kelvin. So, it’s pretty much Amber-colored, which is what I do all day. Because you still need those beneficial spectrums, you know. Those like 1,500 different spectrums you’re getting from sunlight. So, if you’re exposed to, like, an LED light, or a screen light from your computer, you can modify those lights to make it a better situation. But you absolutely still has to have those natural spectrums that come from the Sun. Otherwise, you’re really screwing yourself up.

Dr. Justin Marchegiani: Yeah, I mean, during the day, for me, I’m okay being a little bit overstimulated by light during the day, ‘cause that’s just gonna increase my Cortisol. So, if– as long as everything else is going well, I don’t have a significant Cortisol imbalance, I think it’s fine. I just use it at night; just when the Sun sets. That’s where I pull them out. And I have this one, like, brand now, that I put over my glasses. I’ll put them on, typically, between 8:00 to 9:00 – the last two hours before I go to bed, I put them on.

Evan Brand: Yeah. And I put it too early with the baby so, I mean, at that time during the summer, we’re going to bed before it’s even completely dark outside so, I just kindled down. You know, we’ve got like a little salt lamp to use as a night light, and turned that off. And, we’re good. So–

Dr. Justin Marchegiani: Love it.

Evan Brand: I got a little–

Dr. Justin Marchegiani: Love it.

Evan Brand: I got a little ranty there. I see these pictures of these BluBlockers. These people wearing them, promoting them on Health Conferences. There’s people doing like Facebook ads wearing the glasses during the day. It’s just makes me want to sock them.

Dr. Justin Marchegiani: Yeah, I think I had uhm – I had a Neurosurgeon on the jet cruise recently, and he had them on during the day. But his situation was different. He was up all night doing a Neurosurgery. So he had it on during the next day, because he was tryig to, I think, probably get to bed when he got home. So, I think he was trying to dampen it, and kind of tell his brain that it was night time, so he could get some rest. I think that was a different situation people watch that show. You’re probably thinking about him. I know, I could think of a couple of people that do it at conferences like a freak. I  won’t say their name but, I don’t– I just don’t understand during the day why that’s gonna be the best. I get it at night, right, because you don’t want to lower the Melatonin by upping the Cortisol from the light. So, that makes a lot of sense.

Evan Brand: Well, the Sun, I mean, right now, there’s blue light from the Sun. You’re getting blue spectrum’s during the day.

Dr. Justin Marchegiani: Right.

Evan Brand: And so…

Dr. Justin Marchegiani: Naturally.

Evan Brand: Yeah, naturally. So, it’s not – it’s not like you’re, you’re hacking sunlight. Sunlight is good. You’re never gonna be able to beat that in terms of the spectrum – the color– the color ranges.

Dr. Justin Marchegiani: Totally. Well, we just hit the CBC today, I think saved uhm– the comprehensive metabolic profile for next time. Because I– we’ve already done a good amount. We hit the key CBC markers, RBC, Hemoglobin, Hematocrit, right? We talked about the differentiating, the Iron versus the uhmm– the B12. We talked about the White Blood Cell panel, right? The White Blood Cell, we talked about the uhm – Neutrophils, Lymphocytes, Eosinophils, Basophils. And then one of their marker here, I’ll hit is– we’ll hit in the CBC and the CMP part next time. But you can do markers for Red Blood Cell and Magnesium, which is great but, Magesium kind of comes under the Comprehensive Metabolic Profile. So, we’ll talk about that. Intracellular versus extra cellular so, we always like to do if we can do, a specialty test for, like, the Magnesium Serum versus– I’m sorry. Red Blood Cell Magnesium – that’s better, ‘cause that gives us the window intercellular, inside the blood cell versus outside of that. Kind of what the blood cell swims in if you will.

Evan Brand: Yep. That would be fun.

Dr. Justin Marchegiani: Home. Awesome. Home. Any other questions, comments, concerns?

Evan Brand: We had one from Gupta here. Okay. Gupta: “ What’s the best hormone test?” Kind of a general question but, since we talked about Cortisol and Melatonin today, a lot of times, we’re looking at a salivary uh- Cortisol test, which is gonna tell us a lot about Gut Health. If you got high Cortisol, we know that’s gonna damage somebody’s gut. Uh– so that– that’s what I typically write in. Justin, what are you doing hormone-wise.

Dr. Justin Marchegiani: Yeah. Hormones I’ve been doing and going combination between the Dutch and then also doing more of the BioHealth, the Cortisol Awakening Response. So, we’ll run the #201 and the #205, nd then we’ll add the Cortisol Awakening Response, so we can look at zero, 30, and 60 minutes waking and see if we have that ice bump of Cortisol here, a bump at 30 and then a halfway drop down here. A lot of patients, they’re not even getting that, that Cortisol up. In your awakening response, we get a bump, 50 percent bump, a drop of about a third here, like that. And most people they aren’t getting enough, high enough, and they’re dropping down actually lower. So that give us a pretty much good window of what’s happening with our HPA Axis.

Evan Brand: And yeah, it’s so much more fun to have the Awakening response versus impervious times that’s just having that one morning reading?

Dr. Justin Marchegiani: It’s nice. It gives you a pretty good window what’s happening with the brain, and the hypothalamus-pituitary-adrenal axis, for sure. I love it.

Evan Brand: Stacey, thank you for the feedback. We appreciate it. Uh– Kendra said, She gives a podcast idea. “A Recommended Test: Serum, Urine, etc., For Each Essential Micronutrient: Magnesium, Zinc, B6, Fatty Acids, etc.” I’m gonna guess. You’re gonna tell her just to do a SpectruCell but maybe we’ll save that for future reference.

Dr. Justin Marchegiani: Yeah. I mean, SpectruCell will be great, ‘cause you get more intracellular nutrients there, but yeah, we’ll talk about that next time. There’s other markers that we can look at for Zinc, like Alcohol and Phosphatase, and Magnesium, like the Red Blood Cell Magnesium. So, we’ll say that for next time. We’ll dig in more.

Evan Brand: Cool. People can go check out justinhealth.com. They can check out Justin Store, custom formulations there, lab tests, scheduling consults with him– justinhealth.com. Then myself, just Evan Brand. E-V-A-N Brand dot com (evanbrand.com), and check us out. We’ve got, what? Probably a combined total of five or 600 pieces of contents. So if there’s something there that we didn’t cover today I’m sure he have – in some form or fashion.

Dr. Justin Marchegiani: Yeah, just use the search bar on our site. A lot of people, they come in on some of the questions and they asked questions. Uhm– like about stress and things like that. Uh – we may not be able to answer more very generic questions but that’s why we go back to the site and just put that into our Search browser, and you’ll get uh– lots of Podcasts and other articles on that. So, we don’t mean to ignore you but, go back and use that Search Bar first.

Evan Brand: Yep, totally.

Dr. Justin Marchegiani: Cool. And you no longer the Not Just Paleo guy. You’re uh– you changed your brand. I mean…

Evan Brand: It’s on.

Dr. Justin Marchegiani: Evan Brand changes his brand. Is that a coincidence or what?

Evan Brand: It’s gone. The website, like, went down, and I said, you know what, this is it. I finally got it. I was able to purchase my– my name dot com. So, that’s what I did. Stacey: “Is it okay to take D3 on a regular?” Yeah, probably is. If you’re taking Vitamin K, or you’re doing grass-fed butter. Then, you’ve got the K that’s gonna help act as a traffic cop for the Calcium, so that you’re not upping D3 and then Calcium on your arteries but, just get your levels retested. I had a lady who has taken a bunch of Vitamin D. She got her levels tested. She was above a hundred and twenty (120) and that’s toxic, so you can’t have too much of the good things. So just get your blood checked. If you can get it through your doctor, cool. If you need to get it through somebody like Justin or myself, we can do it on uh– an out of pocket basis, as well, for blood. And, it’s always good to check. Make sure you’re about 60 units.

Dr. Justin Marchegiani: Love it, man. Love it. Well, anything else you want to mention here before we go?

Evan Brand: I don’t think so. People listen on YouTube. They can’t give us a review obviously. But, if you’re listening to the audio portion on iTunes. Give us a five-star review, ‘cause it helps sustain the top of the hills chart, and that way, this functional medicine approach can get to more people and then we beat out people like a Jillian Michaels, who are promoting, like, Calorie Counting and Weighing Yourself, and Weighing and Measuring Your Food, and all that other crap that we just don’t agree with. Is not necessary for you to be optimally healthy. If you give us a five-star review on iTunes, we beat out her, and then this info gets to people like you instead.

Dr. Justin Marchegiani: Hundred percent, man. Awesome. Well, great chat today, Evan.

Evan Brand: Likewise.

Dr. Justin Marchegiani: We gotta do it again, real soon.

Evan Brand: Yes, Sir.

Dr. Justin Marchegiani: Alright, take care.

Evan Brand: Bye.

Dr. Justin Marchegiani: Bye.



“Why Stomach Acid’s Good for You” by Dr. Jonathan Wrights

“Blood Chemistry and CBC Analysis” by Dr. Weatherby

“Hashimoto’s Protocol” by Izabella Wentz

“Why Can’t I Get Better” and “I Can Get Better” by Dr. Richard Horowitz

“The Thyroid Reset” by Justin Marchegiani




The entire contents of this website are based upon the opinions of Dr. Justin Marchegiani unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Justin and his community. Dr. Justin encourages you to make your own health care decisions based upon your research and in partnership with a qualified healthcare professional. These statements have not been evaluated by the Food and Drug Administration. Dr. Marchegiani’s products are not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using any products.