Conventional GI Workup vs Functional Gut Health Program | Podcast #297

If you’ve ever wondered how functional medicine differs from everyday conventional medicine, this is the podcast for you. Dr. J sets out to explore conventional medicine GI workup vs. functional medicine gut-health workup. It’s a compare and contrast while looking at what chronic conditions may be missed by conventional medicine. Check out for more info.

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, they cover:


0:29     Gut Issues, H. Pylori

7:49     How Are These Detected?

18:04   Tests

24:16   Compare and Contrast of Treatments

32:10   Saliva Secretions

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Dr. Justin Marchegiani: Hey guys, it’s Dr. Justin Marchegiani here really excited today we’re going to be having a phenomenal podcast on the topic of conventional medicine, gi workup versus a functional medicine gi workup. We want to just kind of give you guys a little compare and contrast and talk about where others shine and where others may be better, especially for most people who have chronic health challenges that may be missed by your conventional medical workup. Before we dive in, Evan, how are we doing today, man?

Evan Brand: Doing really well, this podcast started with a story. quick story. The best man in my wedding. He called me last night and Hey, how you doing? Everything’s good. Okay, awesome. And then hey, I need some help with my wife. She’s been having a lot of gut issues for the past several months. She went into conventional doctor then went to a I’m assuming she went to some type of a specialist. Gi probably I told them about her issues which were bloating, major abdominal cramping, cramping, and pain, floating stools, possibly some changes with mood, but I don’t know if that was brought up to the doctor. So just conventional gi stuff and some pain that was radiating to the back. So pain in the front that was in radiating to the back. And her protocol was no testing. I don’t even think they did palpation they didn’t do physical exam. I think it they just listened. And then they said, okay, buy this probiotic. This probiotic was something that you and I looked up. It was one strain of bacteria in the bifido family, and it was loaded with fillers. And it was what’s considered a consumer grade product, meaning you don’t have to be a practitioner to get it. And it was just loaded with garbage fillers and sugar and other stuff. It had sucrose like why do you have sucrose so that was it. So that was it. And so then When you and I called this morning, I just said, Look, we’ve got to cover this because she got nowhere. And she spent all this time sitting in a doctor’s office waiting. And now she’s no better off. So I talked with her for a little bit. And we made a protocol for her that I think is going to be far, far better.

Dr. Justin Marchegiani: That’s great. Yeah. So really excellent. And when we see patients on the functional medicine side, most have already gone through a pretty thorough, conventional workup. So, you know, my perspective on a lot of this, not that I’m a trained gastroenterologist, not we’re functional medicine practitioners. But I see lots of patients who have already been through the gamut. And so I really try to understand what’s already been looked at what’s been tested, and you see a pattern, you know, when you see a couple hundred patients kind of go through these intense workups you see a pattern of what’s already been done, and you can kind of see what’s been missed, or kind of what their perspective is. So, most conventional gi doctors, you know that these are ones that are not functional medicine and nutritionally change right 90% are going to be in the conventional Category right there just following the typical internal medicine gastroenterologist, kind of best practices workup. So most are coming in they’re doing a history, they may do a physical exam some kind of a palpation to see where inflammation may be in the intestinal tract right certain areas may lead them to think certain things right, upper left quadrant, right my left that could be stomach kind of things maybe pancreas things, upper right. Could be more on the gallbladder liver area, you know, bottom, like mid left could be more spleen, bottom right mid right could be more intestines, and then lower right lower left could be either appendix on the right could be colon ascending on the right, descending on the left sigmoid colon on the left so that you kind of get a decent area. If you just know the general anatomy of what the inflammation could be Now, the next step is going to be depending upon you know, how invasive that things need to go right. They may recommend a capsule or endoscopy just to get a window. What kind of inflammation is in the intestine and then almost always though, they may need to go deeper into an actual endoscopy which is scoped down the mouth. Alright, colonoscopy is going to be scoped up the rectum to look in the colon area right you have your sigmoidoscopy, which is the last part of the colon before, stool goes into the toilet. And then you have all the way up the different intestinal tracts in the colon, right you have your descending your transverse or ascending and then on the upper side, you have your tummy. You have your tummy on the endoscopy, and then you have the first part of that small intestine. So obviously on the colon they may be looking for if you’re older, maybe polyps, which could be precancerous, they may be looking at inflamed tissue. It could be inflamed tissue from a ulcerative colitis when maybe there’s bleeding. It could be inflamed tissue from Crohn’s disease, which may manifest a little bit differently higher up usually, and usually there’s some level of skip lesions we’re all sort of colitis may not have that on the upper side. There could be ulcers in the stomach, right? Those are all possible things. And then there may be other tests to look at the levels of blood there may be things done like a fecal occult blood, where they’re testing microscopic levels of blood in the stool, maybe looking at calprotectin, which are inflammation markers in the intestines, maybe doing a barium swallow to look for any fistulas or blockages or even bleeding. On a barium swallow those are all like conventional things, they may pull out a ultrasound to look deeper at pancreas or gallbladder or liver, if some of that area comes back and flame or to even monitor monitor some of the krones type of inflammation. Some of the more progressive gastroenterologist are starting to do more of the breath testing, the lactulose breath testing, which may look at hydrogen and methane gases. Some may even do a glucose type of breath testing, it looks at more of the bacterial imbalances in the stomach. These are all other more progressive, forward thinking kinds of functional medicine, functional GIS, maybe doing that. Not a lot do that though. Then after that you have your conventional blood tests which could look for inflammation or immune cells or calprotectin. Or actually no calprotectin has to be in the stool but you could look at C reactive protein, you could look at immune markers, right. You could also look at the blood, you could just look at red blood cells, hemoglobin, hematocrit, iron, because if you’re losing blood, you may see it on a panel like that as well. And then some may also do stool testing. Now they may do more of your conventional stool testing that is less accurate, less specific, maybe not the more cutting edge DNA testing that’s looking for microbes that are more sensitive level parasites, H. pylori virulence factors Candida sibo bacterial overgrowth, right elastase deatta krijgt elastase is an enzyme markers, the adequate amount of digested fat marker. So these are things that they they’re typically not going to look at that we’re going to really dive in deeper because we’re doing a real functional assessment for what’s happening in the gut conventional medicines more looking at a pathological assessment, where we’re looking at PE, here’s optimal digestion what’s functionally not working compared to optimal, because there’s a big spread between, you know, being functionally optimum, and being disease and pathological is a big spread. So the problem is a lot of people are in between, this is where a diagnosis happens. This is where optimal is maybe somewhere in between that area and they’re just not going to get picked up. They’re not going to get assessed or found. And that’s where most 90% are going to be in no man’s land. In regards to their assessment or diagnosis, now we can go into treatment next, but I’m going to just pause there and give you a chance to comment.

Evan Brand: Sure, yeah. Good. Good overview and H. pylori breath testing is sometimes done. 

Dr. Justin Marchegiani: I forgot H. Pylori. I’m sorry. Yes. H. Pylori as well.

Evan Brand: Yeah. So that’s something where, you know, if we, typically what Justin and I are doing when we work with someone is we’re going to have them send us any labs that they’ve done. Maybe the last six months, maybe a year. If We think it’s still relevant. And we’ll take a look at it. So each problem our breath testing will see those. But the truth is that there can in with all these conventional, less accurate tests, there can be an issue with false negatives. So that’s even more frustrating for the client or the patient because they come to us. They’ve got five or six things they’ve done with the GI people, and they still don’t have any answers. And of course, they don’t have any action plan or protocol. So for me, before I figured out that I had h pylori and parasite issues I did the barium swallow, you drink barium, which is terrible. It’s like drinking chalk. And then you go and you get an X ray. I was having a ton of gi burning upper gi burning so that’s where they did the you swallow it and then you basically lay back they then X ray you and try to see what was going on. And, of course, I wish I didn’t have that done because it wasn’t functional. And it gave me no answers. And all they said was Yeah, you may have some inflammation, they just call it idiopathic gastritis and then they send you on your way. No, yeah, meaning Idiot gastritis we don’t have a clue. And then they gave me the recommended acid blocker and the anti spasmodic and sent me on my way. And I said, I’m not taking them, don’t even give me the prescription pad, I’m not going to take it. And then Luckily, I was able to do functional testing, which then confirm the bugs that I had. So, so I’ve been there, I’ve been there, done that, and you made a great point, I just want to kind of restate it in a different way just to make people make sure people are clear with it, which is this this huge, wide, like you call it a spectrum, the spectrum of all the way over on one side is death disease, celiac krones, just like some sort of like you said, a pathological diagnosis. And then on the other end is like optimal gut health. And you could be so far down this hole, very, very close to pathological level of tissue destruction in the gut, but still not enough to technically be celiac or be krones or be this or that. So until you get to that level, to the conventional world, you’re fine. You just got to keep that Go and keep going, keep going until you get to the level of tissue destruction where you could say you are celiac or Crohn’s or pain, colitis or whatever. Now we can prescribe you this drug. And that’s it. And I’ve actually had doctors tell some of my clients during their workups Hey, sorry, you’re not there yet. You’re not bad enough yet. You’re not sick enough yet. We can’t do anything until you get to this point, like with thyroid, you know, your thyroid is not destroyed enough where we’re gonna put you on this drug or we’re going to cut your thyroid out. So just keep living as if you’re living now, once you’re bad enough, then call us back and we’ll cut your thyroid out or we’ll cut out your colon. If it’s diverticulitis. We’re going to wait until you’re in really bad shape. We’ll go ahead and do surgery. Let’s cut a foot of your intestines out. Yay. No, that’s not the answer.

Dr. Justin Marchegiani: Exactly. And then just to kind of echo on it because we see a lot of H. pylori, and conventional medicine may do a endoscopy for that where they’re taking a sample in the upper intestinal tract view the scope, they may do a stool And that may or may not pick it up. And then they’ll typically do the breath testing and like there’s different kinds of breath testing, as I already alluded, right you have your lactulose, which is going to be more your cebo breath tests, it’ll look at hydrogen and methane. You have your glucose, which may look at upper intestinal, upper gut, stomach type of bacterial overgrowth, right lactose takes about two hours to work through the full stomach, the small intestine, so anything after two hours is usually a pretty good window into the colon, because that’s where lactose starts to get absorbed by the bigger, bigger bacteria in the colon. But glucose tends to get absorbed a lot faster in that first, you know, 20 to 40 minutes so it gives you a better window of the stomach. And then you have your h pylori breath test where they’re giving you like it’s a urea breath test, they’re giving you like a urea tablet or a urea solution. And basically, the H pylori in your stomach will take their urea, right because typically how h pylori works, that makes an enzyme called urease. And that method analyzes the urea and the protein into ammonia and co2. So when you give that urea, the H pylori will convert a lot of it into co2 and ammonia. Ammonia has a pH of 11. So it’s very alkaline so that throws off your stomach digestion and lowers your stomach acid, but it also spits off a lot more co2 than in their mess. They’re they’re measuring high amounts of co2 to get a window if you’re positive for H. pylori on that conventional H. pylori breath test. So they’re looking at three things. Typically, they’re looking at breath, maybe a stool antigen, which is the stool under a microscope, they’re looking at maybe an endoscopy, if it’s more serious to rule out gastritis or ulcers, and then maybe a blood test with a look at like an IGG, IGM, or IGA. And it G’s more of a long term marker, so you really want to request an IGM IGA to see if it’s more active and acute. So those are the big things that they’re going to be looking at on the H. pylori side and I just say that because h pylori is a big thing. We find a lot and can be a problem in a large percent of the population after 30 to 50%. And then I would say things like Candida or a fungal overgrowth are very rarely looked at or assessed and will typically look for that in the stool. And we’ll also look for that in the urine via a functional DRAM and a tough test. So we’ll look at things with a good functional stool assessment. We’ll also maybe do that cebo breath test that lactulose SIBO breath test. Now most conventional gi Doc’s don’t do it. There are some like for thinking conventional MDS that are gastro docs, like Dr. Pimentel at a cedar Sinai, he started making more of the breath testing more mainstream on the conventional side, which is good, which is excellent. But still, a lot of conventional Doc’s aren’t even doing it. So we’ll do that. We’ll look at it we’ll run the more progressive sensitive DNA stool tests. And that will also look at the urine test which can look at bacteria in the urine and it can also So look at fungus in the urine, the [inaudible] or I can look at the hippo rate and the indicator which is a marker for bacterial overgrowth, as well as protein putrefaction not breaking down your protein. So benzoates another big one. [inaudible] in a tick is the fungus. And those are HIPAA raised another big one, there’s a couple of 2 phenylacetic acids. Another big one is about 10 markers that we’ll look at for bacterial overgrowth on an organic acid.

Evan Brand: And none of the stuff that we’re going to do is going to be invasive at all we’re going to get into kind of the, you know, compare and contrast some of the treatment options to we have regarding the testing the stool that we’re going to do, it’s an at home stool test, it’s going to be way more accurate. I’d like to put a number on it and say 100 times more accurate and sensitive but I don’t know the exact number. I would just say that. We’ve had hundreds and hundreds of people who’ve done conventional testing through their practitioners, they show up with nothing, even like doctors data has missed in fact For example, but there’s DNA stuff that will run will find or fill in the gaps where the other testing failed or lacked. So that’s going to be the at home stool testing, and then the organic acids testing. That’s amazing. I mean, that even find stuff that the stool test doesn’t find like the yeast overgrowth, and it’s all done at your house. It’s amazing. Nice.

Dr. Justin Marchegiani: Yeah, it’s very, very nice. It’s non invasive. I’ll tell you the problem with a lot of conventional medical assessment, if they’re doing a breath test, fine. If they’re, you know, obviously a good pal patient is really nice, especially when it’s acute, conventional medicines really good at finding Irritable Bowel Disease, like you know, krones ulcerative colitis, or something more like an ulceration. If you’re older that can be helpful at like precancerous polyps, but even that they don’t address why those polyps grow. That’s another conversation. So they’re really good at finding those kinds of things. But the question is, how do we get there is that underlying cause being addressed a lot of times it’s not, and then a lot of times it’s being managed with ppis proton pump inhibitor. Maybe a corticosteroids, some kind of like they have like natural coating products that kind of coat the gut but still don’t fix the underlying issue. May maybe Imodium or some kind of antispasmodic, or anti nausea medication, especially when IBS is a diagnosis because a lot of IBS type of diagnoses or diagnosis of exclusion, meaning they’ve ruled everything out, therefore, they give you this diagnosis, which means, hey, you have some symptoms, but we have no idea why it’s cost or what the causes so they give you this diagnosis, you feel comfortable that you got a label, but that diagnosis is a diagnosis of exclusion. It’s you rule these things out, therefore it has to be this that tells you nothing about the underlying cause. And you’re still recommended just certain medications that control the symptoms, and may create more problems over time. Like if you’re on chronic acid blockers, you’re going to have issues with minerals, and digesting protein and digesting fats and over time, you can have some serious nutrient deficiencies for sure.

Evan Brand: And then you can have mood issues, you’re gonna have sleep issues, because now you’re not making neurotransmitters from the amino acids. So now you’re irritable, you’re anxious, you’re depressed, you can’t sleep at night, and your guts still a wreck. And that was me. And I got the diagnosis of IBS and it was nothing but drugs. And back to my friend’s wife. So they recommended that we talk about that probiotic. It was just one strain, and it had a bunch of garbage fillers in it. They also, of course, told her to eat more fiber. And this is a woman who’s basically pescatarian and she’s eating cooked organic vegetables for almost every meal, I’m like, wow. So they told you eat more fiber? Did they even ask you about your diet? No, of course they didn’t. They didn’t ask you what you’re eating. I mean, vets are better at helping with gut issues. And dogs then gi dogs aren’t helping with gi issues in humans. Why? Well, because the first thing you do when you go into the vet, what’s the vet gonna say? Oh, what kind of food are you feeding him? You go and you take your puppy and oh, my puppies, you know got diarrhea. Oh, what are you feeding your puppy? But that’s not the first question that gi doc asked. Now It’s not the first question we asked either right boy definitely in our it’s definitely in our workup.

Dr. Justin Marchegiani: Oh it’s something that’s going to be going to be asked on day one is one of the most important things for sure. But kind of getting back to the conventional Sykes I really want to give conventional medicine it’s Do you know hat tip where it’s good, it’s really good at a lot of these conventional, you know, irritable bowel diseases or extreme ulceration, they’re just still not good at getting to the underlying issue. So let’s say you have an Irritable Bowel Disease, right? They may give you something like a lialda or mesalamine or a corticosteroid or a biologic or an immunosuppressant or some type of antispasmodic or Imodium just something to manage those symptoms. If it’s bad enough, they may give you chemotherapy like a methotrexate, something like that. They may do deeper testing like a CT scan, if they’re looking at things or a MRI, which doesn’t have the radiation CT has the radiation they made. They made a deeper testing for that. A lot of times they’re still going to want to go inside Do that colonoscopy or endoscopy for sure, which has its own host of issues because you typically have to be under anesthesia for those, okay? And anesthesia has a major negative impact on your gut flora. And sometimes they may even want you to be on antibiotics post treatment sometimes. So it just depends upon the doctor and kind of your situation. But the anesthesia could have some negative impacts on it. And there’s some data it’s more controversial now, but I’ll put it out there. But there’s some data talking about the fact that the equipment that is used to do a colonoscopy, the cameras or endoscopy cannot fully get sanitized due to the sensitivity of the equipment. It can’t fully get sanitized. Therefore, there could be some potential fecal debris on there. from a previous patient. It’s possible right? It’s more controversial.

Evan Brand: No, I don’t think it’s controversial. I’ve seen it for years man, they call them  HAI- hospital acquired infection. It’s huge. It’s one of the leading causes of death in hospital setting is an infection that you pick up by getting a routine procedure done. I actually had a woman who had this happen, and she developed major, major major c diff infection. So she had issues before. You know, she was having a lot of stomach pain, a lot of burning. She went in, went to the gastro, they did the endoscopic, the endoscopy, and let’s go. And after she got home, she had endless, endless, almost to the point where it killed her diarrhea. And I was like, oh, that doesn’t sound good. And guess what she had Clostridium difficile, also known as C diff. So then what happened? She gets the conventional GI Doc’s to prescribe her antibiotics, very, very strong antibiotics. However, C diff is just one of the major bacterial infections that’s become resistant to the antibiotics. The CDC has been warning this about this for years. They now call what we’re in now is the post antibiotic era. Just look up CDC post antibiotic era, you can read about it. And so this woman still had seed if she did the antibiotics, she killed off any remaining good bacteria. And she was still miserable. We ran the testing on her confirmed the C. diff was there via urine and stool. And then we used anti microbial herbs. And guess what, we got the woman better. We got the C. diff gone, and she was fine. So I’m glad that you pointed out they are good at finding stuff. That’s pathological. But yeah, and then they’re not going to tell you why you have Crohn’s and they’re not going to put you on an autoimmune Paleo Diet like we are.

Dr. Justin Marchegiani: Exactly, they’re not going to do that. Now, just to kind of highlight a couple things here. We talked about the hospital acquired infection, there’s also a chance of, you know, rupture, or, you know, poking the hole with with the cameras that are going into your, into your throat or into your rectum as well. It’s always a possibility. So the nice thing about some of these, the assessment and testing that we do, there’s no chance of any side effects, which is excellent and there’s no chance of disrupting your floor either with anesthesia or swallowing radioactive solution, right? So it’s nice to have an assessment that doesn’t really have a chance of causing any more problems. And it gives you that full spectrum because remember, on the conventional medicine side unless there’s this much inflammation on the scale, here’s optimal. Here’s a diagnose visible condition. There’s a large gap here. And if you’re somewhere in this gray area, this is the gray area where the doctor says, Hey, we can’t help you. Hey, it’s all in your head, hey, you’re just getting older. Here’s a prescription for an antidepressant. Like literally, these are things that happen after the fact and there are some doctors that are saying, Oh, well, here’s a probiotic, like you mentioned with your friend that called you and they recommended a crappy antibiotic right now. Hey, that’s better than jumping on the anti depressant, right? That’s at least a good step in the right direction. I appreciate the thought right A for effort, but outcome Not quite. And so the people are starting to wake up a little bit and I think people are under doctors are understanding that patients are going above and beyond and they’re reaching out the doctors like so some not a lot are striking. Trying to get through games stepped up for sure.

Evan Brand: Yeah. And the other story I had in my head, I may have mentioned this for but a male client of mine, he went in and got an endoscopy. And I don’t know exactly what part what material, what piece of the equipment, but anyway, he has a piece of equipment stuck in his body. And he has to go, he has to go in for surgery now to get that piece of equipment removed. And he just went in for a routine scan into scope. And now he’s got something stuck inside of him. And now they got to cut them open and get it out versus we’re having you wake up and pee in a cup at your house and mail it to a lab and we’re getting hundreds of biomarkers from that. And we’re having you poop into a tray and you scoop that into the collection to and you’re also doing that at home. And you’re sending that into the lab. So I mean, just in terms of ease, and you know, I’ve we’ve talked with quite a lot of few people who they’re worried about their immune system, so they don’t want to go around the hospital anyway, where there may be people that they could get exposed to COVID Yeah, so We’re saying, Look, don’t worry, you’ve never had to go anywhere. And with our practice, you still don’t have to go anywhere. And we’ll still mail you everything. You don’t even have to go to a pharmacy yet to pick it up. We’re going to mail you what you need to your door. So that’s fun, more convenient for sure.

Dr. Justin Marchegiani: Love it. But we did a pretty good job. Now we’ll just kind of compare and contrast a lot of the treatments, right? Because I have my six our protocol on how we work on digests or work on supporting someone’s health. So of course, gastroenterologist are typically going to make zero recommendations on food. Now some of the more progressive ones may say, hey, cut out gluten dairy, refined sugar, that that could be common that a lot of times, that’s not going to be enough, or they’ll recommend a conventional low fodmap diet, which could still have other grains and other inflammatory foods in it. So that still may not be great. So we have kind of our own special kinds of diets that we use, whether it’s a specific carbohydrate diet, cutting out females, salicylates, whether it’s not immune diet, which is kind of paleo plus, right, paleo. No grains legumes dairy right on the immunes no nuts seeds nightshades eggs we may do a keto we may do a carnivore we may look at cutting out histamines and a lot of different dietary templates that we have used thousands of times and we kind of know where the best ones to apply are, that’s important because nine times out of 10 your conventional doc won’t even touch that. Okay, next up is we’re going to recommend digestive support. Now your conventional Doc’s more likely to prescribe an acid blocker than anything to help improve digestion. Now, an acid blocker may be reasonable if there’s an ulcer or an acute ulcer. Now, a lot of times also like pain can improve with digestive support. So there’s also like pain we make ask to try a tiny bit of acid, the tiniest amount, maybe a teaspoon, or an eighth of a teaspoon of ACV or lemon juice. If that causes any irritation. We can all assets we just lean on enzymes. We just lean on maybe some bile salts and then we work on adding in extra healing and soothing nutrients to help support the gut lining conventional Medicine are not going to recommend any healing soothing nutrients, they’re not going to recommend glutamine, aloe, dgl, zinc, rising carnosine, they’re not going to recommend any of these high quality nutrients to help support the Go on.

Evan Brand: Let me point out to if you’re putting anything with acid on the shelf, it’s on the shelf temporarily, we’re likely going to bring that in at a future date where, you know, I got into the debate with the GI doc back in the day, and I asked her, Well, why do I feel better when I do extra acid and extra enzyme? She goes, No, that’s not possible. I’m like, I take more stomach acid, the more stomach acid I take, I feel better. I have less bloating. I have less gut pain. Nope, that’s not possible.

Dr. Justin Marchegiani: Okay, that’s someone that does not have an understanding of physiology, right? Because physiology tells us the more stressed and inflamed we get, the more our sympathetic nervous system is activated. Where does that jump blood to? arms, fingers, feet, why run, fight flee. So all that goes away from the intestine so we have a decrease in our digestive juices and we have a decrease in acidity because that’s part of the juices that are produces and then the acidity triggers enzymes to be produced. So if you have any type of acid irritation, unless we’re coughing up blood, or we have an active Oh sir, I always recommend adding a very tiny bit because sometimes, least half the time, it can make it better. Sometimes the mucosa is so raw that it can’t handle it. So if that’s the case, if we can’t handle it, we lean more on enzymes and healing soothing nutrients. If we can’t handle it, then we just gently taper it up. And again, we’re typically recommending a stool test that’s going to look at old cold blood. So we’re going to get a really good window if there’s blood in the stool or run a conventional blood test that will look at red blood cell hemoglobin hematocrit and particular sites, okay, particular sites or young, immature red blood cells over losing a lot of blood. Guess what goes up particular site. So if we see a lot of particular sites that could be a sign of blood loss. Now, women could have that because they bleed a lot men straight Why’s and have a lot of estrogen dominance? So you have to understand the context of what you’re testing. And when.

Evan Brand: Yeah, good point, good point, the calprotectin we are going to be looking at so that is one marker that does have good overlap from conventional to the functional side. We love looking at calprotectin that’ll kind of give us a clue on just how inflamed is the gut? And is it possible that we could throw in a little bit of acid right away, and I’ve had people that they have had high calprotectin. And we were able to still do a low dose, maybe two to 400 milligrams of patane. And that was enough to really calm things down and improve their digestion so much that we then infer that the malabsorption was creating the inflammation in the first place. And all we did is help them break down their foods better and then the inflammation always drops. It’s so fun to see that I’m sure you get the same high from it that I do where you see high calprotectin you’re like well look at this number. It’s scary. We don’t like it. Yeah, protocol, retest boom, look at the levels drop. It’s so satisfying.

Dr. Justin Marchegiani: Yeah, I would also say a lot of the inflammation and the irritation that is in the inside. decimal track can be from poor digestion. So the food purifies it ferments, it runs cinephiles, it basically rots inside your intestines, and that creates his own host of acids that can be irritating. And sometimes taking a little bit of a digestive acid can decrease the rotting acids from the food. So that kind of thought process is a little bit of acid can decrease the production of more acids from the rotting of the food. And big big clinical pro write this down. I always recommend taking acid with food already in the stomach. People can have false positive ulceration symptoms with HCL by not taking their HCL with food and that’s protein and fat. So I always like protein and fat on the bottom of the tummy kind of coating it and then we’ll typically come in if we’re on the fence with a 16th to an eighth of a teaspoon of ACV or lemon juice, tiny bit and some water just a tiny bit and then that’s a good first step because if you can handle that, then usually you can work your way up. If you can get to a teaspoon to a tablespoon, then usually we can start to add in supplemental HCL and go from there. But worst case, if we can’t, or we’re just being more conservative, we just lean more on enzymes. We go to the gut healing nutrients, and the third are repair right repairing the hormones and the gut healing nutrients where we support a lot of the adrenals. and stuff as well. We need testing for that. The fourth RS where we come in and knock out infections. Most people on the conventional side the antibiotic is prescribed first, not fourth. So we set the table so we can go in there and deal with infections better. And then we’re using herbs that have more of a broad spectrum, but I’m more selective for the bad critters versus the good guys, which don’t create as much of a rebound overgrowth, and then we deal with repopulate rynok good bacteria and we’re not doing just to defeat along them with a whole bunch of additives. We’re doing professional strength professional grade, high potency antibiotics that have you know, that the amount of probiotics on our labels is where that would be at expiration. Not at manufacturing. So when you get a product from us, you’re probably getting double the amount that’s actually on the bottle. And then six RS retesting, and we understand that siblings and their spouses may pass infections back and forth. That’s really important to keep that in mind when we have a chronic issue.

Evan Brand: Yeah, and that’s not that’s not going to get brought up ever. I mean, I actually had a actually had a medical doc send me an email, and they were mad at me because I blamed the husband’s H. pylori infection on the wife. And so the wife was working with this doc and was saying, this practitioner, this guy on the internet, is saying that I’m the reason that my husband got reinfected with h pylori. So the medical Doc’s like that’s not possible. That’s not true. I’m like, Look, man, I could send you hundreds of cases I’ve got before and afters here where we tested someone. We then made a protocol we got rid of the infection two to three months later the infection comes back within test the spouse, boom, the spouse is positive, then we put both Have them on a protocol, boom. Now both of them are clear and both of them stay clear. So, I mean, why that would be controversial? I don’t know. But it was it was a funny email.

Dr. Justin Marchegiani: Yeah, I mean, I have one study right here in front of me it’s called saliva secretions in the efficacy of H. pylori. They’re talking about H. pylori was detected in dental plaque and oral lesions and in the saliva.

Evan Brand: When was the year of that study? Just curious.

Dr. Justin Marchegiani: Yeah, I’ll pull it up here right now. So you can see it may put it right up on the screen-

Evan Brand: Because maybe, you know, maybe this was a guy who maybe he hasn’t looked at a journal in 20 years and he doesn’t know that this is possible or true. And while you’re doing that, too, I want to say something about the-

Dr. Justin Marchegiani: 2011 but there’s a lot of studies on this stuff. So there is going to be some h pylori in the saliva for sure.

Evan Brand: Yeah, and I want to talk about the the herbs in such too. So the cool thing is with the anti microbial herbs, those alone can help reduce them. inflammation and we made out of the gate, as opposed to saying, Hey, here’s an acid blocker out of the gate. If we’re waiting on testing, you know, if someone’s really miserable, it may be 2 3 4 weeks turnaround time. We could throw something in right out of the gate that’s going to address and calm things down, which is very, very good. We talked about a guy had that was a teenager with panchal itis we talked about him a few podcasts ago. But anyway, we got him started on a really potent aloe extract right away. And by the time we got his lab results, Two, Three weeks later, he was already significantly better in less pain, less misery. So that’s the cool thing is there are some quote like, I don’t want to call him urgent care, but for lack of a better term, there are some quick fixes that we can implement right away before we get testing.

Dr. Justin Marchegiani: Totally. And then right here, salivary secretions, the Journal of dental think this is out of two round salivary secretions and advocacy of H. pylori eradication. So basically, they see that hey, the oral cavity may be affected, right. And they see that there could be saliva. saliva could contain H pylori secretions and then the conclusion is they find that h pylori eradication from the stomach may reduce the may reduce the salivary secretion of H. pylori. So we see that in some of the studies and this has been around for a while, so, it’s good to know that and that just kind of supports our theory that we’ve seen clinically with spouses passing things back and forth. And, again, you know, it doesn’t have to be a sexual thing, just sharing drinks and maybe silverware and just living in a house where those kind of things happen easier, right? That increases the chance.

Evan Brand: Oh, yeah, we’ve seen it in kids where it’s like, oh, hey, honey tribe, I did this organic dairy free ice cream, and mom’s got h pylori here. She has given her two three year old the spoon and then you and I’ve seen you know, countless children 2 3 4 5 6 year old kids with H. pylori, and my daughter had it my oldest summer she had h polarized so we tested her gut she had parasites first we eradicated those then on the retest H. pylori showed up and then luckily we were able to get rid of that. So you know, we clinically and personally deal with these things all day, every day, so we have a lot of, we have a lot of sympathy and empathy when it comes to the gut work here. And I just feel for all those people like me that they go to the doctor’s, you have so much hope you’re so anxious about the appointment. I remember feeling comforted. I remember I was in so much pain. I remember being in that office waiting for the doctor to come in. And I just felt comforted back then being in that environment. I’m waiting in the office. I’m like, Yes, she’s going to come in here he or she’s going to come in here. They’re going to give me the answer. They’re going to help me they’re going to get me solved. And then my bubble just got burst. I remember walking out of that place just so disappointed. I thought, oh my god, I remember the beginning of my appointment here. I was so thrilled and happy. I’m going to get to the bottom of this thing. And then here I am, you know, X amount of time later so disappointed and had to keep searching. So we feel for you, we’ve been there.

Dr. Justin Marchegiani: 100% and then again, just because someone has h pylori. The healthier you are, the stronger your immune system, the better levels of IGA you used to create which is going to be in the saliva. mucosa mucosal membrane barriers that’s gonna fight these infections. So it’s just because you get exposed to it in the saliva doesn’t mean you’re necessarily going to get an infection. But the more immuno compromised, you are stressed, weaker adrenals gut barrier integrity issues, poor digestion, the greater chance that h pylori that’s in the saliva could gain a foothold in your body. It’s very possible.

Evan Brand: Yeah, good point. I’m glad you pointed that out. Because there’s going to be a couple haters. Eventually, they’re going to hear this and go, Oh, that’s bullcrap. You know, 50% of the population has H. pylori, you’re painting it to be the bad guy dead. Well, in the modern world, people are so toxic, so stressed, so immunocompromised that I don’t think we can coexist the way we used to, because our buckets are so full. So these things do tend to take on a more pathogenic pro inflammatory state than maybe previously where people stress bucket and toxin bucket was less full. So yeah, I’m glad you made that point.

Dr. Justin Marchegiani: Yeah, and again, not everyone will get exposed to it, because their immune system will just knock it out via their IGA and some may get it but they’re going to be able to be Ace symptomatic, and they’re okay. And then they’re just like, hey, this isn’t a problem. And then they project their their good health and their asymptomatic status to Hey, you know this, this can’t be the problem, because I had the same thing, but everyone has a different constitution. And because of that constitution difference, it could affect you differently. For sure.

Evan Brand: Yeah. Well said, Well, I think we did a good job. We covered the testing piece, kind of the conventional colonoscopy and endoscopy, barium X ray scans, MRIs, CAT scans, CT swallowing, radioactive tracers, compared to the at home, organic acids and genetic DNA based stool testing that we’re doing at home with people. We compared the drugs, the antibiotics, the acid blocking medications, the antispasmodics, the immune suppressant or immune modifiers, like you mentioned, possibly an extreme case a chemo drug, versus we’re going to be going for more inflammatory herbs, natural antimicrobial herbs, anti parasitic antifungals, possibly some extra acid and enzymes, maybe some zinc carnosine and other things to heal up the gut later. Maybe some additional mushrooms and adaptogenic herbs to strengthen the immune system, possibly using these things throughout the family with spouses or children to help protect them as well. And then of course, the diet piece possibly, like my dad when he was suffering. When I was a young kid and he was suffering with diverticulitis, he was told to eat more fiber and that was his diet protocol. And it was take you know, GMO Metamucil psyllium husk or whatever it was with natural with it probably wasn’t even natural flavoring back then it was probably artificial flavoring. And that was the protocol versus you mentioned the templates so possibly, low fodmap low histamine, paleo autoimmune carnivore. There’s different things that we’re going to do based on our educated guesses plus, with the labs, the information and then people’s food journals, how are they feeling basically-

Dr. Justin Marchegiani: Even cooking, cooking, a lot of times just cooking those foods up better, avoiding raw foods and that can help a lot right the cooking is pre digestion and if your tummy has a heart digesting the food The more we can pre digest that food within reason you know steamed sauteed even stews or soups instapot crockpot pressure cooker that can really help with helping the tummy access those nutrients better. 

Evan Brand: I brought out the Instant Pot The other day you know it’s summertime it’s hot so it’s not very attractive to bring out the Instant Pot but man, we threw some organic purple sweet potatoes in that instant pot, 10 minutes. It’s awesome. Oh my god, they were so good.

Dr. Justin Marchegiani: Oh, yeah. Like like my carb cheat on the weekend is going to be potatoes because why? Cuz they’re grain free. They’re starchy. I can handle them on the autoimmune side. Some may not be able to but it’s just it’s a really good healthy safe starts and it gives you that mouthfeel that you’d miss from like, you know, breads or grains. That’s my big cheat and I do 10 minutes on the instapot on that it’s wonderful or, you know, at a nice Steakhouse is pretty good too.

Evan Brand: It was hard to believe I could I mean, it was a pretty good sized potato and I thought 10 minutes there’s no way this thing’s going to be done. It was done. We put some butter on that bad boy, some garlic salt. Delicious. 

Dr. Justin Marchegiani: It takes 45 minutes to do Boiling or steaming in real life. I mean, the instapot is pretty amazing how fast they can cook stuff. 

Evan Brand: This episode is brought to you by Instant pot.

Dr. Justin Marchegian: I know right? Awesome well if you guys are enjoying this content and you wanna share with your family and friends, or you wanna dive in and get support from myself, Dr J or Evan,, reach out for Evan. reach out to myself, Dr. J. If you guys enjoy the content we’re available, click down below, whatever you’re source, we have links down below to get access. Make sure you give us a comment. Let us know what you think, what you like, what parts resonate with you, give us a comment, like, share, hit the bell for notifications and we appreciate you guys sharing this with your family and friends, so they can become empowered about their health. You guys have a phenomenal day. Take care ya’ll.

Evan Brand: Bye now.

Dr. Justin Marchegian: Bye.


Audio Podcast:

Low Dose Naltrexone and More | Podcast #185

Welcome to today’s podcast with Dr. Justin and Dr. Sajad Zalzala, a famous family doctor! Find out more about their discussion of the biochemistry and mechanisms Dr. Z learned when he was in medical school to get the extra buffer between conventional and functional medicine. Learn about the relationship of the allopathic medicine and functional medicine through drugs and diseases, like Diabetes, and about the different anti-aging pathways as they discuss more and dig deep into the Low-dose Naltrexone issue.

Watch as they discuss the right supplements and diets to restore health and wellness of patients of all ages.

Dr. Sajad Zalzala

Dr. Sajad Zalzal

In this episode, we cover:

01:39   Integrated/Holistic Medicine and Conventional Medicine

17:51   Metformin

21:47   The Three Anti-Aging Pathways

30:54   Opioid Crisis

47:15   Cannabis




Dr. Justin Marchegiani: Hey there! It’s Dr. Justin Marchegiani in the house. Welcome back to Beyond Wellness Radio. We have Dr. Sajad uh— Zalzala, Dr. Z for short. Dr. Z, welcome to the show!

Dr. Sajad Zalzala: Thanks for having me, Justin.

Dr. Justin Marchegiani: Well, let’s dig in today. So, you’re a family medicine practitioner. You’re a medical doctor and you kind of made your journey over to the functional medicine world. And, it’s always interesting because when you go from the medical doctor realm, you put so much time, so much work into understanding the allopathic side of medicine.

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: And, to come over on to [stutters] Let’s call it the— the uh— the— the good side, right?

Dr. Sajad Zalzala: Uhuh— Uhuh—

Dr. Justin Marchegiani: Walk me through that journey. How did that happen? Did you get disenchanted with conventional medicine? What happened in your life to then cause you to come over unto the uh— to the light, so to speak?

Dr. Sajad Zalzala: Sure. Actually, for me, it happened early on, uhm— right— right in medical school. So, actually, started out my uh— my career after high school uh— as Computer Science major. I— I— First, I don’t want to do anything with medicine uh— but I changed my mind, uhm— you know— a few years into my studies. That’s Computer Science, actually gravitated more towards a customer service helping people rather than, you know, technology.

Dr. Justin Marchegiani: Uhmhm—

Dr. Sajad Zalzala: So, I— I decided, you know, I’m wasting my time with computers and I decided I wanted to go. I— I wanted to be a doctor instead. Uh— So, I kind of switched gears and uh— you know— applied for medical school. I was fortunate to get in. I almost dropped out after the— after the first year of medical school. Uhm— Me— Studying was a lot harder than I thought it’d be, you know. I didn’t have the skills that I— that I needed uh— to uh— you know, to make it through. And, I almost dropped out actually. Uhm— But, what saved me was actually, in my introduction, is Integrated Medicine.or Holistic Medicine. At the time, it wasn’t you know— Functional Medicine is still one of those terms that wasn’t quite used yet, uhm— but I think, at that  time, Integrated medicine was— was the term that was mostly used. Uhm— But the reason I almost dropped out of medical school is because there I was a bit disconnected by what we are learning from the biochemical pathway physiological perspective of what we were learning from the therapeutics perspective. Uhm— You know, it just— it just— It seems like our class—  our class is completely ignored. Everything you could do from a diet, nutritional, you know, lifestyle perspective uhm— to— to help— to help a patient and focus specifically on drugs and surgery, and that was pretty much it. Uhm—

Dr. Justin Marchegiani: Totally. And— And again, I kind of little tongue-in-cheek, put a little jab at the…

Dr. Sajad Zalzala: Yeah.

Dr. Justin Marchegiani: …allopathic uh—

Dr. Sajad Zalzala: [laughs]

Dr. Justin Marchegiani: …medicine community. But, Allopathic Medicine is phenomenal at Acute Traumatic Care…

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani: …where the underlying cause isn’t an issue, right? You got in a car accident….

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani: …the underlying cause is already isolated. It was the car accident ot the trip and fall, right?

Dr. Sajad Zalzala: Hmm—

Dr. Justin Marchegiani: Chronic Medicine or Chronic Degenerative conditions, there’s an underlying cause that’s— that’s still not addressed that if you just…

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: …use medications, we’re not covering it up. We— We’re covering it up. We’re not getting to the root cause. So—

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani: You had this mindset where it was allopathic and then you shifted over because in family medicine, you’re just constantly prescribing drugs for symptoms…

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani: …and not getting to the root cause, correct?

Dr. Sajad Zalzala: Exactly. Exactly. I mean, I think— I think, conventional medicine and all kind of [incomprehensible] medicine is kind of a victim of its own success. BUt, a hundred years ago, I mean, uh— you know, Penicillin was  a big thing. You know, surgeries, surgical techniques were a big thing. And so, they were curi— you know— Allopathic practitioners are curing diseases and kneeling patients uhm— for things that were thought to be incurable. But— But in our— in our day and age, where most people are not dying of infections, where people are not dying of, you know, uh— you know, slivers in their feet and things like that, uh— you know, it— [stutters] they’re trying to take that— the success from a hundred years ago, and trying to— and trying to put it into our— our modern uhm— maladies, and it— it just— it just fails, terribly, because it completely ignores so many things in our biochemical and [stutters] uh— and uh— physiology.

Dr. Justin Marchegiani: Yeah. We’ve come a long way because water is cleaner, right? WE have good water purification process. Maybe we still leave some Fluoride and Chlorine in there but that’s another podcast.

Dr. Sajad Zalzala: [makes a sound]

Dr. Justin Marchegiani: We have, you know, clean— We have food storage systems like refrigerator so we can keep food fresher and such. Uh— Obviously, we do have the pesticide component. We do have indoor plumbing. These kind of things have decreased a lot of the infections, but then now we have all these Chronic Degenerative uh— things that are occuring, like heart disease…

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: …and Cancer at much higher rates. Was there a personal kind of impact with— Did you have a health challenge that kind of pulled you over from conventional medicine into functional medicine?

Dr. Sajad Zalzala: Not until later. I mean, I was a big fan of uh— Integrated Medicine, right? Kind of right from the start that I heard about it. Uhm— But later on I uh— you know— So, I’ve always had a challenge with my weight. I— I was a— I was a big kid back when there weren’t really many big kids.

Dr. Justin Marchegiani: [laughs] Right. Right.

Dr. Sajad Zalzala: Uh— [laughs] So learning about Integrated Medicine function has allowed me to kind of help me control that, and I still struggle with it. Uh— You know, if anybody’s— If anybody’s struggle with their weight, they kind of know what their doctor…

Dr. Justin Marchegiani: Uhmhm—

Dr. Sajad Zalzala: …you know, what I’m talking about. Uhm— But uh— you know, I uh— I learned to clean up my diet. You know, I learned that the uh— food pyramid was completely uh— bogus. Uh— And— And— And— And that— You know, I— I went Gluten-free back in 2011. And even though I’m not a strict as I want to be but uh— but I— I— I still think it’s a big component of— of— of where I’m at today in terms of my health. Uh— [crosstalk] And it— And it shows— Yeah. It shows just the power uh— of— of— of— of just simple things like that.

Dr. Justin Marchegiani: [breathes in]

Dr. Sajad Zalzala: Uhm— That— That just means your medicine’s fully ignores, or they actually try to— try to convince you otherwise. Uh— Like, there was a story and uh— uhm— how people who are Gluten-free are at high risk of having Arsenic poisoning. Uhm— We got to kind of read between the lines and say, “Well, it’s not— It’s not because you’re Gluten-free. It’s because you’re eating so much rice.” [laughs]

Dr. Justin Marchegiani: Exactly. You’re into [incomprehensible] but like—

Dr. Sajad Zalzala: And it has lights saying, “Gluten-free you know— Gluten-free uh— diets are linked to Arsenic toxicity, you know.” So, there’s still be this big war being waged between— you know, between the— the— the natural health community and the— and the conventional allopathic community.

Dr. Justin Marchegiani: A hundred percent, and that’s the problem. A lot of conventional medicine has a lot of confounding variables that aren’t really laid out there. That’s great that you’re able to break that down. And I’m just curious too because I found with a lot of medical doctors there’s like— There’s a sense of arrogance that like, “You know what, I’m in medical school. I’m a medical doctor. Ther— The medical school’s only gonna teach me what is important, and if I didn’t learn it in medical school, it must not be important.” How were you able to turn that part of your brain off and realize you weren’t getting the whole story, this wasn’t it?

Dr. Sajad Zalzala: Well, I guess that for me, because I was fortunate enough to learn about Integrated Medicine early on. Actually, learning about it, functionally, they’re medicine. Listen to Dr. Jeffrey Bland. [crosstalk] I listened to…

Dr. Justin Marchegiani: [crosstalk] Uh— Yeah. Got it.

Dr. Sajad Zalzala: …his— his clinical updates. You know, attending the uh— the— some of the IFM and the Integrated Medicine Conference. It actually helped me learn the allopathic part a lot— a lot more uh— effectively, uh— because— It’s ‘cause it opened— o— opened m— my eyes a lot more. So— So when I learn the allopathic stuff uh— you know, always in the back of my mind’s like, “This is not how it actually treat a patient.” You know, I had a Hypertensive patient. I would not actually actually start them on antihypertensives, you know. I fix their lifestyle first. But—

Dr. Justin Marchegiani: Right!

Dr. Sajad Zalzala: But…

Dr. Justin Marchegiani: Right!

Dr. Sajad Zalzala: …I know the mechanism is action for the medications and I know that the test is asking for this therapy. So— So I always l had a kind of [stutters] I had to act almost like a split personality in some ways where I needed to know what I need to— to think like the allopathic people wanted me to think like they have allopathic educators wanted me to think like. They also had this thing where I knew there was a different way to do it. Uhm— So— So I would— It was never a sense of betrayal as the only real sense of— of betrayal is was the fact that they— that they really didn’t teach any of these other therapies in medical school. Uh— And every time I ask my professor uh— about it like— like— like you’ve learn about a pathway or something like that. What— What couldn’t you— Couldn’t you change that pathway using, for example, you know, Turmeric to— to reduce inflammation rather than some drug or something like that. Or— Or— Or something like that, and then— and then the professor would kind of stare at me. It was like, “Whoah! Hah! Maybe you could? But we don’t have any large randomized controlled trials…

Dr. Justin Marchegiani: Hah!

Dr. Sajad Zalzala: …to  prove that. Uh— So, you know, with this kind of like, you know, move along. You just— just— just— just learn what we want to learn.

Dr. Justin Marchegiani: It’s like, “Of course, you’re not, because you can’t patent some herb— you know, that the mother nature created.” And then, if any drug company spent billion dollars getting it through Phase III Clinical trials, uhm— they wouldn’t have unlimited rights to it…

Dr. Sajad Zalzala: Yeah.

Dr. Justin Marchegiani: …so they would never recoup their money. So, of course, that’s never gonna happen, right?

Dr. Sajad Zalzala: Yeah. Wha— I mean, Functional Medicine is gaining steam uhm— into the mainstream. I mean, you have the Cleveland Clinic. They have a Functional Medicine department. Uhm— You know, you have— you have other major universities and hospital systems kind of down…

Dr. Justin Marchegiani: Yeah.

Dr. Sajad Zalzala: …board. Uhm— I don’t know if— if the— these programs will ever be as effective as we need them to be ‘cause a lot of times they’re kind of padded with uh— “fluff” for lack of better term. Uhm—

Dr. Justin Marchegiani: Totally.

Dr. Sajad Zalzala: But like for example, I mean, not to knock on any hospital systems but, you know, a lot of times it’s, “Oh! Come check out our uh— Holistic Medicine department,” and basically, just Yoga classes. Not the…

Dr. Justin Marchegiani: That’s it.

Dr. Sajad Zalzala: …knot kind Yoga. Yeah. Not the knot kind of Yoga. I mean, Yoga’s a great therapy but— but— but to think that— to think that— that— that, you know, by sprinkle in a little Yoga in a— in a hospital that you call it now Holistic Hospital. You know, I— I think— I think those just uh— uh— uh— whitewashing— whitewashing the whole thing.

Dr. Justin Marchegiani: Oh! I— I totally agree. And I’ve said— I’ve got it on records a few times, I don’t think you’re gonna see— and I could be all wrong. I don’t think you’re gonna see the Functional Medicine at Cleveland Clinical really, truly be what it needs to be. I think it will be water down to some degree…

Dr. Sajad Zalzala: Yeah.

Dr. Justin Marchegiani: …and the reason why I say it is because you’re gonna have tens of millions of dollars invested into a Cancer Wing at Cleveland Clinical Clinic. You’re gonna have tens of millions of dollars invested into a— into a Heart Disease Wing.

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: If you bring Functional Medicine treatment and care into that hospital, that sucks profit and revenue…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …out of those other wings.

Dr. Sajad Zalzala: Mm—

Dr. Justin Marchegiani: I mean, they’re CEOs. Just look at the— you know, the bottom dollar

Dr. Sajad Zalzala:

Dr. Justin Marchegiani: , and they’re gonna be like, “Hey! You know, this one thing is doing okay but, you know, it’s stealing a whole…”

Dr. Sajad Zalzala: Yeah.

Dr. Justin Marchegiani: …”bunch of revenue from what keeps the clinic afloat.” And, there’s a lot of money in Cancer and Heart Disease and Chronic Disease like Diabetes. And, don’t get me wrong, a just— There’s not gonna be the ROI on dr— on supplementation and lifestyle counseling because these aren’t patentable things.

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani: That’s the [inaudible]—

Dr. Sajad Zalzala: Yeah, exactly and absolutely. And then, unfortunately, I think until the healthcare bubble bursts and people realize that— you know, that [stutters] those insane to pay for, you know, 50,000 dollars a year for a therapy that just covers up the symptoms. Until that happens. Uh— Yeah. I think— I think we’re kind of stuck with it, unless— unless patients take— take control of their own health and try to kind of seek out their own therapy.

Dr. Justin Marchegiani: Oh! Totally. Like—

Dr. Sajad Zalzala: Mm—

Dr. Justin Marchegiani: I mean, for instance, uhm— my wife and I had a child at the end of the last summer, and he’s doing phenomenal. But, like a lot of children, as you know, as a family uh— practitioner, is had a— a slight like heart murmur, which a lot of times in— in the child and I— and I think can be totally normal. So, we were just like, “Alright. So, well let’s just get it evaluated.” Uhm— Kind of fast forward to the end, his heart was totally fine…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …but we get the bill back…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …and it was like 3,000 dollars…

Dr. Sajad Zalzala: Yeah.

Dr. Justin Marchegiani: …for an hour of the doctor’s time. I mean, they…

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani: …did like a little uhm— They did a little, I want to say, a ultrasound test.

Dr. Sajad Zalzala: Yeah, Echocardiogram. Yeah.

Dr. Justin Marchegiani: And uh— And then, one other type of test. But those 2,500 dollars, the insurance ended up paying everything but three hundred bucks. But, I’m…

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani: …like, “Wait a minute! Lie, if I just went to the— to the Cardiovascular doctor and was like…

Dr. Sajad Zalzala: Uhuh—

Dr. Justin Marchegiani: …out here, 300 bucks. Just— Just give me what I need from the service perspective…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …we could have just cut out all that whole insurance industry.

Dr. Sajad Zalzala: Right. Right. Right. I know, absolutely. Absolutely. Absolutely. Yeah, I mean— I mean, uh— the direct— direct care and— and self-pay is becoming much more uh— popular as— as copays and deductibles go up. Uh— I mean, I have an incredibly high, you know, deductible on my— on my family’s plan. And I do everything I can to try to stay out of the— of of the healthcare system. You know, I’m fortunate that I have access to the healthcare system uh— you know in the— in ways that I learn other people don’t but— but— but you know, people are smart about it. I think they can also kind of— you know, uh— work with their doctor, their— the- work with their health provider to kind of uh— keep people much more affordable. Uh— And [crosstalk] then— Then, when— Then, when you’re dealing with the insurance and everything’s inside it like uh—

Dr. Justin Marchegiani: One hundred percent, and that’s the issue— is that I’m paying a whole bunch of money for like a high-deductible insurance, where, in the end, I could had just paid that person cash. You know, I think…

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: …having an insurance is great for high-deductible stuff. You get in the car accident. [crosstalk] Something really—

Dr. Sajad Zalzala: [incomprehensible] Yeah.

Dr. Justin Marchegiani: Something really expensive that’s gonna happen and you may need care…

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: …or hospitalization, that’s where I think it’s good. But I think everything else, having an HSA or Flex Spending…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …and then, going with the doctor— ‘Cause with me— I’m not sure how it is in your practice but it’s just me. I have a couple of people that help on the administrative side. I don’t spend all this money on billers and staff and overhead. So, number one, I get more of what I g— what I charge…

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: …and I could charge less than most people because of the situation, right?

Dr. Sajad Zalzala: Yeah, absolutely. [crosstalk] Absolutely. Yeah. That’s why I started this. I w— You know, I’m— In the pre— pre-recorded session, I was speak— talking to you more about why I started this online clinic. Uh— It’s— It’s because by— by doing online, by a long-gauged access, a patient— you know, a— a practitioner directly— It brings down the costs.

Dr. Justin Marchegiani: Huge.

Dr. Sajad Zalzala: There’s also convenient factors as well. I mean, uhm— you know—

Dr. Justin Marchegiani: Don’t commute?

Dr. Sajad Zalzala: You don’t commute, right? You don’t—

Dr. Justin Marchegiani: Wait in the office?

Dr. Sajad Zalzala: Yeah. You don’t have to take a half a day off of your work schedule to go— you know— to go— to go sit— to go sit in a waiting room. And you know you just— you necessarily have to uh— uh— you know [stutters] You could potentially uh— book— book outside of the uh— you know, regular business hours. Uh— Because, usually, practitioners on the other end are, you know— they have a little more flexibility as well. So, it’s— it’s better for the practitioner and— and for the patient.

Dr. Justin Marchegiani: That’s great. And, Dr. Z, what’s your website? So, people listening, if they want to reach out to you and get support, how can they uh—

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: …can hold you?

Dr. Sajad Zalzala: Yeah. So— So, the uh— The online clinic I run is called the Uhm—

Dr. Justin Marchegiani: Love that name.

Dr. Sajad Zalzala: Yeah.

Dr. Justin Marchegiani: We’ll put the uhm— the link right below so if you guys are listening to it and you’re driving and doing something and you can’t access it. Just click below in the description and you’ll find that in there.

Dr. Sajad Zalzala: Sure. Sure. I mean, uh— [stutters] my goal for that clinic is to just try to help as many patients as possible by— by allowing them access to a uh— functional medicine glider. Uhm— One of a— One of the challenges with— with uh— a non-medical functional provider is— you know, the some— some of them faces as— Some— Sometimes, patients need medication uh— uh— to try to, you know, to try to get rid of certain…

Dr. Justin Marchegiani: Stabilize

Dr. Sajad Zalzala: …issues. Exactly. For example, if somebody has like a— has like heavily Yeast infected because of a Yeast Overgrowth— you know, sometimes, you need some kind of solinized standards. Herbs don’t always work as well as it should. Uh— We’re taking probiotics, so that’s kind of a— a situation where, you know, you— you need a medical doctor kind of in the background there to kind of order that. Order blood tests. You know, a lot— a lot of tests and things like that are not— I mean, you’re not able to access directly. Uh— So, I work together with these— with these uh— health coaches or these, well— uh— they’re— they’re functional medicine providers, I call them…

Dr. Justin Marchegiani: Yeah. [crosstalk] It could be a practitioner or another…

Dr. Sajad Zalzala: A practitioner, exactly.

Dr. Justin Marchegiani: …non-prescribing physician like myself.

Dr. Sajad Zalzala: Exactly. So, I kind of collaborate with these— with these non— with these non- uh— prescribing uhm— a non-medical— non-MV uh— uh— p— practitioners. They kind of get the best of both— get the best of both worlds to the patient. I mean, they— they have…

Dr. Justin Marchegiani: Okay.

Dr. Sajad Zalzala: …fantastic educations and experience in functional medicine. And then, when I need that support and supervision from a medical doctor, I’m licensed in 35 states, uhm— So, that allows me kind of broad access to— to pretty much, you know, 90% of the audience that’s listening to you in the United States. Uh— So— So that— That’s kind of my vision for that. YOu know, it’s still fairly recent in terms of its uh— launch. Uhm— You know, we’re still accepting patients. Uh— And— And— And we hope to— We hope that it’ll grow as time goes on if people know more about it.

Dr. Justin Marchegiani: Awesome, Dr. Z. So let’s dig in a little bit deeper here. So, number one, we have like— you know, you talked about like the biochemistry and the mechanisms when you were in medical school. You would dive in, you would understand what the mechanism is. You would try to get kind of your head wrapped around how the drug works for that mechanism. But then, you would say, “Okay. Well, how can we plug in a natural intervention to help support that?” Is that correct?

Dr. Sajad Zalzala: Exactly. Exactly. Again, that’s kind of where— where I listened to Jeff Bland and other— uh— other people like him; really made a big difference in my education.

Dr. Justin Marchegiani: Okay. Well, I’m gonna lay one thing out and then, let’s kind of play a game and just go back and forth here. That way, I think people can— can understand both mindsets. So, we have High Blood Pressure, right?

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: Those are the— I mean, we have the big medications for it. Are gonna be like Hydrochlorothiazide…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …like a water pill. We have Angiotensin-converting enzyme…

Dr. Sajad Zalzala: Uuh—

Dr. Justin Marchegiani: …drowse [inaudible] blockers, right?

Dr. Sajad Zalzala: Right. Right

Dr. Justin Marchegiani: So— So, I look at it as, “Okay. Well, number one, we can help water retention by…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …just helping with Insulin resistance ‘cause Insulin…

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani: …process water retention.

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: We have— We have uhm— the Angiotensin-converting enzyme medications, where we can just support the adrenal function.

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: We can get inflammation in the body down…

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani: …which will help decrease vessel constriction.

Dr. Sajad Zalzala: Mm—

Dr. Justin Marchegiani: Things like Curcumin or— or Ginger or Fish oil will help relax kind of the— the inflammation there. Then also, things like Magnesium, which…

Dr. Sajad Zalzala: Magnesium…

Dr. Justin Marchegiani: …[crosstalk] helps in natural beta-blocker for the heart too.

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani: So, that’s kind of— That’s like…

Dr. Sajad Zalzala: Ome— Omega-3 is so kind of the— the— the flexibility in the arteries and in our— in our blood as well. Uhm— You know, just staying away from inflammatory foods. I mean— I mean a lot of times uh— the— the Circulatory System is so inflamed because of the junk that we feed ourselves. [laughs] Uhm— you know, uh— Yeah, you— you could bring down the blood pressure fairly— fairly quickly by just going on a— you know, super clean— super clean diet. And, I’ve seen that happen uh— you know, quite often. 

Dr. Justin Marchegiani: That’s great. I want to see. Do you have another uh— another drug? Can you cut another mechanism that you can lay out and then just kind of compare and contrast the allopathic versus the functional med uh— mindset like I just did?

Dr. Sajad Zalzala: Uh, well, you know, uhm— Diabetes, for example, that’s a big one. Uhm—

Dr. Justin Marchegiani: Excellent.

Dr. Sajad Zalzala: So— Yeah. Yeah. So, I mean, the number one— the number one prescribed drug is Metformin, and actually, I like that drug. I don’t want to knock it. Uh— And uh— the reason I think it works so well ‘cause it’s actually an extract with uh— I believe it’s the French Lilac or the German Lilac. French lilac…

Dr. Justin Marchegiani: Yep.

Dr. Sajad Zalzala: …I believe.

Dr. Justin Marchegiani: Okay.

Dr. Sajad Zalzala: I think that’s why it’s so powerful. You know, in fact— in fact, every since I started prescribing it just for its anti-aging properties. Uhm— But if you want to go— you know, if you’re purest, and you want to go like completely, you know, natural with that, even though— even though Metformin’s pretty close to that, uh— Berberine is another uh— way you could do it. Uhm— So— So Metformin for those who may not know. Uh— Is this— It works really well because it uhm— uhm— it helps the Insulin receptors work better, uhm— and then also, blocks excess uh— accumulation of sugar storage in the liver. Uhm— So uh— you know— excess creation of sugar in the liver as well. So— So, it really works really well. Uhm— But of course, you know, any— any supplement or medication or anything that should you take externally is only gonna work so far— you know, uh— if— if— if you don’t— You have to make changes to your lifestyle and diet. I mean, I tell patients I’m a big fan of what’s called the Paleo Diet, uhm— you know, like a modified Paleo diet. You know—

Dr. Justin Marchegiani: [crosstalk] Paleo, like Paleo template. Yeah

Dr. Sajad Zalzala: Yeah, exactly. What people try to eat as closely as their ancestors do.

Dr. Justin Marchegiani: Love it.

Dr. Sajad Zalzala: Uhm— [stutters] And that seems to work the best for a wide variety of people. Uhm— You know, they were the largest variety of people. I mean— I mean, there’s some individuality. I mean— I mean, people from Europe may be different from people from Asia and there might be little bit of uh— that kind of tweaking that you need to be there, but I just like the concept that when I think— I think got to be with that Yeast. So— So, anybody— anybody who comes in my office at sessions comes from Diabetes. First thing I do is I make sure that they get on a Pa— Low-carb— Low Starch Paleo Diet. Uh— And then, Metformin’s usually I’ll start with Like, if they want to go uh— they want to go [inaudible] I’ll be with a Berberine. Uhm— But then, from there, I mean, if— if you’re talking about the Insulin sensitivity, you put them on things like Chromium uhm— because, you know— Because Chromium’s important for the uh— for the receptors, Insulin receptors.

Dr. Justin Marchegiani: Yeah.

Dr. Sajad Zalzala: Uhm— You got to put in mind something— s— a good quality B Complex because all those— you know, all the B vitamins are— are— are needed to help process the Carbohydrates. And a lot of people are deficient on those just— just because of the process foods. Uhm—

Dr. Justin Marchegiani: Yup.

Dr. Sajad Zalzala: The Magnesium’s another thing uh— [stutters] that a patient’s on. Uhm— You know, uh— anything with bitter, like bitter Melon, Dandelion— anything that tastes bitter, they said they have substances in that help kind of control a blood sugar as well. Uh— I mean, there’s so many things you can do. Uhm— One medication I do not use for d— Diabetics is a Glyburide or the Sulfonylurea medication.

Dr. Justin Marchegiani: Yeah.

Dr. Sajad Zalzala: Uh— I stay. I stay away far those as possible.

Dr. Justin Marchegiani: Why is that?

Dr. Sajad Zalzala: The reason because uhm— if I— I find it actually helps accelerate Diabetes because what it’s— It kind of forces the pancreas to release more Insulin.

Dr. Justin Marchegiani: Stimulates more Insulin.

Dr. Sajad Zalzala: Exactly. Exactly. And the last thing you want as a Type II Diabetic is more Insulin, uhm— because it burns the pancreas out faster and it’s kind of a faster path down that cliff to you after [incomprehensible] eating Insulin injections. Uhm—

Dr. Justin Marchegiani: Exactly.

Dr. Sajad Zalzala: So—

Dr. Justin Marchegiani: That makes sense. [crosstalk] So, I just want to break that down for the listeners, right? What you’re saying is we have this pathway of Insulin resistance that happens. We have this drug Metformin, which is the— the French Lilac you mentioned, which decreases some Glucose absorption in the— in the gut. It decreases some of the Gluconeogenesis, which means producing sugar from the liver. Also, I think— I mean, you didn’t highlight, but I just want to see. Do you also give some extra B12 to prevent any uh— Anemia issues from the Metformin and Low B12 connection?

Dr. Sajad Zalzala: Oh, yeah! Anybody I’m informing, I always have their B12 level periodically, and— and I encourage them. B12, well that’s part of the B Complex that I tell my Diabetics to take.

Dr. Justin Marchegiani: Got it. So, that’s there. And again, conventional medicine, they’re not touching the diet. They’re typically recommending the food pyramid, which has…

Dr. Sajad Zalzala: Yes.

Dr. Justin Marchegiani: …more grains, more inflammation, higher blood sugar via Cortisol and just Carbohydrates that they’re consuming. And then, you know, typically, it’s the Sulfonylurea medications and then, eventually, they’re on to full on Insulin.

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: And I know, just giving more Insulin to cover up all that sugar. So, you’re actually trying to get to the root issue…

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: …which is the diet and the lifestyle change. You may use a medication, which I do think Metformin is— is a better medication. And again, I think a lot of the anti-aging benefit just come from the fact that we’re getting Insulin down…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …too, right?

Dr. Sajad Zalzala: Right. Well, there are other— There are other uh— anti-aging properties in that formulated system.

Dr. Justin Marchegiani: let’s hear it. I’m curious.

Dr. Sajad Zalzala: Yeah. yeah. So— So there’s three anti-aging pathways. There’s a kind of..

Dr. Justin Marchegiani: Cool.

Dr. Sajad Zalzala: [incomprehensible] Sirtuin gene. Three major ones that we know about and there i— there may be more. So, you’ve got these Sirtuin genes. Uh—

Dr. Justin Marchegiani: Yeah.

Dr. Sajad Zalzala: let’s talk about that. So, you’ve got the uh— the AMPK, uh— A-M-P-K…

Dr. Justin Marchegiani: Yep.

Dr. Sajad Zalzala: …and you’ve got the MTOR. Uhm—

Dr. Justin Marchegiani: Yes.

Dr. Sajad Zalzala: You know, if anybody’s read anything about red wine and Resveratrol, they’ll know about the Sirtuin genes, originally discovered by a— you know, a guy— a brilliant uh— scientist out of a Harvard Medical School back about— about 20 years ago. He discovered that the— that— that from Yeast on up, we have these genes called the Sirtuin genes. Uhm— And— And he found that— that in— that in uh— many organisms, we can actually stimulate the Sirtuin genes by taking the Resveratrol. Now, they spent millions of dollars trying to find Resveratrol derivatives to work in humans. Unfortunately, it never panned out. Uhm— Now, Dr.— His name is Dr. David Sinclair. He’s back in the lab and he’ looking at a substance called NAD or NADH. It’s a derivative of— of uhm— Niacin. Uhm— Uh— Don’t ask me what NAD or NADH is for it’s really long.

Dr. Justin Marchegiani: Yeah.

Dr. Sajad Zalzala: You can look it up. But— But we’ve ignored NAD for a long time. You know, remember from your high school Biology class, uhm— N— you know, NAD was just kind of one of those things that’s just part of the Krebs cycle. We took it for— We took it for granted. You know, we always thought that the end goal is ATP, and we need ATP. But you need N— NAD to make it. We’re also…

Dr. Justin Marchegiani: [crosstalk] It’s a reducing agent, right? NAD’s main job is to— is to grab electrons.

Dr. Sajad Zalzala: Exactly. Exactly. And— And uh— You know, you need a certain number. I can’t remember if I’m at how many but you need a certain number of NAD to make a certain amount of ATP. But as you get older, the— the number of ATP— the number of NAD available to us is— is— is less and less. In fact, there’s this a— well, a study show that at a time you’re 50, you’re down about half as many as much— as much NAD uh— production as— as— as a young healthy adult does. Uh— And that’s— that’s the part of— that’s the problem why the Resveratrol in humans doesn’t seem to work. It’s because of that lack of NAD. Once you get the NAD levels up, then everything works better. And there are— There are some research on some substances that help to help do that. Uhm—

Dr. Justin Marchegiani: So, let’s break that down. So, what pathway was that again that you just mentioned that the— the Resveratrol was with?

Dr. Sajad Zalzala: The Sirtuin. The humans have a— seven—

Dr. Justin Marchegiani: Sirtuin?

Dr. Sajad Zalzala: …seven Sirtuins. Yes—

Dr. Justin Marchegiani: Is that similar to the— to the nerve pathways?

Dr. Sajad Zalzala: Uh— nerve— nerve— uh—

Dr. Justin Marchegiani:  Cell Resveratrol does a lot with the nerve pathways. Resveratrol, Green tre— Green tea— those kind of things.

Dr. Sajad Zalzala: I believe they are [crosstalk] related. I believe they are related. I have to…

Dr. Justin Marchegiani: It must be.

Dr. Sajad Zalzala: …go back to my biochemistry books to— to see how they’re related. Uhm—

Dr. Justin Marchegiani: [crosstalk] So, the first one’s the Sir path. Go ahead. Yes.

Dr. Sajad Zalzala: The Sir path, or the Sirtuin…

Dr. Justin Marchegiani: Uhmhm—

Dr. Sajad Zalzala: …Fluid path, but you need enough NAD in order— in order to— to actually put those certain pathways to— to be activated. And uh— there’s a lot of sc— there’s a lot of research going on in subs— substances to help boost NAD levels. Uhm— The one that’s available right now as a supplement form is called Nicotinamide Riboside or NR. Uhm— It’s kind of costly, but it’s— It’s well— well worth it. Uhm— Uhm— The uh— I find if used in combination with other uhm— Mitochondrial Support uh— supplements that actually works a lot better than by itself, uhm—

Dr. Justin Marchegiani: And then, additional B vitamins would also help with the NAD as well?

Dr. Sajad Zalzala: Uh— Yeah. B— Again, because you got to remember that Krebs cycle.

Dr. Justin Marchegiani: Z— Yeah.

Dr. Sajad Zalzala: With B vitamins involved…

Dr. Justin Marchegiani: Nicotine.

Dr. Sajad Zalzala: …and all that— Exactly. All in that— Well, maybe…

Dr. Justin Marchegiani: FAD as well.

Dr. Sajad Zalzala: …if NAD is— NAD is— is derived from— made from uh— a Niacin or B3 vitamin.

Dr. Justin Marchegiani: Yes.

Dr. Sajad Zalzala: Uhm— So— So, if I don’t have enough NAD, the Sirtuin genes don’t work. So— So, you need— you need both, like Resveratrol to sti— help stimulate the uh— the— the Sirtuin. But you need in that, you know, NAD boosters to help boost it to kind of work more. So kind of fuel, the fuel for the certain uh— proteins. The other two pathways, the uhm— the MTOR and the AMPK— those can be stimulated by things like Intermittent Fasting or fasting.

Dr. Justin Marchegiani: MTOR.

Dr. Sajad Zalzala: Yeah, exactly. Exactly. But also—

Dr. Justin Marchegiani: Also, coffee too, right?

Dr. Sajad Zalzala: Uh—

Dr. Justin Marchegiani: Can coffee help with the MTOR?

Dr. Sajad Zalzala: The— There’s a lot of things that we’re learning about that can help…

Dr. Justin Marchegiani: Yes.

Dr. Sajad Zalzala: …that can now boost MTOR. I’m not— I don’t— I don’t know as much about the studies for coffee but I— I wouldn’t be surprised. I mean— I mean, coffee’s got a lot of things in it, uh— Polyphenols and things like that. Uhm— But— But like I say, it can stimulate those pathways by uh— fasting— fasting, uh— Metformin. Also— Also stimulates those— those pathways well. Uhm—

Dr. Justin Marchegiani: Now, is it primarily doing it through the Insulin sensitivity. Is that how it’s doing it? Or is there another [crosstalk] pathway?

Dr. Sajad Zalzala: No, I think— I think there’s something else to it. I think there’s…

Dr. Justin Marchegiani: Okay.

Dr. Sajad Zalzala: …something else to it. Uh— I don’t exactly how it’s stimulating it, uh— but uh— but you know, when you do— you know, gene arrays and things like that, uh— you know, working analysis, it seems to be uh— uh— you know, stimulating those two pathways uh— for— for the positive. Uh— And that’s why there s— there seem to be more and more traction in getting Metformin. People who are not even Diabetic, you know, Pre-Diabetics, or eve people who just you know, who— who— who just had a little extra trouble losing weight, it seems to be very effective. Uhm— [stutters] And when you add it to a Paleo Type Diet. It just kind of adds that one more layer of—

Dr. Justin Marchegiani: Uhmhm—

Dr. Sajad Zalzala: …of benefit to it. Uhm— So— So, I— I commonly prescribe Intermittent Fasting for my patients. Uhm— And basically, what that is, is you know, you stop eating at like 6:00 o’clock at night. And then, you kind of skip breakfast. You know, I know that’s kind of blasphemy for a lot of nutrition stuff but yeah. You skip breakfast and then you don’t need until you know as— as long as you can go. So, usually it’s about, you know, 10:00 o’clock, noon, so that gives you a good uh— you know, 12-16 hours, where— where your kind of uh— kind of fasting for that period and you’re letting your Digestive tract uh— rest. And your turning on these— these house— housekeeping genes.

Dr. Justin Marchegiani: Yeah. And there’s a 16 by 8 where it’s your having that 16-hour fast [crosstalk] and 8-hour eat window, or an 18 by 6. And if anyone has adrenal issues or blood sugar issues, one thing you can even just think about doing is even a 12 by 12.

Dr. Sajad Zalzala: Yeah.

Dr. Justin Marchegiani: What you may stop eating at 7:00 PM, and then— or let’s say 8:00 PM but then you’re up at 7:30 the next day and you don’t have breakfast ‘til 8:00. And…

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: …that can give you 12-hour window too.

Dr. Sajad Zalzala: Right. Right. Read…

Dr. Justin Marchegiani: If you’re having between.

Dr. Sajad Zalzala: The longer you can go without food, the— the more likely you are to turn on these housekeeping genes. Uhm— The effect is at the M— the MTOR, the AMPK, uh— some of the other— some of the other genes as well. Uh— And— And— And, you know, there’s also a way to do it is called a calorie restriction, but uhm— [stutters] the people who are brave enough to do the TruCalorie restriction. Uh— I— I’ve heard— I’ve heard— I’ve heard that they’re miserable because they just don’t have enough vitality to, you know, they don’t have calor— enough calories in the diet to sustain vitality. Uh—

Dr. Justin Marchegiani: A hundred percent.

Dr. Sajad Zalzala: Again, they— they— they may end up living a little bit longer than the rest of us but, you know, I— you know, I think there are— there ae so many other ways to kind of accomplish that same goal without— without— without that uh— hit to your vitality.

Dr. Justin Marchegiani: Yeah. The problem is I’ll— i— if we’re talking— You know, people talk about nutrition and then use calories a lot, but calorie’s just a form of energy.

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: It’s a measurement of heat. Really, calories in our world are gonna be attached to nutrients.

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani: So, if we’re talking low calorie, we’re also talking a low nutrient diet, and our— our metabolic system to need nutrients.

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: So, it’s not good to shorten the nutrients…

Dr. Sajad Zalzala: All right. Right.

Dr. Justin Marchegiani: …but if you can get the nutrients in but use the fasting window…

Dr. Sajad Zalzala: Uhmhm— Uhmhm—

Dr. Justin Marchegiani: …to still turn on some of that biochemistry that— that has that effect, then you get the best of both worlds.

Dr. Sajad Zalzala: Sure. Sure. Well, what I was referring to is this fad that I think [stutters] that uhm— that came about maybe 20 year ago— 20 years ago, around the same time the discovery of Sirtuin genes, where they— where they took monkeys, for example, and I put them. You know, they did— they didn’t calorie restrict it. Uhm— And yeah. I mean, the monkey was calorie restricted. You know, he was lean. He lived longer without diseases but i— people said he looked miserable. Uhm— They— I think, they— they start losing fertility in things like that just because your body just can’t— you can’t— the body just can’t function on— on such a reduced calorie. And by reduced, I mean, take— take your basal calorie requirement so for me, it would be somewhere around, you know, 2,000 or 2,200 calories, and cut that by 30 percent. And sustain that. That’s really hard to do. Uhm— the people who do it— I don’t know if there’s anybody left [laughs] that was still doing it. Uhm— But— But the p— But there was a society, the Calorie Restriction Society, back like 10-15 years ago. Uh— I don’t know if anybody’s still part of that or not. But, people who do it— I mean, you got to be really strict about it. Uh— And then, you have to be really careful talking about the nutrients. You have to be really careful to get all your nutrients in and that condensed in that lower calorie. I’m not a proponent of calorie restriction. I think there are other ways to do it. I think the Intermittent Fasting will get you most of the benefits. Uhm— Intermittent— Intermittent Fasting— well, you don’t do it everyday. You may..

Dr. Justin Marchegiani: Yes.

Dr. Sajad Zalzala: …do Intermittent Fasting maybe four days out of the week. Uhm— And then that— that’s what I— that’s what I…

Dr. Justin Marchegiani: Yeah.

Dr. Sajad Zalzala: … currently do.And, if there’s a better way— you know, If somebody comes on and mention there’s a better way to do it. You know, I looked at research. I looked at some data behind it [stutters] and I adopt uhm— and I kind of adopt that posture and try it out with myself and see.

Dr. Justin Marchegiani: I think that’s great. I think there’s some really good benefits there. So, really interesting. You broke down those pathways and how uh— Metformin and maybe [stutters] functional medicine practitioner looks at Diabetes or Insulin Resistance. Let’s look at pain. Let’s look at like the enzyme…

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: …pathways. There was the enzyme that kind of works on those sick low oxygenates…

Dr. Sajad Zalzala: Uhmhm— Uhmhm—

Dr. Justin Marchegiani: …pathways. Let’s break that down. What’s the mindset, allopathic versus on the functional medicine there?

Dr. Sajad Zalzala: Yeah. So, I mean, uhm— you know— Pain— Pain is actually a very good topic because, you know, ev— everyday we’re hearing about, “We’re kind of in Opioid crisis. People are over— overdoing Opioid.” But just— just— just a little aside on that— I mean— I mean, I think an addiction, in general, was on the wise. Not just a medication addiction, I think— I think people using pain medication, because— because addiction is just such a big thing now, and a lot of it has to do with the but— you know, the— the— you know, the neurotransmitters and brain being s— so out of whack for— for all sorts of reason. Uh— You know, depleted nutrients, uh— Uhuh—

Dr. Justin Marchegiani: Uhmhm—

Dr. Sajad Zalzala: Just— Just the Chronic stress. Uh— Now, you have cell phones— you know, and the cell phone kind of teaches you how to— how to— how to be addicted. You know, every little minute you’re looking at it, and you know, you’re like that little monkey who— who— who oppress the— who oppress the Dopamine stimulation until they die. Uhm— [clears throat] And so— So, I think, you know, pain is a big thing but we also have to kind of look at— have to look at the addiction uhm— all part of it as well. But, to answer your question, uh— yes. So— So, you know, in the conventional allopathic, if somebody comes to you with some kind of Tendonitis or inflammation somewhere, you know, the first thing you reach for is Ibuprofen, you know, Naproxen, uhm— you know, uh— Celecox— Celecoxib— things like that. Uh— And those— Those uh— uh— blocks the action of the COX-2, uhm— but not without— but not without side effects. Uhm— You know, stomach— stomach issues is big. Uhm— You know, if you’re using the occasional Advil— you know, it’s Ibuprofen. It’s— It’s probably okay but— but, you know, people who are around it all the time, it seems to set them up for things like leaky gut, uhm— dysbiosis, uh— and those can really set you up for even— ironically, for even more inflammation down the line. Uhm—

Dr. Justin Marchegiani: So, basically, the enzymes that those medications block, those enzymes are really important for Hepato— b— basically, repairing the liver, repairing the gut lining…

Dr. Sajad Zalzala: Yeah.

Dr. Justin Marchegiani: …helping the heart to be healthy. So, you’re blocking one enzyme…

Dr. Sajad Zalzala: Uhmhm— Uhmhm—

Dr. Justin Marchegiani: …that creates this inflammatory compound called Prostaglandin 2, right?

Dr. Sajad Zalzala: Uhmhm— Exactly.

Dr. Justin Marchegiani: But then, on the other side of the fence, it’s decreasing the repair of the heart, the gut and the liver, right?

Dr. Sajad Zalzala: Exactly. Exactly. I mean, there— there are much more effective ways and much less an— much, much less dangerous ways of doing it. Uh— You know, something simple as Turmeric and I…

Dr. Justin Marchegiani: Uhmhm—

Dr. Sajad Zalzala: …believe there’s enough Turmeric now, but there’s so many other uh— alternatives out there, but you know Boswellia, uh— Devil’s Claw uhm— you know— you know, Ginger, Celery seed. There’s— There’s [stutters] There’s very— There’s very nice combinations out there as well. I kind of combine all those and kind of in proper ratios. And they have almost none of the side effects you’ll get and the inflammatories uhm— uhm— but again, I mean— I mean, they— they may work you know, if you’re in a pinch, but— but I wo— I— Again, I always recommend trying to figure out why. That— That’s what functional medicine is all about. Why? Why doesn’t the inflammation [inaudible] Why do they have pain? Pain is a symptom. The— There’s something wrong, uhm— and— and you have to try keep— keep— keep peeling the onion, so to speak. You got— you got to keep— keep going to the next layer until— until you figure out why and what therapeutic you need to kind of get in there and fix that pathway. That’s done right.

Dr. Justin Marchegiani: And, you know, those medications, those NSAIDs, they work really good. And they do [crosstalk] really do have, I think acutely, you know, a day or two…

Dr. Sajad Zalzala: Yeah, exactly.

Dr. Justin Marchegiani: …or let’s say you broke uh— you broke a bone or you had a surgery or something. I think they w— they work great, or maybe, you know…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …worst case if it doesn’t happen too often, maybe you drank too much the night before, right? But, we want those longer term— Wha— Wha— One, we want diet and lifestyle strategy [crosstalk] to that keep the inflammation down. But, number two, we want natural strategies that we can use more frequently…

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: …and not have to rely on the big guns, right?

Dr. Sajad Zalzala: Exactly. Exactly. I mean— I mean, I’m not— I’m all— I’m all for, you know, taking an Aspirin or an Advil when you— you know, you got [stutters] you did something you shouldn’t have and [laughs] now you’re gonna pay. You reach one that’s fine, but a long-term use, no. I mean, like you mentioned heart— heart issues uh— you know, raises your blood pressure. Uh— you know, it’s really hard on the kidneys and the liver. Uh— So— So, there’s really no— there’s no good reason. Now, unfortunately, the alternative out there has been the Opioids.

Dr. Justin Marchegiani: Yes. That’s the big hit. Big deal.

Dr. Sajad Zalzala: Yeah. And— And then, that’s— you know, that’s been devastating people in so many different ways. Uhm— You know, uh— the— the chronic activation of the Opioid receptors. Uhm— So— So, first of all Opioid receptors are seem to be everywhere in Nevada. And— And this is a good segue into LDN Low-Dose Naltrexone. Uh—

Dr. Justin Marchegiani: Yes. Perfect.

Dr. Sajad Zalzala: L— LD— Yeah. Opiate Receptors are almost everywhere in your body. You know, when we— when you reach for Tylenol 3 or Percocet or Vicodin, you know, that’s stimulating the Opiate receptors in the brain and the spinal cord to try to reduce the pain. Uhm— But, it’s also blocking the Opiate receptors in our Immune System, in our Pituitary gland, and all [stutters] the Gluteal cells in our brain. You know, they’re— they’re everywhere and— and we’re learning more and more about how important these are. And, that’s why you’ll often see people who are in chronic pain medication, uh— chronic Opioid medications. Uhm— The testosterone’s in the tank. If they’re female, their hormones are all in a whack. Uhm— Uh— You know, [stutters] it just kind of seems to decimate the uh— decimate the uh— the— the Endocrine System body, uh— and in the end will all sorts of— well, long-term— long-term effects. And to make things worse, they stop working after. Uh— And that— And that’s why you get tolerance, and tolerance eventually leads to addiction, where you need more and more and more of it, to get the same effect. Uhm— ‘Cause— ‘Cause eventually, the body starts to  downregulate the Opiate receptors. They’re stimulated way— stimulated way too much. The body downregulates to them uh— them and— and— and you just— you just don’t have any Opiate receptors left now.

Dr. Justin Marchegiani: So, it’s basically like Insulin resistance but with your OPR receptors?

Dr. Sajad Zalzala: Yes. you can think of it like—

Dr. Justin Marchegiani: Yeah.

Dr. Sajad Zalzala: …just like that. I mean, it’s— it’s probably slightly different but yeah. Exactly. So if— So, I— I think— I mean, I don’t— I don’t have any data to prove this but I think the same reasons why all of us are becoming Insulin resistance is the same reason why we’re all becoming Opiate resistance. Now by the way, we make our own Opioids. They’re called Endorphins. You know, uh— they ru— they runner’s high [stutters] and that high that they get when they— when they— when they, you know, exercise. That’s because of release of Endorphins. Uhm— And so— And so, by becoming like Endorphin or Opiate Resistant, we’re actually blunting that— that natural response we get to— to uh— to let go natural Endorphins. And the— And that— And that can have a lot of consequences as well.

Dr. Justin Marchegiani: One hundred percent. And that again, it’s like when you come up and your resistant and then you come back down, I mean, the side effects of coming off Opioids are…

Dr. Sajad Zalzala: Yeah.

Dr. Justin Marchegiani: …tremendous.

Dr. Sajad Zalzala: Right.

Dr. Justin Marchegiani:  And, my big concern is chronic inflammation— You go from NSAIDs, unaddressed, you go to Opioids…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …and the problem is, the more stressed you are and the more inflamed you are— I’ve never found a stressed, a chronically stressed or inflamed person that didn’t have a bad diet, and they didn’t have also a bad gut. And the problem is…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …you mentioned it earlier, beta-Endorphins are natural pain-relieving compound…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …but beta-Endorphin is a 19— uh— I mean, 19 the— 19 amino acids to make beta-Endorphins. So, if we have bad digestion…

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: …we’re not gonna be able to break down those proteins and make our natural…

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: …beta-Endorphins as well.

Dr. Sajad Zalzala: Right. Right. So you have— So you have a production issue but also a receptor issue.

Dr. Justin Marchegiani: Yes.

Dr. Sajad Zalzala: Uh— One way— Now— Now I mentioned that the Opiate receptors are on Immune System as well.

Dr. Justin Marchegiani: Uhmhm—

Dr. Sajad Zalzala: Uh— And— And— And we’re learning more about— more and more about— about the importance of them. We haven’t fully fleshed out the exact amounts, but it seems like people who have Immune System issues, like Rheumatoid arthritis, uh— Fibromyalgia, uhm— you know, Gout, uh— Sorry, not Gout, Psoriasis— things like that, uhm— they— they seem to have a uh— they seem to have a lack of these— was— of these Opioid receptors. And, uhm— uh— And that’s kind of where the— the idea of using Naltrexone comes in play. Uhm— So, Naltrexone, for those who don’t know uh— was originally uh— uhm— approved back in the— in the 80’s or 90’s for— for alcoholism uhm— but at— at the 50-milligram dose, and it’s still used. There’s a lot of— There’s a lot of addiction centers that use uh— Naltrexone uh— to help— to help alcoho— alcoholics stay away from alcohol. Uhm— However, there’s a doctor— I think his name was Dr. Bihari. He— He— He found out, kind of by accident, that- that people who are taking Naltrexone, uhm— they seem— they seem to have a positive effect on the Immune System. Uhm— And so, you know, they play around the dose to try to hear out what the— the optimal dose was, and it turned out the lower the dose the better, up to— up to a point, obviously.

Dr. Justin Marchegiani: So, we’re talking like 2-4 milligram-ish?

Dr. Sajad Zalzala: Yeah. Yes. So, 2 – 4½ — 4½, initially the highest that I’d go. So, the reason it’s called Low-Dose Naltrexone because we’re not using it at pharmacological 15 milligrams. We’re using it more of the physiological, maybe homeopathic— uh— you know, 2 milligram to— to 4 ½ milligrams. Uhm— In fact, I think it’s such a powerful therapy. You know, obviously it doesn’t work by itself. I need to kind of address the other issues, but sometimes, you know, it— it— by itself, I’ve— I’ve seen it work— wonder drug. So, I uh— I have this— I have this web service that everyone— It’s called the, uhm— uh— where uh— you know, a lot of people doing a lot of reading on, and on the end it’s got a lot of— it’s got a lot of uh— you know, coverage on Facebook pages and other news groups, and things like that. Uhm— And— And, if you want to know where they can go to— to get a prescription, a lot of times, the last evac and the family doctor, and the Doc kind of specializes ahead and say, “Well, you’re not alcoholic, why do you need Nal— Naltrexone?” Uh- It’s because, you know, most allopathic doctors have no idea that you can use Naltrexone this way. Uhm— So, I created this website called, where patients can request the uh— descriptive directed consultation, and I evaluate them for prescription for the LDN. It has to be from compounding pharmacy, and there’s several good ones around the country. Uhm— So, that— that’s kind of another site service that I offer as well, uhm— becau— because— because it’s such— I think it’s such a powerful therapy. Uh— The number one reason that I prescribe it is for Fibromyalgia. Uhm— The number two reason is autoimmune conditions of all sorts: MS, Rheumatoid arthritis, Psoriasis— things like that. Uhm— But there’s been more and more a— uh— research on it for— for psychiatric conditions as well. Again, going back to those Opioid receptors and Glial cell which can help— help control the information in the brain, we think that Anxiety depressionism is inflammation in the brain, so if you can do— do anything to reduce that inflammation, uh— it— it seems to help uhm— So, uh— uh— so— so— The way it works, uhm— The mechanism of action for the low-dose Naltrexone, is that you— you— you temporarily block the opioid receptors.

Dr. Justin Marchegiani: Receptors, right?

Dr. Sajad Zalzala: Exactly. And then, uh— but only for a short time and only for a small amount. And so, over time, you actually end up with more Opioid receptor. And it— And it changes gene expressions and things like that to positive, and that help balances the Immune System. It doesn’t activate— It doesn’t overactivate the Immune System. It doesn’t suppress the Immune System either, but it brings it back into a balance. And that’s why it’s also used for things like uhm— uh— infections. In fact— In fact, some of the early work on— on LDL was for HIV, uhm— but a lot of times— you know, people— what people requested for to help fight off uh— you know, uh— Lyme disease, uh— Chronic Epstein Barr Virus infection, uh— thing— things of that nature.

Dr. Justin Marchegiani: That’s great. So, basically, what’s happening is, we have a mild blocking of that…

Dr. Sajad Zalzala: Hmhm—

Dr. Justin Marchegiani: …Opiate receptor site, and then, there’s some compounds that are produced to help modulate the Immune System help that, the T-regulatory cells, to kind of balance out that…

Dr. Sajad Zalzala: Exactly.

Dr. Justin Marchegiani: …ones. But of course, you’re looking at is, “Okay. Here’s like a palliative thing we can do to just kind of help with the Immune System.

Dr. Sajad Zalzala: Uhmhm—

Dr. Justin Marchegiani: You may also be working on the Insulin Resistance, the inflammation.

Dr. Sajad Zalzala: Right. Right.

Dr. Justin Marchegiani: Maybe, Vitamin D is profound as well. So, you may be looking at a bunch of other things, but then, plugging that in as an additional palliative support.

Dr. Sajad Zalzala: Sure.

Dr. Justin Marchegiani: Is that correct?

Dr. Sajad Zalzala: Exactly. Exactly. And, I have uh— about— about half of patients that asked me for— for the prescription are already working with a holistic practitioner and greater practitioners such as yourself, uh— but, you know, who may not have prescribing powers. And it is uh— it is a “prescription only” medication protocol. Uh—

Dr. Justin Marchegiani: I think it’s important because I think a lot of Docs, they— they may say, “Hey. Here’s this natural thing. They prescribe it but they don’t do all the other things that I consider…

Dr. Sajad Zalzala: Right. Exactly.

Dr. Justin Marchegiani: …follow-up upstreams. So, I think it’s important that you’re setting the table upstream, but then you’re also working downstream, too.

Dr. Sajad Zalzala: Exactly. So, anybody that I do a consultation on for the LDN— uh— LDN prescription, I make sure they’re— they’re working with somebody or I put them in touch with somebody before I create. Uh—

Dr. Justin Marchegiani: Oh, that’s great.

Dr. Sajad Zalzala: Yeah.

Dr. Justin Marchegiani: So, I’m just curious. If someone like is addicted to— to— to Fentanyl or Oxycodone or whatever too, can you just list out the— these uhm— these Opiate medications?

Dr. Sajad Zalzala: Yeah. So—

Dr. Justin Marchegiani: Fentanyl, [crosstalk] we have Oxycodone, Percocet—

Dr. Sajad Zalzala: [incomprehensible] found in patches. Oxycodone is found in Percocet. Percocet is a mix…

Dr. Justin Marchegiani: Yeah

Dr. Sajad Zalzala: …of Oxycodone and Acetaminophen [inaudible]. Yeah. You’ve got the Vicodin, which is Hydro— Hydrocodone mixed with Tylenol. Uh— We have Norco. It’s very similar— It’s similar. We have Codeine, which is very weak uh— uhm— uh— Opioid medication. It— It’s converted to Morphine. Uh— Morphine is the— is the original. I mean, that’s what they— that’s what they extract from the Opium, uh— the Opium uh—

Dr. Justin Marchegiani: Right.

Dr. Sajad Zalzala: …poppy plant. Uhm— And uh— uuh— And so—

Dr. Justin Marchegiani: And— And then, with Heroin— Heroin’s also a derivative of that too, right?

Dr. Sajad Zalzala: E— Exactly. Exactly. Uh— The another derivative that is Dilaudid or Hydromorphone.

Dr. Justin Marchegiani: Yeah.

Dr. Sajad Zalzala: It’s about four or five times stronger than uhm— [stutters] than Morphine. Uhm— And so, when we— when we look at these medications, how much somebody’s on, we always look at what’s called a Mor— Morphine equivalent dose.

Dr. Justin Marchegiani: Hmhm—

Dr. Sajad Zalzala: Because like— It’s like at a Morphine the original molecule and all these other Opioids are kind of uh— derivatives. Uhm— Now, outside of these consen— you know, hard Opioids, there are some synthetic Opioids. Uh— Tramadol is one of them.

Dr. Justin Marchegiani: Yup.

Dr. Sajad Zalzala: Uhm— And one of the newer ones on the market is called Nucynta. Uhm— And— And they— They work by [stutters] they activate the Opioid receptor, but not as strongly as Morphine and their derivatives. But, they also have other— other effect to them. Uhm— Patients tend not to tolerate them as well as— [stutters] as a pure Opioid medications because they have like uh— effects on uhm— uuh— the— the effects on Serotonin and Dopamine and things like that the patient just can’t tolerate sometimes.

Dr. Justin Marchegiani: A couple of quick questions. Is Oxycodone and Oxycontin the same thing?

Dr. Sajad Zalzala: Uh— Oxycodone is kind of a generic. Oxycontin, it would be as a brand name. Uh—

Dr. Justin Marchegiani: Brand name.

Dr. Sajad Zalzala: Yeah. And Oxycontin is— is supposed to be an extended-release but uuhm— uh— but that’s actually been replaced by Oxymill, uhm— uh— because too many people were just kind of breaking the tablets, and you know sniffi— I don’t want to give…

Dr. Justin Marchegiani: Right.

Dr. Sajad Zalzala: …anybody ideas [crosstalk] for sniffing.

Dr. Justin Marchegiani: Right. No.

Dr. Sajad Zalzala: That’s a— [laughs]

Dr. Justin Marchegiani: It’s already out there.

Dr. Sajad Zalzala: [laughs] Yeah, exactly. Chewing them, uh— you know— thing— things like that they’re doing just to get that high. Because, again— you know, [stutters] once you get a little bit of that high, you’re always for a next time. You just have to take higher and higher doses to get that high. Uh—

Dr. Justin Marchegiani: So, with Oxy and Hydrocodone, which one’s stronger?

Dr. Sajad Zalzala: Uh— I believe the Ox—

Dr. Justin Marchegiani: The Oxy?

Dr. Sajad Zalzala: Yeah. The Oxycodone, I believe is— is slightly stronger than the Hydrocodone, uh— which is about on par. Uhm— But— But because these are kind of all derivatives of Morphine, I mean, different ones have different— have different uh— reactions uh— in patients. UHm— Like for example, some people say that uh— Oxycodone uhm— doesn’t— doesn’t cause constipation as much as Morphine. Uhm— uh— you know, I— [stutters] I pre— prescribe in my clinic but— but I— I am— I try as much as possible to get patients off of them as much as possible. Actually, I— I don’t prescribe them myself. I have a lot of patients who come to me in my— my practice in Ontario, uh— who— who were on them. And— And it’s just a lot of work uh— to think— to get patients off— off of these Opioids. Uhm—

Dr. Justin Marchegiani: And, do you have a taper? Like, do you have a protocol in which you— you’re tapering off a certain percent over a certain time  or is it just totally customized?

Dr. Sajad Zalzala: Uhm— It’s kind of customized depending on— you know— how long the patient is on it. Uh— I mean, the guidelines say, I think uh— no— no more than ten to 20 percent for a month. Uhm— I find that actually quite aggressive. Sometimes, you have to bring it down just a smidge each— [crosstalk] each month.

Dr. Justin Marchegiani: So, maybe like— maybe like five percent a month is— is reasonable?

Dr. Sajad Zalzala: Yeah. Yeah. And that [stutters] the challenge is that the dose— the dosing seems to be uhm— tsp— is not— is not uhh— l— like, for example, uh— Oxy— Oxycodone comes in, you know, fives and tens. Uh-huh— say…

Dr. Justin Marchegiani: Right.

Dr. Sajad Zalzala: ..gonna create it. Uh— You know [stutters] and kind of find uh— in between. Uhm— There’s also, you know, co— There’s also the uh—  the ant— the agonist— antagonists like uh— Methadone and Suboxone. Uh— Those are a lot more…

Dr. Justin Marchegiani: Right.

Dr. Sajad Zalzala: …popular uhm— but— but— you know, they have some of the same properties as— as your Opioid medications. But— But if you take too much, it kind of blunts the high. Uhm—

Dr. Justin Marchegiani: Do you have any experience with the herb Kratom to help people get off the Oxys?

Dr. Sajad Zalzala: I’ve heard a lot about that. [laughs] Uhm— But I had not— I don’t have any person— I’ve had— I’ve had several patients ask me one, uh— but I haven’t— I— I— I don’t— I don’t know any reliable sources uh— or safe sources so I don’t — I don’t recommend it. Uhm— I’d have to do more— more reading research and I should get— get more feedback from patient before I can make any recommendation. However…

Dr. Justin Marchegiani: [crosstalk] Yeah. For good things to be better.

Dr. Sajad Zalzala: Yeah. However, to— to kind of segue to another topic we’re about— w— w— we’re talking about on the pre-recording— How— How much time do we have by the way?

Dr. Justin Marchegiani: Uhm— We have— We have about f— five or ten minutes left.

Dr. Sajad Zalzala: Oh, okay.

Dr. Justin Marchegiani: How much do you need?

Dr. Sajad Zalzala: Yes. So, just real quick. So, I was completely against, you know, uh— Cannabis. You know, probably…

Dr. Justin Marchegiani: Oh, yeah.

Dr. Sajad Zalzala: …for five years. Oh, yeah. So, I’m completely against it. You know, when— when I had patients come up to me about Cannabis— medical Cannabis, ‘cause— cause it’s legal here in Ontario and several other states. I was like, “You know, okay. The— These— you know, these patients are just kind of find uh— a legal way to get high.” But then, uh— you know— But then I had a medical student with me rotating one day and he’s like, “Doc, you got to— you got to check out the OCBD.” You know, and then— and— and you know, which is a— which is a component of Cannabis. Uhm— It’s Cannabidiol. It’s so— It’s so— so Cannabis, the plant. I mean— I mean, we— we’ve taken it from nature and we’ve kind of hybridized it, and things like that, that [stutters] a lot— a lot of times the recreational one is much higher THC than what we find in nature. Uhm— And so— so a lot of people who— who were looking for— uh— Cannabis as a recreation, will look for the high THC. Uhm— And— ANd THC has some psychoactive properties. It— It can have some therapeu—

Dr. Justin Marchegiani: It will get you high, basically.

Dr. Sajad Zalzala: Exactly. Exactly. But it can help with people with…

Dr. Justin Marchegiani: In the munchies.

Dr. Sajad Zalzala: Exactly. Exactly. It can help in to a limited extent people who have like Anxiety issues, PTSD— things like this. So, there is a place for a little bit of THC.

Dr. Justin Marchegiani: Yeah.

Dr. Sajad Zalzala: Uhm— However, one of the components that I’ve been impressed with the CBD Cannabidiol.

Dr. Justin Marchegiani: Mm—

Dr. Sajad Zalzala: And that— that seems to have a lot of anti-inflammatory effects. In fact, there seems to be specific Endocannabinoid receptors in our— in our— in our selves, in our bodies. Uh— We’re not— We’re not quite sure what they’re there for. Uh— because we haven’t, I don’t— T— To date, I mean, I haven’t— I haven’t seen the news and greatest research of date. There’s nothing in our body that— that stimulates these Endocannabinoid receptors. It’s just but— but these Cannibal [stutters] these uh— these Cannabis extracts do. Uhm— And— And they have a lot of a pos— positive effects on our— on our inflammation on Immune System. Uhm— When I— When I prescribed a CBD Oil, I almost always prescribe it with the highest CBD concentration available. Somewhere…

Dr. Justin Marchegiani: 2 THC

Dr. Sajad Zalzala: …about 20 percent. Exactly. THC— I try to keep THC to a minimum. Uhm— Uh— And— [stutters] And I’ve have patients who h— who have milder, the— they seem to get better on it. I’ve had a co— a couple patients with seizure disorder. Uh— It doesn’t work for everybody with seizures but— but it does seem to— it does seem to help in a couple patients I have..

Dr. Justin Marchegiani: And is that working with the Opiate receptor site? Would you do that in conjunction with LDN or you’re choosing one path or the other to start?

Dr. Sajad Zalzala: Well, they’re separate paths.

Dr. Justin Marchegiani: Okay.

Dr. Sajad Zalzala: So— So, you—

Dr. Justin Marchegiani: But the CBD, it’s still hitting the Opiate receptor though, a little bit, isn’t it?

Dr. Sajad Zalzala: Uuhm— Not— I could say, the— the— the making reaction seems to be this— this uh— uh— uh— Endocannabinoid receptors

Dr. Justin Marchegiani: Okay.

Dr. Sajad Zalzala: Uhm— And— And it’s— And it’s separate. I mean, there are— there are people— Uh— There— There may be some cross— cross-reactivity there, but I think— I think it’s uh— fairly minimal from— for what I know. Uh— And so, there are people routinely on CBD and LDN, and it doesn’t seem to be any reaction. Uhm— Now, if somebody’s on CBD and they want to try LDN, I usually just add precaution and start them on a lower dose than they normally would. Uhm— And then— And then teper them up more slowly.

Dr. Justin Marchegiani: Mm—

Dr. Sajad Zalzala: But— But you know, I’ve had a lot of people using successfully the other, and I see they’re kind of synergistic. Uhm— So, I’ve come around the last couple years on Cannabis. I mean, I— I still think it shouldn’t be used recreationally. Uhm— And I don’t think it’s worth it. I— I think there are just too many— too many problems with using it frequently. But— But if you can get the me— medicinal aspects out of it, uhm— then— then I think— I think it actually [stutters] has the potential of being a— a great uh— adjunct thera— therapeutic to— to all the others that we talked about.

Dr. Justin Marchegiani: So, with the CBD, you’re not getting maybe the slower reaction time, or the munchies or maybe any of the maybe the lower motivation or uhm— memory issues. It’s— It’s more just helping modulate, has some anti-Anxiety stuff to it. It has to be Endocannanib— the Endocannabinoid receptor activation which helps with the Immune System. THC though— I— I do hear it does has some really good pain benefits and some…

Dr. Sajad Zalzala: It does.

Dr. Justin Marchegiani: …anti-nausea stuff, if there’s maybe some chronic pain or some Cancer stuff happening. Is that true too?

Dr. Sajad Zalzala: It does, absolutely. Absolutely. I mean, because I’m not a pain doctor, uh— when— when somebody requests uh— Cannabis, medical Cannabis for pain, there is a Cannabis Pain Medical Clinic here— here in town that I refer them to. Uhm— But— But my gu— But I’m— Uh— I’m much more comfortable prescribing them the low THC because, you get— you get into a lot less legal trouble that way. [laughs] When you start dealing with, you know, THC products then, you know, there’s— there’s uhm— special courses the doctors are expected to go through, and I just haven’t had— I just haven’t had the time t— to do those yet. So, I don’t feel comfortable playing around with THC so much. But CBD I, you know, I haven’t seen any problems with it so far. It certainly doesn’t seem to affect the— the— the cognition, right?

Dr. Justin Marchegiani: And if someone does CBD— If someone does use the CBD, can they— can they work while they do it? Can they drive while they do it?

Dr. Sajad Zalzala: Yes. As far as I know. I mean, as far as I know, I hadn’t seen any way [incomprehensible] with it. Uhm— In fact, a lot of the products in the states now uhm— the— they kind of get around— get around the whole legality should by using Hemp— Hemp-derived CBD. And— And uh— there are farmers that uh— that— that grow uh— uhm— uh— specifically, bred Hemp products that had almost no THC and high CBD. They don’t— Technically , Hemp is still legal in the U.S. It’s not grown in the U.S. It’s grown in Canada. [laughs] Uuh—

Dr. Justin Marchegiani: Mm—

Dr. Sajad Zalzala: But— But— But, you know, Hemp— Hemp— Hemp products. I mean, you can buy Hemp seeds. You can buy uh— uh— you know, cereal with Hemp in it if you like. You can buy Hemp oil. Uhm— But— But— But like I kind of get to get around the— the legality of uh— using Cannabis uh in Marijuana. Uh— A lo— A lot of— A lot of the CBD products over-the-counter, on the market or [inaudible]. Yeah. And [stutters] I don’t think that’s any problem. Uhm— uh— I— You know, the— they seem to work— they seem to work just as well, whether you get it from Hemp or from— from the regular, you know, uh— Cannabis.

Dr. Justin Marchegiani: Amazing. Really great information, and Doc— Dr. Z is licensed in over 35 states here in United States as well. He’s also uh— in Canada too. So, if you’re on both sides of the fence there, feel free and reach out to him.

Dr. Sajad Zalzala: Yeah,

Dr. Justin Marchegiani: rootcauses— plural— So, feel free…

Dr. Sajad Zalzala: Yes.

Dr. Justin Marchegiani: …and reach out to Dr. Z. He may really help provide that extra buffer between the conventional medicine and functional medicine bridge that a lot of people need. Dr. Z, thank you so much Is there anything else you wanted to share with the listeners today?

Dr. Sajad Zalzala: Well, the only, I think, was that LDN Direct if anybody want to be uh— you know— want where is just in a minute. If they’re working with practitioner but they want to try the LDN, uhm— you know, I’d— I’d be more than happy to try to help them. Uh— So, it’s LDNdirectcom. Uh— And— And uh— And then, a lo— a lot of times people don’t have a practitioner to work with, and I refer them to my Root Causes Clinic or to a local practitioner such as yourself.

Dr. Justin Marchegiani: Dr. Z, thank you so much for the information. It’s refreshing getting both sides of the fence there. Have a phenomenal day. We’ll talk soon.

Dr. Sajad Zalzala: Thank you.

Dr. Justin Marchegiani: Thank you.





Dr. Bernard Bihari, Low Dose Naltrexone Pioneer

Dr. David Sinclair, Resveratrol, NAD, and NADH






Clostridium Difficile and Leaky Gut – Podcast #174

In this video, let’s join Dr. Justin Marchegiani and Evan Brand as they talk about the link between Clostridium Difficile and Leaky Gut. Clostridium Difficile is a bacteria found almost everywhere and can cause symptoms like diarrhea, fever, and abdominal pain.

Watch this video as the two functional medicine experts share their thoughts on how this disease can affect your health and what you can do about it.

Dr. Justin Marchegiani

In this episode, we cover:

01:50   Biggest Risk Factor of CDI: Accumulative Antibiotic Exposure

05:32   Mood Issues Equals Gut Issues

07:47   The 6R Protocol

15:23   Fecal Transplant is an Experimental and a Palliative Therapy

21:10   Top Symptoms of Clostridium Difficile


Dr. Justin Marchegiani: Hey, guys. It’s Dr. Justin Marchegiani here with Evan Brand. Evan, how are we doing today, man? Happy Monday.

Evan Brand: Happy Monday to you, the best day of the week. Uh– We’ve got a short limited time but we wanted to dive in and chat about gut infections and how this can affect mental health. We test everyone’s gut. We run a stool test on everyone, organic acids testing on everyone, or nearly everyone as much as possible, because there’s a lot of different markers that conventional doctors are never going to test. Therefore, you’re never gonna know what’s going on unless you can get these specific functional medicine testing run. And, one thing that we see a lot of is Clostridia. And- So, you and I we’re reviewing a little bit of the literature before we jumped on here, that the Clostridia bacteria, oftentimes people are gonna know about C. diff. You’ll hear about Clostridium difficile or C. diff. very commonly spread in like nursing homes and hospitals. A lot of times, it’s causing diarrhea. And there’s actually people dying of this because it’s actually become antibiotic-resistant. So, if you get Con– if you get a conventional doctor to diagnose and treat you for C. diff., it’s gonna be antibiotics. But the problem is, these antibiotics are working very very minimally. You know, they’re working– I don’t have the statistics but it’s not often that– that they work. And then, they come in a second, or a third, or a fourth round of antibiotic, and they still can’t get rid of it. And the things that we use, whether it’s Silver or Oregano, or garlic, or berberines, and barberries and berberries– there’s so many different natural antibiotics out there that we can use, and people don’t talk about this. So, that’s why we’re here to talk about it.

Dr. Justin Marchegiani: In one of the biggest things that predisposes people for C. diff., Clostridium difficile, is antibiotic exposure. I mean, I have one uh– journal article, basically talking about the cumulative antibiotic exposure is the biggest risk factor for Clostridium difficile infection, CDI. So, again, we know antibiotics are used kind of like candy in the conventional medical community. So, you know, the big thing that we’re trying to do is like, (1) let’s always try to do natural herbal botanicals first because, number one, they have a lot of antioxidants to them. Number two, they tend to have effects that inhibit the reflux, or the efflux pumps. And these efflux pumps are– Imagine a canoe with a hole in it and imagine you’re sitting in the canoe. You’re bailing out water, right? As water comes in to the hole, you’re bailing out water back out into the ocean. That’s kind of what efflux pumps do. The hole in the canoe is the antimicrobial or the antibiotics coming in, and then, the efflux pumps are bailing that water out. So, the benefit that we have with the efflux pumps, or the benefit that we have with the natural antimicrobials is we don’t have that– that pail, bailing out the water. We don’t have the critters bailing up the water, so it can take on water faster and we can essentially s– uh– sink the canoe so to speak.

Evan Brand: That’s crazy. Well, let’s chat about the brain a bit. So, there’s a lot of complicated uh– neurochemistry involved and we’ll keep it as simple as possible. If you just Google for yourself, Clostridia brain chemistry or Clostridia HPHPA, this is something that you can find– this picture. And what happens is normally, your neurotransmitters, like Tyrosine, are supposed to get converted into Dopa then into Dopamine. But what happens is, when we pull up your stool test and your organic acids, if we see that you’ve got elevated HPHPA– That’s organic acid that will show high on an OAT Test, a urine test. If you have this bacterial infection, what happens is, your Tyrosine doesn’t get converted into the Dopamine like it’s supposed to because there’s an enzyme. And Justin, maybe you can clear this up too, if I’m– if I’m interpreting this wrong. But these Clostridia species, they create an enzyme, and it’s called Dopamine beta-hydroxylase that causes the Dopamine not to break down properly. So then, all the sudden, you‘ve got aggression and rage and irritability and Schizophrenia and Autism, and all these other things that show up, because this enzyme is cranked up due to the bacterial infec— due to the bacterial infection. Then, you have excess Dopamine. Then, you go crazy. Is that how you interpret that whole cycle?

Dr. Justin Marchegiani: Well, yeah. I mean, if you look at the– uhm— the cycle right– So, we have Phenylalanine, which comes from Tyrosine, and then Phenylalanine can go down into these various Clostridium difficile metabolites. And then, from thee, that Dopamine hydrox— Dopamine beta-hydroxylase enzyme helps convert it downstream. And then, from there, it can also go into Norepinephrine, as well. So again, that’s important because any type of gut [inaudible] affect enzymes in the body, which can affect neurotransmitter conversion. But, number two, Clostridium difficile also causes a lot of digestive issues, especially Diarrhea. So, we know that if there’s Diarrhea happening, that is a good chance that we’re not gonna be able to break down, assimilate, utilize and absorb a lot of the nutrients that we’re taking in our uh– body through our diet and supplementation. So, that may also create more issues, ‘cause then we have less building blocks. So, I definitely see being a two-way street, some of these enzymes may affect optimal conversion of Dopamine in the brain. Remember, Dopamine can’t cross the blood-brain barrier, right? A lot of these amino acids do. And then, these amino acids get converted locally in the brain. And then, we also have the absorption component as well, which is really important.

Evan Brand: Yep. So, if you’ve got mood issues, a lot of times, you’re gonna have gut issues at the same time. When I had parasites, I had H.pylori, I had bacterial overgrowth. I didn’t have C. diff., luckily, but I had other species. My moods were– were not good. And even though, I’d done the Paleo diet for a long time, 80 percent of symptoms were better, but I didn’t get that final 20 percent symptom improvement until I fixed the gut. And Clostridia’s just one one of those things that show up. You mentioned other bacterial overgrowth. A lot of times, we’re not gonna see Clostridium in vacuum. We may see Candida, we may see mold, we may see fungus or fungal toxins, we may see parasites, we may see H. pylori, which is another type of bacterial infection that suppresses stomach acid. And this thing can get out of control. So, if you do have gut symptoms or you do have mood symptoms, whether it’s like aggression, irritability– you feel like your fuse is shorter than it should be, of course, there’s a factor in adrenals. There’s a– a liver component to this. There’s a thyroid component. We could probably chat about. But really, the– the take home messages, you’ve got to get tested for this. And uh– I’ve seen a lot of false negatives too– and maybe you can speak on this. That a conventional testing that is not as sensitive as what we’re using can miss these infections. Can you speak on that?

Dr. Justin Marchegiani: Well, again, the GI Map Testing that we use, we also look at C. diff., the toxin A and the toxin B. These are various toxins produced by these critters, and if you have both of them, A and B, the– You know, that’s gonna be– means you have uh–   a more virulent infection. You need to get treatment A.S.A.P. for that. But you may just have one toxin over the other, A versus B, or B versus A. So, that can give us a pretty good window what’s happening. And, you know, we have the Clostridium difficile species or other species of Clostridium as well. So, on these tests, we’ll see other species that are there but we really want to look for the various toxins that are present as well, ‘cause that’s gonna really cost a lot of the issues. And in conventional medicine, they’re typically using like Vancomycin to treat it. In the natural medicine world, you know, we can use berberines. We can use antimicrobial botanicals, right? There’s also specific probiotics we can use, like Saccharomyces boulardii and specific Lactobacillus species, like the Lactobacillus rhamnosus species. Now, in the the probiotics that we use, like in my Probio Flora, right. We have the rhamnosus in the Lactobacillus all in there together. And we’ll, typically, also hit it with very high dose Saccharomyces boulardii as well. But even before that, Even before we get to step five in that Six R protocol. First R, remove bad foods. Second R, replace enzymes, acids. Third R is gonna be repair the gut lining and the hormones. Fourth R’s removing the infection. So, we work on the fourth R, using a lot of the herbal botanicals to help remove the infection. Fifth R, we work on repopulation. So, again, we hit it in a lot of different steps to make sure we can knock it out fully. We don’t just rely on one antibiotic, because we do know that one of the biggest riks– risk factors for Clostridium difficile infection is cumulative antibiotic exposure according to literature, right?

Evan Brand: Yep. Yep. Well said. Let’s chat about protection a little bit. I mean, let’s say that you have to go visit a friend or a family member in a nursing home or a hospital, what could you do to maybe prevent yourself from picking this up? Because this Clostridia can be airborne.I mean, are you talkin— like, I’ve heard some people spraying Silver, like around their nose, their ears, their mouth, just trying to have like a general barrier. I mean, putting on a facemask, like, what do you do? How do you prevent yourself from picking this infection up, or at least, how do you reduce your risk?

Dr. Justin Marchegiani: Well, number one, uhm— a lot lof it’s gonna be spread in the– in th– in the bathroom, right? Because people have a bowel movement that’s particulate. Maybe they don’t flush, and they can aerosolized out of the toilet seat.

Evan Brand: Oh, gross.

Dr. Justin Marchegiani: …of course, keeping the toilet seat close– Those kind of things. Ideally, you know, trying to avoid a lot of public restrooms. When you have to– to utilize a bowel movement. Or at least just make sure uhm— you know, it’s fully flushed, right? Fully flushed– all that stuff. And uhm— you do your best with that. But that’s how…

Evan Brand: You know what’s crazy?

Dr. Justin Marchegiani: …I–

Evan Brand: The most of the public bathrooms, they don’t have lids on their toilet seats. So you just think of all these hundreds of people going in a public bathroom. There’s usually not a toilet seat. They flush it. That stuff’s going everywhere. Have you seen those studies where they’ve used like– I don’t know if it was a thermal imaging camera or like a UV Camera or a blacklight, and they can see like a the fecal matter is like 10 feet away from the toilet? Have you seen those videos?

Dr. Justin Marchegiani: [sigh] I’ve not seen that. I think it’s got to be getting better today, because a lot of the uhm— toilets kind of flush automatically.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So, there is that benefit, right? As soon as someone gets off the seat, it flushes within a few seconds.

Evan Brand: True.

Dr. Justin Marchegiani: That– That’s better than someone just letting it sit there for a long period of time. Of course, you know, physical contamination is gonna be the big one. So, just touching stuff and not washing your hands– I think it’s good to have one of those uhm— I think it’s EO. EO makes one, but you can get them at Whole Foods. They’re kind of like a– alcohol, herbal…

Evan Brand: Yeah.

Dr. Justin Marchegiani: essential oil kind of rub you can get to spray or the gel. So I think it’s good like, once you’re out, like just kind of do that. You know, use a little bit of that gel or that spray as well. Just because, now you’re out. You haven’t touch anything, and that gives you a good chance of knocking that stuff down. So, I’ve no problem with that. That’s gonna help significantly.

Evan Brand: Yeah.

Dr. Justin Marchegiani: …wants that component dialed in.

Evan Brand: Yeah. Good advice. ‘Cause if you’ve got it on your hands and maybe you scratch your nose or you touch your face or something, and then you’ve get it into the bloodstream.

Dr. Justin Marchegiani: Exactly. And of course, just having a stronger immune system, right? A lot of these things happen when your immunocompromised. So, when you have poor diet, when you’ve poor– that’s when you’ve poor sleep, when you already have a compromised gut issue, these things can happen. So, they very rarely happen just out of isolation. Uhm– you may have other infections and then the C. diff– an issue. You may have other infections that came about because of chronic antibiotic use ‘cause antibiotics can cause rebound overgrowth as well. Or, if you’re using antibiotic– I don’t know, like an H. pylori infection. You’re doing triple therapy, right? A lot of the other uhm— things that are also used outside of Achromycin are gonna be Proton Pump Inhibitors, right? But what does that create? Low stomach acid environment. That’s gonna set you up to not breakdown proteins, be able to break down fats and ionize minerals. So that creates more problems down the road, right?

Evan Brand: Yeah. Well said. So, if you’re on an acid blocker, this conversation should perk your ears up a little bit. Pay attention ‘cause you’re at a higher risk for these infections. We see it every single week between us both. We’ve seen thousands and thousands of gut bugs. So, uh– acid blockers or uh– also birth control pills, too. We know that can affect the gut microbiome a bit. And also, uhm— yeast infections, too. So, if women have had yeast infections, they’re gonna get put on like a Diflucan or a Nystatin, or some other pharmaceutical. That could also change the microbial balance, and you get Clostridia that way. So, basically, any intervention that’s knocked out the good guys is gonna put you at risk, you’re saying.

Dr. Justin Marchegiani: One hundred percent, and just stay out of hospitals. Really, just stay out of, you know, conventional hospitals. I mean, if you have family member who really get sick, and you have to go, totally get it, right? But if you have the ability to wait ‘til someone’s out of the hospital, wait ‘til they’re out.

Evan Brand: Yeah. I mean, my wife uhm— her mom was in the hospital uh– what was it?– maybe a month ago. She had a lung nodule. They couldn’t figure out if it was cancerous or not, so they just took her in anyway and did like a long nodule surgery. And my wife wanted to go into the hospital, but I was like, “With the baby? We just can’t chance it.” So, she told her mom, “Hey, look. We’re just gonna wait it out.” And, it only took an extra day or two for her to get home. Nobody’s feelings were hurt, and she still got to visit her outside of the hospital environment. I mean, the last thing we wanted was, my wife bringing home some type of bug and get the baby sick, you know. So, we just didn’t take the chance.

Dr. Justin Marchegiani: Oh, totally. And, if someone’s in the hospital ‘cause of some, you know, severe reasons, right? Of course, you want to go, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: But if it’s like a severe life and death kind of thing, you know, try to utilize Face– FaceTime or Skype in your smartphone. That’s a good way of connecting ‘cause that– The biggest thing is being in hospitals and getting an antibiotic exposure. And guess what– yes, to the people that get the most antibiotic exposure are who? Right? They’re in hospitals.

Evan Brand: Oh, yeah. Yeah, rational.

Dr. Justin Marchegiani: These are people that are sick and they’re coming in to the ER. They’re coming in, right? ‘Cause the more chronically they’re comin in, typically, more antibiotics are prescribed. Because well that’s really the biggest thing that, you know, conventional medicine has with people that are sick.

Evan Brand: I know, IV is, too. [crosstalk] IV antibiotics. I mean, that’s just. I can’t believe how often that’s dispensed and distributed. It’s kind of scary.

Dr. Justin Marchegiani: A hundred percent. So, in general, like, we look at this from a functional medicine perspective. We can kind of like, zoom in on one type of thing here, which is C. diff., but when we were looking at things, we’re looking at the whole picture. So, C. diff. may be a part of your clinical picture if you have diarrhea or digestive issues or have leaky gut. So, maybe saying is C. diff an issue? It may be. But it may also be a combination of C. diff., H. pylori, and Blastocystis hominis. So, you– everyone has the right to have more than one issue going on at the same time.

Evan Brand: Great.

Dr. Justin Marchegiani: So, they’re just gonna keep that, you know, in the back of your head. A lot of these issues aren’t binary. They’re aren’t on-off. You know, one or the other. You can have multiple different things happening. And of course, the longer these gut issues are present, the more there’s a– an absorption or a bottleneck of nutrients getting into your system. That’s gonna affect your neurotransmitters. That’s gonna affect your adrenals. Also, potentially affect your thyroid, if your not maximally absorbing Selenium or Iodine, or Copper. And then, we know what the whole uhm— what the whole neurotransmitter thing in Dopamine, right? We look at the HPHPA. B6 is very important for Dopamine metabolism. And if we have dysbiotic bacterial overgrowth, that internal production, the B vitamins are gonna be down. And we may not quite be able to absorb the B vitamins in our diet, partly because of the increased transit time, right?

Evan Brand: Yep.

Dr. Justin Marchegiani: And, there’s toxicity and inflammation in the gut, your colon and your intestine’s soaked up a lot of water. Why? It’s doing it to dilute the– the infectious debris so it can flush it out. It’s diluting it and then flushing it out. But, what also is diluted and flushed out is also gonna be all of these micronutrients that are in your intestines that may not have enough time to assimilate, as– absorb and be utilized yet.

Evan Brand: Yep. well said. And then, we’ll give a mention here to fecal transplant. I mean, this is still kind of an ex– uh– e– e— I would say, experiment/ex– uh– I can’t even say the word, Justin. What is it? Experimental therapy?

Dr. Justin Marchegiani: Yeah. Uhmhm–

Evan Brand: Because I’m seeing people that are getting fecal transplants, and there is cool literature that after one, if not two, maybe three of the most fecal transplants, where you’re taking stool from a donor hat does not have C. diff. You’re transplanting that with a capsule of, usually have very, very deep-frozen stool– very, very cold frozen stool, in a capsule form. The C. diff. infected patients swallows that. Theen, within one, two, or at the most, three fecal transplants, the success rate is over 95 percent of curing C. diff. The only thing is, I’m having people that are saying they are getting personality changes, and that they’re starting to have a different preference for music. And if they’re craving fast food when they never craved fast food, and that they’ve gained weight or they’ve lost weight, because we’re finding out these gut bacteria are very unique. And you can take somebody’s gut bacteria from an obese person that doesn’t have C. diff., put it into your– you who’s a skinny person and also, you get obese. And, it’s because you took someone else’s microbiome and out it into your gut. So, I think it’s a– absolute last resort and a lot of the antimicrobials and protocols that you and I use for parasites and other bugs, we’re gonna kill C.diff. in the process of that. So, if that were unsuccessful, maybe, fecal transplant is necessary. But, man, I don’t really want to change my personality, or become obese because I took my bacteria from someone that, that had a– a personality that I didn’t like, or something. I mean, that just sounds– that sounds crazy to me.

Dr. Justin Marchegiani: Yeah. And again, when you do a fecal implant, you know, it– it’s gonna have effects that aren’t gonna be, potentially forever. Because z– when you put bacteria in your gut, it tends to be more transient and pass through.

Evan Brand: Okay.

Dr. Justin Marchegiani: You know, that kind of a microbiome that you have in the beginning is kind of what you have. You can influence it and nodge it in a direction, and a lot of these things tend to be more transient. That’s why, you know, you can’t just take a probiotic once and then get the benefit forever. You’re taking it but then also, may be getting fermented foods in your diet. Those kind of things to alter it. Maybe you’re taking some probiotics, a bottle of it, every quarter or so, once you’re doing really well and you’re getting fermented food in daily. But, again, I look at, like a fecal implant is kind of like a palliative thing.

Evan Brand: Yeah.

Dr. Justin Marchegiani: So, if I’m seeing an improvement with symptoms, and we’re able to knock the infection down without having to do a whole bunch of antibiotics, I think it’s beneficial. My thing is, if you have C. diff. and a whole bunch of other infections, and you’re still eating poorly, or you have other food allergens in there that are causing leaky gut, I see the fecal transplant is kind of like rearranging the deck chairs on the Titanic, so to speak.

Evan Brand: So– [crosstalk] yeah.

Dr. Justin Marchegiani: It’s not quite fixing the root cause better than antibiotics, in my opinion. So, we’ll have to just keep an eye in, and see how these things are– are looking in the literature. It’s the same thing with a lot of these docs that are using the helminth or worm therapy. Right? Uhm– They’re using and stuff to kind of modulate the immune system. I see a lot of that as being palliative, right? If not, we’d see people in third world countries that have lots of parasitic infections and worms, you know, have super robust health, right? Obviously, there are also malnourished and have really poor water supply. But I can imagine an infection driving and improving someone’s health. I ju

Evan Brand: Agree.

Dr. Justin Marchegiani: I just that– For me, I just have a hard time wrapping my head around it. I think it can push the immune system in one way or the other. And because, let’s say, you’re immune system was on this side, maybe more TH2. And now, you push it, more TH1, by giving a helminth or a worm. Then that can shift the immune system more to equilibrium, and you feel better. I don’t think it’s still the root cause, but I, my mind, I always like kind of look at things, “Okay. We have palliative therapies that just fix symptoms, and then palliative therapies that are more natural with less side ef— side effects, right?” Like so– Like, think of a headache, right? Palliative for headache, what’s that.

Evan Brand: Advil.

Dr. Justin Marchegiani: Magnesium, curcumin, right? Well, palliative that’s natural [crosstalk] side effects.

Evan Brand: O-kay.

Dr. Justin Marchegiani: Curcumiin, uh– Magnesium, B6, right– the various– you know, rosemary, ginger, right? Natural palliative things, without side effects. And then the other side, we have Ibuprofen that kills 20,000 people a year, taken properly.

Evan Brand: Yep.

Dr. Justin Marchegiani: So, I look at like palliative and then what’s the risk reward on those palliative things. So, I kind of put the fecal transplant more on the safer side versus like some of these other medications that kill many people, taken properly. So, we got a palliative– safe palliative, unsafe risk-reward, and then also what’s the root cause. So, in functional medicine, we always delineate all three of those.

Evan Brand: Yep. Well said. Well said. Uh– I think we could probably make this conversation longer, but since we’re out of time today, I think that was efficient. You’ve got to get the diet dialed-in. When we’re talking to you guys, we’re always assuming you’re following something like a Paleo template, organic pasture-raised  meats, organic veggies, high-quality berries, maybe some nuts and seeds, if you’re not on an AIP diet and you can tolerate those, you’re getting to bed on time, you’re getting out with the Sun, you’re getting exercise, adequate hydration, no sodas, no– you know– fake fructose in the diet, you’re not skipping meals, you’re getting your adrenals checked out, you’re thyroid, and then you’re jumping into this conversation. So, that’s all the prerequisites required to– to have on-board before you really start diving in to a gut protocol. So, uh– if you want to learn more, we’ve got hundreds of hours of content on this. Keep looking around. Go on Justin’s site, his personal site and blog, where you can also sign up for functional medicine consults. That’s And if you’d like to reach out and schedule a consult with me, you could do the same thing at And make sure you hit Subscribe on Justin’s channel here. Keep the tribe growing, and hit the bell. You’ll get the notifications. We’re gonna be back with you guys next Monday, around the same time. So, stay tuned for more.

Dr. Justin Marchegiani: Absolutely. And just remember, top symptoms for a C. diff. are gonna be watery diarrhea, fever, loss of appetite, uh– belly pain, nausea– these are all symptoms of other kind of infections, too. So, you know, it’s easy for people to– to read about one thing and say, this is me, right? You see it a lot with Lyme– Ly– Lyme disease– those kinds of things. So, you keep that in the back of your mind. Uh– washing with hands and soap, [clears throat] tends to be more effective than just using alcohol. Keep that in the back of your mind. If you’re visiting someone in the hospital, you know, wear the full gown get-up. You know, that same kind of gown that they’d wear. People that had MRSA wear that get-up as well.  So, if you’re gonna see someone, you know, that’s an extra wha— extra, well uh– protection as well, on top of that. Anything else you want to add there, Evan?

Evan Brand: I think that’s it. Get yourself tested. Like I said, reach out to one of us. If you need to get some functional medicine stool testing or organic acids testing done, we look for this. We see it thousands of times a year, but there are natural solutions. So, keep digging. Don’t give up and we’ll talk wiith you guys next week.

Dr. Justin Marchegiani: Absolutely. And then, anyone that’s asking questions here, try to keep it on topic. If you’re going off the deep and talking about things that we’re not chatting about, save that for my daily FAQs, uhm— that way, I can answer you there. I may do one today, so look. I’ll try to put it up in the YouTube queue, so you guys can be aware of it. And someone writes in about Eosinophilic gastroenteritis that can either be from severe food allergies or from other parasites. Allergies and parasites can increase Eosinophils. So, keep that in the back of your mind. Hey, Evan, phenomenal chat today. We’ll be right back here. I’m gonna do a video in a bit. I’ll post it up on YouTube later on today, and I’ll mail you back later on for a live FAQ, so stay tuned. If not, Friday mornings are gonna be when I do that. But look later on today. Evan, phenomenal chat, man. We’ll talk real soon.

Evan Brand: Take care. Bye.

Dr. Justin Marchegiani: Have a great Monday. Bye.


Brain Chemistry, Mood and Amino Acids – Podcast #57

Brain chemistry is the sum of all the chemical messaging that takes place in the brain, which allows it to carry out its daily functions, such as generating movement, speaking, thinking, listening, regulating the systems of the body, and countless others.

Dr. Justin Marchegiani and Evan Brand begin this podcast by sharing patient stories that deal with blood sugar issues and eliminating sugar cravings as well as patientsbrain chemistry
with autoimmune conditions being treated with dietary work and adrenal work. You can reach out to either of them so they can help you put together an action plan on the next steps to do to improve your health. Discover the differences between conventional medicine and functional medicine and how patients’ symptoms are being addressed and what treatments are being given. 

They also get into in-depth discussion about brain chemicals and neurotransmitters. Dr. Justin effectively demonstrates the process of the action potential and the neuro conductivity that take place. Find out how long a person should use amino acids therapeutically in order not to create any deficiencies as Dr. Justin explains it thoroughly in this interview and he tells us what other nutrients you need to be taking while on this type of treatment.

In this episode, topics include:

1:15   Patient stories

8:15   Deeper look into amino acids, brain chemistry and mood

17:45   Difference between conventional medicine and functional medicine

19:45   The length of time to use amino acid therapeutically

24:58   Recommend method to get off medication like SSRIs, etc.








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

Evan Brand:  Hey, not much.  I just finished up some matcha, some organic matcha and schizandra, so I’m feeling pretty turned on in terms of my brain function today.

Dr. Justin Marchegiani:  Turned on.  I like it, man.  That sounds good.  That sounds really good.  Yeah, I’m having–

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  A pretty spectacular morning.  It’s Friday.  It’s–it’s hot.  It’s sunny in Austin, so I mean I can’t really complain.  Actually flying out in a few hours to go up to San Francisco here for the–for the weekend, so I’m pretty excited about that.

Evan Brand:  That sounds good.  What are you doing up there?

Dr. Justin Marchegiani:  You know what?  We’re just doing a little bit of R&R, gonna travel a little bit.  I lived in San Francisco for 5 years so heading back to the old hood.

Evan Brand:  Wow, so it will feel like going home then?

Dr. Justin Marchegiani:  Getting’ away from some of this Texas heat.  Yeah, I know.

Evan Brand:  True.  I’m sure it’s hot.  That’s one thing I’m glad to be back in Kentucky, man.  We’re not burning up like–like I was there.  I was waiting for the snow to come and it never came.

Dr. Justin Marchegiani:  Yeah, well, I hang out in the lake a lot in the summer and that kinda cools off.

Evan Brand:  That’s true.  That’s true.

Dr. Justin Marchegiani:  Go down at the Barton–Barton Creek Springs downtown there, it’s really nice.

Evan Brand:  Yes, it is.

Dr. Justin Marchegiani:  Awesome, buddy.  Awesome.  So anything new with you?  Any patient stories this week?

Evan Brand:  Yeah, actually I just posted a testimonial on my YouTube page or my website if people wanted to see it.  It was a patient that I saw inside of the chiropractor’s office.  One of my very, very few in-person patients that I see these days because I’m like you, a lot of people are not in the local area that need help.  So anyway, she basically eliminated her sugar cravings–I guess I would say I eliminated or maybe she just felt the effects, within 2-3 days of her supplement protocol.  So when I did the initial symptom gathering process on her, I saw that she had some blood sugar issues going on which surprise, most people do and–

Dr. Justin Marchegiani:  Right, exactly.

Evan Brand:  So I recommended some supplements that were gonna some blood sugar.  Some Aqueous Chromium and a couple different other biotics products that have some good, you know, blood sugar support nutrients in there and her testimonial was verbatim to this.  “I usually have trouble going through the candy aisle, but I went into the grocery and I felt like going straight to the vegetable section.”  I was like, “Wow!”

Dr. Justin Marchegiani:  Oh, wow!

Evan Brand:  That’s pretty cool!  So–

Dr. Justin Marchegiani:  That is awesome.

Evan Brand:  She said her stress is already better.  She had a lot going on with her husband.  He’s got some pretty bad health issues and so that stress bucket is full, but she’s already feeling a little bit calmer which has then in turn reducing her amount of emotional and stress eating that she identified with on the questionnaire.  She was one of those people that she feels stressed out, she’ll go and eat like a candy bar and now she is able to–

Dr. Justin Marchegiani:  Right.

Evan Brand:  To work through those times.

Dr. Justin Marchegiani:  Well, that’s awesome, man.

Evan Brand:  What about you?

Dr. Justin Marchegiani:  That’s a great story.  Well, I had a patient.  I’ve actually had a couple of patients in the last week where they had some severe autoimmune conditions.  This one patient I saw has an autoimmune condition called hidradenitis suppurativa.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  So this is a–a really interesting autoimmune condition that like attacks the skin and creates these major boils or welts, almost to the point where they have to be, you know, surgically removed because they become so massive.  This patient had some surgery scheduled to actually get some of these hidradenitis suppurativas removed and we talked and we just did a little bit of dietary work and a little bit of adrenal work off the bat and within 1 month when she got ready to see the general surgeon to have the lesions looked at, they were gone.  And the surgeon was like, “What did you do?”  This–that happened?  The surgeon was flabbergasted and this it really comes down to a lot of the chronic conditions that medicine is seeing are autoimmune and medicine is not addressing the underlying issues of autoimmunity which is stress, which is a leaky gut, which is a lot of food-induced stuff, and there’s a lot of infections and underlying issues on top of that, and now with this patient, we didn’t even have a chance to dive deep enough into the real deeper functional medicine issues but just an autoimmune diet made a massive difference.  And this is just so cool because, you know, conventional medicine doesn’t really have a solution for this but in the functional medicine world where we live, there’s so many things we can do.

Evan Brand:  That’s awesome.  That’s a great story.  Yeah, I’ve actually had a podcast on that topic.  I can’t remember the name of the book now but there’s an author that wrote a book about that and she struggled a ton with it and it’s crazy because it’s a very underrecognized condition.  Some people at first think they have eczema and–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  These other kind of generic skin issues and then they really have an autoimmune skin issue which sounds terrifying.

Dr. Justin Marchegiani:  Oh yeah, and the cool thing about our podcast, I’m really loving our dynamic.  We’re getting a lot of great feedback on your show, on my show, and I think the podcast that we’re producing is just different than most because we’re having a lot of clinical feedback and we’re really helping people walk away with a lot of action items.  I don’t want people just to walk away feeling like they just got some brain candy and it’s like, you know, they got some stuff for jeopardy, right?  I want them to feel like they got some brain candy but they also got like an action item that they can walk away with and make their life better, performance-wise, whether it’s a biohacking thing or a clinical pearl.  Just something they can walk away with.  They can be like, “Yeah, I’m gonna–I’m gonna be better after listening to this podcast, healthier in some way.”

Evan Brand:  Right.  Yeah, I mean, I’m coming up on 150 episodes of my podcast and I’ve really felt for a while that I’m helping people but in a certain way some of these episodes that I’ve put up and I’ve even not up an episode since with some people because I feel like it was blabber and too much about them and not enough about action and things like that, and so I’m really trying to shift the show.  So hopefully, people are enjoying that on my end as well, and I’ve gotten some feedback that that verifies it and the downloads are, you know, higher than ever.  So apparently, something’s working.

Dr. Justin Marchegiani:  Yeah, and anyone listening to this and feeling like, you know what, maybe they’re at a crossroads at their health where they’re not quite sure what to do, reach out to Evan or reach out to me, and we can kind of put together an action plan on what the next step so we can move forward on to get to the underlying cause of your health issues versus just covering up symptoms which is really the only option in the conventional medical model.

Evan Brand:  Yeah, or ignoring them or saying they don’t exist like Lyme disease for example.  That’s a whole another podcast topic, but very timely.

Dr. Justin Marchegiani:  Yeah, or just numbing you out and give you an antidepressant or again, being a functional medicine doctor is stressful, too, because you get to hear all the horror stories.  I can’t tell you how many patients that come see me each week, have seen their medical provi–you know, medical provider, their GP or whatever, and they’ve been told it’s all in their head.  I just–I can’t-

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  I mean, 4 or 5 times a week it makes me wanna pull my hair out because I see people suffering and we see it, they’ve come back on tests where they have functional issues and their conventional doctors are just like, “Yeah, it’s all in your head.”  And then they look at them like they’re making it up and I’m like, “Oh, my God.”  There’s a physiological and biochemical explanation, and just because it doesn’t fit into the mold of, you know, cutting it out or drugging it, it doesn’t mean it’s all in their head.

Evan Brand:  Totally.  Yeah, I’ve seen that, too.  It’s always crazy to look at the symptoms and then you look at the prescriptions they’ve taking, and it’s like, “Why?  Why Lexapro?  Why Valium?”

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Wh–why do you need this stuff?  And I know there’s a time and place for that model for some people and maybe there’s extreme scenarios but oftentimes there’s a much better alternative that happens to come from a plant or some type of botanical extract or something, so there are options out there.  I guess that’s–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Kinda what you’re getting at.

Dr. Justin Marchegiani:  And it may be in their head from the perspective of their gut’s inflamed and inflammation in the gut creates inflammation in the brain, and there may be some brain inflammation meaning it is in their head.  But not from the perspective that the MD is meaning that they’re making it up, right?  There may be an underlying etiology and biochemical issue that is partly affecting the brain but they’re not making it up though.

Evan Brand:  Right.

Dr. Justin Marchegiani:  Cool.  Well, let’s dig in.  We chatted a little bit about amino acids and brain chemistry and mood.  I wanted to dive in deep to that because conventional medicine for the most part it’s anti-depressants, it’s anti-psychotics, it’s benzodiazepines like Xanax and such.  It’s Wellbutrin, right?  SSNRIs, things that modulate norepinephrine or dopamine or the reuptake of serotonin or increased GABA receptor site sensitivity, all these drugs they do nothing but change the location of a lot of these brain chemicals, which I might add all come from protein.  So this is powerful, right?  In the conventional medical kind of field, we have drugs that change the location of these brain compounds or these neurochemical compounds, and in functional medicine world, from just the supplement standpoint, when we give specific amino acids to alter brain chemistry we’re trying to change the amount of these brain chemicals by altering building blocks versus conventional medicine’s just changing the location, and this is a fascinating kind of comparison.  You wanna break it down a little more?

Evan Brand:  Oh, yeah.  Neurotransmitters are basically brain chemicals.  That’s the easy way to remember them and scientists–I haven’t identified per–personally any but I know they’re out there.  Scientists have identified over a hundred and they actually have no clue how many neurotransmitters there are in total.  But typically when we’re talking about helping people with health symptoms, we’re focusing on just a key group of neurotransmitters such as the GABA, the serotonin, you have the dopamine.  You have your adrenalin and then you have your noradrenalin or your epinephrine and norepinephrine, wherever you are in the world, whatever you call it.  And these basically to me, they run the show.  Hormones are equally if not more important, but to me, neurotransmitters are huge and I’ve–I mean, I just wrote an entire book.  It’s not out with the publisher yet, but I just wrote an entire book on neurotransmitters, basically talking about the way that different herbs and supplements interact with this brain chemistry and how you can tweak it towards your benefit, whether somebody listening that just wants some cognitive enhancements, some, you know, brain power, some focus ability or if you’re somebody who can’t go out of your house or go to the grocery store without having a panic attack.  There’s a wide spectrum of people that are struggling, that can get help once they first measure with lab testing and then accurately treat or align or balance those underlying brain chemical deficiencies or imbalances.

Dr. Justin Marchegiani:  Absolutely.  So the first thing we have to look at is that all of our brain chemicals for the most part are made from protein and protein is like the pearl necklace and the individual pearls are like the amino acids.  So amino acids, especially L-tyrosine which gets converted into dopamine, L-trytophan and 5-HTP which gets converted into serotonin, so these are like our master neurochemicals and they all come from protein.  So first step is making sure the diet is protein-rich, good quality, natural organic sources of protein.  That’s number one.  Number two, are we digesting these proteins, right?  Do we have enough hydrochloric acid and enzyme secretions to be able to break it down.  And then number three, if we aren’t able to break it down, what are the underlying infections, dysbiosis, SIBO, parasites, H. pylori, etc. that are creating this malabsorption?  So we kinda look at the front-end how’s the supply chain coming in?  Are we putting enough good amino acids and proteins in our mouth?  Are we breaking them brown?  Is there an infection in the gut that’s affecting that breakdown?  Once we know that front-end chain’s okay, the next is well, where are our protein levels at in our brain?  Where our amino acid level’s at in our brain and we can use symptom surveys that look at dopamine or serotonin symptoms and we can also look at organic acid tests which I think are really cool that can give us a indirect indicator of the metabolites of dopamine which is like vanillin mandelate or homovanillin mandelate or we can look at serotonin in which a good metabolite is 5-hydroxy and doloacetate.  So we can look at these from a empirical perspective, symptoms, but also from a lab perspective.

Evan Brand:  I like to do both.  For me–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  It’s really fun to look at the symptoms and see how accurate some of those symptom questionnaires can be.  I really enjoy Julia Ross’ symptom–symptom questionnaire I guess we’ll call it.  It’s amazing.  I’ll sometimes laugh at some of the symptoms I’m going through and I’ll tell Hannah, my wife, instead of saying like, “I’m feeling blue or low, I’ll just say, ‘Oh, God, I’m low on serotonin today.’”

Dr. Justin Marchegiani:  Yeah, exactly.  And again, conventional medicine, right?  Let’s kinda break it down here, alluded to it briefly.  So I’m gonna do a little demo here, you being able to see me on video, it’ll make more sense to you, I’m gonna try to describe what I’m doing.  So I’m putting my–my two knuckles together like this.  So you can see here, I have one fist on the left side connecting with the other fist on the right side, and I’m gonna leave a little gap between the fists.  So my left arm here, this is my presynaptic neuron, the little gap between my left fist and my right fist is my synapse or the synaptic cleft, and then my right fist here is my post synaptic neuron.  So again, the action potential and the neuro conductivity is happening from this left arm over this little synaptic cleft into the right arm which is my post synaptic neuron.  So I know, big talk, we’ll try to put some demos or pictures in the transcription, so head over to for that.  So you’re gonna see all of the serotonin and dopamine precursors are all up here in–in this presynaptic neuron, it gets released out into this synaptic cleft and that serotonin and dopamine hangs out and it kinda helps bridge that gap from that action potential from that presynaptic neuron to that post synaptic neuron.  Now most drugs, they prevent the reuptake, so the whole idea here is these neurochemicals sit in this synaptic cleft and they get pulled back up into that presynaptic neuron and get recycled.  And what these drugs do is they prevent the reuptake of these neurochemicals so they accumulate and they sit longer in between that synapse where they could have a–a physiological effect.  Now the only problem with that is it works but in the short run it works, but in the long run it doesn’t work because all these meds are doing, they’re just changing the location of where these compounds live.  So instead of being up in that presynaptic neuron, they’re now in that synaptic cleft.  Now the problem is, these neurochemicals get recycled and broken down faster the more they’re in that synaptic cleft.  So the more, the longer you’re on these medications, you actually create more deficiencies with these brain compounds because they’re being recycled faster and that’s why anyone that’s on one of these medications, they’re gonna have the experience of having their dosage–their medication either changed to a stronger one or having an increase in the dosage.  So the whole idea of being able to come off, unless that underlying cause is fixed, typically those symptoms gets worse when you come off these meds.  So that’s why the amino acids are so different because we’re coming in and actually changing the supply, not just the location.

Evan Brand:  Incredible.  Yeah and that explains why–you know, I’ve had some people that have had prescriptions for benzo–I’ll always just call them benzos for short.

Dr. Justin Marchegiani:  Yup.

Evan Brand:  But the Xanax or–

Dr. Justin Marchegiani:  Yup.

Evan Brand:  Valium, you know, that are mostly acting on the GABA receptors, if I’m not mistaken, since those are GABA antagonists, that would be downregulating your actual production of GABA so when they try to come off, they have less GABA than they had before they even started the Xanax and now their panic attacks and their anxiety is tripled or quadrupled what it was before they even started the medicine.

Dr. Justin Marchegiani:  Absolutely, plus the underlying physiological, the underlying biochemical reasons of why they were having anxiety to begin with is just totally ignored, whether it’s excessive stimulation by the adrenals because they’re making too much catecholamines or adrenalin or because they’re gut’s on fire and they’re burning through their neurochemicals, those underlying reasons are ignored.  So the problem only gets worse and worse overtime and then they are reliant upon this constant stream of medications just to control the symptoms so they can function.

Evan Brand:  Yeah, if I go back to the lady that I was discussing at the beginning of the podcast, you know, she was having a lot of blood sugar issues, to me, you know, there’s a piece of the adrenals that are going–that are going haywire because the piece of the blood sugar is going haywire, she’s in her mid-50s right now so she has been dealing with this stuff for a long time, and she has gone to the mainstream doctor before and said, “Hey, I’m completely overwhelmed with my husband.  I’m trying to take care of him.  I’m very sick, etc., etc.,” and the only thing they had to offer her was a) either an anti-depressant or b) an anti-anxiety medicine to handle the stress.  And she said flat out and–and they can see it on the video, she said, “I don’t want the drugs,” and she wouldn’t have gotten better because the blood sugar is the issue or her stress bucket is too full and she doesn’t have enough stress bucket, so that’s kinda where I’m trying to help fix her as opposed to leading her astray.  I mean, it’s just–it’s really scary to be honest with you, how quickly some of this stuff could get derailed.  I’ve talked to you about my blood sugar stuff being–being low in the middle of the day and you’re like, “Dude, Evan, go eat, man,”  Like, “What are you doing?”  Because if I–say, I went to the doctor for some reason and said, “Hey, I’m feeling low and fatigued and maybe a little bit anxious in the middle of the day.”  They’re not gonna ask, “Are you skipping meals and you’re blood sugar is low?”  They’re gonna say, “Well, hey, let’s get you on something.”

Dr. Justin Marchegiani:  Exactly.  Exactly.  And that’s the difference between conventional medicine and functional medicine.  So the first pillar is gonna be blood sugar, right?  Because blood sugar is gonna create your–or is gonna stimulate your adrenals to make more adrenalin or more cortisol to help bring that blood sugar back up and stabilize it which can cause the jitters.  Anyone, you know, gets that feeling where they get those–the little–little Spidey senses going or they get that little tingling, that little butterflies because of stress, well, one of the biggest hormonal stressors is blood sugar imbalances.  That’s number one.  Number two, most people have chronic stress that has now affected their gut and they have malabsorption, they have infections, they have inflammation in their gut and inflammation in the gut creates inflammation in the brain.  Alright?  Now it’s important, right?  A lot of like–like people talk about serotonin in your gut, well, serotonin in your gut–serotonin can’t cross the blood brain barrier, it can’t, same with dopamine.  But the precursors, the substrates to serotonin and dopamine can, meaning the 5-HTP can cross that blood brain barrier.  The L-tyrosine can cross the blood brain.  So these are important things because when we have malabsorption and gut issues and stress, we can therapeutically use these amino acids at specific doses together.  We don’t wanna use them single at least not longer than 2 or 3 months and we can therapeutically boost up brain chemicals.  And it’s important you never wanna take these without B6 as well because B6 is an important carrier, it’s gonna escort that helps these things cross the blood brain barrier and convert into their end-stage neurochemicals.

Evan Brand:  It’d be good to go a little bit deeper on that.  You said don’t take for 2-3 months and I’ve had people that have been on 5-HTP for 2-3 years and they’re wrecked.  And I want you to explain why, because like, “Huh?  Why–why not?”

Dr. Justin Marchegiani:  Well%2

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