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 – 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




Functional Medicine Lab Testing – Podcast #22

In this podcast we will review how tell if you are anemic via blood testing. Do you have adrenal fatigue and how use a cortisol rhythm test to help evaluate this? Do you have a chronic infection that is throwing off your hormones? How do you evaluate blood sugar via lab testing?

lab testing

Dr. Justin Marchegiani talks about the key labs so we can get a clear understanding of how our body is functioning including some tests that we can use to take a deeper look into our cholesterol numbers and what the readings essentially mean in a basic sex hormones panel. He will also give us an insight on the importance of blood sugar management and how we get these tested for fasted glucose, insulin, and hemoglobin A1c.

In this episode, we cover:

05:40   Basic lab tests

15:59   Symptoms that warrant lab tests

19:10   Lab tests prices

32:30   Cardiovascular risk factors and markers to look out for

34:33   Thyroid Testing Overview







Podcast: Play in New Window|Download



Baris Harvey:  Thank you guys for tuning to another episode of Beyond Wellness Radio.  In today’s podcast we are gonna be talking about Lab Testing 101 and diving in so that way you guys kinda have an overview.  But first we wanna make sure that you guys go to beyondwellnessradio.com/newsletter.  This way, you would have–you’ll be the first to get the updates.  We usually have our shows sent out to our–our subscribers before you’ll even hear it on iTunes about 3 episodes early.  So definitely go to beyondwellnessradio.com/newsletter.  We also have a lot of things in the bag coming at you, so a lot of freebies, a lot of good things.  So make sure you get on the newsletter.  Second thing, make sure when you go to beyondwellnessradio.com, you click and take a look at both Just In Health and Really Healthy Now.  Those are both mine and Dr. Justin’s site.  Dr. Justin is a functional medicine practitioner.  So if any of you guys are having some real health complications, like I mentioned before, he is my go-to guy.  So I would definitely hop on there.  Get yourself a complimentary call and–and try to see if maybe you need–you need to get pretty deeper.  We’re about to talk about lab testing today, so you know, he would be the perfect person to go to.  Also if you needed help with getting your nutrition right, your mindset right, and trying to improve your health overall, you can also send me–me a message at reallyhealthynow.com.  You can go on there and go ahead and work with me as well.  So definitely go there.  And one last thing, make sure that you guys go to iTunes and leave us a review.  This really helps us spread the message and yeah, for extra incentive, you know, maybe we’ll start reading these iTunes reviews and giving something away.  So definitely go to iTunes and search Beyond Wellness Radio and give us 5 stars preferably, right?  And yeah, so with that being said, how’s it going today, Dr. Justin?

Dr. Justin Marchegiani:  Oh, it’s great!  Oh, by the way, if everyone wants to review us, Beyond Wellness Radio, and this little button that says Write A Review and that will bring you right to the iTunes page to make it easier.

Baris Harvey:  Oh, very convenient.

Dr. Justin Marchegiani:  Absolutely!  I’m doing great.  I’m actually–we just talked behind a scenes here that I’m getting a whole house water filtration set up and I’m also getting a under the counter unit setup that’s reverse osmosis-based as well, kinda being extra protective as more than likely next year I’ll be, you know, having a baby, keeping my fingers crossed, you know, and–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And we got the reverse osmosis and I also have the system where it infuses some magnesium and calcium minerals back into the system as well, so we’re not totally stripping out the water.

Baris Harvey:  Yeah, I just go to the beach and just drink them; I’m just kidding.  Yeah, but no, definitely.  It’s important to get those minerals in the water, because I know sometimes like we filter everything out, but when we filter everything out, it filters everything out and then you get this–this water has like no minerals, no electric charge, so then it kinda just like flows right through you.

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  So the question that we always wanna know is what did you eat today?  What was your breakfast?

Dr. Justin Marchegiani:  So today was a different day, got up and I worked out in my home gym.  Did some kettlebell swings, did a tabata on the row machine, did some functional lifting on my TRX, and some–just some functional movement exercises.  And then I had a nice little 35 or 45 grams of whey protein with some collagen and some bulletproof coffee and right now, I’m just sipping on a ginger kombucha before lunch.

Baris Harvey:  Yeah, sounds good. I had a–I had an interview this morning so when I woke up I had about, I wanna say like, it wasn’t that much, like 15 or 20 grams of just some–some whey protein with some almond/coconut and I threw an egg in there just for some extra protein.

Dr. Justin Marchegiani:  Nice.

Baris Harvey:  And did I _____, maybe, oh I think I put some–usually when I make like these–these smoothie, I put like a teaspoon of like mocha powder or something like that, and it just, you know, just for some extra kick.

Dr. Justin Marchegiani:  Nice.

Baris Harvey:   And after that, after I was done with that show, I went ahead and cooked actual breakfast that had some chicken sausage and some–2 more eggs.

Dr. Justin Marchegiani:  Awesome.

Baris Harvey:  Just cooked this time.  Yeah, definitely.

Dr. Justin Marchegiani:  Very cool.

Baris Harvey:   So let’s get on with the show.  Today, we want to make sure that we give you guys the 101 to Functional Lab Testing.

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  If you go to your doctor’s, you’re gonna get some basic panels like your a–like get the basic blood work and that can be very useful.  But there’s also some other key labs that you might need to get–to get a deeper understanding of how your body’s functioning.  So with that being said, let’s get it started, Dr. Justin.  What are some of the–or actually before we even talk about some of the functional labs, let’s just talk about some of the basic labs that you might get at, you know, just your normal doctor.

Dr. Justin Marchegiani:  Great.  So we get our basin blood chemistry, our CBC, a complete blood count, or we get like a CMP, a comprehensive metabolic profile, or we get a lipid panel.  These are all basic tests but they really give us some great information.  So a couple of key things we see off the bat when we run like a CBC with differentials.  This is looking at the size of our red blood cells and this can give us some great information.  One, we can figure out if we have an anemia potentially and there’s a couple different kinds of anemia.  If it’s like a microcytic anemia, alright.  Hence the micro part, that means our blood cells are really small.  And then we have like a macrocytic anemia where our blood cells are really big.  So one is more of an iron-based anemia when our cells are small and one’s a–a B12 of folate or B6, typically a B12/B vitamin anemia when the cells are really big.  And both are really important because if our cells are too small we can’t carry oxygen properly and if we don’t have oxygen, well, think back to middle school science class when you have the experiment with the candle, when you put the glass jar over the candle and the candle typically goes out, so we need oxygen for metabolism, electron transport chain, glycolysis, all that good stuff.  And if our red blood cells are too big, well, typically our red blood cells actually get smaller as they get more mature.  So our red blood cells start out big and they actually get smaller when they’re exposed to certain B vitamins, and when they don’t have enough of those B12 folate and/or B6, they get stuck in this bigger size.  So imagine there’s big, goofy red blood cell walking around, it’s like really clumsy, it’s like tripping over things, it’s like a bull in a china shop, that’s what happens when we have a B vitamin deficiency.  These red blood cells aren’t really mature, they aren’t really coordinated, and they don’t carry oxygen and nutrition properly throughout the body.  So we can get fatigue, we can get coldness, numbness, and these things can also lead to thyroid problems, too, which is really one of my big specialties, thyroid and adrenal issues, too.

Baris Harvey:  What are some of the things that we can see?  Because I know, know usually when you go into your–your doctor’s when you get this–this blood chemistry done, usually one of the things we look at is our–is our cholesterol.

Dr. Justin Marchegiani:  Yeah.

Baris Harvey:  So that’s kinda one of the first things that the doctor might pay attention to.  Sometimes it might not be perfect.  What are some of the things we might see on–on their tests and order some other tests that we can do to take a deeper look into our cholesterol numbers?

Dr. Justin Marchegiani:  Well, cholesterol numbers–we can actually get some god information even from conventional tests.  My biggest thing is looking at any number or looking at any cholesterol number or fat number in isolation, typically doesn’t do us much good.  We wanna look at in relation to other numbers.  So for instance, I like HDL.  HDL is a really good number but HDL in conjunction with triglycerides is even better.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  So looking at your triglyceride to HDL ratio, making sure it’s a minimum of 2:1 or less. I like closer to 1:1.  So 1:1 would be like someone having 50 on the HDL and 50 on the triglycerides.  We have a 1:1 ratio.  Where 2:1 would be like 100 on the triglycerides, 50 on the HDL, and then when you over that ratio that’s like getting into over 100 on the trigs, which are triglycerides.  So again, try to get that 1:1 ratio where 1.5 to 1 typically a really, really good place that tells us that we’re recycling cholesterol well and it also tells us that we’re not consuming too much carbohydrates and we’re not getting into a place of insulin resistance.

Baris Harvey:   Yeah, definitely.  I know oftentimes and this probably is an important–when working with a functional medicine practitioner, when we look at the scale like the range, usually the ranges are pretty large and as the diversity and as the population continues to get sicker, sometimes the ranges actually shift, what do you feel about when you have someone who comes to you and like, “Oh, well, my–it says that I’m normal but I don’t really feel right.”?

Dr. Justin Marchegiani:  Yeah.  So we have to look at what a lab test is designed to do.  So typically conventional medicine uses lab tests to pick up pathology or disease.  Nothing wrong with that.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  That’s great.  The only problem is there’s an assumption and the assumption is if you’re not diseased, you’re healthy.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  That is the assumption or said another way, the absence of disease equals health.  And that could not be farther from the truth.  So–

Baris Harvey:  That’s like saying, your car that’s basically, “Oh, you have 4 wheels on your car, oh well, well then it runs, it’s fine.”

Dr. Justin Marchegiani:  Yeah, exactly, exactly.  It’s like saying, “Oh, well, if your car like isn’t like, you know, in a car accident and like bented up it must be perfect, right?”

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  And that’s just, that’s not the case.  So we have to look at what is a lab test.  So typically, anyone that’s, you know, has done like a statistics type of class at a graduate level, they’ll probably hear something known as standard deviations or a bell curve.

Baris Harvey:  Uh-huh.

Dr. Justin Marchegiani:  And a bell curve in a lab testing, we have the normal reference ranges made out of 2 standard deviations either way.  What that means is 95% of the population fits within 2 standard deviations, and outside of that, 2-1/2 on the high and 2-1/2 on the low would equal out of range.  So essentially when we’re looking at lab ranges, 95% of the population are considered normal–

Baris Harvey:   Yeah.

Dr. Justin Marchegiani:  And 2-1/2 on the high and low aren’t.  So 5% aren’t normal, 95% are.  So we know like just go walk around an airport or public event and just walk around and just look at people.  There is no way in heck that 95% of the population are healthy.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  There’s no way.  So when we look at these lab tests, it means–

Baris Harvey:   No, no offense to everybody but–

Dr. Justin Marchegiani:  Yeah.

Baris Harvey:   95%, yeah.

Dr. Justin Marchegiani:  Yeah, I mean, just go walk–just go walk around.  Just go to an airport and just look, right?  I would say like it’s probably 50-50, if less than that, you know.  Probably maybe even 25% of people are really, really healthy.  Like 20% are probably really healthy.

Baris Harvey:   Uh-hmm.

Dr. Justin Marchegiani:  And then the 80% probably have some type of symptom they’re working on and as they progress it gets worse and worse.  But when we look at, the conventional lab tests, obviously we wanna look at the standard lab ranges, because if something’s off there, that’s more of a problem.  It just means the chronicity has been there.  It’s a long–it’s been there longer.  But also we wanna look at things on a spectrum.  So we kind have like our optimal reference range, which is, would be like the middle 30%.  That’s kinda like our reference range and then we look at things as–as they would veer away 10% either direction.  And the farther they go away from that would be potentially the more there’s an issue.  And it just helps us because we can pick things up before they go out of range.  It may take years to go out of range, right?  So if you’re running towards a cliff at full speed, well, it’s just a matter of time before you fall off the cliff.  Conventional medicine says we, you know, we really can’t do much until we literally see you in mid-air off the cliff.  But it’s already too late, you’re gonna hit ground, hit rock bottom.  So if we like we see you heading in that directions, meaning we run a lab test and we see you moving, you know, towards that second standard deviation, we can start making diet and lifestyle and stress interventions.  We can look at things from a functional perspective.  We can do more functional test such as maybe obscure thyroid markers.  We can look at adrenals.  We can look at infections.  We can look at stool testing for SIBO–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And parasites.  We can do things that are a little bit more comprehensive.

Baris Harvey:  Yeah, definitely.  So one of the things I know that is–that is common when it comes to testing is at least when it comes to the functional perspective is a adrenal complex and making sure that you get the–not just a one-time reading but a basically a 4-time markers, kinda of seeing the curve of a cortisol reading.  Why is it important to get an adrenal panel?

Dr. Justin Marchegiani:  Great question.  I’m gonna actually side step that question and then come back to it.

Baris Harvey:   Yeah, sounds good.

Dr. Justin Marchegiani:  Because we talked about anemia right in the beginning.  I know there’s a lot of bio-hackers that really want some solid info.  So real quick with the anemia.  When we start to see our red blood cells, hematocrit, and hemoglobin start dropping, that’s a sign that we have an anemia.  Now when we wanna figure out what kind of anemia it is, well, we would look at iron and transfer factor, and we look at TIBC and transferrin saturation and such, and this would give us some information regarding if it’s an iron-based anemia.  And if we start looking at the B vitamins, we’d look at MCH which is mean corpuscular hemoglobin, MC–excuse me–MCHC or mean corpuscular hemoglobin concentration, or MCV which is mean corpuscular volume.  These are looking at the size of the red blood cells so when these go higher, that’s more of a sign of a B vitamin or B12 anemia.  So we would look at those markers to differentiate, and we may not let–we may not look at them and say, “Well, they have to be way out of range.”  But we may look and say, “Are they in that bottom 10% on the iron or in they in the top 10% on the B vitamin,” and that way we can pick these things up before they’re a problem.  And again, there are specialty tests that we would look at like the urinary methylmalonic acid or we run ferritin or things like that to rule out iron or rule out B12 anemia.  Any questions on the–on the anemia side, Baris?  That’s a big one I find.

Baris Harvey:  Yeah, and I know sometimes people have–it’s–it’s hard because it’s kind of trying to differentiate that B12 anemia and that iron anemia and it–it is also a little bit more common when it comes to the female, especially the female athletes.

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  That we–that we work with, so making sure you’re paying attention–what are some–let’s get into some of the symptoms that we might–we might find if someone’s ane–because that’s–that’s kind of a hard one if we–if we haven’t tested that yet to make sure that maybe we should–maybe we should take that test.  So what are symptoms that if we were having, we should probably take a deeper look into that and get those tested?

Dr. Justin Marchegiani:  Well, one, if we’re vegetarian or vegan, we definitely need the test.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Absolutely essential, especially B12, you know, can affect your nervous system, can affect, you know, you know, peripheral neuropathies, tingling, you know, the generation of the nerves can happen with B12 deficiency.  So if you’re vegan or vegetarian it is absolutely essential, probably one of the most important tests you can do.  That’s step 1.  Two, if you’re having thyroid issues, if you’re losing your hair, if you feel tired, if you just like are looking a little bit more pale, if you’re trying things and you’re not feeling better, and you’re fatigued, it has to be ruled out.  Anemia has to be ruled out.  One, if you’re bleeding excessively around menstruation cycle, you know.  Frankly, I could be a little bit more kind of a TMI here, but if you’re a female and going through more than 3 or 4 tampons per day and bleeding more than 3-4 days a month in your cycle, that may cause an anemia because you’re losing that iron.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  That’s another great indicator right there.

Baris Harvey:  Yeah, so if you have excess of really essential–if you’re woman, if you’re having a heavy flow, if you’re having some-some fatigue issues as well that can definitely be a–be a sign.

Dr. Justin Marchegiani:  Yes, and then now, I think, let’s just kinda back up a little bit, because you talked about the adrenals.  So let’s touch upon that.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  So adrenal testing is really helpful because you’re sympathetic nervous system or the fight or flight mechanism, that this kinda gets activated when we are stressed, this is controlled by our adrenals.  Our adrenals produce cortisol and also adrenalin.  So it’s really great to see how we are functioning because typically cortisol gets pulsed out in a circadian rhythm.  So it’s based upon light and dark.  So in the morning time, we’re getting more sunlight so we have higher amounts of cortisol and as cortisol drops throughout the day along with the sun and darkness sets in, melatonin comes up which pushes cortisol down even more, cortisol drops.  So it’s great to look at that cortisol rhythm, one that tells us how strong our adrenals are, and it also tells us about HPA axis dysfunction which is basically stress affecting the communication of our brain.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Pituitary and hypothalamus talking to our glands, our adrenals.  And if we typically have that HPA axis dysfunction, we can see cortisol kind of basically going up or down and not quite being in the rhythm that it should be and when we see that, it also means there could be some HPT axis dysfunction, meaning hypothalamus, pituitary, thyroid because they’re both really connected.

Baris Harvey:  Yeah, definitely.  I went ahead and went to your site and wanted to look at the lab core, the comprehensive post–it’s almost seeming unbelievable the price right now.  We talked about real quick about the comprehensive bio screen blood test that you have right now currently on your site.

Dr. Justin Marchegiani:  Yeah.  So in details about that, that’s a great test because it’s typically–I work with patients that have insurance.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And when I bill insurance for tests like that, insurance will charge up to $3000 or $4000 sometimes.

Baris Harvey:  Wow.

Dr. Justin Marchegiani:  And the patient may still have to pay like $1300 or $1500 even with coverage.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  So I’m able to get that test for my patients for $299 cash–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  Which is an awesome price because, I mean, and this is the reason why healthcare is so expensive, because no one should be spending $2000 or $3000 for a test like that.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  Especially when the cash discounts are so much more affordable and frankly, we can order almost every thyroid marker known to man, even–even a lot of our autoimmune markers.  We can order–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  All of the markers for CBC, all of the anemia markers.  We can order the urinary analysis as well.  We can order all of the fat markers and inflammation markers like C-reactive protein and fibrinogen and sed rate, and also vitamin D.  So we get just a window into what’s happening inside someone’s body and I recommend, even if you’re healthy, a test like that once a year.  I do a test like that every 6 months.  It’s coming up time for me to do another one, but I do that about twice a year.

Baris Harvey:  Yeah and that’s really good price.  Like that’s an unbelievable price.  Most–most of the labs that–that you’re looking forward to get anything close to that is gonna be, like you mentioned, at least what you have at price here, at least $1200 so you’d be lucky to find it under a thousand.

Dr. Justin Marchegiani:  Yeah, even though–it’s actually even more affordable than WellnessFX.  It’s about $100 to $150 cheaper than WellnessFX, so if anyone want–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  To check that out, justinhealth.com/shop and then click on lab test on the category side on the right and you’ll find it.

Baris Harvey:  Yeah, definitely. So what’s really fun in what we always want the test to find out is the sex hormones.  So what are–what are some of the basic, when usually we get a panel, what are some of the things that we’re gonna find on–on the readings of a basic sex hormones panel?

Dr. Justin Marchegiani:  Well, when we’re looking at sex hormones, there’s a couple things we can look at.  We can look at DHEA or–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  DHEA-sulfate.  This is like an adrenal hormone but it’s precursor for women to estrogen and progesterone and for men, it’s more of a precursor to testosterone.  Again, it’s a great indicator of how our adrenal reserves are because our adrenals are our backup generator for our sex hormones.

Baris Harvey:  Yup.

Dr. Justin Marchegiani:  So so many women that when they transition into menopause or when they have PMS, really their adrenals aren’t helping out.  They aren’t coming to table with some extra sex hormone reserves.  So they’re just sitting there totally dependent upon their ovaries so in menstruation time or in, you know, when the woman is actually cycling, what typically happens is just PMS and maybe excessive bleeding, maybe bloating or cramping or mood issues or headaches.  Things like that happen.  But when the women transitions into menopause, that’s where it gets really bad because then those ovaries, they aren’t working like they used to, and more of up to half of all the hormones are now being totally relied upon from the adrenals.  And then what happens then is we have depression.  We have our skin and hair just going to hell, just looking really–

Baris Harvey:  Uh-huh.

Dr. Justin Marchegiani:  Really bad, mood issues, libido issues, and frankly, my number one clientele typically are women because when this transition happens, it’s really bad.  And conventional medicine typically only offers, if they’re no longer menstruating, they’ll typically offer an anti-depressant or they’ll offer some HRT and maybe they’ll offer it in creams or maybe they’ll offer the horse hormones, Premarin, Proair, and you get some good doctors out there that are doing it more bio-identical now which is great, but even that sometimes they’re still being overdosed, sometimes they’re not using the right estrogens.  I find estriol tends to work better than estradiol.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And also using estrogen in conjunction with progesterone.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  And sometimes these creams aren’t the best because they super saturate.  When I use creams with a woman, it’s typically vaginally because the creams don’t sit around, because the mucosa is so thin vaginally, it’s goes right into the vaginal tract, right into the bloodstream.  I don’t typically do any creams, topically on the skin, and most of the hormones on the hormones that I would use would be one, adrenal-based and/or female hormones, but they’d be liquid.  Sublingual, so we can put it right into our bloodstream, kinda like an injection but without a needle.  We can do it right to our submuscosal, sublingual tissue.

Baris Harvey:  Uh-hmm.  Definitely.  And it’s not just the older women, too, where they are given these treatments that are messing with their sex hormones.  I mean, you can–I’ve seen women get birth control just because they have a painful period and they don’t wanna experience the pain.  But rather than figuring out why it’s painful, it’s like, “Oh, we’ll just take this birth control.”

Dr. Justin Marchegiani:  Yeah.

Baris Harvey:  Or even having depression and having birth control.

Dr. Justin Marchegiani:  Ex–exactly and you know, the way I look at a lot of women that have bad cycles and get put on birth control pill, it’s like going to see a symphony and the conductor is off a little bit.  The conductor isn’t quite, you know, getting the flutes timed up with the horns or the strings, right?  So then we’re not quite in sync, so it’s easy for a symphony that plays beautiful music to sound like noise.  And that’s what happens when you’re–when you’re a female and your cycle is off, right?  The timing of TSH and LH, and our luteal phase and our follicular phase, and our estrogen spike followed by a progesterone rise, all those things are off.  So conventional medicine’s perspective is, “Alright, like, we’re off the symphony, let’s just like–let’s just like pull out our sniper rifle and just shoot the conductor, so then the–the orchestra stops.”  I hope that–I know that imbalance is little bit violent there, but–

Baris Harvey: Oh.

Dr. Justin Marchegiani:  We’re just like we’re mugging–

Baris Harvey:  Exactly.

Dr. Justin Marchegiani:  The conductor.  We’re like knocking the conductor off the stand and what I mean by that is, what we’re doing in females now is we’re just giving a super high amount of synthetic estrogen or progesterone if we’re using the–the Mirena IUD, and we’re just super saturating our hormones synthetically and it starts shutting down our FSH and LH.  These are our pituitary, our brain homones.  These are the conductors, right?

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  So it shuts those down.  Those hormones start to rise a little bit and the reason why is because we’re–actually they would–sorry, those hormones would actually drop a little bit because our hormones are super, super high.  So it just drops down all of our upstream brain hormones because we’re super saturating our estrogen and/or progesterone, and it’s synthetic, too.

Baris Harvey:  Uh-hmm.  Definitely.  Yeah, it’s crazy what’s going on.

Dr. Justin Marchegiani:  I just wanna add one thing there, Baris.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  So like the functional medicine philosophy is, “Hey, we like.” We just take the conductor.  We pull him off to the side, we say, “Hey, man, you know, see the timing over there with the strings and the flutes?  We gotta work on this.”  So we get specific instead of just knocking the conductor and taking away his job.  We actually get in there and try to fix where the timing is off and we can do that with blood sugar support.  We can do that with–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Diet and lifestyle changes.  We can do it cyclical augmentation program where we-synchronized the progesterone.  We can use herbs to help with upstream signaling.  We can support the adrenal glands.  We can address anemias or nutrient deficiencies.  We can also address the infections that are potentially throwing things off.  So it’s kinda like pulling the conductor off to the side, giving him a pep talk, and saying, “Hey, this is what we gotta do,” versus just saying, “Hey, get outta here.  Go home.”

Baris Harvey:  Yeah, exactly, because guess what, you only have one, right?

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  Can’t just replace it.

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  So when you talked a little bit about of the–the nutrients and the diet, oops, something that I feel–it’s weird we don’t really get this tested as much in our–in our normal practitioners, usually you have to go somewhere else to get a total nutrient deficiency panel.

Dr. Justin Marchegiani:  Yeah.

Baris Harvey:  This seems like something that should be like, kinda–kinda basic but I guess why–why isn’t it and–and why–why do we need it?

Dr. Justin Marchegiani:  Well, there’s definitely a couple of nutrients that are really important.  So I already kinda mentioned the B12.  We can infer that by some of the markers I already talked about.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  Also, iron is really important.  We can look at that via ferritin, on our nutrient like on a conventional blood test, we can look at alkaline phosphatase.

Baris Harvey:   Yeah.

Dr. Justin Marchegiani:  If we see it below 50 or 60, that’s typically a sign of zinc deficiency.  Also on blood test, we can look at red blood cells or magnesium red blood cell levels.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  Not magnesium serum but magnesium RBC.  And we can look at–

Baris Harvey:  Yeah, RBC magnesium.

Dr. Justin Marchegiani:  Exactly.  We can look at the intracellular amounts of magnesium which is really, really important.  So those are some that we can get on simple blood tests and then we also run more specialty ones like a SpectraCell test.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Which looks at intracellular nutrients of all kinds.  And then we can also run an organic acid test which is another great indirect way of getting our nutrient levels.  I like the organic acid testing because it’s just easier because you don’t have to go to a lab and get a blood draw.  But both are really good options.

Baris Harvey:  Yeah, definitely.  Another thing, a topic that I know you really like.  Blood sugar management.  Getting our fasted glucose and our insulin and our hemoglobin A1c, like–like what–why are these important and how do we get these tested?

Dr. Justin Marchegiani:  Well, blood sugar’s really important because it’s one of the biggest hormonal stressors on our body.  I just did a video recently about this at youtube.com/justinhealth on blood sugar.  But one of the big things is, we have more hormones that help bring our blood sugar up than bring it down.  So for instance, we have glucagon, cortisol.  We have adrenalin.  We have somatostatin and we have IGF1.  We have probably one more hormone I’m missing, but about 5 or 6 hormones that help bring blood sugar up.  Now, that’s great because evolutionarily speaking, we would have famines and we’d have fasting periods because food wasn’t that abundant so our body adapted to really keep our blood sugar up because typically we were just going without food.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  And now that we have this super abundance, well, we’re having insulin resistance and metabolic syndrome which is basically caused by blood sugar being too high because our body only has one hormone to bring blood sugar down which is insulin and we commonly have insulin resistance now with most of our polycystic ovarian patients, our patients that have PMS, our patients that have adrenal fatigue, patients that have metabolic syndrome, diabetes, Alzheimer’s, they typically have these blood sugar imbalances and one of the biggest stress on the hormonal system is blood sugar stability.  So if we can use markers like fasting glucose can be decent.  It’s a very late stage marker, so it’s not that sensitive.  But if you are above a hundred that could be a problem.  We have hemoglobin A1c.  If you’re above 5.5-5.6, that could be a problem.  We have fructosamine.  That’s a great marker.  We have–let’s see–an oral glucose tolerance test.  We can do that at the lab or we can do a homemade one with a blood sugar meter.  We also have fasting insulin, anything above, you know, 6 or 7 is definitely a sign of moving into insulin resistance.  So we have these great markers we can use because we know blood sugar is definitely an issue that really we have not evolved to a place to deal with high blood sugar.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  We’ve spent way more years with low blood sugar or lower blood sugar because of lack of food abundance and now we have the exact opposite situation, but it’s even worse because we have this lack of–we have this overabundance of food but we have this underabundance of nutrition, meaning we have so many calories available but so little of these calories are–contain nutrients because 90% of food that’s purchased is processed food, meaning it’s packaged.  It’s not found in Mother Nature.

Baris Harvey:  Yeah, definitely.  And I know we’re–we’re coming close to the end of this quick 101, but what–one more would be–alright, I know we–we talked about quickly, like the–the total in what you would get in, you know, cholesterol panel, but if we–you didn’t want and you did like cardiovascular risk, I know some of the things that you might wanna look for is some, you mentioned before, the C-reactive protein but also maybe the lipid particle size.

Dr. Justin Marchegiani:  Yes.

Baris Harvey:  And the number, maybe even like homocysteine.  What–what are-what are some markers that you might be looking for?

Dr. Justin Marchegiani:  So if we’re looking for cardiovascular risk factors, obviously inflammation is gonna be important.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  C-reactive protein, erythrocyte, sedimentary rate, fibrinogen, these are all inflammatory markers, homocysteine as well.  And we can also look at particle size so we can a VAP test, a vertical auto profile, which looks at HDL, pattern A, pattern B; LDL, pattern A, pattern B.  And again, LDL, we want more A; A is good, right?  You want an A on your tset.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  And then LDL B, B for bad so we don’t want much B.  We want more A.  These are the large, fluffy buoyant LDL.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  That’s important and we can also look at lipoprotein (a).  We can also look at genetic test like ApoE proteins, like we–4/4–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  ApoE, E is not a good one.

Baris Harvey:  ApoE protein B, uh-hmm.

Dr. Justin Marchegiani:  ApoE protein B is a little bit different, that’s more particle size–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  But we have a generic ApoE protein testing where 4/4 tends to be the worst.  That means we really can’t be cheating much.  We have 3/4.  We have 2/2, 2/3.  I don’t do too much of those testings because, you know, typically it doesn’t really tell you much other than the fact if you’re 4/4, you should be really on point.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  So if you’re–you’re someone with a 4/4 or a 3/4, it just means you can’t get away with that much, so you gotta manage your stress, you gotta keep the refined sugar to a minimum, keep the healthy fats and healthy proteins and nutrient dense foods up, and the gluten and all the food allergens down for sure.

Baris Harvey:  Yeah, definitely.  Well, sounds good.  I–we got a lotta great information and it seems like some of the important things to focus on is like we make sure we test our sex hormones, our thyroid, our–excuse me–our nutrient deficiencies, blood sugar, and also any of our cardiovascular risk.

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  Pretty good starting places and then of course, there’s so much more, you know, maybe different–

Dr. Justin Marchegiani:  You know what, Baris, I don’t mean–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  To cut you off, I just know if I don’t touch upon this, everyone is gonna be emailing me afterwards–

Baris Harvey:  Oh.

Dr. Justin Marchegiani:  We didn’t talk about thyroid much.

Baris Harvey:  Yeah, yeah, so we, let’s go into it.

Dr. Justin Marchegiani:  Sure.

Baris Harvey:  Because I know, there’s a couple.  You know, there’s a–I mean, basic, you’ll probably go into the thing and just get your–your TSH but we know that we need our free T3, our reverse T3, our T4, and there’s also some other, like you mentioned, the antibodies, go over the thyroid stuff.

Dr. Justin Marchegiani:  Sure, and we’re gonna do a whole podcast on thyroid testing because it’s way too nuisance and it’s not–there’s not enough information out there on it but just a bird’s eye view, most people or most conventional doctors and/or endocrinologist are just doing TSH testing–

Baris Harvey:  Unm.

Dr. Justin Marchegiani:  And maybe T4 testing.  This is helpful for people that have elevated TSH or low T4, because you’ll get picked up–

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  As having a thyroid problem.  The assumption is made though if your T4 isn’t low or if you’re TSH isn’t above 4-1/2 on the West Coast or 5-1/2 on the East Coast–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  Then you’re fine.  The big running joke in functional medicine community–the easiest way to cure someone in California of hypothyroidism is to fly them out to the East Coast because the reference ranges from 4.5 to 5.5.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  That’s the easiest cure, the plane ticket.  But outside of that, people who really are suffering from thyroid issues and TSH and T4 aren’t enough to figure out if there’s a problem.  So we have to do deeper testing and that would include T4, but T4 looks at thyroid hormone in general.  It’s not looking at the functional aspect, the free portion.

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  And the free portion is only about 2% of the thyroid hormone.  Alright?  So I got this analogy from you one time, Baris, because you referred to like the free fractions of thyroid hormone is like driving around a parking spot with a hundred spaces–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  But 98 spaces have cones in them.

Baris Harvey: Yeah.

Dr. Justin Marchegiani:  So that means only 2.  So imagine we have a hundred cars driving around.  So 98 of those cars are our T4 hormone and maybe the only 2 of the cars are really are T4 free.  So only 2 cars out of the hundred get to park in the parking spots.

Baris Harvey:  Yeah.

Dr. Justin Marchegiani:  And that same analogy then happens with T3. So we imagine having a hundred parking spots open for T3, only 2 are actually able to park in because there are cones in all the other parking spots, right?  So we only have 2 hormones or 2% of the hormones that can go in there.  And most people don’t have the ability to convert T4 to T3, and if we don’t have the ability to convert T4 to T3 we may even have higher amounts of reverse T3.  Reverse T3 is like putting another cone in the parking spots.  So instead of having 2 cones available, now we only have 1–excuse me–

Baris Harvey:  Uh-hmm.

Dr. Justin Marchegiani:  If we have only 2 spots available, now we only have 1 spot available.  So it just decreases the ability for our thyroid to even have a metabolic effect, because for the thyroid to work, in our analogy the car has to be able to park in the parking spot.  The free hormone has to be able to park or go into the receptor site.  So again, looking at T4, looking at free and total, and looking at T3, free and total, and then even the antibodies, too.

Baris Harvey:  Yeah, definitely.  Yeah, so we’re gonna go into an entire podcast on thyroid testing because there’s–there’s so many different markers that need to be looked at and so often we’re just–just looking at the TSH which is–is not good enough.

Dr. Justin Marchegiani:  Exactly.

Baris Harvey:  Definitely not good enough and we’re seeing so many people with thyroid issues and all the different metabolic problems and metabolism that’s broken and a lot of it, it, you know, starts from the thyroid, so making sure that we’re actually understanding what’s happening in the body and giving the correct measurements are gonna help us make those changes, so definitely sounds awesome.

Dr. Justin Marchegiani:  Alright, great, my man!

Baris Harvey:  So we wanna remind you again to make sure you go to beyondwellnessradio.com/newsletter.  Make sure that you hop on the list.  You’ll be the first one to be able to access all these podcasts.  Also you’ll be first whenever we have anything ready set to go, any freebies, any kind of launches, you’ll be the first one to know and then also to get further understanding so make sure you go to justinhealth.com and he also has all these labs and the comprehensive lab that we talked about today available that you can just purchase straight from there and to get these labs looked at.  And again, please, please, please give us a review on iTunes.  It helps us so much to spread this message and to–to help anybody.  If you know anybody that needs help with lab testing or have any questions, make sure you send this to them.  Send to an email or tweet it.  It–it really helps get this message sent out.  So thank you, guys, again for listening.  Thank you, Dr. Justin, for your time.

Dr. Justin Marchegiani:  Excellent talk, Baris.  Have a good one!

Baris Harvey:  Yeah.  You, too!



My Lab Tests Are Normal But I Still Have Symptoms

By Dr. Justin Marchegiani

I see patients all the time in my practice that tell me they don’t feel right, yet their medical doctor tells them their lab tests are normal. The typical response from the average medical doctor will be something like this: “It’s all in your head. You may benefit from taking an antidepressant.” Or if you’re a woman, it may be blamed on female hormone issues, and the next solution may be to go on a birth control pill to help normalize your cycle.

Intuitively, people know something’s wrong even if their lab tests aren’t totally in the red. The most common response I hear in my practice—

“My lab tests are normal, but I still don’t feel well!”

Blood Test Normal Range

The problem with this scenario is there are physiological, biochemical, and hormonal explanations for why patients feel the way they do. Conventional medicine typically gives these patients no answers and worst of all, can sometimes make them feel as if they’re making it up.

In the world of functional medicine, we tend to look at things differently than your conventional medical doctor. Most lab tests have originated to include 95% of the population into the normal values. So if your medical doctor tells you your labs look fine, that just means you fit into that 95% category, or two standard deviations away from the mean if you are into statistics.

Anyone that has walked around an airport for just a little bit of time will be able to tell you 95% of the population doesn’t fit into the healthy category. Conventional medicine makes a massive assumption that the absence of disease is health. This is like saying the absence of being poor on the street means you’re rich! I hope my analogies help drive the point home that these assumptions are absurd!

Why the Answers to Symptoms Get Missed by Conventional Lab Testing

As society gets sicker and sicker and sicker, we know the reference ranges get wider, and wider, and wider. So if you are someone that may have been healthy to begin with, and then have a sudden drop in your health, you may still fall within that normal reference range. Thus, being told nothing is wrong.

It’s really not your medical doctor’s fault. Conventional medicine trains physicians to look for pathologies or disease, and this is a good thing. Where this paradigm falls short is when you aren’t sick enough to fall into the category of being diagnosed with a disease. So what do you do next?

Essentially, conventional medicine is saying, “Go home, continue doing what you’re doing, get sicker, and then maybe we’ll be able to diagnose you with something in a few years.” Intuitively, that doesn’t sound right to me. We need to look at things in a more sensitive way so we can pick up this slow and steady breakdown before it becomes a major problem.

Your body is designed to adapt to stress. Maladaptation is the number-one sign that your health is starting to decline. If your body loses the ability to adapt to the various stressors in your life, you will eventually come down with some type of disease. The goal of functional medicine is to figure out where the underlying stressors are coming from. Using specific lab markers that are sensitive, we can chart your overall health function on a spectrum so as we start incorporating treatments, we have objective and subjective markers of improvement.

Functional medicine can look at the exact same labs and potentially pick up subtle things that conventional medicine may not. Click here to get your labs assessed.

Thyroid Lab Testing and the Inadequate TSH Test

Most people have low thyroid symptoms even though their thyroid lab tests are normal! The standard panels that are looked at are typically a TSH test (a brain hormone) and T4 test (a storage thyroid hormone). It always bothers me that conventional doctors very rarely look at the active thyroid hormone (T3) to assess a thyroid problem. Especially since the research over time has shown that TSH testing isn’t the best to assess thyroid function. If TSH is elevated, it’s a surefire sign of thyroid dysfunction, but it’s a marker that tends to elevate late in the game.


functional thyroid range

Above are the markers that I commonly run on my patients to assess which pattern of thyroid dysfunction they have. Thyroid antibodies are also looked at to assess if there is an autoimmune disease at play. Most conventional physicians totally ignore thyroid antibody testing completely because it doesn’t change the conventional treatment; Synthroid will be given either way. Knowing whether or not a patient has an autoimmune thyroid disease (Hashimoto’s thyroiditis) can make all the difference in the world.

When we are dealing with Hashimoto’s, it’s the immune system that is out of balance. It is destroying the thyroid gland. It doesn’t make sense to put all of our focus on the thyroid gland if the immune system is attacking it daily. Some people with Hashimoto’s (hypothyroidism) may need thyroid hormone depending on how bad the damages is. I always recommend getting a full assessment like the one above before it is recommended. Hashimoto’s patients will typically respond better on a combination of T3 and T4, like in Nature-Throid, or a bioidentical thyroid glandular instead of a synthetic T4 medication.

Adrenal Testing

Assessing the glands that help control and regulate stress is very important to your health. Your body is designed to be healthy, and part of being healthy means adapting to stress. Your adrenals are instrumental at producing hormones throughout the day that are designed to do just that.


adrenal fatigue

Cortisol is secreted in a pulsatile fashion, higher in the morning and then tapering off throughout the day. Cortisol is designed to help stabilize blood sugar and help deal with stress and inflammation. The more dysfunctional our adrenals become, we start progressing into deeper stages of adrenal fatigue. This is where our brain (the master controller) isn’t able to communicate with our adrenals properly and we develop HPA axis dysfunction. This is nothing more than communication breakdown that can be fixed with proper diet, lifestyle, stress management, and a properly prescribed adrenal program (specific to your pattern of adrenal fatigue).

Blood Test Markers for Health

Looking at blood test markers from a CBC, CMP, or lipid panel can provide a pretty good idea of how the body’s systems are functioning.


When we see digestive markers, like albumin, globulin, creatinine, BUN, or serum protein, out of balance, it can tip us off that we may be dealing with some digestive inflammation, low stomach acid, leaky gut, and/or malabsorption.

Energy systems

We can look at markers like RBC, Hgb, Hct, MCV, MCH, MCHC, and ferritin, which are markers for an anemia. An anemia typically deals with deficiencies in certain B vitamins, like folate or B12 and/or iron. Most conventional doctors tend to miss these subtle imbalances. And they can contribute to a person’s inability to transport oxygen, create energy, and convert T4 (inactive thyroid hormone) to T3 (active thyroid hormone).


When we see blood sugar markers, like fasting blood sugar, hemoglobin A1C, or insulin, out of balance, it is a good sign there is inflammation. There are more specific markers that can be looked at, like C-reactive protein, ESR (erythrocyte sedimentation rate), fibrinogen, and a triglyceride-to-HDL ratio greater than 2.


When we assess white blood cell (WBC) function, long-term low WBC can be indicative of a chronic infection, while elevated WBC can be a sign of an acute infection. This rule is the same for the WBC’s constituents as well. Below is a list of the specific components of WBCs. We are looking at the markers below in a more sensitive range than the standard lab range, so we can pick up more subtle infections.

  • Neutrophils: Potential bacterial infection including H.pylori
  • Lymphocytes: Potential viral infection
  • Monocytes: Potential parasitic infection and recovering from an infection
  • Eosinophils: More specific for a potential parasite infection
  • Basophils: Can increase due to allergies, inflammation, or parasites.
  • Alkaline phosphatase: When low, a sign of zinc deficiency, which is a key immune-system nutrient

Blood Test Normal Range

Stool Testing

Most people who are tired and moody and have weight gain and hormone imbalances tend to have an infection! I have tested hundreds of patients, and I would say, based on my experience, over 70% have a parasite, bacteria, or fungal infection.

Yet in First World countries, it still isn’t accepted, by and large, that these infections can cause a problem. But having worked with many patients with these infections and having helped to remove the infections, I can tell you I’ve seen significant changes, and my patients will tell you the same.


GI Pathogen Screen

These infections can cause classic GI symptoms, like bloating, gas, constipation, diarrhea, and acid reflux. These infections, at the same time, can cause symptoms that are more nuanced, like depression, hormone imbalances, fatigue, neurological issues, skin issues, and weight gain. It’s hard to connect the dots when these infections aren’t causing the typical symptoms you would see in Third World countries (distended bellies and such).

Click here to receive more great information like this!

So What Do I Do Next?

If you are told that your lab tests are normal but you know something deeper is wrong, you are probably correct. Most of these problems if left alone only get worse and take more time and money to fix later on.

If you need help getting to the bottom of your health challenges, click here!

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.